营养与您的脊柱
营养与您的脊柱患者指南
How can you get enough vitamin D to ensure good body and bone health? Sunlight will produce vitamin D in your skin. Exposure of the skin to sunlight for five to 30 minutes between 10 am and 3 pm (in most geographical locations) twice a week is usually enough to make your own Vitamin D. As you get older, your capacity to produce vitamin D from sunshine slows down.
怎样才能获得足够的维生素D来保证良好的身体和骨骼健康？阳光会在你的皮肤产生维生素D。上午10点到下午3点，每周2次，每次5－30分钟让皮肤接受阳光照射，通常就足够制造自己的维生素D。当年龄增大，通过光照来制造维生素D的能力就慢慢减弱。
Diet may aid you but not with natural foods. Except for cod liver oil and some types of fish (salmon, tuna, mackerel, sardines), vitamin D is not found in what we eat. Only foods that have been fortified with vitamin D (e.g., milk, cereal, yogurt, orange juice) have any significant amounts of this vitamin.
饮食能够帮助我们，但并不是通常的食物。除了鱼肝油和某些种类的鱼（三文鱼、金枪鱼、鲭鱼、沙丁鱼），在我们的食物中没有发现维生素D。只有那些强化了维生素D的食物中，比如牛奶、麦片、酸奶、橙汁，这个维生素才有显著含量。
A very low fat diet will make it harder for you to absorb vitamin D from your food. Lack of sunshine and limited consumption of foods fortified with Vitamin D may mean you need to take a nutritional Vitamin D supplement. Your physician will help you decide what kind and how much to take for your age, health, and risk factors. Vitamin D supplementation may be based on current levels of vitamin D in your blood.
非常低脂肪含量的饮食使你很难从食物中吸收维生素D。缺乏光照和维生素D强化的食物摄入不足可能意味着你需要补充营养的维生素D。你的医生会根据你的年龄、健康状况和风险因子来决定你选择哪种和补充多少。维生素D的补充可能需要根据你当前血液中维生素D的水平。
You may be someone who does not rebuild bone as quickly as you lose it. Nutritional deficiencies can make this problem worse. Caffeine-containing drinks like coffee and colas will cause increased loss of calcium through the urine. Cola drinks with high levels of phosphorus also disrupt calcium metabolism and healthy bones.
有些人重新建造骨骼的速度没有骨丢失快，营养不足使这个问题更为严重。含咖啡因的饮料如咖啡和可乐会导致从尿液中钙流失增加。可乐类饮料含有较高水平的磷也破坏钙的代谢，并影响骨骼健康。
Magnesium is as essential as calcium for strong bones. As much as 50 per cent of your magnesium is found in your bones. Magnesium is required to move calcium into bone. Magnesium is also needed to make vitamin D active. A typical American diet contains much less than the recommended daily requirement for magnesium.
镁对骨骼健康与钙一样重要。人体50%的镁存在于骨骼中。钙转运到骨骼需要镁的参与。维生素D活化过程也需要镁。典型的美式饮食所含的镁所低于日常推荐量。
Magnesium is lost through the urine. This happens when people are stressed. Studies have shown something as common as loud noise levels will increase the loss of magnesium. Alcohol and many drugs used for heart disease and high blood pressure also cause magnesium loss. Bone repair calls for amounts of magnesium usually much higher than the recommended daily allowance.
镁通过尿液排出。当人们紧张时发生。研究表明有些例如象较大噪音这样的常见的事物会引起镁丢失增加。酒精和许多用于心脏病和高血压的药物也会引起镁的流失。骨修复时需要大量的镁，通常比日常推荐量要大得多。
L-lysine is an amino acid that you need to activate intestinal absorption of calcium. You will lose too much calcium through your kidneys if you do not have enough lysine. Lysine is an essential element for building the collagen framework. Minerals like calcium and magnesium weave into collagen to create bone.
L－赖氨酸是一种氨基酸，人类需要它来激活钙在肠道的吸收。如果没有足够的赖氨酸，肾脏中会排出许多钙。赖氨酸是建造胶原框架的基本要素。矿物质如钙和镁编织入胶原中形成骨骼。
You may need supplementation with these minerals, vitamins, and amino acids. This applies to you if you work indoors or don’t get out in the sun much. You are also at risk if you are elderly, or are a sedentary person who drinks a lot of coffee or cola drinks. If you do not digest well, or if you eat a very low fat diet, it may be important to use a good quality supplement to protect your bones.
你可能需要补充这些矿物质、维生素和氨基酸。如果你在室内工作或很少外出晒太阳，就很需要。如果你是老年人，或久坐不动，喝很多咖啡和可乐类饮料，也是高风险人群。如果你消化不良，或脂肪吃得很少，使用高质量的营养补充品来保护骨骼就很重要。
Specific nutritional factors that will increase your risk of pain and inflammation are
增加疼痛和炎症的特殊的营养因素：
· not enough omega 3 fatty acids from ocean fish
· not enough fruits and vegetables in the diet
· not enough vitamin D from sun exposure or fortified foods
· risk factors for vitamin D deficiency (e.g., older age, dark skin, use of sunscreen, obesity, kidney disease, liver disease, use of some medications, milk intolerant)
· not enough of the minerals potassium and magnesium
· not enough protein and high quality fat in the diet to control enzymes that produce inflammation
· too many sweets and starches in the diet, leading to weight gain and to excess insulin
· too many free radical ions from rancid and hydrogenated fats, low nutrient refined foods, chemical additives and residues
来自海鱼的Ω3脂肪酸不足
饮食中水果和蔬菜和水果不足
阳光照射少，强化维生素D的食物不足
维生素D缺乏的危险因素（比如老龄、黑色皮肤、使用防晒霜、肥胖、肾病、肝病、使用某些药物，牛奶不耐受等）
钾、镁等矿物质不足
蛋白质不足、食物中用于生成控制炎症的酶的高质量的脂肪不足
饮食中糖和淀粉过多，导致体重增加和胰岛素过多分泌
来源于酸败和氢化脂肪的自由基离子、低营养的精炼食物、化学添加剂和化学残留物过多。
营养和炎症
Inflammation is most often thought of as the redness, warmth, swelling, and pain that occur with an injury. The body responds this way whether it’s a surgical incision or a spider bite. Inflammation is also present in an infection like a strep throat or the achy, hot finger joints of rheumatoid .
炎症通常被认为是受伤后发生的红、肿、热、痛。无论是外科手术的切口，还是被蜘蛛咬了一口，人体都会发生这样的反应。炎症有时出现在感染的时候，如化脓性咽喉炎或类风温性关节炎疼痛、发热的指关节。
Wound healing and fighting infection are just some of the ways inflammation is activated. Inflammation is happening all the time in more or less obvious ways in your body. Medical science has begun to understand the connection between inflammation and most of the chronic degenerative diseases. Some of these diseases – like cancer, heart disease, or diabetes – develop quietly for many years before causing problems. We aren’t even aware they are present. Pain isn’t always a part of these diseases. People can be pain free even when a lot of tissue damage has occurred. Others conditions, like , gall bladder disease, or degenerative disc disease, make their presence known. Pain with these conditions can range from mild to unbearable.
伤口愈合和对症炎症只是一些炎症激活的的方式。炎症有人体中时常或多或少的发生。医学科学开始认识到炎症和许多慢性退行性疾病之间的关系。有些疾病，比如癌症、心脏病或糖尿病在引起症状以前悄悄地发展了许多年。我们甚至没有意识到它们的存在。疼痛并不总是这些疾病的一部分。有时人们甚至在大量组织损伤发生时也不感觉疼痛。有些疾病，如骨关节炎，胆囊疾病或退行性椎间盘病变，则表现得很明显，这些疾病中疼痛程度从轻度到难以忍受。
These conditions all have one thing in common. The tissues of the body parts involved are inflamed. The process of inflammation depends on a number of different chemical elements. These are called inflammatory mediators. Chemical mediators are released from certain kinds of white blood cells. These white blood cells are part of our immune system. First they travel to a target area. Then they cause a series of reactions that create the tissue changes we refer to as inflammation. At first this process is actually a repair response to some sort of injury or insult to the tissue. Later, the inflammatory process can become chronic and the cause of further injury.
这些疾病都有一个共同点。受累身体部位的组织有炎症。炎症的过程取决于不同的化学元素。这些被称为炎症介质。化学介质释放某些类型的白细胞。这些白血细胞是我们免疫系统的一部分。首先，他们前往目标区域。然后他们引起的一系列组织变化的反应，我们将其称为炎症。起初，这个过程实际上是对某种组织损伤的修复反应。后来，炎症过程就可能转为慢性，造成进一步的损伤。
炎症与背痛
Healthy repair depends on good nutrition. Poor nutrition can lead to damaging inflammation in the joints of your spine. Inflammation causes the loss of the cellular framework that holds bone and connective tissues together. Studies show that some people with osteoarthritis have more rapid damage to their joints. This is because they have more inflammatory chemistry in their bodies.
健康的修复有赖于良好的营养。营养不良会导致脊柱关节的损伤性炎症反应。炎症反应引起将骨和结缔组织维系在一起的细胞框架的丢失。研究表明有些患骨关节炎的人关节损伤更快，这是因为他们体内有更多的的炎性化学物。
Back pain may or may not be present in people with bone or cartilage changes in their spine. For instance many people have x-ray images that show they have flat and bulging discs. Or they may have brittle bones. Yet they have no pain. It is inflammation that causes the tissue changes that create the sensation of pain.
当人们脊柱中的骨和软骨发生改变时可能会表现为背痛，也可能不会。例如有些人X线图像显示椎间盘变扁、膨出，或者他们可能骨质疏松，然而他们没有疼痛。是炎症导致组织变化，产生疼痛的感觉。
Inflammation stimulates the growth of new blood vessels in joint tissues. This growth process also causes new nerves to grow in areas around joint cartilage. Doctors think this new nerve growth may be why back pain goes along with inflammation. The increased tissue activity and the swelling that comes with inflammation can make the new nerves very sensitive. All of the steps in this inflammatory process (new blood vessel growth, new nerve growth) keep each other going in a never-ending cycle. Stopping inflammation will relieve pain and slow down joint damage.
炎症刺激关节组织中新血管的增生。这种增生过程也导致关节软骨周围新的神经增生。医生认为这种新的神经增生可能就是为什么背部疼痛伴随炎症出现。因为炎症使组织活性增加和肿胀使新生神经非常敏感。在这种炎症过程的所有步骤(新血管增生，新的神经增生)使彼此进入一个永无止境的循环。阻止炎症会减轻疼痛，减缓关节损伤。
背痛和肥胖
Abdominal obesity adds to spine problems in very important ways. Fat around your middle can cause strain on the muscles and ligaments that support your spine. The joints of your spine are especially vulnerable to daily wear and tear from lack of support.
腹部肥胖以很重要的方式增加了脊柱问题。人体中间的脂肪会导致支持脊柱的肌肉和韧带的紧张。脊柱如果缺乏支持，特别容易受到日常磨损和撕裂。
Most of us get fat by eating too much of the kind of starchy, refined foods that call up more insulin. Insulin will signal enzymes in your body. These enzymes increase levels of inflammatory cells. They also increase cholesterol and constrict (close down) blood vessels. All of these actions help increase the levels of pain you feel from all over your body.
我们大多数人长胖是因为吃太多的淀粉、精制的食物，刺激分泌更多的胰岛素。胰岛素在体内给酶一个信号。这些酶增加炎症细胞的水平。他们也会增加胆固醇和收缩（或关闭）血管。所有这些活动会增加你对疼痛的感觉。
Abdominal fat is made of the type of cells most active at making the kind of chemistry that causes damaging inflammation to all of your joints. The more belly fat you have, the more inflammatory chemistry you are making. Some lean people are also at risk.
组成腹部脂肪的细胞制造炎症化学物质最活跃，这些炎性介质会引起所有关节的损伤。腹部脂肪越多,你制造的炎症化学物质就越多。有些瘦弱的人也面临这样的风险。
损伤或手术后营养如何影响愈合？
Good circulation is needed to build and repair a surgical incision, injured bone, or connective tissue like cartilage and ligaments. Your blood vessels carry all the raw materials needed to maintain proper strength and function of your bone and connective tissues. Your blood vessels also carry away from these body parts all the waste material from normal wear and tear as well as from injuries. A diet that has too much starch and sweets, and not enough protein and healthy fats, will cause blood vessels to constrict. Then there is less blood flow to the areas that are injured and need repair.
重建和修复手术切口，受伤的骨头或结缔组织，如软骨和韧带，需要良好的血液循环。血管携带维持骨骼和结缔组织适当的强度和功能所需的所有原材料。你的血管也从身体的这些部位带走正常磨损撕裂和损伤的所有废弃物。饮食过多的淀粉和糖果，而不是足够的蛋白质和健康的脂脂，会引起血管收缩。因此流向需要修理的受伤区域的血液就更少了。
All of the chemical reactions that make up the work of growth and repair require good nutrition. Herbs, fruits, and vegetables contain the dietary sources of antiinflammatory chemistry needed for tissue healing. Plant foods have antioxidants that decrease the chemistry that triggers inflammation. This type of plant is called a flavonoid. Flavonoids are plants that have biologic and metabolic properties in the body. They also strengthen the healing process. They do this by knitting collagen fibers into tightly woven connective tissue. The result is well-knitted skin and blood vessels; dense bone; and strong, elastic ligaments and tendons.
生长和修复过程是由化学反应组成的，所有这些工作需要良好的营养。草本植物，水果和蔬菜含有组织愈合所需的食源性抗炎化学物质。植物食品含有抗氧化剂，可减少引发炎症的化学物质。这种类型的植物被称为类黄酮。类黄酮是体内有生理和代谢特性的植物。他们还能通过将胶原纤维紧密编织入结缔组织来促进愈合过程。结果皮肤和血管愈合紧密，骨骼致密，韧带和肌腱坚强有弹性。
What changes can you make to your diet and supplement choices if you have a spine condition?
如果你有脊柱病变，你可以对饮食和营养补充做出哪些改变?
It can be confusing to try to sort out what supplements to take. It’s not always easy to know what foods to eat or not eat to help with a spine-related problem. Different musculoskeletal conditions will have some different nutritional requirements. The form of each supplement will also be important, in terms of how useful it is for your condition.
想要选择什么样的营养补充，可能令人很困惑。对于脊柱相关性病变，往往难以知道哪些食物可吃，哪些不能吃。不同的肌肉骨骼的病变会有不同的营养需求。按照它对你的病变的作用，每种物质的补充形式也很重要。
For example, powdered nutrients in capsules or liquid forms are much more likely to be fully digested and absorbed. Tablets are often less expensive. But they don’t break down in many people’s digestive tracts.
例如，胶囊里的营养粉末或者液体的形式更容易被充分消化和吸收。片剂通常更便宜，但在许多人的消化道里往往难以分解。
Osteoporosis is an example of a spine-related condition with a clear link to nutritional status. Most people with osteoporosis will be advised to take at least a calcium/magnesium supplement. The best quality mineral supplements for osteoporosis are powdered and in the citrate form (for example, calcium citrate). Vitamin D should always be included in an osteoporosis formula.
骨质疏松症是脊柱相关疾病与营养状况之间密切相关的一个例子。大多数患有骨质疏松症的人被建议至少补充钙/镁。骨质疏松症矿物质补充剂被研成粉末和制成柠檬酸形式(例如，柠檬酸钙) 质量最好的。维生素D应该常规被包括在抗骨质疏松的配方里。
Inflammatory conditions benefit from antioxidant nutrients like vitamin E. It must be natural vitamin E, not synthetic. It should always have mixed tocopherols in order to be most effective. Any inflammatory condition can be improved with the addition of at least five fish meals a week. A good, pure fish oil supplement taken daily can also help.
Here are some changes you can make to improve your spine condition. Most people will notice results in less than two weeks by following these general rules
抗氧化营养素，例如维生素E，对炎症性病变有益。必须是天然维生素E，而不是合成的。为了达到最佳疗果，它应该与生育酚混合。每周至少5餐含有鱼肉对任何炎症病变都会有改善。每天补充高品质纯正的鱼油也很有帮助。想要改善脊柱病情，你可以做下面这些改变。通过遵守这些通用原则，大多数人不到2周就能观察到效果。
· Drink at least eight large glasses of water or herbal tea daily. Avoid fruit juices or other beverages with coloring and preservatives added.
This includes soda pop.
· Eliminate simple sugars. Get rid of sweets and starchy, refined white flour foods from your diet.
· Avoid packaged foods with added preservatives and colorings
· Take a high quality multiple vitamin/mineral supplements three times daily with each meal
· If you have any form of arthritis or any inflammatory condition, take a pure fish oil supplement. Most people are helped by one to three grams of combined omega 3 fatty acids daily. Look for EPA and DHA on the label.
· Add vitamin D3 to your supplements; make sure you are get 800 IU to 1000 IU daily. You may need more if you have a history of malabsorption (e.g., celiac disease, inflammatory bowel disease, cystic fibrosis, gastric bypass surgery)
每天喝8大玻璃杯水或草本茶。避免带色素或添加防腐剂的果汁和其他饮料，包括苏打汽水。
消除单糖。将糖果和淀粉、精制白面粉食物从饮食中去除。
避免含有防腐剂和色素的色装零食。
每天三次随每餐服用高质量的多种维生素和矿物质补充剂。
如果你有任何形式的关节炎或其他炎症性疾病，服用纯鱼油补充剂。每天摄入1－3克Ω3脂肪酸对许多人都有帮助。在标签里寻找EPA（二十碳五烯酸）和DHA（二十二碳六烯酸，脑黄金）
在补充剂里增加维生素D3。确保每天摄入800－1000IU。如果你有吸收障碍的病史（例如乳糜泻、炎症性肠病、囊肿性纤维化、胃分流术等），可能需要更多。
Long-term dietary changes can benefit your spine condition. If you are overweight, ask a health professional to help you lose weight, especially abdominal fat. Most people can do this safely by
长期饮食的改变有益于脊柱健康。如果超重，咨询专业健康人士来帮你减肥，尤其是腹部的脂肪。许多人按下列方法去做会很安全：
· eating fresh, raw, or steamed vegetables every day
· eating two or three pieces of fresh fruit every day
· eating five to seven fish meals a week
· eating three to six ounces of clean, lean beef, poultry, lamb, or game meat daily – eggs are also an excellent source of protein for most people
· using olive oil on salads and for cooking daily
· eating fresh nuts and seeds. Almonds, walnuts, and pumpkin seeds give us high quality, healthy fats
每天吃新鲜的、生的或清蒸的蔬菜
每天吃2－3个新鲜水果
每周吃5－7餐鱼肉
每天吃3－6盎司净瘦牛肉、禽肉、羔羊肉或野味。对于大多数人，蛋类也是很好的蛋白质来源。
每天使用橄榄油做色拉或烹调。
食用新鲜的坚果和种子。杏仁、核桃、南瓜子给我们高品质、健康的脂肪。
If you do not have a regular habit of exercise, invest in instruction with a professional who can teach you how to strengthen your muscles and protect your joints. Certain exercises will be very good for some spine conditions, and possibly harmful for others. An exercise professional is your best choice for guidance to design a safe, effective program just for your needs.
如果你没有定期运动的习惯，花钱找一个专业人士，来教你如何加强肌肉和保护关节。某些运动可能对一些脊柱疾病很好,但对其他疾病却可能有害。一个运动专业人士是你最好的选择，他可以专门为你设计一个安全、有效的计划。
多长时间能看到这些变化的效果?
Many people who change their diets see results right away. The difference in body pain levels can be noticed in a matter of days. Reducing inflammation by stopping the triggers that sweets and starches create can be felt very quickly. The effects of diet changes are even more when added to the supportive chemistry of antioxidants. Dietary supplements can encourage your healing even more dramatically.
许多人改变饮食习惯后很快就看到了效果。身体疼痛程度的差异将在几天之内被注意到。通过阻止糖类和淀粉所引发，很快能感觉到炎症反应的减少。当添加抗氧化的化学物质，饮食改变的效果就更加明显膳食补充剂能显著促进愈合过程。
It can take some months of steady supplementation to rebuild your tissues after illness or injury. It depends on how deficient you are in certain nutrients. It may take three to six months for to experience the benefits of a specific supplement program. This time frame may vary based on your condition. Your doctor can advise you about this.
For expert help to start a nutrition plan for your spine health, see a nutritionist or contact a licensed naturopathic physician. Specially trained nutritionists may be available in your area. Many registered dietitians and conventionally trained nutritionists are limited in their ability to give personalized attention to in-hospital patients. You may have to look for an independent practitioner with more advanced training. The ongoing support of a progressive nutritionist can help you start new, healthy habits that will become a permanent part of your daily life.
当生病或受伤以后，需要几个月稳定的补充来重建组织。这取决于你对某种营养物质的缺乏程度。要体验特定营养补充计划的好处需要3－6个月的时间。根据你的病情不同，这个时间范围有所不同。你的医生会给你建议。为了脊柱的健康，你想找一个专家来开始一个营养计划，你应该去找营养师或有认证的自然疗法医师。经过特殊训练的营养师可能对你适合。许多注册饮食学家和传统训练的营养学家对于住院病人提供个性化关注的能力有限。你可能必须去寻找经过更高级训练的有主见的执业医师。一个积极的营养学家的不断支持会帮助你开始全新健康的习惯，并成为你日常生活永久的一部分。
Naturopathic doctors (NDs) are also available to help patients develop healthier nutritional habits for the spine. Naturopathic physicians practice the art and science of natural health care. They are trained at accredited medical colleges. Partnerships between medical doctors and naturopathic physicians are becoming more common all over the U.S. and Canada.
对于帮助病人为脊柱而发展健康的营养习惯，自然疗法医师也很合适。自然疗法医师践行自然保健的艺术和科学。他们在可信任的医学院校里受训。医生和自然疗法医师之间成为合作伙伴在美国和加拿大变得相当普遍。
（胡佰文 译）
患者指南，图文并茂，
分门别类，构思巧妙。
深入浅出，中英对照，
医患携手，共同探讨。
能力有限，时间仓促，
错误难免，诚惶诚恐。
恳请各位，留言指导，
以利再版，更加周到。
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