Top Tips for Managing Back Pain

According to the CDC, lower back pain is the most common type of disability globally. In the US, one in four adults reported having back pain in the last three months. Lower back pain is classified based on the type and duration of clinical symptoms: acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) and chronic (lasting more than 12 weeks). What is alarming is that even with the lack of evidence to support its efficacy, almost 14% of insured patients who sought care for lower back pain were prescribed pharmacological drugs like opioids and/or benzodiazepines. These addictive narcotics and sedatives have severe consequences which can lead to overdose, mis-use and death (nearly 50,000 people died in the US from opioid mis-use in 2019).

So in this blog, I’ll share some evidence-based complementary approaches for back pain that are non-invasive and non-pharmacological treatments.

In this review of 45 clinical trials, participants exhibited significantly lower chronic back pain with exercise intervention. The results found strength/resistance and stabilization/coordination exercise programs to be the most effective forms.  For strengthening and stabilizing exercises for back pain, try:

Acupuncture, massage therapy and yoga were three key modalities recommended based on this analysis of randomized, controlled clinical trials conducted on complementary approaches to back pain management.


This ancient practice has been used in Asia for centuries to treat a myriad of conditions and relieve pain. The Chinese form of acupuncture involves inserting fine needles into the skin to work on the trigger points of the body and stimulate endorphins to kill pain. In other variations of this practice, heat or electrical stimulation may be applied to enhance the effects. Check out my earlier blog on how acupuncture works for managing pain.

When looking for an acupuncturist, make sure you verify the credentials and references prior to getting needled as laws vary by state. If unsure, it’s best to find an acupuncturist with certification from the National Certification Commission for Acupuncture and Oriental Medicine ( Here’s a useful guide I put together on what to look for:

Massage therapy

There are many forms of massage therapy but make sure your practitioner is licensed in your state and certified by a national organization like the American Massage Therapy Association. Also, here’s a quick guide to finding the right massage for you.

In this systematic review of clinical trials conducted on non-pharmacologic treatments for back pain, the strongest recommendations were given for exercise, acupuncture, tai chi, yoga, motor control exercise, and cognitive behavioral therapy.

Tai Chi

Tai Chi is a centuries-old Chinese martial art that utilizes slow, flowing exercises with movement, meditation and rhythmic breathing. Here’s one to try:

For yoga for back pain, here’s a video to check out:

Motor control exercises

These exercises, also called: lumbar stabilization, neuromuscular training, trunk stabilization and segmental stabilizing exercise, utilize a combination of whole-body movements, trunk-focused strengthening exercises, and stretching in order to increase spinal stability. These exercises are well established in the literature to reduce pain and disability.  Here’s a good one to try:

Cognitive behavioral therapy

CBT is a type of psychotherapy that enables you to better cope with negative and challenging situations, including chronic pain. If you’re interested in this form of therapy, look for a qualified, certified CBT counselor/therapist in your area:

Bath for muscle pain

How about a nice soak in the tub with Epsom salts and some essential oils? Although Epsom salts (magnesium sulfate) are widely used for alleviating muscle pain, most research done to date on pain management has been on other forms of magnesium (oral, intravenous). So instead of the aspirin or a non-steroidal anti-inflammatory drug habit (like Advil), try an Epsom salts bath to provide soothing relief to your aches and pains without the side effects.

Clinical aromatherapy has been studied for a variety of conditions including pain management. It is understood that the essential oils have a pain-relieving effect on the body combined with a relaxant effect on the nervous system.

Here’s a pain-killing bath recipe to try:

  • 2 cups Epsom salts
  • 3 drops Rosemary Oil
  • 3 drops Lavender Oil
  • 3 drops Peppermint Oil

Other essential oils with analgesic and anti-spasmodic effects includer ginger, marjoram, geranium, lemongrass and Roman chamomile – so feel free to mix and match based on preference and what’s readily available. Check out some of these tips and join the Pain forum and let me know what works for you!

How to Measure the Value of Virtual Health Care

The pandemic spurred a huge increase in the use of virtual health care. To help policymakers, payers, providers assess the various ways in which virtual care programs could have a positive impact for patients, clinicians, payers, and society going forward, the American Medical Association and Manatt Health developed a framework.

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Promoting Weight Loss by Demoting Inflammation

If you are like many Americans that struggle to lose excess weight, there’s comfort in knowing that you are not alone and all the odds are stacked against you. As our hormones decline with age, our food choices, the toxic environment and the sleep-deprived world we live in tell the cells in our body to hold on to the fat for dear life. In this series of blogs on weight, I’ll cover some evidence-based ways on what NOT TO DO and DO to boost weight loss without counting every calorie we eat and every step we take.

I have personally tried just about every diet in the book and realized after many years that it’s not a one-diet-fits-all approach and that some diets will make you feel better where others will not. Because we live in a world full of gourmands and almost infinite food choices, it’s become even more complicated to know what works and what doesn’t. For example, I don’t do well with wheat and dairy but it took me many years of eating the Western diet to figure that out. You probably heard the advice – it’s NOT what you eat but it’s what you DON’T eat that matters.

Inflammation and Weight

Did you know that inflammation in the body can prevent you from losing weight? Chronic inflammation contributes to insulin resistance and obesity regardless of how much you eat. Obesity is also an inflammatory condition that traps you in the cycle of fat gain and resistant weight loss creating a damned if you do, damned if you don’t situation.

But enough of the bad news. There are ways to promote weight loss without starting a new fad diet or becoming a super athlete. 

Here are some of the inflammatory foods you should consider eliminating from the diet to amp up your body’s fat burning potential:  

Artificial Sweeteners
Artificial sweeteners like Equal, Sweet-n-Low, and NutraSweet contain saccharin or aspartame and are commonly used in foods and beverages to make them sugar-free. If you think reaching for a diet soda is a good idea because it has zero sugar, did you know that consumption of diet soda is also strongly associated with obesity? Not to mention that some people can develop a sensitivity to these artificial sweeteners creating inflammation and joint pain, headaches, skin rashes and swelling. Just say NO to artificial sweeteners. How about trying stevia or allulose instead?

Here are a few to consider:

An estimated 30-50 million Americans are lactose intolerant (where your body lacks the enzyme lactase to break down the lactose sugar). This means that those people should avoid dairy products like milk, cream, cheese, and whey. When you eat what your body cannot handle, stomach discomfort, bloating, cramping, gas, diarrhea/constipation is the inflammatory response. Popping a Lactaid pill to have that slice of pizza or scoop of ice cream is not the answer. If you want to reduce inflammation, listen to your body and avoid products it doesn’t like. Of course, it’s easier said than done. I love ice cream and pizza and will indulge in them infrequently and only when I’ve been following a clean diet and my body feels optimal. But when I’m trying to lose weight, dairy is OUT.

Excess Alcohol
Did you know that drinking too much alcohol not only damages your liver but can permanently change your gut microbiota contributing to alcohol-induced oxidative stress, intestinal permeability to bacteria and other diseases? This study demonstrated the well-established link that excess alcohol can have on the composition of gut microbiota.

Food Allergies
You may be genetically programmed to tolerate less foods than your sibling/parent so it’s important to know how YOU respond to foods. Inability to tolerate the foods you eat will generate chronic inflammation in the body and make it difficult to lose weight. Common allergenic foods include corn, dairy, eggs, nuts, wheat and soy. Consider working with a nutritionist to try an elimination diet to see if any of these foods impact you. Or you can try it at home by eliminating most of the common allergenic foods. Have you heard of the Whole 30 program? Check it out – you may want to try it to see how much weight you lose after 30 days of eating clean. 

Foods containing sugar and processed carbohydrates
Sugar is in almost everything and it’s almost impossible to avoid when you’re eating out. Did you know that sugar (in various forms) triggers the release of advanced glycation end products (AGEs) which increases oxidative stress and inflammation and damages mitochondrial, skeletal, muscle and brain function? This study suggests the need to limit added sugar to reduce inflammation and prevent the development of metabolic and related diseases. Also, enriched bread, cereals, crackers, pastries, cakes and cookies have low nutrient density and fiber content but high glucose spiking potential that lead to an inflammatory state and insulin resistance. As good as it tastes going down, the advance glycation end products (AGEs) generated from eating these foods is your body’s way of telling you to STOP.

Fried Food
French fries, doughnuts, chips, tortillas, and fried chicken are staples of the Western diet. The vegetable oils used to fry these foods are high in omega-6 fatty acids which creates an imbalance with the essential omega-3 fatty acids, leading to inflammatory and autoimmune conditions. To add insult to injury, foods cooked in high temperatures generate a compound called acrylamide which is anticipated to have human carcinogenic effects. Here’s a recipe for Air Fryer French Fries – if you don’t own an air-fryer, you can oven-fry them instead.

Gluten is a general name for proteins found in wheat, rye, spelt, and barley, and acts like a glue to help maintain its shape and provide a chewy texture. Gluten is predominant in wheat products like bread, baked goods, pasta, pizza dough and cereals but can also be found in soups, sauces and salad dressings. If you have sensitivity to gluten, your body will see it as a foreign pathogen triggering an inflammatory response. This study shows how the consumption of wheat and cereal grains can contribute to the manifestation of chronic inflammation and autoimmune diseases by promoting intestinal permeability and a pro-inflammatory immune response.

Processed Meats
If you eat a low-carb diet with animal/sea protein, stay away from deli meat, hot dogs, smoked, cured and other processed foods. These foods stimulate the creation of advanced glycation end products (AGEs) which in turn generates inflammation in the body. AGEs are implicated in the progression of many diseases including diabetes and atherosclerosis.

Preservatives, Artificial Colors and Flavor Enhancers
These additives designed to increase shelf life, make food look tempting and enhance flavor are unnatural substances thereby promoting inflammation in the body. Here are some common preservatives to watch out for:

  • Nitrites (nitrates and nitrosamines)
  • Sulfites/sulfur dioxide
  • Sodium benzoate, potassium benzoate, benzene

Many of the artificial colors have been banned by the FDA but there are still some in the market as it’s being reviewed. Check labels carefully and consider shopping at chains like Trader Joe’s and Whole Foods where they won’t stock any foods with artificial coloring.

If you are a fan of Chinese food like me, you will notice some restaurants still add MSG (monosodium glutamate) to enhance the flavoring of the food. That’s why that Kung Pao chicken tastes so good! In this study, researchers used MSG to induce obesity. And this study showed that MSG promotes liver inflammation. So next time you go for some Chinese food, make sure it’s MSG free!

Trans Fats
Known as partially-hydrogenated oils, trans fats are inexpensive and highly stable with a desirable taste and texture. Some restaurants and fast food chains still use trans fat for frying foods as it can be used multiple times without changing out the oil. Trans fats are also found in cookies, cakes, crackers, and packaged snack foods. And remember, foods can be labeled as “trans-fat free” if they contain less than 0.5g per serving. So read the ingredient list carefully and if it says ‘partially-hydrogenated oils’, it has trans fats. It is evident that consumption of trans fatty acids is associated with higher levels of inflammatory markers leading to conditions like cardiovascular disease and atherosclerosis.

Optimizing Sleep with Diabetes

If you are like a third of American adults, you are probably not getting enough sleep or quality sleep. When I was younger, I used to envy those who thrived on five hours of sleep (or claimed they did) but now, I wish I could sleep more so I can feel more vibrant during the day. If you have diabetes, proper rest is critical so in this blog, I’ll share evidence and tips on the importance of sleep in diabetes management.

Did you know that lack of sleep (less than seven hours per night) can have the following negative impacts:

  • Make you hungrier and more likely to reach for caloric foods that are high in sugar, fat and carbs. I remember the desperately needed pizza runs during college while studying/cramming through the night – which led to the “freshman 15”. Lack of sleep decreases hormones promoting satiety and/or increases hormones promoting hunger so you get a double whammy of eating more and not being satisfied.
  • Studies have shown the impact of sleep deprivation on Increased insulin resistance, thus raising your risk level for diabetes and making it harder to lose weight.
  • Sleep deprivation can Impair mood, performance and cognitive function. I am almost always in a funky mood after a poor night’s sleep so for me, lack of sleep is a depressant.

This study found the correlation between sleep disturbance leading to diabetes risk – and having diabetes can affect your ability to sleep for the following reasons:

  • The need for frequent urination caused by high blood sugar levels.
  • If your blood sugar is low, symptoms like dizziness and sweating can impact your sleep.
  • You may have obstructive sleep apnea (OSA) which is a common sleep disorder in people with diabetes. This is a condition where your breathing repeatedly stops and starts throughout the night which leads to poor sleep quality. This study showed that OSA patients are more likely to develop Type 2 diabetes while more than half of Type 2 diabetes patients suffer from OSA. If you don’t feel rested after sleep, you may want to discuss with your doctor about taking a sleep test. The therapeutic use of a continuous positive airway pressure (CPAP) machine to help you breathe without interruption can have a tremendous impact on your sleep quality.
  • You may be suffering from insomnia which is associated with poor glycemic control as shown in this study.
  • You may have restless leg syndrome (RLS) where you have a constant need to move your legs which is particularly common at night which in turn makes it hard to fall/stay asleep. This study showed that blood glucose and HbA1c were significant predictors of RLS in patients with diabetes.
Ways to optimize sleep
  • Make sure you are adhering to a healthy diet that will keep your glucose levels stable throughout the night. Finish eating at least three hours before bedtime and avoid large meals late in the evening to minimize indigestion and higher blood sugar levels during sleep.
  • Avoid drinking alcohol within three hours of bedtime – it not only raises blood sugar levels but will keep you from falling into the deep sleep your body needs as indicated in this study.
  • If you are a coffee drinker, switch to decaf or herbal tea after lunch so any long-lasting effect of the caffeine doesn’t keep you up at night. I have no trouble metabolizing caffeine but noticed that it raises my glucose levels a bit so I stick to just one cup-a-joe to start my day.
  • Avoid nicotine – it’s not only a stimulant but chronic use has been shown to significantly impact sleep.
  • If you are a napper, have it early in the afternoon and keep it to under 30 minutes. Long naps can disrupt your sleep cycle and make it harder to fall asleep at bedtime.
  • Log in regular exercise (30 minutes a day) as it will improve your sleep but get it done at least three hours before bedtime so you don’t get a second wind from the exercise high.
  • Aim to always sleep in the dark as even the tiniest amount of artificial light can disrupt your circadian rhythm (your sleep and wake cycle) and production of melatonin (hormone that is produced by your body at night to promote deep sleep) as shown in this study. You can wear an eye mask or use blackout curtains to shut out any residual light.
  • Keep your room temperature cool (lower than 72 degrees). When you sleep, your body’s internal temperature drops to its lowest level, generally about four hours after you fall asleep. The cool environment is conducive to sleep as it mimics your body’s sleeping temperature.
  • Turn off the TV at least an hour before bed. The blue light from the device and the stimulation will make it harder for your body to relax and fall into sleep. If you’re like me and need your Netflix to de-stress after a long day, try blue light blocking glasses and/or a blue light filter. Here are some to try:

Blue Light Blocking Glasses

Blue Light Filter Screen Protector

  • If you find it hard to calm your mind from all the activities of the day, how about trying a guided meditation before bed? One to try is the Zen Garden Sleep Meditation available on the Apple Podcast channel which can be downloaded to your iPhone/iPad. I like this option as it allows me to listen to it on airplane mode with no WiFi or cell signals near me to disturb my sleep.

Sweet dreams!