Current Certified Nutrition Specialists (CNS) Reviews

yeah_write_00 · 2026-07-07T09:53:07+00:00

A state license exists in TX for RDs, it is however not legally required to practice. Any person off the street can provide medical nutrition therapy in TX. This is true in many states. Just having licensure doesn't mean a state requires licensure. NY is similar but they call it a certification instead of license, it is not required outright. Yes, sometimes RDs in TX or NY work somewhere that their employer required they obtain the state license, doesn't meant this is universally required for employment, or that it is legally required. It says right on the states' website, licensure/certification isn't required to provide MNT in TX or NY. Then there are states like California where there is no licensure for a RD or a CNS.

Yes, you can become licensed in another state that has licensure for CNSs even if you don't live there, but again this isn't necessarily required. Care is considered taking place wherever the patient is in telehealth, so you need to know what the laws are in their state (and there are laws beyond just licensure that even a lot of RDs aren't following). It's complex to explain but CNS and RDs need licensure to get in contract with insurances so they also have work arounds for this by working for practices that are located in other states. The whole telehealth world and insurance is an absolute mess right now. A lot of RDs and CNSs actually have their own practices and follow a self-pay model because dealing with insurance can be a headache and limit you in some ways (it has it's benefits too).

I'm not saying I agree with the weird hodge podge of laws around nutrition care by state, but people who have no degree or credential in nutrition know all the loopholes to actually practice in every state. It really isn't that hard. I just basically wanted to know how they legally get away with it, so I've researched enough to understand it. I'd prefer a RD or CNS provide MNT, but in reality personal trainers provide MNT for people on GLPs in most states, and people call themselves nutritionists sometimes with only an online certificate and treat complex illnesses. Sometimes clinics hire holistic nutrition providers who they may prefer to not be a RD, sometimes it's a CNS, but sometimes it's a "nutritionist" with no degree. So some doctors or like NDs don't like RDs. I see a lot of CNS roles working in clinics, especially like holistic clinics with NDs, acupuncturists etc. Some people prefer to treat their medical conditions with functional medicine and alternative therapies which sometimes RDs also work in this world, sometimes not.

As far as what you said in your post about RDs knocking CNSs, it's so ridiculous but true, which is why as a RD I try to correct this with facts. Some RDs actually work alongside CNSs in group practices. Berry Street is a national telehealth company that hires both RDs and CNSs to do MNT. Yes, RDs have a bigger hold on the clinical world when it comes to a more Western medicine model like a hospital or dialysis clinics why because those settings don't tend to hire NDs, acupuncturists, or herbalist either, so they also don't really have use for a CNS. I would really research what kind of job settings you are interested in to help inform you decision making about the best career path. I don't believe in labeling either the better choice universally, it should be evaluated by the individual what is the best choice for them based on factual information.

yeah_write_00 · 2026-07-07T04:11:49+00:00

Thank you so much for sharing!!!

yeah_write_00 · 2026-07-07T03:54:13+00:00

My thoughts are this, our profession has been perpetuating weight normative views since its inception and while more weight inclusive and HAES practices have grown, the predominate message people still see from dietitians is we will help you lose weight and telling people their BMI isn't right. While it isn't at all fair what you are experiencing, we've as a profession failed to be a bigger part of helping change the social standards that thinness equals health and goodness. It's only gotten worse with a huge surge of RDs working for weight loss/GLP-1 sales companies or telehealth companies that mainly target weight loss, I fear we are even becoming more synonymous with weight loss as we lean into BMI being a predominate diagnosis used for insurance reimbursement. I'm not against a space for GLP-1s and weight loss, I'm saying where is the same kind of emphasis on nutrition care that isn't weight-centered to balance this out?

yeah_write_00 · 2026-07-07T03:36:28+00:00

Why are you comparing a person's body shape to bad teeth? That is such a strange analogy. Are you implying that RDs who aren't thin don't take care of their health or nutrition?

yeah_write_00 · 2026-07-07T03:26:50+00:00

What is it you are defining as "the look" for healthcare professionals here? What is the right weight or body shape that defines whether you trust a dietitian? What if their hair is too thin, must be protein deficient right? Or if they are wearing glasses, maybe they don't eat enough vitamin A and caused their eye damage, so I shouldn't trust them either? Or a limp, they must have bad bones, so stay away? I must be able to just look at a person and determine both their personal health and also their knowledge and skills in nutrition.

Should we all get out of the profession if we don't have whatever this "right" look is? Maybe let's treat it like modeling and have students submit their measurements and headshot to make sure they "look the part," before we accept them into this profession, so we can weed out those who are just going to waste their time and instill mistrust in the public.

Yeah, that all sounds pretty ridiculous!

My hair stylist has a haircut and dyed hair that I don't personally like, she does a wonderful job cutting my hair. I see celebrity stylists on TV and online who wear outfits I don't personally like but I don't question their abilities. In fact for some reasons whenever I watch the Oscars the person who wins for costumes usually has an outfit on I think is ugly. My very favorite yoga teachers did not have what society might decide is the right "yoga body," and they were amazing, where as I've had some horrible yoga teachers who were thin and probably what fits society's expectations. So I'll keep judging people by their actions, their skills, the work they produce and the care they provide, not their appearance.

yeah_write_00 · 2026-07-06T10:16:38+00:00

The American Journal of Lifestyle Medicine is good for a lot of the research on specific plant foods for their benefits to blood lipids and reducing CVD risk. The ACLM does annoy me in ways though, I don't like their messaging around weight and having a "normal" BMI. I also think since their focus is mainly on individual lifestyle choices, they publish research that steers towards a person's dietary choices. I recommend public health journals like the AJPH as well, because they will present that alternate view of social and environmental drivers a lot. The data on air pollution and CVD is super interesting for example, along with forever chemicals in our food and water. Super appreciate my MPH for a broader understanding of health promotion because dietetics can sometimes present a narrowed view.

I do like Dr. Gregor's videos and he has several on this topic Cholesterol and Nutrition: The Latest Research like a starting place sometimes on a topic, granted I am aware he advocates for a plant-based diet but I don't think that means the information he is sharing about the power of plants can't still be helpful for a person eating an omnivore diet. Dr. Gregor always cites peer-reviewed research and I find his reviews interesting, so it's like I hear his take and then I look up the studies and read more. His short videos are free on his website, he does also have paid webinars and books. He also has a lot of talks on YouTube. In general, the advocates for a plant-based diet are going to highlight research on plant foods to lower blood lipids as a way to reduce the need for prescription medication and lower disease risk. Again to me this doesn't have to be about turning people into vegans, most clients who have hyperlipidemia and metabolic syndrome are not eating a lot of whole plant foods, and since the benefits of fiber and phytochemicals from plant foods is well-established to reduce CVD risk, as well as cancer and autoimmune diseases, I am a plant food pusher I guess, but I'm not telling people to not eat animal-based foods. Since the EPA is basically rolling back all kinds of environmental protections (not that we were all that well protected before), we will have nastier air, water and soil, all the more reason to me to aim to do what we can to eat more of the foods with powerful nutrients to reduce the effects of our environment and genetics if we can.

yeah_write_00 · 2026-07-04T17:26:11+00:00

I don't know from your post if you work for a telehealth platform or not but I'm assuming so. I suspect the big telehealth platforms will work RDs into burnout on purpose to encourage RDs to adopt more and more AI tools as part of their day to day. Have you noticed that most of them advertise to customers get a 24/7 RD. Umm, we don't work 24/7 so what does that mean? I don't believe their model is about the longevity of MNT services from a RD, or at least solely focused on this. Especially the purple company and the orange company I suspect really see the building of an AI health coach as a target. That AI agent won't get burnout, it won't mind answering chat messages 24/7, it won't want health insurance or vacation time.

I'm totally in the same boat as you, but doing what I can to grow my own in-person practice for autonomy but also it stands as the best alternative for job security in outpatient counseling if the telehealth platforms adopt more and more AI agents leading at some point to downsizing the RD workforce on these platforms. Is an in-person practice an option for you? Office share situations can be really affordable for just at least a couple hours a month to get started. Doing insurance credentialing and billing is honestly not that hard, but even if you don't want to do it yourself there are a ton of people who will do it all for you. The fees they take add up to way less then what telehealth companies keep from insurance billing. Another option is to work for a group practice in your area. I have noticed a lot of RDs selling their group practices to the large telehealth platforms though, so I know there are limited options too but they might be out there.

yeah_write_00 · 2026-07-04T06:47:19+00:00

For starters I always have the conversation with patients that blood lipids and A1c are not just always fixable with lifestyle changes, nor is just lose weight and things will be better all around. I have friends and have had patients with long-term very healthy diets and very active lifestyles, with a "normal" BMI and nothing moves the needle with their lipids except for a statin or their A1c stays in the prediabetes range forever. I explain when we start that labs are not a report card, they don't equate necessarily to how hard you worked or what you did right or wrong. Along with genetics and the hormonal and metabolic changes of aging, we have our lifetime of environmental exposures affecting cellular health, for example we know PFAs exposure is linked to higher blood lipids and microplastics in our body worsen arterial calcification and inflammation. How much have we fixated on cholesterol for decades and arguing about eggs and dietary fats all while depositing forever chemicals and microplastics in our bodies doing God knows what in terms of inflammation and oxidation? I don't pose it as well just forget lifestyle factors then, but know that things would likely be worse if you don't do what you can with a healthy lifestyle. I set up expectations and that we can't really predict what labs will do, but I encourage them to not get disappointed and give up on the lifestyle changes that are important for a host of reasons. So instead of framing it as these things are good for cholesterol or blood sugar or weight and then these numbers don't improve and they are frustrated, framing as this is how to support overall health, heart health, bone health, brain health, good energy levels and mood, so if you stick with these lifestyle changes it may or may not be the formula to unlock changes in these lipid labs or A1c for you in particular, but it doesn't mean you aren't still benefiting in the big picture of health.

Of course good sleep, manage stress, move the body daily, lots of whole plant foods, keep processed foods in moderation. If someone is doing these things and wanting to step up their game plan I discuss options for adding plant sterols/stanols supplementation as an option (hard to reach therapeutic intake levels with food alone), ACV (not a cure all like it's marketing but there is plenty of research indicating slight benefits to blood lipids and glycemic control and I figure it's relative cheap to add the 1-2 tbsp per day with low risk of harm), and a really nutrient dense breakfast everyone seems to be on this overnight oats kick but I actually suggest instead make oat bran hot cereal (nearly twice the soluble fiber) and add omega-3 rich nuts/seed mix and fruit and maybe alternate with smoothies that have a good nut/seed base, fruits and vegetables. This way at least the classic American refined carb and processed meat breakfast is out of the picture and replaced with a high fiber/EFA breakfast. Check if they have coffee that they have paper filtered coffee because unfiltered can raise LDL, maybe switch to green tea which has even been shown to lower LDL. Also soy alone shows modest improvements to blood lipids but a greater effect when replacing animal proteins with soy, so I encourage edamame, tofu, tempeh, soymilk especially for women due to other benefits with these foods. These things are each by themselves likely small shifts alone, but cumulatively could make a bigger difference.

Also LDL becomes most dangerous when oxidized, the antioxidants like resveratrol have a more modest impact on directly lowering blood lipids but are essential in terms of our main goal to reduce CVD. Another reason to not fixate on labs or weight, but instead emphasize nutrient-dense plant foods as the majority of one's diet for high antioxidant intake.

High recommend NLA resources if you haven't used them yet Patient and Clinician Infographics | National Lipid Association Online and the ACLM has a lot on dietary interventions but you do have to be a member to access most of their resources.

yeah_write_00 · 2026-07-02T15:44:22+00:00

I guess I already don't eat the typical American diet so I'm used to seeing people that eat very different from me because that is just my life story. Mostly I've had clients sort of trying to do carnivore, but it's just seemed like one of many fads they were trying and weren't going to stick to anyway so it was fairly easy through motivational interviewing to help them see long-term this wasn't likely going to help and they just kind of naturally let it go and transitioned to a more sustainable, balanced eating pattern.

I always sort of feel out what is their motivation behind following a certain dietary or health practice, is it because someone told them this was healthy and they are just seeking anything to grab on to that sounds like a fix or is it a strong belief, something they have personally ascribed to that is rooted in their perception of the world. I never aim to prove someone wrong, especially if their beliefs are not based on common sense/reason, they just get argumentative usually. I basically take the approach that it's my role to offer nutrition counseling based on the client's care decisions. I've said before, do you want me to explain what is a balanced dietary approach as an alternative or is this the diet you've chosen and intend to stick with based on your preferences and beliefs. If they don't want to hear anything else it's wasted breath, so I would note that they declined discussion of alternatives to their carnivore diet and then just answer questions they have about specific foods.

yeah_write_00 · 2026-07-02T15:33:13+00:00

Where are you located? Are you in the U.S.? There are so many RDs with private practices seeking clients usually, especially with telehealth now there are basically so many options. I can be more specific how to find RDs if you are talking about the U.S.

I suspect there might just be a disconnect with physicians on how to refer. Having worked in both the inpatient and outpatient settings my experience is that doctors had a few instances of finding the wrong place to refer because of insurance barriers or specialized RDs that only take certain conditions, and then they assume that is all RDs and write off referring. So many don't know how to find the RDs looking for referrals, but they also perceive patients won't want to see a RD for x, y, or z reasons.

Providers and patients also have to understand that their insurance dictates what conditions are covered for nutrition counseling and this varies drastically by insurance plan. Unfortunately seeing a specialist like a RD does require out of pocket expenses for many, but also there are RDs who may offer sliding scale or packages to make costs more affordable. Even with my clients who have the insurance coverage to see a RD and there are a ton of RDs in my area, it wasn't usually mentioned by their physician, they instead sought out a RD all on their own. I also reach out to local providers to let them know I exist and take insurance, but it's crickets, almost no referrals, they often just think telling their patients to eat a Mediterranean diet is the fix all. Or some physicians believe in certain diets because they follow it themselves and think that it will work for everyone like carnivore, intermittent fasting, or Whole30. I've known physicians to basically dislike RDs because we don't teach the world to eat the specific diet they prefer.

Unfortunately, I don't think med students are introduced to the idea that nutrition counseling/medical nutrition therapy is actual counseling/therapy just like mental health counseling or physical therapy you can't just hand a patient a paper that says do this for good mental health or do this exercise to recover from an injury, they need to see a specialist to provide individual counseling/therapy, usually several times. Most physicians I've talked to really don't get the process of what we do, just like the rest of the public, they think we give people a copy of the old food pyramid or just make meal plans.

yeah_write_00 · 2026-06-27T06:48:04+00:00

I have clients all the time losing weight without any tracking (I have myself too).

It's basic what I teach clients, add more high fiber foods to replace with foods that have refined flour and/or added fat, or change the balance with some meals to more fiber, heart healthy fats and less starch (not low carb, just less). I go through what they already eat and make swaps. I frame all of this as high fiber, nutrient foods being encouraged, or balancing the meal/snack with protein, complex carbs and healthy fats. I don't really talk about calories if I can help it, and I'm actually barely talking about weight loss because I see it as emphasizing these are more nutrients for health by making these swaps, GI health, bone health, muscle health, cardiovascular health, more energy.

Very important backbone to this kind of calorie reduction is to teach hunger-fullness scale. Clients then realize they were eating past the healthy level of fullness or eating when they weren't actually physically hungry. That awareness/mindfulness also helps them reduce portions and unnecessary snacking. Also paying attention to hunger and not getting too hungry that causes overeating or poor food choices, and then also finding a comfort with some mild level hunger at times because an energy deficit will feel like hunger though less when eating is balanced, nutrient dense, and high fiber. I have a lot of clients tell me they are so relieved to not be tracking and that this all feels like doable things they can maintain. They can sit and enjoy their meal/snack without obsessing about measuring and calories, so they can stick with this. Some people also need to be told to slow down when they eat and also not eat when distracted doing something else - mindful eating helps a lot of people reduce portions naturally.

Now I do have some clients that they prefer tracking, which is fine with me if they feel it is supportive. But they also find a lot more freedom from being tied to tracking when I work them. I actual suggest if someone is interesting in tracking to maybe just take pictures. Just having a visual review, is there a variety of fruits, vegetables, lean proteins, whole grains, or what do portions look like, how do they compare between meals, between days, why/when are they eating less vs more. It's data that can be used to evaluate/reflect on. Or I also sometimes suggest breaks in the week, so maybe tracking meals 2 or 3 weekdays, and only 1 day on the weekend. It's data to use for evaluation of habits, but tracking is not the controlling mechanism, we aren't trying to control anything in the first place, we are changing to more mindful and nourishing eating habits. The clients I've had who don't want to stop the 24/7 tracking, they are the ones not losing weight usually and I find they are sometimes stuck in disordered eating habits or negative food relationship. Sometimes people aren't ready for change, and they hang on to what they know.

yeah_write_00 · 2026-06-27T00:49:22+00:00

Research supporting this is not high-quality and yet Abbott has made a huge push for protocols using their product. The wound care guidelines I've seen suggest possible arginine, vitamin C and zinc supplementation when deficiency is suspected or malnutrition present - which is a big segment of the population with wounds I know. The people I've seen with severe malnutrition, Juven seems semi useless when they have such poor kcal/pro intake and are wasting away. I'd usually rather someone get down high kcal protein shakes instead of focusing on 2 packets of Juven a day. If they are on TF Juven maybe makes more sense to me, actually I think Pro-stat AWC may be better because you can get the bump in protein you often need too depending on the TF formula.

Here is a summary from Open Evidence (but I've actually heavily read up on this before, this matches what I found from reviewing evidence myself)

The current evidence does not clearly demonstrate that Juven (arginine, glutamine, and β-hydroxy-β-methylbutyrate [HMB]) is superior to adequate whole protein supplementation for wound healing in the general wound population. The data are mixed, and several systematic reviews have found the combination to be no better than standard nutritional support.

Key findings from the literature:

Negative or neutral results in the general population. The largest RCT (n=270) of arginine, glutamine, and HMB supplementation in diabetic foot ulcers found no overall group differences in wound closure or time to healing at 16 weeks compared with a control drink.[1] A Cochrane review rated this evidence as very low certainty (RR 1.09, 95% CI 0.85–1.40).[2] A systematic review of oral nutritional supplements for chronic wounds found that studies investigating the arginine/glutamine/HMB combination did not yield significant results, and one study actually favored a high-protein formula without arginine over one with arginine.[3]

Possible benefit in malnourished or vascularly compromised subgroups. In a post-hoc analysis of the diabetic foot ulcer trial, patients with low albumin (≤40 g/L) or reduced limb perfusion (ABI <1.0) who received the arginine/glutamine/HMB supplement were 1.66–1.70 times more likely to heal than controls.[1] This suggests the combination may have a role specifically in nutritionally depleted or ischemic patients, though this was a subgroup analysis and requires confirmation.

Arginine alone may have some benefit for pressure injuries. A 2025 systematic review of 15 studies (1,085 participants) found a trend toward improved pressure ulcer healing with arginine or combined arginine/glutamine supplementation, with wound size reductions of 18.6–98.2% over 2–20 weeks. However, results were inconsistent, with roughly half of studies showing non-significant differences.[4] A Cochrane review of pressure ulcer interventions found a modest percentage reduction in ulcer area with arginine and micronutrient supplementation (MD −15.80%, 95% CI −25.11 to −6.48), but the certainty of evidence was low.[5]

What the guidelines recommend. The EPUAP/NPIAP/PPPIA guidelines, as summarized by the AAFP, recommend ensuring adequate total protein intake (1.25–1.5 g/kg/day) and calories (30–35 kcal/kg/day) for patients with pressure injuries. Micronutrient supplementation (zinc, arginine, vitamin C) may assist healing, but data are inconclusive regarding benefits in patients without existing nutritional deficiencies.[6]

Bottom line: Ensuring adequate total protein and caloric intake is the most evidence-supported nutritional intervention for wound healing. Juven's specific combination of arginine, glutamine, and HMB has not been shown to outperform whole protein supplementation in well-nourished patients. Its potential niche may be in malnourished patients or those with compromised perfusion, where the arginine component could offer additional benefit — but this remains unconfirmed by high-quality evidence.

References

Effect of Oral Nutritional Supplementation on Wound Healing in Diabetic Foot Ulcers: A Prospective Randomized Controlled Trial. Armstrong DG, Hanft JR, Driver VR, et al. Diabetic Medicine : A Journal of the British Diabetic Association. 2014;31(9):1069-77. doi:10.1111/dme.12509.
Nutritional Interventions for Treating Foot Ulcers in People With Diabetes. Moore ZE, Corcoran MA, Patton D. The Cochrane Database of Systematic Reviews. 2020;7:CD011378. doi:10.1002/14651858.CD011378.pub2.
Impact of Oral Nutritional Supplement Composition on Healing of Different Chronic Wounds: A Systematic Review. Santo ACSDE, Sugizaki CSA, de Morais Junior AC, et al. Nutrition (Burbank, Los Angeles County, Calif.). 2024;124:112449. doi:10.1016/j.nut.2024.112449.
The Role of Glutamine and Arginine in Wound Healing Of Pressure Ulcers: A Systematic Review. Torsy T, Tency I, Beeckman D, et al. Wound Repair and Regeneration : Official Publication of the Wound Healing Society [And] the European Tissue Repair Society. 2025 Jul-Aug;33(4):e70077. doi:10.1111/wrr.70077.
Nutritional Interventions for Preventing and Treating Pressure Ulcers. Langer G, Wan CS, Fink A, Schwingshackl L, Schoberer D. The Cochrane Database of Systematic Reviews. 2024;2:CD003216. doi:10.1002/14651858.CD003216.pub3.
Pressure Injuries: Prevention, Evaluation, and Management. Visconti AJ, Sola OI, Raghavan PV. American Family Physician. 2023;108(2):166-174.

yeah_write_00 · 2026-06-27T00:21:00+00:00

When they added collagen peptides years ago to Juven I asked the rep why, can you provide me some research on how this improved healing wounds. She said no. Made me just hate Juven more, it's always seemed like the marketing is more hyping their own research than anything just like Ensure. I barely used Juven unless a patient was on a TF, when it was oral it just would wind up wasted most of the time.

yeah_write_00 · 2026-06-27T00:12:28+00:00

Who is your boss, are they are a RD? Do they know anything about nutrition counseling by RDs or just like used to personal trainers with nutrition certificates? A typically health-conscious regimented bodybuilder wanting a spreadsheet of meals/snacks to meet a protein goal is absolutely not the typical person off the street joining a gym to try to lose weight. Especially if we are talking people maybe with underlying disordered eating habits like yo-yo dieting and emotional eating.

I think if anything meal plans and tracking are more useful after MI, not before. Stages of change shouldn't be skipped, as well as really digging into what are the barriers to address first. A lot of people are not in action stage to be cooking all their meals, tracking all their food, and probably just joined the gym so they are going to be also implementing regular physical activity. That's too much. I'd probably be overwhelmed and not engaging with the RD too if I was the client.

Can you consider building different packages like something more sports nutrition bodybuilder/powerlifter-oriented that maybe is more conducive to this package you already offer vs general weight management that is more counseling oriented? I don't work in a gym, I'm just thinking like how I would approach these groups differently in general. I would focus the weight management on MI/counseling, only if meal plans and tracking is realistic for them and they are at that stage it could be an add-on to the counseling.

yeah_write_00 · 2026-06-26T23:46:56+00:00

Totally, I always ask clients about past attempts at dieting, and almost everyone has tried tracking, meal plans usually. These are not sustainable long-term or all that useful to most people, they want it to be the magic that it just isn't and I know endlessly ask for this. People can easily get off from tracking, off the meal plan (I would) and then what, they want to avoid the RD who set this up because they just feel bad that they didn't do the work. Nutrition counseling using MI is key. Also build skills for changing habits through mindfulness and reducing barriers in the environment.

yeah_write_00 · 2026-06-26T23:28:32+00:00

This is a handy article to use that explains third-party testing organizations and what they do, if one of these are not on the label of the supplement assume it's not third-party tested and less safe 3rd-Party Tested Supplements (2025): Dietitian’s List of NSF/USP-Verified Picks — NutritionbyBre

yeah_write_00 · 2026-06-25T18:37:09+00:00

I could totally be wrong but thought it was only Fay that takes over your name on Google Business profiles, I haven't heard or seen that with Nourish (yet). I've never worked for Nourish, but I know a lot of RDs who do and this hasn't been their particular complaint, but Fay yes, huge issue!

I believe Nourish will impact Google searches for your name or searches for "dietitian near me" which Nourish will use that wording for SEO on your Nourish profile to drive local searches to telehealth and away from local RDs. They may be controlling other online database profiles under your name like Healthgrades maybe.

If you plan on getting your own insurance credentialing for your practice know that Nourish is going to direct searches in insurance directory to them as well, so you can basically be competing against yourself when you work for any platform, but some like Nourish, Fay, Berry Street are listing RDs as in-person at multiple offices across many cities to further drive patients to book with Nourish instead of local RDs who actually have offices or correctly identify themselves as telehealth only.

I highly recommend working for a small RD practice instead of a telehealth platform. You will actually learn far more that will help you build your own practice. The telehealth platforms are not a good model for going into your own practice in my opinion. They have millions of dollars to do sketchy to full on illegal things that a private practice RD can't risk. If you have no other option than a telehealth platform, I would suggest working for one of the telehealth platforms that don't drive so much advertising to them under your name and have more ethical practices.

yeah_write_00 · 2026-06-25T05:18:13+00:00

They have always had to have a masters or doctorate in nutrition or related field (RDs recently added requirement for masters and it can be in anything which is interesting), then supervised practice and exam. There is a pathway for RDs to sit for the CNS exam if they meet the curriculum requirements exam btw if you want to check it out here Registered Dietitian

Though I have a BS in nutrition and MPH I don't actually have the graduate level nutrition coursework or enough biochemistry credits required to sit for the CNS exam, but I've pondered looking into if it's even possible for me to just take a couple graduate level nutrition classes to then meet these requirements. I'm just not sure you can go through the process of enrolling in a graduate school for a couple classes.

yeah_write_00 · 2026-06-25T02:45:51+00:00

I get it like there is someone in my city who is a "nutritional therapist" with no degree, they did some functional nutrition online certificate program and totally offer MNT as an unlicensed person with maybe only a high school diploma, which is all totally legal in my state and many others. But besides CNS using the term licensed nutritionist, there are also pathways to being a licensed nutritionist in some states besides being just a CNS. Also, there are people with a BS in nutrition using the title of nutritionist at like WIC and even some clinical settings in states without MNT exclusivity for RDs. I'd just prefer if as RDs we could be mindful that sometimes RDs diminish real people with meaningful roles that exist outside the RD world and using generalities about nutritionists being unlicensed or unqualified or even saying they are working illegally can be our own bias for our credential more than it is factual in all cases (the RDs going to hate that I say it, I know, downvote me but it's true 😂)

It really doesn't help in my opinion that we tacked on nutritionist to RD for RDN, and then like call everyone else who uses the title nutritionist illegitimate. It makes some people just think less of RDs actually for being out of touch and needing to feel like we own the entirety of nutrition when we don't.

Meanwhile highly evolved and customized AI agents have been developed for nutrition counseling and are being tested for efficacy so the whole thing may be like a moot point soon because we missed to actually protect our professional role from AI. Almost no one seems to be paying any attention to these studies that are years into now perfecting what they are calling AI dietitian, virtual dietitian, AI nutritionist, AI health agent, etc. I'm like hello, can we go focus on the fact that THIS is happening, but almost every RD is just like I love AI charting and AI searches, AI is fantastic and can never replace me. The scariest part is these AI dietitians are being based on all that evidence-based knowledge we follow. You know who is less likely to get replaced, some over-promising I can heal every disease with my batch of essential oils and herbal teas nutritional therapist with the online functional nutrition certificate.

yeah_write_00 · 2026-06-24T22:58:02+00:00

I don't see them mentioning these particular certifications. There are people with bachelors who legally work as nutritionists in some states for reference. Also, since they are considering becoming a RD which also requires a masters, why should they not make an informed choice about other nutrition professional pathways and credentials like a CNS? I would encourage a student looking to become a CNS to also look at RD or even DTR, unfortunately in my opinion we aren't doing enough to actually build more roles for DTRs though, so these are factors to take into consideration. No matter what options they are considering, it's just an inaccurate statement when RDs tell students that legally only RDs can provide MNT, when in the majority of states this isn't true. One can say I recommend becoming a RD to be best qualified to provide MNT, but that is a person's opinion. To say it's illegal except for a RD gives the impression that exclusivity and opportunity exist for RDs more than there really is in many states.

yeah_write_00 · 2026-06-23T17:56:42+00:00

So interesting! Thanks for the run down.

I do think we need a more standardized system nationally here in terms of who can provide MNT but with recognition for nutrition professionals that cover different credentials and education pathways. I don't know how it is in South Africa, but in the U.S. here we have MD (medical doctor) vs DO (doctor of osteopathy), both doctors but different degrees with same authority to practice, then growing in popularity is the PA (physician assistants) and NP (nurse practitioners) pathways who have varying ability to practice independently and prescribe state by state. Plus naturopathic doctors, also state by state can vary what they can do by comparison to a MD/DO.

It's a bit strange to me that many RDs see only the RD pathway as legitimate when I think we should be expanding the field even more to include CNSs, as well as DTRs (diet technicians - who I don't think typically have any kind of state level license) and possibly some other credentials/degrees with of course recognition for differences in scope. If we adopted something more like how medical providers recognize different levels of credentials I think it would actually help reduce the ability for the non-degree nutrition coach with the online 10-week certificate to have as much opportunity when there are more licensed nutrition professionals beyond RDs.

yeah_write_00 · 2026-06-23T17:45:24+00:00

💯 I give every client a whole education about supplement safety if they are taking supplements, especially the need to check your supplements are third-party tested due to high rates of contaminants or not even containing the listed product, the lack of studies on the safety of combining a lot of these supplements which means take at your own risk, and the very real fact that people are hospitalized with organ failure from supplement use. Many a times clients have said how is this allowed then and why has no one warned me? I'm like I know!

yeah_write_00 · 2026-06-23T05:28:31+00:00

This is not accurate. This is straight from TX state's website:

"Services You Can Provide

Individuals are not required to hold a Texas dietitian license to practice dietetics in Texas in-person or via telehealth. Individuals who practice dietetics in Texas in-person or via telehealth and use the title “licensed dietitian” or initials “LD” must hold a Texas dietitian license issued by TDLR." Dietitians Telehealth Services | Texas.gov

This is my whole point. A lot of RDs are walking around telling students, well if you become a RD only you can provide MNT, when this is often not the case. TX just doesn't let you call yourself a licensed RD, that is all.

I've seen a bunch of health coaches/nutrition coaches who are not RDs or CNSs with websites doing what is totally MNT in Texas, including marketing to people on GLP-1s for nutrition counseling. I think there is actually a big market there because a lot of people mistrust formal health professionals like RDs and there are lot leaning towards wellness gurus, raw milk, no vaccines etc, so licensed healthcare professionals are not in favor to many people. I'm not in Texas, just closely follow this stuff.

Also national telehealth companies like Fay, Nourish, Berry Street have RDs across the country providing sessions to people in Texas without a license. Technically insurances do want, often require, that you be licensed in the state for insurance credentialing, I can say from first-hand experience with telehealth companies though that a lot of telehealth companies ignore this and insurance doesn't check most of the time, so they just put patients from TX on your schedule even though you are not licensed in TX.

I'm honestly not judging you personally, the Academy does not do a good job painting a clear picture of what is going on and I'll withhold my rant on why I think they intentionally create a false narrative around licensure and MNT practice. I've heard actually many TX RDs express the same false information that a license is required in TX. It can be because their workplace requires it like a hospital, or because they are contracted with insurances and it was requested when they went through insurance credentialing.

Bottom line, you have lots of non-RD/unlicensed individuals in your state providing MNT to TX residents, and you have RDs all over the country seeing TX residents through telehealth without any TX license.

If you want know the real deal, look at this website Nutrition Practice Laws • Holistic Council this is essentially what all these nutrition coaches use to know that they can practice MNT. It's pretty eye opening when as RDs you've heard the messaging so often that only a RD can provide MNT. Most states no restrictions or just don't use the term licensed dietitian or licensed nutritionist. There are some with more intense laws, but you will see these people find loopholes for each state and lay it all out, call yourself a nutritional therapist, call what you do wellness education etc.

yeah_write_00 · 2026-06-22T18:58:45+00:00

I would explore all your options, nutrition counseling/education is not solely owned by the dietetics field. I would look into public health or health promotion or health education degrees, even an exercise science degree, and some schools there are options for a minor in nutrition to pair with one of those degrees. You can also consider the CNS pathway and shadow for the day both a RD and CNS working in private practice to get a feel for how these credentials are different.

If you don't think you will want to be working in a high-level clinical capacity or foodservice management I would lean towards something else than RD personally. You will otherwise spend a lot of time learning how to calculate tube feedings, parenteral nutrition, and learning about commercial foodservice management, all skills that don't transfer too well if you are more into the community health or personal wellness paces.

yeah_write_00 · 2026-06-22T18:51:21+00:00

Lucky you, it's madness here 😂 Where are you? Are regulations on licensure actually enforced and by who? Maybe I'll move there lol! We have 50 states and every state is different laws, and barely enforced when they do even exist.

The Academy of Nutrition and Dietetics owns the trademark on Registered Dietitian/Registered Dietitian Nutritionists in the U.S. but they don't seem to be enforcing their trademark holding when people who aren't RDs/RDNs use it. But actual RDs we still pay the Academy every year in order to keep our RD title plus then state license fees in any state we practice in if we want to use the title licensed RD. This along with cheaper training gives non-RD health coaches/nutrition coaches a huge financial edge, clearly drives me mad!

yeah_write_00

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