How to do 'nutrition' right!
By Donald F. Feeney, DC, DACBN, CCN

About two out of three practitioners offer nutrition as a modality, according to Chiropractic Economics 9th Annual Salary & Expense Survey. This statistic reflects the focus of chiropractors who embrace a total healthcare philosophy.

As desirable as it is to include nutrition in your practice, to provide the most benefit to your patients (and the most income to the clinic), doing it right is more than setting up a display of supplements and hoping patients will buy them.

Some people equate nutrition with weight management. A nutrition component in your practice is much more than weight management. It is a comprehensive approach to feeling better, increasing energy levels, and maintaining health and vitality.

It involves:

1. Defining a patient's goals,
2. Taking a medical history,
3. Giving a physical exam,
4. Ordering or conducting tests, and
5. Recommending an appropriate dietary and supplement protocol.

GOALS

Every patient has different goals. Some want to lose weight; some, to gain weight; others, to improve stamina and energy levels.

Patients who come into your practice may have their own preconceived goals in mind, based on their complaints. Others may determine goals after a thorough assessment of their status.

Set goals so that patients know their baseline as well as what they are aiming to achieve.

MEDICAL HISTORY

Conduct a complete medical history of the patient to identify current and past medical problems, plus family history of medical conditions. Find out about prescription medications being taken, to avoid suggesting anything that may have a contraindication.

PHYSICAL EXAM

Conduct a complete nutritional physical examination that includes objective measurements you can repeat over time. These measures provide reliable data as a foundation to revise the treatment protocol. They also help you to determine appropriate and practical goals with your patient:

• Measure height, weight, percentage of body fat, and BMI. You can take these measures quickly in your office with specialized electronic scales.

Why take these measurements? These are baseline measurements that will help you in future exams to determine if and where the patient is losing weight, drinking enough water, and exercising.

• Measure key body parts. These include the ankles, calves, thigh, hips, abdomen, chest, wrist, forearm, and upper arm.

Why take these measurements? The wrist measurement of the dominant hand correlates to body-frame type. Match this measurement to the individual's height and body frame on a chart, to identify the ideal weight range.

Divide the waist measurement by the hip measurement to identify the patient's risk of cardiovascular disease. (Normal is considered 0.75 for women and 0.80 for men. Higher ratios mean higher risk.)

• Take the patient's blood pressure. Do this while the patient is sitting, standing, lying down, and rising quickly.

Why take this measurement? Blood pressure measurements help you evaluate kidney function, adrenal, risk for arteriosclerosis, and calcium absorption. The systolic pressure should drop six to 12 points from the first measurement to the last. If it does not, the patient may not be drinking enough water or may be serious kidney problems.

The ankle systolic divided by the arm systolic should be above 0.9 if blood flow to the extremities is adequate. If it is below 0.9, arteriosclerosis may be suspected.

A patient should be able to accept a blood-pressure cuff pumped to 220 at the mid calf. Inadequate calcium absorption may cause cramping in the leg with the cuff at less than 220. (Note: Do not do these leg exams if you see varicose veins or the patient has a history of recent surgeries on that leg.)

• Take the patient's pulse. Inquire about his activity level.

Why take this measurement? Use pulse rate along with standing blood pressure to calculate basal metabolism rate.

When you know the patient's weight and activity level, you can determine the correct number of calories for them to lose weight.

• Listen to the heart. Have the patient sit down comfortably on your exam table and listen to heart sounds.

Why listen to the heart sounds? This can be a great help in determining nutritional needs. Heart sounds that come very close together may indicate a need for vitamin E. If the second heart sound is louder than the first, adrenal fatigue may be apparent. If the first heart sound is louder than the second, calcium deficiency may be a problem.

• Measure the patient's cervical rotation. Use an arthrodial protractor. Then have the patient breathe in and out of a small paper bag three or four times. Remeasure the patient's range of motion.

Why take this test? If the range of motion increases on rotation, the patient may be eating too fast because the top of the diaphragm is locked.

• Measure lung capacity with a spirometer.

Why take this measurement? If the spirometer shows less than 80 percent capacity, prescribe breathing exercises. Explain to the patient that inadequate oxygen flow lowers the basal metabolism rate and thus makes it harder to lose weight.

• Measure trace minerals, vitamin C, and B6, B9 and B12 absorption. Use zinc assay, lingual ascorbic assay tests, and homocysteine tests.

Why take these measurements? Assay tests indicate deficiencies.

• Assess the surface of the tongue. Count the taste buds on a millimeter of the surface area of the patient's tongue.

Why take this measurement? The tongue should have at least 50 taste buds per millimeter of the surface. If the patient has significantly fewer taste buds, his brain will not produce the chemicals in the brain that cause satiation. A decreased number of taste buds may be caused by a lack of vitamin B1 and B2 absorption, chewing food too fast, or from whitening or fluoride toothpaste.

• Monitor acidity/alkaline balance. Send your patient home with a form and a kit to monitor their saliva and urine pH for a week to evaluate their acid/alkaline balance.

• Consider blood tests. Blood tests can give additional information on nutritional deficiencies and can be taken at a certified laboratory.

PROTOCOLS

Once you have collected information from the test results and have studied the patient's medical history and complaints, schedule a nutrition counseling session. Review all your material including your suggestions for supplements. Set up a time in the future when you will repeat the process to determine their progress or possibly lack of progress.

Make recommendations on diet, exercise, and supplementation, based on your objective findings. A number of supplement companies provide complete protocols designed to address specific conditions.
Discuss the value of physician-grade supplements with your patient and why you make certain recommendations.

Schedule regular follow-up visits with the patient, which include appropriate reassessments, to measure progress toward his or her goal attainment.

Nutrition is a valuable service to your patients. The correct approach can benefit you both.

Donald F. Feeney DC, DACBN, CCN, runs a chiropractic and nutrition practice in Wilmington, Del. He is also president of the Council on Nutrition of the American Chiropractic Association. He can be contacted at chirodoc71@aol.com.