Nutrition information you can swallow: on avoiding food fads and bad advice

We live in an amazing technological age with access to information and education unprecedented in human history. The internet in particular is such an important vehicle in information sharing: in most places it is open to all to explore and it provides a platform for anyone, including me and this blog, to discuss and publish nearly anything they like. With a few words typed into a search bar the average human is presented with thousands of items to peruse; if there is a question, there is also an answer or a thousand. The abundance of information with accompanying lack of vetting is often a double-edged sword, and the world of nutrition and lifestyle information is no exception. On one side it is wonderful to see some many people interested in eating well; the more people who get as excited as me about nutrition and food, the better. The other side is innumerable claims that lack evidence, plausibility, and good science. I would wager that nutrition has it worse that many other topics for a couple of reasons. First, every human needs to eat in one way or another to survive (sorry breatharians), so we all have a stake in food and nutrition, while we don’t all, for example, have a stake in astrophysics or small engine repair. Second, we westerners tend to judge ourselves and others by the foods that we choose, thus the focus on eating well and choosing the “right” foods. All told, there is still a lot of great nutrition info written by dietitians, health professionals, scientists, and health enthusiasts alike, the trouble is figuring out what is advice worthy of following, what is questionable, and what is downright dangerous.

Below is a list of 5 questions to ask when consuming nutrition information, adapted from this resource.

1. Is the person or product promising a quick fix like fast weight-loss or a miracle cure? If it sounds too good to be true, then it likely is. If there’s one thing we know about being healthy, it’s that there’s no magic pill that will get you there. If there’s two things we know about being healthy, it’s that a person’s health is the outcome of the interactions of hundreds of different factors in both their body and their environment. It is anything but simple. Simple solutions are not going to “fix” systemic problems. Accredited health professionals don’t make these kinds of promises because we know they’re false, and we’re legally not allowed to do that.
2. Are they trying to sell you products such as special foods or supplements? Do they make claims that sound something like “you can’t be healthy without this herb/supplement/etc.? Do their claims make you feel as though you’re failing for not already using this product? Beware the salesperson (whether you are aware that that’s what they are or not) who pitches your ailment and miraculously also sells the “cure”.
3. Do they provide information based on personal stories (i.e. testimonials) rather than on facts? Although it’s nice to hear about a success story from a celebrity, it’s not proof that something works or is true. Always keep in mind: the plural of anecdotes IS NOT data. One hundred “it worked for me” stories without credible evaluation tell us nothing about a products/program’s efficacy or safety. Paid testimonials need to be taken with a large rock of salt because these people have a vested interest in making the product look good. Finally, never underestimate the power of investment bias. The more a person has to lost from using a product/service, the more likely they are to give that thing a positive review, deserved or not.
4. Is their claim based on a single study or a few research studies? A single study is not sufficient evidence on which to base treatment recommendations (in the vast majority of cases). Were the studies with animals or humans? Many of the most appealing and attention-grabbing headlines refer to studies conducted in vitro and/or in animals. These types of studies are important and fascinating but score low applicability points. Are you similar to the humans that were studied (age, sex etc.)? If not, you may not experience the same or any effect as claimed. The stronger the study design (blinded, more participants, proper controls in place) and the more studies available that draw the same conclusions, the stronger the evidence that something it true.
5. What are the person’s qualifications? Remember that anyone can call themselves a nutritionist, a nutrition expert, a culinary guru, a nutrient savant, and any other official-sounding title you can think of. Their education in human nutrition can range from non-existant to university training. Some may even be non-nutrition health providers. Only dietitians have accredited degrees and practical experience specifically in nutrition. Calling one’s self a “nutritionist”, having a medical degree, or adding a fruit or vegetable to one’s name does not bestow the authority of nutrition advice provision on that person. Make sure whoever the source, their training is science-based and from a reputable and accredited source.

Asking these 5 questions before absorbing nutrition advice can help steer clear of money grabs, lies, and potentially harmful practices, all of which go a lot further to keeping you well than many foods fads.

 

Nutrition Month 2017: take the fight out of food

March is special for many dietitians in many ways: fiscal year-end at many of our workplaces, renewal time for College and national association memberships, a mad scramble to get in those last few continuing education points (or find the paperwork for those lunch and learns you’re certain you did THIS year). Oh, and nutrition month! A month to spotlight the importance of good nutrition for every person; a month to showcase dietitians and the wonderful and varied work they do throughout the country. Many local municipalities and provincial/territorial governments release official proclamations for this month every year, and nutrition month events can be found almost anywhere a dietitian works.

Have you heard of nutrition month? Maybe you’ve seen the posters in a local healthcare provider’s office. Did you know that each year there is a new theme? This year the focus is all about renewing our relationship with food, whether that means figuring out where to find safe and trustworthy nutrition advice, making mealtime and food decisions less of a battle ground (for yourself or for others), or learning to eat in a way that is both pleasurable and helps manage your health conditions. Because eating well doesn’t (and shouldn’t) mean forbidden foods, unsafe diets, mealtime meltdowns, or bland and boring meals. There are so many great resources to check out, including the official Nutrition Month 2017 materials at www.dietitians.ca, the Nutrition Summit 2017 at www.nutritionacademy.co, your favourite dietitian’s blog (don’t have one yet? find a new one here), and I’ll be doing my part to make nutrition the star of the month.

Bon appetit!

Resolutions for self

I’ve never been great at long-term planning and goal setting. I’m becoming increasingly skilled at short-term organizational goals (sort of a necessity to keep my household from falling into complete disarray) but grand, overarching plans for the future have been something I’ve bucked ever since I was expected to write outlines for essays ahead of time. Seriously, if the essay wasn’t going to flow out of my pen in one shot fully formed, then it wasn’t going to be written. Also, why think about an assignment casually when you have ample time to prepare when instead you could have the sweet flames of a deadline licking at your back as the best possible creativity generator? But, I digress. Recently, now that I’m realizing that I am in fact a fully fledged adult and that perhaps life would be a little easier if I finally accept some of these behaviours, I am working in earnest towards some professional and personal lifestyle goals. My most recent success was in 2015 when I managed to post a new article every day for November. Last year I tried again but as anyone who followed that endeavour will know, it turned out only to be a brief affair.

We are now solidly into the new year and the time for making resolutions for 2017 has passed, but we are still in the prime of resolution breaking season. It is no secret that many goals will not see the ball drop the following New Year’s Eve; most won’t be remembered past mid-January. There are a lot of reasons why goals don’t materialize, poor planning, low motivation, and low self-efficacy being chief among them. Think about the kinds of goals that tend to be set: they are dramatic, long-term, pass-fail, and frequently carry heavy moral judgements on the character of the person setting the goal. Something along the lines of “this year I will accomplish a lot and change myself entirely”. They might sound great as one shares a tipsy dance to Auld Lang Syne under a starry sky, but it’s not the stuff that real, lasting change or accomplishment is made of. As I always had a hard time coming up with goals and knew I was unlikely to keep them anyway, I gave up on this sort of thing years ago.

None of this is to say that change is bad, quite the contrary. Especially in our lifestyle and our health, change towards healthier, more centred living often provides a wealth of benefits, many unexpected. The thing is, sustained change is hard. If the desire for the outcomes of our efforts was enough to make them reality, most of us would certainly have drastically different lives. The draw of our comfortable and safe old habits is, in most cases, strong enough to bring us right back where we started or even stop us from taking that first step. Setting small, realistic, and sustainable goals in conjunction with planning one’s life to facilitate change is essential. So to is avoiding feeling like or calling one’s self a failure – rarely the motivator Hollywood makes this strategy our to be. Goals based on heavy restriction are generally a recipe for disaster.

Whether one made resolutions or not, whether they are still going or have been quietly tucked away for another year, if you are still looking for some change, I have three suggestions. As I’ve said before, my nutrition advice is rarely sexy but it’s probably likely to help get you where you’re going. I promise, no restriction.

1. Drink water. Just water. Sometimes with a bit of lemon, sometimes with some herbal tea if you like. Have other beverages too if you like, but reach for water first. No need to guzzle gallons daily, but if you feel tired, hungry, headachy, “off”, or just can’t remember the last time you had some, try it. The worst thing that will happen is that you’ll have to pee. Which you should be doing regularly anyway.
2. Eat fibre. Fruits, vegetables, whole grains, beans, peas, lentils, seed, nuts. Eat what you want, just try to incorporate more of these items daily. Start small and add more. High fibre foods certainly have more texture than their processed counterparts, but adding in fibre won’t (shouldn’t) make everything taste like cardboard.
3. Get some physical activity. Move your body as much as you can through the day. If structured exercise or classes or crossfit gyms do it for you, wonderful, but there’s no need to be active specifically in those ways, particularly if you’re just starting out. Just find ways to move, and celebrate your success when you do it.

As I slowly adjust to parenting two small kids and the fatigue and hormone induced anxiety they bring in addition to mulling my future paths, I find physical activity the best management technique to keep me somewhat balanced. My new goal is to be on my treadmill most days of the week for 20 minutes. I’m also committed to walking my children to outings and lessons as a default in place of using the car. This may change once I’m back at work, so I’m thinking ahead to be flexible with my goals once my circumstances change. So far, so good. I’ve definitely had some backsliding weeks, but I’m still going and my goals for myself do not weigh on my shoulders.

Going nuts for coconut oil

Apparently there is nothing coconut oil cannot do. According to innumerable health and lifestyle sites, it’s good for the body inside and out; you’ll never need another fat again. There’s so much hype and beautiful, flowery language around this food that it is really difficult to know what is true, and what is a bit (or an extreme amount) of exaggeration about the virtues of this wonder fat. This article makes some pretty bold assertions, and always, extraordinary claims require extraordinary evidence.

But first, a primer on coconut oil. Despite its name, it is a fat that is solid at room temperature. This is due to the fact that it contains 90% saturated fatty acids, which is more than butter. What sets it apart from most other solid fats is the types of saturated fats in coconut oil. Fatty acids – the components of “fat” – are strings of carbon atoms with a certain number of hydrogen atoms attached, with or without double bonds. Saturated fatty acids have no double bonds; this is what allows them to fit together compactly, making a solid fat. Fatty acids come in many lengths, from 4-carbon chains all the way up to 22 carbons, occasionally more. Most of the saturated fats in butter or animal fats are long-chain, 16 to 20 carbons atoms. Of coconut oil’s 90% saturated fat content, 58% of those fatty acids are medium chain triglycerides (MCTs), 6-12 carbons per chain. These fats are metabolized differently than long fatty acids, and this is a key point to remember when examining the health claims. Interestingly, coconut oil contains no omega-3 fats, the polyunsaturated fats most associated with reduced cardiovascular disease risk. Even butter contains 1% omega-3 fats.

So on to the health claims (paraphrased)

1. Coconut oil has a unique fatty acid composition with medicinal properties.

Yes, it has a unique composition, just like every other fat out there. We wouldn’t expect coconut oil to be exactly like butter, because then it would be butter. The medicinal properties claim comes from the high proportion of MCTs. MCT oil is regularly used in medical nutrition therapy for many conditions including malnutrition, malabsorptive disorders, the ketogenic diet for seizures and other brain disorders, and more. It is a manufactured product, meant to ensure purity, potency, and almost exclusive MCT content. Any health benefits from coconut oil cannot be fairly equated to those of MCT oil because they are very different substances. MCTs do have a beneficial effect on the conditions listed above, however, we cannot extrapolate that people without these conditions would see the same benefits.

2. The people who eat the most coconut oil are the healthiest.

This is another epidemiological finding that cannot imply causation. Both the groups pointed out, the Tokelauans and the Kitavans are small, isolated populations, living largely subsistence lifestyles, with almost no intake of western refined foods. There are so many differences between their genetics predispositions, activity levels, lifestyles, and diet compared to ours in North America that to conclude their apparent reduced incidence of cardiovascular disease is due to coconut oil is unfair at best, deceptive at worst.

3. Coconut oil will help you burn fat, lose weight.

Right now there is not enough evidence to make this assertion. It doesn’t mean it’s not true, or that coconut oil does not have a favourable effcect compared to other fats, it’s just that the research hasn’t been done. A lot of the articles cited in support of this claim, like this one, this one, and this one are very small (12 or fewer subjects each) and completed 20-30 years ago. Small sample size reduces the strength of the evidence, so no big conclusions can be made. And again, some of these studies used MCT oil, not coconut oil; strike two against this claim.

4. Coconut oil has antimicrobial effects.

Most of the studies cited to support this claim are in vitro studies, a.k.a. put-things-in-a-petri-dish-and-see-what-happens study. We learn a lot from this kind of research, it’s what gives us a better understanding and generates many more research hypotheses. But this type of research absolutely cannot be used to make recommendations about human health and interventions. The reason is simple: the human body is not a petri dish. Our bodies are not tightly controlled environments where only one variable is manipulated at a time. Using in vitro studies to make a health claim is like saying that we are made of atoms, atoms are mostly space, thus we are invisible. And interesting idea, but clearly false. Luckily, a better in vivo (in a living being in semi-normal conditions) study was done to test the antimicrobial claims of coconut oil but sadly, the beloved tropical fat didn’t do any better than controls. Please, please, please, if you suspect you have any type of infection, skip the coconut oil and talk to your doctor.

5. Coconut oil can reduce hunger (…thus helping you lose weight).

Just like the previous weight loss claim, the studies cited are old and small, the test diets are very different from typical diet patterns, and once again, they are using MCT oil, not coconut oil. I’m not saying there’s no benefit to coconut oil here, there just isn’t enough good evidence to support that.

6. MCTs in coconut oil are helpful for seizure control, as part of the ketogenic diet.

I feel like we’ve covered this already…but here it goes again. Yes, the high fat ketogenic diet, with or without MCTs, is a very useful treatment for some people with significant neurological disorders. If you do not have a  condition like that, this “benefit” does not apply to you. As always, the claimant is conflating concentrated MCT oil with coconut oil. If you or a loved one do love with a condition for which the ketogenic diet may be prescribed, listen to the advice of your health care team and ignore this claim all together. Ultimately, this claim helps no one and may cause harm to someone who thinks they will get a health “boost” from switching to coconut oil. This is a dangerous path to take.

7. Coconut oil improves blood cholesterol levels, especially the “good ” cholesterol HDL.

This is probably one of the best researched topics in the usefulness of coconut oil at present. Coconut oil does seem to show some favourable effects on cholesterol levels and types. What this tells us is that coconut oil is likely safe and can be part of healthy diet. This does not tell us that we should eschew all other oils and use coconut oil exclusively for all of our fat-based needs.

8. Coconut oil can be used as sunscreen and moisturizer.

Sunscreen can also be used as sunscreen. Coconut oil’s impressive-sounding ability to block out 20% of UV rays is no match for your run-of-the-mill SPF 15 sunscreen which blocks 93% of those rays. As for moisturizer, plant-based oils and fats have been used -and continue to be- for centuries as moisturizers. Cocoa butter, shea butter, and coconut oil tend to be favourites because of the nice smells and smooth, not oily textures. This likely has to do with the MCTs and their low melting point, but I can’t be sure and I’m too tired to keep talking about this. Moving on.

9. Coconut oil can improve Alzheimer’s.

False. Hear-say and case-studies do not equal evidence. Next claim.

10. Coconut oil can help you lose dangerous belly fat.

See the items above for weight loss. There is some research showing that coconut oil may in fact have this positive effect, but as usual, no conclusions should be drawn yet.

If you like coconut oil, great. If you don’t, great. Whether you choose to include it or not is up to you. Either way, your best bet is to include a variety of plant-based fats in your diet, and don’t look for any magic effects in a jar.

Processed foods

We all know processed foods are bad, they should be banished from grocery store shelves. A great idea in theory, but in practicality it probably wouldn’t play out so pleasantly for most of us. Not because it is a poor health choice (quite the opposite) but because our busy lives do not allow for making everything from scratch. If we want to be sticklers, many nutritious staples like bread, canned tomatoes, and frozen berries can all be considered processed foods. I know that I certainly don’t have the funds or the time to buy only fresh produce year round and bake bread weekly. Thus, making distinctions, and as always, understanding our food is very important.

A good rule of thumb is to look for foods that look most like their original form. Foods that are fried, pureed, or batter coated have probably gone through heavy processing. We can be guaranteed that any savoury food with an electric orange colour parted ways with real, dairy cheese a long, long time ago. The more a food has been altered, the more opportunities for loss of nutrients, protein, fibre, and flavour (resulting in an increase in added sugar, fat, and salt – because no one would buy kraft dinner if it tasted like sawdust). If it ready out of the box or can, or you can get a full cooked “meal” in less than 2 minutes, or you’re not sure what foods that product was originally made of, chances are it’s highly processed. Best to consume these just once in a while.

What we’re really looking for is minimally processed foods. Things like canned tomatoes and beans and fish, whole-grain flours and breads, pre-chopped and/or frozen fruits and vegetables fall into this category. In these cases the processing is generally to increase shelf life, preserve palatability, or increase ease of use. So long as there is very little added in the way of sugar, salt, and fats (unless it’s healthy fats), these are wonderful additions to any grocery cart. These processed foods make it easier for more people to afford nutritious foods and they significantly increase the likelyhood that we will actually eat these foods.

Ideally, we would all do it all from scratch, but ideally, we would all also get enough activity every day, learn another language, take our cars for regular maintenance, etc. Our world is less than perfect and our society does not foster the healthy eating and living habits we spout so virtuously.  I’d rather see someone using canned beans in dishes than choosing to avoid legumes altogether because cooking them takes nearly forever. I’d rather see someone eat bagged salad than have 2 heads of lettuce rotting in their crisper.

Make from scratch as much as you can (including minimally processed foods), challenge yourself to find alternatives to pre-made or instant favourites, give yourself time for your tastes to adapt, and don’t beat yourself up about the occasional box of kraft dinner.