Dispelling nutrition myths, ranting, and occasionally, raving


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Got lactose intolerance? More dairy is the answer! (The role of industry in education)

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Last week I participated in a webinar about “dairy’s role in lactose intolerance”. It was presented by Today’s Dietitian and sponsored by Danone. This is a shining example of why industry should not have a place at the table in nutrition education and policy.

The first part of the presentation was fine. It was a review of lactose intolerance prevalence, methods of diagnosing lactose intolerance, symptoms, and so on. Of course, the importance of dairy products in a nutritious diet was impressed upon us. This, despite the fact that they aren’t truly necessary. Yes, dairy can be an easy source of protein, calcium, B12, and vitamin D (this because it’s added, not naturally occurring in dairy) but it’s still possible to obtain these nutrients from other foods.

The second part was where I started to get really annoyed. I should have expected it. It was a webinar developed by dietitians working for Danone but the blatant bias still irritated me. It was discussed how much lactose could be tolerated by those who are lactose intolerant (apparently about 12 grams in a sitting). Recommendations by the NMA (National Medical Association) apparently state that even those suffering from lactose intolerance should still aim to consume three servings of dairy products each day. Their recommendations include: gradually increasing exposure to lactose-containing foods, including low-lactose dairy products such as yoghurt and lactose-free milk, and using lactase enzyme supplements. No suggestion of alternative sources of the nutrients that are available in dairy products. Nope.

I think my favourite slide was the one listing a number of milk alternatives; such as, almond, coconut, soy, and rice “milks”. Descriptions that make them all sounds ever so appealing were used. Soy milk “Off-white/yellowish color”, rice milk “watery texture”. No mention of the nutritional aspects of the milk alternatives. Funny, as in at least one aspect, they are inferior, they all contain significantly less protein than cow’s milk. I think that presenting the nutrition information would have been much more informative than presenting subjective descriptions. I’m of the mind that it’s much better to let people make up their own minds as to whether or not they like a food and I’m pretty disappointed that a presentation by a fellow dietitian would disparage foods based on their own subjective opinion.

Finally, there’s part three of the presentation “lactose-intolerant friendly dishes”. Every single one of these dishes contain dairy. Good grief. My personal fave, “cheesy guacamole” containing both cottage cheese and cheddar cheese. Um… Since when does guacamole contain cheese??? Why on earth would suggested recipes for lactose-intolerant individuals take a naturally lactose-free dish and add lactose? And this is why many people don’t take dietitians seriously. Sigh.


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More on the return to home ec.

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I’ve been hearing a lot about the push for home economics (especially food skills) to return to high schools (as a mandatory course) in Ontario. I’m completely behind this idea. That being said, we were talking about that back when I worked in public health and that was more than two years ago (and I’m sure that the conversation predated my time). I’m not going to hold my breath.

 

I also think that we need to go further than reintroducing a re-vamped sexier home ec. in high schools. We need to catch kids when they’re young. Many elementary schools now have gardens which are a great way to teach children about growing, harvesting, and preparing food. They’re also great places for teaching children about math and other core subjects. I think that food literacy should be one of these school subjects. Children should receive more education about food and nutrition than the occasional food guide or guest dietitian presentation in health class.

 

If we want children to develop healthy habits for life then we need to show them what healthy living is. It’s not enough to ban cookies in the cafeterias. Our goal should be that no student should finish their school without knowing that carrots have green tops, they don’t come in cans, how to grow vegetables with or without a yard, how to prepare basic nutritious meals, how to slice and dice. We have to eat every day and we shouldn’t be allowing any more children to grow-up without the skills to feed themselves.


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Would you go to a self-taught doctor?

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My friend sent me a link to this opinion piece: Who is qualified to give nutrition advice? last week. I found myself growing increasingly frustrated as I was reading. One of the biggest frustrations I find working in the field of nutrition is that everyone’s an expert. I get it, we all eat, and many non-nutrition professionals pay attention to what they’re putting in their bodies. Nutrition information is everywhere and it’s not hard to seek out general, and even specific, nutrition facts. However, there are a couple of problems when it comes to receiving nutrition advice.

 

I don’t mean advice like your aunt telling you how to tweak your lasagna recipe or your friend telling you ways to get your kids to eat their veggies. We all give each other friendly advice like this, regardless of our educational backgrounds. It’s a whole other kettle of fish when you’re paying someone to provide you with a service. I don’t want to say that registered dietitians are the only professionals who are qualified to give nutritional education. But… At this point we are the only regulated nutrition professionals who have accountability. What do I mean by that? We have to register with our provincial regulatory body (in Nova Scotia that’s the Nova Scotia Dietetic Association). As part of our continuing competency program we have to demonstrate ongoing learning and set learning goals for ourselves every year. The NSDA also ensures that we are practicing within our scope of practice (i.e. not performing duties that we’re not properly trained for) and they deal with any complaints about us. We must all hold liability insurance so that if for some reason we’re sued we’re covered. Someone who is “self taught” may know a fair bit about food and nutrition but there is no one to ensure that is actually the case. If they give you inaccurate or unsafe counseling there is no recourse for you to be compensated and for them to be held accountable. If, as dietitians, we cause you harm through our professional practice, we can potentially lose our licences and be barred from providing nutritional counseling.

 

The other problem with obtaining nutrition information from someone who is self-taught is that you don’t know what they actually know. Yeah, I know that’s a little odd sounding. What I’m saying is, with a registered dietitian, you know that they’ve received specific education. We have to take a number of specific courses such as macro- and micro-nutrients, nutrition through the life-cycle, medical nutrition therapy, organic chemistry, biochemistry, etc. We also have to successfully complete a recognized internship program and then a national exam. Someone who is self-taught would not have had these experiences.

 

Dietitians also learn about treating people with various disease states and conditions. We can continue on in our education to specialize in things like diabetes management, oncology, pediatrics, weight management, eating disorders, mental illness, and on and on. None of us would dare claim to be experts in every area and we should be able to recognize our limitations and refer on to someone more knowledgeable when a client/patient presents with a problem outside of our realm of expertise. Just as you wouldn’t (I hope!) go to a self-taught medical doctor, dentist, pharmacist, or any other health care professional, why would you go to a self-taught nutritionist when you could go to a professional dietitian?

 

So… Matt MacDonald… While you may know a lot about nutrition there are a number of reasons why you are not qualified to provide nutrition counselling and why registered dietitians are. By marketing yourself as a nutrition counsellor (or whatever it was you were advertising your services as) you are leading the public to believe that you have a certain level of knowledge and credentials. Perhaps you do know a great deal about nutrition. However, that’s not the issue. The issue is that you are misleading the public and you are potentially putting them at risk.


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If people don’t use calorie labels should we do away with them?

Image from blog.fooducate.com

Image from blog.fooducate.com

A recent study found that the majority of chain restaurant frequenters in the US don’t use nutrition information when it’s made available on the menu. The news articles seemed to be saying that we just shouldn’t bother to include that information on menus as people aren’t using it anyway.

According to the study, only about 36% of people who frequent chain and fast food restaurants use the nutrition information to influence their decisions. Not a huge number but… That’s a sight better than the 0% we had before nutrition information was posted. I think we also need to take into consideration that the sorts of people who are most inclined to use nutrition information when making food choices are also the least likely to be frequenting fast food outlets on a regular basis.

Instead of removing nutrition information because it’s not being used by the majority of customers we should be figuring out how to get people more interested in what they’re putting into their mouths. This is where the government should step up and introduce some multi-pronged public health campaigns. These should serve to educate the public about the benefits of healthy food and the negative effects of malnutrition. They should also raise awareness about nutrition labels, how to read them, and why they’re a useful tool in making healthy choices. They should engage people from all socioeconomic backgrounds and age groups.

Admittedly, there are some problems with nutrition labelling. We must be aware that the labels are not always accurate, particularly in restaurants where there is a likelihood that menu items may not be prepared exactly the same every time and where restaurants wish to show their products in the best possible light. Despite the downfalls, nutrition label are more accurate than our eyes at measuring calories and nutrient content of foods. Rather than doing away with them we should be doing more to help people to use them.


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How to get children to eat more vegetables

A young boy eats a carrot at a collapsed

Have you ever struggled with getting children to eat their vegetables. If you’re a parent, you more than likely have. Parents, parents to be, grandparents, childcare providers, teachers, dietitians, etc. might be interested in learning about a recent study that took a slightly different approach, than the norm,  to getting children to eat their vegetables.

You’ve probably heard that it can take up to 20 separate attempts to get a child to eat a new food. so far the advice is usually just “keep trying”. I think that it’s also important to get children involved in food preparation whenever possible as their far more inclined to eat something that they had a hand in making. This study looked at using a conceptual framework to get children to eat more vegetables. The researchers hypothesized that children are often more intelligent than we give them credit for and, perhaps, simply telling them to eat their vegetables “because they’re good for them” isn’t good enough. The researchers surmised that if children are taught more specific nutrition information that they’ll be more inclined to eat their vegetables. They had some teachers read nutrition books to their students during snack time. Other teachers conducted snack time as per usual. After about three months it was found that not only did the children being provided with the nutrition education have greater nutrition knowledge than the students who were not provided with the education, they also were voluntarily consuming more than twice as many vegetables as when they started the experiment (the control group did not see a significant change in vegetable consumption).

Of course, we don’t know if vegetable consumption changed outside of snack time. Nor do we know if these dietary changes will be sustained. Even so, it’s worth considering teaching children more about food and nutrition, especially if a benefit may be consumption of more vegetables.