Sunday, December 22, 2013

A Final Word (At Least For Now) On Eating Healthy

As I get ready to hang up my stethoscope again, and ponder the over one-thousand conversations I've had with patients and others over the past three years about eating for health, one theme repeatedly comes to mind: despite their belief to the contrary, most people don't truly understand what it means to eat healthy. They are also confused about the value of eating healthy when the diet still includes plenty of unhealthy foods. Healthy foods, no matter how much you eat, do not neutralize the ill effects of unhealthy foods.

As a service to all, here is a brief synopsis of the elements of a healthy diet. It's little technical at first, but I get down to a basic list at the end.

First, let's take a quick look at what are called the essential nutrients, of which there are six categories, that all humans basically need to survive. By essential, we mean that the human body cannot produce these on its own without outside help.

There are:
13 essential vitamins
Vitamins are grouped into two categories:
  • Fat-soluble vitamins are stored in the body's fatty tissue. The four fat-soluble vitamins are vitamins A, D, E, and K.
  • There are nine water-soluble vitamins. The body must use water-soluble vitamins right away. Any left over water-soluble vitamins leave the body through the urine. Vitamin B12 is the only water-soluble vitamin that can be stored in the liver for many years.
There are 15 give or take essential minerals. There are also trace minerals not listed here.
There are 9 essential amino acids
  • histidine, 
  • isoleucine, 
  • leucine, 
  • lysine, 
  • methionine, 
  • phenylalanine, 
  • threonine,  
  • tryptophan
  • valine.
2 essential fatty acids
  • alpha linolenic acid
  • linoleic acid


Some also think that choline, once thought a vitamin, is also an essential nutrient.

There are also other amino acids and fatty acids, and many other compounds in foods, such as antioxidants, enzymes, etc. that are metabolically active but are not essential to the diet as the human body can function without them.

Okay, so what are you supposed to do with all this detail. Nothing really other than eat foods that contain them.

For example, 11 of the vitamins can be obtained from eating fruits and vegetables.

One, vitamin D, can be made by sun exposure or found in foods like unsweetened almond milk.

The other Vitamin, B12, can be found in fish, chicken and meat. I'll come back to these later.

The minerals can be found in vegetables, fruits, nuts, beans whole grains, and seeds.

The amino acids and choline can be found in nuts, whole grains, beans, eggs, fish, chicken and meat.

The fatty acids, or their derivatives, can be found in seeds like chia and flax, as well as healthy wild fish like Alaskan Salmon.

So what does a healthy diet look like?

It contains daily raw fruits and vegetables, fresh or frozen. Fruits must include berries, banana, citrus, apples, and melons. Other fruits are optional. Vegetables must contain leafy green vegetables, collards, onions, tomatoes, carrots, onions, garlic, and mushrooms.
It contains raw whole nuts (includes pecans, almonds, pistachio, Brazil nuts, and macadamia- at least twenty a day except for Brazil nuts-limit to two a day), cooked beans (limit soybean but some okay), raw seeds (chia and flax best, but limit), and minimally processed whole grains like steel cut oatmeal with no preservatives nor genetically modified grains (non-GMO).
It contains wild fatty fish like wild salmon, herring, sardines, cod, halibut, etc. (3-4 times a week)
It contains free range chicken once a week, free range eggs twice a week, and lean antibiotic meat every other week as a side dish.
It includes dark chocolate(for the polyphenols) of at least 70% cacao with less than 5 grams of sugar per serving with a serving size equal to at least a third of the bar.
It contains unsweetened almond milk.
A very little olive or safflower oil.
It contains sun exposure and at least 50 ounces of fluids a day.
Of course, even a good thing in excess is harmful. So eat these foods in moderation, eat mindfully, and remember what the Okinawans say before every meal: Hora Hachi Bu (eat until your 80% full)

A healthy diet does not contain dairy of any kind (after infancy), yogurt included, and definitely not dairy that contains added hormones such as Bovine Recombinant Growth Hormone (which is part of all non-organic dairy), artificial sweeteners or added sugars, processed breads with added sugar, pastas whole grain or otherwise, ketchup with high fructose corn syrup (most), chips, processed snacks, pretzels, crackers, cold cut meats, processed meats, processed cereals like Cheerios and Kashi made from genetically modified grains (also don't be fooled by the label Organic: read the label and watch for added sugar greater than 4 grams per serving-if so, avoid), sweetened drinks or bottled fruit juices, health bars, protein touring products -- including bars, drinks, shakes or any other product touting protein, any supplements (unless prescribed by a knowledgeable physician), any multivitamins (unless pregnant), fried foods, burnt or charred foods, any food with partially hydrogenated on its ingredient list (even if label states no trans-fats), non-sun dried fruit (even if sun-dried eat in moderation), no foods or drinks whatsoever with preservatives added including nitrates and sulfites in particular, too many smoothies even if all raw ingredients--too many calories involved, farm-raised fish, especially tilapia and salmon, more than once a week tuna, non-organic apples, corn or potatoes, movie theater and microwave popcorn, too many oils including coconut, olive, sunflower, and safflower oils, too many starchy vegetables, candies with sugar and chemicals, foods with added dyes, non-organic soy-based products, and more food than you need to live-which is not really all that much after you meet the essential requirements. 

I hope this information has been helpful and I wish you all Bon Appetite. If you have any questions, please feel free to write me at for at least the next six months.


  1. Read your Atlantic article - excellent then followed you on twitter and found this blog. Outstanding blog post. Best wishes in what you endeavor in the future!

  2. Why do you avoid yogurt?

  3. In case you missed seeing my question, I will repeat it:

    Why do you avoid yogurt? I eat a lot of plain, NF Greek yogurt. Just wondering if you know something about this that I don't.

    1. Thanks for repeating the question as I did miss it.

      My primary, personal reason for avoiding any type of yogurt is because I am lactose intolerant. Apparently, so are many people because after we stop nursing, our bodies typically stop produce lactose needed to digest lactate. (As an aside evolutionary biologists believe that lactose intolerance is the normal state and tolerance is a relatively new mutation.)

      Homo sapiens are the only mammals except for domesticated animals who consume any form of dairy after weaning off their mother's milk. Also, it doesn't make a whole lot of sense for us to drink the milk of other species given that such milk is biologically designed for the young of that species that have different molecular and nutritional needs. In addition, milk contains natural hormones for growth that serve no viable purpose after we stop growing.

      Also, the recombinant bovine growth hormone and antibiotics fed to commercial dairy cows end up in conventional’ dairy products.

      Finally, there is inconclusive evidence that casein protein, found in both conventional yogurt and Greek yogurt as well as whey protein found in conventional yogurt in far greater amounts may be associated with cancer and autoimmune diseases. As its inconclusive, I prefer to avoid anything that may be harmful when there is nothing compelling about using it. For example, the calcium in dairy can be found in other foods and some even suggest that the calcium in dairy contributes to bone resorption. Again, inconclusive but enough to convince me to avoid regular use of dairy products.

      By the way, an exhaustive search for which amino acids appear in Greek yogurt was futile. Do you know?

      For protein, I stick to wild fish, nuts, and quinoa and they are more than sufficient.

    2. Steven, Thank you so much for your reply! It's taken so long because I've been studying what you wrote. I have come to believe that you are very correct to avoid dairy, including yogurt. Here's a few links that you may or may not have seen:

      A1 Beta Casein: The Devil in Your Milk -
      Bovine Beta Casein Variants: Implications to Human Nutrition and Health -
      Milk Proteins and Human Health: A1 versus A2 Beta-casein -
      The Role of DPP4 Activity in Cardiovascular Districts: In Vivo and In Vitro Evidence -

      Of course all but the last are heavily biased, but that doesn't necessarily invalidate the information.

      A while ago, I had my genome analyzed for 100,000 SNPs from 23andme. I checked it and it turns out that I have the genotype for DPP4 that is defective in both copies. Which means I may be more unable to digest casein (and gluten) than the average person and that DPP4 may be upregulated for me, which also may lead to adverse health consequences.

      Among the adverse health consequences is reduced bowel motility (which I had been experiencing) as well as the autoimmune probs you mentioned. I checked my diet history and noticed that over the last 4 years, I went from zero casein to averaging about 30g of casein per day. Now, obviously, it may be just coincidence, but shortly after I crossed over 10g per day, my joints became very painful. After I crossed over 15g per day, I became hypothyroid. Somewhere along the way, I started becoming insulin DEFICIENT. Not only that, but somewhere towards the beginning of that period is when I started having problems with bowel motility.

      So, as soon as all this sunk in, I discontinued casein intake. Bowel motility and joint pain began improving after 2 or 3 days. After 10 days casein free, almost all joint pain is gone. Don't know if anything can fix my thyroid.

      I really can't thank you enough. As a small favor, here's the amino acid breakdown for 100g of greek yogurt:

      Tryptophan 1.334
      Threonine 4.514
      Isoleucine 5.347
      Leucine 10.089
      Lysine 8.447
      Methionine 2.428
      Cystine 0.593
      Phenylalanine 5.221
      Tyrosine 5.461
      Valine 6.760
      Arginine 4.492
      Histidine 2.953
      Alanine 3.466
      Aspartic acid 8.185
      Glutamic acid 23.530
      Glycine 2.006
      Proline 11.115
      Serine 5.780

      - Dan (

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