PDF NMT150 Nut wk5 (1) 2023

LOW BACK PAIN AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Vitamin C Magnesium Proteolytic enzymes Vitamin D TREATMENT GOALS Address pres...

LOW BACK PAIN AUTHOR: D R. M A R YA M YA VA R I , M D , P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Vitamin C Magnesium Proteolytic enzymes Vitamin D TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and prevent complications  VITAMIN C o Like vitamin D, it increases calcium absorption in the body which promotes strong and healthy bones. o Vitamin C is known to help in the process of healing fractured and broken bones, wounds and burns. SOURCES Fruits: kiwi, papaya, strawberry, citrus fruits, etc. Veggies: red peppers, parsley, broccoli, brussels' sprouts, asparagus, kale, etc. 5 o The percentage of vitamin C that is absorbed decreases with increasing intake, therefore intravenous administration is required to achieve high levels in the blood. o Any unabsorbed vitamin C may be metabolized by intestinal bacteria. o The capacity to absorb oral vitamin C may increase during an acute illness. 6 THOSE AT MOST RISK OF DEFICIENCY o Children < 1 yr o The elderly, especially those in nursing homes o Low fruit and vegetable intake o Cigarette smokers o People with gastro-esophageal reflux disease 8 o The Upper tolerable intake level (UL) for vitamin C is 2 g/d Most common adverse effects of high doses of oral vitamin C are gastrointestinal: o Gastric irritation o Intestinal gas, bloating, cramping, and pain o Diarrhea Dental erosion (chewable and powdered ascorbic acid only) CAUTION Increased risk of oxalate stone formation. Diseases of iron metabolism such as hemachromatosis, thalassemia, and sideroblastic anemia Vitamin C supplementation above 2 grams per day is contraindicated during pregnancy MAGNESIUM o A 2004 study found that magnesium deficiency is one of the main causes of chronic back pain. o Since magnesium supports muscle and nerve function, a deficiency is directly related to impaired muscle and nerve function that can affect the back. SOURCES o Nuts and seeds o Legumes and whole grains, especially oats, barley, and brown rice o Most vegetables, especially green leafies, corn, and carrots o Seafood and dairy products o Coffee and tea, cocoa and chocolate INCREASED RISK OF DEFICIENCY o Renal disorders o Chronic alcohol abuse o The elderly Prevalence of inadequacy for nutrients with an Estimated Average Requirement in Canadian adult males 19+ years (2004) NUT102i. CCNM https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health- nutrition-surveys/canadian-community-health-survey-cchs/canadian-adults-meet-their-nutrient- requirements-through-food-intake-alone-health-canada-2012.html MAGNESIUM DEFICIENCY Muscle tremor, spasms, cramps, and tetany Chest tightness and shortness of breath Palpitations and cardiac arrhythmias Anxiety, depression, fatigue, insomnia Loss of appetite, nausea and vomiting CONTRAINDICATIONS End-stage renal disease Myasthenia gravis Urinary tract infection with elevated urinary phosphates Kidney stones Hyperparathyroidism PROTEOLYTIC ENZYMES Several studies have shown that proteolytic enzymes are effective at reducing inflammation and symptoms related to inflammatory conditions. Several studies provide preliminary evidence that proteolytic enzymes might be helpful for various forms of chronic pain, including osteoarthritis. DIGESTIVE ENZYMES https://drnealsmoller.com/blog/the-guide-to-digestive-enzymes/ FOOD SOURCES OF DIGESTIVE ENZYMES https://drnealsmoller.com/blog/the-guide-to-digestive-enzymes/ VITAMIN D Bone and lower back pain may be symptoms of inadequate vitamin D levels. Vitamin D helps maintain bone health by improving your body's absorption of calcium. One study in 98 adults with lower back pain linked lower levels of vitamin D to more severe pain. VITAMIN D Skin production depends on: o Length of exposure to the sun o Amount of bare skin exposed o Season and time of day o Level of latitude o Degree of pigmentation o Age SUMMARY Vitamin C 1000 mg/day Magnesium 400 mg/day Proteolytic enzymes Bromelain 1,200-2,000 GDU Fungal protease 100,000-200,000 HUT Nattokinase 2,000-4,000 FIP Papain 3,000,000-6,000,000 PU Serrapeptase 80,000-160,000 SPU Vitamin D 1000 IU/day QUESTION Susan, a 72-year-old female with chronic kidney disease is concerned about low back pain. She drinks 3 glasses of wine every day. She also feels muscle spasms, headaches, and constipation. Which one of the following supplements is the best option for Susan? Vitamin B7 Vitamin E Magnesium Vitamin A REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. Wiley Blackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. Encyclopedia of Nutritional Supplements. Prima Health; 1996. Gropper S, Smith J. Advanced Nutrition and Human Metabolism. 7th Ed. Cengage Learning; 2018. REFERENCES Bahinipati J, Mohapatra RA. Serum magnesium and vitamin D in patients presenting to the orthopedics out-patient department with chronic low back pain. Biomedical and Pharmacology Journal. 2020 Mar 28;13(1):347-52. Bayram S, Şahin K, Anarat FB, Chousein CM, Kocazeybek E, Altan M, Akgül T. The effect of oral magnesium supplementation on acute non-specific low back pain: Prospective randomized clinical trial. The American Journal of Emergency Medicine. 2021 Sep 1;47:125-30. Urits I, Jung JW, Amgalan A, Fortier L, Anya A, Wesp B, Orhurhu V, Cornett EM, Kaye AD, Imani F, Varrassi G. Utilization of magnesium for the treatment of chronic pain. Anesthesiology and Pain Medicine. 2021 Feb;11(1). Dzik KP, Skrobot W, Kaczor KB, Flis DJ, Karnia MJ, Libionka W, Antosiewicz J, Kloc W, Kaczor JJ. Vitamin D deficiency is associated with muscle atrophy and reduced mitochondrial function in patients with chronic low back pain. Oxidative medicine and cellular longevity. 2019 Oct;2019. REFERENCES Park HJ, Lee HJ. Digestive enzyme supplementation in prescription drugs, over-the-counter drugs, and enzyme foods. Journal of Pharmaceutical Investigation. 2022 Dec 14:1-3. Dionne CE, Laurin D, Desrosiers T, Abdous B, Le Sage N, Frenette J, Mondor M, Pelletier S. Serum vitamin C and spinal pain: a nationwide study. Pain. 2016 Nov 1;157(11):2527-35. Smith VH. Vitamin C deficiency is an under-diagnosed contributor to degenerative disc disease in the elderly. Medical hypotheses. 2010 Apr 1;74(4):695-7. Gaby A. Nutritional Medicine.; Perlberg Publishing 2011. Hoffer A, Prousky J. Naturopathic Nutrition: A Guide to Nutrient-Rich Food & Nutritional Supplements for Optimal Health. CCNM Press; 2006. Gaspardy G, Balint G, Mitusova M, Lorincz G. Treatment of sciatica due to intervertebral disc herniation with chymoral tablets. Rheumatology. 1971 Feb 1;11(1):14-9. THANK YOU!