Practicing as a nutritionist is an art! Not just the baking, cooking art side, but the science part of how food behaves in the body—applying it to people to enable them to heal is an art.

When I was first starting out as a nutritionist, it seemed like there was a protocol for everything —low cholesterol, low fat, low sodium. Maybe the most famous— 1200 calorie weight loss plan.

Protocols are  “official guidelines” of practice in any given profession. Nutrition is notorious for its many protocols. Nutrition has evolved a bit since my early days but protocols are still very present. Nutrition protocols now are more likely to also include low-carb, low FODMAP, low histamine, GERD, etc. Even if you practice as a functional nutritionist and you wholeheartedly believe in n=1, you may be searching for the easiest protocol to heal your client’s digestive woes.

Some protocols or guidelines are absolutely necessary in healthcare. And in some areas of medicine, protocols are more necessary than others. Take CPR. Over a decade ago, the broad guidelines for one/two rescuer CPR was 15 chest compressions to two breaths for adults. Now it is 30 chest compressions to 2 breaths, with some caveats.  More focus is on those chest compressions to supply oxygen to the brain and body.

The protocol has changed slightly but an emergency situation requires an efficacious protocol that can be taught to a large volume of people. CPR has saved thousands of lives. Without this specific protocol and standard of care in CPR, a first responder would not have a plan. More advanced first responders are able to adapt to individual needs.

Medicine is dealing with people’s lives—so for the same reasons why one might think protocols are smart and necessary, on the flip side, applying a one size fits all approach is reason to tread cautiously— especially if you get into the pattern of looking for a protocol even before you begin your assessment. Knowing when to deviate is also why physicians use many approved drugs off label because they work to help other conditions other than the original condition they were approved for.

Some protocols have been in place for decades, despite evidence to the contrary, while other protocols seem to change by the year. Generally, functional medicine principles don’t use protocols for the masses, though I am concerned of some wishing they did. It’s not so much that there are no guidelines with functional care—but rather they are adjusted for each individual—still following evidence based medicine, and knowing evidence comes with clinical experience. It’s the why’s, the when's and the what else's that get tricky. There are many layers to practicing as a nutritionist. Remember food affects every cell, organ and system. Your roadmap is the human body and having a strong foundation of anatomy and physiology and nutritional biochemistry. Often your answers are right before you eyes if you look at the map.

Protocols for the treatment of small intestinal bacterial overgrowth (SIBO) is a good example of evolving guidelines. In the last five years, SIBO guidelines have changed several times. First and foremost is to identify if SIBO even exists. But, then what? Do you use an anti-microbial right away, then low FODMAP diet, then challenge phase, then add a probiotic, prebiotic, postbiotic, then what??? And for how long with low FODMAP or low carb or low whatever?

SIBO is a great example of understanding principles of care and N = 1. Medicine doesn’t know the exact guidelines for each person because no two guts are alike. But understanding principles around GI anatomy and function and recognizing symptoms that may be presenting from other systems and then being familiar with the roadmap to that other system will help you determine your client’s next step.

As personalized medicine grows and recognizes how unique we all are, especially when it comes to our gut microbiome and genes, the skills and critical thinking needed to adapt protocols may be the difference in whether or not a patient heals.  

Automatically following a protocol can lead to complacency. Understanding structure and function of body systems, how to prioritize nutrient assessment, labs, supplements and taking each next step is both an art and science.