Welcome back to the Healing Pain Podcast with Joe Tatta, PT, DPT, CNS
The worldwide burden of chronic disease, which includes cardiovascular disease, Type 2 diabetes, hypertension, and cancer are on the rise. It’s expected that by the year 2030, almost 75% of all deaths worldwide and 60% of all disabilities will be attributed to one or more chronic diseases. Considering that most chronic diseases can be prevented or delayed, identifying and targeting modifiable risk factors is of major clinical and public health importance. Suboptimal dietary habits and poor nutrition are a major preventable cause of many chronic diseases.
Without addressing diet and nutrition, there’s an ever-increasing burden on healthcare services. Nutrition plays a key role in lifestyle habits and practices that affect virtually every chronic disease and as a key lifestyle intervention. Nutrition should therefore be viewed as an important aspect of patient care and addressed by all healthcare professionals, including physical therapists. Many of the experts who have spoken to me on the show described nutrition as an essential intervention for treating chronic conditions, including many chronic pain syndromes.
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Nutrition, Pain, And Chronic Disease For The Physical Therapist With Joe Tatta, PT, DPT, CNS
Now and every day, I continue to discuss diet and nutrition with patients and at medical conferences to support this essential lifestyle intervention for the treatment of pain. Let these words be your guide and serve as an entry point into diet and nutrition as a way to heal the body and the mind. We begin with Dr. Tom O’Bryan. You mentioned three weeks. Is three weeks enough to heal your gut and to make people feel better or do they need to be on for a little bit longer period of time?
The three weeks is not enough, but in my entire career and practice, I’ve always had the same approach. You give me three weeks and within three weeks, you should know you’re on the right track. It may take you two years to heal depending on how much damage there is but you should know within three weeks. If you don’t know within three weeks and you’re following the guidelines, then we’ve missed something. I don’t care if you’ve got cancer or whatever it is. You should know within three weeks that you’re feeling better, you’re sleeping better, or your brain is functioning better. Whatever the symptoms are, you should notice a change for the better within three weeks.
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Physical therapist, researcher, and nutritionist, Dr. Carrie Falling. Can I tap into your nutrition information for a little bit?
I certainly could try.
There are going to be people who are reading this and saying, “I have IBD. What can I do to help my IBD as far as nutrition goes?”
If I’m going to be completely honest, I have over the course of my career, steered away from blanketed answers. I find that with the way the internet works now, a lot of these blanketed answers have started to work against some of the ideas that people’s digestive processes, it’s like a personality trait. Your struggle is going to be unique to you. It’s going to be different than my struggle, which is going to be unique to me. People have inherent struggles in terms and even enzymatic ability to produce enzymes within themselves and limitations within that. There are limitations with food sources and lots of genetics and the epigenetics of it all.
Usually what I tell people, if they have IBD, is to see somebody who can help identify what processes they appear to be struggling with and the foods that tend for them to create an inflammatory response because there are the generic foods that we understand often create an inflammatory reaction from people in terms of the legumes and these groups that we know about. Not everybody struggles with that and certainly not to the same degree. If someone doesn’t have access to a practitioner, then I say, “Take these big food groups, take them out for a period of time and see how you go. Once the dust settles, then we can make some decisions,” but ideally, what I want people to do is find somebody.
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Physician researcher and Multiple Sclerosis advocate, Dr. Terry Wahls. Let’s start with the microbiome. Why is a healthy microbiome so important when it comes to healing from an autoimmune disease such as multiple sclerosis or preventing it?
Every month we get more and more information to help us understand more completely the connection between how the gut bacteria that are eating our food and eating the byproducts of each other’s processes. They’re making small molecules that get into the bloodstream that will travel to our brain, cross the blood-brain barrier and influence our mood, our behaviors and the inflammation level in our brain. If we have the wrong mix of bacteria, we have these pro-inflammatory molecules and our liver takes a lot of that trash out, but you could overwhelm the ability of the liver to filter all these harmful small molecules out. We have more evidence each month that more of these autoimmune conditions, there’s a very distinct and different set of bacteria that are growing in the bowels. We’re also seeing even our mental health conditions like schizophrenia, depression, anxiety and obsessive-compulsive disorder have a very different microbiome.
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Physical therapist and Functional Nutrition for Chronic Pain specialist, Lauren Bahr. How has going through my program been different than going to the health coaching program because they do talk a little bit about nutrition in the health coaching program?
Institute for Integrative Nutrition is for the layperson. It’s for anybody. It’s a great foundational program that is very broad. It covers nutrition, sleep, relationships, career and all sorts of things. The program through you was a deeper dive into evidence-based nutrition and more clinically applicable information.
There are going to be PTs who’s reading this, and both of you and I had been through this already. At first, you’re like, “I don’t know if I can do this. Is it okay? Does this fit into my practice?” You start to become this other practitioner. What would you say to a physical therapist who’s on the fence about learning nutrition and integrating it into their practice?
Just like any other new skill or modality that you add, you have to start taking some baby steps. You might go to a manual therapy course over the weekend and Monday morning, you have to start trying it. I think the same is true for nutrition and start learning. There are resources out there, your program, your book and there are other resources. As you start gaining that knowledge, you can start with a simple conversation about sugar and start with baby steps.
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Microbiome researcher, Dr. John Cryan. In the average adults, who are in their 30s, 40s, 50s, is the microbiome stable or is it changing on a day-by-day, week-by-week or month-by-month basis?
It’s a great question and it’s one that we’re still grappling with. For the most part, once we reach an adult, our microbiomes remain relatively stable as long as the environments we live in and the diet we take remains stable. Once you modify them, it is considered that you can alter the microbiome. As we age, it starts to decline. There are studies including studies from here in Cork, Ireland, where people have begun to look at the relationship between the stability of the microbiome and aging and the health outcomes, specifically in relation to frailty and sarcopenia and showing that the more diverse the microbiome is maintained, the better the health outcome. That’s a good lesson for all of our lives. We want to keep a diverse microbiome for a better health outcome. We need to look at ways to do that. Perhaps one of the best ways, at least with the most evidence, is through nutritional sources and the diet.
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Professor of Physical Therapy, Dr. Elizabeth Dean. I want to talk to you about one of your pieces of literature where you talk about the types of clinical competencies that a physiotherapist or a physical therapist may need to make them competent. What are those types of lifestyle interventions that a physical therapist does have the skills to grow on, to start to train, educate, and inform people regarding lifestyle and medicine?
A few years ago in physical therapy, we published a prospectus, ten other faculty members and myself. It was called Prioritizing the Noncommunicable Diseases in Physical Therapy Curricula. We felt we’ve done enough talking now. We had two summits. The last one was in Cape Town. We said, now we’ve got to create the toolbox. We’ve done enough talking around this topic. “What is in the toolbox? What are the competencies that can be readily integrated into an episode of care by a physical therapist?” Those distill out pretty clearly. It doesn’t have to be complicated or hugely time-consuming. In my own clinic, we give the questionnaires out before people come, email these days and a simple smoking questionnaire and nutrition. That’s a bit harder to get a good nutritional assessment, but we’re doing our best. We are now assessed sitting, which is distinct from physical activity and exercise. You can be doing all the right things in terms of exercising at 70% to 85% of your age-predicted maximum for 20 to 40 minutes, 3 to 5 times a week and still have risk factors for the metabolic disease. It’s independently related.
We then go to sleep because we know that in North America, we are particularly sleep-deprived and stressed, the degree of how manageable our stress is. We have assessment tools for those. They are going to be on a website. We call it a toolbox website. We initially designed it for physical therapists. Now, we feel that all health professionals should be speaking the same language from all of us. The three biggest established health professions in the world are nursing followed by medicine, followed by physical therapy. We are the leading non-pharmacologic. There are some countries now where there’s a scope of pharmacologic prescription, but by and large, we are characterized by being non-pharmacologic. Let’s embrace that.
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Functional Medicine physician, Dr. Mark Hyman. There’s a growing field of nutrigenomics. People are becoming very interested in looking at how food directly affects their genes and their biochemistry. Do you think that field would affect the way we use food as nutrition or nutrition as medicine?
Absolutely. One of the tenets of functional medicine, in which I’m a practitioner, is that food is medicine. It’s not just calories. It’s information and it provides instructions that affect your gene expression, your hormones, your inflammation markers, your gut microbiome and almost everything that’s going on in your body in real time every minute. Everything you eat controls all of your biochemical processes and it’s fast. We can take people who are on insulin, change their diet and they get off insulin in a week. That’s how powerful this is. There’s no drug that’s going to get you off insulin in a week. We have the ability to use food in a powerful way and that’s something people don’t understand, how effective it is, how quick it works and how powerful it is.
I just had a woman. She did my program. It’s part of what’s in the book, which is the 10-Day Detox. She said she was scheduled for two knee replacements and she had to cancel them because her knees stop hurting. She lost 30 pounds and she’s sleeping for the first time in her life. Another guy came up to me and says, “I was diabetic. My A1C was 10.4,” which is off the chart. Anything more than 5.5 is bad. He said, “I lost 60 pounds and I got my hemoglobin A1C down to 4.8 which is better than almost everybody.” It was just food. There’s no drug that can do that. People go, “Food is as good as medication.”
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Naturopathic physician, Dr. Alan Christianson. It’s a great point. A client asked me, “I shouldn’t eat beans because I get gassy when I eat them. If I have gas, then it’s somehow disrupting my gut function.” I explained to her that there is probably a good potential that it’s the opposite. There’s probably a good thing in beans that are very good for the flora in your gut. Can you talk about that to us?
It’s the opposite. Not only are they helpful for those ways, but the fact that someone reacts strongly, that’s a sign saying they need help in that way. It’s saying that their flora is not very robust and diverse. The paradox is that the fewer foods we consume, the fewer foods we get able to break down. We hear a lot about the importance of variety in the diet, but people often miss that variety means the most at that macro level of categories. The more variety of food categories you can have, the better. Within categories, variety is still great. Lots of kinds of greens and vegetables are awesome. At the macro level, that’s where variety has the biggest impact.
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Physician, Dr. Steven Masley. How do you respond to people with regards to lots of oils, but olive oil specific is the one that we’re talking about when they say, “That’s still a processed food and if you have heart disease, you shouldn’t have any type of processed oil. If you’d like to eat a whole olive, that’s okay, but not olive oil.”
It doesn’t match with the facts. When you look at what’s been published and randomized clinical trials, adding olive oil improves your cholesterol profile, blood sugar and blood pressure. It decreases your cancer risk. It lowers inflammation and it has been shown to reduce your risk for heart attacks and strokes. In people following an American Heart Association Diet or a Mediterranean diet where they added extra olive oil, it lowered their rate of heart attacks and strokes. It improved their cognitive performance and helped them lose weight. That’s what’s proven. I can’t help what people say and share. It’s hard to discredit olive oil.
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Physical therapist and Functional Nutrition for Chronic Pain specialist, Shannon Morris. Is nutrition something that you’re discussing on the first visit with someone?
Oftentimes. It doesn’t take a tape measure around someone to waste to know that they have metabolic syndrome. Someone will come in and they’ll have in their history checked depression or, “I also have this knee pain and this back pain. I know I just had shoulder surgery.” I’ll start bringing up information about, “What is your diet like? Would you be receptive to talking about a lifestyle change?” Most of them, I always ask permission, but most people are receptive and do want to hear it.
Sometimes they even say, “I’m shocked that I never heard any of this from my doctor.” I saw someone in the hospital with diabetes and they said, “We’re going to do diabetic training.” I was curious about what she was going to get. It was basically how to inject the insulin into our stomach. That was the diabetic training she got. Many people are not informed and they’re open to this. It’s important that we get it when we can. Even if they’re not, there are all kinds of stuff about sleep and stress. I’m like, “Who doesn’t want to hear about it?” It’s important that we do start talking.
Important Links:
- Dr. Tom O’Bryan – previous episode
- Dr. Carrie Falling – previous episode
- Dr. Terry Wahls – previous episode
- Lauren Bahr – previous episode
- Dr. John Cryan – previous episode
- Dr. Elizabeth Dean – previous episode
- Dr. Mark Hyman – previous episode
- 10-Day Detox
- Dr. Alan Christianson – previous episode
- Dr. Steven Masley – previous episode
- Shannon Morris – previous episode
- https://integrativepainscienceinstitute.com/nutrition/
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