One of the things I hear a lot of in My 600 lb Life is “I can’t exercise more because it hurts!” As easy as it would be to dismiss these patients being quitters or lazy or “insert negative comment here,” this one is actually something that makes sense. Pain is our body’s way of telling us that whatever you’re doing is not a good thing. It seems pretty obvious: you touch a hot pan, it hurts and you let go; you try lifting something that’s way too heavy, your back hurts, you put it down. It seems pretty straightforward. Even my workout instructors tell me “if it hurts, stop immediately,” but then there’s usually her little caveat: “discomfort is okay but pain is not.” Discomfort?? Okay, so how do we tell the difference between pain and discomfort??
This is the key to the miscommunication with pain. If you’ve been sitting on a plane (or car) for three hours straight and you finally arrive, you are going to be a little stiff getting up and walking. (There is a pretty interesting explanation for this but it’s a whole different blog post!) Stiffness is pretty obviously discomfort, but when these patients tell Dr. Nowzaradan that it hurts to walk and they can’t walk because their knees/ legs hurt, they are honestly reporting the truth. They are listening to their bodies but they are not understanding what their bodies are telling them. What they are actually interpreting as pain is actually discomfort in most cases. There are patients who do have knee damage (due to their weight usually but sometimes other reasons) and they need to have their joints replaced or repaired, but most of them are simply feeling the effects of being immobile for so long, like when you’ve been stuck in that car for 3 hours- only magnify it by several years! Joints and muscles and tendons and other structural parts used to move the body have essentially rusted into position. Like any tool, the more you use it, the easier it is to use. It’s used to moving and being flexible, but since these patients move as little as possible, their joints are used to disuse and any motion often feels like pain to them. If you are normally a mobile person who has been stuck in a tiny plane seat for several hours, you know when you get up, you are going to be a little stiff. If you play basketball for three hours straight, running and jumping up and down the court, you know your muscles are going to be sore afterwards. This is normal and you know it’s discomfort and not pain because you are a mobile individual. These patients are not normal mobile people. For example, I recently had two workouts back to back which really concentrated on my upper arms and shoulders. The muscles got really tired during the first workout and the next morning they were a little sore. I didn’t think I’d hurt myself or that I was in pain because I knew it was from the workout; I was a little leery of working them out again that evening because I knew they would be very sore later on, but I didn’t think I was going to hurt myself. I’m definitely not a fit or athletic individual, but I move as much as I can. I knew I was feeling discomfort from having worked them hard when they are not used to it. (If anything those two workouts convinced me that I definitely need to work on my upper arms more often!)
Dr. Now usually tells his patients that the more they move, the less they will hurt and many of them are surprised to find out this is the truth. I know this is true for my arthritic knees; for me there is a sweet spot between moving them the way they need to be moved, moving them too much and causing actual pain and not moving them enough so they end up frozen. This is an actual danger with my knees: immobility breeds immobility. If I don’t use it, I’ll lose it- truly! I had been using a treadmill, but while walking is good, the impact on my knees was causing pain and more damage, hence the water aerobics I do now. Still lots of motion and use but much less impact. In fact, many of Dr. Now’s patients end up in the pool in water aerobics.
This is one of the ways we misunderstand what our bodies are telling us. For many of us who are getting back to being mobile, or starting different kinds of workouts for different muscle groups, it really is a tough call distinguishing between discomfort and pain. I know in my case, I was mistaking the painful knees from the treadmill as just discomfort and one of the reasons I saw my doctor is “why isn’t it going away? Am I doing something wrong?” (Yeah!! Hello!!) But sometimes this is what we have to do: if the “discomfort” isn’t going away or is getting worse, maybe it really is pain and you should see your doctor. You need to find your dividing line between the two.
One of the most common miscommunications between our bodies and our brains is when we are “hungry.” You would think this would be another easy lob, but it’s not. (When you get right down to it, it’s a wonder we understand anything our bodies are telling us!) Most of us feel “hungry” for a variety of reasons:1) we really are hungry because our bodies need fuel;2) we smell food and our digestive tract starts preparing to digest it by secreting saliva and stomach acid, resulting in the feeling of hunger; 3) we’re actually thirsty but our brain is interpreting it as hunger; 4) our stomach/ body is used to being fed at a particular time and so it’s “preparing to be fed,” like when you end up eating a meal hours later than usual; 5) if you ate something with a lot of refined/ simple carbs and/ or sugar, once your blood sugar drops, sometimes lower than before you ate, so your body will usually signal that it wants to raise your blood sugar again, usually about 2 hours after you ate the carb-heavy food. This is where we need to decode the message our body is sending us. For me, once I feel hungry or my stomach starts growling, I start asking myself questions: a) (if I’m at the office) did my cubicle neighbor just sit down with his lunch/ snack and am I reacting the aroma of his food? (usually YES!!); b) is it 10:30-11:00? This is when I tend to get coffee and I add a little cream, so my stomach is probably letting me know it’s expecting coffee (the same thing happens between 3:30-4:00 when I get something to drink on my way home); c) is it “lunchtime”? I usually have breakfast around 7:00 a.m. , so by noon, it’s been about 5 hours since I ate & it could be a real request for fuel; d) did I eat a lot of carbs and not a lot of protein/ fat, so my body is reacting to the low blood sugar? If that’s the case, I definitely ignore the hunger or I eat something high protein; e) have I had anything to drink other than the coffee at breakfast? If not, I have some water and wait a while to see if I’m still hungry.
This might sound like too much work for a simple growling stomach, but for me, one of my problems when I was living my fat default lifestyle was that I always felt hungry and I was always confused about should I eat or should I not. I found out later it was because I was doing a lot of the “low fat- high carb” FDA approved (FEDERAL DISASTER ADVICE in my humble opinion!) dietary suggestions. I was not getting any kind of fat (good or bad) as a fuel source in my diet and was eating a lot of the refined grain products (those simple carbs mentioned above) so my blood sugar kept spiking and tanking and my body was trying to keep it even, so eat carbs-get hungry-eat more carbs-get hungry again and the result was I gained weight and had constant blood sugar issues and fatigue. (Thanks, FDA!!) Now when I feel hungry, I run through my little list, determine what the “hunger” message actually is as best I can and try to react appropriately.
One of the other ways our bodies talk to us is with food sensitivities and inflammation. This is linked to a whole plethora of possible problems depending on how long the inflammation and sensitivities have been going on. This is the biggest and most difficult problem of all to solve. Doctors are discovering that inflammation is usually linked to a lot of autoimmune disorders, including things like rheumatoid arthritis, irritable bowel syndrome (IBS), fibromyalgia and thyroid dysfunction, among others. Usually it begins with leaky gut/ intestinal permeability. The foods we ingest are absorbed in our small intestine. If the lining of the small intestine becomes inflamed, undigested foods and other irritants can slip through the lining and end up in our blood stream, but since they haven’t been properly “absorbed,” our immune system treats them like invaders and over time, our immune system becomes hyper-reactive and starts attacking things it shouldn’t be attacking. What’s worse is that some of the invaders it might be attacking look very similar to hormones or tissue that belong in our body and it starts attacking them. This is very common in people who are sensitive to gluten: the protein that causes problems in gluten (gliaden) looks very similar in molecular structure to our thyroid hormones and eventually, the immune system can end up attacking your thyroid, ultimately causing problems there.
The problem with food sensitivities and inflammation of your small intestine is that you don’t usually feel that inflammation. It doesn’t give you a stomachache or cramps or abdominal pain (usually). It manifests in other ways: usually something not related to your bowels becomes inflamed. I know in my case, my knees were causing me pain and I wasn’t doing anything different activity-wise. I was doing my regular water aerobics, walking the same amount of steps, not taking stairs, so I was a little confused. Then, I remembered that I had started taking fish oil supplements again. There have been recent reports that since fish oil supplements (Omega-3 fatty acids) aren’t well regulated, some of the supplements on the market are actually rancid, which creates the inflammation they are supposed to suppress. I stopped taking them for two weeks, my knees got better; I started them up again, and within a week, my knees were hurting again. I stopped and threw them out and no more knee pain. If I hadn’t heard those reports, I would probably still be taking the fish oil, still having painful knees and probably just be thinking it’s my arthritis.
This is where a lot of people are: they have something that hurts and they don’t know it’s something they ate. In some cases, it’s pretty easy to notice: every time you eat dairy and you have gas and cramping and diarrhea. My sister is sensitive to cherries: she eats them and she starts coughing usually within a few minutes. But most things are like my fish oil. There’s no direct link between me taking my fish oil every morning or evening and my knees hurting all day. Even worse, unless the reaction is something serious or extremely disruptive, we don’t go see the doctor to see if we do have a food sensitivity. This situation is compounded by the regular and continued irritation of the small bowel. We all know what happens if you have a cut that goes not only untreated, but is continually aggravated. You cut your hand and don’t clean it or put a bandage on it and every day, you use your hand, re-opening the wound and getting it dirty and still don’t treat it. It becomes infected and only once it’s a real problem do you seek treatment for it. The problem with that scenario is by then it is a major health issue, which in the case of leaky gut can be a thyroid condition or an autoimmune disorder
I’m not telling you to run to the doctor to take a food sensitivity test. You have to be the judge of your own health situation. If you aren’t having any problems or something that you think might be a problem, then there’s no need to worry. You can do your own little experiment if you want by simply eliminating some of the common food allergens out of your diet for two to four weeks (unfortunately it has to be a complete elimination- code for “no cheating!”) and see if you notice any changes. If you feel better or something does change, add one thing back for a couple weeks and see if you feel any different. If your headaches or whatever symptom comes back, you are probably sensitive to whatever you added back. Make a note, eliminate it again (like my fish oil experiment) and move forward with another one. Some of the most common allergens are gluten (wheat), dairy, eggs, nuts, seeds, legumes (including peanuts), caffeine, corn, and GMOs (genetically modified foods/ organisms). This is not comprehensive list, so if you want to try this, try googling common food allergens. A lot of times people who are sensitive to gluten are sensitive to other foods that have similar-looking proteins, like in corn and dairy, so if you are sensitive to gluten, you may have to give up those as well. Sometimes, after you have stopped the constant irritation of your intestinal lining and your immune system calms down, you can go back to eating these foods (maybe the dairy and corn but not the gluten), and other times you can’t. You need to decide what is best for you. In my case, I’m a little lactose intolerant,(yeah, totally not fudging there -eye roll!) and when I went Paleo I stopped eating any dairy months (even the cream in my coffee- which nearly killed me!) and eventually, months later, I found I could have small amounts of it, but when I had more than a few ounces every day, I started feeling the effects again. I know that I really should eliminate it entirely, but what can I say? I like living dangerously! (And it may come back to bite me in the end!)
I’m doing the best I can to decode my body’s messages to me. Some of them are still pretty mysterious and I have no idea what it’s trying to tell me, but I’m still trying! The only way we really know if we’re doing what’s right for us and our health is to listen to our body. It’d be a whole lot easier if it spoke in a language we can easily understand, but it’s doing the best it can. The least we can do it is listen and not ignore the signals it’s sending us!