Andreas Eenfeldt – The Diet Doctor

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Jonathan: Hey everyone, Jonathon Bailor back with another bonus Smarter Science of Slim podcast. Very, very excited to share today’s guest with you because he is not only the proprietor of one of the web’s most visited low-carb, high-fat diet sites, Dietdoctor.com — not only is he a medical doctor, but he is also a wonderful friend, a man I had the chance to meet and dine with on numerous occasions on the recent Low-Carbohydrate Cruise. Truly a great person in addition to a great doctor and a great blogger and a great researcher and just a smart man, Dr. Andreas Eenfeldt, welcome to the show.

Dr. Eenfeldt: Thank you Jonathon, and thank you for your kind introduction.

Jonathan: My pleasure, Dr. Eenfeldt. I wanted to bring you on the show today because you really are on the forefront of — I think a lot of people who listen to this show might not know what’s going on in your native country of Sweden in terms of an intentional intake of fats and an intentional intake of carbohydrate. I’d love if you could illustrate and explain what’s going on for us.

Dr. Eenfeldt: Sure. I mean, for the last couple of years or perhaps I should say five or six years, low-carbohydrate diets have become very popular in Sweden for many reasons, but primarily, obviously, because it works very well. People see their friends doing it. They get inspired to try it out themselves.

There have been a few surveys the last few years showing that perhaps like a quarter of the Swedish population is doing some form of low-carb diet. Perhaps five percent is on a really strict low-carb, high-fat diet where you’re — well, ketogenic diet where you basically exclude all carbs.

It’s been an interesting couple of years for sure. It’s still just picking up momentum, so it’s going to be interesting to see what it leads to.

Jonathan: Andreas, what do you think it is about the Swedish population that has caused this, certainly, exponential and statistically significant rise in a low-carbohydrate, high-fat lifestyle? Why Sweden, and why not some other country?

Dr. Eenfeldt: Yeah. That’s a good question. Obviously, low-carb diets have been popular in your country as well for some period of time. I think we look at Sweden, there were some events in like 2006 to 2008 that sort of sparked this interest, and it kind of started when a family doctor in Sweden got real interested in — her name is Dr. Annika Dahlqvist. She got really interested in this low-carb thing after having lost a lot of weight and improved her health eating that way. She started to prescribe it to her patients.

This was obviously a very controversial thing. She got a lot of attention in the media, and a couple of dieticians notified the medical authorities in Sweden, the National Board of Health and Welfare, because they were worried that this was going to harm her patients and maybe even people might die from eating a high-fat diet. That is what we used to believe, so the National Board of Health and Welfare did a large investigation trying to find out what to do with this doctor and her advice to make sure that they did the right thing.

After a couple of years of this investigation, they came to the conclusion and they basically said that this is okay. This doctor — she can keep giving that advice. We’re not going to criticize her, because the science shows that giving advice on a low-carb diet actually is effective for losing weight, and there’s no clear evidence that it is harmful in any way.

Now, we’re talking back in January of 2008, and that was sort of the start of this movement in Sweden on a larger scale because this got quite a lot of attention in the media, like every television channel and every paper basically wrote and had a — talking about this. So a lot of people became interested in it, and that’s sort of when the interest started to get really big.

Then it’s been, I mean, if you look at people searching on Google for low-carb, high-fat, it’s called LCHF in Sweden. You can see that it’s just been going up every year since 2008. So, it’s exciting.

Jonathan: It’s very exciting. Andreas, have you personally in your practice — because I remember from our talks on the Low-Carb Cruise, which was just such a delight, that there’s still doubt despite the fact that you have almost a quarter of the population doing this, despite the fact that there are countless clinical trials proving the efficacy and safety of this type of lifestyle and despite just basic biology, which explains why it would not be harmful and would be beneficial, there still continues to be some doubt and some concern in even the Swedish medical community. You certainly are part of that medical community. Have you seen any blowback or have you been, for lack of better terms, attacked in any way by your peers for your promotion of this lifestyle?

Dr. Eenfeldt: Personally, I would say more or less no. I mean, some people obviously disagree with me, but I don’t feel like I’ve been really attacked. Not much anyway. I mean, some people do have some objections and so on, but you can discuss it. You can give them references to numerous studies showing that it works and there doesn’t seem to be any danger involved. I think most people, once they get a load of studies like 20 different studies, they tend to briefly look at them and say, “Okay. Yeah, whatever, and keep doing what you’re doing,” and they don’t really have the time or the inclination to sort of really get into this.

Jonathan: That makes a lot of sense. It seems like as long as you have at least one scientific leg to stand on, which it seems like we actually have more than one leg; we have two legs to stand on and maybe a ledge to lean on as well, you can get some groundcover. Dr., I know…

Dr. Eenfeldt: I don’t really feel nervous in any way when I give this kind of advice to my patients. I work as a family doctor. If I meet people with obesity or want to lose weight, specifically if I have a diabetic patient who has a hard time controlling his blood sugar, I always talk about this and see if they are — if it’s possible to motivate them to do a lifestyle change and to eat less carbs and probably more fat. When I do that, I don’t ever feel any nervousness regarding what other people would say, because I know — I’ve been doing this now for, I don’t know, six or seven years in my medical practice. I know what the results will be because I see it every week.

There’s only one problem basically with a low-carb diet in that situation, and that is that some people find it hard to do. They find it hard to give up most of their bread and potatoes and fruit and whatever. But most people, if they’re really motivated to lose weight and improve their health, then they will come to be able to do this. They all come back with having lost weight and improved their health, and usually they feel a lot better too. So, it’s all good.

Jonathan: It’s absolutely all good, and I’m so encouraged to hear that, Andreas. I recently also had the good fortune of talking with Dr. Jeff Gerber, whom I know you’ve spoken with as well. It seems like the more MDs I talk with, the less and less stigma there is, even in the medical community, of prescribing, for lack of better terms, a lower carbohydrate lifestyle. People might say whoop-de-do, but let’s be very clear. That was not the case 20 years ago. It was literally, I mean — as you mentioned with your peer Annika, that was not the case with her and it was not the case with Dr. Atkins. To see that in just a generation, we are in a realm where physicians such as yourself can do this without fear of having your credentials attacked. I see it as amazing. It makes me very happy. What do you think?

Dr. Eenfeldt: Yeah, sure. Absolutely. I think we’re in a totally different place now than compared to Dr. Atkins back in the 70s, 80s and 90s because they didn’t have the good scientific support that we do now. I mean, all the studies I point to when I want to support giving a low-carb diet advice, I mean they’re all from 2003 and after that. It’s all from the last 10 years basically. Before that, there wasn’t really much in the way of, you know, good quality scientific support. Sure, I mean, people like Dr. Atkins knew what happened when people ate a low-carb diet. I mean, he had thousands of patients, but that’s still just anecdotes when you’re trying to support it scientifically, so it’s hard. I think it was hard back then. You really needed to have a lot of confidence to be able to do it.

Now, it’s not hard. I mean, if you look at the scientific literature available, I don’t think there’s any question that this is a very beneficial way to — lifestyle change for people with specific medical problems like obesity, diabetes, high blood pressure and so on — a few more situations.

Jonathan: Andreas, you make a very interesting point there of people with specific medical conditions, because I know sometimes there can be some confusion, potentially, in individuals in the, let’s call it paleo hunter-gatherer community, which is a fantastic community. It’s a community all about food quality. It’s awesome. I love it. It’s very similar to what I recommend and certainly has a lot of science behind it. The distinction is people talk about there are things like potatoes and other starches that are incredibly high in carbohydrate, and are found in nature, and are whole foods and do have some nutrients in them.

But one thing you touched on on the Low-Carb Cruise — and I think this is such a wonderful distinction — is really being clear about are we talking about people who are already sick, like are already metabolically de-conditioned, or are we talking about people who are not? It’s like are we talking about a healthy 20-year-old, or are we talking about a diabetic, post-menopausal woman? Who you are talking about dramatically impacts the safety of starches. What do you think about that?

Dr. Eenfeldt: Absolutely. I think that’s sort of behind all this confusion and sort of negativity sometimes perhaps between the low-carb people, if you want to call them that, and the higher-carb, paleo people. We’re looking at different groups basically. I mean, like you said, if you’re healthy, if you’re fit, if you’re 20 years old and if you do a lot of cross fitting, you don’t really need to eat a ketogenic, low-carb diet probably. It might be that some people enjoy doing that anyway, but probably it’s just not necessary.

On the other hand, if you’re older, if you have more medical problems and more problems controlling your weight, you’re in a very different situation. When it comes to carbohydrates and starches, people are talking about safe starches like rice and potatoes and whatever — sweet potatoes — where there are no toxins and so on. Really, they are safe for some people, perhaps most people, but they’re not safe for all people.

Jonathan: I think there’s such a — as a doctor and as a very well respected doctor, it seems like you have first-hand experience with saying that your recommendations really have to be focused on the patient. I know you want to learn the patient’s medical history. You need to understand the context of the patient, so what do you think when people say things like, “This diet X or eating approach X is the best way for everyone to eat.” What do you think when people say things like that?

Dr. Eenfeldt: Yeah, I think probably the more certain you are of a thing like that, the less you tend to know. The more you learn, the more you realize that there is not one perfect diet for everybody. I mean, at the very least, people have different habits and likes and dislikes and so on — different lifestyles — so we need to sort of fit the diet to the lifestyle as well and the traditional diet of the area where you’re living perhaps and so on. I mean, it depends on who we are talking about, but I do think that most, if not every, person would do better by avoiding the worst carbs like loads of sugar, soda, obviously candy and cakes and white flour and so on. Probably everybody would do well to get rid of that.

We talk about sweet potatoes, maybe some rice. Really, if you can handle it, sure, why not eat it? I don’t think that’s a big problem for most people, but it is a problem for some people. Like a significant minority (??) of the population and perhaps even if you look at the western world, if you look in the United States, for example, you have — what is it, like 68 percent people with obesity or something?

Jonathan: Yeah, it’s about at least two-thirds are overweight. Absolutely, yes.

Dr. Eenfeldt: So, in that situation, maybe most people would do well to stop eating most of the refined starches.

Jonathan: Yeah, and I think you really hit the nail on the head there. There does have to be some sort of generally recommended dietary practice. I mean, that’s just the way the world works. For the longest time, it’s just been horrible. It’s been these food guide pyramids, and MyPlate and each country’s derivation of those USDA monstrosities. But when you’re dealing — your point and Dr. Jay Wortman also made this point on the cruise which are right on — if the country you live in is 70 percent obese, or excuse me, 70 percent overweight, that also means that it’s basically normal to be insulin-resistant. I mean, that is normal, like that is what –even well more than the majority is. The default or the baseline recommendation to be as clear and as helpful as possible needs to be the one that would be healthy for that 70 percent of the population, right?

Dr. Eenfeldt: Yeah. I mean, if you’re going to give diet advice to the entire population, it had better suit the majority. If they’re a disaster for the majority, then it’s not a good recommendation. Obviously, if you look at MyPlate and the old diet guide pyramid, that’s just a disaster. That’s too much grains basically. Too much carbs.

Jonathan: It’s always just interesting too, because I think the one concept that I’ve had the unique opportunity to talk with — I try to talk with a diversity of people in this arena. Recently, I spoke with Dr. Joel Fuhrman and Dr. T. Colin Campbell, who certainly have very strong opinions about both paleo and the low-carb approach. But one point that they shared with the broader community was this idea of eating the most of things that provide essential nutrients and that cause the least damage to the body, and ensuring that we don’t crowd those out by eating things that we don’t need.

One thing that I just have a hard time wrapping my head around is like if a potato just gives you so much joy — like if you just crave — if you’re just like, “Oh my God,” like some people just crave chocolate. If that’s how you felt about a potato and it gave you so much joy, that’s one thing, but it’s like why? I mean, it’s not even like it’s that tasty. I mean, potatoes are really only delicious when you fry them or when you do a bunch of other stuff to them. Same thing with rice. It’s not like an individual is just like, “Oh my God, rice is so delicious.” Why are we even talking about this if these safe starches are not really even that tasty, and it’s a fact that they are not concentrated sources of essential nutrients. They have some essential nutrients, but they can’t compare to fruits and vegetables, let’s say. Why are we even wasting our breath talking about this? What do you think?

Dr. Eenfeldt: That’s a good question, but I mean, I guess some people like it. Some people do like potatoes quite a lot, I know. I mean, not by itself, but combined with like a steak or whatever. Some people like it a lot. I can tell you that for my patients, I think potatoes are one of the three things that are hardest to avoid. It’s like potatoes, and there’s bread and there’s fruit — the three big ones that are hard for some people to leave behind.

Jonathan: Do you see them — this might just be me showing my ignorance, and I’m totally comfortable with that. I’m not sure I’ve ever seen anyone eat a plain potato.

Dr. Eenfeldt: You don’t eat a potato by itself; that’s not fun. Sure. You need something else with it. Anyway, you mentioned Joel Fuhrman and Colin Campbell and this vegan movement. Interestingly, I think you can eat a vegan diet that is way better than what most people eat. If you exclude refined foods basically and processed stuff, and eat plenty of vegetables and so on, that could be okay. I just don’t think there’s any point in avoiding animal products. I think you just make it harder for yourself. I think this debate between low-carb, paleo and vegan people is perhaps, in a way, unnecessary because we’re all talking about improving the food quality, comparing if you go to McDonald’s or something.

Jonathan: The irony I saw, Andreas, was that there’s this — in some ways, you could have imagined there was a spectrum. On like the far left, there’s low-carb, high-fat. On the far right, there is the incredibly high-carb, low-fat approach that like say a T. Colin Campbell — which, in our conversation, he says like 80 percent carbohydrate. Then in the middle, you had paleo. So this was just fascinating to me. The more paleo approves of or encourages safe starches, you’re either going to eat — like if you eat a lot of potatoes, you’re going to be too full to eat other stuff.

Someone like a T. Colin Campbell says that basically the majority of your calories has to come from starch because if they’re not coming from fat, and certainly they’re not going to be coming from protein because he’s a vegan, that you’re going to be essentially — paleo starts to look a lot more like veganism or vegetarianism, ironically. Then the low-carb movement has focused so much on food quality, which is great, that it’s almost like everything has slid down this spectrum. It’s like low-carb has taken on a lot of amazing paleo characteristics, and paleo now seems to actually be taking on more of a high-carb, starchy plant diet characteristics. What do you think about that?

Dr. Eenfeldt: Really, that sounds a bit odd to me. I mean, it’s not — maybe some people, some portions of the paleo movement is like that and some other portions are very much into animal products as well. I mean, it’s certainly not the old Cordain paleo diet if you’re excluding most animal products and eating a lot of starch. That’s something else, right?

Jonathan: Absolutely. My point was more that the more — it seems like the airtime being dedicated to eating starches is, one could say, yes — in talking with Dr. Campbell, his big thing was, like he has this new book called Whole. The focus of the book is just saying eat whole, plant-based foods. Part of what the paleo community focuses on is actually the aversion of many types of plant-based foods, like you want to avoid things with antinutrients in it. For a long time, things like tubers and any kind of starch were really downplayed in favor of more nutrient-dense sources of calories.

The more airtime starches get, the more it seems like there’s just a blurry line between this meatless, whole food paleo, which I guess is not really paleo. It’s not — obviously, there’s a large proportion of the paleo community, much like a large proportion of the low-carb community, recognizes and celebrates the awesome health benefits of high-quality animal foods. I just see it as interesting that as low-carb has evolved, it’s taken on some paleo characteristics. As paleo has evolved, it’s taken on some low-carb characteristics. In fact, as veganism and a plant-based diet — as paleo starts to emphasize the importance or permissibility of starches, those lines start to blur too. It just becomes interesting.

Dr. Eenfeldt: Maybe the vegans will start to eat the high-fat diet, like a high vegetable fat diet. Then it’s all confused.

Jonathan: The irony is that while it may sound like I’m saying this is bad and I wish we could have strong dividing lines, I actually think it’s great. The more we can stop focusing on these subtle differences and start saying don’t eat processed garbage, just move to real food, and once you get to real food, then we can talk about — because you’ll feel better, you’ll look better, you’ll want to do more. Then we can talk about which lifestyle you like the most. Maybe that’s for convenience. Maybe it’s for morality reasons. Maybe whatever. There’s a diversity of options that could work for you.

But the fact that we’re seeing these lines blur — like I actually think if we could focus on that blurry portion a little bit more and focus less on the points of disagreement, that might be key to the tipping point. What do you think?

Dr. Eenfeldt: Yeah, I think definitely us fighting between these groups — fighting the other groups is a shame, because the most important thing might be to get rid of the processed sort of refined starches and sugars that are making people — making 70 percent of the population obese or overweight. A lot of people are getting diabetes and complications from that. I don’t think it’s a problem of eating a low-fat vegan diet. I don’t think people are getting obese from that. I mean, maybe a few, but most people, certainly not.

I don’t think that’s the problem. I have no interest in telling vegans to eat another way. Everybody can keep eating what they’re eating, but I think the problem is that most of the population is sort of into this calories in, calories out mode, where they just think that to lose weight, they need to eat less and they need to move more. I think that’s a horrible oversimplification that makes it more or less impossible for most people to actually lose weight long-term. Of course, it sort of assumes that people can just ignore their hunger, and almost nobody can do that.

Jonathan: You’re spot on, Andreas, and I know you had some first-hand experience with two individuals who certainly don’t believe in that. Their dietary habits certainly, let’s say, reflected their disbelief in that. I’m talking about none other than myself and my wife.

Dr. Eenfeldt: I don’t think I’ve ever met anyone eating more calories than you, and you don’t have like a gram of fat on you. Obviously, there’s something wrong, or maybe like every second I didn’t see you on the cruise you were exercising. That is the other possibility.

Jonathan: I can tell you that was not the case. But I was just laughing because we had the good fortune of having Andreas as well as Dr. Jay Wortman and some other amazing individuals at our dinner table on the Low-Carb Cruise. I’ll just point to one example. There was one meal where I ordered two appetizers and five entrees. Granted, they’re all very, very sane things. I think I had like two salmons, a steak and two other things, and my wife, who is far and away not an overweight individual, had three dinners. Everyone was just looking at us like what the? I’m like, “Hey, we’re just trying to prove a point.”

Dr. Eenfeldt: It was like we needed a bigger table to fit your plates on it. It was funny to see. I was impressed by it. I’ve never seen anybody eat as much as you, I think, ever. Like you said, it’s all good food, plenty of vegetables, to say the least.

Jonathan: Yeah, it was certainly a joy, and I really appreciated our time together.

Dr. Eenfeldt: It was good fun.

Jonathan: It was a lot of fun. Just to wrap up, I really wanted to dig into what motivates you, because if folks haven’t been to your website — and folks, please do check out Dietdoctor.com, because it is an amazing free resource. One of the things you’ll notice is that word free. It’s scientifically based. It’s rigorously researched, and it’s all free. There are no ads. There’s very little if any product placement. You’re a practicing physician. You have a family. You’re a busy guy. What motivates you to do so much for so many, asking for nothing in return?

Dr. Eenfeldt: Well, like you said, I don’t have any [indiscernible 31:18] at all in my English blog, but I do have it on my Swedish, so I won’t claim to be, you know, doing this only for the benefit of others, but perhaps mostly. It pisses me off basically that people are suffering needlessly from these old failed ideas of the past. I really feel that we need to get beyond that and sort of use the science and the experience that exists and spread it so that more people can benefit from it.

I meet people every week at my clinic or maybe when I do lectures and people emailing me — my readers from my blogs — you know, telling me that once they stopped eating all the carbs, they lost weight effortlessly. Their health problems went away. We really want more people to be able to experience that. If they’re just being told that this Coca-Cola logic of today — eat anything, only do it in moderation and move more and everything’s going to be all right. It’s not true. For most people, it’s not going to be okay. Some people can do it; most people can’t. There is a better way, and I guess that’s what’s motivating to me. It’s trying to spread this knowledge to more people so that they can benefit from it.

Jonathan: I think that’s great, Andreas, and I just want to thank you and I want to encourage all of our listeners to please check out Dietdoctor.com. There are very few resources on the internet that are as rich and reliable as Andreas’s site.

Also, I think this is — I’m super hopeful after having this podcast. Just to quickly summarize, we talk about how you’re able to discuss this modern science of food quality in your practice without fear of negative repercussions. We’re talking about how these once completely, let’s call it diverging, thoughts of nutrition in terms of veganism and paleo and low-carb are actually sharing so much now and actually have so much in common. Just talking about the opportunity for folks to see such dramatic health benefits with such little effort if they can start to embrace these common denominators that focus on food and nutrients rather than just calories and moderation.

Man, I think that’s a good place to be. At least it’s a step in the right direction.

Dr. Eenfeldt: Certainly. Yeah, I think you’re doing great work too with your very impressive videos, for example, to spread this information. I mean, I’m an optimist for the future.

Jonathan: I absolutely am. I think the internet giving us the ability to make these connections and to distribute this information, and I think like you said, there’s really nothing that speaks louder than results. The more people we can get this information to and the more people who just do it, and results speak for themselves, it’s pretty hard to argue against results. So, thank you.

Dr. Eenfeldt: Yeah, and I think that’s the main argument for low-carb. It works. For the right kind of person, it just works. It’s so obvious to not only that person but to the people around him or her, and that’s why I’m optimistic for the future that this is just going to spread. With the help of the internet and people like you and lots of other people spreading this, I think we can really make a big impact.

Jonathan: I love it. Well, thank you for all that you do, Dr. Andreas Eenfeldt, and thank you for joining us today. Folks, if you haven’t seen his website, again, it’s Dietdoctor.com. That has to be one of the best URLs ever, so please check it out.

Dr. Eenfeldt: Thank you.

Jonathan: Please remember this week and every week after, eat smarter, exercise smarter and live better. Talk with you soon.