Gut Health: A Look Inside Reveals That What You Eat Can Affect Your Pain

An explanation of the microbiome, how it correlates with pain, and its relation to opioid withdrawal symptoms.

It’s hard to avoid any mentions of gut health these days. Since the discovery that our gut, and subsequently our immune system and even our brains, are influenced by trillions of microbes, scientists have begun searching for ways to manipulate the human microbiome to alleviate a variety of conditions, including pain conditions.

What, Exactly, is the Microbiome?

The microbiome refers to the ecosystem lining the large intestine – yes, there is an ecosystem residing in there. This area includes resident bacteria, viruses, fungi, and other life forms, along with their genes. The gut microbiota refer to the actual “bugs” themselves, the community of beneficial organisms that coexist to help our immune systems ward off infections, among other things. As the second largest metabolic organ in the human body, the gut harbors trillions of microbes belonging to more than 1,000 different species and weighs about 1.5 kilograms, or 3.3 pounds.1

Photo Credit istock Photo TLFurrerThe gut microbiota can modulate, or tweak, the gut-brain axis, which enables them to influence brain function and pain sensation. (Image: iStock)

How the Gut and Brain Work Together

Your gut and the brain can communicate with and influence each other through immunological, neural, and hormonal signals, a concept known as the gut-brain axis. The gut microbiota can even modulate, or tweak, the gut-brain axis through these pathways, which enables them to influence brain function and pain sensation.

Researchers are finding that imbalances in the microbiota-gut-brain axis can lead to metabolic and cardiovascular disease as well as certain neurological diseases (eg, Parkinson’s disease, autism, Alzheimer’s), depression, and chronic pain.2

The gut microbiota can also regulate visceral pain – this is pain that comes from internal organs, such as that caused by irritable bowel syndrome (IBS).3

One recent study showed that a diet high in FODMAPs, that is, carbohydrates and sugar alcohols found in certain foods like wheat and beans, can cause digestive issues in some individuals. Clinically speaking, FODMAPs stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols.” Research shows they can cause changes in the microbiota that result in inflammation, leading to bloating, gas, and even diarrhea, in people with sensitive gastrointestinal tracts.4    

Your Gut Health May Be Influencing Your Pain: From Migraine to Fibromyalgia

Scientists have known for some time that gut microbiota play a role in the development and maintenance of chronic pain. They are now looking into the mechanisms involved and how to best intervene or “disconnect” those relationships.

For example, inflammation and the nervous system’s influence on the gut are thought to play an important role in how migraine develops but until recently, how this occurs has been unclear. New research shows that imbalances in the gut microbiota contribute to migraine-like pain by driving up the production of a specific protein called tumor necrosis factor-alpha (TNFα), which promotes the onset of inflammation in the trigeminal nerve system.5 The trigeminal nerve controls sensation and movement in your face, enabling you to bite and chew.

Researchers are also beginning to study whether certain alterations in the microbiota could predispose someone to fibromyalgia syndrome. Amir Minerbi, MD, at the McGill University Health Centre in Montreal, Canada, together with his team compared the microbiomes of women with fibromyalgia with those without the syndrome to determine whether there might be some identifying factors, such as diet or medications, that could distinguish the two groups.

They found that rather than differences in diet, medication, physical activity, or age, it was the degree of pain, fatigue, or cognitive difficulties the patients experienced that determined the variations in their microbiota.6 The investigators plan to conduct additional studies to determine whether changes in bacteria play a role in the development of fibromyalgia.

The Microbiome May Also Affect How Your Body Reacts to Opioid Withdrawal

Researchers are going a step farther to see if they can manipulate the microbiome as a way to combat the lingering anxiety and depression a person goes through during opioid withdrawal During withdrawal, the gut and the brain become inflamed, causing anxiety, heightened pain sensitivity, and cravings. Relapses can be triggered for years. Anna Taylor, PhD, and her colleagues at the University of Alberta, Canada, explained, “There is evidence that restoring the [altered] microbiome can relieve the anxiety and depression associated with opioid withdrawal and help individuals remain drug-free.”

Specifically, Dr. Taylor and her group used mice to explore the relationship between opioid use and misuse. They found that while any morphine treatment altered the gut microbiota, intermittent morphine (compared to sustained morphine) actually produced a daily state of withdrawal leading to the brain inflammation, heightened pain sensitivity, and impaired reward processing commonly associated with opioid withdrawal.7

Dr. Taylor added, “It is certainly interesting to look at dietary interventions, such as omega-3 fats and probiotics, to restore the integrity of the gut barrier that is lost during opioid withdrawal. The inflammation that occurs following withdrawal may be relieved with an anti-inflammatory diet that is rich in fiber. As the fiber is fermented by the gut bacteria it can help restore microbial diversity and ultimately restore the integrity of the gut.”  

Another recent study in mice showed that the long-term anxiety generated by opioid withdrawal may be offset by dietary supplementation of omega-3 polyunsaturated fatty acids. The beneficial effects of the omega-3 fats on the microbiome may offset the effect of opioids on the gut-brain axis.8

What Foods Can I Eat to Help Restore My Microbiome?

In general, a healthy microbiome is maintained by lifestyle choices that promote microbial diversity and prevent damage to the microbiome and gut. Eating foods high in sugar and refined carbohydrates are associated with a “leaky gut” and increase damage. Such damage leads to inflammation, which, in turn, affects the brain, and its pain response.

However, feeding the microbiome with high-fiber foods, such as whole grains, legumes, nuts, and seeds, as well as omega-3 fats can help lower such inflammation. The gut needs probiotics, such as those found in fermented foods like yogurt and sauerkraut, to increase the microbe population in your body, and prebiotics, which are found in fiber-rich foods like apples, bananas, and broccoli, to stimulate the growth of the healthy microbes.

Not surprisingly, exercise to promote cardiorespiratory fitness, stress management, and adequate sleep round out the lifestyle recommendations to maintain a healthier gut and pain-free body.

Updated on: 05/14/20
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