Dr. Amy Nett: OK, great question. I would say the minority of my patients are probably working directly with a nutritionist. I would say, ballpark, somelike 5 percent or maybe 10 percent. Maybe I’m underestimating a little bit, but it’s certainly less than 25 percent, so we’ll say less than a quarter of my patients are working with a nutritionist. That said, a lot of our patients do come to the practice because they’ve been following Chris for a while, they’ve probably read his book, they probably have a pretty good understanding of what the Paleo diet is. We have a few handouts—and again, we’ll be giving you these handouts as well—on the Paleo reset diet that give patients some guidance. We also have a Paleo low-histamine handout, which we’ll be providing as well. Those provide some general resources for patients, so we can suggest Chris’s book or various resources for patients to try to understand this.
Most of our patients, we do ask that they do a Paleo reset diet for 30 days before their case review appointment. At the initial consult, I’ll get a sense of what a patient’s diet looks like, if they’re already gluten free, dairy free, and if they’re not and if they have not tried either a GAPS Diet, a Specific Carbohydrate Diet, or a strict Paleo diet, then I will give them that handout and ask that they try a fairly strict Paleo reset diet for 30 days so that they do have at least that experience. Then in the case review, we might talk about diet a little bit more.
If they have general questions about macronutrient ratios, that sort of thing, I’ll generally work with patients, to some extent, on diet, but I don’t do a whole lot with diet. In general, I think you’ll find that working with a functional medicine practitioner on diet, people feel like they would rather spend time going over their supplements or their medications or test results. They generally don’t, I think, want to go into the minutiae of diet. That’s when they might want to talk to a nutritionist. If they feel like their diet needs to be a lot stricter or if they’re struggling with severe food sensitivities, that might be one reason people will work with a nutritionist for a lot more support in making sure they’re optimizing their diet. Given that it’s very limited for people who can only eat 10 or 15 different things, they’re trying to sort of optimize the different approaches they can use.
I’ll sometimes also refer out if patients, for example, have high cholesterol and we want them to switch from a standard Paleo diet to a Mediterranean Paleo diet. I’ve had a few patients who really benefit from working with Kelsey and Laura and going to a Mediterranean Paleo diet and understanding how to make that transition. Some other examples are people who are really struggling with blood sugar balance or cortisol issues. That can be another time that just having someone to monitor diet a little bit more closely can be really beneficial.
It’s just figuring out, I think, how much your patient understands already about diet, macronutrient ratios, sources of monounsaturated fats versus saturated fats, and trying to figure out what their level of need is. Hopefully that answers that for you a little bit more.