Over the past several years, there seems to be an increased interest and acceptance of healthier, cleaner eating and a renewed attentiveness to health and wellness in the general population. We are in the midst of a paradigm shift and moving away from the quick and easy, pre-packaged meals, and “diet” foods popular over the past several decades and moving back towards a more “old fashion” approach to eating and preparing food. This includes more fruits, vegetables, nuts, seeds, fish, and 100% whole grains, with less processed foods, artificial flavors, and artificial sugars. The motivations for this movement are likely unique for everyone but there does appear to be more awareness and recognition of the health risks associated with an unhealthy diet and unhealthy weight as well as the potential negative impact that additives, chemical preservatives, pesticides, unhealthy fats and highly processed foods have on our health and general well-being.
 
With this paradigm shift comes an abundance of nutritional advice, programs, and trends that have gained recent media attention, some are new, and others have been around for centuries. A few popular in the media include the Paleo diet, Whole30, the Ketogenic diet, the plant-based diet, the Mediterranean diet, and the Ayurvedic diet, as well as programs such as intermittent fasting, cleanses, and shake programs. Most of these are geared towards weight loss and weight maintenance but many also promote other long-term health benefits. Some of the asserted benefits include improved control of chronic conditions like cardiovascular disease, metabolic syndrome, and Type 2 diabetes, as well as decreased cancer risk, improved digestive issues, improved energy levels and mental clarity, improved sleep patterns and improvement in mental health. It has been well established in the literature that maintaining a healthy weight decreases your risk for cardiovascular disease and many chronic conditions; it makes sense why our patients may be interested in some of these trends for weight loss and overall health. As nurses, it is important that we are aware of different diets that our patients may be following and understand any potential health risks a diet may pose for certain populations.
 
Over the next few weeks we will be reviewing several of these nutritional trends in detail. This blog will provide a brief overview of some of the common ones you may have heard of in the media. It is important to note that many of these diets have not been well studied or compared in well-designed, randomized controlled trials or cohort studies. It remains important that we understand the basics of each one.

The Ayurvedic Diet

What is it?

• A way of eating founded on the Indian Ayruvedic wellness system, an ancient tradition based on balancing energies within the body to improve health and mind.
• The particular diet one follows is based on their dosha (or body type). An individual’s dosha is based on elements of the earth most aligned with their physical, emotional, personality, and food/activity related characteristics.
• The 3 doshas are:
  • Vata (space/air)
  • Pitta (fire/water)
  • Kapha (water/earth)

• Suggested benefits:
  • Promotes a mindful/thoughtful eating which is typically associated with less excess calorie intake and a better relationship with food
  • Possible weight loss, not considered a “diet,” no restriction of one food group or macronutrients, balanced nutrition, flexible

• Disadvantages:
  • Not specifically intended for weight loss, some consider complicated with too many rules
  • Ideally, your dosha would be determined by an Ayurvedic practitioner, which may be expensive or not widely available

Typical food choices:

• Mostly whole and minimally processed foods with a focus on eating herbs and spices (boost satiety) and prebiotics (nourish gut bacteria tied to anti-inflammation, immunity, positive mood) and with avoidance of processed foods
• Based on your dosha, there are particular foods you should favor and some that you should avoid.
• Recommended that all doshas include all six tastes during each meal (sweet, salty, sour, bitter, pungent and astringent), eat mindfully with concentration, eat slow enough to savor food but quick enough that warm food does not get cold, avoid overeating by being mindful of signs of fullness, and eating again only when previous meal has been digested (greater than 3 hours but not more than 6).

Intermittent Fasting/Time Restricted Eating

What is it?

• Considered less of a diet plan and more of a pattern of eating. Typically involves a 12 to 16-hour period of fasting each day with an 8 to 12-hour period during which one can eat.
• The premise is that there is a “fed” and “fasting” state in the body.
  • During a post-prandial state or “fed” state, typically 3-5 hours after eating, your body is digesting and absorbing, and fat burning is low because insulin levels are higher.
  • During a fasting state, which is 8 to 12-hours after your last meal, fat burning is more efficient because insulin levels are lower.
• Fat burning it not optimal during “fed” states but since we typically do not fast for 12 hours at a time, getting to this state during normal eating patterns is rare.
• Suggested benefits:
  • Weight loss, promotes fat loss
  • Decreases risk for chronic conditions including heart disease, diabetes, Alzheimer’s disease, and some cancers
  • Multiple options in terms of timing of fasts; can be done daily, weekly, or bi-weekly
• Disadvantages:
  • Not recommended for those with diabetes
  • You will feel hungry; risk for overeating during your eating periods may lead to poor focus, irritability, or hypoglycemia; risk for dehydration

Typical food choices:

• No restrictions, although some often combine this with one of the Whole30, Paleo or Ketogenic diets  

The Ketogenic or Keto Diet

What is it?

• Involves eating a low carbohydrate diet to promote production of ketones (made when blood glucose is in short supply.) Since carbohydrates and excess proteins are broken down into blood sugar, ketones are not produced when this pattern of eating is dominant. Ketones are produced when fat is used as a fuel source. In this state, insulin levels remain low and should lead to less hunger and a steadier supply of energy.
• High in healthy fats but not necessarily high in protein.
• In general, this involves eating a diet that is approximately less than 10% carbohydrates, 15-25% protein, and 70% or more from fat.
• There is a medical version of this diet which is used to control seizures.
• Suggested benefits:
  • Improved blood sugar control/decreased risk of type 2 diabetes
  • Weight loss, promotes fat loss, better controlled appetite
  • Improved focus and concentration, increased endurance, improved gastrointestinal symptoms (bloating and gas)
• Disadvantages:  
  • May develop a “keto flu” (nausea, constipation, malaise, fatigue, headache) in the beginning stages of starting this program as body adapts to lower carbohydrate intake
  • Electrolyte disturbances
  • Restrictive
  • Risk for higher intake of saturated fat

Typical food choices:

• Meat (ideally organic, pasture-raised), fish, eggs, nuts (limit cashews) and seeds, most vegetables (those that grow above ground have less carbohydrates), healthy fats (coconut, avocado, cacao butter, MCT oil, ghee, meat fat), coffee, tea, berries in moderation, high fat dairy, and bone broth
• Avoidance of starch (bread, pasta, rice, potatoes including sweet potatoes), sugar, grains, potatoes, sugar, milk, most fruits, legumes, beer, margarine

The Mediterranean Diet

What is it?

• Refers to a diet common amongst those living in olive-growing regions of the Mediterranean which is high in healthy fats and low in processed foods. The people in these regions are also more physically active and typically eat meals in larger groups with social support which may also influence the benefits of this diet.

Typical food choices:

• High amounts of monounsaturated fat relative to saturated fat; moderate consumption of alcohol (mainly wine); high consumption of vegetables, fruits, legumes, and grains; moderate consumption of milk and dairy in the form of cheese.
• Healthy fat should comprise 35-40% of total daily calories.
• Recommends cooking at home with fresh and whole ingredients.

• Avoidance of red meat, processed foods, sweets
• Suggested benefits:
  • Lowers cardiovascular risk and type 2 diabetes risk
  • Practical and easy to follow
  • Exposure to high intake of antioxidants (cancer fighting)
  • Not a diet per say, it models a way of living that has been around for centuries
• Disadvantages: no specific, detailed guidelines to follow

The Paleo Diet

What is it?

• A program that promotes eating the way people ate during the Paleolithic era (2.5 million to 10,000 years ago) prior to the advent of farming when dairy, legumes and grains became more readily available, and obesity, diabetes, and heart disease were less prevalent.
• Also called the hunter-gatherer diet or the caveman diet, it is thought that this provides a diet that we are biologically and genetically programmed to tolerate.
• Suggested benefits:
  • Weight loss, improved glucose tolerance, improved blood pressure, more iron intake, better energy levels  
• Disadvantages:
  • Restrictive
  • Potentially expensive/cost prohibitive
  • Risk for high intake of saturated fat
  • Low calcium intake
  • Those with diabetes on insulin could risk hypoglycemia if insulin adjustments are not made with healthcare provider involvement
  • High protein intake may not be appropriate for those with advanced kidney disease

Typical food choices:

• Meat (ideally lean, grass-fed), fish, most fruits, most vegetables, sweet potatoes, seeds, nuts (except peanuts which are actually legumes), ghee, healthy fats (avocado/olive oil) and seeds, natural sugars OK (stevia, maple syrup, honey), spices, some seasonings
• Avoidance of grains, legumes (beans, lentils, peanuts, peas), dairy products, corn, refined sugar, artificial sweeteners, salt, white potatoes, and any highly processed food.

Whole 30

What is it?

• Similar in dietary composition to the Paleo diet but it is meant to “reset” your body by eliminating all potentially inflammatory foods that could exacerbate chronic conditions.
• Essentially an elimination diet which, after 30 days, one food or food group at a time is re-introduced for 3 days, if you still feel good, you would continue this food and re-introduce another category; if then you develop a symptom, the recommendation is that the exacerbating food group be eliminated.
• Suggested benefits:
  • No counting calories; no weighing yourself; no body measurement; claims to curb cravings, boost metabolism, calm immune system and rest digestive system; similar weight loss and improved glucose tolerance claims as the Paleo diet 
• Disadvantages: restrictive; if you go off the program, it is recommended that you restart on day #1; and other disadvantages as listed under the Paleo diet

Typical food choices:

• Meat (ideally lean, grass-fed), fish, most fruits, most vegetables, seeds, sweet potatoes, nuts (except peanuts which are actually legumes), coffee, ghee, vinegar, spices/seasonings, minimal amounts of fruit juices as sweeteners
• Avoidance of refined sugar, alcohol, processed foods, white potatoes, real or added sugar, alcohol, grains, legumes, dairy, MSG, sulfites, carrageenan, baked goods, “junk food”

 
The summaries above are brief and provide an overview of the basic concepts of these health trends. In future blogs we will provide in-depth information including review of any scientific literature supporting or refuting the benefits and risks of each program. The intent of this information is not to provide advice to patients, but rather to familiarize nurses with the information that is out there and raise awareness to risks associated with some of the more extreme dietary trends and programs. A simple piece of advice I once received from a nutritionist is, “If something [off the shelf] has more than 5 ingredients or you can’t pronounce an ingredient, you shouldn’t eat it.” This is a simple tool to help you eat less processed foods. Other nutritionists promote that nothing is off limits if you are able to moderate your intake of unhealthy foods. A broader piece of advice from The Dietary Guidelines for Americans (2015) suggests “the adoption of healthy eating patterns characterized by higher consumption of fruits, vegetables, and whole grains and lower intake of calories, saturated fat, sodium, refined grains, and added sugars.” Overall, everyone is on the same page in promoting healthy lifestyles for our patients and there are so many ways to accomplish this. Our patients need support to find a method that works for them and most importantly, one that is effective and that they can stick to realistically as this is the key to overall health benefits.  
 
Are there other nutritional trends or programs that you have heard of or would like more information on?
 

References:
 
The Ayurvedic Institute (2018). Food Guidelines for Basic Constitutional Types. Retrieved from:
 https://www.ayurveda.com/pdf/food-guidelines.pdf  
 
Mayo Clinic Staff (2017). Paleo diet: What is it and why is it so popular? Retrieved from:
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/paleo-diet/art-20111182
 
Masood W., Uppaluri, K.R. Ketogenic Diet. [Updated 2019 Mar 21]. In: StatPearls [Internet]. Treasure Island  
(FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK499830/
 
Patterson, R.E. & Sears, D.D. (2017). Metabolic Effects of Intermittent Fasting. Annual Review of Nutrition,
37, 371-393. doi: 10.1146/annurev-nutr-071816-064634
 
Romagnolo, D. F., & Selmin, O. I. (2017). Mediterranean Diet and Prevention of Chronic Diseases. Nutrition
Today, 52(5), 208-222. doi:10.1097/NT.0000000000000228
 
U.S. Department of Health and Human Services and U.S. Department of Agriculture, (2015). 2015–2020   
Dietary Guidelines for Americans. 8^th Edition December 2015. Retrieved from http://health.gov/dietaryguidelines
 
The Whole 30 program rules. Retrieved from https://whole30.com/whole30-program-rules/