Nutritional eating pattern case questions

There is no "optimal nutritional diet pattern" that is universal for all people. The effectiveness of all programs is bound to the four core variables of the individual's basic health status, life scenarios, dietary preferences, and metabolic characteristics. Recommendations that depart from these four premises are invalid guidance.

The two consulting clients I just received last month fell into the trap of "copying standard answers". Xiao Zhou, a 28-year-old Internet operator, has polycystic ovary syndrome. He was diagnosed with insulin resistance six months ago. He is 165 and weighs 144 pounds. He read a health blogger who said that the Mediterranean diet is the best diet recognized in the world. He followed it for three months: a large bowl of oatmeal every day, brown rice and quinoa rice for half of lunch and dinner. He must eat an apple after every meal, and deliberately add a spoonful of extra virgin olive oil every day. As a result, I didn't lose 2 pounds, but my testosterone went up again, and my aunt postponed the test for 20 days.

In fact, it's not that the Mediterranean diet is bad, it's that Xiao Zhou's metabolic state cannot handle such a high carbohydrate load. Her insulin sensitivity is worse than that of ordinary people. Replacing refined grains with whole grains does raise blood sugar more slowly, but the amount cannot be tolerated. In addition, she eats high-fructose apples every day, and adds extra fat and calories. The continuous blood sugar fluctuations actually aggravate insulin resistance, and the symptoms of polycystic cysts naturally become worse.

The 52-year-old Aunt Zhang was even more unjust. A physical examination revealed high blood lipids. She heard from a group health account that the ketogenic diet can reduce blood lipids the fastest. She didn’t dare to touch a bite of rice and noodles. She ate pork belly, avocado, and bulletproof coffee for two months. She felt dizzy and weak after eating for two months. She went for a follow-up examination and found that the blood lipids did not drop much, and the uric acid soared to 580, almost causing a gout attack. Her glomerular filtration rate is lower than that of her peers. If her long-term intake of high animal protein and fat prevents metabolic waste from being excreted, then something could go wrong.

There are actually a lot of quarrels about this matter in the nutrition circle now. Most experts in the traditional public health field advocate following the dietary guidelines for residents, with a balanced mix of grains, potatoes, eggs, milk, meat, poultry, and fruits and vegetables in reasonable proportions. This plan has a high error tolerance. As long as healthy people with no clear chronic diseases or metabolic problems follow the diet, they will basically not make big mistakes. The price-performance ratio is also high, and there is no need to buy expensive ingredients.

However, practitioners in the field of functional medicine are more inclined to make individual adjustments. For example, for people with Hashimoto's thyroiditis, even if you are a healthy person, it is best to check for gluten and dairy intolerance first. If your antibodies rise after eating and you are prone to fatigue, even the whole grains and milk recommended by the guidelines must be avoided for a period of time. There are also patients with irritable bowel syndrome who suffer from flatulence and diarrhea if they eat too much coarse grains and cruciferous vegetables that are rich in dietary fiber. It is perfectly fine to temporarily switch to fine rice noodles and low-fiber cooked vegetables.

Oh, by the way, the logic in the field of sports nutrition is different. If you do strength training more than three times a week, or have the need to run horses or ride long distances, then even if you have mild insulin resistance, you must ensure adequate carbohydrate intake. Otherwise, you will become weak and lose muscle during training, which will be more of a loss than the gain. I used to have a fitness friend who, in order to burn fat and carry out low-carb diet, suffered from hypoglycemia and fainted in the gym halfway through training. It was really unnecessary.

The two most controversial issues right now are whether whole grains should be eaten every day, and whether free fructose is healthy. Those who support whole grains use cohort study data to say that people who eat whole grains for a long time have a 30% lower risk of cardiovascular disease. ； Opponents point to clinical cases, saying that many patients with autoimmune diseases have significantly relieved their symptoms after avoiding gluten. Each has its own basis. In fact, it is suitable for different groups of people. The same goes for fruits. It is perfectly fine for healthy people to eat 200-350g a day. But for people with fatty liver and high uric acid, eating high-fructose fruits such as watermelon, mango, and lychee every day will aggravate their condition.

I have been doing consulting for so long, and the advice I usually give to ordinary people is very simple. You need to understand your own situation first: If you have nothing wrong with you, don’t exercise much, and sit in the office from 9 to 5, then you are right to follow the dietary guideline, which is one pound of vegetables and half a pound of fruits every day, a palm of meat, a cup of milk, and a staple food of half whole grains and half fine grains. There is no need to do anything fancy.

If you already have metabolic problems such as obesity, fatty liver, polycystic liver disease, etc., first go to the hospital to check your glucose tolerance and insulin release. If you are sure that you are insulin resistant, you should appropriately reduce the amount of staple food, replace high-sugar fruits with low-sugar ones such as berries, and use less cooking oil. It is much more reliable than following the trend of eating Mediterranean and ketogenic foods.

Oh, by the way, there is another point that is easily overlooked: dietary preferences. Many people think that a healthy diet requires eating grass, which makes every meal taste tasteless and breaks down after two weeks. Then overeating makes things worse. In fact, there is really no need. If you like to eat hot pot, choose a water pot, cook more vegetables, less fat meat, and less sesame sauce and sesame oil as dipping sauce. It is still healthy. If you like rice, there is no need to switch to quinoa that you don't like. Just eat a few bites less. A diet that can be adhered to for a long time is effective.

In fact, to put it bluntly, there is no standard answer to this question. If your stomach is not bloated after eating, you have enough energy, your weight is stable, your physical examination indicators are normal, and you can continue to eat, then it is the best nutritious eating pattern for you. Everything else, no matter how impressive it is, is in vain if it is not suitable for you.