I am emerging (briefly) from grad school hibernation–my husband jokes that I’m taking all my classes “pass/flail”–for a special cause that hits close to home, even though Jennifer Elliott, a dietitian who has been going the rounds with her various professional organizations and institutions, lives in Australia.

She apparently had the gall to suggest to a patient with type 2 diabetes that a low-carbohydrate diet might be beneficial.  Heavens.  What is the world coming to?  Next thing you know, people will start telling us that if we are allergic to poison ivy and it makes us itch all over, we might not want to roll in it.

If you haven’t had a good eyeball roll or facepalm for the day, you should check out her blog, where she recounts one episode after another of Orwellian-level doublespeak with the Dietitian Association of Australia.  It’s a situation I’m quite familiar with, albeit on a much smaller scale and with our homegrown Academy of Nutrition and Dietetics here in the US of A.

The most recent episode reveals her local health district administration (Southern New South Wales Health, SNSW Health to the locals), her former employer, forbidding Jennifer–or anyone else, one must presume–from offering advice about low-carbohydrate diets to patients or clients with diabetes.  What caught my attention was this remark, by Jennifer:

“Can you imagine having to tell a client with diabetes, who has lowered his BGLs [blood glucose levels], lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?”

Well, cue the Twilight Zone music, because we are going there.

What would it be like to tell someone (like my dad, another way this story hits close to home) who has been controlling their diabetes very-well-thank-you with a low carb diet, that they now must eat more carbs, cuz we said so?  Samuel Beckett, eat your heart out.**

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Enter “patient who could be my dad.” Let’s call him Mr. Louis Corbin (LC).  He greets the dutiful dietitian (DD) who is determined to adhere to SNSW Health policies.

LC:  G’Day Ms. Dietitian.

DD:  Hello, Mr. Corbin.  How can I help you?

LC:   Well, I feel like I need to change up my diet a bit, and I’d like some help from a wise, caring, trained professional who will treat me like an individual and not like an aggregated average of a dataset.

DD:  (Laughs demurely.) Well, of course.  As a trained professional, it’s my job to use my clinical judgment to help patients find out what works best for them.

LC:  Beauty!  So, I was diagnosed with pre-diabetes about 10 year ago.

DD:  Really?  Looking at your lab report, your blood sugar and HgA1c levels look perfectly normal.  Tell me about the medications that you are using.

LC:  Well, I’m not actually on any medications.  When I got my diagnosis yonks ago, I borrowed my cousin’s glucometer and figured out which foods were making my blood sugar go up.  I really limit those in my diet now, and my blood sugar seems to be well under control. But I’m getting a little tired of eggs and sausage for brekky every morning.

DD:  Eggs and sausage?  Is that it?

LC:  And some sautéed spinach or sliced tomatoes, most days.  But I’m hoping you can help me with some other brekky ideas.

DD:  Wait now.  There’s simply too much fat in the eggs and sausage, and there’s really not enough carbohydrate–you know, sugars and starches–in that meal–or in your diet in general it seems.  You’ll need to add some fruit and a couple of servings of whole wheat bread or cereal to your breakfast and …

LC:  But tomatoes are technically a fruit …

DD:  But they are a “low carbohydrate” fruit and so they don’t count.

LC:  … and I don’t eat bread or cereal–not even whole wheat.  Those were the things that made my blood sugar go up!

DD:  Of course. We need your blood sugar to go up.  You do know that your brain won’t work without glucose from healthy, whole grains, right?

LC:  My brain seems to be working fine.  I finished “The Age” crossword puzzle while I was in the waiting room!

DD:  Well, it’s quite clear to me that your brain must not be working properly–you’ve put yourself in grave danger.  You need AT LEAST 3 servings of carbohydrate per meal, and not just at breakfast I might add, in order for your body to function properly.

LC:  Three servings per meal!  Crikey! That will make my blood sugars go up for sure!

DD:  Well, yes.  As I said, your blood sugars need to go up.  You see, Mr. LC. , in your addled state, you’ve failed to understand that diabetes is a PROGRESSIVE disease.  And your diabetes hasn’t progressed at all.  In fact, it seems to be quite stalled.

Without progression, we’ll be unable to prescribe pre-insulin drugs like metformin and engage you in the numerous diabetes education programs we have ready and waiting.  Once you’ve been thoroughly well-versed in carbohydrate counting, let’s hope that we can get your diabetes back on track.  Hmmm.  We may need to start you out at 4 servings of carbohydrate per meal …

LC:  But, but, I don’t really want my diabetes to progress.

DD:  Nonsense.  That’s what diabetes does.  You’re deluding yourself if you think otherwise.  I’ve seen hundreds of patients with type 2 diabetes, and I treat them all the same way–with the official Australian Diabetes Society diet–and they all have gotten progressively worse.  So there.

Yes, I understand that your diabetes hasn’t progressed in 10 years on a low carbohydrate diet, but it’s clear why that is.  It’s good that you’ve come to me so we can reverse that trend.  I can help you choose foods that will be sure to start you down the road to full-blown diabetes.

LC:  But I’m feeling bloody top notch.  I’ve even lost a little weight since I started reducing my sugars and starches.

DD:  Oh dear.  I didn’t realize that.  You’ll really need to fill your plate with healthy whole grains so we can get some of that weight back on.  You’re never going to end up on insulin at the rate you’re going.  But no worries.  If you can stick with at least 4 servings of carbs per meal, we might be able to get you on insulin in a few years or so.  Once we’ve got you on a regular dose of insulin, you’ll keep packing the weight on, no problem.

LC:  But I don’t want to be on insulin …

DD:  No “buts.”  Sir, you don’t realize the seriousness of this situation.  It’s not just about the insulin.  Not only do we have prescriptions that need prescribing and diabetes educators that need to educate, we have wound clinics that need wounds, dialysis clinics that need failing kidneys, testing laboratories that need labs to test.  Have you any idea how many people you might put out of work by stalling your diabetes in its tracks?

DD (Continuing): You’ve not only put yourself in danger, you’ve endangered our whole healthcare supply economy!  We have injections to make your blood sugar go down.  We have glucose tablets to make your blood sugar go back up.  We have monitors and supplies and diaries and trackers and coolers and carriers for all of the THINGS you will need when you have diabetes.

We have diabetes foot cream, insoles, socks, and shoes.  And wheelchairs for when your toes rot off–which I can assure you they will if you’ll only improve your diet.  Then you’ll get to use the freight elevator and get one of those special parking passes.  If you play your cards right and follow your diet as I prescribe it , you may even end up with one of those cute little scooters for getting around the grocery store.

LC:  But …

DD:  Now then.  Not to worry.  You’re on the right path now.  You wanted some brekky ideas? Here’s a low-fat, vegetarian recipe for blueberry hotcakes, with 46 grams of carbs.  It’s from “Diabetes Australia,” so you know it’s perfect for someone with diabetes!  It should get your blood sugar going for sure!  And here’s some coupons from the Australian Breakfast Cereal Manufacturers.  I picked up tons of them at my last dietitians conference–they’re working with us to make sure everyone has a healthy, whole grain, cereal product brekky EVERY DAY!

LC:  But …

DD:  No “buts.”  I’ll expect to see you back in about 6 months.  We’ll get that HgA1c moving in the right direction this time and have you on the road to complete and total dependence on the health care system in no time!  Bye now!

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What can you do besides resolve not to move to New South Wales anytime soon?  Write a quickie email to the New South Wales Health Minister, Jillian Skinner, telling her about your experiences as a patient, clinician, family member in successfully managing type 2 diabetes/pre-diabetes/metabolic syndrome/etc. with a carbohydrate-reduced diet.

Email:   office@skinner.minister.nsw.gov.au

CC Jennifer at:  jennifer@babyboomersandbellies.com

And, what the hey, let the Dietitians Association of Australia know what you think too: nationaloffice@daa.asn.au

If you are feeling particularly feisty, go to Jennifer’s blog and post your letter there too, to let her know you stand in solidarity with her.

I personally will be sending Minister Skinner a copy of this post 🙂

**And many thanks to Disco Stew who provided the authentic Australian translation of this conversation!

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Update:  In an appalling case of life-imitating-blog-imitating-life, Disco Stew sent me a link to this piece, written by Jane Feinmann, about type 2 diabetes and the continued use of a low-fat, carbohydrate-laden diet to “treat” it:

When I wrote about this dilemma in the Daily Mail recently, the piece triggered over 200 responses from readers caught in this invidious position.

Mary Megan from London was ‘stunned’ last year when her GP “recommended eating carbohydrates as part of a ‘healthy balanced diet’ when I know for a fact from having tested my blood sugar over the years that carbohydrates are the exact cause of my high blood sugar.”

Way to go, 21st century health care system. Sigh.