First of all, can you tell our blog community what a physician nutritionist is? It’s a title many people may not be familiar with. Dr. Melina: It’s a constantly evolving thing. I’ll talk speciﬁcally about me. I initally boarded as an internist. At the time that I sat for the boards as a Physician Nutrition Specialist, you could be certiﬁed based on practicing in the ﬁeld for years. Now you need to do a one year fellowship to sit for boards. You also have to be boarded [board-certiﬁed] ﬁrst in another specialty. Most of those who are certiﬁed tend to be more in research, academia. Or hospital based. But I’ve chosen to do education. Oldways: That’s such a wonderful thing – doctors with extensive training in nutrition. It’s kind of disappointing to hear that most of these rare Physician Nutritionists are in labs somewhere, and not out working directly with patients. Should people really ask their doctor about diet – if the doctor isn’t you! – or would they be better oﬀ seeking other sources? If so, which ones? Dr. Melina: People really do listen to their doctors. When it comes to nutrition, however, most doctors haven’t had nutrition training and they’re usually more clueless than you are. At this point the best choice is an RD – a registered dietitian. Oldways: What are the greatest myths and misconceptions you ﬁnd people have about what constitutes healthy eating? I’m sure you run into dozens. What are some of those you run into most often, or those you think pose the biggest threats to good health? Dr. Melina: I think people become too hung up on one component of a food, depending on the fad of the day. “If a food is low fat it must be healthy.” “ If a food is low calorie it must be healthy.” “If it’s high ﬁber or if it contains whole grains it must be healthy.” People understand fruits, vegetables and whole grains are healthy. But all too often they focus on one nutrient and think that translates into health. They don’t look at the big picture. Overall composition of the diet is what constitutes health. We need to take a more holistic approach. Packaged foods are unfortunately so much sexier. Apples aren’t competing in ads: no one is saying, “Eat Fuji apples! They’re better than Galas!” Oldways: Recently the Institute of Medicine came out with a report recommending changes in Front of Pack labeling. They’re recommending that consumers will move to healthier foods if four things – total calories, saturated fat, trans fat, and sodium – are called out, on the front of the package. Dr. Melina: I think that’s a problem. What that does is to take a step away from unhealthy… maybe a step toward neutral. But I think there’s a big gap between unhealthy and health-promoting. It’s like our approach to vitamins: the amounts oﬃcially recommended are those that will prevent scurvy, or some other disease, but that’s not necessarily the level needed for good health. We need to move people away from processed foods. 70% of sodium is from processed foods, not from the shaker. Oldways: Let’s talk about another big eﬀort from the government, to change Americans’ eating habits – the 2010 Dietary Guidelines Report. Although we haven’t seen the actual Guidelines yet, the Dietary Guidelines Advisory Committee released its report in June. Did anything strike you, for better or worse, in that report? Dr. Melina: One thing I have heard is an emphasis on moving toward a plant-based diet. I’m concerned we’re going to lose people’s attention when they hear that, especially in the ﬂy-over states. Yes, it’s favorable from a health standpoint, but it’s a big concern of mine. Oldways: Concern that people will say, “Oh, I have to become a vegetarian to eat healthy? Forget it!” – is that what worries you? Dr. Melina: Exactly. What did Oldways ﬁnd most interesting in the Dietary Guidelines Report? Oldways: We’re especially excited about three important points cited by the DGAC in its report – three points that echo the approach Oldways has taken for 20 years, in changing the way people eat. We’d like to get your opinion on these three points. The ﬁrst point is, “Total diet is more important than individual foods or nutrients.” From what you’ve already told us about the importance of the big picture, it’s clear you agree with this. But how on earth do we communicate the total diet message to people? Any ideas? Dr. Melina: A good question. I think you need to start with the basics. With my patients, I tell them to eat foods closest to their natural state, make the majority of your diet whole foods, and then do the best you can with the rest. Look for key words on the label. Whole grains is one of those key words. What were the other two points you mentioned? Oldways: Well, too often nutrition information is all about scolding, and what you shouldn’t eat. For two decades Oldways has been sending a positive message about the pleasures of the table. That’s the second point we’re glad to see emphasized in the DGAC report: “Healthy eating can be delicious.” Do you have any suggestions for good ways to convey a positive message about good food? Dr. Melina: I talk about something called the Alternative Healthy Eating Index. As you probably know, the U.S. government measures how people measure up to an earlier version of the Dietary Guidelines with something called the “Healthy Eating Index.” But research shows their healthy eating index correlates with high markers of inﬂammation. That’s not good. The Alternative Healthy Eating Index combines the best seven components of traditional diets around the world to come up with a diet that can lower inﬂammation markers by about 30%. The seven components are:
- Copious fruits and vegetables
- Including nuts or soy every day
- A greater than 1:1 ratio of polyunsaturated fats to saturated fats. It’s okay to have a little butter on your toast, if you make sure to have olive oil on your salad.
- A 4:1 ratio of white meat and ﬁsh to red meat.
- Moderate alcohol use.
- 15g or more of cereal ﬁber.
- Reduce trans fats