As a doctor, it is my job to figure out the best way to keep my patients healthy. As a doctor that practices integrative and functional medicine, it is my job to make sure diet and lifestyle modification is the foundation on which we achieve optimal health. We now know that food is medicine, and perhaps the most powerful drug on the planet with the power to cause or cure most disease. Food is more than just calories. It is information that controls every aspect of our biology and health.
There is so much controversy out there on what an “ideal” diet should look like, and if you search long enough, you can find legitimate scientific literature to support/refute most every popular diet out there.
Before reading on I want to clarify one thing, I am by no means a dietician and sadly received very little formal nutrition training in medical school. I am writing this as a physician with a personal interest in using food as medicine with my patients.
In my opinion, the biggest problem with a lot of these diets is how the average person interprets them. Let’s look at two seemingly opposite diets, paleo and vegetarian. Many people interpret the paleo diet as an excuse to eat all the meat and fat they want. They will tell you a Big Mac is “paleo” as long as you take off the bun or their ideal plate consists of a 160z T-bone with a small carrot on the side. Vegetarians on the other hand commonly consume large amounts of processed carbohydrates, sugars and potentially inflammatory grains under the guise of health given no animal products are involved. When interpreted in this way I would consider neither approach “healthy.”
However, as it turns out, when interpreted correctly these diets have a lot more in common than you might think. They both focus on real, whole, fresh food that is sustainably raised.
Here are the characteristics of a healthy diet everyone agrees on:
Very low glycemic load – low in sugar, flour and refined carbohydrates of all kinds.
High in vegetables and fruits – the deeper the colors, the more variety, the better. This provides a high phytonutrient content protective against most diseases.
Low in pesticides, antibiotics and hormones – which means sticking with organic, non GMO choices whenever possible. Ideally, choose local as much as possible
No chemicals – additives, preservatives, dyes, MSG, artificial sweeteners and other “Franken Chemicals” that you would never find in nature
Higher in good quality fats – omega 3 fats for all, and most camps advise good quality fats from olive oil, nuts, seeds and avocados.
Adequate protein – for appetite control and muscle synthesis, especially in the elderly.
Ideally organic, local and fresh foods – should be the majority of your diet.
Now here are the more controversial components:
Grains – Whole grains offer a lot of nutritional value for those who can tolerate them. However, for numerous reasons (that I will discuss in another post) the prevalence of NCGS (non-celiac gluten sensitivity) and NCWS (non-celiac wheat sensitivity) has seen a sharp increase in the last 20 years. For millions of Americans gluten creates inflammation, autoimmunity, digestive disorders and has detrimental effects on the central nervous system. It has been pretty eye opening to me both personally and professionally what a difference removing gluten from your diet can make. That being said, not all grains are created equal and I generally recommend people include things like quinoa, buckwheat, wild rice and gluten free oats. However, for type 2 diabetics wanting to reverse their diabetes and for those with autoimmune disease, a grain and bean free diet could be a good experiment for a month or two to see how it impacts health.
Beans – Beans are a great source of fiber, protein and minerals. But they do cause digestive problems for some and if you are diabetic, a mostly bean diet can trigger spikes in blood sugar. Again, moderate amounts are ok – meaning about up to 1 cup a day. There is some concern that beans contain lectins that create inflammation or phytates that impair mineral absorption; however, I think the benefits outweigh the risks when consumed in moderation as part of a vegetable rich diet.
Meat – This is a big one. An important fact to keep in mind is that all meat is not created equal. You have feedlot beef that has more palmitic and myristic acid that raises cholesterol and increases inflammation. Or you have grass fed/finished beef that has more cholesterol neutral stearic acid, and also contains protective omega 3 fats and vitamins A and D which raise glutathione and other antioxidants. Some studies show meat increases heart disease and death rates, but others show the opposite. In truth, it depends on both the quality of the study and the type of meat used, but the evidence in my mind is trending toward meat not being linked to death or heart attacks for the reasons I mentioned above. Eating sustainably raised meat, poultry, and lamb and other esoteric meats such as ostrich, bison or venison as part a healthy diet is not likely harmful and is very helpful in reducing triglycerides, raising HDL (or good cholesterol), lowering blood sugar, reducing belly fat, reducing appetite, raising testosterone and increasing muscle mass. On the other hand, eating an excessive amount of meat puts pressure on the planet i.e. more water use, more climate change, and more energy inputs. My recommendation is to think of meat as the side dish to a plant based meal and only consume grass fed and sustainably-raised meats.
Fish – Fish is an excellent source of healthy fats (EPA/DHA) and lean protein. My biggest concern with fish is the potential for mercury toxicity when consuming large amounts of large bodied fish such as tuna, orange roughy, shark, and swordfish. I recommend choosing small, omega 3 fat rich fish such as sardines or wild salmon. If you have a moral or religious reason for avoiding fish, that’s perfectly ok, but it’s critical to get omega 3 fats, and not just the ALA (or alpha-linolenic acid) found in plants. You need pre-formed DHA which is what most of your brain is made from. The good news is, you can get it from algae.
Dairy – My biggest problem with (bovine) dairy is we have been led to believe it is a “necessary” part of a healthy diet which is absolutely not true. Some people may tolerate it just fine however it is a common source of hidden inflammation in a larger portion of my patients. I generally recommend all my patients do an elimination/provocation diet when they join the practice to identify potential problem foods.
Eggs – For years we were taught that cholesterol is bad, and that eggs are high in cholesterol, so they must be bad too. Now that the National Dietary Guidelines list cholesterol as “no longer a nutrient of concern”, eggs have been exonerated. This is good news as eggs have lots of vitamins, nutrients, and healthy brain fats like choline. That being said, eggs remain a top 5 food allergy in our country which is why our diets have to be personalized.
So what is the bottom line? I think Michael Pollan sums it up best when he said, “Eat real food, not too much, mostly plants.” For me, I have transitioned to eating a more plant based diet with the addition of grass fed, sustainably raised animal proteins. One strategy that has helped me incorporate more plants into my diet is to look up vegetarian recipes from various sources and then add in small amounts of animal protein as a topping or a side dish. Another idea is to subscribe to services such as Hello Fresh or Blue Apron and choose the vegetarian option. This has really opened my eyes (and palate) to healthy, fun and delicious ways to incorporate more plants into my diet.
Bradley Dyer, DO