#38 - De-Mystifying the Nutrition Conversation, Part 2

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 thank you for listening. Today we wrap up our 2-part training titled Demystifying the Nutrition Conversation: Cut Through the Confusion to Help Your Patients Succeed. With Dr. Christopher Marvin. Dr. Christopher Marvin, or Dr. 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 owned and managed a private training studio specializing in one-on-one and online training, and 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. And is a published author having written a book on nutrition. In today's episode, Dr. Marv will provide some simple and easy-to-follow guidelines for meeting your patients where they are. We will also talk about ways to help patients find the best foods for them without demonizing or labeling foods as good or bad. Finally, we will dispel some common misunderstandings and discuss nutrition's role in recovery and healing. Hopefully, by the conclusion of today's episode, you will no longer dread having the nutrition conversation with your patients and are well equipped with a strategy to help your patients walk away feeling empowered to make a positive change in their relationship with food. So with all that being said, let's cue the intro music and dive right in.

When I reached out to folks for potential topics today, because we're changing gears one more time, one that came up at least 5 times was nutrition and its impact on healing and inflammation. So we know that, but too much inflammation can delay healing and lead to chronicity issues. Now, this may seem odd, but just like with that meeting your patients in that first step, what about addressing other big rocks before nutrition? Now, yes, inflammation status from food intake matters, But sleep plays a huge role. We all worry about cognition and mood impact, even one night's sleep, but its impact on our immune system and total body inflammation is huge. Now, this is a perfect example of folks don't think about, and they're once again worrying about tiny minutiae such as food combinations for that extra maybe half of a percentage point, if that, but they're turning around and only getting 5 hours of interrupted sleep a night, and that's definitely mistaking the forest for the tree. We see huge swings in various inflammatory markers, including C-reactive protein, interleukin-6 and more. And this could be from a single night sleep deprivation or more interestingly, several high variability nights of sleep, which is most folks I would argue. And the whole sleep quality and duration, not getting that, that's even been tied to dementia and Alzheimer's as well as a poor vaccine response. We could go over sleep hygiene tips in the Q&A, but just remember, sleep is a big rock item that cannot be ignored. Now, when it comes to the whole giving inflammatory and anti-inflammatory foods, Well, that's where things get complicated because honestly the answer is it depends. Everyone has their own individual responses to food and they may have an interesting intolerance causing low-level inflammation. Now, the best way to figure this out of what specific foods somebody may have their own individual intolerances to is to constantly measure postprandial blood glucose, possibly via continuous blood glucose monitor, to help identify foods where patients are having a higher than expected glycemic response. So, the perfect example is this, is I had a client, she had a higher glycemic response to avocados than bananas, which definitely shouldn't be that way. So, we took the avocado out, potentially due to histamine intolerance, which we might talk about later, and over time, her GI issues started to get better and she started to have less brain fog and symptoms. I do recognize, just like with tracking food, but probably even more so, that most patients are not willing to check their blood glucose levels at all, period. But I'm making a point that the research shows there is huge intra- and interpersonal variability in response to various foods. And we do know that chronic hyperglycemia increases oxidative stress and inflammation. We think we know that for the most part, certain fruits, vegetables, herbs, spices, etc., may— keyword is may— reduce inflammatory status. And that could be in whole food form, juice form, or extract form. But it's not always cut and dry, and there is conflicting evidence on this topic. Personally, that's why I really like The whole patients doing their grocery shopping around the perimeter of the store is a huge first step that pays immediate dividends in this regard, hopefully increasing their intake of colorful fruits and vegetables. Now for another polarizing topic and one we're going to tackle that said for so long it must be true. That's vegetable and seed oils. And just know that yes, they are technically different, but for the clear sake of communication, I'm using those terms interchangeably because that's what most folks talk about and that's what also the research talks about. A very common argument For lowering inflammation to encourage health and healing is to avoid cheap vegetable and seed oils at all costs due to their high linolenic acid content, which is omega-6 polyunsaturated fat. Now, that advice is often followed up with only using high-quality extra virgin olive oil, avocado oil, or macadamia nut oil, along with lots of omega-3s, and flaxseed especially seems to be promoted. And I'll admit, outside of that flaxseed oil recommendation, I preached this paradigm for over a decade. I mean, heck, in the last Q&A section, I went over this in another webinar previously. On paper, this whole argument, it actually makes a lot of sense. Depression, as do turmeric and ginger, which hopefully we'll get to later. Now, when you aren't looking at this argument in a vacuum, simply following pathways, the evidence doesn't support the narrative that vegetable or seed oils are causing massive inflammation and disease. I'm going to stop and repeat that because let me tell you, I had a full-blown existential crisis when I first started reading through the first Recent systematic reviews and meta-analyses myself because that's something I preached forever. Linolenic acid from vegetable and seed oils and its byproducts, including the boogeyman arachidonic acid, do not guarantee increased inflammation in the body or other diseases such as cancer, coronary heart disease, cardiovascular disease, and more. And some studies even found an inverse relationship with coronary heart disease and linolenic acid intakes. This doesn't mean just throw out all the other fats typically promoted. Like, personally, I love high-quality extra virgin olive oil that's super fresh, straight from the farm. And one systematic review found that even deep frying with extra virgin olive oil reduced cardiovascular disease risk, which is interesting because most folks would argue never to cook with extra virgin olive oil due to its low smoke point, let alone deep fry everything. With all this said, pay attention to individual response. So what I mean is I myself, I don't do well with vegetable and seed oils. I get a massive inflammatory response. And I've also had dozens of clients also feel better when we remove these fat sources and switch them to extra virgin olive oil or avocado oil. But I'm the first one to admit it could be a huge placebo effect in play because I preached that narrative until I was blue in the face. Everyone is unique, so pay attention to how you and your patients feel. Remember, basic foods can have large intra- and interpersonal differences in responses. We need to remember nutritional studies, they're flat-out hard to do. We as human beings, we make terrible test subjects unless you're sequestering us in a metabolic ward, which is happening less and less these days. So while it's important to be primarily evidence-based, don't be afraid to listen to what somebody's— or a patient's body's telling you. Now let's go back to the omega-3s. It does appear they do have anti-inflammatory and morbidity-reducing effects, so I do encourage their intake in a ratio of about 4 up to 6 to 1 omega-6 to omega-3. That's a pretty happy medium with good data behind it. Now, if somebody isn't consuming fatty fish 2 to 3 times a week, then supplementing with a high-quality supplement is fine. High-quality source matters for this, and personally, I prefer either fish oil or krill oil. We'll put a pin in the subject as we'll come back to the fish oil debate a little later on. Why not flaxseed, which is typically promoted? Well, the omega-3 polyunsaturated fat in there is typically alpha-linolenic acid, and that's not bioavailable to humans. And while ALA, or alpha-linolenic acid, does convert to EPA, albeit in minimal rates, it doesn't readily convert to DHA. And no, I'm not going to attempt to do the tongue twister of what DHA's word actually is. But this is a key point for plant-based eaters who may struggle to get DHA into their diet. Depending on how strict they are, they can get DHA into their diet via fortified eggs, yogurt, cheese, butter, or beverages like fortified soy milk. And while we're at it, what about red meat? It's often parroted that red meat causes inflammation and disease, reducing lifespan, so we should limit intake. Heck, it was compared to cigarettes at one point by the World Health Organization. Now, a lot of the same arguments are made for red meat as are vegetable and seed oils, especially the whole arachidonic acid argument or a chemical byproduct called TMAO that supposedly increases your risk of heart disease. Before we dive deeper, there is a huge elephant in the room we need to address and it's not the pink one from earlier. Similar to the term healthy that we discussed, in research, red meat, it's just as vague. That category comprises everything from fresh, high-quality lean cuts of beef, lamb, or pork to highly processed lunch meat, sausage, or pepperoni even. Meanwhile, the same exact study doing that comparison has 4, even 5 different categorizations of what plant-based diet the meat eaters are being compared to. That's not really a fair shake. And then there's an even bigger boogeyman at play, and that of the healthy user bias. Because red meat has been demonized for so long, it's lumped in with other risky behaviors. That could be things like alcohol consumption, smoking, and excessive sugar consumption. So honestly, just think about your standard American or Western lifestyle diet. Like we talked about, the connotations and actions surrounding foods really matter. Simply shopping at a health food store, you're more apt to buy more fruits and vegetables than a traditional store. Or that by simply participating in a British nationwide survey, both omnivores and vegetarians alike had significantly reduced mortality rates compared to the national average. Now, why is that? Well, honestly, if you're willing to participate in a study that's full of 100 questionnaires about your nutritional habits, then you probably live a better lifestyle than most for longevity. So here's what we do know. Just like the healthy user bias would suggest, high levels of processed meats, so processed is a keyword, that consumption is inversely related with dietary quality in terms of fiber, fruit, and vegetable intake. And it's those items that provide the microbiota protection against potential cancer or cardiovascular disease outcomes independent of whether red meat is consumed or not. And the short-chain fatty acid butyrate in particular is impactful preventing that. Because it's a very strong anti-inflammatory found in our guts. And we also know that calcium, vitamin C, and vitamin E neutralize the heme iron carcinogenesis concern from fresh red meat, once again showing that quality nutrition— So let's do another very bold statement. In is apt intake of fruits, vegetables, and calcium. So in the context of that, fresh red meat has no association with anything on this list. And on the list, podcasts, cancer, increased mortality, cardiovascular disease, stroke, diabetes, increased inflammation, hypertension, LDL escalation, etc. And fresh is the keyword, not processed. And yes, the famous classification of fresh red meat in the same class as cigarettes, that's been retracted and disproven. So if you or your patients choose to do so, you could absolutely have your fresh red meat along with fruits, vegetables, and plenty of calcium. And if you can't do dairy, know that greens contain a lot of calcium. And I'm not making a blanket statement that everyone should eat red meat, especially if they're not doing it now. That's a personal choice. My motto is live and let live. But if you are, please don't be worried it's going to kill you, prevent you from healing from uncontrolled inflammation in the context of a balanced intake. So before we get to the Q&A, it's another big point I want to make. And honestly, it's okay to say, I don't know, and it's okay to refer out. We're never going to have all the answers and we need to learn to live with that. Nutrition is complicated as all get-up, like I've kind of pointed out today, because There's no one-size-fits-all. So, an example of this is for as long as I've been doing this, I'm still not comfortable working with 100% plant-based patients, right? Because there's a lot of intricacies involved with protein combinations and supplementing and the inherent micronutrient gaps. So, I bet I could manage and figure it out, but that's not putting their health and well-being before my ego thinking I could handle each and every situation. And if you could learn to do that, well, you're gonna help a lot of people and the people you do go get help for, they're gonna be just as appreciative if not more because you put them first before your ego.

Yeah.

And remember, a true sign of an expert says, I don't know, and it depends a lot. So with that, we can get to the Q&A.

Have you ever thought about teaching or launching a podcast? Maybe creating online courses for your patients or a YouTube channel to gain exposure? Or maybe you want to pass on your expertise and knowledge to the next generation of healthcare providers, but don't really know where to get started. If this sounds like you, Then we would love to have a conversation. For almost a decade now, Southeast Professional Education Group has helped healthcare providers, national organizations, and product companies create and launch content for the purpose of educating and engaging their target audience. Whether you want to establish your credibility in your hometown as a means to grow your practice, or if you're looking to enter into the exciting world of continuing education, We would love to talk to you. The great W.B. Yeats said, education is not the filling of a pot, but the lighting of a fire. And I guarantee you there's someone out there waiting for you to light that spark. Simply fill out the interest form linked in the show notes and let's have a conversation. Who knows, maybe a few months from now, you're the one that our podcast subscribers are tuning in to learn from. So click the link to request a time to chat. Let's have a conversation and see how we can help you make 2022 the year that you launch something great. Awesome. Thank you so much. So one of the things that you were talking about was the quality of different oils or the quality of different fats. I know there's a trend right now for people to put coconut oil or MCT oils, or even like the Bulletproof Coffee where they put butter into their coffee. How do you feel about those type of guidelines for general patient population? What do you take into consideration when making those kind of recommendations on MCTs?

So, the whole idea of Bulletproof Coffee was— it's interesting. Originally, it was supposed to be butter because we know that protein from the butter binds to caffeine, so it's a slow trickle of caffeine versus a huge large bolus dose and then the crash. So, it's supposed to give you more sustained levels. And then, along the lines, more emphasis was put on medium-chain triglycerides. Which are an instant fuel source, which is why a lot of people will start sweating when they do that because the liver doesn't have to break it down. I can't tell you how many times clients have been, hey, so I started Bulletproof Coffee and I'm having major GI issues, i.e., diarrhea. It's like, well, if you go from not doing that to all of a sudden consuming massive amounts of both butter and MCT oil with coffee, which is already very hard on our gut, like the body needs to ramp up its different enzymes, lipase and all that, to be able to break it down. So long as If somebody has slowly increased the fat intake as they do it and it's not blindly adding 400, 500, 600, 700 calories they're not accounting for, it's fine. But butter, I would argue, is much more impactful than the MCT oil for getting that slow trickle of caffeine. Does that help?

Absolutely. That makes a lot more sense as to the combination of those. What are your thoughts on recommending potassium salt to a patient that's looking to control their blood pressure better?

Absolutely. So, one thing I was going to talk about is we try and get sodium and potassium in correct ratios consistently day in and day out, primarily for whole food. But if somebody's having a hard time doing that because potassium, we have to make a concerted effort to do so, I do like potassium chloride or salt substitute, never in large amounts, so never more than a quarter teaspoon. And that's with your high salt intake meals to get that ratio. It's because unopposed sodium For over 80% of the population is the issue, not salt alone. So I am a fan of that. I would prefer somebody get like a potassium chloride versus just a salt substitute you get off the grocery store because there are a lot of anti-caking agents and just extra stuff that you get in salt substitute, but it is a valuable tool. All the athletes I work with, they do salt and potassium chloride and taurine before workouts, whether they're strength athletes or endurance athletes. It does go a long way. Huge fan of that. And we want a ratio of 1:1.25 sodium to potassium up to 1:1.5. So, we always want a little bit more potassium than salt, and that's a great way to do so. But just don't go mega-dosing it. Potassium is not something to take lightly, so don't go taking 10 grams of it and thinking you're going to be okay.

There are some popular recommendations about utilizing supplements like L-glutamine essentially to help with some of the insulin resistance or some of the spikes and peaks and valleys in glucose. What are your thoughts on athletes that are using supplements and amino acids in this way to balance out some of their cravings throughout the day or even help them tap into those glucose stores a little bit easier during their workouts? What is the purpose of utilizing something like that?

I personally am not a fan of L-glutamine unless you're trying to heal leaky gut. Yes, glutamine is the most abundant amino acid in our muscle, but it does not correlate to improved performance or body composition or anything like that. So personally, I'm not a fan of L-glutamine for what it's used for and what it's been parroted that it's good for, because the research shows time and time again it doesn't. I do am favorable of amino acids, like essential amino acids, not just BCAAs. BCAAs by themselves, unless somebody is protein deficient or consuming a plant-based diet or an endurance athlete, they're a huge Waste of money in my opinion. Essential amino acids, so you're getting the branched-chain amino acids, which is leucine is the heavy hitter, plus all the other spectrum of the amino acids. I'm a huge fan of that for folks if they have big rocks, right? So spending all this money on fancy powders and pills, that's tiny minutiae if they don't have their sleep prioritized, they don't know how many calories they're consuming, they don't— again, those are things that if big rocks are handled, absolutely. In terms of glucose management, I'm a huge fan of berberine. It's shown to be time and time again similar or as effective as prescription metformin. Now, we're never going to take patients off prescription metformin, but from anecdote, I have had folks respond better to berberine than metformin. So, they asked their doctor for permission to switch, made the switch, hemoglobin A1c levels continued to improve. They did very, very well on it. And as somebody is increasing, I guess fasting windows, whatever you want to call it, but as somebody is getting better at blood glucose management and building basal metabolic rate up, we should get something known as metabolic flexibility should improve. So then you're not getting those huge swings in blood sugar. Your body's going to be better able to regulate blood glucose levels on its own. So you're not getting that crashing or that bunking. There's a few other things I like for glucose management for workouts, but that's kind of beyond the scope of today. So I will leave it at that.

Yes, absolutely. I think that was great. And one of the other questions someone had was in regards to having these conversations with your patients. If you have a patient that knows they have specific dietary issues, be it they have food sensitivities, maybe they even have some true allergies to certain foods, how do you help them build a program around that, especially if their dietary restrictions are significant, like I can't have eggs, I I can't have gluten. Major food groups that are in a lot of different healthy and unhealthy foods, or if you were to categorize them as one or the other.

When it comes to eggs, most folks have issues with egg whites, not the egg yolk, just FYI. So if somebody's having issue with eggs, remove the egg white and you should be good to go. That's how that happened with Hashimoto's patients over and over again. The IgG responses to a specific protein in the egg white versus the yolk. So first of all, you need to have these conversations because you need to get that information. If you're not asking the right questions, you're not going to get that information, which then you have no idea when you're helping them with nutrition. After that, then yeah, like I always ask folks, first of all, what foods do you enjoy? What foods do you not enjoy? So I'm not like putting this in. And more importantly, what foods do you not respond well with? And if they don't— like gluten is a very common one, not that they have celiac, but gluten intolerance is very, very common. And so we need to respect that and just be mindful. So there are gluten-free options. Now those could be just as highly processed as the gluten stuff. So that's something to keep in mind, but we just got to keep that in mind and work around it. And digestion and honestly bowel movements are a great way to monitor how everything's doing, if you're eating foods that are agreeing with you, if you're not. So that's where a food log and consistent intake was really helpful because like I said, most folks are not going to want to check their blood glucose levels at all. So if you're doing at least a food log with symptoms, this is really big with migraines especially. We can start to correlate things and then figure out, okay, every time I eat this specific food or every time I eat out at this specific place, I have symptoms X, Y, and Z. So then we can start to remove it. And then folks who can't do dairy, how many folks who they know and you know they can't do dairy, but they'll still occasionally eat ice cream because they're like, I really want this and I know what I'm signing up for. And that's totally fine as well. So long as there's not like a known pathology present, like we talked about about with the kidneys. So it does get very complicated and very tricky, but just keep everything in mind. And, and there's nothing we have to eat. Hopefully that came across. I am biased towards things, but like, there's nothing you absolutely have to eat. So whatever you could get down that you consistently do and you, and you respond well with, and more power to it.

Wonderful. And I think the key there is that flexibility piece. Like you were saying, it's really up to helping each individual patient and not categorizing a food as good or bad, but really working within the confines of what they need and, and what works for them. One other question we received was in regards to quality component of what you were talking about earlier, the quality of the foods, the quality of the sources. Collagen is another one of those things that a lot of people are ordering on Amazon. Do you have any guidance or recommendations you give on the source of collagen, whether it's bovine or what is a quality versus which is one that you should kind of avoid?

For collagen, if you're just taking in generalized collagen, know that you need at least 20, if not 30 grams per day. So a lot of people aren't getting enough collagen to begin to make a difference. Collagen's still up in the air. The last I looked at it as terms of efficacy or not, I do hydrolyzed beef collagen. I don't do the UC-1 and UC-2. I've tried that for joint stuff and it never made a difference. Because I eat a lot of red meat, I need to get my methionine in order. So I do straight gelatin and collagen together, and that helps me get that specific amino acid up, which I don't get a lot of through my diet. And knock on wood, I haven't had any significant gym injuries since starting that, but— Typically, in terms of sourcing, I'm biased to a few companies, but you want something that's going to not have any proprietary blends. That's a huge red flag. This is going to crush a lot of people's hearts, but typically if it's found at a Costco or a Walmart, it's probably not the best quality. And then just pay attention to how you respond, right? Some people can't handle red dye 40s in a lot of protein collagen supplements, and a lot of people don't do well with that and they have no idea why. So the less stuff you can get on the ingredient label, the more transparency the label has, the better. I don't really know if that helped or not, but that's a very polarizing—

One other question here. One here was, can you advise on reducing serum creatinine levels?

I'm doing this with somebody right now. Okay. I don't like serum creatinine levels, especially for athletes. If you have more muscle mass, if you work out, if you consume creatine, your serum creatinine levels are going to go up. And so, that's why I'm not a huge fan of it. So, let's just say what I'm doing with one of my clients who needs to reduce their serum creatinine levels. We actually lowered his protein intake from animal sources, kept calories the same. We increased his vegetable intake and we had him increase nut intake because he really enjoys nuts, but calories are the same. So, we shouldn't have any changes in the scale weight. We had them stop taking creatine monohydrate, which is one of the few supplements I do recommend. I'm a huge fan of it, especially for older population folks or those on a plant-based diet. It has major cognitive benefit connotations. And then you're going to want to take at least 72 hours off from any sort of hard exercise, preferably more. A full 7 days would be better. So reduce your protein intake specifically from animal meats. Stop creatine monohydrate if you're doing that and don't do any sort of hard exercise 72 hours minimum, preferably a full 7 days. And then, depending on why you need to reduce levels, hopefully you could have a conversation with the individual who's needing to do it. And, if it's for something like life insurance, they don't care if you're an athlete or you have more muscle mass than the average person. So, that's kind of tough, but those are my— the 3 things that come to mind.

Wonderful, thank you. This has been such an informative session, everyone. We really appreciate you joining us today. That was the end of our questions here. Thank you so much, Marv. This was wonderful.

Well, thank you for the opportunity. Really appreciate it. And for everybody who took time out of their day to join us, that's super awesome. I'm super humbled.

That's it for today's episode. Be sure to tune in for episode 39, where we kick off a new training titled 10 Things Every Clinician Should Understand About Orthotics with Dr. David Widemeyer. Although many companies market orthotics to healthcare practitioners, there exists a great lack of understanding of medical necessity and the critical use of orthotics, along with a plethora of common myths surrounding this subject. In this 2-part training, We will clear up the confusion surrounding the role and efficacy of orthotics in clinical chiropractic practice so that you're better equipped to make decisions on whether these devices are right for your patient. Dr. Wedermeyer will discuss these issues, along with basic guidelines for knowing when to order orthotics and how to ensure you're choosing the right device for your patient. You won't want to miss it! Episode 39 drops in 2 weeks. In the near future, we're also planning a few special Q&A episodes with our 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. 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 to 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.