THE BACK PAIN DIET Scientific recommendations for your diet to reduce pain
THE RIGHT CHOICE • The Back Pain Diet is perfect for you. • Unlike physical therapy, chiropractor appointments, and other treatments, The Back Pain Diet actually saves you time. • Think of all the time you spend making appointments, waiting in waiting rooms, and then getting the “treatment” for your back pain. • In this program, you are simply changing some of the things that you eat. Eating is something you do everyday, anyway. • So, making modifications to your diet adds little to no work to your already busy life.
HOW DIET AFFECTS PAIN • INFLAMMATION • BLOOD FLOW
INFLAMMATION • Often pain is due secondary to inflammation that your body experiences. Certain foods can increase this inflammation while others help to reduce it. Certain cells in your body such as fat cells are believed to facilitate production of more inflammatory factors thus weight loss not only decrease mechanical stress on the body it may also help to decrease the overall inflammation.
ATHEROSCLEROSIS • Certain foods and diets can increase your bodies levels of “bad” cholesterol as well as increase your level of atherosclerosis. • The Atherosclerosis Theory of Back Pain states that “a blocked artery impairs your body’s ability to heal back injuries and eliminate pain…blocked lumbar arteries can contribute greatly to intensity and duration of pain.” • A favorite place for these plaques to form is right at the opening near the lumbar arteries. By age 20, nearly 10% of people will have a partially clogged artery. This percentage increases with age. If the lumbar artery is blocked, blood cannot reach your painful back.
The Atherosclerosis Theory of Back Pain • Study by Dr. Leena I. Kauppila published in the journal Spine found that those with chronic pain were much more likely to have high cholesterol and blocked arteries. • Source: Kauppila LI, et al. MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain. Spine. 2004 Oct 1;29(19):2147-52
WHICH ONES? Some foods increase inflammation (Foods That Hurt) • Saturated Fats • Trans Fats • High Glycemic Index Foods Some foods decrease inflammation (Foods That Heal) • Omega-3 • Vitamin D • Antioxidants • Extra Virgin Olive Oil
Anti-inflammatory foodsAlaskan Salmon (wild)Fresh whole fruits, vegetablesBright multi-colored vegetablesGreen teaWaterOlive oilLean poultryNuts, legumes and seedsDark green leafy vegetablesOld fashioned oatmealSpices, especially Turmeric and Ginger Inflammatory foodsSugar, from any sourceProcessed foodsFrench FriesFast FoodsWhite breadPastaIce CreamCheddar CheesesSnack FoodsOils such as vegetable and cornSoda, caffeine and alcohol
FOODS THAT HURT: SATURATED FATS • A study, published in Journal of the American College of Cardiology showed that just one high saturated fat meal increased inflammation. It appears that saturated fats increase inflammation by impairing your body’s natural anti-inflammatory processes. • The amount of eicosonoids that your body produces is proportional to the amount of saturated fats that you eat. Eicosonoids cause inflammation. • Saturated fats also increase your levels of total cholesterol and LDL cholesterol (“bad cholesterol”),, thus increasing your risk of atherosclerosis. Source: Nicholls SJ. Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function. J Am Coll Cardiol. 2006 Aug 15;48(4):715-20. Epub 2006 Jul 24 Saturated fats tend to be found in animal products.
7 Easy Ways to Lower Saturated Fats 1. Use Egg Whites (Egg Beaters) instead of the whole egg. 2. Trim the skin and visible fat from meat before cooking. 3. Choose lean meats like chicken or fish instead of beef and pork (which tend to have a ton of saturated fat). 4. At restaurants, choose baked, broiled, or grilled instead of fried. 5. Choose low or no fat dairy (for example, skim milk instead of whole milk). 6. Sauces and gravy are loaded with saturated fat. Avoid them or ask for them on the side. 7. When choosing salad, try oil based dressings vs. ranch or blue cheese.
TRANS FATS EVEN MORE DANGEROUS THAN SATURATED FATS!!! • The mechanism for this is essentially the same as saturated fats: clogging arteries and increasing inflammation. • Trans fats go a step further by not only increasing LDL, but decreasing HDL (good cholesterol). • Avoid this cholesterol double whammy
% Source of Trans Fats in Diet • Cakes, Cookies, Crackers, Pies, Bread 40% • Animal Products 21% • Candy 1% • Breakfeast Cereal 1% • Salad Dressing 3% • Shortening 4% • Potato Chips, Corn Chips, Popcorn 5% • Fried Potatoes 8% • Margarine 17%
4 Tips to Avoid Trans Fats 1. Read food labels - Since 2003, the FDA has mandated that trans fat be listed on all food labels. A loophole in the labeling is that foods with a half gram (0.5g) of trans fat or less can still say “trans fat free” 2. Portion Control: While it’s best to avoid these high trans fat foods altogether, if you can limit how much you eat at a sitting, you will be doing your back a big favor. 3. Limit the amount of baked goods - These tend to be the foods that have the most trans fat. 4.When at a restaurant, avoid the deep fried options. The cooking oil, after being used again and again (which is the case at most restaurants), ends up being loaded with trans fat. Grilled, broiled, or sautéed foods are much better options.
The Great Debate: Margarine vs. Butter • For years, Americans have been confused about whether butter or margarine is a better choice. This is because we have known about the dangers of saturated fat for years, so doctors and dietitians were • telling everyone: “avoid butter like the plague, eat margarine!” • But we now know that trans fat is even worse than saturated fat. Stick margarine has more trans fat than butter. Now these same people are telling everyone to eat butter and avoid margarine. • Who is right?
The Great Debate: Margarine vs. Butter • Neither butter nor margarine are the healthiest of options and both raise cholesterol quite a bit. In the last few years, a large number of healthier and great-tasting spreads have been released (Olivio, Smart Balance, and Benecol for example are spreads made from olive oil). • Also, many margarines are now made ‘trans-fat free’. Now that these healthy alternatives are available, these healthy spreads are the best choice.
TRANS FATS • A study conducted at Harvard University, which appeared in The Journal of Nutrition, set out to find out whether trans fat simply increases cholesterol, or whether it is also pro-inflammatory. • They found the more trans fats someone ate, the more inflammation was happening in their body. This association was independent of other possible causes of inflammation (e.g. saturated fat intake or obesity). • Source: Lopez-Garcia E. Consumption of trans fatty acids is related to plasma biomarkers of inflammation and endothelial dysfunction. J Nutr. 2005 Mar;135(3):562-6
High Glycemic Index Foods The higher the GI, the faster blood glucose rises.
High Glycemic Index Foods • Low GI diets have been shown to lower the risk of many chronic diseases that have an inflammatory cause (i.e. obesity, diabetes, back pain and heart disease). • When you eat a high GI food, you get a “spike” in blood sugar. In response, your body has to release a ton of insulin to get your blood glucose under control. Insulin is a hormone that your body makes to get glucose out of your blood and into your cells where they belong. If a spike in insulin happens occasionally, your body has no problem adapting. • However, if this occurs again and again, your body has a tougher time keeping up. Your body’s response to this is increasing inflammation.
High Glycemic Index Foods • Another study conducted at Harvard University, that appeared in the journal The American Journal of Clinical Nutrition showed a diet of high GI foods increases inflammation. • They found that the higher the CRP (inflammation), the higher GI the diet tended to be. “Dietary glycemic index is significantly and positively associated with plasma CRP.” Source: Liu S. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002 Mar;75(3):492-8
Glycemic Index Foods High In GI • • Sugary (i.e. candy) • • Processed (i.e. white bread) • • Low in Fiber (i.e.. white rice) • • Low in Protein (i.e.. rice cakes) Foods Low in GI • Produce (i.e. most fruits and vegetables) • Minimally Processed (i.e. whole wheat bread) • High in Fiber (i.e. beans)
Foods that Heal: Omega-3 Fats • Extensive research indicates that Omega-3 fatty acids reduce inflammation and help prevent risk factors associated with chronic disease. OMEGA-3s • Reduced risk of coronary heart disease • Reduced blood triglycerides • Reduced risk of certain cancers • Decreased chronic inflammation • Reduced Crohn’s disease “flare-ups” • Increasing HDL (Good Cholesterol) • Increase Cell Fluidity A healthy cell membrane is dependent on omega-3s.
What Are Omega-3s? There are three main types of Omega-3 fats: 1. Eicosapentaenoic acid (EPA) 2. Docosahexaenoic acid (DHA) 3. Alpha-linolenic acid (ALA) • Omega-3s are a type of fat categorized as an “essential fatty acid”. It is called this because, unlike other types of fats, your body cannot make Omega-3s. • EPA and DHA are the best choices because your body turns these into active anti-inflammatory compounds better than ALA. Fish are an excellent source of omega-3s
Omega-3 Fats • The research published in the journal Surgical Neurology showed a safe alternative to NSAID for treatment for back pain was fish oil. • They gave fish oil capsules instead of NSAIDs to patients with chronic low back pain. • 80% of patients were satisfied with their improvement and 88% said that they would continue taking the supplements. Source: Maroon JC. 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.
Best non-fish sources of Omega-3s • Flax seeds • Walnuts • Tofu • Beans • Soybeans • Winter Squash To get the maximum benefit from Omega-3s, you should eat 4g (4000mg) at the very least on a daily basis.
Omega 6 to Omega 3 Ratio • The typical Omega-6 to Omega-3 ration in the average American diet is about 15:1 • Research is not clear on the “best” ratio of these two fatty acids • Currently most recommendations should be as close to 1:1 as possible.
What About All That Mercury? • Certain types of fish contain high levels of certain toxins (specifically heavy metals). So isn’t eating too much fish dangerous? • The recommendation by the EPA and FDA to limit fish consumption is meant for pregnant women and young children. • Also, those recommendations advise expecting mothers and children to avoid certain types of fish: large, predatory fish like shark, swordfish, and king mackerel are very high in mercury. • Other fish, such as salmon, pollock and catfish, are extremely low in mercury. • Experts agree: “The dangers of not eating fish, including tuna, outweigh the small possible dangers from mercury”. • The bottom line: unless you are pregnant, eating fish (or taking fish oil capsules) is the best way to get pain fighting Omega-3s.
VITAMIN D • For decades, we’ve been talking about the importance of Calcium in the diet. The time has come to get the word out about vitamin D and its contribution to good musculoskeletal health. • Vitamin D has the unique property of being made in your skin with the help of sunlight. This is why it is commonly referred to as the “Sunshine vitamin”. • “Vitamin D deficiency is an unrecognized epidemic in both children and adults throughout the world.”
Vitamin D Influences • Cell Growth • Insulin Resistance (Diabetes) • Immunity • Muscle Function • Nervous System • Cardiovascular System • Blood Pressure • Inflammation • Low Back Pain
Scientific Papers • Study published in the journal Spine, showed that not only were the majority of back pain patients in the study vitamin D deficient, but that vitamin D was an effective treatment of their back pain. • The researchers tested 300 patients with chronic low back pain to see if they had vitamin D deficiency. If they were deficient, they were given vitamin D supplements and then monitored for improvement. • 83% of patients with low back pain were vitamin D deficient. Remarkably, 95% of patients saw a significant improvement in their pain after taking the vitamin D supplements. Source: Al Faraj S, Al Mutairi K. Vitamin D Deficiency and Chronic Low Back Pain in Saudi Arabia. Spine 2003;28:177–179
How Can vitamin D Improve Back Pain? • Inflammation Reduction • Improve Nerve Function • Increased Muscle Strength • Helps Pain Medication Work Better The muscles that support your spine are dependent on Vitamin D
VITAMIN D • There are a lot of different recommendations as to the amount of Vitamin D to take. • The literature and scientists recommend 2,000-4,000 IU daily • Also get a “sensible exposure” to sunlight. • “Screening for vitamin D deficiency should be performed for all patients with chronic low back pain” • The only way to be sure that you are getting enough vitamin D is by getting a blood test called a 25OHD test. • Although milk and some orange juice brands are fortified with vitamin D, the amount is usually minuscule. A serving of milk provides around 100IU of vitamin D. This is only 5% of our goal of 2000IU per day. You would have to drink 20 glasses of milk to reach your daily goal! Fatty fish are a good source of Vitamin D. • Supplements are a safe, effective, and inexpensive way to get vitamin D. • If you get more than 30 minutes of spring or summer sun exposure in a day, no need to take any supplement that day, as your skin has made more than 2,000IU on its own.
Antioxidants • Antioxidants fight free radicals. • Free radicals, also known as reactive oxygen species (ROS) are molecules in your body that are abnormal. They are the byproduct of your body’s normal processing. • New research shows that unchecked free radicals are a major instigator of back pain - and that antioxidants can reduce this pain.
Antioxidants • Reducing Sensitivity to Pain: Free radicals have been shown to “turn on” nerves and increase pain signaling. • Inflammation Reduction • Preventing Clogged Arteries • A study that injected free radicals into mice and then measured their levels of pain before and after administration of antioxidants showed that antioxidants reduced pain in the mice by 98%. Source: A. Hacimuftuoglu et al. Antioxidants attenuate multiple phases of formalin induced nociceptive response in mice. Behavioral Brain Research 173 (2006) 211–216
Top 20 antioxidant containing foods 1. Small red bean (dried), 1/2 cup 2. Wild blueberry, 1 cup 3. Red kidney bean (dried), 1/2 cup 4. Pinto bean, 1/2 cup 5. Blueberry (cultivated), 1 cup 6. Cranberry, 1 cup (whole) 7. Artichoke (cooked hearts), 1 cup 8. Blackberry, 1 cup 9. Prune, 1/2 cup 10. Raspberry, 1 cup 11. Strawberry, 1 cup 12. Red Apple, 1 13. Granny Smith apple, 1 14. Pecan, 1 ounce 15. Sweet cherry, 1 cup 16. Black plum, 1 17. Russet potato, 1 cooked 18. Black bean (dried), 1/2 cup 19. Plum, 1 20. Gala apple, 1
Extra Virgin Olive Oil • Both oleocanthal and Ibuprofen are known as COX inhibitors. • A naturally occurring compound in olive oil, oleocanthal, has the same anti-inflammatory abilities of Ibuprofen! • As little as 1 tbsp (10mg) of olive oil per day can greatly improve your pain relief. Olive oil can be safely used as an NSAID
Extra Virgin Olive Oil • Beauchamp isolated various compounds in olive oil and tested each for its ability to reduce inflammation. • He found that oleocanthal acts as a natural anti-inflammatory compound that has a potency and profile strikingly similar to that of Ibuprofen.” Source: Beauchamp, GK et al. et al. Ibuprofen-like activity in extra-virgin olive oil. Nature 2005, 437, 45-46.
OTHER TIPS 1) Eat Power Foods Are foods that provide your body with energy slowly rather than quick energy foods. Power foods usually are those that are high in complex carbohydrates and proteins and low in simple sugars. 2) Drink Plenty Of Liquids: Water, Milk or Juices 3) Avoid Soda Soda contains both caffeine and phosphoric acid both of with reduce calcium and can weaken bones and increase back pain. 4) Eat Less & More Often Try to eat 5-6 small meals throughout the day instead of 2-3 large meals as we traditionally do. This maintains a more constant metabolic rate. Also try not to over eat and only eat balanced meal. Also remember to eat a healthy breakfast it can give your body a good start in the morning. 5) Void Excessive Caffeine Caffeine can increase muscle tension, as well as decrease calcium. 6) Avoid Excessive Sodium Watch your sodium intake and keep your blood pressure under control. 7) Other Supplements Believed To Be Beneficial Methylsulfonylmethane, GlucosamineandChondroitin Sulfate
OTHER PAIN ELIMINATORS • Vitamin B Complex (Nerve Cell Growth/Function) • Glucosamine/Chondroitin Sulfate Joint Supplement • Capsaicin • Magnesium (Acidic Blood/Insulin Resistance) • Ginger Extract (COX/Lipoxygenase)
Anti-inflammatory Herbs • Willow bark A source of the salicylic acid used to make aspirin, also an antioxidant. Rare allergy possible. It can be blood thinning so it is not advised for use during pregnancy or with anti-coagulant medication. • Boswellia An effective anti-inflammatory pain reliever. It also reduces fever and helps with muscle relaxation. It reduces swelling in cases of brain cancer. Only rare side effects such as mild nausea, loose stools, or skin rash. • Ginger Long history of use as an anti-inflammatory and anti-nausea medicine, appears to have a protective benefit against stomach ulceration. Reduce the pain and disability associated with arthritis, muscle aches, and migraine headaches. It has mild effects that may interfere with blood thinners and drugs used to treat gallstones. • Devil’s Claw Long history of use in the treatment of musculoskeletal complaints. They may increase the blood thinning activity of drugs taken for anti-coagulant therapy. Side effects include mild diarrhea or GI upset, and dizziness. It may increase the blood thinning activity of drugs taken for anti-coagulant therapy.
Anti-inflammatory Herbs • Bromelain A mixture of digestive enzymes that reduces edema and inflammation. It reduces pain and inflammation caused by surgery, arthritis, trauma, or sports injury. It helps to heal and regenerate the digestive lining of the stomach. Can cause an allergic response in some individuals who are also allergic to pineapple, honeybee venom, or olive tree pollen, and may increase the action of anticoagulant drugs. Not enough research has been done to know if bromelain is safe for pregnant or nursing mothers. • Curcumin (Turmeric) Acts as a powerful antioxidant. Also has anti-inflammatory effects equal to some NSAIDs. It assists with wound healing by helping to repair the lining of the colon. Curcumin is not advised if you have certain health problems: bile duct blockage, a blood-clotting disorder, a history of stomach ulcers, or gallbladder disease. May increase the risk of bleeding or increase the effects of blood thinning drugs. Safety in pregnant women or nursing mothers unknown. • Quercetin It slows down the production of histamine and other inflammatory chemicals from white blood cells. It reduces acute inflammation and the swelling and pain of arthritis. Safety in pregnant women or nursing mothers unknown. • OTHERS: Cayenne/Capsaicin, Clematis, Condurango, Echinacea, Kava, Meadowsweet, Pau d’arco, Feverfew, St John’s wort, Valerian
Vitamins and Supplements that have been recommended to reduce pain • Fish Oil 2-3 grams per day • Vitamin D 1000 IU twice per day • Vitamin B complex 250 mg twice per day • Capsaicin Cream applied topically four times per day • Ginger Extract 500 mg twice per day • Magnesium 100 mg twice per day • Willow Bark 400 mg twice per day • Devil’s Claw 600 mg twice per day