August 7, 2012

Nutritional biochemistry

What does lower back pain have in common with low carb eating?

Read Time 8 minutes

Strange question, huh? Before you get too excited, I’m not about to tell you that a low carbohydrate diet is a remedy for back pain.  Instead, I am going to explain a remarkably parallel experience I’ve had. I never made the connection until this week when a reader asked an unrelated question about lower back pain.

The best, worst experience of my life

As my third year of medical school was winding down, and I was just about to embark on a bold fourth year curriculum of back-to-back-to-back-to-back surgical sub-internships, I was on top of the world.  I was 27 years old, living in Palo Alto, California with my best friends, I had a wonderful girlfriend, I was working hard to prepare for my application to a surgical residency, and I still found time to work out like a wannabe Olympian.  What more could I ask for?

One sunny, June afternoon I got out of the pool after a good workout and felt a very strange pain in my lower back.  After riding my bike a few hundred yards to the weight room, it wasn’t getting better.  Actually, it was getting worse.  So bad, in fact, I did something I’d never done before – I decided to skip my workout and pedal home.

I iced my back, took some ibuprofen, and went to bed.  The next morning I woke up only to realize I literally could not get out of bed.  After struggling for some time I had to call my roommate to get me out of bed and help me to the bathroom.  I called my chief resident and apologized that I would not be able to come in to the hospital that day, and assured him I’d be fine the next day.  But I wasn’t.  Nor was I fine the day after or the day after.

A few days later I managed to limp my way into the hospital for rounds and with the help of the residents and nurses who were kind enough to give me intramuscular injections of a potent drug called toradol, I was able to survive, just barely.  The pain had gotten worse over the week and I was unable to sleep in any position except lying face down over a counter in an “L” shape.  But the worst was yet to come.

Within a few more days, not only was my back hurting, but I was also experiencing profound sensory pain in my left leg and left foot.  I realize this may sound hyperbolic, but I am not exaggerating at all when I say it felt like the skin was being torn off the bottom of my left foot.  The only way I could sleep was to tie my left foot in a plastic bag of ice to numb it and take 100 mg of Benadryl (enough to put a horse to sleep).  When the ice melted, I would wake up in pain and need to repeat the routine.

Within about 3 weeks of this back and leg pain, I was starting to worry that something very serious was going on.  I’d had a backache or two before, and in one case it even took a week to resolve.  But this was very different.  One night, when the pain was so bad I couldn’t mask it with any cocktail of drugs I finally relented and went to the ER.  After a thorough exam, the physician sent me to the MRI scanner (for those of you reading this outside of the U.S., it must sound crazy to think that a patient could have a MRI scan so quickly).

The MRI showed not only a large herniation of my L5-S1 disk (a bulging of the disk between my L5 and S1 vertebrae), but it also showed a free fragment of broken disk sitting directly on the S1 nerve root.  While the large bulging disk was likely the cause of my back pain, the free fragment pressing one of the largest nerves in my body was undoubtedly the culprit in my leg and foot pain.

The next morning I was taken to surgery by a (supposedly) talented and reputable neurosurgeon.  I was actually very relieved and excited, despite never having undergone surgery or general anesthesia before.  I was told this surgery would fix the problem immediately.  But it didn’t.  In fact, as it turned out, this was the beginning of a long, sordid ordeal, albeit with a positive take-away that is the point of my story.

I woke up from surgery and immediately realized the pain was still there, in my left foot.  Worse yet, I had trouble moving my right foot, which was completely fine before surgery.  Over the next few days it became clear I had developed something called a foot drop on my right side.  I would later learn the surgeon had operated on the wrong side and likely injured the nerve on the right side. Things had gone from bad to worse.

Compounding this, the surgeon who operated on me refused to believe my description of what I was experiencing and was convinced I was just being “soft” for complaining of persistent pain and a new problem.  After 2 weeks of further deterioration — and only when another physician examined me, and herself ordered another MRI — did my surgeon agree I still had a significant surgical lesion.

That night I went back to the operating room and, this time, operating on the correct side, the surgeon removed a 4-centimeter fragment of disc from my spinal canal that was still compressing my S1 nerve root (below).

back pathology specimen

The next three months proved to be what I would later describe as the “best, worst” experience of my life – an assertion I still maintain nearly 15 years later.  For a number of other reasons and complications I suffered that I won’t detail here for sake of time and space, I became completely debilitated after developing another complication called a facet arthropathy.  So much so that my mother flew to California to stay with me, just to feed me and drive me around to endless doctor appointments.

My dream of becoming a surgeon had quickly vanished along with any athletic aspirations I once had.  I worried whether I’d ever walk again and had begun to accept the fact that I may be addicted to pain killers for the rest of my life. [For anyone familiar with such medications, I was taking about 200 mg of oxycodone per day – about 40 times what a “normal” person would take following a painful dental procedure.]

Things I once took for granted – walking, being able to lean over the sink while brushing my teeth, sneezing without feeling like my kidneys were being ripped out – became distant and fading memories.

Fortunately, with the help of some remarkable doctors (which included several more trips to the operating room), kinesiologists, and physical therapists, I would slowly learn to move again without pain.  I had to train as hard and deliberately for this as I had for every other athletic endeavor I’d ever poured myself into.

I experienced firsthand what narcotic withdrawal is like and the depression that accompanies it.  I experienced firsthand what an arrogant surgeon can do to a patient.  I learned more about medicine in that year than at any other time in my medical training.

As a postscript to this story, I eventually made a remarkable recovery and was able to begin my surgical residency a year later with minimal pain.  Today my back is stronger than it was before this incident. Except for the few people I have shared this story with (until now), no one would ever know what I went through.  I move through the world like someone with a perfectly healthy and strong lower back.

I also gained a profound understanding of pain and addiction, which became one of the most valuable lessons I carried with me through my brief medical career.  It allowed me to understand what a heroin-addicted person goes through, when viewed through the lens of my own experience with the strongest painkillers.

A few years later I would become close friends with Drs. Marty Makary and Peter Pronovost when our paths crossed during my residency at Johns Hopkins.  Marty and Peter have become two of the biggest pioneers of patient safety and the avoidance of medical mistakes.  My story became one of many presented in Marty’s soon-to-be-released book, Unaccountable.

Years later, based on my experience and research I did while overcoming this injury, I gave many talks on the treatment and prevention of lower back injuries and have become a minor expert on the subject.  If anyone is interested, here is a link to one of my presentations (slides only, no video/audio).

What does this have to do with a low carb diet?

Today, when I pick up anything, whether it be a cotton ball or a piece of paper, I do it with my legs, not my back.  When I lean over the sink to brush my teeth, I support the weight of my torso with my arm.  When I get out of a car or out of bed I position myself not to torque my back.  When I need to lift a 265 pound barbeque out of my car, like I did a few months ago, my lower back is never under strain.  How did I learn to do this?  Through a very deliberate and long process of adaptation.  I had to re-learn how to move, how to sit, how to lift, how to sneeze.  Were it not for the long and painful road to recovery I endured, I may have never learned these things.

Many people who suffer back injuries never really recover.  When they do “recover” from one injury, the rate of relapse is very high.  While no two cases are identical, much of the reason for this lies in 2 factors:

  1. The injured person does not learn how to modify their behavior to avoid re-injury.
  2. The injured person does not take the necessary steps to strengthen and rehabilitate their back.

“Curing” a back injury is not a temporary thing or something that just happens because we wish it to be so. It is a very deliberate lifestyle change.  Over time, as we form habits, we can go from consciously thinking through every necessary behavior change – something easy to do when we are in pain – to a place where the behavior is more automatic. But this takes time.

In many ways, transitioning to a low carbohydrate diet is similar.  Consider the figure below.

4 stages

Just like with behaviors that predispose us to lower back injury, most people go through life just eating on autopilot, but eating the wrong things, the “default” things.  They graze in a reactionary manner without any understanding of how what they eat impacts their body.  They are eating in an unconsciously incorrect manner.

Many people learn that what they are eating is actually not ideal and not predisposing them to maximum health.  They move into a place of consciously incorrect behavior.  They realize drinking a Coke with fries and a candy bar is not good for them, despite still eating them.  Some of these people go one step further and actually make corrections – removing sugar and simple carbohydrates from their diet, for example – but doing so requires great effort and deliberate action.  They are now in the realm of consciously correct eating.

This is the place where most people get stuck.  It hurts.  It’s hard to do.  They get frustrated.  Maybe even ridiculed by friends and family.  Most turn back to consciously incorrect eating with brief periods of re-visiting consciously correct eating.  Hence, only a few people make their way into the final stage of unconsciously correct eating, just as only a few people with serious back injuries ever make it into a state of unconsciously correct movement.

Why?

Because it takes a lot of time and a lot of effort.  It’s different for everyone, but I know for me it took almost 2 years to get to the point of unconsciously correct eating.  I had spent 36 years mindlessly eating the wrong way, just as I had spent 27 years mindlessly moving the wrong way before injuring my back.

Sixty years ago it was quite easy to default into the correct way of eating because we were mostly surrounded by foods that supported such eating.  But, our food environment has changed dramatically and today’s default eating (e.g., high amounts of sugar, grains, highly refined carbohydrates) puts most of us – about 60 or 70% of us – at serious risk of metabolic disease.  One day, I believe, the work of NuSI and others will fix this problem, and through the elucidation of unambiguous science allow us to create a food environment that supports easier (and more affordable) default eating of the right foods.   However, until then we have to go through these stages.

If you find yourself feeling frustrated at how difficult it is to get from consciously eating well to unconsciously eating well, remember that you are on a journey.  If you are consistent and patient, if you remind yourself that you are embarking on a journey to change your life and not a short-term fix to look good in a bathing suit next month, you will embrace the right mindset to find the ‘sweet’ spot of unconsciously correct eating.

I will be the first to admit that this is not easy.  But, if you’re reading this, you’re already down the path and you’ll be better able to help the next person who struggles through the 4 stages of transition because you’ve experienced it yourself.

Photo by Meta Zahren on Unsplash

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285 Comments

  1. Thank you for sharing your experience. For everyone that has moved ahead, there are those of us who have not. Your story is inspirational.
    Thank you

  2. Hi Peter,

    I’m a Physio that works with chronic pain conditions and there are several sentences in the blog above that do alarm me but thanks for the post. We are finding out more and more about pain which is interesting but now we need to get more efficient at treating it! The following link makes an interesting read and though you might enjoy reading it.

    http://theconversation.edu.au/pain-really-is-in-the-mind-but-not-in-the-way-you-think-1151

    As you know so well “conventional wisdom” is often misplaced.

    • Thanks David,

      I have herniated discs in my neck(per MRI), and arthritis in my spine(per X-rays). In reading many sites, herniated discs are common, and the person does not even have pain associated with it. Some years ago, I read books by Dr. John E. Sarno. His take was that stress, and our emotions caused our pain. He has has success in treating pain, but only if the person was open to the belief that injury was not the cause of the pain. Those books did get me moving again, and not as afraid of hurting myself again. Also what helped me reduce my pain was getting off of Ambien(side effect is pain), and pain medicines cause rebound pain. I have read sleep medication can damage Gaba in the brain. I am much better now, as long as I stick to the very low carb/moderate protein/high fat diet. I am on no pain medications now. This article mentions mitochondrial damage, and ketosis. There is hope to repair our mitochondria through ketosis. Such damage could be affecting our pain perception, or the diet reduces the inflammation causing pain.

      Just noticed Jill’s post about Dr Sarno. I have read 3 of his books.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245719/?tool=pmcentrez

  3. Wow, that’s intense, Peter. Absolutely great analogy…and one heck of an experience you’ve had. I must say, however, having seen you speak, one of the things that I noticed about you was your impeccable posture…I just always assumed you had a mother that made you balance textbooks on your head or something.
    Thanks for sharing, and keep up the good fight.
    -C

  4. Peter, always look forward to yr posts. Outstanding analogy n quite a story to boot. Also checked out yr slide show n the video, n now I gotta get that book. the cliche holds tru, your health is your wealth.

  5. Great article Peter.

    I am definitely flipping between the consciously correct and consciously incorrect at the moment and that is after 19 months of doing this. I am thankfully back on to consciously correct as of today, but am finding that as I get closer to my goal, I am easing up on my militant anti-carb views, with regards to what I am putting in my own mouth and this means I flip back into eating the wrong things. As you say I would be putting in something I know is bad, whilst at the exact same time thinking why am I eating this. It becomes frustrating at the end of the day knowing that you are deliberately sabotaging your efforts when you clearly know what the answer is.

    It is exhausting to a degree. It all comes down to will power and motivation and I find it interesting that I get to a point where I lose both as I get closer to my goal. Maybe linked to never finishing home renovations projects, but getting close. 🙂 I think I need to reread your earlier posts and get some mojo back again.

    This story though has added back some motivation to my life and was very interesting about your back problems. I have suffered from lower back problems since I was a teenager that is a regular PITA. I have never really learnt how to use my back properly and always thought that if I could only strengthen my back more that it won’t be a problem.

    Thanks.

  6. As the cheesy people on the reality shows would say – “it’s a fantastic journey”, this learning to be unconsciously correct . Mine is in its infancy with a few hurdles to jump, i.e. an Apo E4/E4 genetic makeup and cholesterol off the charts after going LCHF. It certainly exercises the brain with all the studies and websites to trawl through to try and find some answers. I thank you all very much for this website in particular. There are so many theories about E4 (eat low fat vs eat LCHF and don’t worry about cholesterol vs you’re basically stuffed no matter what you do), it’s history and role in so many internal processes – hopefully I can eventually work out what it does for me and how to ‘manage’ it, if that is possible. I’m relieved that, even though my ApoB is at excessive levels, my Trigs and HDL are good and my health is generally excellent. I’d hate to have discovered all this information in my 50s.

    Thanks for all your hard work, Peter, and thanks to everyone else for contributing to the discussion. A discussion which will hopefully eventually make it to mainstream.

  7. Enormously helpful, Peter. I’m about a 15 year chronic LBP guy after a car hit from behind while I was stopped in mine at a red light. I’m stuck in the cycle of reinjuring my back that you describe. (L4 L5 herniation)

    I’m curious – what do you do for driving in the car? I find this is a sure way to reinflame the discs, and one that I cannot seem to avoid …

  8. Peter, as usual, a timely (for me) and well presented argument. Four months into reversing T2, going ok, but weight loss very slow, so often feel like giving up. I’m going to print out the flow chart and read it several times a day as a reminder. Thanks so much.

  9. Holy Cow! What a story! It’s terrifying to think that a doctor can be so arrogant to think that they couldn’t possibly have caused you those additional problems and that you must be making it up! They are just people, after all.

    This discussion of going from unconsciously incorrect to unconsciously correct is exactly my story. It took me about 3 years to get where I am today, but not without a lot of frustration and mess up. It is getting easier and easier to eat correctly and easier and easier not to mess up.

    • So great to hear, Graham. Interesting that the length of time for you to go from stage 1 to stage 4 was also about 3 years. I’m curious to hear from others who have made the transition, also, in terms of how long it took them.

  10. I have found that the biggest challenge in eating low carb is staying award from certain foods during weak moments. Going to the movies and smelling popcorn makes it hard to resist. Knowing that they are bad for you doesn’t negate the fact that you’ve eaten them for decades and really enjoy eating them. I have found that it is mainly really sweet carbs I crave at times, and some of my other favorite old foods don’t taste the same (non sweet to the taste carbs). I tell people that it is both easy and hard to go low carb. You have to plan ahead, cook your own food and take ownership of what you eat. I am making salad dressing now and have a home made cool whip recipe to satisfy my sweet tooth. I think everyone does low carb slightly differently to suit their own tastes and food preferences. I’ve had some back issues over the years but nothing like you describe. I think mine are related to a really tight IT band that pulls my hip and L5 vertibrae forward. It also cause knee pain when running/cycling etc. It can be very frustrating working through sports injuries and you’re lucky to have regained your health. Cheers, Dave

    • Sounds like a “strong” stage 3. You know what’s right, but it’s not yet autonomic. You’re absolutely right, though, the less often you put yourself in stressful situations the better. Planning is huge. You’d be amazed how much time I spend in the average week planning what I’ll eat, especially when traveling or not eating “in my element.”

  11. Wow, when I saw your question and the trailer posted on Facebook (without yet reading your post), I went to a completely different place: ie, that your point is that the problem of bad nutritional science is just part of the bigger problem in medicine. But this post is way deeper than that, and thank you for it. I’m truly sorry you endured this, and no wonder you ultimately chose to get out of the way of the train wreck that is modern healthcare. I know that our darkest hours often lead us to our greatest triumphs, but to say that your story of persistence and personal awareness is inspirational is an understatement. I can personally take many lessons from this post and your experience, and will use this philosophy in a much more intentional way with my clients. Thanks, Peter.

    • Thanks so much, Lorraine. I’m really honored that this post means so much to some folks. When I first wrote it I didn’t think it would resonate, because I had to leave out so many details to keep it short. Sounds like the message still made it through.

    • Yes the message definitely made it through. Not just the 4 stages to conscious correctness, which was nice to read here, it’s a template I’ve always liked, but the reality of persistence in the face of pretty bad odds. Someone else noted here in this thread about how some folks say they read Taubes (or Wolf, Eades etc) and they drop a ton of weight like a walk in the park. I’m not sure how that’s possible frankly, especially as people age beyond their 20’s and have metabolic issues from decades of SAD, and yet the main thing I’ve found that gets people off track is that very same magical thinking about how easy it should be. I’ve found in my own life, and tell folks I work with, to expect to have to do serial re-engineering of everything, not just their diet or work outs; and many times, not just once. Each step reveals something else that must be addressed in the next stage of engineering. In the course of trying to lose weight or improve their diabetes, many end up having to re-evaluate if their jobs are serving them or look at the toxic elements in their relationships, and almost everyone has to finally deal with how they handle life’s hardness by acting out with substances, which is often food. It’s hard and it is often very painful. For you to have made it through that crisis meant that you either had, or had to develop, a belief in yourself to keep going until you got to the other side. Many people lack this, and they remain relentlessly in that gray area of “I’m trying”, which exhausts what confidence and motivation they may have had at the beginning. My personal philosophy is that our issues and illnesses and injuries are there for the purpose of evolving us. What we reveal of ourselves to ourselves on the way through to the other side is the prize. But we have to go all the way through.

      My personal experience with LC is that once I got it right; i.e., got the amount of carbs right, and the timing of eating right (this ended up being very important to me), I no longer had any cravings or hunger. But that process of figuring it out took many, many months of experimentation and included some lost time and energy drain trying to mix ketosis and IF (didn’t work), and a few scary bouts of muscle cramps that were so bad that I worried about cardiac spasms. Salt wasn’t enough for me. I had to do supplemental sodium, potassium chloride, way more magnesium than I had ever taken, and some calcium with k2. I was seriously on the verge of quitting LC, but other than the fact that I feared for my life, I felt exceptionally great ! (lol), particularly mentally and body energy. The biggest awareness once I got all that handled was that even though I no longer had hunger or cravings and I’m never stimulated by the sight or smell of carbs, I still have times when I start thinking about junk food. Interesting to me, is that it’s always associated with me churning mentally about something I need to get done or figure out, and I’m either avoiding it because it’s out of my comfort zone, or it’s just not fully resolved yet in my head. Those situations seem to cause me a low level of anxiety, and my brain starts sending me images of sweets frolicking carefree. I have many recovering addicts in my practice, and I see all of this as the same thing, chasing the hit that’s going to take me out of that day-to-day low grade discomfort of staying present. with stuff that’s pushing me out of my comfort zone.

    • Hi Lorraine,

      Would you mind if I asked you what “formula” of carbs, timing, & supplemental mineral amounts works for you, i.e. you mentioned much more magnesium…?

      Nina

    • Hi Nina, Happy to, but I want to start with the caveat that what is working for me right now may not work for you, and it may not even work for me down the road. It’s just working right now. Also it’s important to note that my goals may not be the same as yours. My goals were/are to reduce or eliminate some symptoms of menopause, and to improve exercise recovery . I’m also very interested in longevity, and I like ketosis for both its impact on insulin growth factor and on autophagy. So with menopause I added a little weight and became borderline IR which is very common, and experienced some symptoms, although pretty minor, of sleep disturbance and some hot flashes and, shall we say, a little emotional intensity.

      Cutting CHO to below 50 g per day, irrespective of calorie intake, immediately eliminated all problems with sleep, and hot flashes, and getting rid of that stuff restored my emotional reserve. This is consistent with issues in the literature about how much of the symptoms of menopause are sex hormone related and how much insulin resistance related.

      I needed to get to about 35-40 g CHO to get into ketosis and stay there. My current formula, then, is 10ish% CHO, 70+%Fat, and up to 20% Pro, and I keep the calories under 1400 right now. I use a diet calculator called Weightmania Pro, which is a professional tool that I use for work, to keep track of diet and blood glucose and ketones (by beta hydroxybutyrate) for the purpose of determining what’s working and what’s not. I’ve lost some pounds, but body composition changes have been pronounced (even though I was already quite fit), and I’m no longer IR.

      Trying to add IF to ketosis did not work for me because the IF pulled me right out of ketosis. So I had to pick my approach and I decided for now to stay with ketosis. I asked Peter about this, and he found it to be true for him as well, related to the bolus protein intake that turns on gluconeogenesis. I’m most stable in ketosis if I eat smaller amounts throughout the day, starting as soon as I get up. If I start with coffee and postpone eating, I’m out of ketosis. I actually prefer eating less frequently, postponing breakfast and exercising fasted, but my body won’t do ketosis that way, and right now ketosis is the experiment.

      Apparently I dump electrolytes like crazy, and this has always been sort of apparent to me, in that I’ve recovered from exercise much better if I was supplementing minerals, but I was typically sloppy about doing it and have had periods of bad recovery because of energy drag and poor muscle recovery.Mineral supplementation has seemed to help. With ketogenic diuresis and drinking tons of water, that went to a whole new level of bad with the muscle cramping mentioned above, and so now my routine is to have broth twice a day mixed with 1/2 tsp of celtic sea salt and a dash of NuSalt (potassium chloride). The first one I have first thing in the morning with Slow-Mag and my first bit of food (before coffee and any training). The second one I have before bed along with a shot of Osteo-Calm.

      I’ve included the details of why I’m doing what I do because the context may not apply to you at all, and you may have to do something entirely different.

  12. Have you read any of Dr. John Sarno’s work on back pain and other pain syndromes like carpal tunnel? I’d be very interested to hear your opinion on his work, which would offer a very different interpretation of what happened to you start to finish.

    • I’ve read 3 of Dr. Sarno’s books, and while I have certainty that unconscious rage is responsible for both pain and musculoskeletal injury in some people, in my experience anyway, those folks typically show up with concommitant issues (like anxiety, depression or food/substance abuse stuff). Even though the idea of his approach is appealing to me as someone very interested in the psychology of our physiology, he lost me when he started claiming that the veritable kitchen sink of disorders was all Tension Myositis. And I have also personally found that most folks are more than willing to process their subconscious stuff that could be triggering their physical symptoms, but this often does not resolve the physical symptoms.

    • In addition to Sarno, I’d suggest the work of Dr. Nortin Hadler to anyone interested in critical views of conventional medical ideas about back (or any musculoskeletal) problems. His book for laypeople about this:

      http://www.amazon.com/Stabbed-Back-Confronting-Overtreated-Society/dp/0807833487/ref=sr_1_4?ie=UTF8&qid=1344366640&sr=8-4&keywords=nortin+hadler

      His book on this topic for medical professionals:

      http://www.amazon.com/Occupational-Musculoskeletal-Disorders-Nortin-Hadler/dp/0781749220/ref=sr_1_10?ie=UTF8&qid=1344366640&sr=8-10&keywords=nortin+hadler

      Hadler believes that it’s a rare case of musculoskeletal pain or disability that benefits from a trip to the doctor, much less medical intervention. There are important exceptions, of course (it sure sounds like Peter was one of them!), but Hadler has concluded that for the most part medicalizing one’s pain and other musculoskeletal challenges only leads to worse outcomes and more suffering.

      As I’ve mentioned previously here, Hadler, among other critics, likewise believes much of the other screening, diagnostic testing, and interventions that are the mainstays of modern medicine frequently cause more harm than good, or at the least don’t have convincing evidence to support them. This includes most cancer screening, cholesterol screening, and interventional cardiology and cardiovascular surgery, among many other examples Hadler reviews in his other books.

      Hadler is a proud academic, conventional doc. He strongly believes in medical testing and intervention—but only when it’s warranted and there’s real evidence to show it will advantage rather than disadvantage the patient.

      (Probably none of this relates to Peter’s story, considering the incredibly extreme suffering and disability he was experiencing, but since Sarno came up I thought I’d also mention Hadler, since their approaches are rather concordant and quite contrary to conventional medical wisdom–although if I’m not mistaken, Sarno’s once-radcial views are finally more accepted now and surgery for back pain has steeply declined as Sarno recommended.)

  13. At the risk of ridicule – mockery – insane fits of laughter –

    I’ll post the following anyway –

    The following protocol has seemed to fix my back – no problems since trying it –

    Method: Take a mixture of the following: – starting dry/ – beans-lentils/peas-wheat-barley-millet-rice – put in a bowl – sprinkle with whey protein and cover with water – never drain the water – just add more water when needed – and eat one teaspoon a day –

    I assume this wet slightly fermented mixture creates some needed substance or the bacteria in the colon use it to do same – redirecting the bodies use of calcium –

    I eat a teaspoonful of this mixture dry for other reasons also –

  14. Good post. Articles like this help me to remember how much effort I’ve put into changing my own life. I’m only 21 years and I’m currently 15 months into my recovery from drug addiction. Only once I finally became conscious of what I was doing to not only my body, but every other aspect of my life as well, was I able to begin the transition to unconsciously correct. In my case, the only way out was a total lifestyle change. I went from drug addict to health nut despite ridicule and being judged ( how ironic is that?). I think if everybody who wanted to change would grasp the idea that real changes come from conscious and active effort (perhaps even pain and sacrifice) the world could be a much place… thank you for what you are doing here Peter!

    • Ian, thank you for being open enough to share this. I can’t tell you how my own addiction to opiates completely changed my view of “addicts,” especially at Hopkins, which sits in the heroin-capital of the United States. I really believe the empathy (not to be confused with sympathy) I had for patients with this affliction would not have been present without my own struggle. And here’s another point, I’ll be you already know…you never really lose the “taste” for it, at least most people don’t. Which is all the more reason to maintain diligence and create a new infrastructure around yourself.
      I used to tell patients who wanted to get off drugs that were going to need a new group of friends. There was little chance they could get clean with the same social support network that fostered their addiction in the first place. Very tough choices. So glad to hear to you’re making progress.

    • To summarize Sarno for the fellow blog readers (hopefully reasonably accurately): Sarno theorizes that a lot of chronic back pain is cause by the body/mind “crying for help/attention/care” due to high stress. Once the condition is consciously recognized, the body/mind recognizes that this activity will not result in the desired response, and ceases generating pain.

      This was brought to my attention years ago while I was having long-term chronic back pain, which was not relieved by a good chiropractor, physical therapy, or exercise. Frustrated, I went to a “body guru” who scheduled me for an MRI to find out what was wrong. Before that happened, I ended up changing jobs suddenly and unexpectedly, resulting a complete loss of stress. A day or so later, my back went through some painful spasms while I was sleeping one night, and the pain was gone forever, and has not reoccurred since. I ended up telling this story to my guru, and his response was immediate “Oh, Sarno pain”. The subsequent MRI showed a 40 year old back with only normal wear and tear – nothing of note.

      I read Sarno’s work and do believe that for some people, this can certainly be a source of pain. This too takes a willingness to abandon conventional wisdom to make progress.

  15. I threw out my back once, and it was hands down the worst pain of my life. I was stuck on all fours for about 2 hours, and then with help I was able to lay down on my back, and was stuck there for about 3 hours, completely unable to move. Had my girlfriend not been there I don’t know what I would have done.

    This happened when I was at my heaviest, about 300 lbs. I was also having really bad sciatica at the time. Getting in and out of my car was, quite literally, a huge pain in the a**.

    For me, exercise and weight loss were the cure. But I did also have to change the way I held my body in various positions. What you say about doing something unconsciously correct really does ring true. I don’t have to think about it anymore. The heartening thing is, after now being on low carb for a year, I’m getting there with diet as well.

  16. Thanks for the link to your presentation. Can you direct me to any more information/articles on how to re-train yourself to use your legs and not your lower back?

  17. Holy crap! I can sincerely say, I’m happy not of that ever happened to ME. Because I’m self-absorbed like that. And very glad you made it through all that to so you could teach us about LDL-P.

  18. I’m so happy for you; what a truly amazing recovery! No one could ever imagine what you have been through, seeing your elite athletic status now. I am always impressed by your readers who say they read Gary’s book and poof! they changed everything about their diet and achieved magical results. Thank you for the encouragement.

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