“You see, we are seeing an epidemic of inflammatory diseases. In fact nearly every modern disease — everything from autoimmune diseases, heart disease, and cancer to obesity, diabetes, and dementia — is caused by inflammation!”
As a Physical Therapist I see a crisis in the clinic. People stuck in the chronic pain cycle are handed medication or given injections and sent on their way with never an offer of hope for any way out of this vicious cycle. Sadly, I have heard stories from people who believe what they have been told; the only way to survive their joint pain is to continue receiving regular cortisone injections while waiting for a joint replacement. Are you really doomed to have pain forever with no one to offer advice on how to actually improve your condition?
One of the most common questions I hear in the clinic is, “Should I use heat or ice?”
Today I want to address an even better remedy for your joints than heat or ice. Fat is the new ice and here’s why.
Patients diagnosed with musculoskeletal diseases reportedly have a predisposition to dysfunction in their Gastrointestinal System.
This study looked at the management of Arthritis in patients with Inflammatory Bowel Disease. They found the most commonly affected joints are the knees, ankles, wrists, elbows, and hips and that joint arthritis normally resolves once the gut disease is under control. So the question begs, why do some in the medical community only focus on pain and inflammatory reduction through medication as opposed to restoring the gut disease and thus the joint disease through nutrition?
Restoration takes time and work. Michael Pollan says, “Time is the missing ingredient in our recipes-and in our lives.” I would argue it is also the missing ingredient in the medical community.
In Physical Therapy we see a large variety of people ranging from very recent injuries (acute) to those with years of dysfunction and breakdown (chronic). Physical Therapists are trained to find and treat biomechanical dysfunctions. Recently, I had a patient who fit into the chronic pain category, but it was not a systemic inflammatory issue. The joint restriction in her Subtalar and Talocrual joints led to weakness and a muscle imbalance. Once resolved, she has been able to return to full activity and is pain free. She has had a mechanical dysfunction for over a year that was not treated properly. I should add that she also has been eating a clean diet and has little to no other medical issues. In contrast, about 57% of the patient population in PT nowadays can be categorized as Sustained Acute.
Sustained acute pain is similar to chronic due to its length of time. However, with sustained acute pain the brain becomes hypersensitive and acts like there is still damage even though the tissues may have healed long before. The immune system drives inflammation because of the natural healing capacity of the body. The brain can keep the body in a chronically inflamed state. Chronic inflammation is when the body’s immune system and neurological systems have been overloaded by trying to continually fix its imbalances. Chronic pain could be the result of a mechanical dysfunction in the body that has not been improved upon yet. Sustained acute pain is more likely the result of an overactive immune system which is much more of an inflammatory disorder than a mechanical disorder. If not rebooted, the brain can keep the body in a chronically inflamed state and the immune system will start attacking healthy tissue and thus the auto-immunity can be born. Not everyone with sustained acute pain is subject to an auto-immune condition, but it is important to know that chronic inflammation is driven by more than just stagnant fluid in the joint. It is also important to know that restoring your sustained/chronic joint inflammation happens more efficiently through the gut than through a topical ice pack.
If the internal environment is not well, then fixing only external mechanical problems will never end up in true restoration. Persistent pain, stiffness, tightness can be much more of an inflammatory problem than a mechanical problem. Inflammation is improved through rebooting the immune system by stress relief, mindfulness, exercise, therapy, and most of all nutrition.
Checklist for Chronic Inflammation
The American Academy of Pain Medicine reports that pain affects more Americans than Diabetes, Heart Disease and Cancer combined. An estimated 100 million Americans are reported to have chronic pain. In her book, Taming Pain, Cheryl Wardlaw gives a checklist to determine if you may be chronically inflamed.
- Do you have recurrent pain anywhere?
- Have you had GI inflammation due to a high dose of antibiotics, viruses, parasites, NSAIDS, or food allergies?
- Do you have consistent pain and inflammation combined with any GI issues like bloating, diarrhea, constipation, acid reflux, pain after eating, or ulcers?
- Do you have a specific injury to point back to in the past 6 months?
- Is your pain unpredictable and not reproduced by any specific movements or positions?
- Is your pain reproduced in a variety of places?
- Do you have stiffness as well as pain?
If you answer yes to any of the above questions, your immune system is stressed. It is time to consider the connection between the food you eat, your gut disorder, and your inflamed immune system having an effect on the rest of your body.
What Controls inflammation?
Your brain is highly focused on pain. Thankfully it wants to warn us of impending doom. The brain will continue firing neurons to the damaged area to keep you hurting so you can do something about it and escape the danger. Sometimes, the injury has healed and the tissue is no longer damaged but there is a disconnect between the body and the brain. In this article Dr Ballantyne and Dr. Sullivan explain, “The intensity of chronic pain can’t be reliably predicted from the extent or severity of tissue damage, since chronic pain is not determined by nociception.” Chronic pain can rewire parts of your brain and if the brain is inflamed and hypersensitive, it has trouble turning off the pain switch so to speak.
How does the brain get inflamed? As I explained before, The Vagus nerve is the direct communication highway between the gut and brain and modulates inflammation by assessing the healthy or unhealthy community of microorganisms (microbiome) in the gut. Your gut health can have an affect on mood, stress levels, and systemic inflammation.
Seventy to eighty percent of our immune cells are housed in the gut. An inflamed GI tract affects the brain negatively and can also create musculoskeletal pain and inflammation through chronic immune activity. In return, the presence of healthy bacteria in one’s gut creates a positive feedback loop between the gut and the brain and improves the action of the vagus nerve.
How to Improve the Immune System through food
Cheryl Wardlaw writes, “To succeed in your journey to stop chronic pain, you have to restore health to the compromised systems of your body. Health means eating the right food and getting the nutrition you need. Too much or too little of a nutrient can actually cause some of your muscle, joint, and nerve symptoms. Imbalance in nutrition will damage cells and trigger an immune response.”
Processed foods of the modern Western diet are filled with trans fats, refined carbohydrates, processed grains, conventional meats, GMO’s, artificial flavors and sweeteners, refined vegetable oils, and pasteurized low fat dairy. Avoid these foods as they increase inflammation and irritate the gut.
Eating an anti-inflammatory diet is the best way to reboot the immune system.
Your diet should be filled with plenty of antioxidants. I wrote about antioxidants and the best foods to decrease inflammation here. Your diet should also be filled with plenty of gut healthy probiotics (blogpost here).
Carbohydrates, protein, and fat are known as macronutrients. The macronutrient that I see people neglect the most in their diet is fat.
Fatty acids in food are known as Omega-6’s and Omega-3’s. The ratio between the two is supposed to be 1:1. In today’s Western diet the ratio can be as high as 40:1, when people consume too much processed foods filled with soy, corn, and refined vegetable oils. There are healthy Omega 6 fatty acids found in poultry, pork, nuts, avocados and eggs, and these can still have a positive effect on your health.
The Omega 6’s found in processed foods are blamed in the pathogenesis of many diseases, including cardiovascular disease, cancer, and inflammatory and autoimmune diseases, whereas increased levels of omega-3’s exert suppressive effects.
When you hear people say ‘eat your fats’, they are mainly talking about Omega-3’s for their heart healthy, brain healthy, gut healthy anti-inflammatory properties. Foods Rich in Omega 3 are the following:
- pasture raised eggs (especially the yolk)
- hemp seeds
- flax seeds
- chia seeds
- pine nuts
- olive oil
- cod-liver oil
One study shows that Fish oil 1,000-2,000 mg daily supplementation had significant efficacy to improve knee performance and also are safe in mild to moderate stages of knee osteoarthritics patients. Fish oil supplements are one way to get a good dose of Omega’3s into your diet. If you choose to take it in supplement form, make sure it is cold pressed since that will ensure more purity and potency of the supplement. I am more of an advocate for including it into your diet through healthy foods, but sometimes a supplement can be effective. You can also find burpless fish oil supplements.
Don’t be afraid of fat. Fat does not make you fat. Sugar does that all by itself. Fat speeds up your metabolism and can help you be much more efficient in burning calories. Advocates of a Ketogenic diet eat a large percentage of foods high in healthy fat. Some receive as high at 75% of their daily calories from fat. This High Fat Low Carb diet (HFLC) is being heralded more and more by doctors as a means to reverse Obesity, Diabetes, and Metabolic Syndromes. I have seen it work in myself and in many of my clients as they have been able to improve gut health, lose weight, and reduce inflammation.
If you are interested in trying a Ketogenic diet make sure you do it properly as most recommend keeping track of the ketones in your blood during the dietary process to make sure your body is in ketosis. Good news, though! There’s an app for that. As always, consult with a Functional medicine doctor, nutritionist, dietician, or certified health coach before you embark on this journey alone.
Did you know that a healthy amount of fat in your diet allows you to curb those sugar cravings?
So next time you reach for an ice pack or NSAID’s to treat your chronically inflamed joints, go instead to your kitchen and make a healthy, nutritious, anti-inflammatory meal filled with antioxidants, probiotics, and healthy Omega 3 fats. I have created another delicious smoothie bowl that is high in healthy fat, has a good amount of Omega-3’s, and contains the antioxidant superfood, Cacao.
Chocolate Banana Avocado Smoothie Bowl
Chocolate Banana Avocado Smoothie Bowl
(with Homemade Cashew Cream see below)
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1 TBS Homemade cashew cream
1/2 cup Full fat coconut milk
1/4 of an Avocado peeled
1 Frozen Banana
1 TBS Cacao nibs
1 tsp Cacao Powder
2 tsp Maple Syrup
1/2 tsp Vanilla
Sprinkle of Himalayan Sea Salt
Blend all ingredients together in your Vitamix
Pour into a bowl and sprinkle with your favorite toppings
Unsweetened Coconut flakes
Fresh or Frozen Berries
Pecans or Walnuts
Drizzle of Honey
Homemade Cashew Cream
- Place 1 cup raw cashews in a bowl
- Fill the bowl with water until the cashews are covered
- Cover and let them soak overnight in the refrigerator
- Grind the water and soaked cashews in your Vitamix until it forms a cream.
If you want personal help with how to create the best anti-inflammatory diet for you, then contact me. I would love to help you.
Feel free to contact me as well if you are a Physical Therapist wondering how to implement nutritional advice with your clientele.
If you want more information to help understand Sustained Acute Pain then I suggest reading the book, Taming Pain.
Feel free to comment below.
Enjoy fat, enjoy life,
Melanie Connell, MPT, MTC, CHC