I felt it time again for my annual rant/PSA on the differences between nutritionists (not a protected term or credential- anyone can say they are a nutritionist), and RD (protected credential like RN, MD, etc). Registered Dietitians are too legit to quit, and why you should be be somewhat skeptical taking nutrition advice from someone who lacks the RD credential.
Brief review: RD/RDN stands for Registered Dietitian, or Registered Dietitian Nutrtionist. The Academy of Nutrtion and Dietetics opted to modify the RD credential about a year ago to make it more relatable to the public- adding the “N” or nutritionist piece.
I have 5 1/2 years of schooling under my belt, a masters degree, I’m a certified diabetes educator (CDE), and have worked in various areas of nutrition: diabetes, weight management, bariatric surgery, chronic kidney disease and various stages of end stage management, cardiac disease, and the list goes on. To read more about how one becomes an RD click here.
Ok. So yes I am talking a bit about my superiority complex, however- I fully admit I have lightened up a bit over the years. I used to shudder at anyone who is not an RD providing Nutrtion info. In fact it used to really piss me off, and in some cases it still does, and I’ll elaborate in a second.
I think we can all agree that obesity, and its associated problems have become a huge issue in this country- and also gloabally.
One issue that comes into play in all of this (again ONE issue) is lack of education. Lack of education on many things: how to read food labels, what’s an appropriate portion size, what are the benefits of eating an apple over a cookie, how to even prepare something like kale…. Why physical activity is a positive thing to incorporate.
I’ve found on various forms of social media that there are people out there, who are not dietitians- that do a good job of sharing helpful general info
But here are some key things to remember.
1) Life experience does not an expert make
I’m sorry. This ties directly into my next point- all our experiences are different and unique to the individual(s), and should be treated as such.
So even though you lost weight and improved your fitness level, I’m sorry but that is a unique experience, it can absolutely serve as a motivator, but it does not an expert make.
2) In fact every experience, like every patient or client is different
I’ve seen it in every demographic, and across various disease states. No case, patient, or person is the same. Please see point #1.
So what makes an RD valuable is that we see so many patients with different issues that I may take something I did with patient A, and sometime I told patient B, and use those to work with patient C. Then patient D might come in and break the mold.
Which means there should be a credential from someone who is providing you with condition specific details versus general healthy eating advice.
General advice: “Eat more fruits and vegetables! They are packed with vitamins, and minerals.”
Condition specific: “You reported you’re retaining fluid, you also reported you’re eating canned vegetables, can we talk about if it would be possible to use frozen or fresh vegetables to save on sodium?”
4) Sometimes it’s about baby steps
Any nutrition professional worth their salt, understands that chronic diseases (I am including obesity in this) understands that this did not happen overnight. Therefore when you only have an hour time slot with a patient (part of which is spent assessing them, asking them about meds, health history, and food preferences) you can’t really throw the book at them and advise them to make changes “a, b, c, d …” And so on.
Sometimes just by asking a patient what changes they are willing to make goes a lot farther.
My point to this is, I have seen patients before that have so many things less than ideal in their diet – that we spend the first session essentially talking about all of those things in a broad sense, but they ultimately leave that day with only 1 or 2 goals to work on.
So just because they return in a month having decreased their pop intake from 5 a day to 1 a day and are only eating out 4 days a week instead of 7- this does not mean that the patient or provider failed.
Having a polarized mentality of “good or bad” or “paleo or not paleo” does not help people in the long term.
5) There is a difference between evidence and preference.
There are I things I do out of preference, not because evidence supports it, but because I either like it or I don’t. When it comes to my patients I draw a firm line between what my preferences are and what is evidence based.
What is evidence based is what is conveyed to my patients, not what I think is “cool”.
For my diabetic patients – I only recommend the ingestion of a sugar sweetened drinks/concentrated sweets (regular sugar) in the instance of low blood sugar (because 15g of this concentrated carb should raise the blood sugar 30-50 points). Therefore not ideal for frequent consumption.
This typically brings up the questions of: “what are sugar sweetened drinks?”, “is diet ok?” “Won’t Splenda give me cancer?” “Those sweeteners leave an awful taste” And so on.
This leads to a conversation about portion size: I.e. “One diet pop is ok, if that keeps you away from regular”, or “have you ever tried sparkling water?” (You have to know your audience). And “the upper limit for Splenda, is 31 packets per day (for a 150 lb person) so we need to talk if you’re any where near that number.”
[The upper limits were determined by Joint Expert Committee on Food Additives of the Food and Agriculture Organization, and the World Health Organization. I learned about it via a webinar from the Diabetes Care and Education practice group].
And lastly “if you’re getting an unpleasant aftertaste after using sugar subs, that’s an indication you’re using too much, trying cutting the amount you’re using in half. In fact if you’re continuously able to do this, you may be able to enjoy these beverages without any sweetener at all”.
6) To be fair all RD’s are different –
This holds true for doctors, and all other health care professionals. Not all RD’s practice “Western medicine”. Again, I liked evidence and I like guidelines- but I comfortably work with concepts like mindful eating, supplements, and elimination diets.
Personally, I feel there is a time, place and a portion for everything
Again if you do not have an understand of chronic diseases, how they work, and how nutrition can play a helpful, or even hurtful role (I.e. Vitamin K foods with Coumadin)- it’s best to leave it to the folks with credentials.
As I’ve worked more in the health field, and grown more as a professional, I have realized the benefit of individuals getting passionate about health, nutrition, and physical activity.
However these individuals such as community health care workers, personal trainers, self styled “nutritionists” etc these individuals can have a positive impact with regard to general healthy eating, and wellness message – giving aid to prevention efforts.
It still grinds me a little that if I were to go out and give someone legal advice- it could absolutely be taken that I’m misrepresenting myself as a lawyer- something that’s taken really seriously, as is misrepresenting yourself as many other things/professions. So it really busts my chops when people style and/or portray themselves as nutrition experts without any type of consequence.
Overall as a patient/client – I think it’s ok to be a skeptic – in fact I encourage it when you’re presented with new information and ideas. Ask to see sources of information, and ask “why”.
Also remember it’s “dietitian” NOT “dietician”.