Calorie Restriction and Physical Therapy

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Diet crazes come and go in the hopes to correct health issues and for weight loss. Many diets are merely fads, not backed by evidence, and/or offer only short-term solutions. One dietary pattern that stands out from the pack is calorie restriction (CR), especially in regards to data on longevity. I have 2 peer-review publications in the area of CR and intermittent fasting, so I can share both the data and experiences of this diet. Let's take a quick look at calorie restriction and what physical therapists (PTs) need to know!

Calorie restriction is a dietary regimen where a person consumes typically 25-40% less calories than usual. In order to accomplish this calorie deficit a person must know their total daily caloric needs over several days. Calculating 25-40% of this total calorie needs a client can then reduce their calorie content of each meal in order to hit their calorie deficit. Usually there is not...

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Should PTs Use a New Model for Weight Loss?

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

For decades the predominant model that dictated weight gain, loss, or maintenance was the energy balance model (EBM). The EBM is rooted in one of the basic laws of thermodynamics. It goes without saying that food contains energy and it is typically measured in a unit known as calories (kilocalories in the dietary world). As a person consumes food it provides energy to do work such as exercise, activities of daily living (ADL), physical therapy, basic living functions, or even sport. Energy can come from recently consumed food or stored energy (e.g. fat, glycogen, or protein) from previously eaten food. 

Clinicians often explain weight loss to patients as “calories-in versus calories-out” or CICO, which directly relates to the EBM. In brief, CICO helps rehab professionals to explain to clients the balance between the energy coming into their body versus the energy they expend: too much food...

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Top 3 Tips for Geriatric Rehab and Nutrition

By Dr. Sean M Wells, DPT, PT, OCS, ATC, CSCS, CNPT, NSCA-CPT, Cert-DN

Exercise is certainly medicine but what if we could do more for our older adult clients? As physical therapists (PTs), occupational therapists (OTs), or personal trainers we strive to push our clients with the best exercise selection and most evidenced-based techniques to improve our clients’ strength, balance, and function. But what if all we are doing is for not because of a client’s poor diet? 

I have seen this time and time again in my clinical practice: a client enters my practice, I examine them and find weakness and balance deficits; we begin a program of resistance training, balance and neuromuscular work, and notably see little change in their function. As I dive deeper into their lifestyle factors (e.g. sleep, stress management, and nutrition) I find they don’t eat enough, drink too much alcohol, and consume overly processed foods devoid of essential nutrients.  Could these...

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Take It To Heart: Low Fat Versus Plant Based Diet

By Dr. Sean M Wells, DPT, PT, OCS, ATC, CSCS, CNPT, NSCA-CPT, Cert-DN

Since the 1980s many dietary guidelines promoted the notion of a low-fat diet in order to reduce cardiovascular disease (CVD) risk. Over the next 30 to 40 years healthcare providers and nutrition researchers found that simply lowering dietary fat alone is not the only answer to reducing heart disease. This is likely because those consuming a low-fat diet may still include junk foods, meat, and smoking -- which have all be directly correlated with higher risk of heart disease, comorbidities, and mortality. Data show that most plant-based oils and fats from sources like nuts, seeds, and some oils can actually be beneficial in lowering heart disease risk. Could a plant-based diet, which includes fats from plant-sources, be better than a low-fat diet? A recent publication provides physical therapists and other providers just the answer.

The new research, coined Coronary Artery Risk Development in Young Adults...

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Dietary Supplements: What PTs Need Know

By Dr. Sean M Wells, DPT, PT, OCS, ATC, CSCS, CNPT, NSCA-CPT, Cert-DN

Three out of four Americans takes some form of dietary supplement every day. From multivitamins to weight loss supplements, the list of dietary supplements is long and the associated costs can be substantial. Physical therapists (PTs) work with a wide range of patient types, many of whom are actively taking supplements for health, to slow aging, or in hopes to reverse a disease state. Obviously these supplements must have some positive impact on our health, right? Doctors of physical therapy (DPTs) are becoming more holistically trained to understand the role of nutrition and dietary supplements: despite this, the answer to above question is convoluted and may even surprise you.

Regulation

Dietary supplements are not regulated by the Food and Drug Administration. This is vastly different than the drugs that many of our patients are taking. The lack of regulation should be a mainstay reason why...

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Nutrition: To Collaborate or Not?

By Dr. Sean M Wells, DPT, PT, OCS, ATC, CSCS, CNPT, NSCA-CPT, Cert-DN

Can you recall a recent treatment session or patient case where you connected with another fellow physical therapist (PT), occupational therapist (OT), or speech therapist (ST)? Overall the treatment session or case probably went well, right? Both you and the other provider worked together, solved several problems, and/or potentially identified major issues that changed the course of rehabilitation. 

In this example it is easy for us in rehabilitation to see how easy it is to collaborate with other rehab professionals -- but what about dieticians? My team and I have long argued that PTs ought to work more collaboratively with these healthcare providers. Let me delve into several reasons why and examples of how nutrition collaboration benefits all.

Dietitians' Education

Dietitians are educated and clinically trained to work with many challenging populations. Their 4 year college education and clinical training...

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Intermittent Fasting and PT

Fasting, or intentional restriction of food intake, has been around for thousand of years. Much of the roots of fasting comes from religious or spiritual ceremonies; today, fasting is often done for the aspects of improving health and longevity, with some still continuing the religious or spiritual purpose. The data on fasting is robust and doctors of physical therapy (DPTs) need to be aware of the benefits, risks, and the how-to of fasting. Let's get started!

Many various forms of fasting exists. Strict or pure fasting includes the abstinence of food altogether. Time restricted fasting or feeding is where a person restricts feeding to a certain number of daytime hours and uses sleep to help create a partial fast. In other words, a person may eat only from 11am to 7pm, while fasting from 7pm to 11am. Some might consider this a form of intermittent fasting, but the true definition of intermittent fasting is where person will consume food ad libitum one day while restricting food...

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The Expanding Scope of Nutrition

By Dr. Sean M Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

The field of nutrition science continually expands. Once seen through only a metabolic and nutrient lens, nutrition science now interconnects with immunology, neurology, and psychology. How these fields of study interact are becoming amazingly complex but may help to shed light into various therapies and prevention for many common chronic conditions. How these various areas of clinical practice interact with nutrition makes it apparent that the practicing physical therapist needs to be aware of how foods interact with human physiology and biochemistry. 

Immunonutrition

Nutrition certainly impacts immunology. From colds to rheumatic flares, diet can certainly mediate certain physiological processes that can drive or promote disease states. Nutrients play a vital role in disease prevention. Water helps to hydrate our eyes and mouth to prevent infections. Vitamin C helps to boost white blood cell count, which...

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Motor Improvement in Parkinson's with Lower Protein Intake

By Dr. Sean M Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Parkinson's Diseases (PD) is a chronic, progressive neurodegenerative disease that significantly impacts movement. Many patients seek the expertise of physical therapists (PTs) to help improve their movements, balance, and quality of life. Exercise is most certainly the mainstay treatment, with resistance training, boxing, HIIT, and balance exercises being some of the top choices. Some clients of my practice have improved their condition so much they no longer use their rolling walkers, need help with transfers, and some even reduce their meds.

Other than exercise, nutrition is another key area that Doctors of Physical Therapy ought to be aware for their clients with PD. Nutrition is intimately related to the causality of PD. From heavy metals in foods like fish to severe alterations in the gut-biome, many nutrition researchers are finding that diet plays a major factor in developing the disease. Consumption of...

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Fasting and the Gut Microbiome

By Dr. Sean M Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

For many decades nutrition experts and researchers were aware that fasting could impact certain disease states. From rheumatoid arthritis (RA), osteoarthritis, and several metabolic diseases (e.g. gout), fasting could reduce symptoms, improve functioning, and/or improve metabolic profiles for a short period. This short period of improvement could help patients during flares or bouts but couldn't offer long lasting effect. Many physiotherapists in the United Kingdom are aware of the power of fasting and vegetarian diets for patients with RA. 

The understanding of how symptomology would improve in light of fasting was not well understood. Some authors offered the notion of the soma vs metabolic tradeoff, where the body took its time to repair its systems vs channeling energy into digesting food. Other researchers suggested that certain foods promote inflammation, and thus, removing food could reduce...

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