The Training and Qualifications of A Nutritionist

 

A lot of lay people thinks that the study of nutrition is all about what foods to take and what foods to avoid to stay health. Some even went to the extent that studying nutrition is all about food supplements such as what vitamins, minerals or nutrients to take daily for good health. Unfortnately man eat food, not nutrients or food supplements. The health food industry capitalizes on public ignorance to promote their food supplements to the lay public and health concious consumers.

Some 50 years ago, just anyone could call themselves a nutritionist by attending a 2-day informal course on 'nutrition' conducted by a salesperson promoting health foods in a hotel. Today, laws have been passed in Parliament to restrict such claims to enforce the title “nutritionist” as legally protected, restricted as a licensed health professional. 

Since then, a number of students who wanted to be a nutritionist often ask me the scope of studying nutrition as I have done, besides my training in physiology, zoology, medicine, chemistry, food quality control that includes analytical food chemistry, microbiology, food laws, statistics, among others. 

They asked what qualifications are required to be a nutritionist, and what subjects do they learn during their 4-year structured training in a university? They also wanted to know how long does he need to study them to be a nutritionist? Is he a professional like a doctor they also asked?

This is a very wide area of study both at academic and professional levels.  It is extremely difficult for me to provide a comprehensive answer. But I shall try since I have done a postgraduate course in nutrition from the University of London in the mid-1960’s.

 A nutritionist is a health professional specializing in the study of nutrition, diet, and how food impacts health. Very briefly, let’s have a look at their qualifications, the subjects they need to study, the length of their education, and their professional status:

Qualifications of a Nutritionist

1. Educational Background:
• Bachelor's Degree: Most nutritionists start with a bachelor's degree in nutrition, dietetics, or a related field. This typically takes four years. Some study nutrition as part of their specialized training in medicine after obtaining their MD or MBBS.
• Master's Degree: Some nutritionists pursue a master's degree for advanced knowledge and better job prospects. This can take an additional 1-2 years. Some of them take up a Master’s degree after becoming a medical doctor, or after a science degree in a biological or medical science field. 
• Doctoral Degree: Others who are interested in research or academic positions, a Ph.D. in nutrition or a related field might be pursued, which takes another 3-5 years.
2. Certification and Licensing:
• A nutritionist is a healthcare professional, and he needs to be registered and licensed before he can practise in most countries including in Malaysia.  In many other regions of the world such as in America to be recognized as a professional nutritionist, one must become an RDN. This involves completing an accredited dietetics program, passing a national exam, and completing supervised practice hours (usually 1200 hours) which typically involves meeting specific educational and exam requirements.

As to what subjects do a nutrition student need to study, this depends on university to university.

However, the core subjects include anatomy, physiology, biochemistry, microbiology, food science and food technology, human nutrition, malnutrition, clinical diagnosis of malnutrition, food consumption, food distribution.

It may includes medical nutrition therapy which is more for dietetics students than broad-based nutrition, public health nutrition, food consumption surveys, sports nutrition, community nutrition, and dietetics management especially if the student combines nutrition with dietetics.

Practical training for a nutrition student is laboratory work that includes chemical analysis of food composition, microbiology, clinical rotation, community nutrition placement, food production, food balance sheet and food distribution.  

The duration of study for an undergraduate degree is 4 years with supervised practice which is approximately 1 year (included in many dietetics programs). An advanced degree requires another 1-5 years, depending on the degree pursued.

Professional status and recognition for nutritionists, especially those who are RDNs, are considered professionals in the healthcare field. They play a crucial role in preventive health care, treatment planning for diet-related diseases, and promoting overall wellness.

In short, a nutritionist is a trained health professional focusing on nutrition and diet. They typically hold at least a bachelor's degree, often have advanced certifications like RDN, and may need licensure to practice. Their education includes a wide range of scientific and health-related subjects, and their study duration can range from four to over ten years, depending on the level of education pursued.

Nutritionists also need to study sociology as well in order to understand human behaviour, food cultures, food habits, food taboos, besides soil science, food production, understand food balance sheet, food distribution, and even on economics in order to understand about wealth and poverty and ability to understand food availability and purchase power besides all those subjects mentioned.

Sociology, human behaviour and food cultures and food practices are included in the study to help nutritionists later on graduation to tailor dietary advice that respects cultural preferences and traditions.

This includes food habits and food taboos and habitual eating patterns that are essential for creating realistic and acceptable dietary plans for diverse populations, besides studying psychology that helps nutritionists understand behaviour changes, motivation, and adherence to dietary recommendations. When they qualify as nutritionists, they may need to promote sustainable eating practices and support local food systems.

 A knowledge of how food is grown, processed, and brought to the consumer, a student in nutrition also studies soil science in order to understand soil health and agriculture in order to understand how food can be grown at optimal levels.   

A study of market helps nutritionists recommend fresh, nutrient-dense options and advocate for better food policies.

A nutrition student also needs to study economics, food distribution and food balance sheet to understand food supply and demand to address issues related to food security and malnutrition. Nutritionists also looks at how food distribution systems help in identifying gaps in food access and developing strategies to ensure equitable food availability. Understanding economic factors such as wealth, poverty, and purchasing power is crucial for addressing food affordability and advising on cost-effective dietary choices is also part of the study for a nutrition student.

Some universities may include some pharmacology into the syllabus of nutrition course work because of drug and food interactions that may interfere with drug intake or cause adverse effects. However, pharmacology isn’t a core part of a nutritionist's training. But an understanding of basic principles of pharmacology can indeed be beneficial for them. Knowledge about drug and food interactions can help nutritionists provide more comprehensive advice to their clients, especially if they are working with individuals who have specific medical conditions or are taking medications.

Some examples of drug and food interactions that may affect nutrition or the therapeutic action of drugs are:

1. Vitamin K and blood thinners (Warfarin): Foods rich in vitamin K, such as leafy green vegetables, can interfere with the action of blood thinning medications like Warfarin. Nutritionists may advise patients on consistent intake of vitamin K-containing foods to avoid fluctuations in medication effectiveness.
2. Grapefruit and statins: Grapefruit juice can inhibit the metabolism of certain statin medications used to lower cholesterol levels, leading to increased drug levels in the body and potential adverse effects. Nutritionists may caution patients on the consumption of grapefruit products while taking statins.
3. High-fibre foods and certain medications: High-fibre foods can affect the absorption of some medications, such as certain antibiotics or thyroid medications. Nutritionists may recommend adjusting the timing of medication intake in relation to meals to minimize interactions.
4. Tyramine-containing foods and MAO inhibitors: Certain foods rich in tyramine, such as aged cheeses, cured meats, and fermented foods, can interact with monoamine oxidase inhibitor (MAOI) antidepressant medications, potentially leading to a dangerous increase in blood pressure. Nutritionists may advise patients on avoiding or limiting these foods while on MAOIs.
5. Calcium and iron absorption: Calcium-rich foods can inhibit the absorption of iron from plant-based sources. Nutritionists may suggest consuming iron-rich foods separately from calcium-rich foods to enhance iron absorption, especially for individuals at risk of iron deficiency.
6. Alcohol and medications: Alcohol can interact with various medications, either enhancing or diminishing their effects. Nutritionists may provide guidance on moderate alcohol consumption and advise patients to avoid alcohol when taking certain medications.
7. Even certain foods need to be avoided in certain diseases. For instance, in G6PD (glucose-6-phosphate dehydrogenase) deficiency which is a genetic condition that affects red blood cells, making them more vulnerable to damage from certain substances. Individuals with G6PD deficiency need to avoid triggering substances, as exposure to these can lead to haemolysis (the destruction of red blood cells), causing symptoms such as anaemia, jaundice, and in severe cases, kidney failure.
8. Beans, particularly fava beans (also known as broad beans), are one of the substances that individuals with G6PD deficiency are advised to avoid. Fava beans contain a compound called vicine, which can cause oxidative stress and trigger homolysis in people with G6PD deficiency.
9. Other legumes and beans may also contain compounds that could potentially trigger haemolysis in individuals with G6PD deficiency. It's important for individuals with this condition to consult with a healthcare professional or a registered dietitian to receive personalized dietary guidance and to identify specific foods and substances they should avoid.

While these examples illustrate some common food and drug interactions, or food and disease interaction, it’s essential for nutritionists to collaborate with healthcare professionals, such as pharmacists and physicians, to ensure comprehensive care for their clients, especially those with complex medical conditions or medication regimens.

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Nutritionists involved in public health need to design programs that consider socioeconomic factors and cultural practices to be effective. This includes community nutrition in community settings where nutritionists must address barriers to healthy eating, such as excessive and unnecessary food intake, and provide education that resonates with the community’s lifestyle and economic situation.

 Nutritionists working in policy decision need a comprehensive understanding of food systems, economics, and sociocultural factors to advocate for effective and equitable nutrition policies.

The field of nutrition is interdisciplinary, and nutritionists benefit greatly from a broad understanding of various subjects that influence diet and health. 

Having said this, a student in nutrition may not necessarily study all the subjects studied by another student in another university during their training. But it does not matter because during work employment after graduation, he may have to deal in an area where he was not trained. His already  very broad wide spectrum training and scientific knowledge in other areas at fairly advanced levels would have equipped him to understand his work requirements for a specific task. With his wide spectrum of learning in the university, he would easily adapt to learning a specific new area within weeks or just within one or two months by reading further on his own or by observation at work. It is very easy for him to cope with new knowledge or new innovation required of him. For instance, he may work in the food industry where food technology, food quality control and an understanding of food labelling, food claims and food laws are required where he was not exposed to during his training as a nutritionist. That does not mean he cannot understand how food is produced, collected, and delivered to the factory for processing although this is the domain of a food scientist and food technologist rather than the job of a nutritionist. Within weeks he would have picked up on food technology, food quality control, food labelling and food claims and food laws. He could even testify in court pertaining to health claims. 

This is no different from a student studying medicine. A doctor or a medical student may not necessarily know every branch of medicine. He may not even once be exposed to certain areas of medicine such as psychiatry, social and preventive medicine, epidemiology, dermatology, cardiology, O & G, paediatrics, radiology or even in traumatology and emergency medicine, let alone in pathology, histopathology or in forensic medicine. 

It may surprise readers that a lot of doctors do not even know first aid except CPR, let alone traumatology and emergency medicine unless doctors are trained in that area, and were placed in that specific department for a few months under a specialist or a consultant. It depends on rotation in training in each department, and the time they spent there. 

Here are some additional subjects why they are important for nutritionists:

• Provide culturally sensitive and practical dietary advice.
• Address broader issues of food security and sustainability.
• Develop comprehensive public health strategies.
• Advocate for policies that improve food systems and public health.

The holistic understanding on nutrition comes from studying these additional subjects equips nutritionists to make a more significant impact on individual and community health, beyond just the biological aspects of nutrition. This interdisciplinary approach is what makes the role of a nutritionist both complex and vital in addressing contemporary health care.

The syllabus for a basic degree in nutrition at the London of London in the early 1960’s which is the first country in Europe that offered a degree in nutrition headed by Professor John Yudkin, MBBS (Lond), MA (Cambridge), MD (Cambridge), PhD (Cambridge), FRCP, FRIC. FIBiol. covered a very broad range of subjects.  

Professor Dr John Yudkin was a very eminent physician, a chemist, a physiologist and a nutritionist who was the Head and Chair of Physiology, and then Chair of Nutrition at Queen Elizabeth College (QEC), University of London in the 1960’s.  There at QEC he initiated Europe, if not the world’s first degree and postgraduate programme in nutrition and dietetics to cover most of the subjects mentioned.

Today most universities throughout the world followed the footsteps of the University of London to offer a degree course in nutrition and or in dietetics.

However, since nutrition is such a broad-based course, each university will have their own programme on which areas of studies to include in their syllabus since they need to look for specialists and expertise to teach them. Some degree courses may emphasize a lot in one area and give less emphasis in other areas.

For example at QCE where I read for my postgraduate under Professor John Yudkin clinical nutrition pertaining to the diagnosis of nutritional deficiency diseases such as marasmus, kwashiorkor, beriberi, scurvy,  pellagra, vitamin B2 (riboflavin) deficiency, iron deficiency anaemia, vitamins A and D deficiencies, night blindness and rickets, vitamin B12 deficiency anaemias, iodine deficiency disorders, calcium and vitamin D deficiencies among others, their  detection and diagnosis were extensively taught. We were all very well trained in the diagnosis and the detection of nutritional deficiency diseases under Prof Dr John Yudkin who was a very eminent clinician and a nutritionist.

Today, due to the rise of affluence in many societies, a nutrition student need to study besides under nutrition and nutrition deficiency diseases such as vitamins A, B, C, D, iron, calcium deficiencies, but also diseases due to overnutrition, characterized by the excessive intake of nutrients, particularly calories, such as obesity, a condition characterized by excessive body fat, which increases the risk of various other diseases, type 2 diabetes, a chronic condition that affects the way the body processes blood sugar (glucose), often linked to obesity and poor diet, cardiovascular diseases such as hypertension (high blood pressure), heart disease, and stroke, often resulting from high cholesterol levels and obesity, metabolic syndrome which is a  cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) where there is a fat builds up in the liver, potentially leading to inflammation and liver damage, certain cancers such as breast, colon, and endometrial cancer, which are linked to obesity and diet. Besides these, diseases of dietary affluence are gout, a form of arthritis caused by excess uric acid in the bloodstream, often associated with a rich diet, gallbladder disease that Includes gallstones, which are more common in people who are overweight or obese, sleep apnoea characterized by pauses in breathing or periods of shallow breathing during sleep, more common in obese individuals, osteoarthritis, a degenerative joint disease exacerbated by the excess weight putting additional strain on joints.

Other diseases due to over nutrition are gastroesophageal reflux disease (GERD) which is a digestive disorder where stomach acid irritates the food pipe lining, linked to obesity and poor diet, kidney disease particularly due to high blood pressure and diabetes. A student may also need to recognize psychological disorders such as depression and anxiety, which can be exacerbated by obesity and poor diet.

These diseases highlight the importance of balanced nutrition and a healthy dietary lifestyle to prevent the adverse effects of overnutrition unlike nutritional deficiency diseases which are much easier to managed. 

Whatever is taught, in a nutrition survey a team of experts such as a nutritionist, a medical doctor, an anthropologist and sociologist, a laboratory scientist, a biostatistician, and medical technologists are always in the team working together each contributing their areas of expertise.

Normally a medical doctor in the team will refer cases of malnutrition to a nutritionist for examination, diagnosis and further evaluation since most of the malnutrition (under and over nutrition) are symptomless or sub-clinical and they do not show up on clinical examinations. Hence, a nutritionist will have to depend also on food consumption studies, biochemical investigations, anthropometry such as weights, heights, skin fold measurements, bone density, among others.  

Since the first course in nutrition was started at the University of London in the early 1960’s, discoveries and advances in nutrition has evolved tremendously over the years to incorporate new scientific findings, technological advancements, and contemporary health challenges for students studying nutrition. While the core subjects remain foundational, modern nutrition programs often include updated content and new areas of study. Here’s an overview of the typical evolution and current trends in nutrition education:

Core Subjects (Consistent Over Time)

1. Human Nutrition: Fundamentals of macronutrients and micronutrients, their metabolism, and their role in health and disease.
2. Biochemistry: Biochemical pathways related to nutrition and metabolism.
3. Physiology: Understanding how the body functions and how it interacts with different nutrients.
4. Food Science: The study of food composition, safety, preservation, and processing.

Evolved and Expanded Subjects

1. Public Health Nutrition: Greater emphasis on community health, epidemiology, and nutrition policy.
2. Clinical Nutrition: More detailed study of medical nutrition therapy for various diseases, including diabetes, cardiovascular diseases, and cancer.
3. Behavioural Nutrition: Enhanced focus on psychology, sociology, and behaviour changes techniques to promote healthy eating habits.

Newer and Emerging Areas

1. Nutrigenomics and Nutrigenetics: The study of how individual genetic differences affect nutrient metabolism and requirements.
2. Sustainability and Food Systems: Understanding the environmental impact of food production and promoting sustainable eating practices.
3. Global Nutrition: Addressing global health issues such as malnutrition, food security, and the impact of globalization on diets.
4. Advanced Technology in Nutrition: Use of data analytics, mobile health applications, and wearable technology to track and improve dietary habits.
5. Ethics and Policy: More comprehensive training on food policy, regulation, and ethical issues in nutrition.

Practical and Applied Learning

• Internships and Practicums: Hands-on experience in clinical settings, community health organizations, and food service management.
• Research Projects: Encouragement to engage in research to understand current issues and develop innovative solutions in nutrition.

While specific curriculum details can vary by program, the University of London and similar institutions now often include a more integrated and comprehensive approach that addresses both traditional and modern aspects of nutrition science. This ensures that graduates are well-prepared to tackle current and future challenges in the field.

Nutrition is now so complex and complicated that it is beyond even a well-qualified nutritionist, let alone a doctor or a clinician to understand everything about food that contains tens of thousands of phytochemicals in them especially in plant-based foods as medicines and their impact on health, diseases and illnesses.

All these areas current students in nutrition may also need to study besides other traditional subjects already discussed above. This is going to be more and more difficult for any student pursuing a degree course in nutrition these days although it depends on university to university on what and how they are going to incorporate new areas and findings to be taught.

In summary, while the core principles of nutrition education have remained steady, there have been significant updates and expansions to keep pace with scientific advancements and global health trends. This ensures that modern nutritionists are equipped with the knowledge and skills needed for today's diverse and complex health environment.

As already said, nutritionists are healthcare professionals who specialize in the study of food, nutrients, and their impact on health. They play a vital role in promoting healthy eating habits and preventing and treating various health conditions through diet and nutrition interventions. 

Here's an overview of what nutritionists do on graduation, and their scope of employment:

1. Assessment and Counselling: Nutritionists assess individuals' dietary habits, nutritional needs, and health goals. Based on their assessment, they provide personalized nutrition counselling and education to help clients make healthier food choices and achieve their health objectives.
2. Menu Planning and Nutritional Analysis: Nutritionists may work with food service establishments such as hospitals, schools, cafeterias, and restaurants to develop menus that meet specific nutritional requirements. They also conduct nutritional analysis of recipes and meals to ensure they meet dietary guidelines and standards.
3. Public Health and Community Nutrition: Many nutritionists work in public health settings, where they design and implement nutrition programs and initiatives aimed at improving the health of communities. They may conduct nutrition education workshops, develop educational materials, and collaborate with other healthcare professionals and community organizations to address nutrition-related issues.
4. Clinical Nutrition: Nutritionists work in clinical settings such as hospitals, clinics, and private practices, where they assess and manage the nutritional needs of individuals with various health conditions. They may work as part of a healthcare team to develop nutrition care plans for patients with conditions such as diabetes, heart disease, obesity, eating disorders, and gastrointestinal disorders.
5. Research and Academia: Some nutritionists who have higher degrees prefer to work in research institutions, universities, and academic settings, where they conduct research studies on nutrition and health. They may investigate the effects of different diets on health outcomes, develop nutrition interventions, and contribute to the advancement of nutritional science through their research findings.
6. Food Industry and Corporate Wellness: Nutritionists may work in the food industry, where they develop and evaluate food products, create nutrition labelling, and provide nutritional expertise for food marketing and advertising. They may also work in corporate wellness programs, where they design and implement employee wellness initiatives focused on nutrition and healthy lifestyle behaviours.
7. Sports Nutrition: Nutritionists specializing in sports nutrition work with athletes and sports teams to optimize performance, enhance recovery, and prevent injuries through tailored nutrition plans. They may provide guidance on pre- and post-workout nutrition, hydration strategies, and supplement use.

Overall, the scope of employment for nutritionists is broad and diverse, encompassing various sectors including healthcare, food service, public health, research, academia, and sports. They play a crucial role in promoting health and well-being through evidence-based nutrition interventions across different populations and settings. So far till today in 2024 I have not heard of any nutrition graduates out of employment.

In fact, most of them find very high-ranking jobs in pharmaceutical companies, health and fittest outlets, in the Ministry of Health as Consultants, as State Nutritionists in the country or in community practice

 I shall write later on discoveries made in the field of nutrition to include functional foods.

-      Lim Juboo