I often make nutritional recommendations to my patients, usually with the intent of improving their microbiome and lowering their inflammation levels to reduce pain as examples. One of the most convenient sources of omega-3 fats that help to accomplish this goal is the lowly sardine. Now the sardine is very controversial, I realize, but it’s a small fish so it is low in environmental pollutants such as mercury, and it comes in a convenient single-serving container that needs no refrigeration. Yesterday I got a glimpse into why some of my patients don’t follow my sardine recommendation. A woman in her late twenties confessed to not eating sardines, interrupted by fits of laughter on her part, because…of a cartoon! She thought all along that sardines had their heads on and eyes intact, because that is how she remembered them from the movie “Cloudy with a Chance of Meatballs”. Here is a clip from that scene: https://www.youtube.com/watch?v=cSKhRVH1Iv4. Ah, the risks of making meal choices based on cartoons…We both got a good laugh from the discussion! So, FYI, sardines do NOT have their heads and eyes when they are canned! Sometimes a patient’s crazy stories can provide a doctor with a welcome break from a busy day. It was greatly appreciated yesterday.
One of the most common pain classes of pain relievers are NSAIDS. This stands for non steroidal anti inflammatory drugs and these are available over the counter (Ibuprofen, Motrin, Tylenol and aspirin are examples) and by prescription (Indocin, Mobic, Toradol and many others). It is estimated that up to 90 million prescriptions for NSAIDS are written in the US every year. This rate of prescribing is estimated to cause as many as 16,500 deaths per year and many more hospitalizations.
What is not discussed as often is the role of NSAIDS in damaging intestinal linings and gut bacterial populations. The damage causes enteropathy, or damage to the intestines. This damage results in altered/abnormal gut bacteria populations, a condition known as dysbiosis. Increased intestinal permeability also creates increased inflammation.
Abnormally increased inflammation is one of the things that causes pain! Isn’t that what NSAIDS are used to treat? It gets more interesting: Increased intestinal permeability is one of the underlying factors driving many conditions like Crohn’s disease, Multiple Sclerosis and Asthma. All three of these conditions are very serious and painful!
Inflammation is the common denominator in pain of most types. Gut bacteria play a huge role in the control of inflammation as the symbiont colony helps to manage the functions of the immune system. Anything that is damaging to the gut bacteria is likely to also increase inflammation and pain syndromes. It has been found that NSAIDS cause damage to gut bacterial colonies. It is even possible that the damage to the intestinal walls is in part due to dysbiosis triggered by the drugs!
Instead of taking NSAIDS and causing all of these problems, consider other more natural approaches to temporary pain relief. Some of these approaches and products have a great deal of research supporting their use. Probiotics would be one recommendation, for the reasons stated above: maintaining normal immune function goes a long way to inhibiting inflammatory pain pathways. A second complimentary product would be curcumin. This spice is possibly the most researched natural anti-inflammatory substance we know of today, and it does not cause the problems that NSAIDS cause.
A healthy lifestyle that includes reduced stress, probiotics, a prebiotic/gut bacteria-healthy diet and non-harmful anti-inflammatory supplements such as curcumin can go a long way to reducing chronic pain! More information about the relationship between symbiotic bacteria and pain reduction strategies will be found in The Symbiont Factor which is on track to be published in June 2014.