Nutritional Priorities

There is a lot of talk about what constitutes a “healthy” diet, but rarely do we ever define what exactly we mean by “healthy”. And when we do define “healthy”, we often get lost focusing on things that have marginal benefit and ignoring those things that have substantial benefit. In this post, I hope to demystify nutrition and offer the framework I use when thinking about food.

As I see it, the two most important markers of the impact of our diet on our bodies are a healthy body composition and an efficient metabolism. I focus on these two because they have the greatest impact on our risk for chronic disease. Poor body composition and metabolism increase our risk for heart disease, diabetes, cancer and more. Only when these have been adequately addressed does it make sense to consider the other impacts of food on our health.

Body Composition

With respect to body composition, I am concerned with two things: body fat percentage and muscle mass.

Body Fat Percentage

For someone that is 20 lb. or more overweight, the single most important thing they can do to improve their health is to lose that extra weight. Eating less calories and moving more should be the priority. Neglecting to prioritize these and focusing instead on things like consuming grass-fed dairy instead of conventional dairy or avocado oil rather than canola oil is to lose sight of what really matters. This means that for such a person a diet that results in fat loss is superior to one that does not, even if the diet consists of “junk food” like popcorn, low calorie ice cream, and diet sodas. This is because the reduction in inflammation and risk of chronic disease that comes from fat loss far outweighs any benefit that could come from a “healthy" diet of avocados and nuts that does not result in fat loss.

Muscle Mass

For those that do not carry excessive body fat, the priority should be to gain strength and muscle mass. For those trainees that are lean but resistant to gaining weight, I often remind them that our strength and muscle mass decrease with age. It is thus imperative that we accumulate enough now to get us through the final decades of our life. Gaining sufficient muscle mass now will

1. protect your skeleton from external traumas such as falls or accidents that can happen at any age,

2. minimize the stress of movement on your joints and tendons

3. improve your metabolic health (see below) and carb tolerance, because muscles are the greatest stores of glycogen (i.e. glucose) in the body,

4. and ensure healthy and independent movement in your final decades, despite

   1. the steady loss of muscle mass that comes with aging and

   2. the sudden loss of muscle mass that comes from periods of prolonged bedrest due to unexpected events like a serious infection, surgery, or even an automobile accident.

In other words, you want a cushion of 20-30 lb. so that as you age and lose some muscle mass, this atrophy does not impair your ability to perform the four fundamental human movements: the hinge, squat, press and pull. Of course, this weight gain doesn’t have to happen in a week or even a year, and, in fact, it shouldn’t happen in such a short period of time, but over the course of several years.

For example, each year, one might devote 8 weeks to gaining 5-8 lb. and then spend the rest of the year maintaining or re-comping. As for how this done, see my post To Bulk or Not to Bulk.

Metabolic Health

Metabolism refers to the process by which we convert the food we eat into energy. Most of this energy comes from the carbohydrates we consume, which is broken down into glucose and then enters the bloodstream. The body then releases a hormone called insulin to help move that glucose into our cells where it is stored as glycogen for use as energy. In healthy individuals, this process works seamlessly and keeps our blood sugar levels within an optimal range. In unhealthy individuals, this process is impaired and leads to high blood sugar, a sign of metabolic dysfunction. The elevated blood sugar, in turn, weakens the immune system, causes hormone imbalances and increases systemic inflammation and risk for chronic diseases like cancer, heart disease, and kidney failure. This impairment to regulate blood sugar levels could be caused by one of two factors:

1. an inability to produce insulin—a condition known as Type I Diabetes. This is a genetic condition that can be managed through medical interventions but for which no cure currently exists.

2. an inability to respond to the insulin that is released by the pancreas, a condition known as insulin resistance, the precursor to Type II Diabetes and metabolic syndrome. Unlike the first impairment, this one is usually a result of lifestyle factors and can be prevented and even reversed with diet and exercise.

To eat a metabolically healthy diet, then, is to be deliberate and conscious of the impact of our food on blood sugar levels. The goal is to bring our average blood sugar levels down to a healthy level and to minimize the number of “spikes” we experience throughout the day.

Because everyone differs in their response to carbohydrates, some experts have recommended the use of Continuous Glucose Monitors (CGMs) for 2-8 weeks to get a clearer picture of your metabolic health. For those that do not have access to this device, Levels, Nutrisense, and Veri are a few of the companies I am aware of that provide access to CGMs and help you understand the current state of your metabolic health.

But even without the use of a CGM, below are some good practices that you can incorporate to improve your metabolic health:

• If you are overweight, reduce body fat. I cannot stress this enough.

• Eliminate or drastically reduce the amount of sugar you drink. Liquids have a much greater impact on blood sugar levels than solids.

• Consume high carb meals or snacks right before or right after working out rather than while you are sitting at your desk to work.

• Go for a short walk right after meals.

• Do not eat close to bedtime.

• Couple your carbs with protein, fats, and fiber to reduce the impact of the carbs on your blood sugar.

• Reduce the amount of added, refined, and processed carbs you consume.

• Opt for lower glycemic foods such as whole-wheat over white bread, or brown rice over white rice, or strawberries and blueberries over bananas and watermelon.

• Exercise: while this post is about the role of diet, I would be remiss not to mention the role of exercise. Steady State Zone 2 training and hypertrophy training both improve metabolic health in important ways. Zone 2 training increases the quantity and quality of your mitochondria, and thereby improves your body’s ability to metabolize carbohydrates. Hypertrophy training increases muscle mass, and thereby increases your body’s glycogen (i.e. glucose) stores. In other words, increasing muscle mass and improving your aerobic base through zone 2 training improves your body’s ability to metabolize carbohydrates, leading to improved carb tolerance.

Now some of you might be reading this and think that I am making a case for low-carb diets. While people with severe cases of insulin resistance might need to go on a low-carb diet for a period of time, for most people, carbohydrates are not bad or harmful in themselves. They serve an important function and are the main source of energy for our bodies.

Also, not all carbohydrates are created equally. Some (like liquid carbs) have a greater impact on our blood sugar than others. Eliminating or drastically reducing these is important. Similarly, not all people are equal in their ability to process carbs. An elite endurance athlete can metabolize carbs much better than the average person and can consume liquid carbs during workouts without deleterious consequences.

Food timing also matters. Having a banana, some watermelon, or even a chocolate chip cookie right before or during an intense workout is less likely to impact your blood sugar adversely.

Conclusion

To conclude, a healthy diet is, first and foremost, one that supports a healthy body composition and, secondly, one that supports an efficient metabolism. If the dietary changes you are incorporating are not improving either of these, then you are missing the forest for the trees. For most people, achieving this will likely mean

• an increase in protein and fiber and

• a decrease in calories, sugar, and processed carbohydrates

Only when these changes have been successfully incorporated does it make sense to look to other ways to improve your diet.