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Prakash Chandran (Host): Today's popular diets, often promise dramatic weight loss results. Many are designed to take advantage of people's willingness to try anything to lose weight. However, most don't result in long-term weight loss success. And sometimes these diets can even jeopardize your health. We're going to talk about it with Ana Evans, Wellness Dietician and Nutrition Program Coordinator at New Hanover Regional Medical Center.

This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. My name is Prakash Chandran. So first of all, Ana, it's great to have you here today. Let's just start with the basics. Why don't these diets that we hear about usually work?

Ana Evans, RDN, LDN (Guest): Yeah. Thank you so much for having me. I think diets don't work because they oftentimes are very restrictive and controlling and while they might give initial results right away, they're super hard to maintain. So, it's really important to focus on a more sustainable plan that makes you feel good and is enjoyable.

Host: You know, what's interesting is I've heard this before that diets are restrictive, but when you're thinking about changing the way that you eat to get healthy, or lose weight, isn't that a diet? How else are you supposed to think about it?

Ana: Right. And I think first of all, defining the word diet is really important. Really, the word diet is just simply the food and drink that is regularly consumed. So, that word in and of itself gets really kinda misconstrued. A lot of people interpret the word diet as again, restrictive. So, really a better mentality is to focus on what you can eat, not what you can't eat.

Host: Okay, that makes a lot of sense. And one of the things that I've heard spoken before is to have a better relationship or a good relationship with the things that you can eat and the things that you can drink. Can you speak to this a little bit?

Ana: Yes. I love that, that phrase, a healthy relationship with food. I focus on that a lot with my clients here at New Hanover. We have a program that really teaches our folks how to eat and why to eat and when to eat as opposed to what to eat. A lot of times we kind of fall into these traps of diets because all we're focusing on is restriction and what we can't eat. But when we slow down and be a little bit more mindful and focus on what food can do for our body and the nutrients we might be missing that might be causing the cravings or causing our fatigue, that is when we see results. So again, focusing on how we eat by slowing down and what the proper times to eat and again, why we eat, what is the food doing for us, that can really create a more joyful and healthy relationship with food?

Host: Understood. So, before we get into the specifics of what a sustainable and good diet is, I want to understand a little bit more around what causes people to think about dieting and how they should begin.

Ana: It's different for everyone. You know, with my clients, it's anything from getting lab results back from their doctor that maybe their blood sugar is high, or maybe their cholesterol is a little high and they feel like they need to start making some changes. Of course, there's the obvious, slow weight gain, especially during the pandemic, the average weight gain in America was one and a half pounds per month. So, that's been up big reason we've seen a lot of people come in now. So, really, you know, and it could be anything from energy levels, to not feeling good in your clothes, to lab results, to family history. So, people want to make changes in their diets for many reasons. I get a lot of athletes that come in as well, who want to improve performance. So, it's really dependent on the individual.

Host: So, regardless of the reason why you want to eat and drink better, where do you recommend that people start? We're talking about this relationship with food and having that healthy relationship, but how do you even begin?

Ana: Sure. A good place to start is just by starting to write things down and identifying without any pun intended, the biggest fish to fry. So, a lot of times we focus on pulling out sugar or stopping drinking or no carbs. And really that might not be appropriate for you just because you heard it in the news or someone else did it and lost weight. So, if you can take an assessment for two or three days and keep a food diary and activity journal and bring it to a dietician and have them look at it with you and identify the places that you could make changes that will give you the biggest results, that would be a really great place to start.

There's not really one place fits all for me to say that everyone should start. Of course there's some broad principles that everyone can benefit from, but that would be a great first step, just starting with some gentle observation of what you're currently doing.

Host: Yeah. I think just understanding what you're putting in your body seems like a really good place to start. I've also heard you talk about the 80-20 rule. Can you maybe speak to this a little bit?

Ana: Yeah, again, I love the 80-20 rule. So, this principle says that in a healthy lifestyle and relationship with food, if you're sort of following a healthy pattern of eating and you're eating mostly unprocessed, clean foods, lean proteins, fruits, and vegetables, kind of doing what you know you're supposed to be doing 80% of the time; you have a little wiggle room around 20% of the time to have the dessert, to have the cocktail, to kind of go outside lines a little bit. Even if you are on your weight loss journey, 80-20 is completely appropriate and teaches you how to enjoy splurges without feeling like you're falling off the wagon.

Host: Okay, that makes a lot of sense. And that actually makes me feel better just talking to you right now.

Ana: Yes. And even if you think about it, you know, if it doesn't say someone eats five times a day, right? So, times seven that's 35 times a week that you're eating 20% of that, you know, is you can kind of go off the wagon five times that you eat. And that gives people a lot of mental freedom around what they eat. So, if you have one snack that's not ideal, or one meal, you just get right back on and the next time you eat.

Host: Totally makes sense. So, one of the things that you're speaking to is first this gentle observation, really just taking in what you are eating and potentially taking it into to a dietician or someone that can help kind of guide you on your food journey. However, there's going to be a lot of people that look at the internet or read these articles around these diets that are around, whether it be keto or paleo or whatever the new fat diet that has come into the mainstream. What would your recommendations be around trying to hop to one of those diets versus trying to do it in a more measured way?

Ana: Sure. A lot of, first of all, I'll say back up and say any plan or food trends that tells you to exclude one macro nutrient, is not a sound or a sustainable plan. And now what I mean by macronutrient is anything that tells you to exclude a protein, carbohydrate or fat. Those are the nutrients your body needs in greatest amounts, usually are not sustainable. Now of course, there are small percentages of people who for medical reasons or other reasons might do well on those. But for most people you need to be having a balanced diet. So, a good place to start would be very simply following what's called the plate method. So, making sure that every time you eat a meal, half your plate is fruits and vegetables. One quarter of the plate is a lean protein, and one quarter of the plate is a whole grain, super simple, basic elementary tip, but it really is sound advice.

Host: Yeah, that's definitely a good framework. One of the things that I wanted to ask you about was label reading. For me personally, sometimes I'll pick up a package of something I'm about to eat and I'll look at the label, but I don't even know what I'm looking for. So, can you maybe provide a good framework for us to think about how we do label reading?

Ana: Yeah. I mean, I'm just going to grab a package of granola I have in front of me right now and just kind of talk you through it. So, the first place my eyes always go is the ingredient list, which is opposite of what most people do, which is go to right to calories or the numbers. So, just start by understanding what is in the package of food you're holding. And you want to go for less ingredients, less words. Make sure you can read everything and make sure sugar is not in the first eight ingredients or so. So, first make sure you can read everything. Just know what you're putting in your body. Ideally, we want to eat foods without packages, fruits, vegetables, whole grains, meats, but of course it's 2021. There's some healthy foods that come in a package. So, start there. Next, do you want to go to those numbers? Look at your serving size. Make sure that what you're putting on your plate is reflecting the numbers that the ingredient list states, then you can look at calories, sodium, added sugars, protein, and carbs.

That's just a really great little kind of plumb line for looking at your food. One of the things I do with my clients is what's called a pantry detox and they get a whole list of things to look for in their ingredients. They get rid of some things, they replace it with healthy oils and healthy salty snacks, sweet snacks, and kind of create a fresh start in their home and that having a healthy environment making the space that you spend the most time in eating with yourself and your family and your friends, having that be very healthy and inviting and a clean environment is a great place to start with making any health changes. Save your splurges for when you're out of the house, the ice cream cones and the heavier meals and the drinks do all that out of the house. Have your own personal space be really healthy and clean eating oriented.

Host: I love that. Just keeping a clean and healthy environment at home in the kitchen I mean, naturally you kind of gravitate and are influenced by the things around you. So, that makes so much sense to me. Can you maybe speak to some of the other things that people can do when they're at home? Maybe around how they cook to just keep that healthier lifestyle going?

Ana: Sure. One of the biggest things that I encourage my clients to do, and we do a lot of classes around, is meal preparation, and it can be as simple or complex as you want it to be. So, you can be a total foodie and plan your meals out for the whole week, or you can just kind of be very simplistic and say, I'm just going to kind of rotate these couple of days of food and I'm going to grill some chicken breasts, hard boil some eggs, get some unsweetened yogurts and pre-bag some fresh veggies and pre-portioned hummus containers.

And just kind of map out what my meals and snacks will be for the week. So, that's a huge thing that people can do. The more you prepare, the less stress there will be around staying on track all week. You know, we create all this anxiety when there's unknowns. Like, what am I going to eat? I got to work and I have nothing to eat. So, naturally of course, you're going to go to the vending machine or get takeout. So, we create all these unnecessary barriers and essentially excuses when we don't take the time to plan and prepare. Meal prep is kind of like a muscle that strengthens over time. When you first do it, it's going to feel like it takes up half your weekend.

It can be really exhausting. One tip to getting started is either grocery shop on a separate day from your meal prep day, so it doesn't feel like you're all consumed by food all weekend or use an online grocery shopping app or website. A lot of times they're free. I know Walmart does it for free over a certain dollar amount. So, that also allows you to not overbuy and not engage in impulse buying. So, that's a really, really great place to start when it comes to getting back on track with healthy eating.

Host: Yeah. You know what, just that framework of using an app or a website, you kind of have to be thoughtful around, like I'm explicitly going to buy these things rather than the browse mentality, where you just pull things off of the shelf, which I'm a hundred percent guilty of. So, that is definitely something that I'm going to try just to keep things more focused.

Ana: Yes. And we just get so mindless and we don't slow our butts down, you know, and the food is, and keeping our body energized and fueled and nourished is the one thing that our body needs and we need to stay alive. Yet it gets put on the back burner. So, we just need to slow down on the weekends, have that cup of coffee, make your shopping list, engage the family, even with some meal planning and get organized. Get yourself a planner. Write things down, take an inventory and then shop in the order of the things that you need in greatest amounts. So, get the most produce. That's what you want to fill most of your cart with, then go to the meat, then go to the grains and the snacks. So, just kind of keep that order of shopping and proportions in mind.

Host: Yeah, there seems to be a persistent theme in our conversation and that's that this stuff takes time. It takes time to really understand the food that you're putting in your body and to also measure out how you're going to eat healthy for the long run. So, it's something that you just need to give yourself a little grace about because it's not something that happens overnight wouldn’t you say?

Ana: Yes, absolutely. It absolutely does not happen overnight. We all have again, different histories, backgrounds even cultural influences, family influences on how we eat and what we eat. So, kind of untangling that in your lifestyle takes time and people oftentimes forget about some of the building blocks as well around good nutrition habits. So, getting good sleep and making sure that again, your environment is healthy, that you're planning, that you're even using what I call a hunger scale before you go ahead and eat. So, on a scale of zero to 10, how hungry are you really? And is it your head telling you you're hungry or is it really your body telling you you're hungry? So, kind of identifying emotional or stress eating versus physical hunger. So, there's just a lot of layers that get ignored when people really want to make a lifestyle change that need to be addressed before you just jump into eating all healthy fat, or cutting out the carbs. You know, there's a lot of layers to it, to really make it last.

Host: Absolutely. One of the things that I wanted to ask you about was the quality of the food that we were taking in. I've heard you should buy only organic or grass fed, and there's so many rules around what you should be buying. Do you have any thoughts around this?

Ana: Sure. I mean, again, it really comes down to the individual and where they need to start. So, I kind of assess and evaluate each person's food diary and might make more specific instructions around quality of food or types of meat or conventional versus organic, but in general, looking out in terms of the meats and the proteins for sodium, added salt, basically. That's a big thing to watch out for of course, going for more raw meats that you can cook yourself versus getting them either frozen or behind a deli, will be much healthier. So, just even a simple step like that getting a fresh chicken breast from the butcher versus a frozen already cooked chicken breast can save you lots of sodium, which we know is linked to high blood pressure. And then when it comes to fruits, really, vegetables, so many people struggle with getting them in.

Don't quote me on this exact number, but I think it's something around 35% of Americans don't eat a fruit or vegetable at all in a day some days of the week. So, to me, that's really alarming. So, just get the fruits and vegetables in. Don't get lost in the weeds, especially at first, when you're trying to change your diet, just try to get them at in either fresh first, frozen without any added sugar or salt, or even canned with no salt added and then focus on some of the buying local, following organic practices. But really if you can get the plate method down first, so half your plate, fruits and vegetables, a quarter of it, some kind of protein that doesn't have added salt or breading or fried, and then a clean whole grain that has lots of fiber, start there and then build your way up. We so often jump into details or the weeds as I like to call them. So, keep it simple and just be gentle with yourself as you make the changes.

Host: Great advice Ana, is there anything else that you'd like to leave our audience with today regarding food or their relationship with food and leading a healthier lifestyle?

Ana: Just have fun with it. Laugh just don't be too hard on yourself. Like I keep saying, be gentle and just look at what you can eat instead of what you can't eat. In this day and age, there are so many blogs and websites and cookbooks and clean foodies that there's no reason you should get bored. Add a lot of variety. Look at things like the texture and flavors of your salad to get different greens every week. Don't just buy the same fruit every week. Rotate things up, switch it up, keep it alive, involve your friends and family and just make it part of your lifestyle and your everyday walk so you don't get burnt out on it. That was a big closing statement, but I'm really passionate about it. And I think it's just so important to make it part of who you are.

Host: Ana, that is perfect. Not too big at all. And I think wonderful advice today. So, thank you so much for your time. That's Ana Evans, Wellness Dietician and Nutrition Program Coordinator at New Hanover Regional Medical Center. Find more nutrition tips, recipes, blogs, and videos at nhrmc.org. And click let's make healthier happen. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This is Healthy Conversations, the podcast from New Hanover Regional Medical Center. I'm Prakash Chandran. Stay well.