Healthy Eating and Good Health: "Plants" not "Plants"

On August 8, 2019, I was supposed to give an invited talk—live, in-person, in Las Vegas, NV. Unfortunately, the weather (and air-traffic control) had different plans. Ultimately, I gave the presentation remotely over the web, but I had pre-recorded the talk (showing slides) just in case the live-streaming didn’t work.  Below is a rough transcript (with select slides). 

Slide 1 - Choose Food

When I imagined one day playing Vegas, I always pictured it more like this ...

Slide 2 - Disclosures

Than like this ...

Slide 3 - Disclosures

But since “what happens in Vegas stays in Vegas,” I’m going to show you this ... [embarrassing trapeze photos from prior to medical school]

Slide 4 - Disclosures

Ultimately, I decided there might be better job security in a white coat than fuchsia tights. So here we are ...

Slide 5 - Choose Food

For those of you who think you’ve walked into the wrong auditorium, this is not Cirque de Soleil; this is Epicure, and I’m delighted to be here. My name is Dr. Sean Lucan and today we’re going to talk healthy eating and good food—Real Food ... food mostly from plants (the living botanical kind) not food from plants (the industrial processing kind).

Slide 6 - Do NOT focus on this

What we are not going to focus on is this. And I’ll explain why ...

Slide 7 - Counting calories = frustrating (futile)

As many of you undoubtedly know from personal experience, counting calories can be an exercise in frustration. How do you determine the number of calories you actually take in (not just what you eat, but what your body actually absorbs) and simultaneously determine how many calories you burn (not just on the treadmill or the exercise bike, but in all the metabolic reactions occurring at every moment within your body), and do so with enough certainty to  guide real-time decisions about much you should be eating or how much exercise you should be doing? 

Slide 8 - How many calories to lose weight?

Yet patients frequently ask me how many fewer calories they need to eat or how many more they need to burn in order to lose weight. A common misconception is that 3,500 calories equals 1 lb (or for the Canadians in the audience, 0.45 kg) of body weight. In other words, if you eat 500 Kcal less per day (or burn 500 Kcal more per day) for 1 week, you will lose 1 lb (or 0.45 kg).  Or will you ...

Slide 9 – Bodies: *NOT* simple math (or magic)

It turns out, human bodies do not operate by simple math. Which, of course makes sense. It can’t be the case that you can lose one lb. a week, week after week, until there are no more lbs. to lose, your weight hits zero, and you simply disappear. As you lose weight, you body fights back ...

Slide 10 – False expectation / disappointment

... such that believing in the 3,500 calorie rule is just a set up for false expectation and disappointment. For example, if you were to eat 100 calories fewer every day (about the equivalent of an average-sized banana), the 3,500-Calorie rule would predict that you would lose 50 lbs (or 22.7 kg) in 5 years. In reality, you would more likely lose only about 10 lbs in that time: Half the weight would be lost in a year, it would take another 2 years to lose 95% of the weight, and over the finally 2 years—even maintaining the same calorie deficit—you would  to lose *only* a ? lb. (or 0.2 kg) ... Despite the same effort, adherence, and struggle.

Slide 11 - Desperate patient: “But doc, I swear …”

And patients really struggle. Something I hear commonly is:  “But doc, I swear ... I’m choosing low-calorie foods, I’m controlling my portions, and I’m really not eating that much (although I’m always hungry) ... I’m trying to exercise (even though I don’t really have much energy) ... I just can’t seem to lose weight” … or “I just can’t keep the weight off.”

Slide 12 - Desperate patient: “But doc, I swear …”

Or more often what I hear is: “but I keep putting on weight!” That’s because most patient are focused on exactly the wrong thing: Most are focused on calories.

Slide 13 - Calorie focus misses the point

A calorie focus completely misses the point. Here are some foods representing calorie-providing food components: protein, fat, carbohydrate, and alcohol.  

Slide 14 - Calorie focus misses the point

A focus on calories almost inevitably becomes a focus on dietary fat because dietary fat has the highest calorie density of any food component. As a consequence, reducing calories usually means cutting out the fat or, more often, replacing fat with lower-calorie carbohydrate. 

Slide 15 - Calorie focus misses the point

But higher-calorie fattier foods are not necessarily bad. And lower-calorie lower-fat foods are not necessarily good.

Slide 16 – A tale of two foods

Let’s take an example.  Consider two possible foods: a handful of walnuts vs. a piece of cake. Even though each food is the same size (100 g in this case), the walnuts have almost twice as many calories with more than 5 times as much fat! The cake is already much lower in calories—and it would be easy to imagine an even lower-calorie version of the cake, swapping out some of the fat for more carbohydrate: refined starches and sugars. So is cake—or low-calorie cake—a healthier, more-weight friendly food than walnuts? 

Slide 17 – A tale of two foods

Actually, whole foods like walnuts are filling; ultra-processed products like cake drive overeating. It is very hard to overeat walnuts; you get pretty full pretty quickly. It’s very easy to have a second (or even third) piece of cake—and then to crave other ultra-processed foods like chips or soda with it as your appetite gets revved up. To be clear, the difference in effect between walnuts and cake has almost nothing to do with the *number* of the calories they themselves provide.

Slide 18 – A tale of two foods

Plants not Plants.

Slide 19 - A tale of two salads

Let’s take another example: a tale of two salads. We’ll say that both salads start with lettuce.  For the salad on the left, we will toss in avocado, sunflower seeds, and olive oil.  For the one on the right, we will add white-bread croutons, sugary dried cranberries coated in high-fructose corn syrup, and syrupy fat-free dressing. 

Slide 20 - A tale of two salads

There is no question salad on the right is higher in calories. In fact, it might have twice as many calories as the salad on the left.  But it is not the calories of the salads themselves that matter. The salad on the left is comprised predominantly of whole foods. The salad on the right is a mix of ultra-processed products. The salad on the left will be more filling, providing better appetite control; the salad on the right will be less filling, stimulating appetite. The one on the right will lead to less subsequent eating later in the day; the one on the right: more subsequent eating.  It’s also probably true that after eating the salad on the left you feel more inclined to move whereas after eating the salad on the right you feel tired and gross and like you need some couch time.

Slide 21 - A tale of two salads

Plants not Plants.

Slide 22 - An unlearned lesson: doing harm

Unfortunately, this is a lesson that just keeps not getting learned. The world keeps focusing on calories and “calories” essentially becomes just another word for dietary fat.  Dietary fats (like naturally occurring oils) get replaced with lower-calorie carbohydrates (like refined starches and added sugars). The result is not that people eat less; they eat more (and get fatter).  Heck, even the jars get fatter, apparently.

Slide 23 - An unlearned lesson: doing harm

Plants not Plants.

Slide 24 - A tale of two approaches

Ultimately, it boils down to two different approaches to weight and health: One approach focuses on calories; the other focuses on food quality and on choosing wholesome, whole, or minimally processed, foods. Certainly these two approaches have some overlap in terms of the foods they would encourage or discourage. Both would encourage most fruits, vegetables, and whole grains. Both would discourage processed meats, fried starches, and sugary drinks.  But a focus on calories would also discourage healthful fatty foods like nuts, olives, and avocados. A focus on calories would encourage ultra-processed foods like low-fat sugary yogurts, refined grains, and low-calorie juice drinks. Is that the best thing for health or for weight?

Slide 25 - Weight change with certain foods

Among studies to look at foods related to weight change (both weight loss and weight gain) is this one from the New England Journal of Medicine from 2011. The figure on the right is hard to read so let me break it down for you. 

Slide 26 - Weight change with certain foods

When it comes to weight, there are food that are good; the look like this: fruits, vegetables, whole grains, nuts. There are also food that are bad; they look like this: ultra-processed fare in various salty and sweet varieties. 

Slide 27 - Weight change with certain foods

Plants not Plants

Slide 28 - Yes --> Sometimes --> Limit

So there is no confusion, let me clarify what I mean by ultra-processed. You start with a natural whole food like fruit—one ingredient. A processed version might look something like this—canned fruit in fruit juice (2 ingredients).  An ultra-processed product looks like this “fruit juice powder”. This product has a long list of ingredients, most of which are barely pronounceable let alone recognizable, one of which is fruit flavoring, none of which is actual fruit.  

Slide 29 - Yes --> Sometimes --> Limit

This product does have “anti-caking agent though,” whatever that is … Actually, that’s probably me: the agent against cake. Or at least the guy that’s telling you we should be limiting our cake.

Slide 30 - Yes --> Sometimes --> Limit

We should be trying to avoid ultra-processed foods in general.

Slide 31 - Yes --> Sometimes --> Limit

We should choose wholesome food that supports healthy weight and good health.  

Slide 32 - Bad

To review, this is Bad: Ultra-processed products. Perhaps *especially*

those engineered to be lower in calories (with removed fat but with added starches and sugars)

Slide 33 - Bad

Plants [the industrial processing kind]

Slide 34 - Good

This is Good.

Slide 35 - Good

Wholesome food

Slide 36 - Good

Real Food

Slide 37 - Good

Food mostly from plants [the living botanical kind]

Slide 38 - The latest science

Now, of course, you can choose ultra-processed products (including those engineered to be low in calories) and go down a path leading to heart disease, cancer, and early death ...

Slide 39 - The latest science

[Heart disease, Cancer, and Early death]

Slide 40 - More science

While you eat more than you intend …

Slide 41 - More science

And gain weight along the way ...

Slide 42 - More science

Plants [the industrial processing kind]

Slide 43 - Even more science

Or you can focus on healthy eating—on Real food; and not focus on calories

Slide 44 - Even more science

But instead focus on food that supports healthy weight and good health.

Slide 45 - Bottom line for good health

·     Healthy eating is about food quality, not food calories

·     Calories definitely count, but we should not be trying to count them

·     Avoid Ultra-processed foods; they drive over-eating—especial overeating other unhealthful foods

·     Enjoy wholesome Real Foods; they provide unconscious calorie control (& good health)

Slide 46 - Choose food

So choose food. Real food.

And chew your food.

Slide 47 - Choose food

And remember: what happens in Vegas ...

I’m Dr. Sean Lucan, it’s been a pleasure.