Who are the best dietary advisers: doctors or dietitians?

homemade ham sandwich with cheese, lettuce and tomato
Homemade instead of packaged food

We are cooped up in our homes, and our dietary patterns are primarily dependent on what food is available to us. Still we are bombarded with dietary advice from the internet, social media, print media, books, friends, and family. Much of that advice is contradictory although lately there has been a convergence emphasizing fresh, whole, plant-based foods. We are cautioned against being seduced by processed foods, particularly those high in sugar or salt. The new food movement, though stalled by COVID-19 and the restrictions we currently live under, still envisions restructuring the current food system. Much dietary advice is aimed at thin bodies with low BMIs led by middle to upper class influencers.

The case for doctors as the best source of dietary advice rests upon availability, access, and personal history. Let’s pay homage to these dedicated souls who are doing their best to keep us alive during the spread of the coronavirus that is devastating communities. Their attention is more likely on disease prevention and treatment for those who become infected rather than on what we are eating. Once this pandemic has abated, many of them will be back hassling us about our weight and dietary practices.

For those of us fortunate to have medical insurance, a routine visit to our personal physician is covered. In those visits, weight is likely to be part of the conversation if only to acknowledge that our current weight is at an acceptable level and not changing. Most of my doctors have been as interested in significant weight loss as in significant weight gain. Unintentional loss of weight can be an indication of an underlying health problem. Seeing the same physician over a number of years provides a ready track record of our weight-change patterns, which may be as useful information as the current weight or BMI itself. Medical doctors are generally effective at evaluating test results in context of our health history, observing trends, diagnosing conditions, and prescribing medications. Most of them, however, are not well-qualified to recommend specific diets or able to follow-up on compliance.

plate of roast chicken with crispy, brown skin intact
Photo taken by Linn Steward RDN at Le Coq Rico, a Manhattan restaurant located in the Flatiron District that serves heritage breed whole birds and pays tribute to American farmers and local terroir. Courtesy of Gourmet Metrics.

The case for dietitians is based on their area of specialization and their embrace of a certain dietary philosophy. Unlike most doctors who receive little education in foods and nutrition, dietitians focus their studies on food and the nutrients in the foods we eat. They tend to specialize in certain aspects of dietary needs such as diabetes, digestive disorders, eating disorders, maternal nutrition, sports nutrition, and weight management. As Elizabeth Strawbridge indicated, dietitians take us from where we are to where we need to go by careful consultation. From what we tell a dietitian about our current wants and desires, we can be guided into a plan that addresses our immediate needs and can anticipate future needs.

Also, unlike physicians who usually have limited time to discuss our health and nutritional issues, dietitians spend more time with their clients to work out a diet we can adhere to and live with. A good one tends to be flexible enough to allow for compromises if we are flexible enough to make changes in our diets even when those changes contradict some of our cherished beliefs about food. A good relationship is one where both the professional and client can work together as a team to design a dietary plan and periodically revisit it to ensure effectiveness and compliance.

assortment of fresh vegetables including cucumbers, eggplants, green onions,greens, squash,turnips, and a zucchini.
More vegetables in our diet?

DIY diets can work if approached with careful study and healthy skepticism. Such diets can save money instead of engaging a professional, but the guidelines outlined in the plan can lead to unplanned expenses in the form of special kitchen equipment or food items. It helps to clearly define the goal at the beginning of the diet whether it is weight loss or to overcome a specific disorder. One needs a detailed plan whether it is available in book form or on the internet. When I went DIY, I looked at about three to five plans that addressed my specific problem/goal. I set up specific criteria upon which to evaluate each plan such as meeting a specific need, the ability to comply, and its scientific merit. I was wary of any plan that promised quick results without pain. No pain, no gain applies here. On the other hand, highly restrictive diets which are difficult to follow are likely to restrict important essential nutrients.

My specialized diets are usually centered around a book written by a registered dietitian. I need to understand the general principles of the diet so that substitutes for foods that I don’t like won’t compromise my dietary goals. That book must also have many good recipes that are relatively easy to prepare. The best of these books combine the expertise of the dietitian and someone with a strong culinary background. Remember, as Linn Steward noted, we eat food and not nutrients. If the foods we eat are not enjoyable, we are unlikely to stick with the diet long. Once the plan is selected, however, it is important to stick to it as much as possible or most of the time to this point will have been wasted.  It is also good to view the plan as part of a permanent modification of lifestyle to prevent from reliving the original problems all over again.

gluten-free, everything bagels and gluten-free bread
Is gluten-free food a good idea?

Diet culture is a term circulating by a segment of dietitians who are pushing back against a society that appears to becoming obsessed with food. A destructive cycle begins with body shaming leading to excessive dieting then disordered eating and blaming the victim when the selected diet is more likely the problem. Diet culture is highlighted in Anti-Diet by Christy Harrison RD, MPH. Her rejection of this culture is part of a larger movement known as Intuitive Eating which will be a topic on this site later in the summer.

My assessment is that our personal physician is best at following our weight pattern over a period of years, diagnosing a food-related issue, and suggesting that we should seek out dietary advice. Unfortunately, MDs are not so good at recommending appropriate diets. It may require spending money out of pocket to see a dietitian, but they are usually the best people to go see to design a specific diet. They have both the knowledge and the time to work out a detailed plan. Choose a dietitian carefully, however, to select one that will design a plan to specific dietary needs rather than forcing us to fit our dietary goals into a standardized plan that does not really address our needs.

Books can be useful to self-administer a diet for a specific malady, but they have limitations and may promise more than they can deliver. I recommend selecting one written by a RD or RDN. Don’t get sucked into a diet culture that turns into a food obsession using an ultra-thin body as the ultimate goal. In writing this post I have decided that when the COVID-19 situation has calmed down I will seek out a dietitian to help me with my IBS and other dietary issues. I have started to develop a series of questions to help me in my search for a good one.

BTW, Linn Steward has a great post on emotional eating during a quarantine. Check it out!

Next week: Food Fights: How History Matters to Contemporary Food Debates

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