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Research Review


Landmark Upper Cervical Safety and Efficacy Study Published
Research Review
Written by Craig York, D.C.   
Wednesday, 29 August 2012 22:12
A
dding to the growing body of evidence supporting the safety, efficacy, efficiency and patient satisfaction regarding upper cervical chiropractic techniques is the recent publication of “Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study.” This latest research project, by the prolific orthospinologists Kirk Eriksen, D.C. and Roderic “Bo” Rochester, D.C., uniquely validates and differentiates upper cervical chiropractic care from other chiropractic techniques and spinal manipulative therapy (SMT) while further documenting its remarkable effectiveness and efficiency. 
 
pelvicboneThough chiropractic procedures have an enviable safety record, some studies have associated the risk of cerebral vascular incidents (stroke) with neck rotation and manipulation. This incidence has been estimated at 1 in 300,000 to 1 in 5.85 million manipulations, with some studies showing no causal relationship. No study has examined the incidence of adverse reactions following upper cervical spinal adjustments and the associated clinical outcomes. The Eriksen study is the first to clearly document the safety of multiple upper cervical techniques with a population of 1,090 patients receiving 2,653 upper cervical adjustments over an average of 17 days. Eighty-three doctors in four countries participated in this exclusively upper cervical study with Orthospinology, Grostic Procedure, NUCCA, Atlas Orthogonal, Advanced Atlas Orthogonal, Blair, Knee Chest, Duff, Toggle and SONAR techniques represented. Each doctor documented the response to care for 10 consecutive new patients for the two week period, with subjects ranging from 18 to 85 years of age with the mean age being 46.1 years. Females outnumbered males 699 (64.1%) to 391 (35.9%) and 95% of patients studied presented with headaches or musculoskeletal pain. No adjunct procedures such as full spine manipulation, mobilization, physical therapy or massage were utilized by the participating doctors, in order to maintain this study as purely upper cervical. 

Adverse events (AEs) have been used to describe unfavorable outcomes with various health care interventions. In this study, the authors chose to document symptomatic reactions (SRs) instead, in order to differentiate changes in a patient’s symptoms that in the clinical sense may represent the process of healing or shifts in posture that, while adverse to the patient, are not considered negative in the short term. A SR was defined as a new complaint or worsening of a presenting complaint by greater than 30%, less than 24 hours after initiation of upper cervical care. The Neck Disability Index (NDI), Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were used to assess the patient’s response to care and the impact of their pain on activities of daily living (ADLs). The intensity of the SR was graded on the 11 point NRS with “0” being no pain and “10” being the worst possible pain. An “intense” SR was defined as greater than 8 on the NRS. The initiation of the SR beginning in less than 30 minutes, .5 to 4 hours, 4 to 24 hours or more than 24 hours was recorded as was the duration of the SR as lasting less than 10 minutes, 10 minutes to 1 hour, 1 hour to 24 hours or more than 24 hours. 
 
Chief complaints distributed into 28 categories with 80.9% being spinal pain or dysfunction, and headaches. The majority of complaints were listed as chronic, associated with mild to moderate disability and moderate pain. 
 
Some of the outstanding clinical outcomes of the study include noted improvement in headache pain at 62.8%, in cervical spine pain at 56.8%, in thoracic spine pain at 58.6% and in lumbar spine pain at 57.0% in the two week period.. Thirty-one percent of patients required only one adjustment, 28.6% required two adjustments, 19.4% required three adjustments, and 11.6% required 4 adjustments while the remaining 9.3% had more than 4 adjustments. On average, patients were treated for 17 days, had 4.5 visits and received 2.4 adjustments. At follow-up, 62.2% of neck pain patients, 68.0% of headache patients, 67.9% of thoracic pain patients and 62.1% of low back pain patients returned to sub-clinical status in the approximate 2-week trial. Significant improved outcomes using NDI and OSW for those patients with disabilities relative to activities of daily living suggest clinical efficacy for patient function following upper cervical care. 
 

Some of the outstanding clinical outcomes of the study include noted improvement in headache pain

SRs were reported by 338 (31%) patients, with 23% of those reactions rated at 0 or 1 and only 56 (5.1%) rated above or equal to 8 on the NRS. Fifty-four percent occurred within 24 hours and 43.8% met the definition of SR (a new symptom not present at baseline or a worsening of a presenting complaint by greater than or equal to 30% occurring less than or equal to 24 hours). Nearly all (95.9%) were nervous, circulatory or musculoskeletal system related with a mean of roughly 3.5 on the NRS. The most frequent SRs meeting the accepted definition were: tiredness, radiating pain, neck pain, dizziness and headache in descending order of frequency. Most SRs were mild in intensity, with short duration of less than 24 hours with little effect on daily activities. There were no reports of serious SRs or AEs. 
 
Patients reported a very high degree of satisfaction with UC chiropractic care, scoring a mean of 9.1/10 on the NRS. Patients that experienced SRs were most likely to rate satisfaction lower, though the study points out the 9.1 score ranks highest among similar satisfaction rates of 7.1, and 5.4 for chiropractic and medical care respectively in the noted Hertzman-Miller study. The study also compares the number of adjustments required and the follow-up period with other chiropractic studies reporting similar or better outcome levels. 
 
This study documents the major strengths of upper cervical chiropractic on safety, effectiveness, efficiency and satisfaction across a broad spectrum of patients distributed over a wide geographical region and engaging in various UC techniques delivered by a relatively large group of doctors. It is yet another testament to the power of this unique approach to health. 
 
Drs. Eriksen and Rochester, with consulting and statistical help from Eric Hurwitz, D.C., PhD, and the contributions of 83 upper cervical chiropractors, have produced a milestone study for the chiropractic profession. The results of this study underscore the importance of UC chiropractic and the magnitude of the contributions to research available when chiropractors work together. The authors and the Board of Chiropractic Orthospinology sincerely thank all the participating doctors for their immense contribution to the growing body of research validating this unique approach to health care. 
 
The entire study may be viewed at:  http://www.biomedcentral.com/1471-2474/12/219 

Dr. Craig York is a 1989 Life University graduate certified in Orthospinology. He currently serves on the Advisory board for The Society of Orthospinology and authors their website, orthospinology.org and The Atlas newsletter. He maintains a private practice in Morrilton, AR and can be reached at: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Red Blood Cell Omega-3 Fatty Acid Levels and Markers of Accelerated Brain Aging Neurology
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Research Review
Written by Dan Murphy, D.C.   
Friday, 01 June 2012 23:31
Z.S. Tan, MD, MPH; W.S. Harris, PhD; A.S. Beiser, PhD; R. Au, PhD; J.J. Himali, MS; and 7 more.
This study was done at Boston University School of Medicine.

Docosahexaenoic acid = DHA
Eicosapentaenoic acid = EPA

T
hese authors note that the most accurate assessment of omega-3 fatty acids is by looking at the membranes of the red blood cells (RBCs). These authors examined the relation of red blood cell (RBC) fatty acid levels DHA and EPA in 1,575 dementia-free participants to standard performance on cognitive tests and to volumetric brain MRI assessment.

KEY POINTS FROM THIS STUDY:
1. “Higher fish intake has been associated with a reduced risk of cardiovascular mortality and stroke.”

2. In an earlier Framingham cohort study, participants in the top quartile of plasma docosahexaenoic acid (DHA) levels had 47% lower risks of Alzheimer’s disease (AD) and all-cause dementia.

3. This study related RBC fatty acid composition to subclinical markers of future dementia. “We related RBC omega-3 fatty acid levels to recognized MRI and cognitive markers of subclinical AD and vascular pathology and of risk for dementia in a large, community-based sample.”redbloodcells

   A. The brain MRI assessment included:
  • Brain volume
  • White matter hyperintensity volume
   B. The cognitive evaluation included:
  • Neuropsychological assessment, including recall time, verbal memory, visuospatial memory, abstract reasoning skills, etc.
4. “We found that lower levels of RBC, DHA and EPA in late middle age were associated with markers of accelerated structural and cognitive aging.” [Key Point]

5. “Fatty acids are integral components of biological membranes, and influence membrane fluidity, ion transport, and other functions. The neuronal cell membrane is no exception; the CNS has the highest concentration of phospholipids in the body.”

6. The omega-3 PUFA DHA is “very inefficiently synthesized from shorter-chain dietary precursor alpha-linolenic acid” and therefore is best obtained preformed from the diet. [Important for strict vegetarians]

7. “The biosynthesis of EPA and DHA from their precursor alpha-linolenic acid appears to decrease with age.”

8. Dietary intake of fatty fish is the main source of the omega-3s DHA and EPA.

9. “DHA and EPA exert several favorable effects on the vasculature, including blood pressure reduction, lowering the risk of thrombosis, reducing inflammation, and lowering serum triglyceride levels. Since vascular risk factors, cerebral atherosclerosis, and stroke have been associated with a higher risk of incident dementia, omega-3 PUFAs may delay cognitive and structural brain aging by some combination of these mechanisms.”

10. The omega-3 PUFAs influence membrane function and the activities of membrane-bound proteins. [Very Important]

11. Omega-3 PUFAs may be “directly linked to the neurodegenerative pathogenesis of AD, including reduction of amyloid-B production, synaptic protection by reducing neuroinflammation and oxidative damage, by increasing levels of brain derived neurotrophic factor, and through reduction of potentially excitotoxic arachidonic acid (omega-6) levels.”

COMMENTS FROM DAN MURPHY

This study adds to the evidence that preformed long-chain EPA and DHA omega-3 fatty acids are crucial for brain function. For years I and many colleagues have routinely tested patient RBC levels of EPA and DHA, and our findings are very concerning: our average patients are critically low in these essential fatty acids.

Healthcare costs are threatening to bankrupt our nation. It is projected that my generation, the Baby Boomers (born 1946-1964), will give our nation nearly 14 million cases of Alzheimer’s Disease; the cost of managing Alzheimer’s alone is projected to exceed $1 trillion per year, creating an unconceivable burden on our citizens. It is imperative for ourselves, our families, our patients and our nation for each of us to consume adequate levels of long-chain preformed EPA and DHA omega-3 fatty acids, and it is easy to do: supplement.

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.

 
Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain Molecular Neurobiology
Research Review
Written by Dan Murphy, D.C.   
Sunday, 01 April 2012 00:00
brainmolecularneurobiologyArtemis P. Simopoulos
This article has 116 references
LA = linoleic acid (plant derived omega-6 fatty acid)
ALA = alpha linolenic acid (plant derived omega-3 fatty acid

From Abstract
 
S
everal sources of information suggest that human beings evolved on a diet that had a ratio of omega-6 to omega-3 fatty acids (FA) of about 1/1. Today, Western diets have a ratio of 10/1 to 20–25/1, indicating that Western diets are deficient in omega-3 FA compared with the diet on which humans evolved and their genetic patterns were established. Docosahexaenoic acid (DHA) is essential for the normal functional development of the brain and retina, particularly in premature infants. DHA accounts for 40% of the membrane phospholipid FA in the brain. The balance of omega-6 and omega-3 FA is important for homeostasis and normal development throughout the life cycle.
 
KEY POINTS FROM THIS STUDY:
  1. Nutrition is an environmental factor that influences gene expression.
  2. Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed. 
  3. “Our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.”
  4. “Humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”
  5. “The increase in trans-fatty acids is detrimental to health.”
  6. “The beneficial health effects of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were described first in the Greenland Eskimos who consumed a high seafood diet and had low rates of coronary heart disease, asthma, type 1 diabetes mellitus, and multiple sclerosis. Since that observation, the beneficial health effects of omega-3 fatty acids have been extended to include benefits related to cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, and mental health.”
  7. The change of omega-6/omega-3 ratio in the food supply of Western societies has occurred over the last 150 years. 
  8. “During evolution, omega-3 fatty acids were found in all foods consumed: meat, wild plants, eggs, fish, nuts, and berries.”
  9. Today in Western societies the omega-6/omega-3 ratio is very high due to the high intake of soybean oil, corn oil, sunflower, safflower, and linseed oil. 
  10. The conversion of ALA to EPA and DHA “appears to be limited and variable.” 
  11. The omega-6/omega-3 ratio is associated with normal “growth and development, as well as in the outcome of hypertension, cancer, arthritis, mental health, allergies and other autoimmune diseases,” as well as the “pathophysiology of atherosclerosis, inflammation, and aging.”
  12.  “DHA is found in high amounts in the membranes of the brain and retina and is critical for proper neurogenesis, neurotransmitter metabolism, neuroprotection and vision. The consumption of high amounts of DHA has been associated with multiple health benefits including brain and retinal development, aging, memory formation, synaptic membrane function, photoreceptor biogenesis and function, and neuroprotection. DHA is essential for pre-natal brain development.”
  13. Omega-3s cause apoptotic death in cancer cells whereas omega-6s allow cancer cells to continue to proliferate.
  14. Psychologic stress in humans causes an overproduction of proinflammatory cytokines, which are minimized with adequate levels of omega-3s.
  15. Diets with a high omega-6/omega-3 ratio may enhance the risk for both depression and inflammatory diseases.
  16.  “LA more than any other nutrient is associated with shorter telomeres and shorter telomeres are associated with aging, cancer and coronary heart disease.”
  17.  Cognitive performance improves with omega-3s.
  18.  “Positive effects of omega-3s on dementia, schizophrenia, and other central nervous system diseases have been reported.”
  19.  Omega-3s can affect not only cognitive functions, but also mood and emotional states and may act as a mood stabilizer. Omega-3s have beneficial effects in some neurological diseases in addition to the chronic fatigue syndrome.
  20.  Omega-3 deficiency in childhood delays brain development and produces irreversible effects, while the same deficiency in aging accelerates the deterioration of brain function.
  21.  Omega-3 intake from ALA does not provide adequate intakes of EPA and DHA. 
  22.  Daily administration of 3 g of omega-3s for 3 months significantly decreased feelings of anger, anxiety and aggression.
  23.  “Western diets are characterized by high omega-6 and low omega-3 fatty acid intake, whereas during the Paleolithic period when human’s genetic profile was established, there was a balance between omega-6 and omega-3 fatty acids. Therefore, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”
  24.  “The balance of omega-6/omega-3 fatty acids is an important determinant in maintaining homeostasis, normal development, and mental health throughout the life cycle.”
  25.  “A low AA/EPA ratio has been proposed as an index of the beneficial effects of omega-3s which have been shown in animal and clinical experiments.”
  26.  Omega-3 deficiency in the brain is associated with “decreased learning ability, with a lower synaptic vesicle density in the hippocampus; whereas, chronic administration of omega-3s improves reference memory-related learning probably due to increased neuroplasticity of the neural membranes.”
  27.  Omega-3 fatty acids have positive effects in patients with dementia, schizophrenia, depression and other central nervous systems diseases.
  28.  Omega-3 fatty acid supplementation could play a role in [reduced] hostility and violence.
  29.  “In humans, the brain is the most outstanding organ in biological development: it follows that the priority is brain growth and development, and in the brain the balance between omega-6 and omega-3 PUFA metabolites is close to 1:1. This ratio should be the target for human nutrition.”
  30. “In Western diets, the omega-6/omega-3 ratio has increased to between 10:1 and 20:1. This high omega-6 proportion is largely made up by LA, is far from optimal and is highly inappropriate for normal growth and development.” 
  31.  “The ratio of omega-6/omega-3 fatty acids in the brain between 1:1 and 2:1 is in agreement with the data from the evolutionary aspects of diet and genetics.” 
  32.  “A ratio of 1:1 to 2:1 omega-6/omega-3 fatty acids should be the target ratio for health.”
 
Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars.  Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.
 
Low Back Pain: Chiropractic Adjustments vs. Skeletal Muscle Relaxants
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Research Review
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Sunday, 18 December 2011 01:07
Chiropractic had a better outcome in 24% of the patients, therefore saving public and private insurers and the American people $10,843,261,761 in skeletal muscle relaxant costs.

Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly, with Becker et al. reporting the incidence to be between 15% to 30% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, "Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason..." (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, "What works? What's proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible?" 
 
prescriptionAs mentioned, low back pain is one of the most common conditions encountered in clinical practice and medications are the most commonly used type of treatment, and muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain, according to Chou (2010). Chou went on to report, "The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension, headache or back pain." They are drugs that have been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, "Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution"(p. 1978). 

Chou (2010) also stated that, "Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects" (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:
 
More common
Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness
 
Less common
Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression; shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes
 
Less common or rare
Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation;  diarrhea; excitement, nervousness, restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)
 
Rare
Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin (http://www.drugs.com/cons/skeletal-muscle-relaxants.html)

Becker et al. (2010) reported the incidence of low back pain in the United States at 22.5% of the population. According to the United States Census Bureau on September 11, 2011, the population of the United States is exactly 312,227,241. If you factor in the 22.5% of patients that experience low back pain, that equates to 70,251,129 people yearly having low back pain. 

According to the Oklahoma Healthcare Advisory (2009), skeletal muscle relaxants for low back pain are indicated for 90 days at a cost averaging $441 (more or less depending upon the brand utilized). If 35% of primary care physicians, as previously noted, utilize muscle relaxants as the primary drug of choice, that equates to $10,843,261,761 in skeletal muscle relaxant costs. 

A study by Legorreta et al. (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed when chiropractic care was pursued, the average cost of treatment per back pain episode was reduced by 28% for patients with chiropractic coverage versus those without chiropractic coverage. Again, for patients with chiropractic coverage versus those without, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%!  

When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to the chiropractic spinal adjustment. 

He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10.

Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.

Within that group of 457% falls patients cared for by muscle relaxants. Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, "Statistically, the chiropractic group responded significantly better than the control group with respect to decrease in pain scores" (p. 396). This was done in "blinded randomized clinical trials, which are considered the gold standard of experimental design" (Hoiriis et al., 2004, p. 396).
 
While chiropractic was reported by Legorreta (2004) to reduce the cost of treatment by 28%, the total cost of muscle relaxants are unnecessary due to outperforming treatment outcomes in comparative analyses. Therefore, chiropractic could be saving public and private insurers and the American people $10,843,261,761 in skeletal muscle relaxant costs, not including the costs of managing side effects of the drugs, hospitalization, ancillary requirements and absenteeism costs that occur due to poorer outcomes.
 
REFERENCES
  1. Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E. (2006). Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.
  2. Becker, A., Held, H., Redaelli, M., Strauch, K., Chenot, J. F., Leonhardt, C.,...Donner-Banzhoff, N. (2010). Low back pain in primary care: Costs of care and prediction of future health care utilization. Spine, 35(18),  1714-1720.
  3. Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.
  4. Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4), 387-402.
  5. Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html
  6. Van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine, 28(17), 1978-1992.
  7. Census.gov. (2011, September 11)  U.S. & World Population Clocks. U.S. Census Bureau, Retrieved from: http://www.census.gov/main/www/popclock.html
  8. Consumer Reports Best Buy Drugs, The Muscle Relaxants (2009) Retrieved from: http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/BBD_Muscle_Relaxants_2Pager.pdf
  9. Legorreta, A.P., Metz, R. D., Nelson, C. F., Ray, S. Chernicoff, H. O., & Dinubile, N. A. (2004). Comparative analysis of individuals with and without chiropractic coverage: Patient characteristics, utilization, costs. Archives of Internal Medicine, 164(18), 1985-1992.
  10. Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473. 
 
 
Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain
Research Review
Written by Dan Murphy, D.C.   
Sunday, 18 December 2011 00:05
supplementsomega6Molecular Neurobiology
January 29, 2011 [epub]
Artemis P. Simopoulos
This article has 116 references
LA = linoleic acid (plant derived omega-6 fatty acid)
ALA = alpha linolenic acid (plant derived omega-3 fatty acid)
 
Abstract
 
Several sources of information suggest that human beings evolved on a diet that had a ratio of omega-6 to omega-3 fatty acids (FA) of about 1/1. Today, Western diets have a ratio of 10/1 to 20–25/1, indicating that Western diets are deficient in omega-3 FA compared with the diet on which humans evolved and their genetic patterns were established. Omega-6 and omega-3 FA are not interconvertible in the human body and are important components of practically all cell membranes. 
 
Studies with nonhuman primates and human newborns indicate that docosahexaenoic acid (DHA) is essential for the normal functional development of the brain and retina, particularly in premature infants. DHA accounts for 40% of the membrane phospholipid FA in the brain.  Both eicosapentaenoic acid (EPA) and DHA have an effect on membrane receptor function and even neurotransmitter generation and metabolism. 
 
There is growing evidence that EPA and DHA could play a role in hostility and violence in addition to the creating beneficial effects on substance abuse disorders and alcoholism.  The balance of omega-6 and omega-3 FA is important for homeostasis and normal development throughout the life cycle.
 
KEY POINTS FROM THIS STUDY:

1)  Nutrition is an environmental factor that influences gene expression.

2)  Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed. 

3)  “Our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.”

4)  “Humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”

5)  The major changes that have taken place in our diets in the past 10,000 years include:

   A)   An increase in energy intake and decrease in energy expenditure
  healthyfood B)   An increase in saturated fat
   C)  An increase in omega-6 fatty acids
   D)  An increase in trans-fatty acids
   E)  An increase in cereal grains
   F)  An increase in fruit and vegetable intake
   G)  A decrease in omega-3 fatty acid intake
   H)  A decrease in complex carbohydrate intake
   I)    A decrease in fiber intake
   J)    A decrease in protein
   K)  A decrease in antioxidants
   L)   A decrease in vitamin D
   M)  A decrease in calcium intake 

6)  “The increase in trans-fatty acids is detrimental to health.”

7)   “The beneficial health effects of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were described first in the Greenland Eskimos who consumed a high seafood diet and had low rates of coronary heart disease, asthma, type 1 diabetes mellitus, and multiple sclerosis. Since that observation, the beneficial health effects of omega-3 fatty acids have been extended to include benefits related to cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, and mental health.”

8)  The change of omega-6/omega-3 ratio in the food supply of Western societies has occurred over the last 150 years. 

9) “During evolution, omega-3 fatty acids were found in all foods consumed: meat, wild plants, eggs, fish, nuts, and berries.”

10) Today in Western societies the omega-6/omega-3 ratio is very  high due to the high intake of soybean, corn, sunflower, safflower, and linseed oils. 

11) “LA is found in high amounts in grains with the exception of     flaxseed, chia, perilla, rapeseed, and walnuts that are rich in ALA.”

12) The green leaves of plants are higher in ALA than LA.

13) The conversion of LA to EPA and DHA “appears to be limited and variable.” 

14)  The omega-6/omega-3 ratio is associated with normal “growth and development, as well as in the outcome of hypertension, cancer, arthritis, mental health, allergies and other autoimmune diseases,” as well as the “pathophysiology of atherosclerosis, inflammation, and aging.”

15) “DHA is found in high amounts in the membranes of the brain and retina and is critical for proper neurogenesis, neurotransmitter metabolism, neuroprotection and vision. The consumption of high amounts of DHA has been associated with multiple health benefits, including brain and retinal development, aging, memory formation, synaptic membrane function, photoreceptor biogenesis and function, and neuroprotection. DHA is essential for pre-natal brain development.”

16) Powerful anti-inflammatory molecules are derived from omega-3 fatty acids: Lipoxins, Resolvins, Protectins and Neuroprotectins. These molecules “function in the resolution of inflammation by activating specific mechanisms to promote homeostasis.”

The omega-6/omega-3 fatty acid ratio is innately critical for brain function, heart health, immunity, joint health, pain syndromes and more.

17) Omega-3s cause apoptotic death in cancer cells whereas omega-6s allowed the cancer cells to continue to proliferate.

18)Psychological stress in humans causes an overproduction of pro-inflammatory Cytokines, which are minimized with adequate levels of omega-3s.

19)Diets with a high omega-6/omega-3 ratio may enhance the risk for both depression and inflammatory diseases.

20) “LA more than any other nutrient is associated with shorter telomeres and shorter telomeres are associated with aging, cancer and coronary heart disease.”

21)“Clinical studies show that cognitive performance improves with omega-3s.”

22) “Positive effects of omega-3s on dementia, schizophrenia, and other central nervous system diseases have been reported.”

23) Omega-3s can affect not only cognitive functions, but also mood and emotional states and may act as a mood stabilizer. Omega-3s have beneficial effects in some neurological diseases in addition to chronic fatigue syndrome.

24) Omega-3 deficiency in childhood delays brain development and produces irreversible effects, while the same deficiency in aging accelerates the deterioration of brain function.

25) Omega-3 intake from ALA does not provide adequate intakes of EPA and DHA. 

26) Substance abusers have low omega-3 fatty acid intakes due to poor dietary habits. Omega-3s are helpful in the treatment of cocaine dependence and alcoholism because they can stabilize neuron membranes.

27)  Daily administration of 3 g of omega-3s for 3 months significantly decreased feelings of anger, anxiety and aggression.

28) “Western diets are characterized by high omega-6 and low omega-3 fatty acid intake, whereas during the Paleolithic period when human’s genetic profile was established, there was a balance between omega-6 and omega-3 fatty acids. Therefore, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”

29) “The balance of omega-6/omega-3 fatty acids is an important determinant in maintaining homeostasis, normal development, and mental health throughout the life cycle.”

30) “It is known that the relative amounts of omega-6 and omega-3 in the cell membrane are responsible for affecting cellular function as the AA competes directly with EPA for incorporation into cell membranes.”

31) “A low AA/EPA ratio has been proposed as an index of the beneficial effects of omega-3s which have been shown in animal and clinical experiments.”

32) The balance of omega-3 and omega-6 fatty acids to the “developing brain may be necessary for normal growth and functional development.” 

33) Omega-3 deficiency in the brain is associated with “decreased learning ability, with a lower synaptic vesicle density in the hippocampus; whereas, chronic administration of omega-3s improves reference memory-related learning probably due to increased neuroplasticity of the neural membranes.”

34) “Cognitive performance improves with omega-3’s supplementation, possibly due to increased hippocampal acetylcholine levels, the anti-inflammatory effects of omega-3s, decreased risk of cardiovascular disease or increased neuroplasticity.” 

35) Omega-3 fatty acids have positive effects in patients with dementia, schizophrenia, depression and other central nervous systems diseases.

36) Omega-3 fatty acid supplementation could play a role in [reduced] hostility and violence.

37) “In carrying out clinical intervention trials, it is essential to increase the omega-3 and decrease the omega-6 fatty acid intake in order to have a balanced omega-6 to omega-3 intake.”

38) “In humans, the brain is the most outstanding organ in biological development: it follows that the priority is brain growth and development, and in the brain the balance between omega-6 and omega-3 PUFA metabolites is close to 1:1. This ratio should be the target for human nutrition.”

39) “In Western diets, the omega-6/omega-3 ratio has increased to between 10:1 and 20:1. This high omega-6 proportion is largely made up by LA, is far from optimal and is highly inappropriate for normal growth and development.” 

40) “The ratio of omega-6/omega-3 fatty acids in the brain between 1:1 and 2:1 is in agreement with the data from the evolutionary aspects of diet and genetics.” 

41) “A ratio of 1:1 to 2:1 omega-6/omega-3 fatty acids should be the target ratio for health.”
 
COMMENTS FROM DAN MURPHY

The omega-6/omega-3 fatty acid ratio is innately critical for brain function, heart health, immunity, joint health, pain syndromes and more. I believe that everyone should have the AA/EPA ratio tested to see if they are in the “target ratio” of 1-2/1, AA/EPA.

The lab we use to test the AA/EPA ratio is Metametrix, at (800) 221-4640. 

The test is called Bloodspot Fatty Acids 0241.

The test is a finger prick draw, not venipuncture.

The omega-3 oils I take are from Nutri-West; I believe their ratios of ALA, EPA, DHA, and GLA are optimal: (800) 443-3333.

Nutri-West has a children’s formula, and both capsules and a liquid for adults:

CompleteChildren’s EPA/DHA (8 per day)
CompleteOmega-3 Essentials (6 per day), or
CompleteHi-Potency Omega-3 Liquid (1 teaspoon per day) for adults

To achieve the “target ratio” most adults need to consume 3,000 mg/d of EPA+DHA.
 
Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars.  Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.
 
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