The Dietitian’s Dilemma.

I first heard of Michelle Hurn when she appeared on a youtube video with Kevin Berry MD. The main thing I noticed was the ration of patient time to coding: five minutes consultation, 30 minutes coding. I work in a place where the healthy heart guidelines are used to control what is being offered to staff, and as a result I’m really challenged to find something that is worthwhile feeding myself and not full of whole grains, sugar, and various green leaves that will push my oxalate levels up. I had kidney stones last year, probably due to that, so my mistrust of the dietitians is considerable.

The Heart Foundation advice.

Michelle Hurn’s life was saved by dieticians. She had severe anorexia as a child, and dietitians managed to allow her to regain a healthy weight without having refeeding syndrome. She recovered, trained as a dietician, discovered long distance running, and then… everything broke down.

An aside. Most runners are told to eat lots and lots of carbs as if you run for about 2 hours or so you will run out of glycogen. I’ve seen my pace slow to survival at 35 km in a marathon when I was young and this happened. She estimated she was eating 300 g or over a half pound of sugar a day when training. This led to exhaustion, anaemia, and sarcopenia. She literally could not run. She was exhausted.

And then she started eating ultra low carbohydrates and recovered. Her partner was appropriately terrified when she did this, as this woman had a lot of issues with food (and other things) so she did not know if this would work. It did.

And her anxiety disappeared.

Her energy returned. She could run again.

To quote Ms Hurn:

I found that many of individuals I saw who were diagnosed with chronic conditions were doing just that, attempting to eat healthy and move as they were able. Unfortunately, they continued to be sick, obese, suffer with debilitating depression, develop wide spread, systemic infections, or end up with organ failure such as kidney failure or heart disease.

What’s worse, is there is so much conflicting information. A quick google search of a “healthy diet” will likely lead you down a rabbit hole on various theories of what humans should eat to thrive. Unfortunately, many of these ideals are motivated by corporate (profit based) interests and have very little to do with restoring and maintaining health.

If you or someone you love has lost and gained hundreds of pounds on various diets, is overweight, diabetic, suffers low energy, poor sleep, feels hungry all the time, has frequent bouts of anxiety or depression, deals with gastrointestinal disorders such as IBS, ulcerative colitis, or frequent gas and bloating, has been diagnosed with hypertension, has chronic inflammation or an autoimmune disorder, or is in the depths or an eating disorder, I am here to offer a message and a different narrative than you’ve likely heard before.

This isn’t your fault. You don’t lack willpower and you’re not a moral failure. The fact that your mother, father, or entire lineage was diagnosed with a particular disease, such as diabetes, does not mean you have to succumb to the same fate.

Instead of blaming ourselves, I believe we need to look at our current nutrition guidelines and entire health care system. Is it possible that we’ve been given incorrect, erroneous information on what humans need to eat to have vibrant physical and mental health?

The short version is eat as your grandparents did — meat, two to three times a day, with some vegetables (or none — they were often not available) and limited to no carbohydrates. You will lose weight doing this, because you will be full — which I am not eating what they healthy heart guidelines say. (You also don’t want to eat as pioneers did — beans and white flour or rice — because that was “iron rations” you used when you could not hunt). And do not eat as the Seventh Day Adventists do: you will get nutritional deficits.

If that was all the book was, then I would not have been tempted to buy it. What the book talks about instead is what healthy eating is deemed to be in the US hospital system. To my mind, you could eat much healthier at MacDonalds, before you start hacking the menu — which you can do, by the way. If I ate this way I would be inflamed, miserable and some intern would be prescribing me insulin. The shocking thing was the quality of the food. Mickey D does have moderate to good quality food: this was industrial.
(Did I add that the food in the cafe at work which meets guidelines tastes like cardboard?).

Instead she adds three or four other chapters. The first is on Diabetes, where she points out that if you lose weight and cut carbohydrates out you will generate gluconeogenesis and you will lose weight. In part this is because fat makes you full. In part it is because you will find your glucoses are lower and your insulin needs less, and the greater your insulin levels the higher your risk of developing obesity. But in general you will do well. She points out that the dieticians want you to eat steady carbobydrates, which you don’t need.

She then talks about anxiety and depression, where there is data on diets, and about psychosis, where there is anecodotal evidence. She misses one of the ugly problems of many medications in mental health: they promote insulin resistance and/or carbohydate craving. Where she is strong is in describing the diet for a psychiatric inpatient unit, which makes the hospital diet elsewhere look good. She is stronger when discussing loss of muscle mass, and the need for bioavailable nutrients. She has excellent pictures of how humans are not gorillas or cows and we therefore cannot eat their diet.

The more frightening chapter was on how the Seventh Day Adventists managed to do trials and get people into decision making places in the American Dietetic Association so they could write guidelines for health. Put simply, these have been used in the first wold and they have failed. There is no ability inside US hospitals to go against guidelines even when the guidelines are wrong. This is profoundly unethical: all guidelines need to be modified and reviewed as more evidence comes to hand, and arguing from authority does not cut it if you are claiming to be evidence based or a scientific discipline.

I found the book at times too confessional and american. I don’t really want to know about her personal life and background. I wanted more data. I found her version of a keto diet too fat based — but I’m not getting up at 3:30 am and running for two hours every morning. (She really needs to think a bit more about periodization and introducing small doses of speed training even for endurance races. The only way to get efficient at running fast is to practice it).

However, it reaffirmed some things we have discovered and I learned some new things. I will keep a hard copy of this on the bookshelf.

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Gunner Q
7 months ago

I’ve always understood that the main priority for hospital food is for it to not be too messy when you puke it up. Not sure if the nurses were joking when they told me that… but that does explain their institutional fascination with Jell-O.

I brown bag food or plan to eat elsewhere, because three days a week the cafeteria for staff is organized by the dieticians and must meet their guidelines. We don’t puke things up, and the food is a joke

7 months ago

I’ve always considered hospital food a bad joke.