When someone decides to seek nutritional support for their health concerns it can be a minefield! A common stumbling block is understanding the difference between a Dietician, a Nutritional Therapist (NT), and a Nutritionist – it’s all about food right? Not quite. There are many similarities between our roles but some distinct differences too! Find out who you need support from in this blog.
Where to begin…
The key when seeking out Nutritional Therapy (NT) support is to ensure that you engage with a therapist who has undergone extensive training and clinical supervision to ensure they are both clinically and professionally competent. There are many people advertising their services as a Nutrition Coach, NT, or Nutritionist, as unfortunately the title itself is not protected. NTs are often said to practice “complementary” or “alternative” medicine and can be undermined by conventional medicine, an issue that is compounded by the lack of industry regulation.
In short, anyone can set up shop as a nutrition expert but have very little training. Believe me, this is a huge bugbear of ours as we worked incredibly hard to qualify in this field. We understand the complexities of the human body systems and it concerns us that uncensored advice is given by those who lack training at the appropriate level.
So how do you know who to choose and who to trust in this booming industry?
Although not regulated by law, you can ensure your NT has extensive training by checking that they are registered with an accrediting body such as the British Association for Nutrition and Lifestyle Medicine (BANT). NTs will also be accredited by the Complementary & Natural Healthcare Council (CNHC), an independent regulator for holistic healthcare practitioners that was set up with government support and has been approved by the Professional Standard Authority for Health & Social Care (PSA). This approval enables GPs to refer patients to work with a CNHC registered Nutritional Therapist, like us.
A side note; so many GPs and patients (you) don’t know this is possible. GPs are so used to working with Dietitians that they haven’t realised they can work with us too.
Be reassured, here at Integral Wellness, we all undertook 3 years of degree-level training, which included 200 hours of clinical practice. Our approach is underpinned by functional medicine and we pride ourselves on practicing evidence-based nutrition. This means that our clinical recommendations are underpinned by the latest scientific evidence which we keep up to date with by completing continuous professional development in areas specific to our field – just as Nutritionists and Dietitians are required to do too.
So what does a registered Nutritional Therapist do?
Registered NTs work alongside clients to support them with their health goals using a combination of nutrition and lifestyle changes to improve their physical and emotional wellbeing. They usually run or work within independent nutrition clinics but can also work within healthcare research, supplement companies, retail, media, family consulting clinics, retreats, and spas.
NTs will often specialise in a specific field so that they can dedicate their research and increase their clinical expertise in that area.
The strength of Nutritional Therapy is that it rejects the one size fits all narrative. Everyone is different and therefore the approach is tailored to an individual’s unique health history, circumstances and needs. NTs will carry out an extensive health and lifestyle check for each client and may also recommend functional testing to help identify the root causes of symptoms and concerns. You can read more about functional testing in our blog.
Food cannot be viewed in isolation as health is influenced by so much more. Our environment, sleep quality, stress, and activity levels all impact physical and mental wellbeing as well as our nutrient status and therefore our health. It is all of these in combination which can lead to the many chronic health conditions that an NT can help you with and it is all of these elements that an NT will therefore address, holistically.
NTs can’t diagnose conditions, prescribe medications, or claim to cure disease. They can identify the key drivers of your symptoms and alleviate them with evidence-based nutrition and therapeutic dosages of scientifically proven supplements specifically selected to address need. They should also practice safely by checking for any interactions between prescribed medications and suggested supplements.
An accredited NT will always work within their remit, work collaboratively with clients’ GPs and consultants and refer back to medical professionals whenever any ‘red flags’ are uncovered.
What is a registered Nutritionist (RNutr)?
A registered Nutritionist will usually have a degree or masters in nutrition. This is a prerequisite to joining the voluntary register of nutritionists accredited by the Association for Nutrition (AfN). Nutritionists may work in public health, the community, industry, charities, research, and industry. They may also work in their own private practice.
They can provide advice about healthy eating and food choices, but not about special diets for medical conditions – this falls under the realm of the Dietician.
However, when Nutritional Therapists (NTs) work outside of a private clinic setting they are also encouraged by their regulatory bodies to call themselves nutritionists rather than NTs! (We know, it’s confusing!)
What is a Dietitian (RD)?
Unlike NTs and Nutritionists, Dieticians are the only nutrition professionals to be governed and regulated by law, they must belong to the statutory regulator, the Health & Care Professions Council (HCPC). This means that their title is regulated and only those who have achieved a BSc Honours or Masters in Dietetics can call themselves Dieticians. It also means that they must abide by strict codes of conduct and practice set out by the HCPC – rather like NTs do with the CNHC. The main difference is that Dieticians are legally mandated to do this whereas NTs choose to.
Dieticians can work within the food industry, education, sport, and public health but most tend to work in both NHS and private settings. If you have been diagnosed with a health condition by your GP and it is identified as diet-related – think conditions such as IBS, colitis, Crohn’s, allergies, obesity, and diabetes (both type 1 & 2), the chances are you will have been referred to a Dietician, who will prescribe a specific diet depending on the presenting condition.
This means that there is a delay between the identification of need and the provision of service due to the NHS waiting lists. It also means that some Dietetic programmes are run as group sessions, e.g for diabetes and obesity, these provide a generalised approach to healthcare that doesn’t work for or suit everyone.
“The part can never be well unless the whole is well” – Plato
Two current NHS food programmes
The Healthier You NHS Diabetes Prevention Programme (NHS DPP) is one such initiative, a nationwide programme where patients at high risk of progressing to type 2 diabetes are referred on by their GP. This programme is for a minimum of 9 months and can be done in face-to-face groups or digitally with an online peer support group. What is fantastic about this programme is that it agrees with a holistic lifestyle change together with healthier eating and weight management.
Another group programme is the NHS Low-Calorie Diet Programme (NHS LCDP), which is aimed at people who are overweight and living with type 2 diabetes. The programme consists of 12 weeks of calorie-constricted meal replacement in the form of soups and shakes followed by support and monitoring for the remainder of the 12 months.
The science… The pilot study behind the rollout of this programme consisted of 149 people in the intervention group and at the end of the first 12 months 46% had achieved diabetes remission vs 4% in the control group (no intervention). Remission was positively associated with weight loss, which means that the higher degree of weight loss the more likely the remission.
What is interesting about this study is that the follow-up at the end of 24 months, showed that those achieving remission in the intervention group had dropped to 36% as the weight had crept back on and with it, diabetes returned.
While it is great news for those who achieved remission it highlights that a generalised programme doesn’t work for everyone. In fact studies (1, 2, 3) show that rapid weight loss as seen with the soups and shakes approach, is one of the largest indicators of rebound weight gain, often the weight can go on quicker than you lost it and you become heavier than when you first started the diet (aka yo-yo dieting!).
Here, at Integral Wellness, we have a track record of supporting our clients to prevent the onset of and achieve remission from type 2 diabetes using real whole foods.
Some of our clients, like Nige, tried the NHS programme but it didn’t work for them and their blood sugars got worse.
Others, like Suzette, didn’t realise they had prediabetes until they came to see us and we spotted the signs.
Take a look at their success stories to find out how they put their diabetes into remission!