Academy of Nutrition and Dietetics: A Giant Step in the Right Direction
“The Academy supports the decision by the 2015 DGAC not to carry forward previous recommendations that cholesterol intake be limited to no more than 300 mg/day, as ‘available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.'”
Conclusion: No restriction on cholesterol
“In the spirit of the 2015 DGAC’s commendable revision of previous DGAC recommendations to limit dietary cholesterol, the Academy suggests that HHS and USDA support a similar revision deemphasizing saturated fat as a nutrient of concern.”
Conclusion: Saturated fat no longer a villain
“There is a distinct and growing lack of scientific consensus on making a single sodium consumption recommendation for all Americans, owing to a growing body of research suggesting that the low sodium intake levels recommended by the DGAC are actually associated with increased mortality for healthy individuals.”
Conclusion: Restricting sodium can lead to negative health consequences
“Carbohydrate contributes a greater amount to the risk for cardiovascular disease than saturated fat, so the replacement of carbohydrate will necessarily result in a greater improvement in risk.”
Conclusion: High intake of carbohydrates is more detrimental to heart health than high intake of saturated fat
While the AND recommends tailoring recommendations to individual needs (for instance, those with congestive heart failure do need to limit sodium intake), it has done a complete about-face in changing its recommendations that people should restrict sodium, saturated fat, and cholesterol in order to improve their health. And frankly, I couldn’t be happier or more proud of my organization for reevaluating their position based on a thorough review of the evidence.
When I started this blog and website back in July of 2011, I’d reviewed a lot of research (both current and decades old) indicating low-carbohydrate diets were healthy, despite being significantly higher in fat, saturated fat, and sodium than recommended by major health organizations. I’d also read dozens of accounts by people who’d improved their health by adopting a carbohydrate-restricted diet and, of course, there was my own experience of completely normalizing my postprandial blood glucose levels by doing so. Since early 2011, I’ve remained a staunch advocate of a low-carb lifestyle, especially for those suffering from diabetes, obesity, insulin resistance, and PCOS. Still, it’s been hard explaining to people why my recommendations differ so much from what they’ve heard from their doctors or other dietitians, as well as what they hear on TV and see on the Nutrition Facts food label (which will need to be revised more than what’s been proposed, given the DGAC’s findings).
As a registered dietitian, I was well aware that I was taking a risk in speaking out against the AND’s recommendations. The topics I cover in this blog are certainly controversial, at least from the point of view of most dietitians and health care providers. However, I’ve worked hard to make sure that every blog post I write is balanced, well-referenced, and takes all of the available evidence into consideration. I also include a disclaimer on my About Me page that my advice may run counter to recommendations of major health organizations, including the AND — one that I may be able to remove in the near future.
Still, in the back of my mind, I’ve always worried about retaliation from dietitians who feel that I may be providing harmful advice to my clients and readers of my blog posts and articles. I know at least two dietitians in other countries are being threatened with discipline for making low-carbohydrate recommendations that include higher amounts of fat and saturated fat than their governing bodies deem healthy. Because these investigations are ongoing, I can’t provide specifics about either case at the moment but will definitely do so in the future. In addition, I’ve received several emails from other dietitians who want to discuss carbohydrate restriction with their overweight and diabetic patients yet feel they can’t because it’s not accepted practice at the facilities where they work. It’s extremely upsetting to me that those of us who give truly beneficial advice are often seen as “rogue” practitioners who reject “evidence-based” guidelines, and that we need to watch our backs.
I sincerely hope that dietetic associations around the world follow the AND’s lead in updating their recommendations given the totality of the evidence, rather than maintaining the status quo. Improving the nutritional health of all individuals should be the highest priority of these organizations, and if that means admitting their previous positions were wrong, they should step up to the plate and do so.
Yes! I’ve always believed that the evidence would eventually win out but I’ve been losing faith that I would live to see it.
I hear you, Tom!
Dietitians as a group have been caught in a very difficult position. Trained to be professionals, in practice of recent years they have been asked to function more like technicians – delivering advice and support within pre-set protocols.
Working with protocols has worked very well for EMTs (Emergency Medical Technicians = ambulance attendants) and we have no lack of respect for the detailed knowledge, skills, empathy, commitment they bring to their challenging work. I think an essential point that makes that work well is – it is clear and transparent that the locus of control of the protocols is not in the EMT’s hands.
For that matter, physicians are increasingly being expected to act more in this way i.e. as deliverers of protocols – that their function lies in knowing the protocols and how well they interact with the patient and apply the skills/protocols.
So, in some ways, dieticians are dealing with a situation in their profession that other health professions, including physicians, may increasingly face, and now or soon.
Many are watching this point in time very closely. I am not alone in feeling that what is at stake is the very question of whether dieticians will take a courageous and difficult stand – and grab and hold on to the professionalism that has been slipping from them.
Physicians rely on the messages of the guidelines and protocols. Dietitians have expressed that they feel a need for their advice to the patient to be what would be approved of by the doc.
In the mean-time, the biggest man-made disaster to ever afflict mankind has raged on.
The locus of control issue has been muddy and shifting.
Kudos to the courage and commitment of the substantial minority within the field who have taken on the complex uncharted territory of crafting a better way forward for their profession.
Thank-you, Franziska, for your excellent blog and other contributions.
(Spoken as someone who’s first profession was as a Dietitian.)
Deanne, thank you so much for your astute and insightful comments. I agree with everything you’ve said and appreciate your kind words of support more than you can imagine.
Franziska – I am so pleased to see this change of policy by the AND. I’m sure you are relieved that they have organizationally caught up with your early and enlightened perspective. Over the years in this low-carb debate, the professionals have quickly brushed off personal experience as “merely anecdotal.” I think that people who take this position must be reminded that the early anecdotal evidence in this case was right! I know anecdotes do not carry the same weight and validity as a controlled trial but perhaps they should not be summarily brushed off and dismissed! Thank you for the professional risk that you took in staking out your early enlightened position on carbohydrates, especially for those of us with diabetes.
Terry, thank you so much for your comments, as well as the great feedback and support.
I agree 100% with your position on anecdotal evidence, as it reflects what’s happening in the real world and should not be rejected. Improvements in A1c and other biomarkers occur almost universally with carbohydrate restriction, and I’m sure there are thousands of n=1’s who’d be happy to provide their own objective data if requested.
I am glad the Academy finally admitted flows in previous recommendations. I guess it couldn’t be easy for them. I hope for the next step – people looking at the individual carbohydrate tolerance and eating according to a BS meter. I am sure you will be recognized as one of pioneers of such sensible approach.
Thanks, Galina. Appreciate your comments and feedback.
Franziska,
Thanks for writing about this. For years I’ve harbored some anger towards the AND for usurping the role of establishing public diabetes nutrition guidelines but not actually doing their job. They instead deferred to others to actually examine the evidence and develop recommendations. And there were seriously entrenched positions that were never questioned. And it isn’t just the AND, it is a whole community of people and organizations including the ADA, the researchers, the government and practitioners. I am really heartened to see the AND stand up and revisit these issues. I have not seen the actual “evidence” assessment, so we really cannot comment on it, but the end result from this position seems much more consistent with what I have seen from the studies. I am so glad that the AND actually seems to be standing up and being a body that performs independent and objective assessments of the evidence for nutrition recommendations. While many Americans think this is what the USDA does, it isn’t.
I’m actually going to attend AADE this year. I’m very interested in how this new position will reverberate through the diabetes education community.
…brian
http://brian-the-bsc.blogspot.com/
Nice to hear from you, Brian, and thanks for making these excellent points. Unfortunately, I’m unable to attend the AADE conference in June, but I hope your experience is a positive one.
I actually attended AADE 2013 and had a good experience. Although I have a lot of issues with dietary guidance coming from educators I found them to be a really caring and compassionate lot. As individuals, many of them seem to really understand how carb restriction can be a successful approach to diabetes nutrition. Sadly I also observed that the profession seemed to be aging and members were finding it more difficult to work as educators (for a variety of reasons). So I am heartened to see younger educators such as yourself in the field (yes I called you younger).
And actually AADE is Aug 5-8 in New Orleans this year. Perhaps there is still time.
…brian
http://brian-the-bsc.blogspot.com/
Thanks for clarifying that the conference is in August, but I’m afraid I won’t be able to make that one either. Hope you enjoy it! And thank you so much for describing me as “younger.” 🙂
Great reading! I am so glad the science is beginning to prevail. I know following a LCHF diet has helped me feel better, eliminate meds, and loose 70 pounds.
The very first link is broken, and should be:
http://www.eatrightpro.org/resource/advocacy/take-action/regulatory-comments/dgac-scientific-report
(not https).
Thanks so much for your comments, Mark! Congratulations on losing 70 pounds and improving your health via a low-carb lifestyle.
Hmm, the link seems to work fine for me as is, but I’ll look into it further. Thanks!
This is AMAZING news! I’m so thankful for all your work Franziska. You are a leader and a role model for so many.
Thank you so much for your comments and kind words, Hannah! They mean a lot to me. Keep up the great work!
Hi Franziska,
What a great TEDx video! And smashing rebuttal from Dr. Eades (which I saw as soon as he posted it some time ago), And the AND position paper. I hadn’t seen it before, and you covered and summarized it beautifully.
(Did you see my column #155 (10/13) about the ADA revised dietary guidelines? Link attached: http://www.thenutritiondebate.com/2013/10/the-nutrition-debate-155-cowabunga-ada.html. Note it was the RDs, not the MDs, who made the recommendations, but they were solicited and then endorsed by the full ADA Executive Committee.
I was also interested to read your personal thoughts about being a ‘rogue’ dietitian and the concerns and risks you have taken and continue to take. It takes courage, and I admire you for having and acting on your convictions. You can be comforted in the knowledge as well that you have been (and are) a pioneer.
Hi Dan,
Thanks so much for the nice feedback! I appreciate your support very much. No, I haven’t had a chance to read your article yet. Sounds very interesting! Thanks for sharing!
For anyone reading this, Dan is referring above to a video and blog post I shared in my June newsletter. If you’re interested in receiving my newsletter, you can subscribe on the home page of this website.
Thank you for your website! And this info from AND specifically. I am an RD who has been out of the workplace for nearly 4 years since having kids. But since I’m keeping up my credentials by taking CEU’s, I’ve been reading books like Keto Clarity, which has opened my mind up to a whole new world and way of thinking about low-carb diets and fat intake. Amy Berger from tuitnutrition.com referred your website to me and I’m so glad she did. I look forward to reading more of your posts.
Hi Jenny,
Thanks so much for your comments and nice feedback! Welcome back to the nutrition world. It’s always great to hear from open-minded RD’s 🙂 Amy is a gifted writer and friend, and I appreciate her referring you to my site. I wish you the best of luck in all your endeavors!
– Franziska