Transcript Slide 1

Mentoring the Mentor
Stuart White, DC, DACBN
713/522-6336
[email protected]
www.wholehealthassoc.com
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www.doctorofthefuture.org
Mentor goals:
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To declare what is possible and establish a
commitment to that possibility
Address personal and professional barriers
limiting the ability to serve
Evolution of vision/mission/ethics that drive
success
Create immediate action steps to apply
learning and growth
Construct the round table of applied
trophologists
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Mentoring the mentor:
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Who are the mentors? – Practitioners
Who are we mentoring? – Patients and
GAP
What’s the purpose? – Optimized life
How does it work? – Whatever you
learn you teach someone else (anyone
else)
Who’s is included? – Self selection, you
pick yourself
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Mentoring the mentor:
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Each participant attends monthly teleconferences
(1 hour in duration, 4th Thursday of every 2nd
month) creating a round table
discussion/exploration of the dynamics and details
of a nutrition-based holistic practice
Each participant chooses how to convey the notes
and information to their world and community – no
information squandering
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Review - Distinguish yourself
• It is more apparent why people are choosing alternative
health care professionals who specialize in a functional
approach
• No matter you specialty or technique you must distinguish
yourself as an expert – people are just seeking to
understand and they need you to do so
• Typically in the healthcare industry people are receiving
shallow answers that leave them puzzled with the mystery
of “Why is this happening to me?” and “ What can I do
about it?”
• Trends research over 10 years ago identified a number of
factors essential to being successful in the nutritional field –
one of those was establishing yourself as an expert
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Review - Explanation as hope
• The practitioner’s ability to explain health issues and therapeutic outcomes
creates an inflation of understanding in the patient which feels like hope
• Today in the professional world there is so much avoidance of ‘giving false
hope’ that often we end up offering little hope at all
• I propose another model that bolsters hope and expectation and subsequently
practices accountability as to whether the therapeutic endeavors are achieved or
not
• As long as the hope that has been instilled is revisited and acknowledged as
being accomplished or not the betrayal of false hope can be avoided
• So as an example, if a practitioner was describing the potential for nutritional
intervention through supplements and diet modification to improve the lipid
profile, then s/he would need to revisit to success or failure of the experiment
within a reasonable period of time
• Our community is starving for legitimate hope, as a starting place, as
empowerment to begin, as an idea to act upon
• There is genius in hope
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Mentor Considerations
Basic Digestion concepts as a primary health issue
Practice architecture considerations
Seven Pillars
Unified Mechanisms
of Health
Promoting Physiology
7 Pillars of Healing
7 Unified Mechanisms of Health
Endocrine/Hormonal
Glycemic Management
pH Bioterrain
Immuno-Inflammatory
Circulatory Status
Digestive Potency
Cellular Vitality
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Endocrine
Hormonal
Cellular
Vitality
Glycemic
Management
Normal
Miracle
Digestive
Potency
Circulatory
Status
pH
Bioterrain
Minerals
Immune
Inflammatory
Tradition & Science
 The wholistic model includes both whole foods and
whole herbs – which is exactly why SP and MediHerb fit
together so well inside the modern day clinical setting
 Whole Foods – Fuel
 Whole Herbs – Activation
 The SAD is missing both and the food substrates and
soils are depleted resulting in pandemic deficiencies
 Science is using folk medicine and remedies to find its
way back to proving and understanding health
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How we developed
 Indeed when you consider that all life evolved by
including lower forms of life and integrating them into
higher forms it becomes apparent why we are so
programmed to understand and respond to whole food
and whole herbs
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Digestion and Dysbiosis
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The Five Tastes
All regions of the
tongue can detect
the 5 basic tastes
Bitter
Salty
Sweet
Umami
Sour
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Bitter Taste Receptors
 Bitter taste receptors: TAS2R
 TAS2Rs are distinct from taste
receptor cells mediating responses
to other taste qualities
 Cells with TAS2R are wired to elicit
aversive behaviour
Meyerhof W, 2005, Elucidation of mammalian bitter taste. Rev
Physiol Biochem Pharmacol. 2005;154:37-72.
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Mennella JA, Spector AC, Reed DR, Coldwell SE, The bad taste of medicines:
overview of basic research on bitter taste. Clin Ther. 2013 Aug;35(8):1225-46.
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The Upper GIT
is a Tasting Organ!
Valussi M. Functional foods with
digestion-enhancing properties.
Int J Food Sci Nutr 2012;
63 (Suppl 1): 82-89
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Bitter Herbs - Bitter Receptors
 Amarogentin from Gentian:
TAS2R1, 4, 39, 43, 46, 47 and 50
 Absinthin from Wormwood :
TAS2R10, 14, 46 and 47
 Hop bitter acids (humulones):
TAS2R1, 14 and 40
 Parthenolide from Feverfew:
TAS2R1, 3, 8, 10, 14, 44 and 46
 Bitter isothiocyanates from Brassicas:
TAS2R38
Meyerhof W, Batram C, Kuhn C et al. Chem Senses 2010; 35(2): 157-170
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Bitters Help Regulate
Metabolic Function
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Alcohol dependency1
Adiposity (TAS2R38)2
Eating behaviour disinhibition3
Body-mass index4
Colon cancer risk5
Altered glucose and insulin
homeostasis (TAS2R9)6
 Insulin resistance7
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References from previous slide
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2
3
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Wang JC et al. Alcohol Clin Exp Res 2007; 31(2): 209-215
Tepper BJ et al. Obesity (Silver Spring) 2008; 16(10): 2289-2295
Dotson CD, Shaw HL, Mitchell BD et al. Appetite 2010; 54(1): 93-99
Feeney E, O'Brien S, Scannell A et al. Proc Nutr Soc 2011; 70(1): 135-143
Carrai M, Steinke V, Vodicka P et al. PLoS One 2011; 6(6): e20464
Dotson CD, Zhang L, Xu H et al. PLoS One 2008; 3(12): e3974
Obara K, Mizutani M, Hitomi Y et al. Clin Nutr 2009; 28(3): 278-284
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MediHerb and SP Bitters
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Digest, 3 to 4 tablets per day
Wormwood Complex, 3 to 4 tablets per day
Golden Seal, 2 to 3 tablets per day
Livton, 3 to 4 tablets per day
 Cruciferous Complete, 3 to 6 capsules per day
 SP Green Food, 3 to 6 capsules per day
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MediHerb Liquid Bitters
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Digest Phytosynergist liquid, 5 mL 3 times daily
Wormwood 1:5
Golden Seal 1:3
Globe Artichoke 1:2
Dandelion Root 1:2
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DiGest
Dandelion root 4:1 extract
from Taraxacum officinale root 500 mg
125 mg
Chen Pi fruit peel 5:1 extract
from Citrus reticulata fruit peel 500 mg
100 mg
Milk Thistle fruit 70:1 extract
30 mg
from Silybum marianum fruit 2.1 g
Containing flavanolignans calc. as silybin 24 mg
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DiGest
Ginger rhizome 5:1 extract
from Zingiber officinale rhizome 100 mg
20 mg
Gentian root 5:1 extract
from Gentiana lutea root 100 mg
20 mg
Chen Pi (Citrus reticulata) fruit peel oil
12.5 mg
Chamomile (Matricaria recutita) flower ess oil
5 mg
Dose: 1 tablet 15 to 30 minutes before each meal
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Digest: Indications
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Sluggish digestion
Poor appetite
Dyspepsia
Flatulence
Constipation
Inflammation of the digestive tract
Cholecystitis, gallstones
To improve tone of the digestive tract
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“Failing the Acid Test”
 Alarming concerns over the long-term safety and
appropriate use of the most common PPIs
“The benefits do not justify the risks for
many users1”
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Katz MH. Failing the acid test: benefits of proton pump inhibitors may not
justify the risks for many users. Arch Intern Med 2010; 170(9): 747-748
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The Gastric Acid Barrier
 A 2012 Meta-Analysis examined the relationship
between proton-pump inhibitors and Clostridium difficile
infection in elderly patients1
 Risk is increased (1.74 times) by concomitant use of
antibiotics
 42 studies and 313,000 participants
1
Kwok CS, etal, Risk of Clostridium difficile Infection With Acid Suppressing
Drugs and Antibiotics: Meta-Analysis. Am J Gastroenterol. 2012 Apr 24. doi:
10.1038/ajg.2012.108. [Epub ahead of print]
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Incretins
 Incretins are gut derived hormones that
stimulate insulin secretion from β cells after
eating
 Regulate glucose homoeostasis, gut
motility, appetite and adiposity
Diakogiannaki E, Gribble FM, Reimann F. Nutrient detection by incretin hormone secreting cells.
Physiol Behav 2012; 106(3): 387–393
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GIP
• Glucose-dependent
insulinotropic polypeptide
GLP-1
• Glucagon-like peptide-1
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Incretins
 GIP is secreted from enteroendocrine K cells mostly
located in the duodenum and upper jejunum1
 GLP-1 is secreted from enteroendocrine L cells found
along the length of the intestinal tract, from duodenum
to colon2
1
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Diakogiannaki E, Gribble FM, Reimann F. Nutrient detection by incretin hormone secreting cells.
Physiol Behav 2012; 106(3): 387–393
Jang HJ, Kokrashvili Z, Theodorakis MJ et al. Gut-expressed gustducin and taste receptors regulate
secretion of glucagon-like peptide-1. PNAS 2007; 104 (38): 15069–15074
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Incretins
 Effect of GIP and GLP-1 combined, accounts for up to 60
% of the insulin secreted after a meal in healthy humans
 Play a crucial role in postprandial glucose homoeostasis
 Patients with long-standing T2DM and poor glycemic
control have deficient GLP-1 secretion
Chia CW, and Egan JM. Role and development of GLP-1 receptor agonists in the management of
diabetes. Diabetes Metab Syndr Obes 2009; 2: 37
GLP-1
 Increases insulin secretion from beta cells
 Suppresses glucagon secretion from alpha cells in the
presence of hyperglycaemia but not hypoglycaemia
 Delays gastric emptying and gut motility which in turns
delays absorption of ingested nutrients and dampens
postprandial glucose uptake
 Increases the duration of postprandial satiety therefore
suppressing appetite and decreasing food intake which
eventually leads to weight loss
Chia CW, and Egan JM. Role and development of GLP-1 receptor agonists in the
management of diabetes. Diabetes Metab Syndr Obes 2009; 2: 37
GLP-1 demonstrates significant trophic
effects (in-vivo)
 Increases islet size
 Regulates islet growth
 Enhances β cell proliferation
 Inhibits β cell apoptosis
Chia CW, and Egan JM. Role and development of GLP-1 receptor agonists in the management of
diabetes. Diabetes Metab Syndr Obes 2009; 2: 37
Grieve DJ, Cassidy RS, Green BD. Emerging cardiovascular actions of the incretin
hormone glucagon-like peptide-1: potential therapeutic benefits beyond
glycemic control? Br J Pharmacol 2009;157(8):1340-1351
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Metabolic Disease and Dysbiosis
L cell viability and GLP-1 production is
negatively affected by dysbiosis
Cani PD et al. Pathol Biol 2008; 56(5): 305-309
Cani PD et al. Pathol Biol 2008; 56(5): 305-309
Cani PD, etal, Pathol Biol. 2008 Jul;56(5):305-9. Epub 2008 Jan 30
Cani PD, etal, Pathol Biol. 2008 Jul;56(5):305-9
GLP-1
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Reference for Previous Slide
Cani PD, Osto M, Geurts L, Everard A, Involvement of gut
microbiota in the development of low-grade
inflammation and type 2 diabetes associated with
obesity. Gut Microbes. 2012 Jul-Aug;3(4):279-88.
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Akkermansia muciniphila
 A. muciniphila is a mucin degrading bacteria
 The dominant bacterium that resides in the mucus layer
of the gut (3 to 5% of the gut microbiota)
 Abundance inversely correlates with body weight and
T2D
 Prebiotics (inulin) increase A. muciniphila by ~100 fold
 Higher L cell activity and increased antimicrobial
peptides
Everard A, Belzer C, Geurts L, Cross-talk between Akkermansia muciniphila and intestinal
epithelium controls diet-induced obesity. Proc Natl Acad Sci U S A. 2013 May 28;110(22):9066-71
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Prebiotics
“Non-digestible food ingredients that
confer health benefits to the host by
selective stimulation of growth and/or
activity of beneficial bacteria in the gut
microbiota”
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Prebiotics
 Non-digestible carbohydrates
glucans, galactans, resistant starch, pectins,
hemicellulose, arabinoxylans
 Inulin-type fructans
 Galacto-oligosaccharides
Non conventional prebiotics
 Plant phenolic compounds from herbs, fruit, vegetables,
chocolate, nuts, green tea, coffee, red wine, peanuts
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Dysbiosis Protocol
• 1 capsule BID all week
or
• 3 capsules BID Sat and Sun only
Gut Flora
Complex
Pre-Biotic
Inulin
• ½ to 1 teaspoon twice per day
or
• WholeFood Fibre or Gastro Fibre
Vitanox
• 2-3 tablets per day, if required
ProSynbiotic
• 3 capsules per day, if required
Gut Flora Complex
Anise (Pimpinella anisum) fruit ess. oil
125 mg
Oregano (Origanum vulgare) leaf ess. oil
75 mg
Andrographis herb 10:1 extract
from Andrographis paniculata herb 1.0 g
Containing andrographolide 10 mg
100 mg
Phellodendron stem bark 20:1 extract
from Phellodendron amurense stem bark 1.6 g
Containing berberine 36 mg
Suggested Dosage: 2-6 capsules per day
80 mg
Phellodendron and Berberine
 The Chinese herb Phellodendron amurense is a rich
source of berberine
 Berberine has a broad antimicrobial activity against
bacteria, fungi and protozoa at concentrations of 10 to
25 mcg/mL (or mg/L)
 Berberine exhibits poor absorption from the gut. Hence
the majority of any administered dose will remain in the
gut, having an effect on these organisms1
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Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill
Livingstone, Edinburgh, 2000, pp 286-296 .
Phellodendron and Berberine
• Gut Flora Complex delivers a dose of 36mg of berberine
per capsule
• Assuming 10% absorption and dilution in 1 litre of
intestinal fluid the following gut lumen concentrations
could be expected
Gut Flora
Complex
1 capsule
Total
Berberine
36 mg
Berberine
Gut Conc.
32 mg/L
2 capsule
3 capsule
72 mg
108 mg
65 mg/L
97 mg/L
Berberine’s Activity is Selective
IC50 values of berberine 1
 75 mcg/mL for Bacillus shigae
 101 mcg/mL for E. coli
 806 mcg/mL for Bifidobacterium adolescentis1
1. Yan D, Wei L, Xiao XH et al. Microcalorimetric investigation of
effect of berberine alkaloids from Coptis chinensis Franch on
intestinal diagnostic flora growth Chin Sci Bull 2009; 54(3): 369373
Dysbiosis Protocol
• 1 capsule BID all week
or
• 3 capsules BID Sat and Sun only
Gut Flora
Complex
Pre-Biotic
Inulin
• ½ to 1 teaspoon twice per day
or
• WholeFood Fibre or Gastro Fibre
Vitanox
• 2-3 tablets per day, if required
ProSynbiotic
• 3 capsules per day, if required
Practice Architecture
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Principles at work
• Sufficient
clinical observation allows mechanisms to be
revealed that will remove the idiopathic mystery of
hypertension and return it to a simple physiological
modulation and resultant augmentation in function, balance,
tissue fortification and promotes healthy genetic expression
• This allows the symptom resolution to occur as a result of
system ‘mosaic’ change, and then of course the downstream
events occur
• The longing in the public is for this sort of detective work to
find the cause and make the correction – increasingly food is
seen as medicine and people are asking more and more for
what foods will change their health patterns
54
Sequential Intervention
 By giving hope through discussion of therapeutic rationale and then
accountably determine if the therapy had efficacy it is possible to initiate
activity that may assist a person to make the changes that result in healing
 Sequential intervention and accountable follow-up can show what has
worked and what may still need to be employed
 Promote an understanding of intervention that creates evolutions in
individual physiology and show the effect of that intervention
 Allow every condition to become a strategic consideration of possible
etiology and therapeutic rationale – people are in search of experts – reveal
yourself
 The comprehensive nature of nutritional therapy means there is always more
physiology to optimize and support leaving an individual constantly refining
as long as they wish to further improve their status
 If the practitioner is accountable s/he will be allowed to experiment with
reasonable ideas
Formula for change:
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Always create formula for patient
each time to understand why the
gained weight and why they lost
weight
No criticism or sharing or pressure –
just pure formula showing itself to
the practitioner and patient
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Leaning In: Listening
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Active listening dispels judgment and shame
The ingredients of active listening are:
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Relatedness
Compassion
Hope
Open probe questions
Demonstrated understanding
Many patients will tear up when this occurs because they have literally
never had anyone listen to them before in this way
It is like listening to a young child tell of their experience – and of course
the young child is always present in all of us
Eventually the practitioner will discover and adopt a unique and specific
posture and approach to active listening and this will become
architecturally part of every consultation
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Accountability:
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The number one factor that permits the practitioner
to initiate nutrition therapy with the patient is
creating accountability to clinical response and
outcome
One of two responses, however worded, are:
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I’m not satisfied with these results
I’m pleased with these results
Every visit after the first must have either one or both of these statements
made
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Learning wisdom Anything can cause anything!
Anything can effect anything!
Everything relates to everything!
Principles at work
• Sufficient
clinical observation allows mechanisms to be
revealed that will remove the idiopathic mystery of
hypertension and return it to a simple physiological
modulation and resultant augmentation in function, balance,
tissue fortification and promotes healthy genetic expression
• This allows the symptom resolution to occur as a result of
system ‘mosaic’ change, and then of course the downstream
events occur
• The longing in the public is for this sort of detective work to
find the cause and make the correction – increasingly food is
seen as medicine and people are asking more and more for
what foods will change their health patterns
60
Sequential Intervention
 By giving hope through discussion of therapeutic rationale and then
accountably determine if the therapy had efficacy it is possible to initiate
activity that may assist a person to make the changes that result in healing
 Sequential intervention and accountable follow-up can show what has
worked and what may still need to be employed
 Promote an understanding of intervention that creates evolutions in
individual physiology and show the effect of that intervention
 See the concept of micro circulation dynamics as a unified mechanism of
disease and a source to health
 Allow every condition to become a strategic consideration of possible
etiology and therapeutic rationale – people are in search of experts – reveal
yourself
 The comprehensive nature of nutritional therapy means there is always more
physiology to optimize and support leaving an individual constantly refining
as long as they wish to further improve their status
 If the practitioner is accountable s/he will be allowed to experiment with
reasonable ideas
Change the world
It wants to
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