A reader asked to submit a brief article on what’s required to become a registered dietician.  I had mixed feelings about it, considering how much bad advice is dispensed by dieticians who’ve been brainwashed into following the Food Pyramid.  But what the heck, we need more people in the field who don’t swallow the “artery-clogging saturated fat” line.  So here it is:

Quick Facts about Being a Registered Dietitian

If your profession has something to do with food and nutrition, it is a
must for you to learn as much as you can about the field that you are in.
This is where your understanding about the basic facts of your specific
field proves to be useful.

For example, if you want to become an RD or a Registered Dietitian, your
primary role would be to promote good health through proper eating.  If
your service as a dietitian is required by a senior citizen, for example,
you will be responsible for preparing food and developing a modified diet
to suit the health requirements of the individual.

Dietitians are also involved in research, while those in the medical
community help patients get the nutrition that they need from artificial
sources if they are unable to consume food normally.

Frequently Asked Questions about Registered Dietitians

Now that you already have an idea about the basic role of an RD, take a
look at the following list of frequently asked questions regarding their
profession:

1. What are the requirements for being a Registered Dietitian?

If you want to become a Registered Dietitian, you need to complete an
internship of at least 900 hours.  However, a nutritionist who wants to
acquire state certification may or may not be required to complete the
same number of hours of internship.

Those who would like to become certified nutritionists with a licence to
practice in their respective states would be required to complete an
internship. This usually requires anywhere from six to twelve months of
internship. If you cannot commit yourself to doing a full-time internship,
there are part-time internship programs which would take about two years
to be completed.

2. Are there state-specific requirements when it comes to the credentials
that you need to have in order to become an RD?

The agency which provides the list of the 46 states which have regulating
laws for dietitians and nutritionists is the Commission on Dietetic
Registration.  This is the credentialing agency for the American Dietetic
Association or ADA – and they are the institution which sets up
requirements such as the 900 hours needed for an RD internship.

In states such as Washington, New Mexico, North Dakota and Maryland,
dietitian is actually different from a nutritionist – while other states
do not clearly define the difference between the two professions.

3. Which agency can you consult if you have further questions regarding
the RD profession?

Check with your state’s Board of Dietetics if you have any questions
regarding the internship requirements for your state.

All in all, whether you’re a nutritionist or an RD, what’s important is to
learn about the state-specific requirements of your profession beforehand
so that there is no confusion between the terms nutritionist and dietitian
as defined by your state’s laws.

About the Author

Amanda Clary writes a non commercial blog focused on her experience on
helping her family and friends to eat healthy. She is a “Nutritionist for
Hobby” and writes on the online nutrition certification blog to help people learn how to get certified and learn all the aspects related to this job (Skills, requisites, everyday problems, upgrading, etc.).

Some of you may already be familiar with Matt Stone, either from his own blog or from his always-interesting comments on this blog. Matt and I agree on many issues, but he’s taken me to task a few times for scaring people away from starches. I asked Matt to write a guest post to explain his views more fully. He graciously agreed. Here it is:

Just Say No to In-Breeding

by Matt Stone of 180DegreeHealth.com

In-breeding is just wrong. I mean, if two things are related to one another, they just shouldn’t be comingling. Things get nasty. People talk. Banjos run wild.

But it’s totally okay for insulin resistance and glucose to hook up. They can shag all night. Get married. Have kids with the normal 10 fingers and 10 toes. All kinds of good stuff. Nothing the least bit immoral or chromosomally risky about. Why? ‘Cuz glucose and insulin resistance are unrelated.

Recently, I was asked to do a guest blog post by Fat Head Master and Commander Tom Naughton, a man who I hold in the utmost regard for translating the work of Gary Taubes into something smart, clever, understandable, and friggin’ hilarious. It’s a tough task indeed — making Taubes palatable to a broad audience is like making a low-fat product taste good. You need lots of high-fructose corn syrup. Crap, bad example, Gary Taubes is a mad HFCS hater! And Naughton too! Don’t worry, I am too. I can usually count the grams of fructose I eat per week on one hand.

Round of applause for Tom. Tom contacted me to do this guest post PRECISELY because he knows that some of my research, theories, and therefore beliefs are not congruent with his and the rest of the low-carb crowd. That is the mark of a real researcher. It still amazes me how much the disease called “like-minded camaraderie” stifles the great health debate. Some low-carb gurus are more stubborn and set in their beliefs than frickin’ vegans. I won’t name any names.

So let’s take another look into insulin resistance, because one thing I can promise you is that it is more complicated than Glucose = Insulin = Obesity, Type 2 diabetes, heart disease, and Cancer. If you get absolutely nothing out of this article, if I lose you along the way, don’t forget that. Everyone who demonizes ANY macronutrient group, especially one that can be found in the milk of every mammal on earth, is a hopeless intellectual cripple.

To begin with, let’s look at just how fragile the Carbs = Disease hypothesis is. You thought the Fat = Disease hypothesis was comical in its simplicity and oversimplification, wait ’til you get a load of this! (Note: I’m not a fan of a low-fat diet, don’t think saturated fat is harmful, and am not a vegetarian, a food-combiner, calorie-counter, or any other kind of diet-dogma nutcase. I’m a researcher with an open mind who’s tried it all).

One of my favorite examples is that continent that eats a primarily low-fat, starch-based diet, but has health that is irrefutably better than the status quo in the United States and many European countries. It’s called Asia. In reference to the British article about Big Fat Lies in which starch was demonized, I created a fun game. It’s called “Count all the obese people on a low-fat, starch-based diet.” Feel free to participate.

Another fine example that shows the greater complexity of the issue of insulin resistance and the disease that stems from it — and its relationship to dietary carbohydrate — is that of the Pima Indians.

Now, wait a second. Didn’t Gary Taubes show that the Pima Indians of Arizona are now the most obese, diabetic, insulin-resistant people on earth? Yes, he did! That I won’t deny. What I’m talking about is the Mountain Pima of Northern Mexico. They don’t live on the American reservation and they continue to follow their traditional farming practices. Their diet does not consist of mostly meat, white flour fried in vegetable oil (fry bread), Pepsi products, alcohol, and packaged “food” products — like the diet of the American Pima. They are the genetic twins of the American Pima, but they, as Andrew Weil describes, “remain lean, active, and free of the diseases of Western civilization, while their relatives from the same gene pool have ballooned into the fat, hypertensive, diabetic Indians who are now so numerous in southern Arizona and northern Mexico.”

What their diet does consist of, in contrast to the American Pima, is EVEN MORE high-glycemic carbohydrates. Their staples are corn (gasp), potatoes (shriek), beans (Holy Lectins, Paleo Man!), and other grains and tubers, along with primarily game meats. Oh, and by the way, I’m not a big fan of Andrew Weil either. Dr. Santa has some kind of boner for soy products and eats enough fructose and polyunsaturated fat to, well, be fat.

What about fructose? Taubes talks about its unique metabolic property. He calls it “the most lipogenic carbohydrate.” Is this significant? I thought high-glycemic carbohydrates that raised our blood sugar and insulin levels the fastest caused insulin resistance and the constellation of metabolic syndrome. I wonder what Richard J. Johnson, author of The Sugar Fix (2008) has to say about that?

“…we have powerful direct evidence to show that consuming too much fructose-rich sugar and HFCS causes the toxic brew of conditions known as metabolic syndrome. Moreover, this same body of research suggests that starchy foods do not induce metabolic syndrome.”

“It’s worth noting here that the glucose in starchy foods may cause blood glucose levels to rise, which stimulates the pancreas to produce insulin. But this is normal and healthy. Dietary glucose does not cause insulin resistance; fructose does.”

“And so begins a vicious cycle caused by eating high-GI foods, which overstimulate the pancreas. It’s an interesting theory, but it is not well supported by the metabolic facts. Stimulating the pancreas to produce insulin is not the problem. Your body is supposed to produce insulin when blood glucose levels rise, so that’s normal and healthy. It is insulin resistance that is closely linked to metabolic syndrome and weight gain. Glucose does not cause insulin resistance. Fructose does. Glucose does not trick your body into persistent hunger. Fructose does.”

Jesus, Dick, settle down. Take it easy, bro. We get the point. Ever think to enroll yourself in fructose-anger management class?

Of course, fructose is a low-glycemic carbohydrate. It causes the lowest blood sugar spike of any carbohydrate. It makes Pepsi (caffeine also can intensify insulin resistance), look like a better choice than a baked potato, when the metabolic effects of the two are as different as Anthony Colpo and Ghandi (they are both bald, but that’s about it). Hence the name of one of the chapters in my most recent book , “The Glycemic Index Catastrophe.”  This is just the tip of the iceberg when it comes to analyzing the glucose vs. fructose issue.  And that is one hell of a big iceberg involving leptin, the hormone with the greatest influence over metabolic rate, appetite, and levels of lipolysis (fat burning) and lipogenesis (fat storage) of any other biochemical. 

In fact, if you had to narrow down insulin resistance to one primary biochemical reason, it would be the state of “leptin resistance,” also thought to be caused primarily by fructose — whereas other dietary carbohydrates have the opposite effect. That’s why starch-based cultures in Asia and elsewhere don’t overeat, have healthy metabolisms, and are generally better off than people in places that put “sugar on top.”

So let me throw this out at you. Even if your blood sugar and insulin surge after ingesting potatoes or rice due to having insulin resistance, let it be known that those potatoes and rice didn’t cause your insulin resistance. Low-glycemic fructose played the heaviest hand in creating that fabulous metabolic state you find yourself in. Cortisol-triggering inflammation from omega 6 overload is a prime suspect as well. If you don’t believe that cortisol can trigger metabolic syndrome, then shoot yourself up with cortisone every day for a year and tell me how it goes for ya. Fructose, cortisol, and other factors, such as lack of key nutrients lost in the carbohydrate-refining process, all play a role.

Which brings up another key point. Refined and unrefined carbohydrates cannot be equated. Even Gary Taubes makes this general assertion in GCBC. T.L. “Peter” Cleave, author of Diabetes, Coronary Thrombosis, and the Saccharine Disease, on which Taubes built a large part of his hypothesis, hit the nail on the head when he stated on page 15 of that book:

“…carbohydrates should not be taken as a single group but as two very different groups; one being natural, unconcentrated carbohydrates, such as unrefined grains, potatoes, and fruits, and the other being unnatural, concentrated carbohydrates, notably refined flour and sugar.”

This was the conclusion he came to after seeing plainly that rural Zulus, eating an extremely high-carbohydrate diet, had none of the health problems of the urban Zulu, who ate a high refined-carbohydrate diet and had every facet of what Cleave called “The Saccharine Disease.” Sounds like metabolic syndrome to me:

“The saccharine disease includes dental decay and pyorrhea; gastric and duodenal ulcer and other forms of indigestion; obesity, diabetes, and coronary disease; constipation, with its complications of varicose veins and hemorrhoids; and primary Escherichia coli infections, like appendicitis, cholecystitis (with or without gall-stones), and primary infections of the urinary tract. The same applies to certain skin condition. Not one of these diseases is for practical purposes ever seen in races who do not consume refined carbohydrates.”

Taubes was right on track to echo this conclusion early on in GCBC (which is one hell of a badass book overall)…

“If cavities are caused primarily by eating sugar and white flour, and cavities appear first in a population no longer eating its traditional diet, followed by obesity, diabetes, and heart disease, then the assumption, until proved otherwise, should be that the other diseases were also caused by these carbohydrates.”

… but veered into Keto Land when he stepped up to the plate in the bottom of the ninth, which is a massive, unfounded, unwarranted, unnecessary, and unfortunate leap.

Yep, it wasn’t until the Epilogue that he sings the praises of a ketogenic diet, which is, don’t say I didn’t warn ya, metabolic suicide if continued long-term. Trust me. My blog has become a sanctuary for low-carbers in metabolic rehab. And I low-carbed for 3 years and felt all the initial benefits too — weight loss, energy, clear skin, fewer allergies — then watched them all fade away, along with my emotional state, and come back with a vengeance. Low-carb is seldom a happily-ever-after, and don’t be stubborn if you start having problems with it. End rant.

The final question is simply, “Where do we go from here?”

If we, as a race of people, are becoming increasingly insulin-resistant — then does that mean that the right “diet for our metabolic type” is a low-carbohydrate diet? Well, it’s a huge step in the right direction that we have good folks like Michael Eades and Uncle Tom Naughton that can at least step outside of the “repeat after me: artery-clogging saturated fat” wacky world of the American Dietetic Association. Finally, we’re getting somewhere at least, and see that our woes are all about hormones, not willpower.

But I think the grandest solution is not to cater to the metabolic disorder known as insulin resistance by running from carbohydrates in fear. Rather, my ambition as a researcher and writer is to truly find the pathways that allow us to topple insulin resistance completely — freeing us to eat whatever macronutrient combo we feel like without compromising our health. We don’t have all the answers yet, but we’re making progress. Dropping my fasting and postprandial glucose levels by 25% recently is a testament to the fact that it can be done. Eating two baked potatoes with my blood sugar peaking at 75 mg/dl one hour later is a metabolic feat few can claim.

Most importantly, people are overcoming hypothyroid symptoms and a low body temperature very quickly, and without medication, by following some of my ideas. I think this is key, as the most successful doctor in history at preventing type 2 diabetes and heart disease (Broda Barnes) did so by keeping the metabolism high, but had to use medication to do it.

And therein lies the true danger of uber-low-carbohydrate diets. All my experience tells me that, the first few years aside, a low-carbohydrate diet and certainly a full-blown ketogenic diet exacerbates a low metabolism. It is not a matter of having a genetically-doomed dysfunctional thyroid gland; it is fixable, and it lies at the core of the health problems we’ve seen explode over the last century. This is why all prolonged restricted diets, low-carb included, in the words of Robert Atkins himself (from page 303 of Dr. Atkins’ New Diet Revolution):

“…tend to shut down thyroid function. This is usually not a problem with the thyroid gland but with the liver, which fails to convert T4 into the more active thyroid principle, T3. The diagnosis is made on clinical grounds with the presence of fatigue, sluggishness, dry skin, coarse or falling hair, an elevation in cholesterol, or a low body temperature.”

To that I will add constipation, bad moods, heartburn, cold hands and feet, and a whole host of other minor but significant health problems. To get an idea of how “shutting down the thyroid” can manifest, Mark Starr’s chapter on Hypothyroidism symptoms is 83 pages long.

This is why the acronym FAD is thrown around 180DegreeHealth quite frequently. The AD stands for All Diets. I’ll leave it up to your imagination as to what the F stands for.

Anyway, if you like compelling health conversation, stop by my blog at www.180degreehealth.blogspot.com. It is a cesspool of agenda-free health information and discussion. It is also free to become a member of my website and access long-winded but very fascinating monthly eZines and podcasts. Go to www.180degreehealth.com to get a piece a that.

Thanks everyone, and best of luck with your health pursuits. I hope that you too can someday achieve that blessed metabolic state that allows you to do what Tom’s son and way-out-of-his-league wife do: sit down and eat whatever they want, until they are full, without becoming obese or diabetic.

Thanks once again to Tom for keeping the conversation going. Clearly mankind hasn’t solved all the riddles of health yet. But thank the Lord Almighty that the low-carb movement got us all eating fatty meat and butter again. What a stupid phase that low-fat thing was!

Thank you, Matt, for sharing your research and your ideas. My wife is indeed out of my league, but fortunately for me, she doesn’t believe it. — Tom

A couple of interesting articles appeared in the British press this week. One was headlined The Big Fat Lies about Britain’s obesity epidemic, written by the author of a just-published book titled Big Fat Lies: Is Your Government Making You Fat?  (The title is a question.  The answer is yes.)  I haven’t seen the book and I’m not even sure if it’s available in the U.S., but the article is a great read … like a quick synopsis of Fat Head or Good Calories, Bad Calories.  Here are some edited quotes, with my comments:

For the past 30 years we’ve been told to eat less and exercise more, to cut back on calories and on saturated fat and, on the whole, we’re doing it. Our calorific intake between the years 1974 and 2004 decreased by 20 per cent. We are eating about 20 per cent more fruit and vegetables than in the Seventies. We are doing approximately 25 per cent more exercise than we were in 1997. But are our waist lines shrinking? No.

Sounds familiar, doesn’t it?  Jogging and joining a gym became popular here in the ’70s as well … along with pet rocks, Jimmy Carter, disaster movies, disco, and calling someone you just met to say, “Uh … I think you might need to go see your doctor for a test.”  I don’t remember anyone jogging or working out when I was a kid in the ’60s.  I also don’t remember seeing many fat people in our small town.

We’re following Government advice on how and what to eat, but that advice is so wrong it is actually making us fatter. The endless message of ‘eat less, do more’ has never been proven using proper clinical trials. And we’ve only started to get really fat since governments started promoting the current low-fat health messages, back in the early Nineties.

Ah, so we probably are fatter than the British.  Our government started pushing low-fat diets in the early ’80s, so we have a ten-year head start.

The Government’s Food Standards Agency (FSA), among others, is pumping out a template of a balanced diet that is based on flawed science that I believe is responsible for thousands of people developing health problems. The co-defendant in the dock with the Government is starch.

Thousands of people developing health problems?  What’s the population of the U.K.?  I’d say it’s probably more like millions, but I guess she’s being cautious.

Another big fat lie we are fed is that we should eat less fat. The simple message is: saturated fats are high in calories and are making us fat. Saturated fats cause heart disease. And most people believe that the fear of saturated fat is based on robust science – why else would the Government be putting out this advice?

In our country, it’s to sell all those subsidized grains.  In Britain, perhaps it’s to provide job security for the National Health Service.

Let’s look at the scientific evidence. When studies have been done with high saturated fat levels combined with low levels of starch and sugar, the subjects not only lost weight faster than the low-calorie, low-fat option but – perhaps more interestingly – the cholesterol profile of the subjects on the high-fat diet was better.

That’s what happened to me when Dr. Mike Eades challenged me to try a high-fat, low-starch diet and check my cholesterol before and after.  My cholesterol dropped and my HDL went up.  But I have to admit, I was kind of nervous waiting for those results to come back.

And the other lie we are fed: exercise more. There is no doubt that exercise is an excellent tool for weight maintenance and is fantastic for our general health. But what is really misleading is the idea that exercise will significantly help you to lose weight.

I attended the European Obesity Conference in 2006, at which Sir Neville Rigby, the former director of policy on the International Obesity Taskforce, referred to several major European studies showing categorically that exercise had no significant impact on the weight of the participants.

Since the conference, one of the studies that has added fuel to the doubters’ fire is the Early Bird Study in Plymouth. This lost its Government financial backing because it showed that exercise made no difference to the weight or weight loss of children.

Anyone who believes governments fund research because they’re interested in the truth should read that last sentence ten times — out loud.  And anyone who believes researchers funded by government grants don’t occasionally fudge their results to keep the money-spigot open should read it twenty times.  (I don’t actually believe reading the sentence twenty times will enlighten the “government is our savior” crowd, but given their slow comprehension, it should keep them occupied and out of trouble for a day or two.)

I’ve heard so many media pundits lamenting about all the lazy, fat Americans waddling around these days, I guess it’s oddly comforting to know our friends across the pond are dealing the same issues.  And I must admit, I felt the same way when I read about the those Swedish Weight Watchers members who collapsed the floor during their weekly weigh-in.  My media-induced impression was that everyone in Sweden is named Helga or Lars and looks like a model.

So the British government, like ours, is handing out advice that makes people fat.  That made it especially interesting to learn how a former leader of the British government trimmed down.  See if this diet, as explained in the online article, sounds familiar:

She fought hard to get the nation’s finances back in trim. But only now can the secret of Margaret Thatcher’s own diet be revealed – 28 eggs a week. The eggs, along with cucumber, spinach, tomatoes, steak and the odd swig of whisky, went towards a strict meal regime that promised to help her shed 20lb in two weeks.

The diet included a daily breakfast of grapefruit, one or two eggs, black coffee or clear tea. Two eggs were served in each weekday lunch, while steak, lamb chops and fish were the staple of most dinners.

Her political opponents probably wish the four eggs per day had given her a heart attack, but she’s 84 and still alive.  The Daily Mail published a graphic of the diet, which I’ve reproduced below.

Looks as if her only significant carbohydrates were grapefruit and a piece of dry toast here and there.  A half-grapefruit contains about 12 net carbs.  A piece of toast is around 20.  That means Ms. Thatcher was on something much like the induction phase of the Atkins diet. Naturally, one of the experts from the British Dietetic Association had to sound a warning:

These kinds of diets are very effective in losing weight quickly but you feel terrible because your blood sugar levels go right down.  You feel cold, shivery, lethargic, fuzzy-minded and weak and can get bad breath.

Ah yes, in populations where type 2 diabetes is at epidemic levels, we certainly wouldn’t want our blood sugars to go down.  We’ve got to keep that glucose spiking all day long to avoid feeling weak.  That’s why cavemen were such wimpy specimens — not enough bread in their diets.

I don’t doubt that some people feel shivery and lethargic after giving up refined carbohydrates.  It’s called withdrawal.  People who give up heroin don’t feel so hot either, but nobody looks at them and says, “Geez, you look terrible!  Shoot up, for Pete’s sake!”

According to the news stories, Ms. Thatcher wanted to lose weight more for the cameras than for her health.  Well, it’s sad but true: image matters in politics.  (If not, Richard Nixon would’ve been elected president in 1960 … although losing the cemetery vote in Chicago didn’t help his chances either.)  It’s tough to live up to the nickname “The Iron Lady” if the iron appears to be jiggling.

But apparently there’s plenty of jiggling going on in Britain these days, just as there is here.  Too bad our governments decided they should tell us how to eat.  Now they’re piling up huge debts to pay for the consequences (meaning we’re all piling up huge debts, since we pay the taxes.)  Pundits in both countries say our health-care systems are broken.  That may be true — but our health got broken first.