What to Expect from working with a Functional Medicine Nutritionist
I do realize that not many people have ever worked with a functional medicine nutritionist, so you may not be sure what to expect. That is understandable. You may have heard of dietitians and you may have worked with one, which is often quite different from my services. The purpose of this page is to map out what a Program with me will involve for both of us, and what to expect. I will also explain my qualifications against dietetic training and why I opted out of the latter. It is important to me that you understand who I am and what I do, also legally, before you decide to work with me!
If you work with a really good functional medicine nutritionist, you can expect your life changed.
Plain and simple. And that is always my goal too. It could mean that your fingers can bend first time in 15 years or that you can now run up and down the stairs again together with your grandchild, or that first time in your life you do not have urgent diarrhea that used to ruin your social life. Your concepts of health, wellness, foods, nutrition, nourishment, and optimal health will likely be put on their head, and you will stretch your belief system and your previous understanding of your diet and lifestyle.
Like other nutritionists, I work to create a process that, hopefully, will guide you for the rest of your life. That in itself is life changing. The sense of knowledge and empowerment is an enormous bonus of our work together and will forever change you as well. And that is why this service is not for everyone. I work with people that are looking for my services and are ready to go. In psychology, we call it “readiness to change”. Some of my patients are already very nutritionally savvy and educated, and some are plain “foodies”, or they are very well studied about natural medicine and nutritional treatments of disease. If you are one of them, you know exactly what you are looking for and I think I can provide that. The more you have worked towards your health the more I can learn from you what worked and what is not working and that helps me help you.
To make sure you know what you are embarking on by working with me, please review these pages to check my background, qualifications and the reason why I am not a dietitian as well as how my credentials measure up to one.
First, let me explain the “Functional” aspect of our work. The model of Functional Medicine has actually been around in one form or another in traditional medicine for many years when your doctor really knew you and treated everything for you and your whole family, investigating the mystery behind your symptoms and teaching you how to improve your health. Later, the concept of naturopathic medicine took hold in the US, and preserved the concept of treating (teaching= doctor means teacher) the whole patient rather than disease, spending time with each patient, and addressing the root cause of the chronic medical condition. Eventually, the Institute of Functional Medicine was created to revive this model of medicine and reintroduce it to current medical community – it is so needed in our current medical system and doctors are NOT trained in it in medical school. I believe this is the future of medicine and if we do not move in this direction, we will fail our patients.
Here is the link to the definition of Functional Medicine, why we need, it and how it is different by Institute of Functional Medicine. To summarize the philosophy of FM from where I stand:
Studying Your Case
The measure of my success is if I can help you find the root cause and then create a protocol that can reverse or repair the damage and give you back the quality of life. The secret is in the detailed work and quiet times between appointments that are factored-in into the cost of your Program. While our follow-ups are 45 minutes, I spend at least 30 minutes prep time prior to each follow up as well as at least 15 minutes more to get you the materials you need. For each one month of a Program, I also allocate specific amount of time to study YOU, whether it means reading a brand new study or a book, analyzing new labs as you send them, seeking a colleague for second opinion, getting on a pertinent webinar…or just studying your whole chart again and again just to see what else we missed….This is part of my commitment and joy of my work.
Personalized Nutrition – Our Work is Always Customized
We peel one layer of the onion at a time to bring your health back. No two people are alike – due to completely unique bio-individuality two people may respond differently to the same therapy and will most likely need a different protocol for the same medical condition. My work is all in detail and there will be a trial and error period in our journey together. My work will differ with each patient.
Test and don’t guess. Proper functional testing can help pinpoint mystery symptoms that can go unresolved with traditional testing. For more on testing, I have created a separate category below on this page called Working with Labs. Feel free to review it to learn more.
Finding Connections through HISTORY…HISTORY…HISTORY…
In FM we recognize that the body is not a sum of organ systems. They all “talk” to each other. When your GI tract is inflamed, your brain will be as well. Your thyroid dysfunction will affect your stomach acid, gallbladder, and gut motility, etc. Our job is to connect those dots. And that is what I do. In order to find these connections, here are some concepts we use:
- Timeline: Taking detailed history is paramount. You will be asked to fill out a time line to help me see visually how things developed. If you have never written out your time line, you will be impressed with how much more events relevant to our case you will remember. It will also help to keep a copy for any future doctors’ appointments to help them see your story.
- Antecedents: I am looking for any predisposing factors in your life or our family history – perhaps your mother was ill during your pregnancy, you were never breast fed, or you were a preemie. Perhaps both parents were heavy smokers and you grew up with lead paint chipping from the walls.
- Triggers: Somewhere in your history, events that triggered your current health challenge are buried or forgotten. Perhaps you have been diagnosed with IBS but you remember distinctly never having gut problems until 2003. Digging deeper, and that can happen even months into the Program, we may suddenly find the root cause. And that is because I keep studying your case, doing proper testing, and rereading your whole history again and again, looking for missing clues. Point in question: a young patient with mystery gut issues including also neurological issues and brain fog, was not responding to the degree we expected. We knew something else was there. We tested stool and found a rare pathogen, often found in polluted waters, and only then did she remember that the very summer when she started to feel sick, she had swum in a very filthy lake.
- Mediators are equally important to find – these are factors perpetuating your condition. Let’s say you have high blood pressure, cholesterol and diabetes, all highly inflammatory conditions, and every day you drink coffee with a creamer that contains partially hydrogenated oil, which, in fact, adds to the raging inflammation. That coffee creamer is your mediator. Another true story.
Functional Nutrition is your Best Tool
Functional Nutrition is nothing more than the core of Functional Medicine. In my opinion, you cannot practice Functional Medicine without Functional Nutrition. And who has the best training in nutrition? A nutritionist! And as an expert in my field with the best training in the country and a lot of experience, I have many more nutrition tools to “cook with” in my “clinical kitchen” than perhaps another clinician who practices Functional Medicine (you do not need a nutrition degree to practice FM).
I mentioned on this website that about 80% of serotonin is made in the gut, up to 80% of our immune system is located there and up to 80% of chronic medical conditions are caused not by your genes but by the nutrients you are lacking or by excesses of triggers that do not serve you (e.g. toxins) or both. Whether you agree with it or not, nutrition IS the core of your health: your hormones, joints, bones, and brain matter depend on nutrients. And that is why at the end of the day, I did not become a naturopathic doctor but a nutritionist and I am serving you today.
I think Functional Nutrition is the highest quality nutritional service a nutritionist can offer.
I also mention my favorite quote from Dr Mark Hyman on the website: “if you practice medicine but are not practicing nutrition, you are not practicing medicine.” Can you see now why I am a Functional Medicine Nutritionist? Can you now see that your gut is at the core of your nutrition wellbeing? How can I not call myself a Functional Gut Nutritionist? No matter where you are with your health, unless we start with the gut, things will not improve just as much as they can. I hope you can see that working with functional nutrition gives you the highest quality of nutrition service and has a lot to offer you.
Intro Session – Interviewing Each Other
First we have the Intro Session together. As you see this work is so in-depth and so involved that it is paramount that we both are a good match and will really enjoy this process together. We may NOT be a good match, or I will not think I can help you, and that is important to recognize too – in that case I will provide you with any resources and referrals I will consider appropriate to move you forward.
Gathering your History
If we both “hire” each other, next step is a very thorough documentation gathering process for you- you will have a list of labs to retrieve or ask your doctor to run, a very thorough intake form, which I keep expanding, and a lot more forms I will ask you to fill out. You will write your time line. Even if you have a list of things that happened to you already written down, I will still ask you to transcribe it on a different form so that we can start seeing relationships between triggers, symptoms, and life events. You will be surprised how many things you will find yourself adding to your time line. This will help us find the root causes of your medical issues. You will also collect a food log for a few days so that I can also learn what and how you like to eat. This process can take you a few days to 2 weeks and is very extensive. Basically, you are sending me your medical life’s story! You will get a specific homework list of all the forms needed.
Sending your Documentation
You will overnight the materials to me via snail mail so that I receive it at least a few days before our first session. Do not send a fax. While fax seems a practical option, it is not a good option for our needs: while on my end, fax follows HIPAA regulations (and I pay for it), when you send a fax, you lack that protection on your part and I really am protective of your medical information and want to be HIPAA compliant; moreover, there may be too many pages for a fax to handle. The last thing we need is parts of the pages missing, being jammed! Finally, it is much easier for me to process information when I read it on paper and can write comments and notes on it.
I typically allocate up to 3 hours to review your materials. It is my favorite part of the process because I am starting to get to know you and building the case in my head. I am also transcribing it into the right order for myself into an electronic charting system I use (HIPAA compliant). That process as well helps me create a case and make sense of all the information.
Our first session will be on the phone or VSEE and will take 2 solid hours. The goal of that session is HISTORY, HISTORY, HISTORY. I need to make sure I understand your story based on what you sent me and I dig a little deeper still since I am already getting a sense of things and know what to ask that may still be missing in the paperwork. The 2 hours go very fast. This is our assessment session.
My Homework Between 1st and 2nd Sessions
Depending on the complexity of your medical history and on your health goals, I may or may not put your food log into a software analysis and create a 8-9 page report for you – when we need this information, we can learn where your macronutrients and micronutrients are and how to understand that in the context of what you eat, your medications, medical condition, and lifestyle. Another important piece of information to know. If you are very ill or underweight and obviously malnourished, we skip this step because we will already know you have multiple nutritional deficiencies. Either way, I factor in another 2-3 hours between our 1st and 2nd session for study, do research, and create a preliminary nutrition/lifestyle protocol based on what I now understand about you. I will also make recommendations for any functional labs that would be beneficial in our case. If you are on medications, I also review drug and nutrient interactions. Finally, I create a preliminary list of foods and supplements appropriate at this time.
After 2 weeks, our second session on the phone or VSEE is another 2 hours. You are getting a completely customized protocol created for you only. The most important aspect of working with a FN is that I treat you as an individual with unique biochemistry and bio-individuality. Even though you may have a condition I have worked with many times, your protocol for it will be very unique to your medical history, presentation, and diet history, etc. My job in this work is to try to connect the dots, make connections among your organ systems and find the triggers, so we can remove or amend them and do repair work. We discuss the ideas of what needs to be done and what direction we should investigate. Any final lab recommendations will be made at this time as well. We are now starting the implementation phase. By the time we have this session, I have spent up to 8 hours total of focused time studying and creating your case! We may be adjusting our protocols as we go, depending what new things we learn, what you remember, and we find from the labs we order.
The remaining follow- ups are bi-monthly and eventually once a month until the end of the Program unless we have more urgent issues and it is more appropriate to do more frequent sessions. Follow-ups are on the phone/VSEE and for each session, I factor in prep time before and work after the session to get you the right resources, the total on average is the time spent at the session equaling the time spent before and after. We test waters, try the protocols, measure, monitor, adjust, as we learn about your body.
How much of Lab Work will we Use?
I will make recommendations for functional labs. However, whenever possible, we will use the labs your doctor can run locally within your medical insurance. There is great value to a very good lab when we need it, and I do have accounts with some of the best functional labs on the markets to have them available for you just in case you do not have access to them through your doctors. At the same time, I do not over-test – I use sound clinical judgment to see if I can assess things empirically and based on symptomology, food log analysis, and medical history alone. This is a conversation that we will always have together before we make a decision, especially when a substantial cost is involved. I will also help you understand the lab results you currently have.
Labs and Functional Ranges
I will help you understand your current lab reports. Some of the traditional medical ranges of what is considered normal and out of range may be outdated and not reflect optimal functions. Have you been told your thyroid is fine, after only one to three markers were routinely retested, while you know you still feel very off? This is such a common story. Did you know that the current normal range for TSH is outdated and should not be the only marker to test for thyroid dys-regulation? And yet my husband’s doctor refused to test other markers because his THS was fine. You may be “within” the lower end of the “normal range” for TSH and have classic symptoms of hypothyroidism, which in FM we call subclinical hypothyroidism. If your insulin is 8 μU/mL, your doctor may tell you are still fine and wait. In FM, we strive to keep you within the level of 5, and we are aware of the inflammatory process already initiated once we move towards 10. Thus, my job is to investigate all your lab results, whatever they are, within the FM recommendations if applicable.
Availability of Functional Labs
I have accounts with some of the best functional labs just in case your doctor does not have them available and if they are instrumental to getting to the root of your problem. Still, our first choice is to go through your doctor. When I caught symptoms of suspected low thyroid function, I used a functional test I provide for my patients on myself that included Reverse T3 because I suspected WHY my thyroid was weakening. I did pay out of pocket. And I was right. But if I had relied on the doctor, he would have told me my TSH was fine and my T3 was a little low and I would have been put on medication. RT3 would have not been tested. And my issue was stress, which could only show with RT3 (stress is one of the causes of high RT3). Have you gone from doctor to doctor with unexplained gut symptoms only to be diagnosed with IBS and put on muscle relaxants? A percentage of such cases may be caused by SIBO, Small Intestinal Bowel Overgrowth, which can be tested with a simple un-invasive breath test. Yet, not many gastroenterologists have that test available in their clinics, and sometimes patients have to drive out of state to get tested, while a family doctor may not even know about SIBO OR the testing for it. I provide a take-home kit for breath test, so regardless how remote you are from a clinic that could provide it, we can still test it. This is exactly why I have certain labs available. The more I work with patients, the more labs as add and learn about. As long as I can help you get better faster, it is worth it!
Uncommonly Tested Labs Available from your Doctor
If needed, I will tell you which tests are readily available from your doctor but (for some reason) are not routinely tested, such as Vit D or methylmelonic acid. For example, 25-hydroxy D (and not 1,25–hydroxyl D) should be tested routinely in every blood work just like glucose or cholesterol, so you can learn your levels in winter versus summer and with versus without supplementation. I agree with Dr Daniel Amen that you should know your D levels like we know your cholesterol. It is not done as often as I would like to see it, although more doctors are testing for it. But some test the 1,25 form (the wrong one), and may conclude in error that you have elevated D level and should stop supplementing. While your doctor may be happy with the 400-800IU daily recommendation of a Vitamin D supplement, in FM we know from research that this level of supplementation cannot help you cut your risk of breast cancer in half or decrease risk of all solid cancers, which requires level of 50ng/mL in blood serum. 400-8000IU will not bump the level to between 80 and 100 either, at which level Vit D can slow down cancer growth in patients with cancer, according to studies. You can see how much more I can offer you just by applying what we know from FM perspective, to the issue of lab testing.
- This is completely personalized work
- I spend more time studying and researching your case and seeking the right support for you than actually consulting with you!
- It takes hours between sessions and those are factored into the cost of the program- otherwise I would not be able to do this level of work – I can only take a few patients at a time and that is still a full time load
- We reassess periodically with the Toxicity and Inflammation Quiz to get a quick GPS map/body scan to catch things that are and are not improving and address them as we go.
- Consults are on the phone or VSEE (equivalent of SKYPE designed for patients and clinicians); in cases of local patients, I have some availability to see you in person, especially for the first session, but it is limited. 1st follow up can still be in person, but after that we do switch to phone/Vsee in most cases.
- Your minimum commitment is a 4-Month Program, but that is a bare minimum, and depending on your situation, you may need 6, or 10 months or more. The first month is very heavy in terms of my workload and 2nd month is when we start to get some movement. It usually takes more than 2 months to start seeing the difference. With that, sometime a single recommendation I make can have a huge positive effect on your symptoms already. Discussing the best Program length for your needs is one of the purposes of the Intro Session.
- I cannot possibly do it without you: you have to commit to studying, reading, doing your homework, watching some videos, and being an active partner in this process. We are both working together and you are the one living in your body 24/7. Your feedback and partnership are paramount to our success.
- If I missed something, misinterpreted something, of you do not feel right about certain recommendations – please address all these issues right away. I work very hard for you, but I am a human and will be the first to admit if I failed to recognize something or missed something important. You want to make sure you always feel comfortable communicating what needs to be said. My only agenda is to help you.
- We designed this website so that it can answer many of your questions. Any detailed questions like payment plans, fees, etc. will be covered during our Intro Session. You will get all tools needed at each step of the process of working together.
I can’t stop telling my family how wonderful I feel.~ R.