APPENDIX G

Practitioners Working in
the Field of Nutrition

The following practitioners can serve as resources and referrals for collaboration and for prescribing nutritional programs. Following the descriptions is a table that includes the credentials, training, and approach for each profession. Share the table with a client who wants to explore her or his options.

NUTRITIONAL COUNSELORS/THERAPISTS

These include certified clinical nutritionists, certified nutritional consultants, certified nutritionists, and board-certified physician nutrition specialists (medical professionals with specialized training in nutrition).

Nutritional counselors work with people to assess their nutritional needs and make recommendations for dietary changes to improve health and well-being. A nutritionist has specific nutritional training but is not a registered dietitian (RD). Regulation of the terms “nutritionist” and “nutritional counselor” varies from state to state.

The Nutritional Therapy Association (NTA) offers a program that trains nutritional therapy practitioners (NTPs) and nutritional therapy consultants (NTCs) with a holistic approach and the philosophy that poor nutrition is behind many of today’s health problems, and that each individual has unique dietary needs.

Nutritional Therapy Association

Website: http://nutritionaltherapy.com/

The National Association of Nutrition Professionals provides a list of a range of continuing education and graduate degree programs.

Website: http://nanp.org/

REGISTERED DIETITIAN S

Registered dieticians (RDs) can help to manage and prevent chronic illness, provide sports nutrition and culinary education, assist with presurgery and postsurgery nutrition, help with eating disorders, lead community efforts to improve food resources, provide guidance with prenatal and perinatal nutrition, and assist with healthy food and nutrition for the elderly. RDs administer medical nutrition therapy in which they review a person’s eating habits, review the individual’s nutritional health, and create a nutritional treatment plan that is personalized for the individual. Often, though not always, the course of study promotes conventional nutritional guidelines rather than more progressive ones, and thus one should explore the approach taken by the dietician.

RDs are required to have a bachelor’s degree with courses on the disease process, food chemistry, food service systems management, physiology, sociology, and biology.

The coursework must be approved by the Academy Accreditation Council for Education in Nutrition and Dietetics. Many RDs also have advanced degrees. RDs are also required to complete an internship and pass a national exam with the Commission on Dietetic Registration. They are also required to receive continuing education. RDs have limits on what they can do, but they often work in health care facilities, hospitals, and private practice facilities, or HMOs as part of a medical team. Physicians often refer patients to RDs for nutritional therapy. To find a RD in your area, go to the website for the Academy of Nutrition and Dietetics at http://www.eatright.org, then click on “Find a Registered Dietitian.”

NATUROPATHIC PHYSICIANS

Naturopathy is a holistic medical system that is guided by the major principle: The Healing Power of Nature (Vis Medicatrix Naturae). It is a blend of natural medicine and allopathic (allopathic) medicine. Naturopathic doctors (NDs) are licensed as primary care physicians in some states (see below) in the United States. Naturopathic practice includes the following diagnostic and therapeutic modalities: clinical and laboratory diagnostic testing, nutritional medicine, botanical medicine, physical medicine (including manipulative therapy), counseling, minor surgery, homeopathy, acupuncture, prescription medication, and obstetrics (natural childbirth).

There are five Naturopathic Medical Schools in the United States; each school provides a low-cost clinic in which physicians complete their training as interns and residents. Some insurance will pay for naturopathic services. NDs are licensed to diagnose and prescribe medicine. Unless they specialize in mental health, they generally have basic training in mental illness medications as well. Their training is a minimum of a four-year program that includes the first two years of basic sciences of a medical (MD) education with the last two years focused on natural, alternative, and preventative medicine. They are required to take board certification exams to obtain state licenses.

Collaborate with an ND to prescribe dietary changes that also include the use of nutrients, glandulars, and reducing or eliminating pharmaceutical drugs. The certifying body is the American Association of Naturopathic Physicians and can be a source of referrals. The following states license NDs: Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Kansas, Maine, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Utah, Vermont, Washington, and territories: Puerto Rico and Virgin Islands. The following states are pending: Illinois, Iowa, Massachusetts, New York, North Carolina, Pennsylvania, and Wisconsin.

Please note that licensed naturopathic physicians should not be confused with naturopath, naprapath, or unlicensed naturopathic practitioners who also practice naturopathic methods but are not licensed by the state.

American Association of Naturopathic Physicians

Website: www.naturopathic.org

FUNCTIONAL MEDICINE PRACTITIONERS

Functional medicine uses a systems-oriented and patient-centered approach, addressing the patient as a whole person. Practitioners of functional medicine take extensive patient histories and take time to understand an individual’s unique health needs. They draw from Western and complementary/alternative medicine focusing on science-based prevention and treatments for body, mind, spirit, lifestyle, family, career, and the environment. To become a functional medicine practitioner, you must already have graduated from an accredited osteopathic, medical, chiropractic, nursing, physician assistant, dentistry, naturopathic, dietetics, pharmacy, acupuncture, or nutrition program; have completed a series of courses in Functional Medicine; and passed written examinations.

Institute for Functional Medicine

Website: www.functionalmedicine.or g

INTEGRATIVE MEDICAL PRACTITIONERS

Integrative medicine draws on both allopathic and complementary/alternative medical practices. It is often evidence-based and takes into account the patient as a whole person, the relationship between the practitioner and the patient, and uses all available therapies that may help in the treatment of a client.

The American Board of Physician Specialties certifies integrative medical doctors once they have successfully passed the Integrative Medicine board certification exam. To take the exam, you must be an MD or DO and have received training specifically in integrative medicine, acupuncture, naturopathy, or chiropractic education.

The American Board of Integrative Holistic Medicine (ABIHM)

Website: http://www.abihm.org

The National Center for Complementary and Integrative Health

Website: https://nccih.nih.gov/

HEALTH COACHES

A health coach supports, educates, mentors, and serves as a role model to motivate individuals, couples, families, and communities to explore and enact positive health choices. A variety of health coach training and certification programs exist and training credentials can vary.

The Institute for Integrative Nutrition combines motivational interviewing–type strategies with nutritional education.

Website: http://www.integrativenutrition.com/career/healthcoaching

Duke University has a program in Integrative Health Coaching

Website: http://www.dukeintegrativemedicine.org/patient-care/integrative-health-coaching

OSTEOPATHIC DOCTORS

Osteopathy is a comprehensive medical system that focuses on disease prevention while using the technology of modern medicine to diagnose and treat illness. It is holistic, looking at the patient as a whole person and not just treating isolated symptoms. Osteopathic physicians (DOs) are fully trained physicians like MDs, who are able to perform surgery and work with prescription drugs. They also emphasize nutritional therapies and manipulative therapies such as cranial osteopathy. They are also trained in a specialty such as surgery, psychiatry, or pediatrics. Examinations to receive state licenses are required for DOs to practice. DOs are more likely to practice primary care specialties and also receive additional training on the musculoskeletal system and osteopathic manipulative medicine, so they use their hands and palpation skills to aid in their diagnoses and treatments.

American Osteopathic Association

Website: http://www.osteopathic.org

TRADITIONAL CHINESE MEDICINE AND ACUPUNCTURISTS

Traditional Chinese medical practitioners and acupuncturists prescribe individualized diets for the whole person. They take a comprehensive history and conduct a thorough assessment that includes pulse taking, tongue reading, and facial diagnosis. The Chinese nutritional approach is based on having a balance of the five tastes (spicy, sour, bitter, sweet, and salty) and six food groups (meats, dairy, fruit, vegetables, grains, and herbs and spices). Chinese medicine also incorporates the concepts of yin and yang to nutrition and recommends different foods for different times of year. For example, the summer is a more active, or yang, time of year, and so to create balance one would eat more grounding, yin foods. Foods are recommended based on their ability to balance conditions of heat, dampness, coldness, dryness, moistness, or an excess or deficiency of yin or yang.

Acupuncture is a traditional Chinese medicine (TCM) approach to healing. Oriental medical practitioners and acupuncturists receive at least master’s-level training in an accredited 3- to 4-year program and must pass certification examinations. Other health care practitioners may also receive abbreviated training (in some states) in acupuncture detoxification protocols that trains them to treat a limited number of points on the body for the treatment of the addictions.

American Association of Oriental Medicine

Website: http://aaom.org

National Association of Detoxification Acupuncture

Website: http://www.acudetox.com /

TRADITIONAL MEDICINE HEALERS/PRACTITIONERS

Traditional medicine involves ways of healing that are passed on from one generation to the next, among families and healers, and is based on indigenous, practical, and observational arts and science. Medicinal plants, animals, foods, the elements, rituals, spirit ways, and touch are all part of the earth’s gifts that make up traditional medicine. Traditional medicine is the property of the communities and nations that it originates from, and it emphasizes restoration of balance and prevention of causes, and requires the vital preservation of the culture and natural resources of its origin. Traditional medicine exists in every culture and is based on the knowledge acquired over many thousands of generations of observation and learning. Traditional medicine contributes many methods to what is now called complementary and alternative medicine.

Center for Traditional Medicine

Website: http://centerfortraditionalmedicine.org/

Center for World Indigenous Studies

Website: http://cwis.org/

World Health Organization

Website: http://www.who.int/en/

Spectrum of Practitioners
Practitioner	What They Do	Approach	Education
Functional medicine practitioner	Patient histories Individual health needs Prevention	Western and alternative medicine Systems oriented Patient centered Practitioner–patient relationship Science based	Graduation from an accredited program Completion of Functional Medicine courses Examinations
Integrative medicine practitioner	Practitioner–patient relationship Use of all available therapies	Evidence based Holistic Allopathic and alternative medicine	Certification exam Could be an MD or DO, RN/ARNP, or PA and have received specific training
Naturopathic physician	Holistic Primary care Diagnosis Prescriptions Testing Nutrition Botanicals Physical medicine Counseling Minor surgery Homeopathy Acupuncture Intravenous and injection therapy Naturopathic obstetrics (natural childbirth)	Holistic The healing power of nature Natural and allopathic medicine	Four-year program Two years of basic sciences of a medical (MD) Two years natural, alternative, and preventative medicine Board certification exams required to obtain state licenses Basic training in mental illness medications
Nutritional counselors/therapists	Nutritional assessment Dietary recommendations Health coaching Meal planning Cooking instruction	Holistic Philosophy: poor nutrition is behind many of today’s health problems Each individual has unique dietary needs	Nutritional therapy consultant (NTC): 9 months of training Nutritional therapy practitioner (NTP): 9 months of training, hands-on functional evaluation training
Osteopathic doctors	Nutritional therapies Manipulative therapies such as cranial osteopathy Psychiatry Pediatrics Prescriptions Surgery	Comprehensive medical system Disease prevention Modern medicine Holistic	Fully trained physicians Examinations to receive state licenses are required
Registered dietitians	Nutritional therapy Personalized nutritional treatment plan Manage and prevent chronic illness Sports nutrition Culinary education Presurgery and postsurgery nutrition Eating disorders Community efforts Prenatal and perinatal nutrition Nutrition for the elderly	Medical nutrition Sometimes hospital/ institutional base Some people who begin as RDs expand into holistic approaches	Bachelor’s degree in a related subject required Coursework approved by the Academy Accreditation Council for Education in Nutrition and Dietetics Internship required Must pass a national exam with the Commission on Dietetic Registration Continuing education required
Traditional Chinese medicine and acupuncturists	Individualized diets Comprehensive history Assessment includes pulse taking, tongue reading, and facial diagnosis Acupuncture Herbal therapies	Holistic Alternative medicine	Master’s-level training in an accredited 3- to 4 -year program required Certification examinations
Traditional medicine healers/practitioners	Medicinal plants Medicinal foods Rituals Spirit ways Touch	Complementary and alternative medicine Indigenous, practical, and observational arts and science Emphasizes restoration of balance and prevention of causes	Knowledge acquired over many thousands of generations of observation and learning Passed on from one generation to the next