Annette Hunsberger Presley RD, co-author of The Liberation Diet and author of the soon to be released book, The Switch Diet, was censured by the (then) American Dietetic Association, now known as The Academy of Nutrition and Dietetics, for recommending that her clients eat real food and avoid processed food.
Invariably complaints against dietitians who recommend carbohydrate restriction or eating natural fats such as coconut oil and butter in preference to margarine and seed oils are laid by fellow dietitians, but in Annette’s case, it wasn’t just one dietitian who was displeased, it was a whole group of them ie the West Texas Dietetic Association.
Annette was accused of violating 3 ethics:
1. The dietetics practitioner practices dietetics based on scientific principles and current information.
2. The dietetics practitioner presents substantiated information and interprets controversial information without personal bias, recognizing that legitimate differences of opinion exist
3. The dietetics practitioner provides sufficient information to enable clients and others to make their own informed decisions
Annette responded to the complaint in a professional manner, saying that she appreciated the opportunity to explain her views and that she believed both she and her colleagues at WTDA are doing what they believe to be right, but that they just disagree on what “right” is. Annette then gave a clear overview of her practices and the extensive research and rationale that informs her advice.
Link to Annette’s response
Annette’s response comprehensively addressed the ADA’s concerns. She must have felt she was in a twilight zone when the ADA informed her that she had been found guilty. Had they even read her response?
The committee’s concession was that they didn’t think Annette wilfully or knowingly violated the code of ethics, so they gave her an educational intervention.
Annette was instructed to review the ADA EAL related to hyperlipidemia and write a report demonstrating her understanding of the issues and how that will result in changes to her practice in the future.
In her initial response, Annette had acknowledged that the work of Dr Mary Enig had motivated her to research the evidence for and against the Diet/Heart hypothesis for herself.
“Dr. Enig also explained why saturated fat was good for humans and why we needed to be eating more of it and why we should not be using vegetable oils. I was shocked and didn’t know what to do with that because it disagreed with everything I had been taught, but I could not dismiss her as a quack because she was right about trans fat. If she was right about the trans fat, it was at least possible for her to be right about saturated fat.”
“I had a choice to make. I could go on as usual and ignore Dr. Enig’s information on saturated fat, or I could do the research myself to see whether or not she was right. Being a firm believer in providing science-based diet information, I decided that it was in the best interests of my clients to at least look at the science.”
I started with Dr. Enig’s references which led to other studies and the only conclusion I could come to based on the science was that most everything I had been taught in school about nutrition was based on inconclusive, extremely biased and poorly done studies. I could find no evidence to support the lipid hypothesis or the food guide pyramid diet. In fact, I found a good amount of evidence that disputed the lipid hypothesis. I went through months of agony over this, not wanting to believe that I had spent 14 years of my life giving out information that was, in fact, not grounded in sound science. In the end, I had to think about my clients. Was it fair to them for me to preach as gospel truth something that was still an unproven theory; a theory that had a good deal of evidence against it? As registered dietitians, we market ourselves as “the nutrition expert,” so we have an obligation and a responsibility to make sure that we are basing our beliefs on good science.”
This is how an ADA representative interpreted what Annette had written:
“The RD asserts that the information provided in support of her position is based on the opinion of a leading scientist in the field (Dr. Mary Enig). It is inappropriate to make
recommendations that ignore an enormous scientific data base as is presented in leading reports from government agencies and health organizations. Moreover, using the professional opinion of just one scientist whose opinion is wildly different from that of numerous credible scientists, government agencies and health organizations also is inappropriate.”
Pipe in Twilight Zone music. But things do improve
When told to review the ADA’s Evidence Analysis Library, to get the “facts” straight and ostensibly to see the errors of her ways, Annette went further and reviewed the rest of the science on the subject. She wrote a paper going through the science from the 1950s to the present demonstrating why we had no scientific support for our fear of saturated fat and cholesterol (see attached)
It appears that the ADA was not at all happy with this and in their letter of response, expressed their disappointment with Annette’s paper and accused her of asking her own questions instead of relying on the questions that had already been asked and answered. Quotes from apparently notable, but nameless, experts include one which started with, “while it’s great that Annette likes to think outside the realm of evidence…”
Another reviewer criticized Annette for presenting a “hodgepodge of papers.”
In their response letter, it is interesting to note that the ADA never once addressed the science and instead resorted to personal attacks.
However, since they could not refute the science, they could not revoke Annette’s license. Instead, they asked that she use a disclaimer when she talked about fat:
“The advice Annette Presley RD LD provides on lipid disorders is not sponsored, approved, recommended or endorsed by the FDA, NIH, USDA or the ADA (now AND) and you should consult a physician before taking her advice.”
Annette said that she was advised to use this for a year but decided to continue because the usual response she gets is, “Oh, then I want to hear what you have to say.”
In 2009 the ADA wrote that the matter was closed and they had verified that Annette was using the disclaimer. However, not long after breathing a sigh of relief at this decision, Annette received another letter from the ADA informing her that another complaint had been filed by the West Texas Dietetic Association, again concerning her views on fat. The ADA
informed them of the agreement and since Annette was using the disclaimer, the complaint did not go anywhere and Annette hasn’t heard a peep since.