Gluten & Pain

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Several Sources of Gluten: Top: High-gluten wheat flour. Right: European spelt. Bottom: Barley. Left: Rolled rye flakes.

Gluten and ailments related to gluten such as celiac disease and gluten sensitivity have received a lot of press over recent years. It seems that more and more people are experiencing some sort of adverse reaction to gluten. Symptoms vary from mild to severe and may include various digestive issues, breathing issues, skin irritation, joint pain, and lethargy.

Recently I’ve been experimenting with getting the gluten out of my diet.  I believe cutting gluten gluten has played a strong role in reducing in my various aches and pains, particularly my Achilles and heel pain. Are You Too Sensitive? is a recent article in Outside Magazine that provides some anecdotal evidence to support my observations.

As I mentioned at the start, gluten seems to cause some degree of distress and inflammation in a good number of people. This may not rise to the level of severe illness but it may be perceived as a threat by the nervous system. So now we’ve got dietary stress. Let’s add that to any number of the other stresses we have including job stress, money stress, or even the normally good stress of exercise. Maybe we’re not sleeping all that well–oh and our seasonal allergies are getting to us.  At some point all this stress builds and the nervous system senses a building threat. We’ve got a threshold below which we don’t feel pain. Once our stress hits that threshold, things change. The nervous system which is always looking out for our best interest (survival) wants us to reduce this threat level. The result may be pain–an action signal–that will alert you to reduce your stress. And what better way to get our attention than via a nice efficient pathway such as our old back pain, knee pain or foot pain?

And gluten is everywhere! Bread, pasta, anything with malt or barley like beer, pancakes, pastries…  Gluten is often found in sauces, ketchup, marinades, soy sauce and ice cream.  It’s often found in processed meat.  (Have a look here for a big long list of gluten-containing products.) So we’re swimming in gluten.  While this stuff may not be so bad in small amounts, if we’re constantly consuming it then it may build to a toxic level. This chronically elevated gluten may well then contribute to chronic pain.

In addition to reducing my heel and Achilles pain, I believe getting the gluten out has helped me recover after tough workouts and bike rides.  I noticed this maybe a week or so after eliminating gluten.  Typically it was easy for me to either lift, ride or run to the point that I’d be sore to some degree for a couple of days.  The result was my next workout would be inhibited. Now I can say with certainty that I’m simply not as sore as I used to be.  This observation is echoed in the Outside Magazine article:

“That’s old news to Robby Ketchell, the director of sports science for the Garmin-Cervélo pro cycling team. Since 2008, riders have experienced improved post-ride recoveries, which Ketchell attributes to the team’s gluten-free diet. ‘When our guys ride, they’re tearing muscle fibers, and that creates inflammation in their bodies,’ says Ketchell. ‘We need to get rid of that inflammation so they can ride strong the next day. The last thing we want is something that causes more inflammation.'”

So if you’re struggling with chronic pain and you’ve tried many methods to address it, addressing your nutrition–and particularly your consumption of gluten–may be a way to move forward.

 

 

 

 

 

 

Threat neuromatrix

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But hold on.  How can something we eat contribute to something like Achilles tendon pain or plantar fasciitis? Well, pain does not always equal an injury.  It is an action signal though, to change something. Sure, if you sprain your ankle or receive a cut or puncture wound, then the pain is fairly indicative of the injury. The pain may cause you to hobble to help preserve the damaged ankle or to treat the wound you’ve received.

In the case of chronic pain however, the root of the problem is rarely the site of the pain. Pain in a particular region may be there for any number of widely varied reasons. Pain may be present as part of a movement problem, lack of sleep, job stress, or even poor eating habits–or often a combination of these types of stress. I’ll elaborate more in a moment.

Feeling pain is also a skill. It’s like learning to taste wine, hear and play music, or acquiring the visual senses of an artist. Our brain and nervous system become efficient and skilled at doing something if we do it enough.  The longer we feel pain in an area, the better we get at feeling pain there. So going forward, if the nervous system needs to get your attention, it will choose to create pain along a smooth, well-known, efficient pathway.

We often feel pain as part of something called the threat neuromatrix. Vital to this concept is understanding any type of perceived threat may generate pain. The brain can produce a pain signal in response to any stimulus or event that threatens our survival. Whether that event is emotional, physical, or even spiritual, if our brain perceives a threat to our survival there is a possibility that we will experience pain or a noxious event of some kind. How does this relate to gluten?

Know When to End Your Run (or Ride or Workout, etc.)

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“Runners who continue running when they are exhausted unknowingly change their running form, which could be related to an increased risk for injury.”

Runners get injured.  I’m a runner and I’ve been injured–a lot. If you’re a runner then you either have been, are or are going to be injured. According to one source, 60-65% of all runners are injured during an average year (by definition, an ‘injury’ is a physical problem severe enough to force a reduction in training).

If you’ve encountered a running injury then you probably know that it’s rarely a simple solution to fix what ails you.  From shoe changes to barefoot running to stretching to foam rolling to foot strengthening exercises, to physical therapy to acupuncture to chiropractic to massage and on and on… This is a huge hassle and it would be wonderful to avoid this kind of aggravation!  So with some particle of optimism, I present an article from Science Daily that may help us avoid injury: When to End a Run to Avoid Injury: Runners Change Form When Running Exhausted.

The article discusses a study from Indiana University published in the Journal of Biomechanics in November 2010.  Researchers observed that subjects demonstrated biomechanical changes as they fatigued during a run.  Runners tended to display excessive motion at the hips, knees and ankles.

The study had subjects run on treadmills until they either reached 85 percent of the subject’s heart rate maximum or a score of 17 (out of 20) on the rating of perceived exertion (RPE). By the end of their runs, all of the runners reported an RPE of at least 15 — studies have shown that RPEs between 13-15 indicate fatigue.  Here’s what you need to pay attention to.  The article states, “Runners’ RPEs could provide some answers, with RPEs of 15-17 indicating runners’ have reached a point where their mechanics have likely begun to change in an undesirable way.”

The RPE scale is shown below.


What does this mean to you the runner?  Don’t run to the point of exhaustion.  Stop when you’re feeling good and strong, not when you feel beaten to hunched-over death.

I’m going to go out on a limb and suggest that we might take this advice for any type of exercise: lifting weights, cycling, martial arts–whatever.  This isn’t to say we should avoid tough workouts but most of our workouts should be comfortably challenging, not torture.  (I’ve mentioned this concept in previous posts; look here and here.)   

Facial expressions can be very useful in gauging our exertion levels.  When I’m working with clients I watch their faces.  When a grimace starts to show we stop the set.  The “scary face” is a transmission from one human to the other humans that something isn’t going all that well.  (Next time you’re in the gym, have a look around and see how many people have a look on their face like they’re being stabbed.  Don’t be that person.) It means we’re butting up against certain physiological limitations.  If we spend enough time doing this we’ll likely end up in some type of pain.  Heed your body’s warnings and you can stop injuries before they start.

The Minimal Shoe Debate Heats Up

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If you’re an exercise geek like me then you may take interest in the latest goings-on over at Zero-Drop, a very fine minimalist running blog.  Three posts are worth reading: “ASICS Have Really Dug In Their Heels,” “The ASICS ‘Minimalst’ Shoe Debate Continues…,” and “The Other Shoe Has Dropped: Dr. Craig Richards Challenges ASICS and Other Shoe Companies.”

It seems that shoe company ASICS is not jumping on the minimal shoe bandwagon like most of their competitors.  ASICS shoe designer Simon Bartold is quoted in the article and he speaks fairly derisively of the movement toward flatter, thinner and more flexible shoes. He demands proof that minimal shoes are healthy and useful for runners.  (Meanwhile, there’s certainly no proof that modern, “good” running shoes are healthy either.)

What’s most interesting however isn’t the article itself but rather the spirited exchange that follows in the comments section where Bertold and the blog author go back and forth over the scientific particulars of this issue.  The discussion gets quite heated and the drama even spills over to another blog. “ASICS vs Zero Drop, Minimalist vs. Maximalist” comes from the great minimalist site, Runblogger.  It’s a very thorough examination of the type of proof that Simon Bertold demands.  The article in fact draws a comment from ASICS’ Bertold that that might be seen as a little bit of backpedaling.

The issue of science and scientific “proof” is a prominent feature of these discussions.  It’s unlikely that any one study will prove 100% whether or not any type of shoe–or no shoe at all–will cause or prevent a given type of injury.  There are many many variables that go into an injury or lack thereof.  (Interestingly, several studies suggest that conventional “good” running shoes matched to foot type do nothing to prevent injuries.)  Further, just because a rigorous study hasn’t been done doesn’t mean that a given cause-and-effect relationship doesn’t exist.  Minimal shoe/barefoot running may or may not in fact be healthier for most people than running in a conventional running shoe but there may be no powerful study that exists that proves either condition.

There’s nothing wrong with examining the anecdotal evidence either.  It’s often the anecdotal stuff that motivates someone to study something, and there’s a lot of anecdotal evidence out there supporting the idea that less shoe is better than more shoe.  I can speak from my observations of clients in the gym (as well as my wife and my own condition) that many people move better and feel better in minimal shoes.  I’m not the only one observing this.  In fact the shoe companies making minimal shoes are responding to the requests of their customers.

Finally, if you find all of this interesting, then you should get over to a recent post at the Science of Sport.  The barefoot running debate: Born to run, shoes & injury: the latest thinking is a remarkably in-depth discussion on the shoe issue.  The Sports Scientists take their subjects very seriously and they always get deep into the science behind athletics.  They discuss the important of running technique and the idea of how to transition from a conventional running shoe to the barefoot/minimal running style.  Very informative stuff there.

 

Potomac 7.5 Mile Swim for the Environment & Team RWB

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The Big Swim

Mike Piet of Arlington, VA is a former client and good friend of mine.  He is a superb triathlete.  He’s competed in several Ironman Triathlons (including the Cozumel Ironman) and countless other triathlons and endurance events.   Most recently he competed in the Potomac 7.5 Mile Swim for the Environment, and he did quite well.  He finished 3rd overall and he was the first non-wetsuited competitor to cross the finish line with a time of 3 hrs 52 min.  Further, he raised $500 as part of the effort to clean up the Potomac River. This is a tremendous achievement and I applaud his efforts.  Here’s a link to his Race Report.

Team Red, White & Blue

Further, Mike will also be racing as a part of Team RWB (Red, White & Blue). Team RWB  is a non-profit organization that brings athletes together in support of wounded war veterans. Their mission is to enrich the lives of wounded veterans and their families. They work to re-introduce wounded vets back into society. RWB members raise funds and awareness through participating in a wide range of athletic events. To learn more about Team RWB including volunteer and donating opportunities, go to the Team RWB site.

If you know a vet then you may know that returning from combat and taking up a “normal” life can be excruciatingly difficult. Combat vets have gone through things that most of us can’t imagine. Upon returning stateside they’re often patted on the back and expected to take up life where they left off, but there is a lot of hard work involved in readjusting to civilian life.  This is the perhaps the hardest part of war. So if you have funds or the time, please find a way to donate to Team RWB.