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
I wanted to let any interested readers know that my article for the ADA’s Diabetes Spectrum is now viewable by all on their website. Two points to keep in mind:
While I did have to make some concessions, I’m still very encouraged that the Spectrum editors asked me to write an article favorable to carbohydrate restriction. Slowly but surely, we are making progress!
I can’t publish the article here because the ADA owns it, but you can access it through this link:
Quick update: My article, "A Low-Carbohydrate, Whole-Foods Approach to Managing Diabetes and Prediabetes" has been published in the Fall/Winter edition of the ADA journal, Diabetes Spectrum! Unfortunately, you won't be able to view it online for several months unless you're a professional ADA member (or you want to shell out $30 for the privilege), although you can read the first few paragraphs. They do offer open access to all archived articles originally posted at least six months prior. I'll try to post a PDF on this site as well if I'm able to.
Essentially, I recommended a moderately low-carb diet (100-110 grams total carbs, 80 grams net), as a starting point. While I definitely believe many people would benefit from going lower (in fact, I generally consume slightly less than half this amount of carbs myself), the notion of taking in less than 130 grams a day is still considered dangerous by many diabetes health professionals, and one of my primary aims was to dispel this myth while recommending a more gradual easing into carbohydrate restriction. Also, for anyone who does read the article, please be aware that it was heavily edited: I was asked to remove some of what I considered important statements and add in content in the form of qualifiers (lots of "however's.") Some of the verbiage is also not my own. Apparently this is what happens to all authors of professional papers, so I can't complain too much. Overall, I think the paper adequately addresses the benefits of, concerns about, and how-to's of low carbohydrate eating.
One other exciting bit of news is that, based on writing this article, I was been asked to speak on a panel at the annual meeting of the American Association of Diabetes Educators (AADE) in August! The name of the panel is "Diabetes Meal Planning," and I believe the other people on the panel will be the dietitians who wrote the Diabetes Spectrum articles "Rationale for the Use of a Mediterranean Diet in Diabetes Management" and "Preparing to Prescribe Plant-Based Diets for Diabetes Prevention and Treatment." While I'm looking forward to this opportunity to promote a way of eating I feel passionately about, I can't deny feeling a little nervous speaking to what will surely be a tough room : doctors, nurses, and dietitians who largely disapprove of low carb (although I'm hoping to find some like-minded practitioners as well). Fortunately, they're giving me plenty of time to prepare.
I just wanted to thank all my regular and new readers for your kind words of support in the comments section of my blog and in your e-mails. It's very gratifying to know how many of you enjoy and in some cases learn from my posts :)
I'm going to be taking a break from blogging for at least a month, possibly more, for a very good reason. The editors at Diabetes Spectrum, a journal of the American Diabetes Association, have asked me to write an article on a low-carbohydrate meal pattern for people with diabetes and prediabetes. Needless to say, this is extremely exciting news and an offer I absolutely could not refuse! Diabetes Spectrum is a peer-reviewed journal whose subscribers are physicians, nurse practitioners, and certified diabetes educators. This could help increase awareness about the benefits and safety of low-carbohydrate diets for diabetes management, which is the reason I started this website in the first place. I'll need to spend many hours researching and writing this article, and since I already have a full-time job and like to devote at least part of my free time to non-nutrition-related things, the blog will have to take a back seat until I've completed the piece.
Thank you all for understanding and for supporting my efforts. I'll definitely be back by mid-to-early March, hopefully with some interesting information about the latest in low-carb research.
Franziska Spritzler, RD, CDE