bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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Dietitians and brand recommendations

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The above tweet really bothered me. Why? For a couple of reasons. One, where is this data coming from? I assume it’s in regards to dietitians in the US, as that’s where the tweet originated. So, can we really paint all dietitians with the same brush? Would dietitians in other countries also be recommending products to clients by brand name 90% of the time in other countries? Are we even talking about dietitians in all areas of practice? After all, we’re a pretty diverse bunch, working in many different areas. 

Two, the implied assumption that this is a bad thing. Maybe I’m the only one, but I immediately felt like we dietitians were somehow doing a disservice to our clients by recommending foods by brand name. The 90% is really quite meaningless. It could mean that a dietitian recommends every food by brand, or it could mean that the dietitian recommends but one of all of the recommended foods by brand. 

Personally, I tend not to recommend foods by brand name. However, I can see times when it might be useful. For example, when telling a client with celiac disease about gluten-free products. Or when someone asks which coconut milk doesn’t contain preservatives or stabilizers. Or when advising someone about humane meat products available at the grocery store. Or when identifying a product which is unique in the market. I don’t think that recommending a product by brand name necessarily means that a dietitian is being influenced by the company in question. I don’t think that it should be taken to mean that his or her credibility is in question. It may simply mean that they are trying to simplify the navigation of grocery store aisles for their clients. 


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Of wellness chats, dietitians, and L-Glutamine

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The other night I had my first exposure to a “wellness chat” on twitter. It was interesting to say the least. The guest* was a registered dietitian in the US. A few of her statements surprised me, and at least a few other RDs. The most surprising tweet read:

What to do when U have a craving? Have a balanced #PFC (protein, fat, carb) snack AND take an L-Glutamine capsule #cravingfree #wellnesschat

A few of us tweeted back at her asking for her to share a link to the research supporting the use of glutamine to reduce cravings. As far as I’m aware, none of us received a satisfactory response. The only response I saw to our requests for research to support her statement was: “Get your supplements where u like, just make sure they’re high quality for effective results.”  This response was also in reply to our expressed concerns that she is selling these supplements (among many others) on her website. In my mind that’s an ethical concern. No health care professional should be profiting from the sale of medications/supplements. It’s an obvious conflict of interest. It’s also a little baffling that she’s doing podcasts extolling the benefits of real food (while also patronizingly insulting many other dietitians by suggesting that we are “brainwashed” into following obsolete dogma taught in school and don’t keep up with current research. Odd, in Canada at least, as part of our professional standards we must demonstrate continued competence by keeping up with current research and new developments in the field) yet profiting from the promotion and sale of supplements.

But… Back to the glutamine issue. My first stop to answer this question was examine.com. They do a great job of slogging through all of the research to get the facts about supplements. The short version of what they say about glutamine is:

A conditionally essential amino acid, only appears to benefit the body as supplementation when otherwise deficient (vegans, vegetarians with low dairy intake) or during prolonged endurance exercise. Anecdotally reported to reduce sugar cravings.

Yes, anecdotally reported to reduce sugar cravings. That means that there is no actual research to support the use of glutamine to reduce sugar cravings. A search of google scholar shows that there are no scientific studies supporting the use of glutamine to reduce sugar cravings. As dietitians we have an obligation to employ evidence-based best practices. This means that we cannot ethically recommend unproven treatments or supplements. I’m not saying that glutamine doesn’t work to reduce sugar cravings. I’m saying that we have no evidence either way. Until there is evidence to support its use in reducing sugar cravings dietitians cannot ethically recommend its use for that purpose.

I have yet to meet a dietitian who fails to keep up to date with current research. It does a great disservice to our profession when one of our fellow RDs suggests that many of us are not up to speed and that she is somehow special and superior to others in the field  because she is “science-based”, especially when she is making recommendations that are not actually based in science. Please be wary of any healthcare professional who is profiting from selling you a cure.

 

*Name has been omitted to protect the guilty. This is something that I struggled a bit with. I decided not to identify the RD in question because I don’t want this to be viewed as a personal attack, it is not.


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Follow Friday: @chowandchatter

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Rebecca Subbiah is a registered dietitian, both in the US and UK. She is also a prolific tweeter and blogger. She shares glimpses into her life, food, and family (as well as yummy nutritious recipes) on her blog Chow and Chatter. She’s always sharing links to recipes, other interesting nutrition-related topics, and social media tips through her twitter feed and is very engaging. It’s always refreshing to see an RD putting a positive face forward for our profession.


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Follow Friday: Open letter of apology to dietitians

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Someone on my twitter feed shared this great open letter of apology to dietitians. It’s not very long and it’s worth a read. My favourite line: “Instead of buying into a plan that’s designed to be tabloid-based income maintenance for a celebrity, why not invest in learning what is right for my body as an individual?  Why not send out a reminder that we can ALL have this specialized care?”


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Bad news for science: naturopaths get positive press

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The twitterverse was all abuzz the other day with the release of a journal article that found that patients who received counselling from naturopaths reduced their risk of heart disease significantly more than patients who only went to see a doctor.

Of course, a number of the authors of the paper reported potential conflicts of interest such as receiving funding from alternative medicine groups and naturopathic organizations. Naturally, they would have a vested interest in showing that there is a benefit to seeing a naturopath.

Doctors, unfortunately, are more often than not, ill-equipped to provide lifestyle and nutrition counselling. It seems pretty obvious that patients provided with an additional level of care would experience better outcomes than the patients who only met with their family doctors. This does not mean that all patients with elevated risk for cardiovascular disease should seek the help of a naturopath. It means that they should be receiving specialized nutrition and lifestyle counselling from a trained health care professional. Ideally, a dietitian as our advice is science-based and we do not promote homeopathic remedies.

The two things I get out of this study are: 1. patients with elevated risk for diseases which can be mitigated by lifestyle changes should receive counselling in the appropriate area(s), 2. doctors should be referring their patients to their appropriate counterparts in healthcare to supply that counselling. The fact that naturopaths were the providers of the counselling in this study is unimportant and gives the false impression to the public that naturopaths are a suitable alternative to doctors and dietitians.