Have you ever made a recommendation to a client, then discovered the client heard something completely different? Or she took part of what you suggested and ignored the rest? Like the time I advised my client about the healthfulness of berries and later found out he had given up all other fruit. That was a nutrition misfire. Maybe it was the client’s all-or-nothing thinking, or maybe I hadn’t been clear enough. After all, there is subtlety in food and nutrition, and getting the message right is a challenge. Stamp out misunderstandings by learning how top nutrition professionals set their clients straight on six all-too-common nutrition misfires.

Misfire #1

Sugar is bad; therefore, all carbs are bad.

“All carbs are not created equal,” advises Kathy McManus, MS, RDN, director of the Department of Nutrition at Brigham and Women’s Hospital in Boston. “There are some unhealthy sources, like white bread, white rice, white potatoes, and foods containing added sugar (cake, cookies, candy and sugar-sweetened beverages). These foods raise blood sugar and can lead to diabetes and weight gain.” But don’t throw the baby out with the bathwater. As McManus points out, “The right types of carbohydrate foods, such as intact whole grains, fruits, vegetables, beans and other legumes, are the foundation for a healthy diet.” (Intact whole grains include all layers of the original kernel: bran, germ and endosperm.)

Because added sugar is “empty-calorie,” providing calories but no additional nutrients, focus clients on reducing added sugar, not on reducing sugar that occurs naturally, as in fruit or all carbohydrates. Help clients navigate this terrain by thinking about the carbohydrate’s context: If it is added sugar or refined grain, limit intake. If it’s in whole foods, dig in, though be mindful of portion control even with healthy foods.

Misfire #2

Vegetarian diets are healthy, so I should avoid all animal foods.

Vegetarians have lower rates of overweight and obesity, diabetes, heart disease, and some cancers compared with those on a typical American diet (Appleby & Key 2016). That sounds pretty compelling, but it doesn’t necessarily mean animal foods (meat, poultry, fish, dairy products) have no place in a healthy diet. In addition to protein, meats are sources of well-absorbed minerals, including iron and zinc, while milk and other dairy products are great sources of calcium.

McManus says that avoiding all animal foods “can be overly restrictive and limit options, especially when eating with friends and family and away from home.” It can be difficult to find enough variety to eat well in restaurants and may be socially isolating. She explains that “plant-based eating” means eating mostly foods from plants (legumes, healthy oils like olive oil, nuts, seeds, whole grains, fruits and vegetables), but it allows for greater flexibility than a vegetarian diet and can include fish, eggs, dairy and some meats. Plant-based eating “supports many of the same health benefits as vegetarianism, such as lower weight, less heart disease and less diabetes, but for many people is a less severe, more sustainable food pattern to support health.” Some call this pattern a “flexitarian” diet.

Misfire #3

Gluten is bad for some people; therefore, everyone should avoid gluten.

Gluten is a protein found in wheat, barley and rye. “The fact that gluten is a protein surprises people, since today’s food conversation is very positive about protein,” says Kim Kirchherr, MS, RDN, a nutrition consultant in Chicago who has worked extensively in supermarket nutrition. “Gluten is the reason bread has that wonderful, chewy texture.”

People with celiac disease react to gluten in a way that damages the lining of their small intestine, leading to digestive symptoms like bloating, diarrhea and malabsorption of nutrients.

Wheat sensitivities are not always related to gluten. “Some people with irritable bowel syndrome are intolerant to the carbohydrate portions of wheat called oligosaccharides. But the majority of us are totally okay to consume wheat and gluten,” says Denise Barratt, MS, RDN, a nutrition consultant and blogger in Asheville, North Carolina, and the author of Farm Fresh Nutrition (vineripenutrition.com). Barratt says gluten-free products may have less iron, fiber and B vitamins, so reconsider switching unless you need to avoid gluten for health reasons.

On the other hand, do we tend to overeat white bread, pizza, cakes, cookies and other less healthy sources of gluten? Yes, we certainly do. Is it the gluten that makes these foods unhealthy? Not for most people! The message shouldn’t be to avoid gluten; it should be to choose more nutrient-dense breads made with whole-grain flours and, especially, more intact whole grains like barley and quinoa, which don’t raise blood sugar as much.

Misfire #4

Juicing is the best way to get your fruit and veggies.

There’s a juice for every day of the week, and your clients have probably tried them all: green juice, detox juice, and juices infused with ginger and turmeric. Recent research has shown that juices are an effective way to increase vitamins, minerals and phytonutrients in the diet (Zheng 2017). In the U.S., most people don’t eat enough fruit or vegetables and may miss out on the nutrients they provide: vitamins A and C, potassium, fiber, phytonutrients, and more.

But is drinking juice better than eating the fruits and vegetables they were squeezed from? No one is arguing that we should drink juice instead of eating whole produce. Juicers usually remove fiber, but fiber is important for digestive health and cholesterol reduction, and it helps keep blood sugar under control. “You may be tossing out some of the great things we eat fruits and veggies for in the first place,” says Kirchherr.

Calories are another consideration. “How many whole oranges are you using for that glass of orange juice? Five? Six? Would you ever sit down and eat that many whole oranges?” asks Kirchherr. You are probably consuming a lot more calories from juice than you would if you were eating the whole fruit. Barratt tells her clients, “It is much more economical and nutritious to eat whole fruits and vegetables in smoothies, salads, soups and stir-fries.”

Misfire #5

Nutrition Facts labels on foods tell me all I need to know about the foods.

“Most of us want a super-simple way to manage the information about things we eat and drink,” says Kirchherr. She recommends using 5% (low in a nutrient) and 20% (high in a nutrient) of the Daily Value as a quick guide. (The Daily Value indicates how much of a nutrient a single serving of the food contributes to an average daily diet of 2,000 calories.) Trying to reduce sodium? Look for 5% or less of the Daily Value. Trying to increase fiber? Go for 20% or more.

However, Kirchherr cautions, “The Nutrition Facts label provides context in terms of calories and nutrition, but the ingredient list gives us more detail about the product. Focusing on one or the other doesn’t give the full nutrition picture.” McManus explains that, for example, fiber is often added to white bread, which boosts the number of grams of fiber on the Nutrition Facts label but doesn’t make white bread as nutritious as whole-wheat bread. Whole-wheat bread lists whole-wheat flour as the first ingredient and contains more vitamins, minerals and phytonutrients, which don’t all appear on the Nutrition Facts label. In addition, says McManus, “Research is limited on the health benefits of some of these added fibers, and they may not be equivalent to naturally occurring fiber in whole grains.”

Also, as McManus reminds clients, “Many of the healthiest foods (fresh fruit, vegetables, fish, poultry, whole grains, nuts and seeds bought in bulk) do not have Nutrition Facts labels.”

Key changes to nutritional labels. By the way, Nutrition Facts labels are changing to be clearer about the number of calories per serving and to reflect current scientific knowledge about nutrients of concern for Americans. There is an overview of the changes at fda.gov/downloads/food/labelingnutrition/ucm511646.pdf.

Misfire #6

Vitamins and minerals are essential for health, so I should take a lot of them.

If you get less than enough iron, you become anemic; too little vitamin C, and you get scurvy. Vitamins and minerals are critical for good health, but the message for clients, says Kirchherr, is “bigger isn’t always better. This is true for things that are good for us, too.” We can’t easily get rid of excess vitamins stored in fat, such as fat-soluble vitamins A, D, E and K. The B vitamins and vitamin C, on the other hand, are water-soluble, and we excrete what we can’t absorb, so taking an excess of those may mean you are essentially flushing the money you paid for them down the toilet.

While a multivitamin and mineral supplement containing around 100% of the Daily Values may be low risk and could make up for nutrients missing in the diet (Ward 2014), we have little research on the long-term effects of large doses of vitamins, minerals and other dietary supplements. In the U.S., laws do not require the Food and Drug Administration to verify safety or effectiveness before dietary supplements are marketed to consumers (NIH 2011). And don’t assume that because a supplement is popular, it is also effective. Many people believe that taking large doses of vitamin C will prevent them from getting colds, but the scientific evidence doesn’t support that belief (PubMed Health 2017).

To avoid nutrition misfires, we need to help clients scratch the surface and see there is more to every nutrition topic than just a sound bite. Kirchherr wisely reminds us, “Extremes, like ‘always’ and ‘never,’ don’t work in food and nutrition.” Perhaps that should be our first message to clients.