Update Issue 1 2019

UPDAT E I S S U E 1 • 2019

Syncing circadian rhythms Holistic support for pain and sleeplessness Being mindful of problematic eating behaviours

Shake It transformation

FI G H T I N G 21 S T CE N T URY FATI G U E by enhancing ancient healing pathways Effective marketing starts with consistency

• EXCITING NEW PRODUCTS AND RESOURCES • PRIVATE HEALTH INSURANCE NEWS •

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Contents Every issue

On the cover

10 FAQs

4 Fighting 21st century fatigue by enhancing healing pathways

Frequently asked questions of our Clinical Support Team

11 In the news In the wake of changes to private health insurance

11 Clinical resources

Motivate and educate patients with ‘Your Shake It Journey’ e-newsletters

12 Product developments

Exciting new products and resources

Do you know how to determine the cause of your patients’ fatigue and how to help them thrive in a modern world?

8 Holistic support for pain and sleeplessness

9 Shake It transformation

16 Syncing circadian rhythms

Why it’s all about the rhythm when setting up your patients for sleep success.

18 Being mindful of

problematic eating behaviours

How recognising and implementing behavioural change could be a key factor in assisting lasting weight management.

14 Effective marketing starts with consistency

How consistency in your marketing will help you to effectively send the right message to the right people.

Find us on Social Media

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SATURDAY 8 TH - MONDAY 10 TH JUNE | RACV ROYAL PINES RESORT, GOLD COAST

MODERN EPIDEMICS:

Practicing Tomorrow’s Medicine, Today In 2019, become one of a new wave of Practitioners aimed with the tools and knowledge to free your patients from new age chronic disease epidemics.

DR JEFFREY BLAND

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PROFESSOR SATCHIN PANDA

PROFESSOR AMANDA SALIS

NICOLE BIJLSMA

DR LEILA MASSON

TO REGISTER: Call 1800 777 648 (Australia) or 0508 227 744 (New Zealand) or visit metagenicscongress.com.au

DR JILL CARNAHAN

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DR ADRIAN LOPRESTI

Stay up to date with all the Congress news and events, join our Facebook Group or see the Congress website.

MetagenicsAU metagenicscongress.com.au 3

SEMINAR PREVIEW

Fighting 21st century fatigue by enhancing ancient healing pathways Do you know how to determine the cause of your patients’ fatigue and how to help them thrive in a modern world?

Written by NATHAN ROSE Technical Education Manager

Things ain’t what they used to be Experienced Practitioners often comment that managing fatigue and chronic illnesses today is more challenging than it has been previously.

Cases are seemingly more complex; patients are presenting with a host of symptoms with greater severity, and their fatigue can be resistant to usual interventions. New lines of research have uncovered novel drivers of fatigue, such as electromagnetic field radiation (EMF) and circadian disruption. Such factors add to the argument made by some that our bodies are experiencing a significant mismatch between our genes and the environment, and we need to return to a primal lifestyle which is better suited to our ancestral physiology. The question is: do patients have to shun modern living in order to regain their health? Perhaps more importantly: how do Practitioners best determine what is causing their patients fatigue, and provide an effective and realistic treatment plan?

Working with our innate healing ability Before attempting to determine the cause/s of a patient’s fatigue, it is worth recognising that the cells in the body have an innate universal ability to adapt to stressors, including ‘modern stressors.’ This is important because if you support the innate stress response, often patients can be on the road to recovery even before the cause/s have been identified and corrected. This has been dubbed the cell danger

response (CDR) by mitochondria researcher Dr Robert Naviaux, who has elegantly identified the cascade of generic cellular healing processes that act to restore cell function after injury by a stressor.1 Importantly, Naviaux argues that chronic conditions, such as fatigue, are often the result of an incomplete CDR healing cycle, instead of the constant presence of a biological stressor. In many cases, the aim of therapy is to support the progression through the CDR in order to overcome chronic disease.2

The canary in the coalmine A key player in orchestrating the CDR are mitochondria. A high energy state is a hallmark of cellular health, thus a decline in mitochondrial energy production is a warning sign that a cell is under stress, and a drop in electron flow in the mitochondria is the alarm signal which initiates the CDR.3 The first step of the CDR (CDR1) is to switch to innate immunity mode.4 Throughout evolution, microbial infection was a major threat to an organism, therefore CDR1 involves the mitochondria converting from an anti-inflammatory and high energy state, to a deliberate pro-inflammatory and high reactive oxygen species (ROS) profile, in an attempt to kill the pathogen.5 Additionally, the CDR1 program disrupts cell communication to neighbouring cells as a method of quarantine to a potentially infected cell.

If the cell is satisfied with the results of CDR1, which is thought to be assessed by a cellular checkpoint system, the healing cycle progresses to CDR2. The theme of CDR2 is

Stress, Injury

Affected Tissue and Organ Performance

Hormesis CDR3 CDR2

CDR1

Recovery CDR3 Illnesses* CDR2 Illnesses* CDR1 Illnesses*

Healing Cycle Time Figure 1: The Cell Danger Response (CDR) consists of three phases, which allows an organ to recover from a stressor and complete the healing process.7 CDR1 is characterised by a switch to innate immunity mode, CDR2 involves proliferation as part of the rebuilding phase and at CDR3 new cells are differentiated and recovery ensues.

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proliferation, as this is the organ rebuild phase after the microbial battle has ended. In this scenario, resources are spent on providing the building blocks, such as stem cells and genetic material. Again, once the cell has performed this role satisfactorily, the CDR program advances in the final stage of healing, CDR3: differentiation. In this mode, cellular energy and resources are used to differentiate the new cells into their specialised roles, and cellular communication is restored, completing the recovery of the organ (Figure 1).6

Stuck in a rut Evidence is mounting to support Naviaux’s view that many chronic diseases are due to a jam in any one of the CDR phases. That is, if the CDR is blocked at a checkpoint, then the innate immunity, proliferation or differentiation programs are left on. CDR 1, 2 and 3 are designed to be short-term phases, and beneficial to the host. However, if the cell is caught in any one of these modes, they become pathological (Figure 2).8 Recent metabolomics studies show that groups of patients with common chronic diseases have a metabolomic profile consistent with one of the CDR phases. For example, chronic fatigue syndrome (CFS) patients, despite potentially having any number of triggers, share a common metabolome that has the precise profile of a prolonged CDR3 state.9 Likewise, in a clinical trial, Naviaux has shown a single dose of a medication helped the cell advance out of CDR3, and significantly improved symptoms of autism in affected children.10

Laying the therapeutic foundations While research on therapeutic strategies to remove roadblocks in the CDR cycle are still evolving, there is enough evidence to take action. Numerous studies show employing foundational nutritional therapies in chronic disease can have a significant impact, suggesting that simply augmenting mitochondrial function can foster CDR healing.

For example, administering lipid replacement therapy (the use of supplements containing cell membrane phospholipids and antioxidants)

SEMINAR PREVIEW

Cell Danger Response

R3

CDR1

CD

As encouraging as this model is for managing chronic disease, there is still a strong case for identifying and removing the triggers of the CDR. If the patient’s physiology is stuck in a CDR mode for too long, this functional problem will eventually lead to structural changes in tissues and organs, which may make it more difficult to manage.23 Classic pathology, such as Koch’s postulate which proclaims one specific organism causes one distinct disease, has been a fitting model for diseases that ravaged humanity until recently. However, modern chronic diseases are seldom caused by a single causative agent and often there are numerous factors that

Chronic Fatigue Syndrome Fibromyalgia Chronic pain syndromes Generalized Anxiety Disorder Major depressive disorder Post-traumatic stress disorder Autism spectrum disorder Migraine headaches POTS Parkinson Alzheimer’s Autoimmunity Amyotrophic lateral sclerosis Osteoarthritis Irritable bowel syndrome

R2

Straws on a camel’s back

• • • • • • • • • • • • • • •

CD

to patients with Lyme disease and subsequent chronic fatigue resulted in a large reduction in fatigue scores.12 Thus, while the therapy did not remove the trigger (Borrelia ssp. infection), the lipid therapy is thought to aid mitochondrial structure and function, and help patients progress out of CDR1 (innate immunity phase).

In the CDR model, a key factor in preventing progress to the next healing step is elevated levels of extracellular ATP (eATP).13 The presence of ATP in the extracellular matrix is a signal of cell danger, as ATP should primarily live inside the cell. Therefore, in the presence of high eATP, the CDR cycle cannot progress. Interestingly, magnesium creates a complex with ATP inside the cell and is thought to help retain intracellular levels of ATP and diminish eATP. This property of magnesium, in addition to its ability to assist mitochondrial function, makes it an ideal candidate to assist the resolution of the CDR. Perhaps this is why magnesium has shown in clinical trials to benefit numerous chronic conditions including fatigue,14 fibromyalgia,15 depression,16 osteoporosis,17 and metabolic syndrome.18 Coenzyme Q10 is another key mitochondrial nutrient with a similar clinical track record to magnesium for treating chronic disease. This antioxidant has also shown benefit to patients with fatigue,19 fibromyalgia,20 migraine21 and cardiovascular disease22 and may act in part by aiding the progression of the CDR.

• Allergies, asthma, atopy • Chronic infections fungal, bacteria (e.g.

Lyme), viral, parasitic

• • • •

Metabolic syndrome Inflammatory bowel disease Benign prostatic hyperplasia Cancer and leukaemia

Naviaux RK et al. Proc Natl Acad Sci U S A. 2016 Sep 13;113(37):E5472-80. doi: 10.1073/pnas.1607571113.

Figure 2: Many chronic diseases are thought to be due to a jam in the CDR in mode 1, 2 or 3. This block in the checkpoint system prevents passage to the next step, and ultimately healing, and is linked to certain manifestations of disease.11

contribute to current epidemics. Like the straw that broke the camel’s back, modern diseases are a death by a thousand lashes, or more technically, they are due to allostatic overload.

Allostasis is the body’s attempt to remain stable in the face of constant environmental stressors.24 Acting like a buffer, an orchestra of hormones and mediators from systems and organs such as the thyroid, hypothalamic pituitary adrenal (HPA) axis, autonomic nervous system (ANS) and pancreas, are in constant flux to help the body maintain a stable internal milieu in the face of 21st century assaults.25 However, the constant attacks can take their toll and this cumulative allostatic (over)load can overpower the buffering capacity and

trigger the CDR. If allostatic overload continues this can cause frank mitochondrial structural pathology,26 as the camel’s back is broken.

The buffering organs and systems are also canaries in the coalmine, as they can feel the effects of allostatic overload and become dysfunctional. Thus, Practitioners may benefit from monitoring biomarkers from the thyroid, HPA axis, ANS and metabolism to get a sense of which systems are feeling the effects of allostasic overload. Practitioners can support these areas to improve buffering capacity which can help improve energy and wellbeing. Table 1 lists some potential signs and symptoms of allostatic overload in key regulatory systems.

Table 1: Screening for allostatic overload on regulatory systems.

Regulatory system

Indications of allostatic overload

Metabolic

Overweight, central obesity

Thyroid

Fatigue

HPA

Stress, anxiety, depression

Immune

Pain mast cell activation syndrome (MCAS) - Fatigue, multi-system, multi-symptom illness.

Consider testing biomarkers Lipids, fasting glucose, fasting insulin, HbA1C TSH, T3, T4, thyroid antibodies Mood and Stress Questionnaire (MSQ), Heart Rate Variability Hs-CRP, ESR, MCAS questionnaire, plasma histamine, urinary methyl histamine

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SEMINAR PREVIEW

Table 2: Screening for biological drivers of fatigue.

Stressor Malnutrition Gastrointestinal pathogen Infection Environmental toxins Biotoxins

Possible symptoms Fatigue, pain, poor immunity, cramps Gastrointestinal symptoms, brain fog, depression, anxiety Fatigue, pain, flu-like symptoms Fatigue, infertility, metabolic syndrome Multi-system, multi-symptom illness

EMF radiation

Headache, insomnia, fatigue

Circadian disruption

Insomnia, metabolic syndrome

Screening tests to consider Iron studies, 25(OH) vitamin D, serum zinc and magnesium PCR parasitology, SIBO breath testing, H. pylori antibodies Serum antibodies, PCR testing Metagenics Detoxification Questionnaire Metagenics CIRS and Biotoxin Questionnaire, visual contrast sensitivity (VCS), HLA Therapeutic trial of avoidance, e.g. turn off Wi-Fi routers in the evening, ensure bed head is not sharing a wall with the Smart Metre/power box or fridges.* Conduct circadian hygiene review* *Handout available on the Metagenics website.

Figuring out fatigue

days to monitor symptoms, especially if there is be challenging to manage. They are often With the CDR healing cycle supported suspicion of biotoxin exposure. Pitch a tent and driven by multiple stressors and recent with foundational nutrients and the patient’s camp in the backyard for the weekend! research shows that fatigue is a systemic particular flagging regulatory systems also • Shotgun before silver bullet: Do a disorder, not simply caused by a tired brain supported to reduce the effects of allostatic therapeutic trial of a general gut detoxification or ‘exhausted’ adrenals. Instead, fatigue load, it is time to identify the key biological before attempting to treat a suspected specific can be seen as a consequence of allostatic stressors in a fatigued patient. In these infection. Improving the microbiome can assist overload where multiple regulatory systems modern times both ancient (e.g. infection) with immunity, detoxification and inflammation are buckling under the relentless biological and contemporary stressors (e.g. EMF) may and may be enough for the regulatory systems stress of contemporary living. Rather than be affecting your patients, making it even more and CDR to allow for healing. If this is not insisting all fatigued patients turn their back on challenging to identity the drivers. Practitioners successful then progress to more advanced the 21st century and retreat to a primal lifestyle can look for clinical ‘tip offs’ that a particular and specialised techniques such as CIRS for recovery, discerning which stressors need biological stressor may be contributing to protocols or targeting stealth infections. to be addressed, and supporting vulnerable the patient’s fatigue by screening for co The above strategies are of low to no cost regulatory systems, can result in patients morbidities accompanying fatigue. Additionally, and can be performed whilst gathering more experiencing relief from fatigue without there are some preliminary screening tools data and waiting on test results. sacrificing all of the benefits that modernity and pathology tests that can further help affords us. Finally, through recognising establishing a working diagnosis (Table 2).

Tackling the three tiers and harnessing the cells innate ability of fatigue Since, it is not uncommon for patients to to heal from insults (Figure 3), including have multiple stressors contributing to their Chronic modern diseases, such as fatigue, modern stressors, patients can thrive fatigue, some heuristic guidelines may are common clinical presentations which can in a modern world. help navigate the therapeutic course.

For example: • Start with Step 1 of the EXPOSOME REGULATORY NETWORK CELL DANGER RESPONSE Metagenics Fatigue Protocol: including Mental and Physical HEALT HPA AXIS H Energy Powder and Enhanced Bioavailability Coenzyme Q10 150 mg.

• Support with nutrition: Ensure the basics are covered; METABOLIC iron, vitamin B12 and vitamin D adequacy can go a long way in some fatigued patients.

• Go for easy wins: Encourage D ISE A SE the patient to establish a healthy MICROBIOME circadian pattern by eating THYROID and sleeping at evolutionary optimal times (see p. 16 for more information). Also do a simple IMMUNE EMF minimisation therapeutic trial by avoiding screen time an hour before bed, switching off the router overnight and avoiding electronic devices ALLOSTATIC LOAD within a metre of the bed.

• Take a break: Ask patients to take part in a digital detox Figure 3: Managing fatigue and chronic disease can be approached by employing three levels of intervention. The exposome (left) represents exogenous triggers and biological stressors. The middle layer represents the regulatory systems that attempt for the weekend. Also consider to buffer this allostatic load. If the allostatic load is too great this can trigger the CDR (right). A comprehensive approach to getting patients out of their fatigue includes facilitating the healing power of the CDR, supporting regulatory systems and identifying and minimising the home or work space for a few biological stressors.

Health

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THE INVISIBLE AGENTS OF CHRONIC ILLNESS CHRONIC INFLAMMATORY RESPONSE SYNDROME MULTIPLE CHEMICAL SENSITIVITY ELECTROMAGNETIC HYPERSENSITIVITY SYNDROME

WEBINAR: WEDNESDAY 10TH APRIL 2019

This webinar is an important environmental update with practical insights from environmental medicine, chronic inflammatory response syndrome (CIRS) management and detoxification strategies to improve resilience and vitality in all patients and provide new strategies for those with chronic intractable illness.

• • • • •

Receive screening tools to recognise environmental insults within complex presentations.

Differentiate the impact of electromagnetic hypersensitivity syndrome, multiple chemical sensitivity, and chronic inflammatory response syndrome.

Understanding testing options to differentiate CIRS from multiple chemical sensitivity.

Learn practical strategies to lessen the impact of electromagnetic fields (EMF).

Personalise prescriptions to maximise resilience in our ever-changing environment.

“If our genes load the gun, the environment pulls the trigger.”

JOANNE MCNEILL

BHSc(Nat)

Joanne is a qualified Naturopath with a passion for critically assessing modern health research and integrating it into traditional natural health principles. Joanne is committed to using a holistic approach to assist Practitioners and their clients to reach their full health potential. As the Metagenics Clinical Education Team Leader, Joanne is involved in producing quality, clinically relevant educational material for Natural Healthcare Practitioners.

Join JOANNE MCNEILL at the following time: 11:00 am 10:30 am 9:30 am 9:00 am 1:00 pm

QLD / NSW / ACT / VIC / TAS SA NT WA New Zealand

Duration: 1 hour (plus Q & A time)

Your investment: $35.00 inc. GST (AUS and NZ) Webinar notes and materials will be emailed to your nominated email address prior to the live webinar.

Available to view for 1 month!

Make sure you register prior to 10th April to access the recording.

TO REGISTER – LOOK OUT FOR THE EMAIL IN YOUR INBOX! 7

C ASE STUDY

Holistic support for pain and sleeplessness

A

62 year old female hairdresser presented to the Metagenics Research Clinic with severe joint pain associated with osteoarthritis. The patient’s primary complaint was pain in her hands, which had increased in severity over the past few months; coinciding with the return of menopausal flushing following cessation of hormone replacement therapy (HRT). At her initial consultation, she rated joint pain severity as 8/10 (Figure 1 baseline) and explained her joints would swell, resulting in reduced mobility in her hands. The Practitioner identified the increase in pain and hot flushes correlated with poor sleep quality; it was not uncommon for the patient to wake every hour for approximately 30 minutes. “I maybe get four to five hours (of sleep) a night if I’m lucky.”

The Practitioner recommended a protocol to reduce the patient’s level of pain, improve her sleep quality and reduce menopausal symptoms (Table 1). To further address her sleeping complaint, the Practitioner provided advice regarding sleep hygiene, including maintaining a bedtime routine, avoiding the use of electronic devices before bed and other measures to ensure the bedroom is conducive to sleep. To the delight of the patient and Practitioner alike, clinical improvements were observed over the five week treatment period , with a significant reduction in joint pain and increased range of movement in her hands (Figure 1). Sleep quality continued to improve each week, with significant marked improvements at week 3 (Figure 2). The patient was elated to regain restorative sleep patterns.

“I am feeling so much better!

I have not slept this well in over six months.”

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Table 1: Prescription based on presenting symptoms.

Prescription High Purity, Low Reflux, Concentrated Fish Oil

Therapeutic Goal EPA and DHA were provided to reduce osteoarthritic pain associated with joint degradation and inflammation.

Lavender oil has sedative effects, countering the excitatory effects of California Poppy and glutamate in neuronal membranes to promote deep, restful sleep.

Passion Flower for Sleep California poppy and Jamaica dogwood have sedative and analgesic benefits, which may assist where the pain is amplified with insomnia.

Vitamins B5, B6 & C for Stress & Adrenal Health

Since stress reduces the thermoneutral zone and subsequently causes hot flushes, nutritional cofactors including activated B vitamins were provided to support the hypothalamic-pituitary-adrenal (HPA) axis.

Oestrogen Lifting Herbs

Rehmannia Six, a traditional Chinese medicine (TCM) herbal combination, was included in the prescription to reduce night sweats, anxiety and insomnia. In a clinical trial involving menopausal women, Rehmannia Six significantly reduced hot flushes and sweating.1

Severity of Symptoms (10 being severe)

Tired of the pain

8

Pain

6

Difficulty with movement

4 2 0

Baseline

Week 2

Week 3

Week 4

Holistic support yields positive results

Figure 1: Reduction in pain and difficulty with movement from baseline to week 5.

The rapid improvement in pain and mobility may be attributed partly due to the anti-inflammatory, analgesic and hormone balancing aspects of the treatment; however it is important not to underplay the role of sleep in the success of this case study. Insomnia can independently contribute to the risk of inflammatory disorders, triggering the innate immune response and impacting genomic, cellular and systemic markers of inflammation; accordingly, ongoing sleep disturbance may contribute to hyperalagesia and impaired pain modulation.2

Therefore restoring sleep can provide significant clinical benefit in improving pain outcomes.

In this case, addressing the presenting complaints with a combination of targeted nutritional and herbal ingredients, as well as lifestyle recommendations, saw remarkable improvements in a relatively short period of time – demonstrating that initiating positive change in a patient’s health isn’t always a marathon, it can be a sprint.

Sleep Quality Score (10 being exceptional)

8 6

Week 5

Sleep Quality

4 2 0

BaselineWeek 2 Week 3 Week 4 Week 5

Figure 2: Improvement in sleep quality from baseline to week 5.

S H A K E I T T R A N S F O R M AT I O N

Do you have a patient who is succeeding on the Shake It Program?

Metagenics has launched the Shake It Transformation Competition on Facebook and your patient could win a $1,500 travel voucher from Allure Travel!* PLUS if your patient is the lucky winner, you win too!

What's in it for you?

• More motivated Shake It patients • Free social media exposure with every patient that shares their story and tags you • If your patient is the winner you also win: Shake lt Recipe Book

LOW FAT EDITION

THE

GET HEALTHY AND CREATE LONG-TERM WELLNESS

Recipe Book

Recipe Book

WELLNESS CREATE LONG-TERM GET HEALTHY AND

THE

Recipe Book GET HEALTHY AND CREATE LONG-TERM WELLNESS

KETOGENIC EDITION

THE

THE

TION LOW FAT EDI

Shake lt Recipe Book

DITION KETOGENIC E

WELLNESS CREATE LONG-TERM GET HEALTHY AND

Recipe Book

–– 6 Shake It Protein Powders (2 x BioPure Pea Protein, 2 x BioPure Collagen Protein, 2 x BioPure Whey Protein)

THE

–– 12 Shake It Patient Packs including: Shake It Shakers, Shake It Tote Bags, Shake It Recipe Books, Shake It Patient Booklets and Shake It Patient Brochures THE

–– A complimentary post on the Shake It Practitioner Weight Management Facebook page promoting your clinic, giving you great exposure and sharing the success you helped your patient achieve with the Shake It Program

YOUR GUIDE TO THE

Feel great, • • • •

be healthy

Real Food Sustained Results Long-Term Wellness Practitioner Advice and Support

Real food Sustained Long-term

* Terms and conditions apply.

Patients can enter through the Shake It Practitioner Weight Management Facebook page where they can share their transformation story. For more details on how to enter and for terms and conditions of the Shake It Transformation Competition, go to shake-it.com.au or shakeit.co.nz

If your patient shares their Shake It transformation, you and your patient could win!

Practitioner

results wellness advice and suppo

rt

Entries open now!

Closing 12th April 2019.

Remember to LIKE the Shake It Practitioner Weight Management Facebook page for great patient-friendly, shareable content!

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FA Q

FAQ

A: Research examining the efficacious components of weight loss programs highlights regular support, i.e. weekly to fortnightly contact for the first 20 to 26 weeks, followed by at least monthly contact thereafter, is integral to weight loss success.1 In fact, the intensity of treatment is believed to be the most important factor in producing weight loss, since low or moderateintensity treatment (<1 visit per month) does not usually produce clinically significant weight loss.2 With this in mind, how can you maintain frequent contact with weight loss patients amidst the busyness of life in a cost effective manner?

While scheduling regular (i.e. at least fortnightly) face-to-face appointments is ideal, the solution depends on what will work best for you and your patients. Suggestions include: • Keep in touch via alternative methods: Incorporate electronic or phone follow-ups between consultations to monitor patients.

For example, send a personal check-in email, or schedule a 15 minute phone call or skype session. If your patient has encountered some challenges or a setback, put it on the agenda to discuss at their next face-to-face consultation.

• Your Shake It Journey: Sign your patient up to Your Shake It Journey e-newsletters, see Clinical Resources on page 11 for more information.

• Group sessions: Group weight loss sessions have also shown to be valuable for long-term weight loss.3 You may wish to facilitate monthly group sessions at your clinic, or encourage your patients to join a local exercise group.

• Tailored treatment plans: Contact may also be tailored, with more frequent sessions initially, which taper in intensity as the patient meets and maintains their weight loss goals.

Consider your options and implement strategies to stay in frequent contact with patients for their best chance of weight loss success.

LOWER SIDE EFFECTS

Q: How can I maintain frequent contact with patients to optimise weight loss success?

Q: How does magnesium bisglycinate differ to other forms of magnesium?

BETTER ABSORPTION

Frequently asked questions of our Clinical Support Team.

A: Magnesium bisglycinate

• Highly stable molecule is protected from binders such as phytates, oxalic acid, tannins and phytochemicals • Protected against binding to water, thereby reducing osmotic laxative effect

Dipeptide Channel

• Small size of glycine means Meta Mag® can be absorbed intact through dipeptide channels • Glycine acts as a pH buffer to support active and passive transport

Active Transport

Meta Mag® - Magnesium bisglycinate H2O

has demonstrated Glycine Passive superior bioavailability Transport Magnesium citrate when compared to other forms of supplemental Binders BLOOD EPITHELIUM INTESTINAL LUMEN magnesium, such as magnesium oxide and magnesium citrate.4,5,6 Meta Mag®, a magnesium bisglycinate, consists of tolerability, avoiding diarrhoea, a common two glycine molecules bound covalently with side effect associated with magnesium magnesium.7,8 This bond protects magnesium supplementation.11,12,13 Glycine also has the from being bound by anti-nutrients such benefit of modulating pH, a process that as phytates, oxalic acid and tannins, while optimises both passive and active magnesium allowing it to be released for absorption.9,10 absorption.14,15 Furthermore, a portion of In addition, this bond reduces the amount of magnesium bisglycinate is absorbed intact water drawn to the magnesium, which not into the enterocyte, through the dipeptide only increases absorption, but also improves channels,16 further improving absorption.

This is a great opportunity to give the cause of your initiative exposure within the Natural Healthcare Practitioner community!

NOMINATIONS CLOSE

7TH APRIL 2019

Head to metagenics.com.au/About/OSCA for entry details or Speak to your Area Sales Manager today!

2018 OSCA Winner Deborah Rugari is the Founder of The House of Healing Humanitarian Foundation.

The foundation provides medical assistance to underprivileged children in Kenya, Sri Lanka, Romania, Congo and Australia.

For more information on how to support The House of Healing Humanitarian go to thehouseofhealing.com.au/Humanitarian-Foundation

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2018 OSCA Winner Deborah Rugari with Paula Hann (Metagenics Managing Director ANZ) and Jimi Wollumbin (One Health Organisation Founder and CEO)

IN THE NEWS

In the news In the wake of changes to private health insurance Despite political pressure from Practitioners and the wider community in support of Natural Medicine, the Australian Government will be removing private health insurance rebates for a range of natural therapies including Naturopathy and Herbalism, effective from 1st April, 2019. Many health insurance companies have begun contacting customers to inform them of the change in recent weeks. Although passed through parliament and enacted in the Private Health Insurance (Reforms) Amendment Rules 2018, Metagenics together with Complementary Medicines Australia (CMA) will continue to lobby a number of independent members of parliament to promote the importance of Naturopathy for Australia’s healthcare system, with the ultimate aim of updating the legislation.

Motivated by the desire to make private health insurance more affordable for all, the Government’s cost-cutting strategy included removing rebates for natural therapies purportedly lacking sufficient evidence. Taking a short-sighted approach, they failed to consider the abundance of high level evidence substantiating the use of individual herbs and nutrients for a wide range of health conditions; instead only reviewing studies on Naturopathy as a complete ‘health service’ (i.e. only papers on Naturopathic practice as a whole were included). Studies of this nature are rare and do not represent the body of evidence supporting the safe and efficacious use of Natural Medicines in practice.

We watch with interest to see how health insurers respond to these changes. Subject to certain rules, they will have the option to offer incentives to members which could include services provided by a Natural Therapist – a potential avenue for insurers to cover Naturopathy and/or Herbal Medicine.

While rebates do provide a (relatively small) financial benefit to the patient, consumers

CLINICAL RESOURCES

will continue to seek the advice of Natural Healthcare Practitioners outside the private health insurance system; and in fact, many patients are already doing so. Importantly, these changes do not impact Practitioners’ ability to practise nor change the nature of services provided to patients. Individuals who are proactively seeking and engaging with Natural Healthcare Practitioners need to be supported in their choices, as Natural Medicine continues to play an integral role in the Australian healthcare landscape.

For more information on the review in question, see Marla Cunningham’s article in the September 2018 Update Magazine: How Did the Australian Government Conclude ‘There’s No Evidence for Naturopathy’?

Visit Your Health Your Choice at yourhealthyourchoice.com.au to have your say.

Clinical resources Your Shake It Journey e-newsletters taken from week 1, 2 and 3

Motivate and educate patients with ‘Your Shake It Journey’ e-newsletters For patients embarking on a weight loss program, there is a considerable amount of new information to absorb – including advice relating to dietary changes, physical activity, and behavioural habits. Furthermore, research highlights the importance of making regular contact with patients to support their weight loss success. In light of this, a comprehensive set of e-newsletters have been developed exclusively for Shake It patients. ‘Your Shake It Journey’ e-newsletters comprise of bite-sized articles delivered over 14 weeks, with three emails in the first six weeks, dropping down to two emails per week for the remaining eight weeks. Topics include foundational nutritional and exercise information, as well as behavioural advice such as goal setting, mindfulness, and tips to stay motivated.

‘Your Shake It Journey’ mirrors the Shake It Program and is tailored to the diet your patient is on – either Ketogenic or Low Fat. Simply go to shake-it.com.au/journey, complete the details, and your patient will begin to receive e-newsletters. Please note, you can only sign your patient up to receive the newsletters once.

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P R O D U C T D E V E LO P M E N T S

NEW RESOURCES

Exciting new product developments Ultra Flora Spectrum Multi-Strain Complex with Five Researched Strength, Scientifically Validated Probiotics.

Help to maintain healthy gut function and wellbeing.

Contains 52.5 billion live organisms from five probiotics at researched strength.

Contents: 30 capsules (VegeCaps) (30 days) or 60 capsules (VegeCaps) (60 days) Order Code: UFS30 (30 Capsules) and UFS60 (60 Capsules) 30 Capsules Wholesale: $30.25 (AUS) / $34.95 (NZ) 60 Capsules Wholesale: $51.50 (AUS) / $59.20 (NZ) Directions: Adults: Take 1 capsule daily.

Each capsule contains: Lactobacillus acidophilus (NCFM®) 20 billion CFU (organisms) Bifidobacterium lactis (Bi-07) 12.5 billion CFU (organisms) Lactobacillus rhamnosus (HN001™) 10 billion CFU (organisms) Bifidobacterium animalis ssp lactis (HN019™) 5 billion CFU (organisms) Saccharomyces cerevisiae (boulardii) (SB) 5 billion CFU (organisms)

Liquid Iodine For Healthy Thyroid Function and Pregnancy Support.

Prevent iodine deficiency.

Assist healthy thyroid gland health and function.

Contents: 44 mL oral liquid (400 days) Vanilla flavour Order Code: IOD44 Wholesale: $9.65 (AUS) / $11.50 (NZ) Directions: Shake well before use.

Adults: Use the dropper to gently squeeze 3 drops (0.11mL) into water once daily.

Glass bottle to preserve ingredient quality. Glass dropper for accurate dosing.

Exciting new resources Clinic Posters

Natural solutions to boost energy.

MAGNESIUM

Why you need magnesium.

Magnesium Patient Brochure - Updated!

(Order Code: BR18 / Pack of 15) • Signs of magnesium deficiency • Why magnesium is an essential mineral • Choosing the right magnesium combination for the right condition

Clinic posters are a great tool to personalise your clinic and create visual interest. Metagenics provides a comprehensive range of educational posters, which are available to order at no cost!

Restore your energy naturally.

Do you know which magnesium is right for you?

Low energy, tiredness and fatigue can affect all aspects of life. A Natural Healthcare Practitioner can determine the underlying factors interfering with energy levels and prescribe a tailored treatment plan, so you can regain your zest for life! Speak with your Natural Healthcare Practitioner today to help you improve your energy levels and achieve long term wellness.

Fatigue Poster - Brand New! (Order Code: FP)

Everyone needs magnesium, some more than others. Magnesium is an essential mineral required for many bodily functions.

It can assist with managing stress, muscle cramps, fatigue and low energy, and heart health. Speak with your Natural Healthcare Practitioner today about which condition specific magnesium supplement is right for you.

MET6110 - 11/18 - MCP

Fatigue Patient Brochure - Updated!

(Order Code: BR29 / Pack of 15) • The causes of fatigue • Lifestyle factors interfering with energy levels • Key nutrients to support energy production

FATIGUE

MET6166 - 11/18 - FP

Metagenics Patient Brochures

Magnesium Poster (Order Code: MCP)

Patient Booklets Patient booklets are informative and easy to read, helping your patients understand and apply the program you have prescribed.

12

Your Guide to Managing Stress YOUR GUIDE TO

STRESS LESS A simple guide to help you manage stress so you can enjoy life at your best.

(Order Code: GMS / Pack of 10) • Updated with new content • Program outline • Advice on managing stress • Goals, diet and lifestyle tips • Personal Wellbeing Journal • Optional product information insert

Your Guide to Energy YOUR GUIDE TO

ENERGY A simple guide to help you manage your energy so you can enjoy life at your best.

(Order Code: GIE / Pack of 10) • Updated with new content • Program outline • Advice on managing fatigue • Diet and lifestyle tips • Energy tracker • Optional product information insert

P R O D U C T D E V E LO P M E N T S

Exciting new product developments Everyday magnesium replenishment

Fibroplex MagActive Powder available in new raspberry and neutral flavour for easy mixing!

Fibroplex MagActive Powder

Fibroplex MagActive for Kids

Fibroplex MagActive Tablet

Meta Mag® Magnesium and Active Bs for Daily Magnesium Supplementation.

Meta Mag® Magnesium and Active Bs to assist with Muscle Function and a Healthy Stress Response.

Meta Mag® Magnesium with Active Vitamin B6 for Every Day Magnesium Supplementation.

Highly bioavailable Meta Mag® with active B vitamins.

All Fibroplex MagActive Powders are naturally sweetened, suitable for children who are fructose sensitive.

Provides 200 mg elemental magnesium featuring exclusive Meta Mag®, a highly bioavailable magnesium, in convenient tablet form.

Contents: 210 g (15 days) and 420 g (30 days) oral powder Order Code: Neutral: FMANS (210 g), FMANL (420 g) Order Code: Raspberry: FMARS (210 g), FMARL (420 g) 210 g Wholesale: $29.95 (AUS) / $34.50 (NZ) 420 g Wholesale: $50.00 (AUS) / $57.50 (NZ) Directions: Adults: Add 1 scoop (7.0 g) to 200 mL of water or juice twice daily.

Contents: 120 g oral powder (34 doses) Raspberry flavour Order Code: FMK Wholesale: $17.70 (AUS) / $20.55 (NZ) Directions: Children: 2 to 4 years: Add ½ metric teaspoon (1.75 g) to 50 mL of water or juice, or to taste, twice daily.

Children: 5 to 12 years: Add 1 metric teaspoon (3.5 g) twice daily with 100 mL of water or juice, or to taste, twice daily.

Contents: 90 tablets (30 days) Order Code: FMAT Wholesale: $25.15 (AUS) / $28.95 (NZ) Directions for use: Take 1 tablet three times daily.

For magnesium supplementation: Take 1 tablet daily.

Sweetening and flavouring for compliance When it comes to Meta Mag® and its superior absorption, fast clinical benefits and minimised risk of side effects, you will be prescribing your patients the most advantageous form of magnesium. Meta Mag® is composed of a magnesium molecule which is covalently bound to two glycine molecules.

Did you know glycine also provides your patients with other clinical benefits beyond its magnesium absorption abilities?

Glycine may be especially beneficial for those experiencing symptoms of: • Sleep issues – glycine has been show to increase muscle relaxation during REM sleep, as well as assist with latency to sleep onset and overall sleep efficiency.

• Fatigue – glycine has been shown to reduce fatigue and improve clear headedness during the day.

Patient compliance is paramount to getting results and taste contributes greatly to this.

The Meta Mag® magnesium range provides a wide range of flavours to balance patient choice with therapeutic considerations. Some of the ways in which this is achieved are due to: • A dedicated flavour technologist to oversee taste trials, flavouring and sweetening.

• Using the right sweetener for the right product.

• Offering a range of sweetness levels to suit personal taste.

• Availability of fructose free flavour options.

• Use of natural colouring agents to enhance flavour perception.

• Avoidance of artificial colours, flavours and sweeteners.

13

BEST PRAC TICE

Effective marketing starts with consistency How consistency in your marketing will help you to effectively send the right message to the right people.

Written by ANGELA CARROLL Programs Manager

J

ust as the real estate adage, ‘Location!

Location! Location!’ implies that location is everything, in marketing there is a similar implication in ‘Be Consistent! Be Consistent! Be Consistent!’ For your marketing to be effective and support your brand, you must be consistent in your message, who you market to, the look and feel of your brand, and your product. Take something to make notes on (i.e. paper or electronic device), and work your way through this article, noting where you need to check your marketing for consistency.

Why is consistency important?

In marketing you have the ability to connect with many people on a daily basis. While not all those you reach will need or want what you have to offer, consistency in marketing and branding will effectively send the right message to the right people.

Consistency builds trust: Being consistent in all you do will build trust in who you are and what you offer. This is important, particularly in the health market, as people have a lot of options. The deciding factor in whether they choose to approach you, stay with you for ongoing care and refer you to others is – trust.

To engage with you, future patients need to: • Trust that you are professional; • Trust you will help them achieve their goals; • Trust in your methods and products; and • Trust that you will take the same good care with their friends and family as you do with them.

Consistency reminds people of you: If your marketing is consistent, and synonymous with the experience patients have with you, when they see your signature branding they are prompted to think about their next engagement with you – without you even having to ask. Your consistent and recognisable marketing is keeping you and your practice in their mind. Even if they don’t act immediately, they will think of you when the need arises.

As an example, I used to always have the same scented flowers in my reception area. Clients would say that whenever they came across the same fragrance somewhere else they would think of me. It can be simple, yet effective.

Consistency says you are dependable: When you are getting to know someone and building a relationship, you start to develop opinions, ideas and assumptions about them based on your interactions. If you are flighty and unfocussed one day, bright and bubbly the next, sullen another day, then calm and focussed the day after, it is hard to gauge exactly who you are and what you stand for.

Now imagine someone is considering doing business with you.

Wouldn’t they be concerned about the consistency in

Think about it, why do you always buy the same brand of milk or butter? It’s predictable. You know what to expect and know you will like the outcome. Giving people a consistent experience across all your channels of communication is similar to always producing a dependable product. Developing a consistent look for your brand and marketing across your website, social media channels and Practice will make clients feel more comfortable with you, and they will be more likely to ‘purchase’ from you again.

14

your work based on their experience with you?

They may think twice about seeing you for care because you are unpredictable. The tone, appearance and messaging in your marketing can be likened to the behaviour and mood swings described above. If your social media voice is whimsical and fun, but your Practice is sterile and plain, you’re sending mixed signals that will confuse clients and leave them feeling like your brand isn’t dependable. This considered, it’s important to be consistent in your approach to send a clear message that you’re dependable.

Consistency will attract your ideal patient: To appeal to your ideal patient, identify your target market, and choose mediums where they can easily find you and speak to them in all you do. Effectively letting your ideal patient know you are part of their tribe and understand them will make you stand out against competitors.

BEST PRAC TICE

Where to check This is pretty straightforward; check anywhere you have left your mark. Some areas like your website, social media platforms, fliers, brochures and so forth will be obvious. The less obvious areas are where you inadvertently market yourself, such as your practice signage, reception area and clinic room/s. The way you conduct your consultations, and your own personal brand also form part of your marketing. Do you walk the talk? While this may seem shallow, even your standard of grooming and clothes you wear are part of your personal brand. Are they consistent with the message you intend to send?

Simple first checks Colour: Wherever you are visible; your practice, website, signage etc., consider colour consistency – pick a colour palette and stick to it. It should be colours that are consistent with your key messaging. They should be reflective of you and appeal to your target market.

Font: All your fonts need to be the same, particularly when on the same site, document, image, etc. Care and consideration should be given to the font you choose. Is it consistent with your message and appealing to your target market? For example, using Times Roman is not consistent with a vital fun message aimed at an early 30s age bracket.

Appearance: Apart from colour and font, consider whether your message clear. Is the

appearance consistent with all your other marketing? When someone sees your material will they recognise or think of your brand? Is the appearance in all you do engaging for your target market? There should be a consistent look and feel.

The next level checks The advice, ‘Be consistent!’ doesn’t just apply to visual appearance. As covered above, it is also how you conduct your communication and interactions. From this perspective, reflect on whether you’re consistent in your behaviour.

Consider, are you consistent in the tone of your social media posts, blogs, newsletters, etc.?

Are you consistent in follow up communication, referrals and interactions with your peers?

Are you consistent in mood and attitude?

Use your marketing strategy and plan As taught at the updated Best Practice one day live event and in the Best Practice webinars, start by creating your marketing strategy to identify your vision and ideal patient. Once you have these, move onto your marketing plan for the year; this will focus your marketing endeavours on your ideal patient and clarify your message and process. If you have missed Best Practice, you may consider attending this year to focus your marketing and help you achieve your practice goals.

Consistency check How are your notes looking? Have you got some areas and aspects to check? Allocate time to this to ensure those who meet you through your marketing know who you are and what you can offer them. Show them you are a Practitioner they can trust. A Practitioner who is dependable and practices with integrity. A Practitioner they would love to engage with. Consistency in your marketing will bring consistency in many other areas of your business.

Research

Bites

Tribulus terrestris supports living libido loca! Traditional herbal medicine tribulus helps ignite libido in pre-menopausal women with diagnosed hypoactive sex drive, according to a recent double-blind, placebo-controlled trial.2 Forty women reporting diminished libido were assigned either 750 mg of tribulus or placebo daily for three months, and were assessed according to sexual desire, arousal, lubrication, orgasm, satisfaction and pain using a validated questionnaire.

Treatment with placebo showed no benefits across symptom scores, however tribulus supplementation significantly improved all parameters of sexual function, in addition to a slight increase in free testosterone levels.

Researchers proclaimed tribulus to be a low risk alternative for boosting low libido, helping to rekindle the flame of intimacy and wellbeing for women.

Clearing the air counts for better birth weight. The hypothesis of reducing air pollution to support foetal growth has been tried, tested and found to be true according to a recent trial.3 Five hundred and forty pregnant women living in a highly polluted Mongolian city were selected in their first or early second trimester and divided into two groups; those who introduced either 1-2 air filters into their home for the remainder of their pregnancy or those who continued living without.

Interestingly, the use of high-efficiency particulate air (HEPA) filters (which reduce indoor air pollution by 29%) correlated with an 85 g increase in mean birth weight of full term infants.

Researchers concluded that implementing air filters may be a simple strategy to mitigate a high pollution environment, thereby positively influencing bub’s birth weight.

15

KEY CLINICAL CONCEPTS

Syncing circadian rhythms Why it’s all about the rhythm when setting up your patients for sleep success.

Written by JOANNE McNEILL Clinical Education Team Leader

E

very cell in the body is under the influence of circadian rhythms.1 These rhythms are controlled by the master clock, called the suprachiasmatic nucleus (SCN), located in the hypothalamus, which responds to the cycle of light and dark.

Signals from the master clock, and other external inputs such as cycles of activity and rest, and feeding and fasting, regulate cycles of genetic expression and metabolic output which impact almost every aspect of health. Disruption to these cycles, a common occurrence in the modern era of electronic light and conflicting work-life schedules, have been implicated in various conditions. These include, psychiatric, neurological, immune, metabolic, cardiovascular, reproductive, and gastrointestinal conditions2; thus making circadian rhythm regulation an important clinical consideration.

Asking the right questions Given the non-specific and broad nature of the conditions associated with circadian rhythm disruption, asking some simple, but specific questions (Table 1) can identify whether these inputs which regulate circadian rhythms need to be addressed.

Lights off Light sends a strong signal to the master clock, and the cycle of natural light can help regulate the circadian rhythm. Blue light, the predominant light produced by electronic sources, inhibits the production of melatonin, the major sleep promoting hormone. This is

alarming when you consider Table 2: Length of sleep recommended according to age.4 that just before bed, most or Age bracket Length of time in hours every night of the week 26% of Newborns 14-17 all adults use the internet and Infants 12-15 16% of working adults are using their electronic devices to work.

Toddlers 11-14 Not surprisingly, both groups Pre-schoolers 10-13 who engage in this behaviour School-aged children 9-11 report frequent sleep difficulties Teenagers 8-10 or daytime sleepiness. 3 The Young adults and adults 7-9 following recommendations Older adults 7-8 can be made to optimise light exposure in order to improve patients’ circadian regulation and sleep: 30 minutes earlier each night until they wake • Screen time: Avoid screens for at least up before their alarm, or until they reach the one hour before bed (e.g. television, laptops, maximum recommended time frame. computers, tablets, and smart phones).

For instance, if your patient is an adult and • Light pollution from electronic lights: who goes to bed at 10pm and needs to wake Use eye masks and/or black out curtains up to an alarm at 5am daily for work (getting while sleeping.* seven hours sleep), then the next night they • Sun exposure: Spend at least 30 minutes would go to bed at 9:30pm, then 9pm, then outside with sunlight on the skin, without 8:30pm until they reached 8pm OR until they getting sunburnt, at the following times: wake up before their alarm. sunrise, between 11am and 1pm, and twilight.

You can also support a patient’s sleep by improving their sleep hygiene. This can be Setting up your patients for achieved by addressing light exposure, as sleep success discussed, as well as making the following While cycles of light and dark regulate sleep, recommendations to ensure that the rest of cycles of activity and rest are in and of their environment and exposures are geared themselves important regulators of circadian to optimise sleep: rhythm. There is certainly no doubt that • If living near a busy road or in a noisy regular, good quality sleep is important for house, use ear plugs during sleep; health. Ideally, patients should aim to sleep • Ensure the bedroom is cool and dark. the recommended sleep time according to An ambient temperature between 16 to 22°C their age (Table 2). If patients wake up to an is ideal; and alarm, it’s recommended that they go to bed • Strictly avoid caffeine after 12pm (e.g. black and green tea, coffee, energy drinks, etc.).

*Black out curtains are particularly important for patients who work night shift.

Table 1: Thorough case taking can identify patients who need to improve their circadian rhythm inputs.

Sleep

When do you go to bed, and when do you wake up?

Does your bed time and time of waking differ depending on the day of the week (e.g. shift work or weekend vs. weekdays)? If so, how?

Do you wake up to an alarm?

Do you wake feeling refreshed?

Light exposure

Are there sources of light that infiltrate your bedroom, such as street lights, traffic lights, lights on electronic equipment, etc.?

If you watch television, what time do you switch it off?

Do you spend time in the afternoon or night on your computer or tablet? If so, when do you switch these off?

Do you use your phone in bed?

What are the times of your first and last intake of calories in a day (including food and calorie containing beverages such as alcohol, juice, milk, etc.)?

Calorie intake Does your meal schedule differ depending on the day of the week (e.g. shift work or weekend vs. weekdays)?

16

Social jet-lag Social jet-lag is a predominantly modern phenomenon which refers to the misalignment between an individual’s biological clock and their work and social schedules. This is often characterised by a marked difference in sleep timing and duration between weekdays and weekends, when they are free to sleep in.5 This mismatch appears to be detrimental for health, with preliminary research suggesting that every hour of social jet-lag increases heart disease risk by 11%.6 However, when weekday sleep is controlled for, sleeping in on the weekend seems to be protective, particularly if weekday sleep is short,7 i.e. the increase in health risk seems to be due inadequate weekday sleep rather than weekend sleep ins. Therefore, there may be some health benefits to catching up

KEY CLINICAL CONCEPTS

on sleep on the weekend by sleeping in.

Breaking the cycle The addition of certain herbs and nutrients can offer further support to patients who need to break the pattern of a disrupted sleep cycle. Specifically, the combination of herbs in California Poppy and Passion Flower for Sleep may foster restful, good-quality sleep; aiding both sleep onset as well as reducing night-time waking. From a nutritional standpoint, Meta Mag® Magnesium bisglycinate, which consists of magnesium bound to two glycine molecules, may be valuable since both supplemental magnesium and glycine have been shown to improve sleep outcomes.8 Moreover, glycine has also been reported to improve sleep onset latency and sleep quality, whilst reducing daytime sleepiness.9 A combination featuring Meta Mag® Magnesium bisglycinate along with ingredients to support the nervous system is Meta Mag® Magnesium, Taurine & Glutamine for Stress.

Food rhythms Rhythms of eating and fasting are another important circadian signal that can impact your patients’ health. Many people spread out their caloric intake over the course of 15 hours which can cause circadian rhythm disruption.

Time restricted feeding has shown promising

benefits in improving metabolic parameters, weight loss, and even energy and sleep.10 For these reasons it’s recommended that patients restrict caloric intake between a 6 to 11 hour window, ideally after sunrise and before sunset.

Patients with metabolic dysfunction may see even more benefit if they restrict eating between a six to eight hour window, with the majority of their caloric intake being consumed in the first half of this window.11,12

The rhythms of life

Shift workers’ sleep enhanced by zinc! Research examining the supportive effects of zinc on nurses’ sleep quality indicates the use of this mineral enhances shift worker wellness.5 Fifty-three intensive care nurses received either 220 mg of zinc sulfate (approximately estimated as 50 mg of elemental zinc) or placebo every three days for four weeks and completed subjective sleep diaries recording sleep quality, latency (time to fall asleep) and duration over a month of shift work. Outcomes of the trial indicated that those taking zinc not only had boosted serum zinc levels, but also fell asleep faster and had significantly improved overall sleep quality and duration compared to participants in the placebo group. Providing functional support for several neurological pathways, zinc may be a simple yet effective approach to improving wellness!

Maybe she’s born with it, maybe it’s collagen protein! Anti-ageing superfood collagen has come out as a strong winner against wrinkles in a recent double-blind, placebo-controlled clinical trial.1 Sixtyfour healthy female subjects aged between 40 and 60 years were instructed to cease all skin care routines and consume either 1,000 mg of collagen or placebo daily for 12 weeks.

They saw a 7.23 fold improvement in skin hydration after 6 weeks, enhanced skin elasticity by 12 weeks, and a 10.5 fold decrease in the appearance of wrinkles at the end of the trial. Collagen is a great way to nourish individuals from the inside out, providing a deeper solution for skin repair, recovery and resilience!

Circadian rhythm disruption is almost ubiquitous with busy, modern lifestyles, and should be considered in every patient.

Combining comprehensive case taking, lifestyle recommendations and strategic use of supplements can help to regulate patients’ cycles of activity and rest, feeding and fasting, and their exposure to light and dark, resulting in far reaching health benefits.

Research

Bites

Big research confirms green tea wards off breast cancer. Findings from a recent meta-analysis has found statistically significant support for the consumption of green tea in reducing the risk of breast cancer and its recurrence.4 Thirteen eligible studies of 163,810 women aged between 20 to 87 years were analysed by researchers in order to better understand the relationship between green tea phytochemicals and rates of breast cancer. The effects of green tea were found to reduce the potential risk of breast cancer and its recurrence by 15% thanks to the daily consumption of 100 to 350 mL of green tea. Whilst our futures can’t be told by tea leaves, a cup of delicious green tea may help change the course of breast cancer one sip at a time!

17

FOOD FOR THOUGHT

Being mindful of problematic eating behaviours How recognising and implementing behavioural change could be a key factor in assisting lasting weight management.

Written by NAOMI DANAHER Clinical Education Officer

E

ach New Year imbues the sentiment of a new start, with many declaring plans to excel in their career, find love, travel or become immersed in a new hobby.

However, when it comes to goal setting in general, it seems the phrase ‘get fit and healthy’ passes more lips than the aforementioned aspirations – and the media certainly supports this ambition with headlines and images convincing one to finally reach their ideal weight. Those embarking on this journey begin brewing with tenacity to see their hopes to fruition; though whether it’s this month or next, the enthusiasm to achieve one’s weight loss goals tends to wane and challenges are met. As the saying goes, old habits die hard.

While the media might not truly have one’s back, conscientious Practitioners certainly do. In previous Update editions (October/ November 2018 and December/January 2018/19), the triage of comprehensive support for weight management has been discussed – that is, providing regular support and feedback to patients, incorporating behavioural strategies, and personalising care (Figure 1).

Techniques Practitioners can use to facilitate behavioural change were previously reviewed, including encouraging self-monitoring, problem solving, and motivational interviewing techniques*. Likewise, an appreciation for individual factors contributing to overweight and obesity serves as an important target for weight management, a component of personalising care.

A notable influence which can be overlooked in weight loss programs is the role of problematic eating behaviours. In some cases, emotional eating, binge eating, external eating or craving-related eating, can be important drivers of weight gain. If these behaviours are present yet not addressed, treatment in the long-term will likely be unsuccessful due to continued overeating – thus compromising weight loss efforts, and personal goals.1

*Update October/November 2018 – Food for Thought: Tackle Obesity with Wrap-Around Care.

Update December/January 2018/19 – Key Clinical Concepts: Two Techniques to Change the Weight

18

Eating in the absence of hunger You may be familiar with the classic movie scene exemplifying emotional eating – a job is lost, a relationship destroyed, or a disaster has unravelled, and the protagonist is seen sitting in a bed of junk food, forcing sugary and salty treats into their mouth in an effort to dull their pain. The reality is however, emotional eating can be a serious challenge for some individuals, and has been shown to be a predictor of basal metabolic index (BMI).2 Essentially, this behaviour may be described as the propensity to overeat in response to stress or certain emotions – most notably negative, yet positive emotions are also believed to be part of emotional eating.3,4 During periods of stress and emotional arousal, individuals with obesity tend to increase their food intake, with a preference for hyper-palatable foods, thereby contributing to weight gain.5 Negative mood states which trigger overeating are thought to function as a coping mechanism, to escape or minimise negative affect.6 Therefore, individuals with obesity may demonstrate a dysregulated physiological response to intense emotion.7 As such, it is theorised there is a disconnect between differentiating physical hunger from emotional arousal, as well as satiety cues, which in turn fosters poor self-regulated eating behaviour.8 This is also a feature of binge eating – the most common eating disorder associated with obesity.9 It is defined as consumption of a larger amount of food than normal within a short period of time (<2 hours) as well as experiencing loss of control over eating.10 It is thought to be an

Provide Regular Support and Feedback

Incorporate Behavioural Strategies

Personalise Care

Figure 1: Triage of comprehensive support.

important contributor to the development of obesity, with almost 70% of individuals who binge eat demonstrating a BMI of 30 and above.11 The suggested management of binge eating disorder among individuals with obesity includes the amalgamation of behavioural weight management, as well as professional psychosocial support.12 These obesity-related eating behaviours have been linked with depression, stress and anxiety; and the presence of psychological symptoms may also impinge on weight loss and maintenance.13,14 A bidirectional relationship has been proposed between obesity and depression, since depression is associated with unhealthy behaviours such as higher caloric intake and physical inactivity; while conversely obesity leads to an increased risk of depression.15,16 Appreciating the connection between obesity-related eating behaviours and these mood states may inform your weight loss treatment plans for patients – for example, providing support with mood and stress formulas, revisiting goals as required, and importantly, working empathetically. Note however, if a patient is demonstrating uncontrolled eating in response to distress, there may be underlying issues requiring a referral to a qualified counsellor or psychologist.

The modern ‘obesogenic’ environment also weighs in on this issue. This environmental influence is particularly problematic when it triggers overeating or consumption of foods that challenge efforts to lose weight. External eating is the name given to the heightened responsiveness to external food-related cues (such as the sight and smell of food) and is associated with overeating and increased BMI.17 Stimulus control techniques, such as removing tempting food from the house or avoiding the junk food aisles in the supermarket, may assist in the management of external eating. More information on stimulus control techniques, and other strategies which may assist in overcoming such challenges (i.e. problem solving) can be found in the Behavioural Change Guide from p. 17 in the Shake It Clinical Guide.

Furthermore, craving-related eating can pose a challenge for individuals battling their weight.18 Food cravings involve obsessive thoughts about food and impulsive

FOOD FOR THOUGHT

consumption of craved foods. People with obesity can experience more frequent and intense cravings for hyper-palatable food, further challenging weight loss efforts.19

Observe and enquire If you suspect cue-reactive eating (i.e. social or psychological) is challenging your patient’s weight loss efforts, conscious questioning and self-monitoring food records may provide clues as to whether the behaviour needs to be addressed. For example, ask your patient if they feel the desire to eat when feeling stressed or lonely, or if they are overeating in certain situations. If your patient is recording their food intake, you can also encourage them to note their thoughts and feelings, as well as places and times connected with making unhealthy choices or overeating. Bringing awareness to eating behaviours in a non-judgemental manner may disturb habits that trigger overeating; a practice known as mindful eating.

Mindful eating Modifying health behaviours through the use of behavioural therapy is a key component in the treatment of overweight and obesity, as it provides a framework for supporting patients to make changes in diet and physical activity patterns.20,21 Mindfulness is considered an acceptance-based behavioural therapy (ABBT) – a form of behavioural treatment that uses a self-regulation framework for understanding the challenges in maintaining weight. Since effective weight management calls for continued self-monitoring of dietary intake and weight, it may come as no surprise that this practice is growing in popularity for disordered eating and weight loss.

Mindfulness may be defined as a state of conscious awareness that arises from purposefully paying attention to experiences in a non-judgemental and accepting manner. It involves observing one’s thoughts,

reducing obesity-related eating behaviours.28 Noteworthy, is that greater effects were found when a combination of formal and informal meditation practices were used, rather than formal meditation practice alone.

Furthermore, a smartphone intervention that targeted craving-related eating using mindful eating practices has also demonstrated positive results.29 In the 28-day self-paced trial, participants experienced significant reductions in craving-related eating and self-reported overeating behaviour. The authors note this form of intervention represents a viable option to reduce problematic overeating in overweight individuals.

The Behavioural Change Guide (within the Shake It Clinical Guide) features a section on mindfulness and provides practical techniques to suggest to patients to increase their awareness to eating.

These are detailed in Figure 2.

feelings, emotions and body without criticism. Mindfulness may be cultivated through a formal meditation practice, or informal exercises incorporated • Before eating ask: Am I hungry? Am I thirsty? into daily life.22 When applied to • While eating, pay attention to the colours, smells, flavours, and eating, labelled textures of food. ‘mindful eating’, it • Chew slowly – this allows the body time to catch up, reducing involves becoming the likelihood of overeating. completely aware • Put utensils or food down between mouthfuls. of the sensations • Avoid multitasking. Remove distractions such as TV, phones, experienced – for computers and books while eating. If a meal is consumed at work, example, chewing take meal breaks away from the desk. slowly, removing • Take note of when cravings occur, and what emotions or stimuli distractions (e.g. trigger these cravings. It can be helpful to keep a craving journal. phones, TV, work) and • Observe the feeling of hunger and satiety throughout the day. noticing the colours, smells, flavours and textures of food.

Figure 2: Informal mindfulness techniques.

It also involves bringing awareness to the experience of eating and the body’s In addition, you may wish to discuss hunger and satiety signals. Ultimately, the goal other opportunities to practice mindfulness is to bring awareness, rather than judgement, with your patient, such as downloading a to emotional eating triggers and experiences. mindfulness app or attending local meditation When awareness is heightened, this may and/or yoga classes. interrupt habits to overeat in response to stress or cues, such as the sight of food.23 Being mindful of individual factors Mindfulness-based interventions (MBIs) targeting eating behaviours have been Changing health-related habits is fundamental shown to be an effective strategy to improve to seeing out weight loss goals and ‘getting obesity-related eating behaviours, including fit and healthy.’ Since health behaviours emotional eating, binge eating, external eating are moulded and reinforced by various and craving-related eating in individuals with psychological and social factors, it is crucial to overweight and obesity.24,25,26 This form of gather an understanding of the motives and therapy is especially useful for those who are engagement in behaviours that foster and susceptible to eating in response to internal and preserve obesity; as well as an appreciation of external cues.27 It is believed to cultivate distress barriers to success. Therefore, noticing the role tolerance, and adaptive coping mechanisms of eating behaviours in a patient’s presentation, which correspond with greater control over and addressing the social and psychological cravings, and well as long-term weight control. cues associated with overeating through A recent systematic review and metatechniques such as mindfulness, may assist in analysis found MBIs were largely effective in lasting weight management.

19

The Maladies of Modernity: Fatigue, Stress and Thyroid Dysfunction

JUNE - JULY 2018 MARCH 2019 LOCATIONS Apply Cutting-Edge Science to Clinic Room Success:

QLD      

Learn the model of allostatic load, and how modern biological stressors can impact mitochondria, thyroid and brain function.

Hear from independent practicing Clinicians on resolving challenging modern-day cases (at certain venues – see list of locations).

Learn about effective treatment strategies to provide foundational energy support and offset biological stressors.

TAS

Brisbane*

Sun 3 March

Rockhampton

Mon 4 March

Mackay

Wed 6 March

Townsville

Thu 7 March

Surfers Paradise*

Fri 8 March

Cairns

Sat 9 March

Understand how new-age biological stressors are threatening your patients’ energy and mental health.

Find out about the fascinating new science on circadian rhythms and how body clocks powerfully affect health.

Learn about the insidious role that electromagnetic fields (EMFs) have on human health and how we can combat them.

Learn from the past, observe the present and look to the future to address the health of the human microbiome and the evolution of probiotic research.

Ballina

Fri 1 March

Baulkham Hills

Sat 2 March

Manly*

Sun 3 March

Newcastle*

Mon 4 March

Forresters Beach

Wed 6 March

Sydney*

Sun 10 March

Batemans Bay

Fri 15 March

Canberra

Sat 16 March

Wollongong

Sun 17 March

Cronulla

Mon 18 March

Albury

Fri 29 March

VIC

ALL SEMINAR TIMES

SPEAKERS

Registration Session 1 Break Session 2 Dinner

     

2:30 to 3:00 pm 3:00 to 4:30 pm 4:30 to 5:00 pm 5:00 to 6:30 pm 6:30 to 7:30 pm

Angela Carroll Nathan Rose Laurence Katsaras Erica Smith Nicola Reid Renee Kucyk

   

Hobart

Fri 29 March

Launceston

Sat 30 March

Barossa Valley

Fri 29 March

Adelaide*

Sat 30 March

Perth*

Sun 10 March

Bunbury

Mon 11 March

Darwin

Tue 12 March

SA  

WA

NSW & ACT           

 

Melbourne*

Sun 3 March

St Kilda

Sat 23 March

Glen Waverley

Mon 25 March

Mornington

Wed 27 March

 

NT 

NEW ZEALAND        

Takapuna

Fri 15 March

Ellerslie

Sat 16 March

Tauranga

Sun 17 March

Napier*

Tue 19 March

Nelson

Wed 27 March

Dunedin

Fri 29 March

Christchurch*

Sat 30 March

Wellington*

Sun 31 March

*These venues will include a short presentation from an independent, local Practitioner.

STUDENTS: $35.00 INCL. GST (AUS AND NZ) | ACCOUNT HOLDERS: $55.00 INCL. GST (AUS) / $59.85 INCL. GST (NZ)

CALL CUSTOMER SERVICE TO RESERVE YOUR PLACE TODAY: 1800 777 648 (AUS) or 0508 227 744 (NZ) metagenics.com.au/events

Metagenics Australia

Metagenics New Zealand

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This paper has been responsibly sourced from a sustainable forest.

MEU1275 - 03/19

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