Michael DiBiasi, Director, Sports and Performance Nutrition for UPMC Sports Medicine

Are you determined how to get healthier in the new year? Michael DiBiasi, Director, Sports and Performance Nutrition for UPMC Sports Medicine, discusses the best ways to get started with healthy eating and exercise.

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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.

– If getting healthier in the new year is among your resolutions, how do you get back on track when it comes to diet and exercise? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Michael DiBiasi. He’s the Director of Sports and Performance Nutrition at UPMC Sports Medicine. Thank you for joining us.

– Thanks for having me here. It’s been a pleasure so far.

– All right. Well, so, let’s get right into this. You know, coming off of the holidays, lots of eating, lots of drinking, lots of holiday parties, when someone comes to you and says, “I want to get back on track,” what’s one of the first things you tell them?

– So, first, what we always try to do with any of our clients or patients is really understand what they mean by “get back on track.” What are your specific goals? We always have clients who say, “I need to get back to where I was.” Well, where was that? What is your why? What’s your reasoning behind this? And so, the more we can understand and empathize with our clients, one, the more they’re going to trust us to really hone in on their specific goals, but also to make sure that we both understand how to reach that specific goal. So, any time that we talk with someone and say, “I want to get back on track, it’s the New Year’s, it’s the holidays,” everything gets crunched into this period of multiple different holidays, family time, indulgences, and then it’s a new year, a new resolution or re-solution. And so, what we really want to focus on with them is not so much trying to do the same thing over and over again without any good results. It’s, well, let’s actually figure out what is holding you back. What are those processes that have held you back beforehand? And let’s address those. Let’s actually devise a smart, attainable goal that is comfortable, that you’re able to actually address. You know, we can go beyond, supersede that goal. So, whenever we work with a new individual or someone that’s trying to develop a particular goal, which usually, at this time, tends to be weight loss or some type of weight management, what we really want to do is ask them, “OK, what is it about that that you are struggling with? What is it about that goal that you want to change? What is it about yourself that you feel needs to be changed?” And let’s actually work out some of those details together. Let’s look at your exercise. Let’s look at your nutrition. Let’s look at the barriers at home and at work and what your normal lifestyle is like. Because there just may be that one factor that you just don’t know that you are failing to address. That could be that linchpin.

– Is it fair to say that different things work for different people, and there’s not really a one-size-fits-all solution to weight loss?

– Correct. Because, you work with a younger individual with a lot more free time, you have more opportunities. You work with someone who’s a family person, who works a lot of hours with very limited time at home or limited time to have to themselves, you can’t put people in a box and say, “This will work for everybody,” because we have to address the lifestyle of individuals. Not everybody has all the time, not everybody has all the resources, not everybody has the same understanding and knowledge of what, and how, and when, and why, and where to do these things. And so, we have to take that individual at their level: put them where they’re comfortable, where they understand that they can make these small, simplified, continuous changes and then watch how that will grow and build into exponential improvements.

– So it really is start small, and build upon that. We should say before anybody starts a diet or exercise plan, they should consult their own doctor about this. OK, let’s just say in the broadest sense, I want to lose 10 pounds. I know you told me before, “Write down your goals.” Why is that?

– So, we’ll use weight loss as the example. We always ask our individual clients and patients, “Write down your goals,” because everybody loves a list. Everybody loves to cross things off a list as well. It’s very cathartic, it makes us feel good. We resonate with being able to complete things. But, also, writing them down reminds you of what your original goal is. It’s quite easy to get into the mindset of, “I’m going to do this, this is what’s going to happen,” and then life happens. And then things start to get in the way, and then you forget the original reason why you had that goal. What was that original goal? And things start to manifest and change, and then we sometimes just give up on that goal. So, writing it down and having it as a reminder of what you specifically wanted to begin with. The great thing about writing it down is, it’s amendable. We can change it consistently. “This goal doesn’t fit my lifestyle right now, so I’m going to change this to make sure that it fits and I still have something to work towards. I have an idea, I have a progress, I have a program, I have support, and I’m going to fulfill this. This goal may not be enough for me; maybe I can shoot a little bit higher.” And so, always having that ability to change up that goal, understand why you wrote that goal down, and then have an understanding of all the potential barriers that are going to hinder you from reaching that goal, have those written down, too. Because we will always see things that will come in our way every single day, whether it’s family, work, lifestyle changes, but it doesn’t matter. We want to write those those down so that way we know, these are things I need to consistently address.

– What’s an example of a goal someone should write down? Is it as broad as, “I want to lose 10 pounds,” or is it, “I want to lose two pounds in the next five weeks?”

– So, using this as the example, when someone comes to me and says, “I want to lose 10 pounds,” OK. I then ask, “So, you’re willing to lose 10 pounds of muscle?” And they say no. And I say, “OK, well, let’s dive in deeper. What do you really want to see?” “Well, I’d like to see a little bit more fat loss.” “OK. Why?” “Well …” And then sometimes they’re younger or older. Now, we start getting to the reasons. “I’ve gained this weight over time because I’ve had children and now it’s been harder for me to lose this weight.” Or, “I have these events that are coming up, and I know that for my self-esteem and what I want, this is where I feel more comfortable.” And we never break down someone’s idea of what their goal is or why they want it. That’s not the point. The point is not to say that your idea is wrong or right, the idea is to say, “Is this valuable enough to you that’s going to improve your performance, your overall health and safety, and get you to that goal, and are you going to be better for it?” So what we try to then do is say, let’s take that very basic idea, and let’s get it down to your “why.” Why do you want this? What are some things that have happened in the process that haven’t gotten you to these areas, and what are you going to do with it once you reach that goal? What’s your end game? Reaching it, and that’s that? Or, is there more that we can do? How are you going to feel? When it comes to diet and exercise, the whole is almost always greater than the sum of its parts. I can lose a little bit of weight, which is great. But think about all the other tangibles and intangibles that will come along with it. We don’t necessarily always just focus on a number on the scale. We focus on all of the other benefits that will come with it, like being more active, feeling more alert, reduced anxiety and stress, being able to spend more time with family and loved ones. Being able to go out and experience life continuously better. And so, we try to build those into the goals, and so that way when that person walks away, they have their basic idea, and now they have a strong understanding of what, why, how they’re going to reach that.

– All right. So, when it comes to these 10 pounds, is it – I know you said in a lot you start slow and you build, but is there anything to be said for, “I’m going to be really strict these first two weeks, and the pounds will start to come off, and then, that’ll be my momentum to keep going?” Or, should it be just gradual things that you’re adding in and perhaps taking out?

– You know, and for some people, that kind of extreme mindset does work. However, it’s not the safest, because the body doesn’t like extremes. The body doesn’t like extreme cold weather, it doesn’t like extreme pain, and it most certainly doesn’t like extreme changes to itself. It will try to curb those. So, while in the most acute short term we can see those results, but in the long term, we almost always get those issues back and then some. And so, what we try to have people focus on is, it’s the small changes that grow and exponentially develop on top of themselves. Again, the whole is greater than the sum of its parts. So, instead of saying over these next few weeks, “I’m going to go on this four- or eight-week diet blast.” OK. Well, it took you a year to gain these extra pounds. Why do you think the body will respond to eight weeks of this incredibly quick loss? It’s not. And so we have to also remind people, “Hey, it took you a little bit to get here. Let’s work on getting you back to where you want to be because of these positive reasons: your health, your mindset, your physicality. And then think of all that time that we will now have to reach this goal and all the other things we get to build into it.” So, those smaller goals, those smaller changes, compound on top of each other. Someone wants to lose, and we’ll just say 10 pounds. Well, let’s actually find a proper timeline that will reach that goal. Let’s just say six months. Six months is a long time, But think what else we could do in six months. You want to work on endurance and exercise, now we have months to actually improve your output and your exercise. Now we have months of developing better sleep patterns, better eating habits, making these lifestyle changes. So, after six months we may not only see more weight loss, but we may also see better strength, better power, better stamina, better endurance, better sleep, better concentration. Would you use six months to develop all of that, or just have eight weeks to have this one thing? I think most clients would say, “Oh, I can get more and a lot more with this, yes.” And so that’s how we look at those small changes compounding over a greater period of time to get the whole greater than the sum of its parts.

– Diet-wise, what makes sense in terms of nutrition, and what folks trying to lose that 10 pounds, maybe it is over the six-month period, what are some of the basics that you think folks should consider when it comes to what they’re eating, and drinking, and putting in their body?

– There are a few things that everybody, regardless of trying to lose weight or not, can really start doing that will help them improve overall health performance. But regarding particular weight loss, a few things that everybody can start off doing is one, eating more whole plant-based foods. In the United States, especially in a western diet, we tend on average to not get enough fiber and consume whole plant-based items. And so, more research is coming out that higher fiber, more whole plant-based, not necessarily strictly vegan or vegetarian, but more whole plants throughout the week, with a little bit more fiber, more continuously.

– What are some examples of those?

– Broccoli, carrots, zucchini, cauliflower, squash. Even some of the fiber bars, some of the whole grains that we can consume, like whole wheat, whole fiber-based carbohydrates, breads and pastas. But looking at from the vegetables standpoint, a lot of people don’t consume them enough. And to some degree, some people just don’t like vegetables, but there are ways to actually incorporate them better into someone’s diet. But doing that, one, reduces overall calories but increases fiber content and increases hydration as well. So, we’ve seen in a lot of the research that individuals who consume higher plant-based diets and also consume higher fiber tend to see better weight loss, not only because we’re consuming just overall less calories, but they also fill us up longer. So, we also tend not to crave foods and binge, because we’re not as hungry as often. We’re also getting packed full of nutrients for every time we eat those vegetables. So, we’re saving those excess calories and increasing those nutrients at the same time that that body needs every single day. So, we’re kind of getting this two-for-one deal every time we up those veggies and fruits on a consistent basis. Other things that individuals can start doing is actually consuming water a little bit more regularly throughout the day, especially in the morning and evening. In the morning…

– Why is that important?

– Well, in the morning, hopefully you’ve been asleep for seven to eight hours, which is the recommendation for most adults. So, the second you wake up, you haven’t been eating anything for seven to eight hours, and you probably haven’t been drinking anything for those seven to eight hours. So, about a third of your life is spent not eating and not drinking anything because a third of your day is spent sleeping, which you absolutely need. So, when you wake up, you are relying on yesterday’s food, and water, and hydration to now sustain you. So, one of the things that you could easily start doing in the morning is having a glass or two of water. You don’t have to chug it, but actually getting it in you early in the morning increases that blood flow, increases nutrients, and actually can reduce that resting heart rate. Because now, when you’re up, you’re a little stressed. You went from nice sleep to now waking up. So, getting a little bit of water in you can actually help reduce that stress a little bit, reduce that resting heart rate, and water fills us up just a little bit. So, it can actually help curb some of those early-morning cravings. Doing it at night as well. Individuals who may struggle with sleep. Well, we want individuals to get a little bit of fluid before they sleep as well because that, one, helps reduce that resting heart rate. And if I can reduce my resting heart rate, I can be a little bit more calmer in bed, I can get into what we call a rest-and-digest phase easier. And if I can fall asleep easier, individuals who get more consistent, better-quality sleep actually see better weight loss and better weight management. Because the brain needs sleep to reset. If it’s not getting consistent sleep, it’s saying it’s active. And if it’s saying it’s active, then it needs energy. And if it needs energy, we get it from calories, and it tends to be a lot of sugary, fatty processed foods ’cause they’re quick. And so, more sleep resets and washes the brain to say it’s a new day, we’re good.

– Back to the fiber. I always thought protein was king, and I thought you were going to say protein is what you should start every day with. And, where does that fit into this? Because I think people think fiber, and I think they think carbs.

– Yes. Well, fiber is what we call a non-nutritive starch. So, we actually don’t derive any significant calories from fiber. So, when we consume things like fruits and vegetables, we can have a great abundance of them without having an overload of excess calories. But having rich fiber that keeps us fuller longer keeps the gut health intact. And more research has just recently come out showing individuals with healthier guts digest food better, absorb nutrients better, and potentially see greater weight loss because we don’t necessarily absorb all of those excess calories as well. Protein is kind of the other individual that we always try to encourage. Now, what really matters is total protein intake by the end of the day. So, for those individuals who are focused on maybe exercising already and consuming high amounts of protein, they may not need any more. But other individuals who actually want to see a little bit more weight loss may not be eating sufficient protein throughout the day. And protein has some similar effects to fiber in the sense that it actually creates what we call a satiating effect. It creates a sense of fullness. So, when you consume something high in protein, say a meat or even a vegetarian protein like tofu or tempeh, the dairy proteins, like yogurt, and milk, and cheese, when we consume them, they actually sit in the stomach a little bit longer because it requires a little bit more energy to actually break down those proteins. So, if it requires more energy, that means it requires more calories to actually digest those proteins. So, we could actually burn a little bit more calories by having a little bit of a higher-protein diet. It’s kind of like throwing the high-octane gas in your car rather than the regular. It costs a little bit more, but it burns a little bit better. And so, doing that a little bit more consistently throughout the day means I have a little bit more muscle protein building, evenly spread. The protein takes a little bit longer to digest, so it actually makes my stomach say I’m full, I don’t need any more food right now. So, it actually can help curb some binging and overeating, so that way I can reduce maybe excess calories by the end of the day. And it helps maintain muscle protein. So that way if I am on a weight loss diet, I don’t sacrifice too much muscle. The last thing you want to do is lose muscle while trying to lose weight. So, if I can up my protein and have it a little bit more spaced out throughout the day – we usually recommend every three to four hours having a little bit of extra protein with your meals – if we do that, not only do we help facilitate a little bit better weight loss, but we also may not consume some of those excess unnecessary calories. It takes a little bit more energy to break that protein down, and we save a little bit more muscle.

– Are there any foods or drinks that you say they should be off limits all the time? Like, “This is probably the worst thing you can eat, this is probably the worst thing you can drink”?

– The only foods that you should never eat are the ones that are going to make you sick or worse. And that’s as honest as it comes to food. When we hear a lot of the rhetoric around these kind of absolutisms around food, no one is an expert in every single food on earth. We don’t know how every single food is going to affect all 7, 8 billion of us. And so, to say this food is absolute no, unfortunately, is just not true. We feel, at least from my professional and personal point of view, every food can fit into someone’s diet. You want that frozen candy bar? OK. You want that delicious chicken salad? Fine. But, how you eat it, when you eat it, not feeling guilty about eating it, now really comes down to mindset and building that confidence in yourself as well. But learning how to put it in your plan really gives that individual a lot more control. Because when we start taking control away from someone, over time, they start to want that back, and then they start to gravitate towards the foods they’ve wanted all along. So, the whole idea behind it is not to take things away, but to learn, teach people how to use them to their best advantages and their goals, so that way, they create that sense of control. They have that sense of control around all the foods that they want, but now when they come to that fork in the road, they know how to make the right decision.

– So, I would say the takeaways in the food department is, add in water, more fiber, more protein. When it comes to exercise, and that’s one of those things of, you’re either all-in, or it’s hard to get started. And so, if it’s hard to get started, you used a term with me the other day I’d never heard of: fitness snacking. It sounds like eating, but it’s not eating. Let’s talk about that.

– So, some of this new research has been coming out over the last few years showing that individuals who can’t necessarily get in 30, 45 minutes a day of consistent exercise, it may be difficult. A lot of recommendations state moderate activity, moderate exercise of 150 minutes a week, minimum, for basic health, or 75 minutes of vigorous activity a week or some combination thereof. Not everybody has the same week, has the same day, and just has the lifestyle that can afford them maybe a gym membership, or if they don’t live in nice, sunny weather all the time. So, we have to take these variables into account. So, individuals who may really have strict jobs, or a large family, or some type of maybe hindrance in their lifestyle, that’s, “I can’t do all of this at this one time.” Fitness snacking is basically taking that lump amount of time that you would dedicate to exercise and breaking it up into smaller-partition time areas. So for example, doing 30 minutes of steady-state exercise on a treadmill, out for a walk with your dog, something. Maybe you don’t have the time to do that. Well, the research is showing, actually doing three 10-minute bouts of roughly that same intensity that you would have done in that solid 30 minutes is showing almost exactly the same improvements or benefits you would’ve gotten, significant changes, compared to that one kind of 30-minute session. Or 45, three 15s. And for a lot of individuals, that may be easier. Can I do 15 minutes in the morning while I’m getting ready for school or for work? Can I do 15 minutes on my lunch break and still have another 15 minutes or so to maybe eat? Can I do 15 minutes while I’m watching TV before I go to bed? Something like that. And doing that more consistently sometimes lets individuals realize, “Actually, I have 20 minutes that I could do this. Now I maybe I only need to do two 20 minutes.” Well that’s 10 more minutes than the 30, and now I don’t have to do it at night. So, those small changes allow the individual to garner confidence in what they actually can and can’t do, but then realize, “I actually have maybe a little bit more time or the ability to do more.” So, once you get started in those small things, a lot more doors open up that you didn’t realize were there. And so, those small changes, like we said, create those longer-term lasting results, and they compound on top of each other. So, that’s why we’re always trying to encourage individuals, don’t focus on trying to be at the gym for two hours, focus on trying to get those smaller periods of time in if that’s what’s available to you because you will still see benefits from it.

– Right. And so, in closing, what else do you want people to keep in mind as we’re heading into this new year?

– Whenever comes into the new year, I want people to remind themselves of, it’s not always about trying to lose. Every time we come into a new year and come up with our resolution, it’s always about, “I want to lose.” And I’m not saying that everybody focuses on weight loss, but that tends to be usually the No. 1 goal: “I need to lose. I need to change.” And so, sometimes I try to remind individuals, let’s not worry about the number on the scale. The number on the scale is going to change every day. You drink some water, you drink a pound of water for lunch, you’re going to gain a pound because you have water in you. You go exercise, you sweat, you’re going to lose weight because you’ve sweated out that water. So, it always changes. What I try to remind individuals is, when you come to a new year, and especially if you’re dead set on making a resolution, let’s actually focus on real changes. Why do you want to change this? Or, have you thought about, I’d like to actually garner more muscle and become stronger. OK, now let’s actually talk about the benefits of that. I have more muscle. That means I can exercise longer. That means I have more stamina. That means I feel physically better, I’m potentially less stressed, maybe less anxious because the exercise actually can help reduce those feelings. And that requires more energy to maintain that more muscle, which means I can also see more weight loss. It’s not just about cardio. Resistance training leads to those things as well. Not to mention the multitude of benefits from lifting weights and exercising. And so, also looking at it from the perspective of, what else could you do in that time? I don’t want to necessarily want to lose weight. Great. Now, let’s focus on I want to be at the gym, or I want to be able to exercise three times a week compared to my one time walking my dog. Great. That’s going to improve cardiovascular health, mood, anxiety, stress, physical strength, and potentially see all those other benefits we want to see. So, let’s start reevaluating the mindset of, let’s not try to lose, but let’s try to gain. Let’s try to gain confidence in my performance. Let’s try to gain more activity. Let’s try to gain the ability to enjoy more fruits and vegetables, more consistent protein. And we’re going to see, again, the whole will be greater than the sum of its parts. The other thing I always try to tell individuals, let’s try to focus on maybe something else other than just you. Can we dedicate some time in the new year to volunteer? Can we get out and do more with our family? Making a focus on, I’m going to spend one full day with my family and not work. You’re going to get a lot more benefits from that from a health perspective as well. I’m going to dedicate time to go on a nature hike, or I’m going to dedicate time to volunteer and maybe clean up a local river. My wife signed us up for the river keeper one time, and we cleaned up the river, and we had a great time, spent hours outside. It was good exercise, we met people, and it was just fun. So, I really try to encourage individuals, don’t focus on the lose, focus on the gain, because you will always look back on that gain as a positive and remember it.

– Well, Michael DiBiasi, thank you so much for coming in and talking with us today. Some great information, great way to start the new year. Thank you for your time.

– Thank you. It was a pleasure.

– Welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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