Line One: Dietitians of Alaska – Deconstructing fad diets

A fad diet is similar to a fad in fashion. It’s a diet that’s generally very popular and designed for the short term. They often promise drastic results, whether that be massive weight loss or drastic improvements in your health. They can sound like a newly discovered hack that promises a new view. All too often, they involve purchasing supplements or vitamins. Over the years, there have been many fad diets, keto, Atkins, intermittent fasting, paleo, even HCG diet, South Beach diet, Whole30 and the cabbage soup diet, and there will certainly be many, many more in the future. While these diets do not do everything they claim, many of them do have some helpful components.

Erika Van Calcar: Well, that’s going to take the next hour, but I’ll try to sum it up. I am now almost 11 years in Alaska, I guess transplant to Alaska from Washington State. Washington and Ohio is where I went to school, got my degree and then masters in nutrition and dietetics. I worked there for a while, then moved up here, like I said, about 11 years ago, and I’ve now been with Anchorage Bariatric, Dietitians of Alaska for almost eight years. In my spare time, I love to go hiking with my dogs, this time of year running away from mosquitoes and puttering around in my garden.

Staci Kloster: Yes. Thank you. Born and raised in Alaska, went to UAA, did my internship here in Alaska, some of the rural communities. I will say, probably what led me into the field of dietetics was that I actually met with a dietitian, and it was what I didn’t want to be, so to speak. I wanted to do better, I guess, to say, and so that kind of led me down the path of dietetics. In my spare time, you will find me hunting, fishing, pretty much again, all those Alaskan fun things to do.

Dr. Justin Clark: Well, last time we had you guys here was earlier in 2024, I believe, and we talked a lot about diet in general. We talked about the difference between dietitians and nutritionists, what a dietitian is. What we didn’t get to talk about last time was a lot of the questions that came from our listeners about different types of diets, particularly fad diets. Because we didn’t get a lot of time to talk about those, I thought we’d do another show to discuss a little bit of those in more detail and get our listeners questions.

Erika Van Calcar: I think if you look at what the medical community also considers or classifies a diet, whether it’s a fad diet or not, like you mentioned, it falls along the lines of, like, fashion trends. If one particular comes to mind, it is this the low carb trend, where it comes in and out of fashion. But also, the typical hallmarks of a fad diet are missing one or several food groups, or restricting food groups relatively nutritionally inadequate. So it’s missing key components, whether that be fiber, or B12, zinc, really touts drastic change. Like you were mentioning earlier, it’s like “lose 20 pounds in two weeks”. Outside of a major medical issue, it’s probably not something we should strive for. You also mentioned the necessity – if you’re going to follow this program, you need to buy these supplements, these powders, these vitamins. Those are all pretty big red flags that this might not be something that’s going to be overall a good health practice, or really sustainable long term.

Soleil Thiele: The one thing that I was going to add in, kind of reiterating what everybody else is saying is – it sounds too good to be true. I think a lot of times fad diets will focus on the short term, but then don’t really address the maintenance of things. So, yes, whereas you might lose, you know, X amount of pounds quickly at first, how do you maintain that? Because a lot of times, like Erika was saying, you’re cutting out something that really isn’t sustainable long term, and usually comes with popularity that it is the “in” thing now and then kind of ebbs and flows, will go away and then circles back around.

Dr. Justin Clark: We see that in Bariatrics, in our new patients, and most of our patients have tried many, many of these diets over time. We’ll call it more of a yo-yo type diet, because they’ll try a Keto or a paleo or something, and then they’ll lose 20-25 pounds, but the second they kind of go off the plan, that yo-yo is right back up and usually actually more. Some people will tell me they’ve lost the same 100 pounds multiple times. I think fad diets probably play into that a lot. Well, let’s get into one of the more common ones that has come up in the last five years or so, and that would be the keto diet. And I know in particular, Erika Van Calcar has a strong opinion about keto. So why don’t we start with you.

Erika Van Calcar: Interestingly enough, the keto diet isn’t actually new. I was doing a little bit of digging last night and eating a lower carbohydrate diet is mentioned all the way back in 18-something, I can’t remember the exact day, but the 1800s. It has been intermittently smattered throughout history, but in the 1920s, 1921, 1923, a doctor by the name of Russell Wilder designed the keto diet, not as we see it now, but like the original keto diet for the treatment of pediatric epilepsy. It had absolutely nothing to do with weight loss. Typically, when I mention that to folks, I get big, wide eyes. In its original state, it was very restrictive. It was about 5% protein, 5% carbohydrate and about 90% fat, so very, very restrictive. But again, it had nothing to do with weight loss, had everything to do with managing seizures.

Staci Kloster: The Institute of Medicine, one of their recommendations of an overall healthy diet is about 45 to 65% carbohydrates, 10 to 35% protein, 20 to 35% fat. So to give that into some better context, if you had a 2000 – calorie diet, then you would be getting about 225 to 325 like grams of carbohydrates, about 50 to 275 grams of protein, 15 to 77 grams of fat, just to put it in tangible context, so that’s what I would say. I mean, everybody, I think that’s one thing with the fad diets – why it works for some and doesn’t work for others is that we’re not all built the same. One doesn’t fit everyone. So definitely with those recommendations, I think there’s also why there’s like a 20% swing in there, somebody might do better on a 35% protein, or even 40%, whereas the next person, maybe 10% is more ideal for them.

Erika Van Calcar: I think the more common keto diet as we see it today, and again, there are so many permutations of the original now, but it talks about somewhere between like 20 to like 50 grams of carbohydrate, which is what a lot of people who want to follow a low carbohydrate diet are used to. So I can imagine them when they hear what Staci had to say between the 250-300 grams of carbohydrate, their heart is now in or their stomach is now in their throat. Protein, typically, it’s going to be around the low end of the standard recommendation, about 20% again, give or take, and then, depending on what variation of the keto diet you’re following, it can be anywhere between 70% fat to 80% fat. That’s what I’ve seen.

Staci Kloster: The easiest way that I think about it is that your body wants carbohydrates for fuel naturally. So then when we restrict those carbohydrates, what is it going to get for fuel? With the keto diet, it then turns that fat into fuel, and so it is now working off the fat intake. That’s something that actually with doing this, I mean the keto diet has been around, like Erika Van Calcar said, for a long time. I’m not necessarily a huge fan of it personally, because with Crohn’s disease, it does not work for me to eat such a high fat diet. So I haven’t really ever cared to know so much about it, I guess, to say. But one thing that I did find interesting, because sometimes we’ll talk about a higher protein diet, and patients will say, oh, a keto diet. But I’m like, keto is more high-fat that even if we want to lift the keto diet restrict proteins, because they can prevent ketosis, and so that protein amount really does matter with the keto diet, of not being too high in protein, but really getting your fuel from fat.

Soleil Thiele: The bad breath is definitely the big one, where it kind of smells like acetone, almost, and that’s just from the ketones that you’re breathing out. Keto flu is also a huge thing that you hear about. So basically you just get the flu-like symptoms from being in that state. And I feel I have, I’ve never done keto myself, but for most people, I think who go through keto, I think most people experience that keto flu, and then I think it lasts a couple weeks, and then it goes away. So those are the two big ones, I would say.

Caller Amelia: Hey, thank you, doctors. I don’t really follow any fad diet. I do eat slightly a bit more protein and less carbs than most, but I’ve been blessed to have a very healthy body weight my whole life, because when I was 21 I lived in Japan for a while, and I adopted their method of eating till 90% full. I’ve done that. I’m 44 now, been a stable, thin weight, and I just don’t eat until I’m full. I forgot the Japanese word for it, but it’s very common there; they call it 90% eating. I thought I would bring that to people’s attention.

Erika Van Calcar: I honestly, I think that’s a fantastic way of approaching eating and a very mindful way of doing it, which is something that you know, both Staci and Soleil and I really try and tap into a lot – to where you’re eating to, I think I call it like, comfortable, full, satisfied, no longer hungry, but you’re not to the point where you’re overfull, uncomfortable-kind-of- Thanksgiving-dinner, which I think a lot of us not necessarily strive for, but that’s what we use as our cue that we are done. Either the plate is clean or we are stuffed to the gills.

Dr. Justin Clark: Loosening my belt or unbuttoning my pants button. It sounds like a great thing also, we hear a lot of…it’s very easy to work…I don’t know the right way to put this – but it’s the timing of your eating, or the length of your meal. If you eat too quickly, you will not get that sensation or that feedback to your brain, because that takes 15 to 20 minutes for your hormone levels to transition from an empty stomach to a full stomach. And so for most of us, I think I speak for myself, I was in the military, we had to eat very, very quickly, and we had three or four minutes, and then you had to move on. So we got used to eating all of our food very, very quickly. But what do you guys suggest to patients in terms of how to eat a meal?

Staci Kloster: Well, I would say probably one of the biggest thing that patients, and I am guilty of it at times too, is put the phone away, TV away, computer away, work away, and actually focus on your food. I think sometimes that can help slow us down, actually, appreciate the meal, not be doing so many other things. It can also help us to not graze, I guess, to say so if I’m watching something, I’m letting dogs out, I’m doing whatever, people getting kids ready – then it’s like, I take a bite, then I go do something. Ten minutes later, I’m taking a bite, and now I have just again – I’m not really ever full, nor am I ever really hungry, and so I’ll eat until my plate is cleared, when I probably only needed half of that. So I think putting the distractions away would be one of my recommendations.

Soleil Thiele: I literally use that same example. One thing I always like to add, just to put it in a picture for people, is imagine yourself at a movie theater and you got your big thing of popcorn in front of you, and 10 minutes into the movie, you look down and half the popcorn is gone already, and you’re like, how do I eat all that? It’s the same thing at home, in front of the TV or in front of your computer or in front of your phone. Your awareness is not on you and your hunger fullness cues, and it’s not on the meal that you’re eating. So, it’s extremely easy to overeat or eat too quickly and all that stuff that we don’t want.

Erika Van Calcar: If I can add one thing to that, though, and that I find for myself, but also several people that I talk to, they live alone – It’s just me and my dogs, and the thought of sitting at a table with no distraction and just food would drive me insane and probably cause me to eat faster, just because I just don’t want to sit there alone looking at my plate of food. I just find that very unappealing. So in those instances, we’ll talk about mindful eating, like with distraction, but still the same thing that Staci said. Take a bite, but then put the plate down, the bowl down, chew well. While your eyes are looking at something else, you are still paying attention to how I’m feeling, my eating speed, and you don’t just have the bowl in front of you, shoveling food into your mouth. So it’s like distracted, mindful eating.

Dr. Justin Clark: So it’s better to portion them out. Don’t eat from the bag. All right, I’m gonna have to work on that one myself. Well, let’s move on. Let’s talk a little bit about intermittent fasting, because we have some emails about that. It’s again, this is something that’s come up. It’s very popular in the last few years, and there’s all some of iterations that I’ve seen our patients trying, whether that’s fasting for eight hours, whether it’s fasting for 12 hours or 16 hours, or fasting once a week or during the week. I mean there’s so many different possibilities.

Soleil Thiele: So to put it simply, it’s periods of fasting and then eating. So the major ones you’ve probably heard about is 16 – 8, so you’re fasting for 16 hours and eating for 8 hours. There’s also the ratio 5 – 2. So 2 of the days out of the week you’re eating maybe 500-600 calories, and the rest of the days you’re eating normally, like you would. So it’s just that cycle between eating and not eating, which we all do. You know, we all sleep for hopefully seven, eight hours a night and that’s a fast right there. It’s just increasing that fast, typically.

Staci Kloster: With any of these diets, what are your goals? What are you trying to accomplish with changing your way of eating? And so if it is weight loss, then something has to change, or nothing is going to change. So even if you went fasting and you did the five – two, the five days a week, you continued to eat like you were, and just two of those days you don’t, depending on what your goals are, I don’t really see where the outcome is going to benefit if you don’t change those five days of what you are eating and then going back to that just general healthy way of eating, of having a good ratio of protein, healthy fats, carbohydrates to meet your needs. I mean as far as intermittent fasting goes, I have some friends and family who do intermittent fasting, but it really has been, the ones that have been successful with it, and very long term, it is a lifestyle. It is not something that they have then gone off of, kind of like when good Year’s resolutions come around and we do something for 30 days, we see a benefit, and then on February 1, we go right back to eating the way that we did, just because you fasted or you did something for 30 days doesn’t then change the long term outcome of how you’re diet is.

Erika Van Calcar: I think that a lot of that goes back to Staci’s comment. Exactly what is your goal? If it’s weight loss, yes, during a period of fasting, the body does start to use both body fat and muscle, which isn’t talked about as much as it probably should be. The body will use both of those elements to produce energy while we are not eating, while we’re sleeping. Is that then ketosis? No. The body needs several days to several weeks to actually convert into full blown ketosis. So, some people will use intermittent fasting as a way to get to ketosis a little bit faster. So the two, while one can lead into the other, the two aren’t necessarily linked.

Dr. Justin Clark: I’ve tried some 24 hour fasting, where I did it, for me, it worked to do it from dinner to dinner, because I could eat dinner and then sleep. So that takes off about eight hours. Then on a busy day, I can skip breakfast and lunch pretty easily, especially if I’m busy and not thinking about food and then you’re right back to dinner, so it’s been about 24 hours. But during the day, there are stuff you can do to sort of curb your hunger a little bit. I mean, drinking fluids is okay when fasting, right? What can people do during the fasting period to, sort of, I don’t know, stay fasting?

Caller Jojo: Thanks so much. Great topic, guys. I’ve been listening. I got a question about intermittent fasting. Here’s briefly my story. When I was in my early teens, I noticed that if I ate anything before maybe 10 am, by 11am I was starving. And then I noticed if I didn’t eat anything, I could not be hungry till noon or one or two o’clock. So that just kind of became what I did mostly, and it’s mostly I just am not hungry. Never have been in the morning. In the past number of years, I’ve done different kinds of fasting. The past number of years, I’ve been not eating until between noon and three o’clock and then, like, a half a sandwich or something light, and then main meal at night. My problem is I’m now considered pre diabetic, and surprises, makes sense, slender and, you know, fairly sedentary, but there’s been a lot of talk back and forth about, “intermittent fasting and diabetes risk and early death risk” and all these things. It’s sort of vague, floating out there. Maybe you can clear the waters a little deeper?

Erika Van Calcar: I think that that brings up a really excellent point, and also an excellent question. I too, hear from a lot of people, and I’m sure Staci and Soleil as well. If I eat first thing in the morning I don’t feel good or then I’m starving by…you know. If I eat at eight, then I’m starving at like, 10 or 11, which then can be frustrating for some people, or they don’t feel like they should be eating that often. So back to the first question, is breakfast the most important meal of the day? I don’t know if there’s a really good, clear cut answer for that. As dietitians, we are groomed to say yes, if you look at the emerging interest in eating to our circadian rhythm, that also seems to hold true. That yes, eating breaking the fast kind of starting, even have, your your biggest meal as your body’s kind of gearing up, not necessarily based on, like the hour on the clock, but like when you actually are getting up and moving around, having that first meal is important. As to then eating, feeling hungry later on, what did you have for breakfast? I know, if I have a bowl of cereal first thing in the morning, well, I’m good for maybe about 30 minutes, and then I go from moderately satisfied to hangry, really quick. By 10-11, o’clock, I would not be a pleasant person to be around. So it may just be a matter of adjusting what you eat in the morning.

Staci Kloster: That is one thing with breakfast. Because honestly, I’m not really a breakfast person. I don’t really care for a lot of breakfast foods, so then that doesn’t seem like I’m very excited to have breakfast. With that being said, I do also think it’s a difference between when are you actually getting up than when are you having your first meal? I don’t really care that it’s breakfast, per se, but are we going for long periods of time without eating? And then what does the rest of your day look like? For example, I mean, a lot of times I will wake up, but if I’m going to do a workout or do something, I don’t typically eat for probably the first three hours, but then I’m looking for something, and then eat pretty consistently throughout the day. I sometimes find it hard to tell patients to eat first thing in the morning, if they really don’t do well eating first thing in the morning, and it kind of sets their day as sluggish. Even having a bite or two of something, I think sometimes when we think of breakfast, we need to have, the bacon and the eggs and the pancakes, we have to have all of this food because, again, we’ve been told it’s your most important meal. But to me, I think you can also just have a little bit of something and move on from it.

So we were talking a little bit about intermittent fasting, and I guess we have so many different diets we can talk about. But let me, let me ask you guys this: So keto, paleo, intermittent fasting, all of these things like, what are some of the good components to take from these diets? And then we can touch on, maybe – because there’s some danger to some of them for some patients. And so maybe we can talk about the good and the bad of fad diets. It doesn’t even have to be a particular diet, but maybe the habit. I don’t know where to start with this, but I’m going to put it on to Erika Van Calcar first in terms of maybe with keto or intermittent fasting, what’s good about those diets? What components would you like to see people do more of?

Erika Van Calcar: That’s a brilliant question and a hard question in the studies that have been done eith either low carb eating, intermittent fasting, low fat, If we want to compare all of those. Low fat diets, low fat, low carb, low fat, high protein, the list goes on and on and on. There are definitely some benefits. They’ve seen in research studies, weight loss improved insulin sensitivity, so your body just utilizes the energy that you put into it better, which can help either decrease blood sugar, prevent diabetes. Improvements in hypertension, improvements in or changes in cancer risk, so decreases in total and LDL, cholesterol and triglycerides. Even with the keto diet, there are some definite improvements in that lipid profile.

The consequences or the drawbacks, being that a lot of those studies are very short term and don’t have a lot of participants, or the dropout rate is really high, so they’re not getting a really good picture of what happens long term. In the short term, they’re seeing some pretty interesting results. But what happens long term? If I were to pick on the keto diet, what happens, let’s say, if you follow this exclusively for six months a year, two years. What happens to your liver? Do you all of a sudden get fatty liver, cirrhosis of the liver? What happens to your triglyceride levels? What happens to your kidneys? You know, if you’re prone to gout, that could be really problematic – eating even a moderately high protein diet. So with intermittent fasting too, are you fasting so long that then you’re not able to take in enough energy, enough vitamins and minerals, and so then are you ending up with deficiencies? So yeah, there are some really intriguing benefits to a lot of these things, but I think the long term consequence is we don’t know enough yet, just because we haven’t been able to study it enough.

Soleil Thiele: I mean, just bouncing off of what Erika Van Calcar just said. There’s research to show that intermittent fasting can kill off cancer cells. But, you have to look deeper into the research and see how many people are involved in this study? How long is this study? How many studies are there that are showing like, oh, yeah, we can replicate this multiple times? I mean, that’d be great if it does, but I do think there needs to be more research to back that claim up, because that’s a big claim.

Staci Kloster: I would also say just because you intermittent-fast doesn’t mean you have a healthy diet. So again, into with a lot of the studies, what is their diet when they are eating and so kind of the question back to, like the cancer, if you were intermittent fasting, just intermittent fasting, to me, doesn’t make it so that you have a higher prevalence of being, you know, risk free of cancer. But what are you eating when you are eating? Is it high in fruits and vegetables? Are you having antioxidants? You know, all of those things. So to me, your diet really does matter when you are eating, whether you’re intermittent fasting or not.

Dr. Justin Clark: Okay, interesting. So with our last six, seven minutes or so, we can talk about anything that you guys would like to talk about with these fad diets. But my question would be, over the years, there’s been lots of sort of wild ones out there, so I want to see what some of your favorites are that you guys have done or learned about or seen patients do. I know in my research, I came across the cabbage soup diet. I have no idea what that is. It sounds disgusting, but has anyone seen anybody on a cabbage soup diet?

Erika Van Calcar: I’ve had a few patients who have mentioned that very short term and a very noisy gut, let’s just say, on that diet. So long term, I will say this kind of, going back to the keto diet, and kind of pros cons that I have heard a number of patients say is that even if the keto diet wasn’t sustainable for them, the one thing that it did help with is kick their sugar cravings down a few notches. And so, that has stuck with them long term. So one of the pros, and I think a lot of these diets, that is sometimes what people are looking for – is to curb something, whether that is back to eating, how you’re eating, likely it’s going to presume and you didn’t have the sugar cravings that you did. Yeah, also, too with schooling to become a dietitian, I often would get questions asked about X, Y and Z diet. We tend to focus on more medical nutrition therapy, whereas diets, I did not have a class on the cabbage soup diets.

Soleil Thiele: Well, I’ll mention the HCG diet because I’ve actually done that before, when I was in high school going through my I-don’t-like-my-body phase. That diet is extremely difficult. There’s different ways to do it. There’s an injection you can get of the hCG. There’s also, like this liquid dropper that you put under your tongue, which is what I did and basically, you take that injection or the little dropper, and you eat like 500 calories a day, focusing on protein and veggies, which are both good things, but 500/600 calories, is not sustainable for I don’t think anyone. So, yeah, that was kind of an intense diet, for sure.

Erika Van Calcar: I just think email us to get an appointment, because I have so many more questions, Holly, than I feel like I can give answers, but I don’t know about Staci or Soleil. I think the biggest one would be, if you do have to go on to a way of eating that restricts a food group, and you know, grains would be a food group, I would talk to a medical professional that specializes in nutrition, medical nutrition therapy at least once, so you can make sure that you are getting a balanced diet. You are getting the vitamins, minerals, fiber, carbohydrate from other sources that you need. Just to make sure that you are hitting all of those benchmarks.

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