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Integrating Therapeutic and Complementary Nutrition

Integrating Therapeutic and Complementary Nutrition by Mary J. Marian, Pamela Williams-Mullen, and Jennifer Muir Bowers, eds. Boca Raton, FL: CRC Taylor & Francis; 2006. Hardcover; 634 pages, Appendix, Index. ISBN-13: 978-08493-1612-8. $80.96.

Healthcare professionals are in need of a scientifically sound book to tell them how to use both conventional and alternative nutritional therapies for their patients. In the Preface to this comprehensive textbook, written by experts in the field of nutrition and medicine, the editors suggest this book will do just that. The book contains a wealth of information on nutritional support for a variety of diseases and conditions. Most chapters include well-referenced complementary and alternative nutrition options from credible, high-quality journals. Unfortunately, the information is not always presented in a usable form for busy healthcare practitioners. Too few of the alternative therapies listed, for example, include the efficacious doses used in the clinical studies. Thus, in order to provide patients both conventional and alternative therapies, the healthcare provider would have to seek out the primary reference in order to apply them. Despite these caveats, any healthcare practitioner who wants an up-to-date book on nutritional support will want to own this book.

The book covers most conditions that can benefit from nutritional attention (e.g., those dealing in the areas of gastrointestinal, skeletal, renal, immune system, and cardiovascular). Most chapters are scholarly, well referenced, and up-to-date. It was not clear from the short biographical sketches how many of the authors of individual chapters actually practice both conventional and alternative nutrition with their patients. I suspect not very many, because too few of the case studies (only about half of the chapters had cases) actually present both forms of therapies as treatments. For example, in one case study regarding the ear, the alternative nutritional therapies cited in the text were not used in the case study, and different alternative therapies (presumably with no scientific support or they would have been mentioned earlier) were presented. Even when good clinical support was available, several of the other cases failed to describe how alternative therapies might be applied. However, chapters on the pancreas, upper gastrointestinal tract, and joints were, to me, home runs. In these, the authors presented excellent examples of how alternative and conventional nutritional therapies can be used together. These chapters were the most satisfying and complied with the editors’ intent.

As with most books this size, repetition is bound to occur. I read several different times about omega-3 fatty acids and the prostaglandin cascade, as well as definitions of alternative, integrative, and complementary nutrition. Cardiovascular disease was covered on its own and then in both the men’s and the women’s health chapters. Some information was not up-to-date, like the mention that commercial fish oil capsules may be contaminated with mercury. Today, all fish oil sold at reputable retail establishments is virtually mercury-free. Also, a small section was devoted to the evils of artificial sweeteners but provided no scientific support. It is fine that the author may have a bias against their use, but in terms of counseling patients, it is preferable to use the published literature as a guide.

A couple of pearls stood out in the book. The chapter explaining the traditional Indian Ayurvedic system of medicine was worth nearly the entire price of the book for me. I had heard about this mode of therapy, but never knew the intricacies surrounding food choices and disease. Really the first dietitians were those practicing this form of medicine. The chapters on joint health and liver disease were also particularly well done. They provided the amounts of the alternative therapies used in an easy-to-read style that will help the busy practitioner find something quickly. In the chapter on renal disease, the authors cautioned against using star fruit (Averrhoa carambola, Oxalidaceae). I wish there were more cautionary snippets like this in other chapters. This crunchy, star-shaped fruit had been reported to induce severe and potentially fatal neurological symptoms including limb numbness and seizures. Finally, I was especially pleased with the chapter on infants and children. The temptation of so many parents is to use the same alternative therapies that they are using on themselves for their children. The authors make it clear that only a few (e.g., fish oil, probiotics) have been tested in children and that others ought to be avoided due to a lack of published clinical evidence documenting their safety and efficacy at a specifically tested dose.

Most chapters cited potential alternative therapies that were published in high-quality journals, and thus believable. It was clear that the authors conducted comprehensive literature searches on each condition and presented as many complementary therapies as they could find. This was one of the best parts of each chapter in this book. I had only wished that more of these potentially helpful therapies were applied to real patient situations. I suspect that in subsequent editions (and I surely hope the editors produce revisions), alternative therapies will have become more commonplace in conventional nutritional practice and more case studies will be provided using both.

—Stacey J. Bell, DSc, RD Research & Development, Twinlab Grand Rapids, MI