April/May 2022 Issue

Clean Eating: The Clean Eating Lifestyle
By Michelle Dudash, RDN
Today’s Dietitian
Vol. 24, No. 4, P. 14

Factors to Consider When Counseling Clients

Interest in clean eating has been surging in popularity for more than a decade.1 In a survey of 1,173 RDs, clean eating was predicted to be the third most popular diet trend in 2022, behind only the keto diet and intermittent fasting.2

This interest in clean eating has led food manufacturers to include clean labels on products and chain restaurants to introduce clean menus.

Sharon Palmer, MSFS, RDN, known as The Plant-Powered Dietitian, and author of the book California Vegan, says, “The survey revealed that dietitians believe online food shopping is the biggest trend from the pandemic, and there is a rise in interest in purchasing clean ingredients and foods from online sources—some of which are making this a big marketing push.”

Based on such growing interest, it appears the clean eating lifestyle isn’t going away anytime soon. Whether they love it or hate it, it’s important for dietitians, as health care professionals, to know its foundation and ins and outs, and how to counsel clients who come knocking for information on this popular eating pattern.

What Is Clean Eating?
While there isn’t an official definition, the foundation of clean eating that most experts and enthusiasts can agree on is that it involves choosing mostly whole foods in their low-processed state. While the term “processed” might ruffle some lab coats, it may be helpful to view food processing as a continuum, not an all-or-nothing stamp of approval or denial as to whether it should be regularly included as part of a healthful diet.

“Dietitians need to keep in mind that there may be some positive elements to consumers’ desire to eat ‘clean,’ such as eating more whole, minimally processed plant foods, and focus on food quality rather than fad diets that exclude healthful foods,” Palmer explains. “Many clients define ‘clean eating’ in a variety of ways, so it’s important for RDs to determine what dietary goals they may have and help them achieve a healthful lifestyle that meets their nutrient needs.”

Consider the journey of soybeans, for example. On the far left sits low-processed dried whole soybeans and edamame. As soybeans travel further along the processing continuum, they can be manufactured into tofu, soymilk, plant-based burgers, and protein bars and powders, where fibers and other nutrients may be removed and sugar, salt, and fats added—often, but not always. While higher-processed foods tend to be more calorically dense than their low-processed counterparts, there are clear exceptions, as is the case with foods such as soymilk and soy burgers, which are prominently featured in the 2020–2025 Dietary Guidelines for Americans. It’s up to consumers (and dietitians) to read food labels and decide how any given food can fit into a more healthful lifestyle while acknowledging budget, culture, and food preferences.

Mitzi Dulan, RD, CSSD, a sports dietitian and founder of simplyFUEL, a high-protein snack company, says, “I have believed in clean eating for a very long time before it became mainstream, so when I first created my products it was already the way I created recipes.” From her experience of owning a food company, she says her customers “definitely feel the most comfortable with reading ingredients that they recognize. Many don’t want to see the word ‘sugar.’ I use honey to sweeten my protein balls and erythritol for my keto granola since most people looking for keto products are OK with sugar alcohols.”

Additional ingredients clean eating enthusiasts may try to avoid include refined oils and flours, fillers, and artificial sweeteners, coloring, and preservatives.

Explore Your Clients’ Intentions
If clients explain their desire to eat clean, what is a well-intentioned dietitian to do?

“When a person says they want to eat clean, I begin by probing and attempt to find out how they define clean eating, what's included in clean eating, and why they feel they need to ‘eat clean,’" says Maya Feller, MS, RD, CDN, owner of Brooklyn-based Maya Feller Nutrition and author of The Southern Comfort Food Diabetes Cookbook. In her practice, her team provides MNT nutrition coaching for the management and risk reduction of noncommunicable diseases. “When I probe further regarding how my patients define clean eating, some have gone on to say, ‘going low carb.’ I see this as an opportunity to educate the patient on the importance of carbohydrates in their pattern of eating and to provide some real nutrition education about macro- and micronutrients.”

Feller adds, “I also usually remind people that foods are dirty when they’re soiled, and when we wash them they become clean. I find that it’s helpful to reframe how we think about foods, ie, moving away from a binary perspective that’s often polarizing.”

Getting Started
Once a clear understanding of the patient’s goals become evident, dietitians can dispense the appropriate tools to develop a plan of action that works with the patient’s culture, lifestyle, and budget.

One great tool to begin with is a strategically stocked kitchen separated into weekly shops and “a big shop” to make grocery shopping a bit more efficient and manageable, and possibly more economical if buying in bulk is feasible. The following is an example of a weekly, monthly, and quarterly shopping list.

Weekly Shopping List
Fresh vegetables in a variety of colors for most meal and snack occasions
Fresh fruit for snacking, salads, and toppings
Milk, yogurt, and cheese (in dairy varieties or fortified plant-based alternatives)
Eggs
Fresh or frozen seafood lower in methylmercury, such as shrimp, cod, tilapia, sardines, and wild salmon
Poultry
Lean red meats
Breads, English muffins, and tortillas (aim to choose half of them as whole grains)
Tofu
Aromatics, including garlic and onion
Fermented foods
Lemons and limes

Monthly or Quarterly Shopping List
Frozen and canned vegetables (check sodium levels on canned vegetables or choose low sodium)
Canned, dried, and frozen beans, peas, and lentils (rinse canned beans or choose low sodium)
Canned tomato products (check sodium levels)
Rice
Ancient grains
Pasta
Nuts, seeds, and butters (check sodium levels)
Oats
Breakfast cereals
Extra-virgin olive oil or other nutritious oils (eg, avocado and sesame oils)
Dried and canned fruit with no added sugars
Canned and pouched tuna, salmon, and other seafood
100% fruit juice
Tea and coffee

As Needed
Vinegars
Herbs and spices
Broths and stocks (check sodium levels or choose low sodium)
Whole grain and nut flours
Beer, wine, and distilled spirits in moderation for appropriate populations

Is Clean Eating for Everyone?
The clean eating lifestyle may be helpful to some patients, but it may be inappropriate for others, including those with a history of eating disorders and orthorexia, an obsession with healthful eating that can damage one’s well-being.

“Since there’s no standard definition for what clean eating is, the perception and impact is often that processed, packaged, and convenience foods are somehow unclean, less desirable, or health harming,” says Cara Harbstreet, MS, RD, LD, a Kansas City–based nationally recognized food and nutrition expert and owner of the private practice Street Smart Nutrition, which specializes in sports nutrition, intuitive eating, and Health At Every Size® counseling. Perhaps even more importantly, “Culturally significant food from global cuisines is usually included in this category, too, which falsely elevates Eurocentric foods to the top of the list for what is considered ‘healthful’ or ‘good.’”

Expert Tips
To better counsel clients and patients on clean eating, dietitians can use the following tips:

• Learn more about agriculture and food production. Dietitians can take free virtual tours to learn about the practices of various food companies and producers, or go on a local farm tour in their community. Understanding the facts can help in the evaluation of how food processing affects the final product and nutritional value.

• Be mindful of language and potential biases when communicating with clients. Harbstreet’s advice: “Building awareness and competency around our language is a continuous process, and you’ll inevitably stumble along the way. Do not let that stop you or slow you from doing what is ethically right in recognizing the humanity in your audience and clients. The impact of your words is greater than the intention behind them, and we are long overdue for a shift in the profession when it comes to this issue.”

Bottom Line
Dietitians can be allies and provide support to clients who want to adopt a clean eating lifestyle rather than shunning them and missing an opportunity for nutrition education. Being a resource to patients and helping them distinguish facts from fearmongering is more important now than ever as the population of noncredentialed nutritionists and online influencers grows and consumers spend more time on social media.

Eating clean needn’t be an all-or-nothing proposition, but rather making more nutrient-rich, whole-food selections when appropriate and available. Dietitians should be mindful about how they communicate with clients, always being respectful of their culturally significant food preferences, and avoid food shaming, as the concept of clean eating can be applied to every culture and food tradition when clients are looking for such opportunities.

— Michelle Dudash, RDN, is a Cordon Bleu–certified chef; author of Clean Eating Kitchen: The Low-Carb Mediterranean Cookbook (Fair Winds Press, 2021) and Clean Eating for Busy Families, revised and expanded; and creator of Spicekick Meal Spice Kits: Your Sidekick in the Kitchen.

References
1. Clean eating. Google Trends website. https://trends.google.com/trends/explore?date=all&geo=US&q=%2Fg%2F11cnc9y0y9. Accessed January 10, 2022.

2. A decade of dietitian insights forecasts a future of food innovations. Pollock Communications website. https://www.lpollockpr.com/in-the-news/a-decade-of-dietitian-insights-forecasts-a-future-of-food-innovations/. Published January 4, 2022.