Like any other normal girl in her mid-twenties, I spent what may be my last ever spring break studying for my looming comprehensive exams, helping my boss Chris Kresser get ready to launch a new product, training for my 10 mile race, and traveling to beautiful Pinehurst, North Carolina for a local dietetics conference with my friend and classmate Courtney. (What, did you think I’d be getting drunk in Mexico or something?)

I wasn’t exactly sure what to expect from the NCDA conference. I’d never been to a conventional nutrition and dietetics conference, but I was pretty sure it was going to be wildly different than the Weston Price Conference, PaleoFX, and the Ancestral Health Symposium. But what I wasn’t sure about was whether or not the conference would be educational, a good networking opportunity, both, or neither.

I was pleased to see that blatant sponsorship by food companies, which is apparently a major problem at national events like FNCE, was not an issue at the NCDA conference. The conference itself was pretty bare bones, with only a view vendors and only a few meals served over the course of the weekend. I suppose that’s a good thing for a small scale, professional conference. I wouldn’t want my membership money being wasted on useless freebies and extravagant meal services.

One thing that did bother me was the quality of the food. I designated myself as gluten-free, and I think the powers that be decided to combine the gluten-free with the vegetarian options. The one meal I ate was literally mashed potatoes with sauteed vegetables on top. So… a couple side dishes, basically. Fortunately, I had brought along a few packs of Steve’s PaleoStix, so I managed to have a complete meal – protein and all! (You should have seen the looks on the other girls’ faces when Courtney and I whipped out meat sticks at a dietetics conference… priceless!)

Aside from the food, I was pretty content with the information I learned over the weekend, and I did take home some important new knowledge. I attended the sessions that seemed most interesting to me, and here’s what I took away from each one:

Licensure in North Carolina

This was an interesting way to kick off the conference, especially considering the hoopla that happened with Steve Cooksey a while back. Obviously that lawsuit has been a thorn in the NCDA’s side, and the speaker, who was an RD and a lawyer, explained the North Carolina licensure laws in detail. She described what it meant to “practice dietetics and nutrition counseling”, which is a service that provides assessment and provision of a personal care plan based on an individual’s health needs. She emphasized that blogging, writing books, giving presentations, and distributing general nutrition information does not require a dietetics license in North Carolina. I think this is important to point out, since a lot of people wrongly assumed that Cooksey was prosecuted by the NCDA for simply writing a blog. It was way more complicated than that.

Something that really shocked me was learning the many different professions that are exempt from the licensure law under NC General Statute 90. This means that a whole variety of professionals that don’t have nutrition degrees are outside of the NCDA’s jurisdiction when it comes to prosecution. Some examples of exempt professionals: acupuncturists, psychologists, athletic trainers, massage therapists, and nurses. What was even more shocking was that there were non-health related professions exempt as well, such as funeral directors, pastoral counselors, and government employees. They may have their own licensure board that can reprimand them, but the NCDA can’t stop them from practicing nutrition counseling. Weird.

Another interesting point was that only 2 people in the past twenty years of licensure laws have ever been brought to prosecution, and this is because their cases involved insurance fraud and malpractice. So I think we all need to cut the NCDA a little slack – it’s not like they’re hunting down non-licensed nutritionists and sending them to jail.

Lights, Camera, Call to Action

This talk was mostly about activism in the public sphere. Registered Dietitians have been fighting to improve their reimbursement rates from insurance companies for a long time. The fact that nutrition services are often not covered by insurance demonstrates how little emphasis preventative care is given in reimbursement policy making. While I understand that many people believe RDs are ineffective due to their use of inaccurate dietary guidelines, I do think that nutrition counseling in and of itself, regardless of the nutrition information provided, can be a good impetus for people to improve their diets and exercise routines. So I think reimbursing RDs is important, provided they are giving effective counseling to their patients and demonstrating their ability to change health outcomes in their clients. Obviously this is difficult but we don’t want to be wasting healthcare money on ineffective services.

Current Evidence for Diet Therapies in the Treatment and Management of Autism Spectrum Disorder

I was really excited to hear this talk since I used to work as a therapist for autistic children, and I’ve heard autism discussed countless numbers of times in the Weston Price community. The speaker explained the presentation of the Autism spectrum disorder, and described the risk factors and prevalence. I was shocked to hear that the prevalence is now 1 in 88 children – back when I worked at the clinic, it was around 1 in 120. That’s insane!

The speaker then briefly described the many different diet therapies that are used to treat autism, including: gluten/casein free, food rotation, the Specific Carbohydrate Diet, the GAPS diet, the Body Ecology diet, the Feingold and Failsafe diets, the Raw Food diet, the Antioxidant diet, the Ketogenic diet, and the Weston A. Price/Traditional diet. I was so excited to see the traditional diets like SCD, GAPS, and WAPF on her list, but unfortunately she suggested that the diets at the end of the list had less evidence to support them than those in the beginning of the list, and that the Weston A. Price diet was “very controversial”.

Additionally, the speaker’s list of resources provided references for all the diets – and yet her reference for the WAPF diet was a Wikipedia article! Not so scientific, I must say. Nonetheless, I was pumped to see that WAPF had snuck its way into mainstream nutrition awareness! In the end, the speaker said that a whole foods, nutrient-dense diet with plenty of gut healing and probiotic foods was ideal for children with autism. (Now why she didn’t recommend the traditional diets in that case, I’ll never know!)

The remainder of the talk described the different behavioral therapy approaches to improving food intake in autistic children, particularly those with sensory issues and picky or disordered eating. Apparently 60% of autistic children have feeding problems, and many food sensitivities are due to G.I. inflammation and immune hyperreactivity. I hope to work with special needs children as an RD in the future, so I was glad to learn some new strategies to recommend to parents of autistic children.

Success with MNT – Behavior Therapy is Key

This was a really inspiring talk given by a woman who is a health coach. She had a crazy life experience story to share in the beginning, which explained how she became a health coach after her own life essentially fell apart. It was amazing to hear how she pulled herself together and began a new career in the midst of pretty terrible circumstances. She explained that people want to be acknowledged, loved, and to have a meaningful life, and part of our job as RDs is to provide those feelings to our clients so that they are motivated to make life changes. It’s also important to emphasize that our clients have everything they need to be successful in lifestyle changes, and that they are capable of changing their health for the better.

A funny term she mentioned was “paralysis by analysis”, which described how people tend to give up on their goals because they over-think about all the different ways things might go wrong. I’m personally guilty of this, so it’s definitely an issue I need to address in my own life. It’s better to make little goals along the way that are achievable rather than setting one massive goal without having any clue how to get there. I really enjoyed this talk and hope to use her guidelines in my future practice as an RD.

Scope of Practice

This talk was interesting to me mainly because the speaker discussed issues with dietitians going outside their scope of practice, and explained how to improve your knowledge and skills set to broaden your scope. I want to be able to do nutrition for integrative and functional medicine, including ordering and reading complicated lab tests for clients. I didn’t realize that there were credentials that needed to be earned to include this in an RD’s career, so I’ll definitely be looking into that after I become an RD and start counseling clients. Fortunately, I’m working at an integrative medicine clinic in the fall for my advanced placement internship, so hopefully my preceptor will be able to point me in the right direction.

Wheat, Gluten, and Health: The Science Behind Gut Health and Food Intolerances

My friend Courtney and I were both looking forward to this talk, mainly because we thought it was going to be ridiculous, considering it was sponsored by the Wheat Foods Council. We expected propaganda and a lot of avoidance of the scientific evidence. Fortunately, our expectations were way off, and this turned out to be the most informative and science-heavy talk of the whole conference.

The first speaker, a PhD level researcher, started off her talk with a quote by Jean-Anthelme Brillat-Savarin: “Digestion, of all the bodily functions, is the one which exercises the greatest influence on the mental state of an individual.” She then dove into the different areas of research on the cause of “gluten sensitvity”, including the health of the microbiome, acid suppression in the stomach, consumption of fermentable fibers, increasing rates of autoimmune disease, and zonulin regulation of the tight junctions in the gut. She even mentioned the American Gut project! If I didn’t know any better, I’d think she was summarizing the views of the Paleo and Ancestral health community on the reasons why gluten should be avoided! Here are some interesting takeaway points that I learned:

• There are 27 different proteins in wheat that people could be allergic to
  • Glutenins are most frequent, gliadins most severe
  • Gliadin can cause wheat dependent exercise induced anaphylaxis
• Antacids like Tums and PPIs may lead to dietary allergies by impairing protein digestion and allowing larger peptides to get into the bloodstream
  • May also increase risk of SIBO, which further increases allergy risk
  • Low stomach allows pathogenic bacteria to survive, causing dysbiosis, contributing to weak tight junctions (AKA leaky gut)
  • In tact proteins cross the gut and trigger immune reactions
• Gluten triggers zonulin increase, leading to intestinal permeability
  • Gut permeability allows certain molecules to cross and intestinal cells to produce reactive proteins:
    • Dietary proteins, antibodies, drugs, xenobiotics, infectious agents, cytokines, neurotransmitters, enzymes
• Fermentable fibers changed into short chain fatty acids like butyrate by gut bacteria, produce folate and biotin to aid in normal colonic cell development, reducing the risk of colon cancer
• Some theories about the increasing prevalence of celiac and gluten sensitivity include:
  • Increased bacterial overgrowth
  • Higher salt intake (not sure why this is a theory though!)
  • Shorter fermentation of bread leading to more availability of peptides like gluten and gliadin in bread products
  • Foodborne infections causing stress in the gut and increasing its permeability
• Following a FODMAP diet can help with IBS and requires the elimination of wheat
• About 6% of the population should avoid gluten and wheat (according to the information provided by this presentation)
  • One third of adults are claiming to cut down or avoid gluten completely
• There is no reliable test for gluten sensitivity
• The average cost of gluten free products is around 250% higher than similar gluten containing products (though I would argue that you shouldn’t buy gluten free versions of grain products on a regular basis)

So all in all, this presentation was actually quite scientifically accurate and up-to-date. One thing that confused me was that the PhD presenter suggested there is data that suggests to reduce risk of developing wheat allergy, babies should have wheat introduced DURING breastfeeding, between 4-7 months old. I’m not sure how I feel about this. In some ways I understand why this would be the case, since if you introduce a food later, the baby’s immune system may not recognize it and provoke an allergic reaction. However, I can’t imagine that not introducing wheat to an infant should put the child at a substantially higher risk for a true wheat allergy. I’d really like to see the data that the speaker was referencing. This article suggests that some evidence shows that four to six months may be the optimal time to promote tolerance of gluten in babies with a family history of type 1 diabetes or Celiac disease. (Where is this study??) But I was really happy to see that the nutrition experts on the Wheat Council are at least staying on top of the same science we in the Ancestral health community are studying… though how they came to entirely different conclusions is beyond me! Ironically, the RD who presented the second half of the talk referred to the Paleo diet as a fad diet. Big surprise there, right?

Sports Nutrition – It’s not just sports drinks

This presentation mainly dealt with myths and truths about dietary strategies for athletes to maximize their muscle growth, strength, and performance. I learned that protein consumption before, during, and after training could show marked increase in muscle synthesis as compared to no protein. I also learned that protein consumption should be at least 15 grams, and that intake above 30 grams shows depreciating returns on muscle growth, so a good pre- or post-workout protein amount is between 15-30 grams of complete protein. Another important point the speaker made was that it’s important to consume carbohydrates with this protein, since insulin is required to deliver amino acids to the muscles, and proteins only raise insulin a small amount. Consuming carbohydrates with the protein will help improve amino acid absorption by the muscle cells.

The speaker also discussed how protein consumption during training can increase insulin and testosterone, reduce cortisol, and lead to greater muscle anabolism and less catabolism. This makes sense, and I think it demonstrates the importance of refueling after a hard workout. While some people may be worried about “canceling out” the calories they burned, I think it’s way more important to avoid the catabolic stress response that will arise from a hard training session with no glycogen and amino acid replenishment. But I don’t know a whole lot about sports nutrition (yet) so this could be inaccurate.

The speaker pointed out that animal proteins lead to greater muscle fiber anabolism and growth than soy proteins, so hopefully this will encourage anyone still eating soy protein to switch to animal protein like whey. Another interesting fact was that amino acids from whole milk are greater utilized in anabolic processes than those from skim milk; while there is no known mechanism to explain this, my theory is that fat soluble vitamins are higher in whole milk and are important for increasing muscle growth.

The presenter also recommended spreading protein intake out throughout the day for more complete digestion and assimilation of the amino acids. This is probably a good recommendation for anyone, including those not looking to gain weight. It can be challenging to eat around 30 grams of protein at breakfast for some people, but it’s important to try to keep your protein intake consistent across meals and not “protein-load” at night when it’s easier to do so.

Well, that about covers everything I learned. I hope you enjoyed reading about my experience, and possibly even learned something yourself! If you have comments or questions, please share them below – I’d love to hear from you!