5. EC Synkowski, MS: An Elegant Solution to Nutritional Woes, the 800g Challenge, 10 Principles, "AND" More

Hello everyone, I'm Dr. Darsha Shah, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined, a podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. It's a month into 2021. You are finally ready to commit to this year being better than the last, but you're still spending your evenings catching up on notes when you could be leaving work with a clean slate. On-time MD teaches physicians critical time management strategies tailored specifically for the unique demands physicians face. Strategies cover the exam room, inbox and EHR meetings and more. Regular module how to delegate without dumping addresses how to delegate tasks to your staff in a way that doesn't make them feel dumped on but inspires them to do their best work. Course creator Phil Bouchet, pediatrician and podcaster wants you to join other physicians who understand the value of their time but are struggling to make a clear and executable plan for action. Join today and say 15% by using the code 2021 at checkout. You also get a money bag guarantee if you don't reclaim three hours a week in the first two months. Now is your chance to join on time MD in reclaim your time for good. Go to doctorpodcast.work.com slash on time MD to get started. Our guest today is EC's in Kowski. EC is the owner of optimized nutrition accompanied with a mission of providing solutions for anyone to improve their health and well being through sustainable dietary methods. Her 8-hennagram challenge has gained a tremendous amount of attention and for good reason because it's truly an elegant solution to a lot of the confusion around nutrition in today's day and age. EC's academic background includes a bachelor's and biochemical engineering a master's in environmental sciences and a second master's in nutrition and functional medicine. More importantly over the past decade EC has been at the forefront of providing quality nutritional education by translating the evidence-based scientific data into practical solutions for everyday success. Her podcast that consists of your project is one of my favorite shows to listen to because she provides valuable digestible insights on the complexities of nutrition. Darshan and I had a great discussion with EC in this episode. We touched on some key points including the opportunity cost of poor nutrition and why we spend so much time and energy addressing this component of health. We talk about the quality versus quantity debate if one is more important. We of course get into her 8-hennagram challenge lazy macros but largely her focus on principles of nutrition rather than any one specific diet. And most importantly we talk about how to implement an influence change on a global level. We had a ton of fun interviewing EC and learning from her but by the end of this I had twice as many questions as going in. Unfortunately though due to time limitations we were not able to continue this interview. I suspect though that this won't be the last time we have a conversation. Now without further delay please enjoy this episode with EC Sinkowski. All right hello everyone welcome to another beautiful morning here. We have none other than EC Sinkowski. So EC welcome thank you so much for joining me in ALT. If you could just tell the listeners who you are you know some of them may have seen your YouTube some of them may have seen your Instagram but can you go ahead and just let us know who you are. Yeah well thank you so much for having me on first of all and yeah I'm EC Sinkowski. I'm the founder and owner of Optimize Me Nutrition where I offer B2B and B2C products to help people get sorted in nutrition and yeah I think people might know me if anything from the 800 gram challenge it's sort of my lead in product. It's really I'm whether or not it's the 800 gram challenge or any of my products. I just want people to find something that's sustainable for them that actually works for nutrition. Awesome yeah EC thank you like Darsha thank you for coming on. I've been so pumped for this conversation. I think the first time I heard you was on the right estate and just your message really resonated with me and then immediately after that I kind of went to have a podcast downloaded the consistency project and kind of just bins through all of those I think I mentioned how much I enjoyed that content and so I've wanted to get you on here for such a long time especially after a recent interaction and just a bit of background for UNR listeners you know I've repeatedly said that nutrition when it comes to nutritional science quality tends to be the most important thing and you know we recently had Dr. Arnton here he's one of my mentors and we talked a lot about nutritional timing and I think we can all agree that that's probably the least important variable when it comes to quality quantity timing but that's one of the ones that we get the most questions about people talk about intermittent fasting time or should it eating you know peri work out nutrition those types of things so we wanted to address those questions first but last week when I asked you to come on and I mentioned that quality was the most important thing you politely disagreed and so I've been anxiously waiting to kind of you know ask what you meant about that so I think that's probably best place to start so yeah yeah you know quality and quantity are important and they often are related and even with timing timing is often related to quantity so I think some of our confusion we keep running around on like which one is best when it's like if we just use the word and we'd be better off right like instead of trying to worry about the one thing let's go ahead and use that word and then we're going to get there but yeah quality is not necessarily more important than quantity in fact I just I've worked with many people but just had a recent interaction with one of my clients and guess what she was overdoing it on the whole quality foods the olive oil and the homemade bread and all of the high you know organic locally sourced whatever so you can still eat too much quantity certainly is a factor for health and we find that all the time that people losing just even five ten pounds in their health markers dramatically improve I don't think they're anywhere near the eight hundred gram challenge or a lazy macros approach but yet we've improved their health and this is simply because there's just less stress on their metabolic health right like their blood glucose is coming down the triglycerides are coming down cholesterol is coming down and it doesn't have to be with this paleo perfect approach and and that's why I don't try to get too dogmatic about nutrition that you know simple changes even in just quantity even if it's less McDonald's we've got some good changes to make and it can be really significant in terms of their overall health picture now why I attack it from the quality perspective is is that we kind of can kill two birds with one stone right like when we focus on quality quantity tends to come down and so this is where those factors tend to be related but if I've got someone and they want to do McDonald's great I'm running with McDonald's and we can get there we can get to some better outcomes as well awesome yeah so you know speaking about that our listeners are probably going to be hearing this episode in in January right 2021 a lot of people are going to be starting diets fat diets maybe it's paleo maybe it's the beganuary maybe it's carnivore um and a lot of people are either going to be struggling with it or they're going to be doing well but can you just explain why so many diets fail and I know you love puns so how can we fuel you know the drive and passion for people to keep it going yeah I do love diet puns when I can work them in um why do diets fail so yeah I mean I there's a lot of different reasons but I think people think there's this one new magic answer or there's one thing you know this one extreme way to do it and they're going to find the best way and for some reason we just keep overshooting like the balanced approach you know it's like some one of my clients just said this and I just love the way that she phrased it it was like for some reason you keep thinking that the more extreme approach is going to outperform the basics that you've been taught forever and like we just keep staying on the outer circle if we just sort of like calm down a little bit and took a balanced approach we're actually going to the results in a more sustainable way so I don't know I think people typically fail diets because they overshoot they want this extreme approach they think they're going to get these results they think that there's something unknown and it's like no guys we know what works and like I don't know if it's just not sexy enough I don't know what the problem is but we just like keep going past it yeah yeah so so you know go on on your Instagram look at your stories now just in the last couple days you're kind of tracking this 800 gram challenge that you started can you take us through that what is the 800 gram challenge for people that don't that for those that don't know about it sure yeah the 800 gram challenges to eat 800 grams by weight of fruits and veggies each day and then you continue to eat whatever else you want right so this is one of the big reasons why it's different than so many other diets is because you're just focusing on addition you're not focusing on elimination you're adding fruits and veggies to the diet and of course that's not all you eat either like people are like is that all eat no no you eat whatever else you want in addition to those 800 grams you also get to pick which fruits and veggies you want if you want to do it on all fruit great you want to do it on all veggies paleo perfect low carb whatever great you just pick the fruits and veggies you want it also doesn't matter if they're cooked canned frozen or fresh so we're not worrying about locally sourced organically grown whatever kale you're you're just having as as you have it you get to that 800 grams and that's it and that's the basic premise of the challenge and to me it's just a really sustainable way to kind of check yourself on quality it kind of came up as this idea of how do I put a metric on quality how do I know when I'm eating a high quality diet because you could say like well I eat a lot of fruits and veggies but what's the metric what's the standard and so this is really how that idea came to be yeah is there a reason you choose 800 grams like rather than a thousand or 600 was there like a research study that's based off of or just just kind of no for sure that there was I was actually playing with a couple different diet ideas at the time I was this was when I was in my masters for nutrition and functional medicine and I was playing with a couple different quality focused diet ideas at the time that I happen to come across this study by Eun at all I hope I'm saying it right it's a-u-n-e in the international journal of epidemiology in 2017 and they were looking at health risk reduction relative to fruit and vegetable consumption okay so they're looking they actually did a meta-analysis of 95 different studies they pulled in all this data said okay when people eat this many fruits and vegetables what happens to their health outcomes and of course they found that 800 grams was a significant number cancer risk actually went down at 600 grams but then stroke all cause mortality cardio vascular disease risk went down to 800 grams and so with this idea of like you know how do I make this into a diet while reading this paper I was like that's it that's a really interesting idea but then of course especially for our US based audience it's like well what's 800 grams like what does that look like and what does that mean in terms of calories and macronutrients and what are the rules going to be like our beans allowed because like for example they didn't include beans in their study and like am I allowing them what about tofu what about you know all these questions so so that's really then where I kind of started playing with it and I played with the idea kind of tracking it myself doing it myself taking data on it putting rules around it for about six months before I was like yeah I like this and then so kind of publicly launched it as a as a diet idea in 2018 yeah you see this has definitely been one of my favorite things and I'm doing it myself actually and so I guess I'm we're gonna talk a little bit more hopefully about lazy macros that's more of the purse that I'm taking but you know just to kind of going back about the quality versus quantity debate and just after I talk to you of course because I'm type A and impatient I kind of went back and just double speeded through some of your podcasts again and the thing that I took away from it is you know I had personally this owned bias that quality tends to be the most important thing of course you know once I got into medicine we're looking at health and longevity those types of things whereas when you're looking at calories in versus calories out you tend to focus a lot more on quantity too but with this 800 gram challenge like you mentioned when people tend to consume a lot of vegetables the volume like and you've done this over the last couple of days you know what 800 grams is sometimes anywhere from 300 to 500 calories and so you're kind of really taking both of those I mean you're killing two birds with the one stone but also how we tend to kind of have our own biases and confirmation bias and when I went back and listened to your podcast that wasn't really your message you weren't emphasizing quality or quantity you were kind of saying both are important but I had this all my own notion and I was like okay that's what you see saying you see agrees with me and therefore I am right and so I think that's really important for us to understand particularly as clinicians as we go through this literature and we're trying to fish stuff out are we only looking for things that support what we already believe versus I think at some point you mentioned that somebody said to you hey like you know you can find any type of research article to support something and you're like isn't that crazy because that means more than one things works and the twist back to the whole idea of hey let's use the word and not necessarily either or so I want to thank you for that yeah I felt humbled after that but in terms of their research study that you talked about in the journal epidemiology I did go through that and that was going to be my question for you hey like you know the beans weren't included and when you look in the fitness space I know you work with a lot of prosecutors and those potatoes beans these are starch stuff we take we look at them as carbs why include those why not just include the fibers vegetables yeah yeah I don't think the literature on potatoes and beans is that problematic you know we find that when people have beans in their diet or when people have potatoes as potatoes not french fries from McDonald's we find that they're probably eating healthier diets overall and so yeah it was just sort of like let's include things let's make this even more flexible like no one's overeating black beans I mean maybe someone's overeating air fried white potatoes but like okay let's stick to reality like not everyone's going to eat 800 grams of that every single day and if they are it's probably better than their current diet so I think a lot of nutrition you have to kind of realize that there's a lot of trade-offs like you have to meet people where there are and find some level of buy-in and not everybody wants to do 800 grams of kale and guess what they don't have to either so how do I get buy-in how do I get interest how do I make this sustainable and the more choices that you give people the more likely it's gonna happen and then of course I mean we could go down the rabbit hole of like the nutrients that are in beans and potatoes resistant starch of course you know and in all the phytochemicals in the beans and all the different fiber types and there's some value there so it's like I think they've been maligned and people like our obesity epidemic is not because of the white potato like it's just not at least not the white potato oven roasted at home right right yeah no I love that and so when we're talking about you know all these nutrient dense foods particularly the vegetables right the the fibers vegetables the carrots and all the fruits and things that you've been posting about what do you think the mechanism is right did they discuss that in that paper at all is it kind of just hey you're consuming less volume and you know you have more quality consumption which is gonna equate the weight loss and therefore better health or is it hey all the polyphenols and carotenoids and you know the antioxidative benefits that might have which may improve vascular and endothelial dysfunction or is it just hey simply reducing sodium and increase in fiber and increase in potassium because of fruit like do you do you think there's one or is it again and multiple things yeah yeah and and of course there's gonna be genetics come into play like some of us are gonna be more risk or more have more risk associated with endothelial dysfunction right and then some of us are gonna be more antioxidant capacity or whatever the permutation of that is you're gonna remember more about the paper that I have because I haven't looked at it probably in the last year or so but I do remember that they were trying to look and see which of the fruits and vegetables were more associated with less risk or more risk than others I think they were trying to group like do berries and apples or something like that like have a better health outcome than others and I don't totally remember there they're finding there but that's where there's a difference between what you're doing at the research level and like okay now I'm going and working with real people like I don't care if the study found that only blueberries were the best fruit out there like let me tell you how many days someone's gonna stick on the all blueberry diet it's not many okay so you know this is where we can't get too lost in you know what exactly does the research say versus what kind of outcome actually changes something clinically and so that's where I'd have to go back and look and see exactly what their conclusions were there but that's where I kind of added my my experience with working with people and just living it myself right like I started I made up rules that I thought were valuable that weren't necessarily part of the study yeah no and so since then though like I know you said you hadn't seen that paper and quite some time have you come across other meta analyses because I know that what was interesting at least in that paper because again because I recently looked at it is they quantified they said hey 80 grams is one serving and therefore 10 servings is kind of what 800 gram it quays to right so just I was on looking at on PubMed seeing hey well what else has been out there and I recently came across this paper in in 2020 is a meta analysis and nutrition reviews and they essentially wanted to look at fruits and veggies and improving cardiovascular risk factors and in this paper interestingly they said that hey greater than three servings of fruits and vegetables lowered diastolic blood pressure some of the lipid parameters like triglycerides specifically so what was interesting is 800 grams just 10 servings and just as little as three servings so I thought that hey is that do you think that this standard American diet and we're not even getting three servings of vegetables do you have any sense of where we are like obviously I think we're doing a lot better today than we were maybe even 10 years ago but do you think that this the average American on this sad diet if you will is even taking three servings a day I think you're onto something I mean according to the USDA 80% of people aren't getting enough fruits and veggies now where their recommendation falls out to the 800 gram challenge the 800 gram challenge can match their their systems a little bit confusing which is why I made up something else but I would say that their recommendations fall closer to the 600 gram level on average and they say that 80% of people aren't getting enough fruits and veggies so yeah I don't think I think the standard American diet maybe has 200 grams and it's going to be from white potato or corn or something like that so yeah we have a lot of work to do and that's why just even small changes and this is why we can't be so obsessed with having the perfect paleo diet because like we don't need you know the perfect diet to have some some great outcomes for sure awesome awesome and so again for for those of us who are very much interested in performance as you mentioned you know we got vegetables in there we'll have some fats so I'm sure that people will try to find a way to sneak them in but again what about protein yeah so this is where lazy macros come in as I understand correctly so you want to talk a little bit about that what that means exactly and how you came up with that concept for sure so yeah I used to work for CrossFit that's kind of my tribe right like I've done CrossFit since 2006 I have a lot of people that are interested in fitness around me so when I came out with the 800 gram challenge a lot of CrossFitters were like this is cool what about protein right and I was like yeah yeah I know I know I just haven't figured out how I want to solve that problem yet and so lazy macros was ultimately the answer to that and lazy macros is just you're continuing to do the 800 gram challenge and then in addition to that you're going to now add this protein target and the protein target that I put out there like the 800 gram number is 0.7 grams per pound of body weight it's generally of your current weight but if you have a significant amount of weight to lose more likely you're going to go with your target weight but the idea is the same you're just sort of hitting this baseline number and then you continue to eat whatever else you want so you eat the fruits and veggies you hit the protein target then yes you can still have the wine the dark chocolate or whatever and and that number is really from a whole different bunch of sources but for my athletic population it's where we find people put on muscle mass from resistance training as well as preserving mass when they're in a cool orc deficit so that probably covers I don't know 99 percent of the goals that of people that I work with so that's where that number came from but you see how am I supposed to get all my protein in if I can only digest 30 grams at a time so that's obviously a myth right that we've now kind of figured out can you can you take us through what you know how much you can actually absorb absorb or digest and kind of just take us through how protein works in the body I think so we we do have a lot of meds who listeners to this I think it would be awesome if you could just explain that to them yeah I'll try um so digestion isn't a 100 percent perfect process um it's a crude analogy but I like it it's sort of like a car wash there's a lot of things going on there's a kind of a train track approach to this it's not going to get every spot off your car digestion is not going to break down every single muscle that you had into this molecular components to be absorbed whether or not that's the amino acids you know fatty acids etc but it's pretty darn good and your body regulates how fast it moves through this track in part because it wants to get all those nutrients out of it right like it's not going to have things moves through so quickly that it won't get the protein out that it needs and so this is where some of the research that suggests that you can only absorb food at a certain rate we we have to look at kind of how how they tested that and if they tested that with only looking at 30 grams of protein at a time that that research isn't going to be applicable to when you eat you know 50 grams of protein at a time or when you eat a large Thanksgiving meal like your body is going to slow down that whole process such that we absorb it so so yeah I mean your your body will hold this food longer in the stomach sometimes several hours so that's it releases almost like a slow drip to then your small intestine where most of the nutrients are absorbed and yeah I mean I think some of these rules that I care about nutrition um and I believe them all you know like I I thought they were all true too but I think what really helps with some of this stuff is you take a step back and you're like how did humans get to like 2020 if that was the case like like would wouldn't we all be dead if like we only absorb like this perfect amount of protein like it just it just seems a little bit gimmicky to me and I think that kind of taking a step back and being like wow we we've been here for a lot of years and somehow we didn't know this to like 1990 well maybe it wasn't actually the right fact right maybe we we have something wrong about that piece of knowledge yeah I love that because I think in some sense we were able to accept that hey you know we had these periods of fasting and periods of feasting and that's what we should start doing fasting again but then you know for some reason the protein to myth was much harder to squash so thank you for kind of sharing that um so again as I mentioned I've been sold on this like it just because I think this is so easy to implement um at least it is for me I'm sure that you're seeing a lot of folks that we're still having some some challenging uh for trying to eat even 800 grams of which investibles a day but you know I think easy in order for us to make these changes stick and make substantial change down the road we're talking 10 20 34 years down the road I know that you currently 41% of the American population is obese right and and that's expected to be greater than 50% in the next 10 to 15 years which is terrifying um all three of us here are hoping that we can do our part to try to avoid that so I think in order to do that we have to just start implementing these or get these concepts involved at a young age right particularly in children we know that we all take hey if you want a child to to learn how to play the piano and exceptionally well they need to start when they're really young same thing with any other skill yet nutrition we're not teaching these nutritional approaches and science and behind it so um is the 800 grand challenge is that safe to to kind of help implement with our children again we're not giving advice to anybody I think we all understand that but is that something to start teaching them and how can we incorporate that teaching our kids with this nutrition yeah um you know historically speaking kids are eating more than 500 calories wow but really early on um I just really don't like numbers for children even when they're additive and not restrictive and even though the 800 gram challenge isn't looking at calories or macronutrients I just don't love this idea of like today you will eat exactly this plan I think taking a page out of CrossFit's playbook for kids um one of the things that they do is they're like you have to pair fitness with fun and I think nutrition can kind of be seen the same way like it doesn't always have to be ice cream and cake but like it shouldn't be this sort of drudgery in this routine it should just be part of the family meals and fruits and veggies should be regular and that's what should be available and I I think that's the way to really approach kids now I have worked with um pediatricians they've done it with their children I've worked with plenty of other people who have done ideas with their children but I think the key is keeping it flexible maybe it's observing your child and be like wow they literally eat one piece of fruit a day let's make it too like that's a great place to start with children not like we're gonna write down your numbers and leaderboard you you know I think probably by the time they get to high school something like that would be more appropriate again because they're not focusing on calories or macronutrients and you know they're just focusing on the weight and addition but I really don't like this idea of setting hard numbers I think setting the basics of healthy meals healthy eating what's available what snacks what are our behaviors around food are way more going to pay off and then sort of setting a number for kids love that gotcha and that makes a lot of sense I argue with Ultima I think they eat underground challenges it's it's super easy when you kind of if you're someone who likes data which I think you know as a nation we're getting into a very we're all data heavier I got a boob we got bit bit bit you know apple apple watches um so I just think it's such an awesome way you know to kind of not complicate the overcomplicated things that we're doing um so I kind of wanted to switch gears here instead of talking about the macros can we delve into the micro so you know being on Instagram I see almost every other pose talking now more about like vitamin D selenium iron himlansol you got to get your micro's in um what how much of a how much do you think these micro's actually play a role and is it something that we should focus on or do you think the macro approach is just good enough yeah I mean it's gonna come back of course to that and right like quality and quality like I want both for sure I do think they matter that the reason why they're essential um we want them in our diet but again I I I don't know like all this stuff like oh am I getting my selenium today or oh am I getting my magnesium today it's like well just go eat fruits and veggies and like whole food protein sources and you're gonna get there like you know some of this too much of a reductionist approach it just gets a little bit silly um so yeah I like people focusing on micro nutrients but not on any single one but on them from the standpoint of when I eat whole foods there's a mixture of them and when I eat a mixture of whole foods I'm going to accumulate the mixture I need that's about the level of specificity that I think people need um for micro nutrients yeah yeah so do you would would you say it's probably worth it to get like these labs for micro nutrients and if you're seeing more than one maybe two three that are like you're kind of low in then you're kind of getting a global picture of okay I need to add more of these like fruits and veggies in or you like because because you just said that you don't think maybe one is enough to justify the change every sure yeah I mean I think well vitamin D is an interesting one because I think there's some issues about the test quality itself although that could probably be true with a lot of micronutrients I have to look more specifically at that um testing is interesting to me uh one of the things that I like to bring up about testing is like this is true of like you know got microbiome testing we could do it for micronutrient analysis testing it's like okay what's gonna change like great we get your results back guess what I'm gonna tell you to do eat more fruits and vegetables like sometimes I'm just sort of like why do I need the tests like what is the test how is that gonna change my direction afterwards most of the time it doesn't now what's interesting about that is some people are motivated by seeing the test result so there is some value there some people when they see oh my gosh my glucose is through through the roof I need to change great if that's what I get you on board with with the 100 gram challenge I'm all for testing I don't really recommend testing though because I have a feeling my my approach afterwards not gonna change partially because I'm also not a doctor right like I'm not looking at lads in any sort of therapeutic way so like my health recommendations aren't gonna change um they're gonna be more fruits and veggies eat the right quantity get enough protein you know exercise sleep and all of that stuff um but again like some people like the data this is why apps are great this is why loop is great like I don't necessarily have to love the product um and and I'm not speaking against any product but I don't have to like agree with everything about the product to realize that there can be a good outcome and this is true with any diet out there this is true with any sort of fitness app out there like if it's driving the change then great do it yeah you see that's such a sound point by you um you know it's it's so funny I think for my physician colleagues we are taught over and over like let's just use muscle skeleton medicine example right somebody comes in with knee pain and you do a thorough exam um you you don't order an MRI you don't do an ultrasound you don't do imaging if there's nothing that's gonna change about your plan you're imaging the the labs everything else the data is supposed to support what your ultimate assessment and plans gonna be and if it doesn't change then there's really kind of just wasting money time unnecessary radiation exposure if it's that type of imaging and so it's the very much the same when it comes to micronutrient testing those types of things that being said though um yeah I think checking an A1C and trying to use a somebody's A1C of 11 it's a little bit different but also it's less expensive so I think that as healthcare providers you know we have to kind of know hey is is the the cost of this test you know the value that I'm gonna get from it is that the benefit gonna motivate individuals can be much higher than what the cost is and I think that that's kind of where your clinical just all comes into it so I do appreciate that uh but speaking of of physicians um I want to thank you because you kind of had her back I think nowadays when you look at social media people are just bashed in doctors left and right uh say oh big pharma this and that you know doctors don't know what they're doing and it's a conspiracy um and I get it I get why that is um because again I think a lot of it is a lack of education right we aren't taught about nutrition where I mean we know that fruits and veggies are good or grandma said it great grandma said it um but that's not what we're learning about medical school we're learning about medications and different type of studies and trials and those things of that nature so um ultimately what would you want physicians who are listening to this this show here to take take away and how can you know they start implementing some of these nutritional um approaches in there to kind of help their patients hmm yeah it's tough I mean I I support conventional medicine a hundred percent um I don't know that their physicians are responsible for our nutrition was um you know they're they're there to save you they're there to put in the stopgap they're there to make sure that you don't die tomorrow they're not there to live with you every day and make the right choices um I don't really know that it's their responsibility I mean this is what how are you responsible for any of your daily behaviors um I I think this has to be a multi multi prong approach to really drive change in our society as a whole I do think we can be doing better with education um you know in terms of our public school system I don't know if it's more public service announcements that apparently helped with smoking somehow we were able to get that down maybe it's more um federal assistance on fruits and veggies and and and maybe there's a sugar tax I don't know it I think there has to be multiple different ways to do this but like under our current system how is a doctor with 15 to 20 minutes going to assess vital labs and make a therapeutic change when I work with people for weeks and we maybe get to you know implementing fruits and veggies right like I think we're tasking our doctors with something that their scope is not and nor where their qualifications are nor do the way we want them to be like when I go to my doctor you know if I have a kidney problem I want the guy who's been researching the kidney and looking at kidney labs for like 20 years right like no he's not going to know about glycogen storage post workout and that's okay so sometimes I think we're just sort of asking too much of them right um and for some reason it's another way that we can outsource the blame game um and there's got to be some level of personal responsibility and then of course some assistance um or other programs and other ways for other populations as well yeah no I mean I definitely appreciate that I'm the same way I think that yeah if I'm going to go see somebody who's going to be for shoulders on what somebody who's had a couple of thousand uh shoulders if it's surgery I mean I think that we very much take that into account but at the same time we also expect that person to know exactly um you know which micronutrients would test if if that's what you're going on on how the once you should be managed perfectly um but but that being said though I do think that there's a foundational level that is very important right because I again um you know if if if we get this right the nutritional aspect sleep exercise diet if though we get those things right a lot of our health was we don't even have to go to the doctor and that's our goal is darshan I talk about this is so many physicians we say preventative medicine preventative medicine um but we don't practice it and so I think that we in order for us to truly practice preventative medicine this something that you kind of have to just invest your time if medical school isn't going to teach you and I think some medical schools are doing a great job um unfortunately ours didn't uh and that's cool too hopefully in the future they will but we have to invest the time ourselves uh to kind of learn this because this is important and it's becoming more and more important um but maybe before we move forward we should maybe talk a little bit about the the opportunity cost of poor nutrition like why does this even matter right I know you did a really awesome podcast on this but um you know for my physician colleagues who hey they're like listen I'm interested in the shoulder I'm interested in the kidney and I want to spend my time that's cool too but why should we care about um you know why should we look at these meta analyses for nutrition rather than looking at statins and you know other drugs and those types of things and study about that stuff yeah yeah yeah I mean I think I think that we have the ability to spend time on other diseases or other conditions where we don't have the answer yet right um where diet nutrition can prevent so much even not just from you know a high cholesterol statin cardiovascular disease risk point of view but an orthopedic risk as well um and that we're we would be able to spend all of those resources elsewhere that could have a better payoff to society um and so that's I think where I get really motivated because it's like yeah we can do this with diet and exercise why do we have PhDs like researching you know drugs for obesity it's like let's get their brains on something else like we can use that power somewhere else we can use all these resources somewhere else so I think there is an opportunity cost lost um and that's why I would love to see you know a lot of that money that's being spent there like going into preventative education or going into subsidies for fruits and vegetables or I don't I don't know I haven't researched into all the solutions they're going into sugar tax or like how do we make these change how do we make such a dent in smoking what can we do from a fruit and vegetable perspective because I think the payoff is going to be worth it um and so that's really what what excites me and and what I would love to see some change in yeah I think this definitely above all our pay grades to try to figure out solutions for that but we're hopeful and that's why we're here today um speaking of making changes I think that for most people or at least for me selfishly you want to start with your loved ones right I tell my wife this I'm like you know what am I doing if if I can reach maybe a hundred two hundred people but I can't get my parents to start eating right or my siblings and those things uh and it's really funny before I became a physician my uncle always used to say that I'm a doctor everywhere except my own household because his mom would never listen to what he has to say uh and and I found that to be true you know my mom my parents um when I would try to communicate with them again as I mentioned I was in the fitness industry and I came home and I was like oh we got to get this out of we got to eat the cage free eggs and we got to go to free range eggs and this and don't buy this even though they're four times is more expensive um I imagine when you first got into true space uh you had some of those difficulties uh communicating with your parents or some of your loved ones um how do you suggest that people might approach um you know when you're communicating with your loved ones when you know they're doing harm and from a selfish perspective you want to protect them because you love them um how can you communicate that uh effectively I don't know that you can um besides kind of just living it and doing it and practicing it and being ready for when they wanted make change um you know I I don't recommend just approaching somebody and being like let's talk about your nutrition in fact like I don't ever bring up nutrition unless I'm asked about it um I think that's from some years learned but um yeah I mean it's just sort of like a staining with everything like people make change when they want to make change and they're going to be motivated by certain things and so you want to be receptive and a good source for that when they're ready you don't want to cut off that possibility right and and by kind of berating them and you have to change and do things my way all of that stuff I can assure you you're you're probably cutting off the chance that you're going to be their resource when they're ready and so I think it's better just to yeah you eat fruits and veggies when you go out you eat foods you often make the the quote better choice whatever it is you maybe bring an option for the family dinner um you maintain a healthy lifestyle and then guess what when they're ready to make a change I'll probably like oh what are you doing and and that's where you have your window and and then then your window to get in and help them make change uh hopefully sustainably in small steps yeah right as uh as Patrick you don't jump in with 14 studies right right it's like I don't know I mean I get questions all the time like do you have the study to show acts and it's like yeah but like is sending somebody this article really really the internet email war like are you gonna get anywhere with that like no just just wait until they're like hey what are you doing for nutrition and then hey why don't you eat some fruits and veggies to join this Facebook group or whatever and that's that can be the the help they need right yeah absolutely for me like you know changing my parents behavior actually sent them a book that was related to South Asians right you know it was I feel like you got to get a little personal uh meet them halfway but again it's going to come down to that self realization for that individual um but speaking about so I'm very much obsessed with like clients and patients psyche right how do we instill change and obviously that's that's very tough to do in 15 minutes and my wife uh does or organizational change uh for for big companies um so you know from her perspective it takes time just like you said are there any other skills that you know you think are needed is a compassion is it empathy is it understanding health coaching habit coaching what are those other things that you're using other than just a very good base of the field of eating healthy yeah yeah I mean I guess it's just kind of the experience of coaching you know in that intra-personal relationships where you kind of can read does this person need more empathy right now does this person need a little bit more tough love do they need to be called out a little bit here you kind of can get a sense of that based in their conversation and what they're saying um a lot of times it will become obvious how they're talking um and how they're saying things and a lot of times people will end up identifying it themselves you know I remember talking to some woman about the 800 gram challenge and oh it's too much food and I'm not losing weight and she keeps talking and I really like wine and cheese and then I just sort of smile hey you already identified the problem right it's the wine and cheese right or sometimes people will be really self-deprecating they're really beating themselves up that would be more of the empathy approach and of course depending on the severity it may or may not be my scope um but yeah you just kind of let them talk and listen and and that I guess comes just with time and experience of working with people and coaching change but there's going to be kind of the different approach of being like hey this is easy you can do this we're just adding fruits and veggies or or it might be something more of like hey let's just cut out the soda today and that's just going to depend again on kind of the person and how they're kind of vocalizing their struggles yeah that's awesome uh I mean I love that and I think that uh one of the things that are really enjoyed again so many things that you posted that I enjoy but you're you're 10 principles I'm not sure when you came up with those and um I mean there's something really good we're going to link to that and I want to specifically ask you about um or I guess there are no particular order right they're not an order of importance is how you wrote them um yeah but one of them was about your diet cannot be validated right I think that's so so many times again when you're in a position of authority such as you are as a nutritionist as as a as a coach such as we are and physicians people will come to us and say hey this is what I'm eating is this good or is this bad to eat right you'll always get those questions and especially for my physician colleagues um you're going to be again my parents aside who don't respect me as a physician I'm just kidding but uh but most the patients will come in and and they'll ask you hey look is this the right thing that I'm doing for my health for x, y and c goal um pretending that we do have the time to have that discussion and for those who are interested in having the discussion I think it's really worth while mentioning that hey weak as physicians we also cannot validate their diet right as a coach are you validating their diet I mean can you just talk a little bit more about how you approach that when they're looking for validation because we all want to be loved we all want validation um how do you handle that situation and then what would you also advise maybe young coaches nutritionist physicians to to kind of handle that situation yeah um I think you can comfort them in there on the right path right like you can say like yeah that looks great to me do I know that's going to prevent the heart attack at 50 no no one does um and so it's kind of a balance of hey giving them the support that based on what we know this is a great strategy nothing is a guarantee there's too many unknowns to be able to do that and in fact I think you should walk away from somebody who tells you that some of the most intelligent people that I've listened to or worked with they are very clear when they don't know and you only earn their respect because of that and and I think it's we see it a lot nutrition it's like well this person says this is the one thing and I'm like that should make you walk away like as much as I love the 800 gram challenge like people are successful with plenty of other diets and that's good for them right like this is my approach because I think I can get more people on board this way than I have with other strategies but I also recognize that it's not perfect and if you're working with somebody who doesn't have that realization then I would suggest that they they probably aren't that experienced if I'm being perfectly honest yeah no I again I can't overemphasize um again it's never one thing is one of your principles from what I recall uh and they're also so really uh good especially when you're looking at I think everything that we've touched on today is kind of in there um but I think you also mentioned that you're have you changed them at all since because you in one of your podcasts you mentioned that you're willing to kind of adapt it as as you learn more does that need those changed? yeah I haven't I've thought about um reframing number 10 there are diminishing returns on attaining perfection um from a different from a few different standpoints that I don't think are really worth going into here I think the overall concept is still there um but yeah I mean I think one of the things that I wanted to kind of hammer on it is one they aren't in any order as you kind of hinted at before they were in that order more for teaching purposes than order of importance they're more sort of equally important but the thing that I really want to drive home to people about them is there's not a single food choice listed in them that I would like to teach nutrition or help people understand nutrition without telling them what to eat and I think that's where we get a lot of confusion it's like when you go to the carnivore people they're telling you to only eat meat and then you go to the plant-based people and you only eat plants and now how how is it the case that people can both that on both diets people can lose weight and improve their health well they're probably changing their quality and the quantity right so let's focus less on the food choices and less on all these specifics and understand the concepts below them and so that was sort of what I wanted to do with the principles is like and that's how to kind of remove the dogmas like no I don't want to force you into a food choice I want you to understand how your food choices align with these ideas yeah I love that I think that uh you know I've said to Darsha a couple of times that when you've been doing this long enough and you listen to experts such as yourself you know John Burdy like all these folks um you tend to see a lot more similarities than differences at least the ones who are really getting it right and and that's what I like to focus on rather than okay what are they saying that kind of because there's going to be some subtle differences but but that's not where probably the true answer is right the true answer somewhere in the middle uh and it's probably what they do agree on um but uh to your point about the diminishing returns for attaining perfection I think there's this really awesome infographic by precision nutrition is called the cost of getting lean I'm sure you've seen it um we're going to post it in here I think that's really worth uh people's time to kind of take a look at you know what really takes to going from if we're looking at body fat for just physique purposes to go from like 15% 10% and down even further um I just that's something I think it's probably their most downloaded infographic if I remember correctly so we'll link to that um but easy let's just say that people listen to this um and they're convinced they like the 100 gram channels they're like oh there's a lot of freedom here this is sustainable as you say I can do this for a long time um but uh you know we got some overachievers who are ready to graduate from this and they're like well what do I do next do you go to a thousand grams do you add more variety I remember Kelly started saying that he does the eight by eight third uh do you do that uh what what do you do next can you graduate from yeah the German volume training of uh exactly eight hundred gram challenge um yeah you can go over eight hundred grams but I purposely said it such that it wasn't this more is better phenomenon I I think that's something that's true I don't know if it's American psyche I don't know if if it's you know just people psyche it's just sort of like this more more more more and I wanted to get away from that um I think quote graduating from the eight hundred gram challenge although I don't really think it ever goes away would be to then add protein as we discussed and then potentially also do macros um and that's to weigh and measure every single thing that you're eating and I don't recommend it because I love it in fact I don't love it but I think you're going to get really clear about your diet and why you don't have the goals when you do that when you analyze the diet comprehensively from a caloric perspective while hitting some quality control points you're going to be like oh that's why I'm not as lean as I want to be and oh that's how much work it takes to get the six pack ads and then you decide whether or not you want to pay to play if you want to have some uh skin in the game for that um and so that would be sort of the progression and then ultimately I want there to like the progression quote to be done you know maybe after macros you learn what to do maybe reach your goals then you figure out okay what can I do forever that's the least amount of work like I actually want nutrition to stop being this I need to keep doing the next new thing because I think there is a certain point at which we've reached the level where we're going to have the biggest payoff where we can reach 120 years old or whatever it is for the longevity and that you don't need to keep constantly tweaking and tinkering and that nutrition can be done for you like you can just sort of keep living some really basic practices and then go take the time to do other things that I think will have a lot better payoff to your longevity or whatever it is I obviously really though um I'm not everybody loves measuring on a scale I think for some people might find that intimidating I know in my own household I love it but you know my better half how would they go about doing it though yeah so of course for the 800 gram challenge they can use kind of a cup system where your closed fist is about a cup and about six of those per day add up to about a hundred grams not leafy greens just add those in yeah they count but they don't weigh much so just go for kind of six fistfuls and you're going to be pretty close plus some leafy greens for protein they can kind of do a palm size you know the thickness the size of your palm and each of the main meals for a lot of people that's going to be pretty close but then beyond that we do have to weigh and measure and this is where like you have to decide what outcome do I want and this is the work that's required it's sort of like saying you know I want a five minute mile but I don't want to go running and it's like all right we're not going to get like I want six pack ads I can't lean out what do I have to do it's like you have to do macros and they're like I don't want to do that it's like okay well you don't want the six pack ads I mean it's that simple so there is some level of like okay you have to decide how much work you're willing to put in for the goal that you say that you want as soon as you say that I don't want to do that that's fine but you may have capped yourself relative to the goal that you kind of set but yeah those those those hand measurements can be pretty effective I would say for like 80 to 90 percent of the population yeah got you that's awesome yeah that's cool um you know I just really want to highlight the one thing you said is you want to be able to teach without telling people what to eat I absolutely love that um I think I just encapsulates so many things that you know as providers as me and ultimatum do is it's it's kind of the same concept but it takes a while to you know be in that healthy state to be consistently doing this 800 gram challenge for maybe a year or two three years before getting ahead of ourselves and going to the next thing and then at one point saying you know what I'm good I that I don't have to wake up and think about the next thing I'm gonna eat this is it I it's it's part of my life but as we know we have research coming through the fire hydrant right it's it's common at us with so many different things some things are just not you know great research a lot of things are great as well how do we navigate that as well right how do we kind of do we kind of turn our head away from those once we figure out what works for us or is it important for us to also kind of look at the data that's upcoming yeah I actually think the data is coming at a slower pace than um the articles that are published like a lot of articles that are published are opinions and and read analyses and when you get down to the clinical studies with humans that's the next key part um there tends to be not a ton of studies this is true for fasting um and especially once you start looking at randomized controlled trials and that certainly doesn't mean that we can't learn things from other studies but I'm continually surprised when I try to go and find a topic on humans with clinically controlled trials there's not a lot even that research about absorption about protein absorption I keep what I could find is that it goes back to the same article from 2006 in one study and it's like wow we're just reciting the same article the same article so I think it's not not pay attention to it but it's to make sure that we're really paying attention to new data not necessarily new opinions because those come out of the fire hose quite rapidly I don't think the data is changing I think what people's opinion about the data is changing that's that's that's a really good point yeah yeah and you see I think I think that's a really important topic right there right I think especially we know that when it comes nutrition really anything uh we've hopped upon the fact that that you have to account for biological variation and at the individual level and especially with nutrition right for some people more fat works better for other people more carb works better for some people you know eating uh it's fasting works so there's so many different variations to it but I think as clinicians and as scientists we do need that evidence to support our practice to some degree otherwise there's no standardization right and I think that unfortunately in somewhat of a litigious society um that we live in you know you kind of need something to hang your hat on um and Darshan I have been spoken about this what does evidence-based medicine mean now versus what it used to and I think we're coming along with redefining that term and we've perhaps used the term evidence informed medicine is better especially when it comes to these types of things nutrition exercise those types of things um but uh like for instance what we know is uh for those who don't know the gold standard for nutritional studies are these metabolic board studies where you basically admit patients on an inpatient setting you get to control what they eat you know what get to with the moderate what they eat um that's much harder to do and even some of the papers that we talked about that that uh that journal epidemiology paper that the meta-analysis mentions that most of them are association studies right even though their sample size is astronomical and so a lot of these are association studies um but so when we have physicians and even myself when I'm trying to implement this into practice um how am I supposed to do that you know maybe not necessarily over statins or other medications or so like how do we balance that how do we balance that art and science side of it yeah I don't know I think your job is tough and mine yeah it's just I think it's I think it's sort of the same thing is like with experience you see enough trends that you're able to you're able to kind of make those recommendations and you you know like you're able to see I don't want to say where the truths are because it makes it sound like there's one answer but again these principal ideas it's like yeah if you're exercising and you're in your holding you know uh correct positions when you're working out you're less likely to um have injury it's the same thing if you're eating more fruits and veggies and you're not eating too many calories that you're less likely to have a cardiovascular disease um and then that's what you hang your hat on you're not you're not guaranteeing anything you're not necessarily the next new different idea you're you're continuing to say the ideas that are useful um and I think that's where I've sort of hang my hat hung my hat what's the word there but it's like I think my message is contrary and only because it's so vanilla right like I think there's this idea that my message has to be so different and so unique when I think it's like well no your message can be what works and that might just be continuing the message of people that were smarter before me right um and so I think that's it you hang your hat on where there's trends and combine with your own experience of what works and I think that's a great place to be yeah that's awesome uh I think that that's that's probably a good place for us to kind of come to a close that we want to be respectful your time because you've been so generous with it but before we let you go you see I want to ask you a somewhat silly question because you'll say this guy has learned nothing in the last hour um no you know in your consistency project uh a tracker you mentioned four things right we're looking at quality quantity um sleep and exercise right uh for most people though do you think that or which one do you think tends to be the biggest lever that drives optimal health is again is there one yeah yeah yeah I mean of course I love that word and right but um typically what I would suggest for people is you're probably going to see the biggest shift with the one that you perform the worst at right like if you already have really high quality diet if you've been paleo perfect for five years or whatever like that you're probably going to try the 800 gram challenge and be like that was easy right but if you're coming from a standard American diet you're going to be like oh my god the 800 gram challenge is so amazing right same thing like with me I I've been trying to post every day and I'm gonna continue for the year or whatever like that and it's like guess what is my weakest link sleep right and so guess what I typically feel the difference when I sleep more it's like I am so consistent on the 800 gram challenge that I don't think I noticed these massive changes from it um and so that's what I would try to folk have people focus like you need all of these things but where you're gonna see the next quote best improvement is when you pull up that weakest link I love that and I see that when you're posting you're typically writing it down the good old pen and paper model and doing you know addition that way is that how you track it or do you track it on my fitness pal as well or something else yeah when I'm doing macros to kind of prove points about calories or when I'm doing macros just to make sure I'm assessing my own diet I do use my fitness pal but when I'm doing the 800 gram challenge or lazy macros for most days I just use pen and paper and this actually was a point I was at a meetup uh like a fitness tech group meetup um back in Colorado and we were talking about apps and of course you know fit tech is so big and health tech is so big and and one of the points that this guy made and I just loved it and I think about all the time is like the app has to beat pen and paper and for me right now there's not something that beats pen and paper in terms of the 800 gram challenge I'm sitting at my desk most days I just write it down next to me some people would rather do it on their phone whatever but that's how simple it has to be if I have to go in there and like log all of the things and it's a pain to log like is it more efficient than me just doing the pen and paper and the other thing that I want to point out and this is where we kind of comes back full circle to our conversation is like I don't need to know that I ate 167 grams of raspberry last Tuesday like what am I going to do with that data I mean I guess some people love it they want to do the micro use analysis that's fine I just don't see all this retrospective on like all of my past habits I just need something that I continue to do to make sure that I actually ate the fruits and veggies and so sometimes I think there's this paralysis of like all this data and it's like well what are we using the data for if the app is driving they have it change if you're logging and that's actually making you eat the fruits and veggies great but do I need to know about my cucumber consumption like I don't know I don't know and so so far pen and paper is is where I've fallen no I like that a lot you know even for me you know starting you know I was using a tractor before and then kind of got away from it because you you got to have a bar code and sometimes these veg and fruits you can't find a bar code right especially for getting organic whatever from a local farmers market and I that should not deter anyone from doing it right because technology doesn't work so using that pen and paper you know I I love that idea I think that's what I'm going to start doing or either notes on my phone um yeah ultimately any other question yeah yeah I know I want to ask if we're talking we're closing up with tracking so easy can you just talk about what the the free tracker that you have on the consistency project what that's about and can people can anybody join that yeah it's uh it's at consistency.optimizemenutrition.com and you literally just say yes or no on the 8-gram challenge your protein target exercise and sleep every day there's a leaderboard that kind of refreshes every week although the records are stored forever um and and that's sort of the level that I think people need each day like I don't know again that we need to log like our warm-up of every workout um and so I made it free just for everyone with this idea of being like hey what does consistency look like like that that's why I want to make sure I log for a year is like what's a good score I actually think averaging because you get a point for each I think at averaging above two you're going to find a pretty healthy individual that means that they're probably doing you know the 800 gram challenge and exercise every single day of the year I'm going to tell you that's going to be a pretty healthy person right um and so that was just sort of it like is there a way that we can create community engagement around some really simple practices um and so people are welcome to join. Awesome yeah we're going to link to that so uh so people can kind of you know have that level of kind of accountability although I know that at some point you guys talked about you know kind of intrinsic accountability versus extrinsic but this is a form of extrinsic accountability um darsh anything that you else you want to ask for? No I just want I'm good I just want to say thank you so much EC for coming on you know I've been sharing your podcast once I fell you know once I came upon it to everyone that I know especially my loved ones um you just have this amazing amazing way of taking such a complex polarizing uh field in nutrition and what I like it the the the word that comes to my mind is zen you just have a zen way of kind of just explaining these things that make it very easy to follow along um and so I really appreciate you for doing everything that you're doing oh thank you thank you very much yeah no and I kind of want to co-sign on that EC I think that um you know it is very challenging darsh and I talk about hey look as physicians were scientists and you know there's also the art of medicine and there's a science of medicine and I think that you are one of the few people who are doing a beautiful job as finding the balance between both and then also being able to shift when it's appropriate so I think that's such a valuable skill that people can learn from um and also want to plug your podcast here the consistency project podcast I think that that's awesome a lot of great content in that and you know if nothing else your analogies are amazing that people can hopefully bar from you and use my personal favorites one are the the ones that are related to personal finance I think those who know me that I'm uh I'm very interested that kind of stuff so when you use them by investing and budgeting um that kind of strikes home with me so thank you for everything that you're doing um we know where can people find you on social media uh we set the consistency project uh your podcast you mentioned your website where else can people find you yeah it's pretty easy to optimize me nutrition.com that's the same handle optimize me nutrition on the social medias and then the consistency project so you've nailed them all awesome well thank you again see you see thank you guys such a great show with EC Sinkowski before we end be sure to use your 15% off code for on time MD by Dr. Phil Bouchet to gain control of your life your focus and your time reach out at doctorpodcast.work.com slash on time MD and use code 2021 at checkout now for the key disclaimer please remember that everything in this podcast is for educational purposes only it does not cost you to practice a medicine nor should it be construed as medical advice no physician patients relationship is formed and anything discussed in this podcast does not represent the views of employers if you enjoy the content of this show please be sure to subscribe and share with someone else who also may benefit from the show thank you for listening and we'll catch you next time