As we all get more and more health conscious, many of us are choosing to take advantage of the services of some sort of nutritional expert. Between various types of nutritionists, dietitians, counsellors and consultants, the task can be a bit daunting in knowing who to best work with. This is part 1 of 4, of a special interview with Alexander Rinehart, MSACN., DC who is a chiropractor and clinical nutritionist, and writes on his site CoActive Health.

In getting to know Alex, I have found him to be highly knowledgeable on all things nutrition related. He specializes in approaching health and wellness from a holistic point of view, while having a strong background in the proper science to support that. I had the chance to ask Alex all sorts of important questions when it comes to our health, nutrition and overall wellness, and will be featuring his responses in a 4 part interview series.

This first part will focus on understanding the difference between a nutritionist and dietitian, and to specifically learn what the work of a clinical nutritionist entails.

In part 2, Alex will share some very timely and valuable nutritional advice and give us a better understanding of how to understand nutrition and healthy eating. In part 3, we will learn to understand how scientific studies are run and their real importance. And finally in part 4, we will look at some commonly prescribed drugs and the role traditional medicine plays in our health.

EVITA: Hi Alex and welcome to Evolving Wellness. It is wonderful to have you here today as we discuss some of the pressing topics in the areas of health and nutrition.

Alex, to start off with your background is in clinical nutrition. Can you share with the readers what exactly that entails and how is it different for example, from other classes of nutritionists or dietitians?

ALEX: Thanks Evita, thanks for giving me an opportunity to speak with you. My training is in Clinical Nutrition, but currently I can only call myself a Nutritionist until I take the Certified Clinical Nutritionist examination this coming August 2010. I must also say that there are a lot of overlaps to how other classes of nutritionists may practice, so my statements are general rules and may not reflect individual practice.

When most people think of Nutritionists, they typically think of Registered Dietitians or RD’s. RD’s are more mainstream and are referred to more often by health professionals. They are trained typically at an undergraduate level and many will pursue graduate training. Once graduated, they also complete some continuing education requirements. Many of their recommendations will reflect meeting the Recommended Daily Allowances (RDA’s) that you find on nutrition labels and helping patients make healthier dietary substitutions and plan their meals. Their training is best equipped to design menus at cafeterias in school and hospital/skilled nursing settings for example and counsel patients on general nutritional strategies. Many will conduct individual consultations as well and help patients with diabetes, weight loss and other nutrition issues.

The American Dietetic Association (ADA) sets many of the guidelines for RD’s and unfortunately, the ADA has historically resisted Nutrition as a “therapy”. The ADA describes nutrition more as a tool used in conjunction with traditional medical treatment to promote general health and wellness. Every approach has it’s value and as is the case in all professions, a few bad eggs can make a lot of noise and promote false generalizations. We could also have a lengthy argument on the political influences on the ADA’s recommendations. What I have found in my studies and my own experience, broad recommendations may be true for a large group, but can fail to apply to specific individuals. For instance drinking skim milk instead of whole milk is better for the entire population, but it still may not be an optimum beverage choice for an individual.

Clinical Nutrition is more concerned with specific clinical cases and giving supportive dietary changes and supplementation in a “clinical” dosage to affect a therapeutic change. To be fully certified as a CCN you need to have a professional degree (MD, DO, DC, etc), have graduate training in nutrition, and in many cases complete a certain number of hours of supervised nutritional counseling.

Although a CCN can unfortunately become just another set of credentials, clinical nutritionists tend to appreciate the interaction of many body systems working together and the role nutrition has to play in those body systems. They are health professionals who utilize nutrition as a core part of their practice.

Clinical nutritionists use general nutrition recommendations as a baseline, but tend to take a more “clinical” approach to individual cases with vitamin supplementation, targeted food selection, and high potency “medical food”, “nutraceuticals” and other herbal remedies. Although it can seem very medical, I take a holistic approach to my evaluations and push toward whole food and lifestyle approaches.

This approach is becoming more and more common and many professional and political groups are lobbying for control over the industry. Pharmaceutical companies are beginning to offer “Pharmaceutical grade” supplements in recognition of some of the documented benefits of these treatment approaches. Tighter Food & Drug Administration (FDA) regulations are also likely on the sale of supplements.

EVITA: That is wonderful information Alex – thank you so much for sharing that. I know that when I was taking my nutrition courses, a lot of the material referenced what the ADA recommends, and I just could not agree with some of it. So your clarification makes a lot of sense as to how that system works.

So based on the above information, please tell us more as to what your practice involves. In other words what does a typical appointment with you look like and what more can clients expect?

ALEX: I look to patterns of symptomatology and how those patterns reflect underlying function which is a better measure of health. It takes at least 45 minutes to over an hour to actually fill out my intake forms and my initial consultations typically take 1.5 hours and can even stretch to be 2 hours long. I take into consideration socioeconomic, chemical, physical, emotional & spiritual aspects of disease, and this takes time.

I have a undergraduate background in “Social Issues and Health” from Juniata College and grew up in a food insecure home so I bring those experiences to the table. I tend to stay away from calorie counting or keeping points systems. Some counting can be valuable in some instances, but it’s not an approach I like to lead with. In most cases, I will also recommend stress reduction and behavior management strategies that we can all benefit from.

In my evaluation, I look as early in to your history as to whether you born by vaginal delivery or c-section, whether you were breastfed or formula fed. I look at medications you may have taken as a child and throughout your adulthood. I care about the relationship you have with your spouse and your kids, and the support network you may have with volunteer or religious organizations. As a holistic practitioner, I need all of this information because if my suggestions cannot work within the context of your life, what use does it have?

I’ve seen close family members grossly mismanaged by the current health system so I want to make sure that I’m honest and direct, while being supportive and challenging at the same time. If I can’t offer something to help a patient, than I refer them to an appropriate professional and do my best to follow-up with their case.

I help patients achieve a wide range of health goals including weight loss, stress reduction, headaches, food allergies and food sensitivities, blood sugar control, and healthy triglyceride and cholesterol levels. I can also use nutrition to support musculoskeletal pain syndromes and related disorders like fibromyalgia. I review potential interactions with medications, and look to the benefits of taking supplements with certain medications. I can even work with depression and behavioral disorders like Attention Deficit Disorder and Autism. The extent and scope of nutrition is incredible and sometimes by its very nature will require co-management with other health professionals.

Even as a chiropractor, I love working with nutrition. Your gut has more nerve connections than your spinal cord and is a highly important immune organ. We have only began to understand the implications of gut-mind-body interactions and I don’t see any one field as a separate entity.

EVITA: Alex thank you so much for all this enlightening information. I really appreciate your approach to health and wellness, especially where nutrition is concerned, as I know of the strong connection between all aspects of our lives, and our health. Traditional medicine likes to tackle one problem at a time, but it often fails to address the individual as a whole, and this can often lead to all sorts of new problems, so your approach is fantastic!

To all of our readers, I hope you enjoyed this first segment with Alexander Rinehart and please join us in part 2 where we will discuss some important facts to keep in mind when deciding what is healthy, and how to approach natural food and nutrition.