Functional testing is increasingly considered an essential tool in providing more personalized patient care and promoting better outcomes. For example, by measuring nutrient levels, clinicians can monitor a key component of overall wellness and increase patient compliance with treatment plans. Nutritional assessments provide an additional level of baseline assessment for practitioners to build a treatment plan, and more comprehensive panels can help uncover areas of concern. However, there are benefits to a deeper inspection of a new patient’s nutrition that go beyond the typical intake questionnaire. This comprehensive but quick assessment—coupled with the laboratory tests you rely on—can paint a clearer picture of your patient.
Ashely Koff, RD, founder of The Better Nutrition Program, has spent over 20 years honing her approach and helping patients achieve better outcomes utilizing a total nutrition assessment tool. She knows that more personalized care is the cornerstone of any functional medicine practice. Koff believes that practitioners and patients genuinely benefit from starting with a more complete and comprehensive understanding of all the factors involved in maintaining an optimal diet.
She designed her total nutrition assessments to help uncover all the missing pieces and paint a clearer picture of her patients. Koff shared her thoughts on the benefits of her total nutrition assessment and some interesting case studies with Fullscript. You can watch the hour-long session here or continue reading below for some highlights and key takeaways that you might find interesting.
Starting with a better definition of better nutrition
Ensuring the practitioner and patient are on the same page is essential. That means providing a clear, common understanding of what “better nutrition” means. As Koff explains, “I had to define what puts the better in nutrition, and this is what we have to focus in on when we’re talking about that goal of getting and keeping better health.”
There are so many complicated definitions out there. It’s helpful to simplify them. Koff describes her definition of “better nutrition” in two equal parts: “Better nutrition is giving the body what it needs to run better AND avoiding or reducing the intake of ingredients that can irritate, overwhelm, or disrupt those efforts.”
Patients can address one or the other, but the path to better health begins by integrating both. Once this understanding is established, it’s easier for practitioners and patients to work towards achieving their wellness goals.
Building a clear roadmap to care
When you know where you are going, the real question is: how do we get there? Koff believes a total nutrition assessment is at the core of mapping this path. Her process provides a more complete picture beyond basic diet questions, including skin care, medications, and beverage intake. The goal is to get all the information possible and avoid missing any form or nutrient. Koff explains, “If the foundation on which you build your plan is full of holes, you won’t have a better foundation. If you’re missing things, you won’t have a complete plan.”
Koff knows that while this approach feels like it’s at the core of functional medicine, there are challenges along the way. “We train this way in integrative medicine, but we don’t have the time, and it isn’t easy,” Koff explains. And we don’t necessarily get the information that we need from our patients, especially at the time that we need it.”
Koff insists it’s well worth the extra effort for the success of her patients and her practice. She encourages practitioners to consider whether the “15-page intake form” actually provides the necessary information. “If your clients are filling it all out and you feel like it really has them arriving and understanding what you’re gonna talk about, great,” she explains. “I found that none of the intake forms that were out there could do what I need to do as efficiently as these three quick pages of questions.”
Still, her total nutrition assessment isn’t one-size-fits-all. Koff has found that different versions of the form work better for different people. “I’ve learned from one of my favorite men’s health experts, Dr. Myles Spar, that how we talk to men, how we ask questions, and things like that, need to be done differently,” explains Koff. From men’s health to heart health, she has worked to develop a variety of assessments to better serve her needs.
Whichever version she turns to, she uses it to map out the conversation she plans to have with her patient. She knows she walks into those appointments well-informed about what needs to be discussed, areas of concern, and what testing she feels might be appropriate.
Kalish explains, “If you’re assuming omega-3s are low then omega-6s are normal or high,” Kalish explains, “and you’re certainly not thinking about giving people a ton of omega-6s. But what you’ll see in labs, some people who aren’t low in omega-3s are actually very low in omega-6s. And in the sense that we don’t even really have a word for this. They’re under-inflamed, I don’t know what the term is, but you can actually have not enough omega-6s.”
Bringing other practitioners along for the ride
Koff knows winning within the first three months is key to patient compliance. While she has many tools to help her get there, she’s passionate about starting patients off with a digestive tune-up.
“It’s not a reset. It’s not curing. It’s not restoring, replenishing, or doing everything. It’s just a tune-up.” She continues, “It’s like going on a road trip, and before you go on the road trip, you get your car checked out because it would be nice to avoid things that could be avoided.”
The most important part is making sure the patient never feels alone. Often, this means including their doctor in the process, working together towards compliance and better outcomes.
“I work with a lot of practitioners that aren’t integratively minded and aren’t open to any of this at the outset,” she explains. “But as long as I can be clear and explain what I’m doing, and it doesn’t seem like I’m just sharing one thing or going off the rails here, then usually I can bring them on board.”
She has found that this collaboration hasn’t only led to greater patient compliance and understanding but also served as a steady stream of additional patient referrals. Overall, the partnerships have benefitted her patients and her practice.
The path to better outcomes is clear
Ultimately, Koff’s path to better outcomes is all about clarity. Start by creating a clear collective definition of success. Then, develop a clearer, more personalized picture of each patient’s nutrition. Lastly, be transparent by sharing your findings and plan with fellow practitioners who can help promote compliance.
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