ALLISON AUBREY, HOST:
Let's talk diet. I bet you can name your fair share, and let's be real. A lot of them are absolutely absurd. I mean, there's the cayenne pepper diet, the baby food diet, that diet where you can only eat grapefruit and eggs. What's the craziest diet you've ever heard of?
DAVID KATZ: I had a friend once tease me about what would be the next big diet. And I think he came up with the pickle juice diet.
AUBREY: Ah, pickle juice - haven't heard that one.
KATZ: And then I recently saw something along those lines, and I thought...
KATZ: ...Boy, I mean, this is life imitating art or some crazy thing.
AUBREY: This is your NPR LIFE KIT for healthy eating. In this episode, how to find a diet that's right for you, and it probably won't be the pickle juice diet.
KATZ: (Laughter) I don't think so. I don't know. Maybe it's right for somebody, but I've never met them.
AUBREY: With the help of one of the country's top diet experts, we're going to cut through all the nutrition noise and tell you how to eat your way to a healthy life - all of that and more right after this.
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AUBREY: I'm Allison Aubrey, and I cover health and wellness here at NPR, including a lot of diet stories. I'm constantly being sent all the latest diet books. And believe me - there are tons of them. It makes me think that we're kind of losing our way.
KATZ: And it's pretty easy to propagate confusion about diet because it's a massively complicated variable.
AUBREY: David Katz is going to help us sort through the world of diets. He's a preventive health physician at Yale University, and he's part of a panel that votes on the U.S. News and World Report's annual list of best diets. The list is really aimed at helping people cut through the confusion. And there's a lot of confusion. We heard from a lot of people, like Mary Robinson (ph).
MARY ROBINSON: When it comes to eating a healthy diet, the thing that confuses me the most is, how do I know I'm being healthy? So I think that it just is overwhelming (laughter) to try and figure out what is going to be best for me.
AUBREY: So let's try to make this simple, and this is your first takeaway. When you pick a diet, you've got to choose one that's compatible with your life. So ask yourself these questions.
KATZ: What do you like to eat? Who do you tend to eat with? What sort of fits diet comfortably into your lifestyle? So, you know, I think the idea that the diet that's going to work best for you is the diet you're actually willing to practice is where the conversation starts.
AUBREY: So once you've thought about these questions, then you can consider all the different diets out there. After all, a diet is just what you eat.
SAM SANDERS, BYLINE: I love to eat. I love to eat.
AUBREY: To help us out, I've brought in NPR's Sam Sanders. He's the host of It's Been A Minute. He's going to help us go through some of the most popular diets ranked by U.S. News, and he brought a snack with him.
SANDERS: I was walking the halls saying hi to folks, and everyone was like, oh, my God. Sam. Hey, there's pizza.
SANDERS: So you're seeing me now eating a slice of pizza.
AUBREY: Let's start with a diet that consistently gets the highest marks. When I say Mediterranean diet, does anything come to mind?
SANDERS: Olive oil.
AUBREY: Olive oil. Good.
AUBREY: And more...
ALLISON AUBREY AND SAM SANDERS: Olive oil.
AUBREY: So here's the lowdown. Sam's going to read us these descriptions of these diets as described by U.S. News. And here's how they talk about the Mediterranean diet.
SANDERS: I will read it for you. (Reading) This diet emphasizes eating fruits, veggies, whole grains, beans, nuts, legumes, olive oil and flavorful herbs and spices, fish and seafood, at least a couple of times a week, and poultry, eggs, cheese and yogurt in moderation, while saving sweets and red meat for special occasions. Top it off with a splash of red wine if you want, and remember to stay physically active and you're set.
AUBREY: Now, traditionally, the Mediterranean diet is followed by some of the most long-lived populations out there. And these regions are called blue zones.
KATZ: There are five blue-zone populations identified to date. These are the people around the world who most routinely live to be 100 and don't get chronic disease. Only five have been identified thus far, and two of them are in Mediterranean countries - one in Ikaria, Greece; one in Sardinia, Italy. And they both have the dietary pattern we just described.
And both of these dietary patterns are high in fat, but it's good fat. And that would sort of be the signature feature of traditional Mediterranean diets - wholesome food, sensible combination. But because of the emphasis on olives and olive oil, nuts and seeds and avocado, the total fat content tends to actually be higher than the typical American diet.
AUBREY: So who might this diet be good for? Well, if you don't want to count calories and your goal is overall good health, you may want to give the Mediterranean diet a try. But make sure you buy good olive oil. And here's a hint. The good stuff often has a best buy or a harvest date on the back of the bottle.
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AUBREY: In some of our other episodes, we talk healthy fats a lot more. But let's now talk about the DASH diet. Have you ever heard of it?
SANDERS: I've never heard of it.
AUBREY: I don't think anyone's heard of it.
AUBREY: But it's actually one of the most researched diets of all time. What is it?
SANDERS: The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is promoted by the National Heart, Lung, and Blood Institute to do exactly that, stop or prevent high blood pressure. It emphasizes the food you've always been told to eat - fruits, veggies, whole grains, lean protein and low-fat dairy, which are high in blood pressure-deflating nutrients like potassium, calcium, protein and fiber.
AUBREY: So what do you notice about this diet? It sounds a whole lot like the Mediterranean diet, and that's for good reason. So here is takeaway No. 2. Good diets tend to have a lot in common.
KATZ: People should take comfort in the fact that when we describe good diets, they sound more alike than different. That's absolutely true.
AUBREY: So the building blocks of both DASH and Mediterranean are fruits, veggies, whole grains. They also allow for moderate amounts of eggs, poultry and dairy. And both recommend taking it easy on sweets, sugary drinks and red meat. And one more thing - following a DASH-type diet is linked to a decreased risk of heart disease and strokes. And David Katz says DASH is pretty easy to follow.
KATZ: It's not all that different from the foods most Americans are eating right now. It's just - it's the typical American diet completely cleaned up. So everything will be familiar. I think that's helpful. It's a much less radical shift. So one of the reasons I tend to give high scores to the DASH diet is, yeah, it's a good diet for sure. There are others that I think might be better. But one of the things we're scoring every year is the practicality.
AUBREY: Which goes back to our takeaway No. 1 - the best diet for you is the one you'll actually follow. You know, as you read these, do these seem like diets to you, or do they just kind of seem like - I don't know - strategies?
SANDERS: Yeah, like, I'm used to diets being like...
AUBREY: Half a cup of cottage cheese in the morning.
SANDERS: ...The egg and spaghetti noodle diet or, like, the tapioca pudding and grapefruit diet - like, really, really rigid and really, really limited. These seem much more wide open than I would think diets usually are.
AUBREY: So does that make it more appealing to you?
SANDERS: Oh, totally. I would do these diets. (Laughter).
AUBREY: Now let's talk about a diet that everybody seems to be talking about, the keto diet.
SANDERS: The keto diet emphasizes weight loss through fat burning. The goal is to quickly lose weight and ultimately feel better with fewer cravings while boosting your mood, mental focus and energy. According to keto proponents, by slashing the carbs you consume and instead filling up on fats, you safely enter a state of ketosis, which sounds like hypnosis. Who is doing this? Why?
AUBREY: And what does ketosis really mean? Well, when your body doesn't have any carbohydrates left to burn for fuel, instead it starts to burn fat. And when that happens, your body is in a state of ketosis. It sounds good - right? - because it can lead to some really quick weight loss. But U.S. News actually ranks keto near the bottom of its list for overall best diets.
We heard from Jeff Geer (ph). He followed the keto diet for about nine weeks. And during that time, he says he put mayonnaise on everything.
JEFF GEER: It feels inappropriate to say anything with, like, that much mayonnaise is a cleanse. But, you know, there it was.
AUBREY: And then he hit a snag.
GEER: And so I was just like, all right. Well, here's how Thanksgiving's going to go. I'm not going to go gigantic, but, like, you know, we'll do up some fried chicken. We'll do some Hasselback potatoes, and then, like, the next day, I was like, did every single ounce of the, like, 18 pounds that I lost just, like, come back?
And then I was just like, well, damn. Like, if I can never deviate from really prescriptive, maybe kind of scary medical diets, then what does it look like going forward? Because I - you know, nine weeks or something is intense, but, like, the next, you know, 60 years - oof (ph).
AUBREY: You can probably tell that Jeff is not really a fan of keto anymore. It was just too extreme for him. And David Katz agrees.
KATZ: Amen, Jeff.
AUBREY: David's first strike against keto - he says it's too hard to stick to. And strike No. 2, David says it just doesn't take a lot of the boxes of a healthy diet.
KATZ: This diet is at odds with human health. It tends to be a very low-fiber diet. That's bad for the gastrointestinal tract. We simply don't know that this diet is compatible with human health across the lifespan. Well, you know, to me, that sounds like a game of Russian roulette. It may go your way. It may not.
AUBREY: Researchers are looking into whether a diet like keto might be good for some people, like those at medical risk due to their weight. And keto does rank high on the U.S. News list for best fast weight-loss diets. But David says that's not necessarily a good goal.
KATZ: I think much of the focus, sadly, is still on losing weight. And all too often, it's on losing weight fast. And one of the things that I routinely point out to anybody who's willing to listen to me is that a cocaine binge in lieu of food will result in rapid weight loss. A bout of cholera will result in rapid weight loss. So, you know, where we ever got the idea that losing weight fast meant anything about finding health, I have no idea. But it's wrong.
AUBREY: And David's final knock on keto has to do with the environment. People who are on the keto diet tend to eat a lot of meat. And red meat production requires a lot of land and water. And that's because you need a lot of it to grow the grains to feed the livestock. And that's your takeaway No. 3. If you want to align your eating habits with a healthy planet, think about the environmental footprint of your diet.
KATZ: I don't think, Allison, we can talk about diet and health and not factor in the health of the planet. I really don't. So that's got to factor in to the dietary discussion. It's hard, you know, not to bump into somebody on the keto diet.
And I think that's sort of double bookkeeping. Well, I can do whatever diet I want for short-term weight loss. Oh, yeah. I really care about climate change. Well, then, no. You've got to connect those dots.
AUBREY: And this also goes for other diets that tend to have a lot of red meat, like the paleo diet.
SANDERS: Paleo diets are based on a simple premise. If the cavemen didn't eat it, you shouldn't either. So long to refined sugar, dairy, legumes and grains. And hello to meat, fish, poultry, fruits and veggies. The idea is that by eliminating modern-era foods, like highly processed carbs and dairy, you can avoid or control, quote, "diseases of civilization," like Type 2 diabetes and heart disease, and likely lose weight, too.
Can I tell you my biggest question with this caveman diet?
SANDERS: Why would I want to live like a caveman? (Laughter) Nothing about my life is caveman-ish (ph). Yeah, I'll pass, no?
KATZ: Yeah, a simple premise, but hard to practice because everything that cavemen ate is extinct. We - we saw to that. So, you know, there are no Stone Age foods available. The best you can do is approximated. Two major problems here - first, a lot of people wave the paleo banner as an excuse to eat bacon, pepperoni and hamburgers. There was no Paleolithic pepperoni. So if you want to eat a variety of...
AUBREY: And no pizza joints either in the caveman era.
KATZ: Exactly, right. So a variety of wild plants and game - I mean, if you want to eat only the wild animals you catch, I think that's probably a healthy diet, frankly. But the big problem with this is you need a lot of space to raise those animals if you're going to eat all those animals. And I did that calculation for the current population of the Earth at about 7.8 billion. And it would require 15 times the surface area of the planet.
KATZ: Yeah, seriously.
AUBREY: So basically, it just can't be done.
KATZ: No, Dorothy, we're not in the Stone Age anymore.
AUBREY: So who might diets such as paleo and keto appeal to? Well, people who like the challenge of this strict set of rules and who like a high-protein diet that usually includes a lot of meat, even if it's not exactly what the caveman ate.
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AUBREY: Now let's move on to plant-based diets, beginning with the vegan diet, which you've heard of - vegetarian with no animal products, no cheese, no eggs, no yogurt. We talked to Carol Flood (ph) whose family is mostly vegan, but she has some doubts.
CAROL FLOOD: My biggest challenge is that I'm constantly worried about my nutritional intake. It's more of the conflicting information that I hear from everybody, that, you know, you're not going to get enough protein. You're going to be low in vitamin B12. And, you know, it's just not a healthy diet. It's just constantly making me question what I'm doing.
AUBREY: David has some advice for Carol.
KATZ: So unfortunately, Carol, you know, is getting a certain amount of urban legend. And, you know, there's long been the notion that you're at risk of not getting enough protein if you have a vegan diet. A well-balanced vegan diet readily provides all of the protein that we need.
AUBREY: One of the plant-based diet that has a lot of research behind it is the Ornish diet. It's the brainchild of a physician named Dean Ornish. He's also a professor at UC San Francisco. And U.S. News gives it a top spot for best diets for your heart.
SANDERS: The diet is low in fat, refined carbohydrates and animal protein, which Ornish says makes it the ideal diet. But it's not just a diet. It also emphasizes exercise, stress management and relationships. (Laughter).
AUBREY: Oh, that makes it hard.
SANDERS: (Laughter) That's a lot.
AUBREY: That's a lot to take on.
You know, we laugh, but Dean Ornish has literally spent his career studying how our diets and a bunch of our other habits influence our health. And David Katz says the Ornish diet is best known for something that's pretty remarkable. It's known for how it can help actually reverse disease. And that's a big deal.
KATZ: He has shown, in a study that relied on coronary angiography, that atherosclerotic plaque in the coronary arteries actually shrunk, regressed, with this dietary intervention. And that's a bar no other diet has cleared today.
It, in fact, is the centerpiece of a heart disease reversal program that Medicare will pay for as an alternative to coronary bypass surgery. So that's a pretty powerful indicator that this is food is medicine.
AUBREY: Now, we don't want you to get confused here because we've talked about some diets that are low in fat, other diets that are high in fat. And David says what this really shows us is that the amount of fat in a diet is not the determining factor in whether it's a good or bad diet.
KATZ: Fat content is it really poor measure of diet quality. You can have a high-fat diet that's really good for you. You can have a low-fat diet that's really good for you. What matters critically is that you eat a diet made up of wholesome foods in some sensible combination.
AUBREY: Now let's talk about some diets that you may see advertised on TV. U.S. News gives both of these diets top marks for weight loss. If I say Weight Watchers, what comes to mind for you?
SANDERS: You got the points.
AUBREY: Counting everything.
SANDERS: Yes. Yes.
AUBREY: Read us the definition of Weight Watchers.
SANDERS: All right. (Reading) Weight Watchers assigns every food and beverage a point value based on its nutrition. The things you know you should eat, like fruits and vegetables, are zero points. Those foods help lay a foundation for a healthier pattern of eating. And there's a low risk for overeating them.
AUBREY: Weight Watchers is really known for doing the group meetings, the group weigh-ins. And Jenny Craig offers personalized consulting and meals you can buy. And these diets tend to rank well because they give you rules about what to eat and motivation to stick with it.
KATZ: As soon as you impose any rules, you're better off in terms of weight, at least, and generally in terms of health, too. So these are approaches that basically put training wheels on the bike. You can't fall over now. Just, you know, do what we tell you. And almost any approach that does that and then builds in support for maintaining your balance on that approach is going to be much better than the baseline diet.
AUBREY: So who do you think these diets are really good for? Well, if you like to track what you eat and you like the idea of someone else holding you accountable so you really stick with it, you might want to try Weight Watchers. And if you like the idea of someone else preparing your meals so you don't have to decide what to eat, maybe Jenny Craig. But you're going to have to pay for both of them.
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AUBREY: You know, there are a lot of diets out there, and we didn't even get to talk about all of them. There's Whole30, intermittent fasting, meal replacement diets. And for some of you out there, one of these might just be right for you.
Now, this is usually the point in our episode where we give you some key takeaways, and I know we threw a lot of information at you. But we really just want you to remember these questions when you're trying to choose a diet.
KATZ: What do you like to eat? Who do you tend to eat with? What sort of fits diet comfortably into your lifestyle?
SANDERS: I also hate the idea of making a thing that I love and enjoy that is happy for me, which is food - making it so regimented where it's - to where it's unhappy.
SANDERS: You know?
AUBREY: Why do so many people do that?
SANDERS: I don't know. I'm not about that life.
AUBREY: If you like what you hear, make sure to check out our other LIFE KIT guides at npr.org/lifekit. There, you'll find a guide about how to find money you didn't know you had. That sounds good, right? And while you're there, subscribe to our newsletter so you don't miss anything.
We've got more guides coming out every month on all sorts of topics.
And here, as always, is a completely random tip, this time from NPR intern Leena Sanzgiri.
LEENA SANZGIRI: So if you scratch a wooden floor or furniture in your house, one good way to cover the scratch is taking a walnut and rubbing it up against the scratch. The oil from the walnut will hide the scratch.
AUBREY: If you've got a tip or want to suggest a topic for our next guide, email us at firstname.lastname@example.org. I'm Allison Aubrey. Thanks for listening.
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