Low back pain became one of the biggest problems for public health systems in the Western world during the second half of the 20th century. The lifetime prevalence of low back pain is reported to be as high as 84 percent, and chronic low back pain is present in about one in five, with one in ten being disabled. It’s an epidemic.
Are people just lifting more heavy stuff? No. “[M]echanical factors, such as lifting and carrying, probably do not have a major role in this disease.” Atherosclerosis can obstruct the arteries that feed the spine, and this diminished blood flow can result in various back problems. This can be seen on special scans. Check them out in my video, Back in Circulation: The Link Between Sciatica and Cholesterol, where you can see the difference between normal and clogged spinal arteries. I also show what they look like on autopsy, where we can see the openings to the spinal arteries getting squeezed shut by cholesterol-filled plaques.
Now, we have MRI imaging that can show the occlusion of spinal arteries in people with back pain, and the degeneration of the discs. Researchers showed that patients with long-term lower back pain had constricted blood flow, and those with high cholesterol appeared to suffer with more severe symptoms. Those with narrowed arteries appear about eight-and-a-half times more likely to have suffered from chronic back pain.
Although disc degeneration has multiple causal factors, with genetic, occupational, and mechanical influences, alteration in nutrition has been proposed as the final common pathway. This makes sense. The discs in our lower back are the largest “avascular” tissue in the body, meaning our discs don’t have any blood vessels. Thus, its nutrition just kind of diffuses in from the margins, making it especially vulnerable to deprivation. Using MRIs, we can measure the effects of impaired blood flow on that diffusion. Because of this vulnerability, discs degenerate far earlier than other musculoskeletal tissues; the first unequivocal findings of degeneration in the discs of the lower spine are seen starting around age 11. Nearly all kids have the beginnings of atherosclerosis by age ten (Heart Disease Starts in Childhood). By the early teen years, we can already see the disks starting to deteriorate. By age 49, 97% percent of the discs of those eating the Standard American Diet show at least grade-2 degradation.
Cholesterol plaques in the wall of the aorta obliterate the openings of spinal arteries. Structures with precarious nutrient supply, such as the intervertebral discs, may suffer and gradually degenerate, as well as herniate. There is a link not only between cholesterol levels and disc degeneration, but also between cholesterol levels and disc herniation.
This compromised blood flow may also damage the nerve roots that come off the spine, causing sciatica. Sciatica is back pain that radiates down the legs, causing additional pain, numbness or weakness, and prolonged disability. Sciatica affects as many as 1 in 20 people. Independent of weight, clinical sciatica may be associated with blood cholesterol levels as well. The nerve roots, which are most commonly associated with sciatic pain, are supplied by some of the arteries most vulnerable to atherosclerotic plaque formation. Obliteration of these arteries by cholesterol buildup results in compromised nutrient supply to the nerve itself. That lack of oxygen to the nerve may play a role in the sciatic nerve crying out in pain. Reduced blood flow also hampers the removal of waste products, such as lactic acid, which can irritate the nerve endings, causing pain and deterioration.
Sadly, low back pain is now common in children and adolescents, and getting worse. Similarly, children are now getting disorders like adult-onset diabetes. Teenagers, starting out their lives with a chronic disease; that’s why it’s never too early to start eating healthier.
Just like back pain can be an indicator of clogged arteries, so can erectile dysfunction: Survival of the Firmest: Erectile Dysfunction and Death. Thankfully, the clogs in our arteries can be reversed! See, for example:
- One in a Thousand: Ending the Heart Disease Epidemic
- Fully Consensual Heart Disease Treatment
- Evidence-Based Medicine or Evidence-Biased?
In health,
Michael Greger, M.D.
PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of Death; More Than an Apple a Day, 2014: From Table to Able: Combating Disabling Diseases with Food; 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet; and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.
