Beyond legislative healthcare debates… • “‘To make affordable healthcare available to the 45 million Americans without health insurance, we must address fundamental causes of health and illness, and provide incentives for healthy ways of living rather than reimbursing only drugs and surgery’” • -Senator Tom Daschle
Why a functional/integrative approach? • Patient centered versus symptom centered • 38% of people in America, more if they are treating a chronic condition (1 -2) • Growing use among women, more educated, and more affluent (1) • Modern medicine has extended lifespan, but made a minimal impact on growth of chronic disease (3) • Bioindividuality means that different people may need different approaches (there is always a percentage in “evidence-based” studies that DON’T get well in the treatment arm? Why not? Why are they different? Is it just about compliance?) • Dietitians bridge a gap between western medicine and complementary medicine • Healthcare is becoming more and more expensive and insurance coverage less for pharmaceuticals – so finding better long-term solutions for people is important
Why the gut? • 1. The “immune-neuroendocrine system” – home of the immune system, aka 2nd brain • 2. Critical role in (4) : • Digestion/nutrient absorption BIG DEAL IN KIDNEY DISEASE • Immune system stability (home to 70-80% of your immune system) BIG DEAL IN KIDNEY DISEASE • Hormone balance BIG DEAL IN KIDNEY DISEASE • Cognitive function • Skin appearance • Heart healthBIG DEAL IN KIDNEY DISEASE • 3. For kidney disease research on the gut and microbiome has shown: delay kidney failure progression, reduce inflammatory marker, improve iron status, stabilization of parahormone levels, decreasing the risk of proteinuric kidney disease. (5)
Answers from gut health aren’t simple • “…the more we know, the more we realize we don’t know and digestion is an incredibly complex system, which is why we’re looking at through multiple lenses.”-Andrea Nakayama, leading functional nutritionist
Why does digestion matter? • 1 – Absorption of micronutrients • 2 – Assimilation of macronutrients • 3- Microbiome support • 4 – Removal of toxins and excess nutrients
What’s the big deal about supplements? • 1. Dietitians want to know more – this is an area where we can make recommendations within our scope of practice • 2. Patients want to know more • 3. There is an important place for herbal and micronutrient supplements in kidney disease if using a functional approach • 4. Difficult to reach therapeutic levels of nutrients with diet alone sometimes. • 5. Supplements can be another tool to help patients who aren’t fully on board with a dietary overhaul
Why are dietitians taking the lead here? • 1. Gut health is inseparable from nutrition • 2. Gut health is not a mainstream treatment area in kidney disease although evidence is mounting on its importance • 3. Dietitians generally are the ones recommending, evaluating, and following supplement use in a clinical setting.