Make nutrition and supplementation work for your patients

An interview with Freddie Ulan, DC, CCN 

Many doctors of chiropractic choose to specialize in nutrition, simply because it has the potential to turn around many chronic health conditions, such as type 2 diabetes and prediabetes.

Incorporating nutrition into your practice, though, means more than making recommendations and hoping patients follow them. Having a system that can identify their issues, make an individualized plan tailored to their needs, and enable them to walk out your door having purchased the necessary products is key to nutrition making a real difference in your patients’ lives. 

Chiropractic Economics had the opportunity to interview Freddie Ulan, DC, CCN, founder of Ulan Nutritional Systems and Nutritional Response Testing. Ulan, who’s been a practicing DC for almost 60 years, told us patients don’t seem to hold their adjustments the way they used to when he started out in the 1960s, and he believes nutrition is the key. 

What follows is our interview, lightly edited for clarity and length. 

Chiropractic Economics: Please explain what a primary subluxation, a secondary subluxation and a recurring subluxation are.

Freddie Ulan: D.D. Palmer, DC, covered these different subluxations in his book The Chiropractic Adjuster: 

A primary subluxation is caused by direct trauma. It could be from lifting something heavy that throws the back out. Or it could be caused by an auto accident. It’s the workman’s compensation type of injury. 

A secondary subluxation is caused by other stressors outside of the spine but in the person’s body. An example could be an impacted tooth. The number of nerve stimuli going back to the spine and brain stem will cause an overflow of nerve activity causing the atlas or axis (first or second cervical) to subluxate. It causes a muscle spasm and that pulls the bone out of place. When you correct it by adjustment, it tends to go back out again. 

Palmer said if a subluxation keeps recurring you need to investigate to find out why that is happening. What’s going on with the body to cause that subluxation to occur? He notes that eating refined white flour products will act as a toxin and will overload the nervous system. You get a continually recurring subluxation.  

A recurring subluxation is one that no matter how often you adjust, keeps recurring. Today, we routinely see patients with subluxations that don’t hold after an adjustment. When that happens, there is some underlying cause. 

CE: What does nutrition have to do with handling recurring subluxations?

Ulan: This is what I call the Viscero-Somatic Reflex: The viscera, an organ, is under stress and sends a reflex up the spine letting the body know it is having a problem and it causes a recurring subluxation. There may be some toxicity that must be removed; the organ may need support; or it can be both. 

A recurring subluxation is handleable in 95% of cases with nutritional support. 

CE: Patients have come to expect DCs to have a level of knowledge on alternative medical issues that meets, or in most cases exceeds, that of their primary medical doctor. How can DCs take advantage of this increase in interest in natural and alternative services?

Ulan: A doctor of chiropractic can take advantage of the rising interest in nutrition and holistic healing by becoming an expert in a system of analysis that enables them to determine the nutritional needs of their patients to keep the spine aligned and functioning well and the nerve channels open. 

By law, the scope of chiropractic is the correction of subluxations. You correct a primary subluxation by adjusting the spine. You correct a secondary subluxation by correcting the source of the subluxation – usually a toxicity, a deficiency, or a combination of both in an organ – with nutrition. And because, as a preexisting condition, that has set up a pattern in the spine, you also adjust the patient. 

But you need a system that enables you to rapidly zero in on these underlying causes of the secondary and recurring subluxations. In addition, chiropractors need a way to communicate what they find to the patient so that they understand this is a genuine health matter – not just a recommendation to take multivitamins. It’s being able to create a designed clinical nutrition program that meets that patient’s specific nutritional needs. 

CE: According to the Council for Responsible Nutrition’s Consumer Survey on Dietary Supplements in 2022, 73% of consumers reported taking essential daily supplements. One year later, that number jumped to 80%. Ninety percent of DCs recommend and sell nutritional supplements to their patients, according to our Salary and Expense Survey. Is just selling nutritional supplements enough to address the need for effective nutritional services?

Ulan: When studies talk about 73% of Americans taking supplements, what they are referring to is a broad-spectrum vitamin and mineral combination. The higher-quality products will benefit the person, but they may not handle any stressed or toxic organ or underlying cause of recurring subluxations. To be effective, a DC needs to have a specific nutritional program addressing the needs of that patient. 

CE: How would a DC integrate effective nutrition services into their current practice?

Ulan: The first step is to do your initial chiropractic examination. You give them a report of findings that includes a section that calls their attention to the fact that depending on how they improve and how well they hold adjustments, you may or may not need to do additional examination and testing. It should include a statement stating you may have to refer the patient for further testing or to see other practitioners to achieve the best possible health improvement. When you first examine a patient, you may suspect right away they are suffering from secondary subluxations. In my clinical experience, if within four to six adjustments the patient is not showing improvement and starting to hold the correction, I recommend a separate examination to see what the nutritional status of the body is.  

It is important to separate these two actions. Even though both are part of the holism of your practice, there is a rhythm to a nutritional analysis versus a chiropractic analysis. Just as there is a rhythm to a nutritional follow-up visit versus a chiropractic follow-up visit. 

The first thing is to learn a nutrition system you can have confidence in, one allowing you to discover whether the patient has a nutritional deficiency component and whether a nutrition program would benefit them or not. The system should enable you to determine what you need to do to help that patient. You also need to be able to educate the patient on what you found and what they need to achieve optimal health improvement. 

The most effective method I’ve seen work is to set up separate hours for nutritional consultation and follow-up visits. That way the nutrition consultation is not seen as an add-on to the chiropractic visit.   

The chiropractic sequence is usually several times a week until they start to hold their adjustment and then it tapers off to once a week and eventually you have them on a monthly maintenance schedule. 

With a nutritional program, you need to give the body time for the nutrition to work. It works best with chiropractic and nutrition consultations on separate days, or different hours on the same day. Another option is to have a dedicated nutrition consultant or coach who does only nutrition visits.  

I start my nutrition patients on a once-a-week schedule for four to six weeks. If you have a system enabling you to rapidly determine how well the nutrition is working, you can do a short follow-up visit each week to fine-tune the program. It may mean adjusting doses or even changing the products they’re taking to get them to a point of stabilization.  

If they have secondary subluxations, this will also be the time when their chiropractic adjustments start to stabilize. Then I put them on every other week for about three months and then re-evaluate their status at the end of that period. During this time, they would be on a maintenance chiropractic schedule too. 

CE: How can adding a nutrition service boost income and lead to an all-cash practice?

Ulan: Nutritional visits done separately can be charged for. The nutrition visits are not covered by insurance. This sets up a cash component for your practice. Add to that, nutrition patients are purchasing supplements for their nutrition program that they need to take on an ongoing basis. That’s another cash flow component. And, as they run out of supplements, they come in to buy more. This gets the patient used to paying cash for services instead of relying on third-party payers. 

Once you have that cash component going well enough, you can decide whether you want to phase out insurance altogether. When I decided it was an appropriate time to change over, I put up a sign in the practice saying, “As of (a date three months ahead) we will no longer be filing insurance claims. We will give you a receipt and you can claim from your insurance.” 

It went very smoothly. It’s a great way to reduce stress and overhead. You remove the insurance component and turn it into a cash practice. 

There is a strong increase in demand for nutritional services in the U.S. If you decide to take advantage of this trend and become more holistic in your practice you can support patients nutritionally, which will help them hold their adjustments and improve their overall health. 

If you bring the patients on properly, they become committed to getting healthy using natural means. A committed patient is a compliant patient.  A compliant patient stays long enough to see results. A patient getting results becomes an avid advocate and spreads the word about your practice. 

FREDDIE ULAN, DC, CCN, is the founder of Nutrition Response Testing®, a safe, noninvasive system of analyzing the body to determine the underlying causes of ill health. His research has resulted in several breakthroughs in the field of nutrition and health. For more information about Nutrition Response Testing, visit nutritionresponsetesting.com. 

GLORIA N. HALL is the editor-in-chief of Chiropractic Economics.