My general nutritional philosophy is in accordance with the total diet approach put forth by the Academy of Nutrition and Dietetics in their position paper Total Diet Approach to Healthy Eating. With the exception of persons who have certain medical contraindications, “all foods can fit.” What this means is that favorite unhealthy foods do not need to be completely avoided, but they should not make up the bulk of a person’s typical dietary pattern, and they should be consumed in moderate portions. I eat cheesecake on my birthday, enjoy homemade apple pie in the autumn, and encourage others that they often do not have to permanently avoid foods that they enjoy to meet their health goals. However, some do need to cut out specific foods as part of their medical nutrition therapy. For others, they may wish to cut out a trigger food(s) to help with weight management. It is nearly impossible to create one-size-fits-all nutrition rules that are appropriate for all persons.
I understand that people have different budget constraints, storage space, and accessibility to food, so I try to provide a variety of options to meet individual needs. For example, fresh, frozen, canned, and dried forms of fruits and vegetables can all provide advantages in different situations. There is no one right way to achieve wellness.
For the healthy population, I recommend dietary patterns that fall within the Acceptable Macronutrient Distribution Ranges or AMDRs. These are the ranges of intake that are “associated with reduced risk of chronic disease” while providing adequate essential nutrients. For adults, these ranges are as follows:
- Carbohydrates 45-65% of calories
- Fat 20-35% of calories
- Protein 10-35% of calories
There are people with certain conditions who undergo supervised medical nutrition therapy which requires diets that provide macros outside of these ranges. People on low carbohydrate diets for diabetes (more on this below) and/or for weight management will often have targets outside of these ranges. Another example is the use of ketogenic diets for intractable epilepsy. Often people want to try diets in “off-label” ways; for example, many are now adopting ketogenic diets for weight loss purposes. While the evidence builds for the use of ketogenic diets in weight loss therapy, registered dietitians can play a role in helping to make sure that the person is getting all of the essential nutrients with this diet. If a person wants to try something out-of-the-box, I will respect their self-determination by helping them to do it in the safest way possible. It is difficult to say whether a particular strategy will be sustainable for weight loss for any one individual and there does not seem to be one “right” way.
There are certain weight loss interventions that have been shown to work for people using the gold-standard of scientific inquiry, the randomized controlled trial. These are the methods that I recommend to people who would like to achieve healthy weight management. The Academy of Nutrition and Dietetics published a position paper in 2016 entitled Interventions for the Treatment of Overweight and Obesity in Adults. Effective interventions mentioned in the paper were:
- Low-calorie diets
- Portion control
- Low-carbohydrate diets
- Structured meal plans
I can personally attest to the effectiveness of some of these methods because I have been able to maintain a 70-pound weight loss for over five years by tracking calories and using portion control. I understand that some have issues with interoception and cannot achieve weight loss intuitively. There is no need to feel shame about that! While calorie tracking can be very helpful to those struggling with overweight and has not been shown to be associated with eating disorders, it is important to mention that it is not appropriate for those who have been diagnosed with a restrictive eating disorder. I also understand that weight stigma and weight bias are important issues. Sometimes the bias is not overt; rather the offender might have unconscious negative attitudes concerning size diversity, an implicit bias. I highly recommend taking the free Implicit Association Tests to check your own biases. https://implicit.harvard.edu/implicit/takeatest.html
Low-carbohydrate diets are a topic that has been receiving a lot of attention in the media and from the public. In October 2018 the American Diabetes Association published a position paper that listed low-carbohydrate diets as one of the interventions that have shown efficacy for diabetes management. They defined low-carbohydrate diets as those that contain <26% kcal from carbohydrate and they specifically mention that diets with 26-45% kcal from carbohydrate did not provide benefit. Dietary factors that improve glycemic control in persons with diabetes also tend to be helpful in weight management. These recommendations are far outside of our current AMDRs but may help reduce chronic disease risk in individuals through improvements in A1C and/or body weight. I think that it is important to keep an open mind; it appears that there is a subset of our population who may fare better on a low-carb diet.
Artificial Sweeteners and Sugar Alcohols
Water is the best choice for hydration for many people. For those suffering from taste fatigue, there are many fun ways to infuse water to add flavor without calories, or the person could try an unsweetened tea. Dietitians often get questions about artificial sweetener
For some people with diabetes who are accustomed to sugar-sweetened products, nonnutritive sweeteners (containing few or no calories) may be an acceptable substitute for nutritive sweeteners (those containing calories such as sugar, honey, agave syrup) when consumed in moderation. While
useof nonnutritive sweeteners does not appear to have a significant effect on glycemic control, they can reduce overall calorie and carbohydrate intake. Most systematic reviews and meta-analyses show benefits for nonnutritive sweetener use in weight loss; however, some research suggests an association with weight gain.
The problem is that we do not know what moderation means for artificial sweeteners. While the FDA has created acceptable daily intakes based on a person’s weight, companies largely lack transparency in sharing exactly how much of the artificial sweeteners are in their drinks. I am hoping that this changes at some point in the future because I think consumers have a right to this information. I have not seen any rigorous studies where humans are given doses of artificial sweeteners under the FDA’s ADIs that can connect these substances to cancers. Information from the National Cancer Institute states that studies have “not demonstrated clear evidence of an association with cancer in humans.” Each person needs to decide the dietary approach that is right for them. Personally, I was careful to avoid artificial sweeteners before my cancer diagnosis, but I am less concerned now.
Sugar alcohols have chemical characteristics of sugars and alcohols. They contain fewer calories than most carbohydrates (2 calories per gram versus 4 calories per gram). Multiple randomized controlled trials have found that sugar alcohols are well-tolerated in doses of up to 10 to 15 g/day, while high doses (>30 g) increase the risk of gastrointestinal disturbance and are not recommended.
All content on this website represents general informational services only. None of the information on this site should be considered a medical diagnosis or a treatment plan. Please consult a registered dietitian or physician who is familiar with your individual medical history before initiating a new dietary program.