They aren’t what you think
At least three supplements can be recommended to patients in virtually every type of chiropractic practice. These three can be the cornerstone of your nutrition practice or simply provide additional support to a targeted patient base. These three are beyond the rote recommendations of magnesium, fish oil and vitamin D. There’s no question that the latter should be recommended. But your patients are smart, and you can do better.
Chiropractic patients are often savvy or at least interested in health enhancement. The lesson of this demographic information is: don’t be too basic. They are already familiar with the importance of magnesium and the role it has in musculoskeletal and neuroendocrine disorders.1-7 They know omega-3-rich fish oil is great for their brain and heart.8,9 Vitamin D is likely already on their shelves for either bone health or its role in both the innate and adaptive immune function.10-13
If your nutritional repertoire is too basic, you have little value to offer in terms of supplementation. Conversely, choosing specialized formulations from trusted brands allows you to provide clinically relevant added value to even the most sophisticated health enthusiasts.
Think about how many patients you saw last week who are suffering from sleep deprivation, anxiety, or depression. Chronically responding to stress can deplete metabolic reserves, and damage cells and organs—leading to nutrient deficiencies and increased systemic inflammation.
Chiropractors understand how stress affects their patients’ bodies arguably better than most other health care practitioners. If you are educating them on this already, it seems reasonable to provide a solution that they can take home.
Some chiropractic doctors recommend mediation or yoga (or other mind-body solutions). I do that too, but I also provide “yoga in a pill.” Adaptogens act on the hypothalamic-pituitary-adrenal (HPA) axis, which is a part of the neuroendocrine system that supports the body’s stress response.
Here’s a suggestion about choosing a product: Don’t rely on a single herb. You want several, well-studied botanicals in one practitioner-developed formula at relevant, studied daily doses for predictability.
Having a formula with some dosing flexibility would be a plus. Avoid liquids for compliance issues. And look to team up with a respectable company that doesn’t allow misidentified plants, heavy metals, toxic contaminants, or the wrong parts of the plants.
Top-of-mind adaptogens are ashwagandha (Withania somnifera), holy basil (Ocimum sanctum), eleuthero (Eleutherococcus senticosus) and my personal favorite, rhodiola (Rhodiola rosea). These adaptogens have independently been the subject of multiple clinical trials and shown to help with cognitive health, anxiety, mood, and fatigue.14-17
In one clinical study, subjects taking rhodiola saw stress-response improvement in as little as three days.18 The same type of rhodiola was also studied in subjects suffering from burnout, a symptom of modern living.19 Sticking with one primary formula of adaptogens also keeps me from having to learn every herb-nutrient, herb-drug, and herb-herb interaction and I can leave my Materia Medica of botanical medicine at home. I can also explain normal and abnormal responses to the formula when patients ask.
Addressing inflammation is first on the list of many treatment plans. Curcumin is a preferred option for its anti-inflammatory and immune-supporting benefits.20 Dosing is often titrated until a desired short-term effect is reached.21 This may be improved joint comfort or elevated mood. That dose can be maintained for months or even years without having to modify it.
When choosing the curcumin product for your shelf, the devil is in the details. It must provide the anti-inflammatory and antioxidant support you need. How it functions and outcomes matter. The money that patients spend should be worthwhile.
Curcumin is often derived from natural turmeric root, which has poor absorption and fast excretion. You want bioavailability, but not through a delivery system that increases intestinal permeability or is otherwise unsafe.
From a bioavailability perspective, consider a three-way comparison that assessed the effectiveness of commercially available curcumin products: curcumin-phospholipid, curcumin with turmeric essential oils, and water-dispersible curcumin using colloidal submicron-particles.22 Blood levels were assessed in healthy volunteers prior to taking each capsule and at 30 minutes, one, two, four, six, and 24 hours after administration. The water-dispersible colloidal submicron formulation had both a substantially greater Cmax and AUC (area under the curve), demonstrating that it reached higher blood levels and stayed in circulation longer for use by the body.
Recently, this water-dispersible formulation was shown to improve cognition in an 18-month trial supported by imaging studies. It also significantly improved depressive symptoms by more than 40 percent in non-depressed subjects. 23 Clinically depressed subjects were excluded from the study, but directionally these data are attractive.
The right form of B-vitamins
A high quality, active B-complex has permanent residence in my office, as it is often the underutilized, missing link for many patients. These water-soluble vitamins are essential for cellular metabolism, red blood cell function and production, and methylation, and serve as cofactors for neurotransmitter synthesis.
Most formulations available in the retail market do not include the active forms of folate, B1, B2, B6, and B12. An active B-complex can be a great choice for those with anxiety, high stress, genetic indications, or who are pregnant.
You can routinely add a B-complex with active forms to patients who are already taking multivitamins, who are under a treatment plan, who report fatigue, stress or mood changes including irritability, depression, burnout, or anxiety.24 And you can recommend it to those who report sleep problems. Recommending a B-complex with active forms, dosing flexibility (so you can dial it up during times of injury or stress), from a brand with integrity shows a patient-centered approach.
Corey Schuler, DC, MS, CNS, RN, LN, is the director of clinical affairs for Integrative Therapeutics. He practices in Wisconsin. Schuler is also adjunct assistant professor at New York Chiropractic College. He is a chapter contributor to both Integrative Medical Nutrition Therapy and the Disease Prevention and Treatment textbooks. He can be contacted through integrativepro.com.
1 Gallai V, Sarchielli P, Coata G, et al. Serum and salivary magnesium levels in migraine. Results in a group of juvenile patients. Headache 1992;32:132-5.
2 Paolisso G, Sgambato S, Gambardella A, et al. Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr. 1992;55:1161-7.
3 Carpenter TO, DeLucia MC, Zhang JH, et al. A randomized controlled study of effects of dietary magnesium oxide supplementation on bone mineral content in healthy girls. J Clin Endocrinol Metab. 2006;91:4866-72.
4 Sherwood RA, Rocks BF, Stewart A, Saxton RS. Magnesium and the premenstrual syndrome. Ann Clin Biochem. 1986;23:667-70.
5 Abraham G, Flechas J. Management of fibromyalgia: Rationale for the use of magnesium and malic acid. J Nutr Med. 1992;3:49-59.
6 Boyle NB, Lawton C, Dye L. The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. Nutrients. 2017;9(5):429.
7 Hornyak M, Voderholzer U, Hohagen F, et al. Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study. Sleep. 1998;21:501-5.
8 Nilsson A, Radeborg K, Salo I, Björck I. Effects of supplementation with n-3 polyunsaturated fatty acids on cognitive performance and cardiometabolic risk markers in healthy 51 to 72 years old subjects: a randomized controlled cross-over study. Nutr J. 2012;11:99.
9 Hamazaki K, Itomura M, Huan M, et al. Effect of omega-3 fatty acid-containing phospholipids on blood catecholamine concentrations in healthy volunteers: a randomized, placebo-controlled, double-blind trial. Nutrition. 2005;21(6):705-10.
10 Brot C, Jorgensen N, Madsen OR, et al. Relationships between bone mineral density, serum vitamin D metabolites and calcium: phosphorus intake in healthy perimenopausal women. J Intern Med. 1999;245:509-16.
11 Nordin BE, Baker MR, Horsman A, Peacock M. A prospective trial of the effect of vitamin D supplementation on metacarpal bone loss in elderly women. Am J Clin Nutr. 1985;42(3):470-4.
12 Komulainen M, Tuppurainen MT, Kroger H, et al. Vitamin D and HRT: no benefit additional to that of HRT alone in prevention of bone loss in early postmenopausal women. A 2.5-year randomized placebo-controlled study. Osteoporosis Int. 1997;7:126-32.
13 Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881-6.
14 Pingali U, Pilli R, Fatima N. Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participants. Pharmacognosy Res. 2014;6(1):12-8.
15 Dey A, Chatterjee SS, Kumar V. Low dose effects of a Withania somnifera extract on altered marble burying behavior in stressed mice. J Intercult Ethnopharmacol. 2016;5(3):274-7.
16 Cicero AFG, Derosa G, Brillante R, et al. Effects of Siberian ginseng (Eleutherococcus senticosus maxim.) on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl. 2004;9:69-73.
17 Bhattacharyya D, SurT, Jana U, Debnath P. Controlled programmed trial of Ocimum sanctum leaf on generalized anxiety disorders. Nepal Med Coll J. 2008;10(3):176-9.
18 Edwards D, Heufelder A, Zimmermann A. Therapeutic effects and safety of Rhodiola rosea extract WS 1375 in subjects with life-stress symptoms-results of an open-label study. Phytother Res. 2012;26(8):1220-5.
19 Kasper S, Dienel A. Multicenter, open-label, exploratory clinical trial with Rhodiola rosea extract in patients suffering from burnout symptoms. Neuropsychiatr Dis Treat. 2017;13:889-98.
20 Sokmen M, Akram Khan M. The antioxidant activity of some curcuminoids and chalcones. Inflammopharmacology. 2016;24(2-3):81-6. 4
21 Asher GN, Spelman K. Clinical utility of curcumin extract. Altern Ther Health Med. 2013;19(2):20-2.
22 Sunagawa Y, Hirano S, Katanasaka Y, et al. Colloidal Submicron-Particle Curcumin Exhibits High Absorption Efficiency – A Double-Blind, 3-Way Crossover Study. J Nutr Sci Vitaminol (Tokyo). 2015;61:37-44.
23 Small G, Siddarth P, Li Z, et al. Memory and Brain Amyloid and Tau Effects of a Bioavailable Form of Curcumin in Non-Demented Adults: A Double-Blind, Placebo-Controlled 18-Month Trial. Am J Geriatr Psychiatry. 2018;26(3):266-77.
24 Van der Beek EJ, Van Dokkum W, Wedel M, et al. Thiamin, riboflavin and vitamin B6: impact of restricted intake on physical performance in man. J Am Coll Nutr. 1994;13:629-40.