Nutrition Advice – When is it within your Scope of Practice?
By Tamzyn Murphy, RD, MSc (Dist.)
Giving nutritional advice has landed many health workers on the wrong side of the law. Even medical doctors aren’t immune from the legal and professional dangers of “giving nutritional advice”. Two famous medical doctors: Prof Noakes, a South African emeritus professor, and Gary Fettke, an Australian surgeon, were taken to their respective professional councils with charges of giving inappropriate nutritional advice. After a 4-year arduous and expensive trial Noakes was acquitted on all counts. However, Fettke was found guilty of giving nutritional advice out of his scope of practice and was banned from speaking about low carbohydrate nutrition, until the verdict was appealed and finally rescinded. Even though these doctors were found innocent, the ramifications of offering unconventional nutritional advice was inconvenient, expensive and traumatic. If can happen to doctors, how much more might other health professions be left quaking in their boots with fear of far worse consequences, when telling their clients or patients what to eat – especially if this advice deviates from conventional dietary guidelines.
Undeniably, “unconventional” dietary advice (like low carbohydrate high fat – LCHF) may be the most effective for a given patient, and therefore indicated. Dr Neville Wellington explains, “nutritional advice should match reality. All nutritional advice needs to be backed up by data, whether scientific or real-life for the patient. If the nutritional advice [conventional or unconventional] of anyone (doctor or dietitian) is not actually improving the health of the patient, then they should re-visit their advice.” However, even when this unconventional nutrition advice is evidence-based and is improving patient outcomes, it’s likely to draw the attention of complainants – those unfamiliar with the evidence-based benefits of LCHF. Also, in certain clinical conditions, nutritional advice may require considerations supported by a higher level of specialised training and evidence, to ensure safety and efficacy. To avoid trouble and optimise the safety of your patients or clients, it’s important to know when you can and can’t advise them about nutrition.
Luckily the rule about when you can give nutritional advice is quite simple…
- Dietitians and doctors are the only health professionals who are allowed to provide nutrition advice for the THERAPEUTIC TREATMENT OR MANAGEMENT OF DISEASES OR CONDITIONS.
Dietitians are qualified and registered health professionals, with a minimum of a 4-year or a 2 year post graduate degree in human nutrition and dietetics. During this degree they are trained in assessing, diagnosing, and treating various medical conditions using individualised nutritional prescriptions – called Medical Nutritional Therapy. While doctors spend far less time on nutrition during their degrees (sometimes as little as 1-2 weeks), they are specialists in the therapeutic treatment of disease, and thus are also qualified to therapeutically treat/manage diseases using nutrition.
- Other health workers or health professionals, including nutritionists and nurses, are only allowed to provide nutrition advice in so far as it pertains to PREVENTION of disease and PROMOTION of health.
For more information about a dietitians’ scope of practice see the Health Professions Council of South Africa’s ACT 56 or 1974. Compare this with a nutritionist’s scope of practice from the Board of Healthcare Funders here.
So, if you are not a dietitian or doctor ensure that the nutritional advice that you are giving is NOT for the treatment of a disease or condition (e.g. metabolic, cardiovascular or neurological diseases, diabetes, cancer etc.). Instead, your nutritional advice should aim to PROMOTE better health and PREVENT diseases and conditions.
The Nutrition Network will be launching an online training designed specifically for Dietitians and Certified Nutrition Specialists on the topic of LCHF/Ketogenic nutrition, LCHF for Health Promotion & Medical Nutrition Therapy. The course has been curated by the Nutrition Network Dietitian Tamzyn Murphy, and is supported by a group of world-class experts in this area. It is set to become an essential part of the tool kit and training for all dietitians globally.
Jayne Bullen, Managing Director of the Nutrition Network: “My heart goes out to the many excellent and meticulous dietitians I know and have visited as a patient in my decades of tackling my own metabolic disorder. Of course, at times I felt angry at their advice which I took seriously but didn’t work. Now, having a deep understanding of the science behind hyperinsulinaemia and its root causes, my perceptions have changed. Dietitians following the current suggested low-fat high carb diets will struggle to effect positive results over the medium to long term for their patients, despite having the best intentions. The root cause is simple: we know that extreme caloric restriction works for those who are insulin sensitive, but that this is not sustainable for the medium to longer-term, even for those who are not struggling with the various stages of metabolic disease. Low-fat foods, which in nature are loaded with fillers and often sugars and carbohydrates, do not satiate and rather cause an insulinogenic response, making patients hungrier quicker and more likely to struggle to adhere to the diet long term.”
It is time to include carb-restriction in your offering for the benefit of your patients and the Nutrition Network can’t wait to support you on this journey!
Dietitians & Certified Nutrition Specialists may pre-register for the training by following this link: www.nutrition-network.org/
Register before 1 November 2019 to qualify for the Early Bird discount!