Partial Credit
Throughout our lives we are taught the value of partial credit. From honorable mention to answering a question on a test, some credit is better than none. And certainly, there is a lot of good to be said for the concept. Cutting down from two packs to six cigarettes per day is a valuable lifestyle change. Eating less French fries, sugar, and white flour are healthy changes that require praise and reinforcement.
When it comes to pain, some lifestyle changes will result in the partial credit of feeling better. Feeling really good and getting out of pain require a different attitude and level of attention to detail. Partial credit with hammers is the example that being hit hard will hurt a lot more than being hit softly. With bees it can be agreed that 20 bee stings will likely hurt more than 1. But with regard to pain it is the immune system that has to settle, and if your system is sensitive to bees it only takes one to kill you. So, while there is likely to be some improvement in pain levels w'ith appropriate dietary restriction, the best results may come from total abstinence from even the tiniest morsel of a particular substance for more than 4-6 weeks. Partially or almost gluten-free may be as meaningful as a little pregnant.
In this fashion, there are some foods and food products that often seem to require black and white abstinence for getting out of pain. For these items, the slightest amount can cause severe pain lasting for several weeks, and these likely need to be totally avoided. Classically trained physicians may initially think it extreme and unlikely for food triggers to be characterized in this fashion. Recall however the severity of reaction in someone sensitive to bee stings to the sting of even one bee. And then consider how many days or weeks it can take to settle immune sensitivity and allergy reactions. For certain people specific foods and even ingredients can upregulate the immune system and provoke the upregulation of inflammatory and pain-increasing mediators. In these circumstances, a trace of dairy can cause the onset of head and neck pain within hours, and a trace of gluten can cause the onset of lower back pain by the next morning. As I paid more attention to this in my practice, I began to realize these phenomena were much more widespread among my patients than I ever imagined. Indeed, it is a rare chronic pain patient who is not affected to this degree.
On the other hand, there are many foods that are necessary for providing important nutrients for healing and should be deliberately ingested. The patient who will not eat any vegetables and lives on fast food is at a disadvantage for healing. In considering food choices, and in addition to micro- and macronutrients, attention must also be given to the microbiome.3 And while every patient is different, there is a general commonality and order for where to start that is applicable to most situations.
New' information related to the microbiome and pain is even more impressive and further relates pain and food. While the microbiome has been related to digestive issues and visceral pain, there is new' correlation to inflammatory pain, neuropathic pain, headache, and even opioid tolerance. Almost every one of my patients who radically decreases sugar, wheat, and potato notices a dramatic increase in the efficacy of their opiates. To go along with these experiences, we are learning more about mechanisms for the clinical observance of the relationship of inflammatory food to pain. One such discovery is that microbiota in the gut produce mediators that modulate and induce peripheral sensitization.4 This relates food choices to allodynia.
A microbiome effect may also lead to a better understanding of the observation that it may not be enough to just be gluten-free. Many people have told me gluten-free provided no improvement until they were also sugar-, dairy-, and potato-free.
Becoming more important in our lives will be the awareness of the effects of long-term low- level exposures to toxic metals, pesticides, herbicides, and more. Low-level constant exposures may steadily increase body burden, and many of these substances have half-lives of many years. It is possible to test for levels of heavy metals and herbicides, and then treat to accelerate detoxification. One of the mechanisms of their adverse effects on our biology is an increase in oxidative stress. More and more it is being recognized that oxidative stress is a common denominator for many health issues.5 These efforts at diagnosis and treatment can help patients with chronic pain and also fatigue.
Example Side Bar
In a brief discussion, an acquaintance admitted he had experience with a low-carb diet, and had lost weight and felt great. I asked, and he revealed that of course it was past tense. I further asked why, and couldn’t he stand feeling that good? His reply speaks volumes, in that it was about lifestyle and he wanted to eat the bread. It later occurred to me that this was not lifestyle at all. Among other things, lifestyle is about spending time with those who matter, participating in activities of recreation, and meditating in nature. Eating bread is more about disease style than lifestyle. What chronic illnesses is one signing up for, and what complications and health issues that otherwise might never happen are now more likely to occur sooner?
As I observed the painful and inflammatory consequences of bread flour on myself and my patients, I was still not convinced that these issues were important for those with no pain. That was until several years ago when I learned about zonulin proteins. Zonulin proteins are secreted by our own cells to enhance the absorption of needed nutrients across membrane barriers. Gluten ingestion is associated with increased zonulin proteins, and thereby also associated with changes in the permeability characteristics of our intestinal barriers, lung barriers, and blood-brain barrier.6 When a substance can compromise the integrity of a protective barrier, it should be recognized as universally detrimental by a multitude of effects. This phenomenon seems to be universal to our species and therefore may make the ingestion of bread more disease style than lifestyle.
