Dear Cleveland Clinic: It’s food, not poison, for crying out loud!

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

Earth to Cleveland Clinic dietitians: please stop sharing your joyless, preachy, pinched-face, finger-wagging lectures about foods you consider to be evil. In a rush to convince the great unwashed out here to improve our daily diet, many so-called “experts” like you seem to believe that nagging and food-shaming are the most effective ways to change behaviour. Trust me, they are not.

Today, I offer two examples of dietary advice, one that I plan to not only ignore but publicly mock, as well as one terrific example (definitely NOT from Cleveland Clinic) that’s already printed and posted on my fridge door.

Example #1:  a Tweet from Cleveland Clinic, below: “Our dietitians picked 7 snacks they would NEVER eat.”

Can you guess the seven deadly snacks they would NEVER eat?

The answers are, surprisingly, not chocolate bars, not ice cream, not even a nice gooey Tim Hortons Maple Dip.

Instead, Cleveland Clinic dietitians slammed baked chips, granola bars, potato chips, veggie sticks, store-bought smoothies (even the expensive kind from your local health food shop, described as being “often jam-packed with added sugar from fruit juice”), or rice cakes (yes! the humble rice cake, bland staple of every dieting woman I know!)

But the final verboten snack that pushed me right off the deep end was the pretzel, trashed dismissively by Cleveland Clinic registered dietician (RD) Kristin Kirkpatrick as “a nutrient zero.”

Of course, it’s a nutrient zero, Kristin.

It’s a PRETZEL!

Nobody nibbles a little pretzel hoping to fulfill their daily protein requirement.

Almost immediately, I could tell that apparently I’m not the only person annoyed by that judgmental tone. Enter Emily, a real life registered dietitian from the Boston area, with her brilliant Twitter response:

“Hey Watch me, an RD, NEVER eating pretzels. It’s food not poison! There are no NEVER foods – ugh”

On behalf of all regular people out here who occasionally allow a pretzel (or a rice cake) to pass their lips, thank you Emily for reminding Cleveland Clinic dietitians how NOT to educate the public or to motivate behaviour change.

(Kristin, by the way, also mentions on her website that she serves on the advisory board for the Dr. Oz Show, which is not something you’d think a professional registered dietician would want to brag about, considering his embarrassing quackery topics like (seriously!) “Six Libido-Boosting Super Foods That Will Save Your Marriage!”  (For a brilliant take on a once-respected cardiac surgeon-turned-TV-ratings hog, watch U.S. Senator Claire McCaskill’s withering dissection of his unfortunate promotion of diet scams and “miracle fat-burner in a bottle” craziness).

But I digress.

As I once wrote about here, social scientists in the field of behaviour change and goal-setting theory tell us that the most effective goals are indeed ones that move you toward a particular objective (approach goal) rather than away from something you’re trying to avoid (avoidance goal).

Any “expert” who tells you that your only option is to STOP doing whatever it is they want you to stop doing (like eating a NEVER food!), is unlikely going to convince you by nagging – because that’s an avoidance goal.

Example #2:  Now contrast that finger-wagging/pinched-face/STOP DOING THAT! avoidance goal with an approach goal from Oldways Preservation Trust. This is a non-profit organization (based in Boston, just like our nice Registered Dietitian Emily) whose motto is “Inspiring Good Health Through Cultural Food Traditions”. 

To celebrate Mediterranean Month starting on May 1st, Oldways produced this simple calendar poster to encourage us to make at least one healthy change per day. Make every day a bit more Mediterranean!

Cleveland Clinic offers us a nagging avoidance goal (NEVER eat these snacks!) while Oldways offers us an approach goal (try just one simple idea every day for a month and see what happens!)

What happens (spoiler alert!) is that at the end, you’ll get to have a glass of wine to celebrate the great month you’ve just had making small but important improvements in diet and in your life! And every day is a small but doable adventure (like the first one: “Take a ‘passeggiata’, an evening walk around the neighbourhood tonight.”)

This concept of approach/avoidance goals is critically important for those living with chronic illness like heart disease. Such a diagnosis can mean we encounter a wall of new rules to live by, during a time when we’re already reeling from trying to make sense of something that makes no sense. We now hear a list of new rules that can sound ominously like:

   “Stop doing everything you really like doing, and start doing everything you don’t like doing.”

I remember sitting in at the back of a lecture hall listening to a talk directed at recently diagnosed heart patients and their families.  A lovely middle-aged woman sat directly in front of me. Before the lecture started, I’d had the chance to chat briefly with this woman, who told me she was scared to death since her heart attack. Since that diagnosis, she had dutifully stopped smoking (a pack-a-day habit over the past 35 years), stopped adding salt to her food, and stopped her evening gin and tonics with her husband before weekend dinners. She’d also been having a lot of trouble getting her new cardiac meds straight so far (take these pills twice a day, these pills once a day).  She looked miserable and scared.

When the guest speaker got to the part of his lecture where he explained how he’d decided that all meat was poison, and had become a strict vegan since his own heart surgery, I could actually see the woman’s shoulders slump forward. I could tell she was worn down by the enormity of far too much reality. She’d already given up the things she most loved to do in life – and now this? 

I wish that, instead of going on (and on) about his own enthusiastic embrace of vegan life, the speaker had suggested instead something more doable – like try a Meatless Monday to start.  That would have been an approach goal.

As our new favourite dietitian Emily reminds us, there are no NEVER foods. No food is evil. Thinking it so simply makes us crave that forbidden food even more. When Cleveland Clinic tells us that even a stupid little rice cake is somehow evil, it’s discouraging enough to make us give up and head straight for the Häagen-Dazs.

As the late tennis legend Arthur Ashe once advised:

“Start where you are, use what you have, do what you can.”

Find out how I did with my Make Each Day Mediterranean calendar, what I liked best, and what I’ll likely not do much more of. Let me know how your own Mediterranean calendar works out for you and your family if you decide to test-drive this particular approach goal for a one-month trial. 

My guess is that we just might enjoy some of these small approach goals so much that we’ll continue incorporating them into everyday life. And that’s good news for our hearts.

Now, go enjoy a nice little rice cake. . .

Q:  What behaviour changes have you tried since your own diagnosis? What worked best to help make the change stick?

♥

NOTE from CAROLYN:   I wrote more many of the changes we’re told to make after a cardiac diagnosis in A Woman’s Guide to Living with Heart Disease.  You can ask for it at your local library or bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

 

See also:

Published by Carolyn Thomas

23 thoughts on “Dear Cleveland Clinic: It’s food, not poison, for crying out loud!”

  1. I can’t imagine how I missed this the first time, but I just took another look at the Cleveland Clinic list of verboten food items. Veggie sticks?!? To me, that means pieces of celery, carrot, and so on etc. Surely they refer to some other food item beyond my ken. Or perhaps I am generous. What else might ‘veggie sticks’ mean?

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    1. Sorry for the delay in responding, Kathleen – somehow I missed your comment on veggie sticks. I’m pretty sure that the ones slammed by the Cleveland Clinic dieticians are the packaged snack food (pictured under Example 1 above) and NOT the actual fresh celery or carrots. At least, I hope so… 😉

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  2. My mom is a PhD dietitian and she would never endorse a list like the one from the Cleveland clinic!

    I have personally been working hard to lose a couple pounds by tracking my calories. At the same time I’ve been aiming for high potassium and 1,500 mg sodium. I’ve been doing really well at that, but not losing weight despite a significant calorie reduction. Probably medication related or due to heart failure. What I have really been struggling with is trying to restrict my liquid to 64 oz a day. It seems like if I drink less, I end up snacking more.

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    1. That’s so discouraging, Karen – not to see results despite a “significant calorie reduction”! You’re right, meds and/or a heart failure diagnosis could indeed impact those results. I’m thinking those cravings for snacks depend on what “snacking more” looks like (e.g. fruit/veggie snacks). Hang in there!!! One day at a time, right?
      PS: I agree with your mother!

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  3. Interesting to see the different approaches that work for different people. I read “How to Prevent and Reverse Heart Disease” after an allergic reaction left me with CHF and AF. I was terrified and willing to try anything. I begrudgingly started eating plant-based, whole-food style (vowing to quit once I got healthy), but I was astonished to find that I love it. It’s like my body screamed “that’s what I’ve been waiting for!” Color me confused, but now with no desire to go back to my old “regular” diet. Lost 80 lbs, lost my diabetes, gained a new love for exercise of all kinds. Do not think I would EVER have even considered PBWF without being scared to death. Go figure.

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  4. Wow! This article really struck home because my 31-year old son has been just about living on pretzels since getting his gallbladder removed last week. Pretzels are a very lowfat snack — one of very few out there. There is definitely a place in our diets for snack foods sometimes!

    When I was diagnosed with type 2 diabetes, long before the heart disease, I remember seeing a dietician or diabetic educator, can’t recall which now. I do remember that she told me I could NEVER eat pizza again! I remember being stunned and horrified at the thought! Needless to say, I did not go back to see her again, and I still eat pizza — just a lot less than I did before.

    When my husband was diagnosed with high blood pressure several years ago and we had to eat low sodium, I began to realize that the words “healthy diet” can be interpreted in about a million different ways depending on the need. A “healthy” diet can be low salt, low sugar, high fiber, all organic, gluten free, dairy free, you name it, and the person on that diet will almost always preach to you about it if it has helped them. But you have to eat what makes YOU healthy. (We especially liked the DASH diet — it’s a very balanced, sensible diet that seems to fill the bill for just about every nutritional need, can be adapted however you want it, and can be used to lose weight.) His blood pressure is well controlled now and we don’t have to be so diligent about the sodium, but we still don’t eat really salty foods.

    One thing I am grateful for today is that it’s gotten a lot easier to find foods you can eat if you have a special need. I remember walking around the grocery store practically in tears reading every food label trying to find something we could eat that was low sodium but quick and easy to make! It’s easier now, it seems like there are more choices for whatever need you may have.

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    1. Lots of good points, Meghan – thanks very much for those. Your pizza story reminded me of my early experience with Weight Watchers back in the 1970s. At that time in the program’s always-evolving history, peanut butter was openly referred to as an “illegal” food. (Talk about making food the enemy! Not just “bad” – but “illegal”!!) The thought of never being able to have a bite of peanut butter for the rest of my life made me crave nothing but peanut butter. . . Your son’s experience “living on pretzels” proves the point, to paraphrase a famous quote, that “one man’s pretzel is another man’s poison…”

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      1. Just an observation on the evolution of Weight Watcher Guidelines: In the late 1960s, while I was in high school, my mother went to Weight Watchers and I followed her diet. At that time, one of the “Illegal” foods was watermelon. Yup. Watermelon.

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        2. Watermelon illegal? Wow! The diabetic exchange-based diet I was on in the 80s allowed a whole cup of watermelon for a fruit exchange as opposed to half a cup of other fruits! And I guess WWs is still “evolving.” I went on WW’s in 2015 following my first heart stent and the Points Plus program at that time allowed any food with all the fruits and veggies you wanted for no points. Funny, I lost 37 pounds and I still think you just can’t get fat on fruits and veggies. Seems to me that any effort you really stick to with weight loss dieting will work!

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  5. The same goes for people who wag their finger at the very people they admonish. Instead of being critical of the messager you might think about the message. Why would you support eating things that create so much harm. Just because that’s the status quo. Because we are use to eating junk it shouldn’t be a big deal. To reply to the dietician, there is no food that is poison just like cigarettes and cocaine aren’t poison. No one dies of one time or occasional use. It happens over time. But your dietician advocates it for what reason. Because it’s no big deal. That’s great reasoning. I’m glad you wag your finger at Cleveland clinic because that’s a real person.

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    1. Hello Hao – I’m not aware of any studies suggesting that eating rice cakes “creates so much harm”, and I’m fairly certain that tobacco and cocaine are indeed far more deadly than a pretzel is.

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  6. Here is one modification that’s been working for us: I keep hummus on hand, and veggies (celery, carrots etc) in cold water, cut up and ready in the frig. So when we come home starving, we can snack on those while making dinner, instead of bread and cheese. Still love (and eat) bread and cheese, just a little less frequently.

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    1. Good example, Kathleen! Me, too. I like to keep a tupperware container filled with chopped veggies ready to go (for snacking, or to throw into a morning omelette or dinner stir-fry. If veggies are handy and ready, I’ll eat them. I wish the Cleveland Clinic dietitians would write something like “Our dietitians picked 7 snacks they LOVE to eat!” (an approach goal!) instead of snarking on what they would NEVER eat…

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      1. Exactly! If vegies are ready to use, I find all kinds of ways to do it. On the same lines, I chop and cook great big bunches of greens with a little olive oil, just the water that clings from washing, and lots of garlic. Once lightly cooked they keep in the frig for over a week, so I toss them in pasta, soups, omelettes, etc. Same with a batch of cooked dried beans. Saves time and money, besides being good for us.

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  7. Good points. I agree with you on the ridiculous posts by so-called medical professionals with advice on never eating or doing something.

    To make it simple, people should just eat and drink what they like in moderation. It’s always good to “try” healthy foods along with the usual diet. Eating and exercise should not be about living longer but about feeling good and staying disease free while one is alive and IF one does live a long life.

    Some of the “diets” people follow are incredibly unhealthy and are endorsed by doctors. The paleo diet makes no sense, and anyone who follows that type of eating is sporting 1/4 of a brain. It’s pretty simple – eat what you like in moderation. The stress of trying to navigate the diet advice from the “medical community” is more harmful for the body than the supposed “forbidden” food itself. People who claim any other way of eating are trying to make money from people who aren’t smart enough to understand they are being scammed.

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    1. Thanks Kristi – you have exactly captured the importance of APPROACH goals when you say “eating and exercise should not be about living longer but about feeling good”. So when I go for a long walk later on, it’s because I love being out by the seaside on a beautiful sunny day, spending fun times with my girlfriends – and NOT because I’m trying to prevent something bad happening to my heart. If only health care providers could adopt that subtle shift in their patient advice/messaging, maybe people might be more open to listening.

      PS I have no knowledge about the brain size of a paleo eater; I prefer to believe instead that everybody has the right to make personal choices about what to eat/not eat – but that right ends at my right not to be preached at!

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  9. Just the first week of that menu would raise my glucose levels sky high. I don’t know why high-carb is equated with healthy when there’s so much evidence to the contrary.

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    1. Hello Holly – I would not describe that first week as “high-carb”. The carbs in Mediterranean-style diets tend to come from unrefined, fibre-rich sources like whole grains and beans, and few diets have been as thoroughly-studied as the Mediterranean diet. Especially for heart patients or those at risk of heart disease, it’s a terrific way to eat (and live!)

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