Nutritional Therapy in GP practices?
It’s heartening to hear at the end of a consultation ‘we could do with one of your kind in every GP practice’. I smile and agree, but think with some despondency – ‘will it ever happen in my lifetime?’
Slowly but surely mainstream medicine is starting to take note of the growing evidence base for nutritional therapy. Diet and lifestyle have been shown to impact health in so many ways, and when chronic disease manifests in middle age from lifestyle choices, it makes sense to consider the tools that lifestyle medicine can provide, as part of the solution. There is undoubtedly growing interest from a large proportion of the public, but resistance persists within a medical system that evolved around prescribing a pill for an ill, and with medical training still being largely pharmaceutically driven, little time is devoted to nutrition.
Is change afoot?
Fracture lines can occur however, within society and politics when change is afoot. And whilst our legacy media is often contradictory and ambivalent when reporting on our growing industry, our nutrition conferences are now well attended by doctors as well as Nutritionists. Some even endorse their support by undertaking additional training in nutrition and lifestyle medicine. But ‘fractures’ can result when positive movement encounters inflexibility, we desperately need to encourage flexibility within the system, to better enable and accommodate change.
Primary Care
General Practice is currently struggling to meet the rising demand for appointments, whilst experiencing significant challenges for staff retention. Perhaps there is also frustration because increasingly the type of health concerns presenting to GPs require a different sort of intervention from the type they have been trained to deliver? Chronic lifestyle-related diseases tend not to get better with the drugs on offer, they aren’t ‘cured’, just ‘managed’ with drugs whose side effects in time often lead to more drugs.
The interventions that can achieve positive outcomes for many chronic, lifestyle related conditions involve dietary and lifestyle change. These are not quick fixes, and sometimes, the therapeutic 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, longlasting 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. They may present with digestive discomfort, bloating, intestinal cramps, with creeping weight gain. Antidepressants like Amitriptyline, or an antispasmodic may be tried, or even an antacid like Omeprazole, but none are looking to address the cause, only the symptoms. A GP may order 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, IBD), a drug can be prescribed to ‘manage’ the disease. Frustration stems from the knowledge now that these diseases are largely avoidable, they might have been prevented, if only the early signs had been properly investigated with functional testing and suitable advice tailored to the individual, with coaching to encourage the necessary behavioural change. The ethos of the Functional Medicine approach is to investigate upstream to identify root causes, which offers the best hope of halting progression towards the subsequent disease.
Definitely not rocket science
The evidence base now undisputedly shows 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 lifestyle factor like diet to trigger the expression of those genes. So as the evidence base grows showing lifestyle as causative for so many chronic, non-communicable 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 individually tailored dietary advice, and frankly lack the time, 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 of education 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 thousands of registered Nutritional Therapists could make, (trained in the IFM model), so much the better. Meanwhile I’ll keep writing, knocking on the door and hoping.
So I was delighted to receive an invitation from Simon Martin, editor of IHCAN magazine (Integrated Healthcare & Applied Nutrition), to write an ‘op-ed piece’ on the very subject, for their September issue. Read the article here.
