bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


10 Comments

Is it unethical for dietitians to sell supplements?

14713553446_d820ee9df7_z

Eggcup of Pills photo by John Twohig on Flickr. Used under a Creative Commons Licence.

Something happened recently that kind of blew my mind. I was always under the impression that it was a conflict of interest for a dietitian to sell supplements. Short of causing someone harm, in my mind, it was pretty much one of the most blatantly wrong things that a dietitian could do. In my mind, it still is, but according to at least one College of Dietitians, it’s not.

I happened to be exploring a fellow dietitian’s website, as I’d seen them make some questionable assertions in blog posts. You know, the sort of sensational “sexy” hype that I’m always saying we RDs don’t make. I happened to notice that they had a “shop” in which you could purchase several supplements. I shared this information with a friend, another dietitian, who passed it along to a contact at the College in their region. The response indicated that this might be a concern; however, if there is scientific backing for the supplements, as long as clients don’t feel pressured into purchasing supplements, while not ideal, it’s kind of okay. What??

One of the main reasons that many mainstream healthcare professionals take an exception to some alternative healthcare professionals is that they peddle supplements to their clients. It shouldn’t matter how much science there is supporting the use of a supplement. For any healthcare professional to receive direct compensation for the sale of a supplement or drug is a clear conflict of interest. No matter how amazing the supplement may be, no matter how questionable the supplement may be, the potential to profit from its sale to a client can cloud the judgement of even the most upstanding healthcare provider.

I can understand the desire to make money by selling things. It can be tough to make a living as a dietitian. A supplement may seem like a fitting choice. However, it undermines our credibility. For one thing, there is little evidence to support the use of most nutritional supplements. Imagine the more extreme scenario: You go to see your doctor who diagnoses you with disease X. Fortunately, there is cure Y which she can sell you. Can you not see the potential for corruption? misdiagnosis? Unnecessary treatment? Incorrect treatment? Despite the best of intentions, this can happen when the person who is assessing your condition is also selling you the cure. It’s unethical for healthcare providers to profit from a direct sale of a treatment.

If you ever visit a healthcare professional who offers to sell you a treatment or cure, please report them to their governing body. Get a second opinion. Do some research. We need you to ensure that all healthcare professionals are doing their utmost to ethically optimize your health.


72 Comments

Sorry, dietitians just aren’t sexy

14-times-food-was-something-it-should-never-be-ciui

Something that’s been weighing on my mind a bit lately is the disappointment that many people seem to have with dietitians and the reasons for this. Basically, it boils down to the fact that we’re not sexy. Nope, we can’t tell you the next great superfood you must buy daily (spoiler: there is no such thing as a “superfood”). We won’t recommend any breakthrough weight loss supplement; sorry, whatever Dr. Oz is selling we’re not buying. We won’t tell you “never eat these five foods“. And we won’t tell you that paleo, Atkins, low-carb, low-fat, gluten-free, vegan, <insert any trendy diet here>, is the best diet.

There are no shortcuts to health. There are no foods that you should never ever eat (I mean, obviously, there are some foods that should be consumed on an occasional basis, such as candy, and others on a regular one, such as vegetables). But we’re never going to tell you not to eat something. We’re also never going to tell you what diet to follow. Our job is to help you figure out the diet that works best for you and how to optimize it to make it as enjoyable and healthy as possible.

Yes, I know that there are loads of other people out there who are more than happy to tell you that their diet is the best, the only, the diet to end all diets. I know that, that level of certainty can be alluring. It’s much more appealing to have someone tell you exactly what you may and may not eat when you’re struggling on your own. It’s not easy to hear that no foods are off the table and that no superfood is going to swoop in to the rescue. However, let’s not confuse confidence with competence. Dietitians are here to help you make the best choices for you, not to impose our own dietary regimes on you. Maybe we’re not sexy or fun or exciting but we’ll be here for you when all of those other diets let you down.


5 Comments

Dietitians and brand recommendations

Photo

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. 


Leave a comment

Of wellness chats, dietitians, and L-Glutamine

l-glutamine

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.


Leave a comment

Follow Friday: @chowandchatter

imgres

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.