When I am discussing this issue with my colleagues, the following are the most common problems I encounter, and my replies to them:
1. Doctors would like to implement oral micronutrient support into their treatment protocols, but don't know where to start.
RX: It is easy to implement micronutrient support into your practice. I recommend you call three professional companies and have them send you literature on their five to ten top-selling products and what they are used for. This would give you a ballpark idea of what may apply to the most common problems encountered in your practice. Then, have the representatives come in and explain to you why their product is better than their competitors' products. They should back their claims with studies from peer-reviewed literature. Tell them you are not interested in testimonials of any kind. You should now have an idea of the products you would like to start with.
2. Doctors are intimidated by the amount of time and effort it takes to "really keep up" with the vast amount of nutritional information that is constantly being published.
RX: Although it does take time and effort to remain on the cutting edge in clinical nutrition, basic micronutrient support with vitamins and minerals is evolving at a much slower and more reasonable pace than the latest application of a chemical intermediate or some other new esoteric substance or compound. You can really increase your treatment effectiveness by providing your patients with the building blocks their bodies require to heal their injuries.
3. In school, doctors received the vitamin-mineral alphabet with deficiency and toxicity signs and symptoms. They were not taught how or what nutritional supplements to use for the types of problems they most commonly encounter Monday through Saturday (I envy you three and four-day-a-weekers).
I recommend that those interested in utilizing micronutrient support for their practice start with basic substances for the most common conditions they encounter. For the majority of DCs, this means nutrition for the neuromusculoskeletal system. Your beginning nutrition arsenal should include the following:
(a) an anti-inflammatory product;
(b) an anti-spasmodic product;
(c) a sprain-strain or connective tissue repair formula;
(d) a formula for intervertebral disc and more severe connective tissue injuries.
Most professional companies employ degreed personnel who can telephonically instruct you on the amounts of their product needed to obtain rapid results. Generally, one must remember that when utilizing nutritional adjuncts in your practice, you will most likely be dosing very liberally for relatively short periods of time. Your goal is to provide an adequate pool of the micronutrients your patients require for the synthesis, repair, and regeneration of their specific problem.
4. Many doctors feel uncomfortable learning nutrition from sales representatives.
RX: There are many ways to easily keep up or enhance your nutritional knowledge without too much time or effort. This author has listened to literally thousands of hours of cassette tapes while traveling. For advice on how to obtain educational material for a busy professional, I recommend you either contact the ACA Council on Nutrition or your professional vitamin representative. If you do not have success with either of these avenues, feel free to contact me at my office.
5. Doctors complain that when using nutritional questionnaires from professional companies, the results indicate many areas of need, which in turn equates to an unreasonable demand on the patient, both from a compliance and a financial standpoint due to the number of supplements to be taken.
RX: Many good companies have patient questionnaire forms designed to sell their product, and show you areas of potential problems.
What I do in my practice is:
a) clean up the patients' diets, which will generally mean lowering their fat intake, lowering their processed food intake, and increasing their fruit, vegetable and whole grain consumption;
b) make sure they are on a potent, well-absorbed multivitamin, multimineral formula;
c) specifically address the one major area of greatest symptomatology as demonstrated by their nutritional questionnaire and give them accessory nutrients for that condition.
Next, I have the patients return in one month and fill out another questionnaire. The results are compared to see what we have accomplished. It is rare that you and the patient will not see improvement in many categories, even though you only specifically addressed one. With the patients now able to see documented improvement via the questionnaire, they will be more compliant and receptive for additional therapy. I continue to nutritionally treat the problems with specialty products until their symptoms have been eliminated or reduced to a level that does not interfere with their normal daily activities. I then begin the process of gently weaning them off supplements until I reach a minimum level needed to maintain homeostasis.
6. Doctors find it difficult to explain why the supplements they carry cost so much more than the ones at the supermarket.
RX: The supplements you carry are specialty formulas that you are unable to purchase at supermarkets, convenience stores, pharmacies, etc. Even many health food stores will not carry the types of products that you require when supplementing for musculoskeletal complaints. I explain to my patients that the reason why these supplements cost more is that they are highly potent and manufactured with extra care at every step from raw materials to packaging. This insures that the product will give the patient the desired results. I also let the patient know that this is not something they will do for a lifetime, but it is a necessary component of their treatment program. When I release patients, I usually instruct them to continue with a good multivitamin, multimineral supplement. If they are not taking a supplement that I am familiar with, I always have them bring the label to me so I can review it to make sure it is adequate for their needs.
7. Doctors are not only unsure about what and how much supplement to give, but also how long to give them.
RX: Using the beginning formulas described in #1, my rules of thumb are:
a) Most conditions I see require natural anti-inflammatories for 3-10 days following the trauma.
b) When a patient presents with acute, involuntary muscular hypertonicities, I dose them with an anti-spasmodic formula hourly for one to two days until the symptoms subside. Next, I will reduce the frequency of dosage to three times a day for one to two days, and finally have the patient take the product once a day for the rest of the week. The patient is instructed to save the remaining product in the event of a future recurrence of their problem;
c) I utilize rehabilitation and/or connective tissue products with the following formula:
- Grade I sprain-strain: patient continues on the product for seven days after total resolution of subjective complaints and objective findings.
- Grade II sprain-strain: I double this to 14 days.
- Grade III injuries: I recommend they continue the extra nutrition for three weeks.
d) Finally, for patients with major intervertebral disc pathology, I will have them continue with a disc formula for at least one month after all subjective complaints and objective findings are absent.
8. Doctors say that chiropractic has had enough of an uphill struggle, and that implementing nutritional supplements only gives our detractors more ways to slam us, and the insurance companies more reason to deny our claims.
RX: It is true that most insurance companies will not reimburse for nutritional supplements. I ask my patients to pay when they receive the product. As for our detractors, I utilize substances that are supported in the literature, and do not recommend products backed only by testimonials. Remember too, many of the conditions you encounter do not require a specialty formula but can be simply solved by referring them to a health food store for the vitamin or mineral that they require to stimulate their recovery process or bring them into homeostasis.
Douglas Andersen, D.C.
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