Dietitians Can Prescribe Therapeutic Diets…But What Are They?

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Personal Nutrition Expert Doctor Santa Barbara

Dr La Puma personal nutritionist doctor los angeles california dietitiansDoctors tend to dismiss nutrition and diets as therapeutic tools, especially for obesity, because we have had so little training in  it.  That’s a hugely missed opportunity for medicine, and now it is about to vanish, at least in hospitals.

One group ready to seize this opportunity are the registered dietitians, who just were given CMS permission to apply for medical staff privileges to prescribe “therapeutic diets” and order lab tests to see if they are working. Presumably, permission for billing CMS is not far behind…and certainly hospitals will investigate this aggressively. After all, every patient needs a diet order.

Although hospital medical staffs must, one-by-one, give permission for dietitians to write orders and lab tests, few organizations will see the potential liability in so-doing, and indeed hospital malpractice policies should cover these clinicians.

Interestingly, other nutritionists should also be permitted to apply for these privileges, though as a practical matter, it’s unlikely any hospital will permit an unlicensed clinician to write orders and work within its organization on a regular basis.

This has the potential to be a big step forward…if dietitians learn more about therapeutic diets, which are not defined. Suffice it to say that if they prescribe the heavily processed foods of the major sponsors of the Academy of Nutrition and Dietetics, patients will not have a fighting chance.

Dr. La Puma, Personal Nutrition Expert Doctor Santa Barbara

If, on the other hand, dietitians prescribe evidence-based, specific, food-centered (more than nutrient-centered) diets that can help patients heal, and which can be continued with support once they leave the hospital, we could see the beginning of a sea change about how clinicians learn about food-as-medicine, or as I’ve called it, culinary medicine. And that will be good for patients, who already understand how important nutrition is, but are often confused by the cacophony of contradictory counsel.

Still, patients will usually need to do their own homework about which foods are good for them and their condition, and which are not.

The opportunity for leadership is huge: what a big difference it would make it patients got hospital food that helped them get better from their disease, instead of having the potential to cause or worsen it, as is still the case in too many hospitals.

Often driven by a quest for better patient satisfaction ratings, many hospitals are now getting better food–meat raised without antibiotics, dairy without BGH, locally grown, seasonally appropriate vegetables, vending machines without junk food, farmer’s markets on campus. A number of hospitals have pioneered the availability of better food, often locally sourced, for patients, visitors and staff. Health Care Without Harm hospitals have been the main movers.

I think dietitians are likely to do better than physicians in this task, if they undertake some specific training in what actually works for specific conditions, so the default diet order is not 2 gram sodium and 2000 calorie ADA (now ACN) diet, but instead an eating pattern: e.g., Mediterranean, Vegetarian, Asian, Ad libitum, Gluten Free, Low Sugar, Low Fat plus those specific foods, meals and recipes that have been clearly shown to help improve a patient’s particular condition.

Curricula in culinary medicine have been proposed and accepted in major medical schools, such as Tulane, the Cleveland Clinic, Harvard, SUNY and Des Moines University, just to name 5 with which I am personally familiar.  In our own first-ever culinary medicine senior elective, we offered recipe lists for 10 common conditions.

These curricula, evidence-based prescriptions and sustainable food efforts should guide therapeutic diets for patients. We have the chance to do something great here: let’s plan to effect it.

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Dr La Puma, Personal Nutrition Expert Doctor Santa Barbara