Dispelling nutrition myths, ranting, and occasionally, raving


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What obesity and homosexuality have in common

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A couple of weeks ago I was listening to an episode of Radiolab on which they shared an episode of the short podcast series Unerased titled: Dr Davison and the Gay Cure. They were talking about the former perception of homosexuality as a disorder and the rise of conversion therapy. As I was listening what they were saying really struck a chord with me. I found myself thinking “this is exactly how people are going to think about weight loss counselling one day”.

On the podcast, they were saying, essentially, it doesn’t matter if people come to us wanting to change. What does it actually mean to help them? “The problem that these people are asking us to solve is a problem we created. That we labeled as a problem.” Even if we could effect certain changes, there is the more important question as to whether we should… It makes no difference how successful the treatment is, it is immoral.” And I was like “YES, this exact same thing could be said about weight loss treatment!”

This belief in relation to homosexuality was considered to be fringe and most people weren’t in support of it initially. This parallels the Health at Every Size/body diversity/weight acceptance movement. There is a lot of push-back from people in the medical community and the general public when it’s suggested that weight is not a condition that needs to be treated. Just as with the acceptance of homosexuality as a normal state, there were a few outspoken pioneers leading the movement and with time, it became more accepted by the mainstream. I feel that this is beginning to happen now with weight. More of us RDs who were always taught that “overweight” and “obesity” are unhealthy are coming to realize that people can be healthy at many different sizes.

Of course, there are still hold-outs and there is still conversion therapy happening in some places. Similarly, there will likely continue to be hold-outs who believe that only thin people can be healthy and that BMI is indicative of health. However, I’m hopeful that we’re reaching a turning point and that one day the medical community will agree that weight is not a “problem” and that weight loss treatments are unethical.


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Are calories an enemy?

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I would like to propose that we stop demonizing calories. All too often I see products promoted as “low-calorie” or “calorie-free”. I hear jokes about things like it’s okay to eat a broken cookie because the calories all leak out. Consuming as few calories as possible is considered virtuous. This despite the fact that we need calories to live.

Just in case you need a quick refresher on calories, despite what many people will have you believe, a calorie is a calorie. The definition of a calorie is, “the heat energy required to raise the temperature of one kilogram (rather than a gram) of water by one degree Celsius”. Calories provide us with energy. Energy to get through each day but also energy for your body’s systems and cells to function. Without a source of calories you will die.

So, why do we think that calories are bad and something to avoid? Because we’ve learned that excess calories, those we don’t use up, are often stored by our bodies for later use in the form of fat. And fat is bad because our society has rather arbitrarily decided that being thin is more attractive. Regardless of your body shape or size though your body still needs calories to function.

Wouldn’t it be wonderful if we lived in a world and mental space where instead of choosing 100 calorie snacks or avoiding foods because they contain “too many calories” we could look at food as a pleasurable way to nourish our bodies? Not just to think of food as fuel but as an essential component of self-care. Calories are not the enemy, they are vital to life.


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Do dietitians follow the Food Guide?

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The above inane tweet last week prompted me to post a couple of tweets in which I screamed into the void about a) people not following dietary guidelines anyway and b) weight not being indicative of health. Which then lead to me posting the following poll:

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Obviously, this is a completely unscientific poll but it does show that the majority (83%) of RDs who responded do not generally follow the dietary guidelines for their respective counties. This could be for any number of reasons. Most didn’t respond with a reason. Those who did said that they weren’t big on fruit of dairy or the carbs (that’s the grains food group) are too high. Personally, I suspect that some days I’m low in vegetable and fruit consumption or milk and alternatives. Other days I’m definitely over. And if I’m being completely honest, I have something from that “other” food group (aka sometimes foods) on the daily.

The truth is, the Food Guide is just a guide. It’s not a bible. It’s intended to provide people with all of the nutrients and energy they need to be healthy and active but everybody is different. We all have different needs and preferences. I know that people really like to rag on dietitians and say that all we do is preach the food guide but I’m here to rain on that parade. Dietitians are people too and we enjoy food for more reasons than just as fuel. We are not robots that run on kale and quinoa. I think that most of us think that the food guide could be improved (and fingers crossed it will be whenever they finally come out with the new version) but we also know that it’s just meant to be a tool.

Food Guides are meant to guide people toward nutritious food choices. They encourage a variety of foods from all of the food groups. The overall message that people should be taking from a food guide is that there are healthy choices in all the food groups and eliminating any one food group may result in deficiencies. Also, that eating only one type of food from each food group (e.g. lettuce as your only veg or bread as your only grain) is not going to provide you with all of the nutrients that you need. However, it’s also important to listen to your own body and nourish it accordingly. If you’re not hungry don’t sweat the fact that you’ve only had 5 servings of vegetables or 4 servings of grains. Conversely, if you’re extra hungry one day, don’t feel like you have to limit yourself to the servings recommended in the Food Guide.

Healthy eating really doesn’t have to be complicated or rigid. In fact, if you think that you’re eating healthily and you’re finding that it is complicated or rigid then you diet (or relationship with food) probably isn’t all that healthy after all.


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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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Whole Life Challenge review

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You know what I’m sick of? Engineers and people with zero nutrition education making claims that you can “biohack” your life, undermining dietitians, and giving one-size-fits all nutrition advice. This rant seems appropriate coming on the heels of my post about the carnivore diet.

Earlier this summer my brother asked for my thoughts about this “Whole Life Challenge” that a bunch of people in his office were doing. He was a little sceptical about the nutrition advice they were providing and wanted to know my thoughts as a registered dietitian.

My first question was, “who is behind this challenge?” Well, we’ve got the founders: Andy who has a background in sales and engineering (quelle surprise) who then opened a crossfit gym and Michael who was a coach and manager at a crossfit gym, and has a degree in philosophy and culinary arts. Well, at least he’s got a little knowledge of food in there but as most know, culinary arts and dietetics are woefully disconnected professions with chefs learning little to nothing about nutrition. The remainder of the team is comprised of the CEO, social media, web development, content manager, corporate relations, a couple of customer service reps, chief technology officer, and public relations. There is absolutely no one working for this enterprise that has any background in nutrition or health. Sigh. 

At a glance, the “challenge” doesn’t look so bad. The idea is to work on seven daily habits over the course of six weeks. You get points for completing each of the daily habits and you’re supposed to play with a team (the more people playing the more money they make this will help “foster success”). The habits are as follows: nutrition, exercise, mobilize, sleep, hydrate, well-being, and reflect. Many of these are areas that most of us could stand to improve on. Of course, I’d like to reiterate that the people who created this challenge have zero education pertaining to any of these topics. Cost is $39 US per player.

Unfortunately, you have to pay to play so I can’t access all of the materials available to players, including the nutrition plans. Fortunately, I have the inside scoop ;) and was able to view the nutrition material. They’ve created three levels with the highest being the “performance level”. This level is for those who, “already have good eating habits that you just want to fine tune, have athletic or performance-related goals, or have a pressing health or inflammation condition that you’d like to address”. The level below that is the “lifestyle level” which is, “A good choice if you are looking for a long-term lifestyle nutrition program. This is a great start to a sustainable practice of living a healthy lifestyle”. The easiest level is “kick start” which is supposedly, “a great place to start if you’re new to the health and fitness game and need to make the most important tweaks to get yourself started in the right direction”.

At each level of the plan you’re given a list of foods that are “compliant” and “non-compliant”. The higher the level, the fewer the foods that are compliant. How did they determine which foods are “compliant” and which are “non-compliant”? Excellent question. I have no idea other than the statement they make at the top of the charts: “When you see (*) next to a food, it indicates the food is compliant but should be eaten in moderation, as there are potentially negative effects from overconsumption”. I assume that this means that they believe there are negative effects from consumption of “non-compliant” foods. What these negative effects are is anyone’s guess. Maybe weight gain? Inflammation? Enjoyment of life? The non-compliant foods for the “performance level” are: deli or processed meats, soy, corn, white potatoes, soybeans, taro, yucca, beans and other legumes, dried fruit with added sugar, peanuts, peanut butter, hydrogenated oil, industrial vegetable and seed oils, every grain and grain product, alcohol, soda (diet or regular), juice, all dairy (except butter), the only snack foods allowed are baked sweet potato fries or chips and baked vegetable chips. Yum yum. To be fair, they do say that this diet would be difficult to maintain long-term and “maybe not even necessary”. Yeah, no shit.

Just for fun, and your reading pleasure, my brother endeavoured to follow this diet for a few days. My brother is a prolific runner, he’s in his third year of a running streak and he’s fast. He eats a balanced and varied diet and enjoys the occasional beer; a candidate for the “performance level” if there ever was one. Unfortunately, he came down with a cold at the same time so his report was: “my lack of energy could have been the diet or being sick”. N of 1, inconclusive.

That being said, while this diet might work for some, it’s probably not the best diet for most endurance athletes. It can be very difficult to obtain sufficient nutrients and calories and attain peak performance on such a limited diet. Also, beans and legumes and whole grains are full of good nutrients as well as being affordable. Any non-medical diet that tells you to eliminate all of these foods is unlikely to be sustainable or healthy in the long-run, particularly for those who engage in long runs (sorry, not sorry).

Six weeks isn’t all that long and when people are working in a group challenge there’s more incentive to stick to a plan than there would be on their own. There’s also minimal risk of nutrient deficiencies being a serious concern over such a short time frame. However, because this challenge is framed as a short-term undertaking and the diet plans aren’t easily sustained, I worry that this will encourage weight cycling in participants (which may actually be more harmful than maintaining a higher weight long-term) and discourage long-term adoption of healthy behaviours. If you’re only adopting these “habits” for six weeks to win a challenge and it’s a major change from your usual lifestyle I can imagine that at the completion most people celebrate finishing by ditching all the “habits”. It would be interesting to see research on participants of a challenge like this.

This plan is also very prescriptive. Apparently I should be drinking 37 ounces of water a day. There is no mention of drinking to thirst here or adjusting intake based on physical activity, temperature, or other fluid intake. You are not learning to listen to your body on a plan like this. There is no allowance for individual differences or personal preferences. Compliant foods equate to “good” and non-compliant equate to “bad”. This reinforces the false moralistic attitude that many people have about food. It also fails to consider that we eat for many different reasons and that taking pleasure in food and enjoying food socially are important aspects of eating. Framing healthy eating as being complicated and unpleasant only serves to make people adopt an all-or-nothing mindset toward a (perceived) healthy diet. Winning at this challenge may only set you up for failure when it’s over.