The Confident Clinician Podcast – Details, episodes & analysis

In this episode, our founder, Dr. Jordan Robertson ND, shares a key paper in the nutritional management of Graves' disease that explains why patients experience rapid weight gain after treatment. 

She discusses the metabolic rate changes that happen at diagnosis, 1 and 6 months after treatment, and how patients can be euthyroid but experience weight gain after ADT. 

This episode is a snapshot of our full Graves' medical topic that supports clinicians with decision-making around supplementation, exercise and conventional treatments. 

The Confident Clinician membership supports hundreds of practitioners every day in practice through our integrative medicine database and standards of care. Our membership opens twice per year, with July 2024 being our next enrolment opportunity for Naturopathic Doctors, Medical Doctors and Nurse Practitioners who practice evidence-based Integrative Medicine. 

In this episode, Dr. Stephanie Bayliss, a Naturopathic Doctor based in British Columbia, reviews how we assess and manage sexual side effects from SSRI’s. Up to 80% of SSRI treated patients can experience sexual side effects. This may include changes to desire, arousal or satisfaction. Dr. Bayliss explores both the conventional care guidelines on managing these sexual side effects, and promising up and coming integrative solutions, including Saffron and Probiotics. 

References:

Hashemi-Mohammadabad, N., Taghavi, S.-A., Lambert, N., Moshtaghi, R., Bazarganipour, F. & Sharifi, M. (2024). Adjuvant administration of probiotic effects on sexual function in depressant women undergoing SSRIs treatment: a double-blinded randomized controlled trial. BMC Psychiatry, 24(1), 44. https://doi.org/10.1186/s12888-023-05429-w 

Izadi, S., Mohammad-Alizadeh-Charandabi, S., Yadollahi, P., & Mirghafourvand, M. (2024). Effect of vitamin E with and without saffron on the sexual function in women of reproductive age with sexual dysfunction: a randomized controlled trial. BMC women's health, 24(1), 143. https://doi.org/10.1186/s12905-024-02980-w 

Kashani, L., Raisi, F., Saroukhani, S., Sohrabi, H., Modabbernia, A., Nasehi, A. A., Jamshidi, A., Ashrafi, M., Mansouri, P., Ghaeli, P., & Akhondzadeh, S. (2013). Saffron for treatment of fluoxetine-induced sexual dysfunction in women: randomized double-blind placebo-controlled study. Human psychopharmacology, 28(1), 54–60. https://doi.org/10.1002/hup.2282

Modabbernia, A., Sohrabi, H., Nasehi, A. A., Raisi, F., Saroukhani, S., Jamshidi, A., Tabrizi, M., Ashrafi, M., & Akhondzadeh, S. (2012). Effect of saffron on fluoxetine-induced sexual impairment in men: randomized double-blind placebo-controlled trial. Psychopharmacology, 223(4), 381–388. https://doi.org/10.1007/s00213-012-2729-6 

Perlis, R. H., Laje, G., Smoller, J. W., Fava, M., Rush, A. J., & McMahon, F. J. (2009). Genetic and clinical predictors of sexual dysfunction in citalopram-treated depressed patients. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 34(7), 1819–1828. https://doi.org/10.1038/npp.2009.4 

In this episode we cover a recent study by Carrick (2023) and the effect of various claims on the beliefs and purchasing by fertility patients. 

The patients in the study were presented with a fake supplement that made claims about surrogate markers with or without additional warnings about risks and/or live birth rate. The findings are incredibly important for integrative clinicians or clinicians who work in fertility and struggle with their patients navigating the online space. 

One of the goals of our mentorship with clinicians inside the Confident Clinician is to help build bridges with conventional practitioners and the standards of care. When clinicians are clear about what the evidence actually says, it increases confidence in both patients and practitioners alike. 

Enjoy the episode! 

Be sure to subscribe to The Stacks, our free integrative medicine magazine for clinicians. You can get your first free copy here. 

Decreasing night time water as a solution for nocturia is a common self-managing strategy that patients use and a common recommendation clinicians use to reduce the number of night time wakings. 

The connection between sodium, fluid balance, urine production and nocturia has been well studied and presents a possible dietary solution to reduce the number of night time wakings your patinets with overactive bladder experience. 

Have a listen to the episode to hear how much sodium you need to cut, and the bigger discussion on sodium, heart disease, sleep apnea, nocturia and metabolic syndrome. 

Today’s podcast shares the literature on PCOS and exercise, and whether we’re causing harm or doing good in our patients when we recommend HIIT. If you’re online, you’ve likely seen mention of “exercise increasing stress” or “exercise worsening cortisol” in patients with PCOS and the suggestion that perhaps these patients shouldn’t do hard exercise because they might “get worse” 

In this episode, we cover the literature on HIIT and PCOS that has been published in the last 18 months, as well as a particular study by Mohammadi (2023) that specifically looks at cortisol in patients with PCOS when they do HIIT (run/walk intervals). 

We also talk about the “forest for the trees” concept of prescribing exercise to our patients and how we can’t get swept away with online trends - especially when there isn’t research to support it. 

Have a listen to the episode and we hope you join us in September for the Integrative Medicine Grand Rounds weekend where we are spending 3 days covering a Women's Health Update. 

In today's episode we share the link between prostate cancer and alcohol, but more importantly, discuss the key thing to think about when looking at older literature on a topic. 

As integrative clinicians, we are often excited about innovation in testing and assessment. We enjoy being the "health detective" that uses the latest technology to help patients be "found" or accurately diagnosed. 

If we want to be innovative with assessment, we also have to apply a particular thought process to the way we read older literature. Are older studies conducted on who we think they are? Or did we change our diagnostic criteria enough that a study published in the 80s is no longer studying who we think we are studying?

We use the conversation about PSA as a screening tool and alcohol intake as a good example of this. 

Your opportunity to join The Confident Clinician is almost here. You can join the wait list here http://www.confidentclinicianclub.com 

You can also test-drive our resources for only $37 (our IBD module) here or in USD here

We know that we don’t make promises in medicine. But what we should be able to do, is explain when a patient may expect results, what we expect to change, and which parts of their condition won’t be improved by our treatment plans. 

Can you do that? 

In today's podcast, we announce our unbelievable offer to get access to our IBD medical topic, downloads, videos and evidence tables for just $37. You can get your access here (CAD, USD). 

We use IBD as an illustration of how we often expect our patients to “get better”, we tell them they will “get better” but the reality of the research is that they might get “partially better on these few well researched parameters of their condition.”  

In our IBD evidence tables, we show you which interventions induce remission versus maintain it, which interventions should change inflammation on colonoscopy (and which don’t) and what to expect from diet change. 

The confidence building that this learning module will give you is worth the $37, even if you don’t routinely see patients with IBD. 

You should be able to communicate to your patients how long it will take to improve, what to expect and what the long game is. This is exactly the kind of confidence-building content we provide our clinicians with every single month inside the Confident Clinician Club.

In this episode, we dive into Relative Energy Deficiency in Sport. You might be missing information when it comes to diagnosing oligomenorrhea, recurrent injuries or illnesses if you’re not evaluating your patients for their energy availability. We’ll review tools to evaluate your patient for RED-S and you’ll learn about energy availability and how even recreational athletes may be at risk for RED-S.  If you want to dig deeper into treatment, you're invited to join Dr. Briana and fellow practitioners in June for the Sports Medicine Update Course. You can learn more here 

References

• Ackerman, K. E., Holtzman, B., Cooper, K. M., Flynn, E. F., Bruinvels, G., Tenforde, A. S., Popp, K. L., Simpkin, A. J. & Parziale, A. L. (2019). Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport. British Journal of Sports Medicine, 53(10), 628. https://doi.org/10.1136/bjsports-2017-098958
  Dave, S. C. & Fisher, M. (2022). Relative energy deficiency in sport (RED – S). Current Problems in Pediatric and Adolescent Health Care, 52(8), 101242. https://doi.org/10.1016/j.cppeds.2022.101242
• Dipla, K., Kraemer, R. R., Constantini, N. W. & Hackney, A. C. (2021). Relative energy deficiency in sports (RED-S): elucidation of endocrine changes affecting the health of males and females. Hormones, 20(1), 35–47. https://doi.org/10.1007/s42000-020-00214-w
  FINN, E. E., TENFORDE, A. S., FREDERICSON, M., GOLDEN, N. H., CARSON, T. L., KARVONEN-GUTIERREZ, C. A. & CARLSON, J. L. (2021). Markers of Low-Iron Status Are Associated with Female Athlete Triad Risk Factors. Medicine & Science in Sports & Exercise, 53(9), 1969–1974. https://doi.org/10.1249/mss.0000000000002660
• Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Murad, M. H., Santoro, N. F. & Warren, M. P. (2017). Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 102(5), 1413–1439. https://doi.org/10.1210/jc.2017-00131
• Keay, N. & Francis, G. (2019). Infographic. Energy availability: concept, control and consequences in relative energy deficiency in sport (RED-S). British Journal of Sports Medicine, 53(20), bjsports-2019-100611. https://doi.org/10.1136/bjsports-2019-100611
• Koltun, K. J., Williams, N. I., Scheid, J. L. & Souza, M. J. D. (2020). Discriminating hypothalamic oligomenorrhea/amenorrhea from hyperandrogenic oligomenorrhea/amenorrhea in exercising women. Applied Physiology, Nutrition, and Metabolism, 45(7), 707–714. https://doi.org/10.1139/apnm-2019-0640
• Logue, D. M., Madigan, S. M., Heinen, M., McDonnell, S.-J., Delahunt, E. & Corish, C. A. (2018a). Screening for risk of low energy availability in athletic and recreationally active females in Ireland. European Journal of Sport Science, 19(1), 1–11. https://doi.org/10.1080/17461391.2018.1526973
• Logue, D. M., Madigan, S. M., Heinen, M., McDonnell, S.-J., Delahunt, E. & Corish, C. A. (2018b). Screening for risk of low energy availability in athletic and recreationally active females in Ireland. European Journal of Sport Science, 19(1), 1–11. https://doi.org/10.1080/17461391.2018.1526973
• Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S.-J. M. & Corish, C. A. (2020). Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients, 12(3), 835. https://doi.org/10.3390/nu12030835
• Loucks, A. B. & Thuma, J. R. (2003). Luteinizing Hormone Pulsatility Is Disrupted at a Threshold of Energy Availability in Regularly Menstruating Women. The Journal of Clinical Endocrinology & Metabolism, 88(1), 297–311. https://doi.org/10.1210/jc.2002-020369
• Melin, A., Tornberg, Å. B., Skouby, S., Faber, J., Ritz, C., Sjödin, A. & Sundgot-Borgen, J. (2014a). The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. British Journal of Sports Medicine, 48(7), 540. https://doi.org/10.1136/bjsports-2013-093240
• Melin, A., Tornberg, Å. B., Skouby, S., Faber, J., Ritz, C., Sjödin, A. & Sundgot-Borgen, J. (2014b). The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. British Journal of Sports Medicine, 48(7), 540. https://doi.org/10.1136/bjsports-2013-093240
• Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R. & Ljungqvist, A. (2014). The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 48(7), 491–497. https://doi.org/10.1136/bjsports-2014-093502
• Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., Meyer, N., Sherman, R., Steffen, K., Budgett, R., Ljungqvist, A. & Ackerman, K. (2015). Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 49(7), 421. https://doi.org/10.1136/bjsports-2014-094559
• Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A. K., Meyer, N. L., Sherman, R. T., Tenforde, A. S., Torstveit, M. K. & Budgett, R. (2018). IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. British Journal of Sports Medicine, 52(11), 687. https://doi.org/10.1136/bjsports-2018-099193
• Schofield, K. L., Thorpe, H. & Sims, S. T. (2019). Resting metabolic rate prediction equations and the validity to assess energy deficiency in the athlete population. Experimental Physiology, 104(4), 469–475. https://doi.org/10.1113/ep087512
• Sim, A. & Burns, S. F. (2021). Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. Journal of Eating Disorders, 9(1), 41. https://doi.org/10.1186/s40337-021-00396-7
• Slater, J., McLay-Cooke, R., Brown, R. & Black, K. (2016). Female Recreational Exercisers at Risk for Low Energy Availability. International Journal of Sport Nutrition and Exercise Metabolism, 26(5), 421–427. https://doi.org/10.1123/ijsnem.2015-0245
• Souza, M. J. D., Williams, N. I., Nattiv, A., Joy, E., Misra, M., Loucks, A. B., Matheson, G., Olmsted, M. P., Barrack, M., Mallinson, R. J., Gibbs, J. C., Goolsby, M., Nichols, J. F., Drinkwater, B., Sanborn, C. (Barney), Agostini, R., Otis, C. L., Johnson, M. D., Hoch, A. Z., … McComb, J. (2014). Misunderstanding the Female Athlete Triad: Refuting the IOC Consensus Statement on Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine, 48(20), 1461. https://doi.org/10.1136/bjsports-2014-093958

This past month in The Confident Clinician we offered a 2-day advanced training course on insulin resistance and diabetes. We offer these courses twice per year for our members and it's one of the best-rated member offers we provide our clinicians. 

In today's episode we examine a recent study that examined the impact of a cheat day on nutrition and whether a "self selected meal" improved satiety, reduced food boredom and helped patients stay on their treatment plan. 

Have a listen to the episode where we cover the study and give you some food-for-thought about how we prescribe nutrition plans to patients to support their metabolic health and weight loss. 

Horgan, A. M. et al. Self-selected meal composition alters the relationship between same-day caloric intake and appetite scores in humans during a long-term ad-libitum feeding study. Eur J Nutr 62, 1003–1009 (2023).

How long did it take for you to decide to prescribe zinc to your patient? 

In this solo episode, our founder, Dr. Jordan Robertson exposes an industry myth and gives you permission to do things in an easier way. 

We've been told the definition of individualized medicine means practitioners spending hours (and going to the ends of the earth) to find a solution for one person. Not only does this lead to practitioner burnout (and not being properly compensated for their time) but it also means that patients aren't always being given the best treatment option possible. 

The Confident Clinician membership and advanced training courses hand practitioners the answers to "what to prescribe" so they can focus on "how to prescribe" instead. 

That, is the real definition of individualized medicine. 

If you're not a member of The Confident Clinician, head to our website at http://www.confidentclinicianclub.com to get on the wait list or to use one of our on demand courses to up your clinical game.