50-100 Patient Visit Increase in 30-90 Days

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

The Challenge

A friend challenged me to write a one page blueprint article on increasing your patient visits by 50 to 100 visits in 30 -90 days. Since this sort of increase is typical of new CBA clients, I figured I’d give you my viewpoint on the topic.

Step One – Capacity

Decide what increase in patient visits you want and then add that to your current volume. Look this new number and figure out if your current facility can handle it. Who is holding what posts? How close to maxed out are the staff now and what would it be like at the new volume?

For prediction, you can use this simple tool. It shows the number of staff, weekly volume and minimum monthly collections

1 DC + 0 Staff = 50 pv/wk = $10K Month 1 DC + 1 Staff = 100pv/wk = $20K Month 1 DC + 2 Staff = 150pv/wk = $30K Month 1 DC + 3 Staff = 200pv/wk = $40K Month

These numbers tend to hold fairly true throughout the spectrum of various styles of chiropractic, however once a practice goes over 200 pvs, and depending on what post the owner doctor chooses to hold, the staff complement will vary.

This is only a tool. If you’d like help evaluating your practice against this guideline, call CBA and one of our consultants will go through it with you.

Hiring

If you determine you need to hire, start now. Chiropractors often fail to predict the amount of time it takes and the number of people you’ll interview/hire before you find one person to hire. Want to know how CBA clients hire? Read my article “How to Hire Staff” at: chirobizacademy.com/wordpress/

Assess the Capacity of your Space

Look at the space in your office compared to the volume you want. Do you have the necessary space and equipment for the increase? If so, great—if not, decide to either adjust your space/ equipment or settle for a smaller increase that will fit the office.

Step 2 –Current Procedures

First we will take up what you are already doing. This is a first line of action that can increase many clinics by 50 visits, alone.

How Well Are You Keeping Them? Look at your new patient procedures. Do you have an effective initial office visit and report of findings that is resulting in 90% or more of referral patients and 75% or more of all patients accepting your recommendations?

Are your recommendations exactly what you believe the patient should receive? Or are you basing it on something else such as insurance coverage or what you think they will accept or can afford?

Look at the rate of fall off in your clinic. This can often be hidden in a disorganized office. However, most doctors know roughly how often this is occurring. Most patients should be finishing your recommended plan.

Now take a look at the percentage of patients that resign onto maintenance care. CBA strategies often result in a resign rate for our clients that ranges from 70%-90%. CBA also teaches a procedure that will encourage every patient to return to your office for a checkup within a few months even if they don’t elect routine maintenance.

Do whatever it takes to address deficiencies in these areas, quickly.

Step 3 - Marketing

New patients into a practice is the gas pedal of the clinic. What will it take to hit your targets? Determine how many additional patients starting on care you’ll need to increase by the desired 50-100 visits. One way is to divide the increase you want by 3. This is assuming new patients start care at 3x/wk.

The other factor is how many weeks at 3x/wk. Let’s assume it’s 8 weeks. You then have 8 weeks to pump up the volume before patients who started in week one begin to decrease frequency. Take your desired visit increase (ie 50) and divide by 3. This is how many additional starts you need. Take that number and divide by how many weeks you want to put between you and your goal. To get a 50 visit increase in 8 wks you need 2.1 additional starts/wk.

Determine your New Patient to Patient start ratio over that same time period. For example, if you’ve averaged 3 starts per week off of 4 new patients, then you see how many more new patients you need in order to hit the starts target.

In our example above, if you determine you need 2.1 additional starts per week for 60 days to hit your target, then you would need 3 additional new patients per week. However, if you are mainly a referral practice, and you decide to start external marketing, it is important to realize that starting non referral patients onto care is more difficult, so you may want to build in a cushion, so let say you’ll need 4-5 additional new patients.

How To Get More New Ones!

Internal marketing is a great place to start. However, depending on your target, this may not be enough. CBA teaches many very effective internal and external strategies.

When it comes to external marketing, CBA clients have found it most efficient to train non doctors to this. However, unless a doctor is trained on how to manage this activity effectively, it can be a total flop. So, for many of our new CBA clients, we will teach them the most efficient external marketing they can do, without staff. This includes lectures, corporate massage events, and internet marketing.

For example, one massage or lecture event per week can generate an additional 5-10 new patients per week. So, for the doctor who knows how to do this, it can be an efficient way to spend a couple of hours.

So figure out your plan today and target out for a 50-100 visit increase in the next 30-90 days! CBA would be happy to help you plan out your expansion (in a free consultation), or just provide you with more info on our program. It’s up to you!

October through December is the best time to start working with CBA. This is because we can teach you our Incredible Holiday Promotion which has proven to increase practices by 50-100 visits per week in the months of January and February!

Learn more about the CBA program or our holiday marketing program. CALL 888-989-0855

Chiropractic Business Academy

Cervical Spine Kyphosis: Disc Degeneration and Spinal Cord Ischemia

Dan Murphy, DC—

Private Practice of Chiropractic;

Diplomate American Board of Chiropractic Orthopedist;

Faculty Life Chiropractic College West;

Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

Since at least the 1970s, chiropractors have been taught that cervical spine kyphotic angulation is associated with a number of adverse effects, including:

• Chronic muscular contraction stress as a consequence of mechanically shifting the center of mass of the head forward, requiring muscle contraction as an effective counter balance. This is well described in the writings of rehabilitation specialists Rene Cailliet, MD.¹
• The acceleration of degenerative disc disease. This is well described in the writings of radiologist Lee Hadley, MD,² and orthopedic surgeon Ruth Jackson, MD.³
• Spinal cord tethering, ischemia and dysfunction, and possibly demyelinating disease. This is well described in the writings of neurosurgeon Alf Breig, MD.⁴

In this current article, I will review two recent studies that supports these teachings:

Kyphosis One Level Above the Cervical Disc Disease: Is the Kyphosis Cause or Effect?⁵

Key points from Ozer et al 2007⁵ include:

1. Reversal of the cervical lordotic curve into a cervical kyphosis “can be due to degenerative, inflammatory, traumatic or neoplastic conditions of the cervical spine.”
2. Cervical spine kyphosis may be a factor in the development of cervical disc herniation and spondylosis.
3. “With a loss of the normal sagittal alignment in kyphosis, the weight-bearing axis shifts anteriorly, and constant muscular contraction is required to maintain upright head posture. Eventually fatigue and pain occur, and the kyphosis progresses. The anterior shift of weight onto the vertebral bodies and degenerated discs results in a vicious cycle of disc degeneration and the formation of vertebral osteophytes. Thus, kyphotic sagittal alignment may provoke further degeneration at the adjacent segment. The increase in weight born by discs at lower level(s) may also cause the nucleus pulposus to herniate or degenerate. In the case of cervical disc disease associated with kyphosis at one level above, instability and kyphosis may perhaps be the initiating event, which later may act as a factor in the development of disc herniation and degeneration one level below.” These concepts of muscular contraction and developmental discogenic degeneration are consistent with the writings of Cailliet, Jackson, and Hadley.
4. Uncorrected cervical spine kyphosis, especially if greater than 11°, can be associated with the following:

1. Cervical disc disease.
2. Progression of the kyphotic angulation.
3. The spinal cord becomes draped and flattened over the posterior aspect of the vertebral bodies, diminishing the microvascular supply to the spinal cord.
4. Adverse stretching or tethering of dentate ligaments and cervical roots.
5. “Direct neuronal injury and myelopathy with progressive deformity may result from both spinal ischemia and increased spinal cord tension.” These concepts are consistent with the writings of Breig.

1. Even mild cervical kyphosis may put the spinal cord at risk for histopathologic and vascular changes. “Maintaining normal cervical anatomy with its lordosis in this region of prominent movement may optimize the cord function.”
2. In kyphosis, “radicular symptoms and findings may develop secondary to foraminal narrowing from uncovertebral and/or facet joint hypertrophy.”
3. Kyphotic angulation one level above the level of cervical disc disease “may be a factor in the development of cervical disc herniation and spondylosis, rather than its result.”

Figure 1. Measurements of cervical spine segmental instability on the lateral cervical x-ray.

Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment⁶

Key points from Uchida et al 2009⁶ include:

1. “The kyphotic deformity associated with cervical spondylosis is the result of progressive subluxation of the apophyseal joints due to degenerative changes in the facet joints and discs.”
2. “In patients with kyphotic deformities, the spinal cord shifts to the anterior portion of the spinal canal and abuts the posterior aspect of the vertebral bodies at the apex of the deformity.”
3. “Dynamic forces caused by segmental instability, which is often seen at the level of kyphosis particularly in cervical flexion movement, contribute to compromised cord function.”
4. These factors are indicative of segmental instability, as determined by evaluation of the flexion lateral cervical radiograph:

1. Segmental anterior vertebral translation ≥ 3 mm in the sagittal plane.
2. Segmental anterior rotation ≥ 10° in the sagittal plane; this angle is constructed by the intersection of the lines drawn on the inferior and superior aspect of adjacent vertebral bodies.
3. Reversed dynamic spinal canal stenosis of ≤ 12 mm on the flexion film; this is measured as the distance between the posterior superior edge of the vertebral body and the anterior edge of the lamina from the segment above, in the flexion position.

1. “Loss of lordosis or kyphotic alignment of the cervical spine and spinal cord may contribute to the development of myelopathy, and in patients with cervical kyphotic deformity, the spinal cord could be compressed by tethering over the apical vertebra or intervertebral disc or by ossification of the posterior longitudinal ligament.”
2. Longitudinal spinal cord distraction is a possible factor in progressive spinal cord dysfunction, and this issue is “often discussed clinically in the pathophysiology of tethered spinal cord syndrome.”

1. Cervical flexion produces flattening of the small feeding vessels to the spinal cord. “If the kyphotic deformity continues, there may be progression of myelomalacia and spinal cord atrophy. Patients with long-standing kyphotic deformities are at risk for progression of myelopathy with resultant permanent damage to the spinal cord.”
2. “We conclude that the sagittal kyphotic deformity related to flexion mechanical stress may be a significant factor in the development of cervical spondylotic myelopathy.”

SUMMARY

These articles emphasize the adverseness of cervical spine kyphosis: accelerated spondylosis, spinal cord tethering and myelopathy. In addition, kyphosis often has concomitant cervical spinal instability as contributing to the myelopathy, and we should check for spinal instability in all patients with cervical kyphosis of greater than 10°. The information presented herein, indicates that cervical spine kyphosis is often a serious clinical finding, especially if greater than 10° of angulation.

REFERENCES

1. Cailliet R. Soft Tissue Pain and Disability, Davis, 1996.
2. Hadley LA, Anatomico-Roentgenographic Studies of the Spine, fourth printing, Charles Thomas, 1979.
3. Jackson R, The Cervical Syndrome, Thomas, 1978.
4. Breig A, Adverse Mechanical Tension in the Central Nervous System: An Analysis of Cause and Effect. 1978. Almqvuist & Wiksell International, Stockholm, Sweden.
5. Özer, Ercan MD; Yücesoy, Kemal MD; Yurtsever, Cem MD; Seçil, Mustafa MD; Kyphosis One Level Above the Cervical Disc Disease: Is the Kyphosis Cause or Effect? Journal of Spinal Disorders & Techniques 2007, Vol. 20, Issue 1, pp 14-19.
6. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi K, Baba H. Cervical Spondylotic Myelopathy Associated with Kyphosis or Sagittal Sigmoid Alignment: Outcome after Anterior or Posterior Decompression; Journal of Neurosurgery: Spine 2009; Vol. 11, pp. 521-528.

Chiropractic BioPhysics, Dan Murphy, DC, Instability Ligament Laxity

My Life As a Chiropractor: A Reflection for the Future

Gerry Clum, DC

President-Life Chiropractic College West

I am a chiropractor. The only career I ever considered was to be a chiropractor. At the age of twelve, a chiropractor inspired me with his person and his skill. My goal as a chiropractor, however mercurial, was for someone to tell me that my hands felt on their neck like the hands of my first chiropractor felt on mine. Chiropractic made so much sense to me and delivered so much good in my life that it gives me chills to think about it.

I loved the simplicity, the elegance and the art of a master-adjustor. I reveled in the person who embodied a spirit of healing that magnified the clinical skill of their profession. I was humbled by the perspective that the chiropractor was the instrument of the healing and not the healer.

I remember standing on the edges of a group of "old-timers" (people who were then the age I am now!) as they related the story of the most recent miracle in their offices. Like kids who had been admitted to a secret club they shared a fellowship that was infectious. They shared the knowledge and the experience of the power of an adjustment and the unfettered joy of providing the "signature gesture" of their life as a chiropractor.

As an educator in chiropractic I dreamt of providing students with a glimpse of that power, joy and enthusiasm. Obviously there were many building blocks that needed to be put in place to get to this point but this was the pay-off!

My first chiropractic mentor, Dr. Cameron Cassan of Port Colborne, Ontario, Canada so embodied every aspect of being a chiropractor that I was immediately captured and mesmerized. My second mentor, Dr. Sid Williams, expanded that spirit of dedication and service through what he related was a Lasting Purpose-loving, serving and giving out of a sense of abundance. In my youth both of these men were bigger than life. In time I realized, even they, had weaknesses and faults like the rest of us! They have been powerful teachers, role models and reference points throughout my life from before my first shave to today!

Along the way I developed my fair share of the arrogance and hubris that effective clinicians seem to have. Even though it has been more than 35 years since I made my living over an adjusting table I still have the thought, deep in my heart, when I see someone who is ill or less healthy then they should be, that it would all be better if I could just get my hands on their neck or their low-back, etc. There is a subset of that arrogance that speaks to the idea that while they may be under chiropractic care, they have not been under my care! This perspective is one of the things that make chiropractic practice and care so special, so personal for both the patient and the provider. It would seem that surgeons would likely share this same kind of point-of-view. I, for one, want my chiropractor or surgeon to have that kind of deep-seated personal perspective on their capacity and skill.

Fortunately one of the lessons I learned from Dr. Williams was about a "heart-hand and a business-hand". In a strange contradiction one was not to know what the other was up to but each informed the other. The business-hand tempered the irrationality of the heart-hand and the heart-hand personalized and humanized the business-hand.

It is easy and tempting to look back in time and romanticize. I remember early December 1970 preparing for Dr. Strang's final exam in anatomy and leaning back in my chair and asking my roommate, Dick Broeg, to feel free to kick me in the ass if at some point down the road I say this was easy! Romanticizing has a tendency to sweeten the good times and to gloss over the tough times. I am not contemplating a return to the "good old days" before licensure, before an infrastructure to support the profession was developed. I am however suggesting that we need a return of that youthful spirit of enthusiasm for our profession, a return to the pride in delivering a life-changing adjustment so potent that the people on both sides of that vertebra knew something tremendous had just occurred.

Whatever you want to say about 1970 and 2010 two things can be said with complete confidence, the basic needs of people haven't changed while the vehicles for them to address those needs have changed greatly. The concepts, language and metaphors we use today may have their roots in earlier times but they must be expressed in a voice reflecting the moment. I didn't need scientific literature as I thought about my career choices. I was my own study with an n of 1 and a great result! "Evidence" was how I felt when I got off Dr. Cassan's adjusting table. In a day of databases, algorithms, computer-modeling and outcome measures we need to be prepared to fill our business-hand with the currency of the moment.

In the past forty years we have moved from a position of all that mattered was how Sally or Sam felt as they got off the adjusting table to all that matters is the predictability of a population-based randomized controlled clinical trial. The pendulum has traversed the full range of its arc and is preparing to come back to the mid-point. We are beginning to appreciate the idea that the population study cannot tell you anything about the circumstance of the individual and that the circumstance of an individual is not a predictor of the experience of the population.

In our search for data we have run from the way it used to be toward a new order. One of the questions we didn't ask is “was the way it used to be bad or was it incomplete?” We assume the new order of things is better and in fact is good, but do we also fail to ask is it complete?

Being excited about chiropractic (not irrational, excited) and being enthusiastic about chiropractic (not illogical, enthusiastic) have been characterized in recent times as less than professional. Being data constrained (not informed, constrained) and being evidence-driven (not guided, driven) have become the epitome of professionalism. One extreme represents the triumph of the heart-hand, the other the supremacy of the business-hand. Neither is adequate by itself.

Forty years down this path I am still working on the balancing act. While I don't deliver chiropractic care over an adjusting table it has become my circumstance to provide it over the conference table. The goal of that delivery is to respond with the input of Dr. Cassan or Dr. Williams and their ilk in one ear and the input of a Dr. Haldemann or Dr. Triano and their ilk in the other-an informed and humanistic approach to the discipline.

My thanks to the American Journal of Clinical Chiropractic and in particular to Deed Harrison, D.C. for the opportunity to briefly reflect on the past forty years. My thanks and heartfelt gratitude to the men and women who have helped enliven these years, whether through support or challenge. My apologies to anyone along the way I have failed to listen to, appreciate, acknowledge or respect.

I can hardly wait for the next forty to unfold!

Life Chiropractic West

Guiding a Patient from Pain into Posture and Organs on Day #1

Fred DiDomenico, DC

Practice Coach and Mentor

INTRODUCTION

Until you have a system that can effectively teach your patients they are coming to you for full spine postural correction to improve overall health, the majority of your new patients come into your office for only pain relief. Spinal corrective techniques are only as effective as your retention. When a patient’s goal is merely pain relief they will not stay long enough for corrective techniques to work. Therefore, your technique is only as effective as your communication.

“Since working with Elite, we have instilled a thorough understanding into our patients that their postural abnormalities are more detrimental than just pain. Now our patients understand their postural abnormalities are affecting their nervous system, diminishing their overall health and decreasing their energy needed to accomplish their lifetime goals. Because of their new heightened understanding our volume has increased 20% and our income has increased $50K per MONTH!” Dr. Sandy Haas

We all know the spine functions as one unit. A problem in one area will affect all areas of the spine. For instance, it has been well documented that one of the most common causes of low back pain is a loss of cervical curve with a forward head posture. It is also well documented that abnormal posture and loss of curves, even forward head posture, causes many disease processes in the body. In Elite Coaching, the only true coaching system built around spinal rehabilitative techniques, we feel it is our responsibility to teach doctors the most effective communication tools to inspire a patient to pay for and perform EVERY step of a spinal rehabilitative program to improve their whole posture and overall health.

New Patient Tour of the Rehab area:

As you are escorting the new patient back to the exam room, your rehab C.A. gives them a unique, inspirational tour of the rehab area. There are scripted one-line inspirational benefits of each piece of rehab equipment that will teach your NP the uniqueness of your office, show them you help many people with conditions like theirs, build their confidence and trust as well as peak their interest in your clinic and services. At the finish of this tour the NP will already know you are different from anyone before you and have far greater value for your care.

“The New Patient Tour, as taught by Elite Coaching, has made the education of our patients so effective they understand why they need our office before they even meet the doctor! We have seen more referrals and increased collections as a result of the superior education that begins with the tour.” Dr. Sandy Haas

Pre-Consultation:

In 3 minutes you shift you NP from pain into posture. The scripts are designed to have the patient verbally agree o you that pain comes and goes, their posture is the bigger problem that can affect their organs and overall health. Organs and overall health are a MUCH BIGGER emotional priority over pain. You can shift their perspective in the first 3 minutes.

Prior to Elite Coaching I sold and defended Chiropractic. Meeting Dr. Fred and applying Elite Coaching systems has shifted me from the ‘sales’ perspective to a ‘coaching perspective. Helping coach patients beyond a pain focus to a postural and health focus makes practice more enjoyable. It allows me to truly provide long term spine and corrective care.” Dr. Brian Paris

Consultation:

After the pain to posture/organ Pre-Consultation we begin the 4 Step Consultation. It is in the consultation the patient will tell you, “I have more problems than I thought,” and “ I didn’t know my posture was affecting my health in so many different ways.” It is in this part of Day #1 that the NP will see that their pain is just a small sliver of the pie of their overall health. When performed in the systematic way it is taught, you will find their emotional reason to commit to a full corrective program for a reason MUCH BIGGER than their pain.

“It’s extremely exciting to watch the light bulbs in our new patient’s eyes when they make the connection between their posture and their health in the consultation.” Dr. David Rowe

Exam:

The Exam physically proves the consultation by revealing how their posture may be causing their health problems. The exam is a kinesthetic experience that turns facts into an emotional impression. They will FEEL their postural injuries and distortions and know with confidence that:

1. you know where their problem is;
2. you can provide a solution to their frustrations with their chronic health problems that no one has been able to show them or help them within the past. You will know how to create high value with high confidence.

“Since I’ve been in Elite, I have literally been able to transform my patient’s awareness of how their posture affects their organs and their overall health. Now I just coach my patients in reaching their health goals.” Dr. T. Bryant

These are some of the Day #1 steps, when performed properly, as trained in Elite Coaching, will produce high quality posture/organ thought based patients that pick you as their doctor from the beginning of their Day #1 experience. You will separate yourself from any other doctor and will deliver what they truly desire that no other doctor has shown them, better health with the most valuable system of health care on the planet, true spinal corrective care.

“Elite Coaching systems have taken me from a place of underselling chiropractic care into confidence with spinal correction, powerful communication teaching patients about posture and their overall health and maximizing the value and their emotional commitment to care. We have increased collections from $35K per month to over $100K per month consistently.” Dr. Josh Purcell

SUMMARY

If you would like to learn how to switch your patients from pain into posture, organs and overall health in your practice, please call Dr. Fred DiDomenico personally at 253-851-8353. Please visit our website at www.elitecoachingllc.com

Chiropractic BioPhysics, Elite , Elite Coaching

Resveratrol and Curcumin: Reversing a Paradigm

Dr. Lynn Toohey, Ph.D, Nutrition

Colorado State University in Ft. Collins, CO

Research Consultant NutriWest

INTRODUCTION

Very recent research has shed light on an age-old question of whether or not you should “boost the immune system” when an autoimmune condition exists. The theory is that if nutrients are increasing T cells, you want to avoid increasing them when you have an aberrant immune system that sends those T cells to attack self tissue. But why then, have nutritional supplements that are known to increase T cell activity also been able to have favorable effects on autoimmune conditions? This is a conundrum that is being elucidated by the fairly recent discovery (2005) of a set of helper T cells called Th17.

It is becoming apparent that the old paradigm of trying to shift T cell populations to predominantly produce either Th1 or Th2 to favor either immune or autoimmune conditions is an incomplete model. With the discovery of Th17, it has become known that this T cell is a master modulator, and that there is a new paradigm for looking at immune and autoimmune disease.

More on the intricate pathways of Th17 in future articles, however, suffice it to say that the huge strides being made in this area of research are reflected in two recent articles (currently in press) that studied the effect of two major nutritional influences (resveratrol and curcumin) on Th17.^1,2

The first article is “The regulatory role of resveratrol on Th17 in autoimmune disease”, and the second article is “Curcumin has bright prospects for the treatment of multiple sclerosis”^1,2, demonstrating by their titles that these nutrients have some interesting potential when it comes to influencing the immune system.

Reversing the paradigm:

Let’s go back to the conundrum of whether or not we should “boost the immune system” when an autoimmune condition exists. It depends. Looking at resveratrol first, it is clear from this emerging research that since resveratrol has the ability to both increase Th17 BUT ALSO increase regulatory T cells (called Tregs), that it can stand to have a profound effect both on the immune system AND autoimmune conditions. In fact, researchers have stated that:

“This review will focus upon the potential for the use of resveratrol, a natural plant compound that has already been shown to be a potent anti-inflammatory compound, as a complementary therapeutic for MS that increases the activity of Tregs, even though it also increases development of Th17.”¹

The article points out that Th17 cells are necessary for complete immunity because the cytokines that they produce are critical to the elimination of the pathogen. However, the activity of Th17 has to be balanced with development of the regulatory T cells (Tregs), or the immune system can stand to lose control. When activity of Th17 is excessive and not balanced by Tregs, there is increased risk for autoimmune disease.

“Therefore, in many autoimmune diseases, Th17 activity exceeds that of Tregs. Therapeutics for treatment of autoimmune diseases such as MS have focused upon immunosupporession, immunomodulation, or even immunoablation of effector cells such as Th17…very few approaches have attempted to therapeutically increase immune regulatory cells such as Tregs in the treatment of autoimmmune disease”.¹

Even though very few approaches have considered focusing on increasing regulation of the aberrant immune system in conditions like MS, that is exactly what these researchers are proposing: by studying nutritional influences such as resveratrol, which can influence regulatory T cells, there is a potential to reverse not only a paradigm of how we look at the immune cascade, but also to reverse a paradigm of how we look at treatment for an autoimmune cascade.

Hence the focus on resveratrol and the ability of resveratrol to increase regulation of the T cells that put the brakes on an over-reactive immune system. Now, let’s take a look at the other nutrient in focus, curcumin, and the other article also in press, “Curcumin has bright prospects for the treatment of multiple sclerosis”.² This second article points out that Th17 cells are considered as a key immunological player for the pathophysiological process of MS, and that curcumin significantly affects this pathway in a favorable manner.

Curcumin is another ingredient that is being considered for modulation of the immune system by way of its effects on Th17 and regulatory T cells. Curcumin has a lipophilic property, being able to pass through all cell membranes and the blood brain barrier (defects in the barrier are correlated to later stages of disease in MS). Through its various properties, including “anti-inflammatory effects, it may have a role in the cure of MS”.³

Researchers in the curcumin article by Xie² previously demonstrated that curcumin decreased the clinical severity of MS in the animal model, and decreased inflammatory cell infiltration in the spinal cord.

Good for nerves/immune system

We have established that resveratrol and curcumin hold great potential for immune regulation, and especially for an autoimmune disease such as MS, where the myelin of nerves is destroyed. In addition to the effects that these nutrients have on the autoimmune activity, these natural ingredients also support nerve health in general. For instance, curcumin’s overall effect on neuroglial cells has been described as “decreased astrocyte proliferation, improved myelogenesis (growth of new myelin sheaths around the nerve bundle), and increased activity and differentiation of oligodendrocytes”.⁴ It is working on many different levels, as does resveratrol. They both act as antioxidants and correctors of mitochondrial dysfunction too.

As another example, scientists have explored “other indirect pathways by which resveratrol can exert its neuroprotective abilities”, and they have discovered that resveratrol affects an important enzyme and is a “unique pathway by which this compound can exert its neuroprotective actions”.⁵ This means that there is more than one mechanism by which resveratrol is believed to exert favorable effects on nerves and the nervous system.

Other nutrients for nerves:

Sulforaphane is found in high concentration in broccoli sprouts. The Journal of Neuroscience reported that it activated an antioxidant response and “conditions neurons against oxidative insult”.⁶ Several sources confirm that sulforaphane protects the brain and brain neurons.⁷

Ginkgo biloba has been called a “neuroprotector”, and the action of protection is described as the ability of ginkgo to detoxify, act as an antioxidant, and normalize energy transfer in brain neurons.⁸

Quercetin is called the most important flavonoid by some, and in addition to many other biological benefits, quercetin “contributes significantly to the protective effects of neuronal cells from oxidative stress-induced neurotoxicity”⁹

SUMMARY

There are several nutrients that support nerve health, and now we know that evidence is emerging that several nutrients (such as resveratrol and curcumin) may even favorably influence the immune attack on the nerves in a condition like MS. Evidence is also accumulating that our perspective of how ingredients affect the overall outcome of the immune system activity is changing, and that we cannot simply say a nutrient “boosts the immune system” and should be avoided in autoimmune conditions for support. Regulation is a major factor, and nutrition could hold a key to that regulation.

References

1. Petro, T. Int Immunopharmacol. 2010; doi:10.1016/j.intimp.2010.07.011 (in press).
2. Xie, L. et al. Int Immunopharmacol. 2010; doi:10.1016/j.intimp.2010.07.013 (in press).
3. Barry, J. et al. J Am Chem Soc 2009;131:4490-8.
4. Ambegaokar et al. Neuro Endocrinol Lett 2003;24:469-73.
5. Zhuang H, et al. Ann N Y Acad Sci. 2003 May;993:276-86.
6. J. Neurosci. 24 (2004) 1101–1112.
7. Brain Res. 2010 Jul 9;1343:178-85.
8. Head KA, Altern Med Rev, 2006; 11(4): 294-329.
9. Filomeni, G et al. Neurobiol Aging. 2010 Jun 29.

Nutriwest

CBP Case Report Published in JVSR 2010

Abe Cardwell, DC, Marco Ferrucci, DC, and Dr. Deed Harrison, DC recently received notice that their case study received final approval for publication in the Journal of Vertebral Subluxation Research. The initial draft of this project was part of the graduation requirements as a senior research project for Marco Ferrucci at Life University College of Chiropractic. The completion of this project also fulfills a requirement for CBP Technique Advanced Certification listing for Dr. Cardwell and Dr. Ferrucci.

Cardwell A, Ferrucci M, Harrison DE. Chiropractic BioPhysics^® (CBP^®) Protocol on a Patient with Tourette’s syndrome, Tardive Dyskinesia, CREST syndrome, and Fatigue. JVSR 2010;Aug 18:1-9. www.jvsr.com

STUDY ABSTRACT

Objective: To present a case of Chiropractic BioPhysics (CBP) protocol of care used on a patient with fatigue, Tourette’s syndrome, tardive dyskinesia, and calcinosis, Raynaud’s, esophageal thickening, sclerodactyly, and telangiectasia (CREST) syndrome.

Clinical Features: A 45-year-old male with a history of fatigue, Tourette’s syndrome, tardive dyskinesia, and CREST syndrome presents to a CBP chiropractic office. The patient stuttered while he spoke and had an uncoordinated stagger as he walked. The patient had tremors in his arms and hands. Postural analysis and A-P cervico-thoracic x-ray showed a 16° right lateral tilt of C5-T4 segments relative to vertical, a 20° left cervico-dorsal (mid-neck scoliosis) angle, a 22mm right lateral translation of C2 relative to T4. Lateral cervical showed a 20° cervical lordosis with a 20° atlas plane angle. All measurements were based on CBP^® protocol for x-ray line drawing.

Interventions and Outcomes: The patient received CBP care over a 12-month period receiving approximately 108 treatment sessions. Mirror image^® adjustments, mirror image exercises, and mirror image traction were used to reduce the patient’s spine and postural subluxations, in addition to a 7mm heel lift for his right shoe. The patient was seen 3 times a week for the first 12 weeks then was seen 2 times a week thereafter for a year. After a few months of care the patient’s wife reported improvements in his energy level and that the tremors were decreasing. After a year of care the patient was markedly improved. Follow-up radiograph showed a C5-T4 lateral tilt angle to vertical of 5° to the right (an 11° improvement), the cervico-dorsal angle was 8.5^o to the left (11.5^o improvement), and the lateral translation of C2 relative to a vertical line up through the center of T4 vertebra was 6mm to the right (16mm improvement).

Conclusion: Reductions of the patient’s abnormal posture and radiographic spinal subluxations using CBP protocol of care may have been responsible for improved neurological issues such as Tourette’s syndrome, tardive dyskinesia, CREST syndrome, and fatigue

Chiropractic BioPhysics