Medical foods are an FDA-regulated category between pharmaceuticals and supplements utilizing targeted nutrition to treat diseases and conditions with GRAS (generally recognized as safe) ingredients.1-4 Supplements are intended for the nutritional support and maintenance of good health in healthy patients and are unable to make disease claims; whereas medical foods can make claims regarding the dietary management of specific diseases and symptoms.
Pharmaceutical medications and medical foods are similar in that they both must have scientific evidence to substantiate their efficacy and disease claims.1-4 However, because all the ingredients in medical foods are GRAS, they do not require pre-market FDA safety approval and do not require a prescription.
Furthermore, medical foods are known to be extremely safe compared to the common side effects and drug interactions associated with pharmaceuticals.
Medical foods are defined by the FDA Orphan Drug Act (1988) as foods specifically formulated and intended for the specific dietary management of a disease or condition, for which distinctive nutritional requirements based on recognized scientific principles are established by medical evaluation. Medical foods are consumed or administered enterally and require physician supervision, as well as current good manufacturing practices (cGMP).1-4
Potential Uses and Therapeutic Benefits in Chiropractic Practice
Several encapsulated medical foods have strong human clinical data, including published double-blind studies against common nonsteroidal anti-inflammatory drugs (NSAIDs). They have demonstrated use as both standalone products and as adjuncts with pharmaceutical medication, often allowing much lower dosing (and thereby considerably reducing side effects).
Encapsulated medical foods are now available to treat many of the most common symptoms seen in a chiropractic practice, including chronic pain and inflammation, sleep disorders, neuropathy, obesity, fatigue, and cognitive decline.
The increased metabolic demands associated with these chronic conditions result in a relative deficiency of amino acids and neurotransmitters, which can be addressed utilizing encapsulated medical foods. This targeted nutritional approach to disease offers practitioners an opportunity to bridge the gap between dietary supplements and pharmaceuticals with a safe, medically validated, nutrient-based tool.
This opportunity to enhance natural healing should complement all chiropractic treatment modalities, improving overall patient care.
Chronic Pain: Definition, Demographics, Economic Burden
Chronic pain is defined as pain that persists or recurs for more than three months and is responsible for widespread suffering. It is estimated to affect more than 30% of people worldwide, with a much greater prevalence seen in the elderly (up to 83% of elderly in nursing-home facilities).5-10
However, unlike acute / subacute pain, which have a biological value by protecting us from further bodily harm, chronic pain has no biological value and persists even after the injury / illness that triggered it has healed or gone away.8-12
Additionally, chronic pain is responsible for enormous health care expenditures and loss of productivity which are more than the annual costs of cancer ($243 billion) and heart disease ($309 billion) combined (annual costs of pain in the United States estimated to be 635 billion USD/year).9-10, 13-14
The Limitations / Dangers of Traditional Analgesics
Commonly, traditional analgesic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and acetaminophen are administered to patients with chronic pain as part of their treatment regimen to optimize functionality by reducing pain and discomfort.
However, these medications have significant therapeutic limitations, especially when utilized long-term because of risks for adverse side effects / events and the potential for drug interactions (especially due to polypharmacy in the elderly).
NSAIDs are known to cause significant gastrointestinal (GI), cardiovascular and renal toxicity including increasing the risk of bleeds (GI / intercranial), especially when combined with blood thinners or newer-generation antidepressants.15-21 NSAIDS also contribute to more than 100,000 hospitalizations for GI complications and at least 16,500 NSAID-related deaths each year in the U.S.22-23
In fact, as a consequence of NSAIDs' well-established side effects, the American Geriatric Society recommends great caution and only supports their use for short periods of time in the elderly (>65 years old).24 Furthermore, new research also suggests NSAIDs may actually delay recovery and contribute to the development of chronic pain.25-26
Opioids are associated with the development of dependence (misuse / abuse), rapid tolerance to their analgesic effects, respiratory depression, constipation, sexual dysfunction, myocardial infarction, and overdose / death; and increase the risk of falls / fractures due to sedation, orthostatic hypotension and dizziness (especially in the elderly).27-28
Paradoxally, opioids may also cause "hyperalgesia" (increase in the perception of pain) in some patients, rather than providing an antinociceptive effect.29
Sadly, the use of prescription opioid medications for chronic pain has contributed greatly to the current "opioid crisis," which has led to countless deaths, numerous opioid-related hospitalizations, devastated families and hundreds of billions of dollars in economic burden.30-32
Acetaminophen, despite being widely regarded as one of the safest pain drug choices in patients with cardiovascular disease and a first-line pain management drug for the elderly, is also the most common cause of acute liver failure and liver transplant in the United States, and the second most common cause of liver transplant worldwide.33-37
In addition, a recent meta-analysis found that acetaminophen was ineffective in the treatment of low back pain and provided only minimal short-term benefit for people with osteoarthritis.38
Based on all the above, finding safe and cost-effective approaches for the treatment of chronic pain is not only a medical necessity and challenge, but also an economic requirement.
"Medical Foods" for Chronic Pain: Effectiveness and Rationale
Two double-blind clinical trials compared a medical food to ibuprofen and naproxen as dietary management of chronic pain and inflammation in patients with chronic low back pain. The research showed that the medical food significantly reduced pain and inflammation when utilized as a stand-alone therapy or in combination with a low-dose NSAID.39-40
The rationale behind addressing pain and inflammatory conditions surrounds the understanding that patients with chronic pain syndromes have increased nutritional requirements and deficiencies in certain amino acids like tryptophan, choline, GABA, L-serine, L-arginine and L-histidine that are precursors for the neurotransmitters (i.e. serotonin, acetylcholine, GABA, D-serine, nitric oxide and brain histamine) that help dampen pain and also help reduce inflammation.39-40
This provides practitioners with a clinically proven, nutrient-based intervention that is a safe and cost-effective alternative / complement to traditional analgesics.
References
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?
