Over the last 16 months or so, I have attempted to point out areas where clinical chiropractic practice and applied nutrition share common ground. The two disciplines intersect dramatically when it comes to the sympathetic and parasympathetic nervous systems maintaining homeostasis.

This month's column begins to explore this relationship and why it is necessary for the chiropractor to be aware that, in addition to a subluxation component, there is a nutritional component to chronic recurrent symptom patterns.

Mention sympathetic-parasympathetic balance to a recent graduate fresh from state and national boards, and you will get a recitation of the influence each system has on the various organs that maintain homeostasis.

In particular, there seems to be the understanding that one system can become dominant over the other and cause symptom patterns obvious to any clinician. While this may be true, it is also true that this happens only in extreme situations, and these are not likely to occur in your treatment room.

What you will see in your treatment room are bodies with some organs in sympathetic dominance, others in parasympathetic dominance, and the rest behaving normally. In other words, whatever action is necessary to maintain homeostasis. As soon as an organ has performed whatever action was required of it to maintain the integrity of the whole, it will return to normal function.

Exhaustion of the homeostatic mechanisms can be recognized by the appearance of symptoms. These symptoms represent normal functions that are no longer occurring appropriately. They are either occurring too fast or too slow, or incompletely. Symptoms are alarms that signal the body is struggling to maintain homeostasis and is approaching exhaustion.

In previous columns, I talked about homeostasis and the necessity of maintaining body temperature, pH, volume of circulating blood, and concentrations of dissolved substances in that volume. I have outlined the process involved in concentrating hydrochloric acid and bicarbonate (alkali) from the blood for the digestive process. When the body is being challenged to maintain blood pH from being pushed in an alkaline direction it will hold enough acid to maintain homeostasis before it will donate it to the digestive process. Obviously, the opposite is also true since an antagonistic relationship exists between H+ and OH-.

These are two critically important mechanisms at work in symptom production that are often overlooked by busy clinicians:

1) The ability to digest food is dependent upon the ability of the ECF (extracellular fluid) to donate acid (H_) and alkali (OH-) for the activation of enzymes. The inability of the ECF to spare one of these ingredients is obviously productive of many symptoms, not just digestive.

2) When acid-base balance of the ECF is stressed, as above, it may be necessary to compensate by shifting electrolytes (especially Ca++ and K+) between the ECF and the cells. Examples of symptoms that can be caused by such a scenario are the constipation and stiff joints that accompany a mild potassium deficiency.

The shifting of electrolytes across cell membranes is controlled by the process of active transport. Here the cell uses energy to transport substances against a concentration gradient; that is, from a region of low concentration to one of high! For example:

*** The body maintains a high concentration of sodium in the extracellular fluids compared to a low concentration inside the cells. The reverse is true of potassium. The body pumps three Na_ ions out of the cell every time it pumps two K+ into the cell.

*** An active transport system pumps calcium to the outside of the cell. Calcium ions are normally maintained at extremely low concentration inside the cell, at a concentration about 10,000 times less than that in the extracellular fluid.

*** Another pump exists for hydrogen. This pump transports hydrogen ions out of cells and is associated with the secretion of hydrochloric acid by the stomach.

Symptoms can be understood based on whether the cell is accumulating Ca++ and H+ on the one hand, or K+ and OH- on the other. An increase of Ca++ and H+ inside the cell produces symptoms of sympathetic dominance. An increase of K+ and OH- inside the cell produces symptoms of parasympathetic dominance.

Now, imagine a patient complaining of a migraine headache with its associated vasoconstriction and perhaps elevated blood pressure. These are symptoms of a sympathetic dominance and they are also symptoms of excess acidity and accumulation of H+ and Ca++ ions inside the cell.

You find and adjust an upper cervical subluxation expecting relief -- aware that you are stimulating the parasympathetic system through the vagus nerve. Will your adjustment be effective and long lasting, or will the patient be back and say "Doc, I don't think you quite got it the last time because the headache came back"?

It is our goal, as clinicians, to identify those processes which are being overburdened by persistently strong stimuli and ease their burden. This implies removing the irritant, whatever it may be.