The Antisocial Doctors Podcast
Join Dr. Rebecca Berens & Dr. Sonia Singh as they unpack viral health trends with curiosity, nuance, and compassion. No snark, no shame —just thoughtful conversations about what’s true, what’s hype, why we're drawn to it and how to find calm and clarity in the chaos of social media and online health advice.
The Antisocial Doctors Podcast
Episode 3: What's Wrong with Eating Clean?
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“Clean eating” is widely promoted as the key to health — but it has no clear definition. In this episode, we explore why this idea resonates, how it moralizes food choices, and what the research shows about its links to restriction, anxiety, and disordered eating.
What we cover:
• Why “clean” vs “dirty” food framing is harmful
• Processed foods and real-world nutrition
• Research on clean eating and restraint
• Why women are especially affected
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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
Rebecca Berens MDand me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
Sonia Singh MDWe're also a millennial women anxious moms and curious humans navigating social media. We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
Rebecca Berens MDThis podcast is meant to be the antidote to your doom. Scrolling, a solve for the anxiety, stress, guilt, shame, and confusion. That comes from social media's messaging around health. In each episode, we discuss a health related topic trending on social media with curiosity, nuance evidence, humility, and compassion.
Sonia Singh MDThis is not your average debunking podcast we wanna explore not just what is trending on social media. But why? Why are so many people drawn to this? What is the nugget of truth here? What are the facts? What can we learn from this as patients and doctors? No shame. No blame, no snark.
Rebecca Berens MDWe're so glad you're here.
Sonia Singh MDHey Rebecca. Hey Sonia. 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. So tell us a little bit about the story that inspired this week's episode. Yeah,
Rebecca Berens MDThis 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. We would pre-round, we would be in the OR all day, then we would. Be post rounding and you never knew when you were going home. So it was one of those situations where it's eat when you can, sleep, when you can, that kind of thing. But my cot student on the rotation was very focused on clean eating. This was something that was very important to them. And I distinctly remember this day that I think it was probably like one or two o'clock in the afternoon. Like I said, we'd been there since four in the morning. We had not eaten anything all day. And. 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. And I remember this person making comments about the granola bars I was eating. Like, oh, those are so processed. Why are you eating that? And then we finally had a chance to go to the cafeteria. So we go to the hospital cafeteria and they said like, oh, there's. Nothing good in this cafeteria. It's also processed, processed crap, I think was the words they used. And all they ate for lunch that day was steamed green beans. 'cause that was the only thing that they deemed clean enough in the cafeteria for them to eat. And then we went home at like six or seven o'clock at night and that was all they had eaten all day. And you know, that breaks the
Sonia Singh MDheart for both of you.
Rebecca Berens MDYes. It was very difficult. And it, it just really, highlighted for me this attitude that there is even amongst healthcare professionals. Mm-hmm. 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.
Speaker 3Mm-hmm.
Rebecca Berens MDSo I wanted to address that today 'cause it's a topic we hear a lot about patients often talking about wanting to eat clean. Yeah. A big, comment on social media. So let's talk about that today. Yeah. So what is the actual claim around clean eating? It's unclear because people don't even really degree in what clean eating is. Yeah. 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. 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. And, and all of these things, clean eating is the answer to everything'll, get sick less, all of this. But again, no actual definitive agreement on what clean eating means. Mm-hmm. I think there's generalized agreement that eating clean means. Means eating more whole foods that are less processed and don't have artificial additives. But again, like which ingredients are considered clean or not? 'cause some clean eating things that are promoted are also processed, right? 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. 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. But I just wanna discuss the concept of clean. Versus not clean eating and how it could be harmful or counterproductive to health.
Sonia Singh MDSo why do you think so many people are drawn to the concept of clean eating?
Rebecca Berens MDSo I think in general, most people. 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. I think that's a generally true value that most people have. 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. But. Again, lots of disagreement on what that actually means. And so in general, I think the concept of health is very important to people. And people want to do everything that they can to be as healthy as they can. And particularly in a world where there's less and less that we can control.
Sonia Singh MDYeah.
Rebecca Berens MDWhat we eat seems like something that we do have control over that could maybe affect our outcomes. So if there's something we can control to make us healthier, that's what we wanna do. I think also nutrition is very confusing. 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. And I think even just amongst families, what's passed down is kind of being lost. Yeah. There's not a lot of. Good understanding of nutrition or how to cook or build a balanced meal. Like we're, we're losing a lot of that societally. And then I think also we live in a society that, for a variety of reasons, heavily stigmatizes people who live in larger bodies. And there's a lot of places that this comes from. I think it's heavily rooted in, the misapplication of the BMI and, the racism that went into that. But. 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. Applied further to food. And you had a really interesting mm-hmm. Book that you told me about that had an interesting quote around this. I'd love to hear you share more about that.
Sonia Singh MDYeah. So I had read this book called Gospel of Wellness by Rinna Raphael. And if you're listening to this podcast and you're interested in anything in the health and wellness space, I highly recommend it. It's really well researched and super interesting. But basically she points out how a lot of different. 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. And so one of the things she talks about in that is this. Idea of purity through food and kind of the moralization of food. And there's a social psychologist, Jonathan Het, who has talked about this as well. So I wanted to share a quote from his TED Talk and the quote is, so. 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. And while the political right may moralize sex more, the political left is really doing a lot of it with food. 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. Now, one thing he kind of touched upon was how purity is uniquely applied to women. 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. And his response was like, what's that? And he's a doctor and also on social media and also listens to a variety of. Podcast bros that talk about health and fitness and he had never really heard the like, he wasn't very familiar with the phrase. And it struck me in that moment gosh, it is really gendered. 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. Like why is that? And I found this other essay called Purity Culture. Diet Culture, and where they intersect, where the author kind of touches upon this. And I thought, what. What she said about it was super interesting. So this is what she says. She says. In the end, purity. Whether access through the medium of food or sexuality expresses itself in our culture through female bodies. It asks those with female bodies to restrain refrain limit. It asks us to make ourselves smaller, both physically and in terms of life experience. 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. Wow. I know. I, I read that and I was like, whew. Oh my gosh. I don't think that's something I had ever consciously thought about when I was hearing the phrase clean eating in the past. The other thing that this kind of points to is the link between clean eating and diet culture. 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. They'll say, I'm on a health journey, or I'm on a fitness journey. And I think it's important to recognize that a lot of times we're actually just saying the same thing. It's just wrapped up as something different.
Rebecca Berens MDYeah. 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. And therefore, if you did. 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. It's a punishment. Mm-hmm. You sinned. You know? It is, it's so wrapped up in that sort of purity and religious kind of talk. Mm-hmm. And, and yeah, like you said, dieting is now becoming a thing of the past, but it's just really gotten another name. Yeah. So yeah, it's, it's a very interesting shift that's happened. I think it's important for us to continuously reexamine it because. It's ultimately all the same problem. Yeah. Wrapped up in different packaging. Totally.
Sonia Singh MDSo tell us what you think the nugget of truth is here. Why is cleaning so compelling to people and what's the truth in it?
Rebecca Berens MDYeah, so the truth is, obviously different foods have different nutritional content. We can't argue about that. That's a hundred percent true. Mm-hmm. And, and there are certainly different nutrients, a variety of different nutrients that we need to have in our diets to be. Healthy to have all of our nutritional needs met. We need to eat consistently enough of the various macronutrients and micronutrients to be able to be healthy. 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. And I think it is important to, to highlight the truth in the fact that if you eat a mostly ultra processed food diet. There probably will be significant lack of certain nutrients, particularly fiber is a big one. Mm-hmm. And we can't hide from that fact, right? Mm-hmm. That's a hundred percent true. And I think, you kind of brought up that sometimes that's. Ignored when people try to talk about this topic.
Speaker 3Mm-hmm.
Rebecca Berens MDBut so we can't hide from that fact. That is true. But I think the important thing to examine is what, what does that really mean? 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?
Sonia Singh MDYeah, 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. And often it's something that. We actually don't have control over and that's why we're seeking it in this place. So anyway, tell us a little bit about what the data and facts are around clean eating.
Rebecca Berens MDOkay. I think first what I wanna comment on is just what does it mean to eat a processed food?
Speaker 3Mm-hmm.
Rebecca Berens MDProcessing 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. Mm-hmm. There's a wide variety of what processed means. 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. Yeah. We are not living in a world anymore where. 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. That's just not how any of us live. And so we do need a way to efficiently distribute food amongst a large number of people in a way that keeps it. Safe and able to be eaten for a longer period of time to survive that transportation. Right. So, so it is important to understand that all processing is not bad. Yeah. And in fact, processing is necessary for us to be able to feed. The Earth's population. Yeah. In the modern world.
Sonia Singh MDAnd there's some examples, like the classic example is flash frozen produce. You know, fruits and vegetables potentially are more nutritious than getting something fresh that's not at the peak ripeness. So you know, this idea that processing automatically equals bad is kind of an oversimplification.
Rebecca Berens MDAbsolutely. And I think, the processed food that I think most people are thinking of when they're thinking of that's like un unclean. 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. This is a true fact. 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. Extra delicious. Yeah. So that you will eat more of it and buy more of it. That's absolutely true. And in the process of doing that, often there are quite a few nutrients. Removed. Mm-hmm. And or even like fiber for example, is, is often very low in those types of foods. 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. Right. And so that is also true and I think it's important to, to recognize the fact that. This is a tactic of food companies for marketing purposes.
Speaker 3Mm-hmm.
Rebecca Berens MDTo 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. We get some neurotransmitters in our brain that tell us like, oh, you've had a satiating meal, now we're full. And, and they're specifically engineered to override that, and I think that's important to call out that that is a factual truth.
Sonia Singh MDYeah. I think. 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. 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. 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. Yeah. Or put a clean label on it. And again, that's just slick marketing. It doesn't actually mean that product is any more nutritious.
Rebecca Berens MDUh, exactly. Exactly. And I think it's bypassing the real problem, which is. We have an inequitable food environment. We have many areas of the country where people live that are food deserts. 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. We work in environments that. Do not allow us adequate break time to go and get a real meal. 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. Taking away their ability to get up, use the bathroom and have a lunch break. Yeah. Been there, you know? Right. Exactly. I mean, every doctor in in the country can attest we do not pee all day. Right. And so it's culturally speaking and, and the way that our society is designed. We have taken away the ability to meet our basic needs. And so people are forced to reach for these more convenient, easy access, fast products just to be able to eat. Yeah. And have enough fuel to get through the day and yeah. It's probably not the most nutritionally balanced option. Yeah. But what choice do people have and and these people that don't have the financial access to go and. Buy all of these fresh foods, the time to prepare it. A lot of these people may be working multiple jobs. Yeah. They have kids they have to take to and from childcare or school. 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. This is your problem. Mm-hmm. Rather than this is a societal problem that as a society we need to fix together.
Sonia Singh MDA hundred percent. 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. One was in undergrad when I got first interested in nutrition, and then I got a master's in nutrition. So then when I was in nutrition school, I was very thoughtful and conscientious about it. And then there was another period towards the end of residency when I was. Thinking a lot about what I was eating. And at the time, clean eating wasn't a phrase. So I was telling people like, I'm just eating real food. That was my phrase at the time. I was reading a lot of Michael Pollan and he talks about food, eating food and eating real food. So I was talking about I only eat real food and I think for me, I was never totally obsessional about it. There wasn't a body image issue there. It was just a little bit heightened attention towards that issue. But I was kind of flirting with Orthorexia at that time, in those times in my life. At the time I was single, I had total control over my food. I had good access to food. I lived in the Bay Area. There was a farmer's market down the street. 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. 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. And, I think at, at this stage of my life, like I have to eat a granola bar. Sometimes I have to go through a drive-through. Sometimes I ate a frozen pizza last night, I ate a frozen pizza for dinner. Um, you know, this is just living in the real world. This is modern life and their realities of modern life. So, I think. 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. And honestly unachievable for a lot of people.
Rebecca Berens MDAnd to your point, I think. The story I hear over and over from my patients who've struggled with disordered eating and even myself, it often starts like that. Mm-hmm. You know, it's like, oh, I just wanna make healthier choices. I wanna, you know, I wanna be healthy, I wanna do the right things. This is how it started for me, is how it started for so many people. Yeah. Trying to include more whole foods, exercising more. There is a strong genetic component to eating disorders that I don't think people fully realize. And. It's one of those things where it's a combination of factors that triggers an eating disorder. Mm-hmm. There's a genetic predisposition, there's some environmental change, like change in your eating habits. Yeah. 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. And, and that combination of things is what kind of. Jumps it into a full eating disorder, so it doesn't happen to everyone. Yeah. Right. 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. And social media use and the development of eating disorders. Mm-hmm. And I can't imagine that it doesn't have a lot to do with eat clean. Mm-hmm. What I eat in the day, and this is what I hear from patients. It's like I was seeing a lot of this. I started doing this, and then it, it progressed. And so I think, there is also real harm
Sonia Singh MDYeah.
Rebecca Berens MDIn promoting that sort of behavior for a decently large population of people.
Sonia Singh MDYeah. 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. 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. Yeah. So can you talk a little bit about orthorexia and what.
Rebecca Berens MDYeah. 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. That That person significantly restricted their intake below their caloric needs for that day.
Speaker 3Mm-hmm.
Rebecca Berens MDBecause the preferred foods were not available. Mm-hmm. Therefore, they did not meet their nutritional needs. And, to be diagnosed with an eating disorder, there has to be a medical and or psychological consequence to your eating behaviors. Mm-hmm. And I would argue that that was one, right? Mm-hmm. Yeah. Where, you're not meeting your co coic needs for the day because you restricted. So significantly based on the food that was available, not being what you believed to be preferred. So with Orthorexia, people think of anorexia as there's a body image component. I'm restricting my mm-hmm. Intake because I want to change my body shape or size. Yeah. Orthorexia could be a similar restriction. Maybe not a claim around body shape or size, but around doing the right thing, quote unquote for eating in a clean way. I'm only going to eat if it's clean. Yeah. And that can lead to significant restriction.
Sonia Singh MDYeah. And I don't know the statistics on this, but I feel like. I see a lot of patients. 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. But, I think it's probably a lot more
Rebecca Berens MDprevalent than we realize. Absolutely. And I think the, It's very normalized also. Yeah. It's, it's not viewed as a problem. Yeah. In
Sonia Singh MDfact, it's celebrated, I think. Yes. In a lot. Yes, it is.
Rebecca Berens MDAnd 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.
Speaker 3And
Rebecca Berens MDthen if you're the doctor that's saying actually, it's maybe okay to eat some processed food if that's all that available. 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. We can promote balanced nutrition for everyone.
Sonia Singh MDYeah.
Rebecca Berens MDBut that has to be balanced. It doesn't have to be so regimented and restrictive.
Sonia Singh MDYou know what's interesting is when I first started doing social media, a lot of times I would just post like. Oh, this is my breakfast. Here's a recipe I'm making for dinner. 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? And what's funny is I got feedback from a lot of patients that were like, oh my God, you eat like I eat. And I think they were saying. They were surprised that I was eating bread, I was eating pasta and I just let my kids make cupcakes out of a box. 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. Like it, to them, it just felt like, so unusual and, remarkable. And that, that really struck me. 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. Yeah, absolutely. Okay. Anyway, let's get on to, data, can you share a little bit of data on what we know about clean eating?
Rebecca Berens MDYeah. 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. And so that is, relating to what we talked about earlier. We are very reliant on processed foods and I think, again, that's blamed a lot for a lot of the. Chronic health conditions mm-hmm. That we have in this country. But, but as I said, there's a lot of other factors to that that we have to consider. 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. There was a study a cross-sectional survey showing. 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. 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. And so I think this is like just a really important thing to keep in mind. Yes, there's maybe benefit. But there are also harms. 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.
Sonia Singh MDYeah, I think that's such a key point. 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? 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. They're low income, there's low resources, there's low health literacy. The nutritional guidance you're gonna give that patient is going to be very different than the guidance you would give a, highly resourced. 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. 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? Who is this serving? 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. 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. 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. 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. 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. So anyway, I think it's important to ask ourselves
Rebecca Berens MDWho is served by this concept. Really. Yeah. 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. And all this stuff that's available that the highest resourced people are, that trickles down to people who. Really don't have the resources for it. Mm-hmm. But they feel like that they need to, that they should be doing this, do that. Yes. 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. Less beneficial things and not putting those resources towards things that would actually be beneficial to them. 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. Yes. In the morning so you can get more protein. 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. Mm-hmm. And so it's really, it's really important to, like you said, who is it serving? I don't think it's serving anyone. Yeah. And it's actively harming some people.
Sonia Singh MDSo what can we learn from all of this as patients and doctors?
Rebecca Berens MDSo I think the important thing to, to see from this is that patients really want this information about nutrition. They really wanna understand how to take better care of themselves, how to eat in a way that's gonna support their health. And it's important that we are giving them that information. And we know that healthcare professionals is, particularly, doctors generally have very little nutrition education in their, medical training. 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. It's important to understand that clean eating does not have a standard definition. Yeah. And clean eating is not a medical recommendation. And I've definitely heard patients. Tell me that a doctor has told them to eat clean. And I don't even know what that means. Yeah. 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. 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. But it's actually more harmful to give flippant, under-researched advice mm-hmm. Than it is to give, it is better to just give nothing in that case. Yeah. Do
Sonia Singh MDyou ever use
Rebecca Berens MDthe
Sonia Singh MDphrase, I think
Rebecca Berens MDI know the answer
Sonia Singh MDto
Rebecca Berens MDthis, the phrase clean eating? Yes. Oh my gosh. Never in a positive sense.
Sonia Singh MDYes. I also never use the phrase, I don't use it on social media, I don't use it with patients. 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. It doesn't mean anything's. Specific, and as the data shows us, it's associated with some increased risk of, disordered eating or dietary restraint.
Rebecca Berens MDYeah, absolutely. 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. What does clean eating mean to you? If, if a patient comes in and says, I'm trying to eat clean. 'cause patients tell me this all the time, they're like, oh, I'm just trying to eat clean. Especially if I've recently maybe diagnosed them with a chronic health condition. Yeah. And they went down a rabbit hole and now they come in and they're like, oh, I'm eating clean now. What does clean eating mean to you? Mm-hmm. What do you, what is, what do you mean by that? Because it doesn't mean the same thing to everyone. So as a physician, we need to know what do they mean by that. And then be able to dispel any misconceptions that they may have about. What is, beneficial for their condition.
Speaker 3Mm-hmm.
Rebecca Berens MDI 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.
Speaker 3Yeah.
Rebecca Berens MDI see a lot of patients who have told me that a doctor has made an assumption about how they were eating. Mm-hmm. Based on their size, their health conditions. Any number of things rather than actually asking. And a lot of patients, particularly those in larger bodies who have had eating disorders. Who went to the doctor and were given a handout that said, oh, you need to lose some weight.
Speaker 3Yeah.
Rebecca Berens MDAnd they were already restricting so severely.
Speaker 3Mm-hmm.
Rebecca Berens MDAnd so ask the question first, and I, I always like to do a 24 hour dietary recall just to get a quick snapshot. It's obviously not perfect, but it's at least. Most people can remember what they ate for the last 24 hours. Yeah. Um, and then you get some, it's an opening point for a conversation. Right? Yeah.
Sonia Singh MDAnd 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. Just believe them. Oh my gosh,
Rebecca Berens MDyes. It's
Sonia Singh MDcost nothing. Just believe them.
Rebecca Berens MDSo many patients have also told me that they did tell Yeah. Someone mm-hmm. About their eating disorder behaviors. Mm-hmm. And they were told like, that's not possible. Yeah. You wouldn't, you wouldn't be this size or it's not, and. 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. Yeah. So yes, absolutely. The next thing I would always ask is what foods do you regularly have access to? So kind of just an assessment of what's currently available easily for you. 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. Mm-hmm. Then you've helped no one. And you've just kind of. 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. Right. I always like to ask too about, not just allergies, but intolerances. Some people really just don't feel good when they eat certain foods. And again, I think they get blown off. Yeah. When they're like, I don't like to eat this. It hurts my stomach. And they're like, oh, you're fine. It's not real. You know, I'm just like, if it makes them feel bad, again, let's believe them. Unless it's an entire food group, right. That can't be replaced. Like I don't eat any carbs. 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. Yeah. Ask about that. Ask about allergies. 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. 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. Mm-hmm. We wanna make sure it's patient centered. And so then we're coming up with a plan that's actually going to work for them.
Sonia Singh MDYeah. 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. So I like to ask, who's preparing your meals? Who's doing the grocery shopping? Do you have time to do that? 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. Is really helpful. 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. The preparation of the food.
Rebecca Berens MDYeah. And I also do like to help by getting a dietician involved. Mm-hmm. Particularly if there's someone who has had an eating disorder history. Because we wanna make sure that we are being very cognizant of meeting their nutritional needs and, and addressing any. Disordered behaviors. 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.
Speaker 3Mm-hmm.
Rebecca Berens MDAnd making those small adjustments in nutrition. And again, it doesn't have to be. Drastic or extreme. It can be simple, small, sustainable changes that will actually fit in their life. 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. A team approach to healthcare is always better.
Speaker 3Yeah.
Rebecca Berens MDAnd 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. Mm-hmm. So purging using diet pills that they bought over the counter or from nebulous sources. Yeah. Laxatives inducing vomiting, are they, are there significant body image concerns? Are they weighing themselves daily? Are they measuring themselves daily? 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. Mm-hmm. So just really important to keep that in mind. And I think it's, like you said, a lot more people. Than we realize. And they're not being met with any support at the doctor's office.
Sonia Singh MDWell, thank you Rebecca. This was such a great conversation. I was really excited to hear about your thoughts on this particular topic, and we wanna hear your thoughts. So feel free to send us feedback. You can reach us at. The antisocial doctors@gmail.com, is that right? That's right, yes. Okay. Okay. 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. So until next time, bye. Thanks Sonia. Hey guys. Last but not least, we have a very important disclaimer. This podcast is intended for educational and entertainment purposes only. The content shared on this podcast, including but not limited to opinions, research discussions, case examples, and commentary, is not medical advice and should not be considered a substitute for professional medical evaluation diagnosis. Or treatment. Listening to this podcast does not establish a physician patient relationship between you and the hosts. We are doctors, but not your doctors. Any medical topics discussed are presented for general informational purposes and may not apply to your individual circumstances. Always seek the advice of your own qualified healthcare professional regarding any questions you have about your health, medical conditions, or treatment options. Never disregard or delay medical advice because of something you've heard on this podcast. While the hosts are licensed physicians, the views and opinions expressed are our own and do not represent those of our employers, institutions, organizations, or professional societies with which we are affiliated. Although we do our best to stay up to date, please note that this podcast includes discussion of emerging research, evolving medical concepts, and differing professional opinions. Medicine is not static and information may change over time. We, the hosts make no guarantees about the accuracy, completeness, or applicability of. Content and we disclaim any liability for actions taken or not taken based on the information provided in this podcast by listening to the Antisocial Doctors podcast. You have agreed to these terms. Thanks again for joining us.