As a chiropractor, you are focused on helping your patients regain their health naturally.
And what is their top complaint? Chronic pain— including low daytime energy, poor sleep patterns, wandering attention, depressed mood, and difficulty maintaining optimal weight.
Relieving patients of these chronic issues requires addressing not just the symptoms, but also the source, which usually resides in the nervous system. It is the central nervous system (CNS), through its beautiful symphony of communication with both the endocrine and immune systems, that truly drives the show. In fact, this understanding has given birth to the new term neuroendocrine immunology, which honors the intricate interplay among neurotransmitters, stress and sex hormones, and the immune system.
It is helpful to think about neurotransmitters through the lens of the autonomic nervous system (ANS). There are two divisions to the ANS: the sympathetic “fight-or-flight” side and the parasympathetic “rest-and-digest” side. Although these two branches are continually balancing against each other throughout the day, for optimal health and function it is best that the parasympathetic side dominate, as it conserves and stores energy and regulates body functions.
When stressed, the sympathetic side kicks in, causing increased heart rate, sweating, irritability, decreased digestive function, lack of focus and impaired short-term memory. When in “parasympathetic land,” patients tend to have fewer cravings, better metabolism, happier moods, healthier bowel function, improved sleep patterns and higher levels of focus and attention.
Order of operations
When patients present with chronic pain, the first lines of defense are typically chiropractic adjustments. Many practitioners also employ nutritional interventions with specific elimination diets and nutritional supplements that support the GI tract and help reduce inflammation. If these measures do not provide relief, it is time to consider additional windows into your patient’s unique physiology.
Just as it is common practice to test a diabetic’s blood sugar before administering insulin, it is useful to perform testing as an objective means for assessing nervous system function and its attendant symptoms relating to mood, sleep and cognition. This model can be called “assess and address,” as it allows the practitioner to individually address their patients’ biochemical imbalances by dealing with the root of symptoms, and achieve better outcomes more rapidly.
Many practitioners test immune markers in the blood and serum, hormones in the saliva and blood, and neurotransmitters in the urine. Although it is possible to test neurotransmitters in the serum and cerebrospinal fluid (CSF), urinary testing is often preferable because of the following benefits:
• The convenience of home sample collection, which is less stressful for patients.
• Normative physiologic ranges.
• More stable than CSF or blood.
• Time averaging of total body output of neurotransmitters, when the bladder is held for a couple of hours before sample collection.
More importantly, there is strong evidence that neurotransmitters excreted in the urine may effectively serve as biomarkers of nervous system function. Studies have demonstrated that intact neurotransmitters are transported from the central nervous system to the periphery, followed by renal filtration of neurotransmitters and excretion in the urine.1
As with any testing, you should only use CLIA-certified labs that are fully licensed in your state and follow your scope of practice.
Urinary testing is a functional test, not a diagnostic one. It does not diagnose insomnia, ADHD, mood challenges, or similar. It merely provides a biochemical outline of which biomarkers are elevated, depleted or within a “normal” range. These patterns help guide a program of customized, individual supplementation.
Note that urine neurotransmitter levels emanate primarily from the patient’s periphery, not their central nervous system. You should not advise your patients that you are recommending a neurotransmitter test to determine their brain levels of serotonin, dopamine or GABA, for example. Rather, you should convey that testing provides data on the total body output of neurotransmitters to help determine the patient’s stage of stress response and guide the appropriate course of nutritional supplementation. Ultimately, the goal is to rebalance and optimize neurotransmitter and adrenal stress hormone responses to chronic stress.
Testing can determine the stage of stress response. For example, early-phase stress response may be indicated by elevated levels of epinephrine, norepinephrine, cortisol and DHEA. In this case, the goal is to down-regulate this elevated stress response and help reset the biochemistry to lower, optimal levels.
A mid-stage stress response may present with a “mixed bag” of biomarkers; some elevated, some optimal and some low. In this case, the results determine which neurotransmitters and hormones need to be down-regulated, and which need to be supported and replenished.
A patient may be in late-stage stress response when biomarkers measure low across the board. This is indicative of true adrenal fatigue from chronic adrenal stress. In this case, all biomarkers show depletion and supplements to help replenish them are suitable.
Regardless of the stage of stress response, many patients’ symptoms and complaints tend to be similar. This is why it is imperative to test and interpret results alongside patient history first. Once a healthy neurotransmitter balance is achieved through supplementation, the patient enters a maintenance phase in which doses are reduced. At this point, the patient notices improvement.
Scott Theirl, DC, DACNB, FACFN, is a chiropractic neurologist in private practice in Milwaukee, Wisc. clinical medical educator with NeuroScience, Inc., which provides health care providers with clinical assessments and nutraceuticals to identify and target neurological and hormonal imbalances. Theirl can be contacted through yourbestbrain.com or neuroscienceinc.com.
1 Marc DT, et al. Neurotransmitters excreted in the urine as biomarkers of nervous system activity: Validity and clinical applicability. Neurosci Biobehav Rev. 2011;35(3):635-44.