June 8, 2018
We are pleased to present Ruth DeBusk, PhD, RDN as the featured member of the month! Ruth is a geneticist and clinical nutritionist with expertise in the genomics and nutrition aspects of functional medicine. A former professor and researcher in the genetics department at Florida State University prior to entering clinical practice, she has extensive research, teaching, and clinical experience and is the author of numerous journal articles, textbook chapters, books, and patents. Ruth is one of the founders of the Dietitians in Integrative and Functional Medicine DPG and served on its Executive Committee for the first couple of years as well as being the original newsletter editor for its first 4 years.
First, I’d like to say what a privilege it is to be one of DIFM’s featured members! I am so proud of where DIFM is today—clearly a leader in contemporary nutrition. If you could have seen our initial band of pioneers pushing the dream of registered dietitians being essential for the coming sea change in healthcare, you probably would have thought we were delusional! Back then dietary supplements, functional medicine, and alternative modes of therapy were only beginning to be taken seriously. I’d like to acknowledge members of DIFM’s original Executive Committee for their bravery in endorsing what was then a revolutionary approach for nutrition professionals. Their years of hard work in birthing the idea and creating a solid road map for future growth has allowed the DPG to be a long-term opportunity for forward-looking nutrition professionals. Lisa Fieber worked tirelessly even before the DPG was birthed, first to get the Academy of Nutrition and Dietetics to consider such a possibility and then as Chair for our first 2 years. She was joined by Cheryl Galligos as Vice-Chair, Rosalyn Franta-Kulik as Secretary, Pamela Williams as Treasurer, and myself as Newsletter Editor, which was then part of the Executive Committee. We also had essential support from various Academy Presidents—Judy Dodd and Jane White readily come to mind—and from members of the House of Delegates. Hats off also to all the subsequent leaders who carried this vision forward over the past 20 years. My apologies to anyone I’ve overlooked; it truly took a village to raise this DPG to the successful entity it is today!
What is your area of practice and how do you incorporate integrative and functional nutrition into your work?
My background is a combination of MS and PhD training in nutrition and food science and what is now genomics and epigenomics. My research focused on the genetic regulation of nutrient absorption and the functional consequences of changes in diet or in key genes involved in either the process of absorption itself (nutrigenetics) or the regulation of the expression of these genes (nutrigenomics). I was fascinated by the potential clinical applications of being able to identify an individual’s genetic potential—both for health and for disease—and then to influence whether one would be ill or well through nutrition. I continued this research focus as a faculty member in the genetics department at Florida State University and enjoyed every minute of that experience.
About the time genomic research and technology had progressed sufficiently that tests were becoming available for clinical use, an opportunity arose to associate with a busy gastroenterology practice that needed genetic analysis and counseling services for their patients with GI cancers. The clinic was amenable to my also offering nutrition services so this opportunity seemed like a good on-ramp for growing a practice focused on nutrition and genetics. At the same time I was just discovering the Institute for Functional Medicine and the world of the functional approach, which made total sense to me because of its biochemical foundation. Not surprisingly applying a functional approach was slow-going for the first couple of years at the clinic but in time became increasingly acceptable as patients improved. The physicians would often send me patients who had no discernible pathology following a thorough workup but were still feeling poorly. Nutrition would work its magic time and again and steadily grew to become a valued service for the clinic.
I’ve since practiced in various areas of nutrition using a functional medicine/functional nutrition approach and patients typically improve, often quite rapidly. There’s really no magic involved in the functional approach—the solution lies in being able to connect the dots from the often diffuse symptoms and incomplete patient history, to get to the root cause of the problem, and to apply the appropriate intervention but these are all skills that can be learned.
In 2011 I joined the very forward-thinking Cathy Snapp, PhD, Director of Behavioral Medicine at the Family Medicine Residency Program in Tallahassee to integrate a functional medicine/functional nutrition approach into residents’ clinical and didactic training and to teach the underlying science and clinical applications of the functional approach, nutrition, and nutritional genomics. An additional goal was to increase the integration of functional medicine/nutrition into the insurance model of care so that it would be more readily available to all regardless of economic status. Cathy and I wrote many a grant to support this work and over time were awarded in excess of $8 million in federal and state funding. External funding was critical to our being able to enhance residents’ exposure to functional medicine through access to international conferences in functional medicine and the associated networking opportunities, Institute for Functional Medicine training courses, and access to outstanding consultants who taught and mentored residents. We worked first with CEO David Jones, MD and then CEO Laurie Hofmann, MPH during this period and both were exceptionally generous in sharing educational opportunities for faculty and residents and tools and educational materials for their patients. As a result of their long-term vision we’ve been able to train a large number of residents and faculty and to establish a functional medicine clinic at the residency that serves the training needs of the residents and benefits patient health. My hope is that in the longer term such clinics at this residency and at the various residencies that have been piloting our programs will provide potential training opportunities for functionally-oriented nutrition professionals.
What are some of the results you have seen since integrating functional nutrition into your practice area?
In short, health can be restored to individuals with chronic disorders. Typically physicians and other providers expect to help patients manage their chronic disorders but don’t hold much hope for restoring health. It’s not that these caring providers don’t want to help patients get well. It’s that their training and practice conditions have not given them the knowledge, skills, experience, and time to implement this type of therapy. Health restoration to those with chronic disease requires expertise in multiple areas in order to make lasting behavioral changes: medicine, genomics, epigenomics, contemporary neuroscience, psychology, social work, nutrition and other lifestyle modalities, and coaching. It’s not realistic to expect the provider to be able to deliver in all these areas.
Our team has consistently demonstrated that functional nutrition is an integral part of chronic disease management and prevention, that chronic disease benefits from a collaborative care team approach, and that there’s a primary role on this team for a functionally-trained nutrition professional. Further, we’ve been able to model how a functional medicine/nutritional/behavioral/ lifestyle choices approach can restore the health of chronic disease patients across the economic continuum and that such an approach can be integrated into a traditional insurance-based practice model. Beyond the training for the physicians has been the recognition that nutrition therapy is essential for health and that other types of healthcare professionals can also make a difference in the health of their patients. For many providers, this type of experience is an eye-opener. It’s unlikely that healthcare will change overnight, but these small steps taken by a large number of healthcare professionals can have a long-term positive influence.
How does your culture influence your work?
Introducing most anything new into an established system seems to require swimming against the tide, which is never easy. I don’t see myself as a born trendsetter; I’ve just always done what I saw needed to be done. I’ve been fortunate to have a strong and broad science background and a gift for connecting the dots in complex situations so that I could wade into seemingly impossible situations and address reservations from others through experience and the ability to substantiate the genetic and biochemical logic behind my suggestions. I was confident that time would prove a course of action to be well grounded, whether or not it was immediately successful. That firm foundation gave me the patience to keep moving ahead.
Fortunately the genetics community has long understood the connection among genes, proteins, and physiological function; the influence of changes in the genes on function and how nutrition can help circumvent the physiological consequences; and the role of lifestyle choices (particularly diet) on gene expression. It was only a matter of time before that approach made its way into the medical community and clinical practice. The original scientific and medical leaders of IFM, Jeffrey Bland, PhD and David Jones, MD, had the foresight and stamina to consistently push for functional medicine to be grounded in the existing and emerging sciences and to welcome all types of clinicians and promote interdisciplinary collaboration. Their foresight was essential to the solid rooting of the functional approach into clinical practice, and later the integration of nutrition, genomics, and epigenomics into functional medicine.
Where have you completed most of your training in integrative and functional nutrition?
About the time I was establishing my practice I was introduced to functional medicine through a nutrition colleague who was strong in biochemistry and thought I’d be interested in lectures that Jeff Bland had recorded. Was I ever! Fortunately the Institute for Functional Medicine had recently been established, and I was able to attend one of the very early annual conferences and absolutely loved the experience. I met a wide variety of clinicians from all over the world who were looking for more effective ways to help their patients get better and who were eager to share with others what was working in their practice. That sharing spirit has continued and has certainly been an invaluable gift for my development in this area. IFM’s educational materials and clinical applications were also invaluable in developing my practice. The most effective teaching has come through practicing this approach with patients. It’s particularly educational for me when the patient is fully engaged as a partner in the process of getting well. Today nutrition is integrated into functional medicine and IFM offers a variety of educational programs and tools that provide a stepwise path for learning the functional approach, as well as tools for use with patients.
Additionally I regularly read the scientific and medical literature for new findings regarding chronic disease in general and specific disorders in particular. During my time at the residency my interests have expanded into the genetic and biochemical bases for behavioral change relating to lifestyle choices so that in addition to the nutrition, genetic, and functional medicine conferences I attend, I have also been exploring various neuroscience conferences and training programs.
What advice would you give anyone interested in learning more about integrative and functional nutrition?
Two exceptionally helpful resources are the Dietitians in Integrative and Functional Medicine DPG and the Institute for Functional Medicine. As a DIFM member we have numerous educational opportunities, from the excellent newsletter to webinars to FNCE, as well as opportunities for learning from experts practicing in this field through the electronic mailing list (EML) and through networking at FNCE and state conferences. IFM membership has also been invaluable. The IFM annual international conference is excellent and explores the scientific foundation and associated clinical approaches to various complex syndromes commonly seen in practice. You’ll also learn about new educational tools and have opportunities to connect with other practitioners. Additionally, IFM offers a path to certification in functional medicine that begins with the Applying Functional Medicine in Clinical Practice foundational course (now available online) and is followed by 6 Advanced Practice Modules (GI, Detox, Immune, Hormone, Cardiometabolic, and Energy) that dive more deeply into the 6 clinical nodes of the functional medicine matrix. Several of the APMs are available by live-streaming. Nutrition is an integral part of the functional medicine approach and is integrated into each of these educational opportunities.
I see the future for DIFM RDNs as limitless, whether in private practice or working in a clinic setting. Healthcare for those with chronic disease will change as the result of multiple collisions from several directions. The global population is aging, the number of patient visits relating to chronic disease is increasing, and the burden on primary care providers will continue to increase. As it becomes clear that chronic disease is lifestyle disease and that, with the appropriate functionally-oriented lifestyle-based behavioral change intervention chronic disease is preventable, pressure will be placed on the system (from insurance companies, from patients, and from healthcare professionals themselves) to deliver effective management and preventive health services. Physicians and other providers will benefit enormously from having RDNs who are functional medicine/functional nutrition competent and can understand the diagnosis and participate in the development and implementation of the therapeutic intervention. Such RDNs will be the recipient of provider-delegated services, will be expected to direct and oversee the health coaches who will soon enter healthcare, can conduct or oversee the conducting of educational programs (including group medical visits), and can serve in other capacities of importance to the practice, such as the certification process for Patient Centered Medical Home designation, which is critical for reimbursement level.