Does it make sense to consult a nutritionist without a specific question?

[Hoopoe]

I could come up with some specific questions but there's nothing that clearly suggests an important nutritional problem in my case (as far as I can tell). Still, I'm curious if a nutritionist might be able to figure out a way to improve my health. Does such a request fall within the usual work performed by nutritionists?

My diet is probably good in comparison to average. Varied, with fiber, vegetables, fruit, meat, eggs, grains, berries, nuts, nearly no sugar, and a low proportion of processed foods.

The questions that I could come up with are:
Why do I have excessive hunger but little to no weight gain despite eating more than others? (my BMI is around 19)
Why do I occasionally have episodes of hypoglycemia and don't tolerate fasting well?
Why do I tend to have excessively loose stool or even diarrhea?

 

[Midnattsol]

All of those questions do pop up from time to time and I'd think most nutritionist would have come across them. So you might be able to get some help.

That said, I have periodic wolf hunger myself, and had I been my own patient as a dietician I would likely not have found anything "wrong" with the diet per se. Not with the diet I had when I had hypoglycemia either. For me I think there is some need for a compound in the body that is not being met when the wolf hunger occurs (I only had hypoglycemia the first year or so I had symptoms, then it went away), but no idea what exactly that need is. I feel best on high protein diet, which may be a clue for my own part, but know others who do well on low-carb diets that would cause me to crash..

 

[Hoopoe]

For me I think there is some need for a compound in the body that is not being met when the wolf hunger occurs

It feels like that for me too. Some of it might be an overcompensation due to impending hypoglycemia, which causes hunger. The hypoglycemia is actually most of the time what I would call pre-hypoglycemia which I believe is a state where glucose would continue to fall to hypoglycemia levels if it were not for successful counterregulation. I know what that feels like because it precedes hypoglycemia.

Is there any sense in trying to add amino acids to the diet for a while to see if that helps?

 

[Creekside]

I haven't seen a nutritionist, but my wild guess, from experience with other medical experts, is that they are more likely to have a "Which common disorder do you have that has an easy answer for?" attitude, rather than an "I love difficult to solve mysteries" attitude. If their pay is based on how many patients they see per day, they won't want mysteries.

Is there any sense in trying to add amino acids to the diet for a while to see if that helps?

My opinion is that trying different amino acids, or fatty acids, or any other nutrients, can be a worthwhile gamble. However, since your diet is already rich in amino acids, you likely won't notice a benefit from supplements. Contrary to that, I found that supplemental carnitine did solve my intolerance to meat (more precisely, a fatty acid in meat), so it is at least possible that higher levels than found in regular food will help. It's up to you to decide whether it's worth the price of the supplements. Despite my success with carnitine, and an experiment with BCAAs, I didn't feel it was worth trying any of the others; I considered the chance of success vs price was just too low.

 

[Midnattsol]

Is there any sense in trying to add amino acids to the diet for a while to see if that helps?

The way I'm thinking about my own diet and metabolic health, is that the high protein diet is likely providing me with some nutrients that help keep some functions running. Possibly a metabolic backup system of sorts, like how the body prefer to use simple glucose as energy, but can also break down fatty acids and/or protein when necessary like when fasting. Some patients groups are advised to avoid fasting since their body's are unable to cope with the additional load of having to maintain glucose levels. I have wondered if it's something similar with me/us though it's not as extreme as say someone with liver problems or a very faulty fatty acid oxidation system.

My glucose levels are fine so I don't think it's a failure to maintain glucose like in the aforementioned examples, but maybe the extra energy required to do so is triggering PEM. Who knows. Wish we had timeseries metabolomics studies when performing a metabolic and/or exertion challenge.

I haven't calculated the percentage of energy from protein in a while, but I'm fairly certain it is >20% of my energy even on days where I'm not trying to eat a lot of protein simply due to the food choices I make. Most countries advocate for protein intake to be 10-20% of total energy intake, or 0.8g/kg body weight. The 20% is mostly for the elderly, so younger people would be advised to be at the lower end.

 

[Trish]

I'm curious if a nutritionist might be able to figure out a way to improve my health. Does such a request fall within the usual work performed by nutritionists?

I don't know whether there is a difference between nutritionists and dieticians where you live.

As I understand it in the UK, dieticians are the fully qualified and registered people who work with individual patients with a health problem that needs changes to diet, supplements etc.

Nutritionists don't have to be registered and can have any or no qualifications. They work more on public health and healthy eating advice to maintain good health etc.

I would assume therefore that, at least in the UK we would want to consult a dietician for indivual analysis of and advice on our diet.

 

[Hoopoe]

The way I'm thinking about my own diet and metabolic health, is that the high protein diet is likely providing me with some nutrients that help keep some functions running.

What about testing to see if any metabolic abnormalities are present? I've heard about urine organic acid tests. Is this the kind of thing that could be useful?

Are the things I'm describing enough to suspect some metabolic problem of the kind that can be detected with widely available tests?

 

[Midnattsol]

What about testing to see if any metabolic abnormalities are present? I've heard about urine organic acid tests. Is this the kind of thing that could be useful?

I think they're interesting, but at least where I am it is not something the dietician orders, we help with adjusting the diet to work around a metabolic problem while still getting the nutrients required. It's been a while since I was reading about these tests and I am not sure how they would be used in clinical practice except for well known metabolic disturbances.

Are the things I'm describing enough to suspect some metabolic problem of the kind that can be detected with widely available tests?

This is difficult to answer. In my own experience as a patient trying to figure out what is going on, then there seem to be a lack of such tests.

I've had celiacs or pwIBS (possible to be screened for those) with similar questions, and the general answer has really been that we don't know exactly what is going on, and then trying to modify the diet if there are any potential causes that can be found. Typically to look at fibre, protein and fat intake to see if this can contribute to not feeling full or any triggers for hypoglycemia and/or change in stools. Two persons can have the same diagnosis and follow a similar diet, but may respond differently and we don't know why.