Question
Hi,

It's really great to find a site like this. It would be great if you could shed any light on what may be causing my symptoms.
It's a really long story where it comes to my back (10 years long) so for my first post, I'll cut to the chase. Here it is:


1 Burning inflamation like pain mainly down the left side of my back but also both sides of neck and a little on right side.  Always in the same places - focused around the same facet joints

2  No weakness in muscles like most beople have with 'back pain' and I have excellent range of movement

3 The pain is brought on by streaching, weight baring exercise and bad posture - worst activity imaginable for me - changing a car tyre, which incidentally I'd be able to do easily.

4 While I'm exercising I'm fine.  The moment I stop I have this inflamation like build up which again, does not cause loss of strength / stability movement- just IMENSE pain.

5 Blood tests show no inflamation (not sure how reliable those tests are) but permanently elevated levels of 'rheumatic factors'.

6 Heat when applied always makes the problem worse - I hate the summer now, it's a nightmare.

7 Cold always improves the problem, I carry ice packs everywhere I go to apply to my back.

8 Eating refined carbs causes the problem to worsen.  I'm on a low carb diet.  I've tested this out on myself many times and I always get a flare up after eating a lot of carbs (once I realised this I found some research suggesting insulin release can exacerbate inflamation)

9 A chiropractic adjustment eliminates all of my pain immediately, but it is temporary, the 'inflamation' builds up again until I'm back to square one after about 10 days.  Trust me on that.. It does not last for me.

10 No shooting pains or pins and needles at all.

MRI reveals a particularly straight lumbar section with double schmorls nodes at L5-S1 and L3-L4... Pretty unusual to have those I think.  Almost everyone has told me they are not significant though.


That's about it.  As you can imagine I've tried just about everything... physio, chiropratic (several), osteopathy, homeopathy,
I even had surgery to remove a disc bulge - it didn't change my symptoms at all.
What I'm really searching for now is some kind of diagnosis.  Surely the above symptoms must point someone in some direction...
My symptoms seem so different from normal back pain, most people equate back pain with having problems moving and muscle weakness - I have none of that - just this horrible build up of SOMETHING.

Facet joint arthritis seemed quite likely to me, but I don't believe thats consistent with there being no inflamation in my blood stream

Anyway.. thats enough for now.. If anyone is willing to postulate their theories I'd be very interested to hear and comment.

Thanks

Ross. :-)

Answer
Dear Ross,

Well a few things to consider.  You have got to have some inflammation in the tissue even if it does not show up on the blood tests, and it may just be generated by your dietary intake alone.  Heat makes it worse, carbohydrates make it worse, and you have documented high RH levels which means that you have some form of inflammatory condition (probably auto-immune) even if it is subclinical in nature.

Now, the lumbar facet arthritis is also contributory... although arthritic changes in the facet joint do not necessarily have to be from inflammation, altered weight bearing and the fact that you have a straightened lumbar spine is enough to cause degeneration of the facet joints and the disk.  Facet degeneration can easily lead to chronic pain...the fact that adjustments eliminate the pain (even though short lived) gives credence to facet generated pain.  I don't think that facet infalmmation is the probelm, but rather facet fixation which produces strain on the joint capsule, and pain transmisssion to increase. Your overall lumbar spine structure is the main problem though, and to change this, traditional chiropractic care needs to be augmented with directional traction for a structural change.  To accomplishe this I would recommend that you get an evaluation from a chiropractic physican who is trained in structural spinal rehabilitation.  you can find one at: www.idealspine.com.  The website will provide you with information on the process of rehab, and a section to the left on the main page to find a qualified physican by state and city.  

Now lets dive into nutrition/this is going to be lengthy:  Additionally, I know that you have some type of food allergy, otherwise carbohydrates would not flare you up asa easily.  That being said, all grain based foods do cause inflammation.  Most people have eaten bread, pasta, and cereals for their entire lives and are addicted to processed and simple carbohydrates (reference the traditional food pyramid). You need to make the conscoius decision to try and eliminate it from your diet.  Giving up this food can be psychologically traumatic, which illustrates the strong and inappropriate emotional connection that we have with food. However, if you visualize eating as a mechanism to fuel your body, then you should not be opposed to making changes that benefit your health and wellbeing. Would you put dirty leaded gas in an expensive sports car?  Remember, you get one body, when it抯 degenerated that抯 it, you don抰 get to replace the engine.  

Whole and refined grains have been consumed for only a short period of time during man抯 2 million years on earth. Our genetics have not changed significantly in that time, and manufactured foods were never consumed before the past few thousand years.   Our digestive system and physiological composition were not intended for the consumption of refined grains, pasta, cereal, soy, beans, dairy, refined sugar, partially hydrogenated fats, and seed oils, such as corn, safflower, cottonseed, sunflower, canola, and soybean oil.  Humans are genetically adapted to eat fruits, vegetables, nuts, fish, fowl, and meat卹emember hunter/gatherer. Consider also, that there are no chronic diseases caused by eating these foods. No matter what disease you may suffer from, none of these foods must be eliminated from the diet. The same cannot be said for grains in particular.  So eat like a caveman.

Gluten:  Numerous biochemical elements and functions make grains an inflammatory food; a protein called gluten has the most tarnished reputation. Celiac disease is a disabling digestive disease, and is caused by the gluten found in grains. Number one on the list of gluten grains is wheat; others include couscous, spelt, kamut, rye, barley, and oats. Among the non-gluten grains are rice, wild rice, millet, and corn. A comprehensive list of gluten foods can be found at Celiac Sprue Association抯 website (www.csaceliacs.org).  Additionally, supermarkets often carry gluten free products in the whole foods section or organic sections.

It is not only those suffering from celiac disease that needs to avoid grains. Gluten can cause many other symptoms and conditions, ranging from schizophrenia to more common conditions such as headache. For example, researchers randomly selected 200 disease-free individuals for the purpose of assessing anti-gluten antibody levels, which is a way to measure gluten sensitivity. A comparison was made of the health complaints between the subjects with the highest antibody levels, and those with the lowest levels.  Results:  15 percent of the subjects who had the highest antibody levels suffered from headaches, chronic fatigue, regular digestive complaints, subtle anemic changes, and NO signs of celiac disease. You should understand that headaches, fatigue, and digestive problems are three of the most common symptoms reported by patients to doctors, so this is very relevant.  Hippocrates, the father of modern medicine stated, 揕et food be your medicine!? but the right types of food are the most important.

Lectins:  All grains and legumes (beans, lentils, soy) also contain sugar-proteins known as lectins, which resist digestion and cooking. Before absorption, lectins are known to cause digestive system inflammation, which may or may not cause obviously linked symptoms. After lectins are absorbed into circulation from the digestive tract, they bind to the surface of cells throughout the body. Researchers state that, 搕here is now abundant evidence that lectins can cause disease in man and animals? They further suggest that lectins may promote the following conditions: allergies, autoimmune problems, cataracts, congenital anomalies, diabetes mellitus, infertility, inflammatory bowel disease, glomerulonephritis (kidney dysfunction), multiple sclerosis, psoriasis, retinitis and rheumatoid arthritis.

Other Problems with Grains:  As most people know, calcium is important for bone health, but most don抰 appreciate how important magnesium is for the protection of nerve function. Grains contain a substance called phytic acid, which is known to reduce the absorption of calcium, magnesium and zinc. Grains also promote an acidic body pH, which is known to be inflammatory. Moreover, grains contain an elevated ratio of omega-6 to omega-3 fatty acids, which causes inflammation. So why have we been told grains are so good for us?  Well, whole grains do contain nutrients and fiber, both of which are healthy and anti-inflammatory. Therefore, grains are marketed as a health food. Most of us are just ignorant about the inflammatory actions of grains. As an adjunct, grains are inexpensive and can be stored easily, so we consume lots of them. We are never told that we can get all the nutrients and fiber we require by eating fruits, vegetables, and nuts, and there is no need to consume grains. Consider this; throughout history, whenever grains were first adopted as a staple which replaced animal-based proteins, a host of negative health outcomes occurred, including:
?A characteristic reduction in stature
?An increase in infant mortality (also due to poor birth practices in industrialized nations)
?A reduction in lifespan卬ow reduced quality of life and obesity
?An increased incidence of infectious diseases
?An increase in iron deficiency anemia
?An increased incidence of bone mineral disorders such as osteomalacia and osteoporosis.
?An increase in the number of dental cavities and enamel defects
Many of these problems still plague us today, and some are actually on the rise. Readers must realize that these seven problems and the numerous conditions mentioned earlier, have only been associated with the consumption of grains and legumes, and have never ever been associated with the consumption of fruit, vegetable, nuts, and healthy animal products.

Inflammation has been implicated in all chronic disease processes, and is regarded as the number one preventable factor in regards to cardiovascular disease, diabetes, cancer, and pain.  All people suffer from inflammation issues to varying degrees.  We all need to focus on reducing our individual inflammation levels.  A proper diet is the key to realizing this goal. There are numerous complicated and ineffective diet plans available on the market today, so what about a no-nonsense approach to anti-inflammatory eating? Let抯 be practical, start by reducing pro-inflammatory foods and work towards elimination and creating a healthy balance.  The less inflammation you eat, the less inflammation you will have and feel. No one will be perfect with their eating卝ust do your best. The following foods cause inflammation and they should be avoided.

● All grains and grain products, including white bread, whole wheat bread, pasta, cereal, pretzels, crackers, and any other product made with grains or flours from grains, which includes most desserts and packaged snacks.
● Partially hydrogenated oils (trans-fats) found in margarine, deep fried foods (French fries, etc.) and most packaged foods.  If its in a box or bag, it probably contains trans-fats!
● Corn oil, safflower oil, sunflower oil, cottonseed oil, soybean oil, and foods made with these oils such as mayonnaise, tartar sauce, margarine, salad dressings, and many packaged foods.
● Soda (regular and diet), dairy, soy, and sugar.
● All artificial sweeteners are toxic and cause inflammation or neuro-toxic effects.
● Commercially produced meat and eggs from 揼rain-fed?animals. Lean cuts of meat are the best choice for non-grass fed animal products, but free range and grass fed meats are the best.

It may be somewhat distressing and/or depressing that so many foods are pro-inflammatory.  Many of my patients have said, 揥hat can I eat, it抯 all bad!?However, more depressing is suffering from any of the numerous diseases and conditions caused by inflammation such as; acne, Alzheimer抯 disease, allergies, arthritis, asthma, atherosclerosis, cancer, chronic fatigue syndrome, chronic pain, fibromyalgia, depression, diabetes, digestive dysfunction, endometriosis, flu symptoms,  heart disease, hypertension, insulin resistance syndrome (pre-diabetes), multiple sclerosis, osteoporosis, painful menstruation, Parkinson抯 disease, and sinusitis.  You need to decide how much pain and suffering you are willing to live with, then eat and exercise accordingly.

You should understand there is no such thing as moderation when it comes to inflammation. With every food you choose to consume, you are either creating inflammation or suppressing it. This is a fact we all must accept. We need to do our best to eat mostly anti-inflammatory foods, and strive for optimum balance. If you are fortunate and have 揼ood?genes, you may be able to handle more inflammatory foods than some of your family members or friends. The problem is that most inflammatory diseases develop slowly and without symptoms卽ntil it is too late. We need to be careful about consuming pro-inflammatory foods, and not take for granted what appears to be good health.  

Fundamentally, all you need to do is eat mostly fruits, vegetables, nuts, fish, chicken, and meat. Eat until you begin to feel full then stop. Take key supplements, which are outlined below, and establish proficient exercise habits. There is no need to make it more complicated than this.

Foods and Dietary Suggestions to Fight Inflammation:
● Eat all fruits and vegetables. Eat fruit raw and vegetables raw or lightly cooked.
● Red and sweet potatoes are suitable when consumed with a protein, such as eggs, fish, meat, wild game, or poultry.
● Fresh fish-(ocean, river, or lake).  The colder the water, the healthier the fish!
● Eat lean cuts of meat, chicken, and eggs from grass-fed animals. Go to eat www.wild.com to find producers of grass-fed animals.  Publix also has a 揋reenwise?section of meats
● Eat anti-inflammatory omega-3 (n-3) eggs:  Christopher Eggs (600 mg n-3 per egg yolk); 4-Grain Vegetarian Omega-3 Eggs (300 mg n-3 per yolk), Sparboe Farms n-3 eggs (250 mg n-3 per yolk), and Eggland抯 Best (110 mg n-3per yolk).  All can be found in local grocery stores. I eat 4-Grain Vegetarian eggs and they are quite tasty.
● Wild game such as deer, elk, fowl, etc卲rovide quality lean protein.
● Nuts: raw almonds, cashews, walnuts, hazelnuts, macadamia nuts.  Careful:  read labels, some nuts have MSG (monosodium glutamate) added which raises inflammation and is a known potent neuro-toxin, please do not eat these or any other food containing MSG.
● Spices: ginger, turmeric, garlic, dill, oregano, coriander, fennel, red chili pepper, basil, rosemary, etc卆re all anti-inflammatory.
● Oils and fats: It is best to use organic oils.  Commercially manufactured oils may concentrate pesticides. Use organic extra virgin olive oil and coconut oil. Butter is also a healthy choice and the best butter comes from grass fed cows. (Organic Valley butter is from grass-fed cows).
● Salad dressing: extra virgin olive oil, balsamic vinegar, lemon juice, mustard, and spices such as ginger, dill, and oregano are great choices.  Avoid processed dressings.
● Thirsty?  Stay away from commercial drinks and sodas!!  Drink water, or organic green tea (non-organic green tea may contain pesticides and should be avoided).
● Alcohol: Red wine and dark beers are the best choices.  Guinness is the most nutritious beer produced and has a low alcohol and carbohydrate content.  Please don抰 over-indulge.
● Candy: Organic Dark chocolate厃um, and it has natural antioxidants.

Meal Suggestions
Meal preparation should not be an obstacle to healthy eating and is easily overcome with simple suggestions.  You don抰 have to significantly alter the meals your currently prepare, and this doesn抰 need to be an arduous process. If you can identify and appreciate the over utilization of refined grains and simple sugars in your diet, simply substitute vegetables for grains, bread, and pasta; and eat more fruits and nuts between meals.  Juicing fruits and vegetables is an easy way to increase your consumption, and can be quite tasty.  The Vitamix blender is the best juicing machine I have found.

Breakfast suggestion: Omega-3 eggs are the best choice, containing quality proteins and fats. Scrambled with your favorite vegetables or potatoes, omelets make easy preparation. It is best to use organic virgin coconut oil or olive oil for cooking eggs and potatoes. If you wish to have oatmeal or grits for you southerners, add a couple of tablespoons of ground up flax seeds, some raisins or berries, and use a little organic half-n-half or cream.
Meal shake: bananas, blueberries [or your favorite fruit], and omega 3 eggs or powdered whey protein is a simple option. You can add some coconut, or your favorite raw nut. Make sure to always use filtered water or organic milk for blending.
Lunch and dinner suggestion: A chicken [fish, steak] Caesar salad without croutons is an example of a meal that contains appropriate portions of vegetables and protein; it is a model meal that can be applied to all other meals. If you feel like dessert, eat more vegetables. Or, wait an hour to see if you are indeed still hungry. If so, have your favorite fruit, or one of the healthy desserts listed below.
Dessert/snack #1: ?cup of organic yogurt or cream combined with fresh fruit.
Dessert/snack #2: ?cup of organic yogurt or cream in a combination of coconut, dates, raisins, and nuts.
Dessert/snack #3: Dark chocolate, raisins, and raw almonds or favorite nut listed above.

Often people feel that they can never eat out in a restaurant, as no anti-inflammatory meals are available. It is important to understand that ethic restaurants offer a wide range of anti-inflammatory meals.  Asian, Greek, Hispanic, Indian, Thai and Italian meals are based on vegetables, fruit, lean animal products, and anti-inflammatory spices, so all can be considered anti-inflammatory!  Try to avoid grains, bread and pasta, which represent modern pro-inflammatory additions to the ancient dietary staples. For cooking at home, any traditional ethnic grain/flour-free recipe can be prepared. Several recently published texts are available to assist you in the kitchen, provide anti-inflammatory nutritional advice and offer a variety of options for meal preparation: The Paleo-diet; The Omega Rx Zone; Eat Fat, Lose Fat; and Nourishing Traditions.

Supplements to Help Fight Inflammation
A multitude of scientific research is pointing to the need for everyone to take supplements in order to promote health and prevent disease; even Harvard Medical Center has stated this in their press releases and research. Inflammation reduction is the key feat for many supplements and other approaches to disease prevention such as pharmaceuticals. Accordingly, the following suggested supplements are selected due to their ability to reduce inflammation and/or promote health. Many people take ten or more of the following supplements, while others opt for one or two. The basic program is for mainly for inflammation support and serves as the core to proper nutrient delivery. It is important to combine supplements in addition to a healthy, anti-inflammatory diet.

Basic Program:  
Main support nutrients for fighting inflammation, promoting health & disease prevention:
~Omega-3 fatty acids 4000 mg per day with an EPA/DHA content of 1.5-2.5 grams day
~Magnesium citrate, malate and chelate (400 mg/day)
~Coenzyme Q10 (60-100 mg/day)
~Pro-Enzymes such as bromelain, ginger, turmeric, and boswellia (1 gram/day)
**A Comprehensive multivitamin, preferably one such as Ideal Health, created for your metabolic type, already contains many of the above listed nutrients. (Get tested)

Additional Recommendations:
~Vitamin D (1000-2000 IU/day)
~Garlic with high Allicin content (5-10 mg allicin/day)
Anti-aging:
~Alpha-Lipoic Acid (200 mg twice per day)
~Acetyl-L-carnitine (500 mg twice per day)
Joint support:
~Glucosamine sulfate (1500 mg/day)
~Chondroitin sulfate (1200-1500 mg/day)
~Methylsulfonylmethane {MSM} (750-1000 mg/day)
Bone support:
~Calcium, citrate or hydroxyapatite form (1000 mg/day)
~Magnesium citrate, malate and chelate (400 mg/day)
~Vitamin D (1000-2000 IU/day)
Digestive support:
~Probiotics (acidophilus/bifidus) (1-3 caps per day)
~Digestive enzymes taken with meals

Now, yes I know that is a lot of supplements, and a very restrictive measure of dietary intake, but what do you have to lose...you have been in chronic pain for a long time now, and even surgery did not help!!  You need to make a choice regarding foods you eat: will they be pro-inflammatory foods or anti-inflammatory foods?

Now on a better note:  I know of a company that can metabolically test you to formulate a custom nutritional package for your individual needs, and it is very inexpensive.  The testing only costs $99.00, and they have a test for food allergies also.  You should take both of those tests.  Additionally they have a test for carbohydrate ingestion response of the body...you might want to consider it.  The testing is easily performed at home with a test kit that you just send back to the lab (postage is pre-paid with FED EX), and they send your reports and formulate your custom nutritional profile and package that is delivered right to your door.  Then you can retest at 3 or 6 months as your symptoms and metabolic profile changes.  I do this with my patients, and we get great results with it.  The custom nutrition costs $70 monthly for the basic program, and if you need any additional nutrient support they give you discounts.  It really works great.  The company is called Ideal Health, and they have completely changed they way I utilize nutrition in my office.  Give my office a call (850) 864-0800 if you are interested in pursuing this option, and I will be happy to get you set up with them.

Hope this helps Ross!!  Best wishes.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

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