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The woman in the coffee shop looked confused as she surveyed the array of baked goods. She fancied something to eat with her coffee but explained that she was diabetic. She asked the barista for his advice and he was very helpful.
“We are really into our nutrition here,” he said. “Try this muffin. It’s sweetened with agave and maple syrup – so no sugar – and to pack an extra nutritional punch, we’ve added protein powder. It would be perfect for you!
“By the way, are you type 1 or 2?” he asked as she paid for her drink and the muffin.
I managed to drink my coffee quietly as she took advice on how to manage her type 1 diabetes from the coffee shop guy. She would have had advice from her doctor and perhaps a dietitian – both licensed healthcare professionals – but she chose to take it from someone who was selling her something.
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It is right that we hear different voices as we develop public health guidelines, and that is why the expert policy group formed by the Department of Health was multidisciplinary. The priority of this policy group was to use the best available science to develop resources to help the public make better-informed food choices.
Those 2016 healthy-eating guidelines and food pyramid were developed from a report of the most recent and robust international evidence collated by expert researchers commissioned by the Health Research Board. This evidence was then reviewed by dietitians, doctors, nutritionists and nurses from the Department of Health, the HSE, Safefood, the Irish Nutrition and Dietetic Institute, the Food Safety Authority of Ireland and Healthy Ireland. Contrary to speculation, there were no representatives from the food industry involved in the development of the food pyramid.
The pyramid has been revised. Science moves on and population health guidelines and policy must reflect this.
The delivery of specialist nutrition advice to patients should be done by a registered and regulated dietitian. Undergraduate dietitians train for four years and have clinical placements in hospitals and the community. When it comes to the complex nutritional needs of patients, other health professionals look to dietitians for expert advice. When it comes to recommending what a nation should eat, health policy advisers do the same.
The problem is that Ireland does not have enough dietitians. The HSE employs about 455 dietitians in Ireland, 120 of whom operate in the community. Twenty-two dietitians graduate from the undergraduate course each year. There are insufficient training supports in place for students, so it’s going to take a long time to achieve the critical mass needed to provide support for Irish patients.
Into the void
Into this vacuum steps the “nutrition experts” with high profiles to market their own brand of advice. Many of these individuals do courses that are not recognised by any university or do no course at all. Their qualifications and activities are not regulated and they are not subject to any sanction if there is misconduct, mis-selling or if they get it wrong. Very often they simply don’t know what they don’t know. Conversely, dietitians must be registered with Coru, the regulator for health and social care professionals, and can be sanctioned. This is to ensure the public is protected.
Qualified clinical professionals are obliged to give advice that is scientifically sound and free of bias. Research is conducted in accordance with internationally recognised guidelines so that personal views or anecdotes, however compelling, do not influence results. Cherry-picking from papers on the internet, without the capacity to place them in the correct clinical context, is not the way to provide advice to the public or to complex patients.
The constant baiting of experts on social media, and disdain for clinical professionals who have trained for years, is akin to those who deny climate change or the efficacy of vaccines because it does not sit with their own agendas, experiences or the books they are selling.
Nutrition, like fashion, has many opinions on what constitutes good taste, with chefs, celebrities, models, fitness gurus and anyone with a social media presence all weighing in. The voice of the qualified professional can be hard to hear above this nutrition noise. But it's worth remembering, there is no recourse if you take your advice from someone who is not regulated and is selling you something: Caveat Emptor.
- Jennifer Feighan is chief executive of the Irish Nutrition and Dietetic Institute