I’ve been trying, like, really, really hard to write a blog post this week. Some pithy article about something, some rebuttal to some media nonsense, a nice piece of science to help people understand some biological phenomenon. I have at least four half-started and at least three near completion… but all of them are tying me in knots.
Because I’m becoming so reticent to share anything at the moment. It seems to be a time when in-fighting, warring, nutritionism and scientific one-upmanship are literally everywhere. Social media is a venerable mudslinging match and I’m almost positive that nobody is listening to anyone else’s arguments anymore. To put one’s head above the parapet is offering oneself up to be vilified, rejected and dismissed as some hysterical, disordered, restrictive, arbitrary, non-scientific, draconian, non-evidence-based, unworthy human…
Or worse… you are dismissed as a ‘blogger’…!!!
How on earth did that term turn into an insult? But it has: it basically means ‘unqualified nobody whose opinion has no basis in fact’.
The worst thing about these arguments is that rather than refute specific points, people seem to be intent on picking holes in the source of, or the reading of, data instead. They’re not presenting alternative evidence, they just accuse opponents of cherry picking their studies. Then these ‘more qualified’ individuals proceed to cherry pick their own selection of data and craft ‘rebuttal’ pieces based on completely different scientific papers which cover vaguely similar elements of almost the same topic – though never exactly… It’s like we’re all having two different conversations but people just think they’re talking about the same thing.
Then, when decent human debate descends beyond the point at which they can argue sensibly (which happens worryingly quickly) you will find the insistence that “nutrition science is hard”… as if that means that it shouldn’t be done and/or give inaccurate or incorrect results – or sometimes, that the labs don’t do studies properly.
You also get the typical criticisms of , “they obviously only read the abstract” or, “the media always distorts the original evidence”. Differences of opinion based on different streams of data end in internet slanging matches which resort to directly attacking the intellectual and educational rigour of authors – from bloggers to mass media journalists to TV presenters with book deals to… basically everyone who voices any opinions whatsoever. Then certain groups gang up on others and exchange basic insults. It is just utterly exhausting – and very school playground.
That’s how I feel at the end of this week – exhausted with all the ‘professionals’ slagging all of the other ‘professionals’ off. For absolutely everything.
But mostly, I feel like I’m the only one who thinks that people are literally having the wrong arguments. Or having arguments for the wrong reasons. Or basically just screaming at the top of their virtual voices to be heard, without listening to the detail or the reasons behind anyone else’s words.
Rather than being helpful people are so concerned with being ‘right’. The implication is that everyone who has a different opinion – or, more often, a different stance and viewpoint on the debate – is wilfully harming other individuals. Why doesn’t it occur to people that sometimes we’re just not talking to the same audience? That all of our voices have a part to play – for different patient populations?
One of the biggest issues I’m meeting at the moment, and it actually is affecting me more than I had realised, is the assertion that anyone without an ANutr or RNutr qualification should not be able to comment on diet.
This has been said on the same feeds as people recommending that gluten is perfectly harmless for everyone except coeliacs, Paleo diets are just caveman recreations that are no better than restrictive diets and filled with red meat and saturated fat, Ketosis is literally killing people and damaging their metabolisms… oh yes and veganism is completely healthy.
It has also been said alongside the recommendation that everyone should take a mental health day when they need to, Mediterranean Diets are clearly the best (obviously, and universally), Olive Oil is the best thing since sliced bread (but preferably eat your olive oil WITH sliced bread…) oh yes, and Intuitive or Mindful Eating is the best and only way to treat your body to be healthy…
Where do I even start? In one breath these people are lambasting rules and restrictions and laying into those who champion a certain diet … then they turn around and do exactly the same thing with a different diet…?
You see for certain subsets of the population every single one of those statements above could be absolutely true. And for different subsets of the population those statements are completely erroneous. For yet more subsets those statements are positively damaging. And somewhere along the line, professionals have assumed that what qualifies them to make the statements they make is the science they’re reading…
Scientific Tennis Matches
I don’t know what it is about the human brain but we often strike me as a confused race. In one breath we want to stand out, be recognised, be unique and appreciated as individuals with special gifts that only we can bring.
In the next breath we look to group programs, mass recommendations, the advice of internet strangers to their followers and also to the generalised scientific evidence as if it can provide universal principles of ‘good for you’, ‘bad for you’ and ‘right and wrong’.
The entire body of health-related scientific literature is based on populations of people. In order to prove statistically relevant, studies have to be conducted on large enough numbers of people. The issue is that if you create a group large enough to gain useful data this can also invoke so many variables that are unforeseen and uncontrolled for, simply because we don’t know what all of them are. You basically dilute the results. This is not a criticism, it’s just a reflection of the way science has to be done (by which I mean needs to be done).
Scientific studies to assess pharmaceutical interventions prioritise safety and thus benefit from such a mass-market approach. The drugs we approve really must benefit the majority to gain this approval. This protects us from foreign, outside chemicals and provides insight into their multifarious interactions with many different human biologies.
Food is different. Nutrition changes the foundations upon which our biochemical reactions are built. Alterations in biochemistry can be imperceptible, they can take months, years and even decades to be shown. It’s a slower, more difficult process to track. And nutrition science is kind of hard.
But moreover, and more importantly, it’s hard because it’s more individualised. Every person’s body is different. Where drugs are a blunt object intervention designed to interrupt and augment physiological processes (and therefore carry much more similar affects across different populations), food provides a subtle and subliminal manipulation which will influence, but possibly not completely alter, the human body. It may do this absolutely uniquely in each different human body.
Which brings me back to the tennis match of the nutrition science world. It really doesn’t matter which dietary approach you pick – there is always an opponent to your point of view. And there are usually studies which back up both sides – even if you pick apart the science and really analyse the data.
What I believe is that this doesn’t make nutritional science flawed or inaccurate. It’s a perfectly logical consequence of the fact that nutrition science should never be about being “right” – biological uniqueness makes universal ‘right’ impossible. Nutrition science should instead be about being specific and precise about the patient populations to whom each nutritional intervention can (and should) be applied.
What I don’t understand is why everyone is so quick to point out everyone else’s inaccuracies, as opposed to just stopping for a nanosecond and reflecting that people are different and that everything works for somebody. We really are delicate, little, individual flowers. And whilst we can construct trials that study variables and make generalisations, when it comes to dietary styles it’s not that there is one right and one wrong…
Why can’t everyone just stop arguing and agree that, in some circumstances, for some people and in some situations – every single different approach could be right?
But no – it seems that those who seek to dismiss anyone’s views which differs from their own don’t want to put down their weapons of dietary oneupmanship. Which brings me back to those ANutrs and RNutrs who, instead of choosing to advocate for certain nutritional styles, they instead promote a specific style of eating which proclaims to offer dietary freedoms whilst kind of ignoring other truths about food and the way food feels…
We all know the slogan for Marmite, “you either love it or you hate it”. OK, there are some people who are indifferent to it – but the point is made: Marmite is divisive.
But the point isn’t “science says that you are either OK with Marmite or you’re not OK with Marmite”. The point is that when you taste it, you know whether you love Marmite or you hate it. And that’s enough. Tasting it is enough – no science required.
Nobody (to my knowledge) has ever made a critical judgement of anybody’s choice to hate marmite.
And yet there are tons of trained professionals, ANutrs and RNutrs included, genuinely levelling criticisms at other people’s choices to not eat bread, to not eat dairy, to not eat sugar, to not eat carbohydrates, to not eat fats, to not eat animal products, to not eat FODMAPs…
So with Marmite it’s enough to say, “I don’t like it”.
But with these other foods (bread, sugar, dairy, carbs, fats, animal products etc. etc. etc.) we apparently have to have some complex justification for our food choices based in scientific evidence, backed up by peer review, referenced and cited by meta-analysis and preferably validated in a randomised, controlled, double-blind study on scores of people and factoring in or including placebo.
Without such evidence, our choice to eliminate a food smacks of an eating disorder or restrictive food preferences based in fear. Obviously.
(WTF? – put an eye roll emoji in here, or the face palm woman… I mean… seriously??!!!)
Even if we can show mechanisms of harm (as is the case with things like gluten, artificial sweeteners and sugar) that’s still not enough, apparently, because mechanism doesn’t equal in vivo effect (the classic retort of any science-based nutritionist who disagrees with a statement)…
Which basically means that, according to the evidence-based nutritionists, we can reject certain foods because we don’t like them (Marmite, coriander) but for other foods – even if we don’t like them, or the way they make us feel, we are disordered and orthorexic if we choose to avoid them.
Not liking the way foods make us feel -whether in the moment of eating or afterwards – is clearly not evidence based enough to be accurate and factual. It’s clearly just us reading some nonsense on some unqualified blogger’s site and believing that (fill in the blank food) must be ‘bad’ for us so ‘creating’ our adverse reaction due to placebo effect, right?
Ergo… by avoiding foods that you feel rubbish eating, you’re unnecessarily restricting and not really listening to your body but to ‘diet dogma’… (and yes, some of these anti-diet dogma, anti-restrictive eating comments come out of the mouths of Vegans).
Which brings me to the buzzword of the moment. The nutritional approach that is supposed to absolve all of the placebo and make us trust our bodies enough to eat all foods and therefore we will be liberated from restrictions: Intuitive or Mindful Eating.
Actually these two words aren’t interchangeable, though many bloggers are choosing to use them as such. Mindful is more about being attentive to your hunger signals and the physiological sensations of preparing, eating, digesting and when to stop eating your food. Intuitive eating is more about trusting your body to ask for what it needs nutritionally and trusting yourself to give it to yourself.
Let me be explicitly clear: these are actually laudable ‘theories’ or ‘ways of eating’ (sorry, it’s difficult to know how to class them because they are, quite literally, not diets). And whilst some critics choose to accuse Intuitive or Mindful Eating of being diets in another guise, that’s actually an unfair criticism.
For example, Intuitive Eating guidelines are at pains to explain that this isn’t just ‘eat when you’re hungry, stop when you’re full’ (thereby introducing rules to your food consumption based only on hunger signals and guilt if you eat outside of those parameters). Instead, it is an approach based in understanding the impact of food on your body and, in a grown up and mature way, electing to eat beyond full at times because you want to and/or choosing not to eat sometimes even though you’re hungry because you’re a little busy and you forget or don’t get time. It’s an attempt to naturalise food consumption and elevate it above the neurotic, rules-based area to which it seems to have descended.
(A little aside… Is it me or is it ironic that the defenders of evidence-based nutritional science are the very people trying to elevate nutrition above food rules and overanalysis…? oh gosh, never mind…)
I want to do Intuitive Eating and Mindful Eating justice and say that the above paragraphs are woefully inadequate to explain the science and the rationale behind these processes. They are worth looking into and investigating if neuroses around food are part of your life.
And yet my hope, desire, wish and plea is that those promoting Intuitive Eating would do people like me the same courtesy when they choose to dismiss the dietary approaches that I use in order to heal *MY* clients.
The problem with the internet, as far as I can tell, is that audience boundaries aren’t clearly defined. This is a problem because everybody thinks everyone is talking to everyone else – and everyone thinks that ALL of the experts are talking to them.
I write, ad nauseam, about the power of nutrition and how it should always be used as a tool that can be as powerful as medicine. This means that, just like with medicine, some nutritional approaches have side effects and contraindications. The health history of the patient must be taken into account etc. etc.
And yet, this week alone I had the second consultations with six different clients who were trying to eat ‘intuitively’ or ‘ethically’ when they initially came to me. All six were suffering appallingly with symptoms that were entirely related to the nutrition that they were consuming. Their mindful meal challenges were great – parasympathetic stress responses were on point and they were stopping when full, really listening when their bodies asked for more. One even listened at 2am in the morning when her body called for more cereal and toast.
The problem was that the foods they were mindfully eating and ethically, intuitively choosing were literally harming their health.
All six experienced seismic shifts in their physiology through just a few days of eating as I had recommended to them. I’m not some weird miracle healer, I just applied specific, personalised common sense principles – actually based on the (shut your eyes if easily offended) Paleo principles of ancestral, genetically appropriate nutrition…. (I know, shock, horror!)
Yes, I removed whole food groups from some of them. Yes, I restricted certain carbohydrates for one. I absolutely banned some processed food substances for a couple of them. I deeply endorsed the consumption of nutrient-dense foods to all – though for one I actually told her to hang fire on the bone broth. I was specific, personal and nuanced with each. Yet in every single one it could be argued that I took away intuition and gave them a prescriptive, restrictive diet.
In every case the consultation this week was mostly them thanking me profusely for the fact that they had either stopped having such dreadful diarrhoea, ceased having skin breakouts, slept for the first time in years – the list goes on. The truth behind this is that for these clients, at this point in their life, in the health situation that they are in – they needed precisely the restrictive diet, food specificity, Functional Medicine prescribed diet that I chose for them. They DID NOT need to listen to the Intuitive Eating, Mindful Nutrition brigade …
So whilst that troop do have serious, scientific points… sometimes it would be nice if they could realise that others do too. I may be using different science, but it doesn’t invalidate my approaches. I wouldn’t use my science of elimination diets to help someone with disordered and emotionally conflicted eating… And sometimes, knowing what to listen to on the internet is all about understanding to whom the writer is talking. Everything might have merit – but not everyone is talking to everyone.
For some people the biggest challenge is emotional restrictiveness and feelings of body shame or self-loathing which are absolutely not going to be helped by a restrictive diet and me handing them a diet sheet which legitimises their over-control by handing them rules to follow and a fitness tracker. For this audience, and I have some of these as clients, I work on emotional healing, the challenging process of learning to trust their bodies, the tricky road to understanding that their worth is not tied up in their body size, shape or food choices. For these clients (whom I love to work with) it’s about digging deeper and understanding the genesis of their physiological malfunctions. For these clients, dietary restriction is not part of the healing – it has become part of their problem.
But for others there’s real work to do to heal people physically and that requires some degree of nutritional precision and manipulation. This is not for weight loss or body composition goals – it’s about helping a physiology that has become derailed and is in a state of suffering. For these clients, nutrition inclusions and restrictions are one vital tool to clear the noise of inflammation and the signals of distress so that we can build health and the foundations of strength.
More often than not, with my client population, each person straddles both of these worlds. It is not my job to be dogmatic about what approach, diet or eating style they need. Instead, it is my job to recognise that living in bodies is complicated and fraught with both emotional and physical baggage.
The bulk of my client population are ridiculously complex – in that they are the people who have real physical dilemmas which require some nutritional specificity, but they are also the vulnerable and emotionally sensitive who need help to hold the dietary restrictions lightly and with grace, rather than as a noose of neuroses based in fear that hangs around their neck.
I am in no way recommending the same diet or approach to all of my clients, nor am I removing their sovereignty over their own bodies. Instead, most of the time, I’m using nutritional manipulations to a) remove physiological distress and b) provide valuable information for their decision processes going forwards.
I am always mindful of the fact that dietary interventions are often a security blanket that becomes a dependency. When health is achieved through a specific way of eating, especially if it’s restrictive, it can become an alarming prospect to remove those restrictions when they are no longer needed. And, once my work is done, the same level of restrictions are often no longer needed. Here is where some people (and some clinicians let their clients) get stuck. And yes, it is here where the criticism levelled at some of my fellow practitioners might be merited.
The irony is that if they bothered to listen long enough, the ANutrs and RNutrs who believe anything “Paleo” to be codswallop would recognise that for most of my colleagues, our initial recommendation of ancestral, genetically-appropriate nutrition, is actually done to clear the barrage of confusing symptoms and patient distress and panic. After this, we actually have the same goals as the Intuitive Eating clan.
My entire aim with all of my clients – whether autoimmune, chronically sick, those with genetic illnesses, digestive issues or psychological/mental health concerns – is to rebuild their trust in their own body and in life again.
This isn’t about saying, “go low carb” (because I rarely, if ever, do), or “go Paleo” (though I do this all the time). It’s about recognising that if somebody is at my clinic they are in a state of physiological ill health and my job is to a) work out why and b) help them heal. It often doesn’t come in that order and I often implement dietary changes long before I know the true reason of their suffering (which is almost always a combination of physical and environmental/emotional). I do this because clearing inflammation and providing an infrastructure of rules is often the first step to the ultimate ability to understand, trust and respect our bodies.
The skill of being a practitioner in this field is choosing the right tool to use with the right patient, at the right time and to hand it to patients with the right emphasis, without instilling fear. My approach works for my clients…
And yes, before anyone says it, I know that the plural of anecdote isn’t evidence. But if you want evidence for the multidisciplinary and multimodal approach that I take – which includes an elimination diet based on restrictions of inflammatory foods and inclusions of whole foods… just check out Terry Wahls’s trials. These keep getting funded because they are showing evidence of improvements in one of conventional medicine’s most hard-fought battles: Multiple Sclerosis.
And then there’s Dale Bredesden’s work in another area in which conventional medicine is failing: Alzheimer’s Disease. The multifactorial approach, including nutritional recommendations which avoid certain whole food groups (shock!, horror!) are actually reversing (not just slowing, not just halting but reversing) neurodegeneration.
Don’t dismiss the trials because they’re young or in too few people – every innovation starts somewhere. And don’t dismiss the body of evidence behind elimination and avoidance-based diets because there are some out there who glorify these tools (useful in illness and healthcare settings) as the next big thing in the weight loss game.
Believe me, we don’t think Gwyneth Paltrow is a guru any more than you do. And if I ate the diet of Deliciously Ella or the Hemsley sisters I would be violently and uncontrollably unwell (and I actually have POTS like Ella – and no her diet would not work for me).
Just because I personally cannot eat the Ella diet is not a reason to dismiss certain nutritional approaches. And nor does it justify promotion of others as if they’re universally beneficial (here’s looking at you Mediterranean diet with more histamine-containing foods than I can literally tolerate). And to state that “Intuition”, “Mindful Eating” and “connecting to your body’s signals” is the only thing necessary in order to find health, happiness and contentment inside your body is utter rubbish. For many, many people with chronic illness – they just need more.
Try to promote “Intuitive Eating” as a healing tool to the patients in the two study groups linked above. Insist that’s the only way to heal to my clients for whom their bodies feel like they are mutinying on them with every breath and mouthful. State to the patients who have been faithfully consuming foods that they’re actually intolerant to and assuming they were insulating themselves from harm because they were doing so ‘mindfully’ that they were obviously not being Mindful enough… it’s just not the right approach for these patients. And it’s heartbreaking to see their confidence and their self-esteem dwindle because their nutritional mindfulness attempts fail and they feel that they just can’t be ‘tuned in’, ‘intuitive’ or ‘self-loving’ enough.
My point, after all this waffle, is that every one of the professionals has a point – and a message – and an audience. But they are absolutely not all the same audience.
We would do well to remember that we would help more patients if we stayed within our own lane and referred out when someone comes towards us who would benefit from someone else’s expertise. And we really would do better if we stopped with all the vitriol and in-fighting. We’re in the healing professions – and no matter what approach you’re peddling, there are no nutrition or even ‘mindful’ eating recommendations that look good when they’re served alongside a pile of bitterness.