This is going to come off kind of weird, but:
I will now take the remainder of this post to qualify that statement.
Here’s what I mean: only in certain, limited contexts does WHAT a person eats play a direct role in their health. We’re talking deficiencies and diseases where the body’s storage and handling of nutrients changes radically.
In these situations, diet or nutrient supplementation needs to be controlled with varying degrees of precision, or, as we so often like to express it in this lovely fucked-up culture of ours, strictness.
I’m talking kidney disease. I’m talking diabetes. I’m talking recovery from cancer. I’m talking scurvy and beriberi and pernicious anemia — and plain old iron-deficiency anemia, too, for that matter. I’m talking inflammatory bowel disease, I’m talking recovery from trauma like surgery or burns or bad wounds or anything which renders you incapable of feeding yourself, thus requiring a tube and/or IV. I’m talking celiac disease and food allergies. I’m talking liver disease. I’m talking certain medications (like monoamine oxidase inhibitors) that don’t play well with certain foods.
And, as far as I’m concerned, these are the only types of situations in which WHAT a person eats takes primacy over HOW they eat it. And even then, in many cases, the WHAT is only just barely more important than the HOW.
Personally, though I’ve completed basic training in the WHAT at university, my interest has always been much stronger in the HOW.
The HOW we eat applies to all of us — disease or no disease, allergy or no allergy, nutritionist or pastry chef.
By way of explicit example: yesterday, I ate two cups of ice cream and a bunch of rainbow Twizzlers for lunch.
I wanted it, I had it, and I felt pretty good about it.
I functioned well physically for the rest of the day.
Later on, I had a bowl of bran cereal for dinner.
Was this balanced? Absolutely not. Was this “healthy” by popular standards? Not at all. Do I eat this way every day? Nope. Was it totally fine for me? Without reservation — yes.
Here’s what I believe: human diets (meaning in this case not “weight loss diets” but “everything one eats”) in their natural, un-fucked-up state are pretty chaotic. We eat a little one day, and a whole shit-ton another day. Using examples from my own life: we might eat a quart of strawberries per week in June, and then drink a quart of homemade Irish Cream in December.
The bottom line? If you’re not messed up around food in some way, it balances out over time.
This is part of the reason that dietetics is such an imprecise science. When you get a three-day food diary from a client and then analyze it for the nutritional breakdown, you’re only getting a snapshot of their entire diet.
Diets change seasonally and regionally by what’s available, they change by what’s on sale, by what you can afford, by what looks good to you on any given day. They change by your mood, since all human beings (since the beginning of time, probably) use food to comfort themselves or to celebrate.
And, lastly, yes — your diet also changes based on your changing physical requirements.
For the most part, a lot of our nutrition — which is to say, the molecules our cells use to work, and to produce the raw materials that comprise our bodies — is stored. And some of those stores last for decades. Or a lifetime.
For example, your skeleton? Yeah, it’s not just the handy-dandy coat rack that your organs hang from, and those chompers you use for donut-munching — it’s also your travelling calcium pantry for whenever your motor neurons need a bunch of calcium ions to work the chemical/electrical ju-ju that triggers a muscle contraction.
You know, so you can walk and talk and scratch your butt and stuff.
These uses for calcium are so effing important that your body is willing to raid that pantry — even weakening it to the point of physical collapse — so you can continue breathing at all costs, even if all your ribs crumble in the process. And that’s part of the reason we have such a GIANT FRIGGIN’ STORE OF CALCIUM in our bodies, enough that it would take years to use up entirely, even if you never ate another milligram of calcium again.
Now. I’m not suggesting that you should stop eating calcium and watch what happens, cause I can tell you right now — your bones are going to weaken as your body raids the pantry, and that’s not good for you. But I am saying that our bodies are pretty well set up to survive, even without food, for quite a while. (And, luckily, calcium is present in so many foods that it can be difficult to avoid.)
We’ve got failsafe upon failsafe upon idiot-proof failsafe working in our favour. And these’ve developed the hard way, by trial and error over hundreds of thousands of years.
So, if you’re like me and, I’m going to guess, like 99% of the people who:
- Have access to the computers and the internet and the basic literacy skills required to read this blog,
- AND if you have adequate access to clean drinking water and enough food so that you’re not constantly hungry,
- AND your food’s safety is regulated by an imperfect but basically functioning agency intended to prevent a huge and lucrative population of tax-payers and stuff-consumers from keeling over dead by the swath,
- AND you don’t have some disease or injury requiring direct and aggressive therapeutic nutrition intervention, then
YOU’RE GOING TO BE FINE.
You can stop obsessing about WHAT to eat now. You’re welcome.
Okay, so I know it isn’t that easy. Sure would be nice if it were, though, eh?
We’ll talk about the HOW next time.
Comments
112 responses to “Eating – the WHAT or the HOW?”
I love this. And, it’s making me feel much better. I’m having horrible food aversions right now (pregnancy), and there is very, very little I can eat, and I can eat very little of what I can eat. Mainly I can manage small portions of carb/protein combos. That’s about it.
I’m trying to remind myself that, as somebody who generally eats a pretty healthy diet and who enjoys her fruits and veggies and dairy, this is okay. It makes sense, if I can’t eat much right now, that it would be protein and carbs I’m eating, since those are things my body is going to use immediately. I’m taking vitamins, so my body probably has enough vitamins and minerals stored up that it’s not as imperative that I get those through my fruits and veggies right now.
It’s also a good thing to remember when I start to worry about my son. Some days all he wants to eat is fruit. Other days, he’ll eat cheese for each meal. Other times, it’s all carbs, all the time. But he’s perfectly healthy, and I’m assuming his body is craving what he needs right then, and it all balances out just fine. The eating habits of children tend to be EXTREMELY erratic, and they probably eat more naturally and intuitively than anybody else.
Oh, I’m so sorry to hear you’re having a rotten time of it, Lori. But it’s true that you’ll probably be fine, even if you have to eat a somewhat unbalanced diet temporarily. And if you’ve got good medical supervision, they’ll help you make sure that things to get too out of hand with the loss of appetite and/or nausea.
Your observation about children is totally spot-on, too — to confirm my obsession with quoting Ellyn Satter:
Wow.
As a former diseased fat person who went from 364 to 180 pounds, your take on nutrition and health seems fantastic! — as in COMPLETE FANTASY!
WHAT YOU EAT plays a HUGE role in your overall health, and to think otherwise is ignoring the obvious.
Sure, I’m all for loving your (our) fat bodies and accepting ourselves as we are. That’s great. But encouraging people to eat whatever they want, etc, as your blog seems to do is way off the mark.
Your still young…and you come off as a perfect representative of a young person who can’t tell shit from shinola — to quote an old saying.
In a few years, if you don’t figure out how to get your body to cooperate metabolically, you’ll probably have diabetes, hypertension and sleep apnea — just like I did.
Until I stopped eating processed foods and started exercising, that is. Now, my blood sugar is normal w/out meds, as is my blood pressure. No sleep apnea, either.
And I can tell you, I like my 180-lb body a hell of a lot more than I did my 364-lb body!
Love yourself. Love your body. But grow up. And remember — most of what you learn in college as a dietician is simply crap propagated by BIG AGRA, the little brother of BIG PHARMA.
Your advice is setting people up for death and disease.
–Kirk in MN
Needless to say, I disagree.
The idea that telling people to eat food they enjoy, without undue panic and worry, is RADICAL and DANGEROUS is, to me, evidence of just how far gone our society is.
I never told anyone to dive into a vat of lard and start chugging. Instead, I encourage people to look at other factors that affect their health, and take a realistic view of how much we can actually control via the food we put in our mouths.
I know it is very popular to believe that what we eat and how we choose to move plays a HUGE role in our health, but I think that is based on a logical fallacy — known as the “Just World Hypothesis,” whereby we believe that somehow deserving people (i.e., those who exercise “right” and eat “right”) will not get sick and die. And that those who don’t toe the line will inevitably suffer.
My advice doesn’t set anyone up for anything, other than critically examining the messages we hear constantly from the public health establishment and the media.
What people choose to do in their own lives is beyond my control. As it should be.
I recognize that there are some people (in fact, quite a few people, even if you use the most pessimistic estimates) who have lost weight, kept it off permanently, and have subsequently enjoyed good health, which they attribute almost unequivocally to the weight loss.
My impression, however, is that weight loss was likely in the cards for these people anyway. A HAES approach would also probably have resulted in weight loss and health improvement.
The health improvements are likely due to a combination of endocrinological factors in addition to the reduction of mass itself. But, of course, our cultural bias being what it is, it’s far more convenient and satisfying to believe that 1) the weight loss occurred through force of will and “doing right” alone, and 2) that all positive health outcomes are directly attributable to that weight loss. In the final analysis, essentially this is saying “I HAVE COMPLETE CONTROL OVER MY HEALTH BASED ENTIRELY ON MY MORALLY SUPERIOR EATING HABITS.”
In short, I think THIS kind of thinking is fantastic — as in, completely based on fantasy.
Also:
In a few years, if you don’t figure out how to get your body to cooperate metabolically, you’ll probably have diabetes, hypertension and sleep apnea — just like I did.
A lot of people have expressed similar sentiments about me in recent days. I’m sure you mean well, but I must tell you how it comes off — as wishing me, personally, ill. It makes me wonder if people are upset that I seem to be “getting away” with something, flaunting some unspoken rule about how I should eat or move, when in fact, no one who’s spoken this way about me actually knows anything about my health status or my personal habits.
You have absolutely no basis on which to diagnose me or calculate my health risks. And the fact that you, and others, persist in doing so (inevitably, drawing the most pessimistic conclusions possible) comes off not only as resentful and mean-spirited, but also threatening.
Please consider that next time you choose to speculate on a stranger’s health status.
So many logical fallacies, so little time.
Kirk, I don’t know you, but my inclination is to guess that you were a diseased person who also happened to be fat. What changed so that you are both no longer diseased (my assumption) and no longer fat? Again, I’m just guessing here, but you probably became more active and made an effort to eat more nutritious foods. So was it the weight loss or the increase in healthy habits that improved your health? You don’t know, and assuming that it was losing weight is simply evidence that you have been suckered by our “thin = healthy” culture. What would have happened had you made changes, gotten healthier (i.e. “less diseased”) and not lost any weight? Would you have failed?
Also, your assumption that what was true for you is true for all fat people is illogical. Your body is not my body is not Michelle’s body. Human bodies are not all identical and do not all function exactly the same. If they did, we’d all look the same, be the same height, weigh the same, etc. There are complex factors that affect how we look, what we weigh, and our health in general.
Also, seriously, how long ago were you a fat person, Kirk? Weight loss diets, as a treatment, can be successful and bring down disease indicators in the short term, and gain usually starts year 2 or 3. By five years out…
As an actual treatment system, weight loss diets have the same success rate as snake oil. It’s not a terribly ethical thing to offer as a treatment option.
So, Kirk, it’s great you’re feeling better. Should you gain weight again,you’re in good company. You can even treat your metabolic disease with exercise (and dietary changes) without tying that treatment to a usually failing course of action: weight loss.
Michelle,
Great rant!
I agree that the HOW is more important than the WHAT. And, ironically, when we create a healthy HOW we are more free to eat a healthy WHAT.
Working with people on the HOW is much more fascinating than the WHAT!
Of course weight and health are different, but what you eat over time makes a HUGE difference for chronic disease. And there are small things, too. I choose not to eat junk food most of the time, because it affects my skin and digestive functioning and overall energy. The small things will vary for people, and might not be worth it at all. But decreasing your risks of heart disease, cancer and stroke are huge! You can’t make your risk zero, but it does have a huge impact, and can be seen by population studies, and what happens when those people switch their diets overall (meaning, not just genes).
You just reference acute conditions, but it makes a huge difference for chronic conditions.
Really? A huge difference for chronic disease?
I am not convinced of this.
Data plz.
(And, just to add to this a little, the best evidence I’ve seen thus far of a certain diet reducing a chronic disease risk factor is for the DASH diet — but again, in studies, this applied only to subjects who were also experiencing an acute issue: hypertension. I don’t think there’s evidence that prescribing DASH — or any other therapeutic diet — to people without current illnesses significantly reduces all-cause mortality. If you know of a study that shows this, I would be interested in reading it.)
Here’s a rather large RCT (n=48,835 postmenopausal women aged 50 to 79 years, of diverse backgrounds and ethnicities) with a rather disappointing conclusion:
(Emphasis mine.)
In this study, it’s a huge RCT, but the RCT is postmenopausal women, aged over 50. To study them for 8 years when they’ve already lived for 50 years (eating who knows what) skews the study in your favor, don’t you think?
My mother just had three heart operations from smoking her whole life. She has now stopped smoking, of course, but she can’t take away the damage that 45 years of smoking did to her body.
Don’t you think it’s the same way with food? If you eat crap for 45 years, you can’t take away the damage it may have caused. I’d like to hear your opinion on this.
I think that’s a fair point. However, I also don’t think it’s likely that *all* the participants in that study (and there were a lot) were very likely to have eaten TOTAL CRAP FOR THEIR ENTIRE LIVES before the study began. Because, contrary to popular opinion, I really don’t think that lowly of the average person and their eating habits.
Perhaps this isn’t a very scientific point for me to make, but, to me, it just sounds…unlikely. I mean, that’s why they get big populations of people to study in the first place, and why they randomize people to the two groups, etc. There was bound to be a *whole range* of eating habits represented by the subjects chosen. I mean, that’s part of what is so great about having a large sample size.
This is very similar to the earlier argument that maybe they’d all been exposed to arsenic or something else that had a negative enough impact to “undo” any positive effects of the actual treatment.
And, if that were the case, then I have to ask — how would this work out in the general population? Sure, maybe we’d see a better treatment effect if the study followed younger people who stayed on the treatment diet for a longer about of time, but at what point would someone actually be *satisfied* with the population chosen and the length of time they were followed? After 10 years? 20? It’s pretty ironic that quite a number of pro-weight loss studies are perfectly damn happy to follow up for 1-2 years, and expect their interpretations to then be accepted at face value.
Also, a good deal of the people who are seeking dietary treatments for health and/or weight loss reasons in The Real World are *precisely* the population reflected in this RCT — postmenopausal women, aged over 50.
In fact, I would hazard a guess that a huge amount of the people who use commercial weight loss services belong to this demographic group. Postmenopausal women over age 50 are not a fringe group, or a small group, especially as the Baby Boom generation ages.
However, I do think it’s a fair point and something worth looking into. I still need to do more research on the What We Eat in America survey (part of NHANES.) I’ve just been too busy reading a ton of other things and attempting to write stuff, so I haven’t managed to figure out what some of that data really *says.*
I agree with Anna here, and I don’t have proof either. I think people who avoid fruits and veggies, and eat lots of bread, meat, cheese, are doing a huge disservice to themselves in the long run, and their chances for cancer, heart disease, diabetes, etc. are much higher. I think soda is toxic, juice is sugar shock, and bacon is just so wrong (and so tasty). There’s no “proof” of global warming either, but the evidence points that direction, and most people who are capable of understanding the science believe in it, because the signs are pointing that way. Unless they have something to sell, similar to food industry propaganda.
I appreciate your position, Julie and Anna, truly. Obviously, it’s one that’s held by a lot of people in very high regard in the scientific community. Still, I disagree.
I’m going to do a little digging and see what I can turn up.
That’s some provocative statements. Ah, to start with, there is certainly proof of global warming, inasmuch as it is a measurable phenomenon, it’s been measured, and it’s happening. Your suspicions about food, however, are more cultural biases than things that have any clear evidence that they are somehow harmful…there is a lot of propaganda about diet, and there’s a lot of money involved in one way or another, and there are lots of issues about social identity and class that are also involved. But the science isn’t there to support the more extreme claims about ‘junk food’ being somehow poisonous. It’s all food, by definition, because it sustains you. Attaching negative emotions to certain foods is terribly unhealthy psychologically, and is perhaps the result of advertising and marketing efforts to influence our food choices rather than any scientific evidence of risk.
If you eat when you’re hungry and put a little effort into varying your diet, you’re at no real risk. That should be the message to get across, I think.
Thanks so much, Chris. I think this is an excellent way to put it.
And welcome.
julie: I happen to know a little about each topic (currently working in government policy on energy conservation/climate change, and have been following nutritional and obesity research for 15 years), and to my knowledge there’s no evidence for your nutritional beliefs that’s anywhere nearly as convincing as the fact that the polar ice cap is melting.
I was under the impression that there’s a tremendous amount of proof for global warming …
This seals it. You’re in TO right? And in private consulting practice?
I need to come see you. And pay you. So that I can tell the diet busybodies in my life that I’m “working with a nutritionist”.
I mean, I hate going to Toronto. But I do it often enough anyway.
I’ll email you :)
Okay, this may be the sort of thing that would require a professional consultation so please feel free to say so if it is, but how does what you eat need to change for pernicious anemia?
I’m diagnosed with deficiencies in B12 and D and living in Seattle. Currently I’m taking supplements for both. No, I’m not a vegetarian — I pretty much eat everything, just not all at once. Well, not okra, but you get the picture. :)
Pretty much, you need to take supplements. In the case of pernicious anemia, there’s usually a problem with your ability to absorb B12, and you have to supplement an amount of it that might be difficult to get from food alone. So the therapeutic nutrition I mentioned for pernicious anemia is in the form of supplementation, not necessarily food (though, of course, it shouldn’t hurt to eat good sources of B12, which is stuff like meat, milk, and eggs.)
As for vitamin D, I’d take the supplement for as long as your doc wants you to. If he/she says that your vit. D status has returned to normal and takes you off the supplement, then it’s a matter of making sure you eat foods that naturally contain, or are fortified with vitamin D (like milk, margarine, salmon, tuna, egg yolks, cod liver oil, mushrooms, etc.) and getting some sun exposure on your skin each day.
However, some experts contend that those of us living in North America may not get the optimal amount of vit. D from sunlight alone due to our climate and position in the northern hemisphere — Health Canada recommends vit. D supplementation of 400 IU per day for all adults over 50 years of age.
Health Canada recommends vit. D supplementation of 400 IU per day for all adults over 50 years of age.
That’s where the “living in Seattle” comes in – Seattle’s north of Toronto :)
See? There you go! You’re practically Canadian.
But presumably not-adequate production through fall-winter-early-spring times? I guess?
Seattle is at 47°N, so you’re almost there. Portland, where I’m originally from, is 45°N.
Toronto? It’s only 43°N. So I actually moved south when I immigrated to Canada.
In my Armchair Research I’ve found that 400IU is now being thought not nearly enough for many people and should be more like 1000IU, given new discoveries about the importance of vitamin D beyond preventing rickets. I know I had to take 10,000IU of D3 (in oil caps) per day for four months to raise my vitamin D levels to the top of the range from Officially Deficient, and it takes 5,0000IU daily for me to maintain a good level.
You might be interested in some of the forum posts at the Pernicious Anemia Society. (You have to join to post but it’s free to read.) I have it and I dose by symptoms not textbook, so it can be 2 injections a week or 1 a month. It averages one every fortnight. There’s a common idea held by doctors that a n injection every three months is sufficient. But this may only work for those that do not have impaired intrinsic factor secretion, such as vegans/vegetarians/other limited diets. Those with pernicious anemia (which by definition involves impaired IF whether by stomach removal, ulcers, antibodies) have a greatly lessened ability to use B12 stored in the liver as the B12 released by the liver requires IF for the body to latch onto it for further use. And B12 released by the liver into the small intestine can’t be re-absorbed well if at all. So someone with PA might have a liver full of B12 and high serum B12…but no way to use it and recycle it. Given that injected hydroxocobalamin is nearly all excreted from the body within 48 hours, it’s unsurprising that people with PA would need more frequent injections than the current textbook recommendation. (Which as I’m sure you’re aware also tend to assume that 99% of people with PA are elderly…which is no longer true, and it also stands to reason that younger people would have a greater need for more B12.) This may also explain why some people feel better taking 1000mcg of oral B12 supplement daily instead of injections every 1-3 months as they have a constant supply of B12 instead of occasional spurts. I supplement my injections with methylcobalamin sublingual lozenges, which works for me.
Sometimes I really wonder just how many early-onset dementia, multiple sclerosis, Parkinson’s, etc, diagnoses are really PA. :/
(Getting off my PA soapbox now.)
Very interesting…thanks for the information. I’m not very knowledgeable about pernicious anemia — it’s something we covered in school, and I’ve met one or two younger people who had it, but I really don’t know all the details, so it’s good to hear from someone with an insider’s perspective.
And yes, I’ve heard that about vitamin D as well. It will be interesting to see if they change the DRI on it, or the recommended supplementation level or anything in the next few years.
For some reason, I’ve totally got vitamin D on the brain in the last few days. I think it’s a very hot topic right now in the literature (how nerdy is that?) and somehow that has trickled down to me.
Well, let’s see – Julie is currently dieting and bashes FA on her blog. I don’t care what you choose to do food wise, but it is extremely rude to come and preach your style of living on others who do NOT want to hear about it. I don’t need you to tell me what type of food I need to put in my body.
If the “science” points to it, please provide it. The dangers of food are grossly exaggerated by those with an agenda, and those people who believe their style of living should be forced upon everybody else.
Meat is bad? Then why does it contain protein, iron, and zinc? Carbs are bad? Then why do they provide your body with the energy it needs to run? Give me a break.
Sarah, I also appreciate your position and obvious passion for the topic. It’s a heated and controversial subject for most of us.
I haven’t mentioned this explicitly, but I don’t have a problem with people who are dieting (or who disagree with fat acceptance) reading and commenting here.
In fact, I’d like us to be able to have frank discussions about dieting, food, and weight — even though I can tell you all up front that I am likely to disagree with your position if you advocate weight loss, and I certainly won’t countenance any kind of evangelizing to, or shaming of, other commenters.
Still, everyone is welcome here, and all relevant opinions (respectfully stated) are valid — even if we disagree.
I’m sorry if anyone may potentially feel triggered by talk of restrictive or fearful attitudes about food, but I think it’s something worth talking about, and not to be afraid of discussing. I am interested in knowing why, for example, Julie and Anna hold their particular opinions, and I’m interested in all of us searching the evidence and bringing to the table what we know, as well as discussing with an open mind those things we merely think we know.
Anyhow, Sarah, I certainly share your position on certain foods being “bad” (which is to say, I don’t think they are), and also on the value in speaking in terms of what the evidence shows, not just gut instincts (which are often inspired more by bias and prejudice than we’d like to admit.)
Please, everyone — let me know if you feel threatened by the type of discussion I’m advocating here. Tell me how you feel about it, and whether you think you’d want to participate in that kind of thing.
What I said is that people who eat lots of meat, bread, and cheese, and avoid veggies and fruits are doing themselves a disservice. YOU are having a snit and misstating my words. I don’t tell anyone what to eat, but neither do I appreciate people coming up and wanting to argue with me because I lost weight, though it’s “impossible and impractical”. You can feel free to bash people who want to lose weight, I can feel free to criticize some aspects of FA that I don’t like. If you read my blog, rather than blurting out your ranty angry comment, you’d see I’m critical of all sides of the issue.
I have all of my opinions about what is poison and not from my biochemistry classes. I took one nutrition class, ever, and don’t believe most of the media. I believe in chemistry, and chemistry only.
Alright, alright. We’ve heard from both of you now. I don’t want this to degrade into some kind of cage match.
People are allowed to disagree with each other here. People are allowed to disagree with fat acceptance, or to disagree with dieting, or with me personally, or whatever.
But I want us to discuss shit here, not just arm-wrestle and have pissing matches. In order to discuss, we’ve gotta put the gauntlets away and agree to engage in a modicum of civility and cheek-turning.
Okay?
Truce?
I don’t think it’s fair to demand that Julie and Anna provide scientific evidence that what you eat matters. They are probably not doctors, scientists, or nutritionists.
It’s pretty well accepted “common knowledge” — not to mention common sense — that eating a well-balanced diet, with lots of vegetables, is good for you, and eating just meat and carbs is going to leave you less healthy, and can actually lead to heart disease and other conditions.
Now, just because it’s common knowledge, that doesn’t make it true. But I think the burden is on you to provide evidence that it’s not true. You argued that what you eat doesn’t matter — I would love to see more proof of that. One study isn’t enough.
I think you’re right, Hannah. The burden of proof is on me, though it can be difficult to prove a negative.
Still, I am interested in finding more citations for this. But I am somewhat constrained by time, so bear with me.
Also, quick PS: What I am saying in this post, and in these comments, is not that eating nutritious foods ISN’T good for you, or DOESN’T confer some health advantages. Naturally, I think eating well is good for people.
What I disagree with is the contention that it makes A HUGE difference in average, healthy people’s health.
The point I am trying to make is that “eating well” (however you choose to define that) is actually only ONE, SMALL variable, among a vast pile of other influential variables, upon our health. And that the media and messages we get from the nutrition establishment or the government or public health agencies or whathaveyou often blow out of proportion the actual benefit (or risk reduction) people can expect to receive from eating in a certain way.
Nutrition is a young science. We don’t know everything. We think our guidelines on healthy diets are good now, but things change, discoveries are made. And eating is only one, small part of your life. Your access to healthcare, your education level, your income, your access to food in the first place, whether you smoke or drink or have congenital health problems all conspire to far, far outweigh the effect of eating 5-10 fruits and vegetables a day on your health.
I wish it weren’t that way. I wish eating a certain way was the magical answer to everything, and would eliminate risk in the way lots of us have been taught that it can.
But, no, after all my education and work in hospitals and seeing people who get sick for absolutely NO reason other than sheer bad luck…no, I don’t think it works that way.
And I think it’s actually unhealthier for us to stress about it to the extent we do, than to relax a little, take the long view on what “good nutrition” is, and let some stuff slide. To allow ourselves to be imperfect, and to be okay with that.
More to come later. Thanks for the comments. They are helping me think this through.
Your approach, Michelle, is really refreshing to see. I wholeheartedly agree that attitude toward the food we eat is more important than the actual foods to a large extent. Obsessing over keeping ‘bad’ foods out of our mouths is just as unhealthy as binging on everything that appeals to us as if we’ll never get another chance to taste it again. You made a good point on this blog that if you happen to eat a larger amount of food than you planned, that can be okay. The whole reward and punishment and guilt and pride over different ways of eating is a significant enemy to overall health.
I happen to be working on this in my own life, it’s been something I think most of us struggle with, it’s pretty inescapable in our culture, and I am still trying to figure out how to to negotiate my way around it.
One issue I have is that I don’t know how to make the choice between eating comfortably, whenever I feel hungry and whatever amount feels good at the time, and thus being unable to fit my clothing properly anymore, or keeping track of food and calories in order to optimize my physical comfort in my clothing and movement choices, even if it means denying myself certain foods at certain times (I don’t deprive myself of entire food groups or anything just quantities and frequencies). I’m curious to know what you think about this, if you think we need to make a choice like this, or if there is a way around it? (Aside from buying bigger clothing)
Also, when you say the how is more important than the what, in terms of eating for otherwise healthy people, are you limiting that to adults and not young children who are growing and developing? I feel that it would make a difference in relation to age. I may be wrong but I have worked with toddlers diagnosed as failure to thrive, as well as overweight and while it has been addressed that children are naturally intuitive eaters, I think parents have a very strong impact, whether positive or negative, and the child who lives off of noodles and fries is going to be far worse off developmentally than the child with balanced foods in hir diet given that they didn’t begin with certain developmental problems already.
Sorry for rambling so long, and I appreciate any feedback you might have.
One issue I have is that I don’t know how to make the choice between eating comfortably, whenever I feel hungry and whatever amount feels good at the time, and thus being unable to fit my clothing properly anymore
Yes, I see this a lot. This is a very common outcome, in my opinion, of living in a culture that doesn’t value internal signals of hunger and satiety. And that’s why it’s not so easy for people to just decide to eat intuitively — it certainly wasn’t easy for me. I had to see a dietitian in order to get help to learn.
I’m curious to know what you think about this, if you think we need to make a choice like this, or if there is a way around it? (Aside from buying bigger clothing)
Well, unfortunately, my choice WOULD be to buy bigger clothing, and trust that, once my eating was sorted out (and any underying medical issues dealt with) my body would return to whatever weight was most appropriate — whether that’s higher or lower. Just as a personal anecdote, my weight stabilized for the first time in my adult life once I sorted my eating out. Previously, I had always gained 10 lbs per year and thought it might never stop.
Also, when you say the how is more important than the what, in terms of eating for otherwise healthy people, are you limiting that to adults and not young children who are growing and developing?
To be clear, when it comes to children, they obviously need appropriate nutrition (WHAT) in order to grow. But choosing this nutrition is only partially up to them, and the HOW is still just as crucial, because problems in the feeding relationship can negatively impact that nutrition.
As Ellyn Satter says, parents should be responsible for the What, When, and Where of feeding, while children should be responsible for the How Much and Whether.
thanks for your reply, also thatnks for the Ellyn Satter, looks like a very helpful resource for parents.
If you’re not messed up around food in some way, it balances out over time.
Unfortunately in this society I think it might be more rare to meet someone who’s not messed up about food in some way.
That said, I really love this entry. I have days where I eat three square meals all with fruits or veggies and I have days like yesterday where I literally eat nothing but pieces of toast with peanut butter (and not the no-sugar, no-salt kind) just throughout the day (ok, yesterday was a bit random, but you get my point.) I enjoy ‘processed’ foods and drink things with artificial sweeteners. And I know that some in the health industry are convinced that anything less than a diet comprised of 98% non-starch vegetables is leading me down the path to all sorts of diseases, but I don’t think the science is behind them at this point. Most of the time, when big epidemiological nutrition studies get their results tested in lab conditions it doesn’t ever seem to back up the initial results. There’s actually an interesting article I read recently on the problems with basing so many nutrition recommendations on these big general studies.
Anyway, to veer off the super-nerd tangent before I write a damn book in your comments, this entry has obviously given me a lot to mull over. So thanks. I’m looking forward to the next one too.
And, you know what, that’s the unfortunate downside to this. And that’s likely also why people are so panicky when it comes to food.
So, the short answer is, of course: stop being messed up.
But that’s so much easier said than done.
Interesting. I’m going to be even more interested in the how. I don’t like the way I feel but I’m not necessarily moved to DO much about it. Honestly, with three kids and two jobs and all the details just in THAT, “diet” eating is hard to squeeze in. But I am reading labels and hubby and I are having fun with finding foods that have ingredients we recognize, and the fewer the better. :) Just in that little bit, eating what we want, I personally am finding myself eating a bit less of it and feeling fine. If weight loss results, hey, I won’t complain. You know?
Gah. I’m such a battler with myself.
Hey cuz :)
I definitely think people should choose foods they feel good about. It’s all a trade-off, determining how much mental real-estate you’re willing to devote to any way of eating. That amount of real-estate is going to differ from person to person…and that’s totally fine.
To me, it sounds like you’re doing pretty well.
I think that frank discussion about food in the context of a blog like this could be very positive. It is hard to maintain fearful and restrictive attitudes when they are scientifically and anecdotally proven to be both not particularly healthful, and in some cases, mentally and emotionally harmful. There are a lot of people that could benefit from that kind of paradigm shift, but they’d first need to feel safe enough to enter this space and express themselves.
After years of eating in an informed and non-judgmental way, I know that I can trust my body to tell me what it needs. This is not everyone’s experience, and reading those experiences is helpful, either in enlightening me, or, more often than not, in re-solidifying my decision to eat whatever the hell feels good in the moment.
I’m glad you think so, casey. I don’t want to alienate people involved in fat acceptance, since I am a truly dyed-in-the-wool fat acceptance person myself. But I also don’t want to wholly insulate this blog, or the conversations we have in comments, from the very pervasive messages of the culture or the opinions of people we disagree with.
And I’m still interested in hearing other commenters tell me where they stand on this, so we can create a stable kind of space here.
Have you read “Mindless Eating”? It’s a great book that discusses the how, why, and how much. The 2 latter of which are the problem in my opinion. I am as big as I am more from how much I eat than what I eat. I do eat fairly healthy most of the time but can go overboard on the healthy foods. I can eat a tub of hummus in one sitting pretty easily. This is an excellent book for anyone who wants to improve their health through food without thinking too much about it or making changes that can be too drastic. You make some really great points in this post. Keep up the good work. I love your frankness.
Yes, I just recently read it. Mindless Eating is all the rage among dietitians here at the moment.
I found it very interesting, but I’m also hesitant to believe that Wansink’s observations can be extrapolated over a person’s entire life. Which is to say, for people who haven’t read the book, yes, I believe external influences (like dish size, time of day, variety of food offered, etc.) do influence what we eat, and we can make “mistakes” in the amount we eat in the short term. Otherwise, we’d never have that experience of leaving the table feeling overstuffed, but just about everyone has had that experience at some point, eating more or less than they really wanted.
However — I give more credit to the human body over time. I think we compensate, over the long term, for eating “mistakes” we might make in the short term. Granted, the way our marketplace and culture is set up leans consistently toward encouraging people to eat more at every opportunity rather than less — but even if it does succeed in influencing people to eat consistently more, and maybe even gain the few kilos that we’ve seen the population gain in the last few decades, I don’t think it’s quite the crisis/tragedy/disaster it’s made out to be.
To complicate my position even further, I dislike aspects of the food industry just as much as I dislike the diet/weight loss industry. If you look into who the stakeholders and umbrella corporations are for both industries, you’ll find lots of overlap — meaning, they are essentially two sides of the same coin, whose purpose is to manipulate people’s desires (whether for food or thinness) for profit. Not just to tap into or exploit those desires, mind you — but to actively manipulate them.
Homey don’t play that.
There are many studies that show the link. You can’t do an effective intervention study though, because you can’t control people’s diets in a scientifically proper way (really *controlled*–that’s why diets fail, right?) over the decades it takes for chronic disease to develop. So you do epidemiological studies, or retrospective studies, or test tube studies (veg A has compound B that decreases C carcinogenic effect).
http://www.diseaseproof.com/archives/cancer-plant-nutrient-phytosterols-may-halt-cancer-development.html
http://jama.ama-assn.org/cgi/content/abstract/302/4/394?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Djousse+&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT
There are a number of reasons the study you cited didn’t work. It could have been not strong enough (not enough veggies), or didn’t follow over enough time, or there could have been something that overshadowed everything else (everyone ate aresenic ;) ). I stick by what I said about it making a strong difference–CVD and type II diabetes do not exist in certain populations until Mc D’s and the like comes–diet was the biggest change for them. There are many studies on this. Certainly lifestyle things like exercise and stress levels played a factor, but we can safely infer (frm our test tube studies) that diet is a big deal.
You said:
Okay, I’ll indulge you for a second here.
So, for that type of diet to do what you propose it does — which is reduce risk in the general population — it would have to be *controlled* to your strict scientific standard, right? And if this can’t even be achieved in an intervention study, then how do you propose it ever be achieved through public health measures on a large, free-living population?
Anyway, that’s not even the immediate point — because they did ensure the intervention was actually followed — whether or not you agree that it was controlled tightly enough, they used validated assessment tools to determine whether the participants were still following the diet. It was a true Randomized Controlled Trial (RCT.)
You also said:
The study followed the people for eight years. Given that most of the nutrition intervention studies I’ve read tend to follow for one or two years, max, this is actually a pretty long time.
It’s true that the diet may not have been super-strict, according to some standards. It was more concerned with lowering the total fat intake to 20% of energy than anything else, apparently.
However — your first statement (that the diet may not have been controlled tightly enough) indicates that you think people would have trouble complying with such a diet. And if they did, why would an even more intense, and presumably difficult-to-follow diet, then be any more practical at reducing risk for the actual population?
If people can’t follow the treatment long enough or closely enough to get the desired effect, then it ain’t a good treatment. No matter how well it performs in a laboratory or a test tube.
Lastly:
This is highly unlikely, given that the sample size was almost 50,000 people, and they were recruited from 40 different centers in the US. Even so, they were randomized to the intervention, so if everyone ate arsenic, then BOTH the control and the treatment group likely had the same exposure to it overall. Given that randomization, the *only* difference between the two groups was the diet.
And yet, they couldn’t show a significant reduction in actual risk. After eight years.
Epidemiological studies can only show correlations. That’s a good place to start, but it just ain’t the whole story. You cannot conclude causation from it.
I’ll respond to the heart failure study you posted when I’ve had a chance to read it. Thanks.
I want to add, whether you eat well or not is still not an ethical thing. But if you are interested in eating healthier, it does make a difference. And if you slowly improve your diet over time, it WILL count, because it’s the big picture that matters. But don’t count and losing weight, and don’t follow a plan, follow some common sense and your body. Use tips from others but see what feels right for you. Or don’t. It’s only your own business.
I would like to know your opinion on how much the “what” of eating matters in your treatment of patients with eating disorders. Specifically, do you focus on this aspect more than the “how” with trying to get the hypothalamus-pituitary axis to function again?
I’d say that the physical issues associated with eating disorders (specifically, anorexia nervosa and bulimia) can actually be treated much like nutrient deficiencies. I mean, the wasting associated with AN is sort of like marasmus, isn’t it? Which is to say, a form of protein-energy malnutrition. And one of the issues commonly associated with BN is a fluid-electrolyte imbalance. These are therapeutic nutrition issues, not general-healthy-population issues. This is malnutrition.
Malnutrition must always be treated with the WHAT — which is food and/or nutrition supplementation and/or nutrition support (i.e. tube feeding.)
The HOW can come later, when the patient is medically stabilized and able to function cognitively.
Precisely! And it is the How that really influences long-term recovery and weight maintenance in the ED population. ED clinics essentially teach those in recovery exactly this: The What does not matter. The How *always* does. The only time that they will argue that the What matters is when whatever the food is, say diet drinks, falls under the category of ‘will inevitably be misused or contribute to ongoing food difficulties’.
Of course I’m not sure how I translate the How into my own life but that’s another story. I have developmental food issues. They can get a bit tricky.
It’s not that I doubt diet can have an effect on long-term health. It’s just that when experts start blaming particular foods as 100% disease-promoting that I think they’re full of it. Since I’m not yet a scientist, I hope it’s ok to link to a couple of posts that explain why I think that is more articulately than I could. (I don’t know your link policy, Michelle, but I wouldn’t think either of these contain anything triggering.)
http://wholehealthsource.blogspot.com/2009/04/modern-diet-health-epidemiology-self.html
http://wholehealthsource.blogspot.com/2009/04/modern-diet-health-epidemiology-self_09.html
I’m totally fine with links. We can always examine them critically.
And my main contention, too, is not with the idea that diet may have *some* effect on long-term health, but the statement that it has a HUGE effect on chronic disease risk, and presumably, on all-cause mortality. Especially in the case of the “healthy population” who haven’t yet developed any strong risk factors or acute diseases.
I’m just very suspicious of such claims, especially in the absence of strong evidence from which causation can be inferred.
Please hurry up and post the HOW part of this. I am very new to HAES. I’m reading Linda Bacon’s book. I can see how I really don’t know how to eat normally for me. I’m including lots more veggies, oatmeal for breakfast, cooking for myself, and eating at the table and exercisng. I know how to binge and I know how to go into low-carb diet mode. It’s hard to try to just eat normal and not be restrictive. It’s hard to let go of the concept of eating for weight loss.
I will, I will, for sure.
But, for right now, please accept my sincere CYBERHUGS AWWWWW.
No, really. I know it’s hard, and it sucks. I will address the HOW tomorrow after I run some errands.
HOWEVER, I cannot promise that it will be the answer to all your problems. Sometimes learning to eat normally is just hard. For a long time.
Martha, yes! I know exactly how you feel! I just read Kate Harding’s book and I’m working on intuitive eating, but finding the hardest thing is to stop eating when I’m full–think it started when Ma put me on my first diet at age 9!
Michelle–how do we clone you down here in the States? I gotta confess, til I found your website, I hadn’t met a nutritionist I could stand. Many seem to have huge control issues, and I met one who told us (with a straight face) that she no longer ate fruit with meals because it took too long to digest and would ferment in your stomach and could get you drunk!
My husband is diabetic and had bypass surgery. He had to meet with a dietitian at his cardiologist’s lipid clinic, and came home livid, almost in tears. His perception of that consult went something like: “Do you eat cheese?” “A little.” “Well, don’t.” He said she did not emphasize any of the things he should be eating (fruits, veggies). Then his cardiologist recommended the South Beach Diet, which makes sense in emphasizing lean meat, whole grains, fruits and veggies, so we try to follow that. Then the next time the cardiologist announced he no longer likes South Beach, he recommends Weight Watchers! Now I know that WW now says you can choose to eat whatever, just use up all your points at once if you like, which isn’t a great idea for a diabetic, so we are trying to stick to the whole grains, fruits, etc. We both are heavy, but are shooting for healthy/HAES.
Anyway, thanks Michelle! Keep it up, you’re a doll!
That is…the most ridiculous thing I’ve ever heard. But I’m fairly certain this is some sort of food-combining myth (popular diet books about food combining include Fit for Life and the Suzanne Somers stuff.) It’s been around as a theory for quite a while, and re-emerges in popularity every now and again, under different names or celebrities.
As for the dietitian at the lipid clinic…sigh. Yeah. That sounds familiar. And totally unhelpful.
You sound like you are making some good efforts, so don’t stress over not knowing the 100% PERFECT DIET to follow or whatever. You sound like you have a strong, credible intuition about what to eat. It’s not going to hurt to apply some of the conventional, conservative nutrition advice (like more whole grains, more fruits and veggies, lean proteins, especially fish and legumes, lower-fat dairy products, avoid trans fats, and maybe replace your cooking oil with canola oil) if you can do so without being restrictive and punitive, or spending way too much time/money planning your diet, or worrying about weight for weight’s sake.
Cause seriously — that kind of stress ain’t good for your heart any more than saturated fat is.
Thanks, I couldn’t agree more. And just so you know, I am a (recovering!) lifetime member of WW from years ago, when I lost 60 lbs. Of course, it’s back, and then some, and apparently I’m not alone, since 95% of people who lose weight gain it back. Oh, and I also do Jazzercise or Curves 5-6 days a week. (heavy sigh)
Looking forward to the HOW -part, Michelle! :) Thanks, again, for a great post.
I thought it wasn’t possible to love your blog any more than I already do, and then you write this post.
But rather than just leave a brown nose comment, I will add one small question to the debate – what about roughage? I know from personal experience that one’s body does not keep adequate stores of roughage. *cough*
Talk fibre to me!
This actually made me laugh. OUT LOUD.
You’re totally right — fibre is NOT stored by the body. At least, not that I know of.
Thankfully, fibre is not really an acute life-or-death issue, and if you’re eating foods that come from plants, you’re likely getting at least some fibre (though, obviously, most people don’t get the “recommended” level of fibre, which is about 25-35 g per day. However, if you’re not having digestive issues, I’m not sure it’s something worth panicking about.)
Fibre is present in fruits, vegetables, legumes, grains, etc. And, obviously, it’s an easy enough thing to change if one notices certain…issues…with…you know…THINGS…which I shall not mention.
Okay, poop. I said it — if you’re having trouble pooping, for heaven’s sake, try to eat more fibre. And drink more water.
Hi Michelle,
I don’t know how happy you are about specific “please-be-my-unpaid-online-nutritionist-for-a-sec” questions, and I’m sure that’s not what the blog is about, but that line about how “calcium is present in so many foods that it can be difficult to avoid” caught my attention, and I really need to ask: could you elaborate a bit on this idea or point me/us to online resources on this issue? The thing is, I’m not too happy about milk, and not a red meat eater, so whenever I mention that no, in fact I *don’t* drink two glasses of milk a day, I get lectured about OMG TEH OSTEOPOROSIS!!!11!!! I really would like to be able to respond with data about how there are other ways to load up on calcium apart from eating/drinking two portions of the better-known calcium-rich substance out there.
Yes, totally! Okay. Very good question. Here is a list of 10 sources of calcium, in order of the amount of calcium they contain per serving (ones I find particularly odd or amusing are capitalized for your entertainment):
1. Yogurt (~450 mg per cup)
2. SARDINES (w/bones, ~430 mg per 3 oz)
3. Swiss cheese (~400 mg per 1.5 oz)
4. Cheddar cheese (~300 mg per 1.5 oz)
5. Milk (obvy, ~300 mg per cup)
6. BLACKSTRAP MOLASSES (~175 mg per Tbsp)
7. Pudding (~145 mg per 1/2 cup)
8. Tofu (if calcium is added – check the label, ~140 mg per 1/2 cup)
9. Flour tortillas (~90 mg per 10″ tortilla)
10. Bok choy (~80 mg per 1/2 cup cooked)
So you have quite a few decent alternatives to milk, and that’s not even getting into all the vegetables that contain decent amounts of calcium. I can email you a couple of handouts that have more detailed food lists, if you like.
(Also, for reference, the recommended amount of calcium for ladeez between 19-50 years of age is 1000 mg per day.)
So, if you want, just eat a bunch of sardines and molasses and tell everyone to go eff themselves.
*CAVEAT: part of the reason the “2 glasses of milk per day” meme has taken such hold is because milk is often fortified with vitamin D, depending on where you live. So that is part the reason. You don’ t JUST need the calcium, you also need the vitamin D. But there are other ways of getting it, too, if you hate milk.
Thanks for the list! (And I’d love to receive those handouts if you have a minute to send them my way). The sardines + molasses +telling people to go eff themselves sounds like a fun plan, by the way :)
I emailed them, so check your inbox :)
Mmmm, blackstrap molasses. My favorite topping for oatmeal. I have a feeling that I’m about to get asked for ways to eat molasses again (my sister-in-law is pregnant for the second time and asked me this question with her first because she’d never heard of it before).
Thank yo!!! It has taken me years to get to a point where I can see that my nutrition will balance out…And more importantly trust my body to balance out.
One of my biggest struggles now is getting others to be more accepting…
Excellent post. Just excellent.
I would like to second the desire for you to makes clones of yourself to do nutrition work in the US. Heh. My mother lost around 75 lbs a few years back and is now in school to become a nutritionist. All because she believes you can only be healthy when thin… and now that she’s thin, she’s magically healthy, and she wants everyone else to become thin and healthy like she did. It’s hard for me… she HAS improved her diet and has finally become healthier, but not because of the weight loss. The weight loss was a side effect of her changing her diet so drastically… but she doesn’t see any of this logically. She sees that she tried to change things to become thin. It worked. BAM! That MUST be why she’s so healthy!
*headdesk*
I cannot have FA conversations with her at all. It’s cognitive dissonance to the Nth degree. And now she plans to gain knowledge and certification and open a fat-hating practice so that she can make everybody as thin AND healthy as she is.
I’m scared, honestly.
See, that’s the only kind of dietitian I’ve encountered, and they make me want to run screaming in the opposite direction. I wonder if your mom knows she has that effect on people?
Hugs, Jasie! I feel your pain.
It seems that you’re in an unusual field if you think nutrition (as in what you eat) is irrelevant, no? Why should there be a field of nutrition at all? Seems, by what you’re saying, that all that is needed is some ED/behavior training. I’m no nutritionist, but I am chemist, and I’ve had to study more biochem than I want to think about, and foods are chemicals. They are both toxic and protective, sometimes in the same plant (or animal). Or lab. Obviously, I think in terms of antioxidants and free radical scavengers, which is different kind of thing than heart disease and diabetes, which I don’t understand, as it’s beyond the scope of organic chemistry.
Regarding global warming, many ideas about nutrition, gravity, evolution, these are theories (at this point). All the evidence points to a certain hypothesis, and it follows a certain path that most can’t deny, but scientifically speaking (different than common sense), it’s still theory. You can’t prove it, can’t rigorously test it, though most accept it, as it CAN be predicted, not always the when, but much of the what and how (at least for global warming)
Julie, are you seriously comparing our very preliminary, conflicted understanding of nutrition (and in particular, your personal interpretation of it) to Newton’s theories, which are incomplete but accurate enough to be used to make dependable predictions in aeronautics and engineering, and the theory of evolution, which is probably also incomplete but has a general aim which is supported by piles and piles of evidence and contradicted by very little?
By all means, live by your interpretations of and intuition on nutritional research, but I doubt they’re on level with Newton’s laws of motion and the theory of evolution.
Julie, you are misunderstanding and misrepresenting what I’ve said here, both in the post and in comments.
I want you to continue to come here and comment, but could you maybe tone down the nastiness just a bit?
I don’t think nutrition is irrelevant. Obviously, for people with certain conditions, it’s HIGHLY relevant. But that doesn’t mean that for extraordinarily privileged people such as ourselves, who live in countries with abundant food supplies and agencies to ensure the safety of both our food and water, and who don’t have health conditions that change the way our bodies handle nutrients, it’s appropriate to be UTTERLY PANICKED about what we eat.
I also don’t think it’s appropriate for people to feel they have to follow one-size-fits-all nutrition recommendations that don’t feel right to them or fit into their actual daily lives. I think people should test which foods allow them to function best, and which foods they enjoy, and can prepare, and have access to, and balance it out that way, rather than just attempting to cheat death at every opportunity by making changes that don’t fit into their lives, or don’t seem helpful.
Chronic disease risk is real, yes. I’m simply not yet convinced that the average, healthy person who eats an average, varied diet is going to dramatically reduce their long-term chronic disease risk and/or mortality risk by making burdensome changes to their daily diet.
In fact, I think such changes often carry other risks that we don’t acknowledge, EVER — and if someone finds making certain changes (like, say, trying to eat 7-9 servings of fruits and vegetables daily) to their diet to be burdensome and reducing their quality of life, then I don’t think it’s worth it.
The cost-benefit analysis of making dietary changes for the chance of reducing chronic disease risk is different for every person. Some people can make those changes easily, without feeling burdened. But for those who honestly can’t, they shouldn’t be doomed to a lifetime of hearing that they are GOING TO DIEEEE OMG!!!, because, at the very least, this can cause a kind of “nocebo” effect that may be just as bad for a person’s physical/mental/overall health as not eating enough fruits and veggies.
That’s my position. Until I see strong evidence to the contrary, that is where I stand.
I’d also like everyone to remember that, at this point, nutrition itself is still a very young science. Our theories about food and disease might very well seem laughable in twenty or fifty years’ time.
I also think that I’m being misconstrued here, not to mention outed and attacked for being a weight loser, but it’s not my blog, so I’ll ignore it. I don’t think people who eat varied diets should panic, or even stress, I just don’t think that most people eat varied enough diets. I think many folks (irrelevant of weight) rarely eat fruits/veggies other than ketchup, and plenty also eat very little fresh food, all processed. You’ve read a bit of my blog, I sometimes talk about what I eat, and I’m far from a health food nut. I eat and thoroughly enjoy, without guilt, many foods that are considered “bad”. I live in an urban area, breathe lots of bad air. I drink alcohol, smoke sometimes, ride a bike on busy streets, encounter dangerous people and germs, and I consider the risks involved in these things, and have either decided that they’re overblown, or I don’t care. This doesn’t mean I don’t wear a bike helmet, wash my hands frequently, or eat my veggies, in the hope of reducing my chances of cancer or flu or getting run over.
I’m sorry you felt outed over the weight loss issue, but if it helps, I, personally, don’t give a crap who here has lost weight and who hasn’t, or who’s currently on a diet or not. That’s not the issue of this blog, though I do write from a fat acceptance perspective.
I see what you’re saying about taking reasonable steps to protect your own safety, even when the risks might be statistically small. As far as that goes, we largely agree with each other. That’s actually what HAES is about, no?
As far as what the average person eats (in North America, at least, since that’s where I’m at and where I’m drawing most of my information from), I think maybe it would be worthwhile to have a good look at nutrition surveys that show what people eat. I’m not convinced that the average person eats so terribly to begin with, and even if they did, there’s value in meeting people where they’re at, without judgment, without panic or derision, and helping them to make small changes that add up over time — if that’s what they want to do.
The problem I have is when we treat those who maybe don’t know, or maybe don’t care much about nutrition, frankly, as if they’re foregone health disasters. We simply don’t know for sure how much of an effect diet really has on health, in the end, when combined with ALL the other factors — from the genetic to the social. And I think it’s shitty, it’s classist, it’s arrogant, and it’s totally unfounded by evidence to take that position. Unfortunately, this is the platform from which many healthcare practitioners as well as laypeople operate, in our society. And I think it’s wrong.
I’m just trying to help dismantle that by writing about the fact that WHAT we eat is actually only one very small part of the very large and intricate puzzle that makes up our health. And that most of us have absolutely no reason to worry as much as we do.
This is a fantastic post. I’m still in the early stages of learning to trust that my body will feed itself how it needs to be fed and that everything will even out, but I’m getting there, and have had bursts of “OMG I’m listening to my body!” in the past few weeks. It’s interesting to realize that I really don’t (always) need to eat everything in front of me.
And on the topic of foods balancing out over time – I had an intensely frustrating conversation with a friend (over dinner out, no less) in which she insisted that watching a fat person eat “unhealthy food” (e.g. McDonald’s) is as frustrating as watching someone with lung cancer smoke a cigarette. Erm, not the same thing (also not your business, but that’s a different issue).
Amen!
First, I totally, completely love this. And your blog, in general.
I do have to say that I wonder how to reconcile the “it doesn’t really matter WHAT” with what I know about corporate food, the ill effects of the ubiquity of processed corn and soy, the differences between the micronutrient profiles of whole foods and highly processed foods. I am still entirely in favor of intuitive eating, of diet balancing out over time, and everything else you talk about here, but I can’t help think that it would be better for our health if we were intuitively eating in a world where highly processed, artificial, sort of frightening foods weren’t everywhere, weren’t promoted with major money behind them, weren’t practically unavoidable. Not that I think having the occasional lunch of rainbow Twizzlers is ZOMG GOING TO KILLZ YOO, or that all “bad” food (ugh, hate that phrase) should be regulated or banned “for our own good”, but when so many of us have access to almost nothing BUT that kind of processed food (when so many live in places where there are no affordable farmers’ markets, but 20 different places to buy soy-fried cord-fed burgers), I gotta say I think that’s a problem, and it’s not good for our health.
Do you have any thoughts on that?
I am wholeheartedly behind the idea that people deserve better access to better quality foods, and certainly more choices in the marketplace (rather than just the illusion of choice, where you have six aisles of different boxes of stuff that all basically are variations on the same few ingredients.) I also agree that less-processed food is probably better for most of us — but again, it’s always a trade-off that depends on the individual and their unique situation.
As I said earlier to Ross, I’m not a huge fan of Big Food, because for one thing, they’re often the same people and/or companies that are behind Big Diet. And I also don’t appreciate companies that seek to actively manipulate my appetite (through the use of certain ingredients or additives) so that I will buy and eat more of their crap than my body actually wants. That said, the mass production and processing of food is what has developed to allow our society to feed a huge population of people, most of whom no longer have the skills to produce their own food. This system does serve a purpose, though it’s clearly an imperfect system, and could use lots and lots of improvement. Or maybe a complete overhaul and revolution. I don’t know.
I mesh well with Linda Bacon on this issue, in believing that what we eat and what we buy has a real impact on the environment, and possibly on our health, too. Certainly someone who goes from eating a diet composed of mostly highly processed foods to a diet composed of mostly staple foods may reduce their health risks, and more importantly, they may FEEL and FUNCTION better in the immediate term. (Digression – the reason I framed this article the way I did is because I don’t believe most of us have such poor diets that we need to make such radical changes, or that such changes will result in a hugely reduced risk. If anything, the fact that the people reading here CHOSE to come to a nutrition blog and pay attention to it probably proves that those of us participating here are at least minimally health-conscious and health literate.)
I’m less convinced that all highly-processed food (even some of the real current “baddies” like HFCS) really is the poison we think it is. The evidence is still being debated, and I like to reserve judgment until stuff like this develops a bit more. Right now, my opinion is that, at worst? Highly-processed foods are probably just lower-quality, somewhat substandard foods compared to less-processed stuff. (And of course, we also have to choose where we draw the line between “overly processed” and less-processed. I mean, bread is “processed” technically, and so are canned and frozen veggies, etc. etc., but no one in their right mind would call those foods unhealthy for the average person. Anyway. That’s a minor side issue.) Highly processed foods offer calories, and often fat and sodium, and some other stuff, but they often don’t have the micronutrients or the beneficial phytochemicals and compounds that less-processed foods can offer.
I don’t think they’re acutely toxic, but I also don’t think it’s a good idea to build a lifetime’s diet from them.
What it comes down to are the nutritional cornerstone concepts of variety and balance — eating too much of anything is not good for you. Eating not enough of anything is not good for you. This is where my main stake in nutrition lies. I don’t believe in throwing nutrition out the window, despite how some people might interpret what I’ve written here. I DO believe in variety and balance.
As I said earlier, a lot of highly-processed food imitates variety in the marketplace (through packaging, different brand names [even from the same parent companies], different shapes and flavourings and colours of the food itself), without actually providing NUTRITIONAL variety. So that’s something to be conscious of when you’re shopping.
The typical, boring dietitian advice is to stick to the perimeter of the grocery store, where the less-processed foods hang out. Eat real fruits and vegetables (frozen or fresh or even canned), cook from scratch as much as you can handle, and try new things. Develop your palate.
In short, eat food. Reserve highly-processed foods for what they should be: a fun and tasty complement to your diet, not the cornerstone.
The most sound nutrition advice I can give to the average, healthy person who doesn’t have any complicating health conditions, is to eat as wide a variety of foods as possible. Statistically and mathematically — and just plain old rationally — speaking, this is the best way that you can spread out your potential health risks and minimize your chances of under- or overnutrition.
This is obviously a very fraught, and very intricate, complex topic. I’m trying to express myself as well as I can, but I’m afraid that my position might seem very confusing to people the more I talk and delve into my stance on food. Let me know if this is the case, and I can try to clarify.
Unsurprisingly, I am in complete agreement with you. Other than that I have more reservations about things like HFCS than you (and you have more education on the topic), you pretty much just said exactly what I believe, in a calm, clear, rational, thorough manner. You rock.
I totally agree with your ideas. It isn’t so much what we are eating. It is usually how we are eating it. I have given up on strict diets because it doesn’t make sense to deprive myself. I know that I can have my favorites everyday as long as I don’t over do it. If I deprive myself, then usually I end up binge eating. Yes, certain foods, don’t make you feel good when you eat them. Everyone needs to consider that. Knowing your body is so important.
I don’t have a whole lot to add to the discussion, but I just wanted to let you know that this post, as well as the thoughtful comments from everyone, has stuck in my brain the past couple days. I’m still ruminating on it. Thanks!
the best website for discussions about science behind nutrition and fat is http://www.junkfoodscience.blogspot.com read it and weap and THEN GET REALLY ANGRY
Michelle your blog is brill.
It’s been unusually hot here in Western Washington State for a few days now, but right now there is this strong, cool breeze blowing that is making the cherry tree branches in the backyard sway, and dappled sunlight on the neighbor’s bamboo plant’s leaves dance, and gorgeous red pears ripening on the tree outside my window.
This post is like that.
A couple more (Canadian) things:
I know Yoni Freedhof drives you crazy, but he’s been on a role in the anti-fat bashing posting department of late.
Here’s a link to a little conversation along the lines of this post I initiated with Dr. Sharma:
http://www.drsharma.ca/obesity-skim-milk-for-breakfast-reduces-appetite.html
A couple of not Canadian things:
I have to show you this graphic I saw on a series of slides. I will track it down and get it to you.
What do you think of this interview?
And, Mindless Eating was interesting in some ways, but also everything I hate about social psychology and “behavioral science.” I think Wansink is about equal parts showman, marketer and evil genius — a mad (social) scientist.
Well, to be perfectly honest with you, I was rolling my eyes so hard the whole time I was reading Mindless Eating that I really skimmed it more than took it in, in depth. I read it in snatches in the bathroom. But, honestly? Not one thing he said in that book impressed me. I was bored by it. I was bored by his thesis. And the book was obviously marketed in a way that made it seem he wanted to be the next Malcolm Gladwell or something.
I mean, don’t get me wrong — I think appetite and satiety is a fascinating subject, and I would love to observe the work they do in such labs. But it seems like the people doing the work get so wrapped up in the thought, “MAYBE WE’LL FIGURE OUT THE NEXT BIG WAY TO RUIN EVERYONE’S APPETITE AND MAKE THEM THIN” (since that’s practically the Gold Rush-slash-Holy Grail of health research at the moment) that they don’t bother to look much deeper into it than that. And that’s frustrating, because I think a lot of their observations could be MORE interesting than that, were they to care enough to pay attention.
One really interesting book I started reading on the topic (but haven’t gotten very far yet in) is called Appetite and Food Intake: Behavioral and Physiological Considerations. It’s much more academic a book than Mindless Eating, but much, much, much more interesting and respectful of the complexities of the human body.
That interview with the food critic is interesting — I like his attitude about not running away from food, of admitting to himself and accepting the fact that he has a big appetite and loves food, but I find the talk of his weight problematic. They relate it to his trouble with dating, etc., and there’s the unspoken assumption throughout his interview that being fat is, obviously, undesirable. But I’ve come to expect that from these types of articles — it’s basically an unexamined bias peeping through, a bias in which all of us are steeped on a daily basis in this culture.
I thought it was nice that he was more “realistic” in his attempts to lose weight than many people are (as he said, eating a far higher number of calories than you’d see on any typical or commercial weight loss plan.) And I’m glad he found a way to stop the restrict-binge cycle. That is awesome. But I got an ominous vibe from his statement that he wasn’t safe from “falling back into old habits” and that he’d have to “work on it” for the rest of his life.
It’s not that I think people should eat mindlessly or without any thought at all, but honestly? Beyond the cooking and the shopping and the dishes, eating itself shouldn’t take that much effort (for someone without a nutrition-specific health problem that requires a therapeutic diet, and even those people can often get so used to it after a while that it’s nearly as effortless as someone who eats “normally.”)
So it strikes me that, while he is being less restrictive than many dieters, and than he, himself used to be, it sounds like he is still engaging in some level of restrained eating — which may have stabilized his weight at a lower range, but which 1) might add unnecessary (and unhealthy) tension and strain to his daily life, and 2) may, sadly, end up being only temporary — putting him right back where he started, in the midst of the binge-restrict cycle.
I hope I’m totally wrong. I hope he is truly at peace with food and his body. But I don’t think what worked for him is likely to work for many other people, or even necessarily to continue working for him.
I was struck by the same thoughts about the Frank Bruni article. I think even if one can overcome the disordered eating behavior he describes of his past, eating disordered thoughts do not necessarily go away. Really learning to trust your body and letting go of trying to control food intake based on what you “think you need” which may be too much/too little is an incredibly hard process. I hope it gets easier with time as I struggle every day with this and am working on learning to trust my body. I am so grateful for your blog where people are contributing from so many different perspectives on this topic.
Wow, I just found your blog via the #fuckyoupeta hash tag on Twitter. I am already a fan. :)
I’ve caught wind of some folks who have studied the effects of a “Western” diet on First Nation (aka Native American) and Aboriginal peoples. They had them revert to as close to their pre-Western eating habits (diets) and the participants lost weight and also gained better health (recognizing that they are not mutually exclusive, but both did happen) in the form of reducing the effects of or eliminating diabetes, heart disease, etc. I thought it was an interesting concept.
Very good point.
I live in a country, and especially a city, where immigration is a huge issue. Dietitians often counsel people to “eat culturally” because it does seem to lower people’s risk of certain diseases when they stick to what their body is accustomed to.
In this case, I do think diet can make a significant difference in a person’s health. But I don’t think these studies are quite the indictment of the “bad Western diet” that they are often interpreted as — rather, I think they show that people’s bodies, and perhaps their genetic composition, reflects the diet they were brought up on. For instance, Inuit people living way up north apparently live very well on incredibly fatty diets — an observation that seems to contradict evidence seen in other populations who don’t respond well to fatty diets.
The bottom line, for me, is that people have individual nutrition needs, and these needs are quite possibly shaped by their culture or family’s traditional diet. For the average person (who I was addressing, rather unspoken, in this post) who lives in the same area their family has lived for a while, their eating is going to balance out over time, and, because they’re essentially “eating culturally” without much effort, rearranging deck chairs, so to speak, isn’t really going to have that much effect.
In fact, this idea sort of reinforces my opinion that eating the type of food you are largely accustomed to (rather than, say, deciding you’re going to switch to a Mediterranean or Japanese diet, from a North American one, because of the literature you’ve read on these populations’ health, or because of some diet book that promotes this) is probably a good idea.
I have a lot of faith in people’s bodies (in the absence of certain underlying conditions) to figure out which food is best for them. I think the food you naturally gravitate to, for the most part (recognizing that some highly-processed foods are designed to manipulate your cravings and appetite), is likely a good fit for you. People who immigrate to a new country and culture often feel homesick for their customary foods — maybe there is a concrete reason for this beyond mere sentimentality.
Ah, but if I ate ‘culturally’ I would be eating meat and potatoes, jello salad with canned fruit, and iceberg lettuce. I’m from the Midwest. So which culture are we talking here? I know, I know, I was the one that brought up a specific type of culture. But since I moved to California, whoo-ee, bring on the vegetables! And damn if I don’t feel better. ;) Anywho, thank’s for considerin’.
I lol’d.
Also: do not KNOCK the Jell-o salad with canned fruit. NECTAR OF THE GODS, my friend. Ambrosia.
I may be late to the party but let me say I love this post. For years I have been racked with guilt that I was destroying my health with the “typical western diet.” I knew how to eat properly from all the experts, I knew how to exercise and I knew which supplements to take. But couldn’t do it. It was just like a diet and I could not stay on such a routine beyond 11 am. Forget the fact that I was already healthy, the real reason I wanted to eat that way was to be thin.
I have been able to get on the wagon and eat lots of healthful fruits and veggies etc. I didn’t feel anything different or better. It just made me think I ruined my body beyond redemption. It just felt like another failure even when I did eat “healthfully.”
It is so helpful of you to say that all this worrying may be for nothing and that I am not hurting myself. Again, thanks so much!
I am vastly excited to see Phase Two: The HOW. Yay!
I love your blog! I just wrote a blog about WHY we eat being more important than WHAT we eat. Keep writing the great blogs! Thanks – Steve
Your blog is a) awesome, b) a very good resource, and c) going in my RSS feed reader.
Fat Nurse <3's Fat Nutritionist!
Thanks Hillary — and my mom is a nurse, so I really appreciate that!
Thank you, thank you, thank you! Although I struggled with my weight during middle school, I am lucky to be naturally thin. That doesn’t mean that I don’t get fed up with the focus on thin=healthy. I am not particularly healthy, but I have friends who are technically overweight, and can kick my ass on a hike or treadmill any day! I berate thin girls who complain about being fat, and remind my not-so-thin friends (who exercise, eat well-ish, etc.) that they are beautiful and in better shape than I!
I attended fashion design school, but have always felt that beauty is not just found in overly thin models. Some of my favorite pieces were made for clients who were most definitely not small!
So again, thank you!
Have you read “Good Calorie, Bad Calorie”? While I agree with you that what we eat is only one fairly small variable in our overall health, he makes a convincing case with historical scientific research that the kind of processed carbs that a lot of the low-fat dogma pushes on people can (not always, but in sensitive people) impair the body’s ability to pull energy out of the fat stores and is associated with all the usual chronic booga-boogas.
Now, I’m not a scientist, and I haven’t gone back and read the original research, and I haven’t gone to look at scientific responses to the book yet, but it made me think.
Great post, by the way!
I haven’t read the entire book, Julie, but I am familiar with Taubes and his premise (basically that refined carbohydrates may cause a lot of the chronic diseases we’ve seen develop in modern society.)
I do think there are likely some unexpected health effects from stuff like refined carbohydrates. But I also take theories like this with a grain of salt and withhold judgment until a really solid review of existing evidence can be done and enveloped into the nutrition practice guidelines. At present, this has not yet happened, and while I am always willing to consider theories, I am less willing to suddenly jump on a certain bandwagon by radically changing the way I eat, or the way I recommend other people eat.
That said, it is a very interesting idea, and Taubes has written some very interesting articles, as well.
Makes sense. I tend to “test” these things by changing my diet and seeing 1) if it’s even possible and 2) how I feel. I know cutting wheat out and limiting sugar make me feel much, much better, but that could be for any number of reasons, few of which are generalizable.
Yeah, and that’s how I’d suggest people try these things out, too. If something makes you honest-to-goodness feel and function better, then maybe that’s optimal for you. Everyone’s nutrient requirements are actually individual, so it’s hard to, as you say, generalize all the time.
I don’t think carbs are bad, per se, but if I had a client who preferred to eat fewer of them because it made them feel better physically, I wouldn’t argue with that. There could be something going on that I can’t see, and I trust people (if they don’t have an eating disorder, that is) to know which foods work best for them, in what amounts.
Another reader who found you through Shapely Prose, and I’m loving what I’ve read here so far! I have to admit I was a little worried by the ‘nutritionist’ part, as in the UK that title has been co-opted by the likes of Gillian McKeith…. but clearly you are not of that ilk :)
Anyway, this post really reminded me of a different but connected point that Ben Goldacre made in a column a while back, and I think in his book as well – that it’s probably a good idea to eat your greens, but realistically, your diet won’t have an enormous impact on your health. And that the obsession with diet as the cause of health problems distracts us from the importance of other factors like class – those of us who are well off and healthy would much rather believe that our good health is due to our own virtue, rather than accept that perhaps we had a bit of an advantage to begin with. Kind of like the idea of the ‘deserving poor’, who are that way because they’re just too lazy to improve themselves. The original article is here.
(He is of course referring to the UK brand of nutritionist I mentioned above…)
Wow, sorry, that was long and tangential, and I probably royally screwed up those tags…I shall now return to lurking :)
Oh yeah, I understand your concerns. I’ve got information about my training and education on the “About” page up at the top, but maybe I need to add to it, or put some of that info in a sidebar or something.
And I wrote an article on McKeith myself back in 2006! I may move it over here into the archives.
Thanks. I love Ben Goldacre :)
Oh yes, once I came to your site the info about your training definitely put my mind at ease. Ben Goldacre is one of the few columnists I reliably read every week, a welcome relief from the usual content of our newspapers. And incidentally he’s also a very nice man. I would love to see the Fat Nutritionist vs. Gillian McKeith!
My intellectual crush on you continues to grow by leaps and bounds, lady. This post, and on top of its awesomeness your kind and intelligent conduct in the comments, leave me near-inarticulate with joy and admiration. I want to say much more, but… yeah, that inarticulateness thing I mentioned already. But: Thank you.
If you love your body, why do you show only your face?
Well…it’s customary for a columnist to have a headshot next to their writing. I don’t think that, because I’m fat, I have more of a responsibility to show my full body than any normal-sized person. My body is not public property, after all, fat or not.
That said, I do show (and always have, since I started this website) most of my body on my About page, and I’ve posted roughly a dozen photos of myself to various (extremely) public websites. Like, you know, Reuters and Newsweek.
If you can’t find them, it ain’t my problem. But it’s not exactly like I’m hiding.
I am, however, becoming slightly annoyed by the freakshow tone of people asking to see my body. Is this some kind of fetish? If so, I’d encourage you, and anyone else, to check out an appropriate fat prOn site to meet your sexual needs.
Wow pa snack. If you love your opinions, why do you show only a pseudonym?
What a hostile thing for you to say.
This blog is very dangerous.
Telling people they can eat what they want and it won’t affect their health is irresponsible.
I would go along with your view if all the food out there were natural, but that is not the case.
Doughnuts, french fries, big Macs, twizzlers, etc. are MAN made PROCESSED foods that nature never intended us to eat.
Even Milk falls into this category. Humans are the only species that drinks the milk of another species into adulthood.
Again, your rationale is perfectly acceptable to me if you quantified your statements by telling people they can eat what and as much as they want as long as it’s natural, not processed food.
As far as “Global Warming”, yes it’s real, the debate is whether it’s natural or man made.
Karl, I’d just like to reiterate that I’m not telling people that food has no impact on their health. In fact, most of the post above is composed of caveats describing situations wherein food DOES impact health quite strongly.
The message here is that food is not the ONLY factor in determining a person’s health. And that, for those of us lucky enough to live in a rich society and not experience food insecurity, or certain diseases that interact with food, the impact of each meal on our long-term health is actually much smaller than we’ve been led to believe.
I also believe that people unequivocally have the right to eat whatever they want, in whatever amount they want. It is entirely a personal choice.
However, because I also work in nutrition, I do think it is worthwhile for people to examine which foods allow them to function and feel better, and, in turn, those foods may have some potential impact on their long-term health, for the better.
Really, my overall goal here is to get people to relax a little bit around food. Food is not poison. It is just food, and it is only one tiny fraction of the whole equation that makes up our overall health.
Here’s what the World Health Organization has to say about Determinants of Health:
Also, I’d just like to point out to everyone who has commented on “doughnut-gate” that:
1) People with diabetes are actually allowed to eat doughnuts if they want. Doughnuts are not poison.
2) A person’s overall diet is more important than one particular food item, and
3) doughnuts do not cause diabetes.
4) In any case, I don’t even have diabetes. So what was your point again?
See some myths about diabetes from the American Diabetes Association.
We are all allowed to eat doughnuts, if we like them. It’s up to us, as individuals, to weigh the risks and benefits of doing so. Personally…I like them. They make me happy. So I eat them sometimes.
[…] But I haven’t broached it yet, because it’s been critical for me to first build the foundational argument that it is your right as an adult to eat whatever, and however you […]
Sorry if this comes out sounding utterly creepy and weird, BUT.
Michelle, I love you.
Thank you so much for all of your articles.
It’s nice to have a shred of sanity amidst all the frantic, chaotic bullshit that society claims is ideal.
I’m a bit late to this party, but at any rate, love this post. I have a 3 1/2 year old son. Somewhere I read (and this might be a bunch of shit), to not get too worked up if a toddler refuses to eat, skips a meal or even refuses to eat in an entire day, that they will consume about the same amount of calories in a given week. I’ve watched him and seen that it seems to be true. One day refuse lunch and eat a normal dinner, but the next morning eat 3 pieces of toast and 2 bananas.
It’s also interesting that toddlers look at food and eating so much more causally. It seems that he eats when he’s hungry, stops when he’s full. No drama :)