March 9 Is RDN Day

Every profession needs their day, but this profession needs something more than a day of celebration, Registered Dietitian Nutritionist day is not something I will celebrate as long as this group continues to promote low fat high carbohydrate meal plans.

Even in hospitals, one should seldom specify a meal for diabetics as it will be very high carbohydrate low fat with few exceptions. You would be better served specifying the food you want or accepting a normal meal and eating the low carbohydrate foods on the tray. The last time I was in the hospital, the doctor ordered my meals, they were very high carbohydrate meals, and I seldom consumed but a taste of a few of the foods on the tray.

Since 2008, the second Wednesday in March has marked Registered Dietitian Nutritionist Day. The Academy of Nutrition and Dietetics (AND) is trying to take control of National Nutrition Month and focus the attention all on them.

Registered dietitian nutritionists meet stringent academic and professional requirements, including earning at least a bachelor’s degree, completing a supervised practice program and passing a registration examination. RDNs must also complete continuing professional educational requirements to maintain registration. More than half of all RDNs have also earned master’s degrees or higher.

For some reason, I sincerely doubt the last statement above. I have read that the number is closer to one third only having a master's degree. Yet in the profession of nutrition that are not members of the Academy of Nutrition and Dietetics (AND) or the American Society of Nutrition (ASN), 82 percent have a master's degree or PhD in nutrition.

This tells me that there are reliable nutritionists available and our support group is fortunate to have access to two of them. We do not need to rely on members of AND and ASN that are shills of Big Food and Big Pharma. This is the reason our group will not celebrate a day for members of AND.

According to a spokesperson for AND, the majority of RDNs work in the treatment and prevention of disease (administering medical nutrition therapy, as part of medical teams), often in hospitals, HMOs, public health clinics, nursing homes or other health care facilities. Additionally, RDNs work throughout the community in schools, fitness centers, food management, food industry, universities, research and private practice.

March is National Nutrition Month, and this is the one reason we do recognize the two nutritionists that work with our support group.

A Reason to Consider a LCHF Food Plan

In the year since I had helped this person get her VA benefits and her original doctor had gotten her an appointment with an endocrinologist, we have stayed in contact infrequently until this month. Now she was seeking my assistance in avoiding statins as her cholesterol levels had taken an upward trend and her regular doctor has prescribed a statin. She knew that she could not avoid them as the readings for her lipid panel had jumped way over the upper limit and her triglycerides were way too high – almost 400.

I asked her what her recent A1c's had been and these were 5.7%, 5.5%, and 5.9%. Very good and gave no indication on why her cholesterol could have increased so dramatically. My next question was about changes in her food plan and what had changed there. The next email started with an Ohh, No, and she admitted that she had increased the number of carbs she was eating, but had thought with the amount of fat she was consuming that she would be okay.

I suggested that she continue with the statin and start lowering the carbohydrates she was consuming. I also suggested that she pay attention to the amount of protein she might not be eating. Then I suggested that she have her doctor refer her to a nutritionist for more balancing of her food plan. The next day I received an email from her doctor asking if I knew of a nutritionist as he did not and he knew I was not referring to a dietitian.

I called my cousin and asked her if she could do this. She said she would as another of our cousins lived in the same town and she was overdue for a visit. I gave her the doctor's email and phone number and she said she would call him. I sent my friend an email saying the doctor could be calling shortly with a referral and that it would be with a cousin of mine. Our emails crossed and she was letting me know she had an appointment for Saturday at her house. She was wondering why on the weekend and at her house.

I had just about finished a response, when I received another email. She was excited and had heard from my cousin by phone and why she wanted it at her home. She asked why I had not told her about a cousin (also a second cousin) that lived in her town. She was glad I had someone to refer to her doctor and even if it was a relative. She knew from my blogs that I had a cousin that was a nutritionist, but had not expected her to want to travel that far.

I completed my response and said that she was the only one I was aware of and I was happy that she was given the phone number to call her directly as I was going to have her call me and give me her my phone number so that I could set up a three way call. Now I did not need to and this was good.

I said that I was not sure where my other cousin lived, but knew she could be in the same part of the state. I have too many second and third cousins and am not sure where many of them live, as we haven't kept in close contact.

She answered that she would let me know how things went and would give my cousin permission to talk to me.

Diabetes Self-Management Education Needs

I have a difficult time understanding the logic behind not educating people with diabetes the basics of Diabetes Self-Management (DSME). If the people responsible for this education are not equipped for this, then they need to teach the basics of Self-Monitoring of Blood Glucose (SMBG).

My cousin that is a nutritionist has asked me quite a few questions lately because she has been working with several other communities needing nutritional assistance. In one community, they had her there for a program with a certified diabetes educator and people were up in arms after the CDE left. She had been present for most of her program and wondered how someone with that much education could not teach, but only offer mandates and dogma.

In the question and answer part after the CDE talk, several had asked questions about sleep apnea and were told that she did not feel qualified to answer any questions about sleep apnea. The questions then turned to questions about what the different blood glucose readings were telling them about the food they were eating and my cousin said she could not believe that she evaded those questions and answered with mandates.

The last question the CDE was asked was about how to avoid depression and diabetes burnout. She started gathering her papers together while telling the people to talk about this with a psychologist. Then she promptly left.

My cousin said that many were hostile at that point, but she waited until she was introduced and said that if the group were interested, she would contact some people and ask if they would be willing to talk to the group about sleep apnea and depression and diabetes burnout. She said she would try to answer some of the questions about blood glucose testing during her presentation. She told the group that she knew of another group that could probably answer a lot of questions, but they would not be trained, as the CDE should have been.

She said her presentation should have been for 45 minutes, but lasted for about an hour and thirty minutes. They had many questions and asked some that she could not answer, but did give her a round of applause when she opened it up for questions and answers. She said nutrition was her specialty and that she was aware of diabetes only because a cousin had it and she had worked with most of our group on their daily nutrition.

The doctor advising that group had stated that he could find someone to talk about sleep apnea and depression, but the group needed more on diabetes management and equipment use. She warned me that she had given out my blog and several had pulled it up and may be sending emails with questions. I told her the doctor had already contacted me and asked for several of our group to speak at their November meeting. I said Tim had also received a call with the same request.

I asked her if she would be available to introduce us and answer more questions. Then I asked her if she was familiar with ketone meters. My cousin laughed and said she could guess why as people on low-carb/high-fat diets should use one if they are interested in maintaining a ketogenic diet. She said she has two of the three meters recommended by most of the medical insurance companies in our state. I said I would be asking for the medical insurance companies served by most of the group she had met.

I said this will be difficult, as most insurance companies will hesitate to reimburse for these, but will for some cases. She agreed and said she would talk directly to the doctor. Tim arrive then and we talked for another hour planning what we could talk about and who would be best for each part. We have more emails to send to the doctor asking questions. We agreed that as things came together for an outline that this should be sent to all the members of this group. Now the work begins.

Diet As Effective As Surgery For Obese Diabetes Patients

For all those considering bariatric surgery, stop, don't. If you wish to find out what you will be able to eat, just get hold of a menu for what they are required to eat for the rest of their life and follow it for a month or more and this will tell you how diet restricted you will be. If you think you can follow this diet for the rest of your life, then the surgery may be for you. However, consider that you can obtain the same results as surgery by using the diet.


This is now proven in a study conducted by researchers at the University of Texas Southwestern Medical Center and published in the journal Diabetes Care. Dr. Ildiko Lingvay, assistant professor of internal medicine and first author of the research, said:  "For years, the question has been whether it is the bariatric surgery or a change in diet that causes the diabetes to improve so rapidly after surgery. We found that the reduction of patients' caloric intake following bariatric surgery is what leads to the major improvements in diabetes, not the surgery itself."


Why people would undergo the Roux-en-Y gastric bypass bariatric surgery to achieve the same results is a puzzle for me. At least with the diet, you will have the opportunity to change lifestyles, especially exercise to help maintain weight loss instead of dealing with the restricted diet for the remainder of your life.


If you are considering gastric bypass bariatric surgery, be careful and do your homework as the surgeons are so anxious to take your money, they often do not tell you about the problems you may experience following surgery and sometimes for the rest of your life. Above all else, do your homework and find out for yourself what the problems may be as each person may react differently.


Because the surgery makes your stomach smaller, you will get full more quickly. This is the good part. The problems start occurring as the food may empty into the small intestine quickly and lead to dumping syndrome. This may cause diarrhea and make you feel faint, shaky, and nauseated. This can also make it difficult for your body to get enough nutrition.


This is where the surgeons and doctors often drop the ball and do not explain that the part of the intestine where many minerals and vitamins are easily absorbed is bypassed. With this, you may have a deficiency in iron, calcium, magnesium, or vitamins and this in turn can lead to osteoporosis. To prevent vitamin and mineral deficiencies, every source recommends working with a dietitian – not always the best as they will be promoting “big food”. I urge people to talk with a nutritionist or someone specializing in nutrition for bariatric surgery for best results as they will cover things more completely and also advise you which supplements are necessary since often you will not be able to consume enough food to make up for the loss of vitamins and minerals. Plus they will work to see that your doctor does test you for the vitamins and minerals to determine what needs to be supplemented. Vitamin B12 is often on the list as well.


Your doctor should, but often does not, give you specific instructions about what to eat after surgery. For the first month or longer, most doctors do not tell you it is necessary to avoid drinking liquids approximately 30 minutes before and after eating. You will of necessity need to eat slowly and chew your food very thoroughly as it will not have the stomach to depend on for breaking down your food. Also for about the first month you will be limited to soft foods and small amounts of food. Then you will need to sip water between meals to avoid dehydration.


It is common to not have regular bowel movements, but try to avoid constipation and straining with bowel movements. Very slowly, solid foods may be added back into your diet. It is very important to chew all foods well and stop eating when you feel full. Not doing this may cause discomfort or nausea and sometimes you will vomit. If you drink a lot of high calorie liquids such as soda or fruit juice, you will not lose weight. If you continually overeat, your stomach will stretch and you will not receive the benefit from your surgery.


As you can see, there are many things to consider and many pitfalls to surgery. I believe it is advisable to develop the mind-set to use the diet approach and work to a low carbohydrate diet that you can stick to and avoid surgery.

Interview with Adele Hite

I came across Adele's blog shortly after the March 1, 2012 post and I have been reading it ever since. Yes, when I had a computer crash, I missed a couple of weeks while converting to a backup computer and getting everything functioning to keep my blog moving. Then her October 9, 2012 blog reached out and finally let me know what I was reading and that it was not the standard nutrition blog. Yes, I had ideas before that, but this one really made me sit up and take notice. Now I am rereading many of her blogs with a new insight and understanding. Keep up the good work Adele!

It is with enthusiasm that I am happy to have an interview with Adele Hite and a person that does understand the needs of people with type 2 diabetes.

Bob: Please tell us whom Adele Hite is that we cannot find on your websites.

Adele: Interesting question. The Adele that is more difficult to find on the web is the one that is truly and deeply outraged at what is going on in our food-health system. I mean really angry. I try to be more calm and circumspect in my writing and in my talks, because there is a whole big food-health establishment that needs to change and diplomacy is important. But in person I can get really upset about the issue, especially when it comes to diabetes, because that hits home for me. My father was diagnosed as prediabetic a number of years ago; his doctor was “old school” enough to give him the options of either eliminating sugars and starches or starting medication (which is a reminder that the way everyone treated diabetes before the widespread use of insulin was to have patients reduce the sugars and starches in their diet). My dad chose the former and enlisted my help. I gave him a glucometer and some basic nutrition biochemistry information. That was all he needed to figure out a diet that keeps his blood sugars in check and his HbA1c normal (not “diabetes-normal,” but truly normal). The diet he settled upon is not one that the American Diabetes Association or the Academy of Nutrition and Dietetics would recommend, although in every respect it is very nutritious, filled with lots of veggies and adequate protein with natural fat at every meal.

When I did my hospital internship, I was horrified to see so many people with diabetes who were losing their bodies bit by bit—a few toes here, a foot there, eventually a lower leg, then the whole leg—with failing kidneys, failing eyesight, and lives that were defined almost entirely by their disease state. They weren’t near death but they were dying, quite literally, piece by piece, It was like some awful science fiction movie; it felt as if we were keeping these folks alive just enough to keep a steady supply of them coming into the hospital, dialysis center, and wound clinic where, as health professionals, we could make a show of treating them and get paid well for doing that—but we weren’t going to give them the opportunity to stop the progress of the disease by being willing to let them eat (gasp!) eggs or steak. Every day, as I saw these folks hooked up to wound suction machines or dialysis, I was profoundly grateful for my dad’s doctor (the now-retired Dr. Ronald Moore of New Bern, NC) and for the opportunities I had to learn that there was a different way. I am just as profoundly angered that we, as health care professionals and public health policymakers, give these patients and their families no other choice. I look at my dad and I know that there is a different ending to his story with diabetes that is not such a happy one. I could be losing him a little bit at a time, watching him suffer for years and years. I could be watching him have toes and feet become black with infection and then chopped off. He could be blind and crippled and enduring the painful process of dialysis multiple times a week. But he had a choice. And I am sickened by the knowledge that there are sons and daughters that have no other choice than to stand by helplessly and watch as those things happen to a mother or father that they love.

Whew. When I’m not outraged and angry, I’m a mom with three dangerously smart and funny children who forbid me to talk about nutrition in front of them, which is fine with me. I do have other interests! I have been teaching yoga for about a dozen years now, although my students teach me far more than I teach them. I also write songs with my husband, who is not only 100% supportive of my work, but who makes sure I have a life away from nutrition. He’s an incredibly talented musician who plays guitar and sings in multiple bands. Sitting in an audience watching people dance to a song I wrote or hearing them sing along is just about the coolest thing ever. I love being outdoors. I walk trails nearby with my husband and friends at least once a week. We go to the beach or to the mountains in NC frequently. I love camping by myself and cross-country skiing with my family. These things keep me sane and calm (most of the time) and help me to maintain perspective. I don’t want the food-health issue to be all I do because I look forward to the day when everyone has the choices my dad had and my efforts are no longer needed.

Bob: What drew you to nutrition and making this a career?

Adele: I’ve always been interested in food. My mom was a terrible cook (sorry, mom) and my brothers and sister and I learned to cook, as we say, in self-defense. I liked cooking and became interested in the nutrition aspects of food when the low-fat, vegetarian agenda took hold of the nation in the 1980s. Embarrassingly enough, I climbed on that bandwagon with little skepticism at the time. It worked fine when I was younger, but as I got older and had kids, I found myself in a constant battle with my weight. At 60+ pounds over my normal weight and officially “obese,” I was valiantly trying to get my weight under control, but the harder I tried, the harder it was to lose. Finally, I was eating about 1200 calories and exercising 2 hours a day—and not losing any more weight. What was worse is that I was miserable. I was hungry and exhausted. My hair was falling out. When I went to my family physician for help because I was sure I had some kind of weird metabolic condition, he told me I was fine but that I needed to lose some weight because my blood pressure and blood sugar numbers were going up. He suggested I eat less and exercise more. To my everlasting credit, I did not kill him on the spot.

Instead, I gave up dieting and exercising and took up research in my local Health Sciences Library, which turned out to be a much more productive way to lose weight! When I finally figured out that I needed more protein and fat and fewer carbohydrates, I did lose weight and I’ve kept my weight in a normal range for over a decade now. But that’s not why I made nutrition a career.

Because Dr. Eric Westman of the Duke Lifestyle Medicine Clinic knew that I’d lost weight using the same type of diet he was using to treat patients in his clinic (our kids went to the same school and we’d been in the PTA together), he asked me to join him in his work. I ended up as the Patient Educator, helping patients learn how to adapt their shopping, eating, and cooking habits to a reduced-carbohydrate diet.

As I got to know these wonderful folks who were struggling with overweight, obesity, and diabetes, I kept hearing the same story over and over again. It was very familiar because it was my story too. They had tried to lose weight by lowering fat and calories and exercising, but it didn’t work very well, or very long—or, for some folks, at all. After finding success with the clinic’s diet, the patients kept asking the same questions. Why were we told that eggs and meat are bad for us and bread and cereal is good for us when we feel so much better on this diet? Most of all, they wanted to know: Why weren’t we given this choice before? I didn’t have an answer, but their own outrage about how this option was never presented to them convinced me to go back to school to try to figure it out what was going on in nutrition and health care.

Bob: Is there a difference between nutrition and dietetics and is this important?

Adele: Yes and no. Both fields are centered around finding or maintaining health through food. But the scope of nutrition is much wider than dietetics, and there are many ways to study or practice nutrition in addition to being a dietitian; you could say that dietetics is a subset of nutrition. Almost by definition, if you are in dietetics, your training and education has been dictated by the Academy of Nutrition and Dietetics (AND) which has a particular agenda shaped by its close association with food and pharmaceutical manufacturers and with the USDA.

The difference between nutrition and dietetics is important because the AND has been leveraging its financial backing to lobby state by state for restrictive licensure laws that allow only Registered Dietitians to practice nutrition. This is a bad thing for the consumer because it would further restrict our already-restricted choices about nutrition information. People deserve the option of hearing a perspective on nutrition that is not influenced by one particular organization. I am fully committed to the idea that dietitians and other nutritionists should be held to high professional standards, but other nutrition professionals actually have higher educational standards than RDs. You can become an RD with only a 4-year Bachelor’s degree plus internship hours, as compared to a Certified Nutrition Specialist which requires Master’s or PhD level training. I also believe that nutrition professionals should be at the forefront of preventive medicine and health care reform—but dietitians cannot be the only nutrition professionals allowed to practice. 

Unfortunately, as long as the AND is chained to USDA guidelines, food manufacturers, and pharmaceutical companies, the interventions and advice of dietitians will be ineffective at best, damaging at worst.  And, as result, dietitians will be poorly paid, our motivations will be suspect, our advice will be (as it should be) disregarded, and as professionals we will be marginalized.  We will remain on the sidelines, as we saw when RDs were denied Medicare/Medicaid coverage for intensive treatment of obesity. If we want to be active players in healthcare, dietitians will have to raise their own standards, and we will have to disengage ourselves from industry influence. We will also have stop treating the policy guidelines that emanate from the USDA as if they are actually science, since they aren’t.

Bob: Is there hope for people with type 2 diabetes that listen to members of the Academy of Nutrition and Dietetics (AND)?

Adele: Well, yes, depending on who those members are! All RDs are not necessarily members of the AND (just as all MDs are not members of the AMA), and even those who are may have progressive, science-based views on nutrition. At the North Caroline Dietetics Association (an affiliate state-level organization of the AND) conference, I heard a colleague discuss the merits of carbohydrate-restricted diets at a question & answer session—and no one contradicted her! Times are changing and those RDs are out there. But you are right that the AND “party line” is probably not the best choice for those with type 2 diabetes. During my training, I was appalled at how much RDs and other diabetes educators rely on educational materials from insulin companies to teach patients about living with diabetes. These are not materials that are going to help patients minimize their insulin consumption, which—along with overall blood sugar control—should be a goal of treating diabetes.

Bob: In rereading your first two blogs (often these set the parameters of things to come), you have spelled out an agenda and I think rightly or correctly laid the groundwork for the blogs that follow. Have you changed any thoughts since?

Adele: Your question prompted me to re-read those blog posts. I will readily admit that I shift my position on matters of food and health all the time, but I still feel pretty good about those posts. The primary shift that has occurred is that, every day, I become increasingly oriented towards looking at the whole food-health system and its dysfunction as an extension of social, cultural and economic trends that have been with us as long as the Guidelines have. Although I would stand by the assertion that the Dietary Guidelines are very much at the center of that dysfunction, in some ways they may be—like obesity—more of a manifestation of other trends than a cause in and of themselves.

Bob: You have two statements that have intrigued me.

The first one is this - “Frequently those arguments (leptin insulin ghrelin, oh my!) boil down to a collection of snapshots from experimental data that may or may not create a physiologically significant or practically useful collage.” What is the significance of these three hormones in the discussion?

Adele: One of the effects of the intense amount of funding and attention that has been poured into obesity research is that we have been learning, as they say, more and more about less and less when it comes to obesity. I love biochemistry, but in nutritional biochemistry, our knowledge level sometimes becomes so detailed that we forget to climb back up the ladder and put all the pieces together. This may be what is happening with some of our investigations into hormones having to do with appetite, like leptin and ghrelin. Investigations into hormones that regulate appetite is, underneath it all, predicated on the assumption that people who are obese eat more than people who aren’t, or at the very least, eat more than they “should”—whatever that means. The fact that we don’t actually know whether or not this is true (or when it is true and when it isn’t)—there is plenty of evidence that people with obesity often do not consume more calories than others—means that this has turned our attention away from trying to figure out why some people utilize the same number of calories differently than others; some store those calories as fat, while others burn them for fuel or use them to build and repair the body.

Leptin is the hormone that is supposed to regulate appetite by telling the brain how much stored energy we have. It was theorized that a leptin deficiency is what prevented appetite from being “turned off” in people with obesity, who by definition have large amounts of stored energy. When we discovered that people with obesity had the same levels of leptin as people with normal body fat levels, we had to start looking at the problem in a different way. Dr. Robert Lustig has been doing a great deal of work with regard to leptin in human subjects, so I would check out his new book, Fat Chance, for a thorough discussion of this hormone.

Ghrelin is a hormone that stimulates hunger, but is also involved in regulating growth, learning, and memory. It is usually talked about as the counterpart to leptin, and like leptin, is linked strongly with insulin activity.

Insulin is very much at the center of our current concerns about health, but you’d be surprised at how little we know about it—and what we do know we seem to have forgotten. Insulin is a master hormone whose effects are felt throughout many metabolic pathways, but it has three very basic functions: 1) to clear glucose from the bloodstream by ushering it into cells where, if it isn’t used as energy, it is eventually stored as fat; 2) to “turn off” glucose production by the liver; and 3) to “turn off” the process that allows body fat to be used as energy. This last function is frequently forgotten in our haste to treat people with diabetes. A Duke endocrinologist who was mystified by the fact that her patients on insulin kept gaining weight—even though she told them to eat less and exercise more--couldn’t even dredge up the fact that preventing “fat-burning” is a primary role of insulin!

Although it is hard to make any sweeping generalizations about people with obesity and our investigations into leptin and ghrelin have shed little light on the issue, we do know one thing about people who are obese: their insulin levels have been elevated. We don’t know how often, or to what extent, or in what fashion, or even why. But we do know that much. Insulin, ghrelin, and leptin are strongly linked physiologically and we are just beginning to untangle those relationships, but at this point I would say that it is rare to have leptin or ghrelin dysregulation without the upstream effects of insulin dysregulation.

We also know that the effects of elevated insulin are not limited to increased fat storage. There is also increased inflammation which may help explain the fact that insulin levels are a strong independent predictor of heart disease. But we haven’t really investigated that relationship because we haven’t developed the tools to do that. The scientific developments that allowed researchers to easily measure serum cholesterol levels drove the investigations into the relationships between diet, serum cholesterol and heart disease—which turned out to be a rather fruitless path until we could start to further break down cholesterol measures into sub-particles. Because of its central role as a “master hormone,” unpacking the relationships between diet, insulin activity, and disease should be, in my opinion, the primary focus of nutrition science. But since we do not currently have a convenient and consistent way of measuring or even talking about insulin, this has not happened. I’m hoping that a breakthrough in insulin measurement will drive research in a long-overdue direction. I know a couple of gentlemen who are working on that now.

Bob: The second is this, “Note that I am not saying “Everything in moderation.” I am saying “Everything in context.”” Is this a key in the way food should be studied and whether a particular food is good for our health at our time and period in life?

Adele: Absolutely. If I ate the way my son eats, I would store a lot of body fat; if he ate the way I eat, he’d be very hungry. Our activity levels are about the same (I would even argue that I’m quite a bit more active than he is, as his favorite form of exercise is to lay on the couch). But I’m a peri-menopausal female, and he is an adolescent male. We have very different internal environments, metabolic and hormonal settings, and diet histories. There is no single dietary approach that would make sense for both of us, unless we are talking about focusing simply on acquiring essential nutrition—and even then, there are likely to be some significant variations between his needs and mine. As a result, it makes little sense to say this food or group of foods is “bad” and another is “good.” A dietary pattern that leads to good health for one person may not lead to good health for another, or even for that same person at a different point in his/her life.

As I see it, the biggest problem in nutrition right now is that we think we know—for all Americans regardless of race, gender, or age—what foods are (and are not) going to lead to good health. Not only do we not know (which makes us out of line when we tell people we do know), but it causes us not to question the effectiveness of any diet that we’ve already determined is a “healthy” one. When this happens, we stop listening to the messages our bodies send us about our health. It doesn’t matter what kind of diet it is, if it does not lead to you waking up in the morning and experiencing a day where you feel healthy—whatever your definition of that is—it isn’t a healthy diet for you. It is the height of presumption for public health leaders to think they know better than your body does what kind of diet that might be.

This assumption means that we have not paid attention to bioindividuality and how that intersects with public health policy. The truth is we don’t know what kind of diet—other than one that provides essential nutrition and helps you maintain a weight that is appropriate for you—will lead to good health for you this year, much less 30-40 years from now.

Bob: What advice can you share for those of us with type 2 diabetes whether they are taking oral medications or using insulin?

Adele: I think the most important thing to remember is that type 2 diabetes does not manifest itself the same way in every person. People have different levels and varieties of insulin production and insulin resistance that contribute to an elevation in blood sugar, which is the metabolic situation that results in a type 2 diabetes diagnosis. Although everyone with type 2 diabetes has low insulin production, just how low can vary significantly. Everyone can reduce the work the pancreas has to do by reducing dietary carbohydrate. But people whose pancreases still make some insulin can reduce or eliminate medication this way, while others with less insulin production cannot.

Insulin resistance occurs throughout the body, but can specifically affect the liver’s ability to “turn off” the production of glucose. If there is insulin resistance in the liver and the liver continually produces more glucose than the body needs, lowering dietary carbohydrate will only get you so far and some sort of medical intervention is almost always necessary.

That said, there is no known physiological need for dietary carbohydrate in the presence of adequate intakes of protein and fat, and dietary carbohydrate is the food group with the most significant impact on blood glucose levels. We also know that there is no known relationship between foods we’ve been told to avoid—meat, eggs, butter, and cheese—and any chronic diseases. At this point, we need to put the burden of proof where it belongs: public health policymakers and advocacy groups need to prove that these nutritious, whole foods are truly as dangerous to our health as we’ve been told before they tell us to avoid them. Whether you are on oral medications, insulin, or controlling your diabetes through diet alone, your overall health will be best served by feeding your body the nutrition it needs, and there is a lot of nutrition to be found in foods we’ve been told not to eat.

Bob: Have you followed the activities and the websites for Gary Taubes and Peter Attia and will they be a help for you, that is, the Nutrition Science Initiative (NuSI)?

Adele: I do follow the activities of Gary and Peter, and I’m thrilled about the developments at NuSI. The work that NuSI is doing will, I believe, support the changes that need to occur in public health nutrition policy. At the same time, science is only part of the problem. The Dietary Guidelines came into existence—and have remained virtually unchanged for 30+ years—due not only to theories being promoted by some in the scientific community, but to political, economic, and social pressures. If this were really all about science, well, the science is inconclusive on most matters of nutrition. If the Dietary Guidelines had been based primarily on science in the first place, they would say two things: 1) get your essential nutrition and 2) maintain a weight that is healthy for you. That’s all we really knew in 1980 when the first Dietary Guidelines were created, and that’s all we really know now. But the Dietary Guidelines are not based on solely on science, and it will take more than science to address the changes needed in our food-health system. However, the efforts of NuSI will certainly help to make the case that the one-size-fits-all dietary paradigm that we’ve been using since 1977 is inappropriate, which it most certainly is.

Bob: I like your last paragraph of your first blog and hope that all of us can do our part. “At the same time, I’m not here to wring my hands in anguish. I’m actively trying to figure out what to do about this mess we’re in. I’d love all the feedback and help and ideas I can get from anyone with enough time on their hands to wade through my musings. Let’s save the world & have fun doing it.”

Adele: Thanks! The work you do educating people with diabetes about their options is essential to the changes we want to make in reforming the system. The current approach to nutrition in treating people with diabetes is probably the weakest link in the chains holding back progress. Your efforts will surely help to break that link.

Bob: Thank you, Adele! It is a pleasure to publish this and there is a wealth of information that needs to be digested and expanded upon.

Her blog is here. Then with Adrienne Larocque they founded Healthy Nation Coalition

and that website is here.  Adele asked me to list an important person, Pam Schoenfeld, another founder and without whom the site would not exist.

Supplements – Does the Elderly Need Them?

This debate has been around for some time and just does not go away. Do elderly people need to take supplements? Some “experts” say no, other “experts” say yes. Many of these “experts” are assuming that the elderly have unlimited funds, can prepare meals that are nutritionally complete, and reside in areas that are safe and easy to move around within. Most of the “experts” have never had to spend a day in the shoes of some of the elderly.

I wish some of these “experts” would have to do a field study of the elderly and really get out and spend a few weeks seeing how they live, how safe it is for them to even walk around the neighborhood they live in, and how little money has to last for a month for food, shelter, and medications. This says nothing about transportation and some of the other necessities of life. Most of these elderly have no money left for supplements.

To ridicule the elderly like Donald B. McCormick, PhD, an Emory professor emeritus of biochemistry and the graduate program in nutrition and health sciences at Emory, takes ridicule to new levels. He says, “A lot of money is wasted in providing unnecessary supplements to millions of people who don't need them.” It is one thing to sit in the towers of academia and make statements like this, but I would have to ask if he has even seen where some of the elderly live. Then he continues, “We know too little to suggest there is a greater need in the elderly for most of these vitamins and minerals. A supplement does not cure the aging process.”

He thinks that the elderly believe they need vitamins and mineral supplements to blunt the aging process and the older they get the more supplements they need. He seems determined to take these supplements away from the elderly. One statement that McCormick makes I have to agree with and it is this - “At very high levels, some vitamins and minerals can be toxic.” This is especially true for many of the fat-soluble vitamins and minerals that the body can't readily flush.

Yes, McCormick does soften his rhetoric further into the article. He almost allows for obtaining most of them from foods, but with dietary changes. While I agree that it is best to obtain your nutrients from food, not all the elderly do well at cooking and balancing their nutritional needs. Not everyone can make use of nutrition experts and others capable of helping them.

Andrea Giancoli, RD, MPH, a spokeswoman for The Academy of Nutrition and Dietetics does carefully say that when counseling older adults, it is first necessary to determine what nutrients are lacking in the diet. I can believe it when she says it is often vitamin D, calcium, and vitamin B12. She does say she tries to fix it with food. I will give her positive marks for saying, “I don't think we should be recommending supplements blindly without assessing their food intake.”

Does the elderly need supplements? This debate will continue and probably never be resolved. I do think many of the elderly need some of the supplements because they do not eat a large variety of foods and are often short of some nutrients. Having seen some of my friends have anemia and be short of Vitamin D and Vitamin B12, I know what can happen. Another area of concern is those supplements that may cause extreme and even deadly side effects when taken with some prescriptions. Therefore, I have to urge caution for any supplements and urge all patients to make sure their physician knows what supplements are being taken.

The Real Meaning of RD

Most of us understand that the acronym RD means registered dietitian. This blogger is trying to draw attention to her blog and states, “RD does NOT stand for “Really Dumb”.” Yes, Adele Hite is poking fun at herself and her occupation, but at the same time is very serious about the idea that her profession needs change. She uses an excellent example like the last link in her first paragraph referencing a very controversial article from the Huffington Post.

I am not sure why one of their own would take this provocative stance, but she has taken on her professional organization before and probably will again. I strongly agree with Adele that the Academy of Nutrition and Dietetics (AND) has gone too far in their attempt to become the only source of recognized nutritional advice. I even agree that this attempt is backfiring on them and some states are even considering (but to-date none have) stopping all licensing of RDs. My own State of Iowa is taking a hard look at the licensure of registered dietitians, presently now allowing them to expand their over reach.

Would I say that even current registered dietitians are rebelling against their own professional organization? Maybe, but a few people may be trying to reorganize it from within. This may be surprising, but if the current people remain at the helm, the organization will soon be a shell of what it was. Following the pronouncements of the American Diabetes Association (ADA) and the US Department of Agriculture (USDA) will not lead to good nutrition of any type. Many of her links do point out the fallacy being promoted by the AND.

The blogger speaks the truth about the AND putting restrictions on its members about avoiding even the appearance of a conflict of interest, but the Academy receives its funds from the food industry and the pharmaceutical industry and clearly has the appearance of solid conflict of interest. This is definitely speaking with forked tongue by a professional organization. Does “do what I say – not what I do” fit the situation.

Quoting from the blog an important point “On the other hand, the “party line” approaches for weight loss are so ineffective, the federal government (and many states) won’t cover many dietitian services to help people lose weight. According to Dr. Wendy Long, chief medical officer of TennCare:

“There’s really no evidence to support the fact that providing those services [from dietitians] would result in a decrease in medical cost, certainly not immediately, and even in the longer term.”

This lack of evidence may be due in part to the (sadly) limited scope of dietetic education and practice. The AND treats the USDA as if it is a scientific authority and not a government agency whose first mandate is to “strengthen the American agricultural economy.” It limits the training of RDs to USDA/HHS-approved diet recommendations despite the fact that even mainstream nutrition establishment scientists feel that the current US dietary recommendations are misguided and inappropriate.”

Follow the links in her blog to read what is behind her statements. I can only say that it would be smart to read carefully her full blog and if you have interests in this, to follow and read many of the links within her blog. I will only say that I am thoroughly enjoying reading her blog at this time. I sincerely hope to do an interview with her in the future. I fully support her position and hope that she continues to enlighten us. As a patient with diabetes, there is hope that changes will take place and either AND will change (doubtful), or a new organization will emerge to give us the correct nutritional advice we so desperately need.

We can all thank her for pulling together a few of the people knowledgeable about nutrition and dietetics that are working to correct the misinformation being foisted upon us by AND, ADA, and USDA. It is sad that the RDs that work for the USDA must spout the whole grains/low fat mantra to keep their jobs.

Will New Tool Really Help Dietitians?

When I read this, I could not believe that this was being said by a registered dietitian. I mean that she is right in what she says, but to say it publicly has to be daring. It is so important that I am going to quote it, "Only 80 percent of the dietitians we surveyed did any pre-assessment of the client's nutrition literacy, which makes it difficult for educators to target their counseling so clients can understand and act on the information they are given." Karen Chapman-Novakofski is a registered dietitian (RD) and University of Illinois professor of nutrition extension.

From a profession that lives by its mandates, mantras, and dogma, this RD speaks very plainly about why dietitians and some nutritionists are often ignored by their clients. The attitude of RDs is so ingrained in their mantras that they do not pre-assess what their patient (client) has knowledge of and what they need to be taught to make the information useful.

I know that I am not surprised at her findings in the survey. Here we get into using terms that are not explained as well as they should be. Before today, I would have thought a nutrition educator was a teaching position at a college or university. On doing my research, this is true, but also encompasses nutrition educators in hospitals and medical centers as well. Some are also involved in business nutrition education, like agriculture businesses Archer Daniel Midlands, Monsanto, and the food industry.

If the 80 percent is from academia, and the medical arena, then this is why we get the mandates, mantras, and dogma. However, I do think that the term nutrition educators is just the latest phase we are going to have to get used to coming out of the Academy of Nutrition and Dietetics. A doctoral student, Heather Gibbs, has developed an algorithm that dietitians can use to determine precisely what knowledge and skills are required for a particular client.

I know algorithms can be very powerful tools, but I wonder how this will help a profession that works with mandates, mantras, and dogma. They seldom change and will avoid the algorithm as they are not as interested in education as they would lead you to believe. It could be that this may be about to change, but I would not get too enthused yet.

Some patients or clients as they are termed in this article need to know how to manage their consumption of carbohydrates, protein, and fat. Many more need to learn how to manage portion sizes and others need to learn how to read labels. Then many clients need to be able to categorize foods into nutrition groups properly. So with this algorithm dietitians will have the questions to assist them in assessing what the knowledge is that the client possesses and then teach the client what they need to know be become more nutritionally knowledgeable and manage their nutritional needs plus work to balance their daily nutrition.

Karen Chapman-Novakofski stresses that until health professional start asking questions to see what knowledge the patient has about nutrition, it will be impossible to effectively teach nutrition and create a behavior change. She also stated that until dietitians narrow their focus and understand what skills and literacy the client patient possesses, they cannot deliver information in a way that will be meaningful or usable by the client.

Dietitians must get away from the education level of the patient to understand that the patient and the level of nutrition they possess. Then the dietitians can adapt the education to fill in the gaps and make the information usable for the client. Chapman-Novakofski also said if you're the one being counseled, don't be afraid to ask “how” questions to force the dietitian to keep the discussion on your level.

The area Chapman-Novakofski did not cover was how to get the dietitian away from mandates, mantras, and dogma. Until these three areas are made useless to the dietitians, little nutritional education will be passed in a usable form for the clients.

Meeting and Working with a Dietitian

Under the present conditions, I would suggest reconsidering any appointment with a registered dietitian (with RD in the title). While I have some friends that are RDs, they know that currently, I still want them for friends, but do not bring up the subject of nutrition when we are together. One of my cousins who is a nutritionist, not a RD,and a member of another organization, does take particular pleasure in confronting me about the situation within the Academy of Nutrition and Dietetics (AND) and how they will lose in the long run. I do think she is doing this to see how I react, but presently I just let her yammering go in one ear and out the other.

Yes, when we do get to the facts and what is in the news and other publications, we do have a spirited discussion. She has met some of our informal group, and she understands what we are doing. She did help one of the group (Allen) get a more balanced meal plan. Even he was surprised about how far out of balance he had been. She asked him to get a scale that he would use and for a week weigh his food and record what he was eating. Since he already had a scale that would work, he asked what we thought and we agreed that this could be an immense help for him.

The following week, she took the information, showed where he was weak nutritionally, and made suggestions to create meals that are more balanced or more balanced for the day. Not only did she give him suggestions, but showed him what the different suggestions could do for him per meal, but as well on a daily basis. He was in awe with the results and commented that he understood why the doctor had run so many tests. Then they both sat and went over the sheet she had prepared. A few adjustments were made and he said he was going to have to go to the grocery store. He also asked how to prepare some of the new vegetables that he generally did not eat. She actually listed different ways to cook some of foods and how to prepare some of them for eating raw. She then surprised even me and gave him her phone number to call when he had questions.

Yes, all of us present made some suggestions, but she kidded us that everyone likes a woman's touch – ooohhhh – ouch. We started kidding Allen about maybe not needing his supplements that the doctor had him taking. She stopped us immediately and asked which supplements. I said we needed to start at the beginning and she agreed.  Allen said he had been on Metformin for many years and one day had been asked by us if he was taking a vitamin B12 supplement or had been tested for the deficiency. He explained that his doctor would not do the test and Tim and I had gotten him to a doctor that I see where they did the tests and several others. Allen explained that he had a vitamin D shot and vitamin B12 shot that day. He explained what the progression had been to the current day.

Allen gave her the supplements he was taking per the doctor’s instructions and the dosage of each. She looked each over and said he had better ignore her suggestions for nutrition change until Allen and she had a chance to talk to his doctor. Then she asked how many of each supplement he had left and Allen stated that on some of them were just about out and he didn't know on a couple. She said that if possible, he should call the doctor's office and get an appointment as soon as possible. Allen called and received an appointment for the following Tuesday, and told the receptionist the reason. About half an hour later, the Doctor called and wanted to review the reason. Allen put the nutritionist on the phone and she explained the reason and what was transpiring. He asked if they could be in his office yet that afternoon. They decided they could, and they were off.

The following day, several more of us got together with the nutritionist and Allen was all smiles. My cousin said that was one of the best meetings with a doctor she had ever been involved in. She had grabbed a couple of books from her car before they had left and the doctor had the same books out when they were in his office. She said she had done some calculations on the way and that was what the doctor had wanted to see. Allen said the doctor was impressed that she had followed Allen's wishes and adapted a meal plan for each meal in the day and if one meal was short, the next meal compensated so that the day was balanced. Since Allen was still adjusting to insulin, the doctor was very happy that she had kept the number of carbohydrates down while still balancing the nutrition.

The doctor did agree with my cousin on holding some of the vegetables until Allen had exhausted the supplements and for them to go ahead if Allen was happy with what she had proposed. The doctor did want Allen to continue the vitamin D and vitamin B12 until the second appointment from now. Allen said his next appointment was in August and that would make the second in November and the doctor said he would order the tests for then and see where his levels were and make any adjustments then. The doctor, according to Allen, had said if he could work with the nutritionist, he should be good with the food supplying sufficient nutrients. The doctor said the tests would either confirm this or lead to more tests to determine if Allen's body was not making use of them in which case there would be a medical mystery to be solved.

Allen said the doctor had quizzed my cousin about her education and affiliation before going over the sheets that she had prepared. Allen was a little surprised that he had checked some of her calculations, but realized that the doctor had relaxed when he saw that his calculations agreed with hers. The doctor asked if she would be pushing the number of carbohydrates up later, and Allen said that he had been told only if that was his desire. My cousin said she told the doctor that she makes suggestions, but works at the ratio the patient desires and said that it would probably be five or six months in making, the transition to the ratio Allen wanted. She said that this would minimize the level of endotoxins.

Brenda, who did make this gathering, spoke up and said this sounded like what her daughter would say. Quick comparison of backgrounds revealed the same university, but members of different organizations. Neither is a member of AND and happy where they are members.

Article about Academy of Nutrition and Dietetics

Are we headed for problems in the field of nutrition? If the Academy for Nutrition and Dietetics (AND) has their way, many people with chronic diseases will be worse off than they are presently. Those of us with diabetes will need to educate ourselves completely about nutrition to avoid the poor information that will be dispensed by those licensed by the AND. AND's former name was ADA (American Dietetic Association),

Currently in several states where AND licensure has been passed by state legislatures, nutritionists of all types are being force out of business. This includes, but is not limited to nutritionists having a PhD in nutrition, but other highly trained nutritionists specializing in other fields, but give out nutritional information. Am I endorsing all types of people giving out nutritional advice? No, but those that have a degree in nutrition should not be forced out of business just because they do not want to belong to AND.

However, this is what is transpiring in many states where the AND has gotten their licensure bills passed. They consider people not part of their organization as competition and are going after them with a vengeance unlike many of us have seen before. Yes, history shows that this has happened before in the medical community between different professions, but the bitterness this time is very bad for the registered dietitians (RD) and style in which the AND is attempting to end competition.

At least now several groups are fighting the efforts of the AND and their campaign to criminalize non-RD nutrition providers. These groups include the Alliance for Natural Health, USA, the American Nutrition Association, and the Weston A. Price Foundation. These groups plus other organizations are mobilizing their memberships and constituents to oppose the AND monopoly. Even consumers will lose the choice of nutrition professionals to choose from and where they wish to receive nutrition information.

If you do not wish to have policies from the American Diabetes Association, the USDA, and other government agencies that the AND follows and advocates, then you need to pay attention and oppose the actions of AND in your state. If you did not read my previous blog on the same topic, read it here and the links in the blog. Read the link for starting this blog here.

I know from correspondence with several people I consider friends in the current AND and outside, that some of them are joining other organizations where they will be able to practice nutrition outside the AND and one is retiring to avoid the squabble. A couple of current RDs will retain their membership in AND until such time as they are able to leave.

It is a shame that so much of the then ADA (American Dietetic Association) and now Academy of Nutrition and Dietetics licensure requirements was pushed through many state legislatures so quietly. Now the battle will be to have the laws repealed or changed to prevent the monopolization of nutrition. Check the licensure requirements for you state here,

Nutrition Needed To Improve Diabetes Diet

Again, those wanting to make a name for themselves use a small study and publicize as widely as possible. This time it is in the name of nutrition. The study is faulty because there was not a control group or a blinded study. Another weakness or fault of the study was not publishing the criteria for selection of study participants. Yes, a few qualifications were mentioned, but these should not have been the only criteria in selection.

Yes, I am being very critical of most studies proclaiming this and that about what people with diabetes should be consuming. Saying that we should be eating a set number of daily servings of low glycemic index foods is not saying that the nutritional needs of an individual are being met or that this is what their body can tolerate. What irritates the worst is a one-size-fits-all mantra that everyone keeps promoting.

Low glycemic index foods can help manage blood glucose levels, but should be used as a guide only as just selecting this type of food can be nutritionally deficient and not the selection we may need for minimum nutrition goals. Yes, low glycemic index carbohydrates that are digested slowly, and are less likely to spike blood glucose levels than would carbohydrates with a high glycemic index may help blood glucose levels, but are they nutritious enough?

The article does say the participants also ate about 500 fewer daily calories and added vegetables, fruits and nuts, and seeds to their diet - all foods that are on the low end of the glycemic index. Again, no nutritional information is given nor are the combinations even discussed.

Carla Miller, associate professor of human nutrition at Ohio State University and lead author of the study stated, "I think we have enough data to say that consuming a low-glycemic-index diet has beneficial outcomes for people with diabetes." “That's a significant statement because no guidelines currently exist for consumption of low-glycemic-index foods,” she noted. “Some experts think a focus on the glycemic index in foods rather than carbohydrates and sugars is too complicated for patients with diabetes to follow. Miller doesn't think that's the case as long as patients receive adequate nutrition education - which was another finding of hers in a study published in 2009.”

What I find amusing is they talk a good line and have good ideas, yet they will not publish this nutritional information online for people to educate themselves. This would not put any money in their pockets like a study. They give us findings that we can be led to believe that good nutrition was taught and people were allowed to make variations in the diet to fit what their meter told them. I doubt this was allowed or even considered. The mantra was low glycemic index level foods and only this.  They also do not mention whether the nutritional level of the food participants were asked to consume were monitored. Yes, at the start of the study, all 35 participants completed a baseline assessment and participated in a five-week group nutrition intervention. No mention is made about the extent or type of nutrition information given, but I can imagine the bulk was about the glycemic index and very little else.

Another disturbing fact missing is that to be eligible, the participants had to have a hemoglobin A1c value of 7 percent or higher; however, I can find no evidence that of a comparative A1c at the completion of the trial. This is disturbing on so many levels. Did they require people with high level A1c's at the beginning to make sure that they would be less likely to complain about their high or higher A1c's at the end of the trial?

Six Ways to Help Manage Type 2 Diabetes – P6

Error 6 - Making Poor Food Choices

When it comes to food, excellent diabetes management is a must. Learn to maintain logs of what you eat, when you eat, and the blood glucose levels before and after eating, especially within the first few months. Be aware of the problem of going off an eating plan. It is the long term unhealthy eating habits that need to be broken and replaced with healthy eating habits. This can take time, but steady progress needs to be a priority.

Carbohydrates become the requirement and you meter needs to be your friend while learning what foods you need to eliminate, reduce in quantity, or that are okay to eat. Since each person can handle different foods, you should talk to your doctor about classes or at least a meeting with a dietitian for guidance and directions for healthy eating. Forget about what you think is healthy eating, it may be more harmful that you imagine.

Learn to read nutrition labels. This will help you calculate the proper amounts of the foods you choose to eat and may provide you with clues as to why you are having problems with your blood glucose levels. This may be more important that you realize now, but eating at a regular time and intervals will assist you in better management of your blood glucose levels.

Do not skip meals as this is the downfall of many people with diabetes. Often you will think that because you skipped a meal, you have a built in deficit of carbohydrates – wrong! The skipped meal does not calculate into allowing for extra carbs later in the day – your liver has taken care of the blood glucose deficit, but adding blood glucose to your system to compensate for the skipped meal. Whether you like it or not, the skipped meal has gained you no carb allowances.

If you doubt me, use your meter to help you see what is happening. Depending on your medication, you may be also creating hypoglycemia and have a blood glucose low which can be dangerous. Skipping medications because you are skipping a meal is also dangerous. This is another reason to learn all you can about the medications you are taking. This can point out the problems, side-effects, and dangers of missing a dose. Plus this may also point out the dangers of not eating or skipping a meal.

Some medications are meant to operate for a set period of time in your body while others have a longer period of operation. All of this means that skipped meals can affect the medications and do more harm that you are expecting. Some combinations of medications create even more troubling complications if you skip meals.

This is why, even though I have blogged about these points separately, they are all interlinked and can be very much part of the integral plan of diabetes management. It is important to remember this and review these on a regular basis. Remember diabetes itself does not cause the complication – it is the lack of diabetes management that does the damage.  If you need to reread the article - it is here.