By Monique Richard MS, RDN, LDN
You have probably heard of a dietitian or a nutritionist. But have you ever heard of an Integrative Dietitian Nutritionist? If you feel like you’re wanting something more than traditional medicine, would like something to compliment the conventional medicine approach, or have tried every diet and are frustrated, an Integrative Dietitian Nutritionist may be what you are looking for.
Understanding the Registered Dietitian Nutritionist Credential
In order to understand what an Integrative Dietitian Nutritionist is, it is important to first clarify that the term dietitian and nutritionist have always been interchangeable within the dietitian credential and in practice. All dietitians are in fact nutritionists; however, not all nutritionists are credentialed, registered dietitians—a very important distinction. The term nutritionist was added to our credential to further clarify for the public, as many may be less familiar with the term dietitian or how it is different from a non-credentialed nutritionist.
The three steps required to become a nationally credentialed registered dietitian nutritionist (RDN) include:
1. A bachelor’s degree completed from an accredited institution with approved curriculum called a Didactic Program in Dietetics (DPD) by the national professional accrediting agency for the profession, the Academy of Nutrition and Dietetics’ Accreditation Council for Education in Nutrition and Dietetics (ACEND).
2. Completion of an accredited dietetic internship (a minimum of 1200 hours, approximately 8-24 months long), with a variety of RDN preceptors in clinical, community, food-service, institutional, culinary, long-term care, school, corporate and private-practice settings.
3. Successfully pass a national examination administered by the Commission on Dietetic Registration (CDR).
The licensed dietitian nutritionist (LDN) credential depends on the state’s licensure laws but it is set up to protect the public from those that are not qualified to practice through these accreditation standards. It is not a requirement at this time for an RDN to hold a master’s degree, but approximately 50% of dietitians do have an advanced degree; in 2024 it will become a requirement to have a master’s degree.¹,²
This is not to say nutritionists or health/wellness coaches are not knowledgeable about nutrition, because they very well could be, depending on the level and quality of education or programs they completed. However, the distinct difference is the years of practice, breadth of experience, and specifically the ability to practice medical nutrition therapy (MNT) protected under the RDN credential. MNT delves into the clinical, metabolic, and systemic manifestations found in acute and chronic diseases such as diabetes, cardiovascular disease, celiac disease, food allergies, hypertension and so much more. Registered dietitian nutritionists’ academic curriculum, internship, and experiences are tailored to train the dietitian well above and beyond macronutrients, micronutrients, and calories.
Understanding Integrative and
Now that we have clarified the difference between registered dietitian nutritionists and others in the field of nutrition, let’s delve into explaining what is considered integrative and functional medicine. The integrative component really focuses on the collaboration and communication between professional and patient, but also incorporates other professionals and modalities in order to achieve optimal health, healing and wellness. It is a holistic approach, individualized for every unique person’s needs. As an example, the recommendations regarding protein or fat will not be the same for every person; the type, composition, preparation or even amount will be, and should be, customized based on several different factors.
Functional medicine doesn’t just look to manage or prevent a disease, but takes a deeper look at the root causes, environmental impact, genetic predisposition, physiological, psychological and interdependent factors that contribute to the disease. Internal (mind, body, spirit) and external factors (physical and social environment) are taken into consideration in order to assess the intervention and treatment. These may include Western, or traditional medicine, along with more alternative and complementary care such as supplementing with herbs, probiotics or specific vitamins and minerals, eliminating specific foods, employing certain cooking methods, or using Ayurveda, Chinese medicine, homeopathy and naturopathy, to name just a few.
Putting It All Together
Finally, this leads us to the questions we often hear of who integrative RDNs are and what do we do. An integrative RDN puts all these components together—from the knowledge attained as a registered dietitian nutritionist to the many components of integrative and functional medicine—and combines it to take it a step further and dig a little deeper. Often working as a team, the integrative RDN collaborates with a physician in order to investigate clinical markers, such as specific laboratory diagnostics that may be indicative of a vitamin, mineral, or nutrient deficiency. A specific whole-foods based plan can be developed and specific supplementation may be necessary. For example, would carnitine and creatine help with an autoimmune disorder? Could Rhodiola tea help with cortisol regulation, sleep, anxiety or depression?
Stress-management is also a main focus of exploration. Teaching patients coping skills and exposing them to activities such as physical movement and release through yoga, massage, Qi gong, energy healing, meditation, or simply identifying triggers and creating a plan to address the stressors present in their life is beneficial.
An integrative RDN may recognize that a detoxification program may be appropriate for the individual as well. However, this is not to be confused with the pop-culture definition of a “detox” and detox fad diets. An integrative RDN will explain the phases of cellular metabolism, how the body physically breaks down food, and how a build-up of toxins inhibits optimal function. Ridding the body of excess toxins, cleaning up the diet and resetting the mechanisms during a brief period are only some of the benefits of nutrition related interventions an integrative RDN may recommend. This is done with specific food recommendations, appropriate fluid, movement, and again, a bigger look at the systemic functions; it is not a one-size-fits-all plan.
These are only some of the examples of what an integrative RDN may include in their practice. See the infographic at www.integrativerd.org to understand more about the categories and subcategories explored. Also, take a look at the Integrative and Functional Medicine video for a visual representation at www.integrativerd.org.
Where do you find them? The Dietitians in Integrative and Functional Medicine Dietetic Practice Group, www.integrativerd.org, is a great resource to find out more information or find an integrative RDN like me in your area.
Please call 423-794-5520 to schedule an appointment with our registered dietitian.
State of Franklin Healthcare Associates
301 Med Tech Parkway, Johnson City, TN 37604
423-795-5520 | www.sofha.net
Further definitions can be further clarified at http://nccam.nih.gov/health/whatiscam.
1. Registered Dietitian (RD) Educational and Professional Requirements, The Academy of Nutrition and Dietetics. http://www.eatright.org/ BecomeanRDorDTR/content.aspx?id=8143. Accessed December 6, 2016.
2. Accreditation Council for Education in Nutrition and Dietetics of the Academy of Nutrition and Dietetics. ACEND Accredita¬tion Standards for Internship Program in Nutrition and Dietetics. 2012. Chicago, IL: The Academy of Nutrition and Dietetics.
www.eatright.org/acend. Accessed December 6, 2016.