5 Simple Eating Rules Your Doctor Should (But Probably Won’t) Discuss

Let’s Get Out of the Health Information Jungle 

Are you overwhelmed by the health infosphere? If you’re on Instagram and interested in health, you get daily posts from influencers promising their brand of diet will make you picture perfect and happy. Or perhaps you’ve seen various headlines in the papers about the latest and greatest diet fad. The diet industry is a billion dollar enterprise. And it’s almost engineered to be confusing. 

What we consume each day is important. Your choices can cause weight gain or loss. Your choices influence your cholesterol, blood pressure and your risk for heart disease and diabetes. It would be great if you could have a discussion with your doctor about the best diet for your health goals. As our primary care physicians are there to help us to navigate through life our healthiest selves. Yet I’m guessing you haven’t had this discussion. (BTW - if you have let me know).

Sadly, doctors are taught very little about nutrition in medical school. I’ve experienced this firsthand. I’m currently four months from graduation from medical school at Louisiana State University New Orleans. I’ve learned details of human anatomy - the paths of the cranial nerves, the details of our vital organs and the physiology of how they fit together. Yet we haven't learned how to keep these vital organs healthy throughout our lifetimes or how to prevent bad stuff like diabetes and heart disease from happening. 

I chose the long and arduous path to become a medical doctor because I believe everyone deserves to live their healthiest, happiest life. Understanding how to keep our bodies, brains and spirits healthy is crucial to living a quality life. In my future work as a primary care physician, working on patient’s eating habits, exercise and stress management will be a large component of my practice. But that’s a 3.5 years away — no need to wait for some dietary guidance. 

Today’s post will dive into some nutrition and eating basics. We’ll cover how you can think about your nutritional goals and then I’ll lay out a few guidelines (rather than rules) you can follow to forge your own best eating plan. 

Ready? Let’s dive in.

What’s Your Intention?

I’m not talking about a New Year’s Resolution or a yoga class. Crucial to designing workable long term eating habits is an understanding of your “why.” 

Why do you want to eat well? What are your health goals? 

Do you want to lose weight? 

Do you want to feel better in your body? 

Are you worried about your slowly increasing cholesterol or fasting blood sugar? 

All of the above? 

Before you go further, I invite you to stop and think about these questions. If you journal, write them down or start a note on your iPhone or computer. In the future if your motivation wanes, returning to your why is the best way to regain motivation and get back on track. There’s no right or wrong here – any reason is valid. 

The Boring Building Blocks 

It’s important to understand the building blocks of our diet as we start. Boring as it sounds – you must understand the macronutrients: carbs, protein and fat in order to design your optimum diet. We need adequate amounts of each of these to maintain our basic bodily functions. Carbohydrates are primarily made up of carbon and water (hence the name), and they are the basic fuel that we use to create the glucose which fuels our activities. Proteins are made up of amino acids (which contain a nitrogen group), and they are used to build our tissues. We need adequate protein to maintain muscle mass and cellular structures. Protein helps to replace tissues like skin, hair, organs and muscle. Fat is the most energy dense of the macros and is used all over the place. While we think of them as making us look pudgy, they are important for many functions from cellular membranes to insulation to the lining of our neurons. They can also be used for fuel if carbohydrates aren’t available – this is the idea behind ketosis. 

There are diets that play with the amounts of each – restricting carbs has been popular over the years. While this does work, because restricting carbs cuts out most of our junk food, what’s more important is the total overall calorie intake. Restricting one macronutrient over the long term isn’t sustainable. My goal is to help you find a diet that works for the long term. If you’re looking for a quick fix, this isn’t the place to read (check out the thousands of posts on Instagram or Tiktok). 

I’d never ask you to count your calories or macronutrients. But you do need to know the basic categories of each so you can design a simple diet. 

Protein is Crucial 

For many years I was vegan, now I've changed my diet to include fish, chicken and even occasional beef.  It's definitely possible to get plenty of protein on a plant-based diet. But I have seen growing research that sources of fatty fish containing Omega-3 Fatty Acids help to improve brain health. When I started the long road to medical school I did all I could to support my brain cells:)

Getting more than enough protein is crucial. The Recommended Dietary Allowances (RDA) of protein are there to ensure that at least 97.5% of the population doesn’t get malnutrition diseases like marasmus or kwashiorkor.  Note that the studies to determine the RDAs are done on healthy college age adults. While you may be getting adequate protein, it may not be enough to build optimal health. We especially want to keep our brains and muscles healthy (this comes from the thinking of Don Layman. Keeping your muscles healthy will lower your risks of obesity, diabetes and heart disease. Muscle is the biggest sink for dietary glucose – meaning that the muscle cells use insulin to pull glucose out of the bloodstream and into the muscles.  In order to replace what’s turned over, we need 300g of protein per day. Our body recycles some amino acids, but as we age the recycling process becomes less efficient. 

How Much Protein?

Getting twice the RDA (0.8g/kg) will ensure that you can build and maintain muscle mass as you age. For a woman who weighs 140 pounds, this falls around 100 g/day (140 pounds is 63 kg, 63 x 0.8 x 2 = 101.8g). But this number doesn’t change if you lose weight, because you always want to maintain your lean muscle mass, which is what protein fuels.  So rather than think of protein as a percentage of your diet, think of protein as a foundation then fill in the other two macronutrients around protein. I encourage you to find the protein sources that you like, but include sources of fatty fish to get your omega-3 fatty acids. Other great protein sources: white fish (flounder, trout, redfish), salmon, sardines, chicken, organic beef, oysters, shrimp. Plant based sources include tofu, tempeh and seitan. Beans are wonderful but take a larger quantity to get required protein. For example, one cup of cooked white beans contains 17g. It’s hard to eat two cups of white beans at a meal to round out your protein at 30g/meal. 

Build Your Plate

How should you fill in the rest of your plate? With minimally processed sources of carbohydrates like sweet potatoes, brown rice, quinoa, beans and vegetables. I like to think of protein and carbs taking up ¼ of our plates with vegetables filling in the other ½. Occasionally having pasta, bread and white rice are okay. The main problem with processed foods is their palatability. They are very easy to overconsume. When we consume foods closer to their whole form they are filling and keep us satisfied for longer. 

Fats are contained within many foods, so we will typically get lots of fats from fish, chicken and meat. Good quality oils like coconut, olive and avocado are great for seasonings and cooking. Avocados are a great source of monounsaturated fats – and they are delicious. 

Avoid Processing 

Processed foods are constructed to be palatable. They feel good on our palates, driving us to eat more. They activate the pleasure and reward pathways in our brains. Though overeating on 1000 calories of a brownie and 1000 calories of cauliflower will cause you to gain weight – try to eat 1000 calories of cauliflower. You would have to eat 15 cups of cooked cauliflower to reach 1000 calories. The Starbucks double chocolate brownie has 480 calories, and it’s not that big. Eat two and you’ve hit 1000. 

This 2019 study by Kevin Hall PhD at the NIH found that people who ate an ultra-processed diet (bagels and cream cheese vs. oatmeal and bananas) gained more weight and consumed an average of 500 additional calories per day. 

Interestingly, most of the increase in calories in the ultra-processed diet came from carbohydrates and fats. The bottom line: eat foods as close as possible to their whole form and you're less likely to overeat.

This idea was also reinforced by the recent book by Michael Easter, Scarcity Brain. He followed the hunter-gatherer tribe the Tsimane of Bolivia. The Tsimane appear to have the healthiest hearts on the planet. Their diet is remarkably simple and free of processed foods. Read more about their diets here. 

Image source: https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30248-7

Snack Sparingly 

With the rise of food processing so has the consumption of snacks. Most snack foods tend to be junk. Eliminate these from your diet. Most of our snacking is from boredom rather than true hunger. If you are truly hungry, have something with nutritional value like an apple or hummus and carrot sticks. If you feel the urge to eat something, try having a cup of green or herbal tea instead. The urge to eat is often to satisfy or suppress some other unpleasant emotion or feeling. Or out of boredom. When you get the urge to eat and you’re not hungry, pick up a quality leisure activity: go for a walk, read a book offline, pet your doggie, etc. 

To Summarize in 5 Guidelines 

I know we’ve gone through a lot of information. I hope to give you the background to my thinking and give you the why behind your dietary choices. 

1. Protein is the building block - calculate your protein requirements, divide by 3 and ensure you’re getting enough
2. Build your plate with protein, starchy carbs, and vegetables 
3. Snack on fruits, vegetables or not at all 
4. Eat foods as close to their whole form as possible
5. Have fun, find what foods you like 

Now, it’s your turn. Start by thinking about your long term health and why you’d like to be this way. Write it down. Then move on to your eating patterns: how much protein do you need? What are your favorite sources of protein? Imagine how you’ll fill in your plate with unprocessed carbohydrates and vegetables.