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Diet Culture 101: Three Red Flags to Look Out for When Reading About New Diet Trends

Rebecca Fallihee hails from Eugene, Oregon. She is a Certified Nutrition Specialist and also is a Licensed Dietician Nutritionist in the state of Illinois. Rebecca graduated from Maryland University of Integrative Health with a MS degree in Nutrition. She has over a decade of teaching public health nutrition, and specializes in many areas of health and nutrition including digestive optimization, metabolic health, sports nutrition, nutritional genetics and autoimmune health among other conditions.

Diet Culture 101: Fad Diets + Medical Diets

In last month’s blog article, we spoke about diet culture and will continue excavating some of the problems for your health goals when diet culture starts to dominate your thought patterns and actions.

Diet Culture is the belief that our physical appearance, primarily weight, body size and shape, are the most important factors to determining health, happiness, morality or status. Check out last month’s article for more about Diet Culture 101. And if you’ve got the basics, let’s dive in today to the benefits and drawbacks of various fad and medical diets.

???? Diet Red Flags ????
First, let’s identify some dieting red flags. Here are our top three, with a few examples of common diets that fall into each category. Then, we will break them down individually. When you see any style of eating that has one or more of these red flags, it’s time to put on your critical thinking cap and talk to a Certified Nutrition Specialist (CNS) to determine if this style of eating is healthy for you.

1. ???? Weight Loss as the Main Focus

Keto, Intermittent Fasting, Vegan (sometimes)

2. ???? Restricting Food Groups or Large Amounts of Food

Keto, Carnivore, Vegan, Low-FODMAP

3. ???? Not Supported by Peer-Reviewed Research as a Long-Term way of Eating
Keto, Carnivore, Intermittent Fasting, Low-FODMAP

What is a Fad Diet?

Now, what’s a fad diet? Similar to trends (and now micro-trends) in fashion, a fad diet is a trendy diet in popular culture. Often, fad diets stem out of a celebrity or influencer popularizing the eating pattern, and the diet is often not a way of eating that is recommended as a dietary pattern among nutrition scientists.

However, in this day and age, you can be sure that there will be a lot of misleading pseudoscientific claims in the media and amongst some so-called “experts” who make unreasonable health and medical claims about the diet. And yes, even some nutritionists and dietitians will start to buy into the proposed health benefits.

There tends to be a nutrition competence curve amongst those knowledgeable in nutrition where the more nutrition expertise and knowledge someone has, the more he or she will respond to nutrition and dieting questions with the answer, “It depends…” or “In this particular situation…if…”. This is known as the Dunning-Kruger effect. Amongst savvy nutrition influencers – and yes that can mean so-called doctors, nutritionists, and dietitians – anyone that is promoting one standard diet as the answer to all health and eating concerns is likely lower on the nutrition competence scale and will present as having exaggerated nutrition confidence. What this might look like is a person using ample scientific concepts and perhaps even studies and bending the outcome interpretations and messaging to their dietary biases. Or they may focus on quick results without mentioning the consequences of losing weight rapidly and then regaining it, or they haven’t looked at the long-term consequences of that way of eating.

On the flip side, the headline-grabbing attention that fad diets incite does invite us to talk more about health, which is a good thing to pay attention to, but it can also be a little like watching cooking videos and shows all day but never actually stepping in the kitchen. In other words, balanced health is a great thing to focus on and create personal intentions for improving, but overly focusing on weight isn’t necessarily the best marker for success – or that goal of balanced health.

What makes something a Medical Diet

Now, let’s get into medical diets. These can walk the line between being utilized for medical nutrition therapy, which both functional nutrition specialists (CNS’s) and registered dietitians (RD’s) practice, and fad diets. Often, the most popular fad diets began and continue as Medical Diets, but have “escaped” the original therapeutic reasons for them, and have spilled over into popular culture, where individuals may misguidedly restrict their intake without having the proper context or support to follow the diet for its medical reason.

A few medical diet examples include:

  • Gluten-Free for Celiac Disease
  • The DASH diet / eating pattern
  • Diabetic diet
  • Low Protein for Renal Patients
  • Allergy-Free
  • Elimination Diet
  • Keto diet for epilepsy
  • Grain-Free
  • Low FODMAP
  • Soft Food Diet

Five Trendy Fad Diets Today

The Keto Diet:

Keto is short for Ketogenic and Ketosis. Ketosis is the biochemical term for when the brain runs out of glucose, which is its preferred energy source. During starvation, or when the brain is critically low on glucose during prolonged fasting, and when in ketosis, the brain will use ketone bodies, produced from fat, as a fuel.

The body will start to use fat as a fuel instead of carbohydrates whenever fats are high in the blood, during fasting and starvation, during long-term low-to mild-intensity exercise, and because of a high-fat, low-carbohydrate diet (1), like the keto diet.

The keto diet has been around since the 1920’s as a medical diet for epileptic children, because nutrition scientists found that depriving the body and brain of glucose and having these children convert fat into energy to function, controlled epilepsy in 10 to 15% of the children whose seizures were otherwise uncontrollable (2.)

To get into ketosis, one has to severely restrict carbohydrates (and protein, because the body will convert protein to a carbohydrate), and rely on primarily fat for all meals. In the classic keto diet for epileptic children, there is a 3 to 4:1 ratio of fat to protein and carbohydrates. Meaning for every three to four grams of fat consumed, there is one gram of protein or carbohydrates eaten. This means that calorically, the diet is about 80-90% fat.

In the last few years, the keto diet has escaped its medical origins, and become a trendy eating pattern for weight loss and blood sugar maintenance. It was also fairly popular in the ultra-running community in the last few years, due to the reliance on fat metabolism and the belief that one can run for a very long time without ever having to rely on or run out of fuel – subsequent studies have shown this style of eating hinders endurance performance.

The Benefits: Because it’s an extreme low-carbohydrate way of eating, individuals with sugar and carb cravings have almost complete resolution of their cravings. They may also lose a lot of weight quickly at the beginning, and because fat is so energy dense, they report high satiety with no need to snack frequently throughout the day.

The Drawbacks: Because it’s an extremely restrictive way of eating, hardly anyone is following this diet correctly, or can sustain it long term. In popular culture recipes, there is often too much protein that makes its way into the eating pattern, so most people aren’t actually in ketosis, but are following more along the lines of either the old Atkins Diet eating approach or a High Fat / Low Carb “keto-lite.”
What’s more, for many individuals who follow this diet, the heavy reliance on fat (and the wrong kind of fat), limited micronutrients, and fiber, can cause digestive issues, and drive up cholesterol, triglycerides and liver enzymes – none of which will help long term health. The keto diet may be extremely detrimental to your ability to participate in social functions that involve eating.

The Carnivore Diet:

As the name implies, this diet is essentially limiting eating to one food group: meat and a few other animal products, including eggs, butter and lard. Some individuals will also eat a bit of dairy products – and coffee or tea. (If you’re going to restrict this much, please don’t ask us to forgo caffeine too!)

The Benefits: Some proponents claim this style of eating puts their autoimmune disease into remission.

The Drawbacks: Like many of the other fad diets, this one does not have good research to support its health claims, and it’s definitely not nutritionally balanced. Omitting so many categories of food and focusing on one is a recipe for digestive issues like constipation, since there is very little fiber in the diet, as well as multiple other nutrient deficiencies.

Intermittent Fasting:

There are multiple ways to do intermittent fasting, ranging from limiting eating to an eight-hour window during the day to undergoing a 24-hour fast one to two days per week. The idea with this diet is that fasting both allows the metabolism to balance and work optimally. Additionally, fasting for longer periods induces a mild stress on the body, with a supercompensation allowing for the metabolism to work more effectively as a result.

The Benefits: Many people report having more energy, clearer thinking, better sleep and the ease in daily lifestyle with not having to eat certain meals. They may also report initial weight loss.

The Drawbacks: This way of eating can be too stressful for many different individuals, particularly women of childbearing years, athletes, and those with medical diagnoses such as diabetes, high blood sugar, or digestive issues. The restrictive nature of it often leads to binging or overeating, and it can promote disordered eating, as well as hormone dysregulation, particularly with circadian rhythms and the HPA (Hypothalamic-Pituitary-Adrenal) axis (4,5), as well as the reproductive cycle in woman (6). It can lead to nutrient deficiency and malnutrition – especially if someone is only consuming one meal per day. Additionally, a common tenant of long-term time-restricted eating is a reduction in lean body mass (6) – the type of weight loss we don’t want to see! Beyond that, the verdict is still out on whether it leads to long-term weight loss (2).

While we don’t generally recommend the more restrictive intermittent fasting diets for most people, nearly everyone can benefit from a 12-hour fast every night with the last meal being eaten at least three hours before bed.

Low FODMAP:

FODMAP stands for Fructo-, Oligo-, Di-, and Mono-saccharides and Polyols – which are all types of fermentable carbohydrates. A low-FODMAP diet aims to reduce these carbohydrates to reduce GI symptoms such as bloating, gas, diarrhea, cramping, etc. It’s frequently recommended medically for individuals who have Irritable Bowel Syndrome (IBS) and/or Small Intestine Bacterial Overgrowth (SIBO).

The Benefits: This way of eating can resolve some GI issues for certain individuals, particularly when followed correctly for a short duration.

The Drawbacks: This is an extremely complicated and restrictive eating pattern which is stressful for most people to follow. The stress-inducing restrictive nature of it can itself provoke many of the symptoms it’s attempting to resolve because there is so much interaction between the nervous system, stress, and GI dysfunction. Additionally, most people begin this dietary pattern of their own accord or at the recommendation of well-intentioned nutrition providers or other healthcare providers, but they continue to restrict all of the FODMAP containing foods long-term. This sets them up for continual GI imbalance and dysfunction because our digestive system requires diversity in foods and nutrients to maintain optimal health, including these types of carbohydrates which feed beneficial gut bacteria. This way of eating can lead to too little fiber in the diet and multiple nutrient deficiencies such as folate, thiamin, Vitamin B6, as well as calcium and vitamin D, among many others. Like many of the other fad diets, it can make socializing with food extremely challenging. A night out at your favorite restaurant? You can pretty much forget about it!

Paleo Diet:

The Paleo diet claims that eating like our prehistoric ancestors will make us leaner and less likely to acquire many of the modern diet-related health problems. It tends to be a high protein and high-fiber eating plan, and because our ancestors were hunter and gatherers rather than farmers, the diet eliminates many processed foods, dairy, refined sugar, grains, potatoes, beans and legumes, salt, and refined oils. Allowed foods tend to be lean meats, fresh fish, fruits, vegetables, eggs, seeds, nuts, and some oils such as olive and coconut oil.

The Benefits: If you take a look at that list of allowed foods, you can easily tell the paleo diet is a whole-food eating pattern, which has substantial health benefits. The reliance on lean proteins and ample fruits, vegetables, nuts, and seeds can mean that for an average person, much of the nutritional bases are covered. The Paleo diet has been shown to be of benefit in some studies comparing it to the Mediterranean and low-fat, high-carbohydrate diets.

The Drawbacks: Like anything, this diet can become too restrictive, or taken heavily out of context. For one, in most places, our ancestors were eating far less protein than this diet relies on, and much more wild plants. It was extremely challenging to successfully hunt meat, and so pre-agrarian peoples were actually eating mostly wild plants, nuts, and seeds. Too, the meat and fish that was being consumed in a paleolithic age is extremely different nutritionally from our modern day feedlot and hatchery-fed meat and fish. Some paleo zealots will make the extra effort to seek out only grass-fed, wild-caught, and organic sources of meat, fish, and vegetables, but the idea that this way of eating truly reflects what our ancestors ate is questionable at best. We simply cannot mimic the nutrients available in paleolithic foods in our modern environment. Also, in some cases people misunderstand the tenets of this diet and take the addition of meat to mean heavily processed and high saturated fat meats such as bacon, sausages, and deli meats / cold cuts.

And a Bonus Diet, Because We Couldn’t Resist…

Vegan:

The vegan diet takes out all animal-based foods including dairy, eggs, fish, meat, and in many cases honey. There are many reasons why someone might choose to follow this dietary pattern, and context matters. For instance, it may be adopted out of animal welfare concerns, for environmental sustainability and climate change mitigation, or purely for health reasons, and it can be followed for a mix of those.

The Benefits: If you’re making sure your nutrient needs are met and you’re following this diet for the environmental benefits, then more power to you. A person who eats a plant-based diet produces 50% less carbon dioxide, uses 13x less water, and uses 18x less land than meat-eaters. That saves 1,100 gallons of water, 30 square feet of forested land, and 20 pounds of CO2 equivalent every day (7). Additionally, there is ample research to support this style of eating to prevent and combat cardiovascular disease and cancer (8). Likewise, let’s just repeat, if you’re following this diet in a way that makes it nutritionally balanced, it can be an optimal style of eating – even long term.

The Drawbacks: If adopted for the wrong reasons or without the context of how to appropriately make up for the food groups that have been removed, this eating pattern can set one up for a myriad of nutritional deficiencies and health imbalances. Nutrients such as calcium, iron, zinc, selenium, vitamin B12, choline, biotin, niacin, riboflavin, Vitamin D, and protein can become deficient without properly balancing foods. And in older vegans, “junk food” vegans, highly active athletes, and those with GI imbalances, these nutritional deficiencies can be exacerbated.

Additionally, there’s been a new fad coming out of combining both the keto and vegan diet together for a “keto vegan” way of eating. That’s high-fat without any animal sources. If we want to talk about restriction, this diet is another recipe for “What can you eat?” And the nutritional deficiencies and health imbalances that can result from either diet will apply to this style of eating.

There is a time and place for medical diets and we recommend working with a Certified Nutrition Specialist (CNS) to make sure you are following the best nutritional plan to reach your optimal health. When learning about any new trends or ways of eating, especially if it’s from a media headline rather than a scientific source, be cautious about the conclusions reached – usually if it sounds too good to be true, it is – and both the most research and traditional medicine-backed ways of eating rarely make headlines. They won’t grab your attention enough to get clicks! ⚠️ Caution ⚠️ should especially be used in reading about any diet that focuses on weight loss or is super restrictive.

You can have lifelong healthy habits and reach your health goals without a restrictive diet or using the scale as a measure of your best health. If you want to learn more about overcoming diet culture and addressing the true measures of health, set up a complimentary discovery call and learn what working with us looks like.

Join the Hope Wellness newsletter to be the first to get access to more future articles and to hear more about a new group program focused on reversing diet culture mentality damage and transforming your relationship to food. We’ll be launching the program in the new year. Stay tuned!

References:
1. Lieberman, M. and Marks, AD. (2013). Mark’s Basic Medical Biochemistry: A Clinical Approach (4th ed.). Wolters Kluwer Health: Baltimore, MD.
2. Mahon, L.K. and Raymon, J.L. (2017). Krause’s Food & The Nutrition Care Process, 14th ed. Elsevier: St. Louis, MO.
3. Harvie, M. and Howell, A. (2017). Potential Benefits and Harms of Intermittent Energy Restriction and Intermittent Fasting Amongst Obese, Overweight and Normal Weight Subjects- A Narrative Review of Human and Animal Evidence. Behavioral Sciences, 7, 4: doi:10.3390/bs/7010004
4. Chawla, S., Beretoulis, S. et al. (2021). The Window Matters: A Systematic Review of Time Restricted Eating Strategies in Relation to Cortisol and Melatonin Secretion. Nutrients, 2021 Jul 23;13(8):2525. doi: 10.3390/nu13082525.
5. Stote, KS., Baer, DJ., et al. (2007). A controlled trial of reduced meal frequency without caloric restriction in healthy, normal-weight, middle-aged adults. American Journal of Clinical Nutrition, 2007 Apr;85(4):981-8. doi: 10.1093/ajcn/85.4.981.
6. Aragon, A. and Schoenfeld, B. (2022). Does Timing Matter? A Narrative Review of Intermittent Fasting Variants and Their Effects on Bodyweight and Body Composition. Nutrients, 14(23), 5022; https://doi.org/10.3390/nu14235022
7. Clean Choice Energy (2019). Saving the Planet, One Meal at a Time.
8. Dinu, M., Abbate, R. et al. (2017). Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Critical Review in Food Science and Nutrition; 57(17):3640-3649. doi: 10.1080/10408398.2016.1138447.
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