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Nutrition in acute and chronic diseases

Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians’ knowledge, use and perceived barriers in Canada



Evidence supports therapeutic carbohydrate restriction (TCR) for managing appropriate patients with chronic illness, but little is known about TCR prescribing among dietitians. This study evaluated dietitians’ knowledge, information use and needs for TCR in Canada.


Registered dietitians (RDs) were recruited (n = 274) from January to December 2020 to collect semi-structured data using an online needs assessment survey (French and English). Descriptive and inferential statistics were used to describe and assess which nine RD practice characteristics predicted TCR prescription in clinical practice.


Respondents were located in all provinces and territories in Canada, with few international responses in the sample (3.5%). We found statistically significant differences between RDs who have prescribed TCR or not in four practice characteristics studied: level of knowledge (p < 0.001), reviewing literature (p = 0.02), clinician referrals (p < 0.001) or personal experience (p < 0.001). Multivariable models showed that the odds of prescribing TCR was associated with intermediate/expert knowledge (OR 5.92 [95% CI: 2.26–17.77]), clinician’s referral (OR 3.22 [1.73–6.14]) and personal experience, whether a former user (OR 2.24 [1.09–4.72]) or a current user of TCR (OR 9.09 [2.70–42.09]), compared to no knowledge, no referral or no experience.


There is a strong link between the use, or lack, of TCR in clinical practice among RDs and their knowledge level, personal experience and clinician referrals/support. Scope exists to develop novel educational tools and resources on scientific evidence for TCR, and increase multidisciplinary teams, so as to better support RDs in Canada to safely implement TCR in appropriate patients with chronic illness.

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Fig. 1
Fig. 2: Frequency of perceived barriers to prescribing TCR in clinical practice across levels of prescribing among dietitians.

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The research team have full control of all primary data. All relevant data are provided in the manuscript and appendices.


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The authors would like to thank all the study participants who gave up their time to participate in the survey. They would also like to thank the Institute of Personalized Therapeutic Nutrition (IPTN) for assisting with the needs assessment survey.

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Authors and Affiliations



AIC and ECW initiated the project, and ECW designed the survey as part of a needs assessment in collaboration with IPTN. AIC and ECW were responsible for data collection and supervised SJK in conducting the data cleaning and statistical analysis as part of a Directed Studies course. All authors were involved in data analysis, interpretation and writing of the manuscript.

Corresponding author

Correspondence to Annalijn I. Conklin.

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Competing interests

ECW is the CEO of Eat Different, Co., which provides nutrition counselling services in Ontario, Canada. The other authors declare no competing interests.

Ethics approval

The approval was obtained from the University of British Columbia Behavioural Research Ethics Board (#H19-03454-A005). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Kim, S.J., Witchell, E.C. & Conklin, A.I. Therapeutic carbohydrate restriction pre-COVID pandemic: assessing registered dietitians’ knowledge, use and perceived barriers in Canada. Eur J Clin Nutr (2022).

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