Introduction
Nutrition is linked with a multitude of conditions. Given the incidence of back pain continues to rise and the quality of food consumed globally continues to decline it is possible there may be a link. Could a persons diet contribute to the onset of back pain? Furthermore could specific nutrients or changes in diet help reduce back pain? This article will outline some specific studies and their potential implications.
Diet As A Cause of Back Pain
Perry et al (2010) examined the correlation between spinal pain and nutrition in a cross-sectional study of adolescents. In univariate analysis in females a reduced incidence of low back pain was associated with consumption of meat, sodium, copper, carotene, vitamin B6, reduced intake of vitamin E, polyunsaturated fat and omega-6 fatty acids. Similarly for females there was a reduced risk of neck/shoulder pain associated with high (fruits and meat) and low intakes (vitamin B12 and 5n3 DPAs). In males, a reduced risk of back pain was associated with high intakes of fruits and low intakes of some nutritional elements iron and nicotinic acid. An increased risk of back pain was associated with highest intakes of fish and seafood in males. A reduced risk of neck and shoulder pain was associated with highest intakes of egg products and sugar products, whilst an increased risk was associated with lowest intakes of cereals, retinol, vitamin D, vitamin B12, and omega-6 fatty acids. Many of these associations are likely not causative. For example vitamin E intake is a marker of omega-6 fatty acid consumption, which on a very basic level could be considered pro-inflammatory.
Atherosclerosis has a known association with diet and lifestyle but may also play a role in back pain. Kauppila (2009) found that atherosclerosis of the aorta and stenosis of the arteries supplying the lumbar spine was associated with disc degeneration and low back pain. Interestingly, as you would expect cardiovascular risk factors were not as closely correlated with back pain. Nonetheless this association shows the potential for nutrition to indirectly influence back pain.
Low pH may play a role in back pain. In their systematic review Liang et al (2012, Archives of Medical Science) highlight three possible mechanisms. Acidic metabolites can escape from the nucleus pulposus and stimulate nerve roots causing back pain. Similarly excessive anaerobic metabolism leads to excessive lactate and muscle spasm causing back pain. Furthermore, low pH within the nucleus pulposus changes the matrix metabolism leading to neuronal death and back pain.
Diet As A Treatment of Back Pain
The importance of an acidic environment in pain production may offer potential for therapeutic intervention. Vorman et al (2001) produced a 53% reduction in pain index, 49% reduction in disability and 29% reduction in physical impairment using 30g/ day of an alkaline based multimineral supplement over 4 weeks. During the study blood pH rose from 7.456 to 7.470. Whilst the systematic review of Liang et al may suggest the mechanism of action was through increasing pH it could also be through improving intracellular magnesium levels. As increasing pH leads to less magnesium being utilised to balance blood pH and more being transported in to cells as found in Vorman et al’s study.
More specific nutrients for a variety of low back pain pathologies can be provided via natural eggshell membrane. Natural eggshell membrane contains glucosamine, chondroitin, hyaluronic acid, manganese and vitamin C. All of which are essential constituents of connective tissue or are essential in the repair process. To date the specific effect of this supplement on low back pain has not been investigated. However, it has been found to reduce pro-inflammatory cytokines in rats (Ritz et al, awaiting publication) and to decrease pain and improve flexibility in joint and connective tissue disorders (Ruff et al 2009). Thus in some patients there may be a rationale for taking it.
Looking more generally at inflammatory biomarkers, consumption of omega-3 fatty acids is correlated with a decrease in C-reactive protein (CRP) amongst others. In their cross-sectional study of 727 women Lopez-Garcia et al (2004) found subjects who were in the top 10% for consumption of the omega 3 fatty acids alpha linolenic acid, docosahexaenoic acid and eicosapentaenoic acid had significantly lower levels of CRP and E-selectin than those with the lowest consumption of omega-3 fatty acids. This is suggestive that dietary modification of inflammatory cytokines may be possible. Thus potentially the diet might alter the inflammatory response.
Conclusion
Of the other studies available perhaps the most interesting are those linking sucrose and soy consumption with lowered pain sensitivity. There are clearly mechanisms through which nutrition could be part of causing back pain and also part of treatment. Perhaps the most promising approach is through optimising pH. This done in conjunction with optimising inflammatory markers through dietary manipulation and providing the necessary building blocks for tissue repair could form part of a general approach.
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