#37 - De-Mystifying the Nutrition Conversation, Part 1

FAKTR, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents. Serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thanks for listening. Today we begin a new 2-part training titled Demystifying the Nutrition Conversation: Cut Through the Confusion to Help Your Patients Succeed. With Dr. Christopher Marvin. When it comes to patient care, providers must consider many different variables that contribute to each person's overall health. When it comes to physical medicine in particular, it's critical to understand your patient's lifestyle, habits, and nutrition so that you can fully understand their body's current capacity for healing and recovery from injury. But having the nutrition conversation isn't always an easy one. Most people are very set in their ways when it comes to their eating habits, and there are definitely negative connotations involved with using the word diet. And further, is it really easy to ask someone to cut back on anything when the food and drinks we consume are such a big part of our daily lives? In this 2-part training, you'll learn how to have the dreaded conversation about food and nutrition with your patients. Learn common sense guidelines for proper nutrition that any patient can follow. And Dr. Marv will discuss how to help your patients cut through the confusion of the latest diet trends they read about online. Dr. Christopher Marvin, or Marv as he's commonly called, has been involved in health, wellness, and fitness for over 14 years. He earned his BS in exercise science from Sonoma State University and his Doctorate of Chiropractic from Palmer College in San Jose, California. Dr. Marv acquired extensive experience in the physical therapy space, as well as in the corporate gym environment as a fitness coach and specialist. He also owned and managed a private training studio specializing in one-on-one and online trainings. His articles have been featured in several noteworthy media outlets, including Men's Health magazine, the Huffington Post, and the San Diego Union-Tribune. In addition to his exercise expertise, Dr. Marv has spent over a decade learning about evidence-based nutrition and supplementation strategies for both the general population and the elite athlete. He's also a published author, having written a book specifically on the topic of nutrition. Now, with all that being said, let's cue the intro music and get started.

Awesome. Thank you very much. Super stoked to be here. So yeah, so today we're gonna be talking about nutrition. The whole goal is to kind of just— there's a lot of conflicting information out there and how you could help patients with nutrition as simple as possible and things that matter most. Here's a little bit about me. I go by Marv. So yeah, that's my real name. It's Christopher Marvin, but I go by Marv. Personally, I'm never too keen on what somebody's personal resume is. If they've been asked to do something like this, they belong there. But that's what I've done. For those who are interested. So I'd rather just dive into it. Just know I do have some notes to my right, but I'd rather just have a conversation versus just reading notes verbatim. So I might pause from time to time just to make sure I covered everything I want. But other than that, let's just have a conversation. So first off, I want to recognize that flat out talking about nutrition can be difficult, right? It's right up there with religion and politics with how strongly someone may tie their identity to, to their personal stance. On top of that, well, we know that's the stats for long-term weight loss. They're simply depressing and absolutely atrocious. The initial findings were found that just 5% of folks are able to maintain weight loss after 1 year, and that 66% or 2/3 of all individuals actually put on more weight than they originally lost after 3 years. The good news is more recent stats show a little bit better story, that 20% are able to maintain their weight loss after just 1 year. But again, long-term, 80% of the initial weight loss has returned within 5 years. So love them or hate them, to quote Dr. Layne Norton, we don't have a weight loss problem as a society, we have a weight gain problem. Meaning we could lose the 10, 20, 30 pounds even over and over again, but keeping that weight off, that's the issue. With all that said, we can still do our best to not be intimidated by tackling nutrition for our patients and helping them out. So first things first, it's important to meet your patients where they're at, especially when they're not open to changing any sort of food at that time. This means your first recommendation might not have anything to do with food at all. It might actually be a lifestyle change. And I could say from personal experience, this is often my first step with significantly deconditioned or overweight individuals. Oftentimes they're pre-diabetic, they're not willing to make nutritional changes. Well, we could still help them out. We have multiple studies showing that simple 10-minute walks after meals greatly improve postprandial blood glucose. leading to lower hemoglobin A1c levels. And that's on par or even better than prescription metformin. Another benefit is if metformin is their monotherapy for their blood glucose control, going for the walks enhances that medication's effects. That's a big deal. And it's also been shown that these simple 10-minute walks after meals can help your patients on their journey to maintain that initial weight loss, which is so key to long-term success. Starting out doesn't have to be anything crazy. Just get them in the habit of doing so. It is going to take some time. So oftentimes I say let's start with 5 minutes and work Work our way up to 10. Over time, if you want to step things up another notch, you could have them alternate between fast and slow walk intervals to further enhance the blood glucose control benefits. But again, simply walking goes a long way. Now, after that first initial step you might take with patients, a simple grocery shopping tip goes a long way when they're ready to start focusing on their food. And I'm serious when I say this is the world's easiest tip that your patients could apply to their next shopping mission that immediately translates to better nutrition choices. So for grocery shopping 101, the first thing I often recommend to folks is do the majority of your shopping around the perimeter of the store. Now let's think about what's around the perimeter of a grocery store. You have your meat and seafood department, the fruit department, the vegetable department, and possibly the dairy department. Now, yes, lactase may be a non-persistent enzyme, so not all of your patients may be able to handle dairy, but most can handle eggs, which we'll talk about later. And I know the question I get over and over again is, well, how do we know if somebody is going to be more apt to handle dairy or not? Well, We know that when it comes to be able to handle dairy in adulthood, it has both epigenetic and genetic factors. So that does complicate things. But we know that those primarily of Northern European descent usually are able to handle dairy in adulthood, while the least chances are tied to those with ancestry from Australia, Native America, Asia, and most of Africa. Now we're going to go back to this whole shop around the grocery store tip. This is where you find what I like to call single ingredient foods. These are usually not coming out of a package or a box. They don't have an ingredient list a mile long that requires a degree in biochemistry to decipher. Again, these are things like your animal meats, your fish, and items such as yams, zucchinis, apples, whatever you want to throw in there. Now, how this tip works over time is perfectly illustrated by what it takes to consume an equal amount of calories from either potatoes or potato chips. There's literally something— and that's the single-grain foods I was talking about. There's literally something known as the bliss point that was discovered by food scientist Howard Moskowitz. That's the perfect amount of crunchy, sweet, and saltiness that overrides natural satiety signaling. Conversely, we get those natural satiety signaling from the single ingredient foods found on the perimeter of the store versus the highly processed items found up and down the center aisles. And it's been estimated that over 80% of all items in a grocery store have added sugar. So here's a great example. I challenge anyone to eat 1,000 calories of potato in a single sitting, which is just under 2 pounds, But eating that same 1,000 calories from potato chips, which is just over 7 ounces, it's pretty easy to do, especially with distracted eating, which is so common today, like sitting in front of the TV or scrolling through our phones. Therefore, this tip of shopping around the perimeter of the store naturally aids with portion control from that normal satiety signaling. It may not happen overnight, but it does happen with time. And in a few weeks, your patients, or you if you're choosing to do this tip, should notice a huge difference in how you feel, hunger levels, and most importantly, portion control naturally kicking in. And we know we're moving in the right direction when you start to notice your palate starts to change, meaning fruits might start tasting sweeter again instead of when you're eating a lot of those highly packaged middle aisle items that make fruits and vegetables taste very bland. But what if your patients want more info? Well, this is the easiest way to teach them about nutrition in just 2 sentences. So this is our million-dollar statement of the day. Please feel free to steal. The quantity of our food determines the number on the weight scale, The quality of our food and the quality of our training or exercise, whatever word you want to use, determines how we look and feel. Let's start with quantity. The law of thermodynamics tells us that no matter what we eat, the quantity of our food determines the number on the weight scale. Period. End of story. Full stop. I don't care if it's 2,000 calories from chicken and vegetables or 2,000 calories from donuts and ice cream. The scale is going to say very close to the same thing. Now, yes, there is a quality component to this, but let's stick with the quantity discussion for now. As we hopefully all know, only 3 scenarios exist: caloric surplus, deficit, or maintenance, and that's what determines body weight. Just know there's a range of calories that qualify for each scenario, so it's not like if you go over or under by 10 calories in a random day that the weight scale changes dramatically. Typically, from personal experience, I found that most people have a 200 to 300 calorie window without any significant changes on the scale. However, some folks might have as much as a 500 calorie window if they've been training really hard, nutritional adherence has been high, and they're typically in a deficit. Now that might seem whack at first, but it's actually a good thing. It's been shown that packaged food items may vary up to 10, even 20% or more from the assigned serving size. So consistency is the key to reach and maintain your nutritional goals, and consistency is a word you're going to hear a lot today. Therefore, this law of thermodynamics clearly shows us that there are no magic foods that burn fat and cause weight loss, just like there's no magic food combinations that do the same. To put it bluntly, the only fat-burning food is the food you don't eat. Now, everybody's metabolic rate will vary, which means everyone will have different requirements for what classifies them as being at a deficit, at maintenance, or in a surplus. We know that metabolic rate is impacted by multiple factors, and some of those include literally your overall body weight, the amount of lean muscle you may have, hormone levels, activity levels, gender or age, past dieting history, and there's even a genetic component we're finding. Now, you and your patients can find online equations that should give you an idea about your basal metabolic rate or BMR, but in my experience, relying on those calculators to tell you your maintenance calories as a definite are not always accurate. They're a best guess, and they definitely don't take into account your dieting history, hormonal health, or genetic variation. So that's why it's important to be at least open to tracking your food intake for a period of time to see what you're truly eating. No, not forever, but to learn what quantities you need and what your personal portion sizes are, it's the most accurate way to do so and easier than you think. But I do recognize that you may have some patience, or there may be some folks on this call today who'd rather pluck their eyelashes out one at a time than to weigh and track calories. So I can't leave you all out to dry with no help. But yes, I want to make very clear that tracking is ideal, and we can do that endeavor in multiple steps, meaning you could literally start out with tracking total calories only, nothing else. But if you're still not willing to do that, or your patience is a definite hard no on that, a method I've used with great success as an introduction to portion control is what I like to call the palm method. So how that works is each meal, we want an open palm-sized portion each of both high-quality protein and fibrous vegetables. Now, the carbohydrates could vary from 1 to 2 cupped hands depending on current fueling needs and goals, and making sure you get in a thumb-sized portion of fat each meal. And granted, if somebody is eating a fattier protein source such as salmon, that will suffice. Otherwise, that thumbful of fat typically equals 1 tablespoon of healthy fats. Now let's go back to the equation and talk quality on the other side. The quality of our food makes a difference, and the quality of our training or exercise makes a difference as well. So both of those factors determine how we look and feel, meaning body composition and overall health. Before we dive into specifics, let's look at a few examples. Somehow, due to the modern marvels of science, we have 2 people who are genetically identical, starting at the same exact health status, and they're eating the same amount of calories, and a slight caloric surplus, which is key. They're consuming the same total protein. What a wonderful time to be alive. Science could do wonderful things in this scenario. However, the first person is consuming the foods you can see on the left, so plenty of fiber and a wide array of micronutrients from colorful vegetables and complex carbs. The second person is consuming those foods on the right, so instead of fiber, eating lots of sugar and simple carbohydrates. Now, who will have the lower body weight and the better internal markers of health? Well, since they're in the same caloric and protein intake, they should be the same in terms of body weight, but who's healthier of these 2? Well, the first person who's eating colorful fruits, veggies, and complex carbs in terms of insulin sensitivity, blood sugar levels, and cholesterol values because of the caloric surplus. Where things get tricky, as it's been shown by Kansas State University Professor Mark Haub in a case study revolving around himself, that so long as you're in a caloric deficit, Eating adequate protein, you could eat a so-called convenience junk food store diet and still lose weight, improve cholesterol and other markers of internal health, even body composition. So as you can see in this picture, and for those on the podcast, I apologize, but we have Mark Cobb here sitting in front of Twinkies and Oreos and Swiss rolls. Now, he was consuming protein shakes, a little bit of spinach every day, and he was resistance training and doing cardio.

And eating those foods, because he had the quantity part of the equation in check, he was able to lose weight, Okay guys, pardon the interruption, but I have to tell you about this exciting event coming up in just a few weeks. So listen up, don't fast forward through this ad. It'll be short and sweet, but something you definitely want to hear about. If you've been a listener to The Factor podcast for any period of time, you know that we wholeheartedly believe there's more to success as a healthcare provider than just knowing the latest research. than just having great clinical skills. I personally have worked with this profession for over a decade now, and time and time again, I've heard students and docs in practice ask about the business side of being successful. How do I build a business? How do I get patients in the door? What's going on with my marketing? A lot of times practitioners just don't know what they don't know. One group that's a great friend of ours and a relationship we have is trying to change that. So on October 22nd and 23rd, I invite you to attend the FlightPath Business Launch Workshop taking place at Texas Chiropractic College. This 2-day intensive workshop will teach you how to successfully launch or grow your practice, providing you with a blueprint and an opportunity to work on your business instead of in your business for the 2 days so that you're prepared to implement what you've learned on Monday morning. To learn more, visit online.txcyro.edu and click on the business workshop link in the main menu. You can also click on the link in our show notes for more details and to register. Again, guys, seating is limited for this event because it is a true workshop. You will be coming and actually working on aspects of your business, such as your social media, your email templates, your website. So I suggest that you register early in order to reserve your seat and get in before the course fills up. And now back to the show.

And that's why I like to have a blend of quantity and quality in check together while we're using the quality aspect to help us consistently hit the quantity part of this equation, like we discussed in the grocery shopping tip at the beginning of today's talk. Now we have 2 more genetically identical folks. Again, modern science is wonderful. They're following the same exact nutrition plan with adequate calories and protein. However, the first person who's on the left, she's resistance training 3 times a week. The other individual doesn't resistance train. Instead, she goes for a jog 3 times a week instead. Now, who's going to have the better body composition of the 2? Well, the individual who's lifting weights is going to have significantly more muscle and correlating overall better body composition due to the muscle building signal. And she's also going to have a higher basal metabolic rate over time as she's increasing her lean tissue. And lastly, one more example. Again, 2 genetically identical folks, they're eating the same amount of calories and following the same workout program that has both cardiovascular and resistance training elements, so it's a very well-thought-out exercise routine. However, the first person, they're consuming 40% of their calories from protein that you can see on the left. I will admit 40% is a little high, but I want to make a clear point. And person 2 is consuming only 10% of their calories from protein that you can see on the right. Now, who's going to have the better body composition and the better gym performance? Well, the first person who's eating more protein will simply because that adequate protein intake is supporting more lean muscle building and aiding with their recovery from the workouts. So as you can see, the golden ticket is a quality workout program in combination with quality foods. Let's dive in further what I mean by quality for nutrition. So we got a few things on this list. What percentage of your foods are those single ingredient foods like I talked about earlier? When it comes to the end target, not beginning based on where somebody's at, but at the end target, we want 70 to 90% of everything we eat coming from that category. And we're saving that remaining 10 to 30% for social settings where we want to fuel our emotional, mental, and even spiritual health while being in the presence of friends and family. Because let's face it, food is a huge part of culture and society. But remember, the food science industry is hell-bent on overriding natural satiety signaling that we get from these single ingredient foods. And that's why I have that ratio at 70 to 90%, which helps with quantity. Another component of quality food is the thermic effect of foods. And we know that protein and fiber have the highest rates and fats are the lowest. Therefore, going from a low protein intake to a higher or at least adequate protein intake may trigger some weight loss if calories maintain the same. But that won't work if you're going from an adequate protein intake to a super high protein intake. But we have studies showing us again and again that if calories and protein are equated for, just about every single diet strategy works if followed consistently. Therefore, it's your job to help you and your patients figure out what they could enjoy and consistently follow because the bottom line is consistent long-term adherence to a subpar nutrition program will always outperform sporadic adherence to a perfect nutrition program and there's no such thing as perfect. This is why in the long term, a ketogenic diet provides no additional lipid marker, weight and fat loss benefits than low-carb non-keto diets. Or even a high-carb but still deficit-based diet when calories and protein are equated for. Now, I know it seems like I just bashed on ketogenic dieting, but it does have its place. We know that it may be very effective for seizure disorders such as childhood epilepsy and Alzheimer's patients. And some folks, well, they just flat out prefer this type of eating due to the craving control and mental clarity benefits they get from it. And if that's the case and they can be consistent with following a ketogenic diet, Great, they found what works for them, more power to them. I do, however, give some pause to this approach since you're eliminating entire macronutrient group potentially resulting in long-term adherence issues. This might, keyword is might, lead to the constant state of yo-yoing on and off ketogenic eating, which oftentimes has left folks I've worked with worse off than when they started, which is why they came to me for help. So again, whatever type of diet strategy your patients could adhere to consistently, that's their key to success. Protein is a very unique macronutrient since it's difficult to store and it's a very inefficient fuel source as compared to carbs or fats. We want certain threshold amounts and in ideal intervals to maximize what's known as muscle protein synthesis, which is key for enhanced performance, yes, but more importantly, improved body composition, which has been tied to improved health outcomes. So body composition is key. Just like everything else in nutrition, there are high-quality sources and low-quality sources of protein. What determines each designation is a specific amino acid leucine, and that's the main promoter of a muscle protein synthetic response. Animal meats and dairy sources are much higher in leucine than plant sources, so it's something to keep in mind. And know that the whole process isn't a straight on or off switch, but it's more of a dimmer switch scenario, meaning there's constant gradients of both anabolic and catabolic processes going on simultaneously in the body. Now I know when I talk about protein and protein intake, a concern that often arises is whether or not protein in high amounts is safe for our kidneys. I am here to tell you that we know for a fact that high protein diets are safe, and this is gonna be the first of many because it's repeated so many times, it must be true topics we're tackling today and hopefully cutting through the confusion to help your patients succeed. Now, the one caveat before we continue is that pathology matters. So if there's a known kidney condition, please follow the specialist dietary guidelines. So back to protein and kidney health. First off, we know that diabetes and obesity are tied to poor kidney function and that end-stage renal disease increases proportionally to BMI. It's another reason why helping your patients with their nutrition is something we can't ignore if we're trying to help them as much as we can. High protein diets, they do change kidney structure, but this is a natural phenomenon known as hyperfiltration, and that results in an increase in size and volume of our glomeruli of the kidneys. It's not a pathological change guaranteeing future failure like we once thought. Patients who have donated kidneys that we followed in this research do not have any increased risk of kidney disease even 2 decades later, and that's a big deal. And yes, there are 2 studies performed recently that got a lot of press which state that high protein diets do harm kidneys, so I do want to quickly address them. Without turning this into a study breakdown and analysis dissertation, all I will say is that they both left a lot to be desired in a lot of areas, specifically data analysis, where the covariates of education and income levels dramatically changed group outcomes. They used relative risk ratio analysis, which is a tool I really, really don't like. And crude measurements for kidney function in one study with minimal differences in protein intakes between the high and the low group in the other study. And interestingly enough, the myocardial infarction population study had all groups, high, medium, and low protein, actually demonstrate less kidney function drop-off than you would anticipate given their history of a heart attack. So take that with a grain of salt. We have multiple studies that show high protein diets are not only safe for healthy people, They offer dramatic improvements to those with diabetes type 2 with improved blood glucose control and reducing triacylglycerol levels, otherwise known as TAGs, and TAGs are a strong independent predictor of cardiovascular disease. Other studies show that replacing carbs with lean, high-quality protein may even reduce cardiovascular disease or lower C-reactive protein levels. Where high-protein diets really shine, in my opinion, and also shown in the literature, is with improved body composition. in both caloric surplus and deficit scenarios. This has even been shown in sedentary senior citizens, which is a big deal. And also, of course, protein increases satiety, improving dietary adherence. And while I will always refer back to the first statement of following specialist guidelines when there is a known pathology, just to protect yourself and your license and put the patient first, it's not cut and dry that low protein diets prevent renal decline and end-stage renal disease. And these are the lists of studies that we have backing this up. Now back to the food quality discussion after that sidebar. Talk about fiber. We know that Americans, we're simply abysmal at getting in fiber. Heck, less than 50% of us get in a mere 1.5 cups of vegetables per day. So it's probably a good idea to have folks put an emphasis on this in terms of quality of nutrition. And fiber is a great way to monitor carbohydrate quality. What I mean is if somebody is eating a good amount of carbohydrates in their tracking, yet they're getting in very little fiber, Well, we know they're mostly eating simple sugars and probably lacking diverse micronutrient intake. And yes, things like apricots and watermelon are going to kind of poke holes in that argument, but hopefully they're not only consuming those 2 fruits. That's why for most of my general population clients, we honestly, we only track total calories, protein, and fiber. And I'm using fiber as a metric to track their carbohydrate quality. So without having to say much, we could show them how their food quality is lacking if once again, they're eating a good amount of carbohydrates, But they're getting in minimal fiber. Again, so long as calories and protein are equated for, there is no shown difference in both body weight and composition of high versus low sugar intake. But we do know that fiber is satiating, which is going to help with dietary adherence. It's good for our gut microbiota, which we're going to talk about later, and it binds to cholesterol in the bloodstream, reducing levels of LDL. We have a few other components in nutrition, but I'll keep this short. That's getting various micronutrient intake from diverse intakes of colorful fruits and vegetables, certain ratios of vitamin and minerals we need, which hopefully we'll get to later, individual responses to food, and what type of fat sources they're getting in. And lastly, with this whole quality argument, are your athletes fueling themselves properly? So for your patients, if they're not athletes and it's not a huge area of focus for them, then it's simply your job and their job to figure out what allocation of macros they feel they're best on. So where do they feel their best in terms of energy, hunger and satiety, recovery, digestion, sleep? I know that carbohydrates and fats most likely will have an inverse relationship, so one goes up, the other goes down. Protein should remain constant, and your fiber intake's correlated with overall caloric intake. But I wanna go over a few specific examples about athletes not fueling themselves properly or common pitfalls. This is not to throw shade or offend anybody, but we do know that Paleolithic dieting has been tied to the CrossFit movement. And I'm here to tell you that strict paleo dieting sucks for fueling CrossFit because you're simply not getting in enough carbohydrate to perform and recover from the intense glycolytic training of CrossFit. Oftentimes I've had clients come to me after they started both paleo and CrossFit together about 8 to 10 months in after they started, and they're doing that as their performance boosting strategy and a weight loss strategy. And the problem is they literally just don't have fuel to get through these workouts and recover. They're literally like a car running out of fuel, and when they ever do hit the gas station, they never fill the tank up to full. They're getting maybe halfway at best, so they're constantly hitting empty over and over again. On the other side of the spectrum, we have the athlete who trains multiple times a day, which is increasingly rare, but if they do, then glycogen replenishment, getting that in as quickly as possible, is crucial, especially after that initial post-workout window. But for everybody else who's only training one time a day or every other day, this is not really that important. We don't need to prioritize it. And actually doing so is just simply falling for marketing BS because we know it takes a full 24 to 36 hours for consumed carbohydrates to be converted and stored as glycogen. So again, if somebody's training multiple times a day, then we need to worry about rapid glycogen replenishment. If not, don't worry about it. Plus, I actually recommend most individuals wait at least 30, if not 60 minutes or more to eat after hard training sessions. Simply because they're in a sympathetic state, there may be some potential gut inflammation going on. Now that last part, gut inflammation, that's theoretical at this point, but I've simply had too many folks have less GI symptoms when we waited to eat after their workouts to completely ignore that. And it may seem like I'm glossing over this, but learning to prepare single ingredient foods is a skill, which means it takes reps. Remember, practice doesn't make perfect, it makes permanent. Encourage your patients to be gentle on themselves and work on week-by-week improvements. And I have some lazy cooking tips we could go over in the Q&A if anybody's interested. And because I kept talking about it, what do I mean by quality for training? Well, since this is a nutrition webinar, all I will say is I'm very biased to resistance training of some sort 2 to 3 days a week, along with some short HIIT cardio, so high-intensity interval training cardio sessions if they're cleared to do so. And hopefully some mobility work, whether it be mobility drills you're giving them yourselves or yoga or Pilates, whatever floats their boat and finds their lost remote. I encourage them to do that and getting in activity on a consistent daily basis. Remember, that's where those 10-minute walks come in handy that we talked about first. And because people might ask, why am I so biased to resistance training? Well, a recent study demonstrated that 3 times a week resistance training reduced cardiovascular death independent of whether cardio or aerobic exercise was done. Now, yes, they use relative risk ratio analysis tool, which I still hate, but otherwise it was still a definitely well put together study. And while it may seem counterintuitive, resistance training is actually incredibly safe. It has lower injury rates than everybody's favorite trick to get fit and healthy, I.e., running. Only 2.1 to 3.1 injury per 1,000 hours with resistance training. And, that's specifically stats from CrossFit, which respectfully I would argue is considerably more dangerous than your traditional resistance training in a gym since it's highly skilled movements done to failure, often in a fatigued state in a group setting. But then, if you look at running injury rates, it's 2.5 to 12 injuries per 1,000 hours. And, where resistance training shines is not only does it build muscle, improve body composition, increases somebody's basal metabolic rate to give them more of a window for if they do vary off their diet. Also makes them more resilient, not only physically but mentally as well, and that's a big deal. Now, at this time, we're gonna stop and focus on a big point I wanna make is that big rocks matter most. I'm gonna say that again, big rocks matter most. If you truly wanna help your patients, please keep your terminology and approach as simple as possible, especially in the beginning. Leave the minor details down to the very end, only once they've got their big rocks down consistently. And honestly, from my experience, for the average population, To get the goals they're after, they really don't need minor details, if ever, but especially not in the beginning. So what I mean is if your patients aren't doing well with the quantity and quality and consistently getting that, they're not practicing proper sleep hygiene, getting both good sleep duration and quality, at least attempting some sort of stress management and consistently getting in both exercise and activity, then worrying about the minutiae such like as food combinations, eating to their circadian rhythm, What type of salt they need to use, are they going to do fasting window lengths, if so, how long, carb timing, supplementation, all of that most likely won't be that impactful in comparison if we tackled big rocks first. If anything, all those tiny little details may overcomplicate things when your patients don't see results, and it's going to be in a timeframe shorter than what you told them about because that's how it is these days. But when they don't see the major results they want, it may discourage them from continuing on. And sure, these minor details, they're great selling points. I'm not going to lie. It makes it look like you have the magic bullet. That's the answer that they've been looking for, that only you could help them. But hopefully selling isn't the only reason why you got into the profession of helping patients, clients, family, friends, whatever cohort name you want to put there. Part of this big rocks matters most equation is that you have, in my opinion, open, candid conversations that this is a process. It takes time. It's not a linear journey by any means. There will be plateaus, potentially even setbacks. There will be times when your patients are gonna wanna call it quits. There's gonna be time when your patients, they're not doing perfect, and that's okay and all part of the process. It is a process. It requires consistency over the long term. Consistency, you're gonna hear it over and over again today. And it's my opinion, if you're going through the trouble to address nutrition with your patients, which a lot of people shy away from, please don't shy away from these hard conversations. Now switching gears here, I don't think folks pay enough attention to the psychology behind nutrition and the labels we and our patients assign to our eating habits. Self-talk matters and labeling matters. It's very easy to start assigning our sense of personal morality to our eating habits, especially when that becomes an area of focus to start looking, feeling, performing your best. So using the terms such as healthy and clean or junk food, plus depending on what type of dietary approach you're following, These terms are assigned very differently to the same foods. Not only do these terms unnecessarily divide everything into good and bad, it muddies the water of the biggest hurdle when it comes to eating properly, which is food quantity matters, like we talked about first. If we decide a food is healthy or clean, we can get carried away with eating too much, especially if we are patients relying on clever marketing and food packaging guiding that assignment. The example I have is nuts. Nobody's going to argue about the various micronutrient healthy fat intake of nuts. You know, they're heart-healthy, but mindlessly snacking on them because they're healthy can lead to serious weight gain consequences. Food quantity matters. Remember, we started off today saying that we as a society struggle with that. The second issue I have with these food labels is the demonization of food, and that can lead to somebody develop a very poor relationship with food. The second we label something as junk, well, we denote it as bad and declare it as untouchable, and then odds are we're going to obsess over it. Especially if it's an old-time favorite food or something you have an emotional tie to as a comfort food, or if you're like me, I don't like being told what I'm not allowed to do. It's the whole pink elephant phenomenon. So I would encourage everybody to close their eyes. So no cheating, please close your eyes. Now, don't think of a pink elephant. I'm pretty sure for those attending live, that same exact pink elephant that's on the screen now, so you could open your eyes, popped in your head. Similarly, if I told you that pizza or chocolate cake or cookies or whatever food group you want to put in there, Is forever to be labeled as untouchable and it happens to be some of your favorite foods or you just don't like being told what to do, that's an issue. You might fight the craving for some time, but let's face it, odds are you're going to give in. And my guess is almost everybody has had an experience like this. So somehow you convince yourself it's acceptable to eat one piece of pizza or chip, or your mom or your grandma cooked it just for you, whatever it may be, because you demonize that food, you have to justify going to the dark and you sit there And sit there and sit there. Then you might have another piece. Self-up for being bad and eating all this junk food. Before long, you may be even further down the rabbit hole feeling guilty, possibly even shameful. I don't know how many times, but I can't tell you how an event like this triggered end-of-days feasting for me on junk food because what's the point? I'll just keep going tonight so tomorrow I can resume my perfect diet of clean foods. I need to get it out of my system since I already broke the seal. Why are we assigning a sense of morality to our dietary habits resulting in us sitting on the pity pot and feeling sorry for ourselves? It's absolute nonsense, but it's far too common these days. That's why I personally like the term SMART. It needs to be smarter. There's some other terms on the screen that other clients have used. Just find whatever terminology works for you. And remember, quantity is a key driver in this equation. So in allowing yourself to have so-called junk foods in moderation, that's a much better place to be than the huge swings described above. But I also do recognize that not everybody else does well with moderation. I mean, I've never been called Moderate Marv in my life. So don't go fooling yourself. Today's the day for the first time in my entire life I'm gonna learn how to do so, especially if your track record is telling you otherwise. But even with that, I wouldn't use that black and white categorizations of food.

That's it for today's episode. Be sure to tune in for episode 38, where we wrap up our training on demystifying the nutrition conversation with Dr. Christopher Marvin. We'll dive into how to meet your patients where they are by offering simple and easy-to-follow guidelines. We will also talk about ways to help patients find the best foods for them without demonizing or labeling foods as good and bad. And we'll dispel some common misunderstandings and discuss nutrition's role in recovery and healing. Guys, this information is absolutely fascinating, and I highly recommend you click the link in our show notes to watch the full webinar so that you can see the visual presentation as well. You won't want to miss it. Episode 38 drops in 2 weeks. In the near future, we're also planning a few special Q&A episodes with past instructors. So please be sure to click on the Q&A link in our show notes and ask any burning questions you may have as they come to mind. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in today's episode. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor-store.com. That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.