Why Diets Suck

In this episode of The Savvy Patient, cohosts Dr. Gillian Goddard and Erin Stein debunk fad diets and explore what the science actually says about healthy eating. We discuss the problems with extreme diets, the limitations of diet studies, and why short-term weight loss doesn't necessarily lead to long-term health. For so many reasons, typical diets and fads are not sustainable. Most dieting strategies lack evidence. We highlight the DASH and Mediterranean diets as the two eating approaches with the strongest evidence, particularly for improving blood pressure, cholesterol, diabetes risk, and overall metabolic health. A healthy diet doesn't need to be extreme: eating mostly whole foods, getting enough fiber, limiting highly processed foods and excess sugar, staying hydrated, and making gradual, sustainable changes are more important than following a perfect diet. Bottom line: Forget the quick fixes. The best diet is one that supports your health and that you can realistically maintain long-term.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

Gillian Goddard: Hello and welcome to The Savvy Patient.

Erin Stein: Hi everyone.

Gillian Goddard: Hi Erin.

Erin Stein: Hi Gillian. We need to work out some standardized greetings and sign offs on this thing. We'll get there. 

Gillian Goddard: Fair enough, fair enough. We will.

Erin Stein: But today we're going to have maybe a little fun talking sh*t about diets.

Gillian Goddard: I mean what else is there to talk about them really?

Erin Stein: Where do we even start?

Gillian Goddard: Why don't we start with how they suck?

Erin Stein: We can start with; I started my career in magazines and a large part of your job at a women's magazine was reinventing how to talk about diets in an article five different ways in every issue of your magazine.

Gillian Goddard: That's so painful. I remember one of my friends in middle school, her mom used to talk about diets and dieting and low fat like all the time. Like she had a recipe for everything that was low fat. Low-fat cinnamon rolls, low fat cookies, and they all used sugar and a lot of applesauce.

Erin Stein: Applesauce is good. I ate a lot of that as a child, actually.

Gillian Goddard: Fair, fair.

Erin Stein: I think it's a little fun to talk about crazy diets that people have subscribed to in the past. Just a quick Google brings up the Sleeping Beauty diet, which isn't really a diet, it's just starvation.

Gillian Goddard: As in, like, Sleeping Beauty didn't eat for a hundred years, so she was probably pretty thin when she woke up?

Erin Stein: Well yeah, I guess. It looks like in the sixties and seventies, which makes sense actually, people would take sleeping pills for days so that they would sleep and not eat.

Gillian Goddard: My mother-in-law was prescribed speed after she had my sister-in-law to help her lose the weight. That combined with her cigarettes got her most of the way there.

Erin Stein: That sounds super “healthy “[laughs]. Oh my god. Then there's the old standby the tapeworm diet. Just, you know, eat a tapeworm. so gross.

Gillian Goddard: So gross. Anybody who wants to ascribe to that diet has never seen a tapeworm.

Erin Stein: No, seriously. And do you think the only thing it's eating in there is the food you're eating?

Gillian Goddard: Well, it's not actually. It's like glommed onto the side of your intestines, sucking your nutrients out that way.

Erin Stein: Ew, ew. So gross. And then of course the cabbage soup diet. I had forgotten about that, but I remember that.

Gillian Goddard: Yes, can you imagine the flatulence?

Erin Stein: I really think it just gave you diarrhea. Like, it's cabbage.

Gillian Goddard: Well, cabbage is super high in fiber and super low in calories, so it also made you feel full. And bloated.

Erin Stein: Sure, okay. And bloated, so not really helpful if you're trying to lose weight. And then I've never heard of this, but according to the internet, there's something called the Breatharian diet where you just breathe that someone believes they can live on sunlight and air alone without eating food. Again, that just sounds like starvation. I don't know.

Gillian Goddard: Like a plant? Yes.

Erin Stein: That sounds like maybe something a cult came up with. Then of course there's all these new diets like eat only meat or only fat or no fat or no sugar, or don't eat nightshade plants but eat these other plants. Don't eat white rice but eat brown rice. Don't eat processed sugar but fruit sugar is okay. No, not even fruit sugar is okay. There's so many. Eat eggs, don't eat eggs.

Gillian Goddard: Yes, these days I feel like diets are all about like get rid of a whole category of food. Just don't eat this whole category of food and that will somehow be the answer.

Erin Stein: It seems like there's some quote unquote diets that are basically like don't eat; like, reasons to prevent eating.

Gillian Goddard: Yes.

Erin Stein: And then related but slightly different is eating empty calories to feel full, like cabbage or the Jello diet,

Gillian Goddard: Right, like that cabbage. Yeah.

Erin Stein: Is not a thing you should ever do.

Gillian Goddard: Gross.

Erin Stein: It's so gross. but then there's these diets that are adding or taking away different types of foods in order to make you feel better. And I think the pitch is like it's optimizing how your body functions. Yes.

Gillian Goddard: It's like hacking your metabolism, kind of, I think is the idea behind them.

Erin Stein: And tapping into how our bodies were made and created to process food. 

Gillian Goddard: Paleo, I think is probably what you're really thinking of.

Erin Stein: Yeah, thank you. The paleo diet. Which I understand the appeal of that, but also, our bodies are not the same as they were eleven thousand years ago.

Gillian Goddard: And those people would go through periods of famine and starvation, which luckily these days in much of the developed world we don't deal with it so much anymore. We have other problems, but we don't have famine and starvation as much.

Erin Stein: Eleven thousand years ago, none of this food was processed. It was all grown. The plants were different, the crops were different, the content, the fiber and the nutrients, all different. They were prepared differently; they were cooked differently. I mean, they used to mix stuff up with fire ash and cook it.

Gillian Goddard: I would think there'd be some carcinogens in that that probably you wouldn't want to be consuming.

Erin Stein: I would think so, yes. again, when we talked about natural, I don't know that hearkening back to the olden times is a good idea most of the time.

Gillian Goddard: Yeah, you talked about women's magazines, you can look back to the beginning of the existence of women's magazines, and they were talking about how to lose weight, gain weight. It's interesting. 'Cause I feel like so much of this is aimed at women and so much less of it is aimed at men, although there are certainly aspects of changing our bodies in certain ways that do get targeted toward men too.

Erin Stein: A thousand percent women have been told for much of our modern age, this wasn't always true, but for much of our modern age, skinnier is better. there is a point in history where this actually turned and became the thing. and then I would say in the last hundred years it's become much more of the thing.

Gillian Goddard: Mm-hmm.

Erin Stein: You know, that whole supermodel.

Gillian Goddard: Heroin chic.

Erin Stein: Heroin chic, yeah. That whole thing made it much worse, but it already existed. And like you said, in the eighteen hundreds there were ads be slimmer. And those corsets that they were yanking to reshape their rib cages and give themselves tiny waists. Like we've always been torturing ourselves to look different. And for men, I think the weight loss is there, but it's not as required, you know, in society. You need to be a skinny woman to get a husband, but you don't need to be a skinny man to get a wife. And so much of this, of course, is tied up with economics and having someone support you.

Gillian Goddard: Right. Yes.

Erin Stein: At least in the past. Nowadays I would say, and in the last couple decades, men are targeted a lot, but it's more about getting them to fit the ideal masculine body which is muscular. So, for them it's all about you got to eat meat and build muscle.

Gillian Goddard: And lots of creatine.

Erin Stein: Lots of creatine, and I worked at a bodybuilding magazine, everyone. And the diets are pretty extreme.

Gillian Goddard: I remember those days. Flex, right?

Erin Stein: Yeah. So we keep telling ourselves what we should and should not eat and is there a prescription for what kinds of foods to eat or not eat that is better for you or not better for you? Doctor Gillian Goddard?

Gillian Goddard: Yeeeeeah. Did you hear the hesitation in my voice?

Erin Stein: Yes.

Gillian Goddard: So, I think it's helpful to think a little bit about gathering data on diets and what we can gather and what we cannot gather and why we know so little about some of these diets that are supposed to be so great for you and why there's really only two diets that have any real evidence behind them.

Erin Stein: This is a good primer on why we do and don't know what we do and don't know.

Gillian Goddard: Yes. So, there's two ways to design a diet study. two ways that it typically gets done. So, one is you recruit a bunch of people, and you randomize them to your diet that you're interested in or to their usual diet. And you give the people who you want to follow your diet a list of instructions and then you tell all the other people keep eating what you're eating. Then you send them out into the world, and you cross your fingers and you have them back usually at three months or six months, but diet studies tend to be short. Now, there's a couple issues with this. In most cases, it's very difficult to placebo control the diet, right? So, the placebo group gets told to do their usual thing. They know that's not the intervention. They're not idiots in most cases, right? All these people know they're in a study, so they may behave better because they're in a study. But you also just don't know if the people who you gave the instructions to, if they're actually following them correctly all the time, most of the time, half the time. It's a little difficult to know how adherent they are to the regimen that you give them. The other issue is the length. Usually these studies are twelve-week studies. So, anyone can do anything for twelve weeks. Not a lot changes in twelve weeks. There's only a few metrics that we would expect to see change in such a short time. And those would be things like weight, blood pressure, blood sugar, maybe cholesterol too, that you would expect to see in a 12-week study that would tell you a lot about how useful a diet is.

Erin Stein: When you say you would see some weight loss, like how much? Because to me that doesn't sound like very long. You're not trying to drop all your weight in a week. We've talked about this before with GLP ones. If you drop too much too fast, it's unhealthy, so you should be losing it gradually. So how much are you really potentially seeing a difference in in three months?

Gillian Goddard: Yeah. I would say in a three-month study you would expect to see something in the neighborhood, of six to twelve pounds. So, not a ton, but you know, like a half a pound, a pound a week. Because remember, we're also averaging everyone together. Some people might lose much more; some people might not lose anything at all or even gain weight. So not a lot, not a lot of weight. You're not going to see a lot of change in a 12-week study. The biggest thing often you see change in is blood pressure. Blood pressure actually responds pretty quickly to dietary changes. And this is probably because some people are salt sensitive, meaning that when they consume more salt, their blood pressure goes up and when they consume less salt, their blood pressure goes down. And in a lot of these diets, especially in someone who maybe is eating a lot of processed foods and then the diet intervention is not processed, you would eat a lot less sodium and so you would see more significant blood pressure changes. But really, it's difficult to see very big effects from a modest intervention in a study that's 12 weeks long. And that is one of the challenges because the longer the study, the more it costs. 

Erin Stein: Yes. And I would also say the bigger the study would be the better to even out these differences. Cause I'm thinking you don't know what these people are starting from. Some of these people might be eating at McDonald's every day. And some people might be eating relatively healthy, but they're going to make some changes you could see much more drastic differences depending on what they're starting from and changing. And if the study is kind of small that might skew things in a way you can't sort out.

Gillian Goddard: It could and this is where when you're reading these studies, you always want to look at where the study was and where they were recruiting. So, you can get some sense of what the baseline was based on when the study was, when it was recruiting, and where it was recruiting. So what hospitals were they doing this in? You know, an inner-city hospital in a low socioeconomic area, one diet might be more predominant versus in a suburban, highly affluent socioeconomic area, the diet might be different. What country is the diet in or is there a particular ethnic group in the study that consumes certain staples in their diet? Rice is always the one that comes to mind right off the bat, that would make the change more significant. A huge portion of the world population subsists on rice. So that is less true in the United States, but when you look globally that is much more true. But it also depends on where you are in the United States, who the population is. And so, if your diet would be a big change from that, you might potentially see some bigger differences. 

Erin Stein: Mm-hmm.

Gillian Goddard: So that's one type of study. The other type of study…well, really, there's three types of studies. You like how I did that? So that's a prospective study. We'll talk about another type of prospective study. A lot of diet data is retrospective, meaning they take existing information and collect it. Or it's prospective, but they're giving people questionnaires. There's this specific validated questionnaire that asks people about the foods that they eat daily, weekly, monthly, never, and people just go through and fill out this questionnaire and then typically the way that information is used is they're like, these types of foods are a Mediterranean diet. And so, we look for all the people who eat these types of foods daily or weekly, right? And that's the worst kind of data because confounders abound. People who at baseline eat more fruits and vegetables have access to more fruits and vegetables; they have a place where they can go to buy those fruits and vegetables; and they have the money to buy them and they have the education to know that they should buy them, and so those people are by definition very different from people who never eat a fruit or a vegetable, for example.

Erin Stein: Mm.

Gillian Goddard: And then the third kind of study is the weirdest kind of study, and I think can solve some problems but creates many others. And this is an inpatient diet study. And these used to be much more common, they're really not very common now, and when I tell you how they work, you will understand why.

Erin Stein: I want to call this the prisoner diet study.

Gillian Goddard: Yes, exactly, exactly. They ask people to volunteer to live on a hospital ward for some set period of time. And obviously the study protocol varies how long that is. So, they live on the hospital ward. Typically, they are required by the study protocol to do a certain amount of exercise. I worked in a cardiopulmonary exercise lab and one of the studies that we did in that exercise lab was one of these inpatient diet studies where the person was supposed to come a certain number of times a week and exercise on the exercise bike in a super measured and controlled way. So, you recruit these people; they live in the hospital; they get fed exactly what the study protocol says they should be fed. They often serve as their own controls. So, they often have them eat in a certain way first and then let them eat anything they want afterwards, and they compare them to themselves, if that makes sense. And the reason for that is it's real hard to get people to participate in these studies. because it's not like you can go to work. You have to be in this hospital ward all the time. And so, you have to find someone who has three to six months, usually they're three months, to live in a hospital ward and never leave. And I will tell you, and I mean this in the nicest possible way, you do not get a representative sample of the world.

Erin Stein: The reason you're doing that or asking someone to live in the hospital is so you can actually see what they're eating and actually control what they are eating because every other kind of study is self-reporting. You're trusting this person.

Gillian Goddard: Exactly.

Erin Stein: And it's not like people are lying, it's just your memory. Like who remembers?

Gillian Goddard: Yeah, people are not great reporters. We don't remember very well.

Erin Stein: I have to really think about it what I ate yesterday and forget about the day before.

Gillian Goddard: Most people can do a twenty-four-hour recall relatively accurately, but if you go much beyond that, they really can't.

Erin Stein: You really can't. I would find it so hard to answer questions such as, how many times a week do you eat this particular food? Vegetable, fruit, whatever. Because sometimes it's in season and we eat a lot. Sometimes I'm over it and I don't want to eat it for two months. So how do I answer that question? I don't really think about it that much, but maybe we do eat tomatoes five days a week and I just don't think about it that way, you know?

Gillian Goddard: Exactly. Yes. Yeah.

Erin Stein: I would find that questionnaire super hard to answer in any way that I felt was accurate.

Gillian Goddard: Yes. So, the workaround to that is one of these inpatient studies, but these inpatient studies are also deeply flawed because they don't represent real life, for example, and people don't want to be in them or can't be in them.

Erin Stein: Even if you could…

Gillian Goddard: Would you?

Erin Stein: …and you were available, what are you doing all day? Like that's not a normal level of activity or engagement or anything really.

Gillian Goddard: Correct. Correct. A hundred percent. It was funny because these patients used to come to the lab to do their like thirty-minute exercise protocol and they would hang out for like two hours because they were bored to death.

Erin Stein: Well, yeah.

Gillian Goddard: We'd be like, “We're kinda working here.”

Erin Stein: I can see both why you might want to try to do that, but also why that's basically impossible.

Gillian Goddard: Yeah, it it's really, really, really, really difficult. A lot of times these studies are focused on weight as the metric or change in body mass index. I will not go on a body mass index rant today. I've done that previously. But there's practical reasons for that, right? It's super easy to track people's weight. You put them on a scale, and you write the number down. and that is why they tend to focus on weight. But I would like to think in this day and age we're a little bit more enlightened and that much of the reason we're interested in diet has less to do with body size and more to do with long-term health. And none of these studies are looking at long-term health outcomes easily because your body's size does not determine your long-term health, and no single metric is going to do that either. And an intervention that only lasts 12 weeks is not going to have a significant impact on your long-term health.

Erin Stein: Right.

Gillian Goddard: So, the data on diets pretty much sucks. So there's the kind where you recruit a bunch of people and give them advice. There's the kind where you recruit a bunch of people and ask them questions about their diet and then look for associations. And then there's the kind where you lock up in a hospital ward. Those are the three main kinds. The last kind is the least common type, as I'm sure no one will be surprised to hear.

Erin Stein: Maybe there's some very specific questions people are trying to answer where that might make sense.

Gillian Goddard: One of the most interesting things that has been done around metabolism and diet in the recent past were some observational studies of the people who participated in The Biggest Loser. So, there was a team of doctors who collected data from those people as they were going through the process of the show and then afterward. And they collected some great data that gets into sort of the next question, which is, you know, when we're talking about long-term health, one of the keys to a diet for long-term health is sustainability and that is because the minute you quit doing whatever diet it is you're doing typically all the benefits that do exist reverse and we know a lot of that because of the data collected from those people and from other studies like that. So, it’s not surprising that, you do this super restrictive diet, and you get some sort of benefit from it, but then it's too restrictive to carry out in real life for any significant period of time. And so, you quit doing it and then all the benefits go away pretty quickly.

Erin Stein: Part of the issue with calling some of these things even diets, these extreme things, like drink a giant thing of celery juice every day. How long are you really going to be able to do that? Not forever.

Gillian Goddard: Correct. The cabbage diet, you're going to be malnourished on the cabbage diet after a very short period of time.

Erin Stein: Yes. I don't want to say to be fair, because I don't think these are ever a good idea, but some of these are pitching themselves as just a quick way to lose some weight. And sure, any extreme situation that you're doing to your body will potentially lose you some weight.

Gillian Goddard: But the problem is and this we know from the data from some really interesting studies, some of which came out of The Biggest Loser, is we know that your metabolism adjusts. If you cut your calories, that dramatically, yes, you will lose some weight, but then ultimately your hypothalamus will slow down your metabolism to a crawl to get you to gain back up to where you were and then some. And so not only do they only work in the moment, they do long-term harm as far as your metabolism, your metabolic rate, because your body has this very strong mechanism to sort of bring you back to a set point, which is why diets don't really work for weight loss, generally speaking, across the board.

Erin Stein: I think that's a critical point. that there's going to be a rebound effect. Like your body wants to be in balance…maybe balance isn't the right word. Maybe stasis is better.

Gillian Goddard: Yes. the scientific term is homeostasis, right?

Erin Stein: Yeah. The body needs things to be in stasis, all the different parts that are all working together need to be there and working together. You need enough nutrients and the kinds of nutrients and vitamins for all of that to be happening. So, any sort of extreme diet that's all this or none of that is going to be problematic from that point of view.

Gillian Goddard: Exactly. Exactly. that's a really, really important point. your body will work to deal with the extreme situation. It evolved to do that. We wouldn't have done very well. if our body hadn't developed those mechanisms because of the food and security that humans have experienced throughout human history. It's only been very recently that a big portion of the population, doesn't experience food insecurity.

Erin Stein: Yeah. and still there are a lot of people who are experiencing that, and it's even worse to impose some body image standard that they should be trying to meet when they don't even have access to healthy food.

Gillian Goddard: Yes, absolutely.

Erin Stein: I have friends who've gone on different diets and some of them are not you know, these fad diets or anything, just followed a protocol that a doctor wrote a book about or whatever. and even when you're following one of these diets, you're going to see results if you're changing your diet in a major way. So, people will say, well, I went on this diet, and it totally worked and it did X, Y, and Z for me. And I'm a little like, well, of course it did something. You saw some change, because if you completely changed your eating habits and what you're eating, if you saw no change, that would be really weird. Right? 

Gillian Goddard: Yes, correct. Right? 

Erin Stein: So, in this way, all diets work and no diets work. 

Gillian Goddard: That's correct.

Erin Stein: Because they all change something. You've changed what you're eating.

Gillian Goddard: Or we wouldn't call it a quote unquote diet.

Erin Stein: Right, you've changed how you're eating it, how much, what times, all these things go into the equation. And so of course there should be some change. It would be quite strange if there was no change. the real question is, is that healthy change long term? And is that going to work for everyone? The answer is going to be no. I'm just going to tell you.

Gillian Goddard: Yes, that's correct. Well, it depends on what your goals are.

Erin Stein: Well, that's the other thing, hopefully more of the dieting trend these days I guess I can't say more because there's still plenty of people who just want to lose weight, but there is a robust field of dieting to optimize your body function and have it function well and live longer.

Gillian Goddard: Yes. and that leads me to the two diets for which there is actually some data. And by diets, I mean the two frameworks for how to eat. One is much closer to a diet. The other is much closer to a sort of eating framework. the one that is more closely related to a diet is the DASH diet. So, the DASH diet, the Dietary Approaches to Stop Hypertension, is a very specific version of a Mediterranean diet. So, it is lots of fruits and vegetables, whole grains, low-fat or fat-free dairy, which I'll go on a rant on in a few minutes. Protein, so we're talking about fish or beans or white meat, chicken, very little fat, and very little sodium. Very little sodium. In some cases, as little as fifteen hundred milligrams of sodium a day. What I would say about the DASH diet is there is data that it works. It does work. It lowers people’s pulse blood pressure and cholesterol. What I also would say about it is good luck following it long term. It's just really, really restrictive. 1500 milligrams of sodium is nothing. I mean, you are not strictly following a DASH diet and eating at a restaurant. You're just not. Don't even look at a bottle of soy sauce. 

Erin Stein: I'm looking at my bottle of Pellegrino.

Gillian Goddard: How much sodium is in your bottle of Pellegrino? Mm-hmm.

Erin Stein: Twenty milligrams.

Gillian Goddard: In water. In mineral water, admittedly, but still. Yeah.

Erin Stein: But that is a diet treating a very specific medical condition.

Gillian Goddard: It is. It is. And it is a diet that has real data behind it. I referenced the other diet that has lots of data behind it, and that is the Mediterranean diet. And the Mediterranean diet is really much more a framework for how to eat. It is less about the specifics of this many servings of this and this many servings of this, which the DASH diet does include, specific numbers of servings of different foods each day. Mediterranean diet is a much more global way of thinking about eating and it does have good data behind it. And when you hear what a Mediterranean diet is, it makes a lot of sense. It is a diet that consists of fruits, vegetables, and whole grains. It includes lean proteins like chicken and fish, and carbohydrates like legumes that are whole and contain lots of fiber. It does not limit fats. But the fats that it includes tend to be plant fats like olive oil and avocados and nuts and seeds, all of which are unsaturated fats and tend to be quite good for us. What I would say about the Mediterranean diet is it also allows for including things like red meat, and full fat dairy and even some sugar in a limited way. And that is sort of the key that makes it sustainable. The Mediterranean diet is supposedly the way that the people along the Mediterranean basin have eaten since the beginning of time because it's what was available to them. And they definitely do eat dairy, and they are not eating low or no fat dairy. They're not eating a lot of processed food. They're not eating a lot of processed white flour. They're not eating a lot of highly processed things out of the grocery store that come in boxes. And so that is really the diet that has the best data for broad application.

Erin Stein: How do we have that data that it is effective?

Gillian Goddard: There's a number of different ways. People first got interested in this diet in the 60s and 70s when they were studying whole populations and whole populations that seem to have lower levels of cardiovascular disease. So that's one way. And I mean you and I can both agree that is probably flawed. There are lots of observational studies, those studies where people check off all the food that they eat frequently or infrequently and so there's lots of corollary data. And then there are some decent-sized, decent length, randomized control trials that look at the Mediterranean diet. And I think some of the reason that you can do decent-sized, decent-length trials with something like the Mediterranean diet is because it is ultimately a sustainable diet, a way of eating, and not eat this many grapes this day and this slice of bread with an egg and you know, it is a framework for thinking about how you eat what you eat and it is less prescriptive.

Erin Stein: So, we have data on this a reasonable amount, but what does the data actually show? Like what is the result of being on a Mediterranean diet?

Gillian Goddard: The biggest result is that it improves metabolic function. So, you're less likely to have cardiovascular disease, you're less likely to have diabetes, it's all these metabolic things. And PS it's not about weight. And that I think is the other important point. That it really is about being healthy and not about your weight. So, you're less likely to get fatty liver, you're less likely to have high blood pressure and high cholesterol, and you're less likely to have diabetes if you eat in this way. And I think that one of the keys of the Mediterranean diet is it's actually quite high fiber. Because if you're eating a lot of fruits, vegetables and whole grains, you're eating a lot of fiber. I mean, basically when we process all these foods to make the food that comes in a box in the grocery store or to make sugary things, basically what we're doing is we're taking the fiber out of the food and leaving the starch and the sugar behind, and the fat. And so, the Mediterranean diet really gets all that fiber in there and so probably the fact that it is high fiber is one of the biggest benefits.

Erin Stein: Gotta eat more hummus.

Gillian Goddard: Mmm, delicious.

Erin Stein: It is. It's my favorite form of eating a chickpea. 

Gillian Goddard: Me too. Me too.

Erin Stein: Cause otherwise the texture can be a little weird for me of a chickpea.

Gillian Goddard: Fair. That's fair.

Erin Stein: I'm not a big vegetable person. I'm much better about it than I used to be, but I really have grown a lot.

Gillian Goddard: You are, you're really growing in that way.

Erin Stein: But you know, it's still like that lima bean, that like thicker bean texture is just, I don't like it. Also, lima beans taste gross. No, they're gross. Ugh.

Gillian Goddard: My grandpa loved lima beans. They were his favorite. A succotash, you could get him to eat a succotash any time.

Erin Stein: No thank you. No thank you.

Gillian Goddard: Fair.

Erin Stein: But I love a hummus. I love olive oil. I've always used olive oil in all of my cooking and eating and never any other kind. I think that has helped a lot. I think that's why my good cholesterol is so high.

Gillian Goddard: Actually, that's genetic, my friend. 

Erin Stein: And here I was trying to give myself credit, Gillian.

Gillian Goddard: I'm sorry. So, I think this is important. Most cholesterol metrics are genetic and the one that is most genetic that you can do the least about is your HDL or your good cholesterol. Yeah.

Erin Stein: Really? This is shocking, and now I'm disappointed.

Gillian Goddard: It’s the truth. I'm sorry.

Erin Stein: So, there are other I guess I would call them medical diets. Like if you have a specific condition or you're going through a specific treatment there are different diets to eat because of what is happening inside. If you have gastrointestinal issues or you're going through chemo or you know, there are other medical diets, but those are very specific to whatever you're going through.

Gillian Goddard: They are, but some of those things are quite common. And I think that this is where we get into trouble with things like prescribing a diet to the whole population. That diet might work well for healthy people without medical issues, but people with gout, for example, need to be careful about consuming certain types of proteins. People with kidney disease have to be careful about their protein consumption. And then people with diabetes have to be really careful about their carbohydrate consumption and especially their simple carbohydrate consumption. So, you can imagine, and I have had patients like this before, if you've got gout kidney disease and diabetes, you're in real trouble because you can basically eat vegetables.

Erin Stein: That would be very tough for me.

Gillian Goddard: It's tough. Yes. It it's definitely tough. But there's also things like, you know, there's things where it's really important to follow the diet. Celiac disease, for example. Like you really do have to be gluten free, or you will not feel good. Or lactose intolerance where you maybe need to be careful about your lactose consumption, but you may have a little bit more wiggle room depending on like the specific dairy products.

Erin Stein: Yep, no one understands why I can eat pizza but not ice cream.

Gillian Goddard: For one thing the cheese-making process metabolizes a lot of the lactose in the milk that's used to make the cheese. So, it is not unusual for people with lactose intolerance to be able to eat some types of cheese in particular, even if they are lactose intolerant, versus ice cream, which is really just cream and sugar, frozen especially, it really is full of lactose. So, so much lactose.

Erin Stein: So much lactose. So sad.

Gillian Goddard: I mean it's really just like drinking a giant glass of milk, which hurts my stomach just thinking about it, and I'm not lactose intolerant.

Erin Stein: So, what about the fat versus low fat versus nonfat and I feel like there is a movement now to eat all the fat all the time and it's good for you and I don't know that it's good for you but I don't know that no fat was good for you either.

Gillian Goddard: It's pretty clear no fat was not good for us. The rates of obesity in this country skyrocketed when we started telling people that they couldn't eat fat, but they could eat all the carbs and sugar that they wanted. I mean, hello, SnackWell’s cookies.

Erin Stein: Ha.

Gillian Goddard: And you think about what types of things they were putting in those products, those low-fat products, to make them taste good.

Erin Stein: Corn syrup, probably.

Gillian Goddard: All kinds of crap. All kinds of crap. when you're talking about low fat products that have been engineered to be low fat or no fat in many situations. I think you have to think about what is replacing that that is making the item taste good. So, I think yogurt is a great place to think about this. If you have regular conventional yogurt Stonyfield Farm or Dannon or whatever, plain, 'cause we're going to be talking about plain here, if you leave the fat in, fine. If you take the fat out, you're going to end up with something that's kind of watery 'cause what you're really left with is the milk protein and the whey the water, right? 'Cause you've taken all the fat out. So, there's milk protein and water and fat and milk essentially. But if you are eating a strained yogurt, like a like a Greek yogurt or Icelandic yogurt, because you've already strained a lot of the fluid out, what you're really left with is the protein, that might be a little bit more palatable. In both of those cases, I would say in the case of conventional yogurt, the way they're making it palatable is by adding a lot of sugar in many cases. And so, you have to think about how are they making the food taste good if they're taking the fat out? That is sort of the question for dairy products. When it comes to other things, I think it's a little bit different. This doesn't mean that like tallow is good for you or that you should be subsisting off of steak, which is all saturated fat. So saturated fat is solid at room temperature, unsaturated fat is liquid at room temperature, and in general you want more unsaturated fat and less saturated fat. But that doesn't mean you need to be drinking skim milk in your coffee if you'd like cream. It's not enough to make a difference. If you were drinking that quart of cream every day, then you might want to go with something lower fat.

Erin Stein: A few things. One, if you're going to overhaul your diet and follow somebody's, eat this this day or eat from these ten meals for dinner, whatever, will see some changes. You want to make sure what you're doing is sustainable and is still a healthy, we'll say it, balanced diet.

Gillian Goddard: Yes. That's exactly right.

Erin Stein: Eat less sugar, but you don't have to eat zero sugar.

Gillian Goddard: Right. Because being a bit moderate is what makes it sustainable.

Erin Stein: Yes. And eat whole foods. If you eat McDonald's once a week, you'll live. I was thinking about this when you're talking about the studies. I'm like, I hope they didn't do any of these studies over the holidays when we're all eating all kinds of extra stuff that we don't normally eat. Yeah. Imagine the results from that. 

Gillian Goddard: Right? Yeah.

Erin Stein: So, it's okay to have indulgences, it's okay to have celebrations. You want your standard everyday food to be relatively healthy. And it's the same thing we say in pretty much every episode, which is just whole foods.

Gillian Goddard: Yes, that's true. 

Erin Stein: Were so boring.

Gillian Goddard: I know I don't mean to be. You also have to keep your celebration limited. I love it when people are like, I just got back from vacation. And I'm like, when did you get back? And they're like, three weeks ago. I just got back from vacation means you got back in like the last week and you're still digging yourself out from the work. the switch back to the daily healthy diet needs to happen fairly quickly.

Erin Stein: Mm-hmm. Yes, I see what you're saying there.

Gillian Goddard: There's a lot of creep.

Erin Stein: Although December's a lost cause. Yeah, there is a lot of creep. And hydration and water are a big part of it too, which we don't really talk about. We're obsessed about food so much. And you need to also make sure you're getting a lot of water. The Mediterranean diet, is there anything that's really quote unquote missing from it? Is it just that it's not as much red meat? It's not as much processed carbs?

Gillian Goddard: Yeah. I think it's missing it's low in sugar. It's low in processed carbohydrates like white flour, white rice. it's low in saturated fat because it's low in red meat and it's really high in fiber, which is nobody's favorite thing to talk about, but is really probably the biggest factor.

Erin Stein: You love fiber.

Gillian Goddard: I do and you know what? I am the first to admit I don't need enough fiber, and that's going to be one of my goals for 2027. I'm going to really focus on my fiber intake.

Erin Stein: Not gonna just get a jar of Metamucil?

Gillian Goddard: My grandmother used to call it Me-tam-usil. my French-Canadian grandmother, she couldn't pronounce it.

Erin Stein: Hopefully we've given you just sort of a baseline of take every diet with a grain of salt. The goal is to eat healthier for longer, to adjust your diet in a way that you can actually accomplish. All these diet books and things online are at fault for some of this. You think you can just start tomorrow. Starting tomorrow, you will completely change everything you're eating, you'll completely change how much you're eating, you'll completely change when you're eating, and that is really difficult for most people.

Gillian Goddard: Yeah, and you're not going to add the amount of fiber that you need overnight and not be in some serious gastrointestinal distress.

Erin Stein: Well, that's the other thing is your system is used to what you're eating. I can't just go eat a bag of broccoli right now. I ate some the other night and upset my stomach. So, I am eating more vegetables, but I am doing it gradually.

Gillian Goddard: Right, exactly. And because these should be long-term health goals, it's fine to make gradual changes as long as you kind of keep steering the ship in the right direction.

Erin Stein: Yeah. It doesn't have to happen overnight. Again, we're not talking about when you have a specific medical issue that you're trying to address with diet. We're talking generally to be healthier, to live longer, to get things functioning better. At the end of the day, it's not rocket science.

Gillian Goddard: No, I know, it's really not.

Erin Stein: And redoing the food pyramid and all this stuff, it's like no, you just got to eat food. Like actual food and not just processed mixes. Yeah.

Gillian Goddard: Closer to how it came out of the ground.

Erin Stein: You got to wash the pesticides off, as we've said.

Gillian Goddard: Yes, let's do that. And the buggies.

Erin Stein: Home gardening does really open your eyes to bugs and things in the garden, and you have to get over some of it. Yeah.

Gillian Goddard: Haha. Yeah, you do. You do. I think we said it all.

Erin Stein: I think we've burned that to the ground pretty well.

Gillian Goddard: Yeah.

Erin Stein: We'll do future episodes on specific things. I want to talk about sugar more specifically and in depth. 

Gillian Goddard: Yes, sugar.

Erin Stein: I'm sure you want to do an entire episode about fiber.

Gillian Goddard: I'd love to do an entire episode of Fiber.

Erin Stein: Maybe we'll do fiber and protein together. 

Gillian Goddard: Okay, fine.

Erin Stein: I feel like fiber on its own is really not enough. All right, thanks for listening. we'll talk to you next time.