Dietitian Expelled from Dietitians Association of Australia for Providing Advice "Inconsistent with Evidence-Based Practice"
It's rather ironic that only a few short weeks ago I was happily writing about the AND's turnabout on several nutrition issues while today I'm sharing the case of an Australian dietitian whose governing body, the Dietitians Association of Australia (DAA), has expelled her because she makes recommendations that are "inconsistent with Evidence-Based Practice." And to add insult to injury, her name has been added to their public list of other dietitians who have been expelled or suspended from the organization for "disciplinary reasons."
For those of you who don't know Jennifer Elliott, she is a dietitian and author from New South Wales, Australia, who has been practicing for more than 30 years. For the past ten, she has recommended a moderately low-carbohydrate diet for people with diabetes and insulin resistance, many of whom have experienced significant improvement as a result of following her advice. This approach arose out of her own extensive research into the causes of insulin resistance, along with the overwhelmingly positive impact carbohydrate restriction has had on her middle daughter, who was diagnosed with this condition as a teen (You can read the full story on Jennifer's website, along with her recent blog posts about the expulsion). She is an extremely bright, responsible, well-regarded dietitian who truly cares about her patients and does everything she can to help them. .Jennifer is also my friend and someone I speak with on a frequent basis.
In Australia, Accredited Practicing Dietitians (APD's, similar to Registered Dietitians or RD's in the US) are required to provide nutrition recommendations that adhere to Australia's Dietary Guidelines. Jennifer has been genuinely perplexed as to how the situation has unfolded. Australia looks to the US, specifically the American Diabetes Association (ADA), as a trusted source of evidence-based information on diabetes management, and in the past DAA has stated that they endorse the ADA guidelines for use by dietitians in Australia. Jennifer has stayed up to date with these guidelines and the changes over the years, including their 2013 position paper Nutrition Therapy Recommendations for the Management of Adults with Diabetes, which states:
"Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals….A variety of eating patterns have been shown modestly effective in managing diabetes including Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH) style, plant-based, lower-fat, and lower-carbohydrate patterns."
It is disingenuous of the DAA to find against Jennifer for using a lower-carbohydrate approach for patients with diabetes and insulin resistance, when the ADA states that it is indeed one of several options that may be followed by such patients. In fact, the ADA asked me to write an article about carbohydrate restriction for their journal Diabetes Spectrum nearly three years ago.
I find it very upsetting and extremely unfair that a caring, dedicated dietitian such as Jennifer, who has helped so many patients improve their health and quality of life, is being treated this way. At this point, several like-minded dietitians, doctors, and researchers are working to publicize Jennifer's story and provide her with support in fighting this ruling. We can use help in spreading the word. And please stay tuned for further details as they become available.
"When you believe in something, fight for it. And when you see injustice, fight harder than you've ever fought before." - Brad Meltzer
Franziska Spritzler, RD, CDE