The Whole30: When in doubt, cut it out.

One of the most notable things about the Whole30 program introduction is the implication, without specifying causes or mechanisms, that enormous swaths of your diet are causing various health problems.

This implication is posed as a series of questions:

“Are your energy levels inconsistent or non-existent? Do you have aches and pains that can’t be explained by over-use or injury? Are you having a hard time losing weight no matter how hard you try? Do you have some sort of condition (like skin issues, digestive ailments, seasonal allergies or fertility issues) that medication hasn’t helped?”

The writers propose that “certain food groups” could be causing these problems, and provide a two-sentence explanation that these are “psychologically unhealthy, hormone-unbalancing, gut-disrupting, inflammatory food groups” that require you to “reset” your metabolism because they cause “systemic inflammation” and “downstream effects.” Instead of explaining how or why, they propose an experiment: cut all of the suspected groups out of your diet for 30 days, and see if you feel better.

This is called an “elimination diet.” If you’ve been vaguely conscious of diet culture for the last decade, you’ll be aware that the concept of the elimination diet has become something of a sacrament. An elimination diet is one where you eliminate a huge number of foods, and even food groups, in an attempt to get to a point where you are no longer having food-related symptoms (usually GI symptoms), and then slowly add foods back in, one by one, in order to tease out which foods initiate the symptoms again. The goal is to, eventually, add in everything you can, except the (hopefully few) foods that actually cause you problems.

In clinical dietetics, the elimination diet is used sparingly, because though it can be a powerful tool in narrowing down problematic foods for someone experiencing IBS symptoms, those symptoms must be severe enough to justify putting a person at increased nutritional risk by significantly curtailing the variety of their diet for weeks at a time. It is also a very difficult process for people to follow, and the people most motivated to stick to an elimination diet usually have the most severe or distressing symptoms.

Vague symptoms like fatigue, aches and pains, and failure to lose weight might not make the cut. These, and other conditions unresponsive to medication, may or may not have any relation to diet. In cases where they do, it would be important for a person to see their doctor and possibly get a referral to a dietitian (especially if the issue is celiac disease, for which an elimination diet could actually interfere with getting a diagnosis.) Most importantly, an elimination diet used in this context is meant to be temporary, and the person is encouraged to add back in as many previously-eliminated foods as they can tolerate. This minimizes their nutritional risk by increasing variety.

This Whole30’s version of the elimination diet is somewhat different. Yes, it is a program meant to last only for 30 days, but there don’t seem to be any clear encouragements to add back in as many foods as possible after the elimination period. In the clinical setting, when a person is undergoing an elimination diet, the dietitian makes it clear that the foods cut out of the diet are not universally bad or toxic; rather, the person has a condition that creates an intolerance (sometimes temporary) to those foods. The Whole30 specifically labels those foods as globally bad and unhealthy. And with the Whole30, the message I’m getting, particularly from people who’ve done the program, is that their goal is to eat in a way as similar to the Whole30 as possible…indefinitely.

Thankfully, this is probably not sustainable for most people. I say “thankfully” because the rules of the Whole30 literally require you to stop eating slightly more than half of the food groups in the diet – grains, dairy, and a good swath of proteins (legumes.) Even if you replace the missing food group servings with servings from the remaining groups (fruits and vegetables, meat/fish/eggs/poultry/nuts and seeds), the overall variety of the diet is severely curtailed (definitely not a good thing), and likely your overall intake is reduced as well (which could be a good thing, but also might not be.)

Given the nutritional concerns, why might someone choose to do a diet like this? Well, possibly because some people experience exceptional health concerns that really do respond best to this program. I’m not denying that those people exist. What I doubt is that every person, or even most persons, embarking on this program fit that description.

What other reasons might there be, then? Symbolism? Ritual? Values? Anxiety?

I suspect that elimination diets, when they are not (entirely) about allergies and intolerances, are actually about purity, about a way of expressing cultural identity, and possibly even political values. These are not bad reasons — the only problem is when these reasons are covered up with misrepresented science.

I suspect that elimination diets are a symbolic way of saying, “There is too much in the world, there is too much in our culture, and I feel overwhelmed with food marketing and grocery store options and consumer culture and the difficult politics of industrialization and the rapid development of technology that has the potential to cause harm, and I’m opting out at least for a while. We have gotten too far away from what I think is the right way to handle and produce food, the best way to be genuinely human, and I am going to do something about it, for myself, as one person. For 30 days, I’m just going to be a human. And if I can do it longer than that, I will try.”

If that’s what it’s about, at least partly, the question then becomes: does it work?

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Rampant speculation in comments.

Posted in Diet Pop Culture | 104 Responses

The Whole30: A quick note on scientific evidence vs. non-scientific arguments.

I like skepticism, as a practice and a way of thinking. I share a lot of the traits and values of people who write skeptically about popular science and popular health and nutrition messages. But I often feel like there is something missing in skeptical conversations, and I hope that, in our discussion of the Whole30, we can try not to miss it.

What’s missing is an acknowledgment that people do things that are not evidence-based, but are often for very good reasons, nevertheless. People make decisions all the time that are not based on scientific evidence or even a factual understanding of how something works, but rather, they make those decisions based on cultural values, or aesthetic preferences, or as a way of expressing and managing the anxieties of being human. Far from being a sign of weakness or irrationality, I think this can make a lot of sense.

Where the skeptical side of me kicks in is when people insist on providing a pseudoscientific rationale for something that is, at core, a non-scientific decision. For example: it is good and honest for someone to choose to exclude pork from their diet based on cultural tradition. That makes perfect sense to me. But if that person turned around and claimed there is a definitive scientific consensus that eating pork causes zinc deficiency, that wouldn’t make sense. It is factually incorrect, and now it also becomes dishonest. Reaching for these kinds of explanations can lead to wildly misconstrued ideas of what science says about an issue, and can mislead other people, sometimes dangerously.

It is okay to make symbolic decisions about the food you eat, as long as you acknowledge making them for symbolic reasons, and as long as you acknowledge that those same decisions don’t necessarily work for other people. It is okay to make aesthetic or moral decisions about the food you eat, but it is not okay to make up out of whole cloth a complicated science-flavoured rationale in order to lend credibility to your choice.

It is very tempting to reach for scientific-sounding explanations, because those explanations are privileged in our culture. They carry a kind of social capital. We all do it sometimes; I see people involved in fat acceptance and Health at Every Size do it fairly often. I try, when I can, to acknowledge that a large part of my perspective about body weight and eating is based on a moral decision I have come to: that it is not acceptable to treat people as less-than based on a physical trait, and that fat people have the moral and legal right to eat normally, without dieting, if they want. There may be some scientific evidence to support the principles of Health at Every Size, but for me, the core of this issue is, and has always been, moral. Science is simply not the appropriate language with which to express moral judgements, because moral judgements are not (may not be?) falsifiable through the scientific method.

That doesn’t mean we can never explore or be critical of those judgements, but it does mean that science-based arguments are probably the wrong tool for the job. It also means that, when you are passionate about a moral or cultural position, you need to be particularly careful about making scientific arguments to complement that position. Because of your personal commitment to the position, you are going to have a harder time being critical of the evidence that seems to support your choice, and being fair to the evidence that doesn’t. And you have to make extra, extra sure that you don’t just…make stuff up. Because then you’re lying.

If you’re making a scientific argument, you open yourself up to having it scrutinized and possibly discredited with arguments based on scientific evidence. But if you make a religious, or symbolic, or aesthetic personal choice, it probably doesn’t make sense to discredit it with scientific reasoning. (“Brad chooses not to eat pork because it is traditional in his culture not to eat pork, and he finds the idea of eating pork disgusting. However, he is WRONG because nutrient analysis shows that pork is a good source of zinc!”)

For what are essentially cultural, religious, or moral arguments, it probably makes more sense to examine them with cultural analysis, a reading of scripture, or moral reasoning and ethical principles. In doing so, however, we are less likely to come to a definitive call of correctness or incorrectness, since all of these things are very subjective and open to multiple valid interpretations — and since, at the end of the day, people have the right to make whatever decisions they want to about their own eating, regardless of how unreasonable we think they are.

What none of us have the right to do, though, is misuse science — whether to defend or to discredit a fundamentally non-scientific argument. It can be very difficult to avoid doing that, but let’s try.

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Or maybe I don’t even know what I’m talking about, in comments.

Posted in Diet Pop Culture | 39 Responses

The Whole30: Concepts of “fitness”

One of the first things that stands out to me as I read the brief introductory article on The Whole30 is this:

“Certain food groups (like sugar, grains, dairy and legumes) could be having a negative impact on your health and fitness without you even realizing it.”

There’s a lot going on here, but for now I want to highlight “fitness.” If I were coming to this article as a someone totally naive of diet culture, I would wonder what type of “fitness” they are referring to, specifically. As someone with some knowledge of health and physiology, the first thing that springs to mind is cardiorespiratory fitness, or specifically, how efficiently a person’s heart and lungs function to provide cells with oxygen so they can utilize chemical fuels (like glucose) to perform work.

However, I suspect, in the context of the rest of the introductory article, and given the focus of the Whole30 program itself, that this is not the “fitness” to which the author is referring (though cardiorespiratory fitness may be a secondary consideration.) I suspect they are referring more to “metabolic fitness,” which is a construct concerning itself with the body’s utilization of glucose and insulin, as well as body composition, or the ratio of lean to adipose tissue in a person’s body.

To me, this is culturally interesting because of a recent (but not unprecedented) shift in diet messaging in the past few decades. Most of you probably remember the low-fat diet messaging of the 1980s and 1990s, which happened to correspond with fitness messaging that focused on aerobic exercise and cardiorespiratory fitness, and the health indicators (serum cholesterol, blood pressure, heart rate, V02 max) used to measure this. It is interesting to me that, with a swing toward (or back toward) low-carbohydrate diet messaging, also seemingly comes a swing toward fitness messaging that focuses on resistance exercise and metabolic fitness.

Aside from these two concepts of “fitness,” whenever the word “fitness” itself is used, I can’t help but ask myself, “fitness for what, specifically?” I don’t mean this as a rhetorical question or a snide attempt at undermining the message, but as an honest attempt to poke beneath the surface.

What are we trying to be fit for, exactly? How does the concept of “fitness” apply to the popular theory that the human environment has changed rapidly enough to outstrip our biological adaptability, rendering most of us presumably “unfit” for the environment in which we find ourselves living? Does it make logical sense to attempt to return the body to a state of “fitness” best adapted to an environment that no longer exists?

I have no idea. Do you?

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More questions than answers, probably, in comments.

Posted in Diet Pop Culture | 45 Responses

Upcoming: An analysis of the Whole30

At the moment, I’m working on my internship research project, which is a critical analysis of a popular diet program, The Whole30.

Over the next week or so, I plan to post snippets of the themes I’m finding as I analyze some text that goes along with the program. Please come back if you’re interested in discussing this, and perhaps other bits of popular diet detritus.

As always, we’ll be wearing our critical thinking caps during the discussion. Though I’m not opposed to hearing both positive and negative stories, this won’t be a place to engage in uncritical diet evangelism. If you find diet stuff triggering, you may want to skip this series.

For now, I’ll leave you with a question: do you know anyone doing The Whole30? I’d love to hear your observations.

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Stories in comments.

Posted in Diet Pop Culture | 71 Responses

How to become a dietetic intern.

“First, try to be something, anything, else.”
-Lorrie Moore, How to Become a Writer

First, decide on a wholly impractical career path at an early age, say, as a writer. Write and bind a book of construction paper and crayon when you’re six. Switch to pencil and start writing poetry at eight. Drag the idea behind you like a security blanket until you’re 18, when it falls apart during three college poetry courses. Decide, if you’re going to write, that you want something to write about.

Leave Portland, Oregon and immigrate to Canada to marry your Canadian boyfriend. Live in rural southern Ontario, among pumpkins and tobacco fields, while you file endless paperwork and photocopy your love letters for immigration officers. Try to sew. Severely undercook a pork roast. Eventually, you’ll go to university like your friends. For now, be a housewife.

Go on a diet. Do it “the right way.” Exercise a lot and pretend to love apples. Lose 30 pounds and realize that your relationship with food is completely bizarre, that you now feel worse about your body instead of better, and that you now have a curious tendency to get sick.

Try Googling nutrition. Search for some kind of truth, and instead, find an avalanche of frenzied, contradictory diet conspiracy theories that make no sense. One night, as you wander through a bookstore, pick up a book about the diet industry from the bargain bin, and smugly laugh at the title, successful dieter that you are. Read it anyway. You will realize you’ve been hurting yourself. Cry, eat chocolates, regain weight, and recover.

You will decide to like yourself anyway.

Think about this, and those Google results, and decide to become a dietitian.

Move from your tiny, rural hamlet to Toronto. Enroll in a university dietetics program. Promptly get sick. Then get sick again. And again. Cut back your classes to part-time, even take some semesters off, to get well.

Be poor. Survive on beans, peanut butter, oatmeal, the cheap fruits and vegetables. At least you know enough about nutrition that you won’t develop a deficiency. Develop a deficiency. Go sometimes without hot water, sometimes without heat, in the dead of winter. Boil water in the teakettle and bathe yourself in the sink. Heat the apartment with your oven. You’ll never take being warm for granted again.

Work nutrition jobs in hospitals for five years. Start in food service. Wake up very early and wear a hairnet. Switch to a clinical job in a diabetes education centre; you can take off your hairnet. Go on to cover inpatient areas like eating disorders, oncology, ICU, and general medicine.

You will miss your mom. You will love, starry-eyed, every dietitian you meet.

Go see a dietitian for yourself and learn to love apples, for real this time. Now you have something to write about, so start a blog about nutrition and write about Health at Every Size. Attend a workshop about eating competence and find yourself starry-eyed all over again.

Help people learn to love eating. Watch a woman taste pumpkin pie for the first time, her face transformed with delight.

Most people won’t understand what you do. Do it anyway.

When you finish your degree, it will have taken many years and innumerable trips to the doctor. For three years, you’ll put off applying for a dietetic internship. You will convince yourself you’ll never get in, that you’re too poor, too sick. Then you’ll find out you were misdiagnosed. When you stop being sick, you’ll immediately apply to everything. After many sleepless nights, you will be offered a spot in a master’s program and an internship. You miss hospitals, so take the internship.

You are finally a dietetic intern. Walk around with your head up. Write a little book about eating and hold a fundraiser to survive the next nine months.

The day you walk down University Avenue to your first rotation, it will be spring after a decade of winter. Wear sunglasses, smile mysteriously. You’ll never take being warm for granted again.

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I’m almost finished with my internship, and you all made it possible. Just one research project to go. Thank you!

Posted in Dietetic Internship | 36 Responses
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