Nutrition plays a very important role in rehabilitation. The body’s capacity to heal is intimately related to our diet. The purpose of this post is not to provide information on the physiological basis of healing or nutritional intake. Rather, it is to stimulate thinking and provide resources for physical therapists to safely and effectively relay nutritional information to patients. If you are interested in the physiology, I believe Lily Mercer provided an excellent succinct, but encompassing review of nutritional advice for the acute phase of tissue healing here. You can also visit the Nutrition Evidence Library or Authority Nutrition to educate yourself via reputable sources.
On that note, most physical therapists are NOT interested in reading and learning the literature on nutrition (maybe not you, because you’re special!). I posted a poll to over 13,500 practicing clinicians in Physical Therapy. I got about 60 responses with mixed results: a minority of clinicians responded that they never educating on nutrition, some stated they will bring it up during an initial evaluation, and a majority reported they field questions only when asked.
There are likely a plethora of reasons why this is the case, including, but not limited to: time, knowledge, and controversy over what is within our scope of practice. Either way, I believe that if we are to provide best possible rehabilitation, we should be able to field their questions appropriately. In my time spent in outpatient and even in inpatient rehab I have heard countless times from patients “I really know I should lose weight, but don’t know where to start”. All we need to do is provide some simple advice. I am a skeptic in a sense that I do not believe in providing a nutritional guideline to follow. Rarely have I seen long lasting patient adherence despite some of them having the motivation to actually make these changes.
Instead, I provide my patients and clients with a very simple initial piece of advice, which has been life changing. It is very straightforward; it does not require significant cognitive effort, rigorous planning, or time consuming meal preparations. I tell my patients to eat a fruit or vegetable at every meal.
Advice this simple is sometimes hard to grasp. I myself often overlook how important simplicity can be, and like to make things more complicated (read some of my other posts for examples). If you want it to be complicated, you can come up with any number of basic scientific components that make up this recommendation – ↑ fiber,↑ phytochemicals, ↑ folic acid,↑ fat soluble Vitamins, and the list goes on. Either way, they are taking a step towards actionable and achieving a small goal with the ultimate purpose of creating habits and meeting an overall larger goal. Note: I will talk about the stages of change more in the future when I review the book Changeology.
The conceptual basis is somewhat like triaging their nutritional deficits. Lets compare this to PT: If I had a patient post total knee replacement, I would not work on knee flexion, core stability, lifting technique, stair descent, and hip strengthening all on day one. It is likely these will be integrated throughout a full plan of care, but again, we are taking this one step at a time.
Eventually, assuming they kept themselves accountable (or you did), the patient will make eating colorful fruits and vegetables a habit. And they will probably be surprised with how they great they feel! Most people feel better with ANY change to their diet. For example, it is not uncommon for people to feel a significant improvement in energy during “detox” diets, which actually restrict calories (the body’s main source of energy). However, it should be noted that if they are unable to follow these directions or you feel as though they need a higher level of intervention, they may benefit from referral to a nutritionist.
Depending on their plan of care, the next advancement is to provide them with information of more substance. At this point, I still do not provide them with a written diet plan. At this stage, I promote an internal locus of control and provide some handouts or the links to the government recommendations via MyPlate or the Nutrition and Health section of the U.S. Department of Veterans Affairs. I let patients educate themselves, with my help to field questions, so they can create a sustainable lifestyle.
This next step should be at discretion of the clinician. Timing is everything with behavioral change. If the patient requests more information and they are compliant with your initial recommendation, go for it. If it is towards their plan of care, maybe it is time to provide their handouts. This way, you do not miss out on a critical, actionable moment where they are motivated to make lifestyle changes.
In the past, a lot of debate has come about around the US government’s nutritional recommendations because of the food pyramid and what percentages of macronutrients are best. The funny thing is, the foundation of these debates, whether true or false, probably do not matter to the person asking your advice on weight loss. As stated earlier, a majority of our patients will see benefit from any change to their diet. At some point, we need to take the principle of simplicity and provide education on the basics: eating correct portions, consuming recommended daily nutrient amounts, and meeting physical activity guidelines. These are ALL listed in the links listed below in simple lists. You would be surprised how these intuitive recommendations are to us as healthcare professionals, yet they are poorly understood to the general public. It is probably somewhat similar to how my tax preparer feels about me each year I visit her. And now, I will end on that note…
Make simple recommendations. DO NOT provide specific advice if you are not well versed in nutritional literature. Let patients educate themselves (with some guidance) for sustainable, healthy lifestyles which can be made in the kitchen. If you believe that they are at high risk due to comorbidities, poor adherence, or psychological factors keep a referral source on hand as well.
“Give a man a fish, he eats for a day. Teach a man to fish, he eats for a lifetime” -Lao Tzu
“Give a (wo)man a healthy meal, they eat healthy for a day. Teach a (wo)man to cook healthy, they eat healthy for a lifetime” –Jared Burch
Here are some links of handouts you can provide in your clinic:
- Add more vegetables
- Reach your nutrition goals
- Healthy mealtime tips
- Enjoy your food, but eat less
- Vary your protein routine
- Eating Healthy with Diabetes
- Mediterranean Diet
- Heathy eating tips for truck drivers
- Prevent weight gain when quitting smoking
- “Yummy benefits cook book II”
These are just 10 out of over 100 free sources from the U.S. Department of Agriculture.
Thank you for reading,
Jared Burch, PT, DPT