Nutritional Therapy in Primary Care?
More than once I have heard a patient say ‘we need one of your kind in every GP practice’, and I smile and I think – so true, but in my lifetime?
And whilst I can but dream, slowly but surely mainstream medicine is starting to take note of our growing evidence base. Diet and lifestyle have been shown to impact health in so many ways, and when chronic disease has developed from lifestyle choices, it makes sense to consider lifestyle medicine as part of the solution. Whilst there is growing interest from the public, there is still some resistance from a system that has evolved to prescribe a pill for an ill, and with medical training being largely pharmaceutically driven, little time is devoted to nutrition.
Fracture lines often occur within society and politics when change is afoot, and one can now see the beginnings of one surfacing in medicine. Fractures can result when movement encounters inflexibility, whereas flexibility within systems better enables and accommodates change.
General Practice is an example of such a system, struggling to meet the rising demand for appointments, whilst at the same time experiencing significant challenges for staff retention. Perhaps there is frustration because the type of health concerns now presenting to GPs require a different sort of intervention from the type they have been trained to deliver? Chronic lifestyle-related diseases don’t get better, and aren’t ‘cured’, just ‘managed’ with drugs, whose side effects can additionally be problematic.
The interventions that can achieve positive outcomes for many chronic health conditions today involve dietary and lifestyle change. Sometimes, such advice – sounding like a dose of common sense – can be met with resistance by generations expecting – and preferring – a simple prescription. I sympathise, because real behavioural change needs ongoing support, not just a few words of advice from a GP who hasn’t the time to deliver individualised 1:2:1 coaching.
For example, let’s look at a typical patient presenting with IBS type symptoms. This may be digestive discomfort, bloating, intestinal cramps, with creeping weight gain, and a GP may order some blood tests to rule out various diagnosable conditions. But blood chemistry has broad reference ranges, meaning sub-clinical metabolic dysfunction can persist for years before a diagnosable disease appears. Once that is reached, (Diabetes, Cardiovascular disease), a drug can be prescribed to ‘manage’ the disease, (a pill for an ill). Except many of these so called ills are avoidable, they might have been prevented, if only the early signs had been identified and suitable advice tailored to the individual, with coaching to encourage behavioural change. This approach of looking upstream to identify root causes offers the best hope of halting the progression towards the subsequent disease.
Science is now revealing that cardiovascular diseases, diabetes and many mental health conditions are largely due to controllable lifestyle factors. Even when there is a ‘genetic predisposition’, it takes an environmental factor like diet to trigger the expression of those genes. So as the evidence base grows showing lifestyle as causative for so many chronic diseases, the more frustrating it must be for good doctors, who lack the training to effectively deliver early, preventative, lifestyle interventions.
It’s not rocket science to ‘look upstream’ for root causes. And it’s not difficult to marry the removal of such root causes to the potential to lower the risk of any subsequent disease. Whilst doctors feel poorly equipped to deliver this dietary advice, the concept of ‘disease prevention’ has in fact now grabbed the public’s attention, and reflects the sort of change needed in a healthcare model currently lacking the ‘flex’ to evolve quickly enough in this direction.
There are initiatives appearing across the pond, the Institute for Functional Medicine is a leader in this field, and their model has informed the curriculum of Nutritional Therapists for some years now, so the sooner Primary Care in the UK recognises this and realises the valuable contribution that registered Nutritional Therapists could make, (trained in the IFM model), so much the better. Meanwhile I’ll keep knocking on the door, I promise.