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Nutrition Assessment: Sit Down and start collecting information

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Last time I noted I would go over a full functional nutrition assessment, step by step. The first thing I do is collect information in three main areas, 1. Lifestyle, 2. Signs and Symptoms, and 3. Biomarkers and Metabolic Pathways. Once I collect all the assessment information, I funnel it into the Core Diagnostic Issues in Integrative and Functional Nutrition. I will review the Core Issues in detail later, in this review I am going to go over the information I collect in 1. Lifestyle. Remember, Integrative and Functional Nutrition is in addition to, not in place of, a regular nutrition assessment so some of the information I collect is pretty conventional. I’ve included a pdf of an assessment form I use. (Click on the word assessment form and it should pop up).

1.    Lifestyle

Lifestyle considers all that affects an individual’s health and susceptibility to disease in relationship to social and community aspects of food and meals. Lifestyle includes three areas; Medical Status, Life Routine, and Food and Nutrient Status.  I am going to review how I collect data on the first two. I will cover Food and Nutrient Status next time.

Medical Status

Medical History

Of course, many medical conditions run in families. You have a 5% to 10% chance of having celiac disease if someone in your family has it. Chronic fatigue syndrome run in families, as does heart disease, depression and others. I use this information to look for clues of any functional impairments or genetic SNPs.

1.       What medical conditions run in your family?

2.       What medical issues do you have?

3.       What is your #1 medical concern?

»      People are most likely to work hardest on the conditions’ that scare them the most.

Medications and Supplements

This is a full review of medications, both prescriptions and over the counter, and supplements.

Some medications, such as antibiotics or antacids can have long-lasting impacts, others have nutrient interactions, both nutrients that may interfere with the medication and those that may lead to increased requirements. Also, think about what the functional action is of the medication. For example, if they take ibuprofen for inflammation and they have gut issues think leaky gut, the need to support detox pathways, and what are other supplement or botanicals that may help reduce inflammation instead.

Add up the total amounts for each of the nutrient from supplements; If you complete the NP Nutrition Assessment on line it will include supplement intakes in the assessment.

Below are links to help you find information on nutrient interactions of medications, nutritional supplements or botanicals:

Medline: Drugs, Supplements and Herbal Information http://www.nlm.nih.gov/medlineplus/druginformation.html 

Natural Medicine provides high quality, evidence-based information about complementary and alternative therapies. https://naturalmedicines.therapeuticresearch.com/  - member of Dietitians in Integrative and Functional Medicine (DIFM) get a free subscription with membership.

NAPRALERT is a database of all natural products, including ethnomedical information, pharmacological / biochemical information. www.napralert.org

4.       Write down, total, and review for possible interactions and total amounts of Medications, Nutrition Supplements, and Botanicals.

Birth Weight

Research supports the role of the prenatal and postnatal environment in contributing to the risk of development of chronic disease. Delivery method and breastfeeding can have long lasting impacts in many areas of health, such as gut bacteria, which can impact metabolic processing, inflammation, and gut permeability.

5.       Birth weight ________Gestation: ________Delivery Method___________ Breastfeed Y/N

Low birth weight is associated with increased risk for chronic conditions as adults; these include type 2 (adult-onset) diabetes, hypertension ischemic heart disease, insulin resistance, glucose intolerance and hypertriglyceridemia, as well as impaired endothelial function, and metabolic syndrome.        

Babies born weighing less than 5 pounds, 8 ounces (2,500 grams) are considered low birth weight. Term Delivery (term is 37 – 41 weeks; before 37 weeks is early)

Men who weighed less than 6 1/2 pounds at birth were 10 times more likely to have metabolic syndrome than the men who weighed more than 9 1/2 pounds at birth. Above or below 7 pounds appears to be a rough cut-off.

Babies born before the 34th weeks of pregnancy are at the greatest risk of life-long morbidity. 

Life Routine

Life routine considers not only daily activities of eating and preparing meals, but the whole food procurement process, as well as social and emotional feelings and timing of food and meals. People need to feel good about themselves and their relationships with others. Research has shown that having social interactions actually makes wounds heal faster, they call it Psychoneuroendocrinology. In fact, wounds were found to heal twice as fast in subjects who had social interaction compared to those who were isolated. It is important to evaluate level of support and relationships.

Food Procurement: Is finding out about how someone gets their food and meals. It can of course have a big impact on health, the level of toxins in food, the desire to give meaning to food and meals, and the cost.

6.    How comfortable are you with food, meal planning, shopping etc?

7.    Where does your food come from? Do you care?                                                          

Generally people don't think about where food comes from, but if you're aiming for better health or you want to make changes you need to think about the source of food. Sources can include: Grocery stores or farmers markets; Food deivery services like Blue Apron or Good Measured Meals http://www.goodmeasuremeals.com/products/about ;     Already prepared foods from resturants or fast food; Buying food in bulk; Community Supported Agriculture (CSA). 

8. Is getting food or preparing meals stressful?

9. What’s your favorite food or meal?

10. How much time do you spend on meal planning?

11. How much control do you feel like you have over your food and meals?

Meal Pattern

Meal patterns are a good way to evaluate how someone sets up their eating each day. Do they ever eat breakfast? Can they go more than a few hours before eating something? Do they eat all their protein in the evening? Questions about how someone eats can help give an idea about how they feel about food, and what ‘healthy eating’ means to them. I am generally looking for how calories are spread out within the day. I like to see the most in the morning and the least at the end of the day. Research has indicated that habitually skipping breakfast is associated with stress-independent over-activity in the HPA axis which could increase risk for cardiometabolic disease, obesity and type 2 diabetes. I encourage people to eat with their circadian rhythm, to have a large breakfast and small dinner. Circadian rhythms follow a pattern of elevated cortisol in the morning, decreasing throughout the day, and increasing melatonin at night. Leptin is a hormone that regulates food intake and energy storage and is secreted in a diurnal rhythm with lowest levels in the morning. Circulating levels of leptin, are influenced by sleep duration and associated with cortisol and TSH levels. 

12.   How many meals do you have on a usual or typical day?

13.   Tell me about each of your meals/snacks?

a.  Where do you eat?

b.  Who do you eat with?

c.   Do you drink coffee/when? (this can affect circadian rhythms)

d.  How many times a day do you eat? How many meals and snamcks? 

14. How much do you enjoy your meals?

Hunger Score

If you are trying to get someone to change how they eat and their relationship with food one of the most important factors is how do they know they are hungry, how hungry they are, and what do you do about it. Mindful eating is based on understanding your hunger queues. What I look for is how someone deals with being hungry. I break hunger into a 4 point scales, 1 – full; 2-not hungry, 3-hungry, 4- starving. No one should eat when they are 1 - full, and people need a plan in situations when they may become 4 - starving. Additionally, people should strive to be aware of the difference between 2 and 3. I explain this concept to clients and ask them about hunger. It can be included in food diaries and plotted. Ideally people should be at a 3 (3.5) before a meal, and a 2 post-meal, three times a day.

15.   How often do you feel hunger?

16.   How does hunger feel?

17.   How often are you at a 1 – full?

18.   What do you do when you feel hunger?

19.   Do you plan your meals knowing when you will get hungry?

20.   Do you have addictive traits that affect how you eat?

Environmental Concerns:

Toxins have been associated with an array of conditions and disease, including thyroid, diabetes, infertility, decreased cellular energy, heart disease and cancer. Foods are a primary source of toxins. Fat soluble toxins such as POPs (persistent organic pollutants) accumulate in high fat foods, primarily of animal origin, like butter. Phthalates leach into foods from plastics or can liners. Some foods absorb more pesticides than others. The Environmental Working Group lists those foods with the most and least pesticides https://www.ewg.org/foodnews/  and the WHO reviews the impact of POPs http://www.who.int/foodsafety/areas_work/chemical-risks/pops/en/. Foods also help with detoxification. Not only are individual nutrients used in detoxification, some foods, nutrients, or plants (botanicals) can help decrease the body’s toxic load.

21.   What are your environmental concern related to food?

22.   Do you pay attention to food packaging, organic, GMO?

23.   Do you cook or store food in plastics or aluminum?

24.   Have you ever had an exposure to toxins?

a.       In a job or hobby, or when you were younger

25.   Do you or have you ever had a garden?

Kitchen Love and Space:

The kitchen is where decisions about food and meals, what to procure and what to prepare, can impact cellular function. From large to small. It should be a place of congregation and joy. The kitchen allows people to express their power of what they believe in. Do they use their power to attain better health by eating better? Do they use their buying power to support those companies and food sources they believe in? Do they work to ensure meals are used to support their social and family structure?

Some research has found that the design of a clinician’s office can affect if patients follow a doctor’s advice. This can include colors, furniture, textures, patterns and lighting. Additionally, behavioral neuroscience research is confirming that physical environments deeply influence one's sense of well-being. It’s not rocket science that the feeling a room gives can affect mood and in-such the attitude to stay focused on a goal. If that goal is health, then the design should support that. Architects and designers are specializing in helping clinicians and hospitals set up health-promoting offices, and it is important to transfer this knowledge to our kitchens and homes.

Besides design elements research has noted that eliminating clutter is essential to maintaining a calm environment, helping to decrease stress and anxiety. Along with an inviting kitchen, a low clutter environment make it easier to focus on health. Design should consider that intuition, sensitivity, and creativity help to create psychologically supportive environments. Planning can go a long way. If the focus is to prepare more meals at home and have family meals, then make the kitchen organized and enjoyable, both aesthetically and practically, to prep, cook, eat and clean.  

Type of kitchen design: Make it realistic. Start out by painting, reorganizing and setting new rules. It doesn’t have to be a totally kitchen redo.
Take control of details: If health is a focus put a bowl of brightly colored fruits on the counter for decoration and snacking.
Don’t forget scents: Plant great smelling herbs (like mint, thyme or lavender), which can be grown in a kitchen garden. 
Get comfortable and organized: Organize drawers, counters and food storage, use good quality mats to stand on, make sure seats are comfortable.

Leslie Harrington, a color consultant and noted expert on the use of color in residential and industrial décor noted, "What color you paint your walls isn't just a matter of aesthetics. It's a tool that can be leveraged to affect emotions and behavior." Warm colors, such as red, yellow, orange, and brown are associated with stimilating conversation. While cooler colors such as blues, greens, and lavender are associated with calming and clean. Though colors that bring fond memories can help put you in a healthy place.

26.      Describe your kitchen?

27.      How happy are you with your kitchen, equipment and dishes?

28.   Describe your favorite kitchen design and kitchen colors?

29.   Do you have basic kitchen equipment?

30.   What is your ideal food/meal experience?

Next time I will cover what information I collect on Food and Nutrient Status. 

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