Nutrition and Low Back Pain

So what does nutrition have to do with low back pain?

The short answer is that no one seems to be quite sure at present.

There are a number of proposed nutrition-related issues, though, that may have some bearing on low back pain.

First, the issue of weight is always an elephant in the room.  I have folks come into the office all the time having been told that their back hurts because they are overweight.  It is an easy thing to blame for lots of things.  Is it true, though, that being overweight increases risk for back pain?

Probably not, at least there is not a clear line connecting weight with back pain symptoms.

A study by Shiri et al. looked at a meta-analysis of a number of different studies on back pain that included analysis of weight.  [Am J Epidemiol. 2010 Jan 15;171(2):135-54. Epub 2009 Dec 11.] They found that “overweight and obesity have the strongest association with seeking care for low back pain and chronic low back pain.” [Am J Epidemiol. 2010 Jan 15;171(2):135-54. Epub 2009 Dec 11.]

A study by Leboeuf-Yde et al. in Spine found that “Obesity is modestly positively associated with low back pain, in particular with chronic or recurrent low back pain. However, because the association is weak, because there is no consistent positive monotonic dose response, and because the link disappears in monozygotic twins who are dissimilar in body mass index, it is unlikely that this association is causal. It is possible, however, that obesity plays a part in the chronicity of simple low back pain.” [Spine (Phila Pa 1976). 1999 Apr 15;24(8):779-83; discussion 783-4.]

There are a few points made by these researchers that worth highlighting. 

• Twin studies have shown that a modest increase in weight (30 lbs overweight) does not increase risk for low back pain (see a related blog post at: http://digg.com/d31IWzE). 
• Being overweight, though, does seem to have some correlation with the chronicity of symptoms.  That is, being overweight may not make it more likely that one experiences low back pain but may make it harder to undo or address symptoms of back pain.

Second, there is an emerging body of interesting literature on the association of atherosclerosis with low back pain.  Atherosclerosis is the same issue that increases our risk for heart disease, stroke, and other issues.  Studies have demonstrated that diminished blood flow may be a cause of low back symptoms and intervertebral disc degeneration.  Korkiakoski et al. found that the degree of arterial stenosis [or narrowing of the arteries in vessels serving the lumbar spine] was associated with intensity of low back and sciatic pain, and sciatica pain duration during the past 3 months.”  [Acta Radiol. 2009 Jan;50(1):48-54.]  The authors concluded that this correlation in the degree of arterial stenosis indicates a role of decreased nutrition in spinal disorders.”

A really interesting article from Kauppila et al. published in Spine in 2004 looked at MR aortography and cholesterol blood tests in 51 patients with long-term lower back pain without specific findings (i.e., spinal or nerve root compression) in regular lumbar MR images. [Spine (Phila Pa 1976). 2004 Oct 1;29(19):2147-52.] This is a more common situation than one might imagine.  I see people all the time with chronic back and leg symptoms that do not have a clear explanation for their pain on a regular MRI of the lumbar spine. 

So these investigators looked at serum cholesterol levels and specific MRI images of the arterial circulation in the lumbar region.  The results of their investigation were very interesting.  They found that in these subjects with chronic symptoms:

• The prevalence of occluded arteries was 2.5 times more than in subjects of corresponding age group
• Disc degeneration was associated with occluded lumbar/middle sacral arteries (P = 0.035)
• Patients with above normal serum LDL cholesterol scored higher in neurogenic symptoms (P = 0.031) and complained more often severe pain (P = 0.049) than those with normal LDL cholesterol

The authors concluded that these findings “indicate that lumbar and middle sacral arteries are often occluded in patients with nonspecific long-term lower back pain. Occlusion of these arteries may also be associated with disc degeneration.” [Spine (Phila Pa 1976). 2004 Oct 1;29(19):2147-52.]

So all of those things that we are supposed to be doing for good heart health, do them for your back as well (exercise, quit smoking, watch cholesterol intake, etc.).  Theoretically, effort to decrease cholesterol levels (LDL specifically) should be helpful (or maybe even preventative) for back pain. 

Should be all be taking Lipitor or Fish Oil to keep from getting back pain?  It is hard to say.  At the very least some consideration for the health of our arteries should complement exercise interventions for back pain.