This Update includes information on the following items:
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- CDBC 15th Annual General Meeting
- 2018-2019 Annual Report
- Congratulations to New Full Registrants!
- Congratulations to UBC 5th Year Dietetic Students!
- BC Dietitian Recognition
- Are you in the 2020 Continuing Competence Program (CCP) Group?
- Website Updates
- You Asked About… the Ketogenic Diet
- Questions? Comments?
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CDBC 15
th
Annual General Meeting
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Thank you to registrants, CDBC Board Directors and Committee members who attended the Annual General Meeting on June 14, 2019. The 2018-2019 AGM had 44 participants joining in person and via webcast. The AGM included an education session on evidence-based practice presented by Dr. Tanis Fenton.
A video recording of the AGM and presentation handouts of the education session will soon be made available for viewing online.
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2018–2019 Annual Report
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on June 12
th
.
This report is also available for viewing on the
College website
. If you missed the AGM, please take time to review College activities completed during the 2018-19 year.
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Congratulations to New Full Registrants!
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Congratulations to the new Full Registrants who passed the Canadian Dietetic Registration Examination (CDRE)
held in May 2019. The CDRE is the national competence examination for Dietitians in Canada.
It is developed and administered by the
Alliance of Canadian Dietetic Regulatory Bodies
. The CDRE is a requirement for full registration privileges by every Canadian province, except Quebec.
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The College is very pleased to welcome successful CDRE candidates to the profession as “Full” registrants. Your registration status has been updated from “Temporary” to “Full” registration on the
Public Register of Dietitians
.
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There are now 1347 Registered Dietitians practicing in BC: 1286 Full Registrants, 27 Temporary Registrants and 34 Non-Practicing Registrants – and the numbers keep growing!
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Congratulations to UBC 5
th
Year Dietetic Students!
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Congratulations to the dietetic students who recently completed their 5
th
year practicum and registration with the CDBC as Temporary Registrants.
Welcome to the CDBC! As regulated health
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professionals, all registrants of the College have the duty to practice dietetics safely, ethically and
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competently. Please be sure to review your legal requirements to practice as Dietitians in BC by
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visiting the
legislation
page of the CDBC website. The College is part of your resource network.
There are a number of educational resources on the College website that may assist you. Please
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call or email to clarify legal and ethical aspects of your practice, to ask questions or provide feedback. We look forward to connecting with you as new registrants!
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BC Dietitian Recognition
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Congratulations to BC Dietitians who were recognized at the 2019 Dietitians ofCanada (DC) Conference held in Ottawa, from June 5-8
th
, 2019. Awards were presented in recognition of the important work and contributions
of the following Dietitian:
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DC Member Recognition Awards – Leadership
These award winners are recognized for their volunteer efforts, professional expertise and achievements that contribute to the advancement of the profession in the area of leadership.
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- Barbara Crocker
- Jenneke van Hemert
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Morgan Award
In honour and memory of the late Susan Morgan, and presented by the Canadian Foundation for Dietetic Research, this award recognizes the personal achievement of a dietetic intern or practicum student for a research project.
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DC Fellows
The Dietitians of Canada Fellow awards is a designation available to members who have demonstrated outstanding professional growth and contributions through educational and professional enhancement, career achievements, initiative, innovation and leadership in Canada.
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- Susan Barr, retired
- Patricia Chuey
- Lynda Corby
- Elizabeth Ann Forster-Coull
- Gerry Kasten
- Ryna Levy-Milne
- Janice Macdonald
- Susan Ross and,
- Karol Traviss, retired
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Are you in the 2020 Continuing Competence Program (CCP) Group?
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CCP submissions will be accepted starting September 1, 2019. Registrants in the 2020 CCP group who wish to be removed in good standing must complete the CCP requirement by March 31, 2020.
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To find out your CCP group, simply login to your CDBC account, and select the tab for “Continuing Competence Program”. Click on “Continuing Compete Program” option and
“Professional Development Plan”. Your CCP year will be displayed on the top left of the screen. All 2020 CCP submissions are due by October 31, 2019 for assessment.
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Website Updates
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You Asked About… the Ketogenic Diet
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What is a ketogenic diet?
This classic ketogenic diet was first described by Dr. R.M. Wilder in 1921 in the medical literature as containing a 4:1 ratio by weight of fat to combined carbohydrate plus protein. Dr. Wilder was looking for a way to control his patient’s epilepsy by inducing ketosis. Since then, a range of 2:1 to 4:1 ratio has been considered an acceptable definition of a classic ketogenic diet
1,2,3
.
Also cited in the literature is a diet consisting of less than 10% of calories coming from carbohydrates, based on a review done by OPDQ, the body regulating dietitians and nutritionists in Quebec, and cited in their ketogenic diet position paper
4
.
More simply, EatRightPRO Academy of Nutrition and Dietetics defines the ketogenic diet as “
any diet therapy in which the dietary composition would be expected to result in a ketogenic state in human metabolism
”
5
. In ketosis, alterations in energy metabolism occur, including a decrease in glucose concentration and an increase in fatty acid oxidation and ketone production.
The ketogenic diet is
9
:
- Often not well understood by the general public. For example, the difference between following a low carbohydrate (South Beach® or Atkins®) diet versus following a very low carbohydrate, moderate protein (ketogenic) diet. This highlights the need to do a literature review regularly and distill the information into a useable format for the general public.
- Not natural, “healthy” or lacking side effects because it involves food; not guaranteed to decrease anti-epilepsy medication.
- Unconventional and alternative, requiring medical supervision for treatment of epilepsy; more than a “diet”, it is a lifestyle; must be chosen for the right patient, can be maintained safely and reversed.
The ketogenic diet has been taking off in popularity, with some doctors recommending it for therapeutic purposes. Can I recommend this diet to my clients?
Most commonly, the ketogenic diet is recommended by neurologists for seizure control in their epilepsy patients
1-5
as well as for some metabolic patients, specifically Pyruvate Dehydrogenase Deficiency (PDHD)
6,7
and Glucose Transporter Type 1 Deficiency (GLUT1)
8
).
Per the
Dietitian’s Regulation
, dietitians’ scope of practice includes “
the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community.
”
While ketogenic diets are considered within dietetic scope, it is important to also consider your individual scope. Do you have the knowledge, skills and judgement to take on a new aspect of practice safely, ethically and competently? Included in the
Standard of Practice
14: “
a Dietitian uses critical thinking to obtain assessment date, determine practice problems, plan, implement and evaluate professional services
.”
To improve your understanding of the ketogenic diet and support your treatment plan, consider using a variety of evidence-based resources such as:
- Peer-reviewed journal articles
- PEN (e.g., knowledge pathway on the clinical effectiveness of the ketogenic diet on weight loss and cardiovascular risk factors in adults with overweight/obesity)
- Cochrane Library
- ASPEN
- Healthevidence.org (rates systematic reviews)
- UpToDate database and,
- Position papers.
Is it ethical for me to counsel a client on a ketogenic diet for other purposes, which may not have research to support the diet?
It may be unethical for you to recommend a ketogenic diet to treat a condition for which there is a lack of evidence. In such a situation, the dietitian should advise the client on the potential risks and benefits of the ketogenic diet, describing the lack of evidence to support the diet (e.g., for long-term weight loss, to aid in specific medical conditions, etc.) The client may choose to pursue the ketogenic diet despite the lack of evidence that it works. In this case, it is important to observe
Standard of Practice
#12: “A Dietitian provides quality professional services that reflect the unique needs,
goals
,
values
and circumstances of the client.” The client may still choose to follow a ketogenic diet. If you are unable to counsel the client in his/her desire for a ketogenic diet due to ethical concerns, or if teaching the ketogenic diet is outside of your scope, you may refer to
QAC Policy 6 – Right to Refuse Treatment
. This policy mandates that you “(1) inform the client of your concerns, (2) give reasonable notice of termination of treatment and, (3) offer alternative options to ensure that the client’s nutritional care needs are being met.” Regardless of whether you counsel the client or refer the client to another dietitian for ketogenic diet counseling, it is important to document the encounter thoroughly, based on the
CDBC Standards for Record Keeping
.
References
- Wilder RM. (1921) The effect on ketonemia on the course of epilepsy. Mayo Clin Bull 2:307.
- Freeman JM, Freeman JB, Kelly MT. The ketogenic diet: a treatment for epilepsy. 3rd ed. New York, NY: Demos Health; 2000.
- Seo JH, Lee YM, Lee JS, Kang HC, Kim HD. Efficacy and tolerability of the ketogenic diet according to lipid:nonlipid ratios—comparison of 3:1 with 4:1 diet. Epilepsia. 2007;48(4):801–5. Epub 2007 Mar 26.
- OPDQ Ketogenic Diet Position Paper. https://opdq.org/wp-content/uploads/2018/06/Position-Diabete-Diete-Cetogene.pdf
- EatRightPRO Academy of Nutrition and Dietetics Practice Paper. https://www.eatrightpro.org/-/media/eatrightpro-files/practice/position-and-practice-papers/practice-papers/classicandmodifiedketogenicdietstreatmentepilepsy.pdf?la=en&hash=681AA0895DFBF515C2A3A2FE7DA3EB5F68832D65
- U.S. Department of Health and Human Services. Genetic and Rare Diseases Information Centre. https://rarediseases.info.nih.gov/diseases/7513/pyruvate-dehydrogenase-complex-deficiency
- Caveats when considering ketogenic diets for the treatment of pyruvate dehydrogenase complex deficiency. https://www.jpeds.com/article/S0022-3476(01)32506-4/pdf
- GLUT1 Deficiency Foundation. https://www.g1dfoundation.org/
- Ketogenic diet therapy for managing medically refractory epilepsy in Canada. Canadian Nutrition Society. https://www.cns-scn.ca/
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Please contact College staff if you have questions about items in this Monthly Update or
if you’d like to schedule a CDBC liaison session.
We look forward to hearing from you!
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