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Science communicator Jonathan Jarry joins us to discuss his history of turning to alternative cures for chronic pain, how he came to be skeptical of the wellness industry, the problems with science journalism, why you probably don’t have a leaky gut (despite what many influencers and wellness practitioners claim), the critical article about “leaky gut syndrome” that resulted in death threats, and lots more.

Jonathan Jarry is a science communicator with McGill University’s Office for Science and Society (OSS), dedicated to separating sense from nonsense on the scientific stage. He has a Master’s degree in molecular biology and he brings his experience in cancer research, human genetics, rehabilitation research, and forensic biology to the work he does for the public. With cardiologist Dr. Christopher Labos, he co-hosts the award-winning medical podcast The Body of Evidence, which aims to contextualize findings in the realm of health research and answer the public's most pressing questions about the biomedical sciences while also being funny and entertaining. He talks about science most Fridays on CTV Montreal News and is regularly interviewed in both English- and French-language media. Learn more about his work at jonathanjarry.com.

Resources and References

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• McGill Office for Science and Society

• The Body of Evidence podcast

• Jonathan on Bluesky 

• Jonathan’s website

• Subscribe on your favorite podcast app

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Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: So, Jonathan, welcome to the show. I'm so excited to talk with you today.

Jonathan Jarry: Well, thank you for the invitation.

Christy Harrison: I'm really excited to talk because you're a science communicator and a skeptic of the wellness industry, and I am, too, and I really love your work. So I think we can talk about a lot of that. We both especially share an interest in looking at the hype around gut health and leaky gut. And so I want to kind of dive into that today. But to start, I'd love to have you tell me a little bit about your background and how you came to do the work that you do.

Jonathan Jarry: So, I'm a scientist by training. I got a bachelor's degree in biochemistry. I did a master's degree in molecular biology. I was really interested in forensics, specifically forensic biology. So I did end up working very briefly in forensic biology, not liking it, always seeking that sort of direct application of science to the public, which I thought I would get with forensics, but that was not the case.

Christy Harrison: This is naive of me, but is this like working in a crime lab or...

Jonathan Jarry: Yes, that sort of thing. I mean, basically it boils down to human identification in the case of forensic biology. And so, yes, a lot of crime labs will basically run DNA samples from crime scenes against reference samples. I was not working in a crime lab. I was working for the US armed forces. They have this massive DNA identification laboratory where they want to bring all of their soldiers home. And so soldiers that don't make it home, they will send out teams to basically unearth bones, crash sites, and they will bring those back. And then you will isolate mitochondrial DNA from those bones and check them against maternal relatives to see if there's a match. So that was the kind of work that I was doing.

And I've also worked in clinical laboratories. So basically sort of diagnosing people with various forms of cancer or trying to figure out if they have a certain genetic variation that will favor one treatment over, over another. So I've done all this kind of work, and I did start doing science communication in my spare time. It must have been 10/12 years ago now, sort of blogging and doing videos and podcasts, and eventually sort of came across this office that we have at McGill University, the Office for Science and Society, or OSS. And that is exactly the kind of work that they do. And so I ended up working for them first part time and then full time. And our whole goal is to disentangle this mess that is out there of good science, of bad science, of things that masquerade as science, and that end up confusing the public.

Christy Harrison: Yeah. Do you have any background or any experience with wellness misinformation yourself or other health concerns that might have led you to some of these treatments and modalities that you're now skeptical of?

Jonathan Jarry: Absolutely. I mean, I saw a chiropractor for quite a bit. I saw an acupuncturist as well, because I had some chronic pain issues. And the chiropractor was a funny one because she would have me lay down on a table for a bit before the actual chiropractic intervention, and she would put this hot compress on my neck and shoulders. And that is something that I know does work, I mean, temporarily, to relieve some of that pain. And at some point, I sort of caught on to the fact that this is the part that was really helping me, not the actual chiropractic work. And so I stopped going, because, of course, in chiropractic, they want you to keep coming back from maintenance treatments. And so I stopped coming.

And she called me one day, basically asking me, why have you stopped coming to see me? I was trying to be diplomatic and not have to explain myself, but here she is calling me. And so I explained to her what was happening, and she said, "Well, if it was as simple as that, I would just set up a bunch of tables and have all my patients just lie there with hot compresses on their bodies. I would save myself a lot of effort." And I said, "Well, maybe that's what you should do." And that was it. That's what happens.

The same thing with the acupuncturist, where it wasn't really working. And we tried electroacupuncture, which is not really acupuncture. We tried dry needling, we tried laser acupuncture, which I didn't know was a thing, but it is a thing.

Christy Harrison: I did that for fertility. When I was doing IVF, I was already super skeptical of everything and was like, I don't think this probably works. But I had five minutes before the appointment to decide if I wanted to do this and did a quick PubMed search, and I was like, well, there's something there. I don't know. And I ended up doing it. Now, having looked into it, I have a daughter. IVF worked for me. And yet now I look back at it, and I think, yeah, that was sort of a waste.

Jonathan Jarry: But, your frame of mind is always, well, what do I have to lose, right? What if it works? And especially a lot of these interventions, they're non-invasive. I mean, not dry needling, but laser acupuncture certainly is non-invasive. And it sounds like the risks are very low. And so you just go, well, let's try this. Who knows? And it got to the point where the acupuncturist was saying, "Well, if you really want this to work, you should also try taking some traditional Chinese herbs." And he was giving me a list of herbs that I needed to go and get from Chinatown, and I started to look into them and seeing that there was a lot of reports of liver toxicity associated with taking these traditional Chinese herbs.

And so I consulted with a medical doctor friend of mine at the time who said, please come and see me, and who talked some sense into me, because I was basically, I started off doing this thing that seemed to be risk free, and then I was slowly rolling down this rabbit hole, and it was becoming riskier and riskier. But once you have the trust of one of these practitioners, and especially since he knew that I was a scientist, he would say, "Well, there are papers about this. Let me send you some papers about this."

And at first, maybe I was just glancing at those papers. I wasn't as well trained as I am now to assess the worth of these papers and to contextualize their findings. And so it was played to my desire for there to be scientific evidence into these things, because there are. If you go looking for papers, you will find papers. But that does not mean that these interventions have been shown to be effective.

Christy Harrison: Right. Because not all papers are created equal. And not all science is good science. And you have to sort of dig in and really look at the methodology and what they're actually claiming to determine whether that's true. It's interesting, you mentioned that you were already a scientist at that point, but you weren't quite as well versed in critically reading and assessing science. I think that's common. I know for me, I was a science journalist and reported on nutrition and health and food, and then went back to school to become a dietitian and got my masters in public health as well. And it was only during the masters of public health portion, although I think I had like a crossover class that I had to take for both, but I had to take a research methods class.

And that was the first time I really was exposed to critical assessment of studies and looking at the quality of evidence and that not all evidence is created equal. And in my history as a reporter, I would just be like, well, there's science, and here's what the abstract says. I didn't always have access to the full study. I would interview the experts and interview someone who had worked on the study or whatever, and maybe quote from a university press release. And I think that's what so many journalists do, especially who are not hardcore science journalists, but more fell into it through other avenues, like I did through food and nutrition reporting. And it's interesting just to hear that someone who's actually a scientist, a working scientist, also had that same experience, that you were not trained on how to do that sort of critical assessment. Or maybe you were trained, but you didn't have as much experience in doing it as deeply.

Jonathan Jarry: Yeah, I had done research as part of my masters, and I would go on to do three years of a PhD program. And it really takes time because you become hyper specialized. You look at papers in your very, very narrow area of research. If you're interested in a particular protein, okay, so what have other people publish about this particular protein? And you can sort of miss the forest for the trees and lack the sort of generalizable skill to assess the worth of a paper or to think in terms of the pyramid of evidence, which is very flawed. But that gives you an idea of where observational studies fall versus experimental studies and the fact that randomized clinical trials, when they are well done, they are more reliable than case control studies. And so there are different types of studies that you can do, and they have their advantages or disadvantages, and some of them are more likely to give you a reliable answer and than others.

And those are things that you may not learn about when you're doing laboratory work. But what really helped me was doing those years in the PhD program, doing this kind of research, seeing other people in my lab and in other labs do research and then have some issues and problems with, for example, data analysis and not being given the right tools to analyze this huge mountain of data that they were generating and then being told, well, figure it out.

And that is kind of how bad science happens. There's no malice there. Sometimes it's just incompetence. You don't have the right kind of support and you end up finding things because you don't really know how to deal with this. And so you find false positives, and false positives are very sexy and so you get them published and then nobody can reproduce them, but you're not going to publish that because that's a negative result. That's not sexy. And so, I spent some time trying to reproduce results that have been published in the literature and not being able to, and we just moved on. And who knows how many other labs were also spending time trying to reproduce these results and were also getting negative results. But at the end of the day, what is left in the literature is that early positive finding. But it turns out to be a false positive. That happens a lot in scientific research.

Christy Harrison: Yeah, that's definitely my hunch too. When reading papers about nutrition and diet, I do a lot of deep dives into diet claims and other wellness claims, and it seems like this stuff is just so early stage and gets picked up by the press and hyped up and turns into its own whole thing, and yet the actual evidence behind it is so scant. And so when people try to reproduce it from different labs or in different populations, it just doesn't hold up.

Jonathan Jarry: Yeah, and diet, nutrition research in general, it's very, very hard to do because you can hardly force people to follow a strict diet for a long period of time. You would have to have them living in the lab and serving them meals and controlling what they eat. Some people will do that for very, very short periods of time, but you can't do that for years and for decades. And so you rely on the choices that people make and they may be different choices, and that may be what really explains the differences in disease outcomes that you see in those groups.

And often this research, it relies on self report questionnaires, food questioners, where people are asked, you know, what did you have for breakfast, you know, a week ago or how often did you eat eggs in the last six months? And I would have a very hard time answering those questions. And I have a fairly stable diet. But, at some point it's very hard to remember these things and maybe you want to please the experimenters and you know that you've been cheating and you're going to not disclose, and so it will alter the results in the end. And so a lot of this research is based on these food questionnaires, which are highly, highly questionable. So it's very hard to study nutrition and to get good, accurate, reproducible data.

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Christy Harrison: Yeah, completely. I've seen some studies, even, that ask people what they ate decades ago. There was evidence on acne and dairy I looked into, and it was like self reported questionnaires for women in their thirties to fifties. One study, I think maybe a couple studies did this that was like older adults or middle aged adults asking them what they ate in their teens, like, how often did you drink milk? How often did you eat cheese when you were 15 years old or whatever?

Jonathan Jarry: Right. I've seen these long studies that are done over the course of decades, which looks very impressive, and then the results is, oh, we found this association. But when you actually dig into the study, they asked this question, like back in the 1980s, once, how often do you eat muffins? And then the person answered in 1985, and now there's this health outcome in 2024,. They're saying, aha, we find an association between eating muffins and getting stomach cancer. And it sounds impressive because, oh, this is part of a cohort that we've been following for decades. So it sounds very impressive. But actually they only administered the food questionnaire once and it was decades ago. I have seen this like this. Of course it leads to headlines because it's sexy, either because it's enticing or because it's very scary and it's just an easy headline to write, but it's complete nonsense.

Christy Harrison: Yeah, that is so wild and just really speaks to the need for critical thinking about science and actually unpacking research among journalists and other people who are disseminating this information. But of course, there's so many systemic issues with that because the people who are doing that are often underpaid and overworked and don't have the time to actually go digging in, nor do they have the training. And I think there's a lot of movement within fields in journalism, so you don't necessarily need any sort of scientific background to just be a general reporter. You might need English or composition kind of rhetoric training to be writing. But you probably don't need science for a lot of the reporting you could do, and then you might stumble into something that actually requires a lot more scientific knowledge and not have that training.

Jonathan Jarry: Yeah, and we've lost a lot of expert science journalists over the years because they were seen as too specialized and there were cutbacks. And so now we are left mostly with generalists who are doing their best but who have to do the job of two and a half employees. They're running around. They don't have the proper background, and they rely on their Rolodex, their virtual Rolodex, to talk to experts about these things. And so you get the kinds of articles that are sort of very standard in health reporting, which is you begin with a person who has been diagnosed with this disease, for example. So you tell the story of Maria, who woke up one day and she felt a lump, and then you've got the researchers who found something new, and they just published, and maybe he's going to cure this disease. And then you go to a scientist who was not part of the study who says, well, yeah, it looks interesting, but, more studies are needed, and you come back to Maria at the end. That is sort of the classic way to structure a health story.

But the problem is that that study might have been done in mice, and, unfortunately, it's unlikely to pay off in humans at all. But even if it does, it will take decades. But you wouldn't know that from reading that particular write up. But it's a kind of story that journalists are trained to write because they see these stories as human interest stories, but they're not. They are science stories. And so they are framed poorly because they want to make sure that people will read them, which I understand, but unfortunately, it gives credence to these stories, and it adds this human element, which makes it more believable. And you feel for the person who's being spotlit in these particular articles when, in fact, the study itself should never have been put in print because it is unremarkable. It was done in an animal model. It was done in cells, in culture flasks. And its relevance is highly questionable.

Christy Harrison: That's such a great point. And I think that human interest piece is really challenging because I'm still a journalist. I still do writing and reporting and books and stuff. And having a story to bring people in is really helpful in a lot of ways to give it some sort of emotional connection to give people an example of what you're talking about. So it's not just a bunch of dry science. And choosing that story, I think, is a huge responsibility. It could just be anecdotal evidence that doesn't match the data, or you could try to find someone whose experience does match the data, but then you're kind of cherry picking, and it's a really complicated thing to report well, I think on science in a way that has that human element or emotional connection for readers, but also is accurate and true to the data.

Jonathan Jarry: It is. If journalists had better access to the scientific literature and if they had more time, it might be easier for them to find better stories to tell about science. I'm writing right now about why measles is so contagious. And I stumbled upon probably this little red report from Australian health authorities about a case that happened in 2010. This little girl from Malawi who had measles and who traveled to Australia and how she infected a few people on that plane, including a guy who had been sitting about 16 rows away from her on the plane and he caught measles from her. That's how contagious it is. That is a fascinating story. That is true, and that does exemplify the contagiousness of the disease. But you have to sort of dig into the scientific literature on this to find these things.

And sometimes the better story is to interview the people in the lab and how they came across their findings, the whole process. Science is a bit of a mystery that you're trying to solve and sort of talking to the people in the lab. "Okay, so you found this, and then what did you think it was? Okay, so then what did you do? Okay, you tested this other thing. Oh, now you find this thing. Oh, that's kind of weird." That can also be a very interesting, almost a murder mystery type of story that you can tell about this that is also accurate. But, yeah, too often the default positions is, "Let's find somebody who has this disease that maybe has been cured now because of this new study that was done in mice."

Again, because this lack of time, a lot of journalists, they fall back into these patterns, into these tried and true models of how are we going to tell this story? And it is unfortunate because it does end up generating a lot of undue hype over specific interventions or ideas, and then these ideas don't pan out in the end. And so you're always stuck in the cycle of hyping up something, and then it goes away. Then you're hyping up the next thing and it goes away. We see this in wellness all the time. Every year there are these new wellness trends that emerge and people can get onto that and then they don't work for them. But don't worry, because there's another one just around the corner, and it's going to be sold to you by the same journalists who will write the same kinds of pieces, about the same kinds of anecdotes and testimonials, and you just keep riding the train from one station to the next and it just never ends.

Christy Harrison: Yeah, that's so interesting. And I think it's probably a good question for people to ask themselves when they're reading journalism about health or just any sort of reports online or whatever, anything trendy is like, where will this be in five years? And what was the thing that was the equivalent of those five years ago, and how did that pan out? It all sort of gets memory holed at some point I think.

Jonathan Jarry: It does. I think it's useful to think in terms of prior plausibility, in terms of bayesian statistics, if I want to get very, very detailed here. This idea of like, okay, so this looks promising on its own, but yes, let's contextualize this. Let's think about all these other things that we've seen that look like this. And have they panned out or not? Well, no, they haven't. And why is that? Well, it's because science is hard and finding things that are going to be effective in the human body but also have a tolerable risk profile, that is difficult. And it's a lot easier to find some things in a bunch of cells that are growing together in the lab. It's also relatively easy to find things that seem to work in mice and rats and hamsters, but it's a lot harder to do this in human beings.

That is why that whole chain of events, from in vitro studies to animal studies to clinical trials to finally getting, for example, a drug approved, that is a very daunting gauntlet. It's very hard for a drug to make it all the way through. With dietary supplements, it's a lot easier because in the United States they are not regulated, so anybody can sell anything, whereas with pharmaceuticals, there is this gauntlet through which the drug needs to survive. And it's very, very hard. But that is how you test something to see if it really works.

Christy Harrison: Yeah. And I think about even, I've been looking at diet drugs recently, and this whole hype and craze for GLP-1s as diet drugs, as weight loss drugs, and the hype cycle for all the past weight loss drugs that were hailed as miracles is so huge. And such a runaway train of hype beyond what is actually known about the drug. And oftentimes, even after getting through that gauntlet of regulation in the pharmaceutical industry, then drugs still are pulled from the market eventually because side effects emerge down the line that were thought to be rare but serious. But then when tons of people take it, it turns out to be actually, a lot of people are having these serious side effects.

Jonathan Jarry: Yeah, it is an imperfect system in the same way that peer review is an imperfect system. When a scientific article is submitted to a journal for publication, it is usually sent out to a few other researchers in the field, who will review it and provide comments anonymously. That is a good system to have, but it is imperfect. There's still a lot of junk that gets published. All of these systems that we have, they are imperfect, but they are necessary and they should be improved. But what we often see in wellness is a disregard for these systems, is a bypassing of these systems, which is how you end up with kind of anything, any kind of junk out there can be sold. And it has a beautiful little label and wonderful testimonials, but it has not gone through this imperfect, though necessary system of quality control.

Christy Harrison: So I think that's really good context for our discussion today that I want to dive into about leaky gut. And you wrote a piece recently that I really liked called You Probably Don't Have a Leaky Gut. And in it, you write that, "There's a kernel of truth to this leaky gut theory, but what you're likely to see online is it's warped, outsized funhouse mirror twin," which I love. Can you explain what the kernel of truth is here and how it gets distorted into misinformation?

Jonathan Jarry: Sure. So, obviously, the lining of our intestines is permeable to a certain extent. This is how food works. This is how we need to break down the food that we eat into very small components, and some of these components will make it through the lining of our intestines and will get absorbed into the blood. So there has to be some kind of permeability there, otherwise we would all die. And in some people, there is what has been termed a sort of an altered intestinal permeability or an abnormal intestinal barrier function. And this is something that has been seen by scientists in things like celiac disease, people who have infections of their intestines, people who have HIV AIDS, a little bit with IBS, with irritable bowel syndrome to a lesser extent.

But those characteristics is this kind of abnormal barrier function. It seems to be more of a consequence of the disease and not a cause of the disease. So there is a kernel of truth there. But what you see now is people that have taken this idea and they have run with it, and they are alleging that a lot of people have a completely leaky gut that allows all kinds of toxins that we get from the modern food that we eat through and into our bloodstream. It might be foods that are toxic. It might be foods that trigger inflammation. It might be fluoride in the water. It might be chronic stress. It might be GMO's.

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Whatever the bugaboo is, it causes leaky gut. And leaky gut itself is used as an explanation for basically every disease you can think of. It apparently causes Parkinson's disease and cancer and multiple sclerosis and allergies and autism. Like, everything you don't like is caused by this leaky gut. And that is something that we see a lot in this kind of alternative medicine space, which is the one true cause of all diseases. And, of course, they have the one cure all that can apply to everyone.

Christy Harrison: Yeah, this one true cause, I feel like it's recycled again and again, talking about how things get sort of hyped up and then memory hold. I feel like there's always sort of a new true cause that keeps going through that cycle in wellness culture. And leaky gut is kind of a recent one that's having its moment. But it'll be interesting to see what happens with this in five or ten years, and then if it pops back up in 20 years, as some of these things do, too.

Jonathan Jarry: Yeah. You look at chiropractic, and for them, it is chiropractic subluxations, which are not a thing. They don't exist. But apparently they cause every disease. In acupuncture, it's the blockage of Qi going through these fictional meridians that just don't exist. Everything, all of these things, they all have this one true cause of all diseases. And it is obviously seductive to people, right? Because it's a very simplistic view of disease, whereas in reality, when you look at the biomedical sciences, when you look at medicine, it is complicated. There are all kinds of causes of diseases.

There are symptoms that overlap from one condition to the other. And treatments are very imperfect. They have side effects. Almost every medical treatment has side effects. So what you get from wellness and from alternative medicine is this beautiful idea of, "It's very simple. It's this one thing that's bad. It's usually something to do with modernity. We need to go back to nature, and here's how you go back to nature, and it's a non-invasive, side effect free intervention that will bring you back closer to how things used to be." And that's very tempting when you're sick.

Christy Harrison: Yeah. It seems like leaky gut is the one true cause du jour, especially in functional medicine and naturopathy. They often seem to connect all symptoms or issues to the, quote unquote, leaky gut. Can you explain sort of why, if you know why, that is so popular in those spaces and sort of how people can protect themselves?

Jonathan Jarry: Well, I think a lot of it boils down to this sort of allergy to modernity and this idea that the modern world is full of toxins that are poorly defined, but that are causing all sorts of diseases. And this sort of this vision of the past as being much better than it used to be. This idea that things were so much better when I was growing up, and now, that I'm getting older, that I have all of these diseases inside of me and around me. Hmm. I wonder what's happening. Oh, it must be the modern world. It must be our food supply. It must be pharmaceuticals. It must be what's in the air, what's in the water.

And of course, there are very real things. We do see contamination of the food supply. We do see problems with people not having access to potable water. We see problems with the air being full of particles that are making us sick. Again, there is a kernel of truth there, but they will run with this idea that things now are worse than they used to be. And so we need to go back to nature. And that is something that, for some reason, is very appealing to the human brain. This idea that if something is natural, it is necessarily good for you and it is harm free because nature is good. But things that are man made things that we humans make, technology, synthetic stuff, artificial stuff, that is bad because we were not meant to have these things. And that is a very, very appealing idea.

And so much, if not all, of alternative medicine and wellness is built around this idea that basically, it has sort of religious overtones of like, "Well, we were kicked out of the Garden of Eden. We need to go back to the Garden of Eden." It's this idea of things used to be so much better in, in the before times, and we are responsible for the diseases that are around us, we have caused these things by leaning into technology and synthetics and artificial stuff. And so we need to go back.

And that brings with it this idea that health is a decision that you make. If you are unhealthy, it's because you are not making the right choices. And that is a very, it's a very harmful notion, because, of course, there are things about our health that are completely outside of our control. There are systemic issues that are making us sick. But in wellness, you very, very often see this blaming the victim mentality. "Oh, you're not well. Well, it's your fault. You're not doing enough. You're not eating well enough. You're not doing enough yoga. You're not treating your leaky gut. If you did all the things that I told you to do, you wouldn't be unhealthy. Look at me. I'm healthy now. I went through my own journey, my healing journey."

It's a personal responsibility, and that is, of course, antithetical to the concept of public health.

Christy Harrison: Yeah. That's so interesting. And it's so complicated, right? Because there are these systemic issues that are real. There are things like air pollution, water pollution that are harmful. There are things that are disrupting the food supply. There's real stuff that's happening. And I think it's scary, and it makes people on edge, and it makes people vulnerable, too, to this sort of back to nature argument and the false claims of pseudoscientists and wellness practitioners and all the rest, because they're taking this grain of truth that exists and these things that are happening in the world that are scary to people and giving this sort of easy explanation.

How do you think people should approach things if they come across some report about environmental pollution, for example, or something I spend a lot of time with, like food contamination and these reports about, heavy metals and chocolate or glyphosate and Cheerios or whatever it might be that create all this kind of fear mongering, and there's all this hype around it and all these media reports. How can people sort of think about these things in context and tease apart what is actually real and perhaps deserves a societal solution and our attention as consumers versus what is trumped up fear mongering?

Jonathan Jarry: It's a very hard question to answer, other than to say they need to find experts that have earned their trust, and they need to listen to what these experts have to say on these topics. And hopefully these experts are transparent about their thought process of, "Here is this new study. Okay, here's why I'm not worried. Here's what they did. Here's what they didn't do. Here's how they analyze their data. Here's the proper context for this." I think that you earn trust through transparency.

I mean, you can't be an expert in everything. An argument that I've heard that I've made before is that if a giant asteroid was headed to Earth, I would not go on the news and pretend to be an expert on what to do with this situation. I would try and find astrophysicists and astronomers and engineers, people who are qualified to comment on what can we do about this? What are the downsides of each intervention? Because I'm not an expert in this particular topic.

And so it is because of how complicated science is, we can't expect members of the public to become epidemiology experts and virology experts and nutrition experts. Some people on Twitter have apparently become experts in everything and the war in Ukraine, and they're experts in everything because they have chosen punditry as their favorite pastime. But for the average person, you can't be an expert at everything. So you have to find experts that you trust. And hopefully, these are not experts who are being paternalizing and saying, "I'm not worried about this. Just listen to me. I'm a doctor." But rather, they will explain why they are worried, why they are not worried. They will contextualize the findings of a particular study, which, again, is something that journalists can't easily do because they lack that context. They're not experts in the field in which they are reporting.

And so that's why you go to actual scientists who have been doing this for years, for decades, who can say, "Well, yes, this one study says this, but we have ten other studies that contradict it. And I think what might have happened here is XYZ." So that is my solution, is that unfortunately, there is this issue of distrust in institutions, and some of it is earned and some of it is not. But at the end of the day, you still need to trust people. When I see a lot of conspiracy theorists who say, "Oh, well, doctors are corrupt and the media is corrupt and governments are corrupt, and you can't trust any of them." They still have to trust people, and they end up trusting these alternative figures in each of these fields. And they listen to certain podcasters and they watch certain people on YouTube.

They are trusting others, because you have to trust other people. You have to decide, what am I going to eat today? What is risky, what is not risky? What do I do if I have cancer? I have to go see somebody. So you do need to trust me. You just have to figure out who is worthy of your trust.

Christy Harrison: Such a good point. And I think some of the people making critiques that are valid critiques in some ways that also get sort of extended and overblown in a lot of ways, too. But there are some valid critiques to be made of the conventional healthcare system of the pharmaceutical industry, et cetera. The person calling it out then somehow gets this unearned trust or this sort of halo around them for calling out the problems and also making up more problems, probably, than really existing.

But maybe we don't just lionize the messenger here. Maybe we say, okay, this person might have an important message, and maybe I'll dig into this and cross check it with other people who are experts and see what they have to say. But not just sort of give unearned trust to people who really just know how to manipulate the algorithm on social media, too. I think that's a big part of it as well, is they're good at communicating. They're good at using sort of the tools of technology to get their message out there and to be everywhere. But that doesn't mean they're necessarily trustworthy.

Jonathan Jarry: And they're good at sounding confident. That is a huge factor that will earn people's trust. If you sound like you really know what you're talking about, you will gain a following, and then you can use that same confidence to sell your audience on dietary supplements, because that is what so many of them do. Either it's their own brand or they have a sponsorship deal with particular supplement maker. But yes, they will sell you supplements. So they will scare you about a particular situation. They will say, I have the answer, and the answer is give me money.

Christy Harrison: Yeah. I always think about the term confidence man. "Conman" comes from confidence man. And it's someone who earns your confidence or who inspires confidence in order to sort of take advantage of people.

Jonathan Jarry: Yeah. I saw this in the early days of the pandemic. There were people who were very confident in their predictions on Twitter, on YouTube, and they earned these very large followings, and they did not know what they were talking about, and they were exaggerating certain risks. They were downplaying other risks, and they were not using the kind of nuance that was necessary, especially at the beginning when we knew so little about the virus. But because they were so brash and so confident, they earned these very large followings, because, of course, people were scared and they had very good reasons to be scared, and they were looking for somebody to follow, somebody to explain to them what was going on. And in those situations, confidence is very, very, very powerful.

Christy Harrison: Totally. Well, I'm thinking about your leaky gut piece again, and thinking about how you sort of identify online advice that says to follow the four R's, or sometimes it's the five R's to patch up the gut. And it's this very specific, very sort of easy to follow idea of like, "You just do this, this, this, and this." It's like, remove all these inflammatory, quote unquote, inflammatory foods, replace the bad foods with dietary supplements, re-inoculate your gut with good bacteria, repair your gut by taking even more supplements. And then rebalance maybe in some cases, too. It does sort of seem very confident and very easy to follow. And there's something reassuring about that. The sixth R maybe, is reassurance.

Jonathan Jarry: "There, there, you'll be fine."

Christy Harrison: Yeah. Right. Versus going to other doctors. I myself have IBS and other GI issues and autoimmune issues and skin issues as well, hormonal conditions. I have a whole litany of things, and I know from past experience that it's so easy to think, well, everything is connected. And if I could just find the one root cause. There is so much discussion now about, quote unquote, root cause medicine and all of this stuff to try to distinguish these naturopathic and functional medicine providers from conventional healthcare. And it can be frustrating in the conventional system to go to specialists and a bunch of different doctors who aren't really all talking to each other or connected in any way. And to present your case and then have them be like, "Well, I'm not really sure. I'm gonna run some tests and do all these other things and rule this out, but at the end of the day, we just don't really know."

And I think that's real. That's the thing. It's like real science and real medicine often doesn't have the answers. And there is nuance and there are big question marks. And I think the confidence from some of these wellness purveyors can fill in that gap and help people feel reassured in the face of this glaring uncertainty of, like, "Okay, but what really is wrong with me and how do I get help?"

Jonathan Jarry: Yeah. One of the big problems that we have as a species is that we are terrible at dealing with uncertainty.

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

This week’s answer is for paid subscribers, but everyone can read the question.

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I have high levels of thyroid antibodies, and nearly every publication on thyroid health, hypothyroidism, and Hashimoto’s recommends a highly restrictive diet. I’m over a year into recovery from disordered eating, thanks in large part to your book, and I feel better than I’ve ever felt now that I’m no longer restricting food. I tolerate lactose and feel like ending carb restriction was the best decision I ever made for my energy levels. I do NOT want to go back to restricting or intentional weight loss.

I recall you sharing on a podcast episode that you have Hashimoto’s. Can you do a deep dive into what the science really says about restricting gluten, dairy, nightshades, coffee, and other supposedly “inflammatory” foods for thyroid health? I’m finding it so hard to navigate and learn about my condition without these strong diet messages, and I’d love your critical take.

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Journalist, podcaster, and author Elise Hu joins us to discuss her background with modeling and disordered eating, why beauty culture is a cousin of diet culture, Elise’s experience with intense beauty standards in Korea, and the realities of pushing back against performances of femininity.

Behind the paywall, Christy and Elise discuss the rise of K-Beauty globally, problematic K-Pop body ideals, the lack of mental health support in many Asian countries, and how the technological gaze is reshaping beauty standards online and around the world.

The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.

Elise Hu is a journalist, podcaster, author and most recently, a filmmaker based in Los Angeles. Currently she’s the host of TED Talks Daily, the flagship podcast from TED conferences. You can also hear her as the co-host of Forever 35 and the host of Raising Us.

Elise previously worked as a TV correspondent at VICE News and a host and correspondent for the radio and digital network NPR. Between 2015 and 2018, she spent lots of time on planes, trains and automobiles as an international correspondent and NPR’s first-ever Seoul bureau chief. She returned to the US in fall 2018 to explore the future through a video show, Future You with Elise Hu.

An honors graduate of the University of Missouri-Columbia’s School of Journalism, Elise’s work has earned a duPont-Columbia award, a Gannett Foundation Award for Innovation in Watchdog Journalism, a National Edward R. Murrow award for best online video, a Gracie Award for hosting, a Webby award for podcasting, and The Austin Chronicle once dubiously named her the “Best TV Reporter Who Can Write.”

Her book, FLAWLESS, came out in 2023. It’s a non-fiction exploration of beauty, consumerism, and womanhood. 

Resources and References

Contains affiliate links to Bookshop.org, where I earn a small commission for any purchases made.

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Elisehu.com

• @elisewho on IG

• elisehu.substack.com

• Flawless: Lessons in Looks and Culture from the K-Beauty Capital by Elise Hu

• Elise’s TED Talk: How digital culture is reshaping our faces and bodies

• Girl on Girl by Sophie Gilbert

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

Subscribe now

Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: I want to talk about beauty culture, the technological gaze, and your book Flawless, which is all about the rise of K-beauty and the years you spent living in Korea. But first I’d love to hear about your background and how you came to do this work.

Elise Hu: I am a longtime journalist. I’ve been a journalist my entire adult life. I am the daughter of Chinese and Taiwanese American immigrants. I grew up in pretty lily white suburbs, St. Louis and then outside of Dallas in a town called Plano, and then went to school for broadcast journalism at the University of Missouri and have been just a curious observer of culture and politics and the economy and all of that and get to ask people intrusive questions for a living. So it’s been super fun.

I found my way to Seoul, South Korea as a foreign correspondent about 10 years ago in 2015 when I was posted there as NPR’s first bureau chief for the Koreas and Japan. So it’s a really vibrant time and one in which I’m still getting to live and talk about. So it’s pretty special that that particular four year spell of my life then ended up being so generative.

Christy Harrison: From the book, it really seems like there’s so much going on in beauty culture in Korea that has translated to the US or prefigured some of what’s happening here. But you also had some intense experiences with diet and beauty culture many years before going to Korea. Like when you were growing up in Texas and started modeling and that pretty quickly spiraled into disordered eating and over exercise. Can you tell us a little bit about that?

Elise Hu: Yeah, so I grew up in the 90s. So first of all, the backdrop of this is the 17 magazines and monoculture of television 90s and now upon review, especially with works like Girl on Girl by the Atlantic writer Sophie Gilbert, the 90s was a very difficult time for women, a pretty misogynistic time in which our media and a lot of our cultural signifiers sexualized women in a way that was kind of pornographic even and it showed up on runways and it showed up in editorial spreads and magazines. Heroin chic was cool. I remember growing up and a lot of other teenage girls having that Kate Moss quote, the model Kate Moss, on their mirrors and on their refrigerators saying, “Nothing tastes as good as being skinny feels.”

And I think that was kind of the early Internet and chat rooms where pro anorexia chat rooms were coming about. And so this was the milieu in which I was coming up. But I largely escaped it. Like I in middle school and even in the first half of high school didn’t think that much about my body at all. I was pretty disembodied, in fact, for good and for ill. So the good way, the sort of fortunate way, was that I wasn’t one of the middle school dieters that I was surrounded by when I was in middle school.

But in my junior year of high school, I rather accidentally got scouted and got signed to a modeling agency in Dallas. And right away they were focused on my body and started asking me questions like, are you working on your body? Oh, if you are going on a vacation, be sure to only eat fruits and vegetables and all of these kinds of things. Adults in my life who I saw as authority figures were placing judgments on my body. The standards that models had to sort of adhere to at the time were very specific. It was really specific bust, waist and hip measurements. And because I don’t really want to be triggering, I’m not going to say specifically what they were.

But I then very quickly went from not having to think about my body or just not being conscious of it at all to being hyper fixated on it. And so then I read all the magazines and really started applying my perfectionistic tendencies at the time to my body and how to regiment and regulate it and got really good at that and it slipped into disordered eating by my senior year of high school. It was very obvious, I think, to a lot of people around me. And though I didn’t really find a way out of it or find help for that until I went off to college.

It really spiraled into a real kind of alienation and isolation, I think that a lot of folks who have battled eating disorders will describe because it takes over your brain. It’s almost like a brain worm where you don’t think about anything else. So I went through this period of like, no concern to hyper concern to disordered eating, and then got a lot of help. My family was helpful. My school environment was helpful in that there were counselors and therapists, and I got a nutritionist. I took a break from school to heal.

And I really thought that after I healed from this period in my life in my disordered eating that I was sort of done with it. I was like, oh, okay, cool. Well, that year was rough, weird. I gained all my weight back and everything and really didn’t think about it for a long time, probably until I moved to Korea. And this is what ties back into my time in Korea, which is I was suddenly thrust into a world in which everybody was my modeling agent. Everybody was making comments about my body and saying, like, oh, do you don’t want to eat that? Or you can get a shrink wrap for your weight, your post baby weight, and you can fix your freckles. And there were just lots of ways to avail myself of corrections and ways to fix my body and have it meet certain standards. Even though by then I was way out of any sort of image conscious field at all.

Christy Harrison: Yeah. Well, it’s interesting cause you talk in the book about after recovery, sort of just probably for self preservation reasons, just not going into that at all, not worrying about how you looked, not thinking about changing your body size or shape or being too into beauty culture and just kind of like shutting it out, which I think has its benefits. But also, as you say in the book, you sort of missed out on maybe sort of a cultural analysis of it from that perspective too.

Elise Hu: Right, right. I think that I sort of needed to, after my experience, I sort of needed to just eschew all body surveillance or anything that would slip me back down a track of aggressive body surveillance or hypervigilance or anything like that.

Christy Harrison: I feel the same. I mean, I’m recovered from an eating disorder as well and I work with clients now who are in recovery. And I think that’s so protective to just shut it all out and try to create your own bubble of body positivity or body neutrality or whatever it might be, body liberation, and just to not go there, not engage with that culture, that self surveillance. But it’s really, really hard in our culture now. I think it probably was easier at the time, I would imagine, to avoid so much of it in your face. Because now we have it 24/7 in our phones, just constantly calling to us.

Elise Hu: Right. And now, upon further review, and now that I’m 43 and I was really inundated with beauty culture and body culture in Korea, I take the opposite view. I probably shouldn’t have been so avoidant of my demons because it was actually really getting introspective and examining the waters in which we swim that really helped me get comfortable and recover fully. Because just avoiding all of our persistent signals in the culture about how we’re supposed to look and not even avoiding but denying it and sort of like pretending that it didn’t exist didn’t help me as a journalist or as a human contribute to how I can solve or how I can address or help others in this big battle that we live in.

Christy Harrison: Yeah, that’s right.

Elise Hu: I actually think I’m doing my best work now as a journalist and sort of fighting for bodily liberation and autonomy. Having had this experience of delving back into the things that really scared me and that I was trying to avoid.

Christy Harrison: It’s a moment in time for many people to create that bubble for themselves, but then inevitably, something is gonna pierce that bubble. The culture will find its way in and so to have some way of dialoguing with or pushing back on or making sense of that culture, I think is really important for ongoing recovery and sustaining it because we can’t just hide forever, unfortunately. And especially the more people fall outside of the culturally conditioned norms and the expectations for bodies in whatever culture they find themselves in, the worse it is and the harder it is to escape that. So I think having some sort of analysis of it is protective as well.

I want to talk about beauty culture and your definition of beauty culture, because you describe it as basically a cousin to diet culture, which I think is great and very apt, and I would say maybe a cousin as well to wellness cult culture. At the broadest level, what is beauty culture? How do you define it? How does it affect our view of ourselves?

Elise Hu: First of all, I think of culture as the way we do things here. So sort of like, this is the way things are around here. And so a lot of us and all over the world live in a broader beauty culture, or we are parts of regions or countries that are sort of subsumed by beauty culture. And I would describe it as a general sort of way of life way of thinking in which your looks are framed as a matter of personal responsibility. And if you fail, it’s a kind of personal failing.

So in beauty cultures, our looks get situated as a matter of personal choice. So this gets really conflated with the consumerism and capitalism that we’re in. Western society and wanting to look a certain way. There’s also Eastern societies and wanting to look a certain way. But for both sides of the planet, places in which having good looks are framed as our responsibility, I would consider beauty cultures.

Christy Harrison: I like that definition. That’s very succinct and simple. And in Korea, it sounds like the pressures from beauty culture were so intense and the expectation of looking a certain way was so suffused throughout society that it just led to all kinds of discrimination and stigma and unfair treatment of people. Can you talk a little bit about what you observed in Korea, the intense beauty standards and pressures you encountered and how that both challenged your recovery and also how you saw it affect people there?

Elise Hu: Yeah, well, there’s a whole 300 page book on it so let me just use this opportunity if you’re interested in these topics and what I found in Korea to check out Flawless: Lessons in Looks and Culture from the K-Beauty Capital. But just to give you the CliffsNotes version, what was so eye opening for me was just the open commentary and the open discrimination on the basis of our looks. And there’s actually a term for it that is rarely used in the English language, but often used in Korea: Lookism.

So just like all the other isms, racism or sexism, it’s discrimination based on our looks. And that would happen so commonly that there was a lot of self policing and people who wouldn’t go out without wearing a face mask. This is pre-Covid or not even leave their apartments at all if they weren’t already done up. They didn’t have a certain amount of makeup and their makeup on or their hair wasn’t perfect.

Christy Harrison: Even to like a convenience store in their building, you said, which just blew my mind.

Elise Hu: Correct. And I found Korea to be very gendered in a way that I wasn’t used to because in the US which is such a pluralistic, multicultural society, I feel like our lines of cleavage in society tend to be around race or class, but not as much on gender. I mean, obviously there’s all sorts of sexism in the US too. But because 97% of Korea is Korean, it’s Korean people, then the social dividing line is really between men and women. And as a result, people sort of pointed out my differences constantly and were surprised that I was in leadership positions. I was often asked, where’s your boss? Or where’s the bureau chief? Or this needs to go through the bureau chief. And I’d have to assert, no, I am in charge, I am the boss. Because an Asian appearing woman couldn’t possibly be the one who was in charge in the assumptions of the people that I ran into.

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There was a lots of persistent commentary about how to improve my looks because the thing about South Korea is it is the most sophisticated aesthetic market in the world, both for skin care and cosmetics, but also for plastic surgery. So you can avail yourself. There was a real democratization of how to fix yourself. Self improvement technologies as I call them. And so because you could easily pay for that facial or that treatment or that injectable or that surgery, why wouldn’t you? So it was one of those like, hey, if there’s the technology to do it, why wouldn’t you do it? Why wouldn’t you pay for that? And so I was constantly being asked why I wasn’t getting my freckles removed.

Christy Harrison: You’re made to feel that was a problem for the first time in life.

Elise Hu: Yes. And then when I went shopping, my size was always a problem because clothes come in something called free size. And I actually have a chapter called “Free size isn’t free” because it was a very specific size, like a women’s size four or two and if you didn’t fit in it, that was it. There wasn’t anything you could buy in that store. So very constraining and marginalizing, I would say.

Christy Harrison: Yeah, completely. I mean, the weight stigma inherent in that. I think about stores, there’s a few stores in the US that have that, where everything is “one size.” And the one size is tiny. But that’s the subject of a lot of debate and scrutiny and sort of rightly called out in many circles as being very weight stigmatizing and body negative. And there’s such an impetus to, again from some circles, because obviously some brands have shrunk and their plus size lines are done away with them or whatever. But for the most part, I think most mainstream brands do have plus size options and they’re relatively inclusive in their sizing. Often could be better, often could go higher on the spectrum, but it’s there.

And again, also in stores, maybe not so much, but at least there’s a range of more than just one size in the stores. And it sounds like in Korea, that’s just not really seen or there are specific, like big and tall kind of, stores that you would have to go to to shop for your size.

Elise Hu: And it was always around the US Military base because it was like, oh, those huge Americans.

Christy Harrison: Big size, big size, big size.

Elise Hu: I actually had big size, big size sort of yelled at me by storekeepers when I was walking down the street. So, yeah, I really went through it. And to be fair, so do a lot of other people who are larger than a size four.

Christy Harrison: There have to be many people in Korea who are larger than a size four so it seemed like there was just so much apologizing for or just taking it as a given almost that this was the way things were. And you had a quote from a beauty entrepreneur who said essentially, you could look at this overwhelming beauty pressure as a negative thing, or you can look at it as a really interesting or creative side of Korea that makes the beauty industry grow faster. That just depressed me so much, that quote. And I’m curious to hear sort of your response to that and just like the sense of was there any pushback on this intense beauty culture? Was there critique of the weight stigma inherent in free size or was that very much a tiny part of the discourse?

Elise Hu: It was a tiny part of the discourse, but things have certainly changed. Ten years ago, there were no plus size models in Korea. It just didn’t exist. But around the period after MeToo and the women’s rights rallies and the women’s rights sort of movement and consciousness raising that really happened among feminists in Korea in 2018, the year that I was moving home, things have really begun to change more and more, especially thanks to Instagram and a lot of people on social media being willing to be visible at any size or at whatever size they’re at. That has led to, for the first time, now there are plus size models in Korea. There’s more inclusiveness when it comes to sizing.

There’s more inclusiveness when it comes to the shades of foundation that you can buy of BB cream and tinted moisturizer. I remember shopping for BB cream, which is the all in one sunscreen, cover up moisturizer that is so popular and ubiquitous in Asia. I remember shopping for BB cream and there just wasn’t any in my shade. I am an Asian American, but I am darker than a lot of folks in Korea. And so basically I just would have to put on stuff that made me whiter that wasn’t my shade. And so that has now changed.

There have been more entrepreneurs and there’s just been more, I think, interest in Korean beauty that has had a positive effect, I think, or a more inclusive effect on the industries there or some of the brands that are now just opening up the possibility for, hey, maybe a little bit more color and larger sizes. So there is some movement because of market demand, but because previously K-beauty companies and K-fashion was just catering to the domestic market, the industries could actually have the domestic consumer base cater to them, like change their bodies, or make sure that their skin color stayed within a certain range. And now it’s the other way around. Because as the audience is getting more global and more diverse, these companies are having to diversify in order to meet their customer demands.

So there is some change I think. It is not as fast and not as broad as I would like to see, but women and some activist-y men inside Korea are pushing for change and snapping back and I love to see it. There was this big campaign to get rid of a lot of before and after imagery in the subway station of plastic surgery. Because plastic surgery ads were just pasted all over. They were everywhere, floor to ceiling lit up ads of before and afters. People got various procedures, especially in Gangnam, which was the self improvement quarter or what they called plastic Surgery Street. And so you would get off the subway and just be inundated with images of how you were supposed to look and how people looked before and how they looked “so much better.”

And a lot of folks decided to campaign against that and push for the removal of those ads. And those have since been removed. And there’s regulation around it. So there is some change. And I feel like Korea was really just a canary in the coal mine. I did so much of this reporting ten years ago now. And the thesis of Flawless is essentially that, hey, the future has already arrived. It’s just not evenly distributed.

And I hate to say that that thesis holds so many of the procedures and so many of that beauty culture attitude of situating our looks as a matter of personal choice and technological optimization that has actually come about not just in celebrity culture in the US but now with so much improvement and sort of the cheaper, less invasive procedures that are available in the U.S.

Christy Harrison: Yeah. And the sort of idea of empowerment, that it’s not just self objectification or going along with the male gaze and trying to make oneself better in that light, but also for Korean women and even families as well, who would pressure their daughters to fit a certain ideal. Looking a certain way was the ticket to a good job, a good marriage, a happy life. So many things that people want in life and the sort of the basics that I mean that we all deserve really, like happiness and fulfillment and a sense of purpose and all of that stuff was very much tied to looks. And looks felt like a ticket to that.

Elise Hu: Absolutely. We have tangled up health and happiness with good looks. And I put this at the foot of hyper capitalism because beauty and beauty culture is really tied to hyper capitalism. And the idea of selling us things. We problematize bodies that don’t fit and then create a market for the solution. And it feels so immovable to confront an industry that markets to kids now or creeps into new areas for growth. Seoul was just a window to sort of time travel forward in a lot of that. And it allows us to look deeper at it.

And I think, as I said at the outset of this conversation, looking deeper at it, let’s not be scared, let’s bravely look more deeply at this, because it is precisely because I analyzed it and I really sort of sat with all of this and I sat with myself longer in front of the mirror, that really led to my own, at least, emotional liberation.

Christy Harrison: Yeah, I mean, it’s so hard to do right in a culture where there is such intense pressure. I mean, it sounds like for you, as an outsider there, you had a little bit of an out. You weren’t expected to be like everybody else, because you weren’t like everybody else. You came from a different place and did different things. And so you were able to opt out maybe a little more easily than some of the people there. I was really struck by The Escape the Corset Movement. Those activists were very brave and they were giving up so much to do that, to take that stand and were sort of publicly ridiculed and lost a lot.

Elise Hu: They were disowned by their families. They were not invited to holiday gatherings anymore because they decided they didn’t want to appear feminine just because they didn’t want to have long hair or wear skirts. There was one girl who told me her mom wanted her to appear feminine and sort of wear femininity so much that she offered to pay her to wear a skirt. And every day that she would wear a skirt, her mom would be like, I will give you X amount of money.

There’s such pressure to perform femininity. And I think that we really have to peel back the layer of the onion and remember that this is a performance. And just as much as women are asked to perform femininity, it’s not good for men who then have to perform a certain kind of masculinity that is also constraining for them. So I’m a feminist for men. I’m a feminist for everyone, so that we can live the way that we truly are and want to express ourselves.

Christy Harrison: Yeah. The K-pop ideal, the K-pop idols have been such a huge cultural export. And K-pop is everywhere now and you make the very good point in the book that the K-pop body ideal is shockingly thin. And there are performers who have talked about the extremely low weight requirements they had to meet and the starvation diets they had to undergo just to try to meet them and the real suffering that they went through to try to look a certain way and meet these ideals.

And it’s not really just the artists who suffer, but it’s also the public, the fans who get served these images of K-pop idols that are so unrealistic and basically, as you make the point, essentially pro anorexia content and that leads to them getting served actual pro ana-content by the algorithm, not to mention just the unrealistic standard that these K-pop idols perpetuate and wanting to look like your favorite K-pop idol or band or whatever can be really detrimental to especially young people. Can you talk about the state of diet culture and eating disorders and eating disorder treatment, such as it is in Korea, and how those ideals and sort of disorder behaviors are getting exported along with K-pop and Korean culture in general?

Elise Hu: In Asian cultures broadly, there is a real stigma around mental health.

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In this bonus episode, Christy answers audience questions about the validity of a test that claims to assess gut health, and whether you really need a restrictive diet to regrow hair when you have an autoimmune condition that causes hair loss. 

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The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.

Writer and linguist Amanda Montell joins us to discuss “magical overthinking” and the cognitive biases that make us vulnerable to misinformation, celebrity culture and its intersections with wellness culture, how to deal with panic headlines, cultish language to watch out for in wellness spaces, and more. 

Amanda Montell is a writer and linguist from Baltimore. She is the author of the acclaimed books Wordslut, Cultish, and The Age of Magical Overthinking. Along with hosting the podcast Sounds Like a Cult, her writing has also appeared in The New York Times, Marie Claire, Harper's Bazaar, and more. She holds a degree in linguistics from NYU and lives in Los Angeles with her partner, plants, and pets. Find her on Instagram @Amanda_Montell. 

Resources and References

• Amanda’s new book, The Age of Magical Overthinking

• Amanda’s previous books, Wordslut and Cultish

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

Subscribe now

Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which was published in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.

Welcome back to Rethinking Wellness. I'm Christy and my guest today is writer and linguist Amanda Montell, who joins me to discuss her new book, The Age of Magical Overthinking. We get into the cognitive biases that make us vulnerable to misinformation, celebrity culture and its intersections with wellness culture, how to deal with panic headlines like you see so much in nutrition and food and wellness reporting, cultish language to watch out for in wellness spaces, and lots more.

Paid subscribers get to hear the full episode, which includes another 30-ish minutes of this great conversation with Amanda. I love what we get into, especially at the end of the episode, I will say. So if you want to upgrade to paid, you can go to rethinkingwellness.substack.com. If you do, you'll not only get to hear extended interviews like this one and all the ones we've done in the past, but you'll also get subscriber only Q and A's and essays, commenting privileges and subscriber threads where you can connect with other listeners and lots more. Plus, I will be so grateful to you for supporting the show and helping keep this an ad and sponsor free space. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes. And thanks so much to everyone who's already become a paid subscriber. I really appreciate your support.

I also want to make sure you know about my second book, which is called The Wellness Trap. It was the inspiration behind this podcast, as I've said many times before, and I launched it to continue the conversations I was having in my reporting. I really just wanted to like release all of my interviews as a podcast, but I decided to do this instead. And if you like the interviews here, I think you'll love the book. It explores the connections between wellness and diet culture, how the wellness space became so overrun with misinformation, including some of the cognitive biases and fallacies that I talk about in this episode with Amanda, why the alternative, integrative, and functional medicine world can lead to so much harm, including disordered eating and lots of other things, and how we can both protect ourselves as individuals and reimagine well being as a society. If any of that sounds interesting, you can learn more and buy the book at christyharrison.com/thewellnesstrap, or pick it up at your favorite local bookstore.

With that, here is my conversation with Amanda Montell. So, Amanda, welcome to Rethinking Wellness. I'm so psyched to talk with you today. Can you just briefly share a bit about what led you to do the work that you do today?

Amanda Montell: Yeah, absolutely. So my background is in linguistics. I studied the relationship between language, gender, and power in college, and that was the subject of my first book, Word Slut. And then as I was writing that book, I continued to develop my fascination in the role of language and culture. And my second book, Cultish, was birthed from that fascination. Also because my dad grew up in a cult. And I was always so interested by the ways that cultishness shows up in everyday life, particularly in the ways that we talk, how certain cultish leaders, from Soulcycle instructors to Gwyneth Paltrow with her Goop empire, really catering this to this wellness podcast, can weaponize cultish language techniques to influence their followings, for better and for worse.

And then as I was researching that book, Cultish, I kept coming across all this really fascinating psychology and behavioral economics research referencing cognitive biases because I was interested in why people end up in cults and why they stay. And these cognitive biases that some listeners may have heard of in the past, like confirmation bias and sunk-cost fallacy, had something to do with the answer. But not only that, these cognitive biases seem to really explain so many of the irrational choices that I had made and was continuing to make in my own life. Like, you know, my decision to stay in a truly toxic cult-like one-on-one romantic relationship in my early twenties, long after that relationship stopped serving me, or the ways that I would enter fight or flight, engaging in some bout of social media conflict that was actually not threatening and not even real.

So I was noticing the ways that these cognitive biases could explain some of my behaviors and then some of the broader irrational behaviors plaguing the zeitgeist at large. And that's kind of what inspired this new book, The Age of Magical Overthinking, which is generally about cognitive biases and the information age.

Christy Harrison: I think it's such an important book, and especially for people who've been caught up in wellness culture and fallen into sort of cult like thinking around that. I think all of your books are important. I'm curious to talk a little bit about your family background because you describe your mom as sort of a niche celebrity. She is an award winning cancer cell biologist. She actually cured her own cancer and very science minded, it sounds like. And then your dad is also a science professor, I think I saw, with his history and his background, having grown up in a cult. So I'm curious how their influence shaped you and might have made you more skeptical to woo-woo wellness stuff or maybe insulated you or maybe not, if there was any way in which you rebelled against that sort of thinking too.

Amanda Montell: I love this question. I actually love being able to write my parents as characters in my work because they are such personas. My dad is, yeah, he's a goof. He spent his teenage years against his will in this pretty notorious cult compound called Synanon. And ironically, that's where he developed his love of science. He's a neuroscientist. Both my parents are research professors, and my dad, at the age of 15, was tasked with running the medical lab at Synanon. They had their own little microbiology lab because they obviously wanted to avoid the outside world and outside hospitals as much as possible. So while other teenagers on the outside were like studying for the SATS or going to the prom, he was culturing culturally followers fingertips for tuberculosis microbes and it was, you know, kind of a sanctuary for him, this lab on the cult compound, the one place in the cult where things seemed to make sense and there was a procedure and you could question ideology, or there actually wasn't any ideology at all.

And so, yeah, he went on to become a research professor. And working in labs is where he met my mom, and she's a cancer cell biologist. Both my parents, I mean, I forget that they do like this really important work because they're just like my parents and I'm constantly making fun of them. Yeah, my mom studies border cell migration, which is important in understanding how cancer cells move. Lol. I've never had to describe my mom's research in public, but my parents always had this halo surrounding them, particularly my mom, who is such a poised individual.

And the first chapter in my book, in this new book is called Are You My Mother, Taylor Swift?: A note on the Halo Effect, which is the cognitive bias underlying how we find role models, including, and these days, especially parasocial role models. And it describes our penchant to think that because we like one single trait in a person, that they must be perfect overall. And this informs these extreme cycles of celebrity worship and dethronement that we see in the culture nowadays. But it sometimes also describes our relationships to our own parents.

And when it comes to the halo effect and, you know, pitfalls, women are often the ones who suffer the worst consequences because we build them up into these one dimensional, god or goddess like figures. And then when they disappoint us in some way, whether these figures are our mothers or our celebrity hashtag mothers like Taylor Swift, we feel the need to punish them, dethrone them in these really grave ways. And those same standards don't necessarily apply to men.

But to answer your question, growing up with these scientists, his parents, yeah, they were deeply left brained, rational minded, had an incredible disdain for mysticism or, you know, really all things spiritual. And so, yeah, I grew up in this atheist household where the good book, the great text that was displayed in our living room, was not the Torah or the Bible, but the dictionary and texts by Darwin and Stephen Hawking. Actually, my parents, they still have, like, a shrine to Stephen Hawking in their house to this day, which is so funny and, like, so on brand for them.

Growing up, you know, I developed this, like, real respect for the scientific method and for not, you know, engaging in beliefs for which there was no evidence. And then, yeah, speaking of the rebelliousness, you know, growing up, I was kind of the melodramatic theater kid of the family, so I was, like, quite a mystery to my parents. And, you know, certainly indulged in a lot of mysticisms that I think perplexed them. I, living in Los Angeles, have no qualms dabbling in a bit of witchcraft or tarot. And I actually, having studied cultish belief and now irrationality and reporting on these subjects have really come to re embrace mysticism, not as a rebellion against my parents, but as a sort of embrace of our inherent delusion as a human species.

You know, there are simply questions that if they can't be fully answered with science, it's only because there are these existential questions of why are we here and how do we make life meaningful? And, of course, there are evidence based therapies for how to feel better in the face of depression and anxiety and such. But I am a firm believer that there is a point, emotionally or existentially, when empirical facts and information stop helping the world make more sense. Actually, it can make it feel more overwhelming and certainly doesn't help you feel better. So I sort of live in this tension of logos and pathos, of head and heart. I have my whole life.

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Christy Harrison: I feel you on that. I'm also similarly minded. I have a lot of skepticism. My parents aren't scientists, but my mom's a therapist and just very sort of rational minded. And actually, as a kid, was always cautioning me against magical thinking and talking about possibility versus probability and sort of trying to instill a more mature way of looking at the world than kind of the kids way of like, "Oh, my God, this could happen. An asteroid could hit the earth. I'm gonna die." That jumping to conclusions.

And then also, I am someone who was raised, I think, to be very over intellectual and sort of lived in my head, and that had a lot of negative consequences on me personally in terms of, like, being in touch with my body, being in touch with my emotions and signs that maybe a relationship wasn't gonna be good for me. I also was in some toxic relationships that I stayed in much longer than I should have and had eating disorders and disconnected from my body in all these different ways and tried to rationalize my eating in order to change the size and shape of my body and ended up in a world of hurt from that. And so, yeah, for me, too, I think learning to sort of bridge that tension, I think has been really important.

Amanda Montell: Yeah, I can certainly relate to that. I've never sort of thought about the correlation between my sciency upbringing and my perfectionistic tendencies. But, yeah, there's probably a cause and effect there. But, yeah, it is something that I've come to embrace as I've gotten older and started doing more of the work that I've been doing on irrationality in the information age is just coming to embrace uncertainty, coming to stomach the cognitive dissonance of not having certain answers all the time, and being open to having conversations with other people who don't have certain answers either about anything.

Christy Harrison: Yeah, I think we're pushed and incentivized to have answers and to have hot takes and to be strident, and that's what does well on social media. That's what gets people celebrity status oftentimes. And so I think pushing back on that and sort of having more nuance and living in that gray space can be a really important antithesis.

Amanda Montell: Yeah, absolutely. You know, nuance doesn't go viral. So under sort of, like, digital age capitalism, it can be really hard to sort of cut through the noise. But it's a challenge I feel like I still have the energy to pursue.

Christy Harrison: Yeah, that's good and important. I want to talk about celebrity culture, which you mentioned, and its intersections with wellness culture. You talk about the loss of trust in institutions and how it paved the way for celebrity worship. Celebs sort of being elevated into these trusted figures that institutions no longer are. And I see that same loss of trust as being part of what led to the rise of wellness culture. Right. It's like people wanting to take their well being into their own hands and find alternatives to the conventional healthcare system that was suspect in the minds of many. That still is suspect in the minds of many.

And personally, I have multiple chronic conditions that took a long time to get diagnosed, and I went through really bad experiences in the conventional healthcare system that also pushed me to find alternatives into the realm of alternative and integrative and functional medicine. So I get it. And then now we have celebrity worship and wellness culture that I think have kind of come together in this phenomenon of the wellness influencer. Right? Like you mentioned, Gwyneth Paltrow, obviously, it's kind of the most glaring example, but there are countless others, and I'm curious how that relates to what you mentioned, the halo effect, where celebrities get this halo on them because of one or a few good traits. How do you see the halo effect playing out in wellness culture?

Amanda Montell: I detail this a little bit in one of the chapters of my book, but my day job for five years before I started focusing on my books full time was working as a beauty editor at a sort of like, beauty and wellness publication. And I actually explicitly remember the editorial meeting in, I want to say, 2017, when one of these very poised, beautiful LA higher ups working at this digital beauty and wellness publication came in to our editorial meeting and was like, "We need to capitalize on this new thing called the influencer halo effect. And we need to find these individuals who have this glow surrounding them because, say, they make the most beautiful latte art, or they have the most beautiful skin, or there's just like, one quality that people are really coming to embrace or even worship in them. And we need to align ourselves with those people to go viral in headlines or to align with them for certain brand affiliations or to do a photo shoot with them or something like that."

So I really see the halo effect manifesting in a strategic way in the wellness industry, where we're finding people who maybe look like some standard of wellness, even though they are not experts or might actually have nothing to do with wellness, and we're putting them up on this pedestal as a figure to be worshipped, to emulate, to listen to when they're hawking sponcon. And that can be insidious, because, again, the halo effect describes this irrational penchant to jump to a conclusion about someone for survival. It's based on this age old mental magic trick that our long ago ancestors would play on themselves for survival and adaptive purposes, where you would clock someone in your tribe of neighbors who had intact teeth and big muscles. And so you would jump to the conclusion that that person had avoided disfigurement in battle and, you know, had was probably a skilled hunter, and thus that would be a wise person to align ourselves with.

We're now applying that to wellness influencers and celebrities. We're looking to these singular role models not only to tell us what to wear or what, you know, supplements to buy, but we're looking to them to save us during this time of incredible mistrust in institutions that were supposed to provide that support. So, yeah, I think it's being capitalized upon it in a very strategic way. Our mental magic tricks are working against us in a very specific way in this time in history.

Christy Harrison: That's so interesting, too, that media companies are specifically seeking out influencers who have that halo effect. And when you think about the information environment we're in and what's being served to us, it is so strategic. It's not just like, this person's interesting and they have something to say, and let's cover them. And this is, like, editorially sound or something. It's like, no, this is a person that we need to hitch our wagon to, to sponge off of their star power or something like that to grow our brand as well.

Amanda Montell: Oh, absolutely. Because, you know, you're talking about the blurred lines between wellness authority, celebrity political figures, business leaders. The Venn diagram has just become a circle. I mean, Gwyneth Paltrow is an example, but in another corner of culture, so is Elon Musk. Starting really with Beatlemania and then fortified with the Reagan era, we really are starting to see celebrities as people who are not just there to entertain us, they're there to guide us, to lead us, to be our spiritual authorities, our parasocial lover. It's why you see Harry Styles on prayer candles or Dolly Parton. That's another great example. And there are positives to this. Of course, it's lovely to have a role model, but celebrity wars, and that includes worship of wellness influencers, is becoming more extreme empirically in our culture today. And that comes with some pretty deleterious consequences to our mental health.

Christy Harrison: Yeah, let's talk about that, because you talk in the book about how celebrity worship is harmful to well being, and I'm really curious to dig into that a little bit. I think that even people who don't think of themselves as necessarily worshipping celebrities, but are simply following them for recommendations or inspiration or something like that can, unfortunately, fall prey to this.

Amanda Montell: I came across some really fascinating research while researching that halo effect chapter, talking about how celebrity worship can fall on a continuum that has been divided into these four categories. And those categories are the entertainment social level, which is defined by attitudes like, my friends and I like to discuss what my favorite celebrity has done. You know, it's like, pretty healthy, pretty normal. But then there was this intense personal feelings category, which could be classified by statements more like, I have frequent thoughts about my favorite celebrity, even when I don't want to.

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Third was this borderline pathological level, characterized by delusional thoughts such as, my favorite celebrity and I have our own code so that we can communicate with each other secretly, which sounds absurd, and, you know, fans might not phrase it exactly that way all the time, but I have noticed that behavior in swifties and also implausible expectations were a part of that. Characterized by phrases like, if I walked through the door of my favorite celebrities home without an invitation, she or he would be happy to see me, as well as self sacrifice. So, you know, I would gladly die in order to save the life of my favorite celebrity.

And a fourth category, labeled deleterious imitation, described these super fans willing to engage in criminal behaviors on behalf of their favorite celebrity. So something like, if I were lucky enough to meet my favorite celebrity and she or he asked me to do something illegal as a favor, I would probably do it. So there are these different categories that have been described over the past decade or so, and the more extreme end comes with these serious consequences.

You know, on the positive end, fandoms can be vehicles to talk about larger issues like feminism and social justice. But on the more dramatic side, there was this 2014 clinical examination of celebrity worship concluding that high levels of standom, as it's called, are associated with body image issues, greater proneness to cosmetic surgery, sensation seeking, cognitive rigidity, identity diffusion, poor interpersonal boundaries, depression, anxiety, dissociation, narcissistic personality tendencies. I mean, compulsive shopping and gambling, stalking behavior. A 2005 study found that addiction and criminal activity were more strongly correlated with celebrity worship than calcium intake with bone mass. So there's just, like, so much evidence to support that we are submitting ourselves to these larger than life figures more than we have in the past, and that it's coming with serious side effects.

Christy Harrison: That is so upsetting. And also, to think about the feedback loop there, too, right? Of, like, I wonder to what extent, because these are associations. So I wonder if there's some sort of driver as well, of people who already have these tendencies. Difficulty with social skills or narcissistic traits that are maybe being amplified by celebrity culture and social media and the environment we live in, and then also making them more likely to seek out celebrities to emulate or if there's some sort of feedback loop going on there.

Amanda Montell: Yeah, it's interesting you bring that up. I mean, the sort of nature vs. nurture or chicken or the egg conversation is one I think I'll be having for the rest of my life. But the title of that chapter is called Are You My Mother, Taylor Swift? because I can't help but notice this really pronounced trend in celebrity stan communities, where we refer to our favorite female celebrities as mother, as mommy. I've seen fans of the pop star Charli XCX say in the very same sentence, her new singles are doing nothing for me whatsoever, but she's still on my mother list. And in a way, that's cheeky.

But also, there is this really fascinating research reflecting that our worship of celebrities is actually connected to mothering, or more specifically, insecure parent child attachment. So there was this pair of studies from just the past few years, 2020 and 2022, that confirmed that young people who are lacking in so called positive stressors from their family members or real life activities, those people were poised to fixate on these media surrogates, on these sort of illusory mothers, and that if you are lacking in those connections or those positive stressors in your real life, you might be more likely to focus on what was called trauma in the virtual world. The celebrity worship, whether it's the start of it or the effect of it, is really creating this hallucinatory environment for young people.

Christy Harrison: Oh, my God, it's so scary. As the mother of a young daughter, I'm trying to do everything I can to inoculate her against that and do my best to create a secure attachment, but it's tough. And I'm sure that there are many parents out there who are scared for this environment, this information environment their kids are living in, and sort of the ease of getting sucked into celebrity stan cult like, cultish sorts of behaviors.

Amanda Montell: I don't ever want to be alarmist with my work, which is so funny, because my last book was about how cults are everywhere. But there is evidence that is at once frightening, that celebrity worship is becoming so extreme. But there's also evidence that the inoculation, as you said, is actually, it's pretty simple. It's human connection. It's strong and fortified genuine relationships in the real world. What's troubling about now is that we are living in a time of seeming hyper connectedness because of how many identities you can perceive on social media within the course of a single hour. And yet at the same time, that sort of social glue that is only found in real life interactions is becoming less sticky or harder to find.

Which is why I think one of the reasons why the Era's tour was so explosively, monoculturally successful, because at long last, after all of these pandemic years, these really intense stans could gather in person and see one another's humanity. And I mean, I'm speculating, but I think that must have been a soothing sort of splash of cool water on the faces of so many stans who'd been engaging in these really heated, intense dynamics with no human interaction to kind of mollify that or humanize that. Yeah, stan interactions can be really, really intense and intimidating and scary looking online. And I think as soon as you bring it offline, that helps a lot.

Christy Harrison: Yeah. Seeing each other's humanity, looking other people in the eyes, has such a huge effect on people's empathy and ability to treat each other with kindness and respect.

Amanda Montell: It's so simple. But I think one of the issues of now is that we are, especially in the wellness space, is that we are sort of overcomplicating and catastrophizing a lot of issues, not to then me sound like a sort of wellness grifter, but there's a reason why "touch grass" has become this really popular slang phrase. And it's a bit, and it's cheeky, but there is some truth and optimism to be found in the truth that a lot of the answers to our sort of existential malaise lie in the sort of human medicine that we've always had access to. It's each other. It's nature. For many of us, obviously, not every problem can be solved by going outside and perceiving a deciduous tree, but you know what I'm saying.

Christy Harrison: Yeah, sure. A lot of it. Yeah, totally. Well, so you mentioned catastrophizing. I definitely want to get into that because I feel like that's got a real connection with manifestation, which you talk about in the book. But before we do, can you just do a quick definition of how you define magical thinking and magical overthinking? Because I think that's important for this context.

Amanda Montell: Magical thinking is this age old human cognitive quirk, and it essentially describes our penchant to believe that our internal thoughts and feelings can affect external events. It's what underlies any kind of idea of manifestation or spiritual belief or irrational behaviors that we might engage in in the face of grief. One of my first exposures to the phrase magical thinking was in the title of Joan Didion's memoir, The Year of Magical Thinking, where she talks about how after the unexpected death of her husband John, she would engage in behaviors like refusing to remove his loafers from the closet, because she felt like if she did that, then there would be no hope of him coming back, you know?

And so magical thinking can be a protective mechanism. It's something that we've always done. But I feel that magical overthinking is a product of the modern age. And I'm sort of describing it as this clash between our innate mysticisms, these mental magic tricks that we've always played on ourselves to cope, to get through life, these cognitive biases and the excess of information, this information age, when there is this capitalistic pressure to know everything under the sun. We're exposed to more data, true and false, in a day, than our ancestors ever would be in the course of their entire life.

And of course, the democratization of information is a great thing. It's better than information only being kept for a high up elite. However, we are sort of not built to be able to process this excess of information. And it's led us to this era that I've been calling the age of magical overthinking. And the book is kind of breaking down how this shows up in these eleven different contexts.

Christy Harrison: Yeah, I think that's so helpful. And magical thinking is something I see so much of in wellness culture. I think probably the most glaring example is manifestation, which is, like you said, the idea that you can literally create reality just by thinking certain thoughts. I also covered that in my book and found it really fascinating, as someone with a history of anxiety, which I can share more about that connection, but you describe manifestation as a conspiracy theory, which I think is really spot on. And yet I know there are probably people listening who swear by manifestation and might be shocked to hear that. So can you explain what you mean by calling it a conspiracy theory?

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Amanda Montell: Yeah. Well, in my defense, I have this chapter in the book called I Swear I Manifested This: A Note on Proportionality Bias, which is this fascinating bias that underlies conspiratorial belief. It's this idea that a big event or even a big feeling must have had a big cause. And as a species, we are really inclined to make those sort of false cause and effect conclusions. And that can work in a negative capacity, like by assuming, "Oh, my God. You know, COVID, it's this big, insurmountable tragedy. Like, the only way that the existence of this thing makes sense is if someone high up engineered it on purpose." Actually, like, a shocking percentage of Americans across the political spectrum believe that COVID was manufactured by the government, at least partially on purpose, which was stunning to me, but it really reflects how strong our proportionality biases.

But on a more positive side, proportionality bias also underlies ideas of manifestation, which. Which, yeah, I argue is a form of a conspiracy theory, because it is this false misattribution of cause and effect in the way that an anti-vaxxer might think that vaccines cause autism as a conspiracy theory, this sort of misattribution of cause and effect in a negative way. A hardcore manifestor might think that the reason why you were once struggling financially or didn't have nice skin, and now you do, was because you practiced the law of attraction. Your thoughts informed your reality, you vision boarded for your life. And I don't think this always has to be a destructive thing. Obviously, I love a vision board as a craft. You know, who doesn't love a good collage?

And there is truth. Absolutely. There is truth to the fact that your thoughts and your attitudes can affect outcomes and things like that. But in that chapter, I tell the story of this cult followed Instagram manifestation guru and how she sort of weaponized and commodified ideas of manifestation in a way that created some victim blaming. Obviously, if you believe that you and your thoughts are individually and solely in the driver's seat of your reality, then if your reality isn't a positive thing or isn't changing, then you're the only person to blame. Not dumb luck or systemic issues or anything like that. It's you.

And so that can be very easy to manipulate and exploit, because if you're like, "Oh, I'm an expert manifestor, I have a proprietary manifestation technique, and if you pay $600 a year, you can access it. And if it doesn't work for you, well, then, sorry, that's your fault." That is a precarious belief system to align with. And the story that I tell in that chapter is how some manifestation gurus on social media right now can actually serve as a gateway to much more insidious, conspiratorial belief.

Christy Harrison: Yeah, I mean, that pipeline is so real. I think there's so much in wellness culture and sort of new age culture in general that can serve as that pipeline to conspiracy theories. And it's scary. I talked in my book about the mental health impacts of manifestation and how manifestation is antithetical to so much of cognitive behavior therapy and other good therapies for anxiety disorders and depression and things like that, where with CBT, there is truth and evidence behind the idea that your thoughts can affect how you feel and how you show up in the world and perhaps can affect outcomes in your life. That having distorted thoughts can cause you to act a certain way that changes your relationships or changes your outcomes in the workplace or things like that. And so there is truth to that.

And as you said, there's a grain of truth to this idea of manifestation, but the idea that your thoughts literally create reality where it's like you can manifest a parking spot or you can manifest a bad haircut or a person to show up in your life or whatever it is, I think that is the real problematic thing, because that's such magical thinking, right? And it's antithetical to the CBT notion of reducing cognitive distortions and helping people see reality more clearly with more nuance and less catastrophizing and less black and white thinking.

And yet it is so tempting to catastrophize in a world like ours, where things feel so big and so bad. And I think that is sort of along the lines of what you were discussing with proportionality bias, right? That there's so much bad going on in the world today that it feels sort of right in a way, to be like, "Oh, the sky is falling, everything is terrible. There's a climate crisis. We're all going to die." I think you might have mentioned this in the book, this idea that it's sort of become a shorthand to just be, like, "We're living in a capitalist hellscape. The world is burning." People just toss off this idea, right?

Amanda Montell: I do. I have a chapter in the book. Sorry. It's so funny to reference all of these cognitive biases because it really is. It's been such a helpful lens for me, because now whenever I see someone engaging in a behavior that makes no sense, that would almost, in a proportionality biased way, cause me to believe, "Oh, my God, they must be making this irrational conclusion because they're evil or deranged" or I don't know, actually what's motivating it is one of these biases. and the one that you're mentioning is called declinism, which is our penchant to think that society or our individual lives are just getting irreversibly worse and worse and worse and worse, despite evidence to the contrary.

And actually, I have an opinion piece coming out soon in Esquire about doomslaying, particularly how this attitude shows up in the ways that we speak colloquially. So you can't notice that phrase is like, you know, bedrotting and doom scrolling and like, you know, "How are you? Other than the world burning and all?" Or like, "How was your weekend surviving through our neoliberal, late stage capitalist hellscape?" You know, like these phrases were really interesting to me, and I was curious about what they were doing to us or what they were saying about us. And my intuition, whenever I, like, embark on one of these projects is to think like, "Oh, my God." You know, it's almost a decline of statitude. It's like, "Oh, my God, you know, speaking this way is causing us to catastrophize, or it's making us desensitize to actual disaster just to make light of the apocalypse in this way."

But then I spoke to all these scholars, and whenever I talk to academics, they always make me feel so much better actually, there's a lot of optimism in having access to these facts or in studying them. And they were saying, well, it's actually a coping mechanism. First responders, when they show up to a really grisly scene, and one of the first things they do, not in front of people who are struggling through that scene, but later on, one of the first things that they do to cope is to make a gallows joke about it. So in a broader way, some of that doomslaying is helping us cope with humor, and it's in a way, helping us acknowledge the reality that, yeah, there are a lot of doomy horrors that the news is tasking us to confront or that life is tasking us to confront. The climate crisis can't be ignored. So that's definitely going on.

And the oversimplification of cause and effect is something that now I completely understand, knowing what proportionality bias is like, we naturally, as a species, want to create a narrative that makes sense for our lives. We do this for our personal lives, too. It's like everything happens for a reason, we tell ourselves, because we want there to be this sequence of plot points that quote, unquote, make sense. And that goes for catastrophes as well. It's too chaotic to think that a tragedy happened for no reason or a series of minuscule events. It's much more satisfying to think that the royal family killed Princess Diana, rather than that it just happened by a horrible accident. And it feels much better to think that we're doing well now and we're doing poorly before because we manifested it. And if we're still not doing well, well, that's our fault.

It's so much more manageable to think that something is your fault. The way that kids will blame themselves for their parents divorce, because it's way too chaotic to think that just shit happens and chaos, chaos, chaos. I'm fortunate to be friends with several therapists, both for my work and for my own brain. And I was talking to one of my best friends, who is a school psychologist recently about CBT, but also ACT, acceptance and commitment therapy. And I really liked that as a solution to some of this digital age anxiety which might manifest in over fixation on manifestation, or even something like imposter syndrome, where we just blame ourselves, blame ourselves, blame ourselves.

And I like the idea of using this acceptance and commitment therapy strategy as a method to soothe that. Because rather than attempting to replace your rational thoughts, it's more about maybe visualizing your thoughts as waves that peak and crest and break. And this happens in cycles and it's fluid and normal, and that we are not our thoughts. That they come in and out like a tide, and everybody has irrational thoughts. I mean, show me someone who doesn't.

Christy Harrison: Yeah, I love that. I think that's been so helpful for me, too. That idea that we are not our thoughts. And I think that's sort of antithetical to manifesting, right? Like the idea that your thoughts literally create reality. It's like, you know, we're sort of doing our best to detach from that notion and recognize that, like, we are not our thoughts. Our thoughts don't manifest in the real world. They don't necessarily have to have any sort of consequence. They can come and go and just be relics of our brain firing off at random and not have to make meaning out of them actually.

Amanda Montell: I do argue a little bit in that proportionality bias chapter that it doesn't mean that life is meaningless, that your thoughts can't influence reality, or that manifestation isn't quote unquote real, or, you know, that there wasn't some big on purpose reason for XYZ tragedy. It's just that meaning is our job. It's not like the universe has your back, but it's also not depressing to think that the universe doesn't have your back. It's simply that, like, the universe is there and it doesn't care. But that doesn't mean that our lives aren't meaningful. I hope that this makes sense. It's like meaning is our job to create in our lives with the people that we love. And if the universe doesn't have our back, that's okay, because someone in our real life does.

Christy Harrison: And I think, too, this idea that we can take on the task of making meaning and that can help sort of organize our reality and help us cope and feel better doesn't mean that we have to seize on every little thing as having some kind of existential meaning, right? It's like we can sort of learn to filter out what is going to go into our sort of constructed self meaning, what is going to go into our meaning making machine, and what is going to maybe get left to the side as just sort of like, "Oh, this doesn't really belong here."

Amanda Montell: I struggle with this so much because whenever anything negative happens or whenever there's a curveball in the narrative of your life, I'm always just like, oh, my God, what does this say about me? What did I do to deserve this? And it's like, maybe life isn't actually a story. Like, maybe this curveball or this tragic plot point doesn't actually say anything about what genre the story of your life is. You know, I really struggle with that myself.

Christy Harrison: I think about this story I heard a long time ago when I was studying mindfulness meditation. I think it was a Buddha story. I could be totally wrong about the origin, but it was something like, guy got a horse. Someone's like, hey, good for you. You got this horse. And he's like, like, we'll see. We'll see. And then the country goes to war, and someone comes and takes the horse, and someone's like, "Oh, man, bummer. You lost your horse." And he's like, "We'll see." And then everybody gets drafted, and every man with a horse has to go to war, but he doesn't have a horse. So this person's like, "Oh, hey, cool. You don't have to go to war." And he's like, "We'll see." And then, just like, everything that happens is sort of like, we'll see, right? We actually don't know how it's going to end up or what twists and turns our life is going to take.

Amanda Montell: Oh, my gosh. That reminds me of this children's book that I actually think had a great effect on me, even if I didn't notice at the time. But it comes up, it lives proverbially rent free in my head I'll say. It's just called Fortunately and it's by Remy Charlip. Go on a wonderfully wild adventure with Ned as he takes on a journey full of mishaps in this book from celebrated dancer, choreographer and beloved author and illustrator Remy Charlip. But it was like the whole book went, "Fortunately, Ned was invited to a surprise party. Unfortunately, the party was a thousand miles away. Fortunately, a friend loaned Ned an airplane. Unfortunately, the motor exploded. Fortunately, there was a parachute."

I think it's important for me to like, revisit that children's book because it wasn't like Freytag's Pyramid, you know, where there's like a beginning and then a challenge and then a climax and then a happy resolution. You know, it's like we like for life to feel that way, but instead it's more like Ned's day, you know? And so, yeah, I think that that book is, lol, me in my thirties, like, re-parenting myself with Ned's day. But it is helpful to kind of go back and be like, what relics from my childhood can inform the way I want to live now?

Christy Harrison: Totally. I know I'm reading my daughter all these kids books and there was a time when I couldn't get through any of them without crying because it just has so much meaning in them and these life lessons and beauty. And also when I was postpartum, up until a year or so after I gave birth, I was just ultra, ultra sensitive and still I haven't gone back to my, I was already highly sensitive before having my daughter, but it's gotten to the next level. Just things will affect me but never used to, you know, so there's that piece of it, too.

Amanda Montell: Oh, my gosh. I can only imagine. My reproductive system is like, let's say it's out of office, but one day it'll go back to work and I'm sure I will have the same reaction.

Christy Harrison: Yeah, it's fascinating. I feel like not enough people talk about that, the sort of emotional, long lasting repercussions of having kids or going through those hormonal changes. I want to talk about another cognitive bias you cover, which is the sunk-cost fallacy. I think this is one that, that shows up so much in wellness culture. You write about it in the context of staying in a toxic relationship, which I have too, but I see it so much in the wellness world and have done this myself, where people will devote themselves to particular alternative protocols or practitioners and spend all this time and money and energy on them, and they don't really see results, or they're still having symptoms, or they're like, maybe it's better. Maybe there's some sort of placebo effect going on, but then it wears off and they just don't really know, but they aren't able to admit it to themselves or to other people for a long time.

I did this myself when I was cutting out gluten 15 plus years ago because I was so invested in doing it. I had written multiple pieces about it for the magazines I was working for at the time. I was telling everybody I knew about it and getting people on board, both to make me gluten free foods when I went over to their house, and also to do it for themselves, like, talking about all the benefits they were supposedly going to get, and convinced some people in my life to go gluten free for a time. And so I made it my whole personality, kind of. And that resulted in hanging onto it much longer than I should.

Because at my heart of hearts, I was like, "I don't actually know if this is helping." I still had to go to the ER for stomach pain while I was gluten free. It wasn't necessarily helping the things I thought it was going to help. I would love to talk about the sunk cost-fallacy and how you see that showing up in wellness culture, and also the idea that it's not necessarily a fallacy, that it actually can be a form of self protection.

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Erin (who asked that I use only her first name) has struggled with psoriasis for her entire adult life. Now in her forties, she’s softspoken and has a youthful energy. She lives in northern Alberta, Canada, about five hours from the nearest major city, so she wasn’t able to find many options for treating psoriasis other than going the pharmaceutical route. Her doctor recommended a topical steroid, which she didn’t think seemed like a good­ long‑term solution, both because she has melanoma in the family and is at higher risk for skin cancer (for which long‑term use of topical steroids may raise the risk, though a 2018 systematic review found no evidence to establish whether or not this is true), and because eventually steroid treatments stopped working well to control her condition. She also felt uneasy about taking biologics—systemic medications that suppress the part of the immune system that’s overactive in psoriasis—and none of her doctors took the time to talk her through these options. “I’ve had so many poor experiences with medical doctors who sort of shame or just don’t have the time for you, or certainly haven’t met me in my hesitation,” she says. “I always seem to get the doctor who’s like, ‘just trust me,’” but that never sat well with her.

So it was no surprise that she was attracted to alternative medicine. “It really appealed to me to be like, okay, I’m in control here,” she says. In addition to the psoriasis, she was also suffering from migraines and severe chronic stomach pain, as well as struggling with anxiety, depression, and exhaustion. She’d never gotten good support for those things, so when she heard about the naturopathic approach, it immediately resonated. It felt like finally she was going to have someone listen to her, take her symptoms seriously, and figure out what was going on. And when she started working with a naturopathic doctor, she got a diagnosis that supposedly explained the cause of all these disparate problems: “leaky gut syndrome.”

That diagnosis, unfortunately, is a dubious one.

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Dr. Mara Einstein joins us to discuss how cult-like marketing tactics have taken over the wellness and diet industries.

She explains how Weight Watchers and other diet programs operate on cult-like principles, why food noise might be a kind of internalized cult leader, the many problematic aspects of how GLP-1s are marketed, and why conspirituality is so problematic.

Behind the paywall, Christy and Mara discuss the cult marketing spectrum, influencers as “cult-like” figures and conspiracy theorists, the anxiety economy that profits from doomscrolling, MLMs, affiliates, and how to get out of brand cults.

The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.

Dr. Mara Einstein is an internationally recognized expert on deceptive marketing. She is a former TV and advertising executive and the author of 8 books, including Hoodwinked: How marketers use the same tactics as cults. You might also recognize Dr. Einstein from her appearance in the Emmy-winning Netflix documentary, Buy Now: The Shopping Conspiracy, which exposes the impact of overconsumption on people and the planet.

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Resources and References

Contains affiliate links to Bookshop.org, where I earn a small commission for any purchases made.

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Mara’s book Hoodwinked

• NXIVM documentary

• LuLaRich documentary

• Brandy Hellville documentary

• Dr. Mara Einstein’s website

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Mara Einstein, welcome to the show. I am so excited to talk with you today about your books and your academic work on how marketers use the same tactics as cults, especially in the wellness and diet space. Because I think there is so much cultishness sort of floating around in these spaces. But before we talk about all that, I’d love to just hear briefly what brought you to this work.

Mara Einstein: Oh boy. Well, in terms of the cult work, that started probably almost 50 years ago, I’ve actually been interested in cults since I was about 13, but academically, I’ve been studying the intersection of marketing and religion for the last 30 years. And one of my first books was called Brands of Faith: Marketing Religion in a Commercial Age. And what I discovered over time is with the introduction of digital technology, that connection in terms of religion or grew exponentially to be more cult-like and not just sort of religious. And that we see that with everything in the digital space. It’s not that you are just a vegetarian, you are a vegan. It’s not that you just like a particular candidate, you love a particular candidate. And so we get separated into all these silos and I’m sure we’ll talk about that.

In terms of weight, I would say that my interest in that goes back about as far. I was on Weight Watchers for the first time when I was 13 years old and so long ago that some people may remember that’s when you used to have to have liver once a week as part of the diet plan. It was awful. Oh my God, it was so awful. And so I’ve been indoctrinated myself into this sort of diet thinking. And I find myself whenever I write a new book, and Hoodwinked was my eighth book, so this will be my ninth book. I find that I write something that I get very angry about because if you’re really pissed off about something, it will drive you forward in terms of how you write the book. It’s a more powerful book.

And so what I found while working on my last book was this idea of how do some of these weight loss plans start to take on the same category of cults, how they are like cults. One of the things actually where I really started to think about this is early on when I was presenting material from the book, people would say to me, yes, but when you’re talking about consumer products, you don’t have a charismatic leader. And I went away and thought about that and I said, no, but you don’t have to. And the reason why we don’t have to is that we have been indoctrinated into a consumer culture over the last 75 years. So there’s certain things we have been trained to think. And that’s particularly true in the weight loss and fitness category.

And so what I sort of discovered within thinking about this is that we have an internal cult leader, particularly if you’re talking about weight loss. Anyone who’s ever been on a diet knows how many calories are you supposed to eat, how much are you supposed to work out? If you’re on Weight Watchers, how many points are you supposed to have? And so you don’t need somebody outside telling you that you have internalized all of that.

Christy Harrison: Yeah, I think that’s really important. And I mean, some of the case studies you talk about in your book Hoodwinked, there is kind of a charismatic leader involved. There are some consumer cults that are driven by a charismatic leader or influencers that you define as cult light and we can get into sort of those gradations and stuff. But yeah, there doesn’t always have to be one because like you said, you sort of internalize this message.

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I’ve spent a long time thinking and writing about diet culture and this system of beliefs that makes us think it’s better to be thin, that denigrates larger bodies, that tells us it’s healthier to eat a certain way and to avoid certain foods. And the good and bad food rhetoric and the oppression that happens of larger bodied people, all of that is just the water that we’re swimming in. I’m curious for you, what brought you to Weight Watchers at 13? And then also we talked before this about sort of your trajectory of getting out. And I think that’s a really interesting part of the story as well.

Mara Einstein: Yeah, my mother, that’s how I ended up at Weight Watchers. She was going there too. And I mean, I wasn’t fat, but I also wasn’t happy with how I looked. So I don’t blame my mother about this. It’s like I was unhappy with something she was doing. It was something that she believed would help me feel better about myself and it did. But what happened is it created a mindset for me over the course of my life to constantly think about what I was eating and also the way that Weight Watchers in particular is set up. And this is really cult-like. You show up to a meeting every week, you become part of a community the community validates you for the things that you do to listen to what the group is telling you to do.

So all of those things are very cult-like in that respect, but what it also does is it regiments your food, which is also cult mentality. And so what happened over time is this sense of deprivation. If I didn’t eat every piece of food that I was entitled to under that regimen, so if I was allowed 20 points and if I made the meat and the vegetables and everything that I had on my plate, gosh darn it, I was going to eat everything because I was entitled to that. And what it then trained me to do was to not listen to my body, to not listen to when I was full, and to eat everything because I was entitled to that and I wasn’t going to give it up.

Christy Harrison: I mean, it makes so much sense, being a disordered eating dietitian and thinking about how people respond under deprivation. It’s like that hoarding mentality and that sense of like, I need to get this all in because I don’t know when my next points are going to come. This is all I have for today, so I have to eat it now. And you’re probably chronically deprived. Most of those diet and weight loss plans have you undereating for what your body actually needs. So it makes sense that you would feel that mentality and that feeling that you needed to eat everything that you possibly could.

Mara Einstein: Right. Well, then you were asking me about how I got out. One of the things cult experts or cult therapists talk about is how do people get out of cults? The way people get out of cults is that there’s this continuing sense of cognitive dissonance, right? This idea that something’s not making sense. And they talk about it in terms of a bookshelf. And so you have one piece of information that doesn’t make sense and you put that on a bookshelf and another piece and you put that on the bookshelf until you have so many pieces on the bookshelf that the bookshelf breaks.

Well, the bookshelf breaking moment for me was I was on Weight Watchers when I was going through menopause, and I was following everything. I’d been doing this for 40, 50 years, and I was following what you’re supposed to do. It had always worked for me before. Six months later, I still hadn’t lost an ounce. And I went to the leader and I said, look, you write it down. Anybody Weight Watchers knows, you write it down or you put it in the app or whatever it is you’re doing. And I showed it to her and I said, this isn’t working for me. And she asked, are you going through menopause? I said, yeah. She said, oh, this isn’t going to work for you. I said, so what am I doing here? What am I doing here?

So that was the breaking moment for me. And what’s really interesting, in, like, the last couple of weeks, Weight Watchers has started promoting a special plan for people for women going through menopause. Interesting, no?

Christy Harrison: Very interesting. And they’ve also started promoting GLP-1 medications. I think that’s a really interesting piece because people are having strong reactions to that. Can you talk a little bit about what you’ve seen in the Weight Watchers in terms of people’s reaction to the GLP-1 push?

Mara Einstein: Well, particularly in terms of Weight Watchers, but certainly not just there. Particularly longtime members, because the whole point, getting into the whole cult, part of this is the goal in Weight Watchers is to become a lifetime member. Because when you become a lifetime member and you maintain your weight, then you don’t pay to go to the meetings anymore. And so you have people who have been doing this for decades, and they have followed the plans and they followed the leader, in air quotes, and then they buy this company that is a telehealth company that allows them to also use GLP-1s.

And so there was a tremendous uproar from people who had been part of the program for all of this time who said, well, wait a minute. You’ve been telling us this is what we’re supposed to do. This is how we’re supposed to lose weight, and now you’re telling us all we need to do is take a drug. So you’ve been lying to us. There were tremendous pushback from people who had been part of the company for a long time. Weight Watchers didn’t change because they knew the trajectory of where weight loss was going. But they did say to people, well, you don’t have to. I don’t have to use GLP-1s. Right? x

But the thing about GLP-1s that I find that’s really interesting. I mean, there’s so many things that are interesting. That’s kind of a rabbit hole. I don’t want to go too far down in the new book because so many other people have talked about it. And what I’m more focusing on is, what are the marketing messages? What are the cultural messages that we’re getting? But what I do find interesting about GLP-1s is, one is this idea of food noise. And I think food noise I would equate with the internalized cult leader. We can think of those things as the same thing.

Christy Harrison: Can you say more about that? Like, how does food noise relate to the internalized cult leader?

Mara Einstein: Well, the idea that when people talk about food noise and they talk about GLP-1s, they say that one of the things that’s so valuable about GLP-1s is they don’t have that constant noise, that constant thinking in their heads of when I can eat again, what can I eat? If I eat that, is that bad? And so it’s this constant battle within your mind about how am I going to negotiate my life with food and still have the body that I ultimately want to have? And so what GLP-1 does is shut that down. So that talk, that food talk is the cult leader saying, you can eat this, but you can’t eat that. You better work out some more. You better take another walk, right? All of that stuff that we constantly say to ourselves.

Christy Harrison: I mean, it’s interesting too, from my perspective, because I’ve been very critical of GLP-1s, and as a dietitian, I’m always thinking about what are the responses to deprivation and how is food deprivation playing a role here? And I see food noise and that kind of chatter in people’s minds as so driven by deprivation. Not just the diet mindset, but the actual act of having too little energy coming in and too little variety in food and feeling so deprived of both pleasure and just enough food in general.

And so it makes sense that when you take an appetite suppressant, it would blunt some of that because it’s blunting your appetite and appetite is often what drives that thinking in the first place. And so when people talk about how GLP-1s quiet the food noise, I’m sort of like, well, yeah, to a point and while you’re on the drug, maybe that’s true. Right, but then what happens when you come off it?

Mara Einstein: Well, that ties into the marketing, right? With the marketing of GLP-1s, you don’t hear about what the problems are with GLP-1s. This whole Serena Williams connecting herself, promoting Ro and my issue with that is one, it wasn’t widely promoted that her husband is an owner and on the board of Ro, which then says that she’s not promoting this because she went out and did a lot of research to find out what the best way to take this medication might be, number one. And number two, it is a medication. It’s not like she’s selling tennis balls or tennis rackets or clothing. She’s selling a medication that people are going to put into their bodies. And because she is who she is, people are going to look at that. And that goes down some dangerous roads that I don’t necessarily think we want to do.

The other thing that I find fascinating in terms of the marketing of GLP-1s now is, is up until recently, this idea of microdosing GLP-1s was something for the hoity toity, right? It was for the rich people would go to the doctors. Well, now Noom is offering microdosing of GLP-1s and the lack of education for people around what they may be doing to their bodies and rather just thinking, oh, I’m going to get thin. Oh, I’m going to get thin is just such a disservice. And this is what I mean about getting pissed off about something.

But the other thing is not just about GLP-1s, but overall and this is the crazy statistic, and it depends on if you include fitness and diet programs and all. But all of that is about $160 billion a year industry. $160 billion a year with a 94 to 98% failure rate and we would accept that in no other category.

Christy Harrison: I have talked about this a lot too, and thought about how bananas it is that that is something we just accept and that this industry continues to exist and continues to flourish and grow and that it’s not something people have put their foot down about, which I think comes partly from the fact that we’re just conditioned to blame ourselves when these things don’t work and when diets inevitably fail for the vast majority of people because of the nature of food restriction and deprivation and the fact that we are not really designed to do that long term. But when we think that, we’re the failure, that it’s a problem of willpower and that we just needed to stick to the diet.

Because some people, if they do the diet and like, you kept going back to Weight Watchers again and again, for some people, if they follow the diet, they can lose weight and keep it off for a time, but then usually something happens. And people will sort of frame it as like, oh, life got in the way, or I just couldn’t keep it up anymore because of whatever’s going on for me right now. But I don’t think that’s really the whole story. I think that it was always destined to fail. You were never going to be able to sustain that long term. Some people can sort of white knuckle it for a long time, but then things interfere. And they do say willpower is a muscle. And if you’re trying to sort of willpower your way into something that’s going to get exhausted after a period of time.

Mara Einstein: I will say, though, that the one thing that GLP-1s did for me and I didn’t take them, I haven’t taken a GLP-1, is that it let me off the hook. It was the one thing that said, it’s genetics, it’s genetics. You’re going to have the body that the rest of your family has. And for me to try and look like somebody who’s skinny or what our culture would say is the body type you’re supposed to have, like, the contortions that I would have to go through in order for that to happen is not how I wanna live my life. So I felt like boulders were lifted off my shoulders when it’s this medication said, it’s not you, it’s genetics. It’s something you do not have control over.

Christy Harrison: Yeah, I think it’s done that for many people. And then there’s paradoxically also the sort of increased weight stigma that the popularity of GLP-1s have brought about in the culture where it’s like, now the beauty ideal has become so much thinner again. But I think that that realization of, like, this is not something that I am going to control. The fact that my body is just designed to be this way, maybe can ease the burden on a lot of people.

Mara Einstein: I see with my students and my daughter is Gen Z, I see her and her friends not having the same kind of issue, concerns, stigma that I think that we had people of older generations. And maybe it’s just the people that I’m seeing, I haven’t studied it enough yet to know whether or not that’s true for the entire cohort. Cause obviously we have the issues of what went on with Instagram and we know from Frances Haugen when she was the Facebook whistleblower, and she specifically talked about the fact that Facebook or Meta knows how bad Instagram is in terms of making particularly teenage girls feel bad about themselves and not only makes them feel bad about themselves, that that platform is worse than other social media platforms when it relates to doing them.

Christy Harrison: Yeah. I mean, I think you’re right that growing up with this sort of constant barrage of images from influencers and from friends too. Right? From people that you know because we spoke about this before offline, but the fact that people can look at their friends images and they’re filtered and they don’t necessarily know it, but they’re like looking at these people looking so “flawless” by our cultural standards. And those images have been manipulated, I think really does a number on people’s self image.

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Mara Einstein: Right. Well, it’s also performative. When you go onto social media, it’s very performative. And what people need to remember is people are showing you their best day. They’re not showing you the fight that they had with their partner or their kid or that they made breakfast and the coffee pot blew up. They’re not showing you those pictures, they’re showing you this very special, very perfect looking life, which is looking even more perfect because of what you say, that you put the filter on the picture on top of it. And there’s plenty of stories, really sad stories of influencers who looked like their lives were perfect and then...

Christy Harrison: They really weren’t. Yeah. I mean, it’s also interesting too. You talk about the highlight reel aspect of it, that people are mostly showing the good stuff. But there’s also a trend recently that has kind of emerged of people crying into the camera and showing the bad, you know, trying to be “authentic” in showing the bad stuff too. But that’s also kind of a performance because that is also not the full spectrum of someone’s life. And sometimes it’s amplified for the camera and all of that.

Mara Einstein: I think it does us a disservice. And I mean that in, we can become very cynical when it becomes a trend. We’re talking about it as a trend. And I have no doubt that there are people hurting right now. Not at all. But when we begin to see video after video after video of somebody crying into the camera or somebody saying, particularly on TikTok, stay here for the full minute so I can pay my attorney or whatever it is, we become pretty callous to that stuff because you begin to wonder, is this real? And, how many people can I help? And that’s where this idea of mutual aid becomes really important, because we can’t help everybody. We can help the people who are in our physical environment primarily.

Christy Harrison: That’s a really helpful point because I feel like I sounded callous just then, saying that this is a trend, but it’s been written about in trend pieces, and it’s become this thing where now, I find myself certainly questioning the authenticity of it or even just questioning sort of the mindset that would lead someone to that. Is that something that they would authentically, whatever authentic means, but normally, traditionally do? Is this something that they just would have thought of on their own, or is this sort of being conditioned and are they being pushed in this direction by the algorithms and what they see being rewarded as well?

I want to talk about the algorithm and how that incentivizes this cult-like, and kind of extreme behavior. But first I want to sort of get into some definitions because we’re using the word cult, and I know that’s a strong and loaded word for a lot of people. So can you define how you use the word cult and how it shows up in different ways, sort of on a spectrum in marketing and in these spaces that we’ve been talking about?

Mara Einstein: Well, there’s a couple of things to talk about in terms of cults, and for this I rely partially on the work of Lauren Dawson and also Janja Lalich, who are religion and cult scholars and experts. The first thing that cults do, and if people start to think about this in terms of your relationship or interaction with diet or exercise program, the first thing that cults do is look for recruits, and particularly they’re looking for vulnerable people. Now, nobody’s more vulnerable than somebody who recommended who is not feeling good about their body and wants to do something about it. And so the second step is to lure with deception. This almost one almost answers itself. If you use this program, you will lose weight. Yeah, maybe, but will you keep it off? All of that stuff.

The next part of the process is to upsell. So once you’ve come in, you’ve taken one class, buy a set of 10, you’ve bought the sessions. You’re paying for the sessions, okay, buy the food, right? So all of that, okay, you’ve bought the sessions, okay, pay for the app and you can then get recipes, right? So it’s all about upsell, upsell, upsell, upsell. And when I talk about this, an example in terms of a religious example so people can relate to it in terms of cults.

I spent two years researching the Kabbalah center for one of my earlier books. And part of being in the Kabbalah center is that you take an introductory class. And part of that introductory class is you get a one on one session with the teacher and you think, oh, you know, great. You’re starting a new spiritual practice, you want to understand it. You’re like, oh, great, this teacher is going to give me extra time. And then you go into the room and you find out it’s a hardcore sell. They want to sell you the books, they want to sell you the red string, all of that kind of stuff. So instead of getting what you need from a spiritual perspective, what you’re getting is a whole bunch of selling.

The next step in the process is to love bomb. So if you are in an online group or if you’re in something like Weight Watchers, you go to the meetings and everybody says, oh, that’s really great, you did great this week. And oh, you fought the devil, you didn’t eat the chocolate cake, right? Everybody’s telling you how wonderful you are. The next step in the process is tough love. And then part of that has to do with, in religious cults, it tends to do with eliciting confessions, right? So anything that they can use against you, right? So, you have issues with your mother, you have problems at work or whatever it is. In something like NXIVM, they had people take naked pictures, right? You know, all of that kind of stuff.

Christy Harrison: Yeah, the collateral, right? They collected collateral on people make sure that they didn’t feel safe to leave, right?

Mara Einstein: Think about people who want to lose weight. I mean, so many pain points that you can hurt them with.

Christy Harrison: When you think about Weight Watchers or a group fitness class or a group therapy type of situation like that, right? Where people are talking about this really vulnerable thing and like how their relationship with their body is affecting other areas of their life, not necessarily saying that Weight Watchers leaders are intentionally trying to weaponize that or the sets out to do that because it’s different than a literal cult in that way. Right. There’s not necessarily that nefarious intention behind it from the start.

Mara Einstein: No. And that’s what’s so insidious about this, is it’s not intentional. And so when I was writing the book and interviewing marketers, I didn’t tell them what the name of the book was. And so the subtitle of the book is How Marketers Use the Same Tactics as Cults. And when I told people that, I got two responses. One was, yeah, that’s what we do. And the other response was, yeah, that’s what we do. And so, some people are like, yeah, I don’t feel good about doing this, but I know that’s ultimately what we do.

So people who are doing this aren’t thinking they’re doing something bad when they’re doing it, they believe they are helping you get to your ultimate goal. Whether you’re talking about a marketer or whether you’re talking about a cult, they’re doing it because they believe it. I mean, and that’s what’s really interesting because one of the things I talk about in the book is multilevel marketing being the sort of canary in the coal mine when we talk about this. And multilevel marketing is legalized pyramid schemes, for lack of a better way to describe them.

And what happens in those cases is the people at the top are making all kinds of money and doing really well, but the people down below aren’t. But the people at the top top, they know exactly what’s going on. People in sort of that middle layer may or may not know that the people below are not doing well. And some of them, when they wake up, they just sort of assume, I’m doing really well at this so I assume everybody else is doing really well at this. And so when they finally find out that no, that’s not happening, that’s usually when the shelf breaks and they suddenly have to say, oh, yeah, maybe what I’m doing isn’t really great, but people aren’t necessarily doing this from a place of trying to sell you something bad. They’re not trying to do it to be bad people. They’re doing it because they think they’re helping you.

Christy Harrison: And because these tactics work. Right? Because it’s effective.

Mara Einstein: Right. Because then the next part is deprivation, hypnosis and meditation. And so obviously, hypnosis and meditation may or not be part of this. In some cases it is, but certainly deprivation, and then renounce anybody who tells you that there’s something wrong with the group. So if anyone tells you, I think of something like CrossFit, they tell you to work out until you throw up, which doesn’t sound particularly healthy to me. But the people who like it, really like it. And when people say, oh, I’m not sure how healthy that is, but they’re like, no, this works for me and I’m going to do it. Then after all of this, this is when a cult will introduce their core beliefs. This is who we really are. When it comes to weight loss, this may be just taking on a more extreme plan, something like that. And then the last part is making it hard to leave.

Christy Harrison: Actually, one question on that, the real core beliefs, because in wellness, I think we see that a lot as well, right? This sort of wellness culture, spaces showing what they really believe may be revealing sort of more woo woo type of beliefs or new age, out there types of things. That were not necessarily part of what somebody signed up for when they started doing this fitness routine or whatever it was.

Mara Einstein: Right. Well, that’s what is really interesting about how conservatives have been so successful in terms of bringing people into that fold. Because if you look at someone like Joe Rogan, but MAHA does this, they all do this, is talk about popular culture and then sort of feed in this rhetoric of conservative politics in it. But you grab them with the pop culture, you grab people with the original physical workout program or New Age program or yoga.

And we particularly saw this with yoga folks and new age folks during the pandemic and this whole issue of conspirituality, that this combination of conspiracy theory and spirituality and that your body is your temple and so you want to do everything you can to keep that temple clean, which is a very new age kind of a thought process. And so that somehow morphed into vaccines can’t be a good thing and we don’t know what they are and why would you put them into your body?

Christy Harrison: Right. It’s sort of an on ramp to this extreme type of thinking about wellness. Absolutely. And then the last aspect of cult indoctrination I’m curious to hear more about that.

Mara Einstein: Severe repercussions for trying to leave. So if we think about this, as in traditional cults, Scientology is a great example. They start following you around. You have to separate from the group. What’s really hard with this is that you have become part of a group. Becoming part of fitness or weight loss program is you become part of a community. And in some cases, if you have been separated from all these other areas of your life, then this becomes your new community. And so how do you find your way back after you’ve separated yourself from them, which could be for you years and if you’re sticking to a particular diet program, are there people you’ve been avoiding because you can’t stick to your program if you’re around those people?

Christy Harrison: And I think in the diet and wellness space, it might not be as overt and clear that they’re making it hard for you to leave as it would with a traditional cult where it’s like they’re coming after you or they’re telling you that your family can’t be trusted or whatever it is. But it is hard to extricate yourself. And I’ve talked to so many people who were in whatever diet and wellness kind of niche that that became their whole community and everybody around them was a part of that. And they had renounced so much of what they used to believe or kind of alienated or felt alienated from people in their lives because of their more extreme beliefs, then to go back from that was a lot harder.

Mara Einstein: Because you also have to say those people who you said, oh, no, no, no, you don’t know what you’re talking about. You have to go back to them and there’s a lot of shame associated with that. And you have to go back to those people and say I was wrong. Which is hard, but hopefully your family and friends will understand. Sometimes we go down the wrong path. We are human and it happens.

Christy Harrison: Yeah. And I hope people will have grace and compassion for others who do that as well. So I’m curious to talk a little bit more about how this cult-like behavior and cult-like thinking shows up in different aspects of marketing, especially in the diet and wellness space. And obviously, you’re not saying that all marketers are cult leaders or all brands are literal cults. Not at least not in most cases, but that there are similarities and it’s like a continuum. So I’m curious what that continuum looks like and sort of how we can spot marketing on different parts of that continuum.

Mara Einstein: The way that I got to writing Hoodwinked was that it was during the pandemic and I was in lockdown cause I live in Queens, New York, which was sort of the epicenter of the pandemic. So we were locked down for a long time. And I was watching the documentary The Vow, which was about the NXIVM cult. And I was watching the series LuLaRich, which was about LuLaRoe, which is a multilevel marketing company. And I looked at those two things side-by-side and I was, was like, wait a minute, these are the same things.

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

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I am so excited that my husband got me a subscription to your Substack as a gift! I always talk about how you do the best research on topics I am so interested in. Can you please cover commonly recommended supplements? In particular, Magnesium, Vitamin D, and Iron are so frequently recommended for both kids and adults. Magnesium especially seems like it’s a miracle mineral that can treat depression & mood, sleep, blood sugar, etc. What data supports these claims?

FYI: my answers here are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.

Thanks for this question, and for your kind feedback! I love the idea of covering commonly recommended supplements. And right now there’s probably none more ubiquitous than magnesium, which is extremely hyped in wellness culture. TikTok testimonials call the mineral “life-changing,” rave that it “fixes your problems completely,” and say it’s the ticket to looking and feeling like a 20-year-old again. In certain integrative- and functional-medicine spaces, it’s unironically referred to as a “miracle” and hailed as a cure-all for a laundry list of genuine ailments as well as dubious diagnoses like “adrenal fatigue” and “chronic candida.”

Is all this excitement warranted? I was, of course, skeptical, but I wanted to do a deep dive into the science to make sure I wasn’t missing anything. And when I did, I quickly realized that I’d need to save the reporting on iron and vitamin D for another time. There’s just too much to say about magnesium first.

When it comes to this much-touted mineral, in many cases the science directly contradicts a lot of the hype—though there are a few specific areas where magnesium may show some promise.

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The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.

Registered nutritionist, author, and friend of the pod Laura Thomas joins us to unpack the problematic notion that you need to eat a ridiculously large number of plants per week for gut health, and what we actually know about how plant foods affect the gut microbiome. We also get into how to distinguish good science from hype, how ultra-processed foods have become so demonized despite a lack of strong evidence, how anti-fat bias is baked into the discourse about both gut health and ultra-processed foods, and lots more. 

Laura is a Registered Nutritionist who helps people feel less afraid of the food they eat and more comfortable in their bodies. Through her work with individuals and families, as well as in her writing, she challenges dominant ideals about ‘good’ and ‘bad’ foods and ‘good’ and ‘bad’ bodies. She holds a PhD in Nutritional Sciences from Texas A&M University, and worked as a post-doctoral research associate at Cornell University before starting her private practice. More recently she received a diploma in Clinical Nutrition and Eating Disorders from UCL. She has published two books: Just Eat It and How To Just Eat It, both of which focus on healing our relationship with food and our body through Intuitive Eating. Her clinical work is focussed on supporting families to end the intergenerational transmission of body shame and disordered eating. She writes the newsletter Can I Have Another Snack?

If you like this conversation, subscribe to hear lots more like it! 

Support the podcast by becoming a paid subscriber, and unlock great perks like extended interviews, subscriber-only Q&As, full access to our archives, commenting privileges and subscriber threads where you can connect with other listeners, and more. Learn more and sign up at rethinkingwellness.substack.com.

Christy's second book, The Wellness Trap, is available wherever books are sold! Order it here, or ask for it in your favorite local bookstore. 

If you're looking to make peace with food and break free from diet and wellness culture, come check out Christy's Intuitive Eating Fundamentals online course.

Resources and References

Contains affiliate links to Amazon and Bookshop.org, where I earn a small commission for any purchases made.

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Laura’s previous appearance on Rethinking Wellness

• Laura’s episode of Food Psych

• Laura’s books, Just Eat It and How To Just Eat It

• Laura’s Can I Have Another Snack? newsletter

• Laura’s piece about “30+PPW”

• Laura’s series on ultra-processed foods

• Karen Throsby on Rethinking Wellness 

• Karen Throsby on Can I Have Another Snack?

• Laura’s Instagram

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

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Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which came out in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.

Hey there. Welcome back to Rethinking Wellness. I'm Christy and my guest today is registered nutritionist, author and friend of the pod, Laura Thomas, who joins me to unpack the problematic notion that you need to eat a huge number of plants per week for gut health and what we actually know about how plant foods affect the gut microbiome. We also get into how to distinguish good science from hype, how ultraprocessed foods have become so demonized despite a lack of strong evidence, how anti-fat bias is baked into the discourse about both gut health and ultraprocessed foods, and lots more. Just a heads up that we do mention some specific numbers in this episode in the context of talking about what the science really says and critically examining it.

The first part of this interview is available for everyone and paid subscribers. Get to hear the whole thing, which includes lots more of this great conversation with Laura. To upgrade, go to rethinkingwellness.substack.com. If you do, you'll not only get to hear extended interviews like this one, but you'll also get subscriber only Q and A's, full access to our archives, commenting privileges, and subscriber threads where you can connect with other listeners and more. Plus, you'll be helping to support the show and allow me to keep doing this work. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes. And thanks so much to everyone who's already a paid subscriber, I couldn't do this without you.

I also want to make sure you know about my second book, which is called the Wellness Trap. The book was the inspiration for this podcast, which I launched to continue the fascinating conversations I had in my reporting. And if you like the interviews here, I think you'll love the book. It explores the connections between wellness and diet culture, how the wellness space became overrun with scams, misinformation, and conspiracy theories why alternative medicine diagnoses like quote unquote leaky gut syndrome and quote unquote adrenal fatigue are misleading and harmful, and how to protect ourselves so that we can find true well being. Just go to christyharrison.com/the wellnesstrap to learn more and buy the book. Or click the link in the show notes. And you can also just pop into your favorite local bookstore and ask for it there.

With that, here is my conversation with Laura Thomas. So Laura, welcome back to rethinking wellness. I'm so excited to talk with you again.

Laura Thomas: Thanks so much for having me. It's great to be back.

Christy Harrison: So we talked about a year ago for Rethinking Wellness, and we've spoken many times before and since offline, but also for my other podcast, Food Psych, so people can check those episodes out if they want to learn more about you and your work and sort of different avenues of your work and research. But for those who don't know you, and I'm sure many do, and you need no introduction, but for those who don't know you, can you just give a quick intro of the work that you do and how you came to do it?

Laura Thomas: Yeah, absolutely. So I'm a UK based registered nutritionist. I sort of have spent a lot of time, a lot of my career working with disordered eating and eating disorders, using a sort of weight inclusive, anti-diet, intuitive eating lens. And sort of more recently, I want to say, over the past five, six years, I've become really interested in, I guess, more the preventative side of things in terms of preventing the intergenerational transmission of disordered eating and body shame. And that's partially coincided with becoming a parent myself. And so I'm really interested in working with parents and families with, particularly mothers who are looking to heal their own relationship with food so that they can help protect their children's relationship with food. And I also do a lot of work in sort of the responsive feeding space. So that's kind of working with the families of children who have feeding differences, whether that's kind of like what we would consider fussy or picky eating or something a bit more extreme than that.

So I feel like I haven't given you a very succinct answer, and it's because I have lots of different interests and I'm kind of really interested in broadly conversations about health and nutrition that sort of influence how we eat and particularly when that might cause fear or anxiety about the food choices that we make and how we feed our family. And so I think that's probably the part that kind of fits into what we're going to be talking about today. And so a big M.O. that I have is to help people feel more comfortable with the food that they eat and more comfortable in their bodies.

Christy Harrison: I love that. That is such a great sort of segue into what we're going to be talking about today, because we both share an interest in gut health and conversations around it and looking at it from a skeptical perspective and seeing how entangled it is with other wellness woo and with fear mongering conversations about food. I'm curious to hear a little bit. About your background in microbiome research, because I've known you for so many years, and it dawned on me recently like, oh, wow, this is a whole part of her career and life that I know nothing about and yet is so relevant to this conversation about gut health and skepticism around it.

Laura Thomas: That's so funny, because I just assumed that people know that this was my kind of first academic career, if you will. So when I was an undergraduate at the University of Aberdeen, a sort of quite well known gut microbiome researcher from somewhere called the Rowett Research Institute, which is folded into the university now. But it was quite a big deal. They started off as actually an animal microbiome sort of research facility. So they were looking at ruminants and sheep and cows, and then they were really on, I would say, like early adoption of microbiome research in humans. And so this researcher came in and spoke to us. I was really, really fascinated as a nutrition student by the idea of the gut microbiome. And so when it came time for us to choose our undergraduate honors research project, I spoke to that researcher and asked if they had any opportunities for me, and they did.

So this is like a three, four month placement that you undertake from sort of the January to the May of your final year and you write your thesis on it. And so, yeah, I went and I studied poop. It was a feeding study. So we were giving people a probiotic yogurt, just a commercial one that you can get in the supermarket, I can get in the supermarket here. And basically we gave it to people for a period of time. Then we sampled their poo before, during and afterwards. And what we saw quite clearly was the DNA from that microbe get introduced into their fecal samples. And then as soon as they stopped eating the yogurt, it disappeared again.

One of my jobs, I remember this so vividly, was standing in the lab trying to culture alive bacterium from this yogurt onto a petri dish, couldn't get it to grow. Now, I don't know if that was my own terrible lab skills at the time, or the point that I kind of want to draw out of that is that oftentimes the products that we're buying commercially, we don't know how viable the bacteria are in them. So anyway, this research project led me to doing a PhD at Texas A&M university, where I was doing similar kind of work in terms of it was the gastrointestinal microbiome. This time we were looking at animal models. I had to collect rat poop from rats at 4 o'clock in the morning for weeks on end. Do not recommend if you can avoid it. And basically we were looking there more at the interaction between the diet that the rat was fed and the sort of prebiotic compounds.

And we can define all of these things as well, if it's helpful. But prebiotic compounds in the rat's diets and then the effect that it had on the immune system and the sort of thesis there was that the gastrointestinal microbiome could potentially mediate the impact that it has on our immune system or on the animal's immune system. So it's a long, convoluted story, but my PhD advisor went kind of off the rails and I ended up switching and sort of starting my PhD research from scratch while in a completely different field. It was more behavioral nutrition, but I've always been really, really fascinated by the gut microbiome. I wrote about this recently, that it's been really interesting to sort of take a step back and watch the sort of hype machine build around the gut microbiome, because actually, when I put my head back into the research more recently, it hasn't really moved on all that much in the sort of 10, 15 years since I was really in that space. And I think that that in and of itself is quite telling.

Christy Harrison: I was looking at the number of studies in PubMed on gut health and gut microbiome, and there's been this huge explosion since the late 1990s, early 2000s. So there's now thousands of studies being published every year. I've sort of had that sense too, that the caliber of the studies isn't really great. It's a lot of animal models, it's a lot of sequencing cells in petri dishes, it's the type of sequencing they're doing on these cells is the methods are even being debated, like 16S RNA or whatever. All these things are still hotly debated in the scientific community and some scientists are saying none of them are really very good for sequencing microbial DNA, and that we might not know a fraction of what we think we know based on these studies.

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Laura Thomas: One thing that I found particularly interesting, and I think speaks to what you're getting at here, Christy, is that we've kind of almost come full circle in the way that we approach microbiome research or where we think we need to go. So we started off by culturing live bacteria in the lab to kind of see what they do and phenotype them. Then there was this huge boon in genomics and bioinformatics, and so we were able to kind of get into the sequencing. Sequencing became a lot cheaper, so we could extract RNA and DNA and figure out exactly who was there. The problem is now that we don't really know what they're doing, so we kind of have a sense of who's there, but we don't know what they're doing.

And so we actually have to go back to the culture techniques that are hundreds and hundreds of years old to find out functionally what those bacteria and yeast and other microorganisms are doing in the gut. And so, yeah, we've had this really completely full circle moment because we have more of a sense of who's there. But again, we don't know what they're doing, and we don't know how important that is, and we don't know where exactly they are in the gastrointestinal tract, which is another kind of thread that scientists are kind of tugging on to figure out where do we need to sample along the gastrointestinal tract.

It's huge. It's really, really long, and we're only taking samples from feces, from poop. But that poop is not representative of what's going on in the seacum and higher up, towards the end of the small intestine and the beginning of the large intestine. And those ecosystems all along the gut are so completely different from one another. I was talking about this on my podcast recently. One part of, if we think of the gastrointestinal tract having lots of different sort of ecosystems all the way along it, you could have a tropical rainforest at one end and sort of English country garden at the other end. Those are very different ecosystems, but we're only looking at sort of what's coming out one end.

But there is some really fascinating research that is inviting people to swallow capsules which sample all along the length of the gastrointestinal tract, which is. I don't even understand how that technology works, but it's really cool. And I think we're going to see, there's going to be some revelations, I think, that come out of that research in the next five to ten years.

Christy Harrison: Well, and the timeline on this is so long, right? It's like five to ten years for interesting revelations that are about the human microbiome, gut microbiome, and then probably a lot more years to really figure out what can we do with this information, right? What does it mean for how people eat or other components that go into the gastrointestinal microbiome, like stress and exposure to different substances and all the rest? But the hype machine, we've both talked about this, how the hype has gotten so far out ahead of the science, right? And that the hype was making people think that they can do things to hack their gut microbiome now to make themselves supposedly healthier.

And there's a lot been written in the popular press and based on sort of early stage research about ratios of particular types of bacteria one to the other, and how that is supposedly linked with body weight. And then a few years after that became so overhyped and stuff, it became clear that actually that doesn't really seem to be the case. And that what we thought we knew about the ratio of different bacteria to one to the other doesn't really have any impact on weight. And this is all so out there in the popular imagination that your gut microbiome has so much to do with your weight, that your gut microbiome has to do with every aspect of health, from physical health realms that don't even touch the gut, but that have gas, like cardiovascular health or whateverevity and all that stuff.

Laura Thomas: A lot of mental health stuff.

Christy Harrison: Right. And the gut brain connection or the gut brain immune connection and all these different things. Right? So given all that hype and sort of how far ahead the press, the popular press and sort of the popular wellness culture imagination is, how far ahead all that's gotten of this actual science, what do you think people should know about that, first of all? And then what are some of the implications of all this hype on people's relationships with food and people's well being?

Laura Thomas: Yeah. So I think, like, I kind of touched on a little bit the way that gut health has been captured in the popular imagination has completely leapfrogged, I think, in my opinion, at least where the science is and what the science can actually reveal to us at this point. And don't get me wrong, I think that the science is absolutely fascinating. I think it is incredible that there are all of these communities of bacteria and other microorganisms living in and on our bodies. I think that's so cool from just, like, a nerdy biology perspective. But I also think that the way that we talk about the potential that the gut microbiome has on our health is massively overstated. I think it's probably a much, much smaller effect than most people think that it is. There are some exceptions to that. Fecal transplants, for example, might be really important for treating particular conditions, but those are clinical medical applications, not the kind of gut health in inverted commas.

Christy Harrison: And not the DIY fecal transplants at home by people who are just biohacking or whatever.

Laura Thomas: Yeah, they are not for an otherwise healthy person. They're in usually quite acute situations. So, yeah, I think there's kind of like, just a leapfrogging of the science. I think that the effect or the magnitude of the impact that the gut microbiome has on our health is a lot smaller than we kind of colloquially understand it. And I think what ends up happening is that this kind of hype machine around gut health has inadvertently obscured other determinants of, first of all, gut health, which we could maybe talk about sort of on an individual level, but on a sort of social level, it completely glosses over the social and structural determinants of health, and kind of, I think, foregrounds this idea of personal responsibility, that we're all individually responsible for taking care of our gut garden, or whatever people call it. That's a real thing that people say. So kind of has that impact.

And the one that you and I are both familiar with through our clinical work, is the anxiety and the apprehension, the sort of micromanagement that can end up happening when we are really, we have this myopic focus on our guts and gut health, and the way that that can lead to or exacerbate disordered eating, which leads to worsening gut health symptoms. And you can get into this really nasty spiral where the things that you are doing to sort of, quote, unquote, look after your gut health end up causing more symptoms, which then cause a doubling down of the so called treatments, which just gets into this really sticky cycle that's hard to break.

Christy Harrison: I think one area of obsession, and one way that people get so taken away from peaceful relationship with food in their bodies, in the gut health realm, is this notion of 30 plus plants per week, right, that you're supposed to eat, or it's 30 plus PPW, as the TikTok girlies are calling it, right? Supposed to be like, you have this optimal microbiome diversity if you're eating that number of plants, whatever that means. You wrote a piece recently about this, about where this notion came from, which I had been so curious about for a while and was added on my long list of things to write about and then was able to check it out.

Laura Thomas: Sorry I pipped you to the post.

Christy Harrison: I appreciate it, because I was dreading that, because it just seemed like such a deep dive.

Laura Thomas: It was a whole thing.

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Christy Harrison: A whole thing. And you did such a thorough and amazing job of reporting on it. So we'll link to the post in the show notes for this piece, but I'd love to dig into that a little bit. Where did this idea originate? And is it really evidence based, or is it another example of the hype machine just getting way far ahead of the science?

Laura Thomas: So it's really, really interesting because there is some science to it and it's a really interesting study. But it's one single, solitary study, which, as you and I both know, is not the burden of evidence that means that we can completely throw out the five a day recommendation and replace it with this 30 plus plants per week recommendation. So it's got completely mangled up in the hype machine. I see a lot of brands here in the UK now using it as part of their marketing, which I think is really, really sneaky, because you can have, in theory, you can have ten plus plant based ingredients in a product, but it doesn't constitute even one portion of fruit and vegetables if we look at it by weight. So there's some really sneaky, like, I think, pulling the wool over people's eyes that I've noticed, at least.

Going back to the actual study. Okay, so this study is a really cool initiative called the American Gut Project, or it was called the American Gut Project. It's now known as the Microsetta initiative. And it's a sort of open source citizen science study whereby people pay a small fee to access a fecal testing kit, and then they send away their sample and they get a readout that tells them the sort of relative proportions and the different genus of bacteria and other microorganisms that are living in their gut and kind of just lets them know what their gut looks like relative to the other people in the study. And then the researchers use this information to kind of just understand the sort of length and breadth of the human microbiome. Right.

This study is a lot bigger than some other studies, and so they've been able to document much more variety in what and who is in the micr obiome or the microbiota, I should say, compared to some other studies that have gone before it. So it's a really interesting study, and I love the sort of open access, citizen science aspect of things. And I think that's a cool model. But I think, first of all, just by virtue of the fact that people have to, they're not paying to participate in the study, but they're paying to cover the cost of the materials, I can't remember exactly how much it is. I want to say it's like $90 or something. So it's not an insignificant amount of money. And so already you are biasing the sample. Right. It's open source, it's citizen science. You don't have a representative sample there straight off the bat. Okay.

So I think that's one thing to keep in mind. Basically, what this study did was, as well as taking the fecal samples, they also asked people to complete a questionnaire about how many plant based foods they ate on a given week. And they kind of give the example of, like, if you have a can of soup and it has tomatoes, onions and carrots in it, I don't know what kind of soup this is. Like, it's a minestrone or something like this. And that would count as three different plant based ingredients.

Okay? Doesn't mention anything about spices, doesn't mention anything about quantities. It just says, count each single plant food as a separate food, more or less. And then it asks people to pick if they eat zero to five, five to ten, and then all the way up to sort of like 30 plus. And then what they do in this study is that they separate out the people who eat more than 30 plants per week, according to this self report, which we've already established is a bit shaky. And then on the other hand, the people who eat less than ten plants per week. I always want to say 30 plants per day, which is even more. I'm sure some people are trying to go for that, but I've seen these recipes on TikTok that are like, this salad has twelve different plants in it. And I'm like, please eat something other than salad. But anyway, if you just eat that salad, babe, you're not going to meet your nutrition requirements.

Christy Harrison: Definitely not.

Laura Thomas: So back to my point. They're comparing people who eat more than 30 plants versus less than ten plants. And they also looked at people who self reported as being, like, vegetarian, vegan, or had an omnivorous diet. And they found that compared to those other categories, those like diet label type categories, that if people reported that they ate more than 30 plants per week, that that kind of correlated more strongly with more diversity. And so these kind of like gut health gurus have taken that little tidbit and extrapolated it to mean that everyone should be eating 30 plus plants per week for optimal gut diversity.

Christy Harrison: And diversity typically gets conflated with gut health. Right? I mean, it seems to be that there's a correlation, perhaps, between greater microbiome diversity in the gut and better health outcomes on certain measures. But in the gut health world, in this corner of wellness culture that's devoted to gut health, it's sort of just substituted one for one. Diversity equals health.

Laura Thomas: Yes, that's a really reductionist sort of interpretation of that finding, but that's not what the study found. The study looked very specifically at a group of maybe or a family. They were looking predominantly at bacteria that had a gene that coded for short chain fatty acid production. So these are things like butyrate and acetate and proprionate, which we do believe to have a protective effect, particularly against colorectal cancer, for example. This is where it comes back to what I was talking about earlier in terms of the functional aspects of the microbiota. So we know back that those butyrate producers are there. We don't know how active they are, we don't know how much butyrate they're producing, because we're only looking at. I think in this case, it was the 16S DNA could be wrong. Don't quote me on that bit. But they were looking at the sort of genetic fingerprint, rather than measuring directly butyrate, as I understand it, basically, they were looking at the sort of fingerprint, and then that has been extrapolated to mean that there's overall gut diversity.

What we can say is that there was maybe diversity in terms of that particular function. But there are so many other functions that the microbiota perform within the gut, whether that's producing nutrients, whether that's digesting particular dietary compounds. There are a ton of different functions within the microbiota. So just because we have diversity within one functional group does not mean that there's overall functionality. And what the research seems to be suggesting, or what scientists at least are trying to tease apart now, is what is more important, is it diversity in a kind of holistic sense of diversity, or is it functional diversity? And I don't think we know that quite yet. But back to this study. It's had this very specific finding. It's not an uninteresting finding, but it is very different from the broader interpretation of that message.

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Christy Harrison: Right. Which has gotten so specific and so applied clinically, like, to individuals saying you need to do this for optimal gut health. Another issue you pointed out with this study is something I see all the time in nutrition research and just drives me up a wall, which is that researchers will compare people at the highest end and the lowest end of the spectrum of intake for particular foods. Or particular nutrients, and then use that to make inferences about the health impacts of those foods, even though people in those groups also differ in other really significant ways. And observational nutrition research rarely controls for them, rarely controls for things like socioeconomic status, education, access to health care, like all of that stuff that has such powerful effects on health outcomes and also differs between groups who are eating less plant food and more plant food, for example. And then there's also the confounding factors like weight stigma and disordered eating and weight cycling, which are almost never controlled for. I've almost never seen.

Laura Thomas: Almost never.

Christy Harrison: So in this case, they compared people who ate ten or fewer plant foods per week with 30 or more plant foods per week. And the people who are eating at those extremes probably have very different lives in many ways. So can you talk a little bit about that and sort of what this study might or might not be controlling for in that regard?

Laura Thomas: Yeah, I think it ties in with what I said earlier in terms of when we are kind of focused on the minutiae of detail, like how many plant based foods are being consumed, we're missing these bigger, broader structural and social determinants of health. So this particular study, I think it used maybe education and socioeconomic position as a sort of proxy for some of these social and structural determinants of health. But they're only going to explain some of the variance between the two groups. There are going to be a lot of invisible or confounding variables that just haven't been taken into consideration. Taken into account. Anti-fat bias, racism, ableism, ageism, even all of these things aren't being directly controlled for in not just this study, but in, broadly speaking, in nutrition research. So all of those things, they have such a bearing on how we move through the world.

And so it's one thing to say, okay, for optimal gut health, if we sort of buy into that, which we've just established is kind of resting on shaky ground. But even if we were to buy into that, then it doesn't help us kind of address all the structural ways that 30 plus plants per week is just not accessible to so many people for a wide variety of reasons, even from sort of quite fundamental clinical reasons, from the perspective of if you've got intestinal failure, if you have Crohn's disease or another inflammatory bowel disease, then depending on the advice that you're getting from your dietitian, that might not be appropriate for you, all the way through to shopping for and preparing and literally just accessing those foods, that's a near impossibility for some people. It's obviously incredibly expensive as well, an elitist.

And I'm also thinking about it as a parent. There's no way in hell my kid is eating 30 plus different plant foods when they're going through that very specific food neophobic phase between sort of the ages of three and five. And it just adds a ton of pressure onto, I think, particularly parents who are probably going to feel quite stressed about how many fruits and vegetables their kids are eating anyway before adding on this imperative to eat 30 different kinds each week. And I know that advocates will say, well, it could just be a pinch of a herb or a pinch of a spice or a cup of coffee, that all counts. That has not been empirically tested. So when they are saying that, they are pulling it out of their ass, because as far as I'm aware, there's no research to suggest that.

Christy Harrison: Right, because it seems like the American Gut Project doesn't even distinguish what counts as a plant, right? Yeah. Or what people are counting. It's just sort of leaving it up to people to count it themselves. I mean, this dovetails with the conversation about ultra processed foods that I want to have with you, because you've written a lot about ultraprocessed foods and how those have become so demonized. And I'd love to talk about how that conversation intersects with the discourse on gut health. But before we get into that, can you just give us an overview of what ultraprocessed foods are and why there's so much talk of them lately?

Laura Thomas: So ultraprocessed foods are a term that sort of developed, I think it was first appeared in the nutrition literature in about 2009, and different researchers have kind of tried to define it in different ways. But the most commonly used classification system for ultra processed foods is something called Nova. And that was developed by a researcher called Carlos Monteiro in Brazil and his research team at, I believe, the University of Sao Paulo. And basically, he came up with this classification system to stratify foods into four different groups. So group one is unprocessed or minimally processed foods. So I think of that as food that pretty much comes straight out of the ground, or it comes from an animal or a fungus, and it hasn't really had much done to it. So it's an apple that you pick off the tree. It's a carrot that you would pull out of the ground. It's an egg that was laid by a chicken. Those would all be considered unprocessed foods.

And then within that group one, you have this minimally processed food subcategory, which are those unprocessed foods that have gone through some sort of processing. Like, it could have been dried, it could have been fermented, it could have been roasted. So coffee is a perfect example of one of these minimally processed foods. Okay, so that's your group one, unprocessed or minimally processed food.

The next group is group two are called processed culinary ingredients. So it's anything that's kind of pressed or ground or milled. It could be butter, for example, or sugar, honey, maple syrup, salt. These are all examples of processed culinary ingredients. Right? So they might have come from. So, for example, sugar comes from sugar cane. Sugar cane would be a minimally processed food. Although you can't eat sugar cane as straight up sugar, the refined product would be considered a processed culinary ingredient.

Group three are considered processed foods. This is where I think it gets interesting, because the word processed food is just thrown around with abandon. But from a technical perspective, it is group one plus group two foods cooked together. So if you go to the farmer's market and you buy fresh bread from your farmers market, that's a processed food. If you make cookies at home from scratch, that's a processed food. If you go to your Italian nana's house and she makes lasagna, that's a processed food. Basically, everything we eat is a processed food. Right? It's undergone some processing. So it's group one plus group two foods together.

And then group four are what is considered ultraprocessed foods. Now, the way that they define it in some documentation is as a formulation made mostly or entirely from substances derived from foods and additives, with little, if any, of that intact group. So this could be a whole range of different things. It could be everything from whey from milk, to gluten from wheat and rye to kind of coloring, flavoring, stabilizers, a whole host of things that we would consider sort of food additives, like E numbers.

But the way that they define it in the sort of Nova documentation is that it's a food additive that is intended to imitate or enhance the sensory qualities of foods, or disguise unpalatable aspects of the final product. So you can see it's a really vague definition that could cover a lot of things. And in my series on ultraprocessed foods, I use the example of this oat bar that my three year old loves. I think they're disgusting, but he loves them. It's kind of like a flaccid granola bar is, like, the best way that I can describe it. So it's mostly oats, but it has concentrated fruit juice in it. And concentrated fruit juice is considered an ultraprocessed food. So even though this bar is comprised mostly of oats, because it has this ultra processed ingredient in it, it would overall be considered an ultra processed food, even though that kind of flies in the face of what the actual definition says.

Carlos Montiaro has been on the record as saying that you can identify an ultra processed food by having at least one item characteristic of the ultra processed foods group. He's basically given us something to try and easily identify an ultraprocessed food. But by that definition, sparkling water would be an ultraprocessed food. If the bar is that it has to have one ingredient that is characteristic of the ultraprocessed food category, then it's very difficult to find something in a supermarket that doesn't meet that criteria.

Christy Harrison: I mean, I'm sure everyone listening knows how demonized ultraprocessed foods are in the mainstream imagination. And we don't need to get into all the ways that shows up, because I think people have probably experienced that and may have some of their own hesitations or fears around ultraprocessed foods. But I think, especially when it comes to gut health, there's some really interesting crossovers or connections there, and there's some arguments being made against ultraprocessed foods in the name of gut health that are really problematic. And one thing I think that the discourse on ultraprocessed foods and gut health have in common, as in a lot of nutrition science as well, is that fear mongering headlines and social media trends, again, have gotten way out ahead of the science. And there's this connection being made to sort of demonize this food that has had a sort of negative valence for a long time, but demonize it in a new way, right? It's like, "Oh, now this is the reason we should be afraid of it." So I'd love to hear your thoughts on that and how much we actually know about ultraprocessed foods in general, and their interaction with the gut microbiome in particular.

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

This week’s answer is for paid subscribers, but everyone can read the question.

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I have a question about how to approach taking supplements when a doctor has asked me to do so. My doctor (a regular MD, not a naturopath or functional medicine doctor) has asked me to take vitamins D & B12 to treat low levels of these vitamins in my blood, as well as probiotics to help with GI issues. I find this gray area confusing, because I'm not being prescribed a medication by this doctor, rather they are asking me to go to my local grocery store or go online to purchase unregulated supplements to treat my conditions. What insight can you give concerning this desire to follow a doctor’s advice while still being wary of buying supplements? Does it make sense to you that this can be confusing for patients, or am I missing something? Thanks for any thoughts you can share.

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Body image scientist and researcher Charlotte Markey, PhD joins us to discuss the many factors that impact body image and how parents can help their kids develop a positive sense of self.

Christy and Charlotte both share examples from their own parenting, including how to handle tricky conversations about body size, gender, and more. They also unpack the difference between body positivity and body neutrality—and why the popular definitions of those terms are different from their use in research.

Behind the paywall, Charlotte explains how she thinks about makeup for girls, adaptive vs maladaptive grooming routines, ways to tell if a kid is struggling with body dysmorphia, and a six-step process for helping young people develop media literacy.

The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.

Charlotte Markey, Ph.D., is a body image scientist and researcher, having studied all things body image and eating behaviors for nearly 30 years! She is passionate about understanding what makes us feel good about our bodies and helping people to develop a healthy body image and relationship with food. Charlotte is a psychology professor at Rutgers University and has published over 100 scholarly articles and chapters about health issues.

Dr. Markey also an author, having most recently published The Body Image Book series (The Body Image Book for Girls in 2020; The Body Image Book for Boys in 2022, Adultish: The Body Image Book for Life in 2024, The 2nd edition of The Body Image Book for Girls will publish in 2026, The Body Image Book for Women will be published in 2027). She also recently co-edited the 3-volume Encyclopedia of Mental Health (2023). She writes regularly for news outlets such as Psychology Today and is often interviewed for TV, news articles, and podcasts.

To learn more about Charlotte Markey, you can visit her website at CharlotteMarkey.com and TheBodyImageBook.com

Resources and References

Contains affiliate links to Bookshop.org, where I earn a small commission for any purchases made.

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Body Image: What the Evidence Really Says, with Charlotte Markey

• CharlotteMarkey.com

• TheBodyImageBook.com

• The Body Image Book for Girls (2nd edition)

• Being You: The Body Image Book for Boys

• Adultish: The Body Image Book for Life

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

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Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Your book is the Body Image Book for Girls and I’m pregnant as we record this, like very pregnant, actually, and my second baby is also going to be a girl. So I feel a really great weight of responsibility to help my now two daughters develop a positive body image. And of course, that’s important in boys too, and kids of all genders. But I think girls are particularly vulnerable for reasons that I know we all discuss. Can you talk about why you wanted to write a book about girls body image?

Charlotte Markey: Yeah. It’s interesting because when I was working on the first edition of The Body Image Book for Girls, I started that around 2017 or 18, I think. And when I was reaching out to people to try to get it published, people were like, well, nonfiction for tweens and teens is just not really a hot market. So there wasn’t a lot of initial enthusiasm until I found the right people. And then I think other parents and moms in particular just seemed to really get it and had sort of the same sentiments that you’ve already shared, which is that as mothers in particular, we feel a great deal of responsibility to help our kids, and maybe especially our daughters, grow up feeling good about themselves and having a positive body image. And as someone who studied these issues my whole adult life, I just realized there weren’t really accessible resources for kids.

Christy Harrison: Yeah, there’s not a lot that’s written specifically for kids. Even in your book, you give little resource boxes at the end of each chapter. And I’ve noticed there’s a few that are like, well, this one’s for parents, but you can still get some good information from it. This one’s written more for grownups, but there’s not a lot for kids specifically.

Charlotte Markey: It’s gotten a lot better in the last five or six or eight years since I started working on these. But the reference I was really using was puberty books and there were far fewer good ones even then than there are now, I think. But when I was reading puberty books with my own daughter, who was about 11 when I started the first edition, I really noticed that there was a lot of focus on, physical growth, as there should be. It’s a puberty book. And then kind of superficial mention of eating healthy and self esteem, and it just didn’t really do body image any justice at all.

Christy Harrison: Yeah. Was it like “healthy eating” advice that didn’t really get into intuitive eating or disordered eating prevention or that kind of thing?

Charlotte Markey: Yeah, I mean, I’m sure you’ll see as your daughters get a little bit older but I started with a variety of the puberty books pretty early because I’m just hypersensitive about all of this, given what I do for a living. And there’s like a little bubble or something about eating. Like, make sure you eat your fruits and vegetables, which, it’s fine. I’m not particularly offended by that, but it doesn’t include any of the sort of nuance, I guess I really wanted even kids to have when it came to how they think about food.

Christy Harrison: Yeah. It sort of also creates this good and bad food dynamic to say, just like, eat your fruits and vegetables without mentioning other food groups or the sort of need for balance and the need for completeness and having enough food.

Charlotte Markey: Yeah. And anything that focuses on just healthy eating for kids or it’s important to feel good about yourself in kind of these very broad strokes, I think misses a lot of the messiness of body image and eating. And it’s not that I expect 12 year olds to get all of that, but I also think we need to give them more information and not talk down to them. That’s something that I really focus on a lot with my own kids. And when I do, any kind of education, kids will get a lot more than we give them credit for by the time they’re tweens. And I think it’s really important to try to give them some of the nuance and not just say like, yeah, don’t eat that, do eat that. They get that that’s an oversimplified view of the world.

Christy Harrison: I’ve been thinking a lot about my older daughter and how to support her body image now that she’s getting big enough to really take in body messages from the culture. Speaking of it starting early, right? She listened to the song We Don’t Talk About Bruno from Encanto, and she asked me what a gut was. And I knew that was coming because I had heard it in the song. It’s like, “He told me I grow a gut. And just like he said,” implying that it’s a bad thing that this guy is growing a gut. And it’s sort of a little throwaway line in the middle of it. But I was like, oh, how am I going to have this conversation? She’s too little to get into a real discussion about diet culture. She will have recently turned four by the time people hear this.

And I said something about like, well, some people think gut is like a big belly and some people think it’s bad to have a big belly, but actually, in our house, we think it’s fine to have any sort of belly and any sort of body, and all bodies are good, and we come in all different shapes and sizes. And she was just kind of like, okay, anyway, moving on. Didn’t really seem to faze her. But I’m curious if you have any advice for this in between age. I know The Body Image Book for Girls is more for tweens and teens, but if there’s anything we can do as parents of younger children to lay the groundwork for positive body image.

Charlotte Markey: I mean, I think exactly what you said is what we want to be saying, and we want to be saying it over and over again in slightly different ways. We’ll get so many opportunities to just insert a sentence or two. And, I mean, even young kids are going to tune out a lecture. So it’s not about having this well prepared, thought out speech about any of this. It’s much more about just reiterating our values across time and then also offering opportunities for kids to ask questions like you did.

Christy Harrison: Well, that’s good to know. Thank you for reassuring me on that. Peppering in those values conversations has been helpful, too. Just to be like, well, some people think this but in our house, we think that she’s already also getting messages from friends at school that their parents are restricting sugar and things like that. And people are snooping in each other’s lunchboxes now.

And one kid said, oh, don’t eat your granola bar. That’s not healthy. You have to eat this food first, you have to eat the dessert last and stuff. And she’s come to me with those questions, too. God, it starts so early. Like the granola bar comment. She was in the twos class when that happened. It’s wild.

Charlotte Markey: Yeah and I mean, I think, too, it’s important as parents to appreciate we’re not gonna always get it right. They’re gonna ask a question and it’s bedtime, and we’re like, oh, come on, we can’t do this now. We’re exhausted. Or you have another kid in the car for some reason, and you maybe don’t want to get into it with another kid. It’s not one conversation. It’s lots of little conversations. And we can do these conversations over as needed, too.

And I think that teaches our kids a lot of valuable lessons to sometimes just say, like, you brought this up last night and I wasn’t really thinking about maybe what your question meant and I’ve been thinking about it since then. And since then I’ve been thinking, I really wanted to share with you something that’s important to me and that’s that you understand that we’re accepting of all people, no matter what they look like or however you want to say it.

But I think we sometimes put too much pressure on ourselves that if we say it wrong once, that’s it, if we don’t have the perfect answer one day, that we’ve done all this damage. And fortunately, kids are pretty resilient.

Christy Harrison: Yeah, I have also had those repeat follow up conversations where I’m like, I said this, but I wasn’t really thinking. We had some friends of hers over who were boys and we had a playdate and they were very wild. And she’s like, why were they being so wild? And I was like, sometimes boys are just wild at this age. And I wasn’t thinking the implications of that. And then I thought about it and I was like, oh, that is not what I want to be teaching her or I don’t want to be putting these sort of gender distinctions in her head.

And I was like, that was sort of silly of me. I was saying something based on a stereotype and tried to explain what a stereotype was and it was like, that wasn’t really what I meant. Some kids are just more wild than others. And I can think of some girls who can be pretty wild too. And she was like, who? And I said, well, you for one can be pretty wild and named sometimes and your other friends and I was just trying to correct my mistake. But she was sort of like, oh, yeah, okay. And it seemed to resonate and then has never been brought up again.

So hopefully that was a decent correction. But I feel like anytime those things happen, I become a lot more comfortable just being like, oh, I can correct the record here. I don’t have to just stick to my guns forever on something.

Charlotte Markey: And I do think it’s really interesting just how receptive young kids can be to that kind of information from a parental figure in particular. I can also think of examples where I just said something really matter of factly to one of my kids, like, oh, no, that person doesn’t have a wife. That person has a husband, or, whatever and they were just like, oh, all right, it’s like this raging political debate outside of our home. But at the time, they’re like, oh, all right. That totally makes sense. And, of course, the world is going to increasingly affect their perceptions of these issues that are so important to us. All we can really do is hope that we’ve, I think, laid the groundwork, keep providing the kind of information that we think is valuable and make sure that we’ve created a safe space so they can ask questions.

We can’t shield them from the outside world as much as we’d love to wrap them in bubble wrap and just leave it at that. But unfortunately, we can’t totally keep the granola bar comment from happening or even some cartoon from being fatphobic.

Christy Harrison: Yeah. So the best we can do is have conversations about it after the fact and point out things that are a little different in the outside world than they are in our home, maybe, or that different people have different values.

Charlotte Markey: And those are good learning opportunities. So in some ways, it’s good just to have the segue to talk about some of the issues, too, because otherwise, it’s all too easy just to forget to say certain things really explicitly. I think we take for granted as parents that we don’t have to lay it all out.

Christy Harrison: We think that it’s gonna be sort of absorbed by osmosis, I guess, too. If we have friends of different sizes and shapes and skin colors and all of that, or we expose them to diverse media and have books about different things that they’ll pick it up, but sometimes that’s not really enough.

Charlotte Markey: Yeah. And I think all of that is important also. I wouldn’t write books for kids if I didn’t think they had the potential to be useful. But I do think that sometimes it’s good for parents just to be pretty explicit and direct about things that we really value, whether it comes to just how we treat other people or how we take care of our own bodies and our health starts off really kind of more general, and as kids get older, the conversations can shift to include more nuance and more detail and be more complicated, as these issues are.

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Christy Harrison: One other thing I’m thinking of when I’m thinking about having conversations that are challenging for kids and redoing conversations as needed is one of the things that comes up so much in the research, and I’m sure you know this better than anyone, is the evidence on parents not talking about their own weight or disparaging their own looks or talking about how they need to lose weight or something like that in front of their kids. That is really protective if we can manage not to have those conversations in front of kids.

And for a lot of parents, that has happened already or that is something that’s happening sometimes, and they’re trying, they’re making an effort, but these things slip out. Or even, I’ve been thinking about my own experience, I had so long to heal from my own disordered eating and internalized weight stigma and have gotten really far in my recovery and my healing from those things. And my body has changed a lot in both fertility treatments leading up to pregnancy and then pregnancy.

And, there’s certain things that I’m still grappling with sort of some internalized weight stigma and some ableism as well. Like, internalized ableism, where I’m like, oh, I can’t do that right now, or I can’t do that anymore. And it’s frustrating to me sometimes that I’m not able to play with her as agilely on the floor as I used to be or sit in her little chairs at her art table because she loves to make art with me. And I try to be neutral about that stuff when I talk to her about it. But I wonder if sometimes, like, a tone comes out that I’m frustrated with this or whatever or that, if she feels frustrated with these limitations that I have, too.

And so I’m just curious, with that piece of it, whether it’s the sort of really subtle stuff like I’m talking about, or more explicit stuff, like, parents have had conversations about their own weight or denigrated, talked negatively about their size or their shape or how they look in front of their kids, how to kind of correct the record on that and have productive conversations about that.

Charlotte Markey: Yeah, I mean, I think there are some really sort of direct and explicit things parents do that can be harmful, like disparage their own bodies. And then there are some much more subtle things. And when I say subtle, I may even mean, like, being sort of generally disparaging or commenting just on, like a celebrity’s weight or something.

So I think what’s important, again, is if you feel like your conversation is not in line with your values and what you’re hoping to teach your kids to then revisit it. I think something like, you can’t sit in the chair right now. Your kid probably doesn’t even really care or won’t ever remember some of it. We worry about more as parents probably and kids may not be picking up on it.

But the first study I ever published over 25 years ago now, we looked at 5-year-old girls and whether or not they were experiencing any dissatisfaction with their bodies. And that was sort of the youngest age group anyone had looked at at that point. And we found that 20% of girls were reporting some body dissatisfaction at 5 years of age and it was linked with mother’s body dissatisfaction. So I don’t know that 5 year olds experience body dissatisfaction the way an adolescent or an adult does. I think what they’re likely to experience is just sort of the internalization of some of the language and expectations that they’re getting from parents. So in this case, mothers.

So if mothers are being disparaging and essentially teaching their daughters that this is just normative, we don’t like our bodies, that that’s kind of what young girls I think are most apt to probably be clinging onto. And then that manifests as its own sort of body dissatisfaction that can only deepen once societal influences become more at play.

Christy Harrison: Is there evidence on sort of the flip side of this that parents speaking positively about their own bodies has any effect on kids body image?

Charlotte Markey: Yeah, I was just looking at a study the other day that, I don’t know if I talk about it in the girl’s book or one of my other books, but yeah, there is some research on this and there’s also some interesting research that when kids become older, so older than your daughter but when kids are actually positive about their bodies, that can have a positive impact on parents.

So we always think of it only going from the parents being the influencers here. But I thought it was really interesting in this one particular study that some younger people think about these issues differently and they’ve had some of the body positivity movement during their lifetime and they’re a little more careful in terms of some of what they say and they’re more thoughtful about some of these issues. They don’t take it all for granted. So sometimes adults can benefit.

Christy Harrison: I’m wondering if there’s any specific positive things that came out of the research that parents can say or ways of modeling a positive relationship with their body, even if they don’t totally feel it because parents may not always feel amazing about their bodies. Even I, having done this work for so many years, I took the little quiz in your book to kind of look at where does your body image fall on this scale? And it was just sort of average, it wasn’t super positive.

So I spend a lot of time in body neutrality, probably where I’m not really thinking about my body or when I am thinking about it, I’m trying to take care of it and be compassionate with it, but not necessarily celebrating it. I’m curious if there’s any sort of specific phrases or ways of relating to one’s body that were beneficial for kids to see.

Charlotte Markey: There’s often a misperception in terms of what at least researchers think of when we think of body positivity and it actually does look more like what in popular spaces is referred to as body neutrality. So this idea of respecting your body, caring for your body, trying to be appreciative of it, treating it as something that has functions that are important, not just a look or an appearance.

So feeling some joy in your body is great and that sort of tips you closer to maybe body positivity as it’s popularly conceptualized. But I think it’s unrealistic to expect that we all feel fabulous and joyful in our bodies all the time. But in terms of trying to help kids, I think, nurture their own appreciation of their body, I think focusing on its functionality can be really important and is also really in tune with, especially among younger kids, just how active they often are.

So when kids are running around or being wild or learning a new activity, I think those are really important times to say, look at how cool it is, what your body was able to do there. Or your running really fast, or can you feel your heart now that you’ve been doing that, see how your heart is helping you and help young kids to grow up thinking more about all these functions because I think young people all too often just think that they’re kind of invincible, right? Like their bodies are just gonna work no matter what they do. And of course that’s not entirely true. They’re resilient, but they still need to be cared for. And also, I’m not a biologist, I’m a psychologist, but if you look at any age appropriate biology books in terms of human anatomy, it’s pretty fascinating and amazing what our bodies are able to do. And I think orienting kids towards that can serve them really well.

Christy Harrison: Yeah, that’s great. That’s really helpful to know. And I thinking about the functionality of my body was very helpful to me and healing my relationship with it and overcome in the later processes of healing from disordered eating and connecting it. I mean, I think it gets tricky with kids connecting food to functionality. I think that gets, especially for young kids, too far ahead of where they are developmentally able to think about food. And maybe appreciation of food and sort of knowing where food comes from is about the extent of it when they’re really young.

But when they get older, teenagers certainly can start to learn also about how food helps fuel them and help them grow and help them do all the things they want to do in a positive way and not have to denigrating certain foods because they’re not “growing foods” or something like that, but starting to think about just how food in general gives us energy.

Charlotte Markey: Yeah. And that’s part of why also I include the puberty chapter in The Body Image Book for Girls and The Body Image Book for Boys because I do think it’s just actually fascinating how much changes internally during puberty. I love telling kids, like, your heart’s gonna double in size. That’s kind of wild when you think about it. Your whole frontal part of your brain is not actually developed yet and that needs to be happening during these adolescent and early adult years. And so taking care of your body means allowing those things to happen and those body parts, those organs, that you need for the rest of your life. So it’s a sort of developmentally fragile period for young people during puberty, and yet it sets the stage in some ways for adulthood.

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Christy Harrison: Well, and there’s so much growth that needs to happen, including weight gain is the point you make. And I think that can be very destabilizing and sometimes downright scary for people in this culture, for kids in this culture, when they’ve been told their body should stay small or they’ve been used to looking a certain way, getting praised for having a childlike body, and then growing into a more adult body and sometimes gaining a lot of weight, sometimes gaining above the average amount and maybe moving into an adult body that is larger.

Charlotte Markey: Sometimes, then they go and see their doctor and, lo and behold, the height weight chart can become a real source of stress. I can’t tell you how many young people I’ve talked with across my career who say that probably a well intentioned physician told them, like, you’re gaining too much weight or you are too big and they hadn’t finished growing. So there was just no reason to be concerned and no reason to recommend weight loss because we don’t want young people losing weight. They are developing in so many ways that they need to be gaining weight still. And it’s just really unfortunate that sometimes people are so concerned about appearance that they forget about some of these functionality issues.

Christy Harrison: And even doctors, even pediatricians who ought to know better and I think some of that comes from pressure from diet culture and the medicalized diet industry, including these GLP-1 manufacturers and the pressure now to prescribe these drugs to kids and kids who are seen as being too high on the growth curves or whatever. It’s just so upsetting to see that because it really can interfere with a kid’s growth and ability to come into their adult body and have their body function the way they need to. It can have a lot of negative impacts to try to intervene and make a kid lose weight at this vulnerable time, like you said.

Charlotte Markey: Yeah, absolutely. I mean, we want kids to be developing hopefully a really healthy relationship with food in their body, able to enjoy food. It becomes increasingly a part of their social life, or at least it should really during the adolescent years. And we want them to be nourishing their body so that all that really cool development can take place. And I really wish in doctor’s visits or school education we focused a lot more on that.

Like, look at these co developmental things that are happening and in order to ensure that they do happen, there’s not actually that much you have to do. You have to eat and rest and ideally be active a little bit if it’s possible. You have to sleep and you have to eat. And the fact that then we even try to minimize some of those related, just sort of basic ways that our bodies need care is really unfortunate.

Christy Harrison: Yeah, I appreciate you saying that. And it is so much simpler than I think a lot of people make it out to be. The body can be trusted, kids’ bodies can be trusted to grow as they need to be. And obviously there are certain medical conditions that would need some additional assistance. And I’ve talked about that a little bit here too. Like my daughter even has a low blood sugar condition that we need to sort of intervene with a little bit more than with a kid who didn’t have something like that. But in general, even with a condition like that, we can find ways to trust kids bodies to grow appropriately.

Charlotte Markey: Yeah, parents are more often than not well intentioned. They want to provide nourishment to their children. And yet a lot of times it’s kind of counterproductive in terms of what we’d really like them to be doing, which is just kind of not having their kids worry about food. I mean, hopefully having enough of it to eat, hopefully developing preferences and learning what they like and learning a little bit maybe about even food preparation, but just not thinking about it a whole lot.

We don’t want them to start using up a ton of mental space in terms of what food is healthy or I do some clinical work too, and I’m sure you’re aware it’s like every kid that I see, it’s like, well, no, I want the protein granola. Protein is just on such a streak right now. And I was like, you don’t need the protein granola. I’m not going to try to step in here for your nutritionist. That’s not my role. But let me tell you most people are getting plenty of protein. Don’t think about it. We really want to protect kids from using up energy and mental space on some of these issues.

That’s one thing that is really in some ways nothing short of tragic if you just think, especially among girls and women, how much energy and brain power is delegated to bodies, appearance, food, and like, what could they be doing instead? You know, what could all of us be doing instead? I feel like we really would take over the world.

Christy Harrison: I know, completely. I mean, this reminds me of something that you write about that I wanted to unpack a little bit, which is the concept of adaptive appearance investment. And this idea that some amount of investment in your appearance or taking care of your appearance is “normal” or positive or can fit in with a positive body image and relationship with food, but then it can tip over as well into this maladaptive appearance investment. And I’m just curious, sort of what that line is for you and what adaptive appearance investment really means.

Sometime I think about, if I just had my husband’s getting ready routine as opposed to mine, right? I mean, in mine I would think of as probably adaptive appearance investment for a woman, like sort of often relative to gender in this day and age, I guess, but like, I do extra steps of skincare and things like that that he doesn’t do. And I’m like, if I could shave off that much time from my routine, how much time would I end up having for other things? What would that add up to over the course of my lifetime? And if we could really get it down to like near zero, that would be amazing. And that’s not always practical in the culture we live in.

Some of my skincare stuff is like I have eczema and I have to do extra moisturizing stuff that he doesn’t do or whatever. Some of it is relative based on the person and their needs and their body’s needs and stuff like that. But I’m just curious to unpack that concept of adaptive appearance investment a little bit.

Charlotte Markey: Yeah, I love dichotomizing adaptive and maladaptive appearance investments. But of course, like everything in the real world, it’s probably this continuum and there’s this very gray area somewhere in the middle. And it’s probably somewhat individual, right? Because like you said, you have sort of some grooming routines that are adaptive for you but in contrast, if your 4-year-old who doesn’t have eczema wanted a whole bunch of skin care products, then maybe we would call that maladaptive.

And I’m sure you’re aware of this recent skin care craze among young kids. And there are these skincare lines now marketed to three and up. One of which I was just reading about this this week actually,

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

My answer to the first question is available to all subscribers (about autoimmune diets and celiac disease), and there’s a bonus one for paid subscribers (about going gluten-free for an autoimmune thyroid condition).

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I was just searching through your website. My daughter has an eating disorder, and your books were mentioned positively in a discussion. I came across your blog post about autoimmune diets. You speak very generically about autoimmune diseases/diets and don’t single any out specifically [ed. note: this piece actually talks specifically about the “autoimmune protocol” diet]. We have celiac disease in our family. Are you saying that you don’t believe a gluten-free diet for someone with celiac is medically necessary?

FYI: my answers here are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.

A gluten-free diet for someone with celiac disease definitely IS medically necessary. Celiac is an autoimmune disease triggered by the consumption of gluten—a protein found in wheat, barley, rye, and related grains—and avoiding gluten is important for managing symptoms and preventing damage to the small intestine. 

Technically I suppose a gluten-free diet for celiac disease could be called an “autoimmune diet,” though that’s not the diet I was referring to in the blog post—that piece was about a specific diet called the “autoimmune protocol,” which excludes many other foods in addition to gluten and is marketed to people with all kinds of other autoimmune diseases (such as inflammatory bowel disease, Hashimoto’s thyroiditis, lupus, and more). But I probably should have mentioned the necessity of a gluten-free diet for celiac disease in the piece, as I have in my other reporting about this issue (such as the Q&As in these two episodes of Food Psych). I’ve now updated the piece to make sure no one misreads it to say that I’m against going gluten-free for celiac disease, which I’m certainly not!

While we’re on the subject, though, I think it’s also important to acknowledge that for people without celiac disease, going gluten-free most likely is not medically necessary—and it could in fact be harmful, both nutritionally and psychologically. Celiac disease is a genetic disorder affecting around 1 percent of the population (though only about 0.7 percent are diagnosed using the “gold standard” intestinal biopsy, and diagnosis can be a multi-step process, as we’ll discuss in my answer to the second question). Among the other 99 percent, many people believe they have an intolerance to gluten—officially called “non-celiac gluten sensitivity” in the scientific literature. But that idea is highly problematic, as I reported in my first book, Anti-Diet:

Non-celiac gluten sensitivity (NCGS) is often misdiagnosed or improperly self-diagnosed. No biological marker identifies the condition, which means it cannot be diagnosed with a blood test or a stool sample: there’s no way to tell from the outside whether or not someone has it, so any diagnosis of NCGS is based solely on people’s self-reported symptoms in response to gluten, combined with tests to rule out celiac disease and wheat allergy. What’s more, in many cases people’s symptoms don’t resolve on a gluten-free diet, and any genuine reaction to gluten-containing products may not be related to gluten at all. 

To date, only a few randomized, controlled trials (RCTs, the most reliable form of study) have tested whether gluten is really the cause of people’s symptoms in NCGS. The best-designed of these studies, published in 2013, showed that when it comes to gluten, there’s a strong “nocebo effect”—a phenomenon where merely thinking that something (such as gluten) is making you sick causes actual symptoms. (It’s the opposite of a placebo effect, where believing that the placebo is making you better reduces your symptoms.) 

In the 2013 study, people weren’t told whether they were getting gluten or not. But many of them thought they were getting gluten and expected to feel bad when eating it, so they did—even those who had in fact been given gluten-free food. It didn’t matter what they were actually eating. “It was just such a strong expectation that they were going to be receiving gluten at some point during their trial,” says Jessica Biesiekierski, the lead author of the study. “I think they had built up such a sense of anxiety and expectation toward when they would feel those symptoms that they [attributed] to gluten.” 

Part of the difficulty with research like this, says Biesiekierski, is that there’s no way to find people to study in NCGS trials who lack strong beliefs about gluten. The only way that researchers can get people into these studies is by finding folks who self-identify as having the condition—a confounding factor, because if you’ve already self-diagnosed with NCGS, you’re more likely to be vulnerable to the nocebo effect with gluten. 

I asked Biesiekierski whether, in light of her research, she thinks non-celiac gluten sensitivity is a viable diagnosis, or whether it even really exists. “I don’t think that it exists,” she says. “And if it does, it’s likely to affect only a very, very small number of people.” That’s not to say that the people who believe they have NCGS don’t legitimately have symptoms; they absolutely do. It’s just that gluten doesn’t seem to be the cause of those symptoms, whereas their beliefs about gluten do seem to play a role. “If somebody so strongly believes that something is going to be responsible for triggering their symptoms, then just that thought is enough sometimes,” Biesiekierski says.

Some wellness practitioners claim to offer tests that can diagnose gluten sensitivity and other “food intolerances.” But these tests—which include hair analysis, applied kinesiology, and blood tests based on IgG antibodies that yield long lists of foods to avoid—lack scientific validity. The same is true for at-home stool tests. As I’ve said before, their results are no better at predicting food sensitivities than chance, so statistically you might be better off asking a Magic 8 Ball whether you were intolerant to gluten—at least it wouldn’t charge you hundreds of dollars out of pocket.

It’s also worth noting that even medically necessary food restrictions can put people at higher risk of disordered eating. A 2021 systematic review representing the best available research (which does have limitations) found that about 9 percent of people with celiac disease also have eating disorders—significantly higher than the prevalence in the general population. Having to avoid certain foods can lead to a preoccupation with one’s diet, which can predispose some people to disordered eating.

That’s not a reason to avoid going gluten-free for celiac disease, of course (see above re: medically necessary). But it’s important to keep in mind that these kinds of conditions can make it more challenging to have a peaceful relationship with food—so if you don’t have a medical reason for avoiding certain foods, in my view it’s simply not worth the risk.

Hi Christy, thank you for everything you do! Both of your podcasts have changed my life and helped me immensely with ditching diet culture and wellness culture, but I have one question that haunts me. I was diagnosed with Hashimoto’s and hypothyroidism two years ago. My functional doctor is great and has helped me get on the right dose of medication, but she has told me I need to be gluten-free like a celiac in a bid to control my autoantibodies and the Hashimoto’s itself. I was told I have celiac genes, but my celiac test was negative two years ago. Is it true that I must be gluten-free? I really try to eat gluten-free, but I feel it has contributed to a fractured relationship with food and may have exacerbated other health problems. I am now also insulin-resistant and pre-diabetic, and she has asked me to take [an herbal supplement] rather than prescribing metformin. My symptoms are getting worse as well. I hope you can help provide some clarity.

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The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.

New York Times bestselling author and former CNN political analyst Kirsten Powers joins us to discuss her history of chronic fatigue and illness, her experience with dubious diagnoses and wild wellness treatments, what she discovered about the true causes of her issues, how disordered eating helped mask and exacerbate her symptoms, how she’s rethought her relationship with work in general and her own past work in particular, her viral post “The way we live in the United States is not normal” and her decision to move to Italy, and more.  

Kirsten Powers is a New York Times bestselling author and writes the bestselling Substack newsletter Changing the Channel. Kirsten served as a CNN senior political analyst for seven years, providing on-air analysis for major political and cultural events. The Columbia Journalism Review called her "an outspoken liberal journalist" in a sea of opposition at Fox News, where she previously served as a political analyst. She was a columnist for USA Today for more than a decade and, before that, for the Daily Beast and the New York Post.

Resources and References

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Kirsten’s book, Saving Grace

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

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Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which was published in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.

Hey there. Welcome to this episode of Rethinking Wellness. My guest today is New York Times bestselling author and former CNN political analyst Kirsten Powers, who's here to discuss her history of chronic fatigue and illness, her experience with dubious diagnoses and wild out there wellness treatments, what she discovered about the true causes of her issues and how disordered eating helped mask and exacerbate her symptoms, how she's rethought her relationship with work, and so much more. As a paid subscriber, you get to hear my full interview with Kirsten, and let me just say this is a really long and juicy one. There is a ton of great stuff behind the paywall, so I'm really glad you get to hear it all.

Just a heads up that we had some technical difficulties toward the very, very end of the interview. So the last few minutes of audio are slightly lower quality, but I know my producer will work her magic and you may not even notice a difference. Before we get to the interview, I just want to thank you so much for supporting the show. It really helps me keep doing this work and helps support my family and my contractors and sort of everyone in my so I really, really appreciate it.

And if you're new here, just know that your subscription not only gets you full interviews like this one, but you also get subscriber only Q and A's and essays every other week, some cool newsletter bonuses on the alternate weeks, full access to our archives, commenting privileges, and subscriber threads where you can connect with each other and lots more. You can get a lot of that right here in your podcast player, since I record the Q and A's and essays as podcast episodes as well. And of course the interviews are here, but for the full experience, you'll probably want to go to rethinkingwellness.substack.com or the Substack app if you have it, or just check your email inbox and everything will be there.

I also want to make sure you know about my second book, which is called the Wellness Trap. You probably do if you're listening to this. You've heard me mention it a lot, but I think since you're clearly into this podcast newsletter, you'll love the book. And I'd be so grateful if you'd pick up a copy for yourself and maybe for a friend or loved one as well. It really expands and extends on the conversations we have here, getting into the connections between wellness and diet culture, dubious diagnoses and spurious cures like the ones that Kirsten had. And you'll hear her talk about the book in this episode and how we can both protect ourselves from wellness misinformation and scams and also reimagine well being as a society.

If any of that sounds interesting, or if you just want to help support the book and the show even more, you can check it out at christyharrison.com/the wellness trap and pick it up at your favorite local bookstore. With that, here is my conversation with Kirsten Powers, the full extended version. So, Kirsten, welcome to Rethinking Wellness. I'm so excited to talk with you today.

Kirsten Powers: I'm so happy to be here.

Christy Harrison: I feel like we have a million things we can get into, and I have a lot of directions I want to go. And this is probably going to be a far ranging conversation, but I think to start us off, I'd love to just sort of anchor us in your history with wellness and diet culture. So can you tell us a little bit about that?

Kirsten Powers: Yeah, I mean, what's interesting is I don't even know that I would have realized that I had a history until I discovered your work, which wasn't actually that long ago. I had sort of this general idea, but I didn't really have a clear framework for it, I guess. Well, first I discovered your Substack and your two podcasts, and then I read your book, and I just really felt like, wow, this is my story, particularly your book, which I know is a lot of your story as well. So I grew up in the seventies and the eighties of Generation X. Wellness wasn't really, I mean, if it was an industry, I wasn't aware of it. And I never read a self help book. I didn't know anybody really who read self help books. And I would say the first time I ever started looking into these kinds of things was when I got sick.

You talk in your book about the dubious diagnoses that was really what ended up happening to me was I had the symptoms that I think a lot of people are familiar with. Started in my late thirties, probably, but really tipped over into something that made life kind of unlivable in my early forties. And it was the chronic fatigue and pain, which I was told was fibromyalgia. I got all of the different diagnoses for the chronic fatigue, you know, the brain fog, all of the different things that come with this whole sort of set of mystery illnesses. And I did what everybody does. You know, you go to your doctor and you go to the endocrinologist, you do all these things, and they tell you, like, there's nothing wrong. Your blood work is great.

They, I think, probably said, "You have too much stress. You need to rest more, you need to sleep more." I felt like that was being dismissive, which, you know, in hindsight, it was actually pretty accurate. So then what happened was, I was talking to a friend, and she said, "Oh, you have to go to this integrative doctor, right? So she's a real doctor, but she does integrative stuff." And so I went to her, and she did some test that allegedly showed I had chronic Lyme. That kind of started it, I think. Up to that point, I think I had started getting involved in the healthy eating thing. You know, "you can solve this with healthy eating." And so I did paleo, and I can't even remember, right? I did whatever at the time, was all the different diets, and where each little food gets demonized, and eventually there's almost nothing that you can eat.

But when I got this kind of diagnosis, I sort of spiraled. I ended up going to the "best" doctor for chronic Lyme. He told me I definitely had chronic Lyme, wanted me to start me on this protocol, and for some reason, I just was like, "I don't think this is it." So, thankfully, I didn't go down that route, but I did freak out that I might have chronic Lyme. So a colleague said, "You need to go see this infectious disease doctor who's my general practitioner, but he's also one of the best infectious disease doctors."

I went to see him. He told me that I did not have chronic Lyme. You know, he sent it out to the best place. But he told me I had reactivated Epstein–Barr, and so there's no cure for a reactivated Epstein–Barr, except he said, take off six months from work, which I was like, I live in America, and so I basically work full time, but I don't have any benefits, so I don't have disability. I don't have any of these things. So that's not possible. So instead I started. I don't know, it's just sort of interesting how it happens, you know, I was doing Bikram yoga, and I mentioned to the teacher, I said, "You know, I was diagnosed with reactivated Epstein–Barr. Is it okay to be doing this kind of exercise?" And then she said, "Well, you need to come see me because I do this thing." I don't know if you've ever heard of it. It's like foot zoning.

Christy Harrison: Oh, no, I've not heard this. Is it related to reflexology at all?

Kirsten Powers: Kind of, but much more complicated. And she was like, "You have to go vegan. You have to cut all the stuff out." She had healed herself doing this. And so then I went on to this very restrictive vegan, like vegan times a million. And I was eating that way. And I was doing the Bikram yoga, and I was doing this foot zoning. And then she got me into the medical medium. What I sort of discovered was, I think what she was prescribing was what the medical medium prescribed. So I was doing that awful blueberry with the seaweed. It was just horrible, you know? And I was just miserable. And I can't even describe just how sick I was.

Christy Harrison: On top of already feeling fatigued and sick and run down.

Kirsten Powers: Yeah. And taking a million supplements, I would hate to go back and add up how much money I was spending on these supplements. And I was doing this for years, even though it wasn't really working. And so it's a long story. Like, this goes over for a long period of time. Now, in my story, actually, I kind of came around to believing that my illness was psychosomatic. And that doesn't mean that I was imagining it. It means that it was rooted in some sort of unprocessed trauma. And so I had gone to a place in Tennessee, and I did their intensive program. It was like a week long therapy program, which a lot of my friends had done. And when I came back from that about three weeks later, I would say I was probably 80% better.

Christy Harrison: So this was like a trauma intensive recovery program.

Kirsten Powers: Yeah. And what ended up being for me was that my father had died of a heart attack, age 61, when I was 35 years old. And it was a horrible shock. And then my grandmother, who I was very close to died a year later. Also, right after my dad died, my stepfather was diagnosed with liver cancer. Died. And I could just go on, all these people died in a very short period of time. And it was after that I started getting sick, and then I got into a really horrible marriage, and we ended up getting divorced. And that's what really tipped me into the really, really bad part.

So I ended up processing my father's death and my grandmother's death, and it was pretty clear I hadn't really processed it. And the doctor who sort of turned me on to the psychosomatic stuff, one of the things that he says is, when it is psychosomatic, you have to stop taking all the supplements. And so I did stop doing the supplements. I don't know at what point I gave up the diet, but I did basically, after that step away from all that kind of stuff. But what I realized when I read your book and when I discovered your work was that the part that I hadn't dealt with, and I would say I was probably 70%. So I still had a lot of fatigue. I still was nothing like before, where it really, truly was just almost impossible to even get out of bed.

But I still was like, something's not quite right. And I already had kind of come to this conclusion. I think you read the piece that I wrote where I had sort of pieced things together that I had serious disordered eating. And it did primarily start around all this wellness stuff. I don't think up until discovering that I really had that many issues with food. I would say I was, like, 40 by the time people started with this, like, don't eat beans, don't eat rice. I didn't know anybody who talked about that kind of stuff. There wasn't a don't eat gluten. It just wasn't really a thing. And then it sort of took over, and it became "this is the solution to all your problems."

Christy Harrison: Yeah, the one true solution.

Kirsten Powers: And so I realized, I think it was on one of your podcasts, or I can't remember, maybe it was in your book, about how so many women are basically living on starvation diets.

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Christy Harrison: And thinking that's normal.

Kirsten Powers: Yeah, and thinking it's normal. And I made a decision. I was like, "Nothing's off the table. Like, I will eat anything." And I was saying, to my husband the other day, because I've been eating a lot of rice, a lot of white rice, which is like poison according to the wellness industry. And I was sitting there eating this white rice, and I was saying to Robert, I was like, this rice tastes so good to me. It's almost like I'm eating a bowl of ice cream because it was so demonized, and I didn't eat it for so long. And I love it so much. It's just so funny that I sit here and I'm like, this is so luxurious. Like eating rice.

Christy Harrison: That's wild.

Kirsten Powers: And so what I did was, and I know you're very not into tracking, right? So I just want to be clear. I'm not advocating tracking, but I actually did track what I was eating because I didn't have any sense of how many carbs I was eating. I just have no idea. And then I kind of looked up how many carbs you're supposed to be eating. I'm in my fifties. I am just now learning this, because carbs are so demonized. So I started eating and tracking, making sure I was getting my carbs. And almost immediately, I felt completely normal.

Christy Harrison: Wow. So you just were not eating enough carbs before, which, I mean, makes total sense.

Kirsten Powers: I wasn't eating enough carbs, and I wasn't eating enough calories.

Christy Harrison: Was this related to what you had learned in the vegan, the really restrictive vegan diet? Or was it partly just stuff you had inherited from diet culture in general? We also have to talk about your position on TV and if that played any sort of role in the body image stuff.

Kirsten Powers: Well, I think that those are all really good questions because it's kind of hard to always get back to where is this coming from? I think part of it was doing these different diets, like paleo, and then I think for a while I did the keto and then vegan, and then just reading all these books. I think just so many foods were off the table that you kind of can't get what you need. You know what I mean? You can't get your nutrients. And I also was eating way too much fiber. I always have indigestion and gas and stuff like that. And it's like, yeah, because you're eating so much freaking fiber.

Christy Harrison: It's wild.

Kirsten Powers: Yeah. And as soon as I stopped doing that, then I all went away. I had no more indigestion. I had no more gas. I had no more of these things. That was part of it. And then when I went into perio menopause, I started gaining weight for the first time in my life. And so then I got very into intermittent fasting. And so then they demonize a whole group of foods, right. So I was kind of piecing together all these different ones, and that's how I kind of got into this. Now, my mother is extremely fatphobic in the extreme, and so I grew up with that. And I do think that being on TV, the conversation around that is probably more about what you have to do to keep your face looking young. Less than my body, but it's being thin or whatever the ideal is.

But I think that it was more that I had unconsciously absorbed all this stuff from my mother that I consciously rejected. Certainly when she would do it, I would just be like, this is so messed up. I consciously thought that, but I also had absorbed it. So I think I had this idea that not just that I needed to be healthy or, like I said, my clothes fit comfortably or whatever, I needed to be skinny, thin. So I had to kind of come to terms with that because I wasn't really conscious of that. And I think also because I had a very high metabolism when I was younger and a lot of anxiety. And between the two things, I tended to just be pretty small and it wasn't healthy.

So I had to kind of come around to, well, what do I want to be? Well, what I want to be is healthy and strong and have energy. Right. And I also really love to exercise intensely. I'm a very physical person, and I always have been. And I played sports when I was young, but I never really could do that because now I know I didn't have enough. I wasn't eating enough.

Christy Harrison: Couldn't fuel that activity.

Kirsten Powers: Yeah. So I try to do the exercises that I really loved, and then I'd be like, "I can't do this. I don't have enough energy." So now I'm doing very intensive exercises, and I feel amazing. I just get rid of all that energy, and I really enjoy it. So I think it was partly my mother and my father, too. I mean, he wasn't as bad as my mother. My mom wouldn't even try to hide it. I think other people would be like, "No, I don't. I'm not like that." My mother's obsessed with it. And it's the kind of thing, if I was to show up and weigh more than I weighed before, she would just glare at me. And so I think that was part of it. I think part of it is just culture.

We just live in a culture that's just bombarding us with these images. But I feel like now I've gotten to a place where I am more conscious of this. And so I'm much more concerned about how I feel. And it is just so interesting how patriarchy works and white supremacy, because they don't even really, in some ways, need to do anything because we're harming ourselves.

Christy Harrison: Right. We're so bought in, and it's so the water we're swimming in.

Kirsten Powers: I mean, yes, they're responsible for the messages that are being sent to us, but, of course, women are often complicit in that, right? So it's like, how can you be equal or do what you need to do if you have no energy?

Christy Harrison: If you're undereating so much that you feel chronically fatigued and you think you have all these wild things. And I think the insidious thing about it, too, is that you know the symptoms of undereating, not to say that everyone has chronic fatigue or thinks they have fibromyalgia or anything like that, or has fibromyalgia, like, is eating in a disordered way. I'm sure for many people, there's many other things going on. But it is interesting because I have talked to a number of people with chronic illnesses who maybe they still have the chronic illness but feel so much better and the symptoms go away a significant percentage when they start eating enough.

But I think the really insidious thing is that when you fall down these wellness rabbit holes and go to practitioners, alternative practitioners, and other people in the wellness space, they'll encourage you to restrict more. It's like it's always food that's being demonized. There's always some restrictive protocol to do and then a bunch of supplements that also are really hard on your system and excessive amounts of fiber, like you said. So it just kind of exacerbates the problem. And then I feel like people start to think when they're in that paradigm, it starts to become easy to be like, "Oh, I just need to cut out more." And that's the message that so many of these alternative providers give too, is like, "Oh, well, it's not just gluten and dairy and this and that. It's also these five other things. Let's try this." And you just end up with a more and more and more limited diet.

Kirsten Powers: And I also think that we have this puritanical kind of culture where we believe we're dirty or bad or whatever, especially if you grew up in a Christian environment that kind of feeds into that also, which is like, "Oh, yeah, I just need to be clean eating and restricting and denying and purifying." All this detox stuff. Oh, I forgot. One of the first things that happened was I went to this place in DC at some integrative health place and they wanted me to be coming in to be getting all these infusions and all this kind of stuff. All of this, like, "You got to purify." And so, I have a whole background of in that same period falling into evangelicalism, being very religious when before, I wasn't at all. And I'm not particularly religious now either. It all kind of came together of that kind of mentality. And so I think it's important for us to always be sort of unpacking the unconscious belief that we have absorbed. That we might even say if someone was to ask us that, we don't really believe them. But if you look at our behavior, what are we doing?

And then the other thing I have to say, no doctor ever asked me how many calories I was eating. Nobody ever said, like, "Can we just talk about are you getting enough calories, when you're so tired?" This is just around us all the time of kind of what is the ideal? What people think is the sort of ideal of the way you're supposed to look versus just being healthy and feeling good. So it's like if you're starving yourself, if you're trying to be a certain size, you're just doing the patriarchy's work, and it's impossible to show up and be as powerful as you want to be if you're exhausted and not getting enough calories. Like, with me, not even able to exercise, which I really need for my mental health. And so everything was kind of organized around that. I just feel like I lost so much of my life to this and spent so much money that I did not have.

Christy Harrison: Right. Because all that stuff is out of pocket. You're probably not getting insurance coverage for this yoga teacher or maybe even some of the integrative stuff.

Kirsten Powers: Oh, no, no, no. It's like, I paid for all that stuff. I did. All the supplements were incredibly expensive. And it wasn't just as, you know, it's not just that you take a supplement. You have to take a certain supplement and buy a certain brand. It's always really expensive. And it was like everything was poisoned was kind of what I was being taught, that all these things are going to harm you somehow and that you have to just do this thing and then you'll be healthy.

I think discovering the disordered eating and starting to eat more healthy was the final piece. I would say, the other big piece was in 2020. So I worked at CNN, and I was always on in prime time. So it's me on TV every night. I was on Anderson Cooper's show mostly, but sometimes I'd be on later on Don Lemon's show, which is from ten to midnight. So I was always on in the evening. And I had to be in New York at least three days a week. I live in DC, so I was always traveling. And that's stressful, right? Like that alone, like, yes, the being on TV thing, but even the just always having to travel and live out of a suitcase and never really being able to get on a routine of any kind.

And so with 2020, I was able to be at home, and start to just live a more normal life. And I wasn't on TV very much because they were really only covering COVID and talking to doctors and people who knew about COVID related things. And so I didn't have the chronic stress of that kind of life. And so I feel like that was the last piece. And I think we talked about this when I interviewed you, that I had felt that I was being dismissed when the doctor said "you need to reduce stress in your life" without appreciating that actually what a major role the stress was playing.

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I just didn't, because it was so normalized that I really didn't understand when they would say, like, "But you have a stressful job." And I'd be like, "It's not really that stressful. I've been doing it for two decades." And what I meant was, like, other people look at it and they'd say, "Oh, my gosh, it must be so stressful to be on TV in front of millions of people doing whatever," and I get that. But for me, it literally was the same as if you were an accountant going to the office. I'd been doing it for so long that I knew how to do it, that it was not stressful in the way that people meant, I think. And so that's why I would be like, well, it's not really that stressful, but it was incredibly draining, you know, especially in post 2016, where things just went upside down.

Christy Harrison: The level of conflict you were probably exposed to at work on a daily basis.

Kirsten Powers: The conflict and the crazy making. Whereas before, I feel like I was more debating something, maybe, or analyzing something, and maybe somebody would say, "Well, actually, I think this." And it would be slightly different, but it would be rooted in reality. Suddenly I was dealing with just made up stuff. If someone would just say something, I'd be like, "That just didn't happen."

Christy Harrison: Because you were talking to people who were in the Trump administration.

Kirsten Powers: They were the surrogates for them. So they didn't actually work in the Trump administration, but they were the people that were brought on, and they were kind of people that came out of nowhere. They weren't people that had a reputation that they had built on being trustworthy, which in the past was most of the people that I was working with. These were people who had been journalists for a long time or had been working in politics for a long time and had built up reputations and knowledge and had something to lose. Now, I had people who had nothing to lose. Well, they had a lot to lose if they angered certain people. So they were incentivized to say things even when they didn't even think they were true. And I know that because we would talk during the breaks and it would be pretty clear that they didn't even really believe it, but that they had to say it because otherwise there'd be hell to pay.

So there was just so much crazy making, and that was stressful. And so I feel like when I was able to kind of get away from that and then I also, in that period, got off of social media for the most part. I was doing everything I could to support my health.

Christy Harrison: Was that sort of in response to the doctor saying you need to take six months off?

Kirsten Powers: I wish that I had done that. That would have been smart, but I didn't. When the doctor said I had to take six months off, what I did was I really prioritized getting sleep and going to bed as early as I could. And really cut back on my socializing. But as we've talked about before, the socializing also really gets cut back when they start cutting all the foods out. And so now you're getting isolated from your friends because you can't eat anything. Eating out becomes, like, a stressful event.

Christy Harrison: You might as well stay home because you're not going to be able to enjoy it anyway.

Kirsten Powers: And I started kind of getting healthier, I would say, in 2019, which is when I went and did that therapy. And that's when I started to come to terms with the roles stress was playing. I just realized I have got to get this under control because I am so jacked up all the time emotionally. And this is just so unhealthy and unsustainable. It's emotionally and physically unsustainable. I can't do this. I simply will not be able to go on if I don't change something. And so after doing a lot of research about what is now, I think, pretty well understood of what happens to your brain and your body when you're on a Twitter, for example. And I just was like, I just can't be doing this. And so I just stopped doing it. And it was as if I was going off of heroin. I swear to God.

Christy Harrison: No. It is so hard. I also took a huge step back from social media. I still have an Instagram account, and that's where I used to spend the most of my time. But I was also on Twitter and also on Facebook, and I just stopped all of it for a while. Now I have someone managing my Instagram for me, and I don't go on. But, that initial period of, like, I would delete it from my phone and then I would be like, "Oh, but I have to put it back just to check something." I couldn't go cold turkey. It was like a slow sort of pulling the blanket out of my hands.

Kirsten Powers: I went cold turkey, and it was brutal. And it took me a couple of weeks. And then after a month, I allowed myself to go on, but only on my computer because it's not as satisfying on your computer because you can't scroll. And so I would do that. And then eventually I lost interest in it. And for me, it was also a particularly hard experience being on there, being a woman in the public sphere on CNN, which Trump had targeted. And so anything you did, people were looking to use it against CNN. So I was being sort of watched to amplify anything that they could kind of even misrepresent to say, "CNN's Kirsten Powers said, X." So it just became especially toxic.

Christy Harrison: Didn't you also say there's another Kirsten Powers, like someone who's totally unrelated to you? Kristen Powers. Who had messages meant for you that were death threats and terrible things.

Kirsten Powers: This poor thing, she was right out of college, a journalist in DC. She actually reached out to me and we had dinner. She wrote a piece about how she's Kristin Powers, @kristenpowers, and she would get things meant for me, and she just couldn't believe the things that people were saying and, like, traumatizing for her. And it wasn't even about her. And, of course, incredibly misogynist. So I never listened to Facebook. I couldn't deal with it. And I did like Instagram. I still do Instagram, though. I'm rarely on it. I rarely post. And I maybe go on it for, I'd say, gosh, I don't even think I'm on it for 20 minutes a week.

Cutting that out, I think, made a huge, huge, huge difference in my life because I have more control over what my unconscious is absorbing. And then I guess Substack has become, for me, it's not really social media, but that's become, where I go, and I love it. The people are so nice and there isn't that trolling, you know, people trying to jump on what you said and misrepresenting it. And so I do love to connect with people. That's the aspect of social media that I liked. And so I feel like I get that from Substack. I am connecting with people. Like I connected with you. It's like you're finding people who think like you think and are talking about things that are interesting and stuff like that. And so I do really like that. But you don't have to deal with what you're dealing with on these social media apps.

When I look at my For You page on Instagram, I just think what can I do to get rid of all of these photoshopped pictures? You're just being constantly inundated with this idea of this bizarre beauty ideal. Nobody looks like this. I don't want to see these pictures, and it doesn't matter that I never touch them. There's no reason the algorithm should be sending them to me. I'm never opening them, and yet they're always there.

Christy Harrison: It's so bizarre.

Kirsten Powers: Yeah. And so you're always being kind of brainwashed I feel like, given these pictures, I never asked for this. I never at any point have followed an account like this. It's never happened. And yet you always put this in my For You page.

Christy Harrison: And it's like it just takes one moment of absent minded scrolling or something and falling down that rabbit hole to get served way more content like that. Another thing, too, about social media that I think is interesting, especially with your story where you didn't recognize the stress you were under and you were sort of like, "Well, my job's not stressful," but you had all these sort of intense pressures going on, objectively stressful things, which I think social media is that for a lot of people, too. It's like, we don't think of it as such because it's just part of our everyday lives, and it seems innocuous and everybody's on it, so it's like, well, why would that cause me particular harm? Or that can't be the problem, but I think it really does.

And there's lots of evidence to show that it's changing our behaviors and our brains and all of these really detrimental ways. But we don't think of it as such until we maybe do some research and start to realize the harm that it's having on us and take that leap. And then you can sort of see on the other side how much better your mental health is. But when you're in it, it doesn't feel like it's stressful.

Kirsten Powers: Yeah. And I think that there's also an easy way to discover this is just go off of it and journal about how you feel, and then go back on and journal about how you feel. It's so obvious that it's making you miserable, and it's affecting you. Whether you think it's affecting you or not. Also, it's just not real. It's like I always say, Instagram is where people go to lie, you know? People are feeling so bad because all these people are like, "I have the perfect marriage," and, "Oh, my mom is my best friend." It's like, no, she's not. It's just not real. I follow accounts on renovating a house in Italy, and so I follow renovation accounts or whatever. Right? So it's like, it's pretty harmless, or I follow people like you or whatever it is.

So when I started doing the therapy in 2019, I started seeing a therapist also who was a Jungian therapist. And I started to learn more about the unconscious and how much of what we do is driven by unconscious beliefs and that you have to really dig into what I really believe that I'm not even aware of and I'm acting out of, but also be aware of what you're allowing into your unconscious. And so everything you're doing is just being picked up. And another area, honestly, is, I hate to say this as a person who worked in the news for so long, but a lot of the news that you're consuming is also jacking up your nervous system. And you have to be careful. You have to do it in a way to see it, be informed, but not this constant, "I need more and more more. I need to know all the time everything that's going on. I need to follow up minute by minute."

Christy Harrison: It's so interesting to me to hear you talk about how you were so jacked up when you were on the news. Of course, you were in that environment where you're exposed to it so much, probably more than the average person who looks at it in their spare time versus all day for work. And I think it's interesting to extrapolate that, perhaps to other people, because I've heard a lot of journalists who work in news say that they're total news junkies and Twitter junkies and that they spend all this time getting on there and they get into Twitter fights and they can't help themselves. The outrage just is at this heightened level. And they sort of boil over sometimes.

To live with that level of outrage, I'm sure it spills over into how the news is framed and constructed and delivered. And therefore, the sort of levels of outrage and maybe less nuanced takes that people are getting from their news, which I think relates to your book, Saving Grace. And I would love to talk about that and sort of how you've rethought some of your work first, how you decided to leave television in the first place, but then also how you started to rethink some of your work, to have more nuance and compassion and speak in ways that were less polarized than you did before.

Kirsten Powers: What's interesting is that people who followed my work over the trajectory of my career will usually say, like, "You're the voice of reason." And I think that was my overarching tone and behavior. And then there was a certain percentage where that's not at all what I was doing, and not consciously.

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

This is a little Q&A grab bag where I delve into the science to answer several questions I’ve gotten (and asked myself) about pregnancy. The first answer is available to everyone (about whether the sex of the baby predicts nausea levels), and the others are for paid subscribers (about whether methylated folate is better than folic acid, whether dates (the fruit) have really been shown to induce labor, and whether there’s an increased risk of stillbirth after 39 weeks for IVF babies).

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Is morning sickness really worse when you’re pregnant with a girl? I saw a post saying “science proves it,” but of course they didn’t give any details about the study.

FYI: my answers here are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.

When I set out to answer this question, I was pretty sure there wouldn’t be any real science to speak of—maybe one study in rats or something like that. So I was surprised to find there is actually quite a bit of (human) scientific literature on this question. It’s all observational and has some limitations, so I don’t think we can definitively say science “proves” that nausea and vomiting of pregnancy (NVP, aka morning sickness) is worse with girls. But it does seem that there’s at least an association.

Population studies going back several decades have found a link between a very severe form of NVP called hyperemesis gravidarum and being pregnant with a girl. For example, a very large 1999 study of Swedish birth and hospital records from 1987–95 found that among mothers hospitalized for hyperemesis gravidarum during the first trimester, the sex ratio of the fetuses was significantly altered (55.7 percent girls in the hyperemesis patients, compared to 48.6 percent girls in the general population). However, there seemed to be no difference in sex ratio for women admitted with hyperemesis gravidarum during the second or third trimester.

Even the common, milder form of NVP seems to be correlated with fetal sex. A 2020 survey of moms’ self-reports from 4,320 pregnancies found that women pregnant with girls reported higher frequencies of NVP than those pregnant with boys. This held true even when controlling for a number of confounding variables, including maternal age, number of previous pregnancies, general susceptibility to nausea, location, and preconceived beliefs about the relationship between fetal sex and NVP. The sex difference was statistically significant, but not necessarily clinically significant: Girl moms rated their symptoms an average of 6.35 on a 1–9 scale, whereas boy moms rated theirs an average of 6.04. So it’s not true that the mere presence of nausea and vomiting—or even of hyperemesis—can predict the sex of the baby. But it does appear that people carrying girls are more likely to report slightly worse nausea and vomiting.

The question is why, and we don’t really know for sure. It may have something to do with the presence of certain hormones in utero with female fetuses, including higher levels of human chorionic gonadotropin (hCG, or the pregnancy hormone), estrogen, and/or a variety of other hormones. But there’s scientific disagreement about whether these explanations are really true; for example, a 2014 systematic review and meta-analysis found inconsistent associations between hyperemesis and HCG, thyroid hormones, leptin, estradiol, progesterone, and white blood cell count. There’s also a theory that NVP is related to normal immune-system changes in pregnancy that result in higher levels of inflammation, but so far there’s no real evidence to bear that out (even the recent, small study testing that theory didn’t find a statistically significant link between inflammatory markers and NVP).

The bottom line: there does seem to be a correlation between worse NVP symptoms and carrying a girl, though it’s unclear why, and nausea and vomiting can certainly affect people pregnant with a fetus of any sex.

Thank you so much for your recent coverage of frequently recommended supplements. You are one of the few I know I can trust to do a legitimate deep dive into these types of things. In this same vein, I am curious what the research says about the value of methylated folate vs. folic acid during pregnancy and at other times. There is a lot of hype about how methylated folate is supposedly better than folic acid, but I am skeptical. From what I understand, even for those with the MTHFR gene mutation, they are still able to absorb an effective (if lower) amount of folic acid from unmethylated versions for things like reducing the risk of neural tube defects. I would LOVE to get your take!

Thanks for your kind words and great question. I think this is one of those cases when wellness culture takes a small grain of truth and blows it up into a huge bowl of misinformation popcorn.

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Pharmacist and Certified Intuitive Eating Counselor Sarah-Jane Garcia joins us to discuss how smart people get caught up in wellness culture.

She shares her path from the realities of being a pharmacist experimenting with elimination diets to how getting certified in integrative medicine exacerbated her orthorexia to why becoming a parent finally opened her eyes to the fear-mongering happening in wellness communities.

Behind the paywall, Christy and Sarah-Jane discuss what it actually took for Sarah-Jane to break free from diet culture, as well as how she returned to conventional medicine through Intuitive Eating.

The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.

Sarah-Jane Garcia is a Certified Intuitive Eating Counselor with personal experience navigating binge eating, restriction, and obsessive clean eating. Discovering Intuitive Eating freed her from intense struggle with food—and inspired her to become a counselor, so she could help other women do the same.

Sarah-Jane offers 1:1 coaching as well as a 12-week group program focused on the Principles of Intuitive Eating. She’s also a Specialty Pharmacist, and her approach blends science, psychology, and lived experience to guide you toward a healthier, more peaceful relationship with food.

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Resources and References

Contains affiliate links to Bookshop.org, where I earn a small commission for any purchases made.

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Sarah-Jane’s website

• The Intuitive Eating Collab

• Food Science Babe

• Intuitive Eating, 4th Edition: A Revolutionary Anti-Diet Approach

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Here’s Christy’s conversation with Sarah-Jane Garcia.

Christy Harrison: You are a pharmacist who got really into wellness culture at one point and eventually started to question it and find your way out. And you have such an interesting journey that I’m excited to talk with you about. But first, I’d love to hear just a bit about your history with diet and wellness culture before all of that. How was your relationship with food and your body growing up and what made you want to go into pharmacy in the first place?

Sarah-Jane Garcia: Well, this is such a convoluted tale, but I’ll do my best to sort of summarize. So growing up, I didn’t have restrictions really on food. It was really not anything that was tough for me to navigate. I grew up very privileged as well. I’m in a thin body. I was spared from any comments from anybody about needing to lose weight or anything like that. But from a young age, I do remember tying my worth to my looks and my body size and my appearance. Like, people would comment on my looks and even though I was part of the A class at school or on the A hockey team, I grew up in South Africa, even though I was able to achieve these accomplishments, it still seemed that my worth became very tied to my looks and my appearance.

I was young teenage years when I moved to the States and I was really unhappy at this time. It was a traumatic experience for me to move at that middle of high school kind of age. And I was pretty lonely. I didn’t really fit in here. But then I also no longer fit in in South Africa. I had pursued modeling for a little bit. Not really because I wanted to, but I sort of felt like I was pushed in that direction a little bit. And then I remembered going to California to this conference and not getting any callbacks after that and feeling like devastated. I remember this mentality of like, I’m just too short and like not skinny enough for the industry.

And I remembered letting that go a little bit. It didn’t really get into my mentality that much. I didn’t hold to that. But I do remember feeling like somewhere along the line I had that had become absorbed within my thinking of how I needed to look for being able to pursue a career in modeling. I was happy to give it up though, because I’m actually quite a shy person and I do not really enjoy being in the spotlight and I was able to really hold on to a little bit of my self worth still because I knew that that was a modeling culture thing and it was not like about really me and my worth, but it was the end of this, like modeling road for me.

And so at that point, I was pretty lonely here in the States. I was navigating new friends groups and I started to somehow outsource my thinking. And I tried so hard to fit in that I would just sort of make friends with anybody and sort of become this chameleon and go with whatever their thoughts and beliefs were about things. I was also told by someone older in my world that I should never expect to have friends because girls weren’t like me. Like, they’ll think that I got this and I’ve got that and I’m privileged or I’m pretty and that it would just be too threatening, which was really tough to hear. And I shouldn’t have bought into it, but I did.

And so then I sort of took it upon myself to just kind of dumb myself down, to be honest. Like, I just felt like, okay, I’m going to focus on making sure that I don’t come across as all of these things that people might view me as. So I did what it took to sort of be liked and to fit in. But along the way, I just really got into fitness and looks because that is then what my worth was tied to. So it’s just this very difficult place to navigate or that was how I felt worthy. But at the same time, I was trying to fit in and dumb myself down in these other ways.

And then by the time I was, like, 19 or 20, I do very much acknowledge the privilege that I have and throughout my childhood and adolescence, there were some pretty significant traumatic experiences that I did go through. I just feel like I could describe myself at that age as very nice and accommodating people pleasing, perfectionistic person, pretty shy and quiet who just wanted to be liked and who tied most of my worth to that outward appearance. Working out was something that was super important to me. I enjoyed it at that time.

I went to college and I heard about the freshman 15. I had a family member, I overheard them talking to another family friend about, oh, it’s just puppy fat, like, expressing a little weight gain that I had in my adolescence that would eventually correct itself. I remember going to the gym and the first time being offered supplements and shakes and things that were supposed to sort of help me maintain or attain this super thin toned body.

Oh, one thing I didn’t mention too, was at this point, I had also had other friends or family members make a comment like, oh, you’ve lost weight, but I hadn’t thought about my body size before. So I was like, well, what was I before? Like, what did you think of me before? So anyway, back to this gym. I was sort of at this gym. And then I remember that trainer took one look at me and he’s like, oh, you’re someone who can just work out for a few days and get the body that you want, aren’t you? And it was like, first of all, was there something wrong with the current body I had? And then second of all, it was like, all it took would be a few days of solid effort and I would get this perfect body? And I did end up getting very, very toned and then I was very hooked.

I remember this distinctly, then a friend had come to visit me from South Africa. And I remember some of our other friends were like, oh, she’s gained so much weight just from being in the States and their portion sizes that they serve there. And I remembered looking at a picture of her and I and us being exactly the same weight. There were a few other things experiences, like with a boyfriend and how he very much tied my worth, I would say, to looks as well, but basically it just became this upkeep. I received continuous comments of my body. Working out now became something I did to maintain my skinny body. And I started to, at this point, binge and restrict. I’d started diets like Slim Fast or cabbage soup diet or whatever else. And then I would end up severely binging.

Everything was tied to my looks. If I broke up a relationship, it was never about, well, we just didn’t mesh and our personality types were different. It was about, like, obviously I wasn’t enough. And so I would just go harder into workouts and fitness. I just never really did this work around loneliness or people pleasing or that.

Christy Harrison: There’s so much in our culture that pushes that too, right? That’s like, if you’re lonely or you have a breakup or something’s going wrong in your life, get better looking, work on your body, right? You can fix it all through diet and exercise and that sort of thing.

Sarah-Jane Garcia: Yeah, exactly. And then like, you’ll show them, right? Like, your revenge body or something. So I then went to pharmacy school. The reason why I got into pharmacy school was actually pretty interesting. I had spent some years not quite sure what I wanted to do. Kinesiology was my major for a while at school and that was like sports science and that was because I wanted to know more about fitness and nutrition. I felt like I was really good at that.

And then due to a few visa issues with my immigration status, I ended up putting off my training for a while. And it wasn’t actually until somebody had said to me have you looked into becoming a pharmacist? I was very interested in the medical field. I just knew I didn’t want to go to medical school. And it was really just from there that I got interested in pharmacy itself. And I was always really interested in chemistry and biology in college. I did well in those classes and it just felt like a logical next step.

At this time I was in pharmacy school and I ended up getting divorced. So I was married pretty young and I got divorced from a really great guy. But in pharmacy school I was now dealing with that and this divorce. And I was still binging and restricting immensely. But what ended up happening at this point was everyone around me was always so impressed at like how well I was handling things or like my dedication to my workouts, which I’d do like at 9pm at night after studying. And I was just really obsessive and perfectionistic about it.

But I would continue to get compliments for how I looked or how dedicated I was to my workouts. And like that made me feel like clearly I’m doing something right to be getting all this praise. I always felt this need to live up to it. Like, not doing it would cause me this identity crisis. At this point in my world, I was just so caught up in binging and restricting. It was just such a struggle. The amount that I could eat, all the things I went through and dealt with and the things I tried, like I couldn’t break free from binge eating. And the cycle of binging and restricting.

Christy Harrison: It’s such a common cycle. I went through it myself and I know many people listening probably have, and I think it was just so eye opening and something that I didn’t even want to really embrace for a long time. But once I finally understood the way that restricting begets binging. And that over exercise contributes to that as well and that you’re creating this energy deficit in your body that your body is just desperate to fill and so binging becomes sort of a survival mechanism almost. That to me was really eye opening.

I’m curious for you, how you got help with binge eating, because I know your recovery process was sort of a long and winding one and led you in some directions that were not so great.

Sarah-Jane Garcia: Yeah, I think at this point I had gone to see my doctor and I had brought this up and I remember she was so kind. But I got like 15 minutes with her and then I remembered seeing in my chart that she had diagnosed me with like chronic fatigue. And I was just like, huh? And I think also anxiety. And I was like, no, it’s not that. I struggle with food. And she had offered some antidepressants at that time. And that was a whole other thing that, I’ve definitely changed how I feel about this, but back then I definitely had a lot of like, well, I can’t take an antidepressant. That’s gonna say so much about who I am or how I struggle. And it’ll just speak to all these parts of me that I don’t really want to feel or confront.

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And I think I did end up trying the antidepressant and it just didn’t work. And I remembered thinking, well, it’s like a 15 minute appointment with her and I didn’t really have enough follow up. I sort of managed it myself. It just didn’t feel like really solid care. She was wonderful herself. But I knew that the system wasn’t set up to where I could go in for longer appointments or anything like that.

I had also started seeing this myself in pharmacy where I was a pharmacist myself and started to see patients and I remembered thinking like, I’m going to know all of my patients. I’m going to know their stories, I’m going to know their history. I’m going to know how to help them. Every time they come to the pharmacy, I’ll know who they are and be someone that they feel really safe and comfortable around. And then I started working in retail pharmacy and it was like, you would go up and be called to counsel a patient on their new medication, and there would be a line out the door and instead of being able to do all of these things, I would say, hi, do you have any questions? Because phones are ringing off the hook and we’ve got people coming through the drive through and there’s doctors on the phone. It just felt like it was just too much to be able to actually invest in that person’s health.

And so that made me sort of start to feel like the conventional system was not really set up in a way to be able to help me and let alone anybody else. I also saw patients who would come to the pharmacy and actually express, like, well, my doctor put me on this med, but I really don’t know if I need it and I didn’t have a discussion with them around what the need was or what the thought process was about why they should be starting something.

And then another big moment for me was as a pharmacist, I had tried to research medications that could help with binge eating, and I did find one. It’s a ADHD medication and it’s an appetite suppressant. But at that time, it was off label for binge eating. So I went back to my doctor and I said, could I try this? And she trusted me. I’m a pharmacist. I was very open and honest with her and she trusted me. But she still went back and had to take 10 minutes to look into it. And then she came back and she was like, okay, yeah, I do see that it’s off label for that. We’ll give it a try.

And on one hand, I super appreciate that, that she was willing to go with something I was recommending for myself. But at the same time, it was like, but you didn’t know about that treatment? Like, what else is out there that I don’t know about or that conventional medicine doesn’t know about that could truly help me? And so that was a very big part of it. And then also feeling like we weren’t getting to the root cause together. It was always just chronic fatigue, anxiety but what’s causing this? Like, how did this even come about?

Christy Harrison: Right? What’s driving me to binge in the first place?

Sarah-Jane Garcia: Exactly. And then at this point, I was at the pharmacy one day, and I remembered I was working with a co-worker, also a pharmacist, and we were sort of talking a little bit about struggling with food. I remember we had all this candy at the pharmacy, and we would both just try so hard to ignore it and not reach for it. And then I remember she said to me, hey, have you ever heard of this elimination diet? And I was like, no. Here’s this pharmacist, right? She’s gone through a science background, and she’s like, I’ve found something that may be, like, really promising, do you want to try it with me? And so we did.

We went on this elimination diet at the same time because it had promised that your issue is probably just sugar and an addiction to sugar. And so if you just cut it out, then you’ll stop binging or struggling with food or at least that’s how I interpreted it. At the same time, that same person, she’s lovely, she was also caught up in her own issues, which is also part of the reason why I wanted to talk about this was because it was so many insightful, educated, smart people that would get caught up in plans or protocols or lifestyle things that would seem promising but end up being actually quite harmful. And it’s interesting how we get snagged and caught up in that.

She ended up introducing me to this online wellness guru, and I started listening to his podcast, and it just made so much sense to me. He would talk about how conventional medicine sort of failed him. He had a chronic illness. He couldn’t find the cause and then he went on this quest to find the root cause of his issue. And so then that resonated with me. Like, yes, yes, I want to know the root issue.

So we tracked the same way. We both had a problem. There was no viable solution from conventional medicine. And then we wanted to look at the root problem, which seemed like the most reasonable thing to do. So then I got really caught up in that world, and I started doing the detoxes, all these supplement protocols. And I think the trickiest part of all was that I felt like it actually worked the first time. I felt better and I was like, oh, gosh, this is it. I have now figured out all these ways to sort of help my issue.

And it didn’t work a few months down the road. It became unsustainable. I couldn’t sustain all these sort of practices that I was supposed to be doing. And when it didn’t work, I ended up believing this rhetoric that it was me not trying hard enough, that I just wasn’t doing it entirely, or I had cheated and had a little bit of sugar during the elimination period so it was like, just basically try harder.

The other thing that was really difficult, this is like such a wild story, but I was on vacation for my wedding in Kauai, and I ended up going into this smoothie bowl and there was the wellness guru. Like, he was there in life.

Christy Harrison: Oh, my gosh.

Sarah-Jane Garcia: And so then I was like, he’s even walking the walk. Like, look at him. He’s in this wellness shop and he’s doing all the things. It was confirmation that this was the correct thing. Right? He was doing all that. Anyway, I started to get really into it and I went on to become certified as an integrative health practice practitioner through his online program. So I took a course on how to correct your body with rest and sleep and supplements and all of these. And I was very much into it, sort of ignoring the times when it wasn’t sustainable and just making that about me not doing it hard enough.

Christy Harrison: Rather than that this protocol was maybe exacerbating things for you or was too restrictive or not the right fit for you.

Sarah-Jane Garcia: Totally. And I also felt like once I got into his world, it would lead me to all these other functional medicine people, and they would have thousands and thousands of followers. And I’d be like, what is this? They can’t all be wrong, you know? So there must be something here. How could they all be wrong? And so one person would lead me down the next algorithm echo chamber world. And it just felt like I just really got snagged and really bought into it all.

Christy Harrison: What was it like to get into that whole community and that social media, holistic wellness, integrative health kind of space? What sort of things did you start to believe?

Sarah-Jane Garcia: Well, so at this point, I wanted to become pregnant. And so I would start to post to these groups about the best way to get my body ready for pregnancy. And I would get all this information that sounded plausible, but looking back on it now was just so unsustainable. Various supplements to take, various morning routines to do, acupuncture, chiropractic, certain amounts of workouts, eating this, eating that. It was a lot. But at that point I was definitely into all of this and did my best to follow all of these guidelines.

Also, the elimination diet that I followed had formed this wellness community for moms who are pregnant or wanted to get pregnant. So I would follow that content a lot, and I would hear about all the things you needed to do to create this healthy baby. And so what ended up happening is now not only was I still binge eating, but I started to now really stress about the food that I was eating and what I wasn’t eating and what I needed to add in to my plans and protocols in order to create a healthy, healthy baby.

Christy Harrison: Yeah, there’s so much pressure on moms to do that and the language, even, of creating this healthy baby. That it’s, like, up to you and it’s all about what you put into your body to create this life in this perfect way. It’s so insidious.

Sarah-Jane Garcia: Yeah, it’s insidious. And it then became just so distressing. It became so distressing because I now felt like I knew what needed to be done to have this healthy, happy pregnancy and ultimately a healthy, happy baby and yet I was still binging and couldn’t stop that. I would email or I’d post in these chats to the group members, like, five months pregnant and I’m really discouraged because I really thought I would be doing clean eating for the full nine months and doing all of these things to help this baby grow.

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And I remembered getting to a point where I was like, I’m really worried that I’m going to be ruining her little organs or her immune system, or I’m gonna create a colicky baby because of the sugar that I have in my body and because of how much I cannot stop binging. I don’t know what to do. And so that was really tough. But a lot of the responses I would get would be like, oh, have you tried this way instead? Or, maybe add in this. They were just not sustainable.

Then I ended up giving birth to her, and she was this beautiful, healthy little baby girl. And in that moment was like, huh, okay. And then I also was like, oh, but it’s because I did all these things correctly. Even though I binged during my pregnancy, I still did the liver pills and the choline supplements, the right amount of exercise. And so I was like, that’s why, that’s what saved this little one. So I had this little girl and now it turned into mommyhood and how to raise this baby to be healthy, what to feed her. But at the same time, I also was very concerned about how to prevent her from having any of the eating issues that I had had.

So I started to look into, like, the best approaches for feeding her and how to feed her, what to feed her. And I got again, through social media, I found some baby feeding accounts. And the one account that I did find I actually really loved and resonated with. But they would show food like sandwiches or peanut butter and jelly or granola bars. And I’m like, wait, isn’t that like, ultra processed? So I liked the philosophy around it, but I was like, okay, but I’m just gonna do everything that’s clean and organic and gluten free or whatever else. And so I kind of went down that road for a little bit.

And I remember then getting to this place where she was going to be starting daycare, and I was so worried about the food that they were going to offer at daycare. I had then again reached out to this mama’s group and said, how do you all deal with knowing that your baby’s gonna go somewhere else for the day and get food that has toxins and pesticides and isn’t organic? How do you guys deal with this? I’m so anxious about it.

And the turning point for me was when I had come across another post on social media from a different baby feeding account and this person had posted a picture of a can of organic pineapple and a can of conventional pineapple. And she had said, we’ve got to stop fear mongering around conventional foods. And what she expressed in that post was the downsides of organic fruits is that that we are, number one, fear mongering around conventional foods to the point where some families are not even feeding their children fruit because they fear what it may do to their children’s bodies or how unhealthy it may be. So they’re not even feeding them fruit and then not feeding them anything at all in its place because they may not have access to the organic version.

And then the other part of that was how it’s creating this judgment of those who do choose to eat or get conventional foods that, like the rest of us sort of judge that choice. And that can be incredibly harmful, especially when the bottom line is that there’s some people that really cannot afford to go to various health food shops and get the kinds of foods that these wellness gurus and influencers are saying are the end all, be all to health. I was struck in that moment. I remember I immediately went and deleted the post, the question that I had sent to the moms group. And I felt so guilty. I was like, I’ve been contributing to this fear and how did this happen?

And then at the same time, I had compassion for myself. I was like, I also was fear mongered to. I was sort of caught in this trap because of this rhetoric that I had started to follow so closely. And so I really tried to just stay grounded in that. But nevertheless, it led me to now a whole new world where I had then started following Food Science Babe. Not Food Babe, Food Science Babe. And I started to see how all of these ideas that I had really thought were super plausible, like toxins and foods, the level of pesticides and foods organic versus non-organic could be broken down in a completely different way and completely debunked. And I just was like, oh, my goodness. That account led to another account.

It was pretty interesting at that point how I had started to now straddle the two worlds and started learning about this other side a little bit more. At this time, I got pregnant with my second baby. And this became very tumultuous because, on one hand, was really trying to loosen the reins on what I allowed myself to eat and so when I did, I would still binge eat. So when I was binge eating, I would allow myself to binge eat. But then I would also flip back to like, oh, my gosh, what if that’s not the correct information? What if that’s not the correct research? Everyone’s doing research on everything. How do I know that that’s the correct information? And so I would really be worried about harming the baby.

And on top of that I couldn’t stomach the “good foods.” I couldn’t stomach any of the food that this protocol had had me follow to create this healthy baby. I could no longer stomach those because I was so nauseous. All I could eat was like, cheese on toast, cheesy toast. And so then I was like, I’m ruining this baby. I’m sugar ridden and he’s getting all of it.

Christy Harrison: What a horrible feeling to have. That’s just so much guilt and so much pain.

Sarah-Jane Garcia: Yeah. I then went to my doctor, my OB-GYN. She was incredible. So incredible. Another turning point for me was that she knew that I wanted to try to approach everything naturally and do all these things, but she was so kind about it. I was able to hold onto my autonomy with her. She never told me what to do. She never pushed for anything. But she would give very plausible, sound reasons as to maybe why we wouldn’t engage in the certain practice in pregnancy or maybe why, for me in particular, a home birth wouldn’t have been the best thing.

She’s a conventional doctor, and I think she just started to really allow me to slowly peep back into conventional medicine again because she also spent like 30 to 45 minutes with me, which was like, not typical in that space. And so it really helped me feel open and safe to explore these other ideas because that’s how we need to feel when we want to open our eyes to other opinions or thoughts or beliefs. We sort of have to feel in a safe space to do that. We don’t want to feel shamed because we’ll totally shut down.

Christy Harrison: And to feel held in empathy too, and have someone give you that space, which, yeah, the fact that she made such time for you and had long appointments and was able to just show up and answer your questions, I’m sure felt very different than this image that you had and all the experiences you’d had in conventional medicine that sort of led you to this integrative place in the first place.

Sarah-Jane Garcia: Exactly, exactly. And she was wonderful and then at the same time, she really didn’t know where to send me for this food stuff. She could tell me till she was blue in the face that I’m not ruining my baby. And she just was like, I’ll look for resources for you, but I really am not sure where to sit. She just really didn’t know what to do with me. I then ended up having my son, and he was perfectly healthy and even more chill than his sister. And this was after a pregnancy of severe binging and no wellnessy products.

And so I was like, oh, my gosh, I’ve been duped. Wellness culture has totally duped me. This baby is fine. And so at this point, I then got upset and angry that somehow I had fallen for this. And then it just took me down this other road of figuring out how and why this has happened. And I’m super, super grateful because that’s been really great to sort of understand how many of us can really get snagged, especially now in our political climate, there’s lots of rhetoric around health and wellness and mis and disinformation and what we should be eating and what we shouldn’t be eating, all in this backdrop of there’s not enough people who get to eat in the first place. It’s very convoluted.

Christy Harrison: What do you feel like eventually helped you address the binge eating and orthorexia? It sounds like all of those experiences started to build up and make you question what you had been doing before and start to feel like, okay, I didn’t ruin my baby by eating in this way and sort of let go of some of the wellnessy stuff, the wellnessy products. I’m curious what other things maybe helped you shift that relationship with food for yourself?

Sarah-Jane Garcia: Yeah, I think it was being able to peek back into parts of conventional medicine and then also being given that safe space through my doctor. And then I had also seen a nutritionist at that time who was recommending that I just eat a few more Kind bars. And I was like, this? Are you sure?

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Most mornings, I hit snooze on my alarm as the sun peeks tentatively through the opaque curtains covering the edges of our heavy-duty blackout shade. A few minutes later, I take my phone out of the nightstand drawer and check my notifications, then start reading the news or whichever newsletter catches my eye. Soon I’ll have to get in the shower so that I can be ready when my daughter wakes up, filling the house with childlike chatter set to the soundtrack of her favorite kids’ songs. 

I love our time together in the mornings, just the two of us after my husband leaves for work (he started a new job last month, thankfully). But it can also be challenging, and these brief moments lying in bed with my phone make me feel connected, however fleetingly, to the world of ideas, of culture, of complex thought—and to parts of myself that feel both important and neglected. 

When the alarm goes off again, I try to grab one last piece of information as I get out of bed, like a swimmer taking a final sip of air before diving underwater. Then I throw open the curtains, lift the shade, and take in the day. 

And lately, throughout this routine, a small voice has been humming in the back of my mind like an incantation: sunlight before screen light. Sunlight before screen light.

This slogan has an intuitive appeal to me, as someone concerned with digital well-being. But it’s also become popular in wellness culture, which always makes me skeptical—and I encountered variations on the phrase several times while researching the dubious evidence behind Andrew Huberman’s “protocols,” which made me even more suspicious. Plus, I had the vague sense that “sunlight before screen light” was somehow tangled up with diet-culture ideas, like the belief that getting light exposure at the “right” times could lead to weight loss or prevent weight gain. 

After weeks of having my morning routine disrupted by a guilt-inducing inner monologue, I decided it was time to investigate the claims. What I found set my mind at ease. There isn’t actually any good science to support the “sunlight before screen light” slogan—or the notion that morning sunlight will somehow shrink your body. 

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The first part of this episode is available to all listeners. To hear the whole thing, become a paid subscriber here.

Writer, speaker, and weight-inclusive health/fitness professional Ragen Chastain joins us to discuss the potential side effects and other downsides of using GLP-1 drugs (like Ozempic and its ilk) for weight loss, the massive influence the manufacturers of these drugs are having on the public discourse about them, why the media don’t often report on these conflicts of interest, how drugmakers have co-opted talking points about weight stigma and weight cycling, how opposition to these drugs in some integrative- and functional-medicine spaces still perpetuates stigmatizing ideas about body size, and more.  

Ragen Chastain is a speaker, writer, researcher, Board Certified Patient Advocate, multi-certified health and fitness professional, and thought leader in weight science, weight stigma, health, and healthcare. Utilizing her background in research methods and statistics, Ragen has brought her signature mix of humor and hard facts to healthcare, corporate, conference, and college audiences from Kaiser Permanente and the Diabetes Education Specialists National Conference, to Amazon and Google, to Dartmouth, Cal Tech and canfitpro. Author of the Weight and Healthcare newsletter, the book Fat: The Owner's Manual, co-author of HAES Health Sheets, and editor of the anthology The Politics of Size, Ragen is frequently featured as an expert in print, radio, television, and documentary film. In her free time, Ragen is a national dance champion, triathlete, and marathoner who holds the Guinness World Record for Heaviest Woman to Complete a Marathon. Ragen lives in Oregon with her fiancée Julianne and a rotating cast of foster dogs.

Resources and References

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Ragen’s Weight and Healthcare newsletter

• Ragen’s appearances on Food Psych episodes 58 & 119

• Overview of the evidence on weight cycling

• Studies finding that weight cycling can explain excess mortality risk

• GLP manufacturers partnering with plus-size influencers

• The Observer’s reporting from 2023 on Novo Nordisk’s influence, and its proposal to target people on unemployment

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast app

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Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Welcome to Rethinking Wellness, a podcast that offers critical thinking and compassionate skepticism about wellness and diet culture, and reflections on how to find true well-being. I'm your host, Christy Harrison, and I'm a registered dietitian, certified intuitive eating counselor, journalist, and author of three books, including Anti-Diet, which was published in 2019, The Emotional Eating, Chronic Dieting, Binge Eating & Body Image Workbook, which came out on February 20th, and The Wellness Trap, which was published in 2023 and is the inspiration for this podcast. You can learn more and get them all at christyharrison.com/books.

Hey there. Welcome to this episode of Rethinking Wellness Today my guest is Ragen Chastain, a friend of the pod and a weight inclusive speaker, writer, and health and fitness professional who joins me to discuss the potential side effects and other downsides of using GLP-1 drugs like Ozempic and its ilk for weight loss. We also talk about the massive influence that the manufacturers of these drugs are having on the public discourse about them, why the media don't often report on these conflicts of interest, how drug makers have co-opted talking points about weight stigma and weight cycling, how opposition to these drugs in some wellness culture spaces like integrative and functional medicine still actually perpetuates stigmatizing ideas about body size, and lots more. It's a great conversation and you can listen to the first half for free and then upgrade to paid to hear the whole thing by going to rethinkingwellness.substack.com.

If you do, you'll not only get to hear full interviews with all of our guests, but you'll also get subscriber only Q and A's, full access to our archives, commenting privileges, and subscriber threads where you can connect with other listeners, and more. Plus, you'll get my undying gratitude for supporting the show. I really am so grateful to everyone who's become a paid subscriber. Just go to rethinkingwellness.substack.com to sign up or click the link in the show notes.

I also want to make sure you know about my second book, which is called The Wellness Trap. You've heard me talk about it here before I launched this podcast to continue the conversations I was having in reporting the book. And if you like the interviews here, I think you'll love the book. It explores the connections between wellness and diet culture, how wellness became so intertwined with misinformation and conspiracy theories and scams, why alternative and integrative and functional medicine, or complementary and alternative medicines, it's sometimes called, can lead to disordered eating and other harms, and how we can both protect ourselves as individuals and reimagine well being as a society.

If any of that sounds interesting, you can check out christyharrison.com/thewellnesstrap to learn more and buy the book or just head to your favorite local bookstore and ask for it there. And now, without any further ado, here;s my conversation with Ragen Chastain Ragen. Welcome to Rethinking Wellness. I'm so excited to have you here.

Ragen Chastain: Oh, thank you for having me. I'm super excited to be here.

Christy Harrison: Yeah, so people will have heard you on Food Psych I'm sure. And they can go back and listen to your episodes. We'll put them in the show notes if they havent heard them for like your full story. But I'd love for you to just tell us a little bit about yourself and your history with wellness culture and diet culture.

Ragen Chastain: Sure. So currently I'm a speaker, writer and researcher. My area of expertise is the intersections of weight science, weight stigma and healthcare. And I actually came to this through the research, trying to find the best diet. I had yo-yo dieted for years and so I decided my background is research methods and statistics and I'm a mega nerd. So it seemed reasonable to me to do a literature review to find the best diet. And through that literature review, realized that there wasn't a single study where more than a tiny fraction of people we're actually succeeding at significant long term weight loss, which sent me down a now more than 20-year rabbit hole of learning about the research in the field.

Christy Harrison: It's amazing. I loved what you shared on the first episode about that deep dive you did into the research and just how eye opening that was for you. So definitely encourage people to check out that episode. We're going to talk today about GLP-1 agonist drugs like Ozempic, which I'm sure people have heard all about them. They're a huge trend. They're a relatively new class of diabetes drugs that have also become blockbuster diet drugs in the last few years. And you've done a ton of great reporting about these drugs in your newsletter. So I want to dig into that today. Can we start off, though, by just having you give us an overview of how these drugs are thought to work?

Ragen Chastain: Yeah, so these drugs are actually type two diabetes drugs. They impact the amount of glucose the liver puts out. They impact your body's relationship with insulin. They also slow gut motility. And so they in various ways impact glycemic management or blood sugar and the thing about these drugs that is special is that they only start acting when blood sugar goes up. And so there's less chance with these drugs than some others that you'll have a hypoglycemic episode, which is low blood sugar, which can be fatal. They're solid type two diabetes drugs, and they work well for people who are contraindicated for other drugs or who can't get glycemic management through other drugs, though they're not necessarily a frontline treatment because of the number of side effects that they have. But, yeah, so that's how they came on the scene.

And then what happened was Nova Nordisk and Eli Lilly realized that people who were taking the drugs for type two diabetes had a side effect of some weight loss, and they decided to exploit that by repackaging them and getting FDA approval for them as weight loss specific drugs.

Christy Harrison: Yeah. And that's where the trouble comes in. What are some of the potential side effects and other downsides of using these drugs for weight loss?

Ragen Chastain: Well, so the thing about the weight loss treatments is that they are a mega dose of a type two diabetes drug. And so what we're talking about for diabetes, they're dosed so that you take the minimum amount of the medication you need in order to get the glycemic management that you want and minimize the side effects. But for the weight loss application, the goal is simply to maximize that weight loss side effect, and you can't maximize that without maximizing all of the dose dependent side effects.

And so just to kind of clear up any confusion, Semaglutide is the name of the drug. It's a Novo Nordisk drug. Ozempic is the type two diabetes application, and Wegovy is the weight loss application. So the required dose of Wegovy is 2.4 milligrams. The maximum dose of Ozempic is two milligrams. And up until two years ago, it was just 1 mg. So it's basically the required dose of Wegovy is more than the maximum dose of Ozempic. So it's, again, a mega dose of these drugs to try to get a side effect to happen at the highest rate.

So the drugs themselves have some significant side effects. First of all, they have what's known as a boxed warning, which is the strongest FDA warning possible for a possible side effect of thyroid C cell tumors. They can also, some lesser known side effects include the fact that they can cause fetal harm and they have a long half life. So they warn that folks both what they call, quote, females and males. And I want to be clear, they're not trans or nonbinary inclusive in their labeling at all, of reproductive potential should discontinue the drug at least two months before a planned pregnancy. However, then they also say once pregnancy is recognized, discontinue the drug. But it's unclear to what extent that will help, given that the half life is so long.

So there's that piece of it. Their common side effects are predominantly gastrointestinal things like nausea, diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, dizziness, stomach pain, eructation, which is burping. But they also have serious side effects, and that can include things like acute pancreatitis, acute gallbladder disease, acute kidney injury, heart rate increases, there's suicidal ideations and behaviors, and also something called Ileus, which part of the drug's effect is. What I mentioned slowed gut motility. So food moves through the digestive system more slowly, but when peristalsis actually ceases, then the body ceases to be able to eliminate solid waste, and that can be fatal and typically requires hospitalization. And that's also a side effect of these drugs. So the side effects are potentially fatal.

Christy Harrison: I had Ileus after my c-section because one potential way of getting it is if you have abdominal surgery and your intestines are manipulated, they can just sort of seize up. And that happened to me, and it was one of the most horrible experiences of my life. The fact that that is a potential side effect is so scary.

Ragen Chastain: A really tragic story from Australia. A woman went on these drugs because she wanted to lose weight for her daughter's wedding, and she got what sounds like Ileus and passed away. So she didn't go to the wedding. Or anything else in her daughter's life. I think there's just not any kind of informed consent that I'm hearing from healthcare practitioners that's honest about that. In fact, people are telling me that when they ask about side effects, they get blown off with things like, "Well, all drugs have side effects," or it's no big deal. And that the first statement is true but not helpful. The second statement is not true.

Christy Harrison: So how are these side effects different? Cause I think the thing is, the risk benefit analysis of any drug is sort of seen as, "Well, this drug has benefits, and this is gonna give you something helpful, and you have to weigh it against the potential risks." And in this case, I think both risk and benefit are so blown out of proportion or confused. Because the risks are a lot bigger than I think a lot of doctors are letting on, certainly than a lot of the mainstream reporting is letting on, which we can talk about more. And then the quote, unquote, benefits of weight loss, as you've reported extensively, and as I've talked about, too, are not actually evident that weight loss is not necessarily a path to health and in fact, can lead to far worse outcomes for many people.

Ragen Chastain: Exactly. And I think it's important for people to understand that when the FDA makes these risk benefit analyses for weight loss interventions, they're testing it against a mountain of research that the weight loss industry has spent literally decades crafting funding, conducting, publishing in journals that they own. That makes these simple correlations between being higher weight and health issues, fails to control for confounding variables at all, and then says, "See, it's so dangerous to be fat that it's worth risking people's lives and quality of life in attempts to make them even a little bit thinner." And the FDA agrees and they approve these interventions.

And so we have to understand that FDA approval doesn't mean safe or it doesn't mean the risk is worth it based on what I might believe the risk is worth, but rather based on the idea that they believe it's worth killing us to make us thin. That's an important thing that doesn't get, I think, talked about as much in terms of the way that this works. And, yeah, the medications themselves. So we only have two years of research on the drugs at this dosage, and one, they show that as soon as people go off the drugs, they regain the weight, which is what every single weight loss drug has experienced ever since weight loss drugs started.

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But Novo Nordisk and Eli Lilly's unbelievably profitable solution is that, "Oh, people just have to stay on these drugs for their whole life," which is why we're seeing aggressively this phrase that, quote, "Obesity is a chronic, lifelong disease," right? That's in support of them selling these drugs to people for their whole lives. But this is on two years of research. And at the end of the two years, people's weight was going up even if they had managed to stay on the drug. And their own research shows that side effects will mean that many people will not be able to stay on the drug.

So even if people do manage to stay on the drug, there's no guarantee that the weight loss will continue, and there's no guarantee that they'll get health benefits in general. There's just this assumption that, "Oh, if we make people thinner, we'll make them healthier." But that's not, as you've said and reported and wrote entire chapters of entire books about, that's not scientific thinking.

Christy Harrison: And so there are people out there who will say, "Well, these drugs have been researched for diabetes for many years, and so there's long term data about them and showing their safety for that. But how does that compare to the research on weight loss? And why can't we use the evidence that's out there on diabetes to support the supposed safety of these drugs for weight loss?

Ragen Chastain: Yeah. So again, Ozempic has been around for six years, and the first four, the maximum dose was one mg and the last two, it was two. So we have research on these drugs used at much lower rates, much lower dosages. So we don't know what happens when you take 2.4 milligrams of this drug every day or every week, rather, for the rest of your life. We don't have that kind of research at all. And so, again, when you're trying to increase the side effect of the drug, you're going to increase all of the dose dependent side effects of the drug. And we don't have long enough research to find that out.

And the research is being funded by Novo Nordisk and Eli Lilly. It's being conducted by people who are either taking payments from them or are directly employed by them. And so there's no real incentive, to be honest. And if you saw the way that they treated their cardiac study, where they, instead of releasing the study, they held the study, but released a press release that had three lies just in the headline alone, they just can't be trusted.

Novo Nordisk, it should be mentioned, was one of, if not the biggest offenders of price gouging on insulin. They, in fact, engaged in what's called shadow pricing. So they would watch what their competitors did, and as soon as their competitors increased the price, they would increase their price. And so we have to realize, we have to look at this through the lens of, this is a company that has already said we will let people die for money. We have no problem with that.

I was speaking at a conference recently, and I was seated next to the current president of the American Medical Association, and we had a great conversation about this. But he said, well, I think the prices will come down because of competition, and I do not share that view because that's not what we've seen Novo Nordisk do. The prices only went up on insulin. And this is a drug whose patent was sold for a dollar to make sure that it always would be affordable.

Christy Harrison: Well, let's talk about Novo Nordisk. These drug manufacturers, Novo Nordisk in particular, but also manufacturers of the other drugs in this class, GLP-1s to some extent as well, have been just pushing these drugs relentlessly as weight loss drugs. And this includes partnering with plus size influencers, influencing the discourse and the media and elsewhere. How have you seen this influence show up? And is it always disclosed?

Ragen Chastain: I would say it's rarely disclosed. There was an article in the New York Times written by Gina Kolata that was essentially lobbying for insurance coverage of these drugs. And that's their holy grail, right? After all of the disasters of Fen-Phen and Redux and people dying, Medicare stopped paying for weight loss drugs. And so their big push here in the States is Medicare coverage, and in other countries, it's getting it on the national formulary. And so this is like a huge goal of theirs. So this article in the New York Times quoted a bunch of experts about the importance of these drugs and why they should be covered by insurance. Every single expert quoted had taken money from Novo Nordisk and or Eli Lilly, and that was not disclosed at all.

Christy Harrison: Yeah, I've seen that a lot in media coverage as well. It's just rampant.

Ragen Chastain: Yeah. And that's sort of some basic journalism, right? If you're quoting a bunch of people who are taking money from the company who you're writing about, that would be something you'd want to talk about. I think it's also important to know that they are starting a bunch of what seem like grassroots campaigns with names like EveryBODY Covered so it sounds a lot like the kind of social impact you would see this campaign from a fat positive or body positive group, but in fact, they're funding them and sort of trying to co-opt the discussion around weight stigma to make it be about weight loss, claiming that the real weight stigma is people not having access to their drugs, claiming that the cure for weight stigma is to lobby your congressman to make Medicare cover these drugs. So it's really, really insidious.

And they're getting well meaning organizations who just simply don't know better, signing onto these. And it's in really sort of despicable ways. They're co-opting decades of actual anti-weight stigma work and trying to center themselves as experts. I was recently on a panel about weight stigma in research, and I didn't know until it was basically too late. It was hosted by someone from the Obesity Action Coalition who only identified them as a patient advocacy organization and forgot to mention that they took over $700,000 last year from Novo Nordisk and Eli Lilly, and that they're almost entirely funded by the weight loss industry.

Christy Harrison: Wow.

Ragen Chastain: One of the researchers on that panel was funded by Weight Watchers and Novo Nordisk and spoke to their talking points and didn't disclose that. And this is what they've done for decades, really, is to infiltrate the healthcare system and then manipulate it from within.

Christy Harrison: They were called out in the UK for sponsoring professional development for medical doctors and also for using sort of shady tactics to get on the national formulary, pushing without disclosing that having medical doctors push for inclusion on the formulary without disclosing that they were taking money from these drug companies. It's great that the UK press has reported on that a little bit. There was some investigative reporting in The Observer and the Guardian. But I don't really see that kind of investigative reporting happening here. Why do you think that is?

Ragen Chastain: Well, the rules in the UK are very different. They're much more restrictive. They don't have commercials for prescription medication on television. And so because I think the rules are not as lax, they're more observant to what is happening. And also Novo has to do even more insidious things to try to get things done. They got actually in trouble with the pharmaceutical trade group there, the APBI, and they had a hearing and they said, "Oh, no, you can't have this medical education that's basically an advertisement for your drug, but call it medical education." And Novo appealed it on the basis that they didn't know that that was wrong. And it backfired so spectacularly that they publicly reprimanded them and suspended them.

In two years, they'll review to see if they get to come back in. I think that there's more scrutiny in the UK because there's more strict rules about how these companies can behave. Here in the states there's also incredible financial ties. I was writing for an outlet that it turned out was being funded by Novo. And so they were promoting what they're calling their, quote unquote, anti-stigma campaign, which is literally named It's Bigger than Me. Like, you get it because fat people are big. If your weight stimulate campaign sounds like it was named by a sixth grade bully, you're probably not an expert in weight stigma.

But of course, their solution to weight stigma is insurance coverage for their drug and access to their drug. And so I talked to my editor and was like, what is happening? And they apologized, and they said, "Yeah, this is a separate department from us." And they let me write a piece essentially, like, point by point, explaining why what Novo Nordisk is doing is unethical and wrong and backhanded, which I appreciated, but it's everywhere. They are raking in billions of dollars, and they are spending those billions of dollars influence peddling.

And they got caught in the UK, and they actually got caught in the US with Saxenda, an earlier drug. And Mikey Mercedes wrote an excellent piece about this in her Patreon. But they got fined millions of dollars because they were told that they had to disclose the dangers of this drug. And then they found out that behind the scenes they were telling their salespeople to downplay the dangers and to tell doctors there were no dangers. So they've been fined for this already.

And what they're really doing is taking every page they can from the Purdue Pharma playbook for OxyContin. Everything that Purdue did that Novo Nordis can duplicate, they're duplicating it, and then they're improving upon it. And so it's incredibly scary to watch it happen in real time and to see people kind of get sucked into it.

Christy Harrison: That's terrifying. Why do you think the media and the US have been generally unsceptical about the influence of these drug companies? Because I've spoken with some outlets over the years, over the last several years, that usually don't take my recommendation to look into the financial influence of these companies. And I think if they do disclose that someone has financial ties to a drug company, the attitude is sort of along the lines of, like, "Well, all, quote unquote, obesity experts take funding from drug companies, and that's just how things are done, and it's not a big deal" kind of thing.

Ragen Chastain: Yeah. And I think that's a big piece of it. That they're like, "Oh, well, yeah, doctors take money from drug companies, but, like, everybody does that." That doesn't make it good or okay. And actually, research shows that even small amounts, like less than $20, impact doctors prescribing behaviors. So when you look at doctors who are taking hundreds of thousands of dollars. We have to start really asking questions. Even if someone doesn't believe that can impact them consciously we have to ask about subconscious bias as well.

And so I also think in our media, I think there's an issue with a 24 hours news cycle that has to be fed. I think there's an issue with there being less and less even survival paying jobs for reporters. And so reporters are being asked to report on science, who never wanted to report on science and have no particular interest or skills there. And also the weight loss industry has done an incredible job of constructing a paradigm where fat equals bad weight loss equals good, is considered beyond settled science, like religion.

And so if somebody says, like, fat, bad weight loss, good, then the reporter goes, absolutely. And they write it, and they reach out to the person who wrote the study, and they don't mention that they've taken hundreds of thousands of dollars from the drug the study was about, and everybody sort of takes it as truth. And so I think there's a lot of layers to why we don't have appropriately scientifically literate, critical media around these drugs.

And it really is a huge issue because Novo Nordisk is taking full advantage of that. Their press release around their cardiac event, for example, said that it slashed cardiac events 20% in adults with, quote, overweight and obesity. In truth, it decreased them 1.8% in people 45 and older with cardiovascular disease and without type two diabetes, and who had a BMI of 27 or above. And BMI is a crap measurement. But if you're talking about people who fall into the, quote, overweight and obese groups, that's 25 and up. So all three of their claims were not true. In case you didn't take research methods, making up definitions for terms that have clear definitions is not a best research practice.

But this is exactly what they did. And it traveled like wildfire through the media, slashes by 20%. I'm co-authoring a study that's looking, in fact, at how that 20% number traveled through the media because it was so outlandishly untrue. It takes advantage of the difference between relative and absolute risk. That's something that a science reporter would or should know or ask about. But instead, it just got copy pasted and they didn't release the study. So you couldn't critique it.

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Christy Harrison: Right.

Ragen Chastain: That's all you had was a press release.

Christy Harrison: I think that's the part of this. That is so insidious, because it plays on pre-existing issues in journalism, where journalists often are covering science and nutrition and food and weight stuff that are not trained in research methods and how to read a study. And they often report on press releases anyway, or have a press release and then call the scientist for some quotes and maybe look at the abstract of the study but often don't even have access to the full study or know how to read the full study if they do.

And then now it's sort of like cutting out the rigorous part of the equation where if they could at least have access to the study, someone could fact check it. Now it's like, "Just look at this press release. Don't look over here at the actual data or evidence." And there's research, too, on how misinformation travels so far and so much farther and wider than the truth, and then corrections barely get any sort of traction. So even if this information went out and then was later corrected by some media outlets, which I don't know if they bother to even do that, if some did, based on reading the actual study, it wouldn't really matter because the 20% number is already stuck in people's head.

And that illusory truth effect idea that I probably will have talked about in my newsletter and on this podcast by now is the idea that if things get repeated enough, people start to think of them as fact, even if they're false, just because of the repetition. And this makes me think of that, where it's like they're taking advantage of that, not really caring about the consequences.

Ragen Chastain: And it also slows down the rate of critique. There are several reporters who as soon as Nova Nordisk releases something, they'll contact me either for a quote or on background. So I would have told them, like, "Oh, no, this is absolute versus relative risk. Here's what they actually found in this study, in these results. And here's what's untrue about the press release." But I actually could not do that. There's no way, because they didn't release the study. So it slows down the critique.

And that's something that they're putting progressively, doing. They're learning and evolving. So they'll see people critique them, and they'll slow down the critique, or they see that the word is getting out that weight cycling creates significant health issues independently that may be getting blamed on being higher weight. And so they've rebranded weight cycling into relapsing, remitting obesity. And they claim that it's part of the chronic disease structure. And so we're to expect that on their drugs, weight will go down and up, not because their drugs don't work, which is the truth, but because this is a relapsing, remitting, life long condition. I mean, gross. I want to find a more scientific word, but it's just disgusting.

Christy Harrison: I want to talk about that rebranding more in a minute. But I'm also just curious to dig in a little bit on the idea of relative versus absolute risk, because I think this is something that for science literacy and sort of reading, reporting in general on food and nutrition and weight and health is useful to people to know about. So can you briefly explain the difference between relative and absolute risk and why the concept of relative risk is so popular in the media?

Ragen Chastain: Sure. So relative risk is the percent of decrease of risk in the group who received an intervention in a study versus the group who did not receive the intervention. So this is a good way to tell the difference between groups in the study, but it is not a good way to determine how the intervention will affect individual risk outside of the study. Absolute risk reduction, that's the actual difference in risk between the group that got the intervention and the group that didn't. And so this is a better number to help us understand what's the likelihood that any given individual is going to benefit from the intervention. And so relative risk reduction is often going to be a much larger number than absolute risk reduction.

So I'll give an example. 200 people have condition X. They get enrolled in a study to see if medication Y reduces death from condition X. So 100 of them are given the medication, 100 are not given the medication. They're in the control group. At the end of that observation period, one person who was given the intervention dies, and two people in the control group die. So the relative risk reduction is the percent risk of death in the intervention group divided by the percent risk of death in the control group. So here 0.01 divided by 0.02, which is 0.5 or 50%. So if I were a drug company who did this study and didn't have good ethics, I might report that there was a 50% reduction in risk.

But the absolute risk is actually calculated, you subtract the percentage of risk reduction in the intervention group from the percentage of risk reduction in the control group. So 2% minus 1% which means the absolute risk reduction here is just one percent, which is a much smaller number, and it far more accurately predicts individual experiences. And so when you see these big percentages, we have to be asking, "Wait, is that relative risk reduction or is that absolute risk reduction?" Because it's a huge difference and it can be incredibly misleading. And like the reader shouldn't have to ask that. The reporter should be asking that. But either way, it's a question somebody needs to be asking.

Christy Harrison: And then there's relative risk reduction versus absolute risk reduction, and then relative risk versus absolute risk as well, which I think is another issue people get really confused about, because if 2% of people in a given group have a harmful outcome, and then there's an increase in risk or a decrease in risk, let's say theres a 50% decreased risk, 1% of the people who take the drug or whatever have the problem. I mean, I know, I have thought this too when it's like, you know, food X reduces your lifespan by X number of years or something, or increases your risk of heart disease by 50%, I think the reading in the general public is to think, oh my God, 50% of people who eat this food get heart disease, right? And that's just not the case. The percentage of risk, relative risk, versus the absolute percentage of people who are going to be at risk of something is incredibly different.

Ragen Chastain: And it's not just the general public. I was advocating for a patient who was denied surgery because his surgeon said that there is a 100% risk of complications at his BMI. And I was like, that is not my understanding. And so we talked about it, and it came out it was a 100% increase in complications. So instead of a 3% risk of complications, there was a 6% risk of complications. That's a 100% increase. Three to six. But what the surgeon understood was that 100% increase in risk meant 100% risk.

Christy Harrison: Oh my God. I mean, and this is a science. This is someone who's trained in research methods, right? Ostensibly.

Ragen Chastain: Yeah. This is someone who's denying healthcare to someone on the basis of their understanding of 100% increase in risk, meaning 100% risk. So it's not surprising that lay people are making this mistake and that these drug companies and pharmaceutical industry in general are taking advantage of that lack of understanding and exploiting it.

Christy Harrison: God, that is just so insidious. So let's circle back to weight cycling, because this is a longstanding thing. I feel like these drug companies are trying to weaponize, as you said, critiques of weight stigma and diet culture, and of the traditional weight paradigm, which have focused a lot on weight stigma and weight cycling, and how the traditional weight paradigm increases people's risks of those things, which in turn increases their risk of all kinds of harmful outcomes or of health problems that get blamed on weight itself.

And when it comes to weight cycling, there's a substantial amount of evidence showing that weight cycling is an independent risk factor for things like heart disease, diabetes, mortality, certain forms of cancer. There's at least two studies and very large cohorts of people that showed weight cycling could account for all of the excess mortality risk associated with being in a larger body, or at least cardiovascular mortality risk, I think. Weight cycling is a serious issue, and weight loss attempts make people vulnerable to it. And yet the makers of these new drugs are trying to harness that information and rebrand weight cycling to their advantage to sell their products. Can you talk a little bit about the sort of insidiousness of that and how people can see through language that is ostensibly geared towards reducing weight stigma or calling out the harms of weight cycling, but then trying to use it to sell these drugs?

Ragen Chastain: Yeah, so it is pretty insidious, and they're getting very good at it. And so I think in terms of when you're looking at something and even if you get a sense this doesn't sound right or could this be, if they're using this phrase that, quote, obesity is a chronic progressive relapsing remitting disease like asthma and heart disease. All of that is junk science, but it supports their paradigm. And so we're seeing that phrase more aggressively used and pushed into healthcare. So if they're using that phrase, that's a real good clue.

If they're saying that the real weight stigma is the lack of access to their drugs or that expanding access to weight loss interventions is how we fight weight stigma. If you're seeing phrases that seem like they would be in a weight neutral health or fat activism community, but then they're using terms like, quote unquote, overweight, or, quote unquote, obese, that is a really good clue that this is coming from the weight loss industry. If they're using person first language where they say a person with, quote, obesity or a person with, quote, overweight or a person affected by one of the O words, that is going to be drug company language, weight loss industry language, that's not language that's supported by a weight neutral health community or fat activism community.

And if they're claiming that lack of access to these weight loss drugs is some kind of social justice issue, and one of the ones that I personally think is the most insidious is that the lack of access to these drugs that black and brown people have is like the real racism in weight stigma, but they don't mention that they grossly underrepresented those communities in the drug trials that they put together and funded. So to now come back and say, "Oh, it's an injustice that these communities don't have access to these drugs," when they didn't include them in appropriate levels in their trials, it just repeats a history of performing experimental medicine on these populations. And so to call that social justice, I just can't even wrap my head around. You have to be on your guard all the time because they're getting really, really good at this.

Christy Harrison: Yeah. Kind of switching gears a little bit from the drug companies themselves. I've been seeing some interesting arguments about these drugs and wellness culture, like in integrative and functional medicine spaces, where some providers and influencers have been saying that the drug side effects are concerning and that people shouldnt take them for weight loss, especially kids. And that's good. I appreciate those critiques. But then in the next breath, they say that the real solution is to address the, quote unquote, root cause of the obesity crisis, which is presumed to be the toxic food environment, ultra processed food, sugar. Like, heavy air quotes around all of this stuff, right? And I'm curious to hear your thoughts on this kind of rhetoric.

Ragen Chastain: Yeah. So it's basically people that've been selling weight loss, but now the way that they were selling weight loss is at risk.

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

This week’s question is about creatine, a supplement that’s been getting a lot of hype in wellness culture. The first part of my answer is available to everyone, and paid subscribers can read the whole thing, including my deep dive into the scientific literature.

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The latest hot supplement these days seems to be creatine. I would love to know more about it and whether or not the current science supports the claims that are being made.

FYI: my answers here are for educational and informational purposes only, aren’t a substitute for medical or mental-health advice, and don’t constitute a provider-patient relationship.

Creatine is indeed a hot supplement in wellness spaces. Long popular with gym-bro types, in recent years creatine has moved into mainstream wellness culture and become increasingly popular with women, thanks in part to influencers and big-name podcasters.

Creatine is an organic compound that helps the muscles produce energy. It’s found naturally in meat, poultry, and fish and synthesized in the body from amino acids in plant proteins (except in rare creatine deficiency disorders that require supplementation). Despite its abundance, many people use creatine supplements to try to get more of the compound, on the belief that it has a wide variety of health benefits.

Health claims about creatine often center on muscle building and athletic performance, which are probably the most common reasons people take the supplement. But the purported benefits also go farther, extending to brain health, gut health, bone density, cardiovascular health, and more.

What does the science really say? You may or may not be surprised to learn that many of the popular claims about creatine are wildly overblown, though there are some grains of truth.

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Researcher Maxine Ali joins us to discuss how wellness micro-influencers and practitioners construct “authentic” online personas to spread misinformation.

We explore the ways that creators with smaller platforms build trust in seemingly less commercial ways than macro-influencers, including: personal stories of illness, medical encounter memes, and hyper-simplified straw man formats. Then Maxine explains why these ways of sharing can lead to powerful parasocial influence that undermines the perceived expertise of medical professionals worldwide.

Behind the paywall, Christy and Maxine unpack what influencers are doing when they’re “truth-telling,” why conspirituality and conspiracy theories thrive online, and how the rise of “mythbusting” has warped into insidious platitudes.

The first half of this episode is available to everyone. To hear the whole thing, become a paid subscriber here.

Maxine Ali is a researcher and teaching fellow of sociolinguistics at King’s College London. She is currently completing her PhD, and holds an MSc in Medical Humanities, and BA in English Language and Communication, also from King’s.

Maxine’s research broadly concerns the intersections between language, culture and health, with a specialist focus on social media contexts. In particular, she is interested in interactional dynamics and practices within online alternative/holistic health and wellness cultures, as well as the significance of these dynamics for the circulation, amplification and legitimation of health mis/disinformation and conspiracy theories. In addition to her academic responsibilities, she is a writer and public speaker, focusing on the language of wellness.

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Resources and References

• Christy’s second book, The Wellness Trap: Break Free from Diet Culture, Disinformation, and Dubious Diagnoses and Find Your True Well-Being

• Subscribe on Substack for extended interviews and more

• Food Psych #208: Media, Wellness-Diet Culture, and the Power of Language with Maxine Ali

• Food Psych #121: The Truth About Diet Culture with Emily Contois

• Maxine’s website

• Christy’s online course, Intuitive Eating Fundamentals

• Subscribe on your favorite podcast appSubscribe on your favorite podcast app

Transcript

Disclaimer: The below transcription is primarily rendered by AI, so errors may have occurred. The original audio file is available above.

Christy Harrison: Maxine Ali, welcome to the show.

Maxine Ali: Hi. Thank you so much for having me. I’m really excited to be here talking to you. It’s been quite a few years since we last caught up.

Christy Harrison: Yeah, we’ve been connected for a while. We first met, I think, or had our first conversation way back in 2019 when I had you on my other podcast, Food Psych. And then later I interviewed you for my book, The Wellness Trap. So those were really great conversations about your history and experience with wellness culture. And people can check those out for your full story. But for the purposes of this interview, I’d love to start off by having you tell us a little bit about your history with diet and wellness culture and how you came to do the work you do today.

Maxine Ali: Sure. So we’re now going back maybe like two decades. So kind of around the time I was like 12 years old, I was diagnosed with a chronic illness called ulcerative colitis. And I had a really difficult time getting a diagnosis. Firstly, I was experiencing kind of a lot of pushback from kind of medical professionals who are saying this is just a normal kind of thing of you growing up, experiencing kind of normal feminine symptoms like period pains and such. And so when I finally got a diagnosis of ulcerative colitis, I was already incredibly unwell. I’d been off from kind of school and sort of life for quite a few months and had a really, really bad time coming to terms with this new reality that I was kind of unwell. Being a young girl, it’s not a kind of reality that I think a lot of people expect to come up against.

I spent a lot of my teen years taking medication, but also kind of experimenting a little bit with sort of the natural and alternative approaches. I had been really exposed growing up to a kind of mentality that natural approaches were much better than medical approaches and there’s no side effects, there’s no downside to trying to control things with diet and diet and kind of lifestyle changes, and did that for kind of a long time until I was about 18 years old and that was when social media was starting to kind of really take off. People were kind of on Instagram and creating health blogs and such. And that was when I encountered wellness culture on Instagram. I guess

I just got really swept up in the aesthetic of it all, the promises of wellness being this pathway to self management and self healing outside of this kind of medical sphere that I’d had a really challenging experience with. And so I went hard into this kind of wellness and alternative health culture type activities. When we spoke last, I think I talked about how I did the whole kind of dairy and gluten free, refined sugar free, all of the free froms that they tell you in wellness culture absolutely needed in order to kind of optimize your health. Initially I was like, this is really working for me.

And also was the thing about wellness is it also offers you this kind of support and community almost because I was living in London at the time where wellness was taking off and I was making friends and meeting people and was like, this is really exciting. I kind of have this community of people with a shared interest to me. But it all just took a really horrible turn when I started to get even more unwell. My symptoms were not improving and I realized that actually a lot of the things that I was doing for wellness was actually making me a lot more sick.

So I lost my period for, I think almost four years. I, of course, as many people do with wellness culture, developed really, really disordered eating habits. So I became absolutely terrified of eating anything that was not deemed clean or healthy, which of course severely restricted my kind of social life as well, being in my late teens, supposed to be kind of experiencing all these new things, all these new adventures with this newfound independence. And I was terrified to kind of go out with my friends and do these kind of all very normal things you’re supposed to be doing at that age. I just really descended into this kind of horrible spiral of being so all consumed by this pursuit of optimal health and meanwhile not actually getting healthier.

Christy Harrison: Yeah, it sounds like the pursuit of wellness made you profoundly unwell, like it took you away from what you were actually looking for. But it’s seductive, right? Because at first it seems like it’s working. And so then when it doesn’t work and when you feel worse, you sort of tend to blame yourself. At least that’s what my experience has been and so many other people I’ve talked to. I’m curious if that was the case for you too, where you just sort of felt like, well, if it worked at first and now it’s not, then it must be that I need to do it more harder or be more diligent about it or something.

Maxine Ali: That is exactly it. Whenever you kind of run into these issues of, why am I not getting better? You turn to social media, you turn to the Internet, and you look for what am I doing wrong? What have I missed? Maybe I’ve just not found the perfect diet yet. And it just pushes you further down this rabbit hole. And there were a lot of different factors going on besides me kind of having these struggles with wellness but the big turning point, I think was really started with the kind of big incident of Belle Gibson being exposed as having lied about having cancer and selling her kind of wellness lifestyle and products off this platform of having healed herself from cancer. And I think that caused this bit of a snowball of realization that wellness was not all it was painted to be.

I started to kind of think a little bit more critically about the kind of information that I was consuming and engaging with, and also started kind of looking at other sources of information. So I think that was around the time as well that I found your podcast at the time, Food Psych, which was honestly, transformative in so many ways. Just kind of getting these experts talking about these wellness trends and actually dissecting them. That was kind of my exit from wellness culture.

Christy Harrison: And you were working in wellness journalism at the time too, right? So it sort of became tied up with your professional life as well.

Maxine Ali: Yeah, it really, really did. After I left university, I started working at Women’s Health magazine and was ecstatic to kind of straight out of uni get this kind of, what I saw, as my dream job of getting to work in the wellness industry. It’s such a well known magazine that so many people in this space, this wellness space, read, engage with, and I thought I’ve hit the jackpot. But I think as I was getting a lot more critical about wellness culture, I was also wanting to kind of use this platform that I now had at Women’s Health to kind of incorporate a bit more evidence based expertise and kind of have a bit more of a responsible conversation about wellness.

So I was kind of trying to use this approach to have a more responsible conversation about wellness, bring in more experts. And what I found was such pushback from editors from the space in general, and this kind of realization that unless it wasn’t profitable and trendy and sexy, it wasn’t going to sell. And they didn’t want this to be part of the conversation.

So I left that space shortly afterwards. I wasn’t there for very long. And I think largely through kind of engaging with your podcast and sort of some of the experts that you had, some of the academics that were really interrogating wellness and diet culture, through this kind of really highly intellectual lens that resonated so strongly with me. So people like Emily Contois, I remember, was one of those podcast episodes that I remember going on a walk and listening to and being just blown away by these kind of perspectives on wellness and diet culture and connecting it to kind of broader social issues.

And I just realized that was something that I really wanted to pursue and kind of learn more about. So I went and did my master’s between 2017 and 18, my master’s in medical humanities, and then from there started doing my PhD partway through the pandemic, which I’m sure we’ll talk a lot about in coming times. But it was really these critical conversations that I was getting exposed to that transformation transformed my perspective on wellness and brought me to what I’m doing today.

Christy Harrison: Yeah, it’s such a fascinating story, and it has a lot in common with, I think, the way so many people come to be critical of wellness culture, where they’re bought into it for a time, and there’s maybe a personal connection there, and with the chronic illness piece, too, that makes you so susceptible. I think that’s one of the areas of real vulnerability that people have when there’s a chronic illness that’s not being addressed effectively by conventional healthcare. It’s totally understandable to get sucked into wellness culture and wellness approaches, especially if your family also is very pro that, you know, “natural” healing and things like that. So, yeah, I can understand that would be fertile ground for you to get into wellness culture.

You’re now completing a PhD in, essentially, critiquing wellness culture and especially on social media, which is so up my alley. So I really want to talk about that and I’d love to hear first just how you came to focus on that in your PhD research and what some of your findings have been.

Maxine Ali: I set out with a kind of really broad aim when I started my PhD. I wrote my proposal back in 2020, so actually slightly before the pandemic even kind of took hold all that much, and I really wanted to just look at the overlaps between wellness culture and cultural notions of femininity. So looking at how the diet fads that are wrapped up in wellness culture just perpetuate age old ideas of what women should be doing to self discipline their bodies, right? Even things like the “strong, not skinny” trend. I think Emily Contois talks about this a lot in her work as well, the kind of abundance diet where we’re not talking about restriction, we’re talking about kind of eating healthily in abundance and just seeing how a lot of this kind of discourse and rhetoric and wellness was just re-perpetuating existing ideas of what women should be doing and looking like with their bodies.

But just because I think the timing of the research really shaped it, starting into the pandemic, when people in general were just intensively online to a much greater degree than before, and also health being so front and center in people’s minds and people sharing their own experiences of health, their own understandings and ideas. And we just saw this huge, huge proliferation of misinformation and conspiratorial thinking within these online health and wellness spheres. And that is essentially kind of the shape that my thesis ended up taking.

So I had my initial focus on chronic illness spaces in digital wellness culture and just seeing how women who had had terrible experiences with doctors in general were engaging with alternative health, kind of what their rationale and motivations were. And it ended up transitioning into, okay, how are these women in wellness culture, these wellness practitioners? I call them influencer healers. I see them as kind of a combination of your traditional sort of influencer role, but they also take up this kind of rhetoric and discourse of healing and self optimization and curing chronic illness.

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And I was just interested in how they constructed their own ideas about health and wellness as truthful and authentic. And conversely then positioning kind of established scientific consensus and research and evidence, positioning that as misinformed, not truthful, unreliable. All of these different kind of ideas that we’re seeing really take hold since the pandemic.

Christy Harrison: So fascinating. And I’m curious what you found because you focus specifically on like ten of these influencer healers in your thesis. I don’t know if you want to name any names or get into sort of who they are, but in broad strokes, what type of influencers are these? You said that they’re alternative healing type of people too, but just curious to know more what their deal is and how they are positioning themselves as arbiters of truth or as being very authentic in a space where they’re then denigrating conventional medicine and expertise and science as maybe inauthentic or not telling the whole truth.

Maxine Ali: So I can name some of them. It might not even be kind of all that relevant. There were 10 influencer healers in particular that I looked at. And just to kind of have it kind of some control across the sample, I was looking specifically at kind of micro-influencers. So people that didn’t have your sort of macro level following. I wasn’t kind of thinking about that sort of hyper commoditized version of wellness that is really important to look at.

But I was in particular looking at sort of these more low level practitioners that use social media as a way to kind of market their services. A lot of them were kind of nutritional therapists or kind of different sorts of wellness practitioners using all sorts of, let’s call it arbitrary titles, because a lot of the time these titles didn’t really have a whole lot of meaning, things like “accredited functional nutritional practitioner,” that kind of thing. A bit of a word salad, almost.

Christy Harrison: Right, there’s not really an actual degree or licensing procedure that goes along with that.

Maxine Ali: Exactly, yes. And they all had the same chronic illness, which is also the chronic illness I had. I felt like that gives me a kind of better insight into the specific kind of repertoires of communication that they’re using. So they were talking a lot of the time very specifically about the context, of IBD care.

Christy Harrison: Inflammatory bowel disease.

Maxine Ali: Right, exactly, yes. Which maybe is not so kind of prominent in the wellness space. But I saw it as relevant in the sense of gut health being a big trend at the time as well. And these influencer healers really latched onto that, were kind of trying to promote themselves as kind of gut health experts. Those were my focus and it was so interesting to kind of look at it from this sort of almost micro-influencer level because actually I think the tactics that they engage in are slightly different to what you see in sort of macro wellness influencers who are kind of more often pushing products and apps and brand partnerships, where that’s a very explicitly kind of commercial element to what macro-influencers are doing.

But micro-influencers, it’s so much more subtle. You almost can’t sort of see the product placements and the self branding as well, being interwoven into the kind of everyday sharing of their life as a wellness participant, a wellness enthusiast.

Christy Harrison: Yeah, and I feel like I’ve heard and read about recently that brands want to work more with micro-influencers these days because they are seen as more authentic, they are seen as less sort of commodified or commercialized and they have that sort of authenticity of the early days of the influencer economy maybe when people are just coming to them for advice and feeling connected to them and have this parasocial relationship maybe. I’m curious what you found in that, in terms of how their audiences relate to them and how they sort of invite their audiences to relate to them in a way too.

Maxine Ali: Yeah, definitely. I mean that was one of the big motivations as well for looking at micro-influencers was there has been this kind of recognition now almost as a bit of a backlash against the kind of mass influencer industry of, oh well, these people with smaller followings, they’re more likely to kind of give their authentic perspective on things and that almost makes their influence a lot more powerful.

They’re also highly under researched as well because of that, because there’s such a kind of focus on know big influences and how people like Kim Kardashian and such are kind of shaping cultural discourse that quite often, the people with kind of less followers get less attention in the research despite having such a significant influence on people’s ideals and perspectives when it comes to health as well as every other area that influence is kind of now participate in.

Christy Harrison: A lot of their posts tell stories about systemic failings in conventional healthcare and the healing power of alternative and complementary and integrative and functional and whatever you want to call it, all these buzzwords, practices and obviously they’re selling their own services in there as well. But it’s sort of couched in this personal narrative it seems like.

And there’s definitely a grain of truth to all that in that there are some major systemic problems with the medical system and we’ve both experienced that. I know many listeners have experienced that where we haven’t felt taken seriously necessarily or it’s taken a long time to get a proper diagnosis or if we’ve gone down rabbit holes of misdiagnoses and it’s not a perfect system by any means. So I think critiquing it is valid. And then yet there’s also this sort of shift or twist that happens where it’s like this valid critique, but then it’s kind of being used in service of selling something that is maybe not so evidence based or helpful or just could lead people in another totally wrong direction.

How have you sort of looked at that process, first of all, of influencers leveraging these problems with the conventional healthcare system to sell alternative medicine and how accurate are their narratives around that? How much have you seen sort of misinformation being spread under the guise of this is what the failings of the conventional healthcare system are and here’s this alternative?

Maxine Ali: So I mean, the short answer is it’s so, so much. And actually one of the biggest chapters from my thesis, I was looking at kind of wellness memes. And so I’m sure if you’ve kind of been on Instagram or TikTok, you’ve kind of seen this big rise of meme videos where people will import sounds into their content and quite often tell a story. So when X happened or POV X, and I can share some examples of that from my kind of wellness data, where I started to kind of first really see this kind of positioning of medical negligence being a really serious, salient kind of storyline in wellness culture was with these memes and in particular kind of medical encounter memes.

So people would be kind of creating these memes of when I went to a doctor with symptoms for three months and they told me it was all in my head, or when my doctor told me that my chronic fatigue was just stress, these kind of stories, which of course, are real stories. There is a very significant issue of medical neglect, disregarding women’s symptoms. Absolutely. But what I found really fascinating was this kind of memification of these experiences. So putting them to kind of funny sounds and audios using this sort of very generic language of memes in general, which are built around kind of familiarity and relatability.

So what gives memes a kind of visibility and currency on social media, it often taps into these kind of shared cultural touch points, whether that’s a well known song or a well known piece of dialogue. And then of course importing that into this shared story of horrible medical encounters. And what I ended up finding from these kind of medical encounter memes, which were really formulaic, they all kind of had the same patterns, they told the same stories, was how over time and through this kind of repetition of these similar kind of accounts, they were basically creating this very homogenized experience of whenever you go to a medical doctor, they will disregard you, they will tell you that your symptoms are all in your head, positioning this experience as a universal truth. And of course it is a real experience.

I’ve experienced it, many people have. But also many people have experienced good experiences with medical professionals. I can conversely say that I have had some very positive experiences. And I think the thing is with social media is it amplifies the negative in a lot of ways. It is these kind of bad stories, these bad experiences that gain traction, that gain visibility through people repetitively sharing them. And so the good experiences don’t get shared, they don’t get that same kind of traction. And so what this ends up cultivating is a kind of a more general consensus about the medical profession as untrustworthy. And that of course is fueling this, now, crisis that we have of distrust in expertise in medical professionals.

And to kind of tack onto that, one of the things I really found with these memes as well was again, memes being these kind of hypersimplified sort of formats of interaction. What I noticed was misinformation was manifesting through them through something called the strawman fallacy. It’s an argumentation strategy that basically relies on misrepresenting a claim or argument in order to kind of render it easily irrefutable. So it quite often happens through kind of quotation or selective quotation and also kind of decontextualizing a particular argument. So it basically relies on attacking a kind of fictitious opponent to bolster your own claims.

So in a nutshell, what I was finding with these wellness memes was how they were taking supposedly claims associated with the medical sphere. So they would say things like, you can’t heal yourself through lifestyle and attribute that to medical professionals or say the body can’t heal itself, that’s the belief of medical professionals, which is an oversimplified statement. Of course, we know in medical spheres there is a recognition of things like immune systems which are directly involved in self repair mechanisms. Similarly, there is a recognition in medicine of lifestyle interventions. They’re just not the be all and end all.

It’s these oversimplifications of a very complex kind of medical idea that get taken up into wellness and then used to say, well, these are clearly ridiculous ideas. It’s ridiculous to say that lifestyle has absolutely no influence whatsoever. And basically these fallacies were brought in in order to say well, the medical industry is stupid. They don’t know what they’re talking about. And so wellness, we’re talking sense, we’re talking the truth and kind of bolstering the legitimacy of this sphere whilst delegitimating that of the medical profession.

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Christy Harrison: Yeah. It’s so insidious and the repetition of it and the memeification of it, like you said, which is so simple and surface level and there’s no nuance to it. Whether it’s saying, “Doctors: ‘You can’t heal yourself through food’,” or “POV: That feeling when your doctor just misses all your symptoms and tells you it’s all in your head.” There’s just no unpacking, there’s no critical thinking, there’s no individualization of it. It’s being sort of flattened into this universal truth or made to seem like a universal truth when the reality is so much more complex.

Maxine Ali: Actually, yeah, absolutely. And that’s the kind of real issue with this sort of memeification trend. It creates this sense of kind of everyone has the same experience because it’s rooted in kind of tapping into kind of familiar touchstones and things that are recognizable and makes it seem like there is a sense of resonance when in reality everyone’s experiences are different.

Christy Harrison: And it’s sort of inviting people to discount or negate experiences they’ve had that have been opposite to that because it turns up the salience on the experience of being dismissed or feeling unheard or feeling like doctors don’t get it and turns down the volume on all the memories you might have of doctors actually being compassionate and helpful or offering you something that was effective. So it selectively shines a light on these things that then get people sort of enraged and make them then prime targets for the sale of alternative medicine and other practices outside of the conventional system.

You’ve been writing this during such a weird time. And I also wrote my book, The Wellness Trap, during the pandemic and sort of a weird time in wellness culture and now it’s just even more pronounced with the rise of RFK Jr. and the MAHA movement in the US and just the kind of explosion of wellness misinformation online and the widespread denigration of expertise and of science and medicine and things like that, I’m curious to know if any of that has intersected in writing the thesis or if that’s shown up in the influencer healers you followed, if any of them have been sort of vocally embracing of MAHA or conspiratorial philosophy.

Maxine Ali: Absolutely. The cases that I was looking at, they spanned different kind of global contexts. I did have naturally some participants in the States and again beginning my kind of data collection just in that sort of late Covid period, so kind of late 2021 into 2022, the anti-vaccination content in particular was just absolutely rife. More so I think in particular in the States because that was just such a big conversation there around kind of mandates in terms of working, it was just amplified on such a big level. And so a lot of the data that I ended up kind of collecting was around anti-vaccination as a big point of focus for the wellness. And of course that’s now spiraled well beyond sort of just the COVID vaccine into all forms of vaccine. And of course now with RFK and his big push against vaccinations, it has gone a little bit wild.

Christy Harrison: It is. Can you share some of your findings on how anti-vaccination rhetoric gets sort of woven into this content? I’m curious what the sort of typical content is and then how the anti-vaccine content is woven in, because I can imagine from influencers that I’ve seen are these sort of influencer healer types, oftentimes there’s the denigration of conventional medicine, the pitching of alternatives, especially diet, restrictive diets and supplements and things like that and then sprinkled in is this other kind of more extreme stuff.

Maxine Ali: Yeah, it’s always difficult to know where to start because I think there was a lot of interesting identity work that was going on around this anti-vaccination positioning. For instance, I had a lot of the influencer healers I was looking at who were really tapping into that kind of maternal discourse. The natural mom, not quite trad wife, but certainly having slight overlaps with that kind of movement and seeing a lot of their feminine intuition as having a higher place in healthcare decision making than science and evidence.

And yet conversely, against that we saw a lot of, actually, the co-optation of feminist rhetoric as well. So I had a lot of instances of data with #mybodymychoice, #bodilyautonomy, these hallmark feminist slogans now becoming something that these wellness and alternative health spokespeople draw upon in order to make a case against scientifically backed vaccinations.

Christy Harrison: That’s so scary.

Maxine Ali: And it was one of those things that really, as a researcher, kind of makes your blood boil. It’s so hard. I’m sure you have this too, with your work when you’re kind of trying to engage with these spaces just to be informed, but it affects you so much mentally because it is awful. It is awful to see the influence and power that these people have and how they weaponize movements, ideas, values that were supposed to uplift people to basically further harm.

Christy Harrison: Yeah, it’s so upsetting. I mean, I was gonna ask what it’s been like for you to follow these influencers so closely as someone who was once a devotee of alternative and holistic practices, but is now so critical of them. Are there ever moments when you feel yourself getting pulled back in,

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It’s Q&A time! You can ask your own question here for a chance to have it answered in an upcoming edition.

Just a reminder that these answers are for educational and informational purposes only, and aren’t a substitute for medical or mental-health advice. Although I am a registered dietitian, I’m not your dietitian (unless you happen to be one of my 1:1 clients—hi!—but even then, this email isn’t a session).

Today’s newsletter is a long one, so my answer to the first part of the first question is available to all subscribers (about hair analysis), and there are a few bonus ones just for paid subscribers (about DUTCH testing, what you’re really looking for with these kinds of tests, and how concerned you should be about recent reports of heavy metals in chocolate).

Hi Christy,

I just discovered your podcast before I was about to spend lots of money on testing, so thank you for all your insights. I’ve been following intuitive eating for years, but I am still healing and learning to accept my body.

I was wondering what your thoughts were on HTMA and DUTCH testing. Is this “new science”? They are so tempting to get for me because it would be so nice to see exactly where I’m lacking so I can just eat the foods that will heal my body and make it run “normally.” But I know there is no magic pill, as you say! Thank you.

—April

I’m so glad the podcast has been helpful to you, and thanks for the great question! My short answer is: I’d recommend continuing to save your money, because these tests aren’t based on solid evidence. They’re unlikely to tell you anything helpful, and they can provide misleading results that cause harm by convincing you to try unnecessary treatments or forgo evidence-based medicine.

I know that can be hard to hear when you want help and healing, especially if you haven’t been getting adequate support in the conventional healthcare system. We’ll come back to this question of what you’re hoping to gain from this kind of testing shortly. But first, let’s talk about each of these tests.

Hair Tissue Mineral Analysis (HTMA)

HTMA supposedly tests the mineral levels in your hair to find deficiencies and “imbalances,” which you can then ostensibly correct through food and supplements (often sold by the provider who ordered the hair analysis).

The problem is that hair can’t actually tell you those things. Like many problematic wellness practices, HTMA is based on a grain of truth: hair testing can help determine whether someone was exposed to illegal drugs, substances banned in sports, or actual poisons (although it has some limitations). But nutrients are a different story, and hair mineral analysis isn’t a precise enough method to use for general health and nutrition screening.

Researchers have known this for decades, going back at least to the 1980s—HTMA definitely is not “new science.” In 1985, a critical review of the evidence published by the Canadian Medical Association found that commercial hair analysis was “imprecise, unnecessary, and probably wasteful.” Minerals in hair don’t reliably indicate minerals in other body tissues—you could have low levels in your hair without having a deficiency, or you could have seemingly “normal” levels in your hair and actually be deficient.

What’s more, the review found, there was no scientific oversight or government regulatory control of information provided by commercial hair-analysis labs. “Therefore, the information may be inaccurate, misleading and even detrimental to the patient’s health,” the report concluded.

That same year, the Journal of the American Medical Association (JAMA) published a small study by medical doctor Stephen Barrett, who sent hair samples from two healthy teenagers to 13 different commercial hair-analysis companies. Barrett found that identical samples produced wildly different results when sent to different labs—and also when they were sent to the same lab under different names. In addition, the labs disagreed about what constituted “normal” values for many of the minerals.

A 2001 study set out to see if anything had changed in the 16 years since Barrett’s paper, and especially since the 1988 passage of the Clinical Laboratory Improvement Act (CLIA), which regulates clinical testing. But in 2001 the situation was still very much the same. “Hair mineral analysis from these laboratories was unreliable, and we recommend that health care practitioners refrain from using such analyses to assess individual nutritional status or suspected environmental exposures,” the researchers wrote. “Problems with the regulation and certification of these laboratories also should be addressed.”

More than a decade further on, these issues remained. A 2013 study of three different hair-analysis labs found that each lab reported different mineral deficiencies, which resulted in conflicting recommendations for supplements and treatments. One lab even reported different deficiencies for two samples of the same hair.

The main reason for these wide variations is that labs basically just make up their own definitions of “normal” because there are no established reference ranges for minerals in human hair. The ranges considered “normal” for blood tests can also vary a bit from lab to lab, but those variations are tiny compared to the large discrepancies in ranges for hair analysis.

Those inconsistencies exist in part because there’s no standard procedure for taking samples, preparing hair for analysis, or extracting minerals, as a 2013 systematic review noted. Until those things are standardized and scientifically validated, it’s impossible to come up with reliable reference ranges for hair analysis. Each testing company has its own protocols, which may or may not lead to internally consistent results at a given lab, but there’s still no evidence-based definition of “normal.”

Regulation of Lab Tests

Some proponents of hair analysis argue that only “bad” HTMA labs are problematic, and that if you go to a few specific labs that are CLIA-certified you’ll get valid results. But CLIA only requires labs to meet standards for things like staff qualifications, timeliness of results, and test accuracy/reliability within that particular lab environment (aka internal consistency). CLIA doesn’t require lab tests to be clinically valid or useful. So alt-med labs might be CLIA certified, but that doesn’t mean their tests are any good.  

The Food and Drug Administration (FDA) historically took an “enforcement discretion” approach to labs offering these kinds of clinically useless tests, meaning that it basically looked the other way. But recently, the agency proposed starting to regulate lab-developed tests, citing their risks to patients. “The FDA is concerned patients could initiate unnecessary treatment, or delay or forego proper treatment altogether, based on inaccurate test results, which could result in harm, including worsening illness or death,” it stated in a news release.  

The agency is seeking public comment on this proposed rule now, but only for another 5 days (I wish I’d gotten on this sooner!). If you want to support better regulation of lab tests, learn more and submit your comment here before December 4. For reference, here’s the comment I submitted:

I am writing in support of the FDA’s proposed rule to provide greater oversight of laboratory-developed tests (LDTs) and to phase out its general enforcement discretion approach to LDTs.

I am a registered dietitian and science journalist, and I hear from many people who are considering non-evidence-based tests such as those purporting to diagnose food intolerances with IgG antibodies, hair tissue mineral analysis for general health and nutrition, the GI-MAP test for gastrointestinal pathogens, and many others. In my review of the evidence (see selected references below), it has become clear to me that these tests can be extremely misleading and risky to patients, who may go on to use unnecessary and harmful treatments and turn away from evidence-based treatments.

Some of the companies producing these tests are simply businesses trying to compete in a crowded marketplace, but many are also savvy marketers that leverage consumer confusion and gaps in the conventional healthcare system. Patients can’t be expected to delve deeply into scientific literature in order to determine whether to take a particular lab test; they need to be able to trust that the tests recommended to them are clinically valid and useful, and that they won’t misinform or cause harm. This is where government oversight plays an essential role in consumer protection.

I urge the FDA to adopt this proposed rule and increase its oversight of LDTs.

Thank you for your time and consideration.

Sincerely,

Christy Harrison, MPH, RD

References:

Gingras, B. A., & Maggiore, J. A. (2020). Performance of a new molecular assay for the detection of gastrointestinal pathogens. Access Microbiology, 2(10), acmi000160. https://doi.org/10.1099/acmi.0.000160

Jones, S. L., Campbell, B., & Hart, T. (2019). Laboratory tests commonly used in complementary and alternative medicine: a review of the evidence. Annals of Clinical Biochemistry, 56(3), 310–325. https://doi.org/10.1177/0004563218824622

Kelso J. M. (2018). Unproven Diagnostic Tests for Adverse Reactions to Foods. The Journal of Allergy and Clinical Immunology. In Practice, 6(2), 362–365. https://doi.org/10.1016/j.jaip.2017.08.021

Thanks so much for the great question, April, and thanks to all the free subscribers for reading! Paid subscribers can stick around for the bonus answers (about DUTCH testing, what you’re really looking for with these kinds of tests, and how concerned you should be about reports of heavy metals in chocolate), and everyone can ask their own questions for a chance to have them answered in an upcoming newsletter.

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