Does the Label Matter? “Dietitian” meets “Nutritionist”

I haven’t had this conversation for about 26 years.  For some reason, it’s coming up fairly regularly now, and I see it’s an important point to make.

I want to be L A B E L E D.

A Dietitian, that is.What is the difference between a dietitian and a nutritionist?

Why? Because you wonder, “What is the difference between a ‘Nutritionist’ and a ‘Dietitian?'”  No need to deny it. You know you do.

I know this because once we talked about it, almost every other health care professional in the room at the Down Syndrome Medical Interest Group Meeting in San Antonio said, “Oh…I’ve always wondered about that! Good to know!” These are some of the most respected names in health care for people with Down syndrome in the United States. And they didn’t know. So don’t feel bad.

Simply put, anyone can call themselves a “nutritionist.” But only some can call themselves a Dietitian.

Let’s compare the two.

Dietitians are registered nationally, and licensed by their state in which they practice. To be registered, one must have at least a BS in Dietetics or Nutrition and complete an internship (or an approved alternative) following graduation. But wait, they’re not done yet! Once these criterion are met, a person is eligible to take the registration exam, administered by the Committee on Dietetic Registration. Once a person successfully passes this exam, they may call themselves a Registered Dietitian and place the letters. “R.D.” after their signature. Last, one can apply for a license to practice in each state they choose to practice medical nutrition therapy.

This rigorous training teaches the RD to work with you – in tandem with your health care team – to create a nutrition therapy plan that fits your lifestyle.

Anyone can call themselves a “nutritionist.” There are no education, ethical, or license-related standards to govern the use of the title. It’s not necessary, but you can obtain a type of certificate from any number of programs – available in magazines, over the internet, on television, and more – for some “training” in nutrition.

Some Dietitians have jobs with the title “Nutritionist.” For example, Dietitians working in the Women Infant and Child program (WIC) are called “Nutritionists,” but their job description requires they are a Registered Dietitian. All individuals working in accredited hospitals, regardless of the job title on the door, are Registered Dietitians.

What about “Coach”?
Another job title to take note of is one that has the word “coach” applied to it. There’s any number of combinations: wellness coach, nutrition coach, lifestyle coach, health coach, and so on. Although accrediting organizations do exist for coaches, there is no regulation on how the term can be used. In the end, anyone can call themselves a “coach.”

Don’t get me wrong. There are some amazing nutritionists and coaches. There are people who can’t meet the rigorous training or pass the registration exam, but have the educational background, for instance.

But there are some who are very scary too. And then, there are those who really just want your money. You may meet a Dietitian like this too. The difference? If you meet a Dietitian whose medical or ethical judgement  you question, you have a course of action.

Nutritionists are not held to ethical standards. There is no mechanism to complain and perhaps strip them of their credentials. If you have a complaint about the professional ethics of an RD, there is a mechanism to do this – just as with physicians.

For example, I make great tools to help people change their environment or develop skills that transform their environment to promote quality health, quality lives, in a connected community. I will coach you to that outcome whether you use my cookbooks or not. I will also sell you my tools without requiring you to participate in any of my programs. They are mutually exclusive.

The short answer is that a Registered Dietitian is someone who is highly trained, whose credentials are monitored, and who is required to complete relevant continuing education to keep their credentials.

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Walking the Walk….Eating the Choices

The most intense learning situations in my life have been in my role as Andy’s Mother. The most rewarding learning experiences come from working with Andy and others who are on this journey with us.

I can tell when people wonder if I actually do the things that I talk about in my own home. It’s a reasonable question, really. Andy, with all his uniqueness, is his own person. What we do is tailored to his success.

Tonight is a great example.

Earlier this year we took trips to our local New Seasons Market, with photos of cuts of meat and text for the specific order, and purchased different cuts of meat. Andy  now thinks the meat department is the best part of the store.

Andy decided that today he wanted to be in charge of our dinner menu. It caught Charli, Andy’s support provider, and me by surprise, but we grabbed a couple of the meat order cards and let him make a choice. He chose chicken kebobs.

Chiken kebob Meat Order request cardChuck Roast Request Card

Off we went to the store. Andy marched straight back to the meat counter, where we met Mason. There were a few people there, but Mason was ready for the next order. As Andy handed over his card, Mason grinned from ear-to-ear, saying “I love this!”

He then asked if he could show the card to his coworkers. They all smiled as they watched Andy waiting – not so patiently – for his kabobs. One person asked if I made these cards. I just smiled and said, “Yes.” (they take less than five minutes to make). They were only impressed for a moment. Andy drew the attention back to himself by peering over the counter to check on Mason’s progress.

Mason handed over our brown wrapped kebobs, and Andy took the package with great pride.

2009 © Phronesis Publishing

Off we went to pay.

As shown in Cooking by Color: Recipes for Independence, I use a broad guide for planning a balanced meal: if the meal has 3 of the 5 food groups, it is balanced. I always warn parents and  providers that this can lead to some odd menus.

Here’s how it went:

I offered Andy a choice of rice or noodles to go with his GF Teriyaki Kabobs. He chose Penne pasta.


I tried again by offering rice noodles or Penne.

He chose Penne.

I offered a choice of tossed  salad or sauteed vegetables.

He chose sauteed vegetables.

So I chose to mix the vegetables in with the pasta – something I do often.

folowing the menu planning guide in Cooking by Color: Recipes for Independence


Chicken Kabob
Penne Pasta with sauteed Broccoli & Carrots


He proudly – and I do mean proudly – ate every bite.

Walking the walk…eating the choices. It’s an adventure I wouldn’t trade for the world.

Posted in Cooking, Cooking by Color, Disability-related, family and friends, General, Health Litearcy, Tools | Leave a comment

A Blast from the Past: Creating Solutions – Disability Solutions

I am pleased to be able to offer electronic copies of Disability Solutions to visitors to my site. This work represents 10 years of investigation, learning, and collaboration with many talented professionals and parents. The articles, are provided here with the same mission as originally intended: To do good for, and with, people with Down syndrome and related disabilities. Many of the topics are timeless and some are one-of-a-kind!

The work related creating, editing, and publishing Disability Solutions was key to my growth as a professional and, more importantly, as a Mother. Every issue touched my family directly, and still do. I hope they will continue to inspire you as well.

You can access the back issues (as pdf files) here.

Many people put in hours of time, free-of-charge, to create these issues. If you are interested in reprinting any of the articles, please honor the following guidelines:

  • Do not change the article.
  • Cite the author fully.
  • Cite the source : reprinted from, Disability Solutions, Vx,Issue X. Accessed at on (insert date of access).
  • You may not use any content in any issue of Disability Solutions for profit. That means, you may not reprint articles in a book or any other publication you plan to sell for profit.

If you have any questions, please do not hesitate to email me. ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )

Reprint Information for Disability Solutions

Disability Solutions was designed to be shared in the public domain, especially for families. If you would like to reprint or share material from Disability Solutions in a book, newsletter, electronic, or any other format for which you will receive any payment, permission is required.

When you do reprint material, please include the author’s name and list Disability Solutions as the source. Please send copy of the article reprinted or the URL of the web page where it is located. Please send requests for permission to the publication address.

Copyright Statement for reprints:

Please include the following when reprinting anything from Disability Solutions

” (Year) © Copyright Creating Solutions. This article is reprinted with permission from Disability Solutions Vol X, Issue X. For more information, visit”

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Cooking by Color is (finally) on it’s way!

I am pleased to announce that the proof is approved and Cooking by Color: Recipes for Independence is on it’s way. I expect my first shipment to arrive in no more than 10 days. Shipment for those who have pre-ordered will begin immediately!

What is Cooking by Color: Recipes for Independence?

Cooking by Color is not just a cookbook. It’s a method. Using color coding, universal design for learning, and plain language, the information in this book is presented to set every cook up for a successful experience in the kitchen. Originally designed for teens and adults with disabilities, the system is useful to many others including college students, novice cooks, or anyone eager to take charge of their cooking and menu planning. Cooking by Color has been tested by a cadre of teens and adults. Let Cooking by Color simplify your life and revolutionize your kitchen experience.

Sample recipe from Cooking By Color: Recipe for Independence

Recipe sample: Tuna Salad

The CBC System consists of:

  • Color coding for measuring tools.
  • Color coding for cutting boards.
  • Easy-to-understand instructions.
  • Visual cues for balancing meals.
  • Tips for success in the kitchen.

The CBC system is perfect for setting new cooks up for success! Order Yours today!

Posted in Cooking, Cooking by Color, Disability-related, family and friends, Health Litearcy, Phronesis Articles, Product Announcement, Tools, visual tools | Leave a comment

What does p**p have to do with learning?

Ok, I admit it. I have a “sardonic” sense of humor. I have an eye for the ironies of life for my child and his peers. The following may not make some very happy, but it reflects a very real truth: the opportunity for a free and appropriate public education (FAPE) in the least restricted environment (LRE) or inclusive community based classroom, is often determined by p**p rather than learning style or even educational skills.

Read on at your own risk.

Nineteen years ago, I thought it was just us. Everyone so incredibly focused on my son’s bowel and bladder habits. Discussing them until I wanted to scream. The school team was so focused on this, it became the center of their educational programming, rather than developing sight words or symbols or other academic topics.

For years, every note that came home included something about the bathroom. Usually in the first sentence. At every IEP meeting, the team wanted to dissect how to get him to communicate that he needed to use the bathroom. All of his communication tools had bathroom as the key focus. The more attention they gave it, the more notes I received. The more notes I received, the more laundry I had to do. It seemed to go in the wrong direction.

Yet he made progress at home. We used a combination of timed suggestions and listening to his emerging communication. We combined bathroom trips with natural events, like leaving the house. He’s a subtle communicator. We act on mere glances when we are learning a new skill. Nine times out of ten, that glance is the start.

When we advocated for him attend a general education classroom with supports in third grade, his bathroom skills were an argument for him to not be included. We managed to negotiate past that, but there was a price. I worked in a community hospital 45 minutes away, just three days a week. At least once a week I would hear my name being paged to an outside call. I would pick up to hear, “Mrs. Medlen, he peed on his sock.” Apparently this is the end of the world.

I thought we were the only ones who were under the microscope in the bathroom.

I was wrong.

I’ve received many calls over the years about p**p. Children with disabilities across the nation, who may be able to say their ABC’s and count to 100, are excluded from kindergarten because of p**p-phobia.

Older students are not allowed time in general education classes because they may have an “accident” in the class. This is very distressing to teachers. So much so, that one young man endured being photographed before being cleaned up. (Do I hear, “child porn”?) Apparently parents don’t understand how distressing it is to have an accident in class. Surely a photograph will help. They were included in his IEP report. There is simply no excuse for this. For this student, these photos were also a part of the school’s evidence to move him to a segregated setting.

One of the children in our neighborhood – who did not receive special education services – had some issues with using the bathroom. No one talked about removing him to a “life skills class” because of his need to learn this skill. True, he need a little less help cleaning up, but he still needed an adult. I bet no one paged his Mom at work.

So I ask you, “What does p**p have to do with learning?”

Rather than debate how this applies in IDEA and other laws, let’s look at a more practical angle.

I understand.  Teachers in K-12 education settings do not expect to have to deal with this. That’s what the IEP is for: accommodations that assist the student to be successful in the least restricted environment. I never expected a general education teacher to be the person to assist my son with his trips to the bathroom. I expect that teacher to teach. He had an Educational Assistant assigned from the Special Education Department, where, I assume, they know students may need assistance in the bathroom. The Educational Assistant’s whose sole purpose was to assist and make accommodations as needed. Still, I understand not wanting to deal with p**p, because I don’t want to deal with it either. And I’m his Mother.

What we all forget is this: the student doesn’t want to deal with p**p –or us.

Which is the point, really.

They certainly don’t want it to be the major subject for objectives in all areas of learning (communication, “life skills,” fine motor, learning to organize ones day…). But that’s what happens if you haven’t mastered that skill. “Johnny will use an icon to communicate he needs to go to the bathroom.” “Johnny will unfasten his pants, pull them down, use the toilet, pull them up, and fasten them with minimal assist.” and on and on.

Instead of, “Johnny will be able to match 10 new sight words from the Dolsch reading list.” or “Johnny will complete a visual project on the food options for pioneers on the Oregon Trail.” And maybe under a list of supports, “Johnny needs 1:1 assistance in use of the bathroom,” with a detailed description of his current, successful routine. Or even just confining bathroom related goals to a section focused on life skills?

More often than not, as I listen to parents on the phone, they tell me they do not have the same level of trouble with bathroom use at home. So I ask, “Tell me what it looks like at home?”

That answer varies widely. But in that answer, I learn where the child is in the process of learning the skills and communicating the need. I also learn what the parents do – whether they realize it or not – to create a successful environment for their child.  Those whose children are learning to use the bathroom typically are working hard on the skill all day and night by setting timers, making visual schedules, even putting recorded switches on the wall to ask for help in the bathroom.

The question becomes, “how can the team create an environment in which the student feels safe enough to communicate in the same way?”

There are two issues as I see it.

1.       Does the child trust the adults to listen? Or trust them in general?

2.       Are the adults “tuned in” to the student’s communication in a positive manner?

You see, it’s our job as adults – teachers, educational assistants, speech language pathologists, parents – to accommodate the student with special needs. To shape the environment for success.

Not the other way around.

Using the bathroom is a very private thing. It requires the ability to relax. Kids who feel  stress and who do not trust the environment will prefer to try to “hold it” than to risk embarrassment, shame, or making others angry. Children who are accustomed to autonomy with regard to using the bathroom, may be breaking rules by leaving their seat and be admonished.They may not feel comfortable sharing or even know how to communicate the need.

Just like everything else, it wouldn’t surprise me that when p**p becomes the main topic for the team, the student knows it. That raises the stress the student feels and lowers his trust. The more staff “encourage” use of a system, the harder it is to learn when a “failure” to use the system results in an accident or an increase in use of the system. It may feel like being badgered. (or….”bullied”? )

We could talk about strategies and communication issues for years.

The question is what does p**p have to do with FAPE?

Using the bathroom is a life skill. One of many. Learning this particular life skill does not require a segregated classroom. Learning to use the bathroom and learning to read alongside the children in the neighborhood are not discreet events. Delayed learning with regard to using the bathroom in a school setting does not mean a child cannot learn to read with the girl next door.

Yes, we adults have to be diligent. We have to do the hard work. We need to make accommodations so that learning this skill is one of many natural lessons about life in a day. We need to follow universal precautions when dealing with accidents. We need to show respect, dignity, and privacy to students who struggle in this area.  And, yes, we need to deal with something we don’t like.

Welcome to adulthood.

P**p has nothing to do with learning in the least restrictive environment.

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Resolution: Quality in Health and Life

Happy 2011!

Like most people, I am in a reflective mood this week. Of course, I’m also on the upside of a devastating accident. The mood is a bit more intense than usual.

Stick to that New Year Resolution

I’ve been reading the usual articles about people setting New Year’s Resolutions, advertisements for helping people be more healthy in 2011. I’ve also been taking in the many articles, cartoons, and videos that make fun of this process.

Why is it something to poke fun about?

Because we’re all dreamers. For the most part, New Year’s Resolutions are a rite of passage. Something we do each year with little thought to how we’ll accomplish it. To top it off, if you’re anything like me,  you make BIG goals.

For parents of kids with Down syndrome and related disabilities, this is can be disastrous. Face it. We’re not like other parents. We have all the same issues as other families, with a teeny tiny bit more. Focusing on ourselves, on our health, is harder. Focusing on our family’s health and creating a quality life for everyone can feel like climbing Mt. Everest.

It can be done!  And you do not need to do it alone. But you do need a plan.

From my observations as both a parent of a child with Down syndrome and autism, and health care professional, we can do it when we create a vision that includes the extra pieces we experience. We can shape our families to live a healthy, quality life in the same way.

The barrier? Sharing your vision and creating the goals toward that vision with someone who is skilled in wellness coaching and understands the uniqueness of your life.

Many years ago, I looked for someone I could talk to. My marriage was in trouble. My health was a mess. I hired a counselor recommended by a friend. I found that I paid more money to educate this person on why I could not do what she suggested to reduce my stress (due to laws around special education or the dynamics of raising my son with Down syndrome) than receiving support.  She gave us a referral for couples counseling, but I went alone. I wanted someone else. This second person had worked in the disability field before going into private practice. What a difference it made! I didn’t have to describe an IEP, explain that I can’t leave my 11 year old in charge of his brother so I can go for a fitness walk, or that I needed to spend time advocating for my family so we could live a quality life. It made the world of difference. Is our life picture perfect? Of course not! But it’s 100% better because I had a coach who understood the influence of disability on life.

The second lesson I’ve learned is that the disability community uses some terrific tools such as person-centered planning and MAPS/PATH tools. We also endure other planning methods like Individual Education Plans and Individual Support Plans (for adults). Our family has experienced all of these. In fact, we use a Person Centered Plan to guide us in the bigger goals for our son.

One of my good friends, the Executive Director of the Northwest Down Syndrome Association, shares her opinion that a person centered plan for someone under 18 is really a family centered plan. There’s some truth to that. I contend it is always a family centered plan. Seriously. If my kids aren’t living a quality life, no matter their age, I am not living a quality life.

But these tools are missing something typically, in their implementation.

Healthy living.

It needs to be an integral part of the plan!

I’m starting 2011 with a new focus for my work and my life.


Quality living, quality support, and creating quality lives for people with Down syndrome and related disabilities, their families, and the people who support them.

If this is a part of your plan for 2011, join me for a free webinar to begin honing your vision for quality living for you and your family and learn about coaching services. Together we will discuss the big picture. You will leave with a tool to create your vision of health for your family.

As always, my focus is on practical tools you can use.

We don’t have time for anything less.

What: Create Your Vision of Health for Your Family
A free webinar
When:  Wednesday, January 26, 2011
:  10am Pacific Time

Register here for your ticket to this event.
Seating is limited.

Posted in Disability-related, family and friends, General, Health Litearcy, Phronesis Articles, Tools | Tagged , , , , , , , , , , | Leave a comment

Does Learning Only Go in One Direction?

Now that I am finally, consistently, back on my feet and able to work after my accident, I’ve been focused on rebuilding my business. While recovering, I pondered whether I should seek traditional work (paid, scheduled, with benefits), or continue on with my private practice. Each has benefits and challenges.

Regardless of the type of work—paid or not—there is an interview process. AS I think about my unique skills as a dietitian, a nutrition coach. I realize that in the process of becoming a knowledgeable advocate for my son, who has Down syndrome, autism, and is nonverbal, I’ve have developed invaluable skills for just about any situation. Here are a few examples:

  • Behavior as communication. I am an expert at dissecting circumstances to uncover why something is happening. Rather than worrying about how many M&Ms someone eats, I want to know what need was met by their consumption.
  • Positive Behavior Support or looking for the win-win scenario. Why get all sweaty and sore jogging if it isn’t enjoyable or has no tangible reward? Find another option!
  • Augmentative and Alternative Communication. Unlike my early years as a dietitian, learning food preferences from someone who has just had a stroke is much easer. Make a communication board and follow eye-gaze!
  • Accommodations and modifications. Learning is a very individual thing. Some people need to hear information, some need to see information, some need to feel information, and others need to experience it in every way possible before it sinks in. Everyone can learn!
  • Learning is a celebration. I thought I knew how to do this until I started nutrition coaching and education with teens and adults with Down syndrome. I’ve never had more fun watching a skill sink in. The joy in understanding what to do to choose healthful living is contagious.

Patience, persistence, and praise are key to any nutrition coaching and essential in my role as Mother. My children, including my son with Down syndrome, taught me invaluable lessons and nurtured priceless skills. It may sound backwards, but is it really? Do the concepts we learn only go in one direction–from the general public to those with disabilities? Or can we learn important skills from people with disabilities and modify the concept to fit our lives, too (the reverse direction)? I think we all learn from each other.

BTW: I am hosting a free webinar to start 2011!

Create Your Vision for Your Family

Wednesday, January 26, 2011 at 10:00 AM

Read more about it here:

Register Today!

Posted in Disability-related, General, Health Litearcy, Phronesis Articles, Tools | Tagged , , , , , , | 5 Comments