You asked and Dr Shane answered………
Sciatica is a common type of pain where the sciatic nerve, which runs from our lower back to our feet, is irritated or compressed.1 Health professionals help us manage and recover from such pain. We can also help self-manage our pain through adhering to appropriate guidelines. Plus, there are several natural nutrients (Vitamin B12, Magnesium, Omega-3 Oils and Turmeric) that maybe useful when we are experiencing pain or offer prophylactic (preventative) help.
In the UK it is estimated that at any one time 2 to 13% of adults self-report with radiating leg pain, with the proportion of people who are diagnosed with sciatica over a year ranging from 2 to 34%. In regards to lifetime prevalence, the proportion of people who experience sciatica at some point during their lifetime is reported to be between 13 to 40% of all adults.2 It is therefore very clear that we will potentially at some point be plagued with sciatica and /or have a family member or friend that is experiencing sciatic pain.
Depending on the severity and acute nature of the pain, the impact of sciatica can significantly affect our quality of life, daily functions, and cause psychological distress. The obvious management of any pain should be undertaken with a health care professional. This professional will diagnose, manage, may prescribe medication, and give self-help advice. The tailored self-management advice will be aligned to your needs and capabilities, including information on the nature of low back pain and sciatica, and encouragement to continue with normal activities.3
Such self-help information, advice, and measures to relieve symptoms may include the recommendation to apply local heat (ensuring that the skin is protected) to hopefully relieve pain and muscle spasm. Symptoms may be eased using a small firm cushion between the knees when sleeping on the side, or several firm pillows propping up the knees when lying on the back, may ease symptoms. Specific exercises to help relieve symptoms, for example provided by the charity Backcare4, maybe offered. In addition to the encouragement to stay active, resume normal activities, and return to work as soon as possible.5
Optimal nerve health is essential to help us potentially reduce the likelihood of experiencing sciatica. B12 supplementation, even in the absence of B12 deficiency, has been shown to act by promoting the process of myelination (insulation that covers the nerves in our body), leading to functional restoration of nerve tissue.6
Good dietary sources of B12 are those of animal origin, including fish, meat, poultry, eggs, and dairy products. In addition, fortified breakfast cereals and fortified nutritional yeasts are readily available sources of vitamin B12 that have high bioavailability.7 It is generally recognised that many adults may have sub-optimal levels of B12, especially adults 60+ years of age.8
B12 is available in multi-nutrient supplement products (usually in the form of cyanocobalamin), in supplements containing other B-complex vitamins, and in supplements containing only vitamin B12. Supplement choice should depend on your intake from foods. B12 only supplements typically have the highest levels (typically 500 to 1,000 mcg), followed by B-complex vitamin products (50 to 500 mcg,) and then multi-nutrient supplement products (5 to 25 mcg).
We are aware that magnesium is very important for many processes in the body, including regulating muscle and nerve function, blood sugar levels, and blood pressure and making protein, bone, and DNA. Magnesium is found naturally in many foods including whole grains, legumes, nuts, seeds, green leafy vegetables (such as spinach) and dairy products including milk and yogurt. Other foods including breakfast cereals can also be fortified with magnesium.
Although it is relatively abundant in the natural foods listed above, magnesium deficiency is reported to be the second most common deficiency in developed countries, after vitamin D.9 Since magnesium is involved in 300+ chemical reactions, it is not surprising that any deficiency can have significant effects on our health. Optimising our levels of magnesium will ensure we do not experience some of the signs of deficiency related to pain including muscular weakness, neuromuscular irritability and abnormally increased sensitivity to pain.10
Magnesium supplementation is best undertaken with food. Commonly, magnesium is seen in combination with calcium and zinc or other ingredients in dietary supplements. Regarding actual doses, reported standards are 200 to 400mg per day. Products can have different forms of magnesium including oxide, chloride, citrate, threonate, gluconate and disglycinate. With the latter three often cited as more absorbable forms.
Interest in omega-3 polyunsaturated fatty acids has escalated in recent years because of their various roles in health promotion and disease risk reduction. Guidelines suggest that we consume adequate amounts of foods rich in omega-3 oils, so we have adequate levels of both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Rich sources are oily fish, for example mackerel, pilchards, trout, salmon, tuna (noting the canning process reduces the omega-3 content).
Reducing our inflammatory response is one aspect in which omega-3 oils have shown promise. With researchers concluding, “omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this selective group.”11 The details of the research indicated that a daily dose of 1200mg of omega-3 fish oil (this in theory could be in part replicated through food sources plus supplementation) resulted in: i) overall pain had significantly improved (60% of group), ii) satisfaction with the results they had seen (80% of the group), iii) would continue to take the omega-3 fish oil supplement (88% of the group). Just as important was the fact that no subjects reported any adverse effects because of the omega-3 supplementation.12 Omega-3 oil supplementation can be taken throughout the day, either with meals or alone.
Turmeric is a common spice and a major ingredient in curry powder. The National Center for Complementary and Integrative Health advise that turmeric is promoted as a dietary supplement for a variety of conditions, including arthritis, digestive disorders, respiratory infections, allergies, liver disease, depression, and many others. Turmeric dietary supplements are made from the dried rhizome and typically contain a mixture of curcuminoids.13
Amongst the many benefits of curcumin, it is the strong anti-inflammatory and antioxidant effects within the body that are of interest in relation to pain management. Research indicates that the powerful anti-inflammatory effects are equivalent to those of prescription medication.14 It is the blocking of the action of cyclooxygenase-2 (COX-2, an enzyme reported to speed up the production of prostaglandins) which is involved in promoting inflammation that is of importance.15
Due to the many reported benefits of turmeric, we should be adding it to the foods we are preparing and eating daily. Turmeric is an excellent source of many nutrients including vitamin C and B6, Manganese, Iron, Potassium, and omega-3 fatty acids. However, to profit from the benefits of curcumin (turmeric contains only ~3% curcumin) we need to realistically supplement.
Many products pair piperine (a black pepper extract) or lipids (BCM-95®, Meriva®) with curcumin to help increase the absorption of curcumin. General recommendations indicate that curcumin is usually taken together with food with daily supplementation ranging from 400 to 1500 mg of curcumin, in divided doses.
Back pain including sciatica is common and often debilitating. We need to work with health professionals to help us cope and manage such pain. We can self-help through ensuring we are doing what we can to help support our health and wellbeing: eating well, staying hydrated, physical activity, sleep, social contact. Plus, specific nutrients mentioned in this post can help us support our wellbeing, including pain management.
If you have a specific interest or would like to see a particular product or nutrient reviewed, please email your request to firstname.lastname@example.org. Educating our customers in respect to the importance of nutrients and the idiosyncrasies between formulas and products is at the heart of what we want to achieve.
This post is meant for educational purposes only and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional. In order to make the blog series easier to read, I have used a conversational tone in many places with personal pronouns, such as “I” and “you.” This is meant only to make it more pleasant to read, and is not meant to imply that the information constitutes any form of advice, whether personal or general.