Take your vitamins, don’t drink that soda, and eat your vegetables.
These words have become part of that adage that holds “you are what you eat,” and over the years proof of the effectiveness of healthy eating and nutritional supplementation in improving symptoms associated with pain and inflammation has grown.
How are chiropractors encouraging their patients to adopt these lifestyle practices as an adjunct to traditional care? Should you sit on the sidelines of integrative medicine or consider incorporating it into your practice?
And if so, why?
We spoke with three experts in nutritional supplementation who have seen firsthand the power of healthy living when it comes to reducing pain, inflammation and other symp- toms associated with many chronic conditions.
Growing adoption reigns
As health care practitioners and patients alike continue to embrace the positive effects of nutritional supplements and healthy eating at increasing rates, the latest terms used to refer to these and similar practices have gained significant acceptance.
“The terms functional or integrative medicine are now widely used and considered viable options,” says Corey Schuler, DC, the director of clinical affairs at a company that provides nutritional supplements through health care as well as through patient-focused distributors. He also maintains an active practice in Hudson, Wisconsin.
“Complementary medicine as a term had trouble gaining traction, but the terms integrative and functional medicine are more easily tolerated,” Schuler says.
A widely acknowledged term for this medicine certainly helps with greater acceptance, but the growing adoption of nutritional supplements and alternative therapies to improve pain and inflammation continues to thrive, thanks to sustained patient demand.
“I think with the information revolution, through smartphones and related technology, everyone is so much more educated when it comes to ingredients and sourcing products,” says L. Douglas Lioon, the CEO and cofounder of a nutraceutical company in Pittsburgh. His product line and formulations are available exclusively to health care practitioners—including chiropractors, naturopaths and MDs nationwide.
“All doctors, including chiropractors, have been more and more involved in nutritional supplementation, and a lot of it is patient-driven thanks to the information revolution,” he adds. “The traditional doctor is being asked about fish oil, curcumin and more because the patients coming in are more educated than ever.”
Schuler agrees. “I’ve long said we have to stay ahead of our patients’ knowledge of health, and doing so now is difficult because patients are very well-educated about their condi- tion or their functional state, and they also know about dietary supplementation and the types of ingredients used or not used,” he says.
According to Stephanie Zgraggen, DC, founder and clinical director of a practice in Charleston, South Carolina, patients open to the idea of nutritional supplementation to improve symptoms associated with various conditions are seeing real results—and this reinforces their interest in functional medicine.
Zgraggen performs clinical nutritional counseling and oversees whole-food supplement protocols with her patients as an adjunct to chiropractic care.
“Most people who choose chiropractic care are already in the right mindset for nutritional health and are looking for something different,” she says. “Patients are definitely open to it. Sometimes, patients will have chronic problems, and I will make one recommendation and they return to the office in a couple of weeks and can’t believe the improvement.
“Chiropractors have become more interested in nutrition therapy over the years because patients are asking for it,” she adds. “If we educate ourselves as practitioners and then send the information on to our patients, they’ll be happier and healthier in the long run.”
Education must go both ways, though, she says. “Many topics we discuss with patients revolve around behavior modification. Changing takes time, and I tell patients that it’s a process. I work on one or two major items or goals. For example, we’ll start with cutting out smoking or soda. The process is a build-up of small changes over time.
“Sometimes, it’s a lot easier to add something than it is to take something away,” Zgraggen says. “I typically start with adding things before taking things away. It’s also a psychological process.”
“A beautiful blend”
According to the experts interviewed for this article, chiropractors are in a perfect place to educate patients about nutritional supplementation and healthy eating.
“Chiropractic medicine and nutritional health are a beautiful blend,” Zgraggen says. “On the nutritional side, we are adding raw materials so the body can function efficiently, and on the chiropractic side, we are removing nerve interference so the nervous system and the brain can function at peak performance.”
Schuler refers to the damage that stress can inflict on the human body and explains how chiropractors and integrative medicine can help.
“Where chiropractors routinely shine is working on the stress response,” he says. “Adapting to stressful environments is an issue for people with cardiovascular disease; there is a high level of cardiovas- cular disease in people who live off of adrenaline, and chiropractors,
by virtue of their job, help people adapt to stress. In these cases, dietary supplements are extremely useful.
Examples are adaptogenic herbs or brain nutrients, as well as nutrients that manage cortisol levels.”
Lioon agrees. “A chiropractor is one of the gatekeepers to natural health—they are positioned perfectly to be experts because anyone going to a chiropractor is likely already accepting of natural medicine.”
Specific nutritional supplements have proven highly effective in addressing pain in her office, Zgraggen says. These include fish oil and white willow bark, which contains salicin, a glucoside related to aspirin that accounts for willow bark’s long use as a traditional pain-reliever.
Also effective for the management of inflammation and pain are omega-3 fatty acids, boswellia, turmeric and of course, healthy eating.
“Essentially, the biggest inflammation creators are processed foods,” she says. “I recommend people go gluten-free and avoid drinking sodas. Refined sugar is the No. 1 item that causes inflammation. Foods that are anti-inflammatory include dark green vegetables, berries, salmon, walnuts and pumpkin seeds.”
Schuler recommends co-enzyme Q10 (CoQ10) when patients are given statins, because statins deplete CoQ10 and can cause rhabdomyolysis (muscle pain and fatigue). He also suggests the use of omega-3 fatty acids, vitamin D supplementation and therapeutic nutrients useful for blood sugar dysregulation such as the herb berberine.
“CEOs and accountants who have stressful lives are not immune to stress and cardiovascular disease,” Schuler says. “When they see their chiropractor, they don’t expect to get hooked up to an EKG, but they might go to them and say, ‘I went to my general practitioner and was told my blood pressure is high, what can you do to help naturally?’ Most chiropractors will jump to minerals like magnesium or herbs like hawthorn for this issue.”
Although the majority of chiropractors have already adopted a range of measures to educate their patients about nutrition and healthy eating, there are still some who have yet to embrace the power of lifestyle changes when combined with traditional chiropractic care.
Experts interviewed for this article recommend that chiropractors seeking to learn more about the benefits of nutritional supplementation begin by taking it slow.
“First of all, there are so many different topics when it comes to nutrition in general,” Zgraggen says. “I suggest that chiropractors choose a topic they’re passionate about and learn it. Look at herbs and food for pain management and inflammation, and use supplements in your office.
Find three companies that offer nutritional products to research and then choose the one that best fits your philosophy. Most supplement companies provide a lot of education on their products.”
Schuler advises pushing ahead one step at a time.
“My advice for chiropractors is to take one step forward, learn one new thing per quarter,” he says. “If you’re already involved in supplementation or food counseling, still take one step forward and learn something new all the time.
“Attend scientific conferences that aren’t sponsored by a single supplement company,” he adds. “Chiropractors can be minimally competent—they don’t have to get a Master’s degree in nutrition to recommend basic things to their patients, and they can be easily networked with people who have advanced degrees in this material.”
Lioon points to the practical power of an alliance between nutrition and chiropractic care. “I think there’s a great opportunity to answer and fulfill a need that is out there for the more nutritionally educated patient, and to use nutrition as an adjunct to spinal manipulation is synergistic,” he says. “Why wouldn’t you want to give the best results to a patient who is in need? It spurs referrals.”
Amy Stankiewicz is a freelance writer based in Cleveland. She has written for trade publications for more than 15 years. She can be contacted at firstname.lastname@example.org.