Specializing in Nutrition with Juanee Surprise, DC President of the ACA Council on Nutrition

Dr. Jiutnee Surprise is the President of the ACA Council on Nutrition, Immediate Past Presi­dent of the Chiropractic Board of Nutrition and the Chairperson of the Tex a s Ch i rap ra c t ic Association Committee on Nutrition. A regis­tered nurse and snmma cum laude graduate of Lite Chiropractic Col- lege. Dr. Surprise holds a Diplomate in both Nutrition and Pain Manage­ment and is a Certified Clinical Nutri­tionist. One of only 16 chiropractors to attain the distinction, .she is also a Fellow of the American Chiropractic College of Nutrition. For the past sev­eral years Dr. Surprise has taught postgraduate courses in nutrition, pain management, Thompson and Nimmo Techniques, practice management and chiropractic assistant programs for chiropractic colleges, state organiza­tions and nutrition companies. Active in community affairs, she is in private practice in Demon, Texas. In an interview with The American Chiropractor (TAC). Juanee Surprise (JS) discusses nutrition and chiroprac­tic from her special vantage point. TAC: Can you explain to us what your current position as President of the ACA Council on Nutrition entails, and, also, tell us a little about any past positions that you have had which have further developed your knowledge in the field of nutrition? JS: The ACA Council on Nutrition (CN) is one of several ACA specialty councils. According to the 2000 Job Analysis of Chiropractic, I 90.4% of chiropractors! utilize nutrition on 36.6% I of their patients; and I nutrition received a "very | important" rating for Importance of Adjunctive Care Knowledge Areas. | The CN is for doctors of 1 chiropractic and others j who have interest in the i topic of nutrition. | As president of an active organization with several hun­dred members I, with other elected Board members, direct and oversee the activities of the CN some of which are: • working with the ACA on matters of importance in nutrition, such as genetically engineered foods, legislation concerned with the use or practice of nutrition, and calci­ um to prevent osteoporosis, to name a few publishing our quarterly journal, Nutritional Perspectives, and our monthly newsletter procuring support from supple­ ment and lab companies in the form of advertising in our journal, on our website or at our semi­ annual meeting/seminar: prod­ uct/service discounts for our mem­ bers; other opportunities that arise from time to time organizing our semi-annual meet­ ing and seminar, which has 150 to 250 attendees special projects, such as commis­ sioning and funding of a nutrition­ al algorithm by a university for the purpose of helping to define the use of nutrition in clinical practice providing members with answers to specific questions on the topic of nutrition, through our lending library and other resources • assisting state associations and boards, where needed, with legis­lation As president, 1 am privileged to rep­resent the CN as a voting member of the ACA House of Delegates, and with media exposure such as this article. I also get to work directly with individu­als dedicated to helping patients through the use of nutrition, which is very rewarding. TAC: Can you tell us about the benefits to the chiropractor who is credentialed in the specialty of nutri­tion, and what it takes to obtain and maintain that status? Further, what is happening on the legislative front that chiropractors should be aware of concerning nutrition in the chiro­practic practice? JS: As of September 2000, the Ameri­can Chiropractic Board on Nutrition is no longer under the auspices of the ACA and the CN. This change was made so the Board could pursue National Certification and Creden-tialling Agency (NCCA) certification, which will give more credence to the Diplomate degree. It will take 18-to-24 months to achieve this certification. The first document, of over 300 pages, has been completed and will be sub­mitted shortly. To be eligible to sit the board exami­nation of the American Chiropractic Board on Nutrition, a doctor must: Be a chiropractor Have been in practice a mini­ mum of 2 years Attend and successfully com- plete a nutrition diplomate course with a minimum of 300 classroom hours, given by a CCE accredited college ! Submit 5 actual patient case histories, in proper format, which are then graded by 3 Diplomates, the scores aver- j aged, and a passing grade is a minimum of 80. Successfully pass, with a min­ imum grade of 80. a written examination. Successfully pass, with a min­ imum grade of 80. each part of a practical examination, con­ sisting of: A) a 12 station practical that includes oral and written questions on laboratory diagnosis, metabolic radi­ ology, treatment proto­ cols, etc. B) oral defense of the previ­ ously passed case histo­ ries. Once a doctor achieves Diplomate status, he/she must maintain the cre­dential by: Attending the semi-annual meeting and seminar, at least, every other year. In the "off year, one of the following must be done: Submit 2 case histories, in proper format for publica­ tion Submit an original article, in proper format for publi­ cation Teach in a chiropractic college Attend a course on a nutrition topic, given by a federally recognized col­ lege, with a minimum of 12 hours 3. Keep dues current. Why become a diplomate? While seminars and short courses on nutrition topics can be useful and provide good information, receiving a certificate for attendance is not the same as achiev­ing an academic degree. In addition to the obvious personal benefits of educa­tion and having a specialty degree, more patients are actively seeking the advice of healthcare professionals trained in nutrition. The practice of nutrition can only benefit the patient and, also, be an additional service pro­vided in a chiropractic practice. Then, too, many insurance companies look more favorably on services rendered by a doctor who has specialty educa­tion on top of their primary profession­al degree, which can help the patient afford the service. While the use of nutrition supple­ments, homeopathic medicine, and botanicals does not have the same potential for serious side effects as most drugs, there is still some risk, when used inappropriately. Risk, coupled with the economic impact of $9 billion dollars in annual sales, has started a movement toward only those with specialty educations or degrees being allowed to give nutri­tional advice. So, even though nutri­tion has always been a part of chiro­practic education and used in clinical practice, it is possible that, without an additional specialty degree, the time may come when chiropractic doctors are not allowed to practice nutrition. In my opinion, this would be a traves­ty, since nutrition presently belongs to the profession. We have been using nutrition to help sick people get well and enhance the effects of the chiro­practic adjustment, while most health care professionals have not even believed improved nutritional status to be an important part of the health equation. TAC: Please explain the two schools of thought in nutrition with regard to whole food and synthetic-based vitamins; and, what are the benefits and/or limitations of each? JS: Let's face it. We should not have to supplement our diets. However, farming, processing and storing prac­tices have greatly depleted the nutrient content of our foods. Lifestyle factors, such as smoking, alcohol and drug misuse, stress, and lack of time to properly prepare food, place additional burden on obtaining adequate nutri­ents. Chronic problems caused or aggravated by nutrient insufficiencies, such as cardiovascular disease, adult onset diabetes, fatigue and obesity, are rampant. Nutrition supplementation has become a must. In nutrition, there are those that believe, and have research to show, micro doses of nutrients in the amounts found naturally in food and, therefore, supplements made from whole foods have the most benefits. This group believes macro dose, labo­ratory-manufactured nutrients to have greater potential for side-effects, and that supplements containing these man-made nutrients are actually toxic to the body. : There is the other school, which ; believes macro doses of nutrients are the fastest, most efficient, frequently less expensive way to treat nutrient insufficiency. They, too, have research showing benefits in patients with insufficiency. Most of these manufac­tured nutrients are still considered "natural" because they are derived from natural substances, such as corn. or have small amounts of a whole food ! substance added to the product, so the label can say it contains whole food. An example of this is a vitamin C made from crystalline ascorbic acid, with some rose hips added during the : manufacturing of the tablets. I This debate between the two schools of thought has been going on for sev­eral decades and will continue, unless one group can prove, beyond a shadow of a doubt, that its method is the best. Chromatograms of a whole food ver­sus a crystalline pure manufactured molecule do show a difference in the molecule. Are these associated intrin- 1 sic factors, found in whole lbod based supplements, as important as some believe? This is one issue every doc­ tor who uses nutrition in practice needs to study and understand. • ' Continued on Page 14 ...from I'ufic 12 Personally, I started out practicing the micro dose, whole food theory, because this was what my mentor practiced. Patient compliance was fre­quently a problem, due to cost, or when they had to take multiple tablets of several products on a daily basis. As I learned more, I switched to using mega dose products. Now, after 20 years of practice, I find times when one method is better than the other for a particular problem or patient, and choose the products based on patient needs. Most frequently. I use a combi­nation of the two theories, since, in my opinion, there is a time and place for both. Speaking of nutrition companies and products, not all are equal. How long has the company been in business? Do they have a pharmaceutical license? Do they encourage tours of their facili­ty? Who formulated the products, and on what scientific basis? There are some basic manufacturing principals good companies use such as: A. Raw materials are quarantined, until they have been tested for identity and strength, and to be sure they are free from chemical and microbial contaminants. B. Is the best form of the nutrient used, and is it put into the best method for administration (tablet, capsule, etc.)? C. Disintegration tests show the tablet actually breaks down and releases the nutrients. D. The equipment used in manufac­ ture is cleaned thoroughly between batches. E. Samples of the product are tested during and after manufacture to be sure it meets the requirements for size, weight, hardness, shape and amount of ingredients. F. Records are kept on each step of the manufacturing process, and the end product labeled, so the records can be accessed, if need­ ed. The company should be able to provide these records upon request. G. The product actually contains what it says on the label. When buying nutrition supplements, the better products will cost more because there is cost associated with following good manufacturing princi­pals. It is false security to buy an inferior product because it is cheaper. However, some supplements are very expensive due to the price structure levels, not the quality of the product. Dr. Juanee Surprise can be reached at 1100 Dallas Drive. Ste. 122, Den-ton, TX 76205. Phone: 940-566-0000; Fax: 940-565-6655: e-mail: [email protected]