Chronic Pain & Food 1 – Article

Before you begin learning about manual movements and methods that are effective in pain resolution the first topic to address is how what you eat either promotes pain and inflammation in your body or fights pain and inflammation.

If you eat the Standard American Diet (SAD) there are some details regarding pain and food that will increase your understanding of just how important it is to nourish your body properly when it comes to resolving chronic pain. You will look at three ways diet promotes pain and chronic inflammation in your body; fat consumption, over-consuming foods high in arachidonic acid, and carrying excess weight.

First, let’s look at how prevalent pain is in our society. Aside from a general medical exam, updating medications, or a post-op visit, when looking at the top ten reasons someone visits the doctor five of them are pain-related.1 They include knee pain, back pain, low back pain, shoulder pain, and stomach pain.

Let’s focus on back pain for now as it is the second most common cause for disability in the United States2 and over 80% of the population will experience back pain at some time in life.3

While there is more than one reason for back pain you may be surprised to learn that impaired circulation can be a major contributing factor. Your body has many miles of blood vessels and they all matter. There has been a focus for decades on circulation to your heart and your brain; but what about your spine?

 

Pain, Impaired Circulation, and Lumbar Artery Disease

You have heard the term Cardiovascular Disease (CVD) but have you heard about Lumbar Artery Disease? I know, not another disease! The fact is that they are both due to the same issue. Let’s look a little closer at the anatomy (form) and physiology (function) of your blood vessels.

Your blood vessels are lined with cells called endothelial cells. These cells are very busy little bees working hard at keeping things running smoothly. They are responsible, among many other things, for dilating your blood vessels (the opposite of constricting or narrowing) and keeping your blood flow optimal. Optimal blood flow provides much needed oxygen and nutrition to all your cells and removes toxins and all the yucky stuff you don’t want sticking around. So, if these cells are so important, don’t you think you need to keep them protected from damage?

I hear you saying “Yes, but how do I do that?” The answer is simple. A low fat, whole food, plant-based diet will help to protect those important little cells from damage. You have learned (or are learning) about food, its relationship to disease, and overall wellbeing from Wellness Forum Health. I want to briefly reinforce the importance of a few of the details of this knowledge as it relates to chronic pain.

Saturated fats, all oils, and dietary cholesterol damage your endothelial cells,4 affecting the production of nitric oxide, which negatively impacts ALL your blood vessels; not just the vessels to your heart and brain. Impaired lumbar artery circulation is seen to relate to degenerative disc disease and back pain. You will see some of the data soon regarding this issue. These foods that harm your endothelial cell function are also high in calories which will negatively impact your ideal weight goals. We’ll look at how excess weight is related to chronic pain later.

In case you aren’t sure what saturated fats are; from a chemical standpoint, they are fat molecules that have no double bonds between carbon molecules because they are saturated with hydrogen molecules. Say what?! Simply put, saturated or hydrogenated fats are typically solid at room temperature (that includes margarine) and eating these foods can impede your endothelial cells from functioning properly. Consuming oils will do the same thing. There are no healthy oils. They all impede circulation and when it comes to cholesterol the only food source is animal foods. Cholesterol is well known for increasing your risk of cardiovascular disease. Plants do not have cholesterol. Your body makes all the cholesterol you need; therefore, you do not need to get it from food.

Saturated fats come mainly from animal sources, including meat, fish, and dairy products. Anything with a face or that comes from anything with a face has saturated fat and cholesterol and NO fiber. This includes cheese which is typically ~70% fat, most of which is saturated! Just one ounce of cheddar cheese contains 113 calories and 29mg of cholesterol. 82 of these calories come from fat and 2/3 of that fat is saturated.6 High-fat foods include salmon. Just 3 ounces of wild, raw Atlantic salmon has 121 calories, 49 of which come from fat, ~25% of which is saturated fat, AND 47mg of cholesterol6 and who eats just 3 ounces?! If you think salmon is a health food because of the media blitz regarding salmon, or ‘low fat’ cheese is good for you, please do your research. Low-fat labels are very misleading. Low-fat cheese is still over 1/3 fat which is well over the 10-15% advised for good health.

The lack of valid, scientific facts behind most of what the media reports would surprise you. As you are learning, reversal of chronic diseases like heart disease, type 2 diabetes, high cholesterol, high blood pressure, obesity, and even pain resolution (if pain is diet and lifestyle-related) is possible by focusing on a low fat, whole-foods, plant-based diet.

You may find the details about back pain and circulation to be quite interesting; especially if you have chronic back pain. The PCRM Conference on Cardiovascular Disease (CVD) in Washington, D.C. in 2015 had a large audience of physicians with specialties in cardiology, endocrinology, etc. PCRM is the Physician’s Committee for Responsible Medicine. There were many presentations on CVD but the most interesting, in my humble opinion because it related to pain, was Dr. Leena Kauppila’s research about Lumbar Artery Disease.

Dr. Kauppila is from Finland and she has performed extensive research for decades studying the relationship between CVD and back pain. Her work shows how impaired lumbar circulation correlates to pain and serious issues like degenerative disc disease. I will share just a few of her numerous studies.

A study published in 1995 found damage to subject’s arteries (atherosclerosis) by the age of 10 and 10% advanced blockages by the age of 20.7 This problem occurred at the opening of the lumbar arteries. How this relates to pain is the greater the blockage observed, the greater the disc degeneration was also seen.

Another study looking at 51 patients with chronic LBP (low back pain) without specific findings (no spinal stenosis or disc herniation) found the prevalence of occluded (impaired circulation) lumbar & middle sacral arteries was 2.5 times higher than in corresponding age and gender-matched population-based autopsy material.8 Simply put, people with a history of chronic LBP are much more likely to have poor circulation in the blood supply to their spine. The data also indicated that patients with above-normal LDL cholesterol complained of more severe back symptoms and they had occluded arteries more often than those with normal LDL cholesterol.

A study of the lumbar & middle sacral arteries of 774 thirty-six to sixty-nine-year-old males showed 18% severely occluded (impaired).9 The researchers assessed the stage of disc degeneration and found that disc degeneration increased with advanced atherosclerosis in the abdominal aorta, and especially with stenosis of the segmental arteries above and below the disc. Again, poor circulation relates to disc degeneration which is well known to relate to chronic back pain.

A study published in 1997 found back pain to correlate with cardiovascular disease. A follow-up study of 606 members of the population-based Framingham cohort indicated that advanced aortic atherosclerosis presenting as calcific deposits in the posterior wall of the aorta (your largest artery) increases risk of disc degeneration and is associated with the occurrence of back pain.10 One wonders if the lumbar arteries were imaged in these subjects what would have been seen?

The bottom line is when your lumbar arteries are not providing the blood supply necessary for health to your spine, pain is the result. The lumbar arteries are numbered 1 through 4 and these arteries can be severely blocked by calcifications and plaques, resulting in dysfunction, disc disease, bone disease, and pain.

Anatomy texts show three main branches off the lumbar arteries and each provides blood supply to a specific region of your body. The Posterior Body Wall provides for your paraspinal muscles, subcutaneous tissue, and skin. The Vertebral Body and Nerve Root provides for your vertebral bone, nerve root, and posterior root ganglion. The Posterior Peritoneum provides for your psoas and quadratus lumborum (deep hip and low back) muscles.

Some of the specifics of how this relates to pain is directly from the work of Dr. Leena Kauppila.

  • paraspinal muscle ischemia (decreased blood supply to muscles around the spine) with resultant pain related to exercise and muscle atrophy
  • bone ischemia (decreased blood supply to vertebra) with resultant dull, constant pain and disc degeneration
  • nerve root ischemia (decreased blood supply to nerve roots) with resultant sciatica and radicular pain
  • posterior peritoneum ischemia (decreased blood supply to the posterior membrane that lines the abdominal cavity and covers abdominal organs) with resultant lateral back pain and pain related to hip muscle activity.

As if chronic back pain isn’t enough to deal with you now know that there is a high correlation between chronic back pain and aortic calcification and atherosclerosis. This means if you have impeded blood flow to your spine, it is highly likely you have impeded blood flow to your heart, your brain, and EVERYwhere. The purpose of presenting this information is not to scare you, it is to inform you. As a physical therapist who specializes in manual techniques and effective self-care methods, I have seen many, many patients with back pain who respond well to treatment, recover from pain and restore function. I have also seen patients who do not. Those, I believe, were due to impaired lumbar circulation. That is why I am obligated to inform patients of how important diet is with regards to chronic pain.

The biggest challenge with definitive diagnosis when nothing shows up with MRIs or X-rays (we look at some interesting data about this in common pain treatments) is that who is testing lumbar artery function when a patient comes in with a complaint of chronic back pain? The typical route is a prescription for pain medication or a muscle relaxant. Often, a referral is made to an orthopedist or a pain management specialist. I don’t know about you but if I have pain I don’t want someone to manage it, I want to get rid of it.

The take away here is that eating to nourish your body and protect your endothelial cells just may resolve your back pain (or joint pain or muscle pain). The good news is that while it took years to create the problem, improvement may be seen (and felt) in just weeks or months. No amount of medications, tests, or procedures will restore impaired circulation but- EATING A WHOLE FOODS PLANT-BASED DIET CAN!11,12,13

References

  1. National Ambulatory Medical Care Survey: 2013 State and National Summary Tables https://www.cdc.gov/nchs/fastats/physician-visits.htm
  2. From the Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults–United States, 1999. JAMA. 2001;285(12):1571–1572.
  3. Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin. 2007;25(2):353–371.
  4. Stephen J. Nicholls, Pia Lundman, Jason A. Harmer, Kaye A. Griffiths, Kerry-Anne Rye, Philip J. Barter, David S. Celermajer. Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High-Density Lipoproteins and Endothelial Function. Journal of the American College of Cardiology, Volume 48, Issue 4, 15 August 2006, Pages 715–720
  5. Blankenhorn, D.H. et al, “The Influence of Diet on the Appearance of New Lesions in Human Coronary Arteries.” JAMA March 23, 1990. 263(12):1646-1652.
  6. www.nutritiondata.com
  7. Kauppila LI. Can low-back pain be due to lumbar artery disease? Lancet 1995;346:88
  8. Kauppila LI, Mikkonen R, Mankinen P, Pelto-Vasenius K, Mäenpää I. MR aortography and serum cholesterol levels in patients with long-term nonspecific lower back pain. Spine 2004;29:2147-52.
  9. Kauppila LI, Penttilä A, Karhunen PJ, Lalu K, Hannikainen P. Lumbar disc degeneration and atherosclerosis of the abdominal aorta. Spine 1994;19:923-29
  10. Kauppila LI, McAlindon T, Evans S, Wilson PW, Kiel D, Felson DT. Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 1997;22:1642-49.
  11. Ornish D, Brown SE, Scherwitz LW, et al. “Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.” Lancet. 1990 Jul 21;336(8708):129–33
  12. Ornish D, Scherwitz L, Billings J, et al. “Intensive lifestyle changes for reversal of coronary heart disease.” JAMA. 1998 Dec 16;280(23):2001–7.
  13. Esselstyn CB., Jr “Resolving the coronary artery disease epidemic through plant-based nutrition.” Prev Cardiol. 2001 Autumn;4(4):171–7