bite my words

Dispelling nutrition myths, ranting, and occasionally, raving


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I guess some RDs are sexy

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Eat big meals… Fat goes quick! Photo by L’imaGiraphe (en travaux) on Flickr. Used under a Creative Commons LIcence.

Right on the heels of my post about we dietitians not being sexy, this article comes out in the Daily Mail, and I’m forced to eat my words (good thing there are no forbidden foods!). Dietitian Trudi Deakin is proclaiming a high-fat, low-carb diet to be the be all and end all, and she’s written the book to “prove” it. Sigh.

Now, as you (my regular readers) know, I’m certainly not one to shy away from fat. New readers, My original by line was “real dietitians eat butter”. However, I also subscribe to the school of thought that says too much of anything is bad for you. Be it fat, salt, sugar, or carrots. You can have too much of a good thing. According to Trudi, saturated fat is the key. While it’s become widely accepted that saturated fat is not the demon it was once believed to be, that doesn’t mean that it’s suddenly a dietary super hero.

Trudi claims that her diet is 82% fat, and she’s never felt healthier. She alleges that high-carb diets are fuelling the obesity epidemic. The gist is that low-fat was wrong so low-carb must be right. Why do we have to go from one extreme to another? I’ll say the same thing about this that I said about demonizing sugar: blaming one nutrient for obesity or chronic disease isn’t getting us anywhere. These are complex problems that aren’t going to be remedied with simple solutions.

This 82% fat has me curious though. What would a diet that’s 82% fat look like? According to Trudi:

BREAKFAST: Three eggs cooked in the microwave with butter and cheese, like a souffle, served with oily fish – smoked salmon or mackerel – or avocado.

LUNCH:A bowl of berries with double cream or a homemade walnut scone, made with ground almonds rather than flour, served with double cream

DINNER: Meat or fish with a serving of vegetables cooked in butter 

Just for fun, I entered this meal plan into my fitness pal to find out the breakdown. Obviously without quantities, it’s near impossible to say exactly what caloric and macronutrient totals would look like. Based on one serving of each of the items listed above, I would only be consuming 995 kcal, and fat would account for roughly 40% of these. If Trudi’s diet is being accurately reported, she’s obviously consuming greater quantities than I recorded, particularly of the high-fat foods. Regardless, it doesn’t sounds overly appealing to me. I’d rather be a few pounds heavier and die a couple of years earlier than never have cereal for breakfast, never snack, and put butter on everything (as much as I love butter).

While Trudi may be content with this restrictive diet for now, it will be interesting to see what will happen with time. Most people following low-carb diets find them to be extremely difficult to follow over the long-term and usually relinquish them. Aside from the difficulty adhering to these low-carb, high-fat diets, there are other risk factors to consider.

Children with epililepsy following ketogenic diets provide us with some insight into the long term effects of a ketogenic diet. A study of children following a ketogenic diet found that poor growth was common. Other side effects were kidney stones and bone fractures.

There’s some other misinformation in the article. Trudi states that she consumes 30 grams of protein at breakfast because “your body doesn’t store it.” Um… I don’t know where this is coming from. While 30 calories at breakfast is certainly reasonable, excess calories, regardless of macronutrient, will be stored as fat.

The unfortunate thing about most weight management research is that “long term” equals several months to a year. While someone might experience weight loss, and find a high-fat diet relatively easy to adhere to for a few months, years, or a lifetime, are a far different story. Trudi’s been following this diet for less than year. Let’s see the tune she’s singing in a decade. Until then, you might want to take her high-fat diet with a grain of salt, or better yet, a baked potato.


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No big fat surprise that butter is being touted as the next Superfood

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Why, oh why must we take everything to the extreme? Is it because simple healthy eating is boring? We have to have “clean eating”, “superfoods”, “low-fat”, “low-carb”, “cleanses”, “high-protein”, yada yada. The latest mantra to irk me “slather on the butter”. I know, I know, I said it first “real dietitians eat butter”. But this doesn’t mean that we have to eat it to excess. What am I on about now? An article in the Daily Mail that I came across on the weekend: Can eating fatty meat, whole milk and lashings of butter help you LOSE weight?

Okay, most of us in the nutrition world have accepted that low-fat was a grievous error. Taking anything to the extreme is a nutritional error. Just because something is not “bad” for you, or even good for you, doesn’t mean that you should consume more of it. The logic seems to go: apples are delicious and nutritious; therefore, an entire bag of them must be even better. In this case, we’re not even referring to foods that we know to be healthy when consumed regularly. We’re referring to foods that were unfairly demonized but have not been shown to lead to good health when consumed daily.

Perhaps, the article in the Daily Mail does not accurately portray Nina Teicholz’s book The Big Fat Surprise. I haven’t read the book, so I can only comment on the news article. Encouraging people to eat more cream, high-fat red meat, butter, and other foods high in saturated fat is not the solution to the obesity epidemic that the Daily Mail would have you believe. Yes, you can lose weight eating anything; remember the Twinkie Doctor? This doesn’t mean that you’re healthier (especially in the long-term).

Apparently Teicholz claims that removing the fat from milk means adding more carbohydrates. No. When you remove fat, you are not adding anything. Yes, an equivalent quantity of skim milk will be higher in carbohydrate (not sugar though) than whole milk. That’s simply a result of what’s left behind when you remove the fat. It’s also higher in protein, minerals, and vitamins. We wrongly vilified saturated fat, let’s blame carbs.

Health and the battle against obesity should not be a nutrient blame-game. How about we stop demonizing and glorifying foods and nutrients and accept that there is a place for bread and a place for butter in a healthy diet.


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Fat does not equal fat

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The article: Anyone Silly Enough to Think Fat is Good for You Needs to See This Brain Study made me want to scream and scarf a bag of potato chips out of spite.

The article reports that the study found that body fat doesn’t just sit around your midsection, it also affects your cognitive function. This lead them to the conclusion that recent reports that dietary fat has been wrongly demonized are incorrect.

What’s my problem with this? One, body fat and dietary fat are not the same! You can become obese by consuming too many fat-free foods. Dietary fat does not equal body fat. The study was looking at  body fat not dietary fat. This means that we can’t go blaming butter. Two, the study was done on mice. Mice are not humansYes, it’s quite likely that excess body fat has negative effects on many aspects of your system. However, we can’t make the leap from a study on mice to humans. And we most certainly can’t make the leap to dietary sources of fat.


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The “real food” fallacy

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All of a sudden, it seems that Zoe Harcombe is everywhere. She was providing ludicrous nutrition advice for sufferers of yeast infections (thanks @RD_Catherine for the link). Sorry y’all yoghurt won’t cure yeast infections. Yes, choosing a yoghurt with probiotics is great for overall health but it’s more because of the by-products produced by the bacteria (e.g. B vitamins) than because of the bacteria themselves. Unfortunately, most of the bacteria in yoghurt will not survive your stomach acid.

What I really want to address though, is her popular article in the Daily Mail (thanks to @ERHWG for sharing the article and her rage): Diets Make Us Fat. The Solution is Simple. The basic premise is that we need to eat “real food” as opposed to fake  “manufactured food”. Calories don’t matter, and we shouldn’t be counting them. All that matters is eating “real food”.

But what is “real food”? I don’t think you’ll find many dietitians who disagree with the importance of cooking and eating more vegetables, fruits, and minimally processed foods for overall health and weight loss. However, I don’t think the division between “real” and “fake” food is particularly useful. Nor is the vilification of whole grains. Grocery shopping is complicated enough and people are hard-pressed for time. Making them feel guilty for buying anything in a package is not going to help them to adopt healthier habits.

It’s also possible to be over weight when consuming a “real food” diet. You know why? Because calories do matter. I’ve met plenty of people who are over weight who eat very healthy diets. Simply telling people that if they eat “real food” is not going to solve the obesity crisis. If I was over weight and someone gave me this advice I would be insulted. Not everyone who is over weight or obese is subsisting on a diet of big macs and kit kat bars. Consuming more calories than we need, regardless of the source, will result in weight gain.

Finally, the reason that diets don’t work is because they’re short-term fixes. Not because people are necessarily consuming the wrong types of foods or because they’re counting calories. The problem with diets is that they have an end date. They are not sustainable lifestyle changes. The other reason that they don’t work is because our food system is broken. Our environment is structured such that the unhealthy choice is the easiest choice and it’s a lot of work not to be over weight. Placing the onus on the individual and suggesting that if they only stopped counting calories and ate “real food” doesn’t even come close to addressing the true societal roots of the obesity epidemic.


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Low-fat vs low-carb

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There’s a lot to unpack from this Daily Mail article a friend alerted me to. The premise: a couple of identical twin doctors decide they need to lose weight. In order to determine which fad diet is better, one goes low-carb, the other goes low-fat. The fact that they are genetically identical and maintained similar levels of physical activity means that they assumed any differences observed would be due to diet. While there is merit to using identical twins in research studies it’s important to note that this was not a scientific experiment. One subject in each group doesn’t lead to robust findings. Other issues: obviously both men knew which diet they were on and there was no control group. So, this wasn’t good science but it’s still possible that we could learn something interesting from their little “experiment”.

Before we look at what they “learned” from the experiment there are a few things in the article that I want to touch on. Firstly, the headline states that “one twin gave up sugar”. Well, yes, but this twin also restricted all forms of carbohydrate, not just sugar. The twin who went on the low-carb diet thought that it would be effective because of the insulin hypothesis of weight gain.

Because these carbohydrates are highly refined, they tend to raise blood sugars and blood insulin levels quickly.  This will tend to cause weight gain and obesity.  This is known as the Carbohydrate-Insulin Hypothesis (CIH), and is the basis of the Atkins diet and many other low carbohydrate (Dukan) and very-low-carbohydrate diets (ketogenic diet). (1)

While it sounds convincing, we know this hypothesis to be incorrect. For one thing, there are many people/populations who consume high-carbohydrate diets and never develop obesity. For another, insulin on its own does not cause obesity (2). Minor quibble, really, but as doctors discussing weight loss they should have their facts straight. Obesity is complicated and there’s no smoking gun out there.

An important point that they make is:

…despite being doctors – I also have a degree in public health – neither of us knew much about losing weight and eating healthily. 

These topics fall between the cracks at medical school. Yes, we understood biochemistry and food metabolism, and knew a lot about the consequences of being overweight. But which diets work, why we eat too much and why losing weight is so hard don’t sit within any medical speciality.

Pity that they didn’t take the opportunity at this stage to point out that this means that assuming your family doctor will tell you if your weight is a health concern or that they are a good resource for weight loss are dangerous assumptions. If you are concerned about your weight being a health issue you need to speak up and voice those concerns. Ask for a referral to a dietitian who specialises in weight management or to a reputable weight management clinic. I really wish they would have mentioned the great resource that we dietitians can be for all things diet and nutrition.

As you may have guessed, both doctors lost weight during the course of their experiment. I hope that they were the only ones who were surprised by this outcome. Naturally they lost weight; they were both on highly restrictive diets, they were both active males, and this was done over a very short period of time (one month). Imagine trying to sustain a diet with the barest minimum of fat or no carbohydrates for the rest of your life!

Fortunately, the doctors reached a conclusion that I actually agree with! That: “For any diet to work you have to be able to keep it up for the rest of your life.”  As I’ve said many times before: to see sustainable weight loss you need to make sustainable changes.