A multidisciplinary approach to expanding your practice
Over the last 18 months, as of this writing, I’ve implemented a weight loss program in my office, offering a personal renovation — or biohacking, to use a new, popular term.
Many patients come in with multiple musculoskeletal and other body system complaints such as pain in ankles, knees, hips, low back and shoulders. If these patients are carrying even 5-10 percent excess fat, then that weight is contributing to their complaints.
It’s more than weight
Excess fat causes inflammation. I sit every new patient down and we talk for a while — they size me up and I size them up. We find out “What matters?” and “What can’t you enjoy?” We get detailed on past and current physical complaints and current physical condition; inquire about old injuries, medical preconditions, medications and vitamins; and assess mental well-being, commitment, job tasks, athletic background, etc.
My treatment style is, “Don’t just come to me and expect me to get you out of pain. I want to help educate you.” The physical problems, mental and emotional issues, depression, lack of vitality, etc., are all rolled into one.
Sometimes treatment needs to start with a fat-loss plan. Does the patient have a strategy for weight loss? If not, we utilize a full-time weight-loss coach, with a program designed to help those who need to lose as little as five pounds to those who need serious weight reduction. Movement and pain compete. Losing excess weight improves physical change to allow more movement and decrease pain. That simply goes back to the “pain gating” system.
Regardless of a person’s degree of fitness, such as an athlete, or unfitness, such as a deconditioned patient, if a person has any of the following: multiple joint aches and pains, cardiac issues, neurological changes, elevated blood sugar, hypertension, elevated triglycerides, inflammation of the liver, sleep apnea, polycystic ovarian disease, atherosclerosis or low HDL — all insulin-resistance related — and is dissatisfied with other attempts at losing weight and is not happy, then that individual has a real chance of losing weight.
We aren’t doing psychology sessions; we are biohacking the body with a ketogenic diet and movement strategies to improve neuroplasticity.
The ketogenic diet
Keto was used for epileptic patients and gradually became famous for its weight-loss benefits. The ketogenic diet reduces carbohydrate intake, with moderate protein and increased good-fat intake, creating a change in the body’s fueling system. A general macronutrient ratio recommended on a keto diet is around 70-80 percent of calories from fat, 15-20 percent from protein and less than 5 percent from carbs. The general goal of keto is to train your body to burn fats instead of carbs.
Glucose is the basic unit of energy our brain can utilize, but with the ketogenic diet the brain is fueled with ketone bodies, β-hydroxybutyrate and acetoacetate. We also see increases in HDL and improved insulin sensitivity, and everything that goes with that. Some people would say the keto diet is difficult to stay on for a long period of time, but that has not been our experience. We have patients who have been on it for more than a year now. If need be, patients have taken short, intermittent breaks, especially for known holidays or celebrations.
Many people find a keto diet very satisfying due to the high fat content, so they report that they have no cravings and find fat loss to be easy. Using the ketogenic diet as a centerpiece, the fat loss method is getting predictable and reliable results. Over the past 18 months, even small amounts of fat loss produce musculoskeletal improvements. Small amounts (5-10 pounds) of fat loss yield dramatic changes in joints and soft tissues.
Regarding packaged foods, the farm-to-table concept is awesome, but not realistic on a daily basis for most working adults. We do have to use some packaged food, but patients are also getting fresh produce and other organic choices for meals. Patients are ready when you offer them a plan. They really have been willing and able to put in the work necessary to trigger health changes.
A former patient, Suzanne, is a nurse. She is sharp and able to grasp and institute the subtleties of the ketogenic diet and biohacking process. She was someone with a requisite life situation, chronic polycystic ovary syndrome.
There is nothing tough about the plan. We use a body composition device to measure her percentage of fat and lean muscle mass. She has a goal of losing 20 pounds of fat and gaining 10 pounds of muscle. Core strength and cardio training start after some fat loss.
We all have a chronological age, but we also have a biological age. The reward is helping patients turn back the hands of time. It can even be measured in your telomeres. When friends and family notice you look better and move better, you have probably traveled backward in time. Are we turning back, or biohacking, the clock in months, years or decades so patients are younger than when they started the process? By any physiological or psychological yardstick, losing 10-100 pounds of deadly body fat, and adding pounds of functional muscle while improving one’s strength and cardiovascular capacity by whatever percent, qualifies as astounding.
Weight loss and movement
Every patient who visits is instructed to start a walking program. Apps on your phone are very useful since they measure your number of steps per day. I know some patients can only do five minutes at a time, but I encourage them to be more intense by adding time, distance, inclines or speed. While walking I suggest practicing breath work: breathe in and out of the nose, holding the exhalation; “box breathing”; rib and diaphragm expansion; walking up and down steps or hills; or wearing a weighted vest.
When patients feel ready, core exercises are introduced, starting with postural and static exercise poses. Isometric exercises do more to improve trunk stiffness and postural function than dynamic exercises. Isometrics should precede dynamic exercises. Eventually we get to squats, dead lifts, bench presses and other moves.
My conditioning program for the de-conditioned: walking in place, higher-knee marching in place, marching in place with a CLX loop around the feet, walking, walking faster, walking up stairs, modest hill walking, power walking, power walking up and down hills, and on to jogging and sprinting. Patients’ understanding of heart rate beats-per-minute gives them a target zone.
Biohacking the clock
This comprehensive approach, without being in a totally integrative practice, vastly improves the quality of life. Getting into shape may be the goal and it takes time. It could be months or years, but that much later patients are still improving.
Biohacking in terms of prevention of heart attack, stroke, diabetes, Alzheimer’s and dementia, as well as improving sleep, tapering off meds, etc., is the new norm. The body fat percentage goal for men is 17 percent and for women 24 percent. When you are continually told that you look great, or you look 5-15 years younger by friends, acquaintances and family, it’s easy to stay motivated on the program.
A weight-loss partnership
I met my office weight-loss coach from being a patient and we became friends. He has experience with understanding people and he knew the ketogenic diet. We created a goal and a website for our patients. I had tried a lot of cleanses and other weight-loss programs over the years in the office, but the ketogenic diet resonated with me. It has since become incredibly popular.
Patients come in to the office for weekly weigh-ins, body composition analysis, and review of the previous week’s food intake log (the log is a requirement), and they get a detailed plan for the next week to keep them accountable and motivated to complete the program. Nothing about the program makes them feel deprived; some patients are still having a cocktail from time to time.
I have practiced with MDs, acupuncturists, PTs and others, but this is the most important integrative practice enhancement I’ve made in my career. This is not just weight loss; this is part of a rehab practice that was years in development.
I’ll tell you a secret: The weight-loss programs bring in more patients than chiropractic programs. At a certain point in time the weight-loss program developed a life of its own. We first started with my patient base, but now patients are sent to me — patients in need of weight loss who can now appreciate the benefits of chiropractic care. Once the body inflammation associated with weight loss is reduced, hands-on therapy and rehab is easier. The team approach regulates the pace when we feel we need to introduce chiropractic to our weight-loss patients.
What patients want and need
No meaningful weight program is a “quick fix,” but our solution is a team approach to lifestyle change and adaptive education. We were early adopters of the therapeutic lifestyle.
Whether you’re an experienced chiropractic adjustor, overweight yourself, a current athlete, a former athlete, just starting out or new to nutrition, the weight-loss path and fitness path is what patients want and need. Helping patients lose even 5-10 percent of excess body fat has everyone on the path to achieving their goals.
Jeffrey Tucker, DC, is the American Chiropractic Association Rehabilitation Council president. He practices in Los Angeles, Calif., and can be reached at drjeffreywtucker.com.