#530 Nutrition with Dr. Joan Salge Blake

Summary

Podcast Summary: The Curbsiders Internal Medicine Podcast

Episode: #530 – Nutrition with Dr. Joan Salge Blake
Date: June 22, 2026
Host: Dr. Matthew Frank Watto & Dr. Paul Nelson Williams
Guest: Dr. Joan Salge Blake, Professor of Nutrition, Boston University

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Episode Overview

This episode offers an evidence-based, practical, and often humorous journey through hot topics in nutrition, with registered dietitian and nutrition professor Dr. Joan Salge Blake as guide. The hosts and Dr. Salge Blake break down common fad diets, clarify misconceptions, and provide actionable recommendations for clinicians and patients alike. The show covers everything from keto and carnivore diets, the virtues (and vices) of plant-based diets, to fiber “maxing,” processed foods, food order, protein needs, and emerging trends in personalized nutrition.

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Key Discussion Points & Insights

1. Dr. Salge Blake’s Philosophy and Credentials

• Background: Clinical Professor at Boston University, multiple degrees in nutrition and education, hosts the "Spoton" nutrition podcast.
• Personal Note: Her mantra, "Nutrition is a science, not an opinion" (05:26).
• Favorite Advice: Nutrition advice should always be rooted in science, not personal anecdotes.

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2. Diets 101: Keto, Paleo, Carnivore

[07:22–15:00] The Keto Diet

• Definition: Extremely low carbohydrate, very high fat—originally developed for epilepsy, now popular for weight loss and diabetes.
• Challenges: “To stay in keto, to stay adhere to that diet is extremely challenging… for the Joe and Josephine on the street, it’s not the best diet for someone who has high cholesterol.” (08:34)
• Risks: High in saturated fat (raises LDL), hard to sustain, significant risk of nutritional deficiencies without expert guidance.
• Adherence & Visual Success: Keto can drive fast weight loss and improve some bio-markers short-term, but long-term risks and adherence are concerns.
• Clinical Pearl: “You can do any crazy diet for short term, but we’re looking for the long term. Any time you eliminate food groups… you’re just eating less variety, [so] weight loss will be great initially, but what are we doing long term?” (10:40)
• Team Approach: If patients insist on these diets, meticulous monitoring and dietitian involvement are critical (21:23).

[34:26–39:45] Paleo & Carnivore Diets

• Paleo: Based on presumed pre-agricultural diets (meat, plants, no grains or dairy).
• Carnivore: Only animal products and some dairy.
  • “Do you know that we have documented cases of people on the carnivore diet that got scurvy?” (35:36)
• Risks: Nutrient deficiencies (e.g., vitamin C deficiency—scurvy), absence of fiber, long-term health risks.
• Refrain: "Whenever you eliminate food groups… you’re not going to get all the nutrients you need." (37:31)

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3. Dietary Patterns Promoted: Mediterranean & DASH

[12:57–14:22], [49:28]

• Evidence Base: Strongest science supports plant-forward diets—fruits, veggies, whole grains, nuts, olive oil, lean protein (especially fish), limited processed meats and saturated fats.
• Benefits: Heart protection, blood pressure lowering, longevity, well-sustained.
• Lifestyle Component: "It's a lifestyle… it's healthy and people walk. It's a whole unbelievable life changing experience." (13:00)
• DASH Diet: Similar benefits, especially for hypertension.

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4. Fiber: The Underrated Superstar

[22:13–28:27]

• “Fiber Maxing”: Recent TikTok trend to increase fiber intake.
• Mechanisms:
  • Insoluble fiber: "Like a broom" for gut motility.
  • Soluble fiber: Lowers cholesterol by binding bile acids (24:42).
• Cautions: Increase fiber gradually to avoid GI distress; ensure adequate fluid intake; Americans generally underconsume fiber (~14–16g vs. recommended 25–30g/day).
  • “We’re pathetic… we're not eating enough whole fruits and vegetables… or whole grains.” (28:06)
• Practical Tip: Spread fiber across meals, go “slow and steady” with increases.

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5. Fats, Oils, & Processed Foods

[28:34–32:58]

• Seed Oils: Most plant-based oils (canola, olive, soybean) are heart-healthy; major exception is coconut oil ("wicked high" in saturated fat).
• Processed Foods: Not all are bad ("canned beans = fabulous!"), problem is with highly processed unhealthy items (soda, sweets), not basic processed foods (e.g., baby carrots).
  • “Not all processed foods are unhealthy… there’re a lot that make your life easier and healthier.” (31:59)
• Restaurant Fryer Oil: Only a concern with repeatedly reheated oils, not single-use home cooking (30:37).

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6. Food Order & Blood Sugar

[43:01–48:49]

• Food Sequence: Eating veggies and protein before carbohydrates can blunt post-meal glucose spikes and increase satiety.
  • “Protein gives satiety… vegetables fill you up before they fill you out.” (43:21)
• Research: Order matters—starch last > reduced glucose spike (45:27).
• Continuous Glucose Monitoring (CGM): Valuable for those with diabetes/prediabetes; less helpful (can be misleading) for healthy individuals (47:44).

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7. Personalized & Precision Nutrition

[18:58–20:27]

• Emerging Research: "Personalized nutrition" to tailor diets based on individual response is coming, but for now, broad plant-forward patterns are the gold standard.
• Lean Mass Hyper-Responders: Some may have extreme LDL increases with high-fat diets—requires close monitoring.

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8. Protein Requirements & Myths

[49:55–55:21]

• General Needs: Most Americans already meet/exceed protein needs; 0.8–1.2g/kg/day is adequate for most.
• Hype: "We've gone crazy with protein… now we've kind of lost our way." (50:21)
• Who needs more?: Athletes, frail older adults, individuals with certain health conditions.
• Diet Quality Over Supplements: Best met through food—less need for protein bars, Pop-Tarts, or supplements for the general public.

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9. Plant-Based, Vegetarian, Vegan Diets

[58:46–61:23]

• Plant-forward is good for everyone: “All healthy diets… are plant-forward. That’s what makes them healthy.” (59:05)
• Vegan/Pure Vegetarian Concerns: Watch for B12, calcium, vitamin D deficits; best to work with a dietitian.
• Vegan ≠ automatically healthy: “Coca-Cola and peanut M&Ms, that’s vegan, but she wouldn’t recommend it as a staple.” (60:42)

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10. Dairy, Eggs, and Fat

[61:23–63:09]

• Full-Fat Dairy: Mixed evidence on risk, but higher in calories and saturated fat. For managing overall calories and heart health, low-fat is often recommended.
• Egg Yolks: Are fine for most, and a good source of choline.
  • “Egg yolks are absolutely fine unless… the price of eggs, is this crazy?” (62:44)

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11. Intermittent Fasting & Meal Timing

[63:21–67:07]

• Time of Eating: Evidence that metabolism is more robust earlier in the day; calories earlier > late-night eating.
• Fasting Cautions: “When you limit eating episodes, you’re limiting the food you eat and therefore the nutrients you can get.” (66:18)
• Skipping Breakfast: Often counterproductive; promotes unhealthy eating patterns.

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12. Non-Nutritive Sweeteners (Diet Sodas)

[67:09–69:39]

• Safety: Generally safe and preferred over sugar-sweetened beverages for prevention of diabetes and obesity.
• Microbiome Concerns: “Microbiome is a whole other episode,” but a poor underlying diet will affect it more than moderate non-nutritive sweetener use.

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Memorable Quotes & Moments

• On Nutrition Science:

  “Nutrition is a science, not an opinion.” – Dr. Joan Salge Blake (05:26)

• On Fad Diets:

  “Nothing is new… Dr. Atkins… very low carbohydrates, high protein, high fat. It’s like fashion, bell bottoms were in the 70s, bell bottoms are now back.” – Dr. Joan Salge Blake (11:32)

• Fiber Magic:

  “Poop is good…. So the soluble fiber latches onto the bile acids and dietary cholesterol and takes it with it in your stool… and it lowers your cholesterol. Is this the best movie you have ever heard?” – Dr. Joan Salge Blake (25:31)

• On Processed Foods:

  “Not all processed foods are unhealthy… canned beans, fabulous. Baby carrots, fabulous. We can’t throw everybody under the bus.” – Dr. Joan Salge Blake (31:59)

• On Carnivore Diet:

  “We have documented cases of people on the carnivore diet that got scurvy. Who the heck gets scurvy?” – Dr. Joan Salge Blake (35:36)

• On Protein Hype:

  “If I see toothpaste being fortified with protein, I am gonna just throw in my hat in the ring. Okay? I can’t stand it anymore.” – Dr. Joan Salge Blake (52:01)

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Timestamps of Important Segments

• [05:26] Nutrition as Science, Not Opinion
• [06:01] Misinformation vs. Disinformation in Nutrition
• [07:22] Defining Keto, Risks, and Scientific Perspective
• [12:30] Research Supporting Mediterranean Diet
• [21:23] Patient Monitoring on Keto/Low Carb Diets
• [22:13] “Fiber Maxing,” Types & Benefits of Fiber
• [28:34] Seed Oils, Saturated Fat & Processed Foods
• [35:36] Carnivore Diet & Risk of Scurvy
• [43:01] The Science of Food Order & Glucose Spikes
• [49:55] Appropriate Protein Targets & Dietary Sources
• [58:46] How to Safely Do Vegetarian/Vegan Diets
• [61:23] Full-Fat vs. Low-Fat Dairy, Egg Yolks
• [63:21] Intermittent Fasting, Timing of Meals
• [67:09] Diet Sodas, Sweeteners, and Microbiome

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Final Takeaways from Dr. Joan Salge Blake ([72:22])

• “Nutrition is a science. It’s not an opinion.”
• Mainstream, plant-forward, balanced diets like Mediterranean and DASH are the healthiest, best-proven overall dietary patterns.
• Avoid extreme, restrictive fad diets; involve a registered dietitian for personalized needs.
• Don’t fear healthy processed foods or non-nutritive sweeteners; focus on overall diet quality.
• Stay critical of trends/celebrity claims—rely on expert, evidence-based guidance.

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Resources

• Find a registered dietitian: eatright.org
• Dr. Salge Blake’s podcast: Spoton (available on all major platforms)

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Summary prepared for listeners who want a high-yield, evidence-based tour of real-world nutrition controversies, practical counseling, and myth-busting—delivered with warmth and humor.

Transcript

[Dr. Matthew Frank Watto]

Hey, before we get to the show, I wanted to remind you to check out our [e-mail] curbsiders. If you haven't signed up yet, sign up now to get ad free episodes, twice monthly, bonus episodes, and a whole bunch of other cool [e-mail] curbsiders Paul, I want to just apologize to you in the audience up front for what I'm about to do.

[Dr. Paul Nelson Williams]

I'm stoked. All right.

[Dr. Matthew Frank Watto]

Why was the dietician kicked out of the casino?

[Dr. Paul Nelson Williams]

I'm not. I'm not gonna get it.

[Dr. Matthew Frank Watto]

She was counting carbs.

[Dr. Joan Salgi Blake]

Shoot.

[Dr. Paul Nelson Williams]

I knew it was cards, too. Have we. So we talked about scurvy in this episode. Matt, have I done my. I feel like I've done the pirate joke before, but I'll do it one more time just in case I have.

[Dr. Matthew Frank Watto]

Yeah, let's do it.

[Dr. Paul Nelson Williams]

What is a pirate's favorite letter?

[Dr. Matthew Frank Watto]

I'm gonna let you say it.

[Dr. Paul Nelson Williams]

Paul.

[Dr. Matthew Frank Watto]

I don't know. Paul, what is it?

[Dr. Paul Nelson Williams]

Oh, no, go ahead and guess.

[Dr. Matthew Frank Watto]

Is it R?

[Dr. Paul Nelson Williams]

You'd think it'd be R, but it'd be the C that he loves. So thank you for setting me up. The Curbsiders podcast is for entertainment, education and information purposes only, and the topics discussed should not be used solely diagnosed, treat, cure or prevent any diseases or conditions. Furthermore, the views and statements expressed on this podcast are solely those of hosts and should not be interpreted to reflect official policy or position of any entity aside from possibly cash, like more hospital and affiliate outreach programs, if indeed there are any. In fact, there are none. Pretty much. We aren't responsible if you screw up. You should always do your own homework and let us know when we're wrong.

[Dr. Matthew Frank Watto]

Welcome back to the curbsiders. I'm Dr. Matthew Frank Watto, here with my great friend, amateur film critic and America's primary care physician, Dr. Paul Nelson Williams. Hey, Paul.

[Dr. Paul Nelson Williams]

Drowning in shame after my joke, but. Hey, Matt, how are you?

[Dr. Matthew Frank Watto]

I'm doing well, Paul. This was a real treat for me, this one because I graduated from Boston University twice, I guess you could say, but I was in Sargent College of Health and Rehabil. And our guest, Dr. Joan Salgi Blake, is a professor of nutrition there and she is a delight. And we are talking about nutrition. It's been a long time since we did a nutrition episode. We talk a lot about, like, you know, we asked her a lot of questions about, like, the popular stuff that's out there, some of the misinformation that's out there. It's a really great episode, so I think people are going to enjoy it. But Paul, tell people, what is it that we do on Curbsiders? Why are we here?

[Dr. Paul Nelson Williams]

Yeah, I wonder if we were getting there. But Matt, we are the internal medicine podc. We use expert interviews to bring you clinical pearls and practice changing knowledge. As you mentioned tonight, we talked to Dr. Joan Salgi Blake, who is a clinical professor at the programs nutrition at Sargent College of Health and Rehabilitation Services. As you mentioned, she earned her bachelor's in food nutrition at Montclair State University, her master's in clinical nutrition at Boston University, did a dietetic internship at the New England Deaconess Hospital, and got her a doctor's education at Boston University School of Education. Tonight, we learned just a lot of her recommendations on how she talks to patients about the various diets that are out there. So we talked about the Keto diet and the Paleo diet and how to talk people through vegetarian and veganism and sort of kind of all the big hits and of course, all my TikTok obsessions as well. I should also mention that Dr. Sajalji Blake has her very own podcast that I think Nat listened to a bunch of episodes for and found it very helpful for this. It's called Spoton, which can be found on all platforms. So without further ado, why don't we get to it?

[Dr. Matthew Frank Watto]

And a reminder that this and most episodes are available for CME credit through VCU healtherbsiders.vcuhealth.org you can also sign up to receive CME through [e-mail] curbsiders okay, Joan, well, I'm really excited to have you here. As I told you, I've been listening to a lot of your podcast episodes, so I want the audience to do that as well. The Spoton podcast. And. But they want to know, and I want to know what are you doing outside of medicine? Like, what are your hobbies or interests right now that you're really enjoying?

[Dr. Joan Salgi Blake]

Right. So outside of nutrition and medicine, how I relax, enjoy myself is I shop. Based on my accent, you're going to realize I'm from New Jersey. And in New Jersey, shopping is like an Olympic sport. So, I mean, I could calculate 20% off before I could speak English. So that's how I relax.

[Dr. Matthew Frank Watto]

That is fantastic.

[Dr. Paul Nelson Williams]

So as a native New Jersey, and I'm going to follow up here, have you transitioned fully to online shopping? Are you still going to physical locations? I know the mall was a part of my childhood. I don't know. So, like, what does your shopping look like these days? How has this evolved over time?

[Dr. Joan Salgi Blake]

Paul, we need to go and touch. We can't. I mean, I do online.

[Dr. Paul Nelson Williams]

This is what I was hoping you'd say. I love this.

[Dr. Joan Salgi Blake]

Yeah, I do online for detergent. Okay, sure. Paul, we need to touch. And I want to tell you something. I. In my town where I live in, there's a TJ Maxx.

[Dr. Paul Nelson Williams]

Oh, sure.

[Dr. Joan Salgi Blake]

And when I die, my ashes are gonna be spread over TJ Maxx because it is ridiculous. Okay.

[Dr. Matthew Frank Watto]

It's like cheers for you. You walk in, they're like, joan, that's exactly.

[Dr. Joan Salgi Blake]

That's like, come new sale.

[Dr. Matthew Frank Watto]

Okay. And then I go, all right, Paul, was that your question or do you wanna. Do you have any other questions?

[Dr. Paul Nelson Williams]

I guess I can ask my typ advice or feedback that you like to give your learners that you've accumulated over time?

[Dr. Joan Salgi Blake]

Yes. My favorite is nutrition is a science and not an opinion.

[Dr. Matthew Frank Watto]

Yeah, I think we get a lot of opinions that might be part of the problem with nutrition at this point.

[Dr. Joan Salgi Blake]

This is called job security for me, Matt, because everybody has an opinion because they all eat. But nutrition is a science as medicine is a science. And so we have to make sure what's out there is accurate and correct the misinformation and more importantly, correct the disinformation, which is challenging.

[Dr. Matthew Frank Watto]

Yeah. So the misinformation is people just saying things that are wrong just because they're not informed. And disinformation is where people are like, almost on purpose, like trying to muddy the waters, Matt.

[Dr. Joan Salgi Blake]

The difference is intent. So let me give you an example of this. Okay? So misinformation would be an apple. Good source of protein. Now we all know that that's misinformation. Disinformation would be, don't eat apples from ABC Orchard because they're gonna give you cancer. That's intent.

[Dr. Matthew Frank Watto]

Yeah. All right, well, let's. We're gonna set the record straight on a lot of things here. Paul, would you read the first case and then let's get into this discussion here. I'm excited for this.

[Dr. Paul Nelson Williams]

Yeah, some great names in these cases too. So I just wanna call these out as we go. So we're gonna start with Breeze. Bri is a 50 year old female. She has type 2 diabetes, high blood pressure, high cholesterol. She comes to our primary care office with her husband Kobe to talk about her diet. She has been doing some reading online and she'd like your opinion on the possible benefits of a low carbohydrate, ketogenic and low fat diets. Because of her diabetes and high cholesterol. She says she doesn't really understand what a keto diet is. So she is seeking our expertise and Joan, yours in particular. So we always like to start sort of simple and then kind of get granular. So just starting broadly, how would you explain to Joan what a ketogenic diet is and how carbohydrates and fat play a role as part of it?

[Dr. Joan Salgi Blake]

Okay. First thing, I want to tell you as medical physicians that when they walk into your office and they need nutrition advice, let's hope you have a registered dietitian nutritionist on staff to give you science based information. That is spot on. That is really, really important because I know Matt and I know Paul, you studied hard through, through medical school, I know you did. But your amount of nutrition that you probably got in medical school was okay. So let's go with someone who has been trained to give you the latest science and that's a registered dietitian nutritionist. Okay. Keto diet. Oh, my goodness gracious. The keto diet is a high fat, very low carbohydrate nutrition pattern that is was designed originally to help people with epilepsy and has done quite well. But I want to tell you, to stay in keto, to stay adhere to that diet is extremely challenging. We're talking about, you know, 55 to 60% of your calories coming from fat, 30 to 35 from protein and little bit from carbohydrates. Well, that's really hard to adhere to and still have a healthy diet. Okay, so you're gonna, you know, again, someone that has epilepsy, they can work with a dietitian to get that done. But for the Joe and Josephine on the street, it's not the best diet for someone who has high cholesterol. Think about that. If you're having that much fat and you're having that much protein, the saturated fat, the heart, healthy, unsaturated fat is probably going to be very high the diet, and that's not good. We know a diet high in saturated fat will increase that bad LDL cholesterol. So we don't want to do that. And also it's going to be very high in dietary cholesterol. What we want to be looking at is more of a diet that is rich in plant. It's more plant forward. Okay. I love plant forward because more fruits, more vegetables will hold great, great lean protein sources, healthy oils and some lean dairy. And that's what you're gonna want best for trying to get your cholesterol down and get your blood pressure down.

[Dr. Matthew Frank Watto]

Yeah. You mentioned heart unhealthy saturated fat. I think part of what's out there now is people think fat doesn't matter, cholesterol doesn't matter. And it seems to be the overwhelming amount of evidence is that it does matter. And most doctors believe that. But there are a couple people kind of on the fringes. And I think what makes the keto diet so sexy is the visual results. The weight loss can happen so rapidly. And, you know, if people do have diabetes because they're eating so low carb, the blood sugar, the blood pressure, that sort of thing gets fixed. But I think the adherence thing, like you said, is a problem. And I'm still worried about the long term, like what's gonna happen, especially for people whose LDL shoots through the roof when they're on these diets.

[Dr. Joan Salgi Blake]

Right. Okay, so let's do. You can do any crazy diet for short term, but we're looking for the long term. Anytime that you eliminate food groups, grains, whatever, you're going to lose weight because you're just eating less variety of foods. The weight loss will be great initially, but what are we doing long term? And you know something? It's not just about getting a heart healthy diet to reduce your risk of hyperlipidemia or high cholesterol. I'm talking longevity here. Okay? So let's look at a diet that is going to help you to lower your cholesterol and give you the right kind of carbohydrates. That's going to help you to live a long and beautiful life. And that's what we want to do. These fad diets. Nothing is new. You're probably not old enough. But you remember Dr. Atkins?

[Dr. Matthew Frank Watto]

Yes, actually. Yeah.

[Dr. Joan Salgi Blake]

Okay. Okay. Oh, so now you're really older than I thought you were. Okay, fine. Okay, so this Dr. Atkins was the same thing. Very low carbohydrates, you know, high protein, high fat. This is nothing new. It's like fashion bell bottoms were in the 70s. Bell bottoms are not back in vogue here. Okay, so this stuff, all same stuff that gets recycled. What we know from research, which is unbelievable, is that a diet that is more high in fiber, Fruits and vegetables, special type of fiber, soluble fiber, which is oats and beans and citrus fruits, as well as lean proteins, a lot of fish, healthy oils such as olive oil and small amounts of lean meat is good for you. And my goodness, I think we should just go sail to the Mediterranean.

[Dr. Matthew Frank Watto]

Hey, I'm down. I've been there before and it's lovely. Paul, did you. Have you been to the Mediterranean yet?

[Dr. Paul Nelson Williams]

No, not yet. Not yet on my list.

[Dr. Matthew Frank Watto]

All the more reason, Paul.

[Dr. Joan Salgi Blake]

Okay, we're gonna talk because at Boston University, I teach a course in Italy every June. Okay, Paul, you're coming. Okay? You're coming. Paul, I'm a tough grader, so I'm not gonna go easy with you, but I te.

[Dr. Paul Nelson Williams]

I'm a type a lunatic. It's going to be fine. This is going to work out great.

[Dr. Joan Salgi Blake]

And then shopping in Italy. Hello. Okay, so what we do is we bring BU students and actually and students outside of Boston University to go there and really immerse themselves in the Mediterranean diet and lifestyle. So Paul and Matt, it's a lifestyle and so they get and they understand this and it's healthy and people walk. It's a whole unbelievable life changing experience. So when see these kind of like keto diets as so extreme, when I know the science for the Mediterranean is so strong that you're eating a healthy diet with a lot of fruits and vegetables and grains, mostly whole grains, and really being able to lower your risk for heart disease. And guess what? We know that fruits and vegetables can help lower high blood pressure. Look at the DASH diet. We know DASH diet was dietary approaches to stop hypertension. And again, rich in fruits and vegetables, rich in whole grains, some fish, a lot of nuts and beans. So we know that this pattern is healthy for your heart, healthy for your high blood pressure. So the question is, why are we going to the extreme of a keto diet, which is unbelievably challenging to follow?

[Dr. Paul Nelson Williams]

So let's. So I'm not going to be as compelling or convincing as you. So a patient comes to see me, they're excited about the keto diet. They've seen it work well with their friends. We're all about harm reduction here. Is this someone for whom you would think about, like having a conversation about fiber supplementation? Like, if you're going to do it, like would. Is there concern for micronutrient deficiencies? Is there anything that you would sort of advise for someone who does pursue this diet, even sort of against your recommendations, is there a way we can sort of minimize the harms of it?

[Dr. Joan Salgi Blake]

Right. It is so strict and so limiting that unless you're working with a registered dietitian nutritionist, there is bound to be lapses in vitamins and minerals. I'm just telling you this right now. So this is not something that Joe and Josephine on the street should just go and read about and try to do. This is something that needs to be tailored if your medical history warrants it. But not to lose weight, not to lower your cholesterol. You don't go to this extreme to do that. So if you are going to follow this, you have to say as a physician, I okay if you want to follow this, what your goals are, but let me hook you up with a registered dietitian that let's figure out if a this is the best diet for you based upon the medicines you're taking and your history. And if you still want to do it, then you get the best guidance to do it as healthfully as possible. But I'm going to tell you a true keto diet is unbelievably challenging to follow.

[Dr. Paul Nelson Williams]

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[Dr. Matthew Frank Watto]

I wanted to ask, among dietitians, outside of treating kids with epilepsy or people with epilepsy, is there the same controversy that it seems to exist just among the general public that do some dietitians think fats are good or carnivore diet is good? Everyone should be on that, but I haven't met that person yet. But I'm just asking if there's controversy in the field or do most people more or less agree with what you're saying, which is what most doctors also kind of believe, like Mediterranean DASH eat a lot of healthy whole foods. What do you think?

[Dr. Joan Salgi Blake]

Okay, so what we know is, and I think what's coming out right now, Matt, that's a great question. We have something coming out from the NIH called personalized nutrition or precision nutrition. These studies are coming out and what we know is that nutrition, just like medicine, is very individualized. Okay. And we're gonna find out more as life goes on here that you may be a person that may want to tailor your carbohydrates or increase your healthy fats away. Okay, so it's gonna what's coming down the pike here is personalization and that's when you need to meet with a registered dietitian nutritionist. What we know now is based on through long term studies that know on a population basis that the DASH diet lowers high blood pressure. The Mediterranean diet will help with heart health. There's going to be tweaks coming down there. So as this research evolves, you may get tweaking, but the big science that we have based upon is that a more balanced diet that is plant forward, low in saturated fat, high in fiber, we can get into the types of fiber in a minute and some fish going out there and healthy oils and lean dairy, man, the science is pretty strong for that.

[Dr. Matthew Frank Watto]

I like what you said there. So how I would counsel our listeners, and this is what I do if someone wants to try or follow a diet, because there is something called a lean mass hyper responder to these high fat diets, like, like carnivore keto, where their lipids go, like through the roof. I'm talking total cholesterol, 500, 600 LDL in the 200s, 3 hundreds. With those, I just tell people that could happen. If you're gonna try to follow this keto diet, 20 to 50 grams of carbs or less per day, we're really gonna have to follow all your markers closely. How do you feel? How do your labs and blood work look? And if there's any problems, and we'll see if it works for you. And then I just tell them the uncertainty about what it's doing to your arteries, if it's raising your cholesterol. So that's kind of where I'm at right now. And I like what you said about personalized medicine. Maybe we'll get more sophisticated on the individual level going forward.

[Dr. Joan Salgi Blake]

I love what you just said, Matt, because this is a team approach where you got a dietitian, you got a doctor, you got a patient, and we want the patient to be happy and help them meet their medical goals. But somebody's got to be watching this. So. And I love the fact you say, okay, if you want to do this, let me tell you, pros, cons, blah, blah, blah. But we're going to monitor this. And if we see something like these ldl, bad cholesterol shoots up, we got to make a change. I mean, we can't keep doing this. So I think that's the problem. The problem, Matt, is that people go off and do these things without you.

[Dr. Matthew Frank Watto]

Right, Yeah, I get it. Well, you mentioned you were going to talk about fiber now, Paul, have you ever heard of the term fiber maxing? I know Joan has because I learned it from her show.

[Dr. Paul Nelson Williams]

I have not.

[Dr. Matthew Frank Watto]

Can you guess what fiber maxing is, Paul? I know you're online, Paul, so you can guess what it is.

[Dr. Paul Nelson Williams]

I'm shocked that I've not actually come across it yet. But of all the maxing, it's probably the healthiest of them. But I would love to hear more. At least when I hitting her face with hammers. This still seems like probably an improvement over looks. Maxing set.

[Dr. Joan Salgi Blake]

So fiber maxing. Okay. You know, it's funny. We have been trying forever to get people to eat more fiber in the diet. And now through social media and TikTok, now we have fiber maxing. And we're like, oh, this is great. That fiber's in the limelight. But wait a minute, it's not that much that quickly. This is cooking dynamite, you know? Okay, so let's rewind here. So fiber, believe it or not, is a nutrient that is actually pretty much not absorbed by the body because you don't have the enzyme to break it down. So what fiber does is like a broom, okay? It's like a broom that sweeps through your GI tract to keep things moving. So it helps with constipation. It's not a sexy problem, but it is a big problem among Americans. Constipation. Of course, constipation can lead to diverticulitis, so in diverticulosis. And so what this fiber does is keep you actually regular and keep things moving. Now, there are certain types of fiber. There's insoluble fiber and soluble fiber. Insoluble is insoluble in water, and soluble is. Okay, so what the soluble fiber is, this is more of a gummy, viscous fiber. And you can find it in oats, you can find it in beans. You can find it in citrus fruits, apples and pears. So this type of fiber can help lower your blood cholesterol levels. But wait a minute, Paul, Matt, I just said you don't absorb it. So how would this. Think about this?

[Dr. Matthew Frank Watto]

I hope you're going to tell us.

[Dr. Joan Salgi Blake]

I love this. So how the heck does this fiber, who never gets absorbed? My jar doesn't get broken down. Lower your cholesterol. Okay, you ready?

[Dr. Matthew Frank Watto]

I'm ready.

[Dr. Joan Salgi Blake]

So the soluble fiber. What will happen is in the GI tract, you have bile acids that go off, that help you absorb and digest fat, Fat with a meal and also dietary cholesterol. Bile acids are full, have cholesterol as part of the bile acids. Typically, when you eat something fatty meal, your bile acids will help with the emulsification. So you can break down the fat and absorb it. But the body is very, very strategic. So they reabsorb the bile acids. Okay, what happens with soluble fiber? Ready? So the soluble fiber, the viscous fiber latches onto the bile acids and dietary cholesterol and takes it with it in your stool.

[Dr. Matthew Frank Watto]

How elegant.

[Dr. Joan Salgi Blake]

How elegant. Okay, that poop is good. Okay, so what happens is the bile acids don't get reabsorbed, and the liver says, what, what, what, what? I got to make bile acids. So the liver will take the Dietary cholesterol from the blood to make the new bile acids that they lost in the poop and make it. And it lowers your cholesterol. Is this the best movie you have ever heard?

[Dr. Matthew Frank Watto]

It's a good movement, I would say

[Dr. Joan Salgi Blake]

it's a good movement and movie

[Dr. Matthew Frank Watto]

and. Yes. And soluble fiber. Chia seeds, if people want to know what soluble fiber is. If you just put a chia seed in water, it'll like the gel kind of comes out of it. Kind of very good visual representation of that. Right.

[Dr. Joan Salgi Blake]

That's a whole nother trend on social media that we have to watch out for also. Do you want me to tell you that? Yeah, Chia seeds.

[Dr. Paul Nelson Williams]

I don't own an overnight oats, so yeah, please tell me if I'm doing something catastrophic.

[Dr. Matthew Frank Watto]

Okay.

[Dr. Joan Salgi Blake]

Because, Paul, overnight oats are beautiful. This is what's happening now. There's crazy things on chia seeds where people are consuming chia seeds dry. Right? Okay. Okay, Paul, you know where I'm going with this? Okay. And then taking fluid in and the chia seeds expands and can cause blockage like esophageal.

[Dr. Matthew Frank Watto]

Okay, is that fiber maxing?

[Dr. Joan Salgi Blake]

No, no, Matt. Bad mat. Okay, so that is not unhealthy. But with the fiber max and with adding more fiber in your diet, Americans are totally falling short of the amount of fiber in your diet. But you don't want to like all of a sudden add all this fiber to your diet because it could have social ramifications because it's not going to be absorbed. So when it gets down to the colon, your bacteria, it's still carbohydrates. Bacteria will say party time and start breaking that down and you'll have a lot of gases, side effects. So you want to go slow and steady when you're adding fiber. You want to make sure you have enough fluid. And also you need to move when you walk. Your GI tract moves. So you little don't. Fiber max. All craziness. You want to add a little at a time, maybe add some at breakfast, then see how you feel, then maybe breakfast, add a little lunch, and slowly add it onto your diet over the

[Dr. Matthew Frank Watto]

course of days to weeks. You mean.

[Dr. Joan Salgi Blake]

Yes. Is you feel comfortable doing this.

[Dr. Matthew Frank Watto]

Do you have number targets that are recommended for men and women? Are they different?

[Dr. Joan Salgi Blake]

Yeah. Yeah. So it's about 25 to 30 grams of fiber a day, and we're coming in about 14 to 16. I mean, we're pathetic. The reason, I'll tell you why, the reason being is that we're not eating enough whole Fruits and vegetables in our diet. We love our grains, but we're not having whole grains. So that's where the problem is.

[Dr. Matthew Frank Watto]

Okay, Paul, do we have another part to this case? Just to move ahead a little bit. I think we've covered a lot of really high yield stuff so far.

[Dr. Paul Nelson Williams]

But while we're. I do want to ask, since we're still in fat territory and I'm not sure we're gonna have a chance to go back there. I did want to says, as our resident TikTok apologist, I hear a lot of demonization of seed oils and sort of when you're talking about the good fats and the bad fats, I guess when a patient comes in, how do you talk about what is good, what is bad, and what is heart? Healthy and what is not?

[Dr. Joan Salgi Blake]

Great. Thank you. Okay. All vegetable oils other than one is very healthy. So I don't care if it's soybean oil or safflower oil or, you know, olive oil is not seed, but canola oil, whatever. The only plant based, let me just say. So these are high in unsaturated fat and low in saturated fat. So we want to be having them replacing saturated fat in your diet because we just said that saturated fat increases the LDL cholesterol. So we don't want to use beef tallow. No, no, no, no, no. We want to use vegetable oils. The only vegetable oil that is wicked high. Now, you know, I'm from Boston, so wicked high in saturated fat is coconut oil. Like, coconut oil is so high in saturated fat. So we want to add fat. Don't worry about that one. That's lovely. But don't have that in your diet to replace saturated fat because it's actually adding more saturated fat than butter and beef cattle. So stick with canola oil, olive oil, soybean oil, which is inexpensive and wonderful. So vegetable oils other than coconut oil is the name of the game.

[Dr. Matthew Frank Watto]

Yeah. And I listened to your episode about this, and one of the other things that you all talked about that I thought was interesting is like the heating of oils. If you're just using it one time you're cooking something, it's not a big deal. The studies where if it's a fryer at a restaurant and they're reusing the oil over and over and over again, then that's where potentially the harmful stuff might come out from you.

[Dr. Joan Salgi Blake]

That's right. But you're not doing that at home. You're stir frying and cleaning or the pans going in the dishwasher. And that's the end of that. So don't even worry about it.

[Dr. Matthew Frank Watto]

And the other thing I think that makes it, it's like the company it keeps type thing. Like, where are most people getting exposed to seed oils? Like, if they're not doing cooking at home, it's like they're getting it from processed foods. You know, they're not.

[Dr. Joan Salgi Blake]

Okay, so let's. Yeah, yeah, so let's go back to this. So again, whether it's processed foods have soybean oil or canola oil in it, that's not the problem in a lot of these processed foods. And let's also talk about that. Not all processed foods are in healthy. Okay, so when we get to the problem with ultra processed food, and there's no definition for that, and I just read today that the FDA is slowing bringing that out, but there's things going on in some of the processed foods. Okay, let's go through this. Okay. Baby carrots, they're processed fabulous. Okay, Beans in a can, fabulous, right? You didn't have to soak them. You drain them. Great soluble fiber. All right, now we get to soda. Processed, not exactly as healthy as beans. You see what I'm saying here?

[Dr. Matthew Frank Watto]

I would say yes.

[Dr. Joan Salgi Blake]

So we have. In this ultra processed category, we have some really healthy foods and then not so healthy. So your sweetened beverages and your sweets and your treats, obviously you know that. But canned beans, because they're processed, fabulous. So what has happened is people have said that everything that's processed is unhealthy, and that's not true because there's a lot of processed food that make your life easier and healthier. And baby carrots, they've been processed, cut down for you. I'd like to have that available to me so I can have it with hummus. You know something? I don't feel like peeling a big carrot. Okay, you don't peel a big carrot. All right, so that's a processed food that's quite healthy. So we can't throw everybody under the bus.

[Dr. Matthew Frank Watto]

And you don't want to make your own hummus, Joan, right?

[Dr. Joan Salgi Blake]

No, I don't have time for my own hummus. I have to go to T.J. maxx. Okay,

[Dr. Matthew Frank Watto]

Paul, what else do we need to talk about here? Or does that satisfy your seed oil question?

[Dr. Paul Nelson Williams]

It does. Yeah. I will say my beloved impossible whopper. Just apropos of this part of the way is it is so delicious is liberal use of coconut oil. So it's. That's one of the things that makes it plant based. So it's loaded with calories and still not substantially healthier. And Joan, you'll correct me if I'm wrong than the regular old whopper. So it's, it's wonderful, it's plant based, but it's also apropos of our processed and bad conversation, probably not the best for you.

[Dr. Joan Salgi Blake]

You know, Paul, that's so. I'm so glad you brought that up because they'll say something like it's plant based. And then they throw on the coconut oil. And then if you did a comparison, you're like, wait a minute. Now here's some good news. Any restaurant that has over 20 facilities in a chain that nutrition information has to be up on their website. So the burger kings, the McDonald's, I mean, anything, you know, kava, sweet greens, whatever, all that nutrition information has to be up on the website. So it would be to your advantage, based upon your medical history, to go before you go and order it. Let me just shop online. You talk about shopping online, Paul, and see what, what is a better choice before I go to that restaurant. And some of them that look sound healthy may not be.

[Dr. Matthew Frank Watto]

So let's move on to our. I think we have a husband for Bri, right? Kobe.

[Dr. Paul Nelson Williams]

We do, yeah. Kobe. So stellar name. So Bri's husband, Kobe is also curious about your thoughts on the paleo and carnivore diets, as some friends from his gym swear by them. So I've not. The paleo diet, I've always been kind of foggy on, but for our audience and for me. Could you describe or define what is a paleo diet? What is a carnivore diet? What does this mean to pa?

[Dr. Joan Salgi Blake]

Sure. So the paleo diet is, you know, this is. They're basing on the eating habits of people gazillion years ago and you know, what was available. So what was available? You weren't going to get breakfast cereals gazillion years ago or whole wheat bread. So basically it was every you could find. So we're talking about plant based, you know, fruits or vegetables and protein sources. Okay. The carnivore diet is sort of taking that from that. And the carnivore diet is really strict where it's only animal products ready for this, animal products and some dairy products with it. So animal products and some dairy products. Do you know that we have documented cases of people on the carnivore diet that got scurvy?

[Dr. Paul Nelson Williams]

Oh, I believe it.

[Dr. Matthew Frank Watto]

I believe it too.

[Dr. Joan Salgi Blake]

Yeah. Okay. So just so I can explain scurvy to the audience here, scurvy is a disease, a deficiency of vitamin C. I mean, who the heck gets scurvy? All you need to minimize scurvy. If you took a shot glass, a half a shot glass of orange juice, you would get enough vitamin C, which is 10 milligrams, to prevent scurvy. I mean, that's all it's taken. So these people are totally not eating any fruits or vegetables, are getting scurvy. So this is the craziest thing in the whole wide world. And again, long term health knock there.

[Dr. Matthew Frank Watto]

I thought it was a joke when I first heard about it. And to have some empathy for people searching out a carnivore diet for various reasons. I know some people just want to do it because they can have abs and it's just easy to control your calories in a way because there's so few food choices. You're not overeating steak or whatever. But I think some people have food allergies or intolerance. And of course, when you cut out like 99% of foods, you're just by dumb luck going to hit the one that might have been causing you problems. But I think our good friend Paul, I don't know if you remember Dr. Iris Wang, she's a GI doctor. And even talking about FODMAP, which is like an evidence based IBS thing that you can temporarily do, she's like, the reason it's temporary is because you don't want to start to select for narrower and narrower gut bacteria. And this is kind of like what you were saying with fiber, Joan, where you have to ramp up your fiber intake. If you're only at 10 grams now and you want to get to 30, you have to slowly go up because your bacteria, your fiber have to change. And I think people can maybe change for the worse if they go to this carnivore diet. But I understand some of the reasons why people are doing it. I wish they wouldn't.

[Dr. Joan Salgi Blake]

Right. Whenever you eliminate food groups, okay, so you need carbohydrates, protein, fat and vitamins and minerals and of course water to survive. Okay. Whenever you eliminate food groups like fruits and vegetables, you're not gonna get vitamin C when just eating the protein group, okay? Okay. You're not, you're not gonna get it. It's not there. Okay? You're not gonna get fiber. So whenever you start doing that, of course you will probably lose weight because you're restricting calories, because you're not eating certain foods. But again, we're talking long term health here. And you need all those vitamins and minerals and nutrients. And if you're not gonna eat em, I don't know what's gonna happen here. I'm sorry. I do know what's gonna happen.

[Dr. Matthew Frank Watto]

Well, the liver king, I mean, at least he was exposed as a scammer with his. He was taking like $10,000 worth of testosterone and growth hormone a month or whatever. Not just eating liver like he. And. And at bull testicles or whatever he claimed he was eating. Okay, well, the Paleo one, to me seems. It seems like it would be hard to follow because you're really not allowed to have even whole grains, which I believe are okay to have, but I think otherwise. Do you have any issues with that? It doesn't sound like there's any major, major gaps, nutrient wise.

[Dr. Joan Salgi Blake]

No, there is. I mean, if you're just going to have vegetables and protein sources. Okay, so you may end up having a lot of protein sources and depending upon what it is, be higher in saturated fat and cholesterol. You're not going to get vitamins. Fruits of this will give you vitamins. But where's the fiber? I mean, you got fiber from that. But where's the whole grains? There's a lot of B vitamins in the whole grains. And where's the dairy? Where's my vitamin D and calcium? Hello.

[Dr. Matthew Frank Watto]

Oh, so they don't do dairy and they don't do, like, nuts and seeds.

[Dr. Joan Salgi Blake]

Whatever you've been. And it's out in the field. Whatever you can find. You know what I mean?

[Dr. Matthew Frank Watto]

Okay.

[Dr. Paul Nelson Williams]

Odd. I don't.

[Dr. Joan Salgi Blake]

Yeah.

[Dr. Paul Nelson Williams]

I just can't.

[Dr. Joan Salgi Blake]

Paul, I also want to tell you that they. In that Paleo era, they lived about 37, you know. I'm going beyond 37. Honey, I am going beyond 37.

[Dr. Matthew Frank Watto]

I'm already beyond 37. And I would like to keep going, too, Joan. So I'm with you, Matt.

[Dr. Paul Nelson Williams]

Do you know this?

[Dr. Matthew Frank Watto]

Maybe I'll even come on a TJ Maxx trip with you. Joan. I don't know. Actually, the Italy. The nutrition course in Italy. That's where we should all be going. Forget T.J. maxx.

[Dr. Paul Nelson Williams]

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[Dr. Matthew Frank Watto]

I didn't know that.

[Dr. Paul Nelson Williams]

And then ascorbic acid is literally derived from meaning without acid. Like that is the word derivation. So a being without an ascorbic without scurvy. So vitamin C. That's how it actually got its name.

[Dr. Matthew Frank Watto]

Well, okay, so Bri wants to know what a balance diet may look like, especially one that still includes meat, because Kobe loves that. So we're going to talk to her about a balanced dietary pattern. But Joan, I want you to talk about the food order thing Which I heard about also on your podcast. Is that like, are lots of people following that or is that still kind of earlier science where it's interesting, but we need to look into it more.

[Dr. Joan Salgi Blake]

This is fascinating. This is absolutely fascinating. So she's been doing this, this researcher I had on, she's been doing this for over 10 years. And it makes sense. This is what we know, that protein increases your satiety. So you want to have protein at every meal. Okay. So you also want to have fruits and vegetables at every meal. Why? Because. Or mostly vegetables at lunch and dinner. Why? Because vegetables are full of fiber and water. So they're going to fill you up up before they fill you out. So we know from research from Penn State that a. This is with Barbara Rolls is that having a salad, a lot of vegetables, lower fat dressing prior to a meal can reduce the calories at the meal by about 10%. That's pretty good. Okay, so by having a food order of vegetables first and then protein, right? It's gonna fill you up. Protein gonna give that satiety. So it may help you to reduce the calories at the meal. I wouldn't say eliminate the whole grains, but I think this order is very, very interesting. We also know now that when it comes to protein, you wanna have protein spread out throughout the day. This is not how a lot of us have been raised. You know, we had a little breakfast, maybe a lunch, whatever, and then we bank all our protein later on at night. We're eating in like a half a rotiss. So what we wanna do is spread out that protein that we have, some at breakfast, some at lunch and some at dinner and spread out the vegetables throughout the meal and the fruits. So we want that combo because if you wait until dinner to get the recommended two and a half cups of vegetables and not have any during the day, you're not gonna meet it. So let's spread it out. So this whole food order and this combo diet is pretty, pretty. And she's been doing research on this. And I hope people go to my Spoton podcast to listen to this episode. It's really, really fascinating. But it's a combination of, you know, using a combination of food to help smart outsmart your stomach.

[Dr. Matthew Frank Watto]

The other thing that I would link to the food order thing that you talked about on the show was the like on TikTok, now we have these people with continuous glucose monitor eating things and seeing what it does to their sugar. And food order there can also affect, like how high, like if you eat the. You said on your show, your researcher said, like vegetables, protein. If you're having that first and then you eat the potatoes at the end of the meal, your sugar goes up less than. And they gave. They. Paul. They like randomized people. Like it was like a crossover thing. Like the same people ate the same meal like two weeks apart, but they ate the starch first in one meal and then they had to start to the very end at the other meal. And there was a pretty drastic difference in the blood sugar spike. So I think it's at least worth. If you have diabetes and you check your finger stick or you wear a cgm, I think it's at least worth trying it out on yourself to see how much of a difference it makes.

[Dr. Joan Salgi Blake]

Okay, let's look at what's going on with that. So when you have, you have an empty stomach, okay, so you had lunch and let's make believe you didn't eat anything all day long. And now it's dinner. Okay, so now what are we talking? Six, seven hours? Right? So we got an empty stomach on there. So if you have bread first, right. And there's nothing in the stomach, that bread is going to be starting to get broken down in the mouth and in the stomach and then go and leave the stomach early because there's nothing in the stomach, and then get absorbed in the small intestine. But if you go first with vegetables and protein source and then now the stomach's full. Okay, so now that bread is not going to be quickly leave the stomach to go to the, the small intestine to be absorbed. So, you know, it's an order. And how soon it leaves your stomach and goes into the small intestine and spike your blood glucose levels.

[Dr. Matthew Frank Watto]

Yeah, and I think it's worth looking into because some of the, you know, people are just getting like, in the past they were just getting thrown onto meds so much earlier, but now we're learning that even just, you know, walking after meals can help control the blood sugar and this food order thing. And I think continuous glucose monitors are one of the ways that. I don't know. Paul, do you think you watch a lot more of these continuous glucose monitor people? Like, I ate this, here's what my sugar did. Do you think they're on balance doing more like doing harm or that they're actually giving some valuable info to people?

[Dr. Paul Nelson Williams]

Paul, it never seems terribly helpful to me. Like, it always just seems sort of alarmist. And I ate and my blood sugars went up. And what do you think about that? Which is not that has fallen off my algorithm as I just sort of scrolled faster and faster when I see it come up. So I'm not sure what the current rhetoric is, but it has never seemed terribly useful. Useful to me.

[Dr. Matthew Frank Watto]

I feel like if I was doing that, I could give some valuable information if I was talking people through it. But it's.

[Dr. Paul Nelson Williams]

It's waiting for you, right?

[Dr. Joan Salgi Blake]

I mean, we know that, you know, there's a difference between jelly beans and green beans. So if you have jelly beans, you know, your blood sugars are going to spike up. And green beans. But, you know, people, you want to eat foods in a combination which is going to affect that level of glucose. So you're not eating isolated foods. So, you know, and these continuous glucose monitors are phenomenal for people with diabetes and pre diabetes, which is a whole nother episode, which is great. But for Joe and Joseph Fee on the street, I think. Do you have really this. Don't get crazy about this. You know what I mean?

[Dr. Matthew Frank Watto]

Oh, yeah, absolutely. That's a good caveat that we're talking about people with prediabetes diabetes that need to worry about that.

[Dr. Paul Nelson Williams]

And I think that's my larger concern is you have someone without any, you know, impaired glucose tolerance. Who. And what does a spike even mean to them? Like, it was 100. It spiked all the way to 108. Like, you're like, well, but. So I. Yeah, I don't. I think in the absence of knowledge, you have the chance to alarm people in a way that is not helpful. So I think that's my. That's my larger concern.

[Dr. Matthew Frank Watto]

This is why Paul is a great co host. He points out, like, you know, things that I miss. I love it.

[Dr. Joan Salgi Blake]

You know why Matt, he's grounded. He's totally grounded.

[Dr. Paul Nelson Williams]

I'm man of the people. I'm always there.

[Dr. Matthew Frank Watto]

Well, okay, so I think we've really. We've steered Bri and Kobe towards, like, more of a balanced Diet, Mediterranean or Dash, where they're getting. They're getting their 25 to 30 grams of fiber a day. They're spreading their protein out throughout the day. They're eating whole grains, beans, nuts, seeds. They're not freaking out about seed oils. What else did we cover? I think that's. Those are a lot of the high points. Right, Paul?

[Dr. Paul Nelson Williams]

Yeah. I do want to ask Joan about protein goals, which I think is also a hot topic too. So we're talking about spreading protein now, but is. I think I'm often asked, well, how much protein should I be eating? And it used to be like 0.8 to 1 gram per kilogram. And now it's, I think 7 grams per kilogram. I'm not sure what the current TikTok recommendation is, but it's seven.

[Dr. Matthew Frank Watto]

Yes.

[Dr. Paul Nelson Williams]

Yeah. So how, as a registered dietitian, how are you counseling patients? Recognizing it may vary depending on what your individual needs are. But in general, what should protein targets be for patients and how should they achieve them?

[Dr. Joan Salgi Blake]

Okay, we've gone crazy with protein for somehow, for some reason, we made it a halo nutrient. And really there are some categories of people that need more not getting enough. And those will fall in. Maybe people that have food insecurity, maybe older people who have issues with consuming enough calories. I do something in my class at Boston University because we do when we talk about protein and we talk about what the needs are, so I make them calculate, you know, based on their body weight. You know, what, how much protein do you need? And so if you're 150 pound woman and you're going, you know, if you're having a gram of protein, the what historically was, is 0.8. So this is even a little bit higher. We're talking 68 grams of protein a day. So they're wowed with that. Oh my gosh, how am I going to do that? Then what I do is make them go through a well balanced 1600 calorie diet. And a well balanced 1600 calorie diet will give you 80 grams of protein. Now, 1600 calories is a weight reducing diet, right?

[Dr. Paul Nelson Williams]

Okay.

[Dr. Joan Salgi Blake]

So if you're maintaining your weight, all right, and especially if you're a young adult, we're talking 25 more than 2,500 calories a day, you're meeting your protein needs. Unless you're doing broccoli and rice.

[Dr. Matthew Frank Watto]

Okay.

[Dr. Joan Salgi Blake]

And then, you know, but if you're eating a well balanced food, you're going to get this. So what has happened with protein? We have made protein, this halo food, and now we've kind of lost our way. And I'll tell you, Matt and Paul, if I see toothpaste being fortified with protein, I am gonna just throw in my hat in the ring. Okay? I can't stand it anymore.

[Dr. Matthew Frank Watto]

I think. Paul, did I send you the donut? Protein donuts, protein ice cream, like these kind of things.

[Dr. Paul Nelson Williams]

I'm very excited about the protein Pop Tarts, I'll be honest with you. Like, this seems like a great way to.

[Dr. Joan Salgi Blake]

Right? So this is what's happening. So people are just crazy about this. So what you want to remember with protein Is well balanced diet. Spread it out throughout the day. So make sure that you get that satiety feeling. We know that your, your muscle mass is. You're synthesizing muscle mass throughout the day. So we want protein to be throughout the day, don't bank it all at night. And we do not need to be going out and getting pop tarts or whatever donuts with protein when you can get enough from your diet. Now when you start going crazy with protein, there's just so much real estate on that plate. So if you're gonna do a side of beef or a rotisserie chicken on the plate, there's gonna be less room on the plate for other nutritious foods, which are the ve and the whole grains and the dairy. So let's not go cuckoo over there. I mean, this is absolutely gone crazy.

[Dr. Matthew Frank Watto]

Yeah, the research, it seems like everyone I've heard that knows about this field says like Americans might be getting like 1.2 grams per kilogram of protein, which is more than what the old RDA was, was 0.0.8. And then for people that are like bodybuilders or professional athletes who want to push it a little more, you know, they can do that. But I've seen like 1.2 to 1.6 grams per kilogram per day. But most people are getting it. I would say if people are on like vegan vegetarian diets and people come in and ask me about it, I say, well, let's get one of the apps that tracks your calories and we can see what your macros are over the course of the next week or two and see if it's really a problem. And then that can get just like objectively prove to, to people whether or not they're getting enough. These apps, if doctors Paul, have you ever used any of these apps for calorie tracking?

[Dr. Paul Nelson Williams]

Oh, sure, yeah, like that. I think Matt, my runner, my fitness pal, I think. Not that we're showing brand preference, but those both I think will count. Macros, if I'm not mistaken.

[Dr. Matthew Frank Watto]

Yeah.

[Dr. Joan Salgi Blake]

Matt, I wanna. Something you said was so spot on that these athletes need more. Of course they need more because they're athletic and they're doing things whether it's weight training or running or whatever. But guess what? Do you know how many calories they need to eat a day fuel that level of activity? So they're coming in like 3,000 calories a day. So the protein is gonna be there. So we don't need to be looking for fortified foods fortified with protein when we Know that if we just ate food, natural food from Mother Nature, we would meet our needs.

[Dr. Matthew Frank Watto]

Yeah, okay. Yeah, you're right. You said beforehand we might need to do two episodes. I can feel I'm resisting taking us down other la to say. You mentioned older adults. I have a lot of patients in their 70s, 80s, appetite starts to wane. Those people I do worry about. And then also I've heard that especially if these people have not been training for decades and decades and they're less active, their muscle might be less responsive, so they might even want to push it a little higher. Is that what you would tell people?

[Dr. Joan Salgi Blake]

Okay, so now we're going into the people that need it. Okay. So the people that may need it, we wanna prevent sarcopenia, okay, but we wanna prevent that later in older adults. This is the problem. Mother Nature is not nice. As you get older, your metabolism decreases, okay? You lose muscle mass and you don't need as many calories. So you need less calories as you get older. But you may need more protein and, and other nutrients. You need more calcium. So that's where you need to be making sure that your diet is very nutrient dense to meet those needs. So very important for older people to be spreading out that protein throughout the day, they need to also be doing weight resistant exercise and they need to meet with someone who is an expert in that so they don't do anything that's gonna harm themselves. So whether it's at the Y or a physical therapist is who I, you know, so that they are understanding to eat more healthy, spread out the protein, get a healthy diet, but do weight resistant exercise because that's gonna help you with increasing lean muscle mass.

[Dr. Matthew Frank Watto]

Yeah. Our recent guest, Dr. EkstromPaul, remember she told us that in retirement, people's full time job should be to stay active, do physical activity. She's a big fan of Tai chi and, and anyway, we're picking up what you're putting down. Our audience knows to. I think you can't give up on people when they have chronic illness or when they're getting older. Those people can do physical activity. It might be modified, but I think the scope of what we expect people to do gets narrower, like more and more narrow over time. And I think we're doing a disservice to people. So I really try to push, like Paul's gonna be one of these 80 year old marathon guys.

[Dr. Paul Nelson Williams]

That's what I'm saying. The early colorectal cancer doesn't get me first, but we'll see.

[Dr. Joan Salgi Blake]

You know, Matt, that's interesting because we have a tsunami of baby boomers and these baby boomers want to live longer and better than the generation before them. So they are very much attuned to what is going to get me to keep me out of the nursery nursing home. And so we know that 65 and over age group is increasing, but what was increasing is 85 and over. And we want to keep those people in their own homes. They can go shopping, do gardening and everything. So we want to make sure that their diet is healthy, that they're doing the type of exercise that doesn't cause injury and are maintaining a healthy and healthy happy lifestyle later in life.

[Dr. Paul Nelson Williams]

All right, Joan, we're coming up on our time here, but we have a million questions for you. But selfishly, I have a couple I want to ask about. So I'd like to hear your take on plant based diets. I know you like sort of a plant forward approach, but how. What is your spiel for patients who are vegetarians or vegans or. Yeah, so I'll stop there.

[Dr. Joan Salgi Blake]

Okay, so all healthy diets, Mediterranean diet, dash diet, it's all plant four. So a lot of plants, that's what makes them healthy. If you're going to be a vegetarian, that could be work wonderful for you, but you gotta be a healthy vegetarian. If you're going to have be a vegetarian and get rid of animal products other than dairy products. And your dairy products are full fat dairy, high in saturated fat that may a lot of cheese that may not be so healthy. If you're gonna go vegan where no animal products, then we gotta make sure that you're meeting your nutrient needs. So vitamin B12 is only found in animal products. So if you're not going to get animal products and a good source of B12, you got to make sure that you are consuming it elsewhere in the diet. So you got to look for foods that are fortified. Really probably need a vitamin supplement. Soy, which may be fortified B12, but you got to meet that knee. The other things you have to make sure, if you're not doing dairy, where's your vitamin D and where's your calcium coming in here? Okay. Very important for bone health throughout your whole life. So again, the soy, make sure that it's fortified with those nutrients. I always recommend that if you want to be a vegan, to sit down with a registered dietitian nutritionist to plan it out because I don't want you to miss out on nutrients because it can have long term effects. So, so you can be a Vegan. But you can be an unhealthy vegan if you're missing out on nutrients, right?

[Dr. Matthew Frank Watto]

Yeah. We had a guest who said a Coca Cola and peanut M&MS, that's vegan, but she wouldn't recommend it as a staple in your diet. You mentioned the full fat versus low fat dairy. Yes, I know low fat dairy. Of course, in the 90s, 2000s, when we were on the low fat, anything that's fat free is automatically amazing. Or low fat is amazing. Pump it with sugar, who cares? But the full fat dairy, I've seen some research that maybe people manage their weight better with full fat dairy. If people are just eating it one serving a week or a couple servings a week, is that a big deal? What do you think there?

[Dr. Joan Salgi Blake]

The full fat dairy research is mixed. Some show that it doesn't have a negative effect on your cholesterol or your weight. Okay, here's the story. Over 70% of Americans are overweight. 40% are in the obese category.

[Dr. Matthew Frank Watto]

Yeah.

[Dr. Joan Salgi Blake]

Okay. So calories count. Okay, I gotcha. Yeah. So if you're gonna have whole milk at 150 calories, all right, and it's gonna have 8 grams of saturated fat, and skim milk is gonna be 80 calories. So I cut it almost in half. No saturated fat fat, but the calcium and the vitamin D is the same. So here I go shopping again. I get the same calcium and vitamin D at less calories. This is like a sale at cheap TJ Maxx for me. Okay, so that's an issue. So, you know, if you want to have whole fat dairy, that's fine. You just want to keep your saturated fat to less than 10% of the total calories. But if you have full fat dairy, dairy, and fatty meats and butter, it's gonna be hard to meet that goal.

[Dr. Matthew Frank Watto]

All right, again, resisting food pyramid talk. I can't believe egg yolks. What about egg yolks? I like the egg yolk. There's a lot. I mean, it's good stuff you're throwing away, I think. But tell me I can eat my egg yolks.

[Dr. Joan Salgi Blake]

No, egg yolks are fine. Actually, the good source of choline, which is a nutrient a lot of Americans are not getting enough of. Egg yolks are absolutely fine unless. And you know, the price of eggs. Is this crazy? I mean, is this absolutely crazy? Let's not throw anything. Yeah, like, hello, eat that whole egg, but make sure you cook it. So I wouldn't worry too much about whole eggs.

[Dr. Matthew Frank Watto]

Okay. I like the Comment about dairy though, you know, the full fat dairy, it's a good way to cut calories. So I hadn't thought of it from that perspective as well. So. All right, Paul, what else is on our list here? We're kind of in our lightning round.

[Dr. Paul Nelson Williams]

Yeah, we'll avoid the raw versus pasteurized conversation, but what about. And I feel like I've not heard as much about the intermittent fasting with the advent of GLP1s and the tirzepatides of the world, but still it's something that patients will ask about. So what is your take on intermittent fasting? So things like alternate day eating or time restricted feeding as it's sometimes known as.

[Dr. Joan Salgi Blake]

Okay, so I'm going to give my age. So when I was in graduate school at Boston University getting my m. Masters in 1984. Okay. Muslim vet. Okay. So what I did my thesis on was ready for this? The effect of a time of day that food is consumed and its relationship to weight loss. I have it. I can show you the bound copy. There wasn't a lot out there now, but we know more now. This is really fascinating. Okay, so your metabolism, your body works with circadian rhythms and that's the 24 hour cycle of your body. What we know now, and more emerging research is coming out is your metabolism is different. It's more robust earlier in the day and less so later in the day day. So it would be beneficial on multiple levels if you ate more of your calories earlier in the day and tapering it down. Americans typically eat like a triangle. The opposite. So as their calories increased as the day goes on. So what happens is they don't eat much for breakfast or some lunch and then they're banking all the calories from 4pm until they're watching Jimmy Kimmel. So what happens is we know now that when you have all those calories later at night, it's going to be more likely to be fat storage. Also, let's face it, when you're watching Jimmy Kimmel, you're not eating oatmeal with berries. Okay. So it's also the type of foods that you're eating. So what we know now, I really welcome that people start eating a better breakfast lunch and having more of a supper than a big dinner and cut out the late night eating. And that's gonna go a long way with a improving the diet quality because you'll have healthier foods during day typically. And also cut back on that late night eating and those calories and that can be a better Way to manage your weight.

[Dr. Matthew Frank Watto]

Yeah. So with the fasting, what I know a lot of people do is they're either gonna cut out breakfast and start eating at least lunch, or they're just gonna stop eating earlier in the day. It's hard socially to stop eating at 4pm or 5pm, but that's what I think. That's. Those are the two choices. But I think a lot more people skip breakfast, so they're kind of doing the opposite of what you just said.

[Dr. Joan Salgi Blake]

And you know, Matt, when you limit your eating episodes, you're limiting the food you eat and therefore the nutrients you can get. Okay, so let's talk about breakfast foods. Let's talk about breakfast foods. Okay. You always judge a person by the people they hang out with. Okay, so you have a whole grain cereal in the morning that hangs out with milk and berries. I mean, those are good friends. And that makes that meal really, really healthy. When you skip that and only maybe eat lunch, then you're eating half a rotisserie chicken or some whatever. And so you're displacing this var, which is going to do a better job of increasing your nutrient needs throughout the day.

[Dr. Matthew Frank Watto]

All right, Paul, what's next?

[Dr. Paul Nelson Williams]

All right, I think my last question. So I practice in the middle of Pennsylvania, and I've made the joke before. If I could snap my fingers and make Turkey Hill iced tea disappear, I would cure diabetes in about half my patients and also probably the obesity epidemic. And I will have patients often say to me, listen, I know that diet sodas are just as bad as the regular, and I never quite know how to respond. Bond with force for that or not? I don't think so, but I just don't feel confident enough. Tell me your take on non nutritive sweeteners versus the standard issue corn syrup.

[Dr. Joan Salgi Blake]

Okay. We know through our studies that non nutritious sweeteners are safe unless you just. That's all you're eating, packets of these. Okay? But they're safe and they are way better than full sweetened beverages for sure. I mean, we all know that. I mean, a diet that's high in added sugars can increase your risk of not only diabetes, but also of heart disease. So this is an alternative that would allow people to have a beverage that doesn't have the added sugar. We know that there's about 27 million Americans that have diabetes. That's nothing. 104 million have free diet diabetes. That means they're on deck to get diabetes. If they don't do something in the next five Years. So we don't want people drinking sweetened beverages. And this is an alternative now if you don't want to use them, you don't lose that. Go take water, sparkling water. They have so much now put lemons and limes in and just drink it. But there's nothing unsafe about this for what we know on a moderate level. And it does displace sweetened beverage. Regino in excess could be a problem.

[Dr. Matthew Frank Watto]

Yeah, I was trying to look into this a little bit. I saw the up to date is one of the sources sometimes we look through and they had a whole article on this. One of the things they were saying, like there's a concern about dysbiosis that's going to mess with your microbiome. And then of course the microbiome is a real thing that's linked to tons of different poor health outcomes. But so it's an area where, where I kind of watch it. I'm not exposed to too many non nutritive sweeteners because I'm eating mostly real foods and just water. So it's not a huge deal for me. But I think again, some of the processed foods, that's mostly where people are encountering these. And you already told us some processed foods are okay. Not all processed foods are created equal for sure.

[Dr. Joan Salgi Blake]

Right. And you know, the microbiome is a whole nother episode.

[Dr. Matthew Frank Watto]

But. But

[Dr. Joan Salgi Blake]

if you're having a diet that's really unhealthy and a lot of sweets and treats, what do you think that's doing for the microbiome?

[Dr. Matthew Frank Watto]

Yes. It's not selecting for the greatest garden of microbes. Yeah. Yeah. All right. Joan, this has been so much fun. Paul and I are going to enroll in this. Can we still enroll in the this June's nutrition course?

[Dr. Joan Salgi Blake]

All right. Amen. Email me and I'll try to get you in. Okay.

[Dr. Matthew Frank Watto]

I really. I mean I think we know who's the smartest person on this call is the one that has figured out a way to teach a course in nutrition in Italy every June. How long have you been doing this for?

[Dr. Joan Salgi Blake]

I've been doing this for about four or five years.

[Dr. Matthew Frank Watto]

Oh, that's amazing.

[Dr. Joan Salgi Blake]

I know. It's the best. It's the best. I have to say. Okay, just say a funny story. So here I am like crazy person talking my hands Italian. I'm 110% Italian. And in Italy they have these wonderful cafes at every corner.

[Dr. Matthew Frank Watto]

Sure.

[Dr. Joan Salgi Blake]

You go there and your neighbor goes there and you have coffee in the morning, you talk to your neighbor, you Talk to your neighbor. You believe this? You talk to your neighbor. It's just lovely. So the first couple days that I was in Italy, the first year I was there, I walked into this lovely little cafe and I said, cappuccino, go. Let's go. And this woman was like, who the heck? There's no cappuccino to go in Italy. They sit down like normal people and have cappuccino and they talk. It took me three days to come down from this us crazy rate of where I was and come down. And that's why you need to be in Italy a month, because you realize you really are really cuckoo. That's what you're gonna find out. You're cuckoo.

[Dr. Matthew Frank Watto]

My family went for two weeks a couple years ago. It was fantastic. I definitely want to go back.

[Dr. Joan Salgi Blake]

So you have to month. You gotta do a month. You gotta do a month.

[Dr. Matthew Frank Watto]

Yeah. Maybe I'll bring Paul this time. Paul's family.

[Dr. Joan Salgi Blake]

You could do this podcast from Italy.

[Dr. Paul Nelson Williams]

Paul.

[Dr. Matthew Frank Watto]

There's gotta be a podcasting conference in Italy that we could get invited to, I'm sure.

[Dr. Paul Nelson Williams]

Yeah. I just have to figure out how to deal with the. So if we can bring him along as emotional support animals.

[Dr. Joan Salgi Blake]

Let me tell you, Italians love their animals. Love their animals. So bring the cat.

[Dr. Matthew Frank Watto]

All right, Joan, we've enjoyed talking to you. First, if you want to just give the audience, like, one or two things that you really want them to remember from this, and then we'll give you a chance to promote anything that you want to, any place you want to direct the audience.

[Dr. Joan Salgi Blake]

Great. Well, I want to say, I repeat what I said in the beginning, that science, nutrition is a science. It's not an opinion. So on social media, people have an opinion about this, but it's based on science. So don't ever, you know, you should really be talking to a registered dietitian nutritionist. You can find [e-mail] in the area to look at your diet, your health, and how to make that work. And then I hope that if you want the latest nutrition information, that is exactly why I started Spot on. And it's a podcast that's on all major podcast platforms. Apple, Spotify, whatever. So, you know, you. You are what you eat.

[Dr. Paul Nelson Williams]

This has been another episode of the Curbsiders, bringing you a little knowledge. Food for your brain hole.

[Dr. Matthew Frank Watto]

Yummy.

[Dr. Paul Nelson Williams]

Great. This is food based. I feel like this is the right time for that. Are you still hungry for more? Join our Patreon and get all of our episodes ad free, plus twice monthly bonus [e-mail] curbsiders you can find our shownotes the curbsiders.com and sign up for email List our weekly show notes in your inbox. This includes our Curbsiders Digest which recaps the latest practice, changing articles, guidelines and news and internal medicine.

[Dr. Matthew Frank Watto]

And we're committed to high value practice changing knowledge. And to do that we need your feedback. So email [e-mail] a reminder that this and most episodes are available for CME credit for all health professionals through VCU healtherbsiders.vcuhealth.org and if you want to to get CME through our Patreon with quarterly bundles then you can do that [e-mail] curbsiders Special thanks to our writer and producer for this episode, Dr. Edison Eddie Jang and to our whole Curbsiders team. Our technical production is dud by Podpaste. Elizabeth Proto does our social media. Jen Watto runs our Patreon. Chris the two man two moderates our discord. Stuart Brigham composed our theme music and with all that, until next time, next time I've been Dr. Matthew Frank Waddo

[Dr. Paul Nelson Williams]

and as always I mean Dr. Paul Nelson Williams. Thank you and goodbye.

[Dr. Matthew Frank Watto]

It's ICCU's new member month and a

[Dr. Paul Nelson Williams]

chance for you to make some serious great. From now until June 30, you can get up to $250 when you open

[Dr. Matthew Frank Watto]

a new membership with checking. So go ahead, join in a branch today or online@ ICCU.com NewMemberMonth Membership required.

[Dr. Paul Nelson Williams]

Must have checking with debit card, E branch and E statements account must remain open for six months. Offer expires June 30, 2026.

[Dr. Matthew Frank Watto]

See website or visit your local branch for more details and complete terms and conditions.

[Dr. Paul Nelson Williams]

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