What do Dietitians ACTUALLY recommend?

What has become apparent to me with the discussions around the Low Carb High Fat (LCHF) diet is that there is a lot of confusion about what dietitians are actually recommending.  Assumptions are being made and we know that they will ultimately get us nowhere. 

Dietitians calculate individualised meal plans by working out total energy requirement and then select a macronutrient split that is appropriate for the patient. Macronutrients include carbohydrates, fats and proteins.  Macronutrient splits will vary depending on nutritional status and medical conditions.

 A fact sheet developed by the Nutrition Society of South Africa stated the following: “Single “best values” for population level recommendations for healthy eating are seldom appropriate.  It is for this reason that recommendations across countries specify “safe ranges” for macronutrient contributions to total energy intake.

For carbohydrates the range varies between 40 to 75%, for protein between 10 to 35% and for fat between 20 to 35%. As both quantity (% contribution to total energy intake) and quality (type and nature) of macronutrients are of importance, guidance on the quality aspects of carbohydrates and fats are also included in most recommendations”.

The position paper “Dietary Fatty Acids for Healthy Adults” has been published in the January 2014 issue of the Journal of the Academy of Nutrition and Dietetics. This position paper confirms that “healthy adults should consume between 20-35 % of their calories from dietary fat”.

If the percentage of fat is above 30% total energy the diet would be considered a high fat diet.  In our practice we mostly use 35-40% fat, 40-45% carbohydrates and 20% protein for weight loss.  Therefore as you can clearly see, when we (dietitians) get accused of prescribing high carb, low fat diets to people it is hugely frustrating as this could not be further from the truth. As for the comments on dietitians using the food pyramid – I have personally not used the food pyramid ever as a dietitian and have been consulting for 10 years now.

We are yet to hear from Prof. Noakes what the macronutrient split of the LCHF diet is; there is no clear cut guide. It is instead based on general recommendations.  At the talk we attended on Tuesday, Prof Tim Noakes stated that he recommends a diet made up of 80% fat (saturated fat) and 25g of carbohydrates. When calculated this would provide a diet that is 80% fat, 10% carbs and 10% protein.

These macronutrient ranges are extreme and are not within safe ranges mentioned above. I would like to see a referenced research article from an International peer reviewed journal that endorses this type of macronutrient split, before Prof. Tim Noakes continues to make unsubstantiated recommendations to the South African public.

References

  1. 1.        Vannice, G., Calif, S. and Rasmussen, H.  2014. Position paper of the Academy of Nutrition and Dietetics: Amount and types of fat we ear affect health and risk of disease. Journal of the Academy of Nutrition and Dietetics.
  2. Senekal, M., Naude, C. and Wentzel-Viljoen, E.  2013.  Fact sheet; Dietary recommendation for health.  Nutrition Society of South Africa.Image

11 thoughts on “What do Dietitians ACTUALLY recommend?

  1. Thank you for your very appropriate blog post on this controversial issue. I am a private practicing dietician in Cape Town and am faced daily with a barrage of questions from a very confused public (patients, friends and family) with regards to the LCHF diet, some have tried and failed, and others have pondered over following it but are put off by the extremity of the guidelines. How low carb is low carb? There is no doubt that the modern day diet is way too high in carbohydrate (especially refined, processed starches as well as sugar, sugary foods and drinks) – and this is not what dietician’s are advocating at all. In my experience of helping people with weight loss, I generally end up reducing (but not eliminating) a large amount of carbohydrate they eat and it still works out to be at least 45% of their total energy. Most of my patients are relieved to know that they can still eat carbohydrates and loose weight – the key being to understand how much, what type and when to eat carbohydrates. It is really not complicated at all! Cutting out carbs is NOT simple, it is in fact complicated, unhealthy, boring, extreme and most importantly unnecessary.

  2. I would like to know – I have been to many Dieticians (I have PCOS) – if what you are doing is the “right way” then why are people getting fatter and more insulin resistant and more infertile by the second? Dietetics certainly did not work for me and I am pretty sure it never will.

  3. Thank you for your feedback Catherine! It is of course important to consider the individualised nature of any diet and respect the fact that each person can benefit from a unique approach. One size does not fit all and we must be critical of any “magic solution” that oversimplifies a complex problem. We are hopeful that this blog series will help to clarify some of these issues for the general public and so appreciate input from Dietitians, such as yourself, as well as other health professionals too. Please do keep the comments coming!

    1. If you think that each case is unique and individual and one size does not fit all, is there ever a scenario that you would recommend an approx 70% fat 20% protein 10% carb approach?

  4. Thank you Nutritional Solutions for this series on this very controversial topic. It is clear that some people think we give one set of advice to all people and that we rely on outdated recommendations.
    There are many fields in our profession and it is ever evolving, but we as Dietitians make sure we stay up to date with the latest in our fields. Some people do not respond well to certian meal plans. Is Dietetics the only thing to blame? No! Consider that there are other factors too that play a role.
    I believe that the heart of every Dietitian is to help his or her patient/client to live a as normal as possible life with their condition. Would severe restrictions of certian food groups really be helping people to live a happier life?

    1. I can honestly say that cutting out starchy carbs (grain, rice etc) and sugar has made my life infinitely better and happier. (I started so in 2005) My n=1 but that is all that really matters, isn’t it? If you can’t see yourself ever being able to cut out these food groups (as I certainly once also thought) you probably are addicted to them (not your fault by the way, it’s the way the brain is, that’s all) Before you knock it, seriously, give it a try.

  5. Millions of people for millions of years ate what was essentially a low carb diet.
    They did fine on it – no cancer, diabetes, high blood pressure, M.S., etc.
    Modern foods (wheat, rice, sugar, vegetable oils, hybridized fruits) aren’t our natural foods.
    It’s not just the quantity of carbs that matter, it’s the source of the carbs.
    Prof Tim’s recommendations are actually more against modern foods than high fat for the sake of it.
    How about making a stand against margarine instead of attacking LCHF?

    1. esspressodrinker, me thinks the fact that the dietician field is beholden financially to “Big Food” answers the question as to why they fail to make a stand against food such as margarine. The SA Heart Foundation’s main sponsor is of course quite ironically the Willowton Group, manufacturers of cooking oils, margarines and baking products. They very food-like substances humans have not evolved to consume. I’m thinking the RD’s and the Heart Foundations are not inclined to want to bite the hand that feeds them. There were plenty of doctors and governments that advised that tobacco would not primarily lead to lung cancer. That smoking in “moderation” was the secret and that “moderate” use was alright. The similarities between “Big Tobacco” and “Big Food” is astounding. I think time will vindicate the HFLC thinkers to the embarrassment of the current Dietician industry. Humans evolved in the wild. Be it the plains of Africa or Asia, the jungles, the coastlines, whatever. Just think about it. Put yourself into any of these environments and try to imagine what it would be that you could eat. Whatever is on that list, THAT is what you should be eating. What would that be? Animals and plants. THAT is what you could eat. Margarines? No. Bread and grains? No. Big, giant over agricultured fruits we see in grocery stores? No. Sugar? No. Count calories? No. It’s really actually SO SIMPLE. Just sit and think about it. And tell me RD’s… what is soooo dangerous about cutting out carbohydrates (a whole food group, as you put it)? I’m just interested to know what carbohydrates give me that the other food groups can’t. I can’t think of anything…

      1. Dieticians are most certainly not beholden to Big Food companies. As medical professionals, Registered Dieticians are “beholden” to translate scientific information about evidence-based nutrition and food into practical dietary advice, they are registered with the Health Professions Council of South Africa and by law need to keep up to date on the latest nutritional information in order to be able to withhold their professions. The core of the Dietetics profession is to give advice on how to achieve optimal health and to prevent chronic diseases of the lifestyle through balanced nutrition. Balanced nutrition in dietary terms refers to obtaining many health promoting nutrients from a variety of food groups, of which whole grain carbohydrates are merely one. The reason for promoting this particular group have nothing to do with any type of sponsorship – rather as a result of keeping up to date to the latest scientific evidence from internationally renowned and highly revered institutions like, for example, Harvard School of Public Health. If you are interested in learning more about how carbohydrates may benefit your health, click on the link for a great explanation on the health benefits of wholegrain carbohydrates – http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/health-gains-from-whole-grains/

  6. Eish………………where to begin?
    The problem with articles like the Harvard one you cite is that they are presented as learned fact, whereas they are actually speculation dressed up in a white lab coat.
    To quote:
    “For millennia, the grains humans ate came straight from the stalk. ”
    And before these Millennia, what did we eat????
    So for perhaps several dozen generations we ate wheat.
    Not enough to justify eating it in my book.
    The rest of the article just blabs on about the benefit of whole grains as opposed to refined grains, never addressing the main problem – Should we be eating grains anyway?
    The article also cites the “Nurses’ Health Studies” , but then stated:
    “swapping whole grains for white rice could help lower diabetes risk: ”
    So what are they saying rice or grains?

    The same Harvard group have recently published a study showing that “Red meat increases death, cancer and heart risk”.
    http://www.nytimes.com/2012/03/13/health/research/red-meat-linked-to-cancer-and-heart-disease.html?src=me&ref=general
    The only problem is if one bothers to dig into the figures a bit. the study is rubbish.
    http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/
    The studies are flawed and the results are irrelevant.
    Epidemiology is STRUGGLING to find any answers, and actually may not be able to give us answers.

    http://geography.ssc.uwo.ca/faculty/baxter/readings/Taubes_limits_epidemiology_Science_1995.pdf
    and
    http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?pagewanted=all&_r=0

    If the science is so shaky, why not defer to nature?
    Millions of our ancestors ate in a very well documented way for millions of years.
    Try it, you may like it!
    What medical practitioners and dietitians have to realise is that the internet has made all these studies available to the layman and we can read the literature and decide for ourselves.

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