Bring Up Pain – Where all of this hurt comes from

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I hurt myself constantly and I am certain you do too. I am so clumsy, though I am not sure why. Maybe I try to hurry up a bit too much, I hate wasting time by lingering on any task for too long. So, for example, I often end up hitting my big toe on one of the corners of the bed base trying to get out of bed in a hurry or cutting myself on a razor haphazardly left in the bathroom drawer when trying to find my eye cream. Other than hurtful to my ego, those experiences hurtful to my body, which leads to pain. Pain is always taken for granted. You are hardly waking up every morning dreading the idea that you’ll eventually experience it, but when it does finally happen you are neither surprise. Pain is experienced by most of us, but despite its universality, very few understand how it works. Actually, can someone please tell me what the heck is pain and how can I fricking get rid of it?

It took me many years of undergraduate studies and then graduate studies to finally understand its main mechanisms, which I will now share with you. I hope that by the end of this article, you not only come to understand pain, but to appreciate it for its complexity and its vital necessity. 

When you think about pain, probably you are thinking about it the same way I did before starting my post-secondary studies. I thought pain was the result of injury. You break your skin; it hurts. You hit your foot; it hurts. You fall; it hurts. You get my point. But that doesn’t explain the headache you got last week, nor does it explain the heartburn you got last time you ate greasy food. It’s easy to point fingers at possible culprits for our pain, but it’s not really clear why it causes the pain in the first place. Why does not drinking enough water causes me headaches?

So, let’s break everything into small steps. The very first thing your body does is feeling things, this is called perception. But when the body perceives something that may be hurtful to you, it becomes known as nociception. The body can sense things that are called stimuli (plural of stimulus) which is a fancy word for sensations. Those stimuli can be of thermal (heat or cold), mechanical (pressure or tension), or chemical (inflammation or toxins) nature. Then considering our example giving earlier, hitting my big toe, and cutting myself led to nociception of a stimulus of mechanical nature. As for the headache and the heartburn, it was from chemical nature. For the headache, there was probably not enough oxygen and for the heartburn, too much acid. 

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Now let’s look at this nociception closer. The changes are perceived by some detectors that we call pain receptors, or more specifically nociceptors. Those nociceptors can differ greatly from each other. They can have different endings which make them able to detect specific types of stimulus or they can also vary in size. The latter will influence how fast the nerve will carry the signal to the brain. It’s this difference in size that makes you sense two pain waves. For example, when you hit your toe. You first grab your toe, but it really was a few seconds after you grabbed it that the intense and sharp sensation started kicking in. This is because the large nerves carried the information related to location and nature of the pain faster than the smaller nerves. It’s those smaller nerves that were responsible to carry the information related to the intensity and emotional nature of the pain and is delayed. This whole process that we just went through is called transduction. 

After transduction there is conduction, which is for us step 2. This step explains how the signal is actually sent to the brain. It will probably not be any news to you, the signal is carried by nerves, or neurons. All these neurons are organized into something that resembles a family tree. In your family tree there are your siblings, your cousins and obviously yourself. All of them serve as an analogy for the first-order neuron or most commonly called primary afferents. As suspected, they stem from wherever you can feel (skin, ears, organs, etc.), and they end at the spinal cord. In your family tree, there are also your parents, your aunts, and your uncles. Those are like the second-order neurons, there are generally fewer than the previous group. They are located in your spinal cord. Then, you have your grandparents. Those are like the third-order neurons and are present from the end of your spinal cord to your brain. Simple, isn’t it? 

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After the signal has reached through all the three levels of neurons and finally the brain, then there is transmission. Transmission refers to the mechanism to which all different information will be sent to their appropriate processing section. Then an output signal will be produced and will be modulated depending on its intensity and its relevance. If the intensity is too much and is not relevant, the signal may be tuned down, or reciprocally up if the situation is reversed. So that makes up two steps: Transmission and Modulation.

The very last step is Perception, and it relates not to the initial perception we introduced when we talked about transduction, but to the final products that leads to a reaction. It is at that moment you grab your toe

So, if I try to summarize everything, first you feel; secondly, the signal goes through three levels of neuron up to the brain; thirdly, the signal is interpreted by the brain; fourthly, the signal is tuned by the brain and lastly it is sent back to the appropriate location to create a reaction. Normally, it takes all those steps to induce pain, but there are some cases where the pain seems to appear out of thin air. That pain is often said to be neuropathic. Where signals are generated in the absence of stimulus detection which is common in chronic muscular diseases. 

Reversely, there is another disease that leads to the inability to generate pain. Doesn’t that sound wonderful, right? People affected by congenital insensitivity to pain with anhidrosis (CIPA) would disagree. Pain is a protective mechanism that forces you to have a reaction when faced to a potentially harmful stimulus. Without pain, most people with CIPA will die before the age of 25. They usually end up burning themselves seriously, biting off their tongues or scratching to the bone, which could eventually lead to infection, which can also lead to death. These are only examples of things that may happen to you without the ability to generate pain. Pain is so important since it is there to avoid putting yourself under unnecessary harm. 

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Pain can also be split into two categories: acute and chronic. We talk about acute pain when dealing with a situation that is sudden and ephemeral (that doesn’t last in time). In contrast, we talk about chronic pain when it’s persistent in time, usually more than three months. So all previously mentioned pain examples were actually all acute, apart from chronic muscular disease. It’s neuropathic nature which tends to be difficult to treat, renders it a chronic disorder. Fibromyalgia is a good example for this, to learn more read Bring Up Fibromyalgia. 

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Now to avoid pain you have different strategies. You can simply take some analgesics like acetaminophen (Tylenol) or ibuprofen (Advil), and if the pain is really intense, morphine. There is also the placebo effect that is really strong in helping face pain. Grabbing your foot when you hit it also greatly helps since it creates some natural inhibition of the pain through a process called the gate control theory. Mindfulness has also been shown to be helpful by redirecting our attention to external stimuli. Obsessing over our pain is detrimental. At best, it blocks the downregulation of the pain and at worst it promotes its upregulation.

Now that you know where pain comes from, my advice to you is to accept it, to cherish it, to listen to it and to respond to it with kindness. Pain is a necessary evil that is an intricate part of life. Whenever you feel pain, remember that you are living, and most important, that you are living science. 

I thank you infinitely for reading this post and if you would like to know more about the mysteries that surround us, please join my subscription list to keep up with my newest content. If you have any questions, please add them to the comment section and I’ll make sure to answer as soon as humanly possible.

Bring Up Intermittent Fasting – What should my eating schedule look like

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Although I was, until most recently, studying the physiology of pain (see Bring Up Pain for more about this topic), it definitely wasn’t the only topic I was interested in. One topic in particular got my attention in the last couple years, Intermittent Fasting or IF. Its many mentions in multiple media platforms was enough to ignite a spark of curiosity, but it was certainly not sufficient enough to have me follow this trend blindfolded. However,  a careful study of the science and its effects from an extensive literature review got me entirely convinced of its benefits. I hate to be a sheep and follow the newest fad, but I have to say that this one might be totally worth trying out.

Being overweight never really felt like a terribly wrong physical state to be in. I like my body and I like that it has led me to have a different perspective on myself. In the last article (Bring Up The Beginning) I’ve mentioned that I was bullied, mainly because I was a full blown nerd, but another reason was my very thin figure. Some people were spreading rumors that I was anorexic. From bad to worst, my family doctor was insisting that I should gain some mass since I was below my intended BMI. However, it was really difficult for me to gain mass. I ate so much, and no, I didn’t purge. Though, I was very athletic, and it was, with hindsight, probably why I could remain so slim.

At the end of high school, I began receiving another type of attention from guys. They started flirting with me. It took me a couple of years to figure out that the only thing they were interested in was my appearance. This realization led me to despise myself, and I then really thought that no one really cared about me. This was definitely the darkest time of my life. Finally, my objective to gain weight finally saw some success and simultaneously I started to date this incredible man that despite my emotionally unstable predisposition was patient and caring. Unconsciously, I started to link gain weight to my potential to be loved and cared for.

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We have to face it. Life is not that easy. If only taking weight would be the solution to finding love then everyone would be aiming for it, I am right? Additionally, with knowledge came the realization that being overweight can lead to several health problems. Turns out, even though I don’t have a negative view of my appearance, I came to accept that I need to redefine what acceptable is. I can see that I will never be that very slim beanpole that I was in high school, ouffs! But I just can’t be ok with being 25 kg over my intended BMI. I understand that most professionals would suggest undertaking moderate physical activities, but it was simply impossible for me and trust me, I’ve tried. I am not saying that I’m abandoning the idea of physical activities forever. For now, I have limitations that make those very difficult to perform while aiming for weight loss. Meanwhile I have to say that I’ve tried outdoor running, at home workout and indoor yoga, none of them seemed suited for me, at least for now. 

Then one day I fell upon an online post claiming intermittent fasting as a healthier alternative for weight loss than stricter dieting methods. The following research I did surprised me. Not only is there scientific evidence claiming that IF can lead to weight loss, at least temporarily, but there are also plenty of other benefits that accompany the adoption of IF. Contrary to many promoted weight loss methods, IF is more of a lifestyle rather than a specific diet change. First, it doesn’t require you to add or suppress certain food. Second, it doesn’t ask you to keep track of your calorie consumption, and at last, you are in control of when you want to stop it or not. The only major difference with If compared to the usual eating habit is the timing of your feeding. Depending on the IF style you choose, you may have more or less freedom, but that decision is up to you.

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I am not claiming here that fasting a revolutionary novelty, but it has been studied very little over the years. Although, recently, there has been a great increase of fasting studies, that may probably have been caused by the reported advantages it could bring to people who have been fasting for cultural or religious reasons. Now, people are intrigued by the fasting phenomena and thus there was the development of a particular type of IF, which got named Time-Restricted Feeding. It is based on a schedule that dictates feeding period over 24-hour days. The most popular TRF are 14:10, 16:8, and 18:6. Those ratios represent how many hours you need to fast next to how many hours you can feed. Thus 14:10 is the most lenient and 18:6 the most stringent of the options mentioned above. The fasting windows might seem harsh, but while fasting requires you not to eat anything, you may still drink as much water, tea, or coffee as you’d like, giving the absence of any sugar or milk addition. There are also many other variations of IF, but it won’t be mentioned here. I personally prefer the 18:6 TRF since it was the technique that created for me the most benefits and the least negative side effects. 

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So, as I’ve mentioned, feeding is not restricted. You can eat as much or as little as you normally do. Yet, you will probably find yourself eating less overall, since you have a shorter eating window. Also, the hunger pangs that often lead to excessive eating and craving may disappear and get you to develop a more mindful eating. The first time I adhered to IF, it took me four days to notice the complete vanishing of hunger pangs. For you, it may take less or more time, but the idea is to stick with it and see where the process will lead you. Tips: Drinking more water really helps you manage your hunger pangs in the first few days. I usually kept with the program for a week before switching it up to allow me to better evaluate where the lacks where, if any.   

As for weight loss, I experienced a loss of 15kg in three months, but I can’t assure you that your loss will be the same, as everyone’s experience will be different. Still, don’t give up if you don’t see the number on your scale dropping. It could simply mean that it could take longer to see any difference. The differences that you will be able to notice are not only pertaining to your weight, but could also benefit your energy level, your concentration, your focus and reduce inflammation. On a more subtle view, it may also have protective effects against many illnesses, like diabetes, cancers, Alzheimer’s disease, heart diseases, and more. It may additionally help you fight ageing.  So even though you might not be interested in losing weight, you could still benefit greatly from adopting an IF approach. 

From the negative side effect perspective, IF could potentially lead to malnutrition, the development of eating disorders or mood changes. Those side effects are triggered by either an over-management of your feeding habits by excessively restricting your eating and/or by not listening for what your body really needs. Malnutrition can be avoided by making sure you eat enough vitamins and nutrients from the different food groups. If you have a very negative self-image triggered by your weight, please abstain from adopting IF, and please I strongly recommend you to ask help from a psychologist or a physician before attempting any feeding habit modifications. If your mood becomes the issue, like becoming irritable, angry, etc., those are normally indicative that you are not consuming as much calorie as you should and I would definitely encourage you to either change your intermittent fasting to a more lenient variation, increase your meal size and/or add snacks between your meals. Warning, please never ever fast intentionally for a period of more than 25 hours or more than 18 hours for consecutives days as it may lead to severe health issues. 

I thank you infinitely for reading this post and if you would like to know more about the mysteries that surround us, please join my subscription list to keep up with my newest content. If you have any questions, please add them to the comment section and I’ll make sure to answer as soon as humanly possible.