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Mentoring the MentorMentoring the Mentor

Stuart White, DC, DACBN713/522-6336stuartwhite@wholehealthassoc.comwww.wholehealthassoc.comwww.doctorofthefuture.org

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Mentor goals: 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: 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:

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

Mentor Considerations

Basic Digestion concepts as a primary health issue

Practice architecture considerations

Seven PillarsUnified Mechanisms

of Health

Promoting Physiology

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7 Pillars of Healing7 Unified Mechanisms of Health

Endocrine/Hormonal Glycemic Management pH Bioterrain Immuno-Inflammatory Circulatory Status Digestive Potency Cellular Vitality

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

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All regions of the tongue can detect the 5 basic tastes

Bitter         Salty         Sweet      Umami        Sour

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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The Upper GITis a Tasting Organ!

Valussi M. Functional foods with digestion-enhancing properties.Int J Food Sci Nutr 2012;63 (Suppl 1): 82-89 19

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:

TAS2R38Meyerhof W, Batram C, Kuhn C et al. Chem Senses 2010; 35(2): 157-170 20

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Bitters Help Regulate Metabolic Function

Alcohol dependency1 Adiposity (TAS2R38)2 Eating behaviour disinhibition3 Body-mass index4 Colon cancer risk5

Altered glucose and insulinhomeostasis (TAS2R9)6

Insulin resistance7

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References from previous slide1 Wang JC et al. Alcohol Clin Exp Res 2007; 31(2): 209-2152 Tepper BJ et al. Obesity (Silver Spring) 2008; 16(10): 2289-22953 Dotson CD, Shaw HL, Mitchell BD et al. Appetite 2010; 54(1): 93-994 Feeney E, O'Brien S, Scannell A et al. Proc Nutr Soc 2011; 70(1): 135-1435 Carrai M, Steinke V, Vodicka P et al. PLoS One 2011; 6(6): e204646 Dotson CD, Zhang L, Xu H et al. PLoS One 2008; 3(12): e39747 Obara K, Mizutani M, Hitomi Y et al. Clin Nutr 2009; 28(3): 278-284

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MediHerb and SP Bitters 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 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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DiGestDandelion root 4:1 extract 125 mgfrom Taraxacum officinale root 500 mg

Chen Pi fruit peel 5:1 extract 100 mgfrom Citrus reticulata fruit peel 500 mg

Milk Thistle fruit 70:1 extract 30 mgfrom Silybum marianum fruit 2.1 gContaining flavanolignans calc. as silybin 24 mg

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DiGestGinger rhizome 5:1 extract 20 mgfrom Zingiber officinale rhizome 100 mg

Gentian root 5:1 extract 20 mgfrom Gentiana lutea root 100 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

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”

1 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 31

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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 Diakogiannaki E, Gribble FM, Reimann F. Nutrient detection by incretin hormone secreting cells. Physiol Behav 2012; 106(3): 387–393

2 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 lossChia 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

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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

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GLP-1

Cani PD, etal, Pathol Biol. 2008 Jul;56(5):305-9

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Reference for Previous SlideCani 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

peptidesEverard 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

Gut Flora ComplexAnise (Pimpinella anisum) fruit ess. oil 125 mg

Oregano (Origanum vulgare) leaf ess. oil 75 mg

Andrographis herb 10:1 extract 100 mgfrom Andrographis paniculata herb 1.0 gContaining andrographolide 10 mg

Phellodendron stem bark 20:1 extract 80 mgfrom Phellodendron amurense stem bark 1.6 gContaining berberine 36 mg

Suggested Dosage: 2-6 capsules per day

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

1 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 FloraComplex

Total Berberine

BerberineGut Conc.

1 capsule 36 mg 32 mg/L

2 capsule 72 mg 65 mg/L3 capsule 108 mg 97 mg/L

Berberine’s Activity is SelectiveIC50 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): 369-373

Dysbiosis Protocol

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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

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

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Formula for change: 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 Active listening dispels judgment and shame The ingredients of active listening are:

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: 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: 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

Learning wisdom -

Anything can cause anything!

Anything can effect anything!

Everything relates to everything!

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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

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

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Change the world

It wants to

Change the world

It wants to