June 16, 2023
A quick search for nutritionists and dietitians on TikTok yields videos with millions of views, many of which contain recipes for healthy eating, reviews for dietary supplements or advice about the dangers or benefits of various wellness products.
TikTok has become a space where medical providers can talk about health risks and recommend lifestyle changes, but it also lets health trends, good and bad, run rampant, even when there is insufficient research to back up claims on the latest powders, superfoods and weight loss tricks. The situation is similar on other social media platforms.
Theresa Shank, a registered dietitian and founder of Philly Dietitian, answers questions about the latest social media trend daily.
"In fact, I start out my sessions just asking them how often they're going to social media or other online sources for general health recommendations," Shank said. "That's helpful because I can get an idea about what their level of exposure has been up until this point. I can find out if they're coming off TikTok or if they read magazines, but I can often just guess based on how they're speaking. If I'm talking to a 21-year-old about ashwagandha, that tells me they've been on social media."
Shank worked as a registered dietitian at Einstein Medical Center for five years before beginning her own private consulting practice in South Philadelphia in 2015. Since then, she has expanded the practice by hiring another provider and opening a second location in Lancaster County, where she gives services ranging from weight management to sports nutrition.
Shank recommended that people act with caution when following advice on social media, even if it comes from a purported expert. Checking accounts for credentials and specialized certifications can ensure that the health advice is from an expert.
"It's a double-edged sword," Shank said. "It saddens me because of the broader range of audience, so that protective layer isn't there. Although I do believe that the majority of these providers are speaking messages of truth, we still can't control how that truth is interpreted, and that's where I think the unfortunate part is. It's a message intended for good health, but if it's interpreted inappropriately it's a detriment to the people listening on these platforms."
When asked about the distinction between registered dietitians and nutritionists, Shank was quick to explain that the titles carry significant difference despite often being used interchangeably. Registered dietitians must complete a bachelor's degree program, a dietetics internship and a national board exam. They also must meet continuing education requirements each year.
Nutritionists are not as regulated; the title can be applied to anyone who offers general nutritional advice, even if they do not have professional training, and licensure requirements vary by state. However, many have completed degrees in nutrition and passed certification courses. For instance, to become a certified nutrition specialist, one needs a master's degree and at least 1,000 hours of practical experience before becoming eligible to take the exam.
Health advice on social media can sometimes be a hotbed of misinformation. When TikTok videos inaccurately claiming that hormonal birth control causes infertility began gaining momentum, gynecologists were quick to debunk the myth, warning users that spreading false information can have a negative impact on public health.
More recently, as semaglutide injections like Ozempic have gained popularity as anti-obesity treatments and appetite suppressants, people have started looking for accessible alternatives that provide the same effects. As a result, some influencers have started promoting berberine, a supplement derived from barberry bushes, as "nature's Ozempic" on social media.
While it has been lauded as a natural, more affordable alternative to Ozempic, experts urge people to proceed with caution.
"When it comes to supplements, I always recommend that people look for products that have third-party testing," Shank said. "Supplements aren't regulated by the Food and Drug Administration, so any company can provide you with a bottle and tell you what it contains. There's no regulation, but some companies go through rigorous testing so that their products are verified to ensure that the label is accurate."
There are several ways people can verify whether a supplements is legitimate and won't pose major harms, Shank said. In addition to finding products subjected to third-party testing, people can search for dietary supplements certified by the National Sanitation Foundation, an organization that independently audits and tests products sold in different industries.
"Medical advice on social media is broad advice," Shank said. "It's for the masses. But at the end of the day, you need to find out what matters most to you. What's helpful to some people may not help you. None of that information is individualized to you, and the person who will give you individualized advice is a registered dietitian who hears you and speaks to you, not just serving up information to whoever will watch them."
For people looking to meet with a registered dietitian, Shank recommended checking with an insurance provider to find affordable services. And the Academy of Nutrition and Dietetics has a searchable list of registered and credentialed nutrition experts throughout the country.
Acknowledging that barriers to health care access persist, Shank said there are several avenues for those looking for professional advice that can't afford to meet one-on-one with a dietitian.
EatingWell provides healthy recipes and meal options with lifestyle articles often written by registered dietitians. Today's Dietitian magazine also provides digestible information about nutrition and wellness, and the Academy of Nutrition and Dietetics has a list of fitness routines and recipes that are free to browse.