As chiropractors, our main treatment focus is the adjustment. We use our hands to correct dysfunction in the spine. There arc numerous methods for assessing the spine, which will not be discussed herein; however, suffice it to say that we all palpate the spine. For a moment, consider the spines you have palpated today...how many people had paraspinal muscles that were sensitive to the touch? Many, if not most, of your patients fall into this category. Under normal circumstances, spinal and other tissues should not be sensitive to normal palpation and movement. When a light touch causes pain, you are being alerted to the fact that your patient's nociceptive system is sensitized. This means that the normally high nociceptor thresholds have been lowered by the presence of the chemical mediators of pain and nociception. "Allodynia" is the term used to describe pain that is induced by normally painless stimuli. With this definition in mind, consider how common it is to find "allodynic" areas in spinal areas that are distant from the area of symptoms. This is actually quite common, and many patients are quite surprised when they discover that their necks are tender and sore, when their area of pain complaint is the low back. What do you think is going on in such a patient's neck? More than likely, their back pain will resolve, yet the neck will remain tender to the touch. Even the back that no longer hurts can be sensitive when palpated. Most of you reading this article can relate to this experience. Some of you may have this problem yourself, which seems to be quite common. You should also be aware that allodynia is characterized by increased nociceptive bombardment into the cord, which not only increases the experience of pain, but also manifests as an increase in segmen-tal sympathetic and somatomotor out- flow, both of which are thought to increase muscle tension and reduce mobility. In other words, the presence of allodynia suggests the presence of a neurologic state that will drive sublux-ation and joint dysfunction. The Diet-induced Pro-inflammatory State In the March/April 2002 issue of JMPT, I reviewed how certain dietary choices create a pro-inflammatory state.1 Most of us were taught the inflammatory process and how to address it with manual care and modalities, such as ice and electrotherapy of some kind. As we know, MD's simply use anti-inflammatory medications. We should realize that both the chiropractic and medical approaches address the inflammation and pain that was ignited by an injury of some kind that could have been micro- or macro-traumatic in nature. All of you know, first hand, how effective the chiropractic approach can be when applied to this clinical scenario. Except for proteolytic enzymes, there is little that nutritional supplements or diet can do for the acute phase of inflammation. Actually, there is good data suggesting that proteolytic enzymes can dramatically improve healing rate, and return to work and sport.2 Irrespective of this nutritional application, within a week or so, most patients improve significantly, care can be reduced, and patients are typically discharged. In this treatment scenario, which is a fairly common approach to patient care, the focus is primarily directed at the acute problem. We, typically, do not think about an underlying chronic systemic problem, that even underlies spinal dysfunction. What do 1 mean by a chronic systemic problem? Consider the following perspective: Allodynia in spinal muscles is very common; however, MD's and researchers don't know about it because MD's don't palpate their patients, and researchers don't have patients. Allodynia exists because chemical mediators of inflammation are bathing spinal nociceptors. If inflammatory mediators are bathing spinal tissues, is it not likely that other tissues might also be exposed to such mediators? For example, what about the heart? Look at the cover of the May issue of Scientific American*, which refers to atherosclerosis as a "fire within." It is now well accepted that atherosclerosis develops over years and is driven by a subclinical inflammatory process. Not surprising, the same inflammatory mediators that cause pain and nociception (which are related to subluxation), also cause atherosclerosis, cancer, Alzheimer's disease and most other chronic diseases', which means that most diseases are driven by a subacute inflammatory process that can go on for years. How does this chronic inflammatory state develop? In short, over time, we eat ourselves into an inflamed state. It is known that cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor (TNF), and the eicosanoids (pros-taglandin E2, thromboxane A2, and leukotriene B4), are the mediators of inflammation and chronic disease, and it is known that omega-6 (n6) fatty acids augment their production.1-4"6 A lifetime of gorging ourselves with n6 rich foods appears to be the problem. Grain and its many forms, such as flours, pasta, cereal, corn chips, and desserts, are foods that are extremely rich in the n6 fatty acids. In contrast, green leafy vegetables, and wild game and fish contain appreciable amounts of anti-inflammatory omega-3 (n3) fatty acids. Up until about 100-150 years ago, we consumed a diet' that was generally well balanced between n6:n3 fatty acids. A 1:1 ratio is ideal for humans. In the past 150 years, we have exposed our tissues to an n6:n3 ratio of 20:1, or greater, which represents an assault on our biochemistry and genetic apparatus. Basically, what this means is that the last two-three generations of humans are distinctly different biochemical creatures from those of centuries past. Babies are now being born with altered ratios of n6:n3 fatty acids, and, within a few short years, they begin to liberally consume n6-rich foods. Give a nutritional adjustment While you may render a patient pain-free with an adjustment, that patient will still leave your office with an n6:n3 ratio that is pro-inflammatory and a promoter of nearly all degenerative diseases. You don't need to do sophisticated tests to discover that your patients are inflamed due to imbalances in n6:n3 fatty acids. Well, you can, if you want to; however, experts agree that this imbalance exists. You can determine if a patient is inflamed by simple palpation. When you discover allodynia in areas where there are no pain complaints, you have discovered that subclinical inflammation exists. When you find allodynia, you should be thinking about urging your patients to alter their eating habits to reduce n6 fatty acids and increase n3's. This is accomplished by their eating less grains and focusing on green leafy vegetables and coldwater fish, in particular. Also, it is recommended that patients take fish oil supplements that provide at least 1 gram ofEPA/DHA,perday. By reducing the inflammatory state with diet and supplementation, you will be helping to create a biochemical environment that is less likely to result in pain and subluxation. In other words, you will be providing your patients with a nutritional adjustment. In a future article, I will discuss the n6 and n3 fatty acids in more detail. You will be shocked when you discover some of the details. Dr. Seaman is the Clinical Chiroprac- tic Consultant for Anabolic Laboratories, one of the first supplement manufacturers to service the chiropractic profession. He is on the postgraduate faculties of several chiropractic colleges, providing nutrition seminars that focus on the needs of the chiropractic patient. Dr. Seaman believes that chiropractors should be thinking like chiropractors, while providing nutritional recommendations. Doctors and patients who follow his programs report improved feelings of well-being, weight loss, dramatic increases in energv, and significant pain reduction. Dr. Seaman can be reached by e-mail at doc(5)lesspainbettprpolfc.om. References 1. Seaman. DR. The diet-induced pro-inflammatory state: a cause of chronic pain and other degenerative diseases'? J Manip Physio! Ther 2002; March/April 2. Bucci L. Nutrition applied to injury rehabilitation and sports medicine. Boca Raton: CRC Press: 1995: p. 13 3. Libby P. Atherosclerosis: the new view. Scientific Am 2002 (May):47-55 4. Fernandes G. Role of omcga-3 fatty acids in health and disease. Nuir Res 1993; 13(suppl):S19-45 5. Myedani S. Effect of (N-3) polyunsatu-rated fatty acids on cytokine production and their biologic function. Nutrition 1996; 12:S8-S14 6. Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr 1999; 70(suppl):560S-69S.
