A common misconception many people have is that people on a low-carbohydrate diet only eat meat. Although "meat only" diets have been studied, and actually have been found to be safe, this is not at all what I suggest. In fact, a well formulated low-carbohydrate diet should really be considered a low to moderate protein diet. Again, we need to strive to get the majority of our calories from fat. I will discuss healthy fats in the next article. Proteins are made up of chains of amino acids. The process of digestion breaks ingested proteins down into amino acids. These amino acids can then be used by your body to make specific proteins needed structurally (bone, muscle) and to support cellular function via signaling and enzymatic activity. Amino acids can also be used for energy or stored as body fat. Of the 20 amino acids used in the human body, 9 are essential. This means they must be eaten. The body can fabricate the other 11 if needed. A complete dietary protein contains all of the essential amino acids. Meat is a complete protein. Incomplete proteins can also be eaten in combination to supply all essential amino acids. This is how vegetarians can ensure proper protein intake. The amount of protein an individual needs is based on the normal turnover of proteins in their body each day. Larger body mass and an increased activity level require increased protein intake. Eating protein beyond this point is not beneficial and could significantly undermine weight-loss efforts. Some amino acids will cause an insulin release. As I discussed in the last blog posting, we are attempting to minimize our insulin levels to allow our body fat to be mobilized for energy, and to stop the blood sugar instability that leads to cravings. For these reasons, it is best to eat the proper amount of protein (a moderate level) for your body and activity level. How much is that? Adequate protein intake for most people is 0.3-0.8 grams of protein per pound of ideal body weight. I often use 0.5 grams as a simple rule of thumb. So this means if your ideal body weight is 150 pounds, you should strive for about 75g of protein over the day. To maximize weight loss, especially if not exercising, aim for the lower end at about 50 grams. Some body-builders consume several times this amount of protein, but their goals are completely different than ours. We are not trying to pack on as much muscle as possible, we are trying to burn body fat for energy while maintaining our muscle mass and optimizing the function of our cells. To put this in perspective, a six ounce steak has about 50 grams of complete protein. A five ounce serving of salmon will deliver 36 grams of protein. A single large egg or a handful of almonds each contains 6 grams of protein. One slice of cheddar cheese will provide 7 grams of protein. Vegetables also contain protein, but at a much lower concentration. As I will further develop in the future, my recommended diet is not vegetarian, but it does contain lots of vegetables. The biggest volume of food you should be eating is non-starchy vegetables, while the biggest source of calories will ultimately be dietary fats. When eaten in significant quantity, vegetables will actually end up supplying a reasonable amount of protein. A common misconception that has been beaten into our heads is that "lean" meats are best. We have been trained to fear fat. For this reason, many people instinctively think of chicken breast, or tuna as excellent protein sources. And they are. But not for optimal body-weight, health, and performance. Why is this? Because they contain no fat. Just 3 ounces of cooked tuna supplies 25 grams of protein, but only 5 grams of fat. Even worse, a half of a chicken breast contains 27 grams of protein and just 3 grams of fat. Remember, we want our body to burn fat, thus we must eat fat. Take home points: 1: Low-carbohydrate does not automatically mean high protein. 2: It is easy to supply your body with adequate protein by consuming a variety of foods. 3: Don't fall into the "lean meat" trap. Lean meats over-supply protein, and under-supply fat. Choose the fattiest cuts of meat and don't feel guilty. 4: When you do choose to eat a lean meat like chicken or non-fatty fish, keep the portion size small, and feel free to add plenty of butter, cream, or olive oil to the sauce.
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In the next few postings, I will break my nutritional recommendations down into a few simple steps. First, it is important to understand that there are only 3 actual food groups. These are the macronutrients. The 3 macronutrients are fats, proteins, and carbohydrates. Each can provide our body with energy. In addition to potentially supplying energy, protein also provides the building blocks that make up the structure of our body. Technically, our body can also obtain energy when it metabolizes alcohol, but this should not make up a significant part of a healthy diet so we will exclude it for now. Carbohydrates are sugars, starches, and fiber. Fiber is the undigestible part of plants and grains and does not provide energy to your body. Whether consumed in the form of sugar or starch, carbohydrates are all broken down, or digested, into sugars. This happens very rapidly in your gastrointestinal tract. Starch is just a long chain of sugar molecules linked together. This linkage is rapidly broken. You can test this by chewing a saltine cracker and not swallowing it. After a few minutes in your mouth the enzyme in your saliva (salivary amylase) begins breaking the starch down into sugar. This is why the chewed cracker begins tasting sweet when held in your mouth. As far as your body is concerned, all absorbed carbohydrates are sugar. When sugar is absorbed, your blood sugar level rises. Although some glucose (sugar) in you blood is necessary, too much is toxic. Your body responds by secreting insulin from the pancreas. This drives the sugar into your cells to provide energy. When your cells have enough supply of sugar, the excess can be stored as glycogen. Glycogen is primarily stored in the liver and muscles. We can only store about a days worth of energy in this form. When glycogen levels are adequate, excess blood sugar is then stored as body fat. The modern diet tends to be rich in carbohydrates, especially processed, refined carbohydrates. As a result of constant exposure to incoming sugars, our body responds by increasing (up-regulating) the carbohydrate metabolizing system. Studies have suggested many people have fasting hyperinsulinemia (abnormally elevated insulin levels beyond what is needed to deal with a recent meal). This can result in 2 major issues: 1- extreme hunger, 2- inability to mobilize body fat for energy. Since insulin lowers blood sugar, when your pancreas, in anticipation of the next carbohydrate rich meal, secretes more insulin than you require, your blood sugar will drop. This can lead to light-headedness, headaches, irritability, and extreme hunger. This leads you to seek out a carbohydrate rich meal, drink, or snack. Although the crisis is temporarily averted and you feel better, the cycle of blood sugar instability and increased resting insulin levels has been reinforced. Assuming you are able to reduce your caloric intake to a level below what you expend in a given day, you would expect to lose weight. As I discussed previously, it is not quite that simple. Elevated insulin inactivates the enzyme necessary to mobilize stored body fat to use it for energy. So even when you eat smaller meals, or even skip meals, if your body is so used to eating a steady supply of carbohydrates and has elevated insulin levels as a result, you will not be able to burn your body fat for energy. Although we have been led to believe that whole grains are healthy, the statistics show the opposite. We have seen constantly increasing levels of obesity, diabetes, heart disease, and dementia as people have been encouraged to consume more grains. Lets keep step one simple. Refined carbohydrates dump a huge amount of sugar into your body. Your body responds by burning some as energy, storing the excess as fat. Continuing this process makes burning body fat for energy very difficult. Unfortunately it is not just candy and desserts I am referring to. Bread, cereal, pasta, low-fat sweetened yogurt, rice, soy milk, fruit, and potatoes are all carbohydrates. To initiate weight-loss we need to change our biochemistry. Our body will respond to the fuel we supply it. If we constantly supply it with carbohydrates, it will respond as I outlined above, leaving you hungry, and making sustained weight-loss nearly impossible. I recommend eliminating all carbohydrates except those found in non-starchy vegetables as the first step to sustainable weight-loss. This will provide the added benefits I discussed previously including: no cravings, better mood, improved mental alertness, and improved physical stamina. There are a variety of potential longer-term benefits I plan on discussing in the future as well. A few important points: 1- When beginning a low-carbohydrate diet, your body will excrete water and salt. Please drink plenty of water, and feel free to add additional salt to your meals, especially if you feel a bit light-headed. This issue generally resolves within a few weeks. 2- You may find yourself eating because it is time to eat, rather than because you are hungry. This happened to me very quickly. It is ok to skip a meal if you are not hungry. Listen to your body, it is amazing how quickly your physiology will adapt to your new diet. 3- If you become hungry, or experience cravings for carbohydrates, eat. But do not eat carbohydrates. Eat fat. Add butter to your vegetables, use heavy cream in your coffee, eat bacon, but do not eat sugar or starches. You are teaching your body to burn fat. So you need to supply it with fat to burn. You may be surprised how quickly the carbohydrate cravings stop. 4- Do not count calories or restrict portion sizes. Just skip the carbohydrates and listen to your body. 5- Eat plenty of non-starchy vegetables and high-quality meats. Stay tuned for the next posting where I will discuss appropriate protein levels. Wait...what? I know. I just violated the first rule of weight loss. For decades, we've been told losing weight is as simple as eating less and exercising more. Everyone "knows" this is true. And we all feel bad because we have no willpower and we fail. This idea is based on the faulty equation: (calories in) - (calories out) = change in body weight. Although thermodynamically it makes sense, biologically it doesn't always. As it turns out, this equation is a gross over-simplification of how our body works. Our bodies have not evolved to shed weight easily. In addition to pushing highly processed, carbohydrate dense foods, our culture has suggested that we need to spend hours each week on machines doing "cardio" to maintain a healthy body weight. Since most people already do their best to follow the faulty USDA food pyramid, they often focus on lack of exercise to explain their inability to lose weight. When I gently bring up the idea of losing weight with my patients, almost universally I hear, "I know, I need to get back in the gym..." Not only do I think exercise as a means to lose weight is unnecessary, particularly in my orthopedic patients, it will very likely be harmful. To take a joint which has been damaged by osteoarthritis and subject it to additional, repetitive, potentially high-impact activity will very likely worsen the symptoms and accelerate the degeneration. And yet because the large lower extremity joints (hip and knee) experience forces of 3-5 times body weight with every move they make, weight loss can be helpful in reducing pain due to arthritis. Additionally, obesity is an independent risk factor for infection following orthopedic surgery. Worse yet, poorly controlled diabetes has a synergistically negative effect with obesity on infection. Clearly, weight loss is needed. Exercise is not the way to achieve it, however. My previous posting began to explain how WHAT we eat may be more important than how MUCH we eat. My spontaneous 25 pound weight loss occurred without entering the gym once. As an orthopedic surgeon, I am on my feet all day in the office and in the operating room, and although I consider myself "active", I did not change my activity level at all during my nutritional experiment. Lets look at the caloric implications of exercise for a moment. A pound of body fat contains 3500 calories of energy. An average person would burn about 500 calories during an hour of jogging. Assuming you could jog for an hour every day of the week, this level of exercise would burn about 3500 calories of fat by the end of the week. If this level of activity were maintained for an entire year, about 50 pounds of body fat would "melt away." Simple. Except for a few biological problems: Appetite is not constant. Basal metabolic rate (the amount of energy you burn at rest) is not constant. Not even highly trained athletes can sustain daily exercise with no rest days and not become injured. And lastly, exercise creates inflammation, which is linked to weight GAIN, and chronic disease. There is excellent experimental evidence suggesting an increase in appetite and calorie consumption following exercise. The sense of entitlement that often accompanies physical exertion, can undermine proper food selection, because after all, you earned that dessert by running those 5 miles this afternoon. Studies have shown a reduction in basal metabolic rate as well as reduction in non-exercise activity thermogenesis (fidgeting) when energy expenditure exceeds intake. Cardiovascular exercise fueled by carbohydrates generates oxidative stress as sugars are converted to energy in our mitochondria. Additionally, stress hormones like cortisol can be released in response to exercise, and through a variety of pathways cause weight gain. Remember our brains evolved when food was not abundant. If our energy output exceeded intake for long we would not survive. We evolved to conserve energy, and to seek out calories. This probably worked very well historically when food was scarce but has become counterproductive in the modern world where highly processed, palatable, energy dense food is omnipresent. These concepts are further developed and supported in "The Calorie Myth" by Jonathan Bailor. Please understand that I am not recommending becoming sedentary. I am simply suggesting that we think differently about attempting to use exercise as a means to lose body fat. I recommend remaining active. Take the stairs. Don't look for the closest parking spot. Walk around the block instead of watching TV. If you really want to lose body fat, I recommend you focus entirely on your diet. I recommend a nutrient dense, low carbohydrate, high fat diet. This does not require calorie counting. You should not feel intense cravings or blood sugar instability. Consider this a longterm/permanent lifestyle change as opposed to a diet- which generally suggests temporary, unpleasant restrictions. Future postings will explain why I believe this way of eating helps people to lose weight, and why even those who don't need to lose weight should do it anyway. I will also explain how exactly to transition to a well-formulated low carbohydrate, high fat diet, and what you may experience while doing so. |
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