Clinical Nutrition in Functional Health

Clinical nutrition used within the contextual framework of Functional Health (FH) is similar in structure, but not theory, to Medical Nutrition Therapy (MNT) practiced by Registered Dietitians as commissioned by the Academy of Nutrition and Dietetics (AND). The difference lies in the theory and how the framework is applied to the individual where MNT is expanded to operate out of the Functional Health Matrix of Assessment and Treatment.

What is Medical Nutrition Therapy in Functional Health?

MNT is a clinically focused approach with a defined system of assessment charting. The acronym for this system is ADIME, assessment, diagnosis, intervention, monitoring, and evaluation and often forms the basis for charting notes.

Assessment

In functional health, the assessment phase differs for clinical nutrition from that of a traditional dietitian or practitioner. In the assessment phase the probing for information and the tests are clinically specific and the information globally pertinent in the areas of environment, social, culture, relationships, stress, sleep, anxiety, eating disorders, food/medication interactions and work. All this information is considered in the nutrition assessment phase of the FH practitioner as opposed to a pure nutrition assessment of calorie intake, food preferences, and medical history.

While general labs are asked for by the traditional dietitian, the FH practitioner may ask for absorption and metabolism tests of a more biochemical nature such as the Schilling test for B12 absorption or a urinary iodine test for thyroid function.

Diagnosis

Clinical nutrition diagnosis is biochemically individual based on specific laboratory tests and the functional health matrix assessment.

Intervention

The interventions for an FH clinical nutrition patient may contain elements gathered from the FH matrix and may often include stress interventions to lower cortisol that affects carbohydrate metabolism or sleep interventions that affect appetite control during the day.

Monitoring

After an intervention one of the most frequent problems is the loss of patients to follow-up. It is essential that nutritional therapies be monitored as many are short-term and lab re-assessments are needed to determine progress and future treatment.

For example, a person with high cholesterol/triglycerides may be placed on a low fat, low carbohydrate diet with Berberine 500 mg 3x/day for six weeks and then a total cholesterol \triglyceride redraw is done to see if progress is being made to determine if berberine needs to be continued or the diet tweaked.

Follow-up

Follow-up is similar to monitoring but you are making specifically scheduled visits to obtain monitoring data, so the patient expects to come back to see the practitioner at a given date and time. It stresses accountability for the intervention.

Goals of Clinical Nutrition in Functional Health

The goals of clinical nutrition are to use the MNT model in such a manner that:

• A healthy eating pattern is learned and maintained
• The maintenance of healthy physiological parameters such as weight, blood lipids, blood pressure, glucose, kidney function, etc.
• Maintenance of positive messages about healthy eating
• Delay the development of disease, i.e. prediabetes, stroke, obesity
• Provide individuals with the tools for day to day meal planning rather than focusing on a single food or micronutrients or fad diets
• Uplift the feeling of wellbeing and zest for all aspects of life surrounding nutrition
• Avoid intake of unhealthy substances such as trans-fat, alcohol, smoking

Core Food Plan

The Core Food Plan was developed to help guide the client in achieving the above-stated goals and represents the first step towards healthier eating. It lays the foundation for a good nutrition plan that can be followed the remainder of one’s life.

Features of the Core Food Plan

• Focus on whole foods-whole plant-based foods are important sources of fiber and phytonutrients
• Promote clean and organic eating – Eating clean food lowers toxin exposure.
• Our food supply has become cluttered with food colorings, additives, preservatives, flavorings, pesticides, and insecticides.
• Focus on getting quality protein- choose lean or moderately lean protein sources from grass-fed and free-range animals and poultry. These proteins are not only “cleaner” but higher in omega-3 fatty acids. Eat complete protein throughout the day. A complete protein means that you get all of the 9 essential amino acids per day in sufficient amounts. Animal and soy are complete proteins. Other foods make complete proteins as they are combined throughout the day, each with a differing amino acid profile. Ask your nutritional professional for guidance if you are a vegan or lacto-ovo vegetarian.
• Eat a balance of quality fats to avoid inflammation and disease – eliminate trans fat (usually found in processed foods); decrease intake of omega-6 and saturated fats from animal sources; increase intake of omega-3 fatty acids from fish and plant foods, and remember that sugar turns to fat in the body.
• Increase intake of fiber from whole grains, fresh fruits, vegetables, and beans. There are two types of fiber – water-soluble and water-insoluble each having a different function. Individuals should strive to get 25-30 grams of total fiber per day from a variety of sources.
• Eat a diet low in sugar and in the glycemic index. Simple sugars not only contribute to excess calories in the diet they contribute to premature aging, the development of coronary heart disease and aggravate the control of diabetes. The glycemic index has to do with how carbohydrates are absorbed, digested and metabolized thus playing a key role in those diseases of insulin dysregulation such as diabetes.
• Achieve a diet with phytodiversity. “Phyto” refers to plant chemicals beneficial for health such as resveratrol from grapes or Epigallocatechin gallate (EGCG) from green tea. Some phytonutrients help regulate blood sugar and blood lipids. The best way to get a diversity of phytonutrients is to eat vegetables and fruits from the “rainbow” of colors available seasonally.

Application

Clinical nutrition is essentially MNT applied within the Functional Health Matrix which customizes all assessments and interventions for the personalization of the care of the individual. It is a comprehensive approach to nutritional intervention that goes more in-depth into clinical nutrition yet is more expansive in its philosophy than the traditional medicine approach.