RD does NOT stand for “Really Dumb”

All you need to do is google “dietitians are stupid.” (Go ahead, I’ll wait here.) “Dumbshit nutritionists” [Free the Animal] all over America are apparently giving out “misleading, scientifically vapid, and possibly harmful information” [Postpartum Punk]. Sadly, it is sometimes hard to argue with that.

The Academy of Nutrition and Dietetics has a professional “Code of Ethics” that states that all Registered Dietitians should avoid even the appearance of a conflict of interest.

“The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or reasonably give an appearance of affecting his/her professional judgment.” *

At the same time, because the organization officially has exactly zero written standards for ensuring that its sponsors actually share the AND’s ostensible vision for “optimizing the nation’s health through food and nutrition,” the Academy of Nutrition and Dietetics accepts money from both food manufacturers and pharmaceutical companies and provides continuing education credits for attending workshops sponsored by Kellogg’s, Kraft and ConAgra.

So what might the Academy of Nutrition and Dietetics be doing with all of this funding? Right now, the AND is fighting a (mostly losing, thankfully) battle to create a complete monopoly on nutrition information and guidance—despite the fact that there is little evidence that this guidance contributes to positive health outcomes.

One the one hand, dietitians are encouraged to turn in anyone who does not rigidly adhere to both licensing standards and/or “professional” standards (some states have turned this into a professional development activity).  Anyone who gives out nutrition information without having the appropriate state-required licensing can be a target (Steve Cooksey’s story has been a newsworthy example of this). But—here’s the scary part—even dietitians with the right credentials can come under attack if they follow their professional judgement rather than the party line (see Annette Presley, below).

On the other hand, the “party line” approaches for weight loss are so ineffective, the federal government (and many states) won’t cover  many dietitian services to help people lose weight.    According to Dr. Wendy Long, chief medical officer of TennCare:

There’s really no evidence to support the fact that providing those services [from dietitians] would result in a decrease in medical cost, certainly not immediately, and even in the longer term.” 

This lack of evidence may be due in part to the (sadly) limited scope of dietetic education and practice. The AND treats the USDA as if it is a scientific authority and not a government agency whose first mandate is to “strengthen the American agricultural economy.” It limits the training of RDs to USDA/HHS-approved diet recommendations despite the fact that even mainstream nutrition establishment scientists feel that the current US dietary recommendations are misguided and inappropriate.

Despite these snugly-fitted, professional handcuffs, there are plenty of RDs out there who not only think for themselves, but who are working to change the system—each in her own way. What they have in common is an unwavering belief in the importance of food in creating healthier individuals and communities. Truly, these women are amazing:

Valerie Berkowitz MS RD CDN CDE worked with Dr. Robert Atkins for a number of years, but has gone one to create her own approach to healthy eating. Valerie is the author of The Stubborn Fat Fix: The Essential Guide to High Fiber, Low Carbohydrate, Whole Food Diets. The book is the basis for a learning module for continuing education credits for RDs—yup, you read that right. Thanks to Valerie’s commitment to making carbohydrate-reduction a mainstream option for health professionals, RDs can get continuing education credits for learning more about low-carb diets. More evidence of her commitment? I got to know Valerie well when I worked with her on a review paper on low-carbohydrate diets —while she had a newborn in tow. (All I did when my children were infants was pray for the opportunity to take a shower.)  Valerie works with her husband, Dr. Keith Berkowitz, as the Director of Nutrition at the Center for Balanced Health, while blogging, writing, and mothering four active children. I know, I know—it makes me want to take a nap just reading about her. But I promise she is fully human and a lovely person. Go visit her at Valerie’s Voice: For the Health of It.

Abby Bloch PhD RD is the Executive Director for Programs and Research at the Dr. Robert C. and Veronica Atkins Foundation. Like Jackie Eberstein, she also has a story about being interviewed by Dr. Atkins and telling him that if she found out that he was a fraud, she would shout it from the rooftops. Well, he wasn’t and she didn’t, and she’s been working with the Atkins Foundation ever since. She is an RD who, quite literally, wrote the book on feeding cancer patients. When she began her career, doctors didn’t think trying to meet the nutritional requirements of cancer patients was all that important: if they lived, they’d eat again eventually; if they didn’t, oh well. Abby’s book paved the way to the now commonplace understanding that appropriate nutrition could make the difference between the first outcome and the second.

Allison Boomer MPH RD is a food writer who brings her nutrition expertise and love for food together in her work for The Boston Globe and other media outlets. I met Allison when she was working on a piece in about fat and the Dietary Guidelines. It hasn’t always been easy for her to educate the public about the complex realities of how science and policy don’t always match up—she makes her editors rather nervous—but she understands the importance of conveying this information in a readable and entertaining manner. As we see the low-fat tide turning, it is due, at least in part, to efforts like hers.

Cassandra Forsythe PhD RD has worked with low-carb researcher Dr. Jeff Volek, but that doesn’t even begin to describe the breadth of her expertise. She combines a background in dietetics, nutrition, and exercise science with a particular interest in women’s health—especially mommy health. If you happen to be a reader with more of a passion for working out than I have (which is likely to be every reader) or if you are not interested in joining the “fat mother’s club” (as my brother so charmingly described the tendency of bearing children to leave women looking permanently 5 months pregnant), check out her fun/exhausting combination of “cute baby and badass mommy” blog.

Suzanne Hobbs PhD RD comes from a different nutrition perspective than many of the women on my list, but she is—quite literally—the only person in America whose area of expertise encompasses both nutrition care and nutrition policy and politics. She is a lifelong vegetarian who writes a newspaper column highlighting the nutrition benefits of a plant-based diet. But she is no more of a vegetarian hard-liner than I am a low-carb one. Instead, she understands that the food choices that people make are complicated, the environment in which those choices are made is confusing, and the real target of concern—for any nutritional paradigm—should be how to take this big messy picture and frame it in a way that will allow us to improve public health nutrition for everyone, rather than to promote any one nutrition agenda. She helped put vegetarian nutrition on the map in the world of dietitians as well as the world of policy. I’m hoping I can learn from her how to stretch the old “top-down” model of nutrition guidance into a new shape that allows us to start thinking differently about how to accommodate individualized nutrition to a public health framework.

Amanda Holliday MS RD LDN is a mother, wife, daughter, and granddaughter—who never relinquishes the importance of those roles as she juggles multiple professional demands as the Director of the University of North Carolina at Chapel Hill’s Registered Dietitian/Masters of Public Health Program, clinician, instructor, public health leader, and blogger. Her family relationships inspired her specialization in nutrition for older adults, another booming subpopulation of Americans for whom standard one-size-fits-all dietary recommendations are inappropriate. Both fearless and humble, she has more integrity in her pinkie toe than most public health advocates could hope to accumulate in their lives. I think she simply lacks the ability to tolerate hypocrisy. She has a deep appreciation for the power of science to improve patient care; she always insisted that her RD students hold themselves to much higher standards of scientific knowledge and expertise than is actually required for dietitians. She also has a healthy respect for the flaws and limitations of science in addressing the complicated needs of real individuals. She never lets her students forget that they are treating people, not symptoms.

Karen Holtmeier MPH RD LN is the RD counterpart to Mary Vernon’s MD leadership at the American Society for Bariatric Physicians as well as director of her own weight loss clinic. She has been educating dietitians and nurses that work with bariatric physicians about the positive health effects of carbohydrate reduction for over a decade, while remaining active within the RD professional community. Not an easy feat to pull off, but Karen is not only warm, funny, and politically savvy, she’s one of the most intrepid women I know. (Traveling by myself still is a little nerve-wracking–with a husband and three kids, I’m used to traveling in a mangy but secure pack loaded down with coolers, pillows, and a bookmobile’s worth of reading material; Karen thinks nothing of hopping in the car for an extended road trip, by herself, up the US west coast and into Canada—tralala. I love that.)

Kris Johnson RD (retired) is one of those “mystery women” I’d run into all over the internets. Like Carmen Sandiego, everywhere I’d go, she seems to have gotten there first. Outraged and intelligent commentary on the attempts of the Academy of Nutrition and Dietetics to create a monopoly on nutrition guidance?

As a retired and reformed dietitian, I can say flat out, dietitians do not understand all there is to know about nutrition. In fact conventional RD’s persist in promulgating some very bad science, such as the misguided advice to avoid saturated fat and cholesterol and aim for a low fat diet. Much of the really useful nutrition information I learned after I retired.

A science-based view of saturated fat in response to outdated precautionary warnings?

Those who have looked carefully at the research have found no evidence that natural saturated fats or cholesterol actually cause heart disease or any other health problem. . . . Excessive amounts of polyunsaturated fats and the trans fats derived from them are the real problem. The best way to improve important cardiac risk factors, that is increase HDL and lower triglycerides, is to limit carbs and most vegetable oils, while getting adequate natural saturated fats in the diet.

I think one of the coolest things about Kris is that she worked as an RD for 15 years, retired, and—instead of spending all day playing Suduko—then she went on to read and learn enough about the shifting paradigm in nutrition to become a vocal and articulate advocate for change. Amazing. Check her out at www.MercyViewMedow.org.

Amy Kubal MS RD LN is another dietitian who combines her expertise in nutrition with a love for athletics. As part of Robb Wolf’s team, she gives the “mainstream” RD designation a paleo twist. Her ability to bridge both worlds is a welcome sign of the times.

Stacia Nordin RD combines her nutrition expertise with permaculture knowledge and the desire to end hunger in Malawi, Africa in a socially, environmentally, and nutritionally sustainable way. Never Ending Food is a family endeavor she shares with her husband and her daughter (who was born in Malawi). I met her after getting a post about the AND’s campaign to create a monopoly on nutrition guidance yanked from an RD discussion board. Her response was sympathetic and encouraging, and she introduced me to a number of other RDs whose agreed with my position, but who had much better diplomacy skills than I do! (One day, we would like to create a network of nutrition professionals with an array of credentials—RD, CNS, CCN, CNC, health coach—to work together to create an environment where all of us can practice our profession with mutual respect.) In the meantime, Stacia and her family’s work continues to inspire me to think about how to make sure that our food reform efforts begin with the communities that they are intended to serve.

Annette Hunsberger Presley RD, co-author of The Liberation Diet, was censured by the (then) American Dietetic Association for recommending that her clients use butter instead of margarine. When told to review the ADA’s Evidence Analysis Library (whose idea of “evidence” is so limited and biased that I have a hard time typing the phrase with straight face) to get the “facts” straight and renounce this position, she did. Plus, she reviewed the rest of the science on the subject and reached a conclusion—as you may have guessed—with which the ADA was not at all happy. You can read her Hyperlipidemia Report here; it’s a pretty amazing piece of work.

Pam Schoenfeld RD is not only a wife, mother, clinician, and public health advocate, she is also the person I blame for getting me into this mess! Together we started Healthy Nation Coalition, and it’s been quite an adventure.I still have the email she sent Dr. Eric Westman (the MD I worked with at the Duke Lifestyle Clinic), and which he passed on to me, describing some of her experiences as an RD intern. Her passion, concern, and professional assessment of nutrition science were inspiring and contagious. She convinced me that I wasn’t too old to go back to school and that I’d come through the dietetic groupthink hazing intact. She was—more or less—right. She remains my hero, mentor, and dear friend.

Picture Franziska Spritzler RD CDE is applying her nutrition expertise to specifically help patients with diabetes (CDE stands for Certified Diabetes Educator).  As Type 2 diabetes has reached epidemic proportions in this country and across the globe, we seem to have forgotten that it is designated in the prominent physician’s handbook, The Merck Manual, as a “disorder of carbohydrate metabolism,” and that, prior to the widespread use of insulin, Type 2 diabetes was effectively treated with a carbohydrate-restricted diet.   As The Low-Carb Dietitian, Franziska is reviving this wisdom in her own practice and for the benefit of everyone struggling with diabetes.

Joanne Slavin PhD RD was a member of the 2010 Dietary Guidelines Advisory Committee. I started following her through the transcripts of those meetings. What caught my attention was her commitment to 3 things: science, food, and people.  She’s been slagged on in the paleo community for being—gasp—a realist about both food prices and the fact that grains can be a perfectly reasonable source of calories for some people—like the teenage male who lives at my house—who actually need calories and can tolerate-grains-just-fine-thank-you. [Labeling her a “dumbshit nutritionist” is—imho—part of why paleo has good reason to be worried about its own future as a fringe-y food and fitness fad. In the brave new world of nutrition, we have to feed everybody, not just the people who agree with that ideology.]

Here’s our “dumbshit nutritionist” speaking to the Registered Dietitians assembled at the North Carolina Dietetics Association conference in April 2012.  Fangirl that I am, I literally tried to write down everything she said:

“The 1977 Dietary Goals were based on politics, not science.”

“Humans can adapt to a wide variety of diets—from 80% carbs to 80% fat.”

“Increasing intake of plant foods, which are low sources of protein, is a bad idea for growing children.”

“People who eat more carbohydrates weigh less, so eat more carbohydrates. Um, it doesn’t work like that.”

“A lot of people don’t get enough protein because of what they are choosing.”

“Dietary advice often has unintended consequences.”

“Micromanaging the diet by imposing strict dietary rules is difficult to support with evidence-based nutrition science.”

“Pink slime was created to come up with a low-fat, high-protein thing to put into processed food.”

“I believe fat needs to go higher and carbs need to go down.”

“It is overall carbohydrate, not just sugar. Just to take sugar out is not going to have any impact on public health.”

Dr. Slavin is NOT a low-carb or paleo diet advocate; she is simply reporting on the realities of nutrition science and policy. But if you have any lingering concerns about her being a “lackey” for the USDA and food industry, here she neatly and sweetly skewers the whole paradigm:

The 2010 Dietary Guidelines for Americans supports less consumption of sodium, solid fats, and added sugars. Make half your grains whole and half your plate fruits and vegetables. Seems simple for the food industry—keep slashing salt (but make sure my food is safe), get rid of added sugar (but add fruit and fruit extracts to everything), and make chips, pizza crust, cookies, and all other grains “whole” so they are healthy. Probably a good idea to tax soda, outlaw French fries, ban chocolate milk in schools (added sugar is bad, right?), and over-regulate school lunch, restaurants, and food manufacturers. Let’s blame the victim too—we know fat people are lazy, uneducated, and low income—too bad they live in food deserts and don’t have access to fresh fruits and vegetables. Hope my BMI is under 25 today!

Dr. Slavin is a mainstream nutrition expert and RD.  She is also an independent thinker and a true scientist.  The paleo community’s stance in making nutritionists like Dr. Slavin out to be the “enemy” is not only short-sighted and counterproductive, it’s inaccurate.   People like her will pave the way for better public health nutrition for everyone–including those who choose paleo diets.

This list would not be complete without a shout-out to all the dietitians I’ve met at the newly-formed PaleoRD group started by Aglaee Jacob MS RD—who deserves her own hooray (Aglaee, Your Paleo RD! It rhymes and everything!). I hope that the existence of such a group—you don’t have to be “paleo” to join—will encourage other RDs to stand up for their own professional understanding of the science and not feel afraid of being censured. There is strength in joining our voices together.

I’d love to hear about other RDs who share the belief—to paraphrase Kris Johnson—that the Academy of Nutrition and Dietetics doesn’t know all there is to know about nutrition and the conviction that as dietitians and nutritionists, we can and should exercise our professional expertise and judgment to help heal the world through food.

* From:
American Dietetic Association. American Dietetic Association/Commission on Dietetic Registration code of ethics for the profession of dietetics and process for consideration of ethics issues. J Am Diet Assoc. 2009 Aug;109(8):1461-7.

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