Knowledge and Proficiency in Low Carbohydrate Nutrition: A Dietitian’s Responsibility.

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By Tamzyn Murphy, RD, MSc (Dist)

Dietitians are the only healthcare professionals whose entire degree is dedicated to equipping them to prescribe personalised nutrition and dietary interventions to promote health and prevent and treat specific health conditions. A dietitian’s bespoke dietary assessment and prescription is called Medical Nutritional Therapy (MNT). Dietitians are qualified and equipped to use MNT in the treatment of a variety of diseases – from chronic kidney disease and liver failure, to diabetes and obesity – and in a variety of populations from paediatric to palliative. Unfathomably, apart from the application of ketogenic diets (the strictest form of low carbohydrate high fat – LCHF) for paediatric refractory epilepsy, dietitians’ extensive nutritional training does not include the research-based application of LCHF diets.

There is strong evidence that LCHF diets’ benefit insulin-resistant conditions (e.g. metabolic syndrome [1-3], Polycystic Ovarian syndrome [4, 5], prediabetes [6, 7], and Type 2 Diabetes [8-11]). Estimates of 30-60% of the population may be insulin resistant [12-14], and this number is rising alongside obesity prevalence [2]. This implies that LCHF could improve the health and reduce the risk of disease in a big portion, if not the majority, of people. This alone is sufficient reason why all Dietitians’ should be trained in LCHF nutrition. Add to this the mounting evidence that an LCHF diet may be as good as, if not better than other dietary interventions for improving body weight control [15-17], heart disease risk [18, 19], and endurance performance [20-22], and in its strictest ketogenic form, cancer [23-26] and Alzheimer’s disease [27-29]. As such, it is essential that dietitians become knowledgeable about LCHF as an MNT option for all of these.

If the scientific support for LCHF weren’t enough reason for Dietitians to become proficient in LCHF MNT, there’s more… Patients have the right to choose their own course of treatment, including dietary intervention. LCHF, in its various forms – including Paleo, Banting and ketogenic diets – is rising in popularity. Individuals are seeking out health professionals to guide them in applying their carbohydrate-restricted diet-of-choice, to troubleshoot problems, assess risk and enhance efficacy – only to be left unsupported and alone. This can result at best in an ineffective dietary intervention, or at worst, adverse effects, disenchantment with the medical fraternity, or even the unnecessary proliferation or progression of a disease.  This is unacceptable. The health professional best equipped to help them – the dietitian – often lacks training in this dietary intervention. It is a dietitian’s responsibility to know how to guide patients and clients to the best form of LCHF for them and then tweak it for success, and be able to advise when to proceed with caution, or contraindicate LCHF in particular patients or situations.

Luckily, increasing numbers of dietitians are realising how effective LCHF diets can be for a variety of clinical applications and are seeing the need for professional guidance for patients pursuing this dietary intervention. Previously, interested dietitians had to educate themselves on this intervention – making their knowledge ad hoc and very dependent on the time they had out of clinical practice to investigate. At last, there is an internationally curated, evidence-based LCHF training designed for dietitians, by dietitians, synthesising the most important evidence and applications of LCHF in clinical practice, so that the health professional responsible Medical Nutritional Therapeutic interventions can help their patients and clients in a meaningful way.

If you are a Dietitian or Certified Nutrition Specialist and are interested in including LCHF in your offering, apply to enrol in our new LCHF FOR DIETITIANS online training by following this link: www.nutrition-network.org/apply-now/.

The training will be launching on 31 October 2019. Register before 1 November 2019 to qualify for the Early Bird Discount.

CPD Pending.

References

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2. Reaven, G.M., The insulin resistance syndrome: definition and dietary approaches to treatment. Annu. Rev. Nutr., 2005. 25: p. 391-406.

3. Gershuni, V.M., S.L. Yan, and V. Medici, Nutritional ketosis for weight management and reversal of metabolic syndrome. Current nutrition reports, 2018. 7(3): p. 97-106.

4. McGrice, M. and J. Porter, The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: a systematic review. Nutrients, 2017. 9(3): p. 204.

5. Mavropoulos, J.C., et al., The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutrition & Metabolism, 2005. 2(1): p. 35.

6. Saslow, L.R., et al., A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PloS one, 2014. 9(4): p. e91027.

7. Spritzler, F., A low-carbohydrate, whole-foods approach to managing diabetes and prediabetes. Diabetes Spectrum, 2012. 25(4): p. 238-243.

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11. Hallberg, S.J., et al., Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Diabetes Therapy, 2018. 9(2): p. 583-612.

12. Aguilar, M., et al., Prevalence of the metabolic syndrome in the United States, 2003-2012. Jama, 2015. 313(19): p. 1973-1974.

13. Esmaillzadeh, A., et al., Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. The American Journal of Clinical Nutrition, 2007. 85(3): p. 910-918.

14. Erasmus, R.T., et al., High prevalence of diabetes mellitus and metabolic syndrome in a South African coloured population: Baseline data of a study in Bellville, Cape Town. South African Medical Journal, 2012. 102(11): p. 841-844.

15. Mansoor, N., et al., Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr, 2016. 115(3): p. 466-79.

16. Paoli, A., et al., Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 2013. 67(8): p. 789-796.

17. Ludwig, D.S. and M.I. Friedman, Increasing adiposity: consequence or cause of overeating? Jama, 2014. 311(21): p. 2167-8.

18. Bhanpuri, N.H., et al., Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovascular diabetology, 2018. 17(1): p. 56.

19. Hu, T., et al., Low-carbohydrate diets and prevalence, incidence and progression of coronary artery calcium in the Multi-Ethnic Study of Atherosclerosis (MESA). British Journal of Nutrition, 2019: p. 1-8.

20. Volek, J.S., et al., Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism, 2016. 65(3): p. 100-110.

21. McSwiney, T., High-Carbohydrate, Ketogenic Diets, Exogenous Ketones: Performance and Health Effects in Endurance Athletes. 2018.

22. McSwiney, F.T., et al., Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism, 2018. 81: p. 25-34.

23. Elsakka, A.M.A., et al., Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up. Frontiers in Nutrition, 2018. 5(20).

24. Seyfried, T., Cancer as a mitochondrial metabolic disease. Frontiers in Cell and Developmental Biology, 2015. 3(43).

25. İyikesici, M.S., et al., Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer. Cureus, 2017. 9(7): p. e1445-e1445.

26. Seyfried, T.N., et al., Metabolic therapy: a new paradigm for managing malignant brain cancer. Cancer letters, 2015. 356(2): p. 289-300.

27. Taylor, M.K., et al., An Experimental Ketogenic Diet for Alzheimer Disease Was Nutritionally Dense and Rich in Vegetables and Avocado. Current Developments in Nutrition, 2019. 3(4).

28. Taylor, M.K., et al., Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer’s disease. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 2018. 4: p. 28-36.

29. Pinto, A., et al., Anti-oxidant and anti-inflammatory activity of ketogenic diet: new perspectives for neuroprotection in Alzheimer’s disease. Antioxidants, 2018. 7(5): p. 63.

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