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Transcript

Lee Tetreault: 

Hello and welcome to frequently asked questions from the session, "Which fad diet, keto, Mediterranean, intermittent fasting, or elimination." We are joined today by Dr. Bethany Doerfler. Doctor, before we get into the questions, can you give a little brief overview of today's session for the audience? 

Bethany Doerfler:

Yes, thank you. The task at hand today is to give attendees some very specific diet advice that they can relay in their practice and to their patients. Many times they're faced with the questions from patients that start with, "What should I eat?" And, "What is the optimal diet for me?" There's no one right way to eat healthy, but there are quite a few important lessons learned in the past few years about which parts of our diet seemed to help us lose weight better than others, as well as which types of foods really fuel us for optimal health. Today, we're looking at the Mediterranean diet. Spoiler alert, it is the winner; it seems to be chock full of the most anti-oxidants and phenolic compounds found in healthy fats, fruits and vegetables, whole grains, and minimizes sugar and processed foods. It produces the most favorable outcomes for cardiovascular disease, has a high adherence rate, and also improves weight loss long-term in individuals.

Lee Tetreault: 

Great, let's get into some of these frequently asked questions here. First, what are the key components of the Mediterranean diet that make it so heart healthy? 

Bethany Doerfler:

The Mediterranean diet is both focused on important foods to eat, as well as the absence of bad. So first, the Mediterranean diet asks people to limit refined sugars, as well as processed foods that can be sources of gut bacteria disrupting emulsifiers. It is also rich in fruits and vegetables which provide important phenolic compounds; these compounds that are unique, not only to fruits and vegetables, but also to cold pressed olive oil have important antioxidant qualities and offer phenolic compounds which act as antioxidants in the body.

Lee Tetreault: 

Is there a cardiovascular risk to following a ketogenic diet?  


Bethany Doerfler:

Ketogenic diets, by their definition, are very low in carbohydrates, typically no more than 5 to 10% of calories come from carbohydrates. They are low to moderate in protein, also somewhere between 10 to 15% of calories from protein. That leaves the remainder of calories, usually 75%, coming from fat. Well, it's possible to do a ketogenic diet that integrates more plant-based fats; those usually contain more carbohydrates than animal-based saturated fats. Unfortunately, this diet happens to be very rich in saturated fats coming from animal protein. We have good data to support that when individuals follow a ketogenic diet typically we see increases in LDL cholesterol, which is the more atherosclerotic type of cholesterol that we're actively trying to limit. At this point, individuals following a ketogenic diet do not appear to have improvements in 'cardio metabolic' outcome measures like you see with Mediterranean diet approach.

Lee Tetreault:

What role does the microbiome play in our diet selection?  


Bethany Doerfler:

We're just starting to see how our microbiome impacts the way that we utilize calories and the cross-talk between cells and inflammation in our body in general. When you eat a diet rich in fruits and vegetables, the oligosaccharides or the medium chain sugars that are in there, combined with the fibers feed the good types of gut bacteria that may have important anti-inflammatory and metabolic controlling effects. When you eat a diet higher in saturated animal fat it seems to proliferate or support some of the more pro-inflammatory types of gut bacteria, and generally we consider diets rich in saturated fat to be crushing to the more anti-inflammatory and kind of overall wellness strains that we are seeing in digestive health.

Lee Tetreault: 

What are the health benefits to intermittent fasting? 

Bethany Doerfler:

Intermittent fasting can be done in a number of ways. It can be done by either restricting the time that you eat in the day, to say 12:00 noon to 5:00 PM. It could be done by eating normally for five days and then fasting for two. There are also other methods that allow you to fast every quarter of the year so to speak, followed up by a Mediterranean style of eating. All of these seem to produce sustained calorie restriction, and there are significant benefits to calorie restriction that you sustain. It is not only weight loss, but also it seems to regulate the way that our body deals with insulin, and on a cellular level it seems to help with autophagy and mitophagy, which likely reduce inflammation and may be playing an important role in protecting us from age-related neuro-degenerative diseases, as well as cancer. So weight loss is helpful, but there may be other very specific benefits to just fasting and restricting.

Lee Tetreault: 

So, with that, should we be recommending intermittent fasting as a method of weight loss to our patients? 

Bethany Doerfler:

We have to go carefully with this. I think that when intermittent fasting is recommended, individuals need to be monitored regularly for changes in cardiovascular health, particularly blood pressure, and that can be when someone loses weight and they're on a blood pressure medication, the dose of medication may need to be adjusted. I think what is a reasonable approach if you don't have the resources to be regularly monitoring someone who is on calorie restricted diet or a fasting type of diet would be to restrict the time of eating. I often give my clients the recommendation that they should stop eating past 6:00 or 7:00 PM, for several reasons. One, it allows a soft fast from 7:00 PM to say 7:00 AM the next day; that's 12 hours of not eating. The other benefit of that is that most people typically aren't snacking on ultra healthy foods past 7:00 PM. So the cut-off time, if you will, also allows for people to clean up some of their more problematic eating behaviors.

Lee Tetreault: 

And lastly, are there specific foods that we should be recommending our patients to eat daily for optimum health? 

Bethany Doerfler:

All of these diets are interesting because when people follow a very structured diet what they naturally do is they stop eating processed snack foods. So I think, number one, a very simple piece of advice that we could give to our clients is, "Please don't eat snack foods; eat real food at snack time." Snack time should be fruits, it should be vegetables, it should be nuts, it could be yogurt or cheese. Number two, it's really important that every meal offers some sort of fruit or vegetable. And the rationale for this is that the colors and the smells that go into making fruits and vegetables; they are kind of unique type of species, also provide these important phytonutrients that function like powerful anti-oxidants. So, the color is really important for us to be focusing on. Many people get bogged down in whether or not they should be eating berries versus bananas or very specific fruits, but it's important to have people focus more so on the color; some purple and red every day, something green every day, something yellow and orange. And these are very tangible recommendations that patients can implement easily.

Lee Tetreault: 

This is great information, doctor. I think I'm gonna put down the [08:46] ____ and get an apple right away. Thank you so much.

Bethany Doerfler:

Good for you, thank you.