I thought I’d write about something that happened with my friend recently. Yes, I’m writing about my friend again… she inspires me, what can I say? She’s been my best friend for years. She’s a pastry chef, likes long walks on the beach, and owns a dog named Jax. Just kidding (lol).

My best friend has been struggling with being underweight her whole life. Since I started studying nutrition in college, I’ve always tried to sort of use her as my test subject and provide her nutrition advice (for free). Pretty lucky she landed a dietitian as a best friend, huh? Well, think again. Seems like anytime I give her nutrition advice, it goes in one ear and out the other. However, when he not-so-qualified boyfriend, coworker, or family member gives her nutrition advice, she actually considers it… what the heck?

It was super frustrating for me to hear all the nutrition advice they are giving her and her not listening to me. I’ll give you some background about what is happening and why she should NOT be listening to anybody except her qualified registered DIETITIAN best friend (or another dietitian that is).

So like I said, she’s been underweight her whole life. While it’s not her intention, food has always been a struggle. She can’t eat enough food to be a healthy weight. We’ve tried different things together but nothing worked and she gives up and stays underweight. However , recently, she wanted to take it seriously because her and her serious boyfriend have been talking about kids in the future. She is well aware that in her current state she’d be unlikely to get pregnant or if she did, have a healthy non-complicated pregnancy. This was the first time she really asked for a solid nutrition plan to get her weight up. When we started doing this, she was already experiencing a whole host of GI symptoms that have made it even more difficult to eat and gain weight. They got BAD. So I suggested she go in to see a GI doctor.

During this time her boyfriend was giving her all this random advice or suggestions… he was CONVINCED she had celiac disease (auto-immune disease where you can’t gluten because you’ll have an immune response to it) and I was convinced that she did NOT. She didn’t really believe me… I mean I’m just her LICENSED dietitian friend right?

So, she eliminated gluten…..

She also got a food allergy and sensitivity test and said she was sensitive/intolerant to LARGE amount of foods. I tried to explain to her that these test are HIGHLY inaccurate and typically they find a lot of false positives (more on this another time). I told her not to eliminate them, we just need to get weight on her. Well, another not-so-qualified somebody in her life suggested she listen to this test. She said to me, “I’m sure a lot of the 1 Stars were false, but I feel like the 3+ starts are real” and started eliminating a whole host of foods despite me advice…

I was furious. Why wasn’t my friend listening to me??? Her diet started to become smaller and smaller in terms of variety. I was getting worried. Why didn’t anybody realize giving her this advice was dangerous? She is already struggling with a whole host of issues and pretty malnourished, and now people thought giving her information to eliminate types of foods was going to work? NO.

She went to a GI doctor and the told her to start eating gluten again so that they could test for celiac. You need to be eating gluten and show the antibodies in your blood (signs that your body is fighting off gluten and having an immune response. She did, got it tested, and waited for the results. Her doctor (well actually, the doctor’s nurse) called her back and told her that she does not have celiac disease but did not give her any advice on what to do next. Does she make another appointment? Does she put gluten back in? Does she schedule a colonoscopy? Nothing. So she went back to eliminating gluten because she said it made her stomach feel better.

One day I snapped on her, when she texted me asking “does oatmeal have bran?”

• Me: Why are you asking that?
• Friend: My stomach has been ***** up the past 3 days, and today I realized it was from the overnight oats I’ve been eating every morning for 3 days.
• Me: I don’t think that’s what you’re getting all the stomach symptoms
• Friend: On my allergy sensitivity sheet Bran was listed as a high sensitivity
• Me: They need to do more testing. As I said to you before, allergy test give you a lot of false positives, especially if you are eating that food regularly. It will say you have an allergy. I don’t want to go if to eliminate all these foods etc and have nobody helping guide you about what to eliminate and how to add it back in etc. I truly do not believe this is a true sensitivity, I think there is something else going on. I just don’t want you to become deficient in other nutrients, that’s why I really need you to follow up with me or somebody who is specialized in nutrition not a doctor or somebody else!!
• Friend: You’ve got a lot going on right now, so I don’t want to add more to your plate. I’m sure the dr will suggest an EDG, and if he doesn’t, I’ll ask for one.
• Me: Girl I really don’t mind helping. I’m really just super concerned, because you’re limiting all these foods and we are trying to get you to gain weight and that’s just going to make things harder. And i don’t truly think you should be limiting all these foods, so it just worries me. We can find around way to make it easier for you to do it too that fits your life more. We can brainstorm
• Friend: Idk why it’s happening out of now where now tho. It’s only been this bad for a few months now, except for the dairy. Dairy has been longer and was the first thing
• Me: Yeah because I think something else is going on. It is very random, that’s why I don’t think it’s these foods and you need to get tested
• Friend: BOYFRIEND (not sharing his name) wants me to start the Specific Carbohydrate Diet, but I’m scared that will make me lose weight He said it restarts your gut. Cleans it out
• Me: NO DON’T DO THAT DUDE
• Friend: It’s hard because everyone is telling me to do different things
• Me: But I told you, everybody is an expert on nutrition but nobody actually knows nutrition. If I find you a dietitian for allergies and food sensitives that is covered by insurance will you go to them. I’m just really worried about you getting nutrition advice from people who don’t fully have a background in nutrition, especially when you’re already at such a low weight. It’s very concerning to me and I need you to be working with somebody regarding nutrition who can give you scientifically backed info and work with the GI doctor
• Friend: I could call my GI and see if they have a nutritionist they work with.
• Me: No I know people. I’ll find somebody… Somebody I trust and know who does good work

I found her a dietitian and she started getting her appointment set up.

Why was I so upset about this? Well, I think its very important that people don’t just try any nutrition advice they here from most people. I don’t think they should be listening to their boyfriends, their family, or even MOST doctors (yes, I said it), as they are not qualified or educated properly on nutrition. There is A LOT of false information put online and people follow this blindly. People are easily influenced by hearing from other rarely second guessing this advice given to them.

In my friends case, it was extremely important that she sees a dietitian vs. eliminating all these foods or listening to others people recommendations as it could be causing her more harm than good especially since she is already at a concerning weight. I know that those people giving her advice have good intentions, but people truly don’t understand the danger in giving nutrition advice to people. Even doctors can’t be trusted with nutrition advice even when you think they can. Maybe other cases may not be as critical as my friend, but it could start off as harmless advice that could lead to something critical. There is evidence that kids who have had their diets limited by food allergies can be susceptible to poor growth and nutrient deficiencies—restricting a child’s diet due to suspected intolerances or sensitivities could have the same effect. In extreme cases, it can lead to malnutrition.

More commonly, it can contribute to an unhealthy relationship with food. Altering eating patterns can increase risk of developing eating disorders. But even without a “diagnose-able eating disorder,” it still could lead to disordered eating patterns. When I looked around for dietitians for my friend, I said to her potential dietitian at the time….

“I have a friend who is having tons of GI problems and working with the GI doc. She’s pretty underweight and trying to gain weight, but with all the GI symptoms, it’s really hard with her to eat enough. I’m really really really cautious about who she sees because I don’t want her excluding a *** ton of foods that she doesn’t need to and then creating this unhealthy relationship with food. And everybody keeps telling her to remove all these things and she listens because she doesn’t have anybody else giving her sound advice. I’m really really cautious about her relationship with food but I’m her best friend so she has a hard time listening to what I say about how dumb it is to just exclude everything without means of putting it back in. Especially because she wants to gain weight. She needs to get it figured out first so she can eat more. I want her with a dietitian I trust to make sure they don’t wreck havoc on her relationship with food.”

You can see I was concerned about her relationship with food. I work with so many individuals that struggle with eating disorders. I can’t even keep track of how many times an eating disorder started as a diet. I mean, it isn’t surprising,

Dieting is the leading risk factor in the development of eating disorders.

No this wasn’t a traditional “lose weight” diet, but it was still an alteration in her food choices (a drastic one) that could cause her to become scared of these other foods.

Her mom texted me concerned as well saying “I am VERY concerned about her weight, AND how now she thinks that there’s nearly NOTHING that she can eat. That’s bad. Very bad. I am very upset about her obsession with her “symptoms” I’m not saying that they aren’t real. But, she has to put calories on and quick. Thank you for advising her to do that. I’m scared for her.”

You see… There is a reason we were so concerned. We know the dangers of eating disorders. I see it every day, how it robs people of their life and happiness. They become fixated. They pursuit of being healthy totally backfires. Even if it doesn’t go as far as an eating disorder, it still causes harm. She shouldn’t be listening to just anybody.

So who should you listen to?

Registered Dietitians (RD)!!

Not your doctor, not your friend, not your personal trainer (yes, I said it), not your family member, or dr. google as my supervisor, Jill Sechi, MS, RD, LD, CEDRD likes to call it. UNLESS THEY ARE DIETITIANS. And remember you always want to see a registered DIETITIAN… NOT a nutritionist… Nutritionist has no legal definition. I’ll include some information about why below.

• Registered Dietitian – After earning a bachelor’s degree at an accredited university, dietitians typically complete an internship or practice program at a health care facility, food service company, hospital, or other organization. They are required to complete 1200 supervised practice hours. Upon completion, students can sit for their national examination; once they pass, they are free to practice as an R.D, or registered dietitian. They are also expected to maintain this license by staying up to date on recent nutrition guidelines though continuing education credits.
• Nutritionist – In the US, the title “nutritionist” is not as regulated as “dietitian,” and tends to have a broader, more general meaning. The title is not generally protected, meaning that it can be used by anyone, unlike “doctor”, for instance, which requires proof of qualifications. Nutritionists typically do not have any professional training, and therefore, should not be involved in the diagnosis and treatment of any diseases.
• But wait, why not doctors? The problem starts with medical school. In a 2015 survey, medical students reported only receiving on average of 19 hours of nutrition education over four years of instruction [1]. They are heavily educated on the human body and the body systems, but not specifically specialized on nutrition. Also, our healthcare system is set up so physicians don’t have time to sit down and understand your nutritional needs. If they get 5 minutes to talk nutrition, that’s a lot. In this timeframe, they say things such as “stay away from saturated fat” or “eat more fiber.” They don’t have the time to sit down and truly understand your dietary needs and make recommendations based on the latest nutrition research. It’s one thing to know something, but it’s another thing to sit down for a longer period of time with the focus on nutrition and look at the client as a whole in order to make a realistic plan. This takes time, not a 10 minute session and a meal plan handout…
• What about your friend? Especially the friend who might seem like they know what they are talking about. For instance, my best friend’s boyfriend, who struggles with Crohn’s disease. Yes, he’s had a lot of nutrition changes that have been beneficial for HIS SPECIFIC CONDITION. what he has learned about nutrition is VERY VERY unique situation to him. His condition is even VERY VERY uniquely treated disorder itself, and then even other people with Crohn’s is unique when compared to each other.

Yes, this includes the “instagram famous fitness influencer” who has a one might see as the “ideal body” and posting before and after pictures saying, “if you follow this diet, you can look like this too.” But do an experiment for me. Compare people who don’t have credentials on instagram and the information they are saying vs. the info that credentialed people are posting. You’ll see how the non-credentialed people information widely varies and those with proper nutrition credentials typically give the same backed-by-science information and do not focus on testimonials and before and after pictures.

My hope is one day people will stay within their scope of practice! I’m mean… I’m not trying to be mean. you wouldn’t let a dietitian perform surgery on you, right?

Scope of practice – services that a qualified health professional is deemed competent to perform, and permitted to undertake. Which essentially means providing information they have the credentials for.

For example…

• Surgeon for surgery
• Dentist for teeth stuff
• Registered Dietitian for nutrition support

NOT…..

Your friend, coworker, instagram model for nutrition support

(unless they are also a dietitian like me)

As Registered Dietitians, we are trained to listen, understand struggles and help you work through difficulties and challenges with nutrition.

Interested in how the situation with my friend turned out? Here’s some indication..

• Friend: “She said the same thing you did about the elimination diet,.. it’s not best to do and thinks I’m malnourished, wants to work on calming stress & anxiety”

WHO WOULD OF THOUGHT….???

References:

1. Kelly M. Adams, W. Scott Butsch, and Martin Kohlmeier, “The State of Nutrition Education at US Medical Schools,” Journal of Biomedical Education, vol. 2015, Article ID 357627, 7 pages, 2015. https://doi.org/10.1155/2015/357627.