Neurological Associates Four F’s Diet


H. Hooshmand, M.D.


From the Book:


Chronic Pain: Reflex Sympathetic Dystrophy Prevention and Management


CRC Press, Boca Raton, Florida

We devised this method of behavior modification more than 10 years ago. This diet is not aimed at losing or gaining weight. It excludes foods that are harmful to your health and aggravate chronic pain (i.e., Five C’s: cookies, cakes, chocolate, cocktails and candy. Other foods to avoid are internal organ meats such as Liver, sausage, and hot dogs). It also emphasizes the intake of foods that help the inhibitory nerve cells that suppress the pain input (4 F’s: Fresh fruit, fresh vegetables, fish, and fowl).

By doing so, the patient’s weight normalizes itself automatically: overweight or underweight extremes normalize close to the patient’s ideal weight.

The four F’s:


  1. Fresh Fruit – not canned.
  2. Fresh vegetables – Olive oil is the best cooking oil.
  3. Fish – baked or broiled. Use fresh lemon juice for flavor. Avoid the use of margarine.
  4. Fowl- skinned! Not fried – baked, roasted or grilled is fine. When you are in a hurry, try wrapping a boneless breast with vegetables (i.e., onions and bell peppers) in aluminum foil and baking – it is quick and easy.

Avoid the five C’s: cookies, cake, chocolate, cocktails, and candy.


Foods to be avoided


Crystalline Sugar Cakes
Soft drinks with sugar Sweet-rolls
Pies Lard
Bologna Crisco and other shortenings (replace with olive oil)
Salami Potato chips
Hot dogs Dips
Sherbet Cake mixes
Ice Cream Alcohol
Enriched white flour (bleached flour) Nondairy cram substitutes
Syrups Margarine
Mayonnaise Donuts
White bread Butter
All fried foods Bacon and any pork
Canned fruits packed in syrup Candies


Foods allowed rarely or sparingly No Coffee (may be replaced with ice tea) Lamb Tea Pulp of potato (may fry in olive oil)


Foods that are allowed


Diet drinks – no caffeine, sugar, and low to no sodium Nuts – raw and unsalted
Skim cheese Honey – natural
Apples Oatmeal (plain and unflavored)
All fresh fruits Low-fat cottage cheese
Unsweetened orange juice Low-fat plain yogurt – flavored has sugar – add your own fresh fruit
Natural fresh – squeezed orange juice and grapefruit juice Sweet potato with skin
Apple juice – no added sugar, natural Eggs – no more than two/week
All fresh vegetables Sardines
Veal All fish
Chicken and other fowl – skinned Cereals – whole grain, low sugar
Lobster (no butter) Shrimp
Lean roast beef (in moderation) Fruits – dried
Raisins Crab
Skim milk Drink 6-8 glasses of water per day
Tuna (water-packed)  

Labels – read them! Be aware of the word “carbohydrates.” Frequently it is a euphemism for sugar. Be aware if the ratio of fat to calories. Avoid high fat to calories ratios. Also, high cholesterol and preservatives/chemicals (or flavorings) should be avoided. An ingredients list that is very long and has many unrecognizable (unpronounceable) words should also be avoided. Remember very low to no added salt.

Food preparation – Avoid adding fats (oil, margarine, etc.) and salt during and after preparation. Try to prepare in ways that do not require oil/fat – such as steam, back, broil, and roast. Definitely do not fry!!! (Olive oil is okay).

Salad Bars – The tendency to eat free food results in excessive calories! Therefore, it is for this reason that salad bars can be deceptive. They seem to be more of a high calorie/fat, all you can eat buffet. When confronted with one, stick to the fresh fruits and vegetables -avoid the desserts (i.e., puddings, cakes, etc.).

Diet fads

“Cheese is rich in cholesterol”. There are two types of cheese: sharp cheese rich in tyrosine is harmful to RSD patients; mild cheese (e.g., mozzarella, ricotta, muenster) contains only 25-30 mg cholesterol per serving (in contrast to liver, 375 mg, and kielbasa, 400 mg).

“Shell fish has too much cholesterol.” Shellfish contains HDL cholesterol, which is preventive against any form of vascular disease.

“Don’t eat food before going to sleep.” Wrong: Don’t consume red meat, coffee, or chocolate. Eating fruits and dairy products before bedtime is quite helpful in chronic pain (such as RSD/CRPS).


Coffee should be avoided altogether in patients suffering from RSD/CRPS; to consider coffee as a simple conveyor of caffeine is naive.


  1. Coffee has an acid-based oil that is an irritant to gastric mucosa. It stimulates the secretion of gastric acidity. Secondarily, the high gastric acidity results in secretion of adrenalin. The secretion of adrenalin stimulates insulin secretion with resultant secondary relative hypoglycemia. The end result is tension, a mild rise in blood pressure, and 2-3 hours later craving sweets because of the relative hypoglycemia. Obviously none of the above is helpful in RSD/CRPS. The rise in plasma epinephrine will undo whatever good medications are doing to counteract the hyperactive dopaminergic system in RSD/CRPS.
  2. Coffee is more harmful than caffeinated soft drinks or tea.
  3. Mild tea does not cause reactive hypoglycemia and a rise in blood pressure.
  4. Tea, if prepared in mild form (not too strong), contains less caffeine. It has no acid-based oil as does coffee. It contains tannin. Tannin or tannic acid curbs thirst and results in less demand for further consumption of tea or coffee.
  5. Coffee and tea both temporarily raise the body temperature. A few minutes after drinking coffee, the stimulation of the dopaminergic system causes colder extremities and a simultaneous rise in systemic temperature. Tea has a much milder effect in this regard. The cold extremities aggravate RSD/CRPS.
  6. Iced tea seems to be the mildest and safest of caffeinated drinks.
  7. A patient with high fever is harmed by coffee and helped by tea and lemon juice. As is the case with home-made chicken soup being helpful to the sick (in contrast with factory-made red meat type of soup) for unknown reasons, mild tea has a healing effect and coffee has an aggravating effect in patients suffering from stress and fever, including stress of complex chronic pain.

Herbal Tea

Just because tea is less harmful than coffee does not imply that herbal tea is good or healthy for anyone. Herbal teas are a variety of different dried vegetable leaves. Some of the herbs contain toxic substances that are harmful to anyone- including RSD/CRPS patients. Because of the variety in strength and quality of chemicals in herbs, the use of herbal teas should be avoided. Some of them contain such high doses of tannins (e.g., sassafras tea) that can be carcinogenic. Catnip, juniper, nutmeg, and hydrangea may be hallucinogenic. Chamomile and marigold may be fatally allergenic. Senna leaves, aloe leaves, and duck roots can be strongly cathartic. Mistletoe leaves and horsetail grass may cause fatal toxicity. So why bother with such chemicals?