Dieting Dilemmas – De-stress your diet!

A conversation between Dr Sheela Nambiar (SN) and Shiny Surendran (SS) at the TFL Fitness Studio September 2019

SN: Thank you all for coming.

Shiny Surendran is a nutritionist having passed out from WCC and Ramachandra medical college.

She currently works at Hande Medical centre. What I appreciate about Shiny is her completely down to earth practicality regarding nutrition. I’m hoping that we can have a sensible discussion about diet which is applicable to people in real life.

Those of you who don’t know me, I am Dr. Sheela Nambiar. I am a gynaecologist. I also practice lifestyle medicine which I think is the future of medicine! Lifestyle medicine is an evidence based approach to preventing and managing non-communicable chronic diseases like diabetes, hypertension, depression, obesity using lifestyle measures. It adresses prevention rather than just management of symptoms. We take into consideration – fitness, food, nutrition, sleep, stress, relationships or social connectedness, psychology and so on. Nutrition is a large part.

To set the ball rolling, my first question to you Shiny would be, what is your take on all the popular diets that have been in existence?

SS: The word “diet” itself puts you in a box. It is about a whole lot of restrictions.

Fad diets come around once in 10 years. If you remember, we both attended a conference in 2013. At SRMC. That is when the Paleo and Keto diets made inroads into India and we met a sports scientist from Cape Town, South Africa who talked about the Keto diet.

Keto is a therapeutic diet. it was originally prescribed by clinical dieticians who work with neurologists, largely paediatrics, for children who have uncontrolled epilepsy. The best way to reduce the episodes would be a Ketogenic diet. Now people have taken that and used that for weight reduction. These diets are supposed to be practiced only by dieticians who work with neurologists.

The best thing would be to have a common sense approach to healthy eating because that is what you would sustain for a long time. These restrictive diets do help initially but they are not sustainable because people get tired of eating just paneer, eggs or meat all the time. So when they go back to their traditional food then they are confused! They have forgotten and have even lost touch with what they ate as children. The word carbs or grains really scares them.

SN: Weight is never only about the food that you take in it is? It’s also about many other things in your life like how much you sleep, how much stress you have, psychological factors and etc. Diet/ food/nutrition is only one aspect of it.

If you are obsessed with your diet and if you count every calorie you consume it is a real tragedy! What I find in some clients which is quite disturbing is their preoccupation with the food. They ruminate about what to eat, what not to eat, what to cook, what not to cook, what to order when they go out, what not to order when they go out, what to eat at the buffet and so on. So you wonder, what about the rest of ones life? Are you are so myopic in your approach that everything revolves around food?

SS: Yes.

SN: There is an obsession with dieting solely for the purpose of weight loss right. Like Shiny said the word “diet” itself is restrictive.

I don’t know a single person who has come in and said ‘I want a diet so that I can become healthier’. They only come because they wanted to lose weight. But weight is not the only thing that determines health to begin with.There are healthy people at different sizes simply because a lot of it has to do with your mind and a lot of it has to do with how you live the rest of your life.So for me it is surprising that today you and I have our work cut out for us from the nutritional perspective, just advising people on the simple principles of nutrition which your grand mother could have perhaps advised you on.

SS: So true.

SN:We are now trying to reinforce the same thing, like eat a lot of vegetables, eat whole foods not refined foods, avoid sugar and so on which is old wisdom. We are saying the same thing except that we are sitting in an office talking to people across the table.

I think one of the main problems is the big food companies that make these convenience foods and we have to blame ourselves for buying buying them despite knowing their shortcomings.

SS:Yes.

SN: It started with the whole ‘low fat’ craze. Everything that was ‘low in fat’ was good for you. You never took a look at the labels to see that probably the calories were absolutely the same but worse, the additives for flavour enhancement made these foods more addictive. Now that the whole low fat craze is done with, ‘High fat’ is all the rage. Butter is back!

SS:And coconut oil is back! As you said, “healthy at different sizes”. We are genetically predisposed to be built a certain way, but can you be a better version of you?

Then there is always this emotional aspect of weight. Don’t we all go through challenges?

I would like to share what happened to me. After being married for 11 years and being unable to conveive, we started treatment for infertility. That is when the weight gain started. It was the stress and the medication, the surgeries, the procedures, 3-4 IUIs and then 2 IVFs. At one point I started having suicidal thoughts, I would cry at the movies for no reason or if I was invited to a baby shower, I would find all kinds of excuses not to go.

I went through this for 8-9 years and at one point, somewhere down the line I also became spiritual because when you are pushed to a corner you ask a lot of questions. Then I made peace with certain things. But now, I understand my clients a lot better. I am able to empathize when somebody says I have been trying to conceive, or has a miscarriage, or has lost a child.

The worst part was people commenting on my weight gain! This body shamingis another very important thing. As a culture we are very insensitive. You just have no clue what that individual is going through. There may be tough situations in their marriage, their finances, may have some litigations going on which is messed up, or may have lost their loved ones. They are the ones who end up gaining weight because of the stress, the elevated cortisol, and unstable blood sugar levels. Such patients will need the help of a psychologist to deal with the stress.

SN:. Would you say food is addictive? Particularly Sugar.

SS: Sugar is like a drug. Yes it has to be banned.

SN: Sugar is highly addictive and it has been found to stimulate the same parts of the brain as cocaine which means if you are a sugar addict, getting off the sugar requires help and you really need to take it seriously. There are many clients who would tell me ‘I just want a small dessert after dinner’. Well if you want it every day, if you derive great pleasure from consuming it, if you have cravings and withdrawal symptoms despite understanding the long term effects with consuming sugar and if you still can’t stop, that’s a definition of an addiction.

I think food in general is also addictive simply because unlike alcohol or street drugs, it is easily available, accessible and completely acceptable. Nobody raises an eyebrow when you pile up your plate at a buffet table but they propably would if you go into Tasmac and buy a pile of booze right?

Our society is also geared to encourage this addiction with all the food Aps and so on making even ordering food so easy, especially for the younger generation.

A while ago, there was this craze/popular dietary advise to eat every two hours. What do you think of that?

SS: That messed up a lot of people I know. That was so wrong and I think the big food companies that made snacks made a lot of money.

Guest in audience– It was  the dietician Rujutha that made this popular!

SN: Well there was just no science behind it. I know there is a saying that people love to ‘hear good news about their bad habits’ and this is something like that. If you drink you like to hear that drinking wine is good for you. You start looking for validations.

Guest in audience: Like smoking prevents Parkinson’s.

SS: You are right I think that is a very valid point that you have brought up. Eating every two hours. Every time you eat, the insulin hormone gets triggered. The best solution is to eat 3 well balanced meals or else have two just meals. That is what your ancestors did and they were active all the time. The NEAT or Non Exercise Activity Thermogenesis is increased.

I had a 7-year old with high insulin level and his neck area is darkened (signs of insulin resistance); The parents work till around 7:30pm. The child is taken care of by the grandparents till about 8:30-8:45 pm. The parents pick him up after that and then cook dinner. The kid is in front of the television all afternoon. He is given soft drinks, sweets and biscuits and that’s it; there’s no physical activity. The Indian way of showering love is through food.

SN:It is kind of double-edged sword. And a lot of your childhood experiences, play out in adulthood. If you had a childhood where food has been used as punishment and as reward, it is deeply ingrained in your subconscious mind. You grow up with some mixed messages about food and a very dysfunctional relationship with it. You are constantly guilty about food. You beat yourself up about it so there is a whole lot of psychology and narrative behind it which we need to be aware of.

Shiny, do you think everybody today needs supplements, given the kind of soil food is grown in and the food we eat?

SS: I think it depends on who you are, if you have undergone a surgery, recovering from an illness like malaria or jaundice and where do you live.

I work with a lot of poor income athletes; they don’t even get three square meals, they just grab some street food or tea, butter biscuits and samosas. I have advised them to have fermented rice and peanut. We need to give low cost options. I would tell them to go to a whole sale egg store and usually where the broken eggs are given away; so I said collect that make scrambled and eat that because you are getting protein. Dhal is expensive, about Rs. 80-90/kg

I have seen politician and actors; I have seen an entire spectrum of clients so it is all about customizing. I recommend a multi vitamin if they really need it but otherwise, I strongly believe in eating balanced, nutritious, homemade food.

SN:So what is your opinion on vegetarianism Shiny, with the usual question, can vegetarians get enough protein?

SS:A possible option is to give them moong chila, besan chilla and adai, pesaratuu and dhokla. They largely depend on mushroom, soy protein and milk products like paneer, cheese.

There are people who are allergic to soy and there are people who refuse to eat mushroom That’s when I try to convince them to use some whey protein or flax hem protein.

SN: Tell us something about lactose and gluten intolerance.

SS: You can develop it even as you get older. A Neutrogenomist test would help.

You can either go on an elimination diet where you start avoiding wheat, rice, barley, bakery products, all breads, semolina, sooji, wheat dosa and wheat upma. Biscuits like Marie, Nutri Choice, wheat flakes. So avoid everything of wheat brand and even wheat germ. You will then figure out what causes your allergy.

Or you could just give your saliva sample and get a Nutrigenomics test done.

SN: And do they do it here?

SS:They do it here and they do it in a couple of places in Chennai, one is in Nungambakkam. It takes three weeks for the results.

So if you hav a gluten allergy, you have rice, poha, idli, dosa and idiyappam. Being a south Indian is a blessing, you can do a fantastic gluten free diet..

Guest from audience: What about millets?

SS: Millets are good but only if you stay very active.

Even if you think about food cravings, it may denote a deficiency of a micro nutrient.

If you have cravings for murukku, mixture, fried pappads you could be deficient in Omega 3 Fatty acids for instance. If you have sugar cravings, chances are there that you have magnesium, Chromium and Manganese deficiency. It is about getting these things. Garden crest seeds, walnuts and almonds have Omega 3. At the cellular level, there may be lot of hunger giving rise to these food cravings.

Sleep is also very important as doc said. Sleep-wake timings and circadian rhythm, are important. Years ago, or rather your grandparents, would have eaten dinner ataboput 4-6 pm. They would’ve gone to bed at around 8 or 8.30 and they would’ve woken up at 4 or 4.30 am. That’s Brahma-muhurtham. That’s the most ideal time because we are in alignment with nature. When you do that, automatically everything else falls in place, you don’t mess up with your hormones. So the root cause of all evil is your Netflix, Amazon Prime and binge-watching television and YouTube. You carry the phone to the bed.

SS: Dr Sheela could you throw some light on Positive psychology?

SN: When you think about psychology and psychiatry, it focuses mainly on what is not right with you. Depression, anxiety, schizophrenia and bipolar disorder etc. The main focus was on illness and how to treat it. But when we look at the human beings, there are so many things that are right with us. So, we need to understand how we can we make what is right with us, better. Positive psychology tries to explore how to thrive rather than just survive. There are several studies, which have been done that show that things like resilience, grit etc. which improve life experience are teachable. So, these are the qualities that will enhance a person’s quality of life and enhance a person’s life experience. CBT is part of it.

SS:So, work on your positives, get back to being positive and stronger?

SN:It’s not just about being ‘positive’ or ‘happy’. That’s the misunderstanding of positive psychology. Its more about working on your strengths, and understanding yourself better.  There is a website www.understandmyself.com that you can go to and get the list of your strengths in the order that they work for you.

SS: Very interesting.

SN: Martin Seligman, often known as the father of Positive Psychology came up with the PERMA model.

P is Positive emotion, E – Engagement, R – relationships, M – meaning and A – accomplishment.

So we work on those aspects, that is the positives of a human being rather than only focusing on how to make an ill person better.

Obviously if you are unwell with lets say depression/bi-polar disorder, you will first need to see a psychiatrist to get to ground zero. Then how do you get beyond that? That’s where PP comes in.

Guest in audience –Something that I’ve been facing all my life. It’s the fact that, I think that, this diet or all this restriction is somehow temporary, and you go back to this wonderful world where you can eat everything and then be thin.

SN:That’s exactly what Shiny said about the perception of the word ‘diet’. It has to become a ‘lifestyle’ or a way of eating for life and sustainable.

SS:Let us not focus only on weight. And let us stop the body shaming! At least, the ones here in this audience, I think we can resolve to say let’s not talk about physical appearances alone. Let’s not judge people because we don’t know the kind of battles that they’re going through.

Guest in audience – And we don’t realize that the beauty ideals that we aspire to, the actresses and actors, don’t themselves look like that. She might not look like that the next month.

Guest in audience– Being a sports physician, I’m working with these kids under 16. All these guys want to have six-packs. I told them a body builder, with his wonderful 6-pack is at his weakest when he is posing. I mean, he has dehydrated for 10 days, he has not had any salt. He is probably on some diuretic.

SS:Also on steroids!

Guest in audience –Celebrities have created such unrealistic expectations of the masses and especially young kids, who are so impressionable. And I have to try and convince them that if you look like Salman Khan, you’re not going to be able to throw a cricket ball! That’s what I’m trying to do with these youngsters. To get them to enjoy the game because that’s why they have been selected to the state in the first place, because they’re good at cricket. No one has selected them on the virtue of their height or their weight, so I ask them to focus on their skills and then try to eat the best they can. So we’ve provided ‘sundal’ in the evening for instance. Then I had to fight with the association to get them eggs. Because TNCA is traditionally very bankrupt so getting eggs into the system was very hard.

SN –So now….. we’re way over time and we’ve had a very interesting conversation.

Shiny thank you for your inputs and valuable insights. Thank you all for coming and interacting to make this so much more meaningful!