Monique Class, MS, APRN, BC Susan Luck, MA, RN, HNB-BC, CCN, HWNC-BC

Weaving Nutrition into an Integrative Nurse Coach Practice

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.

Li festyle Influences

at the Heart of

Functional Medicine and Integrative Nurse Coaching

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

“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.”

• 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

Promotes healthy lifestyle behaviors

Supports growth and change

Provides coaching strategies to reframe, repattern, rebalance

Integrative Nurse Coaching Model

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

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

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

• Emotions • Stress • Relationships • Environmental Toxins • Nutritional Deficiencies

• Nutritional Excesses • Genetics • Medications • Virus and other

organisms

Energy Impairment/Imbalance

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

Integrative Health & Wellness Assessment (IHWA) Wheel

Life Balance & Satisfaction

Relationships

Spiritual

Mental Emotional

Physical (Nutrition, Exercise, Weight)

Environmental

Health Responsibility

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

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

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

Connecting to the Story

Integrative Nurse Coach

Collaborative Healthcare Team

Integrative Nurse Coach Partnership

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

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

Modern Chronic “Diseases”

Epigenetic Effect

Dietary Influence

Lifestyle Habits

Genetic Predisposition

Environmental Load

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?

How bioactive food components, including phytonutrients and chemicals, communicate with genetic information and effect changes within a cell.

Nutrigenomics

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.

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.

Discovering Toxic Exposures and Body Burden

S What are the major patterns of toxicity in your patients and communities?

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

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

New Way of Being with

Ourselves

Presence…

Are you in the moment? Is your client/patient mindful?

Balance

Resilience

Integrative Lifestyle Health and Wellbeing Model

What is Functional Medicine?

FUNCTIONAL MEDICINE addresses the underlying causes of disease,

using a systems-oriented approach and engaging both patient and practitioner in a

therapeutic partnership.

New Way of Thinking

Systems Biology approach

New Way of Being with Our Clients

Neurons that Fire together

Wirer together

Neuroplasticity

Functional Nutrition

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

Food Is…

Food is energy

Basic nourishment to sustain our bodies, Soulful vibration to uplift the

spirit.

Food is information.

We are not our genes.

We are the expression of our genes.

Protein

mRNA

Food and eating are information

*

Protein

mRNA

Food and eating are information.

Food is…

Food is connection.

We are who our friends are.

We are what our friends eat.

Food Is…

Food is medicine. “Let food be your medicine and medicine be your food.”

- Hippocrates

Phytonutrient Density and Diversity

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).”

“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

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.

The Phytochemical Index & Inflammatory Cytokines

Vincent et al. J Hum Nutr Diet. 2010 Feb;23(1):20-9. Epub 2009 Sep 4.

Steps to Getting More Phytonutrients

Aim for 9-13 Servings of Plant Foods Everyday

Steps to Getting More Phytonutrients

Know Your Phytonutrient Sources

Steps to Getting More Phytonutrients

Eat the Rainbow of Colors

Steps to Getting More Phytonutrients

Vary Your Choices

Steps to Getting More Phytonutrients

Maximize Combinations

High Q

uality Fats

Phospholipid Bilayer

The Cell Membrane and Fats

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

Fatty Acid Families

Saturated fats Short-chain Medium-chain Long-chain

Unsaturated fats MUFAs

Omega-7s Omega-9s

PUFAs (EFA) Omega-3s Omega-6s

Omega 3 & 6

Changing Fatty Acid Intake: Omega 6: Omega 3 Ratios

Prehistoric ~ 1900 ~ 2010

1:1 4:1 26:1

n-6 fats n-3 fats

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?

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)

Cooking Impact

Formation of Advanced Glycation Endproducts (AGEs)

Food Funct. 2011 May;2(5):224-34. Epub 2011 Apr 8.

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

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

1,670 citations on Pubmed for “Mediterranean Diet”

The most well-studied “diet”

Data accessed 12/21/12 Pubmed

Avocado • Monounsaturated fat • High Potassium • Vitamin E • Glutathione

Serving Suggestions: Use to garnish omelets, tossed in salads, served as guacamole

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

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

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

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

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

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.

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

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

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

“…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.

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

Contact us

www.iNurseCoach.com

Programs@iNurseCoach.com

www.FunctionalMedicine.com

Monique@thecwh.com