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Is it messed up that a dietitian has different, oftentimes less restrictive, nutrition recommendations than a nutrition influencer? Who cares more about their (and your!) health?
Yeah… it is messed up. But let’s talk about how things got to be this way – from the humble opinions of a registered dietitian. First of all, I like to explain who a registered dietitian actually is. Because if you don’t know the difference between a dietitian and a nutritionist this can get particularly confusing. An RD (registered dietitian) or RDN (registered dietitian nutritionist - yes, confusing) has a couple requirements in order to get that credential:
1. Complete a didactic program in dietetics – most of the time this is a bachelor’s degree in nutrition. The average dietetics course load looks like:
Biology
Chemistry
Biochemistry
Organic chemistry
Medical nutrition therapy
Cooking coursework
Food Science
Counseling
Physiology
And so much more
2. Apply to and get matched with a dietetic internship after college. This is basically another year of school in the form of clinicals and minimal classes. You work with/for a variety of different dietitians in different fields of dietetics to get on the job training and practice.
3. Take the RD exam – an exam testing proficiencies in food service management, clinical dietetics, medical nutrition therapy, management, and community or public health policies. After you pass your RD exam you can choose to go by Registered Dietitian or Registered Dietitian Nutritionist. Key word here being dietitian.
4. Pay for licensure (depending on your state). Then continue to participate in continuing education throughout your career to keep up to date with current research and treatment protocols. Falling behind on continuing education will revoke your status as a dietitian.
5. Potentially get a Master’s Degree. I personally have a Master of Science in medical dietetics. Starting next year, all new dietitians will be required to have a graduate degree to practice.
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What makes a nutritionist a nutritionist? In most states - absolutely nothing. There is no regulatory body to call yourself a nutritionist… so YOU are a nutritionist! And your mom! And that friend who googles her symptoms and watches YouTube videos about nutrition! And your friend who went to GNC once! And that annoying guy at the gym who thinks the carnivore diet is a good idea! And most of the nutrition influencers you see on social media. There are definitely a few credible examples of a nutritionist, but, overall, it is not a term that actually means anything.
So who cares more about my health - the nutrition and fitness influencer who recommends cutting carbs, exercising 2 hours per day, and taking 12 supplements or the RD who wants you to eat a variety of foods, eat enough, and find a joyful way to move your body?
Such a good question, and, honestly, we probably both care about your health. One of us just uses up to date, evidence-based information to give recommendations and the other uses their own feelings and anecdotal evidence. The problem with present day nutrition is that the combination of fatphobia, healthism, diet culture, and wellness culture make it really trendy to diet and exercise in new and radical ways. People are so afraid of poor health and/or fatness that they’ll try just about anything if they’re told it will “work”. “Work” here almost always is code for lose weight.
So, yeah, the person going to extreme measures to attempt to control their body probably does care a lot about their health. They’re doing the absolute most. But it doesn’t mean that an RD promoting a middle ground doesn’t. The RD is typically going to have the world’s most boring advice - eat a variety of foods, move your body in a way that doesn’t feel compulsive, have some fruit and veggies on a regular basis, cook at home when it is accessible, and prioritize eating enough over eating perfectly. It’s boring… but it’s also what we see contribute to good overall health.
Why doesn’t an RD recommend the same things I see on social media?
An RD is a specialist in individualizing care while also prioritizing evidence over anecdotes. Sure, we get it - your aunt’s best friend tried Keto and never, ever was bloated again. And there is likely so much more to that story. Because at the end of the day, we don’t have great evidence that fad diets work. And by “we don’t have great evidence”, I mean we don’t have any good, long-term evidence. How many people have you known in your life who are perpetually on a diet? Always trying the next best thing? Are you one of those people?
Yes, diets oftentimes “work”1 for a little bit. You may even notice some benefits like better labs, your body changes, you feel more energy. And, more often than not, those changes don’t last. So, what your dietitian is trained to help you with is making sustainable changes that support you for more than just changing your body. We’re looking at how you can have the most enjoyable, satisfying way of eating that also supports any health goals you may have. Because when you are eating enjoyable, satisfying foods you are more likely to maintain those changes over time. Which is actually much better for you than crash dieting. (Seen here, and here, and there is a great overall review here).
So how do I figure out if the advice I’m getting is good?
Does it follow what makes the most sense from your experience of nutrition? How do you typically feel your best? Does it drastically cut out specific foods or food groups? Are specific foods being linked to diseases like cancer, heart disease, or diabetes? Does it sound too good to be true? Does it sound like the same promises of that last diet you tried… but with a different macronutrient cut out this time?
Truly, the best information we have about nutrition is to eat as many different foods as we can. The more variety we have, the better our overall health. Each and every food we eat contains different amounts of different nutrients - so when we cut out foods, we are cutting out a potentially important source of vitamins/minerals/macronutrients. There are some nuances to this - like food insecurity, food allergies, and more - but, overall, we see that eating more foods is linked to better satisfaction, enjoyment of eating, and health outcomes. Restriction is definitely trendier, but not necessarily the health promotor that it’s sold as.
If you have more questions, I hear you! This is just scratching the surface of what it means to have good overall nutrition. I encourage you to reach out to a dietitian if you are still feeling lost about how and what you should be eating. If you live in Missouri, Washington, or Oregon, you can actually work with me!
I’m not a dietitian who believes that weight loss is an inherently good thing. I don’t view weight loss as an indicator of success in our work together. I’ll dive deeper into that whole concept in the future.