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Nutritional Factors CAN Affect Spinal Correction

NUTRITIONAL FACTORS CAN AFFECT SPINAL CORRECTION, EXCESSIVE BODY WEIGHT CAN IMPEDE REHABILITATION

Compliments of Dr. Chris Cohen, DC, CCCN

Often pain expressive patients are depressed, eat poorly, don’t get enough exercise, and many are overweight. Their excess weight is generally in the abdomen which asymmetrically loads the musculoskeletal system, especially the spine. Their posture, stance, and gait become altered. The asymmetry sometimes makes it impossible to correct lateral spinal curves; which are necessary for normal coupled motion of the spine, and for the correction of A-P spinal deviations and displacements. Therefore, spinal correction can be difficult or impossible until their weight is reduced and controlled.

All people have different physical, chemical and emotional make ups. Pain expressive people often have other malfunctioning systems, such as the endocrine and the cardio-vascular system. This is often caused by an abnormal nervous and musculoskeletal system. When the spine and musculoskeletal system does not respond to care as expected, or as normal physiological function dictates, this should be an alert to the practitioner to check other systems as well as check the patient’s diet and lifestyle for causes.

Blood sugar and protein levels can and do affect the nerve and muscle functions which affect spinal position and function. A review of blood sugar metabolism and its effects on the physical and emotional responses may explain why needed dietary changes must happen before musculoskeletal spinal changes can be realized.

Education Regarding Protein, Blood Sugar Metabolism and Stress and Spinal Correction

The practitioner should educate all patients about eating habits, protein needs, and blood sugar, as well as oxygen increasing and stress reduction procedures necessary for rehabilitation and spinal correction.

Exercise is the best oxygen increasing stress reduction procedure. (The Pettibon Home Care rehabilitation exercises are an excellent oxygen increasing stress reducing program).

A Brief Review of Blood Sugar Metabolism

Normal blood sugar is 90-120mg/dl (sources do vary in this range). Uncontrolled blood sugar below this range is called hypoglycemia. If uncontrolled and above the normal range the person is diabetic. The term dysglycemic (or dysglycemia) can be used to describe either case.

The glycemic index is a numerical value assigned to a food based on how quickly it causes a rise in blood sugar compared to glucose; the higher the number the faster the rise in blood sugar. The body’s mechanism for down-modulating blood sugar is insulin. When one eats a low-glycemic meal, the digestive process breaks down the food and absorbs it slowly causing a slow rise in blood sugar. The body responds with a small amount of insulin to keep the blood sugar relatively steady. A high glycemic meal causes a sharp spike in blood sugar, which thickens the blood or increases its viscosity. To understand, think of a glass of water with a spoon full of sugar in it. Next compare that to a glass filled with syrup, molasses or honey. Obviously the glass filled with syrup, molasses or honey is thicker and has the most viscosity. This increase in viscosity is what causes so much difficulty with the cardiovascular system of diabetic patients including venous return from the extremities, especially the legs.

When a high-glycemic meal spikes blood sugar the pancreas releases a larger amount of insulin to quickly lower the blood sugar and reduce viscosity and the stress on the heart and cardiovascular system. When the body secretes large amounts of insulin quickly the blood sugar drops very low, very quickly. This is the “crash” that happens after consuming high sugar meals. When the blood sugar drops below normal range the person can accurately be called hypoglycemic. This results in food cravings, and that craving is always for something sweet. After years of eating this way the body becomes desensitized to the insulin and the amount the pancreas must produce becomes disproportionately high. This has been referred to as Metabolic Syndrome, Syndrome X, or Pre-diabetes. This can cause decreased concentration, as the brain’s preferred fuel source is glucose, a sluggish metabolism, weight gain, and generally low energy. Drinks like Rock Star or Red Bull, soda and especially diet soda compound these effects and causes hypoglycemia and dehydration. It also increases the stickiness of the blood platelets making a person’s chances of stroke or heart attack far more likely.

A Review of Cortisol

During sleep the body needs to maintain normal blood sugar, it does this with the hormone cortisol. Cortisol is produced by the adrenal cortex and has been nicknamed the “stress hormone”. During sleep when no food is consumed normal cortisol levels rise and then decline throughout the day. Cortisol stimulates the liver to start a process called gluconeogenesis. This is the process of making glucose from non-carbohydrate sources, such as amino acids. The most readily available are the ones that should be used to make immuno-globulins and are used first. That is why people who eat a nutritionally poor diet also get sick most frequently, because they have decreased their immune function.

The next source of amino acids is from the breakdown of muscle. A patient’s body breaks down muscle to make glucose if they are eating poorly and are keeping their cortisol levels high. Therefore, one’s diet can and does affect the rehabilitation exercises’ effectiveness at building and strengthening muscles involved in restoring musculoskeletal, as well as spinal, form and function.

Checking and monitoring cortisol and insulin can be done very simply. Cortisol levels should be measured ideally at 8am, noon, 4 pm, and 8 pm or four hour intervals starting within an hour of waking or other workouts. Test kits are available from Genova Diagnostics (GDX.net). Normal test results should show elevated cortisol upon workouts and then it should decrease throughout the day.

A practitioner that corrects musculoskeletal problems, as well as spinal form and function, must be able to monitor these functions in addition to physical preparation of spinal soft tissues for correction.

Epinephrine and Pain

During times of stress there is an increase in epinephrine. Epinephrine causes increased blood glucose levels and it increases the rate of which C-fibers fire. C-Fibers are type 4, post-ganglionic unmyelinated nerve fibers that send slow pain signals. C-fiber activation into the mesencephalon causes inhibition of the pontomedullary-reticular formation (PMRF) of the brain. Normal PMRF activation inhibits the IML, the sympathetic, intermedial lateral cell column in the spinal cord between T1 and L2. Uninhibited sympathetic activation causes pupillary dilation, increased heart and respiratory rates, piloerection, decreased gut function, vasoconstriction of deep arteries, and vasodilatation of veins. This process may occur daily due to job stress, family stress, pain or injury, watching T.V. or a movie that really “gets your blood moving”. Epinephrine also causes an unnecessary rise in blood sugar that has to be down-regulated with insulin followed by cortisol. People under stress tend to eat more, eat poorly and have more pain.

Epinephrine and Dopamine

Epinephrine and dopamine have an inverse relationship. Increasing epinephrine decreases dopamine. The lack of dopamine has been shown to lead to decreased focus, decreased concentration, aggressive behavior, depression and emotional instability. Example: ADD, often results by out of control eating habits of the youth and lack of exercise. Monitoring cortisol, the stress hormone, can give one great insight to a patient’s ability to respond to your care. Combined with observations of increased heart rate, sweating, pupillary dilation, “goose bumps” (a sympathetic reaction) pertinent history questions like bowel/bladder habits can certainly help the practitioner tailor their treatment plan to the individual.

Adequate Protein

Adequate protein in a person’s blood must be considered in the most basic level of nerve and muscle function. Nerves and muscles need three basic things to be healthy and function normally: 1. fuel, 2. oxygen, 3. activation.

Activation of nerves and muscles may come in forms of manipulation procedures that cause motion, full range rehab/exercise, and activities of daily living and/or just plain moving around. The mitochondrion uses sugar and oxygen to produce ATP (energy). Remember sodium/potassium exchange pump (Na/K pump), resting membrane potential, and the action potential? Resting membrane potential of a nerve cell is -70mV. The action potential causes the Na/K channel to open. This allows sodium to rush into the cell while potassium rushes out. The charge on the membrane moves toward sodium potential (or less negative) and when it reaches -45mV, or excitation threshold, the nerve “fires”. Then the Na/K pump turns on and starts pushing sodium out of the cell at the energy cost of an ATP molecule.

The pump is a kinase (protein) that has a half-life. That means it must constantly be replaced. The proteins, called proto-oncogenes, for the Na/K pump come from the nucleus of the cell. The cell nucleus responds to stimulation of the cell with a process called Cellular Immediate Early Gene Response (CIEGR). Within nano-seconds after a reflex producing stimulus is introduced into the nervous system, the production of proto-oncogenes (Cfos, Cmir, Cjun) takes place. The proto-oncogenes’ half-life varies, usually from 4-6 hours and may last up to 1-2 days.

Without sufficient protein from the cell nucleus the Na/K pump slows and stops. This leaves a high sodium concentration in the cell. Osmosis occurs, that is water moving from an area of low concentration (outside the cell) to an area of high concentration (inside the cell), to dilute the solution. If too much water is moved into the cell it swells and bursts, that is, the cell dies… therefore, protein deficiency before and during physical rehabilitation activities, including traction-decompression, as well as manipulation can and should be avoided.

The Need for Adequate Protein in the Patient’s Blood at the Time of Treatment And Or Home Care Exercises

1. Any manipulation procedure good or bad that causes joint motion can change symptoms for up to 2 days if there is protein in the patient’s blood.
2. People that have adequate protein in their blood generally respond favorably to their spinal treatment and/or exercise.
3. People that have not consumed food (protein) within 3-4 hours before being treated often will not respond as expected, even if they receive the same treatment that has produced excellent results before, when they had adequate protein in their blood.
4. Actual long lasting correction of spinal form and function is possible only if there is protein in the blood so that a stimulus (Pettibon weighting system) can cause a reflex response that faithfully causes the patient’s own muscles to correct the musculoskeletal system and the spine’s 3-dimensional upright posture relative to gravity.

For the PDF version of this article, CLICK HERE