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Nutrition Deep Dive - How I Think About Food & Eating · Doctor Turned Health Coach

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Welcome to doctor-turned-health-coach. My name is Dr. Ashwari,
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family medicine physician-turned-health-coach.
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And every couple of weeks, I try to do a deep-dive topic.
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So this is going to be an in-depth topic. It's going to be very chill,
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relaxed. I'm just going to share everything that comes to my mind when I reflect on these topics.
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Usually when I do these podcast episodes, I'm going out for a walk in beautiful nature.
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Today I'm in Bend, Oregon, a very high desert feel, but lots of beautiful green pine trees.
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And nutrition is a topic that comes up with every one of my health coaching clients.
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And so it's something that I thought I would just kind of wrap a little bit
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about it and share all of the knowledge that I've acquired over the years about
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nutrition and also address maybe many of the contentious topics, right?
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Where we hear the disagreements about keto and veganism and saturated fat and
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seed oils and all these things.
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So maybe as a preamble, I should kind of zoom out and say that there is no one
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food that's going to negatively impact your health and there is no superfood.
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If we look at actual scientific evidence, not evidence that's paid for by the
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nut industry and not evidence that is paid for by the meat industry,
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and, you know, not public health evidence, but actual epidemiologic,
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solid, individualized clinical evidence, then we know that there is no such
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thing as a terrible food. There's no such thing as a magical food.
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There are eating patterns that seem to be better for one person over another.
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So with that mindset, let's kind of dive in.
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Food, nutrition is not food and nutrition. It's not just a diet.
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It's not just a bunch of ingredients you put together.
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It's an experience. It's a social event. It's fun. It's exciting.
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It's something you look forward to. It's that little stashed sandwich you have
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in the fridge that you're so excited to come home to and eat.
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After work, right? Those are the beautiful things about food and it's meant to be that way.
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We have evolved in some ways beyond the calorie needs of an animal, of an animal in the wild.
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And we have developed this kind of culture around food. And not only is that
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culture critical to our existence, but it is also something that creates that
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bond between me and my wife and my friends and my family,
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me and my mom, every time we get together, we're cooking,
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we're creating these awesome different versions of avocado toast.
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We have our favorite coffees that we both make. We have our favorite coffee
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device that we use. That's food. That's nutrition.
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If somebody were to come along and tell me coffee has too much saturated fat
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from the oils that it secretes, and therefore you should use coffee paper.
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Well, that doesn't make any sense, right?
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It doesn't make any sense because you just ignored what coffee means to me.
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So first, the only way I can make that recommendation is first understanding
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what does coffee mean to someone.
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Coffee may not even, well, some people don't even like coffee, yeah?
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So, okay, let's then dive deeper down and think, what is your risk factor and
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would you really benefit? How much would this move the needle?
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And I think when we can approach food from this more holistic way and approach
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it more from that individualized perspective, very quickly we realize as physicians,
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as nutritionists, as health coaches, that there is a lot more to it.
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And fortunately, there's a lot more creativity that we can bring to this decision-making of food.
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Another topic that has come up a lot that I kind of follow online,
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patients are often very upset, frustrated, rightfully so, when they go to the
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doctor, they don't get any nutrition advice.
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They don't get any nutrition advice, and they go home, and they're like,
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ah, this doctor didn't tell me anything.
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They just pushed a medicine on me, and then they just kicked me out of the room. That's unbelievable.
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Then we have nutritionists who say doctors should not be talking about nutrition.
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This is ridiculous. Doctors have no idea.
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They were never taught anything about nutrition.
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So there's a lot of pushes and
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pulls that physicians face and of course the
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insurance companies usually only pay for about seven to
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ten minutes for an appointment and unfortunately the reason
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for that has been fairly clear the shorter the more you contract an appointment
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time the more likely it is that a doctor is just going to prescribe you something
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or perform a procedure or refer you for more testing and that's often more profitable
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for an insurance company now That could be a wrong interpretation of it.
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That's what currently a lot of health experts assume is the reason why that's happening.
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The topic of nutrition, when it comes to an individual patient,
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think of yourself right now.
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You're a person, you make nutrition choices.
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How do you make those choices? How did you come to make those choices?
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How have your choices evolved over the years?
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Not just the choices you can make, but also the choices you can't make, right?
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When it comes to nutrition, there's things that I just can't do.
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Like I, I'm right now have a cup of coffee in my hand as I'm walking in this
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beautiful space here in the park.
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I can't not have this coffee, meaning I must have this coffee in the morning.
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I did try to set it aside for several months, and I was just miserable. I really was dragging.
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I couldn't do it. Of course, maybe there was an addiction component to it.
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Maybe there was the psychological component to it.
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Maybe it's what's in the coffee. There's a lot of factors, I'm sure.
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But that's something that I'm habituated to. It's not something that I'm going
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to be able to give up easily.
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And why is it that maybe I don't eat certain things that somebody else eats?
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Why is it that I don't struggle with certain foods?
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Well, for me, for example, I have a dairy problem. I can't really consume a lot of dairy.
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So somebody else might see my eating habits and say, wow, you eat so healthy.
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It's like, well, because I can't touch that, that or that.
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And then somebody else might be struggling with bread because bread is their
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heaven and they love, love bread.
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But for example, myself, if I eat a lot of bread, I get constipated.
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I get bloated. I get uncomfortable, so I can't do it. And then I get acne, I get breakout.
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I'm almost 50 years old, and all of a sudden I got acne like a teenager.
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So there are things in our lives that we've developed due to certain limitations.
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But then maybe I also grew up eating a lot of Persian food. I'm from Iran, so I ate Persian food.
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I love Persian food, but I also love Mexican food because I grew up in Southern California.
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When I lived in Spain, I ate a lot of Spanish food, which I actually didn't
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like that much, but it was fun.
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It was fun to eat the Russian salads and the tortilla española and those kind of things, right?
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You just get, all of a sudden it becomes like, oh yeah, I can't wait to do that.
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I would also drink a lot of wine every night and for whatever reason,
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it wasn't throwing off my weight, my sleep or anything.
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And then when I try to do the same here, it's absolutely terrible.
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I don't sleep well. I wake up with a dry mouth, I have palpitations.
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Who knows? Who knows why that happens? But we do grow up with certain genetic
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propensities towards certain foods. We grow up with certain disagreements.
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Certain things just don't agree well with us. And then we've also been habituated
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to certain foods and eating and diet from the way we've been raised.
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Keeping all of that in mind, we can then make the act of eating a bit more intentional.
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Because a time comes in our lives when we, most of us, most of us realize that
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what we're putting into our bodies affects the way we feel, the way we perform,
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and our long-term health.
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And so while maybe when we were in our 20s, we didn't really think much about finances, career.
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Maybe when we were now teenagers, we didn't really think about the importance
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of a romantic relationship.
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The same thing is true with food. As we get older, we realize the importance of it.
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And usually around that time, for most of my health coaching clients,
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their 30s and 40s, they realize, uh-oh, I may have to approach this food thing
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from a different perspective.
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Not that they're doing anything wrong, but it's the same thing with relationships,
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romantic relationships. Back in the day, if somebody hurt your feelings, you would break up.
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And now you realize, actually, hurt feelings are part of romantic relationships. It's what helps us grow.
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No matter how bad something might seem, if you can overcome it and if you can
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both grow from it, that always makes the romantic relationship stronger.
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And in finances, the times that you say no and you put that money away,
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you invest it and it grows, those are the moments when you start seeing important,
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helpful financial benefits in your overall life.
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Food should never be about restriction.
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Food should never be about gluttony. And I always tell my health coaching clients,
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if food is an excess pleasure for you, and what I mean by excess pleasure is
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that it brings you more pleasure than many other things that you do in life.
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It might just be that the pleasure parts of your life are not well balanced.
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Of course, we should get wonderful pleasure from food, but we shouldn't always
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have to get pleasure from food.
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There's other ways that we should be able to derive pleasure so that we don't
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have to rely on food to only give us that pleasure.
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There has to be a component where we really cherish food, we appreciate it,
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so we can chew it very mindfully, but also really appreciate the plants and
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organisms and animals that gave us that food for us to enjoy it.
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And when we lose that touch, when we don't connect with that,
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that's when we start seeing mass animal farming and, you know,
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pesticides and food, and it just loses its, well, meaning and importance.
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Maybe zooming in a little bit
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and kind of discussing all the different fighting ideologies about food.
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Veganism is better. Vegetarianism is better. Keto is better.
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Better than what? That's always the question I ask. Better for whom?
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That's the next question I ask. Every dietary choice you make is never made
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in a vacuum. It's always based on you.
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If you choose to be vegan, it means you're not eating meat.
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And if you forego meat, you're probably doing that because you have a certain
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belief that eating less meat is going to make you healthier.
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If that's true, my question then is, well, what are the top three things that
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could make you healthier in your situation?
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Maybe it's not even a dietary choice. For many of my patients,
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it's sometimes, unfortunately, a prescription choice.
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I have a few health coaching clients right now who desperately need to be on
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prescription medications.
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But for many many reasons they either
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don't want to be or they don't think they need to be so
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we always have those discussions we always delve into
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them on a regular basis but if somebody doesn't want to be
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on a medicine doesn't want to have a surgery that's their
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prerogative to have their right so then maybe
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the second order the second
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order right that was the first order this is a medication issue the
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second order is well maybe it's an activity thing maybe it's a
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stress management thing and then nutrition might
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be a third order third order thing so then
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we address that if it really is a third order thing but not
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with not before addressing exercise there is no there's no concept of vegetarianism
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being better than keto than paleo than whole 30 than any of that stuff those
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are marketing terms those are that's research done in a group of people how
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food affects your health is always individual.
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I've discussed my trend method several times on this podcast. T-R-E-N-D.
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T is for testing. So any change that I make in somebody's dietary pattern or
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suggestion that I make in dietary pattern, we always test it.
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What is it doing to your blood pressure? What is it doing to your mood?
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What is it doing to your waist circumference? What is it doing to your muscle
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mass, your cholesterol. Did I mention blood pressure?
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We might check other markers like inflammation. Well, if everything's trending
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the right way and you enjoy that plant, it doesn't matter what it is,
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whether it's keto or vegan or vegetarian or anything.
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Of course, we hear all the time that the Mediterranean diet is the best diet.
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And of course, then my patients often think, oh, so Mediterranean food is the best food.
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Well, no, the Mediterranean diet is not Mediterranean food. It's an easy misunderstanding.
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And Dr. Ansel Keys, who came up with some of these ideas about Mediterranean
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diet, it's more about the ratio of how you eat.
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You can have somebody who's of Mexican origin, and you can have Mexican food
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be a Mediterranean-style diet.
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You just make sure that the ratios of vegetables, nuts, seeds,
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to protein, to fats, to healthy fats, are all kind of Mediterranean-style.
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That's it. That's all that matters.
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That's all that's important. And yes, Mediterranean diet has right now withstood the test of time.
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But as one can predict in 10 years, it's not going to be the Mediterranean diet.
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It's going to be some new diet.
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It's going to be the Scandinavian diet. It's going to be the East Japan diet.
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And that's okay. You know, we never get caught up with the terminology.
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Terminology doesn't care because your body is agnostic to
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what diet you follow your body's going to respond the
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way it's going to respond and so when it
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comes to the daily food choices i do believe that
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intentionality matters i do believe that we can still absolutely enjoy the food
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that we eat but have a level of mindfulness and awareness and presence where
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we can plan our meals decide what we're going to eat and the reason for that
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is in such a connected world such a connected age that we live,
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where food has become a commercial science that manipulates our taste buds,
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our vision, our eyes, we really do need a little bit of control.
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We have to take back a little bit of control.
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In a previous podcast episode, I talk about conscientiousness.
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Now, when we say somebody doesn't have food conscientiousness,
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I understand that this can seem derogatory and offensive to some.
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And other people, my health coaching clients, have expressed like,
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hey, I don't really like that term. It makes me seem as if I'm not conscientious.
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In fact, it's not so much that you're not a conscientious person if you don't
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have food conscientiousness. It's that you're not a very regimented person when
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it comes to food. You eat ad lib.
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You eat freely. You eat what you enjoy. You eat what sings to your heart.
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It could actually be a better thing, in my opinion.
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Some people are just incredibly disciplined when it comes to food. Who knows why?
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Chances are it's their upbringing. Chances are it's genetics.
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Chances are it's the way they think about food.
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Chances are it's part their fears and they're trying to control their dietary habits.
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That conscientiousness can be beneficial if we all develop a little bit of conscientiousness
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around it So that when we do see that blue and red packaged Dorito ultra-processed food,
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we can say, yes, that is delicious.
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There is no way. There's no denying that.
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But maybe I can, I might have to control how much I'm going to eat.
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Because unfortunately, the way those designers of that food package have planned
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it, they want me to consume half of that package. So I got to plan it.
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I know I can have four pieces and I'm not going to run into any problems.
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Or I know I can have 20 pieces and I'm not going to run into any problems.
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That's conscientiousness. That's all.
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It's the ability to look one step ahead and understand that there is a greater
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force, unfortunately, behind some of these foods the way they're planned.
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Well, during World War II, we needed very good access to easy calories that is fortified.
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So we developed ultra-processed white flour.
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But it's not World War II anymore.
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And yet we still have white flour with a ton of extra additives.
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And unfortunately, it's made it into every single food ingredient, food item.
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And that is problematic. And it has created a lot of problems.
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We could wait for the government to make some changes. Hopefully over time they will.
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But food conscientiousness would tell us that I'm probably going to have to
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just look at the ingredients.
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And if I see enriched white flour or bleached white flour or even whole flour,
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and then all of a sudden I see the additives of vitamin B12 and riboflavin.
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Well, maybe I have to say no to that because unfortunately that's not going to be good for me.
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That's going to have other downstream side effects.
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Maybe, not for everyone, and it depends to what amounts.
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If you're having a little bit here and there, nothing bad will happen, right?
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There's no bad food, but conscientiousness means that there is a bit more intentionality
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without ever, ever sacrificing the joy, the enjoyment that we get from food.
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A topic similar to this, picking between keto and vegan and vegetarian,
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is fasting and of course the macro diets that are very popular.
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Now everybody's saying you should have more protein.
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Okay, when you look at history since the late 1800s, there's been many macro trends.
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Fat is better, no carb is better, no carb is bad, no protein's better.
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Right now we're of course in protein wave. So everybody says protein is the
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best thing that you should have.
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The reality is there is no macro-based diet that is going to be better than one or the other.
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It all depends on you. What is it that you like? And how is it affecting your health?
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If you're gaining more weight than you should, chances are the ratio of food
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for you is not appropriate unless you're okay with your weight.
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In that case, there's no problem.
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Health is an individual decision. how we feel
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inside our body is a very
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unique experience and it's a beautiful experience but it's
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always individualized and macro-based diets just
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don't work fasting gained a lot of popularity unfortunately has and is going
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to continue even more to gain more popularity because there are a lot of men
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in this space there's a lot of like female influencers in this space online
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claiming that it does one thing and another and another and another.
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And they're really good orators. These are fantastic people who can sell you
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your shoe, right? These are people who know how to sell you stuff.
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And their intention may not be bad, but fasting, for the most part,
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when we dive down deep enough, seems to really come down to calories.
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Whether it's time restriction, whether it's dietary restriction such as macro-based
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foods, whether it's calorie restriction, it all essentially comes down to calories
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in and calories out. Now of course, there's the other argument.
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No, the calorie in, calorie out is not an accurate statement.
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There's no such thing. It doesn't work that way. There is truth to that.
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One calorie is not the same as another calorie. In fact, the calorie concept
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is so ridiculous on so many levels. I think it's such a bad concept that we're
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using overall to describe food and energy balance.
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But nevertheless, it is something that we have adopted in popular communication when it comes to food.
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At the same time, it doesn't take away from how parents will try to raise their
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kids and how adults manage their pets' health. Let me explain.
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So when we have a pediatric patient and the mom is there and they're like,
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yeah, I'm having some problems with his food.
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He eats whatever he wants and he's kind of gaining a little bit of weight.
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And at four years old, I'm kind of concerned his weight has really crept up rapidly.
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The first thing that we do is we restrict calories.
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Now, sometimes we also increase activity levels.
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Both of those are going to drop the weight of the child 99% of the time.
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Same with pets. When you go to
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your vet, hey, my cat's been just gaining weight. I'm not quite sure why.
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Well, let's change the feeding schedule around a little bit.
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Let's leave a little bit more room for playtime. And usually the weight will go down.
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So calories in and calories out do have a role in our overall nutrition plan.
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But if you restrict how you eat and you force yourself to exercise...
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That calorie concept will fall apart because it is not sustainable.
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And we know that. We've learned that. That is not the way to do it.
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Restricting, forcing, punishing, all of those things fail in the long run,
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and they're just not going to work.
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So while we can utilize some of these tricks like keto, veganism,
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maybe prioritizing protein, and then playing around with calories,
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we can use these in many different ways to achieve a certain health goal.
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It should always be this bigger health goal. It shouldn't be aesthetics.
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The problem with aesthetics is that it is a third order, fourth order concept,
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and our minds just will let go of that.
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But how you feel inside yourself, as long as you can generally hold space and love for yourself,
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usually first order things are how you feel how your
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health how you perceive your health and
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i think when we make health decisions towards that and that's that's
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that's a learned right conscientiousness is a learned trait right none of us
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are born with it you're only going to develop it you can only learn it some
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of us are lucky that we learned it some of us didn't learn it and it's a beautiful
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thing to learn and it's an easy thing to learn but once we learn the style of
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eating and exercising and moving,
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when to eat, how much to eat.
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We get a sense of what our metabolism is going to be like.
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For example, I know that during stressful times, unfortunately,
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my basal metabolic rate is going to be lower.
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So if I eat during times of stress, I'm only listening to one part of my body.
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And I'm not considering my long-term health.
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And I'm not really eating because that food is that great. Yesterday,
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I did a long, long drive to Portland, Oregon, and...
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Didn't eat. I forgot to eat breakfast. Great. And by the time I got to Portland,
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it was 4 p.m. And then we had to do a bunch of stuff.
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We had to park the car and the car was going to get ticketed if we didn't move
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the car. So it was 6 p.m. and I still hadn't eaten.
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And then I was so starving. I stopped by a grocery store and I just got whatever they had.
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And it wasn't good. Let's just say it was like nasty hummus.
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Well, I call it nasty because it was not at all the kind of hummus I normally
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eat. It was this guac with tons of salt.
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It was this white bread with nothing nutritious in it. It wasn't something I would have eaten.
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And I'll be honest with you, driving at 65 miles an hour, stuffing your face
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with that stuff, it wasn't the
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most pleasant thing, not to mention the stains in the car and my pants.
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This morning when I woke up, I felt like a balloon. I puffed up and I didn't
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eat because it was in this beautiful moment and I was enjoying it.
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No, I ate because I was stressed. I ate because I had restricted.
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I ate because I was starving.
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And that can happen. That's okay. I'm not a bad person. I didn't do anything wrong.
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But when that happens, it's a good way to gauge and say, all right,
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so yes, there are moments where we're going to eat due to stress.
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There's moments we eat because we love the food.
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There's moments where we eat because we're just around a lot of wonderful social people.
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And that's another way to think about food. It's a new way to think about food.
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I think many of us are developing this concept and idea, but it seems to be
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a more sustainable way than restricting and counting calories and figuring out
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macros, which, again, just doesn't seem to last that long.
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In summary, as I wrap this up, I approach nutrition, diet, in many different
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ways with every single client. It's got to be completely...
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Different. I myself, I haven't shared this on the podcast, but I've shared it
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on other platforms, have had a major, major, major binge eating disorder.
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And it was a very difficult time for me because it really changed the way I viewed food.
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I developed a very negative attitude towards food and it took a long time to overcome it.
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And I overcame it in actually a very interesting way, unexpectedly,
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so maybe I got lucky in some way.
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So I always try to think, what is the person's relationship with food? How do they view food?
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How do they think ahead about food? How do they plan their food?
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What does food mean to them?
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And what's their own perception of themselves when they eat well or don't eat well?
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The self-punishing thoughts, the self-deprecating thoughts.
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I love teasing those things out because many
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many times i've discovered that somebody will punish themselves by having tiramisu
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and then because of the punishing feeling and thoughts that's in their head
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they start sabotaging themselves for several days afterwards instead of just
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saying that was amazing and i can't wait to have the next tiramisu.
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I don't think right now I need more tiramisu.
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And so I'm just going to wait. And maybe another opportunity will come for tiramisu.
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Now, unfortunately, in our, again, connected world and in our world of abundance,
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tiramisu tends to be waiting and peeking right around the corner,
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waving at you pretty regularly.
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So if you look for it, it's there. And that's the wonderful thing about tiramisu
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is you can say, I love tiramisu and I will only have the best tiramisu.
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And when the time comes for me to have tiramisu, I will have my tiramisu.
26:53
Sometimes I can win that battle. If you do want to call it a battle,
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I don't like that term. And sometimes I won't win the battle.
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Sometimes I'm just going to give in and that's okay and I'm going to love myself
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and I'm going to love that food and I'm going to cherish it and I'm going to think of it.
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Tonight when I go to bed, I'm going to think about the amazing food that I had
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and then wake up in the morning just so excited about the food I'm going to have.
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But I can also hold space and love and compassion for not only myself, but my diet,
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my health, and what it is that I want to accomplish with this one life that
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I'm given, with this one food pattern of me eating and how much I enjoy it with other people.
27:35
So anyway a little bit of a free wrap about
27:38
nutrition and thank you
27:41
for listening to such a long podcast please share it with anybody that you think
27:44
would benefit i would love your feedback what do you want to hear more about
27:49
what things do you want to learn more about what questions do you have for me
27:53
please go to your favorite podcast app go to you go to apple podcast and leave me a review.
27:59
Those reviews are incredibly helpful to me.
28:02
I get a lot of wonderful suggestions from them and I will address each and every
28:06
one of them in future podcasts.