Anti-inflammatory Diet Could Help Reduce Low Back Pain

If you’re one of the millions of Americans with low back pain, chances are you’ve tried a variety of lifestyle adjustments and remedies to improve your symptoms. Although it may help to upgrade to a high-tech mattress or an ergonomic office chair, new research suggests that you may be able to improve your back pain via a less obvious (and less expensive) route: by changing the foods you eat every day.

The research, presented at the February 2021 Association of Academic Physiatrists (AAP) digital conference, found a link between what people ate and their chances of having low back pain.

“Our findings suggest that diets that are more anti-inflammatory tend to be better for back pain,” says Valerio Tonelli Enrico, a physical therapist, research assistant, and doctoral student at the University of Pittsburgh, who presented the findings.

“An anti-inflammatory diet would include whole grains and lots of fruits and vegetables — similar to the Mediterranean diet,” Tonelli Enrico says.

Chronic Inflammation’s Role in Disease and Pain

Inflammation isn’t always a bad thing: Acute inflammation is actually an important immune response that helps heal injuries or fight illness. But chronic inflammation — inflammation that occurs in healthy tissues or that lasts for months or years — can cause damage and contribute to many chronic diseases, including cancer, heart disease, diabetes, Alzheimer’s disease, and depression, according to the National Institute of Environmental Health Sciences. Chronic inflammation can also play a role in conditions such as arthritis or back pain.

Low back pain is the most common type of pain reported in the United States; one out of every four adults report having low back pain in the previous three months, according to the Centers for Disease Control and Prevention (CDC).

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Low Back Pain Is More Likely in People With a Pro-inflammatory Diet

The study used data from the 2003–2004 National Health and Nutrition Examination (NHANES) survey database and included 3,966 subjects. The incidence of back pain was assessed by whether or not a participant had experienced low back pain at any time in the three months before the survey.

Diet was evaluated through a survey in which participants were asked to recall all the foods they ate in a 24-hour period. Researchers used the Dietary Inflammatory Index (DII), a measure based on nearly 2,000 studies on different foods and their effect on different inflammatory markers, according to a paper published in 2019 in Advances in Nutrition.

A DII score was assigned to each participant in the trial on the basis of the foods they reported eating; the higher the score, the more likely the diet was considered “pro-inflammatory,” or likely to cause inflammation.

Researchers ranked the participants and placed them into quartiles according to their DII score. People in the top quartile, who had the most inflammatory diet, had a 42 percent higher chance of having low back pain compared with the group with the least pro-inflammatory diet.

“From my clinical experience, these findings make sense,” says Ryanne Lachman, RDN, a registered dietitian with the Center for Functional Medicine at Cleveland Clinic in Ohio. “We do commonly see pain associated with inflammation,” she says.

“A 42 percent higher chance of having low back pain with a pro-inflammatory diet is absolutely significant and worth paying attention to,” says Lachman. The DII measurement tool and the inflammatory biomarkers the researchers used are both reliable sources of information, she says.

“The researchers controlled for physical activity, body mass index (BMI), and education, which adds some weight to their findings,” says Lachman. Low back pain can be associated with a higher BMI, and so it’s meaningful that the improvements weren’t just because some people on a low-inflammatory diet weighed less, she adds.

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What Is a Pro-Inflammatory Diet?

Many of the foods that increase inflammation, or are “pro-inflammatory,” can be found in the standard American diet, also known as the SAD diet, says Lachman. “This is a diet where we consume mainly refined grains that are too easily absorbed and create lingering blood sugar problems and weight gain,” she says. Sodas, fruit juices, trans fats, and meat from grain-fed animals can be pro-inflammatory as well, says Lachman.

“One source of inflammation that I think a lot of people don’t realize are refined vegetable oils such as soybean oil, vegetable oil, and corn oil. They’ve all gone through a high level of processing, and they contain omega-6 fats which are inherently pro-inflammatory,” she says. These oils are not only used in cooking, but often used in baked goods such as cookies or cupcakes.

“Some of these things aren’t outright harmful in small doses, but when we have them embedded in every product, every processed food, and every restaurant uses them, that’s when chronic inflammation can ensue — from chronic exposure,” says Lachman.

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Anti-Inflammatory Diet More Likely to Improve Back Pain Related to Inflammation

For this study, everyone who had experienced lower back pain within a three-month period was included in the study, no matter what the cause.

“Low back pain is a complex syndrome that be caused by many different issues, and not all these individuals who experienced low back pain had inflammation as a main driving cause. Some people might have back pain because of an injury or mechanical issue,” says Tonelli Enrico.

Inflammatory back pain is typically caused by a form of inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis, according to the National Institute of Neurological Disorders and Stroke.

Mechanical causes of back pain can result from such things as sleeping on a bad mattress, straining your back during a workout, or being injured in a fall or a car accident.

“If we can zero in on the subset of people with back pain where inflammation is the most important factor, I think that an anti-inflammatory diet might even make a bigger difference in reducing the likelihood of lower back pain,” he says.

Expert Tips on Reducing Inflammation in Your Diet

Although diet may help improve pain, people shouldn’t think that food has the immediate effect that pain medications may provide, says Lachman. “If you change your diet and don’t feel different in the short-term, don’t get discouraged,” she says.

Following an anti-inflammatory diet isn’t just about eliminating foods that cause inflammation, says Lachman. “We also need to eat enough of the kinds of foods that will reduce the triggers for inflammation.”

• Eat lots of colorful fruits and vegetables. “If pain reduction is the primary goal, eating 4 to 6 cups of colorful vegetables and fruits without any added sugars will essentially guarantee a supply of anti-inflammatory nutrients, along with many other benefits,” says Lachman. “This should mostly be veggies, especially things in the cruciferous family such as watercress, broccoli, and arugula; they have really strong anti-inflammatory benefits,” she adds.
• Consuming more omega-3s can help offset omega-6s. “I suggest steering clear of refined oils altogether, but increasing omega-3s can help provide a more anti-inflammatory balance of those oils,” says Lachman. Research, including a paper published in November 2018 in the BMJ, shows that increasing omega-3 consumption while reducing omega-6 consumption reduces the inflammatory response of a high-fat meal. “My suggestions for upping omega-3 intake would include cold-water fish like salmon, sardines, and cod. Plant-based options can include hemp, flax, or chia seeds,” says Lachman.
• Prepare foods with anti-inflammatory spices. Spices such as ginger, cinnamon, and cayenne can be used to decrease inflammation, as well. Turmeric is another good example of this; you can use it in savory foods or add it to a smoothie, says Lachman.

The way you cook certain foods can also worsen inflammation. A 2017 meta-analysis published in Scientific Reports found that frying, roasting, microwaving, searing, or grilling meats, fish, and eggs produces compounds called advanced glycation end products (AGEs).

Although your body produces AGEs naturally and they are found in raw animal products, cooking, especially at high temperatures, forms new AGEs. High levels of the compounds in tissues and blood can trigger an inflammatory response and are suspected to increase inflammation in the body.

To limit this effect, try preparing meat dishes that call for steaming, simmering, or braising, and cut down on processed foods, which have often been exposed to a high cooking temperature to increase their shelf life, according to the Arthritis Foundation.

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Relieving back pain with what you eat

Back pain is one of the most common ailments and it almost always comes with inflammation. It can occur as a result of an injury, poor posture, a too-soft mattress, or improper sleeping position. Luckily, there are ways that inflammation can be remedied. Lifestyle and diet modifications, like adopting a Mediterranean Diet, or eating a plant-based diet, often helps to reduce inflammation in the spine and joints by decreasing pro-inflammatory foods and adding anti-inflammatory foods to your diet.

Inflammation can be triggered by what we eat. Some examples of food that may increase or trigger inflammation, also known as pro-inflammatory foods, are:

• Saturated fats – red meat (especially grain fed animals) and whole fat dairy
• Trans fats – hydrogenated oils seen in baked goods/crackers
• Omega 6 – corn oil, safflower oil, soybean oil, sunflower oil
• Sugar – table sugar and other simple carbohydrates such as cake, white rice and bread

Eating a well-balanced diet comprised of a variety of whole, colorful foods can help reduce inflammatory markers. Some examples of anti-inflammatory foods are:

• Omega 3 – canola oil, walnuts, fish
• Monounsaturated fats – olive oil, peanut oil, nuts, avocado
• Fruits and vegetables
• Whole grains
• Herbs, spices and teas – ginger, turmeric, oregano, sage, cinnamon, cloves, rosemary and green tea

When selecting food to eat, think about including all the colors of the “rainbow” in your shopping cart. Not only will eating these foods provide anti-inflammatory benefits, but they’ll also increase your intake of vital antioxidants. Here’s our starter guide to anti-inflammatory foods to try and how you can incorporate them into meals:

1. Avocados
   Avocados are high in monounsaturated fat. They can help to decrease inflammation of the joints and are good for brain health including neurogenerative diseases.
   Meal idea: Eggs with avocado over whole grain toast

2. Fatty fish
   Fish such as sardines, salmon, anchovies and mackerel are high in omega 3 fatty acids. Since we don’t make omega 3 in our bodies, we must get it from food sources. Nutrients found in these fish can help with autoimmune disorders, diabetes and brain health.
   Meal ideas: Salmon burgers, smoked salmon, sardines over salad
3. Cruciferous vegetables
   Veggies like broccoli, cauliflower and Brussel sprouts are high in phytochemicals, antioxidants, vitamin K, vitamin C, magnesium, and fiber. Broccoli in particular helps to protect against cancer and decrease inflammation.
   Meal ideas: Broccoli salad, steamed broccoli, cauliflower rice
4. Garlic
   Garlic helps combat damage caused by free radicals. Free radicals are unstable atoms that can damage cells, causing illness and aging. Garlic also contains quercetin which may help protect against heart disease and cancer as well as stimulate the immune system to fight diseases.
   Meal ideas: Shrimp in garlic sauce, sautéed garlic with swiss chard
5. Ginger
   Ginger helps to decrease pain and inflammation by “turning off” pain receptors. Ginger also improves gut immunity.
   Meal ideas: Scallops with ginger, ginger soup, ginger tea
6. Flax and chia seeds
   These seeds are high in fiber and omega 3’s and can help balance blood sugar levels, improve gut health and fight free radicals.
   Meal ideas: Add to shakes, yogurt, and salads
7. Berries
   Berries contain anthocyanins which act as antioxidants to help fight free radicals and may offer anti-inflammatory, anti-viral and cancer-fighting benefits.
   Meal ideas: Add to shakes, yogurt, and salads, or have on their own as a snack

David J. BenEliyahu, DC, DAAPM, DABCSP is the Administrative Director of the Back & Neck Pain Center at Mather Hospital. 

Nicole Drepaniotis, MBA, MS, RDN, CSOWM, CDN, is a Registered Dietitian Nutritionist and Nutrition Education Coordinator in Mather Hospital’s Center of Excellence in Metabolic & Bariatric Surgery.

Diet, nutrition in diseases of the back and joints

Many diseases of the musculoskeletal system are often caused by metabolic disorders in the human body, which are often the result of malnutrition. Consider how food can affect the functioning of the musculoskeletal system.

1. The intra-articular fluid has the most alkaline pH-7.74.

   When it changes to the acidic side, cartilage is malnourished, accumulation of under-oxidized products and uric acid salts, which leads to premature wear of cartilage tissue. Therefore, in the diet, it is necessary to limit the consumption of products that lead to acidification of the internal environment of the body, namely: meat, flour, sweet and canned foods. Alkalinization and restoration of the pH of the joints contribute to: dairy products, vegetables and fruits (especially fresh).

2. Formation of uric acid salts.

   When eating protein foods, uric acid salts are formed in the body, which is then excreted through the organs of the excretory system (liver, kidneys). With excessive intake of protein or in violation of the function of internal organs, additional ways of its excretion open: skin, mucous membranes, including the synovial membranes of the joints. This contributes to the accumulation of uric acid salts in the joint cavity, in periarticular tissues, as well as the formation of stones in the internal organs, in the oral cavity (tartar).

   Prevention consists in observing the norm of daily protein intake – no more than 80-100 g per day, limiting meat products. It should be borne in mind that a lot of protein is found in dairy products, cereals, cereals, nuts, and legumes.

3. The use of essential macro- and microelements, vitamins.

   Sulfur is an important element in the construction of collagen and elastin fibers. Its sufficient intake contributes to the timely restoration and renewal of cartilage tissue. A lot of sulfur is found in legumes.

   Calcium is an important building block of bone tissue. Found in dairy products, cheese, spinach, beans, nuts.

   Vitamin D3 improves the absorption of calcium by bone tissue. It is formed in the skin during sunburn, and is also found in fish products.

4. Ensuring normal blood circulation in the muscular-articular apparatus. The main causes of blood flow disorders associated with food intake:

• Blood with cholesterol impedes the movement of blood through the vessels, contributes to the formation of cholesterol plaques, which narrow the lumen of the vessels, limit the flow of nutrients to the tissues. Prevention consists in the need to limit the intake of food rich in cholesterol – meat, fatty foods.
• Blood clotting. To eliminate blood clotting, it is necessary to take a sufficient amount of water up to 1.5-2 liters. per day. This amount also includes water contained in food, in first courses.
• Viscous blood containing a large amount of protein that sticks red blood cells together.
• High level of adrenaline, appears if a person is nervous all the time or is at a high level of adrenaline professionally (eg driver, leader, artist, etc.). Adrenaline always constricts blood vessels, contributing to the difficulty of blood flow.
• The presence of toxins in the blood. To remove them, it is necessary to periodically carry out cleansing procedures, observe the correct diet.

Resume . For normal operation and prevention of diseases of the musculoskeletal system, it is necessary to adhere to a dairy-vegetarian diet, while limiting meat and sweet foods. It is also necessary to limit the total amount of food, do not overeat. Do physical education. Purify the body and normalize the functioning of internal organs with the help of diet and herbal medicine.

Back pain and diet

Lose weight

In case of back pain, the attending physician will definitely recommend a diet to a patient with overweight in order to reduce excess weight and reduce the load on the musculoskeletal system (spine and joints).

In practice, body mass index (BMI) is used to determine overweight. If the BMI is from 25 to 29.9, then this indicates excess weight, if the BMI is above 30, it indicates obesity. To get your BMI, you need to divide your weight (in kilograms) by your height (in meters) squared.

To lose weight, you need to follow two golden rules: reduce your calorie intake and introduce moderate exercise into your life. It is very important to understand that you need to seriously change your lifestyle: short-term diets and physical activity allow you to lose weight, but when you return to old habits, the weight will be restored.

The best way is to make small changes in your lifestyle and stick to them. Then you can gradually add new changes, which also need to be adhered to.

Currently, there are drugs and surgical interventions that help to reduce body weight, but they are indicated only for people with a high BMI and those who have not been able to lose weight through diet and exercise. But even after surgery, patients must adhere to diet and exercise.

Balance your diet

Many studies have examined the effects of various foods and supplements on back pain. A minor analgesic effect was found in black pepper, turmeric, soybeans, avocado, fish oil, and vitamin D. A review of several studies found positive effects of nutritional supplements such as L-carnitine, curcumin, passion fruit skin extract, collagen hydrolyzate, glucosamine and chondroitin, cytidine and uridine.

Strengthen bones

Several independent studies have shown better results in the treatment of patients with back pain who took fish oil (omega 3 fatty acids) for 2 years. This is most likely due to the anti-inflammatory effects of the acids found in fish oil.

If a patient with back pain has osteoporosis or is at increased risk of developing it, two dietary supplements, calcium supplements and vitamin D, should be added to the diet. The main sources of calcium in the diet are milk and other dairy products such as hard cheese , cottage cheese or yogurt, as well as green vegetables (cabbage and broccoli). Some grains, soy products, and fruit juices are fortified with calcium.

“Give food” to nerve fibers

If the spinal roots are damaged, a persistent pain neuropathic syndrome develops. It is manifested by shooting pain, a crawling sensation in the area for which the damaged nerve is responsible, a burning sensation. Pain syndrome significantly reduces the quality of life: it is difficult to sit and stand, bend over, lead an active lifestyle, do your favorite things.

Neuropathic pain develops against the background of damage to the membrane of the spinal root, which consists of myelin. Against the background of the prescribed treatment, the damaged shell can be restored. Studies have shown that nucleotides, B vitamins, and folic acid play an important role in the restoration of this shell. In the complex therapy of pain in the back, the patient may be recommended to take Keltikan® complex, which contains the nucleotide uridine monophosphate, vitamins B6 and B12, folic acid, which contribute to the restoration and regeneration of the nerve fiber. The drug is prescribed 1 capsule in the morning for at least 20 days.

Thus, the patient with back pain is advised to reduce excess body weight by reducing the caloric intake and introducing moderate physical activity. The diet should be balanced and complete. It is recommended to include foods rich in calcium and B vitamins: soybeans, avocados, milk and other dairy products, hard cheese, cottage cheese, yogurt, green vegetables, cabbage, broccoli, fish, liver, chicken meat, eggs, nuts, legumes , bananas. Use black pepper and turmeric in cooking. Recommended intake of fish oil and vitamin D, L-carnitine, passion fruit skin extract, collagen hydrolyzate, glucosamine and chondroitin, cytidine and uridine.

References

• Torlak MS., Bagcaci S., Akpinar E., Okutan O., Nazli MS., Kuccukturk S. The effect of intermittent diet and/or physical therapy in patients with chronic low back pain: A single-blinded randomized controlled trial. // Explore (NY) – 2020 – Vol – NNULL – p.; PMID:32859542
• Bowman M.A., Neale A.V., Seehusen D.A. New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine. // J Am Board Fam Med – 2020 – Vol32 – N6 – p.