🦀 PT Crab Issue 96 - Nutrition, Nutrition, Nutrition

Whatup y’all and welcome to late May. This week, we’re talking nutrition, nutrition, nutrition, because it’s in your scope, it’s essential, and it can help with chronic pain. These researchers really really want you to get into it.

Our King Crab supporters also received two more article this week, like every week. Those were full of information about how diabetes makes everything worse and a breakdown of how demography affects PT utilization in knee OA. To get triple the articles every week, become a supporter here. It’s just $5 per month and a huge help to keep PT Crab running.

Also this week, I have nothing else.

Let’s dive in!

Nutrition for Chronic Pain - And it’s not about weight loss.

The Gist - Nutrition education is in your scope. We’ve covered that before on the Crab and it’s worth reemphasizing now in light of this strong commentary from PTJ. These researchers put together what they call “A Global Call to Action” on the importance of nutrition education in PT practice. According to them, “few physical therapist practice acts include a reference to nutrition education or counseling: therefore, physical therapists are not prohibited from addressing diet and nutrition in practice. Additionally, Title 42 of US Code states that allied health professionals share in the delivery of services related to… diet and nutrition.” They recommend expanding your own knowledge of the field and provide specific resources and reasons why:“Nutrition as a major modifiable determinant of chronic diseases has a bi-directional link with chronic pain and can impact occurrence, maintenance, and perception; therefore, nutrition should be an essential part of the clinical decision-making process.“

After pointing out specifically how nutrition is related to chronic pain and how improving it can improve pain, they go on to highlight the NCPPM, the Nutrition Care Process for Pain Management which describes why and how to use a nutrition assessment and intervention. They also provide a fantastic table that breaks down different diets and the amount of research that shows how they address different pain conditions. Details below.

This is a 14 page paper chock full of useful bits and an overall strong exhortation to add nutrition information to your practice, so I can’t overly summarize aside from readdressing their point, it’s important, effective for chronic pain, and even more paramount now that we’re primary care providers.

Tell Me More - Let’s talk specifically about those diets in the table. They address calorie restriction (AKA intermittent fasting), vegan, vegetarian, plant-forward, Mediterranean, low-carb, low FODMAP, elimination, and fasting. I can’t get through everything obviously, but all of these have evidence that they reduce pain from OA, fibromyalgia, migraine, RA, neuropathy, and more. The Mediterranean diet has the most research, with Level 1 evidence that it can improve OA, Fibromyalgia, Autoimmune disease, RA, MSK function, Anxiety, Cognitive decline, Physical decline, and Chronic degenerative disease. Crucially, the researchers point out that perfect execution of these diets isn’t necessary, commitment to the change is key. Additionally, weight loss isn’t the main medium through which dietary change works to assist these conditions, it’s the lowering of inflammatory load by choosing foods that cause less inflammation. Weight loss can help, but dietary improvement without loss of weight is still gold.

I could go on much longer, but I shan’t. Read the paper.

Will do, where is it? Right here. Free for APTA members.

The best things I read this week:

I’ll be more brief this week. We’re looking at:

• This passenger’s one-star review of the trolley ride from the trolley problem in McSweeney’s
  – “Where to even begin? I mean, first of all, we killed a guy.”
• Pudding.cool’s (the best site you haven’t heard of) visual history of Rickrolling about a video that now has 1.2 billion views.
  – “Never gonna give you up,” etc.
• This podcast from NPR about how people with disabilities are really worried about their ability to vote this year as Republicans crack down on mail in and drop box voting.
• And this piece from the New York Times about who’s now playing D&D and why it matters. I’m currently playing and it’s the shizz.
  – “I really feel like marginalized people are the vanguard of making D&D blow up again,” Mx. Chang said. “People say ‘Stranger Things,’ but I’m like, ‘Nah, it’s the queer community.’”

And that’s our week! Thanks for checking in this Wednesday and I want to report, it’s Wednesday my dudes. Sign up here to support PT Crab.

Have fun!

Here’s this week’s bibliography:

• Tatta, J., Nijs, J., Elma, Ö., Malfliet, A., & Magnusson, D. (2022). The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice. Physical Therapy, 102(4), pzab296. https://doi.org/10.1093/ptj/pzab296