Transcript Slide 1

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.
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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 foods
Alaskan Salmon (wild)
Fresh whole fruits,
vegetables
Bright multi-colored
vegetables
Green tea
Water
Olive oil
Lean poultry
Nuts, legumes and seeds
Dark green leafy vegetables
Old fashioned oatmeal
Spices, especially Turmeric
and Ginger
Inflammatory foods
Sugar, from any source
Processed foods
French Fries
Fast Foods
White bread
Pasta
Ice Cream
Cheddar Cheeses
Snack Foods
Oils such as vegetable and
corn
Soda, 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 antiinflammatory 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).
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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 antiinflammatory 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
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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
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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 antiinflammatory 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, Glucosamine and Chondroitin 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
GOOD NUTRIENTS
AVOID THESE FOODS
Power Foods (high in complex
carbohydrates and proteins)
Starchy foods
Nuts
Saturated Fats
Vegetables
Trans Fats
Extra Virgin Olive Oil
Other Cooking Oils
Fruits
Caffeine
Vitamin D & C
High Sodium Intake
Antioxidants
High Glycemic Index Foods
Omega 3 Fatty Acids
Sweets
Water
Soda
Clean & Lean Meats (Poultry/Fish)
Red Meat
Small Meals (5-6) Day
Large Meals
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