Dispelling nutrition myths, ranting, and occasionally, raving


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Being thin is not a qualification for providing nutrition advice

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Last week a bunch of crossfitters and meatatarians got all worked up because the former president of the Academy of Nutrition and Dietetics (the US organization representing registered nutrition professionals) released a video that essentially warned RDs to watch for people without appropriate credentials providing nutrition advice. Some people evidently felt that she was unworthy to issue such a warning as she did not fit their limited definition of an acceptable body size. There are so many things wrong with this assertion that I don’t even know where to begin.

First, I happen to agree with Beseler (the RD in the video). As I’ve argued in the past, dietitians are regulated healthcare professionals which means that we have to complete a number of requirements to maintain our licencing. Being licenced also means that the public has added protection and recourse in the event that we do provide advice that causes harm. Would the video have more credence if it came from someone slimmer? Let me remind you that being young thin and pretty are not qualifications to provide nutrition advice.

Second, just as being young thin and pretty aren’t qualifications to provide nutrition advice, nor is being old large and unattractive a sign that someone is not qualified to provide nutrition advice. An individual’s appearance is not a reflection of their expertise. Personally, I wouldn’t want to receive nutrition advice from someone who judges others based purely on their size.

Third, I can’t tell from the video what size Beseler is anyway. Her size should be irrelevant anyway. Attacking her based on her weight is bullying. The narrow perception of what bodies are acceptable also shows the narrow-mindedness of the attackers. It also shows the pervasiveness of weight bias in our society. That people are more willing to accept advice from someone who has no nutrition education simply because they fit a thin ideal over someone who is highly credentialed but may not have that “perfect” physique is a sad reflection of our ingrained fear of fat.

Healthy bodies come in all different shapes and sizes. Your worth is not related to your size.


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Are pharmacists the new dietitians?

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The other day I was in a grocery store when a recording came over the PA system encouraging customers to speak to the in-store pharmacist about making healthy food choices. Naturally, I was like “what the fuck??”. People wonder why dietitians are so defensive of our profession. This. This sort of thing is exactly why. Because everyone seems to think that they’re qualified to dole out nutrition advice despite the fact that dietitians are the only professionals who spend over four years studying nutrition in university and must indefinitely continue our education to maintain our licensure.

It’s not cool of the chain to be asking pharmacists to provide dietary counselling. If you want to offer that service, hire yourselves some damn dietitians. It’s also not cool of the pharmacists to accept that added responsibility.

Yes, pharmacists are a wealth of knowledge when it comes to medications and they can be hugely helpful in advising customers about potential drug-nutrient interactions regarding medications that customers are taking. They more often than not, likely have a greater knowledge about nutrients in food than your average person. However, none of this equips them with the expertise to provide nutrition counselling.

The scope of practice for pharmacists in Canada contains no mention of nutrition or dietary counselling. Store owners may not know that this service is outside the scope of practice for pharmacists. Therefore, I believe that the responsibility lies with the pharmacists on-staff to let the company know that they are should not be providing this service to their customers. As allied health professionals they should recognize the limitations of their own scope of practice and defer to RDs in matters of nutrition counselling.

When I worked in a grocery store we had an in-store dietitian as well as pharmacists on-staff and everyone worked together to provide customers with the best service possible. Pharmacists have enough to do without having to get into nutrition counselling with customers, which, when done appropriately, can be quite time-consuming. Do you really want to wait longer to pick up your prescription? Setting aside the issue of expertise, do pharmacists really have the time to devote to counselling customers on nutrition? Let dietitians, who are actually trained to provide individualized dietary advice, provide this service so that pharmacists can focus on their own area of expertise.


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Doctors giving nutrition advice probably shouldn’t reference Pete Evans

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I saw this article last week and had mixed feelings about it. I know that we were all supposed to read it and be horrified that a doctor was reprimanded for giving patients nutrition advice. After all, shouldn’t doctors be doing more to help patients manage their health through lifestyle changes? But… there’s so much that this article doesn’t tell us.

Just to start by clearing the air, obviously you all know that I’m a dietitian. Of course I’m going to feel a little defensive of my profession. The orthopaedic surgeon in question was undermining recommendations given by dietitians at the hospital where he worked. All because he had studied some nutrition on his own. Can you even imagine the outrage that would occur if the tables were turned and a dietitian undermined advice given by a doctor?! I’m certain that the RD would lose her (or his) licence, not just be given a slap on the wrist and told to stop working outside the scope of their practice.

Everyone think that they’re experts in nutrition simply because they eat (yes that’s hyperbole, please don’t send me your #notalleaters comments). So many people believe that doctors are all knowing. Unfortunately, it would seem that some doctors fall prey to this mode of thought as well. Doctors specialize. A doctor who works in oncology is going to have an entirely different knowledge-base and skill set from a doctor who works in neurosurgery. Doctors should not be expected to know everything. Yes, family doctors should be better equipped to provide nutrition advice but an orthopaedic surgeon should defer to the dietitians on-staff. It takes an incredibly high level of self regard to believe that you are more of an expert in a field in which you did a little self-study than a regulated health professional who studied the subject for over four years, is immersed in it on the job, and who must complete on-going education to maintain their credentials.

There’s some amazing irony in the article as well. The author references a television episode with the doctor in question and celebrity chef Pete Evans. For those who are unaware, Evans is a notorious charlatan and has faced entirely warranted criticism for promoting unsafe infant diets amongst other questionable nutrition practices. A few paragraphs down, the author goes on to say:

In addition there are numerous unqualified “gurus” giving advice about what we should and should not be eating. Surely it is preferable to have a doctor giving nutrition advice rather than unqualified individuals, many of whom have a product or program to sell.

Um HELLO??? Pete Evans is the epitome of the unqualified guru with a product to sell. Just prior to this statement, the author even admitted that the majority of doctors receive very little formal nutrition education. So, no. It’s not preferable to have a wholly unqualified doctor providing nutrition advice to people. In a way, it’s worse than having a self-proclaimed “guru” providing nutrition advice because people trust their doctors.

If the doctors referred to in the article truly cared about the well-being of their patients they would refer to appropriate professionals when needed, including registered dietitians. They should also work together with those professionals to provide the best care possible for their patients. Rather than assuming that they have superior knowledge of a subject which they were not adequately trained in.

How about rather than complaining foul when someone is rightly called-out for practicing outside their scope of practice, we talk about the real problem here. That our healthcare system is designed to treat illness rather than prevent it from developing in the first place.


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Ditch the meds: a dietitian dispensing drugs

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Image by mkhmarketing on flickr. Used under a Creative Commons Licence.

One of my biggest pet peeves as a dietitian is the fact that so many non-dietitians fancy themselves to be nutrition experts. It’s one thing when it’s a “holistic nutritionist” at least they have some degree of nutrition education. It’s another entirely when it’s another regulated healthcare professional who seemingly has no concept of scope of practice. For those, such as the pharmacist I came across on twitter who states in her twitter bio “Pharmacist who would rather dispense nutrition than Rx.”, who may not know what scope of practice is: scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. For a pharmacist, that means providing evidence-based advice and guidance on medications. For a dietitians, that means providing evidence-based advice and guidance on nutrition.

The pharmacist in question decided not to become a dietitian because she didn’t want spend the money to study the “low-fat” guidelines that apparently comprise the entirety of a degree in dietetics. How easy it is to be critical of a program when you clearly have no idea what the area of study consists of.

You know, I’d really like to be a pharmacist but I don’t agree with the excessive prescription of antibiotics. I think that instead of going to uni and studying pharmacology I’ll just start telling people what medications they should take for their ailments based on my own research and dispensing them online. Oh but that would be dangerous and I’d probably lose my licence to practice dietetics and face prison time. Yet, somehow it’s totally okay for someone who’s never studied nutrition to use their credentials as a regulated health professional (in a completely different field) to advise and influence people through social media, a blog, and conventional media. Ironically, as a registered dietitian I can’t even provide specific nutrition advice through those channels because sensibly one knows that I don’t have enough knowledge about the recipient of that advice to provide appropriate information.

Why even go to university for years, complete internships, pay to write a national exam, pay the college of dietitians $600 a year, and continue to learn about nutrition when it’s so easy? I could be cherry picking sensational “science” and promoting a “sexy” diet without having taken a single course in nutrition/dietetics. Sigh.

My point is, be savvy about where you get your information. Just because someone has credentials in one field does not make them a credible source of information in another field.

 

 


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Low-carb kids?!

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I came across this article recently detailing how to raise kids on low-carb diets and I honestly can’t even. It’s one thing for adults to choose to follow low-carb diets. It’s a whole other kettle of fish to inflict them on children.

The post is written by a pharmacist. I’m sorry, when did pharmacists become keepers of nutritional expertise? Has this woman never heard of scope of practice? You don’t see me running around telling people to start popping pills for various ailments. This is because I’m a dietitian, I know about food and nutrition. Medications I leave to doctors, NPs, and pharmacists.

Okay, so why is this pharmacist advocating for a low-carb diet for kiddos? The opening statement reads: “Childhood obesity is a huge problem today. Lots of parents are wondering – how do you raise kids without feeding them excessive carbs?” 

Are they? Parents, can you confirm this? It frightens me to think that this may be true.

The article makes a disingenuous comparison between two packed lunches and essentially equates low-carb to “junk food” free and, as far as I can tell, low/no grain. Trotting out that erronous message that modern wheat is different from ancient wheat and therefore the food of the devil.

Does the author bother to mention that grains contain nutrients that are important for growth and development in children? Nope. No mention of ensuring that alternative sources of B vitamins, fibre, vitamin E, certain proteins, and so on must be found for children to be healthy on such a diet. Certainly no mention that this type of diet may be setting up children for a lifetime of disordered eating.

There are other ways to prevent childhood obesity and to promote healthy eating habits in children. Forced orthorexia and elimination of food groups is not one of them. Instead, focus on providing your children with nutritious options. Involve them in food prep. Allow them to have occasional treats. Model healthy eating habits and a positive relationship with food. Eat together as a family as often as possible. Carbs are not the enemy.