Integrative and Functional Nutrition

#006 All things Integrative & Functional Nutrition

Kathie and Sheila 300x300 - #006 All things Integrative & Functional Nutrition

 

Detoxing from dogmatic dietitian education and attitudes for a mind wide open

But first, “you must unlearn what you have learned” YODA

Traditional dietetic education and training gives registered dietitians the foundation they need to practice Medical Nutrition Therapy. If you’ve ever wondered if there’s more you could offer patients and clients, or as a client, wondered if there’s a different lens through which your health concerns could be view, Integrative & Functional Nutrition (IFN) does just that. Sheila and Kathy gives us an informative overview of what IFN is, what it can do and how dietitians can take the next steps to learn more.

More about Kathie Swift and Sheila Dean

Dr. Sheila Dean is a registered and licensed dietitian nutritionist and board-certified integrative and functional medicine practitioner. She was the owner of Palm Harbor Center for Health & Healing, an integrative and functional medicine based private practice and wellness center in Palm Harbor, Florida for 17 years.

 

A published author, national speaker and media spokesperson, Dr. Dean has taught nutrition science for over 21 years as an adjunct professor at the University of Tampa, University of South Florida Morsani School of Medicine, Maryland University of Integrative Health, Schiller International University, Saybrook University, and Saint Petersburg.

 

Kathie Swift is a registered dietitian nutritionist who has been dubbed “the mother of integrative and functional nutrition” by thought leaders in the field. She is the recipient of the Visionary Leadership and Lifetime Achievement Awards by the Dietitians in Integrative and Functional Medicine Dietetic Practice Group of AND or the Academy of Nutrition and Dietetics and has also been recognized by the magazine, Today’s Dietitian, as “a dietitian making a difference”.

 

Kathie is the co-author of The Inside Tract: Your Good Gut Guide to Health and a contributing author to Dr. Hyman’s NY Times Bestseller Ultra-Metabolism. Her most recent book, The Swift Diet: 4 Weeks to Mend the Belly, Lose the Weight, and Get Rid of the Bloat, features the latest science on the microbiome

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Read the transcript

Doug Cook:

Welcome to the Dietitian Rehab podcast where we not only challenge and inspire dietitians to think outside the traditional dogmatic education, training and attitudes for a mind wide open but also to challenge anyone to think differently about your own health. We’ll talk all things food, health and nutrition related as we explore points of view, evidence and strategies for better health that will allow you a fuller understanding of the hot topics that everybody’s talking and asking about.

 

Hey, everyone. Welcome to today’s episode. I’m your host Doug Cook and today’s intro is a little longer because we have two amazing guests that we need to introduce the listeners to. But first is Sheila Dean. She is a registered and licensed dietitian nutritionist and board-certified integrative and functional medicine practitioner. She was the owner of Palm Harbor Center for Health and Healing, an integrative and functional medicine based private practice and wellness center in Palm Harbor, Florida for 17 years. She’s a published author, a national speaker and media spokesperson. Dr. Dean has taught nutrition science for 21 years as adjunct professor at the University of Tampa, the University of South Florida-Missoni School of Medicine, Maryland University of Integrative Health, Schiller International University, Saybrook University and St. Petersburg.

 

And Kathie Swift is also a registered dietician who has been dubbed the mother of integrative and functional nutrition by thought leaders in the field. She is the recipient of the Visionary Leadership and Lifetime Achievement Award by the Dietitians in Integrative and Functional Medicine which is a dietetic practice group of AND or the Academy of Nutrition and Dietetics in the U.S. And she’s also been recognized by the magazine Today’s Dietitians as a dietitian making a difference. Kathie’s a co-author of The Inside Track: Your Good Gut Guide to Health and an contributing author to Dr. Hyman’s New York Times bestseller Ultra-Metabolism. Her recent book, The Swift Diet: 4 Weeks to Mend the Belly, Lose the Fat, and Get Rid of the Bloat features the latest science on the microbiome.

 

So, both Sheila and Kathie are the cofounders of IFNA, The Integrative and Functional Nutrition Academy, a comprehensive online training and mentoring program designed to teach healthcare practitioners how to seek the true root causes of disease, to restore optimal health and function and ultimately transform the practice of nutrition using the most effective integrative and functional nutrition diagnostic tools and treatment protocols for preventing and reversing chronic disease. So, they have graciously offered a coupon to listeners today for their online program for tracks one and four and the coupon code is GetStarted20%. So, that’s GetStarted20%. So, you can use that towards the purchases of track one and track four. So, finally, let’s get on with the show. Great. Well, Sheila and Kathie, welcome to the show. I’m very happy and pleased that you’ve agreed to be on today to talk about all things integrative and functional nutrition. I know the audience which is a mix of dietitian nutritionists, other health professionals and even members of the public will find it really interesting both from a practice point of view but also potentially from using it as a way to help people deal with health issues if they’re looking for this form of treatment or modality. So, again, welcome to the show.

 

Kathie Swift: [00:03:57]

Thank you, Doug. It’s good to be here with you.

 

Sheila Dean: [00:04:01]

Yeah. Thanks, Doug.

 

Doug Cook:

My pleasure. So, I think that what will help everybody is just to get a little orientation to this concept of integrative and functional nutrition, what it is, what it is isn’t. So, I guess I’ll just start with a basic question. What is integrative and functional nutrition?

 

Sheila Dean: [00:04:19]

Well, that’s a great question. I think if I had to give you my bottom line answer, I would say when you think about integrative and functional nutrition, you want to think about root causes, identifying root causes using a systems biology approach, bottom line, so that when a patient presents with a particular condition, naturally there are symptoms and, of course, there’s nothing wrong with wanting to address those symptoms. But with integrative and functional nutrition, we take it a step further. The idea is that through a thorough assessment and naturally you have to be able to ask the right questions to come up with the right answers, right? So, by asking the right questions, by doing a thorough assessment, it’ll help to lead to identifying some root causes and then once you have some of that information, you can then proceed with a systems biology approach to patient care. And that in a nutshell is the distinction between integrative and functional nutrition and a conventional approach which doesn’t tend to focus so much on root causes. So, yeah.

 

Doug Cook:

Yeah. And I think that’s key. So, I’m sure everybody knows I’m a dietitian myself and when I think about traditional training and practice over the past 20 years, what other dietitians might now be reflecting on and the public if anyone in the audience is a general public member that the difference is a symptom might just be something like high blood sugar. And so, you might manage that high blood sugar if you have pre-diabetes or diabetes by using insulin and yes, looking at carbs. But if it’s pre-diabetes or type 2 diabetes, there’s an underlying, as you say, root cause for that and if you’re just chasing the sugar, that doesn’t really get to the root cause which would be hyperinsulinemia which requires sort of a deeper approach and, as you say, a more systems approach. Does that sum it up kind of?

 

Sheila Dean: [00:06:33]

Yeah. No, I think that’s a great example. I mean don’t get me wrong. There’s definitely something to be said about identifying symptoms and I mean, for example, if your patient comes in with a very elevated blood pressure, we need to get that BP down ASAP, right? And so, if a physician wants to put his or her patient on some kind of medication to get the blood pressure down right there and then, that’s a good thing. We don’t want anybody stroking out, right? But then the next question, the next step that needs to be okay, we’ve got you stabilized and now we need to sit down and have a conversation about lifestyle, environmental factors and all of that so that we can really get to the root and really understand what’s going on with the patient.

 

Doug Cook:

Yeah. And it’s an important point to clarify and I’ve always said obviously—I shouldn’t say obviously—but I’ve said myself it’s like no one’s anti-medication, no one’s anti-traditional medicine. There’s a time and place and if it’s warranted, for sure, you want to get those numbers down in your example with the high blood pressure. But if we all know that if we just throw anti-hypertensive medication on there, eventually it will quote wear out for lack of a better word and then you have to up the dose or add more and sometimes that’s warranted but there could be other things to get to that root cause as you say. So, that’s good to clarify.

 

Sheila Dean: [00:08:04]

And I would only add that that’s where this conversation needs to delineate between acute issues and chronic issues. So, the patient walking in with the really elevated BP, that is acute in nature and needs to be addressed right away. But then once the patient’s stabilized, now we need to think about a different model. And I think this is where the lines get blurred and it starts getting confusing because sometimes in traditional medicine, we’re using a wonderful model for acute care medicine but then if it’s applied to chronic disease, it’s not exactly fitting if that makes sense.

 

Doug Cook:

It does. And I’m wondering if you could just clarify for everybody what you mean by a systems approach when it comes to just I guess broadly speaking or you can go into as much depth as you want, a systems approach if you’re tackling a problem or looking at a situation.

 

Sheila Dean: [00:09:05]

Sure. I’ll give you a quick example. Patient comes in and they’re complaining about let’s say their stomach hurts. They’ve got intestinal issues or adjustive issues and they’re saying oh and by the way, I have this weird skin issue going on and also I have these headaches. So, in traditional medicine, we would only be paying attention at one symptom at a time. So, the patient’s entire story is not really being integrated and we’re really just looking at maybe the chief complaint and we’re looking at the symptoms in silos where each complaint becomes this discrete issue that’s dealt in isolation from the others. And again, they’re not integrated. And so, a systems approach is really an integrative approach where we’re thinking about assessment questions that help us understand what might be the underlying—going back to what we said the definition of IFN—which is the underlying root causes that can help explain all right, so what is going on here that’s causing this digestive distress and these skin issues and maybe these headaches where there could be some kind of commonality. So, looking at the different systems as an integrated whole rather than separating those systems out into separate silos if that makes sense.

 

Doug Cook:

It does. And it’s important. I’ve never done a history review on this but I think in the early days of medicine, a couple centuries ago, you’re looking at a complex system like the body and you think okay, well, we’ve got the GI tract, the gastrointestinal tract, we’ve got skin. So, you start to look at it in a more reductive manner to really understand each of those systems and organs, etc. But as you point out, the whole fact is that it’s all integrated and I think people might be really surprised if they’re not familiar with the idea that something like a skin issue could be related to the gut. So, you’ve got the gut. The gut’s made up of muscles and the gut has the immune system embedded in it. It has tons of nerves embedded in it. It’s got microbiota which everybody knows about now and it’s connected to the brain and mood. And so, we’ve got these different specialties. We’ve got a GI doc or a field of specialty. Then we’ve got the nerve people, the skin people and as you say, we treat them in silos and forget about the overlap. So, yeah. So, systems approach is certainly, to me, obvious but I think it’s important to stress for sure.

 

Kathie Swift:

I’ll that in a systems approach what is essential is thinking through really what can be considered imbalances in these systems, for example, in the person with let’s just say a chronic pain condition thinking about an inflammatory basis, as Sheila mentioned, root cause of that oxidative stress, detoxification, dysbiosis, what’s happening in the immune system with much of that immune system being in the gut. So, this model of using systems biology appreciates that there may be these imbalances no matter what the condition is. Whether we’re working with someone with IBS, SIBO, small intestinal bacterial overgrowth, rheumatoid arthritis, cardiovascular disease, it’s really, really important that the approach takes into consideration and digs deep into these various areas and networks of imbalance.

 

Doug Cook:

Gosh. Yeah. That’s helpful for sure because yeah, inflammation is a great example. So, for whatever reason, if someone’s having inflammation, if I’m understanding you, that always involves the immune system and then that can involve so many other things where it intersects with other organs and systems and cells and that type of thing. So, it really is I guess starting at a 35,000 foot view because looking at that holistic, that big-picture, seeing those interconnected parts like a map maybe—I’m just kind of thinking this out loud now—and then seeing where it might need that attention to kind of…

 

Kathie Swift: [00:13:44]

Right. And we’ll use everything, for example, in thinking about moving from signs and symptoms in a functionally nutrition focus physical exam, for example, with regard to inflammation, certainly thinking about biomarkers both conventionally, something like C-reactive protein or other functional markers that we may be looking at. So, it’s also the application or the use of perhaps conventional and functional labs and diagnostics that can help us target and create an intervention plan that truly is going to be unique to that individual.

 

Doug Cook:

It takes a lot of work for sure. It’s not the easy route which is—I’m just trying to think, I don’t want to downplay traditional dietetics but when I hear you speaking and if other dietitians are listening or other people have gone to see maybe healthcare practitioners and dietitians as patients or clients, which the picture you’re painting is very, very different than traditional dietetics and certainly what I learned in my internship. So, to help people understand a little bit better, could you kind of separate or compare and contrast the differences between integrative and functional nutrition versus traditional dietetics?

 

Kathie Swift:

Sure. First, I want to mention that both Sheila and I were trained conventionally traditional dietetics and believe that it is an excellent foundation for expanding into an integrative and functionally nutrition oriented practice because the dietitian has knowledge in physiology, biochemistry, microbiology. Don’t we know that microbiology with the microbiome research has certainly come into the scene? So, they really have an excellent foundation for this. In fact, most RDs when they begin to study and learn about these concepts, functional concepts, it makes sense to them and they see that an integrative and functional nutrition approach is grounded heavily in science. But I would just say that there are some key areas that certainly I think have been shortcomings in our traditional dietetic education where integrative and functional nutrition training programs such as ours seek to fill these gaps—and hopefully we’re doing this very successfully—and that is that we’re really skill building and developing competencies in key clinical areas.

 

So, I’ll just mention a few and one certainly is in a food-as-medicine approach using therapeutic elimination diets whether it’s histamines, specific carbohydrate diet, autoimmune, paleo type. So, we dig deep into these therapeutic elimination diets. I think another area is, of course, looking at conventional labs through a functional lens. In other words, if a reference value is a certain level, is that truly an optimal level? Is normal optimal for functioning? They can be different. Also, other functional labs and diagnostics including everything from nutria genetic testing. In fact, sometimes we think about nutria genetic testing, nutrigenomics as kind of a last resort when if we did have some information on genetics whether it’s methylation or inflammatory SNPs, single nucleotide polymorphisms or such, it can be really very, very helpful. Functional labs like an organic acid test and there are many others. So, certainly I didn’t get that in my traditional dietetic training and we really need to get up to speed with regard to this. It is the nature really of a systems medicine approach.

 

I think the other area, of course, is dietary supplements and there truly is both an art and science to that. We can talk about that more in depth. And then the other area that is I think very, very important are, of course, my body modalities, meditation, breathing techniques and others that certainly we want to be familiar with, we want to practice ourselves and integrate these into a holistic nutrition care plan. So, those are some of the areas that we dig a lot deeper into that can make a difference in our patient outcomes.

 

Doug Cook:

Right. Did you want to add anything, Sheila, before I commented? Because Kathie’s comments brought up a lot of things within me.

 

Sheila Dean:

Yeah. No, I mean I think what Kathie said really kind of was an excellent summary of the various modalities that we’re taking into account as part of our assessment when trying to get to those root causes. And the thing about it is that is because there’s so much to go through, because there’s so much information, because we’re taking such a deep dive, there has to be some kind of methodology to this because it’s really easy to just kind of go all over the place and achieve nothing. And that’s really what our training program does. We start from the beginning and break it down and show you how to start with an assessment or root cause analysis and where to take it from there. And what you start to realize is I mean that obviously this is based in science but there’s also an art to all of this. There’s no doubt.

 

Doug Cook:

Yeah. For sure there’s an art and when Kathie was speaking, I think you kind of whether you realize it or not have summed up I think a lot of—well, for sure, my personal experience—but a lot of other dieticians and especially dietitians who I’ve talked to about integrative and functional nutrition. Because if I can just indulge everybody for a second, when I think about my interest in nutrition, I was just naturally inquisitive as a kid. I liked health. I liked food. I had done some reading on nutrition and I was learning about vitamins and immunity and a whole bunch of different things. And so, I thought well, I’ll go to school and study it. So, I went to the program that I went to here in Toronto was horrible. I was really, really let down and I became quite disenchanted or disillusioned. And then, I did my internship. I started working in the hospital. I was really confident in my clinical skills. I wouldn’t be the clinician I was. So, to Kathie’s point, dieticians have a really strong foundational education and training. But then I was left flat and then I stumbled upon all the stuff, integrative and functional nutrition and I just was like Christmas morning or whatever resonates for people because it was like yes, this is what got me excited in nutrition. This is what I thought I was going to study when I went back to school. It just has so much more breadth and depth. And I know it’s not that dietitians don’t want to offer more. Unless you go on to a little more training and education, you can’t really offer more than what a lot of us do in practice. But there is so much more that we can do. So, there is, as Kathie says, a lot of shortcomings in the sense that there’s so much more that we can do as dietitians and I really think dietitians are in the best possible position to run with this with the proper training like you have with your academy and your online courses because as we all know, there are a lot of nutritionists out there or people calling themselves nutritionists that might have some dodgy or sketchy education. So, I think it’s really something that we could run with as a profession if people want to do that skill build as Kathie said. So, that’s a really, really important part. I think a point, I really think people are hungry for this but again, without the right training, they might feel like they’re floundering a bit.

 

Sheila Dean:

Well, I think what you guys are speaking to here is the fact that you can only offer as much as the tools in your toolkit. So, I mean if you have a basic hammer and a good screwdriver, that’s great. But for some of the more complicated and advanced chronic conditions, I mean autoimmunity is huge and I know that when I was in private practice, people weren’t walking in with one autoimmune condition. Sometimes they were walking in with three or four autoimmune conditions. And even with going back to just a patient with diabetes, as a dietician, we’re trained to kind of go over carb counting which is fantastic and I would never abandon that approach. I think carb counting is a great tool in my toolkit. What we learn in functional nutrition is that there are more tools that we can use to really understand how we can improve the patient’s health and their outcomes so that, as Kathie said, now we’re able to look at labs more critically. For example, are we really going to wait until the patient presents with type 2 diabetes or even borderline diabetes? Why not let’s run a fasting insulin and let’s see if they’re hyperinsulinemic? We all know that you can be hyperinsulinemic with a normal blood glucose. And that would be way earlier in this health and disease continuum and a lot cheaper and easier to make modifications and modulate at that point than when a person’s way on the other side of the spectrum presenting with type 2 diabetes.

 

And so, and the use of dietary supplements, the appropriate and the responsible use of dietary supplements could be another thing to take into consideration as part of your toolkit. For example, again carb counting, that’s wonderful and it’s an important part of medical nutrition therapy for the patient with diabetes but we also know that insulin needs to dock into a receptor and then that reaction is nutrient dependent depending on certain really critical minerals and especially vitamin D. so, we might want to run a vitamin Dan:, we might want to recommend vitamin D and all of these things especially dietary supplement recommendations are, in fact, within the scope of practice for dietitians. And so, I think just keeping in mind that the more tools you have in your toolkit, the more you can do for your patient.

 

Doug Cook:

Yeah. I like that. I like that analogy with the toolkit. You start with what you have and then you build on that and even as you build on that, you can use what you have. You don’t have to wait until you’ve done five years of study. You can do it along the way. You brought up two amazing points that I want to just comment on. One is the one that Kathie mentioned and you did too is this idea of functional lab testing. So, what I find interesting and what a lot of people don’t understand even doctors when I think about my work in the hospital still. So, a perfect example which might help people understand this is a nutrient has to be used in a metabolic pathway properly and adequately to promote that metabolic function. So, a perfect example is B12. So, I work in a geriatric unit and we run B12s on people and they come back and they’re normal to normal high and sometimes high. So, the assumption is they’re more than B12 replete, that they don’t need any B12 supplementation. Other parameters are normal like the MCV, etc. But the B vitamin might not be being used. And so, it’s kind of building up like a bottleneck. So, if we were running other things like methylmalonic acid or these other metabolites B12, you’d see that it’s not being used. So, it’s functionally deficient and if we had a functional test, then that would be more accurate or better. It would have more utilities if I’m getting this right.

 

Sheila Dean: [00:26:21]

Yeah. No, that’s a great example. I mean the presence of a vitamin in the blood doesn’t always reflect tissue levels. And so, it can be a little confusing. Just like you said, you run the patient’s B12 levels and oh, look, they’re normal or even high normal. But that doesn’t necessarily always mean that their tissue levels are where they need to be and sometimes to know what’s going on there, we would have to run some type of functional lab and in this case, in the case of B12, you could look at a methylmalonic acid which by the way is available via labs like Quest and LabCorp. They’re not so obscure that you can only go through boutique laboratories. It’s just that they’re not necessarily part of standard of care and this is what’s unfortunate. That you’re sometimes in a position where we have to just decide whether we want state of the art versus standard of care.

 

Doug Cook:

Yeah. And for me, it’s a little different because I’m in Canada. So, we do have a healthcare system here but they cover the basics in the name of saving money. So, like many places, we do fasting blood sugar and A1C and as you said, you can have high insulin and normal blood sugar and everything’s quote fine until—I’m not sure what the U.S. units are—but for me at 6.1 millimoles because medicine is the treatment model. So, by definition, it’s reactionary. So, at 6.1, the doctor says oh, I have a treatment. It’s metformin. Up until that point, they don’t really have a treatment. And so, when I went to my physical last time, I said you have to do fasting insulin. I want to calculate my HOMA-IR which is an indicator of insulin resistance. So, I think I had to pay $30 out of pocket because our insurer, the provincial insurer is not going to do that because it’s quote seen as too expensive. But then as you just said, when we wait until it’s too late, someone has diabetes, we’re paying way, way, way, way more. So, it does seem short-sighted in that regard. So, I really feel like integrative and functional nutrition can be a lot more preventative and proactive than traditional. And if people knew, I think things would change. It’s just frustrating.

 

Sheila Dean:

Well, Kathie mentioned earlier that we were both conventionally trained, originally conventionally trained dietitians and we value that training. But I do remember before I was introduced to principles of integrative and functional medicine, functional nutrition, we’re skeptical because what we learned was evidence-based, science-based. And so, we’re taught to be skeptical which is not a bad thing. I mean critical thinking is important but I think what we came to learn was that as we continue to investigate, to independently investigate principles of integrative and functional medicine, we started to realize that there is indeed a lot of evidence in the literature, in PubMed, and wow, depending on what medical conference you go to, each organization tends to cherry-pick the data a little bit. And so, that’s why I felt like I needed to just kind of do my own independent investigation and learn what really is out there. And I remember this all happened years and years ago, about two decades ago where I wanted to learn what was the bottom line in organic because it just became such a popular thing and I wasn’t sure. I was skeptical and that was one of the very first steps in me bumping into principles of integrative and functional nutrition and learning that oh, well, look, there is a ton of date out here. And of course, I have to say that my colleague Kathie Swift is the queen of PubMed and is a research ninja and has her fingers—I mean her work is impeccable and she’s truly on the leading edge of research. So, I’m very fortunate.

 

Doug Cook:

Speaking of tools in your toolbox, right?

 

Sheila Dean:

Oh, yeah.

 

Doug Cook:

I had something to say. I don’t know if Kathie wants to chime in. But I’ll speak for myself. So, I found that yes, it is a reality that dietitians tend to be skeptical. There’s a difference between being skeptical, you want to just jump on the bandwagon with everything. But there is a bit of resistance in my experience where it really takes a lot of—like it’s not just a knock on the door. You have to take a sledgehammer to the door and say look, there is evidence that vitamin D preserves pancreas function and type-2 diabetes or prediabetes. They may need more than the thousand units that Health Canada has limited the supplements to have or there is the possibility that a so-called healthy diet is not enough to give enough vitamins and minerals and it’s not a bad thing to use supplements. So, there is this resistance and I find it interesting. But to your point, there’s heaps and heaps of research out there that we’re just not exposed to and I think that’s one of the challenges I’ve found in my early career that we weren’t getting that through regular dietetic channels of education and training unless you went to kind of like a specialized, like we have a Canadian nutritional science organization here. They’re not dietitians. They’re primary researchers in this area. And so, if you’re not going to those things, you’re not going to get it at our conferences and that kind of thing. So, I had a question and feel free to answer or not answer because I’m quite vocal on this. I don’t understand why dietitians are hesitant to recommend or use supplements. I mean if you look at surveys I think, about 70% of dietitians use them. So, they’re closeted supplement users but they don’t in public want to admit it. I have my theories. Do you have any ideas what do you think why dietitians might be resistant?

 

Kathie Swift:

Well, first of all, I think a lack of good training in the responsible and judicious use of dietary supplements and I think also some of it comes from a dietician certainly perhaps being concerned without having a good knowledge base, being concerned that they might do harm to someone. But there is a reality at least in the U.S. Over 60 million folks are self-prescribing. They’re spending an excess of $30 billion in dietary supplements including herbals to address lot to address what? To address their health concerns. I mentioned chronic pain, anxiety, bone health, menopause. I mean and the list goes on. And I think it’s critical that we as dietitians realize this, that we should be taking the lead. We should be the early adopters versus the hesitant bystanders to really guide patients in this area. As Sheila mentioned, it is in our scope of practice. We understand that there could be a drug supplement interaction. And so, I think it’s so important and we really made sure that in almost in each and every module, we’re appropriate. We have separate modules too in our training program on dietary supplements taught by a professor at Bastyr University. We have a robust clinical toolkit. Our students also have access to the Natural Medicine Database which includes both practitioner and patient handouts. So, we appreciate there is a science. You bet. There has been a recent paper published just recently, for example, on dietary supplements for neuropathic pain. There are other research articles certainly on the use of fish oils and tumeric with inflammatory disorders. How do you help prevent someone progressing from osteopenia to osteoporosis with vitamin D and vitamin K2? And I could go on and on. The woman who’s trying to conceive and perhaps we identify she has methylation issues where some B vitamins, certainly methylated B vitamins could be helpful in an appropriate dose. So, again, I for so long on 45-plus years have had a tremendous passion for our profession and it does concern me. I don’t want dietitians being left behind. As you mentioned, Doug, there are other professionals certainly getting involved and we want dietitians to take the lead in this arena I think because they’re very well positioned for the responsible and judicious use of dietary supplements as part of an integrative nutrition care plan.

 

Sheila Dean:

Kathie, I think everything that she said is spot on. I also just want to add that—and this is just going to take a moment to get kind of real here, folks—dietitians go through a lot of science training as Kathie mentioned, biology, chemistry, organic chemistry, physiology, microbiology. So, you go through all of this training and now in the U.S. in the year 2024, dietitians are now going to even be required to have a master’s degree. So, all this training, the last thing a dietitian wants anyone to perceive him/her as is some kind of quack prescribing or recommending supplements when you’re working in an environment where it’s scoffed at or frowned upon. It’s not easy to rise above that and it takes some guts. So, I think a lot of it depends on the environment that you’re in. If you’re in a very forward-thinking environment where your colleagues and your fellow RDs are sort of on the cutting edge and they’re comfortable with, as Kathie said, the responsible and judicious use of dietary supplements, you probably feel more comfortable with it as well and will probably be more likely to be willing to at least look at the data. But let’s face it. If your colleagues and your friends and your RDs and the MDs you work with, if they’re all pooh-poohing the idea, it’s easy to jump on that bandwagon without really taking the true scientific method approach and really looking at it as objectively and independently as possible. And so, these kinds of concepts I mean, it takes a while for the clinical world to catch up with research and I think I even read that it takes like 50 to 100 years or something for what we have already shown in research to actually now be part of clinical care. So, there’s a dynamic there that we don’t really talk about but I think that might be one layer.

 

Doug Cook:

Yeah. You’re both very much more articulate than I am about this topic. Maybe a little more forgiving, I guess sometimes I get impatient. So, it’s important I guess for me to kind of cut some slack to everybody because of the history of how we’re trained, etc. I’ve always wondered if the history of the profession has been food-based and if they recommend supplements, they’ve somehow dropped the ball. I don’t know. No one will ever answer my question. Or if we’ve all bought into the idea of, if you look at the early food guides, it was all about preventing deficiencies during wartime so that if someone’s not walking around with scurvy, then diet’s done its job and the next step is a medical intervention or a drug. And what I find baffling is that we forget that nutrients are nothing more than these chemicals and molecules that aid physiology and biochemistry. And so, it takes more faith to think that they can’t have a beneficial role provided it’s standardized and it’s the right dose and all the usual things that we need to consider, that it couldn’t augment. And I think the research in genetics, as Kathie mentioned, SNPs, [inaudible 00:39:15] mutations that might need special forms of a vitamin or higher doses will change that and eventually will come out of the closet. But yeah, there’s historically been a bit of shaming and bullying around that. For the record, I love supplements. I’ve always used them. I had them growing up as a kid. So, I was just curious to get your perspectives and I think it’s really important what you pointed out.

 

Sheila Dean:

Doug, let me just throw in this one thing and that is sometimes when we get a little enthusiastic or maybe or a little overzealous about it, you can go the opposite direction a little too far. I know this happens a lot when you first start learning about it and you get really excited about supplements and kind of all of a sudden forget all about food. And the next thing you know, you’re recommending a supplement for every imbalance and we don’t want to go the other direction to the extreme as well where now we’re recommending quote-unquote green medicine supplements that just replaced maybe a drug. I think it’s all about a balance where food is the foundation and then based on an assessment, we determine if supplements, dietary supplements are necessary. We try to use the least amount that’s necessary. But yeah, that doesn’t necessarily mean that supplements have no application and no use either. So, I think there’s a balance. The truth is somewhere in the middle.

 

Doug Cook:

Yeah. And you just kind of pulled me there, both of you, bringing those points to bear. So, yeah, I’ve kind of lost sight of that. so, that makes perfect sense to me.

 

Kathie Swift:

Just add too—thank you for that, Sheila—I think it’s really a critical point and Doug, the other point that you made is dietetics was founded and grounded in food, food-based therapies and we all appreciate a food as medicine approach and it really even in our integrative and functional nutrition care plan, it’s where we start absolutely. But we clearly have seen the value of supplements when used wisely and with a good knowledge base. I just checked. There’s a conference, it’s scripts on the use of dietary supplements and natural products each year. And what really—I guess I’m just going to say it—frustrated me is that there was not one registered dietitian on the faculty for that conference. And as we know, and I’m not saying this as a negative, but how much nutrition training is there in medical schools? In fact, we started almost 20 years ago a national program called Food as Medicine in this country because of that, that there wasn’t any nutrition at the time in medical schools. But the fact that perhaps we as dietitians are not valued for our knowledge and role in the area of dietary supplements concerns me which is why we have included so obviously a good knowledge base in our training program. I think it’s really, really been a major gap in our traditional training.

 

Doug Cook:

Yeah. And as you’re talking, you’re reminding me that this is probably largely an issue of confidence. So, it does take training. It’s being aware of the research. It’s being aware of the supplements on the market, the formulas. If you’re taking vitamin D, is it just the dose or is it the ideal blood concentration? There is lots to consider which is why training is good and it’s great that your program has a lot of that as I’m just scanning the modules here which we’ll talk about in a second. I just wondered if out of curiosity, do clients come to you two because they know you practice this way or do they come to you because you’re a dietician and it’s introduced? And the reason I’m asking is if they don’t really know about it and they hear about it, I’m just wondering what their response is like because I’ve had people come to me and I’m a little embarrassed and upset when they’ve said they’ve gone to other dieticians and they’ve been quote useless or of no help which is disheartening because of everything we’ve been talking about, there are missed opportunities and huge learning gaps that could be filled. But I’m wondering if people come to you specifically because you’re a functional nutritionist or they learn about it and what their reaction is like.

 

Kathie Swift:

Yeah. Doug, for me, yes, patients come to me because over the years, they recognize and I even position myself on my website and such as an integrative and functional dietician nutritionist. So, they kind of know and actually seek that type of approach to their healthcare. And something you mentioned that—did you say that it frustrated you about..?

 

Doug Cook:

Well, it frustrated me and it was embarrassing.

 

Kathie Swift:

Yes. And I want to comment on that because yes, that happens to me also and I really believe that it’s important for the patient, for the person that we’re establishing a therapeutic relationship with. I don’t want to add more stress perhaps to that experience. I want to acknowledge that every person, every practitioner and in this case, a dietitian that they may have seen as I believe done their best to provide based on their knowledge, based on their training and background. I really do believe that all healthcare providers have good intentions. So, I like to approach it from a collaborative spirit. I also want to add that when I first got into this which was decades ago and I got into it because my on-ramp was kind of one of these mysterious chronic complex illnesses and interestingly, I come to learn sometimes the reason why other dietitians seek this type of training out when they have tried other approaches and nothing is working. I initially was met with great resistance and I will say that the interesting part of this story is I was at a very what I thought was progressive lifestyle resort, in fact, one of the top in our country here but they were not using a functional lens, a functional medicine approach. And long story short, I think the way we can approach whether it’s people listening out there who are in healthcare clinics, institutions, wherever and you embrace this model, I just proceed with an open heart, open mind, a collaborative spirit. I had to use a lot of diplomacy but I persisted.

 

Another kind of pearl I want to give is reach out to those who perhaps are your mentors in this area, to others. I reached out to some of my teachers back then—Dr. Jeffrey Bland who’s considered the father of functional medicine, Dr. Sidney Baker may be the grandfather of functional medicine, Dr. Leo Galland, well-versed—and actually brought those thought leaders into the facility because I wanted them to hear it not just from Kathie Swift but from others. So, sometimes building a group, starting a book club, an article, reading The Disease Dilution by Dr. Bland or a particular research article. I sent one to someone who contacted us today through The Integrative and Functional Nutrition Academy on a study done with regard to rheumatoid arthritis and a very excellent unique approach with an anti-inflammatory diet. So, I think there are ways that we can build a collaborative movement in the integrative and functional nutrition landscape so to speak that is very positive and inspiring.

 

Doug Cook:

It is and I think it shouldn’t be the future. It’s going to be the future. It should’ve been this way the whole way. But I applaud people like you and Sheila because I tend to give up on things and when I hit up against resistance and that kind of thing, it just makes me want to just kind of do my own thing. So, I think that everything you pointed out is really amazing to highlight in terms of the collaboration, etc. so, yeah, there’s still resistance. I’m wondering if the whole part of learning is you have to get uncomfortable.

 

Kathie Swift:

Yes, yes.

 

Doug Cook:

When you’re rethinking something, it’s not fun. I mean it took me forever. I was the food guide, low fat, no carb kind of guy. And then I was on—this is way back—there were these chat boards when the internet first came out and there are people talking about the zone diet. And I was saying oh my God, it’s dangerous, it’s low carb and it’s the space on your plate. And I was just indignant and I was just a bit arrogant. And so, it’s hard to think that what you might have learned might not be the best. I mean this is me talking. So, it is what we maybe knew at the time. But I think it’s just uncomfortable to kind of think like damn, I may have to rethink this and that’s never fun, right?

 

Sheila Dean:

I wanted to mention real quick that Kathie and I are huge fans of the training and the work that registered dieticians do which is why IFN, which we like to call the integrative and functional nutrition, is really geared for the dietitian. Of course, we do have other nutrition and other healthcare practitioners in the program but primarily dietitians. And part of the reason is because what we’re seeing is that other healthcare professionals including, if you want to put them in that category, health coaches but nurses, acupuncturists, chiropractors, they have all figured out that nutrition is a key part of patient healing and this is what everybody tries to incorporate nutrition in their practices. And so, it starts to become a bit of a turf war. And so, one of the reasons why Kathie and I are so passionate and adamant about getting this information out there is because, as you said Doug, dietitians are so perfectly positioned. They get all this wonderful training. They really are ideally positioned to beat the disseminators of functional nutrition. And so, just have to try every day to not so much focus on the ones that this information is going to fall on a deaf ear because everybody has a choice and everyone has a prerogative. It’s their prerogative to take whatever approach you want to take. But there are a lot of people, a lot of dietitians who are very interested but just need a little encouragement and need some training so that they have a coherent, organized and coherent knowledge about how to approach these cases because it’s a little intimidating. Where do I start? And so, investing in yourself I think is a really important concept and whether it’s our program or some other program, I think that dietitians, we’re huge fans and we really want to make sure the dietitians get more and more credit and more and more knowledge and more involved in integrative and functional nutrition.

 

Doug Cook:

So, to that point, you two are the founders of an amazing online program, Integrative and Functional Nutrition Academy. So, it’s very clinically oriented. It’s all online I believe with amazing mentorship when I think of the lineup—and we’ll point everybody to the website later—medical doctors, scientists, nurse practitioners. It’s really well-rounded and it even includes naturopathic doctors and holistic health counselors which, of course, would be seen as the enemy back in the day. So, it’s very inclusive in that way which is hugely important. So, rather than me just kind of going through this stuff on the website, would you like to take a few minutes just talking about your program and how it works and what it offers dieticians who will be listening?

 

Sheila Dean: [00:53:10]

Well, the IFNA online training program as you mentioned is 100% online. We are accredited providers of approximately a little more than 220 CEUs or continuing education units by the CDR in the United States. Whether that transfers over for dietitians in Canada, I’m not a hundred percent sure but we actually do have quite a few Canadian dietitians. So, you might be able to actually, Doug, help us learn if the CEUs that we offer are accepted by the organization that dietitians in Canada report to. But going back to the program. So, there are 33 modules and these 33 modules are divided into five tracks. It’s a lot like a fellowship or a specialty where it takes about a minimum of nine months to really a maximum of two years to matriculate through each module and we estimate that each module takes between 7 to 10 hours to complete. It’s very thorough. There are nine components to every module that include a clinical toolkit, the video, access to a forum where you can ask questions 24/7, additional resources, research papers. I mean there’s all kinds of things, brandable handouts, patient handouts, PowerPoint slides, clinical protocols. It’s loaded, it’s loaded. The other thing is that it all leads ultimately to an advanced practice credential. So, when you’re done, there is a peer-reviewed board exam that you then take and when hopefully you’ve completed and passed that, you then earn the IFNCP which stands for the integrative and functional nutrition certified practitioner which is really becoming the gold standard what for functional nutrition so that when a dietitian earns her credential or his credential, he or she now is distinguishing themselves as someone who’s gone through formal training, taken a peer-reviewed board exam and we’ve been able to provide opportunities for our IFNCPs that help kind of move them forward in their field.

 

Doug Cook:

Yeah. So, what I find interesting, to put in perspective for listeners, is there’s a hundred thousand I believe dietitians in the U.S., about just less than ten thousand in Canada and I know the Academy of Nutrition and Dietetics has a chapter or network or whatever this term is DIFM which stands for Dietitians in Integrative and Functional Medicine.

 

Sheila Dean:

Yeah, that’s right.

 

Doug Cook:

So, there’s more dietitians in that chapter than there are in all of Canada. So, it really just speaks to the growth and the interest of where this is going. And so, we don’t need CDEs here. Every year we renew our license and we have to set two learning goals. But the point is it really is a beautifully organized program that provides this training in a stepwise manner and then it’s nothing that’s—we still operate within our scope of practice. So, we can’t do finger pricks, we can’t order blood work. But you can use the knowledge within these to apply them to the best and to the full extent that you can within the scope. So, it may not be recognized formally like an RD designation but it really does provide structure for people to tackle whatever they want to and to use whatever they want to. I mean they may want to start using 10% of their knowledge. It’s just baby steps and you go from there.

 

Sheila Dean: [00:56:53]

That’s why we divided the modules into the five tracks. It’s more chunkable and more bite size so to speak. So, a dietitian can get started with track one which is six modules and take a little break and then when they’re ready, they can then register for track two. So, you don’t actually have to register for the entire program at once. It’s done in stages and I think it makes it a little bit more manageable. We are offering the coupon for anyone listening to this podcast. They’re welcome to use the coupon, GetStarted20% and that will get you 20% off of track one.

 

Doug Cook:

So, I have a question. Could somebody jump to track four which I’m looking at now and it’s really interesting.

 

Kathie Swift:

Doug, you read my mind! Sheila did such a great job of describing the program. But I was just sitting here thinking that yes, we have had many dietitians that have looked at the program and said you know what, could I start with track four? Which as you can see, they’re totally—well, you might not be able to see—but totally taught by dietitians and it’s the therapeutic elimination diets track. And I will say it’s one of my favorite tracks. It certainly covers everything from keto to specific carbohydrate and the list goes on. So, yes, someone could start with that track, track four.

 

Sheila Dean:

Ultimately, the only requirement is that if someone would like to earn the advanced practice credential, they would have to complete all five tracks. We also have another option and that is not necessarily everyone, although most are interested in a credential, for those who don’t really want to take the board exam, they can take the first four tracks and we’ll send them a certificate of training that basically just says they’ve gone through the program or the training but they haven’t actually earned a credential. So, we actually have both, a certificate and we offer the credential. And then, of course, the third way to interact with the program is for dieticians in the U.S., if all they’re really looking for are some extra CEUs, they can just take track one and they’ll get something like 46 or 47 CEUs and they don’t necessarily have to keep going. So, there’s a little something for everyone depending on what it is that you’re looking for. One of the other things that I really appreciate is that this is not the school of Sheila and Kathie. We have an amazing faculty where we have 33 different modules and different instructors, different faculty, experts leading these different modules and you’re really learning from the best of the best which we think is a much better model than one person teaching the same module again and again.

 

Doug Cook:

Yeah. No, I totally agree. So, I’ve taken a course like that and I wish I’d found this one first and I don’t want to convince everybody they don’t need tracks one, two, three. But I know track four, if it’s by dieticians for dieticians because I know so many people—I’m on a Facebook page, a dietitian support page on Facebook—and people will be asking what the heck is the low histamine diet? Or do you have anything on the Paleo or specific carbohydrate diet? So, this whole module would be a goldmine in terms of the structured overview and an implementation of these diets. So, I guess I’m just talking about myself here because I’m finding that hugely interesting. So, well, I really want to be conscious of the time because I’ve taken up a lot of your time and I’ve really, really enjoyed it and I know everyone else is really, really going to enjoy it. I think that coupon is great. So, again it’s GetStarted20% for track one and if people want to learn more about the academy or each of you, where can we find more about all of that?

 

Sheila Dean:

The easiest and fastest way to get a response is to simply go to the website which is IFNAcademy.com and at the very top there, you’ll see a tab that says contact us and if you fill that out, we get that immediately. We say we respond within 48 hours but it’s more like within 48 minutes for the most part except for weekends. But we do respond very quickly and if someone would like a personal call, we do our best to do that. Of course, internationally, we will have to figure that out. But yeah, so just fill out your name and email and a way to reach you and we’ll get back with you with any of your questions.

 

Doug Cook:

Great. Anything from Kathie? No, that’s good?

 

Kathie Swift:

I think that’s a wrap. Thank you. Thank you so much, Doug. It was really wonderful to be here and share this conversation.

 

Doug Cook:

Great. So, thanks to you both.

 

Sheila Dean:

Thank you. Thank you so much.

 

Kathie Swift:

Bye, bye.

 

Doug Cook:

Hit subscribe and get ready to expand your nutritional world, your perspective and gain confidence in a way that you didn’t know you could. And be sure to check out my website DougCookRD.com.

 

 

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Doug Cook RDN is a Toronto based integrative and functional nutritionist and dietitian with a focus on digestive, gut, mental health.  Follow me on FacebookInstagram and Twitter.

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