nutritional therapy essay

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• Acta Biomed
• v.93(1); 2022

Nutritional interventions during adolescence and their possible effects.

Ashraf soliman.

1 Department of Pediatrics, Hamad General Hospital, Doha, Qatar; Qatar

Nada Alaaraj

Fawzia alyafei, shayma ahmed.

2 Dietetics and Nutrition, Hamad General Hospital

Rania Elalaily

3 Doha, Primary Health Care, Doha, Qatar

Nada Soliman

4 Primary Health Care, Alexandria, Egypt.

Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini review sums up some important findings in this important complex that link between nutrition, nutritional interventions, and pubertal development. ( www.actabiomedica.it )

Introduction

Puberty entails a progressive nonlinear process starting from prepubescent to full sexual maturity through the interaction and cooperation of biological, physical, and psychological changes. Nutrition is one of the most important factors affecting the onset and progression of pubertal development. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Puberty triggers a growth spurt, which increases nutritional needs including macro and micronutrients. Increased caloric, protein, iron, calcium, zinc, and folate needs must be provided during this critical period of rapid linear growth and bone accretion. Moderate and severe primary or secondary malnutrition can adversely modulate the onset and progression of puberty. The higher incidence of nutritional deficiencies and anorexia nervosa in adolescents imposes a nutritional risk on pubertal development and final adult stature.

Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries, who require nutritional rehabilitation ( 1 ).

Pubertal growth spurt and nutritional requirements

Nutrition during adolescence should meet the following objectives:

• Provide the necessary nutrients to meet the demands of physical and cognitive growth and development.
• Provide adequate stores for illness or pregnancy.
• Prevent adult onset of diseases related to nutrition e.g., cardiovascular diseases, diabetes, osteoporosis, and cancer
• Encourage healthy eating habits and lifestyle.

According to the Dietary Guidelines for Americans 2010, girls ages 9 to 13 generally require

1.400 to 2.200 calories and teen boys ages 14 to 18 require 2000 to 3200 calories per day to maintain healthy body weights. Girls ages 14 to 18 usually need 1.800 to 2.400 calories/daily during puberty. Active pubescent girls require more calories than those with low activity levels

( Table 1 ). Teenage athletes who regularly participate in vigorous sports training may require up to 5,000 calories per day ( 2 ).

Dietary Guidelines in adolescents (by the Advisory Committee. Dietary Guidelines for Americans 2010. (Source: https://health.gov/Dietary Guidelines 2010).

Tracking changes in dietary intake during puberty and their determinants in different populations

Understanding changes in dietary intake during puberty could aid the mapping of dietary interventions for primary prevention. Few studies available describing habitual dietary intake during puberty, differ in terms of study design, follow-up period, data collection methods, age of subjects, and study location. Dietary behaviors observed, range from specific food items or food groups to broader dietary patterns, including a range of foods ( 3 - 9 ).

An assessment of the current diet and nutritional status in many Asian and African countries proved deficient intake of macro and/or micronutrients in a large proportion of adolescents ( Table 2 ) ( 10 - 13 ).

Summary of dietary intake of Adolescents in some LMIC Asian and African countries.

Review of optimal Mediterranean diet (MD) adherence in children and adolescents in southern European countries (Spain, Italy, Cyprus, Greece) showed that the major determinants of adherence to a traditional MD pattern in southern European countries rely on social and demographic factors. Children and adolescents may be the age-groups with the most deteriorated MD profile. In Spain, 49.4% of adolescents demonstrated intermediate adherence. In Greece, in the greater Athens area the overall adherence to the MD was poor. In Cyprus, more than one third of the children followed a poor-quality diet. The authors highlighted a need for nutrition education programs are not limited to children and adolescents but also include parents, teachers, and physicians ( 14 , 15 ).

Dietary patterns and timing of puberty: Effects of quantitatively high-calorie diet on puberty onset

Several lines of evidence support the interplay of nutritional status, energy balance, and hormones in the regulation of growth and pubertal development. Frequently, children with obesity are taller for their age, with accelerated linear growth and advanced skeletal maturation, and tend to mature earlier than lean children. Secular trends toward a declining age at puberty onset with correlated changes in body weight have been reported in economically advanced countries. This has been attributed to excess calorie intake along with reduced physical activity in children ( 16 , 17 ).

Feeding juvenile female rhesus monkeys born and raised with a high-calorie diet results in acceleration of body growth (weight, length, and BMI) and precocious menarche. These changes were associated with increased leptin and IGF-I levels throughout the experiment. These findings supported the importance of the quantity of caloric intake as an important factor in determining the onset and progression of puberty ( 18 ).

In a prospective study conducted in the United States, intake of sugar-sweetened beverages (SSBs) was associated with early sexual development in 5,583 girls. Premenarcheal girls who consumed >1.5 servings of SSBs per day at ages 9–14 years had a statistically significant 24% higher probability of menarche during follow-up than did girls who consumed ≤2 servings of SSBs weekly after adjusting for sociodemographic and maternal characteristics, physical activity, and total caloric intake. In another prospective study of girls from the United States, every standard deviation of caffeine every SD of aspartame intake at 10 years of age was related to a 22% and 20 % higher risk of early menarche. (<11 years of age) after adjusting for potential confounding variables. Neither fructose nor sucrose intake was related to the timing of puberty ( 19 , 20 ).

In a Chinese study, three distinct dietary patterns, “traditional diet”, “unhealthy diet”, and “protein diet” were established. Neither the “traditional diet” pattern nor the “protein diet” pattern showed any association with precocious puberty. The “unhealthy diet” pattern was significantly positively associated with precocious puberty in both and girls. The relationship remained positive only for girls (OR = 1.25, 95% CI = 1.04–1.49) after adjustment for age and BMI but statistically non-significant after further adjustment for socioeconomic factors in both boys and girls ( 21 ).

In an Iranian study on 568 girls, three dietary patterns were defined, i.e., balanced pattern, high calorie and fat pattern and high protein diet pattern. Data from the multivariate regression analysis showed that both balanced dietary pattern and high protein diet pattern were protective factors for precocious puberty, while high calorie and fat pattern was risk factors ( 22 )

Effects of different quantity and quality of protein intake on puberty

Some evidence indicates that animal protein intake during childhood may be related to the earlier onset of puberty. In a small study of girls from the United States, total animal protein intake at 3–8 years of age was related to earlier menarche and age at peak height velocity (APHV). Among German boys and girls, intakes of total and animal protein at 5–6 years of age were related to early APHV, menarche in girls, and voice break in boys ( 23 , 24 ).

Gunther et al. ( 24 ) reported that protein intake from cow milk and other dairy was related to earlier pubertal growth spurts and APHV among 112 German boys and girls. Similarly, in a prospective study of 134 Iranian girls, those with milk intake at ≥ 34 g per day, at 9 years of age, had higher odds of early menarche at or before age 12 years than did girls with milk intake at <34 g per day. Using data from the National Health and Nutrition Examination Survey, Wiley et al. ( 25 ) found that higher milk consumption at ages 5–12 years among 2,057 girls from the United States was associated with an earlier age at menarche. However, these findings were not supported in other studies ( 26 , 27 ).

Other studies suggested that animal protein increased the risk and plant protein decreased the risk of early menarche. Of protein-containing food groups, intakes of poultry and low-fat dairy were marginally associated with a higher risk of early menarche. The odds of early menarche were reduced with higher intake of plant protein. These findings suggested that partly substitution of animal protein with plant sources during childhood may postpone menarche’s timing. ( 28 - 30 ).

The potential effects of animal foods, especially dairy, on the timing of puberty have been attributed to a protein-mediated stimulation of IGF-1 secretion. Higher circulating levels of this hormone during childhood have been related in some studies to an earlier onset of puberty ( 31 ).

Micronutrients and a possible effect on pubertal development

Micronutrient requirements increase during puberty; thus, prepubertal micronutrient status may influence the timing of sexual maturation. Evidence on the effects of micronutrients on the timing of puberty is insufficient and inconsistent. In a randomized controlled trial among 160 Gambian boys, those supplemented with calcium for 12 months had an earlier APHV and shorter adult stature than did boys in the control group ( 32 ). In a randomized study among 144 Swiss girls, those supplemented with calcium from ages 7.9 to 8.9 years reached menarche earlier than did girls who received the placebo ( 33 ).

Kissinger and Sanchez reported a statistically significant, positive association between iron intake and age at menarche among 230 girls from the United States ( 34 ). In a small, randomized trial of 17 Iranian children, those supplemented with zinc had an earlier initiation of puberty compared with children assigned to the placebo group ( 35 ). In another randomized controlled trial of 102 boys ages 13.6 to 15.5 years with short stature and delayed puberty, supplementation with iron and vitamin A resulted in faster testicular growth ( 36 ). In the study by Maclure et al. ( 37 ), vitamin A intake was strongly associated with earlier menarche.

Dietary Fat and Polyunsaturated Fatty Acid Intakes during Childhood may affect Puberty Timing Independent of protein intake.

Among 3425 girls and 2495 boys, children with higher intakes of total fat and PUFA have been more likely to reach their puberty at an earlier age. Associations were not attenuated on additional adjustment for childhood dietary protein intake. ( 38 )

Global prevalence of under-nutrition and nutritional stunting in adolescents

Under-nutrition is the most important cause of growth retardation worldwide. Poverty in the poor countries and self-induced food restriction in the rich countries or malabsorption and chronic systemic diseases are the main causes. There are an estimated 1.8 billion adolescents in the world, with 90% residing in low- and middle-income countries (LMIC). Nutritional deficiencies, suboptimal linear growth, and undernutrition are major public health problems ( 38 , 39 ).

The prevalence of moderate and severe underweight (undernutrition) is highest in South Asia; one in 5 girls aged 5–19 years and nearly one-third of their male peers are underweight. According to the Global School-Based Student Health Survey, more than 10% of surveyed girls were underweight in Mauritius, Sudan, Bangladesh, Maldives, Cambodia, and Vietnam.

In 2016, the mean BMI estimates for youths aged 10–19 in South Asia, Southeast Asia, East Africa, West Africa, and Central Africa were <20 for both male and female adolescents. The lowest BMI were seen in Ethiopia, Niger, Senegal, India, Bangladesh, Myanmar, and Cambodia ( 40 , 41 ).

Health surveys in 58 countries showed that the distribution of height-for-age z-scores (HAZ) for these adolescents a quarter of girls are 2 or more SDs below the mean height-for-age as compared to the WHO/CDC reference population ( 42 ). The limited published estimates of stunting in girls aged 15–19 ranged from 52% in Guatemala and 44% in Bangladesh to 8% in Kenya and 6% in Brazil ( 43 ).

The effect of chronic childhood malnutrition on pubertal growth and development

Chronic primary or secondary malnutrition leads to serious consequences including impaired growth, delayed pubertal development, osteopenia, osteomalacia, anemia, and different syndromes caused by deficiency of vitamins, minerals, essential fatty acids and amino acids, and trace elements ( Table 3 and figure 1 ) ( 1 , 44 ).

Possible negative consequences of undernutrition during adolescence (From Ref. 50, modified).

Effect of dietary patterns on pubertal timing and growth

Pubertal growth and development were compared in 342 privileged, urban children and 347 impoverished rural adolescents from Kenya. Measurements of height, weight, upper arm circumference, and triceps skinfolds revealed marked differences between the two study groups just before the onset of sexual maturation. These differences were also found in the early stages of puberty but notable catch-up was evident throughout the later period of the maturational process. Early stages of sexual maturity were delayed by 3 yr. in malnourished boys with a 2.1 years lag in the age of onset of menarche in rural girls. Derived estimates of body fat as well as direct anthropometry revealed that the onset of puberty is not size related under the circumstances of chronic childhood malnutrition ( 45 ).

Hormonal mediation of delayed puberty during chronic malnutrition ( Figure 1 )

Hormonal adaptation mediates delayed puberty in situations with suboptimal nutrition to prolong growth of the individual and to delay reproductive ability until conditions to support reproduction exist ( 46 ). Current understanding of energy sufficiency or insufficiency signalling pathways considers the HPG-axis to re-activate. Research using animal models revealed new factors important in energy homeostasis. Of particular importance are leptin, ghrelin, kisspeptin, adenosine monophosphate-activated protein kinase (AMPK) and mammalian target of rapamycin (mTOR) ( 47 ).

Abnormalities of the growth hormone (GH-IGF-1) axis and gonadotrophin secretion have been described in patients with primary and secondary malnutrition (chronic renal failure, cystic fibrosis and Crohn’s disease, AN). In addition, increased cytokines produced during chronic diseases such as juvenile idiopathic arthritis and CF may affect the GH-IGF-1 axis ( 48 - 52 ).

Leptin levels are directly related to adipose stores and act within the hypothalamus to adjust energy requirements. The gradual increases in GnRH are highly sensitive to body energy reserves that are influenced by leptin. In chronic undernutrition, leptin levels are low, and there is a loss of leptin permissive action ( 53 ). Ghrelin is secreted from the stomach because of energy insufficiency and acts as an inhibitory control on puberty onset in girls ( 54 ).

Kisspeptin also stimulates directly and indirectly the GnRH neurons that drive HPG axis maturation and puberty onset. Elucidation of the leptin/Kiss pathways require further study, but recent discoveries support a direct connection in undernutrition between leptin deficiency, reduced Kiss1 mRNA expression and reduced kisspeptin immunoreactivity ( 55 - 57 ).

Required interventions to manage nutritional problems in adolescents

Adolescent health and development require many interventions including health education; supportive parenting; nutrition; immunization; psychosocial support; prevention of injuries, violence, harmful practices and substance abuse; sexual and reproductive health information and services; management of communicable and non-communicable diseases.

To respond to the diverse needs of adolescents, different interventions are needed in different countries and communities. A review of the situation in selected South-East Asian countries showed acute scarcity of programs targeted at adolescents in the Region. The major underlying reason for the widespread lack of policies and programs for improving health and nutritional status of adolescents in the Region is a lack of age and sex-disaggregated data on health and nutritional status of adolescents at the national level. Scarcity of trained health providers and adolescent-friendly health centers to deal with the special needs of adolescents are important reasons for the neglect of adolescents in public health programs ( 58 , 59 ).

Strategies for managing adolescent undernutrition

The main strategies suggested for improving adolescent nutrition include food-based strategies like dietary modification and food fortification, for ensuring adequate nutrition at household level; addressing behaviour modification to bring about dietary change in adolescents. This can be achieved through school-based nutrition interventions, using a social marketing approach, behaviour change through communication and mobilizing families and communities; control of micronutrient deficiencies; regular nutrition assessment and counselling of adolescents; care of adolescents during pregnancy and postnatal period; intersectoral linkages at community level and building linkages with adolescent friendly health services ( 60 ).

Catch up growth in in low- and middle-income countries without intervention

Catch-up growth (CUG) from longitudinal cohorts LMIC without intervention showed inconsistent CUG and stunting recovery.

In a longitudinal study in Bangladesh, Svefors et al. ( 61 ) enrolled 1094 children at birth and followed their growth until age 10. The prevalence of stunting was highest at 2 years (50%) decreasing to 29% at 10 years.

In South Africa, Stein et al. ( 62 ) followed up 1918 subjects from birth to twenty years. They reported that progression through puberty modifies the relation between prepubertal and adult anthropometry.

Teivaanmaki et al. ( 63 ), in Malawi, enrolled 767 at birth and followed 522children up to the age of 15 years. Prevalence of stunting was highest at 2 years (80%) decreasing to 37% at 15 years. 84.7% of those stunted at 2 years recovered at least once by 15 years. By 15 years of age, only 9.0% of boys and 19.6% of girls reached advanced puberty.

Fink et al. ( 64 ) studied children in Vietnam, India, Ethiopia, and Peru (n = 976, 976, 974 and 678 respectively) from birth till 15 years. At 8 years of age, 31% of children were stunted. Of children classified as stunted at 8 years of age, 36% recovered from stunting by age of 15 years.

Lundeen et al. ( 65 ) studied a large cohort of children in Brazil, Guatemala, South Africa, Philippines and India from birth to adulthood. The prevalence of stunting was highest at 24 months. The prevalence of stunting decreased from 24 months to adulthood 3.2% (Brazil) to 41.1% (Philippines)]. By adulthood, a small proportion also became stunted (15% in the Philippines to 3% in Brazil). By adulthood, many recovered from stunting (82% in Brazil and 35% in the Philippines].

Bosch et al. ( 66 ), in Bangladesh, followed 707 children from birth to 12–16 years. They reported that adolescent stunting was associated with childhood stunting and childhood underweight.

Adair et al. ( 67 ), in Philippines enrolled 2011 children at birth; and followed them to age 12. Of the 1,252 children stunted at 2 years of age, 379 (30.3%) were not stunted at age 8.5, and 407 (32.5%) were not stunted at age 11–12. Only 1.3% of 11-year-old and 5.1% of 12-year-old girls achieve menarche. Among girls who achieved menarche, there was less stunting.

Effects of nutritional interventions in adolescents with undernutrition ( Figure 2 )

Pros and Cons of nutritional supplementation

The evidence for effective interventions to address nutritional problems in LMICs is mostly weak. Few studies have systematically examined nutritional interventions in settings where dietary inadequacy and micronutrient deficiencies exist. From high income countries (HICs), there is some evidence on interventions for eating disorders, although much further work is needed in these settings as well ( 68 ).

Protein based supplementation intervention in adolescents living in LMIC

A total of 7 protein-based intervention trials provided data to calculate an effect on linear growth were identified. Five studies contained multiple treatment groups, each providing either 2 or 3 data sets. Most of the studies were conducted in LMICs, including 1 in Africa, 2 in East Asia and the Pacific, and 3 in South Asia. The number of subjects in each study ranged from 35 to 190, with mean ages of subjects ranging from 33 to 161 mo. At baseline, 6 study populations had a mean HAZ <-2. Protein supplements were administered as either meat, cow milk (liquid or powder), amino acid–supplemented rice or wheat, casein, whey, or high-protein diets. The duration of supplementation ranged from 0.69 to 24 mo. Most datasets (85%) had a positive effect on size ( 69 - 78 ).

Micronutriments and protein supplementation ( Figure 2 )

The most studied micronutrient is calcium, as calcium absorption and bone mineralization have been shown to increase during early pubertal development among girls with consequences for long-term bone health. Supplementation with calcium, however, has been found to be of limited benefit even in settings where calcium intake was low. For example, in a Gambian cohort of children 10.3 years (Tanner stage 1) at enrolment, calcium supplementation (1,000 mg/day) increased bone mineral content of digital radius but had no impact on bone size or linear growth ( 79 - 81 ).

In a systematic review, several effective nutritional interventions were identified across a wide range of ages, duration, and baseline status; few studies were from LMICs. The overall findings were that interventions with zinc, vitamin A, multiple micronutrients, and protein had a significant impact on improving height; the effect size increases in linear growth ranged from 0.05 HAZ for vitamin A to 0.68 HAZ for protein. Interventions including iron, calcium, iodine, and food supplements showed no significant benefit, although sample sizes for the pooled studies for these were low (approximately 500–1,100). The sample size for the protein studies was low ( n = 939), and yet the effect size was the highest. The multiple micronutrient intervention had modest significant benefits and may be a better way to combine provision of individual nutrients ( 82 ).

Randomized trials of iron supplementation have been shown to significantly improve hemoglobin concentrations among adolescents based on pooled analysis of 7 studies. However, there was a lack of significant impact on linear growth. This nutritional intervention may be worth considering, given the benefit of iron supplementation on cognition in school age children ( 83 , 84 ).

Home fortification of foods with multiple micronutrient powders (MNP) for health and nutrition ( Figure 2 )

Food fortification is defined as the practice of adding vitamins and minerals to commonly consumed foods during processing to increase their nutritional value. It is a proven, safe, and cost-effective strategy for improving diets and for the prevention and control of micronutrient deficiencies. In 2008 and 2012, the Copenhagen Consensus ranked food fortification as one of the most cost-effective development priorities. ( 85 , 86 )

While mandatory food fortification has been used as a strategy to prevent micronutrient deficiencies in HIC, it is still less common in LMICs where food systems are not delivering nutritionally adequate diets due the production and consumption of just a few major starchy food crops (maize, rice, wheat) with low micronutrient content and/or bioavailability (phytate). In the past two decades, food fortification has become increasingly popular in LMICs for several reasons, including rapid urbanization and increasing household purchasing power, leading to a greater proportion of the population relying on processed foods ( 87 , 88 ).

Numerous country-level studies on the impact of food fortification on micronutrient status have shown positive results. A review in 2013 assessed the effects and safety of home (point-of-use) fortification of foods with multiple micronutrient powders on nutritional, health, and developmental outcomes in children. The intervention was consumption of food fortified at the point of use with multiple micronutrient powders formulated with at least iron, zinc and vitamin A compared with placebo, no intervention or the use of iron containing supplements, which is the standard practice. They included eight trials (3748 participants) conducted in LIC countries in Asia, Africa and the Caribbean, where anaemia is a public health problem. Home fortification with MNP reduced anemia by 31% and iron deficiency by 51% in infants and young children when compared with no intervention or placebo. However, authors did not find an effect on growth. In comparison with daily iron supplementation, the use of MNP produced similar results on anaemia and hemoglobin concentrations ( 89 ). In Costa Rica, an evaluation of the impact of iron fortification on anemia prevalence found a significant decrease at the national level in the prevalence of anemia among children and adolescents from 19 to 4% ( 90 ).

In Indonesia, a study conducted in two districts of West Java from 2011 to 2012 assessed the effects of large-scale fortification on the vitamin A status of women and children and found that fortified oil increased vitamin A intake close to the recommended nutrient intakes, contributing on average 38–40% among older children and adolescents ( 91 ).

A meta-analysis that included 43 studies reviewed the effects of food fortification with multiple micronutrients. Compared with placebo/no intervention, multiple micronutrients (MMN) fortification reduced anaemia by 32% (low-quality evidence (LQE)), iron deficiency anaemia by 72% (LQE), iron deficiency by 56% (LQE); vitamin A deficiency by 58% (low-quality evidence), vitamin B2 deficiency by 64% (LQE), vitamin B6 deficiency by 91% (LQE), vitamin B12 deficiency by 58% (LQE), weight-for-age z-scores (WAZ) (LQE) and weight-for-height/length Z-score (WHZ/WLZ) (LQE). The authors were uncertain about the effect of MMN fortification on zinc deficiency and height for-age Z-score ( 92 ).

A systemic review in 2014 suggested that micronutrient supplementation among adolescents (Predominantly females) can significantly decrease anemia prevalence. Interventions to improve nutritional status among “pregnant adolescents” showed statistically significant improved birth weight, decreased low birth weight, and preterm birth ( 93 ).

The WHO recommends iron-folic acid (IFA) supplementation for non-pregnant menstruating girls in contexts with high rates of anemia ( 94 ). On the other hand, another systematic review performed (2017) in both HICs and LIMCs did not find significant association between the effect of multiple micronutrient fortification on child growth outcomes such height/length-for-age z-score (HAZ/LAZ) in 8 studies (n =2889 participants; low-quality evidence) ( 95 ).

In addition, two recent reviews on fortified complementary foods (iron, folic acid, calcium, and vitamin D) in adolescents were uncertain of the effect of MMN fortification on hemoglobin concentrations, calcium supplementation on total body bone mineral content (BMC), calcium plus vitamin D supplementation on total body BMC, and zinc supplementation on zinc levels.

Fortified foods were associated with more diarrhea episodes ( 96 , 97 ).

Protein energy supplementation

Adolescent pregnancy is common in LMIC. In pregnant women in general, especially if they are undernourished, PES increased mean birth weight and decreased the risk of low birth weight, small-for-gestational-age births, and stillbirths. However, no studies have been conducted specifically on adolescent mothers ( 98 ).

Oral nutritional supplements (ONS) and ready to use therapeutic food (RUTF)

RUTF is an energy-dense, mineral- and vitamin-enriched food that requires no preparation and is specifically designed to treat severe acute malnutrition (SAM). RUTF has a similar nutrient composition to F-100 therapeutic milk, which is used to treat SAM in hospital settings. RUTF has significant advantages over liquid-based diets. The paste is oil-based with low water activity and, as such, can be stored at home with little risk of microbial contamination. It is easy to use, digestible and affordable at acceptable cost ( 99 - 101 ).

Ready-made oral nutritional supplements (ONS) are designed for children and available on prescription typically provide 2.4 kcal/ml or 1.5 kcal/ml in 125 ml and 200 ml bottles. One possible strategy to improve nutrient intake in children and adolescents with faltering growth is to reduce ONS volume by increasing the energy and nutrient density. Therefore, these formulas may be used in underweight children and adolescents with volume sensitivity or those with poor appetite ( 102 ).

ONS and RUTF proved to be effective in the management of underweight infants and young children with undernutrition. However, the major global focus of health has been on children under the age of 5 years, while older children (aged 6–9 years) and adolescents (aged 10–19 years) have not received the due attention until lately ( 103 - 105 ).

A controlled trial investigated the effects of energy dense pediatric ONS versus standard ONS in old children and adolescents with low BMI or low weight gain per day (WGD) (n= 34). ONS were randomized to high caloric ONS (cONS) (n =22) or standard ONS (sONS) (n = 12) for a year. Results showed that the WGD, height growth velocity (GV: cm/year), and Ht-SDS increased significantly, in both groups, during the year of ONS. The use of the cONS resulted in significantly greater mean total WGD and BMI-SDS after 6 months and 1 year, compared to the sONS group. The increase in insulin-like growth factor 1 (IGF1-SDS) was significantly higher in the cONS groups versus the sONS group. Moreover, the WGD was correlated significantly with the height GV during the year of ONS intake ( 106 ).

However, the cost of current standard RUTF and OSN is one of the major obstacles to their use in community-based management programs. In addition, the high prevalence of undesirable effects (nausea, vomiting and diarrhea) attributed to RUTF may hinder RUTF acceptability and adherence in some participants ( 107 ).

Supplement (mis)use in healthy adolescents

Although supplements may be necessary and safely consumed in certain specific situations, most healthy adolescents do not need them. Studies have indicated high prevalence of dietary supplement usage by adolescents that ranged from 10% to 74%. These supplements with no or little evidence of beneficial effects in healthy adolescents include proteins, amino acids, beta-hydroxy-beta-methyl butyrate, carnitine, creatine, vitamins, caffeine, and bicarbonate. The widespread use of these unnecessary dietary supplements among adolescents predisposes them to significant health risks ( 108 - 111 ).

Consuming an adequate and balanced healthy diet during the fast phase of pubertal growth spurt is necessary to assure proper growth and normal pubertal development. Excessive intake of some types of proteins, fat, minerals, and vitamins may lead to early puberty. Whereas, malnutrition of macro (proteins essential amino acids) , calories, essential fatty acids) and some micronutrients (iron, zinc, vitamin D ) can markedly delay the onset and/or delay the progress of growth and bone accretion during this critical period of growth ( Figure 1 ). Although some studies suggested positive effect/s of food fortification with micronutrients and supplying more proteins and calories (RUTF and/or ONS) in malnourished children and adolescents ( Figure 2 ), however long term-controlled studies are still highly required to support their positive effect on linear growth and pubertal development.

Acknowledgement:

We would like to present our appreciation and thanks to Prof. Vincenzo De Sanctis for suggesting the idea of this review, his kind guidance, expert editing, and continuous encouragement throughout the preparation of this manuscript.

Conflicts of interest:

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

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Nutritional Therapy and the Management of Cardiovascular Disease

Introduction.

Cardiovascular diseases, CVDs, continue to cause deaths, despite improvements in medical research and clinical practices. CVDs mortality rates have continued to rise, such that in the next 20 years, CVDs are expected to cause more than 23 million deaths. As a result, numerous treatment methods have been developed. These include medication, regular physical exercises, and nutritional therapy. While medication and regular physical exercises provide prevention and cure for CVDs, nutrition-based treatment is a cost-effective and easy-to-implement treatment method. However, effective nutritional therapy requires the assessment of the patient’s nutritional and medical history, which helps in identifying the patient’s nutritional needs. In light of this, various medically acceptable standards govern nutritional assessment.

These standards seem to be necessitated by controversies surrounding research findings on nutritional therapy. This paper aims at evaluating medically acceptable standards on nutritional assessment. It also provides an assessment of medically acceptable nutritional therapy for the prevention and cure of CVDs.

Cardiovascular diseases; the background

The World Health Organization asserts that CVDs “are the leading causes of death and disability in the world” (WHO n.pgn). Cardiovascular diseases, CVDs, are a group of diseases that affect the human heart and related parts, such as the aorta, aortic valves, Endocarditis, among others (Maton 34 to 38). The World Health Organization further adds that for the last two decades, CVDs mortality rates in developed countries have dropped (WHO n.pgn). This implies that the prevalence of CVDs remains high in developing countries. Demographically, men are at a higher risk of CVDs than women (Maton 36).

While research identifies numerous causes of CVDs, the primary cause is thought to be an imbalance of the ratio between two lipoproteins namely LDL and HDL. Other causes of CVDs include a very high level of blood sugar, hypertension, and prolonged exposure to air pollutants such as mercury. It is also thought that the intake of unhealthy foods, as well as irregular eating habits, increases the risk of CVDs.

Nevertheless, debate still rages on about certain controversial research findings. For instance, some researchers claim that a moderate intake of alcoholic drinks reduces the risk of CVDs. These findings have elicited mixed reactions. Arguments to the effect that alcohol intake increases the intake of refined sugars associated with the occurrence of CVDs abound. Nevertheless, The World Health Organization offers medically acceptable standards on prevention and cure of CVDs.

Research on medically acceptable nutritional assessment standards

According to the World Health Organization 2010, CVD mortality is estimated to be 17.3 million. Despite improvements in medical research, the World Health Organization estimates that by the year 2030, CVDs will cause more than 23 million deaths annually (WHO n.pgn). One of the most effective methods for the management of CVDs is nutritional therapy. Current and past research works indicate that nutritional therapy is not effective unless certain nutritional assessment standards are adhered to. Nutritional assessment is a multidimensional approach aimed at identifying a patient’s nutritional requirements. Nutritional assessment leads to the development of patient-specific nutritional therapy. It involves the assessment of a patient’s diet and medical history as well as recording anthropometric patient measurements (Worthington 3).

According to Worthington (2), developing a nutritional therapy requires a thorough assessment of the type of CVD affecting each patient. This implies that in managing CVDs, the one-size-fits-all approach is not applicable. As Lee (646-653) asserts, major nutritional assessment involves the identification of the prevailing cardiovascular disease as well as its cause. Additionally, evaluating the medical history of patients and at-risk individuals is a prerequisite in designing a nutritional treatment plan. In light of these assertions, Charney (45) asserts that regulatory requirements have increased in scope, such that differentiating between nutritional screening and nutritional assessment is now possible. Research by Worthington asserts that nutritional screening is a major component of nutritional assessment (1).

Nutritional screening involves assessing a patient’s nutritional history as well as measuring a patient’s anthropometric data. Anthropometric data captures a patient’s mass, weight, sugar and fat levels, height as well as the level of the patient’s blood pressure. Thus, the National Center for Chronic Disease Prevention and Health Promotion identifies nutritional assessment as a major requirement in the management of CVDs. Assessing a patient’s nutritional requirements is based on thorough nutritional screening (Worthington 2). Additionally, research by the University of Washington reveals that nutritional screening and assessment works when closely monitored by physicians and dieticians. This implies that nutrition screening and assessment programs seem to be medically acceptable standards in the management of CVDs.

As explained herein, proper diagnosis as well as conducting an accurate nutritional assessment enables physicians to design appropriate nutritional therapy. However, research by Olendzki, Speed, and Domino reveals that certain factors, such as patients’ attitudes towards dieting and certain diet components affect the effectiveness of nutritional therapy in the management of CVDs (264). In light of this, The U.S. Preventive Services Task Force has identified nutritional counseling as a major requirement (257). Nutritional counseling helps patients adjust negative attitudes towards certain dietary habits. It also helps patients adapt to, and accept healthy eating habits.

A discussion of medically acceptable nutritional therapy and the management of CVDs

According to the World Health Organization’s statistics, the CVDs mortality rate is expected to rise in the next 20 years. By the year 2030, the World Health Organization estimates that CVDs are likely to cause more than 23 million deaths annually (WHO n.pgn). This is an alarming figure bearing in mind that research in the prevention and cure of CVDs has intensified. This indicates that CVDs are among the leading causes of death globally. The occurrence of CVDs is attributed to several causes, including unhealthy eating habits, exposure to air pollutants, an imbalance in the ratio between two lipoproteins namely LDL and HDL, among others.

The World Health Organization further suggests several methods through which CVDs can be prevented and cured. These include medication, regular exercise, and proper nutrition (WHO n.pgn; Maton 36). The term proper nutrition is synonymous with the term nutritional therapy. Nutritional therapy, according to the World Health Organization, is a cost-effective method for preventing and curing CVDs. It is a multidimensional approach in the management of CVDs and involves the intake of healthy foods as well as the avoidance of unhealthy diet components (WHO n.pgn). Effective nutritional therapy is discussed elsewhere in this essay.

Several factors affect the effectiveness of nutritional therapy in preventing and curing CVDs. As explained by Mason (34 to 38), CVDs are a group of ailments that affect the heart and related parts. Each ailment has its cause. This implies that in developing a treatment method, identifying the prevailing type of CVD seems to be an overarching requirement.

Since each patient requires a unique treatment plan, proper diagnosis helps physicians and dieticians to determine the most appropriate nutritional therapy for each patient.

It is evident that in designing nutritional treatment plan, the one-size -fits-all approach is inapplicable as far as managing CVDs is concerned. Effective prevention and treatment of CVDs requires nutritional assessment for each patient. Conducting thorough nutritional assessment is complicated process, which also requires accuracy in obtaining data on a patient’s nutritional needs. Therefore, nutritional screening seems relevant (Worthington 1, 2).

Nutritional screening precedes nutritional assessment and involves evaluating a patient’s medical and diet history (Worthington 2). This helps physicians identify links between a patient dietary habits and the prevailing CVD. Additionally, these results are correlated with a data from a patient’s anthropometric measurements. It is important to note that significant variations in these measurements indicate a patient’s health status, especially with regards to CVDs. Such correlations also enable physicians and dieticians to design a proper nutritional plan for each CVD patient.

As explained earlier, nutritional therapy is a cost effective method for treating and preventing CVDs. According to Olendzki, Speed and Domino, nutritional therapy is a two phase process (258). Most people believe that avoiding the intake of unhealthy dietary items eliminates the occurrence of CVDs. Unhealthy dietary habits include smoking and exposure to second hand tobacco smoke as well as sustained intake of alcohol (Jani and Rajkuma 357 to 362).

However, there are other unhealthy eating habits. These include sustained intake of foods rich in polyunsaturated fats, refined sugars as well as saturated fats. Additionally, intake of more than one tablespoonful of salt is highly discouraged. Foods rich in these components are associated with occurrence of certain types CVDs. Additionally increased intake of animal proteins, mostly found in red meat is also associated with occurrence of CVDs (Jani and Rajkuma 359).

From the assertions made above, one is likely to conclude that avoidance of the foods mentioned above eliminates the risk of CVDs. Jani and Rajkuma (359) warn against intake of animal proteins especially those found in red meat. This does not imply that proteins are necessarily unhealthy diet items. Olendzki, Speed and Domino assert this and further suggest that CVD patients ought to substitute animal proteins with plant proteins (259). Plant proteins are readily available from leguminous plants, vegetables and whole grain meals such as beans, walnuts, chickpeas, lentils, broccoli, among other food items.

Together with fruits, these foods also provide CVD patients with low fat diet, which further reduces the intake of unhealthy fats. Bearing in mind that intake of foods rich in polyunsaturated and saturated fats causes most types with CVDs, a proper nutritional therapy ought to contain as sufficient amounts of plant proteins. CVDs are not only aggravated by polyunsaturated and saturated fats, but also by omega-6 fatty acids. To mitigate the influence of omega-6 fatty acids, Olendzki, Speed and Domino suggests that patients ought to increase intake of vegetables and soybeans (259. These foods are, rich in omega-3 fatty acids. Intake of these foods corrects the imbalance of “omega-3 and omega-6 fatty acids”, which reduces the risk of CVDs (Olendzki, Speed and Domino 260).

Fruits contain very high levels of sugar. Suggestions made to increase intake of fruits seem to contradict earlier assertions that increased intake of fruits reduces the risk of CVDs. Intake of fruits increases the intake of sugars. Increased intake of sugars, according to the World Health Organization, is unhealthy and causes CVDs. However, Olendzki, Speed and Domino explain that only refined sugars pose significant threat (260). As such, intake of sweetened beverages including alcohol is highly discouraged (Olendzki, Speed and Domino 261).

Designing a nutritional therapy may not necessarily work, due to the fact that each patient has unique nutritional requirements. In addition to this, a patient’s attitude towards certain nutritional component affects the effectiveness of nutritional therapy. However, as indicated by Lee (646-653) and Worthington (2), nutritional assessment involves identifying specific nutritional requirements for each patient.

Based on data derived from each patient, physicians and nutritionist are able to design an individual-specific nutritional treatment plan containing essential nutritional components. To improve the effectiveness of nutritional therapy especially for patients with maladjusted attitudes, nutritional counseling seems to be the most effective course of action (Olendzki, Speed and Domino 257). Nutritional counseling helps patients and at-risk individuals adjust their attitude appropriately as well as adapt to new dietary habits. This further increases the effectiveness of nutritional therapy.

It is unfortunate that CVDs continue to cause deaths, despite advancement in research and medical technology. Most of these deaths are preventable through readily available solutions such as medication, regular exercises and proper nutrition. Yet CVDs mortality rates continue to rise. While the increase in CVD mortality rates is attributed to poor lifestyles, inaccessibility to crucial information on the effects of nutrition seems to be a risk factor. Most people are unaware of the fact that CVDs can be adequately managed through proper nutrition. Additionally, patient’s nutritional attitudes seem to affect the effectiveness of nutritional.

Therefore, an effective nutritional therapy is preceded by nutritional counseling. The occurrence of CVDs is attributed to various causes, each requiring different solution. Each patient has unique treatment needs. This implies that nutritional therapy is only effective if designed for individual patients. Nutritional therapy is a cost effective method of preventing and curing CVDs. Nevertheless, each patient requires a nutritional plan based on the patient’s nutritional and medical needs. Additionally, nutritional counseling improves the effectiveness of nutritional therapy. Thus an effective nutritional therapy for CVD patients is patient -specific as well as proceeded by nutritional counseling.

Recommendations

Designing a nutritional therapy calls for collaboration between nutritionists and physicians. Nutritional counseling is a major requirement if success is to be attained. Nevertheless, nutritionists and physicians lack basic communication and counseling skills. This is a major barrier for physicians and nutritionists counseling CVD patients (Olendzki, Speed and Domino 257). As such, physicians and nutritionists require basic training on communication and counseling skills. Additionally, nutritional assessment relies on data from a patient’s diet history. Obtaining such data is prone to errors since it relies on memory. Accuracy in data gathering improves clinical decision making. As such, this is an area that requires urgent attention.

Works Cited

Charney, Pamela. “Nutrition Screening vs Nutrition Assessment: How Do They Differ?” Nutritional Clinical Practice . 2008. Web.

Jani Brani, and Chris Rajkumar. “Ageing and vascular ageing.” Postgraduate Medical Journal . 82 (2006):357-362. Print.

Lee, Clark. “Indices Of Abdominal Obesity Are Better Discriminators Of Cardiovascular Risk Than BMI: A Meta-Analysis.” Journal of Clinical Epidemiology . 61(2008): 646-653. Print.

Maton, Anthea. Human Biology and Healt h. Englewood Cliffs, New Jersey: Prentice Hall. 1993. Print.

Olendzki, Barbara, Christopher Speed and Frank Domino. “Nutritional Assessment and Counseling for Prevention and Treatment of Cardiovascular Disease”. America Family Physician . 2006. Web.

WHO. Cardiovascular Disease . 2012. Web.

Worthington, Patricia. Nutritional Assessment and Planning in Clinical Care. n.d. Web.

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Nutritional therapy is a holistic approach to health that involves using food and nutrients to manage and prevent diseases while promoting overall well-being. This personalized approach focuses on understanding individual nutritional needs and lifestyle factors to create tailored dietary plans. By emphasizing functional foods rich in essential nutrients, nutritional therapy supports optimal body function and enhances long-term health.

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How does Medical Nutrition Therapy impact healthcare?

How can meal planning reduce psychological stress?

What are key strategies for effective meal planning?

Which principle is a key component of Medical Nutrition Therapy?

How does nutritional therapy personalize dietary interventions?

What is an example of how dietary changes are implemented in nutritional therapy?

What is the primary focus of nutritional therapy?

How does nutritional therapy aid in weight management?

What is a benefit of nutritional therapy in chronic disease management?

What distinguishes Medical Nutrition Therapy (MNT) from Nutritional Therapy?

What is the cornerstone of effective nutritional therapy?

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Nutritional Therapy Definition

Nutritional therapy is a health approach that focuses on the use of diet and nutritional intake to support and promote optimal health. It involves a personalized plan that takes into account an individual's unique dietary needs. Nutritional therapy can be beneficial for managing chronic conditions, supporting healing processes, and maintaining overall well-being.

Nutritional Therapy Meaning

Nutritional therapy refers to the practice of tailoring dietary interventions to the individual's specific health needs and goals. By customizing nutrient intake, it seeks to optimize physical and emotional well-being. This form of therapy is grounded in the idea that proper nutrition can support the body's ability to heal and maintain itself more effectively than just relying on medication.

The approach can involve balancing macronutrients (carbohydrates, proteins, and fats) as well as micronutrients (vitamins and minerals). Here's a basic structure of what nutritional therapy might include:

• Developing a tailored meal plan that suits your health requirements
• Identifying food intolerances and sensitivities
• Teaching you about the importance of whole foods
• Supplying information about how certain nutrients affect your health

Moreover, nutritional therapy often incorporates lifestyle changes that align with the dietary adjustments to promote a holistic approach to health.

Nutritional Therapy : A personalized dietary program that aims to support and improve health through targeted nutrition and lifestyle interventions.

Did you know? Nutritional therapy can help you improve energy levels and enhance mental clarity through balanced nutrient intake.

Nutritional Therapy Explained

Nutritional therapy is often implemented by working closely with a nutritionist who can help assess dietary habits and find areas for improvement. This therapy emphasizes eating nutrient-dense foods while minimizing processed foods to achieve health goals. Here's a closer look at the components:

• Assessment : This initial stage involves evaluating current eating patterns, lifestyle, and health status.
• Goal Setting : Objectives are set based on health objectives and nutritional goals.
• Implementation : Introducing dietary changes, meal plans, and lifestyle adjustments in a sustainable way.
• Monitoring and Adjustment : Regular follow-ups ensure the therapy is effective, with adjustments made as needed.

For example, someone with diabetes may use nutritional therapy to manage blood sugar levels by adjusting carbohydrate intake and choosing low-glycemic foods.

Consider an athlete utilizing nutritional therapy. Their dietary plan may focus on increasing protein intake for muscle repair and carbohydrates for energy, particularly before and after workouts. This customized approach aids in enhancing performance and recovery.

Exploring the science behind nutritional therapy reveals the intricate roles nutrients play in cellular functions. For instance, omega-3 fatty acids, found in fish oils, are known to help reduce inflammation and support brain health. Similarly, antioxidants in fruits and vegetables help combat oxidative stress, which can lead to chronic diseases . By understanding these roles, nutritional therapy can effectively target specific health concerns and conditions, benefiting from the synergistic effects of a well-balanced diet.

Medical Nutrition Therapy Overview

Medical Nutrition Therapy (MNT) is a specialized therapeutic approach that utilizes evidence-based dietary interventions to treat and manage certain medical conditions. It's typically carried out under the supervision of a registered dietitian or nutritionist who tailors the diet to the patient's medical needs. MNT is often part of a broader treatment plan and supports the management of chronic diseases such as diabetes, cardiovascular diseases, and obesity.

Distinction Between Nutritional Therapy and Medical Nutrition Therapy

While both Nutritional Therapy and Medical Nutrition Therapy involve dietary interventions, there are crucial distinctions between the two. Nutritional Therapy primarily focuses on optimizing a person's general health and well-being through food, often involving personalized nutrition plans and lifestyle changes. In contrast, MNT specifically targets nutritional strategies that manage or treat medical conditions.

Here are some key differences:

• Purpose : Nutritional Therapy aims for overall health enhancement, whereas MNT focuses on treating specific health conditions.
• Implementation : Nutritional Therapy is generally carried out by nutrition practitioners, while MNT is usually implemented by registered dietitians.
• Scope : MNT often requires detailed assessments and monitoring of medical parameters, including lab results.

MNT is often covered by health insurance if deemed medically necessary by a healthcare provider.

Core Principles of Medical Nutrition Therapy

Medical Nutrition Therapy is based on several core principles that guide its implementation:

An example of MNT in action could be in the management of kidney disease, where dietary modifications focus on regulating protein, sodium, and potassium intake to support kidney function .

For patients with diabetes, MNT may involve teaching carbohydrate counting techniques, choosing foods with a low glycemic index, and setting meal timing to better stabilize blood sugar levels.

Diving deeper into Medical Nutrition Therapy reveals its expansive role in public health . MNT isn't just limited to individual treatment but can influence larger healthcare outcomes by reducing risks and complications associated with chronic diseases. For instance, effectively managed MNT can decrease hospital admissions, lower medication needs, and ultimately result in cost savings for the healthcare system. The integration of nutritional science with clinical care exemplifies the potential of nutrition as a cornerstone in the management and prevention of diseases.

Nutritional Therapy Techniques

Nutritional therapy techniques are varied and can be tailored to meet individual health needs. These techniques are designed not only to enhance general well-being but also to address specific health concerns through strategic dietary choices.

Personalized Nutritional Assessments

Personalized nutritional assessments are the cornerstone of effective nutritional therapy. They involve evaluating your diet, health, and lifestyle to create a customized nutrition plan. During this process, several key areas are examined:

• Dietary History : An in-depth look at dietary habits, food preferences, and meal timing.
• Nutritional Deficiencies : Identification of any nutrition gaps that need to be addressed.
• Health Status : Evaluation of current health conditions that may influence dietary needs.
• Lifestyle Factors : Consideration of physical activity levels, sleep patterns, and stress levels.

This comprehensive approach ensures that nutritional recommendations are individualized, practical, and effective.

Personalized Nutritional Assessments : A method of evaluating an individual's unique dietary and health needs to tailor a nutrition plan specifically for them.

Regular updates to your personalized nutritional assessment are crucial, as changing health conditions or lifestyle factors can alter dietary needs.

Dietary Modifications and Meal Planning

Dietary modifications involve altering food choices and eating patterns to improve health and prevent or manage diseases. Meal planning is a practical component of dietary modifications, helping you incorporate these changes into daily life seamlessly. Key strategies for effective meal planning include:

• Balancing Macronutrients : Ensuring a good mix of carbohydrates, proteins, and fats.
• Incorporating Whole Foods : Focus on fresh, minimally processed foods for their nutrient density.
• Limiting Processed Foods : Reduce intake of foods high in added sugars, unhealthy fats, and sodium.
• Portion Control : Eating appropriate amounts to maintain or achieve a healthy weight.
• Prep Ahead : Preparing meals in advance to avoid the temptation of unhealthy options.

Meal plans can be simple or complex, depending on your personal needs and goals.

For instance, a person looking to manage hypertension might focus on a low-sodium diet that includes plenty of fruits, vegetables, whole grains, and lean proteins, while avoiding processed and high-salt foods.

Diving deeper into meal planning reveals the psychological benefits it can bring. By reducing meal-time stress, meal planning can increase adherence to dietary goals. When meals are pre-planned and ingredients prepped, it lessens decision fatigue and makes it easier to stick to healthy eating habits. Additionally, the economic benefits cannot be overlooked; effective meal planning can reduce food waste and encourage cost-saving through bulk buying and cooking.

Nutritional Therapy Examples

Nutritional therapy is applied across various health contexts, and it offers tangible benefits in areas like chronic disease management and weight control. By utilizing food as a form of medicine, nutritional therapy can significantly improve quality of life .

Role in Chronic Disease Management

Chronic diseases such as diabetes, cardiovascular disease, and arthritis can be significantly influenced by nutritional therapy. By tailoring nutrient intake, symptoms can be alleviated, and disease progression can be slowed. Here are some ways nutritional therapy plays a role in managing chronic diseases:

• Regulating Blood Sugar Levels : For diabetes, a focus on low-glycemic foods helps maintain steady blood glucose.
• Reducing Inflammation : Omega-3 fatty acids and antioxidants from fruits and vegetables can lower inflammation in arthritis .
• Managing Blood Pressure : Low-sodium diets and potassium-rich foods can help control hypertension.
• Improving Heart Health : Fiber-rich diets and healthy fats, such as those found in avocados and nuts, support cardiovascular well-being.

An example of nutritional therapy in action is its role in rheumatoid arthritis management. By increasing the intake of anti-inflammatory foods like fatty fish, turmeric, and leafy greens, patients have reported reduced joint pain and stiffness.

The science behind nutritional therapy for chronic diseases is compelling. Research has shown that functional foods rich in bioactive compounds can alter metabolic pathways. For instance, flavonoids in berries have been found to improve endothelial function, which is crucial for heart health. Understanding these mechanisms helps healthcare providers design targeted nutritional interventions that complement medical treatments, thereby enhancing overall treatment outcomes.

Nutritional Therapy for Weight Management

Weight management is a common motivation for seeking nutritional therapy. This approach not only focuses on calorie intake but also emphasizes nutrient density, ensuring that the body receives necessary vitamins and minerals while facilitating weight control. Here are strategies employed:

• Portion Control : Teaching the importance of serving sizes to prevent overeating.
• Macronutrient Balance : Ensuring an appropriate distribution of carbohydrates, proteins, and fats to promote satiety and energy.
• Low-Calorie, Nutrient-Dense Foods : Promoting foods like vegetables and lean proteins that are high in nutrients but low in calories.
• Mindful Eating : Encouraging awareness during meals to foster a healthier relationship with food.
• Regular Eating Schedule : Helps stabilize metabolism and prevent excessive hunger.

Nutrient Density : A measure of the nutrients provided by a food relative to its calorie content. Nutrient-dense foods offer essential vitamins and minerals without excess calories.

The DASH diet, effective for weight management , emphasizes foods rich in calcium, magnesium, and potassium. It reduces caloric intake through portion control and limits consumption of sugar-sweetened beverages and high-fat meats.

Mindful eating, combined with nutritional therapy, can improve your relationship with food, reducing tendencies to overeat out of boredom or stress.

Weight management through nutritional therapy also touches on the psychological aspect of eating. Strategies like mindful eating increase awareness of hunger and fullness cues, reducing emotional eating habits. Additionally, understanding the role of different nutrients can demystify the process of dieting, shifting the focus from rigid rules to healthy, intuitive eating that is sustainable long-term.

nutritional therapy - Key takeaways

• Nutritional Therapy Definition : A health approach using diet and nutrition to promote optimal health through personalized plans based on individual dietary needs.
• Nutritional Therapy Meaning : Tailoring dietary interventions to an individual's health needs for physical and emotional well-being, grounded in supporting the body's healing capacity through proper nutrition.
• Medical Nutrition Therapy (MNT) : A therapy using evidence-based dietary interventions, administered by registered dietitians, focused on treating specific medical conditions.
• Nutritional Therapy Techniques : Strategies like personal assessments, balancing macronutrients, addressing nutrient deficiencies, and meal planning to achieve health goals.
• Nutritional Therapy Examples : Managing diabetes with low-glycemic foods, supporting arthritis with anti-inflammatory diets, and improving heart health through omega-3 fatty acids.
• Distinction Between Nutritional Therapy and MNT : Nutritional therapy focuses on health enhancement, whereas MNT targets treating medical conditions with dietary interventions.

Flashcards in nutritional therapy 12

MNT has minimal effect on healthcare systems.

It reduces decision fatigue and eases adherence to dietary goals.

Increase sugar and sodium intake for energy and hydration.

There is no need for progress monitoring in MNT.

By tailoring nutrient intake to individual health needs.

Changing meal plans randomly without monitoring.

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Effective Nutrition and Diet Therapy

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• Nutrition Essays

Good nutritional status is significant in helping the body maintain its functions so that individuals can develop and lead healthy lives. Proper nutrition comes from consuming foods rich in vitamins, carbohydrates, proteins, and fibers. If any of this is missing, the results can be malnutrition and disease. This paper examines some of the dietary recommendations that can help in preventing and treating some diseases. 

Coronary heart disease is a disease that occurs because of the narrowing of coronary arteries, reducing blood and oxygen supply in the heart. People with the disease are at the risk of developing heart attack and angina. However, are many risks factors make the likelihood of developing the disease much higher. One of the risk factors is uncontrolled blood pressure which results in the hardening and thickening of the arteries narrowing the channels through which blood can flow. High-fat cholesterol levels in the blood and body can cause a high level of low-density lipoprotein (LDL) cholesterol which can contribute to the development of atherosclerosis (LeFevre, 2014). People with diabetes also are at a much higher risk because of high blood sugar and raised blood lipids. This combination helps in furring up the blockage of arteries hence increasing the risk of CHD. Being overweight or obese generally increases the chances of a heart attack. Overweight people are known to have high cholesterol and high blood pressure. 

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The nutritional diet that is often recommended for people with coronary heart disease includes AHA restricted fat intake. This diet requires patients to reduce the number of fats in their diet but instead to use monounsaturated fats ( Nix, 2016) . These fats include olive oil, coconut oil alongside with low-calorie intake. This kind of diet also advocates that individuals include vegetables in their daily food intake. A low-carbohydrate intake has also been repeatedly documented to reduce the number of sugars in the blood. Besides, this kind of diet has been proven to help individuals in losing weight. Daily exercises have been shown to improve cardiovascular health. 

Type I and II diabetes 

Type 1 diabetes is also referred to as insulin-dependent diabetes. It occurs when the antibodies start attacking the pancreas hence limiting it from making the needed insulin. This type of diabetes may be as a result of genetic predisposition, but it can also be because of failure of the pancreas to produce insulin. The treatment of Diabetes I involves taking insulin, which is injected into the fatty tissue of the body. In type II Diabetes, the autoimmune system does not attack the beta cells ( Dabelea et al.,2017). The pancreas instead fails to produce to meet the body’s needs. Type 2 diabetes can be controlled through nutrition management, weight exercises, and exercises. 

Kidneys are internal organs that are located underneath the stomach and the intestines. The kidney plays an essential role by filtering wastes and nutrients for other cellular uses. They, therefore, perform their homeostatic functions through the following ways. Kidneys secrete a hormone known as Renin which works by maintaining healthy blood pressure. If the blood pressure of an individual drastically drops or rises very high the renin hormone causes a chain of reaction that stabilizes the blood pressure. Regarding extracellular fluid volume, the angiotensin system works by ensuring the levels of sodium in the blood are regulated to ensure they do not damage the arteries around the kidney leading to kidney disease. The organ also helps in balancing and controlling some elements such as sodium, potassium, and magnesium in the renal filtrate through excretion. The kidneys maintain acid-balance by reabsorbing bicarbonates found in the urine and excreting hydrogen ions into the urine. For instance, if the blood pH is below average, the kidney conserve the hydrogen ion and also reduces the loss of bicarbonates 

Problems of the Accessory glands and nutritional remedies 

The gastrointestinal (GI) tract is involved in the absorption of food. It comprises primary organs such as the mouth, esophagus, stomach and the large intestines. It also includes the accessory organs such as the liver, gallbladder and the pancreas. Numerous problems are associated with the organs and may lead to serious health implications. Cirrhosis is one of the accessory disorder that is found in the liver and is characterized by cell loss( Cullen & Barnes, 2015). In the process of cell loss, there occurs a fatty infiltration that leads to the liver not functioning properly. The dietary treatment of this illness is at least 25 calories and 1 gram of proteins per day. Supplements of vitamins and minerals are often required. In some severe cases, fats and sodium intake are usually restricted. The inflammation of the liver causes hepatitis. Treatment of disease involves plenty of fluids and medical nutrition therapy. Carbohydrates with moderate fats are often recommended to prevent necrosis. Patients are often advised to rake smaller meals rather than large ones. Cholecystitis and Cholelithiasis are diseases caused by the inflammation of the gallbladder inhibiting the flow of bile. This can affect cholesterol regulation causing it to harden thereby leading to the formation of gallstones. Medical nutrition therapy involves taking a clear liquid diet regularly but should be fat restricted to help in dissolving all the gallstones ( Nix, 2016). Pancreatitis is an inflammation of the pancreas caused by surgeries or alcoholism leading to the reduction of pancreatic secretions and bile. Patients suffering from this disease are advised to feed on carbohydrates and proteins to enhance pancreatic secretions frequently. Vitamin supplements are often prescribed to the patient suffering from the illness. 

Cancer and HIV AIDS are discussed in relations to the body’s immune system. Explain in five sentences how immunity functions on quality nutrition management. 

Research shows that macronutrients and micronutrients are essential in fighting infections associated with HIV infection and cancer. HIV infection in most cases compromises the health situation of an individual making him or her becoming susceptible to various diseases. From a nutritionist point of view, it has been shown that lack of a good nutrition results deficiencies in nutrients that results in low immunity which influences viral expression and replication. ( Oguntibeju, Van den Heever, & Van Schalkwyk, 2007). This is quite dangerous to a patient it is to contribute to diseases progression and weight loss. However, a proper diet rich in various nutrients plays an essential role in fighting infectious pathogens that cause diarrhea and respiratory infections. This leads to improvement in the quality of life and prolonged survival. 

The development of cancer has been linked to either bad or good food. For instance, particular kind of foods has been associated to cause cancer. This includes high-fat diets, excessive intake of calories and some of the smoked food such as bacon which has nitrites that are considered to be carcinogenic. However, there are good foods that have been known to prevent cancer such high fiber foods, foods containing vitamin C and A which are known to protect cancer of the lungs and colorectal cancer. It is therefore advisable to take more vegetables, appropriate amounts of proteins and carbohydrates in moderation for the maintenance of a healthy immune system that can fight any infections likely to cause the development of cancer. 

Describe the consequences of nutritional imbalance on the preoperative, immediate postoperative and long-term postoperative periods 

Regardless of the type of surgery, a client’s nutritional status should be evaluated. Most of the surgical patients may come with dietary deficiencies hence. Therefore, improvements should be made to ensure that improvement before the surgery. This is because proper nutrition enhances speedy recovery of the patient. Besides, it gives the patient enough energy for the operation as well as blood regeneration. Nutritional imbalance in preoperative surgery may lead to various consequences. One, a patient with extra tissue of fats have a higher likelihood of getting new infections as pathogens can hide in the layers of fat(Weimann et al.2017). Besides, the fatty tissues may sometimes lead to the retention of anesthetics making it difficult to perform the surgery or the patient taking it longer to recover. Patients who for a long time have not had enough protein and carbohydrates supplements may lack the needed energy required to perform the surgery thereby leading to many delays. 

The postoperative surgery phase requires that the patient has the necessary nutrient for help in meeting the metabolic needs and promote faster healing and recovery. Often, 24 hours after the surgery, the patient is given intravenous solutions that are meant to help them recover water and energy lost. Research shows that many of the adverse outcomes that occur during postoperative period are as a result of poor nutrition. Patients who lack essential nutrients such as Vitamin C may take longer to recover from their wounds as the tissues do not have ample supply of the needed nutrients. Besides, they are likely to develop spontaneous bruises which also increases the risk of pneumonia prolonging the patient’s stay at the hospital. Lack of nutritional imbalance in nutrients such as vitamin K may lead to excessive bleeding. In most cases, the excessive bleeding may be fatal especially if the patient had low blood levels hence leading to death. In some cases, the excessive bleeding in may cause megaloblastic anemia which can be treated by blood transfusion or taking a diet rich in iron. Studies have shown that such kind of patients has a higher likelihood of being hospitalized for a more extended period leading to significant loss of body mass. 

In conclusion, illnesses such as coronary artery, diabetes, and surgery can have devastating effects on the nutritional status of an individual. Proper nutrition should, therefore, be adapted to ensure that the body can fight new infections that may occur. Research has shown that nutritional intervention in the management of diseases such as HIV and cancer may play an essential role in improving the immune response in the body. Malnutrition and nutritional imbalance have been shown to increase disease progression, weight loss and viral replication in diseases. 

References 

Cullen, M., & Barnes, C. (2015). Crohn's disease in adolescence: presentation and treatment. Nursing Standard (2014+) , 29 (37), 50. 

Dabelea, D., Stafford, J. M., Mayer-Davis, E. J., D’Agostino, R., Dolan, L., Imperatore, G.... & Black, M. H. (2017). Association of type 1 diabetes vs. type 2 diabetes diagnosed during childhood and adolescence with complications during teenage years and young adulthood. Jama , 317 (8), 825-835. 

LeFevre, M. L. (2014). Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine , 161 (8), 587-593. 

Nix, S. (2016). Williams' Basic Nutrition & Diet Therapy-E- Book . Elsevier Health Sciences. 

Oguntibeju, O. O., Van den Heever, W. M., & Van Schalkwyk, F. E. (2007). The interrelationship between nutrition and the immune system in HIV infection: a review. Pakistan journal of biological sciences: PJBS , 10 (24), 4327-4338. 

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., ... & Waitzberg, D. L. (2017). ESPEN guideline: clinical nutrition in surgery. Clinical Nutrition , 36 (3), 623-650. 

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The most common types of therapy—and how to choose the best one for you

By LaKeisha Fleming

Expert Contributor Rychel Johnson, MS, LCPC

Reviewed by Stephanie Hope

Fact Checked by Krista Manning

Written by LaKeisha Fleming, Fortune Recommends Writer

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We consulted the most up-to-date scientific articles, studies, and resources to inform this story. The information we provide is supported by cited sources and medical review.

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This guide benefits from the expertise of Joel Frank, PsyD, a clinical psychologist, Rychel Johnson, a licensed clinical professional counselor, and Krista Manning, a medical copy editor and fact-checker.

In 2022, close to 56 million adults in the United States received some form of mental health treatment, including therapy. ( 1 ) Therapy is a beneficial way for a mental health professional to help you address and treat various issues. Yet older adults are less likely to receive the mental health treatment they need than individuals in younger age groups. ( 2 ) This could be due to the stigma of getting mental health care, lack of access to therapists or other professionals, or the erroneous belief that older adults don’t benefit from therapy.

Therapist Rychel Johnson, who primarily works with therapy clients in the millennial and Gen Z age groups, shares that there’s a common theme with how older adults relate to mental health care. “My young adult clients share that their parents don’t feel like therapy is needed unless someone has mental health concerns that place them in danger. Therapy remains stigmatized among many older adults compared to people in younger generations.” This difference makes it difficult for some people to access the care they need.

Despite barriers that can keep people from seeking out care, 75% of people say that therapy helped them treat their mental health issues. ( 3 ) But knowing that therapy can help isn’t enough; it’s important to understand which therapy will address your issues. We discuss the most common types of therapy, the conditions each type of therapy treats, and how to decide which type of therapy works best for you.

Meet the expert

Rychel Johnson, M.S., LCPC , specializes in anxiety and social skills development as a licensed clinical professional counselor. She emphasizes that everyone deserves to feel empowered to live a healthy, balanced life.

Types of therapy

Hundreds of varieties of therapies exist. Various therapies are used to address specific issues. Many of the popular therapy methods fall under the umbrella of psychotherapy, which means a mental health professional helps you work through your challenges. ( 3 ) They can do this in several ways.

“Among the plethora of therapy types, some notable ones include cognitive behavioral therapies, which target negative thoughts and behaviors; psychodynamic therapies, focusing on past experiences and unconscious influences; humanistic therapies, which emphasize personal growth and self-actualization; integrative or holistic therapies, which merge elements from various approaches to fit the individual’s needs; and existential therapies, which delve into life’s existential questions, promoting self-reflection and personal responsibility,” explains Joel Frank, PsyD, a clinical psychologist with Duality Psychological Services .

Read on to understand how the various categories of therapy intersect and how you can determine which one works best for you.

Behavioral therapy

This type of therapy adopts the approach that a person’s behavior can be modified, and those changed behaviors will positively impact your mental health. When using behavioral therapy, therapists help clients get to the root of their problem and determine how to address the behavior constructively.

“It employs various techniques to promote positive behavior changes, including exposure therapy, role-playing, and reinforcement strategies. These methods provide a supportive environment for individuals to learn and practice new behaviors,” says Dr. Frank.

Because this type of therapy focuses on modifying behaviors and incorporating new ways of thinking and acting, it can be woven into other therapy approaches. Some include Applied Behavior Analysis (ABA), which helps individuals with autism learn behaviors that enhance their communication skills and increase their ability to focus. ( 4 ) Cognitive Behavioral Therapy (CBT), which we will dive into in more detail below, helps clients change their behaviors. It differs from behavioral therapy because it adds the element of helping you understand how your thoughts impact your feelings.

Dialectical Behavioral Therapy (DBT), another that we examine below, modifies behavior but uses mindfulness . It’s beneficial in helping people who’ve dealt with trauma cope with an experience. Social Learning Theory focuses on interactions with others and communication in relationships. Improving these interactions can lead to less mental distress and improve mental health.

Cognitive behavioral therapy (CBT)

CBT is one of the most common forms of psychotherapy. ( 5 ) It goes beyond dealing with a person’s behavior. It delves into current thought patterns and past ways of thinking that contribute to your behavior. The therapy then helps you change your thinking patterns, which leads to modifying your negative behaviors and feelings.

Changing your mindset and how you’ve thought about and perceived things for years takes work. CBT can guide you through the process. You can role-play to learn how to manage your reactions in certain situations, do mindfulness exercises to calm your body and mind, and face your fears without running away from them. It’s a multi-faceted therapy style.

“CBT is adaptable and includes various subtypes like rational emotive behavior therapy (REBT), which focuses on challenging irrational beliefs; cognitive therapy, which aims at altering distorted thinking; and mindfulness-based cognitive therapy (MBCT), which integrates mindfulness practices with cognitive therapy techniques,” states Dr. Frank.

CBT is helpful in treating eating disorders, obsessive-compulsive disorder (OCD), phobias, post-traumatic stress disorder (PTSD), schizophrenia, sleep disorders, and more. ( 6 ) It’s also used to treat anxiety, depression, and substance use disorders. If you’re looking into CBT therapy, our list of the best online cognitive behavioral therapy options is a great place to start.

Dialectical behavioral therapy

Referred to as DBT, dialectical behavior therapy focuses on helping people accept the realities in their everyday lives and regulate their emotional behaviors and responses to those realities. ( 7 ) People who deal with strong emotional pain can find ways to cope and heal through DBT. It works by helping you look at unhealthy behaviors and intense emotions, then uses various techniques to implement healthy ways to respond.

“DBT emphasizes developing four key skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness through group therapy, individual therapy, and phone coaching, helping individuals navigate life’s challenges with these guiding principles,” Frank noted.

People who experience borderline personality disorder (BPD) commonly receive DBT as a form of treatment. ( 7 ) It’s also beneficial for a variety of issues, including attention-deficit/hyperactivity disorder (ADHD), Post-traumatic stress disorder (PTSD), and eating disorders.

Psychodynamic therapy

Psychodynamic therapy helps you revisit past experiences, including those from childhood, and looks at how those events impact your current state of mind. It’s a form of talk therapy guiding you through the process of understanding where your emotional distress started as a way of helping you deal with and manage it. Many types of treatment help you explore past events to walk you through trauma and mental upheaval. Psychodynamic therapy is different because it focuses less on behavior and more on the early mental and emotional patterns that led to the behavior.

Psychodynamic therapy resonates well with many people who want to better understand the roots of their mental health issues and stressors. However, exploring childhood and early life experiences may not be for everyone. Johnson shares, “In situations where someone is seeking short-term therapy, psychodynamic may not be appropriate. It’s a longer-term approach.”

Brief psychodynamic therapy is one type of this treatment, where a person has one therapy session (thus the word “brief”) and usually surrounds a frightening or traumatic event. ( 8 ) Psychodynamic family therapy usually happens in a group setting with family members and involves longer-term treatment. Psychodynamic therapy can involve using music or art as the vehicle for a patient to express their thoughts and feelings.

Psychodynamic therapy uses several approaches, including psychoanalysis, which says that conflicts during childhood and unconscious beliefs affect current behavior, and integrative therapies, where therapists combine several therapeutic techniques to help patients through their mental health journey. ( 9 )

People who have had severe emotional or psychological issues can benefit from this type of therapy. ( 10 ) If you’ve had challenges maintaining healthy relationships, dealing with mood disorders, struggling with low self-esteem, or unresolved feelings from past experiences, psychodynamic therapy may be for you. It also helps those dealing with substance abuse and addiction, bipolar disorder, and social anxiety disorder.

Humanistic therapy

Humanistic therapy assumes that each individual is capable of growth, self-awareness, and self-development. ( 11 ) To facilitate healing, humanistic therapists help you focus on your present thoughts rather than delving into past issues.

People with low self-esteem, who feel like they struggle with finding purpose and meaning in their lives, and who feel uncomfortable with who they are could benefit from humanistic therapy. The therapy also helps with addiction, family conflicts, personality disorders, and schizophrenia. ( 12 )

Group therapy

People looking for a supportive therapy experience with others dealing with the same issue may benefit from group therapy. This type of therapy happens when one or more therapists treat several patients simultaneously.

While some patients find groups intimidating, for others, it gives feelings of acceptance.

“Group therapy benefits those seeking to break the isolation of their struggles by connecting with others. It offers a platform for individuals to be heard and share their healing journey. Individuals participating in group therapy can experience personal growth and contribute to a community of support, resilience, and hope,” said Frank.

Group therapy works best when everyone in the group is focused on dealing with a specific problem, like depression, obesity, panic disorders, or substance abuse. Group therapy is also beneficial for those walking through a shared experience, such as losing a loved one to suicide, dealing with miscarriage, or experiencing divorce.

If you are concerned about sharing your thoughts and feelings with others along with your therapist or need help engaging with others in the group dynamic, group therapy may not be suitable for you. Consult your therapist before joining a group to ensure it is the right fit. ( 13 )

How to choose a therapy type

It can be hard to know precisely which type of therapy you need when you’re starting. You may find that a therapist can help you determine which type works best for you. As you make that decision, here are some essential things to consider.

First, think about the issue you want to tackle in therapy. The most common mental health issues that older adults deal with are depression and anxiety. ( 14 ) Loneliness with the loss of friends or the grief of losing a spouse, concerns about finances, and fear of dealing with health challenges can also factor in. Take time to process your thoughts and feelings, then search for a therapist who offers what you need. Remember that you may benefit from more than one type of therapy, as each type provides different approaches and perspectives.

Also, decide whether you want therapy in person or virtually or want a therapist who offers both. Some people love the convenience and flexibility of doing sessions from home. If this interests you, take a look at our recommendations for the best online therapy . Other people don’t want to deal with technology and prefer the connection they feel with an in-person therapy session.

Affordability is a vital part of your therapy search. Most older adults in the United States have mental health coverage through Medicare, but it may not always offer enough coverage to make therapy affordable. And some therapists don’t accept Medicare. ( 15 )

Although you may have private insurance that you want to use, your therapist might not accept it. That means you have to pay out of pocket. Is your therapist cost-prohibitive? Our list of the best online therapy platforms that take insurance may be helpful when researching insurance-friendly therapy.

Making a list of your therapy needs in order of importance is a good place to start your search. Knowing your must-haves versus areas where you’re flexible can save you time and effort in your therapy search.

The most common type of therapy, particularly in Western contexts, is CBT. CBT is a form of psychotherapy based on the idea that our thoughts, feelings, and behaviors are interconnected and that changing negative thought patterns can lead to changes in feelings and behaviors.

CBT has been extensively studied and has strong empirical support. It’s been shown to be effective for a wide range of mental health issues, including depression, anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and many others. ( 5 )

Unlike some other forms of therapy, CBT is often structured and time-limited, usually lasting around 12-20 sessions. This makes it a practical choice for therapists and clients looking for a solution that doesn’t require a long-term commitment.

CBT focuses on teaching clients specific skills that they can use to manage their symptoms and improve their quality of life. These skills can include cognitive restructuring (challenging and changing negative thought patterns), behavioral activation (engaging in positive activities), and problem-solving strategies.

Unlike therapies that delve deeply into the past, CBT is often more focused on current problems and practical solutions. This approach resonates with many people who are looking for tangible results in their daily lives.

The term “deepest” in the context of therapy usually refers to forms of psychotherapy that delve deeply into the unconscious mind, exploring underlying psychological conflicts, past experiences, and deeply ingrained patterns of behavior and emotion. The deepest form of therapy, in this sense, is often considered to be psychoanalysis.

Sigmund Freud developed psychoanalysis in the late 19th and early 20th centuries. It’s based on the theory that unconscious forces, including unresolved conflicts and repressed memories from early childhood, significantly influence an individual’s thoughts, feelings, and behavior. ( 16 )

Psychoanalysis aims to uncover and work through these unconscious influences. This is achieved through techniques such as free association (where the patient speaks freely about whatever comes to mind), dream analysis, and examining resistance and transference (redirecting feelings about significant people in the patient’s life onto the therapist).

Unlike more structured therapies like CBT, psychoanalysis is typically a long-term process, often lasting for several years. Sessions are frequent, usually multiple times a week, and the relationship between the analyst and the patient is central to the therapeutic process.

The concept of “most effective therapy” can vary depending on the specific condition being treated, the individual’s unique needs, preferences, and circumstances, and the context in which the therapy is delivered. However, CBT is often cited as one of the most effective forms of therapy across a wide range of mental health conditions.

Our experts

Rychel Johnson, M.S., LCPC

Rychel is a licensed clinical professional counselor in Kansas. She owns a private practice specializing in anxiety treatment and social skills development. Rychel also enjoys extensive road trips and spending time with her husband, daughter, and two cats.

Krista Manning

Krista Manning is an accomplished medical copy editor and fact-checker who stands out in the pharmaceutical, health, and wellness domains. With a meticulous eye for detail and a command of medical language, Krista ensures the accuracy and clarity of content. Beyond her professional expertise, Krista is an advocate for mental health awareness. Recognizing the crucial intersection of psychological and physical well-being, she actively contributes to projects that promote mental health awareness within the healthcare narrative. Krista’s commitment extends beyond the pages she edits, emphasizing the holistic nature of health communication.

LaKeisha Fleming

Fortune Recommends Writer

About Author

LaKeisha Fleming is a writer, content creator, motivational speaker, instructor, and filmmaker. She is the founder and president of Vision 2:2 Productions, a multimedia production company. She began her career in television news, working for Cable News Network (CNN) in Atlanta. She has also worked as a writer and in various TV and film production roles for Tyler Perry Studios. Her other writing clients include Insider, Verywell Mind, Verywell Family, PsychCentral, and numerous others. Learn more about her work at www.lakeishafleming.com.

• Statista. Number of U.S. Adults Who Received Mental Health Treatment or Counseling in the Past Year from 2002 to 2022. November 2023. https://www.statista.com/statistics/794027/mental-health-treatment-counseling-past-year-us-adults/#:~:text
• Saunders, R. et al. Older Adults Respond Better to Psychological Therapy Than Working-Age Adults: Evidence from a Large Sample of Mental Health Service Attendees. National Library of Medicine. November 1, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411661/
• American Psychological Association. Understanding Psychotherapy and How it Works. Dec. 12, 2023. https://www.apa.org/topics/psychotherapy/understanding
• Patricio da Silva, A. et al. Applied Behavioral Analysis for the Skill Performance of Children with Autism Spectrum Disorder. Frontiers in Psychiatry. April 26, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10169625/
• Cleveland Clinic. Cognitive Behavioral Therapy. August 4, 2022. https://my.clevelandclinic.org/health/treatments/21208-cognitive-behavioral-therapy-cbt
• Mayo Clinic. Cognitive Behavioral Therapy. May 16, 2019. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
• Cleaveland Clinic. Dialectical Behavior Therapy (DBT) Last reviewed on 04/19/2022 https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt
• Gatta, M. et al. Effectiveness of Brief Psychodynamic Therapy with Children and Adolescents: An Outcome Study. Frontiers in Pediatrics. December 20, 2019. https://www.frontiersin.org/articles/10.3389/fped.2019.00501/full
• Lumen Abnormal Psychology. Psychoanalytic and Psychodynamic Therapies. https://courses.lumenlearning.com/wm-abnormalpsych/chapter/types-of-treatment/
• Brenner, B. What Is Psychodynamic Therapy? Therapy Group of DC. June 28, 2021. https://therapygroupdc.com/therapist-dc-blog/what-is-psychodynamic-therapy/
• American Psychological Association. APA Dictionary of Psychology. April 19, 2018 https://dictionary.apa.org/humanistic-therapy
• Doe, E. What Is Humanistic Therapy? February 5, 2024. Mentalhealth.com. https://www.mentalhealth.com/therapy/what-is-humanistic-therapy
• Malhotra, A.; Baker, J. Group Therapy. National Library of Medicine. December 13, 2022. https://www.ncbi.nlm.nih.gov/books/NBK549812/#:~:text
• World Health Organization. October 20, 2023. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
• Gunja, M., et al. Comparing Older Adults’ Mental Health Needs and Access to Treatment in the U.S. and Other High-Income Countries. The Commonwealth Fund. January 21, 2022. https://www.commonwealthfund.org/publications/issue-briefs/2022/jan/comparing-older-adults-mental-health-needs-and-access-treatment
• Martin Tarzian, Mariana Ndrio, and Adegbenro O Fakoya An Introduction and Brief Overview of Psychoanalysis Published online 2023 Sep 13. doi: 10.7759/cureus.45171 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10575551/

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Essay on Nutrition Therapy for Cardiovascular Disease

Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide. It encompasses various conditions affecting the heart and blood vessels, including coronary artery disease, hypertension, and stroke. While medical interventions play a crucial role in managing CVD, nutrition therapy has emerged as a cornerstone in preventing and managing this pervasive health issue. Through targeted dietary interventions, individuals can mitigate risk factors, improve cardiovascular health, and enhance overall well-being.

One of the fundamental principles of nutrition therapy for CVD involves reducing the consumption of saturated fats and trans fats. These unhealthy fats contribute to elevated cholesterol levels, increasing the risk of atherosclerosis and heart disease. By replacing saturated fats with healthier alternatives such as monounsaturated and polyunsaturated fats, individuals can lower their LDL (low-density lipoprotein) cholesterol levels while maintaining or even increasing their HDL (high-density lipoprotein) cholesterol levels. Foods rich in these beneficial fats include avocados, nuts, seeds, and olive oil, all of which can be incorporated into a heart-healthy diet.

In addition to modifying fat intake, adopting a diet rich in fruits, vegetables, whole grains, and legumes is essential for cardiovascular health. These plant-based foods are abundant in vitamins, minerals, antioxidants, and dietary fiber, all of which promote heart health in various ways. Antioxidants, found in colorful fruits and vegetables, help combat oxidative stress and inflammation, which are underlying mechanisms in the development of CVD. Furthermore, the high fiber content of whole grains and legumes aids in lowering cholesterol levels, regulating blood sugar levels, and promoting satiety, thereby reducing the risk of obesity and related cardiovascular complications.

Moreover, attention to sodium intake is crucial in nutrition therapy for CVD, particularly for individuals with hypertension. Excessive sodium consumption can lead to elevated blood pressure, increasing the strain on the heart and blood vessels. Therefore, reducing salt intake by limiting the consumption of processed and packaged foods and opting for fresh, whole foods is paramount. Additionally, incorporating potassium-rich foods such as bananas, spinach, and sweet potatoes can help counteract the effects of sodium and maintain healthy blood pressure levels.

In conclusion, nutrition therapy plays a pivotal role in the prevention and management of cardiovascular disease. By emphasizing a diet rich in healthy fats, fruits, vegetables, whole grains, and lean proteins while minimizing saturated fats, trans fats, and sodium, individuals can significantly reduce their risk of CVD and improve their overall cardiovascular health. Empowering individuals with the knowledge and tools to make informed dietary choices is essential in combating this global health epidemic and fostering a healthier future for generations to come.

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What Is Marek's Disease Marek's disease is a highly contagious viral illness that primarily affects poultry, particularly chickens. It is caused by the Marek's disease virus (MDV), which belongs to the family Herpesviridae. Named after József Marek, the Hungarian veterinarian who first described the disease in the early 20th century, Marek's disease poses significant economic challenges to the poultry industry worldwide. The virus spreads through airborne transmission and contact with contaminated surfaces, making it easily transmissible within and between poultry flocks. Once infected, chickens can shed the virus through dander, feathers, and bodily fluids, further perpetuating the spread of the disease. Marek's disease primarily targets young chickens, typically between 12 and 25 weeks of age, although older birds can also be affected. The clinical manifestations of Marek's disease vary depending on the strain of the virus and the age and immune status of the infected bird. Classical signs include paralysis, particularly of the legs and wings, leading to an inability to stand or move properly. Affected birds may also exhibit neurological symptoms such as tremors, loss of coordination, and behavioral changes. Additionally, Marek's disease can cause tumors to develop in various organs, including the liver, spleen, kidneys, and reproductive tract. Diagnosing Marek's disease often involves a combination of clinical signs, postmortem examination, and laboratory tests such as virus isolation and serological assays. However, vaccination remains the most effective method for controlling the spread of Marek's disease. Several vaccines are available, including live attenuated vaccines and recombinant vaccines, which help reduce the severity of clinical symptoms and decrease viral shedding within flocks. Preventing the spread of Marek's disease requires strict biosecurity measures, including proper sanitation, quarantine procedures for newly acquired birds, and minimizing contact between infected and susceptible individuals. Additionally, maintaining optimal flock health and immunity through balanced nutrition, adequate housing conditions, and stress management can help mitigate the impact of Marek's disease outbreaks. In conclusion, Marek's disease is a significant concern for the poultry industry due to its highly contagious nature and detrimental effects on bird health and productivity. Understanding the transmission, clinical manifestations, diagnosis, and prevention strategies of Marek's disease is crucial for poultry producers to effectively manage and control this infectious poultry disease....

BZ Nutrition Argument Essay

Nutrition is a critical component of overall health and well-being. It directly impacts various aspects of our lives, from physical performance to mental clarity. In recent years, there has been a significant debate regarding the most effective approach to nutrition. While some advocate for traditional dietary guidelines, others argue in favor of newer, more unconventional approaches, such as the BZ nutrition method. This essay aims to explore the arguments for and against BZ nutrition, ultimately evaluating its effectiveness in promoting health and longevity. Proponents of BZ nutrition often highlight its emphasis on bioavailability and nutrient density. Unlike conventional dietary recommendations, which may focus primarily on macronutrient ratios, BZ nutrition prioritizes the consumption of nutrient-dense foods that are readily absorbed by the body. This approach is rooted in the belief that optimal health can be achieved by providing the body with the essential vitamins, minerals, and antioxidants it needs to function optimally. By focusing on nutrient-dense whole foods, BZ nutrition aims to support various bodily functions, including metabolism, immune function, and cellular repair. Furthermore, advocates of BZ nutrition argue that it offers a more sustainable and environmentally friendly approach to eating. The emphasis on whole, minimally processed foods aligns with principles of sustainability and promotes ethical food production practices. Additionally, by reducing reliance on heavily processed foods and animal products, BZ nutrition may have a lower carbon footprint compared to traditional diets. This aspect resonates with individuals who are concerned about the environmental impact of their dietary choices and seek to align their eating habits with their values. However, critics of BZ nutrition raise valid concerns regarding its restrictive nature and potential nutritional imbalances. Some argue that focusing solely on nutrient density may lead to an overly limited diet, lacking in essential macronutrients such as carbohydrates and fats. Additionally, the emphasis on bioavailability may overlook the importance of dietary diversity in promoting gut health and overall well-being. Moreover, BZ nutrition may not be suitable for everyone, particularly individuals with specific dietary requirements or medical conditions that necessitate a more individualized approach to nutrition. In conclusion, while BZ nutrition offers compelling arguments regarding nutrient density, sustainability, and ethical food choices, it is not without its limitations. As with any dietary approach, it is essential to consider individual needs, preferences, and health goals. While BZ nutrition may serve as a valuable framework for some individuals seeking to improve their health through dietary choices, it is crucial to approach it with a critical mindset and consult with a healthcare professional or registered dietitian to ensure nutritional adequacy and overall well-being....

• Nutrition & Dieting

Essay on Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) pose a significant global health challenge, affecting millions of individuals each year and presenting a range of physical, emotional, and social consequences. These diseases, also known as sexually transmitted infections (STIs), are primarily spread through sexual activity, including vaginal, anal, and oral sex. STDs can be caused by bacteria, viruses, parasites, or fungi, and they manifest in various forms, from mild infections to chronic conditions with serious health implications. One of the most alarming aspects of STDs is their prevalence and the ease with which they can be transmitted. Many STDs, such as chlamydia, gonorrhea, and syphilis, can be asymptomatic, meaning individuals may be unaware that they are infected and unknowingly transmit the disease to others. This lack of awareness contributes to the rapid spread of STDs within communities and underscores the importance of regular testing and preventive measures. The consequences of untreated STDs can be severe, leading to a range of health complications. For example, untreated chlamydia and gonorrhea can cause pelvic inflammatory disease (PID) in women, which can result in chronic pelvic pain, infertility, and ectopic pregnancy. Similarly, untreated syphilis can lead to neurological damage, cardiovascular complications, and even death. Additionally, some STDs, such as HIV/AIDS, can weaken the immune system and increase susceptibility to other infections and diseases. Prevention plays a crucial role in combating the spread of STDs and reducing their impact on individuals and communities. Education about safe sex practices, including the consistent and correct use of condoms, can help reduce the risk of transmission. Routine testing for STDs, especially among high-risk populations, enables early detection and treatment, preventing the progression of infections and reducing the likelihood of transmission. Moreover, vaccination against certain STDs, such as human papillomavirus (HPV) and hepatitis B, offers effective protection against infection. In conclusion, sexually transmitted diseases pose a significant public health challenge, with far-reaching consequences for individuals and communities. Awareness, prevention, and early detection are essential in combating the spread of STDs and reducing their impact on global health. By promoting safe sex practices, encouraging regular testing, and expanding access to preventive measures, we can work towards a future where STDs no longer pose a threat to public health and well-being....

Essay about Benefits of Massage Therapy

Massage therapy has been practiced for centuries and has a wide range of benefits for both the body and the mind. One of the primary benefits of massage therapy is its ability to reduce stress and promote relaxation. During a massage, the body releases endorphins, which are neurotransmitters that act as natural painkillers and mood elevators. This can help to reduce feelings of anxiety and depression, as well as improve overall mental well-being. In addition to its mental health benefits, massage therapy can also have a positive impact on physical health. Regular massages can help to improve circulation, reduce muscle tension, and increase flexibility. This can be especially beneficial for athletes or individuals who engage in regular physical activity, as it can help to prevent injuries and speed up recovery time. Massage therapy can also help to alleviate chronic pain conditions, such as arthritis or fibromyalgia, by reducing inflammation and improving blood flow to affected areas. Another benefit of massage therapy is its ability to boost the immune system. By stimulating the lymphatic system, massages can help to remove toxins from the body and improve overall immune function. This can help to prevent illness and promote overall health and well-being. Additionally, massage therapy can help to improve sleep quality, which is essential for a healthy immune system and overall functioning of the body. Overall, the benefits of massage therapy are vast and can have a significant impact on both physical and mental health. Whether you are looking to reduce stress, alleviate pain, or improve your overall well-being, regular massages can be a valuable addition to your self-care routine. With its ability to promote relaxation, reduce muscle tension, and boost the immune system, massage therapy is a holistic approach to health and wellness that can benefit individuals of all ages and backgrounds....

• Alternative Medicine and Therapies
• Psychiatry & Mental Health

Are Video Games Therapy? Essays

Video games have long been a source of entertainment for people of all ages. However, in recent years, there has been a growing discussion surrounding the potential therapeutic benefits of playing video games. While traditionally seen as a form of leisure activity, some experts argue that certain types of video games can have therapeutic effects on mental health and well-being. This has sparked a debate on whether video games can truly be considered a form of therapy. Proponents of the idea that video games can be therapeutic often point to the immersive nature of gaming as a key factor. Video games have the ability to transport players to different worlds, allowing them to escape from reality and experience a sense of accomplishment and control. This can be particularly beneficial for individuals dealing with stress, anxiety, or depression, as it provides a temporary reprieve from their everyday challenges. Moreover, certain video games are specifically designed with therapeutic goals in mind. These games, known as "serious games" or "games for change," aim to address specific issues such as cognitive function, emotional regulation, or social skills. For example, games that incorporate mindfulness techniques or cognitive-behavioral therapy principles have been developed to help individuals manage their mental health more effectively. By engaging with these games, players can learn and practice coping strategies in a safe and interactive environment. However, it is important to note that while some individuals may find solace and comfort in playing video games, they are not a substitute for professional therapy or treatment. Video games should be viewed as a complementary tool that can potentially enhance mental well-being, rather than a standalone form of therapy. Additionally, not all video games are created equal, and some may have negative effects on mental health if played excessively or inappropriately. As with any form of entertainment or activity, moderation and mindfulness are key when it comes to using video games as a means of therapy. In conclusion, the question of whether video games can be considered therapy is complex and multifaceted. While there is evidence to suggest that certain types of video games can have therapeutic benefits, it is essential to approach this topic with caution and a critical eye. By understanding the potential benefits and limitations of using video games as a therapeutic tool, individuals can make informed decisions about incorporating gaming into their mental health regimen....

• Mental Health Awareness

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Saint Petersburg Health & Wellness

Anti-Aging, Functional-Metabolic, Regenerative, Integrative & Preventative Medicine – “Live Well!”

St. Petersburg Health & Wellness

Important information regarding practice closure.

Dr. Cole, Kathie Gonzales, and the staff of St. Petersburg Health & Wellness (SPHW) and Vital Solutions IV Nutrition (VSIVN) have been honored to help care for your health and wellness and provide you a roadmap for your optimal outcomes.

For health reasons, I (Dr. Cole), must follow my own advice and make changes in my lifestyle that support my own wellness. I will be moving into semi-retirement with my focus on authoring educational materials about functional approaches to wellness.  Kathie Gonzales, ARNP, has come to a point in her career where returning to a hospital setting is what calls to her, and is her own best next step professionally.  The result of these changes means that The St Petersburg Health and Wellness office will be closing its doors on 5/28/2022 .   As of that date, Dr. Cole and Kathie Gonzales, ARNP will no longer be available as your personal medical provider. In practical terms, this means they will not be available for appointments, phone calls, or be able to authorize refills for prescriptions. We will make every effort up until that time to provide you with refills for 30-60 days, to give you ample opportunity to obtain a new provider.

If we have been your only medical provider

If we have been your only medical provider, you will need to arrange to have another health care provider take care of your medical needs.  Because our approach is specifically Functional Medicine, you can find additional Functional Medical Practitioners in the area by contacting the American Academy of Anti-Aging Medicine (A4M) at https://www.a4m.com/find-a-doctor.html or the Institute for Functional Medicine (IFM) at https://www.ifm.org/find-a-practitioner/ . Your insurance provider’s directory or local hospital’s physician referral service is another place to check.

Medical Records

Since the virtual business entity of St. Petersburg Health and Wellness itself will continue on, we will be maintaining ownership of all medical records. Legally, all requests for copies of medical records must have a signed authorization to be released. If your doctor needs your medical records, you can sign your doctor’s records request form and they will request them for you. For all other records requests, email your request to  [email protected]  and we will send you the proper medical records release form and any other information to expedite the process. Please understand that the medical record’s email is ONLY for submitting a request for medical records and does not have the ability to answer questions unrelated to the transfer of said records.

For all patients during this transition and beyond:

Continue current protocols.

Continue on your diets and pharmaceutical-grade supplement brands and dosing we have recommended to you. You will still be able to get them through the same portals – Wellevate and WholeScripts – through which you have previously obtained them. Do this in order to continue your “Live Well” lifestyle. This will ultimately keep you healthy and in less need of “sick” (medical) care in the future.

Read: “Supplements Everyone Should Take and Why”(⇐ Click Here)

Order: Specific products for your optimum health

Order: Specific products for gut health

Order: Specific dispensary products 

Gastrointestinal Protocols

If you have been on GI supplements to heal your Intestinal Permeability (Leaky Gut), GI tract, and/or Imbalanced Microbiome, continue your specified diet and all of your GI supplements for 3-6 months from the date you started. Again, you can use the same portals to reorder supplements. My rule of thumb for deciding 3 months versus 6 months is this:

• If your symptoms clear in the 1st month of starting your GI supplements it is generally safe to stop them after 3 months of taking them.
• If your symptoms don’t clear in the 1st month, then you generally want to stay on them for 6 months.

This guideline generally prevents the symptoms and the underlying condition from recurring.

For more information on how to maintain your health as it pertains to your underlying GI health issues, visit articles related to GI Health.

Hormonal Health

For your hormones or other medications, you will need to find another practitioner to prescribe them for you. In determining which practitioner to choose for this, remember your hormones should be optimized for you because all your hormones are intended to work together as a symphony.

Read the information concerning your hormone condition, and “Hormone health – the way to ensure you are being dosed properly”. (⇐ Click Here)

Our Continued Mission for your Health & Wellness

Your health and wellness are still my mission from a broader perspective. I will continue as a source of information to guide your healthy lifestyle and health decisions to maximize your “Live Well” Lifestyle. And so, through our website portal – stpetehw.com – I will provide important, up-to-date health education in an understandable format, as well, as access to effective, Functional Medical treatment protocols for general health and a multitude of health conditions. You will continue to have access to the same quality Pharmaceutical grade (tested for purity, quality, absorption, and effectiveness) therapeutic products. Please review our website if you haven’t done so before, be curious, and look around.

Subscribe so that you get notifications of changes as they happen, as it too will be undergoing significant growth while I transition to a virtual education and information model. You and your health are important to me. If you know me, you know that wellness is a topic I love to research, teach others, and share.

Both Kathie and I wish to thank you for trusting us with your healthcare. We are grateful that you chose us. We appreciate your loyalty and support over the years. We will miss you and wish each of you a love-filled, happy and healthy life.

Live Well, Les Cole, MD and Kathie Gonzales, ARNP

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What Drives Us

Our mission.

We are committed to improving and preserving the Health & Wellness of each and every client who walks through our door. Utilizing the latest research and testing methods; we practice Functional, Anti-Aging, Preventive & Integrative Medicine. We are committed to community education on Healthy Lifestyles.

Read our Testimonials

I love my new doctor and his staff.

I love my new doctor and his staff. They are very supportive and kind. They make me feel like a VIP patient every time I call or go in for an appointment.

Dr. Cole is an Expert in his Field

“We have been going to Vital Solutions for approximately 5 years. Dr. Cole is an expert in his field and the services provided. Jessica is very thorough, professional and knowledgeable! Jeremy and Wendy are always consistent in their help and caring. We are thankful for them and their innovative strategies.”

Emotional Relief that I Would Finally Get Results

“5 stars is a very strong rating and I don’t give them out often. My first appointment with Dr. Cole was 5 months ago and I have never felt better! For many months, my medical practitioner prescribed medications with side effects and no results. I was even scheduled for surgery consultation to “fix” a problem I was dealing with. On my first visit with Dr. Cole, I felt so much emotional relief that I would finally get results. It is true the tests and supplements can be costly. I will say they are necessary for results. I appreciate that he never suggested supplements to try to see if they work. He knew exactly what was needed. The extensive test results showed what was needed and revealed issues no other doctor; primary, gynecologist, or rheumatologist considered. I’ve been consistent with his recommendations and they work. Any questions are promptly responded to and I feel my time is respected during my appointment. His staff, Jessica and Jeremy are just as attentive and knowledgeable. The office is clean and welcoming. Everyone goes above and beyond. I feel 100% confident to recommend to anyone”

Kind, Conscientious, and Above All Very Skilled

“If you are afraid of needles, or not, and need a blood draw or health-inducing IV, fear no more. Jeremy and Jessica, at IV Solutions, are kind, conscientious, and above all very skilled. There are all sorts of wonderful IVs for everything including a hangover, nausea, immune system support, and more. Sorry if this sounds like an advertisement but I really believe in Jeremy and Jessica and the IVs they provide and have had many to improve my multiple health issues.”

The Missing Links in my Overall Health Dilemma

“What a wonderful doctor, staff, and experience! The St. Pete Health and Wellness team is professional and always so friendly. Dr. Cole is brilliant and takes the time to listen to you and understand your unique situation. My health had been challenging me for many years and I am still a young adult. Fatigue and pain were my daily companions. When the conventional medical industry could not offer me any answers or solutions, I turned to integrated medicine and Dr. Les Cole. He literally turned my daily life around! His solutions and treatments were the missing links in my overall health dilemma that no one else has been able to solve. Now I follow his recommendations every day and reap the benefits. Renewed energy, strength, and stamina. Greater concentration and focus. I’m playing tennis again! I cannot encourage you enough to work with Dr. Cole and see the benefits manifested in your life. Thank you Dr. Cole!!”

I Feel I Received a 5-star Treatment

“First, I would like to say I am not a fan of needles. More so my veins do not cooperate. I first went to Vital Solutions for Vitamin IV as a recommendation of a friend. I was feeling run down after traveling and thought this would be a good pick me up. It was more than that! I felt 100% better the following day. The vitamin boost and hydration made me feel great. I later needed supplementation for another issue and Jessica and Jeremy were caring and attentive. I was nervous but they made me feel better about the process. The hours are convenient and the response for an appointment is quick. I feel I received 5-star treatment.”

Keenly Focused on Increasing Vitality and Anti-Aging

“After struggling to find answers on my decreasing energy with my primary care, even after cleaning up my diet and exercise routine, I followed advice to see Kathie Gonzales and wish I had done it two years ago. Kathie and the team drew my blood and tested areas my primary doctor never did. She is an expert on the thyroid and has an amazing consultative approach on the whole body. They are keenly focused on increasing vitality and anti-aging. My primary doctor waited two years while I suffered through premenopausal symptoms and never diagnosed my hypothyroid issue. Net, I am so very happy I made the switch, the entire team there is so responsive and helpful, I recommend them highly.”

Crossfit Competition Recovery

“This place is amazing! We have gone here before Crossfit competitions several times. The IV helps big time. Today I am here as I just arrived from a 30 hour travel time from Italy. I was feeling very run down. So I am getting an IV and already feel much improved. The staff is very helpful and always a pleasure.”

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A ‘Life Review’ Can Be Powerful, at Any Age

Reflecting on the past, through writing or conversation, can help us better appreciate where we are — and where we’re going.

By Emily Laber-Warren

Jodi Wellman was devastated when her mother died of a heart attack at age 58. Cleaning out her apartment made her feel even worse. Drawers and closets overflowed with abandoned projects: unpublished manuscripts and business cards for ventures that had never gotten started.

“My mom was a wake-up call for me,” Ms. Wellman said. “She had these dreams that she didn’t act on.”

At the time, Ms. Wellman was in her early 30s, living in Chicago and working her way up the corporate rungs at a fitness club chain. But, over the course of five years, that work began to feel empty.

Determined not to stagnate like her mother, Ms. Wellman quit her job to become an executive coach, eventually entering a master’s degree program in positive psychology. There, she developed a strategy for living fully: Think about death, a lot.

Now also a speaker and the author of “You Only Die Once,” Ms. Wellman, 48, believes that focusing on how short life is makes you less likely to squander it. To help her clients figure out how to spend their limited time, she asks them dozens of questions, organized by life phase — things like what activities made them happiest as a child, and what they would change about their 40s and 50s.

Her approach is a twist on something called “life review,” where people systematically reflect on their past, through conversations or in writing, to identify character strengths and develop self-awareness and acceptance. The process can occur both with a partner or in small groups, and it typically unfolds in six to 10 weekly sessions.

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Helping Your Child with Autism Thrive

Does my child have autism, autism spectrum disorders (asd), adult autism and relationships.

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Understanding autism treatment options

Types of autism treatment available, behavior therapy, speech-language therapy, physical therapy and occupational therapy, nutritional therapy, cognitive behavior therapy, treatments for medical conditions that often accompany autism, getting the most out of treatment, autism treatments, interventions, and therapy options.

Wondering how you can help your child with autism spectrum disorder reach their fullest potential? Learn more about common autism treatments that can lead to healthy growth and development.

Finding out that your child has autism spectrum disorder (ASD) can be a shock. You might feel upset and even fearful about their future. But it’s important to remember that every child has their own strengths and weaknesses—and a child with autism is no exception.

There are many treatments that can help children with ASD acquire new skills and overcome a variety of developmental challenges. These treatments don’t aim to cure ASD. Instead, they help improve your child’s ability to socialize and play, function academically, and move through everyday life with adaptive skills.

Not every ASD treatment approach is effective for every child, though. It may take some time to tailor the treatment options to your child’s specific needs. But a little patience and persistence can make a big difference in your child’s life. Learning about the many treatments available can help you start to identify which approaches are best for your child and ensure they develop to their full potential.

When it comes to early autism treatment options, there are a dizzying variety of therapies and approaches. Some autism therapies focus on reducing problematic behaviors and building communication and social skills, while others deal with sensory integration problems, motor skills, emotional issues, and food sensitivities.

With so many choices, it is extremely important to do your research, talk to autism treatment experts, and ask questions. But keep in mind that you don’t have to choose just one type of therapy. The goal of autism treatment should be to treat your child’s unique array of symptoms and needs. This often requires a combined treatment approach that incorporates several different types of therapy.

[Read: Helping Your Child with Autism Thrive]

Common autism treatments include behavior therapy, speech-language therapy, play-based therapy, physical therapy, occupational therapy, and nutritional therapy. But keep in mind that the routine is important and the program should be designed in a way that can be sustained. You should think about what skills and behaviors are most essential and treat those first. It may not be possible to tackle everything at once.

Behavior therapy is a commonly used ASD treatment that aims to encourage desired behaviors and reduce unwanted behaviors. Most behavior therapies follow techniques set out by applied behavior analysis (ABA). ABA aims to help a child with ASD understand the connection between behaviors and consequences.

In ABA-based therapy, attempts at desired behavior are positively reinforced. For example, a therapist might offer praise when a child tries to politely ask for help. Because a reward follows the behavior, the child is more likely to repeat the action. On the other hand, if the child has an angry outburst, no reward is given.

ABA is an evidence-based approach. It’s also highly adaptable, so it can meet the needs of each child. Studies show that long-term, intensive therapy can improve a child’s life skills, intellectual abilities, and social skills.

Early Start Denver Model (ESDM)

ESDM is an approach that works best for 12- to 48-month-olds and follows the practices of ABA. The sessions revolve around natural play and joint activities with therapists and parents. Singing could be used to encourage a child with ASD to vocalize, or a mimicry game could be used to teach the child to identify body parts. ESDM focuses on creating positive social interactions, enhancing communication and cognitive skills in the process.

It’s important for you to be involved in your child’s ESDM sessions. Fortunately, the sessions are flexible enough to take place at a clinic or in your own home. A therapist can guide you through what you need to know. Studies, including brain scan research, suggest that ESDM improves language and communication skills as well as adaptive behavior.

Pivotal Response Treatment (PRT)

PRT is another play-based approach that follows ABA practices. Rather than honing in on specific behaviors, PRT focuses on broader areas, including motivation, self-management, response to multiple cues, and initiation of social interactions. By focusing on these pivotal areas, PRT helps children make broad improvements with social skills and communication.

During a session, a therapist might put the child’s favorite food or toy within view but out of reach. A situation like this encourages the child to speak up and ask for the item.

PRT has been studied since the 1970s, and it’s been used in both one-on-one and group sessions. Studies suggest that it can be effective at building communication skills in children.

Discrete Trial Training (DTT)

DTT is an ABA-based approach that is more structured than PRT. A skill is broken down into smaller pieces. When teaching a child with ASD to write their name, a DTT approach might break the process down letter by letter. And forming each letter might be broken down into a stroke-by-stroke process. As the child advances through each step, they receive positive reinforcement.

DTT is effective in teaching skills to children with ASD, and has been used since the 1970s. This type of training doesn’t involve as much natural play as ESDM or PRT.

The three types of ABA-based therapies aren’t your only options. As you consider ASD treatment options, you’ll come across approaches such as positive behavioral support (PBS) and early intensive behavioral intervention (EIBI) as well.

If your child struggles with communication, speech-language therapy can help them improve their verbal and nonverbal skills. To improve verbal skills, a speech-language therapist may guide your child through exercises that involve describing feelings and identifying items and people. Other exercises improve the child’s speech rhythm, sentence structure, and vocabulary. For example, during an exercise your child might be instructed to clap as they speak to bring attention to syllable count and pace.

When it comes to nonverbal communication skills , a speech-language therapist can teach your child about sign language, hand signals, or communication through pictures. Other nonverbal cues, such as making eye contact, can also be improved through speech-language therapy.

Some children with ASD experience difficulties with controlling physical actions. For example, they may have an unusual gait or trouble with handwriting. Physical therapy can build your child’s motor skills. A focus on posture, coordination, balance, and muscle control can improve a child’s social life and sense of well-being.

Occupational therapy helps children with autism build everyday skills that are useful at school or around the home, such as feeding, grooming, and dressing themselves. Similar to physical therapy, occupational therapy can enhance motor skills.

Sessions focus on an individual’s unique needs, so your child may also learn to use assistive devices to adapt to situations and complete tasks. Examples of such devices include a speech-to-text app for a child who struggles with handwriting and a dry-erase board for a child who has difficulty with verbal communication.

Some children with autism struggle with digestive issues as well as bone density issues. On top of that, some children may show an aversion to specific flavors or textures, such as the soft squishiness of tomatoes or the lumpy texture of oatmeal. So, while meeting their nutritional needs is vital, it can also be a tricky endeavor.

[Read: Healthy Food for Kids]

If your child is a picky eater, nutritional therapy can help ensure they’re still following a healthy diet. A nutrition specialist can work with you and your child to create a meal plan that caters to their specific needs and preferences.

You can also take some steps at home to improve your child’s eating habits.

Consider your child’s favorite foods . Try offering them foods with similar tastes or textures. If they like French fries, for example, serve them a side of sweet potato fries for more variety.

Serve new dishes alongside current favorites . This allows you to add new ingredients while at the same time keeping some familiarity. Keep the portions small until your child actually shows a liking for the new food.

Give your child a sense of control by allowing them to select from several new food options. A possible lineup might include broccoli, asparagus, or green beans.

Cognitive behavior therapy (CBT) can help children with ASD understand how thoughts influence behavior. A therapist shows the child how to recognize, reevaluate, and regulate emotions, such as anxiety . This type of therapy is useful for teaching children how to cope with difficult social situations and other challenges in life.

Like other autism treatment options, CBT sessions are personalized to meet the child’s needs. The approach may even be useful in addressing sleep issues, although more research is needed.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Certain medical conditions tend to accompany autism. Here are few examples of common conditions and possible treatments.

Aggression . Some children with autism use aggressive behavior, such as yelling or hitting, to communicate distress. To manage this issue , you’ll first need to understand what your child is trying to tell you. Maybe certain situations or stimuli, such as noises, cause them discomfort. Behavior therapy practices can help them develop more positive ways to express their needs.

Anxiety. Children with ASD may struggle with high anxiety or disorders such as obsessive compulsive disorder (OCD) . Anxiety can contribute to difficulty socializing or negative behaviors such as outbursts. However, there are various ways to manage anxiety. One helpful strategy may include teaching your child to identify anxious feelings. Gradually exposing them to the source of the anxiety in a safe environment may also help.

[Read: Anxiety Disorders and Anxiety Attacks]

Sleep disorders . Restlessness and other sleep disturbances can prevent children with ASD from getting enough sleep at night. Lack of sleep can have a negative effect on concentration and mood. So, it’s important to develop good sleep hygiene practices , such as establishing a calming routine before bed.

Attention deficit hyperactivity disorder (ADHD) . ADHD in children with ASD may involve impulsive behavior or inattentiveness, which can affect performance in school or during social situations. Strategies such as encouraging healthy sleep and exercise practices can help improve concentration.

Gastrointestinal (GI) issues . Children with ASD often deal with GI symptoms, including constipation, bloating, and abdominal pain. Some research suggests that GI symptoms may cause other issues on this list, such as aggression and sleep disturbances. A few ways to treat your child’s GI problems include minimizing stress, encouraging physical activity , increasing fiber and water intake, and keeping track of which foods seem to cause discomfort.

Although professional therapists will guide your child through treatments, you still have an important role to play as a parent . As you explore treatment options for your child, you can take these additional steps to ensure the sessions are as effective as possible.

Start early

Early intervention can increase the effectiveness of treatments. You don’t necessarily have to wait for an official diagnosis before you begin to consider treatment options or even employ some basic strategies at home. Once your child has an official diagnosis and therapy options are available, don’t hesitate to start treatment.

Try multiple treatments at the same time

Not every treatment you try will prove effective for your child. However, you can try multiple treatments at once and look for signs of improvement. Each treatment you rule out gets you one step closer to determining what works. Treatments such as nutritional therapy and speech-language therapy can overlap without causing harm.

Follow through with treatments at home

In some cases, a therapist will guide you through activities that you and your child can complete at home. For example, you might be able to apply play-based activities from PRT and ESDM at home. This is important for several reasons:

• It gives you more time to interact with and learn more about your child.
• Home treatments can also help build on skills learned during clinic visits.
• They can help empower you as a parent.

Establish a consistent schedule

As you explore treatment options, be mindful of your child’s comfort level. Children with ASD tend to thrive when following a consistent schedule. Whenever possible, stick to a routine that incorporates therapy sessions and let your child know when the schedule may change.

Recognize your child’s strengths

Keep an eye out for areas in which your child excels. They may have a knack for music, for example, or have an uncanny eye for detail. Play to their strengths and preferences.

By finding ways to incorporate their strengths into rewards and ASD treatment at home, you can also help keep them engaged. And always remember that whatever obstacles your child may be facing, they have plenty of room to grow.

Hotlines and support

Call the  Autism Society  National Helpline at 1-800-328-8476.

Call the  Child Autism UK helpline  at 01344 882248 or find help and support at  The National Autistic Society .

Call the Early Intervention helpdesk in Perth at 1800 778 581 or  Get support for your child  from NDIS.

Call the  Autism Canada  Family Support Representative at 1-800-983-1795.

Find helplines and support in your area at  Autism New Zealand .

More Information

• Neurodevelopmental Disorders. (2013). In Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. Link
• Linstead, E., Dixon, D. R., Hong, E., Burns, C. O., French, R., Novack, M. N., & Granpeesheh, D. (2017). An evaluation of the effects of intensity and duration on outcomes across treatment domains for children with autism spectrum disorder. Translational Psychiatry, 7(9), e1234. Link
• Gengoux, G. W., Abrams, D. A., Schuck, R., Millan, M. E., Libove, R., Ardel, C. M., Phillips, J. M., Fox, M., Frazier, T. W., & Hardan, A. Y. (2019). A Pivotal Response Treatment Package for Children With Autism Spectrum Disorder: An RCT. Pediatrics, 144(3), e20190178. Link
• McCrae, C. S., Chan, W. S., Curtis, A. F., Deroche, C. B., Munoz, M., Takamatsu, S., Muckerman, J. E., Takahashi, N., McCann, D., McGovney, K., Sahota, P., & Mazurek, M. O. (2020). Cognitive behavioral treatment of insomnia in school-aged children with autism spectrum disorder: A pilot feasibility study. Autism Research: Official Journal of the International Society for Autism Research, 13(1), 167–176. Link
• Restrepo, B., Angkustsiri, K., Taylor, S. L., Rogers, S. J., Cabral, J., Heath, B., Hechtman, A., Solomon, M., Ashwood, P., Amaral, D. G., & Nordahl, C. W. (2020). Developmental–behavioral profiles in children with autism spectrum disorder and co-occurring gastrointestinal symptoms. Autism Research, 13(10), 1778–1789. Link
• Smith, T. (2001). Discrete Trial Training in the Treatment of Autism. Focus on Autism and Other Developmental Disabilities, 16(2), 86–92. Link
• Dawson, G., Jones, E. J. H., Merkle, K., Venema, K., Lowy, R., Faja, S., Kamara, D., Murias, M., Greenson, J., Winter, J., Smith, M., Rogers, S. J., & Webb, S. J. (2012). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51(11), 1150–1159. Link
• Lei, J., & Ventola, P. (2017). Pivotal response treatment for autism spectrum disorder: Current perspectives. Neuropsychiatric Disease and Treatment, 13, 1613–1626. Link
• Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), e17-23. Link
• Geiger, K. B., Carr, J. E., LeBlanc, L. A., Hanney, N. M., Polick, A. S., & Heinicke, M. R. (2012). Teaching Receptive Discriminations to Children With Autism: A Comparison of Traditional and Embedded Discrete Trial Teaching. Behavior Analysis in Practice, 5(2), 49–59. Link

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