What's the Best Diet? Healthy Eating 101

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

thank

you