Views of ACA Council on Nutrition President (1992)

Ira Milner, R.D.
October 7, 2001

What is the Council on Nutrition?
Is it a policy-making body?
What does it do exactly?

There is two parts to the Council, in one sense, that are separate bodies. There is the Council on Nutrition; its main goal is to educate chiropractors in ongoing nutrition services. The Council on Nutrition also helps … Again the main thrust is to become an educative body. There are position papers that have been written. The most recent one is the use of weight-loss programs in the chiropractor’s office, saying that if done properly after a nutritional workup, it’s an appropriate thing for a chiropractor to do. There was a position paper done a couple of years ago on cytotoxic testing, saying that what’s out in the literature doesn’t support the validity of (it) as an accurate way to measure food allergies.

There is another part of the Council called the American Chiropractic Board of Nutrition of which I am the Vice President. That is the organization that puts on the Diplomate exams; there’s a 300-350 hour diplomate program put on nutrition for chiropractors put on by the chiropractic colleges and then the Board of Nutrition holds exams for which candidates sit for. They have to have at least 300 hours of classroom nutrition and pass all the exams given for that and they sit for a three-part examination given over several days and if they successfully complete it they get awarded a diplomate status.

Who develops the questions?

They are developed by chiropractors.

What does the diplomate status allow a chiropractor to do?

Nothing. It’s not a license. It’s just a postgraduate degree that bespeaks of their serious interest in learning about and utilizing nutrition in their practice. It just means you’ve studied nutrition on a postgraduate level and have been examined for your proficiency.

Is there any continuing education required along with it?

There’s a necessity to either be actively teaching in a college, a chiropractic college, or you have to publish once a year. Any valid nutritional or scientific journal will due. There’s also the Council that puts out the Journal of the Council on Nutrition-it’s a quarterly journal-and publishing in that is also acceptable. Actually, yes. Diplomates must also attend at least one yearly educational seminar.

What do you think is appropriate nutrition practice for chiropractors?

Well, we’re going to talk two ways. One is nationally. What the Council of Nutrition recommends, or can say is that chiropractors that are trained … I mean you have a license to do nutrition which includes food, talking, diet alteration and supplementation.

On the national level, the Council can talk about what chiropractors are qualified to do within the scope of chiropractic. And then every state has a separate license, and in some states, chiropractors are allowed to do more or less, depending on the state. In New York, chiropractors are allowed to practice nutrition without the postgraduate degree that I have. Just by the fact you’re a medical doctor or a chiropractor, you can practice nutrition.

How do you feel about chiropractors who sell supplements out of their office?

That’s up to the discretion of the practitioner. I don’t have an ethical problem with that. Again anything in the hands of the wrong person can be misused. We sell some supplements out of our office. It makes it convenient for the patient. We try to compete with whatever is fair and equitable prices.

How does the council feel about applied kinesiology
being used to detect nutritional deficiencies?

Let’s ask a better question. How does the International College of Applied Kinesiology feel about kinesiology being used to detect nutritional deficiencies. Because they are the people who teach and certify people in applied kinesiology.

It is a method of screening for nutritional imbalances. It’s not a method of testing what is deficient in the patient. This is their statement. That still has to be done through traditional testing methods.

Applied kinesiology can just be used as a helpful tool, maybe to fine tune some of those things. But they officially look down on someone who puts vials of substances on a person’s body or drops in their mouth, or pill in their mouth, and saying this is what you are deficient in. It’s not considered proper applied kinesiology.

What do they (ICAK) say about using applied
kinesiology for detecting food allergies?

”I can’t speak for the ICAK. (However, according to) the Council on Nutrition, there’s no official judgment been given on that.

Do you think it has some validity?

Yes. You know what. That is a technique that is very dependent on the operator. You know there are some very gifted human beings out there who, I believe, are very gifted with applied kinesiology and can tell you a whole lot about your body by just doing muscle testing. It’s usually something that can’t be learned or mastered in a couple of months. The people who do that work well have been doing it for years and years. And yes it can be very accurate.

There are many chiropractors who go to a seminar,
practice applied kinesiology, and pretend to be experts.

Exactly, and that’s inappropriate from everyone’s standpoint, including ICAK. ICAK has a Diplomate program themselves. There are a lot of people out there who say they do AK, that don’t.

When people ask me if I do AK, I usually say no I don’t, even though I do a little bit of it … Compared to someone who has a diplomate in it (AK) and who make AK the thrust of their practice. What I do is rudimentary compared in relationship to what they’re looking for and what they’re doing.

Again, there are a lot of people who say they do AK that never even studied properly.

What is considered legitimate and what is considered illegitimate nutrition
practice by the council. For example, the use of such things as glandulars,
enzymes, bee pollen, dietary supplements. What are your feelings about those?

The official stance is this: That a person needs a proper and complete nutritional workup. Upon the findings of that nutritional analysis, supplementation can be utilized that has been shown to be effective for their particular situation.

Now, there are things that have reams and reams of information published in the scientific literature. Evening Primrose Oil (EPO)-there are thousands of citations on EPO.

Now you talk about bee pollen. It may be very effective for certain things and the scientific validation may be much less. And they talk about some other supplements that might have even less. So, it’s up to the doctor’s discretion, but experimental nutrition is not encouraged. If you know what I mean.

You mean use of substances which have not been shown to be effective?

Yeah, yes, but you know that’s a gray area.

How do you determine effectiveness?

Again, speaking for the Council, all we can state is just try to keep everything above board… Keep everything above board. Don’t go too far out on a limb and use what is effective. Now, there are things that have shown their effectiveness that haven’t been tested in clinical trials just because they’re new, if you know what I’m saying.

How have they been shown to be effective if their effectiveness
has not been shown in clinical trials?

‘Ah, let me see what can I think of that we use in our practice. Drinking ginger tea. We tell people to drink ginger tea for colds and flus and stuff like that because I know it’s very helpful and it helps clear up your sinuses.

Does it decrease the duration of colds?

Well, it does help relieve your symptoms. It helps the mucous go, it soothes the stomach. Just from practical experience, I know that that’s an effective home remedy. I recommend it even though there’s never been a big study to show that ginger tea cuts the mucous in your sinus membrane. Yet, that’s a pretty innocuous substance. You can’t go too wrong by telling a person to drink ginger tea. So, the Council wants to promote proper nutritional therapies that have some backbone to them, things that have some clinical trials but I don’t know any nutritionist that doesn’t use things like the ginger, that don’t have a few of these items in their armamentarium that haven’t had massive clinical trials.

A lot of stuff becomes opinions and how you want to practice. Because I know that the literature is full of studies, showing that 80% of senior citizens are on a daily basis don’t get enough folic acid, vitamin D and don’t get enough calcium. I mean it’s unbelievable that study after study shows that, yet people will still say that you can get all your nutrient needs from food alone. But do you is another reality. Again, there’s a big gray area. But all the Council on Nutrition, as an official body, wants to promote is responsible nutrition.

What is involved in the nutritional workup you spoke of earlier?

A proper nutritional workup needs to contain a physical examination. You have to obtain some psychosocial data, meaning family history, personal history, sometimes a Haines and Reye (?) stress of adjustment scale is used. We use that in our practice. ‘You need to do a biochemical analysis which can be something as simple as a SMAC with a CBC and a urine or as complex as a vitamin-mineral assay through blood and other tissues, perhaps the [hair analysis] for toxic minerals.

You can do any of the biochemical tests that are out there. There are food allergy tests that you can do through the blood, there are amino acid profiles. As a doctor, we’re charged with the responsibility of doing what is proper for the patient.

Do you do hair analysis in your practice?

Occasionally, in screening for heavy metal toxicity.

Second Interview

Are your aware of any chiropractors doing anything
that you or the council feel is unscientific or unproven?

Of course.

Can you give me an example?

There are all sorts of people out there both in the chiropractic profession, in health food stores and in the medical profession that use dubious diagnostic techniques … Sometimes I have had patients come to me who have been put on a vitamin regime just from a hair analysis. And that’s not enough information gathered to put someone on a program unless they are on a vitamin, like vitamin C to specifically chelate out one of the heavy metals that might show up on a hair analysis. There are also people who will put people on nutritional programs based on muscle testing alone which at best is educated guesswork. That information (gotten that way through body language, through muscle testing, applied kinesiology should always be backed up with some sort of other standardized testing protocol. And, unfortunately, what is taught in seminars sometimes is bastardized. You know once people come to their office, they can do anything they want. What is taught in seminars is not always what comes out of a practitioners office.

Do chiropractors as a whole prescribe a lot of supplements?

Not necessarily. it depends on the how your practice leans. I personally have a strong background in nutrition and my practice is geared that way so we make recommendations. Some chiropractors never make recommendations for nutrients; they will deal strictly with the spine and nothing else. And some will recommend only one or two specific types of supplements for disk problems. Things that have shown to be effective in terms of supporting the health and nutrition of the disk. So it varies, it goes the whole gamut from nothing, from no recommendations, to putting people on a whole program.

What’s the connection between taking a supplement and
helping someone out with a disk problem?

Well, we know that the disk needs vitamin C to keep, to allow … Vitamin C is part of the ground substance of any connective tissue. There has been research that has shown that disks that are degenerating are dehydrating. And vitamin C has been shown to help the hydration process. There has also been some minerals that have been shown to be helpful. Manganese has been shown to be helpful for disk problems and so those are sometimes put in a product together to help with that. There are also bioflavonoids that have been shown to be anti-inflammatory. So when someone has an acute or chronic disk problem, bioflavonoids can also be of benefit.

What would be a typical amount of vitamin prescribed for this problem

It’s not a large amount in those products geared for disk problems. I thing it’s in the range of 100 or 200 milligrams a day. But vitamin C is also, again the bioflavonoids, which are part of the vitamin C complex are anti-inflammatory so when you take them in larger doses they can have an effect that way. So we’re talking about 1,000 or 2,000 milligrams of vitamin C and/or bioflavonoids, which still isn’t really megadosing but it’s way beyond the RDA.

Where do chiropractors learn about or how to prescribe supplements?

In school and in postgraduate work. The program that the Council on Nutrition and ACBN (American Chiropractic Board of Nutrition) puts on (is) a 300-hour postgraduate education seminar. So there are things like that and as a matter of fact I’m going to see another nutrition seminar put on by Dr. Jeffrey Bland, who is a Ph.D biochemist who is very involved in the nutritional field.

Do they ever get it from meetings and seminars?

Yes and that’s what this is. Except when you’re in school everything else is done on a seminar type of basis. A Saturday Sunday seminar.

What is your opinion about glandulars?

Well, there’s scientifically not much to back up their use, however, a lot of clinicians have found them to be helpful in actual practice.

Do you use them in your practice at all?

We do, it’s not a big thing. Sometimes they are included in some of the supplements we recommend. I think they can be helpful.

There are about 15 or so mail-order companies that supply a whole
range of products to chiropractors. Do chiropractors learn how to use
these supplements in school. I saw an ad in the ACA Journal for a catalog
for Standard Process products and i don’t think it says in the catalog how
to use their products. Where do they learn how to use these products?
Is that something the companies offer support for?

All those companies offer support because sometimes they have unique formulations. However, all of the usage should be based on physiology. What is the supplement doing, how is it doing it, does this patient need this. So I mean that is the rationale. So you always fall back onto basic physiology and biochemistry as to how this works, why this works, is the appropriate supplement for this person?

So a chiropractor may call one of these companies and speak to
someone there that can give them advice about how much to use of a certain
supplement or whether it’s indicated in a particular situation or not?

Right, just like a medical doctor does with drugs. You rely on the information you are getting from the drug company to be correct and reliable, then using your knowledge of again physiology and basic biochemistry you hope to apply that to the person.

Do these companies ever offer seminars to chiropractors to help use their products?

You know I don’t believe that is legal. You cannot make a medical claim for a supplement.

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This article was posted on October 7, 2001.