Recommend your patients to continue sticking to a healthy diet, taking appropriate supplements, exercising, getting enough sleep, and reducing stress — all critical for retaining the improvements with gut health and low back pain
In this new era of health care, chiropractors are sought out for their unique vantage point: caring for the patient from the inside out. At a cellular level, humans are 90% bacteria. Yet, most physicians hyperfocus on the other 10% of cells. It’s the same with genetics. Nearly all DNA in the human body is bacterial. Yet, most physicians just look at the DNA we inherit — and not the 99% that’s found in gut bacteria. That’s where chiropractors flip the script with gut health and low back pain.
When a patient visits your office complaining of low-back pain and sciatica — two of the most common conditions sending patients to chiropractic care — your mind immediately should consider the role of gut bacteria and leaky gut. A patient reporting low-back pain can indicate inflammation throughout the body and gut permeability.
You know what types of testing will ascertain your hypothesis for gut health and low back pain — blood labs and nutrition testing. The following treatment protocols include lifestyle changes, restoring gut health, chiropractic care, low-level laser therapy, and nutritional support to help improve patient outcomes.
It’s this holistic, inside-out approach that differentiates chiropractors from other health practitioners.
What blood labs and nutrition testing reveal about gut health and low back pain
To effectively treat the root cause of your patient’s pain, you’ll need to consider their blood (inflammatory markers) and nutrition testing (food sensitivity and gut barrier permeability) results.
Biochemical profiling or circulating cytokines can assist in diagnosing those with low-back pain.1 Blood testing will confirm the existence of the proinflammatory markers TNF-alpha, IL-1beta, and IL-6. These cytokines are known to enter the blood circulation and contribute to systemic inflammation.
Nutrition testing can identify if food sensitivities, additives, and emulsifiers are causing inflammation. Food sensitivities can damage the intestinal barrier and cause leaky gut syndrome. Conversely, leaky gut syndrome can lead to multiple gut issues, especially food sensitivities. In addition, selected food additives can disrupt the mucosal barrier, allowing for an ingress of microorganisms, which leads to an increase in proinflammatory cytokines, and results in inflammation.2
Modern methods of nutrition testing use blood spots and serum to detect IgG (1-4) responses to a broad array of food proteins and food additives. The testing can reveal sensitivities to approximately 176 different foods and food additives and characterize them by the degree of severity.
To make the results even more accurate, the test also measures immune complexes, the most common food-related pathways in the body. Immune complexes resulting in inflammation are the underlying causes of many musculoskeletal conditions.
Finally, a gut barrier panel (GB panel) can help differentiate between simple sensitivity to inflammation and more extreme levels of leaky gut and identify the specific markers that imply gut permeability, including Candida, zonulin, and occludin.
I admit that the role of nutrition testing in diagnosing and treating musculoskeletal conditions isn’t intuitive. After all, we usually think of nutritional testing to manage digestive issues, food sensitivities, and leaky gut syndrome, not as a cause of low-back pain. Based on the latest research into increased intestinal permeability and the role of the gut microbiome, however, it’s time to expand our thinking and understand of gut health and low back pain and the significant value nutritional testing provides for our patients with musculoskeletal issues.
Restoring gut health with the Super 7(R) Action Plan
Restoring gut health is a crucial step toward improved immunity, reduced systemic inflammation, and a reduced risk of autoimmune disease.
By following my Super 7(R) Action Plan for better gut health — one that has been tried and tested on thousands of patients with positive results — patients can gain better health and a more robust immune system.
Step 1: Reset
The Standard American Diet (SAD) — the diet most Americans eat daily — is high in ultra-processed foods, bad fats, added sugar, chemicals, and excessive salt. Americans get 70% or more of their daily calories from processed foods.
A constant diet of bad fats, dairy products, refined grains, food additives, and sugar is a significant cause of systemic inflammation, dysbiosis, and leaky gut syndrome. Even if you’re average weight, the SAD causes chronic inflammation.
The solution to the inflammatory SAD is simple: stop eating it.
I recommend a plant-forward anti-inflammatory diet, such as the Mediterranean diet. An anti-inflammatory diet is rich in fresh and prepared real foods. It generally contains good fats, fresh fruits and vegetables, fatty fish, nuts, and whole grains. It’s low in processed foods, fried foods, gluten, dairy products, red meat, and processed meats such as bacon and sausages. Moreover, the cornerstone of an anti-inflammatory diet is being low in processed carbohydrates.
Step 2: Remove
The next step in the gut restoration process is removing foods impairing digestion.
Removing the offenders from the gut is a three-step process:
1. Remove food sensitivities — If nutrition testing has revealed that your patient is sensitive to a food, it needs to be removed from their diet for now — but not necessarily for perpetuity.
2. Remove processed foods, sugar, dairy, and gluten — I like to use two simple acronyms to help patients understand the basics of an anti-inflammatory diet: GPS and DNA. GPS represents no gluten, processed foods, and sugar. At the same time, DNA denotes no dairy, nicotine, and artificial sweeteners.
3. Remove unwanted pathogens and liver toxins — Toxins, including LPS from gut bacteria that enter the bloodstream from dysbiosis or a leaky gut, will strain the liver. Because the gut and the liver have a bidirectional relationship, toxins in the gut affect the liver — and vice versa. Detoxing the liver during the removal phase is a crucial part of the program.
A liver detoxification program — guided by a health care practitioner — can help patients get rid of accumulated toxins and reduce the symptoms of toxic build-up.
Step 3: Replace
Replacing and augmenting vital digestive chemistry allows the patient to improve digestion and absorption — the primary role of the gastrointestinal tract.
Shortages of bile, stomach acid, and pancreatic enzymes can throw the microbiome out of balance. Replenishing these supplies can make a big difference.
Step 4: Regenerate
There are myriad nutrients available to help regenerate and repair the damaged intestinal mucosa and the intestinal wall, including:
- L-glutamine for regenerating the mucosa
- Omega-3 fatty acids for calming inflammation and rebuilding the epithelial cell wall
- A collagen supplement for supporting your digestive tract as it heals — it helps seal the leaks
- Ginger for stimulating the production of stomach acid, bile, and pancreatic enzymes
Step 5: Re-inoculate
Ideally, your gut bacteria will consist of about 80-85% beneficial species and about 15-20% unfavorable species. The balance may fluctuate a bit daily and even hour to hour, but your microbiome is healthy when it’s close to the 85/15 ratio. We can use high-quality prebiotics and probiotics to help restore the beneficial bacteria and crowd out the unfriendly ones.
Step 6: Reintroduce and retest
Once gut symptoms improve, a greater variety of foods can be added back to the diet. Now is the time to continue to avoid processed foods and continue to avoid GPS and DNA. You can now consider retesting your patient for food sensitivities or suggest reintroducing some foods.
Step 7: Retain the gains
Recommend your patients to continue sticking to a healthy diet, taking appropriate supplements, exercising, getting enough sleep, and reducing stress — all critical for retaining the improvements with gut health and low back pain.
Leaky gut and low-back pain: Causes and treatment protocols
A growing body of research links increased gut permeability and dysbiosis to degenerative processes in the spine, such as those that cause low-back pain.
For example, in the case of intervertebral disc disease, one potential mechanism is the translocation of bacteria across the gut epithelial barrier and into the intervertebral disc, where they cause inflammation and degenerative damage. Another possible mechanism is systemic inflammation from increased gut permeability and dysbiosis added to existing inflammation from older age, obesity, and poor diet. Yet another potential mechanism is diffusion of inflammatory gut metabolites into the intervertebral disc.3
Treating low-back pain
Low-level laser therapy — Low-level laser therapy (LLLT), also referred to as non-thermal laser therapy, is a highly effective tool for treating low-back pain. Laser light at the 635-nm wavelength has been shown to provide significant pain relief on nociceptive musculoskeletal pain and reduce the use of opioids and NSAID medication.4 This wavelength reduces inflammation by inhibiting the NF-κB inflammasome and the production of the inflammatory COX2 enzyme. It also reduces the production of free radicals in the irradiated area and cuts the production of inflammatory cytokines such as interleukin-1 beta (IL-1β) and TNF-alpha.
In addition, LLLT can be used to create an anti-inflammatory environment in the gut by helping heal and seal the gut lining. Recent research strongly suggests that LLLT to the gut microbiome can help sharply improve microbial diversity. Using laser therapy to rebalance the gut microbiome has shown to have significant therapeutic effects.
It works by stimulating the mitochondria within cells to function better. When stressed, mitochondria don’t produce as much energy, create more damaging free radicals, and don’t efficiently transmit signals between the immune system and the rest of the body. Light from the laser modulates the reactive oxygen species produced within the mitochondria, leading to less free radical damage and inflammation. Normal mitochondrial function — including immune system signaling — returns, and cell metabolism improves.
Therapies targeting inflammation at both sites (lumbar spine and gut) have been shown to be beneficial for optimizing outcomes.
Dietary improvements — There are myriad nutritional supplements that can help treat gut health and low-back pain. Research shows that long-term glucosamine and chondroitin sulfate intake may counteract symptomatic spinal disc degeneration.5 Additionally, omega-3 fatty (n3-FA) acid dietary supplementation reduces systemic inflammation by lowering AA/EPA ratios and has potential protective effects on the progression of spinal disc degeneration.6
I also recommend the following:
- Melatonin — a natural pleiotropic liposoluble molecule widely distributed throughout the body. It can be a potential treatment for intervertebral disc aging and degeneration by exerting multiple functions in disc cells, including antioxidant, anti-inflammatory, autophagy-promoting, and anti-apoptotic effects.7
- Vitamin D — to support back-pain relief. Research shows that subjects with vitamin D deficiency or insufficiency are 2.3 times more likely to exhibit low-back pain than subjects with normal vitamin D3 concentration.8
- ETArolTM — a proprietary extract of New Zealand green-lipped mussels containing the essential fatty acids, eicosatetraenoic acids (ETAs), and for its key role in reducing joint swelling due to arthritis. Studies show that ETA oils from sea mussels are more effective in reducing inflammation than aspirin or ibuprofen.
- Hyaluronic Acid (HA) — a key, natural component of all connective tissue in the body. Production of HA declines with age and this deficiency causes numerous age-associated problems. HA supports resiliency, reduces friction, and acts as a natural shock absorber. Found in high cartilage and synovial fluid concentrations in all joints, HA helps regulate the repair process during injury, inflammation, and surgery.
- Avocado/soybean unsaponifiables (ASU) to increase the production of specialized joint collagen and articular cartilage.
- Nettle leaf, an anti-inflammatory remedy, to suppress cytokine production. It has been shown to suppress a common NF-kappaB pathway.
Improving patients’ gut health can go a long way toward also improving their musculoskeletal problems. In this new era of health, knowing where to begin — in the gut — is the critical starting point.
ROBERT G. SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national/international speaker, author of Amazon’s #1 bestseller “Inside-Out Health,” and founder and CEO of Westchester Integrative Health Center. He graduated magna cum laude from the University of Bridgeport College of Chiropractic and has a Master of Science degree in human nutrition. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for Functional Medicine University and is a seasoned health and wellness expert on the speaking circuits and in the media. A frequently published author in peer-reviewed journals and other mainstream publications, he is a thought leader in his field and practice. His new book, “Immune Reboot: Your Guide to Maximizing Immunity, Restoring Gut Health, and Optimizing Vitality,” was published in November 2022. He can be reached at drrobertsilverman.com.
- North Shore-Long Island Jewish (LIJ) Health System, 7 Jan 2016
- Sara JC, Dominika P , Rafał F. The impact of selected food additives on the gastrointestinal tract in the example of nonspecific inflammatory bowel diseases. Arch Med Sci, 6 July 2020
- Li W, Lai K, Chopra N, Zheng Z, Das A, Diwan AD. Gut-disc axis: A cause of intervertebral disc degeneration and low back pain? Eur Spine J. 2022 Mar 14. doi: 10.1007/s00586-022-07152-8. Epub ahead of print. PMID: 35286474.
- Januskewski J et al. Efficacy of 635nm Red Low-Level Laser on Nociceptive Musculoskeletal Pain Compared to NSAIDS, Opioids, and Other Light Sources Orthopedics and Rheumatology, Ortho & Rheum Open Access J, November 2020.
- BMC Complementary Medicine and Therapies. 2003 Jun 10
- NaPier Z, Kanim LEA, Arabi Y, et al. Med Sci Monit, 2019 Dec 14;25:9531-9537
- Zhangrong C, Qian X, Juntan W, Yukun Z. The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review, Ageing Research Reviews. 2021;70:101394
- BMC research notes. Dec 1, 2019