Because studies show there’s no published experimental
evidence to support that restricting foods such as gluten
is helpful from a nutritional or health stance, dietitians can
educate their clients that gluten-free eating isn’t necessary if
not medically indicated.10,11 For clients who express an interest
in following a gluten-free diet as a means to eat clean, ask
them about their desired outcome, use open-ended questions
and motivational interviewing, and ask permission to counsel
them if they’re willing to listen. Educate them about the
current research on some of the social and health challenges
of unnecessarily restricting foods and about the nutritional
content of whole wheat. Then help them ensure that with or
without wheat, they can achieve a balanced diet. Wheat isn’t
critical to human health as there are other sources of the
nutrients and fiber it provides. Dietitians can support clients
who remain committed to eliminating wheat gluten from the
diet by suggesting alternatives.
Vegetarian Diets
Some clients may inquire about eliminating meat or animal
products, including dairy, in an effort to eat clean. The position
of the Academy of Nutrition and Dietetics states that “appro-
priately planned vegetarian, including vegan, diets are health-
ful, nutritionally adequate, and may provide health benefits for
the prevention and treatment of certain diseases.” Reducing or
eliminating animal products from the diet may in fact be ben-
eficial. RDs can explore with clients why they want to reduce
or eliminate animal products and educate them about how to
do so in a healthful and balanced manner. For example, vegans
need a reliable source of vitamin B 12 from supplements or for-
tified foods. Because vegetarians and vegans are at reduced
risk of certain health conditions, including ischemic heart dis-
ease, type 2 diabetes, hypertension, certain types of cancer,
and obesity, this may be a positive change in their diets.^12
Avoiding Processed Foods
Clean Eating, a magazine founded in 2010, states that “In
every way, clean eating is all about consuming whole food in
its most natural state, or as close to it as possible.”^13 This con-
ception of clean eating—as an effort to consume only whole
or minimally processed foods—could be beneficial, depend-
ing on how the client defines processed foods.^14 Any effort
to limit processed meats, sugar-sweetened soft drinks, and
high-calorie foods with low nutritive value could promote
better health.5 ,15 ,16 When consumers interpret clean eating as
an effort to avoid processed foods and attempt to read labels
to determine how much processing a food has undergone and
how healthful it may be, dietitians can help. They can sup-
port proven beneficial dietary patterns such as the DASH and
Mediterranean diets that include unprocessed and minimally
processed foods, or they can counsel their clients on simply
consuming fewer highly processed foods, addressing nutrients
of concern in these items and including more unprocessed and
minimally processed foods based on their goals and lifestyle.
There’s evidence of increased
rates of obesity and diet-related
noncommunicable diseases in
people from cultures that move
from a more traditional, less
processed dietary pattern to one
that includes more refined sugar,
salt, and saturated and trans fats
found in many processed foods.^17
Evidence supports that sugar-
sweetened beverages, includ-
ing soda and juice, as well as
ultraprocessed foods (defined
as industrial formulations that
include substances not used in
culinary preparations) affect
Americans’ health and impact
their diabetes risk and adipos-
ity.15 ,16 A study in the British Medi-
cal Journal found that up to 82.1%
of Americans consuming the
highest quintile of calories from
processed foods consumed more
than the suggested 10% of the calories from added sugars.^16
Although a group of researchers in Brazil don’t directly
use the term “clean eating” in their research, they explore the
belief that more processed foods are linked to negative health
outcomes. This study classifies foods on a spectrum of less
to more processed, and researchers say they believe that the
potential health consequences of food processing have been
overlooked. The premise of their study is that the consump-
tion of industrially processed food and drink has a direct link to
obesity and related chronic diseases.^5
They classify unprocessed or minimally processed foods
into Group 1. These are foods that have been cleaned, por-
tioned, or naturally preserved in some way including drying,
chilling, or freezing. Fresh meat, milk, legumes, nuts, fruits
and vegetables, water, tea, and coffee all fit into this category.
Group 2 includes substances extracted or purified from Group
1 foods by physical or chemical processing such as milling,
refining, and hydrogenating, eg, flours, oils, salt, and sugar.
The researchers observe that these foods are unpalatable on
their own and need to be combined as culinary ingredients
to make other products. Group 3 includes processed foods
that are ready to eat with little to no preparation. Process-
ing includes salting, sugaring, baking, frying, curing, smoking,
pickling, and canning. These foods are known as fast food or
convenience foods that are made ready to eat and shelf stable
and include bread, cookies, canned fruit in syrup, chocolate,
soda, hot dogs, sausages, baby food, and infant formula.^5
The researchers say that the increased consumption of
industrially processed foods and beverages is one direct cause
of the pandemics of obesity and related chronic diseases,
including type 2 diabetes, citing studies about the effects ofCPE MONTHLY
44 today’s dietitian august 2019