Most of the content of this article is derived from a couple of Dr Michael Greger’s superb ‘NutritionFacts.org’ videos:
Low back pain became one of the biggest health problems in the western world in the latter half of the 20th century and appears to be extending worldwide. Up to 84% of us will suffer from low back pain at some time in our lives, about 1 in 5 will suffer from chronic low back pain, and more than 1 in 10 will be disabled by it.[iii]
Mechanical factors, such as lifting and carrying, are probably not major causes of the disease, but genetic make-up might be[iv], so the fact that the incidence of low back pain is spreading would seem to indicate that there are life-style changes we could adopt which might reduce our risk of succumbing to it, or improve our prognosis if we already have it, in spite of the genetic cards we have been dealt.
The fact that the incidence of low back pain is spreading would seem to indicate that there are life-style changes we could adopt which might reduce our risk of succumbing to it.
One of the primary causes of disc degeneration is thought to be the failure of the supply of nutrients, such as glucose and oxygen, to the disc cells. [v]
Figure 1: Normal (left) and degenerate (right) lumbar intervertebral discs[vii]
Atherosclerosis can cause disc degeneration, and consequent back problems, by obstructing the blood vessels which feed the lumbar spine.[vii] The autopsy and angiography results below show normal (a), and cholesterol-clogged (b) lumbar arteries and their openings in the wall of the abdominal aorta.[viii]
Figure 2: Aortograph showing (a) pairs of normal 2nd–4th lumbar arteries and (b) occluded and narrowed lumbar arteries.[ix] © 2009 European Society for Vascular Surgery
Figure 3: (a) Well-preserved and (b) stenotic orifices of the 2nd–4th lumbar arteries in the posterior wall of the abdominal aorta. Red staining shows fatty streaks.[x] © 2009 European Society for Vascular Surgery
10% of people in developed countries have advanced atheromatous lesions in the abdominal aorta by the age of 20[xi], and smoking and high serum LDL cholesterol levels were found to have the most consistent associations with disc degeneration and nonspecific long-term low back pain. [xii] [xiii]
Aside from its own debilitating effects, low back pain, along with atherosclerotic erectile dysfunction, may serve as a coal-mine canary by indicating an increased risk of death from ischaemic heart disease.[xiv]
‘Slipped’ or herniated discs are associated with high cholesterol and triglyceride levels[xv], and in people with high levels of atherogenic serum lipid levels (independent of BMI), obliteration of lumbar arteries which supply blood to nerve roots may also cause sciatica, in which lower back pain can radiate down the leg to below the knee and cause numbness, motor defects, and prolonged disability.[xvi]
Because of this apparent vulnerability of lumbar discs to deterioration and atrophy as a result of restricted blood flow, starving them of nutrients and hampering removal of waste products such as lactic acid,[xvii] disc degeneration may occur as early as 11 to 16 years of age, with 1 in 5 teens having discs with mild signs of damage.[xviii]
Those of us in developed nations need to wake up to the fact that our standard western diet is resulting in much unnecessary pain for ourselves and our children, and we must begin to dispel the old notion that a ‘balanced’ diet necessarily involves daily consumption of saturated fats in the form of meat, dairy, and eggs.
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© Bruce Cartwright 2015
[i] Greger, M. (2014). Back in Circulation: Sciatica and Cholesterol. [online] Nutritionfacts.org. Available at: http://nutritionfacts.org/video/back-in-circulation-sciatica-and-cholesterol/ [Accessed 17 Mar. 2015].
[ii] Greger, M. (2012). Cholesterol and Lower Back Pain. [online] Nutritionfacts.org. Available at: http://nutritionfacts.org/video/cholesterol-and-lower-back-pain/ [Accessed 17 Mar. 2015].
[iii] Balagué, F., Mannion, A., Pellisé, F. and Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), pp.482-491.
[iv] Ibid.
[v] Urban, J. and Roberts, S. (2003). Degeneration of the intervertebral disc. Arthritis Research & Therapy, 5(3), p.120.
[vi] Ibid.
[vii] Kauppila, L. (2009). Atherosclerosis and Disc Degeneration/Low-Back Pain – A Systematic Review. European Journal of Vascular and Endovascular Surgery, 37(6), pp.661-670.
[viii] Ibid.
[ix] Ibid.
[x] Ibid.
[xi] Ibid.
[xii] Ibid.
[xiii] Kauppila, L., Mikkonen, R., Mankinen, P., Pelto-Vasenius, K. and Mäenpää, I. (2004). MR Aortography and Serum Cholesterol Levels in Patients With… : Spine. [online] Spine. Available at: http://journals.lww.com/spinejournal/Abstract/2004/10010/MR_Aortography_and_Serum_Cholesterol_Levels_in.12.aspx [Accessed 17 Mar. 2015].
[xiv] Penttinen, J. (1994). Back pain and risk of fatal ischaemic heart disease: 13 year follow up of Finnish farmers. BMJ, 309(6964), pp.1267-1278.
[xv] Longo, U., Denaro, L., Spiezia, F., Forriol, F., Maffulli, N. and Denaro, V. (2011). Symptomatic disc herniation and serum lipid levels. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21387192 [Accessed 17 Mar. 2015].
[xvi] Leino-Arjas P, e. (2008). Serum lipids in relation to sciatica among Finns. – PubMed – NCBI. [online] Ncbi.nlm.nih.gov. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17825307 [Accessed 17 Mar. 2015].
[xvii] Kauppila, L., Mikkonen, R., Mankinen, P., Pelto-Vasenius, K. and Mäenpää, I. (2004). MR Aortography and Serum Cholesterol Levels in Patients With… : Spine. [online] Spine. Available at: http://journals.lww.com/spinejournal/Abstract/2004/10010/MR_Aortography_and_Serum_Cholesterol_Levels_in.12.aspx [Accessed 17 Mar. 2015].
[xviii] Urban, J. and Roberts, S. (2003). Arthritis Research & Therapy, 5(3), p.120.
Bruce Cartwright 