“Dieting: Changing our approach from short gains to the long game” – with Casey Seiden

Dr. Fox: Welcome to the “Healthful Woman Podcast,” the fastest-growing podcast in women’s health. Today’s Monday, January 3rd, 2022. I hope you all had a great New Year’s. For those of you who make New Year’s resolutions and are considering jumping back on the weight-loss train, I think you’ll appreciate today’s podcast. I’m joined by Casey Seiden, our wonderful, registered dietician, nutritionist, and diabetes educator to talk all about dieting, which ones work, and which ones don’t. More importantly, we talk about overall strategy regarding healthy eating and weight control. So I think this podcast will be interesting for all of you. Casey is really smart, helpful, and frankly, quite normal, which is not always the case for people in the world of weight loss. All right, thanks for listening. Have a great day. See you Thursday in “High Risk Birth Stories,” for part 2 of Shira Billet’s birth story.
Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. In “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Casey. Welcome back to the podcast. So happy you can join. How’re you doing?
Casey: I’m doing good. Excited to be back with you.
Dr. Fox: We were thinking that it probably makes a lot of sense to talk about diets, and dieting, and, you know, “fad diets,” and what’s good and what’s not, because we’re coming up on the New Year. And traditionally, a lot of people commit or recommit to one of these at the beginning of the year or at New Year’s. So why not? Let’s talk about it.
Casey: Let’s do it.
Dr. Fox: Do you find that to be true for your, let’s say, non-pregnant patients, clients? Do they tend to sort of refocus their energy in the New Year?
Casey: It is that common mentality because everyone is, you know, it’s that clean slate, want to start off fresh, and also just coming off of holiday times, family gatherings where maybe they did indulge a little bit more, eat differently. And so they’re even physically not feeling so great. And they feel like they need to “reset” or reboot. So people will often turn to changing their diet, subscribing to, you know, a specific program to help them do that.
Dr. Fox: From a global level, what is your feeling about that in general, this idea of starting and stopping diets? I mean, because no one’s gonna stay on, like, one diet their whole life. Or maybe they will, but it’s pretty unusual. So are you generally in favor of that kind of reboot? Or do you think it’s just missing the boat and that’s why everyone’s redoing it every year because it just doesn’t work?
Casey: You said it. Exactly. Yeah, you know, there’s a statistic out there that somewhere around, you know, 95% of diets fail. And this is why the diet industry is so lucrative, right? Because people are doing this, this kind of yo-yo dieting or jumping from one to the next. When one stops working, they’ll seek something else out. And we actually know that doing that yo-yo dieting, or maybe they’re losing weight but then gaining it back is often a lot more harmful for their health in the long-term. It’s making blood sugars worse, hormone profiles worse, cholesterol. So I’m generally not a fan of that start over, reboot mindset, you know, the falling off the track, falling off the wagon. Or I will ask, “What track did you fall off of?” Right? If we’re kind of creating sustainable, healthy eating behaviors and habits with, of course, you know, consuming sweets and fun foods in moderation, then there’s no track to fall off of. There’s no need to do a reboot just on January 1.
Dr. Fox: So why do you think it is that they are so popular even though they always fail? Is it an issue of sort of aesthetics, like people want to look better? Is it just they don’t like the number? Is it just that it’s tradition that this is what you do, you know, try to lose some pounds after the New Year or in general?
Casey: There’s just a long-standing history of kind of diet culture. These are the messages that we’ve been steeped in for so long. And definitely social media, celebrities, influencers, you know, the rise of Instagram, TikTok influencers who are showing that they look a certain way and they eat a certain way just keeps putting it in our faces and on our minds that, “Oh, if I want to look that way or be healthy like that person, I have to eat that way.” And it’s often driving people to the quick fix, right? The sexy, fast, low-calorie diet that will help you drop the pounds very quickly. But my big thing is that a lot of those plans and things that we’ll talk about today, they’re not super sustainable. They might get you those results, but what happens when you stop? And the truth is the good, you know, long-term way to do it is slow and gradual weight loss, you know, with working with a dietitian and maybe a coach, rather than just a program that’s gonna overcharge you for false promises, essentially.
Dr. Fox: All right. So I just wanna try to differentiate between two possible messages that people might be hearing, and just so I can understand which one you’re trying to give. Message number one would be, you know, if you are a little bit overweight, or you feel like you have some extra pounds, but you overall live a healthy lifestyle and eat, you know, pretty healthy, don’t bother doing anything. Like, you’re fine, keep going, keep moving along, you’re okay, you know, this is life. Versus yes, we can get you to lose that weight you want to lose, but it has to be sort of the long game. It’s gonna take a while and has to be from slow changes over time. Or is it both messages?
Casey: I think it’s both. Right? I think if you do have valid concerns about your health, or you even just want to look a certain way for appearance’s sake, losing weight is an absolutely valid path to pursue. You know, I don’t have a problem with someone wanting to pursue weight loss. But the second point that you made that is going to be the slower and steady more long-term game is, I think, shown scientifically to be the most helpful when it comes to resolving those health issues.
Dr. Fox: You know, and just we got into the issue of, you know, there’s too much focus on body type and there’s too much focus on size. You know, if someone is whatever weight they are, and they’re healthy, and they are consuming healthy foods, and they are physically fit, should they feel compelled to try to lose weight is really one of the questions.
Casey: Right. And this is something I’ll talk about, you know, with our patients who are pregnant as well, and certainly outside of pregnancy is that, you know, our weight, our body size is not something that we all have fully in our control. There are so many factors at play. There’s genetics, there’s our socioeconomic status, our environment, work stressors. So the number on the scale is not something we can always control. So someone can be in a, you know, larger body, maybe “overweight” or obese BMI, but be eating a really well-balanced diet and have amazing blood levels and be metabolically healthy. So for them, yeah, they might not have to do one of these or feel the pressure to, just to shrink their body, which might be completely unrealistic.
Dr. Fox: Yeah. And I think what you said earlier is true and it fits with this, that it’s really there’s nothing wrong with someone wanting to lose weight, either because they want to look a certain way or because they want to feel a certain way, or because they think they’re going to be healthier. And that’s great. You know, and then there’s strategies, and we’re gonna talk about them today. And it’s also not the message that hey, whatever weight you are, you know, everything’s wonderful because there could be health concerns. But the point is, if you are sort of eating a healthy diet, and have a healthy lifestyle, and you’re, you know, active and exercising, ultimately, that’s a much better way to keep you healthy in the long-term than trying to get to a certain number or a certain size at the endpoint.
Casey: Yes, exactly. Because someone could be in the outward appearance, you know, thin and you would pass them on the street and think, “Oh, wow, they must be so healthy.” But really, they’re guzzling soda and eating Oreos all day long. And their genetic maybe helped them to stay in a smaller body size.
Dr. Fox: Is eating Oreos all day long not good? Is that your professional opinion? Because then I’m screwed.
Casey: If you dip them in peanut butter, it’s adding protein.
Dr. Fox: Right. I need to know. All right. Oreo dip in peanut butter, there you go. You heard it from Casey. She’s a professional. So let’s talk about some of the particular ones. And we sort of came up with a list together. And this is in no specific order. It’s all just, you know, not in order of preference or order of frequency. But I’m gonna throw them out at you and we’re gonna talk about sort of what they are, what is the principle behind them, you know, why they might work or why people claim they might work, and then just get your opinions on it. And again, these are opinions. Some things will work for some people and not for others, but we’re just talking general. So let’s start with the keto diet. So what exactly is the keto, K-E-T-O, diet?
Casey: Keto is kind of the shorthand version for ketogenic, right? So what that means is, it’s a way of eating where you’re restricting carbohydrates so that you’re putting your body into a state of ketosis. Meaning that rather than using carbohydrates for your energy source, you’re gonna start to burn fat for your fuel. And that would then help you lose weight.
Dr. Fox: Now is the thought that it works because since you’re eating carbs, you’re probably eating fewer calories as well? Or is it really meant to be like a metabolic shift that’s gonna cause you to lose weight? I mean, even if you have pound for pound, the same amount of calories, if they’re all non-carbs, your body will process them differently.
Casey: Yes, exactly. Because this could still be a very calorie-dense diet. Obviously, you know, someone’s being asked to consume, what is it? Seventy percent, 80% of their calories from fat, and then 10% to 20% from protein, and then the rest carbohydrates. So it’s pretty calorie-dense. Yeah.
Dr. Fox: Right. And this one is pretty hard, right? I mean, it’s very restrictive to knock carbs out. Because it’s things you may not even know, right, you know, things you cook with and whatnot. I mean, do you have people on a keto diet ever and try to help them with that? And how difficult is it?
Casey: You know, I haven’t had people following, you know, the strictest form of a keto diet. Which would mean that you’re consuming less than, you know, maybe 20 grams of carbohydrate a day, which is very small, that’s equivalent to like one to two slices of bread. So I’ve had some people come to me doing it more out of concerns for like their blood sugar levels. So obviously, if we cut out carbohydrates, you think, “Oh, my blood sugars are going to be incredibly low.” Which sounds like it would be true, but I’ve worked with people to actually help them increase their carbohydrate intake a little bit through carbs such as fruits, vegetables, whole grains, you know, beans, things like that, and they’ve actually seen improvements in their blood sugars.
Dr. Fox: Interesting. Now, keto has been used for certain medical conditions. I know that there’s data on it for people with epilepsy, with seizure disorders, and people have claims for other conditions, but it’s not really proven for them as well. So that’s sort of still being investigated. But I think as far as I know…again, this isn’t my expertise. As far as I know, I think it’s really just epilepsy where it’s used more commonly by doctors.
Casey: Yeah, that’s how I learned about it in school was that for pediatric epilepsy, or the highly-supervised structured diet to go into the state of ketosis. It’s kind of being studied for, you know, Alzheimer’s, other neurological conditions. But as you said, there is not much strong data supporting it.
Dr. Fox: So is this something, number one, that works? And number two, is it something that you would…are you a fan of it? Let’s do that, the KC, you know, thumbs up, thumbs down, or neutral.
Casey: It can be pretty effective to help you drop weight really rapidly. A lot of that weight can be initial water weight at first. Because when we’re cutting out on these carbs, the water just goes with it. It is helping to shift your diet maybe away from consuming more refined carbohydrates, sugars, processed foods, and things like that. But I would say overall, I give keto a thumbs down because it is encouraging you to restrict major food groups. Your intake of fruits, and vegetables, and fiber are incredibly low. So you’re gonna suffer from eating nutrient deficiencies, constipation, not a fun way to go about your day. And we also don’t know the long-term effects of this diet. Because we’re eating so many foods that are high in saturated fat, it could be leading to heart disease down the line. We haven’t seen that yet.
Dr. Fox: Got it. Okay, so thumbs down. And another pointer, it’s not good to live your day, both nutrient deficient and constipated.
Casey: That sounds like a terrible…
Dr. Fox: That’s a tough weekend. Yeah.
Casey: Unless really like [inaudible 00:12:38]. I don’t know.
Dr. Fox: Yeah, yeah. All right. So instead of talking now about restricting food groups, let’s talk about time-restricted. So there’s a really big concept now related to intermittent fasting, or sometimes referred to as time-restrictive feeding. So what exactly are those and what’s the principle behind them?
Casey: So there are a few different ways to do intermittent fasting. Kind of the two popular ones are where you’re doing a 16-hour fast, and then you have the rest of the 8 hours of the day, that window where you can eat ad libitum, meaning there’s no calorie restrictions. The other popular way is to kind of do five regular days and two full-fast days. Kind of similar with keto, it can really help with weight loss. There’s a bit more information on how it can help decrease inflammation in the body. I’ve seen studies that it deals with our insulin profile, because we’re not stimulating the body to kind of eat so frequently, that it could help reduce your insulin levels. So there’s, in some, a little bit more metabolic benefit behind it I’ve seen.
Dr. Fox: Yeah, there are people who are really big proponents of this both in terms of, you know, people frequently are more able, let’s say. Just easier for them to not eat at all for X amount of time, rather than I just can’t eat certain foods because they wanted. Some say, “All right, you know, if I can have that whatever it is four hours from now. Okay, I can make it that far.” So in terms of just being doable is number one. And number two, that they feel there’s tremendous health benefits. I would say this is kind of tough also because your schedule has to be amenable to it. You know, if you have an eight-hour window to eat but that’s also the eight hours you’re at work, that’s tough, right? So it’s not always as easy as it might sound. Have you found a lot of people happy with this and doing it long-term? Or is this something you see people, you know, dropping out of?
Casey: I think it’s one that people do for a while and they stop and then they come back to it. I can’t think of any, like, patients or clients I’ve worked with directly to really follow a bit. But I have a good friend who has actually been doing it for probably two to three years now pretty consistently. And it did improve her health, which I just found so interesting even as a woman. Because intermittent fasting, a little bit of my beef with it for when I see women engaging in it, is that usually our hormone profiles, our blood sugars appreciate eating, you know, a bit more spaced out and consistent throughout the day. A lot of the studies on IF have only been done in men.
Dr. Fox: Oh, interesting.
Casey: And again, like we started out this talk with, some of these diets are gonna work for some people, and some are gonna blow up in the face of others.
Dr. Fox: Interesting. So you’re saying a lot of people are doing intermittent fasting.
Casey: There you go. Yeah.
Dr. Fox: And so, would you give this a thumbs up, a thumbs down?
Casey: I would give it a middle thumb.
Dr. Fox: All right, let’s move to something that a lot of people try, and others have no idea what they’re doing. This is the apple cider vinegar diet. So that just sounds pretty gross. So what’s going on there?
Casey: Thankfully, it wouldn’t necessarily classify as a diet of something that’s ruling everything that you eat, but it’s maybe a diet tool. It beams a lot of popularity, whether that be through the actual apple cider vinegar that we’re all familiar with, you know, the liquid form you might use in your kitchen, or like gummy supplements of it. And this one, I’m actually coming around to. I used to totally just, you know, dismiss something a little frou-frouey like this. But there is quite a bit of evidence behind some of the benefits of apple cider vinegar. A lot of the benefits are circulating around weight loss, reducing cholesterol, lowering your blood sugar levels. So with my work with diabetes and blood sugars, it is something that the research is pretty compelling on to use this as kind of a tool to include in your diet, in your eating pattern.
Dr. Fox: Now, I had a friend of mine who was doing this, and he said the way it helped him is, every time he was hungry, he would have a little apple cider vinegar and it tasted so bad that he wasn’t hungry anymore. And then it was sort of, you know, that way. Is that how it’s intended, or it’s really meant to be a metabolic issue?
Casey: I mean, I get where your friend’s coming from, but I think the intent is more yes, the metabolic outcomes.
Dr. Fox: And also, I’ve noticed that the amount of apple cider vinegar in those gummies is so little compared to if you took a teaspoon of it. Are those gummies real, or is it just sort of, you know, a gimmick to say you’re getting it when, in fact, you’re just having a candy?
Casey: A great website, a great resource that kind of evaluates the supplements out there, and they test a lot of these gummies that are on the market. And a lot of them, you’re right, are advertised as having a certain amount of the acetic acid, which is kind of the active component. And when they’re tested, they do not have that much. So they’re really not being effective. There are a few out there that actually do contain the levels that, you know, have been studied and shown to be effective. But they can be expensive, they can be mixed with sugar. So I always say, go for the real stuff. Make a salad dressing with it, use those cider vinegar as a marinade and consume it that way.
Dr. Fox: Right. Or just take a teaspoon of it and, you know, bottoms up.
Casey: That too. Yeah, put in some water, go for it.
Dr. Fox: All right. So am I hearing that you’re either at or approaching a thumbs up for apple cider vinegar?
Casey: You know, I’m generally a thumbs up for it. It’s not something I say that everyone needs to be doing daily or, like, become obsessive if they miss their apple cider vinegar shot for the day. But for certain populations, it can definitely provide a metabolic benefit.
Dr. Fox: Right. And there really shouldn’t be any harm to it, I would imagine, other than it tastes bad.
Casey: Yeah, I wouldn’t overdo it. I wouldn’t, like, just be guzzling on it all day long. It can erode, like, tooth enamel and it can cause some throat irritation for some people. In pregnancy, we’re talking about it. It’s kind of tough to find, but we’d wanna try to have the apple cider vinegar be pasteurized. So not the raw one.
Dr. Fox: Right. Let’s move on to one that’s new to me, which is called Noom, N-O-O-M, Noom. So what is Noom for our listeners who don’t know what we’re talking about?
Casey: Yeah, it has blown up on TV commercials. And you might have seen ads for it pop up on your web pages that you’re browsing. But basically, it’s marketing itself as like a personalized weight loss plan. It’s an app on your phone. And the main way that it’s structuring and guiding people to make food choices is kind of on what we call, like, the stoplight system. So it’s categorizing foods as either green, like you can eat as many of these as you want, yellow, things to be mindful of, and reds as like no, no, no, like, these are not good foods to eat. It sets you up with, like, a coach. It has this whole framework, if you want to take access to it, you can weigh yourself and report your weight to your coach, all these other kind of fancy features that are making it seem like you have this big support network behind you.
Dr. Fox: And do you have a big support network behind you? Or do you just have some sort of like AI who’s, you know, spitting back based on what you plug in?
Casey: It is a lot of algorithm figuring it out, but there is another person on the other end. But from what I’ve heard and reviews that I read is oftentimes the advice that comes back from that other person is always gonna be centered around will just reduce your calories. Like, “Oh, if you’re not seeing results, well, you just need to click here.” They’re not really digging into, you know, looking at the holistic picture maybe.
Dr. Fox: Yeah. I mean, it’s not the same thing as having, you know, a dietitian, you know, look at what you’re doing and tailor it specifically. I mean, there’s only so much an app can do, obviously. Have you found it to be successful for people and helpful?
Casey: People lose weight on it. Absolutely. It’s not cheap to do. I think it’s over, what is it? My intern helps me here. Two months is $132. So, you know, if you stick with it, then sure it could help you in the long run. But I think it starts to get pricey.
Dr. Fox: I’m trying to differentiate between that and just this concept of anybody who’s so intimately aware of what they’re eating, how much they’re eating, when they’re eating it, what they weigh, you know, all these things are frequently just themselves gonna lead to weight loss, right? There’s, you know, apps where you just plug in what you eat, and they count your calories or assign points. And just getting on the scale once a week, or whatever it is, for a lot of people, that alone is just their motivation. They’re like, “Uh, you know, like, I gained 2 pounds. So I gotta, you know, cut back.” And it’s gonna help as opposed to doing nothing. So I’m curious how much of it is just getting people sort of aware of what they’re doing versus the actual advice.
Casey: Accountability is huge. You know, I met with one of our patients today who just she preferred that app-tracking approach, because it gave her a parameter. Even though she was herself reading a nutrition label and was very nutrition savvy and could, you know, look at a product and say, “Okay, yep, that has maybe more fat and carbs than I want,” plugging it into the app was somehow and for some people just give them that extra level of accountability or reassurance to go off of.
Dr. Fox: Got it. Okay. And how would you differentiate that from intuitive eating, which is another diet, so to speak?
Casey: Well, again, the focus of Noom is, at the end of the day, calorie intake. It’s much less the focus when it comes to intuitive eating. There is no tracking with that, but this is asking you to track, it’s also putting labels on things. So it’s categorizing things as basically good, neutral, or bad. And when we start to assign, you know, moral value to foods, which have no moral value, then I think that just keeps us trapped in that sticky diet culture realm.
Dr. Fox: Does that mean Noom is a thumbs down for you?
Casey: I’m a thumbs down on Noom.
Dr. Fox: Okay. So, differentiate that from intuitive eating.
Casey: Well, intuitive eating, it’s not a diet. It’s an approach to listening to your body and starting to kind of break down diet culture and diet rules that you’ve learned throughout your lifetime and have implemented. It’s a framework based on 10 principles that all kind of focus on, again, you know, saying no to kind of what we call the food police or, like, making peace with food, rejecting this mentality of needing to be on a diet, talks more about listening and honoring your hunger and fullness cues. And then there is a component on nutrition. Like actually, how do we implement what we call gentle nutrition? So it’s really more centered around approaching food and nutrition through more of a self-care lens. And it’s allowing you to make the decisions about how much you’re gonna eat, when you’re gonna eat, what you’re gonna eat.
Dr. Fox: That sounds good. But how does that work practically? Right? So if someone says, “I’m gonna start intuitive eating,” what does that mean? Do they go to a website and read these things? Or there’s, like, a list of, you know, tenants that there’s, like, a mantra they have to chant every day? Like, what happens?
Casey: It’s actually a book. So two dieticians, Elyse Resch and Evelyn Tribole wrote this book back in the ’90s. Since the start of their work, there’s been dozens and dozens of studies in support of intuitive eating and how that interplays with certain health conditions, weight loss, blood sugars, you know, so many things. And yeah, it’s 10 principles. So there is the book that kind of gives you the foundation on the approach of the diet, they also created a workbook that practically helps to walk you through each of the principles. So there’s exercises, self-reflection, questions to ask yourself. And this is a hard process to do on your own, quite frankly. I think some people can be successful with implementing a lot of the principles on their own. But when it comes to, let’s say, like making peace with food, we can’t just tell everyone to just start eating the Oreos. Like, they’re okay. They’re not bad. Just start eating them and your health will be fine. It doesn’t work like that. It has to be a little bit more systematic in how you confront these food rules. So I think a little support along with the literature and the book resources is helpful.
Dr. Fox: And what would be an example, let’s say, of one of these principles, something that maybe one of our listeners would not think intuitively, for example?
Casey: Making peace with food, right? So someone will come to me and they’ll often tell me that certain foods they feel, like, addicted to, or that they just can’t control themselves around. Like, once I start with the bag of m&m’s, I can’t stop. Like, I have to eat the whole thing. And then that spirals into, you know, a cycle of feeling guilty about that binge, and then you restrict, and this just repeats itself. So what intuitive eating will help you to work through is systematically, you know, doing an exercise, kind of having a moment with that, whatever food it is that you put a rule on, you held up on a pedestal as like a bad food, and walking through an eating experience, and really becoming in tune and in touch with, “Well, how did I feel actually eating that?” Reflecting on, “Well, if I ate more of that, would it make me feel uncomfortable? How would that translate into how I feel, essentially?”
And it doesn’t happen just you do that experiment once and you’re cured, you’re done, you’ll never binge on the m&m’s again. It takes a lot of actors in different scenarios to come to terms with, you know, either I really don’t even like that food to begin with, I was just eating it out of habit, or I was bored. Or I really do like that food, but I don’t feel so great when I eat so much of it. Next time I’m gonna be more mindful, maybe have a snack before I plan to have that treat. And, you know, there’s lots of different strategies to kind of keep those foods in our life, but in a more mindful way that kind of respects how we feel in our body.
Dr. Fox: And so that would probably go along with this thing we talked about earlier, more like the long game that, you know, it doesn’t mean that on day one, you cut m&m’s out of your diet. But it means that over time, over a long period of time, you may either not be eating m&m’s, or you’ll be eating them less, or eating few at a time, or whatever it might be, and that so your overall health or eating is better, rather than just sort of, like, having it or not having it.
Casey: Exactly. Yeah, it’s kind of giving ourselves that permission to recognize that all foods are good foods, all foods are allowed to be had. But yeah, so once you allow yourself that permission, sometimes that forbidden food or that “bad food” that you thought of, it becomes less attractive. That ice cream can sit in your freezer for a month and you can have it, or you cannot have it. So it is that long-term…healing your relationship with food long-term.
Dr. Fox: Cool. So I’m guessing you’re a thumbs up on this?
Casey: I’m a thumbs up, yeah.
Dr. Fox: How does it differ from Weight Watchers or something like Weight Watchers? You know, we’re not plugging it. We’re not against it. Just people have heard of it, this concept. What do they do there and programs like it? And how is that different?
Casey: Weight Watchers, Noom, all these, you know, diets that aren’t selling themselves as a diet, they’re kind of saying that this is a lifestyle, right? This is something that you’re meant to do long-term. At the end of the day, most of them are still asking you to track, be aware of what the calories are, kind of have a sense of what are the green foods and the red foods, right, what are the good foods, what are the ones you should avoid. And a lot of them are still based on that premise of intentional weight loss through calorie restriction is the only goal.
Dr. Fox: Yeah. And plus, in Weight Watchers, you know, if you do it sort of the traditional way, you gotta get up on a scale in front of a room of people, which is terrifying. So that’s incentive to not eat for a week.
Casey: Yeah. With the way everything is virtual now, I know there’s a lot more that people do from home. But yeah, having to do that even just in your home, to get on that scale every day or every week can be mentally really challenging for people.
Dr. Fox: And so, what do you feel about it? Is it something you recommend to people or something you don’t because it’s a short-term fix?
Casey: I think they can bring good awareness, right? If someone is like that nutrition movie, and they really don’t know a lot about how to build about a balanced meal or macronutrients and, you know, the importance of getting in a lot of vegetables, you know, I think Weight Watchers and Noom and diets like that do a good job of bringing that awareness to it. So my question is always well, what happens when the diet goes away? When you deactivate the app, you delete it, you don’t have that community anymore, did you learn something? Can you carry it going forward?
Dr. Fox: All right, let’s talk about plant-based or vegan diets. Again, more so, you know, it’s called a diet is sort of different because people don’t usually do temporarily. They say, “All right, I’m gonna do this as long as I can.” How do you feel about that?
Casey: I’m pretty pro-plant-based eating. Because, you know, aside from if you’re choosing to go, let’s say, vegan for whether that’s, you know, ethical reasons, animal rights reasons, or whatever, it’s not really, you know, those people, yes, are more restricting certain food groups. But the term maybe more plant-based is great because it is encouraging people to eat more fruits and vegetables, legumes, nuts and seeds, which are all incredibly healthy foods.
Dr. Fox: And so, someone says they want to go plant-based, not for ethical reasons. Do you try to get them on it 100%? Or do you say, you know, “Listen, let’s get you 90% plant-based and 10%, you know, through, you know, animal products or whatever it is.”?
Casey: Yeah, I think it depends on where they’re…you know, what phase of their eating and what their nutrition looks like when they come to me, right? If someone’s, you know, on kind of the all-day Starbucks, McDonald’s diet, if I can get them eating just more fruits and vegetables, and maybe swapping their morning doughnut for an oatmeal, or having a yogurt, I’m super happy. They don’t maybe need to start moving away from their chicken sandwich or their, you know, beef meatballs completely. So it’d be a slower process for, I feel like, the majority of people.
Dr. Fox: Do you feel that there’s a real benefit to being 100% plant-based versus predominantly plant-based?
Casey: I think if you are doing it in a certain way, there can be a lot of benefits, right? When we are completely restricting animal products, we’re cutting out a lot of nutrients. So it will take some serious supplementation being on top of blood levels of certain nutrients. So if you’re not feeling super confident that you know what those nutrient deficiencies might be, then I would work with someone who does, a dietitian, a doctor, a naturopath who could help to make sure that you are supplementing at the appropriate levels, because some of the deficiencies, you know, can be pretty severe.
Dr. Fox: Right. Because I mean, I know people who say, “Hey, I’m gonna try vegan diets.” And they can, they can buy products and sort of go that way for a while, and maybe very long while but they’re really not sure because they cut out foods that they were having their whole life. And so how are they getting iron, for example? And they may have no idea they’re getting iron. And again, vegan diets can have all of those things if you know what you’re doing. It’s not, A, intuitive, and it’s not gonna just, by default, give you all of the nutrients you might need.
Casey: Right. And I think you just mentioned something about, like, packages too. Because that’s the other way that people can interpret a vegan diet is they’ll go out and they’ll buy all of the plant-based products, which are oftentimes filled with a lot of other additives that are highly processed, processed forms of soy and things like that. So not always the most health-conscious, smart need to make if that’s how you’re going to eat a plant-based diet, eat a vegan diet solely with those products.
Dr. Fox: So I’m hearing a thumbs up with some caveats.
Casey: Yeah, exactly.
Dr. Fox: Let’s switch to something that’s totally different, which is the Optavia diet. What is the Optavia diet?
Casey: So Optavia, it’s not one that you’ll hear about a lot, but I’ve heard of it through the interwebs and seeing some people on it. But it’s another kind of coaching program, but this one is centered around package meals, essentially. So the plan is that you can have kind of one, for lack of a better word, “real meal” where you’re cooking and you’re choosing a protein, two servings of vegetables, a little bit of fat and some starch. So that’s your one, like, real food meal, and the rest of your day is made up of these about 100 calories per serving, what they call fueling. So you’re having maybe four or five of those throughout the day. So what it totals to is someone consuming anywhere from about 800 to 1,200 calories a day.
Dr. Fox: That’s not a lot.
Casey: It is not a lot. You know, a toddler needs about 1,200 calories a day. So seeing a grown woman do something like this is a little uneasy.
Dr. Fox: And I think that they say that it’s effective, meaning that these feelings keep people…based on what’s in them, it keeps people from feeling hungry so they can sort of sustain that very low-calorie diet for X amount of time. Have you found that to be true that at least in the short-term, people lose a lot of weight with these?
Casey: Oh, probably. Yeah. Again, same principle, if we’re gonna cut our calories, you know, 500 under what we need, you’re definitely gonna lose weight rapidly. And a lot of the products are, like, super high in fiber, or they’re using some, you know, artificial forms of fiber. So sure, it’s gonna keep you feeling fuller for longer. You’re also gonna eat maybe more frequently because you have these fuelings four or five times a day. But yeah, like you said, in the long-term, this would be one really tough to keep buying into for an extended period of time. And I don’t think it teaches you very much in the end.
Dr. Fox: Right. Because presumably, when you stop, unless somehow this is retooled how you eat, in the long run, it’s not gonna do that much and the weight will probably just come right back on.
Casey: Yeah, exactly. Unless you’re gonna start, you know, your own kitchen, recreating these fuelings yourself, you know, you’ll be buying into the program and the packaged food forever if you wanted to continue it.
Dr. Fox: Right. Right. So spoiler alert, I know you’re a big fan of the next one. So we’re gonna talk about it. Tell us about the Mediterranean diet.
Casey: This is the gold standard. This is it. This is a really big, studied diet for a lot of different health outcomes. So cardiovascular, blood sugar, cancer, the Mediterranean diet really has had a lot of benefits. So it’s focusing on tons of plant foods, fruits, vegetables, whole grains, nuts and legumes. It’s limiting things like red meat, but you can have plenty of fish, you can have chicken, you can have dairy, eggs. So it’s pretty wholesome, you know, I would say.
Dr. Fox: And what’s interesting is, so you’re talking about all the things that people would…you know, that people eat. What does it not include, right? What does it cut out?
Casey: So it’s really just cutting out a lot of the kind of ultra-processed food. So a lot more packaged foods that are gonna be higher in salt, fats, sugar, you know, sweetened beverages, trying to limit your intake of added sugars, you know, even honey, maple syrup. And then red meat is really the only thing that is limited in the diet.
Dr. Fox: Right. It’s not eliminated, it’s just limited. You don’t have a lot of it.
Casey: Yeah, I’m trying to remember if it’s, like, specifically on the pyramid of it. If it is, yes, very limited.
Dr. Fox: What I find so interesting about the Mediterranean diet is there’s a lot of overlap between that and a vegan diet, but obviously not complete overlap because of, you know, the dairy, the fish, chicken. So on the one hand, it sort of supports a vegan diet, so they each credit each other. On the other hand, it sort of discredits it. And I just think that, you know, conceptually, what it shows to me is that there’s different ways you can go with this. Meaning if you’re someone who really wants to go vegan, great, like, do it. But if you’re someone who’s like, “I don’t wanna give up dairy, or I don’t wanna stop eating eggs, or I don’t wanna, you know, not eat meat ever,” there’s a way to do it that sort of takes a lot of the principles from the vegan diet as well and adds it to, you know, “regular diet” and allows you to be really healthy.
Casey: Yeah, I totally agree. In my mind it’s kind of the question of like, well, do I wanna supplement with this or not? Right? Because the Mediterranean diet, we can consume fatty fish and, you know, get a lot of our DHA, omega-3 fatty acids through the fatty fish. On a vegan diet, you’re not consuming that. So you would need… We don’t find DHA in high amounts in a lot of the foods. So that’s something you need to supplement with both ways of eating, and with a supplement could get you to be…yes, meet all your nutrient needs and very healthy.
Dr. Fox: And what’s the best way someone would learn about a Mediterranean diet? Is it by seeing someone like you? Or is there a lot of good information in books or websites?
Casey: It’s tough to twist the Mediterranean diet. So a lot of what you will find online or from a book is it is what it is. It’s a pretty straightforward diet because it’s not overly restrictive. So I think a lot of the reading you can find on your own is pretty accurate. But a dietitian can certainly help you to implement it, meal plan, help give you ideas, recipe resources, and can kind of take you that step further.
Dr. Fox: So we’ve gone through a bunch of them, you know, just my own review taking notes here. You give a thumbs up to apple cider vinegar, intuitive eating, the Mediterranean diet, a vegan diet, you’re sort of plus-minus on intermittent fasting and time-restrictive feeding, and you see a role potentially for something like Weight Watchers or Noom if it’s gonna teach someone principles, but not so much in the long-term, and you’re not a big fan of Optavia or keto. Correct?
Casey: Great summary. Yeah.
Dr. Fox: All right. So how do you decide if someone comes to you, of the ones that you like, which one to recommend? How do you go through that process with somebody? Because there are so many options here and they’re different, obviously.
Casey: That’s a good question. Because I think in my mind, even when I meet someone and I assess what their health concerns are, what their goals are, what their labs look like, the first question in my mind isn’t what diet do I put them on? Right? It’s kind of like, well, what are small changes that maybe we need to make to improve the overall quality of their eating? And what’s gonna help them feel their best? So it’s a lot of discussing what their motivations are, what’s feasible for them. And then ultimately, just trying to shift the needle towards a more whole foods, well-rounded, balanced, not restrictive way of eating, which I think we saw could fall into many of these approaches.
Dr. Fox: Short-term it might work, you may take off pounds if you need to for a certain, like you wanna fit, you know, inside a pair of jeans, or a dress, or whatever it is, all right, you know, okay. But if you want it to be lasting and to actually be sustainable, you gotta play the long game.
Casey: Yeah, exactly. Which is really hard, but worth it. I think it can happen.
Dr. Fox: Awesome. Casey, thank you so much. Happy New Year.
Casey: Yes, you too.
Dr. Fox: Hope this is really helpful for our listeners. I imagine it will be. And then, obviously, people can reach out to you. How do people find you? Because you’re everywhere. You are ubiquitous. Where do we find you?
Casey: Well, primarily, you know, at MFM through [inaudible 00:40:00]. You can find me there. And then, otherwise, most of my time is over on Instagram. So my handle there is eat.well.together where I focus on kind of a non-diet approach to pregnancy and diabetes care. So, yeah, that’s usually where I am.
Dr. Fox: All right, Casey. Thank you so much. Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com, that’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.
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