Practice management

Holistic Nutrition
A Clinical Approach

by Tammera J. Karr, PhD, BCIH, BCHN

hat is Holistic Nutrition and how does it

differ from that of registered dietitian and
clinical nutrition? Before we can answer these
questions, it is necessary for us to step back
and take a look at the broader picture of food
and human interaction. In order to live we
must eat, that is a simple fact, but what we eat,
why we eat those foods, as well as the single and cumulative effects
of food on the body systems, is a far more complex story.
Everything that is ingested and processed through the digestive
tract becomes more than macronutrients, carbohydrates, fats and
protein; it is in fact a sea of chemicals, minerals, enzymes, and
vitamins, many of which modern research is still exploring. These
chemicals make up every structure, reaction, and function within
the human body. You cannot separate one organ system from another if blood flows to it, then the food you eat and the chemicals
contained in that food go there too.
Every culture on the planet has its own distinct food history. As
man evolved, he learned from observation which foods were safe,
satisfying, strengthening, as well as enlightening, as is the case with
ceremonial foods. With ceremonial foods, each culture has the
ability to digest and utilize foods unique to their environment. An
example of this is the herb Kava. For centuries people of the Pacific
Islands have safely consumed a beverage made from crushed kava
roots. In the 1990s, Kavas calming effects made it popular in Western cultures as an herbal supplement for the treatment of anxiety,
emotional stress, and sleep problems. In 2001, reports of liver damage among Westerners who took kava supplements gained widespread attention. Many Western countries, including the United
States, the United Kingdom, and Canada, banned or regulated the
sale of kava products. Researchers review of 85 scientific studies on
kava toxicity found no consensus, despite several theories that have
emerged over the years. To date, there remains no indisputable
reason for the increased prevalence of kava-induced hepatotoxicity
in Western countries, the researchers say.
With world markets, foods that have never been part of a culture
are now embraced, sometimes to the detriment of the population.
Through the human genome studies, researchers have branched off
into Epigenetics (Buettner, 2008) the study of foods interaction
with cell receptor sites. What ancient man came to do instinctively,
today we are learning the science of food interaction.
Are chronic illnesses the result of pre-dispositions or cellular
malnutrition? It is my belief that it is the latter. As we have moved
farther from our traditional food sources and preparation methods,
our DNA and RNA have received less of the key nutrients needed
for healthy replication. This can be observed by looking at chronic
illness trends over the last 100 years, and also by studying client
interviews. The clients I encounter who have the earliest onset of
chronic illness, depression, or hormone issues are also often those
people whose families have been Americanized for more than three
generations.
In the 1940s, the concept of better living through chemistry
came into vogue. Nutrition science left the kitchens and moved
into the labs. Because of this, today we have more food choices at
our fingertips. They dont spoil or rot, theyre convenient, easy to
fix and they contain the basic macro nutrients: carbohydrates, fat

and protein. What it does not have is the multitude of nutrients

found in fresh foods. These include water-soluble vitamins, essential
fats and sugars, full spectrum protein chains, enzymes, major and
trace minerals, phytochemicals, fat stored vitamins and the list is
still being generated The chemical structure, DNA and RNA, of
the human has not changed or evolved from that of Neolithic man;
however, our food has evolved in a multitude of ways.
Throughout the world, humans are able to produce more tonnage
of consumable foodstuffs than ever before. And yet, as a nation,
America has a pandemic of chronic illnesses: for the first time in
history, there are more overweight people than thin in all social
economic. In 2010, more than 40 million children under the age
of five were overweight. Once considered a problem in high-income
countries, overweight and obesity are now on the rise in low and
middle-income countries, particularly in urban settings. Close to 35
million overweight children are living in developing countries and 8
million in developed countries. (World Health Organization)
Why? What is Different? In reviewing historical information from
the last 60 years, it is my belief that we have dramatically changed
food, food values, and the role of food in the world. No longer does
raw food, local food, organ foods, or industrial chemical free food
grace our tables, schools, hospitals, or mess halls. Today, in compari-

Every culture on the planet has

its own distinct food history...
son to the generations before the 1950s, more prescription medications are being manufactured, prescribed, and used, for depression,
weight loss, GERD, cholesterol, heart conditions, chronic pain, cancer, viruses, and diabetes. The baby boomer generation is the generation of mass pharmacology vs. responsibility, and doctors, who are
offering designer weight loss programs, are on the rise. Again, look
at what has changed it is not human adaptation to food, but the
food itself.
When conducting interviews with clients from multiple generations, the question is always asked, what did you eat, what do you
eat now, how was(is) the food prepared, and from what culinary
culture does the food come. The answers are somewhat as expected
but nonetheless enlightening:

We raised everything we ate.

I can remember sitting on the porch pealing apples from the
neighbors tree with my grandmother for a pie.
Mom cooked everything from scratch.
It was a real treat to eat out on special occasions.
I came home from school and put a hot pocket in the microwave.
I drink a diet pop on the way to work.
I never get lunch, then by the time I get home Im starved
and eat until bed.

What is Holistic Nutrition?

Holistic Nutrition looks at the total person and the unique biochemical responses to their environment and their dietary intake
including supplements and lifestyle. Nutritionists believe food is
our most important medicine, and should be addressed first in the
healing process. Holistic Nutritionists interface with healthcare
practitioners and help in addressing chronic health challenges that
react to changes in food choices, allergens, supplements, deficiencies, and imbalances. Holistic Nutrition honors dietary needs based
on ethnicity, religious, and philosophical beliefs.
Food choices are made for a multitude of reasons; this can be a
result of family history, depression, pain, or enjoyment as well as
malnutrition, and chemistry imbalances. Overeating is more than
self-control issues. For example: If youd just push away from the
table, the doctor said you wouldnt be so fat he was a fine one to
talk with the gut hanging off of him! Im sad to say this is a direct
quote from a client.

Understanding Your Clients Needs

I have a client who is in his/her late 70s, is diabetic, and has had
four open-heart surgeries. This person has a history, that includes
their perception of going hungry as a child; then as an adult, his/
her eating became gluttonous, and their shut off switch failed to
override their deep-seated fear. Telling him/her they had to stop
eating sugar and to get more exercise didnt compute for them.
What does that mean? I heard, If I have to give up everything that
tastes good, whats the point in living?
It takes time to reeducate the pallet to foods natural flavors. A
diabetic craves sugar to feed their glucose starved brain. Initially,
half the challenge is teaching the client they are not being deprived,
but are actually being empowered. Typically a client will report to
me that after two weeks of doing without, they stopped craving
conventional sugar. They forgot how much better food tasted when
it was fresh and they noticed their energy level was better.
What is it I do? For starters you build a relationship with your
clients. You establish trust and then define what they are willing
to do and why. This takes time and may not be available to a busy
medical practitioner. Having a relationship with a Holistic Nutritionist, Holistic Nurse, or registered dietitian who understands
holistic approaches, increases the likelihood of success with type 2
diabetics.
Some individuals may do well for a time on designer weight loss
programs; however, many will find them cost prohibitive or boring

...For starters you build a relationship with your clients, establish trust, and define what
they are willing to do and why....
after 90 days, and the client returns to previous behaviors. A Holistic
Nutritionist helps the client learn new food behaviors by utilizing real
foods, which are affordable, flexible, and safer than protein powders or
supplements that are readily available from discount stores.
Real foods that are locally grown are available to all social economic

classes, and many can be grown in small container gardens or in

community or church gardens. It goes back to the principle of give
a man a fish and he eats for a day; teach him to fish and he eats for a
lifetime.
I have the client pick one thing they want to change; it may be
stopping all soda or bread, or walking continually for 45 minutes
each day. By choosing this one thing, this sets the client up for success and not failure. At their next appointment in 2 weeks, a new
goal is set. For those who want to do it and who are determined to
stay off of medication, I have them stop all soda, grains, starches,
soy, processed foods/sugar and eat only lean proteins (three servings daily the size of their palm), healthy fats, organic vegetables,
and low glycemic fruits. By doing this individuals routinely go
from hemoglobin A1C numbers of 6-7 to 5s in 8 -12 weeks.

Utilize the Glycemic Index

1. Make handouts on postcard sized paper that clients can take

shopping with them. Grocery store tours where clients can
see foods, read labels and learn how to shop.
2. Provide simple recipes utilizing fresh foods. This can be in
the form of recommended websites, in house, hands-on
demonstrations, lending library of cookbooks, or a recommended reading resource list.
3. One plan does not fit everyone. The trend today is to put
clients on vegetarian programs with minimal oil and animal
protein. In my experience, this is wrong. Take time to understand your clients dietary needs based on their activity
levels, age, sex, and heritage.
4. Work with time. Dont rush; your clients did not get in this
shape overnight. Schedule regular appointments and dont
do weigh-ins; instead have clients use tape measurements
of key body locations (the BMI chart does not account for
muscle mass, bone density, and water it also is gender
specific but not always accurate). Check on their progress
and move to the next goal when appropriate. If you pile too
much on them, they will feel overwhelmed and will give up.
5. You have to do this no one can care more than you. Get a
commitment from them and hold them to it. For some you
have to be their motivator, as well as their lifestyle coach.

The use of trace minerals and magnesium glycinate for reduction

in muscle spasms, vascular restriction, and nerve pain associated
with migraines and heart and back injuries can reduce the need for
narcotic pain medications, if begun at the beginning of therapies,
before opium/pain receptors are overloaded. Magnesium has been
called the most important mineral to man and all other living
organisms. It is critical to the metabolic process of one-celled organisms and is the second most abundant mineral found in human
cells.
Currently, there are seventeen minerals considered essential for
human life. As with most minerals, magnesium combines naturally
with other elements. Approximately 60% of the bodys total magnesium is concentrated in the bones, 20% in muscles, and 20% in
soft tissues and the liver. Magnesium works inside our tissue cells,
producing ATP energy for the bodys vital force and triggering the
production of the bodys protein structures by producing DNA.
All muscles, including the heart and blood vessels, are affected
if the magnesium level is deficient. Calcium will flood the smooth
muscle cells causing spasms and constricted blood flow. This can

lead to high blood pressure, arterial spasms, angina and heart attacks.
Vitamin D is another nutrient being underutilized in reducing
heart disease, depression, and chronic pain. Researchers at the
University of California, San Diego School of Medicine and the
Creighton University School of Medicine in Omaha reported that
a markedly higher intake of vitamin D is needed to reach blood
levels in order to prevent, or reduce, the incidence of breast cancer,
colon cancer, multiple sclerosis, and type 1 diabetes than had been
originally thought. I routinely see 25 hydroxy levels below 25
and as low as 4 for chronic pain among elderly and menopausal
women experiencing depression. Our office is in the final stages of
a four-year study of the prevalence of low vitamin D in our client
base. Oral dosages do not always bring an individuals levels up
to optimum ranges, and the use of vitamin D by the population,
while growing, has its own challenges in understanding how this
key nutrient is utilized by both the body and the brain.
While many emergency room and neurological practitioners
utilize B12 for nerve pain, blood disorders and neurological conditions, it is often overlooked until clients fail to respond to other
medications. This simple, water-soluble nutrient may be able to
reduce the need for pharmaceuticals and can improve the quality
of life for younger clients with mood disorders, as well as those
with nerve damage.

B12 Deficiency Mimics:

Alzheimers Disease
Multiple Sclerosis
Parkinsons Disease
Essential Tremor
Vertigo
Depression
Mental Illness
Diabetic Neuropathy
Neurologic Signs and Symptoms
Numbness Tingling
Weakness of Legs, Arms, and Trunk
Unsteady or Abnormal Gait
Problems with Balance
Difficulty Walking
Dizziness
Tremor
Forgetfulness
Memory Loss
Dementia
Impaired Vibration
Abnormal Reflexes
Restless Leg Syndrome
Impotence
Urinary or Fecal Incontinence

There are some very good RDs within communities; although

many of them are not members of the Academy of Nutrition and
Dietetics (AND) formerly the ADA. The AND does not support the
use of organic foods, natural health modalities, herbs, or the glycemic
index.
In 2011 when the ADA was ordered by congress to disclose
their financial information, Sen. Charles Grassley (R-IA), asked
the ADA and other health advocacy groups for a listing of their

payments from the pharmaceutical, medical, and insurance industries. Due to the ADAs lack of financial transparency, the senators
investigation into the ADA is ongoing.
Nutrition organizations and health advocates have long criticized
the Academy of Nutrition and Dietetics for its collusion not only
with the junk food industry, but with the pharmaceutical and agriculture industries. The American Society for Nutrition (ASN), the
largest society for nutrition researchers in the US, openly receives
support from pharmaceutical companies like Abbott Nutrition
and Martek Biosciences, genetic engineering and pesticide giant
Monstanto, food processor ConAgra, and junk food suppliers and
producers Coca-Cola, Mars, Kraft, McDonalds, General Mills,
and Kelloggs, not to mention the Sugar Association, Inc.
I personally have an ethics issue with this, as do many others.
Your clientele may be far better informed than you may think. By
providing information about adjunct modalities and recommendations for lifestyle changes, you are telling your clients that you are
open to other options for their care of their own choosing, and
that are empowering, as well as effective. Clinicians may be able to
reduce the volume of prescriptions written, pharmaceutical liability
complications, and increase compliance and true wellness for their
clients. The Chinese model of payment for keep one well, not
disease management, additionally reduces stress and burnout to
those in the growing Holistic Healthcare profession. This is a winwin situation for everyone.
Works Cited
Buettner, D. (2008). The Blue Zones. Washington DC: National
Geographic.
Dean, C. M. N. (2003). The Miricle of Magnesium. New York:
Ballentine Books.
Daoust, G. A. (2002). The Formula - a personalized 40-30-30
weight loss program. New York: Ballentine Books.
DDS, W. A. (1939, 1945, 2011). Nutriton and Physical Degeneration 20th edition. Lemon Grove CA: Price-Pottenger Nutrition
Foundation.
Schwarzbein, D. M. (2004). The Program - losing weight the
healthy way. Deerfield FL: Health Communications Inc.
Hayes, D. L.(2004). 7 Habits for Healthy Living. Wellness
Watchers International.
Cannell, J. M. (2011). Vitamin D. Here and Now books.
Low Vitamin D Status Among Obese Adolescents: Prevalence
and Response to Treatment. (n.d.).
Holick, M. F., P. M. (2010). The vitamin D Solution. New York:
Hudson Street Press.
Pacholok, S. M., R. B. (2011). Could it be B12? an epidemic of
misdiagnoses. Quill Driver Books.
Shanahan, C. S. (2009). Deep Nutrition - Why your genes need
traditional foods. Lawai : Big Box Books.
Tannahill, R. (1988). Food in History. New York: Three Rivers.