Tuesday, November 5, 2019

Retrospective #262: Should You See a Registered Dietitian Nutritionist?

A Reuters Health Information release I received included the recommendation (of a registered dietitian nutritionist) that “doctors should refer their prediabetic patients to a registered dietitian nutritionist.” She further suggested, “These results [of a prediabetes nutrition therapy trial she led and reported on] further show that medical nutrition therapy should be considered for reimbursement in the treatment of prediabetes to reduce diabetes risk.” A very good idea, I thought, but NOT SO FAST. Let’s first take a look at the “medical nutrition therapy” that she recommended.
“Patients in the INTERVENTION GROUP had been encouraged to follow diets that were calorie-restricted and balanced, so that 60-70% of the energy came from carbohydrates and monounsaturated fat, 15-20% from protein, and less than 7% from saturated fat. They also received a pedometer and diary to record the number of steps taken and minutes of physical activity completed each day,” the release said. In my humble opinion, you should not waste your money on this type of “medical nutrition therapy”. You would do much better to “listen” to your glucometer.
Why? The medical nutrition therapy recommended in this prediabetes nutritional therapy trial was the same standard, one-size-fits-all, USDA’s Dietary Guidelines diet that all Americans eat a balanced diet and exercise more. Ugh!
Readers may recall that I lambasted this very trial’s accomplishments in a recent post, Retrospective #258. The trial’s outcome was a 3% improvement in A1c in the INTERVENTION GROUP and a 7% worsening in the “CONTROL” group. The worsening in the CONTROL GROUP suggests to me an “out-of-control” Epicurean feast of Sybaritic dimensions. The 10% delta does, however, make the very small improvement in the INTERVENTION GROUP look better.
Let’s face it. This RD’s pitch is just an effort to advocate 1) for the government and insurance companies to allow Medicare and other reimbursements for “medical nutrition therapy” and 2) get doctors to send them more business. And under those circumstances, you can’t expect Registered Nutrition Therapists to not follow the “nutrition therapy” that the government and the medical associations recommend, even if they believed otherwise, which they do not!
Business is business, after all, and nutritional therapy service providers have to eat too. Currently, the only way that I know of for patients/clients to get reimbursed by insurance is for the registered dietitian nutritionist to work in a medical doctor’s office.  That is the case, anyway, for obesity counseling services, and that only since 2013. See the Nutrition Debate #146: “Medicare to Pay for Obesity Counseling” for an account of my experience with that. For my cynical take on a related subject, see also, Retrospective #147: “AMA: Obesity is a Disease (for billing purposes).”
You do have an alternative though. If you do your homework, you will seek and find an independent nutrition counselor. My favorite was Franziska Spritzler, RD, CDE, previously blogging as the “Low Carb Dietitian.”  She has since taken full-time work with the Diet Doctor. Franziska in mid-life had changed careers from court reporter to Registered Dietitian and then discovered she was pre-diabetic. She then did her homework and changed her Way of Eating. Afterwards she said, “I'm 47, and thanks to a low-carb lifestyle and gentle exercise, I feel better than I did in my 30s.”
In Franziska’s first blog post back in 2011, one commenter told her, “I'd like to earn a Master's in an ADA-approved program, but am concerned my views about low-carb would create problems with faculty.” Franziska agreed, saying, “Well, I didn't have those views when I went through my didactic nutrition program, so it wasn't an issue for me. But from what I've heard most nutrition professors are not open to LC, although there are a few exceptions.”
So, what’s a person to do? There’s no way that a person like me could get certified as an RD. It’s a cabal. I’d have to keep my mouth shut and intentionally give wrong answers to virtually every question on the test. Fat chance of that!  
My advice is to find an on-line group, join it and read the “sticky” post at the beginning to understand the principles they follow and their rules. And then lurk for a few months. Then, after you’ve acquired a basic understanding, join in the questioning. That’s how I got started almost 19 years ago. Most of these groups are very friendly and supportive. The moderators and participants are all living the low-carb and very low carb experience. They know what it’s about.

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