Offering nutritional supplements makes for synergy when combined with chiropractic care

Nutritional supplements and chiropractic make for a natural partnership. For this reason, nutritional supplements are becoming an integral part of the chiropractic office. There are plenty of options for doctors who want to incorporate nutrition into their practice. There are companies offering both doctor and patient educational resources including seminars, publications, and informational tools.

Chiropractic Products asked three nutritional supplement experts for advice on how best to include this secondary profit center: Daryl DeLuca, vice president of Biotics Research Corp, Rosenburg, Tex; Christopher Katke, senior director of marketing and cofounder of Metagenics, San Clemente, Calif; and Joe Oneal, CEO of Progressive Laboratories Inc, Irving, Tex.

What advice do you have for chiropractors offering nutritional supplements for the first time?

DeLuca: Stay in your comfort zone. Look at your own capabilities and the scope of your practice. Consider products and protocols that fit. As your knowledge and nutritional expertise expands, you can expand the nutritional aspects of your practice accordingly. Remember, the whole idea is to improve the health of your patients.

Katke: Nutritional support for healthy muscles and connective tissues complements chiropractic care and has a proven track record of improving patient outcomes. Examples include metabolic detoxification, support for healthy body composition, gastrointestinal function, blood sugar metabolism, hormone balancing, and many other areas of synergistic benefit.

Are nutrition seminars recommended for chiropractors with a nutrition secondary profit center? If so, what topics do you recommend for new and current chiropractors offering supplements?

DeLuca: For those just getting started, there are good seminars on functional assessments offered by organizations, such as the Nutritional Therapy Association (NTA) and Health Resource Center. Those who obtain training for certification in applied kinesiology learn how nutritional protocols can improve patient outcomes. The Council on Nutrition offers a terrific certified program leading to a Diplomate in Nutrition designation. There are other organizations as well, such as CRA Educational Resources with years of experience teaching techniques that rely on nutritional interventions. For those with an interest in laboratory evaluations, Balancing Body Chemistry and Nutritional Information Services both offer courses in evaluating blood chemistries. Many courses mentioned offer CE credits as well.

What new FDA regulations or legislation should chiropractors be aware of?

DeLuca: The FDA and FTC are taking a hard look at promotional activities from supplement companies and the claims being made. Many companies have clearly stepped over the line. A major area of concern to the FDA is cross-contamination of products with allergens. For example, some people have a life-threatening allergy to peanuts. Therefore, products produced on equipment used to produce products containing peanuts should be labeled as such. Make sure your supplier manufactures products in a facility designed to prevent cross-contamination.

Oneal: In October, the New York Times reported that the FDA is beginning its evaluation of supplement labeling to provide standardization for consumers. Knowing a trustworthy manufacturer is the key for reliability and replicable results. Labeled ingredients can be misleading with potencies that are misrepresented from what is actually provided in the product and may even vary with each capsule. This is an important consideration when patients ask why the products you recommend in your office are any different than something they find on a retail shelf for a lower price.

What should chiropractors be wary of when shopping for a nutrition company?

DeLuca: First, only use suppliers that are primary manufacturers. They are the only ones with complete control over the manufacturing process—quality costs money. It costs to validate raw materials, finished products, and expiration dates. It also costs to perform in-process testing and to establish and maintain hazard analysis of critical control points (HCCAP). Be wary of synthetic ingredients and chemical reactions of two or more compounds. They are not squeezed from bushes, trees, and vegetables.

Katke: A basic obligation of any nutritional company is to provide customers with efficacious formulas based on authentic research and true science and manufactured with verifiable quality control. Testing for quality, potency, and freedom from contaminants—from incoming raw materials to outgoing finished products—is essential to guarantee effectiveness and safety.

Oneal: Stability is represented not only by how long a company has been in business, but by the satisfaction level of its customers and how well they stand behind their name. The wording you want to see on the product description is the designation manufactured by, not manufactured for or distributed by, which probably means it went to the lowest bidder and you may be compromising purity. The law requires one of these three statements to be prominently printed on the label, and if it is absent, be suspicious that the content may even be adulterated.

What should chiropractors expect from their nutrition supplement companies in terms of customer service?

DeLuca: Chiropractors should be able have questions answered quickly by qualified staff, including reasonable technical support that falls within the guidelines of DSHEA. Remember, with very few exceptions, suppliers cannot make claims regarding the treatment, prevention, or mitigating of a disease.

Katke: Companies should have numerous levels of support for their clients, starting with highly trained, knowledgeable field representatives, who can save you time by training your staff and keeping you abreast of the latest in nutritional science and natural health care developments. Research and development is also an important component of customer service that is often overlooked.

Oneal: There is a basic checklist of key points to consider: reasonable shipping costs, courteous and knowledgeable account representatives, dependable order processing and products, and the newest products on the market.

How can chiropractors attract new patients with supplements? How profitable is it for chiropractors?

Oneal: Word-of-mouth and consistent results are the two primary factors that drive a thriving practice. This is the same whether the regimen is chiropractic adjustments or nutritional support. When patients get well, they tell others.

With the influence of positive media attention, nutrition is fast becoming a patient expectation. Doctors who use this trend to their advantage and provide sound protocols to relieve complaints will almost automatically generate revenue.

How important is patient education with nutritional supplements? What kind of educational materials do companies offer?

Katke: Today, people want to understand their treatment program. Quality patient educational material makes for happy and compliant patients. Companies can offer anything from framed wall posters to patient brochures and patient educational sheets. Some offer a full range of educational slide shows.

Oneal: Patient education is synonymous with informed decision. Some companies offer doctor support that is also directed to patient comprehension, such as newsletters with referenced articles on targeted topics of nutritional importance. Doctors should provide these in their reception area (some bind them in a notebook) or use them as quick references in patient consultation.

What are the most common potentially lethal drug and supplement interaction?

Oneal: What often falls into the category of life-threatening interactions are the serious nutrient depletion caused by overuse of prescription and OTC pharmaceuticals, rather than reactions from taking drugs and supplements together.

Patients taking blood thinners such as Coumadin or Warfarin should be monitored on circulatory enhancers that dilate blood vessels like ginkgo biloba or vitamin E, especially before surgery. ACE inhibitors for heart patients can increase potassium, so supplement levels should be watched. Ironically, ACE inhibitors, such as Captopril also deplete sodium (disturbing the electrolyte balance) as well as zinc, which can lead to slow wound healing, lowered immunity, and loss of taste and smell. Studies have suggested a potential problem with products like Di-Gel® or Rolaids® containing aluminum hydroxide when combined with citrate supplements (vitamin C or even orange juice) in that aluminum levels in the body may rise and become a serious concern for those with renal damage. Conversely, long-term use of antacids for heartburn may cause deficiencies of phosphorus, calcium, and folic acid (new studies show a link to breast cancer development).

Preliminary studies show vitamin C may actually enhance the absorption of certain antibiotics like tetracycline. On the other hand, tetracycline used long-term can deplete calcium, magnesium, and zinc, and if given to teenagers can result in serious dysbiosis. Cholesterol lowering drugs like Atorvastatin (or Lipitor®) may react with high dosages of niacin or vitamin B3, which is also a cholesterol-lowering nutrient. This combination may result in severe muscle disorders. However, other studies have shown that niacin taken with Atorvastatin actually enhanced the action of the drug. It should also be noted that most of these reductase inhibitors for cholesterol result in dangerous shortages of coenzyme Q10, which further weakens the heart.

What do you wish to see happen in the nutritional supplement market?

Katke: I hope more companies will offer excellent nutritional tools to help customers redefine the meaning of good health and good health care, so people can experience good health as optimal human function and enjoy the best possible quality of life.

Oneal: Patients are taking a greater responsibility for their own level of health and wellness, especially as it relates to adequate nutrition. Harvard Medical School published a 1993 study showing that more than one-third of the American public made 425 million visits for alternative therapies, such as chiropractic and nutrition. By 1997, a follow-up study showed that the number of visits jumped to 629 million, which is a higher figure than all visits to mainstream medical doctors combined during that calendar year. Statisticians have extrapolated trends showing predictable probabilities for the future—once 50% of the population becomes convinced that natural approaches are valid, it takes less than 10 years to reach 95% saturation.

Julie Z. Lee is a contributing writer for Chiropractic Products.