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How Far Should Our Right To Give Dietary Advice Go?

Hello folks! Today is Fight Back Friday, and as a special treat, we are going to dig into a controversial topic – our right to give dietary advice. Just how far can we go? Stick around and let’s see if we can make our way through this thorny issue.

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The Situation:

This post grew out of a problem that Steve Cooksey is encountering over at Diabetes-Warrior.net. He is currently being investigated by the NCBDN (North Carolina Board of Dietetics/Nutrition) for giving dietary counselling without a license to practice.

Of course, my favorite renegade Richard Nikoley has a superb post over at Free The Animal with a comment section that is eating me alive. You know that I am not a person that is always status quo, but I agree with the NCBDN that Steve Cooksey has gone too far.

My Experience on This Matter:

Okay, for those of you reading my blog a long time now, you know how I was diagnosed with diabetes. You know that I went through a struggle with my sugars, and you know that I went and passed off what I found to you. How can I say that someone else can’t give dietary counseling without a license?

I quickly found that you can find a lot of information online about the disease. A lot of it is shit. People come off like they are an authority on the subject because they are doing something that appears (for now) to be working for them. It’s a nice gesture, they are trying to pass off that information to others.

I stopped doing that because my wife once asked me, “Who do you think you are?”

That question really threw me for a loop. I don’t have credentials, I have absolutely no stake in getting someone better. In fact, (as I see in a lot of blogs out there,) I could easily just turn around and say, “Oh, N=1! Sorry!”

Let’s examine why you need a license to practice medicine or give dietary advice to someone with a medical condition:

 

  • N=1 is fine and all. You can for sure tell me what you have done, and what works for you.
  • What works for you may not work for me. What gives you the tools to dispense advice is clinical experience?
  • When you start dispensing advice to take care of a chronic condition, you are entering into a relationship with the person, who may have adverse responses to your counsel.
  • Like it or not, you also need protection that a license gives you, and so does the patient. If the advice you are giving ends up damaging the patient, there needs to be a consequence.
  • The license is granted by a board under the understanding that you will follow the guidelines laid out as requirements of that license.
  • Your advice should be on the back of data present, not a snake oil remedy, or a pseudo-science. Lives are at stake here.
  • Do we really want to go back to a day where there are no licenses, so you have no guarantee that the advice you are given is grounded on solid evidence? If Ethel tells the village that in order to cure cancer, everyone should eat their tulip bulbs, do we all give that a try? That was what medicine was like before licensing, and science to back it up.
  • By most laws, you are allowed to give nutritional advice to someone who is healthy, and with no medical condition. Once that person is diabetic, or with another medical condition, and seeking individual nutrition information, it is up to the advisor to direct their questions to a medical professional. This is nothing new – all current Paleo/Primal superstars do this – either by a healthy disclaimer, or by simply stating you should see a physician before starting their program.
  • The advice given on most famous sites like, Mark’s Daily Apple, Robb Wolf, and others are very much generalized information. They are at the edge of what is allowed, but notice they don’t cross that edge.

Conclusion

You need to be careful about the advice that you solicit to people. The words, advice that you use can have consequences that you are not able to deal with. This is why almost everyone who gives any advice in the Paleo/Primal field, or in any dietary or nutrition book will ALWAYS preface their advice with the standard legal disclaimer that you should consult your physician before starting a protocol or fitness program.

The problem may come from the so-called “Conventional Wisdom,” but I suggest that fighting the dietician is not the way to solve the problem. What we need are real clinical trials and data so that we can change that conventional wisdom.

Giving dietary advice that is unlicensed is NOT the way forward, it is the way backwards. Indeed, in the case of Steve Cooksey – it further fuels the notion that Primal dietary regiment is on the fringe, not a viable alternative to the standard practices.

Why is that? Because Steve Cooksey is not a licensed dietetic, who IS dispensing advice as if he were. To quote my wife, and many other diabetics, “Who does this guy think he is? Why should I trust him to give me dietary advice over the doctor?”

I have no problem with him telling us what works for him, but to come off like he knows what is best, and is the authority on the matter? I’ll pass thank you – I have my life to worry about.

Your turn!

You may think I am totally off my rocker, many people do. What do you think? Should a person be required to have a license in order to dispense dietary advice to a patient with a medical condition? Let me know in the comments!

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  • http://www.janssushibar.com Jan

    The problem with this, at least in The Grand Ol’ US of A (you live in a different country) is that by requiring someone be licensed to give advice to someone who has ASKED for it (as far as I know, Steve isn’t going around and tackling people on the street and telling them they MUST eat the way he does) is that once they give you a license, they can take it AWAY if they don’t agree with the advice you’re giving. And they DO that, too.

    So let me ask you something – do YOU think the advice the American Diabetes Association gives is good advice? Do YOU follow it to a T? If not, remember you don’t have a license and aren’t qualified to make that determination for anyone – not even YOURSELF.

  • http://welldonechef.com Jason Sandeman

    @Jan -
    No one is saying I can’t decide for myself. In fact, a huge problem with diabetics in non-compliance. You definately don’t need a license for that.
    Yes, a license can be taken away – that’s the point. You need to remember that in the States, (where people are sue-happy!) there needs to be something of a buffer between the patient and the practicing clinitian. The clinitian needs to be protected against lawsuits through the set of guidelines set out by the board, (whether they are right or not…) and the patient needs to be protected in knowing that the clinitian will follow that same set of guidelines.

    As for whether I am qualified to make the decision for myself as to whether I will follow the ADA’s advice, or even think it’s good for me? No one is saying that I’m not allowed to do that. (Or, if I am wrong, please direct me to change my mind on this…)

    What they are saying is that to dispense advice to someone with a medical condition, I need to be licensed. I can’t, by law, give individual nutritional advice to manage the medical condition. What I can do is tell them waht works for me, and tell them to work with their medical professional and that my advice does not replace that of a medical professional.

    This is nothing new – ever since the internet was born, there have been medical disclaimers on sites to prevent this stuff from happening.

  • http://healingcenterofmaine.blogspot.com/ Peter at Healing Center of Maine

    “He is currently being investigated by the NCBDN (North Carolina Board of Dietetics/Nutrition) for giving dietary counselling without a license to practice.”

    I agree with complete disclosure and upfront disclaimers. I agree advice for the treatment of an illness should only come from a person with a medical license.

    However, no licencse should be required to provide “dietary counseling” for improving health. In my experience, the dietary counseling I received from an MD involved taking Lipitor, getting Cortisone shots, and taking medication the rest of my life for my psoriasis.

    Thanks to non-licensed dietary advice, and real food, I no longer need Lipitor, nor Cortisone shots, and I no longer have the psoriasis my MD told me was incurable.

  • http://welldonechef.com Jason Sandeman

    @Peter – I agree. In most cases, (at least up here in Quebec,) a person is referred to a dietician or nutrtionist. A doctor isn’t equipped to give out dietary advice, except in a basic way. (Or with drugs… that’s another story.)

    I find that the doctors even contradict the advice given by the clinical dietitians!

  • http://www.janssushibar.com Jan

    “No one is saying I can’t decide for myself.”

    But if a law can be made that someone they can’t give advice to another who has asked for it – nothing, after all, is making the person asking take the advice (YET) – a law can be made that an individual has no right to make decisions for themselves about what they can and cannot do to treat their own illness. Or eat for that matter – or do you believe the Canadian gov’t has the right to tell you you cannot eat grass-fed beef liver, since they say it’s for your own good? Hmmm? Where does it end?

  • http://welldonechef.com Jason Sandeman

    @Jan – Okay, not sure where this is going… except in circles. :)
    What the law is saying = you can give non-medical advice to someone in regards to diet and nutrition. We aren’t talking about aunt Sally telling you what to do with your diabetes. We are talking about someone who has a site that is advocating their way of eating to manage a disease.

    Would you accept that a website says you could cure your breast cancer by drinking an ounce of olive oil per day? Hey, it worked for them, right?

    As for whether a law could be passed stripping the rights of an individual to choose how they can treat their own illness? I am not aware of any such law anywhere in the world. Besides, a law like that would be difficult, at best, to enforce.

    As for grass-fed beef? I wish I could get some from my local butcher.. Instead I have to find places around here. (I am still searching.) There isn’t a law against it, just strict protocols against some of the farming practises of yore. For instance, I am having difficulty getting pastured eggs that aren’t candled. So far, it looks like you really can’t legally.

    Does the Canadian government have the right? Well, I don’t have an answer for that. I would say no, but I’ve never had it different…

  • http://www.janssushibar.com Jan

    “Besides, a law like that would be difficult, at best, to enforce.”

    You’re joking, right?

  • http://welldonechef.com Jason Sandeman

    @Jan – How exactly could they enforce a law like that? They can give you guidelines… but in the end – you control what goes into your mouth. Whether you can buy it – that’s a different story.

    That’s the thing I am trying to get at here. The message isn’t what’s wrong here. It’s the delivery. Ask yourself this:

    How is calling out the ADA furthering the cause?
    How is telling people that the ADA is out to make their treatment worse by hooking them on insulin making things better?
    How is telling people that 90% of diabetics “fail” helping the cause?
    How is any of that negativity helping the cause?

    That’s the problem I have. Not about Paleo, or Primal. Honestly, I got turned off of the guy’s site a while ago – from the negativity, and the agenda. I still like Robb Wolf, and Mark Sisson, etc. Why? Their message is a positive one.

  • http://www.janssushibar.com Jan

    I really, really didn’t want to go here, but…in the first of his posts about this very issue, Richard made the analogy of “good” Germans loading Jews in boxcars, knowing full well what was waiting at the other end of that train ride, because it’s what they were told to do. He got some negative feedback from that, but it’s a pretty fucking apt example of how easily such a low could be enforced. If you don’t think such tactics are possible today, go ask those poor Amish farmers in Pennsylvania where it is PERFECTLY LEGAL to sell raw milk who have been raided in the middle of the night and had all of their raw milk products confiscated – representing thousands of dollars of income – because the FDA felt like it. They had absolutely no cause; these men were selling directly to consumers who were well aware of what they were purchasing.

    Also, you – in one breath – ask how such a low could be enforced and tell me how government laws and regulations prohibit you from finding, purchasing and consuming the very good you want to eat. What is wrong with this picture?

    I understand you don’t like Steve, and that is certainly your right. You also have the right not to go to his website and read it. You have every right not to take his advice if you find it offensive, incorrect or dangerous. But you have absolutely NO right to take away MY right to go to Steve for advice if that is WHAT I WISH TO DO. THAT is what we are upset about.

  • http://www.janssushibar.com Jan

    Sorry, that should be “laws” and “food.”

    Got a little excited, there.

  • DB, RN

    A license to tell me how to eat? No. Just…No. And hey, the governments been telling us how to eat for years. Where’s THEIR license?

  • http://welldonechef.com Jason Sandeman

    @Jan – I guess I see your point. If the product is not available… then I can’t eat it.
    That is kind of like the language laws here in Quebec. They don’t come right out and ban kids from going to English schools, what they do is make it so if you didn’t go to school in elementary in English, neither can your kids.

    In the case of Steve Cooksey – I don’t have an issue with his message – I have said that from the get go. I just think his delivery sucks. I know that if they guy actually followed the guidelines that EVERYONE else, (even De Vany!) follow, there wouldn’t be a story here.

    It’s like people are getting confused about what the issue really is. Is it freedom of speech? Was it ever really an issue of that, or the disregard of state guidelines. If someone can in one breath tell me it’s not fair, and point out that I am TAKING away your right to that advice, when the guy SHOULDN’T be giving the advice in the first place?

    Instead of giving the advice in a general way, he broke the rules and gave individual advice. That’s what this issue is about, not freedom of speech. If it was a freedom of speech issue, then EVERYONE would be doing it, and NOONE would have a disclaimer on any site, book, or magazine. You know what I am talking about – you see them all the time – hell, even the great Dr. Oz has them.

    Keep in mind, it’s not that I didn’t like the guy… he just put it there, know what I mean? It’s his actions, and what was said in the comments. Things like calling me “whiner,” etc.

    I don’t dispute a right for you to go get advice. That’s your right. Hell, go talk to my grandfather, he would have given you plenty. (He was a herbologist..)

    You didn’t just invoke Godwin’s law, did you? LOL

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  • http://www.janssushibar.com Be

    I think the comparison is apt. In the words of Martin Niemöller:

    First they came for the communists,
    and I didn’t speak out because I wasn’t a communist.

    Then they came for the trade unionists,
    and I didn’t speak out because I wasn’t a trade unionist.

    Then they came for the Jews,
    and I didn’t speak out because I wasn’t a Jew.

    Then they came for the Catholics,
    and I didn’t speak out because I was Protestant.

    Then they came for me
    and there was no one left to speak out for me.

  • http://welldonechef.com Jason Sandeman

    @Be – I see the distinction. What I wonder though, is it taking it too far?

    I read the differing bills/licensing guidelines floating around there on the internet. They are pretty much identical to what is being investigated in Steve Cooksey’s site.

    I agree with freedom of speech. I agree with the right to furnish advice of a GENERAL nature.

    What I don’t agree with is when it becomes specific. In Steve’s case – he is dispensing advice to diabetics – while coming across as an authority in the matter. What Steve has is profound – being an anecdotal experience – but that is where it lies. Sure, it’s hard to argue with his experience – as an example of what *could* happen if you followed his way of eating.

    What is different though, is he is constantly, (to use his own words,) “Taking the American Diabeties Ass.” to task for making people sicker. He still gives out “advice” despite being under investigation.

    What we do is different. Jan – myself – and a lot of other bloggers – we just give general information, never something specific. I have even read in Jan’s posts previously where she states she is guessing, but in no means is an authority on the matter.

    There is nothing in the guidelines saying we can’t blog about health matters, or what works for us. There is nothing stopping us from posting a recipe, or even stating that we think the ADA is wrong. That would be a fundamental violation of a constitutional right.

    It’s not even in the guidelines.

    What is prohibited is giving individual dietary advice without a license. While I can post a primal recipe – I cannot tell someone that it is great for thier blood sugar control if they are a diabetic.

    In fact, my conscience agrees with the guidelines. Who the hell am I to state I know about blood sugar control, and how it affects you? I know myself, and that’s all. You know, the reason I stopped going on about diabetic advice was because I know that I am not qualified to tell you what you should be doing to manage your disease. It’s not a 1st amendment right issue to me – it is based on conscience.

    My last thing to add to this is – think of it like this. Would you trust a blogger to dispense you drug information from a blog? How about letting the guy down the street operate on you to remove a suspicious mole on your skin and tell you whether it’s cancerous or not based on what has happened in his life, or his friends around him?

    I know it’s a hyperbole – but when it comes to a disease – especially a metabolic disease – diet – it is a big deal. No matter what book you read, there is always the admonishment to consult your health care provider and work with them. They also state the advice given is not intended to be medical in nature, and should not replace that of the medical team you are working with.

    Steve seems to want to “stick it to the man,” but he isn’t playing by the rules that everyone else is. He thinks that because he wants to hide behind a constitution that he should be able to do whatever he wants. When I took him to task about that very sentiment, when I asked him what made him different than Mark Sisson, Robb Wolf, Art De Vany (about the need for a disclaimer, and the absense of individual dietary guidance on their respective sites…) – well – let’s say I haven’t heard a peep from him since.

  • http://www.janssushibar.com Jan

    “I don’t dispute a right for you to go get advice. That’s your right.”

    Well, yes – you are. By advocating that Steve Cooksey not be able to give dietary/nutritional advice to diabetics without a license, you must understand he’s at the mercy of those conferring the licenses. If they don’t like his advice, he either won’t get the license or will have it quickly revoked. If he’s not licensed, I can’t go to him for advice if even I want to – and if I did, he could go to jail. So could I, for seeking dietary/nutritional advice from someone who is unlicensed (don’t tell me that’s silly, because that kind of shit happens ALL the time).

    I think the one simple fact you’re missing here is that those of us who are defending Steve’s right to give advice to diabetics, based on his own experience, isn’t that we’re JUST defending his right to dispense said advice, but OUR right to go to him for advice if that’s what we wish to do. In fact, that’s the primary objective in my mind – you’re not just taking away HIS rights, you’re taking away MINE.

    And again, if you don’t care for Steve’s delivery, then don’t listen to him. No one is forcing you to. And so far as I can tell, the only “cause” he’s been hurting is his own. AND if he’s not “playing by the rules” – who’s making the rules? Who says they’re fair? Who says they can’t, shouldn’t or won’t be changed?

  • http://welldonechef.com Jason Sandeman

    @Jan – Okay – show me where someone can go to jail for seeking advice for their condition from someone who is not licensed. Then I will concede the point.

    I can’t find one example of that.

    The issue is not whether you can go to Steve for advice. The issue is when Steve offers you individually tailored dietary advice to manage your condition. There is a BIG distinction there. Steve can give all the general advice that he wants… I.E. “This bacon butter has proved to have no effect on MY blood sugar.” or, “This salad doesn’t have a lot of carbohydrates, which is good for your control.”
    Steve skates a thin line when he says, “Here’s my meal plan to help manage your diabetes.”

    It’s worse when he is talking about his “Diabetes” Nutrtional chart, or his “sample” diabetes nutrtional plan. Se, it’s put out there for the world to see – like he has the credentials to make that plan. He’s doesn’t.

    The issue I am bring up here isn’t really if he has the right to do it. It is *should* he do it? How far can he go?

    As for who is making the rules? I feel like what you are saying is that the rules are no good because the people behind them are corrupt.

    Ask yourself this – why do you think there needed to be a standard in the first place? I’m not talking recently – I’m talking in general. These regulations are NOTHING new. (At least not up here.) The designation of Dietitican has been protected for decades. Whether someone can dispense advice in a clinical matter has been under licence for a LONG time, same with practice. Why do you think that is?

    Do we seriously want to go back to the times when we had some guy roll up into town, hawk some snake oil product that turns everyone blind, then make for the hills? I may not agree with the “conventional wisdom” in whole, but I do agree that there should be some form of licensing so that if someone fucks up – they can be held accountable.

    I look at it this way – in terms of my care, I make that choice. I can chose whether to follow the ADA’s (which is what I am prescribed despite the name being the CDA here,) or do I go on my own?

    The issue gets more thorny when it’s NOT just me, but maybe my kid who has the disease. Perhaps I search online for answers, then I come up to cooksey’s site – who has all this “information,” with testimonials on his site. (I see he even states his plan is good for type 1 diabetics – which HE HAS NO EXPERIENCE at all – not even his own anecdote.)

    Now, perhaps I decide that all those crank doctors don’t know what they are are talking about – Steven Cooksey does. He says Big Pharma is gonna use my kid as an addict for their nefarious evil drug pushing plans! I can manage my kid’s diabetes through his lifestyle – and all will be good, right?

    Now, imagine your type 1 diabetic kid (or in your case, your imagine your grandson was a T1D,) doesn’t wake up one morning because he has had a hypoglycemic reaction. See, diabetes IS COMPLICATED. Everyone makes it out to seem easy – but it’s FAR from easy. No where on Steve Cooksey’s site is there anything for what to do about this, how to prevent it. All there is there is his opinion of how the disease should be managed, based on his own experience. Hell, I am sure he doesn’t even know about how a child needs more carbohydrates and slightly higher blood sugar in order to be a normal, thriving kid. (Why do you think they get so rambunctious?)

    So, without any form of consequenses – like having licensing – there is no way that anyone can do anything about the tragedy that could occur. Steve can just turn around and state, “Oh, well, N=1, it worked for me!”

    That is at the core of the issue here. You and I, as health/food bloggers, have every right to post what we think of the ADA, what we think is a good meal plan, what we think is a good way to manage the disease – in general. When it comes down to individual care – we never had, nor should we ever have – the right to do that without a license.

    To be honest with you – I wouldn’t want it anyway, without knowing what I was doing first. I wouldn’t repair a transmission – I don’t have the experience or skill to do so. I sure as hell wouldn’t advise someone how to do it.

  • http://welldonechef.com Jason Sandeman

    @Jan – To further expand what I am talking about. Let me break it down from his “Diabetes Support” page:

    People it TRULY is SIMPLE… but it is not EASY!!!

    No, diabetes seems simple, but it really isn’t. There are things to think of like neuropothy, gastroparesis, IBS issues, high blood pressure, issues with rapidly normalizing your blood sugars, etc.

    Say NO to the failed nutritional policy that is propped up by tainted nutritional studies and supported by Big Food and Big Pharma.
    Click Here and Here…. if you doubt me :)

    Say NO to the failed diabetes treatment programs that are promoted by the Purveyors of Pain… the American Diabetes Association and the American Association of Diabetes Educators.

    So here he is saying to tell your healthcare team to stick it, and follow him. This is the crux of the issue. Should he be allowed to do this? Let’s say that eveyone just all of a sudden decided to take him up on his offer. How is he equipped to deal with each and every case?

    You know what? I have more experience as a T1 than Steve Cooksey. I can tell you about carb ratios, I can tell you about correcting, whether or not you are still making insulin, (and the joys and fun of that..,) why the doctors want you to go on isulin from when you are diagnosed, (to preserve what little pancreatic function you still have, and to normalize the insulin rates in your body…)

    I can even tell you that almost all T1′s have insulin producing capabilities when they are diagnosed. The problem is the disregulation. Steve advocates that blood sugar is the problem. He even calls me down for saying it’s a symptom. Problem is, he’s making it too simple. Yes, high blood sugars are dangerous, but so is high insulin. Blood sugar isn’t what causes the heart disease, it’s the inflammation from the hyperinsulemia.

    In my example above about the kid not waking up – it is because of the sporadic insulin production capability of the pancreas. Sure, the kid might be on low carb. Awesome. The blood sugars are “normalized,” but then in the middle of the night what happens? The liver dumps glycogen into the system, and the faulty pancreas lets out a whole lot of insulin. (It’s kinda like a hose that’s been blocked for a long time, and is let loose.) The blood sugar drops to a point where the kid goes into a coma, then dies. Now you understand why doctors keep the blood sugars higher in a kid than opt for tight control.

    Also, insulin is not the enemy here. Steve would have you believe that EVIL pharma is only looking to make a buck from you. Look at it this way. Which do you prefer? Let the faulty pancreas do it’s job. take a risk? Or do you prefer to normalize everything? Thing about the pancreas is that it’s lazy. When you are injecting insulin, the pancreas takes the day off. It sees it doesn’t need to work, so it doesn’t. You are essentially preserving the function of the pancreas. (Which while Steven Cooksey advocates against big pharma – ironically Dr. Bernstein counsels this exact protocol in management of type 2 diabetics!)

    You have every right to seek out advice from whoever you want. No one could stop you Jan. That’s not even the issue here. We shouldn’t even make it the issue. (Like you are – by extension.) The issue is should we let someone who is OBVIOUSLY not qualified give individual dietary advice for a medical condition?

  • http://www.myqute.com/blog kelly

    I get you… What about Kevin Gianni or Mike Adams of NaturalNews.com? They are not doctors too. Of course it goes without saying that sick or ill people should consult their doctors for advise, and they should know unless they…hmmm…forgot because of the state they are already in. P.S. I don’t question my grandma when she tells me apples are good for me too, even when I am sick. Only thing is, I never got to see her.