Sudha Raj, PhD, RD is an Associate Professor and Graduate Program Director in the Department of Public Health, Food Studies and Nutrition in the David B Falk College of Sport and Human Dynamics at Syracuse University in New York. On January 23, 2014, Dr. Raj gave an extremely thorough and informative presentation on Integrative and Functional Nutrition as part of LIDA’s educational webinar series for the 2013-2014 year.
Dr. Raj began this presentation by explaining the philosophical basis for the rise in the Integrative and Functional Medical Nutrition practice that many Registered Dietitians are utilizing in their approach to patient care. Dr. Raj mentioned that there is a Dietitians in Integrative and Functional Medicine practice group within the Academy of Nutrition and Dietetics.
Dr. Raj briefly explained the “state of health” in the United States. In 2005, 133 million Americans suffered from one chronic condition; in 2020 this number is expected to grow to 157 million. Americans affected with chronic disease is on the rise and there are several major influences that seem to be contributing to the epidemic of chronic disease including (but not limited to) nutrition, sedentary lifestyles, chronic stress, poverty, lack of health insurance, the aging population, fragmented families/communities and environmental toxicity. The conventional medical approach to disease has resulted in the U.S. spending more on health care than other industrialized countries and despite high rates of hospitalization and cost for chronic conditions, outcomes in the U.S. are not good (references were provided in the power point slides).
Due to excessive rising health care costs and the inadequacy of the current health care system to treat chronic disease, complementary and alternative medicine (CAM) has been brought to the fore as patients and health care providers are seeking alternative paradigms. CAM is described as those medical fields that fall outside of conventional medicine. Patients with chronic disease have turned to CAM due to their desire to feel empowered and improve their quality of life. They are often dissatisfied with conventional therapy and want more personal control in dealing with their chronic condition.
Interest in CAM skyrocketed in the 1990′s resulting in the creation of the National Center for Complementary and Alternative Medicine (NCCAM) within the NIH in 1993. The NIH has classified CAM therapy into 5 categories: manipulative and body-based therapies, mind-body interventions, alternative medical systems, energy therapies and biologically based approaches (which includes diet, herbs, and vitamin approaches). Due to questions that have arisen regarding the safety and efficacy of CAM therapies, the NCCAM has included it it’s agenda the promotion of incorporating clinical trials with 30-30,000 participants and outcomes studies with attention to quality of life with the use of CAM therapies. Questions remain however regarding the lack of product quality, consistency and safety and efficacy as well as the variability in training, credentialing and licensing of practitioners.
Dr. Raj spoke about Integrative Medicine and the Functional Medicine Approach. The NCCAM defines Integrative Medicine as combining mainstream medical therapies and CAM therapies for which there is high quality scientific evidence of safety and effectiveness.The principles of Integrative Medicine promote a patient and practitioner partnership; facilitate the body’s innate healing response; use a holistic approach; an inclusive philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically; recognizes that good medicine should be based in good science, be inquiry driven, and be open to new paradigms; the use of natural, effective, less-invasive interventions whenever possible; the use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease; and training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development. Nutrition has a role in this exciting aspect of patient care since Registered Dietitians can bring together the best CAM and conventional nutrition practices. The Functional Medicine approach incorporates a patient-centered versus disease-centered approach with the main emphasis being addressing the whole person and not just their symptoms. This approach also acknowledges the biochemical uniqueness of and aims to seek a dynamic balance between mind, body, and spirit; addresses the web-like interconnections of internal physiological factors; identifies health as a positive vitality and enhances the health span of the individual (not just the life span) by promoting organ reserve.
Dr. Raj briefly commented on nutritional genomics (nutrigenetics and nutrigenomics) and referred us to the February 2014 Journal of the Academy of Nutrition and Dietetics for the newly published position paper regarding this subject.
Based on this review of both Integrative Medicine and Functional Medicine, Dr. Raj proceeded with the explanation of the Functional Nutrition Approach which takes into account environmental exposures, genetic predisposition and lifestyle influences for each patient and what, if any, dysfunctions arise as a result of the interaction between these three influences. She provided an outline of the tools that are used by Registered Dietitians regarding patient centered care within the Integrative and Functional Medical Nutrition Therapy setting. She spoke about core nutritional imbalances that occur and the goal of nutrition therapy is to achieve balance. She reviewed the Integrative and Functional MNT radial (a flow chart) that is used to assess the patient and to highlight their core nutritional imbalances. Eliciting the patient’s story by exploring antecedents (predisposing factors), triggers (provoke illness/symptoms), and mediators (allow persistence of symptoms) is used to gather information. The GO TO IT tool highlights the entire functional nutrition assessment and intervention process: Gather information via history and objective data; Organize information gathered using a timeline; Tell story back to the patient to ensure accuracy and understanding; Order and prioritize information and acknowledge the patient’s goals and address modifiable behaviors; Initiate further assessment and intervention based upon previous discoveries; Track the effectiveness of the therapeutic approach and identify clinical outcomes. She concluded this presentation with a case study and used the aforementioned tools. Her presentation will continue with Part 2 of this webinar entitled Let Food Be Thy Medicine on February 6, 2014.
About the Author
Lisa Samuels is a Long Island native who is currently a Dietetic Intern at LIU Post. She has a B.A. in Art History from Ithaca College, a B.S. in Nutrition from LIU Post & was also a practicing baker for two years. Lisa has finally found her calling. Combining her love for food, writing, and nutrition, she strives to bring you the latest news in the field.
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