Building Your Team
I've always believed in the power of the team. Perhaps my childhood spent swimming on a competitive swim team instilled these attributes in me. But more specifically ever since I became a health provider did I fully recognize that it often takes a team of providers to fully support a patient or client to reach their health goals. Gone are the days when your family physician is the only provider to handle all your needs, from birth to death. Now this isn't to say that a family physician shouldn't be part of your team but the point is that there are so many aspects to health and wellness that go beyond the typical doctor's office. And I dare say that the traditional model of Western Medicine (dissecting conditions into their smallest possible part) no longer serves the majority of us.
We are each unique, complicated humans living a generally overworked stressed out life. So when our health starts to fail us no one simple answer is going to take care of it. I can use my own health journey as an example. Over the years, I faced various health challenges, probably not uncommon to many.
- Childhood: chronic allergies, headaches
- Teenage/Early 20's: hormonal imbalances, acne
- Adulthood: back issues, digestive ailments (the most recent being just last year)
What I learned addressing these various challenges is that it was never just one pill, exercise, or dietary change that took care of it for me. I've used various methods and providers, in addition to my general PCP (primary care provider), to resolve problems as they've come up; Acupuncture, Traditional Chinese Medicine, Naturopathic Medicine, Massage, Osteopathic Manipulation, Supplements, Herbs, plus many different dietary experiments. Only with the support of a team was I able to successfully resolve and/or manage each of these issues.
For the last few years at UCSF I also had the distinct privilege of being a member of an Integrative Care Team. In all honesty, living my dream of working with other providers to holistically care for our patients. This system is what I believe all of medicine should look like; integratively trained medical doctors working with acupuncturists, massage therapists, psychologists/psychiatrists, physical medicine providers, and integrative dietitian nutritionists. Working together, each of us honoring our own expertise and how it relates to the team efforts, were able to help patients who had "tried everything" and had found no improvement in their situation. We were able to treat the most challenging of cases because we were willing to work together and to think outside the box to find the right solution for each person.
You are reading this article right now and probably contemplating what health issues are currently going on for you. Perhaps it's some stubborn weight that's just not budging, or chronic fatigue, or chronic digestive issues that nothing seems to be helping. Or perhaps it's something more serious like migraines, chronic pain, uncontrolled diabetes, heart issues, or even cancer. Whatever your ailment, regardless of severity, if you're struggling to resolve it with traditional methods, it's time to start building your team.
Here are some recommendation for pulling a team together. Of course a physician should absolutely be part of the team; I would suggest an Integrative or Functional MD if possible. You may also want to consider adding the expertise of a Naturopath or Osteopath who has medical training but will be approaching it with a more holistic and natural lens. The support of a psychologist or Integrative Psychiatrist may also be incredibly helpful. For many conditions, nutrition will have a role to play, and having the support of a nutrition expert to guide you through those changes will be essential. This, however, can be confusing as there are many different providers out there claiming to have nutrition expertise. How do you know which one to work with? Although this is in no way a complete list I thought it would be helpful to outline the differences between several common nutrition-related providers you may come across.
I've had the good fortune to be trained as both a Registered Dietitian (RD) and a Nutritionist so I can more easily speak to both of those. As you can see from the list below, this is a tightly regulated profession and if someone calls them self a Registered Dietitian, then you can be guaranteed they have the following.
- A Bachelor's degree in Nutrition or Dietetics -- this will eventually change to require a Master's degree by the year 2024.
- Completion of an accredited program in Dietetics as well as completion of a minimum of 1200 supervised hours in a Dietetic Internship Program.
- Passed a national Registration Exam.
- Obtained licensure, as dictated by their state of practice.
- Maintained continuing education.
- The RD's scope of practice includes medical nutrition therapy for patients with serious health conditions, such as cancer, diabetes, Crohn's disease, etcetera.
- An RD is trained to address both prevention and disease management and may have experience working in a variety of settings (hospital, outpatient, private practice, food service, schools, etcetera).
- Many insurance plans will offer reimbursement for nutrition services provided by a RD.
I personally feel that my training as a "Certified Nutrition Consultant" was excellent and it complemented what I learned in my Dietetics training. My Dietetics training was heavily grounded in the science of food, nutrition, and human physiology, while my Nutritionist training was more heavily grounded in the art of using food as medicine, in the application of traditional ancestral diets, and in taking lifestyle factors into consideration. I personally feel both paths were equally important in my education.
The challenge though with the title "Nutritionist" is that it carries no regulation, anyone can call them self a Nutritionist despite their training. The gamut runs from the highly qualified and experienced professional to the in-experienced, well intended food hobbyist. As the client, the burden is on you to do your due diligence and make sure you are taking the advice of someone that has actually been properly trained to give that advice.
Another growing field in the health and wellness industry is that of Health Coaching. As with Nutritionist, the title of Health Coach is not currently regulated. This doesn't mean that there aren't highly qualified and exceptional Health Coaches out there but as with Nutritionists, the burden lies on the client to ascertain the training and qualifications of their Health Coach.
Health Coaches typically help clients with wellness-related goals (eating healthy, becoming more active, managing stress, stopping smoking, etc) and offer guidance, motivation, coaching, and support. They take on the role of supportive mentor and guide, helping clients make meaningful health changes, and offer referrals to appropriate professionals when necessary. They are trained in habit change and can help people get to the root of challenges or barriers that may be preventing them from making successful health changes. This could be incredibly helpful if you're feeling stuck or feel like you keep sabotaging your wellness efforts. When it comes to advice around nutrition however, a Health Coach's official scope of practice does not include the prescription of supplements, meal plans, or specific dietary recommendations, as this legally falls under the scope of a Registered Dietitian.
Integrative Dietitian Nutritionist
Integrative Dietitian Nutritionists are Registered Dietitians that have additional training as a Nutritionist and/or Health Coach. They practice an integrated and personalized approach to nutrition, health, and healing. We believe in food as medicine and given the right tools know that the body can heal itself.
When I was in school to become a Registered Dietitian, this sub-group of Dietitians didn't formally exist. We were the renegades and often under the radar. I'm so happy to see this has changed over the last decade and out of all the professional specialties in Dietetics, this one is growing the fastest.
Take Home Message
Don't underestimate the power of the team to more fully support your needs and help you achieve your health goals faster. We are complicated creatures and require a holistic approach to achieve true health. Here's a summary of where I suggest you start in putting together your health team:
- Medical Provider - Integrative or Functionally trained Medical Doctor, Osteopathic Doctor, or Naturopathic Doctor
- Emotional / Mental Support - Health Coach, Psychologist, Integrative Psychiatrist
- Nutrition Support - Integrative Dietitian Nutritionist
- Other Support as Needed - Acupuncture, Massage, Physical Therapy, etc.
If you're ready to add a nutrition expert to your team, let me know!