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: http://bit.ly/Mr4gmv

• 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.

Supersized Disaster

Yes, that's a 44 oz individual serving of soda!

I never recommend soda to my patients or my family members. And I cringe when I walk into fast food restaurants (only to use the bathroom, of course) or a movie theater and see single serving cups in the range of 32-44 ounces. It’s obscene. That volume of sugar devoid of other nutrients, consumed at a single sitting is crazy. Our society has a distorted sense of what normal portions are—not just for beverages, but for food as well. The only place I’ve been able to find a true juice glass, a 4 or 6-ounce size, has been at antique stores. Really. So I support NYC’s Mayor Bloomberg’s recent ban on the sale of supersized sodas, right?

Not at all. While the mayor is desperately trying to change a growing trend of overconsumption and obesity, his new policy restricting the sale of sodas larger than 16 oz is absurd on so many levels.

While I take my freedom for granted, having never lived anywhere that restricted my personal choices, including what I eat, the thought of a law limiting the size of my portions feels, well, un-American. Mark my word; if they try to restrict my purchase of cupcakes after 8 PM, for instance, I’ll start hoarding them at 7. I mean it.

Who decides what you're allowed to eat and how much?

It’s quite a slippery slope. Who decides that Sprite is out, but grape juice is fine? Or that 24 oz smoothies are ok, but soda is not?  Maybe they should halt the sale of those cardiac-inducing hot dogs sold on food carts throughout NY, instead? Sure, there’s nutritional value in the smoothy, but if the driving force behind this policy is obesity and health—why would 24 or more caloric ounces of anything accompanying a meal be appropriate?

Next, will NYC next set limits on who can buy these large caloric beverages? Will we need to weigh-in at the food carts on 5^th Avenue—high BMI? You get the under 16 oz regular soda or the diet one; low BMI? You may choose the supersized drinks—but ONLY those drinks with calories—no diet beverages for you. 

Should we perhaps ban the sale of large portions of diet beverages, given that they displace the calories and nutrients desperately needed by those with eating disorders and those simply underweight?

And what about cost? Can we not buy a bottle of soda at the deli to share with others, resulting in a smaller portion and less cost per person? Bloomberg’s ruling prohibits this.

The unforseen consequences

What message does it send if 16-ounce beverage portions—regular or diet—are considered the norm? Our caloric needs vary; for some, 16 oz of juice is absolutely appropriate. For others, it’s excessive for their need. But a law stating that 16 ounces is fine or distinguishing between soda and juice as healthy versus unhealthy creates a hierarchy people will believe is valid—when it’s not. If we are talking about weight management it's about calories, and a Coke is no different than a bottle of 100% juice. 

Should those with high blood pressure be forbidden
 this heavily salted popcorn?

I understand that simply educating the public to improve health is at best challenging. We are impacted by visual stimuli and sensory prompts to eat, as well as our perception--not just information about what and how much is healthy to consume. Prompted by the suggestion that you can size up for only 75 cents more (which I overheard at the movies yesterday), most of us will go for it. If you perceive that you haven’t eaten much you will continue eating, regardless of your fullness. And if you believe that 16 ounces is appropriate--because the Mayor believes it's fine for your health-- you may be more inclined to select the 16 oz size than something smaller.

If they’re going to set rules…

Perhaps there are better alternatives than Bloomberg’s to reduce our excessive intake—if or when it is unhealthy for the individual. How about a pricing policy removing the financial incentive to size up? If ordering the 32 oz soda vs the 16 oz adds $1.20 vs 20 cents, I suspect there’d be more thought before supersizing.

Yes, this is for real. And financially more sensible that the 32 oz
 which was more expensive per ounce!

Or what about a rule allowing individuals to bring their own snacks into a movie—maybe healthier popcorn from home? Or limiting movie-theater food to a specific eating area as opposed to in front of the screen? Can we not go 90 minutes without a feeding? Why are we encouraging distracted eating, when all evidence supports mindful eating helps us better regulate our intake and our weight?

Yes, something needs to be done to improve the health of our nation. But setting arbitrary boundaries on portions, about good beverages and bad, is hardly the answer. And the fallout from this perhaps well-intended policy may only result in more problems.


And I thought I lived in the liberal Northeast...

The Halo Effect. Your Thoughts About Healthy Foods Can Make or Break Your Weight Struggle.

Convinced of the health merits of such calorie-dense items as almonds, peanut butter and olive oil? You may feel more relaxed, more permissive about eating them as they’re nutrient rich and heart-healthy. After all, they’re good for you, right? So what’s the harm of eating them freely?

But then there’s the frustrated cry I hear most days, by seemingly educated dieters.

"But I eat so well, so healthily, I don't understand why I'm not able to lose weight”.

Thank you Jenny Wan-Chen Lee, a graduate student at Cornell University and her mentor Dr. Wansink for clarifying what’s going on here, confirming and quantifying what I’ve long experienced with my patients the past 25 years in practice. It’s called the halo effect.

What’s the Halo Effect?

Beautiful people are often attributed other positive features, simply because of their beauty. Their beauty radiates a sort of halo, influencing us to see them as smarter, more competent, and more likely to make a better president, for instance.

I enjoyed every morsel of this lavender flavored chocolate, and no,
it was not organic!

Growing evidence suggests that this halo effect may also apply to foods, ultimately influencing our eating. Research has shown that people tend to eat more calories at fast-food establishments claiming to serve "healthier" foods, versus the amount they’d have at a standard fast-food restaurant. Perceiving a food to be more nutritious, they’re less cautious and tend to overindulge. New research by Lee explored the halo effect around organic food, to see if people’s positive notions of organic items would lead them to perceive them as tastier or lower calorie.

“She tested this question by conducting a double-blind, controlled trial in which she asked 144 subjects at the local mall to compare what they thought were conventionally and organically produced chocolate sandwich cookies, plain yogurt, and potato chips. All of the products, however, were actually of the organic variety -- they were just labeled as being "regular" or "organic." Participants were then asked to rate each food for 10 different attributes (e.g., overall taste, perception of fat content) using a scale from 1 to 9. She also asked them to estimate the number of calories in each food item and how much they would be willing to pay.”

“Confirming Lee's health halo hypothesis, the subjects reported preferring almost all of the taste characteristics of the organically-labeled foods, even though they were actually identical to their conventionally-labeled counterparts. The foods labeled "organic" were also perceived to be significantly lower in calories and evoked a higher price tag. In addition, foods with the "organic" label were perceived as being lower in fat and higher in fiber. Overall, organically-labeled chips and cookies were considered to be more nutritious than their "non-organic" counterparts.”

http://www.sciencedaily.com/releases/2011/04/110410130831.htm

From my experience, this halo effect can have a positive or a negative impact on eating, depending on your eating issue.

For those struggling with overeating, the halo effect contributes to eating in

excess. Here's how it happens. If you perceive a food as healthy or good for you, and therefore acceptable to eat, you tend to be less mindful of portions of these foods. So consider that cry I hear frequently from new patients presenting for weight management. Assessing their intake makes it crystal clear—they are simply eating too much of a good thing!

And the Atkins and Zone Diets have made the situation worse, as I see it. If you were indoctrinated with the false information that protein at any cost is the answer and that carbohydrate is the culprit for your weight problems, it’s not so easy to let it go.

 And so excessive portions of protein rich foods are eaten, leading to excessive calories and therefore worsening weight struggles.

It may look attractive in the display, but... 

Trainers at the gym, are also frequently at fault, for propagating nutrition bubbe meises, or old wive’s tales. “Eat more protein to lose weight”, they convince their clients, who return to my office frustrated by their escalating weight (not, I might add, the result of increasing muscle mass).

When I started practice in the 1980s, I remember patients proudly sharing their progress. They'd declare that they had moved from Oreos to Snackwell's fat free cookies, consuming 6 or 8 at a time because they were fat free. But they missed the part that they were not calorie free. These patients were sold on the merits of Snackwells having no fat, which in that era was considered a good thing.

This very same halo effect has its benefits for those dealing with

restrictive eating disorders. It is often easier to include foods seen as healthy, even if only because of their organic label. Yes, for some people, certified organic chocolate feels safer as a means to increase calories than many other items might be. Similarly, a food attribute such as fiber content often allows people to select that food even if it is higher in calories. It's an effect I encourage taking advantage of, as it allows clients to become more comfortable with a wider range of foods.

What does this halo effect mean for you?

If you struggle with restrictive eating, you may find it easier to incorporate foods with some perceived health benefit, something you can justify as good for you. This often makes change easier. This will also lead to greater variety with less deprivation. It can then lead to transference of trust—allowing you to change items, to swap them—recognizing they are equivalent in nutritional value for weight and energy balance. Ultimately, you’ll be more likely to manage your nutritional needs, expanding your food selection and increasing your intake.

For those who believe that simply eating healthy foods without regard to physical need shouldn't result in weight gain, think again. Excessive calories relative to need is what impacts weight. Organic, high fiber, whole grain, omega 3-containing foods may all have their merits. But weight management comes down to calories in versus calories out.