Are dietitians and nutritionists the same? If not, what is the difference between them?
The dietetic approach
Dietitians are registered healthcare professionals that can treat named medical conditions. Only those registered with the statutory regulator, the Health & Care Professions Council (HCPC) can use the title of Dietitian/Registered Dietitian (RD).
Dietitians can prescribe some medicines e.g. insulin, through Trusts/Health Boards. As such, much of their work is spent advising/counselling other medical staff as to the best course of action with an individual’s nutritional status.[1]
Members of the British Dietetic Association (BDA), in association with the National Health Service (NHS), give recommendations such as eating regular meals, not skipping meals or eating late at night, eating slowly and chewing food thoroughly and taking regular exercise and relaxation. They also recommend certain changes in diet based on your symptoms. These include reducing fibre and resistant starch (e.g. whole grains, nuts, seeds, and potatoes) if you are suffering from wind and bloating, increasing fibre and wholegrain if experiencing constipation, and avoiding caffeine and alcohol.
For IBS specifically, while the BDA guidelines mention keeping a symptom diary. They also make it clear that, while symptoms may be related to food consumption (and therefore food allergy), true food allergies are rare and unlikely to cause IBS. However, whilst IBS symptoms could be caused by food intolerance, dieticians tend to recognise food allergies (e.g. nuts, gluten) more than they do food intolerances. As as result they advise against avoiding major food groups, such as wheat and dairy, to prevent deficiency of vital nutrients.
The nutritional therapy approach
Nutritional Therapists (NTs) understand that chronic inflammation plays an essential role in all chronic illnesses. Certain foods and food groups can cause or worsen inflammation in some individuals. This may lead to allergies and intolerances. NTs do not provide medical diagnoses or treatments, but rather they support the underlying health of your body so that it functions better. This support includes both nutritional and lifestyle advice and may include the judicious use of dietary supplements and, if necessary, functional testing. The result is an individualised treatment plan designed to improve your overall health and wellbeing.
A nutrition plan from a nutritionist is usually based on whole, unrefined foods. Natural foods contain a wide variety of complex phyto-chemicals and enzymes, which makes them healthy for you. Water is treated as a separate group from drinks, with a recommended daily intake for adults of around 1.5 litres per day.
Dietetics science
Dietician advice is based typically on a database source such as the Cochrane Collaboration Bandolier. These databases provide clean, simple conclusions for given interventions based only on randomised, controlled trials.
As such the science behind dietetics fails to capitalise on the rapidly evolving sciences of molecular genetics, evolutionary biology and systems biology. Conversely these developments the scientific framework for functional medicine (FM), the scientific and clinical practice discipline that underpins nutritional therapy.
Nutritional therapy and functional medicine
FM originated in the1990s in the USA, when medical doctors, researchers and naturopathic physicians combined to initiate a new healthcare model. Their aim was partly the complex, chronic diseases that represent substantial burdens on Western systems. One of the things that makes FM different from conventional medicine is its emphasis on treating the whole person, not just the symptoms.
Conventional medicine, such as diagnosing and treating diseases, is often focused on one particular aspect of health. Whereas functional medicine takes a holistic approach, looking at the whole person and their lifestyle. Great efforts are made to establish rapport and a collaborative relationship between the patient and the practitioner. This can differ from conventional medicine where very short consultation times make this impractical.
The evidence for functional medicine
There is an increasing body of scientific evidence supporting particular FM approaches. But the focus of FM is not on developing a specific treatment for each patient. Hence, FM puts great importance in identifying imbalances in a metabolism, as opposed to diagnosing diseases. The latter has been claimed exclusively by orthodox physicians via regulatory systems throughout most parts of the Western World.
This holistic approach to healthcare, championed by Functional Medicine (FM), seeks to understand the root causes of a patient’s health issues rather than merely addressing the symptoms. By examining lifestyle, environmental factors, and genetic predispositions, FM practitioners aim to tailor interventions that restore balance and promote optimal health. This patient-centred care model contrasts sharply with the traditional disease-centred focus of conventional medicine. As such, FM offers a more comprehensive strategy for managing chronic conditions, which are often complex and multifaceted. The emphasis on prevention and a deeper understanding of the patient’s unique health profile underscores the potential of FM to revolutionise healthcare, making it a vital complement to existing medical practices.
Conclusion
So what’s the answer to the question should I see a dietitian or a nutritionist? Well, there are clear differences between the approach of dieticians and nutritional therapists. That said both use evidence in a rigorous fashion and neither base their advice on personal opinions or beliefs.
Nutrition and dietetics are two different theories and approaches to achieving some order in the complex area of human nutrition.
In the long run we shall see which approach proves to be the most valid and effective. Meanwhile, we encourage prospective patients who are interested in our services to contact us to discuss their health needs and hear more about approach.
[1] Source: bda.uk.com
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Posted by Tracey Randell | Lead Nutritional Therapist specialising in IBS and other gut-related issues.
