Healthy or unhealthy?

Unhealthy or healthy?

As a Registered Dietitian, a lot of people ask me whether certain foods, recipes, snacks, or meals are “healthy” or “good.” And it’s such a hard question to answer. Our favorite saying in the field is “everything in moderation,” and while I know this isn’t an exciting saying, I still believe it.  A food item like a banana is generally viewed as healthy, but if someone ate 10 bananas every single day, that may not contribute to an overall healthy diet.  Likewise, we wouldn’t generally recommend something like a bowl of ice cream as a healthy food, but if someone only ate one serving a week, they could still have a healthy diet.

Elizabeth is the one that got away. I was the chief recruiter of students for the Food Science major after I moved to the main campus and became Undergraduate Coordinator. Some students likened me to an Army recruiter, but that was a gross exaggeration! When I did see a particularly good student who would fit into our program, however, I did my best to recruit her or him. Elizabeth was torn between Food Science and Dietetics. I made a case for Food Science, but she chose to go the other way. Over a decade later, I am pleased to welcome her to this blogsite with her MPH, RDN credentials to enlighten us on healthy diets. Much as I regretted her decision at the time, I must admit that she made the right one.  

What I’m getting at is that we have to keep everything in perspective by looking at someone’s entire diet – all the foods that they eat over a multi-day period.  And not just what foods they eat but also the serving sizes or portions of those foods.  This “diet” approach is much more balanced in terms of promoting health rather than fixating on each individual meal or food product.

While many people shudder at the word “diet,” it really just means someone’s overall eating plan.  For example, you could follow a vegetarian diet, which means you don’t eat meat, poultry or fish, or a low-carb diet, which means you have a diet higher in fat and protein while avoiding grains, fruits, and other carbohydrate sources.  There are certain diets that are recommended for specific medical conditions as well as diets that are promoted by governmental organizations for general health.

The United States Department of Agriculture (USDA) promotes dietary advice through their “My Plate” campaign. Released in 2011, My Plate encourages a healthy diet by asking people to envision their plate at each meal in the following manner: 50% fruits and vegetables, 25% lean protein, and 25% whole grains.  It’s a simple concept and much easier to translate into day-to-day nutrition advice than its predecessor, “My Pyramid” (introduced in 2005).  For many people, focusing on food groups is a much simpler way to identify a healthy diet, rather than counting numbers such as calories or specific portion sizes

However, for those who do like number crunching, you can also focus on macronutrient ratios as a way to follow a healthy diet.  Macronutrients include carbohydrates, fat, and protein (all the nutrients that contribute to calories to our diet, excluding alcohol).  A generally recommended balance is 50% carbohydrates, 30% fat, and 20% protein.  A low-carb diet could involve reducing the carbohydrate component anywhere from 5% calories (ketogenic diet) to 30%, with fat making up the difference (as high as 60-70% of total calories in some cases). For many people, tracking their “macros” and staying within a specified ratio or balance, is a way to follow a healthy diet.

Then there are fad diets, those that are especially popular in the media, that promise quick results (often for weight loss) but are typically not sustainable in the long run.  Recent examples of these fad diets include the paleo diet, ketogenic diet, and intermittent fasting. When evaluating any type of diet, I always recommend asking yourself the following questions:

1. Does this diet allow for a wide variety of foods and food groups? In other words, how restrictive is this diet?
2. Does this diet seem like something I can follow long-term? How sustainable is this diet?
3. Are there reputable research studies that promote the evidence behind this diet? In other words, how evidence-/science-based is this diet?

Taking these questions into account can still be a challenge and cause debate among people. For example, the first question is all about ensuring that the diet will cover all your “nutritional bases” and allowing for a variety of healthy foods.  However, even restrictive diets like a vegan or ketogenic diet can still promote health for some individuals.  Question 2 is highly personal – I know some people who have been able to follow a very restrictive ketogenic diet for years with great success, while I personally would struggle after just a few weeks. So, your own self-awareness is important when evaluating different diets. Question 3, however, is a more objective one with less room for debate.  Is there evidence to support this diet or not?

When I work with patients, whether one-on-one or when teaching group nutrition classes, I always try to meet each person where they are and encourage behavior change “one step at a time.”  If I describe an overall healthy diet to someone who then confesses their diet is nothing like what I described, I would first ask them what area they felt most confident in and ready to change and then go from there. For example – focusing on changing to calorie-free beverages before changing food choices, or focusing on healthy breakfasts before changing lunch or dinner.  Again, remembering the big picture about their overall diet, and how each food can best fit.

While I’m hesitant to ever prescribe or recommend a specific diet to someone, knowing that we all have different food preferences, health conditions, culinary skills and financial or time limitations, people will inevitably ask for my professional opinion.  In my mind, the diet, or meal plan, that really has the most evidence to support overall health and well- being would be the Mediterranean diet.  This is a diet that is not overly restrictive with any food category (unless you count processed foods as a category) and allows for personalization or flexibility.  The foundation for this diet is plants – fruits, vegetables, whole grains, and legumes with a “healthy” dose of monounsaturated fats, primarily from olive oil.  Protein sources in this diet include legumes, poultry, and fish, with red meat limited to only a few meals per month.  You have likely heard a lot about “plant-based diets” recently, and the Mediterranean one is a great example.

Research has shown that this type of diet can reduce risks for some forms of cancer, diabetes, heart disease and can also assist in managing weight and blood pressure.  Since it is neither a low-carb nor low-fat diet, it is more effective for long-term results as people can more realistically follow this lifestyle approach without restricting entire food groups.  In fact, one of the things I like most about teaching the Mediterranean diet is that almost every type of food can still fit into this plan.  Processed foods, however, are the most restricted item on this diet plan, which could pose an issue for those with limited finances, culinary skills, or time.

There are many great resources online to learn more about the Mediterranean diet, including a personal favorite of mine developed by professionals at NC State University and NC Division of Public Health – the website “Med Instead of Meds” (link below). This website includes videos, recipes, and easy tips to eat a little healthier. After all, a healthy diet is something that we can enjoy one day and one meal at a time.

Elizabeth graduated with her Dietetics degree from the University of Georgia, and completed her Dietetic Internship at Vanderbilt University Medical Center.  After working a few years in a clinical nutrition role, she returned to school to earn her Masters of Public Health in Nutrition from the University of North Carolina at Chapel Hill. Since then, she has worked at a local health department, and now works in a research coordinator role with the Durham VA Medical Center in Durham, North Carolina.  She also teaches online classes through NC State’s “Eat Smart Move More Prevent Diabetes” program.  When she isn’t working either of those jobs,  she volunteers her time as a board member and adoption coordinator with Hope Animal Rescue, based in Durham, NC. 

Next week: Processed food in the COVID-19 era