Mayo Clinic Lead Dietitian on Weight Loss Truths & Nutrition Hype

Ever wondered why some diets work while others fail? Why nutrition advice seems to constantly contradict itself? Or why those GLP-1 medications everyone's talking about are causing such a stir in the wellness world?

In this enlightening conversation with Mayo Clinic nutrition expert Tara Schmidt, we dive deep into the complex realities of weight management, exploring everything from persistent nutrition myths to revolutionary medication approaches. Tara brings refreshing clarity to topics often clouded by misinformation, sharing insights that challenge conventional thinking while remaining grounded in evidence.

The discussion tackles head-on the uncomfortable truth about weight stigma in healthcare settings, where patients often face their most damaging experiences of bias. We explore the concept of "food noise"—that constant mental chatter about food that many experience—and how newer medications are helping some people quiet those thoughts for the first time. Throughout, Tara emphasizes the importance of individualized approaches, noting that adherence to any dietary pattern matters far more than which specific diet you choose.

Perhaps most valuably, Tara offers practical guidance rooted in simplicity rather than sensation. She suggests focusing on what you can add to your diet rather than what to eliminate, considering how your environment shapes your choices, and recognizing the power of small, consistent changes over time. Her approach reminds us that sustainable wellness isn't about perfection but about finding patterns that work within your unique life circumstances.

Whether you're curious about intermittent fasting, wondering about hydration guidelines, or simply trying to navigate contradictory nutrition headlines, this episode provides thoughtful perspective from someone who's dedicated her career to helping people build healthier relationships with food. Subscribe now and join our growing community of listeners seeking evidence-based approaches to wellness that acknowledge both science and lived experience.

Tara Schmidt/Mayo Clinic Resources:

• Tara Schmidt - LinkedIn
• Mayo Clinic Diet’s homepage - Weight Loss Program – The Mayo Clinic Diet 
• Tara Schmidt, Host - Mayo Clinic on Nutrition Podcast Series - Apple Podcasts

A few of Tara's most listened-to episodes:

• Obesity is Not a Moral Failing

Chapters

• 0:00 Introduction to Tara Schmidt
• 4:27 Persistent Nutrition Myths
• 6:58 Calories In, Calories Out Reality
• 12:21 GLP-1 Medications Revolution
• 20:51 Weight Stigma and Medical Bias
• 30:12 Social Media and Nutrition Misinformation
• 39:20 Practical Nutrition and Hydration Tips
• 48:22 Intermittent Fasting and Final Advice

Transcript

"Aussie" Mike James: 0:06

Hello and welcome back to another episode of Wellness Musketeers. I'm Aussie, mike James, joined by my co-host, our medical expert, dr Richard Kennedy. Hello, richard, how are you, mike, and everyone, our economist, ketel Vitting Hello.

David Liss: 0:22

Ketel.

"Aussie" Mike James: 0:22

Hi, and our fitness trainer and man about town. Last but not least, david List. Welcome, david. Hey, it's a pleasure to be here Today. We're thrilled to welcome a special guest, tara Schmidt. A key role in shaping evidence-based, compassionate and inclusive wellness strategies for individuals across the country. She hosts the widely respected Mayo Clinic on Nutrition, where she demystifies complex health trends, debunks diet myths and champions sustainable habits over quick fixes. Welcome, tara, terrific to have you with us today.

Tara Schmidt: 1:06

Thank you so much for having me everyone.

"Aussie" Mike James: 1:08

Pleasure. Tara joins us today to tackle the big questions GLP, commonly known as trade names as Wegovy and Ozempic, etc. Glp medications, diet myths, weight bias and what really works for better health. So if you're ready to rethink your plate and your relationship with food, this conversation's for you. Let's get right into it. So just to start off, tara, what originally drew you to nutrition as a career and what has kept you involved with it?

Tara Schmidt: 1:37

I've been interested in nutrition since childhood, so I don't know if that makes me smart or weird, or just I was the kid like reading the nutrition facts on a cereal box next to my sister, who was older, who was doing the mazes. I'm also a product of the 90s and that was pretty ugly diet culture at the time, so I think that fascinated me. I was a tall kid, which in my mind meant big, which was untrue, but that's not how I felt. So I rolled with it. I got my bachelor's and I loved it. I got my master's, or I did get my master's. Eventually. I did my internship. I loved it. So I've just kind of stuck with it ever since.

"Aussie" Mike James: 2:21

Terrific. Well, what are some of the most persistent nutrition myths you've encountered over the time that are even around, say today, in 2025?

Tara Schmidt: 2:30

The ones that I lose sleep at night over are. Fruit has too much sugar, grains or wheat is inherently bad, and I think more so the use of the phrase or words like poison and toxic when we're talking about foods. I'm not saying that these foods are healthy, of course, but those words bother me a little bit, especially if someone has like a cocktail next to them which includes a toxin of itself and then they're calling you know, someone's kids cheesy rabbits toxic or poisonous.

"Aussie" Mike James: 3:04

Has that just come over the last couple of years? I've noticed that too, I think so.

"Aussie" Mike James: 3:09

Social media, unfortunately, and now you're a child of the 90s but we're quite a bit older than that, the three of us and back when weight loss became a big issue and a commercial issue as well I think about the 70s, 60s, 70s it was pretty much just a case of calories in, calories out. That's what everything was focused on. Does that still pertain, or obviously we're missing the full picture? But does that calories in, calories out still maintain a proper perspective?

Tara Schmidt: 3:37

Yeah, I like to say the math is still the math, but it's a lot more complex than that, right? So the complex of where do you live, how do you eat, what's your body type like, how do your emotions play into this, how does your health play into this? So, yeah, I have a physician that I work with who said you know, I can make anyone lose weight. They're going to come into the hospital and I'm going to give them an NG tube or a nasogastric tube and just tube feed them a certain number of calories. It's going to be less than what they need and guess what? I've got the best diet on the markets. The math is true, but of course we don't live in hospital rooms with NG tubes. If you're privileged enough not to be living in that scenario, it's more complex.

"Aussie" Mike James: 4:25

But at the end of the day, it's just math. Okay, right, well, and how do you respond to when someone asks you the typical party question or wherever you're at, I'm sure, when they know your background, what's the best diet?

Tara Schmidt: 4:35

The one that you'll do. So if we're talking about weight loss, we talk about the percent adherence. So we always have diet A versus, go all the way down to Z which one's better, which one's the best, which one has the best outcomes. And what we know is that you will lose weight. If you're in a calorie deficit, like we talked about, you will lose weight, but whether you keep that weight off or not is unrelated to the diet and more related to your percent adherence to whatever diet you selected. That would be kind of the conversation related to weight loss In terms of best diets for health. There are many of them, but the common denominators, when we look at DASH and Mediterranean, tend to be things like it's plant forward, it's high in fruits and vegetables. It's limited in ultra-processed food. It has omega-3 fatty acids or other healthy fats in it. It's limited in added sugar. So and that's a good news right when we have common denominators that we know have been proven, we don't have to keep fighting over. You know which one made the list this year.

"Aussie" Mike James: 5:39

Okay, I'll hand you over the kettle for some questions about the common weight loss medications and metabolic health.

Ketil Hviding: 5:47

Since you are so kind to give me the word that I can speak, I would actually like to kind of tell you that I had a lab that, since I passed away and your lab are constantly hungry and I would feed that lab the same thing basically every day, because that's the only way we could keep the elite down. So I, you know, I said you know, maybe my wife could give me food like that and therefore I could lose weight, but it never really worked.

Tara Schmidt: 6:16

Adherence, remember adherence.

"Aussie" Mike James: 6:19

If you start chasing cars, we're going gonna be worried about over time.

Ketil Hviding: 6:22

But you know, I can, I can assure you the lab, if you actually put a lab next to like a big container of food, the lab would literally eat itself to death my golden retriever would do the same yeah, it's the same.

Ketil Hviding: 6:36

It's the same thing, okay, so let's then talk about the big elephant in the room. So it's a g whatP and it's a nice technical term for it. It's Ozempic, Wegovy and Mounjaro, for instance, and a few others coming on the market. It's a big business as well and seems actually to work. We do. There's a big buzz about it. How should we really think about this revolution? Can you repeat that? I'm sorry you cut out for me.

Tara Schmidt: 7:03

How should we really think about this revolution? Can you repeat that? I'm sorry you cut out for me.

Ketil Hviding: 7:05

How should we really think about it? Is it really a positive revolution? It's something that's going to solve all our issues and the obesity epidemic around the world not only the United States, unfortunately, oh you know, it's everywhere we can go that far right.

Tara Schmidt: 7:22

You lost me at the end there. We can go that far right. You lost me at the end there. I think that these medications are absolutely going to be life-changing and life-saving for many people. I think that we've seen weight loss percentages that we were previously only seeing with bariatric surgery, and bariatric surgery is still out there and it's still a good option for many people. But I think this is going to be much higher in terms of accessibility. We'll see about cost over the long term and kind of the return on investment. But I think that these are let's at least say that they're a fabulous benefit that we've been waiting a very long time for.

David Liss: 8:00

Will these medications work for everyone, or are there some parts of the population that they just won't work with for some reason?

Tara Schmidt: 8:07

A lot of times what we'll do is we will assess your weight loss at the end of, let's say, 12 weeks and make sure that you are considered a responder. So a non-responder would be someone who's been taking the appropriate dosage for three months and did not lose 5% of their total body weight. I think that that's a smaller percentage because these drugs are pretty powerful, Because they work in the brain, they work in the gut, they're helping the liver, they're helping the pancreas. So these are pretty powerful drugs. We have dual agonists and now we have triple agonists coming, more and more coming. So I think there's a small percentage of people who would be considered non-responders. But the good thing is that at that 12-week appointment a prescribing provider would likely just try a different medication, of course, if that was still safe and appropriate for you.

Ketil Hviding: 8:55

Can you explain what you meant by dual and single agonist?

Tara Schmidt: 8:58

Yeah, so dual agonist. Think of two drugs working for you to help to decrease appetite, increase satiety, slow down the gut and help manage blood sugar. Triple agonists are adding a third let's call it ingredient that's going to help.

Ketil Hviding: 9:16

So those are ingredients in the drug, or is it actually taking one GPL1 together with another, maybe drug for diabetes or something like that?

Tara Schmidt: 9:27

Nope, they're more like ingredients. Now some people do combine, let's say bariatric surgery plus a medication, but the triple agonists are just a different class of medications.

Ketil Hviding: 9:37

Okay, sorry.

David Liss: 9:41

Is Zepbound a triple agonists?

Tara Schmidt: 9:43

Yeah, like chizepatide.

Ketil Hviding: 9:44

Yeah sure I actually. You know, as we all probably know, quite a few people who are on these drugs. It seems like the side effect can be actually quite strong. But I would actually challenge you and say maybe those are the effects. You know you don't feel good in meat, so it really punishes you.

Tara Schmidt: 10:02

I agree that it's part of it. So there are some physicians who will prescribe these medications and at the same time prescribe an anti-emetic and anti-nausea medication, because we know that people struggle with nausea. And there are other physicians who say I'm not giving you an anti-emetic, your nausea is essentially part of the mechanism of action of this drug and of course there's a learning curve for portions and frequency of eating. But yeah, I agree with you. Hopefully it's not a punishment but, as with bariatric surgery, I kind of tell people like there will be a learning curve for you to understand what hunger feels like for you, what fullness or satiety feels like for you. And some of them are just straight up side effects of the drug or of the weight loss themselves. But I agree that some of them are somewhat helpful side effects in this scenario.

David Liss: 10:51

I have a cousin and she's lost 61 pounds. And then she knew that she's going on a family trip to Hawaii so she stopped the medication because she knew she was going to eat or wanted to eat. While she was there she gained 8 pounds and then she she's back. And now she's back on the Medicaid.

Ketil Hviding: 11:15

Another thing is I know someone who actually have diabetes too and actually was able to monitor blood sugar quite carefully before going on one of these drugs, and it's really one of the immediate effects was to be able to flatten the blood sugar, reduce all the spikes, nearly independent of what you ate. So actually it seems to have an effect, over and above the effect on what you actually eat, on how your body processes sugar.

Tara Schmidt: 11:36

Yes, that's correct, and that's especially why these started as diabetes medications, because of their impact on things like insulin and glucose rises after meals.

Ketil Hviding: 11:47

So let's say that you're really focusing on losing weight. Ben, would you say this medication is the right option.

Tara Schmidt: 11:53

I have a conversation with my patients about we consider them essentially kind of four different pathways for weight loss. So you have lifestyle good old diet and exercise. You have medications, and there's a number of them, not just GLP-1s. We also have endoscopic, bariatric therapies, so weight loss procedures that are done endoscopically or down the esophagus, and then we have bariatric surgery and I would say, for people who a medication is right would, of course, depend on the amount of weight that they need to lose. I think people who struggle with hunger, people who struggle with cravings, people struggle with food noise, are good candidates and they're not a good candidate if they anticipate using these. In my mind, if they're looking to lose five pounds, one, they might not even qualify right via the FDA guidelines to be prescribed the medication. But we really have a conversation with patients about looking at these as long-term medications, because obesity is meant to be seen as a chronic condition or chronic disease state.

Ketil Hviding: 12:53

Yeah, can you explain what food noise is? What's that Food noise?

Tara Schmidt: 12:58

Yeah, have any of you ever experienced just like being in your home and not being able to stop thinking about food, like when's my next snack? I just had dinner but I wonder what I'm going to have for dessert. Or like the thing where you like, have your pantry open and you're just staring because you know you want something. So literally just consistent or high, I should say, thoughts of food. And I think that people either know that they have it and can quickly identify that, or they'll say like I don't know what you're talking about and that person doesn't have food noise. If they don't know what I'm talking about in my mind, do any of you have food noise? I absolutely do.

Ketil Hviding: 13:34

Yeah, okay, I recognize the symptoms, but I don't have it all the time. I get it all the time.

Tara Schmidt: 13:41

Yeah, and of course, eating is complex, right, it's psychological, it's physiological, it's environmental, so it's more than I don't mean to make a comment.

Ketil Hviding: 13:52

I got to speak with Tony Robbins. I just told my wife I have some snack, sorry, sorry.

David Liss: 13:59

I spoke with Tony Robbins once.

Tara Schmidt: 14:00

He said that food is the friend that can't say no, or people who are like I don't know the last time I ate and I'm like you don't Like I forgot to eat breakfast.

Ketil Hviding: 14:09

I'm like I've never forgotten to eat breakfast in my life. Some people are like that. So I asked my wife you know there's some more snacks in the house now than there used to be. It's not really a bad snack, but I know that I have a tendency to pick them up. She's trying to hide them, but she was not very smart at it. So I phoned her and I said you have to stop me from finding that and you have to fight me.

"Aussie" Mike James: 14:34

Oh, yes, you have to fight me and stop me.

David Liss: 14:39

Dr Kennedy, what were the most common things related to weight and nutrition that your patients would speak to you about?

Dr. Richard Kennedy: 14:45

Most of it. Well, I sort of have two types of patients. I have the patients who, like Tara just said, want to lose five pounds, 10 pounds for the upcoming wedding. Or you know that they bought this dress and they got to get in it because they want to impress somebody.

Tara Schmidt: 15:03

High school reunion. I hear a lot.

Dr. Richard Kennedy: 15:05

High school reunion, yes, and so it's one of those things. So those people are one thing, and I think that for me, the dilemma that the GLP-1s brought out went because of their success and people losing weight and because it was for a lot of people it was a quick way to do it. It helped them to forget about lifestyle, forget about exercise, because if you just take these drugs you'll actually you will lose weight. For those who it works for Now. So then there's the people who are morbidly obese, the people who's you know, people who are morbidly obese, the people whose you know BMI is 35 plus, kind of stuff. They're different in that most of them at the time, once they are ready, and I would say, you have to meet I've learned you have to meet patients where they are, when they're ready, they will sort of guide you down the path of okay, I'm ready to do this.

Dr. Richard Kennedy: 16:02

I've always been a proponent. I technically hate the word diet because to me, diet means that it's a, for a time, limited period restriction. You go back to whatever is your normal routine, which defeats the purpose. I don't know what the other term we should use is, because everything in the environment has diet attached to it, and so I, you know, but I think that they work.

Dr. Richard Kennedy: 16:28

One of the things I have found is it is, at least for me when I was still practicing, it was harder to get people who were just obese but who didn't have diabetes or who weren't pre-diabetic, to get on these drugs, and particularly because, you know, I was dealing with a population that was in the Medicare population and so Medicare is not covering it, and so and that's a large percentage of people, you know there's a greater percentage and Tara probably will correct me know there's a greater percentage, and Tara probably will correct me, of obese people over 55 than they are under 25. But probably not that much. But I see, you know, you see it and you know it's funny now being an older person and being a patient and sitting in a doctor's office and you see the number of peoples and you see how people many offices have changed the size of the chairs that they put in the waiting area.

Tara Schmidt: 17:26

It's actually a regulation that, depending on, for example, if your clinic practices bariatric surgery, you will have a surveyor or an auditor come and make sure and this is a good thing, right, especially if you're going to do something like bariatric surgery of does the hospital bed? What's the weight limit? Are the toilets floor mounted versus wall mounted? What do the seats look like in the waiting room and in my office? It's kind of fascinating, but in that scenario, it's for the patient and especially so that they can feel comfortable and so that they can feel welcomed in that environment, which is the purpose of why they're there.

Ketil Hviding: 18:02

So one of the things that I think you mentioned is that these medications are kind of forever. Is that fully true or any chance that you can get off them?

Tara Schmidt: 18:13

We don't know yet. So what we do know is that people who stop the medication about one year after cessation of the drug they tend to have regained anywhere from 50 to 66, so half to two thirds of their weight back. And I very commonly kind of overuse this scenario of what if you had a patient with chronic hypertension or high blood pressure? If you take them off their blood pressure medication, they will have a return of their hypertension. So we know that long-term usage is really the only solution we have right now for long-term efficacy. Now we don't have data super far out in terms of what the other options are. It's not likely going to be stopping the drug. If anything, it's likely to be decreasing the dose.

Ketil Hviding: 19:05

Okay, yeah, I mean this is to some extent related to the costs. Obviously, these are medications that are in high demand and somewhat restricted supply, and the companies will say we need to recoup our investment in these drugs. So even a company like Novonogat Nordisk, who claim they are for the benefit of humanity, they seem to have gained a lot of money on this.

Tara Schmidt: 19:34

They're doing okay.

Ketil Hviding: 19:36

But you know, at some stage this will fall, so they will be off, will not be protected, the patent will not be protected anymore and you get more entries into the market and you will actually reduce the cost to the cost of production more closely. I'm an economist, of course, but this can take time. But you know, what do we know about actually how costly it is to produce these costs?

Tara Schmidt: 20:02

Well, and it's complex, of course, and you know better than I about these complexities.

Tara Schmidt: 20:07

But another thing to consider is that oral medication will be coming on the market quite soon, so that could, I believe, will vastly decrease the cost, because now we're not having to use pens or injections. We also have to think about the cost savings that we may end up having insurance companies, for example, because what if you no longer have to take your blood pressure medication because that's resolved? What if you no longer need a knee replacement because your arthritis is doing better and that was really just weight related and that you had knee pain? Because what if our rates of cancer go down? Because I think there's seven different types of cancer that are related to obesity. So I think we're focused, of course, on how expensive these are right now, and it's very difficult to get the ROI out of it because it's so complex. And obesity, you know you can consider, impacts every organ system in the body, in my opinion. So how do we measure the benefits and the cost savings? But we're looking at a pretty like a big sticker shock when you look at the injection itself.

Ketil Hviding: 21:13

So we are here seeing a drug that you know we talked about the side effects. Often those are the immediate side effects. That might not even be side effects, but they be're part of the way they work. But you know, when I put something in my body on a continuous basis, I could be a little worried about what's the long-term effect on my health. Apart from the positive one that you mentioned, maybe there's some possible negative that we haven't studied yet, or do you have any indication what that could be?

Tara Schmidt: 21:41

Yeah, I think they're looking at people now, right, so they're currently looking at people who are going to be five, 10 years, et cetera, on these medications. There is a risk, of course, with any medication that you put in your body, but we're also seeing some really wonderful benefits, right. So we're talking about, like, the decrease in cardiovascular risk. These end up might being used in addiction, for people who struggle with addiction. So, yeah, we we can at least know that they're going to keep a close eye on the population and on these medications, especially people who end up being long term users. But that takes time, right. We have to have people on them for a long time to get those results.

Ketil Hviding: 22:20

I mean, are there any people who are genetically wired to struggle with weight and despite doing everything right, and maybe even with these drugs, and they're not sufficient?

Tara Schmidt: 22:33

Yeah, I do think that genetics play a role. How much of a role, I'm not sure we've uncovered that secret yet, but I believe that genetics play a role. I think your childhood and how you learned about food and nutrition play a significant role. I think trauma can play a role, psychology environment. I'm a pretty big believer that I, at least in America, live in an obesogenic environment. So it's kind of just this big puzzle piece like which piece of the puzzle were you stuck with? Like do you have the genetics and you live in a food desert and your education level is lower, Right, so it can be pretty complex. But yeah, I do think that having the right quote unquote puzzle is probably related to privilege.

David Liss: 23:17

Are rates of obesity related to income or education level?

Tara Schmidt: 23:23

They're linked especially if you think about food access right. So how many fast food restaurants are in that town versus how many grocery stores? What's the cost of fast food versus what is the cost of fresh food? What's access like to a dietician? What's access like to a wellness center? Can kids safely ride their bikes? Is there a sidewalk? So absolutely, there's many, many factors that play a role in weight, but also just nutrition and wellness, that are completely out of a person's control and things have gotten worse everywhere.

Ketil Hviding: 23:59

I gained weight in the first two years, not an enormous amount, but I thought I ate the same thing. It's only you know, it's that, this high fructose corn syrup that is kind of poisoning me all the time when I'm here.

Tara Schmidt: 24:15

I would ask you more questions. So, even though you may have been eating the same things, I would ask you what did transportation look like for you, right? So were you previously walking or riding your bike, or even taking the train, and now you're sitting in your car and sitting in rush hour for multiple hours a day? Even if you were eating the same foods, I would ask you if your portions were different. We're not real good at small portions in the US, small portions in the US. Added sugar, added fats, all the foods that make, all the things that make food taste good, access to food, accessibility, normalizing eating in various aspects of your life or environment so there's a long list for anything, I think.

Ketil Hviding: 24:57

The French would focus a lot on the rhythm of food intake, so they have very regimented times when they eat. So you eat a very small breakfast it might be quite sweet but it's very small and then you eat lunch, and that's about 1230 all over the country and then there might be a little boutique, what they call, and then there's dinner and they can be a little later. In between that it's formed upon to snack. That actually helps quite a lot, although it's not. You know, they drink a lot of wine to that, so that's not so good.

Tara Schmidt: 25:36

We do know that the higher frequency of eating you have in most cases unless you're tracking et cetera and you can do that math yourself but in most cases the higher frequency of eating someone has, the more calories they will consume. Frequency of eating someone has, the more calories they will consume. That's again kind of what I love, just like calories in type things, because most people don't adjust their next meal even though they had a snack, or don't stop their meal halfway through with the anticipation of having a snack, so it tends to just be additive as opposed to adjusted.

"Aussie" Mike James: 26:00

Okay, tara, before we move on to wellness and diet culture, I've just got a couple for you just off the top of my head. When we're talking in the bodybuilding world, they often refer to creatine as an aid. Does that help in weight loss, or is that purely muscle building?

Tara Schmidt: 26:15

Creatine is actually one of the most studied supplements out there, so I am familiar that it's pretty well studied and it does have some benefit to it. I'm not sure if there's good evidence for weight loss per se All right Another one.

Ketil Hviding: 26:31

I was told by my trainer that because I was going actually during the competition where they were weighing you in, that an immediate effect of creatine would be to increase weight, because of water. Yeah, water. But I mean that's just a technical thing, yeah, temporarily.

"Aussie" Mike James: 26:49

Also, there's a lot of talk and I've seen various conflicting research on diet sodas that they can actually have the opposite effect of what they're advertising that they actually put on weight. Do you have any comments on that?

Tara Schmidt: 27:04

My comment would be not mathematically, because zero is zero, but I do ask my patients when you consume an artificial sweetener, when something contains an artificial sweetener, how do you react? And I truly think there are two camps here of if I have an artificial sweetener. Someone said it's kind of like putting water in your gas tank, Like it looks full but it's not going to do anything for you, and so your car expects that it should be able to go, but it doesn't, right, you're not getting a blood sugar rise, you're not getting immediate energy. So I do think there are some people who will then go seek out actual sugar. They'll go seek out that blood sugar rise. They'll go seek out that increase in energy. I also think there are people who have a diet soda and say that's what I needed. I just needed that hyper kind of very sweet taste on my tongue and now I feel good and can move on with their day. So I actually would have a one-on-one conversation to ask you or experiment a little bit with how you react to those.

Ketil Hviding: 28:04

So what about? So I've read. Of course I'm like everybody else looking at the internet and stuff, but the artificial sweetener might have some negative effect on your gut culture. And those might be important for your overall health and how you eat and cravings important for the overall health and how you eat and cravings and all of that.

Tara Schmidt: 28:25

Yeah, artificial sweeteners have been linked to, we could say, maybe poor gut microbiome outcomes or poor gut health. So what I prefer to talk about, of course, is then what has positive impact on the gut microbiome 30 different kinds of plants and fiber and all of the above. But yeah, I've heard that as well.

"Aussie" Mike James: 28:45

Okay, and finally, I mean Kettle alluded there when you're talking about when he first came to America and thought he was eating the same food, but I guess that relates to recording your food or diarizing your food. I swear by I think it's a great app is MyFitnessPal, that we record your daily intake of food and so forth.

Tara Schmidt: 29:04

You're supposed to say Mayo Clinic diet Mike.

"Aussie" Mike James: 29:06

Mayo Clinic. I was just going to ask you.

Tara Schmidt: 29:09

You misspoke accidentally.

"Aussie" Mike James: 29:11

Okay. So what was it again? Mayo Clinic. There is an app that records. Yes, mayo Clinic, okay.

David Liss: 29:19

We'll be sure and put that in the.

Tara Schmidt: 29:21

I'll get you a free account.

"Aussie" Mike James: 29:22

I'm not now off MyFitnessPalm on the Mayo Clinic. All right, so now moving right along on wellness and diet culture, I'll hand you over the day for a couple of questions you may have.

David Liss: 29:31

Yeah Well, I think one thing I just kind of in the news lately this is kind of a little bit of a tangent, but we're seeing a lot of things about the last day or two about sugar and Coke as opposed to high fructose corn syrup, and I don't know if that is any kind of a victory. It's sugar, you know, and I don't know that we need to be having much sugar regardless. We have too much as individuals and as a society.

Tara Schmidt: 29:57

I was quoted an article yesterday on this and the article is a bit political so I'd prefer to not share it because I don't want people on the other side of the party to come at me. But my clinical, non-political opinion, which is exactly what I gave I did not know it was going to be spun politically is that sugar is sugar. Is sugar in this scenario? Right? So high fructose corn syrup is brown sugar is white sugar, is molasses, is honey, is cane sugar is what we've got them all? Right, because in soda, which is what we're talking about, they're still ultra processed, right? So this is not someone like chewing on sugar cane. I think panda bears maybe do that, but they're the only ones that I know that are actually eating this in its natural form. So if we're going to talk about regular soda, in my mind regular soda is regular soda. So that was my take on that and again, we could all use less sugar.

Ketil Hviding: 30:57

So the quote was sugar is sugar, is sugar? Something like that.

Tara Schmidt: 31:01

Yeah, I said added sugar is added sugar is added sugar. We're more eloquent. But yes, they did grab that one.

David Liss: 31:08

One of the things that you've spoken and written about is weight stigma, and what role does weight stigma play in how people experience care and how people feel about themselves?

Tara Schmidt: 31:18

I think it's really complex. Unfortunately, one of the places that people face weight stigma the most is actually in their medical care, and we could even reference what we were talking about and if you go to a waiting room and there's not a chair that fits your body. So weight stigma is really difficult because people experience it in their day-to-day lives. They experience it in opportunities, or lack thereof, for employment, in their sense of belonging in society. People that I've learned the worst stories from are people who've actually undergone dramatic weight loss. I work a lot with bariatric surgery patients.

David Liss: 31:55

In what way? What kind of things do you see?

Tara Schmidt: 31:58

I had a woman once tell me that people open doors for her now and I said what do you mean by that? And she said when I'm out in public, people open doors for me. And I said didn't they open the door for you before? And she said, no, they didn't Now. That medical provider is not wrong in that excess gravitational load on a joint is impactful, but I had a patient once who had cancer. She had a tumor in her knee and felt like she was ignored. Her knee pain and it was not bilateral, but her knee pain was ignored for a very, very long time because they kept telling her it was related to her weight. So those are my worst examples, but profound examples, of weight bias.

David Liss: 32:52

So we read somewhere they called obesity the last acceptable form of discrimination.

Tara Schmidt: 32:58

Yes, and it's more acceptable because people think that it's in our control, right? So the color of skin that you have is the color of skin that you were born with. You did not choose that and that's obviously. There's racism and that's not acceptable. More ideally, not going in our society anymore. But weight bias is accepted because people think that obesity is a choice of they could do something about it.

Dr. Richard Kennedy: 33:32

I actually would interject. I had a patient once who she was 5'2 and 326 pounds and she was going to her brother's wedding and the airline would not. She bought one ticket, but the airline told her you need to buy two tickets. We will not let you fly on this airline unless you buy two tickets. And this sort of ties into what obesity, the effects it has on your mental health and wellness.

Tara Schmidt: 34:10

Absolutely.

Dr. Richard Kennedy: 34:11

It can be quite disruptive. And what does happen? Because it's funny when you at least I know with me when I talk in detail with some of my really obese patients, the first thing they tell you is I don't really eat a lot and you know so. Then I asked them. I said well, you need to do a food diary, you need to tell me everything that you eat for a week and put it in, put a time in it. They were always surprised because they were technically snacking and because in the culture that they grew up, eating was sitting in front of a table with the rest of the family. You eat a full meal and then you go on, but they don't consider snacking as part of eating.

Tara Schmidt: 34:59

And this is exactly what Mike was bringing up with self-monitoring before I yelled at him and yes, mike, regardless of the app that you use, or a post-it note for all I care, right, I don't care how you do it, but self-monitoring tends to be one of the number one predictors of long-term, successful weight loss. And you can do calories, you can do carbohydrate choices, you can do fruits and vegetables. You can just keep tally of how many glasses of wine you had if that's your source of excess calories. But when you have to write it down, you have greater self-awareness. It's not me telling you, as your friendly neighborhood dietitian, what you should have or shouldn't have eaten that day. You're just ideally being neutral and recording what you're sticking in your mouth and you're going to have some awareness of like oh, had a cookie with my coffee this morning, which is exactly what I did because the neighbor brought them over. But if I had to write that down every single morning, we'd have a problem.

"Aussie" Mike James: 35:55

Something applies to exercise People who tend to write that down every single morning. We'd have a problem. Same thing applies to exercise People who tend to write down their exercise makes them much more accountable. Okay, dave, you had a final question, I think there.

David Liss: 36:07

Okay, well, so can you talk about your work debunking misinformation on social media? And why do we believe in these things so easily, from showers to diets, to God knows what?

Tara Schmidt: 36:21

It's engaging, right. People who are good at social media are good at social media for a reason and they make a lot more money, unfortunately, than I do. It's eye catching, it can be shocking, right? Or the article or the cover of the New York Times is meant to be engaging so that someone buys your magazine. It can be appealing results. It can be scandalous. It's interesting, right, and that's what entertainment is. Comparison is pretty boring. Like eat your fruits and vegetables. Everyone Like record what you eat and it hasn't changed that much. And people don't like that. So if I tell you, hey, do you remember what you learned in second grade about nutrition, 85, 90% of that's true. Like, just go, do that. It's not going to sell magazines that's not interesting, but it is true. Magazines that's not interesting, but it is true. So I think it's more of just the excitement around new diet, new food, new toxin, new method for what we're looking for, right. And we also want things very, very quickly and I think misinformation on social media tends to promise things very, very quickly.

"Aussie" Mike James: 37:36

I also found that it's. I've probably spent too much time on YouTube, but I find that it's really adopting some of the old tabloid newspaper methods. Every one of their it's a headline and the video may have nothing to do with it it might have one line in there, but it attracts an attention and people might get on this thing for 30 seconds or something at most, but they've still seen that headline and that is how it creates misinformation. I think it's really employing old methods in a new field in terms of communication.

Tara Schmidt: 38:06

And it gets your click right. You clicked on it, yeah, and that's all they're concerned about.

"Aussie" Mike James: 38:10

That's all they're concerned about. They're not concerned about the People In the American people have short-term interests, you have to catch them.

Dr. Richard Kennedy: 38:21

If you just look at any news feed that's on, they pretty much do everything in cycles of three to five minutes yeah, and nothing more. If it goes beyond that, you tend to lose your audience, because it's hard to keep them engaged.

Ketil Hviding: 38:35

In addition, now the algorithm can tailor it to you. So they have seen that I've been Googling a lot about how to lose weight. They will send me a lot of you know information about that, that 90% of it is not correct and you know the tailoring is the new thing. That is really powerful.

Tara Schmidt: 38:59

It's impeccable. I Googled where I was going on vacation because I wanted to see a picture and I was just bombarded with like the whole world knows where it is right now Because I was getting advertisements and articles and math yeah, it was. I was like, ok, well, that's not a secret anymore.

"Aussie" Mike James: 39:17

Maybe we can hand over to Dr K for some questions on practical nutrition for daily life and longevity. Oh yeah, yes, Tara.

Dr. Richard Kennedy: 39:24

So you've talked about nutrient density and what would you say would be your go-to framework for building a balanced plate.

Tara Schmidt: 39:34

Yeah, I do what we we've done for the past. We're going on about 15 years with with the government's plate method and I don't disagree with it and and that's half or more fruits and vegetables. Variety would be key in the long term. A source of protein, be it lean animal or plantbased protein, a source of whole grain or a different starchy plant. And if you'd like some kind of calcium in your diet and if you want some extra fruit or veggies in there, we kind of consider those to be unlimited. So this is why I don't have a huge social media following, because I say boring answers like that, but that it works right and that's like the good and the bad news of it is like it's not overly complex, but I think people want it to be.

Ketil Hviding: 40:19

Yeah, so you should. I could eat that much fruit and vegetables. No, no fruit. You said fruit, yeah.

Tara Schmidt: 40:25

You know? Here's what I said Unlimited vegetables for everyone.

Ketil Hviding: 40:29

Okay, go nuts Fruit.

Tara Schmidt: 40:32

I I actually tend to say I've had maybe one patient in my career who I had to say back off on the fruit One they were blending it in a smoothie, also had high triglycerides, etc. But 99 out of 100 people, I'm going to say, are not eating enough fruit. So it's extremely rare that I would limit you. Now, if you have diabetes, I'm going to pair it with a meal. We're going to make sure that you count it as part of your carbohydrate sources. Outside of that, I'm really doubtful that you're eating too much. There are a million other foods that I would say let's put on the brakes. Before I've ever told someone like hey, dr Kennedy, I think you had too many apples today. I also think they're self-limiting. Like are you really going to eat 10 bananas? You're going to be constipated as heck. First of all, I just don't think you're going to eat 10 of them. But can I eat 10 handfuls of pretzels or chips Like you? Betcha, see you there.

Ketil Hviding: 41:28

Yeah. So what about the little dessert at the end of the meal? Anything fit well, I just got permission, yeah, yeah comment on that

Ketil Hviding: 41:35

so I you know because I I actually followed someone who actually was tracking the glucoses and it really and and you know the the theory that it works, it posts where it says very different at the end of the meal than at the beginning of the meal is actually pretty true. So if you eat a little bit of sweet at the end of all vegetables or fruits, they will, you know. At least you don't get the same spikes.

Tara Schmidt: 42:03

Yeah, or like if someone had diabetes and they said can I never have a cookie again? I would actually say have a cookie with your lunch, because now you have protein Ideally in that lunch. You obviously have some fiber in there. You have other foods in the stomach that will slow digestion instead of just having a cookie on an empty stomach. So, yeah, I would say put the sweet with the meal. I don't really care necessarily about the timing of it, but if you can put it on the plate and consider it to be okay, that's one of my carbohydrate choices. Or instead of a grain, I'm going to have a cookie. Ok, now we swapped those 15 carbs out of there. That actually is a method that I am absolutely comfortable with.

Dr. Richard Kennedy: 42:43

So what are some of the common healthy foods that you think are misunderstood or that people don't think they are as healthy as the establishment believe?

Tara Schmidt: 42:56

I'm not a huge fan of bars. I think a lot of they're convenient and I absolutely understand that, but I think if you look at the nutrition label of many of them, they're going to be like a healthified or a glorified candy bar in my mind. I also think there is kind of a lot of unnecessary protein products out there, like protein chips. We've got protein popcorn and I'm okay if you have chips and especially popcorn in your life, but does it need to be protein? I'd rather you have like actual popcorn that you pop. That's technically a whole grain, right. And now we've got maybe a healthy omega-3 or a little bit of omega-6 fatty acid in there. But if we get into protein popcorn and protein chips and I saw protein cookies out there now we're just going further down the ultra-processed food aisle or route processed food aisle or route and I think we have some very strong evidence that our high consumption of ultra processed food is absolutely going to impact our health.

Dr. Richard Kennedy: 44:00

And for someone who's trying to make one change to improve their eating habits, what's the most powerful first step one can make?

Tara Schmidt: 44:10

Take stock in what you're currently doing, right. So I could say, hey, my best advice is for you to stop drinking alcohol, but what if you never drank alcohol in the first place? Then that's not good advice, but for someone else it might be hugely meaningful. I could say I need you to start eating more vegetables. What if that person already has vegetables six times a day? That's not relevant to them. So what I really want people to do as their first step is kind of like what Mike was talking about is what are you currently doing and where do you think I look for excess empty calories? So these are one calories that we don't need, but they're also calories that are not providing you with nutrition. And start there. Are you drinking any water? That's a great goal. Are you moving your body at all during the day? That's a great goal. But take stock in your current habits before you make that decision.

Dr. Richard Kennedy: 45:02

So how much water? Is too much water in a day, if there is such a thing?

Tara Schmidt: 45:08

There is because you can get you know you can get water toxicity. I think we saw a really tragic case of that at a raft hazing incident.

"Aussie" Mike James: 45:16

Yes, that's true.

Tara Schmidt: 45:17

Sometimes it can happen with athletes if they're not also pairing it with electrolytes, etc. So for me it depends on your body size, Also your sweating, If you're sweating, if you're exercising, if you're in a very, very hot environment. How we tell people to assess their hydration is by looking at the color of their urine. There's really not a better test. So we like light lemonade, politely speaking, or straw color. If it's darker than that, you're probably dehydrated and especially as the day goes on, it should lighten up. It does not need to be clear. So we're looking for pale yellow and if it's more concentrated than that, have some water in your life.

"Aussie" Mike James: 45:57

And is clear urine. Is there any bad indication of that, tara, if your urine is clear?

Tara Schmidt: 46:01

I don't think so, unless we're getting into that water toxicity range. I don't think it's not to my knowledge. I just don't think it has to be the goal per se.

"Aussie" Mike James: 46:11

What about Dr K? What do you think of that?

Dr. Richard Kennedy: 46:13

Clear no again, I think it depends on the situation. So if you have an and not necessarily an athlete, just someone who's out and about working out on a regular basis, I always tell people when you're young, you can get away with not being as hydrated as you are when you're 35 plus, because you're you know, I think everybody's metabolism changes as we age and what we used to be able to eat, um, when we were younger, and how we could burn calories, you know almost just by thinking. It changes over time and you have to compensate for that. I always tell people they need to listen, because most of us know when we're thirsty, most of us know when I think it's more complex when you're older, because you don't have the same reaction to dehydration that your reactions tend to be you pass out, you fall down Whereas when you're 18, 20, you know your reactions tend to be you pass out, you fall down, whereas when you're 18, 20, you can get dizzy pretty quickly, lightheaded pretty quickly, and so you know the change.

Dr. Richard Kennedy: 47:26

You know, and I've always been a proponent of water and I've had enough personal experiences in my life when I didn't get hydrated enough and the consequences are dire, you know, like fracturing half my face. So yeah, so it's, I think it's a it's it's. It's very important to drink enough, and I always say technically if you were to literally put an ivy in most people and rather take an intravenous line and just draw out all the liquid out of it, all that would be left would be 30 of us, because our body, in the healthy person 70, is water by weight okay, all right.

"Aussie" Mike James: 48:13

Dr k, do you have any other questions to finish off here? No, I'm pretty good.

Ketil Hviding: 48:17

Yes, I have a question. So on the, there's a fad, it's called intermittent fasting. What do you?

Tara Schmidt: 48:25

think about that.

Ketil Hviding: 48:25

What do you think about?

Tara Schmidt: 48:26

There is actually some good evidence for you can call it intermittent fasting or time-restricted eating, but it doesn't need to be overly dramatic. I had an endocrinologist on the podcast and had a full episode on it. I believe that she said we see the most benefit when we fast for at least 12 to 14 hours. So that leaves a 10 to 12 hour eating window, which I think is quite reasonable. But if you think about people's kind of nighttime habits it can get complicated. But I do think, and again so I think a reasonable eating window. There are some benefits because I think your body just needs time when it's not digesting food. It's also not likely necessary that you have that many calories or that you're eating that late at night. So I know that it became quite popularized, kind of in a fad diet type way. But we also have some pretty good actual evidence to support limiting your eating window.

Ketil Hviding: 49:34

So nighttime fasting would count. So let's say I eat at seven o'clock at night and next morning I don't eat before eight. That's pretty good. Okay, and it's breakfast.

Dr. Richard Kennedy: 49:44

That's what it means, breaking the fast An interesting Ramadan where people from sunrise to sunset they take nothing in, but if you've ever been around people in the evenings when they're having that one meal that they're having, and. I always used to be surprised, having had a lot of Muslim patients, how most of them, during Ramadan, never lost any weight. They really had some feasts where you almost make up for all of what you didn't do during sun's daylight hours at night. That's interesting.

Tara Schmidt: 50:23

Yeah, and that's a good comment on. If someone asks me about intermittent fasting or if they're experimenting with it. You know, if people are trying to sneak in their last snack before their time is cut off, I'm like, ok, intermittent fasting is probably just not a good fit for you. But moving your dinner earlier and not eating after dinner, like those are very reasonable habits that we don't have to call intermittent fasting, like it doesn't have to have a name associated with it.

"Aussie" Mike James: 50:52

All right, folks, as we start to wind up after Tara spent such a long time with us, which we really appreciate, of course, just a couple of almost rapid fire questions, if you like. Tara, what's a nutrition belief you've held before that you probably changed your mind about over the years?

Tara Schmidt: 51:07

I have admittedly been judgmental about let's call them diets or fad diets out there that I did not think were necessary. I did not think that they were medically backed or had any good research behind them, and in recent years I have adopted more of a sense of you know what, tara. If it works for that person, why do you care? So I'm trying to be more mature about letting people. But like before, my dietician heart was like no, but that's not the good one, like I don't want you to do that.

Ketil Hviding: 51:39

And I'm trying to just Eating meat is okay if that works for you.

Tara Schmidt: 51:43

If what.

Ketil Hviding: 51:43

Just eating meat, bad meat.

Tara Schmidt: 51:45

Did you see the YouTube video of the girl yelling? Okay, that one's not my favorite. No, it's not my favorite. What favorite? No, it's not my favorite.

"Aussie" Mike James: 51:55

What's one thing you wish everyone knew about their health? Tara.

Tara Schmidt: 51:57

It's individual, so please individualize your choices and your goals to you. A second one, if I can have two, would be one bite can make a difference in a good way of like adding one bite of a plant or fruit or a vegetable or a bean over time can compound to benefits.

"Aussie" Mike James: 52:19

Okay. It's like in the book Atomic Habits. He talks about that, doing small things at a time. If you had one minute with someone standing in front of a fridge at 10 pm, who's talking? Was that, sorry, kettle? Was that you? Okay, all right. Again, if you had one minute with someone standing in front of the fridge at 10 pm debating a binge or maybe a beer, talking personally, what would you say? Go to?

Tara Schmidt: 52:45

bed.

"Aussie" Mike James: 52:45

Okay.

Dr. Richard Kennedy: 52:48

Or if you really want me to do that, I could do my counseling.

Ketil Hviding: 52:53

I would go to bed if you told me that.

Tara Schmidt: 52:54

like that I have small kids, can you?

Tara Schmidt: 52:57

tell I would have bowed my head and I would kind of sneak, snuck up to bed, my mom voice coming out yes, exactly.

Tara Schmidt: 53:06

Or I could say, mike, what you looking for, and what I mean by that, is are you hungry Like? Is your stomach actually telling you that it's empty and you're getting a sign that you need something in your stomach? Are you bored? Are you seeking comfort? Is this habit? Are you just in the pantry? Because that's in the same open concept space as your living room and that's where you're watching TV. Then I'd say, go watch TV in your bedroom, because I'm assuming you don't drink beer in bed and if you do, no judgment.

"Aussie" Mike James: 53:36

I love it, that's a whole other podcast.

Dr. Richard Kennedy: 53:39

No, you're getting it.

"Aussie" Mike James: 53:41

I'm picking on you.

Ketil Hviding: 53:42

We're Australian, we're not drinking beer. You know we drink beer everywhere.

"Aussie" Mike James: 53:47

That's a very bad cultural stereotype, it's true. Yeah, it is, but we always like to leave our listeners with, you know, two or three actionable items just to finish off For a good, healthy nutrition plan. Is it two or three recommendations you think could just point us in the right direction, tara?

Tara Schmidt: 54:05

Think about what you can add to your diet. So much of what's out there is about stop eating this, don't eat that, right. Quit X, y or Z, and it's so much more fun to add. So can you add some fruits or vegetables to your life, right? Can you add some more fish to your diet? Can you add some olive oil when you're going to cook your dinner tonight? So add instead of subtract.

Tara Schmidt: 54:28

Before you make a change, assess your current habits and what would actually be a realistic, meaningful change for you versus what the very attractive TikToker told you to do. And third would be look at how your environment is playing a role. Right, and this is not like you can't have ice cream in the freezer. But if you didn't have ice cream in the freezer, would you have eaten it at 10 o'clock at night? What if you had to get in your car and go drive to the gas station? Most of us wouldn't do that. So are there ways in which you can adapt your environment? Adding things to your fridge pre-cut vegetables, right. Or subtracting things from your fridge or pantry that help support your wellness goals.

"Aussie" Mike James: 55:11

Terrific. That's very unique advice. Really, I think that'll be really beneficial to all of us. So, in closing up, that's a wrap on this inspiring conversation with Tara Schmidt. A huge thanks to you, tara, for joining us today. I know you've got a very busy time, so thank you very much for joining us. It's very beneficial for all of us. Thank you for having me it was a pleasure Terrific.

"Aussie" Mike James: 55:33

And we'll get onto that Mayo Clinic app right as soon as we finish here, thank you. So, folks, if you found this episode valuable, hit, follow on your podcast app so you never miss what's next, and if someone in your life could benefit from this, share it with them. It helps grow our community and spark new conversations. Hit, like and share so we get a hit on a logarithm, or whatever you call it, and you'll find links to Tara's podcast, mayo Clinic on Nutrition, plus more of her content, in the episode description. So, until next time, stay curious, stay kind, and stay well. Thank you, folks.