Friday, July 20, 2012

Who’s Telling You What to Eat?

RDs? Nutritionists? Trainers? Finding healthy, sensible advice to change your relationship with food.

Don't let me teach you to juggle! And don't let some
clown pretend to be a nutrition expert!
I thought about doing a spinal adjustment on my overweight patient with back pain, but then I realized “Hey, I’m a dietitian, what am I thinking? I have no expertise in this!”

Ok, I’m kidding. I wouldn’t dream of guiding clients in areas I am not qualified (although I have made suggestions about stress reduction I would never consider myself a replacement for a therapist). Educating clients on target heart rate and setting realistic exercise goals based on their current health is one thing, but I wouldn’t instruct them on bench presses. Subtle mistakes and misinformation could lead to major problems.

So why don’t other provider types feel the same way when it comes to doling out nutrition information? Take chiropractors for instance. What extensive training qualifies them to tell you how to eat? Or to sell “toxin cleansing systems”, aka serious laxatives, to bulimic patients (I kid you not), all for the sake of a giant profit? Yes, I really had to coach a patient to return a product to her chiropractor who had convinced her that this was the answer to her woes. Thankfully, I was successful.

Trainers and coaches, perhaps well educated in their field getting people exercising, seem to misinform their clients more than most practitioners, requiring a great deal of my time to correct. They propagate fitness magazines’ and supplement manufacturers’ myths about carbs, and protein (they see a major halo around this nutrient) and base their guidance on their own unhealthy beliefs. Not all providers, of course—but many. They share what they believe has worked for them—which has little to do with what is healthy or appropriate for you! Even the Pilates studio I go to is now selling purgatives in pretty packaging suggestive of clean, fresh and natural health. If only they were aware of the damage of these senna filled disguises. Uggh!

I can at least support the "celebrate recovery"!
Then there are those that proudly call themselves nutritionists, which is actually quite a meaningless term. A nutritionist could be a steroid-infused guy pushing supplements at the local vitamin store, with no qualifications for this position other that his availability from 9-5. Or it could be the produce manager at the local Whole Foods or other market. Yes, anyone can call himself a nutritionist.
Admittedly, I too, have referred to myself as a nutritionist—a nutrition consultant my business card still reads. Like others, I began to use this term as a way of differentiating myself from the stereotype of food service dietitians of days gone by. It was a way, perhaps of putting a more updated spin on who we are. The difference, though, between me and those other nutritionists is that I also have very valid credentials in my field—RD, MPH, CDE, LDN (see below for definition of these credentials).

Why should you care about the initials?

Credentials are not just for bragging rights. Rather, they help to separate providers based on their qualifications. There are many bright and well-educated nutritionists—faculty members, PhDs often, who are not Registered Dietitians but rather academics with post docs in nutrition. But while they may have a wealth of wisdom about nutrition research and science, they often lack the clinical and likely the behavioral expertise of someone with an RD with years of experience working with patients. As a result, their recommendations may be less than realistic.

That said, credentials are just a starting point. There are many RDs with good qualifications that I would never refer to—they are too inexperienced or rigid in their approach.  So if you are looking to work with someone, it’s critical that you learn about their experience, their philosophy and their approach to shifting your relationship with food.

Potential for danger

A sign I came upon in Zermatt, Switzerland
A family member living in another state recently contacted me about the guidance he received from a nutritionist. He was instructed on a Paleo Diet—apparently what this nutritionist puts everyone on, regardless of their symptoms. When his symptoms worsened, she said to switch to gluten free and lactose free. But she also suspects heavy metal toxicity. Or, she added, maybe a parasite. Or something. But in the meanwhile, she prescribed her diet  “remedy”, with absolutely no evidence to support it. Oh, and she strongly encouraged a paycheck's worth of supplements which she could conveniently sell him.

And in the meanwhile, this relative is wasting away from his already underweight place. He’s feeling weaker and is nutrient deficient. But he clings to the very personal guidance he’s getting from the nutritionist. MDs have not yet identified his diagnosis nor cure, but this nutritionist is giving him hope. The problem is, this hope comes with a price; namely reducing his energy level and his muscle mass, imposing restrictive (and unnecessary diet rules) and dangling more hope that there is more this quack can do for him.
Perhaps it seems harmless enough. After all, he wasn't getting anywhere with his regular practitioner.

But it absolutely is harmful! Restrictive diets that result in weight loss in those in no position to be losing weight are irresponsible. They may stall constructive, valuable follow up with appropriate specialists. They add confusion to an already overwhelming treatment course. And they provide a false sense of trust—and hope.

Finding the right dietitian

Sometimes, it's hard to know what advice to take!

  • Philosophies may vary, but I’d suggest avoiding anyone suggesting you eliminate whole categories of foods or nutrients, such as carbs, grains, dairy, etc.
  • Avoid those whose recommendations are based solely on their personal experience and lack evidence-based recommendations. It’s no better than a LICSW who starts her session using Tarot cards (this, too, I’ve heard about). Fun, maybe, but not a sanctioned, proven therapy!
  • Learn about their experience treating those struggling with your particular issues. More experience is best, of course.
  • Do they come recommended from other health care providers or peers you can trust? Do they work in collaboration with your other practitioners? This, too, is critical.
  • Do they believe you can change? If they view you as unfixable, damaged goods, discard them and move on to another provider, please!

We are bombarded with nutrition information and much of it is conflicting and inconclusive, some of it downright wrong. And the more confused we get, the less likely we are to take action, to make the necessary changes to support our health.

So choose your providers cautiously. Select those that can intelligently sort through the overwhelming overload of food rules you’re hearing. And be on guard for quacks and those simply stepping out of bounds, dispensing information out of their field. Or even worse, selling you useless and often harmful products for their personal gain.

As for my philosophy?

How great is this?!
You can purchase it from their website:

  • Maybe it’s because I’ve got 26 years of experience behind me. Or perhaps it’s the effect of being diagnosed with a chronic progressive disease (I’ve got Multiple Sclerosis). But personally and professionally I’ve come to believe that life is too short to deny ourselves what we truly enjoy eating. Of course, if you’ve got a severe food allergy (or other such condition) and your survival depends on dietary changes, that’s obviously quite different!
  • You need to weigh the costs and benefits of dietary and lifestyle changes. Sure, weight loss may be appealing, but at what price? Is it really worth the deprivation, the denial, the decreased energy, and the obsessive thoughts to achieve an unrealistic rate of weight change or even an unhealthy weight?
  • Food should be enjoyed with all your senses—regardless of your weight. Everyone deserves to nourish himself and to enjoy eating.
  • Change is challenging, but worth making to improve the quality of your life. And it’s not too late to make it now with the help of a qualified RD.

The credentials:
RD: Registered Dietitian
MPH: Masters in Public Health, in Nutrition (UNC Chapel Hill)
CDE: Certified Diabetes Educator
LDN: Licensed in the state of MA
Not listed: BA in Biology, Brown University, Providence RI.


    I would add that some therapists who work with eating disorders are very good at giving out eating advice and some RDs who don't work with eating disorders are very bad at giving out eating advice. (I'm thinking of the RD that comes to my local farmer's market and sells "cleanse" drinks that she makes at home as a great "meal replacement.") But you kind of touched on this already...

  2. Lori, I really enjoyed this post. Lately, so many bloggers have been touting restrictive diets. Many are "primal" or "paleo" and recently I came across people who are totally eliminating dairy, grains, legumes and sugars from their diet for a set period of time because these foods *could* be negatively impacting their health and fitness without them even realizing it! Or so says the website of the plan in question.

    People are flailing around, jumping on every possible bandwagon in the search of the holy grail of nutrition. In the final analysis, I think we're all deathly afraid of dying (pardon the pun!) and somehow, we think we can cheat death by becoming perfect eaters.

    I have a friend who is not only vegan, but also has an entire drawer of daily supplements in addition to a pantry full of various nutritional powders that she takes religiously. I've got to say, she has beautiful skin, but I suspect a lot it has to do with heredity. Those of us who are fair skinned wrinkle a lot faster. It's just life. Will my friend live a long and healthy life? Who the heck knows.

    My late mother-in-law died at 82--a fairly respectable age-- with just a touch of arthritis and a smoker's hack. She spent her life eating copious amounts of junk food and drinking gallons of coffee. I think if she hadn't smoked, she might have lived a bit longer, but again who knows.

    Anyway, thanks for being sane when it comes to food. Mostly, it's teh crazies who've taken over!