Nutrition and Fitness Professional, LLC

Weight Loss Counseling, Vegetarian, Vegan, & Sports Nutrition, plus Fitness Training Services and Body Fat Assessments

Posts Tagged politics

Gender and Racial Diversity in Registered Dietitian Nutritionists

Jun 22

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Healthcare, Personal Experiences and Opinions | No Comments

Edit: Updated statistics are available at a new link on the CDR website: Current demographics show 98,053 dietitians, 90.6% female, 3.8% male, 5.6% not reported, 77.8% white as of July 3, 2017.  Here’s a list of other credentials issued by the CDR and respective demographics.  The rest of the article will be based on the 2013 demographics.

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According to the Commission on Dietetic Registration’s demographic profile of registered dietitians as of December 1, 2013, 94.3% of RDs are female and 81.8% are white.

Interestingly, many health insurance companies declare network capacity by ‘number of dietitians’ and not the diversity of providers.  I know this because I have had to try very hard to get in-network with a number of insurance companies that have panels 100% of white females only to be told that there is no discrimination policy or diversity quota in place for providers.

There should be.  Patients should have a right to finding a demographic of a provider they identify with: whatever race, gender, religion, or sexual orientation that they feel comfortable with.  Not 100% white females.

You can check this by going to your health insurance provider’s website, looking for specialists, and then selecting nutritionist, dietitian, or registered dietitian, depending on how the profession is listed at your health insurance company.

Don’t get me wrong, white females do very good jobs at nutrition counseling, are fully qualified, and it shouldn’t matter.  However, many different types of people exist in the world, and healthcare can be much more effective if the patient identifies better with their healthcare practitioner.

Being able to choose the demographic of your healthcare practitioner can enhance credibility, trust, and the feeling of being cared for.  Even if objectively there is no difference in the credentials and education, there are subjective differences that it is politically incorrect to even mention but can affect quality of care.  And I’m not talking as a healthcare provider, I’m talking about patients’ perspectives.

Patients come from a variety of backgrounds, cultural, gender, geographic location, religion, sexual orientation, etc.  Healthcare practitioners cannot control initial biases of a patient that may make them discredit the information they receive.  It is a reality whether we like to acknowledge it or not.  Sometimes a patient may not feel comfortable bringing up a question based on who the patient thinks the practitioner perceives him or her to be versus who he or she actually is.

I am all for equal pay and benefits to women and men for whatever job they do. However, if we are going to talk about women in engineering (or any STEM field or law), it shouldn’t be taboo to talk about men in dietetics, a traditionally female field.

Interestingly, women in engineering represent a larger proportion, 13%, according to MIT news, of their workforce than the 3.5% represented by men in dietetics.  I once had a personal training client who went on and on about women in engineering and law, ignorant of the number of men in dietetics.  And who is to say one is more important than the other?  I was able to connect on the feeling of being a minority in a field, but I didn’t feel at liberty to talk about under representation of men in dietetics because it makes me sound like a ‘meninist,’ which is a shameful political view.

Reasons why men aren’t in dietetics?  Many of the jobs do not pay enough is one.  The median full time pay is around $50k/yr, and as someone who is in the field, I can tell you that it is 10-20k less in Austin unless you are a director of a major organization, you may make more.  Since becoming a registered dietitian requires a minimum of a master’s degree starting in 2024, seven years of education to make less money is probably not appealing to men, who are often traditionally (and sometimes still) thought to have to provide for a family and fund the cost of dating.  (Note the RD is a 5 year credential, 4 years for the degree in dietetics and 1 year of supervised practice; many RDs have much more education than the minimum).

But that doesn’t seem to stop men from going into fields like teaching, which has higher numbers than men in dietetics.  In fact, 23.7% of teachers of primary and secondary schools in 2011-2012 were men, according to the National Center for Education Statistics.  So something else must be the case.

Another reason there are fewer men in the profession could be the perception that it has traditionally not been considered masculine to care about calories, have soft skills like counseling, ability to comfortably show empathy, people skills that can elicit behavior change from clients, and ability to meal plan.

Traditionally, men don’t cook or bake as much as women in the home or take care of children, and there are many other skills that traditionally women are thought to be better than men at doing.  (Yes, there are excellent male chefs and stay at home dads, but I am talking traditionally).

Discussions on breastfeeding and/or pregnancy, often done at WIC clinics, are something women are naturally more expert than men at doing because they have the anatomy.

Additionally, there were certain things in the educational experience left over from when the profession may have been more like home economics or closer to working as a chef such as a class on how to set a table, appropriately garnish a plate, and other food service skills.  These may not be appealing to guys in their early 20s in college.

Nutrition science is what attracted me to the profession.  I love the science: nutrition biochemistry and exercise physiology.  Recently, I have also taken a penchant for counseling psychology.  I’m competitive against my younger self at getting people to make changes with regards to their health and well-being in how I implement education and counseling.

In addition, private practice pay is based on how much business you want and how well you market and get client success.  As a competitive person, this is motivating to me.  Whereas working full time, possibly changing people’s lives, and getting paid less than the median expected pay in the profession while not having freedom to practice how best helps patients is a reason not to work as an employee in this field.  That is not motivating to me.

Are men openly accepted in this field?  In some ways yes.  I can tell you that a number of clients have specifically come into my office because of my gender, overtly stating they wanted a male.  I think I may bring in clients who normally would never see a registered and licensed dietitian.  I think diversity in the profession would only help more people to know what we actually do by bringing in more types of people who normally wouldn’t come in.

In MANY other ways, there was a lot of unjust discrimination I endured going through the education and training process of becoming a dietitian (and after becoming one) that, because of aggressive feminism (not true feminism, which is about equality of genders) and/or others’ projections about men, I felt unable to even be allowed to voice opposing viewpoints because it wouldn’t be considered politically correct and fall on deaf ears when 3.5% of the profession is male (much like I stated above, where men represent a smaller percentage of dietetics than women do in engineering).

In fact, I don’t even feel free enough to voice it on this blog.  Suffice it to say, after years of being underestimated and written off as a ‘stupid man’ (quoted, a supervisor during my internship stated under her breath) who couldn’t begin to understand the intricacies and emotions involved in nutrition counseling, it motivated me to start my own private practice because, yeah, I do know what I’m talking about. I feel competent to counsel individuals independently about nutrition and nutrition/exercise-related healthcare.  I certainly have gone out of my way to get the credentials and experience to prove that.

Unfortunately, I don’t have a professional counseling credential behind my name, but I have been to therapy for over 6 years (at time this is written) going twice a week in a group and individual setting and am very familiar with counseling skills having worked through my own issues and seen others of a variety of different personalities and backgrounds work through theirs.  And I’m out about that because I’m proud about it and hold my hat off to the various counseling professionals who are so good at what they do (and I do work with them–my office is surrounded by them!).  I know when to refer patients to seeing a counselor when it is beyond my abilities, which is what our code of ethics states we should do.

Back onto differences between men and women:

Men and women write and emote differently (or if looking at masculine vs feminine gender expression, there is a masculine and feminine way of writing and emoting).  If you are a man (or a woman who writes like a man), chances are you don’t write with many exclamation points in your emails, emoticons, and attempts to influence the recipient’s emotional response of your email.

In dietetics, the female manner of writing is expected in emails.  Our dietetic practice groups have explicit netiquette rules that state that anything that has the effect of disparaging any individual is inappropriate, too terse, bossy/demanding, and abrupt.  While ‘alternative points of view are encouraged,’ they really aren’t.

If you have an alternative point of view, it can have the effect of disparaging an individual if they wish to view it that way, and thus the email is inappropriate because it can feel critical on the way others practice.

I feel, as a man, if I don’t attempt to really spend time on my emails and make them less succinct, well good luck winning friends and influencing people in the profession.  And it’s not like I don’t have other things to do during the day.  It takes a lot of time to write emails in an attempt to not hurt any of the 89,300 people’s feelings in our profession and how they might misinterpret what I wrote and take it offensively.  Well guess what, as a man, I automatically am much more likely to offend someone in our field because of my gender because men are perceived ‘forceful’ in any opinions we have.

While it might be thought of as confidence and life experience in an older woman, for a younger man, it is considered arrogance, regardless of whether I actually have that confidence and life experience.

As someone who went to an all male Catholic school, I was not taught to write in a deferential manner.  I was taught to write to get my point across.

I understand that women’s rights are still not on the same level as men’s.  But to be a scapegoat for all the angst of women by being a male in the profession, that is the job of being a man in a 94.3% female profession (notably 2.2% of the profession didn’t declare a gender, so perhaps we have 2.2% transgender individuals).  I also am expected to behave up to a standard women in the profession don’t hold themselves to (many who don’t follow the code of ethics themselves).  I have personally received emails from multiple other dietitians telling me how to act since becoming a dietitian, both with the ‘tone’ of encouragement and with the ‘tone’ of attempt to control my behavior.

Even when going through my internship program, most of the members of my internship class went to a women’s conference together.  I was not invited or thought of.  I was left out on purpose.  Let’s suffice it to say I didn’t feel part of the group or welcomed.

Enough on gender differences though.  I digress.

There is a great need for more racial diversity within the field of credentialed and practicing licensed dietitians in addition to more gender diversity.  People who need nutrition services come from a wide variety of cultures.  Who better than a practitioner who is trained in the profession and comes from that culture to help people from within the culture?

As much progress in civil rights as there has been in the last century, it isn’t enough.  People of different races deserve the option of a healthcare practitioner of the same race to avoid unsaid prejudices from either side.  Prejudices still exist and need to be acknowledged.

Cultural competence is taught in dietetics education, but it is not enough.  We cannot control a patient’s biases as practitioners, and for the sake of a patient, he or she needs to have the option to choose a practitioner with whom they can at least have confidence fewer assumptions of bias are happening from either side.

Dietetics education programs should be making it a top priority, for the sake of the credibility of the profession and ability to have an impact on more people, to be inclusive of men and non-white racial groups.  An effort needs to be made to make the profession more appealing to minority groups and diversify the profession demographics.  Insurance companies should also have more diversity within their practitioners.  It is unacceptable for 100% of a list of specialists to be white females and that the insurance companies are ok with this.



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Telehealth and Nutrition Counseling in 2017

Jun 11

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Healthcare, Uncategorized | No Comments

The Centers for Medicaid and Medicare Services (CMS) recognizes the place of service code ’02,’ which allows telehealth as a place of service.  Codes licensed dietitians can use to bill insurance include 97802, 97803, and 97804, which are recognized as billable with telehealth according to the CMS website.  Other codes can be seen in the same link (if you are a healthcare practitioner reading this who isn’t a dietitian).

Certain requirements must be met, including using secure software for teleconferencing up to HIPAA standards, an approved originating site, and being an approved distant site practitioner.  According to the CMS website on page 2, an approved originating site can be a physician or healthcare practitioner’s office, which means wherever the practitioner defines his/her office, the telehealth requirement can be met.

Other approved originating sites include “hospitals, critical access hospitals (CAHs), rural health clinics, federally qualified health centers, hospital-based or CAH-based renal dialysis centers (including satellites), skilled nursing facilities (SNFs), and community mental health centers (CMHCs).”

Additionally, the same previously mentioned link also states registered dietitians or nutrition professionals, depending on who is allowed to practice in your state and receive insurance reimbursements, are eligible practitioners to furnish telehealth services.

Other non-dietitian distant site practitioners can be “physicians, nurse practitioners (NPs), physician assistants (PAs), nurse-midwives, clinical nurse specialists (CNSs), certified registered nurse anesthetists, clinical psychologists (CPs)*, and clinical social workers (CSWs)*.”  *CPs and CSWs have limitations.

Unfortunately, dietitians in private practice can only perform telehealth services if the beneficiary (the patient) is at an originating site.  This means patients must still go to their healthcare practitioner’s office to receive the service.  Private payers (non Medicare/Medicaid insurance) may have their own rules, but often Medicare is the example.

 You should check with your private payer for their rules if interested in telehealth over traditional face to face services.

Real time communication, as opposed to delayed communication like email, must be used unless in Alaska or Hawaii.  If billing, a modifier ‘GT’ or ‘GQ’ must be used.  The former states that the service was done “via interactive audio and video telecommunications systems” whereas the latter states it was done “via an asynchronous telecommunications system.”  (same reference link above)

Both the originating site and the distant site practitioner receive payment.

While it is important that communications remain secure, I had hoped telehealth would be implemented in a way that could save healthcare costs and improve access.  Since the originating site must be one of the aforementioned sites (assume for security, not sure), telehealth is still not as convenient as it could be.

A patient must still go to an originating site rather than being able to have the service done via webcam from the convenience of their home or their office.

On the plus side, distant site practitioners can partner with the aforementioned healthcare originating sites to provide covered services.  This DOES improve access for people in rural areas who may not have as easy access to specialists who are allowed to receive reimbursement for telehealth.

At Nutrition and Fitness Professional, LLC, we are available to work with healthcare practitioners who wish to refer their patients via telehealth for medical nutrition therapy (codes 97802, 97803, 97804) and use Google Meet as our secure HIPAA compliant video conferencing platform as well as other G Suite approved HIPAA compliant apps.

It is not necessary for the originating site to have access to G Suite in order for the service to be performed as the client only needs to click on a Google Calendar link.

For specific questions, please contact us.



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Repeal of ObamaCare and Possible Effect on Your Nutrition Counseling Benefit

Feb 6

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Healthcare, Personal Experiences and Opinions | No Comments

At the time this is written, it is still too early to tell whether or not the replacement for the Affordable Care Act will result in the loss of coverage for preventative healthcare services or not.  President Trump has stated that some parts of the healthcare law will remain.

What worries me, as a practice and business that highly uses insurance-based nutrition counseling benefits, is that the loss of the mandate will mean insurance companies could cut their coverage for the services I do unless you have a formal physician referral for a specific medical condition.

Currently, most people do not know (and your insurance company is very evasive in letting you know) that you MAY (about 80% of my clients) get 100% coverage before you even meet your (enormous) deductible for preventative nutrition counseling, unless you have a grandfathered plan from before the Affordable Care Act.

Specifically, I can use a preventative code as a dietitian for preventative services with many insurance plans that results in no copay or coinsurance (yea, too good to be true, right?).

As a licensed dietitian in private practice, I am not allowed to diagnose any specific medical condition and am restricted to using a preventative code or a BMI code (because it is a calculation) to support coverage for nutrition counseling.

This allows individuals to just see me to work on their health rather than having to go do extra work and get other diagnosis codes from their physician, which may be subject to copays, coinsurance, your (huge) deductible, and cost to see your physician for the diagnosis (which also costs money!).

If ObamaCare is repealed, then I sincerely hope that the clause that allows coverage for nutrition services (CPT codes 97802/3/4 medical nutrition therapy) with a preventative ICD-10 code remains for a few reasons:

  1. Individuals who are overweight or obese without a formal diagnosis of a comorbidity (medical condition) face a financial barrier to getting on track with the professional who can literally reverse their condition without drugs or surgery.  Removing this barrier can be a huge boon to getting people in the door who need to work on themselves before they use a cop out excuse like “it is too expensive.”  Individuals WANTING to make a change to their diet and exercise habits needing legitimate information need all the support getting into my office they can get (a whole other blog post on the swamp of misinformation non-degreed fitness professionals give out about weight loss that you probably already self-pay for in personal training sessions).
  2. America pays more for the disease than the prevention.  Small fires are easier to put out than blazing forest fires.  This is a metaphor to saying overweight is easier to treat than type 2 diabetes, surgeon fees for coronary artery bypass, chronic kidney disease dialysis procedures, and pharmaceuticals for band-aid-fixing diseases that can be cured with lifestyle change.  Supporting the healthcare professional, through health insurance, that facilitates lifestyle change is supporting a registered dietitian and exercise physiologist (me).
  3. If my practice dwindles due to the repeal of the Affordable Care Act, I promise you that isn’t because everyone is healthy all of a sudden.  It is because there would not be coverage.  Even though the price of my services is inexpensive compared to what your surgeon or primary care physician costs, many people feel they are already paying for healthcare with their premiums, so they should not have to pay a dime more.  One of the major ways to have more coverage for services is if your premium is higher, to my knowledge.
  4. Loss of coverage for nutrition services would be a step backward in fighting many of the health problems that are easily treated by diet, exercise, and lifestyle changes.
  5. In appeal of Trump’s love for small business owners, as a small business owner, I have spent my blood, sweat, and tears slaving over my private practice for the past 3 years learning how to facilitate coverage for my services through health insurance for the benefit of helping clients and making a living myself.  By no means am I getting rich doing this.  I still work 7 days a week with a part time job seeing clients with my business and through an employer.  I have good success with the clients I do see (they let me know, or I see it myself).  I deserve to not have what I have built over 3 years burnt down just through a change in government administration.  I deserve to not have the rug pulled out from under my feet.  Not enough people are even using the benefit yet, nor is it advertised well enough through your health insurance company (probably because they think they lose money in the short term).

I agree the healthcare law is not perfect.  As a small business owner who is single, male and over age 26, I pay for my own health insurance through the Exchange without a husband or wife with a full time job with benefits a spouse can get on.  It is one of my biggest expenses next to paying for office space in Austin.

However, I also realize that as someone who is extremely fit, healthy, and barely uses his health insurance for anything except my flu shot and annual physical, I am paying for others who are not as fortunate as me to have the knowledge I do about nutrition and exercise and the desire to live the lifestyle.  And I’m fine with this.  I have no issues with it.  I can budget my money well if others need to use their health insurance more.

I know other young people are not aligned with this idea, and I do see the opinion that they feel they pay too much in premiums for something they don’t use and that as healthy people, they shouldn’t have to foot others’ healthcare bills who don’t care as much about their health as they do.

Clearly this is a complicated issue, and it is good that people can stay on their parents’ health insurance until age 26 and that 20 million more people actually have some coverage, but Americans also do not like paying for each other’s healthcare, and that is also a valid opinion.

I urge you to reach out to your representatives and senators with your concerns about the healthcare law reform.  If you are reading this post, you might care a little about preventative healthcare coverage and/or nutrition counseling coverage.  Please don’t be silent during this time when our voices need to be heard.

When it comes to nutrition counseling, Americans deserve legitimate information from a trained, degree-holding, licensed professional who is an expert on the subject and adept at working with individuals and groups.  Americans deserve the right to avert disease before it starts.  Americans deserve the right to prevent further healthcare costs down the road by taking action to a healthier lifestyle now, and they do not need additional financial barriers put in the way merely as a way to myopically cut costs and keep campaign promises.  Long term, it does not save.  Long term, we lose.

Yes, if you cut nutrition counseling, health insurance companies will save a little bit of money now.  But if you cut nutrition counseling long term, disease rates will go up and healthcare costs go up.  Clearly this is not a simple issue and needs to be considered carefully as a new healthcare law is implemented.

Edit 02/07/2017: A professional colleague alerted me to former President Obama’s recent article published in the New England Journal of Medicine on the possible repercussions and irresponsibility of repealing the ACA without a better replacement that is openly discussed first since posting this yesterday.

Please share or comment!



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Why Follow-Ups are Necessary in Nutrition Therapy

Sep 29

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Uncategorized | No Comments

It is utterly impossible for anyone to teach anyone everything they need to know about nutrition and have it stick on the first session.  It is also impossible to have counseling and behavior changes occur, question beliefs, motivations, feelings, and lack of motivations with regards to food and nutrition, lifestyle, and exercise in one session.

One of the biggest failures of clients is those who go from practitioner to practitioner getting opinion after opinion from only your objective information that you fill out on our initial intake forms.  You are more than a set of health statistics.  No one is going to get to know you and figure out what is going on without building a relationship.

Nutrition counseling should be compared to therapy or personal training.  Things often don’t change in one session.  This is especially important to realize for those who use food for reasons other than physical nourishment.  Yea, you know what to do.  Then why aren’t you doing it?  That’s what this is about.  I help you figure out why you do what you do.  I help resolve ambivalence to change.

I’m not saying that sometimes I may do an excellent job and you may learn everything (ha!), but if you came for weight loss, for example, sometimes things I say may not be interpreted or implemented correctly.  Sometimes you have behaviors that are getting in the way of your weight loss.

This leads to cop outs like: “Well I tried.”  Does one time of trying count?  Sure.  However, one session sometimes doesn’t lead to the types of changes you want.  If something isn’t working, it is a sign you need to talk about it.  Why didn’t it work?  Don’t blame yourself for not holding to the results.  Most of what I think I do is figure out how to tailor messages to the individual.  Sometimes it is shooting a moving target with a blindfold on based on questions you asked and hear the answers to direct me where to shoot.

It’s like playing Marco-Polo with one “Marco” and hearing one “Polo” and wondering why we didn’t run into each other in the swimming pool (that’s the only place I ever played that game).  You may change your position in life in the mean time and have everything change.  This happens often when college students join the work force.  Previously, they were walking around between classes all day on a large campus.  Now, they sit all day.

How likely is anyone going to shoot that moving target while blindfolded on the first try?  Maybe if we use the Force? 🙂

How will you or I know that you’ve interpreted something correctly without a follow-up?

Yes, it is an investment to come more than one time, but some of the alternatives aren’t so pretty.  It’s so much easier to change behaviors now before they lead to disease than later when they cost significant medical bills and your ability to live a happy, healthy life significantly decreases.  No one likes to change, but if you think about the future, sometimes changing now isn’t so bad in comparison.

Since “fear of disease” tends to not motivate the general population as much as it does people who study health, another way to put it is this: think how happy you might be once you reach your health goals.  When you’re in that place of health, you’ll feel happier about yourself, feel confident in your body, feel able to move about the world with ease.

When I’m working with personal training clients, they figure out my system.  Each time, we try to add an exercise, add weight, or add repetitions at an existing weight.  It is a steady progression, whatever we do, and it is easy to see how doing that gives them results.  With nutrition, the same thing is needed.  You need to make small yet important changes that you are comfortable or only slightly uncomfortable making.  Once you do them, you get motivated to keep making more changes.

It is difficult to help you make those changes when a client is seen only once and goes forth with some initial tools.  Changing your lifestyle takes work.  It isn’t fun to make changes, but why not revisit and figure out what is working and what isn’t?

Please comment and share!



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Food Allergy, Intolerance, Sensitivity Testing Impacts Disordered Eating

Sep 1

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Personal Experiences and Opinions | No Comments

I am frustrated by the lack of clear information on food allergy, intolerances, and sensitivity testing on the Internet, so I am writing this post to show what I have seen as someone who works with those who may have had these tests in their past.

First off, we all know someone who believes they are allergic to certain foods.  Technically, allergies are serious, so we don’t take any chances with them. In practice, I try to work around people’s real or perceived food allergies, intolerances, or sensitivities.

When I think of a food allergy, I think of anaphylactic shock and hives.  When I think of food intolerance, I think of getting diarrhea due to something like lactose intolerance, where the food, when taken in large enough quantities, draws water into the gut from blood circulation and washes you out because you can’t create enough lactase.

I don’t know what to think about food sensitivities because they weren’t on the RD exam and were mentioned as not one of the two types of reactions you could have and even included as a wrong answer in that multiple choice question on the exam.

Common food allergy testing includes tests and protocols like ALCAT and LEAP, among many others.  A pharmacist, Scott Gavura, did an EXCELLENT blog post about food sensitivity testing for the website sciencebasedmedicine.org and did a lot of work on finding real evidence in the literature to support it.  The short conclusion?  There isn’t.  Check out his post for more detailed info.

Because I won’t attempt to do a better blog post than he did on this subject, I will say, in short, that I support that work he did.  The rest of this post will be what I actually see in clients who have had these sorts of tests as well as my own experience having had allergy testing early in life myself.  It impacts their lives both positively and very negatively.

I had the full 42 pricks in the back and 21 shots in the arm allergy testing done twice in my life, once when I was 11 or 12 and once when I was 22.  The first time, I supposedly was allergic to eastern and western weeds, molds, dust mites, and tomatoes.  Yet, I wasn’t going to get away from dust, molds, and tomatoes in my life.  Hell was I going to miss dad’s pizza on Sundays or not eat spaghetti.  I kept eating it and it had no real effect on me.

Growing up I always had a lot of inflammation in my nose such that I felt like I was congested but actually wasn’t.  Looking back, a lot of that actually just was undiagnosed generalized anxiety disorder, something I’ve struggled with my whole life for reasons that aren’t related to allergies or nutrition at all.

Having worked with an excellent pscyhotherapist on that, I don’t experience those symptoms anymore and can check in with myself when I get anxious.  With this life experience, I’m keen on seeing if it happens in others!

In others, I have heard sensationalized testimonials about how after having their food sensitivity test that they experienced dramatic weight loss and found God.  I won’t even dive into that subject because it is a case by case basis as to how eliminating certain foods can help people.

You would really have to see what that person was actually doing through detailed dietary recalls to see if their testimonial has merit from a nutrition standpoint.  Perhaps they also found love in the the meantime, which released anti-inflammatory cytokines throughout their body.  It could be a number of things.

Some clients have had these tests negatively impact their lives, and some of them aren’t even aware of it.  One client I worked with was told she was allergic to chicken among many other foods by the alternative medicine practitioner.  Her parents tried to keep her in line with her food restrictions throughout life (out of love, which is understandable) enough that she felt left out of social activities involving food.

Imagine going to a birthday party and not being allowed to have what everyone else is having.  Fast forward 10 years when she is allowed to have these foods now and can’t get enough of them such that it leads to overeating of them.

It’s the psychology of deprivation.  The more you restrict it, the more you want it.  Look what happened to Miley Cyrus.  Things will rebalance after they swing the other way for a while.  Right now, she’s just being Miley.

I have worked with others who have such an extensive list of foods they are not allowed to eat from these tests that they literally have trouble constructing a healthy diet out of it, let alone allow for variety.  This is a problem that these tests have that much power over people.

If the person got results and thinks it was from restricting certain foods that lack a legitimate scientific basis, they will live in fear of eating with others for the rest of their lives.  Granted, if you reintroduce some of these banned foods and notice symptoms reappear, then yea, maybe you should avoid them.

However, most of the time when you reintroduce these foods, you DON’T get the same symptoms.  Many find out that you are actually allowed to have all these foods you previously thought were bad for you based off a sham test that costs $450 that the desperate must pay out of pocket for.

Maybe you can start with just a little bit of the banned food and experiment to see if it actually gives you unpleasant symptoms.

Bottom line, these sorts of tests that give you extensive lists of foods to avoid beyond common allergens like soy, tree nuts, peanuts, dairy, wheat, fish, shellfish, and egg (for more info see foodallergy.org) should be given extra scrutiny and skepticism until proven by adding back in offending foods to see if they actually produce symptoms.  This is just called an elimination and reintroduction diet, and you don’t need a $450 test to try one.



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Why I List Out All My Credentials

Aug 31

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Personal Experiences and Opinions | No Comments

The United States educational system allows you to pursue graduate degrees in many fields without the prerequisite background.  This is very true for degrees in the health sciences.  Typically, a master’s degree is about 36 credits and includes research-based coursework, which is often not practical to working with clients.

A master’s degree without a bachelor’s in the field lacks the comprehensive coursework and internship experiences required in a bachelor’s degree, which is usually around 120 credits.  While some of them are general education, most of the other coursework is coursework related to the degree.

Some master’s and doctoral programs require some prerequisites, but not all of them nor are they uniform.  The University of Texas, for example, does not require those with a master’s in kinesiology to have the bachelor’s degree.  Having done my master’s at UT, I would not say that it would qualify me to work in various areas of physical activity since it was such specialized knowledge in exercise physiology, a subject that is probably meaningless had you not had an undergraduate chock full of science to even understand the master’s.

I know what information was NOT in the master’s, so to be practicing without the undergraduate level work and experience required to get that degree is a problem with the educational system.  I also had to complete 3 internships at the undergraduate level for kinesiology.  To not list that against people who just have a master’s is to omit pertinent structured educational experience I have that others do not.  It is not to just list more letters off my name.

I adopted the UK’s manner of listing credentials because the British have it right in terms of recognizing that if you have a PhD, you may not have a bachelor’s and master’s in the subject.  If you have a master’s in a subject, you don’t always have a bachelor’s degree in it (especially in health and fitness).  “Practice in the UK varies from that in the US partly because it is designed to draw attention to the fact that not everybody who possesses a higher ranking award possesses lower ones as well.”

In my particular case, a nutritional sciences degree is NOT the same step-wise prerequisite that a dietetics degree is.  I had to go back to school after having a nutritional sciences degree for another 4 years to complete the dietetics coursework and 1200 hr internship, which is encompassed in the RD credential.  The coursework to become an RD is not 100% science, as my undergraduate education was mostly a pre-med degree.

Dietetics also includes classes on counseling individuals and educating groups, foodservice, community nutrition (WIC, government programs, etc.).  

Had I just had a dietetics degree, I wouldn’t list my other BS degree because it would be included in the RD credential.  The nutritional sciences curriculum at Penn State was a pre-med track with more advanced sciences required than the dietetics track.  Nutrition sciences had to take a more difficult organic chemistry, a microbiology with a lab instead of just lecture, organic chemistry lab, physics 1 and 2 each with a lab, and multiple levels of bio with labs including genetics and PCR.

Additionally, I took college-level anatomy and physiology in high school (and won the award for highest GPA in it at Strake Jesuit College Preparatory), physiology and exercise physiology as an undergraduate at PSU, and then multiple levels of physiology during my master’s, including being a preceptor for the undergraduate UT physiology course and leading study discussions.  Nutrition and fitness is a lot of human physiology.

On a side note, ask people who are “certified nutritionists” whether they had to pass high level sciences (and by pass, good luck getting into a dietetic internship with less than a 3.5 GPA).  You may get a quizzical look.  This is another reason why credentials are important in the nutrition and fitness field.  They won’t be able to stand their ground when it comes to tough questions on human physiology and nutrition.  No one has tested their knowledge and made them pass anything high stakes.

These sciences are a way to weed out people who think they know nutrition and human physiology for a reason.  Everyone thinks they are an expert these days, so it creates artificial competition against real practitioners.  I mean artificial because some people are not qualified to practice but there is no law prohibiting who can do nutrition counseling (or fitness) in Texas.

To think that people would pay people who are of these sham certifications baffles me.  I’ve been told before, “Your rates are too expensive.  I hired someone who charges $30.”  If you are willing to put your health into the hands of someone who only charges $30 an hour as a freelance professional to travel to your home, something is really fishy with that professional.

Even a massage costs 2-5 times that.  Psychotherapists charge 3-6 times that amount and people see them regularly.  $30 an hour doesn’t even pay for day-use office space in Austin among the other costs of being in business.  A small business must pay double taxes on their income as well.  About 50% of my clients only need one session to get them on the right foot, but those who visit more frequently have the best results, especially for weight loss, disordered eating, and eating disorders.

Back on credentials.

Master’s degrees are not uniform from school to school or subject to subject.  Sometimes other nutrition “professionals” just list a master’s degree after their name without saying what that degree is actually in.  If you aren’t listing what it is in these days, you are hiding something.  You should ask what their degree is in.  What if your nutritionist has a master’s in, say, computer science?  How does that relate to them being able to serve you?  Why are they listing it after their name on their nutrition services website?  What if their undergraduate was architecture?

One of the perks of being a credentialed healthcare provider through various health insurance companies is that it is a badge that the provider’s education is legitimate.  Insurance companies verify you actually have what you say you have.  It is a lengthy 3-4 month process for most private insurance except Medicare, which credentials faster within a month.

There are some in the fitness and nutrition field that say they have degrees when they do not.  No one is verifying their information.  This is a problem, so you SHOULD ask.  Anyone can practice fitness or nutrition counseling in Texas.  That’s the law.  They aren’t breaking any laws.  They just cannot call themselves a “licensed dietitian” or a “registered dietitian.”  Anyone can use the term “nutritionist.”  Registered dietitians can also call themselves “registered dietitian nutritionists,” which is also a protected term and credential.

Most personal trainers lack a kinesiology (or exercise science) degree.  Other fields require formal education before certification.  Personal training is backwards–they don’t even care if you have a degree when hiring at most gyms.  In fact, a degree is worth the same as a kettlebell or group exercise certification at most businesses that hire personal trainers in terms of pay rate increases.  This is utterly ridiculous, but it is true.

Now, let’s talk about this emerging field called “functional and integrative medicine.”  First, I am not trashing all practitioners of this field.  There are some people who know what they are doing.  Then there are the hippies who skipped and spurned all traditional education and now think they can practice at the same level as those of us with professional education.

It is one thing to go into functional and integrative (ie a new term for alternative, or non-evidence based) practice as a healthcare professional who has traditional credentials but also tries alternative therapies, and it is another thing to go into it with no professional education at all in the traditional sense and just do alternative therapies because you told yourself you are a badass.

It is another thing to go into the field, proclaim being at the same level, and have no academic background in the subject at all.  This is what a charlatan or quack is.  A charlatan uses marketing, emotions, and bells and whistles to appeal to those who believe that a traditionalist must not know anything at all.  I’m sorry if you had a bad experience with a traditionalist.  Sometimes even good practitioners are not on their game with 100% of their clients or patients all the time.  Maybe getting second opinions is what you need rather than one and blame the whole profession.

Is there more to practicing nutrition than knowing science?  Absolutely.  Good practitioners need to know how to ask the right questions, assess clients’ readiness to change, explore motivations, have good people and business skills, etc.  There is a lot of stuff going into the practice of nutrition than there is just pure science knowledge.  However, to consider all practitioners at the same level in spite of those of us who took the extra effort to actually know our field forward and backward before practicing is myopic!

Not many people get formal education in both nutrition and kinesiology and have a unique perspective of how they interact with experience in both fields.

Feel free to comment and share.



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Nutrition Credential Comparison

May 6

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Uncategorized | No Comments

Michael (Mike) J. Sandoz of MJS Nutrition created this excellent nutrition credential juxtaposition for a project during his dietetic internship.  To date, I have not seen any similar comparison of this caliber on the Internet of all the nutrition credentials out there.  It is important that the public know who to listen to when it comes to nutrition from in this industry, as everyone has their opinion, which is part of the problem!

Be sure to follow Mike on Facebook and Twitter.  I obtained permission from Mike to repost this on my blog for more public exposure of nutrition credentials.  Most clients are not going to go looking for the information.

Notice that some states require licensure to practice nutrition counseling (orange and red).  Yellow states require licensure if you want to become a healthcare provider for health insurance companies.  In all states, having an RD paves the pathway for licensure, but some states also allow the CNS credential to obtain a dietitian license.  If you have any questions, please comment!

MSandoz_Poster Nutrition Credentials Juxtaposed

Mike Sandoz Nutrition Credential Comparison

Nutrition Credential Comparison courtesy of Mike Sandoz



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BCAAs–Waste of Money Supplement Scam

May 2

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Science Analysis | 3 Comments

Branched chain amino acids, or BCAAs, are synonymous with the amino acids leucine, isoleucine, and valine.  These are essential amino acids, of which there are 9.  Essential amino acids are found in pretty much any source of protein or protein complement.  This includes eggs, soy, animal flesh, dairy protein (casein and whey), beans, nuts, seeds, and grains (which tend to be low on lysine, they still have BCAAs).  Essential means you must eat them every day for good nutrition.

I’m tired of seeing this scam promoted.  If you eat protein, your blood has plenty of BCAAs.  If you are worried about your BCAA level going down during exercise, eat dietary sources of protein sometime within 2-3 hours of your workout or a faster absorbing protein 30 min to 1 hour before your workout (whey) if you didn’t plan your day well enough to have dietary sources.  That is a good time period to ensure BCAAs, or protein in general, will be in your blood.

If you supplement with BCAAs or protein and your body doesn’t need it, your liver deaminates (removes the nitrogen group) or transaminates (moves the nitrogen to a different keto acid, making a different amino acid) the amino acid to maintain homeostasis.  The nitrogen group forms urea, which is filtered by the kidneys into your urine.

The carbon backbone of the amino acid is then integrated into either glucogenic pathways (pathways that synthesize glucose) or ketogenic pathways (pathways that synthesize fatty acids and ketones).

In other words, BCAAs become carbohydrate or fat calories, just like dietary carbohydrate and dietary fat do, and an insignificant amount of calories at that.  Except you bought BCAAs, and your body isn’t using them like that.  Consider the cost difference.  Let me break it down for you:

If you bought a container of BCAAs with 40 servings of 10 calories each, you might get 400 Calories from that whole container, according to the label.  That said, they apparently don’t count the protein from amino acids into the total calories on the label.  This particular item actually has 12 Calories from carbohydrate (rounded down to 10, so that is legit), but 5 g of protein from amino acids leucine, isoleucine, and valine.

Add 20 calories to that serving size from the 5g of protein, so there are about 30 calories per serving total.  So, 30 calories times 40 servings means the bottle has 1200 calories total, 3 times as much as reported on the label.

If that’s not enough to make you distrust this supplement, this bottle costs $26.39 at the time this post is written.  For $26.39, you could have bought about 10 bags of rice and 10 bags of beans or lentils, or you could buy 5 bottles of olive oil or 2-3 large containers of nuts if you prefer to get your calories from fat.  All of these are much more cost effective per calorie than buying a bottle of BCAAs.

People who tell you to buy BCAAs may be salesmen trying to make a living in the supplement industry or personal trainers who don’t have any human physiology or biochemistry education who work for gyms that tell you to push supplements or lose your job.  These are not people you should take nutrition advice from.

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Calories Per Mouthful–Rehash Serving Sizes

Feb 24

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Personal Experiences and Opinions | No Comments

Serving sizes.  Arbitrary quantities of food we can measure out to determine the nutrition within a set volume or mass of food.  These work great for people who are analytical and thinking types.  What about for the rest of the population?

I believe in multiple intelligences.  Some people are adept at verbal communication, some are skilled at math and science, some are better at creating new ideas, some are better at organizing, and some are better at learning new ways to move their body through physical space and time such as in athletics.

Not everyone is good at everything.  A person could be really, really bad at catching a ball and doing well in science class but one of the best writers or orators in the world.  They should not be penalized in life for not getting a nutrition label.

Nutrition Facts labels teach to math and science types because they are created by math and science types.  Analytic people.

Nutrition information on serving sizes is only given in one way: via the nutrition facts label on the side of a package.  Other than this, most people do not encounter nutrition information unless you seek it out on TV, the Internet, are the type of person who learns by experimenting on yourself, or you took nutrition in university.  Most high schools don’t teach it in health class.

The side of the nutrition package sometimes gives nutrition information in misleading and unrealistic amounts.  For example, who is really just going to have 1 graham cracker unless mom gives it to the kids in that quantity so it doesn’t spoil their appetite for dinner.  While a serving size is 5 prunes on the side of many brands of prune containers, many people believe that having more than one or two will cause too much bowel motility.

Whether or not this is true, the point is that sometimes you eat more or less than the side of the package considers 1 serving.

Analytic people can do the math in what they ate and convert that into the respective amount of calories, protein, carbohydrate, fat, and fiber.  These same people probably have a food scale that can measure food quantities when the side of the package declares a serving size in grams.

Serving sizes in grams are GREAT for analytic people.  You know exactly how much you get.  Grams make no sense to everyone else in the country, especially the US that doesn’t even use grams as a unit of measure.  People who live in the US are not raised with the metric system or grow up with an intuitive sense of how much a gram, kilogram, or milligram is like those in other countries.

Perhaps this is a small contributor to one of the MANY contributing factors to nutrition confusion in the US.  Sodium is listed in milligrams, for example.

Speaking to the original topic of this post, I propose alternative educational systems that need to be developed that speak to non-analytic people’s strengths in learning.

For example, why can’t nutrition information be listed in units like “Calories per mouthful”?  While a “mouthful” probably really irritates the logical, analytical people in that it is imprecise, it is not THAT imprecise.

It wouldn’t be useless and could be a much better educational tool than expecting non-analytical people to understand what a calorie is, considering the lack of basic nutrition education most people get in the US and the lack of educated nutrition professionals to be able to teach everyone this information efficiently.

(A calorie is basically a point system your body gets to maintain, lose, or gain weight as well as provide energy for activity.  Fat gets 9 points, carbs and protein get 4 points, and alcohol gets 7 points per “gram” according to the system.)

Some registered dietitians teach the intuitive eating concept, ie stopping when full and eating when hungry.  I use this technique for some clients as well.  It is much easier for some people to grasp than the math required with nutrition labels and serving sizes.  Portion/helping sizes are often not the same as a serving size.

A mouthful of pure fat would pack on pounds much faster than a mouthful of protein or carbohydrate, mathematically and bite for bite, but they all have different satiety factors.  Whether or not my idea of a mouthful being a serving size is a good idea or not, the point of this post is that nutrition labels tend to only help analytic people and not the rest.

There needs to be other ways for people to understand nutrition information that do not use math and science.



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What I Like and Dislike about MyPlate

Jan 29

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Personal Experiences and Opinions | No Comments

choosemyplate.gov

Nutrition Education Tool 2011

Most people I discuss nutrition with have heard of the Food Guide Pyramid, possibly MyPyramid, but even fewer have heard about MyPlate, which is the current national nutrition education tool for general population nutrition guidance.  This post discusses my criticism of MyPlate after a brief criticism of the other nutrition teaching tools.

Eleven Grains a Day, What?!

Nutrition Education Tool 1992 Eleven Grains a Day while I sit at my desk, lolwut!

The Food Guide Pyramid was criticized for overemphasizing grains and not putting enough emphasis on fats, among other things.  It also had a hierarchy of importance of food groups, even though clearly protein and vegetables probably should be higher up on that hierarchy.  That said, all food groups are important for their own reasons.

MyPyramid attempted to divide the base of the pyramid into all food groups and had a base of physical activity as well, showing that all food groups are important.  A criticism of MyPyramid was that it was too hard to understand.

Nutrition Education Tool 2005

All food groups are important, but this image was too hard and too busy to understand for most. If you get to the top of the pyramid, I guess you get less food.

MyPlate came out in 2011.  It was set on a plate, which was supposed to make it easy for people to understand since most people eat off of a plate.  While I personally eat all of my meals out of bowls, plates are still easy to understand and can be thought of more as a pie chart.  Most people understand pie charts.  This is a good part about the current educational model.

MyPlate emphasizes vegetables and is the first teaching model to recognize that you just need “protein,” not necessarily meat, which accomodates vegetarian eating.

What I dislike about MyPlate is that there is no mention of healthy fats on there.  Where do the nuts and seeds go?  I guess in the protein spot.  I always point this out to my clients who don’t need a lot of carbohydrate in their diet due to low activity.  I also think that MyPlate makes you think you need a fruit at every meal, which I do not promote.  If you want to fit a fruit in every meal, you can, but I don’t think it is necessary.

MyPlate mentions dairy as the source of calcium in your diet.  While I have nothing against dairy and promote it as a great way to get high quality protein, vitamins, and minerals, you could just have soymilk, almond milk, or plenty of vegetables that provide calcium.  No one is forcing you to have dairy.  However, if you do have almond milk, realize you’re not getting protein and are basically having a fat-sugar fortified beverage.  If you can fit that in your diet, then enjoy.  (diet used loosely as eating habits)

MyPlate doesn’t work very well for certain segments of the population.  For athletes, for example, I decrease the size of the vegetables portion to increase the size of the grains portion.  Yes, you Paleo fans can make MyPlate work if you use potatoes and sweet potatoes, but not everyone is going to go Paleo, ok?  🙂  For weight loss clients, I sometimes decrease the size of the grains part of the plate to enlarge the vegetables part.  For some people who eat tons of fruit who have certain goals, I may decrease the size of that for them.

Harvard Nutrition Education Tool

Harvard’s attempt to compete with the government recommendations. Drab and requires IQ over 100.

The Harvard Plate shows that calcium doesn’t have to come from dairy, and it also cautions against getting too much calcium due to association studies for higher morbidity risks, such as elevated risk of prostate cancer in men.  The evidence is far from conclusive on that, so I caution even mentioning it.

Harvard also puts oils under nuts and seeds, which is interesting considering oils are processed from nuts and seeds.  Which is a more nutrient-dense source of unsaturated fat?  Nuts and seeds.  Vegetables and fruits are grouped together.  Someone could run with that and not eat vegetables then.  Fruits and vegetables were not created equal.  There is too much going on in this pyramid to critique it all in this blog post.  In short, it isn’t perfect either.

When I work with clients, I tailor a message to them.  I may reference MyPlate to jump start a conversation, but I actually use a different teaching method, one I developed myself, that I feel is more effective for clients.  If you’re interested, you’ll just have to book an appointment with me to learn about that 🙂

Please comment and share!



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Calorie Recommendations, Dieting, and Exercise

Jan 22

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions, Science Analysis | 2 Comments

Preface

When you’re trying to lose weight, how many calories is too low?  This question seems simple up front, but upon researching for “the correct” answer, I found that it comes down to what is called “clinical judgement.”

There are a variety of ways to assess how many calories you should be eating, called calorimetry, the measurement of calories.  The current best way to find it during one point in time is indirect calorimetry, where an estimate is taken based off of carbon dioxide to oxygen ratio per gas volume.  Direct calorimetry, or where changes in heat are observed in a closed environment, is not practical for humans.

Without indirect calorimetry, the next best way is to look at what you typically eat for a long period of time and find the average caloric intake from food journaling.  Food journaling is one of the best ways to assess your diet and look at what is working and what isn’t and serves a number of purposes beyond just finding the calories you typically eat.

Unless you walk around with an indirect calorimeter on all the time, the device is only so useful because it only looks at your needs based off of one data point in time.

Then we are left with predictive equations like the Mifflin-St. Jeor equation, which is the current most popular equation for predictive energy needs (1, 2).  These give you an estimate for your resting metabolism.  Then you must add an estimate of energy expenditure based on your activity, which honestly is an educated guess.

Predictive equations are great for a population but may not be as accurate for any particular individual.  You can assess your caloric intake on this website or use any online calculator you want.

What is Formally Recommended for Weight Loss

The simple answer is this one-size fits all calorie recommendation found in the Evidence Analysis Library (EAL) of the Academy of Nutrition and Dietetics.  For women, 1200-1500 Calories are recommended for weight loss along with physical activity.  For men, 1500-1800 Calories are recommended for weight loss along with physical activity.

Having completed the Commission on Dietetic Registration’s Self-Study Module for Adult Weight Management, as well as having seen evidence of this during my master’s and seen this in the EAL, we know that exercise is not an effective way to lose weight from a physiological standpoint.  Perhaps from a psychological or sociological standpoint, exercise is helpful because of reinforcement of good habits, including dietary habits.

Granted, we all know someone who has lost some weight with exercise, but having not followed them around to see how exercising changed their diet habits, I am still skeptical.  Some of my clients are very sure that they have lost weight with exercise alone and no diet change, so perhaps the research isn’t as sensitive to this or the particular people it has that effect on.

Exercise calorie deficits vary widely depending on how fit you are and what you do.  It is possible that some populations may be able to achieve weight loss from exercise, but it is a small percentage in the big picture, according to the research.

Below is a graph from some pooled evidence on whether diet or exercise is more effective for weight loss.  Notice how old the study is, yet people are still trying to exercise off their weight.

Diet beats exercise on weight loss

Not a significant difference on weight loss with diet vs diet and exercise.

Very Low Calorie Diets (VLCDs)

According to the 2009 Position Paper of the Academy of Nutrition and Dietetics on Weight Management, a very low energy (calorie = energy) diet (VLCD henceforth), is defined as “800 Calories (or 6-10 kcal/kg) or less per day” and is typically in the form of liquid meal replacement supplements that are fortified with 100% of vitamin and mineral needs.

These are prescribed under the supervision of an MD for people who are obese by BMI or overweight with comorbidities (like diabetes, cardiovascular disease, etc.).  They are supposed to result in rapid weight loss and can help provide encouragement to individuals with the fast results.  They are not recommended without a healthcare professional’s supervision because you REALLY have to make sure you make your calories count in terms of maximizing the nutrition density per calorie.

Some nutrients are of concern.  When you are not consuming a lot of food, electrolytes such as sodium and potassium, which aid in nerve impulse conduction and heart contractions (mainly calcium) can lead to heart arrhythmias.  Gallstone formation is another complication possibly due to less fat in the diet, and bile can concentrate with less gall bladder contractions.

If you are 250 lbs, a VLCD could be as low as 682 Calories or as high as 1136 Calories.  The 800 Calorie number is open to clinical judgment.  If you are 140 lbs, a VLCD could be as low as 382 Calories or as high as 636 Calories.  That said, you probably would not need to be on a VLCD at 140 lbs.

Since a VLCD starts at 800 Calories and requires medical supervision, beware of any diet that asks you to go to 800 or below calories.  The cabbage soup diet is a medically unsupervised, VLCD that does not provide the array of nutrients for meeting nutrition needs, yet people go on it often considering how popular it is.  I haven’t heard of anyone dying on it, but if you have, please let me know in the comments.

The calorie range of 800-1200 Calories seems to be a range of numbers where not much guidance is given in terms of recommendations for healthcare practitioners.  Many physicians fear going below 1200 Calories with patients, but unfortunately, some people just won’t lose weight at that level of calories.

That said, physician education on nutrition is limited to an elective or two during medical school, should they decide to take it and is not standardized across medical schools.  “On average, [medical] students received 23.9 contact hours of nutrition instruction during medical school (range: 2–70 h).”  So asking your doctor how many calories you need may not be the right question unless they actually studied nutrition.

Does this mean a recommendation of 850 Calories is too low?  It isn’t a VLCD, by definition, and would not require physician supervision.  It depends on who is recommending it and for whom.  A smaller person needs fewer calories than a larger person, so 850 may be very low for someone very large while it may be just low calories for someone smaller.

Registered dietitians are trained to make sure the calories count in your diet to avoid health risks while dieting.  Most of us will not even recommend something that low unless the patient has unsuccessfully tried other levels.

Summary

The take away from all this is that figuring out how many calories you need takes some effort.  We can estimate with equations and calorimetry.  Food journaling is the best way to figure out how to make changes to your diet and see where you can improve.

Very low calorie diets (VLCDs) are generally considered to start at 800 Calories and are not recommended unless you are speaking with someone who studied nutrition and have worked with them unsuccessfully trying other less extreme approaches.

Exercise is not considered a good way to lose weight unless it makes you make better food choices.  It will make you fitter and healthier though so should be encouraged.

If you like this post, please comment and share.  If you don’t like this post, please let me know why in the comments.



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Mind-Body Foods and Health: Alcohol, Chocolate, Tea

Jan 21

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Personal Experiences and Opinions, Science Analysis | No Comments

According to research, drinking moderately may reduce risk of disease and mortality.  This week, it is linked to a reduced risk of heart failure.  Not drinking or drinking too much is supposed to be worse than moderate drinking in terms of risk of disease.  This is often shown in association studies (observational studies).  Not cause and effect studies.

Chocolate is also supposed to be good for you.  Scientific opinion states that 200 mg daily has a cause-effect relationship on endothelial cell-dependent vasodilation (widening) of blood vessels.  Observational studies show it can affect memory, heart disease, stroke, and cholesterol levels.

Drinking tea has been associated with anticancer properties and blood pressure reduction.

I have issues with all of these topics, so this post is going to give you my personal opinion on all of them.

I stay up to date reading the news releases of the latest studies through various channels.  It can sometimes take me 2-3 hours a day to get through it all.  Combine this with my nine years of nutrition and exercise education and training as well as professional practice, I have developed some pretty opinionated thoughts when I hear news on alcohol being good for you or chocolate being good for you.

Here’re my thoughts on these topics:

Alcohol

Nutrition biochemistry says that alcohol can impair B-vitamin absorption and enhance pro-oxidant absorption since it messes with the integrity of the epithelium of the intestines.  Alcoholics are often deficient in thiamine, which is vitamin B1.  Pro-oxidants are the opposite of antioxidants.  One gives an electron and the other receives an electron.

Alcohol forces the liver to detoxify it immediately.  This is one of the few cases I will actually use the word ‘detox’ because it is appropriately used.

Alcohol is empty calories.  It does absolutely no good for your body as a chemical itself.  It is not a necessary nutrient.  It probably isn’t helping you control your weight.  Yet we make it harder on ourselves because some consider you weird if you don’t drink alcohol.

People can become alcoholics from alcohol.  It is used as a way to deal with their issues.  This is so common it is shown in movies and on TV.  You can get withdrawal from it.  It can cause liver cirrhosis, or liver scarring.

Because 71% of people drink alcohol, it is expected in most social gatherings.  It is a socially acceptable drug to use publicly.  Conversely, it is often perceived as socially unacceptable to not be drinking alcohol.

So, with all these things we know about how negative alcohol is to humans, SOMEHOW the studies show that moderate drinking could be good for us, NOT drinking is bad for us, and drinking too much is very bad for us.  There is a J-curve with alcohol consumption.  How does this add up?

The explanation I assert is that it isn’t the alcohol that is making people healthier.  It is the socialization, which is not controlled for in observational (association) studies because MOST people drink with other people at dinner parties or out on the town.

Think about it.  People who drink are out on the town having fun.  Being out on the town involves walking, which is physical activity that counts.  They aren’t depressed and sitting at home being sedentary.  Depressed and sitting at home is often associated with other negative behaviors in itself, such as overeating or drinking alone, and feeling left out.

People who don’t drink can feel pressured to defend their abstinence in social situations, depending on the person.  It can make for a very uncomfortable social experience to be assailed with questions on why someone isn’t drinking when being out.  A Google search of “why is not drinking weird” brings up many posts that can explain the mentality of those who choose not to drink and how it affects their life and other people’s perceptions of it.  Ovik Banerjee wrote a nice post on not drinking’s downstream social effects that got some great comments.

Having fun, laughing, and bonding with others relaxes blood vessels on its own because stress is low so the nervous system is less likely to be constricting your blood vessels.

Perhaps the small amount of alcohol that people feel is necessary for them to have in order to have fun, laugh, and bond with others doesn’t negatively outweigh the benefits of having fun, laughing, and bonding with others.  It may not outweigh the excitement of meeting someone new, being on a date, or being with people you like.

Alcohol is supposed to ward off cognitive decline, magically somehow.  I say this is because people who are drinking alcohol are socializing, which is actually a complex phenomenon of listening to other people, interpreting what they say, reflecting on it based on your own experience, and responding with empathy.  The alternative, sitting alone home by yourself, is probably associated with depression and boredom, which are not very stimulating states compared to socializing.  In my opinion, cognitive decline follows the ‘use it or lose it’ mantra.

People who don’t drink at all are missing out on the benefits of having fun, laughing, and bonding with others, but they also aren’t getting the negative effects of alcohol either.  After all, it does destroy the integrity of your intestinal mucosa and inhibit ion channels in nerve cells, which leads you to the popular mental effects of drinking alcohol.

People who binge drink, you know, those who in college are holding each others hair over the toilet or being propped up on their sides so as to not die in their own vomit, have the worst health effects.  Maybe they are drinking too much because they have other issues they are escaping, trying to fit in too hard, or just hate themselves and take it out on their bodies.

Chocolate

Most people know that it is dark chocolate that is supposed to be better than milk chocolate because it has a higher percentage of cocoa.  Well if that’s the case, then why don’t we just all save some money, leave the candy aisle, and just go to the cooking aisle and buy pure cocoa powder and start using it?

Oh right, it doesn’t taste that good by itself without all the fat and sugar surrounding the cocoa that makes what we know chocolate.  Milk chocolate tastes way better.  Let’s not kid ourselves.

Because I’m scientific and experiment sometimes, I have been purchasing cocoa powder from the cooking aisle ever since I heard about the benefits of chocolate.  I didn’t see the need to get all the extra saturated fat and empty sugar calories from having the candy form because, personally, I don’t need that stuff.  Maybe you do, but I don’t.

Based on the article linked above on the observational benefits of chocolate, I might experience lower cholesterol, heart disease, stroke, memory decline, and relaxation of blood vessels.  I had been adding it to my porridge in the morning, which makes it change color and look like chocolate porridge.  It is an…acquired taste…one that I actually enjoy after doing it for a while.

That said, I honestly don’t think it is doing much for my physiology.  Part of this reason is because I don’t derive the same sense of subjective relaxation and joy most people associate with chocolate, which can lead to the cardiovascular and memory benefits.

Some women say that chocolate stimulates the same area in their brain as sex.  Well, for me, I am not experiencing any orgasm from my cocoa powder in my porridge.  Therefore, it probably isn’t having the same effect on my brain and blood vessels as people who subjectively experience pure, better-than-sex bliss from eating this food.

This gets me to the subject of subjective experience from food.  There are people who will read a study or news release and make a behavior change based upon that study.  If chocolate is found to be good for you, they will start eating it because of the possible, yet mechanism unexplained, health benefits.  They will eat it like medicine.

I have worked with clients like this and probably am this type of person.  These types like to eat chocolate daily because the news releases have said that it is good for you.  Maybe it is good for THEM.  I’m not denying that.  But if you really don’t enjoy eating it, it probably is not giving you the health benefits the article says because people experience food differently.

The same thing goes for tea.

Tea

Compare the experience someone has who enjoys drinking tea vs drinking tea for the health benefits.

Having tea involves taking time out from your day to make the tea, wait for it to cool (or scald your mouth, whichever you do), and slowly sip it while reciting whatever pleasant mantra you have in your mind that relaxes you.  I choose “serenity now.”  Tea is an experience that promotes the flow of chi.  I imagine hearing the rolling waves of the ocean and the pleasant sound of water flowing while pouring tea into my self-crafted colorful pottery mug with its appropriately matching saucer.  Miraculously, I do not have to pee with all these water sounds.  I am spiritually centered and feeling warm zen as I slowly consume my hot water flavored with the leaves of the Camellia sinensis plant.

Now let’s look at another situation.

I boiled or microwaved water and poured it into my tea-stained reused white mug that has a tea bag that I purchased because it has health benefits.  I make sure the water is hot enough to disinfect any bacteria from the last time I used it.  Later, I forgot I poured the tea only come back to it two hours later in a rush as I’m leaving the house, so I quaff down the whole cup of flavored cool water.  It is kind of gross at this point, but I drink it anyway because it is good for me.

Which situation do you think lowered your blood pressure?  Obviously quaffing the stuff down as fast as possible in a rush out the door probably won’t have the same health benefits as sipping soothing flavored water slowly.

I can’t speak to the anticancer effects.  Maybe both situations benefit from just having the phytochemicals in tea.  Many health behaviors and foods are associated with a reduced risk of cancer, but there is not strong enough evidence to say that doing these things all the time will completely prevent cancer.  I would think that scalding your mouth with the tea may increase the risk of mouth cancer due to the turnover of epithelial cells in your mouth, but I can’t say for sure.

Summary

Sometimes the food itself has nothing to do with the reported health benefits associated with a food.  Perhaps some health benefits are chemically related to the foods themselves in some cases, but when association studies come out to promote certain foods, I like to examine things in contexts that people often don’t think about.

Alcohol, tea, and chocolate are good examples of the point that certain foods can have subjective effects on the mind that can confer health benefits for some people.  Others who do not get the same subjective experience from these foods are not weird but socially ostracized, which can have negative health effects if care is not taken to rationalize the whole situation and find other ways to achieve the health benefits.

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Personal Training: Problems in An Unregulated Yet Needed Industry

Nov 9

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | 2 Comments

Personal trainers are the experts on how to get healthy, fit, gain muscle, and lose weight.   Or so much of the public thinks who didn’t do their research.  Unfortunately, MOST personal trainers are given WAY too much undeserved credibility.  A quick Google search will show you how many certifications are online.  Freelance personal training, which is what most trainers do who hope to make it their career, doesn’t even require a certification unless you want liability insurance.

Do most clients ask their trainers if they have liability insurance or a certification?  No.

Do most clients even know what certifications are worthwhile?  No.

Do clients even want to put that much trust in someone who got a certification on a weekend online?  Apparently.

Do you even want to trust someone who got a certification from one of the more reputable sources (ACSM, NASM, ACE, NSCA, Cooper), which requires a testing center, when they don’t even have a formal education in the subject?  Apparently.

Do you trust them to take care of your diabetes, hypertension, orthopedic concerns, cardiovascular concerns, understand what medications limit exercise, etc?  Apparently.

What if you get light headed during training…then what should your trainer do to help that problem and explain it to you?  Are you being taught myths and fads or evidence based techniques?  Why are we doing this exercise?  

Apparently, YES, people do trust people with weekend certifications to know all this information.  The industry proves this due to how many successful fitness “professionals” there are without any education.  The industry is driven by charisma, unfortunately.  This is ONE big problem with the industry.  The number of barely qualified people doing the work far outnumbers those with formal education on what they are doing.

Does your trainer have a degree in kinesiology, exercise science, biomechanics, exercise physiology?  Have they ever taken an anatomy class?  You would think these would be requirements, but they aren’t!

In other fields, non-professionals doing the work of the professionals is not NEARLY as much of a problem.  Companies won’t hire you unless you have a degree in the subject and there aren’t many freelancers who think they can do better than they could do at a company.  You wouldn’t trust any other medical provider to operate on you or otherwise care for your health without formal education.  You wouldn’t trust someone without a JD to give you legal counsel.  Why is it any different with exercise science and nutrition?  People will accept information from ANYONE in this field!  Mantras like “everyone is different” and “it works for me/Cameron Diaz/Dr. Oz/Oprah/Arnold” dilute real knowledge and wisdom when we need it most as a nation.  The number of charlatans drowns out the true professionals.

A second problem is the fact that the lay public thinks personal training will make them lose weight.  It doesn’t make you lose weight.  If that were the case, personal trainers would be rail thin due to all the activity they do every day.  Exercise changes your body composition.  It doesn’t change your weight, and if you’re overweight, you’re not going to change your body composition enough to look like your trainer without nutrition changes.  If anything, you will gain weight because exercise stimulates your appetite due to the muscle breakdown.

You would do better spending your money on a registered dietitian if your goal is weight loss.  Weight loss is one of the biggest issues in America today, and people have the misinformation that exercise causes weight loss.  Most uneducated personal trainers will not know it isn’t the exercise but diet that causes weight loss, and if they do, will they tell you and risk losing you as a client to a registered dietitian?  Probably not because exercise is always good for everything right?  Wrong.

People give WAY too much trust to trainers on topics like nutrition.  Did you know that some people, such as registered dietitians and those with a bachelor’s degree in nutrition, are much more minimally qualified to counsel on nutrition issues?  These include: weight loss and weight gain, cholesterol, hypertension, performance nutrition, and many other nutrition-related issues.  You shouldn’t trust your trainer on nutrition unless they have a degree in nutrition and/or are a registered dietitian, which is someone with a degree who has been accepted into a competitive 1200 hour supervised practice program and proved their efficacy that they know what they are doing.  Not all nutrition majors get into these programs.

A third MAJOR problem is the financial disparity between employment and freelance personal training.  You cannot make a living at most places that employ personal trainers, especially since the Affordable Care Act (thanks Obama).  Some places prevent you from working more than a certain number of hours so that they don’t have to pay you benefits.  Now, the health and wellness specialist, the personal trainer, has to pay for his or her own health insurance.  Most commission places pay anywhere from 33% to 50% to 60% maximum of your client income, expect you to do the sales, and they don’t reward you for being a good trainer or getting results.

The only reasons you would get a pay increase are more certifications, more formal education, or more experience, but it isn’t enough of an increase to make the education cost-effective (but does make a better trainer and decrease risk of injury to the client and ability to achieve client results).  Plus, most of the fitness industry certifications are stupid.  I don’t think I need to get a certification on how to use a kettlebell, battle ropes (lol), vibration training, or TRX after having degrees.  Seriously?  Interestingly, getting a kettlebell certification is a similar increase in pay as a degree at many gyms.  That’s just ABOMINABLE, isn’t it?

Other gyms sell packages of sessions and don’t pay the trainer the rest of the sessions if the client doesn’t finish them with the trainer.  So if you do a good job and your client learns what they are doing ahead of time, they will stop seeing you because you’re a good teacher, and they think you’re pocketing the rest of the sessions.  WRONG.  The trainer just doesn’t get paid because he/she didn’t work the hours.  Additionally, most places make you do all the scheduling, so if you’re not working with a client, you’re playing scheduling whac-a-mole with all your clients times so that you aren’t working 12-15 hour days while sitting around for hours between clients.  If someone cancels repeatedly, you may or may not get paid for reserving that time slot.

Considering the fact that pay at employed training isn’t enough to make a living, many personal trainers end up having to “under the table” train, ie they squat at various gyms that did not hire them, stealing potential clients and not paying for the equipment they use.  Many gyms don’t think you’re training if you’re “working out with” the client–this is one of the stupidest policies I’ve ever seen in my life.  If an extremely fit guy is working out with someone not even at the same level, you think he’s doing it for free?  He’s just doing it out of the kind service of his heart?  You, as a gym, are ok with the liability of that?  Ok then!

This is also unfair to those who are employed legitimately at those gyms because these freelance trainers can charge what they want and not give half their gross to the employer (and a chunk to the government).  Some even only accept cash and then don’t report it on their taxes.  These trainers are taking business away from the gym.  Because it is the responsibility of management and not the other trainers to report “squatting” trainers (definition 3), they often get away with what they are doing.  Management has these policies to avoid confrontational events, but if management doesn’t enforce it, employed trainers just have to watch it happen and have to bite their tongue.

What makes this worse is so many of these barely qualified trainers do it as a hobby on the side and charge a fraction of the prices you must set if you need to make a living in the industry if you are a full-time trainer.  The amateurs are in a freelance, unregulated market, charging less against fully educated, real professionals.  These amateurs who do it as a hobby lack any experience or education.  Anyone can have a great body, but education makes you know the principles behind why it works and how to assess what other people need and teach other people what they are doing that is or isn’t working in a way that they will understand.  These trainers don’t know (or care in some cases) if their training style is healthy long-term.  Some trainers can be extremely enthusiastic but not know a thing about what they are really doing.

People often gravitate to what the cheapest trainer charges who looks good.  Well guess what?  You get what you pay for.  In many cases, this is eye candy.  Chances are the “ugly” or not overly muscle bound trainer knows what he/she is doing more if they are successful.

You might ask, then, what makes someone with a degree different than someone who just has the bare minimum?  The public thinks we’re here to just “give you a workout and tell you what to do,” and often doesn’t even take our profession seriously.  They think it is about leisure.

There are different techniques of training that yield different results.  Strength training is different from bodybuilding, which is different from endurance training.  Flexibility, agility, fat loss, muscle gain, and strength gain all are different training techniques.  Injuries require alternate techniques than uninjured people and have contraindicated exercises.  Diabetics need to know how exercise will affect their metabolism and how to deal with that.  Sometimes counseling techniques are needed to elicit behavior change.  It is impossible for any one trainer to be excellent at all styles of training, even with a degree, but the degree should give them an idea of where to start at  least.

A trainer with a degree in kinesiology will know a more comprehensive way of working out the body so as to not neglect underused muscles that get injured later on because the person didn’t strengthen the neglected muscles while progressing in their program.  The trainer with the degree thinks by anatomy and muscle actions, letting those needs dictate the training program than having a pre-made, one-size-fits-all workout of the day.  Speaking of generic workouts, many new and uneducated trainers think that you have to burn someone to the ground to train them.  This style only works with a certain population of well-fed individuals who want muscle gain who don’t want any specific training adaptations and are fine with not being able to use their affected body parts for days after.  This sort of training also carries a high risk of injury, such as rhabodomyolysis, which is when muscle cell integrity fails and spills contents (myoglobin) into the blood, which can cause acute kidney failure.

That’s not the point of training.  The point of training is to increase your lifetime functional capacity.  One of the most pointless adaptations is to be able to do something 10-15 times in the long term.  Where in life is this useful?  It’s currently a popular training style because people think that’s how many times you have to do each movement.  Granted, I do recommend somewhere in this range for beginners who are still learning movements and want lower risk of injury during the learning phase, but staying in this repetition range long term when you’re not an endurance athlete is nonspecific training.  The point is to get better at something.

Trainers who aren’t educated won’t know what energy systems and adaptations that produces other than it might make you socially look good for whatever body type is trending right now in the magazines and media.

In summary, the lack of education and low barrier to entry to credibility to the fitness field, the dilution of true professionals in the field, and the business structure of the freelance vs employed environment make the personal training industry a hot mess during an obesity crisis in the US.  Obesity is not fixed with physical activity yet people think it does, and registered dietitians are not even recognized as the key to weight loss on many health plans while the public thinks personal training is the way to do it.



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