I have a very vivid memory from high school of a nutrition talk. They had a rubber model of fat, a big, yellow, bubbly, wiggly glob of fat. They then proceeded to tell us how much a problem fat is for health. They held up this fat blob and shook it telling us that fat was bad. This was the early 90’s and low-fat diets were all the rage. I remember my mom rolling her eyes and sighing as I chastised her for cooking with butter. I remember getting a bagel for lunch at school and trying not to put too much cream cheese on it. Now I can imagine my daughter coming home and telling me that I should have more cream cheese and less bagel. That those carbs are killing me and that I need more protein and fat. So, where do we go with this? Is butter evil, how about bread? How do we make sense of all the dietary advice that comes along so we can have a healthy, nourishing relationship with the food we eat?
Let me start by telling you this:
Nobody's really sure about what the healthiest diet is, or if such a thing exists.
Sometimes when I am talking to people about nutrition, it feels like talking about religion or politics. There are many different perspectives which are passionately defended that it’s impossible to determine what is the universal “truth.” Nutritional science is like most science, we postulate ideas and we test them. Often times with nutrition we move too quickly through the scientific method and make a conclusion before we have all the information. It’s understandable that we do this, it would be boring to just be saying we don’t know anything all the time. And perhaps some of these postulations are the “truth.” How else can we decide what we should eat?
“Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome,” John P.A. Ioannidis, a professor of medicine and statistics at Stanford and one of the harshest critics of nutritional science, has written. “In this literature of epidemic proportions, how many results are correct?”
Cholesterol
Let’s start with a talk about cholesterol. From the 2015 dietary guidelines from health.gov: “Dietary cholesterol is found only in animal foods such as egg yolk, dairy products, shellfish, meats, and poultry.” In the early 1900’s scientists saw that plaques in the arteries leading to heart disease were made up of cholesterol and thus postulated that a diet rich in cholesterol would lead to heart disease. Later this idea was supported in studies where rabbits were fed cholesterol-rich diets and subsequently died quicker than their counterparts on lower cholesterol diets. It was further supported when they looked at large populations of people and saw that people with high cholesterol diets were more likely to have heart disease. In the 1960’s the American Heart Association recommended we limit our intake of cholesterol to less than 300 mg per day (there are 200 mg of cholesterol in an egg yolk).
Then, in Feb of 2015, the Dietary Guidelines Advisory Committee, the nation’s top nutrition advisory panel, reversed the recommendation limiting the intake of cholesterol, stating “Adequate evidence is not available for a quantitative limit for dietary cholesterol specific to the Dietary Guidelines.” The reason for the reversal was that larger studies had been unable to substantiate this link and showed that those eating a diet higher in dietary cholesterol didn’t have an increased risk of heart disease. In the 2015 guidelines, they talk about how we can’t make a sweeping statement about one isolated aspect of our diet and how it affects our health. We have to look at overall eating patterns, i.e. look at the big picture. These guidelines did call out specifically that egg yolks and shellfish, although they have a lot of cholesterol, do not have a lot of saturated fat, and thus may be consumed within a variable diet. In other words, maybe the cholesterol in eggs and shellfish isn’t so bad.
So why the back and forth, what is really going on here?
What is going on here is science. This is how our scientific method works. We develop guidelines with the best of our knowledge but these topics are so complex that we constantly have to re-evaluate with more sophisticated studies.
Fat
Let’s talk about full-fat vs. low-fat dairy products. The current recommendations by the dietary guidelines advisory committee are that dairy products that are higher in fat have more calories and do not provide any better nutritional value than low fat. Therefore, the recommendation is to focus on low-fat dairy products. However, this long-held theory has come into question recently. In March of 2015 a study was published in the European Journal of nutrition that showed that there was no link between intake of high-fat dairy products (butter, cream, whole milk) and obesity. In fact, they showed that those eating full-fat dairy had lower rates of obesity than those eating low-fat dairy. Some theorize that not all calories are created equally. They say that the full-fat dairy satiates us more and then allows us to eat less later on. Of course, these studies are merely observational studies (meaning they are the start to our science). Thus, we can’t get pretend that we have found the “truth.” However, I find it very interesting as it calls our conventional wisdom into question.
Carbohydrates
Almost everyone I see who would like to lose weight tells me guiltily that they need to cut out bread. I think many people think “gluten free” means healthy. We have talked about the limitations of our nutritional science and our lack of understanding of the “truth.” I think we need to remember this especially when we are talking about bread and grains. Gluten sensitivity is a real issue and it isn’t uncommon. For those who are sensitive to gluten, bread is evil. However, for those who are not sensitive to gluten, there is room for bread. I do think that it’s very easy to eat too much bread, especially sweet bread because it’s so darn good. I also believe that eating bread alone without a bit of protein and fat to balance it can lead us to eat more later. This goes back to the concept brought up in the 2015 guidelines on cholesterol. We can’t single out one aspect of the diet in isolation and call it bad. We have to look at the overall pattern of eating.
So, with all of that said, I’d like to give you my humble perspective on healthy eating:
Make eating an experience.
I believe that the type of food you are eating is just as important as the environment that you are eating in. There is some interesting science behind the idea that reflecting upon your food, being present when you are eating it (instead of staring at a tv or driving in the car) will make you eat a more appropriate amount. Thinking about food and imagining you are eating it can actually make you eat a bit less. Eating with others, when you can, can build both a support network and guide you towards healthier eating. Enjoy the smells, the colors, and savor what you are eating.
Eat real food.
I don’t believe that shakes, supplements, bars, powders, etc. are healthy. The foods on our earth are incredibly complex and their value can not be re-created in a product that is heavily marketed as “healthy.” Whenever possible eat whole fruits, vegetables, nuts, grains, fish, meats, dairy, and yes, I said it, bread (the minimally processed kind). Moving away from processed foods to real foods will naturally lower your exposure to artificially created trans fats. (This can be found in microwave popcorn, frozen pizzas, some coffee creamers, margarine, and processed baked goods.) In my opinion artificially created trans- fats are really bad.
Change it up and mix it up.
Try new things. Aim for trying a new fruit or veggie every month. When you plan a meal try to have different colors and mix protein with fat and carbohydrates. I believe it’s much better to have white bread with peanut butter, than white bread alone.
Don’t drink your calories.
Water or sparkling water should be your drink. Juice has a lot of calories that go down fast, take it in small doses. Smoothies should be considered a treat. Try to find a way to dislike soda, diet or regular (there is really nothing good about it). Alcohol in moderation.
Don’t demonize foods.
Even the “worst” foods are ok to have once in awhile. What you might find is that if you focus on enjoying and appreciating real food, these processed, high salt, high sugar foods just don’t taste good anymore.
Losing Weight
If you want to lose weight, set very small realistic goals of changing your eating patterns. Be kind and patient with yourself. If you want to add in exercise, make sure you that you love it. Remember exercise alone will not make you lose weight, there is more power in changing what you eat.
Overall, the most important advice I can give is for you to find a diet that you enjoy and makes you feel good.