Chronic Pain and Inflammaging
By George Gillson MD PhD CCFP
Let’s start off by replaying the definition of Inflammaging from the previous post: chronic, low-level, non-sterile inflammation that is widespread (systemic) in the aging individual. Next, recall that the hallmark signs and symptoms of inflammation are pain, redness and swelling! Therefore, and not that I’m happy about it or anything, pain and Inflammaging go hand in hand.
The causes of severe pain are usually obvious: infections, trauma, autoimmune diseases, degenerative changes in the spine and joints. I’m not going to be talking about that kind of pain. I’m talking about lower-level, nagging pain and stiffness that you’re reminded about when you get out of bed or get up after prolonged sitting/driving.
There are many opportunities to address this lower-level type of pain besides over-the-counter NSAIDs and acetaminophen. Besides, over the long haul these medications aren’t doing your kidneys and liver any favors. So I’m just going to start running down the list, if it’s OK with you. It goes without saying that potentially serious underlying problems need to be properly ruled out before looking at pain in the light of Inflammaging.
Food-based Immune Complex Formation/Food Antibody Testing
This is a topic that mainstream medicine loves to hate. National media have done various hatchet pieces on it over the years, for various reasons. It involves eliminating certain foods from the diet based on the results of blood testing to measure levels of IgG antibodies toward a wide range of foods. We can develop elevated antibody levels directed to component molecules of foods (food antigens) due to incomplete digestion. In turn, this can be caused by too little acidity in the stomach and inadequate secretion of digestive enzymes, especially if we also have loose junctions between the cells lining the digestive tract (aka leaky gut). The food-directed antibodies can then form complexes with the food antigens and best case, these complexes are then disposed of in the liver with no adverse effects.
When the liver’s disposal capacity is exceeded due to ingestion of excessive amounts of one offending food or ingestion of smaller amounts of multiple offending foods, the complexes can collect in the capillary beds of many different tissues, attracting the attention of scavenger white cells (neutrophils) and causing inflammation. This may lead to complaints including musculoskeletal pain, headaches, rashes, foggy thinking. This type of reaction is not immediate or severe, as is the case for allergies to things like bees, peanuts, strawberries and spouses, where a person experiences airway swelling, hives and worst case, shock (anaphylaxis)upon exposure.
The EvolveWell Clinic staff have long experience with IgG Food Antibody testing and implementation of any needed dietary changes, supplementation and gut repair strategies. If chronic low-grade pain is an issue for you, IgG Food Antibody testing could help you to eliminate a possible cause. An extensive document describing the science behind this testing is available on request. See References.
Easy On The Sugar
The practice of administering sweets to infants for pain relief dates back to antiquity (Harrison 2008) and even today, honey dissolved in warm water is gargled to sooth sore throats, according to the Cleveland Clinic and may exert anti-inflammatory and anti-bacterial effects. That’s all well and good but if you are troubled by low-grade chronic pain and stiffness, try getting all the refined sugar out of your diet for a month. These links might help: Secret Sugars: 56 Different Names for Sugar and 192 Sugar Sources and Alternate Names. These days you need a PhD in Biochemistry to read the labels.
Above all, avoid high fructose corn syrup (HFCS) like the Plague. There are sites out there that will give you the most common euphemisms for this additive. Increased consumption of HFCS is directly linked to the increase in metabolic syndrome and insulin resistance (pre-diabetes if you will) that we have seen over the last few decades. This disruption of the insulin-glucose balance leads directly to low-grade inflammation/pain.
Sleep is a big factor in pain and pain perception. Our immune system is supposed to go into anti-inflammatory mode during sleep. But many of us intentionally don’t get enough sleep or the quality of our sleep is poor due to eating before bed, too much light exposure before bed, a noisy sleeping partner, sleep apnea, and hormone deficiencies. Addressing these sleep issues in tandem with your Integrative Medicine practitioner might be one way to reduce the amount of pain and stiffness you might be feeling.
I’m specifically calling out hormones again after mentioning them in the previous paragraph. Low estradiol levels in females can have a huge adverse impact on sleep through amelioration of hot flashes and night sweats. Institution of estradiol replacement therapy after a proper Integrative Medicine workup can be life-changing. Many women and men also feel much less “creaky” when low testosterone and low DHEA levels are addressed. This is because these hormones modulate over-activity of the immune system and can exert an anti-inflammatory effect. Low cortisol can also lead to chronic pain and stiffness as cortisol is anti-inflammatory. And since progesterone is the precursor of cortisol, supplementation with progesterone may also be beneficial. All these hormone levels are easily measured via a 24-hour urine test-another test with which the EvolveWell staff has much experience.
Just Keep Swimming, Just Keep Swimming…
A good deal of low grade chronic pain and stiffness (in the absence of significant inflammatory pathology) arises from an increasingly sedentary lifestyle that often accompanies aging. This doesn’t necessarily have anything to do with immunosenescence but everything to do with habit formation-or the lack thereof. It’s often helpful to enroll in a fitness class if you’ve been out of the habit of exercising. Or commit to exercising with a friend so that you can hold each other accountable. You could also buy a dog. People who own dogs live longer and the dog will hold you accountable by bugging the crap out of you whenever it’s walk time.
We now know that maintenance of muscle mass is critical. Healthy muscles send beneficial signals out to everywhere in your body, per the following diagram. There will be a test.
I was kidding about the test; however, in addition to the dog-walking you need to get intentional about your muscle mass. You need three things to maintain/build muscle: resistance training, adequate protein intake (we need more protein as we age due to decreased absorption efficiency) and proper hormone balance: this includes steroid hormones and thyroid hormone. It might also be a good idea to consider yoga or a basic stretching class. And above all, just remember not to overdo the exercise as it takes longer to recover when your age starts with a number greater than or equal to 5. Or maybe it’s 4. I forget which. (Kidding.)
This is essential . Hang out with people who make you laugh. Make them laugh. Hang out with toddlers if you can. Gently tease them a little bit and make them giggle. Do things that bring you joy. Do things for others. Make a list of things to be thankful for and read it every day. Go to Church if that’s your thing, or at least pay attention to your spiritual life. Depression can make everything worse but the things I’ve mentioned are pretty darned good antidepressants with no side effects.
To put the icing on the Lifestyle Cake that I’ve just prepared, I need to mention supplements. As we get older, we don’t always absorb things from our diet the way we did in youth, not to belabor the point. Our appetites and food choices can also change. In respect of this, here are some supplements that I consider to be “must have.” But don’t just take my word for it. You should consult with your Integrative/Functional Medicine practitioner for appropriate dosing and compatibility with any prescription medications you might be taking.
- Zinc, selenium and copper
- Magnesium (and possibly potassium and sodium)
- Vitamin D3
- OmegaGenics EPA-DHA 1000
- n-Acetylcysteine and Glutathione (promote free radical scavenging)
- Purica Methylsulfonylmethane (MSM) powder: 2-4 grams daily in water. Build up to this dose gradually over 3-4 weeks
- Digestive enzymes
- Collagen/Protein powder
- With all the working out you’re going to be doing, you also need to pay attention to your water intake and your intake of sodium and potassium!
We Integrative Medicine/Functional Medicine practitioners like to pounce on these new terms and concepts about our physiology, such as Inflammaging. And our knowledge of physiology is growing by leaps and bounds. The nice thing about this is that the more we delve into things, the more we realize that our grandparents and their grandparents would be greatly amused if we told them that we now know why it’s good for us to get more sleep, eat real food, watch our sugar consumption, use our muscles, play and enjoy our friends and loved ones. The more things change, the more they stay the same.
P.S. The topic for next month is Seasonal Allergies and I will tell you everything I know about MSM: whether you want to know or not.