Dispelling nutrition myths, ranting, and occasionally, raving


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The Food Guide needs to rise above dietary dogma

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A while ago I remember reading an article by some doctors about how the updated Canada’s Food Guide should be promoting a low-carb, high-fat (LCHF) diet. Then last week there was another article about a “prominent Ontario doctor” who asserts that the new Food Guide is being based on “very bad science”. And I’m just so frustrated that doctors, who we all know receive minimal nutrition education, are getting so much press for their self-serving misinformed opinions.

First of all, these doctors all serve to benefit if their particular dietary dogma is promoted. The doctors pushing the LCHF agenda make a living by putting people on this diet. The doctor who said the new Food Guide is based on “very bad science” and should instead contain specific diet recommendations (e.g. low-fat, DASH, LCHF) has received money from the Dairy Farmers of Canada in the past (and as we know, they are highly opposed to the potential shift from the current Food Guide food groupings).

Secondly, they seem to have a poor grasp of population health and the purpose of a national food guide. When we’re talking about population health we’re talking about improving the health of the entire population. We are not trying to address specific medical concerns of illnesses. We’re also not trying to put the entire country on a weight loss diet, which seems to be the perspective that these physicians are taking. Similar to the daily recommended intakes for vitamins and minerals, which are based on the average amount that a healthy person requires each day, the food guide is intended to promote a healthy dietary pattern for most healthy Canadians. Obviously we are all different and our needs and optimal diets will vary, hence the fact that this is called a guide. It’s not a prescriptive diet, it’s one size fits most with some personal tweaking, not one size fits all straight off the rack. It’s not meant to address every, or actually any, disease states. That’s why we have dietitians and doctors and primary healthcare to help individuals with specific health concerns. It’s meant to promote a healthy pattern of eating among as much of the population as possible. It’s not at all, “picking a specific dietary plan for all Canadians is the wrong approach and that, like all clinical processes, treatment should be considered based on individual patient needs” as the doctor in the second article said. It’s providing general guidance on healthy food choices for those who aren’t in need of clinical treatment.

The narrow focus on clinical care and treatment in the realm of healthcare does a disservice to us all. As does the medicalization of eating. In order to promote health and wellness in our communities and country we need to move back upstream and start preventing the need for many doctor visits, hospital stays, and medications. That sort of thing is achieved through population-based measures that address the social determinants of health and general guidelines such as Canada’s Food Guide.

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Why we need to stop with the meat and alternatives

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Ever since the new Food Guide consultations began the dairy and beef industries have been pushing back hard. They’re afraid that if the traditional food groups are dismantled, and if the food guide encourages people to consume more plant-based sources of protein, as has been put forward in the consultation, that there will be decreased consumption of dairy and beef. It’s understandable that they would want to protect their interests. After all, going from being featured prominently in the current (and previous versions) of the Food Guide with food groups named: Milk and alternatives and Meat and alternatives, to receiving little-to-no mention is a bitter pill to swallow. On the other hand, it’s a hugely positive step for the health and wellness of Canadians.

You see, words matter. “Alternative” is generally different than the norm. According to the dictionary, the definition of alternative is, “one of two or more available possibilities.” By naming food groups “Meat and Alternatives” and “Milk and Alternatives” we’ve positioned animal products as the norm and plant-based sources of similar nutrients as differing from the norm or abnormal. This positioning makes it sound like meat and milk are the front-runners and the “alternatives” runners up. This does a disservice to the health and budgets of many Canadians, particularly those living on low incomes, as meat is positioned as something to aspire to and the “alternatives” (which are often more affordable options such as beans, lentils, and tofu) as inferior.

I think that the standard Canadian home-cooked meal is often some variation on meat and potatoes. Having taught cooking classes for people living on low incomes for the past few years I have found that even if participants are open to trying new foods and recipes they are often unable to sell their family members on beans and lentils and other more affordable sources of protein. One of the few negative pieces of feedback we receive is that participants would like more meat in the meals we prepare. For many reasons we emphasize vegetables and “alternative” sources of protein in our classes. Among those reasons are: nutrition, food safety, variety, and affordability. Meat is generally one of the more expensive foods at the grocery store. By creating the impression that meals centred around meat are something to aspire to we’ve really done a disservice to Canadians. The majority of us don’t consume even the minimum recommended servings of vegetables and fruit each day and don’t consume enough fibre.

Milk is widely encouraged as a beverage with meals, on cereal, with snacks, and for sports recovery. It’s been positioned as the beverage for growing children and for seniors for bone health. While not quite as costly as meat, serving for serving, it’s still a pricey beverage in comparison to water and many other drinks. Setting aside vitamin D, which milk is fortified with, there are many other sources of the nutrients we commonly consume milk to obtain. Calcium is found in many leafy green vegetables, tofu, beans, nuts, and seeds. Protein is found in beans, lentils, eggs, nuts, seeds, and tofu.

All this to say, that despite the push-back, I think that (if Canadians pay attention to the new Food Guide when it’s released) ditching the current configuration of food groups, or even just the current naming of food groups, will be beneficial to the health and pocketbooks of most of us. If we stop seeing plant-based sources of protein as “alternative” and start recognizing them for their delicious value then maybe we can get out of that meat and potatoes mentality and start enjoying a wider variety of nutritious meals.


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Naturopaths are jumping onboard #NutritionMonth and this boat ain’t big enough for all of us

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As you probably know, March is Nutrition Month. Traditionally this is the month in which dietitians come out in full force on social media, and in news articles, with nutrition tips, recipes, etc. This year I noticed a change. Yes, dietitians are still out there telling everyone to eat more vegetables, promoting the profession, and encouraging people to “unlock the potential of food”. Interspersed throughout those posts and articles though are ones from a new voice, naturopaths.

On March 15th the Institute for Natural Medicine put out a news release titled “Naturopathic Doctors Complete 155 Hours of Nutrition Education in Medical School: March is Nutrition Month“. In the linked FAQ: “What advanced nutrition education do naturopathic doctors receive?” the INM states that, “Naturopathic doctors provide individualized nutrition assessment and guidance utilizing evidence based nutritional recommendations” (emphasis mine). On addition, one of the “areas of concentration” is “collaboration with Registered Dietitians, as needed”. While part of me is glad to see Nutrition Month catching on, rather than being an echo chamber of RDs, another part of me is frustrated to see it being co-opted by a pseudoscientific profession.

The use of the term “evidence based” concerns me. What evidence might that be? Those of us working in dietetics and medicine often talk about the need for treatments, interventions, and programs to be evidence-based. However, these interventions are only as good as the evidence on which they’re based. Ideally, you want high level evidence like guidelines and and summaries which draw on a larger body of research demonstrating consistent results (check out the 6S Pyramid from the National Collaborating Centre for Methods and Tools for more details). At the bottom of the pyramid, are single studies. The single studies aren’t necessarily poor (they’re the foundation for the higher levels of the pyramid) but if there aren’t many and they aren’t in agreement it becomes difficult to make solid evidence-based recommendations. Also, it can be easy to cherry pick single studies to support nearly any position and proclaim your stance to be “evidence-based”. Without attending naturopath school, I can’t say how credible the evidence-base they’re drawing on is with certainty. However, based on what I see on the websites, social media feeds, and have heard from many people who’ve seen naturopaths, I think it’s wise to question the quality of the nutrition education they’re receiving.

I also question the statement about collaborating with RDs. I’m sure that someone will tell me I’m wrong in the comments but in my experience, I have never heard of a naturopath referring a client to a dietitian. Considering their 155 hours of nutrition education and their alleged nutritional knowledge I’m not sure why they would see a benefit to referring a client on to one of us.

Now, I’ll be the first to tell you that the plural of anecdote is not evidence and I’m sure that seeking responses from twitter is likely to have skewed toward my own bias, but I was curious what sort of nutrition advice people are receiving from naturopaths. I received a number of responses ranging from negative to positive. I assured everyone anonymity so names have been changed – thank you to everyone who was willing to share their experience(s) with me. Here you have it:

The good:

Emma told me that they started seeing a naturopath to improve her diet, energy, and overall health. She found the naturopath to be very down-to-earth with realistic expectations and advice in-line with current research. She said, “She’s always been incredibly supportive; always learning; always approaching everybody as an individual and very willing to make adjustments depending upon someone’s reactions to process.” This naturopath also provided affordable recipes and shopping plans.

Ava went to a naturopath for IBS and was told to try a FODMAP elimination diet.

The bad:

Emma’s naturopath promoted organic products as best and advised her to avoid GMOs.

Ava was also told to eliminate gluten (despite having expressed no issue with gluten and not having celiac disease). She was also not provided with sufficient support to feel like she could adhere to the low-FODMAP diet and quickly abandoned it.

Liam was diagnosed with hypercholesterolemia and prescribed medication by his doctor. He didn’t tolerate it well so he went to a naturopath who sold him a special drink and put him on an alkaline diet.

Sophia went to a naturopath to help her control her severe asthma. The naturopath advised her to eliminate gluten and follow a vegan diet with the explanation that, animal products increase inflammation in the body and were worsening her asthma. As she had previously eliminated gluten and experienced no benefit she followed a vegan diet for about 6 months. She experienced no decrease in symptoms during this time so she reintroduced animal products to her diet.

The ugly:

Liver cleanse supplements were part of the plan provided by Emma’s naturopath.

Olivia went to see a naturopath and was told to cut out dairy, given a stack of photocopied book chapters and opinion pieces, and $800 worth of liver detox tablets, supplements, and powders. To be fair, this was pre-Internet times so photocopies were not so odd, and the profession may have grown since then. But, that also makes the cost of supplements even more exorbitant than it sounds today.

Isabella told me, “I got “nutrition advice” from a naturopath. I walked in, he fat-shamed me, and gave me a whole sheaf of paper basically outlining how I already eat.”

Mia was advised to consume raw milk, and to give the same to her three year old child.

Amelia has both celiac disease and multiple sclerosis. Despite following a gluten-free and dairy-free diet, taking recommended supplements and medications, she still experienced digestive issues. She went to see a naturopath who advised her to get IgG allergy testing. Due to the nature of this not recommended form of allergy testing the naturopath told her she could no longer consume the foods that she was consuming the most of leaving her with very little that she could still eat.

Harper went to see a naturopath after being diagnosed with breast cancer. After spending over $15, 000 on a “natural” treatment overseas she ended up having a double mastectomy but sadly died within a year.

If this is the sort of nutrition advice that naturopaths are providing I’d rather have Nutrition Month remain the echo chamber of dietitians promoting truly evidence-based nutrition recommendations.


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Breathing vs raw food. Should we be getting our oxygen from our diet?

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Does everyone remember when that Australian “health coach” told everyone that cancer is actually good for you (see above)? And then everyone piled on and she relented and removed the post and made a sort-of apology video. I was thinking about that recently after reading this article about a naturopath in Montreal who espoused similar views in her blog. I decided to see what Olivia was up to these days on her Instagram.

Her most recent post was extolling the benefits of an “oxygen-rich diet”. According to her post, people who are oxygen deficient, “are nervous, stubborn, hypersensitive, and have an increased amount of bacterial and fungal infections, as well as disease. Low oxygen creates decreased brain function, congestion, bleeding, and a decrease in sexuality.” At this point you’re probably wondering if you’re oxygen deficient and how you can boost your oxygen levels through an oxygen–rich diet. I mean, nobody wants to be a diseased stubborn dim-wit. Fortunately, Olivia has the answer:

Raw foods are full of oxygen, especially dark green leafy vegetables which contain an abundance of chlorophyll. The chemical structure of chlorophyll is almost identical to the haemoglobin in our red blood cells. The only difference is that the haemoglobin molecule has iron in its nucleus and the chlorophyll molecule has magnesium. The bloodstream then delivers this oxygen to every cell in your body. When you eat greens in blended form, such as a smoothie, this process is even more efficient.

Naturally, this tome is accompanied by a sweet doe-eyed photo of Olivia holding a massive bowl of lettuce. Sadly, contrary to popular opinion, being young and pretty are not qualifications for providing nutrition advice.

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The subtext being that you too can become a more glowing, more vital, blonder bluer-eyed version of yourself if you follow her advice. Of course, none of it’s true.

Let’s start with oxygen deficiency. What is oxygen deficiency? Could we all be silently suffering from insufficient oxygen in our blood? Oxygen deficiency is when your body doesn’t get enough oxygen. This can be caused by health conditions such as asthma, COPD and other lung diseases, and anemia. Most of these are treated with medications and/or supplemental oxygen. Of these, only anemia can be related to diet (more on that later). It’s important to note that when your body doesn’t get enough oxygen you may experience hypoxemia (low blood oxygen) which can quickly lead to hypoxia (low tissue oxygen) which can result in symptoms such as changes in skin colour, coughing, wheezing, confusion, and shortness of breath. It’s important to seek immediate medical attention if this should occur as organ damage can occur within minutes of the onset of symptoms. In other words, a salad is not the recommended course of treatment.

Okay, back to anemia. While there are many forms of anemia with many causes, anemia is when your body doesn’t have enough healthy red blood cells to carry oxygen to your organs. Among the many causes of anemia are iron deficiency and vitamin deficiency (B12 or folate). Generally, if you have reached the point of anemia you’ll need supplements to adequately increase your levels (as always, this blog is not to be taken as medical advice and if you think you may be experiencing anemia you should consult with your doctor). To obtain sufficient quantities of these nutrients it’s important to include food sources of them in your diet. Iron-rich foods include: meat, fish, poultry, legumes, eggs, tofu, spinach, and marmite. The form of iron found in plant-based foods is not as readily absorbed by the body as that found in animal foods. Consuming these foods with vitamin C rich foods can help to increase the absorption. Natural sources of vitamin B12 are only found in animal foods (and nutritional yeast). These include: yoghurt, meat, fish, eggs, and cheese. So far, most of these foods are very different from those Olivia is recommending. Finally, folate is found in dark green leafy vegetables, legumes, and fortified flour (in Canada). These foods may help to increase your blood oxygen levels if your red blood cells are low by increasing the hemoglobin in your blood. There is no direct relationship between consumption of “oxygen-rich” foods and oxygen levels in your blood. The metabolic process is not that simple and the quantity of oxygen that you would consume from food is minuscule in comparison to the quantity of oxygen you obtain from breathing.

This all to say, eating a variety of foods including many plant-based foods can form the basis of a healthy diet but that has nothing to do with the amount of oxygen in said foods.

I’ll leave you with the one sensible comment on the post:

danielparasiliti I think you are getting confused… someone who is oxygen deficient Is not stubborn… but more than likely unconscious or dead…


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Healthspan app review

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I read this article about a “new app that identifies your nutrition gap” a little while ago. According to the article, the app (Healthspan) will make individualized supplement recommendations that you can order in-app based on your diet. Naturally, I was concerned. Ideally, we should be aiming to obtain the majority of our nutrients from food. I envisioned an app designed to push supplement sales and was concerned about the safety and accuracy of recommendations made through an app. I figured I shouldn’t knock it until I tried it though so I downloaded the free app and tried it out for a week.

Healthspan is very similar to other food and activity tracking apps in that you enter your daily food consumption and your physical activity. I’ve written about some of the pitfalls of these apps before, in particular their accuracy when it comes to calories burned and the notion of “earning” more food with exercise.

When you first download Healthspan you enter your weight, height, age, etc and it gives you your daily caloric intake to attain your goal. According to the app, for me to maintain my current weight I should consume 1143 calories a day. This is quite low and certainly lower than the number of calories I actually consume every day. Of course, I “earn” more calories through my regular exercise. Just for fun I changed my goal to see what my daily caloric allotment would be if I wanted to lose two kilos. I now have a measly 914 calories per day to work with. To put that in perspective that’s roughly the calories in a Big Mac and medium fries. A 900 calorie per day diet is generally considered to be a very low calorie diet and not recommended to be undertaken without medical supervision. The app however, provided me with no warning. It just readily lowered my daily calorie goal. Interestingly, when I further decreased my goal weight to 44 kg (which would render me significantly underweight for my height) my calorie goal remained at 914/day.

Healthspan does offer you the opportunity to obtain free supplement samples when you register. Unfortunately, they’re only available to those in the UK so I was unable to determine what the samples were. Following that, you can order supplements through the app but the description of this process given in the original article is a little off-base. The app doesn’t make recommendations based on your recorded dietary intake. Rather, you complete a questionnaire and based on your responses it recommends a multivitamin supplement. The recommendation seemed pretty generic for any woman of my age (see below). Despite this, it still concerns me that supplements are available through the app given the questionable quality and safety of many supplements available on the market.

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Aside from this, another rather significant issue I had with the app was logging my food intake. While it was quite user-friendly to enter foods and beverages I’d consumed, the selection was extremely limited and there was no way to determine ingredients in mixed dishes, nor to enter your own recipes or nutrition information. For example, I made a vegetable curry for supper one evening. There was a vegetable curry option I could add but there was no way of knowing if the ingredients were similar to the curry I ate and for anyone who’s ever had curry, you know that the recipes can vary considerably. The same held for other dishes such as smoothies, lasagna, granola, stir-fry, and so on. There was also a number of foods that I couldn’t find at all in the database and had to make my best guess at what would be most similar. Based on this, I question the ability of the app to record calorie and nutrient intake even remotely accurately.

Each day, the app gives you a score out of 100 that appears to be based on your physical activity and calorie consumption. However, participation in challenges also counts toward this score. Without participating in these optional challenges, I was never able to achieve better than a 60 on any one day. On most days, I was even lower than this. Personally, even though I wasn’t using the app to genuinely achieve any goal, I found this really discouraging. If I was actually trying to reach personal nutrition and physical activity goals I can imagine this score would be off-putting.

I know that people really like apps to track things like food and exercise but I’d give Healthspan a pass if you’re looking for an app for these things.