RALEIGH — Paleo-diet blogger Steve Cooksey is not the only one who’s been censored by the North Carolina Board of Dietetics/Nutrition.

According to a document the board released to Carolina Journal, it has investigated nearly 50 people or organizations over the past five years, including athletic trainers, a nurse, a pharmacist, a spa, and even Duke Integrative Medicine. All have been accused of the same crime — “practicing nutrition” without a license.

Cooksey, who lives near Charlotte, made national news after the director of the board went through his website with a red pen telling him what he could and could not say about food without being a licensed dietician. The libertarian public interest law firm Institute for Justice filed a lawsuit in federal court on his behalf, calling it a major free speech case. Cooksey lost in U.S. District Court, but he and IJ are prepared to take appeals all the way to the U.S. Supreme Court.

But apparently the dietetics board is interested in people other than bloggers. The board, which represents licensed professionals working in the field of diet and nutrition, is interested in anyone who gives advice about what people should eat, whether it’s a medical doctor, a gym trainer, or a man on the street.

Registered dieticians file complaints against providers of nutritional advice on a regular basis, and the board — which was established to protect their professions (along with public safety) — is “obligated” to launch full-fledged investigations of every complaint.

If the accused is found guilty of “assessing” someone’s dietary needs and “counseling” that person as to what she should eat, the party is told to stop. Refusal to do so could lead to misdemeanor criminal charges, which could result in fines or even jail time.

A fine line

According to the Dietetics Board’s director Charla Burrill, it’s a fine line between what kind of advice about nutrition an unlicensed person is free to give.

Anyone can make a statement about what people in general should eat, she said in a telephone interview in April. What you can’t do is tell an individual or group of people what they should eat based on a specific health condition they are experiencing.

For example, if someone has diabetes, an unlicensed person could not tell him to eat less sugar. If someone wanted to lose weight, an unlicensed person could not tell her to eat fewer carbohydrates. That, according to the board, is dietary “assessing and counseling,” a practice reserved for licensed professionals.

That makes Aundrea Scipioni’s job as a holistic health coach tricky. She received her education from the world’s largest nutrition school, the Institute for Integrative Nutrition, a school not recognized by the board.

According to Burrill, Scipioni legally is allowed to give nutritional advice that she would give to all of her clients, regardless of their individual health conditions, like “eat more fresh fruits and veggies.” But personally tailored diet recommendations are not allowed, especially when they are meant to address specific medical conditions.

Scipioni claims she does not give personalized nutrition advice. Her clients set their own goals and she simply helps them achieve those goals.

But a testimonials page on her website led a registered dietician to believe Scipioni was treading on her turf, helping clients get off pain medication, control hypothyroidism, improve cholesterol levels, and boost depressed immune systems.

The dietician filed a complaint in May, and Burrill called Scipioni in July, informing her she was under investigation for practicing “medical nutrition therapy” without a license.

While Burrill never asked Scipioni to remove the testimonials, she mentioned the board’s “concern” about them in multiple emails during the investigation.

In one email she said the board was concerned that her testimonials “may lead the public to believe that one is legally able to provide nutrition care services … when one is not licensed to provide such services.”

Scipioni responded by saying that she “cannot control how [her] clients describe what [she does],” and if she helped improve any medical conditions, it was a result of the same holistic approach she takes with all her clients, which centers on whole, organic foods, physical activity, and emotional and spiritual well-being.

After Scipioni answered all the board’s questions in detail, Burrill said the board still was concerned about the testimonials.

“We will await your response in order to best determine how to proceed with resolving this complaint,” she wrote Sept. 27.

Instead of removing the testimonials, Scipioni placed a more overt disclaimer beneath them and on her homepage.

She informed the board Oct. 1 of the change. Burrill wrote back Oct. 4, the day after CJ had inquired about recent investigations, saying the complaint had been closed and that the Board “may periodically monitor the matter.”

Alternative nutritionists

North Carolina’s dietician licensing law presents a problem for not only non-nutritionists, but also for nutritionists, if they didn’t go to a state-approved school.

Holistic nutritionist Liz Lipski has a Ph.D. in clinical nutrition and 30 years of experience in the field. She is board certified in Texas and California. She is the director of doctoral studies at Hawthorn University, author of Digestive Wellness, Leaky Gut Syndrome, and other nutrition books, and founder of Innovative Healing, a wellness company. She has designed and taught nutrition courses and trains medical doctors, dieticians, and nutritionists to use clinical nutrition in their practices.

But because she fails to meet far lesser educational requirements prescribed by the North Carolina Board of Dietetics/Nutrition, she cannot practice her occupation in any capacity in the state. In order to become licensed in North Carolina, Lipski would have to return to school at the undergraduate level for several semesters. Instead, she chose to move to Atlanta.

Protecting the public?

While the proclaimed purpose requiring licensing of dieticians and nutritionists is to protect the public from advice that could harm their health, some think it’s more about protecting the professions from competition.

“Our fears about these dietetics boards are confirmed,” said Darrell Rogers, campaigns and communication director of the Alliance for Natural Health USA. “Unelected members of the dietetic profession use their position of power to limit competition by harassing and limiting the free speech of others.”

Forbes magazine contributor Michael Ellsberg argues that the American Dietetics Association is pushing for occupational licensing in all states as an attempt to protect not only dieticians from competition, but also the organization’s corporate sponsors — CocaCola, PepsiCo, General Mills, Kelloggs and Unilver — from nutritional opinions that could cut into their profits if they became popular.

Sara Burrows is a contributor to Carolina Journal.