What does a 'Nutritional therapist' do?

What Does a Nutritional Therapist Do?

Have you been dealing with ongoing symptoms and feel like no one’s joining the dots? Maybe you’ve tried diets, supplements, or read endless articles online, yet nothing seems to stick. If this sounds familiar, you might be wondering if a nutritional therapist what could help.

With growing public interest in functional medicine and personalised, preventative care, nutritional therapy is gaining interest. There’s still confusion about the role, who is qualified, and how it differs from general nutrition advice. This blog explains it all.

Nutritional Therapists Offer Personalised, Evidence-Based Health Support

A nutritional therapist applies the science of nutrition and lifestyle medicine to support individuals with a wide range of health concerns. This can include digestive problems, fatigue, hormonal imbalances, immune issues, and more.

They work in a one-to-one setting, assessing each client’s health history, symptoms, diet, lifestyle, and environment to identify potential imbalances. Then they create a tailored plan that supports the body’s ability to heal and function at its best.

Nutritional therapy is:

Personalised – considering your unique biology, history, and lifestyle
Science-informed – based on the latest research in nutrition, epigenetics, and systems biology
Holistic – looking at the whole person, not isolated symptoms

The aim is not to diagnose or replace medical care, but to complement it with targeted nutritional and lifestyle recommendations.

What a Nutritional Therapy Consultation Looks Like

A consultation with a Registered Nutritional Therapist typically involves:

Detailed case history – exploring symptoms, medical history, family history, diet, lifestyle, and environment
Analysis of diet and nutrition status – sometimes supported by laboratory testing
Individualised plan – including food, supplementation, lifestyle changes, and referrals if needed
Follow-up support – adjusting the plan over time based on response and progress

This process helps the therapist and client build a picture of how different factors may be contributing to the client’s health status and how to support improvement in a structured, measurable way.

What to do if you have been told your blood 'fat' ratios are too high.

This blog is version 2 if you like following on from my ‘Know your numbers’ blog. If your numbers reveal that blood fats are too high what can you do?

There is a lot you can do with diet, lifestyle and exercise as well as supplements. I highly recommend working with a health practitioner but I have summarised some of the key initial steps below:

Keep the sugar and processed carbs low,
A low GL Mediterranean diet is ideal
Stop smoking.
Make sure you are eating enough soluble fibre – this helps to bind to cholesterol so it can be excreted from the body.
Eat healthy fats – avocado oil, olive oil, coconut oil, nuts and seeds, wild oily fish
Make sure you’re topped up on antioxidants – think eat the rainbow but also supplementing with vitamin C and fat soluble vitamins is key.
Raw garlic and onion are helpful for lowering cholesterol.
Avoid processed foods they often contain high levels of sugar and trans-fats as they are generally made with cheaper seed and vegetable oils. These oils are delicate (poly unsaturated fatty acids) and can oxidise to trans fats during the manufacturing process or when being re-heated at home.
Avoid trans-fats – this includes ready meals, prepared sauces and salad dressings which often contain them – see point above. Crisps and fried food contain trans-fats. Even home prepped food can create trans fats if we cook with the wrong type of fat such as vegetable oil or seed oils or heat food excessively. If you would like a copy of my handout on which fats to cook with please drop me a line.

As well as the markers in the ‘Know your numbers’ blog https://helenmaxwellnutrition.co.uk/key-health-metrics/ there are a couple of other measurements to keep track of. Your omega 3 fat ratio in your cell membranes is an important marker to keep an eye on which should be between 8 - 12%. In most Europeans this marker is 4% or lower. I have written about this in a separate blog here: https://helenmaxwellnutrition.co.uk/testing-for-omega-3-ratio-in-cell-membranes/.

Your Hba1c marker which measure diabetic risk is also a good marker to monitor. It provides an average of your blood sugar levels over the previous 90 days. Remember if we aren’t burning off the sugar we eat and if our glycogen stores in our skeletal and heart muscle are full then the excess will be turned to fat.

There are numerous key supplements from essential fatty acids, Co Q10 and enzymes such as nattokinase, which can help improve levels of lipids (fats) in the blood. However you need qualified advice to identify the ones most suitable for you and also the correct dose.

Hope this helps to guide you and feel free to contact me if you have questions or are concerned about your own numbers.

Know your numbers

This blog was inspired by an article written by a lady who had a heart attack at the super young age of 42. She did have high cholesterol and some significant family history but it really highlighted to me that ‘knowing your numbers’ is a good thing. I am generally a cautious tester for various reasons. It can make clients anxious and there is often a lot of work you can do just based on a client’s diet and lifestyle questionnaire. However knowing certain key health numbers can also save a life, help with motivation and direct a client’s protocol for maximum support.

HDL cholesterol

Here are the top line numbers we should be aware of and why.

Known as the good cholesterol, low levels of HDL are linked to an increased risk of heart disease. Cholesterol has a metabolic cycle in the body and if this is functioning well your LDL (known as ‘bad’ cholesterol) will be converted to HDL (known as ‘good’ cholesterol) and returned to the liver with any excess being excreted. It’s the overall pattern and clinical picture that matters so if you are unsure what your numbers mean it’s best to talk to your GP or health professional.

OPTIMAL LEVELS ARE:

Total cholesterol - below 5 mmol/L
HDL cholesterol – 1 mmol/L or above

Triglycerides

High triglyceride levels can indicate elevated levels of fat (lipids) in the blood. This figure is measured with a blood test. Remember that fat in the body is not just from fat in the diet. Any sugar that we eat in the diet that the body can’t immediately utilise for energy will be converted to fat. Sugar in the diet is not just from fruit or added sugars such as honey, syrup, sugar etc. We also convert starch from grains and vegetables to sugar during the digestive process and subsequently to fat if your cells and sugar stores (glycogen) are already full. The more processed and refined the food, the quicker this conversion happens.

OPTIMAL LEVELS ARE: below 1.7mmol/L

Blood pressure

High blood pressure stresses your heart and blood vessels, which increases the risk of cardiovascular disease. Healthy blood pressure is a marker of overall metabolic health. We need to manage stress, exercise regularly and maintain a healthy body fat percentage to regulate our blood pressure.

OPTIMAL PRESSURE IS: 120 /80 mm/Hg systolic/diastolic.

Waist to hip (WHR) ratio

Divide your waist circumference by your hip circumference to obtain your WHR.

WHR measures the ratio of your waist to your hip circumference. It determines how much fat is stored around the waist, hips, and buttocks. It is an easy, inexpensive, and generally accurate way to assess the body’s proportion of fat. This is important as not all excess weight carries the same health risks. It can help predict your risk of heart disease and diabetes when reviewed alongside other health markers.

OPTIMAL ratio is:

Men should be more than 1.0
Women should be more than 0.8

Waist circumference

This is another marker for assessing abdominal obesity which is associated with increased health risks and metabolic conditions such as diabetes and heart problems.

OPTIMAL ratio is:

Men should be less than 102 cm.
Women should be less than 90 cm.

I hope you have found this guide to your top-level health markers useful. Remember no test is perfect and no test can fully convey the complexity of your health. To understand your full health picture there are many factors to take into account including information about your diet and lifestyle.

My next blog will summarise how to improve the body’s blood fat picture.

You can read the full article that prompted this blog here: https://www.womenshealthmag.com/uk/health/conditions/a64363807/young-heart-attack/

Vitamin D – test don't guess.

Picture source https://www.anhinternational.org/campaigns/test-take-vitamin-d/

Forms of vitamin D

There are two major forms of vitamin D from two different sources.

Vitamin D3 (cholecalciferol) is our main source (80-90%) and it is produced in the skin following sunlight exposure but it is also found in foods of animal origin. Technically this makes vitamin D a pro hormone.
Vitamin D2 (ergocalciferol) is found in foods of vegetable origin and supplements

A whole host of factors affect how much vitamin D our bodies can make including:

how much skin we expose to the sun
the height and angle of the sun in the sky
the time of year
the duration of exposure
the health (and age) of our liver and kidneys
how well we digest and absorb our food especially fats
excess weight seems to reduce our vitamin D levels
levels of inflammation in the body

Sources of Vitamin D in the diet

In the UK our main dietary sources of vitamin D are food of animal origin, foods fortified with vitamin D and supplementation. Naturally rich food sources include egg yolk and oily fish such as salmon, mackerel, herring and sardines.

Food sources	International Units (IU)
Salmon 140g	408
Mackerel 140g	476
Sardines canned 140g	184
Mushrooms 80g (enriched)	128
1 egg	64
Tuna 140g	60
Beef mince 100g	24
Lamb 90g	20
Butter 10g	4

Vitamin D content is taken from British Nutrition Foundation ‘Vital vitamin D’ resource sourced from McCance and Widdowson's The Composition of Foods: Seventh Summary

Role in the body

Vitamin D plays an important role in musculoskeletal health and neuromuscular function because of its’ role in regulating calcium and phosphorus balance in the body. It also helps regulate magnesium absorption. Vitamin D is therefore vital for bone mineralisation, growth and health. It has other roles especially in immune regulation, insulin sensitivity and heart health.

Vitamin D ideal blood levels

Dr Damien Downing, president of the British Society for Ecological Medicine and vitamin D expert, recommends a vitamin D blood level of at least 75 nmol/L for immune support and levels over 100 nmol/L to lower your risk of cancer and autoimmune disease.

How much to supplement

A general guideline for adults over the age of 18 is around 25 mcg (1000IU) but it very much depends on your baseline blood level. It’s always best to do a test as they are quick, easy and economical blood spot kits. A recent study has shown that 20mcg of vitamin D per day was effective at bringing middle-aged and older adults to vitamin D sufficiency over a 4-week period. It’s also best to retest and discontinue once blood levels of 100 nmol/L are achieved. Fat soluble vitamins can be stored in the body and over 125 nmol/L is considered to increase the risk of adverse events.

Magnesium and K2 may also be required to optimise conversion to the active form and hence optimise absorption.

References

Aislinn F. McCourt, A.F. et al (2023) Serum 25-hydroxyvitamin D response to vitamin D supplementation using different lipid delivery systems in middle-aged and older adults: a randomised controlled trial. British Journal of Nutrition 130 pp.1548–1557. doi:10.1017/S0007114523000636

Bikle, D.D. (2009) Vitamin D and immune function: understanding common pathways; Curr Osteoporos Rep; Jul; 7(2); pp.58-63. doi: 10.1007/s11914-009-0011-6.

SACN (2016) Vitamin D and Health; The Scientific Advisory Committee on nutrition; Available from https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition. (SACN)

The 56 names of sugar

Trying to cut out sugar?

This blog is just for your info if you are trying to cut out sugar. Sugar has so many names. This graphic contains 56 names which are basically all sugar. There are probably more by now but this picture might be useful for you to help remember.

Silent reflux - what is this?

Over 112 million people in Europe, about 20% of the population, are estimated to suffer with acid reflux. Acid reflux occurs when acid from the stomach flows back up into the tube running from the throat to the stomach (the oesophagus). This causes a burning sensation known as acid reflux or heart burn.

Silent reflux occurs during the night and is so named as people often don’t know it is happening. One of the most common symptoms is an unexplained need to cough frequently or clear your throat a lot. This is due to the erosion of the protective mucus which lines the oesophagus or irritation and damage to the cell membrane itself.

Both acid reflux and silent reflux are often treated with medication to reduce the level of acid in the stomach. Too much stomach acid is rarely the issue however, it’s more about stomach acid escaping from the stomach, where it belongs. In fact, both conditions often arise initially due to low levels of stomach acid and digestive enzymes, which frequently decline with age. As digestive function declines the bacteria in the gut (microbiome) can become imbalanced leading to dysbiosis, bloating and gas, or conditions such as small intestine bacterial overgrowth (SIBO). These issues increase the risk of bacterial fermentation, instead of digestion of food. Fermentation causes gas which can lead to a buildup of pressure in the gastrointestinal (GI) tract. If this causes the sphincter at the top of the stomach to open and the acid will reflux, causing burning.

My approach

I am always looking for the root cause of health problems and acid reflux is no exception. There are many steps which can be taken to improve digestion and acid reflux symptoms.

Acid suppression medication from your GP can help with immediate symptom relief and may be needed initially to protect the lining of the oesophagus. It is best not to rely on this long-term however, so we would look to investigate root causes. Is it poor digestive function, bacterial overgrowth or imbalance or are there any structural issues such as weak diaphragm muscles, weak sphincters, hernias, ulcers? Parasites or fungal and yeast infections also need to be ruled out.

Sometimes simple diet and lifestyle changes are all that is required. We will often work to take the pressure off your digestive system whilst starting to improve digestive capacity. There are also some key practical steps that can help such as losing weight, avoiding eating just before bed or avoiding key food triggers such as alcohol, caffeine, spices and chocolate.

Acid reflux symptoms

Common	Less common
Heartburn	Voice changes
Chest pain	Hoarseness
Dry cough	Sore throat
Nausea	Difficulty breathing – asthma symptoms
Thick and bubbly saliva	Teeth damage
Pain in the upper part of the abdomen	Damage to mucous membranes in the mouth

Get in touch

If you would like to get to the bottom of your acid reflux, please get in touch for a free initial chat on 07740 876233. I would love to help you.

References

Holzer, P. (2007) Acid sensing in the gastrointestinal tract; American Journal of Physiology Gastrointestinal and Liver Physiology 292(3): G699-G705 doi: 10.1152/ajpgi.00517.2006

Eom, C-S. et al. (2011) Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-anlaysis. Canadian Medical Association Journal; 183(3) pp.310-319. doi: 10.1503/cmaj.092129

What fats can I cook with?

This blog is a reminder of which fats to use for cooking and which ones are best used cold in salad dressings. It also covers which ones to avoid.

Fatty acids are classified according to the presence and number of double bonds in their carbon chain. Saturated fatty acids (SAFA) contain no double bonds, monounsaturated fatty acids (MUFA) contain one, and polyunsaturated fatty acids (PUFA) contain more than one double bond.

This table above shows the fatty acid composition of various culinary oils.

You can see from the table above that oils tend to be classified according to their largest constituent. We need to cook with oils which are stable when heated and therefore have a high smoke point. The more double bonds a fatty acid has, the more unsaturated and unstable it will be, especially when heated.

The most stable fats are solid at room temperature, so lard etc. Olive oil (virgin/extra virgin) is pressed straight from the seed or fruit without further refining. There is research to show that the phenols in unrefined olive oil protect it from degradation during cooking (Ramirez-Anaya, 2015).

Oils such as rapeseed, sunflower and vegetable are obtained by washing and crushing the seeds, and then using processes such as heating, hexane, solvents, extraction, processing, bleaching, deodorization and peroxide to maximise production volume. As these oils are highly unsaturated (many double bonds) the risk of oxidation from processing is high, either during processing or if used to cook with. Most of these oils are also much higher in omega-6 than omega-3. As our diets tend to be more deficient in omega-3, I focus on hemp and flax (small amount) which have a 4:1 and a 0.3:1 ratio respectively (o-6:o-3) to try to redress this. I also advocate cold pressed and organic versions to preserve quality and nutrient content.

The following table is a guide Whether you wish to cook with animal fats will depend on various criteria including your health and dietary preferences as well as your ability to digest and absorb fat.

Which fat to cook with and which to use for dressings and drizzles

REFS: Del Pilar Ramírez-Anaya, J. et al (2015) Phenols and the antioxidant capacity of Mediterranean vegetables prepared with extra virgin olive oil using different domestic cooking techniques. Food Chemistry Vol 188; pp. 430-438.

Essential fatty acids explained

Image source: https://www.eufic.org/en/whats-in-food/article/the-importance-of-omega-3-and-omega-6-fatty-acids

What they are and how to make sure you eat enough.

There are two fats that humans have to eat as the body cannot make them and they are required for specific functions. They are called omega-3 (ω-3) and omega-6 (ω-6) and known as essential fatty acids (EFA’s) for this reason. They are both polyunsaturated fatty acids (PUFA’s) which means that they have more than one double bond between their carbon back bone. They get their name from the carbon number where their first double bond appears (see pic).

In the diet omega-3 is found in flax, hemp, pumpkin and chia seeds as well as walnuts. The end products of omega-3 (ALA) that the body requires are called EPA and DHA. Fish already contains both which is why it is such a good source, as the body doesn’t need to convert it. The conversion from other sources is very small and many people struggle with it, hence the oily fish recommendation.

Omega-6 is found in vegetable oils from seeds of corn, sunflower, safflower, cotton and soybeans. It is also found in evening primrose oil, borage, starflower and blackcurrant oils. It is converted to a downstream product known as arachidonic acid (AA). This end product (AA) is freely available in meat, egg and dairy products.

Our intake of omega-6 tends to exceed omega-3 considerably due to the nature of most people’s diets and the relatively recent availability of vegetable and sunflower cooking oils. My parents are over 80 but my mum can still remember how she queued up in the grocers to buy a slab of butter, wrapped in greaseproof paper. Most processed foods and ready-made dressings, sauces and jars also contain omega-6.

Research scientist Simopoulos (2002) believes we historically consumed equal amounts of omega-3 and omega-6, a 1:1 ratio. We now consume 15-16.7 times as much omega-6.

Omega-3 and omega-6 fatty acids are however both important components of cell membranes. During the conversion process they produce downstream products (eicosanoids) which regulate our inflammatory responses. Omega-3 eicosanoids are known to have anti-inflammatory effects. The eicosanoids from omega-3 tend to be more anti-inflammatory and anti-coagulatory than omega-6, which produces both inflammatory and anti-inflammatory versions.

Omega-3 and omega-6 both utilise the same conversion enzyme (delta-6-desaturase) so theories have arisen that one process will deprive the other. A high omega-6 intake is thought to reduce the availability of this enzyme and so diminish our omega-3 conversion. This theory and the concept of an “ideal” ratio in the diet is contested but it is generally thought that a ratio of 4:1 (ω-6: ω-3) is optimum.

The European Food Safety Authority concluded that 250 mg a day of EPA and DHA was adequate. They also found that European intake was too low at between 20-40 mg per day for EPA and less than 100-130 mg per day for DHA.

It’s kind of difficult to think about ratio’s when you are out shopping or planning your menus, so this is the way I tend to advise clients. Providing your digestion is good then generally you can obtain enough EPA and DHA by consuming oily fish 2-3 times per week. Otherwise supplementation is likely the best option.

References

https://pubmed.ncbi.nlm.nih.gov/12442909

https://efsa.onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1461

https://www.eufic.org/en/whats-in-food/article/the-importance-of-omega-3-and-omega-6-fatty-acids

https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/recommended-dietary-reference-intakes-nutritional-goals-and-dietary-guidelines-for-fat-and-fatty-acids-a-systematic-review/5C2EDA7CD9C4EAB094F8499B2E122E75

Are you super sensitive to chemicals, food, light and life?

Maybe you feel like you are allergic or reactive to everything and can’t understand why? There can be lots of different reasons for this but before we go removing this and that and trying to identify multiple triggers I like to ask the question “are your cell membranes working right?”

Our cell membranes act as the border control for our body. They control what gets in and what gets out. They act as both the gatekeeper and the hostess.

I recently wrote a blog called ‘Do your cells need an oil change?”. It explains why this is so important for the body to function well and how you can check your status. Go here to read this https://helenmaxwellnutrition.co.uk/testing-for-omega-3-ratio-in-cell-membranes/.

What happens though if your cell membranes are not in great condition? How would you know if this was a problem for you?

I like to think about it this way. Consider each of your cells as a tiny tent and imagine the tent fabric is your cell membrane. If it’s too floppy it will start to cave in and stick to you, or even itself, and the canvas will then start to leak. It’s similar with cell membranes. If they are too flexible and soft they won’t have the necessary structure to keep out undesirable molecules and toxins.

A properly pitched tent will have the necessary structure to filter out what isn’t required (rain). If the material is too rigid though, or poor quality or not breathable it will prevent air circulation. This might mean the inhabitants overheat or don’t breathe properly. Similarly if the tent shape creates too much wind resistance, the poles might break and the tent (membrane) could collapse. Inside your cells this could mean vital nutrients aren’t absorbed or they don’t receive sufficient energy or oxygen to function well.

A change in your cell membrane composition can have a multitude of downstream effects. If your cells aren’t properly nourished this can cause irritability and sensitivity in your body. You might become intolerant to chemicals and foods that were previously fine. Your pain threshold might become much lower. Your eyes might become much more sensitive to light, your tolerance to temperature fluctuations might diminish or touch sensitivity can become problematic. This issue can also be a factor in cardiac dysrhythmias and, if the cells in the brain are affected, brain energy supply will suffer and we get so called ‘brain fog’.

If we want our cells to perform their roles then we must nourish our cell membranes. This means we need to digest our food properly, so we need good levels of stomach acid. We need to absorb our food well which requires good enzyme function and a healthy intestinal barrier. We also need to eat enough fat in our diet of the right type. Fat digestion involves many steps and processes and requires good pancreatic and bile function. This means there are multiple links in the chain which can be vulnerable to malfunction. The good news is all of this can be helped with protocols to improve digestive function, bile function and addressing any deficiencies in diet or micronutrients.

Do your cells need an oil change?

Today’s modern diets can often mean we eat too much or too little fat, or frequently just the wrong type. Our cell membranes consist of lots of oil aka. fat. For optimal performance they require quite a specific ratio of different types of fats, especially with regard to the essential fatty acids (EFA’s), omega 3 and 6. If these are out of sync, cells can malfunction a bit like trying to run your car on the wrong type of oil or petrol.

Cell membranes are your cells’ border control. They control what gets in and what gets out. They act as both the gatekeeper and the hostess.

Every cell in your body has a cell membrane and your body has a lot of cells. Experts think we have in the region of 30 trillion, and we want every one of these to have a healthy cell membrane. If your cell membranes are working correctly, they will let micronutrients in and waste products out. As well as supervising which molecules can enter and exit, most cell metabolism takes place in, on, or around this location. It’s like your very own production line inside you, manufacturing energy and proteins, and churning out waste products such as urea and toxins.

The next thing to understand is that their structure is critical to how well they function. We don’t want them to be too rigid or nothing will get in, or out. We also don’t want them too soft and floppy. This might allow too much in or too much out and over time this could cause multiple issues.

So how can we nourish them and maintain their structure so they can function properly? Firstly, the fat they contain needs to be eaten, as the body cannot make it. Some of these fats have special functions such as the EFA’s. There are many arguments about the correct ratio of fats to eat in the diet but researchers generally agree that we tend to be more deficient in omega 3 which is found in fish, nuts, seeds and vegetable oils.

So by now I think you get the idea that I like my clients to achieve healthy cell membranes because “the stronger our cells the more resilient our selves”.

It’s easy to check our ratios with a simple finger prick test because the concentration in our blood has been found to strongly reflect our dietary intake. The current European average for our omega 3 percentage is less than 4% but research confirms that 8% is optimum, and that this ratio is associated with a 90% reduction in risk of sudden cardiac death.

There is nothing like analytics to demonstrate to my clients (and me) that we either need to work harder on our diet or take targeted supplements to give our cells what they need to function tip top.

https://pubmed.ncbi.nlm.nih.gov/18541601