How to start the nutritional counseling conversation with patients

With nutritional counseling do they want you to guide or make decisions for them, or do they want you to partner with them?

Chiropractors focus on healing the body. While this would include diet, no one eats perfectly all the time, and some patients for their health’s sake need to have the conversation about nutrition. But how do you start, and what should you say or focus on?

“I believe the subject of nutrition should be at the very first visit — waiting for them to ask first is really dropping the ball,” says Jill Briska, DC, owner of Kintsugi Wellness in Lombard, Ill. “As we know 80% of our immune system is in the gut. It is where much of our serotonin is produced, and melatonin, which regulates our sleep cycle, is also produced there. Hippocrates said all diseases begin in the gut. He also said our food should be our medicine. Research is mounting that this is the case. To me nutrition is 90% based on diet. I supplement, but diet is my focus.”

Intake forms and data

Briska uses a standard in-depth intake form (see more below) so that in terms of nutrition, she knows as much about each patient as possible. Part of being a chiropractor, she says, is knowing who you have sitting in front of you.

Is the patient an introvert or extrovert? Highly motivated or not at all (for example, a spouse made them come in for a visit)? Do they want you to guide or make decisions for them (via a plan or system) or do they want you to partner with them, but make their own decisions?

“You get all types,” she says. “I do find many of my patients to be highly informed in matters of health thanks to the internet. They are aware of their own conditions and want a partner in health. I respect that and make sure they are heard.”

Briska says that her conversations about nutrition begin in the same way.

“I designed an in-depth intake form that looks at the patient from the structural, chemical, and emotional aspects,” she says. “The truth is that a deficit in one side of the triad will eventually affect the other sides. No one’s triad is spot on. Emotional stress can cause physiological changes in the body — quite often people’s gut is where that emotional stress manifests problems.

“A challenged digestive tract that has gut permeability can cause no end of problems. For example, there is the strong link between gut and autoimmune diseases. Patients must understand the importance of gut health, but doctors also need to understand that we cannot supplement-away a poor diet. If the person has a compromised gut lining — and many do — supplementation can in some cases be like throwing them down the toilet. I mean that literally.”

State laws and guidelines for nutritional counseling

Be aware, Briska says, that how much nutritional information a chiropractor is permitted to give depends on the state in which you practice. Be sure to check.

In terms of supplements, Briska says, “The line of supplements that you pick should be top notch — organic, highly bioavailable, food-based. You will also need to have more than your basic chiropractic education — you will need to attend nutritional seminars so that you can get the latest research and be knowledgeable of what the diet trends are and what are the pros and cons of these diets.”

Once you have nutritional counseling conversations with your patients, Briska says that it’s important to remember who they are.

“Not all patients do well on a system, but some love it because it gives them a checklist for success,” she says. “Patient follow-through is imperative, and if the patient is wavering about the plan in the office, what do you think they’re going to do when they’re alone?

“Work with them on their level — meet them where they are and go from there. Whatever you prescribe, you must know what you are expecting your patient to do. Always be genuine. Making money is great, but being able to lay your head down at night is even better.”

For more DC nutritional info go to the Chiropractic Economics nutritional resource center at chiroeco.com/nutritional-supplements.