What we know and don't know about nutrition (with Gil Carvalho)

1. Adopt Mediterranean Diet Pattern

Prioritize a traditional Mediterranean dietary pattern, emphasizing fish, seafood, fruits, vegetables, whole grains, some dairy, and olive oil, as it is the most scientifically validated for improving health outcomes.

2. Focus on Whole, Quality Foods

Adopt a positive mindset by focusing on incorporating high-quality, health-promoting whole foods into your diet, rather than fixating on what to eliminate or fearing entire macronutrient categories.

3. Prioritize Diet Sustainability

Choose a dietary pattern that aligns with your personal preferences and is sustainable and enjoyable long-term, as adherence is crucial for lasting success and weight maintenance.

4. Evaluate Evidence Hierarchy

Evaluate nutrition claims by understanding the hierarchy of evidence, prioritizing meta-analyses and randomized controlled trials over anecdotes or mechanistic claims, which are at the bottom.

5. Be Wary of Fear-Based Fads

Be skeptical of diet trends that focus on prohibitions and use fear-based messaging (e.g., ‘poison,’ ’toxic’), as these often block reasoning and lead to unsustainable fad-hopping.

6. Engage in Regular Exercise

Engage in regular physical activity, combining both cardio and resistance training, for numerous health benefits including improved insulin resistance and cardiovascular health.

7. Start Exercise Slowly

Begin exercise slowly and gradually, such as walking for 10 minutes daily, to minimize injury risk and increase long-term adherence, rather than starting with an intense routine that is difficult to sustain.

8. Calorie Intake is Key

Understand that calorie intake is the primary factor in weight loss, but choosing foods that are harder to overeat (e.g., high satiety foods) is a key strategy for managing calorie consumption.

9. Choose Satiating Foods

Choose foods high in protein and fiber, and low in caloric density (e.g., whole, unprocessed foods rich in water), to increase satiety per calorie and aid in weight management.

10. Reduce Refined Carbs

Reduce refined carbohydrate intake, as most Westerners consume excessive amounts; prioritize whole, unprocessed carbohydrate sources like steel-cut oats, quinoa, and corn on the cob.

11. Minimize Processed Meats

Minimize consumption of processed meats (e.g., bacon, beef jerky) as they are consistently linked to higher risks of cardiovascular disease and certain cancers.

12. Prioritize Leaner Meats

Prioritize less processed, leaner cuts of meat, especially fish and seafood, as these are associated with better health outcomes due to their fat composition; limit red meat to sparingly (once or twice a week).

13. Use Blood Work & History

Use personal blood work (lipids, glucose, blood pressure) and family history to assess individual tolerance and risk for health factors like obesity or meat consumption.

14. Request ApoB Test

Request an ApoB test as a more reliable and rigorous measure of heart disease risk than standard LDL or HDL cholesterol, as it quantifies the number of fat-carrying lipoproteins.

15. Measure Insulin Resistance

Consider measuring insulin resistance using metrics like HOMA-IR (requires fasting glucose and insulin) or the TYG index (uses fasting glucose and triglycerides) to detect metabolic issues before glucose levels become overtly high.

16. Differentiate Glucose Levels

Understand that normal glucose fluctuations after meals are physiological and not indicative of diabetes; concern arises when glucose levels remain very high for hours or are high in a fasting state.

17. Eat Meals Earlier

Consider eating meals earlier in the day (morning or early afternoon) for better metabolic outcomes and weight management, as chronobiology suggests timing can affect absorption and metabolism.

18. Dieting: Protein & Resistance

When dieting for weight loss, maintain a reasonably high protein intake and incorporate resistance training to enhance satiety and minimize muscle loss, thereby improving body composition.

19. Recognize Nutrition Misinformation

Be aware that public perception of nutrition science is often skewed by sensationalized headlines and social media, which don’t accurately reflect scientific progress or consensus.

20. Guidelines as Tools

View dietary guidelines as tools to assist in making educated choices, not rigid laws, and ultimately make personal decisions based on your own informed judgment.

21. Beware Mechanistic Claims

Be skeptical of claims that rely solely on biological mechanisms to assert cause and effect without supporting outcome data in humans, especially if they are flashy or counter-current.

22. Understand Saturated Fat Context

Understand that the health impact of saturated fat is context-dependent: it’s less harmful than trans fats or refined carbohydrates but more risky than unsaturated fats or whole carbohydrates for cardiovascular health.

23. Acknowledge Diet Uncertainty

Be aware of the long-term uncertainty of radical diets like ketogenic or extremely low-fat diets, as extensive long-term data (10-20+ years) on their effects is not yet available.

24. Most Westerners Get Protein

Most Westerners already consume sufficient protein and do not need to actively seek more, as they are often getting more than they need.

25. Adjust Protein for Age

Consider moderating protein intake if under 65, but increasing it slightly if older (around 1.2 g/kg body weight), as higher protein may be more beneficial for older adults to counteract anabolic resistance.

26. High Protein & Kidneys

Do not worry about high protein intake damaging kidneys unless you have pre-existing kidney disease or a family history of kidney problems, as this theory has largely been debunked for healthy individuals.

27. Use BMI with Caution

Use BMI as a population-level indicator, but be aware of its limitations for individuals (e.g., muscular people may have high BMI without excess fat), and consider other metrics for personal assessment.

28. Compare Current to Past Weight

Compare your current weight to a leaner period in your past (e.g., college) as a simple indicator of weight gain, as most weight gained after a certain age is typically fat, not muscle.