The Role of The Dietitian in

Integrated and Functional Medicine

Kristen A. Cortazzo
B.S. Nutrition and Dietetics ~ University of North Florida
Sodexo Dietetic Intern
 Objectives

Discuss a basic overview of IFM

Explore the potential of dietetics within IFM

Discuss the role of the dietitian in IFM

Explore recent research

Consider the future of dietetics in IFM

 Ice Breaker

In 1 sentence; will 1 person from each location please share

their meaning or perspective of integrative and functional
medicine.
 Introduction Why IFM?

Validity: trend?

Potential in relation to chronic diseases

Ethical confluence

Evidence-based practice vs. practice-based evidence and

evidence-informed practice.

Chronic diseases are non-linear

Each person is as an individual

 What is IFM?

Evidence-informed

Combines conventional and

alternative

Individualized

Flexible

Assessment tools, and are centered

on the relationship between the

practitioner and the patient.

Integrated vs Functional
 Principles of Integrative Medicine: 3,4

Patient and practitioner are partners in the healing process.

All factors that influence health, wellness, and disease are taken into consideration,
including mind, spirit, and community, as well as the body.
Appropriate use of both conventional and alternative methods facilitates the body's
innate healing response.
Effective interventions that are natural and less invasive should be used whenever
possible.
Integrative medicine neither rejects conventional medicine nor accepts alternative
therapies uncritically.
Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
Alongside the concept of treatment, the broader concepts of health promotion and the
prevention of illness are paramount.
Practitioners of integrative medicine should exemplify its principles and commit
themselves to self-exploration and self-development.
 Where did IFM come from?

Complementary and Alternative Medicine (CAM)

Intended to maintain separation from conventional medicine

Integrative Medicine developed as the more preferred term to emphasize the

collaboration between CAM and conventional medicine

Functional Medicine has evolved alongside of the breakthroughs of genetics, revealing

that genetic predispositions are influenced by environment, lifestyle, stress and diet.
 Current leaders in IFM

Cleveland Clinic

Duke University

The Mayo Clinic

Bastyr University

University of Kansas School of Medicine

Rutgers College

The University of Arizona

 Preparing Dietitians for the Future
Rationale for Future Education of Nutrition and Dietetics Practitioners (ASCEND)7

Implies future dietetic practitioners will require:

increased knowledge, more complex decision making, and a broader array of skills for future practice. 7

Proposed updates

Emergence of non-traditional practice settings, Increased focus on disease prevention and

integrative healthcare, the need for more knowledge in emerging areas such as genomics, telehealth,

behavioral counseling, diet order writing and informatics, improved communication skills in nutrition

and dietetics and an improved ability to understand the patients community and cultural ecosystem. 7
 Changes to Accreditation Standards

ASCEND published updates to the 2017 Didactic Programs in Dietetics (DPD)

and Coordinated Programs (CP) standards

All programs were required to comply by June 1, 2017, to maintain

accreditation

Curriculum and Learning Activities 5.18

Functional and integrative nutrition knowledge is now considered a

required competency.
 Academy of Nutrition and Dietetics Role in IFM

Dietitians in Integrative and Functional Medicine Integrative RDN Certificate Program

(DIFM)
Online training program that educates the
Dietetic Practice Group (DPG) student on critical IFM topics
https://integrativerd.org
Holistic nutrition therapy

Inflammation
Whole foods

The microbiome
Biochemical assessments

Functional Nutrition
IFMNT

Organ function
Tailored supplements

Disease states
Collaboration (Healthcare & Mind/Body)

Ethical topics

Supplements

IFM in the healthcare model

 What does the Research Say
Garlic and cardiovascular profiles11
Meta-analysis

20 trials/ 970 participants

normo-, pre-, and hypertensive

Garlic supplementation

Results:

Overall: Mean +/- SE decrease of 5.1 +/- 2.2 mm Hg (P<0.001) in systolic blood pressure
(SBP)
Overall: Mean +/- SE decrease of 2.5 +/- 1.6 mm Hg (P<.002) in diastolic blood pressure
(DBP).
More significant results were found among hypertensive
8.7 +/- 2.2 mm HG (P<.001) decrease of SBP
6.1 +/- 1.3 mm Hg (P< 0.001) decrease of DBP.
10% reduction of total and LDL cholesterol if taken for greater than 2 months.
 What does the Research Say

Metformin monotherapy versus metformin and Yoga versus oral hypoglycemic drugs and T2DM w/
dyslipidemia
acupuncture co-therapy in T2DM
Randomized parallel study
RCT
n=100
n=39: Tx: 10 sessions over 3 weeks
Tx:
Significant results in co-therapy group:
3 mos yoga
Reduction in BMI & wt
Oral hypoglycemic drugs
Glucose-lowering activity
Significant results in yoga group:
Significant decrease in
Decrease in:
Insulin plasma levels
Total cholesterol & LDL
Plasma TG lowering activity
TG
LDL
Increase in HDL
Leptin

Glucagon-like peptide-1

Significant increase in serotonin

 What does the Research Say

Relationship between B6 status and genome stability in breast

cancer patients.14

Research suggests that B6 deficiency increases susceptibility to breast cancer.

Inadequate dietary B6 may result in interference of DNA development

B6 & synthesis of glutathione

Preventing cellular oxidative stress

How would/ could an RD use this information?

Conventional setting versus IFM setting?

 What does the Research Say
Low level of education on CAM and IFM topics among MDs, RNs and
other clinical practitioners9,10

Consumer inquiry

Factors

Medical competency standards

Personal beliefs

Time constraints

Pt decision making is influenced by the MD and RN.

Unbiased of their own beliefs
 What is The Role of the Dietitian in Integrated
and Functional Medicine?

Critical key-players
IFMNT, Health & Wellness counseling, supplementation education,
nutrition & food science.
Ethics
Our promise to evidence-based practice offers a solid, grounded
foundation to IFM
Critical, un-biased analysis of emerging research
Application
We can take the time needed with our patients
Existing research for ground-breaking standards in patient care
Help push your clinical setting into new ways of thinking
Research
Make valuable contributions
Help support and advance credible practices
Help bring light to non-credible practices that yield caution
 Conclusion
The role of the dietitian requires:

Explore non-conventional practice settings to enhance our

current practice

Collaborate!

Maintain ethical caution, but also take some risks

Secure our positions as credible and respected nutrition

professionals.

The steps are in place, we just have to walk the path!

 Call to Action

Practice integration in your own current setting

This will look for different for everyone

Step outside of your comfort zone

Look into DIFM

 Start your Journey into IFM

Dietitians in Integrative and Functional Medicine Integrative RDN Certificate Program

(DIFM)
Online training program that educates the
Dietetic Practice Group (DPG) patient on critical IFM topics
https://integrativerd.org
Thank you!

Questions?

Comments?
 References
1. Academy of Integrative Health & Medicine (AIHM). Aihmorg. 2017. Available at: https://www.aihm.org. Accessed May 24, 2017.

2. Health Topics AZ. NCCIH. 2016. Available at: https://nccih.nih.gov/health/atoz.htm. Accessed May 24, 2017.

3. Arizona Center for Integrative Medicine. Integrativemedicinearizonaedu. 2016. Available at: https://integrativemedicine.arizona.edu. Accessed May 24, 2017.

4. Duke Integrative Medicine -. Duke Integrative Medicine. 2017. Available at: https://www.dukeintegrativemedicine.org. Accessed May 24, 2017.

5. Dietitians in Integrative and Functional Medicine. Academy of Nutrition and Dietetics. Available at: https://integrativerd.org. Accessed June 12, 2017.

6. Integrative and Lifestyle Medicine. Cleveland Clinic. Available at: https://my.clevelandclinic.org/departments/wellness/integrative/about. Accessed May 23, 2017.

7. Rationale for Future Education Preparation of Nutrition and Dietetics Practitioners. Eatrightproorg. 2017. Available at:
http://www.eatrightpro.org/~/media/eatrightpro%20files/acend/futureeducationmodel/final_rationale_3_1_17.ashx. Accessed June 1, 2017.

8. Crosswalk of 2017 with 2012 Accreditation Standards for Nutrition and Dietetics Coordinated Programs (CP). Academy of Nutrition and Dietetics. 2017. Available
at:
http://www.eatrightpro.org/~/media/eatrightpro%20files/acend/about%20program%20accreditation/accreditation%20standards/cp%20crosswalk%207%2029%2016.ash
x. Accessed June 1, 2017.

9. Spencer C, Lopez G, Cohen L et al. Nurse and patient characteristics predict communication about complementary and alternative medicine. Cancer.
2016;122(10):1552-1559. doi:10.1002/cncr.29819. Available at: http://onlinelibrary.wiley.com/doi/10.1002/cncr.29819/full

10. Tarn D, Guzmn J, Good J, Wenger N, Coulter I, Paterniti D. Provider and Patient Expectations for Dietary Supplement Discussions. Journal of General Internal
Medicine. 2014;29(9):1242-1249. doi:10.1007/s11606-014-2899-5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139527/

11. Ried K. Garlic Lowers Blood Pressure in Hypertensive Individuals, Regulates Serum Cholesterol, and Stimulates Immunity: An Updated Meta-analysis and Review.
Journal of Nutrition. 2016;146(2):389S-396S. doi:10.3945/jn.114.202192. Available at: https://www.ncbi.nlm.nih.gov/pubmed/26764326

12. Firouzjaei A, Li G, Wang N, Liu W, Zhu B. Comparative evaluation of the therapeutic effect of metformin monotherapy with metformin and acupuncture combined
therapy on weight loss and insulin sensitivity in diabetic patients. Nutrition & Diabetes. 2016;6(5):e209. doi:10.1038/nutd.2016.16. Available at:
https://www.ncbi.nlm.nih.gov/pubmed/27136447

13. Shantakumari N, Sequeira S, El deeb R. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart Journal.
2013;65(2):127-131. doi:10.1016/j.ihj.2013.02.010. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861018/

14. Wu X, Xu W, Zhou T et al. The Role of Genetic Polymorphisms as Related to One-Carbon Metabolism, Vitamin B6, and GeneNutrient Interactions in Maintaining
Genomic Stability and Cell Viability in Chinese Breast Cancer Patients. International Journal of Molecular Sciences. 2016;17(7):1003. doi:10.3390/ijms17071003.
Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964379/