The Future of Evidence-Based Nutrition: Artificial Cool Whip or a Ketogenic Diet for Diabetes?
The month of March, also known as National Nutrition Month has prompted a lot of reflection on the current nutrition system in the United States and how we can work to improve it. The question that comes to mind in thinking about the current nutrition landscape is, are we as a country doing our absolute best to improve access to quality foods? Are we doing a sufficient job in increasing awareness around the importance of nutrition for disease prevention, athletic performance, and overall functionality? Are we practicing evidence-based nutrition? From my perspective, the honest answer to these questions is no. We are working off of a medicine-pedaling, chronic disease-centered, food industry-sponsored system and that system is broken. Thanks to functional medicine, CrossFit and other progressive organizations there is a shift that’s started to take place. But in order to continue to make a significant dent, we all need to come together and work towards improving the future landscape of nutrition.
A Broken Nutrition System
Many of the flaws in the current model stem from education and training in nutrition and medical schools. Nutrition students are taught that artificial Cool Whip is an acceptable alternative to Cool Whip for individuals with Type 2 Diabetes. They are taught that ketogenic diets are effective for epilepsy with no mention of the effectiveness for blood sugar control, athletic performance, cancer, and more. Dietitians spend more time telling people to ‘eat less and move more’ than educating on the importance of quality over quantity. Doctors are not sufficiently educated on nutrition. They are forced to spend minimal time with their patients with the emphasis on writing prescriptions for medications rather than lifestyle interventions.
For years I have struggled to understand how the nutrition system was not consistent with a whole foods approach to well-being, dating back to my undergraduate education. Instead of being taught ‘food is medicine’ or ‘food is energy’ or ‘food provides information for your cells’, I was taught ‘food is calories’. Much of the focus was on counseling individuals on lower-calorie alternatives to promote weight loss. In my food science classes, I chose to create gluten-free, dairy-free alternatives for projects where I was told that the only reason to be gluten-free and dairy-free is for celiac disease and lactose intolerance, respectively. In my other classes, my classmates planned menus for people with Type 2 Diabetes using artificially sweetened Cool Whip and Diet Coke while I included sugar-laden Ensure on nearly every menu for case studies of critically ill patients. I remember questioning why we would give a patient with inflammatory bowel disease a beverage that was loaded with inflammation-promoting sugar when it was an inflammatory disease. I was told that any other way of doing it wasn’t evidence based nutrition.
It was my experience in graduate school, as an intern for the Center for Science in the Public Interest (CSPI) that I began to really understand the magnitude of this broken system. CSPI is a non-profit organization, commonly referred to as the nutrition watchdog, that I interned at in Washington DC for my last semester of grad school. I had the choice of going to a few government-based nutrition agencies but I was uninterested in being further clouded by nutrition politics. I liked CSPI because they are a very evidence-based organization that doesn’t accept any funding from the government or the food industry. I sat in on interviews where the founder, Dr. Michael Jacobson questioned Michelle Kwan for becoming a Coca Cola Ambassador while also accepting the position for Member of the President’s Council on Fitness; meetings where Margot Wootan moved forward the ban on junk food advertising in schools, and other meetings where CSPI advocated for a ‘daily value’ on added sugar be included on the newly proposed food label revisions.
While I was interning with CSPI, the 2015 Dietary Guidelines for Americans were being reviewed by the Dietary Guidelines Advisory Committee. This committee of nutrition experts is appointed by the Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA). I sat in on one of their meetings in a large room filled with American flags and 200-300 people. Approximately 75 individuals were given about 2-3 minutes to stand in front of the advisory committee and explain why their product of interest should be included in the new recommendations. The individuals that spoke were there on behalf of the National Dairy Council, the American Dairy Association, the American Beverage Association, the American Candy Association, and organizations that I could not believe even existed. Of all the people that stood in front of the council, there was one doctor and one dietitian for a total of two health experts, who were given the opportunity to speak on behalf of the American people. These individuals were there to protect the health of Americans, urging for changes in the national recommendations that influence the nutrition standards for the School Lunch and Breakfast programs, the Women Infants and Children (WIC) program, and the Supplemental Nutrition Assistance Program (SNAP). Everyone else seemed to be interested in promoting their product on behalf of the bottom line of their organization or company.
It was at that meeting that I questioned the system more than ever. Were the national nutrition guidelines solely based on evidence? Were they in the best interest of the majority of Americans that are either overweight, obese or experiencing a lifestyle-driven chronic disease? Or were they a result of misled policies and industry funded recommendations? The Centers for Disease Control and Prevention states: “chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity and arthritis—are among the most common, costly and preventable of all health problems.” If they are so preventable then what’s stopping them from being prevented?
Functional Nutrition is the Solution
The only way to improve the system is to go back to the basics of nutrition and create a more personalized approach for individuals that is not biased by industry. This is the most effective way to help individuals experience true transformation and empowerment in their health. This was a model that was incorporated in the Cleveland Clinic Center for Functional Medicine, the first hospital-based functional medicine center in the world. After co-creating the nutrition department and working with over 3,000 individuals in three years, I became certain of one thing: functional nutrition changes lives in ways that recommending artificial Cool Whip to diabetics does not. I’ve not seen a diabetic come off of their insulin and medication by subbing out one processed food for another chemically created one. I have however seen it in working with a number of people with Type 2 Diabetes using a whole foods approach to balancing blood sugar, and even using personalized ketogenic nutrition plans that have been shown to be effective.
The solution to our chronic-disease-enabling-system is functional nutrition—creating personalized nutrition recommendations, narrowing in on root causes, shutting out nutritional politics, stopping the message that ‘all foods fit’ in our food system, looking at the microbiome and validated genetics testing and using food to heal people—not just of their weight problems but of their chronic diseases, joint pain and poor performance at the gym. As Dr. Hyman says, high cholesterol is not a Lipitor deficiency, yet Lipitor is commonly the first thing prescribed to a person without addressing the reason for why their cholesterol levels are high to begin with.
We are beginning to shift from a system that continuously chases disease and fails so many to a system focused on creating health and vitality. We as dietitians, doctors, healthcare practitioners, coaches, trainers, government officials, farmers, restaurants, and food consumers all need to take a role in addressing the chronic disease epidemic in a strategic and ‘food first’ way. The urgency is demonstrated in the fact that our annual healthcare expenditure is $2.7 trillion in the United States and 85% of that is for treating or “chasing” chronic disease and mental health conditions. Not to mention the even more pronounced effect that poor nutrition can have on low quality of life, poor performance, low self esteem and not feeling the best. You know the system is broken when children at the age of two to five years old are diagnosed with Type 2 Diabetes. So, let’s continue to fix it. From the lens that I look through there seems to be seven important steps for creating a successful functional nutrition system:
1. More Dietitians & Nutrition Professionals Need to Be Trained in Integrative and Functional Nutrition
Integrative and functional nutrition is an evidence-based approach to nutrition that incorporates personalized recommendations based on whole foods and clean supplements. This past semester, I co-created a graduate level course in integrative and functional nutrition at a very prestigious university. Why is this important? Because it means that institutions that pride themselves on being evidence-based are beginning to embrace this approach. I recommend that all dietitians and other healthcare practitioners enroll in the online training program created by the Integrative and Functional Nutrition Academy (IFNA). This incredible program was created by dietitians Kathie Swift, MS, RDN, LDN, FAND, EBQ and Dr. Sheila Dean, DSc, RDN, LDN, CCN, IFMCP to educate future practitioners on how to incorporate an evidence-based, integrative and functional approach into their nutrition practice. Click here to learn more: https://www.ifnacademy.com/
2. Functional Nutrition Needs to Be Included in Dietetics Curriculum
The dietetics curriculum incorporates a lot of science but there is a serious need for an updated curriculum, one that incorporates a whole foods message and functional nutrition principles. Students cannot continue to be taught that gluten-free only matters for those with celiac disease now that the latest evidence demonstrates that many individuals have non-celiac gluten sensitivity. They also should not continue to be taught that calorie counting is effective and that the quantity of food eaten is more important than the quality. And lastly, future dietitians should be given the latest evidence on the risks of diet soda consumption so that they stop recommending Diet Coke as the ‘perfect zero calorie substitution’ for regular Coke.
3. Medical Students Need to Learn About the Value of Nutrition and Lifestyle Interventions
Along with dietetics education, medical education also needs to continue to be updated. Doctors need to know more about nutrition—simply knowing BMI cutoffs and telling a person that they are obese and need to lose weight is not enough. Fortunately, there are efforts to increase the focus on nutrition and culinary medicine taught in medical schools. I am looking forward to seeing the number of curriculums expand. Patients value their doctors’ opinion more than any other healthcare practitioner. Like dietitians, doctors have a professional obligation to preach the importance of nutrition but also practice it. Individuals are much more likely to listen to recommendations that are made by people that embody the same lifestyle that they preach.
4. Every Doctor Should Have a Dietitian in their Office
At the Cleveland Clinic Center for Functional Medicine every patient is required to see a Registered Dietitian for at least one appointment. They also have a team of dietitians running shared nutrition appointments. Doctors underestimate the impact that proper nutrition interventions can have on outcomes for their patients. As Dr. Hyman often tells his patient, “70% of your joint pain, migraines, bloating, constipation, diarrhea, blood sugar fluctuations, reflux, etc. can be resolved through nutrition”. I’ve worked with doctors that didn’t previously have a dietitian in their office who have said that all of their patients get significantly better, faster, as a result of everyone working with a dietitian. And in an even more ideal world, all offices would have a dietitian, health coach, behavioral therapist and fitness expert or trainer. The team-based approach leads to powerful results.
5. Consumers Need to Take Very Seriously the Power of Voting with their Fork
Don’t underestimate the impact that you as a consumer can have on improving the food system. Big industry used to say that it was impossible to produce healthy food because it does not have an enjoyable taste or the ability to stay stable on the shelves. So instead they sold everyone on the benefits of enjoying delicious, creamy microwavable meals and the convenience factor. That worked but only for so long. People are starting to wake up and read their ingredient lists, question all of the chemicals and added sugars that they see, and demand higher quality for their families. Smaller companies like RX Bar, Simple Mills, Vital Proteins etc. are pushing the envelope and proving to these big companies that it’s possible to succeed financially while also caring about the health of the consumer. The best example of this is the $600 million RX Bar buyout in 2017 where Kellogg’s demonstrated that they are paying attention to companies that care about quality ingredients. This movement is consumer driven. Every dollar that you spend on organic or local food and companies with integrity leads to you shaping the future of food and nutrition in the United States.
6. Non-Licensed Coaches Are Important & Need to Know When to Refer
I’ve worked with a number of health coaches that I value, respect, and appreciate. Coaches of all kinds including health coaches and CrossFit coaches have an invaluable role in helping people improve their health. An organization like CrossFit has the ability to positively impact people’s health in ways that hospitals and doctors’ office do not because of their ability to create a sense of community. I know many people that have changed their lives from the simple and important nutrition messages that CrossFit founder, Greg Classman has spread to CrossFit boxes around the country: Eat meat and vegetables, nuts and seeds, some fruit, little starch and no sugar.
While this message is important for coaches to spread, it’s equally important for health coaches and CrossFit coaches to refer to a nutrition professional when discussing more personalized nutrition recommendations or medical nutrition that is based on a condition or a diagnosis. This allows for people to get the best results with performance and their health because they can assess their genetics, food sensitivities, gut health and how that translates into personalized nutrition. I’ve worked with a number of individuals who do CrossFit and have witnessed the true power in combining functional fitness with functional nutrition! Overall performance and health outcomes dramatically improve when dialing in on a personalized nutrition approach.
7. Farmers Need to Be Incentivized to Farm Nutritious Foods
We need better access to local foods, quality soil, and community-grown efforts to solving our nutrition problems. While places like Costco are an amazing way to increase access, and decrease costs of organic foods, it continues to take us away from growing the freshest foods in our own communities. Don’t get me wrong, I love Costco but I love farmers’ markets even more. When you know your farmer, you know how they are growing their food. Farming is a hard job that does not have many financial incentives, that is unless you run a factory farm that values quantity over quality. Farmers need to be incentivized to grow quality produce without pesticides and herbicides and raise grass-fed animals instead of corn and soy fed animals. The way that we value and compensate farmers should be based on the quality of the foods they produce.
Today it might seem like you are constantly swimming upstream when making healthy choices; but my hope is that if we continue swimming against the stream that it won’t be this way for our children and grandchildren. I envision my children and grandchildren calmly bathing in affordable, organic spinach and clean, filtered water. In order for that to happen we have to keep swimming together. I’d love to continue this conversation throughout the month of March, in honor of National Nutrition Month. Please add your comments below on how we can continue to improve the future of nutrition. I’d love to hear your thoughts. And be sure to remind yourself daily that striving to live a healthy life is incredibly important for you, your family and the world!