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Picking the right nutrition expert
By Betsy Q. Cliff / The Bulletin
Published: March 11. 2010 4:00AM PSTWhat to eat?
It's one of our most basic and yet most vexing questions. There are scores of articles, Web sites and books written on the topic, and still many of us remain confused about how to maintain a healthy diet.
It's no wonder. Advice comes cheap. Good advice, however, is hard to find.
A primary problem is the number of people offering up their opinions. “A lot of people consider themselves to be experts in nutrition simply because they eat,” said Julie Hood, an actual expert in nutrition at Central Oregon Community College.
Hood, a registered dietitian, and other experts acknowledged that there's a lot of unfounded advice out there — and some that's just downright wrong. So, where to turn?
People offering up diet advice come under a number of names: nutritionist, registered dietitian, wellness coach, certified clinical nutritionist. Though these titles have very different meanings, it's not obvious what they are from the title alone.
The differences are critical, as some titles have specific meanings tied to stringent certification requirements. Others have virtually no such requirements and still others imply a distinct philosophy of nutrition.
To assist you in figuring out who is who and what means what, we offer a primer on what people who give out nutrition advice call themselves.
Nutritionist
Perhaps the most common title you'll hear is nutritionist. Even those with other titles sometimes refer to themselves as nutritionists because, as registered dietitian Lori Brizee says, “it's more user-friendly” than dietitian.
Unfortunately, nutritionist is also one of the most vague terms because it's not tied to any particular level of education. “Anybody can call themselves a nutritionist,” Brizee said.
Nutritionist is a broad term used by many offering nutritional advice. Some of those may have a high level of expertise in the topic; others may have no expertise at all.
That means if you find a person calling themselves a nutritionist, you need to ask what other qualifications they have. Many nutritionists will be able to give another title or certification that is likely to be more descriptive.
Registered dietitian
Registered dietitians make up the largest group of nutrition professionals who deal with the public. Unlike a nutritionist, an RD must meet specific requirements to use the title.
“If I were looking for specific advice for treating a particular disorder, I'd be looking for an RD,” said Connie Weaver, head of the department of foods and nutrition at Purdue University, who is not an RD herself. “RDs are allowed to give prescriptions about diets the same way a physician gives drug prescriptions.”
RDs are certified through the American Dietetic Association, one of the largest organizations of nutrition professionals. To be certified, an RD must have a bachelor's degree with nutrition-related coursework and an internship in nutrition, and pass a national examination.
“It's pretty rigorous,” said Brizee, the Bend registered dietitian. “There's a core set of classes in nutrition and food sciences before you can even do an internship.”
RDs also have to complete continuing education courses regularly, which ensures that they stay up on nutrition research. “The ADA is big on evidence-based medicine,” Brizee said.
In Central Oregon, there is a handful of RDs in addition to Brizee and Hood. Many work at hospitals or at outpatient clinics, helping those with health conditions that require special diets.
Registered dietitians are also the only professionals in Oregon allowed to become licensed dietitians, a position that requires a state license.
Many insurance companies and Medicare typically require that license for reimbursement for nutrition services, said Doug Van Fleet, executive secretary of the Oregon Board of Examiners of Licensed Dietitians.
Van Fleet said that, in the state's eyes, looking for the RD or LD certification is a shortcut to finding quality nutrition advice. “As long as the person providing the advice uses the title licensed dietitian,” he said, “you'd be hard-pressed to find better advice.”
Certified nutrition specialist
A certified nutrition specialist receives a certification through the American College of Nutrition, one of the major professional nutrition societies. Those with a CNS designation must have a post-graduate degree, such as a master's degree in a field related to nutrition, and must complete at least 1,000 hours of post-graduate supervised training in addition to coursework.
The designation is much rarer than registered dietitian; there are only four certified nutrition specialists in Oregon. Two of them are PhDs at state universities; two are naturopathic physicians. None practices in Central Oregon.
Though some people with the CNS designation work in clinical settings, said Robert Lin, chair of the CNS certification program, people with the CNS certification are typically more involved in research about nutrition. Unlike a registered dietitian, Lin said, someone with a CNS would not typically be involved in prescribing a specific diet.
Certified clinical nutritionist
This certification implies training in alternative medicine with a focus on nutrition. “Everything is from an alternative perspective,” said Winna Henry, senior director of the Clinical Nutrition Certification Board, located in Dallas and affiliated with the International & American Associations of Clinical Nutritionists.
Henry said, too, the focus of the board is “definitely” on nutritional supplements. At least four of the five scientific advisers on the board have direct ties to the supplement industry, either as an owner or a consultant for a supplement companies. (The fifth, Dr. Steven Haltiwanger, is a medical doctor in Georgia, though is currently on probation through that state's medical board.)
In Bend, at least one professional, Mark W. Davies, a chiropractor, is a certified clinical nutritionist. He chose to get the certification, he said, because the people teaching the courses “were leaders in the field.” Davies said he often uses nutritional supplements, specifically those made by Metagenics, to treat various conditions or nutritional deficiencies.
Davies said that though he had a specialized level of nutritional knowledge thanks to his CCN, he felt his training as a chiropractor would qualify him to dispense nutritional advice. Indeed, look for nutritionist in the phone book or online and many of the listings are for chiropractors.
“Nutrition and wellness is a big part of chiropractic,” said Dave McTeague, executive director of the Oregon Chiropractic Licensing Board. McTeague mentioned advanced courses in botanicals taught at most chiropractic colleges.
Other titles
There are numerous other titles that those dispensing nutrition advice will go by: wellness coach, health coach, nutrition therapist and many others. Typically, these titles do not have specific definitions and do not signify any certain level of training.
A person “can take a weekend course and become certified,” Davies said.
That's not to imply that people who use these titles have nothing to offer, just that you may have to dig a little. Prospective clients shouldn't be afraid to ask more about a person's specific level of training and how they maintain certification.
Weaver, the PhD at Purdue, also suggested that people, as a shortcut, look for those with credentials from one of the three largest nutrition societies: the American Dietetic Association, the American Society for Nutrition and the American College of Nutrition.
When people use titles for which there is no standard, said Hood, the quality is more variable. “I don't want to discredit everyone who is a health coach because some of them are probably really good,” she said. “But there's no standardizing body and that's the big deal.”
Betsy Q. Cliff
can be reached at 541-383-0375 or at bcliff@bendbulletin.com.
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