Thread by @ahhite

Okay, there's a bit of confusion about this out there in Twitterland:

Just as @JesseLunsford points out in this thread, there is no mandate for RDs to "follow" official USDA/HHS dietary guidelines when they counsel patients.

However, that's not the whole picture. 1/

https://twitter.com/jdolphin2572/status/1243195119911788548

First, I don't think we can completely ignore this incident, from around 2008-2009: nmsociety.org/2018/02/18/ann…

There have been other situations that are compared to Ms. Presley's, but they have involved other factors (unproven supplements, etc.) not just dietary information. 2/

Then there's this, from the Academy of Nutrition & Dietetics, an RDs professional organization (eatrightpro.org/media/meet-our…): 3/

In other words, although RDs can & should individualize diets for clients, a "normal" healthy diet is "fruits, vegetables, whole grains and low-fat protein and dairy." This "Healthful Eating Message" aligns nicely with the DGA. 4/

I should add that, as far as I know, there's no "therapeutic carbohydrate restriction" curriculum being taught to dietetics students in MNT anywhere in the US. I would love to learn otherwise. So one reason RDs are opposed to low-carb diets is they don't know how to use them. 5/

Also, and perhaps most importantly, there is "dietitian culture." I don't know if Mr. Lunsford is more shielded from this, as a male, but as an overwhelming white female world, RD-land typically runs according to some very powerful white female communication norms. 6/

One of these norms is that "to disagree is to be disagreeable." Conformity, "fitting in," and following the rules are prized characteristics of a "good soldier" dietitian. Here's a couple of stories from the trenches. 7/

One dietitian who had been in my program a few years ahead of me, was part of the ill-fated "Nutrition Evidence Library" (which was supposed to support the DGA with "evidence" but really only lasted one round, the 2010 DGA). She was given a question to "research" for the NEL. 8/

Which she did. When she came back with results & they weren't the "right" ones (i.e. ones that would support DGA guidance as it has been since its inception in 1980), she was sent back to "try again." After a few rounds of this, she was removed from research activities. 9/

Another dietitian attended a "policy workshop" sponsored by the AND. Everyone was supposed to do essentially the same task as my colleague whose story I told above: look at the evidence and come up with recommendations for the general public based on them. 10/

This dietitian said discussion of evidence that conflicted with DGA guidance was squelched, and she said it was clear to her that there was a "right" answer that they were supposed to arrive at. Let me add that this was a senior dietitian, "mainstream" in every way. 11/

Still, it disturbed her deeply.

I could go on about my own experiences (getting a D on a "personal essay" that suggested that maybe the original DGAs weren't supported by science - a claim acknowledged by the authors of the 1980 edition & reiterated by Walter Willett.) 12/

Within RD culture, conformity is highly valued. And that includes conformity of thinking when it comes to "what 'the science' says" about what a "healthy" diet is. 13/

However - and this part is important - neither the DGA nor the resistance of many dietitians to low-carb diets is about science.

What we are talking about rather are values, specifically the values of white, upper middle class professionals. 14/

These are values that assert that we can all control our "fate" by exerting self-control & making "prudent" choices. Regarding food, this means we can control our health outcomes - and our bodies - by "eating right."

And, until we're told otherwise, "eating right" = DGA. 15/

These are values that assert that a slender, healthy body indicates good citizenship, someone who isn't going to force others to "pay" for her "bad" choices through increased health care costs. 16/

These are values that assert a dietary noblesse oblige. How many dietitians out there went into the profession to "help" other people learn to "eat right"?

(As an aside: how many dietitians went into the profession as a way of naturalizing their own disordered eating?) 17/

Well, this has turned into a bit of rant. I'll stop & close with this: Although it is inaccurate to say that RDs are compelled to follow the DGA, ... 18/

... there are some powerful reasons, which have *nothing* to do with science, that so many of them are resistant to using carb-restriction to treat clients when appropriate. 19/done