Functional Nutrition in Practice
Posted by Andrea Nakayama
In a recent discussion with some Full Body Systems graduates, I asked them to describe what nutrition means to them. Some answers identified the bioindividual approach to care that I teach in Full Body Systems—to go slow and meet patients where they are with their needs for dietary change. And some others discussed nutrients directly—like the power of bringing in a nutrient-dense green smoothie that helps clients actually feel the difference of a cleaner diet.
My favorite response was a pure definition. Although brief, I think it encompasses how we look at the effects and interactions of the foods we eat throughout the entire body.
Nutrition is the process of taking in food and using it for growth, metabolism, and repair.
While that’s a great definition of nutrition, the Functional perspective requires us to look at and understand how growth, metabolism, and repair have different physiological requirements dependent on the individual. This is why a personalized approach to diet and lifestyle modification is key for our success and the future of healthcare. That’s the work we do as Functional Nutrition Counselors.
Today I want us to put aside the psychological aspects for the most part, the areas where we meet patients where they are in terms of execution of dietary change so that they can stick with it and see sustainable results. I always say that we cannot remove the psychological from the physiological, but in this blog, I want to consider the ways in which a client’s “story” impacts what their nutritional needs may be. This allows us to focus on some of the factors that influence bioindividual nutrition therapy.
The ATMs of Functional Nutrition
Let’s first consider what we call the ATMs in Functional Medicine. The ATMs are the antecedents, triggers and mediators. They’re what we need to understand when assessing a client’s history in relation to their nutrition and nutritional needs.
I like to think of the ATMs as a person’s “story.”
You may consider ancestry, alleles, or single nucleotide polymorphisms (SNPs) to be part of a client’s antecedents. Be sure to assess how these factors impact an individual’s ability to take in nutrition and utilize the food they eat. An example here would be a client with a known MTHFR polymorphism. Folate metabolism is, of course, an upstream factor to many downstream conditions such as fatigue, irritability, shortness of breath, and more. So this individual who has an MTHFR polymorphism, if expressed, could have difficulty getting their folate needs met and could benefit from eating more leafy greens, egg yolks (if tolerated), chicken liver and potentially taking a methylated folate supplement.
But hold on…
Don’t think you have to know somebody’s genetics to help them eat and obtain the nutrition the body needs for growth, metabolism and repair. You don’t. I think of genetic testing as a backdrop. It’s like the wallpaper in the background, because, honestly, we don’t know if those single nucleotide polymorphisms, even when they appear as present on those reports, are turned “on” or “off.” So read on, as there’s so much more we can consider as part of a client’s antecedents in our dietary recommendations.
An easy one to think about is lactose, which may bring us back to ancestry, but also to personal history. Some cultures (East Asian and West African, to name just a couple) have lactose intolerance after their young childhood while others (Northern Europeans) have more tolerance. The intolerance (meaning that the body does not naturally produce enough of the enzyme lactase to help digest and absorb the lactose) impacts what we might consider a “good” or “bad” food. This means that we can’t say that a raw and pasteurized dairy is good for everybody because that (unfortunately) won’t be the case if they have a lactose intolerance, or if they have other immune factors that prevent them from healthfully receiving the nutrients in that raw dairy.
This example helps us to see that it’s not always about the food. Instead it’s more about what the body can do with the food.
Factors like birth order and mom’s prenatal nutrition may also be antecedents that better help us understand each individual’s need, while mom and dad’s health histories can play a role as well.
Triggers will also impact the recommendations that we make. Triggers are the things that happened between birth and this moment in time that may impact dietary needs.
We can assess if somebody is on any drugs, any medications that act as “drug muggers,” meaning that they are “mugging” or depleting nutrients from the body through their pharmacological actions. These can easily become biological deficiencies. Sometimes these deficiencies lead to signs, symptoms and can even contribute to a diagnosis of their own. A good example here is the pharmaceutical drug Metformin (used for diabetic treatment), which robs the body of B12, a nutrient needed for the well-being of red blood cells, brain health and nerve function. Or the popular statin drugs (prescribed for lipid management), which decrease the body’s utilization of CoQ10, a nutrient necessary for cellular and mitochondrial function.
Of course, repeat antibiotics throughout someone’s life span are going to impact their microbial terrain and diversity, making probiotic foods and even supplements a potential part of our therapeutic nutritional recommendations.
Even pregnancy depletes the body of certain essential fats because a fetus requires those essential fats to support the development of the brain and nervous system. So mamma can become more depleted dependent on the number of pregnancies she’s had.
Triggers also include every infection and insult that may have altered your client’s terrain–from a car accident to food poisoning to a significant life event. Triggers also can include your client’s past relationship to food itself and to their body. (This is where the psychological must be considered as physiologically relevant. You don’t want to be the trigger!)
Remember that nutrition is, by definition, the process of taking in food and using it for growth, metabolism, and repair. Yet, based on just a few examples we can see that the needs of an individual to obtain growth, metabolism, and repair can be quite different.
Check out the completed Matrix where I mapped this same topic–Functional Nutrition–on my podcast, the 15-Minute Matrix. In this blog, we’re focused on just the left side of the Matrix (those ATMs).
Let’s keep going… Let’s think about nutrition through the lens of working with a child who has Crohn’s or Ulcerative Colitis. Despite eating a healthy diet, they’re still experiencing “failure to thrive” (i.e., little growth) because they can’t utilize the nutrients they are taking in. In these cases, there’s physiological repair that needs to happen in order for growth to occur. (And remember, growth is one of the main purposes of nutrition.) This is where we think through the clinical or physiological lens that repair may be prioritized before growth or metabolism can be achieved. We shift our focus to one where tissue and mucosal restoration are paramount in our nutritional interventions.
Mediators are my favorite part of the Matrix and of clinical practice. They’re what put the client back in the “driver’s seat” of their own health because they recognize what makes them feel better and what makes them feel worse. Mediators also help us to understand the truth behind the saying, “one person’s food is another person’s poison.”
Earlier I mentioned eggs as a main source of folate. They’re also one of the best sources of nutrient choline. These two nutrients are critical for optimal nervous system function. However eggs are also a top inflammatory food.
What to do?
Personally, I have an inflammatory response to eggs. I’ve learned, by understanding my mediators, that I can eat them inside of a paleo-style baked good on occasion, yet if I eat them regularly, or independent of the baking process (remember food is chemistry and the heat and cooking method will affect the protein structured differently), I will experience swelling and tightness in my hands and fingers.
Helping a client or patient to identify their mediators is a journey. The body must be in a “clear” and “calm” state to receive the messages and make the necessary connections. While this is one of the most gratifying parts of being a Functional Nutrition Counselor, it is also a process that takes caring, empathy, real service and deep understanding.
Nutrition is deeper work than a client can find in a handout or on the internet. As I’ve said, this is the work of a new paradigm of thinking where diet and lifestyle modification take their true place in the realm of clinical intervention, as we all know that they should. And this is work that we can and must do.
Ultimately it comes down to a better understanding of where food meets physiology, or as I like to think of it, the symbiosis between the two. And it’s not just food, but all diet and lifestyle modifications, and how they meet and impact the physiological systems.
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