If you have chronic pain, this episode is for you. Hi. I’m Dr. Chris Masterjohn of chismasterjohnphd.com. And this is Chris Masterjohn Lite, where the name of the game is “Details? Shmeetails. Just tell me what works!” And today we’re going to talk about a few things that can work for chronic pain. So, first of all, this episode is not about acute pain. If you get injured, then you need to wait for the injury to heal, or if it’s serious, you need to go to the hospital and have something done about it. We’re not talking about that pain, and in fact, I would say that if you have pain in response to injury, then you want to try not to treat it with anything. If pain is just a nuisance, then you shouldn’t be doing anything to relieve it because number one, that pain is an important feedback system for you. You know when you do things that hurt yourself, when you do things that cause pain, that’s feedback that, “hey, I shouldn’t do that,” and you might know that you shouldn’t do certain things that get you injured, but it’s feeding back not just at a conscious level, but at a subconscious level. And so interfering with that pain could interfere with basically learning how to not hurt yourself in the future, but far more importantly, and I would say this second thing is definitely true, that the first thing I’m kind of speculating, what’s almost certainly true is that the pain is an important feedback system for regulating the amount of inflammation you have. Your body is trying to fix something, but all the things that it’s doing to actively fix that cause pain and that allows your body to know when it’s going overboard in the amount of inflammation that it’s causing to fix whatever is injured. What we’re talking about in this episode is chronic pain, which is pain that after everything is said and done, everything should have been healed by now, but the pain is just still ongoing. If you have chronic pain, you certainly should, no matter what, talk to your doctor about it because there could be an underlying medical reason for that pain that must be addressed, and what I’m talking about here is definitely not a substitute for any potential medical treatment. In fact, your pain might have a very specific cause. It might have a very, be a very specific kind of arthritis that needs a very specific kind of treatment. I’m not talking about those things here, so definitely do seek medical advice about whatever the issue is. What I’m saying here is what are some of the relatively harmless nutritional strategies that you can try either number one, when there is nothing you can find about the specific cause of the pain, or number two, where you are seeking the appropriate treatment, you’re doing everything right, but you still feel like there could be some things that need to be jump-started in your body because the pain just isn’t going away as quickly or as completely as you think it should. So, here are my ideas, and these ideas are speculation built about what do we know about the neurological contributions to chronic pain, and what might work based on that. So first of all, we can separate this into central sensitizers to pain and peripheral sensitizers to pain. Central means anything inside your brain or your spinal cord. Peripheral means anything outside of the central nervous system, outside of your brain and spinal cord. Peripherally pain sensitization, things that make you more sensitive than you should be or get you stuck on that pain, is mainly driven by inflammation. And so that really comes back to resolving and healing inflammation. The last episode was about that. So, I would say first thing to do is go back to the last episode and go through the three potential ways to address chronic inflammation apart from dealing with the cause, and those are: get your essential fatty acids straightened out, especially DHA and arachidonic acid; number two is if you can’t deal with it with just that strategy, the second strategy is use Metagenics Specialized Pro-resolving Mediators, or SPM Active, as a supplement; and step three was use aspirin in conjunction with bicarbonate, glycine, and fish oil in the right way, and definitely don’t try that third protocol without going back and completely listening to the last episode in order to make sure that you’re combining those right. So that’s the first thing. The second thing is, it’s possible that using bicarbonate to raise your urine pH up to 7 in a more-or-less constant way through the day might help. And I say might because it’s definitely true that acid, meaning hydrogen ions, acidity is one of the major things that makes your nerves more sensitive to pain. What is questionable about the bicarbonate approach is that most of that acid that’s relevant is probably coming from tissue damage in the area right around the pain. So it’s not 100% clear that by alkalinizing and getting your—so if you get your urine pH up to 7, you are probably having a very, very, very, very tiny effect on your pH everywhere else in in the blood, in the circulation. And it’s possible that bumping that up might be able to provide a local buffer where that pain is relevant. So I would just say, try it and see if it works. To do this, I would start with a quarter teaspoon of sodium bicarbonate on an empty stomach and test your urine pH throughout the day. So, probably when you wake up, your urine pH is 5 point something, maybe it’s around 6, but it wouldn’t be unreasonable if it were a little below 6. After you eat your first meal and through the rest of the day, it’s probably going to be in the 6’s if everything is working right. You take a quarter teaspoon of baking soda, sodium bicarbonate on an empty stomach, see where that gets you into your urine pH, if it doesn’t get you up to 7, then you need a little bit more. If it gets you up to 7, you want to keep measuring it and see how long that effects last, you want to take your next dose at around the time just before when your urine pH would start dropping. So, it might take a couple days to figure this out, but you want to find a dosing schedule where you’re bringing it up to 7 overall. You could have a benefit by bringing it up higher, but I don’t recommend bringing it higher than 7 chronically because then you would be at risk for potentially pushing your body to alkaline, and there are some negative consequences to how you handle calcium in the blood as a result of that that could cause twitching and other issues like that. So, just get it up to 7 and try to keep it there and see if it helps. If that does nothing, don’t stick with it. If it does help, then I think it’s fairly harmless to, and it’s pretty cheap, to just keep taking the bicarbonate and maintain it there and see if it helps over time. I would just caution, don’t take bicarbonate on a full stomach. Take it away from food because the bicarbonate, apart from losing a lot by burping it out when you’re eating food, you might also hurt your digestion. Okay, so inflammation and acid-base balance are the two things peripherally that could help with the pain. What’s relevant centrally, meaning inside your brain and spinal cord? Here, there are a couple things that are relevant. Inside the central nervous system, probably what’s going on in chronic pain is that you’re laying down patterns that reinforce the pain, and you’re reinforcing those patterns over and over again to make them more stable. There are three strategies that I would recommend to try to minimize the degree to which you are laying down and reinforcing these patterns in your central nervous system. Number one is magnesium; number two is glycine; and number three is GABA. If you want more details about how these are involved in breaking down those patterns or preventing you from laying them down, see my long-form podcast Nutrition in Neuroscience, especially Part 2, which is coming out next week. If you want more information on how to manage magnesium, glycine, and GABA, I will post links in the description of this episode for more details, but briefly, for magnesium, I would use magnesium glycinate or malate, I would not go above 400 milligrams a day, unless you are testing your magnesium status with serum magnesium and red blood cell magnesium, both, and usually adding urine magnesium to the picture. If you don’t want to go through the testing, I would keep it to 400 milligrams. If you do— if you are willing to go through testing, then certainly you could experiment with doses that are higher than that. For glycine, 3 to 5 grams per meal or before bed are all acceptable doses, and instead of taking isolated glycine, you could also take collagen or gelatin. Generally you want to triple the dose when you’re taking collagen or gelatin relative to the dose of glycine. And then for GABA, I would try 100 milligrams to 800 milligrams per day. Now, I say all of these are relatively harmless strategies that you can try at home. Nothing is truly harmless to everyone, so if you have any reason to think that you might be sensitive to strategies like this, or you’ve never done it before, start small, make sure that you’re tolerating it well, and work your way up. This episode is brought to you by Ancestral Supplements Living Collagen. Our Native American ancestors believed that eating the organs from a healthy animal would support the health of the corresponding organ of the individual. Ancestral Supplements has a nose-to-tail product line of grass-fed liver, organs, living collagen, bone marrow, and more. All in the convenience of a capsule. For more information or to buy any of their products, go to chrismasterjohnphd.com/ancestral. This episode is brought to you by Ample. Ample is a meal in a bottle that takes a total of two minutes to prepare, consume, and clean up. It provides the right balance of nutrients needed for a single meal, all from a blend of natural ingredients. Ample is available in original, vegan, and keto versions portioned as either 400 or 600 calories per meal. I’m an advisor to Ample, and I use it to save time when I’m working on major projects on a tight schedule. Head to amplemeal.com and enter the promo code: CHRIS15 at checkout for a 15% discount off your first order. The audio of this episode was enhanced and post-processed by Bob Davodian of Taurean Mixing. You can find more of his work at taureanonlinemixing.com. All right. I hope you found this useful. Signing off, this is Chris Masterjohn of chrismasterjohnphd.com. This has been Chris Masterjohn Lite, and I will see you in the next episode.