Integrative Orthomolecular Medicine Recommendations for Sciatica

Posted on March 13, 2024 by Dr. Cheng

Integrative Orthomolecular Medicine Recommendations for Sciatica

Richard Z. Cheng, M.D., Ph.D.

Caution: This is for information exchange only. Use it under the care of a trained and experienced healthcare provider.

Sciatica is a debilitating multi-factorial inflammatory disease. Elevated oxidative stress is a hallmark at the cellular biochemical level, is essentially the imbalance of too many toxins (oxidants) and insufficient antioxidants. Clinical management aiming for avoidance and reduction of oxidant toxins and supplementation of antioxidants offers a promising approach.

  1. Lifestyle changes to start with a healthy diet:
    1. Low carb/ketogenic diet
    2. Intermittent fasting
    3. Avoid ultra-processed foods
    4. Avoid Omega-6 oil rich seed oils, replace instead with saturated or monosaturated animal-based fats such as butter, lard, avocado, olive oil or coconut oil.
  2. Supplementation of antioxidant vitamins and micronutrients including especially high dose vitamins and other antioxidants. On top of a high dose multivitamin supplementation daily, consider adding:
    1. Vit B1, 500 -1,500 mg daily
    2. Vit B2, 500 -1,500 mg daily
    3. Vit C, 3,000 to 10,000 grams in divided doses daily
    4. Vit D3, 5,000 – 10,000 IU daily. Please note to monitor  blood  Vit D3 levels 2 times annually to keep Vit D3 blood levels between 50-100 ng/ml.
    5. Magnesium glycinate or citrate or threonate, 1,000 – 2,000 mg daily.
    6. Omega-3 oil: 4,000 – 8,000 mg daily
    7. Others: other antioxidants and mitochondrial nutrients, photobiomodulation therapy (near infrared, PBMT/NIR).

Oxidative stress plays a crucial role in sciatica

Oxidative stress has been implicated in various conditions, including spinal cord injury (SCI) and neuropathic pain. Studies have shown that oxidative stress is increased in patients with SCI, potentially contributing to the severity of pain (Fatima 2015). Similarly, in rats, hydroxychloroquine-induced oxidative stress has been linked to axonal atrophy in the sciatic nerve and muscle tissues (Uzar 2012). In the context of traumatic SCI, the combination of increased free radical production and low antioxidant levels leads to enhanced oxidative stress, suggesting a potential role for antioxidant therapy (Bedreag 2014). In the specific case of sciatic nerve injury, oxidative stress has been shown to play a role in the pathophysiology of peripheral neuropathy, with potential modulation by N-acetyl-l-cysteine (Naik 2006). Furthermore, prolonged constriction of the sciatic nerve has been found to affect oxidative stressors and antioxidant enzymes in rats, potentially contributing to locomotory deficits and hyperalgesia (Varija 2009). However, the relationship between neuropathic pain and oxidative stress is complex, with some studies showing changes in antioxidant activity in the spinal cord following nerve injury (Guedes 2006, Scheid 2013, Goecks 2012).

Low carb/ketogenic diet for sciatica

Research suggests that a low-carbohydrate/ketogenic diet may have potential benefits for individuals with sciatica. Yarar-Fisher (2019) found that a low-carbohydrate/high-protein diet improved metabolic health in individuals with spinal cord injury, a population that often experiences sciatica. Liśkiewicz (2016) and Field (2022) both reported positive effects of a ketogenic diet on nerve regeneration and neurological outcomes, respectively. Safari (2020) and Guarnotta (2022) demonstrated the efficacy of a low-calorie diet and a very low-calorie ketogenic diet in reducing pain and disability in chronic sciatica and improving metabolic parameters in hypercortisolism, respectively. However, it is important to note that individuals with spinal cord injury, who are more prone to sciatica, often have nutritional deficiencies and may require dietary intervention and education (Levine, 1992). Further research is needed to fully understand the potential benefits of a low-carbohydrate/ketogenic diet for sciatica.

High dose vitamins and antioxidants for sciatica

  • B vitamins:

Research suggests that high doses of vitamin B12, a water-soluble vitamin, may be beneficial for treating pain conditions, including sciatica (Buesing 2019, Geller 2017, Wang 2018). Vitamin B12 has been shown to have a positive effect on pain intensity and disability in patients with low back pain (Mauro 2000). However, the specific role of high dose vitamin B1 in treating sciatica is not well-established. Further research is needed to determine the efficacy and optimal dosing of vitamin B1 for this condition. Vitamin B12 deficiency is common in spinal cord injury (SCI) and its replacement can improve neurological and psychiatric symptoms, including pain (Petchkrua, 2003).  Vitamins D, B3, and B12 have been shown to have consistent benefits in SCI patients (Pedroza-García, 2022). Systemic administration of vitamins C and E can attenuate neuropathic pain, including that induced by chronic constriction injury of the sciatic nerve (Riffel, 2016). Intramuscular vitamin B12 has been found to alleviate low back pain and related disability (Mauro, 2000). High-dose vitamin D therapy has been reported to completely resolve chronic pain in sickle cell disease (Osunkwo, 2011). Systemic administration of B vitamins can attenuate neuropathic hyperalgesia and reduce spinal neuron injury following temporary spinal cord ischaemia in rats (Yu, 2014). Tissue levels of vitamin B complex and vitamin B12 vary with progression of crush-induced peripheral nerve injury, suggesting potential benefits of supplementation in the acute period (Altun).

  • Vitamin C

High dose antioxidants, particularly vitamins C and E, have been shown to have a positive impact on neuropathic pain and oxidative stress in the sciatic nerve (Riffel 2016, Riffel 2018). High-dose vitamin C has shown potential in treating spinal cord injury (Liao 2004) and reducing neuropathic pain (Riffel 2016). It has also been linked to a reduction in pain days in sickle cell disease (Osunkwo 2012) and a decrease in symptoms of chronic regional pain syndrome (Carr 2017). However, the effectiveness of high-dose vitamin C for sciatica specifically is not well-documented. Other treatments, such as thioctic acid and acetyl-L-carnitine, have shown promise in reducing sciatic pain (Memeo 2008). Further research is needed to determine the specific benefits of high-dose vitamin C for sciatica.

  • Vitamin D

Research suggests that vitamin D deficiency is associated with chronic pain, including sciatica (Holick, 2004; Straube, 2009; Helde-Frankling, 2017; Kragstrup, 2011). Vitamins D, B3, and B12 have been shown to have consistent benefits in SCI patients (Pedroza-García, 2022). High-dose vitamin D3 supplementation has been shown to alleviate chronic pain in various conditions, including sickle cell disease (Osunkwo, 2011). However, the evidence for its effectiveness in treating sciatica specifically is limited. Further research is needed to determine the optimal dosage and potential benefits of high-dose vitamin D3 for sciatica.

  • High dose antioxidants for sciatica

High dose antioxidants, particularly vitamins C and E, have been shown to have a positive impact on neuropathic pain and oxidative stress in the sciatic nerve (Riffel 2016, Riffel 2018). These antioxidants can also improve endoneurial blood flow, motor nerve conduction velocity, and vascular reactivity in the sciatic nerve (Coppey 2001). Alpha-lipoic acid, another antioxidant, has been found to prevent neural damage after a crush injury to the rat sciatic nerve (Senoglu 2009). However, further research is needed to explore the potential of these antioxidants in the treatment of acute spinal cord injury (Hall 2011).

References

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