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 . 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 .
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" formâ€”for the patient to signâ€”which stated: "I am fully aware that these dietary and/or nutritional recommendations are experimental and medically unproven." .
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.
The Nutrabalance setup was similar to [../hair.html 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 laboratoriesâ€”MetPath, National Health Laboratories, and Roche Biomedical Laboratoriesâ€”to designate a "Nutrabalance Profile" so that practitioners could order reports that combined the blood and urine tests results.
In 1985, an undercover investigator who enjoyed excellent health 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," which was untrue. The recommended supplementsâ€”which practitioners typically sell in their offices at a 50% to 100% markupâ€”would have cost several dollars a day.
The metabolic types did 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" or "optimal" range which ensures that some normal lab values will be classified as abnormal.
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." 
In 1985, during a telephone call, 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 . In the 1960s, Kelley developed a program for cancer patients that involved dietary measures, vitamin and enzyme supplements, and computerized "metabolic typing." He claimed that his "Protein Metabolism Evaluation Index" could diagnose cancer before it was clinically apparent and that his "Kelley Malignancy Index could detect "the presence or absence of cancer, the growth rate of the tumor, the location of the tumor mass, prognosis of the treatment, age of the tumor and the regulation of medication for treatment." None of these claims were valid.
In 1970, Kelley was convicted of practicing medicine without a license after witnesses testified that he had diagnosed lung cancer based on blood from a patient's finger and had prescribed dietary supplements, enzymes, and a diet as treatment. In 1976, following court appeals, his dental license was suspended for five years . He didn't practice dentistry again, but he continued to promote his offbeat methods until the mid-1980s through his Dallas-based International Health Institute. Under the institute's umbrella, licensed professionals and "certified metabolic technicians" throughout the United States would administer a 3,200-item questionnaire and send the answers to Dallas. The resultant computer printout provided a lengthy report on "metabolic status" plus detailed instructions covering foods, supplements (typically 100 to 200 pills per day), "detoxification" techniques, and lifestyle changes. Montante became a "Certified Kelley Physician" in 1980 .
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." 
Between 1989 and 1999, I encountered no ads for Nutrabalance services or seminars. In 1999, however, I noticed that Total Health Enterprises was still in business and maintained a Nutrabalance Web site, which indicated that Nutrabalance recommendations were based on data from blood, hair, urine, saliva, and a symptom survey. The reports were longer (20 -50 pages) and contained recommendations for dietary, lifestyle, and recommendations for supplement products from any of 14 manufacturers. The analyses could still be ordered through the company, but practitioners could also buy the software to generate the reports in their offices. A schedule on the Web site listed nine meetings at which the company would exhibit its software. The 1999 meetings included 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.
From about 2006 through 2008, the Nutrabalance Web site was set up so patients could fill out symptom questionnaires online. To access the test, the patient selected the doctor's name from a drop-down list and clicked "enter." During this period, the list contained 42 names, about half of whom were chiropractors. In 2009, I revisited the Nutrabalance Web site and found that the test process looked the same as it did in 1999.
In 1992, the Colorado State Board of Medical Examiners reviewed Montante's care of seven patients and concluded that he had failed to perform and/or document adequate physical examinations and did not adequately document his assessments or treatment plans. The board placed Montante on probation for five years, during which he would be required to have another physician monitor patient charts to ensure that he was practicing medicine according to accepted standards . In 1995, the board amended its order to reduce the number of chart reviews but ordered the practice monitor to comment on whether or not the Nutrabalance reports "constitute a potential threat to patients in that disease or illness may be missed." Montante was also required to notify patients that he "specializes in nutritional consultations and does not provide primary medical care for other medical problems." 
The Bottom Line
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. Nutrabalance reports are filled with nonsense and recommend useless products that can cost thousands of dollars per year. If you encounter a practitioner who uses the Nutrabalance system, please ask the state licensing board to investigate and e-mail a copy of your complaint to me.
- 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.
- 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.
- Montante JR. Telephone conversation with Dr. Stephen Barrett, April 3, 1985.
- Dentist directed McQueen therapy. ADA News, Nov 17, 1980.
- Joseph Montante, M.D. Biographical sketch in flyer for Cancer Control Society convention, 2002.
- Young A. Nutrabalance: A unique advantage for your practice. Nutrition Breakthrough 1:3, July-Sept 1986.
- Stipulation and final order. In the matter of the disciplinary proceeding regarding the license to practice medicine in the State of Colorado of Joseph R. Montante, M.D. August 21, 1992.
- Amendment to the stipulation and order dated August 21, 1992. In the matter of the disciplinary proceeding regarding the license to practice medicine in the State of Colorado of Joseph R. Montante, M.D. August 24, 1995.