Back pain can feel impossible to control. However, there are things that you can do to reduce pain. In this episode, Back Talk Doc host Dr. Sanjiv Lakhia empowers listeners to reduce back pain through mindful eating and nutrition. 

As Dr. Lakhia explains, “It's important that we zoom out and ask ourselves, what's really going on with our food and our diet?” 

By mastering the basics of healthy eating, you can reduce inflammation levels and consequently decrease pain levels. But with the many diets out there, all claiming to be the best, it’s challenging to sort fact from fad. 

That’s why in this episode, Dr. Lakhia teaches you the building blocks of healthy eating rather than talking about a specific diet. Once you understand the necessary components of healthy eating, you can modify your diet to account for any special dietary needs.

Dr. Lakhia provides the listener with five key steps to healthy eating to decrease back pain. These steps may seem simple, but if you can “adopt these basic recommendations, a lot of your health situations will improve. Pain should go down, and you'll feel better,” says Lakhia. Listen to this episode to learn more about each step and the scientific evidence behind them.

💡 Featured Expert 💡

Name: Dr. Sanjiv Lakhia 

What he does: In addition to hosting Back Talk Doc, Dr. Sanjiv Lakhia is a board-certified physiatrist who cares for patients at the Ballantyne and Rock Hill offices of Carolina Neurosurgery & Spine Associates. As a physiatrist, he specializes in non-surgical approaches to spine and orthopedic conditions and offers a diverse range of innovative treatments for back pain, including acupuncture, spinal injections, and prescriptive exercise. 

Company: Carolina Neurosurgery & Spine Associates

Words of wisdom: “If you're aware of who you are when you come to the table to eat and how you feel, it literally can translate into better health or, conversely, create increased levels of inflammation in your body.”

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👉 If you enjoyed this episode of Back Talk Doc, check out our recent episode Releasing Pain and Trauma with David Berceli, PhD

🔎 For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.

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Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.

Welcome. You are listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health brought to you by Carolina Neurosurgery & Spine Associates, where providing personalized, highly skilled and compassionate spine care has been our specialty for over 75 years. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.

Thank you for tuning in to another episode of Back Talk Doc. I am pleased to be sitting behind the mike and recording our 50th episode. It's been a real pleasure bringing you up to date material that you can use to help make your decisions regarding the care of your back and health in general. I thought it'd be fitting that for the 50th episode, I return to a topic that I love passionately, and that is nutrition.

I've done several episodes discussing the link between pain and inflammation. If you haven't had a chance, please go back to my earlier episodes, I did a whole breakdown on the anti-inflammatory Mediterranean diet. I also had a chance to interview a food scientist on the benefits of olive oil, and this is pertinent, because I truly believe the food we eat correlates with how we feel. If you're listening to this podcast, it's probably because you're suffering from pain of some type.

Many of us know that the underlying mechanism of most pain syndromes is that of inflammation. And there are many things that can trigger inflammation in our body, stress, sleep, environmental toxins, and of course, nutrition and nutrition is one of the factors, that I believe people have a fair amount of control over, so it certainly makes sense to optimize your nutrition if you want to feel your best. Now before, when I did my episode on the Mediterranean Diet, I called it the best food plan for inflammation, and today what I want to do is zoom out and really just talk about key aspects of a general Pain Relief Diet. And this is some of the material that I learned in my Integrative Health Fellowship that I went through in the last few years. I think sometimes with food and nutrition, we focus in too detailed and it's important that we zoom out and really ask ourselves, "What's really going on with our food and our diet."

There's so many different quote, unquote diets out there, Keto diet, Paleo, Whole30, Vegan, Whole-Food Plant-Based, Carnivore diet, Gluten-free, Dairy-free diets, food elimination diets. It just goes on and on and on. And sometimes that can over... make something more than it needs to be. So let's zoom out today. Let's talk about just some general aspects, because in my experience, many of us don't even have the basics down, let alone the need to worry about these specific details about certain food sensitivities and what have you. So today let's go through some key things. I want to cover a few aspects of how you should eat, if you are someone who suffers from pain of any type, I'm going to go through some ideas around mindfulness when you eat. We're going to talk a little bit about the importance of dietary patterns and low sugar glycemic load diets.

I want to touch a little bit on the importance of proper amount of fat in your diet, protein and then fiber. And then hopefully by the end of the episode, you'll leave with a good sense of where you should start on a macro level as you evaluate where you are with the foods you eat. I do want to start with this idea of the importance of how we eat, before you even get to what you put in your mouth. It's really fascinating research. There's excellent research about the importance of what's called Mindfulness, which is just a general awareness of what you're eating and how you're eating. And the general idea is that if you're aware of who you are, when you come to the table to eat and how you feel, it literally can translate into better health or conversely create increased levels of inflammation in your body.

I want to start by talking about a study that I found just really unbelievable. The study is titled Depression, Daily Stressors and Inflammatory Responses to High Fat Meals: When Stress Overrides Healthier Food Choices. And this was in the Molecular Psychiatry Journal 2017. And I'll put a link to that in the show notes and the authors are Dr. Kiecolt-Glaser, Fagundes, Amdridge and others. So this came out of a collaborative effort from Ohio State University College of Medicine, Rice University, MD Anderson Cancer Center amongst other institutions. And it's really fascinating, and the gist of it is this, what they did was they say Double Blind Randomized Crossover study, which is one of the higher quality ways to design a trial. And they took people and put them in two separate groups. Essentially they looked at 58 women, 38 breast cancer survivors, and then 20 demographically similar controls.

And their average age was around 53. And they received either a high saturated fat meal or a high oleic sunflower oil meal. And essentially what it was, was this: They measured inflammatory blood markers before and after the meals in both groups. And what they documented was that they really took inventory in terms of the prior day stressors and the influence on the current day meal response and as expected for a woman with no prior day stressors, their C-Reactive Protein and other inflammatory markers were higher following the saturated fat meal than the sunflower oil meal. However, when you applied a stressor to the group that had the sunflower oil meal and then measured the inflammatory markers, literally they became the same, meaning, they both had elevated levels of inflammation on their blood work. So it really shows that even if you're eating quote, unquote "Healthier food", if you're eating it in a state of frustration, hurriedness, anger, it can still create inflammation in your body.

So if you are someone out there who says, "I don't understand, I eat everything right. I'm healthy. I have plenty of fruits and vegetables. I exercise, yet I'm not getting the results I want." It's good to remember that the mindset you bring to the table is as important as what's on your plate. And I found that just to be a fascinating bit of research. So then what can you do about it? Well, a very simple thing I learned from a health coach. When you sit down to eat your food, take a couple deep breaths and just kind of focus in on how you're feeling in the moment. You can express internally some gratitude for the meal. You can say a prayer and just doesn't have to be an outward display. No one has to really know you're doing it, but it can be such a key and powerful intervention to prepare your body, to receive the food and the nourishment, and to metabolize it in a way that's healthy and not inflammatory.

So, that's the first tip, is really be aware of your mindset when you eat. Okay, moving on. I want to touch base a little bit on this idea of Dietary Patterns and Glycemic Load of Foods. Now there's lots and lots of literature out there on the Glycemic Index and the Glycemic Load and for those who aren't familiar, it really just, it's a measure of the type of blood sugar response you'll get to food. Whether it's an apple, a potato, this has all been calculated or measured and the higher the number, kind of the worse the responses, the more amount of insulin your body has to secrete to suppress the blood sugar rise. And in general, when you look at the research dietary patterns, like the Mediterranean Diet have been found to reduce inflammation CRP and inflammatory prostaglandin levels. And it seems to be related to the quality fats in the diet.

And that's why I did my episode earlier on Extra Virgin olive oil, because there's just numerous amazing compounds in these healthy fats that many of them we don't even really know at this point, but we know compounds like Oleocanthal, which have an ibuprofen like effect to lower inflammation. So, that's one pattern is eating healthy fats, can help lower inflammation and pain. Another pattern is that there're multiple studies that show the increased sugar intake, as well as high inflammatory fat and cholesterol intake can increase pain and pain sensitivity when controlling for other factors. And really the way to think about that is, when you combine unhealthy fats with sugar, that's the nuclear bomb, i.e. chocolate cake or some sort of dessert. That's got high amount of fat content with a high amount of sugar content in it. And it can literally make your pain increase.

And there's several studies... There's a study by Elma March 2020, in the Journal Clinical Medicine "Do Nutritional Factors Interact with Chronic Musculoskeletal Pain". And they go through and demonstrate that these factors do exist. So something just to be aware of is when you're combining foods, sugar and fat at the same time tends to have the most negative effects on your pain. And then lastly, in terms of dietary patterns, it's important to realize that adhering more closely to what's called the Healthy Eating Index, which is a measure of how much you're getting in your diet in terms of fruits and vegetables and fiber quality protein literally can lower your CRP levels. So it does matter. There's a direct correlation between what you eat and the inflammation in your body. And that's why I do like the Mediterranean diet, cause it is high in healthy fats, as high in cruciferous vegetables, it's high and healthy proteins and that will set you up to have less inflammation in your body and less pain.

So the take home points there again are, number one, you want to watch how much sugar you're taking in. I mean the sugar content that we have on our diet is... it's just out of control. The general recommendation and guideline is for no more than roughly 25 to 40 grams of sugar a day, but most Americans get anywhere from four to 10 times that, and it's really taken a toll across the country in terms of our health. A big kind of hidden food assassin as I'd call it, would be sugary drinks and beverages, so you want to avoid kind of liquid calories. So these are sweet teas and colas and lemonades and fruit punches, even fruit juice, even if it's raw fruit that you've processed or blended and created your own juice with, that's going to have a significant amount of natural sugar, which will trigger an insulin spike and contribute to elevated levels of inflammation in your body.

So you want to eat really 50%, less daily grams, carbs or sugar or 30 grams on fried carbs and meals and 15 grams per snack. That's really like the baseline, certainly the less you take in the better in terms of sugar. And there is a difference between the types of sugars we eat. Natural sugars such as that comes from fruit with fiber, that's built-in, to slower the insulin response, versus processed sugar refined sugars, which are, they're literally like a hit of crack cocaine, in terms of just a sun on set rise, dopamine hit. It makes you feel good when you have the candy and sweets and then there's a big crash afterwards and that type of cycling through processed foods and sugars, generates a lot of oxidative stress in your body, which is a fancy way of saying internal rusting in your body. It produces free radicals, which damage your cells.

And probably the biggest offender of this in our food supply is high fructose corn syrup. Something to be really aware of and I don't want to get too much in the ways in high fructose corn syrup, but it has a very detrimental effect on your body and something you got to read labels folks, you got to look on the packages, anything that says corn syrup, something to stay away from. And there have been some changes recently, a lot more branding now with foods, but they're just replacing it with other types of sugar. You definitely want to be careful what you're getting in packaged foods.

So the next category I want to cover for you guys today, in terms of trying to design a general food plan for pain has to deal with the type of fats you eat. And the rule of thumb here is, you want to increase the pro-endocannabinoid Omega-3 fats while reducing Pro-Inflammatory fats, foods that are high in Omega-6 that are used for processed packaged food and deep fried foods.

So what does this mean for you kind of day to day is the healthy fats and things like fish, nuts, seeds, almonds, walnuts. These are the ones that you want to have intake of. DHA and EPA tend to look in the literature to be more beneficial for our health and for reducing inflammation. Now there is some growing body of literature that we're overdoing it and that you can have excess of polyunsaturated fatty acids in your diet. So that's why I like to say it's really better to get the good fats from whole foods versus dosing high amounts of supplementation. The key here, though, really when you're talking about fats, it's almost more important about what you don't eat than what you do eat. And you just want to avoid large amounts of omega-6 fats found in vegetable oils like corn oil, cotton seed oil, safflower, oil, soybean oil, sunflower oil, any hydrogenated or partially hydrogenated fats.

And then certainly things like margarine and shortening. I think America and the world could use an oil change and it's really a hidden kind of hidden disaster in our food supply and the foods we eat. Anytime you go to a restaurant, I would say probably 90% of the time that food is going to be cooked in some type of unhealthy vegetable oil. So I'm not saying you don't ever go out to eat, but you have to understand that even if your plate of food looks healthy, how it's prepared really plays a big role in the net physiologic effect on body. So you don't want to totally avoid omega-6. I mean, there certainly are good sources of that. You know, avocados have omega-6, flax seeds, pumpkin seeds, pine nuts, pistachio. So, that can be part of a healthy diet and they do come with a fair amount of fiber, which we will touch on in a little bit.

But again, get it from whole foods, avoid excess amounts and other sources, like hidden omega-6 bad oils and salad dressings, cooking oils, and hydrogenated sources. A rule of thumb there, if it comes in a box or a bag or a package is probably processed in some sort of unhealthy vegetable oil and it's worth your time to review that and just make a decision about how much you want to eat. There is good literature that this stuff matters. A clinical studies on rheumatoid arthritis, over 10 randomized controlled trials have shown that if you can keep a healthy 3:6 ratio, you're going to reduce the amount of anti-inflammatory medications you need and then also there's several trials looking at migraines where reduction of omega-6 and increasing omega-3 can help reduce the headache frequency. So bottom line, there is... Fat matters. Nowm I think if you've been doing any reading or literature review, you should be aware by now that's the idea of low fat, low fat, low fat is good for you is really that's so like 1980s now. It's really not been the case, healthy food plan has healthy fats.

Next let's touch a little bit on the macronutrients of protein. There's a lot of confusion out there on protein, and I'm not going to get into all the different sources like whey and soy and P protein and they're just hemp protein. There's lots of different proteins out there. I would say, though, it's important to look at the amount of protein that you have in your food. And a general rule of thumb, is about one gram per kilogram of body weight of well sourced proteins' kind of split throughout the day. And if you can get that in a whole food form, that's going to be preferable to lots of protein shakes, which, by the way, a lot of the protein shakes, for example, getting smoothies.

And I do it myself sometimes. But understand when you get a commercially prepared smoothie at most of the stores across the country, that is also going to trigger a massive insulin spike, because they are loaded with different types of artificial sweeteners and sugars. So smoothies, folks really, they're more like desserts. If you want a healthy smoothie, I would say, make it yourself, so you can use whole food ingredients. You can use healthy protein. You can really re-label and decide how much sweetener you want to have in your smoothie. But one consideration is that, literature really shows protein is needed for healthy physiology. A lot of this was born out of the research on ketogenic diets and how they can be used to help with seizure control. And you know, like seizures, chronic pain is thought to involve increased excitability of neurons for pain, and this can involve peripheral and central neurons.

So this is a quote from Masino in his article in 2013, where he goes over the ketogenic diet and how it can influence and modulate pain. And it appears from some of the research that he did and we'll put a link to his article as well. It's worth reading, it's called Ketogenic Diets and Pain in the Journal of Child Neurology 2013, August 2013, but he has several key points from his research. Number one, higher protein diets appear to increase Neuromodulatory Adenosine, which is shown to help with pain. And this is really in layman terms. It's one of the key chemical modulators of pain and it's also activated when we do acupuncture. So you can get a same sort of analgesic effect just by having higher protein diet, higher protein diets provide essential amino acids, which are needed to create neuro chemicals to help control pain and block pain.

You also need higher protein to maintain physical function and muscle strength. And this is obviously known in the fitness world. And then also if you are someone who does exercise, protein is important to reduce post-exercise muscle soreness and muscular pain. So again, a lot of people are aware of the need for protein. I think it's important though, that we focus on good sources of protein, whether it's grass fed meats, you can get it in legumes, seeds, nuts, and then preferably lower on the list are things, like protein shakes and protein bars, which are really doctored up with a lot of sugar. One of the reasons the Mediterranean Diet is so beneficial from a nutritional perspective, is that it includes a high amount of what's called polyphenols. So eating a diet high in polyphenols should be another staple, when you're trying to create your general diet approach for pain. Polyphenols are chemicals and nutrients that are found in colorful fruits, vegetables, teas, and spices.

So you want to get close five to 10 servings of these per day different types. So you hear the term either Rainbow Colored Diet and this is what people are talking about. Polyphenols have tremendous amount of research showing how they can help reduce inflammation in the body and that's something that's been documented for several decades now. So this is where the recommendation to get your seven to nine cups of fruits and vegetables per day really comes from, in terms of optimizing your health. And I would frankly, just modify that. I think we need seven to nine cups of vegetables. I don't think Americans are lacking in their fruit and their sweets throughout the day. And you have to be careful with fruits. There are fruits that have higher glycemic index, so higher blood sugar response and lower. So some of the safer ones will be your berries, your blueberries, your raspberries, your black berries, and then things like grapes.

Maybe you want to make those more like a dessert. They have a lot more sugar content in them. Bananas also have a lot of sugar content in them. Again. I want you eating all these, but understanding that not all fruit created equal. And if you're really trying to lower pain in your body, your focus should be more on eating more vegetables, green leafy vegetables. We're talking about spinach and cauliflower and broccoli and kale. You want to have radishes in your diet. All of these are good detoxifiers, they had a lot of fiber for your gut microbiome, the good bugs in your gut. They make and synthesize your vitamins, but they need substrates that come from the food and the vegetables that you should be adding in. So there's, how do you get this type of vegetable amount and quantity into your diet? Because I think most people get maybe two cups a day of vegetables and no folks, the tomato on your hamburger doesn't really count, like lettuce in tomato, I wouldn't count that. That's not what we're talking about here.

About the only way to really do it. But I think in the United States with our society and how we're set up, is really to be intentional about having a very large salad at least once per day, where you can have multiple cups of greens, use healthy, maybe homemade, perfectly homemade salad dressings. I just use quite simply, I just combine extra Virgin olive oil and balsamic vinegar on my salad and then, put whatever vegetables you want on the salad. So just really try and make a point to do that. If that means you have to pack your lunch, take the extra 15 minutes to chop up the vegetables, make your salad and then knock out your requirement for the day. They look at the estimated intake of polyphenols in the United States as about 450 milligrams a day and this is low. We need double to triple that, if you want to lower inflammation in the body.

All right, moving on and wrapping up the last category. That's important in a general food plan for pain, is that a fiber. And this is one that I think is not talked about enough is the amount of fiber healthy fibers that we're getting in our diet and this is all connected. So when you eat the right foods, the beauty is when you eat the right whole foods, they have all this stuff in it. So if you're having a healthy big salad, guess what? You are going to have plenty of polyphenols to lower inflammation, you're going to have tons of fiber to help with your gut microbiome, to help with your bowel movements, to help with cholesterol. That's the beauty of nature and that these foods were created perfect in their own way.

So fiber intake is directly linked to Polyphenol intake, as we just talked about here and that's whether or not eating plenty of vegetables in your diet and the average American consumes about 15 grams per day, which is really lower than the USDA recommended 25 to 38 grams of fiber per day. And really, I think if you wanted to optimize your health and reduce your pain, you probably want to have closer to 60 grams of fiber per day. Now you basically want to get that through your high Polyphenol content foods and also you can get fiber through whole grains and multi-grain foods. So, but just make sure that you are someone who is not sensitive to grains in terms of blood sugar response, or you struggle with blood sugar issues.

Now we know that increased fiber reduces inflammation, markers like CRP. This has been well studied. We've seen trials recently that demonstrate pain relieving benefit of increased fiber. So there's two large longitudinal studies, but they looked at about 6000 subjects and it shows that consistently higher total fiber intake is related to 30 to 60% lower risk of symptomatic knee arthritis. So this was a study by Dai 2017, titled Dietary Intake of Fiber and the risk of knee arthritis in two US perspective cohorts, and that's the Annals Rheumatology Disease and we'll link to that article as well in the show notes. There's also data looking at this for fibromyalgia and other pain syndromes. One word of caution, when you do decide to increase your fiber intake, you want go slow, give your gut some time to accommodate and adapt. So you don't have a lot of indigestion with it, a lot of cramping and bloating. So there you have it folks, this is just general macronutrients principles about how you should design a healthy food plan.

When you're living with pain of any type, whether it's back pain or inflammatory arthritis, again, be mindful with how you eat, try and adopt some sort of pause-practice when you eat. So you can center yourself and be in a state of gratitude. You want to look at adopting important dietary patterns, which can be found in a food plant, like the Mediterranean Diet, but basically looking at a low sugar glycemic, low diet, that has healthy fats, plenty of protein, at least probably a gram per kilogram per day of body weight, in terms of your protein amount, make sure it's well sourced protein though. And then really add in the Polyphenols, we're talking plenty of vegetables into the diet, which will also bring in the right amount of fiber. If you can check those boxes, you're off to a good start. And then you can customize that food plan based upon your specific situation.

Some people have gluten sensitivity, so they'll pull out a lot of the grains from the diet. You may have a food sensitivity to dairy. Some people have gut conditions like SIBO and they can't do as well with some of the fruits and vegetables, they have to modify it from there. So I'm not saying this is the end all be all, but in my experience, majority of people don't even have the basics down. And if you can really approach it from a lifestyle perspective, adopt these basic recommendations, a lot of your health situations will improve, pain should go down and you'll just feel better. So I hope you found that helpful. And thanks for listening today.

Thank you for listening to this episode of Back Talk Doc brought to you by Carolina Neurosurgery and Spine Associates with offices in North and South Carolina. If you'd like to learn more about Dr Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health. On the next episode of Back Talk Doc, additional information is also available at carolinaneurosurgery.com.