By Julie Deardorff, Chicago Tribune reporter
January 28, 2013
After spending four miserable days in the hospital with gallstones, Chicago resident Priscilla Dias Hill resolved to improve her eating habits. Rather than working with a licensed dietitian, however, she chose a holistic health coach.
Dias Hill's coach, Chip Allman-Burgard, came to her home and helped cook meals. The two went grocery shopping together. And he taught her how to choose whole, nutrient-rich foods over heavily processed substances.
But some say health coaches have no business dishing out that sort of nutrition advice — especially when medical issues may be involved — because they are not licensed by the state of Illinois.
"When (a health coach) takes a client shopping, helps in meal preparation, and then counsels on better meal choices, they are performing the job of a registered dietitian," said Jackie King, a registered dietitian and diabetes educator. Those who are not registered dietitians, she added, "have no better credentials than a neighbor or friend who would do the same thing, except they are profiting from it financially."
Long ignored by medical doctors, the field of nutrition is now recognized as an essential part of a healthy lifestyle. As interest grows, registered dietitians have been fighting to protect their turf against an influx of competition from not only health coaches but also pharmacists, acupuncturists, herbalists, chiropractors, personal trainers and bloggers.
The Academy of Nutrition and Dietetics, a trade group that represents registered dietitians, has been working to ensure that only licensed professionals can legally offer detailed nutrition counseling, both by seeking licensure laws in states that do not have them and by opposing efforts to relax rules elsewhere. To help its state affiliates submit licensure bills, the association developed a Model Practice Act to be used as a blueprint and offered training on effective lobbying strategies.
A 2011 report from the group stressed that licensure was critical because it protected the public from "incompetent, unqualified and unskilled practitioners" and encourages its members to report "incidents of harm." It also noted that dietitians face "a significant competitive threat" as other practitioners expand their services to cover nutrition counseling."
Opponents of restrictive licensure laws accuse the dietetics association of trying to monopolize the field by excluding competition and restricting choice at a time when nutrition professionals are needed more than ever.
"Nutrition isn't an occupation like nursing; it's a tool kit used by doctors, life coaches, dietitians, acupuncturists," said Zina Murray, of Chicago, who used a holistic nutrition expert to restore her health and traveled to Springfield to help lobby legislators for broader licensing laws.
Until recently in Illinois, only registered dietitians could qualify as a "licensed dietitian nutritionist," but in December the law was amended to include certified nutrition specialists and several other groups who undergo extensive training.
The new law, which the Illinois Dietetics Association initially opposed but now says is "pleased" has passed, also offers slightly more protection to those who give general nutrition advice, including acupuncturists and employees of health food stores. Health coaches and other unlicensed practitioners may describe themselves as a "nutritionist" or "nutrition coach," provide broad information and encourage healthy eating choices.
What remains unchanged is that unlicensed individuals may not legally call themselves a "nutrition counselor" or another protected title or advise clients on an individualized basis — such as by developing customized diet regimens.
A license is also required to practice medical nutrition therapy, which involves working with people who are ill or have conditions such as diabetes or high cholesterol.
Though some certifications require more science-based nutrition training than others, there isn't a single group that can claim to have the edge, said Dr. David Miller, a pediatrician and licensed acupuncturist who uses herbs and nutrition counseling in his practice.
"The science of nutrition hasn't been established yet and is, in fact, still a very active area of research," Miller said.
At the same time, Miller said, several overarching nutrition principles seem to be holding up: eating fewer processed foods and emphasizing the Mediterranean-style diet, which includes healthy fats, fruits and vegetables.
"The greatest problem is that the public doesn't have access to enough professionals who can help them understand the basics of healthy eating," said Miller, the director of East-West Integrated Medicine in Chicago.
Critics of the Academy of Nutrition and Dietetics' tactics say the group's partnerships with food industry giants — including Coca-Cola, PepsiCo, Con Agra, the National Cattlemen's Beef Association, Mars and the National Dairy Council — hurt the credibility of registered dietitians.
"There are registered dietitians who advocate for chocolate milk, turkey bacon and Splenda With Antioxidants," said Andy Bellatti, a Las Vegas-based registered dietitian. "I find the RD credential much more under attack by RDs who shill for PepsiCo and the Corn Refiners Association than by a well-informed, capable non-RD nutrition professional."
Less than 9 percent of the organization's annual operating budget comes from outside groups, said Joan Salge Blake, a spokeswoman for the Academy of Nutrition and Dietetics. "The academy is very sensitive to even the perception of conflict of interest that may occur," she said, adding that the organization maintains transparency and issues only credible, science-based nutrition information to consumers.
And though licensure favors registered dietitians, the group says laws are "not an attempt to control any market" and don't affect those who simply describe the nutritional value of products. Regulation would, however, provide "recourse for victims of unqualified and unscrupulous individuals dispensing improper advice," the group says.
Health coach Allman-Burgard said he trained through the New York-based Institute for Integrative Nutrition, which offers a yearlong online course. He said he works in conjunction with a medical doctor at his company, Naturally Fortified, and makes it clear to his clients that he is not a registered dietitian.
In fact, he says, "it's often precisely why they choose me."
That was the case for Dias Hill, 32, who was faced with gallbladder surgery. Instead, she hoped Allman-Burgard could help her change her lifestyle "without resorting to unhealthy dieting or medication." The two began working together in May. Today she credits him with helping steer her down the right path and instilling habits that she enjoys, such as her green morning smoothie made with vegetables, fruit, chia or flaxseed, and raw nuts.
"A dedicated health coach offers you something critical: coaching," she said. "It was amazing to work with someone committed to my well-being."
Among the many registered dietitians who work in health care settings is Eric Sharer, who counsels patients at the Block Center for Integrative Cancer Treatment in Skokie on what foods to eat, how much, and whether certain supplements might be dangerous in conjunction with treatment.
Sharer said he believes there's a place for alternative nutritionists, as long as they are well-trained and licensed.
"I've had patients see a practitioner for nutrition counseling and end up on a very unbalanced, potentially health hazardous diet," said Sharer, who also conducts cooking classes for patients going through chemotherapy and radiation treatment. "I've also had many patients buying products they find on the Internet, which often have little health benefits or could be potentially dangerous."
Ineffective or misleading nutrition advice doesn't have to be life-threatening to have an impact, say licensure proponents. In some cases it can cause people to lose faith that lifestyle changes will work.
Chicago-based registered dietitian Monica Joyce recently saw a 24-year-old-client who had been taken off dairy and gluten by another practitioner. But the woman wasn't lactose or gluten intolerant, Joyce said.
"She was confused about what to eat and frustrated by the limitations of the diet. She missed some of her favorite foods yet she hadn't lost any weight on it and was miserable," Joyce said. "The information that people receive from non-RDs is usually fragmented and diluted and sometimes downright wacky."
Bellatti advises that "rather than going by whatever title someone has, go by what they say. "In the same way that an RD who thinks nothing of recommending highly processed 'diet foods' should raise a red flag, so should a nutrition therapist who tells you that you need to subsist on a liquid diet for a week to get rid of toxins."
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