Dispelling nutrition myths, ranting, and occasionally, raving


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Hey food industry, get out of RD conferences! #FNCE

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I had a blog post all written for you lovelies, cued-up, ready to go. Then I started seeing the tweets coming out of FNCE (Food and Nutrition Conference and Expo) and I got all annoyed and tweeted what you see above because apparently I’m a masochist. That unleashed a fun afternoon of back-and-forth with fellow RDs on twitter who either don’t see conflict of interest as an issue in our profession or don’t really care.

I keep being about to say “I’m sorry but…” but I’m NOT SORRY DAMMITYou are not immune to marketing. No one is immune. Not me, not you, not anyone and if you think you are then you are the extremely rare exception or you are sorely mistaken. Many dietitians (myself included) regularly bemoan that we can’t get any respect as a profession. Do you really think that showing your influence can be bought with a free sample is helping us to become respected on the same level as other healthcare professionals?

Let me tell you a little tale. Once upon a time I worked in a grocery store (yes, I was an RD at this time). In my position I was responsible for a department, helping customers, teaching classes, providing demos, etc. Myself, and others in the same role at other stores regularly received training, lunch and learns, and samples from vendors. Product knowledge is important if you are talking to customers about food and supplements. The thing is, we didn’t receive training on or samples of all brands. So which products were we more likely to recommend? The ones we’d gotten to try, the ones we felt more connected to. Sure, I never recommended a product that I was morally against (I told people not to buy raspberry ketones if they asked for my opinion)or didn’t genuinely like, but I’m sure that there were equally good alternatives to many products that I didn’t steer people toward because I had no experience with them.

So, when dietitians argue that industry at conferences is fine, I disagree. Sure, walnuts and almonds are great but if they’re the only nuts there what are the chances that dietitians are going to be subconsciously influenced to promote those to their clients over nuts that don’t have representation at the expo? Yoghurt’s great and there are myriad options at grocery stores. If Siggi’s and Chobani are the only yoghurt brands represented at FNCE, which brands do you think that RDs are going to be more likely to choose and recommend?

Some argued that the FNCE is, in part, an expo. True enough, but as a conference organized by the national dietetic organization in the US it’s expected that most attendees will be dietitians. The focus should be on providing them with current evidence-based nutrition information.Having a captive RD audience for marketing at a conference organized by a body that’s meant to represent RDs is reprehensible. It’s time for the FNCE to drop the E.

Lest you still believe that RDs are a higher breed of human and somehow immune to conflicts of interest and marketing tactics, check out the selection of tweets below. Names and handles have been removed because this is not about singling out dietitians, it’s about drawing attention to the larger issue. Kudos to the companies present at FNCE for generating all of these free advertisements. Shame on the Academy of Nutrition and Dietetics for allowing this to occur.

 

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A closer look at the full-fat dairy prevents T2 diabetes study

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Image by Roey Ahram on flickr. Used under a Creative Commons Licence

Findings of a study suggesting that full-fat dairy products might be protective against the development of T2 diabetes hit the news recently. Of course, you know me, I was curious if the research was sound.

One of the primary authors holds a patent for the use of trans-palmitoleic acid (one of the common fatty acids in dairy products) for the prevention and treatment of insulin resistance, type 2 diabetes, and related conditions. Right off the bat, there’s a red flag as it stands to benefit the author if he can support the assertion that high-fat dairy (or at least one fatty acid in dairy) can treat T2 diabetes.

I thought that it was interesting that they chose to use circulating fatty acid biomarkers as determination for consumption of full fat dairy products. This sounds like a better idea than the typical self-reported food frequency questionnaire. However, I wondered how accurate such a measure is. It seems that I wasn’t the only one with such a concern. When I searched to find out the accuracy of the use of such biomarkers I came across a letter to the editor expressing concern that some of the FA biomarkers used could also be attributed to fish consumption. Some of the FAs used in this study can also come from other meats, so may not all be attributable to dairy consumption. It seems that there are some additional limitations to use of biomarkers in research as lifestyle and disease state factors may affect metabolism and the resulting presence (or absence) of such biomarkers. Essentially, while the use of biomarkers may seem objective, they may not tell the full story. I also question how long biomarkers such of these remain present in the blood following consumption of dairy foods. Would they be indicative of long-term diet patterns or simply of having recently consumed high-fat dairy? Not being knowledgable in the area of biomarker research I can’t answer this question so it may or may not be worth raising.

Importantly, to account for potential confounding variables, the researchers used self-reported physical activity and food frequency questionnaires. Thus, there is always the potential that there might be another cause for the development (or prevention) of T2 diabetes in study participants.

There are also concerns regarding the actual study participants. The researchers used participants in the Nurses Health Study and the Health Professionals Follow-Up Study. These participants, health professionals, may not be reflective of the general population so generalization of the results to all Americans, or those in other countries is not necessarily possible.

I’m also not convinced that, while statistically significant (where is my personal statistician?*), the results hold any real-life meaning. The number of cases of T2 diabetes diagnosed in all study participants wasn’t huge so a 36-44% risk in reduction, while sounding massive, might not translate to a huge decrease in risk in actuality.

*After writing this, I had a friend with an advanced math degree offer to take a look at the original research for me (thanks Scott!). Here’s what he had to say:

My only concern with the data is the sample size of 3,333 which is not that large considering the amount of variables that they are accounting for. More variables the more likelihood of outliers that may not be actual outliers, but the sample size is so small it appears that way. However, they seemed to have introduced enough controls in their testing to reduce the risk.

What does all this mean? Basically, don’t go crazy on high-fat dairy products just yet. However, as you should only be eating a couple of servings of dairy a day anyway, you should go with foods that you enjoy. Why not have a variety of foods; maybe low-fat milk on your cereal, but full-fat yoghurt for a snack? Variety is the spice of life.