Chronic care

I distinctly remember the day almost 50 years ago when my father came home from the doctor’s office with the news that he had been diagnosed with diabetes. He was very upset and I could see that he was afraid of what the consequences would be. He was a World War II veteran who had completed two active tours of duty, and this was the first time I had seen him afraid of anything.

I didn’t know much about diabetes at that time, but I quickly found out why he was so concerned as I witnessed the devastating complications develop. He went from oral meds to insulin and developed peripheral artery disease, neuropathy and ultimately went blind from diabetic retinopathy.

This scenario is happening with an alarming frequency in Canada today as many experts believe we are losing the war against diabetes. According to the Canadian Diabetes Association, diabetes cases will increase by 44 per cent in the next 10 years. In 2015, diabetes affected 22.1 per cent of the population and was responsible for one out of 10 deaths. The World Health Organization estimates it will be the seventh leading cause of death by 2030.

Based on these projections, chiropractors can expect to see more and more diabetic patients in their offices. As chiropractors, we do not treat disease or promise to cure complex conditions like diabetes. Fortunately, there are many things that we can do to help these patients improve their health. I have been researching diabetes for many years and I would like to share what I have uncovered about how chiropractors can influence outcomes for these patients.

Diabetes dilemma
Millions of dollars are being spent finding a solution to the diabetes dilemma because there are some serious shortcomings in our current management of the diabetic patients. Studies recently published in Medpage Today and in the Journal of the American Medical Association have concluded that there is no survival benefit seen among diabetes drugs and no evidence that any of these drugs do anything to reduce the risk of developing complications from diabetes.

According to Dr. Clifford Rosen, endocrinologist, professor of medicine and editor of the New England Journal of Medicine: “We may be using drugs that are great for lowering blood sugar but do nothing for cardiovascular risk. It is unproven whether any of the newer drugs are preventing other diabetic complications such as blindness and amputations.” In order for these medications to be approved and marketed, they just have to reduce blood sugar – they do not have to prove that they reduce risks of complication.

This is very alarming since cardiovascular disease (CVD) leading to stroke or heart attack is the most common cause of death for diabetic patients. Patients are lulled into a false sense of security thinking that they are reducing their risk of CVD by taking these medications.

A new study just released by the Mayo Clinic (2016 Aug 23) found that tight glucose control with drugs had no effect on the incidence of CVD, strokes, kidney damage, retinopathy or neuropathy in diabetic patients. The authors of this study systematically examined journal articles and clinical practice diabetes guidelines published in the last decade on the effect of maintaining an A1c of less than seven per cent on the prevention of diabetic complications. They concluded that new therapeutic approaches to prevent diabetic complications were necessary because of the failure of current treatments to reduce complications. 

The researchers also found that there had been a major shift of opinion in the medical journals regarding glycemic control since 2008 when the ACCORD study was published. The ACCORD study was one of the largest studies ever conducted on type 2 diabetes. The researchers found that there was an increased risk for death with intensive glycemic control. Prior to the ACCORD study, published statements supporting tight glycemic control were 85 per cent supportive, this shifted to a skeptical 20 to 30 per cent after publication of this landmark study.

This year, there have been two major studies that show glucose control with drugs has no effect on complications; the Mayo clinic study and the Medpage Today investigation. This should reduce confidence in this approach even further, as it’s becoming apparent that it’s the medical equivalent of shutting off the fire alarm without putting out the fire.

Dietary counselling is an essential part of improving the health of the diabetic patient. However, recent studies have shown that much of the information that diabetic patients have been receiving are outdated and ineffective. In fact, the latest U.S. Dietary Guidelines for Americans, released last year, contained a significant shift in dietary recommendations that signal how the government had it wrong and is now just playing catch-up with the evidence.

This misinformation has contributed to soaring rates of obesity, diabetes and heart disease. An example of this was the advice to reduce fat, which resulted in people reducing the good fats and oils in their diet. These were replaced with increased consumption of sugar, starches and carbs.

Diabetic patients get much better results when they reduce consumption of foods that cause inflammation and increase intake of good fats. This is one of the main areas that functional medicine doctors focus on when dealing with chronic disease. Functional medicine is also a way for chiropractors to guide their holistic approach.

Nutritional misinformation combined with ineffective medications have contributed to our current situation, where the number of diabetic patients is increasing dramatically and the outcome in terms of complications is not getting any better. One of the bright spots in conventional medicine is the Joslin Diabetes Center (JDC), which is associated with Harvard Medical School. It’s the world’s largest diabetes research facility and employs more than 300 full-time researchers devoted to diabetes. Dr. George King, the chief medical officer at JDC wrote the book, The Diabetes Reset, which covers the causes of diabetes and treatment protocols that are used to reverse diabetes at the Joslin clinic.

Researchers at the Joslin clinic have done extensive research into the latest nutritional protocols for diabetes and King outlines those recommendations in his book. What they are telling their patients to do is quite different than the advice most patients receive today. It will likely be some time before these recommendations become mainstream.

According to King’s research, the main causes of insulin resistance are:
• excess weight
• inflammation
• oxidative damage
• changes in the bacterial flora in the gut

Recent studies have shown that chiropractic treatments can be effective in addressing these issues.

Weight loss
Losing body fat while keeping muscle revolves around proper body chemistry and balancing hormones. Chiropractic adjustments help balance hormones through the spine’s direct relationship to the brain. Interference occurs within the central nervous system when a vertebrae is misaligned or moves incorrectly. This interference triggers an increase in stress hormones, like cortisol, and a decrease in growth hormones by interfering with the afferent stimulation of the hypothalamus.

This relationship has been proven by two important studies. The first one measured metabolic changes after chiropractic adjustments and showed that they had an effect on glucose metabolism, hormone balance and sympathetic tone in the sympathetic nervous system.

Another study in 2009 showed that small misalignments in the spine usually occur without symptoms but can lead to an increase in stress hormones, which are linked to autoimmune disease, type 2 diabetes and poor immune function.

Dr. Roger Sperry, in his Nobel prize winning research, found that 75 per cent of the stimulation to the brain comes from the joint mechanoreceptors in the cervical spine. Altered mechanics of the cervical spine interferes with the pathways leading to the hypothalamus. Since hypothalamus controls hormonal balance, interference to these pathways can lead to hormonal imbalance and weight gain.

Inflammation and oxidative damage
Research has shown that chiropractic adjustments improve internal functions of the body, helping the body overcome chronic disease by reducing inflammation. A 2003 study examined the molecular mechanism by which cells sense and respond to a mechanical stress like a spinal adjustment. They found that chiropractic adjustment can help at a cellular level to mitigate inflammation and oxidative stress by regulating cell chemistry.

Researchers at Canadian Memorial Chiropractic College also found that chiropractic adjustments helped reduce inflammation and improve the functioning of the immune system.

Many diabetic patients develop musculoskeletal conditions such as neuropathy, frozen shoulder, carpal tunnel syndrome and dupuytren’s disease due to inflammation associated with the glycation process. These are conditions that respond very well to chiropractic interventions.

Changes in the bacterial flora of the gut
King has found that a major contributing factor in the development of insulin resistance is a dysfunction of the digestive system. A study published in May 2007 in the World Journal of Gastroenterology makes a direct connection between the function of the digestive system and the cervical spine. The study focuses on neck-stomach syndrome. The mechanics involved in this syndrome are as follows: Cervical spine dysfunction leads to an irritation of the sympathetic nervous system. This irritation reaches the cortex by way of the sympathoadrenal tract and produces an alteration of sympathetic tone. The conclusion of this study was, alignment and proper function of the cervical spine is critical for the proper function of the entire digestive system. This is not surprising due to the large number of joint mechanoreceptors in the cervical spine.

These studies show chiropractic adjustments help to reduce inflammatory cytokines, balance hormones thus promoting weight loss, improve digestive function, reduce the production of stress hormones and reduce oxidative stress. These are all of the causative factors in type 2 diabetes that have been identified by the largest diabetes research facility in the world.

This research is very important to the chiropractic profession as it shows the value of chiropractic care in improving the health of our patients, regardless of diagnosis. It also provides valuable ammunition when confronted with critics that make the argument that chiropractors lack scientific proof to validate what we do.

Although these studies are very important, they are not very useful if they don’t translate into positive clinical results. The following case studies show what is possible with chiropractic treatments.

Case study #1
A forty-five-year-old male came to our clinic to get help with the health challenges he was experiencing as a result of diabetes. He was going blind in one eye among other problems and in order to have the surgery he required to save his vision, he had to get his blood sugars under control. He was unable to do so despite medications and lifestyle modifications.

On his initial visit it was explained to him that he needed to make significant additional changes in diet and lifestyle modifications, as well as chiropractic adjustments to facilitate more normal body function. After his first chiropractic adjustment he took the recommendations home and decided that he would start making the dietary changes the next day and have one last night of indulgence. He ate all the things that he shouldn’t and woke up the next morning expecting his blood sugars to be extremely high. Much to his amazement, his blood sugars were lower than they had been in a very long time. As he followed our recommendations, his blood sugar levels continued to decrease to the point he was able to have the surgery he needed to save his vision and experienced many other health benefits.

An interview with this patient has been posted on YouTube.

Case study # 2
A patient spent two years at one of the best diabetes management clinics in Canada trying to get his diabetes under control. After two years at the cardiac rehabilitation program at Sunnybrook Health Sciences Centre there was no improvement in blood sugar control and no weight loss despite intensive dietary and lifestyle modifications. Immediately after starting the treatment protocols at our clinic there was a marked improvement in blood sugar control and weight loss.

Case study #3
The third case study is a patient who had such high blood sugar levels she was getting rushed to the emergency department at the hospital (fasting levels over 30 mmo/L). Even the doctors at the clinic for fragile diabetic patients could not get her blood sugar levels under control. She was put on a 500 cal per day diet and still continued to gain weight. When she started having chiropractic treatments she was able to dramatically reduce her blood sugar levels and was able to lose a substantial amount of weight.

All of these patients had tried diabetes medications as well as intensive dietary and lifestyle modifications without success. It was only after they had received chiropractic treatments that they began to see improvements. The chiropractic adjustments addressed the causative factors discussed above and as a result, reduced inflammation, balanced hormones and improved digestive function, which ultimately helped them lose weight and achieve better glycemic control. These changes will also help patients derive more benefit from other interventions.

These kinds of results are seen with countless other patients on a consistent basis and a substantial amount of research has been published to corroborate these results. The question is: How can a chiropractic adjustment have this effect?

Vertebral subluxations cause mechanical stress on tendons, ligaments and the joint mechanoreceptors in the spine. These stresses cause inflammation and neurotoxins are released. Dr. Chung Ha Suh and Dr. Marvin Luttges from the University of Colorado discovered that these neurochemicals are released within 45 minutes after spinal misalignment occurs. These chemicals activate the sympathoadrenal system (SAS), and this stress is transmitted to the brain via the pineal hypothalamic tract activating the sympathetic nervous system. This triggers the release of adrenalin and dopamine. Adrenaline causes the cytokine interleukin 6 to be released, which causes inflammation.

Here is an explanation of the hypothalamic pituitary adrenal axis (HPA) and its potential for negatively affecting the stress levels of diabetic patients: Mechanical stress from the subluxation is transmitted to the thalamus through the spinothalamic tract. This activates the limbic system and stimulates the hypothalamus and pituitary gland to release ACTH and cortisol. Cortisol counters insulin by encouraging increased blood sugar and gluconeogenesis. It also increases blood pressure and inhibits digestion. This is beneficial in times of stress, but in the long term can lead to insulin sensitivity, high-blood pressure, digestive problems and many chronic illnesses. By removing the stressor (subluxation) through the adjustment, we stop the chronic stress response and the release of cortisol.

There is also the segmental innervation of the nerves to the pancreas, liver and adrenal glands (all of which are involved in blood sugar regulation) that comes from two areas: the sympathetic fibres come from T5-T9; the parasympathetic fibres come from the celiac trunk of the vagus nerve.

There are many studies that show how interference with the autonomic nervous system can lead to altered function of the regulators of blood sugar.

It is believed that the segmental influence of removing the pressure off of a peripheral nerve has much less influence on visceral function than the influence of subluxation on the HPA axis and the SAS.

There are many books and programs like King’s that claim to be able to reverse or even cure diabetes. These are based on nutritional and lifestyle changes only and maintain that one approach will work for all diabetic patients. I have found that this is not always true. What works for one patient will not work for all. The multifactorial and complex nature of this disease makes it very difficult for one approach to help all patients. There are many cases where these approaches alone have not worked. My experience has been that holistic approaches, like functional medicine, up-to-date nutritional protocols and exercise, are effective in helping diabetic patients improve their health. When these are combined with chiropractic treatments that reduce inflammation and improve digestive function, the results are even better. As demonstrated in the above case studies, it has made a huge impact on the outcomes for these patients. There are many diabetic patients who cannot take diabetic medications due to side effects, and others who are deperately seeking alternative wayst to improve their health.

The World Health Organization calls diabetes the health hazard of the 21st century that is affecting millions of Canadians and is an imminent threat to many more. It is in our best interest for all health professions to join together and help find solutions to this disease. In light of recent research and clinical outcomes, chiropractors are well positioned to be an important part of this.

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Dr. Allan Turner, DC, has been a chiropractor for more than 30 years and runs the Stoufville Health Centre, a multidisciplinary clinic in Stoufville, Ont. He earned his doctor of chiropractic degree from the Canadian Memorial Chiropractic College. You can contact him at drallenturner@gmail.com.