Personal Nutrition

So you’re looking for a nutritionist, someone to help you feel better, maybe improve your stamina at the gym or give your diet a boost? It’s easy to end up in the wrong hands.

Virtually anyone can claim the title “nutritionist” in California because the state doesn’t license or certify those who hand out nutritional or dietary advice. Personal trainers with certificates from weeklong nutrition courses offer eating tips and dispense supplements; consultants order saliva and hair tests before recommending hormone creams for more “vitality”; and herbalists advise “cleansing” and “detoxifying” formulas. Even doctors and nurses may tell you what to eat, although they have only cursory professional training in nutrition.

“A lot of people call themselves ‘nutritionists.’ You have no way of knowing what kind of background those people have,” said Lisa Gibson, executive director of the California Dietetic Assn.

The problem is particularly complicated in California, a state known for originating health and fitness crazes and for its variety of alternative health practitioners. Although 42 states and the District of Columbia require either state licensing or state certification of dietitians or nutritionists to help protect the public from potential harm, California requires only that dietitians alone be registered with their professional organization. (Licensing and certification is pending in three of the remaining seven states; four do nothing.) The state does not define the term “nutritionist” or specify who may hand out dietary advice.

That essentially leaves it up to the consumer to choose wisely. Pick the wrong person and you could be endangering your health, not to mention wasting your money.

“Individuals with serious medical problems may delay or discontinue appropriate medical treatment if they follow advice from someone who claims to be a nutritionist without appropriate education and training,” said Leigh-Anne Rice, chairwoman of the Consumer Protection Committee of the California Dietetic Assn.

Gibson cited as an example a Southern California woman with a precancerous growth in her colon who went to a nutritional consultant last spring for alternative treatment. When the patient told the consultant that the recommended colon-cleansing diet was causing rectal bleeding, the consultant said that was a sign she was healing. The consultant then proceeded to put her on a gallbladder cleansing regimen that produced a potentially lethal muscle condition.

The woman later recovered from that condition and filed a report with the California Dietetic Assn., which tries to monitor questionable and unethical practices.

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Health and Nutrition Claims Abound

Many Americans think that if only we change what we put in our mouths, we can enjoy better health and longer life. Little wonder. We’re bombarded by health and nutrition claims and counterclaims in magazines, bestselling books, newspapers and television infomercials. We hear about new studies demonstrating how certain foods improve one condition, only to be told later that they may increase the risk of another illness.

All of this is having an effect. The most recent biennial survey of the American Dietary Assn. shows that as of late 1999, 28% of those surveyed said they’d made significant changes in their eating behavior to be more healthy, up 2% since 1997. At the same time, the number of people who said healthful eating isn’t a concern dropped from 40% in 1997 to 32%, and the “I know I should do better” types increased from 34% in 1997 to 40%.

Yet Americans are fatter than ever and being diagnosed increasingly with coronary artery disease and type 2 diabetes, both of which can be mitigated by lifestyle improvements.

To steer our way through the thicket of materials--and the conflict between what we know and what we actually do--we increasingly look to experts whose job it is to stay on top of the information.

“We have to remember that nutrition is evolutionary, not revolutionary, and therefore we must be open-minded to new information that comes our way,” said Roxanne Moore, a spokeswoman for the American Dietetic Assn.

Despite the uncertainties, the state of nutritional science today is better than it’s ever been, with a firmer understanding of how overeating, especially gorging on high-fat foods, can clog arteries, promote certain types of cancers and shorten our lives.

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Nutrition Professionals Fall Into Two Categories

Only a few diet professionals are trained and qualified to sort food fact from fiction, weigh unique medical problems, genetic predispositions and behavioral patterns, and devise a way to break through bad eating habits. Although they may have specialties as diverse as herbal medicine, sports nutrition, cardiac heath and eating disorders, they fall into two basic categories:

* Registered dietitians who have earned a four-year degree (after taking courses in the basic sciences, food sciences and behavior sciences), have logged experience in the field and have passed a professional exam of the Commission on Dietetic Registration, a credentialing agency technically separate from the American Dietetic Assn. They also have continuing education requirements.

* Nutritionists who have earned master’s or doctoral degrees in nutrition. Some of them, called certified nutrition specialists, have passed an exam of the American College of Nutrition’s Certification Board for Nutrition Specialists and stay current with continuing education credits.

Such professionals commonly provide dietary advice, or what is called medical nutrition therapy, to treat such conditions as diabetes, obesity and heart disease with dietary changes. However, California law states that only a registered dietitian or a nutritional professional who has a master’s or higher degree in clinical nutrition from a nationally accredited college and is deemed qualified by a referring doctor may treat medical conditions through diet. Although the law doesn’t provide specific penalties or sanctions for violators, they can be prosecuted for practicing medicine without a license.

Often those looking for nutritional advice don’t land in the hands of trained professionals until after other nutrition consultants have failed or made things worse.

Eileen McMullen, a sales planning manager from Yorba Linda, endured two miserable years with stomach problems and fatigue that digestive specialists attributed to colitis, Crohn’s disease, irritable bowel syndrome and finally something “in her head.” After only getting worse on antidepressants and a high-fiber diet, she asked her regular doctor to find her a nutritionist. Last July, before recommending any dietary changes, Evelyn Tribole, a registered dietitian and author of several popular books, suggested that McMullen’s doctor test her for celiac disease, a disorder that makes sufferers unable to digest any grains except corn and rice.

Bingo. The fiber prescribed by a gastroenterologist, who specializes in diseases of the gut, was only making things worse.

Tribole introduced McMullen, a 39-year-old mother of two, to foods she could tolerate (she settles for tortilla chips and rice cakes and looks longingly at the bread and pasta her kids eat) and advised her on meal plans.

“Three days after I started that diet, I felt better. I have my energy back,” said McMullen, who has begun jogging again after months off her regular exercise program.

Although certain conditions such as kidney disease, diabetes and some types of heart disease indisputably improve with dietary changes, as can athletic performance, many folks in generally good health can use nutritional counseling to help prevent disease later on.

“I believe that anyone can benefit from fine-tuning their diet and seeing a nutrition professional, because many of the diseases they’re going to face in 20 or 30 years are slow, progressive, gradual kinds of conditions,” said Penelope Edwards, a certified nutrition specialist from the San Francisco Bay Area.

Often nutritionists can design more healthful plans, sort out conflicting dietary advice and offer behavioral support to help make the changes stick. That’s what helped David Barnes, a former professional football player who became discouraged after he was still packing 290 pounds on his 6-foot-2 frame after a decade of failed diets.

“You go through all the diets, read all the books, do all the stuff, and at the end of the day it doesn’t work,” said Barnes, whose jobs with manufacturers of over-the-counter drugs and supplements have inured him to quick-fix advertising claims. In late January, after looking for a credentialed nutritionist who “knows the human body as well as nutrition,” he found Tribole. She helped him cut out meat, consume five fruits and vegetables daily and, more important, change his focus.

“We talked about how I felt, as opposed to counting calories,” said Barnes, 49. In his first month working with Tribole, he has dropped 8 pounds and has more energy.

Though Tribole works with Barnes in person and over the phone on an ongoing basis, acting like a food therapist, some clients prefer just a consultation to get them started on a new path.

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Diet Specialist May Scan Client’s Pantry, Fridge

Most nutritional counseling begins with a basic medical and food history; some may include additional physical evaluation such as measurements of body fat.

“I use a body composition analysis machine that evaluates the amount of lean body mass and fat,” said Carolyn Katzin, a certified nutrition specialist who practices on Los Angeles’ Westside. From there she calculates how many calories clients burn daily and what it would take for them to drop pounds.

Sometimes she makes home visits, going through the contents of a client’s pantry and refrigerator, reviewing the labels of the foods he or she typically buys, suggesting more healthful items as substitutes.

What the counseling should not include, most experts agree, is reliance on hair analysis or supplements.

Although nutritionists occasionally suggest supplements, “reputable registered dietitians don’t sell vitamins and supplements,” said Keith Ayoob, a nutritionist at the Albert Einstein College of Medicine in New York. “It’s not ethical to do so.”

Roxanne Moore, a registered dietitian and spokeswoman for the American Dietetic Assn., said, “If you go to somebody that’s doing hair analysis, usually what they’re looking to do is sell something to you.” Often clients will be told that supplements will give them more energy or muscle strength, she said. But besides spending money needlessly, Moore added, “you run the risk of being told to do something contradicted by your medical background.”

Most dietary advice should focus on behavior changes and more sensible eating, credentialed nutritionists agree. “There’s so much you know about biochemistry, digestion, aging processes, that the average consumer doesn’t know,” Katzin said. “They go into a store and are told something is going to make them young and virile. It’s fairy dust.”