The Truth About Dietary Fat, Inflammation, and Chronic Pain (It’s Not What You’ve Been Told)

Why Dietary Fat Is Misunderstood And Why Your Nervous System And Mitochondria Care

If you’ve ever been told, “eat whatever you want, nutrition doesn’t affect chronic pain,” you’re not alone. Many people with chronic pain walk out of specialist appointments with the impression that food is irrelevant, or that dietary changes are “alternative” at best and distracting at worst.

That message doesn’t match physiology.

Nutrition is not a side topic in chronic pain. It influences inflammation, mitochondrial energy production, cell membranes, nerve insulation, hormone signaling, and immune tone. All systems that shape how pain is generated and amplified over time. The confusion comes from the fact that nutrition is complicated, and few people have had it explained in a way that connects biochemistry to lived symptoms.

This article focuses on one of the most misunderstood pieces: dietary fat. Not body fat. Not calories. Not diet culture. Just the biology of fats. What types matter, why the source matters, and how fat interacts with inflammation, fatigue, and nerve sensitivity in chronic pain.

Is Fat “Bad”? The Question Itself Is Outdated

When most people hear “fat,” they think of body fat. That association is so strong that it blocks a useful conversation before it starts.

Body fat (adipose tissue) and dietary fat overlap in the public imagination, but physiologically they are not the same thing. Adipose tissue is a storage organ. Dietary fats are macronutrients and structural building blocks used in membranes, hormones, the nervous system, and energy metabolism.

“Fat” Is Not One Thing

If you take one thing from this article, let it be this:

Not all fats behave the same way in the body. Especially in chronic pain.

A useful way to organize fats clinically is by fatty acid families:

• Omega-6 fatty acids - These are essential in small amounts, but in modern diets they are commonly over consumed. Omega-6 fats promote the synthesis of inflammation and contribute to most modern diseases.

• Omega-3 fatty acids - Omega-3 fatty acids are essential polyunsaturated fats critical for heart, brain, and eye health, and are anti-inflammatory. The body cannot produce on its own

• Omega-9 fatty acids - These are generally considered neutral-to-beneficial fats found in foods like olives, avocados, and many nuts. They’re not usually the core of the inflammation conversation, but they can be part of a supportive fat profile.

  
  

  

Where chronic pain patients get misled is when “fat” is treated as one category and discussed as if it all behaves like the worst version of omega-6.

Where Each Fatty Acid Comes From

You are what you eat. Or, better yet, you are what your food eats.

Every nutrition resource out there will likely tell you the same thing: "healthy fats" come from nuts, seeds, and avocados, while "bad fats" come from meat, especially red meat.

Turns out, in this discussion, two things can be right at the same time. While we love nuts and seeds, we also love meat. But the same type of meat can be both inflammatory and anti-inflammatory. The difference comes down to how your meat was raised.

Inflammatory Meats

Non-organic, grain fed animals, and farmed fish have a much higher omega-6 fatty acid profile. Herbicides and pesticides are hard for the body to process and typically get stored in adipose tissue (fat cells). When you consume this meat, you also consume the herbicides and pesticides which wreak havoc on your microbiome. A disrupted microbiome is going to contribute to inflammation more than it is going to be able to fight it. Grains are also high in the omega -6 fatty acid linoleic acid. Once again, this gets passed on to you. The same thing happens with farmed fish.

Anti-Inflammatory Meats

That same cow, pig, chicken, etc. could instead be allowed to roam free and eat organic grass and bugs all day and have a larger omega-3 fatty acid profile. This is because grass and bugs, the natural diet of these animals is high in the omega-3 fatty acid ALA. While humans poorly convert ALA into usable, and more beneficial EPA and DHA, this is not true of other mammals. In this case, our food does the heavy lifting for us and we benefit from more and better fats.

Why Fat Matters In Chronic Pain

Most people hear “fat” and think “inflammation.” That’s real, but it’s not the full story. Chronic pain is not only an inflammation problem. It is also an energy problem and a signal-processing problem. When those systems are strained, pain becomes louder, recovery slows, and symptoms become more unpredictable.

Dietary fats influence chronic pain through at least three major mechanisms:

Inflammatory Signaling

Chronic inflammation is a hallmark of all chronic pain conditions. Inflammation causes pain primarily by releasing chemicals that sensitize nerve endings and by creating physical pressure through swelling. Immune cells release substances like prostaglandins and bradykinin that lower the pain threshold of neurons, causing increased sensitivity (hyperalgesia). Meanwhile, fluid buildup causes tissue swelling that compresses nearby nerves, generating pain. 

Diets high in omega-6 fatty acids and lower in omega-3 fatty acids tip the scales to that your inflammatory pathways synthesize more inflammation than necessary.

Mitochondrial Energy Production (ATP)

Chronic pain patients often describe fatigue that doesn’t behave like normal tiredness. Rest doesn’t restore, exertion triggers disproportionate flares, and muscles feel “chemically sore.” This pattern is often consistent with a common underlying problem: mitochondrial dysfunction.

Your mitochondria are the tiny organelles in your cells that produce energy. Energy to wash the dishes, and energy to heal damaged tissues. Your mitochondria can make energy from two sources: sugar/carbohydrates, and fat. Each molecule of sugar produces only 38 ATP while fat produces 129 ATP. Creating ATP from sugar has another drawback; it produces a lot of lactic acid. If it feels like your muscles burn and ache like you just got done exercising, but all the time, it is because of this.

The point is not that carbohydrates are inherently bad. It is that, in some chronic pain states, the body is already struggling to generate energy efficiently, and fuel selection can influence that strain.

Nervous system structure and insulation

This part rarely gets explained clearly, but it matters.

Myelin, the insulating sheath around nerves, is extremely fat-rich. In standard neurochemistry references, myelin’s dry mass is roughly 70–85% fat. That means lipid availability and lipid composition are not cosmetic. They are structural.

Dietary fat deficiency can disrupt myelin synthesis which leads to poorer nerve conduction. This is seen as poor muscle control and aberrant pain signal firing. But if your nerves are surrounded by myelin composed of omega-6 fatty acids, similar outcomes can occur. Many people are told their chronic pain is due to hypersensitive nerves but are never told why there nerve is hypersensitive. It could be that omega-6s are increasing spontaneous firing of those nerves and your brain is interpreting it as pain.

Saturated Fat: The Nuance Most People Never Hear

Saturated fat has been discussed in public health mostly through a cardiovascular lens. But in chronic pain conversations, it often gets lumped into “inflammatory fat” without context.

The truth is, saturated fats are generally safe and good for you. Saturated fats, on their own, are not associated with a greater risk of heart disease, But rather are associated with less progression of coronary atherosclerosis. But, when consumed with large amounts of sugar and carbohydrates, they lose their anti-inflammatory properties.

Context matters in nutrition more than anything.

Omega-3 Dosing: Why Most People Underestimate How Little They’re Getting

Many people assume they’re getting omega-3s because they occasionally eat fish or because they take a fish oil supplement. But omega-3 content varies tremendously, and labels can be misleading.

There are three types of omega-3s: ALA, EPA, and DHA. ALA is mainly found in plants but is not very usable to humans. It needs to be converted to EPA and DHA to have clinical significance. The problem is that humans are really bad at this conversion.

The recommended daily allowance (RDA) for omega-3s is 250–500 mg/day of combined EPA+DHA for general health. You are unlikely to notice any benefit from this low of a dose.

For heart health, a minimum of 2 grams (2,000mg) of omega-3s is recommended. For chronic pain sufferers aiming to lower their chronic inflammation, 6-8 grams per day is required.

This may seem like a lot, but a 3 oz piece of salmon has about 4 grams of omega-3s. However, not everyone likes fish, so we look to supplementation with fish oil.

Supplement Reality: “Fish Burps” Are Not A Personality Flaw

Many people get "fish burps" from their fish oil supplement, which is rather unsettling. However, this is not normal. If you are a victim of this, it is not your fault, it is your supplement. A surprising amount of fish oil supplements are already rancid by the time you open the bottle. This rancidity is what causes the burps, not your physiology. A high quality fish oil will never cause this sensation.

If you get the "fish burps" you have likely been told that krill oil and algae oil are safe alternatives. While these supplements rarely cause fish burps they are a waste of money. For starters, the concentration of omega-3s is very low; not enough to have much clinical benefit. The second issue is that they are primarily composed of ALA, and as we have discussed, is not beneficial to humans the way it is for other animals.

Absorption And Transport

If you are consistently getting 6-8 grams of omega-3s from your food and high quality supplements, and are still not noticing the anti-inflammatory effects, you may have other issues.

Absorption

You only use what you absorb. Omega-3s require bile and the digestive enzyme, lipase, for absorption. If you have a sluggish gallbladder, or not one at all, you will have a hard time emulsifying fat. Likewise, your pancreas may produce less digestive enzymes over time. A tell tale sign of poor fat absorption is if your stools float or have noticeable globules of fat in them.

Transport

Once you absorb fat, it still needs to get to its final destination. The nutrient, L-carnitine, is responsible for shuttling fat around your body and into your mitochondria where it can create ATP.

The chronic pain takeaway: this is not about dieting, it’s about building a less inflammatory biology

If your pain has been persistent, it means the body’s pain system is spending long periods in a more reactive state. That reactivity is shaped by immune tone, mitochondrial energy availability, and nerve signaling quality.

Dietary fats influence all three.

Incorporating more omega-3s is not a matter of "dieting," it is simply about being more conscious of the source of your food. You may have to search a little harder in the grocery store, or go to a natural foods store, but what you seek exists just about anywhere you are. These switches may be a little more costly, but the savings show up in your health and in your medical bills.

Written By:

Dr. Jason Winkelmann

Chronic Pain Specialist and Educator

Frequently Asked Questions

If I eat more fat, will I gain body fat?

Not automatically. Body fat gain is driven by overall energy balance, metabolic state, insulin signaling, and many other variables. Dietary fat is also a structural nutrient and a fuel source; it isn’t the same thing as adipose tissue. The more relevant question in chronic pain is often: What type of fat am I consuming, and what is it doing to inflammation and energy production?

Is fish the only way to get omega-3s?

Fish (and certain seafoods) are the most direct dietary source of EPA and DHA. However, organic, grass-fed meats are also very high in omega-3s. Many plant sources contain ALA, but conversion to EPA and DHA is limited in humans. That doesn’t make plant omega-3s “useless,” but it does mean they don’t fully substitute for marine omega-3s when EPA/DHA is the target.

Is an “anti-inflammatory diet” just avoiding red meat?

Not necessarily. “Anti-inflammatory” is a shorthand that often becomes too simplistic. In practice, inflammatory potential is influenced by overall dietary pattern, the type of fat profile, ultra-processed foods, and (in animal foods) how the animal was raised and fed. The point is not to declare one food category evil; it’s to understand the biochemical direction your diet is pushing.

How do I know if omega-3 supplements are high quality?

Quality varies widely. Look for products that clearly list EPA and DHA amounts, not just “fish oil,” and ideally include third-party testing. If a product consistently causes strong reflux or “fish burps,” it may not be well tolerated—or may be poorly manufactured or oxidized. If omega-3s matter for your plan, tolerance and quality matter too.