This year we’re saying down with the fad diets once and for all and instead are pledging allegiance to a sustainable, health-promoting approach to eating. Who’s with us?
WRITTEN BY LAUREN JOHNSON
Around 400 B.C., Hippocrates wrote: “Let food be thy medicine and medicine be thy food.” Today, that same notion—that the foods we eat day in and day out can either help prevent and even reverse disease or cause it—is transitioning from a fringe idea to a mainstream school of thought.
Recent studies suggest that genetics account for just one-fifth of our health. Lifestyle choices, including how often we move, whether or not we smoke, how much alcohol we consume and which foods we eat, determine the rest. On the food front, science shows that nutrient-rich fare can help ward off chronic diseases like diabetes and heart disease; frequent consumption of other foods, however, can increase your risk for those same diseases, as well as cancer, obesity and more.
Over the course of a year, the average American consumes a literal ton of food (more than five pounds daily, reports the U.S. Department of Agriculture, or USDA). That means we have an actual ton of influence and three chances a day—plus all those snacks in between—to champion for and promote our health. That’s an encouraging thought, but also a daunting one, considering diets often flop and unhealthy fare is both easily accessible and advertised everywhere.
To help us understand why we crave food that’s detrimental to our health and what a sustainable, wellness-boosting way of eating looks like, we invited to the table three Roper St. Francis Healthcare affiliated doctors: gastroenterologist Will Bulsiewicz, bariatric specialist John Cleek and interventional cardiologist John Ciccone. Together, they paint a picture of a never-diet-again approach to eating; one that anyone, whether you’re looking to lose weight, boost your day-to-day energy levels or improve your longevity, can benefit from.
WHAT’S IN FOOD?
To function properly, our bodies need ample amounts of the following essential macronutrients and micronutrients, which different foods contain in varying amounts. (As the name suggests, micronutrients are needed in smaller quantities than macronutrients; even so, they’re just as vital to our wellbeing.)
• Proteins: Amino acid chains that form the body’s building blocks, help make and repair tissue, fight infection, create hormones and enzymes and boost energy.
• Carbohydrates: Provide quick energy that enters the blood as glucose, the body’s main source of fuel. (These include starches, sugars and fiber.)
• Fats: Lipids that provide energy as well as the fatty acids needed to produce new cells and hormones. They also help the body absorb certain vitamins.
• Vitamins: Organic compounds required for normal cell function, bone strength, clear vision, glowing skin, strong nails and hair and more. (These include vitamins A, B, C and K.)
• Minerals: Chemical elements that aid in regulating bodily processes, such as nerve and muscle function. (Examples include calcium, potassium, iron, magnesium and sodium.)
While we require these for basic bodily functioning, other micronutrients, including antioxidants and phytochemicals, offer additional health perks. Antioxidants shield against cell-damaging free radicals, helping protect us from cancer, Alzheimer’s and heart disease. These health guards are highly concentrated in plant-based foods, including fruits and their juices, vegetables, whole grains, nuts, seeds, herbs, spices and even cocoa. Eating an abundance of brightly colored plants also delivers phytochemicals to keep our bodies and brains operating at their best. These natural plant compounds support eye and immune health, boost healthy cell communication, trigger detoxification, regulate metabolic function and stress responses, lower bad cholesterol and support cognitive and cardiovascular health.
Not all foods are created equal, though. While some fare like colorful vegetables, fruits, unrefined whole grains and lean proteins are rife with the above nutrients, others, such as highly processed refined carbohydrates, sweets and fried foods, are largely deficient in them. Unfortunately, the Standard American Diet is characterized by a high intake of the latter group and low intake of the former—a double strike against our health. “Not only are the most commonly consumed foods in the U.S. lacking in key nutrients, but they also contain an excess of sodium, refined sugars, preservatives and saturated and trans fats—all of which we know can be detrimental to our health,” says Dr. Ciccone. Frequent consumption of these elements can lead to everything from elevated cholesterol and weight gain or obesity to hypertension, heart disease, stroke, diabetes, kidney disease, fatty liver disease, cancer and more.
THE SCIENCE BEHIND CRAVINGS
Why then is unhealthy fare so tempting? “For 99 percent of human history, we lived in famine and died of starvation,” explains Dr. Bulsiewicz, who touts clean eating tips to some 65,000 followers on Instagram (@theguthealthmd). As a result, our bodies became genetically hard-wired to desire calorically dense food. “If you had a taste for macronutrients and ate more when the opportunity arose, you were more likely to survive,” he says. The brain rewards us with a dash of dopamine each time we eat a high-fat, high-sugar food. Much like other addictions, food cravings stem from a yearning for more and more of this feel-good hormone.
We also tend to overeat when we consume nutrient-poor foods, eating them faster than our brains can register. “Fiber, which is a plant-based carbohydrate, triggers the satiety hormone. When you eat ultra-processed foods that have been stripped of their fiber, you don’t feel full until you’ve overshot your caloric intake,” explains Dr. Bulsiewicz. He stresses that fiber intake for 97 percent of Americans is dismal, 10 to 20 grams below the minimum daily recommendations of 25 grams for women and 38 grams for men. Comparatively, “Historians believe that our hunter-gatherer ancestors consumed more than 100 grams of fiber every day,” he notes.
(Left to right) Unprocessed, Processed, and Ultra-Processed
The Hard-to-Swallow Truth about Ultra-Processed Foods
The turn of the 20th century marked a shift in our food-buying habits. From the rise of the hot dog in the late 1800s to the invention of the TV dinner in the 1950s to the introduction of Hamburger Helper and other boxed concoctions in the 70s and 80s, convenience foods have become the norm. Now, more than half of the food Americans eat is considered “ultra-processed.”
While “processed” foods include canned beans, unsweetened yogurt and frozen strawberries (basically any food that has been preserved and packaged for convenience), “ultra-processed“ foods are manmade and include chemicals like preservatives, colorants and emulsifiers. “More than 10,000 additives have entered our food supply, labeled GRAS (generally recognized as safe) by the Food & Drug Administration, even without studies to understand their long-term effects,” says Dr. Bulsiewicz. Whittled down to just starch, ultra-processed carbohydrates trade nutritional value for quick digestion, and contain 90 percent of the added sugars Americans eat.
Ultra-processed foods include chips, soft drinks, cereal bars, certain flavored yogurts, hot dogs, frozen pizza, certain bread products, fast-food hamburgers, microwavable suppers and more. “If you want ready-to-eat, choose frozen fruits, canned veggies and packaged nuts,” says Dr. Ciccone.
To further complicate our relationship with food, fad diets exist, promising weight loss in weeks. However, diets that recommend cutting or limiting an entire macronutrient, such as carbohydrates (like the Atkins or Keto diets) don’t set you up for long-term success or good health, say the doctors. “Unless you’re dealing with an intolerance or allergy like celiac disease, our bodies weren’t designed to cut out whole categories of food for extended periods,” explains Dr. Cleek, board chairman for the American Board of Obesity Medicine. Nutrition is more nuanced than that, he says. “While it’s smart to cut some carbohydrates—like added sugars and refined white breads—other carbohydrates, like those in fruits and vegetables, are beneficial to the body.” Dr. Bulsiewicz adds another drawback of quick-fix diets. “Pounds lost typically include muscle mass,” he says. “As soon as you quit the unsustainable diet, you gain back the weight as all fat and no muscle.”
Instead of a flashy fad diet, the doctors suggest taking a back-to-basics mentality when it comes to eating and a slow-and-steady approach to weight loss. “Remember what food is here for—fueling our body with the macronutrients, vitamins and minerals it needs to survive and thrive,” says Dr. Ciccone. Especially when paired with increased physical activity, the docs agree that focusing on the following principles can both promote your day-to-day health and longevity and yield steady weight loss over time (or help you maintain a healthy weight).
• Consume a wide variety of foods that come from plants, including colorful fruits, both starchy and non-starchy vegetables, legumes, seeds and whole grains. This will ensure you’re getting a wide range of nutrients that not only help your body perform optimally but also help stave off disease.
• Eat less meat. Lean meats like turkey and chicken breast as well as seafood have a place in a healthy, well-balanced diet; however, “it’s best to think of vegetables as the star of the meal and meat as your side,” says Dr. Cleek. “We eat more meat in the U.S. than any other country,” notes Dr. Bulsiewicz. “I’m a huge believer in a plant-based diet, but that doesn’t mean you have to be 100 percent vegan; small shifts toward a more plant-centric way of eating pay off.” For example, a 2019 study found that halving red and processed meat consumption can significantly reduce levels of LDL, or “bad,” cholesterol in the blood.
• Avoid fried and ultra-processed foods and soda. These are loaded with saturated fat, added sugars and excess sodium—frequent consumption of which is known to lead to weight gain and an increased risk for disease. When you’re shopping, read the ingredients list for packaged food items. If it’s more than five lines long and/or filled with ingredients you’re unfamiliar with, chances are it’s considered ultra-processed.
• Pay attention to portion size. When consuming foods that are high in fats, calories and carbohydrates (such as nuts, chicken and whole-grain pasta, respectively), be mindful of your portions (see graphic above for a visual guide). Meanwhile, don’t hold back when it comes to vegetables. A 2017 study from Imperial College London found that consumption of 10 servings of fruits and vegetables daily may be linked to a 24 percent reduced risk of heart disease, a 33 percent reduced risk of stroke, a 31 percent reduced risk in premature death and a 13 percent reduced risk of cancer.
For those seeking more specific guidelines, many experts suggest the Mediterranean style of eating, which emphasizes fresh fruits and vegetables, whole grains, oily fish (like tuna, salmon and mackerel), herbs and healthy fats. Dr. Cleek also recommends Dietary Approaches to Stop Hypertension, commonly called DASH. This diet underscores plenty of produce; low-fat protein like poultry, seafood and beans; healthy dairy such as cottage cheese and Greek yogurt; and complex starches including whole grain rice and whole wheat bread.
Every breakfast, lunch and dinner provides an opportunity to eat foods that nourish and heal. Choosing diverse, well-balanced nutrition can not only reverse disease and promote weight loss, it can also affect how you feel throughout the day. “On a well-balanced diet, you’ll have more energy,” says Dr. Ciccone. “Pair healthy eating with regular exercise, and you’re doing a real service to your present and future self.”
Enlist an Expert
If weight loss is your goal and at-home efforts aren’t yielding progress, talk to your primary care doctor. Patients may be referred to Roper St. Francis Healthcare Bariatric & Weight Loss Surgery, where specialists offer intensive and personalized nutrition therapy, non-surgical interventions and surgical procedures. Those with cardiovascular risk factors such as high blood pressure, abnormal cholesterol, diabetes or pre-diabetes and obesity may be a good fit for the Healthy Lifestyle Program, led by Dr. Ciccone along with a dietitian and personal trainer. Participants, who range in age from 30 to 80, meet in small groups for supervised exercise and nutrition counseling. “After six months, these patients are stronger, more flexible, down about 15 to 20 pounds and often taking fewer medications,” explains Dr. Ciccone.
Primed for Success
A good ultimate goal is to establish a lasting routine of whole-body nourishment rather than restrictive dieting. However, committing to and transitioning to a healthy eating pattern can feel overwhelming. Here, the doctors share ways to set yourself up for success. “Don’t feel pressured to radically change all at once,” says Dr. Bulsiewicz. “This is a journey; have your compass and know where you’re trying to go.”
1. Work in stages. “When you set goals that are too drastic, you may get frustrated and bail,” says Dr. Bulsiewicz. This week, try to eat just one completely plant-based meal, he suggests. “It could be oatmeal with berries for breakfast, a smoothie for lunch or a big salad at dinner.” Next week, aim for two.
2. Plan and meal prep. “Map out, prepare and portion out healthy meals for the week,” suggests Dr. Ciccone, noting that this can help you avoid the hunger frenzy that often steers us toward the drive-through. Not only will you limit cooking and clean up to one day, but you’ll also have nutritious, preservative-free meals ready to heat and eat throughout the workweek. And don’t forget the snacks, says Dr. Cleek, who suggests filling small bags with pre-portioned nuts.
3. Incorporate indulgences. “Treating differs from cheating,” says Dr. Ciccone. “Planning to have an occasional sweet treat for dessert will allow you to reduce your calorie intake during the main course.”
4. Practice mindful eating. Food is more than fuel—it’s a social experience that’s meant to be savored, notes Dr. Bulsiewicz. “Being mentally present to what’s on your plate can help prevent overeating,” he says, suggesting you sit at a table, turn off the electronics and really connect with your food. “Smell it; look at it—don’t just devour it.”
5. Keep a food diary. A journal of what and when you eat can raise awareness of eating patterns. This record can be useful not only for holding yourself accountable to your dietary goals, but also drawing correlations between food and physical reactions. “If you feel lethargic or bloated an hour or two after sitting down to eat, look back at possible food culprits,” says Dr. Cleek.
“It’s weird; I have no desire for sweet or sugary food anymore. The smell of fried foods makes me feel nauseous.” —Jessica Irwin
Jessica Irwin, age 34
Her DIET MAKEOVER journey: Ninety-seven pounds: That’s how much weight Summerville resident Jessica Irwin has lost in the last year. “My energy levels have increased and I believe my skin health has gotten better, too.” In May 2019, Jessica underwent gastric sleeve surgery with Roper St. Francis Healthcare affiliated bariatric surgeon Dr. Bryan Thomas. In addition to the procedure, Jessica worked with Roper St. Francis Healthcare Bariatric & Weight Loss dietitians and doctors to totally overhaul her former eating habits. “I have gotten rid of all fried and processed foods and am extremely cautious of portion sizes,” she says, noting that she focuses on eating whole foods, lean proteins and tons of veggies. Her higher energy levels help fuel CrossFit workouts five days a week and long weekend walks.
A widespread nutrition myth is that, in order to eat ample protein, you need meat on your plate. The truth? Well, first of all, you don’t need as much of the macronutrient as you may think. “Ninety-seven percent of us consume an excess of protein,” says Dr. Bulsiewicz. “The Recommended Dietary Allowance (RDA) of protein in the diet is 0.36 grams per pound of body weight. To put that into perspective, you would need just 36, 54 or 72 grams of protein daily if you weighed 100, 150 or 200 pounds, respectively. Most Americans are doubling or tripling that number.”
When it comes to protein, he says we should worry less about the quantity and more about the quality. “Protein that comes from animals as opposed to plants can increase a person’s chances of developing chronic diseases such as kidney failure, heart disease, diabetes and cancer,” says the doctor. For optimal health, we should maximize plant sources and moderate our intake of animal protein. “The best way to do this is with a diverse mix of plant foods. They all contain protein, and in combination will more than fulfill your needs.” Below are some of his go-to plant-based protein options: