Banish Boring Foods Post Gum Tissue Graft

In the summer of ‘18, I had a tissue graft procedure for some lower gum tissue.  This was a 90 minute procedure with Dr. Joseph Capps of the East Valley Implant and Periodontal Center.

As a clinical dietitian, I have provided recs related to soft foods for various reasons: missing teeth, sores in the mouth, difficulty chewing, or personal preference. However, I never had to actually follow any sort of soft and bland-ish diet. The foods had to be bland, since the gums were bloody and raw for a while.

After a tissue graft procedure on some of my gum tissue, along with a upper palate stent (skin was removed from the roof of my mouth to graft into the gum tissue), I was given food guidelines.  This was my prescribed diet: soft foods, nothing too hot, nothing spicy, and as tolerated.  I could not use straws, and other diet recommendations, such as no crunchy foods.

The gum tissue graft was recommended, since teeth with little gum tissue can become weak over time, which could potentially allow them to become loose. This is not due to poor hygiene, but a combination of having braces twice on the bottom teeth, genetics, and personal variability and the way our gums are.

NOTE: If individuals have this procedure, they should follow all recommendations from their medical provider. This was my experience and what worked for me.

Post Procedure Eats 

The first few days were rather painful, so even though I consumed smoothies and fro yo, I consumed a lot fewer kcal (Calories) than usual, since just opening the mouth, maneuvering liquids within, etc., was just too painful. I transitioned into better more interesting foods as the healing continued. For the first two – three days, really soft (mostly liquid) cool foods were the only things I could tolerate. Over the course of two weeks, I slowly was able to chew a bit but still kept it soft (tofu, soft beans, mash potatoes, etc).

Smoothies

Smoothies are an obvious, and I enjoyed smoothies. Since it took me a while to eat or drink, I created higher fat/protein smoothies to ensure adequate nutrients. A way to get in some easy blended vegetables: spinach, kale, and broccoli were favorites to add.  Adding an avocado provides a significant higher amount of kcal, with some excellent nutrients such as potassium and unsaturated fats.

smoothies

Soup

It’s over 100 degrees daily in Phoenix, so soup is not always my favorite option. However, carrot soup with interesting spices (nothing hot spicy) and coconut milk was a delicious choice. The soups were not hot when consumed. Hot foods are not recommended.

 

Potatoes

I used the Instant Pot to make quick baked potatoes, which then I created into mashed potatoes, using milk, butter, and though I do not always recommend this (because, it depends on the person’s current protein intake), I added two scoops unflavored protein powder.  However, this was super boring, so I only had the potatoes once.

Avocados

Energy and nutrient dense, avocados are a perfect soft food post surgery, maybe by day 3 or 4. They also were great to mix into smoothies, due to their creamy texture. Avocados are also cool and aren’t overly spicy or acidic.

Eggs

Scrambled eggs were an easy soft food to consume, and after my EGD and esophagus dilation (I was choking on numerous foods, including eggs back in May), I can now eat eggs again!  The eggs should be warm or cooled down with no spices. Even salt could irritate the healing gums.  Hard boiled eggs would be too challenging, until maybe week 2 or 3.

Yogurt

I made some plain yogurt in my Instant Pot the weekend before, so I can add my own flavorings and such. I used full fat milk. I now cannot stand most yogurts (except frozen or in smoothies), so I’m glad I liked this then.

Cashew Cheez

I just can’t get enough of varieties of cashew cheez. I love making different types and taste-testing which one is best. Recent ones I have made: basil pesto, rosemary and fennel, garlic / lemon.  I often receive boxes of Banza pasta, and I made cashew cheez to top the pasta, along with blending up broccoli and other vegetables, since consuming vegetables, even soft ones, was too painful.

basil

Other Post Graft Recommendations

  • For the week or two after, only light activity was recommended. Too much bouncing, etc. such as in a kickboxing class would cause pain. I was able to do yoga the next day, but even maybe five days after, I noticed my gums hurt when I stood up on a bike during spin class. So, I stuck to lower impact exercise for about 1.5 weeks. Some recommendations will vary.  I notice other medical facilities recommend no exercise for two weeks.
  • Pain medications – I just took OTC pain meds, as suggested by my doc.
  • Antibiotics to prevent infection. Since it was not just the gum graft on my front bottom teeth gums, but also the skin graft from the roof of my mouth, I had to take antibiotics to prevent infection.
  • Ice packs to prevent swelling.
  • No straws, candies, chewing gum.
  • Follow up appointments.
  • Prescription mouth wash: this was to ensure the area stayed clean, since brushing wasn’t possible, due to the stitches.

Challenges

The main challenge is the obvious – missing out on the crunchy foods I love: popcorn, crunchy vegetables, chewing gum (well not crunchy but has to be skipped). I did not mind not drinking alcohol, since it’s so rare anyway.

It was challenging to obtain adequate vitamin C, since citrus and other Vitamin C containing foods would cause pain in the gums.  Some workarounds: blended broccoli soup, and if a person can tolerate red, green, or yellow peppers (I can’t due to heartburn), those would be ok if made really soft. The first few days, I was in so much pain that just opening my mouth hurt. I had a hard time consuming anything at all.

Recommended Timing

Though I was told that talking would not be challenging, it actually was. So, I had my procedure as soon as I could but at least a week before I had all of these required meetings for my job.  Also, I wished I had my procedure later in the day. Since it hurt so much to consume any liquid or food for 1-3 days after, I should have had a huge breakfast and lunch, then had the procedure. I’d be somewhat less hungry later.

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What to Do / Where to Eat / Fun Workouts

There are four nutrition conferences coming up in the valley: ASPEN in March, the 35th Annual Sports, Cardiovascular, and Wellness Nutrition (SCAN) Symposium in April, Today’s Dietitian Spring Symposium in May, and the Arizona Academy of Nutrition and Dietetics (AZAND) Annual State Conference in June!

I never knew where to go when visiting other cities during conferences, so thought I’d write a post from my perspective – a dietitian who also loves to eat, exercise, and find fun things in new cities.

Check out Downtown!

I can’t say this enough! Many people just focus on Scottsdale when visiting; Scottsdale is overrated, and I am biased, having lived in downtown Phoenix for almost eight years and Scottsdale for a brief stint for about a year. I also lived in the east valley for almost two years, and currently am in Uptown Phoenix. Downtown Phoenix is welcoming to all, has unique events, and has a variety of events, restaurants, and more. I miss my walks in the Roosevelt Historic Neighborhood.

Downtown Phoenix has come a long way since I moved there in 2010, when it was just starting to emerge as a cool place.  There are numerous bars, restaurants, events, and really cool historical neighborhoods! Downtown Phoenix has a more casual vibe, versus Scottsdale spots. The Light Rail is an easy way to get around.

For the younger crowd (I’m almost 38!), Mill Avenue in Tempe has the best bars where collegiates spend their Thursday and Saturday nights.  Rula Bula is an old favorite there.

Favorite Places in Downtown Phoenix

The Original Angel’s Trumpet Ale House is a fun bar, with delicious interesting ciders, the BEST big pretzels, salads, and more. They have a lovely patio, perfect for the spring time weather. There is a second location in Arcadia off 44th St. I haven’t been to this one.

Bitter & Twisted is not only a bar, but they serve interesting foods, like sriracha popcorn! This is further downtown and has a chill classy vibe. Note: This place can get packed, and they won’t allow you to wait in the area near the door.

Pita Jungle has a location off 3rd Ave and Roosevelt, right near my previous apartment building! Pita Jungle has numerous locations across the valley. This is good for vegetarians and meat lovers both. They have delicious hummus, pita, and other unique Mediterranean dishes. It’s a casual spot, with good service and even better music.

Cibo Urban Pizzeria is in an old home, with a beautiful patio, and sometimes includes live music. I love all the food here but especially love the ambiance.

Lola is a fun hipster place for pastries, coffee, tea, and working on a laptop with really good music.

The Vig has locations in four spots in the valley. The one downtown – The Vig Fillmore –  has a cool patio for socializing. There is also The Vig Uptown, near 16th St and Bethany Home. There are locations in North Scottsdale and McCormick Ranch also. They have tasty brunch foods, delicious guac, and crisp fresh cocktails.

Matt’s Big Breakfast is as great as people say, with unique flavors and a local vibe. There are three other locations, including one in Terminal 4 at Sky Harbor Airport.  There is usually a line at the downtown location. I love the eggs, potatoes, and waffles.

The Phoenix Public Market Cafe has tasty dishes. I love the vegetable salad with interesting aioli sauces. This is also the site of the Saturday morning downtown Phoenix farmer’s market.

Valley Bar is a chill cool bar, and it’s a bit tough to find if you are new. It’s not right on Adams, but you go into the alley to get to the entrance. They have cocktails and snacks. This is where you can hear cool independent bands and sometimes local bands.  No Maroon 5 here! Beware: they will not allow Hydroflask or water bottles inside, and late Friday and Saturday nights can be a bit rowdy according to Valley Bar regulars.

The Crescent Ballroom off 2nd Ave and Van Buren is a slightly larger music venue with great music and other events, like trivia on Sunday nights.

The Van Buren is yet another concert venue which is slightly larger than Crescent and hosts bands that are popular and what is considered indie, along with other events. The drinks are not great, so I would recommend drinking at The Crescent, which is a couple blocks east before coming to The Van Buren.

Midtown and Uptown

SCAN Symposium attendees may not want to come all the way downtown, so here are some recommendations for Midtown and Uptown.

I’m not a fan of sushi but know many people are, and it’s close to the SCAN Symposium location: Wild Tunas.  My friend Iris has excellent taste, and she and her friends eat at Wild Tunas almost every New Years Eve. Her review provides some details.

Postino Wine Cafe! Not Postinos –  is a favorite wine bar with the most delicious bruschetta with unique toppings, like almond hummus and tomatoes, or brie and fig jam with apples. Postino offers super quick service, and a lovely patio at the Missouri location. There are locations all over! Today’s Dietitian attendees may want to visit the Postino location off Scottsdale Road and Highland.  The Postino off Central / near Missouri is near other Upward Projects eateries. Postino is my favorite, but I like Federal Pizza, Joyride, and Windsor also!  Note: Do not park in the neighborhoods near the restaurants; these neighborhoods have specific resident parking stickers.

Speaking of pizza, Phoenix and Scottsdale have a lot of delicious pizza restaurants (unless you’re from New York; I haven’t heard the end of it from NY friends!) Spinato’s Pizzeria has unique toppings, but the pizza sauce is better than others I’ve had. There are five locations, so all attendees from the various conferences could enjoy! This article provides more suggestions.

Seafood lovers will love Chula Seafood; there is also a small location in way south Scottsdale.

Verdura Plant-Based Eatery is a new spot for vegan and vegetarian food – and a huge plus – they have amazing music. I enjoyed a meal there on the day of the grand opening.  I heard Bjork, Bowie, and some other great tunes. The whole restaurant is music themed.

Another vegetarian/vegan place that serves veggie-based comfort food is Green New American Vegetarian. They have a location off 7th St (warning: Parking is a pain), and another location in Tempe. Both locations are closed on Sundays.

The cool place to be for hipsters, coffee lovers, and breakfast aficionados is Lux Central.  Lux also has a patio, where I have spent many times hanging out with friends, sipping on tea or coffee, enjoying Lux’s decadent desserts.

Beckett’s Table is technically in Arcadia, but a great choice. It is a trendy unique place with fancy comfort foods.  I love the grilled cheese, tomato soup, and the sangria!

Another Arcadia favorite (near 40th St and Campbell) is La Grande Orange Grocery & Pizzeria. Besides delicious pizza and salads, the homemade English muffins are just right. I buy a package every now and then. My hair stylist also says their iced tea is one of a kind and will go out of her way to pick some up prior to work.

True Food Kitchen has two locations in the valley: Camelback East (just east of Uptown Phoenix) and North Scottsdale at the Scottsdale Quarter.  True Food also has locations in California and Texas, and the menu includes delicious healthy eats. I love the Farmers Market Crudités, which includes chilled raw vegetables, tzatziki and black olive dips. If you’re with a large group, order 2-3 of these (the bowl includes a lot of ice, ha!)

Flower Child is not special to Phoenix; they have locations in other states. It has a variety of healthy eats, though rather pricey for what one gets. I love a lot of their meals, especially the pick three sides.The avocado hummus is creamy with a small amount of spice, delish!

This is nowhere near any of the conferences, but if you love pho, make the trek to Unphogettable, with locations in Mesa and Chandler (east valley). The Unphogettable locations are some of the only I have found that have vegetable-only broth. There may be some in the west valley (Glendale, Peoria), but I’m focusing on Central and North.

The good news? If you don’t have a chance to enjoy some of these places, Sky Harbor Airport has some of the local restaurants within Terminal 4!

Work It Out!

Some of my favorite local places include Urban Yoga (midtown Phoenix), Reformed Pilates (multiple locations), Sutra Yoga (several locations), Sweatshop on Central (uptown), and Blaksteel Fitness in Arcadia area.

  • Urban Yoga was my first true yoga studio experience, and I’m glad I started there.  The instructors are friendly, greet people, and take time to ask about previous yoga experience and injuries. Favorite instructors include Emily, Nancy, Tara, Becki, and Jenn. Tara and Becki (also listed as Rebecca and Bex R.) also teach at Sweatshop, and Jenn and Becki teaches at LifePower off the 101 and Shea.
  • I used to attend Sutra Yoga at the Roosevelt location (I miss living downtown!) I loved the barre and yoga classes.
  • Brooke is my favorite instructor at Reformed Pilates. Some Reformed Pilates studios also have cycle.
  • Sweatshop on Central employs so many of my favorite instructors. Yoga: Tara, Kandi, Bex. Barre: Alexa and Lisa. Cycle: Andi O, Lisa, and Tasha.
  • Take a class with BlakSteel’s owner Todd Shuler. You will be motivated the entire time! I also love Andi O’s bootcamp class Friday mornings (FHITT), Lisa’s barre classes, and Jennifer’s BodyBurn class on Sunday mornings.
  • I’ve enjoyed a couple classes at Hot Yoga Workout in Uptown Phoenix.
  • Blaksteel, Lifepower, Hot Yoga Workout, and Sweatshop are all on ClassPass! Click here for a deal from my account.

For Today’s Dietitian participants who stay further up north, there are some great options. Life Power Yoga (a Lifetime Club that includes only yoga, barre, and Alpha classes) is off the 101 and Shea and usually offer first class free. Check out Becki or Jenn Chiarelli’s classes!

We have chains such as CycleBar, CorePower Yoga, Lifetime Fitness (very few locations), Club Pilates, LA Fitness, Jabz Fitness, and more. I love CycleBar McCormick Ranch, which is off Indian Bend and Scottsdale Road; favorite teachers include Katie and Jillian.

If you already belong to LA Fitness, there are some excellent seasoned instructors at some of the locations. LA Fitness uptown – near 7th Ave and Camelback has great cycle classes with Natasha (Tasha) Mendoza (who also teaches at Sweatshop on Central).  The LA Fitness off 32nd St and Camelback features cycle classes with Carolyn Paulson, whose classes fill up and people fight over bikes (really!) She is one of the best cycling instructors!

Hiking

For a tough up hill climb, check out Piewesta Peak. There are several nice options here. The main one is like climbing up stairs constantly, but the reward includes beautiful views and a nice cardiovascular workout. This is very challenging and offers lovely views.  This is more north Central Phoenix. Parking can be a huge pain.

For a North Scottsdale spot, I love Lost Dog Wash. It’s very easy, but there is ample parking, lovely views, and it’s not crowded. Plus, there are real restrooms, friendly staff, and people who watch out for each other.

Note: This does happen – there are rattlesnakes on the trails at times. Most hikers will warn you. I have had a few friends who have spotted them, based on the warning rattles. Do not wear headphones, so you can any warning signs!

I don’t hike as much as others, but here are some recs.

Camelback Mountain

North Mountain and Shaw Butte (close to SCAN)

Walking and Running

Many neighborhoods are safe in the valley; some are not, though.

If you are staying closer to downtown Phoenix, there are many homeless individuals, just like many other large cities. I have never had any issues, but it’s important to note that. Near Hance Park, there have been times where there are drug issues.

If you are you further north (way north Scottsdale or Anthem), Javelina may make an appearance. I have only seen them early in the morning, before the sun has risen. They can be violent towards small pets and sometimes to humans, especially if they have babies.

People enjoy running the canals and near Granada Park (north Central).

Shopping

Scottsdale Fashion Square is an amazingly huge mall, with designers and normal stores (affordable!) They recently remodeled, so there are more skylights making it more appealing.

Kierland Commons and Scottsdale Quarter include some great shops, along with being able to walk outside in between stores.

Old Town Scottsdale has more of the tourist-type shops, including art, jewelry, and southwest related items.

The Biltmore Shopping Center is ok. It does have True Food, the delicious restaurant described above.

Running on Rice Cakes

Running on Rice Cakes

Sports nutrition is a science. Not only is it a science, but also requires practice, timing and planning. The hardest part is figuring out what works for each individual.  One can study and practice it for years, yet it is still important to do what works for the sport, the individual, and the climate.

I earned a master of science in Exercise and Sports Nutrition, which included my registered dietitian (RD) internship, coursework, and sports nutrition practicums.  and my PhD was in Physical Activity, Nutrition, and Wellness (which now has a new name of Exercise and Nutritional Sciences). With all of that information, it still requires some trial & error, patience, and timing, and I still am experimenting!

All of these practices for Seawheeze were verified, when I attended a talk at the Food & Nutrition Conference & Expo (FNCE) 2017 in Chicago. The speakers indicated that low fiber, low FODMAPs, and other practices were the way to go to prevent GI issues. Still, with the jostling of intestines, there’s no 100% sure way to prevent GI distress.

Carbohydrates Are Not Evil

Contrary to whatever nonsense people state, carbohydrates are not “bad.”  Carbohydrate is the nutrient found in many plant-based foods, dairy, grains, and more. So, fruit and vegetables contain carbs.  Carbs of any type eventually end up as glucose in the blood, which provides our cells and muscles energy. Extra glucose is stored as glycogen, which benefits us during short times of fasting, such as sleep time or during exercise.

This is What Worked for Me – This Does not Work for Everyone

The Seawheeze Half Marathon was on Saturday August 12, 2017.  This is my second half marathon, and I have also completed five 10Ks, one 5K, and one 15K.  Right after some of the longer races I experienced severe GI cramping. This time I ate lightly the night before and did not experience stomach issues. This is likely due to the jostling of the intestines and also how blood is used in the muscles during exercise. However, I wanted to be extra careful for this run, especially since I wanted to enjoy the rest of my day in Vancouver.

Supplements During Seawheeze

Seawheeze’s web site indicated that they would supply Nuun, Gu, water, and fresh fruit at hydration stations.  Nuun tablets dissolve in water. I prefer Gatorade, as it provides adequate sodium and adequate carb (but not too much) during runs.  I did not want to carry a bottle of Gatorade so got used to Nuun instead.   Gu is a sticky thick syrup-y type gel that provides carbohydrates, but I knew I disliked Gu so brought my own during-run snack.

Each Nuun tablet contains:

  • sodium: 360 mg
  • potassium: 100 mg
  • magnesium: 25 mg
  • calcium: 13 mg
  • vitamin c: 38 mg
  • 10 calories
  • 1 g of sugar

This was to be mixed into 16oz of water.  So, during the run, I probably had about three 6oz cups of Nuun.

This is according to the Nuun nutrition site. 

Gatorade is my preferred beverage during races. I prefer Gatorade, since it has just the right percentage of carbohydrates ratio. I also like the research information Gatorade provides on their site.

Pre Competition

The day before the race was a very high carbohydrate, low fat, moderate protein, low sugar, low caffeine day.  Fiber benefits us for many reasons, but right before a race, that excessive fiber can produce gas, bloating, and discomfort. Usually, the day before was no big deal, but I was being extra careful this time.  Fat slows down GI transit and can make one feel ill if consumed right before a run.

I chose the Quaker brand rice cakes. They have a delicious light crunch, and the salt is needed due to the salt lost during sweating.   Whole Foods sells other rice cakes, but they are more dense and not as crunchy.

My meals on Friday included

FullSizeRender-3.jpg

Breakfast:

  • crepe
  • 2 eggs
  • before my walk: 2 rice cakes

The breakfast was at the delicious Cafe Crepe – This was the only meal I consumed a bit of extra sugar and fat – the Nutella on the crepe.

Lunch:

  • 3 rice cakes (lightly salted)
  • Peanut butter
  • Greek yogurt with fruit
  • The most delicious Canadian blueberries

FullSizeRender-4.jpg

Snack:

  • 3 rice cakes
  • Peanut butter
  • Yogurt

Dinner:

  • White rice (about 1.5-2 cups)
  • 2 eggs
  • Snack:
  • 2 small containers applesauce
  • + tons of water and Nuun 

IMG_4066

This day of eating was boring, and I was sad I was in a new city and unable to consume much food. However, to prevent GI issues, I was excited to see if this would work.

Why Low Fiber?

This day still had fiber, just not as much as normal. Fiber was found in the applesauce, blueberries, and small amounts in the rice cakes.

Fiber in foods is so beneficial for our health.  Fiber helps our gastrointestinal tract, certain fibers are related to benefits to heart health and diabetes, and it helps us stay fuller longer.  Fiber also slows gastric emptying.  On any other day, this fact is OK. But, before or during a race, I did not want any additional issues while running!

Some runners / athletes can consume loads of fiber before or during a race and have no issues.  Again, sports nutrition takes practice and is individualized.

Day Of

The half marathon started at 7 am. I woke at 4 am to consume some food.

Breakfast day of:

  • 3 rice cakes
  • 1 Tbsp peanut butter (*Note, for some, this may too much fat, but I have consumed peanut butter before most races and it helps with hunger too)
  • water and Nuun

During Race

From prior research, the information for the half marathon indicated that the hydration stations would include Gu, Nuun, water, and fresh fruit.  I tried Gu in 2006 and other times, and almost immediately feel nauseated after consumption. I recall a former colleague stating, “well I would still eat Gu, even if I hate it, since I know how helpful it is.”  Well, I would rather not be sick to my stomach throughout a run, so I brought my own high carbohydrate easily digested similar sport product: Jelly Belly Sport Beans

I like the lemon lime Jelly Belly sport beans, since they provide a small amount of simple carbohydrate per bean, contain no fiber, are easy to eat while running, and are tart.  In the past, I liked snacking on Clif Bloks. However, they are so chewy, I worried about my dental health.

Post Race

Due to previous gastrointestinal issues with eating well, I read others’ experiences to see what others had done regarding this. I am well aware this is not a scientific process, but I wanted to try anyway.   My pre run day was carefully planned with low fiber, low caffeine, low fat, low sugar, high carbohydrate, and moderate protein, with lots of water and Nuun.

After the race, the Vega brand volunteers handed out some protein bars. This was nice, since the brunch line took about 45 minutes.  I also was impressed, since some people are sensitive to whey protein and/or dairy. The Vega brand bars use pea protein and do not have any whey or dairy products in them.   I was not hungry and decided to wait a bit and hydrate for a while. Most runners could easily consume food right after, but due to my issues in the past, I waited about 90 minutes to eat.

The Bearfoot Bistro volunteers handed out boxed brunches for runners. I thought they did a great job with this meal.

IMG_4031.JPG

The note on the box has a message about why each food was included.

I would agree with everything, though banana bread does not directly provide glycogen from bread itself.   Rather, the carbohydrates that end up as glucose in the blood can later be stored as glycogen in the muscle and liver.

The overnight oatmeal yogurt parfait was my favorite part of the meal; it was tart but just enough sweet to enjoy eating.

 

References

Clark, N.  (2017)  Blog. Carbohydrates? Yes? No? Friend? Foe?  Accessed June 30, 2017 at http://blog.nancyclarkrd.com/2017/01/12/carbohydrates-yes-no-friend-foe/

Clark, N.  (2015). SportsNutrition Guidebook.

Gatorade Sports Science Institute (GSSI). 2017. Retrieved at http://www.gssiweb.org/en/sports-science-exchange/all/sports-nutrition

Gu.  (2017). GU Energy Labs.  Accessed August 25, 2017.   https://guenergy.com/

Jelly Belly Candy Company.  (2017).  Accessed August 25, 2017 at https://www.jellybelly.com/sport-beans-jelly-beans-lemon-lime-6-count-pack/p/92593

Disclaimer: All information in the blog posts are meant for educational and informational purposes only. None of the posts are meant to provide or replace any sort of medical or nutrition advice.  Please seek advice from your medical provider, if needed. I am not paid or endorsed by any companies represented in the blog posts. The views in these blog posts are based on my opinions, research, and knowledge. No information may be reproduced or copied, without my permission.

 

What the Health Documentary Review

As I watched the seemingly popular What the Health documentary on Netflix, I became more and more irritated.  The information is often incorrect, and the shock*umentary aspects were a bit too much.

I am a RD with two graduate degrees in nutrition and exercise, and have worked with a variety of patients and clients over the last 11 years, ranging from healthy active adults who just want some basic advice to critically ill patients with numerous chronic diseases.  I do agree with the importance of a plant-based diet, but oddly, the speakers did not focus specifically on fiber, and also never mentioned physical activity except in one small segment.

Major missing links
The man who made this is not an expert in health or nutrition, and I guess is supposed to be cool in his old VW van to promote, well, I don’t know.

There is a tiny mention of registered dietitians (RDs) with a quick photo of a hospital, then it goes into how the Academy of Nutrition and Dietetics has info from the food industries and receives money from them. Well, not every RD uses these nor agrees with these. RDs do not have to be a part of AND. Even if RDs are part of AND, maybe it is for the benefits of the local level or DPGs. Though the AND may accept money from various companies, that does not benefit RDs. RDs can review research and find information to determine if it’s appropriate for a specific client or patient. Also, hospital dietitians are a tiny fraction of the variety of RD jobs out there.

Some of the MDs on this documentary are making more money now, since they wrote books, which people are likely purchasing after watching this documentary. So that’s kinda hypocritical. There are segments about why don’t MDs provide nutrition advice? We could also ask:

  • why can’t MDs do physical therapy during that same 10 minute appointment?
  • Why can’t MDs also be social workers?
  • Why can’t MDs assess swallow function and provide speech therapy?
  • Why can’t MDs create TPNs?
  • Why can’t MDs provide appropriate mental health counseling?
  • Why can’t MDs provide therapy for a person after a stroke or with disabilities?

Why not? Because medical issues require a team of experts in their own field. Nutrition information is not just a 3 minute conversation. Rather, a RD will tailor information to the patient/client depending on the situation and issues at hand. It is not just a quick hand off of a copy of a 1995 meal plan.

Rather, they feature a person who has a PhD in something else (not nutrition) who got her cert (yes, certification, not a degree) called a Certificate of Holistic Nutrition. I looked this up. This requires six classes. SIX?! It takes about four months. That’s all, and then people can go give people nutrition advice? Dietitians complete much much more than SIX courses. In fact, six classes does not even cover the required science courses we need. RDs complete a BS, a supervised internship, take an exam, and constantly complete continuing education, similar to any other healthcare provider. Continuing education is an absolute must, as it is important to stay up on science.

Did not discuss the role of physical activity in helping prevention of disease.

Did not discuss the role of numerous other risk factors in disease. The cause of diabetes includes numerous things, also including lack of physical activity.

Not all doctors prescribe meds first. Many of my healthcare providers discuss other treatments and never discuss nutrition. In fact, some of my providers can refer patients to RDs (though do people actually go? Often not, but instead use Dr. Google).

The American Diabetes Association doesn’t recommend a specific diet? Why not? Aren’t vegan diets the best? This documentary man found one study to state this. Here is why:

  • Not everyone wants to follow a vegan diet. Even when presented with facts, do people believe them and magically change? Likely not.
  • That was one or two studies. Where are the other studies related to diabetes?
  • What about other types of treatment… Exercise is a huge part of prevention and treatment.

The customer service representatives who answers phones are not going to know every specific detail on their web site. However, the guy in the video made it seem like the organizations had no idea.  Think about this, when you call your medical provider’s office, does the doctor, dentist, PA, NP, ND, answer the phone directly and is immediately available to answer every question?  No, of course not.

Lots of testimonials. Testimonials are very emotional and work to convince people of something, in many ways. They are not evidenced-based or research. One person claimed the diet cured her cancer. Maybe it benefited, but at this time, there is no specific diet that cures cancer.

Did not discuss the bacteria also found in plant-based foods. This does happen.

Motivation to Change
Do people automatically change when presented with facts? Not always! This is why the diet industry is a huge industry that makes loads of money.
Have you ever tried to change? was it easy? Likely not. So try to discuss a diet change for an individual who has been following whatever diet for his/her entire life. Even with direct facts and studies, not everyone wishes to change.

When recommending a registered dietitian (RD), very few of the people actually make that call or appointment to spend money on true nutrition advice, tailored to their personal goals. Yet, there are no issues spending money on temporary things that have no future effects (ie nails, hair, clothing, trinkets, etc). Nutrition advice can be utilized for one’s health, which is related to our quality of life.

Protein
I agree that plant-based proteins are excellent sources of protein PLUS have a good amount of fiber. However….

  • Grains are loaded with protein? Loaded? There are maybe 3-5 grams per serving. The example provided is white rice. White rice is tasty and great with Thai stir fry, but not a whole grain.
  • Vegetables are loaded with protein? Loaded? Maybe 3-4 grams per serving.
  • Yes, many plant based foods contain protein, such as beans, nuts, seeds, and more. Yes, carefully planned vegan meals can contain adequate protein with the appropriate amino acids.
  • Just because this one MD states he never has seen a patient with a protein deficiency, guess what? They do exist. This one fact is not sufficient to make it seem like no one has a protein deficiency. Yes, rare, but it can happen. I wonder if this MD has worked with individuals who are very low income and/or homeless.

Yes – any diet does work if a person follows it. Here’s the thing: when people go super restrictive, maybe that works for 2-3 weeks, maybe 2-3 months. Then, often times, individuals binge or stress out like crazy because they feel so restrictive.

Maybe the main MD of the ADA is not a nutrition expert and did not have time to review every study before speaking to the documentary speaker. Do lawyers automatically have a client’s case ready to go before knowing anything about it? Likely not. People have to prepare to have information ready.

He is correct; the data do not exist on a perfect diet. The man in the documentary provided one diet study and wanted information ASAP.

Why did many of these people not want to be filmed? Yes, the man in the film made it seem like they were covering something. Perhaps. But also, cherry picking data with a few clips likely edited while attacking the organizations does not show the whole picture.

Nutrition is a young science.

Agree on these things

  • Plant-based foods are healthy and many studies indicate this benefits us.
    I can understand the frustration of the patients in the documentary who were told that they must take a lot of meds. I am curious, ten years after this was filmed, are the people who went vegan still following this strict dietary plan?
  • Farm raised fish are generally not that healthy.
  • Yes, some meats are correlated with numerous chronic diseases, such as cancer and CVD, specifically overly processed meats, like lunch meats.
  • Yes, the food industry has a ton of money and advertises towards children.
  • Yes, the government has some food recommendations not necessarily created by registered dietitians and often based on funding.
  • Many people eat junk food; is this new information?
  • Yes, many insurance plans focus on treatment versus prevention. This is unfortunate.
  • Yes, the food industry could use some higher quality standards, but plant-based foods are all the time being recalled for salmonella, etc. It is not just meat and dairy.
  • Yes, the factory farming practices are cruel.
  • Paleo diets are not the best diets, but some people are making it OK with numerous plant-based foods too, so just stating all paleo is horrible, depends on how the person makes his/her diet plans.  That said, Paleo leaves out whole grains, which is not health, as whole grains have numerous B vitamins, fiber, and are delicious!

The documentary used emotionally-based and number based data I learned about in a state AzAND legislative day workshop (the speaker discussed importance of speaking about facts with comparisons, say like planes crashing to specifically indicate numbers). However, this was a bit much. But, I’m sure it influenced people.

The bottom line: Just because it is a documentary does not make it true! Yes, there were studies mentioned; however, the host of the documentary often misinterpreted some of the data, or cherry-picked info and skewed it.  Consuming more fruit, vegetables, legumes, seeds, and nuts is a great idea.