Choosing the right practitioner

My ethos and principles of working

Choosing the right practitioner to help you achieve your health goals can be a difficult process, with internet research making the process even more confusing. For this reason, I have included statements about my own principles of working to help you evaluate whether I am the right person to work in partnership with you.

My clinical decisions are based on a combination of the following factors, and the rationale behind them is explained in more detail below:

  • Highest level medical research (RCT’s, systematic reviews etc)

  • Evidence from ‘lower’ forms of research (case-control studies, case series, epidemiological data,)

  • Reports and medical data provided by a patient’s medical and allied health professionals.

  • Opinion from experts within their field

  • 30 years clinical experience

  • Common sense and theoretical possibility

  • Establishing and respecting a patient’s own belief system and using this as a starting point for change whilst recognising that different mindsets may serve to help or hinder a particular course of action.

  • Recognising that the ‘placebo effect’ represents an individual’s innate propensity to heal, and harnessing this potential through a positive therapeutic relationship is a valid and important way of facilitating recovery.

  • A belief that a successful therapeutic relationship in an atmosphere of trust is paramount in achieving the best health outcomes.

  • Recognising the need for onward referral to mainstream or complementary healthcare practitioners for patients who are unlikely to achieve their optimum health through diet and lifestyle modification alone.

A whole-person approach

  • An individual’s life history, both medical and personal, is seen to be entirely relevant to their current state of health and needs to be fully considered when making decisions about potential paths to take.

  • A one-size-fits-all approach cannot be applied to chronic health conditions and clinical decisions cannot be made to manage one symptom, without considering all the factors that may have contributed to the predisposition, development or maintenance of the symptom. Similarly, two seemingly unrelated symptoms may respond to the same management protocol because the root cause is the same, even though a patient may not have previously recognised a connection between the symptoms.

  • Diet is not the only lifestyle factor that will influence someone’s health. Stress, trauma, emotional distress, sleep disruption, inactivity, poor relationships, entrenched belief systems and environmental factors all have the potential to cause health disruption that dietary changes cannot solve. It is important to recognise and address these factors alongside any dietary changes in order to achieve lasting well-being.

The use of supplements

  • Regardless of the amount of research available, it is evident that what we don't know about the body will always exceed what we do know, and therefore the most  natural approach to food is more likely to accommodate mechanisms of action which, as yet, remain undiscovered.

      Since nature designed nutrients to be consumed in unique packages (i.e wholefoods) rather than in isolation, my approach              focuses primarily on the use of wholefoods within a balanced diet, rather than programmes of supplements which have the            potential to cause imbalances elsewhere in the body if taken at therapeutic levels. I believe that this is a more reliable way of            ensuring that the medical knowledge we don’t have is covered, without endangering health through inappropriate use of the          knowledge we do have.

 

  • If there is evidence to suggest an individual is unable to absorb, consume or utilise nutrients in the normal way, or if tests indicate a deficiency that would account for their symptoms, then supplements may be offered as a way forward.

Evidence-based medicine and the role of medical research in nutrition

  • I work according to the principles of evidence-based medicine using the relevant literature to guide and inform my practice but I do not use it to dictate my clinical decisions at the expense of wider learning and clinical experience. It is one of many tools that I use to determine the best course of action for a patient.

  • The evidence-based medicine paradigm has encouraged a heavy reliance upon the exclusive use of practices that have been ‘proven’ to work through randomised controlled trials (RCTs). However, there are many historical examples where this approach has led to the adoption of treatment pathways which have later been shown to demonstrate incomplete understanding, resulting in misguided practice. I therefore interpret the literature with caution and rarely follow trends in healthcare unless I have good reason to support their use.

  • There may be occasions where clinical experience can testify to the effectiveness of a particular practice and yet there is no robust medical evidence to corroborate it. This does not mean that the practice does not work but it may mean that correct type of research has not been carried out, or that the results have been affected by unknown confounding factors - i.e an absence of proof does not equal proof of absence.  I may therefore choose to make some dietary recommendations based on my study and clinical experience as long as I am confident that it is safe to do so.

  • When evaluating the role of evidence-based medicine within the field of nutrition, it is important to understand that the same research methodology cannot always be universally applied to all methods of healthcare. It is therefore important to recognise that there are fundamental differences between the ways in which nutrients behave in comparison to medicines, in order to understand why the research to support nutritional intervention may often appear to be conflicting.

1. Nutrients are co-dependent upon one another and act synergistically within the body, which makes it very difficult to study them in isolation. Research evaluating the role of wholefoods can be more useful than the analysis of single nutrients since it is more representative of how foods are naturally consumed.

2. It is very difficult to control all the other aspects of someone’s diet in order isolate the effect of a particular nutrient and therefore confounding factors which can distort the results are likely if RCTs are used to analysis individual nutrients.

3. Nutrients act more slowly within the body than medicines, and therefore short-term trials are often unsuited to analyse dietary factors since they are less likely to reveal significant changes in systemic function in the allotted time-scale.

Working with the medical profession.

  • Medical professionals will have different views about the value of working with a patient’s diet. This may depend upon their own area of specialism, the amount of nutritional training they have had themselves, and their own personal belief system about the importance of diet in health and well-being. Most doctors trained in the UK will receive less than 24 hours teaching on nutrition during their 5-6 years of training so cannot be expected to have the knowledge to support their patient’s diet and lifestyle changes unless they have had post-graduate training.

  • My preference is always to work collaboratively alongside my medical colleagues, but my experience is that some will value my work and some won’t.  I will never advise you to go against the advice of a medical professional but I may have suggestions for a way forward that is not routinely used within mainstream medicine, based on my own study and clinical experience. This way of working can attract many labels from the medical field – including ‘complementary’, ‘alternative’ or ‘pseudoscientific’, though my own view is that nutrition is simply biochemistry – a basic but complex science which seeks to explain how foods and our environment can contribute to health or disease.

  • You may be aware, from routine blood tests performed in the NHS, that important roles are currently recognised for certain nutrients, such as Vitamin D, Vitamin B12, folate, calcium and iron. Given that many other micronutrients exist within a healthy diet, it is reasonable to assume that they play equally important parts within the health of the body but the effects of their deficiency are yet to be fully acknowledged or explored. In addition, the potential for phytonutrients and microbial imbalance to significantly impact health is now becoming more well-recognised in some areas of medicine, but we are not yet at the point where these factors are routinely tested in our national health service.

  • The diet and lifestyle recommendations I provide are not designed as an alternative to your medical care. They are designed to optimise your health in the most natural ways possible which may, in some cases mean that the need for medical intervention is reduced.

I have included this information about my principles of working in order to help you make an informed choice when selecting a practitioner. There will be other practitioners who may have a similar job title but work in very different ways to this. If you are still unsure whether I am the right person to work with you, please use my contact details to get in touch so that we can discuss your requirements and the approaches I might use.

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