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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Now, we continue our series, dispelling some nutritional myths that have permeated American culture. We're tackling some of those myths this week, with Sophie Egan, author of How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet. She's a New York Times contributor.

She recently penned the article that inspired this series of conversations, called 10 Nutrition Myths Experts Wish Would Die. We're taking two myths a day, all this week, in order, from her article, to do all 10 by the end of the week. Yesterday, we covered myth number one, fresh fruits and vegetables are always healthier than canned, frozen, or dried varieties, and myth number two, all fat is bad.

Today, we get to three and four-- Calories in, calories out is the most important factor for long-term weight gain, and people with type 2 diabetes shouldn't eat fruit. Also joining us today is Dr. Bisi Alli, dual board-certified internal medicine physician, and lifestyle medicine physician. In other words, she's certified in both things, internal medicine, and lifestyle medicine. Dr. Alli, welcome to WNYC, and Sophie, welcome back.

Dr. Bisi Alli: Thank you so much for having me. [crosstalk]

Sophie Egan: Thank you, great to be here.

Brian Lehrer: Sophie, let's get right to your myth number three-- Calories in, calories out is the most important factor for long-term weight gain. You mean it isn't?

Sophie Egan: Well, this one is a little bit of a half-truth. It's true that if you consume more calories than you burn, you will probably gain weight, and the converse is also true, that if you burn more calories than you consume, you will probably lose weight. The key part about this myth is the long-term point. This is only true, what I just said, for the short-term. The research does not actually support the idea that eating more total calories will cause sustained weight gain, that can ultimately result in becoming overweight, or obese. That's the real distinction there.

Brian Lehrer: You write, "Ultra-processed foods such as refined, starchy snacks, cereals, crackers, energy bars, baked goods, sodas, and sweets can be particularly harmful for weight gain." What about ultra-processed foods actually might make you gain weight more than other foods with the same number of calories?

Sophie Egan: I interviewed Dr. Dariush Mozaffarian of Tufts University for this myth. He emphasized that it's the fact that these ultra-processed foods are really rapidly digested and flood the bloodstream with glucose, fructose, and amino acids, that are converted to fat by the liver. You can think of it as they're too efficient a delivery system, and that's really what leads to that long-term weight gain.

Brian Lehrer: Dr. Alli, I will ask you in a bit about the next myth, which is what you're really on for, but anything you want to say about this one?

Dr. Bisi Alli: I loved Sophie's article, and I just want to echo that it is about the cons of convenience. We want our bodies to do what they do well, which is to process the nutrients that we give it, in their wholest form, so a holistic form. That means the benefit of eating apples, compared to applesauce, we get more nutrients, fiber, vitamins, or even apple compared to when we eat things that are more processed and previously digested for us, like applesauce.

Brian Lehrer: Sophie, before we go on to myth number four, since one of your specialties is human behavior and nutrition, what do you see, what do nutritionists see as the real solution here, if folks are looking to lose weight, or maintain a good weight, and keep track of what they eat in our fast-paced world?

Sophie Egan: Well, we've really internalized culturally, the idea of just counting calories. It's just a simple math equation. The behavior that needs to shift is to really start to prioritize quality over quantity, and that's the guidance from Dr. Dariush Mozaffarian. I would also add that it's really that intersection of quality and quantity. It doesn't mean that calories don't matter.

It just means that we need to shift away from viewing that as the sole element in the equation, and really optimize the quality of the foods, to the point that was just raised, about really whole and minimally processed wherever possible, in addition to that very well established calorie counting.

Brian Lehrer: All right, myth number four-- People with type 2 diabetes shouldn't eat fruit. Dr. Alli, I actually see this as related to the other one, because a calorie is not a calorie, and I guess you're saying sugar isn't sugar.

Dr. Bisi Alli: Perfectly well said. I just want to point out that diabetes is super complex, so much so, that we are actually grateful for all the updates that come from research that informed better decision-making of physicians and other medical professionals [unintelligible 00:05:07]. The American Medical Women's Association, and the American College of Lifestyle Medicine have teamed up to be able to provide more education on topics--

Brian Lehrer: You know what? Let me jump in for a second, because something happened to deteriorate your line just now, so we want to fix that. Sophie, I'll give you a shot at that for the moment. What do you enter with people with type 2 diabetes shouldn't eat fruit as a myth?

Sophie Egan: I think that the reason for this myth is that there is reasonable concern about sugar, but as was just noted, it really depends on how that sugar is being consumed. The conflation is equating juices, which can raise blood sugar levels because of that high sugar and low fiber content, so that ultra-efficient delivery mechanism that we described in the previous myth with whole fruits.

It's that difference that was just mentioned, a whole apple that has the fiber, the structure that helps slow digestion and slow the absorption of that blood sugar. That's really the key, and it's to help those who may be at risk for type 2 diabetes, as well as those who already have it, to actually reap the very well-known health benefits of eating whole fruits that can actually help control blood sugar.

Brian Lehrer: Dr. Alli, I think we have you back. Does this apply to all type 2 diabetics? We may think simply, type 1 and type 2, but as you were saying before, it's complicated, and are there certain fruits that are particularly healthy for people watching their sugar intake?

Dr. Bisi Alli: Excellent question. Diabetes, especially type 2 diabetes, rather, is considered a lifestyle disease, meaning that what we put into our mouths, and how we move our legs do inform our ability to not only prevent diabetes, but when people do have it, to control and even potentially reverse diabetes. Very much important that we consider not just the types of fruit, because yes, there are fruits that have higher glycemic index, like watermelon, and pineapple.

It's more about what we're eating in addition to that, and how we're eating that. For displacing cookies, cakes, crackers, with fruit in its place, that's great. If we're eating those in addition to that, doesn't help to optimize our blood sugars. If we're eating whole forms of fruit and vegetables, ideally, and exercising, we're going to get the best benefits from our lifestyle changes.

Brian Lehrer: Are you also saying there that some fruits, including watermelon and pineapples, what you just named, you just name those two, are worse for people with type 2 diabetes than other kinds of fresh fruits?

Dr. Bisi Alli: Not so much. More saying that those two are examples of fruits that typically have higher glycemic index, they spike your blood sugars more easily. Instead of avoiding them, we want to eat them, say, with other things that have higher protein sources from plants, like nut butters, or plant-based yogurt, and also more complex, high-fiber foods, which fruits do have, and other vegetables.

We just don't want to eat exclusively fruit alone, we want to eat that with vegetables, oatmeal, and spinach, so that we get a more balanced diet. That's the goal, is to eat the rainbow and eat the foods as they come, in their most original source.

Brian Lehrer: Last thing for today, and we'll continue this series tomorrow, Dr. Alli, not only can some people with type 2 diabetes eat fruit, but it also might be beneficial, I think you say, for those who are at risk of developing type 2 diabetes. What does the research say about that?

Dr. Bisi Alli: The research is compelling that when we adopt a diet that's diverse in plant-based foods, meaning vegetables, fruits, legumes, like beans, nuts, seeds, and we're eating them in diversity, by color, and we're making sure that those are eaten over other processed foods, like crackers, cookies, and doughnuts, that we can prevent diseases of lifestyle, like diabetes. I just want to reassure the audience that this information is also something that comes from research.

That's the benefit of having your clinicians who are also aware of these important factors. The American Medical Women's Association and the American College of Lifestyle Medicine have teamed up to be able to provide more training about topics just like this, for free, to clinicians all over the United States, donated even 22 million towards these efforts. We want patients to take advantage of the fact that they can find people that can help them to eat more of the rainbow.

If you can just focus on eating more color in your diet, and focus on less processed, the difference between even a smoothie, and eating the banana, the better off for you.

Brian Lehrer: Dr. Bisi Alli, besides being an MD, is a board member of the American Medical Women's Association. We will continue tomorrow with Sophie Egan, author of the book How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet, as we continue to go down the list in her recent New York Times piece, 10 Nutrition Myths Experts Wish Would Die. Dr. Alli, thank you so much. Sophie, talk to you tomorrow.

Dr. Bisi Alli: Thank you for having me. [crosstalk]

Sophie Egan: Talk to you then. Thank you so much.

Dr. Bisi Alli: I love NPR. Bye-bye.

Brian Lehrer: Thank you. Brian Lehrer on WNYC, much more to come.

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