DEAR DR. BLONZ: I am researching distance-learning programs in nutrition. My goal is to get educated and then build my own practice, where I can offer individuals nutritional expertise and coaching to help them achieve optimal health, energy and a natural body weight specific to their body type. One place is an academy that is accredited and offers a particular type of diploma in comprehensive nutrition. Do you have any knowledge of schools that provide long-distance training in this profession? -- S.F., New York City

DEAR S.F.: I remain skeptical of distance-learning programs’ ability to provide the training needed to serve as an expert in nutrition, or in any area offering medical advice.

Learning how to provide health guidance is a multi-layered undertaking. Many questions need to be asked, and advice needs to be carefully tailored to each person. The individual’s physician often needs to be in the loop to ensure that medications, preexisting health conditions and other relevant factors are considered.

For example, registered dietitians are given theoretical and specialized training, in addition to their four-year college degrees. They often become part of a medical team working with patients and individuals in real-world situations, with instructors providing the requisite guidance. To retain their registered status, dietitians have to participate in continuing education, and many go on to receive additional graduate degrees.

Whatever you decide, be sure to check the instructors’ and administrators’ credentials at any prospective institution. Seek out those with graduate degrees from traditional brick-and-mortar universities, as well as experience in teaching and research. Their training must be in the areas they teach: Someone having a Ph.D. in the arts, for example, should not be portrayed as an expert or “doctor” in the sciences. Be skeptical of institutions where instructors are primarily graduates from that institution or other distance-learning organizations.

Next, consider what doors, if any, that diploma will open for you. These are undergraduate degrees and may only cover basic concepts. Please don’t get me wrong: It is absolutely essential to understand basic concepts. But the complexities of individuals’ problem situations are what lead them to seek expert advice. The key is to keep learning, and build on that foundational knowledge with experience and expert guidance from appropriately trained instructors.

When I lecture, I often state that most people know more about an automobile or major appliance they’re considering purchasing than they do about things relating to their own bodies, health and well-being. The body is a complex interaction of genetics and life experiences. Diet and lifestyle are important players, but much has to be considered when making recommendations to others. Granted, you don’t need a Ph.D. to decide what to have for dinner, but there is a difference between foods as sustenance and the use of foods and dietary supplements to treat or help prevent a particular problem. Those who would come to you for professional advice will be operating under the assumption that you understand their particular “big picture.”

One of the most important concepts is to appreciate your knowledge’s limits -- that is, to recognize when a particular problem is beyond your training. It is perhaps more important to know what you don’t know, than what you do. Professionals must grapple with this all the time.

I wish you the best, and hope that you can find a program that will move you along the road you seek.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: You often mention the benefits of eating fish like salmon or sardines, which are high in omega-3 fats. But does this recommendation hold if you are on anticoagulants? I have deep vein thrombosis, and have been taking Coumadin. As part of my treatment, I go in regularly to measure my “bleeding time.”

I cook and eat fish periodically, and have taken a fish oil supplement for many years. But during a recent call with friends, they warned me that it could be dangerous, and that I should avoid all omega-3 fats from fish or supplements. Since I know these are essential nutrients, what do you advise? -- S.P., Chicago, Illinois

DEAR S.P.: Bottom line up top: If you are taking an anticoagulant such as Coumadin, you need to take care when making changes to your habitual intake of omega-3 fats. That does not mean you should stop or avoid them; the key is to be careful when making changes to your routine intake -- whether increasing or decreasing. Let me explain.

The omega-3 fats at issue include EPA and DHA (eicosapentaenoic acid and docosahexaenoic acid, respectively), which are found in fish and other seafood. These have a shorter cousin, ALA (alpha-linolenic acid), which is found in plants. The body has metabolic pathways that turn ALA into EPA and DHA, but it’s not an efficient process. Most omega-3s of plant origin get used or stored for energy, with only a small fraction being converted into EPA or DHA.

The significance here is that bleeding time -- the tendency and time for one’s blood to clot -- can be affected by significant changes in the level of omega-3s in the body. This includes making additions or reductions in the levels consumed regularly. While these omega-3 fats are essential nutrients for all of us, there is a need to be aware of potential interactions with medicines affected by blood’s tendency to clot.

One such concern is the condition you mention, deep vein thrombosis, in which blood flow is restricted in a vein because a clot has formed. (Read more about DVT at b.link/dvt2020.) One therapy for DVT involves anticoagulants, also referred to as blood thinners -- including the one you take, Coumadin (brand name for warfarin). Such therapies are utilized to fine-tune coagulation to prevent unwanted blood clots, while maintaining the ability to form clots where needed.

When using anticoagulant medications, it is essential to test -- both initially and periodically -- to establish and adjust the dose needed. Once the dose is determined, you don’t want to make changes by adding or stopping elements that can ruin the recipe.

You mentioned that you cook; consider taking a look at a cookbook that focuses on this issue. I am familiar with two such books, both written by physicians: “The Coumadin Cookbook” by Rene Desmarais and “The Dr. Gourmet Diet for Coumadin Users” by Timothy Harlan.

Send questions to: “On Nutrition,” Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.

DEAR DR. BLONZ: What is known about the Ganoderma mushroom that gets roasted and used as a coffee substitute? I am having trouble finding out information from sources that do not benefit from its sale. I had a sample and enjoyed the flavor, and I have read about health benefits, but I want to know more about what I would be ingesting before I buy. Thank you for your help. -- G.G., Hayward, California

Dear G.G.: Definitely best to check things out in advance. A mushroom is a fungus and not considered a plant. It gets the nutrients it needs from organic matter; in essence, mushrooms live off dead plants. A number are treasured for culinary uses, while some are feared for their deadly toxins, and others are known for their psychoactive effects. Some mushrooms are studied for their medicinal properties. For example, a number of mushroom compounds are being investigated for effects on cancer when taken alone or used in conjunction with more conventional therapies. As is often the case with natural-occurring compounds, there can be variations from harvest to harvest. All this translates to plenty of unknowns about the precise identification and level of active ingredients and what they will do in the human body.

The beverage you mention is made from roasted Ganoderma, its full name being Ganoderma lucidum, more commonly known as the reishi mushroom. Reishi mushrooms have a long history in traditional Eastern medicine and herbology. An active area of study with reishi relates to their bioactive compounds and potential benefits to the immune system.

As exciting as this all is, it is essential to not get ahead of the science. I mention this because the compounds in mushrooms evolved to protect the mushroom’s ability to grow and propagate. They are in the mushroom to help the mushroom, not us, so they can be present in tiny amounts (although with some toxins, this is enough!). Does this all change if we “extract” a specific component from a mushroom’s symphony of self-made compounds and then give it to a human at higher levels? It can be an undertaking with some risks, so caution is advised. We should understand what’s going on as best we can to avoid inadvertently ingesting something that can cause harm. (See b.link/vpxxw for a general take on mushrooms.)

I am familiar with reishi being taken as a tea or added to a coffee product; it can also be dried and used as a dietary supplement. I am not very familiar with the roasting of reishi for use as a coffee substitute. It is unclear whether and how a roasting process might affect reishi’s bioactive compounds. Could there be potential interactions with health conditions, medications or other dietary supplements? If it will be used as a routine beverage, will there be an effect from chronic usage?

My concerns might seem a bit excessive, but it is important to think and act prudently when tossing unknowns into our mix, particularly if we have ongoing health conditions and are using medications. (Ironically, it is often when something is wrong and we are disappointed with existing treatments that we turn to such alternatives.) We go through this whenever we add something new, but we have a long history of use as a guide with foods and culinary mushrooms.

I realize that I am leaving you with more questions than answers, but I want you to be aware of the issues. Exercise caution. If you have ongoing health conditions and are taking meds, please run this by your health practitioner and your pharmacist and track what happens.

Send questions to: "On Nutrition," Ed Blonz, c/o Andrews McMeel Syndication, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to questions@blonz.com. Due to the volume of mail, personal replies cannot be provided.