Dispelling nutrition myths, ranting, and occasionally, raving


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How to end hallway medicine

End hallway medicine: ban hallways

There’s been a lot of talk about “hallway medicine” (i.e. patients receiving treatment in hospital hallways due to hospital overcrowding) in Ontario over the past couple of years. A recent report from the Premier’s Council on Improving Healthcare and Ending Hallway Medicine provided recommendations to the government on how to improve the current situation. The key findings from the report were as follows:

    1. Patients and families are having difficulty navigating the health care system and are waiting too long for care. This has a negative impact on their own health and on provider and caregiver well-being.  
    2. The system is facing capacity pressures today, and it does not have the appropriate mix of services, beds, or digital tools to be ready for the projected increase in complex care needs and capacity pressures in the short and long-term. 

Following the release of the report I saw a number of articles and heard several radio interviews, all of which featured emergency room doctors and occasionally nurses. Undoubtedly they have experience which can contribute the the discussion. However, I was frustrated by what I saw as the glaring absence of input from public health. I think that perhaps everyone thinks that the problem lies within the hospitals and therefore the solution can be found there too, even if it’s the suggestion from ER doctors that more home care supports are needed. However, while not an immediate solution to the problem, I think that we need to look further upstream for real long-term solutions. Adding more beds, increasing home care, and improving system navigation for patients are all important but they don’t address the reasons why so many people are ending up in the hospitals in the first place. If we can prevent the need for emergency care then we can reduce the number of people in need of hospital beds.

I was pleased to see that alPHa (Association of Local Public Health Agencies) submitted a response to the report to the government highlighting the important role of public health in improving healthcare and ending hallway medicine. I was also pleased to see OPHA (Ontario Public Health Association) submit a letter to the Minister of Finance advocating for health promotion and chronic disease prevention measures that would help to end hallway medicine. Has anyone seen anything about this in the news though? I haven’t heard any public health officials or representatives publicly advocating for the important role of public health in ending hallway medicine. Public health needs to do better at getting their messages to the public. If people don’t know about what public health does to prevent injuries and chronic disease, reduce infectious disease, and advocate for the social determinants of health then how can we expect them to support these initiatives or even to recognize how these things contribute to the demand for healthcare services?

In addition to the importance of public health in ending hallway medicine I’d like to see more effort to connect with those who are likely most in-the-know about patient concerns: reception staff. Yes, doctors, nurses, other allied health professionals, and patients can all contribute important insights but who speaks to everyone seeking care? Who hears the complaints and concerns that people may not feel comfortable voicing to doctors? Who is at the first point of interaction with the public? Reception staff. I’m sure that they could contribute a great deal of valuable information to the consultation on ending hallway medicine.

If the government truly wants to end hallway medicine they need to consider the reasons that people need healthcare and the impact that their cuts (and decisions) in other areas is going to have on the demand for hospital services. Hallway medicine is not happening in a vacuum. Cuts to social assistance, ending the basic income pilot, cutting support for cycling infrastructure, reducing funding to the Trillium fund, reducing oversight for meat processing facilities, cuts to mental health funding, ending minimum sick days and reducing employee protections, cancelling the planned raise for the minimum wage, increasing accessibility and affordability of alcohol, and on and on, are all going to result in an increased burden on the healthcare system and our hospital hallways are only going to become more crowded.


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Let’s stop glorifying the inability to cook

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Despite the proliferation of cooking shows in recent years it seems that most television programs glorify the anti-cooking life. Sure, there are shows like Masterchef and Chopped and all of the standard celeb cooking shows but those are far removed from the reality of the average home cook. They glorify challenges and gourmet meals, not getting supper on the table for a family after a long day of work.

When I think about pretty much any tv series or movie these days nobody cooks. It’s like a badge of honour to have an untarnished kitchen. A sort a bragging about being unable to cook. Can’t you just picture Olivia Pope curled up on her couch after a long day of falling in and out of love with the president with a big bowl of popcorn and a big glass of wine? Or how about all the shows that have an iconic restaurant, diner, or coffee shop where all of the characters meet on the daily? When I try to think of shows that feature regular family meals they’re all from my childhood and generally assume that it’s the woman’s job to feed the household. I don’t think that equality has to come at the expense of home cooked meals. My boyfriend and I take turns cooking depending on our schedules. Eating out is a treat, not a daily, or even weekly occurrence.

Being able to cook is something that should be considered an essential life skill. I can’t imagine anyone bragging about being illiterate. When people proudly proclaim their incompetence in the kitchen to me that’s the same thing. It’s bragging about being food illiterate. I’m not saying we all need to be gourmet chefs or cook every single meal at home from scratch but we do need a cultural shift. These shows reflect our reality and our reality mirrors these shows. Let’s stop aspiring to a life where the closest we come to cooking is reheating leftover delivery and start showing individuals and households where cooking is the norm.


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Step away from the chips, the grocery store RD is watching you

Not my usual uniform, I swear!

Not my usual uniform, I swear!

A couple of weeks ago the Globe and Mail published an article about the role of “nutrition experts” in grocery stores. It caused a bit of an uproar in the dietitian community for a couple of reasons: one, there was some conflation between nutritionists, dietitians, and naturopaths (if you don’t know why that would upset dietitians then you should read this); two, it poorly represented our roles in grocery stores. Following that, a dietitian published a blog in Huff Post in response to the inflammatory article in the Globe. As a dietitian who worked in a grocery store for several years and who was interview for, and quoted in, the original Globe article I feel obligated to add my belated two cents to the fray.

I actually had a really nice interview with Shawna, we covered a number of topics, and I felt like she was “getting” what I was saying. So, I was a little disappointed when I read the article and saw the quotes that she had chosen. Not to mention that I had asked that grocery retailer I worked for not be identified as employees cannot speak as representatives of the company, a normal PR policy, my job was not “retail dietitian”. I was a Wellbeing Counsellor, and as part of the interview I explained the different roles of the Wellbeing Counsellor and the in-store Dietitian. Wellbeing Counsellors essentially manage the Natural Source and Wellbeing Department in one store (ordering, stocking shelves, inventory, checking for out dates, dumping expired milk…). In addition, they are there to assist customers with any food, supplement, or nutrition-related question they might have. They also teach classes, do demos, and perform community outreach. The in-store Dietitian teaches classes, does demos, store tours, community outreach, and one-on-one counselling. They’re not tied to one department and they usually split their time between two stores.

In retrospect, Shawna was trying to push the helicopter parent/food police angle a bit, and I found it odd when she brought up orthorexia. While I agreed that many people are taking healthy eating to a whole new disordered level of “clean” eating, I suggested that dietitians (I’m now talking about those of us in both Wellbeing Counsellor and Dietitian roles) working in grocery stores can actually serve to combat this. I said that the food industry, the media, and society have made healthy eating far more complicated than it has to be. Dietitians in grocery stores can help you to look past the front-of-package label claims to the true nutritional value of a foods. They can help you make healthier, more delicious choices. They’re not there peering into your cart and judging what you’re eating. They’re not there to push products on you. No one ever told me to sell more of X or Y and as a regulated health professional I would never have done any such thing. Yes, obviously, grocery stores hire us to boost sales but it’s not by pushing products, it’s by having value-added service; by showing customers what they can do with chia seeds or by helping them find the product that’s best going to meet their needs.

When I said that comment about how people often think that dietitians only eat salad (and that we don’t, sometimes we eat candy or chips) it seemed to be met with some surprise. Especially when I insisted that I’m not in the minority; that most dietitians I know would say the same thing. That it’s important to eat a variety of foods and to allow yourself to have treats. I actually hate the term clean eating and am still hoping that my #eatdirty hashtag will catch on. If you’re not enjoying your food then you’re doing it wrong.


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Dr Oz gets schooled and says: #sorrynotsorry

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I’m sure that the whole Dr-Oz-goes-to-the-senate-and-gets-scolded thing is going to be all over all of the blogs for at least the next few days. Despite this, I still feel the need to throw my voice into the fray. I’ve ranted about Dr Oz and his ridiculous supplement (and dietary) proclamations many a time (too many for me to be bothered to even give you a link right now, feel free to search my blog for my scorn). It’s not just weight loss that’s a problem. It’s pretty much every dietary and supplement recommendation that he’s made. Eat a papaya every day? Come on, are we made of money (perhaps Dr Oz should read yesterdays post)? And what happened to variety is the spice of life. Any dietitian worthy of the “RD” after their name will tell you that variety is a key component of a healthy diet.

But that’s all history now, right? Dr Oz, the great and powerful Oz, has (gasp!) apologised for his role in the popularization of useless weight loss supplements. Does this really sound like the words of someone who is truly sorry: “For years I felt that because I did not sell any products that I could be enthusiastic in my coverage and I believe the research surrounding the products I cover has value.”? What I see here is Oz saying that by not putting his name on any product labels that he thought it was okay to tout each and every one of them as the next great MIRACLE weight loss cure on his show. Even more importantly, I see that Oz still believes in the “research” conducted on the products he promotes. Never mind that most of them have little to no scientific research to support their use as weight loss supplements. Never mind that those that do have research invariably have weak biased research. Never mind that he conducted his own “research” into the efficacy of green coffee bean extract using audience members.

Do I think that we’ll see any meaningful change as a result of this hearing? I doubt it. Dr Oz doesn’t believe that he’s done anything sincerely wrong and what he does is popular. Horrifyingly popular. Just a taste of some of the comments on his facebook “apology”:

Dr.Oz, you are amazing. You get people excited about living healthier and happier lives! You show is interesting, lively and is very enjoyable as well as more importantly very informative to watch. Thank you!!!

You have done far more good in your career than any other public medical professional, helping people take responsibility for their health and promoting preventive care and wellness. Don’t listen to the politicians, who are the MOST self-serving of our population and sell out every day to lobbying money. You owe no apologies.

You are a good doctor, and you have done nothing wrong. I am glad you stood up for what is right. Keep on doing what you do best Dr. Oz…
They go on and on in that vein. People want miracle cures. They don’t want to hear that losing weight (and keeping it off) is hard work. That’s why Dr Oz has 4.6 million likes on FB and a syndicated television show and dietitians (like yours truly) are tapping away writing unpaid blogs about nutrition in their spare time. As long as Dr Oz is being given a platform, as long as the network is getting the ratings, and as long as the public are swallowing every pill he proffers he is going to keep dishing them out.