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Exercise and Chronic Pain

Does exercise help or hurt my chronic pain?

Chronic pain is defined as pain that lasts for longer than 3 months. This is the time period chosen because it is beyond when normal tissue healing should occur. In the United States in 2021, an estimated 20.9% of people experienced chronic pain. This is a general term as other forms of chronic pain cause actual continued tissue damage such as cancer or osteoarthritis. Since there are such a wide variety of chronic pain syndromes with different causes, we won’t be diving into any of the specifics of those diseases.

When you experience constant pain that doesn’t go away, it is only normal to question whether or not exercise would be helpful for you. This pain can even begin to affect your daily life. Pain is never fun; therefore, it is our natural response to want to decrease the pain. Our natural instinct is to move less in order to try and reduce pain. It is counter-intuitive that exercise can help improve chronic pain. However, inactivity can also lead to other issues such as muscle atrophy (your muscles get smaller because they’re not being used), poor posture and stability, and other health problems. Fear is a common emotion experienced with chronic pain. Avoidance of certain behaviors or movements that caused pain in the past can invoke more fear and it becomes a vicious cycle. Fear of pain can become debilitating and perpetuate inactivity.

On another note, one of the proposed mechanisms for chronic pain is some kind of local or systemic inflammation. Scientific literature is showing that exercise can decrease systemic inflammation and in contrast, a sedentary lifestyle can even increase or contribute to inflammation. Consistent exercise is the most important thing, even if the sessions are short and of a lower intensity. Additionally, exercise can influence certain neurotransmitters and endogenous opioids (made by our own bodies) which promote the decrease and control of pain through pathways in the brain. Studies are also showing improved neuron regeneration after exercise which could help our nervous system respond better to pain signals. There is also a sensation where exercising a body part that does not hurt can help to decrease the pain in the area that does hurt. In additional to all of these benefits, exercise also helps to reduce fatigue, reduce excess weight, improve sleep, reduce anxiety and improve mood.

This being said, please make sure to talk to your doctor before trying to complete exercises if you are experiencing chronic pain. Figure out a plan that works for you and your specific condition.

If you’re wanting to increase your movement, here are a few non-intimidating forms of movement that you can slowly (and progressively, as possible) try to incorporate into your life:
– Leisurely walks of increasing length: Start slow and increase. For example, walk for 5 minutes, and rest and repeat. Walk for 10 minutes, rest and repeat. Etcetera. 
– Stretching and yoga: Incorporating small amounts of stretching into your day can help to increase flexibility and mobility, especially at the beginning and end of the day and when you’ve been sitting for a while. 
– Light core strengthening: Try getting an exercise ball and use that for various exercises. There’s no need to jump right into an intense amount of crunches.
– Incorporate more activity into your daily tasks. When you get up off a chair, sit down and get up a few more times. When you’re going up the stairs, redo a few stairs at the end. Sweep the floor more often than you need to. 

Schedule an appointment online today with one of our doctors if you’re experiencing chronic pain!

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461882/
https://link.springer.com/chapter/10.1007/978-981-15-1792-1_16
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530716/
https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm#:~:text=During%202021%2C%20an%20estimated%2020.9%25%20of%20U.S.%20adults%20experienced%20chronic,(8.0%25)%20(5).
https://extension.usu.edu/heart/research/exercise-and-chronic-pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993768/
https://www.va.gov/WHOLEHEALTHLIBRARY/docs/Moving-the-Body-in-Chronic-Pain.pdf

Exercise and the Brain

We all know that exercise can help us manage our weight, build muscle, and is generally good for us, right?

Did you know that exercise also helps improve your sleep, mood, thinking and judgment skills, and reduce your risk of some cancers, heart disease, neurodegenerative diseases, and other metabolic diseases such as diabetes and metabolic syndrome?

When we think of the benefits of exercise, improving brain health doesn’t usually come to mind. However, research is showing that regular aerobic exercise (otherwise known as “cardio”, the kind of exercise that gets your heart rate up) helps to improve memory and other learning process. In fact, it can preserve or even increase the volume of the areas of the brain involved with cognitive functions (particularly the hippocampus). Furthermore, exercise induces the creation of new neurons in the brain and more integrated neural networks. Muscle synthesis, as a result of exercise, can cause the release of certain molecules that modify neurotransmission in specific areas of the brain.

In addition to structural changes, exercise can also promote recovery after an injury and has anti-depressive effects. One reason for this could be is that exercise has been known to increase tryptophan (a type of amino acid) levels in the blood which is a precursor to serotonin. A lot of antidepressive medications attempt to increase serotonin as it has a relaxing, feel good effect. Exercise also increases blood flow to the brain and releases endorphins that help to improve mood by influencing pain and the body’s response to stress. Also contributing to this “feel good” effect is an increase in opioids made by the body as a result of acute exercise (a burst of exercise).

Acute, or short-term exercise, has also been shown to increase cognitive function and performance- more specifically motor skills and academic achievement. Studies show that exercise intensity greatly affects the responses that contribute to improved function.

You might be asking yourself this question, what is the best kind of exercise for my brain health?

The kind that you can get yourself to do regularly and enjoy. Sure, a mixture of aerobic (cardio) and resistance training (weight lifting) are beneficial in different ways, but if you absolutely hate both, maybe tennis is the way to go. Or biking. Or swimming.

Here are some tips for incorporating exercise into your life or finding ways of exercising that are enjoyable for you:
– Find an exercise buddy: Nothing is as fun if you’re doing it by yourself. Find someone else who is as committed to exercising as you are and will encourage you to exercise when you don’t want to. 
– Be willing to try something new at least two times: Maybe you decide to try a new fitness class at the gym or a friend invites you to try something out with them like rock climbing or hiking. Maybe something goes wrong and you absolutely hated it. Try it at least one more time. There are always things that can randomly go wrong so give something two chances before giving up on it.
– Try mixing up your exercise routine: Doing the same thing over and over again can increase the risk of injury. Try doing a different activity or exercise routine each time you plan to workout this week.
– Choose activities that you enjoy so that your workout routine is sustainable. If you’re having trouble finding something you enjoy, keep trying new things until something sticks. Just don’t give up.

Sources:
https://medlineplus.gov/benefitsofexercise.html
https://www.nia.nih.gov/health/real-life-benefits-exercise-and-physical-activity
https://neurosciencenews.com/fitness-neuroscience-23228/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770965/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680508/
https://pubmed.ncbi.nlm.nih.gov/2678895/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/#:~:text=Several%20lines%20of%20research%20suggest,function%20in%20the%20human%20brain.
https://pubmed.ncbi.nlm.nih.gov/22480735/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928534/

Mental Health and Functional Neurology

It’s Mental Health Awareness Month and we wanted to invite Christina Hill, a licensed Marriage and Family Therapist, to share with you how integration between functional neurology and counseling/ mental health care services can allow for optimal functioning. 
Our thoughts, emotions and beliefs, along with the quality of our relationships, affect our body’s health and functioning. If you find yourself having a strong emotional response to something that seems elevated beyond your usual level of functioning, it could be a sign that you might benefit from additional support. Our brain sends us messages about whether or not we are safe unconsciously through something called neuroception. This term explains how the body is constantly scanning our environment for cues about safety or danger and subconsciously gathering data to assess any potential threat. If our body isn’t able to metabolize an experience fully, we can end up feeling “stuck” replaying the event or having uncomfortable anxiety symptoms. This can also happen from an accumulation of emotional stress that is stored in the body over a period of time and can put our body and mind into a perpetual state of anticipating danger that can even begin to affect our physical health.
Interventions that incorporate the nervous system can help your body move through the distress and gain resilience for encountering similar triggers in the future. We can target the nervous system through physical interventions like chiropractic adjustments and other neurologic programs such as CogniStrong and/or somatic interventions such as progressive relaxation exercises and visualizations. By processing emotions and addressing unwanted symptoms, the body is better able to “let go” and experience relief. Feeling safe in our bodies is an important part of this process to be effective. Addressing these underlying emotions and life experiences in a safe, non-judgmental environment can sometimes even help get over a hump with some of your physical ailments. If you or someone you love is having difficulty processing emotions or managing life stressors, know that help is available. Reach out and we would be happy to direct you to a caring professional who can help.

Toxic Stress Overload

You’ve heard from everyone that stress is toxic and not good for you, but why is it not good for you?

When we encounter a stressful situation, our bodies have specific responses (we’ll call this a stress response) that allow us to adapt to the present physical or psychological stimuli. Our bodies were designed with this built-in defense mechanism to be able to respond to life or death situations and survive. This is where the “fight or flight” term comes from. Here is an example of what happens in our body during a stress response:

Stress hormones and other neurochemicals increase in the body which causes increased heart rate, blood pressure, and blood glucose- all with the objective of supporting the possibility of needing to expend energy to protect ourselves. The body even begins to shutdown or divert energy away from the body systems that are unnecessary at that moment like the digestive or reproductive systems. You don’t need to worry about procreating or eating a large meal when you’re running away from a bear, right? That’s the idea here.

                                                                       

Under normal circumstances, once the stressor is no longer present or even with a moderate amount of stress, your body is able to adapt and go back to more of a “normal” state where these stress responses are not as ramped up. However, when those stressors are chronically present, your allostatic load can increase. “Allostatic load” refers to the cumulative effects of strong, repeated, or prolonged stressful experiences (regular life situations, drastic life events, and/or consequences from unhealthy behaviors such as poor sleep, smoking, chemical toxicity, etc.) in one’s life. Allostatic “overload” or “toxic stress” occurs when an individual is no longer able to cope or adapt with these physical responses that the body has in response to the stressful experiences.

Our bodies are designed to be able to handle and even thrive on acute, or short-term stress. For example, the physical stress from a hard workout or nervousness that comes from a public speaking engagement or during an exam. Our bodies are able to make little adjustments to be able to cope with a particular situation as long as it is able to return to more of a normal state. However, when this stress becomes chronic and doesn’t ever die down, these hormones and physical responses begin to cause damage to the systems involved in the stress response and cause dysfunctional responses that can lead to things like heart disease, psychiatric disorders, digestive issues, weight gain, infertility, and much more.

Children are particularly susceptible to toxic stress because of their impaired ability to cope as their brains are in a sensitive period of development. Permanent changes in brain physiology and poor health outcomes like immune dysregulation, persistent infections, and various diseases as adults can happen as a result.

What can you do then to prevent toxic stress from occurring and limit your toxic load altogether?

Some situations cannot be controlled like a drastic life event or a stressful work situation. What can be controlled, however, are other lifestyle habits such as exercise, sleep patterns, and food choices.

Here are some tips for limiting harmful behaviors that could contribute to allostatic load:
– Establish consistent and sufficient sleep patterns: Most adults need at least 7 hours of good sleep per night. Try going to bed and waking up at the same times every day, put away the electronic devices one hour before bed and do something relaxing like take a shower or read a book before bed
– Eat a low-inflammatory diet rich in fresh fruits vegetables, fiber, and healthy fats and limit your added sugar and processed foods
– Exercise for at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week
– Try to work with your doctor to decrease any other harmful activities such as excessive drinking or smoking
– Do what you can to limit your chemical toxicity like using cleaner products and ensuring you’re consuming clean water and fruits and vegetables
– Support your body’s own detoxification by eating more fiber, eating plenty of the necessary nutrients, eating plenty of protein, and consuming antioxidants

Although you cannot control the stressful situations that appear in your daily like like work or family, you can incorporate stress reducing practices in order to support your response to these stressful situations.

Here are some ideas for reducing stress in your life:
– Talk regularly with a trusted family member, friend, or counselor to work through normal or drastic life situations
– Adopt stress reducing activities such as: journaling at night to write down stress from the day, connect with other people, get outside as much as you can, and/ or stretch before bed to release muscle tension

Sources:
https://www.ncbi.nlm.nih.gov/books/NBK541120/
https://www.sciencedirect.com/science/article/pii/S0306453019301581
https://www.hsph.harvard.edu/nutritionsource/stress-and-health/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928741/
https://pubmed.ncbi.nlm.nih.gov/32799204/
https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/07/toxic-stress-how-the-bodys-response-can-harm-a-childs-development#:~:text=Children%20are%20especially%20vulnerable%20to,and%20sensitive%20period%20of%20development.
https://www.jneurosci.org/content/40/1/12
https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html
https://www.ifm.org/news-insights/toxic-exposures-cumulative-effect/
https://www.cdc.gov/emotional-wellbeing/features/reduce-stress.htm
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770193/

Nutrients for the Brain: Vitamin K

This important vitamin is involved in the metabolism of neurons in the brain, the development and survival of the nervous system, and the synthesis of specific lipids that are a part of cell membranes in brain cells. It also has shown to be anti-inflammatory and to protect against free radical damage in the brain (from oxidation).

Nutrients for the Brain: Antioxidants

In our next installment of our Brain Healthy Nutrient series, we are going to talk about antioxidants and how they are beneficial for brain health.  

Although the brain weighs roughly 3 pounds (roughly 2% of your body weight), it consumes 20% of the body’s oxygen and 20-25% of the body’s circulating glucose (sugar). The oxygen is required to sustain its high energy needs.

Oxygen is absolutely necessary for the brain to function. Oxygen, however, can give rise to free radicals or reactive oxygen series. The brain is highly diverse organ in how it uses energy which means that it is also highly susceptible to oxidative stress. Oxidative stress is an accumulation of these free radicals in the body that can cause adverse effects. These free radicals can disturb the cell membranes in the brain (which are made up of types of fatty acids that are particularly susceptible), cause breaks in DNA, and can modify proteins (which disrupts their function). This is not good at all. The brain also makes minimal antioxidants on its own which increases its susceptibility.

This is where antioxidants come in. “Anti” means against and “oxidant” means oxidation. Therefore, antioxidants combat the free radicals that result from the oxidation of a particular molecule (it can be oxygen or other compounds). They are able to become oxidized themselves which essentially neutralizes the harmful free radical.

The body has its own antioxidant defense system which it activates when oxidative stress and damage is present. The molecules involved (mostly enzymes and other antioxidants) work to repair damaged DNA and remove oxidized proteins and lipids (fats). Antioxidants (from the diet or made in the body) help to protect the body in this way.

Here are several elements and vitamins involved in the body’s antioxidant systems:
– Selenium: Se plays a role in the antioxidant systems, thyroid function, and immune function. It is neuroprotective by inhibiting the destruction of neurons and anti-inflammatory.
– Zinc: Zn increases the activation of these enzymes involved in the antioxidant systems and inhibits the enzymes that cause oxidation.
– Vitamin C: Vitamin C can directly neutralize free radicals and repair other antioxidants.
– Vitamin E: Vitamin E is an antioxidant itself and helps to protect from the oxidation of cell membranes (like discussed above) and also helps inhibit the destruction of neurons.
– Vitamin A: Vitamin A, and specifically carotenoids (that’s what makes carrots orange), also act as direct antioxidants.

Here are some good dietary sources of antioxidants:
– Polyphenols: Found in berries like blueberries, cherries, and strawberries, tea, chocolate, wine, and spinach.
– Selenium: Found in brazil nuts, fish, shellfish, beef, and poultry.
– Zinc: Found in oysters, beef, pumpkin seeds, and poultry.
-Vitamin C: Found mostly in fruits and vegetables such as citrus fruits (lemon, orange, etc.), cantaloupe, grapefruit, broccoli, bell peppers, and tomatoes.
– Vitamin E: Found in almonds, avocados, sunflower seeds, peanuts, etc.
– Carotenoids (think yellow, orange, and red): pumpkin, carrots, sweet potato, tomato, mangoes, bell peppers, etc.

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805706/#R85
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881419/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3900881/
https://pubmed.ncbi.nlm.nih.gov/15134560/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582347/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835915/
https://www.hsph.harvard.edu/nutritionsource/antioxidants/
https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
https://health.clevelandclinic.org/what-do-antioxidants-do/

Nutrients for the Brain: Folate

Welcome to the next installment of our series on brain healthy nutrients! This week we are going to talk about folate.

There are various B vitamins, but we are going to focus on folate (or folic acid which is the form found in fortified foods like cereal) which is vitamin B9. It is a water-soluble vitamin which means that it is difficult to develop folate toxicity from overconsumption. What role does folate play in the body? Folate, along with the other B vitamins, help enzyme reactions happen in your body that help to make DNA as well as red blood cells. It is also needed for your cells to divide properly and is essential for optimal brain function.

Folate is particularly known as an important nutrient for pregnant mamas to prevent neural tube defects in their children. While it is important in the growth and development of the brain and nervous system, it is also important later in life. Studies have shown correlation between sufficient folate and cognitive and academic performance in children.

There is also a lot of evidence linking deficient folate status, other B vitamins, and elevated concentrations of a compound called homocysteine (not normally a good sign) with cognitive decline in older adults.

Unfortunately, the folates naturally found in foods are often bound to proteins and because of their form, are not absorbed as well as the form typically found in supplements (folic acid). Consequently, only 44-80% of the folates found naturally in foods are absorbed into the blood (the rest are excreted); however the folic acid found in supplements are absorbed at nearly 100%. Although naturally occurring folates are not absorbed in the body as well as the form in supplements, it is still important to eat foods with folate.

Sources of folate in the diet:
– Beef liver: This is a nutrient powerhouse! 3 oz offers 54% of your daily requirement
– Vegetables: dark leafy greens (spinach), asparagus, Brussel sprouts
– Fruits: avocados and orange juice
– Beans and peas: black-eyed peas, green peas, kidney beans
– Folate supplements

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805706/#R85
https://ods.od.nih.gov/factsheets/Folate-Consumer/
https://www.mayoclinic.org/drugs-supplements-folate/art-20364625
https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/emerging-roles-for-folate-and-related-bvitamins-in-brain-health-across-the-lifecycle/4D024A2EEEE4126D725B74118DBEC2D3
https://onlinelibrary.wiley.com/doi/10.1111/nbu.12611
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4867132/
https://lpi.oregonstate.edu/mic/vitamins/folate
https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

Nutrition + Gut Health

How important is gut health and can diet really play a large role in my gut health?Your gut, also known as the entire human intestinal tract, is home to over 100 trillion microbial cells. That’s more than the estimated number of cells that the average man has in his entire body! This complex community of microbes can influence physiology, metabolism, immune function, and synthesize certain vitamins and essential amino acids. Consequently, they are also involved in modulating diseases such as type 2 diabetes, inflammatory bowel disease, cardiovascular disease, and cancer. It has been documented that drastic diet changes can induce large, temporary shifts in the gut microbiota in as little time as 24 hours.

What can happen when many factors such as poor nutrition, stress, heavy alcohol use, and heavy metal toxicity damage the intestinal lining? The junctions between the cells of the gut lining are supposed to be tight, but they begin to spread apart and allow microorganisms to pass through into the blood. This is known as leaky gut syndrome. Altered gut microbiota, otherwise known as dysbiosis, is linked with this increased permeability of the intestinal lining. Studies have also linked intestinal dysfunction and gut dysbiosis to traumatic brain injuries such as a concussion. It is not clear the exact correlation, but a correlation is present.

What can you do to improve your gut health?

  • Eat a diverse diet of fresh fruits and vegetables (these are rich in fiber and essential nutrients)
  • Opt for whole carbohydrate sources such as potatoes, whole grains, and root vegetables instead of eliminating carbs completely (rich in fiber and beneficial carbohydrates)
  • Avoid processed foods that contain simple sugars, inflammatory fats, and additives
  • Consume probiotic-rich foods such as yogurt with live cultures, sauerkraut, kombucha, and pickled vegetables
  • Consume probiotics and enzymes in supplement form to fill the gaps in your diet

Nutrition for Concussion Recovery

What can you do nutritionally to support concussion recovery?

 

Believe it or not, nutrition is not a part of traditional medical treatment for concussions. In fact, Mayo Clinic and Cleveland Clinic say that the main treatment is physical and mental rest, and pain management. No further recommendations are given beyond what is recommended as a healthy diet for all individuals. This blows my mind as the physiological events following a concussion involve a cascade of inflammation and a dramatic increase in the usage of certain nutrients in order to heal the subsequent damage.

Within the first 48 hours of the concussion, blood vessels which are stretched or even torn cause decrease blood flow to the brain which initially causes parts of the brain to become “excited”. This can cause brain cells to die and other injured cells begin to release chemicals that cause inflammation and swelling. Ionic abnormalities in the cells also lead to an increased need for energy in the brain, using almost 40% more glucose than normal in the brain. This increase in oxidative stress and inflammation also increases the need for antioxidants in the brain. These events result in a restructuring process called “brain plasticity”. This is why rest is so important- especially during this period of time following the injury.

 
Nutrients and other factors important for concussion recovery:
– Energy: Our body makes energy out of the food that we eat. Sufficient energy is needed in the form of calories to support recovery. Often, the symptoms (nausea, migraines, etc.) can cause a decrease in appetite and decrease in calorie consumption.
– Protein: Since there is damage to the tissue in the body, additional protein is needed to reconstruct and heal the damaged areas. Some studies suggest 25- 88% more protein is needed than normally recommended for adults.
– Gut health: Gut dysfunction is a hallmark issue with brain injuries. Concussions have been found to modify the bacteria in the gut as well as cause functional and structural damage to the gut.
– Omega 3’s: DHA specifically is the main omega 3 fatty acid in the brain. Omega 3’s are anti-inflammatory, help regulate brain plasticity, and are structurally and functionally important in brain cognition and development.
– Vitamin D: Vitamin D deficiency pre-concussion is linked to poorer recovery rates. It is also involved in regulating brain plasticity and offers neuroprotective effects.
– Magnesium: As a part of the initial ionic imbalance in the brain, acute magnesium deficiency occurs. Magnesium is an important mineral which is involved in enzymatic processes in the brain. Magnesium supplementation was shown to improve recovery.
– Zinc: Zinc plays a very important role in the body’s antioxidant systems, as well as offering anti-inflammatory properties.

Hormonal Health

How can I support my hormonal health? This is a very common question, and not just from women but men, too. Let’s go back to the basics of hormones.

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