Dispelling nutrition myths, ranting, and occasionally, raving


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Response to: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight?

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Someone I follow on twitter recently shared this blog post: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight? by another dietitian, Janet Helm. In the post she mused about dietitians promoting themselves as “non-diet” and what this might say about other dietitians. She agreed with many points made by non-diet dietitians such as Cara Rosenbloom but seemed unwilling to go so far as to embrace the philosophy herself. She ended her post with the following questions: “Can’t we all get along? Can’t intuitive eating and body positivity coexist with losing weight?  Why must we line up on two sides?  Why the conflict?” I’m going to do my best to respond to these questions.

First, I too have asked that same question: “Can’t we all get along?” at times. Remember craisingate? Personally, I don’t think that as dietitians we have to agree on everything. It’s okay for us to have different perspectives and approaches. Also, in the case of diet vs non-diet, I don’t see it as an issue of getting along. Maybe I’m blissfully unaware, but I haven’t seen any “non-diet” dietitians attacking other dietitians for promoting weight management. I don’t see dietitians referring to themselves as “non-diet” as lining up on an opposing side or creating conflict. Rather, I see this identification as a way for dietitians to let prospective clients know that they do not promote weight loss as a goal. In a profession which so many believe our sole mission is to help people lose weight I think that it’s necessary for RDs who do not promote weight loss diets to make this clear up-front. I don’t believe the intent is to pass judgement on other dietitians who haven’t embraced the same approach, or to create a professional divide. However, I can see how a dietitian who has built a career around weight management counselling might see this new-ish movement as a personal judgement.

My friend Cheryl Strachan, aka “Sweet Spot RD” wrote an excellent blog post last week (while I was mulling over how best to respond to Janet’s post): Why I can’t help you lose weight. This heartfelt post explained why she would no longer work with clients on weight loss. Providing the current evidence on weight loss and health and the struggle she went through to reach this position. Rather than having me regurgitate all of the evidence here, I recommend you take a few minutes to go read it and then come back.

Done? Okay, great. So you’ll note that Cheryl mentions that when she studied nutrition in 2003 it was accepted without question that weight management was a significant part of being a dietitian. I can tell you that it was the same when I went back to uni to study nutrition in 2006. I’m not sure if things have changed since then. I suspect that they haven’t, at least not completely. It takes time for institutions and society to change. As a dietitian who has worked in weight management in the past I too have struggled to fully embrace health at every size. I understand why a fellow dietitian would ask: Can’t intuitive eating and body positivity coexist with losing weight? It’s an incredibly tough question and the answer is nuanced and it may not be the same for everyone.

I do believe that intuitive eating and body positivity can peacefully coexist with weight loss. However, I think that this can only be the case when weight loss is not the ultimate goal. For me, body positivity is appreciating your body as it currently exists and continuing to appreciate it if you gain weight or lose weight. It’s about treating yourself with respect and compassion and providing your body and mind with the nourishment they need. If you are doing these things with the clandestine goal of losing weight then you are doing yourself a disservice. That being said, it’s okay to want to lose weight. We live in a society that has conditioned us from a very young age to believe that being thin is important. It’s unrealistic to except this engrained belief to vanish overnight. It takes time to relearn to listen to your body and to treat it with respect when you’ve been viewing it as the enemy, a captor, keeping the real you the thin you hidden away. So, no, body positivity and weight loss can’t coexist but yes, body positivity and weight loss can coexist.

I think that as time goes on and nutrition programs update their curriculums, as old-school dietitians are more exposed to evidence regarding the harms of weight bias and weight loss diets, and the hold-outs retire, that things will change. After all, as dietitians we are supposed to provide evidence-based best practice and the evidence against weight loss diets is mounting. Eventually there will be no non-diet dietitians because that will be the approach we all take.


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The day the Internet dies

Sometimes I think that we would all be so much better off if the Internet collapsed. Or at the very least, social media networks.

I was reading this article: The Death of Civility in the Digital Age that Yoni Freedhoff shared on his blog last week and thinking about how true it is. People are so ready to attack, always looking for a fight, on social media. The interaction of your fingers with your computer or mobile phone sending out words to someone you’ve probably never even met irl is vastly different from having a conversation with someone face-to-face, or even over the phone. It’s so easy to respond hastily and to neglect to consider that your words will be read by a real actual live human.

While I love that I can find the answer to nearly any question immediately on a tiny computer I carry in my purse I find myself more and more often wondering if it’s worth the cost we’re paying. Egregious cellphone bills in Canada aside, I mean what we’re paying in declining humanity and rampant misinformation.

I can find the answer to nearly any question online but anyone can put what they believe to be the answer out there. This means, especially in the world of nutrition, that there can be heaps of misleading, inaccurate, and completely false information that I need to sift through and assess before I come to the correct answer. There is an ever growing mountain of misinformation online and a tide of dietary dogma on social media. It’s ever so tempting to just shut it out but I feel an obligation to stay online to fight it, to try to dilute it with as much truth as I can. Which is hard because there aren’t many hard and fast truths when it comes to a balanced diet, despite what the radical carnivores, vegans, ketoites (I don’t know what they call themselves), LCHF-ists, HCLF-ists, etc etc would have you believe.

I also hate the constant need for self-promotion. I’m reading the novel Radiant Shimmering Light right now and the whole obsession with getting likes on IG, and RTs on Twitter really rings true. There are a few characters in the book who are “lifestyle” bloggers and they present these varnished, edited versions of their lives as currency. They make money through links on their websites and through selling the idea of perfection and self-marketing. The book is kind of poking fun at this world we’ve created but it’s done so in a way that you really feel the anxiety-provoking compulsion of the narrator to check her notifications. It’s nearly impossible for a dietitian, especially one in private practice, to not use social media. There are dietitians who make a living by coaching others on how to optimize their Instagram feeds. Like are you even a dietitian if you’re not posting perfectly styled photos of acai smoothie bowls and kale salads?

Our years of nutrition education and proof of ongoing education are no longer enough. Now we must be savvy social media marketers, chefs, expert food stylists, and photographers. We must be brands in and of ourselves. We must constantly be competing with self-styled nutrition gurus, other dietitians, and ourselves. I know that I’ve probably got my rose-coloured glasses on, but I yearn for a day when I don’t have to see literal meatheads mocking people for eating plants on twitter. When I can be blissfully unaware of the insane dietary advice naturopaths and some chiropractors are doling out to their clients. When I don’t have to see dietitians promoting juice as nutritious.  When we can all just stay in our lanes and do the jobs we were trained to do.


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To keto or not to keto

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I feel like there’s one thing missing from a lot of the discussion about the keto diet (and similar extreme diets, really). Everyone talks a lot about whether or not it “works” with proponents on both sides, research supporting both sides, arguing that it does or doesn’t work for weight loss. The problem with this is the assumption that weight loss is the most important feature of a good diet. It’s not. You can lose weight eating lots of things that are not going to provide you with the nutrients you need. Weight loss is not the most important thing for health, despite what the media, the “wellness” industry, society, and even many health care professionals have lead us to believe.

Just because you feel good on a ketogenic diet and are losing weight doesn’t mean that it’s a good idea. As a dietitian, this is something that I really struggle with. It’s our job to support people. We can tell them that keto is a difficult diet to follow, that it may not be advisable, but when it comes down to it, they decide if it’s something they want to pursue or not. And if they do decide to pursue it, we can’t say “well, good luck, I wash my hands of you”. We have to help them undertake it in as healthy a way as possible. Which kind of blows my mind (and makes me glad that I don’t work in a counselling role) because if someone came to us with an eating disorder we wouldn’t support them in that. How can it be ethical for us to support people in following a diet that may cause them harm?

A little history of keto: the ketogenic diet originated as a treatment for epilepsy in children in the 1920s. It was intended to mimic the effects of fasting through the generation of ketones. In recent years this concept has caught on with people desiring to lose weight. After all, if ketones are produced during fasting, then if a specific diet can promote the production of ketones, it may also lead to weight loss. Not illogical. In some children with epilepsy who do not experience a reduction in seizures with medications, the ketogenic diet can be an effective treatment. However, there are potential side-effects.

A few long-term studies (1, 2) have looked at the effects of the ketogenic diet in children and have found such side-effects as: kidney stones, slowed growth, dyslipidemia, and fractures. There are also short-term risks (2, 3, 4) associated with the diet in children with epilepsy including: acidosis, hypoglycemia, gastrointestinal distress (including vomiting, constipation, diarrhoea, and abdominal pain) dehydration, hypoproteinemia, and lethargy. All of these studies have found low long-term adherence among children. There are many reasons for this: some children see improvement in symptoms, even after discontinuing the diet, others find it difficult to adhere to the diet, for some it’s not effective.

Of course, adults who wish to lose weight are not the same as children who have epilepsy. It’s hard to say if slowed growth in children would have a similar counterpart in an adult. However, many of the short-term side effects may be seen in adults, as may some of the other long-term side effects. In addition, there is potential for nutrient deficiencies when following such a restricted diet. Unfortunately, we don’t have research into the long-term effects of a ketogenic diet on adults using it for weight loss. We have some short-term studies that primarily look at it from the standpoint of whether or not it’s an effective weight loss diet. Maybe it’s perfectly safe, but maybe it’s not. Given that the vast majority of people who lose weight on the diet end up regaining it, and often more, is it really worth taking that risk? By following a keto diet you’re basically enrolling yourself in an uncontrolled experiment.

I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults. What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being. Why is it when we talk about a diet “working” we de facto mean weight loss? Why have we come to value weight loss over every other indicator of health? Why can’t we just value ourselves enough to properly nourish our bodies?


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Will soy give you strong bones? Spoiler: maybe, if you’re a rat

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Recently there was a lot of criticism of a NYT article about what’s making us fat that was really about what diets might make mice fat. Along the same lines is this research from the University of Missouri that found soy diets might increase women’s bone strength.

The study was not on actual human women though, of course. No, this study’s participants were rats. These rats are apparently a good proxy for human women because they are selectively bred to have low fitness levels and, “average American women are relatively inactive both before, and especially after, menopause”. Essentially, both American women (particularly older women) and these rats are lazy so they’re totally interchangeable when it comes to research. As it’s much harder to get women to adhere to specific diets, and there are far more variable to control for and ethical considerations when it comes to human experiments, it just makes sense to use rats.

So, these rats were divided into two groups: one group was fed a corn-based diet (you know, just like the average post-menopausal American woman eats) and the other was fed a soy-based diet. The results showed that: “the tibia bones of the rats that were fed soy were stronger compared to the rats who were fed the corn-based diet, regardless of ovarian hormone status”. Leading to the conclusion that: “Bottom line, this study showed that women might improve bone strength by adding some soy-based whole foods to their diet”.

To recap: rats were fed either corn-based rat food or soy-based rat food. The rats fed the soy-based rat food were found to have stronger leg bones. Therefore, human women can increase their bone strength by eating more soy.

This is ridiculous. We are not rats. We do not live the same lives as laboratory rats. We are not all sedentary. We do not eat the same food as laboratory rats. It is a huge leap to say that this study in rats shows that consumption of soy by women can lead to stronger bones. We are not eating a homogenous diet of corn-based rat food. The forms of soy we consume as humans are very different from that in rat food (e.g. tofu, soy beverage, tempeh, edamame, TVP).

Perhaps soy-based foods can increase bone strength in humans but this study doesn’t tell us that. This study tells us that this breed of rat has stronger bones when fed a soy-based diet than when fed a corn-based diet.


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Can we take chocolate milk out of politics already?

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You would think that I wouldn’t have anything left to say about chocolate milk by now. I wish that you were right. I would have thought that I wouldn’t either until I read this article the other day about the school nutrition policy in New Brunswick and the current provincial election there. This uninformed inane quote from the leader of the PC party got me all riled up again:

“Brian Gallant is focused on taking chocolate milk away from our kids,” Higgs said in a press release. “I’d rather accomplish the same thing by giving our kids better access to organized sports activities and the character-building experience that come from participating in activities with peers.”

Higgs said in a press release that his government would scrap the nutrition policy entirely because, despite the importance of educating children about good nutrition, “we think helping them participate in activities with their peers is the goal – not legislating what’s on the menu.”

This is the sort of thing that makes me want to tear out my hair. It shows a complete lack of understanding of the issue at hand and sends the entirely wrong message to the public.

The first quote implies that 1. the issue at hand is obesity and 2. that we can compensate for whatever we eat through exercise. These are both patent falsehoods.

To address the first issue: the purpose of school nutrition policies is not to address childhood obesity. The purpose of school nutrition policies is to ensure that children are being provided with nutritious food when they’re at school. Schools should not be making money at the direct cost of the health of their students. In some cases, the only nutritious food that children receive may be when they’re at school. This has nothing to do with weight and everything to do with health, growth, and development.

To address the second issue: as much as we may all wish that it’s true, no amount of exercise can compensate for an unhealthy diet. Playing soccer is not somehow going to miraculously provide a child with vitamins and minerals and essential nutrients that are lacking from their diet. That’s just not how it works. As I’ve mentioned before, healthy eating and physical activity are not two sides of one coin, they are both essential components of a healthy lifestyle.

The message that the would-be premier is sending here is the widespread misconception that health is measured by the scale and that we can make-up for an unhealthy diet by exercising more. This is just not true.

Finally, to address the second quote: we know that education (insofar as that means telling people what to eat, giving them a copy of Canada’s Food Guide, and lecturing them about calories) doesn’t work. However, creating a supportive nutrition environment in which healthy eating is the norm, along with teaching food literacy, can teach children life-long healthy eating habits.