• camilocayazaya

Why Bother Seeing a Dietitian?

Updated: Nov 23, 2020

Word on the Street

As a dietitian, I've noticed there’s a lot of confusion around health these days and the picture becomes especially muddy when we start talking about food. It can feel like you’re going insane trying to check all the boxes for healthy eating because you were told that you need to have kale every day but not if the full moon happens on the 13th day of the month and how much protein does kale even have anyway? Shouldn’t you be having extra protein if you breathed harder than usual today? And, oh god, you have to have fish for anti inflammatory Omega 3s and some red meat for iron but won't it cause inflammation? What dishes have both red meat and fish? Do they all have mercury in them? And what about milk? That has protein, but it has to be A2 protein, right? But does milk have gluten? What even is gluten? Oh god.

If any of this sounds familiar, we need to talk.

Everywhere you look, someone seems to be promoting contradictory advice to the last thing you heard and you’ll be lucky if they’ve done any serious study on the subject. After all, who has 5 years to burn learning chemistry, biology, physiology, immunology and metabolic processes in relation to food? Let alone food labelling law, the psychology around eating behaviours, cooking skills, cultural needs, resources impacting food security, policies determining food sovereignty, research, statistical analysis and the complex social determinants of our food choices. If that sounds like a lot, that’s because it is, and good Dietitians are passionate enough about the subject to have put in the work to show competency in all of those areas. This is what makes them qualified to help a wide range of clients with nutrition goals or medical needs. Trust me, I didn’t spend five years only learning to count the calories in cakes and biscuits and how to prescribe weekly food plans, as great as that would’ve been.

Our society is confused about food because everyone feels like they hold some intuitive, God-given expertise on the subject and most people with a platform are more than ready to give you their advice, qualifications be damned! Your job is just to do endless research and filter the wheat from the chaff… all day. Every day. Sigh.

The real problem is that healthy eating advice is boring and we already know how to eat healthy: 2 fruit, 5 veg, lots of water, more exercise, less meat, beer and soft drink. Repeat. What a yawn-fest! How are you supposed to sell new teas, pills, powders, newspapers and health magazines, enhanced performance in the gym, “beach bodies” or the cure for cancer by just saying the same thing every time?

Not only is it boring, but if it’s so good, how come so many people are still getting chronic diseases and dying from poor health? Let’s try something exciting that will keep us safe from disease, like the fatty diet designed for epilepsy (keto)! What about nothing with grains, sugar or refined products in it, incorrectly associated with neanderthals (paleo)? How about only eating every second day (fasting)? What about only eating kilos of fruit (fruitarian)? I can already feel my DNA strands stretching their little double-helix arms in joyful celebration! Except, not really because eating like that sucks and I’d struggle to even afford those diets, let alone follow them.

Playing with our diets is exciting and - as with any conspiracy theory - grants us control over the uncertainty of our lives. Uncertainty that may or may not include disease, cancers and early mortality. Believing in something extreme makes us feel like we’ve cracked a secret code the uninformed masses haven’t bothered to find. Those sheep can follow their 2 fruit and 5 veg and still end up kicking the bucket at age 55 because these industry-lobbied nutrition guidelines are designed to make money, not make you healthy. Or so we’re told.

In reality, just over 5% of us meet the full fruit and veg intake guidelines and only 10% meet the vegetable-only intake guidelines since last count. Most of us eat lots of meat, discretionary, processed, sugary and greasy foods, drink more alcohol and soft drinks than is recommended and generally eat in a way that’s not conducive to perfect health. And that’s fine because we’re not robots, many of us with disposable income choose to eat this way while, for much of Australia and the world, complex social determinants of health decide how and what we eat, as well as determine the time and energy we have to make these choices. Those are big issues that we can’t address here, but we need to stop pretending that the advice is bad when people get sick while not adhering to it. If we want better adherence to healthy eating patterns, we need to give people better opportunities to understand, access and prepare healthy foods. We can start by not promoting low-quality diet advice, for one.

Dietitians have to find creative and interesting ways to help people get closer to these "boring" goals that are personalised and useful for each individual, with modifications to traditional recipes and delicious foods like lasagna or curry instead of just shoving salad in everyone's face and telling them to stop eating cookies.

"Can I interest you in some delicious paleo lawn?"

Restrictive and fad diets are harmful! They cut important variety in our food, can create damaging obsessions around weight and wellbeing; can lead to malnutrition and nutrient deficiencies; promote disease without dietetic management; and most often fail to produce meaningful results over the long-term. Whacky diets often result in further weight gain and a deep sense of failure and shame that then leads to a spiral of more desperate and extreme solutions since this “conventional” advice failed.

We do have to take the time here to address the fact that Dietitians and GPs have recently come under scrutiny for their aggressively weight-centric focus thanks to new evidence from the last decade. As described above, this focus has often overlooked more serious illnesses, promoted psychological conditions like eating disorders, created further weight gain and engendered a general distrust of the medical system. Weight has long been used as a gauge of health and, with the help of marketers and personal trainers, has become a cultural obsession that almost everyone has abused as a way of supposedly making people healthier. We’ve only recently been able to articulate how damaging this paradigm has been, but thankfully, we’re seeing big changes in this space thanks to organisations like HAES Australia.

Demystifying the Clinic

Doing fad diets can be exciting and empowering over the short term, but with clinical and life-threatening conditions, knowing what’s true becomes imperative. Confusion around food needs to be quickly addressed and our mistrust needs to be resolved in order to improve the chances of recovery from these conditions. It can be exhausting for practitioners of any discipline to have to explain the reason for their treatment several times a day to mistrustful family members while they juggle a full caseload of patients, whether in private practice or hospital settings.

Due to the rise of terrible diet advice online, nutrition professionals are especially burdened with the responsibility of clarifying the science around nutritional care for each condition. For example, renal (kidney) conditions may require fluid and salt restrictions, while hypermetabolic conditions like cancer may require high energy and protein diets that include significantly higher protein and carbohydrates to prevent malnutrition during an uphill battle. Evidence-based nutritional care is given while considering physiological needs, cultural and personal food preferences, texture-modification and the resources of a facility or patient, to name a few important factors. What’s right for one person is often inappropriate for another, you can’t just copy-paste dietary solutions for people and that’s why our training takes so long.

Dietetic consults in private practice are rarely about telling people what to eat, and if it is, it's usually about modifying things they already eat to improve intake of necessary nutrients. There's a lot of details to clarify when a person gives an answer to a question like "What do you eat in a day?" and people often don't need recommendations on a particular food. A trained dietitian will notice if their client's complaint relates to food knowledge or something more serious like depression creating disordered eating patterns, or if there are red flags for endometriosis. A consult is often about more than simply recommending foods.

Similarly, creating dietary plans for athletes or people with very specific needs can only be done safely with somebody who considers the full range of nutrients required for a healthy body while also personalising all of their advice to that particular person. Being a dietitian takes extra training, relies on evidence, up-to-date guidelines and grounds practice in scientific principles to determine the best dietary support for a patient. This support is further proven to significantly improve outcomes in clinical care and prevent long-term problems in healthy people who modify their diet.

Natural healing modalities like Naturopathy or Homeopathy have often been used as alternative approaches that use “ancient” knowledge to address the alleged blind spots of modern medicine and the “things doctors don’t want you to know”. Unfortunately, these therapies can often misdiagnose or ineffectively treat critical conditions to use up the valuable time and money of vulnerable patients requiring urgent medical care. It’s common to hear about cancer patients that spend time following ineffective and expensive treatments while their cancer metastasises (spreads), making it much harder to treat later on. Alternative therapies often provide a better role in supporting wholistic aspects of health, but generally not in resolving critical illnesses.

Q: Why do stock photo dietitians need stethoscopes? A: To check the fruit's pulps! Haha, ok I'll see myself out.

Other cases can see rare conditions like Non-Coeliac Gluten Sensitivity, ie. “Gluten Intolerance” being completely misdiagnosed. This so-called intolerance, which is not Coeliac Disease (allergy to gluten), is almost always related to FODMAP sensitivity rather than gluten itself. But alternative therapies have had enough success telling people to stop eating gluten that they can ignore the science and misdiagnose people with a somewhat positive result. The same goes for leaky gut, toxin flushes and intestinal parasites, all common alternative diagnoses that push people to modify their diet in ways that qualified dietary advice could effectively address. These therapies can create unnecessary dietary restrictions, result in expensive supplement purchases or even mislead people about far more serious conditions that require urgent attention.

In contrast to alternative treatments, Medical and Allied Health professionals abide by stringent guidelines for practice developed using reproducible studies and clear empirical data (rather than anecdotal reports from celebrities you know and love). They can even include similar treatments to alternative therapies like probiotics or meditation where gut flora or stress are implicated in a condition, such as Irritable Bowel Syndrome. But this needs to be determined carefully, since it may be a more serious disease with similar symptoms.

It may seem like practitioners want you to stay unwell to make money, but nobody goes through the painfully taxing training of a university medicine and healthcare course with the intention of making people sick. Not only will patients stop seeing someone who’s actively damaging their health, but there are often various healthcare practitioners working in tandem to treat a condition. Dietitians, like any other discipline, need to constantly report to the rest of the medical team about their intervention, whether they work in a hospital or in a private clinic.

If someone is doing a bad job or not following guidelines, not only will they lose accreditation from Dietitians Australia, but the rest of the team will start recommending other practitioners for their patients. Patients who don’t recover are a bad look for everyone involved in their care so any experience of suboptimal care is rarely by design and almost always from human error or a gap in the evidence. Complex patient needs have to be managed under evolving systems where information is regularly updated. Doing a bad job does not make us more money, it makes us less, and there’s enough work out there that we don’t need to make anyone sick.

Where hospitals are concerned, key performance indicators are also consistently scrutinised. Achieving poor recovery rates or changing processes based on pharmaceutical sponsors would be an egregious breach of confidence and look especially unprofessional for any team. A hospital saves more money and increases profits by treating patients quickly and efficiently rather than by having repeat visitors so there’s little financial incentive for an institution to do a bad job. Meanwhile, a treating team looks negligent if they can’t achieve medical stability and may become caught up in career-ending legal action if patients end up worse than when they came in. That should give you confidence that there’s little incentive for staff to endanger their careers by peddling useless medications from corporate sponsors or ineffective treatments to “keep you sick”, even though we might imagine this is an intuitive way for medical practitioners to operate.

Rest assured that even entrenched and far older professions like Medical Doctors continue to change, with acknowledgements that some potentially risky medications like non-steroidal anti-inflammatories, proton pump inhibitors or antibiotics may also end up disproportionately prescribed. While these practices or beliefs have been less than ideal and change can be slow, they are under constant revision using academic processes that then inform universities to train more capable graduates, as would be expected from any responsible institution.

Food is essential for health, but it’s not magic and it’s not something you should be severely modifying without ongoing support from a dietitian. People without any medical conditions should stick to the basic healthy eating principles mentioned earlier, while those struggling to adhere to them or who have specific goals or conditions should seek the advice of a dietitian.

You can book me for dietetic support here.

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