Fad or Rad: An Evaluation of Diet and Fitness to Balance Your Life

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here is your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about the pros and cons of some of the most popular diet and fitness plans. Our guest is Dr. Alan J. Viglione, an internal medicine physician at Orange Coast Memorial Medical Center and Edinger Medical Group. Welcome, Dr. Viglione.

Alan Viglione, MD: Hi, thanks so much for having me.

Deborah Howell (Host): Our pleasure. So, of course, what we eat is essential to a healthy lifestyle and there are a lot, a lot, a lot of diets out there. Both the Atkins diet and the Paleo diet have been really popular in recent years. What are some of the pros and cons of each of these diets?

Alan Viglione, MD: Well, first off, the key to any diet regimen is to find the one that works for your body and find the one that actually makes you feel better. The purpose of any diet routine is to optimize your health from the inside out, right? And ideally manifest that in terms of weight loss, improved fitness, etc. So Atkins and Paleo are both very popular, they're very, very different, but they're only two examples. So my credence is, if neither of them work for you, then try something else. Or better yet, focus on long-term wellness, reduce calories, happiness. I really do think happy people look better, I'll throw that in there too. But Atkins was developed by Dr. Atkins, he's a cardiologist at Cornell Med in New York City. This really was ground zero for the high-fat diets, which actually dates back to the 60s, really came into the public eye maybe in the late 80s and 90s. But the premise is that carbs are bad, they're the root cause of many of life's evils, ranging from hunger to obesity to insulin resistance to overt diabetes. For anybody that's done it, it's a little complicated. There's an induction phase which nearly cuts out carbohydrates, we're talking limiting them to about 5% of your total calories. And that loosens a little bit up to about 20% in what's called a maintenance phase. But, compare that to the prior food pyramid which had carbs at the base of the pyramid, nearly 50%. So clearly Atkins had something right with his new nutritional guidelines suggesting that complex carbs be limited and simple sweets are only on rare occasions, they're up on the top of the pyramid. So, the science is actually really interesting for Atkins. It's loosely verified by a scientific credo, you limit your carbs, you decrease your glycogen, you induce ketosis, suppress your appetite, eat less, lose weight, and live happily ever after. And certain body composition studies, small studies, support that you actually can lose fat at about six months. But no change that I've ever read has happened after 12. So, long-term studies are absolutely needed not only for fat loss but for health and wellness, cardiovascular outcomes, etc. And to be honest with you, this buzzword ketosis, which is paramount in Atkins, is not a favorable word, here at Orange Coast or in the medical community. Starvation mode creates an acidic environment, alters your physiology, puts strain on your heart, increases your respiratory rate, etc., etc. Plus, I will say that Atkins recommends limitations even in fruits and vegetables, which have quite a bit of support for long-term wellness.

Deborah Howell (Host): Right, right.

Alan Viglione, MD: I personally think Atkins has good points and worrisome points, but more credence has to be placed on long-term wellness and I just don't think it's there.

Deborah Howell (Host): Sure. And what about the Paleo diet?

Alan Viglione, MD: So, the Paleo diet is interesting. It's quite a bit newer. It's definitely louder, I will say quote, in the nutritional community. It's obviously short for paleolithic diet, with the premise being, if your early stone throwers did it, then you probably should too. And if they didn't do it, you shouldn't. The idea is also that human evolution peaked at about 10,000 years ago and we're not equipped either physically or chemically to handle certain foods that were introduced after. So processed anything, including dairy, grains, they're out. Meats, fruits, vegetables, they're okay. And this is interesting. So a whole bunch of small cohort studies, crossover studies, observational studies show fantastic endpoints. Satiety, body weight, waist circumference, blood pressure, cholesterol numbers, inflammatory markers, fancy ones like ESR, CRP, yada, yada, yada. But the longest study that I've ever read and I've done quite a bit of research into this was two years follow-up. So that's way too short to claim causation and when I say loud, when it comes to this diet, you hear things on 2 AM infomercials about cures for autism and dementia and PCOS and that's just not true.

Deborah Howell (Host): Yeah.

Alan Viglione, MD: So, but with that said, I like aspects of this too. It's an emergent topic. It kind of progresses into this plant-based diet, which has a little bit more support, I would say. And that's kind of the newer fad. That's actually supported by a whole bunch of cardiologists, that will actually do angiograms and certain studies to show reversal of heart disease when you eat certain foods. But, the point being that both of these diets that we talked about have pros and cons, but much, much, much more research has to be done before we put all of our eggs into any one nutritional basket.

Deborah Howell (Host): Sure. So what do you personally recommend now to your patients when it comes to following a sensible and balanced diet as a way of life?

Alan Viglione, MD: Well, I say keep it as simple as possible. So I stress that there's no magic to diet if it's not getting the results you're looking for, first redefine what you're looking for and then tweak a couple of the parameters in the equation. So first and foremost, unless you're Zac Efron or whoever is training for your next ab role in a movie, please don't count your calories, keep it simple. I tell my patients, figure what your steady state is, what you are, drop 300 or so calories from that a day and, that can even be just cut out that cannoli after dinner, and you'll lose about a pound a week. A little bit of simplification. If you don't, then you gotta consider the types of calories you're taking in and the time of the day matters. I tell this to my patients, shoveling in calories before you go to bed is very different than 7 o'clock in the morning. Add exercise, you'll tackle both ends of the input and the output side of that equation. But, honestly, most importantly, consider a paradigm shift. Our goal, my goal, your goal is to facilitate health and wellness, not water weight, crash diets, beachwear, or whatever.

Deborah Howell (Host): Okay. And we all know that diets don't necessarily work for every person the same way, so how should you go about choosing what might work best for your body and your lifestyle?

Alan Viglione, MD: Exactly. So know and learn your body. Define your goals. If it doesn't work, try something else. So don't get frustrated, just try something new. I really do think that you need to set small, defined, attainable goals, like one pound a week, or training for a 3K. If you want to use training parameters as sort of an endpoint. Wellness is a game of delayed gratification. You're not going to get anywhere with a two-day crash diet. And I also tell my patients that diet and exercise are synergistic. There's positive feedback there. They feed off each other and if you do one, you're going to want to do the other.

Deborah Howell (Host): You've touched on fitness a couple times, so what fitness regimens have you seen gain popularity in recent years?

Alan Viglione, MD: Oh goodness, lots. So CrossFit, TRX, Pilates, boxing, kickboxing, jiu-jitsu, MMA, they're all more popular than ever, and some of it's regional. I grew up on the East Coast and MMA and those sorts of fighting engines weren't nearly as popular.

Deborah Howell (Host): I tried the TRX, it's pretty good. I have it right here. I kind of like it.

Alan Viglione, MD: Yeah, good for you.

Deborah Howell (Host): Yeah, it's just so easy on the joints and you can do it in five minutes and feel like you've done something.

Alan Viglione, MD: Absolutely.

Deborah Howell (Host): Now it's been said that incorporating weights into your workout can be more effective than a cardio workout for burning fat. So what do you recommend to your patients who want to burn fat and gain muscle?

Alan Viglione, MD: Yes, yes. So oxygen debt and basal metabolic rate, they go up when you combine the two, when you combine cardio and weight. You'll actually burn fat throughout the day. That's sort of a known claim. If you're looking at that funny fat-burning picture on the treadmill and feel confused, you probably should be. I kind of find it silly when you're on a treadmill and you're going too fast and you're not in the fat-burning zone so you try to slow down. I think it's silly. You lose fat when you burn calories with safe intensity. Interval training, circuit training, muscle confusion, so, very simply, do what you love, mix it up, and keep your heart rate up.

Deborah Howell (Host): There you go. And get outside if you can.

Alan Viglione, MD: I'm sorry?

Deborah Howell (Host): And get outside if you can.

Alan Viglione, MD: Oh absolutely, if you find your passion you're going to stick with it. And do what you like. I mean I have friends that love to do bodybuilding and you can easily transform that into a heart-healthy routine by keeping your heart rate up. Drop sets, supersets, do something in between. Don't just sit there for three minutes in between your sets.

Deborah Howell (Host): And this is always a good question too, I'd like your opinion on it, how much exercise do we really need every week to maintain our weight and our health?

Alan Viglione, MD: Well, the CDC says five days a week of cardio, two to three days of weight training. I really think everybody's different. Maintaining muscle mass I'd say maybe three days a week, but you absolutely shouldn't cherry-pick muscle groups. They all have to be represented, even legs. For cardio, the magic number seems to be 150 minutes a week. That sounds daunting but you can break that up however you want.

Deborah Howell (Host): Sure.

Alan Viglione, MD: And that includes a few minutes here and there on the stairs at work. But everybody's different. Personally, I either gain or lose, maintaining is a challenging word for me, but I have friends who maintain ultra-marathon level fitness and they just go through life. It's a way of life. Just don't forget that you are in it for the long term. So set your goals accordingly.

Deborah Howell (Host): Okay, sounds good and I have a final question for you, doctor. What should we do first to get started with eating better and getting fit?

Alan Viglione, MD: Well, number one I'd say is make a plan. You're more likely to stick with it. I think organization is key. I think it's paramount. Figure out realistic goals. Maybe find a friend so you can motivate each other. And like we were saying the whole time, keep it simple, keep it attainable, and keep it fun.

Deborah Howell (Host): I love it. Well thank you so much, Dr. Viglione. We're gonna go out and try to do that today and every day. We love that you were here and we appreciate your time and your expertise.

Alan Viglione, MD: Anytime. Thank you so much for having me.

Deborah Howell (Host): For more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all for this time. I'm Deborah Howell, have yourself a terrific day.