The past few years have been an interesting, sometimes surprising, transition for not only our nation's economy, but also for the chiropractic entrepreneur. The old proverb, "May you live in interesting times" is reputed to have a dual meaning, one being a curse, the other a blessing. We indeed are living – and practicing – in interesting times. And the advantage lies with those who choose to see today's practice as an opportunity.
While at Parker in Las Vegas this past January my business partner Dan SwinDell and I coined the term "nutritionally enhanced chiropractic adjustment". As a Gonstead diplomate for 22 years I very much understand and appreciate the value of a specific adjustment. These many years of practice have also revealed a frustration in the net effect, the long term results ideally sought after. I have realized that if the cellular matrix comprising the intervertebral disc and supporting ligaments and tissue is not provided optimal nutrition and circulation, the best, most specific adjustment in the world will not have an optimal effect. In fact far less than optimal is the norm.
Having been in practice now for over twenty-five years, it is increasingly evident that the "good 'ole days" of simple insurance and relaxed practice methods are gone. New and productive ways to increase our service level, provide increasingly higher levels of value for these services are demanded; yet now more than ever it is prudent to keep a sharp eye on financial 'bottom line' of your chiropractic office.
Understanding the Application of Nutrition
The appropriate application of nutrition in chiropractic practice can be a challenge to understand, let alone integrate successfully. The easy route is to rely on the catalogs of the nutritional and vitamin companies. We can portray to our patients that we offer nutrition as part of our patient wellness program, however the slippery slope is finding that we have been reduced to another expression of the allopathic model.
We perceive or even go as far as to "diagnose" a nutritionally-related malady and then let the catalog do the prescribing. More rewarding is taking the time to do the research, whether through formal education in pursuing a nutritional certification or via the route of individual research and education. I have found that the latter was necessary for me to truly understand the prominent role that holistic nutrition plays in enhancing the level of wellness of my practice clients.
I was educated in chiropractic much like others in our profession. Nutrition was definitely not the primary focus, nor did it follow in a close second. While our holistic focus made it easier to absorb and embrace nutritional concepts at a level exceeding most allopathic educational programs, the level of understanding at graduation remained rudimentary at best.
The increasingly sophisticated purchaser of chiropractic services is seeking a more complete answer for their personal health and wellness. While chiropractic can, and I believe should, be at the core of what we as chiropractors offer, a deeper understanding of function is also needed. Exercise, nutrition, other life-balance issues and successful integration of diverse wellness modalities all play a part in the complete wellness picture for the patient. In this article I would like to expand on the nutritional component, most specifically on the subject of nitric oxide precursors and effective antioxidants.
Nitric Oxide
In February of 2011 Bob Anderson, MD and I co-wrote and presented an article for The American Chiropractor discussing the L-arginine nitric oxide precursor and the result of the 1998 Nobel Prize for Physiology or Medicine.1 Since that article was published, my understanding and awareness of not only the impact of nitric oxide on whole body wellness greatly increased, but also the delivery methods of nitric oxide and the vital importance of effective antioxidant support and the role of exercise in the physiological pathways.
While the subluxation is inarguably our primary focus and the life-limiting effects of subluxation apparent to all of us, I find it increasingly difficult to distance myself professionally from the equally harmful effects of what is termed "metabolic syndrome". This collection of clinical risk factors may include hypertension, obesity, hyperglycemia, dyslipidemia, insulin resistance and other high risk indicators, depending on the author and study.2,3
Our patients are by and large ignorant of the causal factors of most of their ill-health.
They might hear that it is good to eat higher amounts of foods containing Omega 3's, yet not understand that it is not so much the presence of the Omega 3's but the over-abundance of Omega 6's that is the real culprit. They might be ingesting large amounts of "good" vitamins and essential metabolic precursors, yet not understand that the lack of regular exercise can significantly negate any net health benefit. This lack of understanding can and does result in very real and quite severe health implications later in life.
And here is another factor…at the risk of a heretical statement…the best adjustment in the world will not provide the nutritional elements and benefits that they need to live their life to the fullest. Mindful supplementation and diet modification for the chiropractic health consumer is key for realizing a complete wellness model.
We can expand our patient's awareness and improve the financial viability of our practice by introducing the patient to a more profound understanding of relevant nutrition.
[pb]There are currently over 117,000 articles and research papers written on the benefits of adequate levels of nitric oxide since the Nobel Prize was awarded in 1998. The scientific community is encouraged by the expanding understanding of how this simple molecule can significantly reduce the risk factors of cardiovascular disease, stroke, diabetes and a host of other disorders. While the significant benefit of this science was economically detoured into the male enhancement drug industry, the holistic benefits of nitric oxide are now available to the consumer as never before.
Food and Supplementation
Though high risk factors such as diabetes, obesity, atherosclerosis and high cholesterol interfere with the endothelial production of nitric oxide, the parallel synthesis pathway utilizing nitrates and nitrites from nitrogen-based food nutrients can provide the necessary nitric oxide.
This combined with supplementation of powerful antioxidants can provide the body with the net nitric oxide effect it needs to provide optimal cardiovascular and immune wellness. Water soluble antioxidants such as those found in fruits and vegetables mitigate the scavenging effect on nitric oxide by powerful free radicals such as superoxide and peroxynitrite.
Fat soluble antioxidants, especially the desmethyl tocotrienol fractions of Vitamin E, assist significantly in reducing the effects of oxidative stress and allow for a more enhanced cardio and immuno-protective effect of increased nitric oxide production.4,5
For many years virtually all of the research surrounding the potential benefits of Vitamin E were centered around the tocopherol isomers of Vitamin E, primarily the alpha isoform. More recent studies have re-visited these studies with Vitamin E stripped of tocopherol finding that it is indeed the tocotrienol fractions, primarily the delta and gamma forms, that provide the greatest health benefits. These tocotrienol fractions, with greatly increased bio-action and benefit due to increased numbers of double bonds, are now understood to be associated with decreasing the viability of cancer cells, increased immune function, cardio-protective benefits and others.6,7
Therefore the best approach is one that utilized the best of both worlds. Specificity is required in the delivery of the adjustment and specificity is also required in the form of targeted nutrition to enhance circulation, cellular repair and optimal function at the most basic cellular level.
The IVD and supporting structures must be able to receive the adjustment and heal with integrity, both functional and at a cellular level.
My earlier attempts at a 'shotgun' approach to nutrition is not only time intensive but inherently allopathic. It makes more sense to me to provide my patients with an understanding of how nutrition supports integrity of tissue and ligament.
Not a Cure-All
The science of nitric oxide is not a cure-all. Whole food nutrition, daily exercise, regular chiropractic care, sensible advice in daily work-place and personal ergonomics are the keys to an effective and sustainable result.
However now that I understand the impact of nitric oxide science, antioxidant protection, and EFA supplementation; I see the value in expanding the service and value of what I offer to my patients.
Please take the time to do a little research in regards to the essential nutrients. While of course the best delivery method would be whole foods, the reality of modern day society combined with the severe depletion of nutrients from foods provided by the present day food industry, wise and thoughtful supplementation is the key to optimal results in practice and optimal wellness for those we serve.
References
Continuing to impress the advertising and marketing world, The Foundation for Chiropractic Progress (F4CP) has again been recognized by industry organizations for its excellence in educating consumers on the benefits of chiropractic, this time through social media, newsletters, and demonstrating thought leadership by promoting holistic well-being.
Dr. Louis Sportelli received the Lee-Homewood Chiropractic Heritage Award during the annual conference of the Association for the History of Chiropractic (AHC). During his nearly 60-year career, Dr. Sportelli has embodied the spirit of the award, given to “living individuals who have made outstanding contributions to the chiropractic profession.”
Presently there is no consensus on the best treatment for Achilles tendon rupture; and its management is still controversial. The treatment options are conservative treatment and surgical repair. With either treatment, be it conservative or surgical, Achilles tendon tears necessitate prolonged recovery and rehabilitative management.
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