Academy of Nutrition and Dietetics: A Giant Step in the Right Direction

Very exciting news this past week! The Academy of Nutrition and Dietetics (AND), formerly known as the American Dietetic Association, released surprising yet highly welcome comments regarding The DGA (Dietary Guidelines Advisory Committee) Scientific Report, which include the following statements: 

"The Academy supports the decision by the 2015 DGAC not to carry forward previous recommendations that cholesterol intake be limited to no more than 300 mg/day, as 'available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.'"  
Conclusion: No restriction on cholesterol

"In the spirit of the 2015 DGAC's commendable revision of previous DGAC recommendations to limit dietary cholesterol, the Academy suggests that HHS and USDA support a similar revision deemphasizing saturated fat as a nutrient of concern."
Conclusion: Saturated fat no longer a villain

"There is a distinct and growing lack of scientific consensus on making a single sodium consumption recommendation for all Americans, owing to a growing body of research suggesting that the low sodium intake levels recommended by the DGAC are actually associated with increased mortality for healthy individuals."
Conclusion: Restricting sodium can lead to negative health consequences

"Carbohydrate contributes a greater amount to the risk for cardiovascular disease than saturated fat, so the replacement of carbohydrate will necessarily result in a greater improvement in risk."
Conclusion: High intake of carbohydrates is more detrimental to heart health than high intake of saturated fat

While the AND recommends tailoring recommendations to individual needs (for instance, those with congestive heart failure do need to limit sodium intake), it has done a complete about-face in changing  its recommendations that people should restrict sodium, saturated fat, and cholesterol in order to improve their health. And frankly, I couldn't be happier or more proud of my organization for reevaluating their position based on a thorough review of the evidence.

When I started this blog and website back in July of 2011, I'd reviewed a lot of research (both current and decades old) indicating low-carbohydrate diets were healthy, despite being significantly higher in fat, saturated fat, and sodium than recommended by major health organizations. I'd also read dozens of accounts by people who'd improved their health by adopting a carbohydrate-restricted diet and, of course, there was my own experience of completely normalizing my postprandial blood glucose levels by doing so. Since early 2011, I've remained a staunch advocate of a low-carb lifestyle, especially for those suffering from diabetes, obesity, insulin resistance, and PCOS. Still, it's been hard explaining to people why my recommendations differ so much from what they've heard from their doctors or other dietitians, as well as what they hear on TV and see on the Nutrition Facts food label (which will need to be revised more than what's been proposed, given the DGAC's findings).

As a registered dietitian, I was well aware that I was taking a risk in speaking out against the AND's recommendations. The topics I cover in this blog are certainly controversial, at least from the point of view of most dietitians and health care providers. However, I've worked hard to make sure that every blog post I write is balanced, well-referenced, and takes all of the available evidence into consideration. I also include a disclaimer on my About Me page that my advice may run counter to recommendations of major health organizations, including the AND -- one that I may be able to remove in the near future. 

Still, in the back of my mind, I've always worried about retaliation from dietitians who feel that I may be providing harmful advice to my clients and readers of my blog posts and articles. I know at least two dietitians in other countries are being threatened with discipline for making low-carbohydrate recommendations that include higher amounts of fat and saturated fat than their governing bodies deem healthy. Because these investigations are ongoing, I can't provide specifics about either case at the moment but will definitely do so in the future. In addition, I've received several emails from other dietitians who want to discuss carbohydrate restriction with their overweight and diabetic patients yet feel they can't because it's not accepted practice at the facilities where they work. It's extremely upsetting to me that those of us who give truly beneficial advice are often seen as "rogue" practitioners who reject "evidence-based" guidelines, and that we need to watch our backs.

I sincerely hope that dietetic associations around the world follow the AND's lead in updating their recommendations given the totality of the evidence, rather than maintaining the status quo. Improving the nutritional health of all individuals should be the highest priority of these organizations, and if that means admitting their previous positions were wrong, they should step up to the plate and do so.

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