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Why I AM an Anti-Diet Doctor

anti-diet Sep 15, 2018

Most doctors enter the field of medicine because they want to "help people." No one tells you when you're a young, idealistic teenager who happens to do well in science and math courses that there are many ways to "help people" that don't involve spending 20+ years of your life in some kind of training. But I digress. 

When I started medical school, I fit into the masses of idealistic bleeding hearts who wanted to give their all to every patient that walked through their doors. I also wanted all of my patients to lose weight. 

I drank the proverbial kool-aid that seeps into every fabric of our being, and traditional medical training no exception, that obesity was an epidemic and that the cure to this public health crisis was to get everyone to lose weightSpoiler alert: that's not the answer. But more on that later...

Never mind the fact that at this time in my own life, I was over-exercising, under-fueling, losing my hair, not getting a period, passing out, and getting bruises the size of my palm all over my extremities. 

And like many in the medical field, the dozen of doctors that I saw were blind to the idea that my weight could be the problem. Because... I was a "normal weight" So, instead, I was referred to countless specialists-- hematologists, reproductive specialists, cardiologists, gastroenterologists, thyroidologists, and even acupuncturists-- who all concluded the same thing: I was healthy.

Only I wasn't healthy. And the vast population of our society is NOT healthy. Yet, the problem is not in identifying that we are an unhealthy population. Our problem is in identifying WHY we are unhealthy.

That's why I'm writing this article.  To address the health of our nation. Just because I'm "anti-diet" doesn't mean I'm "anti-health." Honestly, we've become too concerned with how we label our practices. I hate that as a society, we have become so bogged down with labels of how we practice that we have lost touch with what health even means. 

We all need a little more respect and love and acceptance for individuals if we are ever going to improve the health of our country. As long as we continue emphasizing black-and-white, dichotomous thinking, you're not doing anyone any good-- no matter what side of the fence you're playing on.

To read the Cliff's notes, scroll to the bottom for my "Concluding Thoughts." For my full story, keep reading.

When I Believed Diets Were the Answer

After graduating from my dual degree MD/MPH program, I was fixed in my thinking that weight loss was the cure to solving all problems-- even my own. By this time, I had my first daughter and was focused on losing the baby weight... and because #firstbaby, I did. Fairly easily amidst my very active psychiatry intern year.

Yet, my diet mentality contributed to two big issues once entering #momlife. First was postpartum depression. Second was infertility and thyroid issues.

The Postpartum Depression

Even as a psychiatry intern specializing in perinatal medicine, I was oblivious once again to my own issues. Seeing a pattern here? Nonetheless, it wasn't until my depression became very severe that I finally sought professional help. Before I saw a psychiatrist and ultimately started on medication, I tried all the "natural remedies."

I read Kelly Brogan MD's blog and her work in functional psychiatry and I researched hormones and read Sara Gottfried MD's work. I thought I was getting "the facts" because this information was coming from doctors. Yet, no amount of "clean eating" or exercise ever cured my depression. Medication, therapy, and some big life changes did. 

Whether or not you suffer from postpartum depression or some other kind of mental illness, healthy behaviors can absolutely help. Some studies even indicate that 30 minutes of moderate aerobic exercise showed similar improvements in mood compared to antidepressants.

Here’s the problem though: many individuals tend to minimize mental illness symptoms (and tend to catastrophize medical ailments). So, individuals self-prescribe mild treatments for more severe mental health issues… without ever seeing a professional.

I see similar patterns with my own private practice patients. They try to do things the "natural way."  Yet, the paradox is: it's only when my patients take the plunge to the "dark side" of starting an antidepressant that they begin to actually see the light. A diet will not cure mental health problems, just as it won’t cure a medical problem either.

The Infertility Issues

After I overcame PPD, I began experiencing infertility. When I began having infertility issues and experiencing symptoms of hypothyroidism, I was determined to find a solution. I had already experienced a past history of undiagnosed thyroid issues (remember the hair loss, no period, fainting spells in medical school?)

I was allured by the Paleo communities and Hypothyroid Mom who claimed gluten free was the cure to thyroid problems. I read countless research studies (most of them, rat-based, not human-based, mind you) about the validity. While there are studies that MAY suggest a POSSIBLE improvement in symptoms from a gluten-free diet in celiac patients who also suffer from autoimmune thyroiditis, there is NO conclusive research that suggests that gluten-free diet improves hypothyroidism alone. 

Then, I had a miscarriage.

My world was rocked. I felt lost and alone and confused and like my entire body failed me. I continued to assume that a diet (or the pursuit of weight loss) was the answer for me. Now, I know that the word DIET is just "a way someone eats."

Here's the tricky thing though: no matter how much we try to emphasize the food, we still live in a fat-phobic culture and therefore, MOST efforts of diet change are entered with the desire to lose weight... and thus, promoting once again that weight loss is the answer.

So, I was like many who believed that diet = weight loss = health.

This connection is SO strongly reinforced by culture and the medical community that, in my opinion, it is almost impossible to do "diet-based" work WITHOUT falling in the trap of "weight loss-based" work. But I'm getting ahead of myself.

"This is the tricky thing: no matter how much we try to emphasize the food, we still live in a fat-phobic culture and therefore, MOST efforts of diet change are entered with the desire to lose weight... and thus, promoting once again that weight loss is the answer." - Stefani Reinold MD

For you dietitians or doctors who DO put patients on diets or who work with very medically complicated patients, I totally get it! I urge you: please continue to address, early and often, that the diet that you recommend is NOT in an effort to control their weight, but rather, to help their symptoms. 

This cannot be stated enough, as it is the natural thought pattern of individuals to want to lose weight (or think that weight loss is the answer to all of their life's problems).

Lastly, before I move on, let me shout from the rooftops:

THERE IS NOTHING WRONG WITH MAINSTREAM MEDICINE!

I hate that as a society, we shun mainstream medicine for the "natural route" (which for the record, is so ambiguous that it loses all meaning in my opinion). Let me be the first to admit the MANY flaws of traditional American medicine. But let me also say that traditional American medicine SAVES LIVES! And not just the trauma surgeon, cardiologists, and emergency services. I mean, primary care doctors, pediatricians, and psychiatrists too.

There are some bad doctors out there (or rather, misinformed). And there are also AMAZING doctors! Give your physician some credit. The field of medicine is NOT an easy path-- both the journey and the destination. And we are not ill-informed. Rather, maybe, you are the ill-informed one if you're getting most of your facts from online bloggers who cite research studies out of context. Hmmm... think on that...

        

When I Recognized Diets Don't Work

When I read Intuitive Eating, I was pregnant, geographically separated from my Army husband, and lost. I had been through the ringer of diets. You name it, I tried it. And now, anxious to be going through a high-risk pregnancy without strong support systems around me. I don't even remember ordering the book online. It was sitting in my drawer of my nightstand.

One day I picked it up. And I didn't put it down until I read the whole thing cover to cover.

 For me, Intuitive Eating made sense. The 10 principles explained health in a way that no one had explained it to me. Essentially, stop following outside rules and regulations and instead, learn to acknowledge your own body’s hunger and fullness, all while utilizing external nutrition facts as information not as a law. When I began fully practicing Intuitive Eating, I saw the benefits.

My physical health improved, my thyroid issues resolved, my fertility returned, and my mental health improved. For once in my life, I was fully nourished. Best part was: I was no longer wreaked with the constant mental chatter around food and my body.

Before I go on to speak of the medical and psychological benefits of Intuitive Eating and my stance on the anti-diet space as a whole, let me make one thing clear. While I now summarize my Intuitive Eating journey in one small paragraph, this was literally the HARDEST thing I’ve ever done IN MY LIFE.

I’ve suffered trauma and loss, battled illness, gone through medical training, suffered sexual harassment, written a book, run marathons, backpacked Europe without an iPhone, survived Army deployments, conquered #momlife (most of the time), and even killed a tarantula. But believe me when I say: learning to trust my body was THE hardest thing I’ve done in my life.

I not only had the same struggles as most individuals being surrounded by diet culture and the constant allure of the weight loss sirens, but I’m also a doctor. As a medical professional, I’m in the vast minority.

In fact, I can only count on one hand the number of doctors who I “see eye-to-eye” with on this subject. (If you know of any, please send them here.) Suffice it to say: I’m not just in the minority. I’m a unicorn.

Nonetheless, when I saw the facts, I couldn’t ignore it. So, let me share some of the facts with you. If you want more, go here.

When compared to traditional dieting (including flexible dieting—I see you, macro counters), Intuitive Eating is associated with improved psychological well-being, improved body image, lower body mass index, better health outcomes.

On the other hand, dieting is associated with long-term weight gain, increased psychological distress, and increased heart disease, to name a few of the risks. Counting calories or monitoring your activity through fitness trackers and apps is associated with increased weight and eating disorder behaviors.

Furthermore, the very concept of “managing your weight” or rather, weighing yourself regularly is associated with future weight gain and poor health outcomes.

Specifically, adolescents who weigh themselves regularly have worse body image, and higher rates of binge eating (i.e. recommendations stand that adolescents should NOT be encouraged to weigh themselves). 

Lastly, being at a larger size does not mean you are unhealthy. In fact, cardiologist Carl Lavie cites incredible research actually proving the opposite in his book The Obesity Paradox.

Fat is not bad. Thin is not good. And we could all stand to challenge our own bias toward the size of people's bodies.

           

The Caveat

Some of you well-informed individuals know that a lot of the research associated with the benefits of Intuitive Eating has investigated relationship with eating disorders and disordered eating behaviors. So, as some professionals recommend Intuitive Eating for individuals with history of eating disorders, you may be thinking, is it ONLY beneficial for individuals with eating disorders? Short answer: No. I think Intuitive Eating benefits anyone.

That said, I'll also say that eating disorders are by far the MOST UNDERDIAGNOSED mental illness out there. Almost NO doctor screens for it routinely and since the "thin ideal" saturates our culture, very few individuals recognize their own eating disorders until they suffer severe medical or mental health consequences.

Even though almost 75% of women are dissatisfied with their bodies (and most likely suffer from disordered eating or full-blown eating disorders), only the majority of them actually identify themselves as eating disorder patients.

Furthermore, almost 90% of individuals (mainly women) are or have dieted in the past, and very very very few patients admit they are a "chronic dieter."

Again, the theme of individuals minimizing mental health problems and overvaluing "medical" problems is upheld. This muddies the waters immensely when we are helping individuals find true health, physical and emotional, in our society.

When I Found My Way

We all have to find our own way, find what works for us. I always find it ironic that a practice like Intuitive Eating that is by nature an open-minded, trust-based practice has become a powerful movement instilling distrust and close-mindedness.

That said, here’s where I stand.

If you want to lose weight, I get it. I hear you. I see you. I feel you. I know you.

If you want to go on a diet, I get it. I hear you. I see you. I feel you. I know you.

If you think the pursuit of weight loss is deleterious for your health, I get it. I hear you. I see you. I feel you. I know you.

If you think going on a diet is horrible for your health, I get it. I hear you. I see you. I feel you. I know you.

No matter where you are at in this journey, I get it. We’ve all been there. We all struggle to find our way in this space. I will always be honest and transparent with you though.

From the research today, I do not believe diets lead to permanent weight loss, and I do not believe diets lead to better health outcomes. I also do not believe diets lead to happiness, improved mood, or a perfect life.

Could people benefit from more information about food and nutrition? Sure.

Could people also benefit from more information about medical and mental health issues? Absolutely.

Do all people NEED to believe just as you do? No. A resounding no.

Health is different for everyone. What feels good in your body and what fuels and energizes one person will be different from someone else. If you are a professional in this field, extend compassion to your peers and to your clients and patients.

There is no ONE way to eat, to live, to be. Intuitive Eating is the Holy Grail for some (and yes, for me), but not everyone will “see the light.” We have to be okay with that.

Also, we will all die. I know that’s a sad, morbid reality. But it’s true. No matter what you do to control your food, you will never prevent bad from happening in your life.

Sometimes, shit happens. People die. We get illnesses. And no amount of clean eating will take those pains away.

I’m a believer in Christ and most of my practice and my way of life comes back to analogies to my faith. Just as I know I won’t bring everyone to Christ (nor is it my responsibility), I won’t rescue everyone from the perils of diet culture. That’s okay. Live and let live is how I feel. Send your hate mail somewhere else.

                      

Concluding Thoughts

  1. Yes, our country is sick... but dieting is not the answer.
  2. Mental health needs to be a priority... and sadly, it just isn't... yet.
  3. We could all benefit from looking at our own fat phobia and understanding correlation does not equal causation... girlfriend, a size 8 is still below national average.
  4. Intuitive Eating isn't just "letting yourself go." (Read or re-read the book if you're where "health" and "intuitive eating" collide.)
  5. Intuitive Eating is not the same as anti-diet. (Again, read the book.)
  6. Health is much more than physical health.
  7. Health includes: physical, emotional, spiritual, psychological, social, financial, and spiritual health.
  8. Emotional health may be the most paramount (and undervalued) form of health.
  9. Stress is the new smoking (after dieting, in my opinion).
  10. Functional medicine and integrative health has a place, but so does mainstream medicine. No one strategy is "better" or morally superior.
  11. The diet/ anti-diet argument is only one small piece of our overall health.
  12. Don't forget your emotional health! Stress is the silent killer.
  13. Online business is hard, and us influencers in this space are trying the best we can.
  14. Social media can only show us so much about a person. That's okay. We're all entitled to a little privacy too... without the fear of "not being transparent enough."
  15. We are all hurting human beings. We all want validation, encouragement, and affirmation. Before you fight back, seek to understand.
  16. We all deserve respect. And we owe it to our patients and colleagues to respect their journey and validate their present condition, no matter what.
  17. Doctors are not the devil. Give yours a hug and a thank you next time you see them.
  18. Go see a therapist. Seriously, your life will be better for it.
  19. God loves you. I love you... no matter what you believe. (And if you're still figuring out where you stand on this whole diet/ anti-diet space, that's okay too.)
  20. It's Not About the Food! - Your issues with food or your body (or your ongoing biases around specific "diets") has nothing to do with food or your body. Explore what's really going on.

 

If you'd like to continue the conversation, please find me on Instagram. Look forward to chatting more! 

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