When I first learned about free radicals, they were discussed in the context of nutritional reduction by taking antioxidant supplements (vitamins A, C, E and selenium). This did not make much sense to me, as I was interested in why free radicals were being overproduced and how that process could be modulated.
It turns out supplemental antioxidants are not the primary way to go when dealing with excess production of free radicals. Much more important is eating to create an "antioxidant state" or "anti-inflammatory state" of body physiology, synonymous with a state of wellness. This is accomplished by being in caloric deficit, as most people need to lose weight. In other words, whenever we are in a hypercaloric state, there will be an overproduction of free radicals and a low-grade inflammatory state will manifest.
Free Radicals and the Disc
The average American consumes excess calories and approximately 40 percent comes from refined sugar and flour, which leads to postprandial hyperglycemia initially and chronic hyperglycemia in the long term. All of this excess glucose circulating around will excessively enter cells that are unaccustomed to such a scenario, such as immune cells, endothelial cells, chondrocytes and fibroblasts. The outcome is an overproduction of superoxide free radicals by mitochondria, which subsequently stimulates inflammation signaling pathways.1
In the case of the disc, free radicals induce the overproduction of many inflammatory chemicals including matrix metalloproteinases, the key enzymes involved in the disc degradation and herniation process.2-3
How to Measure Free-Radical Activity
Excess free-radical production participates in the expression of most chronic diseases, including disc herniation, as mentioned above, and osteoarthritis. Important to understand is that the overproduction of free radicals occurs before the onset of these conditions. Assessing free-radical activity can be done both indirectly and directly.
As hyperglycemia leads to a surge in free-radical production, we can use both fasting and postprandial glucose levels as surrogate markers for free-radical activity. Interestingly, the patients most likely to express disc herniation are those living in a chronic state of hyperglycemia, which means identifying patients suffering from the metabolic syndrome and type 2 diabetes is quite relevant to spinal function.4 Waist:hip ratio, which can easily be measured in the clinical setting and correlates to glucose levels, also correlates to free-radical activity.5-6
Specific free-radical tests are also available. Free radicals can be identified directly in blood, urine and breath. Breath tests can actually be performed in real time in the office setting. Since free radicals are part of chronic inflammation and less nebulous to consider mentally, this approach can be useful for goal setting in clinical practice from the perspective of dealing with specific conditions (disc herniation) and/or general wellness.
How to Modulate Oxidative Stress
Multiple metabolic pathways are involved in the production of free radicals. Oxidative stress is a term that refers to the overproduction of free radicals. A key initiator in the process appears to be the overconsumption of sugar and flour, which leads to hyperglycemia and the overproduction of superoxide free radicals by mitochondria.
This initiates a sequence of reactions that causes a cell to release inflammatory mediators, including cytokines, prostaglandins, leukotrienes, growth factors, and metalloproteinase enzymes. This process continues so long as fasting and postprandial hyperglycemia exist. In other words, the most important action step one can take to reduce oxidative stress is to substantially reduce sugar and flour consumption to normalize fasting and postprandial glucose levels.
The problem with this action step is that most people have a reward reaction when sugar and flour are consumed, which is similar to the reaction that occurs when addictive illicit drugs are taken. This is why I refer to sugar and flour as "dietary crack."7
Supplementation Suggestions to Help Reduce Oxidative Stress
It takes willpower and mental vigilance to avoid sugar and flour, so people want to know what nutritional supplements they can take to counterbalance the overconsumption of dietary crack. To be sure, the only way to normalize free-radical production is to normalize blood glucose levels by eating less dietary crack.
In addition to modifying one's diet, multiple supplements can be taken to help reduce oxidative stress. In my view, vitamins C and E should be taken as short-term supplements because they can have pro-oxidant functions unless they are reduced by healthy activity of antioxidant enzymes. In contrast, coenzyme Q10 and lipoic acid are probably the best options, as each functions as an antioxidant, and also facilitates ATP synthesis and insulin sensitivity. Botanicals such as ginger and turmeric provide multiple anti-inflammatory benefits including antioxidant functions.
References
- Seaman DR. The DeFlame Diet. Wilmington (NC): Shadow Panther Press, 2016.
- Suzuki S, et al. Excessive reactive oxygen species are therapeutic targets for intervertebral disc degeneration. Arthritis Res Ther, 2015;17:316.
- Feng C, et al. ROS: crucial intermediators in the pathogenesis of intervertebral disc degeneration. Oxidative Med Cell Longevity, 2017;2017:5601593.
- Seaman DR. "Body Mass Index and Musculoskeletal Pain: Is There a Connection?" Chiropractic Man Ther, 2013;21:15.
- Charles LE, et al. Adiposity measures and oxidative stress among police officers. Obesity, 2008;16:2489-97.
- Siddiqui AH, Gulati R, Tauheed N, Pervez A. Correlation of waist-to-hip ratio (WHR) and oxidative stress in patients with acute myocardial infarction (AMI). J Clin Diagn Res, 2014;8:4-7.
- Seaman DR. "Dietary 'Crackheads' and the Never-Ending Battle Against the Bulging Waistline." Dynamic Chiropractic, April 1, 2013.
