[Apologies to Wade for this - it was caught by Postini originally,
and although I thought I sent it through already, I must have done
something wrong, since I'm not seeing it anywhere. -Adam]
I've been struggling with carpal tunnel, metals poisoning and autoimmunity
for several years now. I sent the following response on Sunday to the
TidBITS Talk posting on carpal tunnel. It's Tuesday and I haven't seen my
response posted to the list. Since this is of interest to several list
members, I thought I would mail it out individually. I've made minor
editorial changes to the original article.
You can access the pub med abstracts I reference by entering the ID numbers
at <
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi>.
Wade Riddick
____________________________
Carpal tunnel can be a symptom of any number of stressful conditions which
affect peripheral nerves, ranging from diabetes to metals poisoning. A
severe enough food allergy or magnesium deficiency can cause muscle spasms
which compress various neurovascular bundles leading to carpal tunnel pain.
You may not even feel anything in the area of compression. A good physical
therapist may be able to sort this out for you.
Other causes of carpal tunnel pain can include B vitamin or other
nutritional deficiency, autoimmunity (especially an inflammatory bowel
problem), pregnancy, growth hormone or sex steroid deficiency, TMJ/TMD,
fungal infection and obesity. Generally speaking, you would probably see
other symptoms but they might appear minor (e.g., athlete's foot, sinus
infections or split fingernails).
Some of these causes can overlap and interrelate. The bottom line is they
would lower your natural pain threshold in some fashion. Women tend to be
more sensitive to pain than men - except redheads, who have a non-funtional
MC-1 receptor mutation in the neuropeptide system - so it's no surprise
women tend to report more upper body neuromuscular pain.* Men may be
protected by our naturally higher carnitine levels (testosterone is a
carnitine transporter). It tends to be the case that taking carnitine
raises the pain threshold while a carnitine deficiency lowers it.
Carnitine transport defects are associated with autoimmune conditions [PMID
17065219], which are more common in women. Acetyl-l-carnitine, in fact, is
one of the few over-the-counter substances which can repair damaged
peripheral nerves (although it can have side effects).
Substances which inhibit protein kinase C (DHEA, fish oils, a low glycemic
index diet) can boost the pain-relieving actions of carnitine [PMID
15223307]. Similarly, substances which activate PKC would reduce this
effect and lower the pain threshold. Sugar elevates PKC (making
antibiotics plus a high glycemic index American diet particularly bad).
Wheat in somebody with celiac disease can elevate PKC. High homocysteine
(i.e., a B vitamin deficit) elevates PKC. Homocysteine also has a nasty
habit of blocking GABA receptors. Even sleep apnea can raise PKC.
Pain can also be a reflection of opioid signaling problems. Certain
autoimmune digestive disorders or even just chronic antibiotic use can
knock out mu opioid and cannabinoid receptors [PMID 17159985], which means
you've got fewer docking stations in nerve cells for your body's own
natural analgesics. Sure enough, when this happens in mice their tolerance
of painful stimulus drops
<
http://www.newscientist.com/article/dn10808.html>. Low-dose naltrexone
can help reverse this alteration and that's probably one reason it's highly
effective for inflammatory bowel disease and Crohn's. PKC is also a factor
here; it can decrease the number of opioid receptors [PMID 17000011].
Blocking PKC helps reduce the tolerance to opiates that develops among
opiate addicts. PKC is also an important part of the signaling process
that opens up the tight junctions of the gastrointestinal tract, resulting
in leaky gut syndrome.
It's easy to think this doesn't apply to you but red meat, cow's milk
(casein), wheat and rice digest into natural opioids. When the gut barrier
is leaky, these partially digested allergens can pass into the bloodstream
and start screwing up your opioid receptors. Heavy metals like mercury can
disrupt both the gut barrier and the opioid system. Mercury is, in fact,
an antibiotic and can disrupt local mu opioid signaling simply through
those properties.
There are plenty of other things that matter to pain perception. Diabetes,
for instance, has a habit of screwing up the body's inhibitory signaling
system (GABA receptors). I bring up carnitine and opioids because the
research is very recent and most physicians probably haven't heard of the
links. Discussing this also gives you an idea of how important various
aspects of your metabolism are to pain perception.
Unfortunately, most orthopedists are not competent in these areas of
medicine. When you're a hammer you tend to see the world as filled with
nails. Surgeons are no different. They tend to see the world as filled
with surgical problems. Indeed, a lot of doctors seem to totally forget
the Krebs cycle once they get out of med school. Finding one who will be
thorough can be difficult.
I don't know if carpal tunnel surgery is appropriate for any given
individual. You'll have to make this determination yourself. I hope this
gives you an idea of how complicated your health problems could really be
once the symptom appears. Also remember that American medicine hasn't yet
heard of statistical quality control. We spend more time and effort
figuring out what movies you like to rent than we do figuring out medical
mysteries.
Wade Riddick
* There's also a gender difference in the ability to cause pain as well.
A female shot nurse will, all other factors being equal, inflict slightly
less pain on her patients because of the way the brain's perception systems
work.
wsu.edu> wrote:![[F]](/Images/i7/site.gif){kind=small}
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