#hwc: issue 2

[bardic-tales]

9.18.2024: HCW: Issue #2: Daily Life: Bianca Moore

Good morning everyone. I am still filling out my tag system for the Final Fantasy 7 side of Fantasy Worlds Collide, so this blog will be filled with lots of headcanons.

As a member and founder of the Creator's Club, I decided to combine my personal HCW with the Creator's Club's HCW event. This is still exploring Bianca Moore's character, Sephiroth, and her downfall. At this point, I have no plans on redeeming Bianca. She is a baddie: through and through.

Someone, please shake Bianca and wake her up. That man isn't good for her. lol.

Content Warnings: blood offerings, body possession, cannibalism (soul siphoning), dark magic, death, emotional manipulation, graphic violence, infernal magic, manipulation, mind control, obsessive behavior, physical intimacy, religious imagery, rituals, self-harm, soul consumption, spiritual manipulation, toxic relationship.

Bianca’s morning and evening routines at the North Crater are deeply interconnected with her role as Sephiroth’s protector / lover and her own self-imposed duty as a ‘Priestess to Jenova’. In the mornings, Bianca rises before dawn. She will go over to the exposed Lifestream and siphon spirit energy from it. Once her celestial and infernal blood was awaken, she doesn’t need human food to survive. Her meals are the souls and life force she extracts from the Lifestream.

With the dark dragon, she will exit the Northern Caves and begin to patrol the crater, ensuring that the barrier that Sephiroth had placed over it remains intact. Her routine is methodical and focused. It is a reflection upon her determination to preserve the crater as a place of power that will serve for Sephiroth’s rebirth. She takes great care to monitor any disturbances or threats, using her infernal magic to eliminate any intruders that may pass through. If the barrier is weakened, she alerts Sephiroth right away through their soul-bond. This devotion to this task shows her unwavering loyalty to Sephiroth, and to a lesser extent, Jenova, as well as her rejection of wanting to return to her former life.

As the day progresses, Bianca’s routine shifts from patrolling to preforming rituals meant to strengthen her bond with Jenova and Sephiroth. These rituals that she conducts in solitude often involves blood offerings — her blood — and energy drawn from the Lifestream. She will often train with Noctemaris, as Solstice has rejected her after her fall from Grace, in the chamber where Sephiroth’s body is rejuvenating. When alone, she will often compose dark poetry and prose, using her words to express her emotions, her devotion to Sephiroth, and her new fascination with power and destruction. As she traveled from Nibelheim to the North Crater with SC X, Bianca collected Sephiroth’s black feathers when he possessed SC X to protect her. She treasures each feather, wearing them under her spaulders, using them as quills and during dark rituals. She uses the feathers as both a focus for channeling energy and a symbol of her unwavering connection to him.

Her connection to Sephiroth is both emotional and spiritual. All of her actions in the crater reflect this. Though she will often act like his lover, there is a sense of reverence in her actions — and his own — as she sees Sephiroth as the god he wants to be.

In the evenings, Bianca’s routine is more about introspection. She will retreat to a secluded part of the crater where she meditates, drawing upon the chaotic energy of the place to center herself and maintain her strength. Her evening prayers are not for salvation but rather power, pleading for Sephiroth’s return to full strength. Bianca finds solace amidst the icy atmosphere of the crater, where she feels most aligned with Sephiroth’s vision.

As night falls, Bianca sleeps very little as her mind is too preoccupied with Sephiroth’s revival and their shared future. When she does rest, it is is brief and punctuated by dark dreams or visits to the dream-scape that Sephiroth has erected in her mind to resemble the Celestial Realm as Bianca is exiled from Heaven.

On several occasions, Sephiroth will take control of one of the Sephiroth Clones (SC X) to initiate physical intimacy with Bianca: sort of like how he messes with Cloud’s mind with the clones. Through these moments, he asserts his presence and deepens their bond, reminding Bianca of their connection, even if his true form is laying dormant and regenerating. She will engage Sephiroth in philosophical discussions, exploring their views on power, destiny, and their shared ambition. Every aspect of her routine, from meditation and collecting his feathers to patrolling the barrier and making sure his true form is ready for his ascension, reflects her dedication to darkness and her desire to remain bound to him.

For more Headcanon Wednesday answers centered on Fantasy Worlds Collide, please see the tag hcw: fwc.

. . .

Also, tagging a few of my mutuals who seemed interested in Bia. Please feel free to tag me in your work, too.

@sliceoflifeshepard @serenofroses @megandaisy9 @watermeezer @nightingaleflowlibrary

@prehistoric-creatures @creativechaosqueen

[handlewithcarezine]

HANDLE WITH CARE VOL. 3 — CALL FOR ARTISTS

Handle With Care zine is now seeking artists for the next volume! We are looking for about 20 artists for this edition.

Important information, boundaries, and legal stuff:

Submission deadline for Vol 3. is January 8th, 2025. If you are accepted but unable to make the deadline for whatever reason, please communicate with us! We are more than willing to be accommodating and figure something out.

The zine's physical dimension will be 6 inches wide, 8 inches tall (15,24 cm by 20,32 cm). Submissions should be in 300 DPI.

The loose theming of Vol 3. is Advertisements and posters. This theme is not strict and does not affect piece submission, but it will guide how we structure the zine as well as guide the aesthetics of the front cover and non-submission pages such as the table of contents and credits section. Feel free to go big and go bold with this theme, if you choose to engage with it! Show off your love, make the piece you would love to hang on your apartment walls!

Visual artists are welcome to submit an additional one-page written accompaniment to their visual artwork if they would like. Fully written works are currently capped to a maximum of five pages, though this may be adjusted once we have a rough idea what people are submitting.

Handle With Care is meant to celebrate raw objectum emotion and experiences, and meant to give these emotions a physical place in the world. We do not have a minimum skill level as a result.

However, we reserve the right to reject or ask for revisions on any submissions that make us uncomfortable, including any romantic depiction of an object that resembles a realistic feral animal or a human child. This zine is printed through a government-owned printing press. If your submission can be misconstrued as something far more concerning than just objectum sexuality by people who are not familiar with the community, it will be rejected for the peace of mind of everyone involved.

HWC is also strictly safe for work. Non-sexual nudity is allowed, although if it crosses a line we may ask for revisions.

All participants must be at least 18. Legal issues with using a minor's work and all that. Minors will be booted off the HWC discord, sorry! You are welcome to enter when you'll be legally an adult.

AI-generated submissions are also currently not allowed. We want to see work straight from objectum artists, not an objectum middleman commissioning ChatGPT for free and taking the credit.

HWC is non-profit. Physical copies are sold only to break even on printing and shipping. Any profit from donations will be re-invested in the zine or split evenly between all contributors.

Artists will retain all rights to their individual work, including copyright and being able to resell it. The zine owner (Ross Gillesby, in this case) is allowed to sell the pieces only in the bundle of the entire zine and not individually, and will not own any copyright to those pieces.

Zine organization and communication is done through a Discord server. If you are interested in submitting something for Handle With Care Vol. 3, please DM this tumblr or email gillesbyross@gmail.com with:

What are you thinking of submitting? If it's a written work, how many pages do you estimate you'll need?

2. Social media or some other way to verify you are not a troll

We already have a cover artist. We currently have an artist maximum of 20 to 25. If there is no more room by the time you send in an application, we will put you on a priority list for Vol. 4.

We're very excited to work on a third volume of the zine!

-Ross and Crispy

[daytodaycurrentaffaires]

Question: In which state the ambitious scheme Ayushman Bharat was launched on 14 April 2018?

(a) Jharkhand

(b) Haryana

(c) Chhattisgarh

(d) Rajasthan

Answer: (c)

Related facts:

The Ayushman Bharat was launched on 14th April 2018 with the inaugural of a HWC at Jangla, a remote place in Chattisgarh, culminated in the launch of the second pillar of Ayushman Bharat- the Pradhan Mantri Jan Arogya Yojana (PMJAY) on 23 Sept, 2018 in Ranchi, Jharkhand.

Dr Harsh Vardhan, Union Minister of Health & Family Welfare launched the Ayushman Bharat Pakhwara, a fortnight of enhancing awareness about the Yojana, (15th-30th September 2019).

This fortnight-long national campaign is launched to enhance awareness around the preventive, promotive and curative aspects of health care, nutrition, yoga and healthy lifestyle through Ayushman Bharat and other related initiatives such as Poshan Abhiyaan and Swachhta Abhiyaan.

The Union health Minister also stated that to mark the first year anniversary of PMJAY, the National Health Authority is organizing a 2-day national workshop, Arogya Manthan, on September 30th and October 1st, 2019.

Major highlights of this scheme:

Under the Ayushman Bharat scheme, more than 21,000 Health & Wellness Centres have become operational and about 47 lakh people have availed of treatments under its Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) pillar.

While the 1.5 lakh Health & Wellness Centres (to be operationalised by Dec 2022) provide comprehensive primary care (CPHC) including preventive and promotive healthcare close to the communities, PMJAY covers 50 crore poor and vulnerable people in the country. It provides a health assurance cover of Rs. 5 lakh per family per year for secondary and tertiary care for serious and catastrophic illnesses.

More than 1.5 Crore population is screened for hypertension and more than 70 lakhs people are put on treatment; similarly, around 1.3 crore population are screened for Diabetes and more than 31 lakhs people are on treatment.

More than 76 lakhs population is screened for oral cavity cancer and out of these, 10,218 people are on treatment. In addition, more than 1.6 Crores have been provided medicines and around 49 lakhs population are provided diagnostic services.

More than 47 lakh hospital treatments worth over Rs 7,500 crore have been carried out under this scheme. Of the total amount utilised, 55% has been on tertiary procedures.

In addition, more than 10 crore beneficiary cards have been issued. As on date, 32 States and Union Territories are implementing the PMJAY.

Under AB-PMJAY, 18,073 hospitals and health care providers have been empanelled across the country. Of this, 53% of the hospitals empanelled are private, especially multi-speciality, and 62% of the treatments have been in these private hospitals.

Nearly all States and Union Territories and get whole-hearted political and administrative support for it. This is a demonstration of the highest ideals of cooperative federalism.

Links:

https://pib.gov.in/PressReleseDetail.aspx?PRID=1585319

https://www.pmjay.gov.in/node/863

[stichtingspots]

Edge of Existence

Een paar dagen geleden zag ik een trailer van een documentaire die zeker mijn interesse heeft. ‘The edge of existence’, zo heet de documentaire die binnenkort uitkomt. En hij gaat in op wellicht het grootste gevaar voor wildlife op dit moment: het mens/dier conflict (human wildlife conflict, hwc). De link naar de trailer zie je hier;

https://www.facebook.com/blackbeanproductions/videos/1115280458573549/?hc_ref=ARSy7EdIKmSTaUyZClOBSsn4cK9uR4R1XhhMfZNpYlAHtDsYUsXVBf2hTfaZDxDdRIk&pnref=story

Het bijschrift van de documentaire meldt:

"This feature length documentary, 'The Edge of Existence' is about human wildlife conflict in Africa, an untold story and an issue that affects the livelihood of people, the conservation of protected areas and the wildlife that inhabits them. Conservation is complex, and the relationship between man and beast is too. There are so many issues that stem from here, and it is important that we understand these if we are going to forge a way forward together that enables people and wildlife to coexist and flourish”.

Direct ook waren er al diverse opmerkingen van dierenliefhebbers. "Conservation is helemaal niet complex. De mens is gewoon slecht en de veroorzaker van alle ellende. Geef de dieren ruimte”. En "ga niet leven in gebied waar wildlife zit” en "dieren hebben ook rechten”. Allemaal uitspraken waar ik me in kan vinden. Alleen, erg realistisch zijn ze niet. De realiteit is dat de wereldbevolking groeit. En iedereen op de wereld wil wat wij ook hebben: een fijn huis, een veilig land, een fatsoenlijk salaris zodat je kinderen naar school kunnen en jij eten op de plank hebt. Dit alles vergt een prijskaartje. Verlies van leefgebied voor wildlife is het logische gevolg van dit prijskaartje. De komende jaren zal wildlife alleen maar meer onder druk komen te staan. En direct daarmee groeit het mens/dier conflict. Oneliners blijven roepen, gaat niet helpen. We zullen moeten dealen met die realiteit.

Een quote uit de trailer "villagers see wildlife as a threat to their livelihood. Animals are just creatures, they can go to hell’. Ik denk dat veel mensen in Afrika (en elders) zo inderdaad kijken naar wildlife. Zeker zij die geen directe inkomsten krijgen uit wildlife zoals uit toerisme, en afhankelijk zijn van veeteelt, hebben niet zoveel op met wildlife. We moeten stoppen met kijken naar wildlife vanuit Westerse ogen. Simpelweg omdat veelal de lokale bevolking wildlife heel anders ziet dan wij. Wij zien in deze dieren meerwaarde. Wij vinden ze mooi, reizen er voor naar Afrika om ze te zien, strijden ervoor om ze voor uitsterving te behoeden en kunnen ons niet voorstellen dat anderen deze dieren als 'pest’ zien. En toch is dit precies hoe wildlife, en zeker roofdieren, heel vaak gezien wordt in Afrika en elders op de wereld. Het is essentieel dat we dit beseffen. We staan namelijk op een cruciaal punt als het aankomt op wildlife. Vele diersoorten dreigen uit te sterven. En we zullen moeten gaan besluiten welke kant we op willen. Maar dan moeten we wel durven kijken vanuit andere perspectieven dan alleen de onze.

Get the picture

Enige tijd terug werd Namibië, waar wij als SPOTS vooral actief zijn, opgeschrikt door veel gedode leeuwen. Niet door jagers maar door de lokale bevolking zelf. Onder hen de 5 musketiers. Broers die wereldberoemd werden door de documentaire Vanishing Kings: Lions of the Namib. Nu is er geen 1 meer. Er kwam geen jager aan te pas, ze werden allemaal gedood door boze boeren in minder dan 1 jaar.

Foto: ORF-Enterprise GmbH & Co/ Will & Liane Steenkamp

Dit geval stond niet op zich. Krantenbericht na krantenbericht verscheen met altijd als deprimerende boodschap: weer leeuwen gedood in het human/wildlife conflict. De wereld (de Westerse Wereld) rouwde bij al die dode leeuwen. Maar niet de boeren van Namibië. In krantenartikelen verschenen ze pontificaal op de foto met de door hen gedode leeuwen. En gaven daarbij aan dat de beste leeuw een dode leeuw was.

Uiteraard vonden wij dierenliefhebbers er van alles van. Ook ik. Maar ik besloot vanaf die tijd eens wat boeren te volgen op social media. Dit waren enkele van hun statements:

“confine lions to Etosha National Park. If they trespass definitely they will R.I.P. We do not eat lions. We eat cattle meat and make money out of them to take care of ourselves. Lions, no among domestic animals and human beings, please!”

“Those who are worried about lion killing are the ones benefiting from them, those cattle pays for our studies, pays for our everyday needs... I myself will do the same as those farmers... Imagine Namibia without cattle!!”

“For those people who are worried about the killing of lions I have question for them, do they have villages and if they have villages how will they feel if the lions enters the entire village and kill they live stock??”

Al met al werd ik op zijn zachtst gezegd, niet erg blij van de commentaren die ik las. Zeker omdat het er niet 1 betrof maar stapels. Het is duidelijk: de boeren aldaar houden niet van leeuwen. Het liefst zien ze geen leeuwen want die zijn een bedreiging voor hun inkomen, het vee. Eerder werd dit al pijnlijk duidelijk toen iemand uit Zimbabwe zelf een artikel schreef naar aanleiding van Cecil’s dood, de leeuw die in 2015 illegaal gedood werd door de Amerikaanse tandarts.  ‘In Zimbabwe we don’t cry for lions’ heet het artikel waarin pijnlijk duidelijk de tegensteling tussen Westerse en Afrikaanse perceptie op wildlife naar voren komt. https://www.nytimes.com/2015/08/05/opinion/in-zimbabwe-we-dont-cry-for-lions.html

Deze boeren zijn geen uitzondering. De meeste boeren wereldwijd zijn niet echt blij met wildlife. Zo schreeuwden onze boeren in Nederland moord en brand toen het bericht naar buiten kwam dat wolven binnenkort weer binnen onze landsgrenzen zullen zijn.

Wat ik hier nu persoonlijk ook van denk, of ik die boeren nu zeikerds vind of niet, ik denk dat dat niet relevant is. Feit is dat ze deze perceptie hebben. En dat we daar dus iets mee moeten doen althans, als we echt oprecht wildlife willen helpen.

Jagen

Ondanks het feit dat de meeste leeuwen gedood worden door het mens/dier conflict, krijgt dit alles relatief weinig aandacht. Dit in tegenstelling tot jacht. 1 ding weet je als media en als stichting zeker. Plaats een post van een gedode leeuw door een jager, en je hebt massa’ss (boze) likes. Als je je hierover genuanceerd uitspreekt, word je vaak direct aan de hoogste boom gehangen. Enerzijds snap ik dat, anderzijds helemaal niet. Omdat ik vind dat de hele discussie extreem zwart/wit wordt aangepakt. En hierin verliest men soms echt het gehele overzicht.

Laat ik Kebbel als voorbeeld nemen, zie foto boven. Enige weken geleden werd bekend dat deze woestijnleeuw opgegeven was voor een tropheehunt. Dierenliefhebbers op social media buitelden over elkaar heen om er schande over te spreken. Kebbel, zo werd gesteld door de jacht aanbieder, was een probleem leeuw. Hij had 2 ezels gedood en de boeren wilden van hem af. Er werd een petitie gestart om de Regering van Namibië op te roepen deze jacht te stoppen. Ook wij als SPOTS plaatsten deze petitie op onze pagina. Dit soort zaken voelt altijd wat dubbel. Ik geloof namelijk enerzijds dat het belangrijkste gevaar voor de leeuw in Namibië vooral ligt in mens/dier conflict. De boeren zien geen meerwaarde in de leeuwen en willen er gewoon van af. De enige manier om dit te veranderen, is dat ze wel meerwaarde gaan zien in leeuwen. Er moet dus een ‘belang’ zijn. Dat belang is vooral geldelijk; helaas werken de meeste mensen nu eenmaal zo. Daarom denk ik dat je trofee jacht niet direct moet afschieten. Simpelweg omdat dit een middel kan zijn naar de bevolking toe, om die leeuw ‘waarde’ te geven. 

Maar, jacht kan ook enorm veel schade toebrengen. Te vaak worden dieren bestempeld als ‘probleem’ en te vaak worden die mannetjes leeuwen afgeschoten met de mooiste manen, simpelweg omdat dit de mooiste trofee is. Helaas gaat het dan vaak om mannetjes die nog in de prime van hun leven zijn of zelfs nog leider van een groep. Door hun dood, lopen hun welpen ook kans gedood te worden door een mannetje die de lege plaats inneemt van de geschoten leeuw. Bij Kebbel waren er te veel vraagtekens. Hij bleek ook nog 1 van de laatste volwassen mannetjes te zijn in dit gebied. Dit zijn dus momenten waarop je moet opstaan en moet zeggen: nee. De Regering van Namibië besloot ook nee te zeggen. De jacht werd afgelast.

De vlag ging uit bij de dierenliefhebbers. Ook bij mij want ik heb vele malen liever levende leeuwen dan leeuwen gedood door een jager. 

Maar, het is van enorm belang direct te beseffen dat hiermee de vlag NIET uit kan. Het is essentieel dat we ook het volgende beseffen. Ja, Kebbel is gered. Althans nu. Wat over blijft zijn boze boeren die hem zien als probleemleeuw. Boeren die zich verraden voelen door een Regering die niet opkomt voor hun belangen (althans, dat is hun perceptie). Boeren die boos zijn dat er ergens ‘greenies’ rondlopen die door dit soort petities opkomen voor leeuwen. Maar hen, de mensen, in de stront laat zakken. Daar kun je maling aan hebben als dierenliefhebber. Je kunt je schouders ophalen en op social media roepen dat je ‘fucking proud bent a greenie te zijn’. En dat die boeren gewoon wijzer moeten zijn en daar gewoon niet moeten leven. Maar feit is dat heel waarschijnlijk de boeren niet rusten alvorens deze leeuw dood is. Het is dus heel wel mogelijk dat Kebbel door een boer geschoten wordt of vergiftigd. En dit laatste is zo’n verschrikkelijke dood dat je je kunt afvragen of een kogel door zijn kop door een jager, niet beter was geweest voor Kebbel. 

Het is dus van belang dat je alle kanten van een verhaal ziet alvorens een besluit te nemen. Omdat een triomf voor jou, geen triomf voor het dier hoeft te betekenen.

Kolonialisme

Jacht roept vooral emotie op. En de commentaren die ik er soms bij lees, doen mijn haren ten berge rijzen. De afgelopen dagen ben ik ook weer de nodige commentaren tegengekomen. Waarbij jacht werd neergezet als de laatste strohalm van kolonialisme.

Een definitie van kolonialisme is: bij kolonisatie is er sprake van uitbreiding van het grondgebied van een soevereine staat. Afhankelijk van de houding van de kolonisator werd er over de inheemse bevolking beslist, werd deze verplaatst of zelfs uitgeroeid. 

Als je sec kijkt, is de lokale bevolking vaak juist blij als er jagers komen om wildlife af te schieten. Even zwart/wit gezegd: ze zien er geen waarde in, nog sterker, wildlife levert alleen problemen op. En op die manier is het probleem opgelost en levert het ook nog wat geld op. Aldus de perceptie van menig lokaal inwoner. 

Ik denk dat de lokale bevolking de jagers dus niet als koloniaal zien. Nog sterker, ik denk dat ze ons dierenliefhebbers alsook de niet jagende toerist, vaak veel meer zo ervaren. 

Wij die vanuit onze airco huizen, vanuit een land waar praktisch geen wildleven meer leeft simpelweg omdat we ze dat niet gunden, hen gaan vertellen dat ze ‘maar moeten samenleven met wildlife’. Wij die het normaal vinden dat zij (de boeren) geen grond hebben om te leven maar dit wel gunnen aan wildlife. Nog sterker, wij vinden het mooi als gebied ontruimd wordt voor dieren, ook al betekent dit dat de bevolking moet verkassen (is dat nu niet de definitie van kolonialisme??).

Ik denk dat de lokale boer ons ziet als koloniaal als wij hen willen dwingen leeuwen te zien zoals wij: als mooie dieren die niet mogen uitsterven terwijl zij het veelal als bedreiging voor lijf en leden zien. Dat wij zelf geen leeuw in de achtertuin willen hebben maar vervolgens wel verlangen dat anderen dat wel ok vinden.

Ik denk dat het woord koloniaal bij hen opkomt als ze ons zien, gekleed in onze safarikleding om in een jeep rond te rijden, sporend naar wildlife, en vervolgens afzakken naar een 5 sterren lodge terwijl zij in een plaggenhut leven die soms wordt vernietigd door rondlopende olifanten.

En ik denk dat zij ons als koloniaal zien als we petities starten om wildlife te redden en daardoor schijnbaar lak hebben aan het feit dat zij er last van hebben.

Like said. Daar kun je als dierenliefhebber je schouders over ophalen. Je kunt vinden dat je in je recht staat en wellicht is dat ook zo. De vraag is echter, red je daar nu dierenlevens mee? 

A must see

Daarom lijkt mij deze documentaire zo enorm belangrijk. A must see voor iedereen die zich dierenliefhebber noemt. Als je althans bereid bent er open in te gaan staan. En stap 1 is dat je durft te laten inzinken dat de dieren waar wij zo van houden, over het algemeen gehaat worden door de mensen die met hen moeten samenleven. Alsook het besef dat als wij daar zouden leven, wij echt niet anders hadden gedacht. 

Dat je durft te realiseren dat simpele oplossingen dus niet voorhanden zijn. En dat we leren beseffen dat als je daadwerkelijk begaan bent met wildlife, je niet tegen hen die ermee moeten leven kunt zeggen ‘jouw probleem’. En dat is feitelijk wat we nu zeggen met al onze oordelen over hen. Als we boehoe roepen als een boer een leeuw doodt of als een dorp een jager uitnodigt om de leeuw af te schieten. We zeggen daarmee dat wat zij denken, voelen, niet klopt en dat wij de waarheid in pacht hebben. Dat is pas koloniaal! 

Want feitelijk is het niet ‘hun’ probleem. Voor hen is er geen probleem. Afschieten al dat wildlife en probleem is opgelost. Wij willen dit niet en dat maakt het 'ons’ probleem. Nelson Mandela zei het ooit zo: “conservation is a white man’s hobby”. Als we dus daadwerkelijk begaan zijn met wildlife, moeten we echt eens proberen ons te verplaatsen in hen die met wildlife moeten samenleven. Dat is super frustrerend, lastig en soms een gebed zonder eind. Maar een andere optie hebben we echt niet....

Ik kan het eigenlijk niet beter verwoorden als de makers van de documentaire:

Conservation is complex, and the relationship between man and beast is too. There are so many issues that stem from here, and it is important that we understand these if we are going to forge a way forward together that enables people and wildlife to coexist and flourish.

Simone Eckhardt

SPOTS

Trailer Edge of extinction: https://www.facebook.com/blackbeanproductions/videos/1115280458573549/?hc_ref=ARSy7EdIKmSTaUyZClOBSsn4cK9uR4R1XhhMfZNpYlAHtDsYUsXVBf2hTfaZDxDdRIk&pnref=story

[iasshikshalove]

Daily Current Affairs 06th April 2020

Today’s  Important  Topic’s  For UPSC Preparation

1.  TESTS, TREATMENT FREE UNDER AYUSHMAN BHARAT.2. LOOK INTO ISSUE OF PAROLE FOR PSA CASES: J&K HC.3. INDIA BANS EXPORT OF HYDROXYCHLOROQUINE.4. PENCH TIGER DEATH RAISES COVID FEARS.5. NEWYORK ZOO TIGER TESTS POSITIVE FOR VIRUS.

TESTS, TREATMENT FREE UNDER AYUSHMAN BHARATAyushman Bharat Scheme:

The Ayushman Bharat Scheme was launched in 2018 to address health issues at all levels – primary, secondary and tertiary. It has two components:

Pradhan Mantri Jan Arogya Yojana (PM-JAY), earlier known as the National Health Protection Scheme (NHPS)

Health and Wellness Centres (HWCs)

Ayushman Bharat is National Health Protection Scheme, which will cover over 10 crore poor and vulnerable families (approximately 50 crore beneficiaries).

Providing coverage upto 5 lakh rupees per family per year for secondary and tertiary care hospitalization.

Ayushman Bharat – National Health Protection Mission will subsume the on-going centrally sponsored schemes –

Rashtriya Swasthya Bima Yojana (RSBY) and

The Senior Citizen Health Insurance Scheme (SCHIS).

Salient Features:

Benefits of the scheme are portable across the country and a beneficiary covered under the scheme will be allowed to take cashless benefits from any public/private empanelled hospitals across the country.

The beneficiaries can avail benefits in both public and empanelled private facilities.

To control costs, the payments for treatment will be done on package rate (to be defined by the Government in advance) basis.

One of the core principles of Ayushman Bharat – National Health Protection Mission is to co-operative federalism and flexibility to states.

For giving policy directions and fostering coordination between Centre and States, it is proposed to set up Ayushman Bharat National Health Protection Mission Council (AB-NHPMC) at apex level Chaired by Union Health and Family Welfare Minister.

States would need to have State Health Agency (SHA) to implement the scheme.

To ensure that the funds reach SHA on time, the transfer of funds from Central Government through Ayushman Bharat – National Health Protection Mission to State Health Agencies may be done through an escrow account directly.

In partnership with NITI Aayog, a robust, modular, scalable and interoperable IT platform will be made operational which will entail a paperless, cashless transaction.

Major Impact:

Ayushman Bharat – National Health Protection Mission will have major impact on reduction of Out of Pocket (OOP) expenditure on ground of:

Increased benefit cover to nearly 40% of the population, (the poorest & the vulnerable)

Covering almost all secondary and many tertiary hospitalizations. (except a negative list)

Coverage of 5 lakh for each family, (no restriction of family size)

This will lead to increased access to quality health and medication.

In addition, the unmet needs of the population which remained hidden due to lack of financial resources will be catered to.

STATES/DISTRICTS COVERED:

Ayushman Bharat – National Health Protection Mission will be rolled out across all States/UTs in all districts with an objective to cover all the targeted beneficiaries.

Pradhan Mantri Jan Arogya Yojana (PM-JAY):

It was launched as the National Health Protection Mission and renamed later.

It is the largest government-funded health insurance scheme in the world.

The scheme offers eligible families an insurance cover of Rs. 5 lakh per annum per family.

This amount is intended to cover all secondary and most tertiary care expenditure incurred.

There is no cap on family size and age under the scheme, to ensure that nobody is left behind.

The cover will include pre and post hospitalisation expenses. It will also cover all pre-existing conditions.

Components of treatment covered under the scheme:

The beneficiary will also receive a defined transport allowance per hospital.

3 days of pre-hospitalisation and 15 days of post-hospitalisation like medicines and diagnostics are covered.

Medical examination, consultation and treatment

Medical consumables and medicines

Intensive and non-intensive care services

Medical implant services

Lab and diagnostic investigations

Complications arising out of treatment

Accommodation benefits and food services

Why in News?

The Central government has decided to provide free testing and treatment of COVID-19 under the Ayushman Bharat Scheme.

This, it notes, will help more than 50 crore Ayushman beneficiaries to get free testing and treatment in designated private hospitals across India.

Confirming this, Indu Bhushan, CEO of Ayushman Bharat, said this would allow beneficiaries to get timely and standard treatment.

Giving details, Dr. Bhushan said: “The empanelled hospitals can use their own authorised testing facilities or tie up with an authorised testing facility for the scheme.

These tests would be carried out as per the protocol set by Indian Council for Medical Research (ICMR) and by private labs approved/registered by the ICMR.

Similarly, treatment of COVID-19 by private hospitals will be covered under AB-PMJAY.”

Private Sector:

Union Health Minister Harsh Vardhan said that “in this unprecedented crisis we have to very actively involve the private sector as a key partner and stakeholder in the fight against COVID-19.

Making testing and treatment available under Ayushman Bharat PM-JAY will significantly expand our capacities by including private sector hospitals and labs and mitigate the adverse impact of this catastrophic illness on the poor.

He added that States were in the process of enlisting private sector hospitals that could be converted into COVID-19 only hospitals.

LOOK INTO ISSUE OF PAROLE FOR PSA CASES: J&K HC

The J&K High Court has asked the High Powered Committee (HPC), convened to de-congest jails by releasing prisoners on parole in the wake of the COVID-19 outbreak, to examine the allegations that no detainee booked under the Public Safety Act (PSA) was being considered for any parole.

Chief Justice Gita Mittal and Justice Rajnesh Oswal passed these orders on Saturday while hearing a Public Interest Litigation on the COVID-19 outbreak and the response given by the J&K administration.

“Let the rules be urgently implemented and steps for grant of special parole to prisoners as is envisaged therein be taken on priority,” observed the division Bench.

The direction came after advocate Pirzada informed the court that the HPC has overlooked the aspect of detenus who have been detained under the PSA.

“The order of the Supreme Court makes a reference only to prisoners without specifying the provision of law under which they may have been imprisoned.”

In his letter, Mr. Pirzada said, “There were indications that there was vulnerability [of catching the virus] in jails in the context of health, hygiene and sanitation.

There is a sizeable number of detainees detained under the PSA and are equally exposed to the hazards of the viral disease in J&K and outside jails.”

Public Safety Act:

The Jammu and Kashmir Public Safety Act, 1978(PSA) is a preventive detention law under which a person is taken into custody to prevent them from acting harmfully against “the security of the state or the maintenance of the public order” in the Indian state of Jammu and Kashmir (now a union territory).

The Public Safety Act, 1978 of Jammu and Kashmir is a defensive detention law that allows taking a person into custody to prevent him or her from acting in any matter that is prejudicial to “the security of the state or the maintenance of the public order”.

Under the act, a person can be held for 2 years without trial and they need not be produced before a court.  

A similar act called the National Security Act (NSA) is used by the other state governments for preventive detention.

Any person can be booked under PSA when an administrative order passed either by Divisional Commissioner (DC) or the District Magistrate (DM).

Any detention under this act can’t be made under the order by police based on specific allegations or for a specific violation of laws.

[robertbryantblog]

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[healthyeating43-blog]

Keto Myths, My Starbucks Keto Iced Coffee & Maltodextrin Hype vs Truth

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Keto Myths, My Starbucks Keto Iced Coffee & Maltodextrin Hype vs Truth

Every time I share a picture of my Starbucks keto iced coffee, there’s a flurry of “that’s not keto!” comments mixed with concerned questions…

Specifically about the maltodextrin in (some) Starbucks sugar free syrups, and whether that kicks you out of ketosis or spikes your insulin worse than sugar.

Today I want to clear that up.

Keto Myths & Maltodextrin Hype

There are many “keto myths” floating around the web, getting repeated countless times without any real proof. People speak on keto like this or that is a hard fact, without anything to back it up other than “I heard…”

Then there’s also the source they heard it from, and the facts (truths) – as well as the facts that are NOT shared in those sources.

I’ll share an example on that so you can see what I mean, which should help you make more informed decisions (and do further research yourself) in the future.

For this post I’m using maltodextrin and my Starbucks order as an example as just one of many common “keto scares.” But what you’ll learn here can help you understand (or better research) similar “hot topics” in the keto community.

The big thing you’ll always hear about anything that contains maltodextrin (and thats A LOT of things!) is that it’s glycemic index is almost twice as high as sugar, and that it will spike your blood sugar through the roof.

You’ll learn what maltodextrin IS and reasons you may want to avoid it, which of the Starbucks sugar-free syrups have maltodextrin and which do not, why people say maltodextrin is “not keto” and more.

You’ll also get to see my blood sugar results – where I tested it on myself.

I’ll give you everything you need to know to decide for yourself…

What IS Maltodextrin?

Maltodextrin is basically just an additive. It’s used as a preservative, a thickener and a filler. It’s also used as a carrier, to add other ingredients to products.

It’s in A LOT of products such as: vitamins, baby formula, beer, beef jerky, medicines, protein bars & shakes, dressings, electrolyte drink mixes, sodas, you name it – you’ll often find it in STEVIA even.

You’ve been consuming and using maltodextrin ALL your life, so it’s nothing new since you went keto. It’s even in personal care products like lotion, shampoo, etc.

There are plenty of reasons NOT to love Maltodextrin but you should make your decision based on ALL the facts. And that decision can be personal to you.

It truly is JUST a preference, not a “keto rule.”

What you’ll often hear in keto communities is maltodextrin is “worse than sugar” – meaning the glycemic index is higher than sugar. The last part is true.

Dr. Eric Berg says maltodextrin is “very severe on your blood sugar” in this video. In another video he says “so if it’s that high on the glycemic index, it’s creating a MASSIVE SURGE in your blood sugar when you consume it.”

I don’t disagree with most of the points in his video, only two of them. First, maltodextrin IS gluten free even when it’s made from wheat: “the processing that wheat starches undergo in the creation of maltodextrin renders it gluten-free.” –source

I also disagree with his comment: “so if it’s that high on the glycemic index, it’s creating a MASSIVE SURGE in your blood sugar when you consume it.”

I’ll explain why. Because I love Dr. Berg and his work.

I’m not saying Maltodextrin is great or even good or that there aren’t reasons you may choose to avoid foods that contain it.

I’ll share all the details with you, then that’s a decision you can make for yourself.

Maltodextrin vs Sugar

(The BIG Point Nobody Mentions!)

The fact that most people are leaving out of their argument that maltodextrin IS THE DEVIL is that there is such a SMALL amount of it in any one serving or any one food or drink you may consume – so you are NOT consuming equal amounts of sugar and maltodextrin, EVER.

That is the (huge) point nobody ever explains.

You simply cannot compare maltodextrin and sugar in that way, as if they are equal, because it would be a highly RARE case that you are consuming more than a TINY amount of maltodextrin – a trace amount, really.

Consider drinking a Starbucks iced coffee with regular vanilla syrup vs sugar-free vanilla syrup. The grams of sugar in a regular sweetened iced coffee vs the grams of maltodextrin in a sugar-free iced coffee are not even comparable.

Let’s look at a real-life example…

Starbucks Iced Coffee is served “lightly sweetened” by default, but is not AT ALL sweet so you would never know it. The classic syrup (sugar water) they add by default has 30 grams of sugar in a 24oz Venti Iced Coffee.

If you add 4 pumps of regular vanilla syrup (not sugar free) to your iced coffee, that’s 20 grams of sugar per tbsp – assuming a pump is a tbsp. When you include the Classic Syrup (30 grams of sugar) you have a total of 110 grams of sugar in a Venti iced coffee with 4 pumps of vanilla syrup.

We’ll use this comparison because the Starbucks sugar-free vanilla syrup has maltodextrin in it.

Compare that to what I would order: a Venti iced coffee with “no classic syrup” (without the sugar water) and 4 pumps of sugar-free vanilla syrup.

Even if you counted 1 carb per pump (some people do, some don’t), that comes to 4 carbs vs 110 carbs.

Again: 20 grams of sugar per pump of regular vanilla syrup, or 20 carbs vs 1 carb per pump of sugar-free vanilla syrup.

See the difference?!

Obviously you are NOT consuming equal amounts of sugar and maltodextrin.

That’s the point no one mentions when they say maltodextrin has a higher glycemic index than sugar. I can’t personally think of a situation on a keto diet where you would consume more than a tiny amount of maltodextrin – and certainly never comparable to the amount of sugar in a high carb version of the same food or drink.

Further down you’ll see that Starbucks lists their sugar free syrups as ZERO carbs per 2 TBSP serving on the nutrition facts label. So I’m not sure who started the rumor that they were 1 carb per pump. Or maybe it’s a round up / round down issue. I have no idea. But I doubt the total carb count of the sugar free syrup (whatever it is) is from the maltodextrin alone, which again – is a trace amount.

Still, in that tiny amount…

Does maltodextrin cause a “MASSIVE SURGE” in your blood sugar?

That’s what I set out to test…

My Starbucks Keto Iced Coffee Order

The photo above was an iced coffee I had from Starbucks this week. I had two actually because I was in the city several days this week. I only have them now and then, it’s not a daily thing just a treat, because I don’t have a Starbucks where I live.

First, you should know: my coffee order is SWEET and it’s HUGE.

I sip on it most of the day and rarely ever finish one in a day. I’ll stick it in the refrigerator and finish it the next day most of the time, even.

That amount of heavy cream usually makes me feel full too, so I eat less on the days I have it. It almost serves as a meal replacement! It has about the same amount of calories as a BPC or fatty coffee, depending on the amount of cream you ask for.

Here’s what I order – and this is how I say it:

Trenta Iced Coffee no classic syrup 5 pumps of sugar free cinnamon dolce 4 pumps of sugar free vanilla and heavy whipping cream – only about 1/3 cup please

I usually say that with my fingers showing I mean 1/3 cup – not one third of THE cup. If I don’t specify the 1/3 cup of heavy cream, I log it as at least half a cup. They can get pretty heavy handed with the cream for my taste.

I’ll show you how I log it (carb count, etc) further down too…

For the purpose of my blood glucose / blood ketone test on this Starbucks iced coffee order (to see if it’s REALLY keto friendly), I ordered a smaller size (24oz vs 31oz) with the same amount of ingredients:

I did that because I wanted to be able to drink the entire thing in under an hour, like I would guess most people do – instead of sipping on it throughout the day.

I’ve been drinking that same Starbucks order over the last year with NO problem, and with my ketone levels holding steady, but for this test I wanted to consume it all at once.

I got one and stuck it in the fridge so I could do this testing at home the next day.

Let me just say… THIS tasted super sweet, more like a milkshake.

I would not normally get this much sweetener in a smaller iced coffee like this, but I wanted to really put this “maltodextrin” issue in the sugar free vanilla to the test.

If that iced coffee had NOT been ordered sugar free and with no classic syrup, it would have been 210 grams of sugar – plus 3.2 carbs for the heavy cream – for a total of 213.2 carbs.

I didn’t order this coffee, a friend brought it to me so I could do this test, so I definitely logged this one with half a cup of HWC (3.2 carbs) vs my usual 1/3 cup request (2.1 carbs).

Again, I’ll show you how I log it below, but even if you DID count 1 carb per pump of sugar free vanilla (the one with maltodextrin), that would come to 4 + 3.2 for a total of 7.2 carbs. I don’t log the syrups because they have zero nutritional value (no carbs, no calories), so I only log the HWC in my daily macro tracking.

On the high end, for the people DO that log EVERY pump as one carb, my order would be 12.2 carbs. Still nowhere near the 213.2 carbs for a NON sugar free version, or the 210 grams of sugar.

Let’s dive into the test results…

Does Maltodextrin REALLY Spike Your Blood Sugar?

The image above is my starting numbers for this test: my glucose and ketone levels before I drank the keto Starbucks iced coffee.

My glucose seemed a little high to start at 99. My baseline is around 85. My ketone levels were my normal level (1.3) for that time of day.

I use the Keto Mojo Blood Glucose & Ketone Testing Kit and that link will get you 15% off. If you want to learn more about it, here’s where I did a VERY enlightening video interview with the founder of Keto Mojo.

For the purpose of this “keto test” I drank the ENTIRE 24 ounce Starbucks iced coffee within 30 minutes.

This one was sweeter than my usual order (a smaller cup with the same amount of cream & sugar free syrups) – so it basically tasted like a MILKSHAKE.

I wanted to really put that “maltodextrin creates a MASSIVE SURGE in your blood sugar when you consume it” comment to the test.

30 minutes after drinking the entire coffee, I tested again:

As you can see, my blood sugar actually came DOWN.

My ketone levels dropped slightly too, but that’s not unusual as they fluctuate throughout the day and before/after you eat. I was still IN KETOSIS at 0.9 and my blood sugar did NOT spike. The opposite actually.

I tested again one full hour after having the coffee:

The result…

The Starbucks Iced Coffee is keto friendly. No question.

4 full pumps of sugar free vanilla syrup with maltodextrin did NOTHING to my blood sugar levels. Zilch – no impact.

So there ya go.

You may still want to avoid maltodextrin for your own personal reasons, which is totally fine. I did a little homework for you – so you know which syrups to NOT choose at Starbucks if that’s your preference…

Starbucks Sugar Free Syrups & Maltodextrin

Starbucks used to offer more sugar free syrup flavors, but right now it seems that at most locations you can only get sugar free vanilla or sugar free cinnamon dolce.

The sugar free vanilla DOES contain maltodextrin, and the sugar free cinnamon dolce does NOT.

Here are the Sugar Free Syrups that are currently available year round:

Sugar Free Vanilla contains maltodextrin Sugar Free Hazelnut contains maltodextrin Sugar Free Cinnamon Dolce does NOT contain maltodextrin

If you click each link, you can view the labels and nutrition facts.

ALL of them say ZERO carbs per 2 TBSP serving.

I think they’ve discontinued the sugar-free hazelnut and caramel syrups, as well as the sugar free peppermint syrup which used to be available during the holidays.

NOTE: their “whipped cream” HAS SUGAR IN IT so you definitely want to avoid that and use heavy cream or half & half in your Starbucks orders instead.

How I Log My Starbucks Keto Friendly Iced Coffee in MyFitnessPal

Some people say the syrups are 1 carb per pump. They don’t affect me and the labels say ZERO on the bottles you buy to use at home, so I don’t log them – but that’s a personal choice (too).

I log the amount of HWC (heavy whipping cream) I ask for which is usually 1/3 cup – or if I don’t specify or it looks lighter than usual, I log it as 1/2 cup (half a cup) to be safe.

Heavy Whipping Cream is 0.4 per tbsp, regardless of what your label says.

When it comes to labeling, they are able to round up or round down.

Anything less than half a carb can be labeled as zero, which is why most heavy whipping cream labels say zero carbs.

That can really add up on you in recipes though!

There are 16 TBSPs in a cup, making HWC 6.4 carbs per cup…

You simply want to find an entry in MyFitnessPal, or the tracker you use, that counts heavy whipping cream (HWC) as 1 carb for 2 TBSP. It’s also 50 calories per TBSP if you’re counting calories.

~

Individual Results May Vary

It’s worth noting that everyone may respond differently to various types of sugar free sweeteners or foods/products. It’s also worth noting that most people DO NOT properly do clean testing like I do, so their results may be skewed or diluted.

I do a full six day clean test on any new food or ingredient. That means I eat super simple known/tested foods (eggs, pecans, beef, etc) and often mono meals (single ingredient meals) for 72 hours prior to a glucose/ketone test.

I do this to get my body to baseline numbers, or optimal ketone/glucose levels, and so that there are NO other factors affecting my test.

I then test a single new food or ingredient (or Starbucks order), and follow that with another 72 hours of clean eating. I do that because it can take up to 72 hours to fully metabolize anything you consume – and longer if you drink alcohol.

I mentioned all of this in my recent sugar free chocolate chips keto test post & video.

I said then and I’ll say again: I don’t trust anyone else’s results.

That’s for two reasons. First because we are all different. And second because I don’t know ANYONE that does a full 6-day CLEAN test, and doesn’t take a single bite of anything else questionable.

This is a matter of comparing avocados to avocados – instead of avocados to apples.

Back to maltodextrin which is apparently “THE KETO DEVIL” according to keto communities and self-proclaimed keto gurus… I found it very interesting that the whole craze is based solely on a glycemic index comparison ONLY.

It’s simply not a fair comparison, as I demonstrated.

A trace amount, and that’s what it is: a TRACE amount, of maltodextrin is not at all the same as a serving of sugar – in any food or in any situation. Unless you’re testing a full TBSP of each side by side, which is just silly.

As for me, I’m going to continue enjoying my keto-friendly Starbucks iced coffees.

It’s really such a minor thing to cause such a HUGE stir across keto communities, in my opinion anyway.

I’m sure I’ve been consuming maltodextrin pretty much all my life, way before I went keto, and in more foods and products than I even care to know about.

I just can’t be bothered to scrutinize every little ingredient ALL the time, or to cut out something so ENJOYABLE as my sugar free iced coffee – which is a treat, by the way, not a daily thing but an occasional indulgence.

I also don’t gulp down the entire thing but rather sip on it and usually drink maybe half, then stick it in the refrigerator and finish the rest of it the next day.

I think at the point that I would get THAT picky about every single ingredient and trace additive in any food or ingredient or bottle of shampoo… I’d also have to question taking my next breath…

You can’t possibly believe the AIR is clean on this polluted planet we live on.

But that’s just me. I want to live freely and enjoy my life, and enjoy the widest range of flavors and foods and experiences, while staying in nutritional ketosis. Simple!

Like I said, it’s a personal preference. My coffee date friend prefers NOT to consume maltodextrin. He also doesn’t eat beef or pork. All personal choices, and all fine by me. He orders the iced coffee with heavy cream and sugar free cinnamon dolce syrup, then adds a packet of stevia from his pocket.

Just between you and I, his stevia packets list dextrose as the first ingredient – which is pretty much the same thing as maltodextrin (proof). Shhhh!!

Dextrose and maltodextrin are very similar. Something to Google if you’re interested. Also, anytime it says “natural flavors” maltodextrin may be used as the carrier for those. I always find it sketchy when “natural flavors” is listed as an ingredient – with no explanation of what those are exactly.

But again, if it tastes good and tests good – I’ll probably eat it.

Thoughts or Questions on Keto Starbucks or Maltodextrin?

Leave a comment and let’s chat!

Best, Lynn Terry, aka @LowCarbTraveler

p.s. This is the kind of thing I absolutely LOVE to dig into and research/test. While I’m sipping my Starbucks coffee full of maltodextrin, of course…

This is the reason you need to do your own testing though, in all seriousness. Don’t just blindly believe everything you read or watch online, or heard somewhere.

It’s all about knowing how YOUR body responds to certain foods or ingredients, your bio-individuality, and not giving in to hype and sensationalism and silly arguments or scare tactics – but testing for the TRUTH.

Here is our 15% off discount link for the Keto Mojo Testing Kit

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[jesseneufeld]

Should Health Coaches and Nutritionists Interpret Lab Tests?

There are now a few companies that are offering this type of training to health coaches, and I suspect that we’re going to see more of them in the future. So, I wanted to take the opportunity in this article to share my position and explain the reasoning behind it.

But before I do that, I want to start by saying that everyone reading this article has a crucial role to play in reversing the chronic disease epidemic, whether you are a medical doctor, a chiropractor, a nutritionist or dietitian, a health coach, a personal trainer, or even what I’ve called a “citizen activist.”

The scale of the challenge we face is enormous, and we need to work together as a community of professionals and advocates to solve it. I spent at least a third of my recent book, Unconventional Medicine, making this argument, and I haven’t stopped believing it. In fact, I feel more strongly about it than ever.

Let’s begin by clarifying some of the roles that are relevant to this discussion because I think there is still a lot of confusion about them. Frankly, I didn’t fully understand the distinctions between these roles myself until just a few years ago.

Should health coaches interpret lab tests for their clients? What about nutritionists? Check out this article for my take on a contentious issue. #changeagent #functionalmedicine #chriskresser

We Need Both Health Coaches and Nutritionists/Dietitians—But They Are Not the Same

The terms “health coach,” “nutritionist,” and “dietitian” are often used interchangeably, but they are not the same.

What Is a Health Coach?

Health coaches are behavior change specialists. They support people in discovering their own strategies and motivation for change, overcoming obstacles, and implementing protocols that have either been prescribed by a clinician or nutritionist/dietitian or that the client has chosen to implement on their own.

This is a critical role since we know that over 85 percent of chronic disease is driven by our behavior and environment—not our genes—and that only 6 percent of Americans consistently engage in the top five health behaviors identified by the Centers for Disease Control: maintaining a healthy weight, not smoking, not drinking excessively, getting enough exercise, and getting enough sleep. (1, 2) (I would also add eating a healthy diet to this list.)

We desperately need properly trained health coaches because information is not enough to change behavior. If it were, 100 percent of Americans would engage in the top health behaviors all the time. Most people know that getting enough exercise and sleep, eating well, and avoiding smoking and drinking excessively are healthy behaviors. But as the statistics show, they still don’t do these things.

And this isn’t just true in the general population. Even in my own Functional Medicine practice with highly motivated patients, some people struggle to implement the changes I suggest. And I know from training thousands of healthcare professionals of all types that lack of compliance is an extremely common problem.

Health coaches fill a critical void in both conventional and Functional Medicine by offering more intensive, patient-centered care. When properly trained, they are skilled in evidence-based methods of supporting change, including:

Motivational interviewing, which helps people to discover their own motivation and strategies for change

Positive psychology, which teaches people to build on what’s working, rather than fixing what’s broken

Understanding the stages of change, which allows health coaches to offer the appropriate type of support at each stage of change

Habit formation and reversal, which supports people to create new, healthy habits and reverse unhealthy ones

Accountability and goal setting, which helps people to stay on track and achieve their goals

All of the knowledge and expertise in the world doesn’t matter unless someone can apply it in their own life. The support of a health coach can make the difference between success and failure in implementing long-term diet, lifestyle, and behavior changes. So, there’s no question in my mind that health coaches will play a crucial role in reversing the chronic disease epidemic. (For more on the importance of health coaches in combating chronic disease, see this article.)

All of that said, health coaches do not typically have training in health and medical sciences (unless they also have another healthcare license or credential). They don’t need this expertise to be successful in supporting behavior change, which is their primary purpose and role.

What Are Dietitians and Nutritionists?

Dietitians and nutritionists are different than health coaches. Whereas a health coach focuses on behavior change, dietitians and nutritionists are experts that assess, diagnose, and treat dietary and nutritional problems at both an individual and a wider public health level.

Generally speaking, the term “registered dietitian” (RD) is more tightly regulated than the term “nutritionist,” but this doesn’t necessarily mean that a dietitian has more training than a nutritionist.

For example, a certified nutrition specialist (CNS) is a highly qualified nutrition professional with both a bachelor’s and a graduate degree (master’s or doctorate) in nutrition, plus 1,000 hours of a supervised internship and a passing score on a rigorous exam.

Registered dietitians are also highly qualified. They have typically attended an accredited bachelor’s program as well as a 1,200-hour supervised internship, and they may have additional licenses or credentials in specific areas of study.

Both dietitians and certified nutrition professionals have had extensive training in health and medical sciences, such as:

Organic chemistry

Biochemistry

Anatomy

Physiology

Genetics

Microbiology

Pharmacology

Statistics

Nutrient metabolism

There are many different degrees, credentials, and qualifications within the nutrition field. Some are regulated and protected, and others are not. For this reason, the range of training that someone using the term “nutritionist” has had can vary wildly, from being self-taught, to a 40-hour course, to hundreds or even thousands of hours of academic and clinical education and experience.

It is beyond the scope of this article to explain all the different career paths that a nutrition professional might pursue, but if you’d like to learn more I’d suggest the following two resources:

Description of Nutrition Professional Degrees/Credentials on the American Nutrition Association website

What Is The Difference Between A Nutritionist And A Dietitian?

Should Health Coaches Interpret Blood Tests?

Let’s begin by discussing blood testing since it is the most common type of testing offered in medicine today.

I believe that health coaches should not interpret blood tests. By “interpret,” I mean “explain the meaning of” the results to the client, which gets very close to (and in some cases may be indistinguishable from) diagnosing a condition or disease.

There are two reasons for this:

Safety and ethics. Many health coaches have not had in-depth training in health and medical sciences that would prepare them to interpret blood work, unless they also hold another license or credential that included that training  (e.g., a nurse, dietitian, occupational therapist, etc.). If a health coach reads a blood panel and misses something important on the results and/or makes an unsuitable recommendation, the client could be harmed.

Legal and regulatory concerns. In many states, a health coach would be infringing on the scope of practice of other practitioners (including dietitians and medical doctors) by interpreting blood tests, and they might be subject to legal action.

It’s important to understand these two reasons separately because even when one does not apply, the other still does.

For example, in some states, the law does not explicitly prohibit a health coach from reviewing blood test results—which is different than interpreting them and making a diagnosis and treatment suggestions. (I’ll explain this distinction further below.) But that does not mean that it is safe or ethical for a health coach without adequate training to do it.

On the other hand, a health coach may have a background in health or medical sciences that would provide a foundation for understanding blood work, but without a credential or license that permits this, she would still be at legal risk.

What about Recognizing “Red Flags” on Blood Tests?

There is one caveat here. Although I don’t think that a health coach should interpret blood tests, I do think that they should be able to recognize “red flags” and risk factors for chronic disease and then make a referral to an appropriate healthcare professional.

The National Board of Medical Examiners (NBME) recently teamed up with the International Consortium of Health & Wellness Coaches (ICHWC) to create an internationally recognized credential for health coaches called the National Board Certified Health & Wellness Coach (NBC-HWC). Section 3 of the Health & Wellness Coach Certifying Exam Content Outline states: (3)

By definition, health and wellness coaches are not content experts in health or disease; they do not diagnose or prescribe, unless a coach has credentials in another profession that allow expert advice to be given. However, it is important for coaches to have a solid working familiarity of current evidence-based recommendations provided by public health groups such as the Centers for Disease Control and National Institutes of Health.

Relevant guidelines and recommendations fall in the areas of health promotion, disease prevention, and lifestyle medicine. The coach should be able to identify risk factors for chronic disease, commonly used biometric measures, and current lifestyle recommendations for optimizing health. An important focus for the coach is to recognize potential imminent danger and medical red flags and to know when and how to refer to another health care professional. [Emphasis added]

There is a crucial difference between interpreting a blood test result and making a diagnosis and treatment recommendations (including nutrition and diet suggestions) based on the result, and recognizing a potential red flag and referring to medical professional for further investigation.

Reviewing lab test results that relate to nutrition or nutrient levels could be considered nutrition education, which health coaches are permitted to do in some states. However, interpreting blood tests and making diagnoses and treatment recommendations would be considered the practice of medicine or medical nutrition therapy in all states, which health coaches are not legally allowed to do.

This distinction is well recognized in other healthcare professions. For example, a nurse working in a hospital might notice and report signs and symptoms of redness, pain, and swelling at an incisional site but would not diagnose an infection or prescribe treatment for it. Instead, she would bring the issue to the attention of a physician, who could then diagnose and treat the problem.

While “reviewing” lab tests to recognize red flags and risk factors and “interpreting” them to diagnose and treat disease are not the same thing, they are often confused and and there’s a fine line between them that health coaches could easily cross.

This is why we train our ADAPT health coaches to avoid interpretation of lab tests entirely, and take a conservative approach to reviewing them if they live in a state that might permit it. If they live in a state that doesn’t, they must avoid even reviewing lab test results.

A Caveat: Health Coaches with Other Licenses or Credentials

Some certified health coaches also have licenses or credentials in other healthcare fields. For example, we have several licensed professionals in our ADAPT Health Coach Training Program, including medical doctors, physical and occupational therapists, and registered dietitians.

In these cases, the health coach does have the training and credentials that would allow them to interpret blood tests. However, most attorneys that I’ve consulted have advised that health coaches that have a license should only interpret labs if they are clearly operating under the scope of practice of their license.

Let’s say you’re a nurse practitioner (NP) and a health coach. If you advertise yourself as a nurse practitioner (that may also incorporate health coaching) and you onboard your patient using the same methods that you would use for any of your patients, you may interpret labs and do all of the other things that your scope of practice as an NP allows you to do.

However, if you advertise yourself as a health coach and onboard the client with only that understanding, then you should operate within the scope of practice of a health coach—not a nurse practitioner.

For this reason, in our ADAPT program we recommend that “dual professionals”—health coaches that are also licensed healthcare providers—advertise and operate within the scope of practice of their licensed profession if they want to be able to incorporate lab testing into their practice.

They can still use health coaching skills and competencies with their patients or clients because, in most cases, the scope of practice of licensed providers (like MDs, NPs, PTs, RDs, etc.) doesn’t preclude them from using these skills along with whatever other activities their licensure enables them to perform.

Should Dietitians and Nutritionists Interpret Blood Tests?

As I mentioned above, registered dietitians (RDs) and certified nutrition professionals often have hundreds or thousands of hours of academic and clinical training in health and medical sciences. This qualifies them to interpret blood test results related to nutrition status.

According to the CDC: (4)

RDNs in clinical practice: Recommend, perform, and/or interpret test results related to nutrition status: blood pressure, anthropometrics (e.g., height and weight, skinfold thickness, waist circumference, calculation of body mass index with classification for malnutrition and obesity), indirect calorimetry, laboratory tests, and waived point-of-care laboratory testing (e.g., blood glucose and cholesterol).

This is also true in a Functional Medicine context. According to the American Dietetic Association: (5)

IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam and conventional laboratory data along with functional tests to assess the integrity of the metabolic networks and core imbalances that may be present.

Certified nutrition professionals with adequate training, such as certified nutrition specialists (CNSs), are also able to interpret blood tests. Section 3cii of the Examination Content Outline for Certified Nutrition Specialists states that a CNS should be able to “[i]nterpret laboratory data as it applies to nutrition-related conditions and systemic imbalances.” (6)

So, it’s clear to me that both RDs and certified nutrition professionals with adequate training should be able to interpret blood test results. This is why we have accepted both RDs and certified nutritional professionals in our ADAPT Practitioner Training Program since its inception in 2016.

What If You’re a Nutritionist without a Nationally or Conventionally Recognized Credential or License?

There are many different career paths and training options for nutritionists, and they can vary significantly in terms of the prerequisites, curriculum, practical supervision (e.g., internship, practicum, etc.), length of study, and other factors.

Moreover, the term “nutritionist” is not regulated or protected. This means that someone could take be self-taught, or take a short course in nutrition (say, 30 to 40 hours) and then refer to themselves as a nutritionist. In these cases, I believe that the individual wouldn’t have the necessary training in health and medical sciences to prepare them to interpret blood testing.

This leads to both ethical and safety concerns and legal and regulatory risk—just as it does with health coaches. A nutritionist without adequate academic and clinical education in health and medical sciences could harm a client if she does not interpret a blood test correctly, and if the client pursued legal action, it’s likely that the nutritionist would not be protected.

It is beyond the scope of this article to address the scope of practice of nutritionists that do not have a nationally or conventionally recognized license or credential. If you fall into this category, please refer to your educational institution or an organization like the National Association of Nutrition Professionals for more information.

Recognizing “Red Flags” and Risk Factors for Chronic Disease

As I mentioned above, although interpreting blood tests is not within the scope of practice of a health coach, the NBME suggests that a health coach should be able to recognize red flags and risk factors of chronic disease, including commonly used biometric tests (i.e., blood tests, blood pressure, etc.).

While I’m not aware of a general scope of practice that covers nutritionists without nationally recognized credentials or licenses, I think it’s also important that these providers are able to recognize red flags and risk factors and make referrals to appropriate healthcare professionals, at least in states that permit review of blood test results by unlicensed providers.

Again, there is significant risk here of the line between review and interpretation blurring, so caution is warranted.

What about Other Types of Lab Testing?

So far in this article, I have focused on the interpretation of blood testing. But what about the interpretation of other types of testing like the stool, saliva, and urine labs that are often used in a Functional or Integrative Medicine context?

This is more of a gray area from both a safety/ethics and legal/regulatory perspective. In general, I believe that registered dietitians and certified nutrition professionals should be able to interpret the results of these types of tests, provided they have been specifically trained in these Functional Medicine diagnostics.

The answer is much less clear in the case of health coaches and nutritionists that do not possess a nationally recognized credential or license, and/or have not had adequate training in health and medical sciences.

Using the results of a stool test from uBiome or a functional lab to make recommendations like eating more fiber or consuming probiotics is very different than interpreting the results of a comprehensive blood panel. The stakes are much higher with blood work, since the results can indicate serious and potentially life-threatening conditions like cancer, hemochromatosis, or Wilson disease.

At the same time, although saliva, stool, and urine testing don’t typically reveal serious conditions, some of the treatments that providers recommend based on these results can be dangerous when prescribed incorrectly.

For example, I know of one case from a few years back when an unlicensed health coach recommended a high dose of DHEA, a hormone, to a client based on the results of that client’s saliva hormone test. What the coach failed to recognize is that a high dose of DHEA could exacerbate the client’s preexisting Graves’ disease, a hyperthyroid condition. After taking the DHEA, the patient experienced tachycardia, palpitations, high blood pressure, and elevated body temperature and had to be taken to the emergency room.

The client hired an attorney and sued the health coach—and also the program that trained the coach to interpret the lab results and prescribe treatment based on them.

So, as you can see, the question of whether a health coach or non-credentialed or non-certified nutritionist should be able to order and interpret saliva, stool, and urine tests is nuanced and complex. In some cases, it may be fine provided that they have adequate training to interpret the specific test in question. In others, I see potential issues from both a safety/ethics and legal/regulatory perspective.

The legal and regulatory landscape is not well defined in the case of Functional Medicine diagnostics because it’s relatively new and until recently has not been on the radar of the organizations that are responsible for creating the laws and regulations that govern who can order and interpret laboratory testing.

I suspect we’ll see more developments in this area over the coming years. Until then, the safest approach is likely to apply the same principles that determine which healthcare providers can interpret blood tests to other Functional Medicine diagnostic tools like saliva, stool, and urine tests.

It Takes a Village to Reverse Chronic Disease

The fact that I don’t believe that health coaches and nutritionists without nationally-recognized credentials or training in health and medical sciences should interpret most lab test results does not in any way mean that I don’t value these vital health professionals.

I know of many skilled and competent nutritionists that are neither RDs nor certified nutritional professionals yet have helped hundreds of people transform their diet and lifestyle, reverse chronic disease, and dramatically improve their quality of life.

Likewise, I’m such a believer in the power of health coaching that I launched a 12-month health coach certification called the ADAPT Health Coach Training Program in 2018. Health coaches have a critical role to play in healthcare because they are working on the front lines to help people change their behavior—and that is arguably the single most important thing we can do to prevent and reverse chronic disease.

So, this article is not about creating a hierarchy in which the providers that can order and interpret lab testing and prescribe treatment are higher up and the providers that focus on behavior change and providing guidance on diet and nutrition are lower down.

That mentality is an artifact of the conventional medical paradigm that values information more than transformation, expertise more than support, and managing and suppressing symptoms more than changing diet, lifestyle, and behavior. It’s exactly the model that got us into this mess in the first place.

Instead, I am a passionate advocate for what I call a “collaborative practice model.” This model links many different providers—clinicians, nurses, dietitians and nutritionists, health coaches, physical therapists, counselors, psychologists, etc.—into an integrated care team that can provide the highest possible level of support to patients.

It recognizes the inherent and equal value of each type of provider and seeks to maximize his or her skill, training, and scope of practice in service of the patient. For example:

Medical doctors and other clinicians focus on the diagnosis and treatment of disease

Nutritionists and dietitians focus on creating individualized nutrition protocols

Health coaches focus on supporting people in implementing the protocols prescribed by nutritionists/dietitians and clinicians and in making successful and lasting behavior change

While each of these providers can have a major impact working independently, I believe that they are even more effective when working together in a collaborative fashion:

A doctor can prescribe a brilliant treatment protocol, but without a nutritionist or dietitian to customize the diet prescription and a health coach to help the patient to implement it, the chances of success are much lower.

A health coach can have a powerful impact on supporting people to make diet, lifestyle, and behavior changes, but if his client is struggling with a significant chronic health problem, working in collaboration with a clinician that can perform the full scope of lab testing and prescribe treatments will lead to better results.

A nutritionist or dietitian can create a perfectly tailored nutrition prescription for her client, with meal plans and recipes, but if the client doesn’t follow it, all of this work will be for naught. This is where a health coach can be so helpful.

It truly does take a village to address this growing problem of chronic disease. If you’re reading this, it means that you’re already playing a role—however big or small—in this healthcare revolution, and I am so grateful for your efforts!

As this article indicates, there are still many gray areas and quite a lot of confusion, even amongst legal and medical professionals that have closely studied these issues. What’s more, the landscape is changing quickly, as professions like health coaching and nutritionists become more common and better recognized.

I will continue to study this topic, consult with healthcare attorneys, and gather feedback from the professional community. I’ll update this article with any new, relevant information.

I’d love to hear your feedback, questions, or concerns in the comments.

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Should Health Coaches and Nutritionists Interpret Lab Tests?

There are now a few companies that are offering this type of training to health coaches, and I suspect that we’re going to see more of them in the future. So, I wanted to take the opportunity in this article to share my position and explain the reasoning behind it.

But before I do that, I want to start by saying that everyone reading this article has a crucial role to play in reversing the chronic disease epidemic, whether you are a medical doctor, a chiropractor, a nutritionist or dietitian, a health coach, a personal trainer, or even what I’ve called a “citizen activist.”

The scale of the challenge we face is enormous, and we need to work together as a community of professionals and advocates to solve it. I spent at least a third of my recent book, Unconventional Medicine, making this argument, and I haven’t stopped believing it. In fact, I feel more strongly about it than ever.

Let’s begin by clarifying some of the roles that are relevant to this discussion because I think there is still a lot of confusion about them. Frankly, I didn’t fully understand the distinctions between these roles myself until just a few years ago.

Should health coaches interpret lab tests for their clients? What about nutritionists? Check out this article for my take on a contentious issue. #changeagent #functionalmedicine #chriskresser

We Need Both Health Coaches and Nutritionists/Dietitians—But They Are Not the Same

The terms “health coach,” “nutritionist,” and “dietitian” are often used interchangeably, but they are not the same.

What Is a Health Coach?

Health coaches are behavior change specialists. They support people in discovering their own strategies and motivation for change, overcoming obstacles, and implementing protocols that have either been prescribed by a clinician or nutritionist/dietitian or that the client has chosen to implement on their own.

This is a critical role since we know that over 85 percent of chronic disease is driven by our behavior and environment—not our genes—and that only 6 percent of Americans consistently engage in the top five health behaviors identified by the Centers for Disease Control: maintaining a healthy weight, not smoking, not drinking excessively, getting enough exercise, and getting enough sleep. (1, 2) (I would also add eating a healthy diet to this list.)

We desperately need properly trained health coaches because information is not enough to change behavior. If it were, 100 percent of Americans would engage in the top health behaviors all the time. Most people know that getting enough exercise and sleep, eating well, and avoiding smoking and drinking excessively are healthy behaviors. But as the statistics show, they still don’t do these things.

And this isn’t just true in the general population. Even in my own Functional Medicine practice with highly motivated patients, some people struggle to implement the changes I suggest. And I know from training thousands of healthcare professionals of all types that lack of compliance is an extremely common problem.

Health coaches fill a critical void in both conventional and Functional Medicine by offering more intensive, patient-centered care. When properly trained, they are skilled in evidence-based methods of supporting change, including:

Motivational interviewing, which helps people to discover their own motivation and strategies for change

Positive psychology, which teaches people to build on what’s working, rather than fixing what’s broken

Understanding the stages of change, which allows health coaches to offer the appropriate type of support at each stage of change

Habit formation and reversal, which supports people to create new, healthy habits and reverse unhealthy ones

Accountability and goal setting, which helps people to stay on track and achieve their goals

All of the knowledge and expertise in the world doesn’t matter unless someone can apply it in their own life. The support of a health coach can make the difference between success and failure in implementing long-term diet, lifestyle, and behavior changes. So, there’s no question in my mind that health coaches will play a crucial role in reversing the chronic disease epidemic. (For more on the importance of health coaches in combating chronic disease, see this article.)

All of that said, health coaches do not typically have training in health and medical sciences (unless they also have another healthcare license or credential). They don’t need this expertise to be successful in supporting behavior change, which is their primary purpose and role.

What Are Dietitians and Nutritionists?

Dietitians and nutritionists are different than health coaches. Whereas a health coach focuses on behavior change, dietitians and nutritionists are experts that assess, diagnose, and treat dietary and nutritional problems at both an individual and a wider public health level.

Generally speaking, the term “registered dietitian” (RD) is more tightly regulated than the term “nutritionist,” but this doesn’t necessarily mean that a dietitian has more training than a nutritionist.

For example, a certified nutrition specialist (CNS) is a highly qualified nutrition professional with both a bachelor’s and a graduate degree (master’s or doctorate) in nutrition, plus 1,000 hours of a supervised internship and a passing score on a rigorous exam.

Registered dietitians are also highly qualified. They have typically attended an accredited bachelor’s program as well as a 1,200-hour supervised internship, and they may have additional licenses or credentials in specific areas of study.

Both dietitians and certified nutrition professionals have had extensive training in health and medical sciences, such as:

Organic chemistry

Biochemistry

Anatomy

Physiology

Genetics

Microbiology

Pharmacology

Statistics

Nutrient metabolism

There are many different degrees, credentials, and qualifications within the nutrition field. Some are regulated and protected, and others are not. For this reason, the range of training that someone using the term “nutritionist” has had can vary wildly, from being self-taught, to a 40-hour course, to hundreds or even thousands of hours of academic and clinical education and experience.

It is beyond the scope of this article to explain all the different career paths that a nutrition professional might pursue, but if you’d like to learn more I’d suggest the following two resources:

Description of Nutrition Professional Degrees/Credentials on the American Nutrition Association website

What Is The Difference Between A Nutritionist And A Dietitian?

Should Health Coaches Interpret Blood Tests?

Let’s begin by discussing blood testing since it is the most common type of testing offered in medicine today.

I believe that health coaches should not interpret blood tests. By “interpret,” I mean “explain the meaning of” the results to the client, which gets very close to (and in some cases may be indistinguishable from) diagnosing a condition or disease.

There are two reasons for this:

Safety and ethics. Many health coaches have not had in-depth training in health and medical sciences that would prepare them to interpret blood work, unless they also hold another license or credential that included that training  (e.g., a nurse, dietitian, occupational therapist, etc.). If a health coach reads a blood panel and misses something important on the results and/or makes an unsuitable recommendation, the client could be harmed.

Legal and regulatory concerns. In many states, a health coach would be infringing on the scope of practice of other practitioners (including dietitians and medical doctors) by interpreting blood tests, and they might be subject to legal action.

It’s important to understand these two reasons separately because even when one does not apply, the other still does.

For example, in some states, the law does not explicitly prohibit a health coach from reviewing blood test results—which is different than interpreting them and making a diagnosis and treatment suggestions. (I’ll explain this distinction further below.) But that does not mean that it is safe or ethical for a health coach without adequate training to do it.

On the other hand, a health coach may have a background in health or medical sciences that would provide a foundation for understanding blood work, but without a credential or license that permits this, she would still be at legal risk.

What about Recognizing “Red Flags” on Blood Tests?

There is one caveat here. Although I don’t think that a health coach should interpret blood tests, I do think that they should be able to recognize “red flags” and risk factors for chronic disease and then make a referral to an appropriate healthcare professional.

The National Board of Medical Examiners (NBME) recently teamed up with the International Consortium of Health & Wellness Coaches (ICHWC) to create an internationally recognized credential for health coaches called the National Board Certified Health & Wellness Coach (NBC-HWC). Section 3 of the Health & Wellness Coach Certifying Exam Content Outline states: (3)

By definition, health and wellness coaches are not content experts in health or disease; they do not diagnose or prescribe, unless a coach has credentials in another profession that allow expert advice to be given. However, it is important for coaches to have a solid working familiarity of current evidence-based recommendations provided by public health groups such as the Centers for Disease Control and National Institutes of Health.

Relevant guidelines and recommendations fall in the areas of health promotion, disease prevention, and lifestyle medicine. The coach should be able to identify risk factors for chronic disease, commonly used biometric measures, and current lifestyle recommendations for optimizing health. An important focus for the coach is to recognize potential imminent danger and medical red flags and to know when and how to refer to another health care professional. [Emphasis added]

There is a crucial difference between interpreting a blood test result and making a diagnosis and treatment recommendations (including nutrition and diet suggestions) based on the result, and recognizing a potential red flag and referring to medical professional for further investigation.

Reviewing lab test results that relate to nutrition or nutrient levels could be considered nutrition education, which health coaches are permitted to do in some states. However, interpreting blood tests and making diagnoses and treatment recommendations would be considered the practice of medicine or medical nutrition therapy in all states, which health coaches are not legally allowed to do.

This distinction is well recognized in other healthcare professions. For example, a nurse working in a hospital might notice and report signs and symptoms of redness, pain, and swelling at an incisional site but would not diagnose an infection or prescribe treatment for it. Instead, she would bring the issue to the attention of a physician, who could then diagnose and treat the problem.

While “reviewing” lab tests to recognize red flags and risk factors and “interpreting” them to diagnose and treat disease are not the same thing, they are often confused and and there’s a fine line between them that health coaches could easily cross.

This is why we train our ADAPT health coaches to avoid interpretation of lab tests entirely, and take a conservative approach to reviewing them if they live in a state that might permit it. If they live in a state that doesn’t, they must avoid even reviewing lab test results.

A Caveat: Health Coaches with Other Licenses or Credentials

Some certified health coaches also have licenses or credentials in other healthcare fields. For example, we have several licensed professionals in our ADAPT Health Coach Training Program, including medical doctors, physical and occupational therapists, and registered dietitians.

In these cases, the health coach does have the training and credentials that would allow them to interpret blood tests. However, most attorneys that I’ve consulted have advised that health coaches that have a license should only interpret labs if they are clearly operating under the scope of practice of their license.

Let’s say you’re a nurse practitioner (NP) and a health coach. If you advertise yourself as a nurse practitioner (that may also incorporate health coaching) and you onboard your patient using the same methods that you would use for any of your patients, you may interpret labs and do all of the other things that your scope of practice as an NP allows you to do.

However, if you advertise yourself as a health coach and onboard the client with only that understanding, then you should operate within the scope of practice of a health coach—not a nurse practitioner.

For this reason, in our ADAPT program we recommend that “dual professionals”—health coaches that are also licensed healthcare providers—advertise and operate within the scope of practice of their licensed profession if they want to be able to incorporate lab testing into their practice.

They can still use health coaching skills and competencies with their patients or clients because, in most cases, the scope of practice of licensed providers (like MDs, NPs, PTs, RDs, etc.) doesn’t preclude them from using these skills along with whatever other activities their licensure enables them to perform.

Should Dietitians and Nutritionists Interpret Blood Tests?

As I mentioned above, registered dietitians (RDs) and certified nutrition professionals often have hundreds or thousands of hours of academic and clinical training in health and medical sciences. This qualifies them to interpret blood test results related to nutrition status.

According to the CDC: (4)

RDNs in clinical practice: Recommend, perform, and/or interpret test results related to nutrition status: blood pressure, anthropometrics (e.g., height and weight, skinfold thickness, waist circumference, calculation of body mass index with classification for malnutrition and obesity), indirect calorimetry, laboratory tests, and waived point-of-care laboratory testing (e.g., blood glucose and cholesterol).

This is also true in a Functional Medicine context. According to the American Dietetic Association: (5)

IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam and conventional laboratory data along with functional tests to assess the integrity of the metabolic networks and core imbalances that may be present.

Certified nutrition professionals with adequate training, such as certified nutrition specialists (CNSs), are also able to interpret blood tests. Section 3cii of the Examination Content Outline for Certified Nutrition Specialists states that a CNS should be able to “[i]nterpret laboratory data as it applies to nutrition-related conditions and systemic imbalances.” (6)

So, it’s clear to me that both RDs and certified nutrition professionals with adequate training should be able to interpret blood test results. This is why we have accepted both RDs and certified nutritional professionals in our ADAPT Practitioner Training Program since its inception in 2016.

What If You’re a Nutritionist without a Nationally or Conventionally Recognized Credential or License?

There are many different career paths and training options for nutritionists, and they can vary significantly in terms of the prerequisites, curriculum, practical supervision (e.g., internship, practicum, etc.), length of study, and other factors.

Moreover, the term “nutritionist” is not regulated or protected. This means that someone could take be self-taught, or take a short course in nutrition (say, 30 to 40 hours) and then refer to themselves as a nutritionist. In these cases, I believe that the individual wouldn’t have the necessary training in health and medical sciences to prepare them to interpret blood testing.

This leads to both ethical and safety concerns and legal and regulatory risk—just as it does with health coaches. A nutritionist without adequate academic and clinical education in health and medical sciences could harm a client if she does not interpret a blood test correctly, and if the client pursued legal action, it’s likely that the nutritionist would not be protected.

It is beyond the scope of this article to address the scope of practice of nutritionists that do not have a nationally or conventionally recognized license or credential. If you fall into this category, please refer to your educational institution or an organization like the National Association of Nutrition Professionals for more information.

Recognizing “Red Flags” and Risk Factors for Chronic Disease

As I mentioned above, although interpreting blood tests is not within the scope of practice of a health coach, the NBME suggests that a health coach should be able to recognize red flags and risk factors of chronic disease, including commonly used biometric tests (i.e., blood tests, blood pressure, etc.).

While I’m not aware of a general scope of practice that covers nutritionists without nationally recognized credentials or licenses, I think it’s also important that these providers are able to recognize red flags and risk factors and make referrals to appropriate healthcare professionals, at least in states that permit review of blood test results by unlicensed providers.

Again, there is significant risk here of the line between review and interpretation blurring, so caution is warranted.

What about Other Types of Lab Testing?

So far in this article, I have focused on the interpretation of blood testing. But what about the interpretation of other types of testing like the stool, saliva, and urine labs that are often used in a Functional or Integrative Medicine context?

This is more of a gray area from both a safety/ethics and legal/regulatory perspective. In general, I believe that registered dietitians and certified nutrition professionals should be able to interpret the results of these types of tests, provided they have been specifically trained in these Functional Medicine diagnostics.

The answer is much less clear in the case of health coaches and nutritionists that do not possess a nationally recognized credential or license, and/or have not had adequate training in health and medical sciences.

Using the results of a stool test from uBiome or a functional lab to make recommendations like eating more fiber or consuming probiotics is very different than interpreting the results of a comprehensive blood panel. The stakes are much higher with blood work, since the results can indicate serious and potentially life-threatening conditions like cancer, hemochromatosis, or Wilson disease.

At the same time, although saliva, stool, and urine testing don’t typically reveal serious conditions, some of the treatments that providers recommend based on these results can be dangerous when prescribed incorrectly.

For example, I know of one case from a few years back when an unlicensed health coach recommended a high dose of DHEA, a hormone, to a client based on the results of that client’s saliva hormone test. What the coach failed to recognize is that a high dose of DHEA could exacerbate the client’s preexisting Graves’ disease, a hyperthyroid condition. After taking the DHEA, the patient experienced tachycardia, palpitations, high blood pressure, and elevated body temperature and had to be taken to the emergency room.

The client hired an attorney and sued the health coach—and also the program that trained the coach to interpret the lab results and prescribe treatment based on them.

So, as you can see, the question of whether a health coach or non-credentialed or non-certified nutritionist should be able to order and interpret saliva, stool, and urine tests is nuanced and complex. In some cases, it may be fine provided that they have adequate training to interpret the specific test in question. In others, I see potential issues from both a safety/ethics and legal/regulatory perspective.

The legal and regulatory landscape is not well defined in the case of Functional Medicine diagnostics because it’s relatively new and until recently has not been on the radar of the organizations that are responsible for creating the laws and regulations that govern who can order and interpret laboratory testing.

I suspect we’ll see more developments in this area over the coming years. Until then, the safest approach is likely to apply the same principles that determine which healthcare providers can interpret blood tests to other Functional Medicine diagnostic tools like saliva, stool, and urine tests.

It Takes a Village to Reverse Chronic Disease

The fact that I don’t believe that health coaches and nutritionists without nationally-recognized credentials or training in health and medical sciences should interpret most lab test results does not in any way mean that I don’t value these vital health professionals.

I know of many skilled and competent nutritionists that are neither RDs nor certified nutritional professionals yet have helped hundreds of people transform their diet and lifestyle, reverse chronic disease, and dramatically improve their quality of life.

Likewise, I’m such a believer in the power of health coaching that I launched a 12-month health coach certification called the ADAPT Health Coach Training Program in 2018. Health coaches have a critical role to play in healthcare because they are working on the front lines to help people change their behavior—and that is arguably the single most important thing we can do to prevent and reverse chronic disease.

So, this article is not about creating a hierarchy in which the providers that can order and interpret lab testing and prescribe treatment are higher up and the providers that focus on behavior change and providing guidance on diet and nutrition are lower down.

That mentality is an artifact of the conventional medical paradigm that values information more than transformation, expertise more than support, and managing and suppressing symptoms more than changing diet, lifestyle, and behavior. It’s exactly the model that got us into this mess in the first place.

Instead, I am a passionate advocate for what I call a “collaborative practice model.” This model links many different providers—clinicians, nurses, dietitians and nutritionists, health coaches, physical therapists, counselors, psychologists, etc.—into an integrated care team that can provide the highest possible level of support to patients.

It recognizes the inherent and equal value of each type of provider and seeks to maximize his or her skill, training, and scope of practice in service of the patient. For example:

Medical doctors and other clinicians focus on the diagnosis and treatment of disease

Nutritionists and dietitians focus on creating individualized nutrition protocols

Health coaches focus on supporting people in implementing the protocols prescribed by nutritionists/dietitians and clinicians and in making successful and lasting behavior change

While each of these providers can have a major impact working independently, I believe that they are even more effective when working together in a collaborative fashion:

A doctor can prescribe a brilliant treatment protocol, but without a nutritionist or dietitian to customize the diet prescription and a health coach to help the patient to implement it, the chances of success are much lower.

A health coach can have a powerful impact on supporting people to make diet, lifestyle, and behavior changes, but if his client is struggling with a significant chronic health problem, working in collaboration with a clinician that can perform the full scope of lab testing and prescribe treatments will lead to better results.

A nutritionist or dietitian can create a perfectly tailored nutrition prescription for her client, with meal plans and recipes, but if the client doesn’t follow it, all of this work will be for naught. This is where a health coach can be so helpful.

It truly does take a village to address this growing problem of chronic disease. If you’re reading this, it means that you’re already playing a role—however big or small—in this healthcare revolution, and I am so grateful for your efforts!

As this article indicates, there are still many gray areas and quite a lot of confusion, even amongst legal and medical professionals that have closely studied these issues. What’s more, the landscape is changing quickly, as professions like health coaching and nutritionists become more common and better recognized.

I will continue to study this topic, consult with healthcare attorneys, and gather feedback from the professional community. I’ll update this article with any new, relevant information.

I’d love to hear your feedback, questions, or concerns in the comments.

The post Should Health Coaches and Nutritionists Interpret Lab Tests? appeared first on Chris Kresser.

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[denisalvney]

Should Health Coaches and Nutritionists Interpret Lab Tests?

There are now a few companies that are offering this type of training to health coaches, and I suspect that we’re going to see more of them in the future. So, I wanted to take the opportunity in this article to share my position and explain the reasoning behind it.

But before I do that, I want to start by saying that everyone reading this article has a crucial role to play in reversing the chronic disease epidemic, whether you are a medical doctor, a chiropractor, a nutritionist or dietitian, a health coach, a personal trainer, or even what I’ve called a “citizen activist.”

The scale of the challenge we face is enormous, and we need to work together as a community of professionals and advocates to solve it. I spent at least a third of my recent book, Unconventional Medicine, making this argument, and I haven’t stopped believing it. In fact, I feel more strongly about it than ever.

Let’s begin by clarifying some of the roles that are relevant to this discussion because I think there is still a lot of confusion about them. Frankly, I didn’t fully understand the distinctions between these roles myself until just a few years ago.

Should health coaches interpret lab tests for their clients? What about nutritionists? Check out this article for my take on a contentious issue. #changeagent #functionalmedicine #chriskresser

We Need Both Health Coaches and Nutritionists/Dietitians—But They Are Not the Same

The terms “health coach,” “nutritionist,” and “dietitian” are often used interchangeably, but they are not the same.

What Is a Health Coach?

Health coaches are behavior change specialists. They support people in discovering their own strategies and motivation for change, overcoming obstacles, and implementing protocols that have either been prescribed by a clinician or nutritionist/dietitian or that the client has chosen to implement on their own.

This is a critical role since we know that over 85 percent of chronic disease is driven by our behavior and environment—not our genes—and that only 6 percent of Americans consistently engage in the top five health behaviors identified by the Centers for Disease Control: maintaining a healthy weight, not smoking, not drinking excessively, getting enough exercise, and getting enough sleep. (1, 2) (I would also add eating a healthy diet to this list.)

We desperately need properly trained health coaches because information is not enough to change behavior. If it were, 100 percent of Americans would engage in the top health behaviors all the time. Most people know that getting enough exercise and sleep, eating well, and avoiding smoking and drinking excessively are healthy behaviors. But as the statistics show, they still don’t do these things.

And this isn’t just true in the general population. Even in my own Functional Medicine practice with highly motivated patients, some people struggle to implement the changes I suggest. And I know from training thousands of healthcare professionals of all types that lack of compliance is an extremely common problem.

Health coaches fill a critical void in both conventional and Functional Medicine by offering more intensive, patient-centered care. When properly trained, they are skilled in evidence-based methods of supporting change, including:

Motivational interviewing, which helps people to discover their own motivation and strategies for change

Positive psychology, which teaches people to build on what’s working, rather than fixing what’s broken

Understanding the stages of change, which allows health coaches to offer the appropriate type of support at each stage of change

Habit formation and reversal, which supports people to create new, healthy habits and reverse unhealthy ones

Accountability and goal setting, which helps people to stay on track and achieve their goals

All of the knowledge and expertise in the world doesn’t matter unless someone can apply it in their own life. The support of a health coach can make the difference between success and failure in implementing long-term diet, lifestyle, and behavior changes. So, there’s no question in my mind that health coaches will play a crucial role in reversing the chronic disease epidemic. (For more on the importance of health coaches in combating chronic disease, see this article.)

All of that said, health coaches do not typically have training in health and medical sciences (unless they also have another healthcare license or credential). They don’t need this expertise to be successful in supporting behavior change, which is their primary purpose and role.

What Are Dietitians and Nutritionists?

Dietitians and nutritionists are different than health coaches. Whereas a health coach focuses on behavior change, dietitians and nutritionists are experts that assess, diagnose, and treat dietary and nutritional problems at both an individual and a wider public health level.

Generally speaking, the term “registered dietitian” (RD) is more tightly regulated than the term “nutritionist,” but this doesn’t necessarily mean that a dietitian has more training than a nutritionist.

For example, a certified nutrition specialist (CNS) is a highly qualified nutrition professional with both a bachelor’s and a graduate degree (master’s or doctorate) in nutrition, plus 1,000 hours of a supervised internship and a passing score on a rigorous exam.

Registered dietitians are also highly qualified. They have typically attended an accredited bachelor’s program as well as a 1,200-hour supervised internship, and they may have additional licenses or credentials in specific areas of study.

Both dietitians and certified nutrition professionals have had extensive training in health and medical sciences, such as:

Organic chemistry

Biochemistry

Anatomy

Physiology

Genetics

Microbiology

Pharmacology

Statistics

Nutrient metabolism

There are many different degrees, credentials, and qualifications within the nutrition field. Some are regulated and protected, and others are not. For this reason, the range of training that someone using the term “nutritionist” has had can vary wildly, from being self-taught, to a 40-hour course, to hundreds or even thousands of hours of academic and clinical education and experience.

It is beyond the scope of this article to explain all the different career paths that a nutrition professional might pursue, but if you’d like to learn more I’d suggest the following two resources:

Description of Nutrition Professional Degrees/Credentials on the American Nutrition Association website

What Is The Difference Between A Nutritionist And A Dietitian?

Should Health Coaches Interpret Blood Tests?

Let’s begin by discussing blood testing since it is the most common type of testing offered in medicine today.

I believe that health coaches should not interpret blood tests. By “interpret,” I mean “explain the meaning of” the results to the client, which gets very close to (and in some cases may be indistinguishable from) diagnosing a condition or disease.

There are two reasons for this:

Safety and ethics. Many health coaches have not had in-depth training in health and medical sciences that would prepare them to interpret blood work, unless they also hold another license or credential that included that training  (e.g., a nurse, dietitian, occupational therapist, etc.). If a health coach reads a blood panel and misses something important on the results and/or makes an unsuitable recommendation, the client could be harmed.

Legal and regulatory concerns. In many states, a health coach would be infringing on the scope of practice of other practitioners (including dietitians and medical doctors) by interpreting blood tests, and they might be subject to legal action.

It’s important to understand these two reasons separately because even when one does not apply, the other still does.

For example, in some states, the law does not explicitly prohibit a health coach from reviewing blood test results—which is different than interpreting them and making a diagnosis and treatment suggestions. (I’ll explain this distinction further below.) But that does not mean that it is safe or ethical for a health coach without adequate training to do it.

On the other hand, a health coach may have a background in health or medical sciences that would provide a foundation for understanding blood work, but without a credential or license that permits this, she would still be at legal risk.

What about Recognizing “Red Flags” on Blood Tests?

There is one caveat here. Although I don’t think that a health coach should interpret blood tests, I do think that they should be able to recognize “red flags” and risk factors for chronic disease and then make a referral to an appropriate healthcare professional.

The National Board of Medical Examiners (NBME) recently teamed up with the International Consortium of Health & Wellness Coaches (ICHWC) to create an internationally recognized credential for health coaches called the National Board Certified Health & Wellness Coach (NBC-HWC). Section 3 of the Health & Wellness Coach Certifying Exam Content Outline states: (3)

By definition, health and wellness coaches are not content experts in health or disease; they do not diagnose or prescribe, unless a coach has credentials in another profession that allow expert advice to be given. However, it is important for coaches to have a solid working familiarity of current evidence-based recommendations provided by public health groups such as the Centers for Disease Control and National Institutes of Health.

Relevant guidelines and recommendations fall in the areas of health promotion, disease prevention, and lifestyle medicine. The coach should be able to identify risk factors for chronic disease, commonly used biometric measures, and current lifestyle recommendations for optimizing health. An important focus for the coach is to recognize potential imminent danger and medical red flags and to know when and how to refer to another health care professional. [Emphasis added]

There is a crucial difference between interpreting a blood test result and making a diagnosis and treatment recommendations (including nutrition and diet suggestions) based on the result, and recognizing a potential red flag and referring to medical professional for further investigation.

Reviewing lab test results that relate to nutrition or nutrient levels could be considered nutrition education, which health coaches are permitted to do in some states. However, interpreting blood tests and making diagnoses and treatment recommendations would be considered the practice of medicine in all states and is explicitly prohibited.

This distinction is well recognized in other healthcare professions. For example, a nurse working in a hospital might notice and report signs and symptoms of redness, pain, and swelling at an incisional site but would not diagnose an infection or prescribe treatment for it. Instead, she would bring the issue to the attention of a physician, who could then diagnose and treat the problem.

While “reviewing” lab tests to recognize red flags and risk factors and “interpreting” them to diagnose and treat disease are not the same thing, they are often confused and and there’s a fine line between them that health coaches could easily cross.

This is why we train our ADAPT health coaches to avoid interpretation of lab tests entirely, and take a conservative approach to reviewing them if they live in a state that might permit it. If they live in a state that doesn’t, they must avoid even reviewing lab test results.

A Caveat: Health Coaches with Other Licenses or Credentials

Some certified health coaches also have licenses or credentials in other healthcare fields. For example, we have several licensed professionals in our ADAPT Health Coach Training Program, including medical doctors, physical and occupational therapists, and registered dietitians.

In these cases, the health coach does have the training and credentials that would allow them to interpret blood tests. However, most attorneys that I’ve consulted have advised that health coaches that have a license should only interpret labs if they are clearly operating under the scope of practice of their license.

Let’s say you’re a nurse practitioner (NP) and a health coach. If you advertise yourself as a nurse practitioner (that may also incorporate health coaching) and you onboard your patient using the same methods that you would use for any of your patients, you may interpret labs and do all of the other things that your scope of practice as an NP allows you to do.

However, if you advertise yourself as a health coach and onboard the client with only that understanding, then you should operate within the scope of practice of a health coach—not a nurse practitioner.

For this reason, in our ADAPT program we recommend that “dual professionals”—health coaches that are also licensed healthcare providers—advertise and operate within the scope of practice of their licensed profession if they want to be able to incorporate lab testing into their practice.

They can still use health coaching skills and competencies with their patients or clients because, in most cases, the scope of practice of licensed providers (like MDs, NPs, PTs, RDs, etc.) doesn’t preclude them from using these skills along with whatever other activities their licensure enables them to perform.

Should Dietitians and Nutritionists Interpret Blood Tests?

As I mentioned above, registered dietitians (RDs) and certified nutrition professionals often have hundreds or thousands of hours of academic and clinical training in health and medical sciences. This qualifies them to interpret blood test results related to nutrition status.

According to the CDC: (4)

RDNs in clinical practice: Recommend, perform, and/or interpret test results related to nutrition status: blood pressure, anthropometrics (e.g., height and weight, skinfold thickness, waist circumference, calculation of body mass index with classification for malnutrition and obesity), indirect calorimetry, laboratory tests, and waived point-of-care laboratory testing (e.g., blood glucose and cholesterol).

This is also true in a Functional Medicine context. According to the American Dietetic Association: (5)

IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam and conventional laboratory data along with functional tests to assess the integrity of the metabolic networks and core imbalances that may be present.

Certified nutrition professionals with adequate training, such as certified nutrition specialists (CNSs), are also able to interpret blood tests. Section 3cii of the Examination Content Outline for Certified Nutrition Specialists states that a CNS should be able to “[i]nterpret laboratory data as it applies to nutrition-related conditions and systemic imbalances.” (6)

So, it’s clear to me that both RDs and certified nutrition professionals with adequate training should be able to interpret blood test results. This is why we have accepted both RDs and certified nutritional professionals in our ADAPT Practitioner Training Program since its inception in 2016.

What If You’re a Nutritionist without a Nationally or Conventionally Recognized Credential or License?

There are many different career paths and training options for nutritionists, and they can vary significantly in terms of the prerequisites, curriculum, practical supervision (e.g., internship, practicum, etc.), length of study, and other factors.

Moreover, the term “nutritionist” is not regulated or protected. This means that someone could take be self-taught, or take a short course in nutrition (say, 30 to 40 hours) and then refer to themselves as a nutritionist. In these cases, I believe that the individual wouldn’t have the necessary training in health and medical sciences to prepare them to interpret blood testing.

This leads to both ethical and safety concerns and legal and regulatory risk—just as it does with health coaches. A nutritionist without adequate academic and clinical education in health and medical sciences could harm a client if she does not interpret a blood test correctly, and if the client pursued legal action, it’s likely that the nutritionist would not be protected.

It is beyond the scope of this article to address the scope of practice of nutritionists that do not have a nationally or conventionally recognized license or credential. If you fall into this category, please refer to your educational institution or an organization like the National Association of Nutrition Professionals for more information.

Recognizing “Red Flags” and Risk Factors for Chronic Disease

As I mentioned above, although interpreting blood tests is not within the scope of practice of a health coach, the NBME suggests that a health coach should be able to recognize red flags and risk factors of chronic disease, including commonly used biometric tests (i.e., blood tests, blood pressure, etc.).

While I’m not aware of a general scope of practice that covers nutritionists without nationally recognized credentials or licenses, I think it’s also important that these providers are able to recognize red flags and risk factors and make referrals to appropriate healthcare professionals, at least in states that permit review of blood test results by unlicensed providers.

Again, there is significant risk here of the line between review and interpretation blurring, so caution is warranted.

What about Other Types of Lab Testing?

So far in this article, I have focused on the interpretation of blood testing. But what about the interpretation of other types of testing like the stool, saliva, and urine labs that are often used in a Functional or Integrative Medicine context?

This is more of a gray area from both a safety/ethics and legal/regulatory perspective. In general, I believe that registered dietitians and certified nutrition professionals should be able to interpret the results of these types of tests, provided they have been specifically trained in these Functional Medicine diagnostics.

The answer is much less clear in the case of health coaches and nutritionists that do not possess a nationally recognized credential or license, and/or have not had adequate training in health and medical sciences.

Using the results of a stool test from uBiome or a functional lab to make recommendations like eating more fiber or consuming probiotics is very different than interpreting the results of a comprehensive blood panel. The stakes are much higher with blood work, since the results can indicate serious and potentially life-threatening conditions like cancer, hemochromatosis, or Wilson disease.

At the same time, although saliva, stool, and urine testing don’t typically reveal serious conditions, some of the treatments that providers recommend based on these results can be dangerous when prescribed incorrectly.

For example, I know of one case from a few years back when an unlicensed health coach recommended a high dose of DHEA, a hormone, to a client based on the results of that client’s saliva hormone test. What the coach failed to recognize is that a high dose of DHEA could exacerbate the client’s preexisting Graves’ disease, a hyperthyroid condition. After taking the DHEA, the patient experienced tachycardia, palpitations, high blood pressure, and elevated body temperature and had to be taken to the emergency room.

The client hired an attorney and sued the health coach—and also the program that trained the coach to interpret the lab results and prescribe treatment based on them.

So, as you can see, the question of whether a health coach or non-credentialed or non-certified nutritionist should be able to order and interpret saliva, stool, and urine tests is nuanced and complex. In some cases, it may be fine provided that they have adequate training to interpret the specific test in question. In others, I see potential issues from both a safety/ethics and legal/regulatory perspective.

The legal and regulatory landscape is not well defined in the case of Functional Medicine diagnostics because it’s relatively new and until recently has not been on the radar of the organizations that are responsible for creating the laws and regulations that govern who can order and interpret laboratory testing.

I suspect we’ll see more developments in this area over the coming years. Until then, the safest approach is likely to apply the same principles that determine which healthcare providers can interpret blood tests to other Functional Medicine diagnostic tools like saliva, stool, and urine tests.

It Takes a Village to Reverse Chronic Disease

The fact that I don’t believe that health coaches and nutritionists without nationally-recognized credentials or training in health and medical sciences should interpret most lab test results does not in any way mean that I don’t value these vital health professionals.

I know of many skilled and competent nutritionists that are neither RDs nor certified nutritional professionals yet have helped hundreds of people transform their diet and lifestyle, reverse chronic disease, and dramatically improve their quality of life.

Likewise, I’m such a believer in the power of health coaching that I launched a 12-month health coach certification called the ADAPT Health Coach Training Program in 2018. Health coaches have a critical role to play in healthcare because they are working on the front lines to help people change their behavior—and that is arguably the single most important thing we can do to prevent and reverse chronic disease.

So, this article is not about creating a hierarchy in which the providers that can order and interpret lab testing and prescribe treatment are higher up and the providers that focus on behavior change and providing guidance on diet and nutrition are lower down.

That mentality is an artifact of the conventional medical paradigm that values information more than transformation, expertise more than support, and managing and suppressing symptoms more than changing diet, lifestyle, and behavior. It’s exactly the model that got us into this mess in the first place.

Instead, I am a passionate advocate for what I call a “collaborative practice model.” This model links many different providers—clinicians, nurses, dietitians and nutritionists, health coaches, physical therapists, counselors, psychologists, etc.—into an integrated care team that can provide the highest possible level of support to patients.

It recognizes the inherent and equal value of each type of provider and seeks to maximize his or her skill, training, and scope of practice in service of the patient. For example:

Medical doctors and other clinicians focus on the diagnosis and treatment of disease

Nutritionists and dietitians focus on creating individualized nutrition protocols

Health coaches focus on supporting people in implementing the protocols prescribed by nutritionists/dietitians and clinicians and in making successful and lasting behavior change

While each of these providers can have a major impact working independently, I believe that they are even more effective when working together in a collaborative fashion:

A doctor can prescribe a brilliant treatment protocol, but without a nutritionist or dietitian to customize the diet prescription and a health coach to help the patient to implement it, the chances of success are much lower.

A health coach can have a powerful impact on supporting people to make diet, lifestyle, and behavior changes, but if his client is struggling with a significant chronic health problem, working in collaboration with a clinician that can perform the full scope of lab testing and prescribe treatments will lead to better results.

A nutritionist or dietitian can create a perfectly tailored nutrition prescription for her client, with meal plans and recipes, but if the client doesn’t follow it, all of this work will be for naught. This is where a health coach can be so helpful.

It truly does take a village to address this growing problem of chronic disease. If you’re reading this, it means that you’re already playing a role—however big or small—in this healthcare revolution, and I am so grateful for your efforts!

As this article indicates, there are still many gray areas and quite a lot of confusion, even amongst legal and medical professionals that have closely studied these issues. What’s more, the landscape is changing quickly, as professions like health coaching and nutritionists become more common and better recognized.

I will continue to study this topic, consult with healthcare attorneys, and gather feedback from the professional community. I’ll update this article with any new, relevant information.

I’d love to hear your feedback, questions, or concerns in the comments.

The post Should Health Coaches and Nutritionists Interpret Lab Tests? appeared first on Chris Kresser.

Should Health Coaches and Nutritionists Interpret Lab Tests? published first on https://chriskresser.com

[shapesnnsizes]

Should Health Coaches and Nutritionists Interpret Lab Tests?

There are now a few companies that are offering this type of training to health coaches, and I suspect that we’re going to see more of them in the future. So, I wanted to take the opportunity in this article to share my position and explain the reasoning behind it.

But before I do that, I want to start by saying that everyone reading this article has a crucial role to play in reversing the chronic disease epidemic, whether you are a medical doctor, a chiropractor, a nutritionist or dietitian, a health coach, a personal trainer, or even what I’ve called a “citizen activist.”

The scale of the challenge we face is enormous, and we need to work together as a community of professionals and advocates to solve it. I spent at least a third of my recent book, Unconventional Medicine, making this argument, and I haven’t stopped believing it. In fact, I feel more strongly about it than ever.

Let’s begin by clarifying some of the roles that are relevant to this discussion because I think there is still a lot of confusion about them. Frankly, I didn’t fully understand the distinctions between these roles myself until just a few years ago.

Should health coaches interpret lab tests for their clients? What about nutritionists? Check out this article for my take on a contentious issue. #changeagent #functionalmedicine #chriskresser

We Need Both Health Coaches and Nutritionists/Dietitians—But They Are Not the Same

The terms “health coach,” “nutritionist,” and “dietitian” are often used interchangeably, but they are not the same.

What Is a Health Coach?

Health coaches are behavior change specialists. They support people in discovering their own strategies and motivation for change, overcoming obstacles, and implementing protocols that have either been prescribed by a clinician or nutritionist/dietitian or that the client has chosen to implement on their own.

This is a critical role since we know that over 85 percent of chronic disease is driven by our behavior and environment—not our genes—and that only 6 percent of Americans consistently engage in the top five health behaviors identified by the Centers for Disease Control: maintaining a healthy weight, not smoking, not drinking excessively, getting enough exercise, and getting enough sleep. (1, 2) (I would also add eating a healthy diet to this list.)

We desperately need properly trained health coaches because information is not enough to change behavior. If it were, 100 percent of Americans would engage in the top health behaviors all the time. Most people know that getting enough exercise and sleep, eating well, and avoiding smoking and drinking excessively are healthy behaviors. But as the statistics show, they still don’t do these things.

And this isn’t just true in the general population. Even in my own Functional Medicine practice with highly motivated patients, some people struggle to implement the changes I suggest. And I know from training thousands of healthcare professionals of all types that lack of compliance is an extremely common problem.

Health coaches fill a critical void in both conventional and Functional Medicine by offering more intensive, patient-centered care. When properly trained, they are skilled in evidence-based methods of supporting change, including:

Motivational interviewing, which helps people to discover their own motivation and strategies for change

Positive psychology, which teaches people to build on what’s working, rather than fixing what’s broken

Understanding the stages of change, which allows health coaches to offer the appropriate type of support at each stage of change

Habit formation and reversal, which supports people to create new, healthy habits and reverse unhealthy ones

Accountability and goal setting, which helps people to stay on track and achieve their goals

All of the knowledge and expertise in the world doesn’t matter unless someone can apply it in their own life. The support of a health coach can make the difference between success and failure in implementing long-term diet, lifestyle, and behavior changes. So, there’s no question in my mind that health coaches will play a crucial role in reversing the chronic disease epidemic. (For more on the importance of health coaches in combating chronic disease, see this article.)

All of that said, health coaches do not typically have training in health and medical sciences (unless they also have another healthcare license or credential). They don’t need this expertise to be successful in supporting behavior change, which is their primary purpose and role.

What Are Dietitians and Nutritionists?

Dietitians and nutritionists are different than health coaches. Whereas a health coach focuses on behavior change, dietitians and nutritionists are experts that assess, diagnose, and treat dietary and nutritional problems at both an individual and a wider public health level.

Generally speaking, the term “registered dietitian” (RD) is more tightly regulated than the term “nutritionist,” but this doesn’t necessarily mean that a dietitian has more training than a nutritionist.

For example, a certified nutrition specialist (CNS) is a highly qualified nutrition professional with both a bachelor’s and a graduate degree (master’s or doctorate) in nutrition, plus 1,000 hours of a supervised internship and a passing score on a rigorous exam.

Registered dietitians are also highly qualified. They have typically attended an accredited bachelor’s program as well as a 1,200-hour supervised internship, and they may have additional licenses or credentials in specific areas of study.

Both dietitians and certified nutrition professionals have had extensive training in health and medical sciences, such as:

Organic chemistry

Biochemistry

Anatomy

Physiology

Genetics

Microbiology

Pharmacology

Statistics

Nutrient metabolism

There are many different degrees, credentials, and qualifications within the nutrition field. Some are regulated and protected, and others are not. For this reason, the range of training that someone using the term “nutritionist” has had can vary wildly, from being self-taught, to a 40-hour course, to hundreds or even thousands of hours of academic and clinical education and experience.

It is beyond the scope of this article to explain all the different career paths that a nutrition professional might pursue, but if you’d like to learn more I’d suggest the following two resources:

Description of Nutrition Professional Degrees/Credentials on the American Nutrition Association website

What Is The Difference Between A Nutritionist And A Dietitian?

Should Health Coaches Interpret Blood Tests?

Let’s begin by discussing blood testing since it is the most common type of testing offered in medicine today.

I believe that health coaches should not interpret blood tests. By “interpret,” I mean “explain the meaning of” the results to the client, which gets very close to (and in some cases may be indistinguishable from) diagnosing a condition or disease.

There are two reasons for this:

Safety and ethics. Many health coaches have not had in-depth training in health and medical sciences that would prepare them to interpret blood work, unless they also hold another license or credential that included that training  (e.g., a nurse, dietitian, occupational therapist, etc.). If a health coach reads a blood panel and misses something important on the results and/or makes an unsuitable recommendation, the client could be harmed.

Legal and regulatory concerns. In many states, a health coach would be infringing on the scope of practice of other practitioners (including dietitians and medical doctors) by interpreting blood tests, and they might be subject to legal action.

It’s important to understand these two reasons separately because even when one does not apply, the other still does.

For example, in some states, the law does not explicitly prohibit a health coach from reviewing blood test results—which is different than interpreting them and making a diagnosis and treatment suggestions. (I’ll explain this distinction further below.) But that does not mean that it is safe or ethical for a health coach without adequate training to do it.

On the other hand, a health coach may have a background in health or medical sciences that would provide a foundation for understanding blood work, but without a credential or license that permits this, she would still be at legal risk.

What about Recognizing “Red Flags” on Blood Tests?

There is one caveat here. Although I don’t think that a health coach should interpret blood tests, I do think that they should be able to recognize “red flags” and risk factors for chronic disease and then make a referral to an appropriate healthcare professional.

The National Board of Medical Examiners (NBME) recently teamed up with the International Consortium of Health & Wellness Coaches (ICHWC) to create an internationally recognized credential for health coaches called the National Board Certified Health & Wellness Coach (NBC-HWC). Section 3 of the Health & Wellness Coach Certifying Exam Content Outline states: (3)

By definition, health and wellness coaches are not content experts in health or disease; they do not diagnose or prescribe, unless a coach has credentials in another profession that allow expert advice to be given. However, it is important for coaches to have a solid working familiarity of current evidence-based recommendations provided by public health groups such as the Centers for Disease Control and National Institutes of Health.

Relevant guidelines and recommendations fall in the areas of health promotion, disease prevention, and lifestyle medicine. The coach should be able to identify risk factors for chronic disease, commonly used biometric measures, and current lifestyle recommendations for optimizing health. An important focus for the coach is to recognize potential imminent danger and medical red flags and to know when and how to refer to another health care professional. [Emphasis added]

There is a crucial difference between interpreting a blood test result and making a diagnosis and treatment recommendations (including nutrition and diet suggestions) based on the result, and recognizing a potential red flag and referring to medical professional for further investigation.

Reviewing lab test results that relate to nutrition or nutrient levels could be considered nutrition education, which health coaches are permitted to do in some states. However, interpreting blood tests and making diagnoses and treatment recommendations would be considered the practice of medicine in all states and is explicitly prohibited.

This distinction is well recognized in other healthcare professions. For example, a nurse working in a hospital might notice and report signs and symptoms of redness, pain, and swelling at an incisional site but would not diagnose an infection or prescribe treatment for it. Instead, she would bring the issue to the attention of a physician, who could then diagnose and treat the problem.

While “reviewing” lab tests to recognize red flags and risk factors and “interpreting” them to diagnose and treat disease are not the same thing, they are often confused and and there’s a fine line between them that health coaches could easily cross.

This is why we train our ADAPT health coaches to avoid interpretation of lab tests entirely, and take a conservative approach to reviewing them if they live in a state that might permit it. If they live in a state that doesn’t, they must avoid even reviewing lab test results.

A Caveat: Health Coaches with Other Licenses or Credentials

Some certified health coaches also have licenses or credentials in other healthcare fields. For example, we have several licensed professionals in our ADAPT Health Coach Training Program, including medical doctors, physical and occupational therapists, and registered dietitians.

In these cases, the health coach does have the training and credentials that would allow them to interpret blood tests. However, most attorneys that I’ve consulted have advised that health coaches that have a license should only interpret labs if they are clearly operating under the scope of practice of their license.

Let’s say you’re a nurse practitioner (NP) and a health coach. If you advertise yourself as a nurse practitioner (that may also incorporate health coaching) and you onboard your patient using the same methods that you would use for any of your patients, you may interpret labs and do all of the other things that your scope of practice as an NP allows you to do.

However, if you advertise yourself as a health coach and onboard the client with only that understanding, then you should operate within the scope of practice of a health coach—not a nurse practitioner.

For this reason, in our ADAPT program we recommend that “dual professionals”—health coaches that are also licensed healthcare providers—advertise and operate within the scope of practice of their licensed profession if they want to be able to incorporate lab testing into their practice.

They can still use health coaching skills and competencies with their patients or clients because, in most cases, the scope of practice of licensed providers (like MDs, NPs, PTs, RDs, etc.) doesn’t preclude them from using these skills along with whatever other activities their licensure enables them to perform.

Should Dietitians and Nutritionists Interpret Blood Tests?

As I mentioned above, registered dietitians (RDs) and certified nutrition professionals often have hundreds or thousands of hours of academic and clinical training in health and medical sciences. This qualifies them to interpret blood test results related to nutrition status.

According to the CDC: (4)

RDNs in clinical practice: Recommend, perform, and/or interpret test results related to nutrition status: blood pressure, anthropometrics (e.g., height and weight, skinfold thickness, waist circumference, calculation of body mass index with classification for malnutrition and obesity), indirect calorimetry, laboratory tests, and waived point-of-care laboratory testing (e.g., blood glucose and cholesterol).

This is also true in a Functional Medicine context. According to the American Dietetic Association: (5)

IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam and conventional laboratory data along with functional tests to assess the integrity of the metabolic networks and core imbalances that may be present.

Certified nutrition professionals with adequate training, such as certified nutrition specialists (CNSs), are also able to interpret blood tests. Section 3cii of the Examination Content Outline for Certified Nutrition Specialists states that a CNS should be able to “[i]nterpret laboratory data as it applies to nutrition-related conditions and systemic imbalances.” (6)

So, it’s clear to me that both RDs and certified nutrition professionals with adequate training should be able to interpret blood test results. This is why we have accepted both RDs and certified nutritional professionals in our ADAPT Practitioner Training Program since its inception in 2016.

What If You’re a Nutritionist without a Nationally or Conventionally Recognized Credential or License?

There are many different career paths and training options for nutritionists, and they can vary significantly in terms of the prerequisites, curriculum, practical supervision (e.g., internship, practicum, etc.), length of study, and other factors.

Moreover, the term “nutritionist” is not regulated or protected. This means that someone could take be self-taught, or take a short course in nutrition (say, 30 to 40 hours) and then refer to themselves as a nutritionist. In these cases, I believe that the individual wouldn’t have the necessary training in health and medical sciences to prepare them to interpret blood testing.

This leads to both ethical and safety concerns and legal and regulatory risk—just as it does with health coaches. A nutritionist without adequate academic and clinical education in health and medical sciences could harm a client if she does not interpret a blood test correctly, and if the client pursued legal action, it’s likely that the nutritionist would not be protected.

It is beyond the scope of this article to address the scope of practice of nutritionists that do not have a nationally or conventionally recognized license or credential. If you fall into this category, please refer to your educational institution or an organization like the National Association of Nutrition Professionals for more information.

Recognizing “Red Flags” and Risk Factors for Chronic Disease

As I mentioned above, although interpreting blood tests is not within the scope of practice of a health coach, the NBME suggests that a health coach should be able to recognize red flags and risk factors of chronic disease, including commonly used biometric tests (i.e., blood tests, blood pressure, etc.).

While I’m not aware of a general scope of practice that covers nutritionists without nationally recognized credentials or licenses, I think it’s also important that these providers are able to recognize red flags and risk factors and make referrals to appropriate healthcare professionals, at least in states that permit review of blood test results by unlicensed providers.

Again, there is significant risk here of the line between review and interpretation blurring, so caution is warranted.

What about Other Types of Lab Testing?

So far in this article, I have focused on the interpretation of blood testing. But what about the interpretation of other types of testing like the stool, saliva, and urine labs that are often used in a Functional or Integrative Medicine context?

This is more of a gray area from both a safety/ethics and legal/regulatory perspective. In general, I believe that registered dietitians and certified nutrition professionals should be able to interpret the results of these types of tests, provided they have been specifically trained in these Functional Medicine diagnostics.

The answer is much less clear in the case of health coaches and nutritionists that do not possess a nationally recognized credential or license, and/or have not had adequate training in health and medical sciences.

Using the results of a stool test from uBiome or a functional lab to make recommendations like eating more fiber or consuming probiotics is very different than interpreting the results of a comprehensive blood panel. The stakes are much higher with blood work, since the results can indicate serious and potentially life-threatening conditions like cancer, hemochromatosis, or Wilson disease.

At the same time, although saliva, stool, and urine testing don’t typically reveal serious conditions, some of the treatments that providers recommend based on these results can be dangerous when prescribed incorrectly.

For example, I know of one case from a few years back when an unlicensed health coach recommended a high dose of DHEA, a hormone, to a client based on the results of that client’s saliva hormone test. What the coach failed to recognize is that a high dose of DHEA could exacerbate the client’s preexisting Graves’ disease, a hyperthyroid condition. After taking the DHEA, the patient experienced tachycardia, palpitations, high blood pressure, and elevated body temperature and had to be taken to the emergency room.

The client hired an attorney and sued the health coach—and also the program that trained the coach to interpret the lab results and prescribe treatment based on them.

So, as you can see, the question of whether a health coach or non-credentialed or non-certified nutritionist should be able to order and interpret saliva, stool, and urine tests is nuanced and complex. In some cases, it may be fine provided that they have adequate training to interpret the specific test in question. In others, I see potential issues from both a safety/ethics and legal/regulatory perspective.

The legal and regulatory landscape is not well defined in the case of Functional Medicine diagnostics because it’s relatively new and until recently has not been on the radar of the organizations that are responsible for creating the laws and regulations that govern who can order and interpret laboratory testing.

I suspect we’ll see more developments in this area over the coming years. Until then, the safest approach is likely to apply the same principles that determine which healthcare providers can interpret blood tests to other Functional Medicine diagnostic tools like saliva, stool, and urine tests.

It Takes a Village to Reverse Chronic Disease

The fact that I don’t believe that health coaches and nutritionists without nationally-recognized credentials or training in health and medical sciences should interpret most lab test results does not in any way mean that I don’t value these vital health professionals.

I know of many skilled and competent nutritionists that are neither RDs nor certified nutritional professionals yet have helped hundreds of people transform their diet and lifestyle, reverse chronic disease, and dramatically improve their quality of life.

Likewise, I’m such a believer in the power of health coaching that I launched a 12-month health coach certification called the ADAPT Health Coach Training Program in 2018. Health coaches have a critical role to play in healthcare because they are working on the front lines to help people change their behavior—and that is arguably the single most important thing we can do to prevent and reverse chronic disease.

So, this article is not about creating a hierarchy in which the providers that can order and interpret lab testing and prescribe treatment are higher up and the providers that focus on behavior change and providing guidance on diet and nutrition are lower down.

That mentality is an artifact of the conventional medical paradigm that values information more than transformation, expertise more than support, and managing and suppressing symptoms more than changing diet, lifestyle, and behavior. It’s exactly the model that got us into this mess in the first place.

Instead, I am a passionate advocate for what I call a “collaborative practice model.” This model links many different providers—clinicians, nurses, dietitians and nutritionists, health coaches, physical therapists, counselors, psychologists, etc.—into an integrated care team that can provide the highest possible level of support to patients.

It recognizes the inherent and equal value of each type of provider and seeks to maximize his or her skill, training, and scope of practice in service of the patient. For example:

Medical doctors and other clinicians focus on the diagnosis and treatment of disease

Nutritionists and dietitians focus on creating individualized nutrition protocols

Health coaches focus on supporting people in implementing the protocols prescribed by nutritionists/dietitians and clinicians and in making successful and lasting behavior change

While each of these providers can have a major impact working independently, I believe that they are even more effective when working together in a collaborative fashion:

A doctor can prescribe a brilliant treatment protocol, but without a nutritionist or dietitian to customize the diet prescription and a health coach to help the patient to implement it, the chances of success are much lower.

A health coach can have a powerful impact on supporting people to make diet, lifestyle, and behavior changes, but if his client is struggling with a significant chronic health problem, working in collaboration with a clinician that can perform the full scope of lab testing and prescribe treatments will lead to better results.

A nutritionist or dietitian can create a perfectly tailored nutrition prescription for her client, with meal plans and recipes, but if the client doesn’t follow it, all of this work will be for naught. This is where a health coach can be so helpful.

It truly does take a village to address this growing problem of chronic disease. If you’re reading this, it means that you’re already playing a role—however big or small—in this healthcare revolution, and I am so grateful for your efforts!

As this article indicates, there are still many gray areas and quite a lot of confusion, even amongst legal and medical professionals that have closely studied these issues. What’s more, the landscape is changing quickly, as professions like health coaching and nutritionists become more common and better recognized.

I will continue to study this topic, consult with healthcare attorneys, and gather feedback from the professional community. I’ll update this article with any new, relevant information.

I’d love to hear your feedback, questions, or concerns in the comments.

The post Should Health Coaches and Nutritionists Interpret Lab Tests? appeared first on Chris Kresser.

[stellatateblog]

HWC’s First DNP Run

Who knows, it could be my only one. We will see.

Today is actually day #2. Woke up at 242.6lbs.

Yesterday I felt mostly normal aside from some slight lethargy. Around 9pm I started getting unusually hot, was sweating in my living room wearing shorts and a tshirt on the couch. Kind of knew what was coming so I went to Walmart and bought a floor fan to use along with the ceiling fan. Slept very heavy, no issues there and thankfully was not soaked in sweat when I got up.

Took my second dose today and feel normal so far. I have been drinking a ton of water and keeping cals around 2100 or so. I’m planning on running it for two weeks at 200mg’s to see what kind of loss I can get, if things are fine at 200 I may bump up to 400 but I’m really in no rush at the moment, just feeling things out.

HWC’s First DNP Run syndicated from https://ugbodybuildingblog.wordpress.com/

[thunderlinkcom]

RSP card of second frame of ONU was not showing clock after change of Optical SCB card of SDH, but subscribers still working

Issue Description

When another SCB card was installed from a different site, as the previous one got faulty, first frame was showing itself on Huawei OLT 

but the second frame was showing all the cards failed, but the subscribers were working on it.

Alarm Information

All cards of frame 2 , showing failed alarm on OLT, but subscribers were working on them.

Handling Process

In the network H303RSP card is installed. The Dip switch SG1 was set to 0000 which shows the equipment is in Normal operation in Remote working mode, i switched the dip switch No. 2 on, it means " Normal Operation in quasi local working mode. CLK showed on the card, which means it's visible by Huawei OLT (Huawei MA5683T), customer confirmed that now he can get display of second frame of the ONU. I then turned the dip switch back to 0000. and clock remained

Root Cause

I checked the Dip switches of the RSP card, they were set to all zero, and the HWC card and cable by which a RSP card communicates with the equipment of upper layer.

Suggestions

When Install a New SCB card, turn RSP card dip switch No 2 active, so that after the service creations on the optical scb card the E1 drops on PV4 card and then lower rack displays it with the help of RSP card.

More configuration of MA5680T:

Huawei MA5680T GPON OLT equipped with 2*GICF 1*GPBD

Huawei MA5680T GPON OLT equipped with  1*GICF 1*X2CS 3*GPFD

Huawei MA5680T GPON OLT equipped with  2*X2CS 8*GPFD

More related:

The FCS error caused by network cable when do the ONT DEMO

Implementation of TR069 protocol in MA5600 series

Application of Time-range In HUAWEI MA5600 Series Equipment