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    Should RDs Be Gatekeepers of Nutrition Advice?

    The Alliance for Natural Health’s Really Eat Right campaign was one of this week’s nutrition hot topics.

    Of special interest was the group’s petition, which addresses concerns over the American Dietetic Association’s collusion with ‘Big Food’ and ‘Big Pharma’, as well as the organization’s “multi-state legislative effort[s] to monopolize nutritional therapy through legislative initiates.”

    While I do not see eye-to-eye with ANH on every issue, I am in full agreement with this one.

    In response, ADA sent out an e-mail to all members, citing “a new negative online campaign containing a barrage of accusations toward ADA [by a] group dedicated to undermining ADA’s licensure efforts and the RD credential, with little concern for the welfare of the public.”

    As a member of ADA, I felt insulted and patronized by that e-mail.  Not only did it conveniently avoid the PepsiCo-sponsored elephant in the room (the “accusations” about Big Food sponsorship are well-known facts, not gossip), they also misrepresented the intentions of ANH’s campaign.

    One of the listserves I am a member of (the Hunger & Environmental Nutrition Dietetic Practice Group’s) brought up this issue for discussion; below, the response I shared (with a few edits for clarity):

    “This is undoubtedly a hot-button issue that leads to very strong opinions, but I wanted to add my two cents.

    First, I agree with Michele Simon that this petition would be more successful if it separated the two issues. I know some RDs would sign it if it solely focused on ADA’s corporate sponsorships. As far as licensure is concerned, it is an issue I have heard both sides of; I initially thought it was a good idea to “protect our credential”, but after some more thinking and discussion, I have my reservations.

    Even though I am an RD, I don’t think RDs are the only people qualified to dole out nutrition advice. I know individuals with Masters and Doctoral degrees in nutrition/public health who do not have the RD credential and are beyond qualified (more so than many RDs I know). Let’s not forget that Marion Nestle — who is not an RD — is, rightfully so, one of this country’s foremost nutrition authorities. I would be hard pressed to find anyone who would argue she isn’t “qualified” to speak on nutrition issues simply because she didn’t complete a dietetic internship.

    I definitely think there needs to be some sort of exam or governing body that grants all nutrition professionals a credential provided they prove competency, but the current one that is supposed to be the golden standard (the DI and RD exam) has several problems. Large portions of the Dietetic Internship and RD Exam have little relevance to the nutrition profession and are entrenched in food politics rather than nutrition science (for my full thoughts on this matter, please read “point number 5″ of this post).

    I was quite fortunate during my dietetic internship in that I had very forward-thinking preceptors (you can’t imagine my relief when an RD at a renowned heart health clinic spoke with patients about the cardiovascular benefits of coconut oil), but some of my peers had preceptors teaching them low-fat diets and pushing artificial sweeteners. I recall one of my fellow interns telling me she brought up concerns over corn oil’s GMO and high omega-6 content to one of her preceptors after I brought it up as a talking point in one of our weekly meetings, only to be scoffed at and told that “corn oil is an unsaturated fat [, so therefore it is heart-healthy].”

    Are there individuals out there who call themselves nutritionists after taking a 6-hour weekend course who know next to nothing and give terrible advice? Absolutely. Does the fact that someone is a ‘holistic nutritionist’ automatically make them an authority? No. At the same time, there are RDs who advocate for chocolate milk, turkey bacon, and “Splenda With Antioxidants”. I understand that clinical positions are usually better suited for RDs since most internships have significant clinical components, but I don’t think RDs should monopolize nutrition counseling, outreach, and education.

    The “RDs are the ONLY ones who know best!” approach carries the risk of our profession becoming highly insular, cutting ourselves off from peers in other faculties who we can learn from. The biggest albatross is how the organization that is supposed to represent us — and have our best interests in mind — sells us out to the highest bidder. I find the RD credential much more “under attack” by RDs who shill for PepsiCo and the Corn Refiners Association than by a well-informed, capable naturopath who doles out nutrition advice.”

    I am a member of the ADA because I value my Registered Dietitian credential. I value it so much that I am passionate about it being respected, especially by the organization that grants it. When I walk into an ADA conference expo floor and see some of the nutritional atrocities I do, I can’t help but feel the credential is not taken seriously. If the ADA is so intent on protecting the sanctity of the RD credential, I suggest it turn its gaze inward and clean its own home first. They should see these ‘controversies’ not as attacks, but as accurate criticisms that help point out why their own actions have undercut the ADA’s reputation and credibility.

    Share

    21 Comments

    1. Kristen said on November 11th, 2011

      Hi Andy,

      Thanks for this post. As a student returning to college to pursue Nutrition, I originally enrolled in a BS/MS program that would have lead me down the RD track. I recently decided, however, given the time needed to pursue the clinical requirements and my own age/point in life, that a Masters in Applied Nutrition would better suit my needs, my professional mission, and my ability to help people in this field. I am ecstatic to hear your support for professionals who don’t happen to have the RD; I, too, firmly believe that are plenty of well-educated, well-intended, and well-versed nutrition professionals in the world who aren’t RDs but can still have a positive, fruitful impact on our food and culture. I also have immense respect for your work, so hearing this kind of support from a source I respect is encouraging. Thanks again!

    2. Mikey Will said on November 11th, 2011

      I didn’t sign the petition for a few reasons. First my feelings behind both issues are not equitable. Some issues aren’t always black and white (which I feel is exemplified by your need to offer further explanation in this blog post). Second, the language of the petition appeared overwhelming leading, well heated, and equally ambiguous (regarding the secondary point). I felt by signing I was offering a blanket acceptance.

      So I went to the main page source. The Alliance for Natural Health (ANH) seemed more intent on carrying out a personal vendetta against ADA/CDR/Dietitians without even a mere semblance of concern for consumer protection. This led me to think: “Is this petition about consumer protection or strengthening the ANH/weakening the ADA & CDR?”

      The legislature for licensure is written with intent to protecting consumers. This is a noble cause, but still it runs the risk being swayed or influenced toward different polarities (i.e. toward CDR). Nonetheless, it seems that a reasonable solution would be drafting alternative legislation in perhaps developing a governing body to allow all credible professionals to practice nutrition therapy, in a way that would protect consumers.

      The issue is the status quo; lack of consumer protection. So far I do not see any solutions from the organizations who are at risk from current legislature, instead all I see is personal attacks of vilification and defamation.

    3. Alexander Rinehart, MS, DC, CCN said on November 11th, 2011

      Thank you so much for speaking out on this Andy, the good news behind all of this is that nutrition is becoming mainstream and so organizations are now fighting over who gets to be the “big shot” voice regulating it all.

      I think the most frustrating part is that even individuals with advanced degrees may have to abide by the ADA’s rules and regulatory standards. For instance, nutrition is part of the scope of many chiropractic degrees. Chiropractors receive more credit hours than medical doctors in nutrition and there are post-graduate certification bodies that help designate further expertise in the subject. My Certified Clinical Nutritionist certification is shared by MD’s, Pharmacists, and DC’s alike – why should more advanced degrees fall under regulatory control by dietitians? …ah yes, politics.

      These certifications such as CCN, and CNS are meant for individuals already possessing an advanced professional degree that goes beyond 4 years of education. They have their own boards, they have their own exams, and their own continuing education requirements and national and international recognition.

      By renaming the ADA to the Academy for Nutrition and Dietetics, the ADA is indirectly admitting that there are distinct differences in how nutritionists and dietitians practice, and a deliberate step to trying to “invite”(aka supplant) other organizations already in place as THE certifying body.

      Glad to see that a growing number of individuals within the ADA are voicing out against the trend. I think that the ADA is overreaching its boundaries and their current campaign will bite them more than it will help them in the end.

    4. Andy Bellatti said on November 11th, 2011

      Mike,

      Thank you for sharing your thoughts. I don’t see the ANH as carrying a vendetta against dietitians, especially since the Really Eat Right campaign coalition is made up of RDs (one of the things I liked!). I also don’t agree that this petition’s main motivation is to ‘strengthen the ANH”. At no point are they claiming to “offer a better credential” or stating that “consumers should only trust practitioners who are part of ANH.” This is by no means “the solution”, but I like that it gets us thinking, and can hopefully lead to a situation where we can find a way for various nutrition professionals — including RDs — to have their skills valued and approved.

    5. Lucas Tafur said on November 11th, 2011

      Hi Andy,

      I think there is a difference between RDs and other scientists who dedicate their career to nutrition. As a nutritionist myself, I think the most important problem is the lack of science in the nutrition curriculum. Sure, you study some biochemistry and physiology, but to really understand how nutrition affects your health it is necessary at least some basic courses on molecular biology and genetics. It seems that most information learned during a nutrition degree is memorizing guidelines, and with the lack of scientific knowledge, it is hard for most to think critically and challenge some unfounded claims.

    6. Kevin said on November 11th, 2011

      Great post. As someone currently reviewing programs to attend for nutrition, it’s been a hassle deciding how I want to go about working within clinical nutrition. I feel the pressure to get the RD credentials just to be a reputable source, even though I don’t agree with aspects of the ADA and think that the science is present to support certain things that the ADA is not on board with yet (such as with your coconut saturated fat and heart health reference). I feel that this issue is similar to D.O.’s not receiving the same credit as M.D.’s in the past but recently gaining a lot more credibility. I would love to go straight to a master’s program in clinical nutrition but I will most likely spend the time (and $) becoming an RD until there is enough job security for non-RD nutrition professionals. I think the ADA has failed in its role to review the research results out there and provide the public with the best health advice. I don’t think it’s the RD’s job to be qualified to do research. Having a stronger background in molecular biology and genetics would be great but the RD’s role is to compound all of the research information into an understandable and applicable set of guidelines for patients to follow by. The politic’ing of this entire situation is frustrating; it would be wonderful to see individuals who have a passion for individual wellness and the science behind it coming together to formulate what is best for the public and to prevent the unnecessary suffering (and economic/environmental impact) of poor diets.

    7. McKel said on November 12th, 2011

      Simply put, I couldn’t agree more Andy!

    8. Mitzi said on November 12th, 2011

      I think there should be a variety of health professionals qualified to advise people about nutrition. It goes without saying that physicians should have to get far better nutrition education than most do, but they can only be expected to know so much. When we need PT, we go to a physical therapist. When we need specific dietary advice for a specific condition, or are planning around a complicated allergy/illness scenario, we need an RD.
      I have had people look at my lunch plate, back when I was a middle school teacher, and ask me for dietary advice! I think we should educate everyone about proper nutrition ideally, so that from an early age a diet centered around whole grains, legumes, vegetables, fruit, nuts, etc. (with other items like lean meat or eggs or dairy on the periphery) would be natural. Junk food would return to being what you ate (and got sick from) at the fair once a year. Then whatever problems arise could be addressed by “tweaking” an already healthy diet to meet individual needs. So much ignorance exists that power struggles for recognition at this time are REALLY counterproductive.

    9. Stephanie said on November 14th, 2011

      Andy, I also appreciate your statement of openness toward those with different degrees. I’m one of those with an MS, but not an RD. Basically, how I translate it is that you would not put me in charge of a patient with kidney disease, but I can advise a school system, design a basic nutrition ed campagin, translate scientific research, or analyze our food system’s impact on health or the environment. Useful, but it’s sometimes frustrating to be sidelined or not considered for a position or denied access because I don’t have the RD. (HEN, for example, does a lot of great work that I’d like to be engaged with but I’m not eligible to join.) Given my career goals are focused on research rather than clinical practice, though, the RD doesn’t really make sense for the cost or time spent on clinical rounds.

      My solution? PhD programs here I come…

    10. Lauren Slayton said on November 14th, 2011

      Andy, fun twitter “fight” this weekend. Now I see why you were so fired up. I don’t think an RD is the holy grail and would listen to anything Marion Nestle has to say BUT (always a but) you need a credential/training. Dr Weil is an MD, Nestle a PhD, the weekend or online course thing makes me weary it does. As far as ADA and the companies at FNCE it is beyond embarrassing and I would love to sign a petition. Ashley Koff cannot give an organics talk because “the evidence isn’t there” but let’s give Hershey’s a big part of the expo? Wrong, wrong and wrong.

    11. Andy Bellatti said on November 14th, 2011

      Hey Lauren,

      For the record, I didn’t perceive that as a “fight” as much as a “healthy exchange of ideas” (which I think Twitter needs more of, sometimes, especially among peers who usually agree on issues!).

      I absolutely agree with you about some sort of credential needed (hence the paragraph about how there needs to be some sort of governing body or exam), but I think the “RDs are the ONLY experts!” belief is very ego-driven (or stems from bitterness that we have to do 1300 unpaid internship hours). I am not advocating for “let anyone call themselves a nutritionist” (especially in light of the “I took a month-long course on colon cleansing” types) as much as I am saying “if someone knows their nutrition science and is well-informed, why should we stop them from contributing to society simply because they lack an RD credential?”.

      There are a lot of “nutritionists” out there with limited knowledge and experience, but I think we owe it to the nutrition profession to have some way of credentialing those who come with a solid knowledge base, regardless of where that base was acquired from. I feel like someone with an MS in nutrition should be able to be validated, even if they do not complete a dietetic internship.

    12. Brandon said on November 15th, 2011

      I agree with what Lucas said. The science classes I had to take for nutrition were too basic.

      One day my physiology professor asks “How do we keep warm?”, so I reply “uncoupling proteins”, to which I get the response “Yes… but that is beyond the scope of this course”. Really?

      I double majored in Biochemistry [& Molecular Biophysics] and Nutrition, and for Biochemistry I had to take advanced Biochemistry (surprise?). I learned more in that class about nutrition than I did in any of my nutrition classes, combined.

    13. Lisa said on November 28th, 2011

      “At the same time, there are RDs who advocate for chocolate milk, turkey bacon, and “Splenda With Antioxidants””

      These are the type most likely found in hospitals, dispensing Absolute Nutrition Advice to eating disordered patients.

      :\

    14. Cary said on December 5th, 2011

      I find it ironic that in my state I can simply call myself a Nutritionist and charge people for my “expertise”, but can’t sit for an exam that would prove/disprove I know my stuff unless I go pay for another degree and the privelege of working somewhere for free twice (two internships required).

    15. Kate said on December 7th, 2011

      I read your post about some parts of the dietitic internship not being relevant to the nutrition field…..but aren’t many dietitians employed in institutional settings, so yes it is important that they know these things.

      I’ve never thought RDs have any sort of monopoly…plenty of people make money handing out nutrition advice without being an RD. I think in those situations people should be prepared to disclose what their qualifications are.

      As far as the comment from the chiropractor, I lived for many years in the town where chiropractic was “invented”. The town had a lot of chiros competing for business. Many of them sell supplements. It seems like a conflict of interest to me to give nutrition counseling, and sell supplements as well in the same business.

    16. Andy Bellatti said on December 7th, 2011

      Kate,

      The fact that dietitians are employed in institutional settings doesn’t mean the RD exam should be so irrelevant to the field. My solution is to make specialized tracks. For example — if you are getting the RD credential to be in food service, then there should be a supplemental short exam you take that deals with that. I am of the belief that the RD exam should focus on nutrition issues. It is ridiculous to have so much of the exam dedicated to issues of human resources, kitchen procedure, and institutional management.

      RDs have a monopoly in many ways. In some states, they are the only ones who can dispense nutrition advice and take insurance. It’s not about “who can hand out nutrition advice”, it is about how that operates, both from a financial and legal sense.

      Not sure about your supplement comment. I know many RDs who sell supplements, mainly because they recommend them to clients and clients often prefer to buy directly from them (as opposed to having to do the legwork of finding ‘a good probiotic’). I don’t understand why you think selling supplements is a conflict of interest. In most cases, RDs recommend supplements as a boost to healthful eating (especially for things like probiotics and vitamin D). RDs and other nutrition professionals who sell supplements are not selling Centrum multivitamins.

    17. Kate said on December 7th, 2011

      I’ve met many dietitians in my work setting but haven’t interacted with any that are in private practice.

      I’m aware they aren’t selling multivitamins. In the case of the chiros (or really anyone else that sells supplements), does the person buying them leave with a clear sense of what they are for, side effects/interactions to watch out for…is there an evaluation at some point to see if continued use is beneficial. Is the supplement recommendation based one research. I used to work with many elderly who would purchase supplements on someone else’s recommendation, they didn’t seem that they knew what they were taking or why. I guess my problem is that a person who is selling supplements is much more likely to recommend them if they know they will be making a profit from them.

    18. Andy Bellatti said on December 7th, 2011

      Kate,

      Every RD I know who sells supplements explains their benefits to clients and is always looking at biochemical assays to ensure they are working. And, they only sell the supplements that they find themselves consistently recommending to clients (not whatever is ‘trendy’ at the time). What you mention about elderly individuals why purchase supplements on someone else’s recommendation sounds like they are being told to do so by a family member (or they read it in a magazine/see it on TV).

      In the same way that it isn’t fair to say all “nutritionists” are quacks, it is also erroneous to assume that every health professional who sells supplements has poor intentions (that may be the case for some, but not all).

    19. Elizabeth Schroeder said on February 22nd, 2012

      I love the fact that you want to protect the RD credentials and yet you still recognize that people who are educated in nutrition are still valuable as well.

      I graduated with my degree in Dietetics in 2008, and have been working as a Diet Technician at a Children’s Hospital since 2006. However when I was graduating, i had a difficult time finding an internship that was a good fit for me. With that i took a lot of time and decided to apply for nursing programs along with internships. Although my heart is still with nutrition, i am extremely grateful i received my BSN in nursing instead of receiving my RD. (I start my first nursing job in March) Throughout my educational experiences i have realized through nursing i have had more opportunities to provide nutrition education in community health settings, and touch more people than i ever did in my Dietetics program.

      Every time i hear about the ADA wanting to protect their credentials, and yet they don’t provide the opportunities for motivated, talented new graduates to help the profession move forward, i get a heavy feeling in my heart and gut. I understand their purpose, yet i see them as the enemy to their own profession. Needless to say, I’m more determined than ever to obtain my CDE and continue to do community health promotion related to nutrition as well as be a nurse. I just really wish there could be more Dietetics BS programs that are the equivalent of a BSN programs experience when it comes to the application of knowledge instead of internships to determine someones RD worthiness.

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