Friday, October 8, 2010

More Controversy Over RD's Giving Nutritional Advice

Dear Blog Readers,
I received a few ‘unhappy’ emails from RD’s (registered dieticians) concerning my article (Blog post 9/27/10) about how the State of Michigan is trying to put a licensing program in place which ensures that only RD’s can give nutritional advice. Please read below to see the controversy. The first letter was written by an RD. My response to her is below that. The third letter was written to the State of Michigan Board of Dietetics and Nutrition by another RD. I say, it is important to hear both sides of the story before choosing a side. I would be interested to hear your comments.
David Brownstein, M.D. (10.8.10)

This letter was written by: Nancy DiMarco, PhD, RD, CSSD.
Re; On Big Brother Controls Nutritional Advice on 9/27/10

I take great offense to the comments by Dr Brownstein because it is clear he does not understand the difference between the registered dietitian and the certified clinical nutritionist. I train students to become registered dietitians and also to attain post graduate certifications and the majority of those students have been in school for 7-8 years by the time they complete their graduate degrees. In contrast, our university has admitted students with the CCN because once they get their credential and think they can practice, they quickly find out how woefully inadequate their training to be and they must then go back to school to get the proper training as the RD. To question the ADA would be like me questioning Dr Brownstein's credentials as an MD. There is no accredited credentialing agency that oversees the CCN, and it is not a member of the National Organization for Competency Assurance to tell potential members that the credentialing process meets national standards. There is no mandate by the CCN to have a bachelor's degree from an accredited academic institution that is recognized by the US Department of Education or CHEA. I could go on and on about the differences, and there are many - I would be more than glad to share an expanded version of these points, but more importantly, I would like to initiate a dialog so that all of your readers can know that the RD is the nutrition expert and there is reason for licensure in many states because the majority of nutrition information that gets passed on as credible is usually not. You can trust information from the ADA and RDs.

Dr. DiMarco,
You are well within your rights to question my credentials as a M.D. to give nutritional advice. In fact, you should. Just because I spent a long time in school getting an M.D. degree does not mean that I am qualified to give correct nutritional advice. It took me many years and much reading (after medical school) to allow me to properly discuss nutrition with my patients. I can guarantee you that M.D.'s are not (and have not been) trained to give proper nutritional advice. Unfortunately, the same holds true for the training RD's receive. It doesn't matter how many years you go to school if you are not taught the correct information. I do question the ADA and their teaching model as it has perpetuated the chronic health care problems we are facing today such as obesity, diabetes, heart disease and hypertension. As for trusting information from the ADA and RD's, I suggest looking at the food choices at any hospital and then deciding whether it is best to trust the advice from the ADA (who receives coroporate sponsorship from Pepsi-Cola, Coca-Cola, Mars, Hershey’s, General Mills, and others). It is clear that the ADA should not be in control of licensing who can and is not capable of giving correct nutritional advice.
David Brownstein, M.D. 10.8.10

4 October 2010
Ms. Rae Ramsdell
Director, Health Regulatory Division
Michigan Dept. of Community Health Bureau of Health Professions
611 West Ottawa
P.O. Box 30670
Lansing, MI 48909-8170

Attention: Michigan Board of Dietetics & Nutrition

Dear Director Ramsdell:

I would like to express my concern about the rules being developed to implement Public Act 333 of 2006, §18351 (on Dietetics and Nutrition Licensing).
I am a registered and licensed dietitian in the state of Texas and can testify to the inadequate training of dietitians. Most of our education and the majority of our exam is focused on food service, not nutrition counseling or wellness. We get basic biochemistry and learn one approach to feeding people in diseased states (usually in a hospital setting), but we do not learn how to use real food, vitamins, minerals, herbs or antioxidants to restore health. We are taught that these things are useless and that no one needs more than the RDA of a nutrient.
I had a client who was going to have a hysterectomy. I had her take 25 mg of iodine (the RDA is 150 mcg) and 6 months later, she no longer needed a hysterectomy. I learned about iodine on my own, outside my formal education and using such a high dose of iodine goes against everything I was taught in school, yet it gave my client a better quality of life and she can still bear children if she so desires. It was in the best interests of my client to ignore what I was taught in school.
While there are some very knowledgeable dietitians out there, having the credential of RD does not qualify someone to dispense accurate, sound nutrition information. Other credentialed nutritionists (CNS, CCN, chiropractors, etc) are just as qualified, if not more so, than a dietitian. It really depends on the person, rather than the credential. Anyone who is open to new ideas and keeps up with the latest research is better qualified to give out nutrition information than a dietitian who only does what they were taught to do in school.
It will be a disservice to citizens in your state to only allow Registered Dietitians and nutritionists supported by the American Dietetic Association to dispense nutrition information. Consumers deserve to have a choice and many now prefer alternative approaches to health rather than what is promoted by the mainstream because they have not been helped by the mainstream advice. Dietitians do not have adequate training in alternative therapies, so we need other nutritionists who are qualified in alternative approaches. Above all, we need choice. That is what democracy is all about, the freedom to choose what is best for self and family.

I am concerned that this will affect a citizen’s choice to adequately protect their health and the health of their family. They should have the right to choose nutritional therapy from a variety of professionals coinciding with their personal health and nutritional philosophy. The rules seem to favor the Registered Dietitian without recognizing the value of other nutrition credentials or professionals with training in nutrition, and serve only to create a monopoly for them, and restrict choice for citizens.

Please ensure that non-restrictive rules are put in place that protect the practice of nutrition and the rights of Michiganders. Thank you for your consideration.

Annette Presley RD LD


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