What the Heck Should I Eat?

It wasn’t the first time I had heard this question when a patient posed it to me in the hospital the other day. The patient was a male in his mid-forties and years ago he was morbidly obese and eventually developed type II diabetes. He lost well over a hundred pounds by reducing his caloric intake and walking every day, yet his diabetes never seemed to be under control. He eventually developed a condition called diabetic neuropathy where his nerves no longer function well. He later lost several toes due to poor circulation. I admitted him to the hospital with a skin infection.

At the time of admission his hgbA1c was almost 10, indicating that his diabetes was not well controlled. He thought that he was eating according to the plan outlined by his nutritionist. He was counting carbohydrates, avoiding eating too much fat and walking everyday. When I informed him that his diabetes was not well controlled, his question to me was “What the heck should I eat?” In my experience many people are confused about what constitutes a healthy diet. That’s partly due to the fact that even the experts can’t agree on the basic elements of a healthy diet. Some think a low fat, plant based diet is the way to go while others promote low carb, high fat diets. They certainly can’t all be right. What does the science have to say?

Even that is a challenging question. Nutritional research is extremely hard to do, especially in free-living humans. It’s also very difficult to do randomized controlled trials (RCT) on nutrition in humans. How can you do a double blind study on a cheeseburger? Thus you can find published studies to support just about any nutritional approach. Virtually every day news headlines tout the benefits or dangers of eating in a certain way based on published studies that may or may not merit such attention.

It also seems like the various nutritional “camps” are often at war with each other. They spend as much time denigrating the nutritional approaches of their enemies as they do promoting their own perspective. Sometimes it seems like things would be calmer discussing religion or politics rather than nutritional science! My patient simply wanted to know if I could offer him any advice about adapting a healthier way to eat. Of course I could have referred him to our hospital nutritionist, but in my experience their advice isn’t always up to date. So what did I do? I took a deep breath and gave him Dr. Wilson’s 22 tips for healthy eating.

My tips are just that—a set of basic principles that allow for some flexibility to take into account individual differences and the fact that we don’t have all the answers. Even if we did discover some rigid eating program that guaranteed a long and healthy life, I doubt that I could get my patients—and likely myself, to follow it for any length of time if it didn’t include some pleasurable aspects of eating. For example, I don’t care what the science says, if I turned down a piece of my wife’s homemade baklava, my health might be just fine but my taste buds definitely wouldn’t be happy and marital harmony would be out the window! In my opinion eating a diet that lacks any pleasure certainly will make life seem like it lasts forever.

My recipe for healthy eating is based on two parts science and one part common sense, whipped until fluffy. I also like to throw in a dash of humor now and then. And please feel free to adjust the recipe to fit your individual taste.

Dr. Wilson’s 22 Tips for Healthy Eating

1. Reduce your intake of processed foods.  Processed foods are made in a factory or commercial kitchen and contain the toxic triad of excessive fructose mainly from sugar and HFCS, high glycemic carbohydrates mainly from grains and excessive omega fatty acids from vegetable oils. Processed foods are likely driving common metabolic disorders like insulin resistance, obesity and type II diabetes as well as all the downstream adverse affects of these metabolic conditions. It is now also clear that processed food is bad for your brain, eventually triggering a form of food-induced brain dysfunction called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome.
2. Limit your fructose intake to less than 25 grams per day.  Please refer to number 1. As my friend Richard Johnson has outlined in his excellent books “The Sugar Fix” and “The Fat Switch”, excessive fructose is a metabolic time bomb in your body. I also like Robert Lustig’s excellent book “Fat Chance”. A small amount of fructose consumed in natural forms such as fruit or honey is fine. Consuming large amounts of fructose from sugar or HFCS is the gateway to insulin resistance and other metabolic problems. Sucrose and HFCS are not just empty calories, they are also chronic toxins so you are better off eliminating them from your diet.
3. Reduce your intake of starchy carbohydrates like grains and especially wheat.  This is even more important if you already have some insulin resistance from consuming too much fructose. Consuming these high glycemic carbohydrates can result in metabolic problems and brain-frying glucose spikes. When you do consume starchy carbohydrates like potatoes or rice, combine them when healthy fats or acids like lemon juice or vinegar to slow down the absorption of the carbohydrate.
4. Balance out your omega 6 to omega 3 ratio.  Although both forms of fatty acids are essential for health, Americans consume way too much omega 6 fatty acids from vegetable oils and not enough omega 3 fatty acids. Your omega 6 to omega 3 ratio should be about 1 to 1. Many people need to take an omega 3 supplement to get this ratio balanced properly. You can order a kit to have this ratio measured. Having the right balance of these fatty acids is critical to maintain healthy cell membranes and cell membranes are involved in just about every biological process in your cells.
5. If you are going to cheat, eat something really good.  Show me someone who never cheats when it comes to eating and I’ll show you someone with a long wooden nose! The secret to successful cheating is to not do it very often and when you do, reserve it for really fantastic food. When I occasionally eat a dessert with sugar in it, it must be a real out of this world dish. Don’t waste your sugar treats on junk like cereal, commercial cookies and candy or commercial baked goods. Again I think I’ll use my Greek wife’s baklava or galaktoboureko as an example of a great cheat.
6. If you are already metabolically damaged (insulin resistance, obesity, type II diabetes), consider using a Paleo diet as a template.  I think a Paleo diet is a great way to eat for just about anyone but some healthy people might find it a bit too restrictive. For those who are metabolically damaged a Paleo or pre-agricultural diet can serve as a template to get your metabolic house back in order because it eliminates all the pro-inflammatory elements in our modern diet. I recommend reading Loren Cordain’s book “The Paleo Answer” or Robb Wolf’s book “The Paleo Solution” for more information about this type of diet. If you want to take it a step further, a ketogenic diet might be the way to go. Low carb blogger Jimmy Moore is the master of this type of diet.
7. Calories don’t count—except when they do. I generally agree with Gary Taubes and others who believe that calories are not the main issue when it comes to diseases like obesity, but my views are somewhat nuanced. If you have healthy brain function and you consume a whole foods diet, then the amount of food you eat will have little influence on how much fat your body stores. If you already have food-induced brain dysfunction (CARB syndrome) and you eat processed foods, the more food you eat the more fat you will store. Calories didn’t cause your CARB syndrome, but once you have it junk calories will definitely push your body to store more fat. Capisce?
8. You don’t need to change your diet if your current eating plan is working.  How do you know if it’s working? I recommend following several important markers. The first is to measure your body composition. If your percent body fat falls in the normal range, you’re good to go. I also recommend measuring some important metabolic markers like fasting glucose and insulin levels, CRP, triglycerides, HDL cholesterol, uric acid and homocysteine. If all of these markers are good, keep doing what you are doing. I also recommend looking out for any of the 22 brain dysfunction symptoms of CARB syndrome. If you have some of these symptoms your metabolism and brain are likely headed together in the wrong direction. As a practicing clinician I am interested in results. You don’t need to tinker with something that is working. By the way, I’ve never seen a junk food diet that passed the above measures.
9. Throw in some exercise to enhance brain function, not to burn calories.  When it comes to losing fat, exercise doesn’t top the list of effective treatments. Studies have shown that exercise is very good for brain function and you need a healthy brain to have a healthy metabolism and body composition. Exercise increases brain derived neurotrophic factor (BDNF), a natural stimulant for brain enhancement.
10. Don’t be afraid of healthy fats.  In my opinion low fat eating has been a bust when it comes to metabolic health and brain function. I’m a big fan of healthy fats like olive oil, coconut oil, avocados, omega 3 fatty acids and animal fats from grass fed birds and animals. If you are worried about what this will do to your cholesterol I recommend that you read Jimmy Moore’s new book “Cholesterol Clarity—What the HDL is Wrong With My Numbers?”.
11. Eat a whole foods diet.  That means it comes from nature, not a factory. Virtually all traditional ethnic diets tend to be fairly healthy. Because each person has a different ethnic and genetic background, you will need to experiment some to find the healthiest diet for you. If your grandma wouldn’t recognize it, don’t eat it.
12. Don’t be afraid to skip meals.  Some people call this intermittent fasting. Our ancestors clearly didn’t eat three squares a day so genetically we are programmed to go without eating for periods of time. Intermittent fasting appears to have some of the longevity benefits of calorie restriction.
13. Learn to cook—or hang out with someone else who loves to cook.  When you cook at home at least you know exactly what goes into the food you are eating. I don’t like surprises when it comes to food. Fortunately my Greek wife is an excellent cook so I am somewhat off the hook on this one. In other words find a Greek wife or husband or learn to cook.
14. If you have diabetes you need to limit your intake of fructose and carbohydrates—period.  Some nutritionists believe that diabetics can safely consume a fair number of carbohydrates because they can adjust their insulin or medications to match their carbohydrate intake. This approach is a roadmap to a metabolic train wreck and poor brain health. You want the cells in your body to be exposed to as little insulin as possible, regardless of whether or not you have diabetes.
15. If vegan is working for you, let’s not fight about it.  There seems to be an ongoing war between the vegan folks and those who favor a low carb or Paleo diet. In my opinion a healthy vegan diet is much better than the Standard American Diet so I don’t want to spend too much time fighting with those who want to eat vegan. Is it an ideal diet for most people? I have my doubts, but then again in my opinion the real money is in getting people off processed foods. If you do decide to stay with vegan, be sure to follow rule number 9.
16. You don’t need whole grains to poop.  Our government seems to be hung on the whole grains thing.  I tend to agree with Loren Cordain and Robb Wolf that whole grains are not a particularly good source of nutrition. You do need fiber to poop, but in my experience if you eat a lot of vegetables and fruits things will work out just fine in the poop department. I know this from personal experience. If you have any doubt I challenge you to eat one of my wife’s veggie filled Greek dishes. I guarantee you that you will do just fine in the poop department.
17. My Plate sucks.  In my opinion our government is clueless when it comes to nutrition. If they tell you to do something, do the opposite and you will likely do just fine.
18. If you end up in the hospital, bring your own food.  Trust me on this one. The food served in most hospitals is atrocious. You enter the hospital sick and vulnerable and then they feed you food that is guaranteed to make you even sicker. Go figure.
19. If your beverage has calories in it, don’t drink it—period. Drink water. Humans have done just fine with water for eons. We don’t need soda, we don’t need juice, we don’t need Gatorade—we simply need water. Please adjust or you will become extremely ill.
20. Slow down.  Good food should be savored and enjoyed. As my wife says, the food should “touch your tooth”. When you eat like there is no tomorrow, your taste buds and brain get left out of the equation, so you are much more likely to eat more food than your body needs. I’m a big fan of the slow food movement.
21. When it comes to protein it’s a goldilocks thing—not too little and not too much.  Getting enough high quality protein is important, but if you consume too much protein the excess will be converted to glucose through the process of gluconeogenesis. I think about 1.5 grams of protein per kilogram of body weight is about right for most people. Athletes and people with injuries may need a little more.
22. Don’t ever under-eat to lose weight.  For years we were told that calorie restricted diets were a great way to lose weight. While that may be true, you want to lose fat, not lean body mass. Because I always measure the body composition of my patients, I know what they are losing. I also know that over-restriction of calories results in too much loss of lean body mass. If you want to lose excessive body fat, read through these 22 tips again.

My patient was very thankful that I took the time to go over these eating tips with him. He was also surprised that nobody had bothered to do so in the past despite his health problems. But these 22 tips for healthy eating aren’t just for those who are metabolically damaged like my patient. They are also very effective a preventing or reversing common chronic diseases and brain disorders. The choice is yours. I’ve given you extremely valuable information based on my over three decades of clinical practice and now you must decide whether or not you are going to use it. In other words the ball is in your court.