Dispelling nutrition myths, ranting, and occasionally, raving


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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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Naturopaths are jumping onboard #NutritionMonth and this boat ain’t big enough for all of us

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As you probably know, March is Nutrition Month. Traditionally this is the month in which dietitians come out in full force on social media, and in news articles, with nutrition tips, recipes, etc. This year I noticed a change. Yes, dietitians are still out there telling everyone to eat more vegetables, promoting the profession, and encouraging people to “unlock the potential of food”. Interspersed throughout those posts and articles though are ones from a new voice, naturopaths.

On March 15th the Institute for Natural Medicine put out a news release titled “Naturopathic Doctors Complete 155 Hours of Nutrition Education in Medical School: March is Nutrition Month“. In the linked FAQ: “What advanced nutrition education do naturopathic doctors receive?” the INM states that, “Naturopathic doctors provide individualized nutrition assessment and guidance utilizing evidence based nutritional recommendations” (emphasis mine). On addition, one of the “areas of concentration” is “collaboration with Registered Dietitians, as needed”. While part of me is glad to see Nutrition Month catching on, rather than being an echo chamber of RDs, another part of me is frustrated to see it being co-opted by a pseudoscientific profession.

The use of the term “evidence based” concerns me. What evidence might that be? Those of us working in dietetics and medicine often talk about the need for treatments, interventions, and programs to be evidence-based. However, these interventions are only as good as the evidence on which they’re based. Ideally, you want high level evidence like guidelines and and summaries which draw on a larger body of research demonstrating consistent results (check out the 6S Pyramid from the National Collaborating Centre for Methods and Tools for more details). At the bottom of the pyramid, are single studies. The single studies aren’t necessarily poor (they’re the foundation for the higher levels of the pyramid) but if there aren’t many and they aren’t in agreement it becomes difficult to make solid evidence-based recommendations. Also, it can be easy to cherry pick single studies to support nearly any position and proclaim your stance to be “evidence-based”. Without attending naturopath school, I can’t say how credible the evidence-base they’re drawing on is with certainty. However, based on what I see on the websites, social media feeds, and have heard from many people who’ve seen naturopaths, I think it’s wise to question the quality of the nutrition education they’re receiving.

I also question the statement about collaborating with RDs. I’m sure that someone will tell me I’m wrong in the comments but in my experience, I have never heard of a naturopath referring a client to a dietitian. Considering their 155 hours of nutrition education and their alleged nutritional knowledge I’m not sure why they would see a benefit to referring a client on to one of us.

Now, I’ll be the first to tell you that the plural of anecdote is not evidence and I’m sure that seeking responses from twitter is likely to have skewed toward my own bias, but I was curious what sort of nutrition advice people are receiving from naturopaths. I received a number of responses ranging from negative to positive. I assured everyone anonymity so names have been changed – thank you to everyone who was willing to share their experience(s) with me. Here you have it:

The good:

Emma told me that they started seeing a naturopath to improve her diet, energy, and overall health. She found the naturopath to be very down-to-earth with realistic expectations and advice in-line with current research. She said, “She’s always been incredibly supportive; always learning; always approaching everybody as an individual and very willing to make adjustments depending upon someone’s reactions to process.” This naturopath also provided affordable recipes and shopping plans.

Ava went to a naturopath for IBS and was told to try a FODMAP elimination diet.

The bad:

Emma’s naturopath promoted organic products as best and advised her to avoid GMOs.

Ava was also told to eliminate gluten (despite having expressed no issue with gluten and not having celiac disease). She was also not provided with sufficient support to feel like she could adhere to the low-FODMAP diet and quickly abandoned it.

Liam was diagnosed with hypercholesterolemia and prescribed medication by his doctor. He didn’t tolerate it well so he went to a naturopath who sold him a special drink and put him on an alkaline diet.

Sophia went to a naturopath to help her control her severe asthma. The naturopath advised her to eliminate gluten and follow a vegan diet with the explanation that, animal products increase inflammation in the body and were worsening her asthma. As she had previously eliminated gluten and experienced no benefit she followed a vegan diet for about 6 months. She experienced no decrease in symptoms during this time so she reintroduced animal products to her diet.

The ugly:

Liver cleanse supplements were part of the plan provided by Emma’s naturopath.

Olivia went to see a naturopath and was told to cut out dairy, given a stack of photocopied book chapters and opinion pieces, and $800 worth of liver detox tablets, supplements, and powders. To be fair, this was pre-Internet times so photocopies were not so odd, and the profession may have grown since then. But, that also makes the cost of supplements even more exorbitant than it sounds today.

Isabella told me, “I got “nutrition advice” from a naturopath. I walked in, he fat-shamed me, and gave me a whole sheaf of paper basically outlining how I already eat.”

Mia was advised to consume raw milk, and to give the same to her three year old child.

Amelia has both celiac disease and multiple sclerosis. Despite following a gluten-free and dairy-free diet, taking recommended supplements and medications, she still experienced digestive issues. She went to see a naturopath who advised her to get IgG allergy testing. Due to the nature of this not recommended form of allergy testing the naturopath told her she could no longer consume the foods that she was consuming the most of leaving her with very little that she could still eat.

Harper went to see a naturopath after being diagnosed with breast cancer. After spending over $15, 000 on a “natural” treatment overseas she ended up having a double mastectomy but sadly died within a year.

If this is the sort of nutrition advice that naturopaths are providing I’d rather have Nutrition Month remain the echo chamber of dietitians promoting truly evidence-based nutrition recommendations.


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How to find a good dietitian

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Photo by Orla MacEachern. Location: Local Source Market.

Last week after I wrote about the issue of dietitians sniping at each other I had a reader ask me how to find a “good” dietitian. That’s a bit of a tricky one but I’ll try my best to address it as it seems very fitting for Nutrition Month. If any of my fellow RDs (or anyone who’s seen a dietitian) have any other tips or suggestions please feel free to chime in, in the comments.

The process will vary from country to country but in Canada, every dietitian must be registered with the provincial regulatory body for the province in which they work. Here they are by province:

Newfoundland – Newfoundland and Labrador College of Dietitians

Nova Scotia – Nova Scotia Dietetic Association (NSDA)

New Brunswick – The New Brunswick Association of Dietitians (NBAD)

Prince Edward Island – PEI Dietitians Registration Board

Quebec – Order Professionnel des Diététistes du Québec

Ontario – College of Dietitians of Ontario

Manitoba – College of Dietitians of Manitoba

Nunavut, Northwest Territories, Yukon – Insofar as I can tell, because there are so few dietitians in the Territories, there are no regulatory bodies. Presumably, RDs working in these areas would maintain registration with the Provincial body where they completed their examination.

Saskatchewan – Saskatchewan Dietitians Association

Alberta – College of Dietitians of Alberta

British Columbia – The College of Dietitians of British Columbia

Some provinces (Ontario, Manitoba, and BC) have free provincial programs that the public can use to contact a dietitian via email or phone. This is a great option if you have a common nutrition concern or question.

Dietitians of Canada also maintains a list of private practice dietitians but it’s not a complete list as you must be a member of DC to be included. Some provinces also have organizations formed and run by dietitians such as the Dietitians Network Nova Scotia. Again, this is not a comprehensive list of all dietitians in NS as membership is voluntary. The nice thing about their list though, is it provides some detail regarding the area each RD works in and their specializations.

You may also wish to contact your local public health unit as they will be able to tell you about dietitian services offered in your area. Many grocery stores also employ dietitians who offer one-on-one nutrition counselling for a reasonable fee.

Once you’ve found all of the private practice dietitians in your area now it’s time for the tricky part. I suggest looking to see if they have a website, exploring the website to get a feel for whether or not they’ll be a good fit for you. As with any counsellor or heath care professional, not all personalities are going to be well-suited. Look to see if they have links to social media accounts and see if you can get an idea of their personality and nutrition philosophy from tweets and facebook posts.

You should be able to narrow-down your search to a few dietitians based on location and your assessment of their online presence. At that point, you may want to pick one and make an appointment for an initial assessment. If that goes well, excellent, you’ve found your RD. If not, there’s no harm in shopping around. The good thing is, we don’t often work in the same location (like hair stylists) so if you don’t like the fit with the first one you see, you can easily try another without fear of encountering the first at your appointment. Find someone who will help you determine your goals, barriers, and provide you with support to overcome those barriers to reach your nutrition goals. However, don’t expect your dietitian to do the work for you. We’ll be your biggest cheerleader and we’ll give you all the tools you need to get you eating your best but you still have to do the actual work and make the lifestyle changes.

 


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Dietitians of Canada remove themselves from corporate sponsors back pockets!

Exciting news: at the close of Nutrition Month it seems that Dietitians of Canada has heard the pleas of many of us Canadian dietitians. As of next year they will no longer be accepting sponsorship from the food industry! This means members will no longer receive coupons for such products as bologna, nutrition posters prominently featuring pork, or fact sheets developed by multinational soft drink companies. This also means that Nutrition Month will be about improving the nutrition of the general population as it will no longer be driven by the agendas of sponsors such as Dairy Farmers of Canada and Hellman’s Mayonnaise. In the long-term it may even mean the elimination of Milk and Alternatives as a food group on Canada’s Food Guide. Imagine the possibilities that can be explored by a national dietetic body driven solely by scientifically proven nutrition research and common sense!

 

 

April Fools! If only it were true…


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Are you getting enough vegetables?

After a month of “busting” nutrition myths it seems only fitting to end with Canada’s Food Guide. Thanks for reading all month and I hope that you’ll continue to read as I return to my regularly scheduled ranting.
Myth 20: It’s too hard to eat all the vegetables and fruit recommended in Canada’s Food Guide.
What Dietitians of Canada says:
“It’s easier than you think! Canada’s Food Guide recommends adults enjoy seven to 10 servings of vegetables and fruit each day. That might sound like a lot, but serving sizes are not very big. For example, a medium fruit or half a cup of vegetables is all it takes to get one serving…”
What I say:
It is hard to eat all the vegetables and fruit recommended in CFG. That’s why you see campaigns like 5 a Day. If it was easy then we’d be seeing more than half of all adult Canadians eating the recommended number of food guide servings but we’re not. In 2008, 46.7% of Canadians reported consuming vegetables and fruit five or more times a day (Stats Can). Keep in mind that the minimum recommended number of Food Guide servings per day is seven, not five. Imagine how much lower the number of Canadians meeting the actual recommendations would be! So, should we lower the number of recommended servings to better match Canadian diets, just like the physical activity guidelines did? Probably not, it’s good to aim high. Just don’t feel badly if you’re not eating eight servings of vegetables and fruit a day. I know that on most days I’m definitely not. Put away your food guide and try to focus on eating a balanced, primarily plant-based diet and you should be okay.