The truth about “Registered Clinical Nutritionists”.
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”.