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Dietician Julia Zumpano joins Butts & Guts for a special episode of Dr. Steele's favorite game, Truth or Myth. With the holidays coming up, learn more about common questions on topics like dieting, superfoods, coffee, vitamins and more to help you maintain a healthy lifestyle.

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Truth or Myth: Your Nutrition Questions Answered

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast, exploring your digestive and surgical health from end to end.

Hi everybody, and welcome to another episode of Butts & Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And I am so excited for this episode. I've been wanting to do this episode for a long time. And that is to try to dispel some of the myths that are out there about nutrition questions, especially as it comes to the holiday time and some of the foods that we eat. So I am super excited to welcome in our expert, Julia Zumpano, who is a dietician here at Cleveland Clinic's Digestive Disease & Surgery Institute. Julia, welcome to Butts & Guts.

Julia Zumpano: Thank you. Thank you for having me. I'm very excited to be here.

Dr. Scott Steele: So tell us a little bit about your background. Where are you from, where'd you train, and how did it come to the point that you're here at the Cleveland Clinic?

Julia Zumpano: So I am from Akron, Ohio, and I went to school at the University of Akron and came to Cleveland for my internship at the Cleveland Clinic. And I've been here since 2003. So I've been at the clinic for quite some time and I'm very happy to be here and serve at such a world-renowned hospital. I do specialize in cardiology. Majority of my time here is being spent in cardiology, specifically preventive cardiology.

Dr. Scott Steele: Well, we're super excited to have you here, and I'm sure the patients that you deal with are super excited that they were assigned to you. So let's start really big because a lot of people don't really know. So obviously, you're a dietician and working here at the Cleveland Clinic, or no matter where other dieticians will work out there. So what is a dietician's role in terms of evaluating, assessing, and then kind of helping patients?

Julia Zumpano: So a dietician's role is really just to help the patient meet their personal and health goals. So it may be a gamut of goals they may have. So it may be personal weight loss or a deciphering, or figuring out a food allergy, or as intense as controlling cholesterol values, blood pressure, maybe helping reduce inflammation, help managing some pain. So there's a lot of issues that a dietician may be helpful with. And the best part of seeing a dietician is it's an individualized approach. So we take very individual steps to see what your current eating habits are, what your personal goals are, what your health goals are. What your food preferences are, what your eating habits are, who you're eating with and where you get your food. And we take all of that in consideration to help you develop a personalized plan that's feasible, and we support you along the process. So being able to give you resources to maximize the benefit of the diet and then your outcomes, your health outcomes.

Dr. Scott Steele: That's great stuff. So what we're going to focus on in this episode today is to try to kind of address some of the more myths and maybe some of the more truths out there about nutrition. One of the things I love to do is walk into the bookstore and see all these different diets and everything, or if I can't sleep in the middle of the night, to turn on the television and find out what they're saying. So we're going to try to talk a little bit about each of those in our famous Truth or Myth format. So super excited to do that.

And let's fully jump into our game here. So I'll start you out with a real easy one, Julia. So Truth or Myth: and this is especially for those of you who may be listening during the holidays out there – the only way to lose weight is to avoid carbs and cut out all the fat. Truth or Myth?

Julia Zumpano: Myth, definitely.

Dr. Scott Steele: And why is that? Tell us a little bit about that.

Julia Zumpano: So there are definitely carbohydrates that do not support a healthy weight, but there are carbohydrates that provide vast amount of nutrients. Carbohydrates are our body's main source of energy. So if exercise is part of your routine, I do feel carbohydrates are very helpful in providing that energy source. So I think if weight loss is your end goal, I do think that including healthy forms of carbohydrates is definitely a way to go.

So healthy forms of carbohydrates include whole foods. So in the forms of fruits, vegetables, legumes, which we also know as beans and lentils, and then even in some cases, you can include some grains and can include some starchy vegetables like sweet potatoes or yams or even corn. So that can be included depending on activity level, how much you want to lose, food preferences, et cetera. But I do think there are carbohydrates that should generally definitely be avoided, but there are some good carbs that provide ample amounts of nutrition that are important to include.

Dr. Scott Steele: Already making me learn, learn. So how about the second one. Truth or Myth: eating turkey, especially obviously during the Thanksgiving time, really does cause you to fall asleep.

Julia Zumpano: So it can, yes. There is chemical in turkey called tryptophan, and tryptophan can cause more sleepiness. Now, just eating a piece of turkey for lunch generally should not provide this outcome, especially in a smaller portion. But especially alongside a very heavy fat-laden, carbohydrate-laden feast of Thanksgiving, or whatever holiday maybe you're feasting on, that portion of tryptophan in turkey may be enhanced by multiple other things, and then could lead to more sleepiness during that timeframe. But there is a mechanism in turkey that can lead to that sleepiness factor. But I think it's definitely enhanced in the setting of a Thanksgiving meal.

Dr. Scott Steele: So I can have a turkey sandwich at lunch and then just go back and see the rest of my clinic then without having to worry about falling asleep.

Julia Zumpano: I think you'd be just fine, unless that turkey sandwich is too big for you to even bite into. But if it's a general three to four ounce portion, I think you'd be just fine.

Dr. Scott Steele: Fantastic. So Truth or Myth: having enough good cholesterol can offset a high amount of bad cholesterol.

Julia Zumpano: Myth. So I do think there is definitely truth to good cholesterol helping support healthy cholesterol values. So good cholesterol, which we call HDL or high-density lipoprotein, it's kind of like a dump truck. It helps transport some of that bad cholesterol out. But that being said, if your bad cholesterol is 200, we're not certain that that good cholesterol can get all of that bad cholesterol out. So it's very based on the exact values to be able to answer that question.

But we do know good cholesterol supports heart health, and you should still work towards means of increasing your good cholesterol, which would be exercise and healthy fats, but you should also work towards decreasing the bad cholesterol, which is decreasing animal products, processed meats, processed foods, fast foods, just heavy eating. So they have to go hand-in-hand.

Dr. Scott Steele: Okay. So the multi-billion dollar industry of diets, we're going to go here now. So Truth or Myth: the Mediterranean diet really is the best diet for everyone to live a healthy life. And you can preface this with telling us a little bit about what is the Mediterranean diet.

Julia Zumpano: Yeah, so the Mediterranean diet is based on countries surrounding the Mediterranean Sea. So they've studied those countries and noticed a reduction in the prevalence of heart disease and cardiovascular disease, which is the number one killer, as we know, in those areas. So then they looked at their lifestyle and they looked at their diet. So their diet is predominantly plant-based. So they're eating an abundance of fruits, vegetables, grains, olive oil, extra-virgin olive oil, and then their main sources of protein are coming from fish, secondary from poultry, and then in small limited amounts, having things like cheese and eggs and red meat. But they're not the foundation of the diet. The diet includes all foods, really, all food groups, but really focuses heavily on plant-based foods. So again, fruits, vegetables, grains, and nuts, seeds, extra-virgin olive oil.

So we've known that that type of eating has proven positive cardiovascular health outcomes. That diet has also been shown to be very anti-inflammatory, which as we all know, pretty much any disease creates inflammation. So anti-inflammatory diets are very minimally processed again. So focused on whole foods, avoiding processed foods, which would be baked goods, snack foods, commercial foods, fast foods, anything really with several, high ingredient list, ingredients that we cannot pronounce. So those are all the foods we're trying to eliminate as much as possible. So, yes, to answer the question, I do think a Mediterranean diet is overall one of the best diets to follow.

Scott Steele: And just sticking on diets very quickly because this one also receives a lot of kind of press out there, the FODMAP diet. For those of our listeners out there, we have discussed the FODMAP diet here on Butts & Guts. But can you just give us a little overview? Is that something good to follow? Is there underlying conditions that you would say I'm going to have for that particular diet?

Julia Zumpano: Absolutely. What it does is it eliminates fermentable sugars. FODMAP stands for a series of fermentable carbohydrates and sugars that can be fermented in the gut. So what happens is when you eat some of these sugars, they create gut symptoms that may include a gamut of symptoms. Might be gas, bloating, indigestion, diarrhea, constipation, very similar to irritable bowel syndrome type symptoms. By eliminating these fermentable carbohydrates or sugars, the gastrointestinal symptoms start to decrease and eventually ideally get much more controllable. So we see a good reduction in these symptoms.

So for people who do suffer from some of these symptoms, or even notice a reaction when you're eating any of these fermentable carbohydrates, eliminating them or following a low FODMAP diet can give you a better direction as to which foods are creating or could be leading to some of these symptoms. So the low FODMAP diet, it's not a diet that's entailed to follow long-term. It's called an elimination diet. So you eliminate every single source of a FODMAP. You take all the FODMAPs out to as low as you possibly can. And then slowly add each group back in to see which food group you could be reacting to. And then you create your own eating plan based on the results of which fermentable sugars you react the most to.

Dr. Scott Steele: Truth or Myth: when it hits close to home, having a 16-year-old daughter and seeing more and more of this. Drinking coffee can stunt a child's growth.

Julia Zumpano: That's a good one. I was told when I was a child that drinking... I'm Eastern European. So my mother would always drink Turkish coffee. And she told me it would make me grow a mustache. So that's why I never drank coffee. So I think all of those are myths. Although, that being said, I do think there are other negative health effects of drinking coffee at an early age, meaning childhood. Sugary, sweetened, caffeinated drinks can be associated with weight gain. There have been some studies related to young girls, caffeinated soft drinks can affect menstrual cycles and the beginning of a menstrual cycle for females. Of course, it affects sleep. It increases anxiety. There have even been studies that show in older adolescents, caffeinated energy drinks can also be associated with some alcohol use. So there's other negative associations. Nothing specifically, I think, clinically proven from a growth standpoint, but other concerns.

Dr. Scott Steele: So maybe more appropriate for the holiday season, but truth or myth. If an adult has had too much to drink, drinking coffee can help offset their impairment.

Julia Zumpano: I would probably say that that's a myth. A common reasoning around that myth would be that intoxication leads to being very sleepy, very tired, very lethargic, and then coffee, which is considered a stimulant, therefore offsets that feeling. So in a short period of time, after you have the caffeine, can create some form of stimulant, which then again leads to, on the other end, a depressant. So you're eventually going to come up, then you'll go back down again. So I wouldn't say that it decreases the severity of intoxication, but more so gives you a stimulant to get through a short period of time.

Dr. Scott Steele: Yeah, it's amazing all the different hangover cures that you can find by simply Googling about. So Truth or Myth: superfoods – like kale, pomegranates, and walnuts – will prevent heart disease.

Julia Zumpano: So I wouldn't say that superfoods can prevent heart disease, but I do think that foods that are high in antioxidants and that are nutrient-dense can lead to overall health benefits that can help you, amongst other practices, prevent disease. So healthy diet is important, but that's not the only key. Minimizing stress, controlling cholesterol, controlling your weight, controlling your blood sugars, controlling your blood pressure, sleeping, exercising. All of those things can prevent heart disease. Food alone is not going to be the only prevention.

Scott Steele: Truth or Myth: and my wife would love to hear a response to this one – so eating fish more than once or twice a week can lead to mercury poisoning.

Julia Zumpano: So it's semi-true. So depending on the kind of fish you're eating and the portion of fish you're eating, if you are eating high mercury fish. Fish that are high in mercury include king mackerel, swordfish, tilefish and shark, those are the ones that are the highest. Now, tuna is another one, canned tuna. If you're eating high mercury fish more than twice a week, so more than six to 12 ounces a week, you can, if you're consistently doing that, can lead to excessive amounts of mercury.

Now, most of us don't eat those fish regularly. Canned tuna would be probably the most concerning on a standard American diet. And chunk light tuna is the way to go if you're going to go canned tuna, because it has less mercury than albacore tuna. Another safe way to go when you're doing canned fish would be purchasing more sustainable canned versions of fish that have specific guidelines for mercury. So it will say low mercury, or lowest in mercury, or controlled in mercury. So you want to look for those kinds of canned tuna that specifically address the mercury in the fish if you're regularly eating canned tuna. I generally recommend no more than six ounces of canned tuna a week.

Scott Steele: Truth or Myth, all things being equal on this one: eating an hour before bedtime will make you gain weight.

Julia Zumpano: That's a tough one as well. So if you have met your caloric need for the day, eating an hour before bedtime consistently exceeds your caloric need, it will lead in weight gain. If you have not met your caloric need, let's say you've had a thousand calories that day, and that's why you're hungry before bedtime, then eating that snack will most likely not lead to weight gain. So that's a difficult question to answer as a yes or no.

But for the most part, with a majority of Americans being overweight or obese, you want to lump a majority of your eating within the most active hours of your day. You really want to minimize what you're eating closer to the inactive hours of your day. So the closer to bedtime you are, the least amount you want to eat and drink. That's your body's hibernating, that's your body's rest and relaxation and hibernation mode. So anything you're going to eat, your body's not burning, it's holding onto. Again, like I said, if your diet was very minimal throughout the day, that's likely not going to lead to weight gain.

Dr. Scott Steele: Truth or Myth: eating spicy food will help you lose weight.

Julia Zumpano: Again, something that it's based by personal intake. So if you're eating French fries and you decide to put cayenne pepper on it, that's not going to help you lose weight. But if you're eating spicy foods on a routine basis, spice can help you slow down how quickly you eat. It can also decrease the amount that you're eating and it also can promote liquid intake during eating. And all of those things slow down the volume of food and eventually can slow down the amount of food you're eating. So in that sense, it certainly can help.

Dr. Scott Steele: Truth or Myth: vitamin C can keep you from catching a cold.

Julia Zumpano: So vitamin C has been known to be a natural immune booster. So it doesn't necessarily help you from catching the cold, but it might help you fight it off with the least amount of symptoms you can have. So your body's ability to fight that cold would be maximized by vitamin C, but multiple other nutrients as well, as we know now. Nutrition and immunity is a very hot topic these days. So keeping your body as healthy as possible. So adequate sleep, fluid, vitamins and minerals, including vitamin C, vitamin D, zinc, antioxidants. Those are all very important to keep your immune system at the utmost running as it possibly can be.

Dr. Scott Steele: Truth or Myth: it doesn't matter what you eat, as long as you count your calories and keep them low.

Julia Zumpano: So I feel that counting calories can work in multiple stages of your life. So I take weight loss as stages. So as we're young or middle age, weight loss is a lot easier to accomplish. Your metabolism is running. You're able to exercise. And I think cutting calories can be very effective. But as you age, your metabolism decreases, your estimated needs decrease. So I think counting calories could still work in later years, but if you're struggling counting calories and not losing weight, then there could be food groups that you're exceeding. You could be eating too much fat, too much carbohydrate, too much sugar, which I don't think all calories are created equal. So I think that the mix of where your calories come from are much more important than the calorie itself.

Dr. Scott Steele: I just had to throw a truth or myth that I'll give to myself. And that's often that you can't have nuts, berries, or popcorn if you have diverticular disease. And I just want to, again, reemphasize that this is not the case. There may be patients out there, listeners, who swear that they've gotten a flare following that. And that may be the case and you may want to avoid it. But in general, that is a myth.

So the last one that's near and dear to my heart. Drinking more than eight Diet Mountain Dews in a day is bad for your health. Truth or Myth?

Julia Zumpano: Truth.

Dr. Scott Steele: I'm going to leave it at that and say it's one of my favorite things in the world.

Julia Zumpano: Truth, truth, truth.

Dr. Scott Steele: So, that was awesome. And thank you so much for kind of walking through some of these myths. What can a patient who comes to see you or any other dietician at the Cleveland Clinic expect? Walk us through very briefly through that type of experience.

Julia Zumpano: Sure. So whether you see us in person or virtually, we'll likely assess your weight and we'll assess your diet, take a diet history. We'll talk about what goals you might have. Take a look at your lab values, any past medical history, any disease states that you really want to work on. And then we'll help you come up with a plan to meet your goals and your health and personal goals.

Dr. Scott Steele: So we like to get to know each of our guests a little bit better. So we're going to end with some quick hitters. So first of all, what's your favorite food?

Julia Zumpano: Well, real food would probably be salads. I've always loved salads, anything fresh, varying the taste. More of an indulgence would be dark chocolate. And I really like dark, dark chocolate. So 85% cocoa or greater.

Dr. Scott Steele: Yeah, yeah. What's your favorite sport?

Julia Zumpano: Soccer, by far.

Dr. Scott Steele: What is the last non-medical book that you've read?

Julia Zumpano: Oh gosh. I can't even recall. The books I read are related to my job.

Dr. Scott Steele: What's the last non-medical magazine that you've read?

Julia Zumpano: Probably Cosmo.

Dr. Scott Steele: There we go. And so name something that you like about living here in Northeast Ohio.

Julia Zumpano: Oh, I love the change of seasons. I think that's great to have different seasons and enjoy different activities and sports. And I also love the variety of cultures and diversity specifically in Cleveland.

Dr. Scott Steele: So that's awesome. What is the final take-home message that you can give to our listeners about just a lot of these myths and a lot of just dietician in general.

Julia Zumpano: In general, I would say eat real food, five ingredients or less, keep it simple, and enjoy the food when you eat it.

Dr. Scott Steele: Great advice. So to learn more about nutrition therapy here at the Cleveland Clinic, please visit ClevelandClinic.org/nutrition. That's ClevelandClinic.org/nutrition. You can also call 216.444.3046. That's 216.444.3046.

And finally, please remember in times like these it's important for you and your family to continue to receive medical care. Rest assured, here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers. Julia, thanks so much for joining us on Butts & Guts.

Julia Zumpano: Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.

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A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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