We do a lot of talking about diets on this page. What makes a healthy diet? Why do people follow ridiculous diets? What the fuck is up with gluten?
So I emailed one of my favorite dietitians, Joe Leech, and asked for some perspectives on science based diets from an RD. My questions in bold, his answers in block quotes and italics.
Most people know that you can help someone plan a balanced diet, but what are the different types of problems that you can help people with as an RD?
Dietitians can help with hundreds of different diet-related conditions, both in an acute hospital setting and in clinics. It depends on their specialty training and experience too, of course.
For example, my website at the moment focuses on autoimmune disease, food intolerance, and nutrigenetics. I try to be a resource of evidence-based, unbiased information about specific health conditions in an online environment swamped with the opposite.
There is very few resources that provide health advice without an agenda, whether it’s promoting a particular diet, a range of supplements or essential oils, or whether they’re just Mike Adams.
Is it just as hard to get someone to stay on a diet for weight loss as it is for a medical issue (celiac, Crohn’s, etc)?
It just depends on how harmful or painful they perceive their condition. Just like with any issue we might face in our daily activities, the more painful or disruptive it is, the more likely we will go out of our way to fix it.
If someone has severe IBS – to the point where they say no to attending parties or public events because they aren’t sure how accessible a toilet will be – then they will follow a low FODMAP diet religiously in an effort to get their normal life back.
The same with IBD like Crohn’s, or with celiacs who steers clear of gluten.
Now let’s look at the opposite. A patient with high blood pressure – who is taking high dose medication, but otherwise experiences no real symptoms that disrupts their life – will typically not stick with significant changes to their diet first time around. It’s just not an obvious pain point that disrupts everyday life.
With weight loss it can go either way, depends on how “painful” someone perceives their excessive weight to be.
In the same vein, what challenges do you come up against in helping clients stay on a diet, and what tools and/or motivation do you give them?
Time is the biggest challenge perceived by clients.
Lack of time to plan for major dietary change. Having to feed the family and not having time to plan different meals, or wanting to have junk food around because the kids demand it.
I really don’t like the phrase “I don’t have time.” It should really be “I don’t make time.” This wouldn’t allow us to shift the blame or responsibility, because ultimately it’s on us. If you really want something, you’ll do what it takes.
Perhaps in very rare instances “I can’t make time right now” might be appropriate. But for 99.9% of people, they simply don’t prioritise health changes.
Food diaries are an effective tool for helping to promote habit change. Just knowing that you need to record what you eat can impact your eating behaviours. And providing a visual way to see eating habits over the course of a week or month really helps introduce a new perspective.
Do people come to you for help for different reasons at different ages or are the reasons all over the map and not linked to age?
In hospital it was just dependent on what ward I was working in, most cases were similar.
Working in private practice it was typically for type 1 or type 2 diabetes, and/or kidney disease, and also food intolerance.
These days on my website the questions I get are almost all about autoimmune disease – particular hypothyroidism – and food intolerance.
What are the whackiest or unhealthiest diets a client has brought to your desk? (I’m hoping for Breatharianism).
I thought about this for a while but nothing extreme or comical comes to mind.
At least nothing from a clinically sane client, because I’ve had some experience working in psychology wards where eating disorders are frightening.
Low carb, low fat, plant based, paleo… do you think there’s merit to these if they help people maintain a healthy body weight (specifically if their body weight was previously affecting their health) or are there any of these that you would really recommend people avoid?
I love this question. My answer is unsexy, unfortunately.
They all have merit for weight loss depending on the person and their lifestyle (that’s why there’s no blanket diet for everyone). As long as the diet you follow helps you to reduce your caloric intake, you will lose weight.
If low carb helps you feel fuller longer (because it’s typically higher protein than a low fat diet), and it means you have to cut out all the starchy junk food you eat, then it will work.
I think low carb has the best success rate, at least in 0-4 year period, because of its effect on appetite. And seems especially useful in those who already have insulin resistance (either pre-diabetic or type 2 diabetic).
Just don’t try to tell me carbs make you fat or give you diabetes. Please.
Low fat can be an easy way to limit calories too, because fat is the most calorie dense nutrient. But it doesn’t work for a lot of people who eat high carb junk food. There are so many people who have successfully lost weight and kept it off on low fat, but low fat is not trendy anymore so we won’t hear about it mainstream.
Plant-based is similar to low fat in that it tends to be higher carb, plus no processed low quality meats (obviously). If it works for you on a social aspect then great.
Paleo works for weight loss too. Although not because it eliminates “inflammatory” grains and legumes. It works because you stopped eating junk food and actually stuck to it. And are now consistently eating less calories as a result.
And there would also be a few outliers with unknown food intolerances (like FOMDAPs or gluten). They would’ve been eating a truck-load of wheat-based foods before, only to be inadvertently remedied by going Paleo.
But Paleo only works because part of the Paleo “way of life” which fuels their personal belief system. But whatever, I won’t tell you to stop if it’s working for you.
On that note, to answer the follow up question, I definitely don’t recommend strict Paleo to anyone. It’s elitist, unscientific, historically inaccurate and makes you a social nightmare.
Assuming an individual does not have an intolerance to legumes, recommended they avoid them is completely against scientific consensus, and eliminates a food uniquely high in protein and fiber, and is also dirt cheap.
Do you eat any foods only for the health benefits?
Yep, I have kefir grains at home that I use to make kefir milk. I would not have started using them if it weren’t for the probiotics.
I use kefir milk in place of regular milk for everything except in my coffee or tea (hot water and bacteria don’t go well). Although that being said, I enjoy the taste of most fermented foods and drinks.
And broccoli. It tastes like shit to be honest, but I eat it anyway.
What do you think is a problem with your field at the moment?
Free speech and the internet.
But seriously, just the fact that anyone online can claim to be – and be recognised by the public and media – as an expert in nutrition, as long as they have either:
– Had a health problem or weight issue that they overcame and can now sell their story
– Received “qualifications” from studying 6 months online for a nutrition certification created by a made-up institution.
– Are or were a TV celebrity
This leads to a gross amount of nutrition misinformation being spread to manipulate people’s health insecurities. This is a problem for the nutrition field in general, but it’s now happening in more and more areas of health science, not just nutrition.
Now if I put my marketer hat on, the other obvious problem is that Dietitians (and scientists in general) are boring as hell and unlikeable. To be blunt.
And terrible at promoting and selling themselves as thought leaders and authorities in the online space. They’ve always relied on traditional media outlets like print and TV news, which are dying in the ass.
I know because I was in that system, and I used to be like that too.
Unfortunately people like Mercola, Vani, and Wolfey are really smart and proactive when it comes to positioning themselves as an authority online. I hate to admit it, but my marketer hat goes off to them because they own, and we can learn a lot from how they do it.
But now, finally, science is pushing back with likeable public figures such as yourself. And I think with the world of video emerging – especially live video – the advantage swings back to us. Because it’s much more difficult to disguise your ignorance and insincerity in video than a blog post.
The future is looking really good for us actually.
(Sorry that section was so long, but I get a bit worked up.)
Do you have a favorite junk food item that you’re sure the ‘clean eating’ advocates would be horrified if they heard an RD enjoyed?
Well I popped my In-N-Out burger cherry for the first time last month, which was delicious. I made that meal public: https://www.facebook.com/dietvsdisease/posts/1740899379458652
Without a doubt though my favourite junk food is microwave popcorn. Mostly “Triple Butter Explosion” flavour, but sometimes just caramel. Enough artificial ingredients to make Vani petition.
Popcorn is actually a better choice (calorie-wise, has some fiber) than potato chips or doritos or whatever, but it’s not particularly good for you. At least not in the quantities I eat.
If you could give everyone one piece of advice on maintaining a healthy diet for life, what would you tell them?
Only one piece of advice makes this is the hardest question of the lot.
LEARN TO COOK, and make time to enjoy the process.
Cooking your own meals is almost always healthier (because everyone does actually know what to eat to be healthy), and it helps you to appreciate what good food really is.
I believe this has a follow on effect that influences how much you eat, what snacks you eat, and even non-diet related aspects of your lifestyle.
That’s just my theory though.