Nutrition Advice for Scoliosis Idiopathic Scoliosis Nutritional Deficiencies Adolescent idiopathic scoliosis (AIS) a spinal disorder with no known cause. Idiopathic scoliosis has many theories as to its pathogenesis. Melatonin may potentially play a role in the cause and progression of scoliosis based on a biochemical theory known as the neuro-endocrine hypothesis. At present, the data available regarding this potential mechanism cannot clearly support this hypothesis simply meaning it may or may not play a role in the cause and progression of scoliosis but there isn’t enough evidence to conclude either way. Melatonin is a hormone secreted by the pineal gland in the brain. It helps regulate other hormones and helps to maintain the bodys circadian rhythm or sleep/awake cycles. This hormone may play a significant role in the timing of puberty where at the onset of puberty there exists a decline in melatonin secretion that occurs as children grow [1]. In another studies scientists found significantly decreased levels of melatonin (actual serum levels with multiple regular overnight samples) in five adolescents with progressive curves, while those with stable curves were similar to controls so low levels with progressive curves. [2] The researchers presumed that melatonin bonded with calmodulin, a calcium binding protein, thereby affecting calcium metabolism. This in turn alters calcium uptake with muscle cells causing asymmetry in para-spinal muscle growth and development. This is interesting because evidence does exist demonstrating a difference in length of the deep intrinsic muscles of the spine associated with larger curves contributing to the actual cause for significant tilt and rotation of individual bones of the spine in the apical region, the peak of the scoliosis curvature. From a theoretical point we can look at melatonin as being involved from two different perspectives: • Premature pubertal growth due to a deficiency in circulating melatonin levels. • Calcium uptake dysfunction. Since melatonin is linked to pubertal growth cycles any early onset of deficiency in circulating levels of melatonin could in fact trigger early pubertal growth. Since scoliosis development and progression is heavily associated with growth cycles this could certainly be part of this multi-factorial problem. It is common knowledge that females enter growth earlier than boys and according to several neurologists have an immature nervous system in regards to spinal balance and postural control functions. So if melatonin deficiency triggers an earlier than normal puberty it will certainly be a disadvantage for the developing child because when the nervous system control of posture is immature and the adolescent enters rapid growth at puberty there is an increased risk of progression of any existing spinal imbalances. The more mature a person is neurologically entering growth the better the body can compensate and right itself to gravity when imbalances are present. The second theoretical model involves melatonin binding to calmodulin. Melatonin-calmodulin binding could influence or perhaps directly control many intracellular Ca++ functions and potentially alter the set-point for cell activity which will follow the fluctuation of circulating levels of melatonin.[4] In patients who have idiopathic scoliosis, calmodulin regulates the contractile properties of muscle through its interaction with calcium. Cohen et al. found a 2.5 to threefold increase in the activity of calmodulin in the platelets of patients who had idiopathic scoliosis. Since deficiencies in circulating melatonin are directly linked to calmodulin levels where low melatonin leads to high levels of calmodulin and high levels of calmodulin are routinely found in progressive scoliosis the neuroendocrine models take on life as possible causes of either initiation of the disease or at least involved in the progressiveness of it. Nutrition and Scoliosis Treatment It may be advantageous to closely monitor any adolescent diagnosed with idiopathic scoliosis for melatonin deficiency by obtaining the proper testing for this hormone relative to the normal levels of circulation at different times of the day and during rest. If circulating levels are deficient or even on the low side I would suggest a supplementation program as well as any other precautionary steps to avoid a cumulative scenario of low levels of circulating melatonin perhaps inducing premature pubertal growth or altering calcium regulation in muscles therefore initiating or increasing risk of progression of adolescent idiopathic scoliosis. Additional studies have found trace mineral levels to be abnormal in patients with idiopathic scoliosis. The majority of information demonstrates high levels of copper and zinc and low levels of selenium.[3] Nutrition Advice for Scoliosis-selenium.jpg This is not an explicit encoursement of Nature Made products or brand name. What researchers are finding is that the ratio of different minerals is more important than just a single mineral being high or low in the body. With larger more progressive scoliosis patients the ratio between copper and selenium was significantly different than control groups. This ratio was off by such a large degree because of both the elevated levels of copper and the deceased levels of selenium occurring at once. Selenium was found to be interlinked to a chemical known as osteopontin found in high levels with patients diagnosed with adolescent idiopathic scoliosis. Osteopontin expression that increases in the patient sample over time is indicative that the patient is at risk for developing a scoliosis. This osteopontin OPN serum level monitoring is apparently able to predict a childs risk of actually developing scoliosis which would hold value if it became a routine blood draw in early growth. I don’t see medical doctors at well checks drawing blood routinely so this will most likely have to be specific to those families with a history of scoliosis. Since selenium levels were found lower and OPN levels were found higher it is a natural assumption that the two chemicals are inversely related meaning if one level goes up the other will go down. Selenium is an antioxidant and carries anti-inflammatory properties. OPN is associated with inflammation and has been found in high levels for several different diseases including cardiovascular, diabetes and psoriasis. Plasma OPN levels being elevated therefore may not be an indicator specifically for scoliosis but may in fact be an indicator of abnormal inflammatory responses to tissue damage or disease processes. The actual inflammatory response specific to adolescent idiopathic scoliosis was found in the growth plates of the apical vertebrae. The question remains is this secondary to the asymmetrical loading of these bones or is it a cause of the asymmetry? The biochemical and nutritional aspects of scoliosis will remain controversial. There is enough scientific evidence to take preventative action in regards to children diagnosed with smaller curves prior to pubertal growth. A simple plan to check melatonin and selenium levels is recommended. Since elevated selenium levels may be harmful it is best to have this checked for deficiency rather than supplementing as a precautionary step. Melatonin is a bit tricky since it has a fluctuating level depending on awake and sleep cycles but since it is relatively benign in excess a preventative strategy in children diagnosed pre puberty is a good idea. Simple things like not sleeping with the lights on or watching too much television also influence melatonin level deficiency. There also is enough anecdotal evidence that supports a healthy diet for children with scoliosis. Kids should avoid high fructose corn syrup, high fat foods, and simply eat more whole grains, fruits, and veggies. References 1. Brzezinski A: Melatonin in humans. N Engl J Med 1997, 336:186-194. PubMed Abstract | Publisher Full Text 2. Machida M, Dubousset J, Imamura Y, Miyashita Y, Yamada T, Kimura J: Melatonin: A possible role in pathogenesis of adolescent idiopathic scoliosis. Spine 1996, 21:1147-1152. PubMed Abstract | Publisher Full Text 3. Changes of Selenium, Copper, and Zinc Content in Hair and Serum of Patients with Idiopathic Scoliosis DASTYCH M. ; CIENCIALA J. ; KRBEC M. 4. Binding of 3H-melatonin to calmodulin. Benítez-King G, Huerto-Delgadillo L, Antón-Tay F. Instituto Mexicano de Psiquiatría, Departamento de Neurofarmacología, D.F.
Posted on: Wed, 19 Nov 2014 20:34:00 +0000
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