Last Friday I was invited to the Cheltenham Literature Festival to take part in the nutrition panel on “The Clean Eating Debate”.
I was asked to be involved as the expert who could provide the scientific reasoning behind whether such a way of eating is suitable or not, based on my work and publications as a Clinical and Sports Dietitian.
The other panellists included Madeleine Shaw, who has been hugely successful with her books, “Ready, Steady, Glow” and “Get the Glow” promoting the idea of a “cleaner” more wholesome way to eat.
The final Panellist was Bee Wilson a highly esteemed food writer, historian and author of 4 books, including her latest, “The First Bite, How we learn to Eat”, a fascinating book that looks closely at the psychology around how and what we eat.
The Panel was headed up by chair Eleanor Mills, Editorial Director of The Sunday Times.
So a great mix of backgrounds to discuss a controversial topic so that the audience could leave armed with facts and the ability to make their own minds up about “Clean Eating”.
Unfortunately this is not how the evening unfolded. When you sit on a panel for a debate, you would like to think that you have an open minded audience. On Friday, it seems that the majority of the audience were there not to be educated but to hear Madeleine speak about her approach to nutrition. Trying to debate in front of a closed audience is an incredibly difficult task and while Bee and I only stated facts, we were met with huge hostility.
For those of you who follow me regularly, will know that my main issue with food bloggers, of which Madeleine is only one of many and I actually want to praise her for coming forward and attending the debate, is that they don’t have a nutritional qualification between them and yet their popularity in the #EatClean market is huge. This is increasingly frustrating when you come from a background with a biochemistry degree and post graduate degrees in both Dietetics and Sports Nutrition.
These Non-qualified food bloggers base their nutritional preaching on n=1. That is, something that has worked for them, will work for the rest of the population. However this is not science and indeed can result in dangerous consequences from nutrient deficiencies, to poor growth and development in teenagers. I appreciate that the majority of these individuals started off posting pictures on instagram, writing blogs and doing the occasional vlog as a completely innocent past time. However what they have attracted is a huge following, sadly not based on scientific reasoning but based on their ability to sell a lifestyle – “eat like me and you will look like me”.
This is where I take issue – I worry about the nonsense nutrition that is being spouted. On Friday, I wanted to have the opportunity to provide the counter argument against the rules that have been created, demonstrating that they were not based on sounds scientific findings.
Some of the key messages I wanted to get across are based on the guidelines they encourage their followers to live by.
This in itself sets up the mentality that if you don’t follow them, then somehow you are not conforming and you have failed.
The majority of food bloggers insist that we should go sugar free; however, within their books, there are ample recipes that contain honey, maple syrup or coconut sugar that again suggests that these are superior to the humble table sugar.
All of these are sugar and the body utilises them in exactly the same way as table sugar –it cannot differentiate. Additionally they also all provide the same amount of energy per 100g. Often these alternatives are promoted as “healthier more nutrient dense” options. However, in order to benefit from the slightly higher mineral content of coconut sugar for example, you would need to consume it in huge quantities, which defeats the object. The main difference is that Coconut sugar costs 10 times the amount of table sugar.
Similarly many of these bloggers encourage you to remove dairy form your diet often promoting almond milk in its place. If you’ve got the time and inclination to make your own almond milk, then perhaps you can accept the claim that with regards to calcium and protein they almost stack up. However the majority of us do not have this time luxury and so resort to buying it from the supermarkets where it costs double the amount of cow’s milk but is devoid of nutritional value – it is just expensive water, containing 0.1g of protein per 100ml in comparison to cows milk that provides 3.4g of protein per 100ml.
The Clean Eating brigade often talk about “inflammation” within the body and how certain foods can “affect your body’s pH” and so encourage a gluten free diet as well as avoiding foods that can cause acidity within the body.
So firstly, having conducted a serious systematic review on the subject of Gluten, I am yet to find a credible article that demonstrates than anyone who is not Coeliac will benefit from a gluten free diet. Thus in my practise as a Dietitan, it is not something I advocate.
When it comes to acidity and alkalinity within the body; the body is an incredibly clever machine and has the ability to keep homeostatic control; that is it has the ability to monitor the body and ensure that a balanced environment is always achieved, without making changes to your nutritional intake.
What we do know that if you eat certain foods, like animal protein, it can cause the PH of our blood to rise.. However the body also has the amazing ability to control this and neutralise so that it maintains a constant environment. It does this in a number of ways but one of the key methods is release of calcium ions from our bones. For healthy body’s this is not a problem, and the body soon returns back to normal. The problem comes in those individuals who are not taking in sufficient calcium, particularly from dairy protein; they do not have sufficient calcium within their diets to replace what has been released from the bone. This in turn can lead to poor bone density and an increase risk of osteoporosis and stress fractures.
I don’t doubt for a minute that these bloggers truly believe what they are saying is true but the bottom line is, it isn’t and as seen, it can actually be dangerous. These individuals are role models to many; people look up to them and so in my mind with such a huge following, there also needs to come responsibility.
One of the key points I wanted to get across on Friday was the potential danger of “clean eating”. I was very clear to point out that I don’t think food fads such as these cause eating disorders – I have worked in the area for long enough and I know it is a very complicated multifactorial mental illness. However individuals with eating disorders make up food rules to live by – this is to maintain their eating disorder, which they feel is keeping them safe but that we know is the complete opposite. The problem with “clean eating” is that it promotes fads such as being gluten, dairy or sugar free. They see the beautiful image of the food blogger that is encouraging this way of eating and it not only glamorises but also consolidates their rules as a way of life, endangering their physical and mental health further. Pretty much every single eating disorder individual I have worked with, young, old, male, female, athlete, no-athlete, talks about the rules; the rules that started, from following food/celebrity bloggers and that now feel difficult to overturn. So many of them believe that if they eat gluten or drink milk then something awful is going to happen to them.
In my practise, I define healthy eating as unrestrained eating; where you eat everything but in moderation and I think here lies the problem: moderation is not innovative; it is not glamorous or sexy and is actually quite difficult to achieve.
Individuals want something new and exciting to follow and while I take my hat off to Madeleine, she has created some really delicious and inspiring recipes, which would encourage even the most resistant to try vegetables; my main worry is that a lot of her suggestions of meals and meal plans are not balanced, increasing the risk of nutrient deficiencies.
I went into Friday’s debate concerned about how big “Clean Eating” has become and hoping to provide information to help individuals make educational decisions around food choice. Sadly I was met by a hugely closed audience who really just wanted to evangelise the benefits.
I stand by my word that being healthy is not just about food; it is also a mind set. The most important lesson I try and teach my daughters and clients is self-acceptance and self worth. This doesn’t come from eating a certain way or following a certain practise, self esteem comes from accepting you are good enough just the way you are. Shouldn’t this be what we try to encourage and in still in each other rather than a sense of failure because we choose to eat food that is deemed “Not Clean”.
Those of you that follow me regularly on social media will know that my two areas of specialism within nutrition are sports and Eating Disorders. More and more though I’m being drawn to the middle ground of this venn diagraph – athletes with eating disorders.
No matter whom I work with, elite, paralympians, football academy players, junior/development/talent pathway or recreational athletes, one of the main outcomes required from my input will be optimal performance.
Of course this is to be expected. The same is true of any sports practitioner; whether that be coach, S&C, psychologist or performance analyst.
The desire to achieve those marginal gains is always top priority –athletes want to be the fastest, the strongest;the need to be the best outstripping all other aspects of their life.
As a practitioner working within a team, it is easy to get caught up in this drive to be the best – with each member helping the athlete to achieve.
But at what cost?
I have come across many practitioners who are so fixed on the performance outcomes that they lose sight of the athlete as an individual.
Often the consult between athlete and practitioner becomes a well rehearsed script; the need to be associated with a gold medal or an athlete’s personal best performance becomes the driving force and the potential to pick up on tell tale signs of stress are missed.
As a dietitian with both clinical and sports qualifications and experience, my responsibility lies with helping the athlete to achieve optimal performance, but without losing sight that an athlete is still a person. I have an important role to play in safe guarding them from potential health risks.
I’m fortunate that I have worked with some great practitioners and coaches who really do look at an athlete as a whole person – yes they want them to train hard but they also take time to listen to the athlete; if an athlete is saying I have a pain in my foot –it is not shrugged off –it is taken seriously and some additional rest days are added in; if an athlete mentions that they are sleeping badly – nutrition and training load is checked. If a female athlete discloses that she has skipped menstruation for several months, this is not just accepted as a norm – it is investigated.
Sadly this is not true of all cases – over the last 12 months I have been approached by several athletes, where the need to achieve by them and their support team has over looked signals that they were struggling. Some arrive with persistent injury; not being given enough time to heal and rehab before going straight back into training. Others have put their bodies under huge stress with large training loads but insufficient energy intake; some have adopted fads – diets, supplements in an attempt to hit those marginal gains with poor supervision by their support team.
Athletes are not just about numbers –like a plant, in order to thrive they need support, understanding and nourishment –sometimes this doesn’t fit in with performance gains.
There are always going to be times when you do need to support an athlete in order to reach a target weight or body composition but it is also important to ensure that the disruption this causes is limited to the shortest time possible.
That said, as a practitioner working in elite sport, it is important to know your boundaries and there are occasions where you need to take a stand and suggest that an athlete takes some time out.
Athletes are driven and in order to make it to the top, are often associated with extreme behaviours. This trait is not too dissimilar to those associated with an Eating disorder –extreme behaviours in the form of rules and rituals around food and exercise in order to maintain their eating disorder because it makes them feel safe and secure, even though this far from the reality.
However in both cases, these individuals need to be told to stop –when they are doing more harm than good, even if it means they will be missing out of a major competition. What good is a podium finish if it’s the only one of your career because the stress you have put your body through has meant that it will never return to its previous form?
It’s great that more and more athletes are speaking out about the pressures they have felt to train in a certain way, be a particular weight or body composition and the lack of support they received. However, what we need is more education around this; how to listen, how to pick up on signs and then how to have that difficult discussion.
I always want to help an athlete achieve their true potential but not at the cost of their long-term health.
I’m not always popular with my approach –its never easy telling an athlete that their training or their nutritional choices are doing them more harm than good but I take pride in always seeing the human in an athlete and not just as a performance outcome!
And for the record, all those I’ve worked with have thanked me in the long run as it has meant they can return to training and a winning form!
As EDAW2016 comes to a close, it has been very obvious from all your responses and reactions to our blogs that many of you –old, young; male, female; athlete and non-athlete are struggling and often suffering in silence. You may not have a fully diagnosed eating disorder but deep down know that life is a out of kilter - being too harsh, never letting yourself off the hook - always searching for that little bit more!
Popular Slogans thrust in our faces on a daily basis consolidate what we already believe - we must keep going!
Motivational?? For those of us that struggle with a sense of self, these slogans can become punishing mantras, setting up a negative and destructive cycle – when will success occur? When will you be good enough?
One of the most striking aspects of working in Eating disorders I have observed is the lack of compassion for ones own body, the inability to be kind to oneself; Instead sticking to extreme behaviours involving restricting energy intake and pushing the body physically to breaking point.
This is the stark reality of an eating disorder - enough is never good enough. no matter what the number on the scale or the size on the jeans say, you can always go that little bit further. Then there will be the rules and rituals that need to be maintained; even when the body is screaming for the individual to stop, the body is showing signs it is breaking down, there is a need for this order and control because without it life feels too unsafe to live in.
Recovering from an Eating disorder, is a long and difficult journey – individuals need constant support and reassurance – something that is not always easy to find.
For those of you who may be on route on this journey or for those of you who may be supporting someone who is perhaps struggling to start this jouney, ABC and I have come up with the followings strategies that may prove helpful.
· Rather than focusing on weight gain, think of recovery as restoration and balance for your body.
· Be aware that negative emotions such as stress, tiredness, anxiety can lead to distorted “feelings” about yourself and your body -you will be tempted to "regain control" but remind yourself that restricting your intake is not a solution - it never has been and has never provided you with the "happiness" you have been in search of.
· Remember weight fluctuates on a daily basis and is usually related to fluid balance -most individuals can be up to 2Kg heavier at the end of the day despite what they have eaten!
· Remember your body requires a minimum number of calories just to be awake, lying still, breathing.
· Remember set backs are part of the journey to recovery but also focus on where you have come from and what you have achieved; perhaps list what you have gained from recovery -the physical - feeling less cold and the emotional - eating a fear food with the realisation that nothing awful happened!
· Your weight is just a number -it doesn't define you and should not dictate how you perceive yourself and more importantly how you think others perceive you -would you judge an individual on their weight?
· Have a favourite outfit or accessory that makes you feel good about yourself that you can wear on days you need confidence.
· If you are having a bad day, confide in someone you trust – a problem shared is a problem halved.
· On days you are struggling, ensure you eat with someone you feel is a good role model.
· Do something nice for yourself, you are worth it!
Most of you will be aware that its Eating Disorder Awareness Week.
Eating disorders have the highest mortality rate of all mental illness and they can affect anyone. No matter who I am working with athletes or non athletes, it never ceases to amaze me just how brutal and punishing an illness it is.
This year for EDAW, Anorexia and Bulimia Care have set up the campaign, A change of gear, where we are looking for your support to join us, make a noise about ABC and share your experiences.
We are very lucky that we have such great ambassadors - one of these Holly Rush, a marathon and ultra marathon runner for the GB team on several occasions has agreed to share her story - all that is left to say is Thank you and we hope it helps.
I was lucky enough be bought up on a farm in the middle of nowhere in Somerset, this may be some peoples nightmare but for me it was simply idyllic. My father was a Gamekeeper and my mother shared her time between looking after me, the copious amount of animals we had, tending her garden and early mornings milking at the local dairy farm. My early days were always spent on the go, helping dad around the farm, messing about with my pony and walking through the woods with the dogs. Structured exercise was never a part of my life or my parents. We just lived a very outdoor active life, full of fresh air and simple things. Food was something we enjoyed but it wasn’t a major part of our lives. We ate a lot of wild game (obviously), fresh veggies (usually swede and kale that dad had pulled out of the ground an hour before dinner) and dumplings (stews were a big part of our lives) and drank gallons of raw milk or water. I don’t remember any processed foods in our house…may be the odd digestive biscuit but as a result I didn’t have the remotest of sweet tooth’s. In fact, when asking Mum the other day about what I actually ate as a child, she reminded me that she kept a huge jar of sweets that friends/relatives gave me that I barely touched (this sounds remarkable now…considering my sugar love affair). I hated sweet fizzy drinks or squash and always favoured water or milky tea. I did however have a very healthy appetite and could easily polish off anyone’s leftovers, something I still have no trouble with today (mum used to say I had hollow legs).
At the age of 8 my parents split up and my mum and I moved out of the farm and into a tiny house in Wells, not far from the farm but into a city….which was a big change for me and something I really struggled with. I saw my dad every day after school at the farm but I missed my freedom to roam and spend time with the animals, my life in Wells was good but again this soon changed when my mum met my stepdad and we moved again. Moving in with a ready-made family was tough but also really exciting. We had all been friends since I was very small but this new set up was set to be a real challenge for everyone concerned. By this time I was 12, still very active with my riding but I wasn’t remotely interested in organised sports as such. Food was just a normal part of my life and not something I really paid any attention to.
Not long before my 18th birthday I made the big decision to follow my boyfriend to London, looking back this was a major turning point in my life. I got a full time job in sales and marketing and starting earning some decent money. Life in London was just extraordinary……after dinner drinks, take away, boozy work pub lunches. All this with little activity came at a price and that was inability to do up my jodhpurs, however this still didn’t seem to bother me enough to do anything about it until I went to watch a work colleague run the LondonMarathon. I remember it clear as day…it was 1996 and it was blisteringly hot. I stood outside a pub near the Cutty Sark and proceeded to quaff down several pints of Stella interspersed with a mega burger whilst cheering on the runners. I had watched the race on telly but never live and I remember being surprised at the number of ‘ordinary’ people running……old, young, thin, fat, fairies, bananas, gorillas and copious amounts of rhinos. I can’t really remember if the beer was talking or I genuinely meant it but I ended up promising my mates I was standing with that I would run the marathon the following year for charity. Clearly I was terribly unfit….I had never taken part in a race before, let alone go for a run, I was 19 and about to start university but I was determined to give it a go.
By December I had contacted an animal charity, got a golden bond place and joined a gym. The charity had been kind enough to send me a rough training plan and organise a few get together days for other runners. This was hilarious as I had no idea of what to wear, what to eat etc. but I bumbled through with the help of others (remember this was before google…..). I entered Bath Half marathon as my first race which went without a hitch but also helped establish that running in rugby shorts and socks don’t make for a comfortable ride (chaffing hell). The marathon itself went better than expected….I made the start line which was a miracle, although it peed it down with rain (which again resulted in lots of chaffing in the most unglamorous places!) I ran the whole way and crossed the line just under 4hrs with a big relived smile on my face. All my family came to watch and we all went to the pub afterwards to celebrate. I genuinely think they all thought that would be the last time I would do something so crazy and go back to my normal ways…….and I guess that’s also what I thought too but things didn’t turn out that way. I’m not sure what happened but something turned a switch on in my head.
After the initial…..praise and adoration of completing the marathon people stopped asking how I got on and could I show them my medal……I started to become quite down and withdrawn, not something I saw coming. I decided to keep training and upped my gym visits to everyday (I was still quite nervous about running outside so tended to do most of my running on the treadmill) whilst keeping an eye on how many take away I was eating and drinking less beer. Within 12 months I was back on the start line with a half pb of 1hr 26 and over a stone lighter…..I ran 3hrs 14 (around that…..I can’t actually remember but I know it was under the 3.15 champ start time). I was over the moon but determined to go faster…all this training had changed my body so much and so quickly, this only equated in my mind that weighing less meant more training and refining my diet even more. By this time I had already binned all snacking and take aways and had increased the time I spent in the gym daily. After the marathon things only got worse. I was spending up to half my day in the gym and if I couldn’t do that I would come back in the evening to expend more calories. I was obsessed with the calorie number on the machine and set myself ridiculous targets that I had to hit before I was able to eat dinner. Calories were counted at every opportunity which was incredibly tiring and frustrating…..something that would have been alien to me when I lived at home…..even now I can tell you how many calories are in 100g of oats or a fun sized Crunchie (this never leaves you no matter how recovered you are). I tended to eat a very calorie restricted breakfast…..avoid lunch or have a cuppa soap or a very small bowl of cereal and then eat a normal dinner in the evening as I didn’t want anyone in the flat to notice I wasn’t eating properly. Obviously my weight was dropping rapidly….I had gone from 10st to now 7.5st. I was running faster and felt good wearing tiny clothes but I was desperately unhappy inside, I had split up with my long term boyfriend, I was struggling at uni (because I spent most of my time in the gym or slept through lectures) and I was totally skint. This all culminated in breaking my foot in a local half marathon just 6 weeks before London Marathon…….I was devastated. Stupidly I didn’t correlate the fact I wasn’t eating anything with poor bone health……my periods had stopped over a year before and not only was I now super stressed I was deeply unhappy. I cross trained like a women possessed and ran the marathon 6 weeks later…..I finished just under 3.15 again but hobbled the last 10k in sheer agony. I spent the next 6 weeks on crutches in a fog of depression. The following two years continued with yo-yoing between stress fractures and trying to finish my degree. During this period of starvation and over exercising I flirted with making myself sick after meals. Depriving myself from food was taking its toll, deep down I loved food and the social aspect it brings to life was missing, I wanted to eat with friends or go out for dinner and let’s face it I was starving but this only made me feel shit afterwards so purging seemed the only option. This is when I realised it had all gone too far, I felt disgusting. I had lost the reason I started running, I had lost my innocence with food and I had become someone I hated. I went to see my GP and unloaded everything on her…..to my surprise she said she had been waiting for me to come and see her as she had red flagged me months ago….…it was a relief.
My bone density was now in the osteoporosis range and my periods had been absent for 8 years. I went for counselling and treatment at my local hospital and with the help of my course tutor I took a year out from uni to go home and recover. I took a long break from competing (5yrs) and actually moved back to Bath to work after completing my degree. It was here that I met my coach and now husband who helped me get back to training and competing at a healthy level.
So where am I now. Whilst I don’t think you can ever truly get over disordered eating I do think you can learn to love yourself and appreciate that there are so many other important things in the world to open your eyes too. I love food, I love running, I love sharing both these things with friends and the people I love. I don’t ever want to be back in that mind set again, I would rather be a normal size than thin, starving and unhappy.
I hope that anyone reading this who sees some similarities does something about it now…….having osteoporosis has seriously affected the way I train and the constant fear of a little niggle being another stress fracture. Food is not the enemy, the way you feel about and see yourself is the key.