BY Hasan Yasin, MD, Integrative and Behavioral Medicine Fellow, and Samuel Mathis, MD, Assistant Professor, UTMB
“Our bodies are our gardens. Our wills are our gardeners.” – William Shakespeare
With the holidays coming soon, many conversations turn to the foods we eat or plan to eat during the holidays. This can be a prime conversation to recommend appropriate and healthy food choices to our patients. Small health-conscious decisions 
can profoundly impact a patient’s health and holiday season.
One of the most straightforward recommendations is to shop the perimeter of the grocery store. The healthiest foods are not found in the aisles but around them. Encourage patients to purchase items that will go bad or things their grandparents would recognize as food. Another essential guideline is to look for foods with few ingredients. We often tell patients that if they cannot pronounce more than 5 ingredients on the box, the item they are holding is not real food, and they should seek an alternative. This technique helps to weed out chemically processed foods that can be toxic to the body. One study found that ultra-processed foods comprised approximately 80% of total caloric intake in North America (1). These foods negatively impact our health and diet and should be limited.
One easy recommendation is to implement the “Altman Rule.” The Altman Rule is a great tool to determine which foods are nutritionally beneficial by comparing the total grams of sugar to the combined grams of protein and fiber. If the grams of protein + fiber are greater than the total grams of sugar, the food item satisfies the Altman Rule and is a healthier option. High protein foods typically have lower glycemic indexes and keep patients feeling fuller longer. Lower glycemic index foods decrease patients’ risk of developing diabetes. A 2019 systematic review and meta-analysis found that low glycemic index diets effectively reduced A1c, glucose levels, cholesterol, and BMI. It did not significantly affect fasting insulin levels, though (2). In this regard, it would be beneficial to recommend lower glycemic index foods for all pre-diabetic patients or those diagnosed with diabetes.
Another common question revolves around the health benefits of organic foods. One complication of using organic foods is the high costs and unclear benefits. The term “Organic” indicates that the food was produced without chemical fertilizers, pesticides, GMOs, or other artificial agents. The limitation of these agents does result in foods with higher nutritional values than foods that are not organic. Studies have found that eating organic foods frequently lowers their overall risk of developing cancer. However, systematic reviews have failed to show that there is a measurable difference in eating organic (3). One general recommendation for our patients on a budget is to buy organic items more prone to absorption of these chemicals. They are referred to as the “Dirty Dozen and Clean Fifteen.” These lists contain fruits and vegetables with the highest and lowest levels of pesticides, respectively. If an item is on the dirty dozen list, purchasing its organic alternative would be most beneficial to reduce the intake of toxic pesticides.
It is vital to have comprehensive discussions with patients regarding the psychology of eating. People often have significant misconceptions regarding their food and how they approach it. I like to make simple recommendations for the holidays to help individuals limit the quantity of food they eat. Using smaller plates has been shown to decrease the amount of food we eat, thus reducing our total caloric intake. Placing your utensils between each bite can help prompt individuals to take time to savor their bite. Drinking a glass of water before a meal can help fill the stomach and decrease the total amount eaten. And remember, you do not have to eat everything on your plate. Eat until you feel 80% full then stop. I often tell patients that it takes 20 minutes for the stomach to tell the brain that they have eaten enough. So, slow down, take one bite at a time, and enjoy the conversation more than the meal.
Finally, we would be remiss if we did not mention the most important rule when choosing healthy foods. Our diet should be primarily plants. That is not to say to recommend all patients become vegetarians, but rather that patients’ diets should consist primarily of plants, with only a quarter of their plate being protein or meat options. These small changes can significantly impact the quality and quantity of food eaten during mealtime. Happy Holidays!
References:
- Martini, D., Godos, J., Bonaccio, M., Vitaglione, P., & Grosso, G. (2021). Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients, 13(10). https://doi.org/10.3390/nu13103390
- Zafar MI, Mills KE, Zheng J, Regmi A, Hu SQ, Gou L, Chen LL. Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2019 Oct 1;110(4):891-902. doi: 10.1093/ajcn/nqz149. PMID: 31374573.
Zafar MI, Mills KE, Zheng J, Regmi A, Hu SQ, Gou L, Chen LL. Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2019 Oct 1;110(4):891-902. doi: 10.1093/ajcn/nqz149. PMID: 31374573.