A Registered Dietitian Explains Why Keto Works Short-Term But Fails Long-Term

Connie Diekman [00:00:00] The simple answer is alcohol is metabolized just like fat, so therefore it goes to storage. So the more alcohol, the more, more you store. This is the Vance Crowe podcast.

Vance Crowe [00:00:15] Welcome back to the podcast everybody. I'm glad you're here. This week I spoke with Connie Dickman, a nutrition and dietetics expert. We jump into all sorts of topics, including how does a dietician view the ketogenic diet, and what is alcohol's impact on your body if you're trying to lose weight. And we even talked about how insulin works with somebody that has diabetes. It was a far ranging interview, and I was glad Connie was willing to sit down. So I hope you enjoy this interview, and if you do, I hope you'll hit that like button and consider subscribing. And if you know of any other experts that I should be talking with, make sure you put it in the comments below. Connie Dickman, welcome to the podcast. I'm glad you could be here. You are actually nutrition and dietetics royalty. As I was looking up your background, you, you, you've been on Oprah and the Good Morning America show. But then even more than that, actually probably a little bit more prestigious as than just the media, is that you were the president of the, the, the big academy for nutrition and dietetics. So how does one go from being just a regular dietician to becoming president of the academy?

Connie Diekman [00:01:23] Lots of blood, sweat, and tears. How's that? Lots of years of dedication. Lots of years of volunteering your time. Lots of years of I wanna make the profession better and I want the public, which we haven't done real well with. I want the public to better understand the importance of good nutrition.

Vance Crowe [00:01:44] And so why don't we, maybe a, a good place to start is what is your profession? There are a lot of people that are out there that are talking about food, and I can tell you how to eat a nutritious meal. But what, what is your profession and why does this make you different than just the woman with a really great blog?

Connie Diekman [00:01:59] What a perfect way to start this. The key, if you want the nutrition expert, is to look for a registered dietician. And the reason I say that is when you see that rd, or in some states you will see an RD n registered dietician nutritionist in the state of Missouri, we're not yet licensed as LDNs. We're licensed as LDS licensed dieticians. So we still tend to use our RD credential in this state. But you'll see either one. The key to the credential is, you know, there's four years bachelor degree behind it. There's a dietetic internship where you went out there and experienced and practiced and learned. And then every five years we have to continue our education and we have to document that we have done continuing education. So it's the credential ensures you of what you're gonna get. Whereas if someone is a nutritionist, who knows, who knows, do they have an education? Did they just read a book? Did they just like the sound of that word? So looking for that RD is really important. If people wanna get nutrition advice that looks at their needs, the body of scientific evidence, and then develops a plan.

Vance Crowe [00:03:24] Okay, so if you have, how many people are in the, the, the academy?

Connie Diekman [00:03:27] We're about a hundred thousand throughout the country.

Vance Crowe [00:03:30] A hundred thousand. Okay. So this brings up an interesting question. If you have a hundred thousand people that are commissioned or registered, do they all think the same thing?

Connie Diekman [00:03:40] We don't. Science is constantly evolving. One of the strong things about registered dieticians is we do base our practice on the science, the body of evidence. But you know, if you go look at science, what we knew yesterday and what we'll know in 20 years likely are gonna be different because it's constantly building on itself. And it's how you interpret it. The core of every registered dietician is gonna be the same, but how they interpret it might change. So in other words, we might look at the issue of fat. 'cause that remains a hot topic. And guidelines from the American government currently say we need to focus more on what we call unsaturated fats. So oils, nuts, fatty fish, and less on fatty meats, cheeses, whole milk. Some people may look at that and say, well, less means I could eat more of those things if I really watched how much fruits and vegetables I eat because I'm not getting fats from other fats. So it's still less. So it's that subtle interpretation. I like to look at it more as this. If we sat down and you said, help me develop a plan that is healthier for me, we'd start with, where are you now? What changes do we need to make to achieve healthier? And then we talk about how you make those. So you might say, and I've had clients say this to me, I cannot do skim milk.

Connie Diekman [00:05:12] I don't care what you say. I will not drink it. Okay, fine then what fat do we give up so that you can still have your 2% or whole milk, but keep your fat at a healthy level.

Vance Crowe [00:05:28] Okay. So, you know, I think it's kind of an, an interesting profession to go into food, right? Or to go into nutrition. Because in a lot of ways, you know, it's very clear whatever you eat is the fuel that you put into your body. It's what makes up all your cells. When you take on the mantle of I'm going to help you learn how to eat, you are actually taking on, like, I'm going to tell you about the very core of life. Do, do you, when you were starting out, what, what were you thinking you were getting into and how did it end up being different than, than what you thought?

Connie Diekman [00:06:02] You know, I think when I started, the focus was very much on the role of diet and disease. So it was more about either how do we prevent it, but probably more about, okay, now you have hypertension, what do we do with it? You know, I started my career at, at Washington University Med School doing lipid fats, doing lipid research. So it was really about somebody who had a high cholesterol. How do we help them get better? Over the years, it's become clear that that piece is obviously key. 'cause we know it, it can work. But what has become more important is why don't we prevent the disease part and let's talk basic nutrition and hopefully delay the disease piece. So you don't have the 40-year-old male who's had a heart attack, you know, now he's 60 or 70 before he has that first one. So that's probably the biggest change, except of course the other big change called social media, which has resulted in almost everybody who puts food in their mouth thinking they're a nutrition expert.

Vance Crowe [00:07:09] And, and what leads you to believe that they're not?

Connie Diekman [00:07:12] What leads me to believe they're not, you know, I think a lot of the things, number one of course is that they don't, they can't support their claim with a credential or the education, you know, and I say that or because it's important and American Society of Nutrition is finishing up their meeting actually right now as we speak. And that's a group of PhD scientists who are all in the field of nutrition. So you may not have RDS on everyone's name in that group, but they're doing the research, you know, they got that PhD in, so they're, you know, you do have that group who's certainly is active in social media, but when you look out there on social media, really it is look for what is their claim to fame, so to speak. You know, is it simply, again, they learned how to do a really good blog or they wrote a book or, you know, do they have that credential piece?

Vance Crowe [00:08:08] So let's talk about what happens. So if, if you're a dietician, just for somebody that's never even heard that this is a career before you've gone through your education, you've done your clinic rotations, and now you've gone out into the world to take a job, what jobs are there out there for a dietician?

Connie Diekman [00:08:27] Well, that's the greatest news, is we really have a core of education that allows us to do many, many things. And granted, you know, my career has been been long, so I have a lot of colleagues who I've seen their careers grow as well. But you look at dieticians, a colleague was president of one of our local community colleges. You have dieticians in the PR world who are working with food companies to position their messages. You have dieticians who are in the sports arena. You have dieticians who are the d the dietician for the, the teams, you know, whether it's cross our fingers and so forth and so on for the blues, or whether it's the cardinals or whomever, dieticians are helping those athletes be the best athletes they can, you know, what are the other opportunities? The opportunities are really, I tell interns and or students all the time, your opportunities are only limited by what you wanna find. Because food is, think about it, you know, food is disease, the athlete, the older adult, look at the, the opportunity in the baby boomers aging and keeping them healthy again, the PR type thing. There's lots out there.

Vance Crowe [00:09:50] So what would be, so let's talk about the older people, right? So they're, as they get older, things change in their body, right? Do they need to eat differently than than the 30 5-year-old?

Connie Diekman [00:10:00] Yeah. Yeah. We do know, and we've always known that as we age, you know, we lose muscle from the age of 30 on muscle mass declines every decade from that point on,

Vance Crowe [00:10:10] Even if you lift.

Connie Diekman [00:10:11] Yep. Yep. Wow. And what it means is you've gotta work harder to maintain what you've got. And it's basically a function of aging of the tissues. It's just the way the body's metabolism is working. Now, that doesn't mean you can't get benefit from lifting, you know, don't get me wrong. The older adults should be lifting as much as when they were young, so as to maintain that there's a, there's a disorder called sarcopenia, which is basically a muscle wasting that occurs with age. And you can delay and or prevent that by working out the falls that older adults have. Those often are a result of failure to keep that muscle mass. So what that of course means is you're looking at trying to get more quality nutrients in fewer calories, because as we age, our metabolism slows, so we can't eat as much. So it's kind of a, a tricky combination,

Vance Crowe [00:11:09] You know, as you were talking about calories, and then you're also talking about preserving muscle mass. I found myself about two years ago, being a, a little bit pissed off because I felt like I had been, I'd been told a lot about nutrition and food pyramids and, and food plates, but nobody had ever made the, the, the observation that proteins, carbs and fats are related to calories. That if you have one gram of protein, you have four calories, right? And same as, same with carbohydrates and then nine, nine on your calories for every gram of fat. No one had ever pointed that out, is that right? So to me, those concepts were totally divorced and, and, and because they were divorced, they didn't mean anything to me. If I turned a box around and looked at it

Connie Diekman [00:12:00] And

Vance Crowe [00:12:00] Said, oh, okay, it has high protein and low fat, that's probably good, but no, no connection there, right? Why in the world does that simple concept, why is that not ubiquitous? Why, why did, why did it take me being in my thirties?

Connie Diekman [00:12:14] Yeah, well, to

Vance Crowe [00:12:15] Learn that,

Connie Diekman [00:12:15] I mean, we don't, unfortunately, we really don't teach health and or nutrition in school. You know, we teach science, we teach biology, you know, you, you get that, of course, middle school and on not the younger years. I think the good news is what we're beginning to see, and it's still slow, is preschool and younger kids learning, as you said, my plate, and why these things are important. They're likely not taking it to the protein, fat carb, you know, I, I look at my granddaughters, one is seven, and the other's four, you know, they, they wouldn't understand those concepts, but they definitely know that it's important to eat fruits and vegetables. It's important to eat some, some grain foods. They, they know the protein piece. They're not good eaters there, which is not uncommon with young kids. But you know, it, it's something we need to teach as a part of life. Again, it probably goes back to, if you look at what we talked about, first up, dietetics started out, it truly started in 1917 as a part of the war. It started in Greece. Really? Yep. They, you know, it was all about feeding our, our soldiers. So

Vance Crowe [00:13:27] That World war, world War I.

Connie Diekman [00:13:28] Yep. Yep. So

Vance Crowe [00:13:29] And so, so what happened? So the, there we were saying our soldiers don't have good nutrition.

Connie Diekman [00:13:34] Yep. And in Cleveland, a group of women came together and talked about how they, they could develop the association. They had been working with soldiers and that's how they came to be the, at that time, the American Dietetic Association. And

Vance Crowe [00:13:49] How did it go? How did they do?

Connie Diekman [00:13:51] Well, we're we're now a hundred and, what is it? 102 years old. So I guess it, it went okay, but it, it became the beginning of recognizing the importance of fuel for health. But again, it tended to be related to, you know, the soldiers in the hospital where they made the biggest impact in the war. And that's that disease connection until, I don't know, it's, it certainly we talked prevention as I started out, but it really was much more disease. It's been the last, what would that be? 30 to 40 years that we've gone, oh, let's talk prevention and disease to hopefully make a difference, which then hopefully means we can get it into the schools.

Vance Crowe [00:14:35] So, so going back to the proteins, carbs, fats, and then calories. There's an adage that people hear, and I'm not so sure that people understand what it means, but I'm interested to hear your thoughts on it. Calories in, calories out. Yeah. Can we, can we do some test on a, on a person and say, this is about the number of calories you need to get and if you get that you're gonna be approximately this weight,

Connie Diekman [00:14:58] We can do that. It won't happen. Yes, there is a test that can do that. It, it will measure, you know, respiration, your body temperature and all of these things. And it won't happen though because of the cost piece. And no one's gonna be able to justify doing it. So we still are operating under approximations. We still are operating under, okay, you know, you're this tall, you weigh this much, you do this much activity. Let's see where we go from there. You know, the whole calories in calories out continues to be a point of conversation because there is something different

Vance Crowe [00:15:32] Point of conversation. That was a very polite way to put it. You're, you're saying there's a little bit of conflict there among, among dieticians

Connie Diekman [00:15:38] Amongst a lot of people, not just amongst dieticians. So

Vance Crowe [00:15:41] There's debate as to whether or not calories in, calories out is a real thing.

Connie Diekman [00:15:45] Calories in, calories out are, is probably a real thing. The question is, what are the calories? In other words, do you burn the same kind of calories as I do?

Vance Crowe [00:15:57] Interesting. You mean

Connie Diekman [00:15:57] Can we calculate your need the same way we calculate mine?

Vance Crowe [00:16:00] Meaning that maybe I burn proteins and carbs faster than another person.

Connie Diekman [00:16:05] Yep, yep. And it all has to do with our metabolisms, which of course, if you think about it, we all are unique. You know, our metabolism is not the same amongst all of us. It all functions differently. And sure we can, and that's what the science has been based upon, is we estimate it based upon men have more muscle mass, therefore they burn more and they need more women, you know, once they reach menopause, burn even less than men because they have less muscle than men do. So you, you can make those kind of basic things, but the question marks are why is it that some people will consume a lower calorie intake and they can't lose any weight. Other people can eat as many calories as they want and they can't gain weight. Something's different in the way in which all of our bodies function. Which is why of course so many of us were so excited that when we got the the DNA genetic mapping done, we'd have the answer and we'd be able to make your diet, your diet. Your diet hasn't worked that way quite yet.

Vance Crowe [00:17:09] Why not?

Connie Diekman [00:17:10] Good question. I I, I don't know that we know why not. There is no question in my mind as a dietician that our bodies are just very complex. You know, you look at, and, and this is the thing that we remind consumers all the time, you know, this is a bag of chemistry, it's a bag of chemical reactions. And they all happen of course, differently. Think about it, when you put 'em in a chemistry lab, they don't all work at the same pace every single time. So does it make a difference? And we know there is a difference, you know, if you put a lot of fiber in the body in your diet, the way it gets digested slows down the absorption of other nutrients. So it may aid nutrient absorption in some people and other people. It goes right through 'em. So there's those kind of variables. And then of course, the big question mark right now is the gut microbiome. And that's a big question mark.

Vance Crowe [00:18:07] So I'm really happy to go in that direction, but I, I'm interested really in this variability. I, I have a good friend named Rob Long that often compares like nutrition or, or dietician's work to macroeconomics, right? So micro on the micro level, we know supply and demand. But as soon as you start stacking global trade and weather and all the things that are required to make macroeconomics work, it becomes a little bit of like the dark arts, right? Yeah. We think that this is what's going to happen. And I think that that's gotta be a challenge in, in your world, that you take this bag of biochemical reactions and you add on their, you know, psychology of Yep. Of how are people making decisions and, and other, so is this going to be a solvable problem or will it be that we're, we're always on the path and, and we're getting a little more directionally accurate all the time.

Connie Diekman [00:19:02] Hard question. 'cause of course it's all about that biology piece. But you know, what I like to, to think is that it is about us as registered dieticians working with each individual we see and not making assumptions for all of them. So in other words, it's really listening to what you do. You know, if you say, and I think back to, you know, the clients or students over the years, you know, if they say they work out every day for 60 minutes and you know, they, they can't seem to either build muscle mass or lose weight depending upon their goal. Alright, let's talk about that workout. What are you doing? Oh, well I lift, okay, well how much are you lifting? Oh, about three pounds. Okay, well now let's revisit where we're going. Oh, it's 30 pounds. Okay, so the variables, which of course is your comparison piece. There's so many variables involved. Oh

Vance Crowe [00:19:57] Yeah. And you can have people that are lifting that in between each set. They're wandering around talking to somebody. Yeah, exactly. And then you have other people that are just cranking on it as hard as they can.

Connie Diekman [00:20:04] Exactly. And the same thing with the cardio piece, which of course is where the calorie burn really comes from. So if somebody's really trying to lose, you know, if they're on that treadmill and they're only going at a, you know, two mile pace is gonna take you a long time, you'll get there, but you're gonna have to go a whole lot longer than if you're out running or you know, the person who's walking faster and all of that. So, so we as registered dieticians have to look at the whole picture. That was one of the things that I enjoyed most with my career. I moved from the WashU Med school, so it was one-on-one patient to private practice where I could work one-on-one with, you know, to the university where I could work one-on-one so we could really talk, you know, tell me about what you're doing, what you wanna do, how you wanna do, so that we could set a plan that hopefully was individualized as opposed to, here, let me give you this tear sheet. And I think that's what we have to recognize is there's some limitations. Not everybody can take that kind of time with patients. You look at patients in the hospital, you know, 15 minutes with the dietician, you look at patients in a doctor's office, how long do you get to spend with your doctor? Oh,

Vance Crowe [00:21:20] I mean, if you're with an a doctor for eight minutes and frankly if they sat and spent that time talking about my nutrition as opposed to my blood work, I'm gonna be pissed off because I'm gonna be like, Hey, we're, we're here to talk about something else. Right? And, and whether or not that's the right thing, I don't know. But that's definitely the way human

Connie Diekman [00:21:37] Humans

Vance Crowe [00:21:37] Behave. Yeah.

Connie Diekman [00:21:38] And, and so, you know, consequently, I think unfortunately we do fall into the pattern of, as you said, okay, you need to eat this many calories or you need to eat this much protein, or, which is why fad diets are so popular because they seem to be the answer here, just do this and everything will be fine. They just don't work that way.

Vance Crowe [00:21:58] So if everybody is individualized, then how in the world can the government put together a food pyramid or a plate that that's gonna make, that's gonna make sense to the masses to 330 million Americans?

Connie Diekman [00:22:10] It is definitely challenging. The good news is we have a process, even though this was questioned in 2015, we have a process that very clearly outlines you put together a scientific committee, that committee reviews the body of evidence. That's an important statement. And just today, I got an email from a colleague who heard me speak a couple weeks ago, and her question today was, I just came across this study. It seems to contradict what she said. What do you think single studies add to the body of evidence? Single studies don't make the evidence. So the committee reviews the body of evidence to see what is it people need to eat to be healthy. And it's very clear the guidelines are about for health. People don't always hear that part.

Vance Crowe [00:23:01] Oh, oh, you, you're saying that they're not necessarily about this is this will help you lose weight or this will help you, you know Right. Put up better cleans. Right. And deadlifts or, okay.

Connie Diekman [00:23:10] Exactly. Okay. Exactly. It's about population health, which is what's tricky. And somebody said this just recently, 'cause the 2020 committee is meeting to the dietary guidelines get done every five years. So the 2020 committee has started meeting, their second meeting is in July.

Vance Crowe [00:23:26] Does the science move that fast? Every five. Do you think they should be meeting every five years?

Connie Diekman [00:23:30] They probably should be meeting more often. Really? Oh, science is is constant. That's the confusion piece. Because right now, well number one, we still are an environment where for researchers it's called publisher parish. So of course, nowadays with the competition, publish means you gotta be doing something, cranking it out, cranking it out. So we have a lot of science every day, but we need the body of evidence. And that's why the five years works. And

Vance Crowe [00:24:00] When they come together, what do they, what do they do?

Connie Diekman [00:24:02] So they look at population health, they look at, you know, what do we need to do to go forward? And then they go through the science that has occurred since the last time. So they tend not to go back, you know, to 2010, 2000. It's since 15 what has transpired. And then based upon that body of evidence, they come up with their report, which then goes on to Department of Health and Human Services and the Food and Drug Administration. They create the guidelines.

Vance Crowe [00:24:34] And those are a group of scientists or a group of bureaucrats or who, who does

Connie Diekman [00:24:38] The,

Vance Crowe [00:24:39] Have you been a part of the scientific committee that was, that was putting forward recommendations?

Connie Diekman [00:24:43] No, I have testified in front of the committee, but I've never been on the committee.

Vance Crowe [00:24:46] And so when you say testify, they bring you Yeah.

Connie Diekman [00:24:49] To

Vance Crowe [00:24:49] Forward. And what kind of questions do they ask you?

Connie Diekman [00:24:51] You can, you can come forward at different meetings, they post it, anybody can do it. You, you make a request to testify at meetings that are open to the public. And I've testified in support of healthier fats. I've testified in support of, what was the other time I'm drawing a blank on the other time. I've done it twice. But again, it's open to the public. So you get some interesting people, you know. Do you know who Mary Lou Hener is?

Vance Crowe [00:25:21] No. Uhuh,

Connie Diekman [00:25:22] She's an actress.

Vance Crowe [00:25:23] Okay.

Connie Diekman [00:25:24] She's one of those people who, what's it called? Where they can remember everything.

Vance Crowe [00:25:29] Okay.

Connie Diekman [00:25:29] Like,

Vance Crowe [00:25:29] Like a photographic memory kind of thing. And,

Connie Diekman [00:25:31] And you know, they can say in, in 2000 on, on June, I don't even know what today is.

Vance Crowe [00:25:36] Oh, okay. Yeah.

Connie Diekman [00:25:37] And they can tell you what happened that day. Right. But she also speaks mainly in, in terms of, of verse in terms of, of poem. She's very interesting. She testified the last time. So see it can be anything from to

Vance Crowe [00:25:51] And did she speak in verse in poem? Yes,

Connie Diekman [00:25:53] She did.

Vance Crowe [00:25:53] She did.

Connie Diekman [00:25:54] She did. That's who she is. So, so the committee is charged with the body of evidence and the committee is charged with putting together this report that says, okay, the evidence indicates this, this, this, and this. This time the committee is looking at some very specific questions. In the past, the kind of looked at the hole, the hole is getting big. So this time they're looking at, this is the first time, 2020 will be the first time we have guidelines for birth to two. We've always been from two forward because the birth to 2-year-old, that's a very different population than the rest of the population. But this time they're looking at that age group, they're looking again at fat, specifically saturated fat. So they will review the body of evidence, make their recommendations, and then we go from there.

Vance Crowe [00:26:41] And you're, you're big into unsaturated nut fats, is that right? So, so talk about that for a little bit.

Connie Diekman [00:26:47] Fat seems to be where I spent much of my career. Yeah. So, you know, I started out in lipid research where we did a cardiovascular study. So I, I really have always been into the science of types of fats, quantity of fat. And over the years it's morphed depending upon, you know, what I'm doing with the rest of my career. At that point you're, you're I guess referencing the Superfood nuts book that I wrote a couple years ago with a chef. And it was an interesting, and it's a good book. It, it is about using nuts as a replacement for whether it's your meat, whether it is as an appetizer. The chef was a very good chef. She really did some nice things that you weren't just throwing nuts on a plate. You really felt like, oh I could do this. And so, you know, I obviously spoke the science of nuts from the standpoint of the fat composition. 'cause that's what's important. The quality of fat is what we've gotta look at. The quality of fat. Sure. Quantity's an issue in terms of calories to your point of earlier. But if you're eating all that saturated fat, not only are you getting the calories, but your impact on your heart is not very good.

Vance Crowe [00:28:03] So there is a, a new trend. I'll see if you've heard of this before probably. Are you familiar with sous v cooking?

Connie Diekman [00:28:08] Yeah.

Vance Crowe [00:28:09] So have you seen how there is now a movement to make your steak and put nut butters on top of it in order to cook with it?

Connie Diekman [00:28:18] I have not seen

Vance Crowe [00:28:18] That. It's fascinating. I've, I've watched probably two or three hours of people enjoying it. Is that right? And I've not yet done it, but I wondered because this is definitely a movement where the, where the nut market is moving into.

Connie Diekman [00:28:30] Yeah, well and it, it, it is definitely, you know, we as a population tend to look at nuts as a snack food period. We don't know what else to do with them. And, and what was nice about doing this book with the chef was she demonstrated I don't, well no, because she wouldn't have used meat 'cause she really tried to keep everything on the vegetarian side. But to how can you get nuts as a part of what you do as opposed to, oh, how am I gonna get those in my diet?

Vance Crowe [00:28:57] Yeah. I mean, I'm not a hundred percent convinced that it isn't a trick to get me to

Connie Diekman [00:29:01] So to steak and steak

Vance Crowe [00:29:02] With peanut butter. But so you had mentioned earlier fad diets, and I think an interesting way to look at fad diets is I heard a speaker named Naval Ravikant and he was on a podcast called Joe, the Joe Rogan experience. And during the podcast he said, all people want three things. They want to be happy, wealthy, and fit. And if they have those three things or if they imagine those three things, that's, that is what they want. And I think that when we talk about fad diets, a lot of the reason that people are so attracted to them is because it has a promise of that third, yeah. That third pillar of being fit. When, when you as a dietician hear about fad diets, you're hearing like, Hey, this is not a thing that's gonna work. But, but tell me more. Open that up more for me.

Connie Diekman [00:29:57] Well, fad diets, just from their term, of course fads are short term things that come and go, you know, whether it's the miniskirt or whether it's the keto diet, you know, fad diets are, are, are not something that last, there might be principles in a lot of them that people can work with and hold onto to develop a lifestyle routine. But the thing that worries me, or worries is the wrong word. The thing that upsets me, I guess is I've seen too many people go from one to the next, to the next to the next. Almost always the weight loss goes up in between, comes back down, goes up even more, comes back down. But the bottom line is they either start out exactly where the, they end up exactly where they started or they weigh more. And nothing is more demoralizing than that experience. And that to me isn't fair that you would promise here, if you do this diet, you'll get, because it isn't gonna do that. Because you can't live without the things you love. And most fat diets cause you to do that. So, you know, when you look at the concept behind them, I think a great example is the Atkins diet, which you know, was around when I was in school,

Vance Crowe [00:31:23] I had a roommate that went on the Atkins diet. It was great because every time I walked through the kitchen, I got some bacon. I was not on the diet. But it seemed like a really good situation for me. You

Connie Diekman [00:31:32] Liked it, but if it worked, why did it go away and come back and go away and come back? You know, we've gotta find, again, it gets back to that issue of we've gotta look at the body of evidence of what it takes to be healthy. To, to your point on the podcast, the health was one of those three variables. And how do we achieve that in a way in which you're happy? 'cause if you don't like what you're eating, if you gotta cut out your favorite food, whether it's you gotta cut out the bacon because you're going vegetarian, or whether it's you gotta cut out the bread because you're going Atkins, keto so forth, and that's your favorite food, I'll you, it's not gonna last.

Vance Crowe [00:32:13] It, it seems to me that it'd be very easy to point and say, well, the reason that those people didn't succeed is because they don't have discipline. Why is that not accurate? Is is it that they, that they, yeah. Why is that not an accurate thing? Because I don't hear you saying that.

Connie Diekman [00:32:31] It, it's sure. That's a little bit of it. You know, in other words, they couldn't keep it up, but likely the bigger issue is they couldn't keep it up because it wasn't enjoyable. You know, you have my thing, whenever I talk to any of our, any of the students, any of the clients, you know, some of the project work that I'm doing right now, food is meant to be enjoyed. So that's our first, do we agree? And then let's go from there in terms of how do we make that healthy for you? Whereas some of the fat diets, it's really about, Nope, this is good, this is bad. You can't eat this, you must eat that. That's more of a, a mandate as opposed to your freedom of choice. That's what bothers me.

Vance Crowe [00:33:25] Well, I, so this morning I was listening to some nutrition podcast just to see what, what's the state of nutrition podcast? And, and I found one where both of them uniformly agreed that they hated diets. And I found myself being really frustrated with two dieticians saying that because on some level, if you, you have to have rules, right? And a diet is just a set of heuristics. It's, it's saying, you know, stay within these parameters and you should achieve this outcome. So if you have dieticians that are saying, I hate diets. Yeah. How, how, how do you square that circle?

Connie Diekman [00:34:02] Yeah, it's a tricky one. The anti-D diet dieticians, it's, it's a moniker, it's a gimmick. It's, you watch two podcasts, so it worked. The reality is diet is the food you put in your mouth to live,

Vance Crowe [00:34:24] Right?

Connie Diekman [00:34:26] So if their premises I'm anti diet, does that mean they as registered dieticians are not equipped to help their clients understand what they need to eat to be healthy?

Vance Crowe [00:34:38] Well, I'm, you know, I should be fair to them because they started talking about things like intuitive dieting and things like that is so, so did I find crazy people on online or did I find

Connie Diekman [00:34:48] No, it's another movement. Intuitive eating has been around and if you look at behavior counseling, you know, my, well,

Vance Crowe [00:34:59] So what is intuitive eating? I intuitive eating. I remember where I was running when I heard it, but that's about all I knew.

Connie Diekman [00:35:03] Intuitive eating is eating to the point at which you recognize you're full, not paying attention to good, bad, not paying attention to, I can't have bacon but eating bacon, but only eating the one slice. And so it's, it's a, it's an intent to be more normalized of your eating as opposed to thinking about your eating. And what some of the dieticians who are in that space are trying to work towards is we're seeing more and more disordered eating in this country. Really? Yeah.

Vance Crowe [00:35:34] That's on the increase.

Connie Diekman [00:35:35] Yeah. And, and diagnosed eating disorders are going up as well. The question marks always when you see those kind of things are, are they really going up or

Vance Crowe [00:35:46] We just diagnos or we just now, now, yeah. Okay.

Connie Diekman [00:35:47] And, and many of the researchers will tell you there's, it's a little bit of both that they're, they're now socially acceptable. So they're getting diagnosed, but then there is a little bit of an

Vance Crowe [00:35:57] Increase. Okay, fair enough.

Connie Diekman [00:35:58] So they're in that space where their premises, that our talk about diet, good foods, bad foods, can't eat, can't eat is causing the disordered eating and or the eating disorders. We don't have the evidence to support that yet. And in fact, some of the position papers out of the academy indicate that is not a cause effect. There's biology behind people who have eating disorders, you know, clinically diagnosed, anorexia, bulimia, even even the eating disorders not otherwise specified. There's clinical diagnosis there

Vance Crowe [00:36:33] And a lot of times those have something to do with food, but they're much more about control. It's psychological. There, there's a lot of other things going on there. It's not just people wanting to be fit. That's

Connie Diekman [00:36:43] Exactly right.

Vance Crowe [00:36:44] Exactly.

Connie Diekman [00:36:45] And that's what we have to be careful of as, as we talk about this. And there's been a lot of, again, conversation professionally about this use of the term anti-D diet because that is putting a moniker on that indicates we shouldn't be talking about what do you need to eat to be healthy? You know, what, what are the key parameters within an eating plan that are gonna allow you to build muscle mass, allow that athlete to recover better. All of those things. So again, it's likely, the social media space is huge. It's one more way to get yourself out there, you know, people don't wanna talk about diets. So in that respect, it's good, but we need to talk about healthy eating.

Vance Crowe [00:37:30] Yeah. And it's such a challenge because with regards to food that has its roots in every aspect of our lives. Yeah. I mean all the way from religion to celebration to, and, and so I think that you have like a really, really tough situation being in diet in dietetics at all. But now in the age of social media, I would imagine it'd be even, even more difficult.

Connie Diekman [00:37:57] It is more difficult because again, anybody can be in social media, there's nothing, there's no, you know, there's no credential. You have to, to get to be in social media and, and therefore you can talk about whatever you wanna talk about and the consumer can't tell the difference. So the confusion is significant. And then the other thing is, as you said, because food is a part of everything we do, and it has a value, you know, food really has value from the standpoint of, you know, what was the reward you got when you got your first a in grade school or, you know, what is it that the family always serves on the special holiday or your birthday? That's a value piece that in many ways ties into who you are as a person. Yeah.

Vance Crowe [00:38:42] I mean, there's very few countries that don't have a national dish. Something that's that's right. That's deeply personal to them.

Connie Diekman [00:38:47] That's exactly right. And it's so important that we remember that piece because again, if you start talking, whether it's talking diet or talking anti-D diet, but all of a sudden you interope on, no, that's important to me or no, that's my value system. You've lost that client. So we really do have to remember, you know, it is, it is psychological. There's no question there. You know, I, I know I had an experience and I had a student recently share a similar experience and now I'm drawing a blank on the students. But mine basically, I'll never forget as a young child, I don't even remember how old, but young eight cream of wheat for breakfast got sick after breakfast. I cannot look at cream of wheats into that day. I mean, that's a psychological connection that we draw to food. So you've got, you've got that and then of course you've got the psychological from the standpoint of individuals viewing how, how their body looks and what food does to their body and you know, the whole eating disorder perception and then the value piece. And of course then we get into the economic component

Vance Crowe [00:39:54] When, you know, when I was living in Kenya, I had a very interesting experience that really kind of jarred me. And it was, we had been doing this home stay visit where you're staying with these various families. And so all the Peace Corps volunteers are within one kind of village. And at the end of it to say thank you, the Peace Corps volunteers because the reason that you live with these families is so they can teach you how to live in Kenya. How do you take a bucket bath? How do you eat

Connie Diekman [00:40:19] Wow.

Vance Crowe [00:40:19] Using the ingredients that are there. How do you, how do you operate? Right? So at the end of this training session, we all got together to cook food for our families. So they all come together and we have this kind of like outdoor picnic and we make the best foods that we can think of and we have money to put towards this. So we are buying the highest quality things from the market. We even make guacamole there. And which they had not had before. They had never thought to mix avocados with peppers and onions and things. So, so we were making a joke that someday we'll come back and that'll be the national dish of, of Kenya. Yeah. But we get all the way done and we had had goat and, and all kinds of things and we get all the way done and the people were like, okay, where's the Ali? And, and we were like, what? And Ali is this ground corn with oil and water? And they were like, I'm a Kenyan, I have not eaten unless, unless I've eaten Ali.

Connie Diekman [00:41:13] Oh wow. There you go.

Vance Crowe [00:41:14] And the reason that they did it, you know, after thinking about it for a long time is this was during famine, during hard times they had to have this pace. They ate it really late at night, which would be completely opposite of the United States. You eat it, you feel full, you go to bed, you don't need to have that many calories, you're just pumping in

Connie Diekman [00:41:32] Filler. Yep, yep. It allows you to, to be able to sleep. Yeah, no, and I think that's exactly what we in this country forget about because we're fortunate food insecurity is on the rise. But as a, as a whole, you know, we don't have issues with food availability and ability to purchase and all of that. So we forget that food has, has a lot of meaning slash value that goes well beyond, oh, that tasted good. And when you talk to people in terms of making diet changes, you have to remember those things. You know, you can, you cannot impose my stuff on you because you're not me. I can share the science, I can share the ideas, I can share the suggestions. But it has to be, as your example just said there, it has to be what works for them.

Vance Crowe [00:42:25] Yeah. And I think that's another reason why the fad diets work so well is because they're not really presented as science. They're presented as a story of change. I had this problem, so I picked this thing up and it, it really helped me. And you mentioned one that I wanted to bring up with you and, and because I, I had a chance to attend the California Academy and give a talk there. Oh

Connie Diekman [00:42:46] Yeah. And

Vance Crowe [00:42:46] So while I was there, I sat in on a bunch of different talks and I saw one on the ketogenic diet. So I thought, here I'm gonna go and I'm gonna learn all about this. And actually what I stumbled my way into was an hour long lecture on how ketosis can help prevent some seizures.

Connie Diekman [00:43:04] Yes.

Vance Crowe [00:43:04] And it, it blew my mind that everyone in there wasn't thinking the way you were how to lose weight. Right. They were thinking of it for its original purpose. So, so talk a little bit about what is the ketogenic diet? Where, where did it come from and, and what do you think about it being an active part of human or of, of American diet right now? Yeah,

Connie Diekman [00:43:24] Yeah. Basically the keto diet, as you said, it's, it's putting the body into a state of ketosis. And, and when the body is in a state of ketosis, it forces it to burn fat. To help fuel the body. There's two problems with that.

Vance Crowe [00:43:39] And the way that it does it is that the, the people don't have carbohydrates at the ready axis.

Connie Diekman [00:43:44] Yeah. Should said

Vance Crowe [00:43:45] That part. So once they've burned off all their glycogen through exercise or just through time, well

Connie Diekman [00:43:49] They don't consume enough. They

Vance Crowe [00:43:50] Don't consume enough,

Connie Diekman [00:43:51] You know, they stay, they stay at a carb somewhere in the ballpark of 50 grams max, I think. And it could even be lower than that. And to give you an example of what that looks like, 50, well, two pieces of bread and a piece of fruit is about 45.

Vance Crowe [00:44:04] Okay.

Connie Diekman [00:44:05] Okay. So that's whole day.

Vance Crowe [00:44:06] And, and for anybody that wants to know about the physiology of it, when you're eating carbohydrates, your body stores that as very quick energy. And, and so when you're going for a run or something like that Yep. That's where you're getting your energy until you get past 35, 40, 50 minutes of hardcore exercise, are you able to get into burning other things other than just the carbs stored in in your muscle? Yeah.

Connie Diekman [00:44:29] The glycogen that we store in the muscle, which is, is carbohydrates converted to its storage farm, is is there to fuel us in between meals. That's the bottom line. Now you referenced the exercise piece. Okay. But

Vance Crowe [00:44:39] It,

Connie Diekman [00:44:39] It really is there so that, you know, our blood sugar doesn't drop too low. Blood sugar is what keeps us going. You know, when, when you look at your glucose levels, blood sugar levels, that's the fuel that the body's operating under. And what you have to stop and think is okay, it fuels the muscle. Hmm. Biggest muscle in the body. Well that would be the heart. So it, it's what keeps the body fueled The brain cannot store glucose. So the brain needs a constant infusion, which again is why we need to eat on a regular basis. That's

Vance Crowe [00:45:11] Why people get hangry when they, when

Connie Diekman [00:45:12] Exactly when

Vance Crowe [00:45:13] They're out of the food, they, they start getting that brain fog and kind of, yep, okay.

Connie Diekman [00:45:16] There's just no glucose

Vance Crowe [00:45:17] Going. I've never heard it

Connie Diekman [00:45:18] Describe this. And that's why they make it referred to as the keto flu because you get that kind of, you know, lethargic, nauseous feeling is that blood sugar is, is dropping way down here as opposed to what I always said to the students, you want your blood sugar to kind of do this all day long. Obviously that's not exactly what it does, but that's what you want. You do not want the roller coaster. 'cause every time you roller coaster, that's where two things happen. One, you get that? Let me think, I think I just read this sentence eight times. Let me think if I can read it again. You know, that kind of dis the brain fog disconnect. Yeah. Right. But you also get that, oh my God, I'm hungry. What is there to eat? I'll eat whatever I can find. And of course we overeat. So what what the principle of the keto diet is, is deplete the body of that carb by not consuming enough. So now you force it to move into burning fat for fuel. But the problem with that is fat won't go to glucose and the body wants glucose. So fat goes to a form that creates these ketone bodies. And when you can get into a state of ketosis, measure your ketones and your urine, it's like, oh good, I'm where I need to be. I'm gonna burn all this fat and lose all this weight. What's happening though is you're burning muscle because you will take anything that's in that muscle for fuel before you go to ketones.

Vance Crowe [00:46:40] Oh,

Connie Diekman [00:46:41] You also, when you consume that much protein, which many of those diets are very, very high, there's a limit to how much protein at one meal we can metabolize and use. And anything beyond that gone,

Vance Crowe [00:46:53] What do you think it is? It's gone 40, 45 grams. We're

Connie Diekman [00:46:55] Kind of at a, I was just at a talk a couple weeks ago and the speaker actually alluded to that it's 30 to 40, whereas some of the researchers I've heard it have said 30 max at a meal.

Vance Crowe [00:47:05] Oh man. Yeah. There's a whole lot of whey protein being, being urinated outta people's systems. Correct. Okay.

Connie Diekman [00:47:11] Which of course goes to the other way. You're losing weight, you're losing a lot of fluid, getting rid of that wasted protein. So the ketone, the the keto diet also does sort of a dry you out because the high protein protein is a diuretic. Carbohydrates, of course carbohydrate. They keep us hydrated.

Vance Crowe [00:47:31] Oh God, I didn't know that. Yeah. Okay, this is good. This

Connie Diekman [00:47:33] Protein's a diuretic.

Vance Crowe [00:47:35] Okay. Wow.

Connie Diekman [00:47:35] So the high protein you're losing not only the waste because we can't use if we don't need the amino acids that are in protein, that's really why we eat it, is the amino acids in it. Okay. So protein is made up of all those amino acids and we need those. If we don't need them, we take the nitrogen off of them and that's waste. So you're losing all of that, which of course also ties in to when you get that kind of not very nice breath. With the keto diet, it's all about the fat burn, the protein waste, it's all about what the body's doing to try to keep you alive when it's not getting the nutrients it needs.

Vance Crowe [00:48:17] So it would sound to me that you are not a big fan of, of the keto diet to

Connie Diekman [00:48:21] Lose weight.

Vance Crowe [00:48:21] Good.

Connie Diekman [00:48:22] No, it's, you are gonna lose weight, but the first time you put carbohydrates back in, you will gain a pretty good amount of weight. Because remember I said the word is carbohydrate.

Vance Crowe [00:48:35] The, so this is fascinating if you, is that why if you eat a big plate of pasta and you haven't been eating pasta, you, you add far more weight on than, than I had no idea.

Connie Diekman [00:48:45] You hold onto the fluids. Yep. Yeah, the body, the body wants carbohydrates, the body wants glucose, the body wants to keep you alive. And we can manipulate all we want and we'll get short term benefits. Which again gets back to that, you know, it bothers me so much that people get these short term benefits, but then they can't, they either achieve their weight or they can't keep it up and then the weight comes back because the body now gets the fuel at once. You know, we've had conversation over the years whether in fact, every time you go on a diet, you change your metabolism. In other words, slow it down. And I don't know that we know the answer still, but we do know that when people go on and off diets over time, they do tend to gain more and have a harder time losing each time they go on a new one. So something's happening metabolically.

Vance Crowe [00:49:38] The, the really sad and somewhat terrifying thing I heard on the podcast that I was listening today to today was almost no diets that anybody does keeps weight off for more than two years. Which to me sounds like a prison sentence in that once you've put on weight, you're always going to be heavy, you're always going to eventually yo-yo back. Is that true?

Connie Diekman [00:50:03] Well, the key there is the use of that word is truly on diets. So in other words, diets don't work healthy eating plans do.

Vance Crowe [00:50:12] When you say healthy eating plans, are you talking about what, what weightlifters refer to as tracking macros? Making sure they get, making sure they get their proteins, carbs, fats and their, and their calories.

Connie Diekman [00:50:24] No,

Vance Crowe [00:50:25] No. I, I thought I was dead on on this. What do you mean then

Connie Diekman [00:50:30] A healthy eating plan is again, where you look at, okay, what does the body need to be healthy? It needs the majority of your calories to come from carbohydrates. Now we can argue is majority 51 or is it 65? You need adequate protein. And again, depending upon age, you look at that older adult, it's gonna be more gram per body weight than the younger adult.

Vance Crowe [00:50:53] And obviously Oh really? The older adults need more protein.

Connie Diekman [00:50:55] Yeah.

Vance Crowe [00:50:56] Even though it's harder to process. Yeah. Okay. Yeah.

Connie Diekman [00:50:58] Well, we lose more.

Vance Crowe [00:50:59] Okay. We

Connie Diekman [00:51:00] Lose it. So we need to put more in, you know, obviously your athletes need more and then we need a minimum of 10% of our calories from fat just to get the essential fatty acids. But then fat becomes that variable of, you know, do you wanna try to lose weight? Do you need to gain weight? What do you need for flavor today? You're gonna have a birthday party, you eat more. So it's meeting those nutrient needs comes first and then it's a matter of, all right, let's talk about what you're doing, how much you need, and what do you like to eat? You know, this counting of macro stuff, it, it's probably contributing to some of our disordered eating because people are so obsessed with the numbers that they aren't paying attention to intuitive eating. They aren't paying attention to, am I enjoying what I'm eating? All they're worried about is the numbers. And then the other part of it is who told them what their number was? You know, some book or did they really sit down with a registered dietician and talk about, this is my exercise, this is how old I am. I mean, think about the, the 18 and 19-year-old football players at WashU. Their calorie need, their protein need is significantly different than the seniors on the team or the swimmers. And divers

Vance Crowe [00:52:12] Just even four years. Even

Connie Diekman [00:52:13] Teenage boys. Teenage boys are like burning engines.

Vance Crowe [00:52:17] Okay. Yeah.

Connie Diekman [00:52:18] I mean, you feed a teenage boy and they burn more calories. So, you know, you, you can't look at, you can't even look at the baseball team, the football team, the basketball team, the cross country team as a whole, because each individual is different. And I know that complicates the situation. 'cause yes, there's a hundred thousand RDS in the United States, but there's obviously a lot more people

Vance Crowe [00:52:40] Than

Connie Diekman [00:52:41] That. It's a 3 million people,

Vance Crowe [00:52:41] Right? Yeah.

Connie Diekman [00:52:42] So we aren't gonna all be able to, to meet individually, but this is where I come back to, we need to look at how does that my plate look and does your plate look like that? So one of the things I've done over the last couple years is I meet with the St. Louis County Police Academy recruits in their basic training to talk about basic nutrition. And that's the thing I really convey to them is, all right, does your plate look like one half is fruits and vegetables?

Vance Crowe [00:53:14] There's no Yeah, yeah. No way. Right,

Connie Diekman [00:53:16] Exactly.

Vance Crowe [00:53:16] If you're sitting in a car and you're trying to get fast food, I mean, unless you're packing a a lettuce

Connie Diekman [00:53:21] Salad.

Vance Crowe [00:53:22] Yeah.

Connie Diekman [00:53:22] Yeah. And for the majority of Americans, I mean, our intake still remains a piece, a piece and a half of fruit a day and about, about a cup of vegetables. And it should be two pieces of fruit and three cups of vegetables. So the majority of us still don't get that basic what we need. Now if you look at that plate, the other thing you'll see is, hmm, where on that plate are the cookies and the chips and the soft drinks and the, they're not there, but of course, where are they on our plates?

Vance Crowe [00:53:55] Yeah, they're there.

Connie Diekman [00:53:56] Yeah.

Vance Crowe [00:53:56] So let's you bring up an interesting point. Let's talk about big sugar and, and the, the idea that there are, there are groups of dieticians that have been paid off to, to do, to do for the soda industry. What, what, yeah, I don't know what, what nine outta 10 doctors did for camel cigarettes.

Connie Diekman [00:54:18] What,

Vance Crowe [00:54:19] What's going on there? What, what is the, what's the, what's the case that people are making against big sugar and, and what are your thoughts on it?

Connie Diekman [00:54:27] Well, there's a lot of cases being made, you know, whether it is because of the healthcare professional connection too, or whether it is, you know, that sugar is killing all of us. Everybody's kind of in a different place on it. You know, I think in my mind, as a registered dietician, the issue is, it is a very, very simple issue. Added sugars. So now that becomes, you know, soft drinks, it becomes sports drinks, it becomes energy, drinks, obviously cookies, candies, all of that, added sugars. They should only go into that eating plan after you've met all those other things. And they should never be more than 10% of your calories. It's quantity. It's quantity. Again, when you look at your plate. Do you see half of it is fruits, vegetables, a quarter is whole grains in a quarter is lean protein. If the answer is no, then added sugars don't fit in your eating plan until you get that plate to measure up. That's what I worry about. I think what we're doing is another perfect example of good food, bad food, diet mentality. Sugar's bad. It's gonna kill you. Fat's bad. It's gonna kill you. It doesn't work. We've seen that. It doesn't work. As soon as you tell the young child, you can't have that, what does the young child want? We're no different. We're just big children. So, you know, I think we, we need to recognize we have a lot in our diet. We need to cut it down. We need to make it either only special occasion or very minimal if we have to do it on a daily basis.

Connie Diekman [00:56:04] You know, I I over the years, would see people who would drink a diet soft drink every morning, excuse me, not a diet. 'cause that obviously wouldn't be a sugar issue, would drink a soda every morning for the caffeine. All right. They're doing the caffeine, other people are doing coffee. Can we make it work? Yeah, you can, but that's not where the problem is. It's, you know, the big gulps, it's the big this, it's all of those things. Now in terms of your, your first premise of, you know, the

Vance Crowe [00:56:32] Partnership piece. Yeah. The Ians being a part of it. Yeah.

Connie Diekman [00:56:36] There's integrity of course up there, number one. And number two is industry partnerships are to everybody's advantage as long as integrity rules it. So in other words, the food industry is gonna sell food. Would you rather they partner with people who help them develop foods and shape their messaging based upon the science, or based upon what the food industry thinks is Right. But that assumes that everybody's playing their role appropriately. There's no question. A lot of people have challenged the, when we were the American Dietetic Association, and actually it was the year I was president, we had partnerships with Coca-Cola and, and Pepsi at that point. Pepsi now is a bigger arm and I'm drawing blank on, you know, all the food companies.

Vance Crowe [00:57:29] Oh yeah. Giant conglomerations. Yeah. Yeah.

Connie Diekman [00:57:31] We're getting, we're getting fewer and fewer. And, and that was a question I fielded from a reporter was, well, obviously, you know, they've bought you and, and you're gonna say whatever you want them to say. And the answer was no. We had very clear guidelines. If you wanna be a partner of the American Dietetic Association, and it holds true as the academy, we will partner, we will review the body of evidence, but we're gonna shape the messages. You're not gonna shape the messages, you're not gonna use our logos. We're not you, you're, you we're just a partner to help the consumer understand what to do. And in fact, at the time, the Coca-Cola company gave a, a, a good donation to the academy's evidence analysis library to assess a question on sugar. And the answer didn't come out quite like they wanted, but the answer came out the way the science said it.

Vance Crowe [00:58:23] So what was it, what was the question?

Connie Diekman [00:58:25] I'm blanking on the question. It it, it related to the impact of sugar consumption, but I don't remember exactly. I I sorry. Therefore,

Vance Crowe [00:58:34] And they didn't, and they didn't,

Connie Diekman [00:58:35] It didn't come out the way they thought it would.

Vance Crowe [00:58:36] And they didn't say, give us our money back or anything. They

Connie Diekman [00:58:38] Couldn't. Nope. Nope. And that's what's important, you know, if you partner with anybody and you sell your soul.

Vance Crowe [00:58:45] Yeah, yeah.

Connie Diekman [00:58:48] So integrity is key. Yes. There have been scientists who have sold their souls and it's unfortunate. And some of them were very good scientists and it's definitely hurt their reputations and their names and, you know, who knows why people do what they do.

Vance Crowe [00:59:05] So you're no longer president of the, of the academy? No. And but you're still in it. Oh

Connie Diekman [00:59:11] Yeah.

Vance Crowe [00:59:11] Okay. But can, what are the current controversies that, that sit in inside of the academy? You have a hundred thousand people talking about the, the very core of life that is food. What is, what are the arguments that are raging right now?

Connie Diekman [00:59:25] A lot of them do revolve around things. We've discussed the intuitive anti-D diet. There's a, a movement called health at every size. And last fall at our annual meeting, there was actually a debate between a researcher in weight management and what does the body of evidence show as it relates to weight management, whether it is effectiveness, whether it is impact on creating eating disorders, and then the health at every size part of it. And the goal of the session was really to look at, okay, what is your science? What is your science? You know, what are your outcome measures? How do you know?

Vance Crowe [01:00:01] And when you're saying health at every size, you're saying that it's a movement. There are some dieticians saying

Connie Diekman [01:00:05] It's a bigger movement than just dieticians.

Vance Crowe [01:00:07] Okay. So tell me what it is. I i

Connie Diekman [01:00:08] Health at every size is a, a movement that started, it's not new. Maybe 20 years, maybe even more. And, and their focus is good. In other words, you can be healthy at any body size. If back to your three words of earlier, you know, back to if you are eating the right things to be healthy, you're working out to be fit. Maybe the happy part doesn't fit.

Vance Crowe [01:00:33] Yeah. The, the happy working and piece fit.

Connie Diekman [01:00:35] It's that piece of really looking at making sure you're getting what your body needs to be healthy. And there's nothing wrong with that. I think we all espouse for that. The thing that is, that the debate focused on was, there is evidence to show that too much body fat increases your risk for disease. It, it's there, you can't ignore it. So we have to acknowledge that if you're carrying extra body weight and you aren't focused on are your joints okay, you know, are you paying attention to your, your blood sugar levels and all of that, you're putting an individual at risk. And we as professionals need to help those people. So this is a big area of conversation. It's ongoing. We partner the academy partners with the Obesity Society, which is all the researchers in the obesity world, to really try to develop messaging that acknowledges, yeah, you can be healthy, but we've gotta talk about how you get there. And we've gotta talk about, is there a point at which for an individual, too much body fat is not healthy, we can't ignore it. How,

Vance Crowe [01:01:46] How does the, how does the academy handle, or, I don't even know how to ask this because, because body weight is so personal, right? And it is such a, such a touchstone. But if you think about the dietician that is really overweight

Connie Diekman [01:02:00] And

Vance Crowe [01:02:00] They're trying to counsel people on good nutrition,

Connie Diekman [01:02:03] It's always been an issue. Really.

Vance Crowe [01:02:05] Yeah.

Connie Diekman [01:02:05] It's always been an issue. It, it's very similar to, you know, when they'd say this, the physician who would tell you to stop smoking as he was smoking his cigarette, you know, that happened for years. Yeah. And, and you know, many dieticians who are in that position, they have done a couple of things. Number one, they've been very self-disclosure, honest, you know, I know what you're going through because I'm going through it myself. I struggle with X, Y, and Z as well, but I can help you and maybe you'll do better than I have done. So that's one way of, I think right or wrong, some dieticians who carry more body fat than they'd like, choose not to go into the patient world. So that's a way of, you know, managing it. But there, the academy has a position paper on weight management. We have a specialty group on weight management. I just finished my year as chair of that group. And you know, we really have some excellent research and some excellent researchers who've looked at, again, the body of evidence. That's what's so important. Don't take single studies and go, oh, there's the answer to my question. I'm gonna do that. What does the body of evidence show us? And it still shows us that there is a point at which people carry too much body fat and it does have negative health implications.

Vance Crowe [01:03:26] Yeah. I mean, there, there's no, no doubt. I mean, you, you can't go, my wife's a physical therapist as you know, and, and there's no way you can go out and jog right on joints if you are just, if you have all that added weight and, and in addition to whatever, I, I just, it's such a difficult thing because I imagine signing up to be a, you know, maybe a different way to look at it is that oftentimes people go towards the field where they learned the most or they had a person make the biggest impact. But if you go into that and you say, I'm gonna be a dietician, people are gonna judge you. Yeah. Every aspect of what you eat and how you look and how you all of those, oh yeah, you're signing up for a hell of a a hell of a thing.

Connie Diekman [01:04:12] Well, no, no question there. And it's been, I, I'd have to stop and think how many years, but you know, I was on TV in St. Louis for

Vance Crowe [01:04:23] Oh man, do it on tv. Yeah,

Connie Diekman [01:04:25] That'd

Vance Crowe [01:04:26] Be

Connie Diekman [01:04:26] Way

Vance Crowe [01:04:26] Hard.

Connie Diekman [01:04:27] 15 years-ish. Something to that effect. And the worst example of what she just stated, I was at, there's a small market in our community where, you know, you can run in and get stuff as opposed to going to the big supermarkets. So I was in, and I was grabbing some stuff, and I don't even remember what the food was that I've putting out there on, on the belt, but it, it was something that maybe didn't fit my plate and the person behind me said something to the effect of, oh my, I didn't think you would be buying those kinds of things. But wait, the best part was my answer. Oh, they're for my children. It was like, did I just say that? But yeah, you're right. You know, you're con a constant scrutiny. You go out to eat with people and people will say, oh, I better not eat that. The dietician's here, whatever it might be. But you know, I guess you, you kind of get over it sometimes. You use it as an opportunity for conversation. You know, I think the thing that, that the profession has looked at of late, and there actually have been some studies in our journal on it, just as you said about, you know, people who've worked out with a PT often end up going to school to be a pt. We have dieticians who have dealt with eating disorders who've gone into the field. And, and that's a bit of a concern because eating disorders are for life. They're not temporary.

Connie Diekman [01:05:58] You know, you, you break an ankle, a hip or whatever it heals. Eating disorders don't usually go away.

Vance Crowe [01:06:04] I had a math teacher that one time told her class, sixth grade math teacher that said, the reason I'm a math teacher is because when I was your age, I hated math and I figured out how to do it. So I thought I'd be your math teacher. And all of us were like, oh great. What the hell was, now she's gonna make us as miserable. But in your, in this case, that would either be the greatest blessing because you've put yourself in a community and now you're surrounded by the research and you see what other people, or the most horrible curse because now you're confronting this every Right. The same demons other people are confronting you seeing too.

Connie Diekman [01:06:38] Right. Right. And that, and that's been the challenge, you know, with the dieticians. And that was what the study basically looked at was, you know, what impact has it had on them as they look at practice and you know, obviously just like everything else with, for some dieticians, it has worked out great. For others, it has only caused them to continue to sit in their eating disorder. But that's, you could take that out of the profession and say that anyway. Right.

Vance Crowe [01:07:07] Because

Connie Diekman [01:07:07] It is a psychological disorder and without the proper help, they're gonna sit in that disorder.

Vance Crowe [01:07:13] Yeah, that's right. And, and constant maintenance. So a total non-sequitur, what should people that, that wanna lose weight know about alcohol and alcohol consumption?

Connie Diekman [01:07:24] It's a tricky one to answer right now. Truthfully, the simple answer is alcohol is metabolized just like fat. So therefore it goes to storage. So the more alcohol, the more more you store.

Vance Crowe [01:07:38] Wait, wait. So if I drink a beer, yeah,

Connie Diekman [01:07:40] It's metabolized just like fat.

Vance Crowe [01:07:42] Not like, so it's not like, well

Connie Diekman [01:07:43] The carbohydrate in the beer and the little bit in the wine will be, will be metabolized as other carbohydrates are.

Vance Crowe [01:07:49] So the car, the sugar that's in there is all gonna go like carbohydrates, but the alcohol that's there, yeah. Whatever percentage it is goes to your liver and turned into fat.

Connie Diekman [01:07:57] Yep, yep. Or

Vance Crowe [01:07:57] Processed as fat,

Connie Diekman [01:07:58] It's processed as fat. So what does that mean? So more of it gets stored. Alcohol of course has more calories per gram than other carbohydrates. So that's the other thing people need to remember. It is more calorie rich, so to speak. The the other thing though, that's looked at right now, it's actually an area of research right now. And I think one of the 2020 questions is on alcohol. I'm almost positive it to, to the point of is it contributing to our obesity epidemic? So as we, as we look at it, you know, it does, it does provide that added calorie piece that you need to stop and think about. Can you afford those added calories? The nutrients that come with it are limited to none. You know? Yes. If you do red wine and even white wine for that matter, you are getting some of the phytonutrients because of course it comes from a grape, you know, if you do beer, okay, there's some hops in there, but the amounts of course are nothing like eating grapes or,

Vance Crowe [01:08:56] You know,

Connie Diekman [01:08:57] Eating wheat or that type of thing. And clearly if you do hard liquor, there's really not much nutrient value. So it, it needs to be looked at in that same kind of empty calorie way. Can you afford those calories? With that said, of course, that's where we get back to. Yeah. But I enjoy, well you know, that's where we then get to what are the health implications. You know, we know from most of the body of evidence, and this has been in the dietary guidelines for every bit of 20 years, if not more. You know, alcohol does have some pretty significant nevi negative impacts. I mean, women probably shouldn't have more than one drink per day in men. It's too, and

Vance Crowe [01:09:37] Really to what, to what effect when, when you say,

Connie Diekman [01:09:39] Well it's, it's tied to the impact on blood sugar. So the impact on insulin, it's tied to, of course alcohol is an irritant and the, the potential of carcinogen in the mouth, it's tied to the heart piece. Yes. Wine in the French paradox, you know, did show a benefit to heart disease. But the alcohol piece, and it's probably like we discussed earlier, this whole gut microbiome thing. You know, what's the alcohol really doing to the gut microbiota and is that having the effect on disease in, in the body? So there's a lot of complexity, but it is an area that's being looked at and a study recently, and I'm drawing a blank on where the study was, but it really did look at, you know, maybe it doesn't belong in the diet because of the potential health implications. Clearly that's not gonna happen. So, you know, the advice then becomes, it needs to be a part of your diet. You need to think about the quantities in your diet. And then of course, you know, having worked with the college pop population, it, it always was about, and you need to think about the behavioral consequences of overconsumption because of course you know it too much alcohol, we know it impairs function, it impairs, you know, so many physical movements. And that's of course when people get in trouble.

Vance Crowe [01:11:02] Do you think most people recognize how big of an impact, how many calories they're taking in by how much they drink?

Connie Diekman [01:11:09] No, alcohol is like so many other things. Whether it is, you know, the birthday cake or whether it is the candies you keep in your drawer, it's that, oh, there's not that much. It doesn't count. We, we do a disconnect with it. You know, I think the only time I've seen people really think about it, it's that disordered eating behavior. You know, Thursday night is the night that college kids go out. So on Thursdays with

Vance Crowe [01:11:36] Thursday and then Friday and then Saturday,

Connie Diekman [01:11:38] Well Thursday's the big one. Yeah. The one

Vance Crowe [01:11:40] They start on. Yes.

Connie Diekman [01:11:41] Right. Right. So Thursday, well I just won't eat because I'm gonna drink. Oh

Vance Crowe [01:11:45] Man. Which of

Connie Diekman [01:11:46] Course only makes the drinking worse in terms of, you know, the impact. See that's the other thing people don't know is alcohol drops blood sugar so that you know, when you drink too much, yes you're intoxicated. But some of the,

Vance Crowe [01:12:00] Is that why you always get hungry then while you're

Connie Diekman [01:12:02] Yeah, yeah.

Vance Crowe [01:12:03] No kidding. Yeah.

Connie Diekman [01:12:04] Yeah. But it's also some of the, you know, when people get into the kind of stumbling behavior and you're going, you only had a drink, you only had two drinks. Well, if it's on an empty stomach, it drops the blood sugar. 'cause it's, again, the way it's metabolized, it affects the blood sugar more quickly. So, you know, it, people have, people have been, people have been stopped when they, you know, aren't really alcohol intoxicated. So in other words, not above the 0.08, but it's because they didn't eat. So the effect was more,

Vance Crowe [01:12:38] I had no idea. I'm very, very glad I asked this. So, so speaking of blood sugar, you know, I've had a chance to learn a little bit about what happens when somebody gets diabetes and they're taking a needle and they're pumping insulin into their, into their body. But let's take a step back and, and you can probably give a better explanation. One, why does somebody develop diabetes? There's two types and then, and then what's going on when, when they're giving themselves insulin?

Connie Diekman [01:13:08] Well, when you look at diabetes, all of it is a metabolic disorder. So there is a genetic component. There is heredity involved. You know, when you look at type one, which we used to call juvenile onset, because we thought it would only happen in young years, we now know it can happen anywhere in the lifespan. And basically what happens in type one is the pancreas is no longer producing the insulin.

Vance Crowe [01:13:34] And what does insulin do?

Connie Diekman [01:13:35] Insulin is what in simple layman's terms is what, when glucose is in your bloodstream and it comes to a cell, insulin opens the door so the glucose can go in the cell rather than staying in your blood sugar and then coming out when we urinate.

Vance Crowe [01:13:50] So, and that comes primarily from carbohydrates.

Connie Diekman [01:13:52] Yeah. Okay. The glucose from your carbohydrates. So you know, when you eat, when we eat, if we don't have diabetes, our body recognizes the presence of carbohydrates. Of course at this point they're glucose in your bloodstream, you release the insulin, it goes to all the cells in your body, opens again the door to let the glucose in. So now the cell gets its energy and you feel good. Remember we talked about blood sugar up, blood sugar down. So the insulin down here lets the glucose go in and your blood sugar comes back to more of a normal level. Type two is when the, the pancreas is still making some insulin. It just may not be enough or it may not be released appropriately. So it might release it when there's no food. Or it might release some when there's food and then a lot later. So in other words, it's just not working the way it should. So there's a lot of glucose, the blood sugar staying in your blood as opposed to going into your cells, which is why people get a lot of lethargy. You know, people often will talk about, as we said earlier, the, the mind fog, but also they'll notice it in their, their vision. They'll notice I just don't feel very good in type one because there is no insulin. One of the classic ways of diagnosis is you see weight loss 'cause your cells don't get the glucose so you lose weight. And then of course the real classics are you start getting a lot of thirst and you're drinking a lot of water.

Vance Crowe [01:15:25] Oh, that's right. Yeah.

Connie Diekman [01:15:26] But that's because you're losing your cells and you gotta flush 'em out of the body.

Vance Crowe [01:15:32] Oh wow.

Connie Diekman [01:15:32] So see really it's the, the impact on the cells and then you've gotta get that water gone or get the water to get the waste gone. Type two, those people tend, tend to be a little bit overweight. But again, it's a genetic piece. So in other words, if you gained weight, you're not automa automatically gonna get type two diabetes. If you gain enough, you probably will struggle with some blood sugar issues. But to diagnose it as type two diabetes, you know, there, there's some, again, criteria to make that real diagnosis. But the reason it, it is associated with weight is fat cells, remember on muscle cells they said the insulin opens the door and the glucose goes in. Muscle cells don't have any doors

Vance Crowe [01:16:16] On fat cells. You mean,

Connie Diekman [01:16:17] Sorry, thank you for, I'm glad you're listening. Fat cells don't have any receptor sites, so no doors. So there's no way to get insulin into a fat cell. So therefore the blood sugar just keeps circulating through the body. So now of course you go and you get your blood done and your blood sugar's way high. And that's because your insulin's just not working right or there's not enough to get what you're eating into the muscle cells.

Vance Crowe [01:16:49] Interesting. Wait, and and that's because the fat cells cover over the muscle cells and then they can't get the, it's the, the

Connie Diekman [01:16:54] Balance of the two. Okay. You know, it's the, you're carrying more body fat, then you've got muscle. So even if the insulin's taken it into the muscle cells, you've got all these cells that aren't nourished and they continue to yell for food and they want more food and you keep eating and it doesn't work and it's the imbalance.

Vance Crowe [01:17:12] Oh wow. Yeah. So the a vicious cycle then. Yeah,

Connie Diekman [01:17:15] Exactly. That's exactly right.

Vance Crowe [01:17:17] So when somebody takes a, an insulin needle out and they, and they pump in some insulin into their body, what then is happening? Well,

Connie Diekman [01:17:24] If they're doing it still by needle, they have to time it with their food. So they have to do it about 30 minutes before they're going to eat so that the insulin is there and ready when the, when the glucose comes in to put it in the cells. You know, if they did the insulin after the meal, they're going to have some problem with some of that glucose being absorbed. Many people now with type one use a pump and the pump is an automatic program to release of insulin. So it'll gives them more flexibility on eating. So they don't have, I mean they still need to manage it 'cause you can't be all over the place. But in the past, and, and I, some people at the beginning still use the, the needle. So as they're learning you, you know, you have to plan out, when am I gonna eat breakfast? What am I going to eat? Am I taking enough insulin to match what I'm going to eat? Same thing for lunch, same thing for dinner. So it it, it becomes very challenging in, in type two you either are using a, an oral medication which kind of is a booster for your insulin. You're definitely using diet and you're using exercise. 'cause again, you wanna try to lose the fat cells, boost the muscle cells and you know, drop your weight if you can.

Vance Crowe [01:18:43] So very, very common thought that I've heard on podcasts talking about diabetes and insulin is that as soon as you get on the insulin system, you are both going to A gain weight and B, never be able to get out of it. Is that true?

Connie Diekman [01:19:01] Well, the first one, the gain weight is a little bit true. The second one is definitely true. If you're a type one diabetic, you're not making any insulin. You have to have insulin. You can't live without it.

Vance Crowe [01:19:14] Okay. And then what about in type two diabetes Type

Connie Diekman [01:19:17] Two? Yes. Some of them will use insulin, no type two diabetes. They, many people can get that back under control.

Vance Crowe [01:19:25] Oh wow.

Connie Diekman [01:19:25] Many people can, it's

Vance Crowe [01:19:26] The most hopeful thing you've said so far today.

Connie Diekman [01:19:28] Oh darn. On the first one on type one about the gain weight. Remember what I said though, with type one, before they get diagnosed, often what happens is they lose weight. So you start taking insulin, you will gain weight. But that's because now your cells are getting their energy. See what was happening before is you were starving because there was nothing to put energy into your cell energy cannot go into a muscle cell without insulin. It's not gonna happen. So you're gonna continue to eat your muscle cells to get that energy so you're starving the body.

Vance Crowe [01:20:02] Okay. And

Connie Diekman [01:20:03] That's why they lose weight before they're diagnosed. And then when they start taking the insulin, they'll gain weight. But it's because the body's getting healthy. Again,

Vance Crowe [01:20:13] The, this is such an interesting thing and I, I see it a lot, but I actually didn't even realize you could take insulin by pill. So that's a, it's

Connie Diekman [01:20:22] A, it's, it's not an insulin as such. It's a, it's called metformin and there may be others right now, that's the one I'm most familiar with. It's a booster to your insulin. So it, it helps your insulin work better. It helps your insulin act when it should act. Now insulin almost, almost always, again, I could be wrong, but almost always it's, it's gotta be the injectable or the pump, which is injectable too.

Vance Crowe [01:20:51] Are you familiar with the concept, the Dunning Kruger effect? This is where, yeah,

Connie Diekman [01:20:56] I just heard that. So

Vance Crowe [01:20:57] Remind me, I, I talk about it a lot. I get invited out to talk about, well how do people know what they know? But the Dunning Kruger effect is the tendency for human beings to vastly overestimate how, how much confidence they should have in their expertise When, so you read one or two books and your confidence spikes and then you know, you read a few more and all of a sudden you start saying, wait a second, the more I learn, the less I feel like I know. So their confidence goes way down and eventually it goes up. And I can tell you that I absolutely suffer from the Dunning Kruger effect around around nutrition. And so it's been a great, great pleasure to to talk with you. And I think there's probably a lot of people that are wondering right now, at what point do I decide I should go pay the money to go see a dietician? So what would be your, as the former president of the academy, what is your way to describe when somebody should go, go talk to a dietician and then what should they look for when they, when they do? Okay.

Connie Diekman [01:21:57] I would say one thing. First I would say you can go for free to eat right.org, which is the Academy of Nutrition and Dietetics website. And there is a lot of information on there. So if you just need all of that, what's right, that's a simple click on the, on the web. If you really wanna do that, sit down, plan it out, figure out what I need to do. Again, you can go to eat right.org and there is a link on there called Find a Nutrition professional. And you enter your zip code and what you're looking for and you'll get a list of dieticians who see individual clients so you can find someone in your area. What

Vance Crowe [01:22:35] Should somebody expect to pay to see a dietician?

Connie Diekman [01:22:38] I think it's all over the place right now. So I'm not sure I can even quote for you. Is it because of course it's geography as well as need and then the individual dietician, you know, if they're in a physician's office, it's a little bit different than if they're a standalone office. But

Vance Crowe [01:22:52] I mean, I guess maybe just a ballpark, this is $50 an hour, it's a $200 an hour. What, what, where would you put it? Are those, is that a right ballpark? You think?

Connie Diekman [01:23:05] It's probably a sa I, I'm not sure for an individual we'd go as high as 200.

Vance Crowe [01:23:10] Okay.

Connie Diekman [01:23:11] As in this area, you know, you go to New York, San Francisco, LA it probably is that for sure.

Vance Crowe [01:23:17] Okay.

Connie Diekman [01:23:17] But my guess would be is we sit here in, in the Midwest, you're looking at, you know, somewhere in that 75 to 150 for an hour. You know, a lot of dieticians will do a, a bundle sort of like cable. They'll do a bundle where you can commit to doing one visit and two or three follow up, which of course are extremely important. And a lot of people don't wanna do 'em 'cause it's extra cost. But that way they can kind of spread the cost so it, it doesn't feel as expensive. You know, what you wanna go for the d to a dietician for again is I wanna develop an eating plan that I enjoy and that I can stick to and that'll help me be the healthiest me that I can be. Now clearly if you have a disease, hypertension, cardiovascular, you know, cholesterol or or diabetes, then make sure you look for a dietician Who specializes in that? Not all of us do.

Vance Crowe [01:24:12] Okay.

Connie Diekman [01:24:13] You know, I would not see someone with kidney disease because I haven't done that since my internship. You know, doing eating disorders and cardiovascular, great, but don't bring me, you know, liver disease. So make sure you look at what people specialize in, ask if they have any sort of insurance. Many diseases are not covered, but it's worth an ask. The more patient ask, the more documentation we can provide to insurance companies that it's needed.

Vance Crowe [01:24:40] Okay.

Connie Diekman [01:24:41] And then when you do the visit, go in prepared with a I want to, whatever, you know, I want to learn how to cook, I want to learn how to, you know, put less salt on, know what your specific goals are. Don't just go in and say I want to eat better. What does that mean? Or I wanna lose weight. Is it weight or is it, I'd like some muscle mass.

Vance Crowe [01:25:08] Right.

Connie Diekman [01:25:08] You know, have your, have your head on in terms of what you're looking for. Generally speaking, a first visit is gonna be an hour 'cause you should get a history. So tell me about yourself. Let's develop a plan and then we go from there. And that takes about an hour. Follow ups are much shorter, maybe a half an hour. And I would always say try to do at least one just because change is hard

Vance Crowe [01:25:29] And a mom that's got some kids at home and wanting to to do better could come in and talk with the dietician about setting up that, that, that's an interesting, yeah. As, as somebody that has a lot of friends that are becoming parents. I know that's a, that's a big question

Connie Diekman [01:25:42] To a lot of people. It's, it's, it's very, it's very confusing. It's very overwhelming. You know, some of the hospitals have outpatient clinics where you can do it as well. So, you know, if you are looking at pediatrics, you might look at your local children's hospital to see, do they just have a clinic where I can go in and talk to the dietician? And that might be more economical. It might also be easier if you're carrying along a bunch of little ones.

Vance Crowe [01:26:04] Yeah. And so to close out, you are actually on social media, at least I found you on Twitter. So why don't you tell everybody what your Twitter handle is about and what types of things you share there so they would know whether or not you're, you're the type of person they wanna follow. Yeah,

Connie Diekman [01:26:20] I am on social media as time allows. So on Twitter, well actually Twitter and Facebook, they're both the same. I just use, which is now my business c, b and then D-I-E-K-M-A-N. So hashtag C-B-D-I-E-K-M-A-N

Vance Crowe [01:26:36] I'll put a link to it.

Connie Diekman [01:26:37] Okay. And you know, my, my goal is to share the science of nutrition and easy to use, whether it's a soundbite or whether it's a link off of Facebook, it, it is about getting people to the right information as opposed to some of the other stuff that's out there. And yes, my areas tend to be cardiovascular eating disorder, sports. You know, I worked with the university athletes, I worked with that football team when they were in St. Louis, huh? Oh,

Vance Crowe [01:27:07] You did, you worked for the Rams?

Connie Diekman [01:27:09] Yeah. Yeah. Wow. I worked for the Rams. So, you know, I, I do sports nutrition as well. I am credentialed in sports dietetics. So those are probably my big areas. But as you know, you know, I, I am a member of the lead network for Bayer. And of course a lot of people jump on that one immediately. Like, number one, what is that? And number two, how could you do that? And lead network of course is leaders engaged in advancing the dialogue. And, and that is such an important thing. We have to talk about where our food comes from, how our farmers produce the food that we need, and how are we gonna feed the world when our population goes from our current seven, 8 billion to, you know, up there at what is the latest projection, 12 or 15 billion, something to that effect in the role of technology. We have to talk about this.

Vance Crowe [01:28:02] Well, I, that would be a, a great thing for you to come back on the show at some point and talk about just as, as one little aside, a lot of people probably don't know that Bayer bought Monsanto. So Bayer is a large agriculture company in addition to being in the pharmaceuticals world. And I used to work there for a brief time with Bayer, but for a longer time with Mon Monsanto.

Connie Diekman [01:28:21] Yeah.

Vance Crowe [01:28:22] In any case, I'm very, very glad that you came by today. This was great and I'll definitely have you again. So thank

Connie Diekman [01:28:27] You so much for jumping

Vance Crowe [01:28:28] Into the water. Thanks.

Connie Diekman [01:28:29] Thank you.

Vance Crowe [01:28:30] Well, that's it for the interview today. I hope you enjoyed it. I know that I learned quite a bit. If you did, I hope you'll consider subscribing and hitting the like button. Make sure you put comments in about what you found interesting and if there's anything I can do to make the interviews better or more informative. And definitely, definitely let me know if there's anybody you think I should be interviewing. I try to do all these interviews in the St. Louis area, so if you know anybody that's already here or somebody that might be swinging by, let me know. I actually don't know who's gonna be next week's interview, so you'll have to tune in. I'll definitely throw it up on Twitter whenever I find out. But I'm looking forward to it. And we'll see you next week.