Microbiome: Linking Nutrition and Pain

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"We are what we eat," stated Dr Tick, "more specifically, we are what we ingest, digest, and absorb."
"We are what we eat," stated Dr Tick, "more specifically, we are what we ingest, digest, and absorb."
The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of Clinical Pain Advisor's conference coverage.

LAS VEGAS — During a presentation she gave at PAINWeek 2017, held September 5-9, 2017, Heather Tick, MD, clinical associate professor of pain medicine at the University of Washington, presented evidence linking nutrition, microbial diversity, and pain.1

The human microbiome, which contains an estimated number of cells 10 times that in the human body, is increasingly thought to play an essential role in inflammation and the immune function. In addition, 70% to 80% of the microbiome is located in the gut. "We are what we eat," stated Dr Tick. "More specifically, we are what we ingest, digest, and absorb."

A European prospective investigation into cancer and nutrition for which 23,000 individuals who were nonsmokers, exercised regularly, had a healthy diet, and had a body mass index <30 kg/m2, were followed for 7.8 years.2 Results from this study showed a great reduction in the risk for major diseases in this population, with a reduction of 93% for diabetes, 81% for heart diseases, 50% for strokes, 36% for cancers.

"Where did we go wrong in North America?" asked Dr Tick. A "food pyramid" issued by the US Department of Agriculture in 1992, and updated in 1996, includes at its base grains, all of which are refined vs whole.3 A later recommendation issued in 2011 by the US Department of Agriculture in the form of a "food plate" advocates for consumption of more vegetables and recommends that at least half of grains ingested should be whole; dairy is also an obligatory part of this recommendation, a point Dr Tick disagrees with.4

A 2010 study in which the microbiomes of children from Europe and from rural Burkina Faso were examined revealed the effect of diet on the microbiota.5 The analysis indicated significant differences in the composition of gut microbiota in these 2 populations: Burkinabé children who consume a vegetarian diet high in fiber had an enrichment in gram-negative bacteroidetes and bacterial genes for cellulose and xylan hydrolysis, which were not detected in European children. Conversely, gram-positive firmicutes was reduced in Burkinabé children and high in European children; African children also had a higher microbial richness and increased species diversity compared with their European counterparts. The study researchers concluded: "Healthy bacterial populations living in the gut may not just exclude disease-causing bugs; by pumping out beneficial compounds, they may actively help to suppress disease." Dr Tick added: "Our microbiome truly is our meta-genome, protecting us."

She pointed to the poor diet consumed by Americans, which includes an average of 150 pounds of sugar per year, amounting to 0.5 pound a day. "Individuals with disease are more likely to have alterations in gut microbial communities," she added. A number of chemicals, including sugar, processed foods, aspartame, antibiotics, and nonsteroidal anti-inflammatory drugs (NSAIDs), are known to damage the human microbiome. For example, 71% of asymptomatic NSAIDs users were found to have small bowel injury.6

"Whenever we eat a meal, we either increase or decrease our inflammation," she continued, and increased inflammation leads to increased pain.

Dr Tick is a strong advocate for the use of turmeric (Curcuma longa) in patients with pain. This root has shown benefits on every type of pain it has been studied for, including knee osteoarthritis pain and postoperative pain.7,8 She recommends administering it in the form of golden milk.

In conclusion, Dr Tick advocated for a diet high in vegetables (half of the plate), with an emphasis on whole unprocessed grains and containing beans, lentils, nuts, and seeds, as well as caffeine in moderation. In addition, according to her, sodas should be banned, and animal protein, sugar, salts, and wrong fats should be reduced.

Read more of Clinical Pain Advisor's coverage of PAINWeek 2017 by visiting the conference page.

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References

  1. Tick H. Microbiome: The link between nutrition and pain. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, NV.
  2. Ford ES, Bergmann MM, Kröger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Arch Intern Med. 2009;169(15):1355-1362.
  3. US Department of Agriculture. My Pyramid. Available at: https://www.cnpp.usda.gov/mypyramid. Accessed September 5, 2017.
  4. US Department of Agriculture. ChooseMyPlate.gov. Available at: https://www.cnpp.usda.gov/mypyramid. Accessed September 5, 2017.
  5. De filippo C, Cavalieri D, Di paola M, et al. Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci USA. 2010;107(33):14691-14696.
  6. Graham DY, Opekun AR, Willingham FF, et al. Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol. 2005;3(1):55-59.
  7. Kuptniratsaikul V, Dajpratham P, Taechaarpornkul W, et al. Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study. Clin Interv Aging. 2014;9:451-458.
  8. Agarwal KA, Tripathi CD, Agarwal BB, Saluja S. Efficacy of turmeric (curcumin) in pain and postoperative fatigue after laparoscopic cholecystectomy: a double-blind, randomized placebo-controlled study. Surg Endosc. 2011;25(12):3805-3810
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