Nutrabalance Is a Gimmick
to Sell Supplements
Stephen Barrett, M.D.
In 1984, Joseph R. Montante, M.D., and Mark D. Shusterman, M.D., of Boulder, Colorado, doing business as Total Health Enterprises, Inc., launched a computerized program called Nutrabalance [1]. The program was promoted through seminars and ads and was targeted to physicians, dentists, "nutritionists," chiropractors, and naturopaths. One ad in a chiropractic journal stated:
Would you believe us if we told you we had a comprehensive nutritional program that would improve your patient care and your profitability? Well, we do. . . .
Nutrabalance is a scientifically and clinically based nutritional analysis program that uses high-tech computerized accuracy to create a balanced, individualized nutritional regimen specifically tailored to match the unique health care needs of your patients. . . .
Because Nutrabalance is comprehensive your recommendations can be efficiently targeted to the underlying source of your patients' problems and not just their symptoms.
A Nutrabalance flyer added:
Using blood and urine test results, which are processed through our Computer Center, Nutrabalance develops a complete nutritional profile for your patients.
Each profile includes an in-depth evaluation and discussion of any physiologic imbalances your patient may have and comprehensive nutritional recommendations geared towards correcting these imbalances. The Nutrabalance system uses a unique classification system based on glandular/organ function which permits dramatically improved specificity in defining your patient's condition. [2]
The evaluation was based on the results of a blood chemistry profile and a urinalysis performed at a legitimate laboratory and submitted to Nutrabalance for interpretation. Nutrabalance then issued a lengthy computerized report which classified the patient according to 14 "metabolic types," listed supposed health problem areas, and recommended dietary changes and food supplements from one of four manufacturer chosen by the patient's doctor. The metabolic types were called "hypothalamus," "pineal," "anterior pituitary," "posterior pituitary," "thyroid," "adrenal," "gonadal," "parathyroid," "pancreas," "gastrointestinal," "liver/spleen," "immune," "high gear," and "low gear." A 95-page manual, which cost $50, listed about 25 types of problems allegedly associated for the first 12 of these types. (Lists were not given for "high gear" and "low gear," because they were "composites" of several other types. The manual also contained an "informed consent" form—for the patient to sign—which stated: "I am fully aware that these dietary and/or nutritional recommendations are experimental and medically unproven." [3].
Doctors who wished to use the company's services were also required to sign a consent form:
I understand that the Nutrabalance recommendations made by Total Health Enterprises, Inc., are meant to be solely educational to the patient, informational to me as the health care practitioner, and are not meant to diagnose or treat disease. I also understand that these recommendations are not designed to take the place of traditional methods of medical treatment. As the health care practitioner using these recommendations, I further consent that no guarantee has been offered in terms of a cure or the outcome from their use in the treatment of any patient.
The Nutrabalance manual also included a "Medical History" and "Preventive History" questionnaires that asked about diet, other lifestyle factors, environmental factors, past and present medical conditions, and various symptoms. However, they also included such nonstandard items as: (a) how long you were breast fed; (b) whether fluorescent lighting "creates stress for you"; and whether you feel "most affected" by: sunshine, lack of sunshine, dampness, high humidity, cold, heat, new moon, full moon, spring, summer, fall, or winter. As far as I can tell, the manual does not indicate how the answers to these questions are useful for formulating a treatment plan.
Expensive Nonsense
The Nutrabalance setup was similar to hair analysis schemes except that, unlike the hair tests, the blood and urine tests were legitimate. In fact, Nutrabalance arranged for three of the nation's largest medical laboratories—MetPath, National Health Laboratories, and Roche Biomedical Laboratories—to designate a "Nutrabalance Profile" so that practitioners could order reports that commbined the blood and urine tests results. The metabolic types do not correspond to anything known to medical science, and the supplement recommendations were nutritionally senseless. The interpretation of the tests was also improper. Medical laboratories list a normal "clinical range" for each laboratory value. Nutrabalance used a narrower "physiologic range," which meant that some normal lab values would be classified as abnormal.
In 1985, an undercover investigator sent two sets of blood and urine test results to Nutrabalance for interpretation. The blood test values were almost identical, but the investigator drank two glasses of water between urine specimens, which made their pH (acidity) and specific gravity differ. The first report classified the "patient" as: "Primary Type: Adrenal, Secondary Type: Posterior Pituitary, Acid/Alkaline Condition: Acid" and recommended an "acid food plan" plus 13 supplement pills per day. The second report classified the patient as: "Primary Type: Adrenal, Secondary Type: Liver Spleen, Acid/Alkaline Condition: Balanced" and recommended a "balanced food plan" plus 10 supplement pills per day. Both reports claimed that the patient had many glandular "imbalances." The recommended supplements—which practitioners typically sell in their offices at a 50% to 100% markup—would have cost several dollars a day.
The recommended treatment also included two weeks of daily "cleansing enemas," which the Nutrabalance Manual said were needed to "detoxify the patient" and to remove "encrusted wastes accumulated along the walls of the colon." The enemas, which were to contain coffee or licorice powder, were to be administered through a tube inserted "8 to 12 inches into the rectum." [5]
In 1985, Montante told me that the company had about 400 clients and was processing about a thousand reports per month and that the program had been adapted from a metabolic-typing system developed by a dentist named William C. Kelley [4]. A 1986 company newsletter stated that Montante and Shusterman practiced "nutritional medicine and preventive health care" in Boulder and that over 90% of their patients participated in the Nutrabalance program as "a foundation in their therapeutic plan." [6]
1999 Update
During the past ten years, I have seen no ads for Nutrabalance services or seminars. Recently, however, I discovered that Total Health Enterprises is still in business and maintains a Nutrabalance Web site. The recommendations can now be based on data from blood, hair, urine, saliva, and a symptom survey. The reports are longer (20 -50 pages) and contain recommendations for dietary, lifestyle, and recommendations for supplement products from any of 14 manufacturers. The analyses can still be ordered through the company, but the software can be purchased so that pracitioners can generate the reports in their offices. A schedule on the Web site lists nine meetings at which the company would exhibit its software. The 1999 meetings include the American Academy of Environmental Medicine (physicians who practice clinical ecology), the American Osteopathic Association, the American Chiropractic Association, the American College of Advancement in Medicine (physicians who do chelation therapy), and the American Association of Anti-Aging Medicine.
I have not yet examined the details of Nutrabalance's current system. The bottom line, however, is that no computerized analysis based on blood chemistry profiles, hair analysis, urinalysis, saliva tests, or a symptom questionnaire can provide a legitimate basis for identifying "metabolic types" or for making supplement recommendations.
If you encounter a practitioner who uses the Nutrabalance system, please ask the state licensing board to investigate and send a copy of your request to me at P.O. Box 1747, Allentown, PA 18105.
References
- Shusterman MD, Montante JR. The science and art of nutritional therapy: Vitamin and glandular supplements. The American Chiropractor, Aug 1984, pp 13-15.
- Shusterman MD, Montante JR. Put in the missing part of your practice. Flyer, undated, distributed in 1984.
- Montante JR, Shusterman MD. The Nutrabalance Manual: A Practical Guide to Implementing Nutrition in Your Practice. Boulder, CO: Total Health Enterprises, 1984.
- Montante JR. Telephone conversation with Dr. Stephen Barrett, April 3, 1985.
- Detoxification regimen for the Nutrabalance program. In Montante JR, Shusterman MD. The Nutrabalance Manual: A Practical Guide to Implementing Nutrition in Your Practice. Boulder, CO: Total Health Enterprises, 1984, pages 54-59.
- Young A. Nutrabalance: A unique advantage for your practice. Nutrition Breakthrough 1:3, July-Sept 1986.
This article was revised on June 2, 1999.