Key principles: 1. It is important to maintain a good weight for you. 2. All diets work (until they don't) 3. What we eat and when we eat it are less crucial than many folks believe 4. Adequate protein in your diet is important 5. Supplements or pro-biotics are probably not necessary 6. We are individuals and what works for others may not work for us
Embark with me, Dr. Bobby Dubois, as we chart a course through the murky waters of nutrition science, where I promise to equip you with the compass you need to navigate the myriad of diet options and health claims. Cut through the confusion with expert analysis as we examine the merits and pitfalls of trendy diets from plant-based to Paleo. By the end of our session, you'll understand why no single diet wears the crown and why the nuances of when and what you eat may not be the be-all and end-all we once thought.
Let's confront the weighty issue of weight loss head-on. Theories abound, but I'll guide you through the labyrinth of the carbohydrate-insulin hypothesis and the satiety theory, shedding light on the overarching principle of energy balance. Discover how personal preferences play a pivotal role in the success of dietary approaches like keto and intermittent fasting, and I'll even pull back the curtain on some of my own unique, albeit anecdotal, tactics for appetite management. Our discussion will illuminate why the search for a "perfect diet" is less about the clock and calendar and more about finding balance and mindfulness in our eating habits.
Finally, we'll hone in on the art of personalizing your health strategy. Together, we'll explore why doubling down on protein intake might be the secret ingredient for longevity and when supplements and probiotics make sense in your regimen. We'll also demystify the individual variability in diet response, including salt sensitivity and its effects on blood pressure. By the close of our conversation, you'll be empowered with the knowledge to conduct your very own N of 1 studies, and tailor your diet for a life not just lived, but well-lived. So join us, and let's start crafting your personalized roadmap to vibrant health.
Key principles: 1. It is important to maintain a good weight for you. 2. All diets work (until they don't) 3. What we eat and when we eat it are less crucial than many folks believe 4. Adequate protein in your diet is important 5. Supplements or pro-biotics are probably not necessary 6. We are individuals and what works for others may not work for us
Embark with me, Dr. Bobby Dubois, as we chart a course through the murky waters of nutrition science, where I promise to equip you with the compass you need to navigate the myriad of diet options and health claims. Cut through the confusion with expert analysis as we examine the merits and pitfalls of trendy diets from plant-based to Paleo. By the end of our session, you'll understand why no single diet wears the crown and why the nuances of when and what you eat may not be the be-all and end-all we once thought.
Let's confront the weighty issue of weight loss head-on. Theories abound, but I'll guide you through the labyrinth of the carbohydrate-insulin hypothesis and the satiety theory, shedding light on the overarching principle of energy balance. Discover how personal preferences play a pivotal role in the success of dietary approaches like keto and intermittent fasting, and I'll even pull back the curtain on some of my own unique, albeit anecdotal, tactics for appetite management. Our discussion will illuminate why the search for a "perfect diet" is less about the clock and calendar and more about finding balance and mindfulness in our eating habits.
Finally, we'll hone in on the art of personalizing your health strategy. Together, we'll explore why doubling down on protein intake might be the secret ingredient for longevity and when supplements and probiotics make sense in your regimen. We'll also demystify the individual variability in diet response, including salt sensitivity and its effects on blood pressure. By the close of our conversation, you'll be empowered with the knowledge to conduct your very own N of 1 studies, and tailor your diet for a life not just lived, but well-lived. So join us, and let's start crafting your personalized roadmap to vibrant health.
Speaker 1:
Hi, I'm Dr Bobby Du Bois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish, and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome everyone.
Speaker 1:
Today's podcast is about our third pillar, nutrition, and it's a really important one. As a reminder, the other five pillars are exercise, sleep, mind-body harmony. Five pillars are exercise, sleep, mind-body harmony, exposure to heat and cold, and social relationships. Now, nutrition might seem pretty straightforward. We eat multiple times a day. That's an enjoyable experience and it sustains us.
Speaker 1:
But nutrition is also a very confusing area. Now, why is it confusing? Well, it's confusing because almost every headline or theory conflicts with another headline or theory. You know some of them include well, plant-based is the healthiest approach. Well, here's one that contrasts Paleo or carnivore diets were what we were meant to eat. So those are clearly opposites. Here's another headline type item. Carbohydrates are bad because they raise insulin. How about Mediterranean diet? Is the secret? Well, it has plenty of carbohydrates, so that one and the insulin one have a bit of a problem together. Fats are bad, especially saturated ones. Probiotics are critical, and intermittent fasting is the key. So all of these headlines often conflict one another, and so this is a very confusing area, and one I hope I can make a bit simpler.
Speaker 1:
Now, why are these headlines so confusing? Well, each of them has an underlying theory, which is good and makes sense, but the not so good part is that, typically, for each theory, there's a scientist or many of them or a doctor or a fitness guru who's built the following and a reputation promoting the theory. Now, that theory may have been tested in a lab perhaps not rigorously tested in people to show that in fact, it works and, most importantly, that that diet or that approach is better than other approaches. And that type of testing and comparison is rarely done in a rigorous fashion. And keep in mind, there may also be financial incentives that are worth understanding when people are promoting one approach or another.
Speaker 1:
Now, I'm not just a skeptic, for no reason. Unfortunately, the history of nutrition science has often steered us wrong, and so it is reasonable, I think, to remain cautious Now. I tend to be, in general in medicine, a show-me guy, so if there's something new, I want to see the evidence, and I want to see evidence repeatedly that shows that it works. So what are some of the examples where nutrition science steered us in the wrong direction? Well, a few decades ago, eggs were bad, shrimp was bad. Now, at the time, it made some sense because high cholesterol in your blood was bad for you and people who had high cholesterol did worse, had heart attacks and died. And eggs and shrimp have cholesterol in them, so it made logical sense that eating those cholesterol-laden foods wasn't a good idea. However, we now know that that's irrelevant in terms of the cholesterol we eat, and eggs are good now, and shrimp is also good.
Speaker 1:
We were also told that coffee is bad. Now, coffee can certainly cause you some jitteriness and make it a little more difficult to sleep, but for most folks, coffee isn't bad, and the reason we thought coffee was bad is that what they didn't realize is that it wasn't the coffee that was hurting people. It's that in the 50s, 60s and 70s, when people had a cup of coffee, they also smoked a cigarette, so the coffee was just a marker for something else that was going on. That was actually quite bad. So nutrition is really important and there's a lot of ways to be steered in a direction that can be problematic.
Speaker 1:
Now, my goal today is not to delve into each theory that could take forever but rather what I hope we can do is provide a high level of assessment of what I think matters and there aren't that many key principles, and hopefully at the end of this, you'll have a better idea. So we're going to explore core ideas and, as always, I only want to focus on things that there is high quality evidence to support. So by the end of today's episode, in about a half hour, I hope that you will have a way to think about your nutrition and a few very tangible ideas about what you can do. Specifically and I like to give the punchline at the beginning as well as in the end it's very important to maintain a good weight for you, and no diet is best or really better than another. Second, when you eat, what you eat and when you eat it within boundaries, of course may not matter as much as many people would argue. Third, getting an adequate amount of protein is quite important to function well, and we all want to live long and well. And finally, the point I will make later on is that each person is different and what works from a nutrition standpoint for one person may or may not work for another. So we need to do our hopefully soon-to-be-comfortable end-of-one studies to figure out what is best for you.
Speaker 1:
Well, I can't do this talk without a disclaimer. I am not a nutritionist, I have not written a book on nutrition and I don't promote a particular theory. I don't own a company in this space. Now, that's probably all good. At least I think it's good. I really don't have a dog in this race or a pony in the race, whatever the right wording is, so I'm not particularly wedded to any theory or approach. What I hope I bring to the subject is that I'm a physician scientist with a lot of experience and focus on understanding evidence of what does and does not work, and have published over 180 peer-reviewed articles on various aspects of medicine. So you might want to understand my general approach. In the absence of good evidence, I don't get real excited about anything new or any new headline about what does or doesn't work. So it's really applicable to nutrition as well. So it's really applicable to nutrition as well. Unfortunately, for much of what you hear in general or read there really isn't adequate evidence to support what folks say is the right way.
Speaker 1:
Okay, with that background, let's dive in. There's a number of principles that I think we can walk through where there is evidence about nutrition. We can walk through where there is evidence about nutrition. Principle number one it is important to maintain a good weight for you. Numerous studies over decades have shown that increasingly, we as Americans are overweight. About a third of us are overweight now and another third are obese, and this was far, far lower 20, 30, 40 years ago and in fact they've tripled since the 1960s. There's also many, many studies that have shown that being overweight causes problems, increases in heart disease and death, can lead to diabetes and all the complications associated with that high blood pressure and cancer. So, yes, being a good weight for you and for me is really important. Well, how do we do it Now?
Speaker 1:
There's many, many, many theories, as I alluded to before, about weight and weight gain and weight loss. Now I personally believe and this is my opinion that no single theory is going to be the answer Now. Perhaps over time we'll figure out how to combine these theories into an understanding that is really helpful for people. But let me at least identify the theories, because each one has something to tell us. The first one is called the energy balance theory, and this is what folks have been thinking about for a hundred years that weight gain or loss relates to how many calories you eat and how many calories you burn, either naturally or with exercise. Now this theory would help us to look at the world and say I guess we need to reduce our intake and increase energy use by exercise. So that's what the energy balance theory might tell us.
Speaker 1:
The carbohydrate insulin hypothesis says that eating carbs so carbs or sugars, simple carbs leads to higher amounts of insulin and that insulin release causes problems, weight gain and other kinds of things. So this theory would tell us that we should eat fewer carbs and certainly fewer sugars. And if we're going to eat carbs, mostly complex carbs. And if we're going to eat carbs, mostly complex carbs. The last of the theories I want to touch on is called the satiety or set point theory. So this would suggest that there are hormones in our gut, hormones in our brain, that tell us when we want to eat and tell us when we've eaten enough. Now this theory would tell us that it's a complicated situation and the genetics may be very important and that certain foods may fill our stomachs better than others. And we've also learned that certain drugs help curb our appetite, like Ozempic semaglutide, the new weight loss drugs. So my view is that the energy balance theory in the end is really important, that it's a function of how many calories we eat and then how many calories we burn. But how you get to that balance may be driven by the carbohydrate insulin hypothesis or the satiety or set point theory. So ultimately, I think these all will work together to help us understand why we gain weight and how we might lose it. So that's the first principle.
Speaker 1:
The second principle and this may not make me happy among a lot of folks is that all diets work. That's the good news until all diets don't work. So every diet you might hear about, like the ones we've talked about the paleo diet and the Mediterranean diet and the DASH diet and the keto diet and the carnivore diet each one of them has good theories to support them and they have some evidence. Now that evidence may be in a lab with blood tests. It may be in a mouse, it may be in primates, and they may have some studies in people that show it works, but generally those studies are not that big and they're not extremely well-designed. So the critical factor is and this is why I think all diets work until they don't is that the critical factor is that these diets are generally not tested head-to-head, and when they are tested head-to-head so some people are on the keto diet, other people are on a plant-based diet, other people are on a low-carb diet none works better than another.
Speaker 1:
I believe that the reason any diet can be effective is it helps us to focus, to be more mindful of what are we eating and how much we're eating, and that typically leads to eating fewer calories. So the diet basically just makes us pay more attention, and that's why one diet doesn't seem to be better than another, and most all diets fail eventually because we lose our motivation and we tend to start more Now. For some people, a particular diet works better for them, and I'm all for that. For some people, the keto diet reduces their appetite and they eat less. Great, some people believe you need to have eight glasses of water. It fills your stomach and hydrates you and it helps you reduce your intake. That works for you Great. For some people, small portions or a greater number of meals or intermittent fasting works for you Great. So I don't believe any particular diet works perfectly, but whatever seems to help you along the way, that's what you should do.
Speaker 1:
Now I have two very non-scientific recommendations and they work for me. They've worked for people I've talked to, but they're not based on any rigorous science, so take it with a grain of salt. So the first one I found to be helpful is if you're about to have dinner, you're going out to dinner and you worry you might eat a lot. Have a spoonful of peanut butter 15 minutes or 30 minutes before dinner and for me, the fat makes me feel less hungry and I'm very much likely to eat less than I otherwise would. The second completely non-scientific approach although there is a little bit of science that supports the concept is if I stop eating midstream. So let's say I have a plate full of food and I eat half the plate and then the phone rings or the doorbell rings or something happens and I have to walk away for 10, 15, 20 minutes. By the time I get back, you know, all of a sudden, I don't really want to eat the rest of my food. I'm not hungry anymore, and so this one, of course, does have some science, as does the peanut butter. You know, fat can be very good at telling us we're not as full, and it does take a little while for the food in the stomach to tell the brain you've had enough. So these are some things you might try.
Speaker 1:
Now we're on to the third principle. Again, people might differ from my beliefs here, but it's an opinion based upon the science and the evidence that I've read. So what we eat and when we eat it are really, I believe, less crucial than many folks believe. Now, this is, of course, within reason, but if, just like as I said about the diets, whether you have more or fewer carbs in your daily diet, more or fewer fats, you will likely remain healthy. Sure, if you ate twinkies all day long and never had a fruit or a vegetable, that wouldn't be good. But if you maintain a good weight, for you those minor variations on how much carbs and how much fat probably don't matter. So I underscore having a good weight for you. But what is a good weight for you? Now, there are tables you can find on the internet that give you average weight by your height and your age, whether you're a man or you're a woman. But most people have a pretty good sense of what their good weight was. Maybe it was when they were in college or in their 20s, where after that they noticed that they had gained weight and it's not their ideal weight. So lots of ways to figure that out. There's also a teaching of shopping around the periphery of the market, where you'll get your fresh fruits and vegetables and meats that are not processed, and that's great. I like this approach, although, to my knowledge and being the evidence-based person I am, no one has done a randomized trial of people shopping around the periphery versus those going up and down every aisle. But if somebody would like to do that study and share the results with me, that would be delightful.
Speaker 1:
I mentioned processed foods, and I'm not an anti-processed foods person. In general, my hesitancy about processed foods is that they're really calorie dense and if you're not careful you can eat a lot of calories very, very quickly. Now why is that? Well, there is the trifecta of irresistible foods. If you combine fat, carbohydrates and salt, for most people that is almost irresistible. Think of pizza Think of is almost irresistible. Think of pizza, think of ice cream. We love that and for many people. In surveys they found these are actually two of the foods that are the hardest to stop eating. Once we start, we really want to eat more and more and more, and the food industry has learned that the combination of fat and carbs and salt are almost irresistible and they put them in all sorts of processed foods, even if you have what you think is a healthy protein bar. Take a look and you'll see that trifecta is also there.
Speaker 1:
Okay, one interesting study which you might think on the surface disputes what I say about what you eat and when you eat it, but when you look carefully, actually supports it. So there's a study that looked at time-restricted diets, intermittent fasting, where you narrow the number of hours during the course of 24 hours where you eat. Some people eat for eight hours window and then they don't eat for 16. Some people do that at four hours and 20 hours lots of different ways to do it. So this was a study of 77 obese patients and they followed him for 12 months, which is a good length of time, and they randomized people to either just eat between the hours of noon and 8 pm, versus the control group, versus a group that All they did was count calories, so they were very mindful of how many calories they were consuming. Now, compared to the control group, which did nothing, both the intermittent fasting group and the calorie counting group lost weight. But the key difference is it didn't matter whether you were doing intermittent fasting or the more classic calorie counting they both lost about the same amount of weight. So, again, what you eat and when you eat it may be somewhat less critical than people think. Principle four adequate protein in your diet is very important.
Speaker 1:
In the exercise podcast that we had a few weeks ago, I talked about how, after about age 30, we all lose 1% to 2% of our muscle mass each year, and obviously over a course of a decade, two decades, three decades. That's a lot of loss of muscle mass, and losing muscle affects our strength, affects our balance, it affects our ability to live well and it also makes falling more likely and it may make it more and more difficult to do the things we love, like hiking or golf or playing with our grandchildren or whatever it might be. So here's an interesting, what I might call a teaser study. It was a study in elderly folks Now. These were folks that were sort of 70 to 79, and they followed them for three years Again, that's a pretty good length of time and they looked at how much protein they ate. And they then looked at how much protein they ate and whether they lost muscle over the course of the years, and what they found is the people who ate the most protein lost 40% less lean body mass which is typically muscle than those that ate very, very little protein. Now, is this a perfect study? No, it's not a perfect study, but it's at least a suggestion that protein intake is going to matter, especially as we get older.
Speaker 1:
Now, the recommended daily allowance that's put out by the federal government says that we need about 50 grams a day, or about a third of a gram per pound of body weight. I weigh 150, and so if you do the math, that comes out to be about 50 grams. Now, unfortunately, that RDA is based upon sustaining our life. It's not an optimal amount. To live long and well, I believe you probably need about double that. So for me, I try to aim for about 100 grams of protein, and when you look at the literature, like I just talked about. That's what you see over and over and over again. Protein's important.
Speaker 1:
Principle number five and we're going to do a whole podcast on this topic. But just to give you the high points, I personally believe that supplements and probiotics are probably not necessary. The punchline is that unless you have a known deficiency of a vitamin or something like that, based upon blood tests or obvious symptoms related to a deficiency, adding supplements are not going to help. They have not been shown in rigorous studies to reduce heart disease or cancer or help us to live longer. Now, the one exception here is multivitamins. A multivitamin a day in some studies has shown a slight reduction in cancer. I take a multivitamin a day. It's cheap, it's not going to hurt me, and why not? But again, we're going to have a whole episode about this and we'll talk about all the common episode about this and we'll talk about all the common supplements and what the evidence is or isn't, like omega-3s and vitamin D and things like that. Okay, principle number six and this is the last of the key principles we are all individuals and what works for others may not work for us.
Speaker 1:
So here's an interesting study looking at genetics and weight gain or weight loss and this kind of gives you a sort of some evidence of how we might want to think about things or how we might not want to. So this is a study. They looked at 145 overweight people. Now there are certain genes that have been typified as carbohydrate responsive, meaning it helps ramp up our ability to consume carbohydrates. And then some people have genes that are fat responsive genes. So this study took four different groups of people and they basically said okay, well, which gene type are you? Are you carbohydrate responsive? Are you fat responsive? And then they gave them both the either the appropriate diet or the opposite diet. So the people who had genes that were carb, high carb and carb responsive, they got high carb diets. The people that were fat responsive got high fat diets. Then they gave people that are carb responsive and they gave them high fat diets. And, conversely, they took people that had the fat responsive genes and they gave them the opposite, which is a high carb diet. What do they find? It didn't matter. There was no difference in weight loss whether your diet reflected the gene that they were measuring or was the opposite of the gene they were measuring. So this tells us that at least today, we can't measure things and give us our answers.
Speaker 1:
Now let me give you a couple more examples, and it's why I am so strongly a believer in the N of 1 studies. So you may have heard, and if you have high blood pressure, your doctor's probably said to you oh, you really need to reduce your salt intake. Be careful about what you add with the salt shaker. Don't have canned soups and canned vegetables, because they're loaded with salt. The problem is not everybody is salt sensitive. Salt might affect blood pressure for some people, but not for others. So there's a study, and again, all these studies I'll link to in the show notes. So they studied about 213 people and what they found?
Speaker 1:
And they tried some with low salt diets and high salt diets and what they found is only half of the people were salt sensitive, meaning if they had a lot of salt, their blood pressure was affected by it. But half the people weren't. Meaning for this group of people, eating salt didn't raise their blood pressure, didn't lower their blood pressure of people eating salt didn't raise their blood pressure, didn't lower their blood pressure, didn't really matter. So what do I take from this? There's only one way to find out if you are salt sensitive and that is, do an N of one study. Take your blood pressure, get a home blood pressure monitor, measure it a couple of times a day for a week and that will be your baseline. And then if you go on a low salt diet for, say, a month and then repeat the blood pressures again after that and ask yourself well, I wonder if my blood pressure changed much when I tried the low salt diet? For a lot of people probably half of the people they won't see any difference in their blood pressure. And if you're somebody that isn't salt sensitive but you enjoy salt, I would argue go ahead and enjoy the salt because it's not affecting you and you should enjoy your life. Similarly, some people eat fatty foods and it affects their cholesterol levels and other people eat fatty foods and it makes no difference whatsoever. I'm one of the people that saturated fats don't really matter for me in terms of my blood cholesterol levels. Again, you can do an N of 1 study. This would require that you get a blood test before and after. But again, you do your baseline. You go on a low-fat diet, you see if it changes, you go back to your regular diet and see what happens and again you will know what works for you or doesn't. Everybody wants personalized medicine. This is a way you can personalize your own healthcare.
Speaker 1:
Okay, we are coming to the end and now it's time to wrap up with some take-home messages. The first it is important to maintain a good weight for you. Second, no diet is best or really better than another. Third, what you eat or when you eat it of course, within boundaries may not matter too much. A balanced diet with foods that you found at the market's periphery will probably be very good for you. Fourth, getting an adequate amount of protein is really important, and it may be twice as much as the 50 grams that you often hear quoted.
Speaker 1:
As I just mentioned, each person is different and what works for one person may or may not work for another. We need to do our N of 1 studies to figure out what works best for you, and we're going to continue with this theme when we do future episodes. Well, I hope today provided you with some practical advice and reassured you that there is no perfect diet or ideal way to eat. Do the best you can. What works for you is the key. Next time, we will explore mind-body harmony. I hope you will continue with me on our journey to live long and well, to improve your health and longevity. Please visit me at drbobbilivelongandwellcom. That's drbobbilivelongandwellcom.