Dispelling nutrition myths, ranting, and occasionally, raving


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Will soy give you strong bones? Spoiler: maybe, if you’re a rat

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Recently there was a lot of criticism of a NYT article about what’s making us fat that was really about what diets might make mice fat. Along the same lines is this research from the University of Missouri that found soy diets might increase women’s bone strength.

The study was not on actual human women though, of course. No, this study’s participants were rats. These rats are apparently a good proxy for human women because they are selectively bred to have low fitness levels and, “average American women are relatively inactive both before, and especially after, menopause”. Essentially, both American women (particularly older women) and these rats are lazy so they’re totally interchangeable when it comes to research. As it’s much harder to get women to adhere to specific diets, and there are far more variable to control for and ethical considerations when it comes to human experiments, it just makes sense to use rats.

So, these rats were divided into two groups: one group was fed a corn-based diet (you know, just like the average post-menopausal American woman eats) and the other was fed a soy-based diet. The results showed that: “the tibia bones of the rats that were fed soy were stronger compared to the rats who were fed the corn-based diet, regardless of ovarian hormone status”. Leading to the conclusion that: “Bottom line, this study showed that women might improve bone strength by adding some soy-based whole foods to their diet”.

To recap: rats were fed either corn-based rat food or soy-based rat food. The rats fed the soy-based rat food were found to have stronger leg bones. Therefore, human women can increase their bone strength by eating more soy.

This is ridiculous. We are not rats. We do not live the same lives as laboratory rats. We are not all sedentary. We do not eat the same food as laboratory rats. It is a huge leap to say that this study in rats shows that consumption of soy by women can lead to stronger bones. We are not eating a homogenous diet of corn-based rat food. The forms of soy we consume as humans are very different from that in rat food (e.g. tofu, soy beverage, tempeh, edamame, TVP).

Perhaps soy-based foods can increase bone strength in humans but this study doesn’t tell us that. This study tells us that this breed of rat has stronger bones when fed a soy-based diet than when fed a corn-based diet.


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If men got pregnant…

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Today I just want to rant a little bit about the patriarchy and research, particularly in relation to mothers and pregnant women. You’ve likely all heard about the difference between men and women when it comes to heart attacks, leading to missed diagnoses in many women, and how most drug trials are done using men so that we have very little evidence regarding the efficacy and side effects of many medications on women across their lifespan.

Then you see results of studies like this one which, despite the cognitive effects of alcohol consumed during breastfeeding no longer being evident when children are 10 years of age, provides the message that breastfeeding women should not consume alcohol. This despite the fact that alcohol is removed from breastmilk at the same rate as it is from the bloodstream. This means that while pumping and dumping is an ineffective measure to prevent infants from consuming alcohol via breastmilk that mothers can still safely consume alcohol and breastfeed provided they allow for adequate time for alcohol to clear from the milk. If you’re a breastfeeding mum, you can use this table to determine how long you’ll need to wait after drinking before you can breastfeed your baby (unfortunately, it might be longer than you would think).

Women who are of childbearing age are often told not to consume alcohol at all. Just on the off chance that they might get knocked up and damage the fetus before they realize that they’re pregnant. Women who are pregnant should definitely never consume any alcohol at all because their baby might end up suffering the effects of Fetal Alcohol Spectrum Disorder (FASD). And yet, many perfectly healthy babies are born to women who consume alcohol during pregnancy, indicating that there is likely a window (or windows) during which a certain amount of alcohol may be consumed without affecting the development of the fetus.

Pregnant women are shamed for drinking coffee, and some have even been refused coffee by baristas (and they say dietitians are the food police!). This despite the fact that pregnant women can safely consume up to 300 mg of caffeine a day (about the amount you’d get from a grande coffee). And the fact that the research on caffeine consumption during pregnancy is mixed.

Pregnant women are not allowed to eat: soft cheese, deli meat, sushi (unless it’s veggie), raw eggs, tuna (and other large fish), organ meat, raw sprouts, paté, unpasteurized juice or cider, store-made salads, and packaged salads, many herbal teas.

Naturally we want to exhibit an abundance of caution when the health of the woman and the fetus/infant are potentially at risk. However, I bet that if men were the ones giving birth that we would know exactly how much of all these things could be safely consumed during pregnancy and breastfeeding and the precise windows during which they needed to be avoided. But because (cis) men don’t give birth or breastfeed but they generally conduct most of the scientific research we are told to err on the side of caution. I mean what do they care if we can’t have a beer for 30 or so years because we might get pregnant at some point during that time, or enjoy some lovely brie because there is a teensy risk that we might get listeriosis and miscarry. As long as we are protecting their offspring that’s all that matters. And if a woman dares to defy all of the dietary restrictions placed on her during pregnancy societal shaming will cause her to toe the line. After all, questioning these restrictions shows that you are an unfit mother and selfishly putting your enjoyment of bruschetta ahead of your own child for whom you should be enthusiastically giving up everything for while your husband is out drinking with his buddies.

Please note: I am not suggesting that women who are pregnant reject all of this dietary advice. There are very real risks to consuming these foods and beverages during pregnancy. I am however suggesting that we reject the unquestioning acceptance of these restrictions because you know that if men were the ones getting pregnant there would already be a body of research into precisely what could be consumed when.


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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.