It was with utter devastation that I, and the rest of our SMHP Board members, learned of the passing of Dr. Adele Hite a few days ago. I’ve been wanting to write this since it happened but I have been, and still am, struggling to find the words. I was introduced to Adele back in mid 2018 by Gary Taubes as we were planning a special session for the LowCarbUSA® San Diego event in July 2018. He suggested she would be a great moderator for this session aimed at soliciting feedback from clinicians who were implementing carbohydrate reduction as a therapeutic intervention in their practices.
I think Gary secretly knew Adele had a lot more on her mind than this but he didn’t say so. I reached out to her and her response was a 2-page document which I often say made me weak at the knees. Her vision was so impossibly enormous that I just couldn’t get my head around it in a way that made me feel like it was even vaguely doable. Her vision was that the concept of Therapeutic Carbohydrate Reduction would be established as Standard of Care (SoC) and would be offered as an option to all patients for whom it was appropriate in all practices. In this response document she sent me, she led with the legal definition of Standard of Care which she had learned when she served on the jury of a medical malpractice lawsuit:
From a legal perspective, “standard of care” is defined as “providing health care in accordance with the standards of practice among members of the same health care profession with similar training and experience situated in the same or similar communities at the time the health care is rendered. In other words, “standard of care” does not come from what is taught in professional training, from public health policy, or even from clinical care guidelines established by professional organizations, although all of these can inform and help define a standard of care. Rather, “standard of care” comes from what a community of clinicians do in the actual provision of care.
Even though I felt totally overwhelmed, we kept talking and she kept pointing to parts of this legal definition and showing me that I had already started to get some of these things in place. She had this amazing knack of showing me how much more I could do if I just got out of my own way. We were totally focused on building the community and we were providing tons of education and training so we had those parts covered already. Then she suggested we produce a Clinical Guidelines document. Even though it is not, in and of itself, SoC it would be the perfect place to start cultivating the conversations that would eventually establish a consensus. We needed a panel of advisors to audit the content of the document and a place to publish the document once it was ready. So, as a starting point, we could publish it on the LowCarbUSA® website and I had access to many of the greatest minds in the field. I put a panel of 12 of these great minds together consisting of David Cavan, MD, FRCP; Mark Cucuzzella MD, FAAFP; Robert Cywes, MD, PhD; Georgia Ede, MD; Gary Fettke, MB, BS, FRACS, FAOrthA; Brian Lenzkes, MD; Timothy D. Noakes, MD, DSc; Bret Scher, MD; Franziska Spritzler, RD, CDE; David Unwin, FRCGP; Eric C. Westman, MD, MHS; and William S. Yancy, Jr., MD, MSH.
Then it was all up to Adele. First thing she did was kick me out of the kitchen! “You’re not a clinician” she said to me, “you can’t have anything to do with the content of this document”. Those of you who knew her well can just imagine her saying that to me, I’m sure. She then set about putting the document together. Once she was done she bounced it off the advisors over and over, constantly feeding all the recommendations back into the document until they were all happy that it was ready to go. The Clinical Guidelines for Carbohydrate Reduction as a Therapeutic Intervention was first published in the May of 2019, just 9 months after she started on the project. It has 133 total references, a link to a deprescribing document, links to patient education documents and many other resources. I found out subsequently that at the same time that she was doing this she was working her regular job AND defending her PhD thesis. By the time we published the guidelines, she had just become Dr. Adele Hite!
Although the Clinical Guidelines document was initially published on the LowCarbUSA® website, we always knew that was not the ideal place for it in the long run. Discussions with Adele and Dr. Tro Kalayjian and others made us realize that a special nonprofit needed to be established as an umbrella for all practitioners who were open to this conversation. Metabolic medicine was a term that started to get bandied about and so ‘The Society of Metabolic Health Practitioners‘ (The SMHP) was born. We moved the guidelines document over to this new site so that it now had a real home and to date it has been translated into 8 other languages. When I let Adele know that this had all happened I know she was thrilled. Her vision was starting to come together.
Now we have a Clinical Guidelines document available in 9 languages; training in place and pathways defined where practitioners interested in metabolic medicine can get accredited; a list of practitioners who are open to this conversation who can help clients and patients get healthy again; a place where practitioners can go and add their names to a support for these guidelines; and a community of practitioners who are discussing cases and these guidelines and arriving at a consensus. And all of this is a reality because of one person, Adele Hite. We are quite a long way off from having this intervention ‘offered as an option to all patients for whom it is appropriate in all practices’ but the day will come, I am sure of that.
Recently, the SMHP presented Adele with a special Achievement Award for her exceptional work in getting this all done. You can read more about that here.
I think the thing that impacted me most about Adele, and that will stay with me always, was her insistence that ‘words matter’. “When you say something,” she would say, “make sure that the words you use reflect what you are trying to say accurately and truthfully and without potential ambiguity!”
Rest in peace my friend! Know that your work, and most especially the Clinical Guidelines document, will live on forever and we will all do our best to continue your work from where you left off.
Adele has named the ‘Reversing T2: A Dr. Sarah Hallberg Legacy Project‘ charity for those wishing to contribute to her legacy. This group has ambitions to become a big tent, to promote the work of the many people who devoted themselves to furthering education on this important topic.
