“Detoxify or Die”: Qualitative Assessments of Ontario Nutritionists’ and Dietitians’ Blog Posts Related to Detoxification Diets

Publication: Canadian Journal of Dietetic Practice and Research
7 February 2019

Abstract

While the title Registered Dietitian (RD) is regulated under provincial legislation in Ontario and other Canadian provinces, the title “nutritionist” is not regulated in Ontario, which poses potential risks to consumers who place misguided trust in those proclaiming to be nutrition experts. This is concerning as nutrition is a complex health care discipline and RDs, the recognized providers of credible nutrition information, must be registered with an accredited regulatory college that requires them to have undergone rigorous training, practicum placements, entrance examinations, and continuous professional development. The purpose of this study was to determine if Ontario-based unregulated nutritionists and RDs are providing safe, evidence-based, information regarding detoxification diets. Content from 10 blog posts were qualitatively analyzed using deductive content analysis with predetermined categorization matrices. The results revealed that Ontario nutritionists promoted detox diets and provided unproven, misleading, and potentially harmful information, whereas Ontario RDs did not promote detox diets and provided evidence-based, harm-reducing information. Additionally, conflicts of interest arose only in nutritionists’ blog posts. RDs provided credible references for their information while nutritionists did not. Protecting the term “nutritionist” for use exclusively by RDs under provincial legislation would be a positive step towards ensuring Ontarians are receiving the highest quality evidence-based nutrition information.

Résumé

Bien que le titre de diététiste (Dt.P.) soit réglementé par la législation provinciale de l’Ontario et des autres provinces canadiennes, celui le titre de « nutritionniste » n’est pas réglementé en Ontario, ce qui pose des risques possibles pour les consommateurs qui font confiance à tort à ceux qui prétendent être des experts en nutrition. Cette situation est préoccupante, car la nutrition est une discipline complexe des soins de santé et les Dt.P., les prestataires reconnus d’information nutritionnelle crédible, doivent être agréés auprès d’un ordre professionnel qui exige d’avoir suivi une formation rigoureuse, effectué des stages, passé des examens d’entrée et de s’adonner à des activités de développement professionnel en continu. Le but de cette étude était de déterminer si les Dt.P. et les nutritionnistes non réglementés de l’Ontario fournissent des renseignements sûrs et fondés sur des données probantes concernant les régimes de désintoxication. Le contenu de 10 billets de blogue a fait l’objet d’une analyse qualitative déductive à l’aide de matrices de catégorisation prédéterminées. Les résultats ont révélé que les nutritionnistes de l’Ontario faisaient la promotion de régimes de désintoxication et fournissaient des renseignements non fondés, trompeurs et potentiellement nocifs. Les Dt.P. de l’Ontario, quant à eux, ne faisaient pas la promotion de ces régimes et fournissaient des renseignements fondés sur des données probantes qui visaient à réduire les risques. De plus, les conflits d’intérêts n’ont surgi que dans les billets de blogues des nutritionnistes. L’information fournie par les Dt.P. était étayée par des références crédibles, alors que ce n’était pas le cas pour les nutritionnistes. La protection du terme « nutritionniste » à l’usage exclusif des Dt.P. en vertu de la législation provinciale serait un pas dans la bonne direction pour s’assurer que la population de l’Ontario reçoit de l’information nutritionnelle fondée sur des données probantes de la plus haute qualité.

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Financial support: No sources of financial support were used.
Conflicts of interest: The last author is the chair of the Professional Titles for Dietitians in Ontario Advocacy Group. Four authors are Ontario Registered Dietitians and 1 author was a dietetic intern when the study was being conducted, and is now a Registered Dietitian in Ontario.

References

1
Statistics Canada. Body mass index, overweight or obese, self-reported, adult, by sex, provinces and territories (percent); [1 screen]. Ottawa, ON: Statistics Canada; c2016, updated 2016 Mar 7 [cited 2017 Nov 15]. Available from: https://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health82b-eng.htm?sdi=bodymassindex.
2
Statistics Canada. Overweight and obese adults (self-reported), 2014; [about 6 screens]. Ottawa, ON: Statistics Canada; c2014, updated 2015 Nov 27 [cited 2017 Nov 15]. Available from: https://www.statcan.gc.ca/pub/82-625-x/2015001/article/14185-eng.htm.
3
Dietetic Student Advocacy (DSA). DSA—dietitians vs. nutritionists. Toronto, ON: YouTube; 2013 [cited 2017 Nov 20]. Video: 6 min. Available from: https://www.youtube.com/watch?v=Nyh85OEdVFE&t=205s.
4
Regulated Health Professions Act (RHPA), R.S.C.; 1991, c. 18.
5
Dietetics Act, R.S.C.; 1991, c. 26.
6
College of Dietitians of Ontario. Requirements under the regulated health professions acts & other statutes. In: College of Dietitians of Ontario. Jurisprudence Handbook for Dietitians in Ontario. Toronto, ON: College of Dietitians of Ontario; 2012. p. 23–35 [cited 2018 Oct 26]. Available from: https://www.collegeofdietitians.org/Resources/Professional-Practice/Requirements-under-the-RHPA-Jurisprudence-Handbook.aspx.
7
Government of Ontario Ministry of Health and Long-Term Care. Health workforce planning and regulatory affairs division—regulated health professions; [about 6 screens]. Toronto, ON: Government of Ontario Ministry of Health and Long-term Care; c2010, updated 2017 May 26 [cited 2017 Nov 14]. Available from: http://www.health.gov.on.ca/en/pro/programs/hhrsd/about/regulated_professions.aspx.
8
College of Dietitians of Ontario. The difference between a nutritionist and a registered dietitian; [1 screen]. Toronto, ON: College of Dietitians of Ontario; c2018, updated 2015 July 28 [cited 2017 Nov 14]. Available from: https://www.collegeofdietitians.org/Resources/About-the-College/Protecting-the-Public/Nutritionist-and-RD-in-Ontario.aspx.
9
Ordre professionnel des diététistes du Québec. Pourquoi choisir une diététiste/nutritionniste; [1 screen]. Montreal, QC: Ordre professionnel des diététistes du Québec; c2018 [cited 2017 Nov 14]. Available from: https://opdq.org/qui-sommes-nous/pourquoi-choisir-une-dietetistenutritionniste/.
10
The Nova Scotia Dietetic Association. General information; [1 screen]. Halifax, NS: The Nova Scotia Dietetic Association; c2018 [cited 2017 Nov 14]. Available from: https://www.nsdassoc.ca/dieticians/general.
11
College of Dietitians of Alberta. Is my dietitian registered?; [1 screen]. Edmonton, AB: College of Dietitians of Alberta; c2018 [cited 2017 Nov 14]. Available from: http://collegeofdietitians.ab.ca/public/how-do-i-know-my-dietitian-is-registered/.
12
Dietitians of Canada. What is a dietitian?; [about 5 screens]. Toronto, ON: Dietitians of Canada; c2018 [cited 2018 Oct 26]. Available from: http://www.unlockfood.ca/en/Articles/Nutrition-Month/What-is-a-Dietitian.aspx.
13
College of Dietitians of Ontario. About registered dietitians; [1 screen]. Toronto, ON: College of Dietitians of Ontario; c2018, updated 2017 Oct 26 [cited 2018 Jan 5]. Available from: https://www.collegeofdietitians.org/Web/Public/About-Registered-Dietitians.aspx.
14
Kealey S. Nutrition and health “experts” you shouldn’t trust; 2018 [cited 2018 June 4]. Available from: http://www.sheilakealey.com/nutrition-experts-shouldnt-trust-2/.
15
The New York Times Magazine. Warning: the wrong nutritionist can be dangerous to your health; 1988 [cited 2018 June 4]. Available from: https://mobile.nytimes.com/1988/04/17/magazine/warning-the-wrong-nutritionist-can-be-dangerous-to-your-health.html.
16
CTV News. Rise of nutrition myths becoming a problem for cancer doctors; 2017 [cited 2018 June 4]. Available from: https://www.ctvnews.ca/mobile/health/rise-of-nutrition-myths-becoming-a-problem-for-cancer-doctors-1.3305118.
17
The Nutrition Press. Why we need to legally regulate both titles ‘Nutritionist’ and ‘Dietitian’ in Australia; 2017 [cited 2017 June 4]. Available from: http://thenutritionpress.com/why-we-need-to-legally-regulate-both-the-titles-nutritionist-and-dietitian-in-australia/.
18
Tonsaker T, Bartlett G, and Trpkov C. Health information on the Internet: gold mine or minefield? Can Fam Physician. 2014;60(5):407–8.
19
Pistolis J, Zimeras S, Chardalias K, Roupa Z, Fildisis G, and Diomidous M. Investigation of the impact of extracting and exchanging health information by using internet and social networks. Acta Inform Med. 2016;24(3):197–201.
20
Canadian Foundation for Dietetic Research. Tracking nutrition trends. Mississauga, ON: Canadian Council of Food and Nutrition; 2015 [cited 2018 June 4]. 52 p. Available from: http://www.cfdr.ca/Downloads/CCFN-docs/CFDR-Tracking-Nutrition-Trends-2015-Report.aspx.
21
Klein AV and Kiat H. Detox diets for toxin elimination and weight management: a critical review of the evidence. J Hum Nutr Diet. 2015;28:675–86.
22
Porter S, British Dietetic Association. Detox diets food fact sheet. Birmingham, UK: British Dietetic Association; 2016 [cited 2018 Jan 5]. 2 p. Available from: https://www.bda.uk.com/foodfacts/detoxdiets.pdf.
23
Dietitians of Canada. Information on cleansing diets; 2015. In: Practice-based evidence in nutrition [PEN]; 2014, updated 2015 Jan 20 [cited 2018 Jan 5]. 2 p. Available from: www.pennutrition.com. Access only by subscription.
24
Acosta RD and Cash BD. Clinical effects of colonic cleansing for general health promotion: a systematic review. Am J Gastroenterol. 2009;104:2830–36.
25
Zeratsky K., Mayo Clinic. Do detox diets offer any health benefits?; [1 screen]. Scottsdale, AZ: Mayo Clinic; c2018 [cited 2018 Jan 5]. Available from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/detox-diets/faq-20058040.
26
Bryant SM and Kolodchak J. Serotonin syndrome resulting from an herbal detox cocktail. Am J Emerg Med. 2004;22:625–6.
27
Johnstone AM. Fasting-the ultimate diet? Obes Rev. 2007;8:211–22.
28
Isner JM, Sours HE, Paris AL, Ferrans VJ, and Roberts WC. Sudden, unexpected death in avid dieters using the liquid-protein-modified-fast diet. Observations in 17 patients and the role of the prolonged QT interval. Circulation. 1979;60:1401–12.
29
Elo S and Kyngä H. The qualitative content analysis process. J Adv Nurs. 2007;62(1):107–15.
30
Ahmed S, Ware P, Visca R, Bareil C, Chouinard MC, Desforges J, et al. The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting. BMC Res Notes. 2015;8:571.
31
Academy Quality Management Committee. Academy of nutrition and dietetics: revised 2017 scope of practice for the registered dietitian nutritionist. J Acad Nutr Diet. 2018;118(1):141–65.
32
Partnership for Dietetic Education and Practice (PDEP). What is accreditation?; [1 screen]; c2018 [cited 2018 Jan 6]. Available from: https://www.pdep.ca/accreditation/accreditation-about.aspx.
33
Dietitians of Canada. Education; [about 2 screens]. Toronto, ON: Dietitians of Canada; c2018 [cited 2017 Nov 14]. Available from: https://www.dietitians.ca/become-a-dietitian/education.aspx.
34
College of Dietitians of Ontario. How to become a dietitian; [1 screen]. Toronto, ON: College of Dietitians of Ontario; c2018, updated 2017 Oct 25 [cited 2017 Dec 8]. Available from: https://www.collegeofdietitians.org/Web/Apply-to-the-College/How-to-become-a-dietitian.aspx.
35
Dietitians of Canada. DEL—overview; [1 screen]. Toronto, ON: Dietitians of Canada; c2018 [cited 2017 Dec 8]. Available from: https://www.dietitians.ca/Become-a-Dietitian/Internships-Practicum-Programs/Overview.aspx.
36
Brescia University College. Diploma in dietetic education & practical training: London, ON: Brescia University College; 2016 [cited 2017 Dec 11]. 2 p. Available from: http://brescia.uwo.ca/academics/wp-content/uploads/sites/2/delightful-downloads/2016/09/DDEPT-Brochure-2016.pdf.
37
Dietitians of Canada. Internships and practicums; [1 screen]. Toronto, ON: Dietitians of Canada; c2018 [cited 2018 Jan 4]. Available from: https://www.dietitians.ca/Become-a-Dietitian/Internships-Practicum-Programs.aspx.
38
Dietitians of Canada. Registration to practice; [1 screen]. Toronto, ON: Dietitians of Canada; c2018 [cited 2017 Nov 14]. Available from: https://www.dietitians.ca/Become-a-Dietitian/Registration-to-Practice.aspx.
39
College of Dietitians of Ontario. Maintaining your membership; [1 screen]. Toronto, ON: College of Dietitians of Ontario; c2018, updated 2014 Jan 20 [cited 2017 Nov 14]. Available from: https://www.collegeofdietitians.org/Web/Members/Registration-Obligations.aspx.
40
Dumas AA, Lemieux S, Lapointe A, Dugrenier M, and Desroches S. A comparative content analysis of vegetarian food blogs written by registered dietitians and non-registered dietitians. Can J Diet Pract Res. 2017;78(2):86–91.
41
Schneider EP, McGovern EE, Lynch CL, and Brown LS. Do food blogs serve as a source of nutritionally balanced recipes? An analysis of 6 popular food blogs. J Nutr Educ Behav. 2013;45(6):696–700.
42
Cesiri D. The blog is served: crossing the “expert/non-expert” border in a corpus of food blogs. Colloquium New Philologies. 2016;1(1):47–62.
43
Wardle JL and Adams J. Indirect and non-health risks associated with complementary and alternative medicine use: an integrative review. Eur J Integr Med. 2014;6(4):409–22.
44
Kris-Etherton PM, Akabas SR, Bales CW, Bistrian B, Braun L, Edwards MS, et al. The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Am J Clin Nutr. 2014;99:1153S–66S.
45
Newmaster S, Grguric M, Shanmughanandhan D, Ramalingam S, and Ragu-pathy S. DNA barcoding detects contamination and substitution in North American herbal products. BMC Med. 2013;11:222.

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Published In

cover image Canadian Journal of Dietetic Practice and Research
Canadian Journal of Dietetic Practice and Research
Volume 80Number 3September 2019
Pages: 116 - 121

History

Version of record online: 7 February 2019

Authors

Affiliations

Jill Toth BSc, RD
School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON
Colleen O’connor PhD, RD
School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON
Brenda Hartman PhD, RD
School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON
Paula Dworatzek PhD, RD
School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON
Schulich Interfaculty Program in Public Health, Western University, London, ON
Justine Horne MScFN, RD, PhD (Candidate)
School of Food and Nutritional Sciences, Brescia University College, Western University, London, ON
School of Health Studies, Western University, London, ON
East Elgin Family Health Team, Aylmer, ON

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