“Your body is your tool.”
It was the phrase that sparked it all. I was a Sophomore dance major on track to earn my Bachelor’s Degree in Fine Arts. The phrase made A LOT of sense: as a dancer, my body is my tool and the foods that I put into it would have a direct result on my performance… right? So, after a few Google searches and a meeting with a so-called “nutrition expert,” I embarked on a lifestyle known as “clean eating.”
There was so much to learn and even more to detangle. “Processed” foods quickly became off-limits and “saturated fat,” “added sugar,” and “high fructose corn syrup” were soon added to that list. I experimented with recipes, discovered “healthy” swaps, and set forth to make all of my meals “nutrient-dense,” “whole,” and “clean.” To be honest, it felt good: I was in full control. In hindsight, however, I realize that this was a false sense of comfort tied with a fat-phobic fear of weight again… something I worked to overcome when fixing my relationship with food (read more about it here).
But then things started to go, well… downhill. It became increasingly difficult to keep up with the clean eating lifestyle. Dinner plans with friends turned into time-consuming research projects as I set forth to find an “acceptable” meal out. Quick trips to the supermarket became hour-long events as I nervously tried to detangle back-of-the-package nutrition facts. I was anxious, obsessed, and on the verge of burnout. I was so determined to “figure it out” that I even decided to swap my pursuit of a BFA for a professional career as a Registered Dietitian Nutritionist.
What I didn’t know at the time, was that my pursuit to “eat clean” was actually a guise for disordered eating. Fast forward lots of years, and the concept of “figuring out” looks way different than I could have ever imagined.
But Rachel, the research says…
How could eating ample amounts of “whole” foods not be healthy? My days were filled with colorful fruits, fibrous veggies, a variety of unsaturated fats, and antioxidant-rich dark chocolate. Though it sounded “perfect” on paper, my “clean eating” lifestyle was far from healthy. What I didn’t understand at the time though, was how to decipher the research. In my perfectionistic mind, understanding the evidence that supports the benefits of consuming those “whole” and nourishing foods meant that in order to “be healthy” I needed to ONLY eat those foods and subsequently eliminate anything deemed “unhealthy.”
I was wrong.
Sure, when we examine the research, studies have found that in large amounts, any and all of these ingredients (for example, added sugar, saturated fat, and high fructose corn syrup) might be associated with some adverse health outcomes, most notably diabetes, heart disease, and chronic inflammation. But fellow anti-diet dietitian Christy Harrison says it best that, “the key phrases here: some studies, in large amounts, and associated with” need to be seriously examined. So, dancers… let’s do it.
Nutrition research: what you need to consider
Nutrition research plays an integral role in how we understand the impacts of various foods and/or behaviors on our health. In an ideal setting, researchers conduct experiments with the hope to draw conclusions based on direct interventions. These Randomized Controlled Trials (RCTs) are considered the “gold standard” of scientific research. In RCTs, participants are randomly placed into different groups. One group receives the hypothesized treatment (for example, a diet low in “processed” foods) and the other receives some kind of control intervention (for example, a diet high in “processed” foods). RCTs are usually performed in a controlled setting (such as in a lab) where external influences are limited. Though ideal, RCTs are too expensive and impractical to conduct long-term (plus, we can’t expect study participants to fully follow diet rules when we know that success rates with dieting are insanely low).
Because of these limitations, most food- and diet-related research is observational. The goal of observational research is to observe patterns in behaviors over time (such as the impact of eating X amount of added sugar per day). From here, researchers can draw associations between levels of intake with various health outcomes, most notably the development of heart disease, diabetes, etc. When conducting observational studies, researchers often look back in time, using medical records, participant self-report, and sometimes even blood samples, to collect information. Observational studies are super interesting as they help to identify any potential associations between our behaviors and our health. But there are 3 major limitations with observational research:
The first is time. For practical reasons, an observational period is usually short: from a couple of weeks to a few years. Short studies make it difficult to draw statistically significant conclusions. In other words, were the associations true or did they happen by chance? The second limitation is relying on study participants to report their food intake. Can you remember what you ate on a Tuesday 3 months ago? Drawing conclusions based on self-report is very unreliable! The third and most problematic limitation is the potential for confounding variables.
Confounding variables are anything that could impact what is observed in a study. Examples include alcohol consumption and cigarette smoking. While researchers often use statistical methods to try to control for these confounding variables (for example, controlling for the participants who smoke versus those who do not smoke), it’s impossible to control for everything. Other confounding variables that can have a huge impact on health outcomes include socioeconomic status, race, and even degree of disordered eating.
Now, since the definition of “disordered eating” is so grey in a culture that normalizes food restrictions and praises over-exercising, it’s hard to define what “normal eating” even means. As I mentioned earlier, it took me years before I knew that my “clean eating lifestyle” was actually disordered! Interestingly, disordered eating behaviors and weight cycling (from bingeing and restricting) have been associated with negative health outcomes, including diabetes. So, it’s nearly impossible to draw conclusions between “eating foods high in X” with specific health outcomes when we know that disordered eating could impede results. Now, in regards to added sugar, could those negative health outcomes be related to an excessive intake of added sugar during a “binge” cycle? Perhaps. And if that’s the case, then it’s safe to say that repairing one’s relationship with food might be a better takeaway.
Okay, so then what even is “healthy?”
For starters, pointing the finger at food and/or weight, as being the sole contributors to what defines “health,” doesn’t account for other determinants of disease risk. In fact, diet and lifestyle make up only 10% of health outcomes with one’s access to clinical care and one’s physical environment being much more impactful. Also, we cannot ignore the negative health outcomes of internalized weight stigma, one of which is heart disease.
But that doesn’t mean we shouldn’t use nutrition research. Systematic reviews and meta-analyses provide helpful tools in understanding the impact of various behaviors on health. These studies examine larger bodies of evidence in comparison to only looking at one study. Oftentimes, however, these studies draw inconclusive results. In regards to heart health, a 2018 review concluded, “to date, a lot of results obtained have produced few conclusions and sometimes, even contradictions.”
Furthermore, when examing the research, we should consider how various studies are defining their variables. In regards to added sugar, Christy Harrison says, “in many studies, participants grouped as consuming the “lowest [amount of] added sugar”… consume an amount equivalent to eating some sweetened foods at every meal and every snack, and having dessert every day.” P.S.- highly recommend you check out Christy’s book, Anti-Diet if you want to learn more about this!
Wow. This is wildly different from how my fellow perfectionists often translate the research: “According to the research, I should “AVOID” or “ELIMINATE” foods with added sugar!” Nope, dancers, even the research shows us that it’s not all-or-nothing!
Well, what should I focus on?
We need to remember that association doesn’t equate to causation. Any manipulation of the macronutrients is likely to result in some form of dieting/restriction or disordered eating. Eating “processed” foods or foods that contain saturated fat, added sugar, and/or high fructose corn syrup will not be the sole contributor to your overall health. In regards to weight, emerging research indicates that a HAES (Health At Every Size) approach (in comparison to a weight-centric intervention) is “associated with statistically and clinically relevant improvements in physiological measures (e.g. blood pressure, blood lipids), health behaviors (e.g. physical activity, eating disorder pathology) and psychosocial outcomes (e.g, mood, self-esteem, body image).”
When it’s practical and economically feasible, incorporating a variety of foods is encouraged. This includes produce (like fruits and veggies), grains, proteins, and sources of fat. This also includes “fun” foods like dessert and so forth. Remember: our health and performance are products of behaviors over time. Here are a few articles to learn more about these various components to a balanced and non-restrictive lifestyle:
So, is it time to drop the idea of “clean eating?”
Yup. And I’d like you to also reassess the intent behind why you’re choosing this type of lifestyle. The “healthiest” diet for a dancer is one that supports all realms of their being: their physical health, mental health, and emotional health. If you’re stressing over what the “healthiest” option on the menu is (like I did!) then you might be putting society’s (practically unattainable) view of “health” before your true needs, desires, and personal preferences.
What’s another reason to drop clean eating? Limited accessibility for most populations. Constraints like time, money, and even a lack of physical ability to obtain what society deems to be “healthy” induce a ton of guilt and shame around food. This is especially true since we know that weight discrimination leads to higher levels of stress and may even be associated with more unhealthy eating behaviors.
When it comes to “healthy eating,” seek advice from a licensed and credentialed source (learn more about this here). Deciphering truth from trend will always be an important aspect to truly redefining what it means to be The Healthy Dancer®.
P.S. Christy Harrison is an incredible resource if you’re wanting to learn more about the dangers of “wellness culture” and how to detangle nutrition research. I’ve learned a lot from her book, Anti-Diet, and you will too!