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Dr. Ai Mukai is a board-certified, fellowship-trained Physical Medicine and Rehabilitation physician (or Physiatrist) with OrthoLoneStar‘s Texas Orthopedics division. Below are her recommendations related to supplements and overall nutrition. Click here to review all of Dr. Mukai’s product recommendations.

Patients frequently ask me about using supplements to help manage their pain and improve their health, especially those who wish to minimize the use of medications. I have given several talks at our national Academy conference on this topic. I like to only recommend supplements that at least have some level of evidence supporting their use and have good safety profiles.

SUPPLEMENTS I RECOMMEND FOR SPINE PAIN AND INFLAMMATION ARE:

1. VITAMIN D-3 – at least 2500 IU/day, up to 5000 IU/day
2. OMEGA 3 FISH OIL – there is a combination Vitamin D and Omega-3 supplement called Coromega
3. MAGNESIUM POWDER – CALM Powder – start 1/2 scoop in water at night, can take up to 1 scoop
   • Caution for laxative effect, although people with chronic constipation may like this effect.
   • Other forms of Magnesium can also be considered.
4. VITAMIN B COMPLEX – liquid or sublingual methylated form is best
5. TURMERIC – need to use with black pepper and consider with ginger. Can also try CBD and Arnica as well.
6. CoQ10 – especially for those on cholesterol lowering medications (statins) – helps with cellular metabolism and fatigue.

For more information around the evidence I use to inform my recommendations, continue reading below.

Physicians have long known that appropriate nutritional interventions can help reduce inflammation and pain and enhance outcomes of other therapies. (Phys Med Rehabil Clin N Am 2015 May 26(2):309-20.) Most commonly recommended is the “anti-inflammatory diet.”

• High in non-starchy vegetables, fruits, legumes, nuts and seeds, healthy oils and whole grains with low animal protein consumption.
• Thought to help with mitochondrial dysfunction, which is recognized as possible cause of many illnesses and painful conditions (Morris et al. Mol Neurobiol, 53(2)(2016)) – through anti-oxidants.

Systematic review of 73 studies investigating nutrition interventions on pain intensity: (https://www.iasp-pain.org/resources/fact-sheets/nutrition-and-chronic-pain/)

• Reduce inflammation: polyphenols (fruits and vegetables) – practical advice for patients: include variety, use frozen mixed vegetables easily incorporated into stir fry or casserole. Use frozen fruits.  Reduced-salt canned vegetables (like tomatoes and lentils). Aim for half of plate covered in fruits and vegetables
• Good quality fats – omega 3 and olive oil – practical advice: include oily fish like salmon and sardines, limit processed and hydrogenated oils – use extra virgin olive oil. Take fish oil supplements (3000 mg daily over 3 months helped reduce pain) want EPA/DHA ratio >1.5.

Specific Food/supplements:

• Turmeric and ginger – studied in both food and supplement form for pain – curcumin – equal to NSAIDs in terms of pain improvement without the risks of NSAIDs – systematic review (JMI Database System Rev Impl Rep, 13(2)(2015)
• Micronutrient deficiency is common in the U.S. – associated with highly processed foods
  • Vitamin D deficiency – best studied deficiency associated with pain and delayed healing (recommend Vitamin D-3 2500-5000 IU/day, can Rx if truly low)
  • Magnesium – impact on muscle spasm, systemic inflammation, hypertension, neuropathic pain and diabetes. Magnesium infusions used for migraine.  May have NMDA receptor blocking properties.
  • Omega 3 – fish oil – 2012 meta-analysis – >2.7g a day of fish oil reduced NSAID consumption in RA patients. Omega 3:6 ratio is low in the U.S. – omega 6 thought to be pro-inflammatory. Flax seed oil (omega3) did not seem to have similar benefit.
  • Vitamin B12 – neuropathy when deficient – neuropathic pain, some evidence that it helps with back pain also. Some people have difficulty methylating the B vitamins (active form) so take methylated form and take the whole vitamin B complex.
• Glucosamine – endogenous amino sugar used in glycoprotein and glycosaminoglycan synthesis (found in synovial fluid, ligaments) – exogenous form from marine exoskeletons or synthetic – 1500mg daily or 500mg TID, glucosamine sulfate better studied than glucosamine hydrochloride
  • Osteoarthritis of the knee – weak evidence that glucosamine sulfate can improve symptoms and slow disease progression (3 year knee joint space narrowing reduction – Pavelká K, Gatterová J, Olejarová M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002;162(18):2113–2123.). (evidence level B) 2005 meta-analysis – showed significant reduction of pain. (Towheed TE, Maxwell L, Anastassiades TP, et al. Glucosamine therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2005;(2):CD002946.)
  • Chondroitin also has evidence that it reduces osteoarthritis symptoms (lower level evidence) but NO evidence that combination is more effective than either agent alone. Chondroitin derived from bovine sources – theoretical potential for disease transmission. Bottom-line: recommend glucosamine only.