25/01/2020
Nutritionist or Dietician?
I was at a lovely birthday party the other day and I struck up a conversation with a worldly and intelligent woman who said something VERY interesting. It was after telling me that she had gone to a nutritionist and had lost a lot of weight and fixed several problems. I asked if she had seen a nutritionist or a dietician, and she, very honestly (like nearly all people I speak to) commented that she had no idea what was the difference.
She guessed, however, and said she had always thought that a nutritionist was much more qualified to deal with nutritional problems, and help one get better, whilst a dietician was someone who simply gave out 'diets' for weight loss. DIETician = weight loss DIETS. I could then understand clearly why so many people have it mixed up.
Let me clarify. And unfortunately, it's not a quick answer.
A NUTRITIONIST is someone who is qualified with up to 3 years of scientific training about the physiology of the body and nutritional deficiencies. They are registered to advise people on how to avoid nutrient deficiencies and enhance and maintain health. The term NUTRITIONIST is a protected and registered title, and only properly qualified people are allowed to call themselves REGISTERED NUTRITIONISTS.
The sad part, however, is that many housewives / gym bunnies etc., develop an interest in nutrition, find it interesting, read a few books and maybe even do a little diploma, and then call themselves a 'health consultant' / 'nutritional consultant' / 'lifestyle consultant' etc., and slide into conversation sometimes that they are a nutritionist.
This is actually against the law. But who is going to take them to task on this? So they continue with what they are doing. Actually often doing more harm than good, but with no idea that they are.
What's more, should their 'diet method' cause any harm / problems / side effects, the patient has NO WAY to hold that self-acclaimed nutrition guru responsible. Because they will throw their hands up and say, " But I never said I was a nutritionist.... I'm just guiding them with what works for me!".... and get off scott-free.
However, should a REGISTERED NUTRITIONIST give nutrition advice that goes wrong, they are held fully accountable and steps can be taken to discipline that practitioner, and ensure that careless nutrition advice doesn't happen again.
Nutritionists are hghly skilled and qualified to advise how people should eat, to avoid all nutritional deficiencies and maintain health and balance. And it's a proper, recognised qualification.
So, we have pseudo-qualified nutritional 'gurus' who call themselves nutritionists, illegally.
Then we have qualified REGISTERED NUTRITIONISTS, who are fully qualified to help people maintain health and avoid nutritional deficiencies. The public is protected and safe knowing that legally, they WILL RECEIVE only scientific advice on healthy eating.
But these REGISTERED NUTRITIONISTS are not REGISTERED DIETICIANS.
A REGISTERED DIETICIAN is a nutritionist who is trained much further to be able to TREAT DISEASE with dietary intervention. The term REGISTERED DIETICIAN is a very protected title, and is extremely tightly controlled by the Health Professionals Council of South Africa, in terms of ensuring that any patient seeing a Registered Dietician will only receive nutritional THERAPY that is scientific and safe. This means that should you suffer from cholesterol problems, kidney failure, liver cirrhosis, Diabetes, phenylketonuria, land up in ICU, etc., a Registered Dietician knows how to treat you to get you better, as part of the medical team.
Us REGISTERED DIETICIANS have done a 3-year Bachelor of Science degree, majoring in Medical Physiology (exactly how the body works at a cellular and biochemical level).
Then, we have completed a 2-year Nutrition and Dietetics post-graduate Honours degree in Medicine, where we then learn about clinical disease and how these diseases should be treated dietetically, alongside the surgery / medication / psychiatric treatment etc.
For instance, should somebody with kidney failure be given a 'healthy, balanced diet', this would send their kidneys into shutdown. The disease warrants the body unable to work normally, and so MANY adjustments in dietary intake have to be made. The dietary prescrition that they will receive has to be worked out against their blood tests, levels of electrolytes, kidney function (measured by certain filtration rates, protein markers and inflammatory markers) and then, according to the stage of kidney failure, protein intake and their nitrogen balance needs to be tighty monitored and dietary changes adjusted regularly and accordingly). Should this person ALSO have a problem with their liver, this needs to be taken into account at the same time, and hepatic treatment be integrated into the prescrition, too, otherwise the liver may worsen, while we are treating the kidneys!
In order to be qualified to treat and prescribe in this way, you can see that the level of physiological knowledge required is extensive, and requires the full 5 years of intensive training at medical school. It also requires tight monitoring and legislation to protect the patient from any medical problems that may arise as a result of such treatment.
1 year of the post-graduate Dietetic training is dedicated to different modules in the hospital (hepatic / renal / burns / paediatric / ICU / general medicine / psychiatric / neonatal / diabetic / maternity etc ), where the dietician works with the full medical team in treating myriad medical disorders within each module. This happens under the supervision of an already registered dietician, to ensure absolute protection for the patient against any form of nutritional malpractice (not having assessed ALL problems and co-morbidities thoroughly / not being aware of potential risks associated with certain dietary treatments / making mistakes with assessment of blood tests etc.)
We also have to complete a Research Thesis of our own, in the hospital, over a 12-month period, which equips us primarily, to be able to understand the difference between a good research paper and a bad one. This is incredibly important, because so often you will have noted 'det gurus' citing several research papers, and claiming that this is reason enough to believe that what they say has been 'proven'.
Many of thse papers, however, can be poorly designed and cannot be used as 'proof' of any statement they may try and make. Knowing how to read conclusions from a research paper is an advanced skill that requires training (I didn't know just how much, until I underwent this training!), and many peple don't know this... hence so many conflicting dietary claims 'based on scientific research'. Many of these people have no idea whether a paper is reliable or not.
Levels of qualification separate the different titles, despite the separations being largely misunderstood by much of the public.
Having read this, you may conclude that perhaps a Registered Dietician is overqualified to treat simple weight loss?
Actually, not AT ALL.
The reason for this, is that most people aren't aware how incredibly complex an endocrine disorder, obesity (or just being overweight) is....
Many people sadly believe that to treat weight loss, one should calculate someone's caloric output, then work out a balanced diet plan that is lower in calories than this output.
Um. I think perhaps this is something that may have been done in the 1960s (and perhaps still attempted by abovementioned 'diet gurus'....), and definitely no longer applies.
Obesity is a serious and multifactorial disease, and should be addressed with care, caution and a very sound knowledge of human physiology and pathology. Once this qualification is attained, it becomes very intimidating in terms of just HOW MUCH CAN GO WRONG in the body and brain, if even slightly incorrect or flippant dietary advice is given.
This is where we dieticians lose our temper when we receive a patient who has done this diet and that diet for weight loss and yet has never seen a registered dietician! The poor person may have started out with 10kg to lose, but most other things are fine.
They come to us as a last option, to try and rectify what the other 'diets' have created: years of fad dietis resulting in a severely obese patient (who cannot lose weight, even if they starve), with co-morbidities like insulin resistance, pre-diabetes, elevated cholesterol, elevated blood pressure, gout, auto-immune disorders, anxiety and depression, and a VERY low self-esteem, feeling as though their body has been taken advantage of.
They are correct.
They have made decisions to go to unqualified psudoscientists who know so little that they DON'T KNOW HOW LITTLE THEY KNOW.
They have been mistreated. But unfortunately, by their own choice.
This is where the danger lies.
The onus is on the public to make the correct choice, and see a Registered Dietician when there is ANY physical problem (from overweight to multi-organ failure). We dieticians are the only ones legally qualified and registered to treat these diseases.
So, to wrap up, who should you see for what?
Lifestyle Consultant... to see for healthy ideas on how to eat to include lots of nutrients in food that you make.
Registered Nutritionist.... to see in order to ensure that you have the correct knowledge to eat to prevent dietary deficiencies in the long-term. Basic and sensible nutrition advice to keep healthy people healthy.
Registered Dietician... to see with any physical / endocrinological disorder, such as diabetes / anorexia / osteoporosis / IBS etc. (yes, and weight loss!!).
The dietetic consultation is long, involved, and highly specialised to treat all disease while making the future eating habits of that patient, practical and enjoyable, within their cultural and financial limits.
The message I'd like to put across to the uninformed (and thus unprotected) public, is that dietary therapy is NOT straightforward nor easy. Sadly, the internet has paved the way for unqualified people to give dietary advice, and it's not only causing MASSIVE confusion, but it's also harming people.
And it's not OK.
Please be aware, also, that a GP is NOT a dietician, by virtue of them being a doctor. A GP will refer a patient with Macular Degeneration to an Opthalmologist for comprehensive treatment. Although the GP knows A LOT about diseases of the eye and some knowledge on how to treat them, they simply aren't qualified enough to handle the full assessment and treatment of something like that.
In just the same way, the dietary treatment of someone with insulin resistance CANNOT be sufficient with a GP, and this is why the more qualified GPs know enough to refer to a Registered Dietician.
If a GP wants to practice dietetics, they would need to do an extra 2 years Dietetics training over and above their degree. I don't think many would want to do that!
So be careful not to think that just because someone sounds clever (or educated, or has a huge following on Instagram), that they are qualified to treat you dietetically. Check if they are REGISTERED with a medical council (not affiliated with some random "Nutrition Experts Alliance of America" or something... ).
Us Registered Dieticians are VERY proud of our advanced qualifications and registration, so no dietician would take offence if you asked directly if they were registered and fully qualified.
After all, the individual is ultimately responsible for his/own health, and the standard of healthcare he/she will seek out.
Treat your body with respect and invest in the correct professional for the correct therapy.
Getting a 'diet' out of a magazine is no way to treat your body properly!
Hopefully this highlights the difference between and psudoscientist ("Health Expert"), Nutritionist, Registered Nutritionist and Registered Dietician.
Happy Friday!
