What is a Registered Dietitian Nutritionist?
How is this different from a nutritionist alone?
Becoming a Registered Dietitian (RD) or the newer term, Registered Dietitian Nutritionist (RDN) requires an undergraduate college degree that includes a range of nutrition related courses, an internship that provides direct, supervised work experience, and successful completion of the RD certification exam. This basic knowledge base is used to gain further experience in areas of particular interest to the dietitian. Because of this, it is helpful to find a dietitian that has worked directly with cancer patients, building an expertise in that area.
For example, for RDNs to earn additional certification as a Board Certified Specialist in Oncology, they must submit verification of at least 2,000 hours working in the field of oncology, and then successfully past the written exam. The results of that exam are good for 5 years, when they must again sit for the exam, ensuring they are still current with oncology nutrition practice.
“Nutritionist” is not a protected description in Colorado, or many other states. While there are some very competent practitioners who are not dietitians, you should always investigate the extent of their education in nutritional science in general and their specific experience working with your diagnosis. Unfortunately, along with the nutritionists trained through credible programs, many others are largely self-educated with mail order degrees from questionable sources.
What is CAM/Complementary and Alternative Medicine and how is it different from Integrative Medicine? AKA why you should always talk to everyone in your health care team!
CAM is a term that has evolved over time, initially called alternative medicine, with rather negative associations for traditional oncologists and primary care physicians. The common fear was that patients pursuing these treatments would use them as their only therapy, delaying the conventional treatments until their cancer had spread and was no longer curable. We now realize that only 8% of patients fall into this group, while two-thirds of cancer patients use both CAM therapies and “Western” treatments.
One patient classified these as “those therapies which I have had to pay for out-of –pocket and never felt comfortable discussing with my physicians”. Patients often fear that their providers won’t accept their efforts outside of standard treatments and want to be “good patients”, so simply don’t mention them. Unfortunately this means that 68% of the physician working with cancer patients don’t have the full picture of what is going on. And there are some significant risks:
- 12-45% of patients can have significant drug/nutrient interactions from mixing over the counter supplements with prescriptions.
- Physical risk. The supplement and CAM world has grown to include practices like “colonic therapy” which involve the risk of bowel perforation, delayed diagnoses, disrupted bowel flora, contaminated equipment and infection, excess water absorption and electrolyte imbalances. Supplements long ago proven not only worthless but harmful, such as laetrile, which is sold as “Vitamin” B 17 on the internet from sources outside of the US.
- There is significant risk of “financial toxicity”. Beware of sites selling you herbal and vitamin products, unless you have verified the worth and safety of that product. Patients with cancer are vulnerable to any promised hope, so be sure to keep your brain engaged when evaluating any new idea. Or as Grouch Marx (and many others) have phrased this:
Keep an open mind, but not so open that your brain falls out.
Integrative Medicine means always communicating with your physicians and other members of your team. While this is your choice, I always recommend you sign the HIPPA documents that will allow legal sharing of the information gathered in our sessions.
Remember: input from all of your providers is a bonus!
Nutrition Science is constantly growing and while the information provided here is intended to be accurate and current, there is no guarantee of accuracy extended or implied. The information offered is not intended to be a substitute for professional medical advice.
You should always establish care with a primary care provider as well as your oncology specialists and consult with them before making any diagnostic, treatment or other healthcare related decisions. Always keep your provider informed of any changes you are considering. This insures mutual education opportunities, and the identification of any conflicts with other treatment needs you might have.
Do you find nutrition studies “soft” and confusing at times? I do!
My background in biology sets me up as a skeptic. The fact that my microbiologist husband can grow his bacteria and get reproducible results is really frustrating, because nutrition studies will never be that simple. For my professional sanity, I’ve had to come to terms with this. Remember:
We are all eating. There is no simple separations of “eating” or “not eating”. Just shades of grey that aren’t easy to tease out.
We are all unique. Unlike animal studies, where researchers use the same strain to limit the variability of genetics, human studies take all comers.
- Genetic differences can affect “need”. For example, Vitamin D levels are affected by the melanin in the skin, leading to higher needs for many people of color. Beyond that, individuals can vary with their ability to make vitamin D with sun exposure, making it important to check the baseline vitamin D levels in the blood, before supplementing.
Humans are not rats, and our brains impact research
- Placebo effects are often significant. When we believe something may be helpful, the mind body connection can to some degree, make it so. This is not necessarily a bad thing, but it makes it difficult to separate true benefits.
- Pleaser effect: Drop “outs”.
Many people sign up for a research trial with the best intentions, but may fail to follow the plan they signed up for Some will truly want to be seen as a good student, and won’t report what they are doing. Even more commonly, many of those enrolled in the study will fail to meet the goals. Typically, studies with survivors have better compliance, meaning they were more likely to stick with the study design, since they are clearly better motivated than those in prevention studies. But, bottom line, we aren’t putting humans in cages and completely controlling what they eat.
- Self interest effect: Drop “ins”.
When anyone is consented for a study, they are given the potential benefits as well as the risks involved. Some study participants, unsure of whether they are in the “control” group that is given a placebo pill, may go to the local health food store and pick up some supplement just to make sure they receive the possible benefit. Of course, this might not be helpful, since some studies actually showed that supplementation was NOT helpful in some situations.
Some reporters look for controversy. Don’t believe everything you read! I’ve been at conferences listening to a researcher present their information and been surprised at what was reported in the paper the next day. Clearly, the author of the post had focused on an entirely different bottom line than that which I had heard. Be sure to look further, investigating several sources of information, rather than relying on one article.