Nutraceuticals and Ethics for the RD

Registered dietitians are constantly asked questions from their patients and clients. Should they take a multivitamin? Where can they find information about taking more than the recommended dose of certain vitamins? Which nutrition supplements are best?

The media is overwhelmingly saturated with energy bars, muscle drinks, herbal remedies, and pills that promise to help people look and feel great. It really is challenging in the face of this media saturation for registered dietitians to promote living a lifestyle of moderation, drinking water, eating fruits and vegetables, and exercising.

Consumers argue that science and technology are figuring out ways that are better than mother nature’s, and moderation is not what they want to hear. Registration dietitians often find it challenging to balance sound information and research with popular culture, especially those in private practice, because consumers may quickly move on to other sources if their nutrition expert does not provide them with quick enough results.

Dietitians struggle with the true or perceived conflict of interest in selling supplements in their practice. Consulting the Academy of Nutrition and Dietetics’ Web site for the Code of Ethics (available at http://www.eatright.org/codeofethics/) may help.

Prior to deciding whether selling products is right for a practice, consider these questions:

• Do you plan to conduct business with honesty, integrity, and fairness?
• Will you present substantiated information and interpret controversial information without personal bias, recognizing that legitimate differences of opinion exist?
• Will you recognize and exercise professional judgment within the limits of your qualifications?
• Will you provide full disclosure when a real or potential conflict of interest among different clients might arise?
• Can you promote products in a manner that is neither false nor misleading?

The Academy of Nutrition and Dietetics’ Web site lists established guidelines that provide direction to dietetics professionals related to recommending and selling of dietary supplements in their practice. The full guidelines are found at: http://www.eatright.org/About/Content.aspx?id=8145.

The 13 guidelines include:

1. Performing a detailed assessment of dietary supplement use for each patient
2. Recommending a dietary supplement based on thorough scientific research
3. Using supplementation only in conjunction with dietary changes, not in place of modifications to the patient’s diet
4. Making recommendations that are in the client’s best interest and deemed safe with regard to clinical status of the patient
5. Reporting adverse reactions to dietary supplementation to the US Food and Drug Administration and other health care professionals
6. Keeping detailed documentation in the patient’s medical record with regard to supplementation use
7. Participating in continuing education in the area of dietary supplementation, because the dietetics professional assumes responsibility and accountability for personal competence in practice
8. Making supplements available to the patient, based on individual needs, without bias, and providing appropriate education
9. Providing disclosure of any financial relationships regarding the sale of dietary supplements to patients or clients
10. Offering factual information about availability of the purchase of supplements
11. Knowing about the regulation of dietary supplements
12. Understanding the legal ramifications of providing supplements through the dietetics professionals’ practice
13. Basing the sale of supplementations on sound business practices

References and recommended readings
Academy of Nutrition and Dietetics. American Dietetic Association/Commission on Dietetic Registration code of ethics for the profession of dietetics and process consideration of ethics issues. J Am Diet Assoc. 2009;109:1461-1467. http://www.eatright.org/codeofethics/. Accessed April 26, 2012.

Academy of Nutrition and Dietetics. Guidelines regarding the recommendation and sale of dietary supplements. http://www.eatright.org/About/Content.aspx?id=8145. Accessed April 26, 2012.

Feeney MJ. When ethics collide: an independent dietetic consultant’s perspective on balancing professional ethics with the wishes of your clients. J Am Diet Assoc. 2008;108:29-30.