Therapeutic Carbohydrate Restriction Before the COVID Pandemic: An Assessment of Knowledge, Use, and Perceived Barriers by Dietitians in Canada


Evidence supports therapeutic carbohydrate restriction (TCR) for the appropriate management of patients with chronic conditions, but little is known about prescribing TCR among dietitians. This study assessed the knowledge, information use, and needs of dietitians regarding RCT in Canada.


Dietitians have been recruited (not= 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 nine DR practice characteristics predicting TCR prescribing in clinical practice.


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


There is a strong relationship between the use or lack of TCR in clinical practice among dietitians and their level of knowledge, personal experience, and clinician referrals/support. There is an opportunity to develop new educational tools and resources on the scientific evidence for TCR and to increase multidisciplinary teams, to better support dietitians in Canada to safely implement TCR in appropriate patients with diseases chronicles.

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