Practitioner Question of the Month – May 2018

My Thoughts on the Product Called Restore

I have received questions about this product from both patients and practitioners. What a practitioner really wants to know is:

1. Is this something I should routinely use in clinical practice that will enhance results?
Or
2. Is this something that will provide results for otherwise non-responsive patients?

What is Restore? It’s a compound that is supposed to reduce leaky gut (restore tight junction function) induced by glyphosate (an herbicide). This herbicide is used predominantly on corn, cotton, soy, wheat, alfalfa, sorghum, and sugar. The amount of the herbicide being used is increasing quite rapidly in the US.

What does the evidence say? Unfortunately, not much. Only two studies are available (1, 2) and both studies are cell line studies, resulting in very poor quality evidence. The studies show a positive effect in a cell culture, but there is still a massive leap to show a benefit in humans. I can’t emphasize how important it is not to be misled by a mechanism unless it has been tied to an outcome. This happens all the time in functional medicine and is a serious and significant problem.

This product may help reduce leaky gut but there are other interventions that have been shown to reduce leaky gut and to improve patient outcomes; probiotics, low FODMAP, gluten free and glutamine just to name a few.

“My patient has tried these already and not responded, could Restore be the missing piece?”

I hope so but I have my doubts. Until there is evidence this product provides any benefit over the interventions that do the same thing but have documented outcome results I will focus on what we know works. If your patients are not responding, sharpen or broaden your skill set so as to have proven tools to help them. Or, refer to someone you feel does. I would not recommend trying fancy new products randomly, this is not how you would want to be treated. Is it?

“I watched an interview with the inventor of the product and found it very compelling though.”

Just because you watched a 60-minute interview on the product does not change the facts. Please don’t fall into the trap of making decisions in clinical practice based on emotion or having a ‘good feeling’. Again, I’d like to say that I hope this product will be shown to be vastly helpful, and I will remain 100% open and change my position if it is. However, what I will not do is jump on the latest bandwagon because the owner of the company is making the rounds on all the marketing channels and trying to promote his product. I do hope he continues to research and develop this product. And I also understand he probably needs income from selling the product to fund future research and this can create a paradox. But, it would not cost much (really very little) to assign two groups of patients with IBS to receive either Restore or a probiotic and then publish a retrospective chart review.

The fact that there is literally zero human outcome data, even though it would not be hard to obtain as I outlined above, yet this product has been appearing everywhere, makes me very suspicious. I hope that I am wrong and I will 100% change my opinion given at least some preliminary human outcome data (even a non-blinded RCT). But until that time I will not subject my patients to experimenting with products that claim to do something with no clinical evidence to support it. And I will remain cautious and suspicious about a company that appears to have robust marketing but has not invested a corresponding amount of effort in human outcome data.

I hope this helps and I hope it illustrates the more important lesson regarding how to evaluate new product health claims.

Are You Putting Yourself First, Ever?

Burnout is a well-recognized problem in healthcare. This is likely caused by a compounding of:

• a prelude to taxing academics
• long and sometimes erratic hours
• the burden of empathy required for ill patients
• financial challenges
• business stress; hiring, firing, systems management, etc.…
• among other factors

It is easy to fall into the trap of decreasing one’s self time to find time to attend all the above. Doing this for a period is understandable to ‘get through’ a challenging period. It is important not to allow this to slowly become your new norm. This can be insidious, gradually allowing you to work too much and not take care of yourself and eventually thinking that this is normal.

Eventually your performance suffers. If you are not taking the time to prepare and eat high-quality food, keep yourself in good physical condition by challenging your body with exercise, pursue a hobby or other source of enjoyment and allow your brain some downtime – you will not be operating as effectively as you could. The longer this is left unchecked the worse your performance will become.

So, what can you do? The first step is recognizing there is a problem. Take some time to reflect on this, or ask a loved one (if you are overworking they are likely already telling you this). If you feel you have drifted into this imbalanced lifestyle, the next step would be defining what a more balanced life would look like (set the goal). Here are some things to consider:

• make yourself a diet plan and exercise schedule
• block time for pursuing that hobby
• set limits or constraints for how much you can work

This last point is the most challenging. It is easy to say ‘work less’ but if your workload doesn’t change then this is not going to happen. So then how to work less?

1. Start saying no more. Cut the bottom 20% of work-related commitments that are the least effective or necessary. And start saying no to more of the new tasks that pop up.

2. Trade your time for money, aka delegate. Look at your day-to-day activities. It is very likely that you don’t need to do all of this and that someone could be trained to take over some of these tasks.

3. Plan better. If you look at your schedule you will likely see the wasted time that could be better utilized. For example, I like to talk with my parents a few times per week. I used to call them when I was done with work for the day. Then I realized that when I walk from my home office to the local coffee shop mid-morning would be a great time to kill two birds with one stone. During these walks, I also catch up on Voxer messages from my team. So, I took the round trip walk of 20 minutes, which I was making 3 times per week, and turned it into productive personal and work time.

Don’t expect to get there overnight. But set your goal and keep gradually working toward a more balanced life. I perform a weekly audit where I check in on how I am doing. I consider this an hour of ‘work time’. In this case, I am ensuring a key member of my team (me) is happy and healthy so that he will be productive. This is when I put myself first. During this time, I reflect on my diet, my exercise plan, hobbies, overall schedule, and goals. I ask questions like: what worked, what didn’t work and why.   I also make sure to give thanks for all that I have even thought to as I am always working towards more.

For example, maybe you keep missing your exercise sessions. Upon examination, you realize that the excuse you always give yourself is you are too tired at the end of the day. You then realize you should move your exercise sessions to the start of the day rather than the end of the day. You may also realize,

I used to skip breakfast because I didn’t plan, but instead had a coffee and told myself ‘I’m intermittent fasting’… Now that I am no longer doing this and eating more frequent meals I have much better energy and mental clarity.  

Having an ideal life requires having an ideal schedule and an ideal schedule is achieved through constant trial, error, and adjustment toward your ideal. Put yourself first, at least for a short time each week, this will do volumes to steer your life in the direction you want it to go rather than allowing it to be pushed by the random influences of life’s entropy.

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