Laura Schoenfeld: Again, that’s really going to depend on the patient because some of my patients come to me and I can give them some diet recommendations but the testing will be important to figure out what the main issue is. I get a ton of IBS clients coming to me that have never been tested for SIBO, and a lot of times a big chunk of the appointment is us talking about their options for getting SIBO testing done. Unfortunately, because I’m not a doctor and I can’t order those tests, I have to find a way for them to get it without me ordering it for them. Sometimes that’s Direct Labs. Sometimes that is looking for someone to refer them to, maybe talking about how to get a GI doctor to do it so their insurance will cover it, so there’s a decent amount of consulting about just getting that test done. But if I have somebody that comes to me with severe IBS and I’m pretty sure it’s SIBO but I want to at least get them started with some positive changes, I’ll, of course, make recommendations about the diet. I’ll probably start them on a low-FODMAP Paleo diet. Usually I don’t go all the way to SCD or GAPS Diet at that point, but I just want to get them started on something that’s going to help with their symptoms and then get them tested if necessary or if we can find a way for them to get tested, and then if they do get positively diagnosed with SIBO, then going down the treatment protocol path for that. I don’t often like to do that on my own because even if I’m using herbals, I feel like that’s kind of toeing the line with scope of practice, so I’ll usually try to find them someone that they can work with unless it’s just not an option and they need me to make the recommendations. That’s just an example of someone that I would suggest testing for sure, but I would also focus on the diet on top of that.
Pretty much all my patients are going to get some kind of diet and lifestyle recommendations, whether that is exercise changes, if that’s stress management changes, if it’s mindset changes, if it’s sleep recommendations. Like I said, the 14Four is great. There’s a lot of great information in there as far as basic lifestyle changes that can really make a big difference for people’s symptoms, but I usually will use some level of questioning and also intuition to decide what really that person’s problem is. Like I said, I have a lot of clients that come to me that are overtraining, undereating, super-stressed out, bad mindset because they feel crappy about their body fat or something. There’s usually a combination of things going on, and it’s not just their diet. My goal with new patients is to really focus on the low-hanging fruit. I’ll say, OK, that person looks like the diet and the exercise are really the two issues right now. I’ll try to get them to sign up for a follow-up package so that I can go into deeper detail about some of the other stuff that maybe isn’t the low-hanging fruit. When I say “low-hanging fruit,” basically that just means things that could be changed fairly easily that are going to make the biggest results. Like I said, maybe someone with SIBO, I want them to get tested because I’m pretty sure they have SIBO but they’ve never been tested. I’m going to give them a diet recommendation so that they can improve their symptoms. I might focus a little bit on stress stuff because we know that stress can affect digestion. There may be a few supplements I throw in there before they’ve even gotten diagnosed, just to help with their symptoms, maybe improve their gut motility, but it’s really dependent on the patient.
Again, especially as a nutritionist, working with people that really do have so many different issues going on, there’s definitely a level of psychology involved. I do a lot of counseling, like actually close to mental health counseling. As a dietitian, we kind of get trained how to do that a little bit. Of course, you’d want to refer out if it’s something more serious, but there’s a lot of psychological stuff that can affect someone’s health or their diet choices, that kind of thing. Like I said, I get a lot of clients with overtraining syndrome or they want to lose weight, but they’re kind of not doing the best fitness approach. Maybe they’re overdoing it or underdoing it or doing a weird combination of things that isn’t really helping. I personally have interest in exercise and different exercise modalities, so I can make some recommendations there to help them get better results.
I know this is getting a little complicated, but hopefully that answers your question, Brent. Basically my goal for my clients is to get them on a diet and lifestyle and supplement protocol that really benefits their symptoms and their goals the best, and then if they need testing, if they need additional deeper integrative and functional work, then I can do that with them if necessary. But a lot of times it’s not necessarily what they need at that point because they might have a lot of lifestyle stuff that they need to deal with.