Nutritional Considerations for Treating Patients with Neuromusculoskeletal Disorders

Nutrition affects all of our body systems, including but not limited to cardiovascular, neurological, muscular, skeletal, endocrine, pulmonary, dermatological, reproductive, genitourinary and gastrointestinal.1 Each system works in a unique, yet complimentary way and none of our systems operate in isolation. The effects of inflammation, from mechanical disruption, physiological abnormalities or disease will produce a response in all systems. A positive healing environment, both internally and externally, requires a good foundation of nutrition. Patient motivation, exercise, tissue mobility, joint flexibility, hydration and good cardiopulmonary function also positively impact healing. Poor nutrition can negatively impact the healing process. Cumulative research suggests the lack of proper nutrition may lead to chronic inflammatory processes, compromised healing, limited recovery and reduced potential for rehabilitation. For example, musculoskeletal injuries may be exacerbated in the face of low levels of Vitamin D. 2 Interestingly, food components, like anti‐ oxidants, resveratrol, whey protein, chlorogenic acid, omega 3 fatty acids, cherry extract, Vitamen C and AloeVera have been linked to increased muscle strength, decreased oxidative stress post exercise, decreased protein cross‐ linking, and decreased inflammatory markers. 3‐9 In controlled animal trials, fructose‐rich diets have been associated with metabolic syndromes which decrease osteogenic potentiation (e.g. impairing bone growth) . 10 Medications, intended to improve recovery and decrease inflammation, may, in fact, impair musculoskeletal recovery and decrease tissue strength (eg non‐steroidal anti‐ inflammatories), specifically 10‐20 days post surgically repaired rotator cuff tendons. 11 Statin drugs for controlling cholesterol, can produce an imbalance of the extracellular matrix of tendons and produce micro‐damage. 12 These nutritional impairments in the musculoskeletal system are also integrated into the neurological system 13‐18, endocrine system19‐22, cardiovascular system, 23‐31 the pulmonary system,32‐34 the GI system and the limbic system.35‐ 40. Psychological factors can also have a direct impact on gut permeability (Gut‐Brain Axis). This connection may explain why increased gluten sensitivity has been reported in patients with schizophrenia,36 acute mania and bipolar disorders. 37,38 This Gut‐Brain‐Axis may also explain why probiotics can improve inflammatory events in general 39,40 and more specifically in patients with inflammatory disease such as Rheumatoid Arthritis 41 and Irritable Bowel Syndrome. 35