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Specialist clinical nutrition: an essential
adjunct to successful manual therapy
Dr Nina Bailey
BSc (Hons) MSc PhD
• Igennus Healthcare Nutrition are a clinical nutrition
specialist providing bespoke support for inflammatory
conditions
• You don’t need to be a nutrition specialist to make a
difference to your client’s health!
• Igennus has established relationships with over 50
chiropractors, osteopaths, acupuncturists,
reflexologists, massage therapists, personal trainers
and fitness instructors…….
CFS/ME/FMS
• Dr Raymond Perrin (PhD) osteopath, neuroscientist and
pioneer of The ‘Perrin Technique’
• The Perrin Technique is a unique lymphatic drainage
technique that treats CFS – all Perrin CFS patients are
recommended to take 1-2g of Igennus EPA
• Igennus collaborates with 96 ‘Perrin Practitioners’ who
use this protocol successfully
Neurodevelopmental disorders
• Robin Pauc – neurologist and chiropractor, founder of the UK
renowned Tinsley House Clinic for childhood developmental
disorders
• Robin Pauc regularly recommends Igennus’ products as an
addition to his treatment programmes:
• ADHD
• Autism
• Asperger's
• Dyslexia
• Dyspraxia
• Igennus EPA used by Dave Scott U.S. triathlete and six-time Ironman
Triathlon World Champion
• Numerous personal trainers use Igennus’ products over generic oils as part
of their sports nutrition package - clients get better results:
 Modulates inflammation
 Immunity support
 Cardiovascular support
 Joint and bone support
 Reduced oxidative stress
 Supports energy requirements
 Supports lean muscle mass/fat burn
 Supports recovery time and performance
Our biggest practitioner accounts are manual/physical
therapists NOT nutrition specialists….
Why do they choose us?
 Premium quality ingredients
 Scientifically proven formulations
 Niche therapeutic target
 Highly specialised
 Expert support team
 Highest purity and lowest contaminants
 They really work!
• Accident
• Injury
• Illness
• Stress
• Tension
• Posture issues
• Muscle spasm
• Over-exertion
All result in nerve and muscle damage = short/long term reduced mobility,
pain and subsequent secondary issues
But most importantly the science……..
Top reason to see a manual therapist:
PAIN!
Pain due to:
• Pain = inflammation = pain – signal that damage is present and protects
against worsening
• Process of inflammation must be tightly regulated in the body. If not,
can lead to unnecessary inflammation and exacerbate pre-existing
issues or initiate new ones otherwise non-problematic
• Unnecessary inflammation / inability to switch off inflammation =
chronic pain and reduced mobility
• PLUS very high risk of inflammation ‘spreading’ systemically = increased
risk of inflammatory disease
Managing pain
• Medication – but like fighting an Australian bush fire with oil - if
you use enough may put out the flame in the short term but long
term MUCH worse
• Many pharmaceuticals also have potentially detrimental side
effects (i.e. COX-2 inhibitors)
• Manual therapy addresses the muscle and nerve issues and
restores function to the body to reduce pain and promote mobility
• But without addressing the route cause of unnecessary
inflammation leads to long term issues and numerous secondary
problems
What is inflammation?
– the normal response of a tissue to injury
– triggered by a number of causes including infection, invading
pathogens (such as bacteria or viruses), trauma or compromised blood
flow
– desirable defence mechanism with undesirable side effects
– normal inflammatory response has an on/off switch
– in chronic inflammation there are issues with down-regulating signals
The key to regulating inflammation is through the
modulation of eicosanoids:
• Pro-inflammatory eicosanoids drive the immune and inflammatory
processes
• Anti-inflammatory eicosanoids act to end the process
• Overproduction of pro-inflammatory products or reduced
production of anti-inflammatory products can result in continued
production of inflammatory products – the hallmark of silent
inflammation
Regulating eicosanoids through diet
• Eicosanoids are derived from a group of polyunsaturated fats
known as omega-6 and omega-3
• The ratio of omega-6 to omega-3 in the diet influences the type
of eicosanoid produced
• The ratio of omega-6 to omega-3 is commonly associated with
health status
• The ratio of KEY omega-6 and omega-3 fats AA and EPA gives us a
direct indication of inflammatory health
• The AA to EPA ratio is an indication of the balance between pro-
inflammatory and anti-inflammatory eicosanoids
• High AA and low EPA levels will drive the inflammatory response and the
subsequent failure to resolve inflammation may increase susceptibility to
the development of chronic, low-grade, inflammation-based diseases
AA to EPA ratio - biomarker of inflammatory status
0 % 4% 8% 12%
Omega-3 index* - biomarker of cardiovascular health
Desirable OptimalUndesirable
*Harris & Von Schacky, 2004
The role of diet and lifestyle in modulating inflammation
• Triggers from chronic altered diet and psycho-emotional stress
negatively influence the resolution step of the inflammatory
response
• Failure to resolve inflammation increases susceptibility to the
development of chronic, low-grade, inflammation-based
diseases due to the constant activation of both the HPA-axis
and innate immune system (Bosma-den Boer et al., 2012)
Resoleomics - the process of inflammation resolutionInflammatoryresponse
Initiation Resolution Termination
PGE2
LTB4
Eicosanoid switch Stop signal
Time
Pro-inflammatory reduced
Anti-inflammatory increased
Bosma-den Boer MM, van Wetten ML, Pruimboom L: Chronic inflammatory diseases are stimulated by current lifestyle:
how diet, stress levels and medication prevent our body from recovering. Nutrition & metabolism 2012, 9:32
•Oily fish via diet in decline
•A major 1st world dietary
deficiency
•Supplementation of food
necessary – milk, spreads
Omegas in food
Omegas in dietary
Supplements
Omegas in
medicines
Omega-3 transition to medicine
Increasing health problems relating to weight issues
Flock MR, Rogers CJ, Prabhu KS, Kris-Etherton PM: Immunometabolic role of long-
chain omega-3 fatty acids in obesity-induced inflammation. Diabetes/metabolism
research and reviews 2013, 29:431-445.
Makki K, Froguel P, Wolowczuk I: Adipose Tissue in Obesity-Related Inflammation
and Insulin Resistance: Cells, Cytokines, and Chemokines. ISRN inflammation 2013,
2013:139239.
Titos E, Claria J: Omega-3-derived mediators counteract obesity-induced adipose
tissue inflammation. Prostaglandins & other lipid mediators 2013, 107:77-84.
White PJ, Marette A: Is omega-3 key to unlocking inflammation in obesity?
Diabetologia 2006, 49:1999-2001.
White PJ, Marette A: Potential role of omega-3-derived resolution mediators in
metabolic inflammation. Immunology and cell biology 2014, 92:324-330.
Omega-3 and bone health
Mangano KM, Sahni S, Kerstetter JE, Kenny AM, Hannan MT: Polyunsaturated fatty
acids and their relation with bone and muscle health in adults. Current
osteoporosis reports 2013, 11:203-212.
McMahon MS: Beneficial effect of omega-3 fatty acids on bone metabolism.
Orthopedics 2012, 35:735-736.
Rousseau JH, Kleppinger A, Kenny AM: Self-reported dietary intake of omega-3
fatty acids and association with bone and lower extremity function. Journal of the
American Geriatrics Society 2009, 57:1781-1788.
Saidenberg Kermanac'h N, Bessis N, Cohen-Solal M, De Vernejoul MC, Boissier MC:
Osteoprotegerin and inflammation. European cytokine network 2002, 13:144-153.
Inflammation, omega-3 and rheumatoid arthritis
Curtis CL, Rees SG, Little CB, Flannery CR, Hughes CE, Wilson C, Dent CM, Otterness
IG, Harwood JL, Caterson B: Pathologic indicators of degradation and inflammation
in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids.
Arthritis and rheumatism 2002, 46:1544-1553.
Sperling RI: Dietary omega-3 fatty acids: effects on lipid mediators of inflammation
and rheumatoid arthritis. Rheumatic diseases clinics of North America 1991,
17:373-389.
Lee YH, Bae SC, Song GG: Omega-3 polyunsaturated fatty acids and the treatment
of rheumatoid arthritis: a meta-analysis. Archives of medical research 2012,
43:356-362.
Omega-3 and pain
Maroon JC, Bost JW: Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for
discogenic pain. Surgical neurology 2006, 65:326-331.
• AA and EPA contents of cell membranes can be altered through
oral administration of omega-3 EPA
• Increasing EPA levels results in a changed pattern of production of
eicosanoids
• Changing the fatty acid composition of cell membranes also affects
immune function and pathways
– changes in membrane structure
– cell signalling
– gene expression of cells and products involved in the inflammatory
cascade and pain signalling
• As health practitioners, you are perfectly placed to guide patients
toward natural co-therapies
• Route of inflammation may not just be due to pain/injury issue,
as consultation/client history may reveal:
• High stress
• Fatigue
• Neurological disorder
• Poor diet and lifestyle
• CVD
• Low mood
• Inflammation is a key driver of a myriad of diseases/conditions
Specialist clinical nutrition: an essential adjunct to successful manual therapy
Specialist clinical nutrition: an essential adjunct to successful manual therapy
Thus, addressing high levels of inflammation by restoring
AA to EPA ratio and increasing the omega-3 index will
reduce:
 Pain
 Fatigue
 Stress
 Risk of modern illness
Measuring inflammation and tracking progress
• Blood spot fatty acid profiling
Omega-6 to omega-3 ratio
AA to EPA ratio
Omega-3 index
• Knowing a client’s baseline omega-3 index allows effective dosing to
increase omega-3 index and reduce the AA to EPA ratio
Omega-3 index Dose required Body weight Minimum dose
Base line Target (mg/kg) (kg) (g)
3 8 0.0222 89 1.98
4 8 0.0172 89 1.53
6 8 0.0072 89 0.64
So remember!
You don’t need to be a nutrition specialist to
make a difference to your clients’ health
Our biggest practitioner accounts are manual
therapists NOT nutrition specialists….
 Expertly formulated EPA supplements to suit all ages and needs
 Scientifically proven co-therapies to support long term health
 Technical support from MSc Nutrition Specialists
 Literature and personalised support for your clients
 Fatty acid blood profiling service allows a bespoke and effective
supplementation regime
Practitioner Scheme benefits:
 A personalised referral code (i.e. SMITH25)
 Highest commission on direct orders
 Best discount for your clients
 Free 1-2-1 training with our highly qualified nutrition team
 Free promotional materials for your clients
 Free profile feature on our website
 Over 45% profit on trade orders
 Instant 30 days free credit
 PLUS additional 20% off your first trade order (effective profit
up to 57%)
info@igennus.com
www.igennus.com
01223 421434
31
References
Bosma-den Boer MM, van Wetten ML, Pruimboom L: Chronic inflammatory diseases are
stimulated by current lifestyle: how diet, stress levels and medication prevent our body from
recovering. Nutrition & metabolism 2012, 9:32.
Flock MR, Skulas-Ray AC, Harris WS, Etherton TD, Fleming JA, Kris-Etherton PM: Determinants of
erythrocyte omega-3 fatty acid content in response to fish oil supplementation: a dose-response
randomized controlled trial. Journal of the American Heart Association 2013, 2:e000513.
Harris WS, Von Schacky C: The Omega-3 Index: a new risk factor for death from coronary heart
disease? Preventive medicine 2004, 39:212-220.
.

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Specialist clinical nutrition: an essential adjunct to successful manual therapy

  • 1. Specialist clinical nutrition: an essential adjunct to successful manual therapy Dr Nina Bailey BSc (Hons) MSc PhD
  • 2. • Igennus Healthcare Nutrition are a clinical nutrition specialist providing bespoke support for inflammatory conditions • You don’t need to be a nutrition specialist to make a difference to your client’s health! • Igennus has established relationships with over 50 chiropractors, osteopaths, acupuncturists, reflexologists, massage therapists, personal trainers and fitness instructors…….
  • 3. CFS/ME/FMS • Dr Raymond Perrin (PhD) osteopath, neuroscientist and pioneer of The ‘Perrin Technique’ • The Perrin Technique is a unique lymphatic drainage technique that treats CFS – all Perrin CFS patients are recommended to take 1-2g of Igennus EPA • Igennus collaborates with 96 ‘Perrin Practitioners’ who use this protocol successfully
  • 4. Neurodevelopmental disorders • Robin Pauc – neurologist and chiropractor, founder of the UK renowned Tinsley House Clinic for childhood developmental disorders • Robin Pauc regularly recommends Igennus’ products as an addition to his treatment programmes: • ADHD • Autism • Asperger's • Dyslexia • Dyspraxia
  • 5. • Igennus EPA used by Dave Scott U.S. triathlete and six-time Ironman Triathlon World Champion • Numerous personal trainers use Igennus’ products over generic oils as part of their sports nutrition package - clients get better results:  Modulates inflammation  Immunity support  Cardiovascular support  Joint and bone support  Reduced oxidative stress  Supports energy requirements  Supports lean muscle mass/fat burn  Supports recovery time and performance Our biggest practitioner accounts are manual/physical therapists NOT nutrition specialists….
  • 6. Why do they choose us?  Premium quality ingredients  Scientifically proven formulations  Niche therapeutic target  Highly specialised  Expert support team  Highest purity and lowest contaminants  They really work!
  • 7. • Accident • Injury • Illness • Stress • Tension • Posture issues • Muscle spasm • Over-exertion All result in nerve and muscle damage = short/long term reduced mobility, pain and subsequent secondary issues But most importantly the science…….. Top reason to see a manual therapist: PAIN! Pain due to:
  • 8. • Pain = inflammation = pain – signal that damage is present and protects against worsening • Process of inflammation must be tightly regulated in the body. If not, can lead to unnecessary inflammation and exacerbate pre-existing issues or initiate new ones otherwise non-problematic • Unnecessary inflammation / inability to switch off inflammation = chronic pain and reduced mobility • PLUS very high risk of inflammation ‘spreading’ systemically = increased risk of inflammatory disease
  • 9. Managing pain • Medication – but like fighting an Australian bush fire with oil - if you use enough may put out the flame in the short term but long term MUCH worse • Many pharmaceuticals also have potentially detrimental side effects (i.e. COX-2 inhibitors) • Manual therapy addresses the muscle and nerve issues and restores function to the body to reduce pain and promote mobility • But without addressing the route cause of unnecessary inflammation leads to long term issues and numerous secondary problems
  • 10. What is inflammation? – the normal response of a tissue to injury – triggered by a number of causes including infection, invading pathogens (such as bacteria or viruses), trauma or compromised blood flow – desirable defence mechanism with undesirable side effects – normal inflammatory response has an on/off switch – in chronic inflammation there are issues with down-regulating signals
  • 11. The key to regulating inflammation is through the modulation of eicosanoids: • Pro-inflammatory eicosanoids drive the immune and inflammatory processes • Anti-inflammatory eicosanoids act to end the process • Overproduction of pro-inflammatory products or reduced production of anti-inflammatory products can result in continued production of inflammatory products – the hallmark of silent inflammation
  • 12. Regulating eicosanoids through diet • Eicosanoids are derived from a group of polyunsaturated fats known as omega-6 and omega-3 • The ratio of omega-6 to omega-3 in the diet influences the type of eicosanoid produced • The ratio of omega-6 to omega-3 is commonly associated with health status • The ratio of KEY omega-6 and omega-3 fats AA and EPA gives us a direct indication of inflammatory health
  • 13. • The AA to EPA ratio is an indication of the balance between pro- inflammatory and anti-inflammatory eicosanoids • High AA and low EPA levels will drive the inflammatory response and the subsequent failure to resolve inflammation may increase susceptibility to the development of chronic, low-grade, inflammation-based diseases AA to EPA ratio - biomarker of inflammatory status
  • 14. 0 % 4% 8% 12% Omega-3 index* - biomarker of cardiovascular health Desirable OptimalUndesirable *Harris & Von Schacky, 2004
  • 15. The role of diet and lifestyle in modulating inflammation • Triggers from chronic altered diet and psycho-emotional stress negatively influence the resolution step of the inflammatory response • Failure to resolve inflammation increases susceptibility to the development of chronic, low-grade, inflammation-based diseases due to the constant activation of both the HPA-axis and innate immune system (Bosma-den Boer et al., 2012)
  • 16. Resoleomics - the process of inflammation resolutionInflammatoryresponse Initiation Resolution Termination PGE2 LTB4 Eicosanoid switch Stop signal Time Pro-inflammatory reduced Anti-inflammatory increased Bosma-den Boer MM, van Wetten ML, Pruimboom L: Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering. Nutrition & metabolism 2012, 9:32
  • 17. •Oily fish via diet in decline •A major 1st world dietary deficiency •Supplementation of food necessary – milk, spreads Omegas in food Omegas in dietary Supplements Omegas in medicines Omega-3 transition to medicine
  • 18. Increasing health problems relating to weight issues Flock MR, Rogers CJ, Prabhu KS, Kris-Etherton PM: Immunometabolic role of long- chain omega-3 fatty acids in obesity-induced inflammation. Diabetes/metabolism research and reviews 2013, 29:431-445. Makki K, Froguel P, Wolowczuk I: Adipose Tissue in Obesity-Related Inflammation and Insulin Resistance: Cells, Cytokines, and Chemokines. ISRN inflammation 2013, 2013:139239. Titos E, Claria J: Omega-3-derived mediators counteract obesity-induced adipose tissue inflammation. Prostaglandins & other lipid mediators 2013, 107:77-84. White PJ, Marette A: Is omega-3 key to unlocking inflammation in obesity? Diabetologia 2006, 49:1999-2001. White PJ, Marette A: Potential role of omega-3-derived resolution mediators in metabolic inflammation. Immunology and cell biology 2014, 92:324-330.
  • 19. Omega-3 and bone health Mangano KM, Sahni S, Kerstetter JE, Kenny AM, Hannan MT: Polyunsaturated fatty acids and their relation with bone and muscle health in adults. Current osteoporosis reports 2013, 11:203-212. McMahon MS: Beneficial effect of omega-3 fatty acids on bone metabolism. Orthopedics 2012, 35:735-736. Rousseau JH, Kleppinger A, Kenny AM: Self-reported dietary intake of omega-3 fatty acids and association with bone and lower extremity function. Journal of the American Geriatrics Society 2009, 57:1781-1788. Saidenberg Kermanac'h N, Bessis N, Cohen-Solal M, De Vernejoul MC, Boissier MC: Osteoprotegerin and inflammation. European cytokine network 2002, 13:144-153.
  • 20. Inflammation, omega-3 and rheumatoid arthritis Curtis CL, Rees SG, Little CB, Flannery CR, Hughes CE, Wilson C, Dent CM, Otterness IG, Harwood JL, Caterson B: Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. Arthritis and rheumatism 2002, 46:1544-1553. Sperling RI: Dietary omega-3 fatty acids: effects on lipid mediators of inflammation and rheumatoid arthritis. Rheumatic diseases clinics of North America 1991, 17:373-389. Lee YH, Bae SC, Song GG: Omega-3 polyunsaturated fatty acids and the treatment of rheumatoid arthritis: a meta-analysis. Archives of medical research 2012, 43:356-362.
  • 21. Omega-3 and pain Maroon JC, Bost JW: Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surgical neurology 2006, 65:326-331.
  • 22. • AA and EPA contents of cell membranes can be altered through oral administration of omega-3 EPA • Increasing EPA levels results in a changed pattern of production of eicosanoids • Changing the fatty acid composition of cell membranes also affects immune function and pathways – changes in membrane structure – cell signalling – gene expression of cells and products involved in the inflammatory cascade and pain signalling
  • 23. • As health practitioners, you are perfectly placed to guide patients toward natural co-therapies • Route of inflammation may not just be due to pain/injury issue, as consultation/client history may reveal: • High stress • Fatigue • Neurological disorder • Poor diet and lifestyle • CVD • Low mood • Inflammation is a key driver of a myriad of diseases/conditions
  • 26. Thus, addressing high levels of inflammation by restoring AA to EPA ratio and increasing the omega-3 index will reduce:  Pain  Fatigue  Stress  Risk of modern illness
  • 27. Measuring inflammation and tracking progress • Blood spot fatty acid profiling Omega-6 to omega-3 ratio AA to EPA ratio Omega-3 index • Knowing a client’s baseline omega-3 index allows effective dosing to increase omega-3 index and reduce the AA to EPA ratio Omega-3 index Dose required Body weight Minimum dose Base line Target (mg/kg) (kg) (g) 3 8 0.0222 89 1.98 4 8 0.0172 89 1.53 6 8 0.0072 89 0.64
  • 28. So remember! You don’t need to be a nutrition specialist to make a difference to your clients’ health Our biggest practitioner accounts are manual therapists NOT nutrition specialists….
  • 29.  Expertly formulated EPA supplements to suit all ages and needs  Scientifically proven co-therapies to support long term health  Technical support from MSc Nutrition Specialists  Literature and personalised support for your clients  Fatty acid blood profiling service allows a bespoke and effective supplementation regime
  • 30. Practitioner Scheme benefits:  A personalised referral code (i.e. SMITH25)  Highest commission on direct orders  Best discount for your clients  Free 1-2-1 training with our highly qualified nutrition team  Free promotional materials for your clients  Free profile feature on our website  Over 45% profit on trade orders  Instant 30 days free credit  PLUS additional 20% off your first trade order (effective profit up to 57%)
  • 32. References Bosma-den Boer MM, van Wetten ML, Pruimboom L: Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering. Nutrition & metabolism 2012, 9:32. Flock MR, Skulas-Ray AC, Harris WS, Etherton TD, Fleming JA, Kris-Etherton PM: Determinants of erythrocyte omega-3 fatty acid content in response to fish oil supplementation: a dose-response randomized controlled trial. Journal of the American Heart Association 2013, 2:e000513. Harris WS, Von Schacky C: The Omega-3 Index: a new risk factor for death from coronary heart disease? Preventive medicine 2004, 39:212-220. .

Notas do Editor

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  11. Inflammation is a key player in bone resorption Role for omega-3 in reducing bone and muscle loss with ageing and reduce fracture risk, higher BMD in omega-3 users
  12. Lee = high doses (2.7g) reduces NSAID intake
  13. Our results mirror other controlled studies that compared ibuprofen and omega-3 EFAs demonstrating equivalent effect in reducing arthritic pain. Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this selective group.
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