Road to RDville: Who’s the expert? (Part 1)


Unless my brain is failing me, I don’t think I’ve written any posts about the ongoing debate about who has the right to provide nutrition advice. It’s a complicated issue, both in terms of the who and the what.

Who

At the top of the heap, we have:

  • The Academy of Nutrition and Dietetics (AND), representing registered dietitians and registered dietitian nutritionists (the RDN is a new designation, and it’s the one I plan to use when I graduate, pass the RD/RDN exam, and become credentialed).
  • The Certification Board for Nutrition Specialists (CBNS), which is the certifying organization for certified nutrition specialists (the CNS credential).

Further down, we have everyone from personal trainers to yoga teachers to health coaches to acupuncturists to health food store employees to supplement store salespeople to chefs to bloggers to your next door neighbor (not necessarily in that order).

What

Few people would quibble if your personal trainer/favorite blogger/next-door neighbor touts the benefits of eating more vegetables, but beyond the most general and universal (read: common sense) nutrition advice, it becomes more sticky.

Not all diets (or eating plans, if you don’t like the D Word) are appropriate for all people. That can be true for people with no existing health problems, but it’s especially true for people who have a chronic disease or other serious health problem. When you are dealing with using nutrition to treat disease, that falls under medical nutrition therapy (MNT). That is not something to take lightly.

I know first hand what it takes to become an RD/RDN. The academic curriculum is science-based and rigorous, and I’m in the middle of completing 1100+ hours of supervised practice experience.

Accordingly, I was a bit peeved last week when I read an article debating the relative merits of the RD/RDN vs. the CNS. The article gave a reasonable blow-by-blow of the current fight (which I won’t even try to explain here), but the part that irked me, in part because it was personally insulting but mostly because it was blatant misinformation, was when CBNS executive director Michael Stroka tried to draw a bizarre line between dietetics and clinical nutrition. He said that CNSs:

“…focus on clinical nutrition, and thus have no desire to be called dietitians…They are not becoming licensed in order to practice dietetics; they are becoming licensed in order to provide medical nutrition therapy.”

Guess what Mr. Stroka…RDs/RDNs also become licensed to provide medical nutrition therapy. Then he said:

“Their specialty is dietetics, while our group’s and other groups’ speciality is science-based clinical nutrition…”

…and…

“…clinical nutrition training is quite different from dietetics training.”

Excuse me? My dietetics training is not science-based clinical nutrition training? Then why have I been taking so many science classes and reading so many scientific journal articles?

Webster’s Dictionary defines dietetics as “The science or art of applying the principles of nutrition to the diet.” My copy of American Heritage Medical Dictionary defines dietetics as “the branch of therapeutics concerned with the practical application of diet in relation to health and disease.” Other medical dictionary definitions of dietetics I found online include:

  • “The science of applying nutritional principles to the planning and preparation of foods and regulation of the diet in relation to health and disease.”
  • “The science of diet and nutrition.”
  • “The practical application of diet in the prophylaxis and treatment of disease.”
  • “The interpretation and application of scientific principles of nutrition to feeding in health and disease.”

So there you have it: Dietetics training = science + clinical nutrition (i.e., practical application).

You can’t interpret and apply science to help people eat to preserve/optimize health and treat disease if you don’t have a proper grounding in science, along with the supervised practice experience to help you refine the practical application of science to humans before being sent out into the world to practice nutrition professionally.

Since this post is already quite long, tomorrow I’ll look at how requirements for the CNS credential compare with what I’ve been spending almost every waking hour of my life working toward for the last 3+ (almost 4) years.