A new Senate bill introduced last week by Sen. Jeff Merkley (D-OR) called the “Older Americans CARE Act” provides funding for programs that support the elderly. The bill states that those services can be provided by “a nurse, registered dietitian, case manager, health coach, or social worker.” As introduced, “nutritionist” is not included in that list. However, after being made aware of the oversight, Sen. Merkley’s office has vowed to add nutritionists when the bill is reintroduced next year.
Under the current bill, only registered dietitians would be eligible to provide medical nutrition therapy (MNT) to patients for the management of chronic disease. Any federal legislation/program that creates a monopoly for dietitians, especially in connection to MNT, should not be supported and ANH quickly put out an action alert calling attention to the issue.
We would like to thank Sen. Merkley and his staff for their timely response to our concerns and understanding of the issue.
Registered dietitians continue to try to carve out unique privileges for themselves, as we saw when we lobbied to amend the Treat and Reduce Obesity Act. We found that particularly galling because the dietetics lobby receives funding from junk food companies like Coca-Cola, Hershey, Council, Mars, and PepsiCo—the very agents of the obesity epidemic. Furthermore, they have conducted continuing education courses sponsored by Coke in which RDs are told that sugar, artificial colors, and nonnutritive sweeteners are perfectly fine for children, and concerns to the contrary are merely “urban myths”!
Any legislation on the state or federal level that excludes nutritionists is at odds with other federal laws. As the Board for Certification of Nutrition Specialists said in a letter to Sen. Merkley:
- Medicare recognizes “other nutrition professionals” as providers of MNT.
- “Other nutrition professionals” are recognized in the Affordable Care Act, and are recognized by a growing number of states.
- The Centers for Medicare and Medicaid (CMS) ruled in May of this year that qualified nutrition professionals be recognized as equal to registered dietitians in eligibility for hospital staff appointments, and for prescriptive diet authority in hospitals (in accordance with hospital policy and state law).
As you may remember, ANH-USA alerted you to the sneaky insertion by the dietetic lobby into draft CMS rules that hospital diets could be ordered by registered dietitians (RDs)— but not by other highly qualified nutrition professionals. Thanks to your messages and our official comments to CMS, the final rule was changed to recognize equally or often more qualified nutrition professionals alongside RDs.
Nutrition professionals are right to demand equal and fair treatment in all legislation, and we thank Sen. Merkley’s office for their efforts to understand the issue and commitment to make changes to the Older Americans CARE Act.
*Editor’s Note: This article has been updated since its first appearance on 9/2/14. ANH-USA commends the efforts of Sen. Merkley’s office to correct their initial oversight. The corresponding Action Alert has been taken down, but we remain vigilant to protect the role of nutritionists in today’s health care system.
sounds about right…just like the patients and the caregivers in Colorado have been excluded from the medical marijuana rules. No one to mention what’s moral, what’s harmful, unconstitutionality–no ‘we the people’ don’t matter…..
Since you have no peer review governing body, I’m glad that there are registered dieticians giving
appropriate advice to patients. Registered dieticians are accountable to their governing bodies.
All licenesed to diagnose professionals should be included I.e. chiropractors, who always have done natural healing, long before governments have tried to put in a box.
Don’t forget, health coach is listed as a provider. Many nutritionists as well as registered dietitians hold a certification as a “health coach”. It is not a difficult certification.
Health coaches can provide nutritional counseling but not nutritionists? now that’s just crazy.
It’s hard to keep abreast of all this news, consisting mostly of attacks on beneficial groups and treatments by profit-motivated groups not greatly concerned with the good of the public — and our own government being so influenced by them. The news is depressgin. When I was younger — that’s quite a while ago! — I never dreamed that our government and associated professional groups would or could be so corrupt. Even allowing for youthful naivete, the direction we’ve taken as a nation is deeply distressing to me.
The food pyramid that I grew up with, turned out to be all wrong. Luckily, I was able to auto-reverse on my own. I was diagnosed with diabetes, and quickly realized that a diet of 50% carbs, 25% fat and 25% protein, was the wrong diet for me. I did this by eating and testing and eating and testing, to find out what foods were doing what. I found that foods containing white flour, as well as high carbohydrate starchy foods, were sending my glucose #s through the roof. Today my diet contains mainly protein and good fat, and lots of green vegetables. My glucose numbers are now within normal range. Many elderly people do not eat well because they don’t have the finances to eat well. Eating healthy can be costly. Taking advice from individuals who are tied to companies that produce junk food, can be much more costly!
Just know that funding of educational seminars by Coke, Pepsi, Mars, are not supported by many 1000’s of RD’s.
Please refrain from grouping all RD’s into a group of ignorant chemical loving unaware professionals that promote commercialized processed foods to all people. While that may be a segment of this professional organization, many scientific findings about whole unprocessed organic foods are being recognized and implemented as superior with many beneficial health outcomes.
I and many RD’s could highlight many poor nutritional practices promoted by ” nutritionists”.
If you want inclusion, prove worthy at a professional level, but don’t tear down a profession that can run circles academically and practice wise around many self proclaimed nutritionists- 500 of them that were grandfathered into the Florida nutrition act in 1989 with minimal to no academic training and recognized degree. Many MS and PhD nutritionists that have strong science backgrounds should be included, just as all RDs seem to bunched together showing you know very little about the diversity of this group, nutritionists are grouped together with many making a bad name for all as well.
cannot respond to action alert on SB2763. someone is directing to another site and I cannot get your response page to stay on screen
Looking into it. Thanks for your feedback!
Unable to take action. Page disappears immediately, in favor of a Yahoo Search Page for Convio. Check it out. Is there any way to contact your Home Page/Support?
Thanks for letting us know! We’re looking into a quick fix right now.
To be a dietician requires at least a 4 year degree in Nutrition and Dietetics and generally in the US 1200 hours of supervised practice.
Nutritionist is a title that can be claimed after a short course or even self proclaimed.
For giving some advice down at the gym on how to improve someone’s diet, a nutritionist might be sufficient. If we are talking about medical care it is absolutely appropriate to require providers to be professionals with credentials such as a registered dietician.
Actually, in many states to legally be called a Nutritionist one needs a Masters of Science in nutrition, to pass a board exam and to have 1,000 supervised hours of experience before a license is granted. That makes nutritionists more qualified to give nutritional advice than some RDs.
Be careful what you wish for – you might get it good and hard!
Federal funding for anything will inevitably be accompanied by strangulation by Federal regulations.
If nutritionists were authorized to receive Federal funding under this bill, you can be sure the funding agency would soon specify onerous unscientific requirements for one to become a “Registered” Nutritionist.
Those who became “Registered” would soon have to forgo their freedom of speech. “You can’t recommend 4,000 IU of vitamin D and 2 grams of vitamin C per day to that Medicare/Medicaid patient! That is felony health care fraud under Federal regulations!”
Stay independent, free, and legally able to speak the truth to those who you care for.
Shame on those who would allow this… we are not all sheep in this world you control…we are watching you
Please include other nutritionists in the Older American Care Act. I have learned more from other Nutrtion Specialist than from Registered Dietitians. The RDs that I have known do not understand about food sensitivities. These other nutrition professionals are open to broadening their knowledge base much more so that RDs. If it were not for them I would be very sick today and not on the road of getting healthier every day.
Thank you. I am 74 yo.
It’s impossible for anybody to be an expert in all things related to nutrition, but to suggest that RDs don’t know about allergy and food sensitivity? I’ve been working in this area, as a dietitian, for over 20 years now. And, I’m not at all happy with AND partnering with coke, cargill and such. The majority of RDs I know agree with me. It’s no longer “our” organization, and I and thousands of my RD colleagues do NOT agree with them. But, regarding elder care – how many non-RD nutritionists are well versed in sarcopenia, malnutrition, renal disease, Tube feedings and TPN? As to nursing home residents “starving” – I’ve seen it, as an RD employee, and couldn’t do a thing about it, unless the owners, that earned millions, would agree to hire more aides to assist with actually feeding residents. The non-RD “nutritionist” that got “moved up” to mgmt before me was responsible for allowing residents to starve, not realizing that you have to actually LOOK at a resident before you chart progress notes.
Or the LTC I worked in where the DON refused to give supplements ordered.
Regarding Nutritionists, it might be helpful to remind the Senator who wrote this piece of legislation, that there is an importance to Nutritionists as evidenced by their pre-eminence inclusion in the North American Free Trade Agreement jointly written and approved by the US government. The exclusion of this profession is a travesty since Nutritionist are included as a Medical/Allied Professional in this legislation that has North American recognition and approval.
So let me get this straight…the folks that brought us “hospital food” are now going to be in charge of nutrition for the elderly? Doesn’t anyone remember visiting grandma in the nursing home, or school lunch? Dieticians are the folks that learn about the cleanliness of the red quarry floors in the kitchen and their entrance exam includes questions about the jello not setting properly in the fridge. Please, a little sanity is called for. Just look at the advertisers in the dieticians journals. Shame…
this is the type of thing that will be the death of us all !! for what ever reason this was done is so so wrong !! fix this yesterday !!
They are afraid to find that many, many Americans are slowly starving to death. Then they will have to give us more to eat and they don’t want to.
I urge Senator Merkley to amend his own bill, the “Older Americans CARE Act,” to include nutritionists as well as other recognized holistic health practitioners.
I agree with this. Yes, I have many colleagues who are great with functional nutrition, but I find when it comes to MNT, RDN’s are better trained. I find that most nutritionists who are not RD’s have not been trained to treat such conditions as renal failure, for example. If someone is on dialysis, I know that I have received the training in school as well as in the medical setting of a hospital to counsel someone. RD’s are also familiar with labs and medications. Does a nutritionist have the knowledge or training to order an intravenous feeding or an enteral tube feed? Do they know about surgical diets? Are they familiar with various types of insulin or diabetic drugs? I am not saying that they are not beneficial, but MNT is much more complicated!
Frankly, I am a big fan of functional medicine and nutrition and incorporate it into my practice. I also have many colleagues that are not RD’s that are great but they also know to refer clients to me when it is beyond their scope. I always value the training that I received in the hospital setting both as an intern and many years working as an RD. The knowledge I received was an integrative part of who I am as a “nutritionist” today.
I also find that the constant attack on RD’s is so uncalled for. Although I am not always proud of the AND’s corporate alliances, I am also grateful for what I have learned and continue to learn through this association. I am also grateful for my training to be an RD through the many years of school I attended to earn my MS and the training and education I received in the field.
I can understand your concerns, but find it very negative and very narrowly focused. To attack all RD’s and the AND is distasteful. There are many doctors out there who are practicing differently than the mainstream, but I don’t see the attack that I see from your organization. They are still part of the AMA.
Personally, I don’t feel anything productive can come from so much negativity.
Thank you for the opportunity to share my views and I wish you all the best.
Diane Giammarino, MSRD, CDN
NY
Diane Giammarino, thank you for your well reasoned comment. I respectfully disagree and I ask that not take the following personally. I am sure you and most if not all other RD’s are honestly helping people every day, but perhaps I can show a slightly different perspective with an example. My wife was a type 2 diabetic for over 40 years. ( She Died at age 69) Toward the end she was in the hospital for a failed fistula as she was on home dialysis. She also had recovered from heart failure (Ejection Fraction measured at 28 – after recovery 60) She had tachycardia for many years caused by an over prescription of T3 thyroid hormone.
One morning the hospital brought her breakfast – dry cereal, low fat milk, egg beaters, applesauce, toast with imitation maple syrup, and black coffee with non dairy creamer and no salt. She asked for the dietitian. The dietitian said this was a proper diet for her condition. My wife replied, I have diabetes, I am told not to eat sugar. I have kidney failure so I am told not to eat protein. I have heart problems so I am told not to eat fat, so exactly what am I supposed to eat? The dietitian’s mouth fell open. She was silent for a long time then she replied, ” You do have a hard case.” Shortly she left the room without giving a reasonable reply. When we asked the doctor, he replied it is a feee country so I went out to a restaurant to get real food.
Many years earlier we had learned together: 1 – There is no science behind the low fat diet for heart disease. It was/is a bad theory that has never been proven in real life. All the science is comparative research shows association not causation. 2 – Fat does not make you fat. The fat intake into the body is tightly regulated. Too much fat and you throw up. 3 – Saturated fats raises HDL cholesterol (the good kind) and makes LDL large and fluffy so saturated fat is not the boogy-man of heart disease.In fact we have as a society so lowered our cholesterol that the majority of heart patients die with normal or low cholesterol. 4 – Carbohydrates are the only food substance that causes blood sugar to rise and require insulin to lower it.
For these reasons, my wife was on a low carb diet and had been for many years over everyones objection and was doing very well for someone with problems of low thyroid and diabetes starting in her youth. She had tried all the medications and insulin but all those did was make her fat. She tried the low fat diet and…
As a board certified traditional naturopath and chair of the 50,000+ member Texas Health Freedom Coalition (www.texashealthfreedom.com), I have strongly believed, for many years, that we are arguing about the wrong issue here.
The tiresome chest thumping on the part of the AND, its state affiliates, and its members with regard to professional qualifications totally misses the point.
This is NOT an issue of qualifications, but of demographics and money.
Regarding the former, when you look at the huge numbers of people who suffer from the various autoimmune disorders, metabolic syndrome, diabetes, etc., it becomes painfully clear that no one professional health care community, no matter how well qualified, possesses adequate numbers of practitioners to effectively address a problem of this scope by themselves. Only by broadening the bandwidth of available health care professions to include nutritionists, naturopaths, herbalists, etc. can we even begin to effectively address this problem.
The second issue, sadly, is what’s really driving the direction of the AND. The whistleblower revelations of internal AND communications, which clearly show their monopolistic intent, lays bare for all to see the true purpose of their organizational agenda, i.e., to protect their profession against competition. The mantra of “protect the public” has been overused by the AND for years. Thankfully the public, and many state lawmakers, are finally waking up to this reality. Exclusionary licensing laws are rapidly becoming a thing of the past, and those who continue to espouse them will soon find themselves marginalized in this debate.
Thank you infinite source for leading me to this discussion. We are not separate. One education over another makes no difference. Those of us who truly want to help others improve their health will get the opportunity AND we will be working with clients who are WILLING to take our advice. If it was your grandma or grandpa would you want them in a place where the people taking care of them are funded by the very people who were a catalyst to their illness? We don’t need government funding. All governments all over the world have failed the people each and every time.
PS. I’ll agree however, that just as there are lousy MDs, chiros and nurses – so, yes, there are some lousy RDs out there!
Very pleased to see that Health Coaches, rightfully so, are included in this bill.
This is not acceptable. I have had a great deal more nutritional training, and help people who do are literally ill on the diets recommended by dietitians. After several decades of ongoing and advanced training and the costs of that training, I would be unable to help the population I serve.
PLEASE do not do this!
All Good Wishes,
T. Dietze
Before adding ND’s to the prescribed list of necessities, you may want to consider the fact that the majority of nutritionists still follow the commercialized post WWII theories which base their information not so much on research but on information provided by food manufacturing companies and corporations. Recently, we have witnessed the denouncing of fraudulent information fed for over 40 years to the public on how to eat and what is healthy, I believe we should wait until possibly nutritionists have a better understanding to what a natural human diet is and the fact that every body is different and no one diet fits everyone.