Adding Dietary Advice and Supplements to Your Practice--The "Baby Step" Method

C hiropractic theory de-scribcs the human body as a self-healing, self-regulating, and self-organiz­ing entity that only needs to be free of nervous system irritation or interference to do its job. What most of us have either forgotten, or were not taught, is that the nervous system is pro­foundly influenced by the nutritional status of the in- dividual. For example, tissue nociceptors that innervate nearly all spinal structures are powerfully activated by the chemical mediators of inflammation, such as pros-taglandin E-2, leukotrienc B-4, bradyki-nin, cytokines, and many others. Once activated, nociceptors can cause pain, create visceral symptoms, and alter segmental muscle function, signs that we commonly as­sociate with sublux-ation. Most of us have also forgotten, or were not taught, that our diet detennines the de- gree to which our body produces inflam­matory chemicals. In other words, we can, basically, eat ourselves into an inflamed and subluxated state. Obviously, if our diet promotes sublux-ation, then part of the correction of sub-luxation should be nutritional. By defini­tion, the healing process involves the resolution of inflammation, and this can­not happen if our diet is inflammatory. In other words, the processes of self-heal­ing, self-regulating, and self-organizing cannot occur in a perpetually inflamed state, or in a nutritionally deprived one. In short, the average American diet creates inflammation due to certain di­ etary excesses, reduces tissue healing due to nutrient deficiencies, and compromises mental and psychologi- cal function due to nutrient deficiencies. Despite what many think, correcting these problems is very simple. You do not need an MS or PhD in nutri­tion or biochemistry to make the basic, and extremely im­portant, nutritional changes that you and nearly all of your patients need. Practical Dietary Applications The first thing you need to do is get your patients to eat less grain. Tell your patients that they need to substitute the letters "ee" for the "ai" in grains, and what you end up with is "greens." I am not going to go into the details of why hu­mans should avoid grains; there is sim­ply not enough space in this article. In a nutshell, grains represent a new food for the human biological system, to which we have yet to adapt. Grains (bread, pasta, desserts, most packaged food) contain excessive amounts of pro-inflammatory omega-6 fatty acids, gluten (to which many are sensitive), lectins that inflame and damage the gut, and deficient amounts of key nutrients such as vitamin C, A, B-12, and beta-carotene.1 A small amount of grain is not a problem for most, but it becomes problematic when relied upon extensively. The Food Pyramid, for example, suggests that we get 6-11 serv­ings of grain per day. There is no good evidence for this quantity of grain con­sumption. Most of us would do much better if we were to replace pro-inflamma­tory grains with anti-inflammatory fruits and vegetables. Believe it or not, most people do not need to make numerous nutritional changes. It boils down to dropping the grains, drinking water instead of soda and the like, and eating more fruits and veg­etables. Practical Supplement Recommendations-The Multivitamin/Mineral Let's say that you currently do not stock supplements in your office. Per­haps you tell patients to get supplements from the local health food store or phar­macy. In fact, it makes much more sense to carry supplements, for at least three basic reasons. First, it is important to know who is making your supplement and if it is a reliable manufacturer. Second, you can in­crease your income by providing a needed ser­vice for your patients. Third, there is good data to suggest that most people need a multi-vitamin/mineral supplement. Providing a multi-nutrient supplement is a good place to start. Several compa­nies that market themselves to the chiro­practic profession manufacture good supplements, and offer numerous prod­ucts; but, if you are new to nutrition, start with a multiple. Consider the following information, which is quite compelling. Many of you reading this article are over 50, or you have patients who arc over 50 years of age. Evidence is begin­ning to emerge suggesting that anyone over the age of 50 should seriously con­sider taking multi-vitamin/mineral. It is now stated, in no uncertain terms, that "inadequate micronulricnt intake among older adults is common, despite the •in­creased prevalence of fortified/enriched foods in the American diet".2 We are not talking about people in their 90's. In this eight-week double-blind, placebo-con­trolled clinical trial that examined how a multinutricnt would impact on micronu-trient status, plasma antioxidant capac­ity, and cytokine production, the subjects ranged in age from 50-87 years. All were characterized as healthy, free-living older adults already consuming fortified diets. The authors concluded that, "supple­mentation with a multivitamin formulated at about 100% Daily Value can decrease the prevalence of suboptimal vitamin sta­tus in older adults, and improve their mi-cronutrient status to levels associated with reduced risk for several chronic dis­eases."2 The same author examined how a multvitamin/mineral supplement would influence homocysteine levels in adults ranging in age from 50-87 years, who al­ready consumed a folate-fortified diet.' After an 8-wk. period, subjects taking the supplement had significantly higher B-vitamin status and lower homocysteine concentration than controls (P: < 0.01). Plasma folate, B-6 and vitamin B-l 2 con­centrations were increased 41.6%, 36.5% and 13.8%, respectively, in the supple­mented group; whereas, no changes were observed in the placebo group. The mean homocysteine concentration decreased 9.6% in the supplemented group (P: < 0.001). while no changes were observed in the placebo group. There were no sig­nificant changes in dietary patterns dur­ing the trial. The authors concluded that a multivitamin/mineral supplement can im­prove B-vitamin status and reduce plasma homocysteine concentration in older adults already consuming a folate-fortified diet. In another double-blind, placebo-con­trolled trial, Chandra4 examined whether supplementation with vitamins and trace elements in modest amounts might influ­ence cognitive function in apparently healthy, elderly subjects. The study in­cluded free-living men and women over 65 years of age, who were randomized to receive a supplement of trace elements and vitamins or a placebo for 12 months. Cognitive function was determined by assessing immediate and long-term memory, abstract thinking, problem-solv­ing ability, and attention. The supple­mented group showed a significant im- provcmcnt in all cognitive tests, except long-term memory recall. Those whose blood-nutrient levels were below the ref­erence standard showed lower responses on cognitive tests. Chandra concluded, "This has considerable clinical and pub­lic health significance. We recommend that such a supplement be provided to all elderly subjects, because it should significantly improve cognition and, thus, quality of life and the ability to per­form activities of daily living. Such a nutritional approach may delay the on­set of Alzheimer's disease."4 While I was unable to find similar arti­cles for people under age 50, my experi­ence with assessing nutrient status in the diets of people in this age group sug­gests that there are similar deficiencies. Many studies, indirectly, suggest the need for most of us to, at least, take a multiple-nutrient supplement. Consider that a recent study explained that food "fortification substantially increased the intakes of all nutrients examined, except calcium, in all age/gender groups but, especially, children". As it turns out, breakfast cereals provided most of the fortified nutrients. "In numerous cases, fortification was responsible for boost­ing median or25"'-percentile intakes from below to above the RDA".5 Fortification represents the addition of nutrients to foods that have been proc­essed. Basically, they add a cheap multi-vitamin/mineral to processed foods. This means that an enormous segment of our population already takes a multinutrient supplement; it is just incomplete. Why not provide them with a good supple­ment instead? Despite what many hear about the medi­cal profession, many are involved in pre­vention, and many take multivitamin/min-eral supplements. For example, in one study involving pharmacy students, re­searchers found that 47% of 692 students take supplements.6 More recently, a ran­domly sampled mail survey of 4,501 fe­male medical doctors revealed that 50% took a multivitamin/mincral supplement.7 Clearly, many pharmacists and medical doctors believe that they need supple-ments-perhaps because they know their diets are deficient, and/or because they believe the RDA's are low. and/or they believe that additional nutrients may have a disease-preventing effect. Conclusion If you are new to nutrition, start with baby steps. Drop the grains, and replace them with greens and other fruits and vegetables. Drink a half-gallon of water per day. And, finally, add a multivitamin/ mineral to your diet. Within one month, you will feel like a different person. David Seaman can be contacted at 4326 Market St., Ste. #100 Wilmington, NC 28403, or by email at docCwLessPainBetterGolf.com. References Cordain L. Cereal grains: Humanity's dou­ ble edge sword. World Rev Nutr Diet 1999; 84:19-73. 2. McKay DL. Perrone G. Rasmussen H. Dallal G. Hartman W. Cao G. Prior RL. RoubenofTR. Blumberg JB. The effects of a multivitamin mineral supplement on micro- nutrient status, anlioxidant capacity and cytokine production in healthy older adults consuming a fortified diet. J Am Coll S'uir 2000 Oct:19(5):613-21. McKay DL. Perrone G. Rasmussen H, Dallal G. Blumberg JB. Multivitamin/mineral sup­ plementation improves plasma B-vitamin status and homocysteine concentration in healthy older adults consuming a folate-for- tified diet. ./ Smr 2000 Dec:L30(l2):3090- 96. Chandra RK. Effect of vitamin and trace clement supplementation on cognitive func­ tion in elderly subjects. Nutrition 2001 Sep;17(9):709'-12. Bcrncr LA. Clydesdale FM. Douglass JS. Fortification contributed greatly to vitamins and mineral intakes in the United States, 1989-1991. ./.Yho-2001; 131(8): 2177-83 d. Ranclli PL. Dickerson RN. White KG. Use of vitamin and mineral supplements by phar­macy students. Am ./ Hosp Pharm 1993: 50(4):674-78. 7. Frank E. Bendich A, Denniston M. Use of vitamin-mineral supplements by female physicians in the United States. Am J Clin Nuir 2000; 72:%l>-~5. _