Reducing inflammation with nutrition enhances patient care and health outcomes.

Every doctor of chiropractic encounters patients with some form of inflammatory disease. The clinical manifestations of chronic inflammatory diseases are staggering, and may include (but are not limited to) neuromusculoskeletal presentations, visceral disorders, and even certain degenerative neurological or metabolic diseases.

Clinically, in addition to vertebral subluxation, patients with an underlying chronic inflammatory disease may present with myofascial trigger points, fibromyalgia and myofascial pain syndromes, headaches, disc herniations, spinal joint pain, arthritis, and osteoporosis; post-traumatic and postsurgical pain; irritable bowel syndrome, digestive and intestinal disorders, heart disease, and menstrual pain; Alzheimer’s disease; and cancer.^1,2

The DC is uniquely qualified to appreciate the vital role of appropriate nutrition in reducing the devastating effects of inflammation associated with various stages of vertebral subluxation and subluxation degeneration. DD Palmer theorized as early as 1895 that inflammation was an essential characteristic of all disease processes associated with the displacement of anatomical structures.^1,3 Components of current chiropractic clinical models of vertebral subluxation complex include analysis of kinesiology, neurology, myology, connective tissue physiology, angiology, inflammatory response, anatomy, physiology, and biochemistry.⁴ Because chiropractors are intimately concerned with the preservation and restoration of health without the use of drugs or surgery, nutritional support for subluxation correction or reduction remains completely consistent with traditional chiropractic approaches to health and healing.

The Role of Nutritional Support
A review of some of the important research findings and current clinical nutrition applications underscores the essential role of appropriate nutritional support for inflammation associated with subluxation and spinal degeneration. Joint hypomobility, myopathology, and histopathological changes such as articular cartilage degeneration and the onset of degenerative arthritis are associated with inflammation due to the accumulation of pro-inflammatory eicosaniods, physiologically active substances derived from arachidonic acid (an omega-6 fatty acid).^1,5-9 Eicosanoids include prostaglandins, leukotrienes, and thromboxanes. Other pro-inflammatory substances such as increased lipid accumulation in chondrocytes and increased free radical formation are also implicated in the onset of degenerative arthritis.^1,5-9

Inflammatory and nociceptive mediators (such as cytokines, prostaglandins, leukotrienes, thromboxanes, nitric acid, histamine, and bradykinin) are produced by infiltrating macrophages and resident cells of injured tissues (histiocytes, fibroblasts, myofibroblasts, endothelial cells, and chondrocytes).^10,11 These biochemical abnormalities characterize the pro-inflammatory and nociceptive components of herniated discs and arthritic joints.^1,10,11 Needle biopsies of the fluids and cells of myofascial trigger points were found to contain pro-inflammatory and nociceptive serotonin, bradykinin, and hyaluronic acid.¹² Fibromyalgia syndrome is associated with increased arachidonic acid levels, dehydration, and a pro-inflammatory diet.²

Other investigators have implicated prostaglandins (PGE2) with cancer,^1,13-16 heart disease,^1,17 osteoporosis,^1,18 and Alzheimer’s disease.^1,19 Inflammatory mediators also appear to drive pathological processes such as rheumatoid arthritis, degenerative joint disease, irritable bowel syndrome, lupus, post-traumatic pain, headaches, and menstrual pain.²

Sadly, the modern American diet, with its unhealthy emphasis on proteins, saturated fats, sugar, refined and processed carbohydrates, and fast foods, has done little to help reduce inflammatory conditions. In fact, it appears to have caused the problem, with diet-related obesity and its related diseases now in epidemic proportions in the United States. According to one expert, obesity is only second to cigarette smoking as a leading cause of death in this country today, and it could become the leading killer as the obesity epidemic worsens and spreads through the world.²⁰ Statistics reveal an obesity rate of approximately 40%, with an overweight population pushing beyond 60% of the general population in the United States.²⁰ From a chiropractic viewpoint, our pro-inflammatory diet is a direct cause of autointoxication associated with subluxation degeneration.

An Anti-Inflammatory Diet
David Seaman, DC, a leading writer and lecturer in the area of clinical nutrition, strongly recommends an anti-inflammatory diet that emphasizes an increased intake of fresh fruits and vegetables (particularly green cruciferous vegetables) for phytonutrients, antioxidants, fiber, and omega-3 fatty acids (particularly alpha-linolenic acid); fish; and water for hydration and detoxification. Also, he strongly recommends a decreased intake of meats, grains, sodas, and dairy products to reduce tissue acidity and pro-inflammatory mediators, particularly arachidonic acid.^1,21

According to Seaman, grains, flours, breads, pastas, cereals, muffins, and desserts contain an excessive amount of pro-inflammatory omega-6 fatty acids, which are essentially devoid of the anti-inflammatory omega-3 fatty acids; increase tissue acidity; and contain gluten and lectins (to which many people are sensitive), which inflame the gut and promote systemic disease.^1,21 Specially labeled omega-3-rich eggs provide a healthier alternative to standard commercial-grade eggs.^1,21 Seaman also recommends supplementing an anti-inflammatory diet with modest amounts of flaxseed oil, omega-3 fatty acids, and fish oils that contain generous amounts of eicosapentaenoic acid and docosahexanoic acid.^1,21

Patients with joint pain and inflammation should also avoid nightshade plants (tomatoes, potatoes, eggplant, peppers, and tobacco).² Smoking lowers pH; causes vasoconstriction; decreases nutrition to tissues; decreases venous perfusion of tissues, allowing metabolic acids and wastes to accumulate; creates a heightened sympathetic state and a heightened perception of pain; and slows healing time.^2,22 Increased acidity leads to increased respiratory rates as the body attempts to neutralize the toxicity, and over time, this process leads to demineralization of bones and the onset of osteoporosis.^2,23,24 Dehydration further exacerbates pain and acid-toxicity levels.^1,2

Many patients who suffer from advanced stages of inflammatory subluxation degeneration may also need additional help in the form of nutritional supplementation. Glucosamine sulfate acts as an effective chondroprotective agent, and methylsulfonylmethane (MSM) acts as an effective natural analgesic and anti-inflammatory agent, particularly when taken in combination.²⁵ Reconstituted hyperimmune milk protein concentrate acts as an anti-inflammatory agent, promoting relief from joint pain, joint stiffness, and immobility associated with osteoarthritis, and may be more effective than glucosamine sulfate.²⁶

Effects of Dietary Deficiencies
High levels of free radicals in inflamed joints may contribute to the incidence of rheumatoid arthritis (RA). One report found that RA patients consumed significantly lower amounts of vitamin A and beta-carotene compared with healthy subjects. It also found that RA patients had significantly lower blood levels of vitamin E and two antioxidant enzymes normally synthesized by the human body: superoxide dismutase and glutathione peroxidase.²⁷

Vitamin D deficiencies, particularly in older women, appear to increase the risk of developing RA. Vitamin D is a potent regulator of calcium homeostasis and may have immunomodulatory effects. One report found that increased vitamin D intake from either foods or supplements lowered the risk of developing RA by 33%.²⁸

Low vitamin C intakes may be associated with the risk of developing inflammatory polyarthritis. One report found that low intakes of fruits, vegetables, and vitamin C tripled the risk of developing inflammatory polyarthritis in comparison with subjects who ingested higher levels of those nutrients.²⁹

Clearly, pro-inflammatory dietary patterns create tissue acidity, skeletal degeneration and pain, and drive a host of other inflammatory diseases. Chiropractors are in a unique position as health care professionals to make important corrective nutritional recommendations to our patients that will enhance the benefits of the chiropractic adjustment and assist in achieving a greater positive clinical outcome. Seaman appropriately calls incorporating the benefits of sound nutritional anti-inflammatory counseling with chiropractic care protocols “the nutritional adjustment,”^1,21 and he views a chiropractic adjustment to be incomplete without the appropriate nutritional component.³⁰

His point is well-made. Chiropractors who do not incorporate anti-inflammatory dietary and nutritional recommendations into their patient-care protocols most likely find that patterns of chronic vertebral subluxation and subluxation degeneration are not responding as well as they would like to chiropractic adjustments. The vast amounts of information available in the literature on nutrition can be overwhelming and sometimes contradictory, but chiropractors who want to learn more about applying sound nutritional principles to their patient-care protocols can start by studying the excellent resources that many of our chiropractic colleagues, particularly those cited in this article, have made readily available in print, online, or in postgraduate continuing-education courses.

The bottom line for many, if not most, patients is that a more plant-based diet, increased hydration, and appropriate nutritional supplementation will help arrest progression of the devastating effects of chronic inflammatory diseases, including those associated with subluxation and spinal degeneration. CP

Gerald A. Anzalone, DC, of Hudson Valley Neck and Back Care, Peekskill, NY, has been in practice for 8 years. He is a writer and lecturer about health care issues and conducts CE classes. Anzalone can be reached at janzalonedc@hotmail.com.

References
1. Seaman D. Nutritional adjustment seminar. New York Chiropractic College: Seminar notes, 2004.
2. Bloom L. The neurology of pain and its clinical application. New York Chiropractic College: Seminar notes, 2004.
3. Keating JC, Cleveland CS, Menke M. Chiropractic history: a primer. Davenport, Iowa: Association of Chiropractic History; 2004:8.
4. Lantz CA. The subluxation complex. In: Gatterman MI, ed. Foundations of Chiropractic Subluxation. St. Louis: Mosby; 1995.
5. Tiku ML, Liesch JB, Roberston FM. Production of hydrogen peroxide by rabbit articular chondrocytes: enhancement by cytokines. J Immunol. 1990;145:690-696.
6. Tiku ML, Shah R, Allison GT. Evidence link chondrocytes lipid peroxidation to cartilage matrix protein degradation: possible role in cartilage aging and the pathogenesis of osteoarthritis. J Biol Chem. 2000;275: 20069-20076.
7. Cotran RS, Kumar V, Collins T. Robbins’ Pathologic Basis of Disease. 6th ed. Philadelphia: WB Saunders; 1999:1-112.
8. Liebenson C. Pathogenesis of chronic back pain. J Manip Physiol Ther. 1992;15:299-308.
9. Cramer G, Fournier J, Henderson C. Degenerative changes of the articular processes following spinal fixation. J Chiropractic Education. 2002;16:7.