I am slowly getting through the book The Grain Brain by David Perlmutter MD, an interesting read covering an issue (obesity, mental and physical health in relation to the western diet) of great importance for 21st century America.
The book discusses a pathological process known as “glycation.” Elevated blood sugars act as a catalyst (a substance that accelerates a chemical reaction) to impair the elasticity in numerous soft tissues about the body including blood vessels. Although not mentioned in the book, this is a component of the pathologic process with those suffering from adhesive capsulitis, more commonly known as frozen shoulder. In this situation, the elevated blood sugars enhance the formation of cross linking bridges from one strand of cartilage to another. As this process continues, it resembles a three dimensional spider web as opposed to the parallel “spaghetti in the box” strands that occur in normal tissue. A frozen shoulder can be very painful with lingering joint stiffness and functional impairment that can go unresolved if not addressed.
Diabetes & Thyroid Issues
As one might surmise, diabetics are more likely to suffer from a frozen shoulder than the balance of the population. In fact, diabetics are approximately 25 times more likely to be impaired by this ailment. Of note, people who are thyroid deficient also suffer more frequently from frozen shoulder. The average age of onset is 51, and females are 3-4 times more likely than men to suffer from this impairment. The definitive correlative is menopause and progressive hormonal deficiencies. The hypothesis in this case being that estrogen and progesterone serve to enhance the integrity and stability of ligamentous (connect a bone to an adjacent bone) structure. As they are depleted, soft tissues of the shoulder are more susceptible to injury/overuse and the body will respond with a ‘fight or flight” autonomic (the part of our nervous system that is not under voluntary control) response to solve it which includes the glycation process.
Another unique origin of frozen shoulder is the seasonal flu shot. I treat 2-3 people annually due to stiffness brought on by the injection.
Frozen Shoulder Onset
Onset is classically a slow progressive process with the patient reporting recurring mild injury or irritation to the shoulder, often times with normal daily activities. One expects the symptoms will resolve on their own, only to be perpetuated by subsequent injury or overuse. As this scenario progresses over the course of weeks and months, functional mobility is slowly lost about the shoulder though the patient is usually able to adopt a compensatory pattern to accomplish their daily activities.
There will ultimately be the “fatal” event with the patient reporting moderate mobility loss in the days following the incident. Again, there is usually the perception that the impairment will abate and it is not until sleep is moderately impaired and/or pain is highly distractive with daily on-goings that formal care is sought.
The Importance of a Balanced Diet
With the systemic underpinnings (appreciate all of the joint and soft tissue symptoms brought on by food allergies and GI inflammatory diseases) the appreciation that blood sugars have an inflammatory effect in conjunction with the glycation process, and the knowledge that sensory pain to the brain coming from the shoulder plays a direct role in the magnitude of joint capsular/ligamentous mobility loss (an autonomic response); a systemic plan of intervention is crucial in conjunction with the coinciding musculo-skeletal treatment. This should include the modification of sugar and overall processed carbohydrate intake.
Though not often discussed, the modification of the classic American diet for those impaired by a frozen shoulder makes sense. Any opportunity to decrease the systemic/autonomic component of this ailment will hasten the ability of the patient and therapist to address and resolve the musculo-skeletal component. This book and many others discuss at length appropriate modifications that one may take to rectify the nature of their food intake, albeit with a grain of salt thinking that the “perfect” diet has yet to be derived via the regression to the mean.
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