weaving nutrition into an integrative nurse coach practice€¦ · objectives 1. review the role of...
TRANSCRIPT
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Monique Class, MS, APRN, BC Susan Luck, MA, RN, HNB-BC, CCN, HWNC-BC
Weaving Nutrition into an Integrative Nurse Coach Practice
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Objectives
1. Review the role of Clinical Nutrition in an Integrative Nurse Coach model.
2. Explore the concept of food as energy.
3. Examine Integrative Nurse Coach strategies in Nutrition and Lifestyle behaviors, choice, and change.
4. Recognize the prevalence of environmental toxic exposures and their potential roles in the development of various chronic diseases.
5. Review the research on Phytochemical diversity and complexity in foods.
6. Co-create a conscious food plan for the client/patient/family.
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Li festyle Influences
at the Heart of
Functional Medicine and Integrative Nurse Coaching
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health promotion proactive participatory
partnering empowering repatterning
Hyman M, Ornish D, Roizen M. Life Style Medicine: Treating the Causes of Disease. Alternative Therapies Nov/Dec 2009, 15(6): 12-14.
$900 billon saved over 10 years with Lifestyle Medicine
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“No amount of medical knowledge will lessen the accountability for nurses to do what nurses do, that is, manage the environment to promote positive life processes.”
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• nursing history/theories and social science
• integrates body-mind-spirit perspective of healing
• acknowledges individual change begins from within before it can be manifested and sustained externally
Foundations: Integrative Nurse Coach Role
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Promotes healthy lifestyle behaviors
Supports growth and change
Provides coaching strategies to reframe, repattern, rebalance
Integrative Nurse Coaching Model
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What is Integrative Nurse Coaching?
• relationship-centered interaction with patient/client, family & community
• skilled, purposeful, results-oriented, & structured
• intention of promoting and achieving individual, family, and community goals
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Interconnectedness: includes the mind, body and spiritual dimensions influence on physiological factors.
Patient/Client-centered: honors and emphasizes the individual’s unique history and story
Biochemical individuality: recognizes the importance of variations in metabolic function that derives from unique genetic and environmental vulnerabilities and strengths among individuals.
Integrative Nurse Coach Core Concepts
C
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Energy Field Principles and Dynamics: understands how thoughts, stress, toxic environments, and a nutrient deficient diet can disrupt our human energy field and impair optimal function and contribute to disease.
Health on a Wellness Continuum: views health as a dynamic balance on multiple levels and seeks to identify, restore & supports our innate reserve as the means to enhance well being & healing throughout the lifecycle.
Optimizing our internal & external healing environments: holds the world view that human health is the microcosm of the macrocosm in the web of life.
Integrative Nurse Coach Core Concepts
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• Emotions • Stress • Relationships • Environmental Toxins • Nutritional Deficiencies
• Nutritional Excesses • Genetics • Medications • Virus and other
organisms
Energy Impairment/Imbalance
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Integrative Nurse Coach Model Dimensions of Health
S CULTURAL
S BIOCHEMICAL
S PHYSICAL
S MENTAL
S EMOTIONAL
S SOCIAL
S PSYCHOLOGICAL
S ENVIRONMENTAL
S SPIRITUAL
S GENETIC
E N E RG Y BA L A N C E
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Integrative Health & Wellness Assessment (IHWA) Wheel
Life Balance & Satisfaction
Relationships
Spiritual
Mental Emotional
Physical (Nutrition, Exercise, Weight)
Environmental
Health Responsibility
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Integrative Nurse Coach
5-Step Process in a Coaching Session
1. Connecting the story.
2. Deep listening and skillful questioning.
3. Inviting opportunities, potentials, and change.
4. Integrating, practicing, and embodying change.
5. Guiding and supporting.self development
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What are the strengths we can focus on?
What are the risks to manage?
What is the person willing and able to do?
What are the roadblocks to success?
What is the first step in an action plan?
Listening to the Story
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Integrative Nurse Coach Process
S Presence & Deep listening S Self-reflective practices
S Awareness/Mindfulness practices
S Meditation (silent and guided)
S Imagery
S ATMs S Antecedents, Triggers, Mediators
S Identifying client strengths
S Connecting with hope and possibilities
S Telling stories – high, low, turning points
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Connecting to the Story
Integrative Nurse Coach
Collaborative Healthcare Team
Integrative Nurse Coach Partnership
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Support: • Biochemical Individuality
• Energy Production
• Metabolic/Hormonal Balance
• Interconnectedness with Environment
• Immune System Function
• Inflammatory Responses
• GI Function & Digestion of Nutrients
• Detoxification & Biotransformation
• Cellular Structural Integrity
Integrative Lifestyle Health
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Disease does not exist!
Integrative Nurse Coach Functional Medicine
Core Concepts
D O W N S T R E A M symptoms
from
U P S T R E A M causes
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Modern Chronic “Diseases”
Epigenetic Effect
Dietary Influence
Lifestyle Habits
Genetic Predisposition
Environmental Load
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Living in the Modern World
S N U T R I T I O N A L L Y depleted
S E N V I R O N M E N T A L L Y challenged
SWhat Can We Modify in our Daily Lives?
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How bioactive food components, including phytonutrients and chemicals, communicate with genetic information and effect changes within a cell.
Nutrigenomics
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Mediterranean diet tied to lower breast cancer risk
American Journal of Clinical Nutrition, July, 2010
S Women who follow a traditional Mediterranean diet may have a lower risk of developing breast cancer after menopause than women with different eating habits, a new study suggests.
S Researchers found that among 14,800 Greek women followed for a decade, those who kept most closely to the region's traditional diet were less likely to be diagnosed with breast cancer than those whose eating habits were least Mediterranean-like.
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Dietary Changes Appear to Affect Levels
of Biomarkers Associated With Alzheimer's Disease
June 13, 2011 Archives of Neurology, one of the JAMA/Archives journals
• Following a low-saturated fat and low-glycemic index diet appears to modulate the risk of developing dementia that proceeds to Alzheimer's disease (AD), and making a switch to this dietary pattern may provide some benefit to those who are experiencing cognitive difficulty.
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Discovering Toxic Exposures and Body Burden
S What are the major patterns of toxicity in your patients and communities?
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Impact of Toxicity on The Body
S Immune System S Auto-immune, viral infections,
allergies, chronic fatigue
S Nervous System S MS, Alzheimer’s, Parkinson’s disease,
memory decline
S Endocrine System S Thyroid, adrenals, male and female fertility,
endocrine related cancers, diabetes
S Cardiovascular System S Heart disease, atherosclerosis, stroke,
blood pressure
S Gastro Intestinal
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ENVIRONMENTAL ASSESSMENT
S Home
S Workplace
S Community
S Lifestyle factors (alcohol, tobacco, recreational drugs, pharmaceuticals)
S Personal care products
S Cleaning products
S Food purchases
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New Way of Being with
Ourselves
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Presence…
Are you in the moment? Is your client/patient mindful?
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Balance
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Resilience
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Integrative Lifestyle Health and Wellbeing Model
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What is Functional Medicine?
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FUNCTIONAL MEDICINE addresses the underlying causes of disease,
using a systems-oriented approach and engaging both patient and practitioner in a
therapeutic partnership.
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New Way of Thinking
Systems Biology approach
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New Way of Being with Our Clients
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Neurons that Fire together
Wirer together
Neuroplasticity
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Functional Nutrition
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Functional Nutrition… S Emphasises the importance of high quality foods and
phytonutrient diversity to address clinical imbalances and
move individuals toward the highest expression of health.
S Educates patients in the Functional Nutrition
Fundamentals of healthy eating while also providing
options to personalise nutrition plans and therapeutic diets
leveraging the IFM’s Food Plan Suites
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Food Is…
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Food is energy
Basic nourishment to sustain our bodies, Soulful vibration to uplift the
spirit.
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Food is information.
We are not our genes.
We are the expression of our genes.
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Protein
mRNA
Food and eating are information
*
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Protein
mRNA
Food and eating are information.
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Food is…
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Food is connection.
We are who our friends are.
We are what our friends eat.
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Food Is…
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Food is medicine. “Let food be your medicine and medicine be your food.”
- Hippocrates
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Phytonutrient Density and Diversity
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Marcon et al. Mutagenesis pp. 1–9, 2011
Phytonutrients Influence Telomere Length
“Data showed that higher consumption of vegetables was related with significantly higher mean TL (P=0.013); in particular, the analysis of the association between micronutrients and mean TL highlighted a significant role of antioxidant intake, especially beta-carotene, on telomere maintenance (P =0.004).”
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“These findings indicate that botanical diversity plays a
role in determining the bioactivity of high-VF
(Vegetable & Fruit) diets and that smaller amounts of
many phytochemicals may have greater beneficial
effects than larger amounts of fewer phytochemicals.”
Choose phytochemical diversity
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Inflammation-Energy-Stress Pathways are Linked.
Howitz KT, Sinclair DA. Xenohormesis: sensing the chemical cues of other species. Cell. 2008 May 2;133(3):387-91.
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The Phytochemical Index & Inflammatory Cytokines
Vincent et al. J Hum Nutr Diet. 2010 Feb;23(1):20-9. Epub 2009 Sep 4.
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Steps to Getting More Phytonutrients
Aim for 9-13 Servings of Plant Foods Everyday
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Steps to Getting More Phytonutrients
Know Your Phytonutrient Sources
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Steps to Getting More Phytonutrients
Eat the Rainbow of Colors
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Steps to Getting More Phytonutrients
Vary Your Choices
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Steps to Getting More Phytonutrients
Maximize Combinations
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High Q
uality Fats
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Phospholipid Bilayer
The Cell Membrane and Fats
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It’s all about balance…
S Balance intake SF (saturated fat), MUFA (monounsaturated), PUFA (polyunsaturated) and EFA (essential fatty acids) through personalization of food plan
S Individual foods within different fat classifications can be prioritized according to their health benefits
S Quantity, quality and preparation of concentrated oils determines health benefits
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Fatty Acid Families
Saturated fats Short-chain Medium-chain Long-chain
Unsaturated fats MUFAs
Omega-7s Omega-9s
PUFAs (EFA) Omega-3s Omega-6s
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Omega 3 & 6
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Changing Fatty Acid Intake: Omega 6: Omega 3 Ratios
Prehistoric ~ 1900 ~ 2010
1:1 4:1 26:1
n-6 fats n-3 fats
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All Omega 6 are not bad It is the over production of AA (Arachidonic Acid) that causes the inflammation!
Lets talk Omegas:
Are all Omega 6 Bad?
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Nutrients needed for the EFA cascade Omega-3 Family Omega-6 Family
Alpha-linolenic acid Linoleic acid
Eicosatetraenoic acid Dihomogamma linolenic acid
Arachidonic acid
Delta-6-desaturase B3 , B6 ,Mg, Zn, Vit C
INH: EtOH, Transfats, DM, Insulin
Eicospentaenoic acid
Delta-5-desaturase requires Zn, B3 , Vit C
Up regulated by insulin
SERIES-2 PG (Inflammatory)
SERIES-3 PG (Anti-
Inflammatory)
SERIES-1 PG (Anti-
Inflammatory)
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Cooking Impact
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Formation of Advanced Glycation Endproducts (AGEs)
Food Funct. 2011 May;2(5):224-34. Epub 2011 Apr 8.
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The Power of Half of an Avocado on Inflammatory Cytokines
N=11 healthy subjects, two acute eating occasions Food Funct. 2013 Feb 26;4(3):384-91. doi: 10.1039/c2fo30226h.
Increased vasoconstriction 2 h after hamburger ingestion, but no difference when avocado was added;
IL-6 increased significantly at 4 hours in postprandial serum after consumption of the hamburger, but no change was observed when avocado was added.
Postprandial serum triglyceride concentration increased, but did not further increase when avocado was ingested with the burger compared to burger alone despite the added fat and calories from the avocado.
Half Avocado (68 grams): Fiber 4.6 g Potassium 345 mg Folate 60 mg MUFAs 6.7 g 114 kcal
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AGE-containing Foods
Gaby A. Nutritional Medicine, 2011; Page 15.; Goldberg et al., JADA 2004; 104:1287-1291.
Food AGE content (kilounits)
Hot dog, 90 g, Broiled 5 min 10,143
Chicken, 3 oz. oven fried 9,000
Chicken, 3 oz. deep fried 6,700
Thin crust pizza, 90 g 6,143 McDonalds hamburger, 90 g 4,876
Fried hamburger, 90 g 2,375 Processed cream cheese, 15 g 1,632
French fries, fast food, 100 g 1,522
Chicken, 3 oz. boiled 1,000
Frozen toasted waffle, 30 g 861
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1,670 citations on Pubmed for “Mediterranean Diet”
The most well-studied “diet”
Data accessed 12/21/12 Pubmed
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Avocado • Monounsaturated fat • High Potassium • Vitamin E • Glutathione
Serving Suggestions: Use to garnish omelets, tossed in salads, served as guacamole
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Blueberries Anthocyanins and Phenolic compounds:
• Improve blood flow to the brain
• Protect neurons from free radical damage
• Improve memory and cognition
Serving Suggestions: • Fresh or frozen- in
smoothies-oatmeal
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Broccoli • Sulphoraphane activates
NRF2 – decreases inflammation
• Increase glutathione • I3C for metabolism of
estrogen
Serving Suggestions: • Chopping and letting it rest
before cooking promotes cancer-protective properties
• Steam only 1 ½ minutes
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Coconut Oil • Medium Chain Triglycerides • High In beta HBA • Increases beta oxidation of
fats Serving Suggestions: • Should be both virgin and
organic • Use in stir-frying – no
oxidation at high heat • Shred on salads and yogurt-
drink as water high in minerals and electrolytes
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Green Tea • High in EGCG • Neuroprotective • Activtes NrF2 • Decreases oxidative damage to
mitochondria • Regulates insulin levels • Powerful antioxidant Serving suggestions: • Poach Salmon with green tea • Drink hot or cold • Put into a smoothie • Poach pears with green tea honey
and cinnamon
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Olive Oil (cold pressed, unfiltered/cloudy, extra virgin
• High in polyphenols-anti-inflammatory
• MUFAs Serving Suggestions; • Cook on medium heat- only
cook with cloudy olive oil (EVOO)
• Add to vegetables and foods after cooking- salad dressings
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Pomegranate • High in antioxidants • Anti-inflammatory • High in Fiber (seeds • Bifunctional Modulator of
Phase 1 & 2 of the liver • High Vit C Serving Suggestions: • Use juice to flavor sauces
and dips-add to vegetable salads-pair with olives.
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Salmon Wild Alaskan • High DHA (omega 3) • High Carotenoids • High Cysteine essential
for glutathione production
• Good source of Co Q 10 Serving suggestions; • Stews, soups, slow-
roasted, baked, & salads
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Seaweed • High in minerals for the
mitochondria
• Antibacterial
• Antioxidant
• Immune enhancing
• High in selenium and magnesium (10 x higher than other veggies)
Serving Suggestions:
• Soak dried seaweed and put in stir- fries, soups, salads, eat dried as nori-sprinkle flakes on veggies-use kelp shaker to replace salt
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Spinach • High Antioxidants that help
with improving memory • High in carotenoids • Flavonoids that provide anti-
inflammatory and antioxidant protection
Serving suggestions: • Boil for one minute to minimize
loss of nutrients and reduce oxalic acid; cooked has more antioxidant than raw
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“…intervention studies strongly suggest that cocoa has several beneficial effects on cardiovascular health, including the lowering of blood pressure, the improvement of vascular function and glucose metabolism, and the reduction of
platelet aggregation and adhesion.
Cocoa, blood pressure, and vascular function
Curr Hypertens Rep.2012 Aug;14(4):279-84. Cocoa, blood pressure, and vascular function. Sudano I, et al.
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Integrative Nurse Coach Process
S Create a Wellness Vision
S Connect with Life Goals
S Client connects to Strengths and Motivators
S SMART goals realistic for change (breakdown large goals)
S Readiness for Change indicators
S Self efficacy-potential for success
S Value to self (not imposed from the outside)
S Identify specific action steps
S Time frame for realistic achieving goals
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Contact us
www.iNurseCoach.com
www.FunctionalMedicine.com