No matter your health goals, nutrition is vital to your wellbeing. The California Center for Functional Medicine (CCFM) views nutrition care as integral to every patient's health care process.
When new patients join us at The California Center for Functional Medicine, they often don’t know what to expect from functional nutrition care. Many are unsure about the differences between conventional and functional nutrition care. In this article, we will discuss the important differences between conventional and functional nutrition care and why working with a functional nutritionist is the ideal solution if your goal is health optimization and long-term wellness.
Functional vs. Conventional Nutrition Care: Health Restoration and Optimization vs. Disease Management
What are the overarching differences between functional and conventional nutrition care? Functional medicine and functional nutrition are patient-centered approaches to restoring and building optimal health that take a root-cause approach to resolving health issues and emphasize nutrition, lifestyle, and personalization. Functional nutrition focuses on an evidence-based, holistic, and personalized approach to optimizing one's diet to treat the root cause of illness, reverse chronic disease, and restore health. I previously defined functional nutrition care in an in-depth blog, What is Functional Nutrition?
Conventional medicine ("Western medicine") focuses on disease detection and management. Once a patient is diagnosed, a treatment plan is developed to manage the symptoms. The medical "toolkit" for managing symptoms often involves pharmaceutical drugs or surgery. Doctors working in the conventional medical system often have little time with their patients, making it difficult to truly get to know the patient and offer personalized solutions that address the root causes of a patient’s health issues.
Similarly, conventional nutrition care also focuses on disease management. For example, renal dietitians provide nutrition care to individuals with chronic kidney disease, and diabetes dietitians work with patients with type 1 and 2 diabetes. Like conventionally trained doctors, many conventionally trained dietitians are great at what they do, but their approaches often lack personalization and don’t necessarily consider the root causes of a patients’ health issues.
On the other hand, there’s absolutely a time and place for conventional nutrition care. For instance, renal dietitians are essential for people with chronic kidney disease who have highly specific and sensitive nutritional needs. Dietitians trained in tube feeding protocols are crucial for sick children who must consume enteral or parenteral nutrition. However, the conventional nutrition care approach usually falls short for the millions of people dealing with chronic diseases such as type 2 diabetes, cardiovascular diseases, depression, and gastrointestinal disorders.
In summary, the overarching differences between conventional and functional nutrition care are that one focuses on disease management while the other focuses on health restoration and optimization.
Next, let’s discuss additional differences between the conventional and functional nutrition care models.
Hospital/Outpatient Center vs. Clinic/Private Practice
Conventional nutrition care is often administered in clinical settings, such as hospitals, nursing homes, and dialysis centers that are part of the conventional medical model. While functional nutrition care is slowly working its way into these conventional healthcare settings, it is more often administered outside the conventional medical system in multidisciplinary health clinics (such as CCFM) or private practices. It can be difficult to fit functional nutrition into a conventional healthcare setting because of time restrictions and limitations on what insurance will cover.
Conventional and Functional Macronutrient and Micronutrient Recommendations Often Differ
Another significant difference between conventional and functional nutrition is how these two branches of nutrition make macronutrient and micronutrient intake recommendations.
Macronutrients are nutrients we need in large amounts in our diets. The primary macronutrients are protein, carbohydrates, and fat. Micronutrients are essential dietary elements, namely vitamins and minerals, needed in small amounts to support the body's normal physiological functions. The types and amounts of macronutrients and micronutrients in your diet significantly influence your health.
Conventional macronutrient guidelines are informed by medical organizations that, in many cases, haven’t updated their dietary recommendations for years. In addition, conventional nutrition macronutrient guidelines are often influenced by the food industry and agricultural interests. For example, it wasn’t until 2019 that the American Diabetes Association finally conceded that a low-carb diet can be beneficial for type 2 diabetes management, after decades of recommending a carbohydrate intake as high as 45% of total calories to diabetics. By the time this position change occurred, functional nutrition practitioners had already been using low-carb and ketogenic diets with people with type 2 diabetes for years.1
A functional nutritionist may recommend a macronutrient distribution of 25-30% protein and 15-20% carbs for a person with type 2 diabetes to help her reduce her blood sugar and improve insulin sensitivity.
Conventional and functional micronutrient recommendations also frequently differ. Conventional micronutrient intake recommendations are usually based on the recommended dietary allowances (RDAs), which are intakes of nutrients sufficient to prevent disease, not necessarily to support optimal health. Functional nutrition micronutrient recommendations consider the RDAs but instead aim to recommend intakes will support optimal health, not merely prevent disease.
For example, the vitamin D RDA for adults 19 years and older is 600 IU per day. Research shows that this RDA is insufficient to support optimal vitamin D levels in many people and doesn't account for interindividual differences in baseline vitamin D level, sun exposure, and dietary vitamin D intake. The functional nutrition recommendation for vitamin D is often higher, in the range of 2000-4000 IU per day in many cases, and is also informed by the patient's baseline vitamin D level and other health variables.2
Recognition of Specific Dietary Needs and Food Sensitivities
Another area in which conventional and functional nutrition differ is that conventional nutrition providers often do not recognize specific food sensitivities that can affect patients.
For example, not all conventional dietitians recognize the existence of non-celiac gluten sensitivity (NCGS), a sensitivity to gluten that is distinct from celiac disease. Many conventionally trained dietitians are not familiar with special diets such as the low-histamine diet for people with histamine sensitivity or MCAS or the autoimmune protocol (AIP) diet for patients with autoimmune conditions. Conversely, functional nutritionists typically receive training during their education around special diets such as low-histamine, low-FODMAP, and AIP diets.
Functional Nutrition Uses Testing to Inform Nutrition Recommendations
Many functional nutritionists use testing to guide their nutrition recommendations for patients. Depending on the setting, a conventionally trained dietitian may or may not use labs to navigate nutrition treatment. In a multidisciplinary environment like CCFM, a nutritionist like myself will use labs ordered by the primary provider, such as comprehensive blood work and SIBO testing, to guide my nutrition recommendations.
For example, if a patient at CCFM does their comprehensive blood panel and it comes back with suboptimal zinc and elevated homocysteine, I will ensure that I discuss whole-food sources of zinc (and the proper amounts of these foods) to include with the patient and how the patient can optimize their intake of methylation nutrients to help lower homocysteine.
To provide another example, if a patient does a stool test at CCFM that shows low levels of Akkermansia muciniphila, an important gut bacterium that helps maintain a healthy gut lining and blood sugar control, I will recommend foods to include to fuel the growth of this beneficial gut microbe.
Functional Nutrition Emphasizes Food Quality
In many cases, conventional nutrition care does not consider the role of food quality, which refers to how foods are grown and manufactured.
For example, conventional nutrition often downplays the health benefits of choosing organic foods. For example, the American Dietetic Association argues that buying organic vs. conventional produce doesn't matter as long as you eat a diverse diet. However, a growing body of scientific evidence indicates distinct differences between conventional and organic produce with vast potential to impact our health.1
For example, in their annual Shopper's Guide to Pesticides in Produce, the Environmental Working Group consistently shows that commonly consumed vegetables and fruits are heavily contaminated with pesticides and herbicides. Furthermore, many non-organic foods, especially wheat and corn, are contaminated with glyphosate, an herbicide linked to toxic effects on cells, immune disruption, and harm to the gut.3, 4
While you by no means need to eat 100% organic food, the scientific evidence indicates that it is an intelligent choice for your health to at least prioritize buying certain organic foods. In addition, organic foods have been found to contain higher levels of certain nutrients, such as vitamin C and flavonoids. Organic foods also demonstrate lower cadmium and pesticide residues and may reduce your exposure to antibiotic-resistant bacteria.5, 6
Conventional nutrition organizations and providers also tend to dismiss concerns about certain novel food-like substances and additives, such as the non-caloric sweetener aspartame. Functional nutrition views novel food additives with caution and often prefers a “guilty until proven innocent” approach to novel industrial food ingredients.7
Generalized vs. Personalized Approach
Finally, conventional nutrition care usually provides generalized recommendations, whereas functional nutrition care makes personalized ones.
For example, a conventional nutrition approach for type 2 diabetes management may advise a patient to “lose weight," engage in carb counting, and eat half of their grains as whole grains. Conversely, a functional nutrition approach to type 2 diabetes may involve the functional nutritionist monitoring a patient's continuous glucose monitor (CGM) remotely and recommending foods that specifically balance the patient's blood sugar response. A functional nutritionist may provide personalized calorie and macronutrient targets designed to help the patient lose weight (if the patient needs to lose weight) and will help the patient identify a variety of food choices that support balanced blood sugar and help the patient meet his or her nutritional needs.
A functional nutritionist will also consider your lifestyle when personalizing your nutrition plan. For example, a functional nutritionist will want to know about your exercise routine to make nutrition recommendations that align with your physical activity level. For example, a patient who runs 40 miles a week and strength trains 3 times a week will have very different nutritional needs compared to a patient who walks around the neighborhood 3 times a week.
As you can see, a personalized approach to nutrition dives deep, so typically, this also means that functional nutrition care involves spending more time with the patient and meeting more frequently than when working with a conventional dietitian.
The Bottom Line on Conventional vs. Functional Nutrition Care
Both conventional and functional nutrition have a place in healthcare. Dietitians and nutritionists in conventional and functional nutrition aim to improve health and prevent disease. However, functional nutrition may be the ideal choice if your goal is to take a root-cause, personalized approach to healing from a chronic health condition (or multiple conditions).
While conventional nutrition primarily focuses on meeting basic dietary requirements, preventing overt nutrient deficiencies, and managing chronic diseases, functional nutrition takes a more personalized and holistic approach.
Functional nutrition care typically takes place in a private practice or clinic, like the California Center for Functional Medicine, recommends macronutrient and micronutrient intakes that support optimal health and are based on the latest research, recognizes and utilizes special diets such as low-histamine and AIP diets, uses testing to inform dietary recommendations, emphasizes food quality, and personalized nutrition recommendations. Whether you aim to heal from a chronic condition or optimize your health, functional nutrition care is an excellent choice.
Functional nutrition is included in all of the California Center for Functional Medicine’s memberships. If you want to learn more about how CCFM’s Functional Nutrition plans can help you please schedule a discovery call.
References
1. ADA’s 2019 Nutrition Therapy Consensus Report - Today’s Dietitian Magazine. (n.d.). Www.todaysdietitian.com. Retrieved November 13, 2023, from https://www.todaysdietitian.com/newarchives/0719p36.shtml#:~:text=Considering%20the%20common%20denominators%20mentioned
2. Vitamin D. The Nutrition Source. (2012, September 18). https://www.hsph.harvard.edu/nutritionsource/vitamin-d/#:~:text=Recommended%20Amounts&text=RDA%3A%20The%20Recommended%20Dietary%20Allowance
3. Puigbò, P., Leino, L. I., Rainio, M. J., Saikkonen, K., Saloniemi, I., & Helander, M. (2022). Does glyphosate affect the human microbiota? Life, 12(5), 707. https://doi.org/10.3390/life12050707
4. Peillex, C., & Pelletier, M. (2020). The impact and toxicity of glyphosate and glyphosate-based herbicides on health and immunity. Journal of Immunotoxicology, 17(1), 163–174. https://doi.org/10.1080/1547691x.2020.1804492
5. Crinnion, W. J. (2010). Organic foods contain higher levels of certain nutrients lower levels of pesticides, and may provide health benefits for the consumer. Alternative Medicine Review: A Journal of Clinical Therapeutic, 15(1), 4–12. https://pubmed.ncbi.nlm.nih.gov/20359265/
6. Vigar, V., Myers, S., Oliver, C., Arellano, J., Robinson, S., & Leifert, C. (2019). A systematic review of organic versus conventional food consumption: Is there a measurable benefit on human health? Nutrients, 12(1), 7. https://doi.org/10.3390/nu12010007
7. (2023). Eatrightpro.org. https://www.eatrightpro.org/about-us/for-media/press-releases/academy-statement-on-aspartame
