chiropractors and nutritional adivce?

[puppypaws]

Hey guys,
I'm sorry if this is the wrong forum for this, but I couldn't find one for chiropractors here. Does anyone know if chiropractors can give nutritional advice to their patients?
thx

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[ahyes]

Of course they can....doesn't mean it will be the right advice though

 

[vanbamm]

We certainly can. As can MD/DO.

 

[taylormade2006]

You have to be aware of drug interactions if you're doing supplements. Personally, I think it reflects poorly on your practice if you coincidentally sell all of the supplements you recommend.

 

[hawkeye pierce]

Retail pharmacists sell supplements/medications they recommend all the time

 

[facetguy]

You have to be aware of drug interactions if you're doing supplements. Personally, I think it reflects poorly on your practice if you coincidentally sell all of the supplements you recommend.

There are lots and lots of supplements out there for sale, and their quality may vary considerably. If you as a healthcare professional believe a patient needs a particular supplement, it's a gamble to send the patient out to buy whatever they randomly happen upon. You can control this by either having specific brands of choice to recommend they purchase at a store, or you can have your brand of choice on hand to provide the patient right then and there. There are some high quality supplement manufacturers, and I'd rather see my patients taking those products.

Would you rather see patients taking supplements you know nothing about or that you don't recommend?

 

[DrDrummer]

Would you rather see patients taking supplements you know nothing about or that you don't recommend?

No, but there's something to be said for avoiding an obvious conflict of interest. It's not that hard to recommend a supplement and point them towards where to obtain it.

 

[facetguy]

No, but there's something to be said for avoiding an obvious conflict of interest. It's not that hard to recommend a supplement and point them towards where to obtain it.

Ethics comes into play in all aspects of healthcare. Nutritional recommendations are no exception.

 

[tehdude]

From my experience with chiropractors and chiropractic nutrition, I would never recommend a pt to heed nutritional advice from one.

 

[jsckvc]

.

 

[jsckvc]

From my experience with chiropractors and chiropractic nutrition, I would never recommend a pt to heed nutritional advice from one.

What experience is that?
Who should they heed it from? Most MD/DO don't know the first thing about nutrition other than the basics. Many chiropractors have been studying nutrition for years due to thier work in an alternative medical field.
I would not heed nutritional advice form most medical doctors. I think I would likley get better info from a chiropractor based on my experience. However, not all providers MD/Chiro have the same level of desire to learn about the subject.

 

[facetguy]

From my experience with chiropractors and chiropractic nutrition, I would never recommend a pt to heed nutritional advice from one.

Is it 'chiropractic nutrition' or just 'nutrition'?

 

[st2205]

Important to clarify what we mean by "nutrition advice". For a healthy patient? As prevention? For an AIDS patient? Geriatrics? Pediatrics? Gymnasts? Cancer patients? Renal failure? Allergy patients? Diabetics? Truck drivers? Factory workers?

 

[hemostat5]

Professional nutritional advice should come from a registered dietitian.

 

[st2205]

Professional nutritional advice should come from a registered dietitian. They have the most training when it comes to that topic. It is my opinion that any other healthcare professional should work in conjunction with an RD when giving nutritional advice, regardless of what degree you hold.

Yet some feel insulted that they aren't regarded as one of the most legitimate sources of dietary knowledge.

 

[tehdude]

Who should they heed it from?

A registered dietitian might be a good start.

Most MD/DO don't know the first thing about nutrition other than the basics.

And their offices don't second as vitamin stores.

I would not heed nutritional advice form most medical doctors.

I wouldn't either, however many medical schools have been including more and more nutrition into their curriculum in recent years.

Many chiropractors have been studying nutrition for years due to thier work in an alternative medical field.

I'm sure they have. But if these things worked and were evidence-based, they would be called "medicine" and not "alternative medicine". I know a chiropractor who has an entire room of supplements, and he can tell you what every one of them supposedly does and why you need to buy it from him for 3x the retail price. There is a clear conflict-of-interest. It wouldn't be an issue if chiropractors recommended a multivitamins and fish oil, like most RD and medical doctors would do. But instead many of them are selling hokey **** like flower extract to treat any and every human ailment. 👎

Is it 'chiropractic nutrition' or just 'nutrition'?

I said chiropractic nutrition because chiropractors seem to have a few practices unique to their field, and some dubious companies market their supplements almost exclusively through chiropractors.

 

[vanbamm]

almost all patients can benefit from a little check on their nutritonal habits- basically you just need to make sure they are getting everything- most don't have alot of money so the best thing to do is do the research yourself and find the cheapest most beneficial nutritional supplements for them, or just give them a little sheet with food on it that has the nutritional content on it and if they need help, help them out.

if they have a condition or are looking for a specific diet- you can point them to some resources and refer them to a dietician.

regardless, as a doc you should have something to say in that area to help them, but you don't need to be an expert when you can refer them to someone who is. you're not going to be making a living giving out diet plans and nutritional counseling as an MD/DO, DC or otherwise if you arent a nutritionist or dietician.

 

[ahyes]

Just for clarification there are almost no (except Calcium and Vit D) supplements that a person should be taking in the absence of a deficiency or clear disease state. Since a Chiropractor does not have the ability/knowledge to diagnose a nutritional deficiency, they are not capable of treating one (also they do not have the ability to prescribe drugs that are needed in many deficiencies). Almost all dietary changes that will be beneficial to a healthy person are from changes in diet - ie food - not supplements. Chiropractors that are peddling the supplements either learned inaccurate information or are looking to make a quick buck.

A RD will aide in eating better and will not peddle nutritional supplements like a DC will. They will stress vitamins/minerals and macronutrient content obtained through food. You'd be hard pressed to find an RD that will give out a supplement without clear disease state (ie referral in chronic kidney disease, post-bariatric surgery...) or in a deficiency. Since chiropractors have no business in most (if not all) disease states or deficiencies, they should not be giving out nutritional advice.

 

[hawkeye pierce]

So you think a daily multivitamin is not a good thing????

 

[facetguy]

Just for clarification there are almost no (except Calcium and Vit D) supplements that a person should be taking in the absence of a deficiency or clear disease state. Since a Chiropractor does not have the ability/knowledge to diagnose a nutritional deficiency, they are not capable of treating one (also they do not have the ability to prescribe drugs that are needed in many deficiencies). Almost all dietary changes that will be beneficial to a healthy person are from changes in diet - ie food - not supplements. Chiropractors that are peddling the supplements either learned inaccurate information or are looking to make a quick buck.

A RD will aide in eating better and will not peddle nutritional supplements like a DC will. They will stress vitamins/minerals and macronutrient content obtained through food. You'd be hard pressed to find an RD that will give out a supplement without clear disease state (ie referral in chronic kidney disease, post-bariatric surgery...) or in a deficiency. Since chiropractors have no business in most (if not all) disease states or deficiencies, they should not be giving out nutritional advice.

Just to clarify, you appear to be saying that our goal as healthcare professionals should be to ensure that our patients are getting just barely enough nutrition to keep them out of a deficiency state. Any additional nutrition beyond that level is either wasted or dangerous. Is that what you are saying?

 

[ahyes]

Absolutely not a good thing. People should be getting their micronutrients from food. Their is no regulation in multivitamins and manufacturers often put in nutrients in forms that aren't absorbed properly/aren't as bioavailable as in food. There have also been examples (selenium) where manufacturers mixed up ug and mg and caused severe adverse affects for the patrons using their product. It is also important to note that a person may already be getting the RDA (or ADI) of a nutrient and a multivitamin may provide an extra 100% (or however much) to that amount. This can lead to far too much intake of certain nutrients and the associated consequences of high intake.

As a side note, different populations/age groups require different amount of nutrients. An amount of a nutrient that is considered positive for one group may actually be harmful to another (think folate positive for prevention of NTDs in pregnant women and also increasing prostate cancer risk in men over 50). Do you really think a multivitamin manufacturer is considering this? Or are they just trying to market their product to the masses...

 

[ahyes]

Just to clarify, you appear to be saying that our goal as healthcare professionals should be to ensure that our patients are getting just barely enough nutrition to keep them out of a deficiency state. Any additional nutrition beyond that level is either wasted or dangerous. Is that what you are saying?

No im saying that optimal nutrition should be obtained through DIET. Not supplementation. Im just saying supplementation (pills, powders...) is only useful in deficiencies

 

[hawkeye pierce]

If you look at multivitamins, they usually do not have 100% of fat soluble vitamins. However, as i'm sure you can look up regarding folic acid, it has many benifits in heart health that MAY override the prostate cancer link.

 

[Magnus2010]

As someone who has done both MD and DC school (and whose 4 year undergrad degree from an accredited American university is in nutrition) - yeah, DC's can offer nutritional advice. I would take a chiropractors nutritional advice 90% of the time over an RD or MD or DO. I took the time to ersearch supplement companies manufacturing too to make sure my products were good.

2 different studies I have read showed that supplements assayed randomly rarely had as much of the good stuff they promised.

The company I use (Pure encapsulations) uses multiple outside labs to assay their products. I think this is important, because not only are they analyzing their products, but by using multiple outside labs I think they avoid the error that is possible by having cousin Bubba run some tests in the basement of the company building. Quality is important and I think Purecaps is the best I have looked at, although there are other good companies out there that I have checked out.

I took home a little more from vitamin sales - maybe cleared another $2 grand/month. Nothing to write home about but it paid a staff salary so that was cool.

 

[vanbamm]

Absolutely not a good thing. People should be getting their micronutrients from food. Their is no regulation in multivitamins and manufacturers often put in nutrients in forms that aren't absorbed properly/aren't as bioavailable as in food. There have also been examples (selenium) where manufacturers mixed up ug and mg and caused severe adverse affects for the patrons using their product. It is also important to note that a person may already be getting the RDA (or ADI) of a nutrient and a multivitamin may provide an extra 100% (or however much) to that amount. This can lead to far too much intake of certain nutrients and the associated consequences of high intake.

As a side note, different populations/age groups require different amount of nutrients. An amount of a nutrient that is considered positive for one group may actually be harmful to another (think folate positive for prevention of NTDs in pregnant women and also increasing prostate cancer risk in men over 50). Do you really think a multivitamin manufacturer is considering this? Or are they just trying to market their product to the masses...

if you've reached the clinical stage as either an MD or DC, i think that person would already know these things. Supplements are just that- SUPPLEMENTS- they do not substitute food- they reinforce the diet- if needed.

Most people can afford to eat the right food and will follow a simple list of the choices you give them- other cases are more complex and need referrals- but, as i've seen in some tough situations, some people can't afford the right food at every meal, or are not eating enough meals because they can't afford to (pride sometimes gets in the way of getting help with food) and so with these people, you need ot intervene BEFORE they develop a deficiency that requires a referral- because that is going to cost money, and they won't go, thus making the situation worse- therefore, if, as a good clinician, you can take the time to find inexpensive supplements that they can go get for a few bucks, they will do it knowing that in the long run, it will SAVE them $ from visits and worse problems-

I would hope that clinicians, regardless of MD/DO or DC, take an interest in nutrition and familiarize themselves with conditions to recognize the symptoms of deficiency so that you can get to it quickly and not worsen the patient.

 

[ahyes]

vanbamm, you are wrong. Supplements are not valuable in PREVENTION. It would also be nice if you could put a little more thought and editing into your posts. Its very frustrating to respond to such poorly worded arguments.

As a caveat, I am also a nutritionist whose master's degree was granted from an ivy. These are my opinions that are shared with (and were shaped by) the faculty and researchers at that institution.

I also thought it was funny that you said "some people can't afford the right food at every meal, or are not eating enough meals because they can't afford to." If they are having trouble affording food, then maybe they shouldn't be wasting their money seeing a DC (who no doubt isn't covered by medical insurance), who is most likely bleeding them dry.

 

[facetguy]

Absolutely not a good thing. People should be getting their micronutrients from food. Their is no regulation in multivitamins and manufacturers often put in nutrients in forms that aren't absorbed properly/aren't as bioavailable as in food. There have also been examples (selenium) where manufacturers mixed up ug and mg and caused severe adverse affects for the patrons using their product. It is also important to note that a person may already be getting the RDA (or ADI) of a nutrient and a multivitamin may provide an extra 100% (or however much) to that amount. This can lead to far too much intake of certain nutrients and the associated consequences of high intake.

As a side note, different populations/age groups require different amount of nutrients. An amount of a nutrient that is considered positive for one group may actually be harmful to another (think folate positive for prevention of NTDs in pregnant women and also increasing prostate cancer risk in men over 50). Do you really think a multivitamin manufacturer is considering this? Or are they just trying to market their product to the masses...

Thank you for making the case as to why it's wise to have available (or know exactly where to get them) trusted supplements from quality manufacturers instead of turning patients loose to get the cheapest crap they can find. Well said.

And when you say 'folate', you need to be specific. If you don't know what I'm talking about, you might want to google it.

No im saying that optimal nutrition should be obtained through DIET. Not supplementation. Im just saying supplementation (pills, powders...) is only useful in deficiencies

I agree that the best way to obtain nutrients is through diet. But you are kidding yourself if you think your typical patient eats well enough to optimize nutrition. The goal should be to improve diet first, no doubt. But there is a place for judicious use of quality supplements. By the way, when you prescribe a statin to a patient that you know will deplete their stores of CoQ10, what food should they eat to make up that CoQ10?

 

[ahyes]

In response to your statin argument, that is a "disease state" that I agree nutritional supplementation can be valuable in. I am arguing only about prevention in a healthy patient.

and would you prefer that I said folic acid...

 

[facetguy]

In response to your statin argument, that is a "disease state" that I agree nutritional supplementation can be valuable in. I am arguing only about prevention in a healthy patient.

and would you prefer that I said folic acid...

Just making sure you understand the current goings-on in the literature regarding synthetic vs. natural forms of folate, the former of which may be the issue regarding the promotion of some cancers. And, yes, quality supplement manufacturers do know the difference and have changed to the natural form in response.

 

[ahyes]

I also get the distinct feeling that vanbamm and facetguy are the same person.

 

[st2205]

I also get the distinct feeling that vanbamm and facetguy are the same person.

Though they often post in the same threads and only discuss chiropractic issues, I'm pretty sure they're two very different individuals.

 

[facetguy]

I also get the distinct feeling that vanbamm and facetguy are the same person.

Though they often post in the same threads and only discuss chiropractic issues, I'm pretty sure they're two very different individuals.

Interesting. We are indeed different people. And, speaking for myself, I like to post about many different issues.

 

[vanbamm]

vanbamm, you are wrong. Supplements are not valuable in PREVENTION. It would also be nice if you could put a little more thought and editing into your posts. Its very frustrating to respond to such poorly worded arguments.

As a caveat, I am also a nutritionist whose master's degree was granted from an ivy. These are my opinions that are shared with (and were shaped by) the faculty and researchers at that institution.

I also thought it was funny that you said "some people can't afford the right food at every meal, or are not eating enough meals because they can't afford to." If they are having trouble affording food, then maybe they shouldn't be wasting their money seeing a DC (who no doubt isn't covered by medical insurance), who is most likely bleeding them dry.

I would have to say that you couldn't be more wrong. Obtaining the right nutrition certainly is a form of prevention; prevention of disease and deficiency (while also serving as nourishment). It makes no difference where you got your degree- it matters who the person is with the degree, so don't try to use that card.

How blind- some people actually offer a percentage of their services for free because they would rather see people get better than turn them away and go on suffering...besides, I am at a college clinic, so what I do is cheap, and if they can't afford it, I will sometimes pay the 15 bucks.As far as bleeding patients dry- I think you should familiarize yourself with the low reimbursement policies that NY has- trust me, DC work alot harder to get that 100K+ salary than MD have to at the reimbursement rates in this state.

 

[vanbamm]

Though they often post in the same threads and only discuss chiropractic issues, I'm pretty sure they're two very different individuals.

And thanks, bc we are.

P.S. If chiro is brought up, I will chime in. If you don't want to hear about it, don't create threads on it!

 

[ahyes]

Vanbamm,

I am done posting here. I have provided the logic of why I believe multivitamins are not valuable in prevention and instead of countering with an actual insightful logical argument, you just repeat your original - and wrong- statement that it is valuable. Provide some reason as to why/how it is valuable. Don't just simply restate that it is.

Every time you post you reaffirm the fears (and hesitations to include you in actual healthcare) I have about those who hold the DC degree. You don't provide logic and/or facts, but instead you unwaveringly stick with your wrong beliefs. You don't discuss things, you tell me that I am wrong and leave it at that.

And just so you know I agree that "Obtaining the right nutrition certainly is a form of prevention; prevention of disease and deficiency (while also serving as nourishment)." I was simply stating that the value in prevention ONLY comes from food and modifications/improvements to diet, not the stupid supplements you will someday peddle to helpless patients in your office after you crack their backs and tell them you cured their diabetes.

 

[facetguy]

ahyes,

The common view of nutrition often revolves around the prevention of deficiency states. You know the drill: vitamin C/scurvy, B1/BeriBeri, vitamin D/rickets, etc. My view, and that of many others, is that nutrition plays a much larger and broader role. This article from 2003 will be of interest to you as someone who has studied some nutrition: http://www.ajcn.org/content/78/5/912.long

The author, a well-respected nutritional scientist, discusses the concept of "long latency deficiency diseases", which differ from the above-noted "index diseases" associated with nutrient deficiency. As you'll see, he uses calcium and vitamin D as examples, both of which you've already made mention of as worthwhile supplements. However, this paper may at least get you thinking in a different fashion about the role of nutrition in health and disease.

[And there is a lot more literature regarding the effectiveness, cost-effectiveness, etc of chiropractic care than you are probably aware of, particularly for neck and back pain. So go easy on us.😉]

 

[vanbamm]

an evidenced based world requires evidence based remarks;

1. The American Journal of Clinical Nutrition : Use of Vitamin E and C, decrease mortality rates in older patients

http://www.ajcn.org/content/64/2/190.short

2. The New England Journal of Medicine: Calcium and Vitamin D supplementation to decrease bone loss

http://ftp.kermit-project.org/itc/hs/pubhealth/p8403/readings/dawson-hughes.pdf

3. CancerEpidemiology,Biomarkers and Prevention: B6 decreases risk of colorectal cancer

http://cebp.aacrjournals.org/content/17/1/171.short

One could really pull up a million sources citing the benefits of supplementation. One could also turn on the TV during the day just to see infomerical after infomercial about proper diet and nutrition and their benefits on the lifecycle. Either way, supplementation as an aid is a tool that can work for some people; as far a pedaling supplements- that is what GNC is for.

 

[ahyes]

Clearly you didn't read the articles you cited.

In the B6 decreases colon cancer risk: "The main sources of vitamin B6 that were included in the questionnaire were beans, legumes, nuts,
eggs, meats, fish, breads, cereals, potatoes, and bananas."

-That is my point, that foods are best for prevention not supplements. This article analyzes the amount of each nutrient ingested via a food frequency questionnaire, not a supplement.

I just couldn't resist another post

 

[vanbamm]

That is true- I think everyone would agree that the best way to get nutrients is naturally- it isn't feasible to replace every micronutrient with a pill- all I'm saying is when there is a deficiency of one, and it is due to that patient simply not taking it in, and if they don't incorporate foods that contain it, and they don't have a pathology that may not allow them to absorb it or is eliminating it, then they may need some help there- I'm not in love with nutrition or supplements, but you've got to be aware of the relationship to pathology and be able to identify it. You speak your mind, don't apologize for posting!

 

[hawkeye pierce]

Ahyes,
In your experience, what percentage of patients are capable/willing of following a diet?

 

[st2205]

Ahyes,
In your experience, what percentage of patients are capable/willing of following a diet?

A good follow-up question: what percentage of those individuals incapable/unwilling to follow a diet are paying out-of-pocket for chiropractic services that are going beyond manipulation?

 

[jsckvc]

.Enough already!
Every single one of you is right and every single one of you is wrong.

This is just a pissing match of opinions

None of you has the authority to decide the right path to health for everyone.

I am surprised to see so much closed mindedness on the Osteopathic forum; don't you do pretty much the same thing as chiropractic manipulation along with your western medicine training.

 

[st2205]

.Enough already!
Every single one of you is right and every single one of you is wrong.

This is just a pissing match of opinions

None of you has the authority to decide the right path to health for everyone.

I am surprised to see so much closed mindedness on the Osteopathic forum; don't you do pretty much the same thing as chiropractic manipulation along with your western medicine training.

Tell that to this guy:

What experience is that?
Who should they heed it from? Most MD/DO don't know the first thing about nutrition other than the basics. Many chiropractors have been studying nutrition for years due to thier work in an alternative medical field.
I would not heed nutritional advice form most medical doctors. I think I would likley get better info from a chiropractor based on my experience. However, not all providers MD/Chiro have the same level of desire to learn about the subject.

 

[jsckvc]

Nice one st2205!
Posting is addictive.
can't wait to see what happens next.

 

[facetguy]

ahyes,

The common view of nutrition often revolves around the prevention of deficiency states. You know the drill: vitamin C/scurvy, B1/BeriBeri, vitamin D/rickets, etc. My view, and that of many others, is that nutrition plays a much larger and broader role. This article from 2003 will be of interest to you as someone who has studied some nutrition: http://www.ajcn.org/content/78/5/912.long

The author, a well-respected nutritional scientist, discusses the concept of "long latency deficiency diseases", which differ from the above-noted "index diseases" associated with nutrient deficiency. As you'll see, he uses calcium and vitamin D as examples, both of which you've already made mention of as worthwhile supplements. However, this paper may at least get you thinking in a different fashion about the role of nutrition in health and disease.

Along these lines, a new paper by Bruce Ames (well-known/respected guy in nutrition circles) discusses the role of selenium in disease. In particular, they talk about the effects of "modest selenium deficiency" over long periods of time. http://www.fasebj.org/content/25/6/1793

From the abstract:
"The triage theory proposes that modest deficiency of any vitamin or mineral (V/M) could increase age-related diseases. V/M-dependent proteins required for short-term survival and/or reproduction (i.e., “essential”) are predicted to be protected on V/M deficiency over other “nonessential” V/M-dependent proteins needed only for long-term health. The result is accumulation of insidious damage, increasing disease risk."

It's my guess that many people have these "modest" deficiencies that eventually catch up with them over time. This is tough to prove definitively for obvious reasons but an important consideration nonetheless.

 

[cbrons]

Professional nutritional advice should come from a registered dietitian. They have the most training when it comes to that topic. It is my opinion that any other healthcare professional should work in conjunction with an RD when giving nutritional advice, regardless of what degree you hold.

false - there are MDs who specialize in nutrition.

 

[bones]

No, but there's something to be said for avoiding an obvious conflict of interest. It's not that hard to recommend a supplement and point them towards where to obtain it.

ditto this.