Carbohydrates and Pain – Do They Influence Inflammation and Recovery?

Carbohydrates have long had a mixed reputation in health and fitness discussions. For some, they represent energy and performance; for others, inflammation, weight gain, and “unhealthy” eating. A common and relevant question from patients is therefore: Can carbohydrates influence pain, inflammation, and recovery?

Current research provides a nuanced answer—rather than a simple yes or no.

Carbohydrates and Inflammation – What Does the Evidence Say?

Inflammation is a natural and necessary part of the body’s repair processes. Problems arise when inflammation becomes chronic and low-grade. Diet can influence this process, but carbohydrates are not a single, uniform category.

Research shows that:

• refined carbohydrates (added sugars, white flour, ultra-processed foods) are associated with higher inflammatory markers

• complex carbohydrates (whole grains, fruits, vegetables, legumes) are often associated with lower levels of inflammation

In other words, quality matters more than quantity alone.

Energy Availability and Pain

Low energy intake—commonly seen in individuals with chronic pain, high training loads, or elevated stress—can place the body in a state characterized by:

• impaired recovery

• increased fatigue

• heightened pain sensitivity

Carbohydrates are the body’s preferred fuel for both daily activity and exercise. Insufficient carbohydrate intake can indirectly worsen pain by increasing strain on the nervous system and reducing tolerance to physical load.

Carbohydrates in Rehabilitation

In rehabilitation after injury or in persistent pain conditions, the goal is to restore load tolerance and functional capacity. Studies suggest that adequate carbohydrate intake:

• supports training quality

• reduces perceived exertion

• may improve adherence to rehabilitation programs

For patients with low energy availability, increasing carbohydrate intake can be just as important as selecting the right exercises.

When Can Carbohydrates Be a Problem?

In some individuals, very high intakes of rapidly absorbed carbohydrates—particularly in combination with low physical activity—may contribute to:

• weight gain

• metabolic dysregulation

• increased systemic inflammation

However, this pattern primarily reflects diets dominated by ultra-processed foods, not carbohydrate intake per se.

Clinical Relevance

For physiotherapists and healthcare professionals, a holistic perspective is essential:

• pain is influenced not only by tissue status, but also by energy availability, sleep, and stress

• dietary advice should be practical rather than restrictive

• “eating less” is rarely the solution for pain and fatigue

A balanced diet with sufficient energy and high-quality carbohydrate sources can support both pain reduction and functional recovery.

Summary

Carbohydrates are not inherently pro-inflammatory. On the contrary, they play a key role in energy availability, recovery, and load tolerance. It is the quality, amount, and context of carbohydrate intake that determine whether they support or hinder health and rehabilitation.

Sources

Calder, P. C., Ahluwalia, N., Brouns, F., Buetler, T., Clement, K., Cunningham, K., Esposito, K., Jönsson, L. S., Kolb, H., Lansink, M., Marcos, A., Margioris, A., Matusheski, N., Nordmann, H., O’Brien, J., Pugliese, G., Rizkalla, S., Schalkwijk, C., Tuomilehto, J., & Wärnberg, J. (2011). Dietary factors and low-grade inflammation in relation to overweight and obesity. British Journal of Nutrition, 106(S3), S5–S78. https://doi.org/10.1017/S0007114511005460

Slater, G., & Phillips, S. M. (2011). Nutrition guidelines for strength sports: Sprinting, weightlifting, throwing events, and bodybuilding. Journal of Sports Sciences, 29(S1), S67–S77. https://doi.org/10.1080/02640414.2011.574722

Loucks, A. B., Kiens, B., & Wright, H. H. (2011). Energy availability in athletes. Journal of Sports Sciences, 29(S1), S7–S15. https://doi.org/10.1080/02640414.2011.588958