Nutritional Priorities

IMG_0690The scenario: an overweight patient comes to the office looking to lose 20lbs by the summer.

The conversation:

Me: “What are you doing now to help you lose weight?”

Patient: “Well I’ve been trying to get only gluten-free stuff at the grocery store, and I’d eat more organic if I could, but it’s expensive.”

The problem: unless this patient is gluten sensitive (they weren’t), they don’t need to be avoiding gluten. Gluten-free does not equate to “healthier,” and it will not aid in weight loss. Similarly, eating organic will also not aid in weight loss. This patient’s nutritional priorities are out of whack.

The solution:

First, identify the issue. Next, identify the goal. Now we need a road map to get there, and you’ll need to sort out what kind of nutritional information is relevant to you and your issues. Here is the cliff notes version for a number of common issues that walk into our office:

Weight loss – Higher calorie foods will work against your goals, so choose foods that are inherently lower in calories: any kind of vegetable, berries, lean meats, no beverages except for water, and smaller portions are your priorities.

Fatigue – The cause of your fatigue will dictate the kind of nutritional support you need. Is it from anemia? Eat red meats, spinach, possibly an iron or B-vitamin supplement. Is it from insomnia? Timing of foods and carbs vs. fats and proteins are your nutritional priorities.

Autoimmune diseases – This one is tricky, and depending on the disease (MS, type I diabetes, rheumatoid arthritis, etc.), different dietary restrictions may be suggested, and yes that may include gluten-free foods. Your nutritional priorities are to avoid trigger foods, and incorporate foods that promote anti-inflammation.

Dyslipidemias – High cholesterol and triglycerides in the blood are often a liver problem in response to poor diet or other disease processes. I rarely recommend my patients eat a low cholesterol or low fat diet, as that common recommendation is now irrelevant (6, 7). Instead, your nutritional priorities would be to remove the metabolic and inflammatory strain on your body (remove sugars, refined carbohydrates) and support the liver’s normal processes (plenty of vegetables, teas, water).


Should I be eating gluten-free? Only if you are gluten-sensitive, or dealing with a health problem that may be impacted by a food sensitivity.

When should I eat organic foods? Although organic foods do contain less pesticides than conventional produce, eating organic is expensive, and because of that, usually falls lower on the priority list. There is some evidence to suggest that organic foods are more nutrient-dense (1, 2), but there is a lack of evidence to suggest that eating conventional produce contributes to disease. Eat organic when you have a budget for it, and try to follow the Dirty Dozen/Clean Fifteen when you can’t. If nothing else, at least wash your produce well with soap and water.

What about genetically modified (GM) foods? This topic is still up for debate and way more in depth than the scope of this post. There is evidence that GM foods may contribute to food allergies, but long-term comprehensive human studies still need to verify this speculation (3). In the meantime, just eat whole, real foods.

Should I be eating a low-carb diet? If you’re trying to achieve specific results, sure–it is helpful for weight loss and type II diabetes, metabolic syndrome, and dyslipidemias. For some people, however, a low-carb diet may not be ideal and must be tried with caution, as some side effects may occur. If your lifestyle is very active, you may find a low-carb diet should not be a priority, and instead eating healthy complex carbohydrates provide you with more benefit.

What supplements do I need to be taking? Supplements are used to bridge gaps in your regular diet, or to provide support for a specific bodily process. You’ll need to assess your current diet and health, identify your goals, and decide which supplements will best serve you.

How am I supposed to know what my nutritional priorities are? Find a nutritionist and go through the process with them–what is the health issue, what is the goal, and how do you get there. Make sure you understand why you’re being recommended certain things, and what their health effects should be.



1. Evaluation of the Micronutrient Composition of Plant Foods Produced by Organic and Conventional Agricultural Methods. (2011) D Hunter, M Foster, JO McArthur, R Ojha, P Petocz, and S Samman. Crit Rev in Food Science & Nutr. 51(6).

2. Organic Foods: Health and Environmental Advantages and Disadvantages. (2012) J Forman, J Silverstein. Pediatrics. 130(5): e1406-e1415.

3. Genetically modified foods: safety, risks, and public concerns–a review. (2013) AS Bawa, KR Anilakumar. J Food Sci Technol. 50(6): 1035-1046.

4. Clinical and laboratory investigation of allergy to genetically modified foods. (2003) JA Bernstein, IL Bernstein, L Bucchini, LR Goldman, RG Hamilton, S Lehrer, C Rubin, HA Sampson. Environ Health Perspect. 111(8): 1114-1121.

5. Dyslipidemias and statins: from guidelines to clinical practice. An updated review of the literature. (2014) T Lucchi, C Vergani. G Ital Cardiol. 15(3): 149-160.

6. The U.S. government is poised to withdraw longstanding warnings about cholesterol. P Whoriskey. The Washington Post. Feb 10 2015. Accessed Feb 18, 2015.


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