I’ve been interested in nutrition my whole life. As an undiagnosed Celiac until age 26, I suffered from major intestinal distress, I struggled to gain weight, had low muscle tone, and incredible blood sugar regulation issues. I was always reading books on nutrition to try to figure out how to fix myself.
Your Money or Your Life
There were several times during my career in marketing (I worked for NPR and natural foods companies, and finally Whole Foods Market), when I wanted to quit my job and dive into a career as a nutritionist. I remember being 28 years old and thinking, “I’m too far down my career path at this point to change direction”. After the birth of my second child, I read the book Your Money or Your Life. It was pretty life changing to view my expenses in terms of “my life force”. Was that $35 shirt worth XX hours of my “life force”? When I looked at the actual cost of for daycare plus the hidden costs (dry cleaning, my commute, meals out, etc.), I think it ended up that I was making about $7 per hour or so, net. It didn’t make any sense to continue to work.
Staying at Home Didn’t Work
I tried staying home with the kids. It wasn’t for me. I know this is blasphemy to many stay at home moms, and I felt a ton of guilt about this. Reading Naomi Wolf’s Misconceptions, gave me some sense of relief (I highly recommend that book to all my mommy friends of young children). It wasn’t until I ended up in therapy, in tears about how horrible I felt as a failed stay at home mom, that I found a solution. My therapist advised me it was OK to want to work. I needed to hear this. We ended up hiring an au pair, which was actually much more affordable than daycare, to live on the farm and watch the kids while I ran the farm stand. The kids and I were both happier when I had more “adult time”, and I was only steps away from them. I know this isn’t the right choice for everyone, but for me it was.
Deciding it was Time
While running the store, our busy CSA, and farm stand kitchen, I was getting more and more questions about nutrition. For example, customers would ask me why coconut oil was so good when it was a saturated fat – the kind of fat that causes heart disease. I would try to look the questions up, but the nutrition information I was finding seemed to lead me in all different directions and I didn’t know which source to trust. Coconut oil was magic according to one book, and the cause of major heart disease according to another book. Meanwhile, although I felt like I was doing things right on a mostly low-fat, low meat, gluten free diet, I still didn’t feel right. My biggest issue was that my blood sugar was still on a roller coaster. I needed to eat a gluten free granola bar or other highly processed snack every one to two hours or else I’d start feeling faint. I decided it was time to learn more about nutrition.
Going Back to School
I attended a Weston A. Price Foundation conference in 2008 and remember going up to Sally Fallon and asking her how to become a nutritionist. She told me to get my RD (Registered Dietitian). At the time, that seemed like a lot of work and I was intimidated. I wasn’t ready for the financial and time commitment the RD program required. Instead, I enrolled in the Nutritional Therapy Association’s program. It was a great foundation to real food nutrition. I learned about healthy sources of protein, carbs and fats, how blood sugar regulation worked, and how proper nutrition supported optimal health. At the end of the course, I had to do a book report. I chose a new book called The Paleo Solution. I followed the 30-day challenge as outlined in the book and it was a complete wake-up call. I went from needing a snack every 90 minutes to being able to go from breakfast to lunch with no crash. No tunnel vision, mood changes, or hunger pangs. I could even skip lunch! My blood sugar issues were finally over. Also, I didn’t feel confused about which way was the “right” way to eat. I finally had the golden key. I decided to open my practice to help people regain their health using the principals as outlined in the book.
Changing My Course
After a short period of time however, I realized that nearly everyone who was coming to me had some sort of disease. People were finding me on the internet and coming to me with conditions that were completely out of my scope as an NTP. I was not qualified to practice medical nutrition therapy, only to counsel people on “healthy eating”. I wanted to be able to practice medical nutrition therapy and see a broader range of people – people who needed prescriptive diets. At this point, I had been to a few paleo conferences and had become friends with Robb Wolf. He suggested I get my RD. This time, I was ready. Getting my RD would mean I could comfortably counsel people with disease and get referrals from doctors, plus accept health insurance. In Massachusetts, health insurance reimbursement for nutrition is pretty good. I talked it over with my husband and got advice from Mat Lalonde. Mat suggested that I just take it slow, and to treat it like a “hobby” – doing one or two classes at a time so it wouldn’t feel so overwhelming. That was a great strategy. So, at age 37, I decided that I’d be 40 soon (whether or not I was 1/2 way towards my RD) so why not take a couple of classes at a time and work towards it? Luckily, I had some stock options from my time at Whole Foods that I could cash in to help fund my education.
Getting the RD
Getting the RD wasn’t easy. I met with an advisor at a Simmons College, and learned about how to complete the Didactic Program in Dietetics Certificate, or DPD. If you have a Bachelors degree, you are able to complete this certificate program in order to qualify for a dietetic internship, which will allow you to sit for the RD exam. Very few schools allow you to get the DPD alone, without a Master’s degree. (Soon, you will be required to have a Master’s Degree in order to be an RD.) Since my main interest was opening a private practice, I thought the additional time and expense of a Master’s degree was not really worth it. The advisor at the school helped me make a plan. In my college days, I actually had taken quite a lot of science courses for an art major, but because it had been so long, I basically needed to start from scratch. Most schools will only accept transfer credits within 10 years of graduation. It was probably for the best because truthfully, I have a my memories from college are foggy at best.
Community College vs. Private College
I found out which pre-requisite classes I could take at a community college, and what my time line would look like. Community college classes were about $400 – $800 each. Simmons College, where I officially received my DPD certificate, charged $1140 per CREDIT, and the classes were all four credits – except for Medical Nutrition Therapy at 6 credits. Yes, that’s one expensive class! I was able to take nine of the classes at a community college. Because I was more mature this time around, and paying for the school myself, I sat in the front row, questioned nearly everything the professor said, and did every bit of reading and homework required in order to get an A. Lucky for me, I was able to text/email Mat whenever I came upon information that seemed questionable. Having a few mentors was key for my survival through the program.
I was able to have a couple of classes removed from my requirements: Intro to Nutrition and a general psych course. Here were the courses I had to take for the Simmons DPD program.
My strategy for getting through these classes was to take them one semester at a time. I also never counted or looked at the number of classes I still had to complete until I was almost done. As Mat suggested, I treated this as a hobby and just put my head down and sucked it up as best I could. There were definitely times when I wanted to quit. I don’t feel that the actual coursework was that difficult. Completing this program is more about perseverance than intelligence. The hardest classes for me were biochemistry and nutrient metabolism, purely because of the volume of memorization that I had to do. I’m a super visual person, so I can easily understand metabolic pathway diagrams. The concepts were not difficult, but I sometimes have a hard time in my old age with memorizing names, structures, theories, etc.
Once I transitioned into being a mom, my time became extremely valuable and I still don’t like to waste any of it. I would always cringe when I found out that one of my projects had to involve other students. Many classes required “group work”, which meant me working with a four or five 19 year old undergrads who weren’t always taking the class as seriously as I am, and they certainly never questioned what they were learning. They would sit around with their diet sodas and low fat yogurt, giggling and wasting my time. In fact, the entire RD program is quite difficult to do as a mom on a part time basis because so many of the classes were during the day (some met for one hour three times a week, in the middle of the day, which pretty much killed my entire day).
The Dietetic Internship
At Simmons, you complete your DPD classes and then you are able to apply to the dietetic internship. Other schools offer “coordinated” programs, meaning you complete the internship at the same time you are working on your classes. The issue around internships is they’re highly competitive and there aren’t enough internships to match the number of DPD candidates. The national match rate is only about 50%. The cost for these internships range from free to over $47,000. Part time options are rare, which made it very difficult for me as a mom and with the other work commitments I had. I had a professional background in food marketing, got an A in every single class, had been a food service manager, had experience with nutrition counseling, had written two cookbooks during my time as a student, and graduated cum laude from my undergrad program, my advisors thought I’d have my pick of any internship. I applied to the only two part time options in Massachusetts: Sodexo and Wellness Workdays. I was rejected. I wasn’t given a reason. I was devastated and worried that all of the time and expense I had put into this program was for nothing. I had no idea what to do next.
I then learned about another pathway towards an internship called the ISPP, which stands for Individualized Supervised Practice Pathway. You are only eligible for an ISPP if you have a PhD or have been rejected from an internship. Yes, I know, this doesn’t make any sense. Anyway, I applied to a distance ISPP and was immediately accepted. The good news is that it only cost about $7,000 (the other two I had applied to were $10,000), I was able to arrange my own rotations, and was able to complete it on a part time or full time basis. They also allowed me to bypass the food service management portion of the internship because of my previous work experience, leaving me to do the community and clinical rotations – this saved me about three months of time. I was able to find a great match for my community/outpatient rotations with Ayla at Boston Functional Nutrition and The Daily Table. However, the bad news is that no hospitals were willing to take me. Every hospital I contacted already had a contract with another internship program and was unwilling to take me on as a “rogue” intern. Sodexo seemed to have cornered most of the market, dominating every clinical internship option so that I was unable to secure any hospital rotation options. It was very frustrating and this seemed unfair. With the help of my ISPP program, I finally found a hospital for my acute rotation and then lined up a long term care facility for my final rotation.
Getting Through the Internship
The actual internship was quite a drain, especially once it got to the acute long term care hospital rotation. I wrote about my hospital experience here. Working full time with a big commute (I had to give myself over an hour each way), plus the additional homework assignments for the program, while being a mom and trying to balance my other work commitments, plus cooking real food, made it nearly impossible to keep my head above water. On top of all of the logistics, I found working in a hospital and in a nursing home incredibly sad. I saw a lot of death. As someone who is focused on the value of real food to prevent chronic disease, spending so much time with people at the end of life really brought me down. I tend to be a highly passionate and empathetic person, which sometimes makes it hard to have a “bubble” to protect me from what I see, which I wrote about here. Because the ISPP is a “do it yourself” internship pathway, I do not recommend it to anyone with little experience or who needs guidance in attending an ISPP program. I pretty much received a dropbox and checklist and was sent on my way.
The best part of my internship and probably the entire RD experience was the time I spent at Massachusetts General Hospital in the Center for Celiac Research under Dr. Alessio Fasano and Dr. Maureen Leonard. People came from all over the country to come to clinic. Their team approach to treating patients was unique and really fun. I got to see first hand how the doctors, nurse practitioner and RD decided what course of action to take. As someone who reads papers on gut health for fun, being part of this team was an incredible experience. I also got to see some of the cutting-edge work done by their research team, which I wrote about here.
The RD Exam
Finally, after the rotation was over, I waited for the email to reach my inbox allowing me to schedule the RD exam. After checking in with my program (and finding out that my paperwork had been sitting on the director’s desk for nearly a month), I was able to schedule the test. I followed the Jean Inman RD Exam Review Course. I found this review critical to being able to pass the exam. I had some very specific questions that came directly from this review course. I felt that nothing on the test actually tested my capacity to be an effective nutrition counselor. The computerized test shut down on me after answering 125 questions and I received a letter saying I passed. I was done.
Advice to Future Real Food Nutritionists
I often get questions from people looking to change careers and become a real food nutritionist. I think my experience at NTA was invaluable. It gave me a very solid foundation in real food. During my RD program, my most valuable takeaways were the hard sciences, the advanced counseling skills, and my rotation under the Celiac Center. I am also grateful for knowing how to breakdown and pull apart a scientific paper, which I love to do.
Advantages and Limitations
When people set up business counseling sessions with me, I generally recommend folks start with the NTA program if they have little or no background in the real food movement. This is especially true if they are trying to decide between the Institute for Integrative Nutrition (IIN) and Nutritional Therapy Association (NTA). NTA is by far the winner in my mind, as everyone I’ve met from IIN leaves feeling very confused and with very little understanding of optimal human nutrition. It’s hard to “unlearn” something, so having a good background is critical. For folks who are ready to make the time and financial commitment, getting your RD credential is really the best path if you’re looking to do medical nutrition therapy, meaning if you’d like to practice nutrition counseling for people with disease. Depending on your state, you may need to have an RD in order to work one-on-one with anyone for a fee.
Below is a chart from the Center for Nutrition Advocacy. If your state is “red” or “orange”, I suggest a chat with a lawyer before you decide you’d like to attend a non-credentialed nutrition program if your goal is to do counseling.
Reimbursement Limitations for RDs
Before becoming an RD, it’s also important to understand your insurance reimbursement limitations. RDs are compensated differently in each state. In New York for example, RD sessions are only reimbursed by insurance for diabetes and renal counseling. Fortunately, in Massachusetts RD counseling is reimbursable in most situations with most insurance companies.
Learning by Doing
Through the last several years, I also have learned a ton from just practicing. My actual sessions with nutrition clients have taught me so much about what works and what doesn’t. Some people are ready to make a big change and others need to come to an optimal diet in baby steps. Some people need accountability and others just need the science of “why” and they’re good to go. I’ve become much better at reading people and designing a diet that will work for them. At the end of the day, a diet plan will only work for someone if they believe it’s sustainable for them.
I have some really exciting opportunities ahead. I have just secured office locations in Boston (overlooking Copley Plaza) and in Concord, MA. I have an additional office in Cambridge opening this summer. I also see patients via Skype and phone. There are a few more projects in the works that are keeping me very busy when I’m not seeing patients. I’m so glad to be done with the program and moving on with my practice!
Are you interested in becoming a nutritionist or want to set up a one-on-one nutrition consult with me? Learn more about how to work with me! I’ll also be answering questions and presenting about my education journey at PaleoFx in Austin Texas in a special workshop (sign up required, and space is limited, so if you’re interested, sign up soon.)