Welcome back to the Healing Pain Podcast with Dr. Joe Tatta, DPT
Is our American diet affecting us? We know that it’s affecting our weight, our metabolic syndrome. We know that it’s leading to diseases such as diabetes and prediabetes. However, it’s also effecting neuropathic pain. Neuropathic pain is pain caused by damage or disease affecting the somatosensory nervous system, a part of the sensory nervous system. No wonder out diet is called SAD or the standard American diet. Almost everything about the western diet or the standard American diet leaves you feeling not well. It’s linked to chronic pain type syndromes, brain fog, anxiety, depression, and many other things. Learn how to retrain your brain and body so you can live the joy-filled and pain-free life you deserve. Dr. Tatta talks about neuropathic pain and share some tips and strategies that you can use to either treat your neuropathic pain or, if you’re a practitioner, what you can do as far as neuropathic pain when it comes to nutrition.
How To Treat Neuropathy And Neuropathic Pain Using Nutrition
It is a pleasure and honor to be here with you where we talk about the latest in pain care and pain science. I just came back from an exciting weekend in Providence, Rhode Island where I was teaching a nutrition course to the physical therapists and physical therapist’s assistant students, our future DPTs or Doctor of Physical Therapy who are coming out of school. That happened at the National Student Conclave. It’s one of the three national conferences that the American Physical Therapy Association puts on every year. I want to say thank you to the APTA and the National Student Conclave for inviting me up to the beautiful city of Providence, Rhode Island. It was such a great time. I spoke to probably about 300 DPT students. They are super excited to get out into the world and help people with pain. They’re also excited to integrate nutrition into their practice, which makes me excited because it’s one of the things that I love about helping people with pain.
I seem to have a lot of questions from our community about neuropathic pain and neuropathy. I figured that I would do a live training or a training for my community where we talk to you about neuropathic pain and share some tips, some strategies that you can use to either treat your neuropathic pain or if you’re a practitioner, what you can do as far as neuropathic pain and the clinical when it comes to nutrition. No matter who you are, if you’d like to access the content of what I’m going to share with you, I’m going to give you free access to it. To access this, all you have to do to download the slides of this presentation is to go to www.DrJoeTatta.com/108Download. If you are on your cell phone, pick it up and text the word 108Download to the number 44222. When you do that, I will send the slide presentation with the slide deck right to your inbox, so you can have it. Whether you’re someone who is struggling with pain or you’re a practitioner, this is a great information to have to help yourself out.
We’re going to be talking about neuropathic pain or neuropathy. I want to start talking about metabolic syndrome. Metabolic syndrome is a clinical diagnosis that your practitioner will diagnose, and you need three out of the five following criteria to be diagnosed with metabolic syndrome. Those criteria are elevated waist circumference, elevated blood pressure or being on hypertension medications, elevated fasting glucose or being on medications for hypoglycemia, elevated triglycerides or reduced HDL, which many of you know as the good cholesterol. You need three out of the five of those. You don’t necessarily have to go for blood tests, two of these you can do easily on your own. One is looking at your waist circumference and two is looking at blood pressure. If you’re a licensed healthcare practitioner, you can do two of these in the clinic. You can measure someone’s waist circumference with a tape measure, and you can measure someone’s blood pressure with a blood pressure cuff. If you don’t have access to testing someone, looking at blood values, you simply ask the patient or if you are the patient, look at your latest annual physical. On your physical, hopefully, you should see triglycerides, HDL and your fasting glucose. If you have three out of five that are out of the normal limits, then you know you have a diagnosis of metabolic syndrome.
The reason why that’s important is that of the diagnosis of metabolic syndrome. Metabolic syndrome is an inflammatory condition. It’s an inflammatory disease. We know that that chronic low grade or sometimes moderate grade inflammation can lead to many types of chronic pain syndromes. Metabolic syndrome is also closely associated with obesity. In the map of the United States of America, there are states where the population of that state has a BMI or a body mass index over the limit of 30. That points to being overweight. It’s not just those states, obesity is a problem throughout every single state in the United States of America, especially when you start to boil it down to certain zip codes or certain parts of those states. Last but not the least, we know that obesity is associated with chronic pain. This is a 2012 study from the Journal of Obesity that looked at people’s BMI, people’s body mass index. It clearly shows no matter what age you are and whether you’re male or female, as you go from being a normal weight to being overweight, tend to be in the obese category one, the obese category two, the obese category three, that chronic pain is more likely to develop.
Numbers Tell A Story
The take home message is as you start to put weight on, as you start to have those metabolic indicators of having metabolic syndrome, you’re more likely to have a chronic pain type syndrome. In the map of the United States of America that looks at the prevalence of diabetes, those same states where obesity is high the rates of diabetes are high there as well. This is all public information you can find on the CDC at CDC.gov or you can find it on the NIH, which is the National Institutes of Health at NIH.gov. I love looking at stats. Sometimes numbers tell a story. In this case, it’s not a very happy story but about 30 million Americans have diabetes. That’s about 10% of the population. Out of those 30 million Americans, seven million of them have been undiagnosed. Meaning they’re walking around with diabetes and they’re not receiving the care that they need. What’s more important to look at and what’s more important to take into consideration as we continue on this podcast and we talk about neuropathic pain is that many more people have prediabetes.
84 million Americans are prediabetic. They have high blood sugar or they have insulin resistance. They are on their way to having diabetes. Even more important is that when we look at people over the age of 65, almost half of all Americans, 48% of those over the age of 65 are prediabetic. Why is this important? Why am I talking about prediabetes and diabetes so much? This is the 2008 study in the Journal of Rheumatology that looked at the ability to regulate blood glucose or the ability of a patient to regulate the blood glucose and chronic widespread pain in their body, meaning pain that happens in multiple joints or multiple areas of the body. This study pointed to a significant association between having diabetes and having that chronic widespread pain that oftentimes you find in conditions like osteoarthritis or you find in conditions like fibromyalgia. We know that when blood sugar is dysregulated, you’re more likely to have chronic, widespread pain in multiple parts of your body.
This is a 2018 study in the Clinical Journal of Translational Neurology. This is not the first study but they found that similar to previous studies, when you have diabetes and when you’re obese, that these are the metabolic drivers of peripheral neuropathy. Having diabetes and having metabolic syndrome are the drivers of peripheral neuropathy. It points to practitioners that we need to pay attention to these metabolic factors and we need to treat these metabolic factors when we help people treat peripheral neuropathy. This is a 2014 study from the Handbook of Clinical Neurology where they look at the epidemiology of polyneuropathy and those who have prediabetes and diabetes. It shows about 25% of those who have painful neuropathy have diabetes. Somewhere between 25% and 62% of patients with idiopathic peripheral neuropathy have diabetes.
Idiopathic neuropathy means that we can’t find a cause for it. We don’t know what the cause for it. Up to 62% of those with idiopathic peripheral neuropathy have prediabetes. About 25% of those have neuropathic pain. Finally, as we look at people who have normal blood glucose or normal glycemia, as they transition to having problematic fasting glucose or impaired fasting glucose, having impaired glucose tolerance and finally up to prediabetes and diabetes is that the frequency is higher. There are certain tests that you can have your practitioner run to look at whether you have prediabetes or whether you have diabetes itself. Those three tests are hemoglobin A1c or A1c, fasting plasma glucose and oral glucose tolerance test.
If any of those are in the prediabetes range then you want to say to your practitioner, “I need some help to regulate my glucose, how can I do that?” or you want to look at your own tests. If you have these in your file at home and say, “I did not know that I fall in the prediabetic or perhaps the diabetic range for A1c, fasting plasma glucose or glucose tolerance.” A1c is especially important because that’s a measurement of long-term inflammation. It’s also a measurement of long-term glucose tolerance. From the 2015 Journal of the American College of Nutrition, we know that chronic disease is driven by inflammation. We know that anti-inflammatory nutrition is important for stabilizing someone’s nutrition. When you’re using anti-inflammatory nutrition, not only do you stabilize your insulin, but you also silence the genes that drive inflammation. There’s no important way to overcome inflammation or to manage chronic inflammation than an anti-inflammatory diet.
The Standard American Diet
The greatest challenge with this is that the average American starts the day off probably with a nice cup of coffee that has about five to ten added teaspoons of sugar. In addition to that, they have either a donut with that or perhaps a bagel, a croissant, a scone or some other type of pastry that is all carbohydrate. It’s all processed carbohydrates that cause your blood sugar and your insulin to spike. Then we move on to lunch where we have these sugar-laden soft drinks or sugar-laden drinks that have added sugar to it. Oftentimes we have a high glycemic or high carbohydrate lunch. Then we move on to dinner where there may be some protein but oftentimes, more than half of that plate is starchy carbohydrates. I often wonder, “Is our American diet affecting us?” We know that it’s affecting our weight. We know that it’s affecting metabolic syndrome. We know that it’s affecting things like diabetes and prediabetes, and it’s also effecting neuropathic pain.
That’s why people call it the SAD or the standard American diet because it leaves you not feeling well physically so it leaves you feeling pain. It’s linked to chronic pain type syndromes. It gives you brain fog. It affects things like anxiety and depression. Almost everything about the Western diet or the standard American diet leaves you feeling not well. When we look at sugar intake, the American Heart Association recommends less than six teaspoons of sugar for an adult female and less than nine teaspoons of sugar for an adult male. However, right now the average American is getting probably more than twenty teaspoons of sugar through their diet every day. It’s coming in the form of processed foods, sugars, cookies, candies, cakes, bread, sugar-laden sodas, soft drinks, coffee, things of that nature. This is the plate from the US government the way they recommend that you eat. You can read this by going to ChooseMyPlate.gov. It does a pretty good job. In my opinion, if you’re struggling with high blood sugar, if you’re insulin resistant, if you’re prediabetic or you’re diabetic and you’ve not been able to regulate your blood glucose, this may be a start. However, I’ll tell you some of the challenges of my plate. First is that the quantity of fruit on this plate that you’re having three times a day is too large. Fruit contains a lot of sugar. That’s why people like it. It tastes sweet. They recommend you have dairy with each serving so that can be a glass of milk, let’s say every time you sit down and eat.
Strategies For Regulating Blood Sugar
Dairy is known to be inflammatory. It’s also known to irritate people with chronic pain type syndromes and dairy also has sugar in it. It’s called lactose. Lactose is a sugar. Last but not the least, perhaps the most important part of this plate is when you look at their recommendation to grains. They say that half your grains should be whole grains. If you’re having a challenge regulating your blood glucose, regulating your blood sugar, I recommend that all of your grains should be whole grains, staying away from the cereals, the bread, the pasta that is processed. My top seven strategies for regulating blood sugar or your blood glucose is to make sure all of your grains are whole grains. Choose beverages that have no added sugars such as water, tea or coffee. Stay away from all of the types of beverages that have sugar added to them. Limit or decrease your portion of grain on your plate. When you look at your plate, 25% of that plate or less should be a grain even if it’s whole grain. Limit or eliminate dairy. Stay well away from the snacks, cookies, cakes, candies, crackers, bread, pasta and sugar added foods.
People enjoy or they like fruit in a can. That fruit in a can oftentimes has added sugar to it. Oftentimes it comes out with that syrup to it. That syrup has a lot of sugar. Then last but not least, eliminate artificial sweeteners or what are known as high-intensity sweeteners. These are the sweeteners that you find in those packets when you go to restaurants that are yellow, blue, red or white. These high-intensity sweeteners may have no calories to them but what they do is they send a signal right to your brain that tells your brain, “This tastes good.” Once you have them, it’s hard to put them down. It’s hard to stay away from other sweetened types of beverages and high starchy foods.
The Seven Healthy Carbs
There are seven healthy carbs I recommend that you can eat every day. Those are brown rice, black rice, quinoa, sweet potato, beans, dark berries like blueberries, raspberries or blackberries, and then winter squash. These are all carbs that are good for you. They also come with a lot of fiber. When you eat them, they slowly get processed in the digestive tract. They don’t spike your blood sugar and they don’t spike your insulin. If you’re saying, “Dr. Joe, that’s great. Brown rice, black rice and quinoa don’t have a lot of flavor to them. It can be a little bland.” What I recommend is when you make those dishes, you sauté them with a couple of teaspoons of olive oil. That olive oil adds flavor. You can also sauté it with some onion, some garlic. Make sure you throw in a lot of things like oregano, marjoram or turmeric. Those things make the brown rice or the quinoa taste good. They also have lots of anti-inflammatory phytonutrients.
The Mediterranean Plate
If you want to know a plate, if you don’t like the USDA plate, I don’t recommend the US plate to my patients. I recommend this plate, the Mediterranean type of plate where half of your plate is non-starchy vegetables. You add some olive oil to that for its anti-inflammatory impact. About 25% of your plate is a healthy piece of protein like fish or poultry. Then a small portion of your plate, 25% or less are whole grains, and you’re drinking things like water, coffee and tea or herbal teas with no sugar added, limiting your dairy. If you’ve already tried all that, then I recommend you try a gluten-free diet. This is an article from the American Academy of Neurology published in February 2018. That recommends a strict gluten-free diet can help protect against nerve pain in those that have gluten sensitivity.
Off the press on October of 2018 from the Journal of Neurology where they looked at those who have gluten neuropathies, those that have a sensitivity to gluten, what they recommend is that neuropathic pain is very prevalent in those with gluten sensitivity. It’s also associated with poor health. A strict gluten-free diet may be protective in helping those with peripheral neuropathic pain and those that have gluten sensitivity. They’re recommending a gluten-free diet if you have neuropathic pain. If you want to look at some of the lab values, I would look at the indicators for metabolic syndrome that is elevated waist circumference, elevated triglycerides, reduced HDL, elevated blood pressure and elevated fasting glucose. Look at the three indicators for diabetes or prediabetes, that’s A1c or hemoglobin A1c, fasting plasma glucose, and your oral glucose tolerance test. If you haven’t had these done in a while, ask your practitioner to run them and look at all the values. Know that changing how you eat can reduce your pain. It’s one of the best evidence-based ways to help you reduce pain. Know that nutrition isn’t the only solution for pain but it may be the one most important solution if you have chronic neuropathic pain and you haven’t been able to find a solution for it.
You can have this slide presentation. It’s available to you for free. All you have to do is go to www.DrJoeTatta.com/108Download, or you can text the word 108Download to the number 44222. If you want a little bit of sweetness in your life, which we all love, what I use and what I recommend to every single one of my patients is 100% organic stevia liquid. You can find this in most grocery stores. I found this one in Whole Foods. It’s a liquid and it comes in a little dropper. I use this every morning. I put one or two little drops into my green tea. On some days where I need more of a pick-me-up, I put one or two drops into a single shot of espresso, this will not spike your insulin. It will not spike your glucose. You can also use this in baking recipes. It’s 100% organic stevia liquid. I love it. It’s super sweet. You only need one or two little drops. It does not taste like white table sugar. Something that takes you a little bit of time to get used to it, but once you get used to it, it’s a good substitute to add to all your recipes and to things like your coffee.
I’m so happy that you could be here with me. Make sure to download the presentation and make sure to share this out with your friends and family on Facebook, Twitter, LinkedIn, whatever your favorite social media handle is. Make sure if you’re new to the podcast to sign up for the mailing list. The way you do that is by going to www.DrJoeTatta.com/podcast. On the right-hand side of the page, you’ll see a little box where you can enter your name and email address. Each week I will send you the latest podcasts to your inbox for free. What can be better than that? It’s been great being with all of you here. Thank you to the APTA and National Student Conclave. We talked about nutrition. I hope this helps you out if you have neuropathic pain or neuropathy, give it a try. Reach out to me on my Facebook page. Let me know how you’re feeling. I’ll see you in our next episode. Thank you so much.
- National Student Conclave
- American Physical Therapy Association
- Dr. Joe Tatta on Facebook
About Dr. Joe Tatta, DPT
Dr. Joe Tatta, DPT teaches you how to retrain your brain and body so you can live the joy-filled and pain-free life you deserve. He is a doctor of physical therapy, functional nutritionist, integrative pain expert and #1 bestselling author of Heal Your Pain Now. He is known for integrating neuroscience, nutrition, psychology and movement into simple treatments for lasting pain relief. Dr. Joe’s mission is to quickly and compassionately heal your pain and reverse the global pain epidemic. You can participate in the conversation weekly on Dr. Joe’s Healing Pain Podcast, or experience the benefits of working with him by joining the Heal Your Pain, Heal Your Life integrated pain-relief program online.
The Healing Pain Podcast features expert interviews and serves as:
A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.
If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at firstname.lastname@example.org. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.