Picture: YINGYING ZHANG https://www.instagram.com/yingyingzux

Picture: YINGYING ZHANG https://www.instagram.com/yingyingzux

UPDATE: HITS (Head In The Sand ) syndrome is infecting dietitians. It’s a global problem, say nutrition researchers. It’s the basis for the belief these dietitians have that low-carb, high-fat (LCHF) diets are dangerous, despite evidence to the contrary. In particular, it feeds their fear of dietary saturated fat. The experts say that fat phobia is simply from a lack of understanding of the difference between correlation and causation in science.

Another sign of HITS syndrome is the latest anonymous statement from the Association for Dietetics in SA (ADSA) and the Nutrition Society of SA. It went out to doctors and dietitians in South Africa in March 2016. It is premised on conventional nutrition low-fat, high-carb “wisdom”. Here, Eategrity consumer activist Sonia Mountford looks at why ADSA risks becoming increasingly irrelevant based on the advice it dishes out.  – Marika Sboros 

By Sonia Mountford

Dieticians wedded to old nutrition paradigms still like to tell people all they have to do to lose weight is … eat less and excercise more. Restricting the practice of nutrition to dietitians only is not in the public’s best interests, more so when  the credibility of their representative body, the Association Dietetics South Africa (ADSA) compromised due to their funding by Big Food.

Yet that is what the Health Professions Council of SA (HSPCA) are seemingly supporting at the behest of ADSA, by helping to press the mute button on all other dietary advice that ADSA disapproves of.

South Africa’s health community is in desperate need of a dose of integrity and needs to acknowledge the growing awareness globally of “conventional” dietary advice being questioned due to Big Food influence.

In The Rise and Fall of Dietetics and of Nutrition Science, 4000 BCE-2000 CE, British epidemiologist Dr Geoffrey Cannon says nutrition science in its modern form dates from the early to mid-nineteenth century; it had the effect of creating dietetics as a separate paramedical profession. “The first generations of physiologists, biochemists and physicians who created nutrition science along the lines of the disciplines in which they were trained, believed they could change the world,” says Cannon.

“So they did, once governments and industry endorsed their ideas. The dimensions of nutrition narrowed but its scope widened. It became less a philosophy of life, more an instrument of state.”

Nutrition science has provided the means for dieticians to influence mainstream media dietary advice and contribute to the definition of a healthy diet for government dietary guidelines and policy.

Nutrition science has become less a philosophy of life and more an instrument of state’ – Dr Geoffrey Cannon

As I have previously questioned, just how trustworthy and credible can this dietary advice be and should dietetic associations and their sponsors have input into national food guidelines?

associations and their sponsors have input into national food guidelines?

ADSA seems to suffer from what I call “head in the sand” (HITS) syndrome: ADSA must be aware that the concerns raised over conflicts of interest by their Big Food sponsorships won’t go away by merely burying their heads in the sand. Denial of these conflicts of interest won’t afford the opportunity for reflection or critical policy changes for the better either.

This is the most concerning aspect of ADSA’s unwillingness to acknowledge the sponsorship concerns repeatedly raised. Along with their unwillingness for real dialogue, their arrogance of claiming the arena of dietary advice puts at risk progress of real solutions to our obesity and the fight against non-communicable diseases (NCD’s, such as obesity, diabetes, heart disease and cancer).

Can South African citizens afford a stronghold on this type of dietary advice? Probably not. Are dieticians and in particular, ADSA in danger of becoming irrelevant if they don’t begin to take these conflicts of interest seriously? Very probably.

HITS syndrome is not unique to ADSA. It’s pretty much a global phenomenon.

Obesity EpidemicBritish nutrition specialist and researcher Dr Zoe Harcombe has questioned these conflicts of interest with the American Dietetic Association, Dietitians Association of Australia  and British Dietetic Association (BDA) in depth in her book The Obesity Epidemic: What caused it? How we can stop it? .

She writes: “After a number of email exchanges, a BDA spokeswoman confirmed “we have been delighted to work with the Sugar Bureau…”

Michele Simon is a US public health lawyer specialising in legal strategies to counter corporate tactics that harm the public’s health, who has been researching and writing about the food industry and food politics since 1996. As previously discussed, her report, AND now a word from our sponsors exposed these same conflicts of interest with the Academy of Nutrition and Dietetics.

In her latest report, Has the American Society for Nutrition Lost All Credibility? Simon castigates the American Society for Nutrition (ASN), the nation’s leading authority of nutrition scientists and researchers, for its cozy relationships with the likes of PepsiCo, Coca-Cola, Nestle, McDonalds, Monsanto, Mars, and the Sugar Association.

Some of the findings were-

Obesity researcher David Allison serves on the editorial board of the American Journal of Clinical Nutrition, ASN’s flagship publication; he has been a consultant to The Sugar Association, World Sugar Research Organization, PepsiCo, Red Bull, Kellogg, Mars, and Dr. Pepper Snapple

Official spokespeople for ASN have conflicts with Coca-Cola, McDonald’s, the American Beverage Association, General Mills, and Cadbury Schweppes

ASN published an 18- page defense of processed food that consists of numerous talking points for the junk food industry, such as “There are no differences between the processing of foods at home or at a factory”

ASN opposes an FDA proposed policy to include added sugars on the Nutrition Facts panel, at a time when excessive sugar consumption is causing a national public health epidemic.

Responding to reporter, Richard Marini in July 2015 on why she looked at how the organisation is financed, “ASN’s research forms the bedrock of nutrition policy,” said Simon.

“When the registered dietitians of AND work with consumers to improve their health, the advice they give often is based on research done by ASN members.”

The response by the American Society for Nutrition to the report is another prime example of HITS syndrome.

“ASN does not have small goals, and therefore we cannot work in a vacuum,” wrote American Society for Nutrition Executive Officer John Courtney. “We believe that scientists in academia, government, and industry can partner to solve the world’s nutrition challenges.”

The above tweet by ADSA questioning other dietary advice that goes against its own dogma can work both ways, including its own advice but the association’s acute case of HITS syndrome seems to prevent them from seeing this.

It raised the question again – why ADSA regularly maintains that highly processed cereal bars can be part of an “active” kid’s diet and say that this advice is evidence-based science? ADSA has said it stands by this advice “within the context of an ideal training diet for active children”.

This in itself creates concerns of legitimacy of the advice that ADSA provides and brings into question the science on which they are basing their advice.

ADSA also insists that its positions of employment by Big Food do so to enable them to influence decision-making from within.Kelly Brownell

Former Yale University professor Dr Kelly Bronwell, now Dean of Sanford School of Public Policy at Duke University, believes this position is “a trap”. That’s based on his 30 years of experience in public health and policy. In a 2012 editorial in the journal PLOS (Public Library of Science) One, titled Thinking Forward: The Quicksand of Appeasing the Food Industry, he goes on to say: “When the history of the world’s attempt to address obesity is written, the greatest failure may be collaboration with and appeasement of the food industry.”

If ADSA is serious about nutritional health then shouldn’t they be driving campaigns on the health risks of processed foods and nutrient deficient cereals?

Many RDs don’t like what is being said about the ADSA, but they don’t tell their organisation to drop its associations and funding from Big Food, which places all dieticians in a bad light, particularly by defending it.

A reformist example of addressing dieticians concerns are the dieticians in the US who stood up and said enough is enough when their Academy of Nutrition and Dietetics (AND) made dietetics a ridiculed profession when they endorsed processed cheese Kraft Singles.

While Kraft told the Times that the Academy had endorsed the product, AND “emphatically denied” the endorsemen. Instead, it said that it was using the seal “drive broader visibility to KidsEatRight.org,” a website the organization created to be “a trusted educational resource for consumers.”

The Kraft story made headlines and resulted in a short segment on The Daily Show, with Jon Stewart saying that AND “is as much an Academy as [Kraft Singles] is cheese.”

Registered dieticians and consumers were outraged, commenting on Facebook pages and online news articles.

“I am saddened to see this post and am truly concerned that such a statement has been put forward that could damage the integrity of professionals not just in the US but also further afield. I am waiting to see what AND say about this issue and hoping AND can identify (and most importantly fix) the issues that lead to this situation.”

“You’re missing the point, AND. If a seal is on a product, from the point of view of the layperson, it IS a seal of approval even if you say it isn’t. For an organization who claims to represent dieticians, you have discredited the members who work so hard to earn their credentials and training. Please stop being a mouthpiece for corporate interests and start taking a real stand for the profession.”

“Thanks a lot Academy of Nutrition and Dietetics you’ve successfully discredited us and made us the butt of media jokes!”

Three RDs, Rachel Begun, Kate Geagan and Regan Jones drafted a Change.org petition calling for AND to “repeal the seal” on Kraft singles. The petition received over 10,000 signatures in the first five days. 11,947 supporters, mostly RD’s, later achieved victory.

On April 1, 2015 they thanked the Academy of Nutrition and Dietetics for their decision to terminate the Kids Eat Right initiative with Kraft.

“It takes courage to sit down and listen to criticism and then do something about it. They did just that—and we believe it will ultimately improve our profession, our organization and our public trust.”

Andy Bellati

Andy Bellati

After the publication of Michele Simon’s report on the Academy of Nutrition and Dietetics, “And Now: A Word From Our Sponsors”, Andy Bellatti, a dietitian who believes the ties between Big Food and health organisations “pose significant conflicts of interest that ultimately damage the reputation of health professionals and inhibit important conversations about our food system and environment”, co-founded Dietitians for Professional Integrity with some of his dietitian colleagues.

Their aim is to address the “very troublesome issue negatively impacting the credential we worked so hard to earn.”

It would be encouraging to see a similar group in SA formed like Dietitians for Professional Integrity by likeminded progressive dieticians with the same concerns. However, RDs here seem mostly to also have an acute case of HITS syndrome.

Journalist and professor Michael Pollan is one of the most influential voices in contemporary dietary debates in the US. Pollan is also very outspoken about nutrition science. In his book, In Defense of Food: An Eater’s Manifesto published in 2008, he discusses the connection of disease and the way in which we produce our food.

Cancer, cardiovascular diseases, diabetes and obesity can all be directly linked to “the rise of highly processed foods and refined grains; the use of chemicals to raise plants and animals in huge monocultures; the superabundance of cheap calories of sugar and fat produced by modern agriculture; and the narrowing of the biological diversity of the human diet to a tiny handful of staple crops, notably wheat, corn, and soy,” writes Pollan.

Since 1980, Pollan says, “sweeteners and added fats have gotten 20 percent cheaper, while fresh fruits and vegetables — products that have, incidentally, lost nutritional value over the past half-century — cost 40 percent more.

And it’s the triumph of misguided food science over food culture that has enabled much of this descent”, says Pollan.

‘The fate of each whole food rises and falls with every change in the nutritional weather, while the processed foods are simply reformulated.’ – Michael Pollan, The New York Times, January 28, 2007

Certainly, food has become a complicated issue, and while scientific nutrition aims to simplify dietary knowledge, it does so without admitting that we just don’t know enough.

When the USDepartment of Agriculture (USDA) published its first dietary recommendations in 1894, specific vitamins and minerals had not even been discovered yet.

The study of soil and gut biomes are still in its infancy and holds great promise to truly understanding how our bodies work in relation to our food and how to grow nutritionally rich food we need healthy soil.

“The problem with nutrient-by-nutrient nutrition science,” points out Marion Nestle, the New York University nutritionist, “is that it takes the nutrient out of the context of food, the food out of the context of diet and the diet out of the context of lifestyle.”

Academia has a place but not the right to push the mute button on any opposing views- particularly if we reflect just how broken our food system is and where we find ourselves after decades of official dietary advice.

How can anyone or any one-group claim to be an authority on dietary advice or nutrition?Instead there is a climate of fear, which leads to less transparency and less open dialogue when one group is demanding the monopoly on dietary advice in South Africa.

There needs to be greater dialogue among health professionals and involvement to include other stakeholder groups such as consumer groups, food sovereignty groups, nutritionists and farmers who can influence the food supply, availability and how the food is grown.

Perhaps that is the greater question we should be asking is: What about our relationship with food? Do we know where our food comes from? How it is farmed, processed and delivered? What is its impact of how our food is produced in South Africa on nutritional food security, environment, human rights, social justice and animal welfare?

While we all bury our heads in the sand, we won’t open up to honest conversations about food politics and the influence that Big Food has on available food choices either.

*This blog was first published on Eategrity