Whey protein and dairy products tend to get negative press from integrative practitioners because of the "insulin-promoting" effects of whey. Interestingly, it is exactly this "insulin promoting" effect that creates positive post-parandial glucose changes in diabetic patients and likely contributes to the preservation of lean tissue in diabetic patients during dieting. 

In this podcast we discuss an article by Memelink (2020) on the use of a Whey protein drink daily and after exercise in patients with type 2 diabetes and the impact the intervention had on HOMA-IR scores and lean tissue. 

We also discuss an article by Smith (2020) and Miller (2021) and how these three articles contribute to our current understanding of using Whey protein in diabetic patients. 

Memelink, R. G. et al. Effect of an Enriched Protein Drink on Muscle Mass and Glycemic Control during Combined Lifestyle Intervention in Older Adults with Obesity and Type 2 Diabetes: A Double-Blind RCT. Nutrients 13, 64 (2020).   Miller, E. G. et al. Effects of whey protein plus vitamin D supplementation combined with progressive resistance training on glycaemic control, body composition, muscle function and cardiometabolic risk factors in middle‐aged and older overweight/obese adults with type 2 diabetes: A 24‐week randomized controlled trial. Diabetes Obes Metabolism 23, 938–949 (2021).   Smith, K., Davies, K. A. B., Stevenson, E. J. & West, D. J. The Clinical Application of Mealtime Whey Protein for the Treatment of Postprandial Hyperglycaemia for People With Type 2 Diabetes: A Long Whey to Go. Frontiers Nutrition 7, 587843 (2020).

Integrative practitioners are in a unique position to help patients make decisions about medications such as Semaglutide (Ozempic). It's important that we deeply understand the data on medications so we can support patients (and not misinform them).   In this podcast we cover the STEP 1 Extension trial by Wilding. (**Note that I misquote in the recording and call it the STEP 5 extension trial).   We discuss topic such as   The morality of obesity medication and ridding yourself of bias. Cohort data - what they give us and what they don't. The STEP 1 extension trial that examines weight regain, cholesterol and blood pressure 1 year after discontinuing Semaglutide. Our possible future role in supporting these patients, but where we need more information.     Our members will be receiving a full intensive program on Insulin resistance and diabetes (including discussion on medication) in the spring of 2023. If you are not a member of The Confident Clinician, you can join the wait list to learn when our membership is available in the future.       DeSouza, C. et al. Efficacy and safety of semaglutide for type 2 diabetes by race and ethnicity: a post hoc analysis of the SUSTAIN trials. J Clin Endocrinol Metabolism 105, 543–556 (2019).   Wilding, J. P. H. et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metabolism 24, 1553–1564 (2022).

Everybody eats, but when is it concerning? How do we define “healthy eating behaviour”? What’s the opposite of disordered eating? This episode with Dr. Sylvi Martin RN & ND opens up the conversation about the landscape of eating behaviour in general, exploring eating disorders, disordered eating behaviour, “normal” eating and introduces evidence-based intuitive eating and mindful eating.

 

Dr. Sylvi Martin, ND is offering an Eating Behaviours Workshop on February 10, 2023, inside the Confident Clinician. Make sure you are on our mailing list to be the first to know when registration opens at the end of January. 

 

Dr. Sylvi Martin BScN RN ND (she/her)

Sylvi is a naturopathic doctor, registered nurse psychotherapist, Certified Intuitive Eating Counsellor and Mindfulness Based Eating Awareness Training (MB-EAT) facilitator based in Toronto. Sylvi applies a weight-inclusive approach to helping individuals experiencing mental health related challenges and disordered eating behaviour.

 Sylvi maintains dual practises in nursing and naturopathic medicine. After completing her Bachelor of Science in Nursing at Laurentian University in 2004, she practised acute care psychiatric nursing at St. Michael’s Hospital in Toronto where she also completed a nursing research fellowship. She went on to graduate from the Canadian College of Naturopathic Medicine in 2009 after which she began her private naturopathic practice in Toronto. In addition to her naturopathic practise, Sylvi maintained her nursing practise by working on a mental health team for an Ontario health regulator where she was also part of a mental health response team for individuals in crisis. She has also completed additional training in Cognitive Behavioural Therapy for Eating Disorders.

When she’s not furthering her training or working on her latest workshop or course, she can be found perfecting her chocolate-savouring skills, feeding her “trust fund squirrels” at the cottage in between dips in the lake, or on the hunt for more scarves in some corner of the world with her partner Dave.

 

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
• Bergner, L., Himmerich, H., Kirkby, K. C., & Steinberg, H. (2021). Descriptions of Disordered Eating in German Psychiatric Textbooks, 1803–2017. Frontiers in Psychiatry, 11, 504157. Retrieved from https://doi.org/10.3389/fpsyt.2020.504157
• Kristeller, J. L., & Hallett, C. B. (1999). An Exploratory Study of a Meditation-based Intervention for Binge Eating Disorder. Journal of Health Psychology, 4(3), 357–363. Retrieved from https://doi.org/10.1177/135910539900400305
• Mason, A. E., Epel, E. S., Kristeller, J., Moran, P. J., Dallman, M., Lustig, R. H., … Daubenmier, J. (2016). Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. Journal of Behavioral Medicine, 39(2), 201–213. Retrieved from https://doi.org/10.1007/s10865-015-9692-8
• Ralph, A. F., Brennan, L., Byrne, S., Caldwell, B., Farmer, J., Hart, L. M., … Hay, P. (2022). Management of eating disorders for people with higher weight: clinical practice guideline. Journal of Eating Disorders, 10(1), 121. Retrieved from https://doi.org/10.1186/s40337-022-00622-w
• Satter, E. (2021). Normal Eating. Available at: https://www.ellynsatterinstitute.org/wp-content/uploads/2021/01/Normal-Eating-1-up-with-EC-2021-secure.pdf
• Tribole, E. & Resch, E. (2020). Intuitive Eating, 4th Edition. St. Martin’s.
• Tylka, T. L., & Diest, A. M. K. V. (2013). The Intuitive Eating Scale–2: Item Refinement and Psychometric Evaluation With College Women and Men. Journal of Counseling Psychology, 60(1), 137–153. Retrieved from https://doi.org/10.1037/a0030893

 

This past month inside The Confident Clinician, we covered the assessment, nutrition and supplements to support patients with IBD. 

In today's episode we share with you the most compelling supplement to use in patients with IBD that hits the most number of treatment targets, some of the other supplements we studied and why most patients have dissatisfaction with their care for their IBD. 

The Confident Clinician membership is opening January 17, 2023 for only 2 weeks until we close off membership access until July. You can learn more about our practice support, database and live ongoing trainings for Naturopathic Doctors here. 

This was the article discussed in the podcast: 

Sun, H. et al. Modulation of Macrophages Using Nanoformulations with Curcumin to Treat Inflammatory Diseases: A Concise Review. Pharm 14, 2239 (2022).

In this episode, Dr. Jordan Robertson shares the content we covered this month inside The Confident Clinician Club IBD module. She shares a new study published in 2022 on the Low FODMAP diet, and the impact that what patients "expect" their diet to do on their subjective symptoms. 

Melgaard et al exposed patients to a FODMAP or placebo provocation after improving patients symptoms with a low-FODMAP diet and showed the impact of how patients expected themselves to feel after a food exposure and their symptoms. 

We also covered

• Why medical doctors are concerned about patients working with integrative practitioners and changing their diet. 
• The limitations of the nutrition research on IBD and where we may want to borrow from IBS literature. 
• The impact of the placebo/nocebo effect on patients with IBD. 

If you're a member of our listener community, we want to invite you to join our free maternal mental health event happening in January. You can sign up for the workshop with our expert cilnicians here. 

Today’s podcast is a fun cognitive gymnastics opportunity for you to think about the influence of bias in your clinical decision making with Dr. Jordan Robertson ND

Fun. We promise. 

Bias is rampant in clinical decision making and it’s important that we break open the conversation by both identifying the types of bias that exist, and thinking about possible examples where this may show up in our clinical lives. 

In this episode, we cover anchoring bias, the availability heuristic, the halo effect, confirmation bias, the framing effect, publication bias and a few others. 

Clinicians need to rebuild their knowledge on an ongoing basis, which is hard for humans to do in general - and really hard as a clinician. We’ll give you some new ways to think about your clinical decision-making and give you a safe space to deconstruct your own ideas to be better in practice. 

Enjoy!

We referred to a few courses that we’ve offered in the Confident Clinician that you can connect with here: www.confidentclinicianclub.com

Certain intervention trials studying nutrition and depression have intentionally included recommendations to include animal protein. In turn, this leads to the question about the particular role of animal protein on mood. In particular, if there is an association between diets that exclude animal protein and depressive symptoms? In this podcast, I dive into a large cohort study that was looking at this question and discuss the interesting findings they (didn’t) find around the vegan diet and what they did find around food exclusion as a variable. 

 

Matta, J., Czernichow, S., Kesse-Guyot, E., Hoertel, N., Limosin, F., Goldberg, M., … Lemogne, C. (2018). Depressive Symptoms and Vegetarian Diets: Results from the Constances Cohort. Nutrients, 10(11), 1695. https://doi.org/10.3390/nu10111695

 

Are you a practitioner and are you interested in Dr. Antonella's Mediterranean Diet Workshop? Registration is open now! Grab your spot here 

A recent meta-analysis (Bytyçi 2022) determined that the prevalence of statin intolerance is around 9%. Given the high rate of statin discontinuation in this group, intolerance should be identified and addressed to better support those who require lipid-lowering to reduce their cardiovascular risk.

 

Today’s podcast will touch on this recent meta-analysis before focusing on the National Lipid Association’s new scientific statement on statin intolerance outlining key considerations and practical tips to systematically approach your suspected intolerant patients. 

 

References discussed in this episode:

Bytyçi, I. et al. Prevalence of statin intolerance: a meta-analysis. Eur Heart J (2022) doi:10.1093/eurheartj/ehac015

Cheeley, M. K. et al. NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient. J Clin Lipidol 16, 361–375

Jacobson, T. A. et al. The STatin Adverse Treatment Experience Survey: Experience of patients reporting side effects of statin therapy. J Clin Lipidol 13, 415–424 (2019)

 

We hosted 500 practitioners at our Menopause Advanced Training course at the beginning of October and covered cognitive health and nutrition as part of that program. 

 

We looked at the impact of the MIND diet on future cognitive function and whether or not we can influence cognitive decline in patients by changing their nutrition. One particular study, although small, pointed out the possible unintended consequences of caloric restriction without educating our patients about nutrition for their brain. 

 

The study by Arjmand (2022) was the deep dive focus of the podcast today and gave some food for thought about how we educate our patients who are dieting about cognitive health. You’ll be surprised at what happened to the group that wasn’t given education on nutrition for brain health and will give you some clinical ideas for how to talk to your patients about MIND diet principles. 

 

If you’re hoping to join The Confident Clinician you can join our wait list at www.confidentclinicianclub.com to get notice when our membership opens in November. 

 

References discussed in this episode: 

Arjmand, G., Abbas-Zadeh, M. & Eftekhari, M. H. Effect of MIND diet intervention on cognitive performance and brain structure in healthy obese women: a randomized controlled trial. Sci Rep-uk 12, 2871 (2022).

Morris, M. C. et al. MIND diet slows cognitive decline with aging. Alzheimer’s Dementia 11, 1015–1022 (2015).

Recently a review article from 2020 caught my eye; Reconsidering the Role of Melatonin in Rheumatoid Arthritis. Sleep is a major issue for RA, and many patients and clinicians are turning to melatonin to aid with sleep issues, are we causing more harm than good?

Melatonin has been known: 

• as a powerful antioxidant and anti-inflammatory properties
• to help with regulating T cell responses, T helper (Th)1, Th17, and regulatory T cells (Tregs).
• to help modulate the circadian rhythm and enhance sleep

On the flip side, there is evidence from animal studies showing there are receptors for melatonin on synovial macrophages which promote the release of some Th-1-type proinflammatory cytokines. It has also been pointed out that the higher blood concentrations of melatonin in arthritic patients, especially in the early morning, might explain the morning stiffness and joint swelling experienced by patients - but does that mean that melatonin should be completely avoided? So far most of that evidence is coming from animal studies but are they translating with similar outcomes in human RCT?

Let’s dive into 2  human trials to see how melatonin impacts your RA clients. Save the Date! Dr. Alison Danby, ND will be running a 1-day Autoimmune 101 Workshop for clinicians on Friday, October 21, 2022. Registration opens September 21st. Join our mailing list to make sure you are in the know to grab those Early Bird Savings.  References: https://confident-clinician-club.s3.ca-central-1.amazonaws.com/The+Expert+Clinician/Autoimmune+101/TCC+Podcast/RA+%26+Melatonin+2007++(1).pdf https://confident-clinician-club.s3.ca-central-1.amazonaws.com/The+Expert+Clinician/Autoimmune+101/TCC+Podcast/RA+and+melatonin+-+2020+RCT+(1).pdf