Patient-centred nutritional therapy

Some training courses in naturopathic nutritional therapy (also known as holistic nutrition) can be very theory-oriented, teaching few or no protocols or structured procedures to follow when dealing with patients or clients.

While many course graduates have a natural aptitude for developing their own protocols, others do not, and may flounder between different theories and philosophies, from treating almost everyone for ‘candida’, to prescribing products based mostly on the latest advertising puffs. This article suggests how to avoid making some of these errors.

In developing nutritional therapy protocols, the first priority is the client.

  • Why is the client consulting you?
  • What is the client expecting from the treatment?
  • How knowledgeable is the client about health in general?
  • Does the client understand the principles of natural medicine and nutritional therapy?
  • How committed is the client to getting well using natural methods?

If you assume that you already know the answers to these questions, not only may there be unexpected consequences but you may find that your client will not be sufficiently committed to the treatment program.

Example

The following is a true story, which was told to me by one of my own clients. James, suffering from irritable bowel syndrome, read in the newspaper about a case of IBS which was successfully treated with naturopathic nutritional therapy. He quickly found out where his nearest nutritional therapist was and consulted her. He was expecting to be given a diet excluding some foods, to spend a few pounds a week on supplements or herbs, and to experience a relief of symptoms within a couple of weeks.

James’ therapist, Anne, gave James a questionnaire to fill in which she normally used as a basis for prescribing dietary supplements. Although James felt pretty healthy apart from his IBS, he thought that as most of the symptoms had applied to him at some time in his life, the nutritional therapist ought to be informed, so he ticked symptoms like ‘lack of energy’, ‘muscle twitches’, and ‘bloodshot eyes’.

Anne was a therapist who loved raw food and really believed in raw food diets because they had benefited her own health enormously. She spent much time at James’ first session explaining the benefits of raw food to him, but said he could also eat some brown rice and yoghurt every day, some steamed vegetables and grilled fish three times a week. He was allowed to drink fruit juice, provided it was diluted, but had to avoid all tea and coffee, alcohol, food additives and sugar. Based on the answers in his questionnaire, Anne prescribed eight different dietary supplements, which she sold him at about 8-15 GBP per pot, and told him to come back in four weeks. His appointment, which had taken one and a half hours, cost him 60 GBP.

James came out feeling optimistic, but once he had bought his vegetables, he did not really know how to prepare them, and he really hated eating them raw. He felt hungry all the time, his head ached, and he desperately craved coffee and beer and his usual diet of fries, meat, cheese sandwiches and chocolate.  However, James persevered with the diet because he really wanted to get over his IBS.

A week went by…

The diet became more and more difficult. James’ friends were commenting on it, and noticing that he looked very thin. His girlfriend didn’t think the diet was doing him any good. ‘Your symptoms haven’t changed at all, in fact your flatulence has got worse, your energy levels are really low, you’re depressed and hungry all the time, and you’re getting dangerously thin,’ she said.

James couldn’t help agreeing that he felt worse rather than better. Although Anne had told him he might get a ‘healing reaction’, he didn’t believe that the way he felt had anything to do with healing, so he went back to his doctor to ask for advice. He took his dietary supplements with him, since he was becoming worried about Anne’s competence as a therapist and thought that maybe he had been prescribed something that wasn’t safe.

‘Vitamins for irritable bowel syndrome?’ said his doctor. ‘There’s absolutely no evidence that they can help at all. Did this woman sell them to you?’ ‘Yes’, said James, beginning to feel foolish. His doctor wrote out another prescription for an anti-spasmodic drug and advised James to avoid foods which gave him flatulence. James went home, threw all his raw food away, consumed a cheese sandwich and a cup of coffee and promptly felt much better. ‘See?’ said his girlfriend, ‘Food had nothing to do with your IBS after all. It looks like you got ripped off.’

James’ therapist contacts him

When James did not come for his next appointment, Anne phoned him to ask if everything was ok. James was reluctant to enter into a long discussion with her, and simply told her that he had found the diet too difficult and abandoned it. Anne said that was a pity since if he had stayed with it in the long term, he would have benefited. Anne was very disappointed, and blamed James for not wanting to take responsibility for his health.

What Anne did wrong

Anne made a lot of mistakes which let down herself and her client.

1. Because Anne was so keen to get everyone to eat a raw food diet—believing in it so firmly as a cure-all, it didn’t really occur to her that James was not payng her to learn about her lifestyle. He saw the diet purely as a treatment to free him of his symptoms. The person with IBS in the newspaper article was cured in two weeks, and he assumed that any nutritional therapist would do the same for him. The person in the newspaper had not complained of hunger, depression or weight loss, and had not been given a lot of vitamins to take.

2. Anne did not carry out an investigative procedure that was appropriate for her client. She should have analysed James’ symptoms and asked him further questions such as whether the IBS had started after a holiday abroad or a tummy upset, whether he had had any stool tests, whether he felt that stress had anything to do with his symptoms, or whether any foods seemed to make his IBS worse. She should have given him a diagnostic diet, explained that it avoided foods commonly linked with IBS, and informed him that his reaction to the diet would confirm whether or not these foods were aggravating his problem.

3. Anne’s treatment protocol did not prioritize correctly. She should have asked James some more questions about the symptoms he had ticked on his questionnaire, to find out which ones were current, and most troublesome. If she had, she would have realized that his only current symptoms were his IBS, and that the expense of vitamin supplements was not really justified at this stage when the money could be more usefully spent on natural digestive soothing and healing agents like fennel, chamomile, liquorice or peppermint tea and slippery elm. These were a priority for James, since his gut wall was damaged and irritated.

4. Anne was not careful enough about the safety of her treatment. Due to his IBS, James was already slightly underweight for his height. The diet guidelines she had given him were not detailed enough, and with her emphasis on raw vegetables and brown rice, James did not know whether he was allowed any fats or oils. Assuming that because fats are mostly frowned on, he should stay away from them, he had literally eaten just the vegetables, with plain boiled brown rice, grilled fish and wholemeal bread. Since he found the food very unpalatable, he didn’t eat very much of it and so lost weight. He tried to phone Anne at her clinic to ask advice, but was informed that she was only there once a week.

5. Anne did not follow up her client soon enough. A month before the next appointment is a very long time, and makes the client feel that he/she is not being properly supervised.

6. Anne failed to take responsibility for giving her client value for his money. She did not know that her diet would cure her client’s IBS, but she allowed him to assume that it would. She may have taken his money for many months, assuring him on each occasion that he would feel better soon when in fact he was getting worse. She made the mistake of adopting a philosophy and trying to adapt her client to it rather than adapting her treatment to her client. When the treatment failed, she blamed her client instead of her treatment, and accused him of not taking responsibility for his health. In fact James had made a superhuman effort to follow the diet Anne had given him, driven on only by his will to get well.

James did eventually return to natural medicine when he was feeling stronger, as he could see no future in taking prescription medicines that only had a temporary effect. He worked with me for three months and we worked on improving his digestion and identifying the foods that were causing his symptoms. These were foods that he ate every day so he did not realize that they were irritating his bowel. James was eventually able to stop taking all conventional medicines.

This article is by Linda Lazarides, founder and course director of the School of Modern Naturopathy.