Dispelling nutrition myths, ranting, and occasionally, raving


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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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Should dietitians use #eatclean on social media?

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A friend shared this article with me last month. For those of you who can’t be bothered to click links or belong to the TL;DR camp (of which, I’ll admit, I’m a frequent member) let me give you the briefest of synopses. It was about clean eating, why people got so sucked in by the notion, and why it won’t freaking die already.

Reading about all of the self-appointed “clean eating” wellness gurus got me thinking about how many of us who rail against fad diets are also inadvertently complicit in keeping them alive. I see lots of well-intentioned dietitians using hashtags like #cleaneating and #eatclean on their Instagram posts. Personally, I prefer the tag #eatdirty although I don’t think it garners me as many likes as it hasn’t quite caught on in the way that I had hoped. Anyhow… I’m not here to judge my fellow RDs. I’m not even sure how I feel about this myself.

There’s a part of me that thinks it’s good for dietitians to be appropriating the “eat clean” hashtag. By doing so, perhaps they’re reaching people who are all-in on the trendy diet train but who might benefit from seeing sensible nutrition and food suggestions from a nutrition professional. On the other hand, is using these hashtags on Instagram lending legitimacy to them? Isn’t it possible that by using the hashtags, no matter the content, it’s implying that the RD posting supports the notion of clean eating? And for all I know, maybe they do, not all of us are on the same page. But let’s assume that they’re using it, not because they believe in “eating clean” (which means nothing by the way), and not because they’re just trying to get more likes (I know, terribly cynical of me), but because they want to show people who are into “clean eating” a more balanced way of approaching food. Is it cool for dietitians to be using the hashtags for this purpose? Even if it means that it lends an air of legitimacy to a silly fad diet. Does the end justify the means? Or would it be better if we risked only preaching to the choir by using hashtags that truly represent our personal philosophies toward food and our professional opinions?


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Follow Friday: @AndyThaRD

For today’s Follow Friday I suggest that you follow fellow RD Andy DeSantis whose goofy antics on social media have fast earned him a number of devoted followers. He tweets at @AndyThaRD but where he really shines is on Instagram. He has his fair share of the obligatory food pics and selfies but he also started a challenge a little while ago asking people to post photos of themselves striking yoga poses with vegetables.

Andy's Vegan Yoga Challenge – You must post a picture of yourself doing a yoga pose that includes a vegan food in a humorous way. Tag me and I will re-post the one I that think is the funniest. FYI I am far from a legit yoga practitioner but that did not stop me from putting a bag of avocados in my mouth and whipping out a poorly executed pose that I learned from P90X. All skill levels welcome 😂😂😂 #yogachallenge #yogagram #yogisofinstagram #veganeats #plantbaseddiet #dietitian #rd2be #nutritionist #yogainspiration #trianglepose #vinyasa #eattherainbow #foodiegram #torontofoodie #yogapose #hippies #yogapants #meditate #spiritualgangster #instavegan #instayoga #vegansofinstagram #plantpower #fitfoodie #healthspo #eatcleantrainmean #onewithnature #ashtanga #forkyeah #instafoodie

A post shared by Andy De Santis RD MPH (@andytherd) on

It needed to be seen to be believed, right? ;)

Andy is serious about supporting new RDs and promoting a healthy lifestyle; he just knows that you can’t take anything (including yourself) too seriously in this business (life?). He recently began featuring blog posts from dietetic students on his blog. The most recent post features a recipe for vegan minestrone from Rachel Asbury, perfect for the cooler temps that are about to hit.

Another recent initiative of his is a YouTube channel “Dudes Talk Nutrition” in partnership with Aussie RD @hearty_nut (aka Joel Feren). Want to know if carrots cause cellulite? Watch their latest video to catch them combatting nutrition myths:


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Hey food industry, get out of RD conferences! #FNCE

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I had a blog post all written for you lovelies, cued-up, ready to go. Then I started seeing the tweets coming out of FNCE (Food and Nutrition Conference and Expo) and I got all annoyed and tweeted what you see above because apparently I’m a masochist. That unleashed a fun afternoon of back-and-forth with fellow RDs on twitter who either don’t see conflict of interest as an issue in our profession or don’t really care.

I keep being about to say “I’m sorry but…” but I’m NOT SORRY DAMMITYou are not immune to marketing. No one is immune. Not me, not you, not anyone and if you think you are then you are the extremely rare exception or you are sorely mistaken. Many dietitians (myself included) regularly bemoan that we can’t get any respect as a profession. Do you really think that showing your influence can be bought with a free sample is helping us to become respected on the same level as other healthcare professionals?

Let me tell you a little tale. Once upon a time I worked in a grocery store (yes, I was an RD at this time). In my position I was responsible for a department, helping customers, teaching classes, providing demos, etc. Myself, and others in the same role at other stores regularly received training, lunch and learns, and samples from vendors. Product knowledge is important if you are talking to customers about food and supplements. The thing is, we didn’t receive training on or samples of all brands. So which products were we more likely to recommend? The ones we’d gotten to try, the ones we felt more connected to. Sure, I never recommended a product that I was morally against (I told people not to buy raspberry ketones if they asked for my opinion)or didn’t genuinely like, but I’m sure that there were equally good alternatives to many products that I didn’t steer people toward because I had no experience with them.

So, when dietitians argue that industry at conferences is fine, I disagree. Sure, walnuts and almonds are great but if they’re the only nuts there what are the chances that dietitians are going to be subconsciously influenced to promote those to their clients over nuts that don’t have representation at the expo? Yoghurt’s great and there are myriad options at grocery stores. If Siggi’s and Chobani are the only yoghurt brands represented at FNCE, which brands do you think that RDs are going to be more likely to choose and recommend?

Some argued that the FNCE is, in part, an expo. True enough, but as a conference organized by the national dietetic organization in the US it’s expected that most attendees will be dietitians. The focus should be on providing them with current evidence-based nutrition information.Having a captive RD audience for marketing at a conference organized by a body that’s meant to represent RDs is reprehensible. It’s time for the FNCE to drop the E.

Lest you still believe that RDs are a higher breed of human and somehow immune to conflicts of interest and marketing tactics, check out the selection of tweets below. Names and handles have been removed because this is not about singling out dietitians, it’s about drawing attention to the larger issue. Kudos to the companies present at FNCE for generating all of these free advertisements. Shame on the Academy of Nutrition and Dietetics for allowing this to occur.

 

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Follow Friday: @emmatrainRD

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Emma Train (nee Holly) and I met early in our nutrition degrees and have stayed in touch since then. You do some good bonding when you’re lab partners in Dr. Kwan’s foods lab and then biochem. Not to mention the interminable bus rides to uni on the 80. Ah, memories. Since then, Emma has provided me with many blog topics (including the damn Ideal Protein, aka the post that won’t die) and now has joined me on the writing and ranting train.

Emma just had her first piece published in Ask Men about nutrition myths that need to die. You can also find her blogging at In Your Face Nutrition where she shares cooking tips, recipes, and food and nutrition thoughts. You can also find her on all of the social medias: Twitter @emmatrainRD, Facebook Emma Train RD, and Instagram @inyourfacenutrition.