Blog, COVID-19 May 8, 2020

Chiropractic and the Immune System the Experts Weigh In – James Chestnut, DC

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Good afternoon. This is Dr. Gerry Clum Of Life University and Today’s Chiropractic Leadership. I recently had the opportunity to sit down and chat with that Dr. James Chestnut about his perspective on the current COVID-19 infection and COVID-19 pandemic that we’re dealing with in the United States and, in fact, the world is dealing with. James was able to share his thoughts on how you and I as chiropractors interface with this problem and how we can make the best contribution to the lives and well-being of our patients and the people in our communities. I hope you’ll take the next few minutes and listen to what James has to say about how you can be more effective in helping your patients deal with this moment in time.

Good morning, ladies and gentlemen. It’s my pleasure to be with Dr. James Chestnut from Victoria, British Columbia, and if you’re a chiropractor or if you’re even remotely involved around the edges of the chiropractic community, you know Dr. Chestnut. You know about his activities throughout the years in terms of wellness and well-being and health promotion. You know about his academic capacity. You know about his research acumen and you know the kind of information that James brings forward to us. Today as part of this series, Today’s Chiropractic Leadership is very pleased to welcome Dr. Chestnut to this conversation. With that being said, the floor is yours, my friend.

Okay, thank you. I think in terms of the way the immune system works, I think a lot of people are hung up on this concept of a novel virus as what we’re dealing with right now. But I think it’s important that everyone understands that /Users/alanweinstein/Desktop/Chiropractic and the Immune System, The Experts Weigh In Part 3 – James Chestnut.txtthe immune system is perfectly set up to deal with novel viruses. That’s the whole concept of the innate immune system. So there are two parts of the immune system. There’s the innate immune system, which is really the phagocytosis, the phagocytes, which really identify non-self. They identify a pathogen like a virus, and then they either engulf the cell with the virus, they engulf the virus itself or they reduce some reactive oxygen species. Basically, they kill it, they attack it and kill it. They’re kind of the first frontline soldiers of the immune system.

And then the other part of the immune system, which is much more specific and much more organized, is the humoral or adaptive or the antibody system they sometimes call it, but that involves the T cells and, and the B cells. The B cells are the ones that actually produce the specific antibodies to the specific antigen or pathogen. And so that’s really more of the more specific, more robust… That’s the whole military coming in to attack this thing. But generally what happens, what’s really important about this particular conversation, is that because viruses like the cold virus, the rhinovirus, the coronavirus, the flu viruses like influenza virus, they have a different strain usually every year, which is why people say if you got the flu last year, you’re not going to be protected from the flu this year.

And that’s because we don’t use our antibody system. We don’t use our adaptive immune system to deal with viruses like the cold and the flu because the virus changes all the time. So an antibody to last year’s virus isn’t specific to this year’s virus so it doesn’t matter. What that means for this discussion is that it’s really the function of our innate immune system that is really used to deal with viruses like influenza and cold, rhino and coronaviruses because it’s going to be new. So the thing that really protects us, the thing that we count on, the reason why people don’t get sick every year from the flu, even though it’s different every year, is because they have this innate immune response, which is able to either attack and kill or reduce the number of those viruses in the body so quickly that it doesn’t get a chance to take hold.

So when we’re talking about seasonal illness we’re always really talking about our innate immune system, not our antibody system. The T cells of the adaptive system are very important as well because they’re part of the quick response but they don’t make antibodies. The antibodies are something that helps us for future immunity much more than they do for that acute crisis. And so I think that’s important for people to understand because I think people get nervous about novel. They put the term “novel” in front of it, but we’re absolutely very well equipped to deal with the novel virus, which is why the vast, vast majority of people who get infected with this coronavirus are absolutely fine. It’s because their innate immune systems are functioning as they should be.

They don’t have any antibodies when they’re first exposed to this virus. They don’t have any antibodies to it. It’s their innate immune system. And in fact, the innate immune system is very important for tagging this virus and putting antigens so that the actual… And that’s what the T cells are going to recognize. And it’s also what the antibodies are going to be produced for. So the two systems work very closely together, but the whole thing is initiated by the innate immune system.

There are two things about an immune response that are incredibly important. One is can we up-regulate it to attack this virus very quickly or attack whatever it is very quickly. So we want to up-regulate it to try and kill that virus. But the other thing that’s equally as important, and this is really important for what we’re talking about here, is can we then make sure it’s called, in the literature it would be called, is it tolerogenic? Are we making sure that we don’t have a huge over-hyperactive response? Do we produce too much inflammation? Do we create an autoimmune response? Do we create atopic disorders and allergies down the line?

And the type of cells that are the most important in terms of regulating the response, up-regulating it when we’re supposed to, but making sure it’s not a hyper-response. And we also need to remember that the thing that people end up dying from, whether it’s from influenza-induced pneumonia or corona-induced ammonia, is a hyper-inflammatory response in the lungs. And so one of the most important parts of immunity isn’t just this idea that we think of that we have to up-regulate it all the time. It’s also to make sure that we control and regulate it properly so that we don’t overdo it, which is really the thing that harms us.

It’s the T regulatory cells called Tregs or T regulatory cells that are the most important part of that in terms of regulating the proper immune response. And we’re going to talk a bit later, but those are some of the things that are really most vulnerable to deficiencies in vitamin D, Omega-3 and vitamin A because those immune cells actually epigenetically up-regulate the receptors for those essential nutrients because those essential nutrients are required to epigenetically change what those regulatory cells can do in order to properly function. So if you’re deficient in the nutrients that those T reg cells require, you’re deficient in immunity, in your immune response, or at least dysfunctional.

Great. Thank you. Thank you. Very helpful and I look forward to coming back to that in the conversation later on. That’s a great segue to the next area that I wanted to chat with you about, is that obviously we’ve got a situation where we’re dealing with a virus that mankind has not seen before. We are in the early stages of that response that you had talked about. And there’s a few constants. The virus itself stays the same across space and time. And the other factor-

At least this year it stays the same.

This year, thank you. Thank you. Thank you. Thank you. Stays the same in this window of time that we’re in right now. So the idea that its presence is one thing and then we look at how we’re responding. We acknowledge that unfortunately in the world today, there is no treatment for this virus. There is no cure for the virus. There is no vaccine for the virus there. There is no known standard of care in dealing with this virus to kill the virus, so to speak, but it’s supportive care of the patient and so on.

And that brings us to the point that you were starting to discuss, I think, is the things that we can do as individuals to make sure that we are as prepared as we can possibly be to confront this virus. It appears from the conversations to ultimately going to be a ubiquitous virus with a high level of contagiousness to it. And therefore the variable as I see it is that we’ve got to strengthen ourselves in relationship to the virus for our own protection, well-being etc. That being said, can you begin some conversation about the steps you would encourage people to take to maintain that well-being?

Sure. And I think it’s such a great learning opportunity right now to understand why, especially our chiropractic paradigm about this idea of baseline health or baseline immune function if you like, is so important at all times. And so the idea of health promotion in a sense right now is almost the same as harm reduction because as you said, there’s really no other harm reduction strategies available to us. And I think the most important thing here is to understand that the variable determining the level of effect or burden or consequence of this pandemic is not the number of people who will be infected. It’s the number of people who get infected who will become seriously ill. And so that’s the main variable here. Everybody will agree.

Now we have to determine what’s the main variable to determining whether or not somebody who gets infected will become seriously ill, require hospitalization, and maybe require a ventilator. Because that’s the thing that’s causing all this overburden and overtaxing of the healthcare system, the financial system, all of the things. So that’s the most important question right now, which is what’s the difference between people who become seriously ill and require hospitalization and ventilator versus those who are immuno competent enough that they can deal with this virus on their own without the need for any medical care? And by the way, the vast majority of people don’t require anything other than staying at home and resting and all the kind of stuff that we talk about.

So one of the things that we have to look at, there’s two variables now. One is what is the thing that is making people immunocompromised? If we look at our culture, there’s lots of things. Immuno compromising, cortical steroid medications is one of those things. Lack of proper healthy lifestyle is one of those things. Improper nutrition, not enough exercise, too much emotional stress, these are all the things that we can talk about that can down-regulate immunity.

And then some of the other things we’d have to discuss are what are the things that our immune system requires in order to function properly, in order to express our immune potential? I think what’s really important is most of the things that compromise our immune system, we’re not going to be able to change in an acute crisis. So I’m going to leave those aside for now, but I want everybody to understand that there are some things that can literally create dysfunction in our immune system, but we’re not going to fix those quickly. But there are some things that we can do that can really help to restore proper function of our immune system, that can make us more immunocompetent, that we can do quite quickly.

Certainly one of those would be exercise but it takes some time to become physically fit but no matter what, if you start right away and just start getting out and going for a walk and exercising. We know if you start eating better foods there’s no doubt about it, meaning you’re going to put less toxic food into you as well. And we also know that if we start dealing with our emotional stress that right away we can make a difference for sure.

But I would like to discuss something that’s more clinically related, which is making sure that people are sufficient in their intake of the essential nutrients, which the literature is unequivocal. This is an evidence-based discussion we’re having now because the literature is very clear that things like vitamin D especially, but also Omega-3 fatty acids and vitamin A are incredibly important nutrients in terms of our immune system that our immune systems literally cannot operate or function properly unless they have sufficient access to these nutrients.

These nutrients are called essential. Biochemically what that means is that our bodies require them, our cells require them, but we cannot make them. Therefore, we have to ingest them or get them through sunlight with vitamin D are ingested. And so what the literature says, which is incredible, is that, and not only just the basic science stuff about how this affects immune cells, that’s basic science research, but there’s actual randomized clinical trials on intervention studies with supplementing with vitamin D and actually decreasing not only the incidence of but the severity of respiratory illnesses like cold and flu. So there’s a lot of evidence out there, even systematic review, which is summarizing all this stuff and showing… And then in the British Medical Journal, they’re actually saying this should be a public health sort of recommendation that makes sure people get sufficient D.

And so what I try to explain to people is, look, let’s not say that these essential nutrients can cure the coronavirus or prevent it. That’s not it. What we’re saying is, is that what these essential nutrients treat is a deficiency in these essential nutrients. However, what we can say with certainty is that a deficient intake of these essential nutrients, producing a deficient supply of these essential nutrients for your immune cells, makes you immunocompromised. There’s no doubt about it. So if you’re deficient and the vast, vast majority of the industrial population is deficient in vitamin D, they are deficient in especially the proper ratio of vitamin D and vitamin A, and they’re definitely deficient in Omega-3 fatty acids because it’s just not readily available in our diet anymore without supplementation. So the vast majority of people are deficient in these things. It’s really simple to correct it and relatively inexpensive and it’s something that can make a difference immediately.

And so I just think that that’s one of the things, on top of just a general healthy lifestyle, that’s one very specific thing to do with immunity that chiropractors can be talking about and should be talking about, in my opinion.

Great, great, great advice. Great counsel. Yeah. James, from your perspective, if I were your patient in your office in Victoria and I was in your office and I just got my adjustment and we were talking about my concerns and fears about this whole milieu, what would your advice be? What would your counsel be to me as a patient? And what do you recommend the guy or gal working over an adjusting table, what’s the conversation they should be having with their patients about this entire situation?

I think the most important thing is to focus on things they can control. So there are things that are going to be out of our control. The definition of stress really is focusing on things that you can’t control. So what I would say is, what are the things you can control? And there are some really commonsense things that the CDC and all these people are putting out, wash your hands, social distancing for the time being. All those things make perfect sense.

But nobody’s really talking to them about how to increase their own baseline health and well-being. And I think that’s a really important role for a chiropractor. It’s also a great time to have that discussion which is to say, look, the most important thing determining the course of this whole thing, whether it’s individually or for society, is your level of baseline health and immunity. Your level of immuno competence, which is really an indissoluble union with your baseline overall health, they’re the same, right? They’re part of the same piece puzzle or the same circle I guess, parts of the same whole.

So what I would say to them is, in my office, what I can say, fortunately, is these things that I’ve been telling you since you started here, all this focus on the importance of making sure that your body, the intelligence of your body, that your genes get these proper inputs so that they can express health for you because your genes are great, they just need the proper ingredients. You’ve got the great blueprint, if you like, and you just need the proper building materials. We’ve got the great recipe. If I can tell you what it is, that what you put in matters.

And that’s something that we can control. Positive thoughts, healthy exercise input, movement input, proper movement of all parts of our body, including our spine, of course, and proper nutrition. That matters. And then trying to block out the things that are going to harm you. So I always say, no matter what, baseline health, immune competence, it’s all based on two things. It’s based on toxicity, limiting the amount of negative things that go in, whether that’s a thought or a bad food or sedentary living, whatever it is, toxicity. And the other one is deficiency. We have to remove toxicities and we have to get rid of deficiencies by creating sufficiency.

So the conversation is, what are you doing that is going to help you have the greatest level of baseline health and immunocompetence possible? Are you taking those supplements? Are you exercising properly? Are you eating well? Are you making sure you don’t have a lot of physical stressors? Are you making sure you don’t have a lot of emotional stressors? And that’s the conversation. But interesting, Dr.Clum, that’s the conversation I have with my patients every day because there’s nothing different about the importance of being immuno competent now than there was before this virus showed up. Because baseline health and immuno competence have an effect on every illness, heart disease, obesity, diabetes, chronic inflammatory diseases, ulcerative colitis, whatever you want to talk about. The things that we’re supposed to, what we put into our body, whether it’s bad or whether we put it in enough good, is always going to be a huge causative factor in our level of baseline health, immunity, quality of life, well-being, enjoyment. It’s important all the time. So that’s the conversation I’d have.

Wonderful. Thank you. Let me ask another question and perhaps as we get to a close here from the opposite perspective, what are a few things that you would like never to hear a chiropractor say about this situation and circumstance at this moment?

I am adamant that a chiropractor should never say, in any environment but especially now, that chiropractic is a treatment for infectious disease or that it could prevent coronavirus or that chiropractic has clinical evidence that it can boost immunity.

I have lectured for many years as you know, and I can show with irrefutable evidence the biological plausibility of the relationship between a segmental problem in the spine, increased nociception, changes in sympathetic activity, changes that are going to lead to hypothalamic pituitary adrenal axis and increased cortisol that could absolutely, absolutely have a relationship to down-regulated immunity and down-regulated overall health. The biological plausibility argument has been won. What has not been won is the clinical evidence argument. And I think now more than ever, it’s important to make that distinction between biological plausibility… And by the way, a decrease in proprioception also causes the same problems. And by the way, the literature is full of material that says even increased pain changes sympathetics and the neuro-endocrine system and autonomic balance. And if you look at Bruce McEwen’s work, who’s literally a founder on allostatic load, who I’ve spoken to personally via email, who says, absolutely a problem in the spine can represent an allostatic load, which can change autonomics and lead to all these issues. I went to the world’s leading expert to check.

So I’m just telling you, there’s no doubt on the biological plausibility, but biological plausibility is not the same as clinical evidence. Clinical evidence means that we have evidence that if we do A, this is the health benefit that we get, a measured health benefit. Chiropractic has never been about treating infectious illnesses or treating any illness. The clinical indicator for a chiropractic adjustment is a spinal finding. That’s what determines whether or not we should adjust somebody.

So we would never say, “You have coronavirus? That’s an indication that you need a chiropractic adjustment. You have heart disease? That’s a…” We would never do that anyway. It doesn’t matter what side of the spectrum we’re on. It we’re on both of those extremes, would agree on one thing. And that is that the legal and peer-reviewed clinical indicator determining whether or not a patient should get a chiropractic adjustment or chiropractic SMT is a spinal finding, not an infectious disease. So my point is this, it’s the wrong question to ask if a chiropractic adjustment can cure or prevent an infectious illness. The right question is, can the problem in the spine that’s a clinical indicator for chiropractic adjustment, can that be related to overall health or overall immune competence?

Biologically, yes. If we want to determine if there’s a clinical connection between people who get regular chiropractic care and people who are less susceptible to respiratory illnesses or heart disease or diabetes or emotional problems, then we’re going to have to do some clinical studies asking that specific question. And those studies haven’t been done. So as I say to people, when you’re talking to a patient in your office, there is reasonable, and most chiropractors have had a lot of clinical experience with seeing people change their overall health and immune status, less colds, less flus. I get it. So that’s a conversation you’d have in your office and explain that indirect relationship with people. But it’s not an evidence-based… It hasn’t met that level of evidence yet.

So that means we shouldn’t be making public claims about it. A public claim requires evidence, clinical evidence. An explanation inside your office to your patient requires biological plausibility. That’s my opinion. And I think in this case we’re going to do nothing but harm to ourselves and to our cultural authority and to our reputation if we make false claims. And that’s how I feel about it.

Great. Well, thank you my friend. I can’t tell you how much I appreciate you taking time out of your busy schedule. I know that we all have had our lives and circumstances up-ended and turned around. I don’t know about you, but I’ve canceled dozens of flights and I’ve got enough credits with the airlines to be able to fly any place I want to fly for a long time.

We can meet in Tahiti when this is all done, Dr. Clum.

That’s a deal. That’s a deal. Well listen, thank you my friend. We appreciate the information, appreciate the insight and the clarity with which you’ve spoken on these issues. And we thank you for all the work you do and you continue to do. We wish you well and take care of yourself and your family. And as they tell you, getting on those airplanes, put your oxygen mask on first. And we’ll go from there.

And I would like to just say to all the chiropractors, I understand how hard this is for the practitioner. That’s not lost on me in any of this. We’re having an academic discussion. The truth is that this is having an enormous impact on offices and individual chiropractors as well. I really feel for them. Honestly, I do. So I hope this helps.

Thank you. Thank you. Thank you. Take care of yourself.

Okay, You, too.

Thank you.

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