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Episode 10. I get asked often about my nutrition background. While I have extensive training in psychology and behavior change, my nutrition training is mostly self-study. I did do a 6-week online Plant-Based Nutrition Certification at Cornell University and have read a lot of nutrition books, but I am certainly not a dietitian or trained in the ins and outs of nutrition. I’m also not a physician.

For this reason, I rely heavily on my esteemed nutrition and medical colleagues to help us understand the evidence for nutrition and how we can apply it in our lives.

Today, I had the pleasure of interviewing my colleague and friend Holly Dykstra, MA, RD, who has her Bachelor’s of Science and Master’s of Arts in dietetics from Western Michigan University and has worked as a registered dietitian since 2008 in many different hospital-based settings, most recently Preventive Cardiology and Cardiac Rehabilitation where she and I worked together at my previous job.

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Plant-Based, Vegan, Vegetarian, Mediterranean, Oh My!

We start by breaking down some of the differences in plant-based diets, Mediterranean diets, vegan diets and what some of the evidence says about the impact of these diets on disease risk. These diets can all fall in the category of “plant-forward” meaning they emphasize plants heavily, but not necessarily exclusively.

We dicuss the fact that the Mediterranean diet is very well studied with 5-10 year follow up data. Interestingly, this diet is often more of an overall lifestyle so we can’t fully separate the “what people are putting in their mouths” with other health-related factors like being physically active, strong social connections, regular relaxation and self-care behaviors, and so on.

“Plant-Forward” diets have strong evidence for:

• Reducing inflammation (reduction in C-Reactive protein, a marker of inflammation – a nutrient dense vegan diet appears to have the strongest evidence for this effect)
• Reducing cognitive decline (Mediterranean diet appears to have the strongest evidence for this effect)
• Among other impacts on reduced disease risk like reduced heart disease, cancer, diabetes, etc

Differences Between Eating Patterns Were Relatively Small

We talked about the fact that differences between the above eating patterns were relatively small. Notably, the samples were smaller for the studies of vegan or vegetarian diets. Not surprisingly, stronger health outcomes are found in more nutrient dense diets versus nutrient poor. That is, you could eat a vegan diet and still eat a lot of processed foods (processed vegan meats, snacks, etc), which would have less of a positive effect on your health than eat whole foods close to their “natural state”.

Types of Carbohydrate Matters a Lot

Holly talked about a study by Satija and colleagues (2017) where they found that when refined carbohydrates (e.g., juice, french fries, desserts) were swapped out for foods like fruits and vegetables and whole grains and saw improved cardiac outcomes.

So remember, eating more whole foods and fewer processed foods matters. Plant-based does not just need to be taken as “eat less meat.”

What about Plant Forward Diets (Vegan, Vegetarian, and Mediterranean) and Weight Loss?

Although I’m not a proponent of focusing on weight loss as the driving factor as I think it can backfire, inquiring minds want to know, do these eating styles impact weight loss? Particularly, I was interested in talking to Holly about long-term outcomes, like 4-5 years.

The answer is yes these eating patterns are associated with weight loss, with a caveat. Most of the large long-term scale studies were done in individuals with relatively lower starting weights, like the Mediterranean diet study. These folks lost 10-20 pounds on average and were able to maintain this for a longer period of time (Martinez-Gonazlez, Gea, & Canela, 2019).

There are some more intensive interventions that show larger impacts for folks starting at higher weights, but we need more research here. However, there is promise for these eating styles greatly reducing and even reversing disease even starting at more progressed disease or higher weights.

Why Isn’t Nutrition’s Impact on Disease Risk More Widely Discussed?

I asked Holly her opinion about why more people weren’t given information regarding nutrition and how powerful it can be in terms of reversing disease risk. She talked about the fact that physicians get a lot of training in a lot of areas but very little nutrition training in their standard medical school curriculum.

She also talked about how it can be challenging for folks to integrate nutrition information alongside standard medical treatments because it can be overwhelming for folks.

Additionally, we talk about the mixed messages we can be bombarded with on social media and this can create some “analysis paralysis” where people just don’t know what to believe.

What about the Ketogenic Diet or Intermittent Fasting?

Holly gives a brief overview of the ketogenic diets and intermittent fasting and the research there.

She expressed that the main concern with the ketogenic diet is that it limits carbohydrates to 10-20% of our calories, which is low compared to a typical Mediterranean diet being closer to 40-60%. This does not give a lot of space for fruits and vegetables which could be problematic depending on what folks are actually eating within this pattern.

We talk about the research here and how we see some effects of ketogenic diets within 3-6 months (weight loss, improved blood sugars, and lipids) but we don’t have the long-term data right now. She also talks about how a lot of those effects might be general improvements in eating patterns and just the impact of the short-term weight. But overall, we just don’t have much long-term data here.

We discuss intermittent fasting (this could involve limiting eating to certain hours of the day) and how there may be some short-term benefits here too (some reduction in inflammatory markers, some weight loss), but we have limited longer-term data as well. She talked about the importance of making sure that people get enough nutrition in in the windows they are eating.

Plant-Based Keto?

We briefly touch on this, and Holly shares that there is some promising data here as you are typically replacing saturated fat with unsaturated fats and can see reduced LDL.

She also talked about a study that showed that replacing saturated fats with either unsaturated fats or with whole grains both showed improvements in heart disease risk (Zong, Li, Yanping, Wanders, et al., 2016). So there are different ways to improve health via nutrition, but the emphasis is usually on less saturated fat, more whole foods, and reduced processed foods.

What is the Summary? What Do We Really Know about Nutrition?

Here’s my take on the big picture pieces of what we know about evidence-based nutrition:

• More whole foods, more plants (fruits, veggies, whole unprocessed grains) are very nutritious and healthful.
• There is good data on plant-forward diets (whole food plant-based, vegetarian, vegan, Mediterranean style eating pattern) in terms of reducing disease risk and some weight loss though these weight losses don’t tend to be incredibly large (at least not in the larger and longer-term studies of over 5 years).
• More whole foods (foods in their natural form, not protein bars or something created in a food lab) is important. A vegan diet can be unhealthful if it’s full of processed foods, so moving away from nutrient poor foods and towards nutrient dense foods is helpful.
• Focusing on weight loss very often undermines focus on what truly impacts our health, like more nutritious quality foods.
• For most people, giving up all animal products does not seem to be necessary to gain significant health benefits.

Let’s Look at the Whole Picture

I mentioned that I’m reading the book Whole: Rethinking the Science of Nutrition by T Colin Campbell. This book talks about how we use a “reductionist” view of nutrition and how this is harmful and gets us caught up in the weeds and distracted from some of the big picture things we do know about our health and nutrition.

How to Use this Information in an Anti-Diet Way

1. Reflect on Your Goals. We talked about ways to focus on your individual health goals, reduce focus on weight loss, and shift the focus to realistic and sustainable habits. One way to do this is to consider eating patterns an experiment and just pay attention to how you feel on that specific eating pattern.
2. Add in Versus Take Out. We also talked about the benefit of focusing on what to add in versus what to restrict. Don’t stress too much about the shoulds, but just look for places where you could add more fruits and vegetables into your diet or more whole foods and stressing less about what you “shouldn’t” be adding. Holly recommends adding in soluble fibers, which comes from plants.
3. Start Small if Overwhelmed. Start with 1 simple change and build from there. Try 1 plant-based meal. I use the Forks Over Knives meal planner and I think it’s a great place to start (and free for the first 14 days). You do not have to overhaul things if you don’t feel ready. You are the boss of you and you get to do what works for you at this point in your life. You have choice, my friends.
4. Re-evaluate and Assess and Build from There. If you do try experiments (with approval by your medical professional of course) with your eating pattern, just evaluating, did I feel healthier? Did this move me towards my goals?
5. Enjoy the Process. If you can try to enjoy the journey and the process, it can be fun. I know this can be incredibly hard!

Disclosure: This page includes affiliate links meaning that I get a commission if you decide to make a purchase through my links, at no cost to you. I have not received any money to promote or review these products.

Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

References

Guasch-Ferre, et al (2019). Meta-analysis of randomized controlled trials of red meat consumption in comparison with various comparison diets on cardiovascular risk factors. Circulation, 139, 1828-1845.

Martinez-Gonazlez, M. A., Gea, A., & Canela, M. R. (2019). The Mediterranean diet and cardiovascular health. Circulation Research, 124, 779-798.

Satija, A. et al.(2017). Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults. Journal of American College of Cardiology, 70, 411-422.

Tonsted, S., Stewart, K., Oda, K., Batech, M., Herring, R.P., Fraser, G.E. (2013). Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutrition Metabolism Cardiovascular Disease, 23, 292-299.

Zong, G., Li, Yanping, Wanders, A. J., et al. (2016). Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies. BMJ, 355.