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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Doctors giving nutrition advice probably shouldn’t reference Pete Evans

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I saw this article last week and had mixed feelings about it. I know that we were all supposed to read it and be horrified that a doctor was reprimanded for giving patients nutrition advice. After all, shouldn’t doctors be doing more to help patients manage their health through lifestyle changes? But… there’s so much that this article doesn’t tell us.

Just to start by clearing the air, obviously you all know that I’m a dietitian. Of course I’m going to feel a little defensive of my profession. The orthopaedic surgeon in question was undermining recommendations given by dietitians at the hospital where he worked. All because he had studied some nutrition on his own. Can you even imagine the outrage that would occur if the tables were turned and a dietitian undermined advice given by a doctor?! I’m certain that the RD would lose her (or his) licence, not just be given a slap on the wrist and told to stop working outside the scope of their practice.

Everyone think that they’re experts in nutrition simply because they eat (yes that’s hyperbole, please don’t send me your #notalleaters comments). So many people believe that doctors are all knowing. Unfortunately, it would seem that some doctors fall prey to this mode of thought as well. Doctors specialize. A doctor who works in oncology is going to have an entirely different knowledge-base and skill set from a doctor who works in neurosurgery. Doctors should not be expected to know everything. Yes, family doctors should be better equipped to provide nutrition advice but an orthopaedic surgeon should defer to the dietitians on-staff. It takes an incredibly high level of self regard to believe that you are more of an expert in a field in which you did a little self-study than a regulated health professional who studied the subject for over four years, is immersed in it on the job, and who must complete on-going education to maintain their credentials.

There’s some amazing irony in the article as well. The author references a television episode with the doctor in question and celebrity chef Pete Evans. For those who are unaware, Evans is a notorious charlatan and has faced entirely warranted criticism for promoting unsafe infant diets amongst other questionable nutrition practices. A few paragraphs down, the author goes on to say:

In addition there are numerous unqualified “gurus” giving advice about what we should and should not be eating. Surely it is preferable to have a doctor giving nutrition advice rather than unqualified individuals, many of whom have a product or program to sell.

Um HELLO??? Pete Evans is the epitome of the unqualified guru with a product to sell. Just prior to this statement, the author even admitted that the majority of doctors receive very little formal nutrition education. So, no. It’s not preferable to have a wholly unqualified doctor providing nutrition advice to people. In a way, it’s worse than having a self-proclaimed “guru” providing nutrition advice because people trust their doctors.

If the doctors referred to in the article truly cared about the well-being of their patients they would refer to appropriate professionals when needed, including registered dietitians. They should also work together with those professionals to provide the best care possible for their patients. Rather than assuming that they have superior knowledge of a subject which they were not adequately trained in.

How about rather than complaining foul when someone is rightly called-out for practicing outside their scope of practice, we talk about the real problem here. That our healthcare system is designed to treat illness rather than prevent it from developing in the first place.


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Why fruit and veg aren’t the right prescription for health

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I feel like I’m being a bit of a stick in the mud, but I’m not sure that I’m onboard with this new fruit and vegetable prescription initiative in New York. Naturally, I’m all for people consuming more fruits and vegetables. I’m just not sure that this is the way to go about getting people to eat more fruit and veg. Nor am I convinced that this is the ideal way to target people.

Doctors are giving out vouchers for fresh produce at a hospital in an area that has a high level of poverty and a low-level of fresh produce consumption (according to the article I linked to, as many as 5 out of 10 people in the area consume no fruit or vegetables in a given day!). These doctors are giving the vouchers to obese patients as they are at greater risk of developing diseases such as type 2 diabetes, cardiovascular disease, and certain cancers. The theory is that this will prevent the development of many of these diseases in these individuals. This is where I see the first problems with this strategy. In an area that is highly impoverished it seems unfair to give these vouchers solely to obese patients. Surely there is a high level of malnutrition amongst the normal, over-, and under-weight population as well considering the fact that insufficient income is the number one factor contributing to food insecurity. Wouldn’t it be better to give these vouchers out to all patients, or at least those earning less than a predetermined income level? Weight is not the best barometer of health and I’m fairly certain that people at all weights and income levels could do with eating more vegetables.

Another concern of mine is that many people won’t have the means, ability, or inclination to prepare fresh produce. Similar to the saying, you can lead a horse to water but you can’t make him drink. It’s all fine and well to tell people “go, get yourselves some fresh vegetables”. It’s another thing entirely for them to actually procure the vegetables and then prepare them in a healthy manner. Anyone who’s ever worked in a food bank can tell you that clients will often pass over fresh produce (there can be a number of reasons for this but it’s often because they’re unfamiliar with the foods and don’t know what to do with them).

My final concern is that this program is likely to have little to no effect on the “obesity epidemic”. Yes, increasing access to fresh nutritious foods is a lovely gesture but it does nothing to combat the obesogenic environment in which we live. We need to overhaul our entire food system and societal structure if we want to make any serious headway with curbing obesity.

This initiative reminds me of the one started in Edmonton by doctors who were (are?) prescribing exercise to their patients. I would still love to see an initiative that saw prescription of dietitian services to patients and not just obese patients. The dietitian could help the patients to figure out ways to improve their dietary habits that would work for them. They could also provide education on nutrition and food preparation and perhaps at this point the patients could be provided with vouchers for fruits and vegetables. It’s obviously not going to put an end to the obesity epidemic but it’s something that could be relatively easily implemented while we fight to change the current food environment.


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Bad news for science: naturopaths get positive press

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The twitterverse was all abuzz the other day with the release of a journal article that found that patients who received counselling from naturopaths reduced their risk of heart disease significantly more than patients who only went to see a doctor.

Of course, a number of the authors of the paper reported potential conflicts of interest such as receiving funding from alternative medicine groups and naturopathic organizations. Naturally, they would have a vested interest in showing that there is a benefit to seeing a naturopath.

Doctors, unfortunately, are more often than not, ill-equipped to provide lifestyle and nutrition counselling. It seems pretty obvious that patients provided with an additional level of care would experience better outcomes than the patients who only met with their family doctors. This does not mean that all patients with elevated risk for cardiovascular disease should seek the help of a naturopath. It means that they should be receiving specialized nutrition and lifestyle counselling from a trained health care professional. Ideally, a dietitian as our advice is science-based and we do not promote homeopathic remedies.

The two things I get out of this study are: 1. patients with elevated risk for diseases which can be mitigated by lifestyle changes should receive counselling in the appropriate area(s), 2. doctors should be referring their patients to their appropriate counterparts in healthcare to supply that counselling. The fact that naturopaths were the providers of the counselling in this study is unimportant and gives the false impression to the public that naturopaths are a suitable alternative to doctors and dietitians.