Dispelling nutrition myths, ranting, and occasionally, raving


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The Food Guide needs to rise above dietary dogma

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A while ago I remember reading an article by some doctors about how the updated Canada’s Food Guide should be promoting a low-carb, high-fat (LCHF) diet. Then last week there was another article about a “prominent Ontario doctor” who asserts that the new Food Guide is being based on “very bad science”. And I’m just so frustrated that doctors, who we all know receive minimal nutrition education, are getting so much press for their self-serving misinformed opinions.

First of all, these doctors all serve to benefit if their particular dietary dogma is promoted. The doctors pushing the LCHF agenda make a living by putting people on this diet. The doctor who said the new Food Guide is based on “very bad science” and should instead contain specific diet recommendations (e.g. low-fat, DASH, LCHF) has received money from the Dairy Farmers of Canada in the past (and as we know, they are highly opposed to the potential shift from the current Food Guide food groupings).

Secondly, they seem to have a poor grasp of population health and the purpose of a national food guide. When we’re talking about population health we’re talking about improving the health of the entire population. We are not trying to address specific medical concerns of illnesses. We’re also not trying to put the entire country on a weight loss diet, which seems to be the perspective that these physicians are taking. Similar to the daily recommended intakes for vitamins and minerals, which are based on the average amount that a healthy person requires each day, the food guide is intended to promote a healthy dietary pattern for most healthy Canadians. Obviously we are all different and our needs and optimal diets will vary, hence the fact that this is called a guide. It’s not a prescriptive diet, it’s one size fits most with some personal tweaking, not one size fits all straight off the rack. It’s not meant to address every, or actually any, disease states. That’s why we have dietitians and doctors and primary healthcare to help individuals with specific health concerns. It’s meant to promote a healthy pattern of eating among as much of the population as possible. It’s not at all, “picking a specific dietary plan for all Canadians is the wrong approach and that, like all clinical processes, treatment should be considered based on individual patient needs” as the doctor in the second article said. It’s providing general guidance on healthy food choices for those who aren’t in need of clinical treatment.

The narrow focus on clinical care and treatment in the realm of healthcare does a disservice to us all. As does the medicalization of eating. In order to promote health and wellness in our communities and country we need to move back upstream and start preventing the need for many doctor visits, hospital stays, and medications. That sort of thing is achieved through population-based measures that address the social determinants of health and general guidelines such as Canada’s Food Guide.

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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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If children are the future we may be in trouble

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After coming across a few teacher resources I’ve started to wonder about what lessons we’re really teaching children in schools.

The first example was actually a list of nutrition curriculum supports for teachers compiled by dietitians. Most of them were great but a few that really stood out to me were ones produced by companies whose m.o. is to sell products, not to educate. I found it concerning that nutrition professionals would consider promoting self-esteem resources from Dove and videos about farming from companies like Kashi to students would be appropriate. Considering the clear lack of media literacy and nutrition literacy in our society, I think it’s vital that as nutrition professionals we do our utmost to promote credible, unbiased (or at least as unbiased as possible) sources of nutrition information to the public and particularly to children and youth.

So, there was that. Then I came across a (US-based) website of “food resources” for teachers with a number of activities featuring candy to teach kids lessons about various subjects such as math and science. For example, we have: gummy bear genetics, gummy worm measurements, the history of marshmallows, math with candies, and chocolate and solvents. Why exactly do we need to use sugary treats to teach children in school? Is this the norm? Is the prevailing perception that children need to be bribed to learn anything in school?

There’s lesson plans on the website including things like “Juice Nutrition 101” which one might reasonably assume would be about the pros and cons of juice. If so, you would be incorrect. It’s actually only about the alleged benefits of juice and was (get this) used with permission from Ocean Spray Cranberries, inc. I shit you not.

What kind of lessons do these sorts of things actually teach children? Not critical thinking, I’m sure. Nor do they teach children accurate unbiased nutrition information. They also normalize and encourage the regular consumption of candy and treats that should really be “sometimes” foods. We need to have more dietitians involved with the development of educational resources. We need to ensure that teachers are nutrition and media literate so that they don’t use resources such as those mentioned above in their classrooms. If children are the future we need to do better at equipping them with the skills to navigate and emerge from this “post truth” era.


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Are dietitians getting too sexy?

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A few years ago I wrote a blog post that really hit a nerve with other dietitians. It was about how dietitians just aren’t sexy. This was in the sense that we don’t hop on trends (unlike other unregulated professionals) and instead are moored in evidence-based practice. Unfortunately, I’m noticing a disturbing trend in dietetics and I’m concerned about the future of my profession.

There have always been some dietitians who believe in unproven practices such as detox, fad diets, and questionable supplements. It’s a shame to see others promoting such nonsense as I feel it reflects poorly on all of us but it’s always been the minority. It’s also been somewhat understandable because it can be a tough field in which to find a secure job. And we probably all have some beliefs that aren’t based in evidence. Experience is important in combination with scientific evidence. However, I feel like in this age of fake news where nothing means anything anymore, that this is infiltrating dietetics at a higher level.

Recently there’s been the introduction of “integrative functional nutrition” which sounds very scientific and pretty great, “A central theme of IFNA training is learning to identify “root causes” of disease in a methodical and systematic fashion rather than the mundane prescription of medical nutrition protocols based on a diagnosis”. Who doesn’t want to get to the root causes of illnesses? I think the main frustration with Western medicine is that there’s often a failure to dig deeper to find the root cause for ailments and simply a treating of symptoms. This is why so many people turn to unscientific alternative health practitioners for help. Unfortunately, “integrative functional nutrition/medicine” tends to be code for the smooshing together evidence-based practices and unproven unscientific practices. The creation of bodies of dietetics incorporating these practices lends false credibility to them.

Last week I attended a nutrition conference. It was generally a really great conference with presenters sharing a variety of perspectives and evidence. There were also presentations by people with lived experience. I think there’s a great deal of value in learning from people who have experience with various conditions, circumstances, illnesses, etc. However, the final presenter was by an individual who had “cured” a severe mental illness through nutrition and supplements with the aid of a Christian doctor in the US. I’m not in a position to question this person’s experience but the presentation made me extremely uncomfortable. I don’t doubt that nutrition plays an important role in supporting mental health. Although I do doubt that we can cure most cases of mental illness through nutrition.

As dietitians, we are always trying to promote ourselves as credible sources of nutrition information. Yet here we are, welcoming a presentation from an individual who was treated by a doctor whom would be dubbed as a quack by most. This guy readily fails Dietitians of Canada’s “Five tips to help you spot misinformation“.

1. Is the person or product promising a quick fix like fast weight-loss or a miracle cure? Check!

2. Are they trying to sell you products such as special foods or supplements? Check!

3. Do they provide information based on personal stories rather than on facts? Check!

4. Is their claim based on a single study or a few research studies? Not sure if the claims are based on any research so yeah, Check!

5. What are the person’s qualifications? Unfortunately, he’s a medical doctor which makes it sound like he’s a qualified professional. But we all know that doesn’t stop Dr Oz from operating outside of his scope of practice. Being a MD doesn’t necessarily mean that an individual is qualified to be providing nutrition services (most doctors receive very little nutrition education during medical school). As far as I can discern, he hasn’t received any specialized nutrition education so… CHECK!

Inviting people who are promoting such quackery to professional conferences undermines our credibility as nutrition professionals. It lends false credibility to their practices and allows these unproven beliefs to infiltrate dietetics. It makes it harder for us to present ourselves as credible nutrition professionals and undermines the ability of the public to trust us.

It’s discouraging to see people seeking out healthcare from unregulated professionals with questionable credentials and practices. But I don’t think the solution lies in taking the attitude that if you can’t beat them, join them. It’s important for us to continue to ground our advice in the best possible scientific evidence if we want to remain trusted healthcare professionals. Otherwise we may as well all burn our degrees and licences because they’ll become as meaningless as the credentials of all the self-styled nutrition gurus.


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Science is not my religion

After I wrote about the study that supposedly showed that consumption of vegetables and fruit has no bearing on cancer development someone commented on facebook that I was undermining “real science” and supporting pseudo-science hacks. I think this raises an important issue when it comes to science and faith.

You see, while I am a supporter of science and detractor of pseudo-science, science is not my religion. I think that holding blind faith in anything is dangerous. Scientific research is hugely important but that doesn’t mean that every piece of research should be taken as gospel. Scientific studies can be flawed, they can be weak, they can be biased, and they can just plain be wrong. That doesn’t mean that we should ignore all scientific studies. It means that we should look at research critically. Whenever possible, we should look at larger bodies of research, rather than single studies, to draw stronger conclusions. We should look at research critically in order to base our decisions, beliefs, and advice on the best possible evidence.

Science is not infallible. That doesn’t mean that we ignore it. It just means that we need to examine it closely before deciding whether or not we accept results and conclusions drawn. Always question things. Be skeptical.

Rather than thinking that being critical of any piece of scientific research is on-par with supporting pseudo-science and quackery, we should think of blindly accepting the results of every piece of scientific research as being on-par with blindly accepting the advice of celebs and self-styled wellness gurus.