There are many paths in the field of Nutrition.
Your path will be uniquely yours. However, I am asked about my journey, my tips and tricks, and my reasoning nearly daily through interactions with my patients, strangers on Instagram, or connections on LinkedIn. I hope this post gives some insight and inspiration to you!
Two Recognized Paths
In the world of Clinical Nutrition, there are two main paths: RD vs. CNS.
Yes, there are also a multitude of other certifications, classes, etc. however, if you want to work with any legitimacy and scope of practice, you would be wise to start with one of these choices! That is because the term Nutritionist is not a protected term! There are several states (green states) where anyone with any level of training (or no training) can call themself a nutritionist.
CNS Licensure Map by the American Nutrition Association
RD Licensure Map by The American Academy of Nutrition and Dietetics
I recognize, and honor, that the majority of people exploiting this loophole are doing so with the best of intentions. These are people who want to help others! They would like to share the knowledge they do have and may even be very thoroughly self-educated! However, nutrition is a complicated subject and without advanced training in subjects such as Nutritional Biochemistry, Medical Nutrition Therapy, or Drug/Nutrient interactions. It’s really important to note that if it is powerful enough to heal, it is powerful enough to harm. Certified practitioners are well versed in this dichotomy and understand the benefits and limitations of tools like supplements, therapeutic diets, and biases in research, etc. As you go through an advanced degree in nutrition, you discover how much we do not yet know and how much we simply cannot know about nutrition. Legitimate training places an emphasis on the limitations of our nutrition knowledge as a medical community as well as our limitations on our research.
Board Certification
There are two boards that certify nutritionists:
Certified Nutrition Specialist® (CNS pathway)
Commission on Dietetic Registration (RD pathway)
Certified Nutritional Specialist (CNS): a Certified Nutrition Specialist is a highly qualified nutritional professional with an advanced degree (graduate or doctorate) from a fully accredited university in nutrition plus 1,000 hours of a supervised internship and must pass the rigorous exam administered by the Board for Certification of Nutrition Specialists…It is the most widely recognized nutrition certification by federal and state governments. It is the only non-dietetics credential and examination widely named in state nutrition licensure laws.
Registered Dietitian (RD): an RD is a food and dietary professional, usually with a 4-year bachelor’s degree and 900-1200 hours in a dietetic internship through an accredited program and passing a dietetics registration exam. Dietitians focus 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. Dietitians often work in health institutions as clinical dietitians, management dietitians, but can also work as community or consultant dietitians.
For a side-by-side comparison, please check out my What Is A CNS page!
Career Outlook
When it comes to the most common career paths, RDs are trained for acute care, such as hospital care, including parenteral (tube) nutrition, while CNSs are trained in chronic care and private clinical practice, working in doctor’s offices or in private wellness centers. This is the traditional path for both, however, these are not exclusive scopes of practice! You'll sometimes find CNSs in hospitals and RDs in functional medicine practices! Many RDs are stepping outside of their traditional scope and pushing the Academy to embrace root-cause medicine in a more formal way! This is a wonderful thing for healthcare as a whole!
Why I Chose CNS
I will be frank; if the Academy of Nutrition and Dietetics had been more accepting of functional medicine and root-cause approaches, I might have gone the traditional RD path. It absolutely would have made job-finding easier!
My choice to pursue my CNS came down to my own, personal convictions around nutrition as well as my own search for health.
(Long-Story-Short) In high-school and through much of undergrad, I was a “Doritos and pizza” vegetarian. I genuinely thought I was my healthiest self by avoiding animal protein but didn’t think much further than that! I also found it amazing that I could eat Doritos, pizza, grilled cheese, etc., and still lose weight! What a Holy Grail, right? Wrong. I became sick. I was barely consuming protein and really poor quality at that. I was addicted to sugar. I had gluten and dairy in every meal and eventually, my body said ENOUGH. My inflammation manifested in a hot-spot in my sacroiliac and was so painful that at times, I couldn’t even put weight on my right leg. This started a routine for far too long of going to my doctor, being prescribed a very strong steroid, inflammation going doing (pain going down), and repeat. I had a standing prescription for a powerful steroid and I was routinely doing a steroid protocol every 2-3 months. Not once did my doctor try to get to the bottom of my crippling pain, however, I would be routinely threatened that if this didn’t stop, the next step was steroid injections into my spine. Thanks, but no thanks.
I started to become interested (obsessed) with learning about nutrition. I read everything I could get my hands on! Eventually, I connected my hyper-inflammatory diet to my pain and as soon as I took my problematic foods out of my diet (and to be honest- completely restructured my diet and reincorporated animal protein) my pain went away. To this day, I can start to feel a twinge in that same spot and know my inflammation levels are creeping up! I was also struggling as a newly-graduated teacher and had an awful time finding work. After a lot of research, I knew my passion was in nutrition and I began to research masters programs. Thanks to my research, I saw a lot of (in my opinion) troubling patterns in the Academy. Conferences being sponsored by McDonald’s, Big Ag, and Big Food having such a stronghold. I also didn’t believe many of the long-standing beliefs of the Academy (like perpetuating the low-fat narrative) were actually helpful to the world at large. And very importantly, I didn’t want to work in a hospital!
Education, Supervision, and Licensure
And that is how I was left with my only other, legitimate, path: the CNS. I found my way to Maryland University of Integrative Health, where I was taught by some of the nation’s thought leaders in nutrition. I was challenged, I was pushed, and I fought for every class. In short, it was an incredible educational experience.
When I graduated, I was living overseas and wasn’t in a position to begin working on my CNS hours. So I worked where I could in nutrition (legally!) and began a post-grad program in Global Health Management. At some point in my career, I would like to work for a NGO- but that’s a future goal!
Upon moving back to the States, I was able to get a job with Parsley Health (fun fact- I was employee #36!) and very, VERY, fortunately, one of the doctors I worked directly with was an approved supervisor with the BCNS. The universe really aligned for me! I was able to finish my 1000 internship hours easily, while also collecting a salary! Win/Win!
However, my experience with collecting CNS hours was a needle-in-a-haystack situation. Most of my colleagues had to pay for supervision hours. There are a number of amazing programs or options and more are coming up (seemingly) daily!
The only thing left to do was to pass my BCNS exam. In the future, I’ll write a more thorough post about studying for the BCNS, but suffice to say, it was SIGNIFICANTLY harder than I ever anticipated. This exam is no joke! There are a number of support resources out there, but I relied heavily on my textbooks, school notes, and practice exams from Studyfor.xyz/cns.
Outlook for CNS
The BCNS is consistently fighting for federal legitimacy for the CNS, but at the time of this writing, this has not yet been accomplished. Federal recognition would provide an equal understanding of the CNS in all 50 states. Unfortunately, right now, the ability to practice as a CNS is drastically different. Your location should be a factor if you are considering RD vs. CNS.
As you go through the job market, you will need to be prepared to educate employees on what a CNS is and why it is valuable and can stand up to a RD (in the correct scope of practice!). I cannot advise on this, but I highly recommend networking with other CNSs to share tips and support! MUIH has an active alumni Facebook Page for just this reason! I am also in the CNS Mastermind Network. Connection is power!
You can also go into private practice! Many CNS Internship programs provide business building/marketing support in addition to clinical support. I highly recommend considering this avenue if your state will allow it!
Ultimately, what you do with your degree and licensure will depend on your clinical passion, your goals, and your location. The CNS path is far from simple or straightforward at times, but I believe it is the best path (and obviously I am biased here!)
I hope this long post is helpful!
xoxo
Erica