Spinal stenosis, a condition characterized by the narrowing of the spinal canal, often leads to pain and discomfort. While various treatments exist, dietary modifications can play a significant role in managing symptoms and potentially slowing the progression of the condition. This article explores evidence-based dietary recommendations for individuals with spinal stenosis, drawing upon recent research and expert opinions.
Understanding Spinal Stenosis and Inflammation
Lumbar spinal stenosis (LSS) is a condition characterized by the narrowing of the spinal canal due to age-related changes in facet joints, discs, and the ligamentum flavum. Spinal stenosis often stems from age-related wear and tear, arthritis, or past injuries. The narrowing puts pressure on the nerves that travel through the spine, leading to pain, numbness, and weakness. Chronic inflammation can exacerbate these symptoms, making dietary strategies that combat inflammation particularly relevant.
The Role of Diet in Spinal Health
Maintaining a healthy diet directly correlates to spinal health, both in preventing and promoting the healing of back complications. An anti-inflammatory diet is key to spinal wellness, as many back issues occur due to the body's natural inflammatory response. Inflammatory foods will increase the body's natural inflammatory response. Weight management is also crucial, as excess weight can put additional strain on the spine.
Polyphenols: A Promising Dietary Component
Recent research suggests that diets rich in polyphenols may be beneficial in preventing LSS. Polyphenols are naturally occurring compounds with antioxidant and anti-inflammatory properties. A case-control study examined the association of dietary polyphenols with the risk of severe lumbar spinal stenosis (LSS). The study included 156 patients with LSS and indication to surgery and 312 controls, matched (1:2) for sex, age (±6 months), and physical activity.
Key Findings on Polyphenols
The polyphenol intake was calculated by matching food consumption data from a 188-item food frequency questionnaire with the Phenol-Explorer database regarding the polyphenol content of each reported food. The average intake of polyphenols in the diet was 595.3 mg/d (±274.1) in cases and 677.8 mg/d (±218.0) in controls. A 1-standard deviation (SD) increase in dietary polyphenols intake was associated with lower odds of LSS. Analyses of different polyphenol classes showed that a per 1-SD in the consumption of flavonoids and stilbenes was related to lower LSS risk.
Read also: VSS and Weight Management
Food Sources of Polyphenols
Cereals and fruits are major sources of polyphenols. To test the hypothesis that a diet rich in polyphenols is favorably associated with the risk of severe LSS, a case-control analysis was performed using data from the cohort of patients of the PREFACE Study. The top foods contributing to the intake of polyphenol classes of cases and matched-controls are reported, with no substantial differences between cases and controls.
Lectin-Free Diet: Reducing Inflammation
Orthopedic spine expert Dr. Hooman Melamed recommends a lectin-free diet. Many popular foods contain lectins, which are a significant source of inflammation that can also lead to chronic conditions such as high blood pressure and high cholesterol.
Acceptable Meats
Processed, red meat is typically what comes to mind when people hear the word “protein,” but these animal-based proteins cause a high inflammatory response in the body. It is always best to limit the amount of animal protein you consume, but switching to lectin-free meats are better options. These include:
- Pastured poultry: chicken, turkey, duck, goose, pheasant, and quail
- Grass-fed meats: bison, wild game, venison, boar, elk, humanely raised pork, lamb, and beef
- Prosciutto (Italian ham)
- Plant-based meat substitutes to reduce inflammation: Meat substitute products such as Quorn: Chik’n Tenders, Chik’n Cutlets, Turk’y Roast. Hemp tofu, and Grain-free tempeh.
Omega-3 and Omega-9 Fatty Acids
Omega-3 fatty acids are polyunsaturated fats that your body cannot make on its own. They offer a variety of health benefits including fighting inflammation and promoting bone health. They can be found in the following foods:
- Salmon
- Sardines
- Anchovies
- Flaxseeds
Omega-3 can also be obtained through fish oil supplements if sufficient amounts cannot be consumed through a regular diet.
Read also: Causes and Treatment of Pyloric Stenosis
Unlike Omega-3 fatty acids, Omega-9 fats can be produced by the body. However, consuming foods high in Omega-9 fats over other types of fat lead to decreased levels of inflammation. Omega-9 fatty acids can be found in the following types of oils:
- Olive
- Almond
- Avocado
- Other acceptable oils include: Algae, Coconut, Macadamia, Walnut, Red palm, and Sesame.
Avoid these lectin-containing oils: Soy, Grape Seed, Corn, Cashew nut, Peanut, Safflower, Canola, Cottonseed, and Partially Hydrogenated Vegetable.
Leafy Green Vegetables
Dark, leafy greens, in particular, have numerous health benefits for bones, eyes, heart, and more. They include Vitamins A, C, E, and K, many of the B-vitamins, antioxidants, fiber, iron, magnesium, and calcium. The following leafy greens are capable of reducing inflammation in the spinal column thus reducing back pain:
- Spinach
- Kale
- Broccoli
- Bok choy
- Chard
- Arugula
Avoid these lectin-containing vegetables: Peas, Sugar snaps, Legumes, Green beans, Chickpeas, Soy, Tofu, Edamame, Beans, and Lentils (unless cooked in a pressure cooker).
Calcium Sources
Calcium is the most essential nutrient for bone health. Consuming an adequate amount of calcium can prevent the development of osteoporosis (weak and brittle bones) as you age. Avoid dairy products from cows such as milk, yogurt, and cheese since they contain lectin. Instead, opt for the following sources of calcium:
Read also: The Hoxsey Diet
- Goat dairy products: goat milk, goat cheese
- Coconut yogurt
- Swiss cheese
- French/Italian cheese
- Vegetables (preferably dark, leafy greens)
- Fish that you eat the bones of (sardines and pilchards)
More Acceptable Foods for Spine Health
- Olives
- Dark chocolate
- Vinegar
- Red wine
- Wild-caught fish
- Fruits (in limited amounts): blueberries, raspberries, strawberries, apples, kiwis
- Dairy-free frozen yogurt
- Goat milk ice cream
More Unacceptable, Lectin-Containing Foods
- Starchy foods: pasta, rice, potatoes, bread, diet drinks
- The following nuts: pumpkin, sunflower, chia, peanuts, cashers
- The following fruits and vegetables: cucumber, zucchini, squashes, melons, tomatoes, bell peppers, eggplant
Additional Dietary and Lifestyle Recommendations
Beyond specific foods, several other dietary and lifestyle factors can influence spinal stenosis symptoms:
- Hydration: Water helps keep your spinal discs hydrated, which is essential for maintaining spinal health.
- Weight Management: Excess weight can put additional strain on your spine.
- Posture: Good posture reduces strain on your spine. Choose chairs with lumbar support or add a cushion to your existing chair.
- Stress Management: Chronic pain can take a toll on your mental health, so incorporating stress-reducing activities is essential.
- Sleep: Sleep is vital for recovery and managing pain. Consider investing in a medium-firm mattress that supports your spine.
The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI)
The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI) was developed and piloted with 10 individuals. The protocol for a randomized controlled trail comparing the SSPANLI intervention to usual non-surgical care follows. One hundred six (106) overweight or obese individuals with LSS will be recruited. Baseline and follow-up testing includes dual energy x-ray absorptiometry, blood draw, 3-day food record, 7-day accelerometry, questionnaire, maximal oxygen consumption, neurological exam, balance testing and a Self-Paced Walking Test.
Intervention Components
During Week 1, the intervention group will receive a pedometer, and a personalized consultation with both a Dietitian and an exercise specialist. Participants will also have access to in-person Coffee Talk meetings every 3 weeks, and meet with the Dietitian and exercise specialist at week 6. The control group will proceed with usual care for the 12-week period. Follow-up testing will occur at Weeks 13 and 24.
Potential Benefits
This lifestyle intervention has the potential to provide a unique, non-surgical management option for people with LSS. Through decreased fat mass and increased function, we may reduce risk for obesity, chronic diseases of inactivity, and pain. The use of e-health interventions provides an opportunity for patients to become more involved in managing their own health.
Study Design and Overview
The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI) is a single-blind RCT comparing the SSPANLI intervention to usual non-surgical care for LSS. This project will evaluate the new e-health lifestyle intervention aimed at decreasing fat mass, increasing physical activity and improving quality of life in older adults with LSS who are overweight or obese. The SSPANLI protocol includes individualized pedometer-based activity recommendations and online nutrition education tools, as well as two personalized consultations with a Registered Dietitian and exercise specialist.
Inclusion and Exclusion Criteria
All participants will be at least 45 years of age and will have received a diagnosis of LSS by a spine surgeon who has both examined the patient and reviewed imaging results (magnetic resonance imaging or computed tomography). All participants will be required to have a BMI of 25 kg/m2 or greater (overweight) and to have maintained a stable bodyweight for the previous 3 months. Exclusion criteria include diagnosed eating disorders, pregnancy, weight over 350 lbs, or any co-morbid conditions that would limit walking significantly or make participation in a walking program medically inadvisable, including severe arthritis, neuropathy or other neuromuscular disease, angina, cardiovascular disease, pulmonary disease, stroke or other neurological disorder, or peripheral vascular disease. Participants currently participating in a diet or lifestyle intervention for weight loss, who are on medications or herbal preparations known to influence bodyweight (including, but not limited to antidepressants and orlistate), or who have had changes in their prescription of lipid-lowering or diabetes medications over the past 3 months will be excluded.
Testing Schedule
Following enrollment, patients will begin the study protocol, which involves 7 testing appointments over a 6 month period. These appointments include Baseline Visit 1 (week -1), Baseline Visit 2 (week 1), 6-week check-in (week 6), Follow-up Visits 1 and 2 (week 13) and Follow-up Visits 3 and 4 (week 24). The intervention begins at Baseline Visit 2 and runs for 12 weeks (weeks 1-12). Enrollment will be continuous throughout the study. Once patients are enrolled they will begin assessments at the next available scheduled date for Baseline Visit 1. Six-week check-in sessions will be arranged individually for each participant. The primary outcomes at each time point will be fat mass (%), steps/day, and quality of life (SF-36).
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