It is past time we abandon the dieting focus.
Instead of focusing on short-term changes in eating habits, something that is often viewed as a challenge, focus on big-picture dietary patterns for sustained health and wellness.
A recent study aimed to assess the association between dietary patterns and all-cause mortality. Dietary patterns refer to our daily diet, not a crash diet that we adopt for 6 weeks. An eating pattern could be plant-based, Mediterranean, traditional western diet, ketogenic, or paleolithic (these are not all of them, just some of the most common lifestyles).
The findings help us simplify our approach to determining what to eat.
The study’s details
This study was a systematic review, consisting of 153 studies (152 observational and 1 randomized control trial). All of the studies included in the paper consisted of adults and older adults (17–84 years old) from 28 different countries (all with high or very high Human Development Index).
I checked the authors, affiliations, and conflicts of interest to ensure this review was sound. The authors concluded most studies were well designed, with rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the studies included. The results were highly consistent, allowing us to better draw conclusions and apply the information to our lives.
What did they find?
According to current research, healthy dietary patterns associated with a decreased risk of all-cause mortality in adults and older adults included higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included, as many studies included plant-based approaches).
Additionally, these healthy patterns were low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Alcoholic beverages were occasionally included in the healthy patterns when consumed in moderation (1–2 drinks).
That’s it.
Eat more plants, fish, and lean meat while eating less red meat, high-fat dairy, and processed foods.
But what about the details? That depends on the individual.
The problem with “one-size-fits-all” eating patterns
One-size-fits-all approaches are inappropriate because we are all different people.
Many approaches to eating are healthy. You can build muscle, control glucose levels, lose fat, and perform well in the gym with a vegan, ketogenic, paleolithic, or fasting approach. Optimal performance and specific goals will be obtained with specific tweaks (e.g. upping protein to about 1.6 g/kg of body weight for building muscle or consuming >70% calories from fat to induce ketosis), but these tweaks are not necessary for good health.
Strict adherence to a diet depends on your wiggle room as well. The phrase “all in moderate” is often abused. If you are a healthy weight, don’t have chronic pain, sleep well, exercise regularly, and don’t have any markers of metabolic disease, then your body will handle dessert or pizza and beers fine. But if you fail to check many of those boxes, your ability to move off the tracks diminishes.
We also need to consider the psychosocial benefits of food (source). Research has shown social support can have protective effects. Your mental health, stress levels, and exercise habits will influence the magnitude of negative health effects.
Dietary habits are also cyclical and goal-dependent.
I use fasting — more details on this shortly — for inflammation, pain in the joint and tendon regions, and longevity. Over the past 8 months, I have consumed a hyper-caloric, high protein diet along with a high training volume (6 days a week) at a high intensity (high proportion of powerlifting and strong man lifts). As a result, my body is beaten up. I pair a de-load week with a 5 day Fasting Mimicking Diet (FMD) to help with recovery.
I use an 8-hour eating window often, but if I am trying to maximize muscle growth — as I did the past 8 months when I added 15 pounds — then I eat every 2–3 hours, often consuming at least 20g of protein each meal. I make sure my overall calorie count is high as well.
Conversely, over the summer of 2020, I had a goal of trimming down. Combining intermittent fasting with a ketogenic approach worked wonders. It wasn’t a crash diet, I continued to eat a heavily plant-based diet, but I was able to lose weight in a sustainable manner.
On a smaller scale, if I need a good night's sleep. I avoid drinking alcohol after dinner, as it can disrupt your sleep cycle and quality of sleep.
My overall strategy remains consistent with the systematic review from the beginning of the article, but the nuances shift depending on my goals.
Big picture recommendations
The following are not medical advice. For specific recommendations about dietary strategies, such as the number of calories you should consume or if supplementation is needed (e.g. Vitamin D), consult a registered dietician. Furthermore, I recommend obtaining a blood panel to know your current health status. This should be more than a standard lipid panel.
These are general recommendations based on the current state of research. My focus is on overall health, not strictly looking good in a bathing suit or increasing your max deadlift. I have included links to the articles. These are not cherry-picked single studies full of conflicts of interest either (which is common in nutrition). These recommendations come with a plethora of research backing them.
Fasting has many health benefits
Fasting is one of the best tools at our disposal for improving longevity. Here is a quick rundown of the benefits of fasting according to this review paper:
Weight loss and metabolic reset
Increased insulin sensitivity
Reduction in inflammation and oxidative damage to proteins, lipids, and DNA
Enhanced immune system function
Frequent meals keep us in an anabolic state, meaning we are constantly promoting cell growth. While this can be beneficial for building muscle, it can be detrimental to long-term health.
Over time, many of our cells become damaged. These cells either become ineffective, unnecessary, or dysfunctional (e.g. cancer). Autophagy is the process of cleaning out those cells and developing new ones. If we are in a constant state of growth and development, autophagy and cell renewal is limited. When we restrict our calories — not only a couple hundred like standard diets — we promote autophagy and cell turnover.
There are many fasting strategies, including intermittent fasting, which commonly employes the eight-hour feeding window. I often use this window, but increase my duration to 24-hour fasts of 5 days of a Fasting Mimicking Diet (FMD) where I limit my intake to one meal a day (dinner with my family).
I encourage you to look more into the various strategies and their benefits. It has been the best change I have made to my dietary habits.
Minimize processed food and eat whole foods
One of the big problems with applying nutrition research is tunnel vision. Studies show fructose can increase the risk for fatty liver disease and diabetes. That does not mean fruits are bad for you. Fruits also contain fiber, phytochemicals, and vitamins. I would advocate for eliminating processed foods, however, which provide unnecessary additions of fructose.
The same is true for saturated fats.
While red meat is associated with an increase in all-cause mortality, that does not mean saturated fat is the sole culprit. We have to look at the whole food source of saturated fats. Research shows that many whole foods (also referred to as the food matrix) that contain saturated fats (such as nuts) are a stronger determinant of health effects than the saturated fat content itself.
Eat more whole foods and reduce processed foods. You don’t need to get caught up in the exact content of macronutrients (protein, fat, and carbs).
Get enough Vitamin D and Fiber
Fiber and Vitamin D are both essential and often lacking with traditional western diets — roughly 95% of Americans fall short in fiber. Processed foods are low in fiber. Much of our Vitamin D is gained from sunlight exposure.
Fiber is associated with reduced risk of cardiovascular disease, coronary heart disease, stroke, hypertension, certain gastrointestinal disorders, obesity, and metabolic dysfunctions (e.g. type 2 diabetes), and colorectal, gastric, and breast cancers. Fiber provides digestive benefits as well, including increased stool bulk, decreased transit time, and fermentation by colonic microflora. For these benefits, you need soluble and insoluble fiber, which are obtained through whole foods, not Fiber One bars.
Vitamin D plays a role in many bodily functions, including our immune, musculoskeletal, metabolic, and neurologic systems. Roughly 80% of our daily needs come from the sun, meaning if you don’t get a lot of sunlight, the need for dietary sources increases. Most vitamin D in the diet comes from fortified foods. If you are lacking in both, supplementation may be needed.
All of these will help with insulin sensitivity and glucose control, which are primary drivers of the development of metabolic disease. These are general recommendations for health. For specific numbers appropriate to you, consult a registered dietician. As mentioned earlier, your diet will shift depending on your goals, but the foundation will remain largely the same.
Don’t overcomplicate the diet and seek quick fixes. Dieting doesn’t work. Adopting a diet, a lifestyle, a pattern of eating, does.