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The Whole Food Dietitian, a.k.a Dr Caryn Zinn, brings forth several inaccuracies within the LCHF section of a recent article in the NZ Nursing Review, titled “Fad Diets: What do dietitians say about the latest crop?”

What a shame that these types of articles are written and published. Nurses have contact with many patients / clients who really need help with their health, and could therefore be key personnel to spread good messages. Needless to say that this article does NOT represent the view of all dietitians. As a dietitian, it is embarrassing for me to read this purely because of the multitude of inaccuracies that are laced throughout the article.

Some KEY inaccuracies just within the LCHF section:

1. ARTICLE POINT:
LCHF is not suitable for people with type 1 diabetes or type 2 diabetes on medication (other than Metformin) because of the risk of hypoglycaemia or ketoacidosis.

1. CZ DIETITIAN POINT:
On the contrary, LCHF is most suitable for people with diabetes. Hypoglycaemia is usually prevented with LCHF – if you don’t go up, you don’t tend to come crashing down! Or is this just too logical? As for ketoacidosis, again in the context of well-controlled low carb, this doesn’t actually eventuate.

2. ARTICLE POINT:
Some people only hear part of the message and see it as a licence to eat high levels of saturated fats, such as butter and fatty meats, without changing other aspects of their diet

2. CZ DIETITIAN POINT:
People only hear half the message in the mainstream nutrition world anyway. People need to take responsibility. If the LCHF message was actually communicated to the world properly (as we’re trying to do) you wouldn’t have this problem.

3. ARTICLE POINT:
A high saturated fat intake results in a higher cardiovascular risk; the reduction in saturated fat intake in the past 50 years has been an important factor in reducing heart disease rates.

3. CZ DIETITIAN POINT:
No need to re-hash here – read the literature people!

4. ARTICLE POINT:
A blanket restriction on all carbohydrates is too restrictive and unnecessary.

4. CZ DIETITIAN POINT:
No-one says it’s a blanket restriction on all carbohydrates – that is an incorrect understanding of this way of eating.

5. ARTICLE POINT:
Some highly nutritious foods that contain carbohydrates – like whole grains, legumes and vegetables – have been shown to protect against heart disease.

5. CZ DIETITIAN POINT:
And who exactly is disputing this? Totally agree, however the wholegrain story is more complex than just the beneficial fibre and B vitamin story that they provide. The excessive carb load, the rising gut-related problems, the level of processing, plus the fact that what we have in our supermarkets are not true wholegrains is somewhat stacked against them

6. ARTICLE POINT:
The restrictive nature of this diet means it may be unsustainable in the long term.

6. CZ DIETITIAN POINT:
Says who? Not the literature. How different is this from the restrictive nature of the mainstream “low fat” guideline? In any way of eating there will be some element of restriction, like sugar and junk foods for example. Methinks the pot is calling the kettle black!

7. ARTICLE POINT:
Some versions suggest taking a multivitamin supplement, suggesting the restricted diet was not providing all the necessary vitamins and minerals

7. CZ DIETITIAN POINT:
With extreme keto perhaps supplementation is warranted, but this is still a very unfair statement for several reasons. When you look at mainstream nutrition, when you restrict calories, you could argue (on the RDI argument) that nutrients aren’t met either and supplementation is required. Of course this doesn’t take into consideration the fact that LCHF eating greatly increases the bio-availability of nutrients from foods.

I could go on, but won’t for want of destroying my keyboard from “angry typing” – needless to say, Nursing Review will be getting a rebuttal from us…stand by!

*****

If you missed the article, you can read it in full here: http://www.nursingreview.co.nz/assets/Issues/June-2015/Nursing-Review-June-2015-Fad-Diets.pdf

Join the discussion 2 Comments

  • Avatar Rachael Wilson says:

    Hello,
    Whilst I am an enthusiast of the LCHF way of life and recommend it a lot for my patients I tend to disagree with your first comment on this post. I am a diabetes specialist dietitian with 10 years of experience specialising in diabetes and to indicate that a LCHF way of life is very suitable for people with diabetes is very dangerous.

    For people who treat their diabetes with insulin or other insulin secretagogue medications having a low carb diet could be very dangerous. It’s not to say that it’s impossible to follow a low carb diet but it requires careful planning with your diabetes care provider. These medications and insulins are required to deal with endogenous glucose release and often the types of insulin available in New Zealand are too powerful and you need to balance a significant amount of carbohydrate with them to prevent hypoglycaemia. If someone is really keen on looking at a low carb diet they should talk to their diabetes team. If someone has type one diabetes an insulin pump designed to meet your basal insulin requirements may be a useful tool in helping someone to do this.

    • What The Fat? What The Fat? says:

      Hi there – thanks for your response, glad to hear you’re an LCHF enthusiast. You are definitely correct in saying that careful thought in working with people with diabetes is required. Unbalanced regimes will be dangerous. If you remove carbs without considering the meds, this is certainly a recipe for disaster. Perhaps I would agree that it might be dangerous if it was not undertaken by a motivated individual, good monitoring of both blood glucose and ketones, along with the support of a forward thinking diabetes management team. If this is all in place, then I would say that LCHF for this population group would be the preferred course of management all round. All robust RCT research on diabetes patients comparing LCHF (even keto) with mainstream has shown outstanding results, and so has practice in this area – again most probably motivated people and comprehensive support – you might also be interested in looking at all these responses published in the BMJ letters for some more evidence of outstanding practice outcomes. http://www.bmj.com/content/351/bmj.h4023/rapid-responses

      With respect to endogenous glucose release I suspect you refer to type 2 diabetes. If you take away the exogenous glucose, the impact of the endogenous glucose changes completely. Again trial and error and monitoring is important. I’m not too sure why you describe the insulins as being “too powerful”. Insulin is insulin….different durations of action, different doses to inject. The trick is to find the type that suits. As you know, the normal and intermediate phase ones are a pain to manage (especially the mixes) but the ultra-long and ultra-short acting make life much easier. Naturally there is going to be a fair amount of trial and error with the initial change, but for people to be able to reduce meds and enjoy the benefits of beautifully stable blood sugar, good HbA1Cs, and in many cases, reduced weight would be totally worth it. To each his own, but I would encourage you to try this (amidst a supportive team of course) J Thanks,

      Regards Caryn

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