What's in a Name? Plenty, When it Comes to Nutrition
Although National Nutrition Month is winding down, our focus on healthy eating and healthy lifestyles will continue all year long. As more and more focus shines on reducing childhood obesity by improving family health habits, the importance of finding reliable nutrition information increases.
As I outlined a few weeks ago in an article celebrating SparkPeople Registered Dietitian, Becky Hand, there is a specific process and set of requirements for people to use the letters R.D. after their name. However, how do you know about the knowledge of someone that has other letters after their name or uses a fancy title such as food coach or weight-loss specialist?
I am one of those people. I have a degree in dietetics and nutrition, successfully completed an accredited supervised practice program, passed the national exam, completed continuing professional education, and had therapeutic diet and nutrition education experience. When I transitioned to a stay-at-home mother for a number of years, it became too difficult and expensive to maintain my continuing education requirements and I decided to allow my registration to expire. Since the "RD" credentials are a legally protected title, I am no longer allowed to call myself a Registered Dietitian unless a complete the registration exam again. Although in some parts of the country, I could call myself a 'nutritionist' or 'dietitian', they violate state licensure laws where I live so SparkPeople has given me the title of "healthy eating expert" which is more of a job description than a legal title.
I hope that my educational background and experience make my qualifications to share healthy eating ideas and options with others obvious. However, that is not always the case so it is very important to know what to look for when seeking out and especially paying for the services of nutrition professionals. Here are some basic things to keep in mind as you are seeking eating advice.
Letters do matter - If someone has the letters R.D. after their name, they are an accredited Registered Dietitian and considered THE nutrition expert. If you need any specialized diet instruction for a medical condition (except diabetes education), these letters should come after the name of the person you meet with. They may also have the letters L.D. (licensed dietitian) or C.D.N. (certified dietitian/nutritionist) depending on the state laws where they practice. In some states, these professionals will call themselves a 'nutritionist' but that is in addition to their letters and not instead of them. The American College of Nutrition has a certification process for professionals that have an advanced degree (master's degree or doctoral) and who have successfully pass an exam and maintain continuing education. The ACN recognizes a C.N.S. (certified nutrition specialist) certification. You may also see them described as a board-certified or professional nutritionist. When making a decision about who will help you with healthy eating or weight loss, know whom you are working with and what their letters mean.
Do not discount job descriptions as unqualified - Just knowing my job title of healthy eating expert doesn't tell you anything about my education or experience. The same can be true for someone that calls himself or herself a food coach or weight-loss specialist. Anyone can call themselves a coach or specialist because they don't have any more certification requirements than the term nutritionist. Job or position titles are not legal titles so don't be fooled by them but don't dismiss them either. If you only thought of me as my job title, you might miss the experience and education I can offer. The same might be true for someone referred to as a food or diet coach or weight-loss specialist. You will have to look a little deeper or ask a few more questions to find out if the job description reflects an individual with an education and experience to perform the job description they represent or if they are trying to pass themselves off as more than they can deliver.
Beware of the personal trainer that poses as a nutrition expert - A personal trainer can be a wonderful help in reaching personal health and fitness goals. Hopefully, through educated selection, the trainer you work with will have the necessary credentials, experience and training philosophy to best help you. Unless the trainer is also a Registered Dietitian, they should not be providing you with any diet or specialized meal plans other than general information about basic healthy eating from the Food Guide Pyramid. If part of your training also includes a focus on supplement powders, pills or special foods sold by them or the gym to help you reach your goals, consider this a red flag and a potential conflict of interest. If bodybuilding is your focus and protein powders or energy drinks and other supplements are recommended, please meet with your medical provider or a Registered Dietitian to talk about the safest nutrition prescription to reach your goals while also maintaining your kidney and liver health.
There are many people sharing nutrition information, some with the education and experience, and some without. When you seek nutrition information to help you reach your goals, do your homework to make sure the information you are receiving is scientifically based and not about selling a product, book or additional service.
What are some titles or terms you have seen people use to pass themselves off as a nutrition expert?
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However they do provide communities Internationally to communicate. Sadly though I looked and found that even though changing your eating habits for the rest of your life and impacting your metabolism is what you are doing ---there were no medical discussions of metabolics in their library. Yet their nutritionist wrote an article about how they could not respond to so called detoxing and other nutritionists or certified whatever are beating the supplement horse to death. And here I read about kicking anyone who says too much protein can kill you. What really can happen is Ignorance willful or unintentional can kill you. What? Food can kill you? Is this the choice of the Spark nutritionist or Harvard that supplies the information. I do not that Harvard is not one of the key spoke medical universities regarding inborn errors in metabolism. One of their nemesis is, but a southern university has a new metabolics and genetics lab that is serving internationally that is kicking well you know.
I am a person with a protein metabolic disorder, a university medical research hospital's lab rat and also an educator each fall about a METABOLIC genetic disorder that involves the damage protein can (and I say can, not will) do to someone if they are undiagnosed with many of the metabolic or kidney disorders that are related to the metabolism of protein and the destruction of your central nervous system (brain), liver, kidneys, endometriosis, miscarriages (try 8 for me), deaths at birth, behavioral problems, personality disorder, leptin disorder and cause the inability to ever loose weight, damage your heart and other muscles, cause long-term edema and kills more males and permanently debilitates and mentally damages more women, but sometimes males worse if they live. So please excuse my spelling sometimes as well as grammatical structure. Comas tend to scramble certain areas in the brain if related to a problem with the urea cycle metabolics.
Here are some truths. In most US nursing schools at a university --nurses receive education in one chapter on this area and one paragraph to the disorders stating it is only children's disease because they did not believe you could live past birth---if you get a bachelor's degree in the United States. I just had a step-daughter graduate last month from a private nursing school and received her RN. Yet when she became ill on Monday, and the doctor suggested cancer she panicked. Little did she realize that her symptoms could be other lesser problems and one possible metabolic disease in their side of the family. They do not receive this education either. It was the ultrasound technician that recognized it probably was not cancer and it was research and returning to the doctor with those questions and family information that is looking down a much less killer path.
Unless a nutritionist or whomever specializes in the specific area of metabolics, obtains further education, and works with research doctors and clinician groups they will probably never ever have exposure to the right level of education and life experience to truly understand the metabolics of lipids, carbohydrates and proteins. --These are words from the nutrition specialists, a research nurse, and two metabolic doctors and my family internist I work with. I personally know four nutrionists with masters, and one with a PhD with that special time in the metabolics area. And yet they are still learning on a daily basis --it is never ending because humans are not created equally amongst our organs and biological systems.
The nutritionist I knew from England, was a registered nurse in her previous life and had worked in that area. She coupled that with the certifications once she reached the US. Her services have never been associated with any gym, spa or such ---she has never taken a corporate dollar to live their program when it is against all she learned. I admire her--but being self employed out there can be tough at times.
General diet programs and programs at gyms do not even consider those metabolic problems when creating programs and selling them as weight loss programs. We had a man on the radio with a personal gym and program stating he guaranteed he could make any loose weight and reach their goals.
I called him. Gave him my background, health conditions and then asked to become a patron since he had the answers I nor doctors had. His program: High proteins, low carbs, and hard exercise. I nicely explained he might want to change his guarantee since he would not accept me and if he did, he would kill me. The radio ad did change and think he ultimately went out of business. His ignorance and desire to become rich quick cost him.
Yesterday I had a small gym call me to woo me back as a patron. Regretfully, I cannot partake in hard rep exercise --if I were to over do it, I could put myself back in a coma if I did not take care of myself. I said no.
You see too much protein/lipids/carbohydrates for a person that cannot assimilate it properly can and has killed people. Protein when burned as energy creates urea. Urea includes nitrogen which is expressed as ammonia. Ammonia is an extreme toxin in your body (think about people dying cleaning out ammonia tanks). Within hours you can be comatose and then dead or if it is a kidney's issue --have damaged kidneys forever and may require a transplant of the liver or kidneys. You may be brain damaged forever minimally or become a vegetable. or at the least you may have severe migraines, pass out, become incoherent, ill when flying....on and on.
Prior to my figuring out what was wrong with me, I had at least gone gluten free (yes gluten is a protein.) And both metabolic disorders and celiac can destroy the villi in the intestine and you will have chronic malabsorbtion which can be minimal or maximum. ---Thus the need for the metabolics specialists to continually run tests and advise you on how to maintain supplements ---yes supplements to stay healthy. They really can save your life. Like it or not. In the US people want the off the market. That means murder to me, they are trying to kill those of us that need them and they cannot be patent medicine so a pharma can make money ---that is the real reason why they are beat to death by pharmas.
So sometimes Protein, Fat or Carbs can kill. We have all heard of diabetics --it is just the other two areas don't have as great of marketing campaign funds. Thus the ignorance of general doctors, nutritionists, and the public. Your regular doctor doesn't even have the time or the resources to know about the disorders or diseases. They thought a few years ago there were 41. Now with the genome project there are many more. How many nutritionists follow metabolic genetic research on diet? I just watch a two hour educational program last night given by an internationally known psychiatrist that has now recognized the importance of metabolics and nutrition on the brain. He has created a new program that seems quite feasible for many people. I had used his books after my coma to locate parts of my damaged brain and work to improve them along with software programs for improving brain cognition and memory. He firmly believes in these to now. And no I am not selling a program against Spark--that is not my intent.
How many of you have ever seen the show from the UK, You are What You Eat. I was all but retching after watching the first I ever saw --there is no way ever, ever, ever, again I will eat certain foods commercially prepared by others again ---only whole food products that I control. I have found a great retraining tool for me to post pictures in my kitchen. Will definitely change some of my eating patterns. Some people call it eating clean or whole food eating (not the store). I may not loose weight, but that lady made a visual impression on me. I will not let my husband even bring them in the house and put them in my refrigerator.
Back to my point....about the metabolic problems. One term is inborn errors of metabolism (IEM). Doctors are now trying to communicate all over the world to educate other doctors because so many do not have the knowledge to recognize these issues. If doctors don't have the education, how can all school educated nutrionists or those with certifications? You have to keep an open mind and always keep learning. Nothing like being at a conference and seeing a doctor openly crying because his country did not have the tools in the rural regions to keep the children alive with my disorder. Now that country is trying and have two cities with specialists. And believe me that country is not small, it is quite LARGE in population. At least most of the country are vegetarians by religion ---that has by practice saved many of the people.
I am not anti-nutritionist or against certifications. But sometimes the ignorance of knowledge is dangerous to those that believe the person sitting across the desk knows all and can help them. Thirty years ago I blindly believed that. I have boxes of records of what medical people tried on me. No more. I drive everyone nuts and question everything to the nth degree. Why not, it's my life not theirs.
I do become angry when someone says that supplements are a mental crutch --I would like to discuss that with the sharp-end of the crutch. That means they have made health assumptions about all the populous and they know better than anyone else --including some of the greatest research doctors in the world. Many here in the United States. That is some powerful certification, but ignorance is not bliss.
It is the same as the doctor that says --I won't talk to you unless you have a cat scan of your sinuses. So you spend a thousand more. And a nurse calls you and says you don't need to see that doctor. When you mention your disorder and the problems you suspect and that nurse says "I have worked in this office 25 years and never heard of that if it existed, I would have heard of it" ---here is another person that is ignorant and uneducated. She made the call without the doctor knowing I found out. And yet that medical office has a great scam going with cat scans and doctor visits. First one costs a whopper because they are a specialist and then you pay for the cat scan.
I went back to the metabolic doctor who sent me in the first place --we researched and we are treating myself together. And one of the largest medical cities in the world---and yes a board has been informed of the treatment, all charges have been removed, letters of apology have been received from the doctor, and I don't think that nurse of 25 years is working there any more. By the way, the research groups make it possible for those clinical doctors to sit on their buttocks and keep closed minds. How sad. Here is the really dumb part....the metabolic group and the other specialist work for the same research university...oops.
So what I have been trying to say and will try to do for the rest of my life ---YES PROTEIN CAN KILL YOU. I personally ended up in the hospital, in a coma and the family was called in to say goodbye....so think about scene for a moment. I was gone, all I remember is total blackness, void. Then flashes of light, I guess God tossed me back, it was not my time. The weekend I was in the hospital. I found the emergency room had 6 other women admitted that month ---all had been on the Atkins diet. This will not happen to all people that do the Atkins diet. But what they are now finding out the problem with metabolizing protein is much more common than they thought and the degree varies widely.
So what can we all do? --how do you get doctors, nutritonists, and the patients themselves to look at the BIG PICTURE which is all over the place and find the root cause, which you may find in the DNA and mitochondria of each cell? How do you stop unintentional assumption?
I wish everyone would quit making general statements that supplements are bad --they may be saving someone's life (like mine) and high protein does not cause problems (I will gladly give you a link to a web page that exists as an international memorial to those that have died at birth or as adults because misdiagnose or ignorance of their doctors (and I am not being mean)--they were never educated properly --because of protein. As we meet more virtual parents or loved ones, names are added. Visual impact is needed to understand that is real. I know my name will be there some day too. This gets worse as you age.
That is why every year, I am asked to be a guest educator to newbie doctors ---Education and awareness is so important. Because you see, it is in this same area where people make the statement that it is calories in and calories out. As a certified nutritionist you need to learn about leptin, relationships to ornithine in the urea cycle and are learning that in many cases the body will absolutely not allow you to loose weight. At somewhere between 20 to 40 pounds you go into a metabolic crisis, the body will rebel and go into a sever edema revenge --which can be worse than loosing the weight. If you the person may not know what it is, how will your nutritionist unless they are educated in and trained in metabolics?
Certifications came along to create a career path for those who did not want to go into management. After the WWII and learning about quality control and Deming they started in manufacturing and transferred to the service industry actively in the 1980s. During my career I helped create such certification paths in two industries and saw a large computer and information company do it too. The certifications were internal first and now are international standards. In the US, states and other groups have become quite demanding about certain certifications. Certifications are to document what technical information you have. You could look at the ones I have achieved and now store the paper in a box. I recommend asking a nutritionist to show you their continued education plan and what they have studied. I have before and walked a way in the general public arena. I had more medical CMEs than they did and I was the one seeking help.
IMHO certifications mean nothing unless you remain open-minded beyond that certification, be a visionary and humanitarian especially if in the field where you deal with human lives. If it is a widget in manufacturing that could never kill a person what does matter? But, as a nutritionist literally each person you meet and treat ---you are taking their life in your hands.
After coming out of my coma, the first nutritionist they gave me had never treated an adult, but she was all they had at the time. You see at that time there were not too many adults alive with my deadly protein disorder. I hugged her and explained we had a lot of work to do. That was 6 years ago. I am very proud to say that most of the core metabolic treatment and research clinics within the area I am involved in --now have nutritionists for infants, children, teens, and then adults. That is not because of me, through research and medicine, more people have been living since 1997. They are charged with first with helping in keeping the person alive and then helping them maintain life. That is a glorious job if done well and must give them great satisfaction. So I believe there are some nutritionists that should be recognized as great humanitarians ---but others need eyes wide open.
So people that just go out and do not get the medical education but get the technical information and hang a shingle in a gym or spa ---be careful.
Realize each human that you meet is different metabolically even though we all have the same pieces parts. You can contribute greatly to people's lives, but above all do no harm. If you do, the life you save ....well you may never know then, but it will be noted in the great cosmic book forever and ever. I need to find that lady from England, I realize she saved my life when I went into a surgery that could have had many complications. My husband brought her prescribed smoothies and juices to the hospital and I lived when at the time the doctors did not think I would. I want her to know now while she is alive how much I owe her even before I had the coma. The eating plan when I went into the coma was not one she had created. Someone else had...
Love, Abbydoodle
(It just dawned on me, I made my first science presentation in the third grade on nutrition and healthy eating--totally forgot about it for about forty something years til right now. No wonder the strong feelings; Mom and some supreme being started me at age 7 on collision course to today. I remember doing all that research and preparing the visual boards on the importance of diet. What a flash forgotten all this time.)
- 3/26/2010 12:31:17 PM
People may choose to go to a nutritionist before ever going to a doctor. Thus the burden of documenting the customer's health, medicine, possible medical issues, and consider the impact of unknown risks lies on that person's shoulder's. Making assumptions can be the death of your patient.
One of the best Nutritionists I ever met, was educated in England then came to the US and gained other certifications. To her the US was icing on the cake. After looking at her library, I agreed. I now have many of those books also. And all have been read. We keep a library of cookbooks and nutrition in our kitchen. She went to the top of the class when I commented in passing one day that my husband had had spinal surgery about 3 months before. We had hoped that more of the nerve damage would have been relieved on the arms --the doctor said at this point that this may be the best it would be. She said not to have despair.
She advised me to purchase a specific brand of coenzyme active b-6 capsules and have hubby take twice a day. He did. Within a week the nerve pain was diminishing and within three the pain we were hoping the surgery would resolve was totally gone.
When he returned to his surgeon, he explained what had happened. Now this surgeon is one that the doctors want when they have to have their spinal chord cut on (we did not know at time) --he was surprised but said please provide the name and such so that he could recommend to patients that seemed to get no relief.
At the next visit with that Nutritionist, I asked about help with my restless legs ---a painful screamer of a problem I have had since childhood --- again she recommended the same B-6. Within a week I was having the first peaceful sleeps that I had had since the womb. It is ten years later and I am still taking the wonder supplement and no restless legs.
Here's the laugh...liver specialist has increased the amount of that active b-6 as well as a sister product of all the other b's. And verified that I stay on the supplements I was one and added two more. The supplements had all been recommended by that first nutritionist. I owe her my life more than once over.
She listened, considered my medical history, current issues including pains, offered meal plans, recipes and advised changes and supplements. That worked for me. I have a team of specialists that now take care of me because of my rare disease --I was not diagnosed until 6 years later. They all insist I stick with the game plan and take my medicine and supplements and keep a special meal plan.
This should be a wakeup call to any person who thinks you know best and believe NO person may not need supplemental help. What about problems with malabsorption --there are disorders and diseases that cause that issue every day to people. Maybe you need further education to be able to advise yes or no. I would want to throttle someone trying to help me if they were flying by the seat of their pants and guessing. Better to tell someone you don't know than to take a chance on harming them.
And I resent that comment I saw about a mental crutch. Because that person already has the wrong closed-mind attitude, they should not be advising people as a nutritionist. Shame !!!!!!!!!! Chose another profession ---do no harm with ignorance and arrogance. It sounds like the god-complex that some doctors have. Don't make assumptions that all people will have metabolisms like you. Never ever do that.
The woman also created special healthy smoothies and juices for me. When I had my hysterectomy --my husband would bring them in a cooler for me. All through the weekend the doctors kept popping in to check on me. I have been in too many times to know I rated weekend friendly visits. So Sunday afternoon I asked why so much attention.
He said that they had to do so extensive clean up from endometriosis that they were afraid of infection or that they would have to go back for a colectomy because of the extent of the damage. I told him don't worry ---I had not eaten the hospital food and was eating food to awaken my bowels. The hospital was feeding me white bread toast, eggs, bacon ----I found out later I had a genetic disorder and can't eat much protein ---thank God for that dietician/nutritionist.
- 3/23/2010 7:39:48 PM
Much as I respect the Dieticians in the area and I know they are very busy I am amazed that the Dieticians are not trying to get their skills covered by Medicare.
Heal thyself with food?
I would if I could get help doing it. Pat in Maine. - 3/22/2010 10:39:37 PM
- 3/22/2010 4:40:23 PM
I could have been one of those coaches, but refused. what the gym was selling was a diet, not a real lifestyle change.
The PTs I work with are all extremely qualified, but as Becky noted, unless they are certified as a RD, they aren't qualified to tell you what you can and can't eat. I'm pretty knowledgeable and I've had several seminars, but I'm not qualified either. I can tell my clients what I tell folks here i.e. eat 6-9 servings of fresh fruit and veggies. eat whole grain bread and cereals, drink your water, etc... that's it. If a client has diabetes, I have to refer them back to their doctor for nutritional information.
It really galls me how many gyms push their employees to sell dietary products that just don't work.
- 3/22/2010 10:06:48 AM
That being said, I DO use protein powders and bars myself. I find them remarkably convenient snacks for a person on the go as much as I am.
Every clients needs are different. Some clients need the mental crutch the supplements provide to get them over that hump. Others don't. If I have to council clients on supplements because they simply have to have that mental crutch (along with a sound diet and safe exercise program) the least I can do is direct them to the safest multivitamin on the market that will meet their individual needs. - 3/22/2010 7:51:30 AM
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