Navigating common nutrition myths and misconceptions

Say you’re counseling a patient. The appointment is going well until (record scratch) they ask you about the latest nutrition fad they saw on social media. Happens all the time. Here, we discuss some common nutrition myths and misconceptions and arm you with the evidence so you can answer your patients in an informed way. 

Should I take activated charcoal?

Recently there is a trend of people consuming activated charcoal to remove toxins from their body at home in the form of an over-the-counter supplement. Although this may seem like this has nothing to do with nutrition, people often perceive RDNs as knowledgeable on all types of oral supplements.  

Activated charcoal is used as a medical intervention for specific toxicities and typically needs to be administered within one hour of ingestion of the toxin to be effective. Charcoal adsorbs specific toxins that are bound to it as opposed to absorbing a substance (like an overdose of Tylenol) into the charcoal. This allows the toxic substance, like a drug overdose, to be removed from the gut.  

Activated charcoal is used in emergency departments in cases of ingestion of toxic substances and is studied for potential benefits with chemotherapy and radiation. But as a dietary supplement to help people remove perceived toxins in the body from overeating or drinking too much alcohol—it is useless. It only serves to make a person’s mouth and stools very black. It will not cause any harm, just be passed through the digestive system. At this time, activated charcoal is not useful as a dietary supplement to remove dietary toxins. 

I eat healthy. How can I still have nutrient deficiencies?

If your patient is a “healthy eater,” they may be surprised to learn that they may still have nutrient deficiencies. Unfortunately, the term healthy is not clearly defined. When it comes to nutrition, it can be vague and unclear what healthy really means, and there can be some person-to-person differences of what constitutes a healthy diet.  

For example, whole grains are considered healthy for the general population—they are a rich source of fiber, carbohydrates, B vitamins, zinc, iron, and antioxidants. But for a person who is following a low-carb diet to help manage their diabetes, whole grains are not as “healthy” because they must be limited and accounted for.  

For a person with celiac disease who cannot have any gluten at all, whole grains are more than just “unhealthy,” they are detrimental.  

A person who is following a ketogenic diet for infertility may be consuming “healthy,” high amounts of fats like avocados and olives. However, that same amount of high-fat foods is “unhealthy” for a person on a Mediterranean diet for heart health.  

Avoidance or limitation of food groups can lead to nutrient deficiencies. Even if these avoidances or limitations are appropriate and necessary, nutrient deficiencies need to be considered. For example, many people with celiac disease who healthily and appropriately follow a gluten-free diet may also be deficient in iron and vitamin B12 due to inadequate intake from other sources and malabsorption issues.  

So, what do you do? When nutrient deficiencies are a concern, recommend taking a multivitamin. It’s like an insurance policy; it helps cover the gaps if they are there. If there are serious concerns, a registered dietitian nutritionist can help navigate other options. Micronutrient lab testing can be considered, but the accuracy of the tests needs to be assessed by each nutrient and each method of testing the level because there are multiple ways to measure some nutrients. Even if patients are eating healthy, they may be experiencing nutrient deficits under the surface. 

Can nutrition impact mental health?

There are so many claims now surrounding diet and what diet can do for your health. People are now claiming that by changing their diet, they alleviated their anxiety, improved their depression, or experienced a drastic change in their child’s ADHD. Is any of this even possible?  

The short answer is yes—nutrition can have a positive change on mental health and these claims are not baseless. The long answer is less straightforward. Research continues to make new discoveries about the gut-brain axis (GBA). The GBA is a two-way street of communication between the central nervous system and the enteric nervous system, which link the emotional and cognitive function of the brain with gut function. This is a complicated street with lots of turns, yielding, and merging—but by exploring this pathway we are learning that the brain influences intestinal function and vice versa.  

If you’ve ever experienced “butterflies in your stomach” or “a nervous stomach” this pathway may seem more tangible to you. With the emerging understanding of the GBA, individual scenarios are being explored and are in the early stages of their research. Some of the research questions explore if specific strains of probiotics reduce anxiety and depression. Can diet interventions impact ADHD behaviors?  

We have more questions than answers today, but preliminary results do show that it is feasible, possible, and possibly reproducible to have specific nutrition interventions impact different aspects of mental health. As an RDN, this is very exciting because it sheds light on just how personalized and powerful nutrition can be. Imagine a person being diagnosed with anxiety and the first line treatment being lifestyle intervention and a consult with you, an RDN, instead of medication. Who knows what the future holds, but let’s be leaders as nutrition experts as we continue to discover more about the GBA and the connection between nutrition and mental health.    

Can diabetes be managed with lifestyle changes alone?

The short answer is yes, but you must select the right patients. As RDNs, we know the power of nutrition for impacting health. The benefit and need for medical nutrition therapy for the management and treatment of Type 2 diabetes is well established, with the American Diabetes Association specifically naming the need for patients to work with RDNs. Management and reversal of obesity with lifestyle interventions of diet and exercise is the first line recommendation for preventing and/or delaying the onset of Type 2 diabetes. If nutrition is so essential to the treatment of diabetes, can diabetes be treated alone without medications?  

With Type 2 diabetes, the first line treatment is often metformin, with lifestyle interventions, including nutrition, as secondary. But this does not have to be the case. First, we must understand that not everyone with a diagnosis of Type 2 diabetes has the same level of insulin resistance. Pancreatic function varies and can decrease over time as the disease progresses, even if the person is initially able to manage their diabetes with diet and exercise alone. Insulin-resistant diabetes has excellent potential for being treated without medications. This is different than insulin insufficiency where the body is just not making enough insulin—where medication interventions are more valuable.  

As with all areas of nutrition, there is not a one size fits all approach—not everyone can treat their Type 2 diabetes with nutrition and exercise alone. But it certainly is possible for many patients and a reasonable first step for some. More and more people are looking to manage diseases without medications, putting RDNs and nutrition in the spotlight to show how much we can do. Many physicians and patients are willing to try lifestyle interventions alone for three to six months before initiating medications, again depending on the severity of the hyperglycemia. More research is needed in this area so that providers and patients understand their options for diabetes management—but nutrition certainly plays a leading role!  

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References:   

 Zellner, T., Prasa, D., Färber, E., Hoffmann-Walbeck, P., Genser, D., & Eyer, F. (2019). The Use of Activated Charcoal to Treat Intoxications. Deutsches Arzteblatt international, 116(18), 311–317. https://doi.org/10.3238/arztebl.2019.0311  

Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of gastroenterology, 28(2), 203–209. 

American Diabetes Association (2022). Standards of Care in Diabetes-2023 Abridged for Primary Care Providers. Clinical diabetes : a publication of the American Diabetes Association, 41(1), 4–31. https://doi.org/10.2337/cd23-as01 

Hallberg, S. J., Gershuni, V. M., Hazbun, T. L., & Athinarayanan, S. J. (2019). Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients, 11(4), 766. https://doi.org/10.3390/nu11040766