Nutrition refers to the process by which the body’s growth, repair and maintenance are achieved through the consumption, breakdown, and utilisation of food products that we consume on a daily basis. A proper and balanced diet must be consumed to ensure sufficient nutrient and energy for the body to perform and sustain physiological mechanisms that allow for everyday activities. Consuming the correct nutrients in the correct amounts gives our body the necessary tools to become strong, healthy, and disease-free. What many of you may not know is that nutrition also plays a critical role for spinal health. The bones, muscles, and ligaments that make up the spine also require adequate nutrition to ensure that they are strong enough to support the body and protect the Central Nervous System. Our daily movements which we carry out are all made possible by our brain and body that includes our spine and its Neuromusculoskeletal system. Thus, without a healthy spine, we would not be able to carry out the same movements efficiently. Spinal cord which is part of the Central Nervous System that is housed within the spine acts as a bridge between the brain and the rest of the body, including our muscles and organs. Therefore, having an unhealthy spine would not only present itself as pain, discomfort, tension that might limit our everyday movements but may also manifest as dysfunction or disorders in our organs. Simply put, proper nutrition helps promote a healthier you.
For those with scoliosis, having proper nutrition and a balanced diet takes on even greater significance. Scoliosis refers to the 3-dimensional distortion of the spine, resulting in a twisting and bending of the spine.1 As the spine loses its natural curves and shifts away from its straight line alignment, excessive and unnecessary forces are borne by the vertebrae and its related disc and associated muscles and ligaments. Vertebrae are individual bones that make up the spine, and discs are shock-absorbing structures found between vertebra – similar to an Oreo cookie, where the biscuits are the vertebra and the cream filling the disc. When an Oreo cookie is evenly pressed, the biscuit should still retain its shape while the cream filling would be squeezed, spreading out evenly. However, when pressure is applied only on one side of the cookie, the biscuit might crumble, and the filling displaced to the opposite side. Our spine is similarly being squeezed or compressed daily due to the forces of gravity, and a neutral, aligned spine allows for the forces to be distributed evenly. In a scoliotic spine, these forces are not evenly distributed; and while our spine would not crumble like an Oreo cookie, the excessive pressures experienced by certain parts of the spine speed up the process of wear and tear that could eventually accelerate spinal degeneration.
The muscles and ligaments around the spine help maintain our upright posture and gives the spine the strength to resist gravity. In a normal spine, the muscles and ligaments that run along either side of the spine work in unison, both doing their part to uphold the spine. For those with scoliosis, there is an imbalance in muscular activity between the left and right side.1 One side would be tense and overactive while the other side would be weak and underused. The same applies to the ligaments. Thus, if the muscles and ligaments on one side are overactive and doing the bulk of the work, the tendency for these muscles and ligaments to get injured or inflamed are higher. Therefore, the deformation of the spine in scoliosis patients leads to improper weight distribution along the spine and differences in muscular activity. As a result, certain areas of the spine, muscle, and ligaments could experience greater wear and tear; and this is where proper nutrition and diet plays an important role. A good nutrition and diet would help create an optimal environment in the body for healing and regeneration, helping to reduce the negative impacts of scoliosis on the body. In the next few sections, we will highlight a few nutrients that can help promote strong bones, muscles, and ligaments for a healthy spine.
Calcium (Ca2+)
Osteopenia and osteoporosis are conditions commonly associated with elderly and scoliosis patients. Both conditions result in a loss of bone mass density and a higher risk of bone fractures, with osteoporosis being the more serious out of the two. In fact, in a particular study, researchers found that up to 68% of scoliosis patients had decreased bone mass density when compared to non-scoliotic individuals.2 Another study on young female scoliosis patients observed that up to 86% of them had lower bone mass density compared to controls at the time of skeletal maturity.3 Given how a scoliotic spine places unnecessary pressures on the spine that could possibly result in greater spinal degeneration, it is imperative that optimum bone mass density be achieved and maintained to reduce the amount of wear and tear occurring, as well as the chances of fractures occurring in later life. Almost all (99%) of the calcium present in the human body is found in our bones in the form of hydroxyapatite, which decreases as we age.4 Therefore, adequate calcium intake is important for the development and maintenance of strong bones. Sufficient calcium intake is associated with increased bone formation in children during their developing years and greater bone mineral content in adolescents and adults.4 Our bones form the framework upon which the rest of our body is built upon. Hence, it would be beneficial to ensure sufficient calcium consumption in our diets to promote strong bones. With that said, consuming excessive amounts of calcium might be detrimental to the kidneys; and should be limited to 800 mg/day for those aged between 19 to 50 years of age.5 Examples of calcium-rich foods include milk, tofu, peanuts, broccoli, spinach, sardines and salmon.
Vitamin D
Vitamin D is known as the sunshine vitamin and plays an important role in calcium metabolism. Consuming copious amounts of calcium would not do you any benefit if your vitamin D levels are low. Vitamin D not only helps to increase the absorption of calcium from the intestines, but also plays an important role in regulating the amounts of calcium circulating within the body, as well as regulating bone mineralisation.6 Vitamin D also has a key role in skeletal development.7 A deficiency in vitamin D during the developing years might lead to skeletal deformities and osteoporosis. It might also lead to a condition known as rickets in children or osteomalacia in adults; both are disorders in bone mineralisation.4 Besides affecting bone health, sufficient vitamin D has been observed to have positive effects on our immune and cardiovascular system.7 Furthermore, as some calcium is required for normal muscular function, deficiencies in vitamin D may indirectly cause impaired muscular function due to reduced calcium levels.4 For scoliosis patients, vitamin D levels have been found to be lower when compared to normal individuals.8,9 Also, vitamin D levels seem to correlate negatively with the Cobb’s angle (i.e. larger Cobb angle, lower vitamin D).9 While it has not been established that vitamin D deficiencies causes scoliosis, it would be good to increase the amounts of vitamin D in the body to allow for optimal calcium absorption and promote bone health. Thankfully, our body can naturally produce vitamin D when our skin is exposed to sunlight.7 Alternatively, vitamin D can also be obtained from foods like eggs, butter, or from supplements.4
Protein
Proteins are the main building blocks for the muscles in our body. Our muscles enable us to perform our everyday movements, while also holding our spine in place to ensure we have an upright posture. As discussed earlier, scoliosis patients have an imbalance in activity of the muscles that run along the spine – the paraspinal muscles. Muscles on the convex side of the curve are tight and overactive while those on the concave side are inactive.1 As a result, synthesis of muscle protein in the paraspinal muscle differ on both sides.10Muscle protein synthesis was found to be highest on the convex side compared to the concave side, especially at the apex of the curve. Paraspinal muscles on the concave side also exhibited more fibrosis and fatty deposits.11 Fibrosis and fatty deposition are exaggerated wound healing responses of the body, suggesting possible tissue damage in the paraspinal muscles on the concave side of the curve. It is believed that the imbalance in muscular activity of the paraspinal muscles in scoliosis patients could be due to dysfunctional neuromuscular activity, which is the way the brain communicates with the muscles.12 The brain communicates with our muscles using neurotransmitters, chemical compounds that are made from amino acids; a derivative of proteins. Therefore, increasing protein consumption would not only provide the body with the required precursors for muscle growth and repair, it could also promote the synthesis of neurotransmitters to facilitate communications between the brain and muscles; creating an ideal environment to alleviate the issues caused by scoliosis.
Magnesium (Mg2+)
Magnesium is often an overlooked micronutrient in the body even though its role within the human body is of fundamental importance. Firstly, magnesium, like vitamin D, plays a role in calcium and bone metabolism. Magnesium deficiency results in altered calcium metabolism that leads to diminished calcium levels in the body and vitamin D abnormalities.4 Studies have shown that reduced magnesium intake may contribute to decreased bone strength and volume, as well as poor bone development.13 Second, magnesium plays an important role in regulating muscle contraction and relaxation. The contraction and relaxation of muscles in the body is a multi-step process that relies heavily on the use of neurotransmitters and calcium ions. Magnesium is vital in this process by playing a role as a calcium ion transporter, ensuring the appropriate levels of calcium ions are available to the muscle fibres for contraction or relaxation.14 Without magnesium, calcium overload might occur, leading to muscle fibres that are more readily contractible and less able to recover from contraction (relax).13 This places undue stress on the muscle fibres, along with greater wear and tear that might eventually lead to cellular death. Lastly, magnesium has also demonstrated a possible role in regulating energy production, promoting immunity and ensuring proper cardiovascular function.13,14 Thus, ensuring adequate consumption of magnesium has many benefits for our health. Since scoliosis patients have imbalances in their muscular activities, especially in their paraspinal muscles and the muscles involved in regulated posture, adequate magnesium consumption may take on greater significance to possibly help promote proper muscle function and minimise any imbalances in muscular activities. Whole grains like brown rice or oats and fruits such as bananas, avocados and raspberries are some examples of magnesium-rich foods.
Iron
Iron is an important component of red blood cells and increasing iron consumption is often recommended to those with anaemia, or low red blood cell counts. However, iron may also play a role in regulating bone formation. Rat models have suggested that iron deficiency contributes to reduced bone formation and bone mass density.4 Iron also plays a significant role in the synthesis of collagen as it helps activate the enzymes required to initiate collagen synthesis. Collagen is an important supportive protein found in the connective tissues of the body, such as our ligaments and intervertebral discs. Importantly, collagen abnormalities have been noted in scoliosis patients and is suspected to be one of the drivers of scoliosis progression.15 Tissue samples from scoliosis patients suggests reduced turnover and remodelling of connective tissue.16 Significantly, turnover rates also differed bilaterally. The convex side of the curve showed evidence of greater connective tissue turnover compared to the concave side,16 which corresponds to the difference in muscular activity as well. Thus, it would make sense to ensure adequate consumption of iron in your diet to provide your body with the necessary tools to promote collagen synthesis and build stronger bones and ligaments. Whole-meal breads and dark leafy vegetables like spinach are some good sources of iron.
Nutrition and Chiropractic Care
Chiropractic care address musculoskeletal issues like lower back pain, neck pain, muscle aches and joint stiffness. Chiropractor address these symptoms through thorough examinations and proper diagnosis such as X-rays and/or MRI. Chiropractor at All Well Scoliosis Centre goes further by addressing the musculoskeletal, biomechanics, and lifestyle of the patients. Why is it important? Chiropractic treatment only part of the treatment process that in fact should really be complemented by proper nutrition, proper stretches, proper exercises, lifestyle modification, and activity of daily living improvement in order to improve recovery rates. It may sound unlikely, but nutrition plays a significant role in the cause of many neuromusculoskeletal problems. For example, high consumption of sugars is known to increase risk of conditions like diabetes and obesity. But, excessive consumption of sugars is also one of the main culprits for the aches and stiffness that people feel in their muscles and joints.17 When too much sugar is consumed, it places the body in a state of inflammation. Our cells begin to shut down as they cannot metabolise the excess sugar, which leads to low energy levels and preventing our muscles from functioning properly. It also leads to a build-up of AGEs (Advanced glycogen end-products), which damages connective tissues like ligaments. Lastly, insulin levels spike and promote fat storage, increasing the stress on our joints. Therefore, when excess sugar is in our system, a lot of stress could be placed on our muscles, ligaments, and joints. Similarly, excessive consumption of salt may also contribute to the onset of musculoskeletal problems. Besides increasing the risk of developing hypertension, high salt intake can also have a detrimental impact on our muscles.18 Firstly, when too much salt is in our system, our kidneys go into overdrive to flush out the excess, and we lose excessive calcium ions the process. As discussed, calcium is an important element in our bones and is required for muscle contraction. Secondly, high salt intake disrupts the delicate balance of sodium-potassium ions in our body that is crucial for muscle contraction, leading to cramps. Furthermore, chronic salt consumption can sensitise our nerves leading to exaggerated responses like muscle spasms. Lastly, excessive salt consumption is also linked to obesity and places the body in a state of inflammation.
In addition to controlling salt and sugar intake, we also must ensure adequate water consumption. Our body is made up of 70% of water, and without which, our body just cannot function as well. Our muscles are also composed of up to 79% of water and is important in ensuring proper muscular function and health. Water also plays an important role for spinal health. As discussed earlier, the spine is composed of individual vertebrae and its associated disc. The gel-like discs are crucial for evenly redistributing forces and its main composition is water. If we do not consume sufficient water, the discs will get dehydrated, losing its shape and becoming brittle. Dehydrated discs lose the ability to redistribute forces evenly along the spine, resulting in increased stress on the spinal joints and increasing the risk of slipped discs and spinal degeneration, eventually leading to musculoskeletal problems; the most common is lower back pain.
Finally, we have to consume a balanced diet to ensure our body receives all the necessary nutrients and fuel for it to function. To build a healthy diet, our meals should consist of 4 key components – proteins, fats, fibre, and carbohydrates. A quarter of our plate should consist of healthy wholegrain foods like brown rice or wholemeal breads to fulfil our carbohydrate intake. Another quarter should consist of protein-rich foods like chicken, fish, and eggs, as well as healthy fats from milk, nuts, or oily fish such as salmon and mackerel. The last half of the plate should be dedicated to fruits and vegetables to ensure adequate fibre and vitamin intake. You may refer to My Healthy Plate, an easy pictorial designed by the Health Promotion Board of Singapore to help you create balanced meals.19 By consuming the right nutrients in the right amounts, we provide our body with the required fuel for the processes of growth, repair and maintenance.
Summary
We have highlighted the importance of some nutrients that we feel should be incorporated into our diets to promote spinal health. We also placed special emphasis on how these nutrients are important for scoliosis patients. While ensuring adequate consumption of these nutrients will not cure scoliosis, it will help create a healthier environment in your body to help promote healing and would do well to complement a scoliosis treatment plan for maximal results. We have also addressed how proper nutrition ties in with chiropractic treatments. A common overriding theme is inflammation. Without proper nutrition, our body would enter a state of inflammation, and the health of our bones, muscles and ligaments suffer as a result. Not to mention increasing the risk of disease like diabetes and hypertension; or promoting the onset of musculoskeletal problems. Remember, the dosage makes the poison and moderation is key. Excessive consumption of anything can do more harm than good. Nutrition affects everything in our body from our spine, to our muscles and our organs; and good nutrition is necessary to complement any chiropractic treatments to ensure you have the best chances of recovery.
References
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19. https://www.healthhub.sg/programmes/55/my-healthy-plate
