Dispelling nutrition myths, ranting, and occasionally, raving


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Help me tell the government that we need @EatRightOntario

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Last week I received some upsetting news: EatRight Ontario is shutting down at the end of March due to a loss of government funding. This is sad news for the dietitians who currently work there who will be losing their jobs, for dietitians across the country who use their resources, and not least of all, for Ontarians who will lose free remote access to the services of Registered Dietitians.

I was still mulling over how to approach this on the blog when I attended a webinar today. It was hosted by Food Secure Canada and was about effective lobbying for food system transformation. As the Members of Parliament were talking about how important it is to copy your local representatives on letters to Minsters I realized that this was just what I needed to do about ERO. I didn’t want to have a big pointless bitchfest on here. I wanted to do something with the potential to make a real difference. My solution: I decided to write a letter to Eric Hoskins, the Minister of Health and Long-Term Care (the department responsible for the now withdrawn funding for ERO) and to cc my local MPP so they’re aware of the huge loss that the termination of this service is going to have on Ontarians and Canadians. I thought that I would share my letter with you so that you can copy and paste it, make it your own if you want, and send it to your MPP and Dr Hoskins. After all, if we don’t let our representatives know what our concerns are, how can be expect them to effectively represent us?

Dear Dr. Hoskins,

It has recently come to my attention that the Ministry of Health and Long-Term Care will no longer be providing funding for EatRight Ontario. As you are aware, ERO is a provider of evidence-based nutrition resources and tools which are used across the country, and beyond. ERO also enables Ontarians who might not otherwise have access to a Registered Dietitian to call or email a RD for free. The loss of these services as of the end of March is going to be a huge blow to these individuals as well as to healthcare professionals, particularly Registered Dietitians, who use these resources and who refer people to their services.

ERO had 22,198 contacts between January 2017 and December 2017. These consisted of 11,562 telephone calls and 10,636 emails. This does not include the millions of visits to the website every year. ERO was also the recent recipient of an internationally recognized eHealthcare Leadership gold medal for Best Overall Internet Site. At a time when other provinces, such as Newfoundland and Saskatchewan are just starting telehealth dietetic services it is a step backward for Ontario to be terminating an established service.

Chronic diseases are the leading causes of preventable death and disability in Canada. Poor diet is a major contributor to risk of chronic disease and is a modifiable risk factor. RDs are the only regulated source of credible nutrition information in Canada. Unfortunately, many Canadians who would benefit from nutrition counselling do not have access to a RD as a result of limited services available in their area and/or a lack of coverage for RD services. A telehealth service such as ERO enables Ontarians, regardless of location or financial means, to access the services of a RD, thus promoting health equity across Ontario. Teledietetics is proven to provide positive outcomes in a number of areas. Such a service saves healthcare dollars by relieving some of the burden on emergency and local healthcare providers by reducing the need for these services. It also allows RDs, particularly those in public health, to focus their efforts on population health interventions as they can direct the public to a central credible source of nutrition information rather than spending time duplicating efforts by all creating similar factsheets and resources.

The loss of ERO will mean a loss of access to credible nutrition information for Ontarians, and Canadians, at a time when it is vital to combat the misinformation widely available on the Internet and peddled by self-styled nutrition “experts”. I urge you to reconsider the decision to terminate the funding for EatRight Ontario. If this is not an option, I ask that you continue to keep the ERO website live until an alternative site can be arranged to house and maintain the resources. I also ask that you include access to Registered Dietitians as part of your consolidated telehealth services.

Respectfully,

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The case for breaking up healthy eating and physical activity

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Have you ever noticed that healthy eating and physical activity are often lumped together? I’ve worked on Healthy Eating Physical Activity (HEPA) teams and seen Healthy Eating Active Living (HEAL) strategies and Healthy Eating Active Fun (HEAF) programs. If you haven’t already noticed it, you probably will now that I’ve introduced that thought to your brain. The thing that I’ve been wondering lately is “why”? At what point did someone say, “hey, let’s lump these two health behaviours together”? And what was the reason for that?

On the face of it, if you’re thinking about healthy eating and physical activity purely from a weight management standpoint it seems to make sense. Most people trying to lose weight will incorporate some sort of combination of the two. Although there are people who will argue that one of the two is more important than the other, but generally in our minds they’re linked. But does it really make sense? I don’t actually think that it does.

On the one hand, you’ve got a health behaviour that involves choosing, preparing, and ingesting food. On the other hand, you’ve got a health behaviour that involves moving your body. These are not two sides of the same coin. They are two completely separate coins. Yes, they both have positive effects on our health and they can both contribute to reduced risk of certain chronic diseases and conditions. However, they are completely independent activities. You can absolutely eat a terrible diet and exercise regularly. You can also eat a super healthy diet and be highly sedentary. If you really wanted to lump health behaviours together why not pair healthy eating and alcohol consumption? Those make far more sense together than physical activity and healthy eating do.

I think that putting physical activity and healthy eating together all the time diminishes the importance of both these activities. It implies that neither is important enough to focus on, on its own. Allowing organizations and those in healthcare and related industries to focus their efforts on one over the other or to spread time thinly across the two. I think it may also help to perpetuate the notion that these behaviours are only important for weight management. When you hear about the two together, what first comes to mind? Is it enjoying a healthy life or is it a certain degree of torment undertaken to stave off obesity?

It’s time for physical activity and healthy eating to break-up. This relationship isn’t healthy and it’s affecting everyone around it. We need to recognize that these behaviours don’t necessarily go hand in hand and that they each have things to offer. If we actually start to value healthy eating and physical activity independently for their own strengths we might be able to improve our own individual relationships with both of these behaviours.


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Making people feel like shit about what they eat isn’t an effective tactic to get them to change

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At some point someone came up with the brilliant idea to use scare tactics, guilt, and shame to convince people to do (or stop doing) certain behaviours. I think it may have originated with smoking cessation where people thought that showing people videos of people smoking through holes in their throats and with horrible mouth cancers would convince people to quit. And then people thought, “hey, it worked for tobacco, let’s try it with food”.

Unfortunately, while these tactics may work in some situations, and with some individuals, as a general rule, making people feel like shit about their choices isn’t a terribly effective strategy to convince them to change.

I see so many (possibly well-meaning) people sharing shaming messages in an effort to get people to follow their dietary regimes that essentially every food is now laden with guilt and dolloped with fear.

There are popular memes trying to make people feel guilty for not being vegan or to make people feel guilty for being vegan.

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There are headlines like “There is no conspiracy: Gluten really is evil”, “7 reasons why you should stop eating meat immediately”, “Eating bananas at breakfast is bad for you”. Books like: 141 Reasons Sugar Ruins Your Health  and The Hidden Dangers of Soy. Not to mention all of the vloggers, bloggers, and Instagram nutritionistas pushing their agendas. Seriously, go to google and type in “why you should never eat ____” and insert pretty much any food in there. You’re pretty much guaranteed to get at least one hit telling you why practically every food is going to kill you.

This isn’t healthy. We should not be afraid of something that is essential to life. Something that should be pleasurable. We shouldn’t be loading every food up with fear.

For those using these fear-based messages to try to convince people to join your diet, you’re probably not having the effect you intended. Rather than convincing people to change you’re quite likely just making them feel like what they’re doing is shameful. Maybe they’ll secretly try to change because they’re embarrassed about their shameful food choices and then just feel even worse if they fail. Maybe they’ll just ingest a little bit more guilt every time they eat something they’ve been told is evil.

The nutrition world has become like some sort of twisted religious cult where once you’ve been “saved” you need to spread the gospel and indoctrinate as many heathen eaters as possible. Instead, how about we stop trying to push our person beliefs onto everyone else? How about accepting that there is no one and only diet? That what works for you and is enjoyable for you might not work for everyone else. Let everyone else enjoy their food in peace unless they ask for your opinion.


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It ain’t easy feeding greens

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Last week this article: Don’t Make Children Eat Their Greens caught my eye, mainly because of the headline. Great dietitian click-bait Guardian ;)

The article is actually much better than the headline makes it appear but I still have to throw my two-cents into the ring. As the author concedes (near the end of the article and prior to launching into his own advice) he is not a dietitian. It reminded me of a photo I’d seen on Instagram recently. It was a page from a book with a quote along the lines of “Not everyone who eats imagines themselves to be a dietitian”. Which I’m sure will amuse my fellow RDs because, in my experience, nearly everyone who eats does fancy themselves to be dietitians. While lived experience can certainly be valuable, it’s not exactly the gold standard of scientific evidence. I appreciate that the author incorporated viewpoints from professionals, such as a dietitian and psychologist, but I actually found some of the comments he included from them to be a little odd.

According to the RD source for the article, “The human body is very clever and can adapt over generations. It can use what resources it has available”. Which is all well and fine but really has no bearing on feeding children in the here and now. Adapting over generations is not the same as adapting over one’s own lifespan. I can personally decide that I’m going to forego certain essential nutrients and expect that my body will just adapt. Without a source of vitamin C, for example, I would invariably eventually develop scurvy.

The other issue I take with the article comes from a seemingly throw-away comment. The author’s (adult) daughter says that she refused to eat peas (and other green vegetables) growing up because “they don’t taste good”. To which the author writes “They don’t”. And this is an issue that the author misses in much of his advice. That issue is role modelling behaviour. Children learn by watching and if they are watching parents who don’t eat or show displeasure with certain foods they’re quite likely to adopt similar attitudes themselves. I can’t help but wonder, if the author’s attitude was more positive toward peas if his daughter might have developed a more favourable attitude toward them as well.

Much of the other advice in the article is spot-on based on current recommendations. Food should not be used as a reward or punishment, mealtimes should not become battlegrounds, caregivers should respect children’s appetites. It’s unfortunate that the headline gives the impression that vegetables are an unnecessary part of a healthy diet. While I’m sure that many meatetarians would be overjoyed with this stance, it’s not really the point of the article, nor is it the correct message. While not nearly as catchy of click-baity, a more accurate headline would be something like “Give Your Children Nutritious Meals and Snacks and Allow Them to Decide How Much to Eat”.


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Don’t eat this, not that!

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Ever notice the proliferation of magazine articles telling you what to eat instead of something else? It’s almost always one crappy food versus another somewhat less crappy (but much less desirable) food so that you’re left feeling guilty if you choose the “not that” and resentful if you choose the “eat this”. And evidently people eat this shit up because I see articles with some variation of this format pretty much weekly (and I don’t even read magazines). There’s even a whole website devoted to the premise with actual books you can buy. Yes, people will pay money to have people tell them what to eat but heaven forbid the government try to simply make it easier for them to make healthier choices.

Despite their “no-diet weight loss solution!” twitter bio, it seems to me that the “eat this, not that!” is all about restriction and food selection based purely on calories. Their website is literally a compendium of terrible trendy nutrition and fitness click-bait. You’ve got everything from “20 ways to boost your metabolism” to “how to lose weight while doing every day tasks” to the following header:

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Oh okay, that sure sounds like a “no-diet weight loss solution”. I mean, at least make the effort to not put the freaking D-word in there if “no-diet” is your shtick.

I spent sometime the other evening scrolling through their twitter feed and I’m convinced that much of what they post is sponsored content. They’ve got things like Dunkin’ Donuts vs Krispy Kreme, fat burning supplements that actually work, how to eat McDonald’s fries without damaging your body, the best and worst Subway sandwiches, almond milk is bad (no protein) but drink this brand not that brand (even though they both only have 1 gram of protein per cup), yay Starbucks (for – I kid you not – having nut “milk” options) but also boo Starbucks (for having high calorie baked goods). Alongside these there’s also lots of your standard: drink more wine, eat more coconut oil, buy these overpriced so-called paleo superfood snacks.

How about we stop shoving shame-laden food down people’s throats and instead promote healthful choices, ways to get people in the kitchen, and the pleasure of eating.