SNSW LHD Keeps Saying NO To Low Carb Diets!

I was warned this would happen.

The joke is that when you write to a Government Minister in Australia with a problem or concern, the objective of the Minister’s office is to make you go away.

But not in this case, surely? What others and I have to say is important; it’s about peoples’ lives and their health. It’s even about the blow-out of the Health budget. It’s how to turn around the rising rates of diabetes and obesity. It’s what the Health Minister would want to hear and act on. Surely???!!!!

Apparently not

If a government department wanted something to go away, here’s the blueprint from the NSW Health Minister’s office:

Step one.

 Receive many requests from researchers, scientists and the public for an inquiry into a mistake that could cost some people their health and potentially their lives.

In this case, the mistake was the CEO of the Southern NSW Local Health District dictating that low carb advice must not be given to any person within the Health District.

Step two.

 1) Ask said CEO to explain the basis for his decision

or

2) Give said CEO the opportunity to say whether or not he’s satisfied with the decision he made.

The NSW Health Minister, Jillian Skinner, unbelievably went for option 2.

And the CEO of the LHD in question responded that he was fine with his decision.

Specifically: “The position in relation to your diet and acceptable dietary advice provided by NSW Health professionals may change over time, however the Local Health District continues to follow the advice of NSW Health and the DAA with regard to dietary advice provided to clients.”

Outcomes

  1. People of the SNSW LHD are denied access to science based low carb dietary advice that could improve their health.
  2. Ministerial get-lost objective achieved.
  3. I have to write another damn letter to the Minister.                                                     This is an edited version:                                                                                             21.10.2015                                                                                                                              Dear Minister Skinner                                                                                                    Further to my request for an inquiry into the actions of the SNSW LHD, which I submitted to your office on 17.9.2015. In that correspondence, I requested these issues be investigated:
    1. Abrogation of responsibility by the SNSW LHD to the Dietitians Association Australia (DAA) for my dismissal

     

    1. The basis for the decision that low carb diets are not evidence based.                            It is an understatement to say that I am disappointed in your response. Instead of your office asking the CEO of the SNSW LHD to provide you with answers regarding my questions, your office passed my inquiry to him, leaving it to him alone to evaluate his own, and his staff’s decisions. Unsurprisingly, his response was that everything is in order; he’s happy with all the decisions and no inquiry is warranted.I would like to reiterate my concerns and provide the CEO’s comments.
      1. Abrogation of responsibility.

      The LHD’s investigation into my case found no hint of professional incompetence (as there is none), however they took DAA’s word for it, without details or explanation, and dismissed me on that basis. This abrogation of responsibility by a government body to a self-regulated membership organisation without knowledge of the standards and processes employed by that organisation (LHD representative admitted this) I believe to be a serious dereliction of duty.

      I would be happy to provide you with full details of DAA’s findings; in short, it appears that I was deregistered either on the basis of my recommendation of LC diets or because DAA did not like the way I kept my notes on one client.  http://www.babyboomersandbellies.com/blog/2015/08/my-case-with-daa-revisited-or-revisiting-my-case-with-daa-or-daa-revisited/

      CEO’s determination: “I am satisfied that there has been no abrogation of responsibility by the Health District to the Dietitians Association of Australia DAA.”

      How nice for him to be able to ignore the fact that in 29 years of my employment with NSW Health there has never been a hint that I was anything less than a competent and experienced professional. The DAA however could say otherwise and NSW Health just accepted that decision without question.

      That is abrogation of responsibility whether the CEO wants to admit it or not. His response is insulting.

       

      1. They got it wrong

       

      SNSW LHD’s decision that low carb diets are not evidence based and are not to be recommended in the LHD is simply wrong and potentially harmful to many people. It may also leave NSW Health open to litigation by people who are being denied advice on reducing carbs, despite this approach being supported by science and the American Diabetes Association guidelines that dietitians are advised to follow.

      I requested that the people who made this decision be asked to answer how they concluded that low carb diets are not evidence based.

      CEO’s response: “The position of the technical advice may well change over time with further research. However, at this time the SNSWLHD is following the advice of NSW Health with regard to dietary advice to clients/ patients.”

      Me: What is NSW Health’s advice exactly?

      To my knowledge, prohibiting the recommendation of low carb diets is not a directive in any other NSW Health District, nor anywhere else in Australia or probably even the world. In addition, the CSIRO backs low carbohydrate management of diabetes. Their recent 2-year study of very low carb versus ‘traditional guideline’ higher carb dietary management showed that low carb gave significantly better results in blood glucose control and cardiovascular risk factors. The low carb participants had a significant reduction in their medication requirements.

      The LHD has gone out on a dangerous limb in making this a directive.

      More from the CEO: “The position in relation to your diet and acceptable dietary advice provided by NSW Health professionals may change over time, however the Local Health District continues to follow the advice of NSW Health and the DAA with regard to dietary advice provided to clients.”

      As I have previously stated, DAA defer to American Diabetes Association (ADA) guidelines for dietetic management of diabetes. ADA guidelines support the use of low carb diets.

      This issue is no longer just about my case, as no doubt you would be aware from the number of letters you have received from scientists, researchers, dietitians and others from around the world.

      I would ask again that the following issues be investigated properly and not referred back to the CEO responsible for the decisions in question.

       

      1. Abrogation of responsibility.

      Request: Explanation as to why DAA’s finding of professional incompetency against me was accepted without question by NSW Health, and subsequently used as the basis for my dismissal, when in 29 years and regular PDPs with my managers, there was never a hint of criticism of my expertise or competency.

       

       

      1. Getting it wrong.

      Request: CEO to provide supportive evidence for the directive that low carb diets are not to be recommended to clients in the LHD.

       

      Specifically: 1. What exactly does NSW Health advise in regard to dietary advice for clients/ patients that the CEO refers to? (needs referencing)

       

      1. What does he believe DAA’s position is concerning dietetic advice for diabetics? (needs referencing)

       

      Thank you again for your consideration of these issues.

       

      Yours sincerely

       

      Jennifer

       

Local health district says no to low carb diets for diabetes

 

Now my saga with the Southern NSW Local Health District administration.

The Southern New South Wales Local Health District (SNSW Health), my former employer, oversees health services for about 200,000 residents. When somebody lodged a complaint about my low carb approach for patients with metabolic syndrome and type 2 diabetes with the DAA (Dietitians Association of Australia), SNSW Health also got into the act.  They came up with specific conditions for my return to practice — this was before I was officially sacked.

Remarkably, they specifically said:

“Nutritional advice to clients must not include a low carbohydrate diet. Jennifer will be advised on the information that she may provide to clients…. ”

Can you imagine having to tell a client with diabetes, who has lowered his BGLs, lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?

In any case, I was prepared to go back to work and fight this from within the organisation. That was not to be.  As I was getting my head around returning to work, DAA informed my employer that the Association had found me guilty of professional misconduct and deregistered me.  DAA’s “Far Deeper Issues” Revealed . SNSW Health immediately went along and fired me.

To bring their obsession into clear view, just before my dismissal, SNSW Health circulated a memo to their executive and dietitians.

It read: “As a result of a recent investigation, please be advised that Southern NSW Local Health District requires adherence to the Dietitians Association of Australia (DAA) Practice Guidelines for Dietitian Management of Diabetes.”

Of course, they admitted that DAA doesn’t actually produce clinical practice guidelines, but that it has produced a Nutrition Manual for use in hospitals and other facilities. So: “As an interim measure, all dietitians employed within Southern NSW Local Health District are directed that all diets prescribed for Diabetics must reflect the principles of Diabetic Diets outlined in the 2014 DAA Nutrition Manual”, which unsurprisingly doesn’t include low carbohydrate diets. In fact, for people with type 2 diabetes, the DAA manual recommends ensuring a regular carbohydrate intake and to spread carbohydrate over the day.

And to make sure all bases are covered, just before firing me, as described above, a suggested script  had been prepared saying that “specific referrals that are received for a low carbohydrate diet from GP’s will be directed to the attention of the local Allied Health Manager who will contact the GP regarding the PP directive.” and, “Further discussion may then occur about the notion of a low carbohydrate intake diet not currently supported by the DAA.”

It’s not easy to be a dietitian in Australia advocating carbohydrate restriction, but even worse to be a person with diabetes in the SNSW Health district where you are denied the choice of a low-carbohydrate diet.

This breakdown in health care may not be evident to the government and a lack of oversight may have allowed this to get out of hand at the local level. I’d like to think that my experience could allow me to be a catalyst for positive change and I would like to suggest that, if you agree that this is a serious problem — not being allowed to offer all beneficial therapies to patients — you might join me in bringing this to the attention of the NSW Health Minister. Hopefully she will initiate some action.

If you think that this is a serious matter, could you please write to the NSW Health Minister, Jillian Skinner, expressing your concerns;  an inquiry or hearing on this issue is reasonable to ask for.

Could I ask that you also post your letter here or leave a comment? Thank you.

Postal:
The Hon. Jillian Skinner, MP
GPO Box 5341
SYDNEY NSW 2001

Email:   office@skinner.minister.nsw.gov.au

 

 

DAA’s “Far Deeper Issues” revealed

“Looks to me like you’ve been stitched up.” This sentiment has been expressed more than once by people familiar with my case, including my lawyer.

I’m not saying that it’s true but it has certainly been my feeling. Now with the help of a legal perspective, I believe I’m better able to clarify what has happened.

This clarification is necessary I believe, in no small part because of what I see as DAA’s continued undermining of my professional competency/ character on social media, often by innuendo. DAA’s tweet from 25.8.15 could be seen as an example of this, by alluding to but not specifying, Far Deeper Issues as reasons for my expulsion. 

 My Story To Date:  

In July 2014 a dietitian lodged a complaint with my employers and forwarded it to the DAA.

The complaint was primarily that low carb diets, (such as those that I recommend to clients with type 2 diabetes and insulin resistance), are not evidence based.

In August 2014, sometime after this complaint was lodged, the complainant forwarded a letter to DAA from a disgruntled client. DAA looked at my website, and I assume became aware of my criticisms of current diet advice cutting carbsExaminer,  and MindFood.

In September 2014, I received a letter from DAA asking me to answer two main issues.

These were:

  1. “Your recommendation of a very low carbohydrate diet for type 2 diabetes management being inconsistent with Evidence Based Practice.”
  1. “The patient letter indicates that you dismissed previous evidence based advice given to this patient and provided contradictory advice, resulting in a disgruntled consumer.” (Note: this was not part of the complaint received by DAA from Dietitian X)

I gave full and comprehensive answers to these issues and followed up with more details when asked.

I received a letter from DAA in April 2015 stating that the DAA board had upheld the complaint from Dietitian X, that the matter constituted a breach of the Code of Conduct and expelled me from the association.

At the time I posted a blog saying that DAA had expelled me because of the use of low carbohydrate diets in diabetes management. This prompted an interesting response from the DAA.  An unidentified person from the National Office emailed me, claiming that the reasons for my expulsion were related to professional competency and not my dietary advice.

I was surprised to receive this letter. The complaint from Dietitian X  primarily concerned my diet approach, specifically that low carbohydrate diets were not evidence based.  The DAA upheld this complaint, and I quote:

“Re:  complaint by Dietitian X”

“The Board resolved:

That the complaint against Jennifer Forman (Elliott) is upheld..”

I posted that if DAA were now suggesting that there was another complaint relied on to expel me, then it would seem that I had not been provided with even a basic level of procedural fairness/natural justice.

This generated some interest on social media, where DAA gave alternate reasons for my dismissal, saying or implying that it was was related to professional competence (George) (DAA Tweet) and non-engagement in the process (must attend hearing) (What if I tell you….). None of this went down well with the public (Dr Halberg) (good call). DAA then said that the details were confidential (have a nice day) (damage control)    

Sometime after these tweets were posted, the DAA seemed to  change their mind about their position on confidentiality and sent me an unsolicited letter “suggesting” that they are within their rights to make the details of my case public.

Even though I found this letter threatening and intimidating, I also thought “excellent idea; now we will get to the truth”. Unfortunately DAA did not follow through.

Lack of transparency

DAA provided my employers and myself with a simple statement of their findings (you’re expelled) (she’s expelled); primarily that I had breached the Code of Conduct and was guilty of professional misconduct.

Professional misconduct is a serious offence and must be extreme to result in de-registration and lifetime ban of a practitioner. It generally involves the potential of harm to the public, negligence and/or unlawful activity.  No such accusations have been brought against me; the complaint was about LC diets, with DAA’s addition of the experience of a disgruntled client.

Are these the “Far deeper issues” responsible for my expulsion from the DAA?

So what exactly were DAA’s grounds for such a harsh finding resulting in loss of my employment and income?

I still find this hard to believe and remain prepared to be corrected by DAA if I’ve made a mistake in my interpretation, but according to a letter I received from DAA in March 2015, it appears the following issues constituted the grounds for DAA’s finding of “professional misconduct”:

 1. Lack of documented diet history.

Prior to a consultation, potential clients provide a written record of their usual dietary intake and it is therefore rarely necessary to repeat this in person.

 2. That I recommended a generic, non-personalised meal plan without a rationale.

Is DAA saying that I suggested the CSIRO Wellbeing diet for a trial period on a whim? If a client who consults me for diet advice fits the diagnostic criteria of Metabolic Syndrome, there is a sound scientific basis as to why a lower carb eating plan is appropriate. I have studied the science behind this, written a well-referenced book about it, been invited to explain my approach to doctors and diabetes educators and advised on and observed the results of this way of eating for 100s of clients.

I have never found it necessary to remind myself in writing why I am recommending a lower carb approach.

My notes do not convey the time taken to explain the rationale of why a reduced carb intake is the approach of choice for a person with high BGLs. This explanation was provided to DAA in my initial answers to the complaint.

 3.  That I incorrectly interpreted biochemistry.

I recorded available biochemistry but no interpretation of these results was documented.

 4. That I did not document an assessment of the client’s nutritional needs.

 In general, the main nutritional need of a client who presents with features of Met Syn and with clear evidence of poor glycaemic control, is a reduction in their intake of carbohydrate. Even though detailed evidence for this assessment is not put in writing each time I see a client, it’s covered when I write my usual: “Features of Met Syn (specified), therefore likely to be IR. Explained pathways of carb metabolism and rationale for reduced carb intake and regular exercise.”

5.  That my notes on this client “did not include an assessment of her previous dietary knowledge, past experience with dietary interventions and her expectations from the dietary counselling I was providing as would be expected from an entry level dietitian”

Firstly, with 35 years experience, I would have thought I’d gone past the entry level mark but if that is DAA’s benchmark, let’s take it further.

Maybe I should have written something along the lines of the following comments in my notes for each of the hundreds of clients with diabetes who have consulted me over the years and have previously been instructed in the conventional diet approach:

a) Assessment of previous dietary knowledge:

 “Client has understood and followed the advice given by the Australian Diabetes Council/ Diabetes Australia/ local diabetes group etc, which recommend a low saturated fat/ low GI diet, with an even spread of carbohydrate over the day. My assessment of this advice is that such a diet is likely to ensure the client’s BGLs will continue to remain high, requiring an increasing amount of diabetes medication to control the resulting hyperglycaemia and predisposing the client to diabetic complications such as retinopathy, CHD, neuropathy and kidney failure.”

b) Past experience with dietary interventions:

I could also have written something like this 100’s of times in clients’ notes:

“Previous dietary interventions appear to have been successful in one sense, in that the client’s reported usual diet contains many lower fat alternatives, mainly low GI options and carbs are spread evenly over the day.

My assessment is that conventional diet advice has not been spectacularly successful in another sense, evidenced by sub-optimal glycaemic control, weight issues, excessive hunger, tiredness, mood swings and the need for increasing amounts of medications to try and manage high BGLs.”

Maybe such documentation would satisfy DAA’s criteria of acceptable record keeping but I know at least one of my managers would have told me off for being a smart arse.

 The simple point appears to be that the DAA apparently doesn’t like the way I kept my notes; at least on this one client, as it seems that is all they went by.

The question in my mind is why DAA, a self regulated professional association thinks it’s role is to assess my notes at all? In the workplace it is the responsibility of managers to assess all aspects of clinicians work via regular Professional Development Plans. These have been carried out over the last 25 years, with hundreds of my records available for scrutiny. For my last PDP it was suggested that I not abbreviate so much to make it easier for others to read; I was not accused of professional misconduct for not providing details DAA expects of an entry level dietitian.

  1. That they found no evidence that I understood how to critically appraise scientific evidence and apply evidence based practice                                                    I would have to assume that my initial responses to the complaint, which provided this information, were ignored, not read or not understood.
  1. That my social media activity did not demonstrate professional and ethical behaviour.

No details were given for this and the naughtiest thing I remember writing on FB is that sometimes I’m embarrassed to say that I’m a dietitian. That hasn’t changed and if asked, I now say that I’m a nutritionist.

These are apparently my breaches of DAA’s Code of Conduct and are the “Far Deeper Issues” on which I was found guilty of professional misconduct, but for good measure DAA added two more things they didn’t like:

  1. No verifiable evidence of on-going education

I have written and published a well-referenced book on the management of type 2 diabetes and metabolic syndrome Baby boomers, Bellies and Blood Sugars and had an article published in a peer reviewed journal in 2014 Flaws, Fallacies and Facts: Reviewing the Early History of the Lipid and Diet/Heart Hypotheses. These can be verified.

2. Non-engagement in a disciplinary process.

DAA has indicated that expulsion is not taken lightly and that it only occurs with non-engagement in the process and/or when there is significant evidence of poor or dangerous practice.

Is the DAA really saying that a reason for dismissal is not doing what their officers tell you?

Do they just make up these rules as they go along because I cannot find mention of such a condition in their constitution.

In my case, I fully engaged in the process until the point that I realised I was facing a kangaroo court. This is the point at which DAA refused to answer my very reasonable questions and instead responded to my letter with the suggestion that I re-read the Complaints and Disciplinary By-Law.

As for significant evidence of poor or dangerous practice …….. I don’t know what to say.

Except this: I have used a lower carb approach for people with diabetes and insulin resistance for over 10 years. The reality of my working life was that I had the support of GPs who referred their clients to me because of the diet approach I used and the success that many clients experienced; participation in regular PDPs over the years with my managers to assess all aspects of my clinical practice and always positive feed-back from  client satisfaction surveys . My manager’s conclusion to one such survey was this:

The most outstanding part of the survey was the client’s comments on the level of understanding they now have about their dietary concerns, meal planning and how well this was communicated to them. There were also comments on the holistic approach Jennifer uses and how at ease they felt with her. The comments indicate that the level of service was excellent and that they all felt motivated to change their eating habits.

These comments included the following:

Maintain the standard. This is the first time I have ever had a simple explanation of my problem and why I should have an eating plan. I was extremely impressed.

Any further assistance offered to Jennifer would be resources well used. Her empathy and practical knowledge are rare assets and we are very lucky to have them.

In addition, a previous complaint by a dietitian about my diet approach was lodged with DAA 8 years ago. Because I was not a member of DAA back then (thankfully), the investigation was carried out by my employer. The complaint was not substantiated and I could continue to practice.

A final word

I’m at a loss to see how the reason for my expulsion from membership is not directly related to my recommendation of a lower carb diet in the treatment of type 2 diabetes, despite denials from the DAA.

I base this on the following, after extensive discussions with my lawyer and others:

 If you take what DAA have said publicly about dismissal not being about my diet approach and remove this as a reason, and as I immediately addressed the use of testimonials on my website, then:

 the investigation was solely about a letter from a patient (who I saw once for little over an hour), sent to another dietitian and expressing dissatisfaction with our interview

 what I said to her was directly related to the low carb issue – this issue therefore remains at the hub of what the DAA was investigating

However, imy dismissal is solely about the handling of that one patient then:

  • The DAA has therefore taken the most serious action that it can take (again, as stated in its own material) against a member, based on a letter of dissatisfaction from one person
  • That person did not come back to me having cancelled her next scheduled appointment so I was not able to assist her with any issues she may have had
  • I would imagine that the DAA would be aware of the number of patients I have seen over my career so believe the level of sanction is extraordinary. 
  • DAA references to “substantial or consistent failure to reach or maintain a reasonable standard of competence” and “Dismissal is very rare …significant evidence of poor or dangerous practice”;  how can this be found on the basis of one person who was “disgruntled” – but obviously not in any physical danger?

I would like to see an inquiry into DAA’s practices, including partnerships with the food industry, the manner in which disciplinary procedures are carried out and DAA’s roles in accreditation of university courses and in the updating of the 2013 Australian Dietary Guidelines.

I believe there is an urgent need for AHPRA (Australian Health Practitioner Regulatory Association) to take over the registration of dietitians, because despite DAA equating its complaints procedures with those of AHPRA, there are significant differences.

AHPRA: When we take action about practitioners, we use the minimum regulatory force to manage the risk posed by their practice, to protect the public. Our actions are designed to protect the public and not to punish practitioners.

 Also, it is my understanding that if a practitioner wants to have a decision by AHPRA reviewed, the matter can be referred to an outside agency, namely the National Health Practitioner Ombudsman.

In comparison, it appears that if a member of DAA wants to have a DAA decision reviewed, he/she makes their request to the DAA! Or if they can afford it, the member may choose to take legal action through the courts.

In it’s submission to the AustralianHealth Ministers’ Advisory Council (2011), DAA said that it, “…….does not seek to become a registered profession, as it has mechanisms …… similar to the AHPRA to provide public protection.”

Maybe they do, but who protects members from the DAA?

I think I’ll stop now, before I start banging my head against the wall.

What’s next?

I would be really interested in any comments and/or suggestions on how to proceed.

There’s a chance that a reversal of DAA’s decision could mean reinstatement in one of my former workplaces. If you think that DAA’s decision was questionable/ unfair, could I ask that you send such a message to DAA.

DAA’s email: nationaloffice@daa.asn.au

I would also appreciate it if you would cc me or post your comment here, so that there can be an independent record of correspondence.

My email: jennifer@babyboomersandbellies.com

Thank you for your support.

 

 

 

DAA vs. Science – DAA’s views on Low Carbohydrate Diets

DAA’s views on Low Carbohydrate Diets

First posted 5.7.2015

I asked Richard Feinman, Professor of Cell Biology at the State University New York Downstate Medical Center and author of The World Turned Upside Down: The Second Low-Carbohydrate Revolution, to comment on statements made by the DAA regarding Low Carbohydrate Diets.

DAA:Not all “low carbohydrate diets” are the same. These diets vary greatly in quality and in how much carbohydrate, protein and fat they contain. It is important to ensure that the diet information you are getting comes from a credible source.”

Professor Feinman: Credible sources on low-carbohydrate diets are laboratories or clinics that have studied such diets and that have good success and are able to explain how they work and how to implement them in your personal setting. Beware of official organisations that have numerous undocumented warnings and, most of all, little or no interaction with people who have actually done the research.

DAA: “Low carbohydrate and high protein diets have recently been promoted for weight loss. Books have especially focused on people who have the cluster of disorders known as Syndrome X or the Metabolic Syndrome.”

Professor Feinman: Extensive peer-reviewed studies have shown that low-carbohydrate diets are most effective for people with metabolic syndrome.

  1. Cornier MA, Donahoo WT, Pereira R, Gurevich I, Westergren R, Enerback S, Eckel PJ, Goalstone ML, Hill JO, Eckel RH et al: Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obes Res 2005, 13(4):703-709.
  2. Volek JS, Feinman RD: Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005, 2:31.
  3. Volek JS, Fernandez ML, Feinman RD, Phinney SD: Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res 2008, 47(5):307-318.
  4. Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD: Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids 2009, 44(4):297-309.

DAA: “Low carbohydrate diets are not new and have regularly come in and out of fashion. However, there has been no long-term research into how well these diets work in treating obesity and its associated disorders of high cholesterol, high blood pressure and insulin resistance.”

Professor Feinman: They are not new and have consistently been shown to be effective. As other diets — low-fat, Mediterranean, Low-GI, Vegetarian — come and go and as they fail to live up to their promise, people return to low-carbohydrate diets which continue to work despite the medical establishment coming up with “concerns.” Low-carb diets are best for diabetes and metabolic syndrome, dramatically improve HDL “good cholesterol,” triglycerides and small-dense (atherogenic) LDL. The response of total cholesterol and total LDL is variable but these markers have failed to be any kind of reliable indicator of health risk. Low carbohydrate diets reliable reduce blood pressure and improve insulin resistance. The statement in the DAA guidelines are demonstrably false and indicate ignorance or bias or both.

DAA: “Some low carbohydrate and high protein diets are of concern because they encourage an excessive intake of saturated fat. There is considerable research that links a high saturated fat diet with an increased risk of heart disease and damage to blood vessels.”

Professor Feinman: “Of concern” is not data. The history of saturated fat in the diet is one of refusal of the medical establishment to accept the failure of the considerable research. Whether one considers this a scandal or simple faltering progression of medical history, the record is clear: the Framingham study showed no effect of dietary total or saturated fat or cholesterol on cardiovascular disease. The failure was repeated by the Tuscaloosa study, The Oslo Heart Study, The Western Electric Study, The Minnesota study and, ultimately The Women’s Health Initiative (WHI) which found no effect on heart disease, weight loss or diabetes, of a diet low in total or saturated fat or cholesterol. Characteristically, in response to the WHI, Elizabeth Nabel, head of NHLBI got on the media to say “nothing’s changed.”  (The sole study that is claimed to have shown an effect, the Finnish Mental Hospital Study, was so compromised by methodological problems that it wasn’t clear whether it was the researchers or the patients who were confronting the largest cognitive problems). If the “increased risk of heart disease and damage to blood vessels” were as stated in the DAA guidelines not one of these studies should have failed. Not one. But they all failed. The DAA is not alone in voicing “concerns” that have no basis in fact.

In any case, the limitations of the “concerns” is reflected in frequent exposes of the poor science and the USDA Guidelines Committee removing cholesterol from its list of “nutrients of concern” and the US Academy of Nutrition and Dietetics offering comments that they should also have removed proscriptions against saturated fat because “they were not consistent with the scientific evidence.”  The DAA’s persistence in maintaining old ideas (which never had any basis in fact) and which have caused demonstrable harm is what should be of concern.

DAA: “A low carbohydrate diet can be deficient in fibre and result in constipation.”

Professor Feinman: The evidence for the importance of fiber is very poor if commonly touted by “experts.”

Widely claimed on the basis of anecdotal evidence but never really studied, most people feel that whatever the truth, constipation is easier to deal with than obesity, diabetes and increased cardiovascular risk factors such as HDL, triglycerides and pattern B LDL.

DAA: “A high protein diet is usually not recommended for people with any degree of kidney impairment or renal disease.”

Professor Feinman: Low-carbohydrate diets are not usually high protein except compared to the protein-deficient diets that many adapt in trying to conform to the standard high carb recommendations. The most widely respected researchers in low-carbohydrate biochemistry are explicit that a low-carbohydrate should not be high protein although protein tends to be a stable part of the diet.

People with any disease should follow recommendations of a physician. What the comment is implying is that high protein (again, not a recommended feature of most low-carbohydrate diets) is a risk for people with normal kidneys. This has now been disproved so many times that, unusual for the medical media, the facts actually appear to be taking hold. This is presumably why this devious approach is being taken by health agencies. In people with diabetes or any degree of insulin resistance, it is the hyperglycemia that is the major risk for renal disease. People with diabetes are at risk for CVD because of the diabetes and you improve that by reducing carbohydrate.

DAA: “Recent reviews into low carbohydrate diets indicate that they are effective in reducing body weight for up to six months.”

Professor Feinman: They have been shown to be effective for up to two years and, significantly, always better in comparison to low-fat diets or diets similar to those recommended by DAA for as long as they are compared. If there were any science in organizations like the DAA, they would fund the long term studies whose clear benefits they want to see last longer.

There is, however, no evidence of any risk if they are continued indefinitely.  In science you can’t assume risk because it is different than what you do. There is physiology. And, of course, in this case, there is history and common sense.
In the end, though, given the determination of the medical establishment to find risk in low-carbohydrate diets, and failure to do so, such diets are probably the very safest. The fact that low-carbohydrate diets are said to “be the same” at longer periods is due to poor compliance because of poor experimental design. In a natural setting, people find them effective for as long as they stay on them. Also, because the controls are low-fat diets, that is, because low-carbohydrate diets are better than others, many people are happy with six months of success.
Finally, there is the unspoken idea that DAA has long-range studies showing effectiveness of their diet with good compliance and great improvement in diabetes. This is what is known in computers as vapor-ware.

DAA: “There is evidence to suggest that, for some people, low carbohydrate diets are easier to comply with than low fat diets.”

Professor Feinman: All real evidence shows, as one would expect, that low-carbohydrate diets are easier to comply with.  This is indicated, first and foremost, by the evidence that the trend in the population has been in the direction of lowering fat and raising carbohydrates as recommended by DAA. The associated increase in obesity means that either these recommendations are not good or that they are hard to comply with, or both.

Most interesting, however, is that in a research setting, in studies where the low-fat diet and the low-carbohydrate diet are compared, the usual protocol is for people in the lowfat group to be directed to consume an explicitly low calorie diet. They are usually required to eat what they were told. In the lowcarb group, in distinction, participants were allowed to eat anything that they wanted as long as they kept carbs low; even if you were to grant that the diets were really equal, which is more demanding and likely to have worse adherence? Which are you more likely to stick with?  That the low-carb diet almost always does better in these circumstances is remarkable. When coupled with the constant discouragement from health agencies like DAA, the superior performance makes a low-carbohydrate diet a near miracle.

DAA: “Also, in the short term, low carbohydrate diets may be more effective in lowering high blood levels of triglycerides than low fat diets.”

Professor Feinman: Thou hast said it. But this is true in the long term as well. Any diminution is usually due to poor ability of the experimenter to encourage subjects to persist.

DAA: “In this era of a worldwide obesity epidemic it is important not to be distracted by quick fix solutions that appear in the popular press.”

Professor Feinman: This is a tip‑off that traditional diets fail (“Oh, no. Keep at it.”). In everything else that we do in life, we shoot for the quickest and most efficient method possible. We recognize that things go wrong and can take longer than we want but only Freudian psychoanalysis and conventional low‑calorie weight loss set out to go slowly by design. Failure is never a problem; you just have to keep doing it.

DAA: “Making a decision to adopt a healthy lifestyle is most effective when it is approached as a long-term change. Smaller changes that can be sustained are most likely to lead to improved health over time.”

Professor Feinman: This sounds good but it is exactly “a healthy lifestyle” that experts have been unable to define. Those who counsel small changes will also point out how common it is for weight and other effects to be regained. Not surprising since small changes over time are discouraging. Smaller changes are never sustained. It is success that encourages persistence. The epidemics of obesity and diabetes that coincide with current diet recommendations tells you where you won’t find success.

DAA: “There is undisputed evidence that the best way to control body weight and excess fat is to balance energy intake with energy output. Choosing foods and an eating pattern that help you to reduce the amount of kilojoules or calories you eat, is the simple key to weight loss when combined with physical activity.”

Professor Feinman: Insofar as there is evidence, it is hotly disputed. The energy balance idea is absurd notwithstanding how often it is quoted. Kilojoules taken in are distributed among work, muscle synthesis, fat synthesis, heat, entropic changes, and reorganization of cell material. The ratio of fat synthesis to the total change is the efficiency (from the standpoint of weight gain). The idea that all metabolic processes have the same efficiency regardless of dietary nutrient distribution is not consistent with undisputed biochemical evidence and, therefore, the experimental exceptions, which, in humans, almost always favor carbohydrate restriction, are to be taken seriously.

Professor Feinman:  In the end, the DAA offers the APD and other Australian citizens little guidance on low-carbohydrate diets beyond undocumented “concerns.”

DAA says: “All our information has been written by Accredited Practising Dietitians (APDs), and is reviewed regularly.

Professor Feinman: That’s what we’re afraid of.

DAA says: “So you can be sure this is the most up-to-date and credible nutrition info around!”

Professor Feinman would appear to disagree.

 

DAA vs. Science – DAA’s views on carbohydrate

DAA’s views on carbohydrate

DAA supports the inclusion of carbohydrate foods, such as bread, rice, pasta, noodles, breakfast cereal, potato, corn, legumes, fruit, milk and yoghurt, in the diets of the general population, people with diabetes, those who are overweight and people with insulin resistance.

I asked Richard Feinman, Professor of Cell Biology at State University of New York Downstate Medical Center and author of The World Turned Upside Down: The Second Low-Carbohydrate Revolution, to comment on statements made by the DAA.

  1. DAA on Carbohydrate:Try to eat carbohydrate-containing foods in every meal to provide the body with energy throughout the day.”

Professor Feinman: “This takes no account of the different ways in which people metabolize carbohydrate-containing foods. Many people find that even moderate amounts of carbohydrates make them fat. It would at least be reasonable to say “if you find that foods containing carbohydrate don’t make you fat…” but that seems not to be their style.”

Continue reading DAA vs. Science – DAA’s views on carbohydrate

Interesting article in Crikey about DAA

Is the Dietitians Association of Australia in the pocket of Big Food?

Reason for my expulsion from DAA

On my blog post a couple of days ago (09/06/2015) I alleged that the reason for my  expulsion from the Dietitians Association of Australia (“DAA”) in April, 2015 was because of my recommendation of lower carbohydrate diets to people with insulin resistance and type 2 diabetes.

This prompted a response from the DAA, emailed to me by an unidentified person from the National Office, and also made public by DAA on social media today, claiming that the reasons for my expulsion were related to professional competence and not my dietary advice. As stated in the DAA email, “……the complaint made against you …….. related to professional competence.”

That was news to me.

Here is the evidence.

Continue reading Reason for my expulsion from DAA

Expelled by DAA! (Dietitians Association of Australia)

I was expelled from the Dietitians Association of Australia (DAA) in 2015 after DAA investigated a complaint against me concerning my recommendation of low carbohydrate diets for people with type 2 diabetes.

Continue reading Expelled by DAA! (Dietitians Association of Australia)