Joan Friedrich, PhD, MA, CDN, CCN, BCIAC New York State Chapter of the International and American Association of Clinical Nutritionists
In the late 1970s, when I first became involved in alternative healthcare, most nontraditional healing systems were unapproved by Western medicine. Traditional institutions did not understand them, and subsequently these methods remained on the fringes of healthcare. Although growing numbers of consumers were beginning to explore these methods, traditional thinkers maintained a firm opposition.
Now, more than 25 years later, the tide of acceptance is finally coming in. In 1999 alone, the scientific community granted the National Institutes of Health (NIH) $50 million to evaluate complementary-alternative medicine (CAM). In 2007 the appropriation for the NIH's National Center for Complementary and Alternative Medicine (NCCAM) was reported to be over $120 million. From this growth it is evident that traditional authorities can no longer ignore the benefits of natural healthcare. As studies supporting nontraditional approaches begin to flood medical literature, former skeptics are changing their views, and once-disparaged therapies are gaining serious recognition. The result is that alternative modalities are being elevated in esteem. They are now regarded as "complementary" or "integrative" therapies-healing methods that can synergistically blend with allopathic, mainstream medicine.
Although the struggles of complementary-alternative healthcare are far from over, enormous strides have been made. Political barriers continue to exist, but many mainstream institutions are attempting to understand nontraditional approaches. As they move forward, many of yesterday's critics are now seeking ways to learn about the very therapies they once refused to accept.
America's Need for Better Nutrition One healthcare area gaining greater recognition of late is nutrition, and the specialty of complementary-alternative nutrition. Twenty-five years ago only a fraction of the population understood the value of good nutrition and nutritional supplementation. Today, greater numbers of people are becoming nutritionally savvy. Close to 50 percent of the population now use nutritional supplements on a daily basis. Whether to ensure adequate nutrition, prevent or treat health conditions, or to optimize health, we now understand why enhancing certain nutrients and using natural products can make a positive difference in health and well-being.
Studies by the U.S. Department of Agriculture (USDA) indicate reasons for this growing trend. Simply stated, our diets are grossly inadequate. Chronic disease accounts for 85 percent of our nation's healthcare bill. Former Surgeon General C. Everett Koop's "Report on Nutrition and Health." (1988), pointed out that diet has a vital influence on health. Five of the leading causes of death-heart diseases, cancer, strokes, diabetes, and atherosclerosis-are all linked to diet.
According to human nutrition expert, Jeffrey Bland, Ph.D., many Americans are "vertically-ill"-not sick enough to be confined to bed, but far from functioning at their optimal health potential. A major reason for this is our lifestyle. As convenience foods become more popular, healthy, nutrient-dense foods are being replaced with empty-calorie foods. Growing numbers of people are out of shape, overweight, and inadequately nourished.
Studies reveal that more than 80 percent of women and 70 percent of men eat less than two-thirds the Recommended Daily Allowance (RDA) of one or more nutrients. Amazingly, government statistics (U.S. Statistical Abstract of 1992) indicate that a whopping 98.5 percent of the U.S. population is unhealthy. Only 1.5 percent of us can actually be classified as healthy.
One thing remains clear. A tremendous need exists for better nutrition and better ways of enhancing wellness and preventing disease. These requisites have created an increasing demand for biochemically oriented nutritionists who are highly trained in complementary-alternative approaches. To meet these demands, a new field of nutrition science began in the 1980s. The first Certified Clinical Nutritionists (CCN) were introduced to the medical and healthcare community in 1991.
Before this date, registered dietitians (RD) were the only credentialed food and dietary professionals. However, the emergence of the CCN provided the consumer and healthcare community with a different type of credentialed nutrition professional, offering a different type of nutrition service.
Although both RDs and CCNs are highly qualified professionals, each provide distinctly different services based on two different types of nutrition research, two different philosophical perspectives, and two different professional orientations.
The Difference Between a Dietitian and Nutritionist An excellent comparison of the dietitian and the nutritionist was made by the International and American Association of Clinical Nutritionists (IAACN ), a professional organization that represents CCNs in all the licensed healthcare fields. According to their informational materials, to understand the difference between dietitians and nutritionists, we must first look at the definitions of "diet" and "nutrition." In the simplest terms, "diet" refers to the foods we eat and beverages we drink, while "nutrition" refers to the biochemical processes that result from food or beverage ingestion.
Let's look more closely. According to Taber's Medical Dictionary, diet is "liquid and solid food substances, regularly consumed in the course of normal living." This can include typical foods such as fruits, grain, vegetables, proteins, and beverages.
Dieticians Dietitians base their approach on dietetic-related research. Some work in academic settings, in industry or in private practice. However, most dietitians provide food and nutritional services within institutional settings (e.g., hospitals, schools, nursing homes).
The major focuses from the dietetic perspective are on calories (energy), quality of food in regard to freshness, sanitation and freedom from spoilage and contamination, meal planning, evaluation of standard measurements of foods, specific diets for certain conditions, and eating patterns based primarily on food groups, such as the food pyramid, and other guidelines based on daily food intake strictly outlined by health organizations.
Nutritionists In comparison, nutritionists are defined by the concept of nutrition. Nutrition is defined as the "sum total of the processes involved in the taking in and utilization of food substances by which growth, repair, and maintenance of activities in the body as a whole or in any of its parts are accomplished-including ingestion, digestion, absorption, and metabolism (assimilation)." Certified Clinical Nutritionists base their approach on up-to-date science in nutrition research based on these concepts. One vital aspect of the CCN's orientation is their highly sophisticated background in complementary-alternative healthcare.
The CCN's food perspective focuses on the classification of food based on nutrient value (e.g., vitamins, minerals, EFAs (essential fatty acids), amino acids, enzymes, and accessory nutrients) of a food in its natural whole-food state. Certified Clinical Nutritionists look at the effects of food treatments (e.g., irradiation, hydrogenization) and chemicals (e.g., pesticides, preservatives, coloring, tenderizers). In addition, they consider how some foods are depleted or altered by cooking (e.g., microwaving, frying), the effects of refining and processing, and how food is actually handled and processed by the body.
A major role of the CCN is to consider how foods are digested, absorbed, and assimilated, and ultimately how food affects the body biochemically. Among the many aspects of nutrition research considered within this context are by-products of digestion, gastrointestinal health, neurotransmitter response, immune function, metabolic shifts and balance, allergic or sensitivity reactions, and systems and pathways of detoxification.
The CCN's approach to diet structure is developed according to what is best for the individual-not necessarily what is a standard recommendation for the general public at large, or for all people experiencing a particular health concern. Rather than strictly advocating a pyramid or food-group-style diet, the CCN will determine the healthiest and most effective program for the individual according to the latest nutrition research and the unique biochemical make-up of the individual.
Clinical Nutritionists and Biochemical Individuality The cornerstone of the Certified Clinical Nutritionist's approach is "biochemical individuality." This theory was originated in the 1950s by biochemist Dr. Roger Williams. Considering the genetic uniqueness of an individual and their need for specific nutrients, Dr. Williams believed that the major chronic degenerative diseases of aging (heart disease, stroke, cancer, diabetes, and arthritis) were related to a lack of proper nutrient support. By providing these nutrients, optimal functioning could be facilitated and premature diseases could be prevented.
The CCN understands this theory and the wide-ranging variability of healthy people with regard to nutritional needs. Each person is seen as having a unique make-up in regard to genetics, endocrine function, digestive efficiencies, stress response patterns, liver detoxification capabilities, and other clinical profiles. Therefore, therapeutic programs developed by the CCN will reflect these variations. What is right for one person may be wrong for another. This applies to both the diet and the supplement protocols.
The Certified Clinical Nutritionist utilizes both classical and current scientific nutritional research. Since they have extensive training in the use of supplementation (often called nutraceuticals), diversified dietary approaches (both traditional and nontraditional), and therapeutic interventions, their programs are highly comprehensive and commonly part of medical nutrition therapy.
Clinical Nutrition: An Applied Discipline Another aspect of the Certified Clinical Nutritionist's approach is the application of current scientific research in biochemistry and physiology. With clinical counseling, the CCN's goal is to promote optimal health and well-being through sound nutritional principles. They recognize that when an individual has a nutritional deficiency, it can lead to biochemical and metabolic imbalances. These alterations can in turn lead to a cascading sequence of events-cellular malnutrition, degeneration, organ and gland dysfunction, and finally, if not corrected, serious nutritionally related diseases.
The assessment In order to correct nutritional deficiencies or prevent deficits, the CCN may assess an individual using any number of methods. Typically, these may include basic anthropometric data (physical state such as height, weight, body composition, blood pressure, and signs and symptoms), medical, diagnostic and family history and medication use, dietary data (including micro and maconutrients), supplement use, and biochemical data. Blood, urine, tissue analysis, and specialty tests such as allergy assessment, gastrointestinal analysis, and other studies reveal further dimensions of biochemical function.
The questionnaire In addition, evaluations often include nutritional questionnaires with as many as 100 or more questions. These evaluations provide additional detail about the person's nutritional inadequacies, possible deficiency symptoms, lifestyle and general health. Like all methods of assessment, they help in determining the type of program best suited for the individual, or if a referral to a physician or other healthcare professional is necessary.
Qualifications of the Certified Clinical Nutritionist Eligibility to become a Certified Clinical Nutritionist includes academic training, a supervised internship, and passing rigorous national clinical boards. Candidates must have a minimum of Baccalaureate degree from a regionally accredited college or university with a completion of 15 core hours in science and 15 core hours in nutrition. Core science hours must include anatomy and physiology, human biology, chemistry, biochemistry, and microbiology. Medical terminology, practice management and other courses are additionally recommended. Typical core nutrition hours include Introduction to Nutrition I and II, Nutrition and Assessment Strategies, Nutrition Counseling Strategies, Nutrition and Disease, Nutrition and Supplementation, Nutrition and Aging and Herbology.
The prospective CCN must also complete an approved supervised internship program with a minimum of 900 hours or have at least five years of previous nutrition practice experience or other approved licensed healthcare internship. All candidates who do not have at least a Master's degree in clinical nutrition from an approved college or university must also complete a post-graduate program in clinical nutrition. The CCN must have advanced skills and knowledge to translate nutrition science into clinical nutrition application for food and dietary planning, supplementation use, and clinical and research applications.
Once all academic and field supervision is successfully completed the candidate sits for an extensive content-valid national board examination. This is issued by the CNCB, the certification board for clinical nutrition, and health care organizations. It is also provides specialty credentialing programs and state license/certification examinations. To maintain certification, the CCN must complete a minimum of 40 hours of approved Continuing Education (CE) units every two years, and take recertification examinations on a periodic basis.
Many CCNs further their clinical training with graduate and post-graduate degrees. Many have advanced specialty credentials in botanical medicine (herbology), homeopathy, medicine, law, pharmacy, counseling, and specialized therapeutic interventions (e.g., detoxification, gastrointestinal support, blood sugar regulation, weight management, cardiovascular risk reduction, immune enhancement, eating disorders, neurology, women and children's health, and preventive healthcare). Others also pursue training and certification in infusion therapy and advanced laboratory assessment.
The cutting edge training of Certified Clinical Nutritionists make them one of today's most relied upon practitioners in the field of integrative complementary-alternative nutrition. Increasingly, consumers and professionals are recognizing CCNs as important partners in the modern healthcare system.
Who are CCNs? Certified Clinical Nutritionists are highly trained, scientifically based nutritionists. Although many CCNs are exclusively nutritionists, many are also members of other licensed healthcare groups. They include physicians, osteopaths, registered pharmacists, dentists, registered nurses, and other healthcare professionals who meet professional qualifications. In addition, medical scientists specializing in such disciplines as biochemistry, molecular biology, endocrinology, psychiatry, and oncology also have become Certified Clinical Nutritionists. Recently, registered dietitians have begun to seek CCN training and certification as an adjunct to their traditionally oriented dietetic training. The number of applicants seeking the CCN credential is rapidly growing each year. Today CCNs have become the preferred source of information about progressive, scientifically based complementary-alternative oriented nutrition.
Where Are CCNs located? Certified Clinical Nutritionists are located throughout the United States and currently, in five foreign countries. Most CCNs work in clinical medical care, private practice, academic, corporate, and industry settings.
For further information about Certified Clinical Nutritionists, please contact the Clinical Nutrition Certification Board (CNCB), at:
15280 Addison Road, Suite 130 Addison, Texas 75001 Telephone: (972) 250-2829 Fax: (972) 250-0233 http://www.cncb.org