Back Pain and Diet

By: Dr. David Friedman

For three decades I’ve treated thousands of patients suffering from back pain, ranging from herniated discs, ligament sprains, muscle strains, fibromyalgia to arthritis.   No matter what type of treatment I perform, whether it’s spinal manipulation, traction, rehabilitative exercises, trigger point therapy, or electrical nerve stimulation, if someone is eating an inflammatory diet, my results are usually futile. One of the biggest underlining culprits of back pain is poor nutrition and digestion, which can lead to chronic inflammation that irritates muscles, ligaments, tendons and/or nerves. A study in the Spine Journal found that nearly one-third of women and one-quarter of men with back pain also had food intolerances or other gastrointestinal complaints. The Journal of Arthritis published research showing that eating whole-food, plant-based foods can lead to a significant reduction of pain in as early as two weeks.

In my book Food Sanity, How to Eat in a World of Fads and Fiction, I explore all of the basic food groups and how they contribute to or reduce a person’s inflammation and pain. The top three inflammatory foods to avoid are processed foods, dairy, and beef.  

Avoid Processed Foods

These are foods that come from a bag, box, package, or can. They can contribute to chronic pain and inflammation because they contain inflammatory ingredients like gluten, trans fats, high levels of omega-6 fatty acids, and artificial chemicals.   It’s also important to cut back on processed sugars. According to the American Journal of Clinical Nutrition, processed sugars trigger the release of inflammatory messengers called cytokines.   If you want a safer way to satisfy that sweet tooth, reach for healthier natural sugar alternatives like coconut sugar, stevia, monk fruit (aka lo han guo,) or xylitol.

Eliminate Dairy

Cow’s milk is public enemy #1.   Drinking this bovine beverage creates an inflammatory reaction in the intestines which can spread to your joints and back. The primary reason is a protein in cow’s milk called casein. While casein makes up approximately 20 percent of the protein found in human breast milk, cow’s milk contains 80 percent, which is far more than humans are designed to break down. Casein is what makes a 100-pound baby calf grow into a 2,000-pound cow. The average human baby weighs less than 8 pounds and grows into a 170-pound adult. Here’s a common-sense question for you: Would you use rocket fuel in the gas tank of your moped? When you put gargantuan-size cow fuel inside a human body, it creates inflammation which can lead to an array of health issues, including back pain!   In my office when patients are suffering from severe back pain and spasms (aka Charley horses,) I always ask them how much milk they consume? The reply I usually get is,   “I drink it every day.” After I convince them to eliminate dairy from their diet, their muscle spasms and associated pain usually subsides within a couple of days.  

Casein from cow’s milk is also used to make glue to hold together wood (think of the cow logo on Elmer’s Glue) and a polymer used to make plastics. If you were to swallow glue, your body would consider this an invasion and attack it. When you ingest casein, or glue made from milk, your body attacks it by producing histamines, which causes mucus production that can lead to inflammation and pain within the body.   Numerous studies, including data from the World Health Organization,   have also linked the consumption of casein with increased risk of heart disease, high cholesterol, type 1 diabetes, and neurological/behavior disorders.

One of the leading causes of death in the elderly is hip fractures, which are more common than the combined risk of breast, uterine and cervical cancer. Worldwide, an osteoporotic fracture is estimated to occur every three seconds! One in two women over the age of fifty and one in eight men will experience an osteoporosis-related fracture. Seventy-five percent of those over the age of sixty-five, who fracture a hip or leg bone, die within ninety days.   One of the biggest fallacies when it comes to food is that cow’s milk can make our bones strong. Actually, there is no concrete evidence proving cow’s milk helps build strong bones, but there is a plethora of evidence showing quite the opposite—milk may actually cause brittle bones (osteoporosis). In 2014, the British Medical Journal analyzed both men and woman and whether bone loss related to their milk consumption.  High milk intake was associated with higher bone fractures and mortality with people that consumed cow’s milk. The scientists concluded this may be due to the high content of lactose in milk increasing oxidative stress, which in turn can weaken bones, making them more prone to fractures.

If you love milk and cheese, there are some delicious dairy-free options including Almond milk, Cashew Milk, Coconut Milk, and Rice Milk.

Eliminate Beef  

Red meat is the next food group you should eat less of, or completely eliminate from your diet. Beef is a major contributor to chronic pain. Compared to other animal foods, red meat from a cow is the most difficult for humans to digest. Fish takes 30 minutes to digest, chicken takes 90 minutes, and beef takes up to 5 hours. Because it takes so long to digest, this red meat can putrefy, causing a waste product called uric acid. If this uric acid remains stagnant in the colon for too long, it will get absorbed into the bloodstream, which can contribute to inflammation, pain, and arthritis. Beef is also high in fats containing arachidonic acid, which can cause inflammation and pain. It also contains purines which get broken down into uric acid, which can cause the excruciatingly painful condition, gout.

On December 29, 2014, Proceedings of the National Academy of Sciences, revealed that cow’s meat contains a unique sugar called Neu5Gc. When people eat this sugar, it triggers an immune response that in turn causes inflammation. Most other carnivores’ bodies are built to process this sugar, but human bodies are not. When humans eat red meat from a cow, this sugar molecule triggers the immune system to constantly produce antibodies to fight it off. When humans eat beef, this sugar molecule triggers the immune system to constantly produce antibodies to fight it off. This can lead to chronic inflammation, back pain, bursitis, and arthritis. This inflammatory sugar is not found in fish, pork or poultry.

If you want to include meat in your diet, opt for low saturated fat varieties like skinless-white meat poultry, lean pork and wild caught fish. Prepare foods using heart-healthy cooking techniques, such as baking, broiling, steaming and grilling with olive oil instead of frying.

Eat Anti-inflammatory Foods

 Fruits and Veggies:

A study from the University of Liverpool shows that fruits and vegetables contain polyphenols that help to protect you from chronic inflammation. The more polyphenols you eat, the greater your protection from chronic inflammation.   Inflammation is reduced by substances such as isorhamnetin, resveratrol, curcumin, and vanillic acid found in things like onions, red grapes, and blueberries.

For veggies, reach for the green leafy varieties like spinach, kale, and collards. They contain flavonoids which have been shown to reduce the risk of inflammatory diseases. In addition, dark green vegetables contain vitamin K, which is capable of preventing inflammation and pain. Research from the American Journal of Epidemiology showed that high vitamin K lowers inflammatory markers in the blood. Broccoli is also a great choice. It contains sulforaphane, a chemical compound which has anti-inflammatory properties and gives broccoli the ability to fight against inflammation. Broccoli consumption may also reduce CRP (C-Reactive Protein) levels, one of the best indicators of inflammation.

Fatty Fish

Fatty fish is one of the best things you can eat to help reduce lower back pain and inflammation.  The omega-3 fatty acids EPA and DHA found in fatty fish restrict inflammation by giving rise to anti-inflammatory mediators called resolvins. This, in turn, reduces pain. The Journal of Surgical Neurology compared ibuprofen and omega-3 EFAs demonstrating the equivalent effect in reducing lower back pain. The omega-3’s from fatty fish were found to be a safer alternative with no side effects compared to NSAIDs for treatment of neck or back pain.

Wild caught salmon, mackerel, tuna, and sardines are the best choices when it comes to fatty fish.

Turmeric

This spice used liberally in India and other parts of Asia to add taste and also a creamy yellow color to foods, may also have anti-inflammatory properties, thanks to its active ingredient called curcumin. This spice has demonstrated anti-inflammatory properties in conditions such as back pain, arthritis, and muscle sprains. Curcumin has been shown to be more effective than some anti-inflammatory drugs including those for rheumatoid arthritis.

Walnuts

These nutritious nuts are rich in the omega-3 fatty acid called alpha-linoleic acid which can lower the level of C-reactive protein, which increases in conditions such as herniated disc, sciatica, and arthritis. They can also reduce free radical damage, which induces inflammation and puts the body under oxidative stress.  Walnuts are also the best "go-to" snack for improving cognitive memory and concentration.

Green Tea

There’s a lot of great information on the health benefits of green tea. The biggest reason is the polyphenols, particularly EGCG in green tea have anti-oxidative and anti-inflammatory effects. Green tea has been shown to reduce the production of the pro-inflammatory cytokines and is beneficial to people suffering from back pain and arthritis. People drinking 3 cups of green tea per day have significantly less back pain and diminished arthritis flair ups compared to those that don’t drink the tea.     The best time to drink green tea is between meals, preferably two hours before or after eating to maximize your nutrient intake.

Give yourself an oil change

Avoid refined trans-fat, omega-6 oil (soy, corn, and cottonseed oil) when cooking and use more extra virgin olive oil, which is a great source of oleic acid, making it powerful anti-inflammatory oil.

Extra virgin olive oil works much the same way as omega-3s do—by potentially reducing painful joint inflammation. A compound called oleocanthal, which gives olive oil its taste, has been shown to have the same effect in the body as aspirin, ibuprofen, and other NSAIDs (nonsteroidal anti-inflammatory drugs).

Extra virgin olive oil contains various phenolic compounds that exert anti-inflammatory actions. Oleocanthal, a phenolic compound found in olive oil, has anti-inflammatory properties similar to ibuprofen without the side effects. Research shows the consumption of virgin olive oil may also decrease inflammation, lowering the risk of atherosclerosis, a condition where arteries become clogged with fatty deposits.

Take Supplements

There are a plethora of supplements touting for reducing pain and inflammation. In my years of practice, I have found four that not only work but the results are backed by science.

Alpha-Lipoic Acid

Alpha-lipoic acid (ALA) is a fatty acid made by your body. A plethora of research has demonstrated ALA’s remarkable ability to reduce inflammation. Another area in which ALA holds promise is in averting the bone loss that accompanies osteoporosis and other degenerative bone conditions. ALA can help strengthen bones by quelling the oxidative stress that threatens to degrade healthy bone density. It also reduces the process of inflammation-induced bone loss in both laboratory and living subjects. Scientists believe that ALA’s ability to prevent bone loss is linked to its inhibitory effects on pro-inflammatory prostaglandins.

Ginger

Ginger can be purchased in capsules, tea or tincture form.   Ginger has been shown to reduce inflammation linked to arthritis, colitis, kidney damage, and diabetes. The medical Journal Pain, showed evidence suggesting that ginger supplements can decrease inflammation and muscle soreness after exercise. Ginger has been found to be superior to non-steroidal anti-inflammatory drugs (NSAIDs) like Tylenol or Advil because NSAIDs only work on one level: to block the formation of inflammatory compounds. Ginger, on the other hand, blocks the formation of the inflammatory compounds-prostaglandins and leukotrienes-and also has antioxidant effects that break down existing inflammation and acidity in the fluid within the joints.

Spirulina

Spirulina is a type of blue-green algae with strong antioxidant and anti-inflammatory effects. Studies in elderly men and women have shown that it may improve inflammatory markers, anemia and immune function leading to healthier aging and stronger immune system. When people with diabetes were put on spirulina for 12 weeks, their levels of the inflammation decreased significantly.

Arnica Montana (Homeopathic)   

Arnica Montana is one of my favorite supplements. I’ve been recommending it since my first year in practice and it’s never let me or any of my patients down. Arnica is one of the best-known homeopathic remedies for reducing inflammation, bruising and trauma. Many plastic surgeons use it with their patients to reduce bruising after cosmetic surgery.  The European Journal of Sport Science published a study showing the participants who used arnica had less pain and muscle tenderness 72 hours after intense exercise. Arnica has been used in traditional medicine for everything from bruises, contusions, sprains and rheumatic diseases to inflammations of the skin.

One of the key ingredients in arnica is called thymol, which has been found to be an effective vasodilator of blood capillaries, which helps facilitate the transport of blood and other fluid accumulations and acts as an anti-inflammatory to aid normal healing processes. 

The saying, “You are what you eat” includes your spine, ligaments, tendons, muscles and the nerves that supply them. What you eat has the power to either heal or harm. The good news is, results from eliminating inflammatory foods and adopting an anti-inflammatory diet can often be felt within just a couple of days! Food is medicine and you now have the prescription.  

REFERENCES:

Dietary Supplements:

* “The effects of topical Arnica on performance, pain and muscle damage after intense eccentric exercise.” Eur J Sport Sci. 2014;14(3):294-300. doi: 10.1080/17461391.2013.829126. Epub 2013 Aug 16.

* “Chemopreventive Effects of Alpha Lipoic Acid on Obesity-Related Cancers.” Ann Nutr Metab. 2016;68(2):137-44. doi: 10.1159/000443994. Epub 2016 Feb 2.

* “Alpha lipoic acid consumptions affect the cytokine profile in multiple sclerosis patients: a double-blind, placebo-controlled, randomized clinical trial.” Neuroimmunomodulation. 2014;21(6):291-6. doi: 10.1159/000356145. Epub 2014 May 6.

 * “A systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy.” Eur J Endocrinol. 2012 Oct;167(4):465-71. doi: 10.1530/EJE-12-0555. Epub 2012 Jul 25.

* “Alpha-Lipoic Acid Alleviates Acute Inflammation and Promotes Lipid Mobilization During the Inflammatory Response in White Adipose Tissue of Mice.” Lipids. 2016 Oct;51(10):1145-1152. doi: 10.1007/s11745-016-4185-2. Epub 2016 Aug 16.

* “Alpha-lipoic acid suppresses osteoclastogenesis despite increasing the receptor activator of nuclear factor kappaB ligand/osteoprotegerin ratio in human bone marrow stromal cells.” J Endocrinol. 2005 Jun;185(3):401-13.

* “Alpha-Lipoic acid inhibits inflammatory bone resorption by suppressing prostaglandin E2 synthesis. J Immunol. 2006 Jan 1;176(1):111-7.

* “Protective effect of ginger volatile oil against acetic acid-induced colitis in rats: a light microscopic evaluation.” J Integr Med. 2014 Mar;12(2):115-20. doi: 10.1016/S2095-4964(14)60011-X.

* “Ginger extract diminishes chronic fructose consumption-induced kidney injury through suppression of renal overexpression of proinflammatory cytokines in rats.” BMC Complement Altern Med. 2014 May 27;14:174. doi: 10.1186/1472-6882-14-174.

* “Anti-inflammatory effects of zingiber officinale in type 2 diabetic patients.” Adv Pharm Bull. 2013;3(2):273-6. doi: 10.5681/apb.2013.044. Epub 2013 Aug 20.

* “The effect of ginger consumption on glycemic status, lipid profile and some inflammatory markers in patients with type 2 diabetes mellitus.” Int J Food Sci Nutr. 2014 Jun;65(4):515-20. doi: 10.3109/09637486.2014.880671. Epub 2014 Feb 4.

 * “Acute effects of ginger extract on biochemical and functional symptoms of delayed onset muscle soreness.” Med J Islam Repub Iran. 2015 Sep 12;29:261. eCollection 2015.

* “Ginger (Zingiber officinale) reduces muscle pain caused by eccentric exercise.” J Pain. 2010 Sep;11(9):894-903. doi: 10.1016/j.jpain.2009.12.013. Epub 2010 Apr 24.

* “Antiinflammatory and antihyperalgesic activity of C-phycocyanin.” (Spirulina.) Anesth Analg. 2009 Apr;108(4):1303-10. doi: 10.1213/ane.0b013e318193e919.

* “C-Phycocyanin, a selective cyclooxygenase-2 inhibitor, induces apoptosis in lipopolysaccharide-stimulated RAW 264.7 macrophages.” (Spirulina.) Biochem Biophys Res Commun. 2003 May 2;304(2):385-92.

* “Edible blue-green algae reduce the production of pro-inflammatory cytokines by inhibiting NF-κB pathway in macrophages and splenocytes.” Biochim Biophys Acta. 2013 Apr;1830(4):2981-8. doi: 10.1016/j.bbagen.2013.01.018. Epub 2013 Jan 26.

* “The effects of Spirulina on anemia and immune function in senior citizens.” Cell Mol Immunol. 2011 May;8(3):248-54. doi: 10.1038/cmi.2010.76. Epub 2011 Jan 31.

* “A randomized double-blind, placebo-controlled study to establish the effects of spirulina in elderly.” Ann Nutr Metab. 2008;52(4):322-8. doi: 10.1159/000151486. Epub 2008 Aug 19.

 * “Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal.” Curr Pharm Des. 2011;17(8):754-68.

* “Green tea polyphenols change the profile of inflammatory cytokine release from lymphocytes of obese and lean rats and protect against oxidative damage.” International immunopharmacology 28, no. 2 (2015): 985-996.

 * “Tea and tea products: chemistry and health-promoting properties.” CRC press, 2008.

Inflammation:

*  “The effects of diet on inflammation - Emphasis on the metabolic syndrome.” J Am Coll Cardiol. 2006;48:677–85. [PubMed]

* “ Inflammation and cancer: How hot is the link?” Biochem Pharmacol. 2006;72:1605–21. [PubMed]

Processed Foods:

* “Glycemic index: overview of implications in health and disease.” 1–4 David JA Jenkins, Cyril WC Kendall, Livia SA Augustin, Silvia Franceschi, Maryam Hamidi, Augustine Marchie, Alexandra L Jenkins, and Mette Axelse

http://ajcn.nutrition.org/content/76/1/266S.full.pdf+html?cnn=yes

Dairy:  

* Cumming RG. 1994. “Case-Control Study of Risk Factors for Hip Fractures in the Elderly.” American Journal of Epidemiology 139 (5). 14 Karl Michaelson. 2014. “Milk Intake and Risk of Mortality and Fractures in Women and Men.” BMJ. 349:g6015. October 28. 15

 * Feskanich D, Willett WC, Stampfer MJ, Colditz GA. 1997. “Milk, Dietary Calcium, and Bone Fractures in Women: A 12-Year Prospective Study.” American Journal of Public Health. 87 (6): 992–7. 16

 * C Kunz et al.1990. “Human-Milk Proteins: Analysis of Casein and Casein Subunits by Anion-Exchange Chromatography, Gel Electrophoresis, and Specific Staining Methods”. The American Society for Clinical Nutrition. 51 (1): 37–46

* “Case-Control Study of Risk Factors for Hip Fractures in the Elderly”. American Journal of Epidemiology. Vol. 139, No. 5, 1994

* “Milk intake and risk of mortality and fractures in women and men” British Medical Journal 2014;349:g6015. October 28 2014

* “Milk, dietary calcium, and bone fractures in women: a 12-year prospective study.” American Journal of Public Health. 1997 Jun;87(6):992-7.

* "Human-milk proteins: analysis of casein and casein subunits by anion-exchange chromatography, gel electrophoresis, and specific staining methods".  The American Society for Clinical Nutrition. 51 (1): 37–46. 1990 

* International Osteoporosis Foundation: Facts and Statistics https://www.iofbonehealth.org/facts-statistics

* “Osteoporosis-related mortality: Time-Trends and Predictive Factors.” Nelly Ziadé. European Medical Journal of Rheumotology. 2014;1:56-64.

Fruits and Veggies:

* “Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis.” Arthritis. 2015; 2015: 708152. Published online 2015 Feb 28. doi:  10.1155/2015/708152

* “Effects of broccoli on anti-inflammation and anti-oxidation according to extraction solvent.” Journal of Food Hygiene and Safety 27, no. 4 (2012): 461-465.

* Br J Nutr, May 28, 2016;115(10):1699–1710

* “Flavonoid content of vegetables.” In International Research Conference on Food, Nutrition and Cancer. 17–18 July 2003, Washington, DC. 2003.

 * “Vitamin K and vitamin D status: associations with inflammatory markers in the Framingham Offspring Study.” American journal of epidemiology 167, no. 3 (2008): 313-320.

 * “Walnuts decrease the risk of cardiovascular disease: a summary of efficacy and biologic mechanisms.” The Journal of Nutrition 144, no. 4 (2014): 547S-554S.

Fatty Fish:

* “Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids.” Nutrition reviews 68, no. 5 (2010): 280-289.

 * “Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.” Surg Neurol. 2006 Apr;65(4):326-31.

Turmeric:

* “Anti-inflammatory properties of curcumin, a major constituent.” Alternative medicine review 14, no. 2 (2009).

 * “Potential therapeutic effects of curcumin, the anti-inflammatory agent, against neurodegenerative, cardiovascular, pulmonary, metabolic, autoimmune and neoplastic diseases.” The international journal of biochemistry & cell biology 41, no. 1 (2009): 40-59.

 * “Anti-inflammatory properties of curcumin, a major constituent of Curcuma longa: a review of preclinical and clinical research.” Altern Med Rev. 2009 Jun;14(2):141-53.

* “A randomized, pilot study to assess the efficacy and safety of curcumin in patients with active rheumatoid arthritis.” Phytother Res. 2012 Nov;26(11):1719-25. doi: 10.1002/ptr.4639. Epub 2012 Mar 9.