What Registered Dietitians Believe: AKA Don’t Trust Everything You Read

Processed, white bread, with sweet, unsalted butter. Yum!

Yes, that’s white bread—homemade by my bread machine, in fact (with my husband’s assistance)—and that indeed is real butter on top, added by yours truly. It was part of my lunch, together with my favorite lentil soup. And, a piece of salted almond dark chocolate, along with a cup of tea I’m still sipping on. A reality program of what RDs really eat? Not quite. Rather, I’m compelled to respond to an article that makes showing up at dinner parties with my real identity as a Registered Dietitian quite challenging!

I stumbled upon 9 Ingredients Nutritionists Won’t Touch as it was retweeted by some RDs on Twitter. Exaggerated statements about foods that dietitians wouldn’t dare eat plastered the article, so I thought I'd clear the air for the sake of people like Brian (not his real name), a blog follower struggling with an eating disorder. He saw this Dietitian's response, which read “An irresponsible piece overgeneralizing about RDs and what is healthy! No soy protein? Only 100% whole grain bread? Really?” He responded “I used to assume all nutrition 'experts' were this rigid - & triggering. Hence I've never consulted any”.

So let me set you straight. This article certainly doesn't represent all dietitians. The hype suggesting we should never eat these 9 ingredients is crazy. No single ingredient moderately consumed is poison. Although I will admit that eating a hotdog every day will greatly increase your risk of cancer. And certainly no one food or ingredient causes weight gain. (Or weight loss. Sorry to disappoint you.) The reason why I'm taking the time to address this is because the last thing you need is more food rules—especially senseless ones.

Since I honestly have never been concerned enough to avoid at all costs the ingredients purported to be avoided by nutritionists, I needed to do a bit of research on these food concerns. With a little bit of digging, here’s what I conclude:

Corn oil and omega 6 fatty acids (FAs)

Sure, I'd recommend an increase in omega three fats from fish such as salmon, sardines, tuna (in moderation if you are in your childbearing years), flax and walnuts, to benefit from their role in reducing inflammation and lowering cardiac risk. But to set a rule that products with ingredients such as corn oil should be banned is unwarranted. Omega 6 FAs also have their benefits, and a focus on the ratio of omega-6 to omega 3s is apparently misguided. Read the experts' review http://circ.ahajournals.org/content/119/6/902.long

The cancer causing additive potassium benzoate and benzene

Here’s an excerpt from the 2009 FDA paper addressing concerns about benzene levels found in beverages: How many and what products were found to have excessive levels of benzene?:

To date, FDA has tested almost 200 soft drink and other beverages in the CFSAN survey. Benzene above 5 ppb was found in a total of ten products. Benzene above 5 ppb was found in nine of the beverage products that contain both added benzoate salts and ascorbic acid. FDA also found benzene above 5 ppb in one cranberry juice beverage with added ascorbic acid but no added benzoates (cranberries contain natural benzoates). The manufacturers have reformulated products, if still manufactured, which were identified in the survey as containing greater than 5 ppb benzene. CFSAN tested samples of these reformulated products and found that benzene levels were less than 1.5 ppb. See also Data on Benzene in Soft Drinks and Other Beverages, including product names and benzene levels.

Don't trust the FDA? Here's a balanced, unbiased piece from Livestrong, June 2011 which references additional sources, too.

Even though benzene levels are not an issue, I’d vote for moderate intake, at best, of sodas.

Soy is poison? This one I had to look up because I was clueless!

In the article on the nine ingredients we supposedly avoid like the plague, Nunez, the  author quotes Valerie Berkowitz RD, saying "Soy protein, soy isolate, and soy oil are present in about 60 percent of the foods on the market and have been shown to impair fertility and affect estrogen in women, lower sex drive, and trigger puberty early in children," she says. "Soy can also add to the imbalance between omega-6 and omega-3 fatty acids."  Unfortunately, the evidence simply isn’t there to support Berkowitz’s claim.

For a balanced review of the pros and cons of soy, check out this Huff Post piece http://www.huffingtonpost.com/neal-barnard-md/settling-the-soy-controve_b_453966.html, which, rather than sensationalizing food ingredients, cites the research from peer-reviewed journals that are considered state-of-the-art.

If you are still concerned about the unproven risks of GMO soy, that shouldn't stop you from choosing organic which eliminates this possible risk. Apparently organic soy is stated to be free not only of pesticides but of genetic modification.

As for palm oil? And processed foods?

My breakfast of smoked fish (with nitrites), enriched white
bread, and saturated-fat containing foods--in moderation, of course.

Sure, I'm not big on palm oil, a saturated fat, but again, it's about the bigger picture. How much are you consuming? Too much saturated fat will increase your LDL or “bad” cholesterol, as it's commonly known. But even those needing to follow a diet low in saturated fat to lower their high blood cholesterol levels can consume up to 7% of their total calories from saturated fat. Certainly that leaves room for the occasional product that has a bit of palm oil as an ingredient.

Nitrates and nitrites have long been acknowledged to be carcinogenic, leading to cancer. So no, I wouldn't recommend frequent intake of hot dogs and bacon. But an occasional dog at a picnic? Be my guest.

The statement about avoiding enriched flour? That one tops the list as the most absurd recommendation, and the mere suggestion that this represents what dietitian's believe would certainly keep me from seeing one! So I'm with you, Brian. What they are suggesting is that enriched is code for refined—because the only foods that need enrichment are those that have been stripped of their original nutrients. That said, all foods do not need to be nutrient powerhouses; refined (unenriched bread) isn't poison, as part of a balanced diet. And of course enriched bread would only bring additional B vitamins to the meal. So what's the problem? Must we always choose the most fiber filled, nutrient-rich food items? Can't we include vegetables for some of the fiber and vitamins and minerals, and simply enjoy the French bread—enriched or otherwise?

Articles like 9 Ingredients perpetuate misinformation about food and nutrition and about dietitians. While it does refer to the nutrition professional as a nutritionist, a general term having no qualifications attached to it, they quoted from many a Registered Dietitian throughout the article.

If you're trying to improve your relationship with food and you visit with a Registered Dietitian whose messages match up with the 9 Ingredients hyped article, do run the other way! But please don't assume that we are all like that. I know I'm not alone in my approach to eating. Registered Dietitians with a focus on behavior change and those with extensive experience treating individuals with eating disorders are most likely to share my approach.

So Brian, hopefully now you’ll reconsider a visit to a dietitian—just find one with a sensible, balanced approach to eating.

Thanks for reading.

Diet Rules: In Response to the Diet Pill Disaster

Imagine the disappointment!

Didn’t you want to believe it? “Finally, a diet pill I can endorse! Check out this link”, with yours truly as the sender. Yes, my Twitter account was hacked, or hijacked, as they say. Someone managed to get into my account dispensing a bunch of tweets as if they had come from me. And this was just one of the creative gems they sent. 

Now, if you have been reading Drop It And Eat for a while, I suspect you were a bit skeptical. And hopefully, you even had the wisdom to stop yourself from clicking and perpetuating the myth.

Maybe you even believed it, but knew it would be trouble, a slippery slope, getting into diet pills. You knew it was too good to be true.

Perhaps you feel addicted to hope—hope for a solution to your daily eating struggle—for assistance with binge eating, obesity, or body dissatisfaction, in spite of a normal body size. Yes, at times a pill may seem like the only answer.

But, dear readers, there are no pills, no magic bullets. Never mind meds; there is no quick fix, no special diet to cure our ills, I’m so sorry to say.

How ironic that this violation of my name and of my Followers came when I was vacationing, reveling in the beauty of Acadia National Park with its stunning vistas, by foot and by cycle. And while enjoying the fabulous bakeries, the flavorful oils and vinegars and local restaurant cuisine. And no, I didn’t enjoy the muffins and scones solely on my active days when I was burning it off; I even enjoyed them at breakfast, before the almost 6 hour drive home, sitting on my butt.

How does this fit with good health, you may be wondering? What kind of dietitian are you, endorsing pastries and other indulgences?

I often find myself defending my approach to eating and to weight management and disease prevention to others—to strangers wondering why I’m photographing their lovely loaves, to friends who question my aversion to seemingly healthy fat free foods, even to patients and Followers who wonder if I really practice what I preach. So I thought I’d share a few thoughts following my 5-day vacation in Maine.

Yes, it's all about balance.

A truly healthy diet:

• is a way of eating that promotes both physical and psychological wellbeing.

• indulges the senses with the pleasure of quality—flavors, textures, smells, experiences.

• involves selecting foods that may be rich, such as the fabulous baked goods from Little Notch Bakery—and enjoying them when hungry (but not so hungry that you can’t savor the flavors and enjoy the food).

• allows for pastries, and chocolates, and cheeses as snacks or as part of a meal, not as a reward for eating a “healthy” meal. Tuesday, it meant blueberry pie mid-morning, after a lovely bike ride. Wednesday, it included blueberry scones (yes, wild Maine blueberries are in season), a chocolate croissant and delectable carrot muffins at breakfast. Monday, it meant a shared apple tartlet as an afternoon snack.

Thanks for helping to make my vacation fabulous! 

• means eating just as much as we need, and trusting that we could always get to the bakery again for another great purchase. Yes, I hit up Little Notch Bakery three times over my 5-day vacation in Acadia—once in each area of the island.

• also means bypassing fat free spreads on my toast—because I don’t like their taste—and dipping my sourdough, white flour bread in olive oil instead. It entails selecting oils with intense aromas, fabulous flavors and nutritional benefits, like those found at Fiore in Bar Harbor.

• means choosing a lighter entrée, at times, because I prefer a less dense dinner after my day of snacking. So it was poached salmon (still a high fat fish, I might add), but in a lighter prep than the other options available.

• means having what I really want, but eating only as much as I truly need. I was in charge of cutting up the baked goods, served on a platter in bite size pieces for 5 of us to share.

I chose the middle one. What a crust!

I’m not kvetching today, post vacation, about my week’s intake; I enjoyed every minute of it. I did not need to go crazy with my eating simply because I was on vacation, because quite frankly, eating like this is totally normal for me. I eat this way all the time. I buy great breads weekly (if I haven’t made my own with the help of a bread machine), I enjoy delicious cheeses (but am mindful of the portions) and I have my share of baked goods (and clearly you’ve already learned of my love of chocolate!). Really. Just ask my friends and family. But I pass on anything sub par, because I truly want to enjoy what I put in my mouth. I take my food pretty seriously.

Tags from a line of women's clothing. Great, no?

Does this eating approach seem foreign to you? Trust me, there is still hope for change. It takes time to learn that you are allowed to enjoy good food, great tasting, quality food. Yes, whether you are overweight, normal weight or underweight you are entitled to the pleasure of eating whatever you would like. Just be sure to eat the amount that’s right for your body.

That is a truly healthy diet.

Time to Clear My Plate. Before You Get Triggered by My Plate, Read This.

Oh, Michelle, I so appreciate your honest and passionate concern for improving the health of our nation, particularly our kids. Really I do! But quite frankly, the subtle messages conveyed through the new USDA My Plate set us way back in our progress.

That’s not to say that I find nothing favorable about it. I do like the bright colors (they make me feel like a kid again), and the concept of half the plate as fruits and vegetables is truly a helpful, and reasonable teaching visual. And, a message I can support. But here’s where we part.

Where are the fats?

Ok, I realize that in the written food group description fats get mentioned, but not encouraged. And let’s face it—it’s the visual image that makes the biggest impact. And in that regard, fats are absent. Yes, in spite of the latest Dietary Guidelines for Americans summarizing the enormous body of research and declaring that increasing (unsaturated) fats should be a goal, comprising up to 30% of all our calories, this message is lost in My Plate.

In fact, in the description accompanying the image, it even sheds a negative light, saying “oils are not a food group”. And by oils they really mean fats, because avocado, for instance is not oil. Funny, in past pyramids, such as 2005, fats were a distinct part of the pyramid and were scattered around as a component of the other food groups. And if fats are not a food group, why is protein? If I remember my basic nutrition way back the three macronutritent groups making up all foods are protein, fats and carbohydrate. Yet My Plate places the nutrient protein on the plate, a component of foods, as if it’s a food, yet states that fats have no place? I don’t get it.

Where’s my favorite food group?

But perhaps the biggest problem I have is the omission of those “empty calorie” villains, the “sweets”. Past health messages from the American Dietetics Association and the recent aforementioned Dietary Guidelines for Americans 2010 instructs us to “find balance between food and physical activity.” At no point do they suggest we should eliminate sweets to prevent obesity.

And speaking of those additional calories, why make such an overreaching statement like “Enjoy your food, but eat less”? Should I suggest this to my normal weight sons? To the healthy growing kids I see? To the many I work with struggling with trusting their hunger, many of whom are working hard to increase their calories by appropriately eating more? Should I be eating less as I’m training for a biking event this month? Such an unnecessary and detrimental generalization! Would it take an eating disordered child for Michelle to be more sensitive to such absurd health recommendations?

This dietitian endorses a health-promoting message to include junk food!

Here’s the scoop. Black and white messages about good foods to eat and bad foods to avoid are damaging. They contribute to society being misinformed about weight management, and about eating in a healthy, balanced and pleasurable way. In life kids and adults are going to eat cupcakes and chocolate and ice cream in all flavors. The problem won’t be that we’re eating these foods. It’s that we view them as bad, feel guilty, and end up overeating them, because we have been convinced that we have done wrong by consuming them—in any amount. Rigid rules and clear omissions teach us nothing. They reinforce the wrong messages. It’s time to get with the times.

Why the beef about dairy?

And to the critics of inclusion of a dairy serving, like Walter Willet at Harvard (who says there’s no evidence to support including a dairy requirement), I’d like to ask you this—are you thinking we’re going to meet our requirement for calcium and Vitamin D from sardines, canned salmon, almonds and broccoli? I don’t think so. Perhaps the USDA could have done better by broadening that category to say “milk and fortified soy milk”; no other non-dairy alternative provides as much protein as well as calcium and Vit D. Yes, there is evidence that we need an adequate intake of these two nutrients, and practical, economical, acceptable sources are few and far between outside of dairy products.

As for the interactive resources, I would love to share my thoughts. But after signing in, the program failed to work when I tried to explore the physical activity section.

Time to go eat. 

My plate will include some homemade waffles this morning, fruit, yogurt, and real Vermont, full sugar maple syrup. And I just might decide to include a piece of pastry for my afternoon snack. And in spite of what My Plate urges, I have no intentions of reducing my portions from their usual level!

Thanks for reading! Enjoy your sweets today.