Salt, like fat, has gotten a bad wrap over the years. We have all heard that salt causes hypertension or high blood pressure which can lead to atherosclerosis, heart attack, stroke, kidney disease and early death. So much fear is associated with this, that we have attempted to remove all salt from our diets. Our salt shakers stay tucked away. When a recipe calls for “salt to taste” we assume it means it’s actually unnecessary.
What I aim to do here is bring the light onto salt to understand how it actually is essential to life and avoiding it at all costs can have a negative impact on your health and function. This blog is not a treatment for heart disease, rather an acknowledgement of the importance of essential electrolytes that we cannot survive without. (In case you were wondering, people sensitive to salt do in fact result in a hypertensive response, BUT this is a small portion of the population and those with renal disease are the most salt sensitive.)
Pain is a subjective experience determined by a localized response and a behavioral response. The localized response is driven by the pain receptors (mechanical, heat and chemical receptors) and nerve endings in the tissue of the injury or damaged area. This information is transmitted to the spinal cord via afferent nociceptors. At the spinal cord the message is relayed through a well-defined pathway to the higher centers in the brain. It is at the higher centers that the behavioral response is stimulated to begin behaviors that are directed at relieving or terminating the experience of pain.
The importance of Vitamin D cannot be ignored. Vitamin D is a natural conversion of blood cholesterol in the presence of UVB spectrum sunlight hitting the skin. Specifically related to intestinal permeability, Vitamin D3 has been shown to preserve epithelial barrier function in the presence of intestinal injury, be it Crohn’s disease or ethanol-induced or poor lifestyle choices. The free source of vitamin D3 is full sun exposure to a majority of your skin, without burning. Yet, during certain times of the year or even job requirements, it is not possible to get the needed skin exposure to produce adequate and therapeutic amounts. You can check your area for when the sun is above the 50 degrees altitude in order to provide UV B exposure for Vitamin D conversion. Spending five to ten minutes for fair skin during peak UV B exposure on a large portion of skin is the most effective and efficient. It’s important to gauge your skins response to avoid burning.
Fish oil or omega 3 fatty acids help recovery and pain reduction because of their ability to reduce inflammation, protect joints, provide a substrate that is neuroprotective (protects the nervous system) with improved dopamine neurons. These fatty acids are primarily found in cold water fish, eggs, cod liver oil and also flaxseed oil.
A recent systematic review and meta-analysis evaluated the effects of Omega-3 fatty acids on patients undergoing surgery for gastrointestinal malignancy. The authors concluded that omega 3 fatty acids were effective in improving the nutritional status and immune function in patients undergoing surgery. The omega -3 fatty acids not only enhanced immunity but attenuated inflammatory response. Another experimental study demonstrated that omega-3 fatty acids significantly decreased wound area by day 7 in diabetic wounds. Additionally, the wound strength was significantly increased by day 15. In an animal model for osteoarthritis cartilage degeneration, docosahexenoic acid (DHA) an Omega- 3 fatty acid, showed promise as a therapeutic agent in osteoarthritis prevention. In the field of dentistry, omega-3 fatty acid effect reduces bone resorption following gingivalis infection. The benefits of omega-3 fatty acids continue to be supported to improve cognitive function as well as reducing central nervous system oxidative stress.
Vitamin C, a natural constituent of many fruits, is a powerful anti-oxidant. It helps to prevent free-radical damage that contributes to aging and degenerative disorders. Vitamin C also prevents other antioxidant vitamins from being oxidized. Eating citrus is a good way to get Vitamin C, but it may not be enough when recovering from injury or surgery to reduce pain and risk.
Specifically, for chronic pain states like Chronic Regional Pain Syndrome (CRPS), Vitamin C used preoperatively at 2 g, reduces the morphine consumption in the post-operative stage. Fifty days of use at 1g/d post-operatively may reduce the CRPS risk development. A meta-analysis supports use of Vitamin C for reducing CRPS risk despite not finding conclusive dosage. Another study concluded that the administration of Vitamin C in preventing CRPS after distal radius fracture is low cost and has few complications. Another systematic review also supports the use of Vitamin C for foot and ankle surgery at 500mg for 45-50 days. There are some conflicting reports on effectiveness of 500mg Vitamin C in reducing pain, and it is worth noting as it may be dose dependent.
Is it possible that bacteria could aid in healing from injury or surgery?
Yes. In fact it is important to promote the variety of bacteria in your gut to promote immune health, reduce pain and reduce risk of infection.
As described in an earlier post about the leaky gut syndrome, supplemental recommendations that may reduce pain and improve healing are geared to promoting gut health. Specifically, the microbiome diversity is strongly linked to gut and mental health. This gut-brain connection is at the core of much of the research around supplemental probiotics. A literature review evaluated the research around use of probiotic use and migraine headache. The findings of improving gut microbiota and reducing inflammation may have positive effects on strengthening the gut and improving brain function. This is important to surgery/injury in that gut health supports brain health which thereby will have a positive benefit in the role of the brain in the pain experience.
What do papaya and pineapple have in common besides being tropical fruit?
They contain potent vegetarian proteases. A protease is an proteolytic enzyme that helps break down protein.
How does this relate to healing from orthopedic injury or surgery? A lot actually.
Proteolytic enzymes aids in breaking down animal proteins when ingested, but also mediates tissue repair and break down of cellular debris associated with inflammation metabolism.
Common medications to address symptoms of pain following orthopedic injury or surgery are those targeted to reduce inflammation. The problem, is that these same medications that reduce pain via inflammatory regulation also impair healing, disrupt the integrity of the gut, and increase the risk for cardiovascular events. Fortunately there is a natural remedy that does not have the negative side effects.
Turmeric is an Indian spice from the ginger family used in curry. It is the spice that gives curry its yellow color. Curcumin is derived from turmeric and is the most active form. This is important because oral absorption of curcumin tenst to be poor due to its low solubility and instability in the intestinal environment. Yet, as an herbal remedy, it is historically used as an antiseptic, antibacterial, anti-inflammatory, pain killer.
Dr Carolyn Dolan DPT, Cert MDT, MSHN
Where physical therapy, nutrition and lifestyle meet, because how you live your life determines whether or not you soar. Inspiring action with information so you can reduce pain, optimize healing and improve function naturally during recovery from injury, surgery or painful condition. This is a website for the open-minded; obstinate need not apply.