Obtaining Diet Data
1. Recall interview: This is what I use in my practice. The recall interview should focus on the general, rather than the specific. Most people get 80 percent to 90 percent of their calories from less than 15 different foods. Therefore, the goal of the interview is to determine what foods are consumed regularly. Points to remember include the following:
- Breakfast varies less than lunch, which varies less than dinner.
- Include midmorning, midafternoon, and evening snacking.
- Remember that it is common for individuals to underestimate the quantities of food they consume - especially the bad stuff.
- Don't forget liquid calories: Fruit juice, milk, soda, alcohol, sports drinks, fruit drinks, sweetened teas, and upscale coffee drinks should be noted.
- Don't worry about details. Whether it is two, three or four pieces of fruit a week, the impression should be the same - not enough.
2. Diet Diary: The diet diary is most useful following the consultation. Diet diaries are more accurate when people write down what they eat and drink immediately following a meal or a snack, rather than waiting until the end of the day. Diet diaries can influence what a person eats and drinks, because he or she knows the data will be reviewed by the clinician. That's why, when used prior to the initial consultation, they often do not accurately reflect normal caloric intake. When employed following the consultation, they can reduce the temptation to eat and drink nonrecommended foods and inform the patient about what and how much is really consumed.
3. Food Questionnaires: There are various food questionnaires available, many of which are provided free of charge or for a nominal fee from supplement companies. They are best used as an adjunct to a recall interview, rather than as a stand-alone method to determine the type, amount, and quantity of food a patient commonly consumes.
4. Computer Analysis: There are many computer programs available to help analyze a patient's diet. The better programs can be quite helpful. However, relying solely on a computer analysis without the necessary background is not in the patient's best interest. The amount of information a trained clinician can obtain from a detailed history can impact what is recommended. No program is free of flaws, which may not be recognized by an undertrained clinician.
When a patient's diet is obtained, the clinician should be able to determine the approximate:
- amount of calories consumed on a daily basis;
- amount, type and quality of protein consumed;
- amount and type of carbohydrates consumed (including identifying the amount of simple carbohydrates and complex carbohydrates, dietary fiber, including both soluble and insoluble levels, and the approximate level of phytochemical ingestion);
- amount of dietary fat consumed, including saturated, polyunsaturated, and monounsaturated fats (enabling you to calculate dietary ratios of fats from the omega-3, 6, and 9 families); and
- amount of vitamins and minerals contained in the foods consumed.
Using the above information, your next step is to correlate the diet data with any diagnosed disorder, symptom complex, pertinent history, and physical findings. Once this is accomplished, you can inform the patient of any dietary recommendations or modifications.
Compliance, compliance, compliance! The easiest way to fail is to expect unrealistic change. The only way the person who eats 10 double cheeseburgers a week will stop cold is if he or she is diagnosed with a life-threatening problem, such as heart disease or cancer. For most people, gradual changes recommended every four to six weeks will help foster new, healthier habits without patients feeling overly restricted.
I've had a number of patients whose only change the first month was one piece of fresh fruit a day, or six sodas a week (down from 12-18 per week). My approach to the 10-double-cheeseburgers-a-week patient is to ask which option he or she would like to follow for the first month: 10 single cheeseburgers a week, or five double cheeseburgers and five grilled, skinless, chicken breast sandwiches. After four to six weeks, the choice is five cheeseburgers and five chicken sandwiches per week, or two double cheeseburgers, three turkey sandwiches, and five chicken sandwiches. (This assumes the patient likes turkey and chicken. If not, I find out what he or she does like, and recommend that). This pattern of gradually improving the type and quality of food continues until both patient and clinician feel satisfied.
G. Douglas Andersen, DC, DACBSP, CCN
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