By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 6 min read

Why ask about diet at all?

“What should I be eating?” is a fair question when your back hurts. The internet is full of confident claims about “anti-inflammatory” eating and diets that “fix” pain. The honest answer is more modest. Diet can help, mostly in indirect ways, and research on diet and back pain specifically is thin.

Here is what the evidence does and does not show.

Diet and chronic pain: what the research shows

The best summary we have is a 2021 systematic review that pulled together 43 studies of whole-food dietary changes in people with various types of chronic pain.^[1] The diets were a mixed bag: vegetarian and vegan diets, elimination diets, calorie restriction, an omega-3 focus and a small number of Mediterranean-style diets. Taken together, the review found an overall benefit of diet on pain, with no single diet standing out as better than the others.^[1]

That last point matters. The authors suggest that what these diets have in common, such as better overall diet quality, more nutrient-dense food and weight loss, may be doing the work rather than any one special ingredient.^[1] Many of the studies were small and not all of them were in back pain, so the results are encouraging rather than conclusive.

You will often read that a Mediterranean diet is “proven” to reduce inflammation and back pain. Only two of the groups in that review used a Mediterranean diet,^[1] so the direct evidence is limited. It is still a sensible, well-balanced way to eat, and there is no reason not to try it.

Body weight and back pain

Weight is where diet most clearly connects with back pain. A meta-analysis of 33 studies found that obesity was linked with more low back pain over the previous year, more chronic low back pain and more people seeking care for back pain.^[2] In the studies that followed people over time, obesity was also linked with developing new back pain.^[2]

An association is not proof that weight causes back pain, and plenty of slim people have bad backs. But extra weight adds load through the lower spine, and losing some often makes it easier to stay active. If you are carrying extra weight, gradual and sustainable weight loss is a reasonable goal. Crash diets are not.

Food for strong bones

The bones of your spine (the vertebrae) need a steady supply of calcium and vitamin D throughout life. Thin, weak bones (osteoporosis) can lead to vertebral fractures, which may cause pain, loss of height and a stooped posture.

Calcium

The NHS advises that adults need 700mg of calcium a day and that most people can get this from a varied diet.^[3] Good sources include milk, cheese and other dairy foods, green leafy vegetables such as kale and okra, soya drinks with added calcium, bread made with fortified flour, and fish where you eat the bones, such as sardines.^[3] Taking more than 1,500mg a day from supplements can cause stomach pain and diarrhoea.^[3]

Calcium tablets are often taken “just in case”. A large review in the BMJ found that higher calcium intake from food was not linked with fewer fractures in people over 50, and that the evidence for calcium supplements preventing fractures was weak and inconsistent.^[4] If you have been diagnosed with osteoporosis, follow the plan your doctor gives you, as calcium and vitamin D are sometimes prescribed alongside bone-protecting medicines.

Vitamin D

Vitamin D helps the body control calcium and phosphate. A lack of it can cause bone pain in adults from a condition called osteomalacia (soft bones).^[5] In the UK we make very little vitamin D from sunlight between October and early March, so the NHS advises everyone to consider a daily 10 microgram (400 IU) supplement in autumn and winter, and all year round if you rarely go outside, live in a care home, cover most of your skin outdoors or have dark skin.^[5] Adults should not take more than 100 micrograms (4,000 IU) a day unless a doctor advises it.^[5]

Protein

Protein supports muscle and bone, and there has been a fashion for high-protein eating. A review covering 40 years of research found little benefit for bone health from increasing protein in healthy adults, but also no sign of harm, at the intakes studied (roughly 0.8 to 1.3g per kilo of body weight a day).^[6] In practice, most people in the UK get enough. Older adults with small appetites, people who are unwell and anyone losing weight quickly may need to pay more attention to it.

A realistic plan

You do not need a special diet. Small, steady changes are easier to keep up.

• Base meals on vegetables, fruit, pulses, wholegrains, nuts and olive oil, with fish a couple of times a week. This is close to a Mediterranean pattern.
• Cut back on highly processed foods, sugary drinks and snacks. These make it easy to eat more calories than you need.
• Include a calcium-rich food at most meals, such as yoghurt, cheese, fortified plant milk, sardines or green vegetables.
• Take a 10 microgram vitamin D supplement from October to March, or all year if you are in a higher-risk group.
• Include some protein at each meal (eggs, fish, beans, lentils, dairy, meat or tofu), particularly if you are older.
• If you want to lose weight, aim for slow, steady loss and combine it with regular activity. Your GP can refer you to local weight management support.
• Drink plenty of water and keep alcohol within the UK low-risk guidelines.

Who should take extra care?

• People with osteoporosis or previous fragility fractures: your bone treatment plan comes first. Ask before stopping or adding supplements.
• People with kidney disease or kidney stones: check with your doctor before taking calcium or vitamin D supplements.
• People on several medicines: ask your pharmacist before adding supplements.

Where diet fits in

For most people, eating well is one part of looking after the spine, along with staying active, sleeping well and not smoking. It will not replace exercise or treatment for a specific problem such as a slipped disc or sciatica, but it supports your general health and your bones for the long term.

References

1. Field R, Pourkazemi F, Turton J, et al. Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Med. 2021;22(3):694-714. Link
2. Shiri R, et al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54. Link
3. NHS. Calcium: vitamins and minerals. NHS website. Link
4. Bolland MJ, et al. Calcium intake and risk of fracture: systematic review. BMJ. 2015;351:h4580. Link
5. NHS. Vitamin D: vitamins and minerals. NHS website. Link
6. Darling AL, et al. Dietary protein and bone health across the life-course: an updated systematic review and meta-analysis over 40 years. Osteoporos Int. 2019;30(4):741-761. Link

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP, physiotherapist or specialist before starting a new treatment.