Keeping Our Eyes on the Ball

Today I'd like to interrupt my series on understanding the short and long-term lessons found within the Rules of Induction (Atkins) and provide space for my husband, Dr. Gil Wilshire, MD to share his thoughts in a guest commentary. So, without further ado:

Keeping Our Eyes on the Ball
Gil Wilshire, MD, FACOG

Back in 2006, Regina and I were interviewed and asked about our thoughts on the future of dietary science and policy. We speculated that carbohydrate restricted diets would be an accepted, main-stream concept by the year 2040. I believe we are well on our way to seeing our goal fulfilled well before this arbitrary temporal milestone.

I try to remain constantly vigilant with regard to new scientific information, and it seems that in every month good, new information is published. Recently, Matt Hayes and colleagues (J. Nutr. 137:1944-50, 2007) drilled deeper into out understanding of carbohydrate restriction, metabolic syndrome, and the biochemistry behind satiety. I am pleased to see that our current shared clinical experience of spontaneous caloric control and rapid reversal of metabolic syndrome is now being bolstered by more clinical data. Although the study in question was rather timid with respect to carbohydrate restriction (it was a South Beach-type protocol) I still found the information valuable.

It is another, peer-reviewed paper to the ever-growing pile of scientific evidence supporting our position.

I would also like to add that my ever-growing clinical experience in my new home of Central Missouri continues to be very gratifying. It seems that not a month goes by where something good happens very quickly after a patient begins their new life style (I dislike the thought of "diets"...this implies a temporary change, instead of a whole new way of being). In my obese, "infertile" patients, it is fairly common for women to become pregnant before instituting hormone therapies. Women who appeared destined for the bariatric surgeon are losing huge amounts of weight...and now are making appointments with the plastic surgeons!

I must say, there are many doctors in the surrounding communities who are truly scratching their heads as our mutual patients make healthy progress eating "high fat" diets. Now, after some period of suspicion, I am actually getting requests to learn more about what we do in my office!

Positive results are very persuasive.

Nothing succeeds like success.

Being married to Regina is never boring, and I am privileged to hear all the latest details occurring within the nutritional community every night when I get home from the office. We are a disparate lot in the "low carb" community, with much independent thinking and talented, innovative thought leaders. I suspect that the field of nutrition and metabolism will never be one of lock-step agreement. However, I would like to take this opportunity to reiterate our common goals and to reinforce our shared understanding:

1) Current dietary recommendations that promote low-fat and low cholesterol diets are unscientific, unproven, and fatally flawed; and,
2) The vast majority of modern humans appear to function best when eating nutritionally dense, whole foods that most closely resemble those foods on which we evolved.

I believe it is these principles that unite us all. There will always be bumps in the road, and we must always be prepared for unexpected turbulence. That's life.

Let's keep our eyes on the ball! Slow, steady progress always wins the race.

Good health to us all!

Gil
Mid-Missouri Reproductive Medicine & Surgery

Rule Five: Break Free from Contradictions

Thus far we've looked at four of the Rules of Induction for the Atkins diet. I've used the Atkins diet rules because no matter which low-carb diet one chooses, these rules have little "gems" that can broadly apply to any controlled-carb diet based on its design, carbohydrate restriction and/or phases.

Today, we'll look at rule five. At first glance, it appears to be in a rather harsh tone toward the reader:

Rule 5:

• Eat nothing that isn't on the Acceptable Food List. And that means absolutely nothing. Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.

Simply put, this rule is reinforcing the importance of being able and ready to begin something new and different while letting go of the "diet baggage" we all had/have that will not serve us well throughout weight loss on a low-carb diet, and certainly not when we maintain our weight later. The only way to say it is straight-out and without sugar-coating it - if you start the diet with bad habits and do not address them, they'll be your undoing on this diet (or any diet) you want to utilize as your means to lose weight.

This rule makes clear that everything on the 'acceptable foods list' is allowed, go and enjoy these foods; those not on the list are not allowed right now - not even one bite, not even if you can manage to include them within your carbohydrate allowance for this period. The time frame here is two weeks and you will not die without the foods that are excluded during this period.

You may crave them, want them, think you need them - but what you 'want' is not always what you 'need' and for now, there are plenty of nutrient-dense foods you are allowed to eat, so take this period to eat those and only those foods; more variety will come in time.

Many wonder why this rule is so harsh. In part it is helping to break habits of the past, in part wiping clean years of eating foods that were not the best choices for health and well-being, in part imploring you to ignore many current dietary contradictions, and in part to help you naturally supress cravings for carbohydrate-rich foods.

Did you catch that last item?

It is true for the vast majority of those starting a low-carb diet; if you can simply stick with the 'acceptable foods list' for your first two weeks, you'll find that cravings for carbohydrate-rich foods diminish quickly and by the end of two-weeks, they're supressed so you no longer think much about having bread or pasta or potatoes or sweets.

Now granted, these foods will always be around you; but you will now have a powerful way to make them less tempting in the future if you can avoid them completely for a couple of weeks.

In the process you'll be rewarded for your efforts and discipline too - you'll lose weight in the first two weeks, find you have more energy at the end of the two weeks, and also realize that the foods you used to reach for in times of stress or to celebrate can be replaced by foods that are better for you and your health.

What this two week period is teaching for the long-term is that you ultimately control what you choose to eat. It is a period that is allowing you time to step back from everything you think you know, retreat from all the contradictions we hear from the "experts," step back from all the habits you've developed over the years, and start again - at the basics.

This particular rule goes against everything we hear and read so often; on the one hand we're repeatedly told part of the underlying reasons for obesity is lack of willpower and discipline; on the other hand we hear often this insistence that if you want something eat it, if you're on a diet and craving whatever it's better to eat it than to not because it's not good to deprive yourself of something you want.

How in the world is one supposed to develop this necessary discipline if they're never challenged and expected to discipline themselves?

As I said, this rule sets a standard for you to hold yourself to, that for a short period of time - two weeks - you will avoid any food that is not on the accepted food list so you can prove to yourself some big things:

• What you think you want to eat isn't always what you need to eat
• Food is not the enemy, nor do you lack willpower; given adequate time and nourishment, your body will help you re-learn how to eat well
• You really don't have to punish yourself to lose weight with feelings of hunger, eat what's allowed and you'll be sated
• You really are empowered to make good decisions and eat delicious food while you lose weight
• You'll really get to experiment and play more with your eating later, as you move forward and continue to lose weight

These first two weeks extend to the longer term as you are empowered to listen to what your body is telling you; you'll initially get over the idea you need starchy or sweet foods all the time, and then understand as you continue, when and where these foods will fit into your long-term menus. Once again, you'll also begin to appreciate just how good real food tastes, and take the foods from these first two weeks into your long-term eating, so they serve as your foundation for the future.

Life Gets in the Way

Just a quick post to let readers know that life has gotten a wee-bit hectic here and this week time is short for writing the continuation of the series in progress. I'll be back on Friday morning with the next installement - hope you'll come back then as we continue looking at the rules of induction (Atkins) and how they provide us with insights for long-term success!

Rule Four: Starches, Sweets: No Longer Staples

Rule 4:

• Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.

For many the thought of not having a piece of bread, a side of pasta or rice, a bowl of cereal, etc. seems way too restrictive. With the low-carb products on the market, like low-carb bread, low-carb pasta, this rule seems silly - one that can be dismissed as long as they maintain rule 3 and keep carbohydrate at or below 20g net each day.

From this rule, we learn by implication - all carbohydrates are not created equal, and thus are not to be treated in a similar manner as you continue along to the long-term and maintain your weight. In baby steps, you'll be given opportunity to re-introduce many, many carbohydrate-rich foods, but for now, you're at square one and starting to learn how to eat well.

It is in this minimum two weeks period you eat those foods which are nutrient powerhouses - meats, poultry, eggs, fish, non-starchy vegetables, non-traditional fruits, good fats/oils and some dairy.

While critics focus on the limitations imposed on low-carbers - no sweets or starches in the first two weeks - often insinuating this is all one is allowed for the long-term, that's not the case.

This is a two-week period to "eat clean" from a limited selection of foods, designed to break you from the habits of old, establish good eating patterns, get back to basics that provide essential nutrients and lay the foundation of what your base diet will be later, when you are allowed to include more carbohydrate from a wide variety of foods.

By excluding bread, pasta, grains, starchy vegetables, most dairy products, nuts, seeds and legumes, this rule takes the focus off what many people consider highlights of their meals - starch; it resets emphasis on those things - protein, fat, nutrient-dense non-starchy vegetables and low-GL fruits - that in the long-term that will now be the foundation of your meal-planning well into maintenance.

Once you have a firm grip on this basic rule, and are eating in a pattern that no longer requires some sort of bread, potatoes, rice, pasta, etc. as a staple of your meals, you're on your way to understanding how these items may be re-introduced later as a complement in your habitual diet if you choose to include one or more of them.

Where before a meal may have been centered around your big bowl of pasta with maybe a small meatball or sausage, a crusty loaf of italian bread and perhaps croutons on your salad, over the long-term, as you mainatin your weight, your meals - if you learn from the rules of induction - are bulit upong your solid foundation of healthful eating - non-starchy vegeteables, quality protein, good fats and, by then, any additional foods you like and can tolerate well as a complement to your meal instead of the focus of the meal.

This rule fosters breaking the mindset that you need carbohydrate-rich foods to provide the majority of calories in each meal and at the end of each day - you don't - and by following this rule and waiting until the time is right to increase carbohydrate, you will be better able to assess what carbs you can and cannot tolerate in your meals as you progress - you'll better appreciate also how to portion your meals with these items "on your plate" in later in maintenance.

These foods, we often believe are staples will no longer be the main attractions in your meals when you're maintaining, but can still be a part of your diet in the long-term.

Trust the good doctor on this one and just don't eat anything that resembles bread, pasta, grains, etc. - no matter how low-carb they're promoted as.

During the first two weeks (minimum) avoid any and all processed products if you can.

Eat clean.

Keep it simple.

Learn.

Appreciate how good real food tastes.

Take your time.

Plan along the way.

Try new foods that are allowed.

Focus on the delicious food that is allowed.

Enjoy your meals!

Enjoy eating!

It's worth it in the long-term!

Rule Three: Vegetables & Fruits are Heart of Controlled-Carb

We hear much of a healthy diet is from eating fruits and vegetables. Research suggests there is a strong correlation between "good" health and "bad" health over the long-term when comparing the dietary habits of those eating a diet rich with fruits and vegetables to those consuming less than recommended levels.

Diets that strategically restrict carbohydrate are often criticized for lack of fruits and vegetables in the dietary approach. Much like the second rule getting lost in translation, from an allowance of a large variety of meats, poultry, fish, shellfish and game to a requirement to eat "fatty steaks, bacon, brie and cheeseburgers," by those unconvinced a low-carb diet is scientifically supported, rule three is often either ignored in the media and/or used to show how unsustainable carbohydrate restriction is in the long-term for someone to do forever.

How about we take a look, and see what the third rule actually says, and what it "pearls" it contains in both the short and long-term, and where vagueness may lead to misinterpretation:

Rule 3:

• Eat no more than 20 grams a day of carbohydrate, most of which must come in the form of salad greens and other vegetables. You can eat approximately three loosely packed cups of salad, or two cups of salad plus one cup of other vegetables.

First, we know from the published books, that the Induction period is a minimum of two weeks; while one can, and many do, stay within the 20g of carbohydrate beyond two weeks, the above rule is in place for at least the first two weeks.

During this time, the person starting the low-carb diet is tasked with two things in this rule:

1. limiting carbohydrate to just 20g a day and
2. ensuring that most of those 20g carbs are from salad greens and other (allowed) vegetables.

As an example, the rule says this is "approximately" three loosely packed cups of "salad" (note not simply salad greens), or two cups of "salad" (again not simply salad greens) plus one cup of other (allowed) vegetables (without mention of raw or cooked state).

We also know that the plan includes a deduction of fiber, so the amount of non-starchy vegetables (and fruits which I'll get to in an upcoming post) - in cups - that one is expected to consume depends highly on which allowed vegetables are selected in a day. Regardless of which are included, a minimum 10g net (deducting fiber) must come from non-starchy vegetables!

We also plainly see that it is not *mandatory* to deduct fiber per the rule above; however, I strongly suggest folks do deduct fiber as it allows a greater intake of non-starchy vegetables, which are not only low in calories, but nutrient powerhouses. When you deduct the fiber, you're able to consume more essential nutrients than if you don't.

I've previously offered examples of how different selections of non-starchy vegetables may look in a day of eating on a plan allowing 20g net in a day. Once again, I am providing examples to emphasize, even at 20g net carbohydrate, where 10g net is the minimum, a low-carb plan - done properly - meets or exceeds intake recommendation of at least five servings per day in the Dietary Recommendations for Americans for fruits and vegetables.

Example 1

• 1-cup green beans (cooked measure)
• 2-cups Shredded Cos/Romaine Lettuce (raw)
• 4-pieces Crimini Mushrooms (raw)
• 1/4-cup Shredded Red Cabbage (raw)
• 4 Cherry Tomatoes (raw)
• 1-cup Spinach (raw)
• Total Carbohydrate = 18g
• Fiber = 8g
• Net Carbohydrate = 10g
• USDA Servings of fruits/vegetables = 5

Example 2

• 1/2 Avocado (raw)
• 3-cups Cos/Romaine Lettuce (raw)
• 4 Cherry Tomatoes (raw)
• 1/4 cup Shredded Red Cabbage (raw)
• 1-cup Spinach (cooked measure)
• 1/2-cup Broccoli Florets (raw)
• 1/2-cup Sliced Cucumber (raw)
• Total Carbohydrate = 24g
• Fiber = 14g
• Net Carbs = 10g
• USDA Servings of fruits/vegetables = 6

Example 3

• 2-cups Shredded Cos/Romaine Lettuce (raw)
• 1/2-cup Cherry Tomatoes (raw)
• 1-cup Spinach (cooked measure)
• 1/2-cup Asparagus (cooked measure)
• 1/2 cup Sweet Green Peppers (cooked measure)
• Total Carbohydrate = 21g
• Fiber = 9g
• Net Carbs = 12g
• USDA Servings of fruits/vegetables = 6

One can see from the examples above, depending on selections made from those fruits and vegetables allowed in the first two weeks, it is not difficult to meet the recommended intake of 5-or-more servings of fruits and vegatables.

The aim to include a minimum of 10g (of the 20g allowed) from non-starchy vegetables is a "must" in the rule above.

It is also clearly stated as a "minimum," and therefore understood that if you would like to include 12g, 15g or more from non-starchy vegetables in lieu of other foods that have carbohydrate, that is also allowed.

So, if one is cognizant of and desiring more than the minimum intake of fruits and vegetables, they are completely allowed to consume more - with the only restriction being not to exceed 20g net (deducting fiber) during the first two weeks.

Must you aim to consume half your allowed carbohydrate from fruits/vegetables? YES

Can you eat more fruits/vegetables (allowed ones), say 12g, 15g, 18g? YES

Can you deduct fiber? YES

Do you have to? NO (but doing so allows a greater intake of fruits/vegetables and associated essential nutrients)

With all that said, and focus on what all the rules mean for the long-term, I contend that one is expected to continue eating this level (as minimum each day) as they progress toward the long-term eating. I believe that this is one more "foundational" part of carbohydrate restricted diets in the long-term and something intended to be continued as one increases carbohydrate and includes a wider selection of foods, including more vegetables, fruits, nuts, seeds, legumes, and if desired, even whole grains.

Many folks say a low/controlled-carb diet is a way of life, yet find it difficult to take what they start with - 20g net (deducting fiber), of which most must be provided by non-starchy vegetables, a 10g minimum each day - and maintain that aspect as one solid foundation to build upon as they continue to lose weight and then maintain their weight.

Old eating habits start to creep back with more carbs; habits such as preferrentially selecting sweeter foods or grains (even if whole grain) with consumption of non-starchy vegetables waning as one re-introduces more carbohydrate.

If one takes this rule, and continues to extend it --- fully --- until they reach 40g net carbohydrate each day (deducting fiber), they will be consuming incredibly healthful levels of fruits and vegetables, and will be able to eat a very wide variety of them too. That is, until 40g carbohydrate is achieved in the diet during weight loss, one must always include half those carbohydrates from fruits and vegetables with each incremental increase in carbohydrate. (Beyond that, it is increasingly difficult to continue adding more non-starchy vegetables and fruits due to their bulk; you can, of course - it's just not as easy to do).

Now that isn't exactly stated explicitly in the rule, but it is from my experience and those I've given assistance, one significant contributor to maintenance of weight in the long-term. That's because if you're aware of and including a lot of fruits and vegetables (specifically non-starchy vegetables and low-glycemic load fruits) it is difficult to consume excess calories each day over the long-term.

It becomes much easier to consume excess calories when you "play" the carb game (like many play the "points" game with Weight Watchers) and make choices to stay within a number, rather than focus on quality of choice.

But if you're committed to making sure that, no matter what intake of carbohydrate you reach (60g, 90, 120g or more), that you always are sure you include at least 10g net minimum at the start and then 20g minimum (net) from non-starchy vegetables/low glycemic-load fruits as you continue along, you'll have a favorable calorie intake that helps maintaining weight easier.

As you add back carbs, this rule must remain in your eating habits, even if you only stick with 10g net as minimum (which I don't suggest you do) as you're learning in the beginning - you cannot add back carbs and eliminate or reduce how many vegetables and salads you eat each day and expect to maintain your weight using grains, nuts, fruits, etc. as your primary source of carbohydrate later....you must always maintain a level of carbs from your vegetables and salad greens - even in maintenace.

This rule, like rule two, is taking you "back to basics" - helping you learn, step-by-step, how to nourish your body with high quality nutrients from real foods; over time you're encouraged to include a wider variety of non-starchy vegetables, low glycemic-load fruits, nuts, seeds, legumes and more, and the starting basics for the diet should be extended out for the long-term; that is, establish now, at the start, that as part of your long-term habitual diet, non-starchy vegetables and low-GL fruits will be a large part of your overall diet - your body will thank you!

Rule Two: Back to Basics

Over the last few decades, the population at large, has slowly been indoctrinated to fear dietary fat; to limit intake of dietary cholesterol; and to limit consumption of foods rich with saturated fat like meat, whole dairy, butter and eggs. This happened despite little evidence that such an approach to eating provided a long-term health benefit, or ability to maintain weight. But, with decades of reinforcement in the popular thinking, it's understandable how the second rule in the Rules of Induction is the most misunderstood and maligned of them all.

Let's take a look:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

Is it any wonder that, when a diet comes along and allows these foods, in complete contradiction to decades of fat phobia propoganda, it is vehemently opposed by the leading health organizations and government agencies? That we're innundated with dire warnings of consequence to health, heaped upon us in a concerted effort to discredit and dismiss anyone who says differently; despite scientific evidence and data supporting not only the inclusion of these foods in the human diet, but their inportant contributions to the human diet!

Ignore the man behind the curtain Dorothy....ignore that in the noble attempts to improve the health of our population, researchers and clinicians were lead astray by what we now know was half-truth data, published in the fifties and sixties.

They know it, we know it, but still it's difficult to come to grips with that fact and reverse direction after decades of building the foundation of a "truth" only to find it terribly flawed. It's often easier to continue on in the lie than face the fact you're wrong; moreso when the entire group and community you exist within endorses the continuation of the established dogma, despite the evidence to the contrary.

It's easier to "kill the messenger" than kill the flawed paradigm that hold these foods are to be limited, heck, even avoided at all cost.

To admit such is akin to killing thyself and the core set of beliefs one holds to be true.

Dramatic license here?

Sure, but it does speak of something critically important one must do for their long-term health when they begin to, perhaps for the first time in their life, establish good eating habits for the rest of their life.

Simply put, the second rule of induction grants us permission to dismiss everything we've been told and taught to hold as truth about eating, macronutrients (carbohydrate, protein, fat) and a "balanced, healthy" diet; allows us to re-learn what it means to be human and eat food; and encourages us to enjoy the experience of truly eating a healthy diet while losing weight and then continue to do so along the way to finally, once and for all, maintain that weight well into the future.

I'm quite the optimist aren't I?

Seriously, don't studies tell us again and again that dieting to lose weight fails, that all we really ever do is get good at losing weight, but we're never quite able to master maintaining our weight in the long-term?

Let's start by examining the very base reason most folks even begin a diet to lose weight - they're overweight or obese and have decided it's time to do something about it.

So they begin, they are off to a good start, they're motivated and continue to be motivated with each incremental decline they see on the scale.

Problem?

Absolutely - the focus is on the scale; the number on the scale matters most and damn the torpedos, no matter how inconvenient, stressful or annoying it is to weigh, measure and count every calorie, the individual is in a battle against their bathroom scale to reach a desired number in the shortest period of time possible.

Millions have mastered this task, only to have to repeat it again and again throughout their life. I apolgize now if this sounds crass, but anyone can lose weight with even just a small level of effort; it doesn't take an Einstein to eat less for weeks or months to reach a number on the scale; most will put up with high levels of discomfort to reach that goal - hunger, moodiness, irritability, stress and counting, measuring and weighing anything they consider putting in their mouth.

In the short-term, such measures do work; in the long-term they fail because the person has been mistakenly led to believe "if only..." they do this, measure that, control this and avoid that over the short-term, somehow that alone will enable them to maintain their new lower weight without much more than keeping on keeping on; except the keeping on part is next to impossible!

That's because the very dogmatic recommendations we're repeatedly told are balanced and healthy to lose weight are scaring people away from the very foods that we need to eat to thrive as humans; this forces an unnatural eating patten across the population due to a deeply flawed fear of dietary fat and cholesterol and leads to failure in the long-term because it is not only unsustainable, it's incompatible with true health in the longer term.

The heart and soul of our metabolism is the endocrine system - when it dysfunctions, a cascade of health problems follow - insulin resistance, high blood pressure, dyslipidemia, diabetes, and other chronic and debhilitating diseases.

Why then are we specifically told to avoid the very foods that fuel the proper function of this system?

The current recommendations not only scare us from healthy food, they make simply eating way too stressful for an average person - measure this, weigh that, watch this, avoid that, don't eat this, that's better, blah, blah, blah - who wants to deal with that much stress each day? Sure, a motivated person, desiring weight loss will submit to such stress to reach a goal - but then what happens? They do what is natural and human - they do what they need to do to relieve the stress and relax, are then an easy target to point to as someone lacking willpower, someone just not commited to sticking with it; someone who simply doesn't care and is lazy!

Anyone who has attempted to lose weight only to regain it can relate - no matter how hard you try to stick with a diet that is, for lack of a better phrase, "high maintenance" to follow each day for the rest of your life - sooner or later you find the "benefit" (weight on scale) isn't worth the time and "stress" (weighing, measuring, going hungry, chastising yourself for wanting to eat, etc.).

As I said in my last post, what if the problem isn't you or your "willpower," but a deep flaw within the recommendations that lead not to success, but failure in the long-term?

Here's the rule again:

Rule 2:

• Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).

The short and long-term secrets within this rule include:

1. Eating "liberally" is not the same as eating until you are stuffed and goes hand-in-hand with rule 6, which we'll look at later this week. This rule is also a natural extention to rule 1 to eat regular sized portions.

2. You're allowed to eat animal foods such as meats, poultry, fish and eggs provides you with combinations of both fats and protein - necessary for health, losing and maintaining weight on a carbohydrate restricted diet.

Note that in the rule, no one is told they must eat "fatty meats" or must consume "bacon, brie and oodles of t-bone steaks." No, instead they're to eat foods that provide both fat and protein; they can choose whatever cuts they like, whatever combinations suit their tastes; whatever they prefer.

Want boneless skinless chicken breast? Allowed.

Want a filet mignon? Allowed.

Want some eggs? Allowed.

Want some dark turkey meat? Allowed

Want some salmon? Allowed.

This "allowance" of all things that provide a good fat-protein combination reinforces our mindfullness not to fear food, food is not the enemy!

Adding to this is that using fats and/or oils as part of your meals is allowed - from sources of natural, good fats and oils; with those natual oils being preferentially from expeller-pressed or cold-pressed sources.

Why are the animal products with combinations of fat and protein and the use of natural fats & oils so important?

By integrating both into your meals you are also beginning the process of balancing your essential fatty acid ratios in your eating from the fats found in these sources, and perhaps for the first time, consuming adequate protein, thus adequate essential amino acids.

Important too is to choose quality, eat well and enjoy your food and meals. Don't worry each day about how much fat is in a particular food or meal at this stage, over time you'll be able to "tweak" as you go and learn better how to nourish your body and eat what really is a well-balanced, healthy diet.

With fat and protein providing the vast majority of "essential" nutrients, this liberal approach at the start of your weight loss diet takes you "back to basics" and with time, provides you the opportunity to not only learn how to eat well for the long-term, but to actually enjoy your meals again - without fear that you're killing yourself with every bite!

Establishing Good Eating Habits: Rule One

Odds are, overweight or not, by the time a girl reaches adulthood, she's tried one or more diets to lose weight or not gain weight; with boys, the incidence of dieting in the teenage years is less prevalent. In early adulthood this often continues, with many women and men developing what is termed "disordered" eating habits; skipping breakfast or other meals, relying on meal replacement products, like ready-to-drink shakes, rather than eat food for all meals, eating lots of small things on the run, or going long hours without eating anything, then taking one large meal at the end of the day, in the belief that will keep thier calorie intake lower over the day.

These types of habits aren't necessarily "eating disorders," though they may be part of one; more often than not, they are habits that one develops over time that are counter-productive to developing and maintaining a healthy relationship with food, and can stand in the way of long-term success when one loses weight and tries to maintain that loss over the long-term.

Food, while an easy target of blame in the weight loss game, is not an enemy to be avoided or held in disdain; it is essential to our health and well-being and, in the long-term, it's not simply learning what to eat that helps one maintain weight, but how to eat that sets the stage for long-term success.

With this understanding, it is easier to see why I believe the first rule in the Rules of Induction (for the Atkins diet) is the most important:

Rule 1:

• Eat either three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.

The first rule is straight forward and critically important not only in the first two weeks, but throughout the entire weight loss period, and then for maintaining weight in the long-term.

The reason is simple - it establishes that one doesn't need to eat in a typical three-meal-a-day pattern, but highlights the importance that eating regularly - even simple smaller meals multiple times each day - is a habit to continue with if you're already doing so, or establish now as you begin and continue to learn how to eat properly for the rest of your life.

Without establishing this as habit, you'll leave yourself open to disordered eating habits and continue to view food and eating as something bad or to be avoided. Now is the time to set aside all that disdain for food, eating, portions, and all that and dismiss that thinking so you can begin to learn to love food again!

This is the first step to "get back to basics" - a means to develop a healthy relationship with food and avoid continuing in a disordered eating pattern that is counter-productive in the long-term. In anything you do in life, be it your job, your hobbies, or anything else that requires skill, one thing that clearly sets apart those who succeed from those that fail is the feeling of confidence in ones ability. Few are "born naturals" in a given situation - most take the time and put in an effort to learn and do along the way, to build their confidence and master whatever it is they enjoy.

This is no different; by taking the time to work on this as you start a diet to lose weight, you will develop not only a sense of confidence that food is really not an enemy (since you will be losing weight while you establish good eating habits), you will also learn to listen to your body and take cues based on hunger to learn when to eat in a pattern that is in synch with your body. This is because eating regularly keeps your metabolism functioning and enables your metabolism to hum along nicely.

If you read the rule, you'll notice it says " three regular-size meals a day or four or five smaller meals" which hints at learning how much is enough; stated another way, portion size is important. If you're inclined to eat three meals a day, these meals will be larger than if you are inclined to eat four or five smaller meals.

We know from the various publications written by Dr. Atkins, that Induction is not a license to overeat or stuff ourselves. In my view, this Induction period is an opportunity to learn what a "portion size" means to you as an individual.

So many weight loss diets prescribe specfic weights and measures, claiming such portions are more than adequate for anyone attempting to lose weight.

But let's be honest - how many are truly satisfied after eating a tiny 2-to-3 ounce portion of bonless, skinless chicken breast? If you're one of the few who find this intake adequate for you and you're satisfied and not hungry, great!

If not, maybe the problem isn't you, or as you are often told, your lack of willpower, but instead that you have not eaten enough to adequately provide for your needs.

Listen to that - have some more - and as you begin to feel that sense of "satisfied," not stuffed, but satisfied and confident you've eaten well, without worry that you're going to be hungry again way too soon, then stop eating.

In this period, you are allowed to portion your meals as "regular-size" meals, keeping in mind that you won't eat larger portions just because you can. If three "regular-size" meals isn't your style, you simply adjust to more "smaller sized" meals in a regular pattern throughout the day.

The key here is to develop good eating habits and then maintain them as you move along.

Long-term this rule is the "golden rule" of maintenance. It is the most important rule of all the rules if you ask me!

By the time you reach maintenance, if you have been following this rule all the time - not just in induction - you're not only eating an adequate level of calories, no longer in ketosis and at your goal weight - you're also in the habit of eating portions that are "normal" for you and eating regularly to keep your metabolism working at a steady pace.

You've also learned that skipping meals may lead to eating more when you do eat and that it is best to keep your appetite sated by eating regularly for your particular needs - whether it is three regular meals each day or four or five smaller meals each day; and you may also have learned you're less likely to snack as often because your appetite is sated with regular meals!

This rule firmly establishes that you are tasked with setting the frequency of your eating pattern, sticking with an eating pattern that is regular, and develop a sense of what your needs are, learn what your "portion size" is in meals, and learn how to eat regularly instead of fearing food or your appetite!

Over the long-term you'll set the stage for success with this rule because you're allowing yourself to establish a healthy relationship with food and come to know that food is not your enemy, eating well is not a bad thing, and that enjoying your meals is truly a wonderful thing!

Handing you the Keys to Success

All weight loss diets come with some sort of rules; how much to eat, what to eat, when to eat, how to control portions, etc. The weight loss diet that enabled me to finally lose the excess weight was Dr. Atkins' New Diet Revolution (1992/1999), and like all other diets had its rules to follow - the Rules of Induction.

While Induction is heavily criticized by many, it is the period I call "back to basics" for the individual just starting out. While one is to carefully count carbohydrate, eating no more than 20g each day, they are also encouraged to view foods once subject to elimination or strict limitation differently; foods like whole eggs, red meat, full fat salad dressings, cream and real cheese are allowed, while "low-fat" products are strongly discouraged.

Within the books published by Dr. Atkins, the list of foods allowed during the first two weeks includes almost any red meat, poultry, fish, shellfish, fowl or game; with caution to limit or avoid nitrates and processed meats. Real whole milk cheese, cream and half & half are allowed within the dairy group, with limits on intake each day if one is consuming them; a long list of non-starchy vegetables and fruits (that is fruits that are fruits that we often don't recognize as "fruit" but are fruits - olives, macadamia nuts, summer squash, cucumber, tomatoes, etc.); all herbs and spices, and finally what to drink and what types and quantity of artificial sweetener is allowed.

One reason I call this the "back to basics" period in the diet is because it is focused on whole foods and provides for the most important essential nutrients our metabolism needs each day - quality protein (essential amino acids), quality fats (essential fatty acids) and nutrient-dense carbohydrates (essential vitamins, minerals and trace elements). The plan also encourages one to supplement with a high quality multi-vitamin (with minerals including potassium, calcium and magnesium; without iron) and provides additional information about other supplements if necessary.

In addition to the basic foods allowed during the period of Induction, the diet focuses the individual to follow what are called the Rules of Induction as a way to help them follow the diet correctly.

The Rules of Induction, from the 1999 publication of Dr. Atkins' New Diet Revolution are as follows: (they differ slightly from those published online by the company since his death in 2003; to read the updated version, published by Atkins Nutritionals, click here)

1. Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.
2. Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).
3. Eat no more than 20 grams a day of carbohydrate, most of which must come from in the form of salad greens and other vegetables. You can eat approximately three cups - loosely packed - of salad, or two cups of salad plus one cup of other vegetables.
4. Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.
5. Eat nothing that isn't on the Acceptable Foods list. And that means absolutely nothing! Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.
6. Adjust the quantity you eat to suit your appetite, especially as it decreases. When you're hungry, eat the amount that makes you feel satisfied, but not stuffed. When you're not hungry, eat a small controlled carbohydrate snack to accompany your nutritional supplements.
7. Don't assume any food is low in carbohydrate—instead, read labels! Check the carb count (it's on every package) or use a carbohydrate gram counter.
8. Eat out as often as you wish but be on guard for hidden carbs in gravies, sauces and dressings. Gravy is often made with flour or cornstarch, and sugar is sometimes an ingredient in salad dressing.
9. Avoid foods or drinks sweetened with aspartame. Instead use sucralose or saccharin. Be sure to count each packet of any of these as 1 gram of carbs.
10. Avoid coffee, tea and soft drinks that contain caffeine. Excessive caffeine has been shown to cause low blood sugar, which can make you crave sugar.
11. Drink at least eight 8-ounce glasses of water each day in addition to anything else you may drink, to hydrate your body, avoid constipation and flush out the by-products of burning fat.
12. If you are constipated, mix a tablespoon or more of psyllium husks in a cup or more of water and drink daily. Or mix ground flaxseed into a shake or sprinkle wheat bran on a salad or vegetables.

You may be wondering why I'm posting this here, today, on my blog?

The reason is simple - over the years of following a diet that is controlled-carb, and maintaining my weight loss, I've realized that the above Rules of Induction contain the keys to long-term maintenance. The critical points needed to succeed in the long-term are right there if we look closely and examine why they are in place for the first two weeks, and why they are necessary throughout weight loss and maintenance.

Years ago I wrote an article for a publication that has since gone out of business, and my original copy is long gone. So, without that in hand to simply re-post here, I'm going to re-write it from my longer-term perspective today, some years later, continuing to follow a controlled-carb approach.

In the coming days and next week, I'll take one or two (if they are related) rules and explain why they are critical in the first two weeks, and the lesson I believe they are teaching us for the long-term. I'll begin tomorrow with the first rule, "Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating;" and provide data as to why it is important not only in the short-term, but also for long-term success.

As you'll learn in the upcoming posts, each of the rules looks to foster one or more things, including:

1. Your responsibility in what you eat
2. Breaking habits that contribute to weight gain
3. Establishing a solid foundation for healthy eating in the future
4. Providing the tools & strategies you'll need to maintain your weight loss
5. Creating good habits that lead to better health
6. Your health and well-being is in your hands and is your responsibility in the long-term

UPDATE: Thank you to a reader who sent me an archived copy of the original article, which i will link to at the end of the upcoming series, for my readers to compare my changes to with my additional years perspective to add to!

Consumer Protection 101

Sometimes it helps to have reminders that as consumers, we do have protections in place to use if we purchase something and are not satisfied with the purchase, or feel we were deceived in the purchase process, we have recourse.

Below you'll find basic information about ways you can request refunds and report misleading, deceptive or fraudulant claims through various agencies and companies.

If you have a complaint about a weight loss product or service, contact one of the following agencies:

Federal Trade Commission (FTC)
The FTC oversees the advertising and marketing of foods, non-prescription drugs, cosmetics, health care services and medical devices exchanged between states.

If you have a complaint, file a Consumer Complaint Form at the FTC's website: www.ftc.gov. Or call 1-877-FTC-HELP.

U.S. Postal Service (USPS)
Postal inspectors investigate crimes, such as fraudulent marketing promotions, that use the U.S. Mail. A crime is considered mail fraud if it originates in the mail, by telephone or on the Internet and is carried out in the U.S. Mail. The United States Postal Inspection Service (USPIS) handles complaints of fraud. If you think you are a victim of weight loss fraud by mail, submit a Mail Fraud Complaint Form to the USPIS online at www.usps.com/postalinspectors/fraud/MailFraudComplaint.htm or file a complaint at your local post office.

Attorneys General
Each state has an Attorney General that serves as a representative of the public interest in addition to providing legal protection to the state's government agencies and legislatures. You can find your state Attorney General?s office information online at www.naag.org/ag/full_ag_table.php.

Better Business Bureau (BBB)
The BBB is a self-regulated organization supported by businesses to provide reports to consumers about companies. The BBB works with law enforcement agencies to stop fraud. You can check on a company, find tips on preventing fraud and file a complaint at the BBB's website: www.bbb.org.

If you make a purchase through PayPal, they have a Buyer Protection Policy that allows you to request a refund within 45-days of purchase.

If you make a purchase using a credit card, you may dispute a purchase through your issuing bank; with a debit card, the bank where you have your account.

Is There a Secret to Success?

Lou Shuler, over at Male Pattern Fitness wrote about the article in Slate yesterday and asked What if Nothing Works?

Weight loss advice almost never helps anyone lose weight.

And yet, something must work. We all know people who've lost weight and kept it off. We've all known non-exercisers who became exercisers. We all know people who've turned their lives around by eating better and exercising more, or at least more effectively.

[...]

Instead, researchers tend to discover, over and over again, that whatever we're doing now just isn't working for most of the people who try it. And sometimes the results are worse than they would've been if the dieters hadn't tried at all.

His observation is dead on if you ask me.

True, I know some people who have lost weight and maintained their lower weight for years (myself included), but I know many, many more who were able to lose weight effectively in the short term, but then as time passed, the weight was regained, sometimes leaving the person heavier than before they dieted to lose weight.

If we look at data from the National Weight Control Registry (NWCR) a self-reported database of "successful losers," we're told they have four similar behaviors post-weight loss:

1. They eat a low-fat diet (23-24% fat) with just 1300-1500 calories a day
2. They eat breakfast everyday
3. They monitor weight frequently with 75% weighing themself once a week
4. They engage in a high level of physical activity - 60 to 90 minutes a day

Me?

None of the above - daily I eat almost twice as many calories each day with a lot more fat; I skip breakfast more often than not; if I remember I might weigh myself once a month and my activity is daily routine stuff, not a formal exercise program specifically to meet certain targets each day.

For me, it's been eating adequate calories to meet, yet not exceed, my active metabolic requirements each day with primary focus on consuming sufficient quality protein - whatever fat that includes, so be it; eating breakfast if I'm hungry, but not forcing myself to do so if I'm not; I weigh myself occasionally and if my clothes feel a bit snug, weigh to see what's up - if I'm a few pounds up, I review what I'm eating daily and make adjustments if necessary; and I maintain a level of activity that really isn't much more than day-to-day things, but I do have to say includes keeping up with an extremely active almost three child!

Which leaves me wondering - how do you maintain weight once you've lost weight?

If you've lost weight and are able to maintain that loss, share here how you've done it...if you've lost to only re-gain the weight, what do you think is the problem?

What's Stress Got to Do With It?

Getting away on vacation is always so relaxing - there is nothing like kicking back and just doing whatever, whenever you want! Not only does getting away from the daily grind of life allow to you unwind and not think about much, it relaxes body and mind, which reduces stress that you often don't realize you have in your daily life. So while I often get emailed asking "you're going away again?" - I can't help but resume my blog posts with a study just published in Nature Medicine, Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome.

As was reported in the Washington Post today, "Scientists reported yesterday that they have uncovered a biological switch by which stress can promote obesity, a discovery that could help explain the world's growing weight problem and lead to new ways to melt flab and manipulate fat for cosmetic purposes.

In a series of experiments on mice, researchers showed that the neurochemical pathway they identified promotes fat growth in chronically stressed animals that eat the equivalent of a junk-food diet. Researchers found that laboratory mice subjected to daily stress and also fed a high-fat diet for a few weeks became obese. (Georgetown University Medical Center) The international team also showed that blocking those signals can prevent fat accumulation and shrink fat deposits and that stimulating the pathway can strategically create new deposits -- possibly offering new ways to remove fat as well as to mold youthful faces, firmer buttocks and bigger breasts.

"It's very exciting," said Zofia Zukowska of Georgetown University's Department of Physiology and Biophysics, who led the research, published online by the journal Nature Medicine. "This could be revolutionary.""

The study findings are being heavily reported in the media and most are highlighting the potential for pharmaceutical development, but few are talking about the real implications of the findings - can reduction of stress in real life lead to lower weight and a decreased risk of developing chronic disease?

Before I delve into that, first let's see what the researchers did in their experiments. The study was an animal model that involved mice. The researchers divided the mice into various groups - some ate a "normal" mouse diet, some ate a high fat, high sugar "junk-food" mouse diet. To see the effect of stress on the mice with each diet, some mice were highly stressed while others were allowed to carry on as mice do in their cages.

Unstressed mice consuming the "normal" diet did not gain weight.

Unstressed mice consuming the "junk food" diet did not gain weight.

Stressed mice consuming their "normal" diet did not gain weight.

Stressed mice consuming the "junk food" did gain weight.

This finding, especially if replicated in future studies, is critically important in our understanding of diet and health. This is because the findings showed that it was not diet alone that stimulated weight gain, nor was it stress alone. It was the specific combination of stress coupled with what researchers described as a "high-fat, high-sugar" diet that led to weight gain.

And not just any weight gain, but specifically fat accumulation in the belly - visceral fat; which we now understand is more detrimental to long-term health than subcutaneous fat which accumulates in places like the butt, thighs or arms. The stressed mice consuming a junk food diet also experienced glucose intolerance, elevated blood pressure, inflammation of the blood vessels and fat accumulation in the liver and in muscle tissue.

Simply put, they developed Metabolic Syndrome.

They did this not consuming excessive calories either - the researchers noted that the weight gain and fat accumulation in the stressed mice consuming the junk food diet was greater than expected given the calories consumed. Yet the mice consuming the same diet who were not stressed did not gain weight.

So it wasn't just the diet that mattered, it wasn't just stress that mattered; what mattered was the stress together with a junk food diet that conspired with each other to disrupt the production and pathways of neuropeptide Y (NPY).

Which leaves me wondering and pondering about many of the different dots still to be connected as we move forward to resolve the "obesity epidemic"...in the coming days I'm going to present additional data and studies to see what dots we might connect and what might be our solutions in the future.

I'll leave you with what Lou Shuler noted in his Male Pattern Fitness blog yesterday:

So, according to news reports, the "breakthrough" is a magic bullet that will selectively reduce fat deposits. Then there's some kind of opposite pill that will put fat on in selected places. If it works out in human experiments, somebody will make billions of dollars off these pills. I'm happy for them -- I wouldn't mind having some extra commas on my balance sheets -- but let's not forget that it'll be years before people will be able to use this chemical liposuction.

Meanwhile, anybody can stop eating junk food now. Today. The FDA doesn't have to give you permission to not enter the drive-through. The U.S. Patent Office doesn't have to put its seal on your decision not to supersize. It's here, it's free, it's open-source. It's dietary Linux. It doesn't discriminate by race, gender, religion, or income.

And it couldn't be simpler: All you have to do is eat something besides junk food.

It's so easy I couldn't even write a book about it. Chapter 1 tells you not to eat junk food. There is no chapter 2.

Why isn't that discovery being treated as the breakthrough, and the possibility of magic pills as an interesting sidebar?

Oh, yes - and as requested in emails while I was away, some pictures from our vacation:

Driving a boat on Norfork Lake, AR:

The big guy, with a mighty big fish:

My little guy, two months shy of his third birthday!