Dispelling nutrition myths, ranting, and occasionally, raving


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No, watching What the Health does not qualify you to provide nutrition counselling

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I saw a couple of RDs I know tweeting about this article a couple of weeks ago and I just had to add my two cents. I honestly think that freedom of speech is being misconstrued in the US and this is not an issue of freedom of speech at all.

So the issue is there’s a “health coach” in Florida who’s mad because she was told that she’s not allowed to provide dietary advice to people because she doesn’t have a licence. She think that impinges on her freedom of speech. Her lawyer claims that “getting a licence is incredibly burdensome”. Well, no frigging shit. Getting a university degree in any field ain’t cheap and then having to complete internships, pay to write the national exam, and then paying annual fees to retain your licence is time consuming and costly. It totally sucks but does that mean we should tell people they can go ahead and practice dietetics without a licence? I think not.

What seems to be lost in this story is the reason why people become licenced dietitians in the first place. That licence is not there for our benefit. It’s there to protect the public, the people who pay to receive credible evidence-based nutrition counselling. It’s not a benefit to dietitians, it’s to protect the public from us. That licence tells anyone seeking counsel from a dietitian that we are qualified to provide that advice and if we screw-up they have legal means by which to hold us accountable.

As registered dietitians we acknowledge our scope of practice and the limitations of our expertise and work within those confines. This “health coach” may be quite knowledgable about nutrition but there’s no accountability. We don’t know what we don’t know and while she may believe that she’s well enough informed to provide nutrition counselling, she’s not in the position to be able to make that assertion. That’s why there are standardized examinations and competencies that must be met by dietitians, to ensure we all meet a certain level of expertise.

Licencing is common in many professions, from doctors to dentists to mechanics to pilots. The reason for that licencing is always the same, to protect the public from charlatans and ensure that these professionals meet a certain standard.

This is not a freedom of speech issue. No one is telling this woman that she can’t talk about nutrition to whomever she wishes. She can proselytize to fellow grocery shoppers in the cereal aisle. She can tweet about her beliefs. This is practicing dietetics/nutrition without a licence. This is making money by providing personalized nutrition advice to individuals without the appropriate qualifications. To allow her to do so would be the same as allowing me to perform bariatric surgery because I’ve read some books and researched it or allowing someone to fly a plane because they flew some in a video game once. To allow a health coach to practice as a dietitian without the appropriate credentials is putting the public at risk.

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Aloe vera: healing or harmful?

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Image by Andreas Issleib on flickr. Used under a Creative Commons Licence.

A little while ago when I was looking for blogspiration a friend told me to take a look at a certain “nutritionist” on twitter. Since then, I’ve had her on my back burner because she certainly looked like she would have some good blog fodder (cured her incurable illness through diet) but I couldn’t be bothered to look through all her posts. Well, today’s the day I move her to the front burner.

I was reading her post on the healing properties of aloe. I found myself hoping that she would provide a balanced picture because I didn’t really want to write about aloe. Sadly, she did not, so here we are. As I feel that simply extolling the virtues of a food, without providing cautions is irresponsible, even if you don’t have a regulatory body protecting the public from you. Sorry, sorry, I digress.

In her post she writes about the magical properties of aloe: anti-viral, anti-bacterial, anti-inflammatory. Unfortunately, there she didn’t link to any research so I can’t comment on the quality of the studies used to make these claims. As far as I can tell, to date there’s been very little (if any) research on human subjects. However, some in vitro studies and animal have shown some promise when it comes to the anti-viral (1, 2) and anti-microbial (3, 4) properties of aloe vera. Of course, based on the current research, there’s no way to know what dose or form of aloe would (if at all) be effective in humans. It’s entirely possible that oral ingestion of aloe would not have any positive benefits in relation to viruses and bacteria.

Some mouse studies and in vitro have shown promising wound healing and anti-inflammatory effects of aloe vera (when administered both topically and orally) (5, 6). Again, there has yet to be any conclusive research done in humans.

Okay, it sounds a bit promising but… Then come the concerns. Before you start adding a handful of aloe vera plant to your smoothie you should be aware that the exterior portion of the leaf has a laxative effect. There are other longer lasting concerns about aloe vera consumption than diarrhea. My friend Helen has written about many of them on her blog Food and Nonsense. These include a risk of cancer and impaired liver function. Over at Examine, the only conclusive research they’ve found so far for aloe supplementation is for increased intestinal motility (i.e. to combat constipation). The Mayo Clinic provides a long list of cautions against the ingestion of aloe vera products, including the risk of inducing uterine contractions in pregnant women. I’ve also blogged about the consumption of aloe vera juice in the past.

I believe that my final statement in that post stands the test of time: Just because it’s “natural” doesn’t mean it’s good for you.

 


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21 easy food swaps that will totally leave you feeling like you’re missing out

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Image “Vegemite for Sue” by mobil’homme on flickr, used under a Creative Commons licence.

A couple of RDs I know on twitter shared the this post recently and deemed it “food wankery”. An apt description. Let me fix that for you…

21 “easy” food swaps you can make now without missing out

  1. Sugar. Swap it for rice malt syrup less sugar. Sugar by any other name (including rice malt syrup) is still sugar. Try to avoid sugary drinks and keep sweet treats actual treats.
  2. Vegetable oil. Swap it for coconut oil what ever type of oil you prefer when cooking. Coconut oil does have a higher smoke point than most other oils making it a good choice for higher heats. However, it’s also very expensive. Use the oil that you prefer, can afford, and have on-hand. Despite what you may have heard, coconut oil is not a miracle food and “oil pulling” is bullshit but can be done with any type of oil. It’s important to consume a variety of types of fats so don’t toss your EVOO and butter and use coconut oil for all of your cooking; switch it up.
  3. White flour. Swap it for gluten free flour alternative <if you have celiac disease>. Most gluten free flours are far more expensive than white flour and don’t provide the same texture. It’s true that white flour isn’t the healthiest thing you can eat but refined gluten free flours are on-par with white flour or even less nutritious as they may not be enriched. Unless you have celiac disease there’s no reason to go gluten-free just make sure you’re consuming a variety of grains and that the majority of your servings are whole grain.
  4. White rice. Swap it for quinoa brown and wild rice mixes. Brown rice has more fibre and nutrients than white rice as it’s simply less refined white rice. Quinoa is not as protein-rich as the superfood marketers would have you believe. Sure, it’s great to switch it up but quinoa is another super expensive food.
  5. White wine vinegar. Swap for apple cider vinegar depending on the recipe. Unpasturized apple cider vinegar contains probiotics in the sediment (aka “the mother”) which may be beneficial. However, the flavour of apple cider vinegar may not always work for the recipe that you’re making and the small amount that you consume in a dressing is unlikely to provide any substantial health benefit.
  6. Wheat crackers. Swap for seed and vege crackers/snaps whole grain crackers. Seed and veg are fine but most crackers that contain them are still white flour based with a smattering or seeds or vegetables. Look for crackers with minimal ingredients and whole grains. You can also find some great legume based crackers and tortilla chips in stores now.
  7. Commercial muesli. Swap for rolled oats mixed with nuts, spices and organic dried fruits or simply fresh fruits. Okay, this isn’t a bad suggestion, although commercial muesli doesn’t usually have much added sugar anyway; most of it comes from the dried fruit.
  8. Commercial chocolate. Swap for raw fair trade chocolate. If you can find/afford/enjoy raw chocolate then go for it. If you enjoy “commercial” chocolate go for it. Try to choose fair trade so that the farmers get appropriately reimbursed.
  9. Wheat pasta. Swap for rice, buckwheat, quinoa or legume based pasta whole grain pasta. Choose whole grain for more fibre. Other pastas can also be good sources of fibre but many gluten-free options are actually lower in fibre. Read the labels and choose the best option that you enjoy.
  10. Packet muesli bars. Swap for a small handful of nuts and seeds, bliss balls — or bake your own or choose fresh fruit, hummus, veg, there are many snack options. What the heck are “bliss balls” anyway?! Something pretentious packed full of super expensive ingredients no doubt.
  11. Vegemite. Swap for a mix of tamari and tahini. I don’t have a suggested swap for this one either. Although one of my tweeps suggested “the inside of a trashcan” – haters gonna hate. Yes, vegemite is high in sodium (173 mg in 5 g) considering the quantity in one serving. It’s also a good source of B vitamins and consumed in small quantities occasionally there’s little harm in that. Switch it up with natural nut and seed butters.
  12. Table salt. Swap for sea salt or Himalayan crystal salt herbs and spices. Sea salt is no better for you than table salt. Try seasoning your food with herbs, lemon zest, and spices to cut back on sodium.
  13. Bottled sauces. Swap for simple combinations of fresh or dried herbs and spices to season foods. This is also acceptable. However, you can find healthy bottled sauces in a pinch. Look for no-salt-added options or better yet, make your own.
  14. Instant coffee. swap for freshly brewed plunger coffee, green tea or dandelion tea real coffee. Sorry, I’m a coffee snob. You should not be drinking instant coffee. Go for ANY OTHER coffee.
  15. Poppers. Swap for fresh vegetable juices or smoothies. fruit. I don’t know what poppers are but whole fruit is better than juice. Home made smoothies can also be a good choice as long as you’re not adding juice or sugar. Sweeten with frozen banana chunks.
  16. Soft drinks. Swap for sparkling water with lemon, lime, orange or pomegranate. This is also a good suggestion. I’ve been loving the Blue Menu sparkling waters this summer.
  17. Peanut butter. Swap for pure nut butter or a natural peanut butter without added vegetable oils. Choose peanut butters and other nut and seed butters without any ingredients besides nuts. There’s unnecessary added sugar, salt, and fat in most peanut butters. Beware of labels that proclaim “natural” that aren’t just peanuts.
  18. Nutella. Swap for raw cacao mixed with almond butter, or make your own with roasted hazelnuts, raw cacao, maple and coconut milk. it really depends what you’re using it for. We all know that Nutella is delicious but not nutritious. If you’re having a spread on toast go for a nut or seed butter unless you want to turn it into a chocolate bar. However, if you’re having an occasional treat or using it in a baked good unless you’re ambitious enough to make your own healthier version then a little’s not such a big deal.
  19. Potato chips. Swap for rice crackers <and a feeling of utter dissatisfaction and excessive consumption of other foods>. I’m sorry but I don’t know anyone who is satisfied by rice crackers when they’re craving potato chips. If you are, power to ya. If you’re like most other human beings, and you’re craving potato chips then allow yourself to have a small portion, don’t eat straight from a large bag. If you have a microwave you can make your own healthier portion-controlled potato chips.
  20. Cookies. Swap for bliss balls or bars. Again with the bliss balls. Are these akin to rocky mountain oysters? I won’t lie, sometimes I made energy balls for a snack but cookies are a whole other thing. Cookies are a treat. They’re not sustenance to get you through the sleepy morning hours between breakfast and lunch. If you want a cookie, go for it, preferably homemade, fresh from the oven. A “bliss ball” is unlikely to satisfy that craving and it’s better to have a little of what you want than a whole bunch of other random foods to try to fill that cookie sized hole in your tummy.
  21. Sweetened dried fruits. Swap for organic unsweetened dried fruit or fresh fruit. Unless you’re one of the few people who is sensitive to sulphites in dried fruit there’s no need to avoid dried fruit in order to avoid sulphites. Avoid sweetened dried fruit because dried fruit is already full of sugar as the sugar in fresh fruit becomes concentrated in dried fruit. Because dried fruit is sticky and full of sugar it’s also a great promoter of dental caries. If you do choose dried fruit you should have only a small portion, try to pair it with something like nuts or cheese, and be sure to brush your teeth after.

You don’t have to swap the foods that you enjoy for expensive pretentious foods to be healthy. Try to eat healthy foods that you enjoy 80% of the time and really savour those treats the other 20%.


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Would you go to a self-taught doctor?

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My friend sent me a link to this opinion piece: Who is qualified to give nutrition advice? last week. I found myself growing increasingly frustrated as I was reading. One of the biggest frustrations I find working in the field of nutrition is that everyone’s an expert. I get it, we all eat, and many non-nutrition professionals pay attention to what they’re putting in their bodies. Nutrition information is everywhere and it’s not hard to seek out general, and even specific, nutrition facts. However, there are a couple of problems when it comes to receiving nutrition advice.

 

I don’t mean advice like your aunt telling you how to tweak your lasagna recipe or your friend telling you ways to get your kids to eat their veggies. We all give each other friendly advice like this, regardless of our educational backgrounds. It’s a whole other kettle of fish when you’re paying someone to provide you with a service. I don’t want to say that registered dietitians are the only professionals who are qualified to give nutritional education. But… At this point we are the only regulated nutrition professionals who have accountability. What do I mean by that? We have to register with our provincial regulatory body (in Nova Scotia that’s the Nova Scotia Dietetic Association). As part of our continuing competency program we have to demonstrate ongoing learning and set learning goals for ourselves every year. The NSDA also ensures that we are practicing within our scope of practice (i.e. not performing duties that we’re not properly trained for) and they deal with any complaints about us. We must all hold liability insurance so that if for some reason we’re sued we’re covered. Someone who is “self taught” may know a fair bit about food and nutrition but there is no one to ensure that is actually the case. If they give you inaccurate or unsafe counseling there is no recourse for you to be compensated and for them to be held accountable. If, as dietitians, we cause you harm through our professional practice, we can potentially lose our licences and be barred from providing nutritional counseling.

 

The other problem with obtaining nutrition information from someone who is self-taught is that you don’t know what they actually know. Yeah, I know that’s a little odd sounding. What I’m saying is, with a registered dietitian, you know that they’ve received specific education. We have to take a number of specific courses such as macro- and micro-nutrients, nutrition through the life-cycle, medical nutrition therapy, organic chemistry, biochemistry, etc. We also have to successfully complete a recognized internship program and then a national exam. Someone who is self-taught would not have had these experiences.

 

Dietitians also learn about treating people with various disease states and conditions. We can continue on in our education to specialize in things like diabetes management, oncology, pediatrics, weight management, eating disorders, mental illness, and on and on. None of us would dare claim to be experts in every area and we should be able to recognize our limitations and refer on to someone more knowledgeable when a client/patient presents with a problem outside of our realm of expertise. Just as you wouldn’t (I hope!) go to a self-taught medical doctor, dentist, pharmacist, or any other health care professional, why would you go to a self-taught nutritionist when you could go to a professional dietitian?

 

So… Matt MacDonald… While you may know a lot about nutrition there are a number of reasons why you are not qualified to provide nutrition counselling and why registered dietitians are. By marketing yourself as a nutrition counsellor (or whatever it was you were advertising your services as) you are leading the public to believe that you have a certain level of knowledge and credentials. Perhaps you do know a great deal about nutrition. However, that’s not the issue. The issue is that you are misleading the public and you are potentially putting them at risk.


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What’s the difference between a dietitian and a nutritionist?

Myth 19: There is no difference between a dietitian and a nutritionist.
What Dietitians of Canada says:
“Dietitians are one of a kind… Dietitians must be part of a regulatory body, just like doctors, pharmacists, and nurses. The terms “Registered Dietitian,” “Professional Dietitian” and “Dietitian” are protected by law. In many provinces, there are no laws to protects the title “nutritionist.””
What I say:
Yes and no. In some provinces nutritionist is a protected term. However, in most provinces nutritionist is not a protected term so anyone can call themselves a nutritionist. RDs who have a masters in human nutrition often call themselves nutritionists, regardless of province. Being part of a regulatory body means that we are licenced and held accountable. Unregulated nutritionists do not have that same accountability and often have little education to support their knowledge of nutrition. Check that the person providing you with nutrition advice has the credentials to be doing so. For an interesting and balanced take on the differences between dietitians and nutritionists I highly recommend Erik Davis three-part series The Legitimacy Diet. I’ve linked to the third part here as it also has a list of the provinces where nutritionist is a protected term. Links to the first and second parts are on the right-hand side of the page.