How to Make Your Own "Marijuana"

What's up with Marijuana and Pain?

I have at least a few patients per week ask my opinion on marijuana for chronic pain. It's all over the media, and certainly running around in many Facebook groups for pain sufferers. So, is there really anything to this? Actually, there is. With a quick medical literature review, one can find oodles of legitimate research about marijuana, its effects on pain, and its ability to augment the effects of opiate narcotics. The better question is "Why is it still an "investigational" drug?" Unfortunately, I don't have any power over the regulation of medical marijuana. However, I and many of my colleagues are pretty convinced that there's enough evidence for marijuana's benefit in pain management to make a good argument for a change in its drug status.

Do I recommend marijuana to my patients?

Honestly, it's a little tricky to answer this one, since marijuana itself is illegal in many states at this time. My opinion about it's effect on pain doesn't necessarily lead to recommending its use. What I mean by that is, I don't want my patients to get arrested. And there are undesirable side effects of smoking or ingesting marijuana.

In Texas, marijuana possession is still punished pretty severely. There is a very restrictive law allowing low-THC, high-CBD in Texas, of which some people are taking advantage. A lot of states, however, have laws regarding marijuana and its derivatives making it quite legal. About half of the States allow marijuana in some form, either broadly legal for recreational use, or for specific cases such as epilepsy or cancer.

What's the difference between marijuana, CBD, and THC?

Marijuana is the whole cannabis sativa plant. It contains two active substances called tetrahydrocannabinol (THC) and cannabidiol (CBD). Both of these interact with receptors in your body and brain, but in different ways.

THC is the major psychoactive substance, meaning it's what causes the "high" you get when you smoke marijuana or ingest it. It mimics the effect of two natural chemicals that your body makes, anandamide and 2-AG. It also is the substance that is thought to be detrimental to your health. It has an addiction potential, alters brain development in teens increasing the risk for substance abuse (gateway drug theory), increases chances of psych issues like schizophrenia, reduces school grades and overall lifetime achievement, and makes it more likely for you to get in a car accident (especially if you're drinking alcohol too).

CBD oil is the non-psychoactive substance. It actually looks a lot like THC in its chemical make-up, but the bonds are a little different. This prevents it from creating the "high", and also reduces pretty significantly the undesirable side effects of THC listed above. It has been shown in clinical research to have a mostly positive effect on:
Nausea and vomiting
Appetite (increasing it in cancer patients)
Pain
Anxiety
Sleep

I can make "marijuana"; so can you!

I must admit, you and I don't really make marijuana, per se. But our bodies and brains make two substances that activate the same receptors as marijuana. Basically, if marijuana creates an effect in the brain, then it is activating a receptor. Those receptors are there because our bodies make chemicals that bind to them. The chemicals I'm talking about I listed above, anandamide and 2-AG. These are naturally made by your body and bind the endocannabinoid receptors in your body, spinal cord, and brain.

Activating endocannabinoid receptors does a few things, one of which is reducing pain sensitivity. It does this by down-regulating pain sensors, and also by augmenting the effects of natural and synthetic narcotics.

How do I make marijuana?

Again, it's not really marijuana you're making. But the best way to get your body to release the endocannabinoids anandamide and 2-AG seems to be with exercise. Have you ever heard of the "runner's high"? Literature points to the feelings of wellness and euphoria after intense exercise being linked to release of endocannabinoids. Long distance runners will tell you that it's addictive, that they feel calm and relaxed after running. In studies, patients have a higher tolerance to pain after exercising. So, exercise is kind of like smoking a doobie. It helps you relax, and alters your perception of pain. Natural weed!

Should I get CBD Oil for my Pain?

Again, I can't recommend something that is illegal in many places. I can say that if your state has legalized use of marijuana, that there is proven medical benefit of CBD oil on pain perception. Take that for what its worth. I do, however, highly recommend using exercise to create the same response. Exercise has all sorts of benefits other than activating cannabinoid receptors. Obviously, it helps with weight loss, maintaining healthy bones, and heart status. It also improves your microbiome (see You Feel What You Eat). So, get out and exercise! And maybe consider CBD oil if it's legal in your state.

References
https://www.cnn.com/2018/04/29/health/medical-marijuana-opioids/index.html
https://www.ncbi.nlm.nih.gov/pubmed/29513392
https://www.thelancet.com/action/showPdf?pii=S2468-2667%2818%2930110-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302052/
https://statelaws.findlaw.com/texas-law/texas-marijuana-laws.html
https://cbdoilreview.org/cbd-cannabidiol/thc-cbd/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827335/
https://www.ncbi.nlm.nih.gov/pubmed/21175589
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724924/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724924/pdf/v038p00536.pdf

Fight Pain with Happiness

Your Mindset Matters!

In our hurried, anxious society it’s hard to be happy. It takes work and creativity to enjoy ourselves. But did you know that happiness helps reduce pain?

How is that possible? Well, pain is very context driven. The brain only perceives pain when it makes sense, under the right context. The whole purpose of pain is to alert the brain to possible tissue damage, so you’ll react - like move your hand off a hot stove. When the context is wrong, i.e. you’re happy and enjoying yourself, the pain signals don’t make sense and the brain assumes they aren’t as important.

The way to interfere with pain is experience more happy emotions and less unhappy ones. Pain is processed faster when it’s linked to an unhappy emotion like fear, guilt, anger, disgust, hatred, or rejection. The brain assumes that if you are unhappy, the pain signals may be more important. Pain is processed slower when it’s linked to positive emotions like:

-Happiness
-Love
-Calmness
-Interest
-Enthusiasm
-Passion
-Gratitude

 

Mindfulness

How do you experience these emotions or more of them? Mindfulness!

Being mindful is focusing on something intently. This can be your breathing, your blessings, or any other happy thoughts and things!

Focusing on the bright side

Didn’t get a front row parking spot at the store?
Bright side: Exercise!

Raining out today?
Bright side: No need to water the plants!

Savoring

This is my favorite.
Savor a good book, a pleasant smell, or the hug and laughter of your partner and kids.

Smell the Roses

Stop and enjoy all the little things like a nice day, a helpful stranger, or a beautiful rose!

Positive Thinking

Write down and save your positive thoughts. This simple act has been shown to reduce pain. It may help change your thinking from negative to positive, which can change your whole focus.

Volunteering

Helping other people has been shown to reduce pain. Volunteer at your church, local food pantry, Big Brother/Big Sisters, or your local library. It’s all good for you!

Journal about Thankfulness

Actively writing (with a pen - not on the computer) is linked to a positive mindset and lower pain.

Acts of Kindness

Little acts of kindness can actually make a big difference in your pain. So buy a cup of coffee for the guy behind you in line, hold the door for someone, or help an elderly shopper with his/her groceries.

Laughter

It’s just like they say: Laughter is the best medicine. Watch a funny movie, go see a comedian, or swap funny stories with friends or family. Laughing actually releases natural painkillers (the good kind that don’t cause the brain’s reward systems to misbehave!).

Make a Deposit in your Positive Memory Bank

Thinking and talking about happy times in your life creates positive emotions, which helps reduce pain. Look at baby pictures, wedding photos, or talk about the good ol’ times. You get the idea. Think of what warms your heart and work to increase it. If you succeed in focusing on the positive, and stop focusing on the negative, your brain will follow suit.

For best results, you should seek help from a pelvic pain specialist. Your specialist can untangle where your pain is coming from and recommend the right treatment for you.

The Sources of Pain

The Source Makes a Difference

Why do we even have pain signals?

You'd think the whole world would be better if we just didn't have pain at all. But it's simply not that easy. Pain is actually really important. The whole purpose of pain is to alert your brain to possible tissue damage, so you move your hand off a hot stove. People who have spinal cord injuries sometimes get a cut where they can't feel it. The cut then becomes infected, and the person doesn't know until they're really sick with high fevers and possibly sepsis. It's important for our bodies to be able to feel pain to keep us safe.

Where do pain signals come from?

Pain signals related to tissue damage start with activation of something called nociceptors. These are sensory neurons all around your body that fire when there's possible tissue damage. They are easier to activate when there's inflammation and immune system activation hanging around. These two things are what help your body heal wounds and prevent infections. It makes sense that when your body is trying to fight an infection, you might want to know about it. 

 When your body is sending pain signals related to possible damage, the signals can come in different kinds of flavors:organ pain and non-organ pain. 

Pain coming from internal organs

Organ pain comes from internal organs such as your stomach, gallbladder, uterus, ovaries, intestines, and bladder.  

Pain signals from your organs mostly come from the organ being stretched (such as your stomach when you eat too much), lack of blood flow (such as your foot “going to sleep” when you sit on it), and inflammation (caused by illness or injury).

Acute pain* from an organ can be caused by appendicitis, a hot gallbladder or a heart attack. It may be accompanied by symptoms such a tightness or squeezing fullness, being pale, sweaty, or feeling a sense of impending doom. Heart attack symptoms also may include pain in the left arm, shoulder, neck, and jawline. Acute pelvic organ pain is most often felt with bladder infections or period cramps. 

Chronic pain** from an organ tends to be more like a dull ache, discomfort or nausea that won’t go away. The pain can fluctuate. When it is bad, you can have nausea and sweating. When the pain lessens, you’ll experience a more general discomfort. Perhaps you’ll feel a constant need to urinate or empty your bowels. These sensations are common.

Pain coming from other places.

Pain from skin, muscle, bones, joints, and ligaments is considered non-organ pain. These are usually a little easier for your brain to figure out. The neurons in these locations will fire with almost any unpleasant sensation; stretch, heat, cutting, inflammation etc...

In your pelvis, though, the pain signals get mixed up with the organs, making it especially hard for your brain to figure things out.

The pelvis is a tight area, with lots of stuff in it, including your bladder, uterus, tubes, ovaries, bowel, muscles, nerves, and fascial tissue. The body has to transmit information from all these things to the brain for processing. Because it's such a tight area, there's only a few spots in the spinal cord that are available to transmit ALL of this information. Once the information gets to the spine, the pain signals all get thrown in together. What your brain reads is "there's pain somewhere in my pelvis". Every body feels that different. Some people feel it as bladder pain or bowel pain, some feel it as ovary pain.

What is pelvic and intimate pain, and what can be done about it?

Pain specialists define pelvic pain as anything that hurts between your belly button and mid thighs, front and back. (See What’s in the Pelvis?). Intimate pain is anything that hurts in your genital region, including pain with sexual intercourse.

You may have been told at one time that your pain is “all in your head,” or you’re “blowing things out of proportion.” But rest assured, chronic pelvic and sexual pain are medical problems.

Seeking help from a pelvic pain specialist is the best approach to help diagnosis and manage pelvic pain. S/he can teach you how to get your brain and body to stop making your pain worse than it needs to be.

* Acute pain is defined as a one-time or brief event

**Chronic pain is defined as lasting from a few weeks to more than six months

References:

1. Aredo J, Heyrana K, Karp B, Shah J, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Seminars in Reproductive Medicine. 2017;35(1):88-97.
2. Huang L, Kutch JJ, Ellingson BM, Martucci KT, Harris RE, Clauw DJ, Mackey S, Mayer EA, Schaeffer AJ, Apkarian AV, Farmer MA, MAPP. Brain white matter changes associated with urological chronic pelvic pain syndrome: multisite neuroimaging from a MAPP case-control study. Pain. 2016;157:2782-2791.

How Your Body and Brain Process Pain

How Your Body and Brain Process Pain

Pain is processed differently, depending on its source.

When pain is generated in your body, it is transmitted as a signal to the spinal cord, past several gateways, and then to the brain where it is finally processed. Once the brain decides the signal warrants a response, and what kind of response, it sends a signal back down to the body for a reaction.

Here’s a simple diagram:



Copyrighted 2018 When It Hurts Down There

One time, brief pain

When the pain is a one-time or brief event (also called “acute”), the signals follow a path like the one pictured here. For instance, if you burn your left hand with a curling iron, the cell damage in your skin is the instigator of the pain signal. The signal goes to your spinal cord, which sends the signal up to your brain.

If your lower midbrain decides the signal is important, the signal gets passed on to the midbrain. These gateways decide how bad the pain is and relies on the upper brain to confirm: it’s your left hand; the pain is moderately intense; and that it’s a burn and not a cut. The brain then sends a signal to your right hand to move the curling iron away from the skin and to put your left hand under cold water. This all happens in a split second.

Chronic, lasting pain

With chronic (constant) pain, weird things happen with the pain signals in the body. When the same nerves in the body have to fire over and over again, they’ll yell for help by releasing nerve-recruiting chemicals.

When you get the experience of pain over and over again, the brain can’t tell if it’s dangerous, and the nerves in the brain can start overreacting.

For example, the body may think there’s damage, such as inflammation, immune system activation, or an abnormal nerve signal. So the pain-processing nerves in the brain think that they too need more help. They start recruiting their brain neighbors to help process the pain, and make more connections and branches. This “neighboring help” may partly be driven by inflammation and stress that can result in high levels of inflammation chemicals and stress hormones. All this activity from the constant pain can make the brain more sensitive to pain.

With pelvic pain, the brain doesn’t know exactly where the pain signals are coming from. When you have chronic pain in your pelvis, your body may not have to send a signal to the brain to get a reaction. It can just start reacting on its own! And the brain can also get mixed signals from the “neighboring help” and link things like your daily bodily functions, touch, and movement to the pain.

Think of the pain signal in your body acting like a fire alarm.

Normally a fire alarm goes off only if there's smoke or a fire. You wouldn’t expect the alarm to sound when you simply light a match or turn on the stove. Normally you wouldn’t expect pain because of average bodily functions, such as having a bowel movement or coughing, or when you have sex. But when your body and brain get overly sensitized to the pain, bodily functions, normal touch, and movement will now cause pain too.

As a result, your “alarm” will go off randomly, even when there’s nothing happening!

Seeking help from a pelvic pain specialist is the best approach to help diagnosis and manage pelvic pain. And given the complexity of the pelvic area (See What’s in the Pelvis?), pain is often in more than one site. Your specialist can untangle where your pain is coming from and recommend a course of treatment.

References:



Hampson JP, Reed BD, Clauw DJ, Bhavsar R, Gracely RH, Haefner HK, Harris, RE. Augmented central pain processing in vulvodynia. J Pain. 2013;14(6):579-589.

Janicki T. Chronic pelvic pain as a form of complex regional pain syndrome. Clinical Obstetrics and Gynecology. 2003;46(4):797-803.

Mercier C, Léonard G. Interactions between pain and the motor cortex: Insights from research on phantom limb pain and complex regional pain syndrome. Physiother Can. 2011;63(3):305-314.

Kim W, Kim SK. Neural circuitry remodeling and structural plasticity in the cortex during chronic pain. Korean J Physiol Pharmacol. 2016;20(1):1-8.

Aredo J, Heyrana K, Karp B, Shah J, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Seminars in Reproductive Medicine. 2017;35(1):88-97.

Lee Y, Park K. Irritable bowel syndrome: Emerging paradigm in pathophysiology. World J Gastroenterology. 2014;20(10):2456-2469.

Schrepf A, O’Donnell MA, Luo Y, Bradley CS, Kreder KJ, Lutgendorf S, MAPP Network. Inflammation and inflammatory control in interstitial cystitis/bladder pain syndrome: associations with painful symptoms. Pain. 2014;155(9):1755-1761.

what's in the Pelvis

What’s in the Pelvis?

Understanding the complexity of the pelvis goes a long way in understanding why it may be difficult to pinpoint and treat the exact source of your pain and discomfort.

The pelvis is a tight area with many organs and structures. It includes your bladder, uterus, Fallopian tubes, ovaries, bowels, muscles, nerves, skin, and more!



Copyrighted 2018 When It Hurts Down There



The body transmits information from all these parts and places to the spinal cord, which sends the signal to the brain for processing. The problem lies in the fact there are only a few spots in the spinal cord available to transmit all of this information.

From the picture you can see in the picture how complex and interwoven the parts of the pelvis are, and how a pain signal might get confused on its way to the spinal column and brain.

As a result, what your brain receives is "there's pain somewhere in my pelvis." Because the brain is not sure of the origin of the pain or the severity, it has to guess. And on top of that, the brain can become so confused that the organ and skin pain signals get mixed up. So, while it may be that your bladder needs attention, you feel it in the muscles and skin of your buttocks.

Without knowing the source of the pain, getting a firm diagnosis is a challenge. Which is why a pelvic pain specialist can help. S/he can untangle where your pain is coming from, which is often more than one site, and develop a course of treatment.

1. Aredo J, Heyrana K, Karp B, Shah J, Stratton P. Relating chronic pelvic pain and endometriosis to signs of sensitization and myofascial pain and dysfunction. Seminars in Reproductive Medicine. 2017;35(1):88-97.

How Pain Works

How Pain Works

All pelvic pain patients have several things in common. Pain starts in the body, gets sent up the spinal cord, and gets processed in the brain. This happens in every single person. It's kind of like a relay race. If the baton doesn't get passed, or if someone poops out and stops running, the baton never makes it to the finish line. Without a pain signal or the ability to relay and process it, you wouldn’t have pain.  Think about people with spinal cord injuries and paralysis. Paralyzed people can’t feel pain below their injury. The pain signals are still there, but they can’t get to the brain. The pain doesn’t get past the injury in the spine. No relay, no pain.

Pain Tolerance

Once the pain makes it all the way to the brain, it has to be processed. This is where things get even more interesting. There are multiple studies that show that patients with chronic pain have a different tolerance for pain. If you took a person without a pain condition and laid them down in an MRI machine, it would take something pretty noxious, like poking them with a sharp object to see a lighting up of the pain centers in the brain. In pelvic pain patients, the MRI shows the pain centers lighting up much easier, like with normal touch, or sometimes even just light touch with a cotton swab! Everyone’s tolerance for lighting up the pain centers is a little different.
 

Pain Processing Centers

All pain is processed in the same areas of the brain. Science doesn’t have this completely figured out yet, but we do know that pain signals go through certain pathways, hitting certain areas for processing. As the pain is processed, it’s localized and given meaning and context. The same mixture of chemicals are released when you’re riding a rollercoaster and when you’re being chased by a bear. How does the brain know which one is fun and which one is scary?

By knowing which areas are being used for processing, we can figure out what to do to interfere with that part of the process and make more pleasure and less pain. All pain is also modifiable by changing the circumstances of the pain and its surroundings.

Feed Your Body Good

Feed Your Body Good

Avoiding foods that cause pain

YOUR DIET

Your diet is a huge factor affecting inflammation in the body. As we discussed in “You feel what you eat,” if you eat foods that cause inflammation, you will have more pain. Avoiding all inflammation-causing foods seems logical but would be very difficult. So the idea isn’t to remove these foods from your diet entirely, but to reduce your general intake.

Some of the foods that may cause you inflammation and pain:
Gluten
Refined carbs
Fried food

Processed meat
Red meat
Margarine, shortening, lard

We’re not really sure how all of these foods cause inflammation, but the effects on the blood and body stress chemicals have been revealed through a number of scientific studies.

Gluten

Gluten is a protein found in wheat, barley, and rye. It gets a really bad rap, but scientists think it may be the underlying problem is that gluten is “housed” in many foods considered “simple carbs.” Yet, however consumed, scientific study shows that gluten-containing foods are inflammatory.

As of late, you can find gluten-free foods in almost any grocery store. There are enough gluten-free substitutes these days to replace just about all of your favorite foods. Although, the tricky thing about gluten it’s in a lot of foods you might not suspect, e.g. soy sauce and mixed spices. You need to read ingredient lists and look for wheat, barley, rye, “modified food starch” and/or a disclaimer like “processed in a facility that processes wheat.” The latter is probably okay to eat, unless you are allergic to gluten.


Refined carbs

Refined carbs are any type of sugar or starch-containing food that has been processed. Unrefined carbs are the carbohydrate-containing foods in nature, such as an unprocessed sweet potato or corn kernel. When you take these carbs and grind, heat, or change them in any way, it “processes” them. The more processed the food, the more refined.

Processed carbs are easier for your body to digest, but their digestion produces inflammation. A (very) short list of foods to avoid are:

Table, brown, and confectioners sugar
Most syrups (e.g., corn, agave)
Fruit juices
Anything labeled instant (e.g., instant oatmeal, white rice)
Anything labeled starch (e.g., cornstarch, potato starch)


Fried food


Putting anything into hot oil makes it bad for you. This is due to the heated oil. Most of the oils used to fry foods are hydrogenated vegetable oils, containing trans fatty acids, which increase inflammation.

When you eat too much trans fatty acid, it results in toxins that permeate the bowel wall and cause trouble. So “Just say No!” to french fries, potato chips, and deep fried Twinkies.

Processed meat

Bacon lovers beware. Meat processing causes the chemical advanced glycation end products (AGEs) to be released. AGEs activate the human immune system, which alters your cells’ make-up. Which is bad for your gut and for you. So hang up your bacon, step away from the hot dogs, retire the jerky and avoid the sausage.

Red meat

The effects of red meat are a little more debated in some medical circles. It is thought to cause inflammation in the same way that processed meat does, through AGEs. However, the problem may lay in the way we cook meat. Charring a steak may be tasty, but it releases AGEs. The more cooked the meat, the higher the AGEs. As such, red meat cooked any way contains AGEs, so it’s best to limit your intake as much as possible.

Margarine, shortening, lard, and saturated fats
These processed oils are removed from their respective foods using a chemical that is a component of gasoline. Yuck! The processing causes the foods to have a high content of trans fatty acids. See “Fried Food” above to learn why this is bad for you! Saturated fats would include cheese, heavy cream, butter, fatty meats, sausage, etc...

References: 

Lee Y, Park K. Irritable bowel syndrome: Emerging paradigm in pathophysiology. World J Gastroenterology. 2014;20(10):2456-2469.

Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26:995-1001.

Fritsche K. The science of fatty acids and inflammation. Adv Nutr. 2015;6:293S-301S

Okada Y, Tsuzuki Y, Ueda T, Hozumi H, Sato S, Hokari R, Kurihara C, Watanabe C, Tomita K, Komot S, Kawaguchi A, Nagao S, Miura S. Trans fatty acids in diets act as a precipitating factor for gut inflammation? J Gastroenterol Hepatol. 2013;28(S4):29-32.

Uribarri J, Woodruff S, Goodman S, Cai W, Chen X, Ryzik R, Rong A, Striker G, Vlassara H. Advanced glycation end products in foods and a practical guide to their reduction in the diet. J Am Diet Assoc. 2010;110(6):911-916.

You Feel What You Eat

You Feel What You Eat

You’ve heard the saying “you are what you eat,” right? Well, you also “feel what you eat”. If you eat foods that cause inflammation, you’ll have more pain. Your diet is a huge factor affecting inflammation in the body. And inflammation is a context in which your brain thinks pain signals are more important. Inflammation makes your pain sensing nerves more sensitive and jumpy.

The way certain foods cause inflammation is not completely understood, but it is certain that many foods affect the gut microbiome (the mix of good bacteria and microbes that are supposed to be in your gut) This allows toxins to be released into the bloodstream. The toxins causes the immune system to rev up and release additional unnecessary proteins, which causes inflammation. All this activity is picked up and communicated with your brain.

So we “feel what we eat” because food-caused inflammation increases pain

But what can you do about it?

The most effective way to slow down the immune system and reduce inflammation is to change your diet. Yep, it’s that simple. Changing what you eat will significantly improve your pain.


The second way is to add back and support good bacteria with probiotics and prebiotics. (Probiotics are strains of good bacteria. Prebiotics specifically feed the good microbes in the gut.) Taking probiotics has been shown to reduce inflammation and symptoms of several pain syndromes including irritable bowel.

The third thing you can do is to avoid taking antibiotics, unless absolutely necessary as decided by your healthcare provider.

The fourth and theoretically the most fun is to get regular exercise. This helps in digestion, and also helps support the gut microbiome.

Step ONE

I cover all these steps in detail in my e-book, When It Hurts Down There, but here I’ll just briefly expand on Step One.


To slow down the immune system and reduce inflammation you simply need to avoid the foods most linked to inflammation-related pain. These are gluten, refined carbs, fried foods, processed meats, red meat, and processed fats. 

Again, we’re not really sure how all of these foods cause inflammation, but the effects on the blood and body stress chemicals have been shown in multiple scientific studies.

I understand that avoiding all of these foods completely would be very difficult. So, the idea isn’t to remove them from your diet entirely, but to reduce your general intake. The body is meant to have some amount of inflammation reaction to fight off infections, but you want to lower the unnecessary activation of the system. A thoughtful diet without foods that trigger trouble in your gut can lead to less pain, a healthier lifestyle, and a happier you!



References:

Lee Y, Park K. Irritable bowel syndrome: Emerging paradigm in pathophysiology. World J Gastroenterology. 2014;20(10):2456-2469.

Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26:995-1001.

Fritsche K. The science of fatty acids and inflammation. Adv Nutr. 2015;6:293S-301S

MacDermott RP. Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet. Inflamm Bowel Dis. 2007;13(1):91-96.

Moloney RD, Johnson AC, O’Mahoney SM, Dinan TG, Greenwood-Van Meerveld B, Cryan JF. Stress and the microbiota-gut-brain axis in visceral pain: relevance to irritable bowel syndrome. CNS Neurosci Ther. 2016;22(2):102-117.

Tillisch K. The effects of gut microbiota on CNS function in humans. Gut Microbes. 2014;5(3):404-410.

El-Salhy M, Gundersen D. Diet in irritable bowel syndrome. Nutrition Journal. 2015;14:36.

You're not alone! Pelvic pain is really common

The Puzzle of Pelvic Pain

I've fairly recently been invited to join a Facebook group of people suffering from pelvic pain problems. One of my patients invited me to the group, and let me tell you, it's an amazing cadre of women. They lift each other up, give encouragement, and point each other in the right direction for getting a diagnosis etc... I feel kind of like an outsider in there because as much as I'd love for it to be possible, I can't diagnose over the internet. It's really a puzzle figuring out where your pain is coming from, and a hands on exam is absolutely necessary. That's actually the most fun part of my job. I've always loved working puzzles.


Anyhoo, joining this group has helped many women realize they're not alone in the fight against pain. There's a sense of loneliness in pelvic pain patients, feeling like you're the only one out there dealing with this. And it's so not true!

You Are NOT Alone!!

Chronic pelvic pain is a really common issue. The guesses for how many people suffer with this is between 4% and 90% of women worldwide. I can’t even find numbers for men. That’s a pretty wide range, so narrowing down the type of pain to whether it’s with periods only, with sex only, or totally random, we can get a little better idea. With menstrual period pain, it’s around 30-40% of women worldwide. Pain with sex is probably closer to about 20%, although in the US it’s particularly high, at about 45%. Random pain is pretty common too; about 20% of the world’s population has this.

So, if you have pelvic pain, know you’re not alone. Some of the best statistics say that probably 1 in 3 women have pelvic pain, and that it’s chronic in about 1 in 7. Look around you at work sometime. If there’s more than 7 women in your office, guess what? It’s probably not just you!

If you are one of the hundreds of thousands of women world-wide dealing with pelvic pain, I can help. I love doing these kinds of puzzles! You can make an appointment with me at Nurture Womens Health.

Reference:
Latthe P, Latthe M, Say L, Gülmezoglu M, Kahn K. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;6:177.

Queefing- the feminine way to pass gas

UM, PARDON ME?

I've been seeing a lot of questions lately in my office and online about "queefing". Whomever came up with the term queefing, in my humble opinion, is an absolute genius! So, what exactly is the definition of queefing? According to Dictionary.com:

NOUN: Slang: Vulgar. an expulsion of air through the vagina.

Anybody else a little irritated with the use of the word "vulgar "there? As if women are trying to be sexual about passing gas through the vagina. Truth be known, there's not a real term for passing wind from the vagina. "Why," you ask? Probably because men don't do this, so it's never been added to the "non-slang" dictionary. In medical literature the phenomenon of farting from your lady parts is known as either "vaginal wind", or "vaginal air." There are only a few literature articles on the subject, listed in the wee tiny print below. Some of the info here is collected from those articles, some of it's just from my experience, both personal, and with patients. (Yes, I queef on occasion. As you'll find out, most women do!)

Queefing FAQs

Since there seems to be a lot of confusion about queefing, so let's tackle the most common questions.

How common is queefing?

In the general population, we just don't know for sure. One literature review, says it's between 1 and 69%. The single article I could locate on the topic of prevalence found that 69% of women pass gas via the vagina at least twice a week. Let's go with 69% as the best number we've got. Asking around my office and my female friends, most women will admit they've queefed before, even if it isn't a regular problem.

How does the air get in there?

Vaginal air can come from two places. First, it can get in the vagina from something called a fistula. A fistula is a little opening between the bowel and the vagina, most often seen after traumatic prolonged vaginal delivery, or after vaginal/pelvic surgery. This can be diagnosed in your doctor's office or with imaging, like a CT or MRI.

The most common way for air to get into the vagina is from outside the body. The classic time is during sex. With repeated penetration, the penis pushes air from outside up into the vagina. After sex queefs are by far the most common. Air can also get inside the vagina during exercising, especially activities like yoga where your bum is up in the air. Some people suck air up inside the vagina while shifting around in their chairs at work, or while moving around in their sleep. When you're sitting or lying down, the pelvic floor tends to be less tight, and allows for air to seep up in there. Then when you stand up, it comes out.  This is particularly the case in ladies with tight pelvic floor muscles. The tightness of the muscles seems to help suck in the air, and keep it trapped.

Does a queef smell bad?

If a man farts in the forest, and no one is there to appreciate it, does it smell? Depends on how you think about it. In order for something to smell, a nose must be there to inhale the chemicals that produce a signal in the brain of a particular odor. When you pass flatus (that's the actual medical term for rectal gas) most of the time it has little or no odor. Rectal gas is a combination of swallowed air and byproducts of the microbes living in your gut. Certain foods notorious for gas (like broccoli and milk) are partly broken down by bacteria in your gut, which produces hydrogen sulfide. That chemical is what gives smelly farts their odor.

Is queefing dangerous?

Nope. Not in the least. If it's associated with a fistula, it'll need to be fixed. But classic passage of vaginal air that's trapped is common, and normal. It doesn't hurt, and is not dangerous. But it can be embarrassing. Many times a queef makes a noise similar to a fart. That sound can draw attention, obviously, and women with regular queefs tend to feel shameful about it. 

Is there anything I can do to reduce or stop it?

There's no literature on this. These recommendations come from experience and from a little medical logic. If you queef mostly after sex, using a good lubricant can help. When the penis slides more easily, it doesn't push as much air up in there. Good lubricants are generally either water or silicone based. You'll need to use one that's pH balanced. The lubricants I recommend to my patients are "Good Clean Love", "Desert Harvest Glide", and "Uberlube". If you're one that queefs after sitting too long at work, getting up regularly will reduce the likelihood of having the sound.

What's next?

If you queef more than twice a week, you may have a pelvic floor issue. You can always come by my office to talk about the sensitive topics like this. We'll figure out if your queefs are concerning or just the garden variety "gentle wind". You can make an appointment with me at Nurture Womens Health. 

https://www.ncbi.nlm.nih.gov/pubmed/28494270

https://www.ncbi.nlm.nih.gov/pubmed/26241266

https://www.ncbi.nlm.nih.gov/pubmed/14677001