I was listening to the Dean Edell on the radio one day who was stating that a calorie is a calorie as far as weight loss is concerned and I recently read on Quora a comment from someone claiming to be a registered dietitian that calories were not equivalent. (I personally would claim that a calorie is a calorie, but if you eat your RDA in twinkies, you are going to be hungry and you are going to miss some essential nutrients and if that keeps up, you are going to die of malnutrition). I presume that a dietitian’s training is grounded in evidence-based medicine, but I have always been a bit suspicious of dietitians and nutritionists (and a few doctors as well) as practitioners of woo. What’s the straight dope?
Yes, the twinkie diet, if you stuck to the RDA of calories, would mean you would not be overweight when you died of malnutrition.
Roddy
eta: in other words, it’s two different issues. Dr Dean Edell was presumably talking strictly about weight loss. The dietitian was presumably talking about nutrition. Clearly, if you are attempting to lose weight by limiting calories, you need to make those calories count with good nutritional value.
Context is everything in this type of conversation. You can speak of calories in many different ways so it’s not clear that anything is in conflict here.
A Cal is a Cal and any Cal provides the same amount of energy. However, different sources of Calories have different effects on the body.
For example, glycemic index: the amount of sugar that’s glucose verses fructose. If I understand it correctly, while the two are consumed the same way, they’re stored different ways. One goes to body fat, the other to the liver. Glycemic index is something that diabetics have to keep in mind.
So, even in the simple case of one type of sugar versus another, there are diatetic consequences, despite the fact that a Cal has the same energy content regardless of source.
Calories are a measure of the theoretical energy available in a food based upon the release in a bomb calorimeter. Your body is not a bomb calorimeter, and different nutrients are used in different ways regardless of the caloric content. Calories (which are actually kilocalories in engineering measurements) are only a very gross estimation of what your body is getting from the food you eat.
As for doctors versus dieticians: doctors receive very little actual education about nutrition in medical school and unless they have studied in a nutrition-related specialty they have essentially a layman’s knowledge of nutrition. Registered dietitions theoretically know much more about nutritional science, but my experience has been that many RDs actually have very skewed or ill-informed ideas about nutrition, such as the value of juicing or “purging” diets.
You hear this view commonly from people flogging a variety of weird diet notions, but I don’t think it’s true.
While training specifically focused on nutrition is limited in med school, biochemical bases of metabolism and diseases caused by excessive/inadequate nutrition do get a lot of study. Med school courses are supplemented by practical experience and training in residency and practice, geared to specialty requirements.
No, I don’t think physicians are as capable as good dieticians when it comes to, say, drawing up a meal plan and supplementation for a patient receiving chronic care. But they are certainly able to evaluate and recommend good diets, counsel obese and malnourished patients etc.
Not that this applies to SOAT, but when you hear a woo-ist going on about “Doctors don’t know anything about nutrition”, what it typically means is “Doctors don’t buy into my goofy theories on nutrition”.
But this is pretty much my point; physicians should know something about the deficiencies associated with pathological nutrition that are within their area of practice, but they are not generally well educated about what comprises a nutritionally complete diet beyond very basic elements. Any physician should be able to diagnose a basic vitamin or mineral deficiency and recommend the correct supplementation, but in actually recommending what you should eat in order to get good nutrition they aren’t really more knowledgeable than an educated layman.
And this goes to other areas as well, such as exercise and preventitive medicine; medical doctors are taught to look for problems and correct them, not recommend useful preventitive lifestyle measures beyond “Don’t smoke, drink, or eat fatty foods.”
Just following good advice not to smoke, drink excessively or overeat would prevent or ameliorate a vast amount of disease. But that’s really really hard for most people to do.
Lots simpler to complain that “My doctor doesn’t know anything about this fabulous new miracle food/supplement”.
I’m not exactly clear what your point here is. That physicians who specialize in research and clinical practice on nutrition and preventative medicine have greater knowledge about nutrition and preventative health than a layman? Of course they do; that is their area of research. But the amount of training your typical M.D. gets in medical school and residency is negligible. If you ask your typical family physician, he’ll tell you to avoid fats, eat a “balanced” diet according to FDA guidelines, and don’t smoke or drink to excess. This is neither especially helpful or informed advice, especially given how screwed up the FDA guidelines are.
So please educate me: what facets of a “nutritionally complete diet” are physicians ignorant about and thus expose their patients to significant pathology unnecessarily?
Evidence not confined to anecdotes would be appreciated.
Oh, and examples I provided of physician involvement in nutrition are not confined to research, but involve day-to-day clinical work.
Do non-physicians get 20 hours of education in nutrition during their schooling? If not, the comment that physicians have essentially a layman’s knowledge of nutrition (which also ignores post-graduate education for docs) is non-viable.
And I hate to repeat myself, but: “what facets of a “nutritionally complete diet” are physicians ignorant about and thus expose their patients to significant pathology unnecessarily?”
I am not for one moment advocating strange weight loss diets, but a calorie is not a calorie when looking at nutrition.
Food is assessed for calorific value by completely oxidising (burning) it in laboratory conditions.
Now, consider nuts. Highly calorific. Or Sweetcorn. Less so. Without going into too much detail, chewed nuts and swallowed kernals of corn exit the body in consideably less than fully oxidised form. Think about it. This is because of less than complete breakdown of the product. Now if you swallowed a liquid in which the nuts and or sweetcorn had been pulverised, your digestive tract would extract most of the calories; whereas normally a considerable number of calories are simply excreted.
There have been attempts to give a better assessment of energy taken through the digestive tract, but none have been too successful.
What exactly the fuck is your point here, other than trying to be as pedantic as humanly possible? Any high school student who takes the required health and hygiene class will get more than twenty hours of education on nutrition and health. Twenty hours of education, even that the medical school or graduate school level, is nowhere equivalent to the education and training received by a registered dietician.
Doctors are often unaware of the exact constituents in food or what makes food healthy or unhealthy. They will typically advise avoiding foods with high cholesterol even though body levels of cholesterol indicators do not directly correspond with dietary cholesterol and fail to note that the human body manufactures and regulates cholesterols based upon overall dietary and activity balance, not on dietary cholesterol intake. Most doctors will also tell you to “cut out the fat” without making clear distinctions between healthy and unhealthy sources of dietary fat. Unless a physician has worked in a field specifically related to nutrition, his or her knowledge of nutrition is likely at the same level as a reasonably literate layman.
My point is to highlight the silliness of contending that physicians know only as much about nutrition as the average non-physician (“layman”), which is patently false.
I don’t know how you’re defining this, but equating what “any high school student” gets (do most high schools even require a nutrition class at all?) with physician training during and after med school is beyond silliness.
Still waiting to hear what deficiency disease or other ailment physicians are inflicting on their patients by not having the same amount of diet tutelage as dieticians. And no, being annoyed because your doc tells you to consume less fatty calories does not qualify as a disease.
I don’t know what education doctors have, but I’d take anything a dietician says with a grain of salt. (Hah! Pun intended.)
For a while in college, I taught the computer section of a class for nutrition majors, most of them seniors at that time. The class was how to communicate nutrition information, so they did things like design flyers and web sites.
What still makes my jaw hit the table is the fact that none of these people knew the first thing about science. They’d take a study that concludes “Asians have less heart disease” and then write a flyer about how eating rice and drinking green tea is heart-healthy. Nobody ever taught them that correlation does not prove causation. No one ever taught them the difference between statistical confidence levels, controlled experiments vs case studies or “these results merit further study” vs “these results are now peer-reviewed scientific fact.”
It is not “patently false” and you can fucking well stop lying by saying that it is. A registered dietician spends 2-3 years in school and performing internships to gain both a technical and practical understanding of how to evaluate and implement both individual and group nutrition plans with a focus on remedial and preventative nutrition. A medical student has a cursory introduction to the basics of nutrition with an emphasis on pathological nutrition, e.g. what vitamins or crucial nutrients are deficient that would result in a chronic condition or illness.
Every junior high/high school curricula I have ever seen included a mandatory health class, which includes as least some cursory coverage of nutrition. As you clearly have fuck all knowledge about what is and is not presented in the standard curricula, your opinion means exactly jack shit.
So, you are so busy trying to shove words in my mouth you can’t comprehend what a complete dipshit you are being? Good work.
There is another significant difference between different Calories. If you eat a certain number of Calories and get a certain amount of exercise, you’ll lose weight… But depending on what those Calories are from, it might be really hard to only eat that many. If you’re getting your Calories from soft drinks, for instance, you can gulp down a mega-drink in ten minutes, and digest it completely within an hour or less, leaving you ready for another one. Get the same amount of Calories from fresh vegetables, though, and you’re probably going to be full, and have no interest in eating anything more until the next mealtime.