December 8, 2020 • 45 mins
Wednesday 9th December
Dietetics Digest
Tips for New Dietitians, evidence-based practice and guidelines feat. Mike Patterson (Episode 6)
In this episode, we have Mike Patterson. Mike is a Specialist Intestinal Failure Dietitian currently conducting his PhD in Palliative PN and PVG. Mike is also a Muay Thai Coach in his spare time.
Resources Mentioned:
- Twitter thread of tips for new dietitians
- Research and Guidelines mentioned.
- Mike Patterson (Twitter)
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Mike Patterson (00:00):
When you look at evidence based practice is sort
(00:02):
of looking at the evidence baseclinical experience, and also
the patient's perspectivebecause you might have the best
evidence base in the world forsomething. And you might have
the best clinical experience.
But if the patient doesn't wantto do also, if it's not suitable
to the patient, it's not goingto be correct. Anyway.
Aaron Boysen (00:21):
Welcome to the dietetics digest podcast, a
podcast that helps youunderstand more about the
different areas of dietetics andnutrition and what others are
doing within them. We do this bytalking to inspiring and
influential individuals that areadvancing practice in some way,
shape and form. Our mission isto create a resource that helps
(00:41):
dieticians to build, grow andshare ideas with each other to
help advance their practice andthe practice of others. I am
your host, Aaron Boysen. Hello,Michael Patterson. And thank you
for joining us today ondietetics digest podcast.
Maybe you could start withintroducing yourself who is
Michael Patterson
Mike Patterson (01:01):
are a dietitian.
I'm currently back in my oldrole as a clinical dietitian,
but our pre Corona and also inabout five weeks time on
clinical research fellowshipsand nutrition. So it's got a PhD
mixed in there. So I'm employedby Holyoke medical school. As a
research fellow, I do a PhD. Aspart of that sponsored by Yauch
cancer research looking atpalliative pn venting.
(01:24):
gastrostomy is in Manipur,bollock structured palliative
intervention in South Korea,
Aaron Boysen (01:30):
what really triggered the interest in that
area in particular.
Mike Patterson (01:33):
And so pretty much since I qualified, I knew I
wanted to be intestinal failure.
So I covered colorectal as partof mercy basement, I did my
consolidation on Colorado, whatI found really, really
interesting. So as soon as I gotto my jobs, I got a job in
hardware. I did my seedplacement, nice shout out to
contractor. So luckily, it'sbeen five that was my first
(01:54):
rotation, the rotation, so it'sbeen like six or nine months,
I've managed to sort of topMarines are doing it, but 18
months. So I got sound a littlebit longer. I knew I wanted to
sort of delve into piano, Ialways covered when pn dietitian
was off, always picked up newpatients if they were busy. And
then we started doing a littlebit more positive pn as a
(02:14):
nutrition team. And thencolleague of mine to do their
PhD. So she's another fellow atbolier Medical School. And he
said obviously PhDs coming up ondbrs cancer research. So it's
got been in around this area. SoI met with my no supervisor,
who's a professor of medicineput the idea to her about
investigating parts of pn,Gaston is about function issues,
(02:37):
mainly Medicaid. So the ResearchCentre are currently doing some
research looking at sort ofpatient reported outcomes in
malignant bowel obstruction. Sothey're already looking into
that area. And then when I spokeabout nutrition and the
gastrostomy side of things, shewas really interested. So she
said to me, and my centreresearch dietitian, that she
wants an army of dietitians. Andso
Aaron Boysen (02:59):
should we start the recruitment drive right
here?
Mike Patterson (03:02):
Yeah, maybe she just said there's some she has
some issues with some of theevidence. So she wants to prove
that evidence. So I appreciateand get more dietitians into
research. It should be out.
Aaron Boysen (03:12):
So you said you always had interest in the area
of intestinal failure. Was thatoriginally from when you first
started dietetics? Or did thatinterest grow throughout your
time in dietetics?
Mike Patterson (03:24):
So dietetics is actually a second career for me.
So I left school 16 did anapprenticeship. So I was a
telecoms engineer for five and ahalf to six years. It paid very
well, it was like there's nothought process to it a lot of
time, you just put cablestogether and really frustrated.
So then offering Andriyredundancies with a half decent
(03:45):
pair to go with it. So I tookthat my other half family got
pig farm. So I worked on thatfor a while while thinking about
different choices. So I'vealways been interested in sports
nutrition, just from personalperspective, looking for a new
career and my sister's a videoalways always interested in
nutrition dietetics so differentaccess costs and different
undergrad for sort of Germanundergrad, maybe go down the
(04:07):
smart route. I do the nonclinical placements. I did my
undergrad at Leeds I did the nonclinical soft spots, research
placement leads and then when Idid my placements, Southland,
colorectal got introduced to pnis quite Science Nation without
a word from a from a dieteticperspective, you get to play
about those numbers a bit mustinvolve a bit more sort of
medicine involved with it. Sobecause of that just sort of
(04:30):
knew straight away, this is thearea I want to work in. Well,
Aaron Boysen (04:33):
thank you. That's really interesting. It's really
interesting to hear the thoughtprocess you took in choosing
where your eventual directionwould be. And I think that's
really important when we'rediscussing the next topic
because it's really important tounderstand that everyone's
journey is different. However,there are commonalities in which
we can support each other in anda few months ago, you put out a
tweet, which was sort of aroundhalf ranting and half tips for
(04:58):
new dieticians. Possibly juststarting out in a career in
dietetics. So just like thattweet, I want this podcast or
maybe a little bit of ranting,but really aimed at those new
dieticians and advice for them.
So bring us on to one of thefirst points you mentioned in
the tweet. And it resonated withme, because obviously, we go
through lots of topics in ourdegree, we cover lots of
(05:20):
different areas. And sometimesthings aren't at the forefront
of our mind when we graduate,you've got other things on your
mind. And going into your firstjob, you want to make sure you
prepared, is there any area thatyou think New dietitian should
brush up on? Or just refreshtheir knowledge before they get
started?
Mike Patterson (05:40):
Yes and no. So I sort of do like to jump into
things and just give it a go seewhat happens. In terms of
refreshing, definitely. So Istill do it now, especially when
you come up with it. So you seea new condition or think about
something else. So especiallyfrom where I am now with
intestinal failure, but goingback to pretty much every aspect
(06:01):
starts ethics, physiology. Soit's the thing that you learned
in first year? Well, I certainlydid when you do this, like, why
am I landed this one and thiscome foreseer when you've done
all your other modules, you'vedone all your placement,
physiology comes a little bitout of your mind. And then for
me, when you got back, when youstart working, you come back on
placement, you start a job fulltime, physiology becomes that
(06:24):
much more important, I think interms of when you have a good
understanding of physiology, itimproves your understanding the
medicine, so I'm not expectingdietitians to be medics. We're
not medics, but having thatreally good knowledge of
physiology really helps improvein terms of your medical
knowledge. I think it helps youunderstand the disease a little
bit better. What's actuallyhappening body where you're
(06:45):
digesting information is goingto help us think Yeah,
physiology is probably the bigone. I've said it on the on the
thread. But in terms of I'm verybiassed that gi physiology, you
need to know your GI physiology.
I don't doesn't care whatcondition it is, it's probably
going to end up in the gut. Ifit doesn't, obviously, it's
intestinal failure. But again,we still need really, really
good gi physiology. And I'm
Aaron Boysen (07:06):
running through some of those theoretical topics
that may not have been all seemto have been as applicable at
the time now that you're workingare almost directly applicable
to your work.
Mike Patterson (07:19):
Yeah, yeah. So it's just that was going on
right in your mind. And just, Ialways think if you just take a
little bit of the backward stepsand times, because you probably
just want to jump into it. Butif you then you know you're
assessing the patient and lookinto their solid medical
history. If you actually think alittle bit about the physiology
can help, what you're then goingto want to do with that person
(07:40):
is going to inform your planthat little bit more.
Aaron Boysen (07:41):
So how am I understanding physiology inform
your plan.
Mike Patterson (07:44):
So it might help you solve a problem, even
something like fatmalabsorption. If you don't
understand where something getsabsorbed, or what happens when
someone's won't absorb them, ifyou don't have that good
understanding, you might notpick up on it, it might not be
something that a medic couldpick up on as well. So if
someone's having like theatheria medic might not pick up
on it. But because asdietitians, we often have the
luxury of having a little bitmore patient contact times in
(08:07):
the medical world, again,something where communication
skills come in, but we get tohave a bit more of an in depth
chat with someone. So you mightpick up on some triggers that
they're giving you that maybethey've not had a chance to
discuss with a medic, if youapply a little bit of physiology
to it, you might be able tothink, ah, maybe it's something
that you can always discuss themwith their medics as well. I
think if you have a goodunderstanding of physiology,
(08:29):
when you're discussing somethingwith a medic as well, it makes
it that little bit easier,because you can explain what
your thought process is becauseof x y Zed, and it might just
get that point across a littlebit more.
Aaron Boysen (08:40):
You mentioned a little bit about communication
skills. Is there a way to brushup on those before we start our
new jobs?
Mike Patterson (08:47):
I think sometimes from what you do at
uni, very, very sort ofstructured, very formal doesn't
always apply necessarily,especially to me in an acute
hospital restaurant is quitesick, you're not always going to
be able to chair someone with alittle pedal following and, you
know, if you push up and justthink, at least if I can focus
(09:08):
on that paraphrasing andsummarising I think that's the
two big ones I take is that youcan actually do that quite
easily with someone in acutecare. So you might not be able
to do everything else, you mightnot be able to sort of guide
someone as much towards a goal.
I don't think he can in sort ofdifferent areas of dietetics he
can sort of it's a little bitharder, I think in an acute
setting for someone to come upwith that on plan. As much as I
(09:31):
think he was at leastparaphrasing and summarising
what's happening. You're able tosort out plan together a little
bit more focusing on that
Aaron Boysen (09:37):
paraphrasing and summarising Why do you think
those particular skills are mostbeneficial in an acute setting?
Mike Patterson (09:43):
I think it just again, this active listener at
least it shows to the patientthat you're actually listening
to them and they get tounderstand sort of what they've
said back and for me as well. Ithelps me remember what patients
said to me. I'm not a big fan ofsome people are but I'm Not a
big fan of sitting thererecording things on paper, I
find it quite distracting forme. I don't know if the patient
(10:06):
does, but for me as well, if Iparaphrase throughout, if I
summarise at the end orsummarise where Mary's
appropriate, it helps meremember what that patient said
to me. And then I could go backand write whatever notes that
tells me I can. I can rememberhistory a little bit better.
Aaron Boysen (10:21):
Yeah, I've noticed that too. And it really
resonates with me, because whenI summarise or paraphrase
something to a patient inhospital, and maybe I've
forgotten something, or maybe Ididn't have appropriate emphasis
on an area that was reallyimportant to them, they can
reinforce that area, so that I'maware of what's what's most
(10:41):
important to them.
Mike Patterson (10:42):
Yeah, percent.
Aaron Boysen (10:43):
So we talked a little bit about communication
with patients. But I want totake you back to what we were
discussing earlier. It's alittle bit our knowing
physiology helps us discussthings with the MDT so that
doctors, physios, nurses,Speech, Language therapists,
occupational therapists, andother members of the MDT, do you
(11:03):
have any tips on communicatingwith them? I remember when I was
a newly qualified dietitian,because I felt quite new. And I
felt that my knowledge wasn'tfully developed. And I also felt
like when people said, buildrapport, it meant, Hey, did you
see the football game on Sundaynight, and I'm just terrible at
those sorts of conversations.
Mike Patterson (11:24):
And I'm the same as you are for small talk, not a
big one for small talk, in termsof, I think it is different
depending on who you're talkingto, as I said before, like with
medics, I tend to find a goodway that they sort of respect to
that a little bit more, but tosort of get to know that a
little bit more, if you know,your patient story, get really,
really, really good at knowingyour patient story. So you know,
(11:47):
eight year old guy admitted withthis history of this, this is
currently happening on thistreatment devices. This is this
is this is happening. So this iswhy I think I should do this. So
I think for a consultant, hemight have 20 3040 patients on
the ward days looking afterthat, if you say our current
issue about Mr. Smith, Mr.
(12:08):
Smith, if you can sound Can Ijust ask you about Mr. Smith, we
lost the story, it's gonna makeit a little bit easier for him.
And I think that's a good way toget chatting. If you know your
patient story, it makes iteasier to chat with medics and
then you know, a bit more likelyto just chat randomly or ask you
about a patient. And the samething I I find that like the
physios speech and language, orthe therapist goes back to the
(12:29):
fact that I think as dietitianswe have that little bit more
time with patients, we get toknow them a little bit more
often patients will tell youcertain personal things. So dog
or cat by variable R, and Ifound a good way to sort of
break the ice for the physios orspeech language is talking about
patient bring something likethat, like the little sort of
finer details and stories thatthe patient tells you, and
(12:52):
probably told the othertherapist that story, basically,
I just find it's a good way toget chatting about it. Also,
this is can really be helped fora lot of people, but I think
being male and being being adietitian is a bit of a novelty.
So I think that honestly helpspeople noticing you because
first of all, just being themale dietician, I, I've often
(13:13):
been that the only maledietician where I've worked. So
it's like, it's the male world.
So you get to know peoplebecause because of that I've
worked
Aaron Boysen (13:23):
in a hospital where I have that novelty
factor. But currently where Iwork, there's actually quite a
few male dieticians in theoffice, I think there's about
five in our cute team. So Ithink by now that novelty factor
is unfortunately worn off. Infact, saying that one of our new
dietetic assistant started, andshe mentioned that she didn't
(13:45):
realise how female dominateddietetics was because there was
so many males in the office.
Mike Patterson (13:53):
That novelty value. And they also think in
terms of when you're a new bandfive, that probably is brand new
f1, there's going to be brandnew, brand new speech and
language therapists all probablyfeel very similar. And I do tend
to find like newer punk fives,newer therapists, newer doctors
do tend to just end up chatting,I think similar age similar
experiences tend to find a newstart chapter. Also rotation, I
(14:16):
think help as well. So if youknow you're on a set reward for
six 912 months, you do get tounderstand a little bit more
they get to know you. And thatreally helped.
Aaron Boysen (14:25):
I think by being there for a longer amount of
time. It makes it easier forpeople to invest in a
relationship, because you knowhow long it's going to last?
Mike Patterson (14:34):
Yeah, like I always found if I'm going on to
a new Ward and an Old Covenant,it's always good to go have a
chat with water stuff, it'sgoing to be there water while
the charge less. It's there oneso don't just introduce
yourself, however awkward it maybe and just say I'm going to be
here for the next 912 months.
Aaron Boysen (14:51):
So you've been there yourself. You've been a
newly qualified been fivedietitian and now your F 10, a
phrase highly specialistdietitian.
Mike Patterson (15:00):
Knock on it.
Aaron Boysen (15:01):
So you've seen it from both sides. If you were
giving advice or if you weresort of looking back, is there
any advice you would give toyourself as a newly qualified
band, five dietitian,
Mike Patterson (15:12):
quite a few things. So going back to that
point last, and I don't think weneed to be mad, but I wish I
just understood medicine thatlittle bit better when it first
came out. And I think probablyis something that you pick up
with experience. And as I said,going back to the physiology,
having good knowledge ofphysiology, biochemistry will
help do a refresher on that. SoI think in terms of I wish we
(15:35):
just had that little bit betterknowledge of medicine, I just
think it really, really helps interms of getting you understand,
and especially sort of when youfirst read medical notes of
that, but the right thing, and Iactually do them constantly on
Google, like what does thatmean? What does that mean? What
does that mean? But again, itprobably just comes with
experience, again, this pointand massively biassed towards
(15:57):
but research skills. We do doresearch as an undergrad, as
opposed to graph, but I think itcould be improved that little
bit more. Especially it's notlike a critical thinking skills.
I think for me, when you improveyour critical thinking skill to
problem solving becomes thatmuch better matches think it
allows you to break things downa little bit more. So yeah,
(16:18):
having my personal perspectiveis that every dietitian would
have to do some sort of researchfor a lot of people might not
like it. But I just think it'sreally, really important as as a
profession that we have a reallygood knowledge and understanding
Aaron Boysen (16:32):
of research methodology. So in your mind,
what would the benefit of thoseresearch skills be?
Mike Patterson (16:37):
Because in terms of I think a lot of the times
the way that huge generalisationis that sort of be quite happy
to offer guideline below, right.
That's what the guideline says,This is what I'll do. Whereas I
think if you have that littlebit better knowledge of research
methodology know how to find aninteresting, perfect because the
evidence base is constantlyevolving in nutrition and
(16:57):
dietetics. There's a lot ofareas where there isn't a great
evidence base. But if you justhave that little bit more of a
reshot skill, you might be ableto find something or even if
it's something quite small, likea case study or a little case
series of patients, you mightthen be able to apply something
like that to your practice, isthat there's not really an
evidence base, but I found this,this and this. So I'm going to
(17:18):
try this in my practice. And aslong as it's safe, that's what
you're causing no harm you cansell, why are you doing that?
Well, I found this and somepeople have had a bit of
success, there's no evidencethat can go off anywhere. So I
might as well try this, and thenthat'll monitor it, and go from
there. And again, methodology, Ithink it's something that's
really, really important interms of like when you read in
the paper, and most people readan abstract that might go to the
(17:40):
results. Because this site willgo through the methodology fast,
obviously, because of themethodology, see whether it's
good or bad, and you can go fromthere, then you can look at the
results in the discussion. So mysupervisor said to me, pretty
much when looking at purpose,just look at the methodology and
the discussion. So themethodology will tell you
whether what they've done isgood or bad. And the discussion
is, they should hopefully tellyou what they've done good or
(18:02):
bad, and what is good. Whatabout it's bad topic. So having
that good understanding themethodology, social media really
helps.
Aaron Boysen (18:09):
Thank you. That was actually first pointed out
to me when I was on non clinicalplacement, I was working with
some PhD students, they had ajournal club, a couple of lunch
times a week, and they invitedme along to it. And that was one
of the tips they gave me toreally understand the quality of
the research that was readingthe methods was the most
important area. And I think fromthen on, it was really eye
(18:31):
opening to me when I readresearch to sort of the results
can be quite appealing. But itis the methods make or break an
article from research,
Mike Patterson (18:41):
especially sort of who have done the research on
it really, really helps. So youmight find like someone might be
caught in set guideline. Butthen when you actually look at
the guideline, it might be ourthe evidence base is based on 18
year old males who have got anormal BMI, and you've got a
female who's BMI 14 from here,but you're following that
guideline, because it's sogeneric white, if you've got a
(19:03):
good standard methodology andlook at the guidelines says
that, but when actually look,it's not relevant to my patient
population whatsoever. And ifyou don't have that sort of
critical thinking skills, youmight spell the guidelines as
that. Whereas if you have thatlittle bit of delving into
papers and thinking, Well, youknow, or even if this sort of
papers that are very similar toyour patient population, you
(19:24):
might say, well, there's notreally much of an evidence base,
but this pair back looked at apatient population group are
very similar. So I'm going tosort of use that as a basis
angle from that, I think sort ofevidence based practice is
looking at best availableevidence. So if you can then
work out what is the bestavailable evidence, you can sort
(19:45):
of go from there. Thank you. I
Aaron Boysen (19:46):
think that's so important to understand, not
only the guideline, actuallywhat that guideline is based on
because it can really inform ourpractice. And I think there's
lots of talk about guidelinesare just guidelines, but how can
you really Understand theguideline enough to use it as a
guideline, if you don'tunderstand what underpins it, if
you don't understand thestrength of the evidence, the
(20:07):
limitations of that evidence inyour patient cohort, I mean, if
you don't actually understandthe guidance, there's only two
ways to follow it. Follow itwith exactness or whimsically
break it comes from Yeah, youalmost need to know the rules.
In order to break the ruleseffectively, you need to know
what the guidelines is based onto know that it doesn't fit your
patient population, because ifyou don't know you're based on
(20:30):
sort of whimsical feelings, andnot based on evidence,
Mike Patterson (20:35):
yeah, definitely. And when you look at
evidence based practice is sortof looking at the evidence base
clinical experience, and alsothe patient's perspective,
because you might have the bestevidence base in the world for
something. And you might havethe best clinical experience.
But if the patient doesn't wantto do also, it's not suitable to
the attention, it's not going tobe going anywhere. Even when you
(20:56):
look at these best practices,then three things, you need the
best available evidence,whatever that may be, you're not
always going to get an amazingRCT that tells you this, you
need to sort of see what fromyour clinical experience,
whether you've tried somethingbefore, what your patient
population, whether you've seensort of something similar in
this patient population groupbefore, and also what, what the
(21:16):
patient wants to do. Thank you.
Aaron Boysen (21:18):
I think that's really important things that
we'll discuss there. Now in yourTwitter thread you also mention
about anthropometricmeasurements that are not
weight, what measurements wereyou referring to? And how are
they useful?
Mike Patterson (21:30):
So they were obviously that is a really
useful tool to start off with.
And I think either iron softwareis really useful, but where it
can be manipulated, so much. Sooutside of clinical practice, I
tie box, so I used to sort ofcompete a little bit, but now I
just do coaching, I work withsome athletes that currently, so
(21:51):
merely MMA fighters, and work onprocedures. So in terms of
professionally, you can findpeople who lose 6789 kilos in a
week overnight, so weight can bemanipulated that easy. So
basically put someone on areally, really low carbohydrate
diet, dehydration them a littlebit. So you've lost the glycogen
stores, you've lost the waterattached to that, under the
(22:12):
hydrated. So has someone lostseven kilos overnight on just
the hydrated and it can besimilar in terms of clinical
perspective. So and this is feedfor a couple of days, not the
right IVs to correct it may havelost four kilos, but might not
have lost four kilos becausethey're just really, really dry.
So if you have a good on Sundaybiochemistry, look at a blood
sample, I have not lost fourkilos that just really dry. And
(22:35):
the other end of the spectrum,there's so many conditions that
we look at where there's goingto be some aspect of fluid
retention. So renal patients,that's number of real patients
are going to be fluidoverloaded. One of the reasons
for dialysis, heart failurepatients going to be massively
fluid overload. If you look atliver patients that might have
1516 1718 kilos worth of thesizes in there, even from my
(22:58):
side of things and surgicalpatients, vast majority of
surgical patients get some fluidretention after surgery. Well,
the first thing I got taught asa surgical dietitian is after
surgery, make sure you look atthe legs, make sure you say is
right for the squeeze yourankles, because more often than
not, they're going to havesomebody on the legs, you might
have a lot of squeezing theirankle, right? Yeah, that's
probably this is why we're it'soften not the greatest because
(23:19):
there's so many differentconditions where you can get
fluid retention, you might getexcited, and it's just going to
mask what's happening. So someof them really, really easy ones
a minute params confirms tricepsskinfold, calf circumference,
grip strength, they're allrelatively cheap, pretty
convenient. They're not to sortof invest if I know some
universities do do isaaqaccreditation. This is another
(23:42):
thing that I wish I was taughtmore citations. I wish that
every university made sure thatevery dietitian that came out
uni had isaaq Would you mind
Aaron Boysen (23:49):
explaining what isaaq is for those who maybe
aren't aware.
Mike Patterson (23:53):
So the International Society for the
advancement that kind ofanthropometry so because the
level three you can teach, butthe level one does various
measurements I would do to getmy eyes at training in the
middle of nowhere, but obviouslythere is a small pandemic
happening. So as a level one youdo satin bone calf measurements
(24:15):
and set muscle thicknesses andalso callipers. So it's just a
way that you can assess them onbody composition rather than
just checking something to whereyou can then assess for things
like muscle mass with the bonegas, trying to look at sort of
what's more skeletal structureis mostly the callipers to look
at. And it's just much easiermethod. So I think sort of you
(24:37):
know, it'd be great if we coulddecks all our patients on the
same deck same the samehydration tricks every time Not
gonna happen. Probably notethical to have access to
everyone. But things like thatare much easier, much more
practical method of just gettingan idea of what someone's body
composition is actually doing.
And I think in terms of gripstrength especially it's going
(24:59):
to give you a look Get morefunctional data as well. So I
found on through really goodconversations with medics as
well. So going back to theintestinal failure side of
things, I had a guy with a highoutput stone that was on max
meds to district him, and hisweight was massively
fluctuating. So it didn'tactually look like he was losing
weight. So he was a tradesman.
(25:20):
So expect them to have a prettygood grip strength, reasonable
muscle mass. So I was discussingit with the medics and saying,
look, this is what happening. Ithink it's worth just
fluctuating because we stillmolossia Friday, the medics are
a little bit unsure did fullanswer on it, it showed in terms
of prescriptions was, you know,much less than what it should
have been for a guy his age andalso in terms of from just mid
(25:40):
upper arms conference castconference showed that he didn't
have the muscle mass you'dexpect for a guy his age to
adapt to the medics and said,Look, this is what's happening.
He's going down. This is notwhat we'd expect for this guy,
especially being a tradesman,he's probably using his hands
quite a bit. And then thedecision made was to start him
on piano, ready to reverse thesurgery. So he ended up on the
end for about three and a half,four months, to start utilising
(26:04):
the fact that his weight wasfluctuating so much looking at
using the bloodspot to use ananthro, I was able to convince
the medics that he was needingfurther nutritional support. And
the patient was actually reallyagainst me. And at first, he was
just like, No, I don't want todo it. And then after we started
him on it, and once he got inhis former regime, yeah,
absolutely love that stuff.
Because like a new book, er,because he got so much better.
(26:24):
The fact that he was betternourished. And you know, pretty
much the reasons that I did wasbecause I could prove to her
that he was malnourished. It wasfortunate to work.
Aaron Boysen (26:33):
Thank you. That's really interesting. I mean, I
knew about Isaak, but I justthought it was marketed towards
Oh, it was made for more sportsprofessionals or people working
in sports medicine, and I sortof thought it was maybe
impractical in clinicalpractice. And but I guess I'm
wrong.
Mike Patterson (26:53):
Yeah, I think sort of, it's marketed that a
little bit more towards sports,you got think first, a lot
sports are probably going to bedoing more body composition
assessments, we would do it. ButI just think in terms of their
teaching methods to take acorrect measurement. So
especially sort of like, errorcan be huge between the same
people doing it, and also sortof taking the right measurement.
(27:15):
So you know, if you take ameasurement, a couple of
centimetres different on theare, the measurement might be
massively different. So if youget taught the correct technique
to do it, even stuff, liketaking capsules, mid upper arm
taking callipers, I just thinkit's really, really applicable.
And because there's so manyconditions, as I say, Why Where
is useful, but at the same time,doesn't matter of limitations.
(27:36):
If you can do some pretty easy,quick answer. I think it just
makes an assessment so much morecomprehensive, I think it helps
from a patient perspective aswell. If you're showing that
their strengths increase, thenyou can show it to them that
their nutrition interventionswork and that you're getting
some functional outcomes isreally important for patients,
especially if they can't see anychanges in the way because it's
(27:57):
been masked by deema, or look orsighted.
Aaron Boysen (28:01):
Thank you so much.
I think that's so important,especially over the last couple
of months for myself, it'sreally illustrated the
limitations of weight, but also,BMI and BMI in the context of a
lot of our screening tools, hasvery crucial to acknowledge
limitations that are prevalent.
That brings me on to anothertopic recently due to
(28:24):
coronavirus, and a lot morepatients being an ICU. And
having prolonged periods of timeon non invasive ventilators,
they might have lose a dramaticamount of weight, but maybe not
have a reduced BMI. What's thedietitians role in helping those
patients? So basically, you'vedone an assessment and you found
(28:44):
out that this patient is healthyor even overweight or obese BMI,
but has a dramatic amount ofmuscle mass loss due to recent
weight loss? How would youapproach that
Mike Patterson (28:57):
those patients so like, yeah, sarcopenic base
is quite an interesting one interms of they've got to really,
really poor health outcomesthere that if they're going to
have high adiposity, that's notgoing to be a great outcome for
them. But also the fact ifthey're gonna have low muscle
mass, it's really going toimpact them. So the first thing
I do is I speak to the physiosand see what they're up to. So
(29:17):
we know in terms of gainingmuscle mass, the biggest driver
is going to be some form ofresistance exercise. resistance
exercise doesn't mean thatthey're going to have to be
hitting the gym five days aweek, you know, so just means at
least some resistance for them.
And in terms of nutrition, Ithink it's sort of quite an
interesting one, because you'regonna have to try and address a
(29:38):
couple of different things. Soyou're going to try to have to
address the fact that haveprobably been having an energy
surplus, so you're going tomaybe want to look at reducing
their caloric intake, kind ofwant to put them in an energy
deficit. And alongside that,you're going to have to address
the protein intake. So we knowin terms of building battery
mass, you can build up the masswhen you're in a deficit.
(30:00):
Especially for someone who'ssort of like quite a novice when
it comes to resistance training.
But again, this is where I thinksports dieticians, sports
nutritionist sports dieticiansand a general clinical dietitian
are probably disagree what ahigh protein diet is since a
Chappie called Josie Antonio,who's the editor for journal of
the National Society of sportsnutrition. So he's done quite a
(30:21):
bit of research on really highprotein intake. So you're
looking at three, three and ahalf to four and a half grammes
per keto. So he sort of arguesthat he plus a high protein diet
is something over two grammes,tequila, and I probably sit on
that side of the fence with him,but high protein diet is
probably something either twogrammes per kilo so there's some
work done by Brad Schoenfeld andon Aragon, so they said to
(30:44):
maximise the anabolic effects ofprotein, you need to be looking
at both doses. So four meals aminimum of four meals, a point
four grammes per Keilar up toARDS point 1.55 grammes. So for
these patients, you're going tobe looking at trying to get 1.6
to 2.2 grammes of protein andideally split all the four even
meals. So this is the wholething I said on my tonight about
(31:06):
looking at stimulating muscleprotein synthesis. So this
again, was sarcopenia. As a guy,Professor protein says to
Philips, how much that'scovered. So anyone who's got an
interest in nutrition support,who's got an interest in
sarcopenia, we need to look atthe lack of stupidity. So
there's a dietician. So she's anIrish dietitian, still a doctor.
(31:26):
And so she did some work fewyears ago, looking at protein
distributions. As I thinkhistorically, if you looked at
probably a sort of typicalBritish diet, you've been
looking at sort of quite askewed proteintech, generally
pretty rubbish and breakfasttime, maybe a little bit more
than than lunch, probably thebig hair protein on a meal. So I
think aiming a little bittowards sort of those evenly
(31:48):
distributed protein patterns, agood idea, especially for a
sarcopenia patient, so for theirsarcopenic obesity, they're
looking at creating some sort ofcalorie deficit, to reduce the
fat mass, you need to make surethey're going to get some sort
of resistance training. Sospeaking with physios and see
what videos can do, and thenlooking at sort of optimising
the protein intake, try to finda bit of a nice, even
(32:09):
distribution of a sort of atleast three to four meals and
trying to hit that once the 2.2grammes, Sue Phillips has
actually published somethingreally, really recently looking
at nutritional supplements insarcopenia. Not it's not purely
sarcopenic, obesity, so the bigones created. So great things
got really, really, really goodevidence. So some of the things
that we're looking at that thesack kapena is created between D
(32:33):
and omega three. So that's I'velooked at some of their
supplements. So there's somethings that people can look into
as well.
Aaron Boysen (32:40):
Oh, that's really interesting, actually. So say I
had a patient that was a stepdown from ICU, and he has
experienced a massive amount ofmuscle loss during his time in
ICU, and covid. Lows on there,he was on for a prolonged period
of time, would you recommendcreatine monohydrate to those
kind of patients,
Mike Patterson (33:01):
I think it's definitely something worth
discussing with a patient. I'mnot saying that every single
sarcopenic obesity patient needsto be creative. Some people
would probably disagree that APRneeds to be created. I do know a
few people have that viewpoint,but it's just something worth
considering. So if you're reallytrying to optimise that patient,
if you've if you've managed tosort of get them into a good
(33:21):
eating pattern, where youprobably think they are losing a
little bit of fat mass, again,this is where answers can be
really important, not justlooking at the way because you
want to make sure that they'regaining some muscle tissue. So
if you sort of got them inthere, they have an energy
deficit, making sure thatthey're getting a good amount of
protein going in. I thinkcreatine is definitely something
that you can discuss with apatient. I'm not saying for
(33:42):
every single patient, especiallyin terms of portability, the
convenience, you know, you haveto take everything into account,
but it's definitely worth worthlooking at. And I think that's
something that I think in termsof supplements from an acute
side of things, it's very muchpushed towards do there are
clinical nutritional supplementsIs that fun to use. And, and
(34:04):
it's something I talk about whenmy patients quite a bit. It's
our commercial available sportsnutrition supplement can be
proven ingredients that can berelatively cheap ish.
Aaron Boysen (34:16):
And in fact, they might have less calories and a
similar amount of protein, whichis useful in this patient
cohort.
Mike Patterson (34:21):
Yeah, definitely. And I think that's
all set for an underweightpatient or sarcopenia. You know,
sometimes a whey protein shakewith a bit of a cream in that
might test, some nutritionalsupport.
Aaron Boysen (34:35):
There's lots of different nutritional
supplements out there and takesome preferences may vary. I
personally actually quite likemost nutritional supplements,
but I think the point is clearthat there's lots of evidence
out there for supplements likecreatine In fact, more than some
products, some ingredients thatare used in clinical nutritional
supplements HMB comes to mind.
Mike Patterson (34:56):
So with the HMP As I mentioned before about
Philips, so if anyone wants totalk HMP, have a chat with Prof.
Phillips and see what he thinksof HIV. And again, this is a
very, very knowledgeablegentleman who's does get the
protein props. So he does a lotwith with with muscle tissue.
(35:19):
HMB. Yeah, we'll leave it atthat.
Aaron Boysen (35:22):
So, onto another topic, you've talked a little
bit about your experienceoutside of dietetics. With, with
fighters, I think it was MMAfighters and sports nutrition
more generally, is thereanything you've learned from
outside of the normal diastaticsphere that's helped you during
your clinical work?
Mike Patterson (35:43):
Yeah, so a lot of it is, a lot of it does come
back to sort of sports nutritionis probably a little bit more at
the forefront when it comes tooptimising muscle mass. And the
really interesting thing is thata lot of sports nutritionists,
when you actually look at theytheir work, they don't just work
with athletes, a lot of theresearch that they do is with
(36:04):
clinical populations. So I thinksort of just getting to know
different researchers anddifferent ideas. And it's just
opened me up to a lot of reallyknowledgeable people who are by
background, sports nutritionist,but do a lot of stuff that's
very, very clinically relevant.
So again, I say we're fighters.
And one of the things that we dowith biters in terms of Alan MC,
(36:27):
where is put them on a lowresidue diet. So again, low
residue doesn't really have adefinition, no one can really
say what low residue is what isresidue, and you've got its
moral fibre diet. Again, it's alittle bit more in terms of it's
a little bit more theoretical,whereas the team Liverpool, john
Moore's are actually looking atthis. So they're going to do
(36:47):
some trials, in terms of whatwe're different actually happens
with a low residue, low fibrediet, and so it's something that
they use with their so there's achap called Colin Evans, who
does a lot with professionalfighters. So he's looking into
it. And I think it'd be quiteinteresting in terms of what
they find with the low residueor the low fibre diet in terms
(37:08):
of what happens with these sortof the wear of people's stalls
and what happens with it,because it's going to be quite
applicable to what we do withstoma patients. We tell a high
output stoma patient, you needto follow a low fibre low
residue diet because it's goingto reduce the output from your
stoma and some things thatthey're going to do with these
patients. Yes, the physiology isgoing to be slightly different,
(37:30):
slightly different, but it'll bequite interesting to see sort of
what's coming out in terms of adry or wet wet from there still
and what will happen actually,in terms of the stoma patient,
something's out there the linksbetween sports and clinical,
probably flossing, and peoplethink
Aaron Boysen (37:45):
definitely, especially with that example,
you just shared. So in thethread also, you talked a little
bit about weight management. Nowmany dietitians might think I'm
not in weight management, so whywould I need to know about it,
but you think every dietitianshould know about it?
Mike Patterson (37:59):
Why. So this goes to the trusted dietitian,
dietitians are the experts. Ilike to think that you would
trust dietitians, we are theexperts in a lot of areas, but I
think people use that as sort ofWe Are the be all and end all of
nutrition is a protected title.
(38:19):
And I think a lot ofnutritionists, sports nutrition,
when it came to the real nittygritty of Clinical Nutrition
would be absolutely clueless,the wonder what the doing. So
this is why we are protectedbecause we do have that
knowledge is very, verycritical. But I think to be sort
of seen as an expert, I don'tlike that word for an expert to
me, you have to be so who wouldMr. Ridley the unshackled you
(38:43):
know, these, these really goodresearchers cover Australia, I
would say they are experts, theyhave a thesis, they are experts,
the stuff that they'republishing is brilliant,
brilliant, knowledgeable. But Ithink as a dietitian, you need
to have a good understanding ofthe basics. So this was put into
me from Lindsey King and Helenwhite, which I'm sure you'll be
aware of if you went to Leeds.
(39:03):
So what they said to me is, as adietitian to Joe public are
gonna want you to know, therandom questions on this new
diets out what's your thoughtson it? What's the best thing for
web management? Are my son playsfootball, he runs all these 10
cares? What does he need to do?
So these are quite like randomquestions that the general
public gonna want you to knowabout. So if you say trust a
(39:24):
decision, we are the expert,you're gonna have to have a
basic knowledge of what thecurrent evidence is for pretty
basic super sports nutrition,what the current evidence is for
weight management is low carbbest, this high carb rest, you
know, we're getting to thatdebate because the goal though
is if you have that new, goodunderstanding of the basic
knowledge, I'm not expecting ICUdietitian to have the best web
(39:49):
management knowledge in theworld and run, you know, tier
three tier four clinic or ifthey have a good understanding
of Oh, yeah, that review cameout recently to say that
actually, if calories arecontrolled brought in equal, no
weight loss is better than that.
I just think that helps theprofession that little bit more
gains that a little bit morerespect in terms of from the
other sort of areas of nutritionis yet where the experts on
(40:13):
really, really clinical side ofthings. But we do have a good
foundation of general nutritionstuff that maybe is a bit more
public health.
Aaron Boysen (40:20):
Yeah, exactly. So it's knowing the answer to the
questions Joe public want toknow, because they're not going
to ask you about more clinicalquestions.
Mike Patterson (40:29):
What I don't what do I What do I feed the
beast patient on the fields onthe unit? Well, they might do is
fasting better than keto? Isketo, about Weight Watchers? You
know, these are the sorts ofthings that someone's going to
ask you. So it's just sort ofhaving that decent foundational
knowledge to say, well, x, y,and Zed. You know, this is
(40:50):
probably not better than this,because of this.
Aaron Boysen (40:52):
So how does the dietitian get all this
knowledge? I mean, there's somuch information out there. And
they're working days only, maybehalf eight to half, or,
Mike Patterson (41:02):
yeah, it is you have to be a massive nerd
lightweight, just pretty muchread all this stuff. So there's
a few different things. And I'dsay. So one thing that I gained
massive amounts of knowledgefrom this is hopeless, something
I'll be doing his podcast. So Icommuted from home to Leeds and
for my undergrad. So that wasfour years. And then I did post
grad courses at noon yoplait. Sothat was another two years. So
(41:25):
I've got six years worth ofcommutes there. So probably one
of the best podcasts out therein terms of the nutrition is
sigma. So Danny Landon's podcastis unbelievable. And the things
he has on there is not justsports, nutrition, he has a lot
of clinical stuff. And I foundthem really, really useful. And
the thing with that is aresearcher might talk about
something. And then they'llusually put up their website,
(41:48):
their social profiling, you canfollow him on that. And they'll
probably put on their socialmedia, their research, they'll
post on there, they mightretweet someone else's research
in that area. So you can followthem that way. If you're like
me, you stalk researchers andresearch get and you see
constantly get email updatesfrom when they're publishing,
it's a good idea to find out whothe experts are in your area. So
(42:09):
I mentioned before about alittle bit later, in Australia,
obviously, Danny bear in the UK,and then the chaplain as well
from us. So Paul academicals,and Santa Vishnu, Vishnu,
Denise's from Duke. And so theseare sort of experts from the
quick care side of things, ifyou follow them on social media,
(42:30):
or even if you want to pop thatout onto research get for me. So
in terms of politic pn, there'sa few people looking at it. So
team down at UCL, the dieticiancalled leave keen, who's doing
quite a bit with some of theconsultants down there from
Manchester, Salford, there's alady called AnnMarie sailboats
who's doing a lot politic. Andso there are people I saw start
(42:52):
to see what's coming out fromthat side of things. Interesting
crit care as well. So that's whyI named names, I follow them. So
social medias grant research getso researchgate is basically
like a reset social media iswhere people just put what
they've published on theirsocial media places to follow
people on that, as your countryget old debts what they publish,
and podcasts again, I thinkthey're sort of three really
(43:14):
useful things to findinformation, you do have to be a
bit of a nerd, like me, you'renot going to get this done
between the hours of eight andfour. When you're seeing
patients you've got nuts towrite up, you're probably not
going to get all the same andobviously get solid like cn
magazine, video digest andthings which do have snippets in
(43:34):
but I just don't think theyprobably got to the dat as much
as you'd find from social media.
And the thing with social mediais social media has its own peer
review as well. So someone willpublish a paper and some might
comment on that maybe didn't dothis right or really like the
way that they've done this soyou can get people's other
researchers feedback on thatpaper straight away.
Aaron Boysen (43:56):
Exactly. So we can follow the people on social
media for their research. Can wefollow you on social media and
catch up with your research?
Mike Patterson (44:03):
Yeah, so although I just post gets follow
other people for that reset.
Aaron Boysen (44:12):
So everyone wants to follow you on social media,
they can get some entertaininggifts. Thank you so much for
being on the dietetics digestpodcast.
Mike Patterson (44:28):
Some guests.
Aaron Boysen (44:29):
Thank you everybody for listening to the
dietetics digest podcastreferences and links to
everything discussed in thisepisode will be in the show
notes and join us another timefor the episode of The dietetics
digest podcast.
Thanks for joining me this weekon dietetics digest, make sure
(44:50):
to visit my website a dieteticsdigest comm where you can listen
to the podcast or why notconsider subscribing on Apple
podcasts stitcher smart radioSpotify or basically just ask
Alexa, and you'll never miss ashow. And while you're at it, if
you found this show valuable,you could do one of two things.
Firstly, if you could leave areview on the podcast that
(45:11):
you're listening to, maybe theapple podcast or Stitcher smart
radio, and you could tell afriend about the podcast that
would be really helpful to helpgrow the podcast. Thank you so
much for the support, and have alovely week day, wherever you
are.
When you look at evidence based practice is sort
(00:02):
of looking at the evidence baseclinical experience, and also
the patient's perspectivebecause you might have the best
evidence base in the world forsomething. And you might have
the best clinical experience.
But if the patient doesn't wantto do also, if it's not suitable
to the patient, it's not goingto be correct. Anyway.
Aaron Boysen (00:21):
Welcome to the dietetics digest podcast, a
podcast that helps youunderstand more about the
different areas of dietetics andnutrition and what others are
doing within them. We do this bytalking to inspiring and
influential individuals that areadvancing practice in some way,
shape and form. Our mission isto create a resource that helps
(00:41):
dieticians to build, grow andshare ideas with each other to
help advance their practice andthe practice of others. I am
your host, Aaron Boysen. Hello,Michael Patterson. And thank you
for joining us today ondietetics digest podcast.
Maybe you could start withintroducing yourself who is
Michael Patterson
Mike Patterson (01:01):
are a dietitian.
I'm currently back in my oldrole as a clinical dietitian,
but our pre Corona and also inabout five weeks time on
clinical research fellowshipsand nutrition. So it's got a PhD
mixed in there. So I'm employedby Holyoke medical school. As a
research fellow, I do a PhD. Aspart of that sponsored by Yauch
cancer research looking atpalliative pn venting.
(01:24):
gastrostomy is in Manipur,bollock structured palliative
intervention in South Korea,
Aaron Boysen (01:30):
what really triggered the interest in that
area in particular.
Mike Patterson (01:33):
And so pretty much since I qualified, I knew I
wanted to be intestinal failure.
So I covered colorectal as partof mercy basement, I did my
consolidation on Colorado, whatI found really, really
interesting. So as soon as I gotto my jobs, I got a job in
hardware. I did my seedplacement, nice shout out to
contractor. So luckily, it'sbeen five that was my first
(01:54):
rotation, the rotation, so it'sbeen like six or nine months,
I've managed to sort of topMarines are doing it, but 18
months. So I got sound a littlebit longer. I knew I wanted to
sort of delve into piano, Ialways covered when pn dietitian
was off, always picked up newpatients if they were busy. And
then we started doing a littlebit more positive pn as a
(02:14):
nutrition team. And thencolleague of mine to do their
PhD. So she's another fellow atbolier Medical School. And he
said obviously PhDs coming up ondbrs cancer research. So it's
got been in around this area. SoI met with my no supervisor,
who's a professor of medicineput the idea to her about
investigating parts of pn,Gaston is about function issues,
(02:37):
mainly Medicaid. So the ResearchCentre are currently doing some
research looking at sort ofpatient reported outcomes in
malignant bowel obstruction. Sothey're already looking into
that area. And then when I spokeabout nutrition and the
gastrostomy side of things, shewas really interested. So she
said to me, and my centreresearch dietitian, that she
wants an army of dietitians. Andso
Aaron Boysen (02:59):
should we start the recruitment drive right
here?
Mike Patterson (03:02):
Yeah, maybe she just said there's some she has
some issues with some of theevidence. So she wants to prove
that evidence. So I appreciateand get more dietitians into
research. It should be out.
Aaron Boysen (03:12):
So you said you always had interest in the area
of intestinal failure. Was thatoriginally from when you first
started dietetics? Or did thatinterest grow throughout your
time in dietetics?
Mike Patterson (03:24):
So dietetics is actually a second career for me.
So I left school 16 did anapprenticeship. So I was a
telecoms engineer for five and ahalf to six years. It paid very
well, it was like there's nothought process to it a lot of
time, you just put cablestogether and really frustrated.
So then offering Andriyredundancies with a half decent
(03:45):
pair to go with it. So I tookthat my other half family got
pig farm. So I worked on thatfor a while while thinking about
different choices. So I'vealways been interested in sports
nutrition, just from personalperspective, looking for a new
career and my sister's a videoalways always interested in
nutrition dietetics so differentaccess costs and different
undergrad for sort of Germanundergrad, maybe go down the
(04:07):
smart route. I do the nonclinical placements. I did my
undergrad at Leeds I did the nonclinical soft spots, research
placement leads and then when Idid my placements, Southland,
colorectal got introduced to pnis quite Science Nation without
a word from a from a dieteticperspective, you get to play
about those numbers a bit mustinvolve a bit more sort of
medicine involved with it. Sobecause of that just sort of
(04:30):
knew straight away, this is thearea I want to work in. Well,
Aaron Boysen (04:33):
thank you. That's really interesting. It's really
interesting to hear the thoughtprocess you took in choosing
where your eventual directionwould be. And I think that's
really important when we'rediscussing the next topic
because it's really important tounderstand that everyone's
journey is different. However,there are commonalities in which
we can support each other in anda few months ago, you put out a
tweet, which was sort of aroundhalf ranting and half tips for
(04:58):
new dieticians. Possibly juststarting out in a career in
dietetics. So just like thattweet, I want this podcast or
maybe a little bit of ranting,but really aimed at those new
dieticians and advice for them.
So bring us on to one of thefirst points you mentioned in
the tweet. And it resonated withme, because obviously, we go
through lots of topics in ourdegree, we cover lots of
(05:20):
different areas. And sometimesthings aren't at the forefront
of our mind when we graduate,you've got other things on your
mind. And going into your firstjob, you want to make sure you
prepared, is there any area thatyou think New dietitian should
brush up on? Or just refreshtheir knowledge before they get
started?
Mike Patterson (05:40):
Yes and no. So I sort of do like to jump into
things and just give it a go seewhat happens. In terms of
refreshing, definitely. So Istill do it now, especially when
you come up with it. So you seea new condition or think about
something else. So especiallyfrom where I am now with
intestinal failure, but goingback to pretty much every aspect
(06:01):
starts ethics, physiology. Soit's the thing that you learned
in first year? Well, I certainlydid when you do this, like, why
am I landed this one and thiscome foreseer when you've done
all your other modules, you'vedone all your placement,
physiology comes a little bitout of your mind. And then for
me, when you got back, when youstart working, you come back on
placement, you start a job fulltime, physiology becomes that
(06:24):
much more important, I think interms of when you have a good
understanding of physiology, itimproves your understanding the
medicine, so I'm not expectingdietitians to be medics. We're
not medics, but having thatreally good knowledge of
physiology really helps improvein terms of your medical
knowledge. I think it helps youunderstand the disease a little
bit better. What's actuallyhappening body where you're
(06:45):
digesting information is goingto help us think Yeah,
physiology is probably the bigone. I've said it on the on the
thread. But in terms of I'm verybiassed that gi physiology, you
need to know your GI physiology.
I don't doesn't care whatcondition it is, it's probably
going to end up in the gut. Ifit doesn't, obviously, it's
intestinal failure. But again,we still need really, really
good gi physiology. And I'm
Aaron Boysen (07:06):
running through some of those theoretical topics
that may not have been all seemto have been as applicable at
the time now that you're workingare almost directly applicable
to your work.
Mike Patterson (07:19):
Yeah, yeah. So it's just that was going on
right in your mind. And just, Ialways think if you just take a
little bit of the backward stepsand times, because you probably
just want to jump into it. Butif you then you know you're
assessing the patient and lookinto their solid medical
history. If you actually think alittle bit about the physiology
can help, what you're then goingto want to do with that person
(07:40):
is going to inform your planthat little bit more.
Aaron Boysen (07:41):
So how am I understanding physiology inform
your plan.
Mike Patterson (07:44):
So it might help you solve a problem, even
something like fatmalabsorption. If you don't
understand where something getsabsorbed, or what happens when
someone's won't absorb them, ifyou don't have that good
understanding, you might notpick up on it, it might not be
something that a medic couldpick up on as well. So if
someone's having like theatheria medic might not pick up
on it. But because asdietitians, we often have the
luxury of having a little bitmore patient contact times in
(08:07):
the medical world, again,something where communication
skills come in, but we get tohave a bit more of an in depth
chat with someone. So you mightpick up on some triggers that
they're giving you that maybethey've not had a chance to
discuss with a medic, if youapply a little bit of physiology
to it, you might be able tothink, ah, maybe it's something
that you can always discuss themwith their medics as well. I
think if you have a goodunderstanding of physiology,
(08:29):
when you're discussing somethingwith a medic as well, it makes
it that little bit easier,because you can explain what
your thought process is becauseof x y Zed, and it might just
get that point across a littlebit more.
Aaron Boysen (08:40):
You mentioned a little bit about communication
skills. Is there a way to brushup on those before we start our
new jobs?
Mike Patterson (08:47):
I think sometimes from what you do at
uni, very, very sort ofstructured, very formal doesn't
always apply necessarily,especially to me in an acute
hospital restaurant is quitesick, you're not always going to
be able to chair someone with alittle pedal following and, you
know, if you push up and justthink, at least if I can focus
(09:08):
on that paraphrasing andsummarising I think that's the
two big ones I take is that youcan actually do that quite
easily with someone in acutecare. So you might not be able
to do everything else, you mightnot be able to sort of guide
someone as much towards a goal.
I don't think he can in sort ofdifferent areas of dietetics he
can sort of it's a little bitharder, I think in an acute
setting for someone to come upwith that on plan. As much as I
(09:31):
think he was at leastparaphrasing and summarising
what's happening. You're able tosort out plan together a little
bit more focusing on that
Aaron Boysen (09:37):
paraphrasing and summarising Why do you think
those particular skills are mostbeneficial in an acute setting?
Mike Patterson (09:43):
I think it just again, this active listener at
least it shows to the patientthat you're actually listening
to them and they get tounderstand sort of what they've
said back and for me as well. Ithelps me remember what patients
said to me. I'm not a big fan ofsome people are but I'm Not a
big fan of sitting thererecording things on paper, I
find it quite distracting forme. I don't know if the patient
(10:06):
does, but for me as well, if Iparaphrase throughout, if I
summarise at the end orsummarise where Mary's
appropriate, it helps meremember what that patient said
to me. And then I could go backand write whatever notes that
tells me I can. I can rememberhistory a little bit better.
Aaron Boysen (10:21):
Yeah, I've noticed that too. And it really
resonates with me, because whenI summarise or paraphrase
something to a patient inhospital, and maybe I've
forgotten something, or maybe Ididn't have appropriate emphasis
on an area that was reallyimportant to them, they can
reinforce that area, so that I'maware of what's what's most
(10:41):
important to them.
Mike Patterson (10:42):
Yeah, percent.
Aaron Boysen (10:43):
So we talked a little bit about communication
with patients. But I want totake you back to what we were
discussing earlier. It's alittle bit our knowing
physiology helps us discussthings with the MDT so that
doctors, physios, nurses,Speech, Language therapists,
occupational therapists, andother members of the MDT, do you
(11:03):
have any tips on communicatingwith them? I remember when I was
a newly qualified dietitian,because I felt quite new. And I
felt that my knowledge wasn'tfully developed. And I also felt
like when people said, buildrapport, it meant, Hey, did you
see the football game on Sundaynight, and I'm just terrible at
those sorts of conversations.
Mike Patterson (11:24):
And I'm the same as you are for small talk, not a
big one for small talk, in termsof, I think it is different
depending on who you're talkingto, as I said before, like with
medics, I tend to find a goodway that they sort of respect to
that a little bit more, but tosort of get to know that a
little bit more, if you know,your patient story, get really,
really, really good at knowingyour patient story. So you know,
(11:47):
eight year old guy admitted withthis history of this, this is
currently happening on thistreatment devices. This is this
is this is happening. So this iswhy I think I should do this. So
I think for a consultant, hemight have 20 3040 patients on
the ward days looking afterthat, if you say our current
issue about Mr. Smith, Mr.
(12:08):
Smith, if you can sound Can Ijust ask you about Mr. Smith, we
lost the story, it's gonna makeit a little bit easier for him.
And I think that's a good way toget chatting. If you know your
patient story, it makes iteasier to chat with medics and
then you know, a bit more likelyto just chat randomly or ask you
about a patient. And the samething I I find that like the
physios speech and language, orthe therapist goes back to the
(12:29):
fact that I think as dietitianswe have that little bit more
time with patients, we get toknow them a little bit more
often patients will tell youcertain personal things. So dog
or cat by variable R, and Ifound a good way to sort of
break the ice for the physios orspeech language is talking about
patient bring something likethat, like the little sort of
finer details and stories thatthe patient tells you, and
(12:52):
probably told the othertherapist that story, basically,
I just find it's a good way toget chatting about it. Also,
this is can really be helped fora lot of people, but I think
being male and being being adietitian is a bit of a novelty.
So I think that honestly helpspeople noticing you because
first of all, just being themale dietician, I, I've often
(13:13):
been that the only maledietician where I've worked. So
it's like, it's the male world.
So you get to know peoplebecause because of that I've
worked
Aaron Boysen (13:23):
in a hospital where I have that novelty
factor. But currently where Iwork, there's actually quite a
few male dieticians in theoffice, I think there's about
five in our cute team. So Ithink by now that novelty factor
is unfortunately worn off. Infact, saying that one of our new
dietetic assistant started, andshe mentioned that she didn't
(13:45):
realise how female dominateddietetics was because there was
so many males in the office.
Mike Patterson (13:53):
That novelty value. And they also think in
terms of when you're a new bandfive, that probably is brand new
f1, there's going to be brandnew, brand new speech and
language therapists all probablyfeel very similar. And I do tend
to find like newer punk fives,newer therapists, newer doctors
do tend to just end up chatting,I think similar age similar
experiences tend to find a newstart chapter. Also rotation, I
(14:16):
think help as well. So if youknow you're on a set reward for
six 912 months, you do get tounderstand a little bit more
they get to know you. And thatreally helped.
Aaron Boysen (14:25):
I think by being there for a longer amount of
time. It makes it easier forpeople to invest in a
relationship, because you knowhow long it's going to last?
Mike Patterson (14:34):
Yeah, like I always found if I'm going on to
a new Ward and an Old Covenant,it's always good to go have a
chat with water stuff, it'sgoing to be there water while
the charge less. It's there oneso don't just introduce
yourself, however awkward it maybe and just say I'm going to be
here for the next 912 months.
Aaron Boysen (14:51):
So you've been there yourself. You've been a
newly qualified been fivedietitian and now your F 10, a
phrase highly specialistdietitian.
Mike Patterson (15:00):
Knock on it.
Aaron Boysen (15:01):
So you've seen it from both sides. If you were
giving advice or if you weresort of looking back, is there
any advice you would give toyourself as a newly qualified
band, five dietitian,
Mike Patterson (15:12):
quite a few things. So going back to that
point last, and I don't think weneed to be mad, but I wish I
just understood medicine thatlittle bit better when it first
came out. And I think probablyis something that you pick up
with experience. And as I said,going back to the physiology,
having good knowledge ofphysiology, biochemistry will
help do a refresher on that. SoI think in terms of I wish we
(15:35):
just had that little bit betterknowledge of medicine, I just
think it really, really helps interms of getting you understand,
and especially sort of when youfirst read medical notes of
that, but the right thing, and Iactually do them constantly on
Google, like what does thatmean? What does that mean? What
does that mean? But again, itprobably just comes with
experience, again, this pointand massively biassed towards
(15:57):
but research skills. We do doresearch as an undergrad, as
opposed to graph, but I think itcould be improved that little
bit more. Especially it's notlike a critical thinking skills.
I think for me, when you improveyour critical thinking skill to
problem solving becomes thatmuch better matches think it
allows you to break things downa little bit more. So yeah,
(16:18):
having my personal perspectiveis that every dietitian would
have to do some sort of researchfor a lot of people might not
like it. But I just think it'sreally, really important as as a
profession that we have a reallygood knowledge and understanding
Aaron Boysen (16:32):
of research methodology. So in your mind,
what would the benefit of thoseresearch skills be?
Mike Patterson (16:37):
Because in terms of I think a lot of the times
the way that huge generalisationis that sort of be quite happy
to offer guideline below, right.
That's what the guideline says,This is what I'll do. Whereas I
think if you have that littlebit better knowledge of research
methodology know how to find aninteresting, perfect because the
evidence base is constantlyevolving in nutrition and
(16:57):
dietetics. There's a lot ofareas where there isn't a great
evidence base. But if you justhave that little bit more of a
reshot skill, you might be ableto find something or even if
it's something quite small, likea case study or a little case
series of patients, you mightthen be able to apply something
like that to your practice, isthat there's not really an
evidence base, but I found this,this and this. So I'm going to
(17:18):
try this in my practice. And aslong as it's safe, that's what
you're causing no harm you cansell, why are you doing that?
Well, I found this and somepeople have had a bit of
success, there's no evidencethat can go off anywhere. So I
might as well try this, and thenthat'll monitor it, and go from
there. And again, methodology, Ithink it's something that's
really, really important interms of like when you read in
the paper, and most people readan abstract that might go to the
(17:40):
results. Because this site willgo through the methodology fast,
obviously, because of themethodology, see whether it's
good or bad, and you can go fromthere, then you can look at the
results in the discussion. So mysupervisor said to me, pretty
much when looking at purpose,just look at the methodology and
the discussion. So themethodology will tell you
whether what they've done isgood or bad. And the discussion
is, they should hopefully tellyou what they've done good or
(18:02):
bad, and what is good. Whatabout it's bad topic. So having
that good understanding themethodology, social media really
helps.
Aaron Boysen (18:09):
Thank you. That was actually first pointed out
to me when I was on non clinicalplacement, I was working with
some PhD students, they had ajournal club, a couple of lunch
times a week, and they invitedme along to it. And that was one
of the tips they gave me toreally understand the quality of
the research that was readingthe methods was the most
important area. And I think fromthen on, it was really eye
(18:31):
opening to me when I readresearch to sort of the results
can be quite appealing. But itis the methods make or break an
article from research,
Mike Patterson (18:41):
especially sort of who have done the research on
it really, really helps. So youmight find like someone might be
caught in set guideline. Butthen when you actually look at
the guideline, it might be ourthe evidence base is based on 18
year old males who have got anormal BMI, and you've got a
female who's BMI 14 from here,but you're following that
guideline, because it's sogeneric white, if you've got a
(19:03):
good standard methodology andlook at the guidelines says
that, but when actually look,it's not relevant to my patient
population whatsoever. And ifyou don't have that sort of
critical thinking skills, youmight spell the guidelines as
that. Whereas if you have thatlittle bit of delving into
papers and thinking, Well, youknow, or even if this sort of
papers that are very similar toyour patient population, you
(19:24):
might say, well, there's notreally much of an evidence base,
but this pair back looked at apatient population group are
very similar. So I'm going tosort of use that as a basis
angle from that, I think sort ofevidence based practice is
looking at best availableevidence. So if you can then
work out what is the bestavailable evidence, you can sort
(19:45):
of go from there. Thank you. I
Aaron Boysen (19:46):
think that's so important to understand, not
only the guideline, actuallywhat that guideline is based on
because it can really inform ourpractice. And I think there's
lots of talk about guidelinesare just guidelines, but how can
you really Understand theguideline enough to use it as a
guideline, if you don'tunderstand what underpins it, if
you don't understand thestrength of the evidence, the
(20:07):
limitations of that evidence inyour patient cohort, I mean, if
you don't actually understandthe guidance, there's only two
ways to follow it. Follow itwith exactness or whimsically
break it comes from Yeah, youalmost need to know the rules.
In order to break the ruleseffectively, you need to know
what the guidelines is based onto know that it doesn't fit your
patient population, because ifyou don't know you're based on
(20:30):
sort of whimsical feelings, andnot based on evidence,
Mike Patterson (20:35):
yeah, definitely. And when you look at
evidence based practice is sortof looking at the evidence base
clinical experience, and alsothe patient's perspective,
because you might have the bestevidence base in the world for
something. And you might havethe best clinical experience.
But if the patient doesn't wantto do also, it's not suitable to
the attention, it's not going tobe going anywhere. Even when you
(20:56):
look at these best practices,then three things, you need the
best available evidence,whatever that may be, you're not
always going to get an amazingRCT that tells you this, you
need to sort of see what fromyour clinical experience,
whether you've tried somethingbefore, what your patient
population, whether you've seensort of something similar in
this patient population groupbefore, and also what, what the
(21:16):
patient wants to do. Thank you.
Aaron Boysen (21:18):
I think that's really important things that
we'll discuss there. Now in yourTwitter thread you also mention
about anthropometricmeasurements that are not
weight, what measurements wereyou referring to? And how are
they useful?
Mike Patterson (21:30):
So they were obviously that is a really
useful tool to start off with.
And I think either iron softwareis really useful, but where it
can be manipulated, so much. Sooutside of clinical practice, I
tie box, so I used to sort ofcompete a little bit, but now I
just do coaching, I work withsome athletes that currently, so
(21:51):
merely MMA fighters, and work onprocedures. So in terms of
professionally, you can findpeople who lose 6789 kilos in a
week overnight, so weight can bemanipulated that easy. So
basically put someone on areally, really low carbohydrate
diet, dehydration them a littlebit. So you've lost the glycogen
stores, you've lost the waterattached to that, under the
(22:12):
hydrated. So has someone lostseven kilos overnight on just
the hydrated and it can besimilar in terms of clinical
perspective. So and this is feedfor a couple of days, not the
right IVs to correct it may havelost four kilos, but might not
have lost four kilos becausethey're just really, really dry.
So if you have a good on Sundaybiochemistry, look at a blood
sample, I have not lost fourkilos that just really dry. And
(22:35):
the other end of the spectrum,there's so many conditions that
we look at where there's goingto be some aspect of fluid
retention. So renal patients,that's number of real patients
are going to be fluidoverloaded. One of the reasons
for dialysis, heart failurepatients going to be massively
fluid overload. If you look atliver patients that might have
1516 1718 kilos worth of thesizes in there, even from my
(22:58):
side of things and surgicalpatients, vast majority of
surgical patients get some fluidretention after surgery. Well,
the first thing I got taught asa surgical dietitian is after
surgery, make sure you look atthe legs, make sure you say is
right for the squeeze yourankles, because more often than
not, they're going to havesomebody on the legs, you might
have a lot of squeezing theirankle, right? Yeah, that's
probably this is why we're it'soften not the greatest because
(23:19):
there's so many differentconditions where you can get
fluid retention, you might getexcited, and it's just going to
mask what's happening. So someof them really, really easy ones
a minute params confirms tricepsskinfold, calf circumference,
grip strength, they're allrelatively cheap, pretty
convenient. They're not to sortof invest if I know some
universities do do isaaqaccreditation. This is another
(23:42):
thing that I wish I was taughtmore citations. I wish that
every university made sure thatevery dietitian that came out
uni had isaaq Would you mind
Aaron Boysen (23:49):
explaining what isaaq is for those who maybe
aren't aware.
Mike Patterson (23:53):
So the International Society for the
advancement that kind ofanthropometry so because the
level three you can teach, butthe level one does various
measurements I would do to getmy eyes at training in the
middle of nowhere, but obviouslythere is a small pandemic
happening. So as a level one youdo satin bone calf measurements
(24:15):
and set muscle thicknesses andalso callipers. So it's just a
way that you can assess them onbody composition rather than
just checking something to whereyou can then assess for things
like muscle mass with the bonegas, trying to look at sort of
what's more skeletal structureis mostly the callipers to look
at. And it's just much easiermethod. So I think sort of you
(24:37):
know, it'd be great if we coulddecks all our patients on the
same deck same the samehydration tricks every time Not
gonna happen. Probably notethical to have access to
everyone. But things like thatare much easier, much more
practical method of just gettingan idea of what someone's body
composition is actually doing.
And I think in terms of gripstrength especially it's going
(24:59):
to give you a look Get morefunctional data as well. So I
found on through really goodconversations with medics as
well. So going back to theintestinal failure side of
things, I had a guy with a highoutput stone that was on max
meds to district him, and hisweight was massively
fluctuating. So it didn'tactually look like he was losing
weight. So he was a tradesman.
(25:20):
So expect them to have a prettygood grip strength, reasonable
muscle mass. So I was discussingit with the medics and saying,
look, this is what happening. Ithink it's worth just
fluctuating because we stillmolossia Friday, the medics are
a little bit unsure did fullanswer on it, it showed in terms
of prescriptions was, you know,much less than what it should
have been for a guy his age andalso in terms of from just mid
(25:40):
upper arms conference castconference showed that he didn't
have the muscle mass you'dexpect for a guy his age to
adapt to the medics and said,Look, this is what's happening.
He's going down. This is notwhat we'd expect for this guy,
especially being a tradesman,he's probably using his hands
quite a bit. And then thedecision made was to start him
on piano, ready to reverse thesurgery. So he ended up on the
end for about three and a half,four months, to start utilising
(26:04):
the fact that his weight wasfluctuating so much looking at
using the bloodspot to use ananthro, I was able to convince
the medics that he was needingfurther nutritional support. And
the patient was actually reallyagainst me. And at first, he was
just like, No, I don't want todo it. And then after we started
him on it, and once he got inhis former regime, yeah,
absolutely love that stuff.
Because like a new book, er,because he got so much better.
(26:24):
The fact that he was betternourished. And you know, pretty
much the reasons that I did wasbecause I could prove to her
that he was malnourished. It wasfortunate to work.
Aaron Boysen (26:33):
Thank you. That's really interesting. I mean, I
knew about Isaak, but I justthought it was marketed towards
Oh, it was made for more sportsprofessionals or people working
in sports medicine, and I sortof thought it was maybe
impractical in clinicalpractice. And but I guess I'm
wrong.
Mike Patterson (26:53):
Yeah, I think sort of, it's marketed that a
little bit more towards sports,you got think first, a lot
sports are probably going to bedoing more body composition
assessments, we would do it. ButI just think in terms of their
teaching methods to take acorrect measurement. So
especially sort of like, errorcan be huge between the same
people doing it, and also sortof taking the right measurement.
(27:15):
So you know, if you take ameasurement, a couple of
centimetres different on theare, the measurement might be
massively different. So if youget taught the correct technique
to do it, even stuff, liketaking capsules, mid upper arm
taking callipers, I just thinkit's really, really applicable.
And because there's so manyconditions, as I say, Why Where
is useful, but at the same time,doesn't matter of limitations.
(27:36):
If you can do some pretty easy,quick answer. I think it just
makes an assessment so much morecomprehensive, I think it helps
from a patient perspective aswell. If you're showing that
their strengths increase, thenyou can show it to them that
their nutrition interventionswork and that you're getting
some functional outcomes isreally important for patients,
especially if they can't see anychanges in the way because it's
(27:57):
been masked by deema, or look orsighted.
Aaron Boysen (28:01):
Thank you so much.
I think that's so important,especially over the last couple
of months for myself, it'sreally illustrated the
limitations of weight, but also,BMI and BMI in the context of a
lot of our screening tools, hasvery crucial to acknowledge
limitations that are prevalent.
That brings me on to anothertopic recently due to
(28:24):
coronavirus, and a lot morepatients being an ICU. And
having prolonged periods of timeon non invasive ventilators,
they might have lose a dramaticamount of weight, but maybe not
have a reduced BMI. What's thedietitians role in helping those
patients? So basically, you'vedone an assessment and you found
(28:44):
out that this patient is healthyor even overweight or obese BMI,
but has a dramatic amount ofmuscle mass loss due to recent
weight loss? How would youapproach that
Mike Patterson (28:57):
those patients so like, yeah, sarcopenic base
is quite an interesting one interms of they've got to really,
really poor health outcomesthere that if they're going to
have high adiposity, that's notgoing to be a great outcome for
them. But also the fact ifthey're gonna have low muscle
mass, it's really going toimpact them. So the first thing
I do is I speak to the physiosand see what they're up to. So
(29:17):
we know in terms of gainingmuscle mass, the biggest driver
is going to be some form ofresistance exercise. resistance
exercise doesn't mean thatthey're going to have to be
hitting the gym five days aweek, you know, so just means at
least some resistance for them.
And in terms of nutrition, Ithink it's sort of quite an
interesting one, because you'regonna have to try and address a
(29:38):
couple of different things. Soyou're going to try to have to
address the fact that haveprobably been having an energy
surplus, so you're going tomaybe want to look at reducing
their caloric intake, kind ofwant to put them in an energy
deficit. And alongside that,you're going to have to address
the protein intake. So we knowin terms of building battery
mass, you can build up the masswhen you're in a deficit.
(30:00):
Especially for someone who'ssort of like quite a novice when
it comes to resistance training.
But again, this is where I thinksports dieticians, sports
nutritionist sports dieticiansand a general clinical dietitian
are probably disagree what ahigh protein diet is since a
Chappie called Josie Antonio,who's the editor for journal of
the National Society of sportsnutrition. So he's done quite a
(30:21):
bit of research on really highprotein intake. So you're
looking at three, three and ahalf to four and a half grammes
per keto. So he sort of arguesthat he plus a high protein diet
is something over two grammes,tequila, and I probably sit on
that side of the fence with him,but high protein diet is
probably something either twogrammes per kilo so there's some
work done by Brad Schoenfeld andon Aragon, so they said to
(30:44):
maximise the anabolic effects ofprotein, you need to be looking
at both doses. So four meals aminimum of four meals, a point
four grammes per Keilar up toARDS point 1.55 grammes. So for
these patients, you're going tobe looking at trying to get 1.6
to 2.2 grammes of protein andideally split all the four even
meals. So this is the wholething I said on my tonight about
(31:06):
looking at stimulating muscleprotein synthesis. So this
again, was sarcopenia. As a guy,Professor protein says to
Philips, how much that'scovered. So anyone who's got an
interest in nutrition support,who's got an interest in
sarcopenia, we need to look atthe lack of stupidity. So
there's a dietician. So she's anIrish dietitian, still a doctor.
(31:26):
And so she did some work fewyears ago, looking at protein
distributions. As I thinkhistorically, if you looked at
probably a sort of typicalBritish diet, you've been
looking at sort of quite askewed proteintech, generally
pretty rubbish and breakfasttime, maybe a little bit more
than than lunch, probably thebig hair protein on a meal. So I
think aiming a little bittowards sort of those evenly
(31:48):
distributed protein patterns, agood idea, especially for a
sarcopenia patient, so for theirsarcopenic obesity, they're
looking at creating some sort ofcalorie deficit, to reduce the
fat mass, you need to make surethey're going to get some sort
of resistance training. Sospeaking with physios and see
what videos can do, and thenlooking at sort of optimising
the protein intake, try to finda bit of a nice, even
(32:09):
distribution of a sort of atleast three to four meals and
trying to hit that once the 2.2grammes, Sue Phillips has
actually published somethingreally, really recently looking
at nutritional supplements insarcopenia. Not it's not purely
sarcopenic, obesity, so the bigones created. So great things
got really, really, really goodevidence. So some of the things
that we're looking at that thesack kapena is created between D
(32:33):
and omega three. So that's I'velooked at some of their
supplements. So there's somethings that people can look into
as well.
Aaron Boysen (32:40):
Oh, that's really interesting, actually. So say I
had a patient that was a stepdown from ICU, and he has
experienced a massive amount ofmuscle loss during his time in
ICU, and covid. Lows on there,he was on for a prolonged period
of time, would you recommendcreatine monohydrate to those
kind of patients,
Mike Patterson (33:01):
I think it's definitely something worth
discussing with a patient. I'mnot saying that every single
sarcopenic obesity patient needsto be creative. Some people
would probably disagree that APRneeds to be created. I do know a
few people have that viewpoint,but it's just something worth
considering. So if you're reallytrying to optimise that patient,
if you've if you've managed tosort of get them into a good
(33:21):
eating pattern, where youprobably think they are losing a
little bit of fat mass, again,this is where answers can be
really important, not justlooking at the way because you
want to make sure that they'regaining some muscle tissue. So
if you sort of got them inthere, they have an energy
deficit, making sure thatthey're getting a good amount of
protein going in. I thinkcreatine is definitely something
that you can discuss with apatient. I'm not saying for
(33:42):
every single patient, especiallyin terms of portability, the
convenience, you know, you haveto take everything into account,
but it's definitely worth worthlooking at. And I think that's
something that I think in termsof supplements from an acute
side of things, it's very muchpushed towards do there are
clinical nutritional supplementsIs that fun to use. And, and
(34:04):
it's something I talk about whenmy patients quite a bit. It's
our commercial available sportsnutrition supplement can be
proven ingredients that can berelatively cheap ish.
Aaron Boysen (34:16):
And in fact, they might have less calories and a
similar amount of protein, whichis useful in this patient
cohort.
Mike Patterson (34:21):
Yeah, definitely. And I think that's
all set for an underweightpatient or sarcopenia. You know,
sometimes a whey protein shakewith a bit of a cream in that
might test, some nutritionalsupport.
Aaron Boysen (34:35):
There's lots of different nutritional
supplements out there and takesome preferences may vary. I
personally actually quite likemost nutritional supplements,
but I think the point is clearthat there's lots of evidence
out there for supplements likecreatine In fact, more than some
products, some ingredients thatare used in clinical nutritional
supplements HMB comes to mind.
Mike Patterson (34:56):
So with the HMP As I mentioned before about
Philips, so if anyone wants totalk HMP, have a chat with Prof.
Phillips and see what he thinksof HIV. And again, this is a
very, very knowledgeablegentleman who's does get the
protein props. So he does a lotwith with with muscle tissue.
(35:19):
HMB. Yeah, we'll leave it atthat.
Aaron Boysen (35:22):
So, onto another topic, you've talked a little
bit about your experienceoutside of dietetics. With, with
fighters, I think it was MMAfighters and sports nutrition
more generally, is thereanything you've learned from
outside of the normal diastaticsphere that's helped you during
your clinical work?
Mike Patterson (35:43):
Yeah, so a lot of it is, a lot of it does come
back to sort of sports nutritionis probably a little bit more at
the forefront when it comes tooptimising muscle mass. And the
really interesting thing is thata lot of sports nutritionists,
when you actually look at theytheir work, they don't just work
with athletes, a lot of theresearch that they do is with
(36:04):
clinical populations. So I thinksort of just getting to know
different researchers anddifferent ideas. And it's just
opened me up to a lot of reallyknowledgeable people who are by
background, sports nutritionist,but do a lot of stuff that's
very, very clinically relevant.
So again, I say we're fighters.
And one of the things that we dowith biters in terms of Alan MC,
(36:27):
where is put them on a lowresidue diet. So again, low
residue doesn't really have adefinition, no one can really
say what low residue is what isresidue, and you've got its
moral fibre diet. Again, it's alittle bit more in terms of it's
a little bit more theoretical,whereas the team Liverpool, john
Moore's are actually looking atthis. So they're going to do
(36:47):
some trials, in terms of whatwe're different actually happens
with a low residue, low fibrediet, and so it's something that
they use with their so there's achap called Colin Evans, who
does a lot with professionalfighters. So he's looking into
it. And I think it'd be quiteinteresting in terms of what
they find with the low residueor the low fibre diet in terms
(37:08):
of what happens with these sortof the wear of people's stalls
and what happens with it,because it's going to be quite
applicable to what we do withstoma patients. We tell a high
output stoma patient, you needto follow a low fibre low
residue diet because it's goingto reduce the output from your
stoma and some things thatthey're going to do with these
patients. Yes, the physiology isgoing to be slightly different,
(37:30):
slightly different, but it'll bequite interesting to see sort of
what's coming out in terms of adry or wet wet from there still
and what will happen actually,in terms of the stoma patient,
something's out there the linksbetween sports and clinical,
probably flossing, and peoplethink
Aaron Boysen (37:45):
definitely, especially with that example,
you just shared. So in thethread also, you talked a little
bit about weight management. Nowmany dietitians might think I'm
not in weight management, so whywould I need to know about it,
but you think every dietitianshould know about it?
Mike Patterson (37:59):
Why. So this goes to the trusted dietitian,
dietitians are the experts. Ilike to think that you would
trust dietitians, we are theexperts in a lot of areas, but I
think people use that as sort ofWe Are the be all and end all of
nutrition is a protected title.
(38:19):
And I think a lot ofnutritionists, sports nutrition,
when it came to the real nittygritty of Clinical Nutrition
would be absolutely clueless,the wonder what the doing. So
this is why we are protectedbecause we do have that
knowledge is very, verycritical. But I think to be sort
of seen as an expert, I don'tlike that word for an expert to
me, you have to be so who wouldMr. Ridley the unshackled you
(38:43):
know, these, these really goodresearchers cover Australia, I
would say they are experts, theyhave a thesis, they are experts,
the stuff that they'republishing is brilliant,
brilliant, knowledgeable. But Ithink as a dietitian, you need
to have a good understanding ofthe basics. So this was put into
me from Lindsey King and Helenwhite, which I'm sure you'll be
aware of if you went to Leeds.
(39:03):
So what they said to me is, as adietitian to Joe public are
gonna want you to know, therandom questions on this new
diets out what's your thoughtson it? What's the best thing for
web management? Are my son playsfootball, he runs all these 10
cares? What does he need to do?
So these are quite like randomquestions that the general
public gonna want you to knowabout. So if you say trust a
(39:24):
decision, we are the expert,you're gonna have to have a
basic knowledge of what thecurrent evidence is for pretty
basic super sports nutrition,what the current evidence is for
weight management is low carbbest, this high carb rest, you
know, we're getting to thatdebate because the goal though
is if you have that new, goodunderstanding of the basic
knowledge, I'm not expecting ICUdietitian to have the best web
(39:49):
management knowledge in theworld and run, you know, tier
three tier four clinic or ifthey have a good understanding
of Oh, yeah, that review cameout recently to say that
actually, if calories arecontrolled brought in equal, no
weight loss is better than that.
I just think that helps theprofession that little bit more
gains that a little bit morerespect in terms of from the
other sort of areas of nutritionis yet where the experts on
(40:13):
really, really clinical side ofthings. But we do have a good
foundation of general nutritionstuff that maybe is a bit more
public health.
Aaron Boysen (40:20):
Yeah, exactly. So it's knowing the answer to the
questions Joe public want toknow, because they're not going
to ask you about more clinicalquestions.
Mike Patterson (40:29):
What I don't what do I What do I feed the
beast patient on the fields onthe unit? Well, they might do is
fasting better than keto? Isketo, about Weight Watchers? You
know, these are the sorts ofthings that someone's going to
ask you. So it's just sort ofhaving that decent foundational
knowledge to say, well, x, y,and Zed. You know, this is
(40:50):
probably not better than this,because of this.
Aaron Boysen (40:52):
So how does the dietitian get all this
knowledge? I mean, there's somuch information out there. And
they're working days only, maybehalf eight to half, or,
Mike Patterson (41:02):
yeah, it is you have to be a massive nerd
lightweight, just pretty muchread all this stuff. So there's
a few different things. And I'dsay. So one thing that I gained
massive amounts of knowledgefrom this is hopeless, something
I'll be doing his podcast. So Icommuted from home to Leeds and
for my undergrad. So that wasfour years. And then I did post
grad courses at noon yoplait. Sothat was another two years. So
(41:25):
I've got six years worth ofcommutes there. So probably one
of the best podcasts out therein terms of the nutrition is
sigma. So Danny Landon's podcastis unbelievable. And the things
he has on there is not justsports, nutrition, he has a lot
of clinical stuff. And I foundthem really, really useful. And
the thing with that is aresearcher might talk about
something. And then they'llusually put up their website,
(41:48):
their social profiling, you canfollow him on that. And they'll
probably put on their socialmedia, their research, they'll
post on there, they mightretweet someone else's research
in that area. So you can followthem that way. If you're like
me, you stalk researchers andresearch get and you see
constantly get email updatesfrom when they're publishing,
it's a good idea to find out whothe experts are in your area. So
(42:09):
I mentioned before about alittle bit later, in Australia,
obviously, Danny bear in the UK,and then the chaplain as well
from us. So Paul academicals,and Santa Vishnu, Vishnu,
Denise's from Duke. And so theseare sort of experts from the
quick care side of things, ifyou follow them on social media,
(42:30):
or even if you want to pop thatout onto research get for me. So
in terms of politic pn, there'sa few people looking at it. So
team down at UCL, the dieticiancalled leave keen, who's doing
quite a bit with some of theconsultants down there from
Manchester, Salford, there's alady called AnnMarie sailboats
who's doing a lot politic. Andso there are people I saw start
(42:52):
to see what's coming out fromthat side of things. Interesting
crit care as well. So that's whyI named names, I follow them. So
social medias grant research getso researchgate is basically
like a reset social media iswhere people just put what
they've published on theirsocial media places to follow
people on that, as your countryget old debts what they publish,
and podcasts again, I thinkthey're sort of three really
(43:14):
useful things to findinformation, you do have to be a
bit of a nerd, like me, you'renot going to get this done
between the hours of eight andfour. When you're seeing
patients you've got nuts towrite up, you're probably not
going to get all the same andobviously get solid like cn
magazine, video digest andthings which do have snippets in
(43:34):
but I just don't think theyprobably got to the dat as much
as you'd find from social media.
And the thing with social mediais social media has its own peer
review as well. So someone willpublish a paper and some might
comment on that maybe didn't dothis right or really like the
way that they've done this soyou can get people's other
researchers feedback on thatpaper straight away.
Aaron Boysen (43:56):
Exactly. So we can follow the people on social
media for their research. Can wefollow you on social media and
catch up with your research?
Mike Patterson (44:03):
Yeah, so although I just post gets follow
other people for that reset.
Aaron Boysen (44:12):
So everyone wants to follow you on social media,
they can get some entertaininggifts. Thank you so much for
being on the dietetics digestpodcast.
Mike Patterson (44:28):
Some guests.
Aaron Boysen (44:29):
Thank you everybody for listening to the
dietetics digest podcastreferences and links to
everything discussed in thisepisode will be in the show
notes and join us another timefor the episode of The dietetics
digest podcast.
Thanks for joining me this weekon dietetics digest, make sure
(44:50):
to visit my website a dieteticsdigest comm where you can listen
to the podcast or why notconsider subscribing on Apple
podcasts stitcher smart radioSpotify or basically just ask
Alexa, and you'll never miss ashow. And while you're at it, if
you found this show valuable,you could do one of two things.
Firstly, if you could leave areview on the podcast that
(45:11):
you're listening to, maybe theapple podcast or Stitcher smart
radio, and you could tell afriend about the podcast that
would be really helpful to helpgrow the podcast. Thank you so
much for the support, and have alovely week day, wherever you
are.
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