Question: I am a new graduate and would like to add a nutritional component to my practice. I am confused where to start. A mailer from a practice builder recommended I sell algae, cassette tapes push colloidal minerals, and representatives call on me for vitamins, minerals, herbs, and homeopathics. Can you please give me some advice on where to start?
Answer: Even though you were drilled in school about being primary care, the fact is you will not see sore throats, fevers, stomachaches, lacerations, or infections on a regular basis. You will see acute and chronic articular and muscular pain. Thus, I recommend you target your nutritional products on the conditions that will make up the majority of your practice. When you feel comfortable with neuromusculoskeletal nutritional support, it is likely you will begin to get referrals for other nutritional conditions. You can expand to those areas you feel comfortable managing, with substances supported by the literature.
The following are the types of formulas and the key ingredients you should look for. No two companies have the exact same formula and accessory nutrients will vary:
A: Regular readers of this column know we have discussed this topic in depth numerous times. To make a long story short, proteolytic enzymes will work best when you (1) give enterically coated preparations on an empty stomach; (2) begin as soon as possible following trauma (first three days, and continue for three to seven days); (3) dose at least four times a day in amounts high enough that will loosen the stool; when stool becomes loose, reduce the dose 25% and maintain; (4) use preparations with vegetable and animal sources. Multiple enzymes have a wider spectrum of activity than single enzymes. Thus, I prefer products that contain more than one type of enzyme.
The downside to proteolytic enzymes is the lack of standardization concerning units of activity. Unfortunately, there is no one uniform unit of measurement of activity in enzymes. Furthermore, many products do not list activity, but instead list the weight of the product, which means nothing. I recommend that you call the manufacturers and ask for a technical adviser (usually a DC, MD, ND, or PhD) to give you specific information on dosing to reduce inflammation. Due to FDA regulations, the amount of proteolytic enzymes needed to reduce inflammation is substantially greater than the directions printed on the label. To have success with proteolytic enzymes, be prepared to dose two to five tablets every one to four hours, depending on the nature and extent of the trauma as well as the size of the patient.
Q: Do you have any dietary advice you give patients with injuries?
A: Yes, and you don't have to be a chiropractic nutritionist to help your patients nutritionally when they are injured. I recommend the following for the average injured patient:
A: Glucosamine is a micronutrient that stimulates the synthesis and repair of connective tissue. In European studies it has reduced pain and degeneration in animals and humans with osteoarthritis. Theoretically, it should also be beneficial for sprain-strain and disc injuries, although I have not seen any human studies in this area yet.
There are three types of glucosamine: glucosamine sulfate, glucosamine hydrochloride, and N-acetyl glucosamine. Glucosamine sulfate and glucosamine hydrochloride are the forms that will stimulate connective tissue repair. N-acetyl glucosamine is used by cells in the gastrointestinal tract. It can be quite helpful for stomach and intestinal disorders, but is not effective for musculoskeletal conditions.
All the studies on glucosamine used at least 1500 mg a day for six to eight weeks in arthritic patients. There are a lot of new products on the market boasting that they contain glucosamine. When you read the fine print, you may see amounts in the 20 to 100mg range per tablet. This is called nutritional fluff. The salesperson will tell you the other ingredients in the formula are synergistic, so you do not need as much glucosamine (which is expensive). When this happens, ask the representative to give you copies of the studies on their products that were published in reputable journals.
Finally, many of the patients you encounter will be on nonsteroidal, anti-inflammatory drugs (NSAIDs). When a person is uncomfortable, NSAIDs can significantly reduce pain. NSAIDs also have negative side effects such as gastrointestinal irritation. A lesser known side effect of NSAIDs is (in animal studies) the inhibition of collagen and glycosaminoglycan (GAG) synthesis. Even though a patient will feel better, they will be healing slower. Glucosamine can reverse NSAIDs' inhibition of GAG and collagen synthesis, and thus is recommended for patients who regularly take medications in this family.
Q: What is your favorite product for overall good health?
A: I like to see patients eat two kinds of fruit and consume six servings of vegetables from the dark green leaf, cruciferous, and red, orange, yellow families each day. A serving size is approximately a half cup of a chopped or grated vegetable. You can easily consume six to eight servings of vegetables in one sitting by simply having a large salad.
G. Douglas Andersen, DC, DACBSP, CCN
Brea, California
DC
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
