Dispelling nutrition myths, ranting, and occasionally, raving


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Why science is failing

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After my fellow dietitian Abby Langer wrote this article for Self, which I personally felt was quite considered and rather generous to the carnivore movement, I noticed a commonality among many of the people spewing abuse and vitriol (does an all-meat diet make you exceptionally angry?) toward her, and RDs in general. Any guesses? It was that many of them were engineers. I’m not sure what’s up with that. However, I can tell you that they are far more confident in their belief in the magic of the carnivore diet than I am in probably anything.

Then I was listening to StartUp podcast and something clicked. This season they’re following what’s called a “church plant” which is people trying to start new churches. On the last episode they were talking to a researcher who said that membership in all Christian churches in North America is declining, except for at evangelical churches. The reason for that? The certainty the evangelical church provides. Unlike other churches where there may be grey areas, things left up to interpretation, the evangelical church has definitive answers. And people like certainty. In religion and in nutrition.

You’ve probably heard the comparison of certain dietary beliefs to religious beliefs before. It’s nothing new. People attach their sense of self to a religious or dietary belief. They’re vegan, paleo, vegetarian, carnivore, catholic, or muslim. In the realm of diets, dietitians are agnostic. In the realm of medicine, Western doctors are agnostic. A great deal of the time, science is agnostic. We constantly question our beliefs and change them as new evidence comes to light. When someone asks is corn good for me we inwardly cringe because there are so many ways to answer that question and they all start with “it depends”. The carnivores are the evangelicals of the dietary world. They have all the answers with the utmost certainty. And how can someone who’s desperate to find a diet that will cure what ails them not be enticed by that confidence when faced with dietitians and doctors who are saying “let’s try this first and if that doesn’t work then we’ll try this” and on and on. We don’t offer a one-size-fits-all approach. We offer tailoring to help individuals find the way of eating that fits them best.

If you want certainty without evidence then you can find all the advice you want, and then some, from carnivorous engineers on twitter. If you’d rather have uncertainty and a little variety in your diet then find yourself a dietitian.


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A smile doesn’t hide your weight bias

 

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I completed an online course on weight bias and stigma for healthcare professionals last week. There was quite a bit that was good but there were a couple of things that rubbed me the wrong way.

If you’re not already aware Obesity Canada states that, “weight bias refers to negative attitudes and views about obesity and about people with obesity. Weight stigma refers to social stereotypes and misconceptions about obesity. These social stereotypes and misconceptions include beliefs that  people with obesity are lazy, awkward, sloppy, non-compliant, unintelligent, unsuccessful and lacking self-discipline or self-control.” 

Weight bias and stigma can cause significant harm to fat people. In fact, they likely cause more damage to people than carrying extra weight itself does.

The course I took was very good about making this clear and provided the facts as well as showing how harmful weight bias can be to patients. However, there was a video with some experts that I felt undermined the message. Here are the quotes that bothered me:

“If weight loss was easy we wouldn’t have the current obesity epidemic that we have.” – Director of Research and Anti-Stigma Initiatives at the Yale Rudd Center

“People think that for someone who’s overweight all they need to lose weight is some self-control and trying harder to eat less and exercise more. If that only worked we wouldn’t have the problem that we have today. The causes of obesity are very complex…” – Director of Research and School Programs at the Yale Rudd Center

The Yale Rudd Center is well-regarded for their work in reducing weight stigma and both of these individuals quoted above are prominent in the field. At first glance what they’ve said seems innocuous. However, the fact that this was a course intended to combat weight stigma, the experts are saying that obesity is an “epidemic” and a “problem” runs counter to the message they’re trying to convey. It just goes to show how deeply ingrained weight bias is when the very experts trying to counter it are inadvertently perpetuating it. When you say that obesity is a problem then you are saying that fat people are a problem. And I don’t see how that’s not stigmatizing.

The other problem I had with the course were the case scenario videos they shared. There would be one video where staff and medical professionals were rude and unprofessional to patients regarding their weight. Then they would show a video that was intended to show a positive interaction. Really the only differences in the “good” videos were that the healthcare professional was all smiles and asked the patient if they could talk about their weight before advising behaviour change under the guise of promoting healthy behaviours rather than telling them directly to lose weight. To me, the message was the same, it was “you need to lose weight” delivered with a smile rather than scorn. There was still no looking at overall health to determine if weight loss was actually warranted, there was still no consideration of other causes of the presenting ailments, and there was still no recognition that simply telling people to eat healthier and move more (especially without first determining what their current lifestyle is like) is not an effective way to get people to lose weight.

Overall, I felt that the message of the importance of not perpetuating weight bias was lost when all the healthcare professionals were still delivering the message to their patients that they should lose weight. And yes, some people can benefit from losing some weight, but this should be determined with appropriate assessment and then weight management options need to be appropriately discussed with the patient. Simply telling someone, on the basis of their BMI, to eat less and move more with a smile is not helpful.

If you do happen to know of a good online weight bias course please let me know as I’m still looking!


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If you’re cheating on your diet, then you should probably break-up with it

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Yes, the above post is undoubtedly very cute. Using emojis is a fun way to make your point. However, I would argue that if you are struggling with your weight that you should actually reverse the suggestion by Dr Nadolsky.

I’m not saying, eat unhealthy food all day every day. I’m saying, take some of those “treat” foods from the weekend and enjoy them whenever you feel like it. Something more along these lines:

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If you’re struggling with your weight and you’re eating super healthy through the week and then you “undo” all your hard work by eating a bunch of crap on the weekend your problem is not the weekend. Your problem is the week. If your workweek diet is very restrictive and doesn’t allow room for treats, or carbs, or entire food groups, then it’s not a sustainable way of eating. If you feel deprived during the week, then it’s not a sustainable way of eating. If you can’t continue to eat the way you eat during the week through the weekend, then it’s not a sustainable way of eating. If your diet through the week is devoid of pleasure, then it’s not a sustainable way of eating. If you’re cheating on your diet whether it be for one day a week, or all weekend, then you should probably break-up with it.

Regardless of your weight, your diet should be one that you enjoy. That provides you with nourishment and pleasure. You should be able to enjoy your food every damn day of the week.


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Are pharmacists the new dietitians?

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The other day I was in a grocery store when a recording came over the PA system encouraging customers to speak to the in-store pharmacist about making healthy food choices. Naturally, I was like “what the fuck??”. People wonder why dietitians are so defensive of our profession. This. This sort of thing is exactly why. Because everyone seems to think that they’re qualified to dole out nutrition advice despite the fact that dietitians are the only professionals who spend over four years studying nutrition in university and must indefinitely continue our education to maintain our licensure.

It’s not cool of the chain to be asking pharmacists to provide dietary counselling. If you want to offer that service, hire yourselves some damn dietitians. It’s also not cool of the pharmacists to accept that added responsibility.

Yes, pharmacists are a wealth of knowledge when it comes to medications and they can be hugely helpful in advising customers about potential drug-nutrient interactions regarding medications that customers are taking. They more often than not, likely have a greater knowledge about nutrients in food than your average person. However, none of this equips them with the expertise to provide nutrition counselling.

The scope of practice for pharmacists in Canada contains no mention of nutrition or dietary counselling. Store owners may not know that this service is outside the scope of practice for pharmacists. Therefore, I believe that the responsibility lies with the pharmacists on-staff to let the company know that they are should not be providing this service to their customers. As allied health professionals they should recognize the limitations of their own scope of practice and defer to RDs in matters of nutrition counselling.

When I worked in a grocery store we had an in-store dietitian as well as pharmacists on-staff and everyone worked together to provide customers with the best service possible. Pharmacists have enough to do without having to get into nutrition counselling with customers, which, when done appropriately, can be quite time-consuming. Do you really want to wait longer to pick up your prescription? Setting aside the issue of expertise, do pharmacists really have the time to devote to counselling customers on nutrition? Let dietitians, who are actually trained to provide individualized dietary advice, provide this service so that pharmacists can focus on their own area of expertise.


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Just because it’s “always delicious” doesn’t mean it’s not a diet book

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Last week I attended the Ambition Nutrition Symposium in Toronto, to which I was fortunate enough to win free tickets. The theme of the conference was “bringing it home” and was intended to help translate nutrition theory into the kitchen and onto client’s plates. While I’m not sure the day really succeeded in that regard, I still found it to be an interesting conference with a variety of speakers and delicious food (thank you George Brown culinary students!). That being said, from my perspective, there was an elephant in the room. That elephant was the tension between professions and dietary dogma.

We started the day with a great presentation by Dr. Kelly Brownell, director of the World Food Policy Centre, among numerous other titles. He spoke about the difficulty we often face when addressing food-related issues through policy as something that benefits one area (e.g. nutrition) may cause unintended harm in another (e.g. agriculture). The goal of his new centre is to bring stakeholders from all the areas together to try to develop policies that will benefit all areas. As an aside, one thing I noticed about the list of stakeholders he shared was the lack of the public. As “end users” I think that it’s essential that the public (or specific groups from the public such as those experiencing food insecurity) are involved in these discussions.

Later in the morning we had an excellent presentation by Nishta Saxena, a dietitian. Maybe I’m a little bit biased as an RD but I felt that she did a fantastic job of presenting the struggles we face in addressing healthy eating with clients when they are constantly bombarded by misinformation in social media. How do we combat “sexy” social media influencers as professionals who must provide evidence-based factual information and are less inclined to posed half naked with overflowing mason jars of green smoothies? Several years later and dietitians still aren’t sexy ;)

We also had Saxena and chef Christine Cushing call out juicing and juice diets (while a new cold pressed juice company presented at one of the breakout sessions and provided samples during food breaks). Cushing mocked the caveman diet and then we had a snack break with “paleo” brownies. Saxena belittled meal kits and our swag bags contained a coupon for Hello Fresh. Hello elephant.

Follow-up Saxena’s fantastic presentation with a discussion with Dr. David Ludwig and his wife chef Dawn Ludwig to promote their new book “Always Delicious” which we all got a copy of in our swag bags. Full disclosure, I have been critical of Ludwig in the past. I tried to come into it with an open mind though, I really did but the elephant would not settle down. Despite their protestations that it was not a diet book, if it talks about weight loss, fat adaptation, is filled with testimonials (from readers who have lost weight), and has a prescriptive DIET with three phases, it’s a goddamn diet book. I’m not going to get into the science of his insulin hypothesis here because my point is not to critique his beliefs but if you want to read more about it I recommend this short article by Stephan Guyenet. I’m also not here to question the “success” people have had on Ludwig’s diet. If people are happier and healthier following this plan, I think that’s great. My issue is with the framing of this diet as the best way to eat for everyone and that the best way of eating is one that promotes weight loss. They talked about “NSVs” (non-scale victories) but the only examples I saw in the book and heard during the talk were a reduction in blood pressure and going down a pant size (which while technically not a weight loss “victory” is still a “victory” over an “unruly” body).

For a day that was meant to promote health through food there was a whole lot of talk about The Obesity Problem which is really not the direction that we want to take if we want to encourage people to have healthy relationships with food and their kitchens. I encourage everyone to read this piece about one woman’s “life as a public health crisis”.  If obesity is a “problem” then food is the enemy. That mindset does not lead to healthy attitudes and behaviours. You don’t need to “retrain” your fat cells, they are not disobedient puppies. Rather, we as a society need to retrain our attitudes toward our bodies and our food so that we can once again be friends with both.