Diet and Chronic Pain: Does Sugar Cause Back Pain?
Can diet cause back pain? Research can't say that yet, but it points somewhere. In a national survey of 4,123 US adults, people with chronic spinal pain ate about as many calories as everyone else but a poorer-quality diet, with more added sugar. In reviews of studies where people with chronic pain of many kinds changed what they ate, pain scores went down overall. Dr. Jeff counts what we eat among the "three T's" that get in the way of good health, and this post goes through what the studies found.
Can diet cause back pain? The short answer
- Diet quality and spinal pain go together. In the US survey, people in the top third for diet quality had 24% lower odds of reporting chronic spinal pain than people in the bottom third, after allowing for weight, activity and calories.
- Added sugar stood out. People in the middle and top thirds for added sugar had 46% and 41% higher odds of chronic spinal pain than people who ate the least.
- Changing diet has reduced pain in studies. A 2021 review of 43 studies of whole-food diet changes in people with chronic pain, not only back pain, found pain went down overall, and no single diet stood out.
- We can talk it through at your visit. Nutritional counseling is part of the supportive care we offer when it fits your plan.
If pain has been hanging on, you can book a first visit or call us at (931) 591-3740, or read on for what the studies found.
Dr. Jeff on toxins, diet and chronic pain
Jeffrey T. Morrey, D.C., recorded this video on the second of his three T's. On screen is a Google AI answer to his search, and some of its details don't match the papers it summarizes, so the figures in this post come from the published studies. His comparison of a poor diet with sugar and cavities is his view as a chiropractor; the studies cited here don't measure it in people.
Video: toxins, diet and chronic pain (3 min 49 s)
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Watch on YouTube (new tab) ↗Questions about diet and your pain? Book a first visit or call us at (931) 591-3740.
Does diet affect back pain?
A 2020 study in Pain Reports used the National Health and Nutrition Examination Survey, a US government survey designed to represent the whole country. It covered 4,123 adults aged 20 to 69. Each described what they'd eaten over two separate days, and the researchers scored their diets on the Healthy Eating Index, the federal measure of how closely a diet follows the dietary guidelines. People counted as having chronic spinal pain if they had pain, aching or stiffness along the neck, back or hip almost every day for at least six weeks, and it never completely went away. 800 of them, about 1 in 5, did.
People with chronic spinal pain ate about the same number of calories as people without it, but a poorer-quality diet: less fruit, whole grain, dairy and protein, and more sodium, saturated fat and added sugar. After allowing for age, sex, race, weight, activity, calories and pain medication, people in the top third for overall diet quality had 24% lower odds of chronic spinal pain than the bottom third. Eating more fruit also went with lower odds.
Does sugar cause back pain?
The same survey can't say sugar causes it, but added sugar was the part of the diet that stood out:
| Added sugar, compared with the bottom third | Odds of chronic spinal pain |
|---|---|
| Middle third | 46% higher |
| Top third | 41% higher |
The link showed up at levels below the federal limit of the time, 10% of daily calories. The current guidelines recommend no added sugar at all.
What it can't show. It's a snapshot, so it can't tell which came first. The authors note it's unclear whether a poor diet leads to pain, pain leads to a poorer diet, or both. Pain was self-reported rather than diagnosed, and two days of food recall is a rough measure of how someone usually eats.
Can changing your diet reduce pain?
Studies that changed what people ate point to yes. A 2021 review in Pain Medicine gathered 43 studies of people with chronic pain of many kinds who switched to a whole-food diet of one sort or another. Pooling 25 of the groups showed pain went down, whether the studies were grouped by diet or by type of pain, and no single diet came out ahead. The authors suggest that what the diets have in common, such as better diet quality, more nutrients for the calories and weight loss, may be part of why.
An earlier review of 71 studies found changing the overall diet reduced pain in 12 of 16 studies that tried it.
What are AGEs, and do they affect your spine?
AGEs, short for advanced glycation end products, are compounds that come up on screen in Dr. Jeff's video. They build up in the body's tissues with high blood sugar, or from eating food processed at high heat.
Spinal discs are rich in collagen and have a slow metabolism, which researchers say makes them particularly prone to collecting AGEs. A 2018 study in mice tested whether AGEs from food actually reach them. Mice raised on a high-AGE diet had AGEs build up in their discs, and the discs became stiffer, with more crosslinking in their outer ring, mainly in females. The authors conclude that a high-AGE diet can be a source of the crosslinking and collagen damage known to matter in disc degeneration. That's in mice, and it measured the discs, not pain.
Observational research also links diabetes, where high blood sugar speeds AGE build-up, with spinal pain. A 2026 review in Chiropractic & Manual Therapies found people with diabetes had 1.44 times the odds of reporting low back pain and 1.42 times the odds of reporting spinal pain. In the studies that followed people over time, diabetes went with developing spinal pain, though not significantly with developing low back pain. Those studies show a link with diabetes, not with diet.
If your back or neck has been sore for a while, a first visit is where we look at what's behind it: book online or call us at (931) 591-3740.
What does Dr. Jeff mean by toxins?
"Toxins" is chiropractic's traditional word, and in this video Dr. Jeff uses it for what we eat: sugary drinks like sweet tea, processed food, junk food and a diet high in saturated fat. In this video it means everyday food, not a detox or a special product, and he's clear it doesn't mean having a perfect diet.
Which foods should I cut back on?
The federal Dietary Guidelines for Americans, 2025-2030 cover much of the same ground as Dr. Jeff. The guidelines advise:
- Avoiding sugar-sweetened drinks, such as sodas, fruit drinks and energy drinks. Sweet tea counts, because its sugar is added.
- Avoiding highly processed foods that are salty or sweet, like chips, cookies and candy, and favoring home-prepared meals.
- Cutting back on refined carbohydrates, including white bread and ready-to-eat or packaged breakfast options. That's where Dr. Jeff's point about breakfast cereal fits.
- Keeping saturated fat, in general, to no more than 10% of daily calories.
The guidelines' emphasis is whole foods: protein, dairy, vegetables, fruits, healthy fats and whole grains. If you have diabetes, kidney disease or another condition that affects what you can eat, plan changes with your doctor or a registered dietitian.
Dr. Jeff's take: toxins, the second of the three T's
This video completes the series that started with his PACBACK walk-through: the "three T's" of thoughts, toxins and traumas, an idea he traces back to chiropractic's founders. He took thoughts, meaning stress, first, and traumas, with desk sitting as his example, next.
For him, these are the things that "get in the way of you having good health." He knows how much of what we eat comes from family traditions, so his advice is to start tweaking those habits; it doesn't have to be perfect. And he invites the conversation: "If you come in, you want to talk about it, feel free to ask me. I'll sit down, go through it."
Talking about diet at your visit
A first visit starts with your history and an exam, and we tell you what we find before we recommend anything. Depending on what we find, care can include adjustments and exercises to keep up between visits. Nutritional counseling is part of the supportive care we offer when it fits your overall plan, alongside the other things outside the office that affect your pain, like stress, how much you move and your posture.
Some back pain needs emergency care first, including back pain with difficulty passing urine or any other new change in bladder or bowel control, numbness in the area that would touch a saddle, or a leg that's getting weaker. See all the warning signs.
Book a visit
Whether it's your back, your neck or somewhere else, a first visit in Clarksville is where we start working out what's behind your pain and what you can change, at the table and in the office. We'll tell you what we find, including when it isn't something we treat. If we are not able to help you with your problem or are unable to reduce your pain levels, we will make sure to give you a recommendation to another experienced provider.
Book your first visit or call us at (931) 591-3740.
Research, with context.
Selected published sources behind what we've written, each with what it found and what it can't tell us. We give you both halves because no paper can diagnose you or predict how your own care will go.
Association of chronic spinal pain with diet quality
4,123 US adults aged 20 to 69 in the 2009-2010 National Health and Nutrition Examination Survey (NHANES), 800 of whom reported pain, aching or stiffness along the neck, back or hip almost every day for at least six weeks that never completely went away.
What it foundPeople with chronic spinal pain ate about as many calories as people without it but had a poorer-quality diet. After adjustment, people in the top third for diet quality had 24% lower odds of reporting chronic spinal pain than the bottom third, and more fruit went with lower odds. In the Results, people in the middle and top thirds for added sugar had 46% and 41% higher odds than the bottom third; the abstract gives 49%, which does not match.
What it can't tell usA one-time snapshot from two 24-hour food recalls and self-reported pain, so it can't show whether poor diet leads to pain or pain leads to a poorer diet.
Publication details & citation
Zick et al. Association of chronic spinal pain with diet quality. Pain Reports. 2020. DOI: 10.1097/PR9.0000000000000837.
Read the publication recordDietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis
43 studies of 48 groups of people with chronic pain given a whole-food diet change, including elimination, vegetarian or vegan, single-food, calorie-restriction, omega-3 and Mediterranean diets.
What it foundA meta-analysis of 25 groups found diet changes reduced pain, whether grouped by diet type or by pain condition, with no single diet standing out. 17 groups reported an improvement of at least two points, or 33%, on a pain scale.
What it can't tell usThe studies included uncontrolled before-and-after designs and case reports as well as controlled trials, and the diets and pain conditions varied widely. The authors suggest shared factors such as diet quality and weight loss rather than one diet.
Publication details & citation
Field et al. Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Medicine. 2021. DOI: 10.1093/pm/pnaa378.
Read the publication recordA systematic review and meta-analysis of nutrition interventions for chronic noncancer pain
71 studies of adults with a chronic pain condition given a nutrition intervention, 23 of them pooled.
What it foundChanging the overall diet reduced reported pain in 12 of 16 studies, against 11 of 46 for supplements. Overall, nutrition interventions had a significant effect on pain, with changes to the whole diet or to one nutrient having the greatest effect.
What it can't tell usThe interventions and pain conditions differed widely, and only a third of the studies could be pooled.
Publication details & citation
Brain et al. A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain. Journal of Human Nutrition and Dietetics. 2019. DOI: 10.1111/jhn.12601.
Read the publication recordDietary advanced glycation end-product consumption leads to mechanical stiffening of murine intervertebral discs
Mice bred for at least three generations on a high-AGE or low-AGE diet and studied at 6 months of age.
What it foundThe high-AGE diet led to AGE build-up in the spinal discs, stiffer discs and more AGE crosslinking in their outer ring, mainly in females. The authors conclude high-AGE diets can be a source of the crosslinking and collagen damage known to matter in disc degeneration.
What it can't tell usA study in mice. It measured disc stiffness and structure, not pain, and doesn't show the same happens in people.
Publication details & citation
Krishnamoorthy et al. Dietary advanced glycation end-product consumption leads to mechanical stiffening of murine intervertebral discs. Disease Models & Mechanisms. 2018. DOI: 10.1242/dmm.036012.
Read the publication recordIs there an association between diabetes and neck and back pain? An updated systematic review with meta-analyses
15 observational studies from 2017 to 2025, 11 of them pooled, comparing adults with and without diabetes.
What it foundPeople with diabetes had 1.44 times the odds of reporting low back pain (592,901 people) and 1.42 times the odds of reporting spinal pain. In studies that followed people over time, diabetes went with 1.27 times the odds of developing spinal pain, but not significantly with developing low back pain.
What it can't tell usObservational studies, so they show a link rather than a cause, and the review didn't look at diet.
Publication details & citation
Dale et al. Is there an association between diabetes and neck and back pain? An updated systematic review with meta-analyses. Chiropractic & Manual Therapies. 2026. DOI: 10.1186/s12998-026-00650-2.
Read the publication record
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