Author Archives: Jonah Soolman

He Said, She Said: Exercise as Penance

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He Said

Data are only as useful as our understanding of them. Food labeling represents an opportunity for education while simultaneously illustrating the tremendous challenge of conveying complex ideas in a space only slightly larger than a postage stamp.

The nature of my work is one-on-one counseling, and as such, public health policy is not my area of expertise, but I can still recognize when those charged with such decisions are barking up the wrong tree. Such is the case with Britain’s idea to indicate the exercise load necessary to burn the calories in a given food.

First, remember that proclamations of calorie content are often flawed. Earlier in my career, I created nutrition labels for a university dining service as well as for cooking software. The labels that I produced reflected my best estimates based on other people’s estimates of generalities. Food manufacturers utilize a similar process to create their labels, and laws that allow rounding further cloud the picture. As the game of telephone teaches us, inaccuracies creep in with each step we take further away from the source.

Second, despite what activity trackers and cardio equipment dashboards would have us believe, estimations of caloric expenditure are similarly problematic. Your soda can may inform you that you need to run for 15 minutes to burn off the calories contained within, but this overgeneralization does not take into account your age, size, body composition, running mechanics, exercise intensity, course terrain, or any of the other variables that impact the energy that you as an individual will expend during a specific 15-minute bout of jogging.

Third, even if the data for calories consumed and burned were as accurate as can be, the implied calories-in-vs.-calories-out paradigm is an oversimplification of the complexities affecting weight regulation and overall health. Our eating and physical activity behaviors do matter, of course, but they are mere pieces in a puzzle mainly comprised of factors that are out of our hands.

Last, the presentation of a tradeoff between eating and physical activity reinforces a commonly held and problematic notion that food choices are worthy of punishment and exercise is our penance. As I recently told BuzzFeed and the Daily Meal, the good/bad food dichotomy, so prevalent in our society, links issues of morality, virtue, and guilt to our eating behaviors and is counterproductive. Nutrition and exercise activity have enough variables already without confounding them further with judgment.

A healthy relationship with food and physical activity means uncoupling moralization from such behaviors, not reinforcing the bond.

She Said

Earlier this month, Jonah and I were watching NECN when a news story came on that made us both cringe. Apparently, Britain is considering creating new food labels that not only tell the consumer how many calories are in the food, but how long the consumer would need to exercise to “burn off” that food. The proposed label would look like this: next to the calories that are listed for the food, there would be two stick figures of a person walking and running. Underneath those stick figures would be the number of minutes that someone would have to engage in either walking or running to negate the calories they consumed.

I find this idea to be highly problematic for several reasons. Firstly, as Jonah and I have written about before, the idea of “calories in, calories out,” is very much oversimplified. Most people believe that if an individual eats an extra 500 calories per day, that individual will have gained a pound of fat after a week. Unfortunately, it isn’t that simple. Numerous studies have shown that everyone processes calories differently, with some individuals getting more calories from the food they eat and others getting fewer calories from the same amount of food, resulting in some people gaining weight and others not gaining a pound.

One such study looked at identical twins and weight gain. Each pair of twins was fed an extra 1,000 calories per day for 100 days while under close observation (i.e., they were confined to a closed section of a university dorm). What the researchers found was that while the twins in each pair gained (or did not gain) the same amount of weight, there was a huge difference between the sets of twins. For instance, one pair of twins gained more than 29 pounds by the end of the intervention, while another pair only gained about 9 pounds. The conclusion that was reached was that some people are more efficient calorie burners, while others are more efficient at storing extra calories.

Aside from the fact that every body processes calories differently, I also take issue with the idea that one should be concerned with “burning off” what they are eating. In my work with people with eating disorders, there are quite a few individuals who engage in exercise bulimia. This means that these individuals will binge and then will try to compensate for the binge by over-exercising. It is a debilitating disease, and I believe that these labels would exacerbate symptoms for these individuals.

Finally, as I have written about before, I believe that exercise should not simply be viewed as a way to burn calories or to “right our wrongs.” Rather, as the Health at Every Size® principles suggest, physical activity should be a way for us to connect with our bodies by engaging in activities that we enjoy. Instead of torturing oneself in the gym to repent for last night’s cake, how about enjoying a walk outside in the sunshine to improve one’s mental, physical, and emotional health? Instead of calculating how many minutes one would need to log on the treadmill to “undo” a cookie, I think it is much healthier to use exercise as a way to feel more alive in our bodies rather than as a weight control tool.

Leave the Fat Kid Alone

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Note: A slightly edited version of this piece appears in the April 2016 issue of Boston Baseball Magazine.

If you are like me, you wonder what the baserunner and first baseman talk about between pitches. When an athlete meets a peer, the dynamic is presumably different from an interaction with a fan that likely centers around adulation and an autograph.

When dietitians get together, chances are that at some point, we will touch on whatever nutrition-related myths and stereotypes are currently damaging our society, such as those reflected in the widespread negative reaction Pablo Sandoval received for his weight upon arriving at spring training.

Consider the following separate, but related, questions:

If Sandoval loses weight, will he play better?

Maybe, but not necessarily.

We look at Sandoval’s physique and dream about the offensive and defensive punishments he could inflict upon the league if only he bore a closer resemblance to Adrian Beltre or Evan Longoria. These fantasies have some merit, as a leaner, smaller, or lighter body can certainly have athletic upsides sometimes.

However, a significant difference exists between an athlete who naturally has a given size or shape versus someone who tries to force his body into that mold. Since weight loss does not happen by magic, we have to consider whether the behaviors Sandoval adopts in pursuit of weight loss would improve his game.

The outcome could go either way. We have seen in a variety of sports, including baseball, examples of athletes who played worse after losing weight, in part because over-exercise and/or food restriction left them depleted and vulnerable to fatigue, injury, impaired concentration, nutrient deficiencies, depression, sleeping difficulties, eating disorders, muscle atrophy, and other unintended consequences, none of which are conducive to top performance.

If Sandoval decides to lose weight, will he be able to do so?

In the short term, probably, but in the long run, he will most likely gain it back plus more.

Approximately 95% of people who attempt to lose weight will regain it one to five years down the road, and roughly 60% of these individuals will end up heavier than they were at baseline. Weight regain is common even if someone maintains the behaviors that promoted the weight loss in the first place.

Contrary to popular myth, our weight is largely out of our hands. The calories-in-versus-calories-out paradigm is a gross oversimplification of the complexities affecting weight regulation. While we might be able to manipulate our body size through behavior changes for a short while, biological mechanisms promoting weight regain almost always win out in the end.

If you subscribe to the theory that Sandoval’s weight is affecting his play, what level of performance do you expect out of him in the most likely scenario that he ends up bigger?

What does our treatment of Sandoval say about society?

Fans and media have labeled Sandoval “disgusting,” “lazy,” and “pathetic.” By the transitive property, these derogatory terms apply to everyone who has a body type similar to his.

The message is that fat is to be loathed, that larger individuals are not worthy of the respect enjoyed by the rest of us. We reject stereotypes based on race, religion, ethnicity, or sexual orientation while we inexplicably tolerate those based on body size that are no more accurate than the others, yet are just as abhorrent.

The idea that we can tell how someone eats or exercises based on his shape or weight is a myth. Some people built like linebackers never lift weights, some skinny-as-a-rail folks subsist on fast food, and some obese individuals are more active and have a healthier relationship with food than all of them but inhabit bigger bodies for other reasons.

Weight stigma oftentimes inspires people to sacrifice health for the pursuit of a size. Pressure to be thin leads to dieting, which is a predictor of a variety of problems, including eating disorders. These life-threatening illnesses are so common in Massachusetts that if the crowd at a sold-out Fenway Park represented a random sample of the state’s population, those in attendance with a diagnosed eating disorder would likely fill section 41.

Okay, but professional athletes like Sandoval constitute a different and special class of people, right?

Let’s take a step back and look at the bigger picture. Sandoval is a professional athlete because his talent, practice, and opportunities have coalesced into a skill set that lends itself to strong performance in an activity mankind recently created called baseball and he lives in a culture in which we pay such people to play it for our entertainment.

None of that means he has any more or less ability to manipulate his weight differently from the general population. Sandoval is a product of evolution just like the rest of us, and he has come into being because his ancestors’ physiological mechanisms that resisted weight loss allowed them to survive periods of starvation and reproduce while others perished. In this regard, professional athletes and spectators are all in the same boat.

Fans have every right to feel whatever emotions they may have about a player. If they want to get on someone for not performing, they can absolutely do that. However, I would encourage fans to criticize athletes for lack of production or work ethic directly rather than using body size, weight, or shape as a proxy, as the latter behavior is fueled much more by myths and stereotypes rather than science and sends a dangerous message to everyone who hears it.

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Zootopia

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Generally speaking, Zootopia is a really nice Disney film. As Joanne and I were walking out of the theater and talking about how much we both liked it, she turned to me and said, “There was only one thing about it that bothered me, and I am guessing you know what it is.” Sure enough, I did, as the same problem had caught my eye as well.

The main reason I like the film is because it teaches some wonderful lessons about having the courage to be different, break down barriers, and acknowledge and overcome prejudice. However, the writers missed an opportunity to apply these same themes to body size and instead reinforced widely-held stereotypes about larger individuals.

Although the film does feature characters of various shapes and sizes, both protagonists are stick thin while the rounder characters are generally presented in a more negative light, such as the main character’s portly father, who in his first scene explains how he was too afraid to go after what he really wanted in life and settled for one spent as a carrot farmer.

The most glaring example is Officer Clawhauser, a large, dopey, and disorganized character often shown with food or in the act of eating. An early scene in the film portrays him as so messy and oblivious that he is unaware that he has a donut lodged in his collar.

How ironic, and unfortunate, that in a film that is largely about breaking down stereotypes, Disney glaringly reinforces one. The writers probably never even considered there might be an issue with this because the sad truth is that in a society in which we generally reject stereotypes based on race, religion, ethnicity, or sexual orientation, we inexplicably tolerate those based on body size that are no more accurate than the others, yet are just as abhorrent.

If you bring your children to see Zootopia, consider using the occasion to talk about body size and its associated prejudice. The film does a solid job of teaching that not all prey animals are cowardly, predators need not be savage, and the symbolism contained therein about the human race, but it misses an opportunity to shut down the stereotypes that heroes must be thin and larger individuals are glutinous, lazy, or unkept. This is where you, the parents, can come in and complete the lesson.

Objective / Subjective

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Numbers. Nutrition and exercise are full of them. We can tabulate calories and grams, measure portion sizes, count servings, and analyze food journals. Thanks to various electronic gadgets and apps, we can keep tabs on our steps, estimate our metabolic rate, and track other biomarkers.

As a guy who holds a degree in mathematics and used to work as a research analyst, nobody loves objective data more than I do. When I began my career transition and was moonlighting as a personal trainer, I made use of several physical tests – the Rockport walking treadmill, the sit-and-reach, the list goes on – to quantifiably track my clients’ progress over time. My career as a dietitian started off similarly, as I relied heavily upon bioimpedance analysis data, weight, and estimated macronutrient needs to guide my nutrition advice.

Imagine my surprise when, through a combination of additional education and experience, I realized how little these quantitative data actually matter. On the first day of the first nutrition course I ever took, the professor began with a brief survey of the social, cultural, personal, and financial factors that influence eating behavior. In our diet-minded society in which food is thought to be just fuel and any persuasions to the contrary are seen as weaknesses and sources of guilt, we easily forget how important this basic truth really is.

One of my patients recently told me that his wife purchased a diet book that emphasizes the glycemic index and she would like the two of them to begin eating in accordance with the author’s guidelines. Objectively, the glycemic index, which is a measure of how quickly various foods raise blood sugar relative to a standard (usually white bread), makes some sense. If a food breaks down more slowly, we stay full for longer, eat less, and consequently lose weight. At least, that is what the book’s author wants its readers to believe. Just aim for the low-number foods on the glycemic index chart and we are all set.

Right around the same time my patient told me about this book, another patient relayed to me an experience he had regarding hamburger buns. His parents typically made burgers on whole wheat slider buns that he thought were okay – not great, not awful, but okay – and he normally ate two or three burgers as the meat from the normal-sized patties jutted out beyond the rolls’ perimeter like a UFO. For reasons that remain a mystery to my patient, his mother decided to make burgers on normal white buns one evening. In contrast to their whole wheat counterparts, these white buns hit the spot. He had one burger, felt satisfied, and stopped eating. Turned out that for him, the white bread, which is sky high on the glycemic index, was actually the better choice and kept him from overeating.

The more I work with my patients, the more I am reminded of how the subjective is often of greater importance than the objective, that the qualitative usually trumps the quantitative. Numbers still have their place, for sure, but they really only play a supportive role. This, I have learned, is one of the most significant differences between nutrition on paper and nutrition in real life.

Healthcare For Some

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Yesterday I ran the Five College Realtors 10-Miler, which was my first event since last summer’s surgery and my first road race since September 2013. My time was well off my personal record for this course, which I set the last time I ran it in 2007, but I have been through quite a lot in the last nine years so expecting to pick up where I left off would have been unrealistic. Besides, it was just great to be able to race again regardless of what the clock said.

As I have written before, I owe a debt of gratitude to everybody who has helped me recover over the last two-plus years, but at the same time I think others who do not receive the same level of care from their own support systems, including their medical teams.

When I went to my primary care doctor in late 2013 complaining of back pain, I received orders for x-rays, an MRI, and a CT scan, referrals to see a physical therapist, a physiatrist, and multiple surgeons, and a collaborative discussion about the pros and cons of complementary treatments, such as acupuncture, chiropractics, massage, and neuromuscular therapy. Subsequently, I received a topical medication, oral medicines, injections, and referrals to more surgeons. Ultimately I required an operation, and then another one, more scans, and physical therapy that continues to this day.

When my “overweight” patients go to their doctors complaining of back pain, more often than not they report receiving one intervention and one intervention only, one that research shows is only achievable for a tiny fraction of the people who attempt to attain it and may not improve their condition even if they do: a directive to lose weight.

Are we not all deserving of thorough, collaborative, evidence-based healthcare, or just those of us who are thin?

He Said, She Said: “I want to lose weight”

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He Said

When faced with “I’ve got some good news and some bad news,” most people seemingly prefer to hear the latter first. With that in mind, let us first look at the results of weight loss pursuits before coming around to the opportunities we have for change.

Short-term and long-term weight loss are two entirely different animals. The ease with which short-term weight loss is promoted creates false expectations for long-term weight loss. Pretty much any kind of restriction (Paleo, Weight Watchers, gluten-free, low-carb, low-fat, weighing/measuring portions, following a scripted meal plan, commercial meal substitutes, etc.) performs about the same: initial weight loss followed by regain that often surpasses the baseline weight. The overall body of research suggests that pursuit of intentional weight loss is approximately 12 times more likely to result in ultimate weight gain rather than loss.

The patients who come to me looking to lose weight often have similar stories. They list the various diets they have tried over the years before disclosing “and now I am the heaviest I have ever been in my whole life.” Frequently, they look back on their body size and shape from before the first diet, the body they were unhappy with at the time, with a new longing, like an empty-handed gambler wishing he had put his coins to better use rather than wasting them in the slot machine.

While their reasons for wanting to lose weight vary, they are all valid and understandable in the context of our society in which weight stigma, size discrimination, diet culture, and misinformation are so prevalent. These unfortunate realities bleed into our healthcare system and can influence otherwise-great doctors to recommend weight loss rather than evidence-based treatments.

The good news is that the underlying reasons for wanting to lose weight are oftentimes attainable if we pursue them directly rather than using weight loss as a proxy. Whether your goal is to improve your blood pressure, lower your cholesterol, control your blood sugar, perform your sport better, our build a fabulous wardrobe, or anything else along those lines, your likelihood of success is much higher if you put weight to the side and go for your goal head-on.

 

She Said

Weight is a heavy topic (pun intended) in my work with eating disorders. Even though I put a lot of effort into making sure that weight is not the focus of my work with patients, inevitably, it will come up. Usually, my patients express fear around the possibility of gaining weight by eating intuitively (or by following a meal plan). In addition to this fear of weight gain, many of my patients also desperately want to lose weight. When the patient is in the “overweight” or “obese” BMI category (a completely bogus way of measuring one’s health), the discussion of losing weight is particularly tricky. Oftentimes this patient will come into my office with a recommendation from their doctor to lose 10% of their body weight in order to improve their health. This, coupled with society’s belief that “everybody knows that being heavy is unhealthy,” also complicates matters considerably.

When a patient comes to see me with hopes that I will help him or her lose weight, I often feel like the Grinch. As I try to explain to them that weight is not a measure of health, that one can be heavy and healthy (or thin and unhealthy), and that society’s fear and hatred of fat is a real thing, I can see their eyes glaze over. And then, when I talk about how 95-98% of all intentional weight loss attempts (via diets) result in weight regain, sometimes I can see panic in their eyes. You see, even though “everybody knows” that diets don’t work, many people believe that if they just try hard enough and if they really, really want it, they can be part of that 2-5%.

As Jonah and I have written about too many times to count, we practice from a Health at Every Size® (HAES) perspective. This means that we believe that health is a multifactor concept that cannot just be boiled down to how much someone weighs. We believe that when someone eats in a nourishing, pleasurable, and intuitive way, when someone engages in physical activity that feels good to their body, when they manage their stress, get enough sleep, avoid smoking, manage health conditions with the help of a health professional, etc., that they can achieve health regardless of what the scale says. Weight only gives us a tiny bit of information about the person. It can tell us something is amiss if there is a large shift either up or down (unintentional weight gain or loss), but otherwise, by itself, it really cannot tell us if someone is healthy.

Another thing I talk about with my patients is that bodies are supposed to come in all shapes and sizes. Even though our society might disagree, some people are just meant to be larger than others. It’s in our genes. We all have a set weight range where our weight would naturally settle in if we ate and moved intuitively. While we might have some ability to move up or down a couple of pounds within this weight range, trying to go outside this weight range takes extreme measures. Our bodies fight these extreme measures in every way possible, but for 95-98% of us, we will return to our set weight range, regardless of whether or not we continue dieting.

But in our society, being heavy is seen as a weakness in someone’s character, that he or she is lazy, undisciplined, and reckless with their health. People make assumptions about others based on their weight, and it seriously stinks. So when an “overweight” or “obese” patient comes into my office desperately wanting to lose weight, I get it. No one wants to be seen as lazy, weak-willed, or stupid. My hope is that someday soon society’s views about weight will shift and that people will start to understand that we all have different genetic makeups, and that while weight can tell us what our relationship with gravity is, it cannot tell us whether someone is healthy, happy, or worthy.

Locally Grown

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In response to the piece I published a couple of weeks ago on Tom Brady’s diet, a reader posted the following comment:

“Great…except I’m not sure why farmer’s markets are included in the nutrition buzz fad list. I get most of my produce (veges, fruit, cheese, nuts, bread) from farmer’s markets because it’s better quality than the woeful stuff sold in Australian supermarkets, plus it supports local producers rather than the big supermarkets who make life difficult for our farmers.“

She is referring to the passage in which I wrote, “He [Tom Brady’s personal chef] hits on nearly every current nutrition buzz phrase except for farmers markets, raw, dairy free, gluten free, and no white foods, but don’t worry, he brings these up later.” The commenter inserted “fad” where I had used the word “phrase,” which may have been intentional or an oversight, but either way I think the substitution fits.

A fad, as defined by Merriam-Webster, is “a practice or interest followed for a time with exaggerated zeal.” Breaking down this definition into parts and focusing first on time, we see evidence that the boom of farmers markets might have a shelf life. Between 1994 and 2013, the number of American farmers markets more than doubled, but is beginning to plateau.

One of the main reasons produce is transported from a distance is because the land and conditions necessary for mass growth do not always exist within local communities. My friend took the following picture of me in front of a corn field in Iowa while we were on our cross-country bicycle trip. He could have panned the camera around in any direction and the picture would have looked pretty much the same. In fact, much of the country through which we rode is comprised of farmland all the way from the roadside to the horizon.

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The United States contains an estimated 954,000,000 acres of farmland and approximately 322,000,000 people, which equates to an average of 2.96 acres of farmland per person. In contrast, my state of Massachusetts is 6,754,560 acres in total and was home to a population of 6,745,408 residents in 2014, which equals a density of only 1.00 acre per person. Even if we were all ready and willing to transform our yards, roofs, and windowsills into our own personal farms, the math suggests we do not have enough land to meet our state’s food demands through local growth alone. The comparison is not perfect, as it neglects to account for exporting, but my point is that while farmers markets may satisfy the complete needs of some individuals and play a partial role for others, they will never be able to satisfy the masses without a radical shift in our population and/or how we construct our society.

The second part of the definition of a fad, “exaggerated zeal,” plays itself out in the belief that produce from farmers markets is inherently better for us and our environment than what one would find in the grocery store. The notion that locally-grown produce contains higher quantities of vitamins and minerals relative to fruits and vegetables shipped from far distances does have merit, as seen with vitamin C, for example, but how much does it matter?

Velandia et al. wrote, “Scurvy [which is caused by vitamin C deficiency] is a disease rarely seen in developed countries where fortified food products and multiple supplements fill the market. However, poor diets devoid of fresh fruits and vegetables and low food variety can still cause this often forgotten disease.” For people whose diets are restricted, upside exists for selecting foods that are dense in nutrients in order to make the most of what they are eating, but otherwise consumption of fruits and vegetables – regardless of whether they are purchased at a farmers market or the grocery store – is enough to prevent such deficiencies.

Buying locally-grown foods spares energy and emissions that would otherwise be expended to transport products from a distance. This makes sense, but the situation is not so black and white. The sample size is small, granted, but of the three farmers markets I have visited in my community, none of them sold organic produce, only conventional foods. How do we weigh which is more harmful/beneficial for the environment: transporting organic produce from a distance, or pouring chemicals into our local community to grow conventional fruits and vegetables? [Note: Additionally, as a reader pointed out after I originally published this piece, the very idea that organic farming practices are more friendly for the environment than conventional methods is up for debate.]

Because their popularity seems temporary in nature and based largely on an exaggerated good/bad food dichotomy, farmers markets make my list of nutrition buzz phrases/fads. Having said that, we make no judgments regarding where people shop or for their rationale for doing so. As long as people have access to the food they need to properly nourish themselves, it’s all good.

David Bowie

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David Bowie and Duran Duran are the only two artists I have been listening to virtually my entire life, and somewhere in an unpacked moving box in our basement sits my tape copy of the former’s Let’s Dance album that I got in kindergarten.

Although I do not care for everything Bowie released, I greatly respected his ability to oscillate between styles so drastically that I was left enjoying only parts of his catalog, as opposed to those of artists whose sound is so consistent that I can accurately base my impression of their body of work on a single song.

His versatility, I expected, would form the basis of the numerous tributes that poured in via social media yesterday as the shocking news of his illness and death became public. While some of them certainly did, several centered around the profound impact Bowie had on many individuals and our culture as a whole in terms of empowerment, self-acceptance, and tolerance for diversity and differences.

Nobody said it better than Richey Rose, a guitarist living in New York City, in the following tribute he posted yesterday:

“I had my Bowie phase a little over 10 years ago, when I was a sophomore in college. I had just gotten my first record player and found Hunky Dory at Pop’s (best used record store in my hometown of Lexington, KY). Of course I’d always known Bowie, especially because I’d just gone through a massive Velvets/Warhol/60’s & 70’s NYC discovery the year before… but that record was my first effort into becoming properly acquainted with him as an artist. Needless to say it opened Pandora’s box. I became obsessed and fully engrossed in everything he’d done. A friend gifted me an original pressing of Ziggy and I promptly wore it out; teaching myself all the guitar parts along the way. YouTube was just starting and there were interviews, videos, concert footage – it was my own personal archive into David’s creations and contributions to the world. I was beyond inspired. I’d always been self-conscious about being too skinny, too ‘pretty’ if you will, and had grown up being mercilessly teased because of it. Bowie was literally the first artist/person/thing to make me feel strong and powerful because of my body instead of feeling the total opposite, which I’d done for so many years before. I thought he was a total fucking badass; I thought he was God. Reading everyone’s stories today I realize that Bowie touched EVERY one of us on so many different levels… but not just musically. Sure his records taught me an invaluable amount about songwriting, melody, production, etc. but furthermore Bowie inspired and forever changed my perspective on life. For that I am eternally indebted and grateful. There’s certainly a bit of Bowie inside us all… RIP.“

The bold face used above was my own doing in order to emphasize the passage that I expect most universally resonates and relates to our work as dietitians. Joanne and I do a great deal of activism in the size acceptance movement because on a daily basis we see the consequences of people living under the oppression of weight stigma: eating disorders, shoddy medical care, failing weight-loss pursuits, bullying, weight cycling, disordered eating, and other conditions, approaches, and consequences that only serve to worsen health, not improve it.

In an era when another celebrity gained our trust only to abuse it and built us up until it was personally and financially advantageous to tear us down, Bowie’s lessons of acceptance and being true to ourselves juxtapose in even greater contrast and feel that much more important to reinforce. No matter which Bowie era is your favorite, whether you are a Starman, Ziggy Stardust, Young Americans, Scary Monsters, Modern Love, Heart’s Filthy Lesson, Reality, or Lazarus fan, or even if none of those are your cup of tea, we can all recognize that he impacted our world in a way that extended well beyond his music.

Day 662/193: Collaboration

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Thanks to a great medical team, a supportive family, a generous bone donor, and a boatload of titanium, my spine is now the healthiest it has been in years. My surgeon gave me clearance last week to resume running. Not since 2013 have I been able to step outside and go for a jog.

In addition to expressing my gratitude for everybody who has aided me, I also want to thank myself for everything I have done to help my own cause. While doing so is admittedly not the most gracious of moves, danger exists in giving the impression that we are to solely look outside of ourselves for help. Although health outcomes are never guaranteed or entirely in our control to achieve, patients who come into my office, fold their arms, lean back in their chair, and direct “Just tell me what to eat” rarely do as well in the long run as those who collaborate and take a more active role in their own care. Nutrition may be my area of expertise, but my patients are the experts in their own lives, so the highest likelihood of success comes from working together.

Anyway, my two favorite races are the Mount Washington Road Race and the Five College Realtors 10-Miler, the latter of which is coming up late next month. The other day, I mentioned to my physical therapist that I am interested in running it this year. Given that she tends to be my foil, a voice of caution and conservatism who brings reason and sensibility to my ambitious ideas, I figured she would tell me that the 10-miler made more sense as a 2017 goal. Surprisingly, she thinks the likelihood of me being able to race it next month is high. Whoa. We talked about training for the event in the context of my continued surgical recovery and together we developed a plan. In other words, we collaborated.

The GOAT(’s) Fad Diet

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If you are like me, you wonder what the baserunner and first baseman talk about between pitches. When an athlete meets a peer, the dynamic is presumably different from an interaction with a fan that likely centers around adulation and an autograph.

When dietitians get together, chances are high that at some point we will touch on whatever nutrition-related fads and ridiculousness are currently hindering our work. We laugh, not because we are making fun of anybody, but because misinformation is so pervasive and challenging to our profession that sometimes all we can do is approach our upstream paddle with humor.

The deeper reality, which often goes unspoken but is silently understood, is how terribly harmful nutrition myths, bad information, half truths, and fear mongering are to our patients. All it takes is one meme, 140-character post, headline, hyperlink, or soundbite and the population is led astray in an instant. Just one celebrity endorsement carries more weight in the eyes of many than the educated stances of professionals who have dedicated their careers to the field of nutrition.

Consider Allen Campbell, personal chef for Tom Brady and Gisele Bundchen, and the interview he recently gave to boston.com about his clients’ diets and their shared perspectives on nutrition. Initially I chuckled at the absurdity, but I quickly remembered that hundreds if not thousands of people are likely to risk their own health as they assume this, umm, information to be fact and internalize it.

Let’s look at some of the standout excerpts.

“My philosophy starts in my own life, and with my own lifestyle and eating habits. I make conscious decisions to buy local and organic, and to stay away from GMOs, and to think about the future of the planet and the future of humans.”

He hits on nearly every current nutrition buzz phrase except for farmers markets, raw, dairy free, gluten free, and no white foods, but don’t worry, he brings those up later.

“I took a plant-based nutrition course earlier this year. It was an online course through Cornell, and it’s taught by a doctor named T. Colin Campbell, who’s behind ‘The China Study.’ My philosophy is that a plant-based diet has the power to reverse and prevent disease.”

Four or five years ago, a patient came into my office touting “The China Study” – which has been largely debunked, by the way – and told me, “A plant-based diet is the only one that heals.” She also stated, “The government puts rat poison in the water, but they just don’t tell us.” Sometimes, apparently, hyperbole and paranoia go hand in hand.

“So, 80 percent of what they [Brady and Bundchen] eat is vegetables. [I buy] the freshest vegetables. If it’s not organic, I don’t use it. And whole grains: brown rice, quinoa, millet, beans. The other 20 percent is lean meats: grass-fed organic steak, duck every now and then, and chicken. As for fish, I mostly cook wild salmon. It’s very different than a traditional American diet. But if you just eat sugar and carbs – which a lot of people do – your body is so acidic, and that causes disease.”

Actually, most Americans get more than enough protein. Someone who ate just sugar and other carbohydrates would likely develop kwashiorkor, marasmus, or a similar problem related to protein malnutrition. We learned about these conditions in the first semester of actual nutrition school, but apparently they were never covered in Campbell’s online course.

If your body is acidic, your medical chart probably lists a diagnosis of metabolic acidosis, respiratory acidosis, or diabetic ketoacidosis – none of which are caused by overconsumption of sugar or other carbohydrates – and you are reading this blog from your hospital bed.

“Tom [Brady] recently outed Frosted Flakes and Coca-Cola on WEEI. I love that he did that. Sugar is the death of people.”

As it turns out, your brain runs on sugar, and without adequate glucose in your system, you risk a myriad of problems, including death. What Brady did was oversimplify a complex problem by scapegoating an ingredient, which plays into the fears that fuel disordered eating and eating disorders.

“No white sugar. No white flour. NO MSG. I’ll use raw olive oil, but I never cook with olive oil. I only cook with coconut oil. Fats like canola oil turn into trans fats.”

People continue to fear canola oil based on myths that run counter to actual science. Trans fats, which occur naturally in only trace amounts, are made in large quantities through a chemical process known as hydrogenation. This reaction, while not terribly complex, involves more than just sticking the substrate in the oven.

“[Tom] doesn’t eat nightshades, because they’re not anti-inflammatory. So no tomatoes, no peppers, mushrooms, or eggplants. Tomatoes trickle in every now and then, but just maybe once a month. I’m very cautious about tomatoes. They cause inflammation.”

The research supporting the notion that tomatoes cause inflammation is spotty at best, with some studies showing the exact opposite effect. The evidence is about as strong as that showing the positive impact that tomatoes might have on eyesight. Maybe if you ate more tomatoes, Tom, you would not have thrown that goal line interception against Philadelphia.

Do the kids eat the same things Tom and Gisele eat? “Yeah, I mean pretty much . . . . For snacks, I make fruit rolls from bananas, pineapple, and spirulina. Spirulina is an algae. It’s a super fruit. I dehydrate it. I dehydrate a lot of things. I have three dehydrators in their kitchen. I also make raw granola and raw chocolate chip cookies.”

I have no idea what a “super fruit” is, but I am assuming that being a fruit is a prerequisite for consideration, which excludes an algae like spirulina. Anyway, my colleagues and I consistently find that children raised in households where food is restricted tend to have significant overeating problems once they reach adulthood. Westgate SuperBooks declared Brady’s New England Patriots 9-2 co-favorites to win next month’s Super Bowl, while I will set the odds of Brady’s children bingeing on college dining hall pizza and soft serve much, much higher.

As the interview continues on, the topics turn away from general nutrition and instead touch upon examples of dishes the chef makes and his typical workday, neither of which are within the scope of this particular blog entry.

People look at Tom Brady, 38 years old and still at the top of his game, and figure his nutrition regimen must be at least partially responsible. That may be true, but as I have written before, both about Brady in particular and professional athletes in general, their upsides for rigidity are unlikely to exist for laymen, and the virtues they bestow upon their diets can be off base.

Consider Dave Scott, six-time winner of the Hawaii Ironman Triathlon, who famously washed off his cottage cheese before consumption in order to remove as much fat as possible because he believed a low-fat, high-carbohydrate diet gave him an edge over the competition. It strikes me as more than mere coincidence that Scott was doing this in the 1980s when fear of dietary fat was at its peak.

Similarly, while I have no doubt that Brady believes his diet enables him to perform his best, let us also recognize that his eating behaviors are reflections of nearly every single one of today’s nutrition fads.