Many personal trainers offer nutrition advice to their clients. However, they probably shouldn't.

What's wrong with that?, you ask. Personal trainers do this all the time, right? Certainly, diet and nutrition issues come into play if the exercise goal is to lose weight, or to perform well in a race, or to "get big muscles."

NUTRITION COUNSELING REQUIRES LICENSURE/CERTIFICATION

At least 40 states, plus the District of Columbia require licensure of nutrition/dietetics professionals. In most states, the licensing statutes explicitly define the scope of practice and state that performing as a nutrition/dietetics professional without first obtaining a license is illegal. In addition, many employers require dietetics professionals to be registered with the Commission on Dietetics Registration.

It is acceptable for healthcare professionals (ie., other than registered dietitians) to make nutrition recommendations, however no healthcare professional receives as much formal education on nutrition as do registered dietitians....including physicians. In fact, many medical schools don't provide any formalized course on nutrition (Adams KM, et al. 2006) (Adams KM, et al. 2010).

It is very important for healthcare professionals to know when to refer patients to another clinician. For example, you probably wouldn't ask your dentist for advice on how to lower your cholesterol. Even though your dentist has the legal authority to prescribe drugs, and, may actually know quite a bit about how to manage cholesterol imbalances, it would be inappropriate for him/her to write a prescription for a cholesterol-lowering drug. Why? Because it's outside the scope of professional practice for a dentist.

On the other hand, we find it perfectly acceptable to listen to nutrition advice when personal trainers provide it, even though most personal trainers are not licensed healthcare professionals, let alone registered dietitians. This discrepancy is magnified when you realize that medical students and practicing physicians feel inadequately trained in nutrition (Adams KM, et al. 2010).

STANDARDS OF PRACTICE FOR PERSONAL TRAINERS

The American Council on Exercise (ACE) is one of the leading fitness organizations that certify personal trainers. Their Code of Ethics does not mention nutrition counseling specifically, however it does state that personal trainers should "refer clients to more qualified health or medical professionals when appropriate." In their training manual for personal trainers, they state: "if you are not a registered dietitian or healthcare professional, you should avoid making specific recommendations and refer your client to a registered dietitian or physician."

On the topic of recommending dietary supplements, ACE has adopted a firm stance. Their Position Statement on Nutritional Supplements states: "It is the position of the American Council on Exercise that it is outside the defined scope of practice of a fitness professional to recommend, prescribe, sell, or supply nutritional supplements to clients."

LEGAL RAMIFICATIONS

And the legal ramifications of inappropriate nutritional counseling can be staggering.

In the 1999 case Capati vs. Crunch Fitness, Anne Marie Capati, 37, died from a brain hemorrhage after a physical trainer gave her a list of herbal supplements to take despite knowing that she had high blood pressure that required medication. One product recommended and taken, Thermadrene, contained “20 mg of active ephedra, 150 mg guarana seed, 80 mg caffeine, 75 mg purple willow bark, 60 mg cayenne pepper, and 40 mg ginger root.”

Ephedra, particularly when used in combination with caffeine, has led to thousands of reports of adverse effects (see the related story "Ephedra: A Dangerous Supplement"). The use of these substances by someone with hypertension, particularly when they are taking medication for that condition, is extremely risky. In this case, it led to a death and a $320 million lawsuit.

But fines could be levied against a personal trainer who engages in nutrition counseling even if the conduct did not result in harm.

Actions (eg., behavior) can be just as important as titles and certifications: In one Ohio case (Ohio Board of Dietetics vs. Brown, 83 Ohio App; 3d 242, 1993.), the state issued a cease and desist notice based on this issue.

Thus, both criminal and civil penalties are possible when nutritional counseling is found to be inappropriate.

WHERE DO YOU DRAW THE LINE?

Personal trainers are frequently sought out by clients who want to lose weight. And, as mentioned above, proper nutrition is an important element of many fitness goals.

While it may seem pretty obvious that dentists should not be treating elevated cholesterol, where to draw the line when it comes to nutrition advice is much more blurry.

Here's an example of appropriate and inappropriate nutritional comments in a hypothetical conversation between a personal trainer and a client (from a presentation at ACSM, Orlando, FL, April 12, 2006):

• Acceptable: "Orange juice is a good source of vitamin C."
• Not Acceptable: "You should drink more orange juice."

The difference is subtle, but clear. The first comment is simply a statement of fact. The second statement is a recommendation...much different.

Here are some guidelines:

• Work with a personal trainer who holds a certification from a reputable organization such as American Council on Exercise (ACE), the American College of Sports Medicine (ACSM), the National Strength and Conditioning Association (NSCA), or the National Athletic Trainers Association (NATA). Even better, find one who also has a college degree in a related exercise, fitness, or healthcare discipline.

• Talk to a qualified dietitian before making any major change in your diet. Note that there are dietitians who specialize in "sports nutrition." These people are very skilled in optimizing an athlete's nutritional plan. They can be found by contacting the American Dietetic Association (see below).

• Don't take any nutritional supplements without first talking to a knowledgeable pharmacist or physician. Note that even many healthcare professionals -- including dietitians -- aren't aware of some of the concerns and risks associated with nutritional supplements. So, when in doubt, it's probably best to avoid taking any supplements until you know they are safe for you.

SUMMARY

While it's true that many fitness goals cannot be addressed without also considering proper nutrition, that does not mean that personal trainers should be giving out that advice.

Unless your personal trainer is also a licensed and registered dietitian, be highly suspicious if he or she suggests that you take supplements, or, makes specific nutritional recommendations. Not only are these behaviors inappropriate for personal trainers, but, some supplements can lead to very serious side effects.

FOR MORE INFORMATION

The American College of Sports Medicine (www.ACSM.org) is the leading professional and scientific group in the field of exercise science.

The American Council on Exercise (www.ACEFitness.org) is one of the leading certifying groups for personal trainers.

The American Dietetic Association can be contacted at: www.EatRight.org.

The Commission on Dietetic Registration (www.CDRnet.org) is the credentialing agency for the American Dietetic Association. One of the certifications that the CDR offers is a "Specialist in Sports Dietetics Nutrition."

Readers may also be interested in these stories:

• How to Choose A Personal Trainer

EXPERT HEALTH and FITNESS COACHING

Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) He also provides a one-on-one Health Coaching Service. Contact him through the Contact Us page.

REFERENCES

Adams KM, Lindell KC, Kohlmeier M, et al. Status of nutrition education in medical schools. Am J Clin Nutr 2006;83 (suppl):941S-944S. Abstract

Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in US medical schools: latest update of a national survey. Acad Med 2010;85:1537-1542. Abstract

Bryant CS, Green DJ, eds., Personal Trainer Manual, 3rd ed., American Council on Exercise, 2003, p. 472, 541.

Capati v. Crunch Fitness Int’l, No. 113218, N.Y. Sup. Ct. filed June 28, 1999.

ABOUT THE AUTHOR

Stan Reents, PharmD, is a former healthcare professional. He is a member of the American College of Lifestyle Medicine (ACLM) and a member of the American College of Sports Medicine (ACSM). In the past, he has been certified as a Health Fitness Specialist by ACSM, as a Certified Health Coach by ACE, as a Personal Trainer by ACE, and as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Senior Softball USA, Training and Conditioning and other fitness publications.