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Interviewer: Eating well is a crucial component for good health, but for a lot of us, it's a skill that we never really were taught or learned much about. The Utah Wellness Bus visits communities and offers free health screenings in addition to education to anybody who wants it. And if you visit the Wellness Bus, one of the people you might talk to is our guest today, clinical dietician Alex Marie Hernandez.

In today's interview, we're going to talk to Alex about tips that could help you eat healthier, some common barriers and misconceptions about eating well, and how a free nutrition counseling session from Utah Wellness Bus can help you understand about nutrition and help you improve your health.

Alex, let's go ahead and start with what could somebody expect during a nutrition counseling session if they visit you on the Wellness Bus?

Alex: Part of the sessions when somebody comes to see me for a nutrition or lifestyle coaching is that we take some time to get to know the client. So part of that includes a dietary assessment. So I ask them, "What do you normally eat? What does a normal day of eating look like for you?" And from there, I can then see what are some of the common foods that they eat? What are some of those that maybe we can improve?

Based off of that, then we go into different nutrition, education topics, right? So one thing that's very helpful is learning how to read a nutrition label, which is something that a lot of people aren't too familiar with. So just checking that nutrition label for things like added sugars.

And then a lot of times, if they are drinking something, for example, that has a lot of added sugars . . . Just yesterday, I had a client who mentioned that she was drinking a lot of vitamin water. She was like, "This is great. I'm getting lots of vitamins."

Interviewer: It sounds healthy.

Alex: Yeah. And then I'm like, "What brand is it? Let's take a look at this." So we look it up online, we look at the nutrition label, and it turns out it has like 26 grams of added sugars in one bottle. And she was having multiple every day.

So then we go through and we look at . . . we'll compare that to what the maximum amount that you should be having in a day is, and then they come to that realization, "Wow, I'm having a lot of added sugars and I didn't even know."

So things like that. The nutrition label is a very great tool in figuring out how to make healthier choices.

Interviewer: Do you find that a lot of not such great stuff is hiding in our food and we really need to do some research . . .

Alex: Oh, yeah.

Interviewer: . . . looking at that label to figure out what that is?

Alex: Mm-hmm. Because some things can be marketed as healthy. The label will make it seem like it's a healthy choice, but you look at that nutrition label and it turns out that's not the case.

One example that I talk to a lot about with clients is when it comes to breads, like whole wheat bread. It may say that, but you look at the nutrition label, look at the fiber content, and it actually doesn't have a lot of fiber. You look at the ingredients, whole grains is not one of the first ingredients. So that nutrition label is going to tell you the truth versus what's just marketed or advertised on that label in the front of the product.

Interviewer: And this is kind of a new phenomenon, isn't it? That you have to be aware of what's in your food. I would think many years ago, we made a lot of our meals from scratch, so we kind of knew what was in our food, but now you just really don't know. You do have to do that due diligence.

Alex: Yeah.

Interviewer: Give me a tip on how I can start that process, because it sounds a little overwhelming, right? I've got to know what I'm looking for, and then I've got to know how much of that thing that I can have and still be healthy. I've got to do all that math. So how do you make it simple for people? Or is there not a way to make it simple?

Alex: There is a way to make it simple. But I guess my tip here . . . I don't know if it's appropriate, but come to the Wellness Bus.

Interviewer: That's right. Take advantage of you.

Alex: Yeah. We can talk about it some more, because one of the things we offer as well in these sessions is this health coaching book. And it has a lot of great information, visuals, things are colorful, which makes it easier to understand.

So we go over those things. We point things out. We do some teach-back as well, like, "Well, now that we've learned this, can you tell me this?" So I really think taking the time to talk to someone who can walk you through that is going to be helpful. So come to the Wellness Bus.

Interviewer: And realize that it is complicated.

Alex: It is complicated, yeah.

Interviewer: I think some people might feel a little ashamed, like, "Well, I should understand this stuff," but it's not necessarily super easy to understand all the time.

Alex: Right. And I'm trying to think . . . I don't know if it's always taught in schools. I took a nutrition class in high school, which is where I became interested in nutrition, and that's where we went over the nutrition label. But even then, not too much in depth. It was later on when I studied more nutrition that I better understood how to use that nutrition label.

Interviewer: Right. You've this for how many years of schooling?

Alex: Oh, I took longer to get my Bachelor's, but . . .

Interviewer: But it's a Bachelor's degree, so . . .

Alex: Bachelor's plus Master's. In a few years, Master's will be required for all dieticians.

Interviewer: Okay. So I think that really illustrates how much there is out there to know that somebody could dedicate two degrees to it, right? So come to the bus and capitalize on that knowledge that you have.

Alex: Yes.

Interviewer: What do people think their nutritional challenges are generally, and do they align with what you know?

Alex: We work with a lot of diverse communities, right? So I think with that, a lot of people come to the bus thinking that their cultural foods are not healthy foods. And we want to highlight that you can still eat healthy within your cultural foods.

When they come to the United States, maybe they're presented with one way of eating, and that that's the only way of healthy eating. But that's not true. There are so many healthy foods across the world.

For example, the Mediterranean diet, right? That's one of the healthiest diets in the world. So it's just highlighting their staple foods and why those are healthy.

A lot of times, it just comes down to portion sizes, right? Maybe people are eating too much of one thing and not really balancing it out with the other nutrients that they need.

Interviewer: What are some of the barriers to good nutrition that you encounter? So we talked about just knowledge. Are there other barriers?

Alex: There are other barriers. For example, access to healthy foods. That's a big challenge. Sometimes, we'll talk about some . . . For an example, healthy fats like salmon, great source of healthy fats. But when I mention that, they'll say, "Oh, that's too expensive." So then we can talk about other sources of healthy fats as well, right?

Or even thinking about frozen or canned foods, it's okay to eat those foods. Again, just reading that nutrition label is going to help you make better choices there.

But we can also talk about food pantry, local resources, where they can go get more food if they're not able to afford that at the grocery store. And also just talking about how you can still eat healthy on a budget is important. So I think that access to foods is another big barrier that we encounter.

Interviewer: How about time to make meals at home? Is that a barrier?

Alex: That is another one as well, yeah. That's a good point. And there, we talk about ideas. Based on what they like, their food preferences, what are some quick, easy meals or even snacks that you can eat to incorporate more healthy eating?

One thing, for example, that I mention a lot is baby carrots are super easy to take with you as a way to add some more vegetable in your day. However, people don't think that. Maybe it's not as glamorous, but there are ways to do it. There are.

Interviewer: When somebody comes to the Wellness Bus, if they see it in their neighborhood and they want to come in and talk to a nutritionist there, you, is there something they should prepare? Should they come in with a list of what they've eaten for the past couple days? Is there anything else that they should come in with that could make the job a little bit easier, more productive?

Alex: I want to say that they don't have to prepare at all if it's going to make it easier for them to come in. No worries. Just come in. I'll ask you the questions to learn what I need to know to help you.

Interviewer: One of the programs on the bus is called Journey to Health. Tell me a little bit about that.

Alex: It's a nutrition education program. We're collaborating with the Nutrition Department at the University of Utah. It's six months long. There are four nutrition classes that a participant would go to. And then part of it is also to come see me, dietician on the bus, for two sessions. And then at the end, the participants gather together for a community meal to celebrate their successes and what they've accomplished throughout the program.

The program has been very well received by the community. People are loving it. Some of the classes include cooking demos. You get free gifts like kitchen items, which is wonderful. Learn how to shop around a grocery store and find healthy foods on a budget.

It's been something that people have really enjoyed. And when they come see me, they rave about the classes, like, "They were great. I love them. When are there more?" I was like, "Sorry, there were only four classes."

But it's great because they get a good foundation of healthy eating from the classes. And then when they come see me, we can talk more individualized about their specific situation, what's going on, and how we can set some goals specific to them. It's open to the community, so come check it out.

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Scot: Mitch mentioned that he was using a product named Huel to Troy, and Troy and I went, "What?" We had no idea what he was talking about.

Troy: No idea.

Scot: Yeah. And he explained it to us a little bit and then had some questions that we couldn't answer about it, so we thought, "Well, let's get our nutritionist Thunder Jalili on the show."

So this is "Who Cares About Men's Health," providing information, inspiration, and a different interpretation about men and men's health. We've got a good crew here. I love this crew. I love this crew right here. I provide the BS. My name is Scot Singpiel. He provides the MD. His name is Dr. Troy Madsen.

Troy: Thanks, Scot. We love you too.

Scot: And then we have Ph.D. Thunder Jalili. He knows so much about nutrition and how the body processes nutrition and does its nutrition thing. And I know I completely just undersold what you've spent your whole career doing, but let me just say Thunder is really smart about this stuff.

Thunder: That was a great introduction. I'll take it.

Scot: Okay. Yeah, you're great. And then we have Mitch.

Mitch: Hey.

Scot: He's a Hueligan, apparently, I've come to find out.

Mitch: Yeah. There's a t-shirt even that they sent me. It's a whole thing.

Scot: Yeah. So you ordered some of these Huel meal replacement products. Are they meal replacement products? What are they, Mitch?

Mitch: So you hear about them sometimes on podcasts, on some of the tech blogs that I read all the time. They were definitely invented by Silicon Valley tech bros for tech bros. All of the branding and everything is very, very much, "It is the world's number one complete food." It's not a meal replacement. It is a food.

And the kind of concept is that, "In this busy world that we're all in, you don't have time to think about your nutrition, your macros, what you're going to eat. So we have created a product that is a 'nutritionally complete meal' with an exact amount of calories, an exact perfect amount of," according to them, "macro distribution." It's vegetarian. There's supposed to be a ton of nutrients in it. It's all super foods. Who knows what's in it?

And it's okay. It's not the most delicious thing in the whole wide world, but it's okay. I don't know. I just was curious, how much of this is all hype to repackage the old SlimFast-style meal replacements of the '90s to today's tech culture? So I'm glad that we have Thunder on to kind of talk me through this.

Troy: Mitch, I'm curious. Do they market it as this is all you eat? Or you're on the go, you need a quick meal, you eat your Huel? Or is it just, "This is your food. This will sustain you and you will eat nothing else"?

Mitch: So there are a couple of brands out there that are not Huel that I have not tried that do market it as, "This is all you eat." You eat three shakes a day and you're perfect. All the nutrition your body needs. I couldn't really get behind that particular brand because the idea of just drinking a kind of earthy-tasting protein powder . . . It was like protein powder plus dirt plus a little bit of chocolate. Eating that three times a day, slurping that down was not my idea of a good time.

So the Huel and the reason I hopped on the Huel train was they have what is called their . . .

Scot: Is this your next t-shirt, the Huel Train?

Mitch: Choo-choo, all aboard.

Scot: He's in deep, guys. He's in deep. Intervention.

Mitch: Yes. But what I liked about the kind of marketing for the Huel is that they market it as, "This is a healthy lunch to have." They talk about how you can have their breakfast shake and their lunch and then have whatever you want for dinner. It's this idea of, "Don't go for fast food. Have this instead." And I appreciated that more than thinking I was joining some group of people who just don't like food anymore. I do like food. I don't know. I don't get it.

Troy: Well, I've got to tell you, Mitch, and I mentioned this to Scot off the air here, that I used to do a lot of cholesterol testing on people as part of a job I had. And this one guy, he was a tech guy, and I checked his numbers and I was blown away. I had never seen cholesterol numbers like he had. Crazy, crazy low LDL, crazy high HDL. I was like, "What do you eat?" He said, "Soylent. All I'll eat is Soylent." He said, "Totally on a Soylent diet." It was crazy.

Mitch: So he was doing the goop? He was doing the goop all day, and it was . . . Oh, my God.

Troy: Yeah. He was doing it all day, every day. That was all he ate. So he was not doing Huel like you're talking about it where it's like, "Hey, this is your healthy lunch and you can eat whatever you want for dinner." He was going all in. It sounds like some of these are marketing where it's just like, "24/7 this is all you eat." But the numbers were impressive. I will say that.

Mitch: That's crazy. Okay.

Thunder: That sounds like such a boring food culture.

Troy: It sounds horrendous, but . . .

Thunder: I know. It's like the Russian Gulag of eating.

Troy: Exactly. It's just like, "Eat your porridge."

Scot: I knew that Thunder was going to . . . Thunder is very pro-real food just because I think he enjoys the experience of eating real food.

Thunder: And it tastes good. You can make it taste good too. Isn't that a bonus?

Troy: I was going to say Thunder has already referred to me as the metronome of eating. These guys take it to a whole new level.

Thunder: That's right. You can set your watch by the way Troy eats.

Troy: That's right. But these guys, this was something else, the Soylent diet. And it sounds like probably some of these people that are doing Huel 24/7. That's a whole other level.

Scot: Thunder, what's your take on this? To me, my initial reaction is this probably is not good. I don't know. But then I hear what Troy just said. So what's your take?

Thunder: Like you guys, I am kind of a novice to the whole world of Huel and I tried to educate myself a little bit about it. I don't think they're doing anything new, as Mitch mentioned.

Over decades, there have always been food substitutes, meal substitutes, and they're always marketed with the same sort of thing. "You're too busy to make food, so eat this," or, "You want something healthy and you don't know how, eat this." etc.

So my take on it, this is probably not a terrible thing if you want to do it sometimes. I think, overall, the danger . . . I don't know if danger is the right word, but the problem with this sort of thing, in my opinion, is that it gets you really used to reaching for a convenience product to get your meal out of the way and move on to the next phase of the rat race.

I don't know. To me, it sounds restrictive. I've never tasted it, so I don't know if it's delicious or if it tastes like crappy camp food. But that's one of the things that I would wonder about. Would it get boring? I mean, you're all excited, you do it for a few weeks or a month, and then you're totally sick of eating all these lunches because you're rotating between the same five options.

I don't know, but maybe we'll find out because Mitchell is doing the experiment for us. So we'll get some information about it.

Troy: Along those lines, Thunder, too, I wonder . . . There probably are some beneficial health effects. I don't doubt that. I just wonder about the psychology of eating that way 24/7 and what the long-term effects of that are. Is it like being in the desert with just a small amount of water and then you get to the oasis and when you finally get a chance to drink water, you just overdo it and kill yourself? Do you just break down at some point and just go crazy and just eat tons of fast food? I don't know.

Thunder: Yeah, that's a great point. The health thing and then do you just totally go off the deep end because you can't take it anymore with the monotony?

I will say, regarding the health aspect of it, I'm split in my mindset of that. Just glancing at some of the ingredients and nutrition labels, it doesn't look like it's bad from a health standpoint at all. It's just that I wonder if you become reliant on it, does that prevent you from going out and seeking whole foods on your own? Do you get so used to the convenience that then the meals you do on your own tend not to be great because you've kind of fallen off the wagon of cooking and finding whole foods and going down the classic nutrition route?

Mitch: That's interesting because that was the big thing that I was wondering about. We talk a lot about whole foods. We talk a lot about they're the best possible version. But we've also said like, "Eh, if it's frozen, it's okay. It's still pretty nutritious." And this flash dried or whatever it is. It's 100% like camp food. It tastes . . .

Thunder: Yeah, freeze-dried

Mitch: . . . like camp food, but maybe a little bit better. I don't know. Maybe I'm just biased. But ultimately, is the processing or anything problematic for the foods that are in it, the ingredients? Is the nutritional value impacted by the way that it's formulated and shipped and packaged?

Thunder: I mean, the general answer is probably some, but it's hard to answer specifically without taking the ingredients in their natural state before they're freeze-dried or whatever and comparing them to the rehydrated version.

So we're going to guess that, yeah, there's going to be some degradation of some of the vitamins. But who knows exactly how much? Hopefully, you make it up with other parts of your diet as well, or maybe by just eating enough Huel that if the levels are lower, you eat enough volume to make up for it.

Scot: Hey, question for you Thunder. One of the things that you talked about one time was the food matrix that the nutrients reside in, and that makes a difference, right?

Thunder: It does make a difference, but this does seem to be like whole food. So I've got to give them credit for that. They're taking whole ingredients, not just powderized this or that. They're incorporating whole foods, which theoretically would address the food matrix issue.

Scot: All right. So, Mitch, I'm confused. I thought these were shakes.

Mitch: They do make shakes. That is an option you can have. I found them to be gross. That is a personal . . . That is not an official stance for this podcast or our organization. That is just a Mitch Sears opinion. Kind of gross.

Thunder: They taste like wallpaper paste.

Mitch: No, more like . . .

Scot: And that is a Thunder Jalili opinion. Not necessarily . . .

Mitch: Not the podcast.

Thunder: A completely uninformed opinion because I've never even tasted it.

Mitch: Sure. No, it's more along the lines of . . . Have you guys ever had the taste of pea-based protein powder? That weird veggie taste? You mix that with the smell of dirt and you mix it up with some almond milk and that's . . .

Thunder: My mouth is watering.

Scot: Again, why are you doing this?

Mitch: But I don't eat that. I eat the fancy hot and savory stuff. It's like a mac and cheese. And it's got quinoa-based noodles and a yeast-based cheese sauce, right? Or a Mexican chili that's full of lentils and beans and whatever. So it's 100% like the camp food you'd get at an REI or something like that, the kind of freeze-dried, rehydrate type stuff.

Scot: And do they amp up other nutritional stuff by adding additional things to it?

Mitch: That's what they say. They say they're able to increase the amount of plant-based protein. There are 27 vitamins and minerals. It's high in fiber because it's all lentil- and veggie-based.

Troy: Mitch, it sounds like you're going to do this.

Mitch: What? What am I doing? I just have it sometimes.

Troy: Are you doing Huel? I thought you were . . .

Mitch: I'm doing it.

Troy: I thought you were going all in on it. You're doing it. You're actively doing it.

Mitch: Oh, no. I am currently eating some Huel for lunches and I have another one that is some fancy oats that I have in the morning, high-protein oats. It's a similar concept. But it's not like I'm doing it every single day every, single meal.

Troy: Okay.

Mitch: I just mix it in there when I know I'm going to have a busy day or something like that. So I just do that rather than go get a gas station taquito.

Troy: Okay. So it's going to . . .

Thunder: The infamous roller food.

Troy: Yeah, it beats the alternative.

Scot: Yeah. I guess in comparison to that, it's pretty good stuff, right?

Troy: No, it really sounds like it is.

Thunder: In the application that Mitch is using, it's probably fine because he is not living off it. It's not the staple of his diet. Yeah, I don't really see any problem with it.

I think in the grand scheme of things, if you look across the spectrum of people that would be interested in this, maybe you'll get some people who want to make this their meal all the time. And that could have some issues.

I mean, for one, it's probably really expensive, and for two, it probably gets them away from exploring what they could get out of real foods and just gets them locked into this particular panel of meals.

And then as Troy was saying earlier, what if you just get to a point where you're like, "I can't take it anymore," and you just fall off the wagon and just will eat anything because you need a different taste?

Troy: And along those lines too, you mentioned cost, Thunder. Mitch, what are you finding in terms of how much you're paying for a meal?

Mitch: So it ends up being about $3 per meal.

Troy: That's pretty cheap.

Mitch: Maybe a touch more than that.

Scot: That's way cheap.

Mitch: So that's kind of more . . .

Troy: That's really cheap.

Mitch: Yes. They give you a bunch of bags. You have to order a certain amount, so there is a bit of an upfront cost. But yeah, for me to have just a couple of bags in the back, just on-hand, emergency replacement food, it's been nice. It's been nice to have that. I do worry that this feels processed. This feels like a trap. This feels like it's all snake oil or something like that. So I wanted to figure out.

Thunder: Technically, Mitch, it is processed because it's dehydrated and you have to reconstitute it.

Mitch: Yes. But is it killing the nutritional value? That kind of stuff.

Thunder: Yeah. And again, that's difficult to say. There's probably a little bit of a hit with the nutrients, with the vitamins and the phytochemicals, but it's impossible to say how much.

I have a couple of technical questions about the Huel. So you add water and you just throw it in the microwave. Is that how you prep these?

Mitch: Yeah. You put two scoops. They have these little special measuring scoops. If you want to get real technical about it, they give you the exact weight measurements, and then you put a couple of scoops of water, throw it in the microwave for two minutes.

Thunder: So how much food does this make? Are you full? Are you satiated from eating that?

Mitch: Yeah. It's a big bowl.

Thunder: Okay.

Troy: I'm just confused, Mitch. Yeah, I'm just trying to figure out what these meals are, because my initial thought when I heard about this, I thought of Soylent. With Soylent, you're just drinking soybeans. I mean, it's just like a soybean paste and that's what you're drinking.

It sounds like, though, here you're talking about different varieties. They are like camp food, but some have a pasta sort of consistency to it. Others are just protein drinks. So it sounds like there at least is some variety both in the texture and the flavor of it.

Mitch: Oh, yeah. And I think that's kind of what drew me to it. They've got chilis, they've got Cajun dishes, they've got curries, they've got a chicken and mushroom. And they always spell it a little different because there's no meat in any of their products. A tomato and herb. A sweet and sour if you're feeling like you need a little bit of takeout Asian-type food. It's a good mix. They're okay. They're all pretty okay.

Troy: Yeah. For me, for someone who's certainly not a nutritionist, the way you're doing it seems to make sense where you're using them to substitute certain meals. It's not like it's overly expensive. It sure beats some of the alternatives for fast food or quick meals.

And it sounds like, from what Thunder is saying, there's definite nutritional value there. It's not like the freeze-drying process is necessarily causing it to lose a lot of that. So it seems like a pretty good approach.

And talking about it and just looking at their website here, I'm actually intrigued and maybe this will make it into my food metronome. We'll see.

Mitch: Oh, sure.

Thunder: Hey, I'm looking at the offerings, the hot and savory offerings. There are nine. They're advertised on the website. And I think it'd be neat just to real quick look at some of these ingredients, because they do emphasize the whole food thing.

I'm looking at yellow coconut curry because I actually like coconut curry. So they have dried grains, which consist of brown rice and quinoa, pea proteins, flaxseed, coconut milk powder, raisins, desiccated coconut, which just means dried up coconut, yellow coconut curry. So these are all pretty much whole ingredients that you would use if you're making coconut curry.

And then at the end, they have all the other things they add to it to bump up the nutritional content. And what I mean by that is ascorbic acid, which is vitamin C, nicotinamide. Is that in cigarettes? Nicotine? No, that's actually a vitamin.

Troy: No, I don't think it's the same thing. Yeah, nicotine is in cigarettes, but I don't think nicotinamide makes it in there.

Thunder: But it's funny. People will look at ingredients and they have no idea what some of these are because we're not used to seeing these added to food. They have alpha-tocopherol, which is vitamin E, lutein, which is a carotenoid, a vitamin A derivative, calcium, zinc, retinol acetate. So you guys get the idea.

Troy: Interesting.

Thunder: They're basically putting a multivitamin in these products. And every one has basically elements of a multivitamin added to it.

Troy: Yeah, that's interesting to hear that because as I was scanning over it, I got the impression it's a lot of, like you said, whole foods and you're getting the nutrition from that. It sounds like it has that certain component, which is the bulk of it, but then they're adding a whole lot to it as well to get those vitamins in there.

Thunder: Yeah. That's good for the label.

Mitch: I was so sure that there was going to be an "Oh, Mitch, you're ruining everything" episode. This is awesome.

Scot: I'm actually a little surprised too. And this feels like it's becoming an ad for this product, which it certainly is not, right? I'm still skeptical. I don't know why. I find that to be interesting. It doesn't sound like it's expensive. I figured it would be. It sounds like it tastes okay. It sounds like Thunder is reading the label and he is like, "Yeah, this seems all right." Troy is all like, "If you're just using it as a once in a while meal replacement, that'd be fine."

Thunder: Yeah, and I think that's the take-home message. Once in a while meal replacement, this is okay. You could do a lot worse.

I think what Troy and I agree on is that you don't want this to be the foundation of your diet all the time because while you could get by strictly from a nutrition standpoint, I think you miss out on other things. You miss out on trying new foods, trying new sources of nutrients, and the element of extra nutrition you get from fresh things, farmer's market products and so forth. But as a once in a while meal supplement, I think go for it, Mitch.

Mitch: Cool.

Thunder: I can't even really ding them for too much sodium. That's the low hanging fruit. You always bash on frozen foods or processed foods. "Oh, it has too much sodium." It doesn't really have a lot of sodium either. Yeah, as far as meal replacements go, it doesn't look like it's bad.

Scot: All right, Mitch.

Thunder: For me, it would really come down to taste, if I can stomach it or not.

Scot: Why don't you invite us over for a Huel dinner and we could do some taste testing?

Troy: Yeah. Speaking of inviting people for meals, why don't you serve us up a Huel buffet? We can try all sorts of different Huels.

Scot: We could all sit down at the table and then you can get up and you could put it in the bowl and we can watch you use the specially designed scoop to put two scoops of water in your food and then put it in the microwave and you can bring it out. That'd be great.

Thunder: It could be like a bonding food preparation experience like we talk about except with powder.

Mitch: It just feels like a joke on some sci-fi show of some sort where it's like, "Oh, yes, let me reconstitute the meal."

Scot: Who knows? That may be the way of the future. So I think this episode was all about Mitch wanting permission that this is okay.

Troy: Yeah.

Mitch: Yeah, basically.

Scot: Am I getting it correct that you guys are giving him permission?

Thunder: Yes. Mitch, you have permission to have occasional Huel.

Scot: All right, Mitch. Permission granted.

Mitch: Yes.

Scot: Can we wrap up the episode?

Mitch: Absolutely.

Scot: Okay. Thank you for listening and thank you for caring about men's health.

Salt, sugar, and fat, what's not to like? Well, there is such a thing as too much of a good thing, and salt may be one of them.

We evolved as humans in a low-sodium environment, the inlands of Africa. We have taste buds specifically for salt, sodium chloride, and most of us like salty things. We may be the sweatiest animal on the planet, and we lose salt when we sweat from heat and vigorous exercise. So we do have dietary needs for a little bit of sodium chloride, the chemical we usually mean when we use the word "salt" in terms of food. But is there such a thing as too much salt?

We know that drinking seawater is remarkably unpleasant because it's too salty, and you can't survive by getting your water needs from seawater. You'll die.

And when we eat a lot of salt in our food, potato chips followed by boxed macaroni and cheese for lunch and a store-bought pizza with cheese and pepperoni for dinner, we get thirsty. We drink a lot of water, and we wake up all puffy. And who wants to wake up puffy? And all that puff shows up on the bathroom scales. Well, being puffy means that your body has held on to water to help dilute all the salt in your blood that you ate yesterday, and holding on to extra water means that your blood pressure can go up. And when your blood pressure goes up, it puts you at risk for heart disease and strokes and kidney failure.

America's high-salt diet, on average 3,000 to 6,000 milligrams a day, has been linked to high blood pressure, a leading risk of heart attacks, strokes, and kidney failure. More than 4 in 10 American adults have high blood pressure, and among black adults the number is 6 in 10.

The issue of salt in food is a complicated one. Of course, some people are sensitive to increased amounts of salt in their diet. Research studies have defined this salt sensitivity as people for whom an increase of 1,000 milligrams of sodium, about half a teaspoon of table salt, increases their blood pressure by 5%. Now, that doesn't sound like very much, but it's a significant difference when it comes to health outcomes. Some people are genetically salt sensitive, and some people are salt sensitive because they already have a chronic medical condition that gets worse on a high-salt diet.

Of course, there are studies that suggest that people who eat sodium at the 3,000 to 6,000 milligrams per day and say they don't necessarily have bad health outcomes. An international study of more than 100,000 people suggests that while there's a relationship between salt intake and high blood pressure, if you don't already have high blood pressure and you're not over 60 or eating way too much salt, salt won't have much impact on your blood pressure. However, most research suggests that a lower sodium diet is good for people who are older, over 50, who are African American descent, who have high blood pressure or diabetes, or whose blood pressure is gradually creeping up.

The Institute of Medicine, the Dietary Guidelines for Americans, and the American Heart Association recommend limiting your sodium intake to no more than 2,300 milligrams a day. That's about a teaspoon. People with heart failure and kidney disease are advised to keep their sodium at about 1,200 milligrams a day or about half a teaspoon. And for the very significant percent of Americans who have kidney stones, including yours truly, excess salt in the diet contributes to the formation of the most common kinds of kidney stones. Ouch. I had to have that explained to me by my urologist.

Now, low-sodium diet, that's easy, you say. You wouldn't put half a teaspoon from your saltshaker on your food each day. It turns out that the major source of sodium in our diet comes from prepared foods from the store, that boxed macaroni and cheese, prepared soup, bread, prepared salad dressings. About 70% of the sodium people consume comes from premade or packaged foods according to the FDA.

With that in mind, the FDA recently issued voluntary guidelines for the food industry to lower the amount of sodium in prepared foods, manufacturers, restaurants, and food service operators. These guidelines are voluntary and temporary to seek to decrease average sodium intake from approximately 3,400 milligrams to 3,000 milligrams per day, about a 12% reduction over the next 2.5 years. Now, that isn't very much, but it can make a difference in a population of people.

A recent study published in "The New England Journal of Medicine," done in China in 600 rural villages, randomized households to using regular salt in their cooking to a salt substitute, which switched out about 25% of the sodium chloride in their saltshaker with potassium chloride. This isn't enough for most people to taste the difference. They were encouraged to use a little less salt in their cooking, but could use other sources of sodium, like soy sauce, in the usual way. This is a very small dietary change. The control villages did their regular cooking. There were about 21,000 people in the study, with an average follow-up of about 5 years. The average age of the participants was 65 years. Half of them were women. About 72% had a history of stroke, and 88% had hypertension. That's a pretty high risk group. There was about a 15% decrease in strokes and major cardiovascular events and deaths in the salt substitute group over this 5 years, which would be quite significant if you're talking about a billion people or talking about 10 years. So it was kind of a big deal.

Other studies have shown similar effects in the U.S. in people who adhere to the DASH diet, which stands for dietary approaches to stop hypertension, sort of a Mediterranean diet with lower sodium. They have lower blood pressures.

So how much sodium in your diet if you're mostly healthy? About 2,300 milligrams or one teaspoon of table salt. If you have genetic or medical conditions that predispose you to greater risks with salt, even less. If you're like the average American and get 70% of your sodium intake from prepared and packaged foods, read the label.

Americans consume a lot more salt in their diet today than they did 50 years ago. Largely this is a change in how we cook or rather how we don't cook. Many more meals are pre-prepared from the store, and many more meals are eaten out with a lot of salt. Women are often in charge of the food shopping and food prep in the house. Clearly this isn't always the case, and there are many days many people just don't cook. They eat out and they eat foods in restaurants that are often very high in sodium and few actually will give you the amount, but sometimes you can look it up online. Or they eat in prepared or prepackaged foods.

Sodium is important enough for your health that the FDA food labels on the back of the package let you know how much sodium there is per serving. Your local pizza place with high sodium crust, high sodium cheese, and high sodium pepperoni, yum, won't have the sodium content. You can make choices in the food you buy. Many prepared food companies, like Campbell Soup, have offered lower sodium soup options in their canned soups. Even the chip aisle in the grocery store has chips with lower sodium.

So what do the labels on the front of the box mean? Sodium free or salt free, each serving in this product contains less than five milligrams of sodium, very low sodium. Each serving contains 35 milligrams of sodium or less, low sodium. Each serving contains 140 milligrams of sodium or less, reduced or less sodium. The product contains at least 25% less sodium than the regular version, but in the case of some soups that may mean going from 700 milligrams of sodium per serving to 500 per serving, and that is still a lot. Unsalted or no salt added, no salt added during processing of food that normally contains salt. So this could still be salty.

So make a commitment to cook more food at home from scratch and more whole foods, whole grains, veggies and beans, and don't add salt when you cook. Let people add the salt at the table if they need. Adding spices, pepper, or lemon can increase the flavor in your home foods without adding extra sodium. Do you like sea salt on your chocolate chip cookies? Forget adding salt to the dough and sparingly grind a few flakes, a very few flakes on the top of the cookies.

Even though you and your family might not be salt sensitive or have risk factors that would make a low-sodium diet important, some of you will someday. Getting out of the salt habit, eating more food cooked at home by somebody is good for you and the people you love. Have everyone become involve in food shopping choices and cooking at least some of the time and guide these choices, and that will help everyone be more independent in their sodium, sugar, and calorie choices and maybe your face won't be so puffy after pizza night.

Dr. Jones: So you've been very successful at achieving your weight loss goal. Congratulations. But you don't fill out your bra anymore. What is that about?

Most women who undertake a significant weight loss through diet or through weight loss surgery are hoping to lose fat. That's the part of the body that we don't need so much. We don't want to lose a lot of muscle when we do a weight loss thing. But some parts of our body are mostly fat, and that would be our breasts, and weight loss may lead to a body change that isn't welcome. So what can we do about that?

Today, in the virtual Scope Studio, I'm talking with Dr. Cori Agarwal. She is a plastic surgeon who specializes in aesthetic and reconstructive surgery at the University of Utah, and she has an interest in helping women find the body that they're looking for.

So I have some questions about this, because this is a really interesting topic for people who have really undergone a basic transformation of their body, whether it was 30 or 50 pounds, or they lost baby weight and the baby and then they nursed and so their body isn't the same. After substantial weight loss, women may find their bodies change in ways that they hadn't anticipated. Can you talk about weight loss and how it affects breast structure?

Dr. Agarwal: I think that's a really overlooked conversation when people set out to lose weight. They're really focused on health and kind of the getting back to feeling more active. And sometimes it's a surprise when there's this negative effect on specifically the breasts.

The breasts, as you mentioned earlier, are made up of quite a bit of fatty tissue, and that really varies person to person. But I'd say most women, especially as we age, the breasts become more and more percentage of fat. So when you lose weight all over your body and you lose fatty weight, naturally some amount of that is going to come off of the breasts. And you don't always know until you're there. So, for some women, it's just a minor effect. And for some, it's completely deflated after the weight loss.

Dr. Jones: Oh, deflated. I mean, it's hard enough getting older and if you've had babies, but to have . . . even that word deflated, that would have me rushing to you to get some help.

Dr. Agarwal: Well, I was going to say the deflation, it's really important to think of it in two areas. There is the loss of volume, so the loss of this fat where you really just lose the size of your breast. And then there's the deflation, the sagging of the skin where the nipples kind of point down and everything stretches down.

And those two we really think of separately and independently. When we talk what options there are for rejuvenating and filling the breasts, we really think of the sagging and the loss of volume separately, because not every individual has as much sagging or as much loss of volume.

Dr. Jones: When you said there are really two parts to two different kinds of changes that happen with weight loss, there's sagging and then volume, what are you going to do? What are the procedures here that you're going to undertake with this woman?

Dr. Agarwal: There are really two main objectives. And one is to fill the volume to the size that was lost. And for some women, they want to be a little bit smaller than they were to start. Some want to be a little bit bigger. And to fill that volume back, to restore that deflated volume, the mainstay operation is a breast augmentation, and that's placing an implant in the breast usually behind the muscle to regain the volume.

However, if the skin has at the same time sagged, which it usually does, in the process, there needs to be a skin tightening procedure done at the same time. And that's called a mastopexy or breast lift.

Now, these can be done independently. Someone may just want the lift. They might like the size that they've ended up, but everything's just droopy. So we'll just do the breast lift. And then more commonly, we will offer and recommend a lift with an implant, because in most people, I think both of those processes are happening. That's something that's very individualized, but I think it's important to think of those two separately, the lift and the augmentation.

Dr. Jones: And so, rather than some people thinking they're just going to have a little incision somewhere and something is going to be slipped in and pumped up or something, you're really going to have to remove some skin and maybe lift the nipple.

Dr. Agarwal: Right. I think that's often a surprise for women because they think, "Well, this is just like a deflated balloon. I'm just going to fill up the balloon," but they haven't really noticed how far things have stretched. And we really have to have an honest conversation about what it will look like with just the implant, or if you really want or would recommend a lift along with that implant.

Dr. Jones: So what are the options for women who would choose breast surgery? Do you call it aesthetic or cosmetic, or in this case, is it really reconstructive and is it paid for by insurance?

Dr. Agarwal: That's a really important thing, and so many things are blurred in the world of plastic and reconstructive surgery. A lot of things that we do that are reconstructive really are also cosmetic, and there is a blurred line, especially when it comes to the breast.

So when we talk about the words cosmetic and reconstructive, what we're usually getting to is "Will insurance pay for it?" Because if insurance sees it as cosmetic, then even if we think it's really truly a reconstructive thing, building your body back, we have to call it cosmetic. And the sad truth is that for most breasts that have sagged or lost volume almost all the time will be considered cosmetic by insurance companies and is not covered.

Dr. Jones: Well, for women who part of their weight loss journey has been becoming really active, and now they have breasts that don't want to stay where they want to put them, that ends up getting in the way of their being the physically active person that they have to be if they're going to maintain their weight loss.

Dr. Agarwal: Right. And we do try to make those arguments to insurance, but I think that it's just outside the scope of what we can declare medically necessary for the breast. Breasts sag for so many reasons. Pretty much anyone who has gone through a pregnancy and nursed a baby, even just age, breasts just sag almost 100% of the time. And so I think that's just beyond what we can argue for insurance to cover.

Dr. Jones: Knowing that many people who lose weight gain it back again, is there any recommendation about waiting for weight to stabilize for a while before considering breast augmentation? I mean, we've all watched the successes and failures on "The Biggest Loser," and some people are back right where they started from within a year or two. So how do you counsel people in terms of when they should consider this reconstruction?

Dr. Agarwal: I think as a general rule of thumb after a lot of weight loss, we'd like people to maintain their weight for about six months. If it's just a quick diet that's severe and maybe they're going to bounce right back in a couple of months . . . but by six months of sustained weight loss, most people are pretty steady in their weight. So that's the general recommendation, but of course, it's very individualized.

Dr. Jones: Right. And can this surgery be part of a larger surgery? So you certainly know people who have maybe had bariatric surgery and they lost 150 pounds, and now they have sagging not just in their breasts, but throughout skin, all over their body, which becomes a significant issue in just terms of staying healthy. Can you do redundant skin reduction at the same time that you do a breast surgery, or are these staged at different times?

Dr. Agarwal: I think both are true for each individual. When we're thinking about doing reduction of skin, tightening of skin after a lot of weight loss, safety is the main priority. We want to limit the amount of time under anesthesia for any individuals. So if they came in and said, "I want my breasts and my belly and my thighs and my back," we really have to slow it down and say, "Okay, what's the most important thing here? Can we combine it with something else?"

We try to limit the surgery time somewhere between three and six hours. And so we can do sometimes breast work with something else, but depending on what other areas are the priorities, it's very common to stage this.

But that's the conversation we have after we get to know the patient and see how healthy they are, how prepared they are for a long recovery. So it can go both ways.

Dr. Jones: So when you say how healthy they are and how emotionally prepared, it's hard when you have just a few minutes to get to know someone. And I know that sometimes before people undergo bariatric surgery, they might actually see a behavioral psychologist. But how do you get to know people to know that this is the right thing for them to do and they're not just seeking something that's really unobtainable? How do you set realistic expectations about what they're hoping for?

Dr. Agarwal: This is really important. We spend a lot of time . . . I'd say the first visit is usually about an hour. And during that time, a portion of it is talking about the surgery and evaluating them. But a big part of it is talking about how they've gotten to that point, how they feel, what their expectations are, and then their social support. I think social support is critical when you talk about getting through a big surgery like that. And so we'll make sure that they've really thought through who needs to help them, someone to help with the children, someone to help with themselves and their work. So that first visit, we do a fair amount of that really trying to get to know someone.

And you're right, it's only one visit, but usually we have another one or two visits after that before surgery and really get to these critical questions of whether they've thought this through and have the support on the other side. Some will have to really set realistic expectations, that you will not have a 20-year-old body after this, but you will have this and you won't have that. So we try to be really realistic and not try to sugarcoat it or make it seem better or easier than it will be.

Dr. Jones: Right. Well, I would think that most people having gone through . . . particularly if it was significant weight loss, they've been with this body for a while and they know what they're looking for, and I bet you they're mostly pretty realistic. They're not coming in with perfect breasts hoping for more perfect breasts.

Dr. Agarwal: I wish that was the case in everyone. I think there are certainly a lot of women who are exactly in that category, but there are a lot of people who still . . . maybe it's a lot of the TV shows out there, but there is an idea that there's some magic that happens and some Photoshopping. I do think we have to ground them sometimes if maybe what they've been seeing isn't realistic, because . . .

Dr. Jones: I've seen some of those YouTube videos, the befores and the afters, and I look at the afters and say, "How can she have lost 150 pounds and have breasts and legs that look like that? Is that real?"

Dr. Agarwal: Exactly. So you have to take a lot of it with a grain of salt, and so that's the job. I think that that's the consultation. You're not going to know that before really meeting with your surgeon and understanding what can be achieved.

Dr. Jones: I want to thank you because I hadn't really thought about this one. Certainly I've had patients over the years who were thinking about bariatric surgery, and I didn't really take them through all the steps that this will happen when you get there. You will get there, but then this may happen. It may not. So I want to thank you for giving us some insight.

And for women who've taken the big steps to make a big positive change in their body through weight loss, there are sometimes still steps to take to feel like yourself again. You're not alone and there are options and procedures that can help.

I want to thank you, Dr. Agarwal, for joining us. And thanks for everyone who's listening on The Scope.

Scot: All right. We're back with Thunder Jalili. He's our resident nutrition expert. And we're going to throw out another one of these things you might see on the internet, or some of this common sense, or, you know, something that you've believed for a long time. And we're going to find out if it's truth or if Thunder is going to debunk it on "Truth or Thunder-Debunked." Thunder, are you ready for your challenge today?

Thunder: I hope so.

Scot:: All right. Does eating at night really cause weight gains? Because there's this kind of, I think, this wisdom that you eat late at night and that's what's going to cause weight gains if you're eating like right before bed or something like that. So is that truth, or are you going to Thunder-debunk it today?

Thunder: No, I actually think there's truth to that.

Scot: What?

Thunder: Yeah.

Troy: Good, I was going to say don't tell me this is not true, because my whole takeaway from all our discussions is that this is true.

Scot: All right. Well, go ahead and explain.

Thunder: We talked in earlier podcasts about kind of the length of time that you eat, in terms of like what time do you eat in the morning when you wake up and then kind of when in the day you stop eating. And as we eat, our insulin levels go up, and that's kind of the hormone to store nutrients like fat.

So people that do that late-night snacking, you know, they've got to have something at, you know, 10:00, 11:00, 12:00 at night, maybe even later, they're kind of extending that whole time that they're putting calories into their system, and their insulin levels are high. So that's a recipe for, you know, storing fat.

So one of the ways that we would, like, advise somebody if they want to try to lose weight, you know, what are some easy steps I can think about, well, one of the easy steps is try not to eat after dinner, you know. Then you kind of have a longer time period where your body can go into that natural fasting state overnight and that helps us control our weight.

Troy: See, I'm so glad you said that, Thunder, because I have now, after all of these discussions we've had about this, I now watch the clock. I don't eat after 8:00, and sometimes it is a rush to get calories in before 8:00 p.m. I admit it's a little weird, but sometimes I am just like, okay, gotta eat, gotta eat, gotta eat. Okay, it's 8:00, I'm done.

Scot: So if you do work later, though, let's say you don't start eating until 6:00 p.m. and you shut it down at midnight. You're eating at night. Is that going to cause weight gains? Is there something about the night, or is it really just about that time of eating and not eating?

Thunder: It's not . . . there's nothing special about night. It's about the time period.

Troy: So maybe it was Thunder-debunked then. So it's nothing about the night in general. It's more just that period between when you last ate and when you eat again.

Thunder: Yeah. Oh, that's true. I guess in that sense it could be debunked. I guess I was assuming most people, you know, do have kind of a more regular schedule of having, you know, three meals, more or less, a day and then throwing snacks in there. So the night snacking, when I hear that, I assume that the person is, you know, kind of doing that normal, three-meals-a-day thing. But, yeah, to your point, if that's not you, if your first meal doesn't come until 4:00 in the afternoon, then, by all means, eat at 10:00.

Being confined in a space close to the refrigerator isn't good for me. Is it good for you?

So you're at home, with kids, with partners, or by yourself. You're cozy and in your most stretchy yoga pants and a big turtleneck fleece. Well, that describes me. Now, I can put on some nice earrings and a cover of scarf and call it dressed up for a Zoom meeting, and no one can see below my waist. But sooner or later, I'm going to have to put on my jeans.

This is how many Americans are making food choices this pandemic, during physical isolation. They are eating junk food. According to Bloomberg News, sales of Oreos, Cheetos, and boxed macaroni and cheese are up. Cans of Spam are up 37%. Of course, those in charge of the shopping may be looking for food with a long shelf life, a very long shelf life. Whether you're buying comfort food because you are stressed and want the foods that you had when someone was taking care of you or you're buying foods that you can use to bargain with your kids into doing some schoolwork, these choices aren't very good ones, not for you or your family.

One of the problems is, when these foods are in the cupboard or the fridge, you and your family are close to the fridge all day long. For the kids, it's a shuffle between the sweet caffeinated drinks, the chips, and the computer. For you, it is snack, snack, snack all day. The fridge and the goodies are always there, and you are always there.

We probably evolved to crave sweet, salt, and fat. We evolved in a low salt environment, so salty is craved. The easiest foods that were low energy to hunt and gather and chew were an advantage when they were high energy in our bodies, meaning easy calories, not high energy like coffee. That meant sugar and fat. Salt, sugar, and fat. And the comfort food industry knows this and adds a lot of fat and salt to their chips, bagels, cookies, and boxed macaroni and cheese.

We are not hunter-gatherers anymore, except in the time of quarantine when we hunt for chips and gather them up to eat in front of the TV. Hunter-gatherers walked all day long and were always on the verge of starvation. We are not. We evolved to pack away these calories into fat to use during times of stress. But this was caloric stress, not this pandemic stress when we may be flooded with calories.

Now, refined carbs, such as cookies, donuts, and granola bars, are the largest source of calories in the American diet, followed by breads, chips, sugary drinks, pizza, and pasta dishes, and other processed foods. They're also high in sodium, except for the sugary drinks. These foods are awful for our blood pressure, our cholesterol, and our insulin. These carbs are low fiber carbs, so they increase the insulin response and push us closer to diabetes.

In this COVID-19 epidemic, people who are hypertensive, obese, and diabetic, and they often all go together, are at the highest risk of becoming seriously ill and dying from this virus. Eating well may help our immune system. Eating poorly may suppress our immune system. Eating poorly makes you feel out of control in your life, and you're already in a global pandemic that is out of your control. However, eating well is in your control, so here are some suggestions.

Eat a healthy meal. Then, make your shopping list. Buy only what is on your list. Plan your shop and shop your plan. Don't buy that awful stuff. It's a rare treat, not a daily treat. The stores are well stocked with fresh produce. Buy crunchy veggies and hummus, or better yet, make your own hummus and you can make it with less fat. Dip veggies into plain Greek yogurt spiced up with whatever works for you and your family. It's really easy if you have a blender or a food processor. And it's cheaper. Lock down the fridge for 22 hours a day, the fridge and the cupboards. If possible, set a time for meals, and everyone helps. This pandemic time is not the time when kids are all over the place with friends and activities. This is not the time, unless you're an essential worker, a health care provider, first responders, grocery store workers, car fixers, electricians, plumbers, and farmers, that you are spread out all over the city at mealtimes. You're all home. Set a schedule and stick to it.

Phones, laptops, iPad, etc. are left behind. Make the food at these meals count, count for you and your family if you have your family with you. Make the food count nutritionally. Whole foods and grains and colors and spices. Limit salt. No easy carbs. Everyone helps chop, cook, and clean. Those who don't cook have to clean.

If you cannot get by on three meals a day, schedule snacks. Keep them prepared so that they're right there in the fridge. Alcohol can short-circuit your resolve. Make it once a week treat, not a daily necessity.

Kids say, "I'm hungry," and that whine goes right to your mommy brain. If they're really hungry, they'll eat fruit and veggies. If they don't want that, then they're not really hungry. No foods squirreled away in the bedrooms. It's okay to go to bed a little hungry. Don't eat a lot of easy calories before you go to bed or your kids go to bed. It's especially bad for your heart, your gut, your immune system, and your sugar control.

If you get this virus, you need a strong heart and strong lungs. There are many ways to exercise during this time. Physically distanced walks, jumping jacks in the living room. There are jillions of exercise classes online that you can do in front of your computer or your smart TV. You can do them in your yoga stretchy pants, and you already have them on.

So, just some ideas, and thanks for joining us on The Scope.