Disclaimer - ChiroCredit · •Blood sugar imbalance •Too much stress •pH-imbalance ... Poor quality diet ... • Appetite dysregulation 48. 17 49 3

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Evaluating and Addressing Our Patients’ Underlying Health Challenges

Nutrition

Presented by:Dr. Richard Powers, DC

Holistic Primary Care1

Copyright by Dr. Richard Powers, DCAll rights reserved. No copying, duplication, replicationin any form by any means without written permission.

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DisclaimerThe material presented in these documents are for

informational purposes only and is not intended to diagnose, treat, cure, or prevent any disease, nor is it a substitute for examination by a physician, nor for an individualized (or customized) protocol based upon your own patient’s needs.

Dr. Powers does not assume any responsibility for any outcome resulting from the lack of appropriate assessment and a personalized care plan based on the particular needs of each patient.

The information is the opinion of the presenter and based upon many year of his education, research, and clinical experience, and is not necessarily endorsed (nor denied) by ChiroCredit® who is only providing the platform for the presentation.

Information and claims about substances mentioned herein have not been evaluated or approved by the FDA.

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Help people live their best life … – Provide astonishing service that truly and favorably

impacts quality of people’s livesEnjoy prosperity… – Make an excellent living by offering exceptional

valueDo it all with ease …– Establishing systems and algorithms to guide

decision-making (evaluation and treatment)

Why are we in practice?

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“A man should look for what is, and not for what he thinks should be.”

Albert Einstein

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• You already know– Be open to hearing in a new way

• You’re already doing– If working, keep doing

• You would like to do– Work them in to operating system

• Feel overwhelmed– Prioritize a list and start with 1-2 points

• Can’t see how to incorporate– Consider adding later

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Why People Seek Our Care:

• Pain/Headaches

• Fatigue

• Anxiety/Depression

• Disturbed Sleep

• Allergies

• Weight/Shape Challenges

• Disease states7

Potential Underlying Causes:

• Vitamin deficiency• Thyroid condition (HPT)• Blood sugar imbalance• Too much stress• pH-imbalance (Over-acid)• Dysbiosis/SIBO• Methylation defect• Estrogen dominance• Mineral deficiency• Autoimmune reaction• Oxidative stress• Chronic inflammation

• Gluten sensitivity• Excessive toxic burden• Low HCl/enzymes• Too sedentary• Adrenal insufficiency (HPA)• Food sensitivity• Heavy metal toxicity• Sleep “debt”• Poor quality diet• Over-exercising• Imbalanced lifestyle (W:P)• Leaky gut

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How do we get sick?

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• Bad genes

• Bad cholesterol

• Bad luck

… smoking, drinking …

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“There is nothing more deceptive than an obvious fact.”

Sherlock Holmes

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How do we get sick?

• Live inconsistent with “rules” (Laws of Nature)

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Just a glimpse of cellular biochemistry;Mulitply by trillions of cells all

Communicating and interacting …

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How do we get sick?


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How do we get sick?

• Body adapts– E.g., stress response – Alarm stage (Selye)


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How do we get sick?



• Body compensates (exceed adaptable limits)

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How do we get sick?


• Body compensates (exceed adaptable limits)


Compensation = adaptation + cost–E.g., stress response – Resistance/Exhaustive stages–E.g., nutritional triage theory (Ames)

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Nutritional Triage TheoryBruce Ames, PhD

• Insufficient Vitamin K… preferentially = blood clotting… little to activate calcitonin and GLA protein

• Insufficient Iron… preferentially = hemoglobin formation… little for T3 metabolism

• Insufficient Vitamin D… preferentially = calcium binding… little to activate all 900+ genes

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How do we get sick?

• Body adapts• Body compensates (exceed adaptable limits)


Compensation = adaptation + cost

• Exceed body’s limits …

PATHOLOGY!

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What “rules” are we breaking?

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“85% of all disease is lifestyle-related.”- NIH (National Institute of Health)

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“71 cents of each healthcare dollar is spent on treating conditions that are lifestyle-related and potentially reducible by behavioral changes.”

- Prof. Roger Seehafer, Purdue University

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Pick a disease … any disease!

Where do almost all disease processes begin?

• Nutritional Insufficiency• Lack of Proper Movement• Sleep Debt• Toxic Overload• Unmanaged Stress

SYMPTOMS

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Stress +

Toxicity

Nutrition+

Exercise+

Sleep 25

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9

8

7

6

5

4

3

2

1

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BURDEN

(stress +toxicity)

Internal Resistance!

(nutrition + exercise + sleep)

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DIET … Nutritional InsufficiencyEXERCISE … Too much/littleSLEEP … Sleep DebtTOXICITY … Toxic OverloadSTRESS … Unmanaged Stress

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• Pain

• Fatigue

• Mood Disorders


• Disease states

“You’re Sick and Fat!”• Start exercising!• Lose some weight!• Eat better!• Stop smoking!

“And, when diet and exercise isn’t enough …”

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• Pain

• Fatigue

• Mood Disorders


• Disease states

Nutritional Insufficiencies

Inappropriate Movement

Sleep Debt

Toxic Overload

Unmanaged Stress

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Health-Responsibility

• Knowledge = safe and effective• Personalized = individual needs• Accountability = on-going support• Monitoring = program adjustments

Guidance & Understanding

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SYMPTOMS SYMPTOMS SYMPTOMS SYMPTOMS

STRESS SLEEP DEBT

POOR DIET + DEHYDRATION

TOXICITY + DRUGS

POOR EXERCISE

ADRENAL SEX HORMONE THYROID IMMUNE

FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

What conditions do most of our patients HAVE or are

trying to PREVENT?

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

And, what ultimately CAUSED these conditions?

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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Evaluating and Addressing Our Patients’ Primary Health Challenges

• Nutritional Insufficiency• Lack of Proper Movement• Sleep Debt• Toxic Overload• Unmanaged Stress

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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Evaluating and Addressing Our Patients’ Underlying Health Challenges

– Gut health (dysbiosis, SIBO, …)– Adrenal imbalance– Thyroid imbalance– Sex Hormone imbalances– Blood Sugar dysregulation– Oxidative Stress– Methylation defects

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• What fundamentally affects expression of health?

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STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

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EVIDENCE?

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1. Nutritional Insufficiency

• Delayed healing and repair• Decreased capacity to detoxify• Increased oxidative stress• Methylation defects• Mood disorders• Sleep challenges

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2. Inadequate (improper) Movement

• Sarcopenia = loss of function = accelerated aging (Biomarkers: The 10 Keys to Prolonging Vitality by Evans; USDA Human Nutrition Research Center on Aging at Tufts University)

• Lymph stasis = immune function• Insulin resistance = dysglycemia• Venous stasis = decreased circulation =

increased toxic load• Appetite dysregulation

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3. Sleep “Debt”

“I’m a night person, and I do best going to bed at 2AM and getting up late in the morning.”

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“I know I only need 5 hours of sleep because as long as I get my 4 cups of coffee, I can go all day.”

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“I’ll catch up on my sleep after I’m dead.”

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Sleep “Debt”

Leptin + Ghrelin

• Increased hunger– refined carbs– poor quality fats

Spiegel K, et al Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004 Dec 7;141(11):846-50.

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Sleep “Debt”

• Insulin resistance = dysglycemia– 24-hr sleep deprivation decreased insulin

sensitivity

Gonzalez-Ortiz, et al Effects of sleep deprivation on insulin sensitivity and cortisol concentrations in healthy subjects. Diabetes Nutr Metab2000 Apr;13)2):80-3

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Sleep “Debt”

• Elevated cortisol = unmanaged stress– A night of sleep deprivation caused

cortisol levels to be significantly higher than at baseline

Voderholzer U, et al. Impact of sleep deprivation and subsequent recovery sleep on cortisol in unmedicated depressed patients. Am J Psychiatry. 2004 Aug;161(8):1404-10.

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Sleep “Debt”

• Systemic inflammation = immune issues

Vgontzas AN, et al. Circadian interleukin-6 secretion and quantity and depth of sleep J Clin Endocrinol Metab 1999;84:2603-7

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Sleep “Debt”

• Hypertension– Blood pressure and heart rate significantly

increased in the morning after a sleep-insufficient night.

Lusardi P, et al. Effects of insufficient sleep on blood pressure in hypertensive patients: a 24-h study. Am J Hypertens 1999 Jan;12(1 Pt 1):63-8.

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Sleep “Debt”

• Nutrient depletion– Magnesium– Iron

Kuhn E, Brodan V. Changes in the circadian rhythm of serum iron induced by a 5-day sleep deprivation. Eur J Appl Physiol Occup Physiol 1982;49(2):215-22

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Sleep “Debt”

• Increased hunger• Insulin resistance• Elevated cortisol• Systemic inflammation• Hypertension• Internal body clock disruption• Nutrient depletion

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4. Toxic Overload

• Depletes nutrient reserves = nutrient insufficiency

• Induces inflammation = infection, cancer, allergy, autoimmune

• Increases ROS = accelerated cell death

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MERCURY

Sources Biochemistry Clinical Symptoms

- Mining and

Chemical

Industries

- Fish/Shellfish

- Dental work and

medical treatment

(thimerosal)

-SH binding

-Oxidative stress

-Penetrates nerves and binds to cysteines on Ach receptors resulting in neurologic dysfunction.

-retrograde axonal transport

-Denervation of nerve fibers similar to the pathology of

MS, and Hg can leak into the BBB and reduce nerve conduction velocity and VEP

-CFS, FMS, joint pain

-metallic taste, changes in vision & hearing

-tremors, ataxia

-cognitive dysfunction, depression, irritability

-renal and GI disturbances

-weight loss

-increased susceptibility to infections

-peripheral neuropathy

-autoimmunity

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LEAD

Sources Biochemistry Clinical Symptoms

-Drinking water

-Dinnerware with

lead glazing

-Paint products

-Soil around older

homes painted

with lead based

paints are still

contaminated

with lead

-SH binding

-Alters calcium-mediated cellular processes

-Reduces nerve conduction velocity in peripheral nerves

-Interferes in the heme biosynthetic pathway leading to anemia

-Fatigue

-Encephalopathy with impaired concentration, short-term memory deficits, insomnia, anxiety, depression, irritability, decreased IQ

-Elevated BP, chronic renal failure, anemia

- Abd colic, peripheral nerve dysfunction, reproductive dysfunction

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• Brain ‘fog’• Confused• Irritable• Mood swings• Restlessness • Headaches• Chemical sensitivities• Joint Pain• Hives, rashes• Fluid retention• Feels ‘unwell’

• Immune dysfunction– Under/Overactive – Autoimmune

• Digestive disorders• Food sensitivities• Chronic fatigue• Frequent illness• Loss or exaggerated sense of

smell or taste• Weight gain• Sleep disturbances

Toxicity Symptoms

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Practical Approach to Clinical Detoxification:

– WHY, WHO, WHEN, HOW to Detoxify– Safe, Effective & Comfortable– Measuring Results– Patient Q&A– Post-Detox Considerations

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5. Unmanaged Stress

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Unmanaged Stress

Sympatheticotonia

Toxicity

Sleep Debt

Tired

Lack of Exercise

Disturbed sleep rhythms

Decreased digestive response

Incomplete digestion

Dysbiosis

Poor absorption nutrients

Nutrient Insufficiency

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Unmanaged Stress• Feel bad … need to feel better

Drawn to poor quality food Attracted to gluten/casein

Stressed

Feel better!

Dulls senses Morphine-like substances

Nutrient Insufficiency Immune Dysregulation68

Unmanaged Stress

HPA stimulation (adrenals)

Inflammation

Sex hormoneimbalance

DysglycemiaCortisol Imbalance

Fatigue / Weight Gain

Thyroid Imbalance

Pain

Anxiety / Depression

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Courtesy of: Robert Rakowski, DC70


What fundamentally affects expression of health?

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• How do we efficiently identify these key primary health challenges?

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• How do we efficiently identify these key primary health challenges?

• How do we begin reversing these detrimental health trends?

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Our Patients’ Primary Health Challenges:

• Nutritional Insufficiency• Inappropriate Movement• Sleep Debt• Toxic Overload• Unmanaged Stress

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1. Nutritional Insufficiency:Nutrient needs > Nutrient availability

• Nutrient-poor diet?• Inadequate digestion?• Poor absorption?• Increased nutrient demand?

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NUTRIENT-POOR DIET?

• Depleted Soil• Herbicides• Insecticides• Antibiotics• Hormones• Refined• Processed• Bleached

• Irradiated• Pasteurized• Homogenized• Chemically preserved• Artificially colored• Artificially flavored• Artificially sweetened• Genetically Modified

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Inadequate Digestion + Poor Nutrient Absorption + Increased Nutrient Demand:

Poor Food Quality

Absorption

Gut Health

Water Quality

Air Quality

Chronic Stress

EM Radiation

Hormonal Status

Aging

Genetic Influences

Sleep Debt

Diseases

Lifestyle Factors

Pharmaceuticals

Toxic exposure

Cultural/Ethnic

Pregnancy

Sedentary

Smoking

Disease states

Alcohol79

Nutritional Insufficiency:How? Why?

Poor Quality of food (organic?)chemicals; microwave; grilled; sugar

Low Plant : Animal ratioLow Raw : Cooked ratioMeal timing (skip meals; PM-eating)Macronutrient imbalance (type? quality?)

Trans-fats; soy protein; refined carbs

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Nutritional Insufficiency:EVALUATION

Medical/Health History:– Digestive/Absorption Challenges

• Symptoms– GERD– Constipation / Diarrhea– Bloating– Abdominal pain

• Low HCl– Age; muscle testing; pH-test– Methylation defect– Poor stress management

• Poor gut health– Dysbiosis questionnaire 81

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Medical/Health History:– Increased demand for nutrients

• Depletion from Meds (Rx; OTC)• Depletion from Detoxification • Unmanaged Stress• Supplements

– Too much or too little– Wrong ratio– Incorrect form

Examination: (appearance…) 82


Questionnaires:− Nutrient Poor Diet

Diet Report (3 or 7-day) ☺Very detailed = More commitment

Diet QuestionnaireLess detailed = Less commitment

Diet Checklist ☺General idea = Quick & easy

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– Vitamin C = Water-soluble antioxidant• Vit C reagent or test strip

– Vitamin E (CoQ10; lipoic acid) = Fat-soluble antioxidants• Oxidata (lipid peroxides)

– Calcium = Calcium; Vit D; (PTH; thyroid)• Sulkowitch reagent

– Alkaline minerals = Acid/alkaline balance• pH: 5.3-6.5

– Digestive enzymes = Gut health/SIBO• (Indican reagent)

In-office Urine Testing:

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– Potassium = fluid balance; nerve/muscle; (common def.) – Magnesium = 300+ enzymes; ATP; (common def.)– Zinc = immune function; Zn: Cu– Chromium = blood sugar regulation– Selenium = detox; antioxidant; (overdose)

– Copper = immunity; RBCs; (Cu:Zn; Cu:Mb) (overdose)– Manganese = bone; liver; kidney; (Mn-SOD)– Molybdenum = Purine metabolism (high uric acid);

growth; (Mb:Cu)

CAUTION: Overdosing mineral co-factors.

In-office 8 Mineral Tally (taste test):

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Nutritional Insufficiency:1. Nutrient Replenishment

Nutrient-rich Diet:Food “Traffic Light” Dietary chart ☺

Foundational Supplements: (potency/purity vs. OTC)Bioactive vitaminsChelated mineralsEPA/DHA (fish/krill oil)Antioxidant (“green” powder or blend)(Probiotic)

Replenish Deficiencies: (history/testing/extrapolated)Vit C; Vit E; Lipoic acid; CoQ10; (Vit D…) Sulforophane; Curcumin; EGCG; Resveretrol… 86

Nutritional Insufficiency:2. Digestive Support

Stress management:• Exercise• Restorative Sleep• Balance• Paced Breathing (meal-time)

Therapeutic Supplements: (4R = gut support)

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The 4R Program

• Remove– Allergens, Antigens, Pathogens, Parasites

• Replace– Acid and Enzymes

• Reinoculate– Symbiotic Flora (pre and probiotics)

• Repair– Gut Mucosal Integrity Nutrients

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Nutritional Insufficiency:2. Digestive Support

Therapeutic Supplements: (4R = gut support)• Remove: Berberine; Tannins; Uva Ursi; Oregano; etc.• Replace: HCl; Digestive Enzymes• Inoculate: Probiotics; Prebiotics; Fiber• Repair: Glutamine; Immunoglobulins; Zinc carnosine

Stress management:• Exercise• Restorative Sleep• Balance• Paced Breathing (meal-time)

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Nutritional Insufficiency:3. Decrease demand

Replace OTC (Rx) Therapeutic Support:• GERD: Zinc carnosine; aloe; ginger • Stomach Ulcers: Bismuth; Sulforophane• Pain: Boswellia (AKBA) ; Curcumin (absorption?) ;

White willow; Serropeptase/Nattokinase• Sleep Challenges: Magnolia; L-Theanine; Phos-

serine; Melatonin*• Mood Disorders: GABA; SAMe*; L-Theanine;

Taurine (inc. GABA)

• HTN: CoQ10; L-Arginine*; Nattokinase• Cholesterol/Lipids: Fish/Krill oils; Pantethine;

Policosanol; (Red Yeast Rice*; Niacin-TR*) 90

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2. Inadequate (Improper) Movement:

• Too little – sedentary• Too much – exceed limits of:

– Musculoskeletal system– Metabolic recovery

“Too much of a good thing is … great!”Marilyn Monroe

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Hitting the “Sweet-Spot”… when just enough is just enough.

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Inadequate (Improper) Movement:EVALUATION

Medical/health history:– Exercise habits (sedentary vs. marathoner)– Surgeries; trauma (exercise limitations)

Signs & Symptoms:– Weight/shape challenges– Accelerated aging

Examination:– Neuromusculoskeletal (muscle strength & length;

joint subluxations/restrictions; neurological deficits)– Waist measurement

Testing:– BIA (low BCM = low muscle mass)

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Inadequate (Improper) Movement:Guidance

Foundational support:Next-step exercise1. Low-intensity + flexibility training (post-exercise)2. Coordination + balance training (e.g., BOSU “ball”)3. High-intensity = weight/resistance & recovery training

Specific support:Treatment to alleviate injuries/imbalances• Chiropractic care• Therapeutic Aids

– Low-level Laser therapy– Ultrasound– Myofascial work, etc.

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3. Sleep “Debt”:Sleep needs > Sleep received

• Insufficient quantity• Poor quality, non-restorative sleep• Timing issues

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Sleep “Debt”:EVALUATION

Medical/health history:– Sleep latency (time to fall asleep) 10-15 mins.– Sleep maintenance (ability to stay asleep)– Sleep habits (bedtime; sleep aids)– Sleep apnea (use of CPAP device; dental appliance)

Symptoms:– Sleepy/fatigued (without stimulants)

Questionnaire:– Epworth Sleepiness Score

Testing:– HRV (Heart Rate Variability)– (Sleep Study) 96

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SLEEP DEBT

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NO SLEEP DEBT

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Sleep “Debt”:Guidance

Foundational support:– Exercise & Nutrient Sufficiency– More sleep (bed earlier; naps) = Quantity– Restorative sleep = Quality

• Lighting cues• Meal timing• Sleep environment• Evening Wind-Down Routine ☺

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Therapeutic Sleep Aids:– Sleep Latency (melatonin): Methylation;

Tryptophan / 5-HTP-CR*; Melatonin CR*

100


Tryptophan(iron)

5-OH-Tryptophan (5-HTP)

Serotoninmethylation (B6, B9, B12)

Melatonin101


Therapeutic Sleep Aids:– Sleep Latency: Methylation; Tryptophan /

5-HTP-CR*; Melatonin CR*− Sleep Maintenance: Magnolia; L-Theanine;

(5-HTP*; Melatonin CR*)− High PM Cortisol: Ashwaganda; Phos-

serine; Lactium; (L-Theanine; Magnolia)− Racing thoughts/anxiety: L-Theanine;

GABA (or b-phenyl-GABA) ; Inositol

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Case Study:

• 52 y.o. female• Goal: Lose weight (and feel better, too)• Findings:

– Nutrient deficiencies– Sleep ‘debt’– Inappropriate exercise– Excessive toxic burden– Unmanaged stress

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• Guidelines: 5 Fundamental Areas• 12 weeks later:

– Felt much better overall– No change in weight and shape– Successful in 4 of 5 areas

• Snoring husband:– Persistent issue with sleep ‘debt’

• Vacation:– No husband = Slept well

• Result:Loss 2 inches in waist + 4 lbs fat in 14 days

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4. Toxic Overload:Toxic load > Detox Systems

IN OUT

105

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Toxic Overload:Toxic load > Detox Systems

• Toxic Exposure = (IN)– External sources– Internal sources

• Competency of Detox Pathways = (OUT)– Liver/Gall bladder– Kidneys– Colon

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Medical/health history:– Air quality (indoor; outdoor)– Water quality (tap; well; purified)– Diet (fiber; chemicals; Ab’s; hormones; fish;

microwave)– Habits (smoking; EtOH)– Dental (amalgums; bridges; crowns)– Drugs (Rx; OTC; recreational)– Hobbies; workplace; travel– Personal care products (cosmetics; cleaners; soaps,

etc.)

Toxic Exposure: EXTERNAL Sources

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Medical/health history:– Gut health/dysbiosis = Exotoxins/Endotoxins– Inflammation/immune challenges = ROS/RNS

Symptoms:– Chronic complaints (pain…)– Abdominal/gut-related complaints– MSQ>60

Toxic Exposure: INTERNAL Sources

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Detoxification: COMPETENT PATHWAYS

Symptoms:• COLON: Constipation (gut complaints)• LIVER: Fatigue; chronic pain/inflammation; chemical

sensitivities (Phase 1 / 2 Imbalance = pathological detox.)• NEUROLOGICAL: Cognitive; mood; ADHD

(neurodegenerative conditions)• THYROID: Fatigue; weight; etc. (hyper/hypo)• (multiple diagnoses)

Examination:• Tenderness:

– RLQ (ICV)– RUQ (Lvr/GB)– Epigastrium (GERD)– LLQ (Colon) 109

In-office testing:• BIA (high ECW; low Phase Angle)

Toxic Overload:EVALUATION

110

Bio-Impedance Analysis (BIA):ICW/ECW = Toxicity

“Toxins can increase the level of osmoticallyactive substances and therefore cause an increase in the ECW.”

(Niebauer, J, Volk H-D, Kemp M, Dominguez M, et al. “Endotoxin and immune

activation in chronic heart failure: Lancet. 1999; 353:1838-1842)

111

38

In-office testing:• BIA (high ECW; low Phase Angle)• VCS (Visual Contrast Sensitivity =

biotoxins)


112

Visual Contrast Sensitivity (VCS)

113

In-office testing:• BIA (low ICW; low Phase Angle)• VCS (Visual Contrast Sensitivity =

biotoxins)• Urine (bilirubin; urobilinogen; indican)


Blood: (ALT; AST; GGT; LDH; bilirubin…)

Special: (Stool analysis; Toxic Metal Challenge test; Porphyrins; Organophosphates; Phthalates; Parabens; Volatile Solvents; BPA; Chlorinated Pesticides, etc.)

114

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Toxic Overload:Guidance

Address the Fundamentals:Dietary Habits (food quality; meal timing)

Nutrition (micro/macronutrient balance)

Exercise (appropriate movement)

Restorative Sleep (make up “sleep debt”)

Stress Management (+ drug use, alcohol)

115


STRESS SLEEP DEBT


TOXICITY + DRUGS

POOR EXERCISE


FUNCTIONBLOOD SUGAR

OSTEO-POROSIS

HEART ATTACKS

ALZHEIMERS OBESITY

CANCER DIABETES

AUTO-IMMUNE

INFECTION

ALLERGIES

DYSBIOSIS LEAKY GUT

FOODALLERGIES

CHRONICINFLAMMATION

OXIDATIVE

STRESSLOW

OXYGEN

ANSIMBALANCE

LOW HCl

NUTRIENTDEPLETION

METHYLDEFECT

EXCESS TOXICITY

OVER ACID

POOR LYMPH

116

Toxic Overload:Guidance

Foundational support:– Avoid sources toxic exposure

• Substitute non-toxic alternatives– General detox support

• Gut health support (4R, e.g., pre- and probiotics, etc.)• 14, 21, 28-day Detox Program (“passive” detox)

Specific support:– Liver: Silymarin; NAC; Lipoic Acid– Gall bladder: Inositol; choline (PC); dandelion; guggul; blk radish– Methylation/GSH: NAC; B2/B6/B12/folic acid; TMG; SAMe*– Hormone detox: DIM; Ca-D-glucurate; curcumin; sulforophane– Heavy metals: DMPS*; DMSA*; EDTA*; chlorella*

Nutrition 358: 3-hrs on Detoxification 117

40

Unmanaged Stress:Stressors > Stress Resiliency

2 Choices:• Lower Stress• Improve Stress Resiliency

118

EVENT + STATE = RESPONSE

RESPONSEEVENT + STATE =

Event

Response

STATE = Thoughts+ Habits

119

Unmanaged Stress:EVALUATION

Medical/health history:– Top 5 things burdening your heart?– Balance of:

• Work-Recreation• Exercise-Rest

Examination:– B/P

• Hypertension (“alarm” stage)• Hypotension (“exhaustive” stage)• Postural response

– Resting Pulse; paradoxical pupil; hyperactive achilles DTR; weak sartorius 120

41


In-office:– HRV (Heart Rate Variability)

Testing:Evaluate Demonstrate Monitor

121

STRESS

122

STRESS

123

42


In-office:– HRV (Heart Rate Variability)– BIA (Bio-Impedence Analysis) - sarcopenia


124

Bio-Impedance Analysis (BIA):BCM = Muscle Mass

“There may be no single feature of age-related decline more striking than the decline in lean body mass in affecting ambulation, mobility, energy intake, overall nutrient intake and status, independence and breathing.”

Journal of Nutrition 127:990S-991S (1997)

125


In-office:– HRV (Heart Rate Variability)– BIA (Bio-Impedence Analysis) - sarcopenia

Send-out:– Hormones (Cortisol-ASI rhythm; DHEA)


126

43

Salivary Hormone Test:Adrenal Stress Index (ASI)

127


In-office:– HRV (Heart Rate Variability)– BIA (Bio-Impedence Analysis)

Send-out:– Hormones (Cortisol-ASI rhythm; DHEA)

– Blood (high stress = cortisol steal = low aldosterone = low Na+high K)– Organic Acids (also in NutrEval; ION)

– catabolic vs. anabolic


128

MANAGING ONE’S “STATE”– BALANCE:

• Work-Play (contribution/re-creation)• Move-Rest (exercise/sleep)

– Stress “Tool Kit”– Fulfillment (career; home) – Nourishment needs

Unmanaged Stress:Guidance

129

44


Foundational support:– Remove stressors (relationship; career; environment)– Improve stress response

• Address nourishment, sleep, exercise, toxicity• Do more of what you love to do• Life Schedule ☺= Balance of giving/receiving • Paced breathing• Music; Laughter; Animals• Meditation; Yoga

– Counseling

130


Specific Support:– Therapeutic Stress Aids:

• General: B5/B6; Rhodiola; Cordyceps; Ginseng

• Hyper/alarm: Ashwaganda; Magnolia; L-Theanine

• Hypo/exhaustion: Adrenal glandular; Licorice; Cortisol

131

BIG PICTURE

132

45

133

134

Life is like playing a violin in public and learning the instrument as one goes on.

Samuel Butler

135

46

In-Office Testing:

• Bio-Impedence Analysis (BIA)

• Heart Rate Variability (HRV)

• Visual Contrast Sensitivity (VCS)

• Urinalysis

• 8 Mineral Tally

• Painless• Harmless• Efficient

136

Bio-Impedance Analysis (BIA)(measuring Resistance and Reactance)

137

Bio-Impedance Analysis (BIA)BCM = Muscle Mass

“There may be no single feature of age-related decline more striking than the decline in lean body mass in affecting ambulation, mobility, energy intake, overall nutrient intake and status, independence and breathing.”

Journal of Nutrition 127:990S-991S (1997)

138

47

Bio-Impedance Analysis (BIA):ICW/ECW = Toxicity

“Toxins can increase the level of osmoticallyactive substances and therefore cause an increase in the ECW.”

(Niebauer, J, Volk H-D, Kemp M, Dominguez M, et al. “Endotoxin and immune

activation in chronic heart failure: Lancet. 1999; 353:1838-1842)

139

Bio-Impedance Analysis (BIA):PHASE ANGLE

“A reduction in Phase Angle, when measured serially in a patient, has been associated with states of chronic or acute illness.”

Jeffrey Bland, Ph.D.The Clinical Relevance of Bio-Impedance Analysis (BIA)

140

Bio-Impedence Analysis (BIA)

BCM (body cell/muscle mass) – stress

ICW/ECW (fluid distribution) – toxicity

Capacitance– cell membrane health

Phase Angle– overall biomarker

141

48

Bio-Impedence Analysis (BIA)

Visualizing and Monitoring:Unmanaged StressToxic BurdenBody CompositionVitality

142

143

Heart Rate Variability (HRV)

Visualizing & MonitoringUNMANAGED STRESS

and SLEEP DEBT

144

49

1st

2nd

HOW?

3rd

145

3 regions of Power Spectrum

© Copyright 1996 Institute of HeartMath146


© Copyright 1996 Institute of HeartMath

STRESS

147

50



HEALTHY

148



SLEEP DEBT

149

STRESS

SLEEP DEBT

HEALTHY

150

51

STRESS SLEEP DEBT

HEALTHY151


Theory:• Biotoxins induce inflammation• Elevates inflammatory cytokines (e.g., TNF-a)• Promotes hypercoagulation • Reduces blood flow in retinal capillaries• Impairs contrast sensitivity

152


153

52


154


155

156

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Medical & Health HistorySymptomsExaminationTesting:

In-office (cost effective)Send-out (more costly)

Evaluate Primary Challenges:

157


In-office Testing:– BIA (BioImpedence Analysis)

• Toxicity clues & Unmanaged stress clues– HRV (Heart Rate Variability)

• Unmanaged stress and Sleep ‘debt’ clues– VCS (Visual Contrast Sensitivity)

• Toxicity clues– Urinalysis & 8-Mineral Tally

• Nutrient & Toxicity clues– (EDS) (e.g., Zyto - Elite 5.0)

5-10 mins. each test (45 mins. for all)(Clinical Assistant) 158

Send-out Testing: (as indicated)– Hormones

» salivary; urine-metabolites– Iodine; Toxic metals

» urine challenge tests– Oxidative stress profiles

» urine; blood– Gut/digestive health

» stool analysis– Nutrient sufficiency/balance

» fatty acids; amino acids; organic acids– Genomic/genetic studies


159

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LifestyleNutrient-rich foodProper, regular exerciseMore restorative sleepMinimize toxic exposureStress management

Addressing Primary Challenges:

NutriceuticalsFoundationalReplenishmentTherapeutic

TreatmentBody-work (chiropractic care; massage;

cranio-sacral; myofascial; acupuncture…)Therapeutic Aids (low-level Laser)Medication / Surgery 160

• Valuable Service• Profitable business• Personal fulfillment• Do it with ease

Successful Practice:

Efficiently gather the “CLUES”

161

Practicing with Ease:

• Big Picture: Focus on what helps most of the people most of the time

• Simplicity: Begin with the obvious clues• Compliance: Choose the easier steps first• Reality: Learn … Live … Heal• Expectations: As in life, healing isn’t linear• Inspiration: “Be the change you wish to see in the

world.” (Ghandi)

162

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We make a living by what we get, we make a life by what we give.

Sir Winston Churchill

163


Thank you.

164

Resources:Heart Rate Variability (HRV)

• www.HeartMath.com (www.heartmath.org)BioImpedence Analysis (BIA)

• www.RJLsystems.comUrine testing

• www.NaturalHealthyConcepts.com– VitaChek-C-50 test strip (Vit C)

• www.ApexEnergetics.com– Oxidata reagent (lipid peroxidation = fat soluble antioxidants) – (Vit C reagent)

• www.FisherSci.com– Sulkowitch reagent (calcium)– pH paper (acid/alkaline balance)

8-Mineral Tally test• www.BodyBio.com/storeproduct402.aspx

Epworth Sleepiness Score• www.epworthsleepinessscale.com/

Visual Contrast Sensitivity (VCS) = ? 165

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Ready-to-go “Hand-outs”:“Evaluating and Guiding Your Patient’s Lifestyle Habits ”

(available at ChiroCredit.com online store)

– Food “Traffic-Light” Dietary Chart• Green-light = nutrient-rich, hypoallergenic food• Yellow-light = potentially hypoallergenic food• Red-light = poor quality “food”

– (2) Diet Checklists: (Complete & Limited versions)• 1-page, quick-glance of patient’s current diet

– 7-day Diet-Activity Report• Detailed assessment of dietary, exercise, sleep

– Evening Wind-down Routine• Restorative sleep guidelines

– Life Schedule Chart• Supports establishment of new healthy habits

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