Your Back Pain is coming from INSIDE YOUR HOUSE!
OK, sorry if that reference to the old movie, When a Stranger Calls, triggered anyone (30 second trailer/meme here), but the title is probably correct. In the past decade, research has shown us that if we compare the X-rays and MRIs of people without back pain to people with back pain, they look frightfully similar (1). How can this be? It’s because the things that seem to be best associated with a painful disc are not apparent on an MRI or X-ray. Those things are inflammatory cytokines (2). For most of our readers here, the amount of circulating inflammatory cytokines in your body are due to your behavior in 2 rooms in your home…the bedroom and the kitchen. Let me explain…
Inflammation is a normal process in the human body. It helps us ward off infection and heal injury. However, certain factors involving diet and lifestyle can increase to amount of circulating inflammatory cytokines in the body. Researchers learned years ago that when they examine the excised disc herniation material from a back pain patient, they note a marked increase in the amount of inflammatory cytokines like, TNF-α, IL-6 and IL-8 (3). Other more recent studies have shown that people with higher systemic levels of inflammatory cytokines will have higher levels of inflammatory cytokines in the disc.(4) It’s a bit like having a lot of gas and tinder around when a fire is started. A small spark (injury associated with movement) can turn into a raging house fire (severe back pain that doesn’t go away) when the spark and fuel are paired. It turns out that you make most of the fuel for your fire in your bedroom (sleep quality) and in your kitchen (food choices).
Poor sleep causes a particular increase in one inflammatory cytokine called interleukin-6 (IL-6).(5) We also see this cytokine in high concentrations in the discs of people with back pain.(6) Many of you with back pain have already noted that your back hurts more on the day after a crappy night’s sleep. Here’s the connection to the kitchen. Research shows that poor sleep increases the stress hormone cortisol, and that increased cortisol causes impulse eating.(7,8) People with high cortisol have also been shown to make food choices that are higher in carbs and fat.(9) That pairing of carbs + fat flips a survival switch to make you gain weight. (10) No wonder that weight gain that results in obesity has long been known to be well correlated with low back pain.(11)
So if your back hurts and doesn’t seem to be getting better despite your best efforts with your chiropractor, physical therapist, spine surgeon and tarot card reader, consider doubling down on getting good quality sleep. Learn more by reading this book. Track your sleep using this device. FYI, I don’t get any profits from those recommendations. Reduce your carbs in your diet and choose foods that don’t spike your glycemic response. You can use a CGM to track your own body’s glycemic response to different foods. Then go do the thing that is best associated with a reduction in blood sugar and in back pain…exercise.(12)
Go for a walk, go for a run, a ruck or bike ride. Do some strength training and some work on the muscles that stabilize your back.
Back pain is a multi-factorial problem that requires a multi-variate solution. Get an action plan and commit to doing some regular effort on these accounts and watch the cool healing capacity of your body start to kick in!
References:
- Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S,Turner JA,Avins AL, James K,Wald JT, Kallmes DF, Jarvik JG. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811–6
2. Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA Jr, Riew KD, Lenke LG, Chahine NO. Inflammatory biomarkers of low back pain and disc degeneration: a review. Ann N Y Acad Sci. 2017 Dec;1410(1):68–84. doi: 10.1111/nyas.13551. PMID: 29265416; PMCID: PMC5744892.
3. Lim YZ, Wang Y, Cicuttini FM, Hughes HJ, Chou L, Urquhart DM, Ong PX, Hussain SM. Association Between Inflammatory Biomarkers and Nonspecific Low Back Pain: A Systematic Review. Clin J Pain. 2020 May;36(5):379–389. doi: 10.1097/AJP.0000000000000810. PMID: 31990692.
4. Patil P, Dong Q, Wang D, Chang J, Wiley C, Demaria M, Lee J, Kang J, Niedernhofer LJ, Robbins PD, Sowa G, Campisi J, Zhou D, Vo N. Systemic clearance of p16INK4a -positive senescent cells mitigates age-associated intervertebral disc degeneration. Aging Cell. 2019 Jun;18(3):e12927. doi: 10.1111/acel.12927. Epub 2019 Mar 21. PMID: 30900385; PMCID: PMC6516165.
5. Heffner KL, France CR, Trost Z, Ng HM, Pigeon WR. Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain. 2011 Jan;27(1):35–41. doi: 10.1097/ajp.0b013e3181eef761. PMID: 21188850; PMCID: PMC3058637.
6. Schistad EI, Espeland A, Pedersen LM, Sandvik L, Gjerstad J, Røe C. Association between baseline IL-6 and 1-year recovery in lumbar radicular pain. Eur J Pain. 2014 Nov;18(10):1394–401. doi: 10.1002/j.1532–2149.2014.502.x. Epub 2014 Apr 2. PMID: 24692238.
7. Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev. 2018 Jul;63:25–40. doi: 10.1016/j.cpr.2018.05.006. Epub 2018 May 28. PMID: 29879564.
8. McCuen-Wurst C, Ruggieri M, Allison KC. Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities. Ann N Y Acad Sci. 2018 Jan;1411(1):96–105. doi: 10.1111/nyas.13467. Epub 2017 Oct 16. PMID: 29044551; PMCID: PMC5788730.
9. Gallegos-Gonzalez G, Pineda-García G, Serrano-Medina A, Martinez AL, Ochoa-Ruiz E. Association between Stress and Metabolic Syndrome and its Mediating Factors in University Students. Am J Health Behav. 2021 Nov 15;45(6):1091–1102. doi: 10.5993/AJHB.45.6.12. PMID: 34969419.
10. Erdmann J, Tholl S, Schusdziarra V. Effect of carbohydrate- and protein-rich meals on exercise-induced activation of lipolysis in obese subjects. Horm Metab Res. 2010 Apr;42(4):290–4. doi: 10.1055/s-0029–1243637. Epub 2010 Jan 21. PMID: 20094973.
11. da Cruz Fernandes IM, Pinto RZ, Ferreira P, Lira FS. Low back pain, obesity, and inflammatory markers: exercise as potential treatment. J Exerc Rehabil. 2018 Apr 26;14(2):168–174. doi: 10.12965/jer.1836070.035. PMID: 29740548; PMCID: PMC5931150.
12. Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med. 2017 Jul;84(7 Suppl 1):S15-S21. doi: 10.3949/ccjm.84.s1.03. PMID: 28708479; PMCID: PMC5846677.
