 I get questions from patients all the time about how to eat at a restaurant without derailing their diet. Of course cooking your own food is best because you can control everything that goes into it (not to mention you save a lot of money!) but when you want to be social and go to dinner that’s ok too!
Here is what you should order when eating at a Mexican restaurant: Appetizer:
SK  Obesity, diabetes, and heart disease have skyrocketed and continue to increase since the government’s recommendation for low-fat diet for a healthy heart starting in the 1970s. When we take a closer look at the evidence connecting saturated fat and heart disease, the evidence presented is pretty weak, and more and more evidence is mounting and getting recognition against the long term belief that saturated fat intake leads to cardiovascular disease and death.
The low-fat mantra all started in the 1950s with a scientist named Ancel Keys. He performed a couple of highly flawed studies where he "cherry-picked" data to show that saturuated fat intake caused heart disease. The government and food industry locked onto this idea, despite data and numerous studies that have flooded in to debunk this theory. I highly recommend the books Eat Fat Get Thin by Mark Hyman, MD, and Why We Get Fat by Gary Taubes, for more information and citations of this. Here are 5 reasons that saturated fats are not going to increase your risk for heart disease or death: 1. Low-fat diets are NOT effective at preventing heart disease No study has been able to prove that a low fat diet will decrease risk of cardiovascular mortality. Plenty of studies show that saturated fat can increase total cholesterol, and then make the simplified conclusion that saturated fats lead to heart disease. But this is highly misleading because yes, saturated fat will increase total cholesterol because it increases HDL cholesterol (good cholesterol), as well as the good type of LDL cholesterol (more on this below); however, no study can show a direct link between saturated fat intake and cardiovascular related death. Again, there are more studies then I could ever reference, but here are a couple good ones: In 2010, an analysis of 21 quality studies that looked at roughly 350,000 individuals up to a 21 year period found no risk of saturated fat intake with cardiovascular disease or stroke And lastly, one of the largest and most expensive and long term clinical trials called the Women’s Health Inititiative (WHI) was meant to show the benefit of a low-fat diet for lowering cholesterol and heart disease. After eight years of this study, the women on low-fat diet had lowered their total and LDL cholesterol, however, there was no beneficial effect on heart disease, stroke, or cancer found from eating a low fat diet. 2. Fat increases your HDL cholesterol (good cholesterol) Low HDL cholesterol has been found to be a far greater risk factor of having a heart attack than a high LDL cholesterol . When you replace fat in your diet (including saturated fat), with carbohydrate, this lowers your HDL cholesterol. A study by The New England Journal of Medicine explains that a low HDL cholesterol is a “biomarker for dietary carbohydrate.” Saturated fats have been shown to increase your HDL cholesterol (good cholesterol), and to have either no effect on your triglyceride cholesterol or to reduce this (another type of bad cholesterol). In practice, when I get a patient's labs back and I see a low HDL cholesterol level with high triglycerides, this is an indicator to me that this individual is eating a high carb, low fat diet. 3. Fat increases large LDL particles (good type) and decrease small LDL particles (bad type) Yes, to make things more confusing there are different types of LDL, large "fluffy" type (think cotton balls), small dense type (think rocks), and many other sizes in between. We want more of the large LDL particles to small dense LDL particles because the small dense LDL particles are much easier to lodge themselves into the walls of your arteries causing your arteries to narrow which leads to decreased blood flow (ie oxygen to your heart). These small dense LDL particles also are known to oxidize which leads to rancidity and inflammation in the blood vessels. Saturated fats will increase large LDL and decrease small LDL which in effect will cut your risk of heart disease. 4. Replacing saturated fats with carbohydrates increases bad cholesterol This is more of a summary of the above, but I want to reiterate that replacing saturated fats for carbohydrates makes your cholesterol profile much worse. Carbohydrates have been shown to decrease your good HDL cholesterol while increasing small particle LDL bad cholesterol, as well as inceasing your triglyceride cholesterol. As mentioned above, heart disease is most associated with a low HDL cholesterol and high triglyceride cholesterol. LDL is a little harder to predict with heart disease because of the varying sizes and conflicting evidence. 5. Prevents "Diabesity" Cutting back on fat almost enevitably means you are going to add carbohydrates to your diet, and high carbohydrate intake is what leads to diabetes as well as obesity - this is something that is not disputed. Obesity is a risk factor in itself for heart disease, as is diabetes, put these two major risk factos together and you are talking about a massive increase in your chance of cardiovascular disease (think heart attack). Just as guidelines have changed in terms of cholesterol containing foods (in case you didn’t know, cholesterol containing foods do not raise bad cholesterol and this has finally been recognized by the American Heart Association (AHA) and the United States Department of Agriculture (USDA)) I have a hunch that there will be new guidelines for saturated fats in the near future. Be sure to increase your intake of good saturated fats such as organic eggs, organic grass-fed beef, coconut oil, and dark chocolate. SK  One of the most frequent questions I have in practice is about wheat/gluten-free and my take on how it effects the body and mind. I started doing more research on the topic and I found more than enough reasons to cut out wheat completely from my own diet. Here are the top 8 to get you started:
1. Not the original wheat First of all, wheat is not what it was thousands of years ago, or even fifty years ago. Wheat today is produced by countless hybridiazations making for thousands of different potentially harmfull proteins and other compounds We now have “wheat” that was grown in synthetic soil, saturated in chemicals, made to survive the worst environmental conditions and cultivated so that no pest would eat it – and we’re wondering if this could make us sick? Currently there is no requirement for crops that have undergone hybridization to be tested on animals or humans. Read more about this here and here. 2. Increases blood sugar higher than table sugar Wheat’s main carbohydrate is Amylopectin A and raises your blood sugar higher and faster than any other carbohydrate including table sugar! When there is a large amount of sugar in your blood all at once, this signals a large amount of insulin to remove this sugar as quickly as possible and deliver this preferentially to your fat cells (why we call insulin the fat storage hormone). This is why you feel hungry an hour or two after eating a wheat product – all the sugar has been removed from your bloodstream by then and your cells are still hungry because your fat cells are hogging all of the energy. 3. Addictive Wheat contains a unique protein called gliadin which, when broken down in the body into polypeptides, crosses the blood-brain barrier and binds the morphine receptor in the brain (i.e. euphoric center). These particular polypeptides are termed “exorphins” (exogenous morphine like compounds) because of how like other opiates, you feel a mini-high after ingesting and a slump short while after. In short, these exorphins stimulate the addictive, pleasure seeking part of your brain, stimulating your appetite making you want more and more. Just as other drugs that bind the morphin receptor (think heroin, morphin), this repeated exposure distorts the brain causing mental fog, sluggishness, fatigue and makes one more susceptible to depression and other psychological disorders down the road. Interesting note - there are now drugs that contain naloxone to treat obesity. Naloxone is formerly known as a drug used to treat narcotic overdose, most notably heroin. It works for weight loss because it blocks the morphine receptor, exorphins are unable to bind, and thus prevents appetite from being stimulated. 4. Blocks your brain from understanding you are full Digested wheat proteins have been found to block the leptin receptor. This is bad because leptin functions to tell our brain that we are full - if this is being blocked, you are more likely to be hungrier regardless of how much you may have just eaten. 5. Increased risk for diabetes and obesity This goes along with it’s addictive like quality, stimulating your appetite, increasing blood sugar rapidly, and blocking the mechanism that tells you that you are full. This is a recipe for you to overeat (overeat carbohydrates in particular because of their addictive quality), which leads to obesity and diabetes from too much carbohydrate ingestion aka chronic high blood sugar. I hear all the time from slender patients not understanding how they can be at risk for diabetes with a normal weight and eating healthy “whole grains.” It doesn’t matter if you are thin or overweight, if you are consuming a high carbohydrate diet (which is easiest to do with consuming too many wheat products) your blood sugar will be chronically elevated unless you start making changes. 6. Worsening ADHD This is still a controversial topic and more studies need to be done to look at this, but there have been many studies showing the improvement of ADHD in children and adults when cutting out the wheat products. You can read more about this here. 7. Inflammation to your gut Gluten is the main protein of wheat, and it is made up of two proteins gliadin and glutenins. Gliadin is the primary group that triggers the immune response (i.e. infallmation) in celiac diease. But even beyond gluten and celiac diease, there are a wide range of other proteins present in wheat, more than could ever be accounted for due to the countless transformations via countless cross-breeding of strains as discussed above. These modified proteins as well as gluten have been shown to be associated with irritable bowel syndrome in non-celiac disease individuals, and accounts for digestive issues in individuals without full-blown celiac diease. This is why individuals who cut out wheat tend to have less stomach issues. 8. Joint inflammation As discussed above, wheat products raise your blood sugar more than nearly all foods. The more your blood sugar rises, the more glycation occurs. Glycation is when a sugar binds to protein causing irrversible changes, and thereby modifies proteins in the blood stream, body tissues, and joints. Glycation is particularly damaging to cartilage, and when cartilage proteins become glycated they become stiff. Overtime, glycation makes the cartilage brittle, stiff, and crumbling resulting in more pain and destruction in your joints. I know it sounds hard to cut back on wheat (because wheat is in virtually all processed foods), but replace with filling full fat foods – avocado, eggs, olive oil, cheese, etc. Healthy non-processed fats should be the bulk of your diet, as the low-fat craze has brought upon the increased obesity, diabetes, and heart diease rate since it was instituted in the 1970s - more on this for another post. If you want to read more about the effects of wheat I highly recommend the book Wheat Belly by cardiologist William Davis, MD. SK  This is a short list of some of the most common foods marketed as healthy, when more often than not they are no better than eating dessert. Always read the nutrition label and the ingredients list before purchasing a food. You have to watch out for sugar because it triggers insulin (fat storage hormone) to be released, whose job is to get sugar out of your blood as quickly as possible and store it somewhere for later use (think your thighs). Unless you are training for something like a marathon or ironman where your muscles will be the first to receive the sugar, try to keep your daily sugar to a minimum - like under 25 grams per day.
1. Skim Milk. Non-fat or “skim milk” has a surprisingly high amount of sugar. Most brands have about 12 grams per cup – this is almost half the amount of total sugar that is recommended you ingest each day! To put this into perspective, this is the same amount of sugar as eating three Original Chips Ahoy! Cookies or three Milano Original Cookies. I am not a huge fan of cow’s milk (for many other reasons), and I recommend trying unsweetened almond, cashew, or coconut milk as an alternative. 2. Protein/Nutrition Bars. In general, I recommend staying away from all “high protein,” “high fiber,” “gluten free,” or however else the given bar has been marked as healthy. Strip back all of the fancy advertising and look at the nutrition label and you will find that most of these "health" bars are no better than a candy bar. For example, compare a Snickers Bar to a Clif Bar: a Snickers Bar has 27 grams of sugar and 4 grams of protein. A Clif bar can have up to 25 grams of sugar and 9 grams of protein…is there really that much of a difference between the two?? – Others popular bars to avoid include Balance bars, Luna Bars, Pure Bars, Lara Bars, and even Kind Bars which can be high in sugar. Rule of thumb, stay away from any bar with 10 grams of sugar or more. The only protein bars I recommend are Quest bars because they are high in protein and fiber, low in sugar and in overall ingredients, and Think Thin Bars which are also a healthier alternative. 3. Yogurt. Yogurt can be very healthy because it is generally high in protein and low in fat. However, you have to be careful with choosing yogurt because most have a ton of added sugar, be especially cognizant of the the non-fat versions because the fat is replaced with sugar to make it taste better. Always check the nutrition label, more than 7g of sugar per serving and you have a dessert not a healthy snack. My favorite is Plain Greek Yogurt Trader Joe's brand which has 22 grams of protein and 6 grams sugar per cup. 4. Granola. Be very picky with granola, the vast majority are heavy in sugar and calories, and low in fiber. Granola is meant to be eaten in a small serving size, usually like a ¼ or ½ cup, meaning you could easily be eating 4 servings in one sitting. And just because the packaging says “made with honey” or “made with all natural ingredients” or some other deceiving marketing claim, this doesn’t make the food any healthier, sugar is sugar. I don’t really recommend granola in general, but if you are going to eat it I recommend eating it plain and would avoid eating it with anything else sugary such as yogurt and/or fruit. 5. Cereal. Cereal is generally not a great choice. Almost all cereals are loaded with sugar, low in fiber, and low in protein. And why is everyone eating Raisen Bran??!! It seems like just about every other patient I see is eating this. Raisen Bran has 18 grams of sugar per serving, 18 grams! This is almost the total amount of sugar that you should have in an entire day. Then add some skim milk on there and this puts you over the edge. Forget the raisens and just get plain bran cereal, you can always add your own raisens on top if necessary. The only cereals I recommend are Fiber One Original Cereal (14 grams of fiber per ½ cup!) or Trader Joe’s High Fiber cereal (9 grams of fiber per 2/3 cup) because both are low in sugar and high in fiber. 6. Sports Drinks. Everyone knows that soda is a diet-don't, but most sports drinks are just as bad. For example, a 12 fl oz bottle of Coca-Cola Coke has around 33 grams of sugar. A bottle of Gatorade has almost 50 grams of sugar (due to having 2.5 servings per bottle). And watch out for those bottled teas because they can have over 20 grams of sugar per serving and can have multiple servings within one bottle. Alternatives to these super sweet drinks are G2 which is a lower calorie version of Gatorade, Vitamin Water Zero, and PowerAid Zero. SK Patients come into my office everyday for stomach issues (gas, bloating, constipation, etc) and believe that gluten must be the sole culprit. Yes, gluten certainly can wreak havoc on the body, but another factor could be an intolerance to one or more types of FODMAPs. FODMAPs are short chain carbohydrates found in virtually all gluten containing food products and can cause the same undesirable gastrointestinal side effects as gluten. FODMAP stands for “fermentable oligosaccharides disaccharides monosaccharides and polyols" and include fructans (wheat, pastries, pasta), galactans (chickpeas, lentils, beans, soy), lactose (all dairy products), fructose (honey, apples, pears), and polyols (sugar alcohols such as sorbitol and stone fruits such as as avocado). Foods range in their amount of FODMAPs, some having very low amounts that are unlikely to cause stomach issues, to foods that have very high amounts which are most likely to cause problems. FODMAP containing foods may only cause side effects when eaten in large amounts (i.e. the American diet) so just because your favorite food is on the high FODMAP list does not necessarily mean it needs to be completely eliminated from your diet. Figure out if you have sensitivity to FODMAPs by cutting out FODMAP containing foods for a few weeks and then slowly re-introducing them back into your diet one at a time, and/or pay attention to how you feel after eating FODMAP rich foods. Below is a list of FODMAP containing foods - from low amounts of FODMAPs to high amounts. SK   1. Get your dressing on the side.Most dressings are high in fat, sugar, and salt for very little servings sizes (think size of a ping pong ball). Get more bang for your buck with dressings that are great in flavor and have a better nutritional profile such as hummus, hot sauce, soy sauce, or balsamic vinegar. Always ask for dressing to be on the side, you are more likely to use less of it. 2. More vegetables.Vegetables fill you up due to their high fiber and high water content. The body cannot digest fiber and so it takes longer for high fiber foods to pass through your system, thus keeping you fuller longer while at the same time causing your body to absorb fewer calories. Fiber also keeps your cholesterol in check by binding to cholesterol and literally expelling it from your body with each trip to the bathroom. 3. Ask for the bread or bun to be non-toasted.Toasted means buttered, in most cases. The majority of restaurants will default to toasting your bread while also adding butter, resulting in more calories and fat added to your meal without you even realizing it. 4. Go open face on your sandwich.You will not miss the top piece of bread from your sandwich. Most breads from restaurants are low in fiber, high in empty carbs and won’t do anything to help you stay full. Instead, pile on the protein and vegetables, these will fill you up more than an empty calorie extra piece of bread will. 5. Poach the eggs.Poached means eggs are cooked in water without anything else added to them. Rest assured your poached eggs will not have vegetable oils added them. 6. If you go omelet, ask how it's made.Make sure to ask how the omelets are made. Restaurants may other inflammatories such as milk that may be problematic for you. And of course always add vegetables! 7. Get that Sushi with brown rice or quinoa.Opt for brown rice or quinoa with sushi (preferably quinoa which contains all of the essential amino acids making it a complete protein while also being high in fiber). It can be misleading as to how much rice you are taking in - one roll of sushi and the rice could be ¼-1/2 cup of rice (aka sugar). And definitely stay away from tempura which is code for fried.
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