Atherosclerosis and Low Back Pain

Atherosclerosis is well-known for its role in the development of coronary heart disease and stroke. The vascular occlusion that it causes leads to the infarction of heart and brain tissue. But coronary and cerebral blood vessels are by no means the only vessels that become clogged by atheromatous plaques. In 1993, Kauppila et al., from the department of forensic medicine at Helsinki University, postulated that insufficient arterial blood flow may play a role in low back pain. Their post-mortem angiographic study found that, compared to controls, significantly more people with a history of low back pain had anomalies in the arteries that supplied the lumbar spine – the arteries were narrowed by atheromatous lesions and some were completely missing.

Since that landmark study, several cadaver and clinical studies have corroborated the link between stenosis (and occlusion) of the lumbar arteries and the presence of low back pain. In fact, many studies have found an association between the aforementioned lumbar vascular insufficiency and degeneration of the corresponding lumbar discs. This shouldn’t be a surprise because, as Kauppila states, “the disc is located at the end of the nutrient chain, making it one of the first structures to suffer during insufficient nutrient supply.”

In epidemiological studies, associations between cardiovascular risk factors and low back pain (or disc degeneration) are weaker and conflicting. Nevertheless, several studies have linked high blood cholesterol and smoking with low back pain and disc degeneration. It’s important to remember that correlation is different from causation and more research is needed to determine a cause and effect relationship. So, a healthy diet and abstinence from smoking may play a role in the prevention and treatment of low back pain. Further still, and this is pure conjecture on my part, they may have a role to play in maintaining the health of all poorly vascularised tissues (spinal discs, tendons, articular cartilage of joints, etc.).

High Cholesterol Can Cause Tendon Pathology

A recent literature review by Yang et al. suggests that high blood cholesterol is a risk factor in the development and progression of tendon pathology. They found that cholesterol levels were directly correlated with the severity of tendon problems. There is evidence that elevated cholesterol levels lead to inflammatory, structural and mechanical changes in tendons which predispose patients with high cholesterol levels to an increased risk of developing tendinopathies.

Sleep Deprivation Can Negatively Affect Cholesterol Levels And Inflammation

Vilma Aho et al from the University of Helsinki conducted 2 studies looking into the effects of sleep deprivation. The first study was experimental and consisted of partial sleep restriction to a small group of subjects. The second was an epidemiological study with over 2700 individuals. Blood samples were analysed in both cases.

The analyses revealed decreased circulating High Density Lipoproteins (HDL cholesterol), otherwise known as ‘good cholesterol’, and elevated inflammatory markers. Sleep loss decreased the expression of genes encoding cholesterol transporters and increased expression in pathways involved in inflammatory responses. The findings help to explain why sleep deprivation is a risk factor for cardiometabolic disease.

High Cholesterol Linked To Tendon Problems

A group of Australian researchers have conducted a systematic review of literature to find articles that looked at the relationship between fat levels in blood and tendon pathology and/or pain. Their results were published in the British Journal of Sports Medicine. They found that people with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol (“bad cholesterol”) and triglycerides, as well as lower high-density lipoprotein cholesterol (“good cholesterol”).

The researchers conclude that although a relationship exists between an individual’s lipid profile and tendon health, further longitudinal studies are required to determine whether it is a cause and effect relationship.

Interestingly, the results of the China Study, one of the most comprehensive studies of nutrition ever conducted, found that one of the best predictors of diseases of affluence (heart disease, diabetes, cancer, etc.) was blood cholesterol.

BBC Horizon’s – Eat, Fast And Live Longer

Another great programme from BBC Horizon presented by Dr Moseley. He starts off the programme by following the oldest man to complete the London marathon…a 101 yr old sikh who is healthy and takes no medication…the typical 65 yr old european takes 6 pills a day! The centenarian attributes his good health to his diet and more specifically his small portion size…about half of a normal adult”s.

This is not the first time that caloric restriction has been linked to longevity. In the 1930s, during the great depression in the US, although there were widespread food shortages…surprisingly life expectancy increased by 6 years. During the same period scientists at Cornell University found that animals on restricted diets lived longer.

Dr Moseley had a keen personal interest in the subject because of the threat of disease due to elevated blood sugar and cholesterol. He traveled the US speaking to the most eminent specialists in the field in a quest for a solution to his health problems. His first port of call was Professor Luigi Fontana from Washington University and Salerno Schools of Medicine. Prof Fontana advised a diet low in calories but high in nutrients and introduced Dr Moseley to Joe. Joe was in his 50s and had been on 1900 kcal/day for about 10 years. His body fat was 11.5% whereas Dr Moseley”s, also in his 50s, had a body fat % of about 27. Although the benefits were clear, Dr Moseley wanted to understand the mechanism in the hope of being able to draw the benefits without having to do any of the hard work! This is one of the reasons I like his programmes…his attitude is typical of the average european (or american)…we want results quickly, with as little effort as possible…sound familiar?

He then met up with Professor Valter Longo at the University of Southern California. Prof Longo showed him a special mouse…about half the size of a normal mouse…but incredibly it had a lifespan that was 40% longer…the equivalent of 120 human casino jameshallison years! The mouse had been genetically modified to have low levels of the a growth hormone called Insulin-like Growth Factor 1 (IGF1). IGF1 is thought to be the link between calorie restriction and longevity. There are about 350 people worldwide who have genetically inherited low levels of IGF1. Their condition is named Laron syndrome and although some of them smoke and eat what they want, amazingly they don”t get diabetes or cancer! Low levels of IGF1 seem to increase cell repair and decrease cell division (which probably accounts for their extremely small stature).

Protein has been found to increase our metabolism and put us in “go-go” mode but the downside is that it decreases cell repair. Three things can help decrease levels of IGF1: decreasing calorie intake, decreasing protein intake and lastly, the most effective way…is by fasting. Fasting can dramatically reduces levels of blood glucose and IGF1 within as little as 24 hrs. Obviously fasting can be dangerous and should only be undertaken if in good health and under close medical supervision. So Dr Moseley decided to give it a go for 3.5 days. He only allowed himself water, black tea and a 50 kcal soup each day. As expected, his blood sugar decreased significantly and his IGF1 levels halved. Unfortunately, the effects are only temporary and one would need to decrease protein intake and fast every couple of months to maintain changes…not for Dr Moseley, so he continued his search…

Dr Krista Varady from the University of Illinois at Chicago had a much more palatable proposition…eat as much of whatever you want on one day and eat a reduced amount of whatever you want the following day…feed day, fast day, feed day, fast day, etc. It”s called Alternate Day Fasting (ADF). On the fast days women are advised to eat 400-500 kcal and men 500-600 kcal. Preliminary trials with overweight subjects are showing promising results including weight loss, lower levels of bad cholesterol and fats in blood and decreased blood pressure.

Lastly, Dr Moseley paid a visit to Dr Mark Mattsen from the National Institute on Aging in Baltimore. He has conducted animal experiments on intermittent fasting and has found that it postpones the development of Alzheimer”s and senile dementia like diseases. Sporadic bouts of hunger seem to trigger the growth of new neurones! In evolutionary terms, this would have provided a survival advantage in times of famine. Intermittent fasting has better effects on the brain than daily calorie restriction. Dr Mattsen suggested alternating 5 days of normal eating with 2 days of fasting. So Dr Moseley gave it a go for 5 weeks. On the normal days her took in around 200 kcal and on the fast days he ate about 600 kcal. Please bear in mind that normal calorie intake is based on sex, height, weight and activity. The results were extremely impressive. He managed to lose 1 stone and decrease his body fat from 27% to 19%! His blood sugar levels decreased to within normal limits, his IGF1 levels halved, his total cholesterol decreased and his good cholesterol increased. I assume that although he could have eaten whatever he wanted, he was sensible about it.

Dr Moseley ended the programme by saying that it was “the most interesting journey that I”ve ever been on…and I”ve never said that before”.