What Should I Eat? (The Gluttony That Plagues Us)

What Should I Eat? (The Gluttony That Plagues Us)

Most evidence-based clinicians refer to large double blind randomized clinical trials as our guideposts for treatments we offer our patients. But even the longest clinical trials don’t cross the average age that we will live to. So, when a patient comes to a clinician and asks the most basic question: what should I eat? we don’t have THE clinical trial to answer the question. And given the length and cost of the trial needed to answer the question, we may never have that trial.

As diet has become more closely linked to health outcomes, we’ve come up with the DASH, Heart Healthy, American Diabetic Association, Mediterranean diets. Just to name a few. These diets have been validated through numerous means; for example, clinicians have turned to fancy statistics to churn numerous small studies through meta-analyses to validate the cardiovascular and cerebrovascular protective effects of the Mediterranean diet. And then, of course, there are popular metabolic hacks, like the Ketogenic/Paleo diets and intermittent fasting, that are often implemented and are being studied.
But what if we took an anthropological lens to diet. This is exactly what Dan Buettner has done with his Blue Zones franchise. Within these Blue Zones, Dan Buettner and his National Geographic team have found “people reach age 100 at rates 10 times greater than in the United States.”1 He and his team found 5 Blue Zones:
1. Ikaria, Greece
2. Okinawa, Japan
3. Ogliastra Region, Sardinia
4. Loma Linda, California
5. Nicoya Peninsula, Costa Rica
After reading one of Buettner’s books, I have started incorporating and recommending some of the “evidence-based common denominators,” which include dietary recommendations.
1. Move Naturally
2. Purpose
3. Down Shift
4. 80% Rule
5. Plant Slant
6. Wine @ 5
7. Belong
8. Loved Ones First
9. Right Tribe

A common misconception is changing your diet to a blue zone diet will result in 100 plus year life span. On my read, Buettner’s books carry a deeper message. Just remember diet is important, but it’s not the only thing.

The denominators synergize to give a lifelong effect but let me first focus on the denominator that’ll give the most bang for your buck. Overeating is a huge problem for me and my patients. The excess calories lead to the obvious issues: obesity, diabetes, heart disease, just to name a few. The Okinawans have developed “hara hachi bu,” the rule of eating to 80% full, to counteract the gluttony that plagues us.

I put this into practice by first learning what it means to be full for me. I picked a typical time that I eat. Then I picked the two meals that I eat: a healthy meal and a cheat meal. Though extremely important, I won’t get into what I consider healthy versus cheat, or how I often I eat one over the other. I will write more on this later, but here I want to focus on “hara hachi bu.” In both instances, I gave myself an hour and plenty food. I measured the starting amount, then I started eating slowly over an hour. I ate until I was full, which only took about 30 min. But I gave myself the full hour to see if I wanted more. At the end of the hour, I measured what I had left and subtracted that from my starting amount. This is what I call my full amount. Now I calculated 80% of this amount. For the next week, I went on 80% of full. To my surprise my stomach felt lighter, but I did not feel hungry. It felt odd, but not uncomfortable. Starting here has resulted in tremendous personal health gains.
You can adapt this concept to any of the diets I mentioned above or any diet you chose. And it’s vital you chose the right diet and again, I’ll get into that later. But here I want to focus on how much you eat.

Hara hachi bu is such a powerful concept that many patients undergo surgery or a procedure to induce the same results. Lap band surgery and sleeve gastrectomy are commonplace now days; and though less common, their complications also ping the radar of emergency departments. As an internist, I am conservative in recommending surgery for my patients; but what I call surgical hara hachi bu (surgical limitation of gastric capacity) is something should be strongly considered by a patient (in consultation with her/his physician) to prevent the toxic effects of over-eating; but first, consider self-administered hara hachi bu.

1. Blue Zone History https://www.bluezones.com/
2. Buettner, Dan. The Blue Zones Solution: Eating and Living Like the World’s Healthiest People. Washington, D.C: National Geographic Society, 2015. Print.


I grew up in Salt Lake City and a suburb of Houston. I completed my MD and MBA in the great state of Texas. I gravitated to Austin and have found a home base for my journey. I spend my time working as a Hospitalist (inpatient internal medicine doctor), consuming information, writing, working out, investing, traveling, and hanging with my dog.