Today’s Conversations on Leadership (TCL), a thought-leadership vehicle of Life University, has released a conversation moderated by Gerard W. Clum, D.C., director of The Octagon at Life University, seeking to bring greater clarity to the expectations of the practicing chiropractor during the COVID-19 pandemic.
Panel members were:
- Heidi Haavik, DC, PhD., Director of Research, Centre for Chiropractic Research at the New Zealand Chiropractic College;
- Dan Murphy, DC, DABCO, a faculty member at Life Chiropractic College West;
- James Chestnut, BEd., MS, DC, founder and president of The Wellness Practice
“Life University wishes to thank Drs. Haavik, Murphy and Chestnut for their expertise and counsel in helping each of us, as chiropractors, understand what we can say, what we should say and, perhaps most importantly, what we should not say about the role of chiropractic care in immune-health matters and in relationship to COVID-19 in particular,” said Life University President Rob Scott, DC, PhD.
Transcript highlights included:
Dr. Clum: I’ll be very candid with you, I’ve been involved in chiropractic for almost 50 years. I’ve never seen a more critical moment than we’re in right now. And it doesn’t have to do with anything specifically about chiropractic, but we’re caught up in this moment where the anxiety, the fear, the frustration on the part of the consumer, on the part of the public at large, on the part of nations is so immense and is so critical that anything that can be misinterpreted will be, and anything that can be misunderstood will be misunderstood.
…So the purpose and the function of this conversation, is to give you a firm grasp of what you can say, what you should say, and perhaps again, most importantly, what you shouldn’t say in your office and far more importantly in public settings such as social media about the interface of chiropractic care to this problem that’s before us.
Question: As a chiropractic practitioner, as a neuroscientist, and a researcher about the status of information about chiropractic care and the defense systems of the body, what is it that we can say and what should we be saying in our offices regarding the relationship that chiropractic care may hold for patients at this moment in time?
Dr. Haavik: We’ve actually got more research than I actually thought when it comes to chiropractic and the immune system, and I must do a bit of a plug to CMCC on that note because they’ve done a bulk of these studies, which is really interesting. What we can say for sure in our offices to our patients is that there definitely is credible evidence for a link, a connection between chiropractic adjustments and immune system functions.
But these studies are based on basic science studies, and what we’re lacking, and what we’ve got to be very careful about, is translating that into clinical claims because we have no studies yet that look at ‘Would chiropractic care prevent you from getting sick or would chiropractic care reduce the symptoms of being sick, or the frequency of getting sick?’ Those studies haven’t been done yet. So, all we really know for sure is that chiropractic definitely influences the nervous system. And chiropractic definitely influences the immune system, but we don’t yet know what does that mean clinically for a patient in your practice. So, that’s where we’ve got to be very, very careful.
Q: So that being said, what would the conversation in an office be in the ideal sense in your mind, between the practitioner and their patient?
Dr. Haavik: So, you could tell your patients that we definitely know that chiropractic adjustments can change neurochemicals in the body that are related to immune system function. We know we can increase things like substance P or oxytocin or neurotensin. We know we can change certain interleukin cytokine levels. So, we know we can have an immune system effect, but we don’t know what that effect would mean for them just yet…And this is the key difference between basic science studies and clinical trials, and it’s the clinical trials that we are lacking because basic science studies really looks at ‘How does something work?’ and ‘Is there a connection?.’ And those studies, we’ve actually got quite a few. So we know chiropractic care influences the nervous system, and in particular, very important parts of the nervous system that are known to influence the immune system. And there are direct studies that show that chiropractic adjustments change immune system functions.
Q: You’ve written a great deal about stress in your work and the relationship of sympathetic tone or parasympathetic suppression and its effect upon the patient and their circumstances. I don’t know what it’s like in New Zealand, but it is wall-to-wall 24/7 radio, TV streaming, everything. Can you speak to the issue in general? Stress in relationship to immune function?
Dr. Haavik: It’s really quite sad. And because not only their stress in relation to getting this virus and then what does that mean, but also a lot of people are losing their jobs, so there’s massive amounts of financial stress. People are losing their homes, because they suddenly can’t pay their rent. So, stress at the moment is going to skyrocket. And that’s something that I think we chiropractors need to be acutely aware of because that stress is so incredibly detrimental for our brain function and for our immune system function. We know that stress will turn off the rational reasoning part of our brain called the prefrontal cortex and we also knows that we know that it activates the limbic systems, the panic systems in our brains, the danger warning signals, they get elevated or heightened.
…And what’s really interesting is that prefrontal cortex, this part just behind our forehead, is extremely important in balancing the autonomic nervous system and in controlling that hypothalamus, pituitary adrenal axis of the immune system. We know therefore that it’s vitally involved in our immune system, full stop. And stress turns that part of the brain off…we’ve got direct-evidence that stress increases your susceptibility to getting sick. It prolongs you being sick, and it usually worsens your symptoms. So this is not a good thing at the moment.
Q: If you had to answer the question, give me two, three or four things that you hope you wouldn’t hear from a chiropractor at this time, about this problem, relative to COVID-19, what would they be?
Dr. Haavik: Okay. I would, I would not want to hear a chiropractor saying that chiropractic care can prevent you from getting coronavirus. I would not want to hear a chiropractor saying that we have evidence that chiropractic care would improve your symptoms if you’ve got coronavirus. I wouldn’t want to hear those kinds of claims that we could prevent it, reduce the symptoms, and speed up the healing process.
We just don’t have…those studies haven’t been done. The links are there, and it’s really up to us as a profession now to do these studies. The onus is for us to support the research and fund the research where we actually test those questions. You know, we know there’s a strong link now, so does then chiropractic care prevent infections, does it speed up recovery times? Does it reduce the frequency of you getting sick? Those studies haven’t been done…so, we literally don’t know. I would prefer it if the chiropractic profession didn’t go say those things because we do not have the evidence. And like you said before, right now we’re under a lot of scrutiny, and it’s really, really important that as primary health care professionals, what we say is accurate and is up to date according to the latest scientific evidence.
Q: Can you begin some conversation about the steps you would encourage people to take to maintain wellbeing?
Dr. Chestnut: I think that’s such a great learning opportunity right now to understand why, especially our chiropractic paradigm about this idea of baseline health or baseline immune function, if you like, is so important at all times. And so the idea of health promotion in a sense right now is almost the same as harm reduction because as you said, there’s really no other harm reduction strategies available to us.
…And so if we look at our culture, there’s a lots of things, immuno-compromising corticosteroid medication is one of those things. Lack of proper healthy lifestyle is one of those things, improper nutrition, not enough exercise, too much emotional stress. These are all the things that we can talk about that can downregulate immunity. And then some of the other things we’d have to discuss are what are the things that our immune system requires in order to function properly in order to express our immune potential…But there are some things that we can do that can really help to restore proper function of our immune system that can make us more immunocompetent that we can do quite quickly. Certainly, one of those would be exercise, but it takes some time to come physically fit. But no matter what, if you start right away and just start getting out and going for a walk and exercising, we know if you start eating better foods, there’s no doubt about it, meaning you are going to put less toxic food into you as well. We also know that if we, we start dealing with our emotional stress, that right away can make a difference for sure.
I would like to discuss something that’s more clinically related, which is making sure that people are sufficient in their intake of the essential nutrients, about which the literature is unequivocal. This is an evidence-based discussion we’re having now because the literature is very clear that things like Vitamin D especially, but also Omega-3 fatty acids and Vitamin A, are incredibly important nutrients in terms of our immune system, that our immune systems literally cannot operate or function properly unless they have sufficient access to these nutrients, and these nutrients are called essential.
Biochemically what that means is that our bodies require them, our cells require them, but we cannot make them. Therefore, we have to ingest them, or get them through sunlight with Vitamin D, or ingest it. And so what the literature says, which is incredible, is that not only just the basic science info about how this affects immune cells, that’s basic science research, but there’s actual randomized clinical trials on intervention studies with supplementing with Vitamin D and actually decreasing not only the incidence of, but the severity of respiratory illnesses like cold and flu. So there’s a lot of evidence out there and even systematic reviews summarizing all the stuff they are showing. And then in the British Medical Journal, a public health recommendation that makes sure people get sufficient D.
…So if you’re deficient, and vast majority of the population is deficient in Vitamin D, they are deficient in, especially the proper ratio of Vitamin D and Vitamin A. And they’re definitely deficient in Omega-3 fatty acids because it’s just not readily available in our diet anymore without supplementation. It’s really simple to correct it and relatively inexpensive, and it’s something that can make a difference immediately. And so I, I just think that that’s one of the things on top of just a general healthy lifestyle. That’s one very specific thing to do with immunity that chiropractors can be talking about and should be talking about my opinion.
Dr. Clum: It’s a mistake to say there is no evidence of a potential relationship between chiropractic care and immune function. There is basic science evidence to this effect. It is also a mistake to say that chiropractic care will shorten, or lessen the severity of, of a given viral infection, COVID-19 or otherwise, as this evidence has yet to be developed.
This is a very critical time. The entire world is on edge over this COVID infection. As a result, anything that’s said is being hyper-analyzed, being put through a hyper-critical lens, and we need to be extremely cautious about what we say at this moment in time. We also, at this time, perhaps more than any other in our history or in the history of social media, we need to make sure that when we offer our opinions that they’re offered as opinions and not as facts…My hope and my request of you is to provide chiropractic care during the COVID-19 era, with appropriate precautions, as you did before this time and as you will after this time. The care your patients needed before the COVID-19 reality, during and after this situation, will not change much likely. Providing chiropractic care is a part of a patient’s health recovery, and wellbeing strategy does not change in the presence of COVID-19…Learn as much as you can, and be as prepared as you can for yourself, your family, and your patients.
To read the full transcript go to living.life.edu/wp-content/uploads/2020/04/4027-TCL-video-transcript-4-9.pdf.
For the latest COVID-19 info for doctors of chiropractic, including upcoming webinars, updates, resources and articles from Chiropractic Economics, go to chiroeco.com/coronavirus-covid-19.
