EXPERT > Doctor In The House

Eating Right To Stay Healthy

By Dr. Alan Titchenal
Interviewed by Melissa Moniz
Wednesday - July 16, 2008
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Dr. Alan Titchenal
Nutritionist, Associate Professor of the Human Nutrition, Food and Animal Sciences at UH-Manoa

In your opinion, what are the most concerning nutritional problems right now?

It’s one of those questions that’s difficult to know where to start because it depends on which group of people you are looking at. We tend to look at the nation as a whole, and what appear to be the biggest problems are obesity and growing risks of diabetes and other chronic diseases. Some of these are nutrition-related, but obviously a lot of other things play a role. Other aspects of lifestyle play a big role, such as daily physical activity. I think it has changed quite a lot for younger children and even older children. It’s important for children to have physical activity, and some parents will make opportunities for that, but I think there are too many children who don’t get those opportunities and then they don’t learn a lifestyle of physical activity. Then it’s hard to start that up later in life.

As far as the diet side of obesity, what do you feel is the primary concern?

I think a lot of times it starts in the early years of life. So if we start talking first about children, on the nutrition side it’s kind of mixed bag. If you’re not burning enough calories, then what you eat becomes much more important. And as I watch things change over the years, foods that were once considered to be special treats have become mainstays of the diet. So you have a problem with too many calories and not enough nutrients.

Is it fair to say that these bad eating habits parents instill in their children at a young age stay with them as adults?

If you look at research that’s out there on this, probably one of the strongest influences on our food choices is how we were raised. Our cultural background certainly influences our food choices, but the foods we ate growing up are what is familiar to us and what we’re most comfortable with. So I do think we tend to go back to that. That’s not to say that people don’t go into a health kick and change their diet. But what I often see is people who change their diet for the better and move to the right direction, but then go too far. So they feel better initially, but over time the nutrient deficiencies take effect on the body and eventually they develop new problems.

What’s your comment to those who say “it’s more expensive to eat healthy,” and compare the cost of organic foods to fast food?

I think there’s some truth to that statement, but it is also a bit of a cop out because if you look at the cost of whole grain brown rice, beans, vegetables and fruits - those things are inexpensive. I think learning to shop seasonally for fruits and vegetables helps keep it inexpensive. And going to farmer’s markets tends to help. Finding good protein sources also can be expensive. We always recommend that people look for the leaner red meats because those are the best options.

What are some suggestions for parents to get their children to eat healthier, including vegetables and other things they may not like?

I’m no expert in that area because I don’t have children of my own, but from the outside what could help is involving children in food preparation to some extent, getting children curious about food. So if you want to interest them in a certain kind of fruit, you could get a cookie cutter and let them cut mango slices into shapes. There’s a lot of experts who would disagree, but at dinner time, if they eat their vegetables, they can get dessert. I know some people say you shouldn’t bribe, but it does get them to try to eat healthy things. But you should never force a child to eat everything, and you should never force a child to eat everything on their plate, because what you’re forcing them to do is override their own internal cues. If they learn not to pay attention to those internal cues, you may be putting them at risk of not being in tune with their calorie intake.

There are a lot of diets that focus on cutting out specific foods and even food groups. Are there any, in your opinion, that are harmful?

Any of them, if they are done in extremes, can be harmful eventually. The problem with diets that go to extremes is - because it might move someone in the right direction and they may feel better initially - it sometimes can go too far and then the person becomes out of balance in a new way. I think we still have a lot to learn, and as people’s lifestyles change, their dietary needs change. So the research looking at how much carbohydrate and how much protein is best in the diet has been a big debate for years. You have the no-carb diets and the no-protein diets. The answer, I think, is somewhere between those extremes.

We talked about obesity as an increasing problem. On the opposite spectrum, are eating disorders also increasing?

I don’t know that they are on the rise, but they are certainly not declining. Based on what we see here on campus, eating disorders are very common and a big problem. We’re only beginning to understand how to best treat eating disorders.

Do most cases start off as a diet and then evolve into an eating disorder?

It seems that it does start with a fear of being fat or a want to be thin. So it’s going to dietary extremes, and it seems that once the nutritional status has been compromised then the psychological problem makes that fear grow. Then it just compounds itself and you have a serious eating disorder that is very difficult to treat.

Can you talk about iron deficiencies?

Iron deficiency is one of the big problems we’re seeing on campus. What seems to be at the root of that is that they’re trying to eat more healthy and they’re cutting out too much iron. A whole host of things can happen. Of course, being fatigued. It can be harder to stay focused and concentrate. Depression can come from iron deficiency. Other things that we see that may be associated is hair thinning, restless legs syndrome, and sometimes that’s related to iron deficiency. Classic for someone who has been low on iron can develop fingernail problems. We do see it in vegetarians who don’t eat a good vegetarian diet. The challenge with a vegetarian diet is it’s a lot harder to do it right. So that’s another example of someone changing for the better, but it’s so extreme. It can take months, even years, for the iron deficiency to kick in.

Is the food pyramid still the standard for a well-balanced diet?

It still pertains today. I think the big message to take home is if we eat across all those food groups in moderate amounts, then we’ll be more likely to have a healthy diet. If we eliminate any one of those food groups, then we’re losing important nutrients.