Maryke, Queen of (Vegan?) Dietitians

Hypocrisy of the Church

Religions are often accused of being hypocritical. When you set a high moral standard, you often end up with egg on your face when you do not live up to it. Whether it is paedophilia and the Catholic Church or Buddhists releasing birds as a good deed, we can prosecute, punish, amend behaviour and seek forgiveness.

But what of those who act hypocritically to begin an inquisition as did Bloody Mary?

In the context of dietitians, what if they claim to be an evidence-based organisation and then proceed to ignore scientific evidence? What if they apply their scientific knowledge inconsistently? Should there be a ‘Special Place in Hell’ for them?

Veganism

While vegetarianism has been around for a long time, its more extreme sibling, veganism, traces its named history to 1944. 

Veganism has its proponents and critics. The PCRM, related to the animal rights organisation PETA, has championed the research and arguments for the healthiness of the vegan lifestyle.

Let me state that I have no problem if you choose to follow a diet for any reason. That includes fasting if that is the informed effect that you wish to achieve. I have nothing against vegans personally, although I do not agree with them if they use ‘dodgy’ scientific reasoning to make claims that the vegan diet is superior for health.

One voice against veganism is Lierre Keith (a former vegan) who has written a book criticising veganism. Dr Zoe Harcombe has summarised that book well in her blog post if you wish to understand the case against veganism. You can read the book if you want the detailed case.

To be balanced here is a pro-vegan book and a link to a pro-vegan site.

While there is an abundance of some nutrients on a vegan diet, we learn from the pro-vegan site:

Vegans are vulnerable to deficiencies in vitamins B12 and D, omega-3 fatty acids, and calcium. …  Vegans need to supplement B12 because there is no reliable source in their diet.

So it is no secret and even the pro-vegans will tell you that a vegan diet has dietary risks and you must plan that diet well and need supplements to be healthy.

Veganism & Dietetics

We also learn from this website that a vegan diet is supported by Canadian Dietitians and Australian Dietitians among others. In fact, there is wide support for the vegan diet across dietetic organisations internationally. British Dietitians even have an alliance with the Vegan Society and an MOU.

South African dietitians (ADSA) don’t seem to have public statements about their policy on veganism however they endorse vegan nutritional science by promoting veganism and a number of their registered dietitians support plant-based diets and practice vegan dietetics. Like Canadian, British and Australian dietetics organisations, South African dietitians also belong to the International Confederation of Dietetic Organisations. The next ICDA Congress will be in Cape Town in 2020.

It should not be surprising that internationally all dietitians sing from the same hymnbook. Vegans would make very good clients for dietitians given that a vegan diet needs to be well planned and supplemented to be healthy.

LCHF & Dietetics

Unlike veganism, which has the full support of dietitian’s organisations, a low carbohydrate (Banting or LCHF) diet is labelled by them as a diet that is dangerous. I won’t repeat the volumes that have been written about the dietetic organisations’ fear and loathing of low carb. Here is just one example from the Dietitian’s Association of Australia.

What is the reason for this? Low carbohydrate diets involve avoiding starchy, sugary and vegetable oil-based processed foods from the food industry that are a regarded by many as a modern scourge to health. LCHF eaters are more likely to be shopping at the farmers’ market, cooking food from scratch, and avoiding ‘soda pop’ and boxed cereals. The case has been made that commercial interests (such as sponsorships by the food industry of dietetic associations) are behind their non-acceptance of low carb diets.

Double Standards?

Vegan diets strictly omit all animal-derived products notably meat, eggs, fish and all dairy. LCHF diets limit or avoid sugary fruits, starchy vegetables and grains but include low carb fruits & vegetables, dairy, meat, eggs, and fish. The picture below gives you an idea of just a few of the many foods that are typically included in a low carb diet.

If there were any valid concern over the healthiness of LCHF diets then surely such a diet could be well planned by a dietitian just as a vegan diet is? If the diet was perhaps deficient in a vitamin surely it could be supplemented as vitamin B12 must mandatorily be on a vegan diet? Are dietitians competent with the vegan diet and clueless to deal with other diets that do not include certain foods? It seems unlikely. Instead, it smells like hypocrisy and I was not the first to notice this.

Complaint Against Prof. Tim Noakes

You may be aware that Claire Jusling Strydom, the former ADSA president, lodged a complaint with the Health Professions Council of South Africa (HPCSA) against Prof. Tim Noakes, a distinguished South African scientist and medical doctor. This was because of this tweet that he made three years ago suggesting that babies can be weaned onto LCHF foods. The tweet was in response to a question by a lady who was asking on twitter about the best foods given that she was breastfeeding and some elements of her food might come through her breast milk. The lady in question was not his patient. The resulting inquiry has been described as the nutrition trial of the century. If you wish you can read more of the details here.

The ADSA stated about its complaint:

The complaint was prompted by a tweet from Professor Tim Noakes offering low carbohydrate and high fat complementary feeding advice to a mother. This advice is considered unconventional advice that is not evidence-based nor in line with the current paediatric food-based dietary guidelines for South Africa or any international paediatric dietary guidelines.

In summary, during and after an inquiry lasting three years:

1. The ADSA usurped responsibility for the complaint from its former president.
2. Well before a ‘verdict’ had been reached, the HPCSA falsely pronounced Prof. Noakes ‘guilty’ in a press release.
3. An investigative journalist has written that the food industry may be behind this trial.
4. Prof Noakes was actually found ‘not guilty’ on all ten points.
5. During the trial, he presented the evidence-base for an LCHF diet and why it is healthy. You can review that substantial evidence-base conveniently divided into 80 short videos of testimony on youtube.
6. The HPCSA has now appealed the decision of its own tribunal and this debacle is set to continue.

Common Sense Check

As a quick check, look at the picture above showing a small subset of foods that would commonly be understood to be LCHF by the public. It was taken from one of the prime consumer websites for LCHF (dietdoctor.com). Do those foods look unhealthy for a young infant as they transition to solid food? A quick common sense test tells you something more than the salmon in the picture is fishy with this whole affair.

Let us have a closer look at the critical part of SA’s paediatric guidelines for a child after six months of age as they begin complementary feeding and start the move to more solid foods:

PAHO and WHO provide the following guidelines with regard to complementary foods that can provide adequate nutrients to meet the growing breastfed child’s nutritional needs: • Provide a variety of foods to ensure that nutrient needs are met. • Meat, poultry, fish and eggs should be eaten daily, or as often as possible. At this age, vegetarian diets cannot meet nutrient needs, unless nutrient supplements or fortified products are used. • Vitamin A-rich vegetables and fruit should be eaten daily. • Provide diets with an adequate fat content. • Use fortified complementary foods or vitaminmineral supplements for the infant, as needed.

Again, look at just the small subset of LCHF foods in the picture.  Do you see a major problem? To me, this looks compliant with the guidelines yet the ADSA was not satisfied. Note the text in green above. You may well ask that if a vegetarian diet is explicitly called unsuitable, then what of its more extreme sibling the vegan diet?

SA Dietitians and Vegan Diets for Infants

Well, you may be surprised to learn that registered South African dietitians do not seem to have a problem with the vegan diet for infants.

In an article in defence of a vegan diet for infants (in response to concerns over the death of an Italian child fed vegan food) South African registered dietitian Jessica Kotlowitz was quoted as saying:

So if any of the people quoted in this article really want to make a difference and prevent childhood deaths from malnutrition, they will promote the adoption of vegan and vegetarian diets.

I am not a dietitian but sorry Jessica, that is not consistent with SA’s paediatric guidelines for complementary feeding. Please see the text in green.

In an article posted on the ADSA’s own website, SA registered dietitian Cheryl Meyer says:

Contrary to common belief, a properly planned vegan diet is proven to be healthy and nutritionally adequate for people of all ages.

Cheryl, that advice (at 131 characters) is equal to a tweet. You didn’t mention breastfeeding as long as possible which ADSA criticised Prof. Noakes about after the trial but you had room in the article to do so. The essential need to supplement B12 is not mentioned at all in the entire article! Again, I am not a dietitian but I am sorry Cheryl, but that is also not consistent with SA’s paediatric guidelines for complementary feeding. Read the text in green above. Especially, not mentioning the need for B12 supplementation at any age is a dangerous omission for the public who read your article.

What Should Vegan Babies Eat?

So what should vegan babies be weaned onto? Well the SA dietitians don’t say but their US cousins give us the following advice:

Wean vegan infants with soy milk fortified with calcium and vitamins B12 and D. Milk alternatives, such as soy, rice, almond, hemp, etc., are not recommended during the first year of life as a primary drink because it is low in both protein and energy.

Wow! Do dietitians really think that is a healthy option? They also do not mention how the baby will get critical omega 3 fatty acids commonly supplemented to kids in fish oil. It certainly flies in the face of South Africa’s paediatric dietary guidelines.

When parents get this wrong the results are horrific. Aside from the Italian case mentioned above, there was this more recent case in Belgium. Here is yet another warning.  More here and this paper gives a case study of what happens when a vegan breastfeeding mother does not supplement adequately.  Where was that advice from the dietitians?

Unlike LCHF, a bad vegan diet is a proven risk to infant health, however, dietitian organisations tolerate that risk. It appears that the ADSA has not counselled, cautioned or complained about its dietitians to the HPCSA or had them retract their public statements nor has it issued a clear policy on vegan paediatric nutrition. At the same time, they have set off a nebulous complaints process over LCHF that has dragged on for three years against Prof. Tim Noakes and which now is going to appeal. How can this be reconciled?

ADSA Noakes Aftermath

In their press release after the not-guilty verdict, the ADSA expanded the detail of their concern about Prof. Noakes’ tweet. Among their criticism was that Prof. Noakes did not emphasise that breastfeeding be continued. This was not emphasised by either Jessica or Cheryl either and they had much more space to use than the 2 spare characters that Prof. Noakes had in his tweet. That press release also makes much of the uncertainty caused by twitter but the vegan advice given by its own dietitian’s remains unaddressed and it is in more conventional media than twitter.

The ADSA further expanded their concern (post-verdict) with the following text:

When foods rich in carbohydrates such as whole grains and legumes are avoided and other carbohydrate food sources such as dairy, fruits and vegetables are restricted, thediet can become deficient in certain essential nutrients, such as vitamin C, B1, B3, B6, folate, magnesium and fibre. Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies can compromise growth, and cognitive and physical development. 

It is a bit late to expand to this after the trial. If you didn’t say that in the trial and it is a material criticism then why expand now? If it was said and considered during the case then its sour grapes after a verdict where it must have been considered.  Let us see how their text looks if properly worded for concerns over a vegan diet for infants:

When foods rich in protein such as meat, fish, eggs, and dairy are restricted, the diet can become deficient in energy and certain essential nutrients, such as vitamin B12, D, Omega-3 fatty acids and calcium. Because infants and young children are considered a vulnerable group, the potential for nutrient deficiencies is a serious concern. Deficiencies have caused death and can compromise growth, and cognitive and physical development. 

I think you can see that a vegan diet presents at least an equal risk, and more likely a greater risk than an LCHF diet for infants.

This hypocrisy has its parallel with (Bloody) Mary Tudor who issued a proclamation that she would not compel her subjects to follow Catholicism and then proceeded to put the senior clergy on trial.

Effective Leadership or Piousness?

The press release by the ADSA following the verdict can be described as extraordinary for both its lack of leadership following the events that they themselves created and the lack of any concrete response to a three-year nutrition inquiry.

The ADSA would do well to learn about the failure of Mary Tudor’s ‘inquisition’ to bring back the Catholic faith to England. Unlike the successful Spanish Inquisitions, the failure of Mary’s effort is attributed to the inability to conduct trials in secret. The truth came out to the public. Of course, Dr Gary Fettke has suffered the fate of a successful secret LCHF trial in Australia allegedly vexatiously instigated by its dietitians.

Suffering from failure due to the effects of the truth, Mary Tudor, had a propaganda letter published entitled “A Godly Treatise concerning the Masse, for the Instruction of the simple and Unlearned People” and this press release is reminiscent both of its necessity and tone. 

ADSA president Maryke Gallagher stated:

We have no personal gripe with Professor Noakes. Our concern has always been about the health of babies.

If ADSA’s concern was about the health of babies, then why have you not acted against your vegan dietitians who have committed dietetic indiscretions that at least equal Tim Noakes’?  It certainly makes this appear to be a lie and the complaint an inquisition. I note that the public already has the ADSA pegged as liars from the press release.

Hypocrisy and Denial?

With apparent hypocrisy over the acceptance of veganism as safe for infants and denial to confront the science of LCHF, why should we not see the ADSA as a religion with anointed clergy? A anti-scientific religion running an inquisition that didn’t burn Prof. Noakes at the stake the first time. 

Maryke, Queen of Dietitians, concludes with:

South Africans have also been confused by the ebb and flow of this divisive nutrition debate and the inconsistent nutritional advice provided over many years. That is unfortunate. I’m pleased this is over and we can now focus on other urgent nutrition challenges we have in South Africa.

What could be more important than addressing South Africa’s diabesity crisis with a weight normalising dietary change? One that your actions forced a scientist and doctor to provide testimony about to show as healthy?

An evidence and science based organisation cannot just ignore 80 videos of Prof. Tim Noakes’ scientific evidence.  Prof. Noakes is the real A1 rated scientist here and at least that was begrudgingly acknowledged.

This seems the kind of arrogance that we would expect from a monarch having failed in an inquisition.  “There is nothing to see here, move along and keep faith in the anointed.” In the meantime, the inquisitors continue to try and burn the heretic with an appeal that could have stopped by admitting it was a scientific mistake.

No Maryke, Queen of Dietitians, this is not over and the ADSA cannot continue like nothing happened. The ADSA is not blameless- dietitians are the instigators of this inquisition. It seems despite publicly brushing your hands, the HPCSA is determined to keep your complaint going and that was within your power to remedy.

A Special Place in Hell

I asked the question at the beginning if there was a special place in hell for hypocritical science-based organisations that ignore scientific evidence. If there isn’t then there should be.

As a health consumer, I ask you to consider carefully whether your health is worth risking with anti-science anti-evidence organisations. Choose your dietetic advice and dietitian wisely and that applies even if you are vegan and in any jurisdction in the world.

Consumer imposed hell by voting with your feet is the best message you can send and if you cannot find a dietitian, there is plenty of more scientific advice on the Internet.  Errr yes, the horror of truth from ‘Dr Google’ is something that the Spaniards unfortunately never had.

What happened to Mary Tudor? Well, every school girl and boy knows that history did not treat her kindly and despite her many machinations, the truth won and England chose the Anglican way.