1) Diagnosing nutritional insufficiencies by:

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• conducting a whole-body assessment to identify clinical signs and symptoms of nutritional deficiencies/ insufficiencies (e.g. stools, digestion, nails, hair, skin, sleep, menstruation, muscles, joints, mood, body temperature regulation, fatigue, stress, exercise etc.);

• using specific blood tests, stool tests 

• diet assessment

• assessing medications impact on nutritional status.   

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Blood tests may include functional diagnostic pathology tests such as:

• comprehensive digestive stool analyses (CDSAs),

• Microbiome testing

• Organic Acid Testing (OAT)

• Nutrigenomic/Nutrigenetic testing 

• Neurotransmitter testing and

• Hormone Testing. 

 

These tests can help identify nutrient deficiencies, metabolic dysfunction, oxidative stress, mitochondrial dysfunction, immune dysregulation, and gastrointestinal dysfunction/ microbiome disturbance including loss of mucosal tolerance, and genetic SNP (single nucleotide polymorphism) that enhance the need for certain nutrients and nutrition interventions.

2) Correcting deficiencies with the most appropriate nutritional supplement and/or functional foods.  Where nutrient doses are significantly above the National Recommended Values (NRVs) of Upper Limits (ULs) set for healthy individuals, dietitians should be clear about safe precedents (research interventions) and have a clear clinical rationale that uses advanced knowledge of nutritional biochemistry. Dietitians will also take extra precautions for biochemical monitoring and evaluation.

 

3) Evidence base of nutraceutical supplements and their use as short term targeted adjunctive therapy in managing and treating various conditions. APDs should be able to provide patients with expert advice on the efficacy, safe dosing practices, expected duration, desired outcomes and potential adverse reactions of taking NCs. Dietitians need to establish routine monitoring and evaluation protocols with patients taking NCs. These protocols should reflect the level of risk associated with each NC and patient. Advanced practices for the evaluation and therapeutic use of NCs will include proactively checking for drug-nutraceutical interactions using IM gateway or by consulting technical support provided by the NC company or by consulting the patient's pharmacist. Point 3 supports the practical implementation of the DAA Role Statement for Dietitians in the Private Sector.

4) Apply all of these clinical observations, medical diagnoses, standard and specialist lab tests to form a comprehensive assessment and Nutritional diagnosis (IDNT) to inform an intervention that integrates a more complex multi-system view of bioregulatory factors involved in complex and chronic illness (e.g. understand the complexities of the gut-brain system for advanced nutrition therapies in neuro-developmental, neuro-degenerative and psychiatric disorders).

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5) Use these comprehensive assessments to implement advanced medical nutrition therapies. These assessments will enable dietitians to build more effective individually tailored and strategic nutritional plans which directly target problematic pathophysiologies. It will involve

• implementation of therapeutic diets (e.g. plant-based diets such as the Mediterranean diet rich in legumes)

• use of functional foods and

• where indicated short-term targeted NCs used as adjunctive therapy to help treat/manage the condition (this may involve retaining the patient’s current self-prescribed NCs or recommending other more appropriate NCs). 

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