On June 25th, 2018 Governor Roy Cooper of North Carolina signed into law H.B. 357. This law creates a new exemption for the unlicensed providing of nutrition advice. Previously, the law required that only those with a state-issued license could provide such advice, and only those who qualify as a Dietitian could apply for and be granted said license.
The new exemption, which went into effect July 1st, 2018 states that the North Carolina Dietetics Practice Act – and its licensure requirement - does not apply to:
"Any individual who provides nutrition information, guidance, encouragement, individualized nutrition recommendations, or weight control services that do not constitute medical nutrition therapy...." as defined in the law so long as the individual "..does not hold himself or herself out as a licensed dietitian/nutritionist or a licensed nutritionist" and does not seek to provide medical nutrition therapy...."
The new exemption allows holistic practitioners to perform most of the services provided by their education and training for remuneration, namely individualized meal planning, food recommendations, as well as education and recommendation (but not prescribing) of dietary supplements. However the use of “functional” evaluations where a practitioner is in physical contact with a client is still off limits to those who are not expressly authorized under the law.
To be exempt from licensure, holistic practitioners shall not practice “medical nutrition therapy” which is defined as:
"The provision of nutrition care services for the purpose of managing or treating a medical condition.”
As a practical matter, holistic practitioners should never attempt, advertise, or give the impression that they can diagnose, treat, or cure a disease. Furthermore, they should make it clear in their disclosure statements, client consultations, advertising and marketing, and website that their services are not for the purpose of providing medical nutrition therapy.
Frequently Asked Questions
Will I need to hang a sign in my office or have an otherwise visible notice that I am not licensed?
No, there is no requirement that you notify or display that you are not licensed, but it’s always a good best-practice to include this in your disclosure forms to clients.
If a client has a previously diagnosed medical condition, can I still work with them?
Yes, but you must make it clear in both verbal and writing disclosures and agreements with the client that the purpose of your interaction and services are not to provide medical nutrition therapy, and you will not attempt to diagnose, treat, or cure any disease.
My client is currently under a doctor’s care, does this limit what I can do with them?
No, again so long your purpose is not medical nutrition therapy.
Can I practice via the internet?
Yes. The new law defines Telepractice as “The delivery of services under this Article by means other than in-person, including by telephone, e-mail, Internet, or other methods of electronic communication." Further it states:
“Telepractice” as defined in the new law “is not prohibited … so long as (i) it is appropriate for the individual receiving the services and (ii) the level of care provided meets the required level of care for that individual. An individual providing services regulated by this
Article via telepractice shall comply with, and shall be subject to, all the licensing and disciplinary provisions of this Article.”
Providing nutrition advice via telepractice is not prohibited so long as you are not providing or giving the impression that you provide medical nutrition therapy, or in using certain protected titles.
Can I order lab tests?
No. While you may educate and recommend to clients that they seek out lab tests on their own, you may not order or prescribe such tests.
Can I help my client interpret lab results?
Yes, and no. Laboratory testing has significant consequences for holistic practitioners, and in general you should avoid direct involvement with them. You can certainly provide the client with general information and education about lab testing, but you must be extremely careful that you are not discussing anything which could be construed as diagnosing, treating, or curing a disease, or medical nutrition therapy. The best practice here is to simply educate the client about laboratory testing, but insist that they speak to their doctor who can order those tests for them, or seek out those which they may order on their own absent a doctor’s order.
Can I call myself a holistic nutritionist? What about a certified holistic nutritionist?
You may not use the occupational title of “nutritionist” and care must be given in your marketing, website, and promotional materials that you do not give the impression that you are a nutritionist, or that you are licensed or otherwise certified by the state. If you have a board certification, for example NANP, you could say that you are “NANP Certified in Holistic Nutrition.” If you are an NTP, for example, you could call yourself a “Nutritional Therapist” or say that you are a Specialist in Holistic Nutrition. It is only the title “nutritionist” or “dietitian” that are restricted.
Source: General Statutes 90-350 and NC Administrative Code, Title 21, Chapter 17