It’s Not Drugs, Exercise or Surgery…

If you have persistent back pain, most doctors look for structural problems—a herniated disc, for example, or a misaligned spine. These can be real issues, but they point to a solution for only a small percentage of patients.

Surprisingly, back pain can be the result of poor nutrition and poor digestion, which causes chronic inflammation that irritates muscles, ligaments, tendons and/or nerves. A recent study in Asian Spine Journal found that nearly one-third of women and one-quarter of men with back pain also had food intolerances or other gastrointestinal complaints.

Dietary changes won’t always eliminate back pain (although they might), but they often reduce pain significantly. If you rate your pain as an eight, for example, changing your diet could reduce it to a manageable two or three. What to do…

Get enough fiber. If you’re often constipated or have infrequent bowel movements, you’ll have buildups of ­toxins that increase inflammation and back pain. A high-fiber diet can fix this and reduce your back pain.

My advice: Look at your stool. It should be more or less smooth (and should pass easily). If it is lumpy and hard, you probably need more fiber. ­Increase your water, fruit and vegetable intake.

Cut back on caffeine. Caffeine is a stimulant that increases levels of cortisol, a hormone that triggers inflammation. People who drink a lot of coffee or other caffeinated beverages are more likely to have painful muscle cramps and spasms.

My advice: Eliminate caffeine for two to three weeks. If this makes a big improvement, give it up altogether. If it doesn’t help, you can go back to it because caffeine isn’t the culprit.

Stay well-hydrated. Many of my patients don’t drink water very often. This is a problem because you need water to improve digestion and reduce ­inflammation—and because people who don’t drink much water often consume less healthful beverages, such as sodas. ­Water also helps lubricate the spinal discs and can help prevent fissures, cracks in the discs that can allow the soft middle portion to bulge out and press against a nerve.

Everyone with back pain should drink between four and 10 glasses of water a day. The first thing I do every morning is drink a big glass of water. If you’re not a fan of plain water, you can spruce it up with a squeeze of lemon or lime or substitute watered-down juice (half juice, half water).

Eliminate all added sugar. The average American consumes about 175 pounds of sugar a year—from soft drinks, desserts and even packaged foods that you wouldn’t imagine are loaded with sugar, such as white bread, salad dressing, ketchup and pasta sauce.

The rapid rise in glucose (blood sugar) that occurs when you eat sweetened foods triggers the production of cytokines, proteins secreted by immune cells that increase inflammation. A high-sugar diet also irritates the digestive tract, which can lead to back pain.

My advice: Give up all added sugar for at least three weeks. It takes about two weeks for existing inflammation to “calm.” Staying off added sugar for an additional week will help reinforce the change in your usual habits. After that, you can reintroduce a small amount of sugar—by having an occasional dessert, for example, or adding a small amount of sugar to your morning coffee.

If you add back a bit of sugar and your pain doesn’t increase, you’ll know that you can enjoy some sugar. On the other hand, you might notice that you’re having more back pain again, in which case you’ll want to cut out sugar.

Eat more organic produce. Most people know that antioxidants in fruits and vegetables—substances such as vitamin C, lycopene and indole-3-carbinol—can reduce levels of cell-damaging molecules (free radicals) that cause inflammation. In my experience, getting more antioxidants isn’t as effective for pain as improving digestion (with fiber, cutting back on sugar, etc.), but it can help. I tell patients to buy organic produce because it won’t be tainted with pesticides or other inflammatory chemicals. Also, a recent study found that organic corn contained 58% more antioxidants and that organic marionberries (a type of blackberry) had up to 50% more antioxidants than their nonorganic counterparts.

Look for sensitivities. The healthiest diet in the world won’t improve back pain if you’re eating foods that trigger a reaction in you. Many foods (including foods considered healthy, such as broccoli) can trigger symptoms in some people. In addition to pain, these symptoms could include digestive irritation, sleepiness after a meal, fogginess, achiness and/or congestion.

To find out whether you’re sensitive to one or more foods, track what you eat with a journal. When you notice an increase in pain, you can review the journal and find the food(s) that might be responsible. In addition to the foods mentioned in this article, dairy and gluten are common ­offenders.

My advice: When you identify a likely food suspect—maybe you drank a beer on the day your back got worse—give it up for a few weeks. If your symptoms improve, test your conclusion by having a small amount of that food or beverage. If the pain increases again, you’ll know that you have to avoid that food in the future. Or you can go to a gastroenterologist, a nutritionist, an allergist or an integrative medical doctor for food-sensitivity testing.