The Link Between Nutrition and Pain Is too Strong to Ignore in Your PT Practice
By Joe Tatta, PT, DPT
Here's a situation I bet you see all too often in your practice: a patient or client comes to you to overcome pain and increase mobility, and you see almost immediately that working on the mechanics of motion won't be enough—they could really benefit from some lifestyle changes as well. Frequently, one of those changes involves thinking more carefully about the food they're putting into their bodies.
Despite Hippocrates' oft-quoted "Let food be thy medicine," most physicians receive only a few hours of instruction about nutrition and coaching to help patients change their eating habits. Yet studies like this one from the National Institutes of Health show nutritional education becomes an incredibly useful tool to improve overall health outcomes for patients and specifically reduce inflammation.
As PTs, we are presented with a real opportunity here. Research shows that PTs can play an active role in lifestyle-related interventions such as nutrition. Providing information on nutrition will put you ahead of the curve with your peers while improving your patients' results.
Early in my practice, I saw how obesity often contributed to my patients' pain. Once I began providing information on some simple diet and lifestyle strategies with my patients, many lost weight, felt better, and dramatically reduced their pain. Nutrition became the missing link to help my patients manage and relieve pain.
Over time, I've found that nutritional screening and informational strategies can make a difference in 5 conditions associated with pain that we often see in our practices:
- Inflammation. Copious inflammatory foods, including vegetable oils, populate the Western diet. Most observational and interventional studies show a traditional Mediterranean diet, rich in healthy fatty acids, fruits, vegetables and fiber, provides anti-inflammatory benefits. Among specific conditions, studies show a Mediterranean diet rich in polyunsaturated fatty acids and antioxidants provide anti-inflammatory effects that benefit individuals with rheumatoid arthritis. Epidemiologic and clinical evidence likewise shows an optimal diet can reduce inflammation that, among other things, contributes to metabolic syndrome.
- Obesity. As we all know, a vicious cycle ensues as obesity contributes to numerous chronic pain conditions, and the pain in turn can lead to sedentary behavior that increases obesity. Studies prove what I've seen countless times in my own practice: weight loss must become a crucial aspect of overall pain rehabilitation.
- Osteoarthritis (OA). Studies have shown a relationship between pain and food intake among overweight and obese patients with OA. Fortunately, obesity is the most modifiable risk factor for knee OA. Of course, pain management is crucial to reducing OA symptoms. But even that may have a nutrition connection: one systematic review found scientific evidence to support some specific nutritional interventions–including omega 3 fatty acids–to relieve symptoms among patients with OA. Studies also show various nutrient deficiencies, including vitamins C and D as well as selenium, contribute to OA.
- Autoimmune disease. NIH estimates that 23.5 million Americans have an autoimmune disease (compare that with cancer, which affects 13 million Americans). Over 80 autoimmune disorders exist, including Crohn's disease, rheumatoid arthritis, multiple sclerosis, and type 1 diabetes. Of course, genetic predisposition, environmental factors (including infections), and gut dysbiosis play major roles in autoimmune disease development. But increasingly, researchers believe adverse dietary changes over the past 50 years–including gluten intolerances, altered gut bacteria, and vitamin D deficiencies–also contribute to that increased rate of autoimmune diseases. Chief among those changes is our prevalent high-sugar, high-salt, processed-food heavy diet that paves the pathway for autoimmune diseases. Nutrient-poor diets only exacerbate that problem: evidence shows vitamin D, vitamin A, selenium, zinc, omega-3 fatty acids, probiotics, and flavanol deficiencies contribute to autoimmune diseases.
- Prediabetes and type 2 diabetes. Type 2 diabetes affects 29.1 million Americans (that's over 9% of the population) and paves the way for serious complications such as heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetic neuropathic pain, a common diabetes complication and the most common form of neuropathic pain, affects over 90% of people with diabetes. Studies show increased musculoskeletal pain in patients with type 2 diabetes adversely impacts body mass index, quality of life, physical function, and physical activity abilities. The link between diabetes and nutrition is a fundamental one that should never be set aside.
Working with patients suffering these and other conditions, I'm often impressed how optimal nutrition becomes the needle-mover to alleviate pain and help people heal. So how can a PT incorporate these considerations into practice? Here are a few simple tactics you can use right now:
- Ask nutrition-related questions during your initial consultation. Simple things like "do you take a multivitamin" or "about how many vegetable servings do you eat a week" can help lead to gradual dietary tweaks that yield impressive results.
- Have your patients keep a 24-hour food diary. Beyond establishing adherence and accountability, asking patients to write down everything they eat for 24 hours provides insight to their daily eating habits. Once you have that insight, you can help them gradually improve those habits.
- Offer some simple information. Rather than impose a major dietary overhaul, ask patients to do things that don't seem so overwhelming; for example, to increase their water intake, or eliminate processed foods and sugar.
- Create simple, attainable goals. Begin by allowing your patients to experience success in some way. You might ask a patient to lose 5 pounds over 3 weeks, or provide information about incorporating more omega-3 fats into their diet combined with their exercise program. These goals are doable, and they can provide your patient with the confidence to take on more challenging targets.
- Offer your patients other ways to access information on better nutrition. Providing your patients with collateral sources of information—a helpful blog post, or an engaging book on nutrition—helps to reinforce the idea that the benefits of what they're doing are well-established, and that they're not alone in their journey toward healthier living. During a subsequent visit, ask patients if they got anything out of what you shared. The more reliable, readable information they receive, the better the chances that they'll begin to become genuinely interested in the topic themselves, and for the long run. Over time, I've even had a few patients recommend books and blogs to me. Refer patients to nutrition and dietary professionals when their needs exceed the professional scope and your personal scope of practice.
If you've incorporated nutritional screening and information into your practice, what did you find was the most challenging aspect? Did you see results when patients made those changes? Share your thoughts below.
Joe Tatta, PT, DPT, is a board-certified nutrition specialist and functional medicine practitioner who specializes in treating lifestyle-related musculoskeletal, metabolic, and autoimmune health issues. He is the creator of the Healing Pain Online Summit and The Healing Pain Podcast, and is the author of Heal Your Pain Now: A revolutionary program to reset your brain and body for a pain-free life by Da Capo Press. Learn more by visiting www.drjoetatta.com/apta.
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