bowl of fruit and veggies Advice

by Erin Michaela Sweeney July 29, 2019

Dear Hope: Who Knows About Nutrition?

Please answer this one-question survey. If you need a cancerous tumor removed, who would you choose to operate?
  1. a board-certified M.D. with years of experience in this type of surgery who keeps up on the latest techniques in this oncological specialty
  2. someone whose business card has some letters after his name
Of course you’d choose A, right?!? After a cancer diagnosis, it’s important to find an “A” person when seeking guidance on what to eat and drink.

The 411 on Registered Dieticians

About three months into my cancer treatments, my hematological-oncologist (that’s a blood cancer doc) sequestered me in the hospital again. Various members of my care team visited, including — for the first time — a registered dietician (RD). She wanted to highlight protein-rich options on the patient menu that were vegetarian friendly. I appreciated the RD sharing her knowledge.
Back then, I didn’t think about the years that went into her becoming an RD who helps cancer patients. Turns out there are four U.S. requirements to become an oncology nutrition RD. You must : 
  1. earn a bachelor’s degree with a dietetics focus
  2. complete an accredited six to 12 month supervised training program
  3. pass a Commission on Dietetic Registration–administered national exam
  4. receive board certification by (i) documenting practice experience and (ii) passing the board exam, both in oncology nutrition
Every five years, they need to demonstrate 75 hours of valid continuing professional education (CPE). To re-certify in the oncology nutrition specialty, they need to show additional specialized hours of CPE. Plus, there might be additional state requirements to become and maintain the oncology nutrition RD status. That’s a lot of dedication!

What About Nutritionists?

In some states, including California and Texas, you can call yourself a nutritionist without any knowledge, skills or abilities. No schooling, no training, no exams, no nothing.
Are all self-proclaimed nutritionists just selling snake oil? Of course not. But be mindful to verify their experience with oncology nutrition and do a quick online search to see what the letters after their name really indicate. Here’s an overview: 
  • CNCs, or certified nutritional consultants, only passed an open-book exam
  • CNs, or certified nutritionists, only passed a six-class distance learning program with an exam or received a two-year college degree
  • CD/CDNs and LD/LDNs are state-granted certificates and licenses to practice as dietitians or dietitians/nutritionists in the specific state according to its particular standards, which are often far lower than national standards for RDs
  • CNSs, or certified nutrition specialists, already have graduate degrees in a related field, passed an exam and completed 1,000 hours of supervised practice

Good — and Good for You — Recipes 

I did a quick search for “cancer cookbooks” on Amazon this month. Turns out that only five of the top 100 bestselling authors listed RD credentials. Rest assured that the recipes on, are reviewed by City of Hope's Chefs and Nutrition Department
The next time you read a scary headline libeling one of your comfort foods, don’t just throw out that yummy. Check with an expert online or at your cancer center to understand the whole picture.


Soon after my cancer diagnosis, I had the good fortune of an oncology nutrition RD visiting me during one of my hospital stays. She shared her expertise, and I gained insights into how I could make good nutritional choices during my cancer treatments. That knowledge gave me a sense of control, which made the rollercoaster ride of cancer more manageable.

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