Dr. Susan Kleiner Discusses the "The Good Mood Diet" with The Diet Channel
Let's get started with a bit about your background as a registered dietitian.
My undergraduate degree was in Biology. At the time, you could spend six months in an approved hospital experience and then sit for the RD Exam, so that's what I did. But I always knew that I wanted to get my PhD and do research. So I went back for my doctorate at Case Western Reserve University. There I got my masters and my PhD in Nutrition in Human Performance. The term Sports Nutrition hardly existed at that time.
And where did you go from there?
I worked with the Cleveland Clinic because they had a big sports medicine program there. My interest was in the area of muscle building, because this was the very early 80's and nobody was looking at muscle and nutrition.
Everything was about endurance performance, or long distance exercise. I had been a modern dancer, and modern dancers have a lot of upper-body muscle, who I felt were much healthier than other types of dancers because of that. And it's been proven that modern dancers are much healthier than the ballet dancers who had a lot of lower body muscle mass, but looked like skeletons on the top.
That makes sense.
I was really interested in muscle and health, and I got into bodybuilding and doing research on bodybuilding. I looked at thirty-five professional male bodybuilders, seventeen non-steroid users, and eighteen steroid users, and looked at the impact of bodybuilding on body composition, described their diets, and the risk of cardiovascular disease. It was the largest study ever at the time looking at the impact of diet and steroid use on muscle and health. So that was my entry into the world of Sports Nutrition. And it was a good jump start to my career because the Cleveland Clinic did a National Press Conference announcing the results of my study, which came on the heals of Ben Johnson being caught using steroids at the Seoul Olympics. It became a really public event, and I was ushered into the world of journalism, as all the muscle magazines then interviewed me and my study results were on the front page of newspapers across the country.
So how, then, did you end up moving from bodybuilding into the world of weight loss?
When working with bodybuilders, I was working mostly with men; meanwhile, everyone else was beginning to work with eating disorders, people eating less and less, and having emotional disorders with food.
So you saw a big difference there?
Yes. I was working with men who just wanted to get bigger and more powerful--people who had no disordered relationship with food at all. It gave me a really healthy attitude towards food. But not everyone was trying to become a professional bodybuilder. So when I came to Seattle, I broadened out my practice, because up until then I only worked with competitive athletes. Seattle was such a fitness-oriented town that there were a lot more people to work with. More people were coming to me for help saying, I wouldn't call myself an athlete but I exercise five days a week. So I changed my practice to everyone who exercises. So now, the requirement in my practice is you have to exercise, even if that just means walking everyday. Otherwise, my diet will just be another one that ends up in the trash. If you are active then everything starts to work.
What challenges did you find when you expanded your practice from competitive athletes to "regular" active people?
I was confronted with all these really unhealthy attitudes about food. But by working one-on-one with people, I could help them change and create a very positive outlook.
So this is where The Good Mood Diet comes in, right? Can you explain what led you to write this book?
Close to a decade ago, I was confronted with an athlete who was clinically depressed. This was a really elite star athlete who had a huge contract. But he wasn't showing up to practice; he wasn't showing up to anything. I could see that he needed psychiatric help, which I recommended. But it quickly became clear that he would not receive any kind of therapeutic help because once that gets into the papers, he can't be traded. So everything was on my shoulders.
You were supposed to bring this athlete out of clinical depression with diet?
I could have declined, but I knew that food affected mood. I had been reading a lot about neurobiology, so I knew there was research in this area, and I delved into it pretty deeply. But I only had nine weeks to get this guy in shape, so instead of doing what a good scientist would do, which was keep his diet constant and change one thing, I threw everything I found on food and mood into one diet. That's the true story, and the change was really remarkable.
How was he different after he started on your diet?
The guy literally wasn't getting out of bed before. But after starting on the diet, he was getting up and showing up to practice. Everything was changing. His body responded dramatically as well. The alteration in his body composition in five weeks was so dramatic, and I was convinced that the control was happening in the brain. So, not only were we altering mood dramatically by changing food chemistry, but we were also altering body composition by changing the chemistry of the brain.
You mention in the book the concept of the "Food/Mood Superhighway." Can you explain how that works?
There are two big things that influence the food choices that we make. We can rationally choose food to influence our mood, and that's one lane. We know that there is a list of feel-great foods, and if we eat a lot from that list it will make us feel great. Besides the stomach, which is going through digestion after you eat, the first organ to be affected by the food that you eat is your brain. So by making selections out of the feel-great foods list, we can feel great.
And feeling great makes us continue to make good choices?
Right. Your good mood will help to sustain those choices because that's how you want to feel. But choosing foods from the feel-bad list can also make you feel good sometimes too.
But this is a temporary good feeling, right?
Yes, it is. If you choose these foods frequently, it makes you feel bad, but your brain starts to crave that kind of fuel. Then you will continue to choose those foods and you will be stuck in a vicious cycle, needing the instant gratification that the feel-bad foods give you. So the lanes run both ways, in either direction. If you are on a good mood highway with feel-great foods, feeling great will sustain those food choices. If you are on the bad mood highway and are continually eating feel-bad foods, you will be stuck there too, until you make the rational choice to jump.
And then, many people who are stuck there seem to try to just eat less quantity of everything in order to lose weight.
Right. And it makes them feel even more miserable.
Another interesting point that you make, which may seem counterintuitive to some, is that weight loss does not occur from starving yourself. Can you explain why that is?
Sure. Going back to the depressed athlete we talked about earlier. He is seven feet tall and he was hardly eating two thousand calories a day. But on a weekly basis, his percent body fat was going up. So here we had a man who required five thousand calories a day just to sustain his bodyweight, and on eighteen hundred calories a day, his body fat was going up, and he was absolutely not losing weight. His weight wasn't changing, but he was losing muscle and gaining fat. Because muscle is your metabolic tissue, and fat just hangs around, the more muscle you lose, the less calories you burn, and the lower your metabolic rate. Whether you're a lead athlete or you're anybody else, the biology stays the same. A typical weight-loss diet tells you to eat a thousand to twelve hundred calories a day. Most women over forty require a thousand to thirteen hundred calories for just their basal metabolic needs everyday (younger women need even more).
And that is before any type of activity or exercise?
Right. That doesn't mean doing much of anything except resting. If that's all you are eating, how would you expect to exercise? So, all those diets that say follow this liquid meal plan and follow a healthy exercise regimen just don't add up, because on that type of calorie restriction you don't have enough energy to do it. You do not even have the energy to sustain all the systems in your body at peak levels. So your body, because it is a very efficient machine that has survived over millennia of plague and famine and starving, slows down to meet the available energy. Then by doing the same activities you used to do, you burn fewer calories. So where your metabolic rate may typically be thirteen hundred calories at rest, it may only now be eleven hundred.
It certainly isn't worth all the misery of dieting if that is the result!
No, it isn't. Now you've slowed your metabolic rate, and you are eating a twelve hundred calorie-diet and you are not losing weight.
So how does your diet differ?
The Good Mood Diet puts foods to work for you. Not only do you eat foods that make you feel great, you eat more food--no less than sixteen hundred calories. You eat enough to maintain your energy level and keep your metabolism from slowing down.
And how are people responding?
The reports I am getting on my website are that people can't believe how much food they can eat, and they are losing weight. And they feel great! This is what I hear over an over again from everyone who tries The Good Mood Diet, within days from when they start. In the book I wrote about Trish Zuccotti, who is a gold medal holder in Olympic weightlifting. Trish has one of the most exuberant personalities I have ever encountered. She wanted to drop some weight and change weight classes, and that's how she ended up with me. So I incorporated all this stuff into the diet to help her with that, but I didn't expect to see a change in mood in her at all.
You mean in somebody who didn't seem to have a problem with mood?
Right. She was very high energy and extremely motivated. But four days after she started on the diet, she called me and she said the same thing others were saying: I don't know what you've got in this diet, Susan, but I feel better than I have ever felt in my life.
That must be very exciting for people who have struggled with dieting.
It's very exciting. People who can't get through all the food, and then finally start to be able to, lose weight while not feeling deprived. As they become more active and they gain more muscle, the fat falls off. The cascade of events goes like this: you eat better, you start to feel better, you have more energy. So you exercise more or harder, and then you start to add the food around exercise. You feel better, you start to sleep better, and now you are starting to eating breakfast because you are more rested and you are hungrier.
Well, let's get down to some of the specifics of your program, starting with the "Good Mood Accelerator Phase." Can you explain the rationale behind that?
I see myself as an educator and a motivator. I have found that the easiest educational approach is to start with black and white; these foods are in, these foods are out. So they go on the accelerator phase, which eliminates all feel-bad foods for 2 weeks, and you feel better pretty quickly. If you start out with you can have a little bit of this and a little bit of that, it's a wavy line. Being very black and white allows you to know how good you can really feel. And then, after that it's kind of up to you--you titrate.
What does it mean to titrate?
One at a time, you can add back foods that you eliminated during the accelerator phase, such as sugar, caffeine, alcohol, etc. If how you feel doesn't change and you are still on track, then enjoy them in moderation. Because we know that in small amounts all of these things make us feel good.
But what if you can't do the moderation thing?
Some people will say to me I can't do a little bit of sugar. If you can't do a little bit, then don't do it at all. But in time you will be able to do a little bit, because you will be in touch with how you feel, will recognize when you start to feel bad, and stop it. For example, you might notice that you didn't sleep very well, or you are cranky or fatigued after you introduced sugar back into your diet. If you know that eliminating the sugar again will get you back to feeling great, then you're likely to do it. Therefore, how you feel becomes your guide. I have gotten reports from people I worked with in a Good Mood Diet study who, a year after the study ended, are still following the "Good Mood plan." Many of them continued to lose weight. Others reported that they no longer wait to regain twenty, thirty, or even fifty pounds before doing something about it. When they fall off the plan, before any significant weight gain occurs, they recognize how crummy they feel and can't wait to get back on the plan. So it's all about how you feel, not about what you weigh, though weight loss comes anyway.
That makes sense. So you have a list of feel-great foods that you encourage your clients to choose from as much as possible. A lot of the foods you include are obvious choices, such as berries, beans, and broccoli. Others are not quite as obvious and may even be controversial, such as egg yolks, caffeine-containing beverages, and milk. Can you specifically address those and explain their importance?
Sure. The feel-great food list could be a book. Any fruit or vegetable could be on there. But every food on that list has a research study or more behind it; that's how it ended up on the list. I am sort of non-politically correct with my pushing of egg yolks. But egg yolks are the only major source of phospholipids, which are required to create a healthy cell membrane. Two specific phospholipids, phosphatidylcholine (PC) and phosphatidylserine (PS) have been looked at for over a decade as integrally linked to the health of the brain cell. There is a lot of research on diseases of the brain, such as Alzheimer's and Parkinson's disease, which has shown that supplementing with PC and PS can slow the rate of progression of these diseases. Therefore, PC and PS are commonly used supplements in early stage Alzheimer's and Parkinson's, as well as in other diseases of the brain. So my question was, What about a healthy brain, does it even matter? There is one study done on college-aged men given a memory test as a baseline, supplementing with PS, and then given another memory test after supplementation. The study showed a very significant enhancement of the test results after supplementation. So not only do we know that these are really important components of a healthy cell throughout the entire body, but they seem to be particularly significant in the brain. Phosoplipids in the diet come primarily from egg yolk and soy lecithin.
If you don't eat eggs, could you get enough phospholipids from soy?
It would be hard, because most of the soy we eat has been defatted, and the phospholipids are found in the fat portion of the soybean. Also, the phospholipids in soy and eggs are not identical. Finally, eggs also contain choline, which is the basis of all neurotransmission in the brain. Choline, which is now an essential nutrient, comes from only a handful of sources in the diet; egg yolks being the primary source. So, it appears to me an extraordinarily important nutrient. And when I look at people's diets, I see that if they don't eat egg yolks, they don't get nearly enough choline in their diets.
So you recommend one egg yolk a day?
I say one egg yolk a day, and the reason is several-fold. We don't really know how much phospholipids we need in the diet. And the research is very clear that an egg yolk a day doesn't raise cholesterol levels.
Within The Good Mood Diet, I can add an egg yolk a day, and still stay within American Heart Association's guidelines of three hundred milligrams of cholesterol a day. So, I sort of meet everybody's needs that way. But if you have heart disease and your cardiologist isn't comfortable with this, you can certainly alternate soy with egg. The funny thing is that when I travel around the country and give these talks, the question now becomes, So now do I keep the egg yolk and dump the egg white?
But the nutritional quality of the egg white has never been disputed, right?
Right. It's such a wonderful source of protein, and it's so great to have it in the morning. Lots of people have a bowl of cereal in the morning, but when they start adding the egg along with their cereal, there's a remarkable change in how they feel. This is probably from both the protein as well as the nutrients in the egg yolk.
Let's move onto milk. Why is it on the feel-great list?
Milk is such an ideal "Good Mood food" because it gives you a high level of tryptophan. People know turkey is high in tryptophan. So is whey protein, which is found in milk. Carbohydrate is essential for the ushering of tryptophan across the blood brain barrier, raising serotonin levels. Studies have shown that consuming a combination of carbohydrate and whey protein reduces feelings of anxiety, anger, and frustration, so you have better coping skills against stress. This is likely due to that increase in serotonin levels. So in milk, you've got the carbohydrate (lactose) and the whey protein all in one package. That's the brain benefit of milk. Then there is the benefit to the body. Whey protein has a beautiful array of essential amino acids and branched-chain amino acids to help muscle repair, recover, and grow. Whey protein has been used in sports nutrition for years because we know it's a superior protein to promote muscle strength and growth. It is a fast protein, meaning it is easily digested and absorbed. Finally, when you drink milk, you also get casein, which we call a slow protein because it is more slowly digested and absorbed. It is like a time release formula, keeping us fuller longer. So milk is a great mind-body food.
That is fascinating. Now how about caffeine?
Caffeine is a stimulant. For that reason, it can make you feel good. If you are very caffeine sensitive and don't already drink it, don't start. But if you like a cup of coffee in the morning, as I do, feel free to keep it up. I like to put my caffeine to work for me by having it before I exercise. I do this because it decreases my rate of perceived exertion, meaning it makes me feel like I am not working as hard as I am, so I exercise harder and longer.
So in a way it is actually good for you?
There is absolutely no evidence that caffeine in doses of one to two beverages a day is bad for anybody. It doesn't even affect blood pressure. Therefore, I am not going to tell you to take it out of your diet. But I will provide guidelines for caffeine consumption. We know that caffeine has a long half-life, lasting about six hours in your system, so since the goal is to calm down going into the evening, sleep well, and be well rested, then you don't want to have caffeine after about noon. Then in the afternoon, if you feel like you would like a little pick me up, try some green tea. People don't seem to react to tea in the same way they react to the caffeine from the coffee and soda. Tea is lower in caffeine, and it doesn't seem to give you the same jittery effect. And you also get a bunch of antioxidants from tea.
You mentioned a goal of being well rested. Can you speak about the importance of good rest when you are trying to lose weight?
Rest is so important, both for building muscle and burning fat. And nothing will kill you faster than being sleep deprived. In all of the chronic diseases that we know of, the risk is much higher in people who are chronically sleep deprived. And when your brain is craving rest, you easily fall into the trap of looking for the foods that you think are going to give you more energy, which usually adds more caffeine, sugar, and fat to your diet. But that's a misinterpretation of what you really need, which is rest.
So we make poor food choices when we're tired?
Yes, but that is only half of the story. Also during deep sleep, there is an increase in growth hormone secretion, which helps you grow muscle or maintain the muscle that you have. Without enough sleep, you don't get that spike, which means you will lose muscle and slow your metabolic rate. In addition, lack of rest will raise stress hormones such as cortisol, whose goal is to hang on to fat and make more fat. Think twenty thousand years ago; your body is perceiving environmental stress, which at that time meant food shortage or illness. To protect us, your body is not going to burn fat. You are going to hang on to it, and even worse, you are going to manufacture it.
So even if you are eating right, you will not get anywhere if you are not sleeping enough?
Despite eating right and exercising, you will stand still if you are not sleeping well.
You recommend that everybody drink hot cocoa before bed. Is this to help you sleep better, and if so, how does it work?
It is to help you get a good night sleep, feel decadent, and wake up with energy. We've already talked about milk as an ideal "Good Mood food." We have about sixteen different serotonin receptors in the brain that turn on and off based on a number of different things, one is the day-night cycle. During the day, the receptors are on, and serotonin makes you feel alert, awake, and in a high mood state. As the sun goes down those receptors turn off, and different ones turn on, and serotonin makes you feel sleepy and relaxed. So now you drink milk, which raises your serotonin levels, and since it is night time, it relaxes you and gets you ready for bed. So the milk before bed thing really is true - it really has a calming effect. But if I told people to have a glass of milk before bed, I think most people would think milk and cookies. I also think milk just isn't appealing to most people. And this was the way to add the chocolate, in the form of non-dutched cocoa powder, which tastes decadent but is very healthy for you. More and more, we are finding how important the natural phytochemicals in cocoa are for blood pressure and all around health. So you have your hot cocoa in the evening, with a sweetener rather than sugar, for those who are trying to lose weight. If you are on a higher calorie plan, you can put the sugar in your cocoa at night if it doesn't affect your sleep. But drinking the hot cooca accomplishes a number of things; it gets the milk in you; it's warm which is very soothing in the evening, and it creates a ritual. Rituals are really important for reducing stress. We have all kinds of rituals to get children ready for bed, but we don't do it for ourselves. We are doing all kinds of very active things and then we abruptly to go to bed, which makes it very difficult to relax and fall asleep.
So this is as much about the act of doing something relaxing before bed as it is about the nutritional composition of the hot cocoa?
Exactly. The rituals around bedtime are critically important to get our brain and our body relaxed in order to sleep. Then you are not lying in bed for two hours before you finally fall asleep. I have kids who are school aged, and they know that when I have my hot cocoa nobody is allowed to be jumping all over me and bothering me. This is my quiet time where I am getting ready for bed. The ritual of it all is very important. It's a huge stress reducer because you know what's coming - there is no unknown. You can anticipate that time in the evening, where you are going to have that delicious hot cocoa. And then all those cravings that happen at night seem to go away also.
This is all fascinating stuff. I regret that we have to stop here. What final message would you like to give to the readers of this interview?
I want to reiterate that the whole point of The Good Mood Diet is to get people to focus on their brain rather than on a scale or their body, and to let go of any negative body images. I am finding the image of feeding the brain takes away all the guilt and the negative self-talk. It's a very powerful mantra for people to think about what they need to feed their brains rather than what they can or can't eat next. There's so much about this philosophy that really frees people. I often hear You saved my life; I couldn't think negatively about food one more time, or I was so trapped in this cycle of guilt and thinking that I am a bad person. And yet it all just seems to just fall away with The Good Mood Diet.