“What’s Wrong with the U.S. Dietary Guidelines?” & Other Nutrition & Weight Loss Qs Answered by Adele Hite, RD, MPH
A few weeks ago, I had the privilege of interviewing Adele Hite, RD, MPH and PhD-in-training at the UNC Gillings School of Public Health. I contacted Adele after watching her speak at the 2010 Dietary Guidelines Press Conference. I found her speech so simple to comprehend — and yet so full of wisdom and inspiring — that I simply had to hear more. The interview that ensues is just me picking her brain for ways to fix our broken food and healthcare systems (yeah, it’s a huge undertaking!). She also shares insight on the nutrition degree options, how to pick a good program, her own personal health and weight loss journey, legit resources for health and nutrition, and tips to go about hacking what Adele calls the “scientific industrial food complex.”
The real problem, in Adele’s opinion, is the skewed dietary guidelines, which only propagate myths (Yeah, I too was shocked to hear that saturated fats can be good for you(!) about a year ago). Despite years of trying to follow the US dietary guidelines, Americans have seen obesity and lifestyle diseases like diabetes and heart disease increase as never before … Something is terribly wrong, and we can’t stay quiet much longer. My friends, I introduce to you the passionate Adele Hite:
And the second part:
An Interview with Nutrition Student and PhD Candidate Adele Hite, RD MPH
On getting a nutrition degree …
1. What’s the best route to take for someone interested in dispensing nutrition information?
First of all, I think it’s terrific that you want to get involved — right now it seems like a lot of people kicking away at this problem on their own. It’s important to find a way to collaborate and join forces. The route you will want to take will depend on what you want to do. If you want to write books, you can do that now. If want to publish online on blogs, it will depend on state regulations how much ‘advice’ you can give, even for free. Take a look at state licenses and requirements; once you figure out what those are, you have some choices. There are a number of certifications out there besides the traditional RD route; you can get a clinical nutritionist certification or a nutritional specialist certification. You have to have a Master’s degree or a PhD to apply for these certifications, so they’re quite rigorous. There are also interning hours you’ll have to complete. I like these certifications because they’re associated with the American College of Nutrition, an organization that has recently passed a resolution stating they will not take funding from industry, and that the Academy of Nutrition and Dietetics (AND) would do well to follow suit.
There are other options as well – you can be a nutritional therapist or a health coach. But if you want people to take you seriously, you have to get established credentials. At the same time, getting established credentials means you have to slog through the established curriculum. That could be painful but it can also be very illuminating. I didn’t know the system was so broken until I got involved in the system myself.
I had a wonderful mentor through this, Pam Schoenfeld, co-founder of the Healthy Nation Coalition. She contacted me while I was still working at the Duke Clinic. She has been sort of going “You’ll be okay Adele; you’ll live through it”, which has been a big support for me! And now her daughter [Laura has a great paleo-focused blog called Ancestralize Me], is here at UNC in my program. We all just try to support each other, even if we have different views about how much of the message we want to pass along. It all depends on how controversial you’re willing to be — I’ve gotten some heat for my perspectives on nutrition … but that’s okay since I’m still a student!
2. What is the most ‘valid’ real food, science-based nutrition program out there?
The certified nutrition specialist is the up-and-coming one. I think that’s what people are going to start turning to instead of the Registered Dietitian (RD) degree. Part of the reason for its popularity is that it requires a higher degree of education — you have to have a Master’s or PhD. To be an RD, you can just have a bachelor’s, so it’s not as rigorous in training. I have a friend who actually set up a program at the NY Chiropractic College and we talked about it a good deal. If I had to do it all over again, that’s the kind of program I’d want. It’s teaching you how to understand what’s going on with the person in terms of lab values and lifestyle and really personalizes nutrition. Best of all, it’s free of a lot of the dogma that you get when you go through AND.
However, it’s important to note that those who are certified nutrition specialists or health coaches and are not certified by the AND can be asked to stop practicing nutrition if the state in which they reside passes a law stating that one needs an RD degree to practice. This is important to some degree because we don’t want people who don’t know anything about nutrition advertising themselves as nutritionists. But at the same time, as with doctors who can be an MD or a DO, there is more than one way to be certified as a professional in nutrition. Just because the AND doesn’t want to recognize this just yet doesn’t mean it’s not so. If you got one of those certifications, it would be worth fighting for, now wouldn’t it?
3. If everyone who wants to practice nutrition has to get an RD degree, is there a program that you recommend?
I would recommend my program at UNC, and for good reason. I recommended it to Pam’s daughter – she wouldn’t want her daughter to go through a program where Laura’s opportunities to learn and inquire are squashed at every turn. That is not the way that UNC operates at all. I imagine that there are similarly good programs out there, but I don’t know them. However, I can give you some tips on figuring out how to go about selecting a program:
- Find out who is the director of program
- Learn about his or her educational background
- If they have lot of research done in areas that are well-established in the field but that we know to be erroneous, this is a red flag — is it all whole grains and fiber? Is the focus on polyunsaturated fats? I’m making sweeping generalizations, but there is a possibility that that program would be less open to questioning that standard way of thinking.
- Look at the faculty members’ backgrounds since they are going to be giving the instruction, and you want to ask the same question: are these people really invested in the status quo, and for what reasons?
- Find out if in that department of nutrition, there is a five-hundred-pound gorilla who is the big name in that department who gets all the funding, who writes all the books, and who has his or her name on 800 different articles every month. If so, there’s a good chance that this person is likely inflexible and embedded in the status quo.
Again, these indications wouldn’t necessarily mean that the program itself will be inflexible; it just means you may run into more issues, or not be able to raise the questions that you want to raise as easily.
Adele’s journey and food philosophy
4. You were a vegetarian for many years before becoming a convert to real foods (including animal protein and high-quality fats). What prompted this change? Was there an “aha moment” for you?
I can put my finger right on that moment. When I have an exam or another paper to write, or when I’m just overwhelmed by the material, I remember a patient I met at the clinic whose circumstances and story I’ve been able to relate to on a personal level. When I was working at the Duke Clinic, I was educating her about the low-carb diet that we use in the clinic. I start telling her about the importance of eating good delicious food, but the need to give up sugary desserts. She started crying, and I felt bad for her. I realized that most people don’t want to be told to give up anything and so I started telling her about sugar-free cheesecake recipes she can make, etc. Then, she looked up at me with a furious look on her face and I realized she’s mad at me! In a shaky voice, she said: “I have already given up almost everything. I gave up desserts and sweets years ago. I haven’t had a piece of chocolate in forever.” So, she’d already given up everything we’d asked her to give up years ago. But she was also surprised and relieved to find out from me that she can eat real food … that she can have eggs for breakfast and blue cheese dressing — and still lose weight.
First, she didn’t believe me. But then she said: “If what you’re telling me is true, then I’ve been hungry for the past twenty years for no good reason.” And that just struck me to the bone! Because if we see a child who is hungry, we don’t want him to feel one single hunger pang; we want to feed him. But a middle-aged woman who is overweight or obese … our reaction is often: “Let her be hungry; that’s her tough luck!” And that just infuriates me now when I think about it. If we’re overweight or obese, we’re expected to just be hungry and deal with it. And there is something deeply wrong with that.
We got her straightened out, and she started losing weight, gaining energy and getting her life back, and she’d say to me, “Hey Adele, when are you going to get started? When are you going to fix this problem?” This is what really inspired me — I saw it as a social injustice!
I was also one of these people; I was obese, struggling to lose weight, eating less and exercising more, and just being marginally successful at best. And people would give a most discouraging reaction, like “you must not be trying your best” or “you must be lying to yourself or others about what you are eating”. These statements are not only condescending, but also devaluing of another person’s human experience. You get that a lot — even in studies. We assume that people lie about their intake, but we don’t question the intake instrument: Are they accurately probing? Do fat people want to just hide their dietary habits from us? To suggest this is just offensive.
I was a vegetarian for my first two pregnancies, and I had difficult pregnancies; one baby was born 4 weeks early and another 6 weeks early … just a lot of problems. With my third pregnancy, my OB-GYN said “you will eat protein at every meal.” And he made such a big deal out of it; so I did it, and my pregnancy went smoothly! Now, did I put two and two together? No, I did not! After I gave birth, I went back to low-fat vegetarian eating and 6 months after I gave birth, I weighed more than before I gave birth! My weight went in the wrong direction, which was so frustrating. I joined a gym, did everything I was supposed to do, but I was miserable.
There’s that moment when you go “I’ll just have to live as a fat person, because I can’t live like this!” Then, I thought there has got to be a better way to do this. “Maybe there’s something wrong with me — surely it’s my thyroid”, I thought. I went to my family practitioner’s office and they found that my blood pressure and blood glucose were going up. Their solution? I should eat less and exercise more! I was so upset about that, the doctor left and sent in the Physician’s Assistant, who finally gave me some truly useful advice: “Don’t worry so much about the fat; make sure you’re getting protein at every meal.” And then I thought “What’s all this about protein? I thought a plant-based diet was best and all this red meat was bad for you …”, and I just didn’t believe a word he said, but it was the second time I had heard that message.
I went over to the Health Sciences Library at UNC with my littlest one in the stroller, and I was using the then-high-tech tool called the Internet, scrounging as much information as I could. I understood two pieces of information: carbohydrates were mostly for energy, and that body fat is stored energy! In my brain I said “Why am I putting energy into my body when obviously I have been storing plenty of it?” I didn’t know about the insulin thing or anything like that, but that just sort of struck me. Then I picked up the book Protein Power by Mike and Mary Eades, and there was a sentence in there that said there is no dietary requirement for carbohydrate, which again, I did not believe at the time. But I starred and underlined it, and thought maybe there’s something here.
Putting together the advice to increase protein and reduce carbohydrates, I changed my diet. My God, was it a life-changer for me! I started losing weight and feeling great … and started to acquire muscle, which was a brand new thing for me because when I was thin, I still wasn’t muscular. Eight or nine months down the road, I decided that I was doing so well that I had to go back to my old dietary habits! I added more plant-protein, some eggs, and low-fat cheese, and I gained 15 pounds in a month, felt terrible again, and decided it’s not what I need to be doing. It really is all about experimentation; it’s important to find out what works best for each of us, individually. It’s true that some parameters have been hidden from the public, such as the information about the fat-storing consequences of carbohydrates. There’s also misinformation that has been propagated, such as the lipid hypothesis. Additionally, the supposed dangers of saturated fats were overstated. That doesn’t mean that everybody will do well on one particular diet, but there is a range of normal …
This is what makes being a nutritionist really important — to tailor advice to peoples’ needs. Well-trained nutritionists can help people evaluate the science, see how it applies to them, evaluate their own body’s messages, because that can be an art by itself. We haven’t been taught as Americans to understand what the body is trying to tell us. Nutritionists can be especially valuable to help people make these educated guesses about their own dietary habits and lifestyle.
5. A lot of people who are trying their best to lose weight on a “low-fat” diet are struggling, and now we know that this is because they are likely consuming a large amount of simple carbs instead. As a result of the media indoctrinating the public about the supposed danger of fats, many are hesitant to increase their fat intake. What are some resources you would recommend that would help to convince someone to consider a more traditional diet that doesn’t shun fats?
It’s tricky, because some of the resistance comes from “I love the foods I’m eating now, even though I can see quite plainly that they’re not providing me with the best health.” So you have to look at the population that you’re trying to approach. The Weston A. Price Foundation is a good resource for families; Nourishing Traditions is a good resource for mothers raising children. NT is not about weight loss; it’s just about returning to a way we used to eat before all these industrial processed foods entered our food system. For younger people, I think the Paleo lifestyle really captures their imagination. I really like Robb Wolf’s book, The Paleo Solution, and his approach because he has that attitude of “don’t just take my word for it; look at some other evidence.” The audience for the low-carb lifestyle seems to be people who are already severely disregulated, who are obese, diabetic, etc — this makes sense because they need a stronger prescription. The book that just came out by Stephen Phinney and Jeff Volek called The Art and Science of Low Carbohydrate Living is a valuable resource. There’s lots of material out there; you have to simply address the specific needs of who you are trying to help.
6. There’s a lot of contention in the food blog world regarding grains and whether or not we need them for good health. Primal and paleo
I guess if someone asked me “should I stop grains?”, I’d ask them why they’re eating them in the first place! What’s your motivation for eating them now? If you’re eating grains just because you like them or you’re used to eating them, then how much pain is it going to cause you to give that up? Is it going to be a real struggle for you? Then, we are looking at other issues besides just nutritional content. I thought this was a good question actually, because we do see a lot of zealotry or moralizing about food in the world, and I think it’s interesting especially when we’re looking at ancestral ways of eating. Do we look at the far, far past — the caveman’s diet? I’m taking a food culture and anthropology class and one of the things we know is that we ate a lot of insects and grubs when we were at sustenance-level eating, but I don’t see anybody zealously defending eating bugs! I think a lot of times what we’re defending are our own cultural norms and our own personal proclivities, and maybe even addictions.
If you’re a person who likes puttering around in the kitchen and like sprouting stuff, pickling stuff, and fermenting stuff, then getting grains to the point where they’re not toxic can be fun for you. For someone else, these processes can be seen as additional chores, and it may not be worth it for them, so they cut it out completely.
On hacking the food/healthcare system …
7. What do you think is the biggest problem with our industrial food system? Can you think of actionable ways to gather together like-minded people beyond the grass-roots level to effect real change?
When you’re a hammer, everything looks like a nail; so my answer to the biggest problem is going to be the dietary guidelines. I used to not think this way, but it seems that all major barriers that I run into when it comes to reform have the dietary guidelines behind them. “We can’t do this” or “we can’t change this” because of what it says in the dietary guidelines. As long as the USDA and the HHS own the definition of “healthy”, there is so much we are unable to change — our agricultural food supply structure, the labeling of products, the advice we give people in medical care and health care systems, the information distributed in the media, our health educational system, all funding for studies — each one of those is tied back to the guidelines. I’m not saying we need to necessarily change the guidelines; I’m saying we might just need to dismantle the system or try a different way to talk to the public about how to achieve health by making food choices that are appropriate for individuals. It’s not necessarily going to be the current top-down system that we’ve got, because goodness knows — it just has not worked all that well!
To me, it’s a real puzzle. If I put up another graph that shows installation of a plastics factory and at the bottom it’s cancer incidence … and you saw an inflection point like that, people will definitely think there is some type of relationship to this crazy slope. But when you relate obesity to the dietary guidelines, this is the response I get: “Well, people are moving less.” I think there’s not that big of a difference between how much we were moving in 1980 and how much people are moving now … but there weren’t a lot of fat people in 1980! I was alive and remember it. My parents didn’t own a pair of jogging shoes; in fact, no adults I knew “exercised” when I graduated from high school. Kids had sports in high school but adults didn’t play sports or exercise, but no one I knew was really fat. So, what changed? There are all sorts of excuses … women in the workforce, automobiles, etc. But what it comes down to is when we added the guidelines; it affected every aspect of our food system. It changed the way that Americans thought about food and their health. They were taught to think that they can get health out of a box. They were no longer taught to listen to their own bodies or their grandmother’s advice, or pay attention to what is real food or isn’t. If it comes from a manufacturer and if it’s been quantified, labeled and health-claimed, then it’s okay … and everything else — an egg, a pork chop — is suspect. It has fundamentally changed the way that we think about our food.
So what can we do about it?
First of all, I think we have to get rid of these silos; we have to stop saying “my diet is better than your diet” to everybody, including vegetarians. It’s vital to acknowledge that there are different paths people are going to take to health, but we are going to agree on the fact that our current industrialized food system isn’t working. This doesn’t mean that we have to eliminate it or that it’s going to go away; it just means that it’s going to be different than how it works now. The best thing as I’ve said before is to join forces — those who are in the slow food movement, the agricultural reform movement, WAPF, paleo, low-carb, healthcare reform movement … all these people, if they came together as one and were willing to simply agree on the fact that what we’ve been doing up until now is not working, we can start to push for things to change. We don’t have the answers. If we create another top-down, one-size-fits-all system — another dietary prescription that we think is right for everyone — we will fail again, because there will be unintended consequences that we don’t know about just like there were unintended consequences from 1980 that they didn’t know about.
The work that you’re doing — just getting the word out — is so important. Tell stories like yours over and over again. I share that I tried following the rules, and they didn’t work for me. Why aren’t we questioning the status quo? Being in the academic scientific community, we are simply not asking the questions. It’s almost forbidden to “go there”. This is not because scientists don’t care or are afraid. I think they ask the questions by themselves, but once they get to a certain status, they need to stop asking questions in order to secure funding or get accepted into the club. The system is rigged — not necessarily against people, but rigged for other peoples’ special interests. There’s a lot of political bullying, pressure in the form of funding, etc without taking into account what happens when you hand the nutrition business over to the agency whose real mandate is to promote agricultural products. At what point [is the USDA] going to recommend a change in diet that’s going to really hurt some of the big agricultural businesses? It doesn’t make a lot of sense.
8. What is the simplest way to convince the general public that the current dietary recommendations are sub-par?
The joke always is “I have a copy of Good Calories, Bad Calories, but only read the first half” because once you get into the second half, you’ll just want to cry! The first half is a page-turner; it’s just fabulous. Go to the library and just read the first half; don’t feel guilty about not reading the second half [because it's known to be very difficult to understand] — that’s a great place to see where it sort of all went awry. Unfortunately, I don’t think there’s good documentation yet of what happens next. I wrote my Master’s paper on this, which I just put up on the web, so more people have access to it, and hopefully that’s the whole purpose of starting a blog — just so I’ll have an outlet for that. What the public doesn’t understand is that we tend to blame a lot of this on industry. That’s not entirely unfounded, but the big industrial culprit at work here is what I call the “scientific industrial food complex”. A lot of people make their living from funding to study science that is sort of geared to prove the theory behind the [current] guidelines. It’s biased from the outset. Scientists come to science with their own biases, with their own microscopic view of the world … because they’ve been taught to specialize and narrow their focus.
When it comes to nutrition, it’s exacerbated because we have this giant umbrella called the dietary guidelines. So if you’re a scientist putting together a study and you want to know what the “healthy diet” is going to be, you don’t have to guess; you’re programmed to look to the dietary guidelines. If you put in any other diet in there and call it healthy, you will be going against the organization that is funding you! So if you want to study nutrition, you have to study the nutrition of the dietary guidelines. People have the reaction of “where’s the science that says …” or, “well I read in Fuhrman’s book and he quotes lots of studies that show …” Well, he also tells us that broccoli has more protein than steak, which is just goofy! Until we begin to be skeptical of who we’re believing when we think we’re believing science, we will remain confused. It’s a culture change or a paradigm shift, and it will take some time for things to change.
People in the medical establishment also have to be on board. Doctors are not taught proper preventive care. The healthcare community is one of those threads that when you start tugging at food and nutrition policy in America, you get tangled up in … because the funding for studies about cholesterol and about saturated fats, sodium, and all these other measurements of heart-health, come from — to a large extent — the NIH, which is housed in Health and Human Services, which is one of the places that creates the dietary guidelines in the first place! So, it’s not an independent agency. Therefore, you have a funding agency that is going to want to fund studies that support the guidelines that the other part of the agency has already come up with and already said that these are what should be. The agency is not going to try to undermine its own work, so it will try to limit funding in areas that might upset the status quo. And that’s the core of the problem.
In America, we’ve been taught that medication and surgery are going to fix us. And that’s an expensive and ineffective route to go. Statin drugs are a perfect example of causing more problems than they solve for some people. That said, as Americans, we need to step up and take up responsibility for our own health.
9. So, factory farmed beef versus an organic granola bar. What are your thoughts?
I would rather have someone have factory-farmed beef over organic granola bars. That’s my take on it based on what I saw in the clinic. From a clinical perspective, the meat is going to make the person better faster than the so-called healthy whole grains. The organic granola bar is going to raise the blood sugar faster and the person will have a harder time losing weight. From an environmental perspective, not so much. We have a little burger place by our house and we call it the “Magic McDonald’s”. All their food is handmade: meat is ground on the premises, the fries are hand-cut and fried in non-GMO oil (I’d be happier if they were fried in lard, but they have to cater to their consumer base). Just think how much better it would be to turn McDonald’s into this. It’s still burger and fries, but the quality is incomparable. And it’s a local business, so I’m supporting the local economy too.
You can’t have impossible standards right out of the gate. You have to help people find what can make their health better, and then we can figure out how to make the world better. If I could change one thing for most people, I would encourage them to switch from cereal to eggs for breakfast everyday, and so many other things will fall into place!
On making locally-grown foods more accessible …
10. My topic of greatest interest at this point is this: I’m trying to understand what are the main barriers to making locally and sustainably sourced food more directly available to consumers, and what it would take for more farmers to embrace a more organic and sustainable (and traditional) approach to farming. What would it really take to change the paradigm and the ecosystem of agriculture and food economics?
I’m right on board with you. I think it’s a very interesting issue to tackle. I’m taking a social entrepreneurship class and working on a project that addresses this. I think what it’s going to take is a combination of top-down policy change and bottom-up culture change and consumer awareness. There are some barriers that policy changes can reduce: enforcing anti-trust regulations in the food industry so we are no longer centralizing all of our meat processing, for example. That’s a real problem for consumers because everything we want to eat comes from these centralized processing plants where everything gets processed the same way. It’s a problem for farmers because they end up being contractors in a vertically-organized system instead of being their own entrepreneurs on the farm. So we need to encourage and support smaller circles of production, processing and retail, through state funds and local funds. Instead of food being grown in North Carolina, shipped out of state for processing, and brought back in to be sold, let’s keep it all local.
If we keep things local, we keep things in our local community, and we have a lot more control over the extent of the processing, and the farmers end up having more control over what their part of the production line is. They control what they grow, and who they sell to. It diversifies what is happening on the farm, gives them a more stable basis for income, and it’s good for the consumer because we are getting things a lot closer to home. But to make this work, we have to increase demand by consumer information through the health care system. So if doctors were recommending a whole foods diet, if their first-line treatment for diabetes were farmers’ market produce and meat, that would change consumer demand! You can’t tell me that buying prescriptions from the drugstore is cost-effective compared to even buying more expensive meat products.
Again, I sound like a broken record, but it comes down to the dietary guidelines — they tell our healthcare providers what to recommend! My nephew is in medical school now and he was told (and I was so pleased to hear it) that a low-carb diet is the best treatment for diabetes. But then he was told that the patient won’t follow through with it, so a medication would still be necessary. But just because someone might not follow through with something doesn’t mean you should not provide her with the correct information and let her decide! We need to lower the barriers for the consumer instead of blaming the consumer for not wanting to follow a lifestyle treatment that is going to be really effective.
If demand increases, industry will follow. The industry will go to where the consumer will put his/her money. The flip side of that is industry also regulates what the consumer wants; by putting certain health claims on the packages of food, that manipulates consumer demand. Consumers may think that the absence of a health claim on broccoli or pork chop is weird, and that somehow the presence of a health claim on Cheerios — no matter how unscientific or meaningless — overrides the real food items. So we need to have a more informed consumer base; and I think industry will shift according to consumer demand.
Who is Adele Hite?
Taken from her new blog, Eathropology, Adele is “a PhD graduate student in Nutrition Epidemiology at UNC-Chapel Hill. She completed a Masters of Public Health/Registered Dietitian (RD MPH) program, a Masters of Arts in Teaching, and a BA in English at the same institution and she still doesn’t care much about basketball. She’s a mom, a yoga instructor, an omnivore, a songwriter, proud co-founder of the Healthy Nation Coalition, and a general thorn in the side of the nutrition establishment.”