Blog, COVID-19 May 8, 2020

Chiropractic and the Immune System the Experts Weigh In – Heidi Haavik, DC

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Good afternoon. This is Dr. Gerry Clum on behalf of Life University and Today’s Chiropractic Leadership.

Recently, I had the chance to sit down with Dr. Heidi Haavik, the Director of Research at the New Zealand Center for Research at the New Zealand College of Chiropractic in Auckland, New Zealand. Heidi and I were able to spend about 15 minutes together to chat about the current perspective that she has on the impact of the chiropractic adjustment on the neurology and immunology of the human being, in particular in relationship to the current COVID-19 virus circumstances. I hope you’ll take the next few minutes to spend with us and ChiroSecure and listen to Heidi’s perspective on what we need to think about and how we need to relate to our patients.

Good afternoon. This is Dr. Gerry Clum again, and we’re continuing our discussion with notable individuals in the chiropractic community who can help inform us and give us perspective on where we are in relationship to the COVID-19 circumstances in our respective countries and around the world.

Today, we have the good fortune of sitting down with Dr. Heidi Haavik from Auckland, New Zealand, the Director of Haavik Research and is the key and principal researcher at the New Zealand College of Chiropractic in Auckland, New Zealand. So Heidi, welcome and glad to have you with us this afternoon.

Thanks Gerry. It’s a pleasure to be here.

Well, Heidi, I’m going to kind of cut to the chase on this thing. We’re all supportive of the World Health Organization’s recommendations regarding sanitation and distancing and the common sense measures that are going on. We’re obviously all acutely aware of the significance that this problem holds around the globe.

But what I’d like to try and get from you are your thoughts as a chiropractic practitioner, as a neuroscientist and a researcher about the status of information about chiropractic care and the defense systems of the body. What is it that we can say, and what should we be saying in our offices regarding the relationship that chiropractic care may hold for patients at this moment in time?

Yes. Well, I’ve spent the last wee while looking into this in detail and completing a big review on the topic. So it’s very interesting. We’ve actually got more research than I actually thought when it comes to chiropractic and the immune system. I must do a bit of a plug to CMCC on that note, because they’ve done a bulk of these studies, which is really interesting.

What we can say for sure in our offices to our patients is that there definitely is credible evidence for a link, a connection between chiropractic adjustments and immune system functions. But these studies are based on basic science studies, and what we’re lacking and what we’ve got to be very careful about, is translating that into clinical claims, because we have no studies yet that look at would chiropractic care prevent you from getting sick or would chiropractic care reduce the symptoms of being sick or the frequency of getting sick? Those studies haven’t been done yet.

So all we really know for sure is that chiropractic definitely influences the nervous system, and chiropractic definitely influences the immune system. But we don’t yet know what does that mean clinically for a patient in your practice. So that’s where we’ve got to be very, very careful.

Great. That being said, what would the conversation in an office be in the ideal sense in your mind between the practitioner and their patient?

So things like you could tell your patients that we definitely know that chiropractic adjustments can change neuro-chemicals in the body that are related to immune system function. We know we can increase things like substance P or oxytocin or neurotensin. We know we can change certain interleukin cytokine levels. So we know we can have an immune system effect, but we don’t know what that effect would mean for them just yet. So we don’t know whether that would prevent you from getting coronavirus. We don’t know if that would reduce your symptoms if you have coronavirus. We don’t know those bits yet.

This is the key difference between basic science studies and clinical trials. It’s the clinical trials that we are lacking, because basic science studies really look at how does something work and is there a connection? Those studies, we’ve actually got quite a few. We know chiropractic care influences the nervous system, and in particular, very important parts of the nervous system that are known to influence the immune system. There’s direct studies that show that chiropractic adjustments change immune system functions. So the connection is for sure those basic science studies, the mechanism. We know that there is a connection, but we don’t yet know whether that means that you will not get sick or be less sick or recover faster, because those clinical trials just simply haven’t been done. It could be that we can help with that, but we just don’t know, because those clinical trials haven’t been done.

Right, right, right. Unfortunately, or fortunately, depending upon I guess your point of view, is that they haven’t been done successfully in medicine either, is that no one has a handle on an appropriate treatment or a recommended treatment in relationship to this virus at this point in time.

There are-

I’m sorry. [crosstalk 00:06:25].

There are obviously studies in the medical world that look at viruses in general, and there’s quite a bit that’s known about that. But obviously, I’m assuming you’re relating to COVID-19. No, no studies have been done on COVID-19. But I was thinking in general basically with the immune system. I mean, obviously, no studies at all on the connection between chiropractic and COVID-19, full stop.

Absolutely. Absolutely. We’re on the same page on that for sure. Okay.

So Heidi, what I’d also like to talk about in a related sense is the things … You’ve written a great deal about stress in your work and the relationship of sympathetic tone or parasympathetic suppression and its effect upon the patient and their circumstances. I don’t know what it’s like in New Zealand, but it is wall-to-wall 24/7 radio, TV, streaming, everything. Can you speak to the issue in general of stress in relationship to immune function?

Yeah, it’s really quite sad, and because not only the stress in relation to getting this virus, and then what does that mean; but also, a lot of people are losing their jobs. So there’s massive amounts of financial stress. People are losing their homes, because they suddenly can’t pay their rent.

So stress at the moment is going to skyrocket. That’s something that I think we chiropractors need to be acutely aware of. Because that stress is so incredibly detrimental for our brain function, we know that stress will turn off the rational reasoning part of our brain called the prefrontal cortex. We know that it activates the limbic systems, the panic systems in our brains, the danger warning signals. They get elevated or heightened. We know that this also activates our sympathetic nervous system, and we also know that it activates our hypothalamic pituitary adrenal axis.

Both of these, the autonomic nervous system and the hypothalamus pituitary adrenal axis are both highly involved in the neuroimmune connection. Because the way the brain operates or the way the body operates is that it has these little clusters of immune cells, nerve cells and glial cells. They’re called neuroimmune cell units or cell clusters, and they’re scattered throughout the body to sense what’s going on in your body if there’s some invading pathogen or stressful trauma.

If they detect anything like that, they will signal this to the brain in two main ways. One direct way via the afferent fibers in the vagus nerve, so that parasympathetic nervous system. It’s really a massive sensory system for the brain to figure out what’s going on in the body. But these little cytokines that are released if there is a pathogen or a local inflammatory process somewhere can also go via the circulation up to these little parts of the brain where it can cross the blood-brain barrier. Again, the brain is notified that there is inflammation happening in the body.

What the body then will do is activate two main systems. One is the sympathetic nervous system. So it can directly activate the sympathetic nervous system and releases norepinephrine. This influences the local immune response. You can also activate the parasympathetic nervous system. These are both the divisions of the autonomic nervous system. The parasympathetic nervous [inaudible 00:00:10:04], this is the efferent fibers of the vagus nerve. This is known as our cholinergic antiinflammatory system. So it again keeps things in balance.

But the brain also has a endocrine response, and it can activate the hypothalamus pituitary adrenal axis and release cortisol. The sympathetic nervous system can also directly activate that adrenal gland and help release adrenaline. So these are the ways that the nervous system balances out the immune response that happens in the body.

The key here is balance and keeping this all under an appropriate response, because you don’t actually want too much inflammation, but you also don’t want too little inflammation. Because too little inflammation can make you more susceptible to diseases and cancers and a whole host of things. But we also know that too much inflammation is associated with a whole host of chronic diseases today, which I’ve talked a lot about before. So it’s very, very important this balance.

What’s really interesting is, that prefrontal cortex, this part just behind our forehead, is extremely important in balancing the autonomic nervous system and in controlling that hypothalamus pituitary adrenal axis of the immune system. We know therefore that it’s vitally involved in our immune system, full stop. Stress turns that part of the brain off. So this is where we think a lot of neuroimmune problems originally arise from.

So if you think of the rising stress that’s driving these inflammatory processes in the body, turning off the antiinflammatory systems in the body and turning off your major controller, the prefrontal cortex that would balance out these systems, you can see where this just heads one way. This is where, again, we’ve got direct evidence that stress increases your susceptibility from getting sick. It prolongs you being sick, and it usually worsens your symptoms. So this is not a good thing at the moment.

That’s an understatement of all time, that’s for sure. Thank you for that discussion. Excuse me.

I’m going to ask possibly the same question I’ve asked you before, but in reverse. If you had to answer the question, give me two, three or four things that you hope you wouldn’t hear from a chiropractor at this time about this problem relative to COVID-19. What would they be?

Okay. I would not want to hear a chiropractor saying that chiropractic care can prevent you from getting coronavirus. I would not want to hear a chiropractor saying that we have evidence that chiropractic care would improve your symptoms if you’ve got coronavirus. I wouldn’t want to hear those kinds of claims, that we could prevent it, reduce the symptoms and speed up the healing process. Those studies haven’t been done.

The links are there, and it’s really up to us as a profession now to do these studies. I mean, the onus is for us to actually support the research and fund the research where we actually test those questions. We know there’s a strong link now, so does then chiropractic care prevent infections? Does it speed up recovery times? Does it reduce the frequency of you getting sick? But those studies haven’t been done, so we literally don’t know. So I would prefer it if the chiropractic profession didn’t go say those things, because we do not have the evidence.

Like you said before, right now we’re under a lot of scrutiny, and it’s really, really important that as primary healthcare professionals, what we say is accurate and is up to date according to the latest scientific evidence.

Perfect. Thank you, thank you. I appreciate it. I think that’s great counsel for people in their offices, great counsel certainly for their social media activities and things of that nature. So we appreciate that very much.

Heidi, is there anything you had hoped we would chat about today that we haven’t gotten to that you’d like to add to the discussion?

I’d probably like to just add in again that there are clear connections now between chiropractic care and the nervous system and the way it works, that chiropractic care certainly seems to enable the brain and body to be more accurately aware of what’s going on. This little bit of evidence showing that we can improve its ability to adapt. We know now that there’s these clear connections with the immune system as well.

So it makes sense that chiropractic care would be a wonderful thing at this time. It’s really sad, because here in New Zealand, we’re literally banned from seeing patients. I mean, that to me is heartbreaking, because the model is there that shows that we probably would help people in the situation. But I’ll be extremely careful with making those clinical claims, because it’s those clinical claims that we just don’t have.

Well, Heidi, I thank you very much. I wish you all the best and for you and your family and all our friends in New Zealand.

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