Many health care practitioners are searching for ways to ethically increase their patient load and at the same time make clinical practice more rewarding professionally and financially.

Last month, I suggested the possibility of increasing the service you render your patients by screening for potential chronic degenerative diseases. Recognizing those patients at risk for specific future problems allows you to both teach the patient how to maintain their health and monitor their progress. The experience is thus rewarding for you and the grateful patient. Preventing chronic degenerative conditions before they can be measured quantitatively does wonders for building referrals.

Sick care is practiced by recognizing and characterizing disease conditions (diagnosis). Once the diagnosis is pronounced, treatment is dictated by currently accepted therapeutic procedures. However, until the exact disease process can be measured and identified, there can be no acceptable procedures. Therefore, the practice of prescribing drugs for symptoms is guesswork at best and produces haphazard and often catastrophic results.

Many doctors do not take the time to inquire into their patients' dietary habits, primarily because of the lack of objective clinical findings that suggest a problem exists.

The easiest and most definitive screening procedure for problems in this area is identifying persistent or recurring loss of a normal thoracic kyphosis. Generally, it is a transitory condition related to muscle contraction and not osseous abnormality. It is most commonly caused by muscle contractions associated with viscero-somatic reflexes from those organs that receive their spinal innervation from T4 to T9. The list includes the heart, lungs, bronchi, stomach, pancreas, spleen, liver, gallbladder, and adrenal glands.

When loss of the normal thoracic kyphosis (so-called "anterior dorsals") is found, palpate for postprandial muscle contractions under the right and left anterior costal arches and in the epigastric area. Palpatory muscle contraction (trigger points) and soreness will always help delineate the stressed digestive organ. Inquiry into the patient's last meal will be quite instructive. These findings are often, but not necessarily, associated with chronic headache patterns.

When no digestive stress is present (the presence of symptoms is irrelevant) and blood glucose levels are normal, muscle contractions under the costal arches and in the mid-thoracic spine will not be found. Henri Gillet, D.C., found that three to ten cups of coffee will produce them![1] Consider the correlation between this and the following two studies.

A study released by the Harvard School of Public Health this year found that men who eat processed meats (such as bacon and sausage) are 46% more likely to develop type 2 diabetes than men who eat less of these foods. Over 40,000 healthy men between the ages of 40 and 75 were studied. The results were dose-related -- the highest incidence was among those men who ate processed meat five or more times per week.[2]

A study of the effects of caffeine on blood sugar levels was completed this year.[3] It is known that caffeine can enter the brain and directly increase blood pressure and stimulate the release of stress hormones (cortisol). These hormones are known to affect insulin and therefore blood sugar levels.

Insulin sensitivity was measured in selected healthy individuals after administration of caffeine or placebo. The caffeine administered was the equivalent of three cups of coffee. The study showed that caffeine increased both blood pressure and stress hormone levels. It decreased the effectiveness of insulin by 15%.

The findings of these two studies fit very nicely with last month's column about screening for pre-diabetes.

Poor diet, inadequate digestion, stress, and caffeine all play a role in the development of type 2 diabetes which is now reaching epidemic proportions. Pharmaceutical companies will continue to develop drugs for its treatment, but the best approach is drug-free prevention, according to Daniel Einhorn, M.D., director of the Scripps Whittier Diabetes Institute.

He states that loss of five to seven percent of body weight within one year, coupled with walking or bicycling 150 minutes a week (30 minutes per day) is the best therapy known. But he says that most people will need the guidance of a health care professional to achieve those

results.[4] Why shouldn't that be you?

1. H Gillet and M Liekens, Belgian Chiropractic Research Notes, 12th ed., Huntington Beach, CA: Motion Palpation Institute, 1985, p.18.

2. RM van Dam et al., "Dietary fat and meat intake in relation to risk of type 2 diabetes in men," Harvard School of Public Health, Diabetes Care 25:417-424, 2002.

3. GB Keijzers, BE DeGalan, CJ Tack, P Smits from Univ Nijmegen Med Ctr, Netherlands, "Caffeine can decrease insulin sensitivity in humans," Diabetes Care 25:364-369, 2002.

4. D DeNoon, "Will new drugs head off diabetes? Exercise, diet still best way to treat pre-diabetes," WebMD, 10 May 2002, http://my.webmd.com/ content/article/1689.52790.