March 19, 2024

Adjusting for Immunity: Aligning Chiropractic Care And Microbiome Modulation For Optimal Outcomes

By Kristen Klos-Maki, DC, and Jocelyn Strand, ND

As a practicing chiropractor, you’ve seen firsthand the benefits of optimizing neurological function to support immunity. You know that every system in the body requires healthy innervation to function properly. Unfortunately, there is little research related directly to chiropractic manipulation and immune function – with the exception of evidence to support the clinical benefits of manipulation in inflammatory illness.¹

But dig a little deeper and you will find a vast amount of information documenting the many interactions between the nervous and immune systems. And our understanding of the bidirectional nature of these two systems continues to evolve.

Modern medicine has created a compartmentalization of individual body systems through specialization. As a result, scientific understanding of the intricacies and connections that comprise a wholly integrated body has been delayed. However, the neurological and immune systems rely on one another to function in every moment. From injury repair to mood regulation, to learning (think neuroplasticity), to fighting infection – our bodies depend on the integration between these two vital systems. Science now confirms this, and research continues to reveal more depth and complexity than was previously understood.

An Updated Understanding

It is well established that the nervous system innervates lymphoid organs (bone marrow, thymus, spleen, and lymph nodes) and that immune molecules have activity in both the peripheral nervous system (PNS) and central nervous system (CNS) (e.g., sensory function and local pain sensitization).

A published review of research examining neuroimmune interactions suggests that categorizing interactions between the immune and neurological systems as short-range and long-range can help simplify our understanding of the complexities of this bidirectional relationship moving forward.²

Short-range interactions

Immune cells released in the periphery affect local nerve endings, which then modify immune organs, creating a bi-directional relationship.
Immune cells release mediators in the CNS, resulting in neuronal plasticity during development and in the adult synapse.

Long-range interactions

Immune cells activate the CNS and help regulate the systemic fight against infection while permitting the nervous system to regulate immune function at distant sites. This axis may account for pathologies previously attributed only to organ dysfunction.

Neurohormonal mediators (see table below) released by the CNS have systemic effects on lymphatic organs.

Neurotransmitter

Epinephrine and norepinephrine – Catecholamines that act as both neurotransmitters and hormones to help maintain homeostasis via the ANS³
Acetylcholine – neurotransmitter and chemical messenger used for cell-to-cell communication in the neurological system via binding of cholinergic (nicotinic and muscarinic) receptors.⁴

Physiologic Effects

Modify blood pressure, enhance muscle contractility, relaxation of smooth muscle in GI and urinary tracts and bronchioles, modify blood sugar, stimulate lipolysis. Epi inhibits degranulation of mast cells and basophils.
Muscarinic – vasodilation, reduced heart rate, vagus nerve stimulation, GI tone and motility, bronchoconstriction, and hyperpnea, parasympathetic activity in the urinary tract, exocrine gland secretion.

The Interconnectedness of the Immune and Neurological Systems

Robert Dantzer’s review article on neuroimmune interactions, quoted above, highlights our current understanding of the complex nature of this relationship with the following observations:

Lymphoid organ innervation

All lymphoid organs, except for what is contained in the GI tract, are innervated only by the sympathetic nervous system (SNS). The GI tract has both SNS and PNS innervation.

Lymphocytes release the neurotransmitter acetylcholine – a primary neurotransmitter for interneuronal communication. Its effects vary depending on the target tissue.
Innervation modifies the blood supply to lymphoid organs and as a result, immune cell functionality.

Catecholamines influence immune cells, prompting them to prioritize innate immunity (responsible for rapid and nonspecific immune responses against invaders⁵), but also affecting adaptive immunity.

Innate immune cells (natural killers, phagocytes, degranulating cells) contain beta 2 adrenergic and alpha 1 and 2 adrenergic receptors. When bound, they increase inflammatory response via the nuclear factor kappa beta (NF-κB) pathway, resulting in a rapid release of proinflammatory cytokines.
Adaptive immune cells (T and B cells, associated antibodies) contain only beta 2 adrenergic receptors. Binding generally increases proinflammatory cytokines needed for tissue repair and fighting infection. But also influences migration and monocyte egress to quell the inflammatory response.
Norepinephrine promotes immune cell differentiation from CD4+ to Th1 cells, resulting in the release of IFN-γ and activation of cellular immunity.⁶
Some phagocytic cells release both epinephrine and norepinephrine when activated, actively participating in the synthesis and degradation of these neurotransmitters.

Glucocorticoids (cortisol)

Activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis in the CNS – and the resulting release of cortisol in response to stress – directly impacts immune function.
When glucocorticoid receptors (GR) are bound, immune activity is suppressed, including downregulation of NF-κB and genes encoding for inflammatory mediators, adhesion molecules, and enzymes.

A growing awareness of the intimate relationship between the immune and nervous systems and all its complexities makes a compelling case for optimizing neurological function as a supportive measure for optimal immunity.

Chiropractic Care and Immune Function

What are the possible contributors to what we see clinically concerning immunity and chiropractic care? Knowing that healthy neurological activity is a requisite for health in every body system, the answer is – many! Here are a few possibilities:

Optimization of both short- and long-range neurological function, resulting in improved immune competence.
Stress reduction via human touch, body comfort, and pain reduction.
Holistic care and the inclusion of a healthy diet, nutritional support, and lifestyle recommendations.
Optimized digestive function through support for the vagal nerve and enteric nervous system health, resulting in immune competence and improved nutrient absorption.

Botanicals, the Microbiome, and the Immune System

Botanicals offer a simple yet powerful tool to further support immune function. They work in several ways, the most pertinent of which include:

Immunomodulation

Research from The Journal of Athletic Enhancement showed a 66% increase in sIgA in the oropharynx within 30 minutes of using a botanical throat spray on athletes with suppressed sIgA.⁷
Olive leaf extract has been shown to modify immune response by increasing IFN-γ production – resulting in higher absolute numbers of CD8+ and NK cells – and maintaining a balance between T regulatory and Th17 cells. These are powerful activities that support the balance between immune competence and tolerance.

Microbiome balance

Modulation of the microbiome is emerging as a therapeutic target to optimize physiology across the whole body.⁸ To date, research has largely focused on prebiotics, probiotics, and postbiotics. Individual plant constituents have been investigated with impressive results. Biocidin Botanicals’ pilot research has illustrated the ability of botanical formulations to restore microbial balance and promote healing in the GI tract.

Research shows conclusively that microbial dysbiosis in the gut (and throughout the various microbial niches in the body) is a potent risk factor for poor outcomes in many infections.^9,10 Fortunately, the gastrointestinal microbiome is readily accessible and can be modulated with the use of botanicals.

Case Study: Using Botanicals to Modulate the Microbiome

We are witnessing firsthand how modulating the microbiome with the use of botanicals can positively impact immune function in the following ongoing case study:

A 54-year-old female teacher presented with fatigue, chronic pain, gas, bloating, a history of Celiac disease, and Hashimoto’s thyroiditis.
She reported being the first to catch every “bug” that came through her class and the last to recover from it, missing school days regularly throughout her career.
Testing showed microbial dysbiosis in her gut, as well as dyslipidemia and hyperinsulinemia.
Intervention included:

Botanical antimicrobial
Binder
Spore-based probiotic
Gut healing powder

Outcomes

The most remarkable clinical improvement is that the participant has remained healthy for the 2023-2024 school year despite multiple infectious exposures. She has never experienced this in her nearly 30 years of teaching.
Decreased joint pain, with a notable improvement in joint comfort going up and down stairs.
Gut microbiome testing showed improvement in Methanobrevibacter smithii, a bacteria found in methane-dominant Small Intestine Bowel Overgrowth (SIBO).
Decrease in insulin and triglyceride levels.

Focus on Whole-Body Wellness

Patients can potentially experience greater benefits from the power of chiropractic care that incorporates all of the systems of the body. Focusing on whole-body wellness includes taking advantage of an opportunity to educate the patient at each visit.

You may already offer diet and lifestyle counseling. It also makes sense to educate patients about the many ways in which the immune and nervous systems work together. In doing this, we can explain how neurotransmitters impact the body and affect the different organ systems. We can then ask broader functional care questions to directly evaluate the patient’s immune and nervous system at each visit, going beyond merely asking, “How are you feeling?”

Potential questions to add to your patient intake include:

How has your stress level been since our last visit?
Any changes in diet?
How are you sleeping?
How is your digestion? Do you experience bloating or acid reflux?
Are you experiencing any dizziness, especially when transitioning from sitting to standing or lying down to standing?
Do you experience an urgent or frequent need to urinate?
Have you recently contracted any viruses or received any vaccinations?
Do you experience a loss of appetite or feel full quickly when eating?

All of these questions can help connect the dots – for you as a practitioner and your patients – on how their nervous and immune systems are functioning. Educating patients through the types of questions you ask allows them to fully understand what is going on in the body, why they are manifesting specific symptoms, and what steps can be taken to improve their health. If the patient understands the “why” behind a recommendation for care, they are more likely to follow through with their treatment plan.

Chiropractic Adjustments & Integrated Botanicals

There’s a powerful, natural synergy in combining chiropractic adjustments and botanicals in a treatment plan to support all systems in the body. Botanicals can make a great adjunctive therapeutic approach to chiropractic care when supporting a patient’s overall health and wellness, physical function and postural alignment, and immune function. Herbs can aid in supporting a healthy balance of inflammation in the body, improving circulation and delivery of oxygen and nutrients throughout the body, and easing tension in the musculoskeletal system. These potential benefits can lead to better patient outcomes and long-term support.

It’s likely you entered the chiropractic profession out of a desire to help people improve their health. And there’s no better feeling than alighting on the combination of care and treatment that helps a person resume the activities of daily life pain-free. You’ve invested time, energy, and financial resources to acquire the tools you use to help patients achieve well-being. Adding herbal therapeutics to modulate immune function and the microbiome to your chiropractic care will benefit your patients – and give you the satisfaction of helping them achieve overall health and well-being.

Kristen Klos-Maki, DC, is Biocidin Botanicals’ Assistant Director of Research and a chiropractor certified in nutrition and the Webster Technique. Before joining Biocidin Botanicals, she was in private practice in Duluth, Minnesota, specializing in maternal health and pediatrics. A believer in the research-backed benefits of natural healthcare, Dr. Klos-Maki closely follows developments in current treatment methods and creates research protocols.

Jocelyn Strand, ND, is Senior Director of Clinical Education and Research for Biocidin Botanicals. She brings both a reverence for botanicals and a passion for science to her role. Dr. Strand monitors and participates in research, trains clinicians, and is a respected and engaging speaker. Before joining Biocidin Botanicals in 2019, Dr. Strand was a primary care provider in private practice for 11 years through the Minnesota Board of Medical Practice. She specialized in GI system disorders, Lyme disease, and autoimmune conditions.

Resources:

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