By Chelsea Fuchs MS, dietetic intern at Teachers College, Columbia University

Interview with with Mary Beth Augustine, a leading expert in the field of integrative and functional nutrition.

What is integrative and functional nutrition?

For those of you unfamiliar with the term, integrative and functional nutrition embodies a systems-oriented, whole person approach, and today, it is the preferred term for alternative and conventional medicine.  As a Registered Dietitian and Certified Nutritionist at the Beth Israel Continuum Center for Health and Healing, Ms. Augustine combines clinical wisdom with integrative approaches to make personalized recommendations for the prevention and management of a variety of acute and chronic conditions.

I thought Ms. Augustine would be the perfect person to discuss pediatric food intolerances and allergies with, and her wealth of knowledge provided me with much insight into this complicated, and often frustrating, issue.  In regard to food intolerances in any individual, Ms. Augustine uses a simple school of thought in her practice.  Her approach, and the approach widely used and accepted in integrative and functional medicine, is that if an individual experiences chronic, frequent, and daily symptoms, food intolerance should automatically be considered.  As such, the foods that the individual eats most chronically, frequently, or daily should be taken into consideration.  For example, if a young child experiences persistent bloating or gas, and reports intake of dairy on a daily basis, it would be appropriate to assume that dairy could be related to the troublesome symptoms.  In other words, with any chronic condition (ie: chronic headaches, chronic behavioral problems), food intolerance should always be evaluated.  According to Ms Augustine, while food may not always be causative, to a person’s condition or symptoms, approximately 90% of the time (based on her observations in 18 years of practice), food is contributory.

Once food intolerance is suspected, Ms. Augustine typically starts with an elimination diet, the first line of diet therapy in integrative and functional nutrition.  This involves removing the suspected trigger foods from the diet for a specified period of time.  Gluten is always the first trigger that Ms. Augustine considers when evaluating any condition or symptom, since almost everyone eats gluten on a regular basis. When conducting an elimination diet, Ms. Augustine often takes a reductionist approach, and the first three foods she eliminates are gluten, dairy, and soy, in that order.  As Ms. Augustine notes, “In my 18 years of practice, I believe that the number one change you can make to a person’s health is gluten.  If you are thriving from head to toe, you don’t need to consider gluten, but otherwise, it should always be taken into consideration.”

If she suspects gluten intolerance, Ms. Augustine recommends that her patients strictly adhere to a gluten-free diet for three months before considering a gluten provocation phase (also called a food challenge), which involves adding gluten-containing foods back into the diet, approximately 2-3 times per day, for a 7 day period (though some individuals should not do a gluten provocation- this should be individualized with the physician or nutritionist).  This elimination phase followed by food provocation phase is the same protocol the integrative community uses for other common trigger food groups like dairy, soy, corn, eggs, nuts, nightshades, citrus, and shellfish.  However, unlike with gluten intolerance, for these foods, the elimination diet will last 3-4 weeks, followed by a 3-5 day food provocation phase.

While it is important to note that there is no general consensus or agreement on the proper protocol for an elimination diet or food provocation challenge, this is the approach most commonly used in the integrative area of practice.  And, studies show that elimination diets are indeed an effective mode of treatment in the management of food intolerances.  In fact, a study in the International Journal of Pediatric Otorhinolaryngology found that elimination diets are a necessary modality of treatment for patients suffering from secretory otitis media (ear infections).  Bottom line?  If you, or your child, are suffering from any condition or chronic symptom, food should be evaluated and taken into consideration, and food intolerance should always be suspected.  Of course, parents should not put their child on any sort of elimination diet before speaking with a health professional who can conduct a proper assessment.  Before avoiding specific foods, it is extremely important to see a specialist who can design a balanced diet to meet the child’s nutritional needs, while still avoiding potential trigger foods.  For more information on Mary Beth Augustine and the Beth Israel Continuum Center for Health and Healing, be sure to visit the Center’s website:


Interview, Mary Beth Augustine