Goals of Clinical Nutrition as Part of Functional Nutrition Practice

​Clinical nutrition used within the contextual framework of Functional Medicine (FM) 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 Medicine Matrix of assessment and treatment.

What is Medical Nutrition Therapy in Functional Medicine?
​ MNT is a clinically focused approach with a defined system of assessment charting and intervention, evaluation, and follow-up considerations. The acronym for this system is ADIME, assessment, diagnosis, intervention, monitoring, and evaluation, and often forms the basis for charting notes.

Assessment
In functional medicine, 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 is globally pertinent in the areas of environment, society, culture, relationships, stress, sleep, anxiety, eating disorders, food/medication interactions, and work. All this information is considered in the nutrition assessment phase of the FM practitioner as opposed to a pure nutrition assessment of calorie intake, food preferences, and medical history.

While the traditional dietitian asks for general labs, the FM practitioner may ask for more biochemical absorption and metabolism tests, such as the Shillings test for B12 absorption or a urinary iodine test for thyroid function.

Diagnosis
Clinical nutrition diagnoses are biochemically individual based on specific laboratory tests and the functional medicine matrix assessment.

Intervention
The interventions for an FM clinical nutrition patient may contain elements gathered from the FM matrix and may often include stress interventions to lower cortisol, which 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. Nutritional therapies must be monitored as many are short-term, and lab reassessments 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. 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 specific scheduled visits to obtain monitoring data, so the patient expects to come back to see the practitioner on a given date and time. It stresses accountability for the intervention.

Goals of Clinical Nutrition in Functional Medicine
The goals of clinical nutrition are to use the MNT model in such a manner that:

• A healthy eating pattern is learned and maintained.
• It is expected that healthy physiological parameters such as weight, blood lipids, blood pressure, glucose, and kidney function will be maintained.
• Maintenance of positive messages about healthy eating is assessed.
• There is a delay in the development of disease, i.e., prediabetes.
• The therapist provides individuals with the tools for day-to-day meal planning rather than focusing on a single food or micronutrients or fad diets.
• The therapist promotes and uplifts the feeling of well-being and zest for all aspects of life surrounding nutrition.
• The patient avoids intake of unhealthy substances such as trans-fat, alcohol, and smoking.

Application
Clinical nutrition is essentially MNT applied within the Functional Medicine Matrix, which customizes all assessments and interventions to personalize the individual's care. It is a comprehensive approach to nutritional intervention that goes deeper yet is more expansive than traditional medicine.