Everything in Moderation…Except Moderation

“You’re a nutritionist, tell us what we should all be eating!”

Well, I might be a nutritionist for short, but in actuality I’m a nutrition medicine practitioner.

Nutrition medicine: I’ve been practising this for nine years now, but still struggle to explain to people what it is. My patients know – because they are collaborating in a treatment program involving it. But the elevator spiel to the person next to me? I have yet to perfect it, or even create it.

So now let me make an attempt with a short anecdote.

I was in Melbourne recently, presenting at a conference on constipation and herbal medicine. I was on the bus back to the airport eavesdropping on a conversation next to me between an older man and a younger woman. The woman was a sports nutritionist, and the man was interested in the relevance of this to his horses.

The woman had to race off before the bus set off, as she’d left a package on her last bus. She got back on just in time and we exchanged joking pleasantries about her close call. The older man then chided her on the nature of the package, which was chocolate. The young woman defended herself by saying

“I’m a dietitian – I preach everything in moderation!”

Now I’m not sure whether she was speaking for all dietitians, but I thought this an interesting place to start on trying to explain what nutrition medicine is – and how it differs from dietetics.

I would describe nutrition medicine as an approach that counsels the opposite, that is:

Nothing in moderation (except maybe moderation)!

Nutrition medicine is based on individual nutrient requirements. I don’t recommend one diet for all people at all times. In fact, I am not in the business of giving general guidelines at all – and the closest I would go to this might be “eat more vegetables, especially greens”.

We are not all identical. We have different genes, different health issues and different “weak spots”. Nutrition medicine is about pinning down which of these weak spots are impacting on our health. Technically, we aim to identify what processes in the body are malfunctioning to allow symptoms to arise. These might be neurological (e.g. neurotransmitter production), endocrinological (e.g. thyroid hormone action) or biochemical (e.g. nutrient availability in the relevant tissue). All of these – not just the last – are influenced by the raw materials we provide the body with (that is, food and, specifically, nutrients). We can influence these pathways by the way in which we facilitate the availability of different nutrients.

That’s why I don’t believe in moderation.

Several pieces of fruit a day? Not if you have fructose malabsorption-related irritable bowel syndrome.

400ug folic acid for all? Not if you have the MTHFR gene polymorphism.

Daily protein requirement = body weight x 0.8g? Not if you’re recovering from surgery.

Just take a multivitamin? Not if you have a relative copper overload.

Six slices of wholegrain bread a day? Now, don’t get me started…

Nutrition medicine is a rational, scientifically-based adjunct to physiotherapy (or any medical, paramedical or non-medical therapy, for that matter) based on individual requirements. These individual requirements are determined from a combination of general or functional laboratory testing and the clinical picture. Yes, they are guided by research…but then modified for the individual.

But if anyone can come up with a good elevator spiel on what nutrition medicine is, I would be very open to hearing it!

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