Nutritional Support for the Musculoskeletal Practice, Part II

In part one (January 26, 1998 issue of DC) we reviewed the key ingredients and dosing advice for natural anti-inflammatory and antispasmodic formulas. This month we will conclude by focusing on the other three key formulas for the musculoskeletal practitioner.

Osteoarthritis Formulas

An osteoarthritis formula should contain glucosamine at levels equal to those that have been found effective in research studies. The most studied form of glucosamine is the sulfate form. Glucosamine hydrochloride can also work. Formulas that contain N-acetyl glucosamine should be reserved for patients with intestinal problems, because N-acetyl glucosamine is scavenged by the gut and does not appear to have the antiarthritic effect of the other forms. Support nutrients in arthritis formulas will vary.

Tips on Using Arthritis Formulas:

• Average size patients should consume 1,500 mg of glucosamine sulfate a day for six to eight weeks.


• To help with compliance, purchase those brands that will total 1,500 mg using only two or three capsules per day.


• For patients over 200 pounds, I recommend dosing glucosamine at the rate of 10 mg per pound.


• After six or eight weeks, you may either discontinue glucosamine completely or reduce the dose to approximately 3 mg per pound of body weight. I will let the patient decide.


• If a patient has gastrointestinal problems using a glucosamine formula, change brands. Because formulas and manufacturing processes differ so much, some people will be intolerant to a supplement from one brand, never realizing that they would be able to easily tolerate a preparation from a different company.

Bone Building Formulas

As our population ages, chiropractors are seeing more patients with osteoporosis. Many of your patients will take one-pill-a-day multivitamins that contain the RDA of some of the vitamins, but very small amounts of the macrominerals calcium and magnesium. Thus, a bone building formula will be one that may be utilized often. Calcium, magnesium, and vitamin D are the hallmark ingredients for a bone building formula. Trace minerals boron and silicon can help osseous mineral uptake and are often not in multivitamin preparations. If a patient is not taking a multivitamin, look for formulas that also include zinc, copper, manganese, and vitamin K.

Tips on Bone Building Formulas:

• Daily totals (adding multivitamin to the bone building formula or bone building formula alone):

Calcium: 800-1500 mg per day
Magnesium: 300-600 mg per day
Vitamin D: 200-600 IU per day

• Dose calcium and magnesium formulas twice per day, because many people will not efficiently digest and assimilate more than 500-700 mg of calcium at one time.


• Choose formulas that have more than one type of calcium (because our digestive systems differ).


• Choose brands that minimize the amount of tablets or capsules a patient must consume each day to get the required amounts (the greater the number of pills the average person has to take, the greater the chance of poor compliance).


• The large range in dose recommendations (800-1500 mg of calcium per day) is due to many factors, including current status of the patient, family history, diet, and age.


• Bone building formulas are not just for geriatrics. In my practice, every female over the age of 12 is evaluated. Those who do not have an adequate mineral intake (and there are many) are strongly urged to start a lifetime program.

Basic Injury Support Formulas

The key ingredients of a basic injury support formula should include vitamin B6, vitamin C, bioflavonoids, magnesium, zinc, copper, and manganese. A basic injury formula is best utilized for patients who do not take vitamins at all, or are taking a low potency one-pill-a-day multivitamin and enter your office with a significant injury. Patients with strong pack-type multivitamin and mineral formulas may not need this type of supplement. Your goal is to prevent any deficiencies (frank or subclinical) and insure there is an adequate nutrient pool present for your patients to synthesize, repair, and regenerate their tissues.

Tips on Basic Injury Support Formulas:

• Recommended for any injury that takes longer than two weeks of active care.


• Rough dosing guidelines for basic injury support formulas are as follows. Dose depending on frequency of treatment. That is, when the patients are in more acute stages, they will require more support. If a patient has a complaint that is requiring three or more visits per week, my rule of thumb is that the injury support formula should be dosed with each meal. As the patient's symptoms subside and treatment is reduced to two times per week, supplementation can also be reduced to twice a day, and then once a day as their symptoms recede to a point where they only require one treatment per week.


• When the patient is asymptomatic and discharged, it is a good idea to recommend continued supplementation one time per day with food for 4-12 weeks. The length of continued supplementation depends on the nature and extent of the injury. It is well known that when patients are asymptomatic and able to perform all activities of normal daily living without pain or discomfort, cellular remodeling and repair after significant trauma will continue for weeks and months.

Once you are comfortable utilizing nutritional support for your musculoskeletal patients, it will be easier to expand nutritional supplements into problems that are unique to your practice.

G. Douglas Andersen, DC, DACBSP, CCN, DACBN
Brea, California