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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The dark side of dietetics

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Is there any other profession in which there is as much infighting as there is in dietetics? Seriously though. Is there?

All too often I see RDs attacking each other, undermining each other, subtweeting the heck out of each other. Maybe it’s that social media has brought our differences to the fore. Maybe it’s that it’s far too easy to belittle someone when you just have to tap out a short message on social media and it’s there for all the world to see. But why is there what seems to me to be an excessive amount of vitriol amongst members of my profession?

Perhaps it’s that there aren’t enough jobs to go around so it feels like everyone’s stepping on everyone else’s toes. The pie isn’t big enough for everyone to get a reasonably sized piece (yes, I had to use a food metaphor. It’s my duty as a dietitian).

Don’t get me wrong. I’m not saying that we all have to agree on everything. There are many approaches to various aspects of dietetics and with such an evolving field there’s bound to be differences of opinion. Honestly, I’ve been critical of other RDs myself although I try not to make it personal. I find it hard to resist calling out examples of what I believe to be a lack of ethics or subpar advice.

But seeing dietitians attack other dietitians for differing opinions is not cool. There’s no need to insult someone because you don’t agree. Just because you are so confident in your dogma, or perhaps because you’re so insecure about your promotion of specific products that doesn’t make those who see things differently wrong or bad dietitians. There’s no need to publicly disparage them. It does a disservice to our entire profession. And god knows with everyone else and their dog thinking that they’re qualified to spout nutrition advice we don’t need those within our profession taking each other down. The pie isn’t going to get any bigger. Rather than squabbling over one piece while the self-styled nutritionists run away with the pan we need to figure out a better way to share amongst ourselves.


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Is it unethical for dietitians to sell supplements?

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Eggcup of Pills photo by John Twohig on Flickr. Used under a Creative Commons Licence.

Something happened recently that kind of blew my mind. I was always under the impression that it was a conflict of interest for a dietitian to sell supplements. Short of causing someone harm, in my mind, it was pretty much one of the most blatantly wrong things that a dietitian could do. In my mind, it still is, but according to at least one College of Dietitians, it’s not.

I happened to be exploring a fellow dietitian’s website, as I’d seen them make some questionable assertions in blog posts. You know, the sort of sensational “sexy” hype that I’m always saying we RDs don’t make. I happened to notice that they had a “shop” in which you could purchase several supplements. I shared this information with a friend, another dietitian, who passed it along to a contact at the College in their region. The response indicated that this might be a concern; however, if there is scientific backing for the supplements, as long as clients don’t feel pressured into purchasing supplements, while not ideal, it’s kind of okay. What??

One of the main reasons that many mainstream healthcare professionals take an exception to some alternative healthcare professionals is that they peddle supplements to their clients. It shouldn’t matter how much science there is supporting the use of a supplement. For any healthcare professional to receive direct compensation for the sale of a supplement or drug is a clear conflict of interest. No matter how amazing the supplement may be, no matter how questionable the supplement may be, the potential to profit from its sale to a client can cloud the judgement of even the most upstanding healthcare provider.

I can understand the desire to make money by selling things. It can be tough to make a living as a dietitian. A supplement may seem like a fitting choice. However, it undermines our credibility. For one thing, there is little evidence to support the use of most nutritional supplements. Imagine the more extreme scenario: You go to see your doctor who diagnoses you with disease X. Fortunately, there is cure Y which she can sell you. Can you not see the potential for corruption? misdiagnosis? Unnecessary treatment? Incorrect treatment? Despite the best of intentions, this can happen when the person who is assessing your condition is also selling you the cure. It’s unethical for healthcare providers to profit from a direct sale of a treatment.

If you ever visit a healthcare professional who offers to sell you a treatment or cure, please report them to their governing body. Get a second opinion. Do some research. We need you to ensure that all healthcare professionals are doing their utmost to ethically optimize your health.


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Of wellness chats, dietitians, and L-Glutamine

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The other night I had my first exposure to a “wellness chat” on twitter. It was interesting to say the least. The guest* was a registered dietitian in the US. A few of her statements surprised me, and at least a few other RDs. The most surprising tweet read:

What to do when U have a craving? Have a balanced #PFC (protein, fat, carb) snack AND take an L-Glutamine capsule #cravingfree #wellnesschat

A few of us tweeted back at her asking for her to share a link to the research supporting the use of glutamine to reduce cravings. As far as I’m aware, none of us received a satisfactory response. The only response I saw to our requests for research to support her statement was: “Get your supplements where u like, just make sure they’re high quality for effective results.”  This response was also in reply to our expressed concerns that she is selling these supplements (among many others) on her website. In my mind that’s an ethical concern. No health care professional should be profiting from the sale of medications/supplements. It’s an obvious conflict of interest. It’s also a little baffling that she’s doing podcasts extolling the benefits of real food (while also patronizingly insulting many other dietitians by suggesting that we are “brainwashed” into following obsolete dogma taught in school and don’t keep up with current research. Odd, in Canada at least, as part of our professional standards we must demonstrate continued competence by keeping up with current research and new developments in the field) yet profiting from the promotion and sale of supplements.

But… Back to the glutamine issue. My first stop to answer this question was examine.com. They do a great job of slogging through all of the research to get the facts about supplements. The short version of what they say about glutamine is:

A conditionally essential amino acid, only appears to benefit the body as supplementation when otherwise deficient (vegans, vegetarians with low dairy intake) or during prolonged endurance exercise. Anecdotally reported to reduce sugar cravings.

Yes, anecdotally reported to reduce sugar cravings. That means that there is no actual research to support the use of glutamine to reduce sugar cravings. A search of google scholar shows that there are no scientific studies supporting the use of glutamine to reduce sugar cravings. As dietitians we have an obligation to employ evidence-based best practices. This means that we cannot ethically recommend unproven treatments or supplements. I’m not saying that glutamine doesn’t work to reduce sugar cravings. I’m saying that we have no evidence either way. Until there is evidence to support its use in reducing sugar cravings dietitians cannot ethically recommend its use for that purpose.

I have yet to meet a dietitian who fails to keep up to date with current research. It does a great disservice to our profession when one of our fellow RDs suggests that many of us are not up to speed and that she is somehow special and superior to others in the field  because she is “science-based”, especially when she is making recommendations that are not actually based in science. Please be wary of any healthcare professional who is profiting from selling you a cure.

 

*Name has been omitted to protect the guilty. This is something that I struggled a bit with. I decided not to identify the RD in question because I don’t want this to be viewed as a personal attack, it is not.


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McDonald’s, dietitians, and ethics

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It was all over the news last week. McDonald’s Director of Nutrition (a dietitian) proclaiming that their food is healthy.

A part of me feels sorry for this poor woman. As a dietitian, I know how difficult it can be to find work in our field. It also made me sad to read her statement that she eats McDonald’s food 1-2 times a day and is already feeding foods from there to her two-year-old child. I understand that she has an obligation to make her employer look good. However, as a dietitian, I also find it incredibly distasteful that a fellow professional would be promoting McDonald’s as a healthy choice. Where does an RDs ethical responsibility lie? With his/her employer or with the public?

In the interview, Cindy Goody, the RD in question, mentions a couple of products that are served on buns made with 8 grams of whole grains. What the heck does this mean? Not much, actually. It just means that out of the total weight of ingredients in the bun, 8 grams of it is whole grain. An average bun is about 50-60 grams. That means that the remaining 42-52 grams are from other flour, sugar, and other ingredients that go into a bun. It doesn’t mean that the bun contains 8 grams of fibre. Not particularly impressive.

Goody also mentions that foods are being made healthier by reducing calories and sodium. As all you nutrition savvy people know, removing crap from an unhealthy food does not automatically make it healthy. You are still likely to be missing out on important nutrients (such as fibre, healthy fats, potassium, calcium, antioxidants, etc.) if you’re regularly eating from McDonald’s “healthy” menu options. Sure, there are better and worse choices you can make if you’re eating at McDonald’s but highly processed fast food is never going to be a match for a balanced, home-cooked meal.