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QOTW: Why do dietitians seem to push whole grains and even diet soda?

Question from Be Well Reader:

I have done some research and recently started eating a more unprocessed diet. The more I read, the more I find dietitians and doctors pushing whole grains and a switch to diet soda.  Then, I read something that says don't eat wheat or drink artificial sweetener. So, what do I do? Why do dietitians and other health professionals seem to push whole grains and sometimes even diet soda?

Thanks for the question Tiffany!

To me, this demonstrates the difference between a dietitian, or doctor, and the average healthy person. Anyone knows to eat more fruits and vegetables, eat less sugar, exercise more, didn't need my 8 year education to tell you that. People who become healthy on their own accord (even super healthy) often find one thing that works for them and run with it. Whether it's Paleo, Veganism, Vegetarianism, Atkin's, etc. These people find their niche and research it until they know exactly what they should eat and not eat for that particular diet. That is great! For them. As for the rest of the population, the more than 1/3 of the population that is obese, the ones who work 2 jobs as a single parent to make ends meet, the ones who have never been taught how to eat healthy, the ones who were raised on fast food, or even the kids who have their whole lives to eat healthy, these drastic diets just don't work. As a dietitian, I went to school to learn biochemical reactions of food in the body, yes. I also had multiple college classes on counseling, therapy, and meeting people where they are...not where I am.

Honestly, I often feel that people who became healthy on their own think dietitians don't want the rest of the population to become healthier. I feel like they take the diet that worked for them and think everyone should use it. I commend them for transforming their own lifestyles but remind them that not every family is the same. That is why one diet doesn't work for everyone but an overall healthy lifestyle can be generalized enough to work for everyone. Most of the time when a dietitian writes an article, or offers advice, we are writing it for the general population. I have learned more in these past two years of working with the general population than I ever learned in school.

For example:
Dietitians get bad reputations for pushing whole grains when the rest of the fitness and diet world is screaming no-gluten. Would one benefit from the Paleo lifestyle? Of course! Who wouldn't be healthier if they ate lean meats, fruits and veggies! At the other end of the spectrum we have the vegan who insists animal products are the reason for our obesity epidemic. Dietitians must be hypocrites if they can  push whole grains, low fat milk, and lean animal products while still claiming to want to solve the obesity epidemic... As an RD, part of my job is to tell you what to eat for optimal health, but the other part of my job is finding out what steps your family can take right now to improve your health and then, we can take baby steps (maybe even years!) to get you to your optimal health. That's why if you are thinking about a particular "diet" you would like for your family to try, you should meet individually with a dietitian.

Picture this:
I walk into a patients room. Their child diagnosed today with type 2 diabetes. They are starting insulin and need to count carbs. I teach them how to count carbs, then say "but I really don't want you to eat any bread at all. In fact, let's talk about how to be gluten free because bread will make you fat." There you have it, sheer panic in the parents' face. It is just an inappropriate time. Right now, they were just diagnosed with a disease they likely know little about, they need to learn carb counting and insulin dosing. Yes, type 2 is due to excessive intake and limited exercise that resulted in obesity, so I discuss how healthy eating with type 2 and even exercise can improve the outcome, but the minute I tell a family they need to cut out an entire food group, they shut down and view me as the hoity-toity dietitian who can afford gluten free food. At that point, I would have lost their trust.

Another example comes from a pre-diabetes family I saw. We discussed healthy eating and exercise to prevent type 2 diabetes in the young child. After the education the mom asked what I thought about the vegan diet because she read that the vegan diet can erase type 2 diabetes. I explained that the diet itself doesn't erase the disease, it is instead, due to the weight loss that one would experience from changing their Standard American Diet to the Vegan diet. Plus, her child had eaten a large amount of meat just that morning...Do I think a Vegan diet would help her lose weight and reverse her type 2 diabetes? Yes. Do I think this family was ready for that? Given the 4 hot dogs her child had eaten that morning, no! So, I encouraged them to start slow because I want them to succeed.

More than 50% of the population I work with is on Medicaid so I have to be very realistic with goals that will help them make small changes. I think you would be surprised at some of the responses I hear when I ask people what they ate the day before. I have a great poker-face! You must create a relationship with your patients so that you can help them set realistic goals. Typically, after a year or so of healthy changes, they become easier and more routine. Then people take another step towards healthier eating. For example, if you drink regular soda because you talked to your friend who said it's better to drink an occasional regular than diet so you blocked out the idea of diet soda. But, now you feel like you have to do something. Then, we work out a plan to switch to diet soda because you can't stand water, but know you need to drink fewer calories. Does this mean I am promoting diet soda? No, but I am promoting no sugar in your drinks. Your healthy friend says "that dietitian doesn't know what she's talking about, diet soda is terrible." But this dietitian has a long-term plan for you! A year later, you come in and decide that you can probably try to drink only water now with the occasional diet soda= more progress. Then, six months later you decide you don't even like diet soda so you only drink water! Score! See how long that took? Almost 2 years but you now only drink water!
Click here for Harvard's Plate vs. MyPlate Post

Don't get me wrong---I am not trying to discourage people from getting healthier on their own and finding something that works for them. I think a lot of people who become healthy on their own (and now criticize anything they deem unhealthy) fail to take into consideration that the person they are talking to, might not be on their level of commitment. Then, they give dietitians and other health professionals a hard time about promoting the USDA version of the American diet. Just because I encourage a patient to switch to whole grain bread instead of white bread doesn't mean I eat bread daily myself. I can't tell you the last time I bought a loaf of bread let alone had a sandwich! But I am not here to talk about what I do. It took me years of healthy eating (plus a college degree) to find my own groove and once I get married I am going to have to adjust more than I want to. I (and other dietitians) are here to help you find out what works for you! Dietitians seem to push whole wheat bread and diet soda in general interviews because they are better choices than the white bread and regular soda most of the population eats. A lot of people can't thrive on the all or nothing principle when it comes to food so they need to know how to change one thing first. So, next time you read an article written by a dietitian to the general population, remember that while you may be nutrition savvy, others may need basic information to start building a foundation for better health.

Do you have a nutrition question you have been wondering about? Email your question to and you just might get your answer in next week's Question of the Week.

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