Category: Nutrition

:dropcap_open:I:dropcap_close:n presenting the concept of internal health—a chiropractic specialty—I have been advocating an examination approach that recognizes that muscle contraction accompanied inevitably with loss of range of motion can be caused not only by a structural problem but visceral function as well. In other words, they should not be separated when we attempt to establish the cause of chronic recurring subluxation patterns. Those of you who have been reading my articles for years know that I believe that chiropractors are the only healers that have been trained to simultaneously integrate the anatomy, physiology, and neurology involved with a patient’s symptoms before making a treatment plan. To have a treatment plan be successfully concluded, you must start by finding the cause.

That brings us to an important consideration: What tests can you perform in your office that other practitioners do not? Unfortunately, I have found that most chiropractors do not include a periodic postural screening of their patients. What better way to begin screening for muscle contraction and then find its cause? A visual inspection only takes about one minute and is one of the most effective means of patient education available to you. No expensive equipment is needed, except perhaps a full length mirror. Once postural deviations are identified and related to their symptoms, the patient can recognize when they need to return to your office—before their symptoms return.

In my two previous columns, I described how to quickly determine the structural side of weakness—be it on the left, right or, if the stress crosses over affecting the organs of the lower abdomen. In December, I discussed how to determine spinal flexibility, whether the patient can tolerate compression or decompression (traction).

The chart on this page lists the various organs in the body.  Each shares spinal innervation with a set of muscles and a specific surface area on the skin. These connections were developed during the third week of embryonic life from the ectoderm, mesoderm, and endoderm germinal layers and can provide a very accurate diagnostic system when properly employed.

Here is a suggestion that may help you to find if a visceral problem is the cause of a patient’s chronic, recurring subluxation pattern. Identify the chronic spinal subluxation and then palpate the muscles that share the innervation for contraction, soreness and pain. Most of these will be located on the anterior of the body. Next, adjust the spinal innervation. Now repalpate for the anterior contraction(s). If they are gone, the cause was structural; but, if they are still present, the cause is visceral. Who else can do that?

As you make your spinal corrections, can you name the effects that each has on the affected organ? Do you attempt to correlate the patients’ symptoms to this chart and then palpate within the affected muscles to determine if the cause of the structural subluxation or misalignment came from a visceral stress?

Once learned, this system of diagnosis adds very little time to an office call, but experience has taught me that it may very well double your referrals and income in a short period of time. That should be worth a small investment of your time.  How many of the spinal innervations and autonomic effects have you committed to memory from the following list?

:dropcap_open:Successful doctors treat the cause of the problem, not the symptoms.:quoteleft_close:

Successful doctors treat the cause of the problem, not the symptoms.  They are able to quickly and accurately determine the source of the patient’s stress, devise a plan of treatment, and confidently convey their findings to the patient. They specialize in helping problem cases—the ones no one else can help. They solve these cases by identifying the specific cause(s) of the patients’ symptoms that have not been identified elsewhere.

I would suggest that to enhance your practice you need the following:

 

1. An examination that identifies the exact cause of your patient’s symptoms, be it anatomical, physiological, or neurological.
2. Absolute confidence that your examination will stand the light of scientific scrutiny and will yield information quickly and accurately.
3. A ceremony that both educates and inspires your patient. Ceremonies are important and you already have one.  It is your office procedure.

It is my intention to continue this series by offering a series of 24 articles, one each month, each dealing with a specific visceral syndrome. I will discuss symptoms and muscle contraction patterns and related structural problems that may have become chronic because the underlying visceral dysfunction has not been identified.

:dropcap_open:T:dropcap_close:here has been a flurry of discussion, speculation and even hard to believe health claims surrounding the supplementing of the amino acid L-arginine.

L-arginine is considered a conditionally-essential amino acid, meaning that it is not found in sufficient levels in the “normal” human diet. Amounts that produce the clinical effects suggested by research highlighted below must be received in supplement form.  In 1998 the Nobel Prize for physiology or medicine was awarded to three scientists for their discovery of the signaling properties of nitric oxide on the cardiovascular system.

L-arginine stimulates the natural production of nitric oxide (NO) in the cardiovascular system. The formation of nitric oxide is dependent on the action of endothelial nitric oxide synthase (eNOS) on its substrate L-arginine.¹ Nitric oxide’s enhancement of blood vessel compliance manifests its salutary effect in hypertension, decreased peripheral vascular resistance and enhanced cardiac function.^2,3 Downstream metabolites of nitric oxide improve vasocompliance and enhance capillary circulation, enhance inflammation control and cognitive function, and equilibrate neurotransmitter function.  Some research is indicating that nitric oxide might be one of the most important signaling molecules of the body.

This nitric oxide science went on to be used in the synthesis of the family of male enhancement drugs while the major natural heart health benefits were largely ignored.

NO concentrations are also known to decrease with advancing age.⁴ Food sources of L-arginine include wheat germ, oat flakes, cheese, cottage cheese, eggs, whole milk, chocolate, yogurt, pork, chicken and turkey and avocado.⁵

To date, L-arginine has been used primarily as a supplement to enhance muscle mass in athletes as well as increasing circulation.  More recently, in concert with other amino acids (including L-citrulline)⁶ and other nutrients, the more significant effects of nitric oxide health are becoming more evident.

The rationale behind recommending an L-arginine nutrient blend to patients is based on its ability to support optimal cardiovascular function and control inflammation, two very significant players in virtually every metabolic process in the body.

 

L-Arginine and heart health:  The Science

The benefits of good nitric oxide levels supported by sufficient intake of an L-arginine product include greatly decreased risk of a cardiovascular event. Endothelial damage is crucial for the progress of atherosclerosis; risk factors for atherosclerosis represent crucial factors associated with endothelial dysfunction. Patients with cardiovascular disease are characterized by impaired endothelial function and several agents have been proposed as potential modulators include antioxidants and L-arginine.⁷

:dropcap_open:L-arginine stimulates the natural production of nitric oxide (NO) in the cardiovascular system.:quoteleft_close:

Asymmetric dimethylarginine (ADMA) inhibits production of nitric oxide by competing with arginine for nitric oxide synthase binding. Since ADMA has been implicated as a cardiovascular risk factor in congestive heart failure,⁸ increased carotid artery intima-medial thickening,⁹ chronic kidney disease,¹⁰ L-arginine supplementation has therefore been indicated as a treatment in cardiac diseases.⁸

Nitric oxide synthase, the enzyme responsible for nitric oxide formation, has been found in the hypothalamus and pituitary gland itself.  Nitric oxide down-regulates the release of corticotrophin releasing hormone from the rat hypothalamus in vitro, suggesting its role in regulating the secretion of pituitary ACTH and of corticosteroids from the adrenal cortex. These results are direct evidence that endogenous NO significantly inhibits the HPA response to central stimulation under in vivo conditions.¹¹ In socially organized mammals, the predominating stressors are not physical events but arise from the immediate social environment. In laboratory rats, social stress inhibits the modulating nitric oxide effect on the corticotrophin releasing hormone-induced ACTH response.¹²

 

Summary:

Because the combination of high stress and suboptimal nutrition contributes to increased cardiovascular risk, the importance of reducing that risk with supplementation with L-arginine is even more advisable for our patients.  The science supporting the benefits of supplemental L-arginine is underscored by almost two decades of research and thousands of scientific papers and articles.  This humble amino acid, properly combined with a supporting blend of nutrients, can provide a very powerful tool to strengthen the body’s resistance to one of the highest health risks of modern day life.

 

Dr. Chinn is a 1986 Life graduate (Marietta) and has been practicing in Seattle for 24 years and is a board member of the Gonstead Clinical Studies Society.  He is the co-creator of the nutritional cardiovascular formula Acctrix, co-founder of Unisal Wellness Technologies and is the author of Symphony of Wellness and Soaring Beyond Fear.  His book Symphony of Wellness focuses on the science and benefits of L-arginine and nitric oxide for cardiovascular health.  He can be reached at [email protected].

Bob Anderson, M.D., University of Washington Medical School, is the founding president of the American Board of Integrative Holistic Medicine and an Adjunct Faculty Instructor at Bastyr University.  He is the chief medical consultant for Unisal Wellness and contributing advisor for Unisal Wellness. He is the author of several books, including Clinician’s Guide to Holistic Medicine, published in 2001.

 

References:

1.  Joshi, MS, et al.  Receptor-mediated activation of nitric oxide synthesis by arginine in endothelial cells.  Proc Natl Acad Sci U S A 2007; 104:9982

2.  Davies, SA, et al. Neuropeptide stimulation of the nitric oxide signaling pathway in Drosophila melanogaster Malpighian tubules.   Am J Physiol 1997; 273:R823

3.  Yin H, et al.   Nitric oxide mediates cardiac protection of tissue kallikrein by reducing inflammation and ventricular remodeling after myocardial ischemia/reperfusion. Life Sci 2008; 82:156

4.  Dumitriu IL, et al. [New insight into nitric oxide involvement in regulation of airways smooth muscle tone] in Romanian. Rev Med Chir Soc Med Nat Iasi 2007; 111:454.

5.  Braverman, ER, Pfeiffer, CC. The Healing Nutrients Within. New Canaan, CT, Keats Publishing, 1987  p. 169.

6.  Romero, M, et al.  Therapeutic use of citrulline in cardiovascular disease. Cardiovasc Drug Rev 2006; 24:275

7.  Tousoulis, D, et al.  Endothelial dysfunction: potential clinical implications.  Minerva Med 2010; 101:271.

8.  Visser, M, et al. The role of asymmetric dimethylarginine and arginine in the failing heart and its vasculature. Eur J Heart Fail 2010; 12:1274.

9.  Riccioni, G et al. Relationship between asymmetric dimethylarginine and asymptomatic carotid atherosclerosis. J Biol Regul Homeost Agents 2010; 24:351

10. Mihout F, et al. Asymmetric dimethylarginine (ADMA) induces chronic kidney disease through a mechanism involving collagen and TGF-β1 synthesis. J Pathol 2011; 223:37

11. Bugajski J, et al. Mediation by nitric oxide of the carbachol-induced corticosterone secretion in rats. J Physiol Pharmacol 1997; 48:277.

12. Bugajski J.  Social stress adapts signaling pathways involved in stimulation of the hypothalamic-pituitary-adrenal axis.  J Physiol Pharmacol 1999; 50:367.

Mental state or supplements for an improved performance?

There is little evidence to support the notion that we can take nutritional supplements and improve performance or increase strength in a significant fashion. In all likelihood, the mental state of the athlete is the deciding factor. An example of this was a placebo study that involved the perceived use of anabolic steroids. Wilmore and Costill describe this study in their exercise physiology text (1). Fifteen male athletes who had been heavily involved in weight-lifting for the previous volunteered for a weight-training experiment. They were told that those who made the greatest strength gains over the preliminary 4-month training period would be selected for the second phase of study in which they would receive Dianabol.

Six subjects were enrolled in the second phase of the study, which consisted of a 4-week period of training. At then end of the second phase, the strength gains achieved during the last seven weeks of the competition phase were compared to the 4-week placebo period during which the subjects thought they were getting the anabolic steroid. There was only a 2% improvement in strength during the last seven weeks of the competition phase compared to a 10% improvement in just four weeks during the placebo phase.

A personal example takes me back to my high school days. I was a high jumper and my best jump was 6’2” at the time of our county championships during my senior year. At that point I was working 3 nights per week to make money so I could pay for a bike trip that coming summer. A buddy and I decided to pedal from our town in New Jersey to Daytona Beach.

The night before the county championship I bussed tables for 8 hours until after midnight and only got about 4 hours sleep, which was highly irregular for me during my intensely heavy sleeping high school years. So I show up to the event too tired to worry about my performance and fully not expecting to do well, so I was relaxed, carefree and unattached to the outcome. To my surprise, and everyone else, I jumped 6’6”, won the championship, and was told that I cleared 6’5” by at least six inches.

If they only made bottles of “relaxed, carefree, and unattached to the outcome” pills, I would likely have done much better in other high school sports and probably often shoot in the low 70’s when I play golf now.

Eating better for performance?

:quoteright_open:Between games they would munch on various snacks, including soda, candy, chips, and the like.:quoteright_close:

A friend of mine helped to coach his daughter’s weekend lacrosse team. They would often play two games in a row and most of the girls on both teams were dragging by the middle of the second game. Between games they would munch on various snacks, including soda, candy, chips, and the like.

So, one season he changes the between-meal dining option to vegetables, fruit and nuts, and educates the girls and parents to similarly avoid the unhealthy elsewhere. By the third weekend, his team was plowing through the second game without fatigue, which was associated with more victories. I realize this is an anecdote, however, it is certainly worth a try and has overall health benefits that have been established.

Avoiding the pro-inflammatory state and reducing injuries?

Dyslipidemia has been associated with tendinopathy expression. For example, lipid deposition is known to occur in tendons, high cholesterol levels have been observed among individuals with Achilles tendon rupture, and the esterified fraction of cholesterol is elevated in biopsies from Achilles tendinopathy subjects (2).

In another study, anthropometric measures were determined in elite level volleyball players over the age of 18 with patella tendinopathy. Male players with a waistline of greater than 33 inches appear to at greater risk for developing tendinopathy. The authors state that the additional weight may excessively load the patella tendon and also suggest that, “as waist girth is an accurate anthropometric surrogate for abdominal adipose tissue, free fatty acids and cytokines released by abdominal adipose tissue may have a role in tendon pathology” (3).

Whether due to excess body weight or increased inflammation, or both, maintaining appropriate abdominal girth appears to be important for male volleyball players looking to avoid patella tendinopathy. The fashion in which this may apply to other sports and types of injuries is not presently known; however, this should not stop of from getting patients to maintain appropriate abdominal girth.

The best operational approach to nutrition for athletes

A diet that is rich in nutritious foods, including vegetables, fruit, nuts, lean meat, fish, tubers, and certain seeds such as chia and hemp appears to be the best option. This approach reduces inflammation and prevents cardiovascular disease and diabetes (4). Supplements that help to reduce inflammation and support metabolism include a multivitamin, magnesium, fish oil, and vitamin D (5-9). Vitamin D may be of special importance for athletic performance, especially during winter months (10).

 

Dr. David Seaman is a Professor of Clinical Sciences at NUHS-St Pete and is a Clinical Consultant for Anabolic Laboratories. He has written numerous articles on the treatment options for chronic pain patients, with a focus on nutritional management.

He can be reached at [email protected].

References

1.  Wilmore JH, Costill DL. Physiology of sport and exercise. Champaign, IL: Human Kinetics. 1994: p.321-322.

2.  Gaida JE et al. Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc. 2009;41(6):1194-97.

3.  Malliaras P, Cook JL, Kent PM. Anthropometric risk factors for patellar tendon injury among volleyball players. Br J Sports Med 2007;41:259-63.

4. O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008;51:249-55.

5. Ames BN. Increasing longevity by tuning up metabolism. To maximize human health, lifespan, scientists must abandon outdated models of micronutrients. EMBO Rep. 2005;6(S1):S20-S24.

6. Church TS, Earnest CP, Wood KA, Kampert JB. Reduction of C-reactive protein levels through use of a multivitamin. Am J Med. 2003;115:702–707.

7. King DE, Mainous AG, Geesey ME, Egan BM, Rehman S. Magnesium supplement intake and C-reactive protein levels in adults. Nutr Res. 2006;26:193-96.

8. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233:674-88.

9. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(suppl):1080S-86S.

10. Cannell JJ, Hollis BW, Sorenson MB, Taft TN, Anderson JJ. Athletic performance and vitamin D. Med Sci Sports Exerc. 2009;41(5):1102-10.

My New Year’s Resolution—Is Now the Time to Build or Elevate My Practice with Nutrition? A Clinical Nutritionist’s Expectation

A majority of your patients committed themselves to a health related New Year’s Resolution on January 1st. Studies show they will implement a nutrition or exercise program in the next 3 months as a result of their desire to improve their health. Are you and your staff ready to grab a piece of this multi-billion dollar industry yet? Most likely, if you’re a chiropractor in America, you will eventually have to incorporate a multitude of services to leverage your practice, just to be able to survive. Due to insurance cutbacks, shrinking income, and a genuine desire to be a well-rounded holistic practitioner, chiropractors are aggressively searching for new clinical services and approaches to wellness to Incorporate into their practices. In the next decade, I predict that the chiropractic profession will continue to emerge as major providers for wellness and nutritional therapies. Recently, I see more chiropractors incorporating lifestyle counseling and long term (behavior modification) nutrition programs into their practices for their patients, in addition to providing nutritional supplements and detoxification therapies that many offer now.

:dropcap_open:I predict that the chiropractic profession will continue to emerge as major providers for wellness and nutritional therapies.:quoteleft_close:

Having trained over 700 physician practices with Lifestyle counseling programs in the past 20 years, I have experienced many changes within the chiropractic profession. Chiropractors (and most medical professionals) are getting frustrated with insurance company cutbacks and are now aggressively diversifying their practices with nutrition. Nutritional supplement companies heavily market to chiropractors and, as a result, many are becoming vitamin dispensers. Network marketing companies jump at the chance to incorporate chiropractors as their distributors, since many see a high quantity of weekly patients and are looked at as “wellness” providers by their patients. Also, chiropractors, compared to most health practitioners, have a good business sense about them and often are natural “marketers”. The challenge with any medical professional is to have a balance between your patients’ clinical needs and your practice’s business needs, with effective patient outcomes based on valid research.

Looking at the multitude of health practitioners in America, chiropractors have been well trained in musculoskeletal, and neurophysiology systems of the human body, which naturally provides a strong clinical foundation to be able to run with nutrition in your practice, if you desire to do so. With advanced nutritional training and certifications available, many chiropractors have obviously specialized in nutrition with their chiropractic practices to be able to have an edge on their competition.

Generally, practitioners have varied nutritional approaches to nutritional counseling, and many are continuously looking for the next “magic bullet”, especially your patients! Traditional medical doctors predominantly use medications, appetite suppressants, B12 injections, meal replacements, and bypass surgeries to promote weight loss and disease management. Also, many MDs provide their patients with generic pharmaceutical diet sheets. DOs, like chiropractors, have traditionally been trained to incorporate physical medicine and obviously some holistic nutrition and conventional pharmaceutical approaches to weight loss and disease prevention. Acupuncturists and naturopaths specialize in homeopathy, herbal and energy medicine with some physical medicine and incorporating an Eastern Medicine philosophy. Lastly, personal trainers have incorporated nutrition counseling in their services, often focusing on supplements and a basic elementary “diet” with stringent food restrictions for fat reduction and weight loss, usually with little emphasis on disease prevention or management.

The 2011 Whole Food Approach to Holistic Nutrition Counseling Based on Evidence-based Research

Which health practitioner in the US now effectively specializes in Holistic nutrition counseling using real food as it pertains to disease prevention and weight loss with a program that addresses the relationship that individuals have with eating? Commercial weight loss companies have turned this into a multibillion dollar industry; the average cost to lose 20 lbs. is $1,000-$1,600 in America. Nutri-System, Jenny Craig and now many “medical” programs focus on delivering packaged foods to patients for weight loss that are filled with preservatives and additives that are contra indicated for wellness and disease prevention. Programs that just focus on point counting and food restrictions may create a psychological hardship which typically increases hunger and cravings and could lead to food dependency or even a food obsession over time. Dietitians, such as myself, are traditionally trained to focus nutrition counseling with food and teach patients how to scientifically and intuitively eat. The traditional dietetic training has a conventional approach rather than a homeopathic, complimentary approach to counseling and, in the past, did not incorporate many of the holistic philosophies that chiropractors often recommend for their patients. However, many dietitians, chiropractors, and physicians have advanced their training through certifications and courses to include homeopathic, nutraceutics, and detoxification and energy medicine, which I feel has its place with nutritional counseling for many patients in America and will have a positive effect on patient outcomes in practice income.

Our philosophy is as a result of private counseling with patients in our clinics, and consulting with doctors nationwide. We incorporate a proprietary metabolic analyzer and software that your assistant, CA or a “wellness coach” can customize a sliding scale nutrition and exercise program based on the patient’s metabolic rate, age, height, weight, lean mass and activity level for weight loss, gain or maintenance. Our focus is to manage patient blood sugar swings effectively, without having to count carb grams, food groups or calories or providing unnecessary food restrictions. Managing blood sugars effectively usually decreases hunger, cravings, or fatigue. Our program can accommodate most patient or physician philosophies, such as Atkins, Zone, Paleolithic, Fibromyalgia or even the HCG diet protocol.

We also provide clinical protocols for hyperlipidemias, pre-diabetes, metabolic syndrome, fatty liver disease, sports nutrition, pain management, chronic fatigue, migraines, etc., which incorporate conventional and alternative approaches, including specific nutritional supplements and quantities recommended to help manage medical or nutritional challenges naturally.

The key to motivating your patients to embrace changing their eating habits and adopting a new lifestyle is to provide 4-12 weekly nutritional sessions that spell out in detail what and why patients should eat at home, in restaurants, or while traveling or entertaining. For our patients, we provide specific weekly goals, shopping lists, simple recipes, menus and the specific name brand foods that we recommend for each and every patient based on their food preferences, lifestyle, medical/nutritional needs and budget.

Lifestyle counseling programs based on patients’ eating real food are significantly less expensive to the patient, more profitable for the doctor, and market very well in today’s economic climate. Many of the chiropractors that we have consulted feel that patients like to eat whole healthy natural food and appreciate not being obligated to purchase diet products. Also, they feel focusing on long term lifestyle changes is personally rewarding to the doctor and effectively builds loyal, happy, referring patients within their practices.

 

Christopher Fuzy, M.S., R.D., L.D., is the Founder of PhysicianWellnessProgram.com, has a Master’s Degree in Clinical & Sports Nutrition, and has offices in Ft. Lauderdale and Boca Raton, FL. Over the past 20 years, he has trained over 700 physicians nationwide in the implementation of his Lifestyle Nutrition Counseling Program®. For more information or to try your own nutritional program, visit www.PhysicianWellnessProgram.com or call 1-800-699-8106.

Provide Far-Reaching Benefits Using a Lifestyle Nutrition Counseling Program

by Howard Berg, D.C., C.C.S.P., and Christopher Fuzy, M.S., R.D, L.D/N.

 

As chiropractors, most of the nutritional counseling programs we offer our patients focus on nutritional supplements. Occasionally, meal replacements or packaged foods are recommended. Go to the weight management section in your local yellow pages. Everybody is advertising medications, packaged foods, meal replacements or expensive, network marketing weight loss and detox products. Typically, our patients would buy those products and/or foods; they would lose some weight, eventually stop taking the products, and then gain that weight back, plus some.

Some of our patients have tried menu-planning web sites that send recipes and general menus weekly. But a recent study, performed by the University of Pennsylvania’s Department of Weight & Eating Disorders Program, found that these “one-size-fits-all” meal plans are not that effective. The study, published in the Obesity Research Journal, followed forty-seven women over the course of a year.

The women were provided one year of intensive motivational menus, e-mails (two to three times per week), articles, food recipes, food journals, calorie-logging and exercise suggestions. The results of the study found that the internet counseling participants only lost about four percent of their body weight after one year of counseling. The authors concluded, “These findings suggest that consumers are unlikely to achieve clinically significant weight loss by using internet programs that provide primarily information about diet and physical activity.”¹ We are learning that face to face individualized health risk assessments, office-based nutritional counseling and wellness programs are more effective and generate significantly more nutritional referrals than internet based nutrition counseling programs.

Personalizing Nutritional Seminars & Corporate Wellness Programs Using Health Risk Assessments

Nutritional Workshops can be a great tool for driving new patients to your door. Who doesn’t want to lose weight? With a little leg work, a power-point presentation that reviews, and an effective program that can deliver accurate, individualized nutrition counseling and health risk assessment to groups or individuals, the process can be fairly simple. Effective workshops can be done either in your office, locally at hotels or corporations, at community gatherings or at local small businesses.

You can use a power point presentation that corresponds to the client’s health risk assessment report. First, you distribute the Health Risk Assessment forms to all your attendees at the beginning of the workshop. By reviewing each page, while the clients have reports that provide specific lifestyle recommendations, it will make them feel that the seminar is individualized for them. This is the most personalized way to deliver nutrition counseling and health risk assessment to groups. Also, any reports you provide to your clients should carry the practice name and phone number on it, to make follow-up office appointments for chiropractic or nutrition counseling.

The Secret of Generating Significant Chiropractic Referrals to Your Practice

Here’s the secret! You must offer something to the community that your competition is not. In this time of financial awareness, people are looking for more value for their dollars. If you can offer customized and personal nutritional programs to each patient, that has been validated by the University of Southern California, without selling nutritional products and giving them unrealistic food restrictions, and still get results—you will be very busy!

One of the keys will be to provide a program, based on the patient’s food preferences, metabolic rate, age, height, weight, lean mass and activity level. You can be assured that the patients will get the clinical results they are looking for—without hunger or fatigue. When you provide a program which is based on education and long-term behavior modification techniques, and your patients are seeing results, your office will be flooded with referrals.

You can teach your chiropractic assistant to do quick Health Risk Assessments and patients will jump at the opportunity to receive one. The Consumer Center for Public Interest (CSPI) conducted a study, which showed the average commercialized weight loss program in America costs from $960 to $1,600 per client to lose 20 pounds. These programs were not physician supervised and, generally, patients regained the weight they had lost after they stopped buying the nutritional products.

Depending upon your market, you can charge anywhere from $395 to $495 for a four to six session package of individualized weekly nutritional sessions, or approximately $295 per client, for group workshops that focus on eating real food. This means, that you can offer a program, based out of your office that costs less than one-third of the national average for a nutrition/weight-loss program. When your patients see the value of this, not only will they be more likely to participate, they will be more likely to refer, as well.

 

 

Howard Berg, D.C., C.C.S.P., graduated from Life Chiropractic College in 1997. He holds certifications as both a Golf Fitness Instructor and Yoga Instructor. Dr. Berg is the owner of Island Chiropractic and Wellness Center, located on St. Simons Island, Georgia.

 

Christopher Fuzy, M.S, R.D., L.D., has a Masters degree in Clinical & Sports Nutrition and undergraduate degrees in nutrition and chemistry and has implemented and trained over 700 physicians nationwide with the Lifestyle Nutrition program in the past nineteen years.For more information or a Practice Consultation, go to www.PhysicianWellnessProgram.com or call 1-800-699-8106.

Reference

1. Obesity Research Journal, 2004 Jun;12(6):1011-8.

The Truth about Weight Loss and Obesity

by Dr. James P. Cima, D.C.

 

Why Diet and Exercise Do Not Work and How Our Profession Can Spear-Head the Obesity Epidemic

How many patients and or loved ones do you treat where there is a direct correlation between their weight and their physical condition(s)?

There are many instances when patients come into my office where their weight is the largest contributing factor to their physical impairment and yet a lot of doctors will not address this issue. Even when you address this issue as delicately and politely as possible, do you create a nutritional program to improve their weight control? If not, then you are losing a very lucrative portion of your practice.

If you are not addressing this issue, either by omission or commission, then you are not giving the patients what they really need and desperately want.

This is an epidemic where people are paranoid because they have such issues with their weight. How many times do you hear, “Can’t eat this,” or “Have to eat that even though I hate it.” You go out to a fine restaurant and instead of enjoying yourself, you either feel guilty by what you ordered or deprived by what you did not order.

Why? Because people are obsessed with their weight and they do not know the truth and are misinformed about weight control, and the statistics bear this out.

In 1962, the Centers for Disease Control (CDC) research statistics showed that the percentage of obesity in America’s population was at 13 percent. By 1980, it had risen to 15 percent; by 1994 to 23 percent; and, by the year 2000, the obesity progression in America had reached an unprecedented 31 percent!

Web MD states that:

• 58 million people are overweight.

• 40 million people are obese.

• 3 million people are morbidly obese.

• 80% of type II diabetes is related to obesity

• 70% of cardiovascular disease is related to obesity

• 42% of breast and colon cancer diagnosed among obese individuals is related to obesity.

The U.S. Surgeon General, Richard H. Carmona, stated in a report on July 16, 2003, that, “These overwhelming research statistics reveal an alarming obesity trend, the need for diagnosis, and a call to action.” (The Surgeon General forgot to mention the musculo- skeletal degenerative damage due to this epidemic that we see daily.) The two leading culprits perpetuating the epidemic of obesity are the food and the weight loss industry. The food industry is continually pushing calorie dense foods loaded with fat, white sugar, salt, and chemicals that not only put pounds of fat on our bodies, but are addicting as well. The only thing growing faster than the epidemic of obesity is the weight loss industry. We have diets, exercise programs, and weight loss Guru’s now more than ever. So why are we a nation of overweight and obese people? Because of all the garbage and nonsense that they are feeding us, literally!

The purpose of this article is to arm our profession with sensible and sound nutritional principles that will allow us to deal with this epidemic. If we, as a profession, do not seize this opportunity, others will, and it will threaten the health and economy of this nation. In this article, I will be addressing the questions that most of my patients ask about the principles of weight control.

Why does “losing weight” not work?

It is because weight loss is not only the wrong target or goal but it is unhealthy. If your goal is to lose weight, then I can almost guarantee you that you will fail and damage body chemistry. In fact, I can bet that after you lose your weight it will come back and you will have gained more weight than you lost. The biggest problem for most people is that they are fixated on achieving some number on the scale…. You get on the scale and, if you do not like the number, your day is ruined…. Sound familiar? The truth is the only one who knows how much you weigh is you, nobody else cares. Life isn’t a carnival or circus where people guess your weight. They have no idea how much you weigh, but they DO know what you look like. If you look great, you get complimented; they never ask how much you weigh. So, if your target is weight loss, then you are shooting at the wrong target and you can never do the right things to achieve the body and health you always wanted to achieve.

What should my target (goal) be if I want people to compliment my physical appearance?

The answer is simple: it’s body composition! What is body composition? It is looking at the composition of what the body is composed of, which is water, fat, and lean tissue (muscle). You see, when you lose weight through fad diets and exercise programs, you never take into account that your weight loss (especially at the beginning) is mostly lean tissue (muscle, organ, gland and bone) and water and very little fat. Depending on what type of diet(s) and exercise(s) you engage in over time can speed up this process where you continually increase the fat composition of your body until it is almost too late. You have stalled your metabolism and your body fat content has gone through the roof. Now you look for a simple fix to a complex problem as you go to the next huckster for the next con game. So, it is not how much weight you lose, it is what you lose. Now you can see why weight loss does not work and is the wrong goal.

When your goal is body composition, you must have the proper nutrition to fuel, repair and rebuild your body so those percentages stay healthy

What are healthy body composition percentages?

If we were to look at the healthy percentages of what your body composition should be composed of, it would be this:

1. Water makes up about 50-60% of your body weight

2. Lean body tissue makes up from between 30-40% of your body weight and is composed of your organs, glands, muscles, bones, and integument. (THE CALORIE BURNING CAPACITY OF YOUR BODY)

3. Body fat should make up 10-20% of your body weight. This fat is important for the production of your skin, cell membranes, protection of your organs, brain and nervous system, energy storage, and lymph production.

4. Minerals and carbohydrates account for 1-2% of your body weight.

How can I master my body composition?

Through the secrets of metabolic stimulation! If you can master your body composition, you will never have to worry about your weight and how you look again! Once you learn the secrets of metabolic stimulation to change and improve your body composition, you will be able to eat more and create the body you always wanted. The secrets of metabolic stimulation will be explored through the next three segments of this article.

 

For more information about this program, contact Dr. Cima at 1-877-627-2770 or visit www.cimasystem.com.

Docosahexaenoic acid (DHA) is an omega-3 fatty acid that is an important structural element of the central nervous system and retina. The need for DHA may be most critical for brain and eye development from conception through the second year of life. Significant brain growth occurs during the third trimester of pregnancy and through the first two years of life. This is a time of rapid accumulation of DHA over EPA in an infant’s brain.

Supplementation with DHA, whether from fish oil or algal oil vegan sources, has been shown to increase DHA levels in both the blood and milk of pregnant women.^3,4,5 Therefore, although DHA supplementation is indicated in anyone who does not eat fish regularly; it is especially important for pregnant and nursing women and their infants to support structural development of their babies’ brain and eyes.

 

Benefits for Breastfed Babies’ Brains

The children of mothers who received DHA for the first four months of breastfeeding were tested and compared to the children of mothers who consumed a placebo with results as follows:

• At 2.5 years of age, they were found to have enhanced psychomotor development.⁴

 • At 4 years of age, they showed improved intelligence scores.⁶

• In their fifth year of life, they performed better on some sustained attention tests.⁷

DHA Current Intakes and Recommendations

• The average intake of DHA by pregnant or nursing women in the U.S. is about 54 mg/day.⁸

• While a daily value for DHA has not yet been established, expert panels have recommended at least 200 to 300 mg DHA/day for pregnant and nursing women.^9,10

• Although there are no official intake recommendations for DHA in children, studies showed that actual intakes are far less than adequate for optimal growth and development. While most experts recommend at least 100 to 150 milligrams of DHA for kids per day, actual intakes appear to be closer to 20 to 50 milligrams per day only.¹¹ Dietary DHA sources include foods such as salmon, tuna, and other fatty fish. A 3 oz serving of salmon provides about 600 mg of DHA.

• The FDA and EPA have advised pregnant and nursing women to avoid certain fish due to mercury levels, and to eat up to 12 ounces per week of a variety of fish and shellfish that are lower in mercury.¹²

• DHA from agal oil (MartekTM) offer a vegan, environmentally sustainable and toxin free alternative to fish oils. This DHA source accepted as GRAS (Generally Recognized as Safe) by the U.S. Food and Drug Administration for use in infant formula.

Synergistic Considerations

Omega-3 fatty acids are polyunsaturates (PUFA) and, as such, are highly liable to oxidation. Therefore, coincident supplementation with vitamin E, a lipid antioxidant, is to be strongly considered. Also, as fatty fish is a major source of dietary vitamin D, inclusion of vitamin D in the supplementation schedule is also to be strongly considered in those supplementing with fish oil, partly because they do not frequently consume fatty fish. At the same time, vitamin A intake is to be limited because of its teratogenic potential. For vegans, meat and fish are major sources of folic acid and vitamin B12, so supplementing these as well, may be important. Indeed, as neural tube defects occur early in pregnancy, folate status is an important consideration in all fecundate females.

Delivery Forms

Fortunately, today there are many ways to supplement DHA. Formats include small easy to swallow capsules, gummies, ready to mix powdered drinks and inclusion in foods like OJ and yogurt. Some of these formats also provide vitamins D, E and/or folate and B12.

Closing Remarks

As doctors of chiropractic, we are especially concerned with the optimal function of the nervous system. As such, given the important time window for optimal DHA supplementation in the fetus and infant and its relation to brain development, it behooves us to consider sharing this information with our female patients of childbearing age.

Dr. John H. Maher is co-founder of BioPharma Scientific and creator of “The SuperFood Solution™: Lifelong Wellness Made Easy” (www.superfoodsolution.com). He can be reached by email at [email protected].

Part 2 of a 2 part Series (cont. from part 1 in nov. 2009)

Abstract:  Detrimental effects of drugs on nutrition status are a common occurrence but, because they usually occur over time (vs. what is considered an adverse event or allergic reaction, which occurs quickly), they are seldom recognized or corrected. Chiropractic treatment, however, takes place over a much longer time frame. Because of this, doctors of chiropractic are in a unique position to recognize the interactions of medication and nutritional status and, if knowledgeable in the area of drug induced nutrient depletion, they have an opportunity to help their patients recover nutritional adequacy and restore metabolic homeostasis.

Thiazide Diuretics:  Hydrochlorothiazide (HCTZ) depletes magnesium, zinc, CoQ10 potassium and sodium. Side effects of the drug include the development of back pain, anxiety and leg weakness. And long term, it can even contribute to development of Type 2 diabetes. The depletion of magnesium alone can lead to all of the above-mentioned side effects. CoQ10 depletion significantly impacts energy production in cells because it is needed to shuttle carnitine into cells. Since heart cells are very dependent on that constant source of energy, CoQ10 depletion can really affect the heart, in addition to other large muscles. People experiencing CoQ10 depletion will often have noticeable muscle weakness. For example, I have had patients report much more difficulty getting up off the floor or even out of their chair.

I make it a regular practice to put any patients on HCTZ for high blood pressure on magnesium and CoQ10 at the very least; however, it is best if a multi vitamin includes some zinc and that they eat a high potassium diet. The CoQ10 is especially important to prevent the development of congestive heart failure, the very problem you are trying to prevent from the high blood pressure for which this drug is used.

Antacids
Proton Pump Inhibitors (PPI’s) such as Prilosec (omeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), and Protonix (pantoprazole) have long been known to deplete vitamin B12 and folic acid. The H2 blocking drugs like Tagamet (cimetidine) and Zantac (ranitidine) also deplete B12 and folate in addition to vitamin D and, because this category of drugs reduces stomach acid, it affects the absorption of the minerals, calcium, iron, and zinc.

These are the second leading category of drugs sold in the United States. While these drugs were intended only for short-term use, many people remain on these drugs for years without monitoring vitamin D status or other symptoms. Studies have now clearly shown a link between use of these drugs and increased risk of osteoporosis. In fact, PPI’s now actually carry a warning that they can cause osteoporosis. Typically, women are considered to be a greater risk of osteoporosis; but the studies found that these drugs also dramatically increased the risk in men, as well. So, it is important to be on the lookout for both men and women who are at risk of developing osteoporosis through long-term use of this category of drugs.

Oral Contraceptives
Oral contraceptives, likewise, cause significant chronic nutritional imbalances. In the past, we warned women that oral contraceptives depleted B vitamins, including folate, vitamin C, magnesium, selenium, zinc, and the amino acid tyrosine. Newer studies have found that oral contraceptives also deplete CoQ10. While it is well known that young women need to replace folate after being on birth control before trying to get pregnant, to prevent neural tub defects, it has been my observation that many young women undergo mood changes after going on oral contraceptives, in addition to noticing that they are very tired. Several studies have reported that the B6 depletion results in depression because of the reduced synthesis of serotonin in a subset of women. However, these depletions can lead to a host of problems including anemia, cervical dysplasia, bleeding gums, lowered immunity, and elevated homocysteine.

It has been discussed that these nutrient depletions were observed in older studies in which higher dosages of hormones were used. While I have noticed the effects of lower dosage birth control are not as pronounced as they used to be in the higher hormone dosage pills, depending on the woman’s nutritional habits prior to starting the pill, they can still have significant side effects.

The contraceptive Yaz (ethinylestradiol + drospirenone) gets tremendous interest from women and huge ad dollars. This medication has been approved in Europe long enough that the Belgian government financed post-release impact studies. Yaz causes a relative deficiency of zinc by causing accumulation of copper.7 Other contraceptives are also noted to cause a less severe accumulation of copper, but are better known for the depletions I mentioned above, as well as the disruption of the metabolism of the carotenes and tocopherols. Specifically, oral contraceptives frequently result in depletion of beta-carotene and gamma- (although not alpha-) tocopherol.8 Depletion of these important anti oxidants could increase a person’s risk of any of the diseases related to increased internal inflammation such as heart disease and cancer.

These are just a few examples of how important it is to consider drug actions on metabolism. Doctors of chiropractic are in an enviable position, because they can stop the downward spiral in their patients’ health by counseling on drug-induced nutritional depletions and, in so doing, can build patient trust and satisfaction. While this endeavor will require professional supervision of a carefully considered program of nutritional supplementation, appropriate care for nutritional balance will greatly enhance the ability to deliver the results patients expect and deserve.

 

Dr. James B. LaValle is a clinical pharmacist and board certified clinical nutritionist. He is co-founder of the LaValle Metabolic Institute and an adjunct professor of pharmacy practice at the University of Cincinnati College of Pharmacy and University of South Florida College of Medicine. He is the author of 16 books and has 25 years of clinical experience in pharmaco-nutrition and therapeutics. Call 1-513-366-2127 for more information.

We, as chiropractors, should begin or continue our thinking process into as many natural healing avenues, so that we can become known as the natural healing source in our communities. We should be known as the “go to guy” when a patient or community member has any question concerning what he or she has been diagnosed with. We should be the primary physician when it comes to treating all types of health related situations through the usage of natural techniques and nutritional materials.

You are sitting on a gold mine of an untapped profit center in your office. Let me give to you a simple example. You walk into your favorite grocery store and look around. Every available space on every aisle is filled with food and related products that make money for the grocer. Your local grocery store is filled with hundreds of individual profit centers all under one roof.

Look around your office. Do you have available space to open a new profit center in your office—a profit center that could and will help every patient that comes through your clinic doors? Of course you do. I began years ago bringing in a nutritional profit center, just by putting up three shelves over the CA’s desk. Now, we have shelves everywhere ,with hundreds of products that we sell to our patients as well as through our website. My rationale for bringing a nutritional profit center into my office was the following: Every patient that walks into my office has other health concerns besides spinal problems: allergies/high blood pressure/diabetes/hormone imbalances/overweight/stress/thyroid, just to name a few problems. And there are many more. With your in-house nutritional center, you can offer sound nutritional foundations and formulations for all these health problems.

What an in-house nutritional center can do for you

 

Here are various reasons why each and every chiropractor should consider adding an in-house nutritional center in their office. Remember, all that it will take is a few shelves and nutritional supplements:

• Expand Your Services to Each and Every Patient

• Show the Patient that Their Doctor Has the Finest Nutritional Products on the Market Today

• Sending Patients to the Health Food Store Gives Extra Revenue to the Store, Not to the Doctor

• Sending Patients to the Health Food Store Ends in Noncompliance on the Part of the Patient. They May Even Pick up the Wrong Product

• Adds an Additional Revenue Stream to Your Practice.

• Capitalizes on The Wellness Boom by Positioning Your Chiropractic Practice as the Community Wellness Center

• You Can Private Label Your Nutritional Products, so that Your Patients Will Recommend Your Products to Others

• Retains Your Patients Longer. They Will Come Back to Purchase Professional Branded Products Not Available to the General Public.

The most simplistic way to begin to bring a nutritional center into your office is doing what I did about 15 years ago. I began to offer to my patients the most basic of nutritional product—the Multiple Vitamin. I can guarantee you that almost every patient and person that you see is taking a multiple vitamin. My question to you is, did they get this vitamin supplement from you? It can be that easy. After finding success with a multiple vitamin you can begin to bring into your practice common popular nutritional products. These could include an emulsified Vitamin D, an All Natural Vitamin C, a Joint Repair Formula to give to all your joint related cases from accidents to sports injuries, a CoQ10 for cardiac health, a fish oil supplement, a cholesterol lowering supplement and many more. Start slow; learn more and then bring more into your nutritional profit center. A few months after the success that you are having, you can become more objective with your nutritional recommendations. You can begin to analyze blood tests for their nutritional deficiencies, and order saliva testing for hormonal imbalances and adrenal fatigue. You can take this profit center to any heights that you desire. Of course, we must never lose sight of our primary intention: to get our patient well. Unlike thirty years ago, when orthopedic supports and hot packs were the only extra profit center most chiropractors had, we now have an array of nutritional healing materials, as well as techniques available to us to offer to our patients.

Now you can become known as the community wellness center by bringing into your office an in-house nutritional center. A profit center for you = a healing center for your community.

by Stan Guberman, D.C.

Dr. Stan Guberman is a licensed chiropractic physician and a certified acupuncturist. He has been practicing clinical nutrition for over 30 years. He has developed many private labeled nutritional formulations used by 1000’s of chiropractors. He can be reached at 1-800-333-9942 or at his website, www.drguberman.com.