Dietitians are a critical part of modern medicine. In the hospital, dieticians not only educate patients on dietary treatment of diseases such as diabetes and heart disease; they also evaluate the nutritional status of critically ill patients and develop nutrition plans that may involve tube feeding or intravenous feeding. This is complicated, and takes into account a patient’s nutritional needs, medical conditions, etc. They are highly trained professionals.

If you want to see a dietitian lose it, call them a “nutritionist”. “Dietitian” is a specific profession governed by specific educational and licensing requirements. A dietitian can call themselves a nutritionist, but so can just about anyone else. As with other health care professions, dietitians have good reason to protect their profession. Protecting their profession protects their patients. Dietary fads are among the most prolific of medical scams and good information can be hard to find. Registered dietitians explicitly strive to utilize evidence to guide their practice. And critically, they have a published Code of Ethics.*

As is not uncommon, there are those who, in the name of “health freedom” (and profit), object to the dietitian “monopoly” on nutritional therapy.   One way they have done this is to claim the title “nutritionist” and set up a certification system. Once this structure is in place, it’s easier to get states to approve them as licensed professionals.  In this second area—state licensing—they are enlisting allies that comprise many of  “the usual suspects”.

Clinical Nutritionists

One group that is attempting to create an alternative path to nutritional therapy is the Clinical Nutrition Certification Board. Upon first learning of “clinical nutritionists” my first question was why would anyone want a second, parallel route to dietary science?  What’s wrong with the system we already have in place?

First let’s review the basic qualifications for registered dietitians (RDs):

  • Earned a bachelor’s degree with course work approved by ADA’s Commission on Accreditation for Dietetics Education. Coursework typically includes food and nutrition sciences, foodservice systems management, business, economics, computer science, sociology, biochemistry, physiology, microbiology and chemistry.
  • Completed an accredited, supervised practice program at a health-care facility, community agency or foodservice corporation.
  • Passed a national examination administered by the Commission on Dietetic Registration.
  • Completes continuing professional educational requirements to maintain registration.

The requirements for the clinical nutrition board look superficially similar.  But looking a little deeper reveals some disturbing trends.  For example, rather than the real-world training program required for an RD, they require online coursework.   And they explicitly court naturopaths, a group of doctor-wannabes who claim to be “integrative” but who actually practice magic rather than medicine, including in their practices such nonsense as homeopathy and reiki.  And as we’ve seen time and time again, once you open the door on one disproved or implausible practice, anything can (and will) walk through.

It would appear that the CNCB is not only encouraging fake doctors to apply, but also explicitly requiring “training” in fake medicine.   In the description of their examinations, they require:

Knowledge of alternative evaluation techniques (i.e., homeopathic interrogation, acupuncture meridian interrogation, kinesiology, chelation therapy, Herbology, reflexology, allergic food provocation testing electromagnetic frequency challenge) as related to nutritional assessment

Any certification process that requires a knowledge of  “electromagnetic frequency challenge” without mentioning it as a wallet-emptying magic trick is not worthy of official recognition.

But official recognition is exactly what they want.

State Licensing

The state of Michigan is currently working on regulations for the licensing of dietitians and nutritionists.  A Michigan naturopath is rather concerned about this process and is helping campaign on behalf of the “Michigan Nutrition Association”.

Our mission is to serve the interests of the public and Michigan professionals who incorporate human nutrition in their practice and patient care. We envision a vibrant community of CNS, CCN, CNC, CN, DACBN, Pharmacists, Medical Doctors, Nurses, Chiropractors, Naturopathic Doctors and many other professionals working in the interest of public health.

What this essentially means is that they are lobbying to allow pseudo-professionals such as chiropractors and naturopaths to be “licensed dietitians and nutritionists”.  In addition to giving them a patina of legitimacy (but no more than a patina), it might allow them to order laboratory tests (and there is no shortage of profit to be found in these).

This tactic of seeking legal rather than professional legitimacy is a growing and disturbing trend.  Hopefully, the legal process will be informed more by evidence than by the lobbying of pseudo-professionals, but I’m not terribly optimistic.

_________________

*This code is much more sophisticated and transparent than that offered by the CNCB, and includes this statement:

6. The dietetics practitioner does
not engage in false or misleading
practices or communications.
a. The dietetics practitioner does
not engage in false or deceptive
advertising of his or her
services.
b. The dietetics practitioner promotes
or endorses specific goods
or products only in a manner
that is not false and misleading.
c. The dietetics practitioner provides
accurate and truthful information
in communicating
with the public.
6. The dietetics practitioner does
not engage in false or misleading
practices or communications.
a. The dietetics practitioner does
not engage in false or deceptive
advertising of his or her
services.
b. The dietetics practitioner promotes
or endorses specific goods
or products only in a manner
that is not false and misleading.
c. The dietetics practitioner provides
accurate and truthful information
in communicating
with the public.

Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.