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What's the Best Diet? Healthy Eating 101

I'm dr. Mike Evans and today I'm talking

about healthy eating it's a huge topic

he didn't seem 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 stick you with

the big picture I'd point out that

eating it's 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 commute 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

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 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 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 - 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 diet showed it wasn't less

carbs 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 food row

that nudges you toward 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 prepackaged or famous doctors take

or 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 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. Celeste nod 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 when 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

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% how about low-fat well I

think our story is 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 not

so good and we're reducing these we have

saturated fats mostly in dairy and red

meat and plant oils like coconut or palm

they seem not so good in excess but okay

in moderation

then we have your monounsaturated fats

or Musa the Mediterranean diet which

I'll discuss in a second is pretty high

in move Faso avocados nuts seeds olive

oil dark chocolate and shows health

benefits finally we have proof eyes so

these are the longer chain fats found in

oily fishes early trial 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

MOFA and proof of 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

state versus a salmon steak or lentils

or a handful of almonds most data points

that if you eat healthy protein white

meat nuts beings fish you do better

especially if it is spread throughout

the day perhaps most importantly at

breakfast

there are also some tights showing good

results in people with disease so the

DASH diet dropping high blood pressure

by five to eleven millimeters of mercury

or or low glycemic index diet dropping

a1c the measurement for blood sugar over

time in 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 has 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 moral to

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 formulas or 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 in 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 Isles 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 NWC are

administered 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 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 foods some count of

calories others ate all foods just

limited their quantities 70 percent a

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 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 weigh in yourself

and using this as a small nudge in your

daily food decisions as an example

75% of NWC our subjects weighed

themselves weekly 36% daily and they

looked at this more closely at the stop

regained trial where daily self wayne

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 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

maybe switch something you do a lot so

for example eating breakfast snacking

drinking you could 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

color drinks a day to water I know this

doesn't sound too sexy but the dr. Mike

switcheroo diet might actually chip away

the 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 multi-faceted American Heart

Association diet versus a 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 the hae groups

slightly more and both improve

cardiovascular markers now I like this

idea of pushing healthier food rather

than just restricting or fencing off

other food other data is shown satiety

our our feeling of being full it's not

just about calories calories that come

from proteins 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 percent 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 sedentary

so when my patients tell me they are

active but have been unsuccessful at

weight-loss I shrugged 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 make it easier to

make the right choice day after day we

call this redesigned choice architecture

and involves two types of what I call

quote nudge awareness first is knowing

that our world is full of triggers

towards unhealthy or overeating

convenient shiny foods at the counter

supersizing 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're 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 ten a predictable stressor as

one Singh 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 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 take some

self-knowledge are you a nighttime

nibbler or an emotional eater I'm a

grazer I'll eat whatever is there so my

changes 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 juice

because I can't stop eating those things

my final behavior is more of an attitude

80/20 so if you're making the healthier

choice

eighty percent of time and your 20% is

not too high cal

I and you should be thrilled I've been 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 in a single

diet aportfolio behaviors small tweaks /

big changes single ingredient foods /

multi ingredient and processed foods

dinner at home self-awareness depending

less on constant willpower more and

tweaking your week to make mindless

healthy eating more likely my final

point is more about health at every size

and you know 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 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