This post is by my mother, a private practice RD in Randolph, New Jersey. You can find out more about her nutrition counseling by visiting her website: Reinvent Your Diet.
I will apologize in advance if you are one of the MDs who study the science before they dispense nutrition advice to their patients. But this morning I was mad, really mad. Mad enough to feel like giving up on my mission to reach the mainstream adults and their children who desperately need better nutrition advice.
In my state’s health care system, an MD can pull rank on an RD on just about anything – and that includes being an “authority” on nutrition. This is somewhat common, despite their lack of training beyond a few hours of nutrition that most medical students receive. Compare that to my several thousands of hours spent in undergraduate and graduate level classes, a 10-month internship, multiple conferences, seminars, webinars, regular reading of articles and books, conversations with peers, and conversations with experts in the ever-evolving field of nutritional science, medicine, and practice. But then, I am just a lowly RD, so what could I really know?
Case in point: today I received an email from the mother of a 6 year old girl who I am seeing for chronic constipation. The mother’s goal is to wean her daughter off Miralax which she has been dependent on since the age of 2; even though the child’s gastroenterologist feels this is not a concern. My recommendations included a higher fat, more adequate protein diet, emphasizing natural fats and including some dairy fat. (Mother had already tried a dairy-free diet without results, but we may have to try this again). I also asked the mother to restrict all wheat products for 4 weeks until our next session, substituting potatoes, sweet potatoes, and some rice/rice pasta for the grain group. This is without knowing if this young girl had been tested for celiac disease or not. Note – the young girl is very thin for her age and I suspect some sort of malabsorption or gut dysfunction. I also gave her a good probiotic.
Anyway, the mother spoke with the MD after our initial session, and confirmed that her daughter had tested negative for celiac. Furthermore, the MD did not think it was necessary to restrict gluten/grains/wheat, and besides, the mother noticed no difference in daughter after one week on wheat-free diet. She added lightheartedly that they “missed pizza” and was “glad not to have to do this anymore.” As expected, the MD also disagreed with my higher fat diet recommendations, but the mother was okay with a higher fat diet. In fact, she purchased a Nourishing Traditions Cookbook per my advice and had already visited our local artisanal cheese shop to find good full-fat cheese.
So in the wisdom of Robb Wolf, should I fire this client?
My daughter Laura (this blog owner) said I should just tell her that I can’t work them anymore if the mother does not want to follow my advice. This is just one of numerous examples of MDs telling their patients that I am not giving them accurate advice, often despite obvious improvements in their health, weight, and lab results. I have had a few clients leave my practice because their MDs advised them to do so.
I am not sure if it is worth the aggravation any more. I had great plans to really make a difference – and I know that for the majority of my clients I do make a difference. But my hope was to work with children, young women, and pregnant women pretty much exclusively in the future, and this is not the first pediatrician/MD that discouraged my clients from following my advice. My head knows that I should hang in there, as I remember learning the broader nutritional truth when my kids were in their young teens - I was both mad and grateful at the same time. But the fact is, I don’t know if I care as much anymore. Maybe we can only really reach the people who are truly seeking this information, and clearly not everyone is ready for this. For me even taking insurance is a big hassle. I am so back and forth on this as I know many young families rely on insurance benefits to pay for healthcare services, and many would not come to me if I did not take insurance. Sorry to whine, but I am somewhat discouraged that a practice model like mine is an unrealistic goal in our current healthcare system.
Does anyone else have a story like this to share? Any words of encouragement for my mom?