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Ovulation Pain or Mittelschmerz

Posted: Thursday, December 19, 2013 at 8:00:22 AM EST by Alyssa Tait

 Can you feel when you're ovulating?

That niggling pain is back again, low down in the left of your lower abdomen. It’d be nice to just sit down and put your legs up, but you’ve got to keep working.  That time of month again – no, you’re not due for your period for another two weeks! This is mid-cycle pain. Not only do you get period pain, but you’re hassled in the middle of the month by more pain! Why?

That cyclic stabbing pain in one side of the lower abdomen that some women experience is known as ‘’Mittelschmerz’’ (meaning middle pain) or ovulation pain. It is typically described as occurring at mid-cycle. However, this is dependent on the length of the cycle. It would be more accurate to say it occurs approximately 2 weeks before the menstrual period – that is, at the time of ovulation.

Ovulation pain tends to switch sides from month to month (depending on which ovary you are ovulating from, obviously). For most women it lasts a few hours or less – just enough to let them know they are ovulating. For some women, it lasts for more days. And for some very unlucky women, it is severe and can be accompanied by other symptoms such as nausea or even vomiting.

The precise cause of Mittelschmerz is uncertain. It may be due to the enlargement of the follicle before the egg bursts forth in ovulation, or the rupture of the follicle itself, with the spilling of its contents into the surrounding tissue. Whatever it is, if it is anything more than a minor nuisance, you may want to have it looked into.

Severe Mittelschmerz is often due to endometriosis, a condition where the inner lining of the uterus (the endometrium) ends up implanted in places it shouldn’t be. Endometriosis can only be definitively diagnosed with a laparoscopy – a relatively invasive procedure. Women with endometriosis usually have painful and heavy periods as well, and sometimes pelvic or abdominal pain at other times of the month. This can imitate irritable bowel syndrome.

In my experience, cyclical abdominal or pelvic pain is more likely to occur when there are ‘’tissue restrictions’’ around the organs involved (in this case, the ovary, fallopian tube and uterus). For example, endometriosis causes adhesions (scarring) within the tissue which causes it to tighten up and be less flexible. As your pelvic organs contain smooth muscle and are designed to be very mobile, these restrictions can result in you feeling things you shouldn’t (such as pain) – or feeling sensations more strongly than necessary. Tissue restrictions that can be palpated by an experienced physiotherapist are certainly present where there is endometriosis, but many women I see with these problems do not have a diagnosis of endometriosis (yet, anyway).  In my experience, ovulation pain, period pain and other pelvic or abdominal pains can be successfully treated by gently easing these tissue restrictions. This involves a form of tissue release known as visceral manipulation, or visceral-specific myofascial release. Visceral manipulation is very gentle and performed through the abdomen by a physiotherapist who has trained specifically in this technique. It can provide relief within just a few sessions.

Contact us for an assessment using this approach and possible visceral manipulation treatment, or just to make an enquiry.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Chronic Pain - Do You Really Get It?

Posted: Saturday, August 16, 2014 at 7:07:16 PM EST by Alyssa Tait

You step on a thumbtack, and yow! – your body pulls your foot back faster than you know what hit you.

You accidentally touch that hot plate, and eeek! – you’ve pulled your hand back off it in the blink of an eye.

‘’Pain is the message your body part sends your brain when your body part is being damaged’’…right?

WRONG. This is a huge misunderstanding of pain, especially the area of chronic pain or persistent pain. It is a big mistake to make. If you misunderstand your pain, it can actually impede your recovery.

So what is pain, then, actually? Pain is what is PRODUCED by your brain and nerves (your central nervous system, or CNS) in response to a THREAT to the body tissues. That’s right, a THREAT. It does not have to be real or true damage. In fact, in chronic pain, it rarely is. Instead, your brain senses the body is in danger, and responds accordingly. It actually puts together an individualised pattern of pain in order to protect you from this potential threat. Believe it or not, this is what modern neuroscience research teaches us!

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Of course if you have persistent pain, it is very important to have all the appropriate investigations done to rule out (or at least tease out) any causes directly related to tissue damage. If nothing can be found – or if pain is out of proportion to what would be expected for the specific tissue damage – then you can be sure that your central nervous system (CNS) is playing a big role in maintaining your pain.

The complex pattern of pain that your CNS puts together can involve a contribution from multiple systems in your body. As well as pain, you might have emotional or psychological changes (anxiety or depression), muscular changes (tense, sore muscles that are bracing you to deal with your pain, or run away from it) circulation changes (heat or cold in the sore area), tissue changes (weak or fragile skin in the painful area) and hormonal changes, which can affect your energy, sleep and the health of your whole body. All of this put together is like a big personalised puzzle of pain! Putting together the different parts of the puzzle is very important in overcoming the persistent pain.

In summary, persistent pain (or chronic pain) is complex but enormously changeable. In order to solve the puzzle of your persistent pain, you need to be able to put the pieces of the puzzle together, and bit by bit, see the picture clearly. Retraining the brain is an important part of resolving chronic pain; retraining the brain in chronic pain in the vulva and pelvis is a particular focus of mine as a clinician.

If you experience persistent pain – regardless of the cause – you need to address the central nervous system. You may benefit from a physiotherapy session dedicated to learning about pain and what causes it to persist – and how you can change this. When you book in for an appointment, mention you are wanting ‘’pain education’’ – and if you can, bring your loved one with you, so they can understand your pain as well. If you are a female and pain is somewhere in the pelvis, you can also start work on retraining your brain by using my e-book Outsmart Your Pain.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Epigenetics and Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:25:00 PM EST by Alyssa Tait

How targeted nutrition can affect your pain experience

Epigenetics: it’s a bit of a buzzword floating around at the moment, but what does it actually mean?

Epigenetics is the study of how environmental factors influence what genes your body ‘’decides to express’’. We all know about our genes – in fact we often resign ourselves to a medical condition or symptom because it’s ‘’in our genes’’. However, it’s also the case that you can have the gene for something but not get the disease. This is because of epigenetics – the way our environmental influences affect our gene expression.

These environmental factors are not just the obvious ones: exposure to radiation from a nuclear disaster, exposure to chemicals in a factory accident, exposure to too many UV rays sunbaking on the beach. Environmental factors start in utero (that is, as a baby in the womb), and don’t stop as long as you are still breathing!

One important chemical processes in our cells that influence epigenetics is DNA methylation. The effects of diet on DNA methylation have been well studied. Your ‘’methylation status’’ greatly affects your likelihood of developing certain conditions that may be ‘’in your genes’’, such as heart disease, cancer and depression. The field of nutrition medicine (practised at Equilibria) focuses on optimising individual health via nutrition, and optimising methylation status is one way we do this.

A 2012 study in the journal Pain Medicine discussed the role of methylation and other epigenetic processes in chronic pain. Specifically, it focussed on how acute pain (which is normal in healing) turns into chronic pain (which is a living nightmare for millions of people).  How does epigenetics affect whether your pain will hang around and turn ugly?

Here are three mechanisms whereby improving your epigenetics (such as via nutrition) can reduce the transition of acute pain to chronic pain:

  • By altering your sensitivity to opioids, your natural pain-relieving chemicals
  • By altering the production of inflammatory chemicals, called ‘’cytokines’’
  • By altering how responsive your cells are to steroids (important hormones, such as vitamin D – so there’s a clear nutritional lead already!)

As a physiotherapist and nutrition medicine practitioner immersed in chronic pain, I treat people every day with chronic pelvic pain using not just physical techniques alone, but targeted nutrition strategies. It seems that research is heading more into this area. In the meantime, has your pain been affected by your nutritional status? I would be interested to hear people’s personal stories.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Chronic Pelvic Pain - some media coverage at last!

Posted: Wednesday, December 18, 2013 at 12:22:26 PM EST by Alyssa Tait

ABC radio’s Health Matters show yesterday covered one of the most overlooked health problems in Australia: chronic pelvic pain.

One of my patients rang and let me know about it, for which I was very grateful. I downloaded the recording after work, and as I listened to it, I recognised in the stories things I am told over and over again in my clinic.

Despite the fact that everyone’s journey is unique, so many themes arise again and again: the physical suffering, the loneliness and social isolation, the despair at being made to feel like you’re crazy, malingering or exaggerating. The tendency to diagnose depression or anxiety when the symptoms don’t perfectly add up. The complete lack of awareness in a large majority of (otherwise capable) health professionals.

The symptoms that people mentioned echoed those of so many women and men I have seen over the years. To take just a handful of examples:

  • The constant burning pain
  • Being unable to sit down or find a comfortable position
  • The feeling of ‘’little cuts all over the vulva’’
  • The ‘’red hot poker up the backside’’ feeling

These symptoms are described to me every day by different patients, most of whom assume they are the only one who has them. But what I hear most commonly from my patients is

‘’Why did it take me so long to find you?’’

My patients have typically seen ten or more health professionals before me who either

  • Didn’t take the problem seriously
  • Didn’t recognise the symptoms
  • Didn’t refer appropriately
  • Wrote the symptoms off as caused by depression, anxiety, or a lack of sex life
  • Did not seem to care, and even seemed skeptical

It is a relief for people to finally find someone who understands chronic pelvic pain. To be frank, health professionals who really ‘’get it’’ are thin on the ground. The good news is that, because there are so few with good expertise in this area, those of us who understand it have good networks – so we know the people you need to see for the essential multi-disciplinary approach.

An important point raised during the broadcast as well as from listeners’ e-mails is that pelvic pain can have important identifiable medical causes, such as fractures and cancer.

However, when appropriate medical investigations have been done, and no clear cause has been found (and keep in mind a laparoscopy is required to definitively rule out endometriosis), then this is a case of chronic pelvic pain.

Chronic pelvic pain has many subtypes, some of which are diagnoses in themselves. There are also concepts that anyone with chronic pelvic pain will want to understand. You may want to investigate the following:

All of these are conditions I have successfully treated here at Equilibria for the past eight years.

I’m not sure how long the broadcast will be available for download, but it is thoroughly recommended listening.

Go to:

http://www.abc.net.au/radionational/programs/lifematters/pelvic-pain/4502250#comments

 If you are suffering from chronic pelvic pain, come in and get some help.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Butterflies, ulcers and the irritable bowel

Posted: Wednesday, December 18, 2013 at 12:21:26 PM EST by Alyssa Tait

Why stress is so bad for your gut

It used to be generally held wisdom that stress gives you ulcers. Then a smart Australian found that a bacterium called Helicobacter pylori was able to directly cause ulcers. This was a pivotal discovery – but does it mean we should throw out the baby with the bathwater? It is important to acknowledge the extent to which stress really does harm your gastrointestinal tract. While other (often more direct) causes are continually discovered, don’t forget about stress!

So what are some of the negative effects of stress on your gut?

The concept of the ‘’brain-gut axis’’ is important here. The brain and the gut are very closely linked and the brain affects the gut in a variety of ways. However, the gut has a huge number of nerves – more than in the spinal cord. This is sometimes known as the ‘’gut mini-brain’’ or the ‘’second brain’’. This ‘’second brain’’ can initiate and perpetuate many of these effects itself – which is what makes gut function so complex

Some of the effects of stress on your gut are:

1)      changes in gastrointestinal motility

Stress affects the movement of food through your digestive tract. It can speed it up, slow it down or cause uncoordinated movement, resulting in spasms or cramps.

2)      increase in visceral perception

This means that stress makes you more sensitive. It makes you feel every little movement and every little sensation more strongly than normal.

3)      changes in gastrointestinal secretion

Stress alters the production of hydrochloric acid, digestive enzymes and bile. Normal amounts and normal timing of production of these is critical for healthy, comfortable bowel function.

4)      increase in intestinal permeability

Increased permeability of the intestinal wall is colloquially known as ‘’leaky gut’’, but is a well-established medical fact in various gut conditions and systemic conditions. It can increase your potential for allergic reaction and other forms of immune activation.

5)      negative effects on regenerative capacity of gastrointestinal mucosa and mucosal blood flow

The mucosa is the protective inner lining of your gut. Stress affects its ability to heal quickly, and affects the circulation that keeps it healthy.

6)      negative effects on intestinal microbiota.

Intestinal flora, or the ‘’good bugs’’ that keep your gut healthy,  get (deservedly) quite a lot of press. Stress depletes these ‘’good bugs’’ within hours.

7)      Immune effects

Mast cells are chemicals that translate the stress signals into the release of a wide range of neurotransmitters and proinflammatory chemicals called cytokines, which can significantly affect gut function.

Does all this sound like irritable bowel syndrome (IBS)? Not surprisingly, interventions that target stress have been shown to help IBS. For example, there is strong evidence for the benefits of mindfulness meditation, cognitive behavioural therapy and gut-directed hypnotherapy in IBS.

I don’t want to imply that IBS, or other gut issues, are ‘’all in the mind’’. Future posts will focus on some of the specific pathophysiology behind IBS. However, the effects of stress on the gut should not be underestimated. It appears that the irritable bowel is…well, literally irritable!
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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Accidental Bowel Leakage: What You Need to Know

Posted: Thursday, August 14, 2014 at 11:08:28 AM EST by Alyssa Tait

It’s one of the worst feelings there is: the sense you’re going to lose control of the bowels.

And if accidental bowel leakage actually occurs, it can feel like the worst calamity.

It’s human nature for this to be one of the worst fears. Control of our bodily functions is integral to our sense of dignity as adults. Loss of control brings with it the potential for deep shame and can make us feel either childlike (like before we developed control) or as though we are “old and worn-out” (which we dread, no matter what our age). And if loss of bladder control can feel disastrous, loss of control of the bowels is that much worse.

Accidental bowel leakage is often known as “faecal incontinence”.

If you have this problem, then giving it this label probably makes it even worse. It conjures up the most extreme possible images. In actual fact, accidental bowel leakage is a spectrum from the “barely there” mark or stain on the underwear, to the “worst case scenario” of loss of a full bowel motion in a public place. It can occur with urge (you needed to go but couldn’t get there in time) or with physical exertion (such as squatting or sneezing). It can occur with no sensation whatsoever – you go to the toilet and notice a mark on your underwear, having no idea it occurred. It can be so slight that there is not even a sign on the underwear – but you feel that awful sense that something is coming out, and when you go to the toilet, there is something to wipe away. Accidental bowel leakage also covers the problem of passing wind without meaning to, or when trying not to. This commonly occurs when bending over, squatting, or moving from sitting to standing, but can also occur with coughing, sneezing or even laughing (which has a way of immediately wiping the smile off your face).

Overall, accidental bowel leakage can appear in a variety of ways, and can be socially devastating – even if it is simply the fear and dread that it is going to happen. It can affect your life in so many ways. One young man I saw was a mechanic in the army and had to keep leaving his work to go to the toilet. His problem had occurred after haemorrhoid surgery. Another young girl who had severe bowel urgency while in hospital with a stomach problem went on to develop a chronic pelvic pain syndrome because she was “hanging on so tight” for fear of leakage. I have seen several people with full loss of bowel control from the effects of radiation for cancer. It can even occur in association with irritable bowel syndrome. And postnatally, loss of bowel control is cruelly prevalent, especially after injury to the anal sphincter, as in a third-degree tear or episiotomy.

Despite its devastating impact, research from last year showed that more than two-thirds of women with accidental bowel leakage do not seek help for it. Considering that this is treatable and often curable, this seems to me to be the real tragedy.

Watch this space for an upcoming blog post describing what can often be a simple solution for accidental bowel leakage.

If you are concerned about an issue you might have with your bowel, send me a confidential e-mail for advice.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Coeliac Disease: could you spot this in your child?

Posted: Wednesday, December 18, 2013 at 12:15:28 PM EST by Alyssa Tait

Up to one in one hundred people have coeliac disease. The problem is, most of these don’t know it.

What signs would alert you to this in your child, or the children you treat?

A 2013 study suggests the common symptoms of coeliac disease depend on the age of the child.

Kids younger than six with coeliac disease are most likely to have diarrhoea and failure to thrive (that is, be small for age, short and skinny, with poor growth).

Kids older than six with coeliac disease are more likely to have the same symptoms an adult with coeliac disease would: “irritable bowel” symptoms. Abdominal pain and nausea are two of the key symptoms here. This is interesting, as nausea is not often thought of as a symptom of coeliac disease.

Abdominal pain was the most common symptom, being present in more than 50% of the sample of kids who were diagnosed with coeliac disease. It’s interesting to note than only just over a quarter of the kids had the symptom of diarrhoea, which people often mistakenly think of as the key symptom of coeliac disease.  In fact, in the seven-to-thirteen age group, there was actually constipation in over 10%, and in the under-sixes, it was present in almost a quarter. This makes it clear that we should not forget about the possibility of coeliac disease in our paediatric patients with constipation!

Big tummies are also the other thing to look out for, especially in the under-sixes, one-third of whom had abdominal distension.

One final note was that in this group, approximately 13% of them were IgA deficient. Note well: this means that a blood screen for coeliac disease will produce a false negative in these kids. In other words, the (correct) diagnosis of coeliac disease will be missed! This is because the standard blood tests for coeliac disease (transglutaminase antibody and IgA antigliadin) both are IgA-based. They rely on normal amounts of IgA being present in the serum. If there is IgA deficiency, the individual will not test positive to coeliac disease on blood tests even when they have it.

Finally, coeliac disease is hard to diagnose in the under-fours. This is because until four years of age, coeliac serum testing is unreliable. So don’t assume that if your four-year old patient had a negative test for coeliac disease a year ago, she is clear of the disease. If you suspect it’s a possibility, make sure you refer appropriately for testing.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Nutrients in Chronic Pain

Posted: Wednesday, December 18, 2013 at 12:12:00 PM EST by Alyssa Tait

Part 1: Magnesium

Chronic pain is complex; no one can deny that. Anyone who is experiencing chronic pain can think of their pain as a giant puzzle. There are many pieces that make up the picture, and an often-overlooked piece is the nutrition piece. Nutrients, which trigger certain (normal) physiological functions, are one part of this nutrition piece, and magnesium is a single one of these numerous nutrients that play a role in the process of persistent pain.

What is the role of magnesium in the body? Magnesium is a cation that plays numerous roles in various body compartments.

It helps maintain the internal “balance” (homeostasis) within the cell, so is imperative in cellular function. Magnesium has a “calcium channel blocking” action.

It is present in high amounts in the extracellular compartments, influencing excitability of nerves and nerve conduction. It has a role in skeletal, smooth and cardiac muscle function.

It is a cofactor for many enzymes, including those involved in the production of brain and gut neurotransmitters, thus influencing both gut and brain function.

Magnesium seems to be linked to various pain disorders and has some potential to help them:

One study showed a statistically significant link between low serum magnesium levels and myofascial pain syndrome. A 2012 study showed that magnesium supplementation helped to prevent migraine. Magnesium reduced pain in primary dysmenorrhea in a 1992 study. Furthermore, a 2007 systematic review of randomised trials found evidence for decreased postoperative analgesic requirements when magnesium was given.

Is there any evidence for the efficacy of magnesium administration in chronic or persistent pain?

One study showed that giving magnesium before surgery could help reduce both muscle fasciculations (twitching or spasms) and myalgia (muscle pain) experienced post-operatively.

Central sensitisation is a key process underlying chronic or persistent pain. An experiment was done with rats, whereby a drug called fentanyl was administered to produce delayed hyperalgesia (a sort of “exaggerated pain”). This was to try to create an animal model of central sensitisation.  Administering magnesium to the rats partially offset this process, resulting in less pain.

In chronic pain, we know there is abnormal processing of sensation. This is part of the “syndrome”, if you like, that is chronic pain (regardless of where in the body you feel it). Certain receptors called the NMDA (N-methyl-D-aspartate) are involved as “gates” that help process this sensation. Activation of the NMDA receptor leads to abnormal processing of sensation – therefore increased pain. This effect – part of what is known as “central sensitisation” – has effects in the spinal cord, in an area called the dorsal horn, as well as in the brain itself. Magnesium is involved in blocking the NMDA receptor, so that process cannot take place.  This was shown in an experiment with rats with in whom neuropathic pain was induced. The rats developed something called “allodynia” (where a stimulus that is not usually painful becomes painful) and mechanical hypersensitivity (where touch or pressure feels oversensitive). Giving magnesium to the rats “fixed” the allodynia (i.e. made them not feel this abnormal pain to normal stimulus) and delayed the onset of mechanical hypersensitivity, and stopped the change that takes place at the dorsal horn of the spinal cord. Hyperalgesia and allodynia are two aspects of the pain experience that we test in women who have vulvodynia and similar pelvic pain conditions. This makes these findings especially interesting to anyone experiencing these conditions.

Another group of rats was subjected to treatment that creates hyperalgesia. In this experiment, opioid agonists were used to try to resolve the pain (drugs like morphine). The morphine didn’t work – except when the group of rats were given magnesium first, which enhanced the analgesic effect of the morphine. Morphine works in the brain – so it seems that magnesium helps the “brain side” of chronic pain.

Finally, a 2013 study gives us some nice findings on magnesium in neuropathic pain. A 2-week intravenous magnesium infusion followed by 4 weeks of oral magnesium supplementation can reduce pain intensity and improve lumbar spine mobility during a 6-month period in patients with refractory chronic low back pain with a neuropathic component.

Ultimately, magnesium is cheap and fairly harmless as long as you don’t have a kidney disorder.  It’s certainly worth using if you experience persistent pain – and judge for yourself whether it helps. Clinicians working with people with pain should also consider giving magnesium early – before the pain becomes chronic. This might save a whole lot of grief. Not all magnesium supplements are the same, however; absorption (and therefore effectiveness) varies markedly across the different forms. For help in choosing an appropriate magnesium supplement, contact us at Equilibria.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Nutrition: Nothing In Moderation (Except Moderation)

Posted: Wednesday, December 18, 2013 at 11:37:14 AM EST by Alyssa Tait

“You’re a nutritionist, tell us what we should all be eating!”

Well, I might be a nutritionist for short, but in actuality I’m a nutrition medicine practitioner.

Nutrition medicine: I’ve been practising this for nine years now, but still struggle to explain to people what it is. My patients know – because they are collaborating in a treatment program involving it. But the elevator spiel to the person next to me? I have yet to perfect it, or even create it.

So now let me make an attempt with a short anecdote.

I was in Melbourne recently, presenting at a conference on constipation and herbal medicine. I was on the bus back to the airport eavesdropping on a conversation next to me between an older man and a younger woman. The woman was a sports nutritionist, and the man was interested in the relevance of this to his horses.

The woman had to race off before the bus set off, as she’d left a package on her last bus. She got back on just in time and we exchanged joking pleasantries about her close call. The older man then chided her on the nature of the package, which was chocolate. The young woman defended herself by saying

“I’m a dietitian – I preach everything in moderation!”

Now I’m not sure whether she was speaking for all dietitians, but I thought this an interesting place to start on trying to explain what nutrition medicine is – and how it differs from dietetics.

I would describe nutrition medicine as an approach that counsels the opposite, that is:

Nothing in moderation (except maybe moderation)!

Nutrition medicine is based on individual nutrient requirements. I don’t recommend one diet for all people at all times. In fact, I am not in the business of giving general guidelines at all – and the closest I would go to this might be “eat more vegetables, especially greens”.

We are not all identical. We have different genes, different health issues and different “weak spots”. Nutrition medicine is about pinning down which of these weak spots are impacting on our health. Technically, we aim to identify what processes in the body are malfunctioning to allow symptoms to arise. These might be neurological (e.g. neurotransmitter production), endocrinological (e.g. thyroid hormone action) or biochemical (e.g. nutrient availability in the relevant tissue). All of these – not just the last – are influenced by the raw materials we provide the body with (that is, food and, specifically, nutrients). We can influence these pathways by the way in which we facilitate the availability of different nutrients.

That’s why I don’t believe in moderation.

Several pieces of fruit a day? Not if you have fructose malabsorption-related irritable bowel syndrome.

400ug folate for all? Not if you have the MTHFR gene polymorphism.

Daily protein requirement = body weight x 0.8g? Not if you’re recovering from surgery.

Just take a multivitamin? Not if you have a relative copper overload.

Six slices of wholegrain bread a day? Now, don’t get me started…

Nutrition medicine is a rational, scientifically-based adjunct to physiotherapy (or any medical, paramedical or non-medical therapy, for that matter) based on individual requirements. These individual requirements are determined from a combination of general or functional laboratory testing and the clinical picture. Yes, they are guided by research…but then modified for the individual.

But if anyone can come up with a good elevator spiel on what nutrition medicine is, I would be very open to hearing it!

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter

Going Gluten-Free: What You Should Do First

Posted: Tuesday, December 17, 2013 at 5:04:05 PM EST by Alyssa Tait

Gone are the days (I hope) that people believe gluten-free is just the latest fad.

It’s undeniable that many people, for many different reasons, feel much better on a gluten-free diet.

It is important that a person has a coeliac screen before going gluten-free. The reason for this is that if they go on a gluten-free diet and feel fabulous, they are likely to never let so much as a wheat cracker pass their lips again (which is great) - but this precludes ever doing a coeliac test again, as you need to be eating wheat in fair quantities for a coeliac blood test to be reliable.

 So why does the coeliac test matter?

It matters because there IS a difference between being coeliac and non-coeliac gluten sensitive. Coeliac disease brings with it some well-documented significantly increased risks of things like bowel cancer and osteoporosis. Non-coeliac gluten sensitive doesn't (though keep in mind research is in its early days.

So you need to know why you are removing gluten.

If you are coeliac, you need to be much stricter in order to avoid these risks. If you are non-coeliac gluten sensitive, you may choose not to consume gluten, but chances are, the occasional crumb from someone else's toast is going to find its way into your butter, and that may not do you serious  harm. If you are coeliac, this WILL do you harm, and you need to take extra measures to avoid it.

The second comment is this: non-coeliac gluten intolerance may be on the rise, but so is FODMAPS intolerance, which also causes digestive symptoms when bread is consumed. In one recent study of a group of patients with functional gastrointestinal disorders (e.g. irritable bowel syndrome), 60% had a FODMAPS intolerance! It is important we don't label ourselves as "non-coeliac gluten intolerant" when it is actually a FODMAPs intolerance we have, as this creates confusion and  scepticism about the concept of gluten intolerance, which doesn't help the kid with autism, the kid with diabetes, and all the rest of the people with genuine non-coeliac gluten intolerance. This is a bit like the impact that "pescovegetarians" or fish-eating vegetarians have on the genuine vegetarian movement - it dilutes the concept and makes it much harder for genuine vegetarians to defend their stance.

By all means let's get rid of the wheat and/or gluten out of our diets because it's great for our health and makes us feel good.

 But - let's leave it at that and not use research that may not apply to us to convince others. Or, alternatively, get yourself tested - make sure you are not coeliac, which carries its own special health risks due to unintended ingestion of tiny amounts of gluten - and see if the reason you feel better without wheat is a FODMAPs intolerance, which may then lead you to realise you also feel a lot better on a true low-FODMAPs diet, which requires exclusion of more than just gluten-containing foods.

I do need to add the caveat that coeliac testing is not as straightforward as it appears to be either. But that’s the topic for another post.

In the meantime, here is a link to a great educational web-event called the Gluten E-Summit, part of which is still being aired free, for around the next 24 hours. For access to an economical digital package which I would thoroughly recommend as providing some of the most up-to-date information on gluten from some top researchers, click here.

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About Alyssa Tait

Alyssa runs Equilibria Physiotherapy & Nutrition, a clinic focusing on integrative solutions for pelvic health issues including all types of pelvic pain, bladder and bowel control issues, fertility, and irritable bowel syndrome.

Alyssa’s website www.equilibriahealth.com.au is an information hub related to all things relating to the function of the female pelvis.

She aims to help as many people as possible restore balance to their pelvis through education, effective treatment and empowering lifestyle choices.

Alyssa enjoys playing the clarinet and rollerblading, though (much to the gratitude of her patients), not while she is consulting.

Connect with Alyssa  |  Facebook  |  Google Plus | linkedin | Twitter
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