Vitamin D is well understood to be vital in bone formulation and maintaining bodily calcium homeostasis. A growing body of research indicates a definite link role for vitamin D in autoimmunity prevention as well. This simple supplement may be key in preventing and treating autoimmune diseases.

Understanding Vitamin D 

Vitamin D is a fat-soluble vitamin that plays a role in both calcium homeostasis and overall bone health. Vitamin D promotes calcium absorption in the gut, maintaining adequate calcium and phosphate concentrations. Without sufficient levels of vitamin D, bones can become brittle, thin, or misshapen. Diseases such as rickets and osteomalacia are the result of vitamin D deficiency. Vitamin D-related calcium deficiencies can also lead to hypocalcemic tetany which causes cramps and spasming due to involuntary muscle contraction.

In addition to modulating cell and bone growth and initiating bone remodeling, vitamin D also takes part in the reduction of inflammation, metabolizing glucose, and modulating neuromuscular function and the immune system. The role of vitamin D in autoimmunity is still under scrutiny and is further explored below. 

Vitamin D is produced endogenously in human cells when the skin is exposed to UV radiation, particularly from sunlight. Vitamin D can also be consumed, and is naturally present in some foods, though some people (especially those who do not live in very sunny climates) require dietary supplements to bring their vitamin D levels to viable values.

What is Autoimmunity?

Autoimmunity occurs when the body mistakes its own tissues or organs for harmful intruders. The immune system sends out its defenses to attack itself. Autoimmunity arises in many forms, including rheumatoid arthritis, Crohn’s disease, and multiple sclerosis. Type 1 diabetes is a common autoimmune disease in which the immune system destroys the cells in the pancreas that produce insulin.

While the symptoms of immunity are dependent on its form, common examples include tissue damage, inflammation, and loss of functionality in compromised organs. Incidents of autoimmunity seem to be on the rise among Western countries, but emerging research indicates that introducing greater levels of vitamin D in autoimmunity cases may be an effective treatment method.

Increasing Vitamin D in Autoimmunity Treatment

Vitamin D deficiency has a clear association with many conditions and diseases, including poor bone health, cardiovascular disease, and even cancer. In fact, before the discovery of antibiotics, mycobacterial infections such as tuberculosis used to be treated with vitamin D. A continuously growing body of research indicates that vitamin D deficiency also plays a role in autoimmune diseases. 

In a study published in 2017, “Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential,” authors Dankers, et al. examine the role of vitamin D in autoimmunity’s progression. Working with the understanding that vitamin D deficiency is common in patients suffering from autoimmunity, the study examined the mechanism of vitamin D in the immune response.

How It Works 

Vitamin D exists in the body in an inactive precursor form: 25(OH)D3. Before it can perform its role in the immune response, 25(OH)D3 must be converted into its active vitamin D form. This conversion, previously thought to be conducted only in the liver, can be completed by many different immune cells, including macrophages, monocytes, B cells, T cells, and dendritic cells. Conversion of inactive 25(OH)D3 to active vitamin D by immune cells allows the concentration of vitamin D to be regulated locally at the site of inflammation.

Blood lymphocytes display receptors for active vitamin D which allow the vitamin to influence the body’s immune response. Nearly all immune cells express this receptor, making them prone to modulation mediated by active vitamin D. Initial binding to the receptor—a nuclear receptor—initiates a signaling cascade. If levels of active vitamin D are low, calcium in the body must be mobilized from the bone rather than from the intestines.

The Conclusion of Dankers, et al. 

While active vitamin D is best known for its role in facilitating calcium absorption into the intestine and thus maintaining calcium homeostasis, research continues to indicate that the vitamin has a larger part to play. Because immune cells are involved in the local activation of vitamin D and vitamin D receptors are found on all immune cells, the vitamin clearly has an important role in the work of the immune system. 

Dankers, et al. consider the available literature evidence sufficient to advocate for vitamin D supplementation to be included in the treatment and prevention of autoimmune diseases such as type 1 diabetes, Crohn’s disease, rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus.

COPD causes respiratory problems in millions of people across the world. While traditional medicine cannot do much for its correction, a growing body of research indicates that treating COPD with spinal manipulation can help minimize symptoms and pain.

What Is COPD?

Chronic obstructive pulmonary disease (COPD) is a term for a group of conditions that causes respiratory problems due to airflow blockage. Emphysema and chronic bronchitis are examples. In these and other COPD conditions, airflow is limited, making simple tasks like walking upstairs difficult.

COPD is diagnosed using a simple breathing test called spirometry, in which a small machine connected to a mouthpiece is used to monitor the volume and rate of airflow breathed in and out over a period of time. The test is brief and safe and allows medical professionals to detect COPD to begin treating it.

Inhalation of tobacco smoke is the most common cause of the disease, though air pollution, respiratory infection, and a family history of COPD also put people at risk. Across the world, COPD ranks as the sixth highest cause of death for both men and women. 16 million Americans have been diagnosed, and many more may go undiagnosed. COPD does not have a cure, but it can be treated.

Reviewing the Role of Spinal Manipulation in Treating COPD

The effectiveness of treating COPD with spinal manipulation has long been a subject of study, and in 2016, Wearing, et al. published their compiled findings from past research in The Journal of Alternative and Complementary Medicine, published under the title “Use of Spinal Manipulation Therapy for Management of COPD.” 

These authors reviewed studies that documented treating COPD with spinal manipulation (defined by low-amplitude, high-velocity manipulation common in chiropractic). This included research of COPD treatment utilizing spinal manipulation with and without the employment of other therapies, such as exercise, making it the first systematic review of its kind.

Wearing, et al. limited their review to studies with participants above the age of 18 years with a pre-existing diagnosis of COPD. Six articles met the inclusion criteria and were included in the review. These include three randomized controlled trials in which exercise from a pulmonary rehabilitation program was combined with spinal manipulation therapy, one case series, one pre-post observational study, and one single case study. 

The manual therapies employed in the review incorporated a range of spinal manipulation techniques. The review also examined variations in results when physical exercises and/or pharmacological interventions were employed in addition to spinal manipulation. Measures of the success of treating COPD with spinal manipulation included a six-minute walking test, various lung-capacity tests, and a number of respiratory questionnaires.

Though sample sizes were small, ranging from 1 to 33 participants, the results compiled by Wearing, et al. hint at the effectiveness of spinal manipulation as a treatment method for the management of COPD. They also highlight the need for further research about the value of combining exercise with such treatment.

The Efficacy of Treating COPD with Spinal Manipulation 

Taking all findings into account, treating COPD with spinal manipulation was found to have great potential to alter respiratory mechanics in COPD and other chronic respiratory diseases such as asthma. Patients with COPD and other respiratory conditions may take heart that methodologies as natural as spinal manipulation can help improve breathing ability and minimize fear.

The review indicated that manual therapy—which includes joint mobilization, spinal manipulation, and soft tissue therapy in addition to other techniques—offered redress for changes in respiratory mechanics associated with declining lung function caused by COPD. These improvements included increased flexibility of both chest wall and thoracic excursion which helped to reduce the work of breathing in patients for which breathing is naturally more difficult.

Though the ill side effect of muscle soreness up to 24 hours after treatment was present in the data, such soreness resolved itself without additional treatment and did not outweigh the improvements to exercise capacity and lung function. Exercise capacity has been shown to be a predictor of mortality in COPD cases, so even small improvements should not be underestimated. Following the administration of spinal manipulation therapy, five of the six studies reported improvements in both exercise performance and lung function.

All three of the randomized trials reviewed resulted in improved exercise capacity and lung function following a combination of spinal manipulation therapy in conjunction with exercise. These findings point to the efficacy of non-pharmacological interventions in treating COPD and improved benefits when spinal manipulation and exercise as treatment methods are combined as compared to when either modality is used alone.

The knee is a complex joint, often considered the most complex in the human body. It also bears the body’s weight and wears out relatively quickly. It is no wonder that a quarter of people suffer from degenerative knee disease after the age of 50. Arthroscopic knee surgery is a common option for the mitigation of degenerative knee pain, however, growing evidence suggests that the method is not as effective as we have previously thought.

What Is Knee Arthroscopy

Arthroscopic knee surgery is a surgical procedure that allows physicians to assess the knee joint in a less-invasive manner. Traditional knee surgery requires a large incision before helpful diagnostic information can be ascertained. Knee arthroscopy allows surgeons to make small incisions with specialized instruments, often reducing patient recovery times drastically.

“Arthroscopy” refers to the arthroscope inserted for the duration of the surgery. It is a small tube containing a system of lenses, a light, and a small video camera. With the arthroscope inside the knee, a physician can use the images relayed to video monitors to perform minute surgery on the joint. More than two million such surgeries are performed each year throughout the world. 

Is Arthroscopic Knee Surgery Worth It?

The decision to undergo surgery is based on many different factors, including immediacy of need for treatment, the risks of the procedure, other treatment options available, and the patient’s own comfort levels of undergoing surgery. The dangers of arthroscopic knee surgery, in addition to the sheer burden of undergoing knee surgery, can be dramatic.

Risks

While the procedure is often purported to have a success rate over 90%, every individual case is different, and like any medical procedure, there can be complications. A surgeon assesses each case individually before going ahead, but unforeseen problems can arise. These may include infection and clotting, both of which lead to other major health challenges, and even nerve damage, which can negatively affect a patient’s lifestyle for years.

Recovery Time

Because the surgery requires such small incisions and utilizes such fine tools, recovery time for arthroscopic surgery is often markedly reduced compared to other knee surgeries. While patients do feel residual pain, stiffness, or swelling as their knees recover, it is, again, comparatively less.

Efficacy

When a physician says that a procedure has a 90% success rate, that number is highly encouraging. If the doctor quotes a figure closer to 15%, the appeal is dramatically reduced. Unfortunately, though initial pain relief after arthroscopic knee surgery is almost guaranteed, depending on the underlying cause of knee trouble, the results may not last. 

A study conducted by Siemieniuk, et al. and published in the British Journal of Sports Medicine in March 2018 found that improvements initially experienced by knee arthroscopy patients lasted at least three months in less than 15% of participants. For none of the participants was the benefit sustained for one year. While the incidence of complications is well-cited, there is no evidence of important lasting benefit.

How can this be? How can the values of initial success and lasting result differ so dramatically? While many people see marked improvement after arthroscopic knee surgery, the authors of the study suggest that improvements may be more associated with the natural course of degenerative knee arthritis, co-interventions, or even placebo effects than previously considered.

Unfortunately, that is the nature of degenerative knee disease. It is a chronic condition in which symptoms are known to fluctuate. While for the majority of patients, pain levels decrease over time with regular medical care and prescribed physical therapy, it can be difficult to wade through the process when pain levels are high. However, doing so and delaying knee replacement is encouraged when possible. Those for whom knee arthroscopy is truly beneficial are those who suffer from locked knees.

Alternative Treatment to Knee Arthroscopy

The study by Siemieniuk, et al. adds to the body of evidence suggesting that the benefits of knee arthroscopy simply do not outweigh the risks and recovery process. Though recovery times are shorter and the process is less painful than traditional knee surgery, for most cases, the need for surgery at all can be avoided by other non-invasive means.

Depending on the underlying problem in a patient’s knees, knee arthroscopy has proven to be no more effective than exercise therapy, and when the surgical burden, postoperative limitations, and rare serious adverse effects associated with arthroscopic knee surgery are weighed, the disheartening lack of lasting results makes physical therapy all the more appealing. Consult with both your general physician and chiropractor to know which treatment method is best for your knees.