The truth about “Reg­is­tered Clin­i­cal Nu­tri­tion­ists”.

North & South - - Columns - by jenny ni­cholls

Jenny Ni­cholls on mis­lead­ing “med­i­cal” ti­tles.

“The me­nace to un­der­stand­ing [is] not so much ig­no­rance as the il­lu­sion of knowl­edge.” Au­thor and li­brar­ian Daniel J. Boorstin.

The English sci­en­tist and writer Ben Goldacre once ap­plied for a cer­tifi­cate from the American As­so­ci­a­tion of Nu­tri­tional Con­sul­tants (AANC) for Hen­ri­etta, his dead cat.

His tar­get was a celebrity nu­tri­tion­ist called Gil­lian Mck­eith, who had in­cluded this im­pres­sivesound­ing cer­ti­fi­ca­tion in her CV.

Af­ter the cer­tifi­cate duly ar­rived by post – no ques­tions asked – Goldacre wrote a with­er­ing blog about Mck­eith’s lack of aca­demic cre­den­tials: “It looks as if all you need to be a cer­ti­fied mem­ber of the AANC is a name, an ad­dress, and a spare $60. You don’t need to be hu­man. You don’t even need to be alive.”

In fair­ness, since be­stow­ing a cer­tifi­cate on Goldacre’s dead moggy, the AANC has tight­ened its cri­te­ria for the cer­tifi­cate. First, you need to ap­ply for mem­ber­ship, which will cost non-us res­i­dents $US80 a year. The fine print on the on­line ap­pli­ca­tion page now reads: “I un­der­stand that with any mem­ber­ship, a colour pho­to­graph clearly show­ing my face is re­quired. My mem­ber­ship will not be pro­cessed un­til I have sent the AANC my photo, ei­ther by mail or email.” Tough cat bis­cuits, Hen­ri­etta. Never mind. In this coun­try, all our dead cat needs is a Face­book page armed with a blurb about “tox­ins” and “well­ness”. In New Zealand, that is all it takes to set up shop as a “nu­tri­tion­ist”.

That’s right. Here, a pray­ing man­tis could call it­self a “nu­tri­tion­ist”, a “clin­i­cal nu­tri­tion­ist”, a “ther­a­peu­tic nu­tri­tion­ist” or a “holis­tic nu­tri­tion­ist” – all of which are not de­fined by law, un­like ti­tles such as “doc­tor”, “nurse”, “mid­wife” or “den­tist”.

De­spite be­ing a food flake with an un­shake­able faith in the lifeen­hanc­ing role of dough­nuts, I could set up a web­site to­day sell­ing my­self as a “holis­tic ther­a­peu­tic natur­o­pathic clin­i­cal nu­tri­tion­ist” – with­out even a plau­si­ble-sound­ing, “flex­i­ble” on­line course (no ex­ams or grad­u­a­tion re­quired).

There are, of course, well- qual­i­fied nu­tri­tion­ists in New Zealand. The

best way to spot one is by look­ing out for the ti­tle “reg­is­tered nu­tri­tion­ist”. This means they are qual­i­fied enough to be granted reg­is­tra­tion by the Nu­tri­tion So­ci­ety of New Zealand, which re­quires an un­der­grad­u­ate de­gree in hu­man nu­tri­tion or science, and three years’ pro­fes­sional ex­pe­ri­ence, or the equiv­a­lent.

Con­fus­ingly, a “reg­is­tered clin­i­cal nu­tri­tion­ist” is un­likely to be as highly qual­i­fied as a “reg­is­tered nu­tri­tion­ist”. This is be­cause the Nu­tri­tion So­ci­ety of New Zealand has a much higher aca­demic bar to reg­is­tra­tion than the Clin­i­cal Nu­tri­tion As­so­ci­a­tion.

In fact, use of the term “clin­i­cal” – along with “holis­tic” and “ther­a­peu­tic” – can be warn­ing signs that the nu­tri­tion­ist doesn’t have a Bach­e­lor of Science (BSC) and a Mas­ter’s in Nu­tri­tion – the min­i­mum you should ex­pect if you’re pay­ing for ad­vice, par­tic­u­larly if you have a se­ri­ous med­i­cal con­di­tion such as di­a­betes or Crohn’s disease.

The job de­scrip­tion “reg­is­tered clin­i­cal nu­tri­tion­ist” alarms Sheila Skeaff, president of the Nu­tri­tion So­ci­ety of New Zealand. “I’m fa­mil­iar with ‘reg­is­tered clin­i­cal nu­tri­tion­ist’ and it is not the same thing as a reg­is­tered nu­tri­tion­ist,” she says. “The use and pro­mo­tion of the term reg­is­tered clin­i­cal nu­tri­tion­ist is some­thing that both the Nu­tri­tion So­ci­ety of New Zealand and the Nu­tri­tion So­ci­ety of Aus­tralia are grap­pling with.

“In my view, it’s a clever back- door term for al­ter­na­tive health prac­ti­tion­ers to by­pass the ac­cepted, recog­nised and ev­i­dence-based sphere of nu­tri­tion science. Peo­ple who use this term are very un­likely to meet the qual­i­fi­ca­tions needed to be a reg­is­tered nu­tri­tion­ist [i.e. a recog­nised nu­tri­tion or di­etet­ics de­gree].”

There is only one field of nu­tri­tional ex­per­tise in New Zealand where the ti­tle is pro­tected le­gally. If I called my­self a “di­eti­tian”, I’d be break­ing the law. As with other med­i­cal ti­tles, an ap­pro­pri­ate de­gree is re­quired and con­tin­u­ing ca­reer com­pe­tency stan­dards. The mas­ter’s part of the de­gree in­volves work­ing with hospi­tal pa­tients.

An ad­mit­tedly un­sci­en­tific poll in my of­fice sug­gests few peo­ple know the dif­fer­ence be­tween a job ti­tle that could be backed with the qual­i­fi­ca­tions of Ben Goldacre’s dead cat and a di­eti­tian with years of univer­sity study and train­ing.

Given a choice of eight job ti­tles, only five out of 21 of my ter­tiary ed­u­cated, mid­dle- class col­leagues would seek out a di­eti­tian if they de­vel­oped a se­ri­ous med­i­cal prob­lem like di­a­betes. Twelve said they would opt for a “clin­i­cal nu­tri­tion­ist” or a “nu­tri­tion­ist,” and one would con­sult a “qual­i­fied natur­opath”.

Only two of the 21 knew “di­eti­tian” was the one med­i­cal ti­tle among the group of eight that’s pro­tected by law. (Most peo­ple thought it was “clin­i­cal nu­tri­tion­ist”, although two picked “qual­i­fied natur­opath”.)

This wide­spread con­fu­sion up­sets di­eti­tians such as Welling­to­nian Sarah El­liott.

“I think the public have the right to know who the most qual­i­fied and re­li­able nu­tri­tion ex­perts are,” she says. “Di­eti­tians are gov­erned by an eth­i­cal code and reg­u­lated by law. It is ex­tremely frus­trat­ing for a reg­is­tered nu­tri­tion­ist or di­eti­tian with years of qual­ity study to be un­der­mined by some­one call­ing them­selves a nu­tri­tion­ist, with a short on­line course. Bet­ter reg­u­la­tion would be fan­tas­tic – but com­pli­cated.”

Di­eti­tians like El­liott also face com­pe­ti­tion from the fads spread by so­cial me­dia blog­gers, on­line #in­flu­encers like Gwyneth Pal­trow’s web­site Goop and opin­ion­ated food blog­gers like Chrissy Teigen. Even the word “diet” (un­for­tu­nately for di­eti­tians) seems to be fad­ing in pop­u­lar cul­ture – replaced by phrases like “clean eat­ing”. At last count, #cleaneat­ing boasted 31,418,958 posts on In­sta­gram.

“I have is­sues with this term,” says El­liott. “If you think of the opposite, ‘dirty’ eat­ing, this can feed into the guilt peo­ple of­ten feel when not eat­ing ac­cord­ing to their rules. And as for ‘su­per­foods’, I be­lieve ‘su­per eat­ing habits’ is more im­por­tant. It’s your over­all ap­proach that has more of an im­pact on your health than any one food. A lot of money is made from the fear we are ac­cu­mu­lat­ing ‘tox­ins’ and need to ‘detox’.”

El­liott also dis­likes the idea that “food is medicine”.

“This phrase tends to be pushed by those who be­lieve food can re­place rather than com­ple­ment medicine, and that can be very dan­ger­ous.”

Sig­nif­i­cant harm can be caused by de­luded but well-mean­ing nu­tri­tion­ists. El­liott says she saw one young woman who had been put on such a strict diet by her per­sonal trainer – a so-called “sports nu­tri­tion­ist” – that she de­vel­oped an eat­ing dis­or­der. “It took more than a year for her to re­turn to a healthy re­la­tion­ship with food. I was fu­ri­ous!”

She says she also took on a client who, she dis­cov­ered, was over­dos­ing on mag­ne­sium. “She was re­ceiv­ing mag­ne­sium from three sup­ple­ments, which was over her safe thresh­old. Sup­ple­ments need to be as­sessed for an in­di­vid­ual’s needs. Oth­er­wise it re­ally is a waste of money.”

Not to men­tion ex­pen­sive, and dan­ger­ous. A mag­ne­sium over­dose can cause nau­sea, di­ar­rhoea, low blood pres­sure, mus­cle weak­ness and, in high doses, death.

An­other di­eti­tian, Mary­rose Spence, de­scribed to North & South meet­ing a client with low iron due to un­nec­es­sary ad­vice to avoid red meat, and an­other with a bowel con­di­tion ex­ac­er­bated by a strict high-fi­bre diet. She also of­ten sees weight-loss di­ets that re­duce en­ergy lev­els but not weight.

“The food-science pa­pers we took [while study­ing at univer­sity] are in­cred­i­bly im­por­tant,” she says. “Peo­ple for­get there is science be­hind foods: un­for­tu­nately, this is of­ten drowned out in the me­dia.”

Con­fus­ingly, a “reg­is­tered clin­i­cal nu­tri­tion­ist” is un­likely to be as highly qual­i­fied as a “reg­is­tered nu­tri­tion­ist”.

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