Want the truth about what we eat? Ask our girlfriends…

by Carolyn Thomas    @HeartSisters

More reports from the Department of the Bleedin’ Obvious, my heart sisters. Last year, a group of 45 international nutrition scientists launched a campaign to end the use of one of their most commonly-used research tools: the self-reported food diary.(1)  These scientists now claim that “dietary recall is skewed towards healthier behaviour.”

In plain English, it means this: people participating in nutrition studies lie to researchers about what they actually eat, preferring instead to enter foods into their daily food diary like “kale” and “quinoa” before submitting their self-reports.

And let’s face it, a person who has volunteered for a nutrition study may be too embarrassed to officially record for posterity something like: “I ate half a box of Turtles today just to get them out of the house.”*  (And really, I can’t be the only woman to ever admit to this, can I?)  

Trouble is, nutrition scientists are shocked by this research news because they’re thinking like nutrition scientists, not like Real Live People staring down an opened box of Turtles chocolates. I suspect that scientists have been asking the wrong people to fill out those self-reported food diaries.

What they need to do is to ask our girlfriends what we’ve been eating.

Our girlfriends know us and love us, and – most importantly! – have shared many a late-night wine-fueled confessional around our guilty pleasures. I can tell you precisely, for example, which of my friends during a stressful crisis is likely to dig into the Doritos, and which is heading straight for the Häagen-Dazs.

Meanwhile, we may officially self-report something like this in our official researchers’ food diary . . .

Day One, Breakfast:3/4 c. Green Smoothie (organic kale, spinach, chia seeds, swiss chard, hemp hearts, dairy/gluten/soy-free protein powder, unsprayed grass clippings); three small raw almonds; one rice cracker;  mint herbal tea made with filtered all-natural environmentally-sourced no-fat extra-lean fair-trade spring water.”

But if it were our girlfriends reading our food diaries instead of nutrition scientists who neither know us nor love us, they would grab the Sharpie pens right out of our chubby hands and replace that self-report with The Harsh Truth, something like this:

Day One, Breakfast:  “She just scarfed down a double Eggs Florentine at brunch; chef’s special pesto roasted potatoes; one paper-thin wedge of the melon garnish; coffee – lots of coffee – with cream, not any of that lo-fat fake swill. Plus, she helped to polish off my leftover bacon (half a slice).”

Apparently, getting to that truth is critically important if you’re a nutrition scientist. This kind of dietary research seeks to answer questions like:

  • Is a high-fat diet linked to breast cancer? 
  • Do fruit and vegetables protect against Alzheimer’s disease? 
  • Does a Mediterranean Diet help prevent heart disease?

For example, researchers studying obesity have intuitively assumed that people are obese because they consume too many calories. They’ve been puzzled, understandably, by paradoxical research findings that suggests obese people were actually eating fewer calories than people of normally weight.

But as the international nutrition study’s lead author Dr. David Allison explained:

That was completely wrong. The correct answer is that, on average, obese people eat more than non-obese people. The wrong result was found and that confused the field for many years by relying on self-reporting.

“All of these studies, if they are based on self-reported estimates of calorie intake, really don’t contain scientifically meaningful information.”

Research results that don’t include accurate food diary data represent a serious problem. As one of the report’s authors warned, the flawed data collected in “thousands of scientific papers each year” could actually result in public health policies that are not science-based at all.

WHAT?  Thousands of scientific papers resulting in public health decisions that are not science-based?

Yet this isn’t new news.

Fifteen years ago, a study published in the Journal of Epidemiology and Community Health reported that research participants exhibited a “reluctance to report consumption of unhealthy foods.”(2):
“A major problem in self-reported dietary studies is people who under-report their true habitual food intake.” 

And even further back, a 1982 study published in the American Journal of Clinical Nutrition(3) showed that self-monitored records of research subjects’ food intake “may not be accurate”. In a study of overweight women (ranging in age from 24 to 53, mean age 44.6 years), scientists looked specifically at their food diaries and concluded:

“Judgments about calorie intake based on these estimates may not be accurate. Inaccuracies in the food records may render them non-representative of subject eating behaviour. “

So given the weight (no pun intended) of prior studies on precisely this problematic issue with self-reported dietary journals, why do nutrition scientists continue to rely on them?

Dr. John Ioannidis has suggested that even consistent results across studies don’t reflect accuracy in the link between eating _____ and developing _____, but rather “a literature that is written, peer reviewed and edited by fervent believers who will not accept any result other than what perpetuates their beliefs.”

Meanwhile, Dr. Allison admits that his study has taken a controversial stand and sparked mixed reaction from a nutrition science community that has depended on self-reported food diaries for decades:
“Much of the scientific community applauds us and says it’s a refreshing point of view. But as you might expect, some individuals who have based much of their research career on the use of these methods say we can’t abandon them because in part we don’t have anything better.”
Aside from research needs, using a food diary for purely personal reasons can actually be effective in losing weight, making sure we meet minimal dietary requirements (like veggies!) or tracking foods that may be causing problems for us. Charlotte Watts, author of The De-Stress Effect, reminds us that keeping track of what and when we eat by starting a food diary can help us make positive and healthy changes in five key ways. For example, a food diary can:
  • help us see the big picture (not just individual food choices, but the cumulative effect over a whole day or a whole week)
  • help us to identify patterns (when we write things down, we can start to see patterns develop for certain foods that might be contributing to a specific problem)
  • help to kickstart us into action (even when we believe we’re eating healthy foods, we might be surprised by tracking the little snacks we enjoy here and there – and it’s also useful to count total servings of fruit and veggies per day)
  • help us to feel more in control (writing things down helps the brain make sense of them, and helps us regain a sense of control over our eating habits)
  • help us to eat more mindfully (when we write down all snacks, drinks, Turtles, or grazing throughout the day, we can become aware of how much mindless eating can happen).
But for nutrition scientists seeking something better than self-reported food diaries for research purposes?
Try a buddy system that recruits our girlfriends to offer you the honest truth about our food diary reporting.
Q:  Have you ever fibbed while completing a self-reported food diary?
NOTE FROM CAROLYN:   I wrote more about how heart patients (and others) can improve our mood in my book, A Woman’s Guide to Living with Heart Disease , published by Johns Hopkins University Press in 2017.  You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher (use their code HTWN to save 20% off the list price of my book)

See also:

No, really – patient education that’s actually useful!

Six steps to stop emotional eating

A doctor discovers the heart-smart joys of eating vegan

Mediterranean Diet: it’s all Greek to me

De-junk your kitchen to start heart-smart eating

Heart-smart food rules: your dietary dos and don’ts

Food trends: why we eat the way we do

Mindless eating: 8 reasons women eat when we’re not even hungry

*  Turtles:  Heavenly morsels of pecans, caramel and chocolate; a Christmas tradition during my childhood. Sadly, I haven’t actually had a Turtle in many years, although I still have the occasional lovely nostalgic dream about eating one . . .


(1)  N V Dhurandhar, D Schoeller, A W Brown, S B Heymsfield, D Thomas, T I A Sørensen, J R Speakman, M Jeansonne, D B Allison. Energy balance measurement: when something is not better than nothing. International Journal of Obesity, 2014; DOI: 10.1038/ijo.2014.199
(2) A Cook et al. The problem of accuracy in dietary surveys. Analysis of the over 65 UK National Diet and Nutrition Survey. J Epidemiol Community Health 2000;54:611-616 doi:10.1136/jech.54.8.611
(3) D Lansky et al.  Estimates of food quantity and calories: errors in self-report among obese patients. Journal of Clinical Nutrition, 35: April 1982, pp.727-732.

11 thoughts on “Want the truth about what we eat? Ask our girlfriends…

  1. I too grew up in a Ukrainian family Carolyn 🙂 My mother would regularly give me the “top of the (whole) milk” where all the goodness was.

    I too struggle to keep off the salt, cream, butter, sugar etc etc. However the rate at which the scientists change their advice on what we may or may not consume with a clear conscience is way too fast for me. I now try to eat as sensible and varied diet as I can whilst allowing myself the odd Turtle type treat. I live in France now where the patisseries are to die for & I’m only flesh & blood!

    I eat smaller portions and exercise as much as I can.
    As to lying in a food diary – I’ve never kept one but I lie to myself often so I’m sure I would.

    Pass the wonky halo……

    Liked by 1 person

    1. Anna, I love that wonky halo image. You are so right: science flip flops back and forth almost weekly: fat is bad, now fat is good; red meat is bad, now red meat is good; alcohol is bad, now moderate alcohol consumption is good, etc etc. Living among all those exquisite French patisseries = temptation!!


    2. I no longer try to keep up with the flip-flop of dietary rules and also have come to think that the best way is a variety of foods, smaller portions and as much exercise as possible. And it feels better. Besides, I could never live in France and swear off patisseries. It would feel too sad.

      Liked by 1 person

  2. You mean I am supposed to report CHICOLATE??? I thought since it was as necessary as air it had no calories!!! To think I’ve been doing it wrong all these years…..


    Liked by 1 person

  3. Ohgawd! How I love turtles! Especially robed in dark chocolate…

    But in reading I immediately thought of something else: the standard questions the medical assistant asks before every single primary care appointment. One of them is whether you drink alcohol. If so, how many drinks a week? And I blithely report that I have a glass of wine or a beer just about every day of the week, once in a while (like with my book group) more.

    She widens her eyes and asks me whether I think that’s a problem. Nope, I don’t. And her eyes get even wider. “Look, I gave you an honest answer.” But if she really thinks my alcohol consumption is remarkable, I would say that other people don’t, and, if that’s how she acts, WHY they don’t.

    Liked by 1 person

    1. Good point, Kathleen! In the face of such judgement, no wonder we might have a hard time being boldly truthful. (It’s like the time back in my teens when I angrily confronted my little brother (still holding the pinking shears in his chubby 5 year old fist) if he was the one who had cut the green polka dot bow off my new dress. His emphatic fib: “NO! It must have been somebody who LOOKS like me!”)

      A medical assistant who clearly disapproves of your honest answer is more likely to hear whitewashed fibs to escape that “look”. Extra points to you for being honest!


  4. Funny! And, oh, so true!

    But the other truth is just how hard it is to deny yourself “good food,” especially your favourite treats and/or comfort foods after a heart attack. It really does feel like adding insult to injury.

    My particular downfall was salt – I loved it, especially in the form of potato chips and dip, crisp bacon and a good steak – meat without a touch of salt is just so bland. So going cold turkey after my “cardiac event” was very hard, indeed.

    Truth be told, I struggled with it bad-humouredly for a long time, before finally making peace with the new regime and still crave the odd chip or two from time to time, like I’m told ex-smokers do a cigarette. And this is three years out.

    I haven’t fibbed on a dietary self-report as yet, however, simply because I haven’t been asked. But don’t tempt me!

    Liked by 1 person

    1. Thanks Judy! It can be a big shock for the freshly-diagnosed heart patient to rethink their entire pantry, grocery lists and eating preferences. For me, the toughest part at first was adding enough veggies. I grew up in a Ukrainian family where we considered dill pickles to be a vegetable course. . . Thanks to my daughter (who is very strict!) I have by now acquired a preference for lovely fresh salads – as you say, making peace with the new (healthy) regime!


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