Opinion on misinformation in the nutritional profession

A place to get your questions answered from McDougall staff dietitian, Jeff Novick, MS, RDN.

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Opinion on misinformation in the nutritional profession

Postby nine9s » Thu Mar 13, 2008 7:42 am

Jeff,

I often wonder about something I experienced a few years ago. My employer sponsored a “health” seminar where a registered nutritional dietician, with a master’s degree, talked. During the talk she answered two questions of mine and the answers seemed to be wrong on what I would think is very basic knowledge in your field. I wonder if you agree that it was a case of incompetence and I wonder if you see this lack of knowledge often entertained by some in your field (while not to the extreme sited below, I often see similar missinformation in print, etc.) And if you do see that it is common, do you see any particular cause for it?

The two topics/questions:

During one point of her seminar, she said fruit had no protein. I raised my hand to ask if she meant it had low protein or if she actually meant none. She said, “none, fruit has no protein.” After the seminar I researched fruit nutritional information and found that while some fruit, such as apple, is very low, that others have over 10% of their calories as protein and that an assortment of commonly eaten fruit balances out to about 8% of their calories being protein (which is more than human milk has) and certainly is not “none.”

Then later she said vegetables have not fat. Again I raised my hand to ask if she meant low fat (which is not even the case as many vegetables have 10% to 15% range) or no fat. She said, “no fat, vegetables have no fat.” At that time I did not have the knowledge to quote the fat percentage of different vegetables, so I offered as a rebuttal, “how do you get vegetable oils then.” She said something along the lines, well there is a very scant amount of fat but it takes huge quantities of vegetables to get oils, so for single servings of vegetables, there is no fat.
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Re: Opinion on misinformation in the nutritional profession

Postby JeffN » Thu Mar 13, 2008 9:10 am

nine9s wrote:Jeff,

I often wonder about something I experienced a few years ago. My employer sponsored a “health” seminar where a registered nutritional dietician, with a master’s degree, talked. During the talk she answered two questions of mine and the answers seemed to be wrong on what I would think is very basic knowledge in your field. I wonder if you agree that it was a case of incompetence and I wonder if you see this lack of knowledge often entertained by some in your field (while not to the extreme sited below, I often see similar missinformation in print, etc.) And if you do see that it is common, do you see any particular cause for it?

The two topics/questions:

During one point of her seminar, she said fruit had no protein. I raised my hand to ask if she meant it had low protein or if she actually meant none. She said, “none, fruit has no protein.” After the seminar I researched fruit nutritional information and found that while some fruit, such as apple, is very low, that others have over 10% of their calories as protein and that an assortment of commonly eaten fruit balances out to about 8% of their calories being protein (which is more than human milk has) and certainly is not “none.”

Then later she said vegetables have not fat. Again I raised my hand to ask if she meant low fat (which is not even the case as many vegetables have 10% to 15% range) or no fat. She said, “no fat, vegetables have no fat.” At that time I did not have the knowledge to quote the fat percentage of different vegetables, so I offered as a rebuttal, “how do you get vegetable oils then.” She said something along the lines, well there is a very scant amount of fat but it takes huge quantities of vegetables to get oils, so for single servings of vegetables, there is no fat.


You ask a great question and one that only has a very sad answer.

One of my greatest sources of fustration is the competency level of those who are professionals in my field.

Don't get me wrong, there are many many incredibly talented, smart and cutting edge dietitians and nutritionists. Unfortunately, they are the exception.

Part of the reason, I think this is so, is due to the heavy influence and connections the profession has with the food industry. Even the ADA has strong ties to the food industry and often steps back from taking a stand on issues that may compromise those relationships. There was a recent example of this with sodium content in foods. These food companies advertise in our professional journal, the JADA, which would be unacceptable in any mainstream medical journal.

In addition, the education to become an RD is standardized in the USA (and some other countries) as the education is designed by the ADA and developed to help you learn certain basic and fundamentals that they want you to know. In addition, to receive the RD certification, everyone takes the same/similar test and the education is geared to learning the material to pass the test.

One other issue, is that for most health care professions, a Masters is the minimum acceptable degree and for many a PhD or primary care doctor degree is needed. Not so with RDs. You can get a Bachelors Degree and become an RD. I personally think that all RDs should be required to have a Masters Degree that includes a thesis.

And, lets remember, not everyone goes into a field to be a cutting edge expert. Some go just to get a job or to do something they think is easy and/or fun.

To pass the RD test I had to answer several questions with answers I knew were wrong, but were what they were expecting me to answer to get it right.

Recently, I was invited to be the Keynote speaker at the Florida International University Educational Lecture Series. They also invited the head of the dietetics department at the university and several of the Professors, who were also RDs from the department to debate me after my talk.

When my talk was over the 3 of them said they had nothing to say and nothing to argue with. :)

Then came the questions from the answer and of course, the question of dairy came up. I gave my response as outlined in a thread here. The head of the Department literally grabbed the microphone from me to defend dairy and basically give a 10 minute commercial for dairy. When she was done, she even said, "and I know even Jeff will agree with me that milk is a healthy food and everyone should drink at least 2-3 glasses a day". To which I stood up from the dais, folded my arms across my chest and shook my head back and forth several times and the whole audience laughed. :)

Now, the real irony? She was very overweight, and was of the background of a culture that typically does not digest diary products well. In addition, FIU is a real melting pot of culture so many many in the audience could not digest dairy. And, they even came up to me afterwards and commented on how much they disagreed with the Dept Chair and agreed with me.

I am on 3 professional RD listserves that discuss nutrition regularly and are very active. The amount of misinformation that goes on is very upsetting and disturbing to me. The RDs are as misinformed as anyone and are as likely to buy into whatever food scam/fad comes along. As I always tell them, if this is what the professionals think, no wonder the country is in such trouble. They consider me a radical and a heretic.

However, if we step back and take a bigger picture look at all professions today, is it not the same? How many really good professionals in any profession are there? Maybe 1-5%?

The reason the RD gave the answers they did is because that is the generic info that is taught in relation to the Food Groups. Each food group is assigned an average value for protein, carb and fat, to make analyzing a diet easy. It is a general tool for estimates and not a precise way to analyze food or diets

Using this system, the average value of protein assigned per serving of fruit is 0, and the average value of fat assigned per serving of vegetable is also 0, which ar not 100% accurate.

You can see a sample of the generic meal planning exchange list here and where they get the misinfo from

http://www.indiacurry.com/diabetes/diabetesexchange.htm

The 0s for protein in fruit and 0s for fat in vegetables were from rounding down the averages, which per serving were low.

In Health
Jeff Novick, MS, RD
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Re: Opinion on misinformation in the nutritional profession

Postby JeffN » Thu Mar 13, 2008 9:21 am

nine9s wrote:Then later she said vegetables have not fat. Again I raised my hand to ask if she meant low fat (which is not even the case as many vegetables have 10% to 15% range) or no fat. She said, “no fat, vegetables have no fat.” At that time I did not have the knowledge to quote the fat percentage of different vegetables, so I offered as a rebuttal, “how do you get vegetable oils then.” She said something along the lines, well there is a very scant amount of fat but it takes huge quantities of vegetables to get oils, so for single servings of vegetables, there is no fat.


In one of my talks, I always say that vegetables do have fat and can be a good source of polyunsaturated fats, and the essential fats yet so many people are always shocked to hear this. They say, "I didn't know vegetables had fat!". To which I say, "Where do we get corn oil or "vegetable" oil from? Walnuts? :)

Wow, now I can add in that even my colleagues don't know this.

Thanks :)

In Health
Jeff Novick, MS, RD

PS one more story. I was invited by WVU to help educate their staff and health professionals over a period of 2 years with some ongoing lecture series. One time, I did a 3 day weekend lecture series that was only for the health professional schools (MDs, DDS, RNs, etc). The talks were well received by all the MDs and doctors and nurses, and eventually they incorporated a unviersity wide healthy living program.

However, on the third day of this weekend, towards one of the ends of my talks, someone stood up and raised their hand vigorously. I called on them and they said that they thought i was really misrepresenting nutrition and giving people misleading information about food and nutrients. What I was saying was not true and I was twisting everything.

I said all my info comes straight from the NAS, WHO, USDA and all the leading medical/science journals.

Who was she? One of the only RD's there and the RD that ran the outpatient Ornish program in town.

Oy Vey!

:)
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Postby nomikins » Thu Mar 13, 2008 10:37 am

>>>Who was she? One of the only RD's there and the RD that ran the outpatient Ornish program in town. <<<


:eek:

ROTFLMAO!

I have to fight the fight of "where do you get your protein?" all the time. My answer: The same place as the cows and chickens. Plants and grains (and lots of potatoes).

:-D
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Postby fiddler3 » Thu Mar 13, 2008 1:41 pm

Gee, Jeff, are they going to let you back into the state of Florida? lolol

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Re: Opinion on misinformation in the nutritional profession

Postby nine9s » Thu Mar 13, 2008 2:32 pm

JeffN wrote:However, if we step back and take a bigger picture look at all professions today, is it not the same? How many really good professionals in any profession are there? Maybe 1-5%?

The reason the RD gave the answers they did is because that is the generic info that is taught in relation to the Food Groups. Each food group is assigned an average value for protein, carb and fat, to make analyzing a diet easy. It is a general tool for estimates and not a precise way to analyze food or diets

Using this system, the average value of protein assigned per serving of fruit is 0, and the average value of fat assigned per serving of vegetable is also 0, which ar not 100% accurate.

You can see a sample of the generic meal planning exchange list here and where they get the misinfo from

http://www.indiacurry.com/diabetes/diabetesexchange.htm

The 0s for protein in fruit and 0s for fat in vegetables were from rounding down the averages, which per serving were low.

In Health
Jeff Novick, MS, RD


Those are all good point on the “cause.” I often take it for granted that I look at stuff in detail and do not feel comfortable until I understand something versus just accepting summaries/buzz words, etc. But that stance is the minority, as you wrote in all professions. I think most people, even trained dieticians as you showed in examples, do not really understand what percentage of something’s calories mean. I am often telling people, as the subject comes up, that many vegetables, for example greens, are about 10% fat. They look at me as if I am alien, and not because I am stating vegetables have fat but because I say 10% of their calories are fat – most have no idea what I mean by that. Many think I mean 10% of your “daily” fat needs are in the greens. When I see the puzzled looks, I simply say of the calories you get from greens, 10% of those calories are fat. They still give me the “alien” looks. I guess it goes back to basic math, many just have trouble with conceptualizing what fractions and percentages really mean.
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Postby JeffN » Thu Mar 13, 2008 4:17 pm

When I went back to school to do my graduate studies, I would do some tutoring for extra $$. I used to tutor organic and biochemistry. We would go over the formulas and the person would say, "i dont get how to do that". So, we would review it and then go over the formula again ,to which, they would make the same comment. So, I would say, what part don't you exactly get? And they would say, the math. I dont get how to do the math (multiplication, division and fractions).

These were undergraduate upperclassman and graduate students.

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Postby karin_kiwi » Thu Mar 13, 2008 6:07 pm

I sympathise, Jeff. My mother went back to get a degree in human nutrition (she's followed McDougall-type principles for over a decade) and it nearly killed her. The programs and teaching staff are funded by meat, dairy and food technology industries here in New Zealand, as I guess they are in most places. A few of the staff were willing to let her write about "alternative" diets as long as she referenced things correctly and to the nth degree, but many more absolutely refused to accept her essays or answers, regardless of how much core scientific/biological theory she used, articles from top peer-reviewed journals she cited, statistics from epidemiological data she sourced and so on. Having to choose between writing garbage she knew was wrong to get decent grades or writing the truth to get barely passing grades caused her severe emotional stress that took years to get over. The refusal to look at the evidence was such a betrayal, by the very people who set themselves up as experts on human health as it related to nutrition. It's one thing to be ignorant if one has not seen evidence, it's quite another to be willfully ignorant in the face of the evidence.
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Postby serenity » Thu Mar 13, 2008 8:40 pm

karin_kiwi wrote:I sympathise, Jeff. My mother went back to get a degree in human nutrition (she's followed McDougall-type principles for over a decade) and it nearly killed her. The programs and teaching staff are funded by meat, dairy and food technology industries here in New Zealand, as I guess they are in most places. A few of the staff were willing to let her write about "alternative" diets as long as she referenced things correctly and to the nth degree, but many more absolutely refused to accept her essays or answers, regardless of how much core scientific/biological theory she used, articles from top peer-reviewed journals she cited, statistics from epidemiological data she sourced and so on. Having to choose between writing garbage she knew was wrong to get decent grades or writing the truth to get barely passing grades caused her severe emotional stress that took years to get over. The refusal to look at the evidence was such a betrayal, by the very people who set themselves up as experts on human health as it related to nutrition. It's one thing to be ignorant if one has not seen evidence, it's quite another to be willfully ignorant in the face of the evidence.


Oh, I empathize. At one time, I considered changing professions and was accepted into a Masters program for nutrition. I only lasted 2 semesters. While there were several reasons that I chose not to pursue it, one major one was that my personality type is not compatible with what I would have had to put up with. It was just so wrong.
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University courses/state exams - A HORROR!

Postby Worfie500 » Fri Mar 14, 2008 2:10 am

Child nutrition and rearing was the "to the death" "NO!" arguments with the professor of pediatrics while I was at SFSU's Nursing Department in the 80's. The courses back then were still mainly "all women" and a lot of these women had chldren - and many vegetarians - and lactose intolerant african american and asian american women. ACH! I used to sit there and think what she had to say was a bunch of crap, but regardless of it, she said you want to get your license? These are the answers to the exam. It made me - and not just me - crazy. If a client were to ask me about nutritional choices - cow milk - for a growing child, I'm to tell them "sure, cow milk, especially the full fat type because a growning child needs the extra calories is the way to go" is what I should answer??? My brother's soon to be19y.o. son almost died at the beach when he was 4 from DMI, his mom for what ever reason stopped breast feeding real early and gave him formula. His BS was in the thousands and he was in a coma for five days. Even after the "event" the information from the dietician IMO wasn't the best, kept telling them to give him milk, more animal based products.

Human nutrition is such a hot and "emotional" topic - wait till you see what is served in a hospital! I really don't believe the RD really approves of the stuff, but is forced to try and design "whatever" with the garbage that comes in from the contracted firms. ´

I'm off ranting again, but even over 20 years later I still think about what I had to learn to "pass the test".
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Postby Yoga Nurse » Fri Mar 14, 2008 12:08 pm

Oh, hospital food- don't get me going- my husband who does CT in a local hospital accuses dietary of trying to drum up business with all the fat, salt and other bad stuff they serve the patients!

What really makes me crazy is that it's always recommended when someone is a vegetarian that they'll be okay if they get special dietary advice from a dietician. From what I've read here that may be the worst thing they can do. How sad.
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Postby kriscos » Fri Mar 14, 2008 3:12 pm

Wow! Thanks for all of the great insight and advice regarding higher education! I've been exploring going back to school in many of the areas you all wrote about, but maybe not! I will just continue my outstanding education here on the discussion boards. Thanks everyone!
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Postby Quiet Heather » Fri Mar 14, 2008 3:21 pm

I've wanted to pursue becoming an RD for many years, and the one thing that's held me back is knowing that I would disagree with much of what is taught on nutrition. Recently, however, I've come to the conclusion that America needs more RDs who actually know what they're talking about, and sitting through a few years worth of "garbage in, garbage out" is a small price to pay to become one of the few good RDs out there. It might take me five or more years to complete my degree since I have to work full time and take care of my three kids, but I'm going to do it. :D
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Postby JeffN » Sat Mar 15, 2008 8:44 am

Quiet Heather wrote:I've wanted to pursue becoming an RD for many years, and the one thing that's held me back is knowing that I would disagree with much of what is taught on nutrition. Recently, however, I've come to the conclusion that America needs more RDs who actually know what they're talking about, and sitting through a few years worth of "garbage in, garbage out" is a small price to pay to become one of the few good RDs out there. It might take me five or more years to complete my degree since I have to work full time and take care of my three kids, but I'm going to do it. :D


Congratulations!! I could not have said it better and it was the same thinking behind the same choice I eventually made.

In spite of everything I said about all the negatives and some of my colleagues, the truth is, it is one of the BEST decisions I ever made. Putting up with a few controversies over the few years of the programs were well worth it as it has helped me and allowed me to do what I have done over the last 10 years and also to get to where I am today and do what I do today.

In addition, I was able to impact the programs and the professors that I worked with over the years. It is a two way street. And, I was able to impact the local medical school and the Family Practice center and Hospital in town. None of that would have ever happened if I didn't go back to school to become an RD

Besides, I do not know of any profession, whether it be teaching, economic, business, accounting, etc where anyone is going to agree 100% with everything they are taught during their formal education.

In addition, there are many great RDs out there. A small percent of the total, but none the less, many. And, I think one of the best ways to help make a change is by getting involved, especially from the inside out, with some of these organizations.

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Postby Quiet Heather » Sun Mar 16, 2008 4:57 am

Jeff, thanks for the encouragement! Your story is inspiring. Changing the system from the inside is exactly what I'd like to do. Plus, having some initials behind my name might make some people I know take what I say a little more seriously. :-)
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