weight loss drugs versus eating real whole food

In 2005, I started writing a medical mystery called Not Quite Dead, where a diabetes researcher discovers a drug that helps people to lose a remarkable amount of weight. Only there might be significant side effects. My idea was that if people knew about these side effects, the drug might flop.

…After three months on the experimental drug, the mice were losing about fifteen percent of their body weight. Of equal importance, no significant side effects could be noted. So none were.

—Not Quite Dead (page 7)

If you think this sounds a little like semaglutide, a medication initially developed to control blood sugar (also called Ozempic or Wegovy), but which turned out to be a jaw-droppingly effective medication for weight loss, you’d be wrong. Because despite a link to thyroid cancer, the drug is an absolute blockbuster. These side effects might turn out to be much ado about nothing. Or, they might not.

What happens when there is a new medication that gets widely used by millions of people, possibly for decades, is that we learn more about the drug—both good and bad. Using a newly approved medication is a little bit of an experiment, but if the benefits outweigh the potential costs for a given individual, it is not unreasonable to try it. I have prescribed semaglutide (and others in this medication class) for patients who are able to get a hold of it (read: afford it, because in the US, it is almost $1,000 a month without insurance) and who medically qualify for it. It’s hard not to get excited about this medication, especially for people who struggle with their weight and diabetes.

For years, the medications to control diabetes led to further weight gain, precipitating a vicious cycle in which people with diabetes would need more and more medication to control their blood sugar as their weight increased. Drugs that help people with diabetes to lose weight and break this cycle were long sought after. These drugs got additional approval for people with a medical problem that wasn’t diabetes, like high blood pressure or sleep apnea, and obesity. It makes sense that people with stubborn medical problems would want to take a newly approved drug that might help them lose weight and better control their medical issues. But now, it seems that everyone wants semaglutide. Articles are being written about healthy people who want to lose 10 or 20 pounds and find a provider to prescribe the medication. Instead of being afraid of side effects, which I thought would doom the fictional medication in my book, people are more concerned with weight loss, even in the absence of medical problems.

Vanity often gets the blame for the incredible off-label demand for these new medications. But, I don’t agree with this. Besides marketing and societal pressures to be thin, we are actually hungry—hungrier than we think we should be—and we are looking for something, anything to help control our cravings.

Besides marketing and societal pressures to be thin, we are actually hungry—hungrier than we think we should be—and we are looking for something, anything to help control our cravings.

A piece of the puzzle that I write about in Eat Everything: How to Ditch Additives and Emulsifiers, Heal Your Body, and Reclaim the Joy of Food, is the idea that when our digestive systems are presented with certain food additives, they encourage us to eat more.

In Eat Everything, I tell the story of a patient named Thomas (not his real name), who reports that he feels like he can’t control himself around store-bought ultra-processed cookies and cakes. But, Thomas has a lot more control over his intake of sweets when he is eating homemade desserts made with whole ingredients—even if they are cookies and cakes. Those treats have lots of sugar and flour in them too, but they don’t generally have a substance, ubiquitous in ultra-processed food, called maltodextrin.

Maltodextrin imparts a sweetness to foods and can allow producers to use less “sugar.” So, it can make an ultra-processed food appear lower in sugar than it otherwise would be. It helps the product to last longer on the shelf too. As a result, you can now find it on ingredient lists on everything from breakfast cereals to pricey chocolates. But, it has been noted to raise blood sugar faster than real sugar does, causes mice to consume more calories when they are given the substance in their water, and is even taken by bodybuilders who are trying to bulk up on purpose. There have also been studies linking it to changes in our gut microbiomes that may contribute to colitis. The International Organization for Inflammatory Bowel Diseases asks patients suffering from colitis to avoid maltodextrin in their 2020 guidelines. While maltodextrin might be the biggest offender, there are plenty of other reasons to avoid ultra-processed foods.

Most of my patients can’t afford expensive weight loss drugs, even if they have diabetes or other conditions for which they’ve been approved. Sometimes we turn to less expensive medications to help with weight loss (after discussions about benefits and possible side effects), but sometimes we are only left with dietary modification and that can work, too.

In one of the best-done studies on ultra-processed versus whole foods, participants lost two pounds in just two weeks of being on a whole foods diet, while they gained two pounds when on the ultra-processed one. Large population-based studies have also shown a strong association between the consumption of ultra-processed foods and weight gain. Importantly, ultra-processed foods aren’t just what we think of as “junk” foods like fast food and candy. Many whole-grain breads and yogurts marketed as health foods are classified as ultra-processed.

Whether or not you are in the market for one of the new weight loss drugs, if you want to cut cravings and increase your ability to be sated by your food, skip the ultra-processed stuff (especially foods with maltodextrin) and try to eat as whole food-based a diet as possible. Sure, eggs are expensive these days, but not as expensive as semaglutide.

To learn more about how avoiding key additives can help you manage your weight more easily:

best diet for losing weight

“Which diet is best for losing weight?”

That’s a question I’m asked a lot.

Few seem to have a straight answer for that one, except for people who have deeply held religious-like, ideological beliefs around food. Keto adherents are quite sure that avoiding carbs is the way to go. For vegans, eliminating animal products provides a clear path to health. If you’d like to experience the passion of an old school religious war without the bloodshed, head over to your favorite social media battlefield and read a few keto responses to a vegan post or vegan responses to keto posts. While they may not actually be killing each other, each is convinced that the other’s dietary habits will do it for them.

Low-carb, High-fat vs. High-carb, Low-fat

That brings us to Dr. Kevin Hall of the National Institutes of Health (NIH), who has entered the arena as a peacemaker of sorts by providing combatants with a healthy dose of science. Dr. Hall designed a study where participants would be fed either a high-fat, low-carb diet or a low-fat, high-carb diet. The participants had two weeks in each arm of the trial, so that they could be compared to themselves. Like a previous study he had done at the NIH looking at an ultra-processed diet vs. a whole foods diet, all the food was provided to the participants and their activity was carefully tracked. Also like the former study, participants could eat as much as they wanted and the food was rated by them as pretty good in both arms of the trial.

The folks on the low-fat diet ate about 500-700 fewer calories a day, but had higher insulin and blood sugar levels (suspected drivers of some diet-related diseases). The people doing the high-fat diet ate more calories, but had lower insulin and blood sugar levels. There were possibly advantages to both diets.

So, back to the original question, which one produced more weight loss?

Examples of dinners given to study participants: low-carb, animal-based diet (top) and low-fat, plant-based diet (bottom). Amber Courville and Paule Joseph, NIH

Here’s where we need to go back to Dr. Hall’s previous work on ultra-processed vs. whole foods diets.

Participants in this study lost about 2 pounds on the whole foods diet and gained 2 pounds on the ultra-processed one. When he designed the low-fat vs. low-carb study, he pretty much avoided giving the participants ultra-processed foods.

The short answer is that they both resulted in weight loss, but the low-fat diet resulted in more body fat loss in the participants. Case closed? The vegans win, right? But wait! These weren’t restrictive diets. I told you earlier that the people in the study could eat as much as they wanted. Neither the low-fat nor the low-carb participants were hungry and they both lost weight, though the low-fat participants lost a little bit more. How?

OK, but the vegans still win? Sort of. Plant-based diets are probably better for you, both in the short term, like in this study and in the long term, as Dean Ornish and others have shown with improved cardiovascular outcomes. So, if you can avoid eating animals, that might be best for you and for the environment. But even if you can’t or don’t want to (and I don’t want to either, so don’t feel bad), if you can avoid ultra-processed foods (think stuff that has ingredients on the list that you wouldn’t have in your own pantry or in anyone’s pantry for that matter), you’ll be a lot healthier and quite possibly weigh a bit less too.

So, how do I answer the question, “Which diet is best?”

It turns out that it’s not so complicated after all: Any style of eating that avoids ultra-processed foods that you can stick with and enjoy.

Easy holiday foods that are gut-safe

I started watching Ina Garten on the Food Network about ten years ago, when I first attempted to make food from scratch instead of from boxes. She told me to buy “good vanilla” and “good olive oil.” So, I did that. When holiday time came, Ina’s advice was to never spare the butter and to always have extra chicken broth on-hand. I did that too. Afterall, if Ina said it, even if it was a little pricier and a bit more work, I was on it.

Her food is aspirational. Like trying to dance or sing—I’m not going to do it perfectly, but I’m going to be better for having tried. And I figure, the more I try, the better I’ll get (okay, maybe that’s not true for the singing).

But in a twist that felt like a departure from her usual commandments, this year, Ina told us to head to the supermarket and stock up on packages in a New York Times article titled, “Ina Garten’s Store-Bought Thanksgiving: To make the holiday easier for home cooks, we asked the culinary contessa to create a menu that lets premade ingredients do much of the work.”

Reading the headline, I felt gut-punched. If Ina was giving up, what hope was there for us mere mortals? But reading the article, I began to get inspired. In my book, Eat Everything, I devote an entire chapter to making more gut-friendly foods with ready-made ingredients that are less processed. Instead of just everyday foods, could the same strategy also work to make holiday meals more gut-friendly?

I decided, like my idol Ina did, to find out.

Pie is not only a Thanksgiving and Christmas staple but a classic American dessert.

holiday pie crusts without additivesAnd the filling generally isn’t the hard part. It’s the crust that can throw us off track. Could I find a decent pie dough that didn’t have emulsifiers and dough conditioners? I went to Whole Foods to find out.

Wholly Wholesome has a crust that is just flour, palm fruit shortening (which they state is “responsibly sourced”), water, sugar, and salt. No emulsifiers, but also not in stock on the day I went. Instead, Whole Foods was carrying the unrolled-out version by the same company, which contained both guar gum and locust bean gum.

These gum additives have been shown to disrupt the gut microbiome and people seem to feel much better when they cut them out.

So, I also looked at their gluten-free version even though, in general, I eat all the gluten I can. And to my surprise, no gums in the gluten-free pie crust! These gum additives have been shown to disrupt the gut microbiome and people seem to feel much better when they cut them out. There were two reasonable options for ready-made pie crust out there (and I wound up finding another at Trader Joe’s a few days later). The key is to always check the ingredient list, even from a brand you might trust.

Next up, potatoes—a holiday table must-have.

Ina suggests that there are good frozen or refrigerated mashed potatoes out there if you add enough sour cream, parmesan, butter, salt and pepper to the pre-prepared stuff. And it’s true for your gut too.There are brands of pre-mashed potatoes like Simply Potatoes that don’t have much else added to them except for dextrose (which is a simple sugar) and a few probably “okay” preservatives.

Check the sour cream for additives (the affordable Daisy brand has none!) and please take a minute to grate your own parmesan from a block to avoid gut-roiling added anti-caking agents. If you are celebrating Hanukkah (I am!), you can get shredded, frozen potatoes to make latkes—a huge time saver—with the same dextrose and probably “okay” preservatives as the mashed stuff. Just remember to defrost and then drain the shredded potatoes on paper towels to get as much of the moisture out as possible before you mix in the egg, onion, salt and pepper, and fry until golden.

Finally, the main course.

If you are tired of turkey after Thanksgiving, so tired in fact that you don’t feel like making anything at all, you could always pick up a rotisserie chicken, or three. But be careful, a lot of store-prepared poultry has flavor-enhancing additives like maltodextrin that you probably want to avoid if you are going for stomach-safe. Many stores will sell chicken that is just chicken, but don’t forget to check how it’s seasoned for a happier holiday.

We’ve been given permission to make holiday cooking easier to do, now we can also harness our ability to make the shortcuts easier on our stomachs, too.

A well-known professor of neurology was giving a lecture to a large audience of internal medicine physicians.

“If a patient says they have a headache, do you believe them?”

The audience nodded in agreement.

“But you can’t do a blood test for a headache. A headache won’t show up on a CT or MRI. How do you know they truly have a headache? How can you confirm it?”

The answer, the professor revealed, was that no one feels compelled to “confirm” that someone has a headache because most of us have experienced a headache. A person merely saying their head hurts is enough to diagnose a headache. It is easy to relate to a pain someone is describing when you yourself, or perhaps a good friend or relative, have experienced similar symptoms.

What can be more challenging is when we are trying to describe a feeling that is not as commonplace as a headache. Sometimes we are experiencing a symptom that will reveal itself as a disorder on a blood test or radiological study. But often, there is a vague discomfort or malaise, that may not show up on any test. The symptoms may range from slight to severe enough to keep someone from being able to go to work or school. Something is wrong and it isn’t clear what that something is.

But you know your body best. You know when something has changed or if something isn’t right. And we want to be able to give a name to something that isn’t right. Because once we have a name for it, we can try to find a reason for it, and then hopefully a way to make it better.

In an era of seemingly endless test options, it can be difficult to accept the fact that we often don’t have a test for many ailments. There is no reliable test to confirm IBS, myalgic encephalitis/chronic fatigue syndrome, long-Covid, various pain syndromes, and a host of other illnesses. We should recall that, before we had widely available imaging tests for conditions such as multiple sclerosis (MS) or endometriosis, patients (who happened to be mostly women in the case of MS and all women in the case of endometriosis) were dismissed as “hysterical” or told it was all in their heads. Abandoned by their doctors, they were more easily victimized by the snake-oil salesmen of their day as they searched for something, anything, to get themselves better.

It is said that history may not repeat itself, but it rhymes. Being taken seriously when we know something isn’t right with our bodies is still a challenge. The big difference today, is that we are now able to share and hear lots of stories from around the world. And there is strength in numbers. It may not raise a diagnosis of IBS or long-Covid to the level of understanding that most of us have of what a headache feels like, but it hopefully will increase empathy for those who experience symptoms for which there is no quick and easy test.

Poop jokes aren’t my favorite, but, they are a solid #2. Okay, not the best dad (or in my case, mom) joke, but I have others! We all do. There are a lot of poop jokes out there.

Gastrointestinal health is something that hasn’t been taken seriously for a long time—at least not since the position of attendant to the British monarch’s stool (known as the Groom of the Stool) was abolished in 1901. Considered a posting of honor (as opposed to a crappy job) for hundreds of years, as flush toilets and toilet paper became all the rage, poop was relegated to becoming the butt of our jokes (sorry).

But with the rise of DNA analysis and the ability to see just what is inside our most comedically valued organ, gut health has become anything but a laughing matter. It may be the key to unlocking better health for many of us.

Let’s examine what’s changed:

  1900s thinking:
Our gut is a long tube from our mouths to our behinds.
2000s thinking:
Our gut is a complex organ made up of our own cells along with trillions of microorganisms. It has vital impacts on our immune system, our moods, and even hormonal regulation of how much and when we want to eat.
1900s thinking:
Our gut will absorb the nutrients we need and poop out the things we don’t.
2000s thinking:
Whatever we aren’t digesting, we are feeding to those microorganisms in our guts (called the microbiome). What we eat promotes which organisms grow and where in our guts they are growing.
1900s thinking:
The total amount of calories you eat along with macronutrients like carbs, fats, and protein will determine how much you weigh and how healthy you are.
2000s thinking:
Calories and macronutrients can be important, but they aren’t the whole story. Eating ultra-processed foods (especially those with emulsifiers) can cause us to eat more and gain excess weight, can disrupt the microbiome and our gut lining, and are a contributor to the exponentially rising rates of a host of diseases.
1900s thinking:
It doesn’t matter how ingredients are processed. Adding vitamins and other supplements to ultra-processed foods is the same as getting them from whole foods.
2000s thinking:
Getting nutrition from whole foods is critically important to good health.

Our bodies, along with our microbiomes, digest whole foods differently than food that has been ultra-processed. We are just beginning to understand how an additive, when extracted from a “natural” source, may be disruptive to the synergistic relationship between ourselves and our microorganisms.

There are a lot of new and exciting discoveries being made in gut health, because ultimately, medical ideas are like diapers (okay, last one, I promise). They need to be examined and changed when they aren’t quite right.

Gluten and dairy have been deemed the enemy. For some people who have celiac disease or complete lactose intolerance, yes, these foods need to be avoided.

But what about the rest of us?

Many people abandon foods that contain gluten or dairy in the hopes of feeling better. Maybe we have joint pains or stomach trouble. Maybe we are putting on weight and don’t understand why. We start by getting rid of these foods and perhaps feel a little better. So then we hear that we should avoid other foods, like tomatoes or garlic, and drop those. Before we know it, our diets are extremely restricted, but we really don’t feel that much better. There may be an easier and far less restrictive way to improve our health.

The biggest problem in the so-called Standard American Diet, which has now become standard in the diets of almost every country today, is ULTRA-PROCESSED foods.

How can we tell the difference between processed and ultra-processed?

There are a few definitions out there, but I’ve found the simplest way to figure out the ultra-processed stuff that should be avoided is to be on the lookout for certain additives in packaged food.
Is this a perfect method? No. Nothing is perfect. Trying to be perfect is a recipe for feeling inadequate and defeated. The goal is to feel better and that means accepting what we are able to reasonably accomplish in the midst of a busy day. Avoid these additives, eat everything that is actual food, and see how much better you feel.

Carrageenan (commonly used in creams and dairy substitutes for stability)

Cellulose (pre-shredded cheeses and powdered parmesan are generally coated in cellulose. DO NOT use pre-shredded and bagged cheeses which can also contain anti-fungal agents.)

Food Gums (commonly used in shelf stable products like dressings):

  • Acacia Gum
  • Cellulose Gum (Also called: Carboxymethylcellulose)
  • Gellan Gum
  • Guar Gum
  • Locust Bean Gum (Also called: Carob Bean Gum)
  • Xanthan Gum

Inulin (Also called: oligofructose, oligofructose-enriched inulin, chicory root fiber, chicory root extract or fructooligosaccharides)

Lecithin(can be derived from soy, sunflower, or other sources and are used in many different packaged foods, so may be the most difficult to avoid—just do your best, but don’t sweat if you are consuming a little of it)

Modified fill-in-the-blank Starch (used in shelf stable products)

Maltodextrin (used as a flavor enhancer and stabilizer in shelf stable products)

Monoglycerides/Diglycerides (used in breads, especially those that stay soft like flour tortillas that don’t need to be kept frozen)

Polysorbate 60/80  (commonly used in frostings and desserts)

The following are generally used as sugar substitutes. Please just use real sugar (in moderation) and NOT these:

Glycerol (glycerin/e)





Stevia (Stevioside)

What should we be eating?


They have lycopene in them! And lycopene should protect us from cancer and heart disease. Do we cook them to get their maximal benefit or eat them raw? Should we be eating them everyday? It was all anyone could talk about ten years ago.

And then…we stopped talking about lycopene and started talking about lectins.

Tomatoes have lectins in them! And lectins might promote disease. Should we remove the seeds from tomatoes? Should we cook them? Should we avoid them altogether?

What’s someone who doesn’t want to die (at least, not right away) to do?

Since pretty much everything we eat has been labeled as potentially toxic by someone, somewhere, calling themselves a health guru (or maybe even a doctor), better be safe and reach for “food” wrapped in shiny packaging proclaiming how natural and organic it is.

GMO-free! Hormone-free! No lectins!

Or better yet, reach for a bottle (or ten) of supplements that are supposed to ward off disease and be much better for us than whatever dangers may lurk in the produce aisle. That we have been lured away from fresh fruits, vegetables, and grains by all kinds of diets and self-proclaimed experts is one of the greatest cons perpetrated on the American people since George Parker was offering to sell his marks the Brooklyn Bridge.

I’m not a conspiracy theorist by nature and am more likely to attribute the missteps we make to earnest ignorance rather than to malicious intent. But, the rate at which the latest entrant into the “real food is bad for you” diet seems to sweep the nation, makes me wonder if the ultra-processed food industry doesn’t give the craze a small, or maybe even a big, push.

It turns out that fad diet gurus and ultra-processed food purveyors make for strange, but profitable, bedfellows. The more real, whole food you are afraid to eat, the more packaged stuff you’ll be forced to buy—after all, you have to eat something to sustain life, let alone prolong it. Whether that package is a cardboard box filled with flakes of questionable health value or a plastic bottle of the latest and greatest dietary supplement, someone, somewhere, is spending very little to charge you a whole lot for what you could probably get from an apple.

The profit margins on produce are thin. The money made on ultra-processed foods runs into the trillions. The supplement industry is also doing quite well. So, maybe it’s not a conspiracy, but there’s not a lot of marketing dollars to be spent on salads.

A professor once told me that any drug the pharmaceutical companies have to advertise probably doesn’t work very well.

“If it’s really good, everyone will just use it. It will advertise itself.”

Well, it turns out, that professor underestimated how effective marketing can be or maybe he just overestimated how smart we are.

Because whole foods have been proven in study after study to promote a healthy weight and long life. No fad diet has ever been shown to do much of anything for adherents long-term (very few people can stick with them for very long anyway). And the evidence for 99.9% of the supplements out there is shaky at best and sometimes shows that they are harmful.

And yet, the hucksters selling us the equivalent of the Brooklyn Bridge are making best-seller lists, while whole-food proponents like Marion Nestle and Tim Spector, sometimes seem to be shouting into the void. The latter has the bulk of the evidence, but the former has the sales pitch.

So, I’ll propose a new diet—the half-plate vegetables diet. Just make sure every time you eat, at least half of your plate has veggies on it (and no, French fries don’t count, kids). What I’ve learned though, is that if the diet is going to be a success, it’ll need a catchier name. I’m taking suggestions….



How should you talk to your doctor? Short answer: Like you would talk to any other human. It’s your doctor’s job to listen.

Here goes the longer answer.

This week, I gave a lecture to first-year medical students on how to take a medical history from a patient. I’ve delivered this lecture for the past seven years. The central message I impart to the students is one that reaches back to the beginning of modern medicine, but is no less relevant today.

Sir William Osler, a physician from the 1800s, stated it most clearly when he said, “Listen to your patient. (They are) giving you the diagnosis.”

I put this quote up on a slide for the students, who are new to medical school, but who have nevertheless heard this quote already from several faculty before hearing it from me. I tell them, “We repeat it a lot, but then we ignore it.”

I ask the students, “If it is so important to listen to our patients, why don’t we?”

“There’s not enough time.”

“We’re too busy.”

“We have biases.”

“We forget how important it is.”

The students call out all the right answers. What used to a be a 30-minute office visit has been cut down to 15 minutes, if that. Computer work and paperwork have increased at an astronomical rate, further cutting into patient care time. We rush to judgement, abandoning the idea that we should be thinking about all possible diagnoses before narrowing our focus. And, in an era where blood tests and imaging studies abound and require only a click of the computer mouse to order, minutes can be saved by just doing that, at the expense of giving our attention to the person in front of us.

Over the next three hours, through practice patient interviews and other small group exercises, I try to convince the students that no matter what the external forces pressing on them are, when they have a patient in front of them over the course of their careers, they should try to block out the rest of the world and just listen. They will have many more practice and empathy-building sessions over the next several years of their medical education, but eventually, they will enter the real world. And the real world does not pay doctors to listen to their patients. It pays them to go quickly and “efficiently” through their day.

So, what’s a patient to do?

I have a friend who is dealing with a very serious health issue. She tells me how she brings copies of her tests and CDs of her scans along with her so the results are always on hand in case the doctor doesn’t have them. She tries to be as brief as possible and show little emotion to her obviously harried physician, who she fears will dismiss her if she is too “difficult.” Instead of being able to focus on what she needs from her visit, she tries to bond with the doctor over shared interests and manage the doctor’s needs. And my heart breaks for her every time I hear about her latest visit. In addition to dealing with a miserable diagnosis, she has to expend mental energy to try to figure out how to make the most of the time with her physician.

It shouldn’t be this way, but for so many patients, it is. As medical professionals, we have to do better. Someone who comes to us for care and compassion deserves just that. There are some medical facilities that give their physicians the resources to be able to spend more time with their patients. There are physicians in private practice who have, through a combination of good luck and good business sense, figured out how to keep a practice afloat and give their patients the time they need. In some areas, these practices can be hard to find, or even if they exist, they are not necessarily on your insurance plan.

I can ask you to find a doctor who will give you the time to listen, but I imagine that you’ve tried this already. So, as much as it pains me to say it, my friend is doing what she needs to do to be heard and treated appropriately. Bring your important records with you (never assume the doctor has them). Be ready to summarize your story as “efficiently” (yes, I hate this word in medicine) as possible. For some people, bringing a typed-out version of their story can help. Tell your doctor all the issues you would like for them to address at the beginning of the visit so you can be sure that something you may need isn’t left until the end when time may have run out. And importantly, be your own advocate. If something isn’t right, say so. If something isn’t working, say so. Ultimately, your doctor wants you to get better. They want to help, but the system we all find ourselves in isn’t conducive to forming a strong patient-doctor relationship. There are some who are working to change this, but as always, change can never come fast enough.


A few years ago, my not-quite-teenage son began commenting on whether or not the food I was making was a “superfood.” Salmon and blueberries had been designated by him as “super” and not because they were particularly tasty (although I think they are). According to my son and the latest articles he had perused on the internet, there was supposedly a magical array of nutrients in the food that would somehow help us to live longer.

“The search for superfoods (or whatever they were called back then) has been a time-honored tradition since at least the 1950s, when American physiologist, Ancel Keys traveled to countries around the Mediterranean and documented their lower rates of heart disease, cancer, and other ailments.”

I was just glad he was eating salmon and blueberries and let him keep on thinking they were magically super since I was also super exhausted trying to get my kids to eat foods that were nutritionally sound. So, if nutritionally sound was being rebranded as super, I wasn’t going to argue the point.

The allure of finding a faraway magical food or foods, is in many ways like the quest for the Fountain of Youth, and so, my son had hit on a historically popular trend. The search for superfoods (or whatever they were called back then) has been a time-honored tradition since at least the 1950s, when American physiologist, Ancel Keys traveled to countries around the Mediterranean and documented their lower rates of heart disease, cancer, and other ailments. He posited it was something in their diet. It was called the Seven Countries Study and like its name implies, Keys looked at food from seven countries—which happens to be a lot of countries and a lot of different foods. The common threads in the so-called Mediterranean Diet, were identified as olive oil, fish, fruits, veggies, nuts, whole grains, and wine.

Scientists wondered what exactly was in those foods that was so super and began doing research studies that added nuts or wine or olive oil to see if those things in isolation were helpful. Many of those studies (though poorly designed) showed that they were. And so, in the coming decades, Americans were encouraged to eat more of those foods. Not a bad idea, but not the whole story either. Despite switching over from canola oil to olive oil and from white pasta to whole grain pasta (which isn’t exactly traditionally Mediterranean), our higher rates of disease persisted. It turns out that you can’t take out two or three components of a healthy diet and add them to an unhealthy diet and viola—expect similar results. Even worse, you can’t extract a chemical or two, package them in a supplement and declare victory over disease.

Resveratrol was supposed to be one of the substances that made blueberries super and was also found in red wine. But instead of having to find berries out of season or drink wine which was high in calories (and also one would be limited by the alcohol content if one were sensible), a pill was created. Why bother with actual foods and beverages if one could just find a magic pill? Better yet, pill purveyors could charge upwards of $100 a bottle and so advertised their wares heavily. By offering the secret to longevity with barely any effort required, daytime talk shows brought in lots of viewers, clinics sprung up, and people parted with billions of dollars. And yet, our life expectancy has not increased.

What is starting to be increasingly recognized by researchers is that it isn’t one substance or a handful of foods that make the Mediterranean Diet special. It isn’t even the Mediterranean. There is longevity to be found around the world (see: “Blue Zone” below) where there are fewer chronic diseases and people live longer lives (but even Blue Zones are somewhat Western-centric and undoubtedly there are many other places that would qualify). Blue Zone residents practice lifestyles where they eat whole, fresh foods, have communities ties, and walk or do a fair amount of physical work. This is what was going on in the Mediterranean when Keys visited.

And yet, as my son made clear, we are still looking for the magical super foods, or even more reductive, magical supplements, when the answer for how to eat and how to live has been staring us in the face for decades (Hint: the answer isn’t in a supplement).


My mother’s mother, who had lived with us, passed away when I was still quite young, so I don’t remember too much about her. But I do remember the prunes.

Every morning, my Bubbeh (grandmother in Yiddish), would have a handful of prunes with her breakfast. I had a vague sense that it was to help her in the bathroom and it was something that older people just happened to eat regularly—like soup. I’m not sure where these ideas came from, but I suppose I must have seen other older people eating prunes while discussing their digestion. At some point, I had also decided that they were somehow not delicious and politely declined prune-containing desserts when they were infrequently offered to me.

So, you can imagine my surprise when one day, desperate for Hamentashen (Jewish holiday cookies) and finding only prune-filled ones remaining, I decided to go for it and eat the geriatric flavor which turned out to be my new favorite. You can further imagine my surprise when I discovered that prunes are not only delicious, but actually magical.

“a serving of prunes a day helps with constipation more than a similar amount of psyllium fiber”

While doing some reading on constipation for the book I am currently working on, I fell down a rabbit hole of research, with one article leading me to look up another and that article leading me to look up yet another. This path ended at a well-done study published in an obscure journal called “Alimentary Pharmacology and Therapeutics” which showed that a serving of prunes a day helps with constipation more than a similar amount of psyllium fiber (the stuff most often recommended for constipation). The authors of the study were gastroenterologists from the University of Iowa who carefully selected their patients to make sure they didn’t have other diseases and then did something called a “cross over” so that the same people switched and got the same treatments separated by a week. It is a way to compare like to like and probably the best way to do a study where you can’t keep the treatment a secret (called blinding).

Even if the prunes had worked just as well, it should have been big news. But they had actually worked a bit better. Here’s a truly natural and fairly inexpensive way to help with constipation—a problem about 20% of people are thought to suffer with. And yet, ten years on, I hadn’t heard about this miracle cure. Perhaps I had been lacking in my keeping up to date with guidelines? So, I looked up the American Gastroenterological Association guidelines on constipation. Nope. No mention of prunes. Then I went to their website geared towards the lay-person. Surely they would suggest that people pop a couple prunes (more like 12 to be consistent with the aforementioned study) before bringing out the medications. Also no!

Are the authorities on the GI system as biased against prunes as I once was? It would seem so.

This isn’t to say that prunes will work for everyone. The study, while well done, was small in size with only 40 participants, and people who haven’t discussed their constipation with their doctors may need a medical work up to make sure there isn’t a more serious condition underlying the slow stools.

But for now, I’ll be keeping a bag of prunes in my pantry. Just like my Bubbeh did.