Principles of Healthy Nutrition

Patients always ask me what food they should eat to get healthy or stay that way. Even more people want to know if a specific diet is better than another one. I tell them that a list of recipes or specific foods will feed you for a day, but understanding the principles of healthy nutrition will feed you for a lifetime.

In schools now, students spend a lot of time learning about the concept of multiplication and understand what it means before they memorize their “times tables”. Similarly, if you understand the importance and benefit of fiber, that is more important than knowing that an avocado has 13 grams of it.

“A list of recipes or healthy ingredients will feed you for a day, but understanding the principles of healthy nutrition will feed you for a lifetime.”

– Doctor T

If you understand the basic concepts behind healthy eating, they can be adapted to different tastes and different health problems, because no single nutrition plan is perfect for everyone. If you have high blood pressure and high LDL cholesterol, you may not benefit from the same diet as someone who is overweight and has diabetes. A weightlifter may require a different diet than a marathon runner. A supertaster may not tolerate the same eating plan as a low-taster.

Hundreds of books have been written about nutrition. There is a lot of interesting and useful information out there, but a lot of it is muddled up with pseudo-science and opinion. Don’t feel overwhelmed or discouraged – the important thing is that you are here, trying to educate yourself and making an effort to improve yourself. The good thing is, you don’t have to read all of those books. Most of the benefits of a healthy diet can be extracted from a few simple principles. You don’t have to obsess over every little thing you eat, but just try to make slow adjustments to shift from unhealthy to healthy. I will review three simple principles that you can apply to all of the food you eat, helping to create a healthier version of you.

Shift from Sugar to Fiber

The average American consumes about half of their calories in the form of carbohydrates, making them the largest portion of our diets. Unfortunately, the type of carbohydrates we consume has decreased in quality. We are getting smaller amounts from fiber in the form of vegetables and whole grains and more from sugars and refined carbohydrates in processed flours.

Everyone argues about carbs vs. fat vs. protein, but they all forget that fiber is the best macronutrient. It is calorie-free and slows the digestion of other carbohydrates, resulting in a smaller spike in blood glucose and insulin. It is also satiating, meaning you feel more full, and eat less food that has calories. Also, certain kinds of fiber can prevent absorption of cholesterol in the intestine. The documented benefits of fiber range include decreases in cardiovascular disease, diabetes, colon cancer, and overall death rates.

Everyone argues about carbs vs. fat vs. protein, but they all forget that fiber is the best macronutrient.

– Doctor T

Carbohydrates have gotten a bad rap recently from all the hype advocating for low-carb diets. Certainly, sugars and highly refined carbohydrates can be harmful and lead to weight gain, but there is a lot of evidence supporting the health benefits of high-fiber foods such as whole grains and beans and lentils. So, in general, there is no harm from carbohydrates in foods that are also high in fiber.

How much fiber should you be eating? This is a challenging question because it depends on how many calories you consume in a day, and that can vary day to day. Also, it’s awfully difficult to count your fiber intake throughout the day. Instead of counting, I suggest using the TRACk^TM Method (doctor T’s RAtio of fiber to Carbohydrates). To do this, you should eat foods that have at least one-tenth as much fiber as carbohydrates. For example, if a serving has 20 grams of carbs, you want it to contain at least 2 grams of fiber.

How did I come up with this equation? (You can skip this part if you don’t like math.) The recommended fiber intake is 14 grams per 1000 calories. The average carbohydrate intake is about 50 percent of calories. That would be 125 grams of carbohydrate per 1000 calories. Add 14 grams of fiber and you get about 140 grams, and 14 is one-tenth of 140!

Of course, this means that this equation works for a standard diet. If you eat a low-carb diet, hopefully you eat a lot of low-carb, high-fiber vegetables to get adequate fiber. Atkins-style diets, which are more meat-heavy, may not get enough fiber through his method, whereas ketogenic diets are more likely to get adequate fiber through vegetable intake.

How do you ensure that you get this ratio of fiber? Make sure to read labels, eat whole grains and avoid sugars! Whole grains generally have at least a one to ten ratio of fiber to carbs. Vegetables are usually much higher. If you are looking at something that has a lower than 1 to 10 ratio of fiber (fast food, dessert, etc.), make a mental note that it is “unhealthy” and try to avoid it, or make up the fiber elsewhere, such as with some low-carb vegetables.

I tell my patients to be wary of eating anything white (cauliflower is an exception). Pasta is very dangerous in terms of carbohydrate intake. Unless it is made with whole wheat, pasta has very little fiber. Additionally, it is really easy to eat a LOT of pasta. A typical box of pasta has eight servings – very few people eat just one-eighth of a box.

Replace white rice with brown rice, and white bread with whole grain bread. Read labels to make sure that your bread is made completely of whole grains and doesn’t just contain whole grains. This is where the TRACk^TM Method comes in handy – you don’t need to read all the ingredients, you can just ensure that there is at least a 1:10 ratio of fiber to carbs.

What about potatoes? They are white, but they are a vegetable, right?Potatoes have very little fiber (especially when peeled) and lots of carbs, and you usually need to add fat and salt in some fashion to make them taste good. I have only met a few patients in my career that would eat plain baked potatoes. I generally advise patients, especially those who are overweight or have metabolic syndrome or diabetes, to avoid potatoes altogether.

Another way to use the TRACk^TM Method is to think of fiber like money. Every time you consume high fiber foods (greater than 1:10 ratio), you are putting fiber “in the bank”. Things that have an approximately 1:10 ratio of fiber to carbs don’t cause you to gain or lose “money”. When you eat sugars or low-fiber carbs, you are “spending”. If you find that you are spending too much on a given day because you had dessert or a bowl of pasta, you need to put more in the bank with vegetables.

Shift from sodium to potassium

Hypertension is the most common disease in the United States. One of the major contributors to this disease is an unbalanced ratio of potassium and sodium.

For much of history, salt (sodium) was rare and precious. As a result, our bodies have evolved to hang on to sodium. Only during the last few hundred years has sodium become plentiful. By my calculations, since life evolved out of the oceans 400 million years ago, sodium was scarce for 99.9999% of that time. Now, the average American consumes over 3400 milligrams a day, even though our bodies only require 200 milligrams a day or less.

Our body exchanges potassium for sodium. This means that if you eat more potassium, you will urinate more sodium. Unfortunately, we don’t consume nearly enough potassium. Where do you find potassium? Fruits, vegetables, beans and lentils, and dairy. Unfortunately, much of the benefit of the potassium found in these founds is negated by the addition of sodium if these foods are canned. Always try to eat fresh foods, and read labels otherwise.

How much potassium do we need? A good rule of thumb is twice as much potassium as sodium, but even more may be better. This rule is hard to implement without counting throughout the day, because most foods are high in one and low in the other. Additionally, potassium content is not always listed on nutrition labels. The key is to eat more foods that have lots of potassium (fruits, vegetables, dairy, beans and lentils, whole grains, fish and meats) and less that have sodium (almost anything in a box, bag, pouch, or can). You can be more aware of your sodium intake by reading labels carefully. A lot of foods that don’t taste particularly salty, like bread, will have more sodium than you would expect. Condiments and sauces are another common source of sodium.

I tell my patients to stick to the edges of the grocery store. This is where you will find fresh fruits and vegetables, unprocessed meats, and dairy products. These items haven’t been combined with salt or other preservatives which can be harmful to your health.

Eating out, whether it is fancy food or fast food, will result in a high sodium intake. A lot of restaurants have low-calorie, low-fat, and sometimes even low-carb options, but it is pretty rare to find low-sodium dishes.

Shift from animals to plants

There is a lot of data suggesting the benefits of a plant-based diet. Vegetarian and vegan eating patterns have been associated with longer life, less cardiovascular disease, and fewer cancers. Eating more fruits and vegetables indirectly supports the two principles above (more potassium and more fiber). Also, animal products contain more saturated fats and cholesterol, whereas plants contain healthier unsaturated fats. There is good evidence that replacing saturated fats with unsaturated fats decreases the risk of cardiovascular disease. Much of the decrease in coronary disease over the last 30 years is thought to be related to replacement of lard and butter for cooking with healthier vegetable oils.

In addition to saturated fat and cholesterol, recent research has proposed a link between molecules called carnitine, choline, and lecithin, which are found in animal products such as meat and egg yolks, and cardiovascular disease. These molecules are metabolized by bacteria in the intestines to another molecule called trimethylamine N-oxide, or TMAO. TMAO levels in the blood have been associated with heart attack risk.

The truth is, most studies don’t say that meat is universally unhealthy. Processed red meats (think breakfast meats such as ham, bacon, and sausage, as well as hot dogs and some deli meats) are pretty convincingly associated with heart disease and cancer, but we can’t say the same for unprocessed red meat, poultry, and seafood. However, the more meat you eat, the less room you have for healthier, plant-based foods that have fiber, potassium, and a wider variety of micronutrients.

If you eat a standard American diet, which is pretty meat-heavy, you don’t have to become a vegan to improve your health. Shifting from red meat to lean poultry and seafood decreases saturated fat and choline intake. Also, fatty fish has much more healthy omega-3 fats than grain-fed beef. Another option is to start by being vegetarian for one day a week. This is a good way to adjust to the idea of a less meat-heavy diet. Simply substituting an ingredient or two for meat on occasion can also be a good start (think walnut tacos). There is no shortage of tasty vegetarian recipes that you can try.

Summary

The standard American diet is high in sugar and sodium, and low in fiber and potassium. This has resulted in high rates of cardiovascular disease and cancer and possibly inflammatory diseases as well. Adjusting these ratios can improve health, with a plant-based diet being one way to achieve these benefits.

Remember, you don’t have to completely implement all of these changes overnight. You don’t have to cut out every unhealthy food overnight, just like you wouldn’t try running a marathon tomorrow. Start by being aware of what you are eating. Read the labels in the grocery store. Read the published nutritional information when you eat out (it should be available at the restaurant or online). Make mental notes of what is good and what is bad. Choose healthier options. If you choose something unhealthy, eat less of it. If you happen to be a fan of something that is healthy, eat lots of it. Try to make slow changes and adapt your mindset. These sort of changes are more likely to last for the long-term.

“You don’t have to cut out every unhealthy food overnight, just like you wouldn’t try running a marathon tomorrow.”

– Doctor T

As a personal anecdote, I used to have a very unhealthy diet. I ate a lot of meat. In fact, I couldn’t even envision a vegetarian meal. Meat was the focus of my meals with a few added ingredients. If you were to ask me to cook something vegetarian, it would probably be an assembly of side dishes. I also have a horrible sweet tooth. I generally would have dessert after lunch and dinner every day, without even thinking about it. I never even gave a thought to whole grains, and I don’t really like vegetables. Over the last ten years, my diet has changed a lot. I’m not a vegetarian, but I eat a lot less meat, and no red meat. I rarely eat out, and we use very few processed foods at home. I still love my dessert, but have it less often and less of it. None of these things happened overnight, and I still don’t eat the healthiest diet imaginable, but it’s progress, and I hope to keep making progress. I hope you do too. Good luck!