Spirit of Eating Plan B

Eating well is simple. It can be simple. And it's worth it to make it simple.

Friday, September 7, 2012

How healthily do you want to eat?

After a lecture a man asked me why I do not recommend a paleo-type diet although I said during the lecture that it's usually a very healthy diet - and his opinion was that I was promoting a less healthy diet when allowing many things he didn't. Why do I "allow" eating food for which the health effects are minimal or even unhealthy- say a potato? Well I used paleodiet just as an example as it is by no means automatically healthier than any other diet type. And the main question is that how healthy diet should we pursue. If I consider my usual advice it would be easy to say that one could eat more healthy diet. Eating advice could always be healthier, and even healthier - and still healthier. But it's not a good idea to chase the optimally healthy diet.

Naturally I want people to heat healthily and I'm sure my advice leads to a healthy diet - but it doesn't mean everything has to be healthy. Why don't I optimize? Very shortly put I could say I aim for well-being and health is only one block of many in that set. And if some other block (taste, social flexibility, stress-free eating etc.) needs more space to attain better well-being health can easily lend some of that space. This is certainly a common sense argument that many already know. But there are other reasons..

How healthy is healthy enough?
Another reason is that saying what is a healthy enough diet and what is not is very much a thin line that can be drawn anywhere. It's simply an opinion, not a fact. And the line has to be drawn somewhere because it is utopistic to as healthy as possible because neither science nor any person has an idea of the optimal diet - and if they claim they do they don't know enough. How so?

For example is my discussion with the older man followed some variety of paleo diet and called it an optimal diet. It was easy to counter that it might be slightly healthier than what i outlined in my lecture but is surely is not optimal: did he gnaw bones? Eat insects? Etc... and thus getting rare nutrients - such as glucosamine - that our usual diet doesn't contain. Of course he didn't and of course the diet wasn't optimal. And even if he did there would have been countless other issues that knowingly or likely improve health: Did he eat most food raw? Surely there wasn't added salt anywhere?.. There is no end to these questions and in fact his diet was not optimal. And I'm pretty sure no one other on this planet eats an optimally healthy diet because none of know our genetic makeup and thus not the optimal diet for it. The man had just drawn the line in a slightly different place than i had. More on the health side, less on the flexibility and taste side in his case (he did say having some problems in these). It was neither right nor wrong, it was just his choice.

Then there's also the fact that there is a name for trying to as healthy as possible - orthorexia. While working with eating disorders it is quite obvious that there is a limit to how healthy you can try to eat before thought patterns and practices associated with disordered eating start growing.

Then there are all the other lifestyle factors. Theoretically, if we aimed at optimal dietary recommendations we should - in all fairness - aim at optimal recommendations in other aspects of life too. What would be the point of spending energy on eating as healthy as possible while sleeping too little and being too inactive - I don't see one. That's when things get really complicated. Aiming for "optimal" physical activity (..naturally not really known either..) would surely mean a lot more activity than the present recommendations of 30-60 mins a day. Here in Finland, 2/3 of population doesn’t make even the 30 mins a day and i still remember the cries of disbelief when the upper limit of 60 mins was established some years ago: unrealistic!! we have a life u know!!.. But a total amount of around 1,5 h activity a day would likely be needed. And that's just the amount and as to the quality it would need to be adjusted to cover all the aspects of motor function, flexibility, aerobic fitness etc. while still taking care to avoid injuries. And that's just exercise - add to that recommendation of optimal sleep, stress management, dental care, ergonomy... Noooo, I really don't want people to strive for optimal!! They do have a life u know!!!

The point is that whatever we recommend it is never optimal and it is always just a question of where we draw the line of "healthy enough". Even during the times of evidence-based medicine, all recommendations and guidance is very much a product of opinion and especially opinion about what is realistic and feasible. So it is with eating too. You can make it healthy and easy.. or healthier and bit more difficult..or very healthy and very difficult (and possibly also unhealthy in the end). For example the present recommendation of eating veggies, fruit and berries is around 400-500 g day in Finland and likely around that number wherever you are. Of course 400-500 g a day is not the optimal intake and more is better - but Finns happen to eat around 350 g a day so it’s a realistic goal. Surely the optimal intake is somewhere with 4-digit gram figures but few dare to set those goals. Which is fine by me - I usually recommend just going over 500 g a day.

Line has to be drawn somewhere even though no thresholds exist
So the idea is clear. Lines have to be drawn and some balance between healthy eating and feasibility has to be found. Recommendations draw this line somewhere and individual people may draw it elsewhere. Whenever you see any general recommendations it is worthwhile to consider whether you share the same ideals as those giving recommendations. If you don't want to make any bigger fuzz about eating there are likely recommendations you shouldn't mind about. And if you want to eat really healthily the recommendations are just the starting point.

Then there's also the question of how much are you willing to do just based on speculation - when something MIGHT be healthy but then again it might not. When we just don't know - organic food for example? I'm quite sure most people do not want guidance based on speculation and I would leave these things to more devoted healthy eaters and not recommend it to all. But then again there are many who are willing to go far to the zone of unknown - that's fine, just don't expect others to follow.

People vary on how much they are willing to put emphasis on the health aspect of eating and that's fine. I just wish people would stop trying to eat as healthy as possible because the concept in itself is an unreachable, utopic dream - and while chasing the dream the payout diminishes the further you go. With a poor diet you get huge benefits with small changes, with a very good diet to start with it is debatable what gains there might be to improve it further.

About me and this blog

So, it is time to move into international territories from now on. I have been asked to do this several times by readers of my Finnish blog who have wanted their friends abroad to be able to read this stuff too.

About my work
I'm a nutritionist and usually call myself nutrition or obesity researcher. In addition to weight management I've been interested in eating disorders, body composition assessment and sports nutrition and in all these I have been doing clinical work and scientific research :

Lack of  effect of long-term antioxidant supplementation on incidence of upper-respiratory-tract infections in athletes. 
Fogelholm, Mikael, Vasankari, Tornmi, Borg, Patrik, Katila, Riikka  & Tuomi, Tirno. Proceedings of the Nutrition Society / Volume 57 / Issue 04 / November 1998

Deurenberg P, Andreoli A, Borg P, Kukkonen-Harjula K, et al Eur J Clin Nutr. 2001 Nov; 55 (11) :973-9.  
Borg P, Kukkonen-Harjula K, Fogelholm M, Pasanen M. Int J Obes Relat Metab Disord. 2002 May, 26 (5) :676-83.
Borg P, Fogelholm M, Kukkonen-Harjula J Obes Relat K.Int Metab Disord. 2004 Dec; 28 (12) :1548-54.
Kukkonen-Harjula KT, PT Borg, Nenonen AM, Fogelholm MG.Prev Med. 2005 Sep-Oct; 41 (3-4) :784-90.
Linna MS, Borg P, Kukkonen-Harjula K, M Fogelholm, Nenonen A, Ahotupa M, Vasankari TJ.Int J Obes (Lond). 2007 Feb, 31 (2) :245-53.
Eklund C, Nenonen A, Kukkonen-Harjula K, Borg P, Fogelholm M, Laine S, Huhtala H, Lehtimaki T, Hurme M.Eur Cytokine Netw. 2006 Jun; 17 (2) :131-5.
Borg P, Fogelholm M.Obes Rev. 2007 May; 8 Suppl 2:47-52
Pietiläinen KH, Kaprio J, Borg P, G Plasqui, Yki-Järvinen H, Kujala UM, Rose RJ, Westerterp KR, Rissanen A. Obesity (Silver Spring).2008 Feb, 16 (2) :409-14

I started initially as a "pure" researcher but after some years I started yearning more and more for clinical work. I just felt there's no way I'm going to learn enough just by doing research. Knowledge and experience from research is needed, but for expertise and practical solutions you also need clinical work for several reasons. So, past few years I've been doing more clinical work and concentrated on my main areas: well-being, weight loss and maintenance, eating disorders and sports nutrition. Of course the main health issues come with all this.

On top of this I tend to lecture a lot and I've written 5 books: 1 in sports nutrition and 4 in weight topics. The first of my weight-loss books was loosely called "Relaxed/laid-back weight management" and the name has somehow lived in Finland to this day to sum up an easier approach to weight management. The name might sound too good to be true but the truth is that in weight management people's views have pretty much stagnated to what it used to be decades ago. The dietary focus in weight management may have shifted during decades, but the attitudes and eating psychology towards weight-loss has remained much the same despite huge advances in scientific knowledge. As a result, people still try to manage their weight by very difficult means and there is an easier way.

Thats enough about me for now.

About this blog
I presume this blog is going to be a lot like my Finnish blog. Especially as I will start by translating earlier topics. I will mostly focus on eating but may touch issues in other areas too. The blog's name implies what I usually experience in clinical work - to eat better people have to adopt a whole new approach to eating which in many ways might be quite the opposite of what they used to do. Thus words Easier Eating Plan B. Future posts will explain this in more detailed but to put shortly it usually means eating as much as you like, worrying less about eating, improving some dietary factors but neglecting many, not doing/eating anything displeasing - it's easier, its more enjoyable and (despite many don't believe it) it's effective. In many ways it is similar to intuitive eating which seems to be developed much the same time as my own idea of eating - likely many others too felt that about 10 years ago the science and clinical experience was starting to build up and show the errant ways of the past.

Is there any need for this blog? Well, that is for readers to evaluate, but there cannot be too many blogs discussing both dietary factors AND eating psychology from a viewpoint of a clinician and a researcher. I can't say my rss-reader is filled up with open-minded, somehow science based blogs that are NOT looking eating from a viewpoint of some diet - whether its low-carb, paleo, recommendation-based or whatever. (So no, there is no optimal diet. There are just several possibilities for good eating which stem from personal preferences, environmental factors, lifestyle factors and individual factors. The number of factors involved is simply so big that it's just ridiculous to think there could be a "best diet".) There are hundreds of nutrition blogs, some dozen use some kind of science based approach when possible/useful, a few are also open-minded and not stuck to some ideology - but not many that I've seen seems to include eating psychology/behavior. Lot of of talk about nutrition, much less about eating - it actually bothers me because both are equally important and if forced I'd admit that eating behaviour is even more important because it largely dictates the nutritional possibilities. But as no one's forcing me let's just say they are equally important.

I also believe there is a need for a message saying that good eating can be SIMPLE. Because it is simple. If you want you can surf all day looking for information on a perfect diet and you can make it reaaaallyyy difficult. But it's mostly useless. The basics of good eating is really simple and sticking to those will get you through most ordeals - and especially weight management which is the most common driver for eating better. When I say good eating is simple, it doesn't mean its always easy - but it's heck of a lot easier than what most people try to do. The way to simple eating is understanding which things are really important and which are not - important ones we focus on and on the rest less so. What we don't want to happen is putting effort in minor details and counterproductive changes and neglecting the major factors - and this is what often happens and eating get's really difficult.

There have been times when people have suspected that thinking eating could be simple only shows my ignorance of all the tricks that nutrition and our body has to offer. Well no one surely can know them all, but I do consider it very important for me to know these minor details and I actively follow about 60-70 science journals plus I have some dozen PubMed search phrase crawlers waiting to bite new studies - naive example of following research but there you go. But I also think I don't need to talk about all the little details and discrepancies nutrition science has to offer - these make eating just more difficult and often add to the general impression of uncertainty. If I wrote about all those tiny factors I might seem like an up-to-date science geek but from my point of view I just didn't do my job to keep things simple and common-sense. And that's my aim.

I'm sure there is lot more to say, but this will suffice for a short introduction. Hope you enjoy reading these posts in the future and especially i hope these posts help readers to follow a more tasty, enjoyable and better diet.

Some small technical aspects
I don't like using scientific citations in the text although there is science behind pretty much all I say - and if there's not I usually mention it. When I use some citations, its usually through a link to a single study. Of course one single study never confirms anything and those links are usually just representing an example of my opinion - there are always studies with different results too and I've still come to my conclusion. So no huge reference lists can be found here - I want to blog leisurely and not write a scientific article. Writing this way is just so much faster and more enjoyable - and as to my conclusions the reader's will either believe all, some or none of the text. The references wouldn't likely change that.