Dispelling nutrition myths, ranting, and occasionally, raving


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Response to: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight?

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Someone I follow on twitter recently shared this blog post: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight? by another dietitian, Janet Helm. In the post she mused about dietitians promoting themselves as “non-diet” and what this might say about other dietitians. She agreed with many points made by dietitians, quoted in RD/writer Cara Rosenbloom’s recent excellent piece for the Washington Post about non-diet dietitians, but seemed unwilling to go so far as to embrace the philosophy herself. She ended her post with the following questions: “Can’t we all get along? Can’t intuitive eating and body positivity coexist with losing weight?  Why must we line up on two sides?  Why the conflict?” I’m going to do my best to respond to these questions.

First, I too have asked that same question: “Can’t we all get along?” at times. Remember craisingate? Personally, I don’t think that as dietitians we have to agree on everything. It’s okay for us to have different perspectives and approaches. Also, in the case of diet vs non-diet, I don’t see it as an issue of getting along. Maybe I’m blissfully unaware, but I haven’t seen any “non-diet” dietitians attacking other dietitians for promoting weight management. I don’t see dietitians referring to themselves as “non-diet” as lining up on an opposing side or creating conflict. Rather, I see this identification as a way for dietitians to let prospective clients know that they do not promote weight loss as a goal. In a profession which so many believe our sole mission is to help people lose weight I think that it’s necessary for RDs who do not promote weight loss diets to make this clear up-front. I don’t believe the intent is to pass judgement on other dietitians who haven’t embraced the same approach, or to create a professional divide. However, I can see how a dietitian who has built a career around weight management counselling might see this new-ish movement as a personal judgement.

My friend Cheryl Strachan, aka “Sweet Spot RD” wrote an excellent blog post last week (while I was mulling over how best to respond to Janet’s post): Why I can’t help you lose weight. This heartfelt post explained why she would no longer work with clients on weight loss. Providing the current evidence on weight loss and health and the struggle she went through to reach this position. Rather than having me regurgitate all of the evidence here, I recommend you take a few minutes to go read it and then come back.

Done? Okay, great. So you’ll note that Cheryl mentions that when she studied nutrition in 2003 it was accepted without question that weight management was a significant part of being a dietitian. I can tell you that it was the same when I went back to uni to study nutrition in 2006. I’m not sure if things have changed since then. I suspect that they haven’t, at least not completely. It takes time for institutions and society to change. As a dietitian who has worked in weight management in the past I too have struggled to fully embrace health at every size. I understand why a fellow dietitian would ask: Can’t intuitive eating and body positivity coexist with losing weight? It’s an incredibly tough question and the answer is nuanced and it may not be the same for everyone.

I do believe that intuitive eating and body positivity can peacefully coexist with weight loss. However, I think that this can only be the case when weight loss is not the ultimate goal. For me, body positivity is appreciating your body as it currently exists and continuing to appreciate it if you gain weight or lose weight. It’s about treating yourself with respect and compassion and providing your body and mind with the nourishment they need. If you are doing these things with the clandestine goal of losing weight then you are doing yourself a disservice. That being said, it’s okay to want to lose weight. We live in a society that has conditioned us from a very young age to believe that being thin is important. It’s unrealistic to except this engrained belief to vanish overnight. It takes time to relearn to listen to your body and to treat it with respect when you’ve been viewing it as the enemy, a captor, keeping the real you the thin you hidden away. So, no, body positivity and weight loss can’t coexist but yes, body positivity and weight loss can coexist.

I think that as time goes on and nutrition programs update their curriculums, as old-school dietitians are more exposed to evidence regarding the harms of weight bias and weight loss diets, and the hold-outs retire, that things will change. After all, as dietitians we are supposed to provide evidence-based best practice and the evidence against weight loss diets is mounting. Eventually there will be no non-diet dietitians because that will be the approach we all take.


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Can we take chocolate milk out of politics already?

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You would think that I wouldn’t have anything left to say about chocolate milk by now. I wish that you were right. I would have thought that I wouldn’t either until I read this article the other day about the school nutrition policy in New Brunswick and the current provincial election there. This uninformed inane quote from the leader of the PC party got me all riled up again:

“Brian Gallant is focused on taking chocolate milk away from our kids,” Higgs said in a press release. “I’d rather accomplish the same thing by giving our kids better access to organized sports activities and the character-building experience that come from participating in activities with peers.”

Higgs said in a press release that his government would scrap the nutrition policy entirely because, despite the importance of educating children about good nutrition, “we think helping them participate in activities with their peers is the goal – not legislating what’s on the menu.”

This is the sort of thing that makes me want to tear out my hair. It shows a complete lack of understanding of the issue at hand and sends the entirely wrong message to the public.

The first quote implies that 1. the issue at hand is obesity and 2. that we can compensate for whatever we eat through exercise. These are both patent falsehoods.

To address the first issue: the purpose of school nutrition policies is not to address childhood obesity. The purpose of school nutrition policies is to ensure that children are being provided with nutritious food when they’re at school. Schools should not be making money at the direct cost of the health of their students. In some cases, the only nutritious food that children receive may be when they’re at school. This has nothing to do with weight and everything to do with health, growth, and development.

To address the second issue: as much as we may all wish that it’s true, no amount of exercise can compensate for an unhealthy diet. Playing soccer is not somehow going to miraculously provide a child with vitamins and minerals and essential nutrients that are lacking from their diet. That’s just not how it works. As I’ve mentioned before, healthy eating and physical activity are not two sides of one coin, they are both essential components of a healthy lifestyle.

The message that the would-be premier is sending here is the widespread misconception that health is measured by the scale and that we can make-up for an unhealthy diet by exercising more. This is just not true.

Finally, to address the second quote: we know that education (insofar as that means telling people what to eat, giving them a copy of Canada’s Food Guide, and lecturing them about calories) doesn’t work. However, creating a supportive nutrition environment in which healthy eating is the norm, along with teaching food literacy, can teach children life-long healthy eating habits.


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In the chocolate milk war which side will you take?

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A school in Ottawa decided to no-longer offer chocolate milk to students as part of their milk program. This, I should add, was based on a vote taken at a parent council meeting. Predictably, a bunch of parents, students, and assorted individuals from all over the province are outraged at this infringement on their freedom. This despite the fact that chocolate milk has not been banned from the school, the school is simply no-longer selling it to the kids.

I’m listening to the radio call-in program about this outrage and quite frankly I feel like throwing up my hands, saying eat and drink what ever you damn want, and going off to farm alpacas or something similar that will simultaneously allow me to forsake my current profession and keep contact with human beings at a bare minimum. I mean honestly, what is wrong with people. It is that vital that your child have chocolate milk at school once a week that you’re launching a protest over the removal of chocolate milk from the school milk program but you can’t be assed to pick up a carton of chocolate milk at the store to send to school in your child’s lunch? Do you not normally buy groceries? How do you feed your child outside of school if it’s too much of an ordeal to dump a cup of chocolate milk in a container and pop it in your kid’s lunch box? Lest you think I’m exaggerating, just listen to the first guest on the show. This is literally her argument. If you want your child to have chocolate milk so badly, give it to them yourself. You can let your kid guzzle chocolate milk at home until the cows come home.

Then, there are people arguing that kids should get chocolate milk as part of the school milk program because this may be the only little bit of nutrition they get. That may well be true (and this is incredibly sad) but may I be so bold as to point out that white milk is still available through the program? As my friend Yoni has often argued, suggesting that children be given chocolate milk for the nutrition in milk is like arguing that they be given apple pie for the nutrition in fruit.

I think that many of the people arguing for keeping chocolate milk on-offer in schools have fallen for the marketing hype and genuinely think that chocolate milk is a “health” food. There was one dad who called in and said that his kids drink chocolate milk every day and nothing else sweet, except juice. But he was all for pop being banned in schools because kids get too much sugar. Well, one cup of orange juice has 22 grams of sugar, the same amount of pop has 26 grams, and chocolate milk has 24 grams. That’s not a huge difference. If sugar is your concern, then chocolate milk and pop are on par with each other.

Removing chocolate milk from a school milk program is not denying parents the right to give their children chocolate milk. It’s removing one source in a landscape that is saturated in chocolate milk, pop, juice, sports drinks, and energy drinks. Should any and all foods be available for purchase in schools? Schools do not have an obligation to act as grocery stores. They do not have to sell any and all products that a child might desire. Making white milk the only option (for sale) in schools helps to make the healthy choice the default for students.

There is no good reason for schools to be offering children chocolate milk as part of their milk programs. I applaud this school for taking the initiative to remove the option of chocolate milk from their program. Schools should be places where children learn and that includes learning healthy behaviours, including making healthy food choices. Schools should not be profiting from selling children foods that should not be a regular part of their diets. It’s disgraceful that some parents think that daily delivery of chocolate milk is a greater priority than the actual health and well-being of their children. So much so that they are willing to publicly fight against a decision that was made with the children’s best interest at heart. If they have this much time and passion about school nutrition maybe they can take some of that energy and put it into fighting for a national school lunch program. You know, something that would actually benefit children. Sorry if I sound a little harsh but it frustrates me to no-end that people are so self-centred that they are unwilling to put the well-being of children, both their own, and others ahead of their own uninformed opinions. Cry me a freaking river (of chocolate milk).


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Whole Life Challenge review

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You know what I’m sick of? Engineers and people with zero nutrition education making claims that you can “biohack” your life, undermining dietitians, and giving one-size-fits all nutrition advice. This rant seems appropriate coming on the heels of my post about the carnivore diet.

Earlier this summer my brother asked for my thoughts about this “Whole Life Challenge” that a bunch of people in his office were doing. He was a little sceptical about the nutrition advice they were providing and wanted to know my thoughts as a registered dietitian.

My first question was, “who is behind this challenge?” Well, we’ve got the founders: Andy who has a background in sales and engineering (quelle surprise) who then opened a crossfit gym and Michael who was a coach and manager at a crossfit gym, and has a degree in philosophy and culinary arts. Well, at least he’s got a little knowledge of food in there but as most know, culinary arts and dietetics are woefully disconnected professions with chefs learning little to nothing about nutrition. The remainder of the team is comprised of the CEO, social media, web development, content manager, corporate relations, a couple of customer service reps, chief technology officer, and public relations. There is absolutely no one working for this enterprise that has any background in nutrition or health. Sigh. 

At a glance, the “challenge” doesn’t look so bad. The idea is to work on seven daily habits over the course of six weeks. You get points for completing each of the daily habits and you’re supposed to play with a team (the more people playing the more money they make this will help “foster success”). The habits are as follows: nutrition, exercise, mobilize, sleep, hydrate, well-being, and reflect. Many of these are areas that most of us could stand to improve on. Of course, I’d like to reiterate that the people who created this challenge have zero education pertaining to any of these topics. Cost is $39 US per player.

Unfortunately, you have to pay to play so I can’t access all of the materials available to players, including the nutrition plans. Fortunately, I have the inside scoop ;) and was able to view the nutrition material. They’ve created three levels with the highest being the “performance level”. This level is for those who, “already have good eating habits that you just want to fine tune, have athletic or performance-related goals, or have a pressing health or inflammation condition that you’d like to address”. The level below that is the “lifestyle level” which is, “A good choice if you are looking for a long-term lifestyle nutrition program. This is a great start to a sustainable practice of living a healthy lifestyle”. The easiest level is “kick start” which is supposedly, “a great place to start if you’re new to the health and fitness game and need to make the most important tweaks to get yourself started in the right direction”.

At each level of the plan you’re given a list of foods that are “compliant” and “non-compliant”. The higher the level, the fewer the foods that are compliant. How did they determine which foods are “compliant” and which are “non-compliant”? Excellent question. I have no idea other than the statement they make at the top of the charts: “When you see (*) next to a food, it indicates the food is compliant but should be eaten in moderation, as there are potentially negative effects from overconsumption”. I assume that this means that they believe there are negative effects from consumption of “non-compliant” foods. What these negative effects are is anyone’s guess. Maybe weight gain? Inflammation? Enjoyment of life? The non-compliant foods for the “performance level” are: deli or processed meats, soy, corn, white potatoes, soybeans, taro, yucca, beans and other legumes, dried fruit with added sugar, peanuts, peanut butter, hydrogenated oil, industrial vegetable and seed oils, every grain and grain product, alcohol, soda (diet or regular), juice, all dairy (except butter), the only snack foods allowed are baked sweet potato fries or chips and baked vegetable chips. Yum yum. To be fair, they do say that this diet would be difficult to maintain long-term and “maybe not even necessary”. Yeah, no shit.

Just for fun, and your reading pleasure, my brother endeavoured to follow this diet for a few days. My brother is a prolific runner, he’s in his third year of a running streak and he’s fast. He eats a balanced and varied diet and enjoys the occasional beer; a candidate for the “performance level” if there ever was one. Unfortunately, he came down with a cold at the same time so his report was: “my lack of energy could have been the diet or being sick”. N of 1, inconclusive.

That being said, while this diet might work for some, it’s probably not the best diet for most endurance athletes. It can be very difficult to obtain sufficient nutrients and calories and attain peak performance on such a limited diet. Also, beans and legumes and whole grains are full of good nutrients as well as being affordable. Any non-medical diet that tells you to eliminate all of these foods is unlikely to be sustainable or healthy in the long-run, particularly for those who engage in long runs (sorry, not sorry).

Six weeks isn’t all that long and when people are working in a group challenge there’s more incentive to stick to a plan than there would be on their own. There’s also minimal risk of nutrient deficiencies being a serious concern over such a short time frame. However, because this challenge is framed as a short-term undertaking and the diet plans aren’t easily sustained, I worry that this will encourage weight cycling in participants (which may actually be more harmful than maintaining a higher weight long-term) and discourage long-term adoption of healthy behaviours. If you’re only adopting these “habits” for six weeks to win a challenge and it’s a major change from your usual lifestyle I can imagine that at the completion most people celebrate finishing by ditching all the “habits”. It would be interesting to see research on participants of a challenge like this.

This plan is also very prescriptive. Apparently I should be drinking 37 ounces of water a day. There is no mention of drinking to thirst here or adjusting intake based on physical activity, temperature, or other fluid intake. You are not learning to listen to your body on a plan like this. There is no allowance for individual differences or personal preferences. Compliant foods equate to “good” and non-compliant equate to “bad”. This reinforces the false moralistic attitude that many people have about food. It also fails to consider that we eat for many different reasons and that taking pleasure in food and enjoying food socially are important aspects of eating. Framing healthy eating as being complicated and unpleasant only serves to make people adopt an all-or-nothing mindset toward a (perceived) healthy diet. Winning at this challenge may only set you up for failure when it’s over.


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Why science is failing

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After my fellow dietitian Abby Langer wrote this article for Self, which I personally felt was quite considered and rather generous to the carnivore movement, I noticed a commonality among many of the people spewing abuse and vitriol (does an all-meat diet make you exceptionally angry?) toward her, and RDs in general. Any guesses? It was that many of them were engineers. I’m not sure what’s up with that. However, I can tell you that they are far more confident in their belief in the magic of the carnivore diet than I am in probably anything.

Then I was listening to StartUp podcast and something clicked. This season they’re following what’s called a “church plant” which is people trying to start new churches. On the last episode they were talking to a researcher who said that membership in all Christian churches in North America is declining, except for at evangelical churches. The reason for that? The certainty the evangelical church provides. Unlike other churches where there may be grey areas, things left up to interpretation, the evangelical church has definitive answers. And people like certainty. In religion and in nutrition.

You’ve probably heard the comparison of certain dietary beliefs to religious beliefs before. It’s nothing new. People attach their sense of self to a religious or dietary belief. They’re vegan, paleo, vegetarian, carnivore, catholic, or muslim. In the realm of diets, dietitians are agnostic. In the realm of medicine, Western doctors are agnostic. A great deal of the time, science is agnostic. We constantly question our beliefs and change them as new evidence comes to light. When someone asks is corn good for me we inwardly cringe because there are so many ways to answer that question and they all start with “it depends”. The carnivores are the evangelicals of the dietary world. They have all the answers with the utmost certainty. And how can someone who’s desperate to find a diet that will cure what ails them not be enticed by that confidence when faced with dietitians and doctors who are saying “let’s try this first and if that doesn’t work then we’ll try this” and on and on. We don’t offer a one-size-fits-all approach. We offer tailoring to help individuals find the way of eating that fits them best.

If you want certainty without evidence then you can find all the advice you want, and then some, from carnivorous engineers on twitter. If you’d rather have uncertainty and a little variety in your diet then find yourself a dietitian.