Dispelling nutrition myths, ranting, and occasionally, raving


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What to eat when you’re pregnant

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By now you may be aware that I’m pregnant. This is great news both personally and for more blog material – apologies if prenatal nutrition is of no interest to you. Now that the word is out, I feel comfortable sharing some of my observations.

First off, take the nutrition advice from apps with a grain of salt. These were likely not developed by registered dietitians and may not contain the greatest information. Aside from those, you might be getting your nutrition recommendations from prenatal classes which you would think would be better but I wasn’t super impressed with some of the information provided in the online class that I did (here’s hoping the in-person class is better!).

The general advice is fine: this is an important time to be getting adequate nutrition as, though technically not, the fetus is pretty damn close to a parasite. It’s going to deplete you of all of your iron and calcium stores if you don’t makes sure you’re consuming enough to replenish them. However, I took exception to some of the outdated advice I saw in the class I completed.

There’s a section on gestational diabetes which is followed-up by the section on prenatal nutrition. In this section there’s a sample meal plan which is whack for anyone, let alone a pregnant woman who is concerned about developing gestational diabetes. Highlights include breakfast: toast, oatmeal with banana, jam, and a glass of milk; snack: vanilla yoghurt and dried apricots; bedtime snack: frozen yoghurt. Hello blood sugar spikes! And I mean honestly, who eats toast and oatmeal for breakfast? Get some damn protein in there (nut butter, nuts, seeds, eggs…). And that snack, smh. Plain or no sugar-added yoghurt with berries would be a better choice or there are loads of other nutritious snack options that don’t contain sugar. I thought we’d moved past recommending frozen yoghurt like a decade ago. It’s generally higher in sugar than ice cream and not nearly as nutritious as regular un-frozen yoghurt. Which leads me to the swap suggestions.

There was a page of “if you’re craving this, try that”. Not that there was anything wrong with the suggestions (things like pretzels instead of potato chips and a grilled chicken burger instead of a regular beef burger) but I’m of the mind that you should listen to your body and give it what it wants. There is nothing wrong with having some chips or a burger when you’re pregnant, or when you’re not. And then there was that freaking frozen yoghurt again! I saw ice cream and groaned and said to my boyfriend, “how much do you want to bet they’re going to say to have froyo instead?” Wisely, not a bet he was willing to take as, of course, it was frozen yoghurt.

At one point they advised to “avoid foods with chemicals” which is meaningless and completely unhelpful advice. All food is comprised of chemicals.

I also wish that they had acknowledged the food aversions, cravings, and nausea/vomiting that many pregnant women experience. For women who are experiencing severe “morning” sickness it can be better to eat what they can stomach when they can stomach it. You can tell women to eat lots of vegetables, fish, and whole grains but if these foods aren’t going to sit well with them then that advice is not helpful. Women who require advice beyond that provided in the online class should ask their doctor for a referral to see a Registered Dietitian. Those living in Ontario can also call Telehealth Ontario at 1-866-797-0000 Monday-Friday 9-5 to speak with a RD for free.

There should also be recognition that listening to our bodies and our hunger and fullness cues is important. If you want ice cream, eat some ice cream. And if you want frozen yoghurt (to each their own), eat some froyo. Just like you’ll learn when it comes time for infant feeding, you should trust yourself and trust your tummy.


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The real cause of Type 2 Diabetes

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The other day someone I follow on Twitter shared a tweet from an MD/PhD student that said that, “excess calories causes diabetes” and that this results from ready availability of palatable food, sedentary lifestyles, and genetics. Apparently anyone who disagrees with this assertion is either trying to sell you something or wants you to think they’re smart. I scrolled back and forth a few times before deciding I really didn’t want to get into a “thing” on twitter but it really got under my skin and I just can’t let it go. I decided that blogging about it would be more productive than arguing with someone who’s already made up their mind about the motives for my disagreement without hearing why I take issue with his sweeping statement. Just to be clear: I have nothing to sell you and I’m not trying to make you think that I’m smart. I just don’t like this simplification of a complicated disease.

To begin, I am assuming that the tweeter was referring to Type 2 Diabetes, not Type 1. A little bit of a pet peeve of mine when people don’t distinguish between the two because despite leading to similar consequences they really are separate diseases with different causes and treatments.

Okay, so my problem with this doctor’s statement is really the implications that it has for people with T2D and the lack of acknowledgement of health inequities that contribute to the development of T2D. Yes, he mentions that it’s the food environment and the inactive lifestyle that is common in our society that’s the problem. This, I will admit, is a step above simply blaming people for eating too much and not exercising enough. However, the implied solution is the same for both messages: don’t eat too many calories and get off your lazy butts and you won’t get T2D. Unfortunately, it’s not that simple. For many, poverty and health inequities are at the root of many chronic diseases, including T2D.

Recent research has highlighted the relationship between the social determinants of health and chronic diseases, such as T2D. This research has shown that, “social determinants (such as income, education, housing, and access to nutritious food) are central to the development and progression of Type 2 diabetes” and, “individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals”. That’s right, privilege provides greater protection against developing Type 2 Diabetes than does lifestyle “choices” while poverty greatly increases risk. Not to mention that certain racialized and ethnic groups are often touted as having greater risk for T2D even though much (if not all) of this increased risk can be attributed to inequities and racism experienced by these groups.

We need to stop thinking about T2D as the result of lifestyle choices and start thinking about it as the result of societal structures. If you have the level of privilege where you can choose to eat healthfully and be physically active that’s great and you should absolutely do so. But we need to stop pretending that it’s lifestyle “choices” that are causing this disease when many people do not have that choice.


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Is it #NutritionMonth2019 or #DairyFarmersofCanadaMonth and #AvocadosofMexicoMonth?

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We need to talk about Nutrition Month. More specifically, we need to talk about Dietitians of Canada’s Nutrition Month recipes. It’s been a long time (back in 2012 to be specific) since I wrote about the issue of sponsorship in regard to DC’s Nutrition Month materials. To be honest, I feel like a bit of a traitor doing it (DC does many great things to advocate for dietitians), but I think that it’s a real issue. Accepting sponsorship for Nutrition Month is undermining DC’s (and by association all Canadian dietitian’s) credibility.

When DC first released their Nutrition Month recipes I was disappointed, but not surprised, to see that they were sponsored by Dairy Farmers of Canada and Avocados from Mexico. Don’t get me wrong, I consume both dairy and avocados. This is not to cast aspersions on either of those foods. However, I think that a dietetic organization accepting sponsorship from the food industry (no matter what the foods are) creates a conflict of interest. I also think that there are additional reasons why featuring these particular foods in DC resources is problematic. I’ll get into that a little later. So, as I said, I wasn’t surprised. This is nothing new for DC. I had a little rant with my RD colleagues (one of whom also happened to point out that the content of the handouts, aside from the recipes was simply duplicated from last year, sigh) and then let it go.

My frustration was reignited last week when fellow RD, Pamela Fergusson voiced her concern about the industry sponsorship of Nutrition Month on Instagram last week. She’s also written an excellent blog post about this issue that you should read.

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That got me curious so I went on the Nutrition Month website and counted how many times dairy and avocados appear in their featured recipes. Out of ten recipes, eight include dairy and four include avocados. There are 12 additional recipes on their handouts, eleven of these include dairy and six include avocados. That’s a lot of dairy and avocados!

While I love avocados, they are freaking expensive. They’re usually about $2 a piece at the grocery store here. Given that food insecurity is an issue across Canada, DC even has position papers on both individual and household and community food insecurity, it struck me as a little inappropriate for them to so prominently feature a food that’s not within the budget for many Canadians. Even for those who don’t struggle with food insecurity, avocados are often more of a luxury item than a staple food. The same goes for many dairy products, particularly cheese, which is featured in many of the DC Nutrition Month recipes. Realistically, who’s making a “crab and remoulade sandwich” for lunch??

In addition to the issue of cost, there’s the lack of alignment with the new Food Guide. Despite what many people would have you believe, milk (and dairy products) have not been removed from the new Food Guide. They’ve simply been incorporated into the new “protein foods” grouping. However, there is a strong emphasis on choosing plant-based sources of protein more often. I realize that DC would have already developed their resources before the new Food Guide came out. Even so, the old Food Guide only recommended two servings of milk (and alternatives) daily for adults. No matter which Food Guide you look at, it doesn’t make sense that DC would feature dairy in the majority of their Nutrition Month recipes.

This takes me to one last issue that I stumbled upon while tallying up the recipes featuring dairy and/or avocados. That issue is the nutrition information for the Turmeric Basil Roasted Turkey Burger. This burger contains 936 calories, 48 grams of fat (9.1 g of which are saturated), and 773 mg of sodium. To put that in perspective, that’s 416 more calories and 20 grams more fat than are in a big mac (177 mg less sodium though). It’s about 3/4 of a day’s recommended maximum intake of fat and over 1/3 of the maximum recommended intake for sodium. That’s just in one burger! I thought for sure this had to be a mistake so I tweeted at DC to ask them about it. This is the reply I received:

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A “hearty” burger indeed! As much as I believe that all foods fit and that having treats is part of a healthy diet, I really don’t think that a recipe like this is appropriate for a dietetic organization to be promoting. When people are looking for recipes from Dietitians of Canada they’re looking for recipes that meet certain nutrition criteria. They’re looking for recipes that are going to provide them with a reasonable number of calories, not too much fat or salt or sugar and plenty of vitamins and minerals. I think it undermines their credibility as an organization when they allow sponsors (such as Avocados of Mexico who developed this recipe) to be put ahead of the public who rely on dietitians for unbiased nutrition information.


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Is milk out?

I’ve been hearing a number of complaints and concerns about the new Food Guide. The one I’ve been hearing the most is that “dairy is out”. I’d like to dispel that. No, dairy is not “out”. Yes, the “milk and alternatives” food group is gone; as is “meat and alternatives” but milk and dairy products still fit within the protein group in the new guide.

The Food Guide now recommends a proportion-based approach to eating, rather than a more prescriptive portion-based approach. Rather than telling you how many servings of each food group to have every day, and how big a serving is, the new guide simply advises you make half your plate vegetables (and fruit), one quarter protein foods, and the other quarter whole grains. It promotes consuming plant-based protein foods “more often”. This is pretty subjective and should – in theory – make it a lot easier for people to adopt. For some people this may mean consuming plant-based protein foods in larger amounts than animal-based proteins. For others, this may mean consuming plant-based sources of protein more often than they usually do. In a country that’s extremely meat-centric this could mean something as simple as adding more beans to a chili and cutting back on the meat slightly.

I’d also like to point out that given that a quarter of your plate should be devoted to protein foods you can easily mix and match to your heart’s content. This might mean that you have lentils and salmon (like I did last night), cheese and bean casserole, tofu and chicken, etc. It might mean that at one meal your protein comes from milk or meat but that at another it comes from legumes or nuts. Snacks can (and generally should) also include a source of protein. If you eat three meals and two snacks a day this means that there are ample opportunities for you to consume protein from a variety of foods, including milk products if you desire.

Personally, I think that having a food group specifically for milk (and alternatives) was unwarranted and I’m glad to see it go. There are many people who can’t consume milk products (due to lactose intolerance or an allergy) as well as those who choose not to and it is entirely possible to consume a nutritious diet without the inclusion of milk. For those who are concerned about where people will get their vitamin D and calcium from without milk products there are other food sources of these nutrients.

Vitamin D is pretty near impossible to consume enough of through food sources alone anyway, at least during the winter months in Canada and Health Canada recommends all adults over the age of 50 take a supplement of 400 IU/d. I’d also like to point out that milk is fortified with vitamin D as are most plant-based milk alternatives (always check the label to be sure). Other food sources of vitamin D include: egg yolks, salmon and other fatty fish, some meats, and other fortified foods which may include things such as orange juice and cereal.

Non-dairy food sources of calcium include: dark leafy greens (like spinach, collards, and kale), soy beverage, canned fish (eat those bones!), tofu (if prepared with calcium), beans, nuts, seeds, and even blackstrap molasses.

If you are concerned that you may not be meeting your nutrient needs through your diet I recommend keeping a food journal and making an appointment with a registered dietitian.


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Another hot take on Canada’s new food guide

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You all know that I can always find something to bitch about. I’m that girl who’s always the one to find a bug in her freshly picked raspberries or the bone in her piece of fish. My mum will attest to that. It was a running joke in my family that if there was anything weird to be found in the food, I would be the one to find it. So, it should come as no surprise that I have lots to say about the new food guide. But… it may come as a surprise that I don’t actually have anything negative to say about it! In fact, I think it’s pretty fucking great.

In no particular order, here are the changes that I’m most excited about:

  • The addition of food skills (and food literacy). This is literally 85% of my job and it feels really good to have Health Canada supporting it as an important part of healthy eating.
  • The removal of juice as a serving of fruit. It’s going to be so nice not to have to deal with that terrible piece of advice anymore.
  • The removal of serving sizes and recommended number of servings. They confused people and it’s impossible to make recommendations that will work for the entire population. I can’t wait to no longer hear “I can’t eat ALL that” again.
  • I’m glad they got rid of the meat and alternatives and milk and alternatives food groups and lumped them into a proteins group from which they encourage plant-based sources of protein.
  • I appreciate the inclusion of Indigenous foods and ways of eating and the acknowledgement that many people in remote communities and on reserves may struggle to meet the recommendations in the food guide.
  • Following from that, I also appreciate the recognition that external factors, in particular, many social determinants of health, can affect the ability of people to follow a healthy diet.
  • I’m glad that water is recommended as the beverage of choice, again bye bye juice and chocolate milk 👋🏻👋🏻👋🏻
  • I like that the emphasis is on promoting health and only once is weight mentioned. As I’ve ranted about in the past, the food guide is not supposed to be a weight loss diet plan.
  • The photos included in the guide are really appealing. They look way more appetizing to me than the old cartoonish images did. Plus, they’re all about full meals and not just random foods.
  • The overall focus is on a healthy pattern of eating, not just individual nutrients. Much more in-line with how we actually eat. Plus it’s advised that we enjoy (wow!) our food.

My one concern (aside from a couple of very minor things) is that apparently Health Canada does not plan on making the resources for the general public available in print. I think this is a huge mistake. Not everyone has ready Internet access. Also, the old food guide was used in schools and other educational settings (including the food literacy classes I teach) as a teaching tool. I work in public health and we get MANY requests from schools, organizations, and individuals for copies of the food guide. I’m not sure how we’re going to educate people and incorporate the food guide into our programs if we don’t have a print resource available. I hope that Health Canada will reconsider this decision so that everyone has equal opportunity to benefit from the new food guide.