Careers in genetic and metabolic nutrition: where to search for information, foods, and training

July 2, 3:19 PMSacramento Nutrition ExaminerAnne Hart

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Are you interested in a nutrtion career and at the same time curious about genetics and the human genome? Are you looking for a career with practical applications to helping people tailor foods to best fit their metabolic or genetic variations?

On the job, you might have to help patients find low-protein food products to tailor their diets to their genetic variations. Other patients would have different nutritional needs. Frequently not only dietitians, but nurses and genetic counselors may enter the field of genetic/metabolic dietetics/nutrition with further education and training.

Interestingly, some social workers with further training become genetic counselors  just as some nurses with further training become registered dietitians specializing in genetic/metabolic nutrition. It's also an open field for biochemistry majors as well as genetics students taking a minor in dietetics and food science. And food science majors can minor in genetics.

It's an open door with a career ladder. For another nutrition-related career alternative, see the USA article of August 14, 2005, New Degree Programs Produce Chef Scientists. And view the article, "DeBusk RM, Fogarty CP, Ordovas JM, et al. "Nutritional genomics in practice: Where do we begin?" Journal of the American Dietetic Association. 2005;105(4):589-598. Also see the article, "Hot New Careers in Dietetics," by Mary Franz, MS, RD, LD in Today's Dietitian, Vol. 9, No.7, page 52.

There's a career path in nutrigenomics, which explores the interaction of genes, diet, and lifestyle factors to develop strategies to prevent, slow the progression of, or reverse chronic diseases. One area under research is tailoring your food, lifestyle, and supplements to your individual metabolic and genetic variations. Studying nutrition-related chronic disease is another area of research.

Clinical dietitians may specialize in using genetic and biochemical risk factor profiles to work with patients in order to develop personalized care plans for individuals diagnosed with chronic diseases. Another area of work and research is studying nutrition-related diseases, especially the chronic illnesses and nutritional or chemical imbalances in patients due to genetic or metabolic variations. Another career area is genetic testing and counseling combined with nutrition therapy to patients, where the dietitian works in a specialty area with physicians, such as a gastroenterology practice.

To reach the top in a specialty, you'd need to be a registered dietician (RD) and also earn a PhD in dietetics/nutrition with a special emphasis. The career ladder would be different for a registered dietitian with a B.S. or M.S. working in a hospital or for an HMO counseling patients who need customized or special diets, such as diabetics or persons with kidney diseases.

But you don't have to have an alternative career. You can become a genetic/metabolic dietitian or nutrition consultant without having to study for some other related health career first. You'd combine the study of nutrition/dietetics with the study of genetics, and you don't have to go to medical school to land a stable job in this field. Here's how to explore this career possibility.

What does a genetic/metabolic nutritionist do on the job, and what type of training is required? You work with patients and their physicians to find the best tailored diet and nutritional information for an individual's genetic variation. First, you should prepare to be a licensed dietitian. Then you might wish to join Genetic Metabolic Dietitians International (GMDI). They also have a job listings site for members. Find an accredited college that prepares you to take the national exam to become a licensed dietitian emphasizing special diets. Ask how many students have passed the national exam after taking a nutrition, dietetics, or food science major at that school.

According to its site, "The mission of GMDI is to provide standards of excellence and leadership in nutrition therapy for genetic metabolic disorders through clinical practice, education, advocacy, and research. GMDI members are leading practitioners in nutrition therapy who have joined together to identify education and training needs and to develop standards of practice in this highly specialized field. Membership provides opportunities for professional education and research, as well as networking and peer support."

The mission of GMDI, according to its web site, is to provide standards of excellence and leadership in nutrition therapy for genetic metabolic disorders through clinical practice, education, advocacy, and research. GMDI members are leading practitioners in nutrition therapy who have joined together to identify education and training needs and to develop standards of practice in this highly specialized field. Membership provides opportunities for professional education and research, as well as networking and peer support.

Beginning in 2005, a group of experienced dietitians from both the US and Canada joined together to develop a professional organization to enhance and support the practice of genetic metabolic nutrition. That organization, GMDI, is now incorporated as a nonprofit professional organization specifically for nutritionists and other health care practitioners working in this specialty.

Today, GMDI provides leadership in nutrition therapy for genetic metabolic disorders through clinical practice, education, advocacy, and research. Membership in the organization provides opportunities for professional education, research, networking, training and peer support.

Fulfilling the Mission of GMDI began in April 2006 with the First Annual GMDI Metabolic Nutrition Conference. This meeting showcased key issues in newborn screening and clinical management of genetic metabolic diseases, and provided interactive, hands-on opportunities for both experienced dietitians and those who were new to the field.

The association site notes, "Genetic Metabolic Dietitians International (GMDI) Is Not a Substitute for Medical Advice." How do you become a genetic metabolic dietitian in the first place? If you study at an accredited university with a food science, nutrition, or dietetics major that also has been accredited, take the course of studies that emphasizes preparing you to become a licensed dietitian, and you pass the national exam, you can then specialize in genetic and metabolic dietetics/nutrition.

You aren't required to join any organization to become a dietitian. If you do decide to join one of the professional associations, find out whether they are open only to licensed dietitians or to anyone interested in reporting nutritional information. GMDI has developed guidelines for MCADD and VLCADD. If you're a member of GMDI, you can view these guidelines and have the opportunity to provide your feedback, based on your professional experience in managing these disorders. Members also can add comments to the site.

MCADD refers to medium chain acyl CoA dehydrogenase deficiency (MCADD) is caused by mutations in the medium chain acyl CoA dehydrogenase (MCAD) gene leading to insufficient enzymatic activity to allow complete mitochondrial beta oxidation of fatty acids. Genetics: MCADD is inherited as an autosomal recessive disorder. The gene is found on 1p31 and has 12 exons (2,3). The most common mutation, among those of Northern European descent , is 985A>G ( K329E). View the MCADD site for further descriptions, medical disclaimers, and symptoms of MCADD.  

VLCADD refers to very Long Chain Acyl CoA Dehydrogenase Deficiency (VLCADD) is an autosomal recessive disorder caused by mutations in the acyl-coenzyme A dehydrogenase gene leading to insufficient enzymatic activity to allow complete mitochondrial beta-oxidation of long chain fatty acids. Long chain fats contain carbon lengths of 14 or greater. View the VLCADD site for further descriptions, medical disclaimers, and symptoms of  VLCADD.  VLCADD is inherited in an autosomal recessive manner.

The exact incidence of VLCADD is not established. It is estimated to affect 1 in 40,000 to 120,000 people.  Individuals with a positive newborn screening are seen at metabolic centers for further testing before the diagnosis can be confirmed.

Confirmatory testing usually includes plasma acylcarnitine profile, plasma carnitine, urine organic acids, enzyme analysis, and mutational analysis. See American College of Medical Genetics Guidelines. Incidence: In the US, the incidence is ~ 1 in 10,000 births among Caucasians. There is a lower incidence among African Americans and Latinos

You don't have to be a member to view the MCADD or VLADD sites. The career of genetic/metabolic dietitian entails being a licensed dietitian emphasizing special diets that are tailored to patients with special genetically-based and metabolically-based food/nutrition requirements.

Metabolic Medical Food Companies

Abbott Nutrition
PO Box 1317
Columbus, OH 43216

Applied Nutrition, Corp
10 Saddle Road
Cedar Knolls, NJ 07927

Low Protein Foods
(low protein foods)

Milupa, North America
22513 Gateway center Drive
Clarksburg, MD 20871

Mead Johnson
Medical Department (Products)
2400 West Lloyd Expressway
Evansville, IN 47721

Nutricia North America
PO Box 117
Gaithersburg, MD 20884

Solace Nutrition
One Research Court
Suite 450
Rockville, MD 20850

Vitaflo USA
123 East Neck Road
Huntington, NY 11743

Professional Organizations
American College of Medical Genetics (ACMG)
American Dietetic Association (ADA)
American Society of Human Genetics (ASHG)
Association of Genetic Technologists (AGT)
International Society of Nurses in Genetics (ISONG)
Genetic Metabolic Dietitians International (GMDI)
National Coalition for Health Professional Education in Genetics (NCHPEG)
National Society of Genetic Counselors (NSGC)
Society of Inherited Metabolic Disorders (SIMD)

Nutritional Genomics Resources
• Centre of Excellence in Nutrigenomics (New Zealand)
• The Dutch Nutrigenomics Consortium 
• The European Nutrigenomics Organisation 
• The NCMHD Center of Excellence for Nutritional Genomics