How care works
What working with a precision dietitian is really like
Working with a precision dietitian means a first visit built around listening, a close look at your history and labs, and a written plan of clear, simple steps that is adjusted at follow-up visits. It is personal, gradual and coordinated with your doctor, not a standard meal plan or a quick fix.
Clinically reviewed by Dr. Ambily Kushal, RD, MS, PhD · Published · Last reviewed
What does “precision nutrition” actually mean?
Precision nutrition means food advice fitted to you, using your history, lab results, preferences and goals instead of a standard plan. It describes a way of working, and it promises no particular result.
Dr. Ambily Kushal, RD, MS, PhD, has more than 19 years in clinical practice, research and teaching. She is a registered dietitian who works in a functional-medicine-informed way, which means looking for contributors such as insulin resistance, inflammation, gut function, nutrient levels and hormones, then using food and habits to address them.
Where it adds value, she also uses nutrigenomics, the study of how genes and nutrition interact. The Academy of Nutrition and Dietetics’ 2014 position paper calls it a developing field. Here it is a possible tool, not the center of care, and we make no claim that a genetic result will change what you should eat.
She is a dietitian, not a physician. She does not diagnose conditions or prescribe, change or stop medicine. Those stay with your doctor.
What happens at the first visit?
The first visit is mostly listening. You tell your story, your dietitian asks about your history and daily life, and you leave knowing the next steps.
It is a 60-minute video session. One patient wrote after a first visit that Dr. Ambily took the time to get to know them and explained next steps, which is a fair summary of the goal.
A full history
Expect questions about your symptoms and their timeline, medical and family history, medications, sleep, stress, digestion and a typical day of eating. None of it is a test. It is how the plan gets matched to you.
Getting to know your lifestyle
Your work hours, who cooks, your cuisine, your budget and how much time you have in the kitchen all shape what is realistic. Plans that ignore these tend not to last.
Explaining the next steps
You agree the first practical steps before you log off, so you are not left with a long list or a vague promise.
How do labs and possible root causes fit in?
Existing lab results are read in plain language and used to shape the advice. Questions and labs together point to possible root causes that food and habits can address.
Dr. Ambily looks at the lab results you already have. Your doctor orders the tests and makes the diagnosis. The dietitian’s job is to explain what the numbers might mean for your eating and to point out what is worth discussing with your doctor. Medical tests help detect conditions and support a diagnosis, which is why they sit with your doctor.
One patient used the phrase “possible root causes.” It is worded carefully because these are leads, not verdicts. Insulin resistance, gut function, inflammation, nutrient levels or hormones might be contributing to how you feel. Careful questions and your labs help decide which leads are worth following first.
- Bring recent labs and a list of your medications if you can.
- If something looks like it needs medical attention, you are told to take it to your doctor.
- Nothing is assumed from a single number.
What does the written action plan look like?
It is a short plan of clear, simple steps in order of priority, written so you can act on it the next day. The aim is a few changes that fit your life, not an overhaul.
One patient describes being given the main points to work on, and another describes instructions that are clear, simple and actionable. A plan like that usually names the first two or three changes, not twenty.
Her approach includes personalized macros and whole-food meal planning around your cuisine, budget and cooking time. Where habits are the sticking point, she uses behavior-change methods such as motivational interviewing and cognitive behavioral techniques, which means working with your reasons and obstacles instead of handing you rules.
- Priorities in order, so you know what to do first.
- Food ideas from your own cuisine.
- What to track, if anything, and when to check back in.
Will you be handed a long list of extras?
No, because a supplement is suggested only when your history or labs support it, and your dietitian says so when food is the better answer. Any supplement question is one to settle with your dietitian and your doctor.
One patient put it this way: the dietitian did not bombard them with supplements, and followed an iterative approach instead. Iterative means you change one or two things, see how you respond, then decide the next step.
That pace also protects you. Many people take several medicines at once, and the FDA advises talking with your doctor or pharmacist before using a supplement. A dietitian who coordinates with your doctor keeps the whole picture in view.
What happens at follow-up visits?
You review what worked and what did not, look at new labs or symptoms, and adjust the plan. It changes as your numbers, symptoms and energy change.
Follow-up is where the plan becomes yours. You report what happened, whether it was a good week or a hard one, and the next steps respond to it. One patient in ongoing care credited follow-up visits where Dr. Ambily listens and adjusts the plan.
One patient in ongoing care also mentions learning something new at each appointment, and that learning is part of what keeps people going.
What happens when you slip?
You talk about it, work out what got in the way, and adjust the plan. A slip is information, not a failure.
Every plan meets a holiday, a stressful month, an illness or a week of travel. One patient wrote that even after a slip, they were not made to feel it was the end of the world. That tone matters, because shame makes people hide the truth from the person trying to help.
Her methods include motivational interviewing and intuitive eating principles, along with attention to sleep and the mind-body connection. If eating is driven by stress or a difficult relationship with food, that is treated as part of the picture. If you live with an eating disorder, you also need a specialist eating-disorder team.
Will you learn how food works with your body?
That is a core goal. You should understand why you are eating the way you are, so you can make good choices without being told what to do each time.
One patient describes having the science broken down and now understanding how one thing affects the other. That is the long-term payoff of a personalized approach: you get better at reading your own body and your own labs.
It is also why the work is not a quick fix. A plan you understand is a plan you can adapt when life changes.
Who is this kind of care for, and who should see a doctor first?
It suits adults with chronic metabolic or digestive conditions who want a plan built on their own labs and history. Some needs call for a doctor or another specialist first.
A good fit if you
- Live with diabetes, prediabetes, high blood pressure or cholesterol, fatty liver, PCOS or a thyroid condition
- Have IBS, SIBO, reflux, IBD or celiac disease and want a structured approach
- Take a GLP-1 medicine and want nutrition support alongside it
- Want to understand your lab results and what to do about them
See a doctor or specialist first if you
- Have a medical emergency: call 911 or go to the nearest emergency room
- Need a diagnosis, a prescription or a medicine change: that is for your doctor
- Have blood in the stool, black stools, unintended weight loss, trouble swallowing, persistent vomiting or fever
- Are living with an eating disorder: you need a specialist eating-disorder team
How do you start?
Book a 60-minute video first visit for $140, paid by card.
It is self-pay and not billed to insurance. In most states no referral is needed to book a $140 self-pay first visit. In California, medical nutrition therapy from a registered dietitian is provided on a referral from the patient’s physician (Business and Professions Code §2586).
Dr. Ambily sees patients by secure video from Seattle, Washington, and you need to be located in one of the states she serves at the time of each visit. Before the visit, gather recent labs, a list of your medications and a note about what you most want help with.
If you prefer ongoing support, The Personalized Care Plan is $600 a month (30 days): four 60-minute video sessions, one a week, a personal nutrition plan adjusted week by week, and chat and call support between sessions.
Not sure whether this fits? A first visit is a chance to see how she works before you commit to more.
What patients say about this kind of care
One patient wrote after a first visit that the dietitian took the time to get to know them and explained next steps.
“She took the time to get to know me and explained next steps.”
One patient said the dietitian listened to all their concerns, then discussed the main points to work on.
“She listened to all my concerns, then discussed the main points to improve my overall health that would help with weight loss.”
One patient described a dietitian asking strategic questions to get to the possible root causes.
“She was very strategic, asking questions to get to the possible root causes”
One patient with long-standing symptoms contrasts a dietitian's step-by-step approach with being given many supplements at once.
“She did not bombard me with supplements … but rather followed an iterative approach.”
One patient, after 18 sessions, wrote that a slip is not treated as the end of the world.
“even when I slip, she doesn't make me feel like it's the end of the world.”
One patient in ongoing care said each appointment teaches them something new.
“She's very knowledgeable and teaches me something new every appointment.”
One patient valued clear advice and resources based on science, tailored to their needs and progress.
“Dr. Ambily provides clear advice and resources based on science. She tailored her guidance based on my needs and progress.”
Excerpts from patient reviews of Dr. Ambily Kushal, quoted word for word. Each describes one person’s care; individual experiences vary and are not a promise of results.
Frequently asked questions
Is a precision dietitian a medical doctor?
No. Dr. Ambily Kushal holds RD, MS and PhD credentials and is a registered dietitian, not a physician. She does not diagnose conditions or prescribe, change or stop medicine, and she coordinates with your care team.
What should I bring to the first visit?
Recent lab results, a list of your medications, and a short note on your symptoms and goals. Mention any condition your doctor is treating so the plan fits your wider care.
Will my dietitian push supplements?
Not as a rule. Your dietitian suggests a supplement only when your history or labs support it, and says so when food is the better answer. Any supplement is a question to settle with your dietitian and your doctor.
What if I cannot follow the plan one week?
Tell your dietitian. A slip is useful information about what got in the way, and the plan is adjusted around it.
Is genetic testing part of the care?
Dr. Ambily uses nutrigenomics only where it adds value. It is not required, and no genetic result is a promise of how you will respond.
Do I need a referral to book?
In most states no referral is needed to book a $140 self-pay first visit. In California, medical nutrition therapy from a registered dietitian is provided on a referral from the patient’s physician (Business and Professions Code §2586).
Sources
- Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (Diabetes Care (American Diabetes Association), 2019)
- Position of the Academy of Nutrition and Dietetics: nutritional genomics (Journal of the Academy of Nutrition and Dietetics (PubMed))
- Information for Consumers on Using Dietary Supplements (U.S. Food and Drug Administration)
- Medical Tests (MedlinePlus, National Library of Medicine)
- Healthy Living with Diabetes (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK))
Related reading
- Why a dietitian should read your labs
- Functional nutrition dietitian
- Your first visit
- Dietitians and supplements
- Articles
Our condition guides are general education, not medical advice. Talk with your doctor about your own diagnosis, tests and medicines.