Dispelling nutrition myths, ranting, and occasionally, raving


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Book Review: @thefuckitdiet

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This review is not going to be as thorough as I like to be. I listened to this book on Audible while I was doing other things like cooking, cleaning, and walking the dog so I didn’t take notes and I wasn’t always paying the closest attention. That being said, for the most part, I thought it was great.

The overall message of the book is that we need to stop being so hard on ourselves for doing something as natural as eating food. That in order to reestablish a healthy relationship with food we need to stop dieting altogether and give ourselves permission to consume food in ways that we have told ourselves is “wrong”. For example, allowing ourselves to eat foods we’ve told ourselves are “bad” and allowing ourselves to overeat. This book is basically about undoing the conditioning we’ve done to ourselves over the years by making eating emotionally fraught.

The only real issue I took with any of the book was with some of the science, which I found to be questionable. I should have taken notes because I can’t remember exactly what Dooner was saying and having listened to the audiobook it’s not like I can easily flip to the references to look things up. I do remember her talking about the causes of candida overgrowth and mention of heavy metals being the cause (not sugar consumption). As far as I’m aware, there is still a lack of quality research in this area, and we really don’t know what causes some women to be prone to yeast infections. Dooner also mentions Chris Kresser as a source at one point (no, not a source of candida, but as an expert on something – again, I should have taken notes). I’m not a fan of Kresser. He’s got something to sell and claims to have the cure for everything that ails us. His website is a trove of red flags when it comes to nutrition information and he’s an acupuncturist and anti-vaxxer who cured his own chronic illness. Not someone I would want to be associated with. Anyway… as long as you don’t get hung-up on the science, I think that a lot of people could benefit from this book.

Dooner offers practical actions for the reader to undertake that should help move them closer to a healthy relationship with food. I think her attitude and approach are refreshing. I mean, her entire “diet” is literally: fuck it. Stop stressing so much about food. Stop trying to force your body to conform to some fucked-up wealthy white patriarchal ideal. Forget everything you’ve learned or told yourself over the years about diet, food, and what you should and shouldn’t be doing. Stop wasting time and energy obsessing about your weight and start living life to the fullest.

If you’re interested, Dooner is running an online book club starting on May 26th (you only have a few more days to enrol – enrolment ends on May 24th – so get off that fence if you’re thinking about it). This will include weekly Q&A sessions, discussion, and more. Check-out thefuckitdiet.com/club to learn more and sign-up. You can also follow Dooner on twitter and instgram @thefuckitdiet where she shares snippets from the book, quotes, and stories of her adorable dog.


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What obesity and homosexuality have in common

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A couple of weeks ago I was listening to an episode of Radiolab on which they shared an episode of the short podcast series Unerased titled: Dr Davison and the Gay Cure. They were talking about the former perception of homosexuality as a disorder and the rise of conversion therapy. As I was listening what they were saying really struck a chord with me. I found myself thinking “this is exactly how people are going to think about weight loss counselling one day”.

On the podcast, they were saying, essentially, it doesn’t matter if people come to us wanting to change. What does it actually mean to help them? “The problem that these people are asking us to solve is a problem we created. That we labeled as a problem.” Even if we could effect certain changes, there is the more important question as to whether we should… It makes no difference how successful the treatment is, it is immoral.” And I was like “YES, this exact same thing could be said about weight loss treatment!”

This belief in relation to homosexuality was considered to be fringe and most people weren’t in support of it initially. This parallels the Health at Every Size/body diversity/weight acceptance movement. There is a lot of push-back from people in the medical community and the general public when it’s suggested that weight is not a condition that needs to be treated. Just as with the acceptance of homosexuality as a normal state, there were a few outspoken pioneers leading the movement and with time, it became more accepted by the mainstream. I feel that this is beginning to happen now with weight. More of us RDs who were always taught that “overweight” and “obesity” are unhealthy are coming to realize that people can be healthy at many different sizes.

Of course, there are still hold-outs and there is still conversion therapy happening in some places. Similarly, there will likely continue to be hold-outs who believe that only thin people can be healthy and that BMI is indicative of health. However, I’m hopeful that we’re reaching a turning point and that one day the medical community will agree that weight is not a “problem” and that weight loss treatments are unethical.


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Response to: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight?

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Someone I follow on twitter recently shared this blog post: The Rise of the Anti-Diet Movement: Is it No Longer P.C. to Want to Lose Weight? by another dietitian, Janet Helm. In the post she mused about dietitians promoting themselves as “non-diet” and what this might say about other dietitians. She agreed with many points made by dietitians, quoted in RD/writer Cara Rosenbloom’s recent excellent piece for the Washington Post about non-diet dietitians, but seemed unwilling to go so far as to embrace the philosophy herself. She ended her post with the following questions: “Can’t we all get along? Can’t intuitive eating and body positivity coexist with losing weight?  Why must we line up on two sides?  Why the conflict?” I’m going to do my best to respond to these questions.

First, I too have asked that same question: “Can’t we all get along?” at times. Remember craisingate? Personally, I don’t think that as dietitians we have to agree on everything. It’s okay for us to have different perspectives and approaches. Also, in the case of diet vs non-diet, I don’t see it as an issue of getting along. Maybe I’m blissfully unaware, but I haven’t seen any “non-diet” dietitians attacking other dietitians for promoting weight management. I don’t see dietitians referring to themselves as “non-diet” as lining up on an opposing side or creating conflict. Rather, I see this identification as a way for dietitians to let prospective clients know that they do not promote weight loss as a goal. In a profession which so many believe our sole mission is to help people lose weight I think that it’s necessary for RDs who do not promote weight loss diets to make this clear up-front. I don’t believe the intent is to pass judgement on other dietitians who haven’t embraced the same approach, or to create a professional divide. However, I can see how a dietitian who has built a career around weight management counselling might see this new-ish movement as a personal judgement.

My friend Cheryl Strachan, aka “Sweet Spot RD” wrote an excellent blog post last week (while I was mulling over how best to respond to Janet’s post): Why I can’t help you lose weight. This heartfelt post explained why she would no longer work with clients on weight loss. Providing the current evidence on weight loss and health and the struggle she went through to reach this position. Rather than having me regurgitate all of the evidence here, I recommend you take a few minutes to go read it and then come back.

Done? Okay, great. So you’ll note that Cheryl mentions that when she studied nutrition in 2003 it was accepted without question that weight management was a significant part of being a dietitian. I can tell you that it was the same when I went back to uni to study nutrition in 2006. I’m not sure if things have changed since then. I suspect that they haven’t, at least not completely. It takes time for institutions and society to change. As a dietitian who has worked in weight management in the past I too have struggled to fully embrace health at every size. I understand why a fellow dietitian would ask: Can’t intuitive eating and body positivity coexist with losing weight? It’s an incredibly tough question and the answer is nuanced and it may not be the same for everyone.

I do believe that intuitive eating and body positivity can peacefully coexist with weight loss. However, I think that this can only be the case when weight loss is not the ultimate goal. For me, body positivity is appreciating your body as it currently exists and continuing to appreciate it if you gain weight or lose weight. It’s about treating yourself with respect and compassion and providing your body and mind with the nourishment they need. If you are doing these things with the clandestine goal of losing weight then you are doing yourself a disservice. That being said, it’s okay to want to lose weight. We live in a society that has conditioned us from a very young age to believe that being thin is important. It’s unrealistic to except this engrained belief to vanish overnight. It takes time to relearn to listen to your body and to treat it with respect when you’ve been viewing it as the enemy, a captor, keeping the real you the thin you hidden away. So, no, body positivity and weight loss can’t coexist but yes, body positivity and weight loss can coexist.

I think that as time goes on and nutrition programs update their curriculums, as old-school dietitians are more exposed to evidence regarding the harms of weight bias and weight loss diets, and the hold-outs retire, that things will change. After all, as dietitians we are supposed to provide evidence-based best practice and the evidence against weight loss diets is mounting. Eventually there will be no non-diet dietitians because that will be the approach we all take.


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To keto or not to keto

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I feel like there’s one thing missing from a lot of the discussion about the keto diet (and similar extreme diets, really). Everyone talks a lot about whether or not it “works” with proponents on both sides, research supporting both sides, arguing that it does or doesn’t work for weight loss. The problem with this is the assumption that weight loss is the most important feature of a good diet. It’s not. You can lose weight eating lots of things that are not going to provide you with the nutrients you need. Weight loss is not the most important thing for health, despite what the media, the “wellness” industry, society, and even many health care professionals have lead us to believe.

Just because you feel good on a ketogenic diet and are losing weight doesn’t mean that it’s a good idea. As a dietitian, this is something that I really struggle with. It’s our job to support people. We can tell them that keto is a difficult diet to follow, that it may not be advisable, but when it comes down to it, they decide if it’s something they want to pursue or not. And if they do decide to pursue it, we can’t say “well, good luck, I wash my hands of you”. We have to help them undertake it in as healthy a way as possible. Which kind of blows my mind (and makes me glad that I don’t work in a counselling role) because if someone came to us with an eating disorder we wouldn’t support them in that. How can it be ethical for us to support people in following a diet that may cause them harm?

A little history of keto: the ketogenic diet originated as a treatment for epilepsy in children in the 1920s. It was intended to mimic the effects of fasting through the generation of ketones. In recent years this concept has caught on with people desiring to lose weight. After all, if ketones are produced during fasting, then if a specific diet can promote the production of ketones, it may also lead to weight loss. Not illogical. In some children with epilepsy who do not experience a reduction in seizures with medications, the ketogenic diet can be an effective treatment. However, there are potential side-effects.

A few long-term studies (1, 2) have looked at the effects of the ketogenic diet in children and have found such side-effects as: kidney stones, slowed growth, dyslipidemia, and fractures. There are also short-term risks (2, 3, 4) associated with the diet in children with epilepsy including: acidosis, hypoglycemia, gastrointestinal distress (including vomiting, constipation, diarrhoea, and abdominal pain) dehydration, hypoproteinemia, and lethargy. All of these studies have found low long-term adherence among children. There are many reasons for this: some children see improvement in symptoms, even after discontinuing the diet, others find it difficult to adhere to the diet, for some it’s not effective.

Of course, adults who wish to lose weight are not the same as children who have epilepsy. It’s hard to say if slowed growth in children would have a similar counterpart in an adult. However, many of the short-term side effects may be seen in adults, as may some of the other long-term side effects. In addition, there is potential for nutrient deficiencies when following such a restricted diet. Unfortunately, we don’t have research into the long-term effects of a ketogenic diet on adults using it for weight loss. We have some short-term studies that primarily look at it from the standpoint of whether or not it’s an effective weight loss diet. Maybe it’s perfectly safe, but maybe it’s not. Given that the vast majority of people who lose weight on the diet end up regaining it, and often more, is it really worth taking that risk? By following a keto diet you’re basically enrolling yourself in an uncontrolled experiment.

I think it would be interesting to know what the long-term effects of a ketogenic diet for weight loss are in adults. What I’d really like to know though is why we have become so obsessed with being thin that we are willing to adopt disordered eating habits at the expense of other aspects of our health and well-being. Why is it when we talk about a diet “working” we de facto mean weight loss? Why have we come to value weight loss over every other indicator of health? Why can’t we just value ourselves enough to properly nourish our bodies?


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Whole Life Challenge review

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You know what I’m sick of? Engineers and people with zero nutrition education making claims that you can “biohack” your life, undermining dietitians, and giving one-size-fits all nutrition advice. This rant seems appropriate coming on the heels of my post about the carnivore diet.

Earlier this summer my brother asked for my thoughts about this “Whole Life Challenge” that a bunch of people in his office were doing. He was a little sceptical about the nutrition advice they were providing and wanted to know my thoughts as a registered dietitian.

My first question was, “who is behind this challenge?” Well, we’ve got the founders: Andy who has a background in sales and engineering (quelle surprise) who then opened a crossfit gym and Michael who was a coach and manager at a crossfit gym, and has a degree in philosophy and culinary arts. Well, at least he’s got a little knowledge of food in there but as most know, culinary arts and dietetics are woefully disconnected professions with chefs learning little to nothing about nutrition. The remainder of the team is comprised of the CEO, social media, web development, content manager, corporate relations, a couple of customer service reps, chief technology officer, and public relations. There is absolutely no one working for this enterprise that has any background in nutrition or health. Sigh. 

At a glance, the “challenge” doesn’t look so bad. The idea is to work on seven daily habits over the course of six weeks. You get points for completing each of the daily habits and you’re supposed to play with a team (the more people playing the more money they make this will help “foster success”). The habits are as follows: nutrition, exercise, mobilize, sleep, hydrate, well-being, and reflect. Many of these are areas that most of us could stand to improve on. Of course, I’d like to reiterate that the people who created this challenge have zero education pertaining to any of these topics. Cost is $39 US per player.

Unfortunately, you have to pay to play so I can’t access all of the materials available to players, including the nutrition plans. Fortunately, I have the inside scoop ;) and was able to view the nutrition material. They’ve created three levels with the highest being the “performance level”. This level is for those who, “already have good eating habits that you just want to fine tune, have athletic or performance-related goals, or have a pressing health or inflammation condition that you’d like to address”. The level below that is the “lifestyle level” which is, “A good choice if you are looking for a long-term lifestyle nutrition program. This is a great start to a sustainable practice of living a healthy lifestyle”. The easiest level is “kick start” which is supposedly, “a great place to start if you’re new to the health and fitness game and need to make the most important tweaks to get yourself started in the right direction”.

At each level of the plan you’re given a list of foods that are “compliant” and “non-compliant”. The higher the level, the fewer the foods that are compliant. How did they determine which foods are “compliant” and which are “non-compliant”? Excellent question. I have no idea other than the statement they make at the top of the charts: “When you see (*) next to a food, it indicates the food is compliant but should be eaten in moderation, as there are potentially negative effects from overconsumption”. I assume that this means that they believe there are negative effects from consumption of “non-compliant” foods. What these negative effects are is anyone’s guess. Maybe weight gain? Inflammation? Enjoyment of life? The non-compliant foods for the “performance level” are: deli or processed meats, soy, corn, white potatoes, soybeans, taro, yucca, beans and other legumes, dried fruit with added sugar, peanuts, peanut butter, hydrogenated oil, industrial vegetable and seed oils, every grain and grain product, alcohol, soda (diet or regular), juice, all dairy (except butter), the only snack foods allowed are baked sweet potato fries or chips and baked vegetable chips. Yum yum. To be fair, they do say that this diet would be difficult to maintain long-term and “maybe not even necessary”. Yeah, no shit.

Just for fun, and your reading pleasure, my brother endeavoured to follow this diet for a few days. My brother is a prolific runner, he’s in his third year of a running streak and he’s fast. He eats a balanced and varied diet and enjoys the occasional beer; a candidate for the “performance level” if there ever was one. Unfortunately, he came down with a cold at the same time so his report was: “my lack of energy could have been the diet or being sick”. N of 1, inconclusive.

That being said, while this diet might work for some, it’s probably not the best diet for most endurance athletes. It can be very difficult to obtain sufficient nutrients and calories and attain peak performance on such a limited diet. Also, beans and legumes and whole grains are full of good nutrients as well as being affordable. Any non-medical diet that tells you to eliminate all of these foods is unlikely to be sustainable or healthy in the long-run, particularly for those who engage in long runs (sorry, not sorry).

Six weeks isn’t all that long and when people are working in a group challenge there’s more incentive to stick to a plan than there would be on their own. There’s also minimal risk of nutrient deficiencies being a serious concern over such a short time frame. However, because this challenge is framed as a short-term undertaking and the diet plans aren’t easily sustained, I worry that this will encourage weight cycling in participants (which may actually be more harmful than maintaining a higher weight long-term) and discourage long-term adoption of healthy behaviours. If you’re only adopting these “habits” for six weeks to win a challenge and it’s a major change from your usual lifestyle I can imagine that at the completion most people celebrate finishing by ditching all the “habits”. It would be interesting to see research on participants of a challenge like this.

This plan is also very prescriptive. Apparently I should be drinking 37 ounces of water a day. There is no mention of drinking to thirst here or adjusting intake based on physical activity, temperature, or other fluid intake. You are not learning to listen to your body on a plan like this. There is no allowance for individual differences or personal preferences. Compliant foods equate to “good” and non-compliant equate to “bad”. This reinforces the false moralistic attitude that many people have about food. It also fails to consider that we eat for many different reasons and that taking pleasure in food and enjoying food socially are important aspects of eating. Framing healthy eating as being complicated and unpleasant only serves to make people adopt an all-or-nothing mindset toward a (perceived) healthy diet. Winning at this challenge may only set you up for failure when it’s over.