Incorporating nutrition into a medical practice

An apple a day keeps the PA away? Okay not quite. But let’s talk about nutrition and medicine.

Before reading this, know that I’ve been a PA for approximately 30 seconds.

I will continue to update this post, but rather that wait to write it when I feel comfortable, I’m writing it during the uncomfortable part. When I’m still getting my sea legs, feel dizzy from learning/information overload constantly, and really trying to figure out how I want my practice to look like.

I did write a post about how I incorporated nutrition into rotation while in PA school, and you can find that here.

Here are some ways that I integrate nutrition and lifestyle medicine into my own practice right now.

1. Asking about ACCESS to healthful foods. Do your patients have enough money, transportation, and located close to grocery stores? Are they able to independently reach for higher items on shelves (eggs, meats, canned and frozen items) / produce sections? All important to first acknowledge.
2. Emphasizing culturally competent care! Making sure not to recommend eliminating certain foods which are staples in certain cultures (ie try cauliflower rice instead of rice!!! nope.)
3. Inquiring about relationship with food and/or history of disorganized eating. If so, ensuring not to center the appointment around food and inviting patients to notify me if I use language that is triggering. And also noting this history in a patient’s chart (if they’d like) to ensure avoiding weights for appointments in the future (unless it’s clinically necessary / indicated). 
4. Also asking about feelings surrounding mealtime – are you stressed/happy/sad before eating? This is relevant for digestion!
5. When doing intakes at new appointments, I ask for a “typical day of eating.” This kind of opens the door to see if patients want to talk about nutrition or not. I ask about the foods, the timing of the foods, and feelings surrounding food. Disclaimer: if there is a history of eating disorder or disordered eating, this isn’t something I’d ask. I also ask “when was the last time you felt well” and “do you have any health goals.” And about stress management, mood, and sleep. This serves as a way to gauge motivation for lifestyle change. It is my job to present options as patients are ready and wanting them. It’s NOT my job to push nutrition information at someone who has no interest or is not ready for this conversation. Sometimes (oftentimes) these things take time and building a trustful and honest relationship first.
6. If a patient is discussing a concern for abdominal pain, chronic headaches, hormonal symptoms (irregular periods / spotting), acne/rashes, or dizziness, aka anything that doesn’t QUITE fit any concrete clinical picture, I always end the appointment asking the patient to do some homework. Ie make a 3-5 day food, lifestyle, and symptom journal / diary, and have them send it to me through the online communication portal. I’ll then schedule a follow-up in 1-2 weeks, so that I have time to review the journal and discuss it a before the next appointment. Here is an example of a chart I made and sent to a patient:

3. I’m currently trying to start group sessions emphasizing nutrition and lifestyle interventions for common symptoms (fatigue, back pain, chronic abdominal pain/IBS). Check out how I made that happen here. 
4. Advocating for certain dietary choices in certain populations. If a patient is presenting for joint pain, we discuss anti-inflammatory diet in regards to a comprehensive pain management plan. If it’s diabetes, we discuss managing refined sugars/carbohydrates. If it’s hormone irregularities, we sprinkle in some education about being mindful of artificial sweeteners, inflammatory oils, hidden sugars, and loading up on estrogen detoxing cruciferous vegetables to name a few. With migraines, in addition to medications, I’ll suggest a low histamine diet. With IBS I’ll discuss avoiding onions, garlic, and nightshades (or low FODMAP if this feels realistic to a paitent). There are easy (and quick!) ways to suggest these things to patient, ask them to do a little research and see if it seems like a realistic and doable intervention, and then help guide them through.
5. If after the food/symptom journal is complete and there are no obvious triggers, and there is no history of disordered/disorganized eating, I may suggest an elimination diet. Typically I say start with one food to eliminate and try this for 3 weeks, and then slowly, slowly, slowly reintegrate (common dietary triggers: gluten, dairy, soy, corn, onions, garlic, nightshades).
6. Apps / resources! If a patient wants to try gluten free, I’ll recommend “find me gf” app. If trying IBS, I like “Monash University Fodmap diet” app.

Okay that’s all for now! I’ll let you know how I continue to integrate, and update this post accordingly. As always, would love to hear thoughts and suggestions in the comments!