Ask Dr. Cheryl

Topics discussed in this episode:

• Who are the experts in nutrition? (0:34)
• Why Dr. Cheryl pursued a Doctorate in Clinical Nutrition (4:18)
• Limitations in the current system of nutrition counseling (5:35)
• Approaching nutrition and health from a realistic mindset (10:53)

Transcript:

Welcome to The Wellness Table. I'm Dr. Cheryl Bothwell. And on this show we're going to talk about nutrition, longevity and lots of other fun things. But today on the show, we want to talk about one of the questions I'm asked so often is what's the difference between a nutritionist, a dietitian, and what's a doctor of clinical nutrition? So today we want to answer those questions.

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So the topic of what's the difference between dietitian and nutritionist and a doctor of clinical nutrition can be very confusing to people that are searching for care and wondering, how do I get nutrition information and who do I go to and who are the experts of nutrition. And we certainly know that that wouldn't be your physician.So that's not their specialty. And we hear the physicians themselves talk about that. They are not trained in nutrition other than one basic course in nutrition that happens during medical school. But they really are experts of physiology and biochemistry. And so from that sense, when we talk about physicians don't have all the training in nutrition, then I'm going to come to their defense and say, But nutrition, really, when you do a bachelor's degree as a dietitian, it's really chemistry and biochemistry type major is what you have. So that's the similarity in medicine. And so there's a real foundation in how does the body work and what's metabolism like. And the dietician goes deeper into digestion and then we go into therapeutic diets and that's where the physicians don't go as much into Is that therapeutic diet and what's that look like if somebody has this condition or post-surgery, what's that look like?

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So if we were going to differentiate between if somebody, say, had a bachelor's degree in nutrition or if they had a public health degree in public health nutrition, but they're not a registered dietitian, then the difference would be that they they could have learned all of the mechanism, the biology, the physiology, all about nutrition in the body. But when it comes to patient care and the therapeutic side, the registered dietitian is uniquely trained to therapeutically treat disease from that nutrition knowledge.

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So they take that knowledge and move it into patient clinical care. So they're really the clinician. So if you're looking at a registered dietitian and so in the field of registered dietitian and me, I'm a registered dietitian, the challenge has been who's a nutritionist? So a dietitian has we've just now taken on that. I am now a registered dietitian, nutritionist, and we have moved from R.D. to R.D.N because registered dietitians want to own that word nutritionist because it's been so confusing. But technically, anyone can call themselves a nutritionist, and that's the news that makes it so confusing. So I can call myself a nutritionist. If I took a course, if I went into the naturopathic world, if I went into public health, I had some nutrition classes, I could technically say that I am a nutritionist. So that word is not I would just say branded as I think of a company like I can't call myself a physician if I haven't passed the medical boards. We protect that. But nutritionist is not a protected term. So what I would say to you is the simplest thing is that a dietitian will never call themselves a nutritionist. She's going to say that if you see the word nutritionist, we will always say, I'm a registered dietitian, nutritionist, and we've just added that word so that people can feel like I'm looking for a nutritionist. And we just kind of added into registered dietitian. So that's what that's a bachelor's degree. And soon in 2024, to become a registered dietitian is a master's minimum level trained. You've done all of your nutrition training, chemistry, biochemistry, physiology, you've done your clinical hours, and you have a master's degree minimum as of 2024. And what I did was from all of that, I loved all of the training and I love being a student.

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And so I went on then and I pursued a doctorate in clinical nutrition. And to have a doctorate in clinical nutrition, you have to be a registered dietitian. So after I became a registered dietitian passed, the boards began to practice. I was so excited. I'm like, my dream was to become a registered dietitian and to just help change the world in the way people age and use food as the medicine and look at what is every single type of food we can eat to have a medicine like effect.  And that was my challenge. And then I began to see real patients. And I remember the first person that walked in the room after I was registered and I was registered dietitian passed my boards and I'm ready to see my first patient. And I had done a lot of public health, community and health education, and I was a cookbook author. So I'd done a lot of book signings and a lot of public speaking things. But now I'm like a registered dietitian and and I can really talk to someone that has diabetes and here's your diet and even get insurance reimbursement for doing it. So I'm like, this is the moment. This is my exciting time. and I started to look at individual counseling and I began to see the challenges of, oh, there's only like six visits they have left or, you know, the insurance model. Unknown And we've talked a little bit about that, where there isn't time for the dietitian to really now I'm talking about in the outpatient model and the acute model, we see a dietician within 24 hours. We have all the rules of what a dietitian has to do.

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So to have nutrition education paid by your insurance company, what I was finding was like, oh, this patient had 70 pounds of weight to lose, but they needed to have 100 pounds of weight to lose to meet the criteria for insurance reimbursement. So in nutrition counseling for weight loss wasn't covered unless somebody was 100 pounds or more overweight. And then there was still a limited number of visits. That became very frustrating to me because I felt like this person needs more. Okay, I'm past the number of visits, but they still need me in their life. This is a lifelong wellness journey. Eight visits isn't going to be enough to like change your whole life and be like, What am I going to do in two years? And we start to see why are people, 90% of people, when we put them on a behavior change something in their lifestyle or whatever of food that they need to eat, 90 to 95% have gone back and stopped doing that healthy habit. After two years, only 5% continue. So this is a very high fail rate and this was my profession.

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So I'm looking at how am I going to change and change, make life long lasting change in people's lives. And so as I began to see the complexity of asking people to stop eating things because I'm all over, well, we can't eat that. We shouldn't eat that. This is bad. Okay, that's a really bad food. Oh, if you have diabetes, you can't do that. And that was my training and I began to see that these were real people. And I'm asking them to give up foods that they absolutely love, foods that, celebrated family or on my birthday. This would be a big question, what am I going to do if I can't have my birthday cake and I have diabetes? I mean, their quality of life and their mind and their happy factor, I was taking it all away. So either they're a force with a choice of either manage my blood sugar and be good and come in and they'd walk in the door and say, I was really good this month. That's how they'd meet me at my visit. And I feeling like, someone they have to report to. It's like a probation officer, you know? And I did all the things I'm supposed to do, and if they didn't do it, they'd skip the visit. So I began to see this is like a really messed up system where I'm the guilt trip person. And so if I haven't done good, I don't go. So I stopped my visit, and if I did really good, they show up proud and they want to star. And we did so good. And you should have seen what I did. And I lost 10 pounds and all. It's like a celebration. So we're either celebrating or skipping a visit. And I'm like, the people that stopped coming became my challenge. And when we talk about this, this is something I'll say when it comes to what we see on social media or health influencers or these diets that people say are so successful. And I'll often say, but in that in that platform, do you know how many followers stopped doing what you were doing? Are you tracking the quit rate? And so I began to see like how many people stopped attending because those are the people I want to help and yet the people that were doing perfect, was I making them happier or was I just putting them on more of a guilt trip so they did better at being self-disciplined and tortured, doing things they hate. So I just felt like something was really messed up and I needed to do something different. So I began to look at what was the research that was out there and is there any more I can understand about nutrition to maybe motivate people more?

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So what I found with nutrition was that it was really I wanted to be cutting edge. I wanted to know the latest studies and what they meant. And is that study accurate and why is there so much inaccuracy between, let's say, is is coconut good or like right now, is coconut bad? Like, oh, and then we see the shelf a third of the of the sale selling of let's say, coconut water drop when a study comes out in this report on the news. And then I look at that study and I'm like, do I understand that study? And are we listening to somebody else interpreting that study in? Did they understand nutrition? Who interpreted that study and who funded that study? And that's what led me to I wanted to know more. I didn't want to ask, you know, my husband at the time, Dr. James Peters, you know, two doctorates. I was called him the double doctor. And I would just say, is that a good study? And he had a epidemiology doctorate. So I'm like, is that a super good study? Is that accurate? And I just got to the place that I didn't want to look at my audience. And when they'd asked me what I recommended, I'm a registered dietitian, nutritionist, and I'm still asking more questions. And so that's why I pursued my doctorate in clinical nutrition at Rutgers University and spent seven years deep, deep, deeper than I ever thought I ever wanted to go to understand research and also know how to actually do my own study and my own original work that I could really understand the statistics and how it works, and is that the right statistical formula? And is a study good or not? And then having done my own studies, knowing, oh wow, I can see the missing pieces and it all began to make sense. And that journey really changed me. So I took my clinical experience that I had with real people who were struggling with what do I do on my birthday? Or what about Thanksgiving or What will I eat for Christmas? And, you know, do I go? They're totally deprived. And I started out teaching them, you know, I just fell right into what dietitians what we taught, you know, like, okay, well when you go try to go fall and try to eat, you know, and I came up with let's get two apples before, you know, 30 minutes before you go somewhere that you're not going to have control of what you eat.

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And yes, that works. You know, and there are different tips and things, but ultimately, it's like me encouraging you to restrict. And I took that experience and tied it with understanding, nutrition and the research so I could answer the questions about, is this food healthy for me? And beginning to change the narrative where I wanted to walk on this journey with you being myself real, what do I really do? And not act like I got this all figured out? I'm living in the real world with you, and I face birthday cakes and I face I like that ice cream at night. I live in that world and I love food and I love cooking. So as I look at this, I feel you. If we're sacrificing taste. I voted to live ten years younger. I'm in that club. If we have to give up all flavor for the rest of our life, I want to shut her down ten years earlier. But I never thought about I could get a stroke and be debilitated. And then I'm like, Oh, well, maybe I'll rethink that. But overall I was in the club. That taste trumps everything. So I want you to know that I feel that. So I'm in this journey with you. I don't expect perfection, but I mostly want us to feel like we're in a judge free zone. And when I was it take ten and when I sat in the clinics across 4000 patients that I saw during that decade and I would see every group, there was the same types of people, the people that wanted to be perfect, and they had that inner judge inside of them that said, You're good when you didn't eat that birthday cake, now you're good and you're bad because you ate it, or I'm better than you because you ate it. And I watched you eat it and I skipped it or I lost 10 pounds and you gained 10 pounds. Like this whole thing of watching people. And we see it in social media body image as a whole. Another thing that I really want to talk about, but just accepting our bodies, natural blueprint, our DNA blueprint, but being as healthy as we can be and what society wants us to look like and how do we fit in that.

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I was surprised how many people would come in and visit me, and their goal was to lose 10 pounds so that they could be happier, so that their husband would love them more, so that they would be more attractive and these are very sad things to me because it's like, can we just love ourselves and what our body is and just healthy? Isn't this static moment that I lost my 10 pounds happiness, I lost the 10 pounds healthy is I got the blood pressure to look good right now. I might have taken the medicine to do it, but it's all looking good right now and I'm feeling like I can go to the beach and feel proud of myself. And I've been exercising and I went to the gym. But are we really happy and are we really as healthy as we can be today? And that's my heart for you is to be a real place where the cutting edge nutrition that also seeing you as a real whole person and what's the healthiest we can be today. And again, that takes me back to The Score. These are the ten healthiest foods that ten habits that we can do every day, that we're doing healthy, where the healthiest we can be. We weigh our best weight that we can weigh today because we ate the very best. And as we get into this, we can begin to relax, enjoy life, be present and start erasing that inner judge that says we're good or bad and just be in a safe place where begin to enjoy, love each other and support this journey and know that it's not about a diet, it's not about restriction, it's not about I ate that cake. So now I'm bad. It's all about let's do this all together. It's a lifelong journey, and every day we start as a new health journey. Day.

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One thing I wanted to add to and we talk about nutritionists is it's not a protected word. And so anybody can call themselves a nutritionist that studied or had a few nutrition classes or taken a certification can be called a nutritionist. So it's one of the reasons why you will not see a registered dietitian just refer to themselves specifically as a nutritionist. But what I've found that's changing a little bit, that's more in the clinical world. But what I'm finding, like in the in social media and as we start to see more health professionals like myself moving into podcasts and YouTube and things like this, people are searching. So if you go into a Google search, they're searching nutritionists. And so if they're searching for that, the dietitian wants to show up. And so we have not wanted to call ourself a nutritionist, but we find that if I want you to find this podcast, I need to put the word nutritionist or you're not going to find it. So that's been a little bit of a challenge for registered dietitians to sort of cross that line. So when you talk about who I am or what I am, I'm a doctor of clinical nutrition, which is really a whole nother baby from being a dietitian. I look at them as they're all nutrition, but very different. If I wasn't a registered dietitian, I wouldn't be as strong as I am. It all builds to becoming great as a doctor of clinical nutrition, but the doctor clinical nutrition, I would assign it more as more of a Ph.D. style where it's research statistics, not as specific. I did my residency as well in my original research. So my residency we talked about with the blood pressure, and I work with cardiovascular disease. doctor of clinical nutrition, it's clinical and research doctorate, and it was everything I wanted it to be. And that's where I created My Score. And I was able to do the statistical research of The Score. But one of the things I want to say then that can be so confusing is that we're seeing and we see it, especially in California right now, is that the doctor of chiropractic medicine that chiropractors are looking for their niche.

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And so in California, they're going after nutrition to be their niche. And it's one of the reasons they created a professional doctor of clinical nutrition because we didn't have a doctorate specifically that was for nutrition. So it was opening the door for chiropractic medicine to come in and take that nutrition side of it. But when we look at nutrition, the way they're looking at it is they needed something to augment because there's not a lot of money in chiropractic medicine. And so I look at it from a business side that they began to sell supplements. And so that's where we saw supplements being sold. And now we see a lot of health influencers, chiropractic doctors across practiced medicine, doing very well online, explaining, you know, they've they've learned physiology of the body. They are not registered dietitians. They have not specialized in nutrition, but they're very interested in natural care. And even DOs, doctor of osteopathic medicine, I find them to be they went, you know, there's the M.D., the medical doctor, there's the D.O., doctor of Osteopathic Medicine, and then there's chiropractors. And I find that the docs in the chiropractors are much more interested in natural ways to heal using less medicine, but they have focused on using the spine manipulation to do that. And this is just my take on it. That isn't enough. So they had to start moving to where real stuff happens. And again, I'm a little biased because I believe it's all about the food, but when we start moving to nutrition medicine, we'll start changing the lives of our patients. So no matter who you are, if you start asking your patients to start taking a supplement when they weren't eating healthy, they might feel better and then they'll start coming back to you more.

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And then again, remember we talked about like, I can't get you to come back to my patient visit. Well, with chiropractic medicine, I need you to return. So you'll return to get more supplement all your return to if you start to feel better. If you're not doing better from my care, I probably won't see you again. And so when we're in those care of prevention or treatment and using natural treatment, you're going to find a lot of shakes, a lot of bars and supplements being sold because how will we monetize nutrition medicine or nutrition education? We don't have a way to monetize it because people don't have the money to pay. A lot of people don't have the money to pay for nutrition, education, so we can use a supplement and that can pay for your visit. So again, I want to come back to you. If you're selling supplements, if you're selling bars and I'm, you know, do whatever anybody has to do, if you're helping people, it's great. But a chiropractor is not a nutritionist. They could technically call themself that. But we're really hoping to wrap up that word and identify it. And the registered dietitians are really saying we do need to own that word. So I just want to say that part of it, that it can be very confusing, but there's lots of good people out there that want to help. And I want us to all come together, not isolate all of us, but whoever cares about real nutrition. If you're a physician, if you're a nurse practitioner, if you're a chiropractor, if you're a D.O., if you're a registered dietitian, if you're a health influencer, let's just get on the same page so that we're not against each other. But let's think about how we can help people and give good, trusted information that's based on science and real life people with clinical experience.