What’s The Best Diet
Today I will be talking about What’s The Best Diet for you and all about healthy eating. It’s a huge topic. But it’s actually pretty complex. We 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, 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, supersized, high-calorie food. The other side of the energy balance equation, i.e. activity has also changed is our generation has a severe case of Sydney disease, nightly TV, commute, spectacular video games, moving sidewalks, and most of us now are city knowledge workers. Our culture pushes us towards the easy button instead of making our days harder. On the other side of the equation, I think it’s important to remember that eating is grand food that brings together families, builds communities, and gives us health.
OK, 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. 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 re-frame this, our society lurches from diet to diet, looking for some magic formula. But it’s not the formula as much as the pattern. Instead of obsessing about the exact composition of a diet, science tells us to choose the one we like the best and can actually stick to. A Cochrane meta-analysis in 2015, looking at what bumped the success of commercial weight loss, diet showed it wasn’t fewer carbs or fat. It was more structured 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 with self-aware people does to improve their chances of controlling future irrational or impulsive behaviors.
So instead of autopilot, you follow a food rule that nudges you towards certain eating decisions, mostly less overeating. Each commercial diet has its own magic formula for 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 its pre-packaged or famous doctors take or whatever.
And I suppose my two messages with macronutrients are one. 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 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. Celestron 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 balance 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 much sugar has worked its way into our diet. I mean, many drinks have eight or more teaspoons of sugar. 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 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 that when the doctor diagnoses patients with prediabetes, 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 an hour a day, five to seven percent weight loss, eating less saturated fats, and eating more fiber. That reduced 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. Yeah, B, trans fat, so fried fast food, many packaged baked goods, not so good. And we’re reducing these. We have saturated fats mostly in dairy and red meat. The plant was like coconut or palm. They seem not so good in excess but OK in moderation. Then we have your monounsaturated fats or Mufa. The Mediterranean diet, which I’ll discuss in a second, is pretty high and move fast. So avocados, nuts, seeds, olive oil, dark chocolate and shows health benefits.
Finally, we have Pufa. 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 sad mistake or lentils or a handful of ailments. 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 diets showing good results in people with the disease. So, the Dash diet dropping high blood pressure by five to 11 millimeters of mercury or low glycaemic index diet dropping agency, the measurement for blood sugar over time and people with diabetes by point five percentage points.
Many patients have high cholesterol, and Dr. David Jenkins and his colleagues at the University of Toronto have shown they can reduce cholesterol by 35 percent 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 less with a vegetarian or vegan or local diet.
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.
OK, 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 on healthy outcomes like less cancer, heart disease, dementia, and 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, 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 the 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 10000 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 percent said they modified their food intake in some way and 94 percent increase their activity levels. But there wasn’t one formula most restricted some food, some kind of calories. Others ate all foods, just limited their quantities. 70 percent eat breakfast every day. The majority watch 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 in important. Losing weight is one thing, but it seems like the trickier part, at least for about 80 percent of us, is keeping it off within ourselves. And using this as a small nudge in your daily food decisions is an example. 75 percent of NWC, our subjects weighed themselves weekly, 36 percent daily. And they looked at this more closely at the stop gain trial, where the daily cell phone was associated with a decreased risk of regaining two points three kilograms or five 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 seeing what you have eaten can actually double your weight loss. So, I think awareness is undersold, it may 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 that maybe switch something to 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.
The final behavior is the Attitude 80- 20. If you are making a healthier choice 80 percent of the time, and your 20 percent is not too high cal you should be thrilled, having a piece of dark chocolate or a good meal out. If we are into this for the long term, so we are not looking for perfection we are looking for consistency. So in the end I hope I got you to think a bit differently about how you eat.
Originally published at https://www.justhealthonline.com.
