It's easier than ever to find an article about "healthy eating." A quick search on Google provided over 860,000,000 results...and another 35,800,000 videos (yikes).
I recognize and appreciate that people are passionate about nutrition. I also recognize that once we find something that "works" for us, we want to shout it from the roof tops! I truly believe that many professionals should talk about food to with their clients - it's a cornerstone to health. However, it's important to recognize whether the "truth" you preach to your clients is helpful or harmful.
Everywhere you look, there's a new super food advertised to cure you (looking at you coconut oil) and another food being blamed and shamed for causing disease (poor milk and eggs). I cringe at the content posted by physically flawless nutrition "experts" - citing "good" and "bad" food lists, promoting intermittent fasting, or listing broccoli as a protein source (while broccoli has some protein, you'd have to eat ~7 cups for it to have the same protein as 1 cup of beans or 2 oz of chicken...just a thought).
I do NOT believe that anyone is intentionally trying to cause anyone harm or deceit. Rather it's a product of the society we live in. Nutrition has become more about "belief" than science. We look to convenient, easy to read, motivating, promising resources like magazines, newspapers, and social media. If someone looks the part, we take their word as gospel. But sometimes what we believe to be "healthy" isn't effective. And moreover, if those recommendations are made without understanding the whole person's situation, they can do a lot of harm.
Here are just a few stories I've heard in the last weeks from patients about recommendations they've received from health professionals (whether in a personal visit or via social media):
The recommendations on the left are not "wrong" necessarily. Every single one has an element of truth and/or support. However, many of the statements don't take a person's personal circumstance into consideration AND/OR fail to decipher the chemistry of food from the morality of a food.
Here are 3 ways to help clients with nutrition without hurting them...
3 ways to avoid misleading clients
Understand the person you are speaking to
The entire evaluation alone can take anywhere from 15-45 minutes depending on the complexity of the patient's physical and emotional health as well as cultural expectations...not to mention the person's willingness to share information. That doesn't take into consideration educating the patient, brainstorming solutions, or finding social/emotional balance with food.
So just what exactly do you need to take into consideration? Consider breaking the food "process" into 4 steps - you have to figure out where you're eating, what/how to prepare it, what to eat, and how much to eat (not always necessarily in any particular order). Here are just a few of the questions I'm considering in helping someone figure out what to eat.
(By now my husband has stopped reading and/or is saying,
"why did you make an incredibly simple 'decision' so complicated!"
But that's my point - we assume that food is 1.) a decision and 2.) easy.
In reality, it's incredibly individual)
As I've discussed in a previous blog post, our nutrition "decisions" are not separate from the rest of our lives. Making blanket recommendations without taking into consideration the whole circumstance, often leaves the patient with changes that either incredibly uncomfortable and/or unsustainable.
So for example, take the recommendation for a diabetic, "Eat brown rice instead of white rice." The reason is because a food with more fiber should create less blood sugar than a lower fiber food. However, the change on their blood sugar will actually be modest to negligible, because the recommendation fails to take into consideration how effective that 2 gram increase in fiber will actually have on the body. Additionally, many of my patients from Nepal, India, and China were raised on eating white rice 2-3x/day. One patient from Nepal told me that you don't ask someone over for a meal. Instead, the phrase is akin to, "would you like to eat rice with me?" Now for some, these changes are incredibly easy. But for others, it's a mountain.
Focus on chemistry, not hype
There are many well intentioned general guidelines out there (choose brown rice instead of white; choose lower sugar foods / beverages etc; choose low fat dairy products). However, these recommendations can be tricky depending on the person you're working with - especially if you're not looking at the chemistry of the food you're recommending or don't fully understand how that chemistry affects the body.
For example, I recently had a client with diabetes tell me that they were told to eat corn flakes + a banana instead of raisin bran to improve their blood sugar. They made the swap but didn't see any difference. Why?
At first glance, it seems like a helpful suggestion. Raisin bran has more sugar per serving than corn flakes. And since bananas are "natural" they're a "better sugar," right? It also increases the overall volume of the meal so presumably, you'd eat less overall. However, the person who made the recommendation failed to take into consideration a few things :
1.) chemistry - when you do the math, you end up with 2 choices that have fairly similar TOTAL carbohydrate content (...and carbohydrates are what create blood sugar). Additionally, it's virtually the same amount of sugar. You also end up with LESS fiber and protein in the "healthier" option which means the person will be hungry sooner AND blood sugar will actually go slightly higher...
2.) behavior - the client ended up eating an overall bigger bowl of corn flakes + banana because they felt they "could" and "should" because it was healthier (they even added a little extra sugar because they didn't find the corn flakes sweet enough). But, since the chemistries of each were virtually the same, the blood sugar actually went higher by choosing the "healthier" choice.
Coconut oil is another favorite example in my office. A patient trying to eat healthier and lower their cholesterol switched to coconut oil because they heard it was healthier. And since it was "healthier," they used it for roasting, sauteing, and as a dressing. After 6 months of eating "healthier" their cholesterol was actually higher...why?
When you look at the chemistry coconut oil vs olive oil, you realize it is virtually 100% saturated fat and 1 tablespoon provides 12 g of the 20 g recommended limit (an imbalance of saturated and unsaturated fat is actually what can drive cholesterol bonkers in the body). While it's socially popular right now, it's chemistry it not necessarily great for the body.
Reflect on the scope you're
comfortable and trained
This is the hardest section to write because I understand the passion and enthusiasm people have for helping others eat well. Especially when eating well is so tightly linked to health outcomes. However, without the ability to do a thorough assessment or the knowledge to truly understand the biochemical effect of food on the body, it's easy to mislead and even cause irreparable physical and/or psychological harm.
Luckily, the process of eating is such a complicated, nuanced task that it's possible to consider the roles we all play in supporting others.
Consider breaking the process into 4 steps (in no particular order). There's a lot to do to support and motivate others to teach people how to cook (without recommending products), get organized around cooking, get motivated to cook, teach what belongs in each food group, or just provide general encouragement or support. I would argue that it best to leave it to a dietitian to explore exactly what foods / products to choose, how to manage a health condition, or figure out what portion is "right."
Signs you might want to call in a dietitian
It's common that people are reluctant to see a dietitian. I get it, I was one of those people. I even saw a few dietitians and had crummy experiences (one told me that only people with eating disorders like pretzels .... and another gave me, [as a 10 year old], a 3-page handout on all the different types of beans...because I wanted to be vegetarian). Luckily, just like any other provider, we all have a different practice styles.
If your client, patient, friend, or family member starts saying any of the following, they may really benefit from checking in with a dietitian for a detailed assessment and individualized food / health plan:
"I know what to do, I just don't do it"
"I just don't have any self control / will power"
"It's just too hard"
"I need to learn a skill _[read labels, count carbs, dose insulin based on food]_"
"I don't feel like I get to eat what I love anymore"
"I used to eat _[pick a style]_ but I can't make myself do it anymore"
"I eat great all day but can't stop eating at night"
"I'm confused about what I can and cannot eat"
"What do I do when I eat out?"
"What if I don't like to cook?"
"How do I eat at parties / bbqs?"
"I'm confused about what to eat to manage _[multiple health conditions]_"
"I feel hungry all the time"
"I feel full all the time"
"I feel like I eat too much"
"I'm so tired since I changed my food"
"I'm afraid to eat"
"I feel bad about what and/or how I eat"
"I eat great all week and then on the weekend..."
"I can stick to the diet for _[days/weeks/month]_ but then I fall off track"
"I can't afford to eat this way"
Moral of the story...
The "best" choice isn't as simple as what's in a magazine or popular on social media. It takes a lot of time understanding the person you're talking to and the impact of chemistry on the body to guide people towards the most effective food choices. There are roles we can all play in supporting others, but don't under estimate the power of the dietitian.
Stay nourished friends!
DISCLAIMER: The writing here is for informational and educational purposes only. It is NOT a substitute for individual care. Your needs may vary. or individual support, please contact a provider.
Please note it's been a number of years since I have updated these posts. The content and philosophies may have changed as I've grown as a provider. Please reach out with questions or concerns.
Dietitian, personal trainer, mother, wife, runner, and endurance athlete supporting well-being, one bit and bite at a time