What a lame title, but hopefully you clicked on it to read it 🤷🏽.

So, I like food. I really like food. I once planned an entire trip to Asia just to find food. I’m also simultaneously not that picky about certain foods while other foods I’d be a self-proclaimed connoisseur or unintentional snob about. I’ve been known to fancy fine dining and also eat gas station sushi, so things are all over the place. If you haven’t seen yet, I put up a bunch of pictures of all the fancy food pictures i tried to take of things i made at home in 2020 during the heart of the ‘stay at home’ part of the COVID-19 pandemic pre-vaccine: https://thenomadicpediatrician.com/quarantine-qooking/

That being said, I’m a big proponent of healthy eating and the idea of using food as medicine. Finding ways to eat healthier with particular focused goals of improving our overall health and modifications can help to treat certain health conditions like Diabetes, Autoimmune Disorders and Chronic Pain. However, food should be used as a COMPLEMENT, not a replacement, to medicine. Now, I live an outrageously busy life currently, so I am the first to admit i have a hard time always following what I recommend on food, but in my particular case i’m constrained by living in hotels and often not having literal means to cook. Still, there are ways to manage and I’ve been able to find a balance of how i eat and my overall activities to at the least avoid excessive weight gain. One of my biggest pet peeves is when people in medicine judge and criticize patients for their life choices, especially when they aren’t able to be consistent with their own and/or are hypocritical about it. So, these are my overall condensed thoughts on healthy eating/food habits for the everyday busybody that can hopefully help with long-term health that I DO try to do for my own sake as well. As for the question as to whether I have credibility to write this, I’m certainly not a Registered Dietitian (RD) (who are very often and incorrectly referred to as “nutritionists” or “dietary”; please stop calling my friends that), but I was lucky enough to spend some time studying “Culinary Medicine” in medical school (www.culinarymedicine.org) and got to spend some time with great chefs and dietitians at Johnson and Wales University.

1. Seek moderation and lifelong lifestyle changes over intermittent and exaggerated diet changes. I NEVER recommend to my patients to make 180 degree changes overnight. These changes are unsustainable. If you love your white rice, don’t stop eating it, but maybe eat less of it or try mixing it with cauliflower rice or brown rice for continued texture but improved nutrition.
   
2. Think about nutrient density and caloric density. An example of HIGH nutrient density and LOW caloric density: Most vegetables, particularly ‘leafy greens’ like spinach and kale, bell peppers, radishes, mushrooms. An example of HIGH nutrient density and HIGH caloric density: Avocados, nuts. An example of LOW nutrient density and HIGH caloric density (aka stuff to avoid): Basically all typical junk food.
   
3. Try to avoid processed foods by sticking to the perimeter and avoiding the aisles at the grocery store. Most processed food has additives, preservatives and ingredients that increase the caloric density. Interestingly, they tend to be located in central aisles. If you make ONE move of just going to mainly the perimeter of the store, you’ll find this is where most of the produce is or raw foods.
   
4. Fiber is our friend. Fiber comes in two broad categories of being soluble or insoluble. While the details can be important, having a general good intake of fiber can help to lower cholesterol, keep you feeling full longer, help normalize blood sugar and bowel movements and overall is connected with increased longevity. The goal should be around 25-30 grams of dietary fiber (no supplements) per day. Higher is preferred for men, and lower for older people. Food high in fiber includes: legumes, beans, whole grains and cereals, whole fruits (NOT juice) and vegetables. (https://www.ucsfhealth.org/education/increasing-fiber-intake)
   
5. Drink more water and less sugary (or alcoholic) things. Like, don’t go too too crazy, but this is something that people notoriously don’t do very well. Women and men have varying body compositions of water and adults are different than kids, but this isn’t a medical talk. Basically the goal per the National Academies of Science, Engineering and Medicine recommend 125 ounces (3.7 L) for Men and 91 ounces (2.7 L) for women – so, 100 ounces is a good target if anything. The idea of 8 cups a day comes out to 64 ounces, which isn’t a bad place to start considering we probably aren’t getting close to that to begin with. (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256)
   
6. The truth about fat and cholesterol. In the last 10 years or so there’s more evidence that DIETARY cholesterol doesn’t quite translate to elevated serum cholesterol levels for most people. Absorption, the liver and genetics play into this. What matters more is FAT consumption. It’s all this basic biochemistry stuff we learned about in early medical school; but that’s not important. From what we CURRENTLY know the goal is to have Higher HDL (H = Healthy) and Lower LDL (L = Lousy). To help with this, a generic teaching i’ve had throughout the years is Monounsaturated = The Best; Polyunsaturated = Good; Saturated = Bad; Trans = Awful. Avoid hydrogenated oils and stuff too. Monounsaturated/polyunsaturated fats tend to improve HDLs and the saturated/trans-unsaturated fats tend to worsen LDLs. At least, this is where my current understanding is on these things; and, you’re talking to someone that was able to make measurable HDL/LDL changes only by diet changes one year! So good that my internist told me he had to eat his words since he didn’t think i could do it and I did.
   
7. Smaller portions, meal planning and team work. One of the things i’ve become fairly expert at over the years is meal planning. If you do it right and ahead of time, it can be significantly cheaper. One of my favorite ‘Food as Medicine’ kind of things, if you take a small amount of time to plan, it’s even cheaper than fast food which always seems cheaper. Lastly, for all of my kids with obesity, I find a majority of the time the main nidus of the problem is that the family buys unhealthy foods or stores all of the above bad choices at home. Making choices with a partner or family to overall change behaviors has the best outcome. Find an accountabilibuddy.
   
8. Avoid fads and diets. There are reasons that certain diets help with weight loss, eg: intermittent fasting, ketogenic diets, paleo… But, overall most of them are questionably safe. If you’re going to choose one lifestyle modification, however, a few that have been consistently showing to have long term benefits are The Mediterranean Diet and The DASH Diet. These are somewhat outdated with how quickly evolution happens in knowledge and information, but have been backed by research for a long enough time that it’s a good adjunct in complementary medicine to western treatment for medical conditions. Personally, I love the tenants of the Mediterranean Diet… Especially since it allows alcohol… There’s also no need to go gluten free without a known allergy or reaction, gluten DOES have benefits that I won’t dig into here.
   
9. Measure oils and avoid that deep frying thing. Did you know that there are around ~120 calories per 1 tablespoon of oil?! We all know that we often just pour oil into a frying pan for sauteing or frying, likely rarely measuring the actual amount we’re using. Easily therefore, you can see there it’s very easy to add in hidden calories here. Moving to certain cooking methods instead such as grilling and baking can help to eliminate these hidden calories entirely.
   
10. Flavor alternatives – Get ALL THE HERBS. Some people really love to add salt to things *coughcough.* And, while a little can help a dish and be necessary, for certain health conditions like hypertension (aka high blood pressure), salt control is important. For most people the American Heart Association recommends a maximum of 2300mg per day of salt; 1500mg if you have a heart condition. Some people crave sweet. For both of these cravings, I’ve found that adding in various spices (cumin, paprika, chipotle pepper), herbs (rosemary, thyme, oregano) and ALL the garlic, can often help me minimize the amount of additional salt. Cheese and mushrooms bring a certain taste of Umami which is really what we often crave.

Lastly, don’t beat yourself up too much! The further I move along in my early career in Medicine, the more i’m learning about how much people really feel guilty about their choices. We all have guilty pleasures, we all do things that we maybe ‘shouldn’t do’ and the last thing we need is to give up. Any progress is progress and feeling overall healthier is the most important thing in life, over numbers, appearances and social norms. So, if you stray from the path, reset your GPS and find your way back.

Image taken from https://www.johnscottus.ie/nutrition-for-children/