What you eat plays a leading role in your health and well-being. When someone eats healthy, it helps to protect against many chronic diseases such as heart disease, prediabetes, type 2 diabetes and obesity. But with so many fad diets and food recommendations out there, it can be hard for patients to navigate what to eat and what not to eat.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines and how to take charge of their health through preventive care.
In this installment, three AMA members took time to discuss what they wish patients knew about healthy eating. They are:
- Stephen Devries, MD, a preventive cardiologist and executive director of the nonprofit Gaples Institute in Chicago.
- Adejoke Melody Johnson, MD, an internist in Danville, Pennsylvania at Geisinger Medical Center and clinical nutrition, bariatric medicine and weight management fellow at Geisinger.
- Ethan Lazarus, MD, a family physician and obesity medicine specialist in Greenwood Village, Colorado.
Geisinger is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Eat healthy to prevent chronic disease
“Nutrition has a tremendous impact on preventing and managing chronic diseases, and it’s interesting how all of these conditions are connected,” said Dr. Johnson. “High blood pressure damages your blood vessels and that itself causes heart disease and also diabetes.”
“But the good news is one of the most powerful tools that we have is healthy eating,” she said, noting two eating plans that are highly recommended are the Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet.
“For example, the DASH diet consists of lower sodium intake. We usually recommend less than 2 grams per day, and also increase your potassium,” Dr. Johnson said. “Patients who were on a DASH diet, researchers found that their blood pressures dropped significantly and deaths from heart disease decreased.”
“Also, for diabetes, we mainly recommend foods with low glycemic index, such as whole grains, brown rice, fiber-rich vegetables, because we found that these foods slow the absorption of sugar into the bloodstream,” she said. “Whether we’re talking about heart disease, hypertension or diabetes, the evidence is consistent that nutrition does help.”
It is not a one size fits all solution
Dr. Johnson begins conversations with her patients by noting that there is “no one size that fits all when it comes to eating healthy because what works for one may not work for the other.”
“That being said, there are some golden rules that do apply to everyone such as balance and variety,” she said. “Your body runs best when you give it the right mix of carbs, protein and healthy fats.”
“Secondly, quality. You want to eat foods that are whole foods, lean protein, healthy oils and less processed foods,” Dr. Johnson said. “That’s why the Mediterranean diet gets so much love because it’s all of those principles in action.”
Figure out your eating patterns
There are many different ways to approach healthy eating, but “it’s not all that helpful to just tell people to eat more fruits and vegetables—they’ve already been told that hundreds of times,” said Dr. Lazarus, adding that “people have a pretty good idea of what healthy food is but we tend to eat in an unhealthy way in spite of this.”
“Instead of just focusing on what to eat, it's nice to back up a few steps and think about why we are eating the way that we're eating because most of our eating behavior is not really predetermined with choice,” he said. “A lot of times we're just eating what's there or what's served or because we're stressed, tired or bored.
“And so, the first step should be to figure out your eating patterns, eating triggers and why you're eating in a certain way,” Dr. Lazarus added.
Eat meals prepared at home
“A simple way to stack the deck in your favor is to eat meals prepared at home as often as possible,” said Dr. Devries. When cooking at home, focus on “meals made from a combination of unprocessed foods that don’t have labels, such as vegetables, beans, whole grains and fruit.”
It is important to note that “restaurant and takeout foods are nearly always higher in calories and added salt compared to their home-cooked counterparts,” he said. That is because “at home, you have far more control, and most people will eat much smaller portions with much more healthful ingredients than those purchased on the run.”
Create an eating schedule and plan
When thinking about eating, it is important to approach it like you would with other healthy behaviors, said Dr. Lazarus. “And probably the most important thing a person can do is figure out an eating schedule and an eating plan.
“People who are successful in eating healthier don’t just try to make a choice at every meal—they actually have a plan about what their day or their week is going to look like,” he added. “We’ve got to get away from eating in a haphazard way or what sounds good and start eating based on a plan.”
“Eating healthfully is one of the foundations of good health,” said Dr. Devries. “Even when medication is required, it’s important to emphasize to patients that medication alone can’t do it all.”
“Optimal health will always require attention to nutrition and lifestyle,” he said.
Pay attention to how you feel
“An intuitive way to eat more healthfully is to become attuned to signals from your body,” Dr. Devries explained. “For example, how do you feel after snacking on a donut compared to eating a piece of fruit or a handful of nuts? How about a burger and fries compared to a salad topped with beans or fish?”
While “junk food might seem appealing in the moment, a tell-tale sign of how healthful it is for you is how you feel an hour later,” he said. “Do you feel sleepy or energized? In need of another sugar-hit or satiated?”
What is important is that “if you listen carefully, your body will signal what it needs,” Dr. Devries emphasized.
Stay away from added sugars
“Sugar-sweetened drinks are the single biggest source of added sugar in the diet,” said Dr. Devries. “A great start to reducing added sugar is to replace soda and energy drinks with water or unsweetened carbonated beverages.
And if “patients say that healthful eating is too expensive, you can remind them that plain water is far cheaper than soda,” he added, noting that “if sugar-filled desserts are your typical fare, a good strategy is to have a piece of fruit for dessert.
“Even if the temptation for cakes or cookies remains, you’ll likely eat far fewer after starting with fruit,” Dr. Devries said.
Incorporate potassium
“A lot of people don't realize that potassium is also important, so please eat your bananas,” said Dr. Johnson, noting that “potassium is very important for blood vessels.”
“Increasing your potassium also helps with the elasticity of your blood vessels and helps with your blood pressure as well,” she said. “It also helps with water balance.”
Know what foods to focus on
When it comes to choosing what to eat, again, try to focus on “foods that don’t have—or need—labels,” said Dr. Devries. Those include “fruits, vegetables, beans and whole grains.”
“If you add animal-sourced foods, go for the better choices like healthfully prepared fish and unsweetened yogurt,” he said, adding that it is important to also avoid certain foods such as “the main offenders,” which are “sugar sweetened drinks, processed meats and fried foods.”
“With the Mediterranean lifestyle, part of it is the food choices which are fruits, vegetables, nuts, lean protein and olive oil—they’re generally good foods,” said Dr. Lazarus, adding that it is important to avoid highly processed foods.
“The problem is people crave the highly processed foods when they’re stressed,” he added. “And it’s usually crunchy stuff like chips or, more commonly, I see the ice cream and the peanut butter usually in the evening.”
One tip is to prepackage or prepare healthy snacks that are ready to go because “if you’re going to reach for something because you’re craving stuff, you reach for something healthy,” said Dr. Lazarus.
Don’t change everything at once
“People really feel overwhelmed because there’s just so much advice out there. My best advice is don’t try to change everything at once—just pick one thing that’s most important to you right now and make it practical,” Dr. Johnson said. “For example, if you have high blood pressure, focus on lowering your salt intake.”
“A simple step would be learning how to read food labels and choosing foods that have less than 140 milligrams of sodium per serving would be good,” she said. “It’s about just taking it one step at a time and then once those habits feel natural, you can move on to the next.”
Personalize your nutrition plan
“It’s absolutely essential to personalize nutrition. There is no one size fits all diet because we all have different health conditions, different lifestyles and even different responses to the same food,” Dr. Johnson said. “For example, someone living with diabetes cannot approach food the same way as someone without it approaches food.”
“Tailoring your diet to your goals is so important because if your goal is weight loss, for example, you may need a different approach than someone who is focused on building muscle,” she said. “The same thing with age as well. What works for a young athlete is not what’s going to work for an older adult.”
“The key takeaway is that nutrition should be individualized, and the healthiest plan is the one that meets your body's needs and supports whatever medical conditions that you have and that it is sustainable for your lifestyle,” Dr. Johnson said.
Good eating begins with proper sleep
When stress happens, eating healthy and getting a good night’s sleep go out the window. But a key step in eating better is having a good sleep schedule.
“A good eating schedule starts with your sleep schedule,” explained Dr. Lazarus. That is because “one of the first things to go when people are stressed out is their sleep. It's like they're tired, but then they can't fall asleep, they have insomnia and then they wake up and they're tired and then they're stressed—it’s a self-perpetuating cycle.
“A lot of times where I like to get started is trying to go to bed at the same time, trying to wake up at the same time and getting a reasonable number of hours of sleep,” he added. “That way you will have enough energy to get through the day.”
Carbohydrates are not the enemy
“One of the biggest misconceptions that I hear is that you have to cut your carbs to lose weight,” said Dr. Johnson. “That idea really stems from diets such as the keto diet, which will show quick results, but they’re not going to be sustainable and can even be harmful.”
“At first you will see weight loss and your blood sugar will be low, but the problem is that when you deprive your body of carbohydrates for too long, you can develop more insulin resistance,” she said. “So, the next time you eat a carb, even something as healthy as a fruit, your blood sugar would spike up and your body would start to store that extra energy as fat. That’s why the weight often comes back very quickly.
“The fact that it’s not really sustainable and other complications from a lower carb diet, such as nutrient deficiencies, and stress on the kidneys and liver,” Dr. Johnson added. “So, carbs are not the enemies. The key is choosing the right foods and balancing them with protein and healthy fats.”
Identify macronutrients
Carbohydrates, fats and protein are all macronutrients, which are the main building blocks of food that are needed in relatively large amounts. But how do you know how much of each to choose?
“It isn’t possible to generalize about an ideal macronutrient distribution as individual needs vary based on medical history, stage of life and activity level,” said Dr. Devries. “It’s interesting to note that protein content has become a big selling point on food labels, but most Americans already get more protein than they need.
“For both fats and carbs, quality is even more important than quantity,” he added, noting that “avocados and French fries are both high fat items, but with obviously different impacts on health.”
“The same is true with carbohydrates—quality matters,” Dr. Devries said, adding that “think blueberries versus butterscotch.”
Recognize micronutrients
Micronutrients, needed in smaller amounts, include minerals and vitamins.
“There is no need for most people to focus on micronutrients,” said Dr. Devries. That is because “a daily diet that includes a variety of colorful vegetables and fruit, whole grains, legumes and healthy sources of protein will automatically check the boxes of needed micronutrients.
“One exception is that individuals who consume no animal products generally require a B12 supplement,” he added.
It's about building a lifestyle
“I always say that it’s more about building a lifestyle and one strategy that I emphasize is to focus on behavior change,” Dr. Johnson said. “Real transformation comes from when you leave old habits behind and make more shifts that can become a part of your life.
“So, rather than cutting out food, why don’t we add more nutrient dense foods such as vegetables, fruits and whole grains,” she added. “Second, make small realistic swaps. Rather than drinking soda five times a week, how about twice a week? Then drink water instead of soda and you can go up from there.”
“Small steps do add up to help it feel less overwhelming,” Dr. Johnson said. “The third thing is recognizing emotional eating versus physical hunger. Many of us eat because we’re stressed and bored, not because we’re actually hungry.”
“One thing that helps me is meal prepping. I even prep my snacks because it helps me to prevent grazing and it keeps my portions aligned with my goals,” she said. “Also, learn how to read food labels. That’s one of the best tools.”
Nutrition is more than numbers on a scale
It is important to remember that “nutrition goes beyond the numbers on the scale,” Dr. Johnson said. “It’s important to ask yourself: Are you eating healthy for your family? Are you eating healthier for your long-term health, for energy or better mental health?
“Because when patients connect their eating habits to a deeper purpose, it becomes much easier to stay consistent with a healthy diet,” she added.
