Flat tummy . . . or, Why your dietitian is fat

When I go to the hospital, I am continually amazed at some of the hospital staff: 5 ft 4 inch nurses weighing over 200 lbs, etc.

But what I find particularly bothersome are some (not all) hospital dietitans--presumably experts at the day-to-day of healthy eating--who waddle through the halls, easily 40, 50, or more pounds overweight. It is, to say the least, credibility-challenging for an obese dietitian to be providing nutritional advice to men or women recovering after bypass or stent while clearly not in command of nutritional health herself.

What's behind this perverse situation? How can a person charged to dispense "healthy" nutritional information clearly display such clear-cut evidence of poor nutrition?

How would you view a success coach dressed in rags? Or a reading coach who can barely read a sentence?

Easy: She follows her own advice.

Hospital dietitians are essentially forced to adhere to nutritional guidelines of "official" organizations, such as the American Heart Association and the USDA. There is some reason behind this. Imagine a rogue dietitian decides to advocate some crazy diet that yields dangerous effects, e.g., high-potassium diets in people with kidney disease. There is a role for oversite on the information any hospital staff member dispenses.

The problem, of course, doesn't lie with the dietitian, but with the organizations drafting the guidelines. For years, the mantra of hospital diets was "low-fat." More recently, this dated message has begun--only begun--to falter, but now replaced with the "healthy, whole grain" mantra. And that is the advice the hapless dietitian follows herself, unwittingly indulging in foods that make us fat.

Sadly, the "healthy, whole grain" message also contributes to heart disease via drop in HDL, increased triglycerides, a huge surge in small LDL, rise in blood sugar, increased resistance to insulin, tummy fat, and diabetes. Yes, the diet provided to survivors of heart attack increases risk.

The "healthy, whole grain" message also enjoys apparent "validation" through the enormous proliferation of commercial products cleverly disguised as healthy: Cheerios, Raisin Bran, whole grain bread, whole wheat pasta, etc. The "healthy, whole grain" message, while a health disaster, is undoubtedly a commercial success.

I'll bet that our fat dietitian friend enjoys a breakfast of healthy, whole grains in skim milk, followed by a lunch of low-fat chicken breast on two slices of whole grain bread, and ends her day with a healthy meal of whole wheat pasta. She then ascribes her continually climbing weight and size 16 figure to slow metabolism, lack of exercise, or the once-a-week piece of chocolate.

Wheat has no role in the Track Your Plaque program for coronary plaque control and reversal. In fact, my personal view is that wheat has no role in the human diet whatsoever.

More on this concept can be found at:

What's worse than sugar?

The Wheat-Deficiency Syndrome


Nutritional approaches: Large vs. Small LDL

Are you wheat-free?

Comments (19) -

  • Brock Cusick

    12/20/2008 5:26:00 PM |

    Dr. Davis,

    In your clinical practice, do you see good results from patients who continue to eat oats and/or brown rice as long as they cut out sugar, wheat and corn?  

    I ask because Dr. Weston Price's research found examples of cultures that used these grains (oats and rice) while continuing to exhibit signs of good health. He did not have access to modern diagnostics however, so perhaps he missed some indicators.

    Kind regards,

    Brock Cusick

  • baldsue

    12/20/2008 7:16:00 PM |

    Each time I contemplated seeking advice from a dietitian, I changed my mind after I saw the dietitian and decided I was doing well enough on my own.  Never felt like I could believe or trust dietary advice from someone whose BMI was obviously higher than my own.

    And I love my new flat stomach.

  • Anonymous

    12/20/2008 9:44:00 PM |

    My father had surgery 7 years ago at a well known Indianapolis hospital. During visitation I could not help but notice how overweight (some obese) the female receptionists and nurses were. They all looked to be in their early to mid 30s.I was speechless.

  • Anonymous

    12/21/2008 7:40:00 AM |

    that's what can happened even to a best-selling author of diet books http://tinyurl.com/8d4d4m

    in my country there's a saying "a shoemaker that walks on bare feet"

  • Anonymous

    12/21/2008 7:42:00 PM |

    http://www.ncbi.nlm.nih.gov/pubmed/19083495

    Long-term consumption of a carbohydrate-restricted diet does not induce deleterious metabolic effects

  • Leniza

    12/22/2008 5:51:00 PM |

    I don't think that overweight dieticians (and nurses, and doctors)even follow their own advice. Not that that advice isn't garbage anyway, but I doubt that whole grains and lots of fruit and lean meats make up the bulk of their diets. It's probably more the case that these people aren't following the rules they give their patients (not that the rules would work, anyway). "Knowing" something and choosing to do it are two different things. I completely agree with you on sugar and wheat, but that doesn't mean I'm not going to indulge without guilt during the holidays (I don't have any health problems, though.)

    It's like with smoking. People KNOW it's bad for them, but they still do it. I know several doctors who tell their patients to quit smoking, but who smoke like chimneys themselves. I used to work with a PULMONARY PATHOLOGIST who was a chain smoker.

  • Jean-Luc Boissonneault

    12/22/2008 7:40:00 PM |

    Thank you, I'm so glad you said this! This makes me sick! I say practice what you preach or don't preach at all. At my personal training centre, my trainers are all in good shape. I tell them it's like a hopelessman giving financial advice.

  • Anonymous

    12/23/2008 3:27:00 PM |

    Dr. Davis, thought you'd find this interesting:

    http://www.sciencedaily.com/releases/2008/12/081215184308.htm

    Journal reference:

       1. Piconi et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness.

    The FASEB Journal, 2008; DOI: 10.1096/fj.08-119578

  • Ricardo Carvalho

    12/29/2008 1:16:00 PM |

    Dear Dr. Davis, I suppose the WHO wants everyone to be fat, don't they?! Nutritionists simply follow these poor recommendations. Who's fault? -> http://www.euro.who.int/nutrition/20030321_1

  • extropolitca

    12/29/2008 11:03:00 PM |

    WHO is right in his recommendation.
    Right with the mean of the people living on Earth.
    I'm italian, living in Italy.
    Mediterranean diet (the real deal) is very good if you are a peasant in agricultural job doing hard work (4.000 Kcal/day). Than you can eat your pound or two a day of bread plus salami, cheese and olive oil and fruits, be full, lean and healthy.

    You move to city, start to work in an office, cut all to 2.000 kCal/day proportionally and you find yourself hungry, gaining fat and lacking minerals and vitamins with the same diet.

  • Juhana Harju

    1/1/2009 1:22:00 PM |

    This is a naughty blog entry... but I agree. Smile I have been pondering the same question.

    While I approve the use of whole grains, I agree with Extropolitcan's view that reduced energy expenditure should lead to changes in diet. We should probably use more nutrient dense foods. I would also like to promote the idea of moderation, which is really a beautiful and positive idea, not appreciated enough in our Western culture.

    Wishing everyone a Happy New Year,

    Juhana Harju
    BMI 22

  • Anonymous

    11/25/2009 5:35:44 PM |

    I've seen more fat doctors than fat dietitians. I'm a dietitian and I'm at a perfect body weight, AND I follow my own advice, which is to eat in moderation. This is an extremely unfair stereotype to make. Between doctors and nurses thinking they know all about nutrition with minimal education in it, and patients asking for advice and then telling you that you're wrong right to your face, it's no wonder clinical nutrition has such a high burnout rate and low rate of job satisfaction.

  • Anonymous

    5/13/2010 1:52:39 AM |

    I'm a fat dietitian, and we fat dietitians know how much we are hated.

    I find it interesting that the topic of "dietitians that follow their own advice" had to be written with such contempt. Consider the message your readers came away with...many commented on their contempt of fat people rather than grasping the diet advice you are promoting. "A naughty post" BMI 22 wrote. Why naughty? Because ridiculing someone for being fat is still acceptable behavior in this part of the world, even though we know we should not "throw stones". Consider promoting your message without inciting the contempt of others.

    In addition, consider how being fat can't be hidden, the way other characteristics can. For example, what physical characteristics are required of a realtor, plumber, grocery clerk, insurance salesperson? It might not matter if they were fat since they are not dispensing "health" advice, but consider all of the unseen ways they might deviate from the norm.

  • Anonymous

    7/6/2010 6:47:04 PM |

    I'm a dietitian as well, and although not "fat", I find it challenging to maintain weight. This not because of any "bad" advice I'm giving, it's just the way life is sometimes.

    That said---I hope that someday you are publicly ridiculed for something you struggle with. I hope you are ridiculed for your imperfections, which I'm sure you have. Dietitians aren't any more perfect than anyone else. Just because we understand the physiology behind things doesn't mean that life is any easier for us. Maybe the "fat dietitian" in the hallway has things going on in her life that you don't know about, and you should keep your "fat" mouth shut about it.

  • buy jeans

    11/4/2010 6:34:29 PM |

    Sadly, the "healthy, whole grain" message also contributes to heart disease via drop in HDL, increased triglycerides, a huge surge in small LDL, rise in blood sugar, increased resistance to insulin, tummy fat, and diabetes. Yes, the diet provided to survivors of heart attack increases risk.

  • Michael Scott

    10/1/2011 2:31:15 AM |

    I'm 69 and have been on Atkins, level one, for a little more than eleven years.  I now consider myself a "former" overeater because as long as I remain below twenty grams of carbs per day, I'm totally in control of my eating.  Even after eleven years I understand that my chances of ever being able  to eat more than 20 grams of carbs per day will never happen!  Like an alcoholic, whenever I reach my "carb limit" I have to stop at that point.  I can't eat even a single bite of any grain products without "falling off the wagon".  A single bite of bread or pizza crust and I become an alcoholic with food!  I'm just amazed that more dietitians  are not overweight eating grains.  Anyone who can eat grains and still remain under 400 pounds has my admiration.

    Mike Scott

  • Dr. William Davis

    10/1/2011 1:45:47 PM |

    Hi, Mike--

    Your experience is something like my personal experience, though my carbohydrate cutoff is around 30 grams per day. Some of us are just not equipped to handle the high insulin requirement, while others can get away with much more. Find your individual path and stick to it!

  • Michael Scott

    10/1/2011 3:21:52 PM |

    This information is for the dietitian who suggested eating in moderation.  Is this the same advice we give to an alcoholic?  Do we tell them to drink in moderation?   About the only advice an over eater receives from a doctor or dietitian is:  Starve yourself for the rest of your life and don't forget to kill yourself exercising!  Now we all know that these may not be their exact words, but trust me that is exactly what an over eater hears just before going into “full panic mode”.  When my eating was “totally out of control”, I had as much chance of stopping at one slice of bread as a “down and out” alcoholic has of stopping after one drink!  Until we all understand this, there is almost no long term hope for a “fat” person.  We do not suggest that an alcoholic drink in moderation for a very good reason.  How can we advise someone with a major eating disorder to eat the very foods they are addicted too.  Had I not given up whole grains, fruit and any high carb vegetables, I would now be 400 pounds.  I learned this thanks to Dr. Atkins.  If not for him I wouldn't be here now.  How many 400 pound, 69 year old men do you know?  Moderation of grains/alcohol will never work.  

    Michael Scott (again)

  • Dr. William Davis

    10/2/2011 2:44:08 PM |

    Well said, Michael!

    You make a crucial point: How many 400 pound, 69 year old men do you know?

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"Millions of needless deaths"

"Millions of needless deaths"

"Millions of needless deaths" is the title of an editorial by Life Extension Magazine's Bill Faloon.

". . . If vitamin D’s only benefit was to reduce coronary heart attack rates by 142%, the net savings (after deducting the cost of the vitamin D) if every American supplemented properly would be around $84 billion each year. That’s enough to put a major dent in the health care cost crisis that is forecast to bankrupt Medicare and many private insurance plans."

Although I don't agree with all the over-the-top commentary that issues from Mr. Faloon or Life Extension (although I sit on their Medical Advisory Board), I agree with virtually all of the issues he raises with vitamin D.

Despite the enormously compelling observations of vitamin D potential effects in populations, the medical community's reluctance comes from the lack of treatment data. In other words, what we lack are long-term data on vitamin D supplementation vs. placebo on rate of heart attack, vitamin D vs. placebo on risk of colon cancer, etc.

The data that exists connecting vitamin D levels with cardiovascular risk originate from three population observations:

1) The NHANES data in 16,000 participants showed 20% increased risk of cardiovascular events in those with vitamin D levels <20>20 ng/ml after factoring in all standard risk factors.

Another NHANES analysis showed the high prevalence of vitamin D deficiency in those with cardiovascular disease.

2) A German study of 2500 participants that showed showed the lowest quartile of vitamin D levels (<13.3>28.4 ng/ml.

3) The Health Professionals' Follow-Up Study of 18,000 males showed a 2.4-fold increase in cardiovascular events in those with vitamin D levels <15>30 ng/ml.

While we lack treatment data (vitamin D vs. placebo) in a large population, we do have data that Suzie Rockway, Mary Kwasny (both from Rush University, Chicago) and I generated on the effect of vitamin D as a part of a broader treatment program on coronary calcium scores:

Effect of a Combined Therapeutic Approach of Intensive Lipid Management, Omega-3 Fatty Acid Supplementation, and Increased Serum 25 (OH) Vitamin D on Coronary Calcium Scores in Asymptomatic Adults.
Davis W, Rockway S, Kwasny M. Amer J Ther 2008 (Dec 15).

The impact of intensive lipid management, omega-3 fatty acid, and vitamin D3 supplementation on atherosclerotic plaque was assessed through serial computed tomography coronary calcium scoring (CCS). Low-density lipoprotein cholesterol reduction with statin therapy has not been shown to reduce or slow progression of serial CCS in several recent studies, casting doubt on the usefulness of this approach for tracking atherosclerotic progression. In an open-label study, 45 male and female subjects with CCS of >/= 50 without symptoms of heart disease were treated with statin therapy, niacin, and omega-3 fatty acid supplementation to achieve low-density lipoprotein cholesterol and triglycerides /=60 mg/dL; and vitamin D3 supplementation to achieve serum levels of >/=50 ng/mL 25(OH) vitamin D, in addition to diet advice. Lipid profiles of subjects were significantly changed as follows: total cholesterol -24%, low-density lipoprotein -41%; triglycerides -42%, high-density lipoprotein +19%, and mean serum 25(OH) vitamin D levels +83%. After a mean of 18 months, 20 subjects experienced decrease in CCS with mean change of -14.5% (range 0% to -64%); 22 subjects experienced no change or slow annual rate of CCS increase of +12% (range 1%-29%). Only 3 subjects experienced annual CCS progression exceeding 29% (44%-71%). Despite wide variation in response, substantial reduction of CCS was achieved in 44% of subjects and slowed plaque growth in 49% of the subjects applying a broad treatment program.


I also summed up the data as of early 2008 in a Life Extension article:

Vitamin D's Crucial Role in Cardiovascular Protection


I do agree with Mr. Faloon: It's time to take the vitamin D issue very seriously. Personally, I think it is foolhardy to not correct vitamin D deficiency, even in the absence of long-term treatment data.

Should we subject people living in tropical climates with vitamin D blood levels of 90 ng/ml to long-term observation? Though that has not yet been done, it has been done--in effect--through observations on the prevalence of diabetes, heart disease, and various cancers by latitude: the farther away from the equator, the greater the prevalence of these diseases.

That's more than good enough for me.

Comments (4) -

  • Anonymous

    1/7/2009 1:11:00 AM |

    How is it possible to reduce the risk of heart attack by 142%? I studied a different math, I guess.

  • Jenny

    1/7/2009 7:22:00 PM |

    Dr. Davis,

    Though I have seen the research suggesting that low Vitamin D is strongly associated with diabetes, I wonder if you can comment on this study that found that there was no change on insulin sensitivity when Vitamin D levels were raised in people without diabetes.

    Glucose tolerance and vitamin D: Effects of treating vitamin D deficiency. Kamilia Tai et al.

    Your study looks very interesting, and I hope you can get it published. But because you altered several variables at once it is not possible to attribute the effect to any of the variables in isolation.

    I am eagerly awaiting more research that will see if Vitamin D supplementation actually reverses health conditions, or whether high levels are a marker of some other problem--changes in fat tissue, kidney function, etc.

  • vin

    1/8/2009 4:20:00 PM |

    Rockway,Kwasny study you quoted showed reduction in calcium count in 44% and slow progress in 49% of the people. Figure of 44% success rate is very disappointing, seeing the test subjects were given almost the same food and supplement regime as you recommend in your blog.
    What is wrong with the test? Why isn't the success rate 90%?

  • buy jeans

    11/3/2010 12:26:59 PM |

    While we lack treatment data (vitamin D vs. placebo) in a large population, we do have data that Suzie Rockway, Mary Kwasny (both from Rush University, Chicago) and I generated on the effect of vitamin D as a part of a broader treatment program on coronary calcium scores:

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