Behind the Counter with Keith-Thomas Ayoob, RD


Dr. Jessica interviewed Keith-Thomas Ayoob, a registered dietician and Associate Clinical Professor Emeritus at the Albert Einstein College of Medicine in New York City.

  1. When did you first start working as a registered dietician (RD)? 

I have been an RD since 1980, so I’m now 40 years in! I was in graduate school back then, working on my doctorate and working part-time as a “relief” dietitian, so I’d fill in on weekends and when they needed someone during the week. It was great because, as a relief, I’d be experiencing all the different hospital units: oncology, cardiac ICU, pediatrics, the works.  

  1. What inspired you to become an RD? 

Nutrition science was my undergraduate degree. I always enjoyed learning how the body worked, and the more I learned about how truly complex it is, the more fascinated I became.  Plus, in a nutrition curriculum, you also learn about food science, not just nutrition. Food science focuses on food before you eat it. Nutrition is what happens once you put it into your mouth.  

  1. How would you say your approach differs from other RDs?  

?My approach has definitely evolved over the years, because I keep learning, but also because nutrition is such an evolving science. I came up in a health care setting where the patient was the focus, not the statistics. My kids and families aren’t often “typical,” or they wouldn’t be in our clinic. I always felt I had to dig a little deeper with my patients and their family lives, to see what might be contributing to the child’s nutrition issues.  

There is the “cut-and-dry” approach that focuses mostly on educating people about what to eat and what a balanced diet is. However, just focusing on education doesn’t cut it any longer. It’s about motivating people to make changes. The combination of education WITH motivation can have much more of an impact than education alone.  

  1. You have a strong background in pediatrics, including working with children with special needs. Could you please elaborate on your “meet them where they live” approach to working with these children and their caregivers on nutritional issues?

When it comes to changing diets and eating behaviors, you have to remember you’re treating the child AND the caregiver. Caregivers need to know they don’t have to make huge food and eating changes all at once. I also tell them how long they should expect things to take. For a child with autism who eats 5 foods, parents need to know that he may never eat the same way as everyone else, but if he can accept at least two or three foods in each group, that’s enough.  Even that may take a year, and the only thing they need to really do is be patient and be consistent. It’s about baby steps towards improving, not big leaps to perfection. It’s about helping meet the child’s nutrient needs and also helping the caregiver feel he/she is doing their best.  

  1. What other chronic illnesses can benefit from particular diets? Can you please elaborate on one example? 

Many kids with ADHD are on medication to help them focus at school and do their best academically. When medication is prescribed, it’s often quite helpful, but there are side effects, the most common being a poor appetite. For these kids, it’s so important to get a solid breakfast into them every day. It might be the only thing they eat until dinner, so it must do double duty if possible, with calories, protein, and micronutrients. Most importantly, I stress that, once it becomes routine, it’s much easier—it’s a learning process. 

  1. You talk about myth-busting when it comes to nutrition. The spread of misinformation has been a big issue with COVID-19 as well. What changes would you like to see to the way health information is shared online? 

One very popular online thing is “immune boosters.” Foods and supplements may “support” the immune system, but only a vaccine will actually boost immunity. That’s what it’s designed to do.  All nutrients “support” immunity, but support is such a vague term that it’s almost meaningless.

There is so much “junk science” online that credible sources get diluted or even lost. Please, follow your doctor’s or medical professional’s advice. It’s easy to get sucked in by celebrities, sports players, or others with high profiles, who talk about what they do, but it’s a huge risk.  Hydroxychloroquine is a perfect example. People are desperate for a COVID-19 cure and this just won’t do it. And anything described as a “miracle” food or supplement should be passed by.  Period.  

  1. Can you please “cut to the chase” and give us your top 5 pieces of advice for anyone struggling to live a healthier lifestyle during these tumultuous times?

Comfort food is perfectly understandable for the short term, but we’re in this for the long haul and we need to get back on track:

  • Protein matters. It comes in plant and animal forms, and unless you’re a vegan, get it from both animal and plant sources. Every meal, every day. 
  • MOVE. It’s absolutely safe to go outside and walk or be otherwise physically active. In fact, you should if you can as long as you wear a mask and keep your distance from others. If the benefits of physical activity were derived from a drug, it would be the most demanded drug ever. It’s not in pharmacies though, it’s in your shoes. Use them.
  • Best diet? Maybe it’s a screen diet. Cut it off at least an hour before bedtime and give yourself permission to do nothing. The world will spin without you and still be there in the morning. You’ll have missed nothing and improved your chance for better sleep.
  • Sleep is medicine, in my book, so for most people, no eating at least 2 hours before bedtime. You’ll have a better quality, deeper sleep when your digestive system isn’t working so hard breaking down food.  
  • Yes, fruit and vegetables are critically important, and there’s no substitute for them nutritionally. Frozen and canned are fine (canned beans should be in every pantry) and they last, but include fresh when you can, too. Summer fruit is unbeatable. Aim for at least 2 cups a day, total, but the more the better.
  1. Anything else you’d like to add?

One thing people ask me about is if I’m a vegetarian or vegan. I’m neither. I eat everything and I don’t like wasting food. That said, people think you have to be strict about being vegan or vegetarian but you don’t. That’s a self-imposed thing, but being a “flexitarian” is perfectly fine.  Or just being an omnivore who sometimes eats vegan or vegetarian meals. It doesn’t have to be either/or. And I’m just glad dark chocolate fits all the above eating styles.

Dr. Ayoob is a strong advocate against fad dieting and has testified before Congress against the marketing of diet pills to children in addition to co-authoring He the Academy of Nutrition and Dietetics’ position paper on food and nutrition myths and misinformation. 

Dr. Ayoob received his doctorate degree from Columbia University’s Teachers College, his Master’s from the Columbia University College of Physicians and Surgeons, and he did his undergraduate work at the University of California at Davis. His website is www.cuttothechasenutrition.com, where he writes his EdibleRx column. 

Dr. Jessica Nouhavandi

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