"Eat Food, not Too Much, Mostly Plants."

“Learning how to eat,” that is a goal that I sometimes hear. It is true, eating has gotten quite complicated. When did we forget how to eat? With keto, intermittent fasting, Paleo, macro management, nightshade free diets, meal preparation services, specialty grocery stores and food manufactures advertising gluten free, vegan, organic, and low carb, perhaps we have gotten so many mixed messages.

In today’s blog, we will look at the nutrition approach I typically use as a base starting point. Most of this is aimed at drowning out the noise of "diets" and getting back to our roots! Brace yourself, it is very complicated (jk):

“Eat food, not too much, mostly plants.” If it has a label, read it!

Let’s look at each part of this plan.

Eat Food, Read Labels

This phrase means to eat mostly whole, unprocessed food, that looks like it does at its origin. Most food that falls into this category does not have a label. This is things like fruit, vegetables, beans, sweet potatoes, and eggs. To know what you are eating, if it has a label, read it! This includes both the calories, carbohydrates, fat, and the ingredients list. Remember, the front of the package is advertising to get you to buy it, the label and the ingredients list is what is regulated and tells you “the truth.” Some of the most successful advertising techniques are to put, depending on which fad is popular at the time, statements on the front of the package like, “organic, low carb, keto friendly, low fat, gluten free.” The common pitfalls for each of these are:

Organic- not all organic food is healthy. Organic refers to chemicals.

Low Carb- these may contain high sugar alcohols, which some people absorb and can cause gastrointestinal upset. These products also may be high fat and high calorie

Keto friendly- again, a keto diet is a high fat diet. Most people who are trying to manage weight need to be very careful with the amount of fat in their diet because fat contains 2.25 times more calories per gram than protein and carbohydrates. Food units are generally in weight. That is why potato chip bags are half empty. So, if you eat 60 grams of fat, you will be eating 2.25 times more calories than if you ate 60 grams carbohydrates.

Low fat - this was popular a few decades ago. That is when the food industry took food out and put sugar in, and some people think that was key in increasing the obesity epidemic and stopping the decline in heart attacks. Get around this by eating whole food that does not have sugar added to it.

Some tips to help you get this part right are:

• If it comes in a bag or a box with a barcode, it likely has been processed.

• If it has an ingredients list that is long, it likely has ingredients to prolong the shelf life or preserve it.

• If it has ingredients in it and you do not know what the things are, you might not want to eat them.

Not Too Much

This part of the statement means that energy balance still has a role in weight management. We have talked a lot about how “calorie in, calories out” does not explain the whole story of a person’s weight because the body has hormones that affect a person’s metabolism. But, for the hormones, medications, and metabolism that you have, the number of calories does matter. Common pitfalls here are when people eat healthy food, but the calorie content is higher than they can sustain for a healthier weight for their activity level, or when a person is focusing on some aspect other than calories and unknowingly consuming more calories than they think. For example, this can happen when a person is counting carbs on labels, but not also counting calories. People eat food, not calories, so it is not that I recommend counting calories, but if you are counting carbs, and you have to eat something, it is more likely you are eating fat, and that goes back to the calorie density of fat that is 2.25 times more calories than the carbohydrates you are avoiding. Another common pitfall with this is intermittent fasting, when a person only eats for a specified number of hours per day, but is not looking at the number of calories eaten during that time. Even if you only eat for 6 hours per 24 hours, it is not that hard to eat 1800 calories in 6 hours, especially if you are focusing on timing and have a false sense of security that calories don’t matter as much if you do not eat the other hours of the day.

An easy way to make sure you are not eating too much is to use the strategy of “scoop, sprinkle, or spoon foods.” This means that if a food is low in calorie density, you can just scoop it onto your plate as it is harder to get too many calories. Examples are green vegetables and leafy greens. A “sprinkle” food is a food that is medium in calorie density. This is something like beans or pasta. A serving is about the size of your fist. A “spoon” food is high in calorie density. This is basically fats, like oils and butters and cream. With these, you may use a soup spoon or estimate the serving size as the size of your thumb. Common pitfalls with spoon foods are cream or butter in coffee, salad dressing, and dips. With this strategy, with just your fist and your thumb, you can get foods right sized.

Mostly Plants

There are a lot of studies and arguments on health risks of meat; this is not about those. Whether you choose to eat meat or not, I don’t think there is much doubt on the benefits of phytonutrients in fruits and vegetables. Some experts think that the benefits of a vegetarian diet come from adding plants rather than taking out meat. For weight management, the benefits of plants are that they generally have a high water content, a high fiber content, and a low calorie density. A low calorie density means that there is a small amount of calories in a large volume of food. This is the opposite of fat. One apple has 10% fewer calories than one tablespoon of fat, and yet many people today are avoiding fruit because they are completely carbohydrate, and sugar at that. A study released in 2017 showed that only 1 in 10 adults gets the recommended daily allowance of fruits and vegetables. If you focus on putting these in, it frequently “crowds out” other things, so you end up consuming fewer calories and feeling more full. You will probably not be constipated, either!

Meal Replacements

So, where do meal replacments or protein supplements fall into this? They are in a box and have a label, so why am I using them? Here is what I think is the role of medical foods:

• to use as a prescription meal plan for 3 to 6 months to lose 10 to 27% of your body weight if you have that amount to lose. Studies show that nutrition interventions with grocery food typically achieve about 5% weight loss.

• To replace one meal per day after losing 10% or more of your body weight to prevent weight regain. Studies show that weight regain happens in 85% of people who lose weight non surgically who are not taking an anti obesity medication if they are not replacing at least one meal per day with a medical food

• To provide other sources of meals and snacks during maintenance that are low calorie and yet still contain the needed macro and micronutrients for a health body and body composition, including protein and vitamins and probiotics. It is difficult to find a 160 calorie meal that contains 20 grams of protein and 20% of your recommended daily allowance of vitamins in a non fortified food source

• To get a meal replacement that has high quality, easily digestible nutrients free from unnecessary additives. There are commercially available products that will have similar amounts of protein, carbs, and fat, but the quality is not all the same.

• Be sure to check with your physician before starting making any major nutrition changes or weight loss program, especially if you have medical conditions or take medications.

Take Back Your Food,

Valerie Sutherland, MD