How to Build an Evidenced-Based Nutrition Practice by Ronald Grisanti D.C., D.A.B.C.O., M.S. People are flocking to their local health food mega- stores hoping to find a natural solution for their aches and pains. You have the unique opportunity to position yourself as the local expert in the growing and well-accepted field of clinical nutrition. Many are looking for nutritional guidance and direction. Who better to fill the shoe than you, the local chiropractor? Most chiropractors are missing a huge opportunity not to mention a substantial amount of income by not including nutrition as a part of their overall service package. By following six steps, you can build a well-respected and profitable nutrition practice. Step 1: The PDQ As a primary physician, it is your responsibility to conduct a thorough consultation. Investigation of your patient s chief complaint is your primary objective. However, do not overlook the importance of obtaining a general-symptom review. This is where the patient diagnostic questionnaire (PDQ) comes into play. The PDQ is a complementary medical questionnaire that consists of approximately 200 questions. Although most chiropractors incorporate a general-symptom survey, few take advantage of this powerful tool to expand their practice. The PDQ is part of the initial forms all new patients are required to complete on their first visit. You will be surprised to discover that patients are actually impressed with your thoroughness. The PDQ should also be given to all active patients. I suggest that you simply inform your patients that you are updating their medical records and you would like them to complete the PDQ. The information that patients include on this form opens the door to you recommending nutritional therapeutics. Although most seek our services for a specific problem, don t overlook the fact that these same patients are suffering from other conditions that have not responded to traditional medical treatment. Many of my patients express gratitude that I treat more than neck and back problems. Here is a sampling of the most common questions that make up my PDQ: 1. Are you overweight? 2. Do you suffer from asthma? 3. Do you have high blood pressure? 4. Do you have constipation? 5. Do you have hemorrhoids? 6. Do you have joint stiffness in the morning? 7. Do you have frequent headaches? 8. Are you often dizzy? 9. Do you suffer from motion sickness? 1
10. Do you suffer from painful feet? 11. Do you suffer from psoriasis or eczema? 12. Do you have frequent urination? 13. Do you have excessive thirst? 14. Are you a diabetic? 15. Do you have painful menstrual periods? 16. Do you have hot flashes? 17. Do you have yeast infections? 18. Do you have PMS? 19. Do you suffer from prostate problems? 20. Do you have difficulty falling asleep or staying asleep? 21. Do you suffer from depression or anxiety? 22. Do you have balance problems? 23. Are you frequently fatigued? 24. Do you have knee pain? 25. Do you have shoulder problems? 26. Do you have elbow problems? 27. Do you suffer from chronic sinusitis? 28. Do you have allergies? 29. Do you have irritable bowel syndrome? 30. Do you suffer from erectile dysfunction? Step 2: Ask the Patient Once a patient has achieved a measure of improvement with his or her primary neuromuscular condition, it is then that I ask if he or she is satisfied with the way his or her other conditions are being managed. After 24 years in practice, I can honestly say that most patients are more concerned about their blood pressure, high cholesterol, fibromyalgia, or diabetes than their neck pain. In fact, these same patients are searching the Internet or asking their local health food clerk for answers to many health ailments. The following script is a simple yet powerful way to question your patients: Mrs Jones, I am happy to see that your neck pain has improved. I was reviewing your initial medical questionnaire and see that you have been suffering from arthritis. I am curious: Is your current treatment helping? Based on the patient s reply, I would then ask if he or she has considered an alternative or nutritional solution for his or her specific health condition. I have discovered that patients are unlikely to discuss other health problems unless you have first achieved success with their primary problem. In addition, don t assume just because you have succeeded in treating your patient s primary condition that he or she will allow you to handle other more serious (in the patient s mind) problems like fibromyalgia, high blood pressure, or diabetes. 2
I can tell you firsthand that patients are looking for answers, but they are not necessarily looking for you to be the one to help them. You have to follow a logical sequence for the patient to gain trust and acceptance that you can help. Step 3: Obtain Medical Records When your patient expresses frustration with the lack of improvement with his or her present medical treatment, I then suggest that you obtain a copy of his or her medical records and a copy of his or her last blood test. Unfortunately, most chiropractors rarely request past medical records and will miss one of the greatest opportunities to help their patients with other health challenges. Patients expect a DC to review their present and past medical records. The simple act of requesting your patient s medical records changes your patient s perception of who you are. Don t underestimate this crucial step in building a successful clinical nutrition practice. Most patients are delighted by your interest and look forward to learning what you have discovered that may have been overlooked by their primary physician. One of my recent patients was Eileen, age 54. Her chief complaint was generalized joint pain with occasional swelling of her hands and feet. Eileen s family physician had ordered a metabolic blood profile and stated in his records that her labs were well within normal limits. Review of Eileen s medical records revealed a possible arthritic condition. Her physician prescribed an antiinflammatory drug. Although Eileen was informed that her labs were well within normal limits, I still wanted to see them for myself. The following is what I discovered: Cholesterol: 122 Triglycerides: 68 HDL Cholesterol: 75 Based on my studies in nutritional medicine, these findings made me suspicious of a possible auto-immune disease. I ordered a Sed rate, C-Reactive Protein, Rheumatoid Factor, and ANA. The results of these tests clearing revealed Eileen s problem. Sed Rate: 56 C-reactive Protein: 5.4 Rheumatoid Factor: positive ANA: negative Based on these findings, I decided to refer Eileen to a rheumatologist and at the same time began an in-depth review of possible causes of the rheumatoid diagnosis. Further labs were ordered, including a fatty-acid profile, which revealed a 3
significant imbalance of Omega 3 to 6 ratio. Treatment included balancing the fatty acids, prescribing a natural agent consisting of boswellia and turmeric, and advising that she completely avoid nightshade foods (white potatoes, peppers, eggplant, tomatoes, and paprika). Eileen s symptomatic improvement was remarkable. Her most recent labs revealed a significant reduction of her symptoms. She is off all prescription medications as of this writing. Step 4: The Nutritional Consultation The patient is scheduled for an in-office or telephone consultation to review your findings. This consultation will encompass a review of their questionnaire, medical records, and blood-test results. You will be surprised by what you will discover. As a matter of fact, out of the hundreds of consultations I have conducted, it is rare that I don t find something of significance contributing to a patient s disease. Another recent patient was Peter, age 62, who consulted with me for high blood pressure. Over the past 2 years, Peter s physician had tried various antihypertensive medications, including beta-blockers, ACE inhibitors, calcium channel blockers, and vasodilators. Although his blood pressure was stable, he would still experience periods when his blood pressure would jump to higher than 180/105. His physician was concerned about these periodic surges, but he was at a loss as to what else to prescribe. When Peter consulted with me, I decided to order a Red Blood Cell Erythrocyte Mineral Test. The results revealed a significant depletion of magnesium. I decided to start Peter on an 18% specially formulated magnesium chloride. Remarkably, his blood pressure plummeted to below 130/75. In fact, his blood medication had to be re-evaluated to prevent his blood pressure from dropping too low. As of this writing, Peter s physician is carefully observing Peter s response to my treatment and has commented that he will likely stop his blood pressure medication. Step 5: Additional Laboratory Testing Based on your review of the patient s medical records and questionnaire, you may find that more testing is necessary to pinpoint the underlying cause of a specific health complaint. A woman brought in her son, Cameron, 12, to see me about his chief complaint of sinus infections and allergies. The problem had been present for 6 years. The patient had previously seen three medical physicians about the complaint. Medical testing included a CT scan of the sinuses and was found to be negative for any pathologies. Results from prescription drugs were poor. After evaluating Cameron, and reviewing his medical records, I decided to order an airborne allergy test and food-sensitivity test. The results revealed that the patient was highly allergic to Aspergillus fumigatus and Alternaria alternata molds. I instructed the patient s mother on how to identify molds in her residence 4
and what steps were necessary to eliminate them. I also prescribed a natural pharmaceutical that increases his immune system s response to molds and fungi. After 3 weeks, the patient was completely free of symptoms and has remained that way for the last 2 years. Step 6: Treatment Unlike practitioners of the one-size-fits-all approach, practitioners of nutritional medicine treat patients based on objective findings. Information derived from blood tests, saliva, and stool tests are hard data, providing the DC the opportunity to offer precision treatment. More important, objective findings via hard-data lab tests encourage patient compliance. People embrace the written word of lab testing. I have yet to see a patient miss an appointment who was scheduled to review his or her most recent blood test or any other lab test. People will step over nails to learn the facts of their lab tests. If you are ready to expand your practice and take on challenging and interesting cases, then the practice of nutritional medicine will be right up your alley. Never in the history of chiropractic has there been more information on the what, how, and why of incorporating nutrition in the practice of chiropractic. Chiropractic Mentors 4200 East North Street Suite 14 Greenville, South Carolina 29615 Phone: 864-292-0226 FAX: 864-268-7022 E-mail: drgrisanti@charter.net 5