What You Should Really Be Eating (and Not!) with Kristin Kirkpatrick, RD

Podcast Transcript

Nada Youssef: Hi. Welcome to Facebook Live. I'm your host, Nada Youssef. And today, we are talking nutrition with our featured expert, Kristin Kirkpatrick. She's a registered dietician here in Cleveland Clinic and a manager of Wellness Nutrition Services. So if you guys have any questions regarding nutrition, please put in the comments section below, and we'll get to it in the next half and hour or so. Before we begin, please remember this is for informational purposes only and it's not to replace your own physician's advice. So thank you so much for being here today.

Kristin K.: Thank you Nada. So excited.

Nada Youssef: Do you want to introduce yourself a little bit to our audience before we begin?

Kristin K.: Yeah. Absolutely. So my name's Kristin and I lead the Nutrition Services here for the Cleveland Clinic Wellness Institute. I am so excited to be here today because I have so many people connecting with me through social media all the time with questions. And I always think if you have a question, so does about 2,000 other people. So I'm here to answer them. I have a lot of experience with our patients here, and I'm ready to go. So bring them on.

Nada Youssef: Excellent. Well, I want to start with kind of just very general, nutrition is confusing to me.

Kristin K.: So confusing.

Nada Youssef: Because one person says one thing, you know I'm starting to read a lot about intermittent fasting, about Ketogenic diet, but then there's Mediterranean diet. There's elimination diet. There's so much, what are we suppose to look at? How do we know what to pick?

Kristin K.: So I think the first thing that we want to focus on, this is really important. I get this question all the time. What's the right diet? Like, "A new book came out." Or, "I just saw this on social media, what the heck do I follow?" So the right diet is the one that's going to fit into your lifestyle the best. So you have to look at your environment, who are you living with? So if your craving is like cookies, and you have a spouse or a friend that continues to bring it in the house, it's going to be a challenging one. Maybe we focus on something else. As far as the structure of the diet, for me, I really like to personalize it to the patients. Even though things like Mediterranean diet and DASH. Those are rated very highly. They don't work for everybody. So again, it really depends on what you're looking for. The one thing I cannot stress enough, and I probably going to say it a million times today, is the importance of eating food. So whatever diet you're going to choose, it's gotta be food.

Nada Youssef: Okay. Not juicing? No juice?

Kristin K.: Well, we can add in juicing a little bit.

Nada Youssef: Okay.

Kristin K.: Well, a little bit, but I'll just say just to start it off. Michael Pollan designs food as something that comes from nature, is fed from nature and will eventually rot. So think about what you had for breakfast, what you're going to have for lunch, dinner, does it meet that criteria? 90% of the time, I want my patients meeting that criteria.

Nada Youssef: Sure. Perfect. Okay. Well, and hopefully today's discussion will help everybody kind of guide us of what we're supposed to do. What kind of diet works the best for us. So kind of let's start something with the Food Pyramid. I know in like 2011, it was kind of ditched for a new plate portion.

Kristin K.: Change the plates.

Nada Youssef: Yeah, myplate.gov.

Kristin K.: Yeah.

Nada Youssef: So I'm kind of looking at it, and I wanted to talk about what are the biggest differences. Like, what was accepted to be healthy for us versus today, that seems very different from the pyramids, the plate. It looks very very different. And if you guys want to take a look at it, it's choosemyplate.gov. And it shows you kind of what it looks like and what are the portions that you are supposed to be eating. So let's talk about like grains.

Kristin K.: Grains. Yeah. So My Plate, the new thing with it is that My Plate recommend that half of your grain should be whole grains. For my patients, I think all of your grain should be whole grains. Now, are you going to go to a restaurant every once in a while and have something on a white bun? Absolutely. Okay? Again, 85% to 90% we're eating that food, and not some of those processed calories. So with the grains, it's great that they're recommending the 50%. We need to bump that up much more significantly than that.

Nada Youssef: Sure.

Kristin K.: I like that it has the plates option there. That you can actually look at that because for some people especially people that are very visual, it helps with depicting, "Okay, what should I kind of do here." But it doesn't really get specifics in my opinion. Specific enough on what are the best protein choices for you. Definitely, doesn't go into fats in that picture of the plates. Many people either can't tolerate dairy, or don't want dairy. It's the only drink that's there. I would love to see a glass of water there instead or a glass of wine because it's fine to drink your calories, but I say it's only going to be something like wine. Very much in moderation or water or coffee. So those are some three options that we should perhaps have there.

Nada Youssef: Have besides the dairy?

Kristin K.: Yeah. Not everyone wants dairy. So just some things to think about, it's one option. I will say I love the tracking mechanism from My Plate. So a lot of people have found that very helpful. A lot of my patients. Just going on and being able to use their analysis tool. You can analyze recipes on it. You can look at your diets. So it's always going to recommend, make recommendations based on the My Plate structure, but at least you can start tracking. It's one of those ways that you can track some of your food.

Nada Youssef: Sure. And while I was looking at this, I could not find any oil or fats. So I did a little bit more digging. I went into the website. They do give you one tablespoon of vegetable oil, and says nothing about coconut oil. What is your take on coconut oil, saturated fat? Because I know it's kind of controversial.

Kristin K.: Or even olive oil.

Nada Youssef: Right.

Kristin K.: I mean things like that, right? I wouldn't say vegetable oil will be my oil of choice for my patients.

Nada Youssef: Sure.

Kristin K.: Saturated fats are really really controversial, as we know. And coconut oil is definitely up there. So what I tell my patient is, I don't think we have enough evidence to really start pouring coconut oil on everything. Right? We probably have a few human studies that show some positive impact. We have a ton of animal studies. In my opinion, that's not enough. I'm hoping we'll get more and I think we will. But we do have a million studies on olive oil. Plenty of studies on olive oil that show the benefits. Reduction of breast cancer risk and longevity, and I mean you name it, you got the benefits there.

So again, coconut oil, I know is very sexy right now. Very exciting. Butter is also in the same realm. So again, going back to that whole food process. I would rather have my patients eat butter than margarine. And I eat butter. I don't eat margarine. So again, with coconut oil, you can use it. You can definitely use it if you're going to be cooking at a high smoke points, but also keep in mind when you cook that high, it does change the fats a little bit. So again, it's fine in moderation. I don't think there's enough evidence to say, we should be like having spoonfuls of it as a snack.

Nada Youssef: Okay. Sounds good. And then I'm going to jump to the protein section of the Plate. Protein is different when you're talking about a vegetarian versus someone that eats meats.

Kristin K.: Yeah. Sure.

Nada Youssef: Is meat a part of this? Or is protein, are we just talking about protein in vegetables? Beans and-

Kristin K.: Right so that's a little bit of the problem with the Plate is that it's speaking in generality. So if you're going to have meat, if that's something that you're going to have of course, with my patients, I'm always suggesting that they have grass-fed, pasture-raised meats. Again, there's a very big difference. Just because of the fact that a cow that's eating how a cow should, fed from nature, let's go back to that definition, they're going to get some more omega 3 fatty acids. It's just going to be a better option. Now, given that, I still don't think people should be eating meat every single solitary day. When you eat it, make sure it's quality, but probably try and limit it to no more than three times a week, if that's something you want to have. And let's keep in mind Nada that you don't have to right? You can if you want, but you don't have to have meat to get the protein that you want.

Just seeing the emergence in the fast few months of all of these vegan athletes has really gotten people excited about that. So to look at these men that are competing, that are now talking about, like Kyrie Irving from the Celtics. And like all of these professional athletes. Now people are like, "Wow!" Like, "They're getting the energy so there must be something to it." So not to say that's a diet you have to do, but don't discount it just because you think you're not going to get quality protein.

Nada Youssef: And to make it a complete diet that's also nutritious, you do need to add maybe like B12 supplements. Things that you will not get from plants.

Kristin K.: Yup. If you're going to become vegan obviously, B12 supplements. For us, we recommend taking sublingual B12 supplements. So that's going to be under the tongue. The process of absorption of B12 starts with your saliva, and it kind of ends with stomach acid. So if you're sitting out there and you happen to be older, we lose stomach acid as we age. And so, we see a lot of our elderly patients actually have B12 deficiencies because they don't have that stomach acid. So taking or don't have as much rather, so taking that sublingually actually helps the process.

Nada Youssef: Okay. Great. Well, we're starting to get some questions in here. First, I'll start with Pamela, "I need help in figuring out what things I could eat, having diabetes, high cholesterol, and of course, too much fat."

Kristin K.: Too much fat. Thank you Pamela for your question. So things you can eat. There's a lot of evidence that if you have diabetes, and you have high cholesterol, a low carb diet maybe a really good option. I mean just a lot of studies. I actually wrote about this a few months ago on my today.com blog. So when we look at a low carb diet, I think we automatically have this fear of, "Oh my gosh! I'm going to be starving. And I just ... Sounds awful and oh my gosh." I kind of rephrase it for my patients. I call it a smart carb diet. So what you want to do is you want to upgrade your current carbohydrate sources so that you're only eating carbs that are also high in fiber, and also higher in protein. So I'll give you an example of that okay?

Nada Youssef: Yes.

Kristin K.: Instead of having a regular pasta. Like a whole wheat pasta, which is healthy. A 100% whole grain, but has a lot of carbs. That has about 44 grams of carb for a cup on average. And maybe about 4 grams of fiber. If you swap that for a bean based pasta. So now we're using a lentil pasta, a black bean pasta, a chickpea pasta. The fiber is much higher, much much higher and the protein's also higher. So nutrient density goes up, and because our body cannot digest fiber, you essentially subtract the fiber from the carbs. Okay? So that's how many carbs you're actually ingesting.

Nada Youssef: Sure.

Kristin K.: Long story short, a low carb diet has been shown to be just phenomenal for luring all those things as have fasting, which I know we're going to talk about. So that's another thing Pamela that you should stay tune for because we're going to bring that up.

Nada Youssef: Yeah. We can talk about that a little bit now if you would like. Well, first I want to talk about the Ketogenic diet because we're talking about low carbs. So Ketogenic diet is what?

Kristin K.: Ketogenic diet is a diet that is extremely high in fats. It's moderate in protein and it's low in carbs. So to give you kind of an idea of this. The fat is going to be anywhere between 70% to 80%. Carb about 5% and then protein makes up the rest. I was telling Nada before we started that I never put a patient on a diet that I haven't tried. So I've tried a lot of different diets. Because you have to have that perspective of what your patient is what your patient is going to go through and whether it's sustainable. And I was really surprised by my experience with the Ketogenic diet. I did it for ... My assignment was to do it for 30 days, I ended up taking it to 45 days.

Nada Youssef: Wow!

Kristin K.: And so, I had a lot of energy. I actually lost weights, which is a difficult thing for me because I was an obese child. So when you're a child and you gain a ton of weight, you gain a lot of cells. It doesn't work out well for adulthood. Makes it more difficult. But there were a lot go great things I was able to see as result. So a Ketogenic diet is not for everyone. So if you have type one diabetic. Let's say you have really severe kidney disease, pregnant, breastfeeding. It's definitely a diet you want to talk about with your physician or your dietician ahead of time. But for some people it might be a good approach to try.

Nada Youssef: Okay. Great. Well, let's go to Julie, "What cookbook would you recommend to make a meal plan? Because that's the worse about a diet."

Kristin K.: Meal plans, right. So Julie, thanks for the question. Good one. So what I do is I think cook books are great. For me, personally, I actually go to websites to find my recipes because I can kind of filter. Cook books give you everything that that author wants you to see. I will be bias and tell you that there are about 50 recipes in my book, Skinny Liver, which are great and they're all meant for weight loss. So that's one, but then that's total bias that I'm putting out there, even though they're great. I've tried them all. Of course, I made them, but if you go to websites. Cleveland Clinic actually has an amazing recipe database. You can filter though what you're looking for.

The other thing that I would recommend if you are going to be searching for cook books are look for cook books that have three to five ingredients as their main ingredients that they're going to have in the total recipe. The reason I say that, is because how many cook books have you bought, place it on the shelf, you do three recipes. Maybe you bring them out and do those same three recipes. A lot of people today, especially my patients, they don't have time. They're like, "I want five ingredients and I want to make this in five different ways."

Nada Youssef: Sure. Now, with the meal prepping, a lot of people do meal prep for the week. And they have kind of like the same proteins, the same veggies every single day, five or seven days a week. Is that okay? Because I've read somewhere that it's better to kind of take your nutrients from maybe fish sometime and then some chicken sometime. To be eating the same thing.

Kristin K.: It doesn't have to, as long as you're getting something well-rounded. Like I wouldn't eat the same thing every day, but if you ought to make a meal for example. Like some people have the same breakfast every single day. That would be fine. That would be something I would recommend. I would also say, Julie, for your question, to think about what your goals are. So if your goals are, "Okay. I want to lose weight, but I also want to reduce my blood glucose because that happens to be creeping up." That might be one cook book option. So that would be another suggestion. I would also encourage you to look at apps too. Because apps are great because it's on your phone. You go to grocery store, you got your shopping list. You don't have to bring that book with you. So it's just whatever it is that makes you be able to stay on whatever the plan is long term, that's what you want to focus on.

Nada Youssef: Customize whatever you need to stay on track.

Kristin K.: Exactly.

Nada Youssef: Okay. And then I have another Julie, "how do you trick your mind at night to not snack?" Sleep, right?

Kristin K.: Yeah, Julie.

Nada Youssef: Just go to bed man.

Kristin K.: So here's the thing and this is such an obvious question. Most people when they're snacking at night, they're not hungry. How do you sleep-

Nada Youssef: It's a habit.

Kristin K.: It's habit. They're bored. They're going to watch the game. They want to have some pretzels with it. So a few things. Number one, if you want to allow yourself a snack, you can and what I would say is have a pretty much an almost no carb snack. So a handful of nuts, something like that. Some new evidence that looks at a concept called time restricted feeding, which is an actually a fasting approach has found that when you eat at night, after dinner, you are like so much likely to number one, gain weight. Number two, not be able to lose weight. So it is a really a tough habit to break. I get that. And obviously going to sleep helps with that. But if you're able to do it for at least one to two weeks, you'd be surprised that you can get into that and never think about it again. It's like another habit, right?

So either have something like string cheese or have like a spoonful of peanut butter. I actually will take crunchy peanut butter, okay so, crunchy peanut butter. I will dip it in like just dark chocolate chips that I've microwaved. So I'll dip it in that in a plastic spoon and I have like multiples of these and I'll stick them in my freezer. So when I'm like, "Oh I really want something that's like kind of sweet but good." It's not too much sugar because you're just getting a little bit of the chocolate and then because it's frozen, you just kind of suck on it. So that's a great snack to like satisfy you. Doesn't provide the crunch, a lot of people want crunch.

Nada Youssef: Well, that's why nuts I think are very healthy. They have the good fat and they keep you full. So that's actually really-

Kristin K.: But we don't really need to be full at night.

Nada Youssef: We don't want to be full because it doesn't help.

Kristin K.: Yeah. We don't need a fuel, right? You want your body to tap into fat while your sleeping not into glucose, right?

Nada Youssef: Sure.

Kristin K.: Yeah. You don't need it.

Nada Youssef: Well, speaking of glucose. Let's talk about intermittent fasting.

Kristin K.: Yes.

Nada Youssef: That's the big, hot topic right now.

Kristin K.: I love intermittent fasting.

Nada Youssef: Yes. Let's talk about it. You know, I'm trying to experiment with it a little bit. I know you have or are right now.

Kristin K.: Yeah.

Nada Youssef: Yeah. Tell our audience what it is and why it's a great thing for-

Kristin K.: Yeah. So intermittent fasting has just a ton of research. Both in animals and in humans that were seen coming out. So this is not something that is like quacky in any way. Some of the research looks at just longevity, reduction of certain cancers, reduction of weight, reduction of hunger and cravings that helps for those late night eaters. There are several different options you can take. The two most popular are going to be intermittent and that's when you eat two days out of the week. If you're a woman, you have 500 calories that day. If you're a man, you have 600 calories. We actually have an amazing infographic on our Health Essentials website that actually breaks down those days. So that's the question I always, like, "Well, tell me what to eat on those days." We already have an infographic on Cleveland Clinic that everyone should look at to see how to do that.

The second option and this is the one that has had some really interesting studies come out in the past six weeks is that time restricted feeding approach. So that is when you simply eat a regular diet, regular healthy diet, and stop eating around four or five. Now, that sounds crazy to some people-

Nada Youssef: Four or five P.M.? Just done for the day?

Kristin K.: You're done. Four or five. So that sounds a little nuts. So for a lot of my patients I'll them, "Well, either don't eat after dinner or like let's try and end it like 6:00 or 6:30." Okay, so that's more feasible. Again, a lot of these things, these studies will be in lab settings et cetera. So what they have found though in a lot of these studies when ... I think it was women in the last study. When they stop eating at four, it didn't really matter what they ate throughout the day. It was the fact that they stop eating at four, which was fascinating. So that's not to say pig out all day and then at four just stop and you're going to lose weight. But we always still want to focus on healthy, sound dieting. And when I say dieting, I mean what we're eating. I don't mean diet.

Nada Youssef: Sure.

Kristin K.: But like thinking about stopping earlier in the day and really asking yourself like looking at food as

fuel because that's the way I look at it. If you look at food as fuel, what the heck are you fueling after eight o'clock at night. Unless you workout at night and that's totally different, right?

 

Nada Youssef: Right.

Kristin K.: So that's just the way to think about it. So if you can stop eating at five, six o'clock, you might see some benefits. I can tell you anecdotally, tons of my patients, especially post menopausal women have lost weight on either intermittent fasting or time restricted feeding.

Nada Youssef: And this has something to do with ketosis? Does this when-

Kristin K.: It doesn't have to do with ketosis because an intermittent fasting is not necessarily low carb, right? So if you think about it on an intermittent fasting, your fat actually shouldn't be too high because fat has a lot of calories. So while we don't want to count calories. On a true 500 calorie day, you don't want to blow out your calories with nuts. Right?

Nada Youssef: Right.

Kristin K.: So it's not some Ketogenic that puts you in ketosis. Intermittent fasting simply puts your body in a fast. So what happens is, it reduces the reliance on insulin and blood glucose. And that in turn helps you with weight loss and then reduction of those cravings. Because you know willpower does not work, I always tell my patients, "Willpower is nothing more than walking by a cookie, wanting that cookie and saying I don't want the cookie. I don't want the cookie. I don't want the cookie." And then you think about it all night because you want that cookie, right? So that's willpower. It doesn't work.

Nada Youssef: Right.

Kristin K.: So if you can take away the craving for the cookie, walk past the cookie, and be like, "It doesn't even impact me." That's what intermittent fasting can help you over time. When I did it, I can tell you the first like ten days were a little bit rough. I did feel hunger, but after that you get use to it. You get use to it.

Nada Youssef: Yeah. That's amazing actually. Just the fact that you can walk by and not even have the craving for that cookie is powerful.

Kristin K.: It doesn't happen overnight. There's a lot of things that go into wanting that cookie.

Nada Youssef: I bet.

Kristin K.: Right? But-

Nada Youssef: For a cookie. Okay and we have William, "How does someone who's gluten-free, dairy-free, and soy-free get optimal nutrition?"

Kristin K.: Yeah. Great. That's likely ... I gotta tell you that's like half of my patients. So gluten-free is really easy. What you want to do is focus on intact grains. So you want to try and stay away from kind of ... Well, not kind of, but definitely you want to stay away from the big time processed gluten-free products. Okay? So you still want to eat food. So intact gluten-free grains are going to be buckwheat. They're going to be gluten-free oats, quinoa. Those are going to be some great options for you to look at. Dairy-free, I think the second one was dairy-free, is that right?

Nada Youssef: Yes. Dairy-free, soy-free, and gluten-free.

Kristin K.: Okay. So dairy-free again, I don't know if you're a 100% dairy-free or if it's just lactose recasting regardless, what you want to do is you want to switch to more nut based products. So as long as you're not nut-free, you can easily get more nut milks. You don't want to get sugar in your nut milks, but you can do that. Soy is also easy. I know probably the question you have, "Well, how the heck do I get protein?" So quinoa, pea protein, those are probably two really good sources of protein that you can get. And don't forget, beans are one of the best sources of protein ever. And that is a great example of one of those smart carbs. So a black bean has lot of carbs but then, a ton of fiber. So again, beans, quinoa. Those type of things are places where you can get that. And totally doable. Totally totally doable.

Nada Youssef: Perfect. Great. I have ... I think I'm saying it right, Niqueel, "Recently, we had a trial to stop milk in diabetic patients. That shows very good outcomes. As a doctor, I am really amazed by the result of such patients and what is your opinion?"

Kristin K.: Yeah. So dairy is a tough one. I just did a presentation last week. And one of my slides, asked the question, if dairy is evil? Because that's how people talk about it. It's like, "Oh! Dairy! It's awful!" We definitely have some studies that show positive impact in diabetic patients. I'm sure you're aware of those, that look at dairy consumption, but there's also some benefits of perhaps cutting dairy as well. I don't know from a scientific standpoint. I'd love to see your study published because I'd love to look at that. But from the perspective of taking dairy out of our diet, I personally do not feel that we need dairy in the diet. Whether your diabetic or anything. I think that there's plenty of ways we can get calcium from other sources easily. So I don't think it's an essential. I think it's always been told to us that dairy is an essential especially it starts when you're a child.

Nada Youssef: Yeah. I mean I remember the commercials with the cat milk mustache. Now, it's nowhere to be found, but it's always changing.

Kristin K.: Yeah. So that's a very clear message that we get as children. And again, I mean not to kind of take the middle ground on it. I'm not sure if it's evil. I don't think we have enough data yet, but I also don't think we need it in the diet. So I would love to see your study because I love seeing ... Especially in the diabetic population because we've had kind of the opposite, looking at full fat dairy and how that helps with type 2 diabetics.

Nada Youssef: Very interesting. Well, let's go back to that Keto diet, we have Melinda. She's asking, "Is the Keto diet safe for kids? My husband wants to try it to reduce his number of migraines as well."

Kristin K.: Yeah. Interesting. So I would say it depends on how old your kids are. I have a two year old and a five year old, definitely not.

Nada Youssef: Okay.

Kristin K.: One of the problems with Ketogenic diet is, especially in the beginning while you're trying to figure it out. I went through this is, you ... Well, two problems I'll out with kids, you can become really constipated. Because when your carbs are so low, it's hard to figure out like, how am I going to move stuff for this system-

Nada Youssef: So how do you? Like even as an adult, is it the fats that usually accounts for that?

Kristin K.: No, it's a lot of time it's like where you're getting carbs from [crosstalk 00:24:11] of select nuts or like a piece of bro colli or things like that. From the beginning while you're learning, it's hard, but it becomes easier. I think kids can be a challenging ... At least, my kids are, challenging kind of dietary approach. And so, I think like I wouldn't recommend it for anyone less than 18 years old. There's a lot of nutrients, they're growing, things like that. So it's not a time to really test something that's ... You know, frankly, tough diet. It's not the easiest diet to follow. So yeah, that would be my suggestion. And especially taking away the whole grains. I don't think I'd take whole grains away from kids. But definitely, you want to get the whole grains as opposed to like the white bread. Things like that.

Nada Youssef: Well, talking about kids. I also have two little one, seven and four. What's ... And the biggest challenge is school lunch like, I want to make sure that I'm not contributing to any kind of sugar and I want to make them as healthy as I can. And they'll always go for the junk. What do you pack your kids?

Kristin K.: So that is a really challenging one. The other thing is you want your kids to eat it. Right?

Nada Youssef: Yeah.

Kristin K.: I remember my mom would like pack me something and I have to throw it on the trash.

Nada Youssef: [crosstalk 00:25:17] It's all done.

Kristin K.: An apple. What are you talking about?

Nada Youssef: "Where did you egg go?"

Kristin K.: Right. So what I would say from a perspective of what you pack is like you got to ... Your four year old, your seven?

Nada Youssef: Yeah. Seven and four.

Kristin K.: Okay. So perfect age and even three in some case, right? You have totally engage them and involve in the process, right? So like you go to the grocery store. What I tell my five year old, who by the way is super picky. I never use that word with him because there are studies that show that parents that like say their children are picky, sometimes become picky. So it's like, you kind of what your parents think you are. Okay? So I don't use that word with him, but from a perspective kind of having a little bit of difficulty. We'll go to the grocery store and I'll say, "Okay I want you to choose five things, five colors. Different colors. They cannot be like a cereal or like artificial. And let's see how we can incorporate that into your lunches." So make it kind of fun. Make it something that you can really kind of get involved with. And even involve your child, even your four year old in packing lunch.

Nada Youssef: Yes.

Kristin K.: Because that way you'll know like if your kids like, "Are you crazy? I'm not going to eat this." You'll know exactly.

Nada Youssef: Right. So that's kind of what I want to do like pick a fruit that you're going to eat for lunch.

Kristin K.: Right.

Nada Youssef: And that kind of make them pack it with me

Kristin K.: You might have to cut that fruits, right?

Nada Youssef: Yeah. Of course.

Kristin K.: And you might have to cut that fruit. And you might have to have a dip.

Nada Youssef: Sure.

Kristin K.: So you gotta figure out what clicks in your kid. Like my two year old loves dips, right? My four year old, you put a dip in front of him, he won't eat anything. Right? So like, it depends on how your child eats, but keep trying things. They say with kids, you gotta try 15 times.

Nada Youssef: What's that?

Kristin K.: I know. That's a lot. I'm now on like 12 with some foods with high fiber on. I'm still unsuccessful, but I'm positive.

Nada Youssef: Sure. Okay. Well, let's go to Andy, "What are your top foods for a heart healthy diet?"

Kristin K.: Heart healthy diets so you know this is kind of vary based on what expert you ask. Obviously, we have experts here at the Cleveland Clinic that would recommend a very low fat diet, less than 10%. That's a lot of times for more severe heart disease. For generalized heart healthy diet, my suggestion is using 100% whole grains, healthy fats. So definitely the olive oils, omega 3 fatty acids. That's another thing I would incorporate. So you can get that through marine based. You can get that through walnuts, flaxseeds, chia. Any of those options.

What you want to stay away from, and obviously tons of fruits and vegetables, right? What you want to stay away from on a heart healthy diet is sugar, right? Sugar is the big one. Fat used to be the real villain in heart disease. And then we had all these studies come out and not we know better. So it's not really fat we're thinking. Now, we're really seeing the damage that sugar does to the endothelial, to other parts of the lining of the blood vessels that are feeding you know definitely the heart.

Yeah. I think that from that perspective like, cutting sugar out or I think this was from Andy. So we're talking to a guy or even following American Heart Association guidelines for men, which is no more than a 130 calories coming from added sugars.

Nada Youssef: Okay.

Kristin K.: So that's kind of your guideline. And that's like no more. So that doesn't mean that's like what you get to have. It means you don't go over that.

Nada Youssef: You said 130 grams?

Kristin K.: Calories.

Nada Youssef: Oh okay. Grams of I don't know sugar.

Kristin K.: So to calculate that Andy, what you would do is, let's say you have an energy bar for example. Let's say it has 25 grams of sugar, every gram of sugar has four calories. So you take that 25 and multiply it by four, your energy bar has a 100 calories. And you get 130, which means you're almost done for the day, right?

Nada Youssef: Yeah.

Kristin K.: So we're not looking at natural sources that we would find in fruits and some part, dairy because lactose is a simple sugar. But we're really looking at where sugar is added in the ingredient list as something added.

Nada Youssef: Okay. Let's talk about sugar.

Kristin K.: Oh my gosh! How much time do you have?

Nada Youssef: A lot of time they're like, "Oh sugar is sweetener. Sugar is sweetener." But they both sound like they're really both bad news.

Kristin K.: Right. They're both bad news.

Nada Youssef: What are we to do?

Kristin K.: We definitely have studies looking at that. It really kind of ... I like to simplify it a little bit more. So really look out both sugar and sweetener, and really sweetener a little bit more than sugar, keeps that sweet taste on your taste buds.

Nada Youssef: Your body still think that it's-

Kristin K.: Well, not only thinks it, but still wants it.

Nada Youssef: Okay.

Kristin K.: Right?

Nada Youssef: Craves it.

Kristin K.: Right. So I mean this is true for salt. This is true for sugar. So when you take sugar out of your diet, which is really hard to do within six weeks. And then you have something that you use to have in your old life, you'll be like, "Oh my gosh! I can't believe how sweet this is." But currently, you wouldn't have that. So how do you get that out of your diet? I will be honest with you, I have patients that I have worked with that I am on month nine. And we are working on nothing but taking sugar out of the diet. And it's probably one of the most challenging things because it is everywhere, right?

Nada Youssef: Yes.

Kristin K.: And it's also very entwined in celebrations and things like that. So a lot of my patients will say, "Man, I was doing really great and then my nephew had a birthday party. And there was just sugar everywhere." So it's one of those things that it's really tough, but I will say is the first thing you can do is number one, take out all the diet colas. Right?

Nada Youssef: Okay. [crosstalk 00:30:14]

Kristin K.: All the diet colas. All of the diet drinks. Those just keep that sweet on your lips. And we know definitely from some animal studies, they may in fact still increase insulin right? And there's that disconnect between the brain and the gut. So the brain's totally confused, "I'm getting the sweet, I'm not getting any calories." Right? "Do I increase insulin? What the heck is going on?" But artificial sweeteners are also incredibly sweet. Incredibly sweet. So they give you even more of that [crosstalk 00:30:39] intensity.

Nada Youssef: Sweeter. Exactly.

Kristin K.: So give that up first. That's kind of your first goal. There are some products on the market that I like. If it's like really hard to like be like, "Okay, well, what do I drink? I hate water." A lot of people don't like water.

Nada Youssef: Sure.

Kristin K.: So there are some products on the market that I think are actually really good, that have a little bit of real sugar, but yet not a lot of calories. Okay? Or some seltzers that have nothing added in or some seltzers that are out there that actually have a little bit of fruit juice in, but not so much that it would really impact your insulin. Those are good options and then once you take care of that, then you're going to really for the big ticket items. So if your thing is like gummy bears or licorice, you're going to start trying to cut that out. And really the key is to not have it in your house.

Nada Youssef: Yeah.

Kristin K.: So I mean that's the thing. I mean I had a patient who had licorice in her glove compartment. And really took her a while to ... That was part of her habit on the way home from work, right? So we had to replace it with a different habit.

Nada Youssef: Sure and healthier one.

Kristin K.: Yup.

Nada Youssef: Great. Well. Let's see. We have Gale, "I'm getting bariatric surgery in a couple of weeks and I'm freaking out a bit about how to get in fiber. I eat a lot of high fiber foods now, but I'm concerned about how to get it in post op."

Kristin K.: Yeah. So Gale, congrats. I'm excited for you. You will definitely still be able to get fiber in. Number one, I would say this is a discussion you want to have with you bariatric team. So that's going to be number one. And most likely after surgery, they're going to go through that with you especially the dietician on the team, but I have plenty of bariatric patients. I will say that they can still get fiber in, they just get smaller amounts. So since the size of the stomach, if it's a true bariatric surgery, and not like a sleeve or something like that. Since the size of the stomach is going to be reduced, you're still going to get that in but you are just going to get smaller amounts and you shouldn't really have an issue. At the beginning, you might while you're still getting use to that. But really overtime, you can really kind of ... Not have a ton of fiber, but you can have enough, where you shouldn't become constipated. And if you have to supplement in the beginning with some products, that's okay too.

Nada Youssef: Okay. Great. Well, we only have a few minutes and before I let you go, it's been a pleasure, but is there anything you want our audience to know that maybe we haven't touched on? Anything you want to talk about?

Kristin K.: Yeah. I would say ... And I'm just saying from like I see hundreds of patients here every year at the Cleveland Clinic. And one of the ways that I see patients is virtually. So a lot of people don't know that. So if you're watching and you live in Texas or you live some place else, many of my patients do virtuals, which means they don't come in to our location here even though it's gorgeous where we are. But they don't come in to our physical location, we actually do a face to face encounter through the computer. People can use their phones. That kind of thing.

The other thing that we offer and we could also do this virtually is nutrigenomics testing. So this could be a whole other talk in it of itself, but nutrigenomics is basically looking at the connection between your genes and your dietary preferences. So we have 45-gene tests that does look at how you're absorbing certain vitamins and minerals. What the best weight loss plan for you? For some people, it's going to be higher protein, for some people, it's gonna be very low in saturated fat, your genes don't lie and they never change. So our goal is to look at epigenetics, which the gene expression and how we can make recommendations about your diet that are incredibly personal based on your genes.

So just two things to think about if you're not here in Cleveland and you do want to get some more information. All of the dieticians on the Wellness Institute team do do virtual consults nutrigenomics.

Nada Youssef: Great. Thank you so much. It's been a pleasure.

Kristin K.: Thank you. And make sure you guys join us next Thursday, we're actually going to kick off Heart Month by presenting to you CPR basics with Dr. Menon and Dan Solomon. So you don't want to miss that and make sure for health tips and information and to stay up to date with Cleveland Clinic, follow us on Facebook, Twitter, Instagram and SnapChat, @clevelandclinic, one word. Thank you. We'll see you next week.