With more than 400 published randomized trials in orthopedics, the science in targeted clinical nutrition is advancing rapidly and the case for utilizing it as a modality in patient care has become firmly established, including adoption by leading orthopedic hospitals.
Richard: Welcome back to Agile Me a Physical Therapy Leadership podcast series. A Podcast devised to help emerging and experienced therapy leaders learn more about various topics relevant to outpatient therapy services. Today's podcast is titled, “Nutritional Supplements to Assist in the Management of Musculoskeletal Conditions and Improved Postoperative Orthopaedic Outcomes.” Our guest today is Eziah Syed. Welcome. Before we dive into the topic, we'd love to know a little bit about you and your background. I know that you are the founder of CEO of MAND and prior to that you were an Associate Director of Global Strategy and Innovation at Deloitte. But I'd love to have a little bit more colour perhaps for the listeners.
Eziah: Yeah, sure. I am actually Canadian by origin, so I grew up in a small town, two hours east of Toronto called Kingston, which is actually one of the first capitals of Canada. In my youth, there was a very active sportsperson who played sort of national-level basketball and was involved in many, many, many sports. Did most of my schooling in the post-high school in the Toronto area. I did my MBA in undergraduate and business psychology. Then I was doing my MBA, I got recruited by Citibank. They were on a campus, and I got a job in New York and have really been there since 2003, working in a variety of different roles in strategy and innovation for large enterprises like Deloitte and City. But I've also worked as an entrepreneur. So I helped my brother start three physical therapy practices, which are now flourishing in Manhattan and also spent some time at a really exciting tech startup as a leading product strategy at that firm.
Richard: That's remarkable. I didn't realize you've been involved directly in the PT space. I know we've kind of chatted, but direct experience is fantastic. So, what happens at the cold face as such?
Eziah: Yeah. I mean, everything from helping my brother to think through his business plan, to designing the website, to thinking through patient flows and patient experience and all those types of things.
Richard: Hopefully you are safe and your brother's safe in New York and the worst of the pandemic is over.
Eziah: Yeah. Thank you very much for asking. It was bleak and certainly very dark at times, but I think New York is turning the corner. Every time I go into the city now there are more, more and more people on the street. It's more and more energy, and I think the warm weather is also helping people's moods hopefully we're past the worst.
Richard: So, as we dive in, obviously clinicians have very little understanding, knowledge, and education as it pertains to nutrition. For instance, when I trained, I think there are probably two lecturers and I think I probably slept through them because they were useless. Anyway, so to help clinicians and PT listeners. What do we mean when we say nutritional supplements?
Eziah: Yeah. First, let me just say, I think this conversation that we're having is emblematic of the conversation that's taking place across orthopaedic departments and hospitals as I've been in leading hospitals over the course of the past four years, and nutrition becoming a very hot topic. And the reason for that is science now has become very well established. So, when we say nutritional supplements, what we mean is typically in the normal course of a diet, many folks are simply not getting the nutrients they need from the diet alone. So, our whole mantra of eating healthy unfortunately is falling on deaf ears. So, for example there was a very large study done by the Journal of Nutrition which surveyed 16,000 American persons. What they found was that there were deficiencies and key micronutrients across the board, like very significant deficiencies. And the study, exhaustive, concluded that while we're overfed as a society, we're really under nerves. So, the quality of the food that we're eating is just insufficient. And so, what supplements, there are different classes of supplements. Men is a clinical nutrition company. We're very focused on clinical indications and outcomes and how we can influence those. But really, supplements are not to replace a diet, but to augment a diet. So, if we're deficient, can we utilize a nutritional supplement to actually address some of those deficiencies? And so used intelligently, there's a very important role that nutritional supplements can play in augmenting diets.
Richard: I find it's almost criminal. The fact is that the US is a highly developed country relative to most countries or a lot of countries, and it's remarkable that we are talking about malnutrition and dietary issues associated with the general population, not only with regards to maintaining healthy being, but then kind of addressing or assisting with pathology or injuries or any type of morbidity of any sort, is it?
Eziah: Yeah, the stats are quite staggering. 86% of our costs in our healthcare system are going towards treating chronic conditions, and only 3% are going towards preventing them. Roughly 12% of the population has more than four or five chronic conditions. Roughly 40% have two chronic conditions. So, the system as it is not getting the job done. We have pockets of excellence, but our healthcare system isn't advancing, in good health despite our best efforts. So, I think we need some changes, and there's a very certainty in orthopaedics. 50% of people are going into physical therapy or surgery, malnourished and that's been shown through numerous studies that lead to poor outcomes. So, there's certainly a very important role that we can define for targeted supplementation that will help improve healthcare in general.
Richard: I am glad you brought up the issue of preoperative nutritional supplementation because my wife had two hip replacements. It's been a little while since I've been in full-time treatment, and I was very surprised that that had become part of the pre-op routine. I was impressed in many ways but surprised by the fact that society was at a point where it was deemed appropriate to facilitate better outcomes. To dive into that point a little bit, what specific nutritional supplements are helpful in the management of muscle fetal conditions?
Eziah: Yeah, there's several nutrients that are commonly studied. Everything from, antioxidants, vitamins, and minerals, to some of the core ones, are amino acids, essential fatty acids, and proteins. There have also been studies done on botanicals, such as tumours for their anti-inflammatory values. So, there have been now 400 studies published in clinical trials in the orthopaedics domain across several different indications, and we can certainly dive into some of those to talk about the specific outcomes that were derived. I can tell you that when we started to speak to leading hospitals roughly four years ago, we started with men. Nutrition wasn't a hot topic, but when I go in today, invariably the leaders in orthopaedics are telling me, we know this is important. We're behind in this domain or we must catch up in this domain. So perioperative nutrition is going to become the standard of care. Many of the leading hospitals have already implemented it. We spoke to Geisinger in a panel that we had the other day. The leader there, Dr Michael Shook, has said that they reduced their length of stay by 50% and saved 1.5 million for the hospital just through nutritional intervention strategies. So, this is becoming a very, very important topic.
Richard: It's interesting how healthcare is changing as it pertains to almost taking a step back and what I recall, going back to basics instead of focusing on high-tech solutions necessarily to try and drive outcomes they're looking at. What I would say is very simple solutions or enhancements in the care through, for instance, as we're talking about nutritional supplements, and it's remarkable the level of impact that nutritional supplements can have in this instance, isn't it?
Eziah: Yeah, in a very short duration. So, when you can deliver, we really do, or we are as a company living the mantra of food as medicine, but we can now bring a new level of science and rigour that previously hasn't been applied to the domain to really demonstrate that we can get hard scientific outcomes as a result of this. So, this is truly looking at natural compounds versus synthetic ones. The whole world of pharma fell in love with synthetic compounds. I think part of the reason for that is you can patent them and when you can patent things, you can extract a lot of profit from the system. In our case, what we're saying is there is a lot of evidentiary data that natural compounds can do wonderful things for health. Now we need to bring a new level of scientific rigour to study these natural compounds and get them out to the public in an easily consumable fashion. So, this whole, again mantra of just eating well, it only works for our percentage of the population that's very disciplined. So, can we create easy-to-use solutions that'll have a real impact utilizing organic natural compounds and not synthetic ones? And it seems the simplest area to look at. We've been preaching food is medicine, or we've understood the relationship between food and medicine for our entire human history. But only now are we really starting to apply for heart science and show, quantitative results.
Richard: Obviously, as you say, pharma has been dominant really. In many respects and nutritional supplements, either rightly or wrongly have kind of taken a backseat somewhat, and I think perhaps some of that might be a result of limited scientific evidence in the past, but that sounds as if it's changed significantly. What type of scientific research studies have been done regarding the use of nutritional supplements for recovery?
Eziah: Well, they cover quite a broad domain. Not just postoperatively, but everything from sort of bone soft tissue healing just in the sort of PT context, immune response, the sarcopenia and reversing muscle wasting to return of function in the postoperative patient setting. So, I can give you sort of some examples. One of the things that's common in knee replacements is a patient might get very significant muscle atrophy and weakness that can persist for years and a decent per percentage of patients get this. So, the orthopaedic community has looked-for high-tech solutions to this, and we've spoken to surgeons, said, we try to solve this using stem, nothing worked. So, we have demonstrated through an intervention that you can preserve in the pre postop period, and the muscle will function faster or better, and so you can actually get return to function much faster using this particular intervention in seven days pre op. On the day of surgery, we showed reduction in inflammatory markers. We showed better muscle proliferation of muscle T cells and then postop faster return to function. And that's just a short one week, pre two weeks post intervention. So, there are several studies like this. There are now 400 published, trials in orthopaedics and the number have been increasing dramatically year over year. We have ourselves just now just shy of a dozen trials advance just as a company.
Richard: These scientific studies are published in mainstream scientific literature, correct?
Eziah: Correct. So our studies been published in the Journal of Bone and Joint Surgery, which is sort of the academic standard in orthopaedics in the Journal of Clinical Investigation in Human Physiology, not to mention other journals. So, these are highly respected peer review journals that these studies are being published in. We'll continue the conversation after a short music break and advertisement. Agile EMR is a comprehensive all in one electronic medical record solution created by physical therapists or physical therapists. Features include everything you need to run your physical therapy practice in one place. To schedule a demonstration of Agile EMR, visit our website at www.agiletherapyemr.com
Richard: Welcome back to Agile and Me a physical therapy leadership podcast. What do you believe is an appropriate protocol? So if we stick with say, hip knee replacements, the increasingly common surgery and the numbers of those surgeries are expected to increase significantly with the baby boomers as it pertains specifically to nutritional supplements pre-op. What type of protocol are you seeing or does the research show.
Eziah: Yeah, it varies across the conditions, Richard. So, in the joint replacement studies that there have now a handful of very respective studies, the most recent one was done out of Japan. We're happy about that because whenever there's an independent verification of one of our interventions, the approach that we're taking, that really, I think, it’s a good thing to have in our space because it just validates the approach. That one won the award from the ME Society. Very prestigious award for the quality of the design of the study. The interventions have typically started one week pre-operation and then lasted anywhere from two weeks to six weeks post. The intervention that we currently have deployed in joint replacement is showing results as early as two weeks post. Depending on the level of the trauma, what we're trying to achieve, the intervention can go longer post-surgery. Certainly, there can be advantages to continuing a maintenance program. The job of healing is not done in the acute period as a leader in physical therapy. Healing continues almost daily. So certainly, maintenance is an important consideration and that can continue post the acute phase of recovery.
Richard: If we kind of dive into the weeds a little bit. How do the nutritional supplements themselves help? Why do they help? Why do we believe, or why do we think that they help with Musculoskeletal Recovery?
Eziah: When a person's injured his/her, nutritional needs increase quite dramatically. 20 to 50% increase in the metabolic rate. And the body's and needs for energy to repair the tissues just increase quite significantly depending on the level of severity of the trauma. So, when we talked about earlier about the nutritional deficiency this is the increase in need above the baseline for a normal, healthy person. So, if you think about the malnourished person, it's not getting sufficient nutrients. It's a big nutrition gap that must be addressed. These targeted interventions try to do is address that nutritional gap to ensure that the person's metabolic needs are addressed and there can be specific delivery of nutrients out late in tissue healing. So, there have been several immunotherapy studies that show improved wound healing and lower risk of infection. As an example, a number of studies shows that we can actually preserve muscle. One week of lying in a bed post-surgery leads to consider. Muscle atrophy. A lot of people don't really think about that. If I take something that reduces that muscle atrophy, can I get back up on my feet faster? I personally started mend because I had a bone fracture that was very slow to heal. I was at the 11-week mark still experiencing pain in my foot, went back to my podiatrist. He showed through the scans that the bone hadn't fully healed and it typical. A stress fracture is healing in six to eight weeks. In my case, I'm three weeks past that. That has a very significant impact on my quality of life. I was going absolutely stir crazy, and if my podiatrist was aware that there were evidence-based products that can help support bone healing, why not recommend that to the patient? It's another clinical modality, and I think that's the important thing to convey to the physical therapy community is that this is real. This is hard science. This is a clinical modality no different than your STEM unit or your other modalities that you're using in the physical therapy environment. If you're focused on getting the best possible outcomes for your patient. It's incumbent on PTs to become aware of the research and the science and be able to address patient needs and wants. We've conducted a survey with patients 1300 patients in the physical therapy realm. 91% said that they believe nutrition is very important to their physical therapy. The same 91% said that they want their physical therapists recommending a solution. So, this is coming. Patients are clever, they're aware of the role of nutrition and healing. You're educated, they're reading about it. We're certainly going to be doing a lot of education, and so clinicians are going to get more and more questions about this. And we think it's an important clinical modality to be utilizing.
Richard: The point that I think is interesting as well is the fact that these nutritional supplements aren't there to negate any other component of care. It is a, in addition to, isn't it? It's not as if it's an either or yeah. But it's a part of a comprehensive management. Is that right?
Eziah: Absolutely. This is multimodal care patients. This is not to replace anything else. I think as you've observed and mentioned, this is really about looking at this as a modality, as a part of a multi-pronged approach to treating the patient. And it's also important to note that we're as a company, we're not advocating that suddenly PTs recommend solutions for patients because they're diabetic. That's not your role. You're treating musculoskeletal conditions. And this is all about utilizing nutritional interventions intelligently to treat musculoskeletal conditions and not about kind of stepping outside of that domain. And there's now a huge body of PTs can rely on that shows reduce inflammation, reduce pain, increase joint mobility, acceleration in repairing the damaged tissue, reversing sarcopenia, enhancing bone health, improving muscle function and quality. All these things that go directly into the Musculo glial realm. That's what we're advocating for.
Richard: Based on the benefits that really, you've just mentioned. The idea of just using nutritional supplements pre and postoperative is only a very small component, isn't it really? We should be thinking of nutritional supplements perhaps for all conditions, be they operative or non-operative since such a high proportion of population is malnutrition.
Eziah: 100% Right. So, I didn't have a surgery, I had a stress fracture, and I was experiencing pain 11 weeks and the bone hadn't healed. Why? Because I was nutritionally compromised. Why not? It's not because I don't get sufficient food. I eat three meals at the, I eat quite extravagantly many times. But I was still nutritionally compromised and that slowed down the bone healing. So, this is about treating a wide variety of muscle conditions and making sure. Again, more than 50% of the population is malnourished. That is going to create poorer outcomes. And so, we need to do something about that. And this is one of the modifiable risk factors that we can intervene on. And it must, it must be done to give better, better patient outcomes.
Richard: When I look back, I'm confident that majority of patients would probably have benefit from nutritional supplements, recommendation for myself, but through lack of knowledge, ignorance, and perhaps lack of academic literature years ago. I never felt comfortable, confident. I always thought it was perhaps voodoo in some respects, but that's completely changed, hasn't it? Now with the, as you say, with 400 plus studies and it, it's beginning to enter mainstream. I think attitudes are changing, aren't they? And I think they must change even further by the sounds of it.
Eziah: Yeah, I think some of the cynicism is well deserved and well founded because the industry quite frankly hasn't done itself any favours by allowing products to be sitting on store shelves that have virtually no real hard evidence. So, we're endeavouring to create a completely new class of nutritional supplements that we're calling sort of pharma minded clinical nutrition that is very targeted and backed by real evidence. So, we have a study, for example, that's underway with Mayo Clinic and obviously the number one hospital in the world, perennial. Yeah, the world has come a long way in this realm. There are very high-quality studies that clinicians, my brother cares about patient outcomes first and foremost, and he cares about hard science and evidence, and I know that all clinicians do. They're evidence-based folks. They're trained scientists. So there is a reliable body of science and evidence that PTs can now look to say, yes, I'm making a recommendation based on hard facts and data and science and not in a realm that is not understood.
Richard: Clinicians should feel comfortable, shouldn't they? That for instance with the men product there's been, and there is, and there will continue to be academic rigor applied to it, to how it's used, and then the outcomes associated with.
Eziah: Yes, we have studies advancing with the best orthopaedic hospitals in the world, Mayo Hospital for Special surgery Penn Medicine among others. So when they look at our data and our science and our products, they can feel very confident that not only is it backed by good science and good studies, but it's actually being utilized in hospital with the leading orthopaedic surgeons the folks that are referring them to patients. So, there will be an expectation, I believe, from orthopaedic surgeons that their patients are getting the best level of care from their PTs, and this is a modality that they're comfortable with and they're implementing. So, it would be a natural extension that PTs would do the same.
Richard: So, by the sense of it, there are various studies that you are actively engaged, involved with it now. Would you be able to perhaps highlight one or two that are relevant perhaps for the therapist and what they're looking at and what we are hoping to do?
Eziah: Sure. We had so obviously the study with Mayo that's currently underway and about to complete is taking the intervention that we've demonstrated in the total joint population that preserves muscle and has faster return to function to see if we can kind of lift those results and reproduce them in the new arthroscopy population. So that is very much a period postop surgical study booking at. What can be done in that population? With Penn, what we're advancing is a blood albumin study. So, blood album, low blood albumin has been shown to be an independent risk factor in patients with higher morbidity, poor outcomes in general. So, we're looking at a study to demonstrate that you can correct blood albumin utilizing our solution. We had a university sports medicine, very leading university on the East coast reached out to us and said, we're very interested in studying mend on for neuromuscular issues particularly for PS populations, so we can do a controlled release of the essential amino acids and create better motor function. So, we're going to be working with them to advance that study. That's a very exciting domain that we've been thinking about for quite some time on. How can you utilize some of these interventions to create better muscle function in, in folks that, that have compromised by neuromuscular diseases. So that gives you kind of a flavour of sort of a cross section of the types of things we're looking at. We also have a product we'll be introducing soon. Just a daily inflammation product. In fact, by good signs and studies that shows that you can impact low level inflammation in the average person by just taking sort of one pill a day of a natural set of compounds. We're really excited about these. We think they're going to make a real difference in people's lives, and particularly, for clinicians that are trying to get good outcomes for patients.
Richard: How can outpatient therapists educate patients and promote the utilization of nutritional supplements?
Eziah: It's kind of a two-part journey. The way that we look at it is men must do its job of making sure that the public is aware of the very critical role. We think the end is missing from that. And so, we want to educate the population that whenever you're thinking about healing and recovery, don't just think about rest. Ice compression, elevation. Think about nutrition. So, we're creating an Ackerman nicer. And so, we'll do our job. So over time, we believe patients will be coming in more and more asking about the role of nutrition if they aren't already. Furthermore, we've created a variety of different educational tools for patients that can be leveraged. So, we have everything from product literatures to videos to a magazine that focuses on healing stories and education. So, we make all these tools available for, for PTs because we know many PTs aren't, don't feel comfortable talking about nutrition because they're not educated in the realm. But utilizing our tools, it becomes an easy conversation because patients come in pre-exposed to the information and if, if PTs are familiar with just some of the clinical studies that have been published, they can then just have a very natural dialogue with the patient on why this is important and the products that they might recommend that they. We'll continue the conversation after a short music break and advertisement. Most orthotic manufacturers take a one shape fits all approach to solving lower body pain and symptoms. They focus on arch support for temporary pain relief, which can end up leading to inefficiencies and injuries. That's where Bio Correct is different, more than just an insert. Bio Correct is a fully customizable foot orthotic system engineered to address and treat biomechanical imbalances of the entire body and we're backed by more than 25 years of experience. To learn more, visit us at biocorrect.com
Richard: Welcome back. As a clinician, as part of the plan of care or the discussion with the patient. Obviously, we've got the conversation specific to doing, performing certain movements or avoiding certain activities, et cetera. And we talk about sleep, importance of rest. I think the natural progression isn't it. By the sound of it is to talk about nutrition as supplements as well. I think that's a natural progression to the convert the larger conversation, isn't it?
Eziah: Yeah. We think that's our core thesis is that it really is an essential part of the conversation. You ignore nutrition at the, at the risk of ignoring, the best outcomes that you can get for the patient. Now remember, we have passed a very high threshold of scientific credibility and being accepted into hospital formularies. What that means, Hospital panel board reviewed men science, reviewed operational considerations, risk considerations, and said we want to purchase this and give it to our patients because we believe in driving best the best patient outcomes that we can drive. So, hospitals are doing it, leading orthopaedic surgeons are doing it. This is coming as a domain and it's incumbent on PTs to become more and more aware. Of this this domain because it's a natural conversation to be having with patients.
Richard: I think that you raised a good point. I think the fear of clinicians is to promote a supplement that doesn't have the level of quality control that we are really talking about here. I know that your product does based on the scientific evidence and literature and studies that have been completed, but that is a fear, isn't it? The therapist must be very careful.
Eziah: They absolutely do. I mean they're, again, knowing my brother's mindset, he's an evidence-based guy. He wants to see the data and the science and the quality before he recommends anything to his patient. The last thing he wants is the patient to have a bad outcome and then go and complain to the orthopaedic surgeon to say, Hey I took this, and this is what he recommended to me. And then the orthos caught blindsided. But what should give PTs comfort? This has met the highest high standards and thresholds they can take cover, if you will, to say, look, this is being utilized in several different hospitals. Leading orthopaedic surgeons from chiefs of departments on down are recommending this to their patients. And furthermore, we've not in the last four years had a single adverse outcome. And that's the nice thing when you take a pharmaceutical drug, there's 400 different warnings on other things that can happen to you that'll adversely impact you. And there's sort of the one benefit with natural compounds. You don't find that; you don't find sort of the body's ability to process these things that exist in nature don't create additional risks. So, we haven't seen any adverse outcomes as a result of our products. So, I think they, they can take a lot of comfort in that.
Richard: That's an important point for, for patients just general consumers, isn't it? The fact that this is a natural substance compound, and the risks are, Negligible. I wouldn't say there is never any risk but certainly, based on what you've seen is negligible. I think that that's great point. Till nutritional supplements become a standard of care. Physical therapists can have the conversation with their patients because obviously most patients are managed by physicians, orthopaedic physicians or whomever, depending on the condition that's presenting to the therapist and whilst there's an increasing acknowledgement of nutritional supplements helping with musculoskeletal care there's going to be scepticism within the surgeons and physicians themselves. How do you think the clinicians going to perhaps tackle that in itself?
Eziah: That’s part of our job as well as a company. So that's why we had a panel discussion just a week ago with leaders from Mayo, HSS, Geisinger Penn, to really talk about this, this topic and how important it is. These were chiefs of departments in orthopaedics discussing the critical role for targeted clinical nutrition. So that this is not something Richard, I believe, that we're going to achieve overnight. It's going to have to be a sustained effort over time to make this. So you can certainly, if a PTs interested in this domain, sign up for one of our newsletters where we weekly or biweekly, will be sending you the summary of the latest research so that you as a clinician can stay on top of it, be aware of it, and being able to have. And meaningful conversation with your patients. We've also heard loud and clear from PTs that, look, I'm not a trained dietician, so how do I deploy this? And so, we've made very simple cheat sheets. So, if it's this indication you recommend this product, if it's this other indication you recommend this product. So, it just becomes as simple as being aware of the two or three key or four key products that we have, the science that backs it, being able to recommend that for, for the patients. So, we know we need to make it simple. We know that we need to get the science out to as many physicians as possible. We're actively working on several things to educate the domain. Like I said, I think given the adoption by certain of the most important hospitals, this invariably will get more and more traction in the marketplace and someday become standard.
Richard: We've talked significantly about the academic papers and scientific literature. How would our listeners and clinicians go about finding information specific to the clinical trials you, you've mentioned today?
Eziah: Yeah, we've created an entire binder of research that we can easily email out to the clinicians. So, if you want to just kind of go to the website med.me Sign up or send us an info request. From there saying that, I'd love to look at some of the clinical research. We'll, we'll send you out the summaries that we've packaged up. Now, keep in mind there's a lot of clinical literature. This is a big document, but it summarizes for you some of the key studies that have been conducted. We think we need more champions just like this podcast of folks that are starting the conversation and making folks understand how critical this is. And over time more and more clinicians will be educated as well, patients.
Richard: I would imagine the papers that you have would be able to assist not only educating patients, but even actually educating physicians in certain instances.
Eziah: Oh yeah. We've, we designed specific documents that are for physicians. So, PT’s can just send it off to their physician and say, you're the clinical trials that support this particular product. And we found that to be very many of our PTs are in fact doing that. They're sending the literature on to the referring physician so that there is alignment between the two on the tools that are being utilized.
Richard: The podcast is specifically for physical therapy leaders, even though I'm sure treating clinicians will be listening and as leaders, as owners of practices, I think the, one of the questions is can nutritional supplements, can they add as an additional revenue stream and, and how might that work?
Eziah: Yeah, the emphatic answer is yes. Not only is it permissible, but given that the clear established body of science, we think it's critical for PTs to view this as something that they need to offer in clinic. So that we really separate the argument into sort of two. There's one is the clinical argument, which we always start with, and that's really been sort of the focus of this podcast, but there's a business model argument as well, so, Like I said, in our survey of 1300 patients, 91% said that they want their PT to recommend at nutrition products. So, you already have the permission from the patient. So rather than going down into the CVS or Walgreens stores with products that don't have any clinical trials supporting them they want to come to use a professional. second, a PTA has put nutrition in scope of practice as they recognize, just as we've discussed on this call, just how important it's to get a good patient outcome. So, it's in scope of practice. They're actively encouraging you to have a nutrition conversation with the patients. There is a set of criteria that needs to be met for this to be. Allowable by the FDA first, there needs to be a clear scientific basis for the recommendation. So, what we've said earlier is you shouldn't be trying to treat diabetes because that is not a musculoskeletal condition. But if you're trying to treat a musculoskeletal condition and there's evidence behind a product, it is 100% permissible that you can make money off that product, provided you make a disclosure. So somewhere in your literature that you're passing onto the patient, it must say that you have a financial interest in it and that the products are available elsewhere. So, you can't be the sole distributor of that product. So, if those conditions are met that there's a scientific basis, there's a disclosure somewhere, and you're not the sole distributor, this is FDA compliant. A PTA is saying, you should be doing it 91% of your patients are saying that you can be doing it. And we made it simple and given the headwinds in his business, his costs of labour are going up, his rent is going up, and yet the insurance companies keep cutting rates on him. And so, the business models never remain static. Business models always evolve, and we think it's important. PTs, I spend time with my brother talking about business model evolution to really look at this as a clinically necessary, but also business model, necessary evolution of their business. And if that can be done, we think this can add a very important revenue stream that is totally consistent with what patients are asking.
Richard: Interesting. A lot of clinics I think, are exploring the concept of providing nutritional counselling, but I think equally important is. Promotion of academically supported quality control, nutritional supplements isn't.
Eziah: Yeah, the nutritional counselling’s all about, more about sort of lifestyle and getting the persons nutrition, sound in general. What we're really talking about here is orthopaedic outcomes. I really want to make that distinction clear, is that we're not talking about a person's general nutritional status. Making them, that's the really the job of a RD. What we're talking about here is you can utilize very targeted delivery of nutritional supplements to get better outcomes, and that we think is very essential, important modality for PTs to utilize. It's certainly fine if PTs want to expand and offer nutrition counsel, as, another service offering within their umbrella. A lot of practices are beginning. Offer other types of expert expertise and care. But that's not really what we're talking about. We're talking about core to the business model of MSK outcomes. This is an essential new modality and modality that one can make money from and improve the health of their business. So that's really what we're focused on.
Richard: We could talk all day about this, and unfortunately, we're running out time. What final thoughts, suggestions, or knowledge would you like to impart to the listeners as before we leave?
Richard: Thank you so much for spending some time today talking about nutritional supplements. I've certainly learned a lot and I believe that it is an important part, like you are advocating in the care of physical therapy patients and I'm hopeful that it will become another tool in the, in the toolbox and helping our patients gain optimal function and outcomes. So thank you.
Podcast Transcript
Richard: Welcome back to Agile Me a Physical Therapy Leadership podcast series. A Podcast devised to help emerging and experienced therapy leaders learn more about various topics relevant to outpatient therapy services. Today's podcast is titled, “Nutritional Supplements to Assist in the Management of Musculoskeletal Conditions and Improved Postoperative Orthopaedic Outcomes.” Our guest today is Eziah Syed. Welcome. Before we dive into the topic, we'd love to know a little bit about you and your background. I know that you are the founder of CEO of MAND and prior to that you were an Associate Director of Global Strategy and Innovation at Deloitte. But I'd love to have a little bit more colour perhaps for the listeners.
Eziah: Yeah, sure. I am actually Canadian by origin, so I grew up in a small town, two hours east of Toronto called Kingston, which is actually one of the first capitals of Canada. In my youth, there was a very active sportsperson who played sort of national-level basketball and was involved in many, many, many sports. Did most of my schooling in the post-high school in the Toronto area. I did my MBA in undergraduate and business psychology. Then I was doing my MBA, I got recruited by Citibank. They were on a campus, and I got a job in New York and have really been there since 2003, working in a variety of different roles in strategy and innovation for large enterprises like Deloitte and City. But I've also worked as an entrepreneur. So I helped my brother start three physical therapy practices, which are now flourishing in Manhattan and also spent some time at a really exciting tech startup as a leading product strategy at that firm.
Richard: That's remarkable. I didn't realize you've been involved directly in the PT space. I know we've kind of chatted, but direct experience is fantastic. So, what happens at the cold face as such?
Eziah: Yeah. I mean, everything from helping my brother to think through his business plan, to designing the website, to thinking through patient flows and patient experience and all those types of things.
Richard: Hopefully you are safe and your brother's safe in New York and the worst of the pandemic is over.
Eziah: Yeah. Thank you very much for asking. It was bleak and certainly very dark at times, but I think New York is turning the corner. Every time I go into the city now there are more, more and more people on the street. It's more and more energy, and I think the warm weather is also helping people's moods hopefully we're past the worst.
Richard: So, as we dive in, obviously clinicians have very little understanding, knowledge, and education as it pertains to nutrition. For instance, when I trained, I think there are probably two lecturers and I think I probably slept through them because they were useless. Anyway, so to help clinicians and PT listeners. What do we mean when we say nutritional supplements?
Eziah: Yeah. First, let me just say, I think this conversation that we're having is emblematic of the conversation that's taking place across orthopaedic departments and hospitals as I've been in leading hospitals over the course of the past four years, and nutrition becoming a very hot topic. And the reason for that is science now has become very well established. So, when we say nutritional supplements, what we mean is typically in the normal course of a diet, many folks are simply not getting the nutrients they need from the diet alone. So, our whole mantra of eating healthy unfortunately is falling on deaf ears. So, for example there was a very large study done by the Journal of Nutrition which surveyed 16,000 American persons. What they found was that there were deficiencies and key micronutrients across the board, like very significant deficiencies. And the study, exhaustive, concluded that while we're overfed as a society, we're really under nerves. So, the quality of the food that we're eating is just insufficient. And so, what supplements, there are different classes of supplements. Men is a clinical nutrition company. We're very focused on clinical indications and outcomes and how we can influence those. But really, supplements are not to replace a diet, but to augment a diet. So, if we're deficient, can we utilize a nutritional supplement to actually address some of those deficiencies? And so used intelligently, there's a very important role that nutritional supplements can play in augmenting diets.
Richard: I find it's almost criminal. The fact is that the US is a highly developed country relative to most countries or a lot of countries, and it's remarkable that we are talking about malnutrition and dietary issues associated with the general population, not only with regards to maintaining healthy being, but then kind of addressing or assisting with pathology or injuries or any type of morbidity of any sort, is it?
Eziah: Yeah, the stats are quite staggering. 86% of our costs in our healthcare system are going towards treating chronic conditions, and only 3% are going towards preventing them. Roughly 12% of the population has more than four or five chronic conditions. Roughly 40% have two chronic conditions. So, the system as it is not getting the job done. We have pockets of excellence, but our healthcare system isn't advancing, in good health despite our best efforts. So, I think we need some changes, and there's a very certainty in orthopaedics. 50% of people are going into physical therapy or surgery, malnourished and that's been shown through numerous studies that lead to poor outcomes. So, there's certainly a very important role that we can define for targeted supplementation that will help improve healthcare in general.
Richard: I am glad you brought up the issue of preoperative nutritional supplementation because my wife had two hip replacements. It's been a little while since I've been in full-time treatment, and I was very surprised that that had become part of the pre-op routine. I was impressed in many ways but surprised by the fact that society was at a point where it was deemed appropriate to facilitate better outcomes. To dive into that point a little bit, what specific nutritional supplements are helpful in the management of muscle fetal conditions?
Eziah: Yeah, there's several nutrients that are commonly studied. Everything from, antioxidants, vitamins, and minerals, to some of the core ones, are amino acids, essential fatty acids, and proteins. There have also been studies done on botanicals, such as tumours for their anti-inflammatory values. So, there have been now 400 studies published in clinical trials in the orthopaedics domain across several different indications, and we can certainly dive into some of those to talk about the specific outcomes that were derived. I can tell you that when we started to speak to leading hospitals roughly four years ago, we started with men. Nutrition wasn't a hot topic, but when I go in today, invariably the leaders in orthopaedics are telling me, we know this is important. We're behind in this domain or we must catch up in this domain. So perioperative nutrition is going to become the standard of care. Many of the leading hospitals have already implemented it. We spoke to Geisinger in a panel that we had the other day. The leader there, Dr Michael Shook, has said that they reduced their length of stay by 50% and saved 1.5 million for the hospital just through nutritional intervention strategies. So, this is becoming a very, very important topic.
Richard: It's interesting how healthcare is changing as it pertains to almost taking a step back and what I recall, going back to basics instead of focusing on high-tech solutions necessarily to try and drive outcomes they're looking at. What I would say is very simple solutions or enhancements in the care through, for instance, as we're talking about nutritional supplements, and it's remarkable the level of impact that nutritional supplements can have in this instance, isn't it?
Eziah: Yeah, in a very short duration. So, when you can deliver, we really do, or we are as a company living the mantra of food as medicine, but we can now bring a new level of science and rigour that previously hasn't been applied to the domain to really demonstrate that we can get hard scientific outcomes as a result of this. So, this is truly looking at natural compounds versus synthetic ones. The whole world of pharma fell in love with synthetic compounds. I think part of the reason for that is you can patent them and when you can patent things, you can extract a lot of profit from the system. In our case, what we're saying is there is a lot of evidentiary data that natural compounds can do wonderful things for health. Now we need to bring a new level of scientific rigour to study these natural compounds and get them out to the public in an easily consumable fashion. So, this whole, again mantra of just eating well, it only works for our percentage of the population that's very disciplined. So, can we create easy-to-use solutions that'll have a real impact utilizing organic natural compounds and not synthetic ones? And it seems the simplest area to look at. We've been preaching food is medicine, or we've understood the relationship between food and medicine for our entire human history. But only now are we really starting to apply for heart science and show, quantitative results.
Richard: Obviously, as you say, pharma has been dominant really. In many respects and nutritional supplements, either rightly or wrongly have kind of taken a backseat somewhat, and I think perhaps some of that might be a result of limited scientific evidence in the past, but that sounds as if it's changed significantly. What type of scientific research studies have been done regarding the use of nutritional supplements for recovery?
Eziah: Well, they cover quite a broad domain. Not just postoperatively, but everything from sort of bone soft tissue healing just in the sort of PT context, immune response, the sarcopenia and reversing muscle wasting to return of function in the postoperative patient setting. So, I can give you sort of some examples. One of the things that's common in knee replacements is a patient might get very significant muscle atrophy and weakness that can persist for years and a decent per percentage of patients get this. So, the orthopaedic community has looked-for high-tech solutions to this, and we've spoken to surgeons, said, we try to solve this using stem, nothing worked. So, we have demonstrated through an intervention that you can preserve in the pre postop period, and the muscle will function faster or better, and so you can actually get return to function much faster using this particular intervention in seven days pre op. On the day of surgery, we showed reduction in inflammatory markers. We showed better muscle proliferation of muscle T cells and then postop faster return to function. And that's just a short one week, pre two weeks post intervention. So, there are several studies like this. There are now 400 published, trials in orthopaedics and the number have been increasing dramatically year over year. We have ourselves just now just shy of a dozen trials advance just as a company.
Richard: These scientific studies are published in mainstream scientific literature, correct?
Eziah: Correct. So our studies been published in the Journal of Bone and Joint Surgery, which is sort of the academic standard in orthopaedics in the Journal of Clinical Investigation in Human Physiology, not to mention other journals. So, these are highly respected peer review journals that these studies are being published in. We'll continue the conversation after a short music break and advertisement. Agile EMR is a comprehensive all in one electronic medical record solution created by physical therapists or physical therapists. Features include everything you need to run your physical therapy practice in one place. To schedule a demonstration of Agile EMR, visit our website at www.agiletherapyemr.com
Richard: Welcome back to Agile and Me a physical therapy leadership podcast. What do you believe is an appropriate protocol? So if we stick with say, hip knee replacements, the increasingly common surgery and the numbers of those surgeries are expected to increase significantly with the baby boomers as it pertains specifically to nutritional supplements pre-op. What type of protocol are you seeing or does the research show.
Eziah: Yeah, it varies across the conditions, Richard. So, in the joint replacement studies that there have now a handful of very respective studies, the most recent one was done out of Japan. We're happy about that because whenever there's an independent verification of one of our interventions, the approach that we're taking, that really, I think, it’s a good thing to have in our space because it just validates the approach. That one won the award from the ME Society. Very prestigious award for the quality of the design of the study. The interventions have typically started one week pre-operation and then lasted anywhere from two weeks to six weeks post. The intervention that we currently have deployed in joint replacement is showing results as early as two weeks post. Depending on the level of the trauma, what we're trying to achieve, the intervention can go longer post-surgery. Certainly, there can be advantages to continuing a maintenance program. The job of healing is not done in the acute period as a leader in physical therapy. Healing continues almost daily. So certainly, maintenance is an important consideration and that can continue post the acute phase of recovery.
Richard: If we kind of dive into the weeds a little bit. How do the nutritional supplements themselves help? Why do they help? Why do we believe, or why do we think that they help with Musculoskeletal Recovery?
Eziah: When a person's injured his/her, nutritional needs increase quite dramatically. 20 to 50% increase in the metabolic rate. And the body's and needs for energy to repair the tissues just increase quite significantly depending on the level of severity of the trauma. So, when we talked about earlier about the nutritional deficiency this is the increase in need above the baseline for a normal, healthy person. So, if you think about the malnourished person, it's not getting sufficient nutrients. It's a big nutrition gap that must be addressed. These targeted interventions try to do is address that nutritional gap to ensure that the person's metabolic needs are addressed and there can be specific delivery of nutrients out late in tissue healing. So, there have been several immunotherapy studies that show improved wound healing and lower risk of infection. As an example, a number of studies shows that we can actually preserve muscle. One week of lying in a bed post-surgery leads to consider. Muscle atrophy. A lot of people don't really think about that. If I take something that reduces that muscle atrophy, can I get back up on my feet faster? I personally started mend because I had a bone fracture that was very slow to heal. I was at the 11-week mark still experiencing pain in my foot, went back to my podiatrist. He showed through the scans that the bone hadn't fully healed and it typical. A stress fracture is healing in six to eight weeks. In my case, I'm three weeks past that. That has a very significant impact on my quality of life. I was going absolutely stir crazy, and if my podiatrist was aware that there were evidence-based products that can help support bone healing, why not recommend that to the patient? It's another clinical modality, and I think that's the important thing to convey to the physical therapy community is that this is real. This is hard science. This is a clinical modality no different than your STEM unit or your other modalities that you're using in the physical therapy environment. If you're focused on getting the best possible outcomes for your patient. It's incumbent on PTs to become aware of the research and the science and be able to address patient needs and wants. We've conducted a survey with patients 1300 patients in the physical therapy realm. 91% said that they believe nutrition is very important to their physical therapy. The same 91% said that they want their physical therapists recommending a solution. So, this is coming. Patients are clever, they're aware of the role of nutrition and healing. You're educated, they're reading about it. We're certainly going to be doing a lot of education, and so clinicians are going to get more and more questions about this. And we think it's an important clinical modality to be utilizing.
Richard: The point that I think is interesting as well is the fact that these nutritional supplements aren't there to negate any other component of care. It is a, in addition to, isn't it? It's not as if it's an either or yeah. But it's a part of a comprehensive management. Is that right?
Eziah: Absolutely. This is multimodal care patients. This is not to replace anything else. I think as you've observed and mentioned, this is really about looking at this as a modality, as a part of a multi-pronged approach to treating the patient. And it's also important to note that we're as a company, we're not advocating that suddenly PTs recommend solutions for patients because they're diabetic. That's not your role. You're treating musculoskeletal conditions. And this is all about utilizing nutritional interventions intelligently to treat musculoskeletal conditions and not about kind of stepping outside of that domain. And there's now a huge body of PTs can rely on that shows reduce inflammation, reduce pain, increase joint mobility, acceleration in repairing the damaged tissue, reversing sarcopenia, enhancing bone health, improving muscle function and quality. All these things that go directly into the Musculo glial realm. That's what we're advocating for.
Richard: Based on the benefits that really, you've just mentioned. The idea of just using nutritional supplements pre and postoperative is only a very small component, isn't it really? We should be thinking of nutritional supplements perhaps for all conditions, be they operative or non-operative since such a high proportion of population is malnutrition.
Eziah: 100% Right. So, I didn't have a surgery, I had a stress fracture, and I was experiencing pain 11 weeks and the bone hadn't healed. Why? Because I was nutritionally compromised. Why not? It's not because I don't get sufficient food. I eat three meals at the, I eat quite extravagantly many times. But I was still nutritionally compromised and that slowed down the bone healing. So, this is about treating a wide variety of muscle conditions and making sure. Again, more than 50% of the population is malnourished. That is going to create poorer outcomes. And so, we need to do something about that. And this is one of the modifiable risk factors that we can intervene on. And it must, it must be done to give better, better patient outcomes.
Richard: When I look back, I'm confident that majority of patients would probably have benefit from nutritional supplements, recommendation for myself, but through lack of knowledge, ignorance, and perhaps lack of academic literature years ago. I never felt comfortable, confident. I always thought it was perhaps voodoo in some respects, but that's completely changed, hasn't it? Now with the, as you say, with 400 plus studies and it, it's beginning to enter mainstream. I think attitudes are changing, aren't they? And I think they must change even further by the sounds of it.
Eziah: Yeah, I think some of the cynicism is well deserved and well founded because the industry quite frankly hasn't done itself any favours by allowing products to be sitting on store shelves that have virtually no real hard evidence. So, we're endeavouring to create a completely new class of nutritional supplements that we're calling sort of pharma minded clinical nutrition that is very targeted and backed by real evidence. So, we have a study, for example, that's underway with Mayo Clinic and obviously the number one hospital in the world, perennial. Yeah, the world has come a long way in this realm. There are very high-quality studies that clinicians, my brother cares about patient outcomes first and foremost, and he cares about hard science and evidence, and I know that all clinicians do. They're evidence-based folks. They're trained scientists. So there is a reliable body of science and evidence that PTs can now look to say, yes, I'm making a recommendation based on hard facts and data and science and not in a realm that is not understood.
Richard: Clinicians should feel comfortable, shouldn't they? That for instance with the men product there's been, and there is, and there will continue to be academic rigor applied to it, to how it's used, and then the outcomes associated with.
Eziah: Yes, we have studies advancing with the best orthopaedic hospitals in the world, Mayo Hospital for Special surgery Penn Medicine among others. So when they look at our data and our science and our products, they can feel very confident that not only is it backed by good science and good studies, but it's actually being utilized in hospital with the leading orthopaedic surgeons the folks that are referring them to patients. So, there will be an expectation, I believe, from orthopaedic surgeons that their patients are getting the best level of care from their PTs, and this is a modality that they're comfortable with and they're implementing. So, it would be a natural extension that PTs would do the same.
Richard: So, by the sense of it, there are various studies that you are actively engaged, involved with it now. Would you be able to perhaps highlight one or two that are relevant perhaps for the therapist and what they're looking at and what we are hoping to do?
Eziah: Sure. We had so obviously the study with Mayo that's currently underway and about to complete is taking the intervention that we've demonstrated in the total joint population that preserves muscle and has faster return to function to see if we can kind of lift those results and reproduce them in the new arthroscopy population. So that is very much a period postop surgical study booking at. What can be done in that population? With Penn, what we're advancing is a blood albumin study. So, blood album, low blood albumin has been shown to be an independent risk factor in patients with higher morbidity, poor outcomes in general. So, we're looking at a study to demonstrate that you can correct blood albumin utilizing our solution. We had a university sports medicine, very leading university on the East coast reached out to us and said, we're very interested in studying mend on for neuromuscular issues particularly for PS populations, so we can do a controlled release of the essential amino acids and create better motor function. So, we're going to be working with them to advance that study. That's a very exciting domain that we've been thinking about for quite some time on. How can you utilize some of these interventions to create better muscle function in, in folks that, that have compromised by neuromuscular diseases. So that gives you kind of a flavour of sort of a cross section of the types of things we're looking at. We also have a product we'll be introducing soon. Just a daily inflammation product. In fact, by good signs and studies that shows that you can impact low level inflammation in the average person by just taking sort of one pill a day of a natural set of compounds. We're really excited about these. We think they're going to make a real difference in people's lives, and particularly, for clinicians that are trying to get good outcomes for patients.
Richard: How can outpatient therapists educate patients and promote the utilization of nutritional supplements?
Eziah: It's kind of a two-part journey. The way that we look at it is men must do its job of making sure that the public is aware of the very critical role. We think the end is missing from that. And so, we want to educate the population that whenever you're thinking about healing and recovery, don't just think about rest. Ice compression, elevation. Think about nutrition. So, we're creating an Ackerman nicer. And so, we'll do our job. So over time, we believe patients will be coming in more and more asking about the role of nutrition if they aren't already. Furthermore, we've created a variety of different educational tools for patients that can be leveraged. So, we have everything from product literatures to videos to a magazine that focuses on healing stories and education. So, we make all these tools available for, for PTs because we know many PTs aren't, don't feel comfortable talking about nutrition because they're not educated in the realm. But utilizing our tools, it becomes an easy conversation because patients come in pre-exposed to the information and if, if PTs are familiar with just some of the clinical studies that have been published, they can then just have a very natural dialogue with the patient on why this is important and the products that they might recommend that they. We'll continue the conversation after a short music break and advertisement. Most orthotic manufacturers take a one shape fits all approach to solving lower body pain and symptoms. They focus on arch support for temporary pain relief, which can end up leading to inefficiencies and injuries. That's where Bio Correct is different, more than just an insert. Bio Correct is a fully customizable foot orthotic system engineered to address and treat biomechanical imbalances of the entire body and we're backed by more than 25 years of experience. To learn more, visit us at biocorrect.com
Richard: Welcome back. As a clinician, as part of the plan of care or the discussion with the patient. Obviously, we've got the conversation specific to doing, performing certain movements or avoiding certain activities, et cetera. And we talk about sleep, importance of rest. I think the natural progression isn't it. By the sound of it is to talk about nutrition as supplements as well. I think that's a natural progression to the convert the larger conversation, isn't it?
Eziah: Yeah. We think that's our core thesis is that it really is an essential part of the conversation. You ignore nutrition at the, at the risk of ignoring, the best outcomes that you can get for the patient. Now remember, we have passed a very high threshold of scientific credibility and being accepted into hospital formularies. What that means, Hospital panel board reviewed men science, reviewed operational considerations, risk considerations, and said we want to purchase this and give it to our patients because we believe in driving best the best patient outcomes that we can drive. So, hospitals are doing it, leading orthopaedic surgeons are doing it. This is coming as a domain and it's incumbent on PTs to become more and more aware. Of this this domain because it's a natural conversation to be having with patients.
Richard: I think that you raised a good point. I think the fear of clinicians is to promote a supplement that doesn't have the level of quality control that we are really talking about here. I know that your product does based on the scientific evidence and literature and studies that have been completed, but that is a fear, isn't it? The therapist must be very careful.
Eziah: They absolutely do. I mean they're, again, knowing my brother's mindset, he's an evidence-based guy. He wants to see the data and the science and the quality before he recommends anything to his patient. The last thing he wants is the patient to have a bad outcome and then go and complain to the orthopaedic surgeon to say, Hey I took this, and this is what he recommended to me. And then the orthos caught blindsided. But what should give PTs comfort? This has met the highest high standards and thresholds they can take cover, if you will, to say, look, this is being utilized in several different hospitals. Leading orthopaedic surgeons from chiefs of departments on down are recommending this to their patients. And furthermore, we've not in the last four years had a single adverse outcome. And that's the nice thing when you take a pharmaceutical drug, there's 400 different warnings on other things that can happen to you that'll adversely impact you. And there's sort of the one benefit with natural compounds. You don't find that; you don't find sort of the body's ability to process these things that exist in nature don't create additional risks. So, we haven't seen any adverse outcomes as a result of our products. So, I think they, they can take a lot of comfort in that.
Richard: That's an important point for, for patients just general consumers, isn't it? The fact that this is a natural substance compound, and the risks are, Negligible. I wouldn't say there is never any risk but certainly, based on what you've seen is negligible. I think that that's great point. Till nutritional supplements become a standard of care. Physical therapists can have the conversation with their patients because obviously most patients are managed by physicians, orthopaedic physicians or whomever, depending on the condition that's presenting to the therapist and whilst there's an increasing acknowledgement of nutritional supplements helping with musculoskeletal care there's going to be scepticism within the surgeons and physicians themselves. How do you think the clinicians going to perhaps tackle that in itself?
Eziah: That’s part of our job as well as a company. So that's why we had a panel discussion just a week ago with leaders from Mayo, HSS, Geisinger Penn, to really talk about this, this topic and how important it is. These were chiefs of departments in orthopaedics discussing the critical role for targeted clinical nutrition. So that this is not something Richard, I believe, that we're going to achieve overnight. It's going to have to be a sustained effort over time to make this. So you can certainly, if a PTs interested in this domain, sign up for one of our newsletters where we weekly or biweekly, will be sending you the summary of the latest research so that you as a clinician can stay on top of it, be aware of it, and being able to have. And meaningful conversation with your patients. We've also heard loud and clear from PTs that, look, I'm not a trained dietician, so how do I deploy this? And so, we've made very simple cheat sheets. So, if it's this indication you recommend this product, if it's this other indication you recommend this product. So, it just becomes as simple as being aware of the two or three key or four key products that we have, the science that backs it, being able to recommend that for, for the patients. So, we know we need to make it simple. We know that we need to get the science out to as many physicians as possible. We're actively working on several things to educate the domain. Like I said, I think given the adoption by certain of the most important hospitals, this invariably will get more and more traction in the marketplace and someday become standard.
Richard: We've talked significantly about the academic papers and scientific literature. How would our listeners and clinicians go about finding information specific to the clinical trials you, you've mentioned today?
Eziah: Yeah, we've created an entire binder of research that we can easily email out to the clinicians. So, if you want to just kind of go to the website med.me Sign up or send us an info request. From there saying that, I'd love to look at some of the clinical research. We'll, we'll send you out the summaries that we've packaged up. Now, keep in mind there's a lot of clinical literature. This is a big document, but it summarizes for you some of the key studies that have been conducted. We think we need more champions just like this podcast of folks that are starting the conversation and making folks understand how critical this is. And over time more and more clinicians will be educated as well, patients.
Richard: I would imagine the papers that you have would be able to assist not only educating patients, but even actually educating physicians in certain instances.
Eziah: Oh yeah. We've, we designed specific documents that are for physicians. So, PT’s can just send it off to their physician and say, you're the clinical trials that support this particular product. And we found that to be very many of our PTs are in fact doing that. They're sending the literature on to the referring physician so that there is alignment between the two on the tools that are being utilized.
Richard: The podcast is specifically for physical therapy leaders, even though I'm sure treating clinicians will be listening and as leaders, as owners of practices, I think the, one of the questions is can nutritional supplements, can they add as an additional revenue stream and, and how might that work?
Eziah: Yeah, the emphatic answer is yes. Not only is it permissible, but given that the clear established body of science, we think it's critical for PTs to view this as something that they need to offer in clinic. So that we really separate the argument into sort of two. There's one is the clinical argument, which we always start with, and that's really been sort of the focus of this podcast, but there's a business model argument as well, so, Like I said, in our survey of 1300 patients, 91% said that they want their PT to recommend at nutrition products. So, you already have the permission from the patient. So rather than going down into the CVS or Walgreens stores with products that don't have any clinical trials supporting them they want to come to use a professional. second, a PTA has put nutrition in scope of practice as they recognize, just as we've discussed on this call, just how important it's to get a good patient outcome. So, it's in scope of practice. They're actively encouraging you to have a nutrition conversation with the patients. There is a set of criteria that needs to be met for this to be. Allowable by the FDA first, there needs to be a clear scientific basis for the recommendation. So, what we've said earlier is you shouldn't be trying to treat diabetes because that is not a musculoskeletal condition. But if you're trying to treat a musculoskeletal condition and there's evidence behind a product, it is 100% permissible that you can make money off that product, provided you make a disclosure. So somewhere in your literature that you're passing onto the patient, it must say that you have a financial interest in it and that the products are available elsewhere. So, you can't be the sole distributor of that product. So, if those conditions are met that there's a scientific basis, there's a disclosure somewhere, and you're not the sole distributor, this is FDA compliant. A PTA is saying, you should be doing it 91% of your patients are saying that you can be doing it. And we made it simple and given the headwinds in his business, his costs of labour are going up, his rent is going up, and yet the insurance companies keep cutting rates on him. And so, the business models never remain static. Business models always evolve, and we think it's important. PTs, I spend time with my brother talking about business model evolution to really look at this as a clinically necessary, but also business model, necessary evolution of their business. And if that can be done, we think this can add a very important revenue stream that is totally consistent with what patients are asking.
Richard: Interesting. A lot of clinics I think, are exploring the concept of providing nutritional counselling, but I think equally important is. Promotion of academically supported quality control, nutritional supplements isn't.
Eziah: Yeah, the nutritional counselling’s all about, more about sort of lifestyle and getting the persons nutrition, sound in general. What we're really talking about here is orthopaedic outcomes. I really want to make that distinction clear, is that we're not talking about a person's general nutritional status. Making them, that's the really the job of a RD. What we're talking about here is you can utilize very targeted delivery of nutritional supplements to get better outcomes, and that we think is very essential, important modality for PTs to utilize. It's certainly fine if PTs want to expand and offer nutrition counsel, as, another service offering within their umbrella. A lot of practices are beginning. Offer other types of expert expertise and care. But that's not really what we're talking about. We're talking about core to the business model of MSK outcomes. This is an essential new modality and modality that one can make money from and improve the health of their business. So that's really what we're focused on.
Richard: We could talk all day about this, and unfortunately, we're running out time. What final thoughts, suggestions, or knowledge would you like to impart to the listeners as before we leave?
Richard: Thank you so much for spending some time today talking about nutritional supplements. I've certainly learned a lot and I believe that it is an important part, like you are advocating in the care of physical therapy patients and I'm hopeful that it will become another tool in the, in the toolbox and helping our patients gain optimal function and outcomes. So thank you.