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What is on your plate?

Over the past few years, it is evident that fitness has become popular. People are consciously trying to change their eating habits and adopt a better lifestyle. However, only a small population is actually aware of what they are eating. Most of us assume that exercising is the easiest way to shed some weight and become ‘healthy’. (Why weight loss is not necessarily healthy, is a story for another day). While exercising certainly has its benefits, majority of us do not know what is on our plate. Diet and exercise are interrelated.
We’ve grouped foods into ‘good’ and ‘bad’ or ‘healthy’ and ‘unhealthy’ without knowing its function or how it would affect us. We eliminate food groups for the sake of weight loss and aesthetic goals. We are willing to take shortcuts even if it means compromising health.
The purpose of this article is to educate and bust some myths surrounding the essential nutrients we need to function. Some may surprise you, so sit tight!

The Macronutrients:

Macronutrients are nutrients that are required in large amounts by the body. These nutrients perform several essential functions from providing energy to regulating hormones. The macronutrients along with their roles are described below:
Carbohydrates: Carbohydrates are a food group whose main function is to provide energy to the body. They are broken down into glucose, which is then utilised to perform several functions by the body. Carbohydrates are commonly classified into simple and complex carbohydrates.
Simple carbohydrates: These are quickly absorbed into the bloodstream and thus provide a rapid source of energy. For example, fruit juices, refined sugar and candies are some sources of simple carbohydrates.
Complex carbohydrates: These are slowly released into the bloodstream and keep you full for longer. Whole grains, vegetables, beans, fruits and pulses are some examples.
It isn’t uncommon for someone to cut out carbohydrates from their diet when they’re trying to shed some weight. For every gram of carbohydrate consumed, the body holds onto three grams of water. So, the initial weight loss seen when carbohydrates are eliminated is actually just loss of water! There exists a belief that carbohydrate rich food hinder a person’s weight loss, while protein and fat rich food keep one satiated. However, contrary to this, it was found that in obese and overweight individuals, high carbohydrate diets were perceived to be more satiating than high fat diets. In fact, hedonic appeal (pleasure) for high fat foods were suppressed compared to high carbohydrate foods. It was also found that participants consumed close to 990 calories more on an average on the high fat diet (1). This means, that switching to high carbohydrate diets may actually help in regulating appetite in the short term.
Protein: We would have studied back in school, that proteins are the building blocks of the body. This is absolutely correct! Protein is a constituent of everything from our hair and nails to hormones and muscles. The building blocks that make up protein are called amino acids. Of these amino acids, there is a group called essential amino acids, which our body cannot make. Hence, it needs to be obtained from the diet. Complete proteins (containing all 9 essential amino acids) include meat, poultry, dairy, soy and quinoa. Incomplete proteins (do not contain all essential amino acids) include mostly plant based sources such as pulses and beans. Hence, for a plant based eater, a combination of a vegetarian protein source and a dairy source might help completing the amino acid profile.
A healthy human being needs about 0.8-1g/kg body weight of protein every day. But, do we Indians really consume enough protein? Before anyone gets defensive and talks about how an Indian diet is balanced and the most ‘healthy’, let me point you toward some evidence that isn’t anecdotal. In 2015, the Indian Market Research Bureau (IMRB) conducted a survey (2) to determine protein consumption of adults in the country. They recruited 1260 participants from over 7 cities. They concluded that close to 9 out of 10 Indians consume a protein deficient diet. In fact, 91% of the vegetarians and 85% of non vegetarians were consuming an insufficient amount of protein.
But is consuming high amounts of protein harmful? No, not at all. A recent meta-analysis has concluded that consuming a high protein diet (≥1.5g/kg body weight) did not adversely affect kidney function in healthy adults (3). Similarly, in a year long study in healthy resistance trained males, it was found that a high protein diet (>3g/kg body weight) did not have harmful effects (4). However, those with preexisting renal conditions need to be cautious with their protein intake.
Fat: Fat is an extremely important macronutrient which we often neglect or fear. However, fat also acts as a source of energy and helps in absorption of fat soluble vitamins. Fat rich food are sources of essential fatty acids (those which your body cannot make). These fatty acids are classified as omega-3 and omega-6. While we do get a good amount of omega-6, we often forget the importance of omega-3 fatty acids. Omega-3 fatty acids help in maintaining heart health and brain function. Further, there needs to be a certain balance between the two fatty acids. While we get omega-6 sources very easily from cooking oils like sunflower or corn oil, our consumption of omega-3 sources are fairly low. Inclusion of fatty fish like salmon, flax seeds, chia seeds and walnuts help in reversing this.
But does eating fat make you gain weight? Nope. If you control for your overall daily requirement of food, consuming fat rich food will not hinder your weight loss. So eat your eggs with the yolk! But wait. Does eating whole eggs increase cholesterol? It depends. There are hypo and hyper responders to cholesterol. For the majority of the healthy population, consuming eggs only shows a mild alterations in plasma cholesterol, or in fact none at all! (5). If you are a hyper responder and you have poor dietary habits to begin with, then you must be a little cautious. This excellent summary of egg consumption and cholesterol will give you better insight (6).

The Micros:

Micronutrients, like the name suggests are nutrients that are needed in fairly smaller amounts in comparison to macronutrients. Despite this, they play several important roles. Micronutrients are vitamins and minerals found in a wide variety of food items from fruits and vegetables to whole grains and seeds. We often tend to turn a blind eye towards inclusion of micronutrients in our diet, without knowing their importance.
For example, Vitamin D, a fat soluble vitamin plays an extremely important role in absorption of calcium and bone health. Vitamin D deficiency is prevalent throughout the country, with 70-100% in the general population (7). Cheese, egg yolks and fortified dairy products are some food sources of vitamin D. However, milk and dairy products in India are rarely fortified with vitamin D. In addition to this, calcium intake is also far below the recommended intake (7). While sunlight is also a good source of vitamin D, it is not solely the solution for reversing the deficiency. Hence, supplementing vitamin D should not be viewed as a taboo. Do consult your nutritionist or doctor for more details.
Despite supplements being easily accessible, a food first approach must be employed. If you are deficient in a certain vitamin or mineral, then yes you will need to bring your levels back to normal. But to prevent deficiency, ensure you include a wide variety of fruits and vegetables in your diet. In addition to this, also add whole grains, legumes, nuts and lean protein into your diet. The more diverse your diet is, the more micronutrients you get!
Water: One more addition to the ‘neglected’ basket is water. Why do we need water? Water makes up about 60% of your body. Water is essential for almost all functions from transporting nutrients (blood is also composed of water) to excretion! With India’s temperature soaring most of the time, the chances of dehydration are highly likely.
How do you identify if you are dehydrated (or need more water)? Physically, one can rely on thirst as a cue to drink water. Dry mouth, dizziness and exhaustion are some symptoms of dehydration. However, your urine colour can be one way to assess your hydration status. The more pale your urine is, the more hydrated you are. Similarly, the darker it is, the less hydrated you are. Ideally, your urine colour should be around 5-6 in the image attached below. However, this isn’t an assessment set in stone as different foods you eat can also influence your urine colour.

Some of these were a shocker to you weren’t they? Every nutrient has a role to play in helping the body function. When we cut out whole food groups for the sake of losing a couple of kilos, we are in some way, compromising our health. A handy tip to remember to ensure that you prioritise health is ‘balanced meals with rainbow colours’. The more colours you add to your plate, the more variety of nutrients you include!
Hope this gave you all an insight into how important it is to know what you eat and how they help you perform your daily activities.

References:

1) Hopkins, M, Gibbons, C, Caudwell, P, Blundell4,JE, Finlayson, G. Differing effects of high-fat or high-carbohydrate meals on food hedonics in overweight and obese individuals. British Journal of Nutrition. 2016;115(10):1875-1884
2) Mahajan, M. Protein consumption in diet of adult Indians : a general consumer survey (PRODIGY). Indian Medical Gazette.2015;149(4):149-150
3) Devries, CM, Sithamparapillai, A, Brimble, KS, Banfield, L, Morton, RW, Phillips, SM. Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis. The Journal of Nutrition and Disease. 2018; 148(11): 1760-1775.
4) Antonio, J, Ellerbroek, A, Silver T, Vargas, L, Tamayo, A, Buehn, R, Peacock, CA. A High Protein Diet Has No Harmful Effects: A One-Year Crossover Study in Resistance-Trained Males. Journal of Nutrition and Metabolism.2016;1-5
5) Fernandez, ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Current Opinion in Clinical Nutrition and Metabolic care. 2006;9(1):8-12
6) Examine. Will eating eggs increase my cholesterol? Available from:
7) G, R, Gupta, A.Vitamin D Deficiency in India: Prevalence, Casualties and Interventions. Nutrients.2014;6(2):729-775

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Fad Diets – Why they don’t work in the long run.

“Sorry, I can’t eat cake I’m on a diet”
By definition, a “diet” is the sum of energy and nutrients obtained from foods and beverages consumed regularly by individuals. To put it in simple terms, it is what you eat and drink on a day to day basis. Somewhere along the way, the meaning shifted to something more specific. Something that people dread. You guessed it right – Weight loss.
As a generation, we are used to quick results. Everything from groceries to electronics can be bought with a click. Unintentionally (or not) we have begun to channel that into how our bodies respond to an external stimulus, such as food and exercise. We expect results within a short span of time and will go to great lengths to ensure that it happens! Ever completely cut off a food group or had just juices for a week to shed some weight? That is exactly what I’m talking about.
This is what we call a ‘fad diet’. It’s nothing but a trend that claims to guarantee rapid weight loss and have an upper hand over our perfectly normal balanced diet. Most of the claims around fad diets might seem appealing.
“Guaranteed weight loss in a week!”
“Helps in removing harmful toxins from your body”
“Carbohydrates are stored as fat. Switch to fat as your primary source of energy.”
Sounds familiar? Although these claims might seem appealing, the diet by itself is extremely restrictive. Every single nutrient has a role to play in our body and nothing in isolation is inherently bad. Any ‘diet’ that you choose to follow is completely based on individual preference. But, is it sustainable? Is it personalised to help achieve your goals? It is imperative that everyone is informed of the pros and cons of these diets and make an informed choice. For that reason, here is a compilation of the most popular diets:
(1) Ketogenic diet: Both carbohydrates and fat can be used as a source of energy by the body. The body relies on glucose (broken down from carbohydrates) when one consumes their normal diet (1). In the complete absence or reduced amount (<20g) of carbohydrates in the body, the body enters a state of ketosis, wherein it relies entirely on stored fat for energy. Signs of ketosis can be identified by increased ketone bodies in the blood, headaches and fatigue due to extremely low carbohydrate intake and bad breath. Breakdown of fat results in the rise of ketone bodies in the blood, which are used as an alternate source of fuel. The ketogenic diet involves consuming minimal to no carbohydrates (~5% from diet) and using fat (~75% from diet) as a source of energy. It encourages consumption of copious amounts of fat from sources like bacon, ghee,butter,nuts,cheese etc. Starch, grains, beans and legumes, fruit and starchy vegetables are avoided. The sources of fat usually consumed in a keto diet are low chain triglycerides (LCT’s). Off late, consumption of fat sources that contain Medium Chain Triglycerides (MCT’s) like coconut oil are observed. Although they do not contain concentrated amounts of MCT’s, it is suggested that MCT’s generate more ketone bodies and may be more beneficial to incorporate in a keto diet (1).
Pros: A ketogenic diet was developed for children diagnosed with epilepsy. It was said to be therapeutic as fats do not spike insulin. It works by stabilising various mechanisms related to synaptic functions and thus has an anti-seizure effect. So you know who it actually benefits (2). Although, consumption of high amounts of fats can induce better satiety (3), thus reducing food consumption in subsequent meals. This can potentially help in losing weight. In order to adapt a ketogenic diet to the current lifestyles and improve adherence, a cyclical keto diet came into the picture. This involves following a keto diet for 4-5 days and increase carb intake for 1-3 days. There is currently no evidence to support the validity of a cyclical ketogenic diet.
Cons: A ketogenic diet can be extremely restrictive. Cutting all sources of carbohydrates can lead to irritability, ‘brain fog’, mood swings, headache and even constipation, due to lack of fibre in the diet. Although it might result in weight loss (provided you’re in a caloric deficit), it may not be sustainable in the long run. I mean, how long are you going to stay away from a good slice of pizza? On a more serious note, the exclusion of whole grains, fruits and vegetables could lead to deficiencies of B vitamins, iron, zinc etc. Further, the long term effects of such a high fat diet haven’t been studied.

(2) Paleo Diet: The Paleolithic diet or paleo diet resembles what hunters or cavemen ate several years ago. This diet primarily revolves around what our ancestors had access to – Whole foods. And by that, I literally mean, whole foods only. Sounds easy? Not really. You see, cavemen didn’t cultivate their food. So what they ate was what they could find. So on this diet, the idea is to avoid anything that could be made in a factory. What this diet would comprise of would be meat, free range eggs, fruits, vegetables, nuts and seeds. In order to adapt it to the current scenario, consuming spices/condiments and olive/coconut oil are acceptable. It has been speculated that they did have access to grains. However, evidence for a paleo diet to be superior than a balanced diet is still in question (4).
Pros: Any food that is ‘processed’ such as aerated beverages, most dairy products, legumes/beans, vegetable oils and even grains are not to be consumed on this diet. Since you will be consuming an abundance of fruits and vegetables, there lies an advantage. The focus on whole foods does steer us away from a conventional diet primarily filled with calorie dense foods of low nutrient content. In fact, studies have shown that a paleo diet improves insulin sensitivity, blood pressure and cholesterol (5).
Cons: To start with, the diet is pretty restrictive. More than it, it also creates a list of ‘good food’ and ‘bad food’. That by itself creates a sense of fear of food and is problematic. Further, we can follow a perfectly wise diet even with the inclusion of dairy, starch and legumes. The exclusion of dairy might lead to a deficiency in calcium(4).
(3) Detox diet: A detox diet is used to eliminate toxins from the body and assist with weight loss. These are also commonly known as juice cleanses. However, it can also involve consuming vitamins, minerals, laxatives and other ‘cleansing foods’ (6). While most commercial detox diets do not specify the ‘toxins’ they claim to remove, it should be noted here that the dose of the said toxin determines its harmfulness (7). For example, even an essential mineral like Iodine when present in excess can lead to thyroid disorder. Does that mean iodine in isolation is a toxin?
Various organs in our body, and in specific the liver are involved in eliminating potential toxins from the body. Commercial detox diets lure the masses promising rapid weight loss, but there is no scientific evidence to support this claim.
Pros: Well. This is a tough one. In a recent review on detox diets (7), it was highlighted that some plant based foods like coriander, citric acid (found in citrus fruits) and malic acid (found in grapes) can help in removing toxic metals from the body. However, most of these studies were performed on animals and can’t be generalised to the human population. While these detox diets may be successful in inducing weight loss in the short term, they may not be sustainable in the long run.
Cons: Detox diets involve severe energy restriction and might lead to nutrient deficiencies. For example, by just drinking juices for a week, one may not meet their recommended protein intake! Further, detox dieters could potentially be over consuming supplements/laxatives (7). A variety of nutrients need to be consumed on a daily basis, which a detox diet may not be able to provide.
(4) GM diet: A diet that was initially created for the employee of General Motors (GM), the GM diet allows you to eat a certain combination of foods each day. For example, on day one you eat only fruit (except bananas). On day two, only vegetables. This pattern of consuming specific foods continues for a period of 7 days. Since fruits, vegetables and other items allowed in the diet are low calorie, it has been shown to induce weight loss. However, as much as it is popular, there isn’t any research to support the claims of this diet.
Pros: Although a GM diet does include some whole foods, it follows a restrictive and specific pattern.
Cons: We need a variety of nutrients on a daily basis. By consuming just fruits throughout the day, other nutrients such as protein, fat and several other micronutrients available in whole grains, fruits and vegetables are neglected. Moreover, tendency to feel hungry might be prevalent. The weight lost on a GM diet may be temporary. Since it isn’t something you can follow lifelong (fight me!), there lies a possibility of regaining the weight lost.
Do you sense a pattern with all these diets? All of these diets involve restricting either all your food or a specific food/food group. Do you think that’s sustainable and that you can follow it life long? Not really right? In an ideal scenario, for a diet to be sustainable, it needs to be personalised to suit you and your goals. There isn’t one specific diet that is applicable to everyone. As mentioned before, all nutrients play a specific role in your body. Completely cutting yourself off from one for the sake of losing weight does more harm than good. Always make an informed decision when it comes to your fitness goals. The shortcuts might seem tempting, but remember health is wealth.

References:

1) Walcyzk, T, Wick, JY. The ketogenic diet: making a comeback. The Consultant Pharmacist. 2017; 32(7), 388-396.
2) Rho, JM. How does the ketogenic diet induce anti-seizure effects? Neuroscience Letters. 2017; 637, 4-10
3) Paoli, A. Ketogenic diet for obesity: Friend or foe?. International Journal of Environmental Research and Public Health. 2014; 11(2),2092-1207.
4) Pitt, CE. Cutting through the Paleo hype: The evidence for the Paleolithic diet. Australian Family Physician. 2016; 45(1): 35-38.
5) Tarantino, G, Citro, V and Finelli, C. Hype or Reality: Should Patients with Metabolic Syndrome-related NAFLD be on the Hunter-Gatherer (Paleo) Diet to Decrease Morbidity?.Journal of Gastrointestinal and Liver disease. 2015; 24(3): 359-368.
6) Allen, J, Montalto, M, Lovejoy, J, Weber, W. Detoxification in naturopathic medicine: a survey. Journal of Alternative and Complementary Medicine. 2011;17(12):1175-1180.
7) Klein, AV, Hiat, H. Detox diets for toxin elimination and weight management: a critical review of the evidence. Journal of Human Nutrition and Dietetics. 2014; 28(6): 675-686.
8) Healthline. What is the Cyclical Ketogenic Diet? Everything you need to know.
9) Medical News Today. What are the signs of ketosis?
10) Harvard T.H. Chan School of Public Health. Diet Review: Ketogenic Diet for weight loss.
11) Masharani, U, Sherchan, P, Schloetter, M, Stratford, S, Xiao, A, Sebastian, A, Nolte Kennedy, M and Frassetto, L. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. European Journal of Clinical Nutrition.2015; 69(8), 944-948.
12) Harvard T.H. Chan School of Public Health. Diet Review: Paleo diet for weight loss.
13) Precision Nutrition. The Paleo problem.

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One Size Does Not Fit All.

If you meet a nutritionist/dietitian and they hand you a pre-made meal template without understanding your lifestyle, you need to do just one thing.

RUN.

It is not an unfamiliar practice for ‘nutrition coaches’ and for that matter even qualified nutritionists to hand out premade diet plans to any client that walks in. With the market flooded with ‘detox plans’ and ‘diet plans that require no exercise’, we are made to believe that there is one superior ‘diet’ that can help us achieve our fitness goals. Marketing does play a role, but it also reflects how gullible enough we are to actually be the target audience. It is imperative to understand that each of us are extremely different from one another. Everything from eating habits and food preferences to sleep schedules differ greatly from person to person. So how do we expect one universal ‘diet plan’ to work? You might agree to bite your teeth and eat what that template tells you to. But for how long? Is it teaching you how to build sustainable eating habits or is it just temporary? Are you looking at long term health or short term aesthetic outcomes?

With this in mind, several nutritionists and dietitians are now offering tailor made plans suited to each individual. These ‘personalised nutrition’ plans are slowly gaining momentum. Like the name suggests, these are interventions or advice that are developed from individual characteristics (1). Interventions like these may help in bringing out more effective behavioural changes (2). Personalised nutrition can be applied to individuals with specific conditions such as pregnancy or old age (1). The goal of such interventions are primarily to benefit health, but could also be applicable to meet specific goals such as performance in sport (3).

Here is an excerpt from nutritionist Varsha.

“I once had a client who consulted with a nutritionist before meeting me, this nutritionist did not take the said client’s lifestyle into account, did not interact much and asked her if she wanted to lose X number of kilos in Y number of months. She then based her charges on the number of kilos to be dropped. This has become a common practice. In addition, any information with respect to nutrition, is easily accessible on the internet. People need to know that these claims need to be backed by a body of research. For this reason, it’s always important to get guidance from a professional who is well qualified and up to date with current research.”

In 2016, a large study was conducted by Celis-Morales et al. (4) over 6 months, recruiting participants from seven European countries. They were either given conventional dietary advice or personalised advice based on the individual’s diet and phenotype and/or genotype. It was observed that a personalised diet was more effective in creating sustainable habits. Nevertheless, there are always two sides to a coin. While the theoretical evidence for personalised nutrition is still not clear, marketing can lure consumers into taking unreliable tests that have limited evidence.

In conclusion, it is imperative for you as consumers, to be aware of the various evidence based trust worthy nutritionists who care about your goals and more importantly, your health. While the evidence for personalised nutrition seems promising, it is also crucial for you, to be aware of unregulated tests in the market. Further, it is clear that there is no ‘one size fits all approach’, when it comes to nutrition. A diet and exercise plan suited to YOUR lifestyle, accounting for YOUR food preferences, goals and/or clinical condition(s) is what works always.

References:

1) Ordovas, JM, Ferguson, LR, Tai, ES, Mathers, JC. Personalised Nutrition and health. The British Medical Journal. 2018; 361:bmj.k2173

2) Woolf, SH,Purnell, JQ. The good life: working together to promote opportunity and improve population health and well-being. Journal of the American Medical Association. 2016;315(16): 1706-1708.

3) Jeukendrup, A. A Step Towards Personalized Sports Nutrition: Carbohydrate Intake During Exercise. Sports Medicine.2014; 44(Suppl 1): 25-33.

4) Celis-Morales C, Livingstone K, Marsaux C, Macready A, Fallaize R, O’Donovan C et al. Effect of personalized nutrition on health-related behaviour change: evidence from the Food4me European randomized controlled trial. International Journal of Epidemiology. 2016;46(2):578-588.

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