Every January US News and World Report lists the top diets.  These are vetted by legitimate nutrition professionals.  This year they are the:

1. Mediterranean Diet
2. Dash Diet
3. Flexitarian Diet
4. MIND Diet

What do all of these “diets” have in common? They limit sugar and other processed foods. They include plenty of vegetables and fruit, legumes, nuts and whole grains. Whole foods are the focus. All of these “diets” put the quality of the food first.

What do whole foods get us? A longer life! IN 2022 a study was released (PLOS Medicine Fadness et al 2/8/22) that indicated that at age 20 if you switch from a Standard American Diet (SAD Diet) to a “optimized diet” you can add 10 and 13 years to your life expectancy for females and males respectively. We aren’t 20 anymore. But at age 60 switching from the SAD diet to an optimized diet results in 8 additional years for women and 9 for men. Even changing to a “healthy” diet at age 80 resulted in 3.5 extra years of life. The biggest gains came from adding legumes, whole grains and nuts and limiting processed foods.

Are you focusing on whole foods. Keep track of the number of meals that contain only whole foods. We will skip snacks for now. These would be meals where ideally you don’t open a package to eat or prepare the food. If you do open a package, the food that comes out looks close to the food that went into it, for example, tomato sauce and frozen veggies. Fruit gummies pressed in the shape of a fruit does not count. Neither does a TV dinner. But 100% whole grain bread is ok. And if you make your own salad dressing instead of opening a bottle, give yourself an extra point. See how close to 21 meals you get.

Remember Self Care, IS Health Care,
Kim

Risk of every chronic disease is lower if plenty of vegetables and fruit are in the diet. New research identifies reduced psychological distress with higher vegetable and fruit consumption. Why is that? Of course, they contain plenty of essential nutrients like Vitamin C and B vitamins. But that’s not where the magic is. The magic is in the phytochemicals that aren’t exactly essential for life but are absolutely necessary for a healthy life.

Why are phytochemicals so effective? They reduce inflammation, a primary driver of chronic disease. They influence cell signaling and genetic expression. Phytochemicals support immune health. Non-digestible fibers are critical for a healthy gut microbiome. And it is quite interesting that among cancer patients receiving immunotherapy, those who consume a high fiber plant focused diet are more likely to respond to the immune therapy.

How much do we need? It would be pretty tough to eat too much vegetables and fruit. The minimum is 5 servings of vegetables and fruit not including starchy vegetables or fruit juice. The biggest health benefits come from eating leafy green vegetables (kale, spinach) and fruits and vegetables rich in vitamin C and beta carotene (citrus, berries, carrots). There is nothing wrong with starchy vegetables like sweet potatoes but they shouldn’t make up the bulk of your vegetable choices. Fruit juice is just sugar in disguise. The emphasis should be on vegetables.
Many of the phytochemicals we want in our diet are the compounds producing the color in plants. I’m sure the concept of eating the rainbow is not new to you. What are the colors? Blue/purple, red, yellow/orange, green, white. Each contains different phytochemical with different benefits. We are most often lacking blue/purple colors.

So for your physical and mental health, eat vegetables and fruit. This week instead of counting the number of vegetables and fruits, count the number of different colors a day. It should be 5, one from each color category. The number should be 35!

Warning, I’m on a rant. And for good reason. There is really no redeeming value of ultra-processed food unless you are on an island with no vegetation, no animals and no insects to eat!

What is ultra-processed food? These are the foods in packages that contain many added ingredients (sugar, salt, fat, and artificial colors/preservatives). Ultra-processed foods are made mostly from substances extracted from foods. They are food like substances that do not resemble the original food.

In the US we are eating way too much ultra-processed food. Between 2001 -2002 and 2017-2018 the percent of calories in the US diet coming from ultra-processed foods increased from 53.5% to 57% (Juul et al Jan 2022). What’s shocking to me is not the increase so much as the amount. Over half of our calories come from ultra-processed foods and sadly for kids it is up to two thirds! And with-it too much sugar, refined carbohydrates, salt and unhealthy fats.

Sadly, we live in a toxic food environment where ultra-processed foods with its enticing marketing are the new Sirens leading us this time, not Ulysses to an early death! This is not much of an exaggeration. Ultra-processed food is associated with increased risk of diabetes, cardiovascular disease, and cancer. It is the driver of the obesity epidemic by increasing insulin resistance, messing up the gut microbiome and causing inflammation.

A small but very well done study randomized people to eat an ultra-processed or unprocessed diet for two weeks (Hall K, 2019). Participants were able to self-select the foods to eat but the choices were matched by calories and macronutrients. What they found those eating the ultra-processed diet for two weeks consumed on average 500 extra calories a day and gained almost 2lbs. Some participants did not gain weight and others gained 13lbs in two weeks. So clearly there are other factors at play.

Clearly some processing of food is ok and even necessary. Processing is needed for food preservation and food safety. Minimally processed foods such as washed salad greens, frozen or even canned vegetables and fruit have much of their nutrients, phytochemicals and fiber still intact. But Cheetos or even corn flakes are pretty far removed from corn.

We need to stop kidding ourselves that all foods can be eaten in moderation. That is simply not true. At most, some foods can be a rare treat. If you elect to consume ultra-processed foods do so with the knowledge that it is detrimental to your health. Last week my son made homemade brownies. That treat was worth it. But the Pay Day I caved in and ate yesterday at the end of a stressful week at work was not. That was stress eating. You need to decide for yourselves when the negative consequences of ultra-processed foods are worth it. This week be mindful of when ultra-processed foods sneak into your diet.

The topic of weight loss is so loaded. Fat shaming is real and makes issues worse. Self-acceptance around weight is vital. But it is also clear that excess weight contributes to chronic health problems and early mortality even from COVID. What about dropping a few pounds makes sense and what doesn’t?

Fact #1: Even a small amount of weight loss (5%) can decrease risk of chronic disease. We don’t need to waste our time trying to get back to what we weighed decades ago.

Fact #2: Some people do lose weight and keep it off. What we know about the people who do keep weight off is that they focus on behaviors not the goal of weight loss, the lifestyle not the outcome. They sit less, move more. They also have a social support system that supports a healthy lifestyle including accountability buddies.

Fact #3: All calories are equal. A calorie is a measurement of energy, the amount of energy needed to raise the temperature of 1 kilogram of water by 1 degree Celsius. It doesn’t matter where that energy source comes from. It could be from a stick of wood!

But losing weight is not as simple cutting calories and going on a “diet”. Check out the image at the end for all the contributors to what we weigh.

Fallacy #1: All you need to do is cut back on calories. Calories may be equal, BUT the food sources of those calories affect your body VERY differently.

You knew processed food would be a top villain. All foods require some energy to “digest” because they need to be broken down in order to be absorbed. Foods that are processed don’t take as much energy to “digest”. A study comparing the energy it takes to “digest” food, ie the thermic effect of food, found that it takes 137 calories to digest a whole wheat bread unprocessed cheese sandwich (Barr S 2010). But it took only 73 calories to digest a white bread, processed cheese sandwich. That is a difference of 64 calories. Over time those extra calories add up.

There are other ways your food choices influence the balance of calories. Consumption of high fructose corn syrup like what is found in soft drinks, may increase appetite through the hormone ghereln. It is also associated with more fat deposited in the liver. FYI, fructose in fruit with its fiber doesn’t have the same effect. Processed carbohydrates lead to insulin resistance which makes fat storage easier. The carbohydrates in processed foods are rapidly absorbed resulting in big peaks and valleys in blood glucose leading to hunger.

On the positive side some foods, in particular protein containing foods fill us up so we take in fewer calories. Fiber has a similar effect. Consuming protein and fiber in the morning sets us up for being less hungry during the day. Protein as part of a healthy snack is also a good idea. No surprise, vegetables and fruit promote weight loss and weight stability (Dreher et al Nutrients 2020).

Fallacy #2: People who lose weight have more willpower. This idea just sets up unrealistic expectations and ultimately feeling bad when will power “fails”. Call it willpower, call it self-control, it doesn’t matter, we all have a very limited supply. Advertising, unrealistic images, “well meaning” friends or family, lack of sleep, evolution and more are chipping away at that limited supply of will power. Does it really make sense for our predecessors, who faced a lack of calories on a regularly, to eat a salad or the honey they just found? Better to set up your environment so you don’t need to use willpower.

Fallacy #3: All I need to do is exercise more. Of course, exercise burns some calories. But if weight loss is a goal, it will take more than exercising more. The biggest role for exercise is in maintaining weight or weight lost. Resistance training may not burn a lot of calories while you exercise but resistance training results in greater muscle mass and that burns more calories than adipose tissue even if you are just sitting. If you happen to be purposefully cutting calories, resistance training is even more important since it helps prevent the muscle loss that often comes with weight loss from cutting calories (Sardeli, 2018)

An underappreciated contributor to challenges with weight is lack of sleep! People with insufficient sleep are more likely to be overweight and to gain weight. We have all experienced how a lack of sleep makes decision making difficult. But that isn’t the only reason we tend to go for the easy, often more processed food choice. Turns out lack of sleep also increases release of the hormone ghrelin which makes us feel hungry and decreases release of the hormone leptin which helps us feel full.
So, what to do if weight loss is a goal? Don’t go on a weight loss diet! A small and underappreciated study demonstrated the effectiveness of just focusing on a plant-based diet. The Broad Study randomized people to a 12-week whole food plant based, low fat diet or continuation of their usual diet. No one was asked to decrease calories or count calories. The group who received the whole food plant-based diet lost 19 lbs at the end of the 12-week intervention. But they continued to lose weight having lost on average 26 lbs at 6mo and 25 lbs at 12 mos. All without counting a calorie.

The success of the Broad study supports the idea that weight loss can be a side effect of a healthy lifestyle not the goal. For a healthy lifestyle it is important to make health promoting food choices, move, get adequate sleep but also to cultivate mindfulness and human connection. But not in such a rigid way that we are depleting our “willpower”. Better off with strong convictions, loosely held. And isn’t it cool that we get to move and make human connections through Dragonheart?

Time to tackle the macronutrients, protein, carbohydrates and fat. They are called macronutrients because they are required in larger quantities. The protein we eat, or the amino acids they contain, are the building blocks of proteins in our body. Proteins are required for immune function, enzymes for cellular processes, certain hormones, cell structure and of course repair and remodeling of muscle. There are 9 amino acids that are essential (EAA), meaning we must get them in our diet. Of the EAA leucine seems to be the most important for muscle building.

How much do we need? The requirement for an adult is 0.8g/kg (0.4 g/lb) body weight. It is based on a level that achieved nitrogen balance and did not take into consideration activity. For individuals carrying extra weight, the body weight to use for the calculation should be based on adjusted weight. Check out the Examine.Com protein needs calculator. FYI, Examine.com is a great resource for diet/supplement information. It is very well referenced.

Athletes need more protein, from 1.2-1.7 g/kg (0.6-0.7 grams/lb) with endurance athletes needing the lower end and strength athletes needing the higher end of that range. Athletes consuming protein within a couple of hours after resistance training can help maximize “muscle building”. That protein can be real food. And the window is wider than we think.

We also need more protein as we age primarily because we are less efficient at building muscle. But if we have been physically active our whole lives the resistance to building muscle is minimized (Moore D, Sports Med 2021). And of course both endurance- and resistance-type exercises help us maintain muscle.

How much at a time? For the best chance at using protein for muscle protein synthesis a common recommendation recently is to consume 30 grams a meal for two meals, with breakfast being the more important meal. But remember eating protein alone does not create new muscle mass there must be a stimulus from exercise. Then 15-25grams at other meals/snack helps with satiety, protein synthesis and evens out insulin spikes.

What does 25 g look like?

This brings us to animal vs. plant protein. You can see that to get 25g of protein from certain foods requires a large quantity and a lot of calories. Animal proteins are “complete” meaning they contain all 9 EAAs. The plant foods that are considered a complete protein are limited. Soy foods (example: tofu, tempeh) are complete proteins. Quinoa, hemp, chia are also complete proteins but the volume needed to get 25 grams is pretty high. But they are great additions to foods to boost protein.

Plant protein food sources that are incomplete protein sources can be combined to provide all EAA. For example, a peanut butter sandwich. Does this need to be in the same meal? Probably not. Ezekiel bread contains a combination of whole foods that ends up containing all EAA.

The decision to include animal foods in your diet is an individual choice. They can certainly be part of a “healthy” diet. Likewise, you can have a “healthy” diet that does not contain animal products. But remember there are plenty of ultraprocessed foods that are vegetarian. They do not contribute to health.

Even though carbohydrates aren’t technically essential for our body, our bodies were designed to digest, use and store carbohydrates and to be healthy we need some carbohydrates. This is particularly true for athletes.

Carbohydrates are found in almost all foods. How health promoting they are depends on whether they are naked or fully clothed. Naked carbohydrates are simple carbohydrates meaning they are not very big, don’t contain much protein, fat and fiber and are easy to digest. This results in tall, sharp peaks of glucose. Fully clothed carbohydrates are complex meaning they are longer and have other components found naturally in food such as protein, fat, and fiber. The complexity makes it slower to digest and absorb. This results in a flatter wider increase in blood glucose when it is consumed.

Naked carbohydrates are found in ultraprocessed foods like sugar and refined flours. They are also in extruded products like cornflakes and cheerios. Table sugar, honey, maple syrup are all naked. So is candy that is essentially all sugar like Skittles or Jelly Beans. Fruit juice is also naked.

High fructose corn syrup is probably the most notorious naked carbohydrate. There are lots of not very good reasons why there is an abundance of corn. Food scientists figured out how to extract the starch and convert some if it into fructose so it tastes more like table sugar. It results in higher glucose spikes but has additional negative health impacts due to the extra fructose such as increased fat disposition in the liver.

Bread and baked products made with “white” all purpose flour spike blood glucose just as much as sugar. Weirdly pasta, which is made from refined flour, doesn’t have a very high glycemic index. The way it is prepared coats the “starch” (carbohydrate) in protein making it slower to digest. I’m not necessarily recommending pasta. There are healthier alternatives such as spiralized vegetables or spaghetti squash. That works for some recipes but definitely not all. There are so many more pasta options including pasta made from beans, cauliflower, or Shiratake (konjac) noodles.

Fully clothed carbohydrates are in or very close to their natural state. This would be vegetables, beans (legumes) and whole grains. They contain fiber, protein, sometimes fat that all make it harder for the body to rapidly digest and absorb the glucose contained in the food. Non starchy vegetables don’t cause much of a glucose bump because of all the fiber. Starchy vegetables such as potatoes and sweet potatoes do which is why they should be limited in a healthy diet.

Even though whole grain bread is a healthier choice than “white” bread in terms of nutrients and fiber, its glycemic index is almost identical. Probably because there isn’t that much fiber, fat and protein to slow down absorption. Sourdough bread, though, has a lower glycemic index. The fermentation process lowers the starch content. Whole grain sourdough bread has the advantage of sourdough with the added benefits of the nutrients and fiber in whole grains. If you are at all interested in baking, I highly recommend the book Bittman Bread for making whole grain sourdough bread. It is super easy and forgiving. It takes me about 15 minutes a week to take care of the starter and deal with making the bread.

We talked all about glucose but the glucose peaks are not the real problem. It is the elevated insulin that is required to handle the glucose load that results in increased risk of diabetes, cardiovascular disease, some cancers and even Alzheimer’s disease. There are ways we can blunt our glucose and therefore insulin spikes. One way is to eat fully clothed carbohydrates. You can also put some clothes on your carbohydrate. For example, peanut butter on your banana. Changing the order that we eat our food at a meal also helps. Eat vegetables first, then eat the protein and fat and end with the “starchy” foods of the meal. Finally, don’t start your day with dessert, ie processed cereal. Instead have a savory breakfast or leftovers for breakfast.

Good grief, we were so averse to fat in the 90’s. We were told in no uncertain terms that saturated fat was bad and we should reduce the amount we were consuming. This was based on large epidemiologic studies that suggested that lowering saturated fat would reduce cholesterol and heart disease. So food companies went about cutting fat in processed food replacing it with sugar. The results were not positive. We gained more weight and rates of diabetes increased. Interestingly, historical analysis of internal documents from the sugar industry in the 1960’s and 70’s identified an agenda to make sugar seem not so bad and cast fat as the culprit for health problems (Kearns et al 2016).

The focus today is the macronutrient fat, not high fat vs low fat diets. A bit of chemistry is needed to understand fat. A saturated fat has no double bonds between carbons and is solid at room temperature. A polyunsaturated fat has double bonds. Most are cis double bonds which puts a kink in the carbon chain. As a result, it can’t pack together as tightly and is liquid at room temperature. Who knew that organic chemistry would be so helpful?

Let’s start with a 4 letter fat: Trans fats. Trans fats have a double bond in the “trans” position. Small amounts of trans fats are found in nature but the vast majority in the diet comes from hydrogenating” ie adding hydrogens to corn oil. That’s how we got Crisco, that weird white solid fat. The properties of trans fats makes them very useful in the preparation of processed food. But they increase LDL cholesterol and decrease HDL cholesterol. Trans fats are so bad they have been banned since 2018. But they are still present in the food supply. A company can list 0 grams if the product contains less than .5 grams per serving. Look for words like “hydrogenated oil” or “partially hydrogenated oil”. They are still found in bakery products, microwave popcorn, fried foods. AVOID THEM.

Saturated fats are found primarily in animal products. There is data suggesting that they contribute to cardiovascular disease but maybe less than we thought now that studies separate out trans fats and saturated fats. Saturated fats should probably be limited especially for those with cardiovascular disease or risk. Coconut oil contains the highest amounts of saturated fat. It is mostly medium chain not long carbon chains like other saturated fat. Coconut oil increases LDL cholesterol but also increases HDL cholesterol. Even so, use in moderation. There is a lot of hype around coconut oil.

Overall polyunsaturated fats are healthier. But avoiding refined vegetable oils is a good idea. These are polyunsaturated oils like corn and soybean oil which are also used in large amounts in processed foods. They are inflammatory and when used in frying they can create trans fats. “Vegetable oils” tend to be high in omega 6 fatty acids, meaning the first double bond is in the 6th position (more organic chemistry). Our diet has shifted way too much toward omega 6 fats with proportionately fewer, healthier, omega 3 fats. A healthy ratio is 4:1 omega 6 to omega 3 or less. The Standard American diet is 10:1. A higher leads to chronic inflammation and impaired health of cell membranes.

No fat is 100% of any one type of fatty acid. See the table below. It is always a mix. Foods high in omega 3 fats include fatty fish, flax seed, nuts. Interestingly, (though not in the table) grass fed meat/dairy has more omega 3 fats than grain fed. Olive oil is also not a 4 letter fat. It is a monounsaturated fat meaning there is only one double bond and is associated with lowering LDL cholesterol and inflammation and should be a primary source of fat in our diets. Once again, go for quality and avoid processed food. Cooking properties are important too. High heat is not good for some oils. This is a link to a HEALTHLINE article that goes deeper into some oils and their cooking properties: https://www.healthline.com/nutrition/best-cooking-oils

If you compare a vegetarian diet to the Standard American Diet, ie the SAD diet, the vegetarian diet is healthier by far and there is plenty of research to back that up. But what if you compare the diet of individuals who have an overall healthy lifestyle and just vary in what they eat. A study that followed over 64,000 healthy vegetarians and non vegetarians in Europe found that mortality rates did not differ significantly between nonvegetarians and vegetarians or between meat eaters, fish eaters, and vegetarians (Key T, 2009). The Adventist Health Study 2 compared different diet patterns of over 73,000 Seventh Day Adventists. The male vegetarians compared to the non vegetarians had a 12% lower risk of all cause mortality but this was not true for the women (Orlich M, 2013). Researchers then compared diet patterns, vegan, lacto-ovo vegetarian, pesco vegetarian and semi vegetarian to a non vegetarian diet. The Pesco vegetarians appeared to have lower risk of all cause mortality and mortality due to cardiovascular disease. So, comparing healthy vegetarians to non vegetarians there is not that much difference. But that is the key. The whole lifestyle package should be good, no smoking or excess drinking, exercise and consume lots of plants.

Let’s be clear. We are not talking about poultry or fish. And the red meat I’m talking about is not processed meat such as bacon or bologna. Processed meat is considered a Class 1 carcinogen and is associated with increased risk of both cancer and cardiovascular disease (Wang X 2015; Iqbal R 2021). There is more than one carcinogenic component of processed meat but nitrates/nitrites are primary culprits. Nitrate free processed meats still have nitrates added. Food companies use natural sources such as celery juice or powder and then it does not need to be listed on the label. But acts the same way. BTW celery is not a problem! We don’t know enough about meat that is preserved through fermenting it may be a better option.

I eat limited amounts of red meat. I grew up on a ranch and this was our cultural diet pattern. And I like the taste. After ditching the brainwashing about the benefits of “beef” I grew up with, I still continue to eat some red meat. From health perspective the primary reason is protein. Red meat provides a calorie efficient source of high-quality protein. Eating animal protein is linked to increased lean muscle mass and reduction in muscle loss with age (Alexandrov, 2018). If you look at typical serving sizes you need to eat more plant protein to obtain the same amount of protein in red meat. Can you preserve muscle without red meat, sure.

What does 25 g look like:

The environmental impact of meat should not be ignored. If I didn’t have access to local organic and/or grass-fed meat I’d have a hard time continuing to eat animal products in general. The current system of raising animals in a concentrated (ie confined) animal feeding operation (CAFO) has huge environmental and ethical impacts and promotes a type of agriculture that is not sustainable. CAFO’s provide a cheap product at the supermarket but we are not paying for the true cost. Grass fed/organic options for meat can be an important part of a regenerative agriculture system which can contribute to improving our current climate predicament.

There are health benefits of eating grass-fed animal foods (meat and dairy). They are higher in omega 3 fatty acids compared to omega 6 fatty acids. Grass fed animal foods are higher in Conjugated Linoleic Acid (CLA), which is a “healthy” trans omega 6 fatty acid found in nature. CLA may be helpful for promoting weight loss. However, randomized control trials of supplementation show mixed results. Better to get CLA from food rather than a supplement. Finally, food from grass fed animal products are 2-20 times higher in phytonutrients than grain fed animals (van Vliet et al 2021).

Just because some red meat is “healthier” doesn’t mean you should eat it every day. Red meat is a class 2A carcinogen. High heat cooking, such as grilling, may also create cancer-promoting compounds. Too much red meat is associated with cardiovascular disease. How much red meat is ok? Another look at the Adventist 2 study suggested that a ½ oz per day did not increase risk, that isn’t much. A Harvard study suggested a ½ serving or (about 1 ½ oz) per day of unprocessed red meat does not increase cardiovascular risk but more than that does (Al Shaar L, 2019). The meat in these studies was most likely feedlot raised meat. Grass fed may not be as risky, we just don’t know. To optimize the health promoting aspects of your diet I’d suggest limiting red meat to 3 maybe 4 servings a week as part of an otherwise healthy plant-based diet. Next week Eugenie will provide the perspective of someone following a Vegetarian diet.