Fundamentals of Nutrition – Part 1

This post is a deep dive into nutrition: my philosophy, advice, and insights into the best diets and how to eat, developed over more than a decade of working with patients.

Given that most people are often fixated on what not to eat when it comes to their diet, I hope you will be pleasantly surprised to find the focus here on learning what to eat, by discovering how different foods make you feel and how they impact your individual health.

Like many people, when I started practicing medicine, I had very dogmatic views about nutrition. I was idealistic, but as I saw more and more patients, I started to realize that this idealistic, one-size-fits-all approach to nutrition wasn’t working.

The longer I’ve practiced medicine, the more flexible I’ve become about nutrition. After looking at thousands of people’s diets and how they impact health and bloodwork, you realize that there is a wide variety of what works best when it comes to food.

I work with people who follow vegan diets, all-meat diets, pescatarian diets, vegetarian diets, paleo diets, Mediterranean diets, and everything you can imagine in between. So this post is going to be more about general principles of philosophy of nutrition that will serve everyone, no matter the specifics of what you eat.

In Part 2 of this post (coming soon), we’ll dive into more specifics about macronutrient management and specific micronutrients to be aware of.

How to Start Thinking About Nutrition

So: the reason there is a never-ending debate on this topic is that there is no one single best diet that works for everybody and there likely never will be. Believe me, I’ve tried them all at one point or another in my research to help clients and improve my own health, and I can guarantee you that what works for one person is not going to be what works for you.
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​There are definitely foods on a spectrum of health that are much healthier (like artichokes) and food-like products that are less healthy (processed foods, like Cheetos). But when it comes down to what and how you decide to eat, it is deeply personal and highly individual.
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​Many factors influence what will be the best fit for you. These include the time you have available for cooking and eating your meals, who you are cooking for (partner, kids, extended family), where you live and your community (whether your physical environment is close to the sea or inland), your budget, hobbies, travel, health, genetics, ethical concerns, religion and, of course, your taste preferences.
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​The truth is that most diets have some great things to offer, which is why most people feel better initially when they start any new diet. Having some healthy guiding principles, as well as creating more awareness around what you put into your mouth each and every day tends to be better than nothing.

Here is my basic motto when it comes to nutrition: Focus on real food, not processed. Consume a variety of foods and colors. Notice how different foods make you feel. Get to know your blood biomarkers and use this information to guide your choices.

​What A Healthy Diet Should Achieve

Your focus should be on finding a diet that promotes the greatest health potential for your body.

You may find that the diet that works best is one of the specific diets that we have a name for (such as Paleo, vegetarian, Mediterranean, etc), or it may be a way of eating that you have created for yourself, borne out of paying attention to how food makes you feel.
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In order for a diet to be a good fit for you, it will promote these five key areas of health:

1 – Stable and uplifted mood
2 – Balanced blood sugar response
3 – Healthy hormone communication
4 – Great digestion
5 – Resilient immune system

What Is The Healthiest Diet?

There are some diets that may be healthier than others, but there is no one “healthiest diet”.

My overall philosophy of nutrition is that you should eat the diet that is best suited to you. You need methods to scientifically and systematically figure this out. I recommend using the combination of blood tests (and tools like glucometers or continuous glucose monitors, more on that in Part 2!) and frequent dietary experimentation.

The goal is not restriction. The end goal of diet experimentation should be to create flexibility. This means that no matter how you eat on a daily basis, when you go on vacation, or have a birthday, or go out with friends, you should be able to enjoy foods that are not part of your everyday diet.

Food is meant to be enjoyed; it’s a critical part of having a good quality of life, and my goal is to get my clients’ health to a point where they can have all those important food experiences without having severe consequences.

Everybody’s ability to be flexible is different, and sometimes for periods of time you won’t be able to be very flexible, in order to prepare yourself for periods where you can be, but my goal is to get you to that point where your life is not limited by food.

Whenever I start working with someone, we’ll talk about what they’ve been eating habitually, and gradually start experimenting to figure out how certain foods affect their body and health. If you’ve been eating the same way for your whole life, and have a whole range of issues but have never done any experimentation, that’s a huge opportunity and it’s usually where I’ll choose to start.

Knowing how to experiment and track the changes in your health and blood work is far more important than following a specific diet.

People often don’t connect what’s going on in their blood work to what they’re eating, apart from maybe cholesterol. But the truth is, everything you eat impacts so much more than just your cholesterol. So using blood work to track your diet is a great way to assess if what you’re eating is a good fit for you.

The other thing that’s often missing is that how you eat is really important. Making sure you eat at regular times, incorporating different fasting protocols as appropriate, chewing your food thoroughly, not eating too fast — all of this is just as important as what you’re eating.

How Do I Know If My Diet Is Working For Me?

A big indication that something in your diet isn’t working for you is that after eating, you feel really tired. It might be that you are not tolerating one of the foods you eat regularly, you ate too much, or that you are not eating enough of a macronutrient (like protein or fat).

For some people, no matter what they eat, no matter what time of day, they’re exhausted after eating. This is a big sign that what you’re eating is not supporting your energy levels, and this will show up in your blood work for sure.

If you’re energetic after you eat, that’s a good sign that you’re going in the right direction with your diet. People also usually notice outward signs as the first indications that a food experiment is working: their hair, skin and nails look a bit better. Their skin and eyes are brighter, and their hair and nails are stronger.

Digestive symptoms are also good clues. If you experience bloating, cramping, gas, or indigestion after eating, then either something you’re eating or the way you’re eating is not working for you.

Some signs that your dietary changes are working include more regularity in your stools, less bloating, less gas, and a reduction in pain and discomfort.

Nutrition Roadmap: 10 Steps to Start Working Through Your Own Diet

If you want to change your diet or start experimenting with your nutrition at home, here are the 10 key stages to work through. These are listed in order of importance, and become gradually more complex as you progress.

1 – Increase whole foods

This is the key first step in improving the overall quality of your diet. Focus on eating whole foods that are close to their original form found in nature. Limit foods that are processed and packaged, or have become a ‘food-like product’ (candy and many snack foods fall into this category). Read food labels and limit products that contain ingredients that you don’t recognize as food. Start with cleaning out your home pantry and donate foods that you’d like to replace for healthier versions.

2 – Drink enough water daily

People will sometimes tell me that they eat foods that have enough water in them that they don’t need to drink water. Now, if you’re goal is simply to survive — just to stay alive — then that’s true. But for optimal health, brain function, digestive health, stable energy, it’s not enough. To get started with this, get a pitcher that will hold the entire amount of water you need to drink in a day (hint – half your body weight in ounces daily). Fill it first thing in the morning, drink from it throughout the day, and see how much of it you drink. This holds you accountable because you can see how much you’re actually drinking.

3 – Get to know your relationship with food

Your mental relationship with food is a big one for a lot of people. If you’re used to restricting a lot of foods in your diet or have used food as a punishment or reward, it can be really difficult to start to see food as a neutral or positive part of your life. And if you have an all-or-nothing mentality — where the conditions have to be perfect for you to eat healthily or you’re not doing it at all — then starting to move towards flexibility is a big adjustment. I have covered this topic in much greater depth in my March newsletter.

4 – Increase your diet diversity to support a healthy microbiome

Sometimes following a strict diet means that you end up eating the same small group of foods over and over. This lack of diet diversity really impacts your gut microbiome over time. You need diet diversity to have a healthy diversity of bacteria in your gut. Microbiome diversity helps to prevent many chronic diseases.

One of my favorite ways to determine your diet diveristy is with the 50 Foods Challenge — attempting to eat 50+ different foods each week. Do you think you easily hit 50 or does this task sound completely daunting? There is only one way to find out! Grab a pen and paper and write down the numbers 1 to 50. After each meal list the different foods in that meal. Make sure to add oils, herbs, and spices. Each different food can only be listed once!

You have one week to get to 50 — GO!

@DRALEXISSHIELDS

5 – Eat on a schedule

Do you need to reduce the total number of hours you eat during the day (ie removing unplanned snacking from your routine), do you need to plan the timing of meals, introduce fasting, or balance blood sugar with regular protein snacking? Eating on a schedule is ideal because it regulates your hormones and blood sugar. If your body is expecting to eat and digest at the same times every day, this can help stabilize your circadian rhythms, which in turn improves your energy levels and your sleep. Optimally, you should limit the number of hours that you eat during the day to <8-10.

6 – Adjust how you eat for optimal digestion and absorption

Choosing appropriate portion sizes is very important to feeling good after you eat. Too small a portion and you’re going to be unsatisfied, more likely to snack later, and potentially not eating enough calories for your needs; too big a portion and you’re going to be uncomfortable, disrupt digestion, and possibly take in too many calories for your needs. Make sure that you’re chewing your food really well and eating slowly to help ease your digestion and improve your body’s ability to take the nutrients and energy it needs from your food.

7 – Determine your food intolerances (and allergies)

Learning to experiment with how food makes you feel is a crucial part of learning to eat intuitively and flexibly in any situation. When you know how specific foods make you feel, you’ll be able to start to sense what your body needs (or really doesn’t) at any given moment. Tracking your body’s response to different foods (eg blood sugar, digestion, mood, energy, sleep, etc) can be a long process — it can take years to get a comprehensive view of what works for you. Luckily there are tools that can help you to speed up the process a bit, specifically blood tests and continuous glucose monitors (more on this in Part 2 of Nutrition Basics – coming soon!).

8 – Improve the quality of your food and water

Shifting your focus to organic produce, grass-fed or pasture-raised animal products, and filtered water is going to reduce some of the toxic load on your body by removing antibiotics, hormones, pesticides, and chemicals from your diet. Farm-fresh produce also tastes better, so it’s a good way to expand your palate to include foods that you may have previously thought you didn’t like (when the problem was actually poor quality or being poorly cooked!). There are some foods that are more important than others to eat organic, based on the pesticides used in conventional food production.

Check out the EWG’s 2021 Shopper’s Guide to Pesticides in Produce – The Dirty Dozen and The Clean Fifteen.

And, here is the EWG’s guide to choosing the best water filtration for your home. For an easy and cheap option that requires no installation, I recommend Berkey Water Filters.

I always thought I hated celery until I moved to Oregon for med school — we purchased a farm share and in the first box they delivered contained celery unlike any I had tasted before. It wasn’t the watery, stringy, bland pale green sticks I was used to — it was deep green, crisp, fresh, and full of flavor. I felt like it was the first time I had ever really tasted celery.

@dralexisshields

9 – Create greater diet flexibility within your personal limits

A big part of maintaining a healthy balanced relationship to food is learning your own limits and making conscious food decisions. Not everything you eat will be in total alignment with your health needs and goals 100% of the time.

It’s important to practice saying no to foods when the consequences aren’t worth it and maintaining guilt-free enjoyment when it is worth it. Striking a good balance with this takes PRACTICE!

Flexibility is the ultimate sign of good health and means that you are able to maintain good health even when your diet, fitness, and lifestyle choices are not perfect all of the time. So, the goal with a healthy balanced sustainable diet is to create more flexibility, not more restrictions and limitations without there being a good reason for them.

10 – Track your nutrition

Once you’ve tackled 1 through 9 above and you are ready for more detail, learning to track your macronutrient and micronutrient intake and using tools like continuous glucose monitors (CGMs) can allow you to make small tweaks that help you achieve specific health and fitness goals more effectively. You might also start to adjust your nutrition based on your energy expenditure and activity levels each day (for example, eating more starch on the days you exercise).

Foods That Don’t Feel Good

Like I continue to say, flexibility is the ultimate sign of good health. ​However, sometimes your health situation may require you to make certain changes to your diet either temporarily or permanently. For example, if you are lactose intolerant you may not be able to tolerate dairy often or ever. If you have Celiac disease you will not be able to eat foods containing gluten without severe health consequences.

However, many of us have foods that we don’t digest particularly well if they are eaten in too big a portion or too often.

I am lactose intolerant and can only eat very small amounts of butter, cheese, and yogurt infrequently. When I am under stress my ability to tolerate these foods worsens. But, when I am on vacation and stress-free I can tolerate more. Proper stress management does amazing things on a cellular level in the body.

– DR. ALEXIS SHIELDS

So experimenting with your diet is the best way to figure out what these foods are for you and how to balance them in your diet so that they do not promote poor health immediately or gradually over time.

I can help you to identify what foods may be the biggest problem using your list of health problems as our guide — certain foods tend to cause certain issues very reliably, such as dairy leading to skin issues, acne and chronic loose stools, or certain grains leading to chronic back pain and fatigue.

Click here to see what it’s like to work with me.

Blood Test for Food Intolerances

There are blood tests that can help you to identify true food allergies, but when it comes to foods that you just don’t tolerate well the test results are not so clear. I wish there was a perfect test for helping to identify these food-based intolerances but at this point in time, there isn’t.

There are blood-based food intolerance tests on the market that measure different types of responses to food. On occasion, these tests can be helpful in difficult cases or when you just need a starting point. But, there are nuances to interpreting the results.

The gold standard for determining food intolerances is still by eliminating the food in question from your diet for an extended period of time (typically 30+ days) and then reintroducing it to observe the changes to your health. Even if you do a food intolerance test, you will still have to do the elimination. For this reason, many people skip the testing and just go right to experimenting with foods that they already suspect might not be working for them.

Grey Area Foods

It is the current dietary fad to lower the intake of carbohydrates as a panacea for all nutrition-related health problems. This is not necessarily a bad thing — most of the quick and easy fast foods are very high in carbohydrates and lead to eating too much sugar on a regular basis — but create a healthy balance with food, I don’t recommend villainizing an entire macronutrient. Remember that all vegetables and fruits are carbohydrates!

This villainizing has happened before, with dietary fats, and then everyone discovered that fat is actually crucial for a healthy body, and the same is true for carbohydrates.

The real issue here is that not all carbs are created equal. You need a healthy balance of carbs from plants to maintain a healthy balanced digestive system.

Again, different people thrive (which I define as having a sense of excellent wellbeing and optimal blood biomarkers), on a different balance of macronutrients — fat, protein, and carbohydrates.

Some people simply thrive on higher amounts of carbohydrates, fat, or protein than others, and this is why I like to talk about certain types of food as Grey Area Foods (GAFs).

GAFs are foods that one person may tolerate just fine or even get significant benefits from eating, but that are clearly detrimental to the health of another person. Some examples of GAFs are grains (wheat, corn, oats, etc.), alcohol, chocolate, caffeine, dairy, legumes, potato, nightshades, cruciferous vegetables, soy, pseudo-grains (buckwheat and quinoa), fruit and sweeteners.

Reactions to GAFs are determined on an individual basis. You will need to experiment to determine how much (if any) of these foods you can tolerate. Your reaction to these foods may change as your health changes. If you are already suspicious about your ability to tolerate any of the GAFs, that’s a great place to start experimenting.

Some Final Thoughts…

Nutrition is one of the most significant contributors to our overall health, wellbeing, and longevity. It’s a complex area that can take many years to truly figure out for your individual needs.

Working with many people on their nutrition over the years, these are basic tenets of nutrition that I believe to be true:

• Food is meant to be one of our greatest enjoyments in life — it’s community, culture, travel, and celebration
• Healthy food does not equal bland or boring. Healthy should be satisfying, full of flavor and delicious (I’m looking at you, dry plain chicken breast)
• What works for one person may not work for you (even if you’re related to that person)
• What makes you feel nourished and healthy may change overtime as your tastes and health changes
• You don’t have to cook, but learning to cook is often how people learn to eat healthier food, develop a more diverse palate, and have a better appreciation for food
• Your tastes change and can be trained, but with that said you may never learn to like a certain food
• How you grew up with food deeply impacts your relationship with food in both good and bad ways
• Some people treat their diet like a religion with dogmatic rigid beliefs. I truly believe that flexibility is key when it comes to maintaining a healthy mindset around food.

I hope this post helps you feel excited and empowered to start working towards developing the diet that helps you thrive. Part 2 will be published soon, and if you would like to explore how I can help you do that in a more systematic way, please click here to find out more about working together.