Welcome to ‘Dear Laura’ - a monthly column where I fashion myself as an agony aunt and answer the questions that readers submit. If you’d like to send in a question for me to answer next month, you can submit it here.
I’m happy to answer Qs about anti-diet nutrition, developing a more peaceful relationship to food and weight-inclusive health, annoying diet trends and news stories, body image challenges, and, of course, challenges with feeding your kiddos. Please give as much detail as you’re comfortable with and let me know if you’d like me to include your name or keep it anon.
Please remember that these answers are for educational purposes only and are not a substitute for medical or nutritional advice; please speak to your GP or a qualified nutrition professional if you need further support.
Last week I answered part of Kathy’s question (below) by exploring the evidence base behind restrictive diets for the management of symptoms of endometriosis (endo). You can catch up on what the evidence says about avoiding things like gluten and high FODMAPs foods here:
Today I want to hone in on another aspect of Kathy’s question, this time around the seemingly wildfire spread of mis- and dis- information. As a reminder, here’s what Kathy sent in:
An Instagram influencer I follow posted a story saying she’d seen, in the stories of an even bigger influencer, the Guardian article on the results of the study saying eating gluten-free reduced endometriosis pain in up to 50% of sufferers. The first influencer, within 5 minutes of reading this, had gone GF and was asking her followers to send her food ideas.
This jumped out at me on a few levels. Firstly, the wildfire spread of an idea via influencers - in this case, a substantial food restriction. Secondly, how neglected by the medical system people with endometriosis are, and what a devastating condition it is. Thirdly, how little research looks at women’s health. Fourthly, how casually such a huge dietary shift as ‘just eat GF’ is thrown out to people without care for the overall effect on their relationship to food, etc. And that’s not even looking at the study quality yet… Not sure if this is a pertinent topic - fine if it’s not - just sharing as I felt a gut reaction to it on lots of levels.
I want to pick up on the idea Kathy is touching on here around the ‘wildfire spread of an idea via influencers’ and the casual way huge dietary restrictions are thrown around despite, as I hope we’ve established, not a shred of evidence. I specifically want to pinpoint the underlying mechanisms that enable influencers to spread misinformation, but also uncover why it’s difficult to pinpoint what constitutes misinformation in the first place.
To do this, I’d like to use the example of an ‘endometriosis influencer’. Now, this isn’t the influencer that Kathy was referencing in her Q. But since talking to my pal Humaira Mayet, who is pretty plugged into all of this stuff, I have since learned about Sophie Richards. Richards – who bills herself as a ‘Woman’s Health Advocate’ and is training to be a ‘hormonal coach’ – suffers from endometriosis and posts advice to her almost 400k and 700k followers on TikTok and Instagram, respectively.
Now I want to make it very clear here that I am critiquing the underlying frames of Richards’ work, not Richards herself. I hold a great deal of empathy for anyone who has struggled to get answers for their pain and feels dismissed, gaslit, and unheard by the medical establishment. Once again, it makes perfect sense to me why someone might seek out alternative answers, or feel empowered by taking control of their diet and lifestyle.
Health influencers – for want of a better term – also serve an important function in terms of sharing experiences about navigating the health care system, getting a diagnosis, treatment options, and as sources of information and support. At the same time, they hold a lot of power over vulnerable people, and when that power goes unchecked, well, people get hurt.
This is why I’m uneasy that Richards is promoting fringe ideas about diet and nutrition, without the qualifications (and attendant checks and balances) to do so safely. Specifically, she promotes the autoimmune protocol (or AIP) – a severely restrictive elimination diet – that is not empirically tested to support endometriosis. Or any condition for that matter.
The AIP involves eliminating virtually all foods except from some meats, a handful of fruits and vegetables, and some oils. Grains and legumes like oats, lentils, rice or pasta; nightshades like tomatoes, aubergines and bell peppers; spices like cinnamon and paprika; coffee; dairy products and eggs; and nuts like peanuts, almonds and pistachios are all forbidden. Ditto any kind of ‘processed’ food. At least in the initial elimination phase, which can last anywhere from 30-90 days. The idea being that you reintroduce each food one at a time and then note if there’s any reaction to it. What constitutes a reaction, however, is vague and easily confounded by the unpredictable nature of bodies.
During her own reintroduction phase, for example, Richards shared a dramatic video whereby she reintroduced chilli flakes. Her experience is that these caused ‘inflammation’, indicating that they should be permanently eliminated from the diet. However, there is no clearly defined or objective measure of ‘inflammation’. She seems, from what I can tell, to be conflating ‘inflammation’ with ‘swelling’. She talks about how, up until this point (day 41 of her diet) she had seen a reduction in ‘inflammation’ in her face, arms, and stomach. Bluntly, this is not a reduction in inflammation. She lost weight. And in the grand tradition of anti-fat bias, has confused it for ‘health’.
I don’t want to spend too much time on the AIP per se. Jess Steir from Unbiased Science has done a handy little infographic here and a whole podcast episode here. Suffice to say, it’s extreme, unnecessary, and pretty wild that Penguin Random House – who are publishing Richards’ upcoming book – apparently learned nothing from Belle Gibson Gate.
What I want to focus on is how, despite everything we learned from the fallout around clean eating, we still gravitate towards health mis- and disinformation. Why is it that we love a grifter?
