RDs? Nutritionists? Trainers? Finding healthy, sensible advice to change your relationship with
food.
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Don't let me teach you to juggle! And don't let some clown pretend to be a nutrition expert! |
I thought about doing a spinal adjustment
on my overweight patient with back pain, but then I realized “Hey, I’m a
dietitian, what am I thinking? I have
no expertise in this!”
Ok, I’m kidding. I wouldn’t dream of
guiding clients in areas I am not qualified (although I have made suggestions
about stress reduction I would never consider myself a replacement for a
therapist). Educating clients on target heart rate and setting realistic
exercise goals based on their current health is one thing, but I wouldn’t
instruct them on bench presses. Subtle mistakes and misinformation could lead
to major problems.
So why don’t other provider types feel
the same way when it comes to doling out nutrition information? Take chiropractors
for instance. What extensive training qualifies them to tell you how to eat? Or
to sell “toxin cleansing systems”, aka serious laxatives, to bulimic patients
(I kid you not), all for the sake of a giant profit? Yes, I really had to coach
a patient to return a product to her chiropractor who had convinced her that
this was the answer to her woes. Thankfully, I was successful.
Trainers and coaches, perhaps well
educated in their field getting people exercising, seem to misinform their
clients more than most practitioners, requiring a great deal of my time to
correct. They propagate fitness magazines’ and supplement manufacturers’ myths
about carbs, and protein (they see a major halo around this nutrient) and base
their guidance on their own unhealthy beliefs. Not all providers, of course—but
many. They share what they believe has worked for them—which has little to do with what is healthy or appropriate for
you! Even the Pilates studio I go to is
now selling purgatives in pretty packaging suggestive of clean, fresh and
natural health. If only they were aware of the damage of these senna filled
disguises. Uggh!
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I can at least support the "celebrate recovery"! |
Then there are those that proudly call
themselves nutritionists, which is actually quite a meaningless term. A nutritionist
could be a steroid-infused guy pushing supplements at the local vitamin store,
with no qualifications for this position other that his availability from 9-5.
Or it could be the produce manager at the local Whole Foods or other market.
Yes, anyone can call himself a nutritionist.
Admittedly, I too, have referred to
myself as a nutritionist—a nutrition
consultant my business card still reads. Like others, I began to use this
term as a way of differentiating myself from the stereotype of food service
dietitians of days gone by. It was a way, perhaps of putting a more updated
spin on who we are. The difference, though, between me and those other
nutritionists is that I also have very valid credentials in my field—RD, MPH, CDE,
LDN (see below for definition of these credentials).
Why should you care
about the initials?
Credentials are not just for bragging rights. Rather, they
help to separate providers based on their qualifications. There are many bright
and well-educated nutritionists—faculty members, PhDs often, who are not
Registered Dietitians but rather academics with post docs in nutrition. But
while they may have a wealth of wisdom about nutrition research and science,
they often lack the clinical and likely the behavioral expertise of someone
with an RD with years of experience working with patients. As a result, their
recommendations may be less than realistic.
That said, credentials are just a starting point. There are
many RDs with good qualifications that I would never refer to—they are too
inexperienced or rigid in their approach. So if you are looking to work with someone, it’s critical
that you learn about their experience, their philosophy and their approach to
shifting your relationship with food.
Potential for danger
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A sign I came upon in Zermatt, Switzerland |
A family member living in another state
recently contacted me about the guidance he received from a nutritionist. He
was instructed on a Paleo Diet—apparently what this nutritionist puts everyone
on, regardless of their symptoms. When his symptoms worsened, she said to
switch to gluten free and lactose free. But she also suspects heavy metal
toxicity. Or, she added, maybe a parasite. Or something. But in the meanwhile,
she prescribed her diet “remedy”,
with absolutely no evidence to support it. Oh, and she strongly encouraged a
paycheck's worth of supplements which she could conveniently sell him.
And in the meanwhile, this relative is
wasting away from his already underweight place. He’s feeling weaker and is
nutrient deficient. But he clings to the very personal guidance he’s getting
from the nutritionist. MDs have not yet identified his diagnosis nor cure, but
this nutritionist is giving him hope. The problem is, this hope comes with a
price; namely reducing his energy level and his muscle mass, imposing
restrictive (and unnecessary diet rules) and dangling more hope that there is
more this quack can do for him.
Perhaps it seems harmless enough. After
all, he wasn't getting anywhere with his regular practitioner.
But it absolutely is harmful! Restrictive
diets that result in weight loss in those in no position to be losing weight
are irresponsible. They may stall constructive, valuable follow up with
appropriate specialists. They add confusion to an already overwhelming
treatment course. And they provide a false sense of trust—and hope.
Finding the right dietitian
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Sometimes, it's hard to know what advice to take! |
- Philosophies may vary, but I’d suggest
avoiding anyone suggesting you eliminate whole categories of foods or nutrients,
such as carbs, grains, dairy, etc.
- Avoid those whose recommendations are
based solely on their personal experience and lack evidence-based
recommendations. It’s no better than a LICSW who starts her session using Tarot
cards (this, too, I’ve heard about). Fun, maybe, but not a sanctioned, proven
therapy!
- Learn about their experience treating
those struggling with your particular issues. More experience is best, of
course.
- Do they come recommended from other
health care providers or peers you can trust? Do they work in collaboration
with your other practitioners? This, too, is critical.
- Do they believe you can change? If they
view you as unfixable, damaged goods, discard
them and move on to another provider, please!
We are bombarded with nutrition
information and much of it is conflicting and inconclusive, some of it downright
wrong. And the more confused we get, the less likely we are to take action, to
make the necessary changes to support our health.
So choose your providers cautiously.
Select those that can intelligently sort through the overwhelming overload of
food rules you’re hearing. And be on guard for quacks and those simply stepping
out of bounds, dispensing information out of their field. Or even worse,
selling you useless and often harmful products for their personal gain.
As for my philosophy?
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How great is this?! You can purchase it from their website: http://bit.ly/Mr4gmv |
- Maybe it’s because I’ve got 26 years of
experience behind me. Or perhaps it’s the effect of being diagnosed with a
chronic progressive disease (I’ve got Multiple Sclerosis). But personally and
professionally I’ve come to believe that life is too short to deny ourselves what we
truly enjoy eating. Of course, if you’ve got a severe food allergy (or other
such condition) and your survival depends on dietary changes, that’s obviously
quite different!
- You need to weigh the costs and benefits of
dietary and lifestyle changes. Sure, weight loss may be appealing, but
at what price? Is it really worth the deprivation, the denial, the decreased
energy, and the obsessive thoughts to achieve an unrealistic rate of weight
change or even an unhealthy weight?
- Food should be enjoyed with all your senses—regardless of your weight. Everyone deserves to nourish himself and
to enjoy eating.
- Change is challenging, but worth making to improve the quality of your life. And it’s not too late to make it
now with the help of a qualified RD.
The credentials:
RD: Registered Dietitian
MPH: Masters in Public Health, in Nutrition (UNC Chapel Hill)
CDE: Certified Diabetes Educator
LDN: Licensed in the state of MA
Not listed: BA in Biology, Brown University, Providence RI.