JEREMY: Hello and welcome to another episode of Eat This Podcast with me, Jeremy Cherfas. One of the things I find deeply puzzling about the world of food is the sheer excess of advice on nutrition. For almost any given idea that some food or other is good, there's an excellent chance that you can find the exact opposite opinion in seconds. Butter will kill you. Seed oils will kill you. And it's as true for how you should eat as for what you should eat.
Fast for 16 hours a day, or eat six small meals a day. You know the kind of thing. It seems that anybody can say almost anything they like when it comes to diet, nutrition and advice. And that's despite the fact that in many places around the world, it's actually illegal to give nutritional advice if you're not officially qualified. That's why I welcomed the chance to talk to Tara Schmidt, a registered dietitian at the Mayo Clinic in Rochester,
Minnesota. She's the host of the Mayo Clinic's podcast On Nutrition. I took the opportunity to quiz Tara Schmidt about the long training she had to go through to become a registered dietitian -- bachelors, masters, internship, board exams. And I wondered how she felt about all that conflicting advice. TARA: Here's the analogy that I give. My husband is a financial advisor, so he has a degree in finance.
He's passed all the exams. He can legally give people advice and he can trade their stocks, etc. I have money in a bank account too. I know a little bit about stocks and bonds. I have some, but I have no right to give people advice on the stock market. So I think that that's what happens with food. People have knowledge. Everyone eats, everyone has an opinion. But there are some people who probably don't have the qualifications to give advice.
In the state of Minnesota, it's actually illegal to call yourself a nutritionist unless you are a registered dietitian. And that's again, different by country and different by state. But the Academy of Nutrition and Dietetics, who's kind of our governing body or credentialing body in the states, they have tried to kind of hammer down on: people who are registered dieticians, are the ones who have the qualification, the education and the background to give advice.
JEREMY: But that doesn't stop people giving advice. TARA: Of course not. Of course not. Welcome to the world of the internet. JEREMY: Well, exactly. I mean, presumably you could you could live somewhere where there is no requirement for being registered or board certified or anything like that, and you can't stop people from somewhere else reading what you what you put out. TARA: Correct. JEREMY: Is that a problem for you?
TARA: It's a frustration for me . Now, I would like it to be known that not everything that people put out there, whether they're a registered dietician or not, is incorrect. And there are not many, but maybe even a few registered dieticians that don't have the same values or beliefs that I have. So everyone is entitled to their opinion, and food is a sensitive topic.
I think that that's what's most challenging for me, is that people have really strong beliefs on these principles, and what I always go back to, and what I kind of tell myself at night when my blood pressure is high, is that I went to school for this. I did my internship at Mayo, so I've always been at Mayo Clinic. I learned from Mayo. I work at Mayo. We're very evidence based, and it's actually okay to recognize that that's a little bit of a bias that I have.
Mayo, i think I can say, it has a little bit of what we would call biomedical bias. We don't do much unless there's about 10,000 studies saying the same thing. And that makes us a little slow sometimes, but that's also saved us many, many times. Right. So I'm proud to work where I work. I'm proud to be a registered dietician.
But it can be difficult when there are people with a louder voice than I have, or there are people with more marketing dollars than I have spewing incorrect information. And I'm going to call it incorrect because either it's been disproven in research, or there is no research or evidence to say that it's correct.
JEREMY: I did an episode a little while ago about fad diets, and one of the things that came up, they offer a simple kind of solution with a whole lot of beneficial results, and they may even work to begin with. TARA: They do! JEREMY: Yeah, but one of the things is that people fall off fad diets. If they did it for weight loss, then they put the weight back on. I just wonder, do you think it's possible to be addicted to the
idea of a fad diet? The idea that some simple change is going to turn everything around. TARA: I think we are so used to things coming to us extremely quickly. I ordered something from Amazon yesterday. I would like it to be here in about five minutes and I expect it to. Right. And what fad diets do, and this is what I tell my patients and my members, if something seems too good to be true, it probably is. If you have a red flag kind of going off in the back of your mind, or ...
I've seen a billboard that says, lose this many pounds, no exercise required, like beep beep. Let's back up here. This is not a good one. The problem is that fad diets work just like you said. They tend to be calorie controlled in some way or another. They would never say that, but they're somehow calorie controlling you, which mathematically works. Putting you in a calorie deficit, you lose weight. The problem with them is that they tend to be not sustainable.
Whatever they're having you do is not likely going to fit into your lifestyle literally for the rest of your life. So we bounce back, we regain, and we start over looking for the next thing. So that's weight cycling or yo-yo dieting, fad dieting, whatever word you want to say. The problem is that it works, but not long term. JEREMY: Yeah, but people go on to the next fad diet. They don't go back and do it again.
So they maybe, maybe what they're doing is saying, okay, this time this is, this one is different. TARA: Yeah. And they are very good at marketing them. And they have a lot of money behind them sometimes. JEREMY: But the money behind them point is interesting. I mean, my feeling is that ... Well, I don't know. I don't know. I mean, the book, the book deal, buying the diet plan, all of that. L et me come back to a slightly different question.
Do you think there's a sense in which people who do turn to fad diets, do you think they feel let down by the medical profession. TARA: I think that's possible. I also think part of the problem, it may be more so of the problem, is that we live, I believe, in an obesogenic environment. We live in an incredibly difficult environment to eat healthfully, to have regular exercise, to have non-exercise activity as part of our daily lives.
I think calorically dense, low nutrient, highly palatable food is more accessible and often cheaper than your good old fruits and vegetables. So I think it's this horrific kind of tornado of the environment that we live in. The messages probably, that were given about body size and being a normal or lower weight equals health, which I disagree with, of course. Young girls, but also boys, you know, being exposed to "this is the right type of body to have" at a very, very young age.
And then maybe not feeling that support from the medical field of this is what we can give you, because time is very limited in that sense, of course, and in what we often give people in the medical field -- which is, hey, let's put you in a reasonable caloric deficit for many, many weeks -- is not what they want because they want what's fast because that's how our brains work, I think. JEREMY: Yeah. O n the obesogenic environment, I mean, that's also something I've been very well aware of.
Is there something specifically about ultra processed foods, do you think? Or is it just that they're engineered so that we eat more of them, do you think? W hat I'm getting at is, is it the ultra processing or is it that we eat so much of them? TARA: I think that's one and the same, right?
So like you said, they are engineered by very, very smart people to be the exact crunch that you're looking for, to be the exact level of salty and sweet and mouthfeel and how quickly are they digested in the mouth, but also in the stomach. How are they packaged? How appealing are they to my children, who like colourful things or who want cartoons on their cereal box? And that mixture of ingredients, I think is problematic.
In addition to it tasting very, very good and having the ability for us to eat them in excessive quantities, I also think the ingredients themselves, of course, are inflammatory in many cases, not all, of course. I think we also have to be realistic when we talk about fad dieting. Like you said, one of the biggest factors of people who regain weight versus people who are able to maintain weight loss is actually not the diet that they started on. It was their percent adherence to that diet.
So if someone adheres very, very well to a very, very restrictive diet, but they're able to adhere to it, they'll actually be just as successful as someone who only cut out, you know, 200, 300, 400 calories and did so. At the end of a year, regardless of the diet, people lose about the same amount of weight. The people who regained weight were those who were not able to adhere. So that's good and bad news, right? It's good news that any diet will work if you do it.
It's bad news that any diet will work if you do it. JEREMY: That's that's really interesting, but the whole idea of the diet versus diet. How hard is it to get people to change what they eat, n ot for six weeks, not for six months, not for a year, but every single day. Is that something you can even try to do at the Mayo Clinic? TARA: We try to do it with the Mayo Clinic Diet.
And this is, I always say, this is such a horrible sales pitch, but what we actually tell our members on our weight loss platform is: I hope you don't have to use this diet in the future. I hope this is an educational tool for you to learn how to eat healthfully, with an appropriate calorie amount with nutrient dense foods. And then I hope you can say goodbye to us. And that's probably not something that the finance department's real thrilled with.
But again, our core belief is that we put our patients first, our members, in this case, it's a subscription programme. So we are more in the field of educating so people can learn how to do it and take that knowledge and go practice versus ... Many other, of course, dieting programmes out there could care less if you learn anything, as long as you're learning what the rules are for their programme. And again, people can be successful, but it's not that long term health that's the outcome.
JEREMY: Is there any nutrition education in the public school system in the United States? TARA: Not very much. We'll say that it tends to fall to Health Class, which has a wide range of curriculum in terms of what people learn, it was Home Ec and Health Class back when I was young. It's now called Family and Consumer Science Education, I believe. But that's also something that's been cut very frequently from schools because they're more focused on math and science.
But I took a heck of a lot of science to become a registered dietician. So I think it should be in there in the science somewhere. JEREMY: Because it's kind of interesting what's happening, what I'm reading, what's happening with school diets that actually maybe school diets could possibly become better balanced nutritionally, because I'm sure children learn a lot of what is good to eat, unquote, from what they eat, what they eat every day at school.
And certainly here in Europe, you know, countries like France, Italy, a lot of countries are very careful about what they feed children at state schools. TARA: Yeah. I don't think we're doing that in the United States. I would like to blame budget. It tends to come down to budget of why we can't
do this better. So I would say in the United States, children are learning how to eat what is healthy and all of their habits more so at home, which is very difficult because when we talk about how do we change behaviours, or when you asked how difficult it is to change someone's diet, these things are very, very ingrained in us. They're very ritualistic. They're very habitual, very mindless. So when you have grown up in an eating environment with someone else, mostly,
quote, controlling your food choices -- right? -- your parents for many years, I would imagine that's quite difficult to change when you come into adulthood and are in control of your own grocery bill and what ends up on the table. JEREMY: The other thing that's interesting, I find interesting, is that governments, governments everywhere issue guidelines for what people should eat.
And one of the things that they all have in common is that people find it incredibly difficult to meet those guidelines, even something as simple as five fruit and veg a day. Why? Why is that? I mean, why can't ... You'd think government would be able to say, to give people an option that they could at least meet. TARA: I think it can be met. When you look at ... So I'm most familiar, of course, with the US dietary guidelines. When I look at them, I think they can be met.
I don't think we're asking too much. What I think is difficult again is the time and the access and the familiarity and the trust that we're talking about when we talk about those guidelines. JEREMY: Are you saying that people trust the food manufacturers more than they trust the government?
TARA: I think they mistrust where those guidelines come from, which I disagree with personally and professionally, because I know some people who sit on that board and they were professors of mine in college. I think there's an assumption of where did this come from, and who paid you to write this down? Which I again personally don't agree is true, but I think there is some mistrust, at least in our country, related to that topic. JEREMY: Do food labels, do package labels help?
TARA: If people read them. Yes. JEREMY: What's the if in there? TARA: We got to get people to ... That p eople don't look at them. Right? So if you turn a package over and you read the label, there's all the information that you need, right? B ut I do think there is confusion among that label. I think there is a lack of education related how to read that label and who has time,
right? I'm a dietician, so I love flipping packages over and choosing the right one and explaining to my children why we're picking A versus B. B ut I also think that food marketing is quite fascinating and that a label can be extremely confusing to the average consumer. There's colours, there's words, there's marketing. Let's just leave it at that.
JEREMY: Well, can marketing be regulated? S ome some governments around the world have managed to say, yeah, we insist that this is the way you label the food package. TARA: Yeah. And it can be. But then the food company knows a way around that, right. So if I give you a guideline of "you're not allowed to say this". Well, then they're going to say that. If you're not allowed to do this, then they're going to do that. So again, they're good at their jobs.
And whether it's deceitful, I don't know . Whether it's just, you know, getting someone to buy their product, they're excellent at it. And again, they're also manufacturing foods that taste good. And I'm not going to deny that they don't taste good. I think the amount of information out there is getting muddy, right, is muddying what I want consumers to hear. Budget maybe making that difficult. Familiarity with these products, that have been around and get better and better,
is difficult to change. And time is always going to be a barrier in terms of preparing healthy meals made from mostly whole foods. JEREMY: And and of course, nowadays you don't even need to diet because you can just get one of these drugs -- Ozempic and all the rest of them -- and that's fine. Y ou will stop eating. You will lose weight. Have those been oversold, do you think? TARA: I think there's an appropriate way to utilise these drugs and there's an inappropriate way.
In a perfect world, these would be used in conjunction. And this is actually what the studies say. But no one ever remembers this part of it. These drugs are meant to be used in conjunction with a pretty regimented lifestyle programme, right. So when we look at the subjects, the study subjects who took these drugs, they were given counseling by registered dieticians. They were assisted in being in a caloric deficit.
They had an exercise programme. These drugs are going to be absolutely life changing for a lot of people, and they're going to improve and likely save lives of many people, which is fabulous. We've been waiting a long time for something like this. However, I am very concerned with the large numbers of patients who go off of these drugs, which is quite high, whether that's financial barrier or side effects, etc. if they have not changed the foundation of their lifestyle.
Have we just gone back to fad dieting? Have we just gone back to yo-yo dieting?
A nd that's concerning for me, especially because these drugs are going to have a larger impact on things like lean mass, bone mass, etc. JEREMY: I t's hard to avoid the impression that, at least when you look at the marketing, that sometimes these drugs are used by people who can afford them to lose a silly amount of weight, and that they're not used by people who ought to be able to afford them and really need to not just lose their weight, but get their health under control.
I have no idea how that's going to play out. Do you have any do you have any thoughts on that? TARA: I do know, and I think one of the studies was just stopped from a safety standpoint, I do know that those companies are working tirelessly on creating an oral agent of these drugs, which should, in theory, decrease the cost significantly. So that would be the hope that in the next, let's call it five years, accessibility in terms of cost and maybe therefore in terms of coverage will improve.
JEREMY: What's the one ... I mean, we keep coming back to sort of changing, not changing the diet you follow, but changing your diet. What's the one thing you would like everybody to know and maybe to act on? TARA: I find myself saying the phrase eating pattern quite often in my education and in my counseling. I think we fall to articles about singular foods, right? This singular food is great for you. Eat it. Unlimited amounts. This singular food is horrific for you.
Are processed foods good or bad? So I get asked a lot about singular nutrients and singular foods. And I always come back to -- before we talk about that food, can we talk about your eating pattern? And the word diet would be a wonderful substitute if people recognize that diet is just simply what you put in your mouth to nourish
yourself. So I talk a lot about eating pattern, because if you want to enjoy an ultra processed snack food that we know has no nutritional value, that's okay in my book, because how often do you have it and how much? JEREMY: Four times a day. As much as I can get. TARA: Well, then I'll counsel you on that, right? But we tend to have all of these questions or all of this vilification of these. This food is bad and this oil is bad and you should be substituting it for this one.
Where we have so many wonderful foods in this world, some that are more nutritious than others. And I do think that they can all fit, but people don't really like that answer. They want to be told exactly what to eat, exactly what not to eat, what to never have, what they should yell at their sibling forever eating. But we don't eat in a vacuum. And this is also part of why nutrition is so hard to study, right? Because it tends to be retrospective or it tends to be population based.
We don't lock people in rooms and feed them often. JEREMY: You know, it's sort of gone away, but five or six, maybe ten years ago --- I don't know, time flies -- the people who kind of locked themselves in a room voluntarily, the tech bros and what have you, they were going for this sort of, you know, the complete nutrition in a drink. You don't need to eat. This is refueling. Soylent. That's kind of gone away. Is that a good thing?
TARA: I think so because what was that? Providing you with health is so complex. I think we really look for it to be easy. We look for a pill. We look for a food. We look for a supplement because we are so used to having these very simple answers. And I beg people to take a step back and focus on singular changes, as small as they may be, as opposed to dramatic rules: five pounds in five days; drink or take this pill and you'll get everything that you
need. Because I think food is more than just nutrients. It's social. It's comfort, good or bad. It's a way that we celebrate. It can be a way that we grieve. It's meant to be pleasurable. Maybe we've gotten too good at that, but it's more complex than just eating for calories and vitamins and minerals.
JEREMY: Amen to that. I was talking to Tara Schmidt, lead dietician for the Mayo Clinic Diet, and I really liked her point that "diet is just simply what you put in your mouth to nourish yourself". You look after that and you won't need anything that's actually labeled as a diet. But of course, I'm not actually giving advice here. I'm just expressing my opinion, which you should definitely agree with. I'll put a link to the podcast Tara Schmidt hosts in the show notes at EatThisPodcast.com.
It's also time to do the marketing thing again. So let me first thank all the people who donate to support the show, which keeps it available for everyone and which makes the transcript possible. You can join them from the website at eatthispodcast.com/supporters. And then there's my occasional request that if you like the show, please leave a rating or review wherever you get your podcasts. Better yet, tell a friend directly. It all helps to introduce new people to Eat This Podcast.
And if you do do that, thanks so much. I really appreciate it. From me, Jeremy Cherfas and Eat This Podcast, goodbye and thanks for listening.