Can we trust dietitians?

(mcebis) #1

Can we trust dietitians for keto advice? That is what my blog attempts to answer today.

The evidence may surprise you.

(David Driver) #2

I have never gained weight more quickly than when I was strictly following a dietitianā€™s instructions. Seriously, like ten pounds a month for three months before I stopped.

(Nick) #3

The great, great majority of dieticians are unthinking followers of agripharma propaganda, and following their advice, except in specific circumstances related to particular diseases, will make you sicker and sadder.

Of course, there are a handful of actually intelligent free-thinkers, but theyā€™re very difficult to find.

(A ham loving ham! - VA6KD) #4

Before I discovered keto, I was referred by my doctor to consider bariatric surgery. The bariatric clinic put me on a programme leading up to surgery to first try to lose weight by diet and exercise.

The dietitian immediately cut all my fats as I think these were the easy targets to bring down my daily calories. It was low or zero fat everything and detailed food journaling. A panel of ā€œdiet expertsā€ reviewed my situation and they calculated my basal metabolic rate to be 2600 (k)calories per day and dropped my intake to approx 2000. I started gaining weight. Down to 1800 and I still gained weightā€¦Down to 1600 and I still (very very slowly) gained weight. At this point I started feeling like crap. Lethargic, mentally tired, sore, dizzy spells, constantly growling stomach. All the while Iā€™m trying to work a fairly active job. After more than a year of no weight loss and some gain, the dietitian had the nerve to suggest that I must have been cheating on the diet. After that last visit I sat in the parking lot in my car and cried. Did I mention that was also feeling depressed and hopeless on the no-fat diet?

Then I stumbled on to Richard and Carlā€™s podcast after googling for successful weight loss strategies and decided to give keto a go. Down 40+ pounds in six months is successful in my book. No hunger pangs anymore, energy and mental clarity are back better than I can ever remember. I donā€™t count calories and just eat to fullness when hungry.

So, no, I donā€™t trust dietitians. Everything my dietitian spouted was conventional, formulaic and convenient for them. When I suggested trying keto my dietitian turned white and said it would be a death sentence. My last complete blood work up says alomost the exact opposite and Iā€™m no longer a candidate for bariatric surgery. Surprise!

Edited: a couple of dropped words.

(Keto in Katy) #5

Amazing story @keehan.

Dietitians, MDs ā€¦ thereā€™s really little difference is there? They are teaching what they have been trained.

But when you see that your training is not producing good outcomes, why would you not seek a better approach?

(John) #6

Cognitive dissonance

In psychology, cognitive dissonance is the mental stress (discomfort) experienced by a person who simultaneously holds two or more contradictory beliefs, ideas, or values, when performing an action that contradicts those beliefs, ideas, and values; or when confronted with new information that contradicts existing beliefs, ideas, and values.

A dietitian has to believe how they have been trained is good science, thousands in the occupation over decades, so if the training is right they are left with 2 options, they are incompetent or the patient is cheating. Iā€™m a good person who is doing the best I can to help others, iā€™m following what I have been taught to a tee, if it is not working then they have to be cheating.

(Leslie) #7

Working in a Histopathology laboratory, there are a fewā€¦ universal ā€˜truthsā€™:

  1. Almost all gastric biopsy requisitions will request testing to ā€˜Rule Out Helicobacter Pyloriā€™.
  2. Not all gastric biopsies will test positive for Helicobacter Pylori.
  3. However when we do get that ONE H-Pylori + testā€¦moneyshotā€¦ this is why we need to test all gastric bxs for H-Pylori.
    Never mind the 10,500 specimen that were negative.

Given that anecdote, Iā€™ll answer the question:

  1. Almost all dietitians will say X about low-fat dieting and weight loss or cholesterol levels.
  2. Almost all clients will follow dietitian recommendations for low- fat diets for weight loss or LDL mitigation.
    3.When that ONE client loses weight and improves LDLā€¦ money shot. Never mind any correlating underlying variables. Never mind the 10,500 clients whose digestion and blood glucose and LDL have been negatively impacted by low fat dieting.

Tl;dr conventional wisdom is not > or = biological functionality.

(mcebis) #8

I love your story. Thanks.

#9

Iā€™m a personal trainer, recovering dieter, and have embraced keto. I recently viewed an online training that discussed plant based diets. I have a client who is veg for religious reasons (which is why I watched the video) and doing keto. This dietician described ketosis as making you feel lethargic, brain fog, and dangerous due to high protein levels. She also went on to advocate very high carb from fruit and veg because all the fiber fills you up and creates satiety, but fat is bad because it has no fiber. OMG, I was livid! I watched for 2 hours and never got the info I was seeking regarding actual nutrition concerns on a vegetarian diet.

I also stood in a hospital room as a visitor to a family member who has T2D and listened to the hospital dietician tell him to eat more grain!

So, no I donā€™t trust dieticians or physicians. Physicians have very little nutrition training and itā€™s in the first year, if at all, and is quickly forgotten.

(I want abs... olutely all the bacon) #10

Thank you for sharing your arduous journey to health improvements, happy to hear you were able to avoid surgery despite the worst dietary advice and then accusation of cheating. Stay strong and continue to question everything :blush:

(A ham loving ham! - VA6KD) #11

The funny thing at least to me is that if I had just listened, really listened to what my body has always craved, I would have been OK all along. Iā€™m in my mid-40ā€™s now and have battled weight all my life. Iā€™ve always craved fatty foods, but unfortunately theyā€™ve always been accompanied with high carbs too. Iā€™ve dieted on and off over the years but always cut the fat since weā€™re constantly told fat is the offending calorie source. Had I only cut carbs and sugars instead! But even now, when friends and family are now really noticing my weight loss, presented with my proof, after I show them the science, show them the masses of other successful weight loss stories from keto, show them the dangers of high sugars, they still just frequently chortle to themselves about how much of a fool I am for eating fatty foods. They see it as an attack on everything they believe and automatically go into a defensive position. Iā€™ll never push keto on anyone, rather Iā€™ll just show them the science and show them the results. It just takes a little open mindnessā€¦thatā€™s all.

(Meeping up the Science!) #12

You should not trust any provider, whether they are a doctor, counselor, or nutritionist, without assessing them.

Do not doubt you are a consumer first and a patient second. This is the way our healthcare system is. You must be educated and assertive in order to get the care you require. Donā€™t hesitate to do this by any means necessary.

(Stickin' with mammoth) #13

Unless the dietitian has the word ā€œketoā€ somewhere in their title, the short answer is No.

(jketoscribe) #14

Dietitians do the same thing (recommend low calorie, low fat diets) over and over and get the same poor results, and continue doing the same thing. They blame the patients instead of seeing whatā€™s happening and questioning their own paradigm. The very definition of insanity.

One thing that contributes to this problem is the fact that insurance reimbursement for dietitian consultation is very short term. When a sick, fat person changes from SAD to almost any dietary recommendation there is some immediate weight loss and improvement in health. So the dietitian sees ā€œsuccessā€. But 6 or 12 months down the line thereā€™s a 98% failure rate. Because of the initial improvement. The dietitian gets to claim success and blame failure on the patient slacking off without her ā€œhelpā€.

I have no faith in someone who refuses to recognize that their beliefs are ineffective and continues to blame others for their failure.

Itā€™s personal to me. I worked for twenty years in another allied health profession. A lot of what I was taught in school and what was believed in my profession was not effective or true. I got to the point where I couldnā€™t stand the charade anymore, or the insurance games I had to play to get paid for what I really did when it was helpful and effective. I eventually went back to school and got a degree in another profession that is 180 degrees opposite and I have 100% autonomy to do the very best job I can possibly do.

There are a growing number of dietitians out there refusing to play along anymore, they are the only ones Iā€™d trust.

#15

Having pictures of bacon :bacon: in their office would be a good sign!

(Stickin' with mammoth) #16

The faint scent of bacon in their clothes is the prime tip-off.

(Tom) #17

Iā€™ll share what I call the ā€œMaxim of Circular Dietitiansā€, which is based off of my observations of many (of course there are exceptions) dietitians over the years:

THE MAXIM (a work in progress):

There are two main phenotypes of dietitians:
A. Those who have never struggled with weight and thus never questioned the current guidelines.
B. Those who did have a weight issue, but were lucky enough to have good results with the guidelines, thus they never question the guidelines.

(Stickin' with mammoth) #18

Absofuckinglutely.

#19

This is awesome.

Reminds me of the famous phrase:

Those who were born on the finish line believe they have run the race.

(Keto in Katy) #20

Also, from Upton Sinclair:

It is difficult to get a man to understand something when his salary depends upon his not understanding it.