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    5 Ways the Nutrition Field Hinders Its Own Progress

    I often write about the external factors that pose a threat to the nutrition field, including (but not limited to) Big Food’s egregious advertising budgets, deceptive claims on food packaging, misguided agricultural policies that subsidize foods we should be eating less of, and politics that taint seemingly-subjective processes like FDA-approval of substances that end up in our food supply.

    This time, however, I’m shining the spotlight inward, taking a look at pervasive, accepted, and often times unquestioned concepts, ideas, and issues within the field of nutrition that carry a significant risk of self-harm.  They are dangerous because they don’t allow for growth, critical analysis, or substantive dialogue; instead, they minimize the nutrition field’s importance and have helped create the current free-for-all we are in, where the term “nutrition expert” is as loosely thrown around as “reality TV star”.  Although presented in no particular order; in my mind, they are all equally damaging.

    1) “There is no such thing as junk food”/”there are no bad foods”:

    This is one of the core philosophies that comes up with eating disorder patients.  In that particular context, I comprehend its importance — strip away judgmental labels on food and bring it to its most basic function: nourishment for survival.  However, I’ve increasingly started seeing some people in the nutrition field, who do not work in the realm of eating disorders, bring this up as a ‘take-home’ message for all their clients.

    I understand that, to varying degrees, food is closely tied with emotions.  If a client reports eating a king size Snickers bar as a snack every day, a response of “Ew, why would you eat that?” is unprofessional, unnecessarily aggressive, and not at all helpful.  I am by no means condoning the heinous “Jillian Michaels method” of trying to pass off belittling as “motivation”.

    That said, I believe that the ultimate goal of a nutritionist or dietitian is to help people eat better.  I am not a “weight loss-itian”.  I don’t consider my job done simply because someone loses 10 pounds in 2 months. After all, weight loss can be achieved by eating minimally nutritious foods while keeping calories down.

    My intent is to help people reevaluate how they view food and get them back to “nutritional basics”, so to speak.  In order to do that, I can’t equalize the playing field and say something as disingenuous as “there is no such thing as junk food.”  One individual I’ve worked worked with used to start their day — five days a week — with a diet soda and a fast food breakfast sandwich.  Over the course of several months of working together, he shifted and eventually ended up replacing that with a bowl of “loaded” oatmeal (think fresh fruit, nuts/or seeds/or respective butters, and various spices).  One of the first things he told me was how much better he physically and mentally felt as a result of eating a healthier breakfast.

    So, yes, there most certainly is junk food, which usually makes people feel sluggish, tired, and generally “not good”.  Nutrition professionals need to recognize — and capitalize on — that.  Telling someone  that it’s okay to keep eating a fast food breakfast sandwich,  “but instead of a diet soda, have orange juice” doesn’t do anyone any favors.  Sure, changes do not happen overnight (meaning someone may benefit from stepping down gradually and going from eating something five days a week to three days a week to one day a week), but change should still be encouraged.  It has been my experience that many people eat unhealthy foods simply out of habit and ease; once they begin to appreciate new and different flavors, their tastebuds undergo a metamorphosis as well and they find unhealthy foods less palatable.

    2) “Moderation!”

    To my ears, “everything in moderation!” is the equivalent of six hundreds fingernails on a chalkboard, the never-ending drip of a leaky faucet, and an eternally-ringing phone that never gets answered.  Just like the word “natural” — which food companies love to plaster on the most un-natural of products — the term “moderation” is absolutely meaningless.  Ask twenty different dietitians what it means and you’ll get twenty different responses.

    “But that’s the beauty of it — each person can define it themselves!”, some say.  That doesn’t sound like beauty to me; it sounds like chaos.

    “Everything in moderation” is another way in which we as nutrition professionals do a huge disservice to ourselves by once again unnecessarily equalizing the nutritional field.  “Everything in moderation” operates on the inane — and utterly insane — notion that peaches, Pop-Tarts, muffins, soda, lentils, and tomatoes should all be approached the same way.

    Three cups of mixed greens as part of a salad are not the same thing as three cups of chocolate pudding.  A large Dunkin’ Donuts Mountain Dew coolatta should not be consumed with the same frequency as unsweetened green tea.  It’s silly to pretend that eating a pint of blueberries throughout the course of a day for two weeks should be perceived in the same way as a eating a pint of Haagen Dazs on a daily basis over that same period of time.

    Nutrition professionals should not act like defense lawyers for fast food companies, especially at a time where the average American could seriously benefit from eating less fast food.  Again, this does not mean someone has to be scolded for eating unhealthy foods on occasion.  However, we can not — and should not — deny that certain foods belong in the “eat always” category, others in the “eat sometimes” category, and others in the “eat rarely” category.

    Some people argue that if we do not preach moderation, we are setting the stage for unreachable perfectionism and eating disorders, a position that I find grossly melodramatic.  Recommending that people shy away from fast food whenever possible is not about perfection; it’s healthful advice.

    3) “Healthy Eater = Red Flag”

    Most of my nutrition textbooks are quick to point out that vegetarians, vegans, and “those who avoid certain food groups” must be dealt with carefully, for if they do not plan their diets adequately, all sorts of nutritional ills could befall them.  Meanwhile, the average American (and by average, that means omnivore) falls short of the recommended intake of fiber and several minerals, including magnesium.  Of course, this is not because omnivorous diets are inherently unhealthy, but because the majority of omnivores are eating highly processed foods with little nutritional value.

    The “vegans must plan their diets adequately or else!” operates under the beyond-elementary assumption that “meat = protein and iron” and “milk = calcium and vitamin D”, and if you don’t eat either of those two things, well, you’ve got your work cut out for you.  Forethought, knowledge, and planning are important for all diets.  Simply being omnivore does not mean one can throw caution to the wind and not worry about nutrient deficiencies.

    It troubles me that, rather than recognize the significant amount of research which shows that plant-based diets (as well as omnivorous ones that are largely plant-centric) provide a multitude of health benefits, most of mainstream nutrition treats these eating patterns as “niche”, “fads”, or ones that need close medical supervision.  Don’t even get me started on the ignorant and fear-mongering magazine articles which warn mothers that if their teenage daughter is considering vegetarianism, she could be on her way to an eating disorder (because, you know, vegetarians just eat a small bowl of salad with no dressing as a meal).

    4) “You Have To Be Realistic”:

    This is often mentioned as a way to justify telling people they can still eat at their favorite fast food chain; “just get the small portion”.  I used to think this way when I first started studying nutrition, before I interacted with any clients.  I now see that the most satisfied individuals I have worked with are those who stepped outside their comfort zone.  Sure, they stop by a fast food place for some fries every now and then, but they can’t believe they once ate fast food several times a week.

    We should not feel “bad” for gently challenging people, or for suggesting healthier meals.  One irritating straw-man argument I often hear is “not everyone is going to eat steamed kale and brown rice”, as if the only options available to people were a quadruple Baconator burger from a fast food chain or a bowl of steamed vegetables.  There are plenty of foods that fit between that spectrum, and which have the added bonus of helping people learn where food comes from and gets them involved in preparation (I’m talking something as simple as buying a sweet potato, washing it, cutting it into planks, mixing that with some olive or coconut oil and spices, and letting it bake for 20 minutes).  Simply because it has become “the norm” to nuke dinner in the microwave or get take-out a few times a week does not mean we as health professionals should encourage that.  After all, it has become the norm for people to have credit card debt, but you’d be hard-pressed to find a financial advisor who will say “eh, $3,000 in credit card debt is no biggie; most people have $20,000!”.

    Instead of telling people to “just choose a diet soda” next time they go out to eat, we should truly tell them why diet soda isn’t that great of a choice to start with.  This is not about scare tactics or “forbidding” foods; it’s about providing people with the gift of information.  Simply parroting the press-release-friendly “well, the research says all artificial sweeteners is safe” is not helpful or even accurate.  The best thing we can truly say is that “the current research, which is limited, politically charged, and says nothing about long-term use, proposes that these artificial sweeteners are safe.”  That at least provides a more realistic overview of the issue.  People have the right to know that Splenda has been found to alter gut microflora and therefore interfere with mineral absorption.  I am not a Splenda executive; I am a nutrition professional, and as such I can’t honestly tell someone “Splenda is totally fine, just have no more than two packets a day.”

    Then there’s the notion that recommending quinoa (which these days is available at Costco and Trader Joe’s) or a vegan bean-based chili or a kale-based salad that takes 15 minutes to prepare is “asking for too much” or “not realistic”.  In my experience, most people are interested in new foods and are willing to try anything once.  Whole grains cook just like refined grains; some just take an additional 10 minutes.  So what?  They are an additional 10 minutes that don’t require someone to be in the kitchen.

    Of course, I am talking about people who live in cities and towns where they can feasibly get these items (food deserts are a different challenge).

    This is not about turning people into vegetarians or vegans, but we can not deny that the average Americans needs to eat more fruits, vegetables, and whole grains.   In order for this to happen, people need to be appropriately challenged and exposed to new ways of eating.

    5) The American Dietetic Association Isn’t A Health Organization:

    I am currently studying to take my Registered Dietitian exam.  This past weekend I was reviewing several hundred practice questions provided in a study guide given to me by a fellow intern.  As I flipped through the pages, I felt a mixture of frustration and disbelief that, assuming the exam poses similar questions, this is what the American Dietetic Association considers important information.

    As far as I can tell, these practice questions are from 2003.  Every question that relates to food science involves red meat, eggs, cakes, margarine, and pies.  In fact, the correct answer to a question on the best way to lower sodium in a meal was to use low-sodium margarine in place of regular margarine.  The ADA wants to make sure I know how to prevent a cake from coming out too spongy, and yet apparently doesn’t care if I know the nutritional differences between — and specific health benefits of — chia seeds, hemp seeds, and flax seeds, or the health implications of a diet too high in omega 6 and too low in omega 3 fatty acids.

    Other questions that the ADA considers important — so important, in fact, that they dedicate an entire third of the exam to them — have to do with the layout of a food service kitchen, what cleaning cycle is best for a dishwasher, how to deal with budget reductions in a food service facility, and how much hamburger I would need to make 300 three-ounce patties with a 20 percent shrinkage.  And here I thought it was important to know how the mineral content of whole wheat flour differs from that of white flour.

    Frustrating, to say the least.  Oh, and, of course, I am expected to answer that I should worry about vitamin B12 and vitamin D deficiencies if a client tells me they are vegan.  Funny — thinking back to my outpatient and clinical experiences, about 90% of patients were vitamin D deficient, and I would wager that 98% of them were omnivores.  This question is especially silly given that almost all vegan dairy alternatives are fortified with vitamin D and B12.

    As a future Registered Dietitian, I am beginning to understand why the credential is completely foreign to the average American, why we are often seen by some people as advocates for lobby groups rather than health, and why the field we are supposed to have ownership of is claimed by so many.  I am encouraged, though, to have met Registered Dietitians who are independent thinkers and are passionate about clean and healthful eating.  It’s my sincere hope that we can mobilize and help bring the field we have so much faith in to the forward-thinking place where it truly belongs.

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    113 Comments

    1. Mick said on July 19th, 2011

      The ADA and the overwhelming majority of school programs churning out dietitians are just as sick as the average American. This is very sick and very sad. Without a complete overhaul of these broken programs, true education is left in the hands of the student.

      The only way to change this is from the inside.

    2. Andy Bellatti said on July 19th, 2011

      Mick,

      That is one reason why I am so glad HEN (the Hunger and Environmental Nutrition Dietetic Practice Group within the ADA) not only exists, but is growing in membership and supporters each year.

    3. Andy Bellatti said on July 19th, 2011

      Thank you for your support and comments, Carol and Abigail.

    4. Kate Shaw said on July 19th, 2011

      Thanks for a great post Andy! As an RD with an MPH in Community Nutrition I really relate to and appreciate the messaging in this post. My only question is with regards to the bit on Splenda. Can you tell me from which source(s) you got this info? I’m aware of a lone 2008 Duke U. study conducted on male rats but have seen no others to support this conclusion. Not arguing against your point, just curious.
      Thanks again!

    5. Ginger said on July 19th, 2011

      This is sadly funny. Two times this week caring, overweight, obviously unhealthy, omnivore friends have inquired if my diet of fruits, veggies, and beans contained enough protein. I smiled and said. There is protein in everything and loads of it in greens and beans. One said but not very much. I wanted to shout—you don’t need very much. But I bit my lip and smiled.

    6. CJ said on July 19th, 2011

      Great post. I saw your headline and kept reading hoping to see that you’d make the last point (#5). It’s interesting, because I come at this as the patient/client of a nutritionist. I didn’t know ADA had corporate sponsorships, but I figured as much because of the recommendations I’ve been given.

      I was actually pretty close to vegan before I came in, but was skipping meals and making common mistakes. So no weight loss. When I got to the nutritionist, I was told I had to eat protein if I really wanted to lose weight. Forget all that “extreme” stuff I was doing. Then the food recommendations piled up — all kinds of unhealthy things I had banished from my pantry long ago (bread, pasta, meat, chicken, yogurt, cottage cheese, string cheese, etc). As long as it was low fat, it was fine. I have been really disturbed by this. I even recommended Forks Over Knives and was told there is no science to that. Other juicing and raw food regimens — same response. Wouldn’t given them the time of day.

      It kills me b/c I need the structure of a program and someone to be accountable to in order to lose weight, but I am following something I really don’t believe in. I feel like when I finish seeing this person, I won’t know how to eat because I was so far down the clean eating/unprocessed/plant-based path before, and now I have been dragged back into the “you need to eat lots of protein to lose weight” world.

      Argh.

    7. BrettFutureRD said on July 19th, 2011

      I think the biggest point here is that there are no simple take home messages that work for everyone. I for one do believe there are no good foods and bad foods, but I wouldn’t cut the statement off there. I would say there are no good foods and bad foods, but there are good and bad diets. For example, patients on low phosphorus renal diets would have trouble getting the calories they need on whole foods, because many of them are high in phosphorus. So they small amounts of nutrient dense foods, but may need energy dense foods low in phosphorus like say a snickers bar to meet their caloric needs. As you see here, a “bad” food is helping them meet their caloric needs. Conversely, a person who eats 4 pounds of carrots a day is also bad. It may be a “good” food, but the way they are eating them makes it a bad diet. So I think that’s where the dietitian mantra comes from. I do however feel like it is not an appropriate statement to make to lay people because of the exceptions there are to it.

    8. BrettFutureRD said on July 19th, 2011

      I agree completely on your point on moderation. It drives me nuts whenever I hear it. I think telling people to eat in moderation causes the opposite effect. Not only do people in general not like being told what to eat, they don’t like being told how much. Portion sizing is the bane of the nutrition field. Moderation and portion sizing assumes that everyone, no matter what their activity level, gender, body shape or size, should eat the same amount of food in the same sizes. Moderation also teaches people to rely on external cues rather than internal cues to decide how much they should eat.

    9. BrettFutureRD said on July 19th, 2011

      Your third point drives me nuts as a former Vegan. ALL diets have their own special considerations. Some omnivores don’t get enough fiber either, just like Vegans need to make sure they are getting a reliable source of B12. All diets need fruits, nuts and vegetables to have long term health. Vegan diets definitely get more scrutiny than it deserves. Any diet can be eaten in an unhealthful way.

    10. BrettFutureRD said on July 19th, 2011

      The problem I have with your 4th point is that, taking away a person’s favorite foods, and having them replace their diet with all new foods, isn’t going to help them either. If you tell someone they can’t have a certain food like the food police, all they are going to want is that food, and eventually their will-power is going to break, and they will most likely consume more than they would normally. I do agree however with challenging patients to go outside their comfort zone and trying new foods. But the more restrictive you make their diet, the more likely they are going to snap back to old habits. So being realistic, albeit a vague thing to follow, should mean knowing that patients are open to new foods to a point, but being too restrictive and completely revamping a diet with new foods.

    11. BrettFutureRD said on July 19th, 2011

      Finally, I completely agree about the emphasis on food service in the dietetics field. From past classmates that have already taken the exam, I am under the impression that the ADA does not have it’s thumbs on the pulse of the Dietetics industry. It’s no wonder that most people don’t/aren’t able to go to a dietitian for nutritional advice.

    12. Marilyn Weissman said on July 20th, 2011

      AMEN! I hope you don’t deal with blinders on like so many dieticians. I met with an R.D. for high cholesterol (but hey, my HDL or good cholesterol was sky high) and was told to avoid eggs, butter, and to eat tofu etc. Never mind that the tofu affects one’s hormones and that I eat butter and eggs in moderation, to say the least and that I am not overweight, not a smoker, I exercise etc. One size does not fit all!!

    13. julie said on July 21st, 2011

      I’m not an aspiring nutritionist, but was obese much of my teenage/adult life, and personally, I really like moderation. My mother is a big fan of all/nothing, as in “you should eat nothing but fruits/veggies”, and my fave crappy mom advice “there’s no reason you should ever eat any fat at all”. So, I find a piece of bacon mixed into my spinach and mushrooms and egg makes it much tastier, and allows me to tolerate the 12-grain cardboard bread, rather than white bread, which I like better, but eat “in moderation”, which is when there is no other choice. Sometimes I feel like eating half a cookie, it’s not every day, or even every week, and it’s certainly not the whole box. If most people don’t truly understand the concept of moderation, maybe they should somehow figure it out, but I like it much better than rigid rules and uncompromising lifestyles. As for fast food? Only once in the last few years, when traveling, when there was really no other option, and I was starving. But, I do eat a burger once every month or two. Consider me a big fan of moderation, which is not the same as an excuse to eat crap in huge amounts, but allows a little flexibility, and permission to occasionally eat something not very healthy.

    14. veganlady said on July 21st, 2011

      WOW. 🙂

      As a vegan who has had her share of judgmental doctors and nurses who feel the need to lecture about my nutrition, I am grateful.

      I am very aware of my nutritional needs and think I do a pretty awesome job of meeting them. Just because I have made an ethical choice to not eat animal products does not mean I don’t care about how food makes me feel. And I feel GOOD! 🙂

    15. veganlady said on July 21st, 2011

      I should also add that not all health professionals have been judgmental about my choice to abstain from animal products. I voluntarily went to a nutritionist/dietician (I can’t remember her actual credentials, sorry!) in graduate school because I was in a food rut and lacking in prep. time from my busy schedule. She was very helpful in coming up with quick veggie-friendly ideas and helped me learn portion sizes (I wasn’t eating enough because I was always on the run). She also helped me see the importance of taking even just a 15 minute break to eat away from my desk.
      Recently a nurse asked if I consumed enough dairy in an intake session for my yearly exam. I said, “Well, I’m vegan, so I drink rice milk usually and use it in foods.” She thought that was great and told me I was in good shape then since it’s fortified! I already knew that, but it was so nice to hear a health professional acknowledge my choice of a vegan alternative.
      Other rational people are out there! 🙂

    16. Kelly F said on July 22nd, 2011

      Hi Andy,

      It’s like you took the words right out of my mouth! I completely agree with everything you said. It’s reassuring to know that other nutrition professionals share my philosophies. Sometimes I feel like I am surrounded by people advocating that “there are no bad foods” and pushing the “everything in moderation” mentality. It’s our job to educate people about food–the good and the bad.

      I just finished my DI and will be taking the RD exam in the next couple of weeks. I completely agree with you that some of the study questions are ridiculous. I don’t know why I have to know how to bake a cake…why would I ever want to serve cake to patients or recommend eating cake to clients?

      Keep writing! You are an inspiration!

      ~Kelly F

    17. Mark Osborne said on July 22nd, 2011

      Thanks a very interesting post. Given my passion for nutrition people have asked me why I don’t become an RD. I couldn’t imagine trying to be a surgeon without a medical degree, but the area of nutrition still seems to be wild frontier where the guru’s often affect change more than the credentialed professionals.

      I suspect I would get more out of T Colin Campbell’s Plant Based Nutrition course in far less time that it would take me to get an RD.

      Still it’s reassuring to hear that there is change afoot and that RDs like Jack Norris, Ginny Messina and soon yourself are out there.

    18. Doug Cook, RD said on July 23rd, 2011

      Oh Andy, where DO I begin? You and I share the same frustrations. I have been a dietitian for 12 years and I often say/think that I don’t have a lot in common with other RDs, although having the credentials certainly opens more doors and allows me to ‘work within’…

      I’ve always hated the expression ‘variety, balance and moderation’ for the very fact that it can neither be qualified nor quantified and it doesn’t help anyone. ‘All foods can fit’, again how often?, how much? etc…most don’t go below the surface when it comes to explaining deeper nutritional concepts or providing context during presentations or go beyond making general ‘motherhood statements’ like ‘vegetables are good for you’. I’m not sure if it’s a lack of effort, skill, confidence, ability to communicate etc…

      Most, if not all, of my RD colleagues have bought into the idea that Canada’s Food Guide or the US Pyramid/My Plate is sufficient to meet all of one’s nutritional needs. If those models are followed most of the time, say 75%, then people will be fine, after all it WILL prevent overt clinical deficiencies but what about optimal intake? What about the idea of nutrient triaging? The idea that a clinical deficiency of magnesium may be achieved with the estimated 200mg that most get today but what about the well understood benefits magnesium has on lowering diabetes risk, improving bone health, lowering blood pressure and more with higher intakes, possibly up to 500mg per day?

      I recently developed a series of nutrition programs for a cancer support network here in Toronto and in several of the presentations I included chia, salba and hemp seeds (in addition to flax). The dietitians who reviewed the presentations removed those examples citing that most people have not heard of them and they could be expensive (salba)!!!! WTf???? Who are they to be so paternalistic and obviously don’t do their homework and denied the patients the right to choose for themselves!

      The other issue of course is the notion that a lot of RDs don’t take the time to do their own research and feel that the ‘experts’ are to be trusted. So the RDs go to seminars introducing a new product, something like sterol fortified margarine and just continue to buy into the idea that total LDL is the sole risk factor for CVD and focus on that and then take the fancy/glossy binder home and then tell patients to eat margarine with sterols to help reduce their risk for CVD!!

      Anyway..there are a lot inherent problems and RDs continue to think that the public sees them as the source eternal for nutritional advice and wisdom but I’ve learned that the public is highly skeptical when it comes to RDs and their simplistic ‘alliance’ with industry and are looking to other ‘nutritionists, in all variations thereof with respect to education and training’..at the very least, RDs need to be open to other points of views and look at nutrition in a new light or they will miss out on a huge opportunity to be true experts in their field, RDs have fantastic education and training and are in the perfect position to really take a stand – BUT they/we don’t like to ‘make waves’ or ‘upset anyone’ so we’d never say apple jack cheerios are shite! we’d rather say ‘it’s ok, go aead and eat them, everything in moderation’!!!!

    19. Connie said on July 23rd, 2011

      I am not an RD or anything like that. I am joe (actually jane) average consumer. I hate to cook. Probably since the food I make tastes like garbage. I have multiple food intolerances so I can’t do fast food anymore. In fact I can only have 1 or 2 dishes at most restaurants. It sucks. Out loud. I have been sick more in the last few months, I assume due to the fact that I give myself food poisoning.

      I wish I could say that this better and harder to make food was helping but it’s not. I am much sicker than I was. I was so relieved to get out of my mom’s house as a teen because she was an awful cook too. It was so nice to order food that was actually palatable. Now I’m back where I started.

      I crave moderation. A little wheat would go a long way to making me happy!!! Just one big mac might last me a month. Pass the *()^%$%&# brown rice and kale.

    20. Joyce said on July 23rd, 2011

      Your article is right on – I was a dietitian for years and now teach nutrition at a large University. I will use your article in class next year!

    21. Hilary said on July 23rd, 2011

      Hi Andy,

      Thanks for the article! I’m with you all the way, apart from the ‘more whole grains’ bit. (But if you mean fewer refined grains, then yes, I’m still with you.)

      You said in a comment above:

      That whole “hard to get nutrients you need on a veg/vegan diet” meme needs to be laid to rest. I would love for people who believe that to explain, specifically, which nutrients they are referring to and to point out how it is “hard” to get them.

      Here’s that specific explanation, which I found made interesting reading:
      http://www.westonaprice.org/abcs-of-nutrition/vegetarianism-and-plant-foods/1640-vegetarianism-and-nutrient-deficiencies

      I think that could be helpful to those who are vegetarian/vegan, to ensure they have all their bases covered. (Vitamin A especially – that part came as news to me.)

      Until just over a year ago, I was vegetarian, had been for 20 years with several of those as a vegan. I’d have laughed if anyone suggested I had any nutritional deficiencies. OK, I had flaky skin in places from recurring fungal infections, thinning hair and split ends, but then I’d had all those for years – they were just part of how my body worked. And OK, I was getting more illnesses than I did as a child, and my joints ached, but I was 37 so this was normal. And I was about 3 stone (40+ lbs) overweight – but I was eating *healthy*, wasn’t I? Low-fat whole grain vegetarian? (And taking a good quality multi-vitamin/mineral, too.)

      A year ago I started eating Primal, so now I eat lots of vegetables, meat and fish, along with some dairy, fruit, nuts and seeds. One year on and this has halted the hair loss, eliminated the split ends, wiped out the fungal skin infections, prevented the colds and stopped the joint pain. Also, I’ve lost the excess 3 stone.

      Undoubtedly some of the improvement will be down to going grain-free and almost sugar-free. But my best guess would be that some of it is also down to curing deficiencies – particularly in protein and vitamin A – and correcting an omega 3/6 imbalance.

    22. DanWay said on July 23rd, 2011

      Haven’t read through all the comments so I apologize if it’s already been mentioned. Another huge problem with current dietician practices (in Canada anyway) is the refusal to talk numbers (ie calories). Just because the old “calories in, calories out” equation doesn’t work perfectly for everyone, it is still essential that people understand this at a basic fundamental level. If you eat more calories/energy than you expel, it is very likely you will gain weight. Apparently calorie counting also leads to eating disorders and compulsive behaviour and is thus dangerous and to be avoided. Not true. Obsessing over every calorie isn’t likely to be helpful but having a general idea of each days balance and then calculating this over a period of weeks and months can go far into watching how much we are eating and also which foods are providing the bulk of our daily energy. In general, if one is eating a large amount of calories, it is likely than at least some of them are coming from poor nutritional sources.

    23. Christina RD said on July 23rd, 2011

      Interesting post, thank you. I don’t see a lot of posts mentioning the importance of assessing what is realistic for each individual in terms of what stage of change they are in, how many changes they are willing to try, etc. My main complaint about the dietetic program is that there is no focus on counselling skills. I’ve had to search out information such as Molly Kellogg’s on motivation interviewing to learn how to be a nutritional counselor, not just someone who provides information without determining why it would matter to that person. A lot of students will make the beginner’s error of assuming that healthy eating is a priority to everyone and this is certainly not the case.

      I work in mental health where many people are on tight budgets, have low energy levels which limits their ability to cook and grocery shop, or they may have increased appetite from their medication. I would never recommend salba or other specialty items to people when just eating regular meals and having a few vegetables is a big step for many of my clients. It is extremely important to really listen to the person to customize your recommendations for them. That to me is what I am most proud of in terms of being a dietitian vs the diet industry, that we don’t advocate a one size fits all approach. Yes the public health messages are standardized but in one to one counselling most dietitians work hard to customize their suggestions to their clients. Please will the university programs include counselling courses in their curriculum so that new RDs do not have to learn the hard way how to deliver their information in a way that is heard.

    24. Noel said on July 24th, 2011

      thank you!! I could give you so many hugs and kisses for this post. I am a recent vegan and I am also on my way to become an RD. Lately I am becoming more and more aware of my future industry challenges. I couldn’t agree with you more on your points. Thanks for the tips about the exam. And good luck with yours!

    25. Marsha Hudnall said on July 25th, 2011

      Hi, Andy,

      Been meaning to comment on your great post but couldn’t find the time. Now that I do, I’m glad to see so many of the comments making some of my points. Particularly like your and WRG’s discussion. The one point I don’t see addressed is the concept of moderation and eating disorders. While I agree putting some definition to moderation can be important, the concept itself has been instrumental in helping many of the women I’ve worked with over the past 30 years learn how to eat in a way that truly sustains them. It is all about getting over the “all or nothing,” and it goes both ways. On another note, so glad to hear your voice and many more of the young RDs. As someone who has been in the profession for over 30 years, I’ve seen things change, albeit slowly. But they don’t change unless people speak up. Being a part of ADA can give greater opportunity to be a voice of change.

    26. Lyza May said on July 25th, 2011

      I agree with most of what you say, it’s very true what you say. I find it horrifying to think that if you go to school for Nutrition that you are locked into that mainstream nutrition mentality. I would encourage you to look further into some of your advice though. Grains/Legumes are hard to digest and should be soaked— they are known as anti-nutrients. Also, you mention vegan alternative diary and meat products are a good alternative to meat but they are highly processed, a lot of soy products are genetically modified (92% of soy is GMO). And fortified foods should be avoided because they are synthesized and could cause harm to you. There are some great websites that could open your eyes to even deeper, nourishing nutrition. http://www.westonaprice.org/ and http://www.mercola.com/. Good Luck to you!

    27. Nora said on July 25th, 2011

      Andy, did you see this? You’ve captured the zeitgeist.

      http://www.nytimes.com/2011/07/19/health/19brody.html?_r=1&ref=health

      It’s focused on weight-loss but hits some of your points.

    28. Nora said on July 25th, 2011

      Connie, that makes me very sad. Try the kale in a shake with some pineapple juice. Put some tamari and chia and hemp seeds on the brown rice. Yum.

    29. Pamelia Krotz said on July 25th, 2011

      Keep up the great work, I love the information I get here.

    30. Andy Bellatti said on July 25th, 2011

      Lyza,

      If you read through some of posts, you will see I am very much concerned with genetic modification of foods, and that I do not consider soy burgers or soy ice cream “health foods”. My point about vegan alternatives solely referred to milks, which includes almond milk, coconut milk, hemp milk, etc.

      I am familiar with the Weston A Price organization, and have blogged about why I don’t see eye-to-eye with them on many nutrition issues.

    31. Lyza May said on July 25th, 2011

      Thanks for clarifying that Andy. I look forward to looking through your site. I found this article because it was shared on facebook.

    32. Connie said on July 26th, 2011

      Nora:

      I’m allowed no sugar or fruit, so thus no pineapple juice.

    33. Lorrie RD said on July 26th, 2011

      I just want to echo Christina’s post about counselling skills. I was a very zealous new RD not that long ago, but through working with mental health patients and eating disorders, have learned that it isn’t what is important to us that matters, it’s what’s important to our patients. Learn to listen to your patients – they know deep down what they want to change with their food, and with some minor angling and information can make the changes they need to improve their health. For all new (and old) RDs, try to take a counselling course like Molly Kellog’s.

    34. Rob said on July 28th, 2011

      Andy, I didn’t make it through all of the comments yet, but I’m curious if your view of the RD exam has changed since took (and passed!) the exam?

      for the last 8-9 months that I’ve been pursuing getting in to the nutrition field it has been with the eventual goal of becoming an RD, but honestly… the last few months that has been wavering a bit. I still want to pursue the field, to help others, and am still pushing towards a nutrition sciences degree… but I am not sure if my pathway will take me all the way to getting the RD. Some of it is that image of the ADA you mention.

      But I’ve got a long ways to go before I have to make that choice, so who knows.

      As far as “moderation”, what I tell people is that it is not about what I can or can not eat. It is about making choices, and where before… if you were to put my “good” and “bad” choices on a scale, it was very heavily tipped to the bad side. Now, it’s quite the opposite (ok, this works better when you can do it visually! heh). Well, most days it is anyways.

      @mcnee

    35. Andy Bellatti said on July 29th, 2011

      Doug,

      Great point you make regarding ‘preventing clinical deficiencies’ and ‘optimal intake’ being two very different things.

      Very upsetting to hear that your examples of healthful seeds were deleted form your presentation because people don’t know what they are and could be expensive. Right, because the way to deal with lack of exposure is to propagate it. As for cost — as you said, that is for patients to decide whether or not they want to spend money on hemp and chia seeds. You are not demanding they purchase them, simply letting them know. I am sorry you have to deal with such narrow-mindedness around you.

      Also agree with you regarding plant sterols. I never bring that up in discussion with patients because the only way to get “enough” of them is by using plant-sterol-fortified margarines, a product I am not going to go out of my way to condone.

      And, yes, we need to start taking positions and not be afraid of calling out BS when I see it. I am always happy to call out Fiber One for the ‘wolf in sheep’s clothing’ that it is, even if it means someone munching on a Fiber One bar while reading my blog will feel offended for 5 seconds (not only do I doubt they would feel offended; I’d also like to think they would appreciate knowing they are not being told the whole story).

    36. Andy Bellatti said on July 29th, 2011

      Joyce,

      Thank you for your encouragement. Very happy and flattered to hear you’ll have your students read this post!

    37. Andy Bellatti said on July 29th, 2011

      Dan (@DanWay),

      The leap that is made from ‘telling people they can eat well sets them up for perfection and eating disorders’ astounds me. Ironically, the products with the word “Skinny” in their name are usually low-calorie, ultra-processed junk.

    38. Andy Bellatti said on July 29th, 2011

      Christina,

      My experience has been somewhat different. My Masters program offered a counseling course (taught by an RD who is also a psychotherapist), which was great to take. Additionally, during my Dietetic Internship we had some workshops on motivational interviewing.

      Of course there are instances where the way we speak to clients are different. This post has more to do with the nutrition messages I keep seeing repeated over and over (mainly by RDs) in magazines, TV shows, and other mediums.

    39. Andy Bellatti said on July 29th, 2011

      Hi Noel,

      Update: as of Tuesday (7/26) I am now a Registered Dietitian. Best of luck with your career; happy to hear you will be joining the ranks!

    40. Andy Bellatti said on July 29th, 2011

      Rob,

      My view of the RD exam since taking it has not changed. Almost 40% of the exam relates to food service management. I would say about 5 to 10% of what was on the exam were things that relate to healthier eating/cooking.

      I understand why you may question your goal of becoming an RD; I questioned it a few times on my way. However, I am glad I remained focused. I think it speaks volumes when RDs brings these topics up (rather than “outsiders”). Otherwise, these “outsiders” are often dismissed with “well, they are not RDs”, which stifles conversation and detracts from the core issues.

    41. Lauren said on August 1st, 2011

      Wow! So many comments to scroll through. 🙂

      I LOVED the third section about vegan/vegetarian diets. I am flexitarian, and I cannot believe what hostility I have met from other people when they find out I have an interest in vegetarianism. I also don’t give in to that “drink a billion glasses of milk a day or get osteoporosis” BS, and my mom HATES that about me. Whenever I visit my parents’ house, she obsesses over my calcium intake. So when I read that paragraph on this blog, I copy and pasted it onto a note in my iPod so I’d be able to recite it for her and make her re-think. I read it to her just yesterday, and I also tried to explain to her that nutrition is about more than just calcium and protein, and I mentioned magnesium, Vitamin K, etc. Her response? “You never hear about people dying from diseases because of magnesium deficiencies.” Unbelievable.

    42. Andy Bellatti said on August 1st, 2011

      Lauren,

      Thanks for your comment. In regards to no one “dying from diseases because of magnesium deficiencies”, the issue is that low intakes of minerals (as well as antioxidants, flavonoids, etc) increase our risk for other diseases. No one will die from consuming 50% of their magnesium needs over the course of years, but that low intake makes it more likely that person will develop hypertension, for example. Just pointing that out in case you want a rebuttal.

      Sorry to hear you’re facing such hostility simply for expressing an interest in vegetarianism. I love that you seek out knowledge and want to be well-informed. Best wishes.

    43. Will said on August 11th, 2011

      Congrats on calling out the ADA, and the overall premise was great. It was all going so well until the “but we can not deny that the average Americans needs to eat more fruits, vegetables, and whole grains.”
      Ummm, yes I can definitely deny the more whole grains suggestion. There is absolutely nothing positive to say about the prevalence of grains in today’s society and it’s link to our rapid decline in health.
      And the vegetarian link is obvious – pro-vegan/vegetarianism by default becomes pro-grains. That is the major shortcoming of veganism.
      I could cite a myriad of research and resources for you to delve further into this fact. But from what I’ve taken from your article you’re the type to be proactive in investigating this for yourself to garner better perspective and offer the best possible solution to your clients. Oh how I long to see the day that a registered dietician publicly admits the folly of grain-crazy ways and supports the cosmption of more animal products: A step towards our ancestral hunter/gatherer ways and a step away from our agricultral downfall.
      This push away from obvious junk food is a step closer, but it seems I’ll still be waiting for the real deal.
      I hope your number 4 tip steers you toward this truth instead of away from it.
      Best,
      Will.

    44. Suzy said on August 15th, 2011

      This is a great article. I agree with a lot of what you have written. I really wanted to comment on your response:

      “Otherwise, these “outsiders” are often dismissed with “well, they are not RDs”, which stifles conversation and detracts from the core issues.”

      I feel like I am one of these outsiders. I have a Master’s degree in Nutrition but decided not to pursue becoming an RD. At the time it wasn’t clear if that was the path I wanted to take. Now many years later I still do not have a desire to become an RD but I do feel like the lack of those letters after my name causes others, mostly RDs, to look at me as though they have much more knowledge. I have been in the nutrition field for quite some time. I have taught numerous classes and I try to continually further my education through research. I have actually been a preceptor to dietetic interns and I am also a CDE. I hope you and other RDs will keep your open mind about not only about alternative nutrition theories and new data, but also about those with an alternative educational path. Thanks!

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