Your Pain is Not Because You’re “Fat”

Your Pain is Not Because You’re “Fat”

What do I know about the struggle to lose weight? Not much and I don’t pretend to. That is a genetic “crap shoot” that I came out on the lucky side of.

What I DO know is that pain does not happen to overweight people alone.

The other thing I know and hear about more often than I should, is how doctors of all specialties commonly and unabashedly display extreme prejudice against people who are overweight.  Numerous patients of mine tell me similar stories about reaching out for help with their pain and being met with a host of physician encounters that leave them feeling judged and ashamed.  So many doctors are quick to blame the weight and slow to investigate past the fat.

Anyone in this day and age knows about the correlation between obesity and disease and mortality.  I’ll go out on a limb here and suggest that the majority of overweight patients know that it’s not ideal to be on the heavy side.  The last thing they need to hear is that everything wrong with them is because of their weight. First of all, that’s just not always true and more importantly, blaming their weight is certainly not something they need a doctor’s help doing.

When has fat-shaming ever helped anyone make positive lasting change? Being judged by careless strangers is one thing but by your own healthcare provider is quite another and shouldn’t be allowed.

If someone has been steadily on the heavy side for the majority of their lifetime and there hasn’t been a sudden recent change in weight, then the skeleton – while perhaps stressed in ways that lighter people aren’t – has had years to adapt.  Our bodies are pretty amazing that way and given years to slowly get used to something, we just do.  The likelihood that suddenly the weight is the main problem is unlikely for this sort of scenario.
I see plenty of lean and “fit” looking people who just wake up one day in pain and have no idea why.  We don’t say to those people: “Well it’s obviously because you’re too skinny.  Come back and see me when you’ve gained some weight.”

Here’s another problematic drawing of parallels that seems to happen quite a bit…

Any sized woman who experiences a 9 month gain of pregnancy weight should never be compared with someone who is chronically overweight.  It is completely different. Not only do most overweight people not gain that quickly but they also aren’t experiencing the unique destabilizing and mechanically disorienting effects of massive hormonal and blood volume changes.

If weight is legitimately suspected as the cause for pain, then the last thing you should do as a doc is dismiss the patient with a sweeping prescription for exercise and calorie restriction when the more likely chronic weight-related risk is cardiovascular.  If anything, this person needs to have a heart health check first.

When a patient feels alienated from their physician due to the shame over their weight, it creates a dangerous  barrier to receiving true healthcare solutions.

I hear first-hand from patients that they will simply not return for care when they feel unfairly judged and dismissed and this can be more dangerous than the weight itself.

We do need to be clear with our patients about the facts:

But facts can be shared without judgment and blame. Higher body fat percentage is a real health risk. Abdominal fat is the worst. It predisposes us to higher levels of chronic inflammation which can manifest in many ways – not just through pain.  Evidence shows that it’s inflammation that is the huge risk factor and linked with a host of diseases.

Doctors and patients alike need to be aware of the cold hard fact that body fat percentage can be dangerously high in underweight, average weight and overweight people.  This is why everyone of absolutely any size, needs to avoid being sedentary, eliminate inflammatory foods and care for their stress levels and stress coping – all of which have been shown to play a role with inflammation which is the ultimate killer.

It’s never just the weight alone.

When there is pain, the pain chemistry needs to be addressed first and foremost.  Yes, fat cells contribute to inflammation which can stack the deck against us and cause pain, but every person’s situation is unique.  Look at the mechanics.  Consider individual body chemistry.  Inquire about psycho-social factors.  These are the inroads to better, more compassionate self-care which is where weight loss can begin if indeed that is appropriate for that patient.

We are emotional creatures first.  The physical body is a reflection of who we are.  All bodies need to be greeted with kindness and respect first before change can be made.


image credit: By Peter Paul Rubens – The Prado in Google Earth: Home – 7th level of zoom, JPEG compression quality: Photoshop 10., Public Domain, https://commons.wikimedia.org/w/index.php?curid=22620913

Save

Advertisements
What IS “Integrative” Healthcare?

What IS “Integrative” Healthcare?

By The U.S. Army (2012 Warrior Games) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

“Integrative medicine” is a term that has become very trendy in the health and wellness industry.  It’s an approach inspired by some of the leaders in the Functional Medicine movement.  As soon as it became evident that patients demand it which means there are big dollars at stake, even mainstream medicine is coming on board.  Cleveland Clinic has opened a dedicated wing for Integrative and Lifestyle Medicine  as has Johns Hopkins with their Integrative Medicine and Digestive Center.

So, what is it exactly?

It’s healthcare designed to treat the whole person (shocker). Many of us in the natural healthcare industry who have been practicing with this mindset for decades can’t help but roll our eyes a little bit at this “new” movement, but it is one to celebrate.

It feels to me like the general public is just catching up with how I’ve been living for most of my life personally, and now professionally for close to 25 years.  What we see in the integrative circles of healthcare is a coming-together of East and West, an acceptance of the interdependence of both sides.

“Integration” refers to the coordination of care between mainstream Western medicine and traditional or “alternative” methods including but not limited to acupuncture, chiropractic, massage therapy, yoga, meditation and other lifestyle modifications. You can find “Functional Medicine” on Wikipedia defined as: medical practice or treatments that focus on optimal functioning of the body and its organs, usually involving systems of holistic or alternative medicine.  

The functional medicine movement was started by a chiropractor with a PhD in biochemistry – Jeffrey Bland.  He bravely championed the long held old-world wisdom of viewing health and disease not as a linear process between one cause and one effect, but rather a complex symphony with multiple orchestral sections that all depend on each other for harmony.   Now people like Mark Hyman MD and a slew of others, straddling mainstream and traditional methods, have embraced this much needed common-sense approach.

Integration? Or Collaboration?

What we are seeing and hearing increasingly from numerous medical centers and hospitals, as many of them move to offer these kinds of approaches under one roof, is validation of this kind of wisdom-medicine for use in the Western model.

This week’s national news headlines on ABC’s GMA morning programming included a story highlighting the benefits of integrative medicine for cancer patients at all stages of care.  The use of acupuncture, movement therapy like yoga, massage and meditation were given as examples of treatment methods used to address the emotional, spiritual and physical needs together.

Some of you who follow this blog know that, just a few weeks ago, I attended a conference held by the Academy of Integrative Health and Medicine (AIHM) where I met medical doctors, physician assistants, nurses, naturopaths, acupuncturists and other chiropractors.  All of us together acknowledging the role of each other’s specialties in the full care of a patient while remembering to also live the path that we advocate for by indulging in some reflective self care.

In conversation with someone over breakfast at this AIHM conference I shared that I am a chiropractor in solo practice. I was met with “So you don’t actually practice integrative medicine…”

This took me aback a bit because I believe I actually do the ultimate integrative practice.   This exchange made me consider that perhaps the confusion is with the concept of “collaborative” vs. “integrative”.  Solo practice means I run a one-woman-show but does not preclude my patients from receiving collaborative (or “integrative”) care.  In my opinion collaboration is essential to integrative approaches.

This meeting of two worlds, in my opinion, can happen just as effectively in a more expansive community setting and not just under one roof. Successful collaborative care for the whole person is much more about the attitudes of providers than a physical facility with a name. I see my job as more of a healthcare traffic cop of sorts.

With the training that every chiropractor receives – to serve as a primary / portal of entry provider  – we are charged with the responsibility of knowing when chiropractic will serve our patients and when other modalities are more appropriate or needed in conjunction with our work.  Who better then, to assess and help patients prioritize treatment methods and direct them to the right practitioners?

I am extremely comfortable with my limitations as a practitioner and for true whole-person healthcare I think it’s essential to beware the delusion that any one of us can be everything to everyone.

For patients who don’t yet have a healthcare team, I regularly bring their attention to physiatry, physical therapy, massage, acupuncture, psychotherapy, and whenever needed, direct them back to their mainstream medical provider or any  number of medical specialists.

Do you have a healthcare team of alternative and mainstream providers?  Are you enjoying the integrative medicine movement?  You deserve to.  Status quo is changing.  Expect more.

 

 

 

Tissue Acidity is Real. Debunking the “Debunkers”.

Tissue Acidity is Real. Debunking the “Debunkers”.

strumenti laboratorio chimicoThe controversial issue concerning the role of pH in health is one with heated opinions on both sides of the fence. But what are those sides of the fence? Well, there is a strong cohort opposed to the concepts that acidity or alkalinity (measured on a scale of pH) is in some form or another related to health and, in particular, that the food we eat has any bearing on our body’s pH value. The other side is preoccupied with promoting products like pH-regulated water that will supposedly “cure” you of all diseases. Neither position on the matter is doing justice to the facts.

I write about the influence of pH in my book Every Body’s Guide to Everyday Pain. There is no scarcity of research to support the fact that low tissue pH (acidity) is associated with inflammation, which can lead to pain.1-6 This is an extremely relevant point when considering the paradigm shift necessary to recognize early indicators of dysfunction and imbalance — these will help us learn to avoid the perplexing everyday variety of pain that often seems to appear out of nowhere.

Block Quote #1The science of pH in human physiology is complex. There is no easy cause-and-effect scenario to follow, and no straightforward way exists to measure pH in the body in real time. For example, urine pH values do not accurately represent the pH values in your joints and tissues, and salivary pH is not directly representative of your intestinal pH status because normally food is processed by your gastrointestinal tract and, in doing so, the composition of what you ingested has changed. The reality is that the acid/alkaline status of your body is a moving target and is not uniform across all systems.  These crude measurements (urine and saliva) act as red herrings and provide—at best—educated guesses about what the body is actually going through at any particular moment.

One very important truth that every pH “debunker” gets right is that blood pH does not fluctuate. This tight control over blood pH levels is essential to keeping us within the very narrow parameters needed by our cardiovascular system to keep us alive. Keeping our blood pH from fluctuating is so important that, when we are exposed to acidifying influences that could disrupt our blood chemistry balance, an elaborate biochemical dance occurs in all other body systems in an effort to “take the hit” for us. Our body copes in other ways to handle the stress and temporarily becomes compromised in some way to protect the blood pH from potentially life-threatening fluctuations.

What sorts of things cause this kind of pH-shifting biochemical stress? Anything that our cells are exposed to in the course of daily life can cause a shift—air, food, and water act as the three main vectors. Our air is filled with byproducts of industrial exhausts and at different times of the year with complex plant proteins that become airborne and act as allergens. Food comes in many formats in our society of “now” and modern conveniences. Packaging, processing, and preservatives introduce chemical compounds that our bodies were not Block Quote #2designed to tolerate on a regular basis, and what we think of as water is no longer just H2O (two molecules of hydrogen and one of oxygen). Water is generally considered safe, but the measures needed to create safe drinking water in developed countries may also introduce miniscule amounts of foreign molecules into the water supply.

The key realization here is to understand that the issue isn’t necessarily exclusively about the pH value of these substances themselves, rather that, in large part, it’s the body’s protective responses in the face of biochemical stressors that change our tissue chemistry

Let’s look at a common response to biologic “invaders”: Histamine. Histamine is an irritant produced in response to a wide array of allergens, and evidence suggests that histamine itself presents an acidifying effect.7-9 These inevitable acidic influences have to hit us somewhere and, if not the blood, then where?

An important distinction often missing from these discussions about pH is that blood pH is not the same as tissue pH. Tissues are bathed in interstitial fluid made up of lymphatic and cellular materials (amino acids, hormones, sugars, fatty acids, coenzymes, neurotransmitters, salts, and cellular waste)—none of which equates to blood. In processing biochemical stress from any source—whether dietary, environmental, or emotional—it turns out that the tissues of the body, not the blood, are the most affected.

Armed with these facts about pH in the body and its association with inflammation, it’s compelling to consider the following possibility: It seems that every food theory that aims at decreasing inflammation and enhancing gut and brain health (based on the acidity/alkalinity of your food or not) are successful to at least some degree. Could the true reason for this be because of the net effect on tissue pH? Well, it’s not quite that simple. There’s a catch: People report a wide variety of results. So, does that mean all this food hype is bunk?

It’s certainly not “bunk,” per se, but it’s worth remembering that, if no measurable correlation exists between the acidifying influence of the food itself and a particular person’s body pH, then any results seen (whether good or bad) are likely a factor of that person individual’s biologic response based on his or her unique genetic profile. So, what does that mean? It means that results are highly variable.

Which foods or airborne particles do your cells consider to be allergens (ie, foreign)? Firstly, this is something that changes as we age; secondly, it’s dictated by your genetic profile; and, thirdly, to complicate matters, outside influences (environmental, including stress) can change the responses of your genes to allergens.

These are the facts:

  1. In general, inflammation is at the root of dysfunction and disease.10
  2. Tissue acidity provides an environment conducive to inflammation.11

If we can avoid providing the perfect playground for pain and disease, then why shouldn’t we try? Exploring the foods and substances that expose your cells to the least amount of acidifying stress is a very personal journey. The array of widely touted food theories may be appropriate for some people and represent a good place to start, but you may find you’ll require some guidance from a natural medicine practitioner at some point to help you pinpoint what your specific situation calls for and the individual needs of your body.

For professionals in the dietetics field or those in the food industry to claim that what we eat doesn’t affect our health in this way seems a bit ironic and counter to the mission. I hope the conversation continues for the sake of shedding light on ways to minimize biochemical stress—whether that be through dietary changes, lifestyle modification, or in other ways—with the ultimate goal being to increase quality of life for all.

 

References

  1. Bray GE, Ying Z, Baillie LD, Zhai R, Mulligan SJ, Verge VM. Extracellular pH and neuronal depolarization serve as dynamic switches to rapidly mobilize trkA to the membrane of adult sensory neurons. J Neurosci. 2013;33(19):8202-8215.
  2. Ugawa S, Ueda T, Ishida Y, Nishigaki M, Shibata Y, Shimada S. Amiloride-blockable acid-sensing ion channels are leading acid sensors expressed in human nociceptors. J Clin Invest. 2002;110(8):1185-1190.
  3. Wu WL, Cheng CF, Sun WH, Wong CW, Chen CC. Targeting ASIC3 for pain, anxiety, and insulin resistance. Pharmacol Ther. 2012;134(2):127-138.
  4. Birklein F, Weber M, Ernst M, Riedl B, Neundorfer B, Handwerker HO. Experimental tissue acidosis leads to increased pain in complex regional pain syndrome (CRPS). Pain. 2000;87(2):227-234.
  5. Lin CC, Chen WN, Chen CJ, Lin YW, Zimmer A, Chen CC. An antinociceptive role for substance P in acid induced chronic muscle pain. Proc Natl Acad Sci USA. 2012;109(2):E76-E83.
  6. Steen KH, Steen AE, Kreysel HW, Reeh PW. Inflammatory mediators potentiate pain induced by experimental tissue acidosis. Pain. 1996;66(2-3):163-170.
  7. Uvnäs B, ed. Histamine and Histamine Antagonists. New York: Springer-Verlag; 1991.
  8. Hiller A, The effect of histamine on the acid-base balance. J Biol Chem. 1926;833-46.
  9. Rocha e Silva M, Rothschild HA. Histamine. Its chemistry, metabolism and physiological and pharmacological actions. Springer-Verlag Berlin Heidelberg GmbH. 1966:233.
  10. Cohen S, Janicki-Deverts D, Doyle WJ, Miller GE, Frank E, Rabin BS, Turner RB. Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proc Natl Acad Sci U S A. 2012;109(16):5995-5999.
  11. Jankowski JA, ed. Inflammation and Gastrointestinal Cancers. New York: Springer; 2011.