Dietary Supplements: What PTs Need Know

Jul 01, 2021

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?

Jun 17, 2021

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

May 26, 2021

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

May 17, 2021

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

May 10, 2021

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

May 01, 2021

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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Congestive Heart Failure and Nutrition

Mar 31, 2021

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

Cardiac physical therapy is a rewarding area of PT practice that takes precision, complex thinking, and a team of specialists working toward a common goal. Often patients in cardiac rehabilitation present with chest pain (angina), ischemic heart disease, stents, bypass surgeries, and/or heart failure.

Doctors of physical therapy do their best to push these patients to maximize their endurance, functioning, and cardiac capability. We often do this through various interventions like treadmill exercises, stepping, strengthening, and breathing techniques.  After a recent study, nutrition may be one of those interventions that PTs need to focus more on.

New Study

Published in the British Journal of Nutrition, researchers found a correlation with plant-focused diets, like the MIND and Mediterranean diets, with left ventricular function. Specifically the researchers looked at cohort sample of 2,512 patients from...

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BPPV and Vitamin D

Feb 23, 2021

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

Vitamin D is a crucial nutrient that can be obtained from the sun and has seemingly endless roles in human health. Despite our ability to gain vitamin D from the sun, most Americans are deficient, perhaps due to improper or lacking sun exposure, dietary patterns, or other reasons. Supplementation is simple, effective, and has been shown to have positive impacts on not just our bones -- it can help muscle strength, balance, and even the immune system for some patients.

Yet another role for vitamin D may be in the prevention of benign paroxysmal positional vertigo, or BPPV. BPPV is one of the most common neuro-otological conditions DPTs see in clinical practice. BPPV can leave patients with a spinning sensation, inability to sleep, and balance or fall issues. Physical therapists commonly treat patients with BPPV using the evidenced based technique known as the Epley Maneuver. Other treatments include patient education...

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Naysayers of Nutrition and Physical Therapy

Feb 16, 2021

"D" in the in professional abbreviation DPT stands for Doctor, as in Doctor of Physical Therapy. Our profession has made great leaps and bounds in its stride to becoming experts in movement, the neuromuscular system, and wellness. Much of our success has been through diligent efforts to improve the educational standards of our PT students. We've also continually raised the bar by encouraging most States to enact stricter continuing education standards, licensing, and rigorous specializations and fellowships. Such training and advanced education, along with our doctorate, prepares us to provide care in direct access, primary care, wellness centers, rehab facilities, hospital, gyms, and sports complexes to name a few. We are managing simple injuries now without much of the red tape and bureaucracy, while helping those with devastating diseases and ailments get better. Despite all the progress I feel we still have a stock of PTs that are holding us back, especially in...

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Should PTs Advocate for a Low Carb Animal Diet or a High Carb Plant Based Diet?

Jan 28, 2021

For the last several decades low carb advocates have pitched their diet as means to weight loss, better glycemic control, and even life extension. Many avid fans, like Noakes and Attia, have thrown around several low level studies or short term studies to support the low carb dietary pattern. Meanwhile, the data for more plant focused, carb rich diets like the Mediterranean and Whole food plant based diets have been gleaning more and more support. From prospective trials to population and epidemiology data, such plant focused diets seem to be the ideal pattern for physical therapists (PTs) to recommend to many clients. Let's take a look a recent National Institute of Health (NIH) trial comparing a low carb animal based diet to a high carb plant focused diet.

Published in Nature Medicine, the NIH trial was relatively small and focused on short term results. Researchers housed the participants in a NIH controlled facility, proving to increase the internal validity and controls of the...

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