https://www.listennotes.com/e/9b3e918f835746f0a04930197e46fceb

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are back with more awesome brand new research. We'll be sure to drop a link down in the show notes. This one is titled region specific mitophagy in nucleus pulposis, annulus fibrosis and cartilage endplate of intervertebral disc degeneration mechanisms and therapeutic strategies. That is a mouthful, but this is basically all around the cellular science of disc degeneration. Lots of great messaging, lots of clinical pearls, some conversation starters with patients for sure. Now before we get started, I wanna say a few words about patient pilot. Patient pilot's new and improved. And if you have an email list, patient list of more than 500 people and you're not actively communicating with them, you're leaving money on the table, you're leaving opportunity to help people on the table. And if I'm blunt about it, many of them are probably going to the chiropractor down the street. They probably because you're not actively communicating with them, if you don't care enough to communicate consistently, they're probably not gonna care enough to come back. Patient pilot solves that problem. We also have a seven day money back guarantee. Absolutely no reason not to come on over, see what we have going on. Visit thesmartchiropractor.com Again, that is thesmartchiropractor.com, start reactivating patients money back guarantee, head over there and go for it. Drop a link in the show notes as well. But as I said at the top of this episode today we're talking about a cutting edge research study. It dives into the cellular science that directly impacts spinal health and what you do as a chiropractor. And it's all about the role of mitophagy in intervertebral disc degeneration. Again, this study is from 2025, brand new, actually came out in the Journal of Frontiers in Pharmacology. The not exactly a top read for me personally. But this study has nothing to do with that. What it has to do is the science of degeneration and it takes us into the mitochondrial world of the spine and specifically looking at how dysfunction in mitophagy, which is basically the body's mechanism for removing damaged mitochondria can contribute to intervertebral disc disease in three distinct regions. All three of these regions are gonna sound real interesting to you. One is the nucleus pulposus. Two, annulus fibrosis. Three, cartilage end plates. So this is an impactful study. All of us are gonna deal with it. As I like to say, time and gravity are undefeated and mitochondria need to get shuffled out as time goes on. That's mitophagy. So how does this happen? And when that happens, how can it, does it contribute to degenerative changes of the discs, specifically in those three places? So if you are listening and you've ever wanted to understand why degeneration starts and also how you might be able to intervene either earlier or more effectively with your patients, then this is a top episode for you. Now, why does this matter? Well, we know intervertebral disc disease is a primary major big time contributor to spinal disorders of all types. Disability, chronic back pain, all of it ties in there. And while often you and I, we focus on the mechanical causes, this paper showcases that cellular stress and mitochondrial dysfunction can also be and are major drivers of of disc challenges. In this paper specifically explores what they call region specific mitophagy, Meaning those different parts of the disks, they actually degrade in different ways. How and why? Well, we'll get into that. But as you can imagine, the annulus has a different composition than the annulus has a different composition than the end plate has a different composition than the nucleus. So all of these things are impacted differently as mitochondria are taken in and out. And that's what we call mitophagy. So a quote from this paper that's impactful early on is that mitophagy is essential for maintaining mitochondrial health and plays a region specific role in disc degeneration. And that is impactful for a few different reasons. Why one, mitophagy happens, right? It's going to happen. That's a normal part of aging, It's a normal part of life. It's a normal part of how our bodies work. But there can be some side effects of that, and that can be degenerative changes over time. So again, mitophagy is the process by which cells are selectively remove damaged mitochondria. And the goal of that is actually to prevent inflammation, to prevent oxidative stress, and to prevent cellular death. Sounds like a great mechanism to me. And it is. And in a healthy spine, mitophagy helps maintain cellular function by cleaning out damaged mitochondria and making sure Everything is functioning at the highest level possible. But in intervertebral disc degeneration, mitophagy becomes impaired. That is a key statement, and it's key to understand what that leads to. What does it lead to? It leads to accumulative, oxidative stress, it leads to cell death, it leads to inflammation, it can lead to breakdown of the cellular matrix, it can lead to disc degeneration. So in a healthy spine, the cleansing process is a really good thing. But as a spine degenerates over time, and we know, you know, degenerative changes over time is a normal part. Now, advanced degenerative changes showcase something's wrong. But as time and gravity are over all of us, there's a certain amount of degeneration that occurs. And as that happens, mitophagy is affected. And those are the results that oxidative stress, cellular death, inflammation, matrix breakdown, disc degeneration, et cetera. So let's get region specific because there are some differences between the nucleus, the annulus, and the cartilage end plate. So let's start with the nucleus pulposus and we'll work our way out. The nucleus pupulsa cells are the first, first to show signs of degenerative changes often, which is interesting, I actually didn't know that explicitly. So nucleus pulposis cells, the first place we see cellular degeneration. So what are the key disruptors there? Well, some of these are inflammation, right? You know, TNF, IL1, oxidative stress, mechanical overload. And basically what happens then is damaged mitochondria trigger a variety of mechanisms, and those mechanisms, so to speak, advance the degenerative changes. So there's Basically an inflammatory NLRP3 is what they call it, real technical. It's activated and it worsens degeneration by blocking mitophagy in increasing inflammatory cytokines. So this is that negative cascade. Now we're going to talk about how you and your patients can take active steps to combat this. But the bottom line is, within the nucleus, when there is NLRP3 activation, it actually accelerates degenerative changes by blocking mitophagy. What happens then? They don't clean things out. And that increases inflammatory cytokines, therefore advancing that challenge. Big problems. So let's dive into the annulus. Fibrosis damage here can lead to disc herniation and instability. So again, remember that the annulus is around that nucleus. And man, if that starts to break down, you start to end up with some challenges potentially. And oxidative stress in the annulus and lipid Dysfunction can impair mitophagy in the annulus fibrosis. And when that happens, annulus fibrosis cells become more prone to cell death. Death. Now, annulus fibrosis degeneration affects things that you are very, very well accustomed to. Disc height, fibrotic healing, and weakens the overall disc structure. Those are not great things to have happening, right? So stopping, inhibiting, reducing, slowing down that degenerative process as early as you can, before it gets to the point before proactive care, before it gets to the point of symptomatology, is really, really important. So we'll come back around to that in a moment. But let's talk cartilage endplate. Cartilage endplate degeneration disrupts nutrient transfer, starving that disc mitochondria. Damage in the cartilage endplate can lead to decreased ATP and cell death. Again, this is. These are not good things. In other words, they are advancing the degenerative changes. So often I see there's a lot of young docs out there that even though we think about function, we focus on pain with our patients. And hey, if a patient's coming in in pain and wants to get out of pain, that's a top priority. That's their goal. But as a clinician, as a chiropractor, keep your eye on the ball. Movement is critical, as we'll talk about. By the time you notice degenerative changes on a film, it doesn't mean it's too late, but it means that they're there, you know, so why not do everything you can to minimize those degenerative changes before they show up on an image or before they show up with pain. This is about proactive care. And often this becomes. I agree that you wanna be balanced in your approach to proactive care so you don't feel like you're selling something somebody don't need. But don't throw the baby out with the bathwater. Understand that proactive care, in my opinion, for children, for adolescents, for teenagers, for young adults, for adults, you name it, is a really good thing. And the research shows that, in my opinion, unequivocally. So let's talk about some of the chiropractic implications that we can see within this study. It's one is that if you geek out on this stuff, you can start talking about cellular health. If you do functional medicine and you're already talking about cellular things in your practice, well, this is a great study that ties it directly to the spine. Most patients and many chiropractors out there think of disc degeneration as structural. And this paper shows that it's actually metabolic and mitochondrial. Big difference. So what might this sound like to your patients? Hey, disc health starts at the cellular level. When your cells aren't clean up, damaged mitochondria prolifera take effect and the whole system starts to break down. That's a little bit of a sloppy way to say it, but I think you get what I'm saying. Helping people understand that disc health starts at the cellular level and the cell's mitochondria needs to get cleaned out appropriately. Really important. Well, how do you do that? Well, one way to do that is through movement and loading. These are therapeutic. So while excessive load way overboard can harm mitochondria over appropriate motion and exercise, stimulate mitophagy and protect the cells, the adjustments that you deliver, the mobility exercises that you recommend can influence these intracellular processes in a positive way, especially when they're combined with an anti inflammatory lifestyle. So this is the heart of chiropractic as far as I'm concerned. And again, I think back to individual segments. A segment that's not moving appropriately is going to be more likely to degenerate over time as opposed to a segment that is. So it can't always only be about the exercise. Hey, spinal stability exercises, mobility exercises, super important. But don't forget about the adjustment, getting in there and helping joints move. Otherwise, we all know you have compensatory effects. So you have the, you know, if you're only doing stability exercises, there's a likelihood that a segment that's not moving appropriately, that that needs an adjustment, it doesn't get an adjustment, still doesn't move appropriately. And the above and below segments, as the person goes through their exercises, they compensate for the lack of motion on the segment in between when the facets aren't moving as well as they could be or should be. And guess what? You might not pick up on it unless you're literally doing your examination in the proper way. So if you're just looking at whole ranges of motion instead of getting in there with your hands, seeing what needs to be adjusted, I think it's one of the most important things we can do. Additionally, functional nutrition and antioxidants, big allies in our fight to reduce these challenges. So encouraging dietary choices that support mitochondrial resilience, particularly for people that have chronic back pain or early degeneration, really, really important. So if you're recommending nutrition, if you're doing lifestyle anti inflammatory diet, however you want to approach that, then this paper man Talk about speaking into that in a way that is real and that is powerful, powerful stuff. So couple takeaways here. Please remember, disc degeneration is not just about wear and tear. It's wear and tear plus poor mitochondrial housekeeping. You as a chiropractor can influence the disc health of every patient in your practice by promoting proper loading, proper movement, getting in there with your adjustments, checking people with consistency, anti inflammatory nutrition education, and ultimately proper mitophagy is actually a healing mechanism. That's what you want to have happen. It's when things go off the rails and it's inhibited or stopped that the challenges start. So I loved this study. I think it was a great way to frame out a pretty complex topic in a way that makes a lot of sense to me and I hope it makes a lot of sense to you. Now, if you have not left a rating or review for this podcast, I'm gonna ask you to do so. That helps more and more docs find out about it. So scroll on down, tap some stars, leave me feedback, whatever it might be. I'd greatly, greatly appreciate it and it is my ask for sure. Additionally, if you are looking for a EHR where you do not need a user manual. Yes, you do not need a user manual. Imagine that. Turncloud. Turncloud is it. They've stripped away everything that's not essential. They've left everything you need to be able to run your practice more efficiently and effectively. So if you have been buying bummed out on software bloat over time and you're like man, this thing is way too complex, Turncloud is probably your answer. Schedule a demo with their team, have a conversation turncloud.com, i will drop that link down in the show notes. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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