“You are what you Eat.” This is a common phrase, but in functional medicine, we take that phrase much further. As Tracy from SAFM summarizes, we are “what we eat, digest, absorb, convert to final forms, and get past the cell membrane (and where relevant, into a sensitive receptor!)”
You’ve probably also heard phrases like “Food is Medicine” or “Disease begins in the Gut.” These are commonly recited in the functional medicine arena as well, and for good reason. Nutrition is the cornerstone of every functional medicine treatment plan, and yet the moment a practitioner begins to dip their toe into the waters of this vastly complex subject, it becomes very apparent just how little most pharmacists and medical providers learn about nutrition in their formal training. This leads to even more questions about the role of nutrition in the pharmacist’s toolkit, and the role of pharmacists in the overall nutrition plan. The key to successful nutrition outcomes is not to try to know it all, but to know when and where to collaborate and refer. Let’s dive into the details.
Pharmacist’s Scope of Practice:
As pharmacists become more versed in functional medicine and the role that nutrition plays in the care plan, the question arises of how in-depth can and should the pharmacist proceed with nutrition counseling? This comes down to one thing: scope of practice. According to the American Nutrition Association (theANA.org):
Pharmacists are regulated in every state, but the inclusion of language concerning nutrition care in these laws varies widely from state to state. In many states, the broad nature of a pharmacy scope of practice could be interpreted to include the use of nutrition tools. Some state laws explicitly include the use of nutrition as it relates to promoting health and preventing disease, while others limit the use of nutrition to counseling about food-drug interactions. In a state with an exclusive scope of practice nutrition law, it is illegal for a pharmacist without a nutrition/dietetics license to provide nutrition counseling unless:
The practitioner has a state license or state certification that recognizes nutrition counseling as part of the legal scope of practice; or
The practitioner’s nutrition guidance is covered under an exemption to the nutrition/dietetics licensing law.
A key term to understand is “medical nutrition therapy” which is defined as individualized nutrition plans designed to treat and manage a particular disease state. Generally speaking, providing MNT and billing for MNT is reserved for licensed/registered dietitian nutritionists (LDN or RDN or RD) and in some states, Certified Nutrition Specialists (CNS). And to be realistic, providing detailed, quality MNT is likely beyond the scope of practice and knowledge base / skill level of most pharmacists and other medical practitioners for that matter. True MNT is providing an entire micro and macronutrient analysis of the patient’s current diet (usually by reviewing food diaries) and target nutrition plan, complete with caloric calculations and meal plans for each day, all tailored specifically to their disease state with the goal of actually treating and managing that disease.
The key here is understanding if you are practicing nutrition within your pharmacy scope, or attempting to practice nutrition outside of your pharmacy scope.
Pharmacist’s Role in Nutrition (in-scope):
Are you looking to incorporate basic nutrition counseling under your pharmacist scope, as described in the first section? If so, you are likely good to go, but be sure to check your state nutrition and pharmacy laws as described above.
Traditionally, pharmacists receive nutrition training in pharmacy school as it relates to two distinct areas: inpatient and outpatient.
1. Inpatient nutrition might involve managing things like TPN (total parenteral nutrition) and critical electrolyte imbalances. There is an entire BPS “Nutrition Support Pharmacy Specialty Certification (BCNSP)” dedicated to this very particular path. These are patients in acute situations, or potential very advanced / severe chronic disease process, and thank goodness for modern medicine being able to support the body’s physiology when a patient may be unable to eat and digest on their own.
2. Outpatient nutrition might involve topics like recommending dietary changes to manage chronic conditions, or managing drug-nutrient interactions and depletions. Within every treatment guideline, the first step is almost always “lifestyle modification” but we have a tendency to gloss right by this topic and move into the drug therapy. Some examples of diet or nutrition topics a pharmacist would be well equipped to discuss include:
- teaching patients about “carb counting” to dose their insulin
- recommending a DASH diet or Mediterranean diet for high blood pressure or cholesterol, or other pre-set yet non-individualized meal plan examples to a patient (Whole 30)
- dispensing prescription nutrients for clinical deficiencies such as potassium 20mEq or vitamin D 50,000 IU
- dispensing medical foods like Metanx for patients with diabetic peripheral neuropathy
- considering drug-nutrient interactions like grapefruit juice and statins, or vitamin K containing foods and warfarin
- designing an optimal plan for timing medications for patients on multiple medications, some that are required to be taken with food and others on an empty stomach
- recommending various vitamins, minerals, and herbal supplements over the counter, as well as nutrition products like protein shakes
- referring complex patients to a nutritionist / dietitian when it becomes apparent that the patient would benefit from a more through analysis and plan
Practicing as a Nutritionist (beyond the pharmacist’s scope)
Are you attempting to practice nutrition as a standalone service outside of your pharmacist scope or pharmacist services? This can be more challenging; you will need to thoroughly review the nutrition laws for your state. If you are in a red state, then most likely you will need to become licensed RD in order to truly practice nutrition. If yellow, then you may need to become a licensed RD or potentially a Certified Nutrition Specialist (CNS) which being recognized in more states for nutrition licensure. If green, then lucky you! Anyone off the street can call themselves a nutritionist and give out whatever nutrition advice they would like! In any case, it’s still important to understand that you cannot practice medicine, and more boards or legal situations would still hold you accountable to your highest licensure (aka your pharmacist’s license.) It is important to meet with a lawyer and have solid contracts in place that outline the differences in pharmacy services and nutrition services, and which one you are offering.
Nutrition Training Programs:
Here are some examples of popular nutrition programs you might consider. Please note that you will also see training programs for “nutrition coaching” or “health coaching” with a focus on nutrition. Be sure to also read our Blog post on Health Coaching to understand the difference in scope of practice between pharmacist and health coach! Again, if you are in a red or yellow state, then MNT is potentially even further outside the scope of a health coach (a non-licensed modality) than it is a pharmacist! In red and yellow states, the pharmacist license is protective for us to provide basic nutrition information as a pharmacist.
- Master’s Programs: If you know you want a Master’s Degree ($20,000+) or want to become a licensed dietitian nutritionist or CNS:
- University of Western States
- Maryland University of Integrative Sciences
- University of Bridgeport
- George Washington University School of Medicine and Health Sciences
- Stony Brook University
- Bastyr University
- Non-degree nutrition training certificate programs: (again, these do not change your scope of practice):
- Institute for Integrative Nutrition (IIN) – Health Coach Training Program (HCTP) <–click the link to receive an automatic discount on registration!
- Functional Diagnostic Nutrition (FDN) <– click the link to tour the course
- Functional Nutrition Alliance (FNA)
- Institute for Integrative Nutrition (IIN)
- IFNA (Integrative and Functional Nutrition Academy)
- NTA (Nutritional Therapy Association)
- American College of Nutrition (ACN): Certified Nutrition Specialist (CNS) * the only one that can lead to licensure in some states
- Clinical Nutrition Certification Board (CNCB): Certified Clinical Nutritionist (CCN)
- National Association of Nutrition Professionals (NANP): Board Certified in Holistic Nutrition® (BCHN®)
- There are other sports / fitness related nutrition programs as well geared towards personal trainers, but these tend to focus on the more outdated model of counting calories, so we will not discuss them here.
Understanding the laws and scope of practice considerations between pharmacy, nutrition, and health coaching can be complex! Ultimately, it comes down to getting clear on how you want to practice and what will be most fulfilling for you. This is why we recommend joining the Functional Medicine Pharmacists Bootcamp (FMPhB) before investing in any training or certificate programs! Our 5 modules will walk you through the process of getting clear about the Framework for your Vision, and helping you decide on the right Professional Training or Certification options, so that you don’t go spending $10,000+ on a certification that you don’t actually need! Your pharmacist license likely provides all the protection and education that you need, and it’s just a matter of finding the right resources to supplement your knowledge. We help you accomplish this through our Market Research and Clinical SWOT Analysis process inside the Bootcamp. Have questions? Click here: Learn more about the Bootcamp!