Excerpt from “Pain Free 1-2-3: A Proven Program for Eliminating Chronic Pain Now!” By Jacob Teitelbaum, M.D

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The following excerpt is from Chapter 2, “Giving Your Body What it Needs to Heal Your Pain”

By Jacob Teitelbaum, M.D.

This chapter explains how to optimize nutritional support, get adequate sleep, and address hormonal deficiencies. Pain often will not go away until each area of the body’s need is adequately handled. For example, it may surprise you to know that nutritional and hormonal deficiencies and/or fungal infections (usually secondary to antibiotic use) can aggravate neuropathic or back pain. Because of this, it is a good idea for you to read this entire chapter, as I outline a simplified approach for making sure that all of the key principles for treating your pain are addressed. It is important not to forget that some simple general principles and lifestyle issues are critical to the treatment of chronic pain. For example, exercise daily for at least twenty minutes if you’re able. Swimming, walking, and yoga are good choices.

Optimizing Nutritional Support

The American diet is awful. In fact, it is often called the “standard American diet,” or SAD, and the initials are appropriate. The average American’s diet includes 150 pounds of added sugar per year, accounting for approximately 18 percent of caloric intake. Sugar suppresses your immune system and stimulates yeast overgrowth in your bowel. Yeast grows by fermenting sugar and says thank you for all this added sugar by making billions of baby yeasts.

Another dietary stress is white flour. Vitamins were discovered by a settler who went on sailing expeditions with Dutch explorers. He found that the colonists were becoming ill, yet the colony’s chickens were looking unusually healthy. Finding this to be curious, he began feeding the chickens’ food to the people. Over a period of several weeks, the people became stronger and healthier. He (incorrectly) named the chicken feed vital amines, meaning “vital proteins” and began selling it. The name was later shortened to vitamins.

Today, scientists understand what happened to those colonists. Polishing off the brown outer coat, or bran, from rice had become fashionable. The rice bran was then used as chicken feed. The bran, however, contains most of the vitamins and minerals. The colonists therefore quickly became nutritionally deficient, while the chickens flourished. In the United States, approximately 18 percent of calories come from white flour. However, white flour just like white rice, has had the bran removed and therefore is also significantly depleted of vitamins and minerals.

As you can see, from just the use of white flour and added sugar, Americans often reduce their vitamin and mineral intake by around 35 percent. Adding to this problem are the nutrients that are lost in the canning of vegetables and in the processing of foods, which can cause vitamin losses of up to 80 percent.

The Link Between Nutrient Deficiency, Diseases, and Chronic Pain

As Dr. S. B. Eaton noted in his study in the prestigious New England Journal of Medicine, “Physicians and nutritionists are increasingly convinced that the dietary habits adopted by Western society over the past one hundred years make an important etiologic [causative] contribution to coronary heart diseases [angina], hypertension, diabetes, and some types of cancer.” This is the same conclusion that was reached by the authors of Western Diseases: Their Emergence and Prevention by the Harvard University Press.

Just as nutritional deficiencies can cause these medical problems, not having adequate nutrients can cause pain and keep the pain from going away. The late Dr. Janet Travell, White House physician for Presidents John F. Kennedy and Lyndon B. Johnson, and professor emeritus of internal medicine at George Washington University, co-wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is acknowledged as the authoritative work on muscle pain. In one chapter alone, Dr. Travell and co-author Dr. David Simons referenced 317 studies showing that problems such as hormonal, vitamin, and mineral deficiencies can contribute to muscle disorders. Dr. Travell strongly encouraged me in my work, and my landmark study on effective pain management was dedicated to her memory.

Numerous other studies have shown that adequate amounts of vitamins and minerals, especially folic acid, zinc (found to be very low in people with fibromyalgia), and selenium, are critical for proper immune function – that is, for defense against infections. Vitamin A, beta carotene, vitamin B6, vitamin C, vitamin E, iron, and many other nutrients also have been found to be very important in keeping the body’s defenses strong.

Vitamin and Mineral Supplementation

Every vitamin and nutritional mineral, amino acid, and nutritional cofactor is very important in some way to health. The body depends on receiving vitamins and minerals from the diet because it cannot make them itself. If you are low in vitamins, minerals, and other nutrients, your pain simply will not go away!

For example, inositol; vitamins B1, B6, and B12; zinc; and antioxidants are critical for healing neuropathies (nerve pain). For muscle pain, magnesium, B vitamins, antioxidants, zinc, iodine, selenium, and malic acid are critical. In fact, each kind of pain has different nutrients that are important for its relief.

Although many excellent physicians use them, I do not recommend checking blood levels for most nutrients because the tests are often inaccurate, expensive, and/or unnecessary. I feel it is better and less expensive to simply use the vitamins. The exceptions would be iron and vitamin B12 levels. Let’s discuss some key nutrients in a bit more depth.

Iron is important because an iron level that is too low can cause pain, fatigue, poor immune function, cold intolerance, decreased thyroid function, and poor memory. Too high an iron level can cause arthritis, diabetes, inflammation, and even death. I routinely recommend that all my chronic pain patients have their iron level, total iron binding capacity (TIBC), and ferritin levels checked.

Even if a person’s iron level is suboptimal but still normal, that person will often feel fatigue and pain, despite test results saying that the person is not anemic. Significant iron deficiency symptoms can often occur with a low “normal” iron level. Because of this, anyone whose ferritin level is below 40, or whose percentage of saturation is less than 22 percent, should be given a trial treatment of iron therapy.

Vitamin B12

Vitamin B12 is another key nutrient. Technically, the B12 level is normal if it is over 208 picograms per deciliter (pg/dL) of blood. However, studies have shown that people can suffer severe and sometimes long-term nerve and brain dysfunction from B12 deficiency, even if their levels are as high as 300 pg/dL. Why are the “normal” levels set so low? In part, the normal values were initially set according to what prevents anemia. However, the needs of brains and nervous systems for vitamin B12 are often much higher than those of the bone marrow.

Also, as much as I hate to admit it, medical schools have greatly enjoyed poking fun at the old-time doctors who gave vitamin B12 shots for fatigue. The use B12 shots despite “normal” blood levels is considered almost a symbol of unscientific, archaic medicine. As noted in an editorial in the New England Journal of Medicine, however, current findings suggest that those old-time doctors may have been right. In addition, a recent study using the respected Framingham database showed the evidence of B12 deficiency occurs even with levels over 500 pg/dL. I suspect, though, that the modern medical establishment will be a little slow to eat crow.

It is no surprise, then, when their other problems are also treated, many people respond dramatically to B12 injections. In addition to fatigue, it can be very helpful for nerve pain, migraines, and other problems. If a patient’s B12 level is under 540 pg/mL, I treat that person with a 1 cc (1,000 to 3,000 microgram) injection of vitamin B12 one to five times week, for fifteen injections. These shots are very safe and fairly inexpensive.

Usually, if a patient is going to benefit from the shots, I see improvement by ten weeks. But if a patients feels worse when the injections are stopped, I resume giving the shots, usually giving one every one to five weeks (but as often to three to four times a week in some cases) for an extended period of time. Most people can maintain excellent B12 levels by taking 500 micrograms of B12.

Other B Vitamins

Vitamins B1, B2, B6, an dB12 have been found to be clinically effective in helping a number of chronic pain conditions, including low back pain, migraines, sciatica, trigeminal neuralgia, and diabetic neuropathy. Now researchers at the Parker Institute in Dallas have conducted a study suggesting that these vitamins may also help treat painful sprains, old fractures, burns, and bruises. The study suggests that B vitamins may possess the ability to block a certain type of pain receptor, especially in patients with neuropathic pain.


Magnesium is probably the single most important nutrient for pain relief. It is involved In hundreds of different functions and is routinely low in the American diet as a result of food processing. The average American diet supplies less than 300 mg of magnesium per day, while the average Asian diet supplies over 600 mg per day. I generally recommend taking 900 mg of malic acid and 150 to 200 mg of magnesium glycinate a day. If diarrhea and cramps are not a problem, you can take up to 500 mg of magnesium daily. If you get uncomfortable diarrhea from the magnesium, cut the dosage back and then slowly increase the dose as is comfortable.

If your body’s magnesium stores are low, your muscles will stay in spasm and your pain will not resolve. This is one of the reasons that taking magnesium is so critical. In addition, magnesium is important for your muscle and body strength and energy. Most of your magnesium is inside your cells, and the blood tests only measure the magnesium in your blood, making blood tests an unreliable measure. Almost everyone with pain should take magnesium, but if you have kidney failure, discuss your dosage and regimen with your physician.

Magnesium absorption is very difficult, which is why I like to use the glycinate form. Plain magnesium oxide is also available and is the most inexpensive form, but your body may not absorb it well. If you choose to take magnesium oxide, take 500 mg per day.

In addition to helping muscle pain when taken by mouth or intravenously, intravenous (and often oral) magnesium has other benefits as well. Two grams of intravenous magnesium given over two minutes will routinely knock out an acute migraine. In addition, it is very good for esophageal spasms and for preventing kidney stones.


Most people do not need calcium supplementation, and (as is the case with iron) taking it at the same time as a thyroid hormone will block the thyroid hormone’s absorption. Some people’s pain improves with taking calcium, and others get worse. In addition, calcium is best taken with meals to enhance absorption, and at night as it also helps sleep.

Most calcium tablets are made of calcium carbonate (chalk) and often will not dissolve in the stomach. They then go out in the stool, having done no good along the way. It is better to use chewable calcium or other forms of calcium such as calcium citrate or chelates, taking 500 to 600 mg at bedtime and perhaps the same amount at dinner. This is most important, however, in women over forty years old. Although calcium gets much attention in the treatment of osteoporosis, other nutrients are as, or more, important (see Chapter 6). In fact, countries with the highest calcium intakes often have the highest rates of osteoporosis.

Vitamins C and Vitamin D

In a study of 324 patients with arthritis of the knee, those taking over 200 mg a day of vitamin C had less pain than those taking smaller amounts. One epidemiologic study also suggested that taking vitamin C may prevent the development of pain and worsening of the arthritis as seen on x-ray.

Another problem is that people tend to get most of their vitamin D from exposure to sunlight, and unfortunately, most Americans have been misled into thinking that sunshine is bad for them. Most of the skin cancers that are caused by excess sun exposure are not especially dangerous and are easy to treat. Some doctors also think that the rise in dangerous skin cancers (melanomas) is also associated with excess sun exposure. I do not believe this is the case, as most melanomas occur in clothed areas that are not exposed to the sun.

As time goes on, I think we’ll find that the increase in this single type of dangerous skin cancer is largely caused by other factors besides sunshine. Dr. Michael Holick, director of the vitamin D research lab at Boston University Medical Center, thinks that “the current message that all unprotected sun exposure is bad for you is extreme…the original message was that people should limit their sun exposure, not that they should avoid the sun entirely. I do believe that some unprotected exposure to the sun is important for health.”

This is supported by evidence that vitamin D deficiency can contribute to many cancers including prostate, colon, and breast cancer. Dr. Holick feels that vitamin D deficiency can contribute to many cancers including prostate, colon, and breast cancer. Dr. Holick feels that vitamin D may also help protect against heart disease, autoimmune disease, and even type 1 diabetes.

For example, multiple sclerosis is mostly seen in northern latitudes where people get less sunshine. Now we are also finding that vitamin D deficiency may contribute to unexplained muscle and bone pain. In a study of 150 children and adults with unexplained muscle and bone pain, almost all were found to be deficient in vitamin D – with many being severely deficient with very low vitamin D levels.

The RDA (which I feel is often inadequate) for vitamin D is 200 to 400 IU/day for most people. One glass of fortified milk or orange juice has approximately 100 units of vitamin D, and most multivitamins have 400 units or less. To put it in perspective, a light-skinned person wearing a swimsuit at the beach will get about 20,000 units of vitamin D in the time it takes his or her skin to get lightly pink.


This nutrient is a double-edged sword. Because copper is pro-inflammatory, it can aggravate arthritis and many other inflammatory and autoimmune processes. On the other hand, copper deficiency can contribute to deficiencies of a critical antioxidant called superoxide dismutase. The bottom line is that it’s good to get just a tiny bit of copper. To be on the safe side, I recommend approximately 0.5 mg a day.

Essential Fatty Acids

Although we get excessive fat in the American diet, most of it is not the type our bodies need. Your body needs specific fats for proper hormonal and cell function. For example, the omega-3 fatty acids found in fish oils are anti-inflammatory and can be helpful in rheumatoid arthritis and other types of pain. As a fringe benefit, high intakes of fish oil are associated with a decreased risk of Alzheimer’s disease and cognitive impairment.

The preceding excerpt is reprinted with kind permission from Dr. Jacob Teitelbaum. Pain Free 1-2-3 by Jacob Teitelbaum, M.D., is published by McGraw Hill and will be available in February, 2006 – for more information and to purchase, please visit www.Vitality101.com.

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