Top 10 Reasons Why Diabetics Hate Dieticians

My latest ramblings about Hope Warshaw have go me thinking about Dieticians, and specifically Registed Dieticians and the American Dietetic Association. I've met many dieticians and almost universally, I have found them genuinely caring people trying to help us as patients. At times, I've also found RDs who are well educated, thoughtful, and often in disagreement with much of what their own dietician community and association does. So, I ask that all those in the community to please not take this as a personal criticism and rather a stereotyping and broad generalization. If I have offended you in any way, by my narrow minded insulting manner, then I humbly apologize ahead of time. My hope would be that even RDs that read this would see the spirit of truth in some of these statements.

So without further ado, and in homage to David Letterman, here are my:

Top 10 Reasons
Why Diabetic Patients Hate Registered Dieticians

10. They believe they are the only source of truth about healthy diets for diabetics, all other sources are not approved by them are “dangerous” and attempts are made to “silence” them.

9. They have declared war on obesity, fighting a symptom of diabetes, not considering that maybe it is not a “cause.”

8. They have inserted themselves into public health policy (particularly wrt diet), but failed to provide competent leadership and when they do lobby our government, they don’t do it for the patient, but for their interests.

7. Vegan diets are “healthy,” particularly for diabetics and even for infants (too bad they die).

6. They fail to understand the patient is depressed and poor; they aren’t stupid and making bad choices.

5. They always claim an evidence basis and that science supports their recommendations, but they have no competency in science, statistics, or experimentation.

4. They mostly have no clue about exercise or sports.

3. They cannot understand how being a diabetic might lead a patient to have “food issues.”

2. They are a “shill” for Big Food, overtly pro-industry, and allowing corruptive influences to pervade their operations and advice.

1. Despite a trail of overwhelming evidence, dieticians still declare low carb diets as ineffective, harmful and unproven as a healthy diet for diabetics. If you can’t get the most basic thing right, how can a patient trust anything that comes from a Dietician?

Please feel free to add your own or comment on these.


My experiences with RD’s mirrors your article, in many respects. I find them to be (personal experience here, not universal I’m sure) unscientific, knee-jerk on the subject of carbs (“eat plenty!”), unwilling to speak the truth about the truly crappy food pervading the wares of Big Food (“Coke is crap. So is Pepsi. So are all other HFCS plus caffeine plus food coloring plus chemicals so-called “beverages” on offer from Big Food.”), unwilling to put their feet down in the institutions where they work on the prepared so-called “foods” being given to patients, students, etc. (“Jello is NOT a food, white hamburger buns are NOT a requirement for human health, canned and syruped fruit cocktail is NOT the same thing as a fresh orange in terms of “food value”, etc”)

The whole “no bad foods” campaign made me so angry I washed my hands of them a long time ago.

If they won’t speak the truth to power, what are they good for? Not much.

Plastic food!

LOL! Good old plastic food!

Isn’t going straight to hatred kind of a sort of modern “road rage” type thing?

A couple of hundred years ago the founding fathers wrote some words of tolerance for other viewpoints into the constitution that have helped guide us towards some (not always perfect, I will admit!) tolerance of religious and cultural viewpoints. I’d like to think that we can sort of live in tolerance (even if it’s kind of “the school they went to didn’t teach them very well” or “they just don’t know any better because they aren’t diabetics themselves”) rather than launch straight to hatred.

BTW, it was a dietician nearly 30 years ago that first taught me the basics of carb counting. And even today I sometimes (most often when I get hit by the “pizza effect”) get some deep insights into the wisdom of the ADA exchange diet (you’re probably not nearly old enough to remember the ADA exchange diet being current). There is some accidentalness in that wisdom, sure, but I’m willing to admit that it’s possible to be wise by accident.

Very soon after I was first diagnosed (and still very sick from the leftovers of DKA), I had my first meeting with a RD. It is mildly funny to me now, because just as she was pulling out the plastic food, I because super nauseous and said “pardon me, I need to go vomit.” The two weren’t related, but the timing was perfect. It still makes me smile to this day.

I was given the ADA exchange diet by a dietician 2 years ago. All the literature I received was from the ADA. I recently looked on their website and the literature was gone, I guess it’s been recently retired.

My Mom is a registered Dietician (Retired now, explaining the “old school”)…with a PhD at that. The same 10 guidelines she has been lecturing me for years…sometimes we have endless discussion/debate about
But I love my wonderful Mom…Truly cares for me…I listen to her always…doesn’t mean Id follow her to the “T” =)
Perhaps she is one of those RDs you’ve met bsc!

Even better than plastic food is plastic muscle and fat!

Well, I did admit I was being narrow minded and insulting. I hadn’t really thought of it as “dietician rage.” And I do know the exchange diet, I was not taught it, but you are right, some of the same ideas can be see in the Total Available Glucose method.

And while I would like to be more tolerant, sometimes when faced with fundamentalist views, there is no ground for compromise.

I believe that the ADA has concluded that it was bringing the wrath of god onto itself by advocating a (high carb) diet. So it quietly moved the ADtA (American Dietetic Association) over to be the “front.” That way, it could not be hindered in its fundraising. All the same people, Hope Warshaw, Marion Franz, … just moved over and continued the diet debacle. The ADA has removed virutally all practice and guidance on diet from it’s website, including everything about the exchange diet.

I obviously never intended to insult anybody’s mom.

You won’t find many RDs with a Phd. My aunt was also an RD years ago and had a Phd, but her Phd was in Home Economics. You really don’t hear about that degree anymore.

I wonder what your mom would say about my list?

Nah…no insults there. Im actually confirming that your list is indeed what she has been telling me for years now…and arguing with her is an endless battle! Her PhD is in Dietary Nutrition. She is also a registered nurse.
Err…Id rather not show her your list…might be World War 2 in the making LOL

In my, admittedly, little experience:

  1. They refer you to a book, which pretty much makes their jobs (meaning the time and money spent seeing them is wasteful). And if you think carrying a meter, spare insulin, glucose, etc. everywhere is bulky, try carrying around a freakin’ BOOK everwhere!
  2. They don’t have the medical background to explain WHY… for example, why fiber-carbs get counted different from “regular” carbs, but only if it’s 5 or more.
  3. They are a little disconnected from life. Homemade salad dressing or boiled chicken with the skin peeled off just doesn’t work for me (but, with paprika you can make anything delicious!!)
  4. They are hypocritical. You can eat ANYTHING you want! As long as you limit yourself to 3/8ths of a blueberry and replace the whipped cream with freezer-cold skim milk, aerated with one of those as-seen-on-TV gadgets.

I exaggerate a bit, but after 30 years of T1D, I get very little benefit from seeing a dietician, which is why I resist as hard as I can.

Interesting that you say the “no bad foods” campaign, Jean. Was that actually a formal campaign? Because that is pretty much what I experienced when I was sent to a dietician right after my diagnosis. She was very nice and very sympatico, and when I told her “I’m a vegetarian and I eat very healthy and haven’t eaten sugar for 12 years” she responded that was great and there was no reason to change anything. Of course I loved this and felt she was a very wise woman. Fast forward two years to when I started to learn about carbs and I realized that she should have asked me more about my diet as a vegetarian because of course it was filled with rice and pasta!

I just thought it was all California “it’s all good” thinking, now I hear it’s a campaign! She might have actually spoken those words “no bad foods”.


Numbers 1-5 definitely resonate with me.

#5 - They often seem totally adverse to experimentation. I mean, we are not all the same, and we all have different lives/bodies/schedules/etc. What works for one person may not work for another. Over the years, I’ve often found out how to incorporate D into my routine and, more than once, I’ve been chastised for doing something by a dietician because it didn’t meet their “guidelines.” But it worked for me and allowed me to do what I wanted to do while controlling my BGs. Isn’t that the ultimate goal?

#4 - No, they often don’t understand sports and exercise. They also seem to lump all exercise into the same general category, and all exercise is not the same. There are activities I do which cause me to go low and activities I do which cause me to go high. For me, it depends on the amount of adreneline involved. If I run alone, I go low, but when I run a road race and have all that adreneline pumping, I can easily go upwards of 280. For me, exercise and T1D have always been a trial and error experience, and dieticians don’t like that.

#3 - This one really irks me, especially as it pertains to dieticians treating type 1 folks. For many of us, food is a constant, daily issue from a young age. Many of us D ladies go through puberty (a rough “body image” time for any girl) with D and this just makes things really, really hard. In addition, because so much about T1D involves control, this all just sets you up for an eating disorder. Either dieticians don’t talk about this or they develop an attitude that you should be counting every single carb, calorie, and gram of fat that goes into your mouth. They rarely preach balance in my experience and for many of us, that’s what we need.

#1 - And this one is the icing on the cake. I eat low carb now after years of eating a “normal” diet. During the “normal” diet phase, my control was horrible. But when I bring my carbs down to around 90-150g/day, I get much better control. Not perfect, but FAR better. And isn’t that the end goal? Back in the 80s, low carb/high protein was recommended for diabetics. I realize we have faster, “better” insulins now, but the basic elements of the disease have not changed. Too many of us know that we have far better control when we cut the carbs back, so why is it that dieticians have dug their heels in the sand with this one? During my last visit with a dietician before going back on the pump, I told her that we were just going to have to agree to disagree on this one.

I personally tend to be more subversive than to go to outright “dietician rage”.

e.g. do what actually works. Maybe lie and say I’m following somebody’s rule when I’m actually doing what really works.

The alternative I suppose is to “live by the letter” of some dietician’s recommendation just out of spite. The union equivalent is “work to rule”, where the employees make sure they follow each and every company policy to the point where no useful work ever gets done.

“Malicious compliance” is perhaps a better term. Wikipedia on malicious compliance

My personal #11 would be as follows:

They believe that what is in the book is always correct, even when confronted with conflicting evidence from the patient’s blood glucose meter.

This stems from a year-long battle I’ve had with my diabetes team over the use of cherries as a hypo treatment. They also insist that cherries do not need to be bolused for. But my meter disagrees and I’d rather listen to my meter!

The last time I saw a dietitian was many, many years ago. In addition to having diabetes, I’m a picky eater, and NOT a cook. So I’m a dietitian’s nightmare, anyway.

I was handed an exchange book (I told you it was a long time ago!), and given a meal plan of 3 meals and 3 snacks. Well, if you’re going to have that many snacks, then your meals become so small as to be snacks also, and I just couldn’t stand being hungry all the time. I really tried to stick to this plan for about 6 months before throwing my hands up and abandoning it.

Meanwhile, my BGs were going up, anyway, my doc tried Glucotrol for 5 months, which didn’t work, so I finally went on insulin. And ate as I pleased. My weight stayed stable, until last year, when I had a major depression and binged hugely on carbs and gained weight – went into a coma and almost died. That was what got me thinking (finally) about low-carb – I had been hearing about it for years but never thought I could tolerate it. But when I got home from the hospital, I decided to try it, and lost about 30 lb., got the best lipid numbers EVER, have far more stable BGs and am never hungry, except when it’s time to eat.

One story is an anecdote, but thousands of them should make the establishment look around and say “Maybe there’s something to this!” As if…