Quebec family physician Dr Èvelyne Bourdua-Roy looks set to become “Canada’s Tim Noakes”. Bourdua-Roy’s regulatory body, the Quebec College of Physicians, is investigating her for comments on diet and nutrition she made on a radio talk-show.
Nutritionists who may be members of Dietitians of Canada (DoC) lodged complaints with the College, claiming that Bourdua-Roy made “inappropriate declarations”.
They also claim that she gave “medical opinions” that could “mislead the public on low-carb, high-fat (LCHF)/ketogenic diets”. (Ketogenic diets are very low-carb, very high-fat but low-to-moderate protein).
The parallels with Bourdua-Roy and Prof Tim Noakes are striking even as there are differences.
In both cases, the complainants claim that Bourdua-Roy and Noakes dispensed medical “advice”, not information. And that advice is dangerous. In both cases, the dietitians and nutritionists give no evidence in support of their claims.
And no alleged “victim” of that “dangerous” medical “advice” has complained or claimed any hurt.
Bourdua-Roy was a guest on the radio show. One talk-show host made disparaging comments about nutritionists and dismissed their advice as “useless”. He also described them as “no better than astrologers”.
Bourdua-Roy defended nutritionists and said that not all give bad advice. However, two infuriated nutritionists called the radio station to complain and one said that she would lodge a complaint. Subsequently, two did just that – but with the Royal College of Physicians and against Bourdua-Roy.
Among her comments, during the interview, Bourdua-Roy referred to findings of the multi-centre PURE study that the Lancet published recently. PURE results show strong association between eating too little fat, including saturated, and raised risk of heart attack and stroke.
Bourdua-Roy, who runs a metabolic clinic outside Montreal, also told me that she gave general information only. “I gave no specific medical advice to anyone during the radio interview,” she said.
The College immediately issued her with a summons to appear to answer the complaints.
In Noakes’s case, Johannesburg dietitian Claire Julsing Strydom complained to the HPCSA about a single tweet he made to a breastfeeding mother. In it, he said that good first foods for infant weaning are LCHF. Thus, for infants, he was suggesting meat, fish chicken, eggs, dairy and vegetables.
Strydom was president of the Association for Dietetics in South Africa (ADSA) when she complained about Noakes. She and ADSA regularly dish up the same “advice” as Noakes gave in his tweet.
In his evidence at the HPCSA hearing, Noakes explained why his tweet was information, not specific medical advice. And in closing arguments, counsel for Noakes, Michael van der Nest, SC, described Strydom as nothing more than a “disgruntled dietitian“.
She was angry because the public seemed to be listening more to Noakes than to her, Van der Nest said. Strydom used Noakes’s tweet as a “pretext” to launch a full-scale attack on Noakes and LCHF, he said. And “miraculously”, she managed to get the HPCSA to do her bidding.
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Bourdua-Roy has an advantage over Noakes in defence of her professional reputation against the nutritionists’ complaints. Many of her medical colleagues openly support the science for benefits of LCHF and ketogenic diets.
Last year, 200 Canadian doctors and allied health professional signed an open letter to their government. They called for radical reform of nutrition guidelines to include low-carb, healthy-natural-fat diets. Over 700 doctors and other health professionals, including dietitians and nutritionists, have since signed the letter.
Those doctors actually represent a much larger group of approximately 2,600 Canadian clinicians, mostly
physicians. Health Canada is considering a revision of the country’s dietary guidelines. However, many doctors say these don’t go far enough.
In July 2017, they sent a rebuttal letter to Health Canada. They say that they are “greatly concerned about the drastic deterioration in our nation’s health over the last four decades of poor dietary advice”. And as such, they are “using food as medicine to cure disease”.
Yet the College of Physicians appear to have taken a leaf straight out of the HPCSA’s prosecutorial book against Noakes. Both have not first investigated whether the complaints were vexatious. Thus, both overlooked conflicts of interest the dietitians and nutritionists have in laying their complaints.
The DoC website says that as with dietitian, nutritionist is a “protected title” in Quebec. And just as with sister dietitians’ associations globally, DoC and ADSA are heavily conflicted. They accept sponsorship money from all the “biggies” – Big Food, Big Sugar, Big Soft Drinks (with Coca-Cola driving from the front) and Big Pharma. Many of their members have industry links.
Noakes is one up on Bourdua-Roy in that he at least knows who his accusers are. The College of Physicians allow anonymous complaints. So does the Australian Health Practitioners Regulatory Agency (AHPRA).
Two years down the line, Australia’s Tim Noakes, orthopaedic surgeon Dr Gary Fettke, still doesn’t know who reported him to AHPRA. That was for telling diabetic patients to reduce their sugar intake. Fettke prefers not to have to amputate limbs from diabetic patients as a consequence of their condition. He tells his patients that simple dietary change can save both life and limb.
Fettke does know that the complainants are members of the Dietitians Association of Australia (DAA).
DAA has made its opposition to LCHF and ketogenic diets well known. AHPRA slapped a lifetime ban on Fettke for his troubles in trying to save diabetic patients’ limbs and lives.
The Canadian nutritionists’ claim against Bourdua-Roy of “inappropriate declarations” is not unlike DAA dietitians’ claim against Fettke. They accused him of “inappropriately reversing a patient’s diabetes”.
In Bourdua-Roy’s case, prominent dietitians wrote a letter of opinion to Le Soleil newspaper after the radio interview. The letter’s first signatory is Caroline Dubeau, regional director of Dietitians of Canada (DoC), for Quebec.
Dubeau echoes Strydom and ADSA’s views on LCHF diets and support for orthodox low-fat, high-carb diets. She dismisses LCHF as “fashionable”, in other words, a fad.
Dubeau and colleagues claim that LCHF carries “certain risks”, including “triggering an eating disorder” – without offering any evidence for those claims.
And as Strydom and ADSA do routinely, DoC regularly argue for sugar and other dietary carbohydrates as part of a healthy “balanced” diet.
Bourdua-Roy posted a hard-hitting response to Dubeau’s letter, in an article in the Huffington Post that 80 other Canadian doctors signed. The headline: Low-Carb, High-Fat Is What We Physicians Eat. You Should, Too.
In it, the physicians say they are concerned about misinformation in the media from health-care professionals. They say that LCHF is not a fad. It’s a way of eating that’s “as old as the world”.
Just as importantly, they give robust evidence to support their opinions.
“Human beings evolved by eating this way for hundreds of thousands of years,” the authors say.
“In fact, humans have only been eating an abnormally high quantity of carbohydrates (bread, pasta, potatoes, rice, fruits and sweets) for about four decades.”
The real fad and restrictive diet, they say, is the conventional low-fat diet that Canada’s official guidelines recommend. Those following it must observe food restrictions, such as avoiding whole-dairy products, fatty cheeses, full cream, butter, eggs and certain cuts of meat. The same applies to those who choose to be vegetarians.
“When it comes to health, we all make choices,” the physicians say. The low-carb diet “is no exception” and “not any more restrictive than other diets”.
They also say that the public has the right to low-carb diets as an option. And they have personal and clinical experience of benefits of LCHF and ketogenic diets compared to the low-fat diet.
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They say that the main aim of LCHF is not rapid weight loss. It’s a “way of eating, a way of life”. They offer LCHF to patients based on robust evidence that it helps to reverse lifestyle chronic diseases. These include type 2 diabetes, metabolic syndrome, chronic pain, chronic fatigue, and hypertension, etc.
Bourdua-Roy and colleagues dismiss the myth that the brain needs carbohydrate foods to function. They say that Canada’s current guidelines keep patients on medication. As a result, they usually require increasing dosages.
The authors also ask: “Don’t we say that type 2 diabetes is a chronic and progressive disease? It doesn’t have to be this way.”
They say that in its current state, Canada’s Food Guide is not balanced. It overemphasises relatively nutrient-poor carbohydrates, including processed and ultra-processed carbohydrates, and under-emphasises fats.
The doctors also point out that no one has ever tested these dietary recommendations in a population to see if they are good for our health. There are also no scientific studies to support the guidelines.
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They emphasise the consequences for public health after the US and Canada launched the guidelines, and specifically, the recommended carb servings. Rates of obesity, type 2 diabetes and cardiovascular diseases, to name only these three chronic diseases, “have exploded”.
The physicians pose the question that Noakes has often posed: Are official dietary guidelines making us sick?They echo Noakes’s opinion that it makes more sense for patients with diabetes to reduce their sugar intakes significantly rather than give them drugs to manage the excess blood sugar.
Bourdua-Roy and colleagues say that they want to work with nutritionists and dieticians. Their aim is to help patients not just manage chronic diseases that their lifestyle choices cause but to reverse them.
Dubeau replied to my email asking for comment on DoC members’ complaints against Bourdua-Roy. However, she did not answer any of the relevant questions.
(Editor’s note: Dubeau has replied again to stress that neither she nor DoC lodged the complaints. Despite being asked, she did not say whether the nutritionists who complained are DoC members.)
Dubeau said that DoC has been “very supportive of the revision Canada’s Food Guide”. She said that it was important to “distinguish between types/sources of saturated fat”. Dubeau emphasised “replacing saturated fat with unsaturated fats”, not total fat reduction messages. However, she gave no evidence on which DoC bases this advice.
Similarly, Quebec College of Physicians president and director general Dr Charles Bernard did not answer any questions. He turned my email over to his communications chief Leslie Labranche. Labranche said that according to the rules, the College could not “confirm or deny” an investigation of Bourdua-Roy.
However, in a registered letter summonsing Bourdua-Roy to a meeting, they told her that she can have a lawyer present.
One Canadian doctor told me that the College of Physicians “are not really on the physician’s side but they try to maintain best practice in the province”. How they choose to prosecute Bourdua-Roy will show the validity of that assessment.