Dispelling nutrition myths, ranting, and occasionally, raving


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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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Does protecting the public infringe on freedom of speech?

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So, I already blogged about a very similar issue not all that long ago, but I can’t let this article pass without comment.

Essentially people (aka business owners who are hiring unqualified individuals) are pissed off because they won’t be able to hire just anybody to provide nutrition counselling to customers and clients if a NY bill passes. Which means they might actually have to hire qualified nutrition professionals (aka Registered Dietitians) and maybe pay them a semi-decent salary if they want to continue offering nutrition counsel to their clientele.

The bill would define the practice of dietitians and nutritionists and make it illegal for anyone to provide these nutrition services who’s not licenced by the State to practice either dietetics or medicine. The example the article provides to make their case that this is outrageous, in my opinion, actually serves to exemplify precisely why this bill would be a good thing.

The representative of the group attempting to defeat the bill complained that someone who’s not licenced to provide nutrition services would be able to say, “for example, “Fish contains vitamin B12.” But you could not go further to say, “If you’re feeling tired, or lack energy, try foods or supplementing with vitamin B12.”” You see, a RD would know better than to give a recommendation like this because it’s not our job to diagnose. Rather, we might suggest that a person bring their concern to their doctor and ask about having their vitamin B12 level checked. There can be many reasons why an individual is lacking energy and we wouldn’t just push a supplement on someone. I can see why health food store owners might not want to hire us as pushing supplements is what keeps them in business.

Again, what the article fails to mention is the reason for the bill. It’s not for the benefit of Registered Dietitians, although it would likely benefit RDs practicing in NY. No, it’s to protect the public. It’s to ensure that unscrupulous and/or inadequately trained individuals aren’t providing nutrition services to the unwitting public (although there are plenty of exemptions). It’s so that the public aren’t provided unhelpful, or even potentially harmful nutrition advice. It’s so that the public aren’t pushed to buy unnecessary, or even potentially harmful supplements. It’s so that the public aren’t encouraged to follow unhelpful, or even potentially harmful diets. It’s so that the public don’t have to navigate the confusing titles to determine if a professional is qualified to provide them with advice. This bill would serve to ensure that the public is receiving nutrition services from qualified credible regulated professionals.


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If children are the future we may be in trouble

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After coming across a few teacher resources I’ve started to wonder about what lessons we’re really teaching children in schools.

The first example was actually a list of nutrition curriculum supports for teachers compiled by dietitians. Most of them were great but a few that really stood out to me were ones produced by companies whose m.o. is to sell products, not to educate. I found it concerning that nutrition professionals would consider promoting self-esteem resources from Dove and videos about farming from companies like Kashi to students would be appropriate. Considering the clear lack of media literacy and nutrition literacy in our society, I think it’s vital that as nutrition professionals we do our utmost to promote credible, unbiased (or at least as unbiased as possible) sources of nutrition information to the public and particularly to children and youth.

So, there was that. Then I came across a (US-based) website of “food resources” for teachers with a number of activities featuring candy to teach kids lessons about various subjects such as math and science. For example, we have: gummy bear genetics, gummy worm measurements, the history of marshmallows, math with candies, and chocolate and solvents. Why exactly do we need to use sugary treats to teach children in school? Is this the norm? Is the prevailing perception that children need to be bribed to learn anything in school?

There’s lesson plans on the website including things like “Juice Nutrition 101” which one might reasonably assume would be about the pros and cons of juice. If so, you would be incorrect. It’s actually only about the alleged benefits of juice and was (get this) used with permission from Ocean Spray Cranberries, inc. I shit you not.

What kind of lessons do these sorts of things actually teach children? Not critical thinking, I’m sure. Nor do they teach children accurate unbiased nutrition information. They also normalize and encourage the regular consumption of candy and treats that should really be “sometimes” foods. We need to have more dietitians involved with the development of educational resources. We need to ensure that teachers are nutrition and media literate so that they don’t use resources such as those mentioned above in their classrooms. If children are the future we need to do better at equipping them with the skills to navigate and emerge from this “post truth” era.


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Are dietitians getting too sexy?

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A few years ago I wrote a blog post that really hit a nerve with other dietitians. It was about how dietitians just aren’t sexy. This was in the sense that we don’t hop on trends (unlike other unregulated professionals) and instead are moored in evidence-based practice. Unfortunately, I’m noticing a disturbing trend in dietetics and I’m concerned about the future of my profession.

There have always been some dietitians who believe in unproven practices such as detox, fad diets, and questionable supplements. It’s a shame to see others promoting such nonsense as I feel it reflects poorly on all of us but it’s always been the minority. It’s also been somewhat understandable because it can be a tough field in which to find a secure job. And we probably all have some beliefs that aren’t based in evidence. Experience is important in combination with scientific evidence. However, I feel like in this age of fake news where nothing means anything anymore, that this is infiltrating dietetics at a higher level.

Recently there’s been the introduction of “integrative functional nutrition” which sounds very scientific and pretty great, “A central theme of IFNA training is learning to identify “root causes” of disease in a methodical and systematic fashion rather than the mundane prescription of medical nutrition protocols based on a diagnosis”. Who doesn’t want to get to the root causes of illnesses? I think the main frustration with Western medicine is that there’s often a failure to dig deeper to find the root cause for ailments and simply a treating of symptoms. This is why so many people turn to unscientific alternative health practitioners for help. Unfortunately, “integrative functional nutrition/medicine” tends to be code for the smooshing together evidence-based practices and unproven unscientific practices. The creation of bodies of dietetics incorporating these practices lends false credibility to them.

Last week I attended a nutrition conference. It was generally a really great conference with presenters sharing a variety of perspectives and evidence. There were also presentations by people with lived experience. I think there’s a great deal of value in learning from people who have experience with various conditions, circumstances, illnesses, etc. However, the final presenter was by an individual who had “cured” a severe mental illness through nutrition and supplements with the aid of a Christian doctor in the US. I’m not in a position to question this person’s experience but the presentation made me extremely uncomfortable. I don’t doubt that nutrition plays an important role in supporting mental health. Although I do doubt that we can cure most cases of mental illness through nutrition.

As dietitians, we are always trying to promote ourselves as credible sources of nutrition information. Yet here we are, welcoming a presentation from an individual who was treated by a doctor whom would be dubbed as a quack by most. This guy readily fails Dietitians of Canada’s “Five tips to help you spot misinformation“.

1. Is the person or product promising a quick fix like fast weight-loss or a miracle cure? Check!

2. Are they trying to sell you products such as special foods or supplements? Check!

3. Do they provide information based on personal stories rather than on facts? Check!

4. Is their claim based on a single study or a few research studies? Not sure if the claims are based on any research so yeah, Check!

5. What are the person’s qualifications? Unfortunately, he’s a medical doctor which makes it sound like he’s a qualified professional. But we all know that doesn’t stop Dr Oz from operating outside of his scope of practice. Being a MD doesn’t necessarily mean that an individual is qualified to be providing nutrition services (most doctors receive very little nutrition education during medical school). As far as I can discern, he hasn’t received any specialized nutrition education so… CHECK!

Inviting people who are promoting such quackery to professional conferences undermines our credibility as nutrition professionals. It lends false credibility to their practices and allows these unproven beliefs to infiltrate dietetics. It makes it harder for us to present ourselves as credible nutrition professionals and undermines the ability of the public to trust us.

It’s discouraging to see people seeking out healthcare from unregulated professionals with questionable credentials and practices. But I don’t think the solution lies in taking the attitude that if you can’t beat them, join them. It’s important for us to continue to ground our advice in the best possible scientific evidence if we want to remain trusted healthcare professionals. Otherwise we may as well all burn our degrees and licences because they’ll become as meaningless as the credentials of all the self-styled nutrition gurus.


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Should dietitians use #eatclean on social media?

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A friend shared this article with me last month. For those of you who can’t be bothered to click links or belong to the TL;DR camp (of which, I’ll admit, I’m a frequent member) let me give you the briefest of synopses. It was about clean eating, why people got so sucked in by the notion, and why it won’t freaking die already.

Reading about all of the self-appointed “clean eating” wellness gurus got me thinking about how many of us who rail against fad diets are also inadvertently complicit in keeping them alive. I see lots of well-intentioned dietitians using hashtags like #cleaneating and #eatclean on their Instagram posts. Personally, I prefer the tag #eatdirty although I don’t think it garners me as many likes as it hasn’t quite caught on in the way that I had hoped. Anyhow… I’m not here to judge my fellow RDs. I’m not even sure how I feel about this myself.

There’s a part of me that thinks it’s good for dietitians to be appropriating the “eat clean” hashtag. By doing so, perhaps they’re reaching people who are all-in on the trendy diet train but who might benefit from seeing sensible nutrition and food suggestions from a nutrition professional. On the other hand, is using these hashtags on Instagram lending legitimacy to them? Isn’t it possible that by using the hashtags, no matter the content, it’s implying that the RD posting supports the notion of clean eating? And for all I know, maybe they do, not all of us are on the same page. But let’s assume that they’re using it, not because they believe in “eating clean” (which means nothing by the way), and not because they’re just trying to get more likes (I know, terribly cynical of me), but because they want to show people who are into “clean eating” a more balanced way of approaching food. Is it cool for dietitians to be using the hashtags for this purpose? Even if it means that it lends an air of legitimacy to a silly fad diet. Does the end justify the means? Or would it be better if we risked only preaching to the choir by using hashtags that truly represent our personal philosophies toward food and our professional opinions?