Description of a Session
The specific nutrition needs of each person are unique and vary according to their genetics, age, gender, degree of systems functioning, and lifestyle (including diet, activity, alcohol and tobacco use). Therefore it is essential to individualize treatment accordingly.

An initial consultation will usually take an hour during which time the nutrition therapist will obtain a comprehensive health appraisal. The health appraisal will include history of present health and any physical symptoms, past medical history, family history, current diet and accounting of meal patterns (who is responsible for shopping for food and food preparation, how many meals are consumed away from home), lifestyle habits (smoking, alcohol intake, and exercise patterns), social and emotional history, allergies (food, drug, or plant allergies) prescription and over-the-counter medication usage, dietary supplement usage, and anthropometric measurements (height, weight, body composition).

The nutrition therapist may use questionnaires to help assess for nutritional deficiencies, food allergies, sensitivities, or intolerances, or for symptoms of toxic overload which may impact the digestion, metabolism, or absorption of nutrients, or for impaired functioning of the any of the body’s systems (circulatory system, endocrine system, respiratory system, mind and nervous system, reproductive system, urinary system, digestive system, immune system, eyes/ears/nose/throat/mouth, skin and hair, and musculo-skeletal system).

Available biochemical testing will be reviewed (e.g.; blood glucose, lipid profile, iron studies) and additional biochemical testing may be recommended if the need is identified. The nutrition therapist will assess the nutrition status and nutritional needs for each person and develop a detailed plan of nutrition therapy to guide the patient to their goals (e.g., weight loss, controlled blood pressure, normalization of lipid profile, reduced fatigue, improved pain management, reduced diabetic complications, etc).

Recommended changes will include increased use of “healing foods” or “dietary inhibitors” (foods which inhibit disease or dysfunction), and decreased use of “dietary promoters” (foods which promote disease or dysfunction). The nutrition therapist may suggest juices, teas, broths, soups, edible flowers, and medicinal spices and herbs to complement the diet, or dietary supplements (including, but not limited to vitamins, minerals, essential fatty acids, herbal remedies) as needed. Patients may be referred to other practitioners to aid in healing and recovery. A detailed written summary of all recommendations will be provided to patients, and additional reading materials for food and nutrition may be provided or recommended. Oftentimes patients may be given journals for food recording or symptom recording to bring to the next appointment to help the patient and nutrition therapist identify areas for future treatment.

Course of Treatment
The initial consultation determines the course of treatment. If the history obtained suggests a degree of “dysfunction” impairing digestion, metabolism, absorption, or utilization of nutrients, then biochemical testing (urine, blood, or saliva) may be recommended to further evaluate biochemical and metabolic requirements and to determine the course of treatment indicated via dietary modification and dietary supplement use.

Sometimes the exact nature and course of treatment is obvious. For people who are generally well, and may just wish to “lose a few pounds”, “eat better”, or reduce their risk of chronic disease as a preventative measure, the course of nutrition therapy simply involves instruction of “foods to eat less of” and “foods to eat more of”.

How many sessions are needed?
The number of sessions needed depend upon the condition being treated, how successfully the recommended diet and lifestyle modifications are incorporated into an individuals daily routine, and how quickly the individual responds to treatment. Biochemical testing may be recommended to assess progress and success of treatment. The nutrition therapy regimen may be revised if progress is impeded (cholesterol remains elevated despite strict compliance to recommended nutrition therapy and activity regimen), when a particular condition is “resolved” (e.g.; weight loss is achieved, fatigue is improved, anemia is resolved etc.), or when another medical condition is superimposed.

Side Effects
Most complementary diets recommend generally healthy patterns of eating with increased intake of foods, nutrients, or non-nutritive compounds that are dietary inhibitors of disease, and reduction/elimination of foods, nutrients, and non-nutritive compounds that are promoters of disease. Most people can and should tolerate these diet changes with few side effects.

Dietary supplement use can pose side effects as they have a broad range of biological activity. Side effects can be of varying predictability and specificity, having clinical complications ranging from mild (e.g. gastrointestinal upset or hives) to life-threatening (anaphylaxis) and even fatal. The informed consumer/patient should consider the strength of the evidence before initiating supplementation use. Is the evidence to support its use convincing, probable, possible or insufficient? A qualified practitioner should evaluate dietary supplement use for safety and efficacy to ascertain that there are no medical contraindications to the use of specific dietary supplements, to ensure that the benefits of supplementation outweigh the risks, and to aid the patient in making an informed decision regarding purchasing a quality dietary supplement. For further information see Nutritional Therapy Safety Issues and Herbal Medicine Side Effects and Safety Issues.

Safety Issues
The trained nutrition therapist designs these dietary modification and elimination diets with improved health in mind. However, diet therapy regimens that eliminate many food groups may be deficient in micronutrients (vitamins, minerals, trace elements, and non-nutritive compounds), therefore posing potential harm for long term use. Children, pregnant and lactating women, the elderly, and people with chronic illness should undertake such changes only with a qualified nutrition therapist. People of any age and degree of functioning can benefit from the use of diet therapy under the supervision of a qualified practitioner who modifies the diet to the unique needs of each individual. Diet therapy is normally one of the safest, most non-invasive, complementary therapies available.

Dietary supplements (products containing either individually, or in combination, vitamins, minerals, herbs or other botanicals, amino acids, or other products for use to supplement the diet by increasing total dietary intake) are considered to be “foods” under Congress’ 1994 ruling of the Dietary Supplement Health Education Act (DSHEA). Therefore, dietary supplements are exempt from the requirements for new drug or food additive approval. The public should be aware that dietary supplements are not regulated in the same manner of drugs or food additives. There is no burden on the manufacturer to establish the safety or effectiveness of dietary supplements for use by the public. The informed consumer should also be aware that dietary supplements lack “standardization”. Some proponents support standardization of dietary supplements (most often herbs or other botanicals) and others do not, stating that beneficial therapeutic action may not be attributed to just one compound, but may in fact be related to a synergistic action from a number of active compounds in different parts of the plant (root, leaf, flower, seed, fruit, bark). Supplements can also be potentially adulterated, misbranded, or contaminated. Examples of misbranding and contamination include cases of lead contamination in imported Chinese herbs, or ginseng supplements that contain varying levels of ginseng as different from the level identified on the label. Quality control and good manufacturing practices are essential to establishing safety of a product. Lawmakers continue to seek a balance between agency control over dietary supplements, health claims, and regulation.

Controlled use of dietary supplements under the care of a qualified practitioner can be safe. Much research supports the use of dietary supplements to treat or prevent certain conditions, including B6 for morning sickness and premenstrual syndrome, vitamin E for angina, folate in the treatment of depression, prenatal supplementation for the prevention of neural tube defects in infants, and garlic for use in preventing atherosclerosis.

However, some medical conditions may contraindicate the use of certain dietary supplements, such as patients with hypertension taking dietary supplements that may increase blood pressure. There may also be times in the lifecycle such as pregnancy, lactation, or infancy where supplement use may be contraindicated. It is also essential to consider food, drug, or plant allergies prior to dietary supplement use. It is of critical importance to recognize that many dietary supplements can mimic, magnify, or oppose the use of prescription drugs, and thus anyone taking prescription medication on regular basis should have their dietary supplement regimen evaluated for potential drug-nutrient interactions. Accordingly, when a person’s medical history changes (a condition is resolved, or a new condition develops), or their prescription medications change (a medication is discontinued, or a new medication is prescribed), so too should their dietary supplementation regimen be reevaluated for safety. Given that dietary supplements can have a broad range of biological activity, it is essential to have a qualified practitioner evaluate any dietary supplement regimen for safety and to monitor supplementation on an ongoing basis to avoid any potential toxicity. Under the supervision of a qualified practitioner, dietary supplementation can be safe and effective for the treatment of specific conditions.

It is essential to keep safety and efficacy of dietary modification and dietary supplement use in mind. It is best for the individual to make an informed decision as to which complementary therapies they choose to integrate into conventional care. It is best that this be done in an atmosphere of shared decision-making between the patient and health care provider(s).

Other Modalities That Work Well With Nutritional Therapy
No research has been done in this area yet, but many nutritionists find that other modalities complement nutrition therapy. Humans do not eat merely for sustenance or make food choices primarily for health reasons. Food habits and dietary intake are influenced by social, environmental, emotional, psychological, cultural, and economic factors and stresses. Degree of health and functioning also impacts food choices and dietary intake. As such, it is reasonable to assume that modalities that improve quality of life, enhance well being, and reduce symptoms might favorably impact food habits and nutritional intake. Examples include relaxation therapies such as massage, meditation, hypnosis, or visualization utilized by the cancer patient to reduce stress, pain and anxiety, which may offer the dual benefit of improving appetite and dietary intake to complement the nutrition therapy to promote weight gain. Tai-chi or yoga may help to reduce elevated blood pressure and complement the nutrition therapy for hypertension. Acupuncture to reduce symptoms of nausea, pain, or irritable bowel syndrome may complement the nutrition therapy for those conditions in a desirable additive effect.

Content last modified on Mar 26, 2003