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Episode 3: What's Wrong with Eating Clean? · The Antisocial Doctors Podcast

• 1:27
  Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
• 1:38
  Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
• 1:43
  Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
• 1:48
  Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
• 1:56
  Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
• 1:58
  Rebecca Berens MD: Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion.
• 2:02
  Rebecca Berens MD: That comes from social media's messaging around health.
• 2:05
  Rebecca Berens MD: In each episode, we discuss a health related topic trending on social media with curiosity, nuance evidence, humility, and compassion.
• 2:12
  Sonia Singh MD: This is not your average debunking podcast we wanna explore not just what is trending on social media.
• 2:17
  Sonia Singh MD: But why?
• 2:18
  Sonia Singh MD: Why are so many people drawn to this?
• 2:20
  Sonia Singh MD: What is the nugget of truth here?
• 2:21
  Sonia Singh MD: What are the facts?
• 2:23
  Sonia Singh MD: What can we learn from this as patients and doctors?
• 2:25
  Sonia Singh MD: No shame.
• 2:26
  Sonia Singh MD: No blame, no snark.
• 2:27
  Rebecca Berens MD: We're so glad you're here.
• 2:43
  Sonia Singh MD: Hey Rebecca.
• 2:44
  Sonia Singh MD: Hey Sonia.
• 2:45
  Sonia Singh MD: I am really excited to cover this topic It's one that I think we both have a lot of strong opinions on for various reasons.
• 2:51
  Sonia Singh MD: So tell us a little bit about the story that inspired this week's episode.
• 2:54
  Sonia Singh MD: Yeah,
• 2:55
  Rebecca Berens MD: This is a story from when I was a medical student on a surgery rotation and, the student that was on the rotation with me, we were both getting there at literally four in the morning and leaving at maybe seven o'clock at night.
• 3:06
  Rebecca Berens MD: We would pre-round, we would be in the OR all day, then we would.
• 3:08
  Rebecca Berens MD: Be post rounding and you never knew when you were going home.
• 3:12
  Rebecca Berens MD: So it was one of those situations where it's eat when you can, sleep, when you can, that kind of thing.
• 3:16
  Rebecca Berens MD: But my cot student on the rotation was very focused on clean eating.
• 3:20
  Rebecca Berens MD: This was something that was very important to them.
• 3:22
  Rebecca Berens MD: And I distinctly remember this day that I think it was probably like one or two o'clock in the afternoon.
• 3:28
  Rebecca Berens MD: Like I said, we'd been there since four in the morning.
• 3:30
  Rebecca Berens MD: We had not eaten anything all day.
• 3:32
  Rebecca Berens MD: And.
• 3:33
  Rebecca Berens MD: I was still recovering from my eating shoulder at this point and was, carrying granola bars in my pocket to just make sure I could eat something.
• 3:41
  Rebecca Berens MD: And I remember this person making comments about the granola bars I was eating.
• 3:46
  Rebecca Berens MD: Like, oh, those are so processed.
• 3:48
  Rebecca Berens MD: Why are you eating that?
• 3:49
  Rebecca Berens MD: And then we finally had a chance to go to the cafeteria.
• 3:51
  Rebecca Berens MD: So we go to the hospital cafeteria and they said like, oh, there's.
• 3:55
  Rebecca Berens MD: Nothing good in this cafeteria.
• 3:57
  Rebecca Berens MD: It's also processed, processed crap, I think was the words they used.
• 4:00
  Rebecca Berens MD: And all they ate for lunch that day was steamed green beans.
• 4:04
  Rebecca Berens MD: 'cause that was the only thing that they deemed clean enough in the cafeteria for them to eat.
• 4:08
  Rebecca Berens MD: And then we went home at like six or seven o'clock at night and that was all they had eaten all day.
• 4:12
  Rebecca Berens MD: And you know, that breaks the
• 4:13
  Sonia Singh MD: heart for both of you.
• 4:14
  Rebecca Berens MD: Yes.
• 4:15
  Rebecca Berens MD: It was very difficult.
• 4:16
  Rebecca Berens MD: And it, it just really, highlighted for me this attitude that there is even amongst healthcare professionals.
• 4:22
  Rebecca Berens MD: Mm-hmm.
• 4:22
  Rebecca Berens MD: Like we know that's not a healthy behavior to go that long, eating only some steamed green beans, but this attitude about clean eating is so pervasive.
• 4:30
  Speaker 3: Mm-hmm.
• 4:30
  Rebecca Berens MD: So I wanted to address that today'cause it's a topic we hear a lot about patients often talking about wanting to eat clean.
• 4:36
  Rebecca Berens MD: Yeah.
• 4:36
  Rebecca Berens MD: A big, comment on social media.
• 4:38
  Rebecca Berens MD: So let's talk about that today.
• 4:39
  Rebecca Berens MD: Yeah.
• 4:40
  Rebecca Berens MD: So what is the actual claim around clean eating?
• 4:42
  Rebecca Berens MD: It's unclear because people don't even really degree in what clean eating is.
• 4:46
  Rebecca Berens MD: Yeah.
• 4:47
  Rebecca Berens MD: You know, there's no clear definition about what clean eating is, but I think there, there is this sort of generalized claim amongst influencers, fitness gurus, biohackers.
• 4:58
  Rebecca Berens MD: The various people on social media who advocate that we should eat clean and if we eat clean, we will be able to reduce our risk of chronic disease and we'll be healthy and we'll be happier and, our weight will be better.
• 5:11
  Rebecca Berens MD: And, and all of these things, clean eating is the answer to everything'll, get sick less, all of this.
• 5:15
  Rebecca Berens MD: But again, no actual definitive agreement on what clean eating means.
• 5:19
  Rebecca Berens MD: Mm-hmm.
• 5:19
  Rebecca Berens MD: I think there's generalized agreement that eating clean means.
• 5:23
  Rebecca Berens MD: Means eating more whole foods that are less processed and don't have artificial additives.
• 5:27
  Rebecca Berens MD: But again, like which ingredients are considered clean or not?
• 5:30
  Rebecca Berens MD: 'cause some clean eating things that are promoted are also processed, right?
• 5:34
  Rebecca Berens MD: Just have slightly different ingredients than the unclean or dirty, or, I don't even, I don't know what the other version is considered.
• 5:40
  Rebecca Berens MD: So we're not gonna have time in this podcast to go into the nitty gritty about every single one of those various ingredients and whether it's considered clean or not.
• 5:47
  Rebecca Berens MD: But I just wanna discuss the concept of clean.
• 5:50
  Rebecca Berens MD: Versus not clean eating and how it could be harmful or counterproductive to health.
• 5:56
  Sonia Singh MD: So why do you think so many people are drawn to the concept of clean eating?
• 6:01
  Rebecca Berens MD: So I think in general, most people.
• 6:04
  Rebecca Berens MD: A, a strong value for them is wanting to live a long and healthy life with as little interaction with the healthcare system as possible.
• 6:11
  Rebecca Berens MD: I think that's a generally true value that most people have.
• 6:14
  Rebecca Berens MD: And in general, I think we found a study that showed in general there is a very strong positive perception of clean eating amongst adolescents and adults in the us.
• 6:25
  Rebecca Berens MD: But.
• 6:27
  Rebecca Berens MD: Again, lots of disagreement on what that actually means.
• 6:30
  Rebecca Berens MD: And so in general, I think the concept of health is very important to people.
• 6:33
  Rebecca Berens MD: And people want to do everything that they can to be as healthy as they can.
• 6:37
  Rebecca Berens MD: And particularly in a world where there's less and less that we can control.
• 6:42
  Sonia Singh MD: Yeah.
• 6:42
  Rebecca Berens MD: What we eat seems like something that we do have control over that could maybe affect our outcomes.
• 6:47
  Rebecca Berens MD: So if there's something we can control to make us healthier, that's what we wanna do.
• 6:51
  Rebecca Berens MD: I think also nutrition is very confusing.
• 6:53
  Rebecca Berens MD: And particularly in the way that foods are labeled or even the education about it, there's very little education in general about nutrition in school.
• 7:02
  Rebecca Berens MD: And I think even just amongst families, what's passed down is kind of being lost.
• 7:08
  Rebecca Berens MD: Yeah.
• 7:08
  Rebecca Berens MD: There's not a lot of.
• 7:09
  Rebecca Berens MD: Good understanding of nutrition or how to cook or build a balanced meal.
• 7:13
  Rebecca Berens MD: Like we're, we're losing a lot of that societally.
• 7:15
  Rebecca Berens MD: And then I think also we live in a society that, for a variety of reasons, heavily stigmatizes people who live in larger bodies.
• 7:24
  Rebecca Berens MD: And there's a lot of places that this comes from.
• 7:27
  Rebecca Berens MD: I think it's heavily rooted in, the misapplication of the BMI and, the racism that went into that.
• 7:33
  Rebecca Berens MD: But.
• 7:35
  Rebecca Berens MD: In general, there's just this sort of good and evil when it comes to what you eat and your body size, and that's just so deeply ingrained in us, societally and culturally that I think it's then being.
• 7:49
  Rebecca Berens MD: Applied further to food.
• 7:51
  Rebecca Berens MD: And you had a really interesting mm-hmm.
• 7:52
  Rebecca Berens MD: Book that you told me about that had an interesting quote around this.
• 7:55
  Rebecca Berens MD: I'd love to hear you share more about that.
• 7:57
  Sonia Singh MD: Yeah.
• 7:58
  Sonia Singh MD: So I had read this book called Gospel of Wellness by Rinna Raphael.
• 8:02
  Sonia Singh MD: And if you're listening to this podcast and you're interested in anything in the health and wellness space, I highly recommend it.
• 8:08
  Sonia Singh MD: It's really well researched and super interesting.
• 8:10
  Sonia Singh MD: But basically she points out how a lot of different.
• 8:14
  Sonia Singh MD: Virtues and ideologies that were prevalent in organized religion are now kind of being applied to wellness practices as less and less people are part of organized religion.
• 8:25
  Sonia Singh MD: And so one of the things she talks about in that is this.
• 8:29
  Sonia Singh MD: Idea of purity through food and kind of the moralization of food.
• 8:34
  Sonia Singh MD: And there's a social psychologist, Jonathan Het, who has talked about this as well.
• 8:38
  Sonia Singh MD: So I wanted to share a quote from his TED Talk and the quote is, so.
• 8:43
  Sonia Singh MD: Purity is not just about suppressing female sexuality, it's about any kind of ideology, any kind of idea that tells you that you can attain virtue by controlling what you do with your body, by controlling what you put into your body.
• 8:57
  Sonia Singh MD: And while the political right may moralize sex more, the political left is really doing a lot of it with food.
• 9:03
  Sonia Singh MD: Food is becoming moralized, and a lot of it is ideas about purity and about what you're willing to touch or put into your body.
• 9:11
  Sonia Singh MD: Now, one thing he kind of touched upon was how purity is uniquely applied to women.
• 9:17
  Sonia Singh MD: And it's funny because when we were researching for this topic, I mentioned to my husband, oh, we're doing an episode on clean eating.
• 9:24
  Sonia Singh MD: And his response was like, what's that?
• 9:26
  Sonia Singh MD: And he's a doctor and also on social media and also listens to a variety of.
• 9:32
  Sonia Singh MD: Podcast bros that talk about health and fitness and he had never really heard the like, he wasn't very familiar with the phrase.
• 9:39
  Sonia Singh MD: And it struck me in that moment gosh, it is really gendered.
• 9:42
  Sonia Singh MD: Like it is something that you definitely hear female influencers talk about way more than you hear male influencers talk about, which is a really interesting idea.
• 9:50
  Sonia Singh MD: Like why is that?
• 9:52
  Sonia Singh MD: And I found this other essay called Purity Culture.
• 9:56
  Sonia Singh MD: Diet Culture, and where they intersect, where the author kind of touches upon this.
• 9:59
  Sonia Singh MD: And I thought, what.
• 10:00
  Sonia Singh MD: What she said about it was super interesting.
• 10:02
  Sonia Singh MD: So this is what she says.
• 10:02
  Sonia Singh MD: She says.
• 10:04
  Sonia Singh MD: In the end, purity.
• 10:06
  Sonia Singh MD: Whether access through the medium of food or sexuality expresses itself in our culture through female bodies.
• 10:13
  Sonia Singh MD: It asks those with female bodies to restrain refrain limit.
• 10:17
  Sonia Singh MD: It asks us to make ourselves smaller, both physically and in terms of life experience.
• 10:22
  Sonia Singh MD: It asks us to take less and be satisfied with what we get, and that's why a rejection of purity culture must be accompanied by a rejection of diet culture.
• 10:32
  Sonia Singh MD: Wow.
• 10:32
  Sonia Singh MD: I know.
• 10:33
  Sonia Singh MD: I, I read that and I was like, whew.
• 10:35
  Sonia Singh MD: Oh my gosh.
• 10:36
  Sonia Singh MD: I don't think that's something I had ever consciously thought about when I was hearing the phrase clean eating in the past.
• 10:41
  Sonia Singh MD: The other thing that this kind of points to is the link between clean eating and diet culture.
• 10:45
  Sonia Singh MD: And it's funny now that, I don't think it's acceptable or cool for people to be like, I'm on a diet, so most people will say, I'm trying to eat clean.
• 10:54
  Sonia Singh MD: They'll say, I'm on a health journey, or I'm on a fitness journey.
• 10:57
  Sonia Singh MD: And I think it's important to recognize that a lot of times we're actually just saying the same thing.
• 11:01
  Sonia Singh MD: It's just wrapped up as something different.
• 11:04
  Rebecca Berens MD: Yeah.
• 11:04
  Rebecca Berens MD: Ultimately, the concept that's being stated there is if something bad happens to you, it's your fault because you didn't do the right thing, you were not virtuous.
• 11:12
  Rebecca Berens MD: And therefore, if you did.
• 11:13
  Rebecca Berens MD: If you do get diabetes or have some other sort of health problem, it's because you didn't do something like, this is your fault.
• 11:19
  Rebecca Berens MD: It's a punishment.
• 11:20
  Rebecca Berens MD: Mm-hmm.
• 11:21
  Rebecca Berens MD: You sinned.
• 11:21
  Rebecca Berens MD: You know?
• 11:21
  Rebecca Berens MD: It is, it's so wrapped up in that sort of purity and religious kind of talk.
• 11:26
  Rebecca Berens MD: Mm-hmm.
• 11:27
  Rebecca Berens MD: And, and yeah, like you said, dieting is now becoming a thing of the past, but it's just really gotten another name.
• 11:33
  Rebecca Berens MD: Yeah.
• 11:33
  Rebecca Berens MD: So yeah, it's, it's a very interesting shift that's happened.
• 11:36
  Rebecca Berens MD: I think it's important for us to continuously reexamine it because.
• 11:40
  Rebecca Berens MD: It's ultimately all the same problem.
• 11:42
  Rebecca Berens MD: Yeah.
• 11:42
  Rebecca Berens MD: Wrapped up in different packaging.
• 11:43
  Rebecca Berens MD: Totally.
• 11:44
  Sonia Singh MD: So tell us what you think the nugget of truth is here.
• 11:47
  Sonia Singh MD: Why is cleaning so compelling to people and what's the truth in it?
• 11:50
  Rebecca Berens MD: Yeah, so the truth is, obviously different foods have different nutritional content.
• 11:55
  Rebecca Berens MD: We can't argue about that.
• 11:56
  Rebecca Berens MD: That's a hundred percent true.
• 11:57
  Rebecca Berens MD: Mm-hmm.
• 11:58
  Rebecca Berens MD: And, and there are certainly different nutrients, a variety of different nutrients that we need to have in our diets to be.
• 12:04
  Rebecca Berens MD: Healthy to have all of our nutritional needs met.
• 12:06
  Rebecca Berens MD: We need to eat consistently enough of the various macronutrients and micronutrients to be able to be healthy.
• 12:12
  Rebecca Berens MD: And if we have, a lack of some or all of a certain food group or a certain nutrient group, we are likely to suffer some sort of health consequence as a result of that.
• 12:21
  Rebecca Berens MD: And I think it is important to, to highlight the truth in the fact that if you eat a mostly ultra processed food diet.
• 12:29
  Rebecca Berens MD: There probably will be significant lack of certain nutrients, particularly fiber is a big one.
• 12:34
  Rebecca Berens MD: Mm-hmm.
• 12:34
  Rebecca Berens MD: And we can't hide from that fact, right?
• 12:36
  Rebecca Berens MD: Mm-hmm.
• 12:36
  Rebecca Berens MD: That's a hundred percent true.
• 12:37
  Rebecca Berens MD: And I think, you kind of brought up that sometimes that's.
• 12:41
  Rebecca Berens MD: Ignored when people try to talk about this topic.
• 12:43
  Speaker 3: Mm-hmm.
• 12:44
  Rebecca Berens MD: But so we can't hide from that fact.
• 12:46
  Rebecca Berens MD: That is true.
• 12:47
  Rebecca Berens MD: But I think the important thing to examine is what, what does that really mean?
• 12:51
  Rebecca Berens MD: What is the, the true factual of how much that nutrition is affecting your health, and how much of it is other factors that we maybe have less control over?
• 13:00
  Sonia Singh MD: Yeah, I think that topic of control or the theme of control is gonna come up over and over again in a lot of our episodes where, oftentimes what we're seeking when we're taking these types of, suggestions and this guidance from social media is some type of control and autonomy over something.
• 13:17
  Sonia Singh MD: And often it's something that.
• 13:19
  Sonia Singh MD: We actually don't have control over and that's why we're seeking it in this place.
• 13:22
  Sonia Singh MD: So anyway, tell us a little bit about what the data and facts are around clean eating.
• 13:27
  Rebecca Berens MD: Okay.
• 13:28
  Rebecca Berens MD: I think first what I wanna comment on is just what does it mean to eat a processed food?
• 13:32
  Speaker 3: Mm-hmm.
• 13:33
  Rebecca Berens MD: Processing can be anything from Peeling and cutting a vegetable that's technically processing all the way to creating a prepackaged snack that has a very long shelf life and is full of, salt and additives that make it super tasty and crunchy and delicious.
• 13:48
  Rebecca Berens MD: Mm-hmm.
• 13:48
  Rebecca Berens MD: There's a wide variety of what processed means.
• 13:51
  Rebecca Berens MD: And I think if we were to entirely eliminate processed food, the vast majority of people would not have access to enough food on a consistent basis.
• 13:59
  Rebecca Berens MD: Yeah.
• 13:59
  Rebecca Berens MD: We are not living in a world anymore where.
• 14:02
  Rebecca Berens MD: We have a farm in the backyard that we can go and pick fresh produce and slaughter our own animals and, grind our own grain.
• 14:08
  Rebecca Berens MD: That's just not how any of us live.
• 14:10
  Rebecca Berens MD: And so we do need a way to efficiently distribute food amongst a large number of people in a way that keeps it.
• 14:18
  Rebecca Berens MD: Safe and able to be eaten for a longer period of time to survive that transportation.
• 14:22
  Rebecca Berens MD: Right.
• 14:22
  Rebecca Berens MD: So, so it is important to understand that all processing is not bad.
• 14:27
  Rebecca Berens MD: Yeah.
• 14:27
  Rebecca Berens MD: And in fact, processing is necessary for us to be able to feed.
• 14:31
  Rebecca Berens MD: The Earth's population.
• 14:32
  Rebecca Berens MD: Yeah.
• 14:32
  Rebecca Berens MD: In the modern world.
• 14:33
  Sonia Singh MD: And there's some examples, like the classic example is flash frozen produce.
• 14:37
  Sonia Singh MD: You know, fruits and vegetables potentially are more nutritious than getting something fresh that's not at the peak ripeness.
• 14:42
  Sonia Singh MD: So you know, this idea that processing automatically equals bad is kind of an oversimplification.
• 14:49
  Rebecca Berens MD: Absolutely.
• 14:50
  Rebecca Berens MD: And I think, the processed food that I think most people are thinking of when they're thinking of that's like un unclean.
• 14:56
  Rebecca Berens MD: I don't know what you're supposed to call the other food, but unclean food is typically the food that's been specifically engineered by food companies to taste good so that we will eat and buy more of it.
• 15:07
  Rebecca Berens MD: This is a true fact.
• 15:09
  Rebecca Berens MD: The food manufacturers literally have food scientists that sit there and try to come up with the perfect combination of crunchiness and saltiness and sweetness to make a snack.
• 15:17
  Rebecca Berens MD: Extra delicious.
• 15:18
  Rebecca Berens MD: Yeah.
• 15:18
  Rebecca Berens MD: So that you will eat more of it and buy more of it.
• 15:20
  Rebecca Berens MD: That's absolutely true.
• 15:21
  Rebecca Berens MD: And in the process of doing that, often there are quite a few nutrients.
• 15:25
  Rebecca Berens MD: Removed.
• 15:26
  Rebecca Berens MD: Mm-hmm.
• 15:27
  Rebecca Berens MD: And or even like fiber for example, is, is often very low in those types of foods.
• 15:31
  Rebecca Berens MD: And so they are less nutritionally dense, meaning the number of macronutrients and micronutrients and fiber per calorie is less in a food like that versus a less processed or more whole food.
• 15:42
  Rebecca Berens MD: Right.
• 15:43
  Rebecca Berens MD: And so that is also true and I think it's important to, to recognize the fact that.
• 15:46
  Rebecca Berens MD: This is a tactic of food companies for marketing purposes.
• 15:50
  Speaker 3: Mm-hmm.
• 15:50
  Rebecca Berens MD: To make us buy more food because it bypasses our normal signals for satiety That we have when we eat a food normally, we get some hormonal feedback from our stomach when it feels stretched and full.
• 16:02
  Rebecca Berens MD: We get some neurotransmitters in our brain that tell us like, oh, you've had a satiating meal, now we're full.
• 16:07
  Rebecca Berens MD: And, and they're specifically engineered to override that, and I think that's important to call out that that is a factual truth.
• 16:13
  Sonia Singh MD: Yeah.
• 16:13
  Sonia Singh MD: I think.
• 16:13
  Sonia Singh MD: What we're seeing a lot of attention around now is on the additives and the preservatives and the dyes, and what I always try to emphasize with people about processed foods is what makes ultra processed foods harmful is really, it's that combination, like you said, of salt, sugar, and fat that makes you wanna eat more and override those signals.
• 16:31
  Sonia Singh MD: But it's also just what they're devoid of and what they're replacing in your diet, and how, Most Americans don't get enough fiber, and so these foods are going to be providing you a bunch of calories without fiber.
• 16:40
  Sonia Singh MD: And I think right now the focus is so much on additives, preservatives, and dyes, that you could make a product that is totally processed and still devoid of a lot of nutrients and just remove some of those things and call it clean.
• 16:52
  Sonia Singh MD: Yeah.
• 16:52
  Sonia Singh MD: Or put a clean label on it.
• 16:54
  Sonia Singh MD: And again, that's just slick marketing.
• 16:55
  Sonia Singh MD: It doesn't actually mean that product is any more nutritious.
• 16:58
  Rebecca Berens MD: Uh, exactly.
• 16:59
  Rebecca Berens MD: Exactly.
• 16:59
  Rebecca Berens MD: And I think it's bypassing the real problem, which is.
• 17:03
  Rebecca Berens MD: We have an inequitable food environment.
• 17:07
  Rebecca Berens MD: We have many areas of the country where people live that are food deserts.
• 17:11
  Rebecca Berens MD: There is no grocery store that has fresh foods available, or the people who live there have limited funds to be able to purchase those types of fresh foods.
• 17:20
  Rebecca Berens MD: We work in environments that.
• 17:23
  Rebecca Berens MD: Do not allow us adequate break time to go and get a real meal.
• 17:26
  Rebecca Berens MD: People are eating a rushed DoorDash meal at their desk because they are working a job that has such immense pressure on them that it's.
• 17:34
  Rebecca Berens MD: Taking away their ability to get up, use the bathroom and have a lunch break.
• 17:37
  Rebecca Berens MD: Yeah.
• 17:37
  Rebecca Berens MD: Been there, you know?
• 17:38
  Rebecca Berens MD: Right.
• 17:39
  Rebecca Berens MD: Exactly.
• 17:39
  Rebecca Berens MD: I mean, every doctor in in the country can attest we do not pee all day.
• 17:44
  Rebecca Berens MD: Right.
• 17:44
  Rebecca Berens MD: And so it's culturally speaking and, and the way that our society is designed.
• 17:50
  Rebecca Berens MD: We have taken away the ability to meet our basic needs.
• 17:53
  Rebecca Berens MD: And so people are forced to reach for these more convenient, easy access, fast products just to be able to eat.
• 17:59
  Rebecca Berens MD: Yeah.
• 18:00
  Rebecca Berens MD: And have enough fuel to get through the day and yeah.
• 18:02
  Rebecca Berens MD: It's probably not the most nutritionally balanced option.
• 18:05
  Rebecca Berens MD: Yeah.
• 18:05
  Rebecca Berens MD: But what choice do people have and and these people that don't have the financial access to go and.
• 18:11
  Rebecca Berens MD: Buy all of these fresh foods, the time to prepare it.
• 18:14
  Rebecca Berens MD: A lot of these people may be working multiple jobs.
• 18:16
  Rebecca Berens MD: Yeah.
• 18:17
  Rebecca Berens MD: They have kids they have to take to and from childcare or school.
• 18:20
  Rebecca Berens MD: It's we're expecting a lot from people and we're taking a lot from people, but when you make the focus about the additives or the dyes, it tells people oh, you have complete control over this.
• 18:31
  Rebecca Berens MD: This is your problem.
• 18:32
  Rebecca Berens MD: Mm-hmm.
• 18:32
  Rebecca Berens MD: Rather than this is a societal problem that as a society we need to fix together.
• 18:36
  Sonia Singh MD: A hundred percent.
• 18:37
  Sonia Singh MD: I actually, so I wanted to share sort of, this was all before clean eating became a thing, but I went through a few phases in my life where I was like very conscientious about what I was eating.
• 18:47
  Sonia Singh MD: One was in undergrad when I got first interested in nutrition, and then I got a master's in nutrition.
• 18:53
  Sonia Singh MD: So then when I was in nutrition school, I was very thoughtful and conscientious about it.
• 18:56
  Sonia Singh MD: And then there was another period towards the end of residency when I was.
• 18:59
  Sonia Singh MD: Thinking a lot about what I was eating.
• 19:01
  Sonia Singh MD: And at the time, clean eating wasn't a phrase.
• 19:03
  Sonia Singh MD: So I was telling people like, I'm just eating real food.
• 19:05
  Sonia Singh MD: That was my phrase at the time.
• 19:06
  Sonia Singh MD: I was reading a lot of Michael Pollan and he talks about food, eating food and eating real food.
• 19:10
  Sonia Singh MD: So I was talking about I only eat real food and I think for me, I was never totally obsessional about it.
• 19:16
  Sonia Singh MD: There wasn't a body image issue there.
• 19:18
  Sonia Singh MD: It was just a little bit heightened attention towards that issue.
• 19:21
  Sonia Singh MD: But I was kind of flirting with Orthorexia at that time, in those times in my life.
• 19:26
  Sonia Singh MD: At the time I was single, I had total control over my food.
• 19:30
  Sonia Singh MD: I had good access to food.
• 19:31
  Sonia Singh MD: I lived in the Bay Area.
• 19:32
  Sonia Singh MD: There was a farmer's market down the street.
• 19:34
  Sonia Singh MD: It was actually not that hard for me to eat real food, eat real food, quote unquote if I tried to hold myself to those standards that I had now as a 39-year-old woman with two picky kids and a husband who has a totally different palette and preferences than mine.
• 19:49
  Sonia Singh MD: I would be just drowning in guilt and shame, especially if that those foods were like, tied to morality and purity and all the things we're talking about.
• 19:58
  Sonia Singh MD: And, I think at, at this stage of my life, like I have to eat a granola bar.
• 20:02
  Sonia Singh MD: Sometimes I have to go through a drive-through.
• 20:03
  Sonia Singh MD: Sometimes I ate a frozen pizza last night, I ate a frozen pizza for dinner.
• 20:06
  Sonia Singh MD: Um, you know, this is just living in the real world.
• 20:09
  Sonia Singh MD: This is modern life and their realities of modern life.
• 20:12
  Sonia Singh MD: So, I think.
• 20:13
  Sonia Singh MD: For a lot of people, I imagine when they're seeing, people sharing their clean eating tips and their clean eating recipes, it feels very aspirational.
• 20:23
  Sonia Singh MD: And honestly unachievable for a lot of people.
• 20:26
  Rebecca Berens MD: And to your point, I think.
• 20:28
  Rebecca Berens MD: The story I hear over and over from my patients who've struggled with disordered eating and even myself, it often starts like that.
• 20:34
  Rebecca Berens MD: Mm-hmm.
• 20:35
  Rebecca Berens MD: You know, it's like, oh, I just wanna make healthier choices.
• 20:37
  Rebecca Berens MD: I wanna, you know, I wanna be healthy, I wanna do the right things.
• 20:41
  Rebecca Berens MD: This is how it started for me, is how it started for so many people.
• 20:44
  Rebecca Berens MD: Yeah.
• 20:44
  Rebecca Berens MD: Trying to include more whole foods, exercising more.
• 20:47
  Rebecca Berens MD: There is a strong genetic component to eating disorders that I don't think people fully realize.
• 20:51
  Rebecca Berens MD: And.
• 20:52
  Rebecca Berens MD: It's one of those things where it's a combination of factors that triggers an eating disorder.
• 20:56
  Rebecca Berens MD: Mm-hmm.
• 20:57
  Rebecca Berens MD: There's a genetic predisposition, there's some environmental change, like change in your eating habits.
• 21:03
  Rebecca Berens MD: Yeah.
• 21:03
  Rebecca Berens MD: There's maybe other psychological stressors that are heightening your need for control or, the way that you're responding to the stressors in your life is going to be a trigger.
• 21:12
  Rebecca Berens MD: And, and that combination of things is what kind of.
• 21:15
  Rebecca Berens MD: Jumps it into a full eating disorder, so it doesn't happen to everyone.
• 21:18
  Rebecca Berens MD: Yeah.
• 21:19
  Rebecca Berens MD: Right.
• 21:19
  Rebecca Berens MD: Like in your case, you maybe didn't go fully down that rabbit hole, but it, it does happen to a lot of people and, and we do see data showing that there is a correlation, for example, with adolescents mm-hmm.
• 21:28
  Rebecca Berens MD: And social media use and the development of eating disorders.
• 21:31
  Rebecca Berens MD: Mm-hmm.
• 21:31
  Rebecca Berens MD: And I can't imagine that it doesn't have a lot to do with eat clean.
• 21:36
  Rebecca Berens MD: Mm-hmm.
• 21:36
  Rebecca Berens MD: What I eat in the day, and this is what I hear from patients.
• 21:38
  Rebecca Berens MD: It's like I was seeing a lot of this.
• 21:40
  Rebecca Berens MD: I started doing this, and then it, it progressed.
• 21:44
  Rebecca Berens MD: And so I think, there is also real harm
• 21:46
  Sonia Singh MD: Yeah.
• 21:46
  Rebecca Berens MD: In promoting that sort of behavior for a decently large population of people.
• 21:52
  Sonia Singh MD: Yeah.
• 21:52
  Sonia Singh MD: I, I think that, you're hitting on a point of like, we've shifted away, I think sometimes from overtly talking about thinness as the goal or a certain body type as the goal, even though that may be the underlying goal and.
• 22:05
  Sonia Singh MD: Positioning it as just clean eating or eating for good health is kind of a way to mask and have it be socially more acceptable to say well, I'm just trying to eat clean, rather than oh, I'm just trying to be X number of pounds, or I'm trying to and actually I realized that I used the word orthorexia and we never really defined it.
• 22:22
  Sonia Singh MD: Yeah.
• 22:22
  Sonia Singh MD: So can you talk a little bit about orthorexia and what.
• 22:24
  Rebecca Berens MD: Yeah.
• 22:24
  Rebecca Berens MD: So Orthorexia, it's not an official DSM diagnosis necessarily, but, but essentially it is, it is when clean eating starts to devolve into more disordered behavior to where there's actual, like the person I mentioned at the beginning of this episode, the medical student mm-hmm.
• 22:39
  Rebecca Berens MD: That That person significantly restricted their intake below their caloric needs for that day.
• 22:44
  Speaker 3: Mm-hmm.
• 22:45
  Rebecca Berens MD: Because the preferred foods were not available.
• 22:48
  Rebecca Berens MD: Mm-hmm.
• 22:48
  Rebecca Berens MD: Therefore, they did not meet their nutritional needs.
• 22:50
  Rebecca Berens MD: And, to be diagnosed with an eating disorder, there has to be a medical and or psychological consequence to your eating behaviors.
• 22:56
  Rebecca Berens MD: Mm-hmm.
• 22:57
  Rebecca Berens MD: And I would argue that that was one, right?
• 22:59
  Rebecca Berens MD: Mm-hmm.
• 22:59
  Rebecca Berens MD: Yeah.
• 22:59
  Rebecca Berens MD: Where, you're not meeting your co coic needs for the day because you restricted.
• 23:03
  Rebecca Berens MD: So significantly based on the food that was available, not being what you believed to be preferred.
• 23:08
  Rebecca Berens MD: So with Orthorexia, people think of anorexia as there's a body image component.
• 23:12
  Rebecca Berens MD: I'm restricting my mm-hmm.
• 23:13
  Rebecca Berens MD: Intake because I want to change my body shape or size.
• 23:15
  Rebecca Berens MD: Yeah.
• 23:15
  Rebecca Berens MD: Orthorexia could be a similar restriction.
• 23:19
  Rebecca Berens MD: Maybe not a claim around body shape or size, but around doing the right thing, quote unquote for eating in a clean way.
• 23:26
  Rebecca Berens MD: I'm only going to eat if it's clean.
• 23:28
  Rebecca Berens MD: Yeah.
• 23:28
  Rebecca Berens MD: And that can lead to significant restriction.
• 23:30
  Sonia Singh MD: Yeah.
• 23:30
  Sonia Singh MD: And I don't know the statistics on this, but I feel like.
• 23:33
  Sonia Singh MD: I see a lot of patients.
• 23:34
  Sonia Singh MD: I mean, that's a selection bias thing because I think a lot of them are really invested in their health, and so they're going outta their way to find doctors and seek out, professionals and, investing in their health.
• 23:43
  Sonia Singh MD: But, I think it's probably a lot more
• 23:45
  Rebecca Berens MD: prevalent than we realize.
• 23:46
  Rebecca Berens MD: Absolutely.
• 23:47
  Rebecca Berens MD: And I think the, It's very normalized also.
• 23:49
  Rebecca Berens MD: Yeah.
• 23:49
  Rebecca Berens MD: It's, it's not viewed as a problem.
• 23:51
  Rebecca Berens MD: Yeah.
• 23:51
  Rebecca Berens MD: In
• 23:52
  Sonia Singh MD: fact, it's celebrated, I think.
• 23:53
  Sonia Singh MD: Yes.
• 23:53
  Sonia Singh MD: In a lot.
• 23:53
  Sonia Singh MD: Yes, it is.
• 23:54
  Rebecca Berens MD: And that's why it's, it's particularly harmful for people who aren't prone to developing eating disorder because their behaviors that are disordered and actually harming them are celebrated and encouraged.
• 24:04
  Speaker 3: And
• 24:04
  Rebecca Berens MD: then if you're the doctor that's saying actually, it's maybe okay to eat some processed food if that's all that available.
• 24:09
  Rebecca Berens MD: On social media, someone will say you're promoting obesity, or whatever it is that they're saying, and it's just, it doesn't have to be this false dichotomy.
• 24:16
  Rebecca Berens MD: We can promote balanced nutrition for everyone.
• 24:19
  Sonia Singh MD: Yeah.
• 24:19
  Rebecca Berens MD: But that has to be balanced.
• 24:21
  Rebecca Berens MD: It doesn't have to be so regimented and restrictive.
• 24:23
  Sonia Singh MD: You know what's interesting is when I first started doing social media, a lot of times I would just post like.
• 24:29
  Sonia Singh MD: Oh, this is my breakfast.
• 24:30
  Sonia Singh MD: Here's a recipe I'm making for dinner.
• 24:32
  Sonia Singh MD: And honestly, I was doing it because it's easy free content, and I was doing that stuff anyway and I was like, why not share it?
• 24:37
  Sonia Singh MD: And what's funny is I got feedback from a lot of patients that were like, oh my God, you eat like I eat.
• 24:43
  Sonia Singh MD: And I think they were saying.
• 24:45
  Sonia Singh MD: They were surprised that I was eating bread, I was eating pasta and I just let my kids make cupcakes out of a box.
• 24:51
  Sonia Singh MD: You know, they, I think they were so conditioned to see people in the health and wellness space presenting these really idealized, grain-free, gluten-free, da da da, the, these very rigid meals that, to see somebody just pour something out of a jar and making some boiled pasta and, throwing some, throwing a bag salad on the table.
• 25:11
  Sonia Singh MD: Like it, to them, it just felt like, so unusual and, remarkable.
• 25:15
  Sonia Singh MD: And that, that really struck me.
• 25:16
  Sonia Singh MD: I was I I didn't realize people thought that, I guess they assumed that like, all doctors or people who are in the healthcare space are eating these very rigid diets, and that's not true at all.
• 25:27
  Sonia Singh MD: Yeah, absolutely.
• 25:28
  Sonia Singh MD: Okay.
• 25:29
  Sonia Singh MD: Anyway, let's get on to, data, can you share a little bit of data on what we know about clean eating?
• 25:34
  Rebecca Berens MD: Yeah.
• 25:34
  Rebecca Berens MD: So, one thing that we found was, so according to a 2015 study by the CDC, approximately 60% of the average Americans diet comes from processed foods.
• 25:42
  Rebecca Berens MD: And so that is, relating to what we talked about earlier.
• 25:46
  Rebecca Berens MD: We are very reliant on processed foods and I think, again, that's blamed a lot for a lot of the.
• 25:53
  Rebecca Berens MD: Chronic health conditions mm-hmm.
• 25:54
  Rebecca Berens MD: That we have in this country.
• 25:55
  Rebecca Berens MD: But, but as I said, there's a lot of other factors to that that we have to consider.
• 26:00
  Rebecca Berens MD: we found several articles, again, detailing the data behind what we're talking about, about how this can contribute to more restrictive, restrained eating or even disordered or eating disorders.
• 26:11
  Rebecca Berens MD: There was a study a cross-sectional survey showing.
• 26:14
  Rebecca Berens MD: Women ranging in age from 17 to 55, and a significantly higher population of women who adhere to dietary advice from clean eating sites met the dietary guidelines.
• 26:24
  Rebecca Berens MD: So improved nutrition However, they also had significantly higher levels of restrained eating, which again, in the right person, in the right side of circumstances can turn into an eating disorder.
• 26:37
  Rebecca Berens MD: And so I think this is like just a really important thing to keep in mind.
• 26:39
  Rebecca Berens MD: Yes, there's maybe benefit.
• 26:41
  Rebecca Berens MD: But there are also harms.
• 26:42
  Rebecca Berens MD: And so like anything in medicine, when we're making a recommendation, we have to be aware of the benefits of in harms and individualize those recommendations to the patient in front of us.
• 26:51
  Sonia Singh MD: Yeah, I think that's such a key point.
• 26:53
  Sonia Singh MD: Like whenever I see nutrition advice on social media especially, I always try to think about like how would you apply this to different populations?
• 27:01
  Sonia Singh MD: Because, you and I know as physicians that the advice you would give to somebody in like A-F-Q-H-C-A federally qualified health center.
• 27:07
  Sonia Singh MD: They're low income, there's low resources, there's low health literacy.
• 27:10
  Sonia Singh MD: The nutritional guidance you're gonna give that patient is going to be very different than the guidance you would give a, highly resourced.
• 27:17
  Sonia Singh MD: A professional woman in her forties who's consuming a ton of content on social media, about health, who maybe has a history of perfectionism and disordered eating, that person is gonna get a very different nutrition talk, uh, than, the first patient.
• 27:28
  Sonia Singh MD: And so I think it's, when we're talking about clean eating, a lot of times I'm asking myself Who is this really for?
• 27:34
  Sonia Singh MD: Who is this serving?
• 27:35
  Sonia Singh MD: Because I think for a lot of patients, like the vast majority of Americans who are eating a ton of processed food now, it's pretty unachievable.
• 27:42
  Sonia Singh MD: It's kind of aspirational for patients who don't have a lot of resources who live in food deserts, it's really gonna be challenging to do this.
• 27:49
  Sonia Singh MD: But then for patients on the other end of the spectrum who do have resources and do have high health literacy and know a lot about nutrition already.
• 27:57
  Sonia Singh MD: I don't know that this even serves them because as you're describing the likelihood of them adhering to it is also linked to the likelihood of them having restrained eating, which I think is important to, I think the phrase restrained eating kind of sounds like it could be a good thing.
• 28:11
  Sonia Singh MD: Like yeah, you have control, but this is a very specific thing and it refers to obsessive effort to restrict and control calorie intake and food choices, and it's been linked strongly to disordered eating.
• 28:21
  Sonia Singh MD: So anyway, I think it's important to ask ourselves
• 28:24
  Rebecca Berens MD: Who is served by this concept.
• 28:25
  Rebecca Berens MD: Really.
• 28:26
  Rebecca Berens MD: Yeah.
• 28:26
  Rebecca Berens MD: And another thing I guess that I just wanna mention, this is the conversation I have with one of my patients, that the conversations that we have with the highest resourced people like you see now with all this biohacking mm-hmm.
• 28:36
  Rebecca Berens MD: And all this stuff that's available that the highest resourced people are, that trickles down to people who.
• 28:42
  Rebecca Berens MD: Really don't have the resources for it.
• 28:44
  Rebecca Berens MD: Mm-hmm.
• 28:45
  Rebecca Berens MD: But they feel like that they need to, that they should be doing this, do that.
• 28:47
  Rebecca Berens MD: Yes.
• 28:47
  Rebecca Berens MD: And so then not only are people doing things that might be harmful to them, they're also using their limited resources towards these Yeah.
• 28:55
  Rebecca Berens MD: Less beneficial things and not putting those resources towards things that would actually be beneficial to them.
• 29:01
  Rebecca Berens MD: So for an individual who has limited funds, if they're seeing content on Instagram that's like, oh, you've gotta buy this super expensive protein powder to add to your coffee.
• 29:09
  Rebecca Berens MD: Yes.
• 29:09
  Rebecca Berens MD: In the morning so you can get more protein.
• 29:11
  Rebecca Berens MD: Now they're spending money on this expensive protein coffee powder instead of, more fruits and vegetables that week and what actually is gonna make them healthier.
• 29:19
  Rebecca Berens MD: Mm-hmm.
• 29:19
  Rebecca Berens MD: And so it's really, it's really important to, like you said, who is it serving?
• 29:23
  Rebecca Berens MD: I don't think it's serving anyone.
• 29:25
  Rebecca Berens MD: Yeah.
• 29:25
  Rebecca Berens MD: And it's actively harming some people.
• 29:27
  Sonia Singh MD: So what can we learn from all of this as patients and doctors?
• 29:31
  Rebecca Berens MD: So I think the important thing to, to see from this is that patients really want this information about nutrition.
• 29:37
  Rebecca Berens MD: They really wanna understand how to take better care of themselves, how to eat in a way that's gonna support their health.
• 29:42
  Rebecca Berens MD: And it's important that we are giving them that information.
• 29:45
  Rebecca Berens MD: And we know that healthcare professionals is, particularly, doctors generally have very little nutrition education in their, medical training.
• 29:52
  Rebecca Berens MD: And we need to increase that and be able to provide that better to patients in general, not just from the healthcare system, but also in the general education system from childhood.
• 30:02
  Rebecca Berens MD: It's important to understand that clean eating does not have a standard definition.
• 30:06
  Rebecca Berens MD: Yeah.
• 30:06
  Rebecca Berens MD: And clean eating is not a medical recommendation.
• 30:08
  Rebecca Berens MD: And I've definitely heard patients.
• 30:10
  Rebecca Berens MD: Tell me that a doctor has told them to eat clean.
• 30:13
  Rebecca Berens MD: And I don't even know what that means.
• 30:15
  Rebecca Berens MD: Yeah.
• 30:15
  Rebecca Berens MD: And so I think if you're a physician giving dietary advice to the patient if that's the best you can do, it's better to just not Yeah.
• 30:22
  Rebecca Berens MD: And maybe refer them to a registered dietician or someone who can provide the nutrition education if you don't have the time or resources to do so.
• 30:29
  Rebecca Berens MD: But it's actually more harmful to give flippant, under-researched advice mm-hmm.
• 30:34
  Rebecca Berens MD: Than it is to give, it is better to just give nothing in that case.
• 30:37
  Rebecca Berens MD: Yeah.
• 30:38
  Rebecca Berens MD: Do
• 30:38
  Sonia Singh MD: you ever use
• 30:39
  Rebecca Berens MD: the
• 30:39
  Sonia Singh MD: phrase, I think
• 30:39
  Rebecca Berens MD: I know the answer
• 30:40
  Sonia Singh MD: to
• 30:40
  Rebecca Berens MD: this, the phrase clean eating?
• 30:42
  Rebecca Berens MD: Yes.
• 30:43
  Rebecca Berens MD: Oh my gosh.
• 30:43
  Rebecca Berens MD: Never in a positive sense.
• 30:46
  Sonia Singh MD: Yes.
• 30:46
  Sonia Singh MD: I also never use the phrase, I don't use it on social media, I don't use it with patients.
• 30:51
  Sonia Singh MD: I just think, and I, and I feel even more strongly about this now, having reviewed the data, it's just so unnecessarily moralizing of food decisions.
• 31:01
  Sonia Singh MD: It doesn't mean anything's.
• 31:02
  Sonia Singh MD: Specific, and as the data shows us, it's associated with some increased risk of, disordered eating or dietary restraint.
• 31:11
  Rebecca Berens MD: Yeah, absolutely.
• 31:12
  Rebecca Berens MD: So I think when we're, as doctors coming to terms to talking with our patients about this I think the important thing to do when we do wanna start giving nutrition advice relating to health is to, or if they ask maybe about nutrition advice.
• 31:27
  Rebecca Berens MD: What does clean eating mean to you?
• 31:29
  Rebecca Berens MD: If, if a patient comes in and says, I'm trying to eat clean.
• 31:31
  Rebecca Berens MD: 'cause patients tell me this all the time, they're like, oh, I'm just trying to eat clean.
• 31:34
  Rebecca Berens MD: Especially if I've recently maybe diagnosed them with a chronic health condition.
• 31:37
  Rebecca Berens MD: Yeah.
• 31:37
  Rebecca Berens MD: And they went down a rabbit hole and now they come in and they're like, oh, I'm eating clean now.
• 31:40
  Rebecca Berens MD: What does clean eating mean to you?
• 31:42
  Rebecca Berens MD: Mm-hmm.
• 31:42
  Rebecca Berens MD: What do you, what is, what do you mean by that?
• 31:44
  Rebecca Berens MD: Because it doesn't mean the same thing to everyone.
• 31:45
  Rebecca Berens MD: So as a physician, we need to know what do they mean by that.
• 31:48
  Rebecca Berens MD: And then be able to dispel any misconceptions that they may have about.
• 31:52
  Rebecca Berens MD: What is, beneficial for their condition.
• 31:54
  Speaker 3: Mm-hmm.
• 31:55
  Rebecca Berens MD: I think it's also important to, when we are seeing a patient,'cause I've also heard this a lot from patients before giving nutrition advice ask.
• 32:03
  Speaker 3: Yeah.
• 32:03
  Rebecca Berens MD: I see a lot of patients who have told me that a doctor has made an assumption about how they were eating.
• 32:09
  Rebecca Berens MD: Mm-hmm.
• 32:09
  Rebecca Berens MD: Based on their size, their health conditions.
• 32:12
  Rebecca Berens MD: Any number of things rather than actually asking.
• 32:14
  Rebecca Berens MD: And a lot of patients, particularly those in larger bodies who have had eating disorders.
• 32:18
  Rebecca Berens MD: Who went to the doctor and were given a handout that said, oh, you need to lose some weight.
• 32:21
  Speaker 3: Yeah.
• 32:21
  Rebecca Berens MD: And they were already restricting so severely.
• 32:24
  Speaker 3: Mm-hmm.
• 32:24
  Rebecca Berens MD: And so ask the question first, and I, I always like to do a 24 hour dietary recall just to get a quick snapshot.
• 32:31
  Rebecca Berens MD: It's obviously not perfect, but it's at least.
• 32:32
  Rebecca Berens MD: Most people can remember what they ate for the last 24 hours.
• 32:35
  Rebecca Berens MD: Yeah.
• 32:35
  Rebecca Berens MD: Um, and then you get some, it's an opening point for a conversation.
• 32:38
  Rebecca Berens MD: Right?
• 32:38
  Rebecca Berens MD: Yeah.
• 32:39
  Sonia Singh MD: And I, I'm gonna add to this, which goes without saying, which is why you didn't write it or say it, but believe them.
• 32:44
  Sonia Singh MD: Just believe them.
• 32:45
  Sonia Singh MD: Oh my gosh,
• 32:46
  Rebecca Berens MD: yes.
• 32:46
  Rebecca Berens MD: It's
• 32:46
  Sonia Singh MD: cost nothing.
• 32:47
  Sonia Singh MD: Just believe them.
• 32:49
  Rebecca Berens MD: So many patients have also told me that they did tell Yeah.
• 32:52
  Rebecca Berens MD: Someone mm-hmm.
• 32:53
  Rebecca Berens MD: About their eating disorder behaviors.
• 32:55
  Rebecca Berens MD: Mm-hmm.
• 32:55
  Rebecca Berens MD: And they were told like, that's not possible.
• 32:58
  Rebecca Berens MD: Yeah.
• 32:58
  Rebecca Berens MD: You wouldn't, you wouldn't be this size or it's not, and.
• 33:01
  Rebecca Berens MD: It's just crazy to me the things that people will say to patients when they have disclosed something that's so painful and difficult for them.
• 33:09
  Rebecca Berens MD: Yeah.
• 33:09
  Rebecca Berens MD: So yes, absolutely.
• 33:11
  Rebecca Berens MD: The next thing I would always ask is what foods do you regularly have access to?
• 33:16
  Rebecca Berens MD: So kind of just an assessment of what's currently available easily for you.
• 33:19
  Rebecca Berens MD: Because if you go onto a rant and be like, oh, do this, and this, and they actually don't have the ability to do any of that.
• 33:23
  Rebecca Berens MD: Mm-hmm.
• 33:24
  Rebecca Berens MD: Then you've helped no one.
• 33:25
  Rebecca Berens MD: And you've just kind of.
• 33:27
  Rebecca Berens MD: Created some shame for that person of like, oh, uh, I'm not able to do the thing that the doctor's asking me to do.
• 33:32
  Rebecca Berens MD: Right.
• 33:32
  Rebecca Berens MD: I always like to ask too about, not just allergies, but intolerances.
• 33:36
  Rebecca Berens MD: Some people really just don't feel good when they eat certain foods.
• 33:38
  Rebecca Berens MD: And again, I think they get blown off.
• 33:39
  Rebecca Berens MD: Yeah.
• 33:39
  Rebecca Berens MD: When they're like, I don't like to eat this.
• 33:41
  Rebecca Berens MD: It hurts my stomach.
• 33:42
  Rebecca Berens MD: And they're like, oh, you're fine.
• 33:43
  Rebecca Berens MD: It's not real.
• 33:44
  Rebecca Berens MD: You know, I'm just like, if it makes them feel bad, again, let's believe them.
• 33:48
  Rebecca Berens MD: Unless it's an entire food group, right.
• 33:49
  Rebecca Berens MD: That can't be replaced.
• 33:50
  Rebecca Berens MD: Like I don't eat any carbs.
• 33:51
  Rebecca Berens MD: Obviously that's not reasonable, but, But if, if there's a certain food group that they're just like, eh, it's, I don't like it, it hurts my stomach, whatever.
• 33:58
  Rebecca Berens MD: Yeah.
• 33:58
  Rebecca Berens MD: Ask about that.
• 33:59
  Rebecca Berens MD: Ask about allergies.
• 34:00
  Rebecca Berens MD: Ask about cultural, religious foods that they incorporate into their diet or religious practices around their diet, because we have to be sensitive to that.
• 34:08
  Rebecca Berens MD: And if it's not something that they're going to incorporate because of cultural, religious reasons, and it's pointless to even talk about it.
• 34:13
  Rebecca Berens MD: Mm-hmm.
• 34:14
  Rebecca Berens MD: We wanna make sure it's patient centered.
• 34:15
  Rebecca Berens MD: And so then we're coming up with a plan that's actually going to work for them.
• 34:19
  Sonia Singh MD: Yeah.
• 34:19
  Sonia Singh MD: Another thing I like to add is my practice is focused on busy women, and I think time is like one of their biggest limitations.
• 34:26
  Sonia Singh MD: So I like to ask, who's preparing your meals?
• 34:28
  Sonia Singh MD: Who's doing the grocery shopping?
• 34:29
  Sonia Singh MD: Do you have time to do that?
• 34:31
  Sonia Singh MD: Or the skill or the desire to,'cause not everybody wants to be doing those things and so, just getting a sense of all of the context around what they're eating absolutely.
• 34:40
  Sonia Singh MD: Is really helpful.
• 34:41
  Sonia Singh MD: And I think sometimes again, if you didn't collect that information and you just started, advising them on what to do, they might feel sort of gaslit or like a failure for not being able to achieve that because they simply have zero time to actually do the Absolutely.
• 34:55
  Sonia Singh MD: The preparation of the food.
• 34:56
  Rebecca Berens MD: Yeah.
• 34:57
  Rebecca Berens MD: And I also do like to help by getting a dietician involved.
• 35:00
  Rebecca Berens MD: Mm-hmm.
• 35:00
  Rebecca Berens MD: Particularly if there's someone who has had an eating disorder history.
• 35:03
  Rebecca Berens MD: Because we wanna make sure that we are being very cognizant of meeting their nutritional needs and, and addressing any.
• 35:08
  Rebecca Berens MD: Disordered behaviors.
• 35:09
  Rebecca Berens MD: So an eating disorder dietician in that case, but even a patient who has high blood pressure, diabetes and has never had disordered eating can benefit from meeting with a dietician because they are specifically trained in addressing these medical conditions with medical nutrition therapy.
• 35:23
  Speaker 3: Mm-hmm.
• 35:24
  Rebecca Berens MD: And making those small adjustments in nutrition.
• 35:26
  Rebecca Berens MD: And again, it doesn't have to be.
• 35:27
  Rebecca Berens MD: Drastic or extreme.
• 35:28
  Rebecca Berens MD: It can be simple, small, sustainable changes that will actually fit in their life.
• 35:32
  Rebecca Berens MD: But always, especially if you're a doctor that doesn't have a lot of time to get this into your visit, because I've been there and I know how it is.
• 35:38
  Rebecca Berens MD: A team approach to healthcare is always better.
• 35:41
  Speaker 3: Yeah.
• 35:41
  Rebecca Berens MD: And then I think the other thing that I certainly always ask about and I think is important, and I think more physicians should do, is asking about specifically disordered eating behaviors.
• 35:51
  Rebecca Berens MD: Mm-hmm.
• 35:52
  Rebecca Berens MD: So purging using diet pills that they bought over the counter or from nebulous sources.
• 35:58
  Rebecca Berens MD: Yeah.
• 35:58
  Rebecca Berens MD: Laxatives inducing vomiting, are they, are there significant body image concerns?
• 36:03
  Rebecca Berens MD: Are they weighing themselves daily?
• 36:04
  Rebecca Berens MD: Are they measuring themselves daily?
• 36:06
  Rebecca Berens MD: These are behaviors that people are not necessarily gonna volunteer because there's a lot of stigma around it, but it's important to be aware of because that's something that a person really needs some help with and may need some, therapeutic support from a therapist who's trained in eating disorders as well.
• 36:18
  Rebecca Berens MD: Mm-hmm.
• 36:18
  Rebecca Berens MD: So just really important to keep that in mind.
• 36:20
  Rebecca Berens MD: And I think it's, like you said, a lot more people.
• 36:22
  Rebecca Berens MD: Than we realize.
• 36:24
  Rebecca Berens MD: And they're not being met with any support at the doctor's office.
• 36:28
  Sonia Singh MD: Well, thank you Rebecca.
• 36:29
  Sonia Singh MD: This was such a great conversation.
• 36:30
  Sonia Singh MD: I was really excited to hear about your thoughts on this particular topic, and we wanna hear your thoughts.
• 36:35
  Sonia Singh MD: So feel free to send us feedback.
• 36:38
  Sonia Singh MD: You can reach us at.
• 36:40
  Sonia Singh MD: The antisocial doctors@gmail.com, is that right?
• 36:43
  Sonia Singh MD: That's right, yes.
• 36:43
  Sonia Singh MD: Okay.
• 36:44
  Sonia Singh MD: Okay.
• 36:44
  Sonia Singh MD: And as always in the show notes, we'll have some references and some people you can consider following on Instagram for more accurate and balanced nutritional advice.
• 36:54
  Sonia Singh MD: So until next time, bye.
• 36:56
  Sonia Singh MD: Thanks Sonia.
• 36:58
  Sonia Singh MD: Hey guys.
• 36:59
  Sonia Singh MD: Last but not least, we have a very important disclaimer.
• 37:02
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• 37:07
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• 37:20
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• 38:27
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• 38:29
  Sonia Singh MD: Thanks again for joining us.