NO LOW-CARB FOR YOU!

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.

WTF

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?

Sponsors of the ADS

A “Who’s Who of pharmaceutical and medical supply companies”? Nah, just the sponsors of the last Australian Diabetes Society conference.

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.

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What Simon Doesn’t Say: An Expose with a Hidden Agenda

The Academy of Nutrition and Dietetics (AND) is squirming over a recent report written by Michele Simon of Eat Drink Politics that address ANDs corporate sponsorship program. The president of AND warns members not to believe everything they read and to mind the source (I supposed the assumption is RDs would be too sheep-like to do otherwise? Good thing Daddy Sheep warned us!), saying  ” . . . the majority of the report consists of publicly available facts filtered through the author’s opinions. She is of course entitled to her opinions. But opinions are not facts.”

I’m no fan of the Academy of Nutrition and Dietetics (AND), although they haven’t yet revoked my membership. I’m also no fan of industrialized food, although I do think the food industry has an important role to play in reforming our food-health system. I am also not a big fan of hypocrisy, which is why I have a good bit of trouble with the report, entitled Are America’s Nutrition Professionals in the Pocket of Big Food?

The answer is—I believe—a resounding “yes,” and Healthy Nation Coalition has explored how this compromised position extends not just to the food industry but the USDA itself. Clearly, the AND is an industry-friendly organization, and the USDA relies on AND-trained dietitians to confirm its own industry-friendly guidelines.

While I applaud Simon’s efforts to hold the AND more accountable for its relationships with industry, AND leadership is correct in pronouncing Simon’s reporting as one-sided and biased.  Simon is happy to slam the health-washing, cultural insensitivity, and hidden agendas of food manufacturers and the Academy, but if the propaganda, insensitivity, and agendas are vegatarian*—well, then she’s just fine with it, thank you very much.

“Healthy” smoothies are okay with Simon; meaty cheesy Big Macs are not.

Simon complains that “the banners at the McDonald’s booth showed images of healthy foods like smoothies,” but didn’t show McRibs and Big Macs. The implication, of course is that “healthy” smoothies” (with 78 grams of sugar and 4 grams of protein) aren’t so bad—even if they are from McDonald’s—compared to those meaty, cheesy foods like a Big Mac. Never mind that your body actually needs the protein that a Big Mac can provide and has little use for the 78 grams of sugar in a smoothie, except for fat storage.

How dare the Dairy Council target lactose-intolerant African-Americans! Every one knows all African-Americans would be healthier on a vegan diet . . .

Simon quotes an RD who points out that it is culturally inappropriate for the National Dairy Council to target African-American and Hispanic communities, considering the high rates of lactose intolerance in those populations, a remark with which I fully agree. Simon then goes on to complain about the inappropriateness of the Pork Board handing out educational material at “a nutrition conference where almost no countering information could be found about how a meat-centered diet can lead to chronic disease”?  In fact it would inappropriate to provide such “countering information” as the declaration that a meat-centered diet leads to disease is an ideological stance and not a scientific one. I would go on to add that it is also a culturally-insensitive stance, as pork is at the center of not only African-American and Hispanic food culture (barbeque, chorizo), but Chinese and Eastern European cuisine as well (lup cheong and kielbasa). It seems cultural sensitivity is fine if it means we can take away meaty, cheesy foods—but not when such sensitivity would allow them.

It’s not culturally insensitive to ban pork products–like these lup cheong– from a healthy diet; we’re just doing everyone a favor.

Simon’s take on the not-so-hidden relationships between the AND and the food industry is well-trod ground as she herself acknowledges, but to Simon some associations are apparently more odious than others:

In 1995, New York Times reporter Marian Burros wrote about criticisms of the [AND] for taking funding from industry groups such as the Sugar Association, the Meat Board, and companies such as McDonald’s, CocaCola, and Mars. According to Burros: “Nothing negative is ever included in materials produced by the association, a fact that critics attribute to its link to industry.” In that same article, veteran sustainable food advocate and Columbia University Professor Joan Gussow noted that giving money to registered dietitians is how industry silences its critics.

Simon pointedly calls out the National Cattleman’s Beef Association as an “especially loyal” sponsor. But if giving money means AND will only say positive things about your food product, it’s difficult to explain AND’s resounding endorsement of vegetarian and vegan diets, with “tips of the day” like “Endless Meat-Free Options” and articles that show you how to “Build Muscle, No Steak Required,” plus the promotion of stories such as “All Red Meat is Bad for You” in their daily newsletter. If I were the Beef Association, I’d want my money back.

Private consulting firms that have a “good” agenda don’t need to be held to the same levels of transparency as the “bad” ones.

I fully commend Simon’s calls for transparency, but the transparency knife cuts both ways. The AND/industry report was authored by Simon under the auspices of Eat Drink Politics, a self-described (by Simon) “industry watchdog” group that is also a “private consulting firm.” As such, while Simon is willing to disclose some of its clients, she states that “Some of our clients and funders prefer to remain anonymous for various reasons and we respect those wishes” (emphasis mine). So while she accuses the International Food Information Council of being “an industry front group” (which I think is pretty accurate), we can’t really tell who or what Eat Drink Politics is a “front” for, although we can take an educated guess.

The Eat Drink Politics website alerts us to an alarming situation regarding Deceptive Health Claims:

“The food industry has a challenge on its hands. Most health experts agree that the optimum diet is one based mostly on whole, plant foods, the kind that come from nature and not a factory. So, to convince Americans they can still eat their favorite meat, cheese, soda and junk food, many companies are using meaningless labels such as “all-natural” and engaging in other deceptive marketing practices” (emphasis mine).

Yup, meat and cheese—that’s about as un-natural as it comes.

It doesn’t take a rocket scientist to look through the science and figure out that “most health experts” don’t actually agree that the “optimum” diet is based mostly on whole, plant foods (actually I’m pretty sure it just takes a journalist, specifically Gary Taubes). It’s also pretty easy to figure out what Simon’s idea of a “whole, plant food” diet is:

“A diet based on whole plant foods minimizes or eliminates all animal products, including meat, poultry, fish, dairy, eggs, and their byproducts.”

Can you say—vegan?

Simon goes to great lengths in her book Appetite for Profit to deny that she has any vegan agenda, as she has been accused of by the Center for Consumer Freedom (a group Simon depicts—again, accurately, in my opinion—as a food and beverage industry front group).  She’s clearly sensitive to the fact that the word “vegan” is too loaded with negative connotations to actually use it when she suggests that “a diet that resembles my own would be optimal for most people.”

She accuses Center for Consumer Freedom of keeping its corporate sponsorship anonymous in order to engage in more provocative PR claims and of manipulating language to make it look like she’s pushing a personal agenda. But she seems pretty comfortable with keeping her own sponsors anonymous, with using provocative claims to alarm the public, and with using consumer-friendly language to gloss over aspects of her own personal biases that the public may find off-putting. I guess she figures it’s okay because she’s believes she’s got “decades of accepted nutrition science” and a “scientifically supported view” on the side of her personal nutritional biases.

I think Simon’s 5 recommendations to AND are long overdue. There is no doubt that AND would benefit from increased transparency; more input from members; sponsorship guidelines; an elimination of corporate-sponsored education; and stronger policy leadership.

But I cannot support is what I think is Simon’s most disturbing suggestion, that AND commit itself to policy action now—specifically taxation of sugar-sweetened beverages**—before a full review of scientific evidence and long-term implications can be ascertained.

According to Simon, “not every policy issue or decision can wait for months (or years) of committee review and analysis.” On the contrary, I would argue that more policy decisions that attempt to manipulate the health behaviors of Americans by relying on unproven assumptions about the relationships between food and health can and should wait for months or years or indefinitely, until consistent, quality experimental data is obtained or until observational data reveal consistent and unmistakably-high risks. Right now, the health crisis that Simon seems intent on addressing (and I applaud her intentions, if not her methods) is at least in part a result of sweeping changes made to our food system 35 years ago without such evidence in hand.

Simon’s unquestioning belief in her own nutritional agenda is a result of that policy experiment, but it isn’t the solution. It’s time we stop trying to change the eating habits of our fellow Americans—which is the underlying intention behind taxing soda and believing that a diet that resembles your own is best for everyone else—and start trying to change the regulatory, economic, and political framework that restricts access to both the food and the knowledge that individuals need to make their own decisions about their own health.

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In case you missed my interview with Bob Fenton, a fellow blogger who has type 2 diabetes, you can find it here: 

Adele holds forth on diabetes, dietetics, and why the refusal to admit the limitations of our nutrition knowledge is a dangerous thing.

Next up is a guest post from a friend and fellow graduate student, James Woodward, whose background in economics and public policy gives him a rather different perspective on how we might go about accomplishing the task of reforming our food-health system.  It will also provide a bridge to my next series on “Eatanomics” which will explore how food, health, and the economy are intertwined. 

*”Vegatarian” is a term I use to indicate veganism disguised as vegetarianism. While lacto-ovo-vegetarian dietary patterns are complete and perfectly healthy, vegan diets must rely on fortification or supplementation to be complete, as acknowledged by the promoters of such diets (just read the “fine print”).

**Sugar-sweetened beverages are usually pretty nutritionally useless, but we simply don’t know what sort of unintended repercussions a soda tax will have, or where to draw the taxation line. One study has shown that beer-drinking households responded to a six-month soft drink tax by buying more beer.

National Nutrition Policy – just a little out of touch?

My good friend, Laura Schoenfeld, must have just returned from the UNC-Chapel Hill MPH/RD program’s annual field trip to Washington, DC, because she just wrote a terrific blog post about her experiences. It reminded me of my own field trip a few years back, as she reports hearing “statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we don’t know how to get them to eat that way.” Yup–the science of what we should eat is almost irrelevant. Read the whole post. It’s gem.

Nutrition Policy

One of the major themes I heard come up over and over during our three days in Washington D.C. was the emphasis on “science-based” nutrition policy. From the Dietary Guidelines themselves, to the policies created to enact the guidelines, to the food manufacturers’ efforts to create product based on those guidelines, it would seem that taking an evidence-based approach is the gold standard for nutrition in our country. After all, why would we want to enact national nutrition policies that cost billions of dollars but don’t actually work?

The major issue I saw over the three days was that most of the speakers were under the impression that their understanding of nutrition science was infallible and completely up-to-date. I heard statements like “the tenets of nutrition are stable,” that “the science of what we should eat is almost irrelevant,” and that “we know what people should be eating, but we…

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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.