From Keto, intermittent fasting, detoxes, and more, Jeff Lucchino, MS, RDN, Director of Sports Nutrition, UPMC Sports Medicine discusses whether they’re healthy and which ones work.
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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Keto, intermittent fasting, detoxes, and more. There’s lots on the fad diet front these days. So, do they work and are they healthy? Hi, I’m Tonia Caruso. Welcome to this “UPMC HealthBeat” podcast. And joining us right now is Jeff Lucchino. He is the director of Sports Nutrition for UPMC Sports Medicine. Thank you so much for joining us.
– My pleasure, thank you for having me. I appreciate it.
– So, I guess in general, why do we call these fad diets, and do they have any merits?
– So, first off, they’re fad diets because there’s really no research behind these diets. They’re kind of not made up, but someone will kind of create these diets over their own experience or small population experience and, say, “OK, wow, we saw some great data here. We saw some great results with this small population, or even personally myself, why not put this on the major markets and see if everybody starts doing this, they’ll start losing weight, better their health.” With traditional calories in, calories out, where there’s been thousands of articles, thousands of data poured into that. And then we look at these fad diets, like keto, for example, there’s really no supportive research when it comes to just a general person losing weight, sustaining that weight loss long-term.
– So, you don’t see the research, but if someone says I’m trying this and it works, isn’t that enough? And are there some benefits for these in terms of jump-starting?
– I think the jump-start part, yes. I think if a client is coming to, let’s say myself or another dietician, and wanting that quick result, that instant result, and, you know, you could say, OK, we’ll try this. Or maybe, you know, entertain this diet. We’ll try for a short period of time. They most likely will see a lot of water loss, a lot of calorie deficit taking place, that will kind of prompt a good weight-loss amount in a short period of time. However, that client has to understand, and the dietician has to relate to that client and say, “Listen, this is not a long-term plan. This is not going to sustain weight loss long-term.” So, this might jump-start you for three months, give or take, but long-term, we have to go back to more of a sustainable approach. So, that’s where it, I think for the clients, it’s like a little bit of a, well, I want this to be my lifestyle, I want this to be forever. And you have to coach them and say, “This is temporary, not forever.” But the biggest missing piece is that these people that try the diets, they actually don’t have a professional guide them through it. They just do it on a social media, you know, post, that’s what they see. Or a friend did it, so they just do the same thing, and their friend might weigh 50 pounds more than they do. And so they’re eating the same way their friend is, which they shouldn’t be. So, there’s a lot of misguidance out there.
– OK, but let’s talk through them. Let’s start first with keto. What, in essence, is the theory behind the keto diet?
– So, keto was started a long, long time ago, and it was for younger adolescents, kids that had epilepsy. That was the main focus behind keto, or the main reason that keto came to fruition, is they found that it decreased seizure activity. So they were like, “Wow, this is great. Like, keto is a great diet.” And then over time, someone, I’m not even sure who the person is, came out and said, “Well, why don’t we try this for weight loss? It decreases carbs drastically, it’s kind of moderate protein, high fat. Let’s try it on just healthy population.” And, lo and behold, people lost weight. But here’s the thing, the calorie deficit was so great. Anytime you put somebody from a calorie surplus into a deficit, they’re going to lose weight, they’re going to lose water. So, I think the cool approach about the keto initially was, “I don’t feel hungry, I’m not eating carbohydrates, I’m losing all this weight, I have so much energy.” It is a temporary short-term diet.
– So, they talk about ketosis, and explain what that is. But aren’t you eating more fats on this diet?
– So aren’t you taking in more calories?
– Not more calories. You’re diminishing the carbohydrates. The protein stays moderate, and the fat goes up. So, fat is the highest calorie per gram macronutrient. However, you’re still going to be in a deficit. So, you’re dropping that carbs, which is, in most cases, 50% of a normal adult’s diet is carbohydrates. So, you go from 50% to 5%, which is kind of keto, you’re basically turning that body into kind of a fat, I don’t want to say storage, but you’re us utilizing fat more than carbohydrates. The problem is that our bodies are accustomed to using carbohydrates. Brain function, we use carbohydrates. Muscle function, carbohydrates. Fat, we definitely use, but we don’t use it when we’re active. We don’t use it when we’re in really a cognitive, I would say aggressional standpoint, of like, studying something, memorizing. And that’s where like, you know, really relying on fatty acids in going ketosis, which is basically the body using ketones, right? Internal ketones-
– What’s a ketone?
– Ketones is when the body is, when you’re utilizing, we take out carbohydrates and you start implementing more fat. Basically, the fatty acids turn to these ketones. These ketones are kind of like balls of energy. And our body starts using these as forms of energy because we don’t have carbohydrates now. So, ketones are kind of a form of energy our body and brain start using. A lot of people experience brain fog. A lot of people experience lethargy after about a month or two months, because fat is just not a reliable, high-transitional energy source our bodies can use quickly. It takes a long time for a fat molecule, or a ketone, to be produced into quick energy. So, if I’m a hundred-meter dash runner, or if I’m, let’s say, an average adult and run on the treadmill, I’m probably going to eventually feel like 2 miles, maybe it felt great before, now it feels like I’m climbing Mount Everest because of just my body’s relying on a slow transitional energy source now.
– OK. So keto, detoxes, all the rage, especially, you know, coming off the holidays, heading into January. Detox. So, and there are lots of different detoxes, the liquid ones, just in general, what about detoxes?
– Yeah, so our liver, let me just put it this way, our liver does a fantastic job of detoxing the body. Anyone who thinks, like, my body’s not detoxifying enough, have your liver tested, talk to a specialist about your liver function, have some blood work done if you think your body’s not detoxifying just general toxins in general. That should be the first step, right, if you think your body’s not detoxifying things the right way. Most people go down the road of buying a supplement that has, you know, just a lot of water, a lot of fluid. And just, I mean, what it basically does is kind of helps you go to the bathroom more. I mean, it just excretes everything in your body, but excretes vitamins, minerals, it doesn’t really excrete that much toxins. It’s excreting the vitamins and minerals that are water-soluble, and that’s what a lot of these supplements, and waters, and juices pretty much do, is they just flush a lot of these things out. So, it’s not the best way to detoxify the body. Liver function, having good liver function’s the best way to detoxify the body.
– So, but though, is it a good jump start if, let’s say, so if you’re doing a liquid one and you’re not eating for three days because you’re drinking whatever these juices are —
– Can that set you on a healthy weight loss?
– I would prefer not because I think when you go from a liquid diet to a food diet, that could be a big shock. And we actually create more thermic effect when we eat food than drink. So, by eating food, whole food, we actually burn more calories during that process than just drinking. So, you’re actually taking away about 10% of your thermic burn per day when you drink rather than eat. So, to me, it’s not smart. It’s not safe, it’s not effective. I think people should focus on how much they’re drinking a day. Like, if you’re not drinking enough fluid a day, that’s a great place to start to say, “Wow, I need to maybe detoxify my body that way instead of just doing like a supplement, a $30 to $40 juice that doesn’t really work,” that just flushes out everything, you know, vitamins minerals, all of the above.
– What’s a general rule of thumb for how much water you should be taking in a day?
– I like just the athletes to general people to be about half their body weight in ounces of fluid. Now, that doesn’t mean just water. I’m talking about juices, unsweetened teas, coffee, teas, you know, all the things that really are lower-calorie, those should all be accumulated into that half the body weight in ounces of fluid. Alcohol is the only type of beverage that dehydrates us. So if you’re going to kind of stay away from dehydration beverages, that’s the category. Sodas count. Energy drinks, unfortunately, which I’m not for, they do count. Everything counts besides alcohol.
– Is there a, like, a clean food detox? If you weren’t going to do liquids, but if you were going to try to do a detox food-wise, what should that look like?
– If someone is consuming a lot of processed food and a lot of, let’s say out-to-eat food, sodium would be the biggest culprit: sodium and calories. But if you really want to reduce your water weight, your intracellular water, right, sodium is a good place to start if you’re consuming a high-sodium diet. And if you’re eating a lot of processed foods, on-the-go foods, so to speak, that would be probably the most reasonable place to start and most acceptable place to start, is just bringing that sodium down a little bit and eating more, we’ll call more natural foods, less processed, cleaner foods, one-ingredient, two-ingredient foods, not 20-, 30-ingredient foods.
– All right. Intermittent fasting. OK, let’s tell folks first what this is. And I’ve had so many people say they have lost weight.
– Yeah, so there’s a couple different types. So you could do a 5/2, which is five days eating, two days fasting, and we’re talking two days of no food.
– That’s not the one I was talking about.
– Which is pretty aggressive. That’s, to me, a little bit too aggressive, but it does exist. Then you have of kind of your 8/16, which is the most common one. You eat eight hours, you fast 16. The reason that works so well is it gives people structure. It gives people a window of time to eat. And, in that case, they’re probably going to have a calorie deficit because most people, what they do is they start eating around 7 a.m. They don’t stop until around 10 p.m. And they shouldn’t be doing that in general. Like, you should have definitely a cutoff time, reasonably, and you should definitely be having some smart meals and smart snacks throughout your day. Most people that do intermittent fasting, they cut out maybe a third of their calories by narrowing that window of eating. That’s why it works so well for some people. I’m OK with that approach if you’re saying, “This is my window.” For athletes, intermittent fasting is an absolute no because they practice in the morning, at night, midday. They should not have a fasting window or an eating window. They should be very flexible. General people that work like a typical job, you know, semi-active, that maybe could work for them.
– So, ideally, what was the timeframe again?
– Eight to 16. So, like eight hours eating, 16 hours fasting. And you can kind of pick whatever eight hours you want. It could be 12 to 8. It could be, you know, 8 to 4. It could be 7 to 3, whatever, you know, eight-hour window you want to pick, you pick it.
– And is it just because you’re not eating as much longer that you start to lose weight?
– Can you lose a lot of weight?
– You can lose some weight. I mean, you know, it depends on the person, how much they have to lose or need to lose, but you can definitely lose a little bit of weight just by having some structure. But it depends on, you know, if you’re working out and you’re working out 7:00 at night and you’re eating window’s from 8 to 4, just imagine you’re coming home from the gym and you can’t eat, which is definitely not a good approach at all because you’re going to bed hungry. It’s disrupting your sleep, your melatonin release. You’re having bad sleep, you wake up in the morning, you feel horrible. So, you have to watch when you plan it, when you work out, you know, is it sustainable? I mean, if you have a busy lifestyle, it’s probably not the best approach.
– Would you prefer that over the one of five days eating and two days not eating?
– Yes, if I had to pick one of the two, yes. Because the two days of not eating, it’s defeating the whole purpose of what food actually does positively for the body and for weight loss. Food helps weight loss; it doesn’t hurt weight loss. That’s what the misconception is. People think less is more, and sometimes more is more, so more food, more weight loss, depending on the type of food and if a client’s in a high calorie deficit, they might need to eat more. They might be hypometabolic, which happens a lot.
– OK. Paleo, what is that?
– So, paleo, you know, millions of years ago our ancestors, who we obviously have never met before, they ate a very kind of meat, nuts, seeds, kind of almost like a, whatever was available kind of diet, right? No processed foods, of course, didn’t exist back then. So, whatever they can kind of hunt and scavenge for, that’s what they ate. So, that’s the approach people have taken, is kind of eating this kind of really narrow amount of foods. So you have your fruits, your vegetables, your nuts, your seeds, your meats, no grains — pretty much no grains whatsoever. That was it. And so, if I had to say approach that maybe could be worked in kind of healthfully, that might be one of the approaches that could be worked in. However, I would definitely implement some grains within that plan. Healthy grains, more of like an ancient grain, like a quinoa, or maybe even like a whole wheat pasta, those type of really good whole grains, that should be the worked-in piece. But, other than that, like, you know, promoting more lean protein, nuts, seeds, fruits, and vegetables, to me, that’s a great plan. To me, that’s fine to do that for someone who’s not doing that.
– So, the grains, why are the grains important? I know you talked about the brain and carbohydrates.
– But everything else you’ve told me has been like, the carbohydrates are the culprits in terms of gaining weight.
– So, why should we put these grains in there?
– So, grains. Grains are important for a lot of reasons. They contain certain vitamins and minerals that our bodies basically need every day to function or need long-term to function at a very good level. So, you’re going to be missing some B vitamins if you take away grains, missing fiber if you take away grains. That leads to maybe GI issues or inconsistent bowel movements. It’s also our main energy source. So, if we take that main energy source away and we transition out of it, you know, our bodies just don’t know what to do. And they kind of, again, over time, it becomes like you’re hitting a wall every single day. You know, we’re accustomed to eating a certain diet throughout our lifespan, and carbohydrates are the main, one of the main focal points of that diet. When we take that big focal point out, our bodies are just kind of in limbo, like, what are we going to do here? What’s the next step? And a high-protein, high-fat diet’s very expensive. So also, too, you have to watch your wallets as well. And now, with gas prices, everything going up, inflation, like it’s going to cost you actually more money to eat these diets than before. So, I mean, grains, I mean, especially the right grains, definitely should be a focal point of your dietary intake, a big focal point of it.
– All right. Vegan, vegetarian, Mediterranean. Are those the three winners? I don’t know, vegan?
– Vegan and vegetarian are tough because you’re restricted. You’re restricted and also for, let’s say a young female athlete, which I work with a lot, that population, you’re going to be missing iron because animal protein has a good source of iron, plant not so much. You’re going to be missing folate, B12. These are vitamins you might have to supplement, or you might have to inject in various ways in your plant diet. And also the population I work with, that 18 to 22 on campus, it doesn’t really kind of, you know, really have a customizable vegetarian plan when you go to the dining hall. It has a couple select options, but like, you’re really limited on campus what you can eat if you’re vegan or vegetarian. So, those plans, I would say, if done the right way, and if you’re not a student-athlete, like in college, if you’re on your own, you have your own budget, you can make that work, do a little prep, a little cooking, monitor that closely, get regular blood work done, I think yes, someone could do that really well. The Mediterranean side is where, I’m more for that. I love that plan because you’re, you’re admitting a more-
– Let’s tell everybody what’s in it.
– Yeah, you’re adding more omega-3s, which are fantastic, through fish, nuts, and seeds. Which, fish is one of the best and most underrated protein sources out there, especially fatty fish like salmon and tuna, very underrated. We should eat more of those, about three times a week, if we can. It promotes more chicken and turkey, lean source of protein, low fat. The nuts and seeds category, again, great source of nutrients, great source of good fat, monounsaturated fat. We also have good fiber there. We have good zinc there, which helps decrease stress. So, there’s a lot of benefits to those foods in general. And then you get the fruits and vegetable side, which, as a population, we just don’t eat enough of, and they really help reduce inflammatory response for an athlete. So, if I’m an athlete and I’m training five, six, seven days a week, I need to reduce my inflammation, and those foods do it for the athlete. So, that kind of plan, I think, is great. I think it’s great, but again, the fish side, expensive, the grains are there, but they’re more ancient grains, the whole grains, which again are hard to find and more expensive than your typical white grains. So, it’s a little bit of like, again, not the best approach for our student-athlete, but general people out there, if they want to take an approach that kind of makes things a little bit better and healthier, the Mediterranean, to me, is one of the better diets that’s on the mass market.
– So, when we talk about, we see everywhere now plant-based diets.
– Is there something to be said, though, that moving toward plant-based and away from, in particular, red meat is a good route to go?
– I think definitely doing a 50/50 approach is what I would do. That’s why I suggest to a lot of general people who come up to me and say, “What should I do?” Athletes, especially: “What should I do?” I’ve seen documentaries on plant-based protein, athletes are switching over completely, like, “what should I do?” No. 1, there’s no valid research to back up a purely 100% plant-based diet that has better performance benefits for an athlete than an animal-based diet or a mixture of the two. The second thing is that when you take out the animal, you’re going to miss that iron. You’re going to miss the zinc. You’re going to miss some key properties that are definitely obviously beneficial, highly beneficial for an active individual. So, you kind of have to watch how drastic you change things. I do think a 50/50 approach would be great. Like, maybe animal-based in the morning, plant-based midday, and then maybe a mixture at night, like, doing that to me would be fine, but I wouldn’t do one or the other completely.
– All right, so in general, not an athlete, just someone who is looking to lose weight and to get healthy.
– What is a good starting point? What should they keep in mind?
– So, No. 1 thing is have a goal, and I’m not talking about like a long-term goal, like a six-month goal or year goal, have a next-week goal, have a today goal. Like, what are you going to do today? I think the first thing a lot of people miss is having a good outline of eating. No. 1 thing, are you eating breakfast every day? I mean, everybody goes back and forth about breakfast. Should I do it, should I not do it? Yes, you should do it. There’s research that supports eating breakfast will actually help a client lose weight initially and keep the weight off long-term. There is valid research behind that. And I’m big fan of eating every three to five hours for something called muscle protein synthesis. Now, I know that’s more of a sporty term than a general population term, but let’s even talk about this: satiety, feeling full. When you have a six-, seven-hour gap between a meal or a snack, you’re so ravenously hungry that you’re going to overeat. You’re automatically going to overeat. So, if you’re eating on a good outline of every three to five hours, you’re going to stay pretty, relatively semi-full. You’re going to be ready to eat, but not ravenously hungry. You’re going to make better decisions about what you’re eating, how much you’re eating. So, I do like clients to have a good outline where it’s almost like a domino effect. The dominoes are kind of close enough where you tip one over, it knocks the next one over, but not too far away or not too close to each other. So, general people should eat about four times a day, three meals and a snack. That’s usually where I start most clients. I think the other parts that are kind of non-food related, the hydration we spoke about is key. The sleeping is also key. General people should get, adults should get seven hours a night. Now, if you’re getting a lot less than that, what’s going to happen is that our hunger’s going to be more rampant the next day, maybe, our stress level will be more higher, we’ll be less resilient to stress as well. Like, less sleep, less resilience to stress, less resilience to control our hunger. So, therefore, by not getting enough sleep, you’ll be more susceptible to overeating. So, those three pillars, I call them, of we’ll call ’em just overall health and wellness, that a general person should definitely try to embody right away.
– Is that, in general, what you follow?
– Yes, I’ve been following that. I’m 37 years old. I mean, every day we all get older, but I’m 37 years old, and I’ve been doing this since I was 15 years old. So, I’ve been doing it for over 20 years. And I really, I started small, I started slow. I mean, it wasn’t like I just said, OK, tomorrow I’m going to sleep eight hours a night. I’m going to drink this much fluid. I literally just started with my food, eating more, eating smart, like, just having breakfast every morning, taking care of my body better, hydrating through workouts, trying to sleep eight to 10 hours a night. Like, I started with one, got into a habit, and then tried the other one and got into a habit. So, I kind of built myself up in a way.
– Is there any food that you absolutely just will not eat?
– Hmm. Me personally, no. I’ll try everything. I mean, I’m a dietician, I try everything. I would say there’s not one food out there that an individual coming to me, if they had this food and they like it, right, and they say to me, “Should I just cut this out?” My answer’s always no. Never cut it out. That’s always a plan for disaster. Now, unless you’re allergic to the food or your doctor says, “Don’t eat this ever again,” then that’s a different story. But, if a client is just like, “I love my afternoon glass of wine,” you know, OK, if you’re doing two glasses, let’s bring that down to one. Or someone says, “You know, I love my Halloween candy. Can I have like, you know, maybe a handful every now and then?” Absolutely. That is not going to make the difference between you losing and gaining. And that’s something, again, we only have a short amount of time, you know, in our life. So we should definitely enjoy food and embrace food, but we should not be restrictive, but we should be having a better balance of the good to the not-so good.
– Okay, and then, is there a superfood that you tell everyone to eat?
– There’s a lot of them. I mean, the one that I love when it’s in season is berries. I mean, I think berries, especially strawberries and blueberries, I think they’re so packed with antioxidants and they’re such easy, convenient foods, especially for an athlete looking for that source of vitamin C, fiber, but also just the fruit category in general.
– But aren’t they filled with sugar?
– Well, the sugar’s good. That’s the carbohydrates, and here’s the coolest thing about fruit. And everybody talks about, “Oh, fruit, I think it’s so bad for me. I want to do low glycemic index foods.” And I’m like, next time you pick up an apple or banana, is there a label on that apple or banana? And everybody’s like, “Well, of course not.” I’m like, that’s a one-ingredient food. Pick up something off the shelf that you eat every day. Look how many ingredients are on that granola bar, on that protein powder. There’s seven, eight, 10, 20 ingredients. Like, so what is better for your body? What’s more natural for your body? What’s your body going to accept more? That fruit, by far, it’s a better energy source. There’s a lot more nutrition behind it as well.
– So, where should someone go? Does this start with a conversation with someone’s PCP? Are there good online sources? Where should someone go if they want to begin a diet?
– I think starting a conversation with someone you trust, whether that’s your PCP, a PT, athletic trainer, even if you know a dietician and you haven’t really spoken to them about this, or maybe you have, but you haven’t had that conversation in a while, going back to that person that you trust, having that conversation to start and then hopefully the referral process will lead you to a dietician or qualified professional to kind of carry that conversation over and begin that person on a lifestyle program. So, I will always say, start with a medical professional that you trust and that you know, and there should be a referral process after that conversation.
– All right, well, Jeff Lucchino, such great information. We will have you back because we could talk about diets all day long. Thank you for your time today.
– Thank you, appreciate it.
– I’m Tonia Caruso, thank you for joining us. This is “UPMC HealthBeat.”
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