Chiropractic + Naturopathic Doctor • JulyAugust 2019 • COVER STORY: Body fuel

Nutrition goes hand in hand with pain management and acts as one of the most powerful adjunctive complements to chiropractic. Promoting essential nutrition and a healthy lifestyle is an important goal and I have witnessed its profound effects on pain relief as a practising chiropractor of 30 plus years. Proper nutrition has the power to support injury recovery and rehabilitation, reduce joint and muscle pain, and boost energy while reducing fatigue.

One of the greatest predictors of pain seen in the chiropractic industry is inflammation. Inflammation has a significant effect on the severity of pain we experience, our perception of pain and the healing process. There are many contributing factors to inflammation, such as obesity, smoking, chronic stress and excessive alcohol consumption. However, diet provides one of the greatest impacts and acts as the most significant predictor of inflammation. More specifically the SAD diet (standard American diet) is a culprit of inflammation. The SAD diet includes highly processed and packaged foods, high intakes of red meat, high-fat dairy products, refined carbs, processed sugars etc. A diet rich in these foods will manifest as inflammatory processes, joint pain, muscle pain and other health concerns.

The anti-inflammatory diet focuses on restricting intake of the previously mentioned foods as seen in the SAD diet and puts emphasis on feeding the body with foods to help combat and reduce the body's pro-inflammatory responses while preventing chronic pain. The focus of this diet is to incorporate nutrient-dense foods, whole grains, plant-based proteins, healthy fats and fish. Dark leafy greens and antioxidant-rich fruits are high in essential vitamins and minerals and also contain significant amounts of fibre. For healthy fats high in omega-3 fatty acids, patients should consume cold water fish (ie. salmon) and try adding olive oil, avocados and nuts to their daily diet. With this in place, it’s important to try limiting red meat consumption to roughly once weekly. This diet will also help to facilitate minor weight reductions, which can help alleviate joint pain by reducing pressure and stress placed on joints daily.

Omega-3 fatty acids play an important role in reducing inflammation, supporting cardiovascular health, reducing serum triglycerides along with many other benefits. Omega-3’s are important to supplement, as it is difficult to reach a therapeutic dose from food alone. The main omega-3 fatty acids are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both EPA and DHA help to block inflammatory cytokines and prostaglandins. Supplementing with fish oil has proven a significant benefit in practice when patients are suffering joint pain due to rheumatoid arthritis, lupus or experiencing generalized morning stiffness. In addition, studies have suggested fish oil as a highly effective complement to the use of NSAIDS in reducing discogenic pain. When choosing a fish oil it is important to choose one with a 2:1 EPA:DHA ratio and achieve a minimum of 1-3g daily dose to achieve optimal anti-inflammatory effects.

Curcumin is famous in the natural health industry as being the go-to anti- inflammatory supplement. It is a major constituent found in turmeric, which has been used traditionally in the treatment of inflammation for many years. As many are familiar with the inflammatory cascade, cyclooxygenase 2 (COX 2) enzymes are responsible for producing prostaglandins that promote inflammation and pain. Curcumin is unique in that it limits the expression of COX 2 enzymes and therefore reduces the production of pro-inflammatory prostaglandins. There is clinical evidence to suggest its improvements in pain for cases of osteoarthritis, joint swelling, generalized joint pain and morning stiffness. It also aids in improving joint mobility. Choosing a curcumin supplement can be difficult to navigate. It is important to look for capsules that are coated to increase bioavailability and absorption and more importantly to avoid first pass metabolism. This ensures that is readily utilized by the body and absorbed rather than being quickly metabolized and excreted.

These serve an important purpose for the reduction of joint pain by assisting in the structural support of our joints. While possessing minor anti-inflammatory properties, they assist in the structural support by reinforcing cartilage, connective tissue and assisting in joint lubrication. Supplementation has been shown to reduce associated joint pain and improve joint function and mobility. In practice, it has demonstrated benefits for reducing joint degeneration, osteoarthritis of the spine and reducing chronic low back pain. Studies suggest supplementing 1500mg of glucosamine and 1200mg of chondroitin daily for optimal therapeutic benefit.

With all factors considered, it is important to keep in mind that although diet is a strong predictor of health and pain management, it is wise to consider that it is largely enhanced with the support of other practices. These practices include engaging in regular physical activity, limiting tobacco and alcohol use and engaging in self-care practices of interest. Fuelling bodies with proper nutrition and supplementation is a key component in pain management, as an adjunctive to chiropractic treatments and is fundamental to the healing journey.

As a chiropractor, I strive to ensure that my patients are not living in pain and look to enhance their quality of life on a daily basis. With a doctor as teacher principle in mind, I take the time to educate my patients on nutritional awareness. Whether experiencing acute or chronic pain, by educating individuals on the benefits of nutrition and pain management, it not only enhances their awareness but also promotes motivation of lifestyle changes that will positively enhance their quality of life and perception of pain.

Disclaimer: To patients taking other medications and dealing with complex health concerns, I always recommend consulting with an ND or MD prior to engaging in supplementation to determine what is right for them based on personal specific needs.

DR. HOWARD ZAMICK, DC, runs a multidisciplinary practice at Newmarket Chiropractic & Sports Injury Clinic. He also acts as an advisor to Healthy Planet, with 25 stores across Southern Ontario and an online store at HealthyPlanetCanada.com.