Episode 67 - Rethinking Osteoarthritis and Degenerative Disc Disease
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Episode Summary
If your back has been hurting and you haven’t been able to find relief, or you have chronic recurrent arthritic pain, it may be time to explore new options.
On this episode of Back Talk Doc, Dr. Sanjiv Lakhia hosts a solo episode to reframe how patients should be thinking about osteoarthritis and degenerative disc disease. He proposes that patients move away from thinking of these conditions as the inevitable result of wear and tear, and instead look at them through the lens of metabolic dysfunction.
Using a framework focusing on food and supplementation options, Dr. Lakhia discusses the connection between what we put in our bodies and the pain that we feel.
Two of the biggest culprits for inflammation in the North American diet are gluten and dairy. Studies have shown that removing these from your diet can reduce back pain. Dr. Lakhia discusses the benefits of adding collagen, EGCG, melatonin, and a botanical nutrient combination that uses cannabidiol and a fatty acid known as palmitoylethanolamide (PEA). Each supplement is backed by research and has shown promise for treating back pain.
“I think those are some really exciting options to consider beyond the typical thought process of just vitamin D, turmeric, and fish oil,” says Dr. Lakhia. For those interested in learning more, check out the 14 Day Challenge that is available on Dr. Lakhia’s website.
Featured Expert
Name: Sanjiv Lakhia, DO
What she does: As a board-certified physiatrist and integrative medicine physician at Carolina NeuroSurgery & Spine Associates, Dr. Lakia specializes in nonsurgical approaches to spine and orthopedic conditions and offers a diverse range of innovative treatments for back pain, including acupuncture, spinal injections, and prescriptive exercise. Dr. Lakhia favors a conservative, holistic approach to spine care and understands the importance of getting to know each patient. He believes that listening to a patient without judgment is essential to finding the best course of treatment for back pain relief and a return to a normal life.
Company: Carolina NeuroSurgery & Spine Associates
Words of wisdom: “We know that patients and consumers nowadays are spending lots of time on the internet downloading, digesting information at a very, very rapid pace. So as clinicians, it's our duty to keep up as best we can with the evolving literature in the space.”
Connect: Website | LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
Gluten has been linked to far more than just celiac disease. There are various non-celiac and non-GI related manifestations of gluten sensitivity, including peripheral neuropathy, skin issues, cognitive decline, and mental health disorders. A retrospective case report on 110 patients with chronic lower back pain found improvements after following a gluten-free diet, despite not having celiac disease.
As you age, support your collagen levels with a supplement. Consider adding bone broth or collagen supplements like Fortigel and Fortibone to your diet. These have been backed by clinical trials and have shown to be helpful for conditions such as osteoarthritis, knee pain, low back pain, osteoporosis, and osteopenia. Adding a collagen scoop to your diet, either by blending it with almond milk or incorporating it into a shake, can be a great way to support your bone and joint health.
EGCG should be in your toolkit. Adding green tea extract, which has EGCG, to your routine can act as an antioxidant and inhibit the negative effects of inflammatory cytokines like interleukin-1 beta, providing significant protection against cell death in degenerative disc disease. An article in Frontiers in Pharmacology notes that EGCG can reprogram the circadian clock within disc cells. These findings emphasize the beneficial impact of EGCG in mitigating oxidative stress and promoting disc cell health.
Episode Insights
[01:38] Thinking needs to evolve: Dr. Lakhia introduces the episode by challenging listeners to reconsider how they have been thinking about osteoarthritis and degenerative disc disease.
[07:58] Common offenders for inflammation: The two most common causes of inflammation that Dr. Lakhia sees are gluten and casein.
[11:36] Gluten and back pain: Gluten sensitivities extend far beyond just celiac disease. Dr. Lakhia discusses an article from the Journal of Medical Hypothesis the link between gluten sensitivity and low back pain.
[14:18] Dairy is a common food allergen: It can be very difficult to avoid dairy in the standard American diet. However, it may be a source of inflammation for people and can be worth avoiding.
[16:40] Collagen is everywhere: Dr. Lakhia recommends researching whole-body collagen because collagen peptides support bone, joint, and skin health. More information on collagen can be found at Designs For Health.
[19:26] Silent assassins for inflammation: EGCG should be in everyone’s toolkit. A great source on EGCG is Dr. Elizabeth Yurth at Boulder Longevity, one of the premier instructors and physicians in the world regarding peptides, nutrition, and bone and joint health.
[22:00] Combat degenerative disc disease: Dr. Lakhia references an article from the National Institute of Health on the restorative properties of EGCG.
[26:01] Melatonin isn’t just for sleep: Melatonin is a potent antioxidant and Dr. Lakhia recommends adding it as a supplement to help with back pain. Frontiers in Physiology has published articles that study the effect of melatonin on disc degeneration.
[29:54] PEA has tremendous potential benefits: PEA is an endogenous endocannabinoid receptor agonist that is made in your body and stimulates your endocannabinoid receptors. For a refresher on CBD, check out Episode 38 of Back Talk Doc.
[28:57] Take the 14 Day Challenge: To learn more and try some of the things discussed in this episode, visit Dr. Lakhia’s website to take the 14 Day Challenge.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode Bone and Spine Health With Dr. Stephanie Plummer.
Take Dr. Lakhia’s 14 Day Challenge to get your health back on track.
Apply for an Integrative Medicine consult with Dr. Lakhia (NC/SC residents only).
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
If your back has been hurting and you haven’t been able to find relief, or you have chronic recurrent arthritic pain, it may be time to explore new options.
On this episode of Back Talk Doc, Dr. Sanjiv Lakhia hosts a solo episode to reframe how patients should be thinking about osteoarthritis and degenerative disc disease. He proposes that patients move away from thinking of these conditions as the inevitable result of wear and tear, and instead look at them through the lens of metabolic dysfunction.
Using a framework focusing on food and supplementation options, Dr. Lakhia discusses the connection between what we put in our bodies and the pain that we feel.
Two of the biggest culprits for inflammation in the North American diet are gluten and dairy. Studies have shown that removing these from your diet can reduce back pain. Dr. Lakhia discusses the benefits of adding collagen, EGCG, melatonin, and a botanical nutrient combination that uses cannabidiol and a fatty acid known as palmitoylethanolamide (PEA). Each supplement is backed by research and has shown promise for treating back pain.
“I think those are some really exciting options to consider beyond the typical thought process of just vitamin D, turmeric, and fish oil,” says Dr. Lakhia. For those interested in learning more, check out the 14 Day Challenge that is available on Dr. Lakhia’s website.
Featured Expert
Name: Sanjiv Lakhia, DO
What she does: As a board-certified physiatrist and integrative medicine physician at Carolina NeuroSurgery & Spine Associates, Dr. Lakia specializes in nonsurgical approaches to spine and orthopedic conditions and offers a diverse range of innovative treatments for back pain, including acupuncture, spinal injections, and prescriptive exercise. Dr. Lakhia favors a conservative, holistic approach to spine care and understands the importance of getting to know each patient. He believes that listening to a patient without judgment is essential to finding the best course of treatment for back pain relief and a return to a normal life.
Company: Carolina NeuroSurgery & Spine Associates
Words of wisdom: “We know that patients and consumers nowadays are spending lots of time on the internet downloading, digesting information at a very, very rapid pace. So as clinicians, it's our duty to keep up as best we can with the evolving literature in the space.”
Connect: Website | LinkedIn
Anchor Points
Top takeaways from this Back Talk Doc episode
Gluten has been linked to far more than just celiac disease. There are various non-celiac and non-GI related manifestations of gluten sensitivity, including peripheral neuropathy, skin issues, cognitive decline, and mental health disorders. A retrospective case report on 110 patients with chronic lower back pain found improvements after following a gluten-free diet, despite not having celiac disease.
As you age, support your collagen levels with a supplement. Consider adding bone broth or collagen supplements like Fortigel and Fortibone to your diet. These have been backed by clinical trials and have shown to be helpful for conditions such as osteoarthritis, knee pain, low back pain, osteoporosis, and osteopenia. Adding a collagen scoop to your diet, either by blending it with almond milk or incorporating it into a shake, can be a great way to support your bone and joint health.
EGCG should be in your toolkit. Adding green tea extract, which has EGCG, to your routine can act as an antioxidant and inhibit the negative effects of inflammatory cytokines like interleukin-1 beta, providing significant protection against cell death in degenerative disc disease. An article in Frontiers in Pharmacology notes that EGCG can reprogram the circadian clock within disc cells. These findings emphasize the beneficial impact of EGCG in mitigating oxidative stress and promoting disc cell health.
Episode Insights
[01:38] Thinking needs to evolve: Dr. Lakhia introduces the episode by challenging listeners to reconsider how they have been thinking about osteoarthritis and degenerative disc disease.
[07:58] Common offenders for inflammation: The two most common causes of inflammation that Dr. Lakhia sees are gluten and casein.
[11:36] Gluten and back pain: Gluten sensitivities extend far beyond just celiac disease. Dr. Lakhia discusses an article from the Journal of Medical Hypothesis the link between gluten sensitivity and low back pain.
[14:18] Dairy is a common food allergen: It can be very difficult to avoid dairy in the standard American diet. However, it may be a source of inflammation for people and can be worth avoiding.
[16:40] Collagen is everywhere: Dr. Lakhia recommends researching whole-body collagen because collagen peptides support bone, joint, and skin health. More information on collagen can be found at Designs For Health.
[19:26] Silent assassins for inflammation: EGCG should be in everyone’s toolkit. A great source on EGCG is Dr. Elizabeth Yurth at Boulder Longevity, one of the premier instructors and physicians in the world regarding peptides, nutrition, and bone and joint health.
[22:00] Combat degenerative disc disease: Dr. Lakhia references an article from the National Institute of Health on the restorative properties of EGCG.
[26:01] Melatonin isn’t just for sleep: Melatonin is a potent antioxidant and Dr. Lakhia recommends adding it as a supplement to help with back pain. Frontiers in Physiology has published articles that study the effect of melatonin on disc degeneration.
[29:54] PEA has tremendous potential benefits: PEA is an endogenous endocannabinoid receptor agonist that is made in your body and stimulates your endocannabinoid receptors. For a refresher on CBD, check out Episode 38 of Back Talk Doc.
[28:57] Take the 14 Day Challenge: To learn more and try some of the things discussed in this episode, visit Dr. Lakhia’s website to take the 14 Day Challenge.
Subscribe & Contact
If you enjoyed this episode of Back Talk Doc, check out our recent episode Bone and Spine Health With Dr. Stephanie Plummer.
Take Dr. Lakhia’s 14 Day Challenge to get your health back on track.
Apply for an Integrative Medicine consult with Dr. Lakhia (NC/SC residents only).
For more information on Dr. Sanjiv Lakhia and the podcast visit BackTalkDoc.com.
Subscribe in your favorite podcast app.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
Voiceover (00:01):
Welcome. You're listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your back talk doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia (00:38):
Welcome friends. It's good to be back on the mic. Today I'm going to be bringing you a solo episode. I wanted to take the time and really dive into something that's been on my mind and a topic that I encounter frequently, day-to-day in clinical care, and really try and reframe how you think about the idea of osteoarthritis, degenerative disc disease and this wear and tear process that is assumed to happen for almost all of us. I'll often hear people talk about their joint pain and their disc disease as something that's fatalistic, meaning, yeah, my mom had it, my dad had it, runs in the genes, and it really implies that there's not much that can be done to turn that process around. The general medical model really looks at osteoarthritis as a wear and tear phenomenon, just like the tires on our car wearing out over time.
(01:38):
And it really implies that the more you use something, the more you use a joint, the more you use your back, that over time you're going to wear it out and it eventually just needs to be replaced or there may not be much you can do about it. So when I talk to people in the office, oftentimes when I'm taking a history, people will recall old injuries, accidents and familial history. And of course all those things play a role, but I think looking at it under the lens of wear and tear really is an outdated model for osteoarthritis. You know what's surprising to hear, I was recently at a conference learning about peptide therapy and the topic came up about insulin. And insulin is probably the world's number one use peptide obviously for diabetes. And it was shocking to me to hear the discovery of insulin to the time it became available for clinical use, it was 17 years. 17 years folks. That's a long time.
(02:36):
So what does that mean? That means that there are discoveries happening every day and literature being published every day that no one is reading. And because of the bureaucracies and systems in place involving healthcare, particularly United States, there's significant delays from getting good science to the market. Now, of course, these processes are in play to protect the consumer, protect the patient, and I don't want to disparage that, but it's very hard to move forward in clinical medicine when the new advances come in at a snails pace or a trickle. People don't wait, like if you're suffering from pain and injury, you don't want to be told that there may be a treatment option available, but come back in 10 years. So what are we supposed to do? I am very much someone who has a foot in both sides of the medicine world that is a kind of alternative integrative and conventional.
(03:36):
I practice an integrated form of physiatry, deal with a lot of people with pain. And I always ask myself, when someone's in front of me and I'm thinking about a potential treatment that maybe isn't a mainstream treatment, I ask myself, number one, is there a proven safety? Number two, is there reasonable scientific basis for it and preferably some human trials. Number three, is it a reasonable cost for the person sitting in front of me? Does it make sense? And then lastly, is it practical? And I feel like if I can check those boxes, then it's worth a conversation because I know you guys out there and the reason you're listening to a podcast like this is you're out looking for answers. We know that patients and consumers nowadays are really just spending lots of time on the internet downloading. They're digesting information at a very, very rapid pace.
(04:29):
So as clinicians, it's our duty to keep up as best we can with the evolving literature in the space. So that brings me back to this idea of osteoarthritis and degenerative disc disease, which are different entities, but they are somewhat the same. And I want to shift your thinking from a wear and tear phenomenon, which still has its place, but we should really start thinking about these orthopedic and spinal conditions in terms of metabolic dysfunction in the body. And a downstream effect can be pain in our joints and pain in our back. Very similar to how we look at autoimmune conditions, rheumatoid arthritis, psoriatic arthritis, multiple sclerosis, we know that there's disrupted metabolic processes, there's inflammatory processes in play that have ultimately destructive effects on the body. Now, the argument has been made for a long time that osteoarthritis is not an inflammatory condition. If you have knee arthritis and you run blood panels, typically sedimentation rate and CRP, either two common markers used to look for systemic inflammation, they may not be elevated.
(05:40):
But again, I think that's outdated. That's an outdated process or thought process. We know that those do not cover all the basis of inflammation. There are numerous cytokine reactions, tumor necrosis factor, interleukin one beta come to mind that we know now in animal studies are elevated at least at the joint level if not systemically in these degenerative conditions. And I think it's important to have that framework in place because it opens the door up to numerous other pathways to encourage people to heal their own body. And this is what I've been trying to do in my clinic and I've been doing it for years and I'm always evolving how I think and how I approach things.
(06:23):
So today I want to give you a framework. I've put together a plan for people to go through who want to try and heal their joints on their own. I'll talk to you a little more about that in the end, but let's talk about a few things. Number one, I want to talk about my favorite friend, that's nutrition and pain, and we're going to get a little more specific than prior episodes. If you haven't had a chance, go back and listen to my episodes on the anti-inflammatory diet and then pain and food from a macro view. So I've done two podcasts and also did a terrific one on olive oil, which talks about its health benefits. So those are three right there can give you a great level of education as you explore the topic of food and its connection to your pain. But I want to talk about food and specifically two offenders that I see in terms of inflammation and food, and that's gluten and casein. And then I want to pivot to some supplementation options.
(07:16):
And again, this podcast is for informational purposes only, and even though I am a doctor, I may not be your doctor. So you want to run any ideas by your medical professionals before you dive in and purchase product or make lifestyle changes. But this information is out there. I'm just pulling together for you in a way that hopefully makes some sense. So if you're thinking about what can you do, let's say you're listening right now and your back's been hurting for a long time and you just can't get any relief, or you have this chronic nagging recurrent arthritic knee and you've done some shots and things and you don't want to get any knee replacement, or at least you want to try and avoid it, what are some options? So let's start with talking about food and food really, you can look at it from multiple levels.
(07:58):
There's a macro level where you talk about ratios of proteins, carbohydrates and fats, and then there's the micro level where you've got micronutrients, your minerals, your magnesium, potassium, your phosphorus, selenium, chromium. And then you can also look at it in terms of inflammatory triggers. And that's, I'm going to touch on a little bit today, but it's not something I've delve into before. And I'm actually going to do a deeper dive on food elimination diet coming up here in the next month. I'll be interviewing a terrific health coach on the topic, but gluten and casein I think are worth mentioning because to me clinically they're the most common offenders and they're the easiest to pull out of your diet. So what I would suggest is if you're having a lot of pain and inflammation, considering a short trial of gluten and dairy free would make a lot of sense.
(08:54):
But let me give you a little bit of background. Gluten is a vegetable protein and it has been shown in the medical literature to have correlations with autoimmune illness and you do not have to have celiac disease that is gastrointestinal symptoms to have issues with gluten. There are non-celiac and non-GI related manifestations of gluten sensitivity and there's correlations in the literature of all sorts of issues, peripheral neuropathy, skin issues, cognitive decline, mental health disorder, the list goes on and on. All you have to do is type in gluten and whatever your condition and search that on the internet, and you're going to find research articles discussing a potential correlation. And there's a lot of theories behind why gluten, which is the primary storage protein of wheat grains, why it's become such an issue. And I'm not here to give you that answer.
(09:52):
I mean there are theories about how the wheat crops are dusted with Roundup and they're just not the same wheat crops that we had growing up. I don't know if that's true or not. There's also some correlation with our disrupted microbiomes and our inability to process proteins the way we used to. But gluten is very prevalent in the western diet and the estimates are five to 20 grams per day is consumed in the most typical diets. And gluten containing foods include cereals like wheat and rye and barley and oats. These are staple foods in most American diets, and it's really hard to go through a day without being exposed to gluten. It's in not just the wheat breads, cookies, crackers, pastries, it's in some of our sauces and seasonings. It's really in almost everything, baked goods, anything that comes in a box almost always has some degree of gluten in the product and people are exposed at very, very high levels.
(10:51):
And the gluten peptide really triggers immune reaction in the nervous system and what we call glial cell activation. And the glial cells are immune cells in the central nervous system and brain that are there to really protect your brain health, but can be up regulated and really agitated and inflamed through chronic exposure to gluten if you have sensitivity to gluten. And there are certainly correlations in the medical literature, even suggestions about gluten exposure contributing to schizophrenia and all sorts of neurologic disorders. Well, what about gluten and back pain, right? Because this is the Back Talk Doc. I talk about back pain and what are the correlations? Are there any? Well, I want to talk to you about an article that came out in the Journal of Medical Hypothesis, 2020 February 28th addition titled Non Celiac Gluten Sensitivity and Chronic Refractory Low Back Pain with Spondyloarthritis Features. Wow, that's a lot.
(11:55):
So really what they did was they did a retrospective case report where they basically went back and looked through observational data of 110 patients in a rheumatology clinic. And these were patients with refractory low back pain and spondyloarthritis features and they followed a gluten-free diet despite celiac disease being ruled out. Again, that's a key. Certainly you want to test for celiac if you have concern, but normal blood work for celiac does not exclude gluten as a potential issue if you have pain of any type. So what happened? Looking at the data here, the average age at low back pain onset was 30, and these people had had pain for at least 15 years. Of the 110 patients, 79% of the patients experienced improvement and 62 of the patients achieved what's called demanding improvement, which really meant that they were at least one of the following, they were totally asymptomatic or had remission of their chronic back pain and returned to work or returned to normal life or went from bed wheelchair to being able to walk or return to being independent with their ADLs or even discontinue their pain meds.
(13:07):
That's really a staggering number. It's really unheard of with any drug injection or other therapy to have statistically this relevant of a positive response. These people also in this study had improvement even when they had classic axial spinal arthritis. This is where they have autoimmune inflammation changes along the spinal axis. People who had eye inflammation like associated with ankylosing spondylitis, 13 of the 16 of them, they had improvement with their uveitis or inflammation in their eye. And out of 83 patients who had concurrent fibromyalgia, 48 had significant improvement. So this is very, very powerful. I'll post a link to this study. Again, it's a small study. This is not a randomized placebo controlled trial, which you're not going to get when you're looking at nutritional interventions in general. They're just very difficult and expensive to put together. So that is something that I want you guys, I'll link to that and I really want you to take a look at that study as a bit of evidence.
(14:04):
And I will tell you I've seen that in my clinic as well play out. Dairy as well is the second one that you may want to consider pulling out of your diet. The literature on correlation between dairy and pain is not as consistent as is a gluten. However, dairy is a common food allergen for people. It triggers a mutagenic inflammatory response, particularly for kids who have a lot of sinus infections, asthma, the peptide or the protein in dairy called casein also has been shown to activate receptors in the brain and it has a morphine-like effect. They call it acacia morphine effect in the brain where it can activate signals in the brain that are correlate with inflammation and even dull the brain activity. So it makes a lot of sense. Again, it's very, very hard to avoid dairy in the standard American diet. A lot of people grew up drinking a lot of milk, and it just seems to me that these foods are not the same foods that we used to eat growing up.
(15:05):
They're not prepared the same way, they're processed. A lot of the milk has hormone additives, preservatives. So again, I'm not sitting here railing on wheat and railing on the dairy industry, but I am concerned about the quality of food and the inflammatory reactions that they trigger in the body. There is some concern about, or at least question about whey protein and casein are very similar, but there are different substances. Whey and casein or animal proteins derived from milk. Whey protein enters the blood within an hour while casein takes about seven to eight hours to enter the blood. So cow's milk contains more casein than breast milk, and casein is more difficult to digest than whey which has a higher nutritional value. There's a lot of bodybuilders who enjoy using whey protein supplement. After a workout, it can really repair small micro tears that form in the muscle fibers and also whey protein can help with sleep and a lot of different things.
(16:01):
But if we're concerned here about potential food sensitivity to dairy, it's worth pulling that out of your diet as well as you're trying to help heal your joints and reduce your pain. So I would start with a trial of dairy and gluten-free diet as a starting point to reducing pain and inflammation in your body. Now, once you have that in place, there are supplementations nutraceuticals that are worth talking about in this space that I think you may want to consider researching more for yourself. The first one I would talk about here is whole body collagen. Collagen definitely is everywhere, particularly in the dermatologic world where it's hard to find a skin formula without some version of collagen to help with wrinkles and just help you look better. But you can take collagen peptides to support bone, joint and skin health. So what is collagen? It's a type of protein that accounts for as much as 30% of your body's total protein.
(17:02):
It acts as a primary structural component of connective tissue and supports a variety of tissues including your tendons, your skin, your teeth, your joints, and your bones. It has significant roles in wound healing, tissue repair, blood vessels. It's really involved in every soft tissue, connective tissue function in your body. Now, there are at least 29 distinct types of collagens grouped from eight families, and I don't want to get into all of the physiology behind it. Type one collagen though is a major type of collagen in vertebrae connective tissue and the most abundant collagen in skin, bone, teeth, tendon, ligaments and organs. Type two collagens found in cartilage and type threes found in the skin muscles and blood vessels. And this information is excellent, and I'm taking it from David Brady ND and some of the literaries put out at Designs For Health where I recommend and use a lot of their supplementation for my patients.
(17:59):
So collagen levels of course decline with age and it's worthwhile supporting it with your diet. Now an easier way to, or at least an easy way to add extra collagen into your diet is through bone broth. Bone broth is loaded with amino acids and collagens and sipping on bone broth throughout the day can be advantageous, but you can take collagen and supplementation form. Now, there are some better research versions of collagen FORTIGEL, F-O-R-T-I-G-E-L collagen peptide blend is backed by multiple clinical trials and has been found to be beneficial in osteoarthritis, knee pain, low back pain, and it's one that I recommend and the product I'll talk about later. FORTIBONE also is a collagen peptide blend. Five grams of this per day has been shown to be helpful for bone support for post menopausal females with osteoporosis or osteopenia, and it's been shown to also improve bone mineral density in total.
(19:00):
So looking at adding some collagen to your diet, I like having collagen scoop. You can have a once a day just in, blend it with some almond milk with some ice, or even half a banana and have it as a shake. It's a great addition when you're trying to support your bone and joint health. Once you have your gluten-free diet and your collagen in place, let's talk about two really kind of like silent assassins in the space of supplementation for degenerative processes, inflammatory processes, and these don't get a lot of press, and this is something I came across in my pep pack course and a lot of it is being talked about by Dr. Elizabeth Yurth at Boulder Longevity out in Colorado. And she's really one of the premier instructors and physicians in the world regarding peptide, nutrition and bone and joint health. And would love to get her on the show one time, but EGCG is one of the tools that should be in your toolbox or at least be considered.
(19:58):
It's epigallocatechin gallate, and it's the most active constituent of green tea. Now green tea is one of my favorites, and it's from the leaves of Camilla sinensis, and that's where all of tea is derived from. And it just depends on the processing of the tea or the leaves in terms of whether you're not green tea, white tea, black tea and research has shown that consuming five to six or more cups of green tea per day can be beneficial on many levels. But in this case, I'm talking about taking the active ingredient EGCG in supplementation form. Why? Well, there's numerous potential benefits. It's an antioxidant and has anti-inflammatory properties. EGCG has been shown to increase energy expenditure and fat oxidation, so it can help with weight reduction. It really increases what's called postprandial thermogenesis. It really is like adding coal to the fire. Stimulates your metabolism.
(21:00):
Blood sugar support is also part of the benefits of EGCG. It inhibits intestinal glucose uptake and it also can increase the G-L-U-T, GLUT4 transport in relationship to high sugar, high fructose meals. And that plays a role in your appetite suppression. And that's also what's being talked about a lot in many of the weight loss products that are out there. EGCG is good for cancer, reducing your risk of cancer and metastases. It supports the cardiovascular system. And again, when we're talking about pain, it also plays a role in testosterone metabolism, helping to shunt the testosterone away from negative estrogenic byproducts. Circling back though to the topic at hand in terms of joint pain, back pain, disc pain, osteoarthritis, how does EGCG influence those states?
(22:00):
Let's start by looking at article titled The Natural Polyphenol Epigallocatechin Gallate protects intervertebral dis cells from Oxidative Stress, and this was put out by Krupkova, K-R-U-P-K-O-V-A and colleagues in February 2016. I'll put a link to this article as well. And really what they talk about is in their study degenerative disc disease and the immune pathways that are triggered during this process. One of the primary immune modulators that contributes to wear and tear of your disc is the up regulation of interferon, excuse me, interleukin-1 beta. And in their research article, they really show in cell culture studies that EGCG is a significant free radical scavenger and inhibits or blocks the negative effects of these inflammatory cytokines like interleukin-1 beta. Has a remarkable effect and protective effect on cell death in the disc. This is really critical information because up till now understanding on a molecular and cellular level how disc disease occurs, it's really been difficult to put all the pieces of the puzzle together.
(23:17):
But now that we have good understanding about the inflammatory pathways, we can look at natural treatments to down-regulate these inflammatory pathways in our discs. And EGCG really has good data to support that effect. Now the other thing that EGCG has been shown to do in terms of being helpful with degenerative disc disease is that it can reprogram the circadian clock of the disc. Now this is really a fascinating article from November 2021, frontiers in pharmacology entitled EGCG Ameliorates Intervertebral disc degeneration through reprogramming of the circadian clock. And what the authors have discussed is that even within all of our cells of the body, there's a type of circadian clock that when follow correctly, when we follow the rhythms of life through the rhythms of the sunlight, our health is in an optimal state. And when we do not follow that circadian rhythm, not only does it disrupt our sleep, it disrupts everything down to a cellular level and there's even a circadian clock within the disc themselves.
(24:28):
And this is really fascinating article, it's a lot to take in, but just to suggest that EGCG can really be like a control alt delete in terms of resetting that circadian clock in the body and within your disc cells. I found it to be really fascinating article to look at. And what they really did was they injured these discs in the study and then they re-MRI'd them after eight weeks and found protective effects of EGCG. So it's just blew my mind that on a cellular level like this, something as simple as green tea extract can help regulate degradation of disc cells. So add that to your armamentarium as something that you can take daily to help offset some of the oxidative stress that's going on in your joints and in your lumbar disc. The next item I want to talk about that you should consider adding to your toolbox as you battle the challenges of osteoarthritis, spinal disc and joint pain is melatonin.
(25:29):
Now know what you're thinking. Melatonin is really just for sleep and of course it is. Melatonin is a hormone secreted by the pineal gland, which is a pea-sized endocrine gland located in the brain, and it's critical for helping you to really sync your sleep rhythms with the sunlight and the circadian rhythm. So yes, it does regulate your body's sleep response when you're exposed to natural light and a low dose of melatonin before bed can really help you fall asleep. But that's not what I'm really referring to here. A lot of people don't know that melatonin is a very potent antioxidant. It's anti-inflammatory. There's good research about its neuroprotective effects and it really can modulate your immune system by enhancing mitochondrial function and protecting your DNA. In fact, melatonin has been shown to scavenger free radicals and is reported to stimulate the immune system by the production of interleukins, interferon gamma, T-cells, your precursors to B and T-cells.
(26:33):
It also influences interleukin-1 beta, which we talked about earlier as a major player in the inflammatory cascade of disc disease and joint disease. So folks, melatonin really is a potent anti-inflammatory that has actual some literature when you look at it from the perspective of back pain and disc disease. So let's talk about that a little bit. I want to go over briefly an article that was in the Frontiers of Physiology published 2021 June 14th, 2021, and the title of this article is that Melatonin Attenuates Intervertebral Disc Degeneration Via Maintaining Cartilaginous Endplate Integrity in Rats. So what does that mean? It basically means that when they utilize melatonin in an environment of cartilage degeneration in rats, it really blunted that cascade. And it's a very scientific article. Don't want to get into the weeds with, but this is not the only one, and I'll link to it in the show notes for those of you that are really medical or scientific and want to learn about it.
(27:35):
But there are several articles now in the medical literature looking at the potential benefits of using melatonin to help preserve disc health or offset the inflammatory cascade that develops with degenerative disc disease. It can help stabilize the annulus and the nucleus. It's a real potent anti-inflammatory and it's something that you can take at higher doses, higher therapeutic doses to help offset the inflammatory effects of degenerative joint disease and osteoarthritis. And I think it's something that has not talked about enough because of science, at least the animal studies. Now there aren't, again, large scale studies on humans, but we do know there's good evidence in the literature regarding the potential benefits of melatonin and helping to prevent breast cancer recurrence. And those in the oncology world utilize melatonin at 20 milligrams at night quite frequently as part of their integrative approach to cancer care.
(28:37):
So what I'm suggesting here is that we should consider putting it in our toolbox as an integrative approach to pain and joint pain specifically. You'll get certainly the benefits about regulation of your circadian rhythm, but you also will get the anti-inflammatory benefits that will be very helpful over time for pain. Now again, this is not the equivalent of taking a pain pill. We're talking about really putting down good fertilizer so that down the road you have a very green lawn. This is part of a preventative program, but also can be in the acute phase, be part of an acute pain treatment protocol. It certainly wouldn't be the only thing you do, but it could be part of what you're doing when you're suffering from a flare up of your baseline pain because it will modulate down the inflammatory interleukins and help to reduce the inflammation on a cellular level.
(29:25):
So there you go. You've covered now collagen, we've talked about EGCG and melatonin. And then wrapping up, I guess the integrative approach here that I'm proposing for osteoarthritis and joint pain and degenerative disc disease would be a botanical nutrient combination that uses cannabidiol and a fatty acid known as palmitoylethanolamide, P-E-A. So let's talk about PEA first because it's not as known, but I think has tremendous potential benefits. PEA is an endogenous endocannabinoid receptor agonist. So what that means is it's made in your body and it stimulates your endocannabinoid receptors. And we've talked a lot about endocannabinoids and CBD on a prior podcast where I interviewed the head of the company One Less CBD or One Less Pain. I'll link to that in the show notes. And he had put together a topical formula with CBD to help reduce your reliance on NSAIDs. So it's worth a listen.
(30:25):
But PEA is produced from phospholipids in your body as a response to stimulus such as immune stress, and it's also found in food sources like soybeans, eggs, milks, tomatoes, black eye peas, and peanuts. It's classified what's called an autacoid local injury antagonist amide, ALIAmide.
(30:47):
And this is a family of molecules that are involved in lipid metabolism. It also blocks nociceptors, which are pain receptors and can down-regulate inflammation. It has really significant influences on the immune system and inflammatory response as it down-regulates what's called mast cells and pro-inflammatory modulators and inhibits glial cells. So glial cells we talked about before, so it's a glial cell inhibitor and a mast cell inhibitor and mast cells are elevated in are allergic responses that can trigger a lot of inflammation in our body. In the medical literature, when you look at PEA, it does have some good observational and clinical data showing that it can decrease pain. It's been studied in endometriosis, postoperative pain, knee pain from osteoarthritis, diabetic neuropathy, carpal tunnel syndrome, and chemotherapy induced neuropathy. There was actually one head-to-head study where it compared to ibuprofen, and this was for people with TMJ and it seemed to be at least equivalent, if not slightly better than the ibuprofen group.
(31:48):
There's also been what's called meta-analysis. These are studies where they look at large groups of studies and just kind of pull the final conclusions and they found that it does reduce pain in a significant manner. So PEA is very, very safe. Again, it's studied in a lot of different conditions and including low back pain and traumatic nerve injury as well, and pain from sciatica. So anyone listening here have sciatica or low back pain, you should be taking notes. The product that I'm recommending or at least suggesting you look at is combined with full spectrum cannabinoids. So cannabinoids, we'll briefly touch on those. Again, this is the famous CBD. CBD is a type of cannabinoids, and I've gone over this issue before on the podcast. Cannabinoids have wide-ranging benefits. The CB2 receptors are in the brain, the nervous system, the spleen, your white blood cells.
(32:40):
And when you support your CBD system in the body through nutrition or supplementation, you can also have a positive effect on pain and inflammation and your neuroprotective pathways are activated. And again, we could do a whole hour show on just looking at the literature now that's exploded on CBD and maybe that's something we'll do in the future just to give it its due attention. But I think this is a, think about the CBD, PEA combo really to help down regulate some of the nerve pain and neuropathic symptoms that can go along with disc disease and osteoarthritis, that burning, that tingling, that aching type of discomfort.
(33:17):
Okay, let's take a moment and summarize as we've covered a lot of material here today. I've really been proposing a paradigm shift in terms of how you look at your joint pain. That is shifting your mindset from one of fatalistic, genetic, wear and tear like a car tire, nothing you can do to one of metabolic related lifestyle related with lots of tools in the toolbox to try and stabilize or reverse these processes. I think it's a very empowering way to look at things. And it's supported by the literature. Gluten-free, dairy-free diet is a place to start. I think there's plenty of evidence now about the inflammatory nature of gluten and dairy, how it can activate glial cells in the body, create a hyper state of pain and trigger just a fair amount of inflammation. It's a low risk, high yield potential diet to trial.
(34:10):
Then also looking at novel approaches of supplementation like melatonin for pain and inflammation supported by the literature. Looking at melatonin's role in suppressing inflammatory reactions for degenerative disc disease along with the active ingredient of green tea, which is EGCG. Using these catechins at a high level can really help with the acute and chronic inflammatory response. And then just supportive joint nutrition with collagen powder. You want to use a version of collagen that's been well studied, FORTIGEL has extensive research behind it, but there are others. And then looking at botanicals or fatty acids like PEA, palmitoylethanolamide and CBD or the cannabidiol system. Both of these systems when up regulated have good data showing positive physiologic effects and in particular helping with the neurologic and nervous system response to pain and injury.
(35:11):
I think those are some really exciting options to consider beyond the typical thought process of just vitamin D, turmeric and fish oil. If this is something that you're like, wow, maybe I should go at it, I've gone ahead and done some legwork for you. If you go to drlakhia.com, that's D-R-L-A-K-H-I-A forward slash 14 day, that's one, four, D-A-Y. Put together a 14-day challenge for those that are interested in trying to turn things around. Check out the webpage. I've got more information about the challenge. It's something that's there, it's available for people to look at. And again, just one more disclaimer. Before you start any nutritional changes or any supplementation, you want to run this by your medical team, make sure it's the right thing for you. Because I'm speaking really in broad terms. I'm providing information, not medical advice, but I do think some very simple things, some common sense things can really benefit most people.
(36:07):
So I hope you enjoyed that today. It's something that was on top of mind and I wanted to get out there for you all. And I really would ask that if you enjoyed the material on this podcast, please go on iTunes and give me a five star review and share these episodes with your friends and family. I'm one of the few guys out there who really does a deep dive on back pain from all angles, and I know it's such a problem in our country and I'm passionate about even just improving one life. Remember the best form of healthcare is self-care. And until the next episode, I've got your back.
Voiceover (36:45):
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
Welcome. You're listening to Back Talk Doc where you'll find answers to some of the most common questions about back pain and spine health, brought to you by Carolina Neurosurgery and Spine Associates, where cutting edge nationally recognized care is delivered through a compassionate approach. This podcast is for informational purposes only and not intended to be used as personalized medical advice. And now it's time to understand the cause of back pain and learn about options to get you back on track. Here's your back talk doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia (00:38):
Welcome friends. It's good to be back on the mic. Today I'm going to be bringing you a solo episode. I wanted to take the time and really dive into something that's been on my mind and a topic that I encounter frequently, day-to-day in clinical care, and really try and reframe how you think about the idea of osteoarthritis, degenerative disc disease and this wear and tear process that is assumed to happen for almost all of us. I'll often hear people talk about their joint pain and their disc disease as something that's fatalistic, meaning, yeah, my mom had it, my dad had it, runs in the genes, and it really implies that there's not much that can be done to turn that process around. The general medical model really looks at osteoarthritis as a wear and tear phenomenon, just like the tires on our car wearing out over time.
(01:38):
And it really implies that the more you use something, the more you use a joint, the more you use your back, that over time you're going to wear it out and it eventually just needs to be replaced or there may not be much you can do about it. So when I talk to people in the office, oftentimes when I'm taking a history, people will recall old injuries, accidents and familial history. And of course all those things play a role, but I think looking at it under the lens of wear and tear really is an outdated model for osteoarthritis. You know what's surprising to hear, I was recently at a conference learning about peptide therapy and the topic came up about insulin. And insulin is probably the world's number one use peptide obviously for diabetes. And it was shocking to me to hear the discovery of insulin to the time it became available for clinical use, it was 17 years. 17 years folks. That's a long time.
(02:36):
So what does that mean? That means that there are discoveries happening every day and literature being published every day that no one is reading. And because of the bureaucracies and systems in place involving healthcare, particularly United States, there's significant delays from getting good science to the market. Now, of course, these processes are in play to protect the consumer, protect the patient, and I don't want to disparage that, but it's very hard to move forward in clinical medicine when the new advances come in at a snails pace or a trickle. People don't wait, like if you're suffering from pain and injury, you don't want to be told that there may be a treatment option available, but come back in 10 years. So what are we supposed to do? I am very much someone who has a foot in both sides of the medicine world that is a kind of alternative integrative and conventional.
(03:36):
I practice an integrated form of physiatry, deal with a lot of people with pain. And I always ask myself, when someone's in front of me and I'm thinking about a potential treatment that maybe isn't a mainstream treatment, I ask myself, number one, is there a proven safety? Number two, is there reasonable scientific basis for it and preferably some human trials. Number three, is it a reasonable cost for the person sitting in front of me? Does it make sense? And then lastly, is it practical? And I feel like if I can check those boxes, then it's worth a conversation because I know you guys out there and the reason you're listening to a podcast like this is you're out looking for answers. We know that patients and consumers nowadays are really just spending lots of time on the internet downloading. They're digesting information at a very, very rapid pace.
(04:29):
So as clinicians, it's our duty to keep up as best we can with the evolving literature in the space. So that brings me back to this idea of osteoarthritis and degenerative disc disease, which are different entities, but they are somewhat the same. And I want to shift your thinking from a wear and tear phenomenon, which still has its place, but we should really start thinking about these orthopedic and spinal conditions in terms of metabolic dysfunction in the body. And a downstream effect can be pain in our joints and pain in our back. Very similar to how we look at autoimmune conditions, rheumatoid arthritis, psoriatic arthritis, multiple sclerosis, we know that there's disrupted metabolic processes, there's inflammatory processes in play that have ultimately destructive effects on the body. Now, the argument has been made for a long time that osteoarthritis is not an inflammatory condition. If you have knee arthritis and you run blood panels, typically sedimentation rate and CRP, either two common markers used to look for systemic inflammation, they may not be elevated.
(05:40):
But again, I think that's outdated. That's an outdated process or thought process. We know that those do not cover all the basis of inflammation. There are numerous cytokine reactions, tumor necrosis factor, interleukin one beta come to mind that we know now in animal studies are elevated at least at the joint level if not systemically in these degenerative conditions. And I think it's important to have that framework in place because it opens the door up to numerous other pathways to encourage people to heal their own body. And this is what I've been trying to do in my clinic and I've been doing it for years and I'm always evolving how I think and how I approach things.
(06:23):
So today I want to give you a framework. I've put together a plan for people to go through who want to try and heal their joints on their own. I'll talk to you a little more about that in the end, but let's talk about a few things. Number one, I want to talk about my favorite friend, that's nutrition and pain, and we're going to get a little more specific than prior episodes. If you haven't had a chance, go back and listen to my episodes on the anti-inflammatory diet and then pain and food from a macro view. So I've done two podcasts and also did a terrific one on olive oil, which talks about its health benefits. So those are three right there can give you a great level of education as you explore the topic of food and its connection to your pain. But I want to talk about food and specifically two offenders that I see in terms of inflammation and food, and that's gluten and casein. And then I want to pivot to some supplementation options.
(07:16):
And again, this podcast is for informational purposes only, and even though I am a doctor, I may not be your doctor. So you want to run any ideas by your medical professionals before you dive in and purchase product or make lifestyle changes. But this information is out there. I'm just pulling together for you in a way that hopefully makes some sense. So if you're thinking about what can you do, let's say you're listening right now and your back's been hurting for a long time and you just can't get any relief, or you have this chronic nagging recurrent arthritic knee and you've done some shots and things and you don't want to get any knee replacement, or at least you want to try and avoid it, what are some options? So let's start with talking about food and food really, you can look at it from multiple levels.
(07:58):
There's a macro level where you talk about ratios of proteins, carbohydrates and fats, and then there's the micro level where you've got micronutrients, your minerals, your magnesium, potassium, your phosphorus, selenium, chromium. And then you can also look at it in terms of inflammatory triggers. And that's, I'm going to touch on a little bit today, but it's not something I've delve into before. And I'm actually going to do a deeper dive on food elimination diet coming up here in the next month. I'll be interviewing a terrific health coach on the topic, but gluten and casein I think are worth mentioning because to me clinically they're the most common offenders and they're the easiest to pull out of your diet. So what I would suggest is if you're having a lot of pain and inflammation, considering a short trial of gluten and dairy free would make a lot of sense.
(08:54):
But let me give you a little bit of background. Gluten is a vegetable protein and it has been shown in the medical literature to have correlations with autoimmune illness and you do not have to have celiac disease that is gastrointestinal symptoms to have issues with gluten. There are non-celiac and non-GI related manifestations of gluten sensitivity and there's correlations in the literature of all sorts of issues, peripheral neuropathy, skin issues, cognitive decline, mental health disorder, the list goes on and on. All you have to do is type in gluten and whatever your condition and search that on the internet, and you're going to find research articles discussing a potential correlation. And there's a lot of theories behind why gluten, which is the primary storage protein of wheat grains, why it's become such an issue. And I'm not here to give you that answer.
(09:52):
I mean there are theories about how the wheat crops are dusted with Roundup and they're just not the same wheat crops that we had growing up. I don't know if that's true or not. There's also some correlation with our disrupted microbiomes and our inability to process proteins the way we used to. But gluten is very prevalent in the western diet and the estimates are five to 20 grams per day is consumed in the most typical diets. And gluten containing foods include cereals like wheat and rye and barley and oats. These are staple foods in most American diets, and it's really hard to go through a day without being exposed to gluten. It's in not just the wheat breads, cookies, crackers, pastries, it's in some of our sauces and seasonings. It's really in almost everything, baked goods, anything that comes in a box almost always has some degree of gluten in the product and people are exposed at very, very high levels.
(10:51):
And the gluten peptide really triggers immune reaction in the nervous system and what we call glial cell activation. And the glial cells are immune cells in the central nervous system and brain that are there to really protect your brain health, but can be up regulated and really agitated and inflamed through chronic exposure to gluten if you have sensitivity to gluten. And there are certainly correlations in the medical literature, even suggestions about gluten exposure contributing to schizophrenia and all sorts of neurologic disorders. Well, what about gluten and back pain, right? Because this is the Back Talk Doc. I talk about back pain and what are the correlations? Are there any? Well, I want to talk to you about an article that came out in the Journal of Medical Hypothesis, 2020 February 28th addition titled Non Celiac Gluten Sensitivity and Chronic Refractory Low Back Pain with Spondyloarthritis Features. Wow, that's a lot.
(11:55):
So really what they did was they did a retrospective case report where they basically went back and looked through observational data of 110 patients in a rheumatology clinic. And these were patients with refractory low back pain and spondyloarthritis features and they followed a gluten-free diet despite celiac disease being ruled out. Again, that's a key. Certainly you want to test for celiac if you have concern, but normal blood work for celiac does not exclude gluten as a potential issue if you have pain of any type. So what happened? Looking at the data here, the average age at low back pain onset was 30, and these people had had pain for at least 15 years. Of the 110 patients, 79% of the patients experienced improvement and 62 of the patients achieved what's called demanding improvement, which really meant that they were at least one of the following, they were totally asymptomatic or had remission of their chronic back pain and returned to work or returned to normal life or went from bed wheelchair to being able to walk or return to being independent with their ADLs or even discontinue their pain meds.
(13:07):
That's really a staggering number. It's really unheard of with any drug injection or other therapy to have statistically this relevant of a positive response. These people also in this study had improvement even when they had classic axial spinal arthritis. This is where they have autoimmune inflammation changes along the spinal axis. People who had eye inflammation like associated with ankylosing spondylitis, 13 of the 16 of them, they had improvement with their uveitis or inflammation in their eye. And out of 83 patients who had concurrent fibromyalgia, 48 had significant improvement. So this is very, very powerful. I'll post a link to this study. Again, it's a small study. This is not a randomized placebo controlled trial, which you're not going to get when you're looking at nutritional interventions in general. They're just very difficult and expensive to put together. So that is something that I want you guys, I'll link to that and I really want you to take a look at that study as a bit of evidence.
(14:04):
And I will tell you I've seen that in my clinic as well play out. Dairy as well is the second one that you may want to consider pulling out of your diet. The literature on correlation between dairy and pain is not as consistent as is a gluten. However, dairy is a common food allergen for people. It triggers a mutagenic inflammatory response, particularly for kids who have a lot of sinus infections, asthma, the peptide or the protein in dairy called casein also has been shown to activate receptors in the brain and it has a morphine-like effect. They call it acacia morphine effect in the brain where it can activate signals in the brain that are correlate with inflammation and even dull the brain activity. So it makes a lot of sense. Again, it's very, very hard to avoid dairy in the standard American diet. A lot of people grew up drinking a lot of milk, and it just seems to me that these foods are not the same foods that we used to eat growing up.
(15:05):
They're not prepared the same way, they're processed. A lot of the milk has hormone additives, preservatives. So again, I'm not sitting here railing on wheat and railing on the dairy industry, but I am concerned about the quality of food and the inflammatory reactions that they trigger in the body. There is some concern about, or at least question about whey protein and casein are very similar, but there are different substances. Whey and casein or animal proteins derived from milk. Whey protein enters the blood within an hour while casein takes about seven to eight hours to enter the blood. So cow's milk contains more casein than breast milk, and casein is more difficult to digest than whey which has a higher nutritional value. There's a lot of bodybuilders who enjoy using whey protein supplement. After a workout, it can really repair small micro tears that form in the muscle fibers and also whey protein can help with sleep and a lot of different things.
(16:01):
But if we're concerned here about potential food sensitivity to dairy, it's worth pulling that out of your diet as well as you're trying to help heal your joints and reduce your pain. So I would start with a trial of dairy and gluten-free diet as a starting point to reducing pain and inflammation in your body. Now, once you have that in place, there are supplementations nutraceuticals that are worth talking about in this space that I think you may want to consider researching more for yourself. The first one I would talk about here is whole body collagen. Collagen definitely is everywhere, particularly in the dermatologic world where it's hard to find a skin formula without some version of collagen to help with wrinkles and just help you look better. But you can take collagen peptides to support bone, joint and skin health. So what is collagen? It's a type of protein that accounts for as much as 30% of your body's total protein.
(17:02):
It acts as a primary structural component of connective tissue and supports a variety of tissues including your tendons, your skin, your teeth, your joints, and your bones. It has significant roles in wound healing, tissue repair, blood vessels. It's really involved in every soft tissue, connective tissue function in your body. Now, there are at least 29 distinct types of collagens grouped from eight families, and I don't want to get into all of the physiology behind it. Type one collagen though is a major type of collagen in vertebrae connective tissue and the most abundant collagen in skin, bone, teeth, tendon, ligaments and organs. Type two collagens found in cartilage and type threes found in the skin muscles and blood vessels. And this information is excellent, and I'm taking it from David Brady ND and some of the literaries put out at Designs For Health where I recommend and use a lot of their supplementation for my patients.
(17:59):
So collagen levels of course decline with age and it's worthwhile supporting it with your diet. Now an easier way to, or at least an easy way to add extra collagen into your diet is through bone broth. Bone broth is loaded with amino acids and collagens and sipping on bone broth throughout the day can be advantageous, but you can take collagen and supplementation form. Now, there are some better research versions of collagen FORTIGEL, F-O-R-T-I-G-E-L collagen peptide blend is backed by multiple clinical trials and has been found to be beneficial in osteoarthritis, knee pain, low back pain, and it's one that I recommend and the product I'll talk about later. FORTIBONE also is a collagen peptide blend. Five grams of this per day has been shown to be helpful for bone support for post menopausal females with osteoporosis or osteopenia, and it's been shown to also improve bone mineral density in total.
(19:00):
So looking at adding some collagen to your diet, I like having collagen scoop. You can have a once a day just in, blend it with some almond milk with some ice, or even half a banana and have it as a shake. It's a great addition when you're trying to support your bone and joint health. Once you have your gluten-free diet and your collagen in place, let's talk about two really kind of like silent assassins in the space of supplementation for degenerative processes, inflammatory processes, and these don't get a lot of press, and this is something I came across in my pep pack course and a lot of it is being talked about by Dr. Elizabeth Yurth at Boulder Longevity out in Colorado. And she's really one of the premier instructors and physicians in the world regarding peptide, nutrition and bone and joint health. And would love to get her on the show one time, but EGCG is one of the tools that should be in your toolbox or at least be considered.
(19:58):
It's epigallocatechin gallate, and it's the most active constituent of green tea. Now green tea is one of my favorites, and it's from the leaves of Camilla sinensis, and that's where all of tea is derived from. And it just depends on the processing of the tea or the leaves in terms of whether you're not green tea, white tea, black tea and research has shown that consuming five to six or more cups of green tea per day can be beneficial on many levels. But in this case, I'm talking about taking the active ingredient EGCG in supplementation form. Why? Well, there's numerous potential benefits. It's an antioxidant and has anti-inflammatory properties. EGCG has been shown to increase energy expenditure and fat oxidation, so it can help with weight reduction. It really increases what's called postprandial thermogenesis. It really is like adding coal to the fire. Stimulates your metabolism.
(21:00):
Blood sugar support is also part of the benefits of EGCG. It inhibits intestinal glucose uptake and it also can increase the G-L-U-T, GLUT4 transport in relationship to high sugar, high fructose meals. And that plays a role in your appetite suppression. And that's also what's being talked about a lot in many of the weight loss products that are out there. EGCG is good for cancer, reducing your risk of cancer and metastases. It supports the cardiovascular system. And again, when we're talking about pain, it also plays a role in testosterone metabolism, helping to shunt the testosterone away from negative estrogenic byproducts. Circling back though to the topic at hand in terms of joint pain, back pain, disc pain, osteoarthritis, how does EGCG influence those states?
(22:00):
Let's start by looking at article titled The Natural Polyphenol Epigallocatechin Gallate protects intervertebral dis cells from Oxidative Stress, and this was put out by Krupkova, K-R-U-P-K-O-V-A and colleagues in February 2016. I'll put a link to this article as well. And really what they talk about is in their study degenerative disc disease and the immune pathways that are triggered during this process. One of the primary immune modulators that contributes to wear and tear of your disc is the up regulation of interferon, excuse me, interleukin-1 beta. And in their research article, they really show in cell culture studies that EGCG is a significant free radical scavenger and inhibits or blocks the negative effects of these inflammatory cytokines like interleukin-1 beta. Has a remarkable effect and protective effect on cell death in the disc. This is really critical information because up till now understanding on a molecular and cellular level how disc disease occurs, it's really been difficult to put all the pieces of the puzzle together.
(23:17):
But now that we have good understanding about the inflammatory pathways, we can look at natural treatments to down-regulate these inflammatory pathways in our discs. And EGCG really has good data to support that effect. Now the other thing that EGCG has been shown to do in terms of being helpful with degenerative disc disease is that it can reprogram the circadian clock of the disc. Now this is really a fascinating article from November 2021, frontiers in pharmacology entitled EGCG Ameliorates Intervertebral disc degeneration through reprogramming of the circadian clock. And what the authors have discussed is that even within all of our cells of the body, there's a type of circadian clock that when follow correctly, when we follow the rhythms of life through the rhythms of the sunlight, our health is in an optimal state. And when we do not follow that circadian rhythm, not only does it disrupt our sleep, it disrupts everything down to a cellular level and there's even a circadian clock within the disc themselves.
(24:28):
And this is really fascinating article, it's a lot to take in, but just to suggest that EGCG can really be like a control alt delete in terms of resetting that circadian clock in the body and within your disc cells. I found it to be really fascinating article to look at. And what they really did was they injured these discs in the study and then they re-MRI'd them after eight weeks and found protective effects of EGCG. So it's just blew my mind that on a cellular level like this, something as simple as green tea extract can help regulate degradation of disc cells. So add that to your armamentarium as something that you can take daily to help offset some of the oxidative stress that's going on in your joints and in your lumbar disc. The next item I want to talk about that you should consider adding to your toolbox as you battle the challenges of osteoarthritis, spinal disc and joint pain is melatonin.
(25:29):
Now know what you're thinking. Melatonin is really just for sleep and of course it is. Melatonin is a hormone secreted by the pineal gland, which is a pea-sized endocrine gland located in the brain, and it's critical for helping you to really sync your sleep rhythms with the sunlight and the circadian rhythm. So yes, it does regulate your body's sleep response when you're exposed to natural light and a low dose of melatonin before bed can really help you fall asleep. But that's not what I'm really referring to here. A lot of people don't know that melatonin is a very potent antioxidant. It's anti-inflammatory. There's good research about its neuroprotective effects and it really can modulate your immune system by enhancing mitochondrial function and protecting your DNA. In fact, melatonin has been shown to scavenger free radicals and is reported to stimulate the immune system by the production of interleukins, interferon gamma, T-cells, your precursors to B and T-cells.
(26:33):
It also influences interleukin-1 beta, which we talked about earlier as a major player in the inflammatory cascade of disc disease and joint disease. So folks, melatonin really is a potent anti-inflammatory that has actual some literature when you look at it from the perspective of back pain and disc disease. So let's talk about that a little bit. I want to go over briefly an article that was in the Frontiers of Physiology published 2021 June 14th, 2021, and the title of this article is that Melatonin Attenuates Intervertebral Disc Degeneration Via Maintaining Cartilaginous Endplate Integrity in Rats. So what does that mean? It basically means that when they utilize melatonin in an environment of cartilage degeneration in rats, it really blunted that cascade. And it's a very scientific article. Don't want to get into the weeds with, but this is not the only one, and I'll link to it in the show notes for those of you that are really medical or scientific and want to learn about it.
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But there are several articles now in the medical literature looking at the potential benefits of using melatonin to help preserve disc health or offset the inflammatory cascade that develops with degenerative disc disease. It can help stabilize the annulus and the nucleus. It's a real potent anti-inflammatory and it's something that you can take at higher doses, higher therapeutic doses to help offset the inflammatory effects of degenerative joint disease and osteoarthritis. And I think it's something that has not talked about enough because of science, at least the animal studies. Now there aren't, again, large scale studies on humans, but we do know there's good evidence in the literature regarding the potential benefits of melatonin and helping to prevent breast cancer recurrence. And those in the oncology world utilize melatonin at 20 milligrams at night quite frequently as part of their integrative approach to cancer care.
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So what I'm suggesting here is that we should consider putting it in our toolbox as an integrative approach to pain and joint pain specifically. You'll get certainly the benefits about regulation of your circadian rhythm, but you also will get the anti-inflammatory benefits that will be very helpful over time for pain. Now again, this is not the equivalent of taking a pain pill. We're talking about really putting down good fertilizer so that down the road you have a very green lawn. This is part of a preventative program, but also can be in the acute phase, be part of an acute pain treatment protocol. It certainly wouldn't be the only thing you do, but it could be part of what you're doing when you're suffering from a flare up of your baseline pain because it will modulate down the inflammatory interleukins and help to reduce the inflammation on a cellular level.
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So there you go. You've covered now collagen, we've talked about EGCG and melatonin. And then wrapping up, I guess the integrative approach here that I'm proposing for osteoarthritis and joint pain and degenerative disc disease would be a botanical nutrient combination that uses cannabidiol and a fatty acid known as palmitoylethanolamide, P-E-A. So let's talk about PEA first because it's not as known, but I think has tremendous potential benefits. PEA is an endogenous endocannabinoid receptor agonist. So what that means is it's made in your body and it stimulates your endocannabinoid receptors. And we've talked a lot about endocannabinoids and CBD on a prior podcast where I interviewed the head of the company One Less CBD or One Less Pain. I'll link to that in the show notes. And he had put together a topical formula with CBD to help reduce your reliance on NSAIDs. So it's worth a listen.
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But PEA is produced from phospholipids in your body as a response to stimulus such as immune stress, and it's also found in food sources like soybeans, eggs, milks, tomatoes, black eye peas, and peanuts. It's classified what's called an autacoid local injury antagonist amide, ALIAmide.
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And this is a family of molecules that are involved in lipid metabolism. It also blocks nociceptors, which are pain receptors and can down-regulate inflammation. It has really significant influences on the immune system and inflammatory response as it down-regulates what's called mast cells and pro-inflammatory modulators and inhibits glial cells. So glial cells we talked about before, so it's a glial cell inhibitor and a mast cell inhibitor and mast cells are elevated in are allergic responses that can trigger a lot of inflammation in our body. In the medical literature, when you look at PEA, it does have some good observational and clinical data showing that it can decrease pain. It's been studied in endometriosis, postoperative pain, knee pain from osteoarthritis, diabetic neuropathy, carpal tunnel syndrome, and chemotherapy induced neuropathy. There was actually one head-to-head study where it compared to ibuprofen, and this was for people with TMJ and it seemed to be at least equivalent, if not slightly better than the ibuprofen group.
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There's also been what's called meta-analysis. These are studies where they look at large groups of studies and just kind of pull the final conclusions and they found that it does reduce pain in a significant manner. So PEA is very, very safe. Again, it's studied in a lot of different conditions and including low back pain and traumatic nerve injury as well, and pain from sciatica. So anyone listening here have sciatica or low back pain, you should be taking notes. The product that I'm recommending or at least suggesting you look at is combined with full spectrum cannabinoids. So cannabinoids, we'll briefly touch on those. Again, this is the famous CBD. CBD is a type of cannabinoids, and I've gone over this issue before on the podcast. Cannabinoids have wide-ranging benefits. The CB2 receptors are in the brain, the nervous system, the spleen, your white blood cells.
(32:40):
And when you support your CBD system in the body through nutrition or supplementation, you can also have a positive effect on pain and inflammation and your neuroprotective pathways are activated. And again, we could do a whole hour show on just looking at the literature now that's exploded on CBD and maybe that's something we'll do in the future just to give it its due attention. But I think this is a, think about the CBD, PEA combo really to help down regulate some of the nerve pain and neuropathic symptoms that can go along with disc disease and osteoarthritis, that burning, that tingling, that aching type of discomfort.
(33:17):
Okay, let's take a moment and summarize as we've covered a lot of material here today. I've really been proposing a paradigm shift in terms of how you look at your joint pain. That is shifting your mindset from one of fatalistic, genetic, wear and tear like a car tire, nothing you can do to one of metabolic related lifestyle related with lots of tools in the toolbox to try and stabilize or reverse these processes. I think it's a very empowering way to look at things. And it's supported by the literature. Gluten-free, dairy-free diet is a place to start. I think there's plenty of evidence now about the inflammatory nature of gluten and dairy, how it can activate glial cells in the body, create a hyper state of pain and trigger just a fair amount of inflammation. It's a low risk, high yield potential diet to trial.
(34:10):
Then also looking at novel approaches of supplementation like melatonin for pain and inflammation supported by the literature. Looking at melatonin's role in suppressing inflammatory reactions for degenerative disc disease along with the active ingredient of green tea, which is EGCG. Using these catechins at a high level can really help with the acute and chronic inflammatory response. And then just supportive joint nutrition with collagen powder. You want to use a version of collagen that's been well studied, FORTIGEL has extensive research behind it, but there are others. And then looking at botanicals or fatty acids like PEA, palmitoylethanolamide and CBD or the cannabidiol system. Both of these systems when up regulated have good data showing positive physiologic effects and in particular helping with the neurologic and nervous system response to pain and injury.
(35:11):
I think those are some really exciting options to consider beyond the typical thought process of just vitamin D, turmeric and fish oil. If this is something that you're like, wow, maybe I should go at it, I've gone ahead and done some legwork for you. If you go to drlakhia.com, that's D-R-L-A-K-H-I-A forward slash 14 day, that's one, four, D-A-Y. Put together a 14-day challenge for those that are interested in trying to turn things around. Check out the webpage. I've got more information about the challenge. It's something that's there, it's available for people to look at. And again, just one more disclaimer. Before you start any nutritional changes or any supplementation, you want to run this by your medical team, make sure it's the right thing for you. Because I'm speaking really in broad terms. I'm providing information, not medical advice, but I do think some very simple things, some common sense things can really benefit most people.
(36:07):
So I hope you enjoyed that today. It's something that was on top of mind and I wanted to get out there for you all. And I really would ask that if you enjoyed the material on this podcast, please go on iTunes and give me a five star review and share these episodes with your friends and family. I'm one of the few guys out there who really does a deep dive on back pain from all angles, and I know it's such a problem in our country and I'm passionate about even just improving one life. Remember the best form of healthcare is self-care. And until the next episode, I've got your back.
Voiceover (36:45):
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.