She found out what I was doing and she is amazingly qualified for what she's doing. So let me tell you about it. She got her Masters of nutritional biochemistry from Tufts, then she got a PhD in behavioral nutrition from Columbia, then she became board certified as a clinical nutrition specialist scholar.
Then she's done research with both academic and Pharma-based research and she has her own clinical practice where she's helping teens, she's helping adults and she's helping them improve their lives with a low-carb lifestyle. She has a number of practical tips, a lot from the behavioral side, which we probably don't spend enough time talking about.
So I hope you walk away from this interview with a lot of those little pearls, because she really has a lot of them and she knows what she's talking about, she has a lot of experience, a lot of education and her passion for helping people really comes out. So I truly enjoy this interview, it had a very special meaning for me.
I hope you can appreciate that and enjoy it as well. So if you want the full transcripts go to DietDoctor.com and of course you can go to learn all about our guides and our recipes and meal plans. There is a ton of information on DietDoctor.com. So enjoy this interview today with Lauren Bartel Weiss. Lauren Bartel Weiss, thank you so much for joining me on the DietDoctor podcast.
In grad school I was more of a Mediterranean diet person, but I soon came to realize that the effect that carbohydrates have on our body and on our insulin levels and doing trial and error and myself I decided that low-carb was really the way to go and the way to have long-term success with weight loss and keeping the weight off over long-term.
And I actually looked at the intake of fatty acids in pregnant mothers and the risk of a birth defect, called gastroschisis in the babies and what I found pretty consistently was the benefit of the Omega-3 fatty acids and the detriment of the Omega-6 fatty acids.
So yes a fishing expedition could happen. I think I was lucky and I really had my theory and my hypothesis ready and organized and I found something that I expected to find, but as with another large data sets, and we know the issues in nutritional epi, that the observational studies and the cohort studies, it's really hard to assess diet to get accurate measurements of diet and to weed out individual nutrients and how those are related to disease. It's very, very difficult, but that's really all we have now.
But yeah, having everything completely controlled is different than going and analyzing data. You don't know who collected it, you don't know the participants that were involved. So it is a really different experience. Why I did do this clinical trial is because it was a drug plus an exercise program. My justification was if we're going to be doing some kind of exercise with these participants then I was okay doing do it.
And the skeptic could say it's because they had it in a certain way to make their drug look better. So the skeptic would say- yeah, I think it's really interesting. And so you're still on staff at UCSD still doing research, but now you've branched out to do more clinical work and actually help people one-on-one. And that's where your background as a behavioral nutritionist I think probably really shines, because we can talk about what to eat all day long, but if people aren't going to actually take the steps to make that part of their lifestyle, it doesn't matter.
I think a lot of people are unfamiliar probably with behavioral nutrition. I have to admit I was, I didn't realize you could get a degree in behavioral nutrition until we reconnected. And I think that's fantastic because it's so important. So walk us through sort of the thought process of what makes behavioral nutrition different from just nutritional science.
One eating plan or diet will work for one and not work for the other, but in order to progress somebody to achieving long-term dietary behavior change success it has to be guided by some kind of behavioral change along the way.
So there's a lot of different determinants that can be identified in people as to what's going to create a change. There's health belief model that looks at perceived risk. So what's the risk of not making the change? So I do that with people who have family histories of chronic disease. Someone with a family history of heart disease or diabetes.
I say, look, you have a family history... Your father had diabetes, your grandfather had diabetes. You could be next in line if you don't make the change. So you have to to kind of create this risk in their mind and that's a little manipulation but that's kind of what these theories do, is they bring this information out for people to really think about it or perceived benefits, what are the benefits of making a change?
Or the perceived barriers, what barriers do you see that are in the way of making the change? So we work through that and incorporate that into the straight nutrition education. Then you also have the stages models, which you're probably familiar with the trans-theoretical model or the stages of change.
And it really is a skill which is why I spent 10 years studying behavioral nutrition, because it's not just a book that I can read and say, I will try this and if that doesn't work then too bad. So it really is a skill that I acquired that took a very long time in trying to read the person and figure out which determinant and which motivator or mediator is going to work to get them to say, "I need to make this change", and along the way trying to identify the mediators that will help progress that person through the journey.
We will go through that and work through that and then set new goals for every week. And hopefully by the end they have all these great goals that have helped them get through for long-term success and then there's always a few longer-term goals that are really more like 3 to 6 months out. And goal-setting is a super important part.
So I usually use a combination of all theories and all the mediators depending on what I see my client needs, but a big thing for the stages of change of self-efficacy, in other words for self-confidence. So it's really giving these people the self-confidence that they can make this change, because that's the biggest thing.
Making a dietary change is a huge lifestyle change, it's not very easy. So you have to figure out how am I going to increase confidence, how am I going to empower them to be able to be successful with this change and be okay with being out for dinner or in social settings and sticking to their plan and giving them the tools to get through difficult times like that.
I usually have to seek people out or I hear, "I have this sleep apnea..." or some condition and I say, "You should do something about it" and then I try to work with them through that. So the other, precontemplation is hard to work with, but it's my goal to get them to contemplation and then to preparation.
And then education is really important in the contemplation stage too. Educating them about nutrition and about food and using evidence-based research to really show this is where all the research is and this is where you are and we really want to be in a different place.
I love doing that, I don't mind being texted at 9 o'clock at night- "I'm at this restaurant, there is nothing... what do I do?" Or, "I am not feeling that great". I like to keep them motivated and that really is an important part and really close to my heart that this is an individualized, personalized approach. And to get some people through it, I just have to be there for them until they can really go on their own and as I talked about having the self-efficacy to take it and run with it.
I love that passion, I love that commitment and that's certainly not what you'll get if you just ask your local doctor for nutritional advice. So speaking of which, just jumping around a little bit, you actually taught nutrition in medical school. If you want to call that, the way you describe your experience sounds like you're extremely limited on what you can do. Tell me about that experience.
And that was basically it. I did sit in on a couple of small groups which where they bring in the simulated patients, they bring in an obese patient and the students have to assess the patient and the patient leaves and they come back with dietary advice. And I was just blown away by some of the conversations that the medical students were having with these simulated patients because there was no basis for the information. And it just really bumps me out, that these medical students are not getting more nutrition education.
And if they don't have the right education, they really shouldn't be giving this information to people and they should be referred to dietitians or to nutritionists. Yes, it seems that medical students want it, I just don't know how they're going to ever figure out the place to put it in medical school curriculum, unless it's totally revamped.
I do a lot of pros and cons, this is called decisional balance kind of deciding which is the better way to go to list the pros, and these are going to be the benefits. Or to list the cons and be okay with, well it's just too hard, or I don't have time, or carbs are easy to get and cheap. And I go through those cons with them, and try to work through them, and turn them into pros.
Then I go into a low-carb Paleo, which is always an option, or a low-carb Mediterranean which is an option, so I do take some of these more popular eating styles, and just make them more low-carb... I'm big on low glycemic index. I think that most of my clients that come in and want keto leave doing more of a low glycemic index eating plan, because it's just better for their life style.
I basically have to figure out their lifestyle, figure out what they do on the weekends, and whether this eating plan is maintainable for them, and when I get someone that says, "I just can't give up my beer on the weekends", I have to re-think that, and find another plan that's going to work, keeping them on something five days a week, and letting them slip a little bit, teaching them how to slip correctly, and hopefully then having success with that. It really depends on each individual person.
omeone could get off of keto stay on a low-carb diet, still gain a little weight back. It takes a while to figure out what works for somebody, and whether they're going to be happy with their lifestyle and eating lifestyle that they're choosing.
Most of my teenagers end up doing either a low carb Paleo, or a low glycemic index, which allows someone to enjoy a cupcake if they want to enjoy a cup cake with their friends, just knowing that you're going to have to find a fat somewhere to eat it with, and you may have a little bit of a blood sugar set back that day. But I educate these teens, they know what happens now when they eat something with the high glycemic index carb. They are aware, "I just ate in 20 minutes, my blood sugar is going to spike and I'm not going to feel that good." They have to make those decisions.
The goals they work with me are personal goals, they're not really shared with the group unless they want to be shared. But the overall nutritional education and working through some of these obstacles, they're basically the same with other teenagers.
There is education for athletes, that there is a fine balance, and yes you might need some healthier whole grains and some lower glycemic index carbs to kind of get you through your sport, but the days that you're not really exercising a lot, you don't need to be carb loading.
And I think that this whole carb loading issue came about from marathon runners, but a lot of athletes think I absolutely have to carb-load and those recreational athletes really don't need that. Everybody is individual, I have to see how much energy has been expended, how quick they need the energy. And then on their off times I tried to get them to a low carbohydrate plan, if weight loss is a goal.
Being at your absolute best might not be the requirement. You can do that workout fasted or low-carb as an adult, but as a teen you may need those carbs for the extra energy. When you were talking about carbohydrates you've mentioned healthy whole grains and I think it's so interesting how it's almost become one word "healthy-whole-grains". I want to explore that a little bit with you. It's interesting when you look at the research of whole grain; give me your idea or your understanding of the research of whole grains, and what makes them healthy whole grains.
Finding the right place for them, if they are required, because they do have important nutrients especially for the teenagers. I don't know if whole grains are required if you really seek out the nutrients that are in whole grains in other types of food. But fibers might be big for the whole grains, and that's really important to be getting regular fiber.
And that's also interesting about whole grain research, if you compare to refined grains it's going to show a benefit. But, it's never actually been compared to a low-carb high vegetable, high meat kind of a diet.
That comparison hasn't been done. I think it's so interesting, but again the age of the patient might make a big difference. And fruit as well... fruit is promoted as healthy, and nutritious, and I'm sure a lot of the teenage athletes are having fruit with every meal to get their carbs. And again if your goals are athletic performance, maybe that's okay, but if your goal is weight lost, you approach it differently.
In terms of the normal adult, if they want to incorporate some fruit into their day, you can have some of the berries, have them early and teenagers especially if they're exercising, I think that fruits are an important part of their growth and development, but I think you can overdo the fruit thinking on I'm eating only fruit, because it's really healthy, and it actually is a carbohydrate.
Usually I don't want them, but if I have to have them, or I want a bowl of fruit or something at that point, three o'clock is my last time. And the theory behind that is by five or around five o'clock my blood sugar, my insulin level have now tapered off, they're enough stabilized, and then I eat my dinner, basically a keto dinner with a glycemic index under 20 which I developed myself calling a very low glycemic index.
So, if you're eating a food which is basically a protein and green vegetable because there's really nothing left to eat. If you're eating a glycemic index under 20, then your insulin is low, and you're not building the fat basically while you sleep. It's kind of a mechanism to either not build or try to lose some fat while you're sleeping.
Not only from a social standpoint, because if you don't have that restriction, you can snack all night long with carby food, or certainly kids could but you said that restriction is more in line with our circadian rhythm or insulin and keeps you from snacking any unhealthier food at night. I think it's really helpful, so you can burn that fat while you sleep.
Bret:Yes. Now with the lot of clients weight loss is sort of the biggest goal, but you also have clients who have trouble with weight gain or they feel better on the keto diet, but they're actually losing weight and don't want to, and you have to find tips for them to maintain weight? Lauren: Yes, definitely. I mean if I go on a keto diet for an extended period of time, I'm in a weight that is too light and not comfortable where I want to be.
It does happen the other reverse but it's finding ways to maintain that balance and everybody is different, and that's when I try to transition them to maybe a low-carb Mediterranean or a low glycemic index. It's different for everybody, people who want to stay on the keto, then I've got to figure out a way for them to eat or eat more, or get some more fats in. But it is difficult to get someone to gain too much weight on a keto diet.
They're harder to get, the Omega 3s, the mono and saturated fats like avocado and olive oil, it seems like those are not as readily used on the keto diet and I feel like those should be emphasized because they're just better for our health, and they give us more health benefits. I'm not anti-saturated fat but I think there definitely should be a balance of the healthier unsaturated fats with the saturated fats.
I don't think that saturated fats are unhealthy they're certainly better than a carbohydrate, but I think there are options and balance that need to occur during a keto diet.
Now let's transition for a second away from your role as a nutritionist and as a scientist, and in your role as a mom. You've got two daughters, who are very active and athletic and are kids, and will probably eat like kids, and act like kids. How do you balance that role as mom, letting your kids be kids, but knowing what you know about the nutrition and the science and want your kids to know that as well?
I approach that in a very delicate way, I don't make a big deal about it, I don't talk about bodies, or weight or anything. But they do know what carbohydrate does, they're probably one of the two most educated 8 and 11 year old girls in nutrition, they could probably sit here and do a really interesting podcast for you one day.
That was interesting, my daughter and I actually watched that podcast together, and it sparked a conversation about the different eating plans. He said his daughters think he's crazy, my kids sometimes say, "Just eat one bite of this cookie." And I am like "I don't want it." "Come on, one bite is not going to hurt you."
You don't want to be crazy about it, but I say, "You know what? That's my rules." And they're like, "It's only 3:05" and I'm like, "It's after three. If I allow 3:05, then I allow 3:30, and I allow 4:00, and this is my rule." They have fun with it, I don't think it's going to develop any unhealthy eating issues but they're very educated. We had dinner the other night and my daughter said, "Who would ever dream of being a nutritionist for a job?"
And I thought that's interesting, because you could look it in two ways; you could also look at it just as a teaching moment, to say "I chose not to do this for X, Y and Z" and you make your own decision. You can approach it, in other way, I respect you for making that decision.
Personally I take the other approach, and my kids know, daddy is not going to eat cake, daddy is not going to have ice cream, daddy is not going to have that. And, that's okay, I don't say, "You shouldn't have it either." Just say "This is my choice, and this is why, and you guys make your own choice." It's an education... they frequently ask me as they're eating their cake, "This have a lot of carbohydrates? This is bad for me?", and I'm like "Oh, yes..." as the the scoop goes into their mouth. But it's a process. You have to start somewhere.
And hopefully this low-carb movement and these low-carbers are really going to help expedite that process because there is a major weight and obesity problem and not only in this country but in this world, and how we're going to approach it, and try to change it and fix it, it's going to take just as many years as it took to develop 30 years of guidelines telling us to eat the carbohydrates. I'm glad to be part of this process, and I hope that I can really impact as many people as I can with my journey and with my knowledge.
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