Healthy Food

What’s the Best Diet? Healthy Eating 101

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hi i’m dr mike evans and today i’m talking about healthy eating it’s a huge topic eating seems simple but it’s actually pretty complex so i thought it would just focus on what i’d say if you and i sat down in the clinic i might start by wondering what we’re shooting for weight loss less overeating healthy eating a longer better life then sticking with the big picture i’d point out that eating is just one behavior in a healthy cascade exercising regularly leads to better stress management and sleep which leads to better food decisions to more energy less chronic disease and so on if it’s weight loss you’re after that’s easy conceptually don’t eat as much and move more the problem is it’s not so easy keeping up this energy balance in the real world in industrialized countries we are surrounded by a limitless supply of inexpensive tasty super-sized high-calorie food the other side of the energy balance equation ie activity has also changed as our generation has a severe case of sitting disease nightly tv commutes spectacular video games moving sidewalks and most of us now are sitting knowledge workers our culture pushes us towards the easy button instead of making our days harder on the other other side of the equation i think it’s important to remember that eating is grand food brings together families builds communities and gives us health okay so let’s start with the question i most often get about eating what’s the best diet for losing weight i’m not surprised people are confused while you’re watching this video there’s probably a pop-up window from the diet industry telling you about a diet a detox or a superfood not to mention the hollywood star that just started that diet no research has shown convincingly that one commercial diet trumps all the rest the only thing that predicted success in head-to-head trials was how well you stuck to whichever diet you picked so to reframe this our society lurches from diet to diet looking for some magic formula but but it’s not the formula as much as the pattern instead of obsessing about the exact composition of a diet the science tells us to choose the one you like the best and can actually stick to a cochrane meta-analysis in 2015 looking at what bumped the success of commercial weight loss diets showed it wasn’t less carbs or or fat it was more structure and more in-person social support really diets are just food rules that influence our pattern of eating or what the economists call a commitment device what self-aware people do to improve their chances of controlling future irrational or impulsive behaviors so instead of autopilot you follow a food world that nudges you towards certain eating decisions mostly less overeating each commercial diet has their own magic formula of what we call macronutrients so low carb high protein low fat sugar and so on and they typically have a story to go with it so you can eat like a caveman or use a scoring system or it’s pre-packaged or a famous doctor’s take or or whatever and i suppose my two messages with macronutrients are one i i think we spent too much time and energy focusing on them and two it’s really more about quality than quantity low carb well carbs can be healthy in their complex form fruits veggies legumes whole grains and not so healthy in their simple form like free sugars and and refined starches you know let’s face it carbs taste awesome and our society tends to overeat them so people who restrict their intake tend to lose weight however when we study relative weight loss outcomes a 2014 systematic review by dr celeste naud and colleagues looked at weight and cardiovascular markers of at-risk people on low-carb diets that were followed for up to two years and they found no difference compared to balanced weight loss diets so how about lowering sugar well if i had to pick one word to describe sugar in industrialized societies it would be sneaky so so much sugar has worked its way into our diets i mean many drinks have eight or more teaspoons of sugar the the average american intake is approximately 20 teaspoons of sugar a day more in teenagers and less in canada it’s the obvious sweets but but it’s also foods we think of as healthy so cereals and granola bars and fruit juices when high sugar contributes to excess calories that is when we seem to get into trouble one interesting caveat is it is that when i diagnose patients with pre-diabetes the first thing they do is drop sugar from their diet however when we look at the diabetes prevention trials it was less about sugar restriction and more about the healthy cascade of being active half hour a day five to seven percent weight loss eating less saturated fats and eating more fiber that reduce risk of progression to diabetes by 58 percent how about low fat well i think our story has changed on fat from all bad to again more of a continuum you have your trans fat so fried fast food many packaged baked goods uh not so good and we’re reducing these we have saturated fats mostly in dairy and and red meat and plant oils like coconut or palm these seem not so good in excess but okay in moderation then we have your monounsaturated fats or mufa the mediterranean diet which i’ll discuss in a second is pretty high in mufasa so avocados nuts seeds olive oil dark chocolate and shows health benefits finally we have pufas so these are the longer chain fats found in oily fishes early trials showed some reduction in cardiac events more recent trials not so enthusiastic meta-analysis still showing some small benefit no harm so the suggestion is at least two servings a week people seem to do better when they replace saturated fats with mufa and pufa fats what about high protein diets again it’s more quality than quantity protein can come in different packages with different health effects so say comparing a high salt ham steak versus a salmon steak or lentils or a handful of almonds most data points that if you eat healthy protein white meat nuts beans fish you do better especially if it is spread throughout the day perhaps most importantly at breakfast there are also some diet showing good results in people with disease so the dash diet dropping high blood pressure by 5 to 11 millimeters of mercury or or low glycemic index diet dropping a1c the measurement for blood sugar over time and people with diabetes by 0.5 percentage points many of our patients have high cholesterol and dr david jenkins and his colleagues here at the university of toronto have shown they can reduce cholesterol by 35 with the portfolio diet the data for vegetarianism has largely come from cohort studies and now some randomized trials showing that people do better it’s hard not to conclude that a diet rich in plant-based unprocessed foods is a smart diet and of course many people make the excellent point that the burden on our planet is is less with a vegetarian or vegan or local diets one way to think about all this is to reflect on brazil’s new dietary guidelines here they shifted from focusing on the perfect macronutrient mix towards more appreciation of food stepping back a bit to see you know we’re buying more ultra processed foods and packaged foods that can be eaten anywhere and that maybe there’s an opportunity for healthier eating and better relationships by encouraging creating meals with your family and friends okay if there’s no magic formula is there a diet that actually does work i think the answer is yes the diet is more about culture and small behaviors a diet not focused on weight loss but unhealthy outcomes like less cancer heart disease dementia a longer life the diet with the most robust evidence is a mediterranean diet instead of food rules or absolutes this is more about moderation less meat more veggies fruit for dessert i think shopping at the market or at least at the outer aisles of a grocery store not the processed foods for sale in the inner aisles it’s called the mediterranean diet but really it’s more of a lifestyle a region that traditionally includes lots of physical activity regular meals and good social support so let’s continue this shift from diets to healthy behaviors that affect our eating by looking at the national weight control registry the nwcr administers annual questionnaires to more than 10 000 people more women than men who have lost quite a bit of weight and kept it off for more than a year not surprisingly 98 said they modified their food intake in some way and and 94 increase their activity levels but there wasn’t one formula most restricted some foods some counted calories others ate all foods just limited their quantities 78 ate breakfast every day the majority watched less than 10 hours of tv and ate out just three times a week and these people generally exceeded the prescribed half hour day of activity averaging an hour a day mostly walking nearly all registry members indicated that weight loss led to improvements in their level of energy physical mobility general mood self-confidence and physical health feedback loops seem important losing weight is one thing but it seems like the trickier part at least for about eighty percent of us is keeping it off weighing yourself and using this as a small nudge in your daily food decisions is an example 75 percent of nwcr subjects weighed themselves weekly 36 percent daily and they looked at this more closely at the stop regained trial where daily self wane was associated with a decreased risk of regaining 2.3 kilograms or 5 pounds on average another feedback nudge is a food diary even just for a week and easier now with apps patients find this so simple they don’t do it but but seeing what you’ve eaten can actually double your weight loss so i think awareness is undersold it might be what you’re eating or weighing but it’s also about knowing that life is messy and to enjoy it we need some flexibility or that you simply feel better when you eat better that’s why i like the idea of starting with small changes or as i call them tweaks maybe switch something you do a lot so for example eating breakfast snacking drinking you can switch your average cereal for some oatmeal or shredded wheat a handful of almonds instead of a bag of chips maybe switch three of your colored drinks a day to water i know this doesn’t sound too sexy but the dr mike switcheroo diet might actually chip away at a pound a week or or better yet might make you feel better another angle is adding instead of subtracting so dr sherry pagoda and colleagues randomized metabolically at risk individuals to either a multifaceted american heart association diet versus the simpler advice of just increasing fiber to 30 grams throughout the day so getting on the brand wagon a trip to beantown berry picking both groups lost weight dha group slightly more and both improved cardiovascular markers now i like this idea of pushing healthier food rather than just restricting or fencing off other food other data showing satiety our feeling of being full is not just about calories calories that come from proteins and and fibers actually can make us feel more full another angle is social support which can actually help our eating behaviors another study where people were either going it alone versus having three or more friends or family members supporting them maintaining weight loss at 10 months jumped from 24 to 66 on the subject of support having a dietitian even if just online helps they’re like a genius bar for your eating activity is interesting the context of eating research shows us that people who are active even when they have obesity live longer than skinny sedentaries so when my patients tell me they are active but have been unsuccessful at weight loss i shrug my shoulders and say actually you have been successful you’re active it’s easier to draw calories through diet but i i think it’s important to know that the research shows that people who exercise have more success at maintaining their weight my final two points about healthy eating focus on this long-term play and attitude as restrictive diets have proven hard to sustain many are now turning from the individual to what surrounds the individual changing our eating environment to make it easier to make the right choice day after day we call this redesign choice architecture and involves two types of what i call quote nudge awareness first is knowing that our world is full of triggers towards unhealthier overeating convenient shiny foods at the counter super sizing marketing as dr brian wansink points out most of us don’t overeat because we’re hungry secondly is an awareness of what nudges you personally we are creatures of habit we do the same thing every week and each of us has cues certain foods pastries at the coffee counter a time 11 3 or 10 a predictable stressor as wansing says the opportunity here is to re-engineer small behaviors that move you from mindless overeating to mindless better eating maybe it’s redesigning your kitchen when you leave cookies on the counter they are much more likely to be eaten but the same is true for fruits and veggies smaller plates glasses less super-sized containers and not eating from the bag are simple nudges to reduce mindless eating redesign takes some self-knowledge are you a nighttime nibbler or an emotional eater i’m a grazer i’ll eat whatever is there so my change is at the grocery store i know it’s pathetic i should cut fruits myself but mindless healthy eating happens for me when i buy pre-cut fruit and just like i might tell a smoker not to have cigarettes in the house i also don’t buy super sour jude views because i can’t stop eating those things my final behavior is more of an attitude 80 20.

So if you’re making a healthier choice 80 of the time and your 20 is not too high cal i and you should be thrilled having a piece of dark chocolate a good meal out some pie we’re into this for the long term so i’m not looking for perfection i’m looking for consistency so in the end i hope i’ve got you to think a bit differently about how you eat instead of investing a single diet a portfolio behaviors small tweaks over big changes single ingredient foods over multi-ingredient and processed foods dinner at home self-awareness depending less on constant willpower and more in tweaking your week to make mindless healthy eating more likely my final point is more about health at every size you know i i get that people want weight loss and obesity is a risk factor for disease but honestly if my patients can work with their factory settings to be more mindful of their eating move more a bit more self-love and start thinking more about what’s healthy to eat rather than what not to eat i’d be happy so maybe now is the time to start your very own better life experiment thanks for listening you

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