Science-Based Nutrition Part 2: Individuality

An Alternative To Anti-Diet

This article is part two of the SBN series. Read part one here.

The Individual

The scientific method is the best method of inquiry within the field of nutrition. However, sometimes there is not a study available to describe every individual case. Certain individuals can anecdotally feel better on a particular form of diet even if that diet is not supported by the research. It’s important to keep in mind research is never absolute, even if science is the best way to get close to the truth it is still limited. These limitations can stem from a number of factors such as demographics of individuals studied, sample size, research methodology, or more. These factors can hinder a professional's understanding of individual considerations. While the norm of universalism in science is ideal it is not always the case. People have unique backgrounds, goals, needs, and circumstances. Dealing with people is a messy ordeal and getting them to change their dietary habits is an even messier ordeal.

Think of science as the outline of a paper, it is like the general rule of thumb or guiding principle. Nevertheless, the paper still needs substance and detail, these details will vary considerably. When working with people see the science as the general outline but do not miss out on the details (their individuality). Sometimes it is okay and perhaps necessary to stray from the outline but do not get so caught up in the details things become fuzzy. A paper without structure would be garbage and a paper without substance would be generic. Clients need varying degrees of structure as they would need various degrees of personalization. Striking that fine balance between general structure and personalized touch.

Experience

Each person is first and foremost an individual. Individuals in the sense they have their own unique perspectives, strengths, weaknesses, histories, etc. Each person is shaped through their own experience, as a professional working with clients taking into account their experience matters.

While the scientific method is the best way to understand nutrition the application of science in the real world is not so clear-cut. A study could be released showing the best diet for human health but if no one follows that diet it doesn’t matter. Dealing with humans is messy and complicated, which is why scientists use averages in research but when one looks at the raw data there is often variance between individuals. People do not respond the same way to the same dietary changes, this is clear in research as it is in real life.

Therefore, science should be viewed as a guide for best practices. Sometimes professionals have to deviate from that guide to truly cater to the people they work with. Different people have different needs, a young athlete will not have the same needs as a mom with three kids; so one often has to work within the framework of individual experience. One method might work for one client but not for another client for whatever reason. Understanding the reasons and tailoring the dietary approach to that individual is a hallmark of an effective practitioner.

Some people will anecdotally feel better with certain methods than others even if these methods lack strong scientific evidence. Even with a lack of evidence, a method could work subjectively for that individual. However, to be cautious, this isn’t to suggest what works for one person anecdotally is universally true for everyone nor does it suggest that method works a particular way. The placebo effect is a real phenomenon, it doesn’t indicate a dietary method is inherently special.

For example, some individuals lose a lot of weight on the ketogenic diet. These individuals often feel subjectively better, have better control over their blood glucose, and feel less hungry all the time. Does this mean the ketogenic diet is magical? Of course not, feeling subjectively ‘better’ is vague and can refer to a number of different factors, but some people actually feel worse on a ketogenic diet. The weight loss was due to a caloric deficit not because of insulin, weight loss itself is associated with blood glucose control, and those on a ketogenic diet consume more fat and protein which is more satiating. With these considerations, one can conclude a ketogenic diet is not universally the best diet for everyone. However, one must also acknowledge this approach can work favorably for some people.

Being of Service

Practitioners are meant to be of service. This involves thinking of the client first. The client’s needs, wants, and personal considerations matter always. A practitioner should not force a method upon a client merely because they prefer it. Nutrition often has to be tailored to the individual and changed over time. This is a level of consideration that cannot be provided by a cookie-cutter meal plan print out.

This consideration of the individual invites collaboration, not force, on the part of the practitioner. The practitioner is not the dominating expert but a collaborative force to elicit change. This draws heavily on the motivational interviewing approach as change cannot be forced but elicited. The change that is trying to be elicited in this case relates to diet, which is obviously difficult, but the four processes of motivational interviewing can help achieve this.

According to creators William Miller and Stephen Rollnick, motivational interviewing (MI) is a collaborative, person-centered form of guiding to elicit and strengthen motivation to change in a counseling setting. However, the approach has been adopted in numerous settings related to lifestyle changes and coaching. The four processes of motivational interviewing are engaging, focusing, evoking, and planning.

1. Engaging- the foundation for working with a client rests upon the relationship between the professional and the client. This relationship needs to be productive and involve mutual respect. Mutual respect is established through careful listening, reflecting back on experiences, leaning into a person's strengths, and supporting their autonomy.

2. Focusing- this process involves helping the client find what is important to them. That realization is then used to come up with a shared purpose between professional and client. The client determines their own goals, ambivalence, and obstacles. Then change can be brought into the picture.

3. Evoking- once a focus is discovered and agreed upon the professional gently explores the client’s “why” for change. This involves looking at the motivation, ideas, and personal interest in changing. This process typically requires the professional to pay attention to language surrounding change to gauge where the client is; are they ready to change, indecisive, or not ready yet?

4. Planning- this process is optional but it explores the “how” for change. During this process, autonomy should be respected as the plan comes largely from the client. The plan should be aligned with the client’s motivations, strengths, self-knowledge, and values. Professionals insert advice only when warranted and appropriate (e.g. client wants to change, knows what they want to change, knows why they want to change, but they don’t know exactly how.)

The four processes of MI frame how a professional ought to interact with probably most clients. Respecting a client's individuality by respecting their autonomy, self-knowledge, values, intrinsic motivations, and self-efficacy. Practitioners are seen more as a guiding force than a strict arbitrator of rules. However, individual considerations matter, MI might not be an effective approach for everyone and there are many other effective tools to elicit change out there. What was outlined was a basic introduction to MI to give insight into the processes of respecting individuality. More tools will be covered for practitioners in the “Professionalism” section of SBN. 

In the spirit of this paradigm (Science-Based Nutrition), MI has quite a bit of evidence backing it up.

Resolution

I assume most people reading this have a desire to help people. We help people live healthier lifestyles not by force, shame, and blame but by support and information. Practitioners give support while science and experience can provide the information. The end goal is to not only help people achieve their goals but empower them with the tools and knowledge to sustain those goals. A person can not have a coach forever so it only makes sense to have the end in mind.

Many people ignore the end or what I call after action, they succeed at their goal and then proceed to go back to their old habits. I believe this is the underpinning for the failure of many fad diets, they are short term quick fixes with no plan afterward. A person can follow a strict approach for a couple of weeks but eventually, they will stop. After they stop they will either go back to what they were doing before and then probably go back to another short-term fix, a concept known by many as yo-yo dieting. Stopping yo-yo dieting requires practitioners to pay attention to not only short-term benefits but more so long-term benefits especially for the general population. The general population often needs lifestyle-related intervention, that can involve their habits, mindset, behaviors, relationships, etc.

So, we can quickly see it is deeper than counting one’s macros, humans are complex social animals. A variety of people respond differently to a variety of approaches, one approach might be appropriate for one person but inappropriate for another. A practitioner should pay attention to these differences between people and even the changes within the same person; people often change their goals, perspectives, habits, and lives. Human beings are not static in that sense, science gives us the guide but the individual dictates the details.