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!

Back to Our Regularly Scheduled Program

You may recall the alarming headlines reported here that suggested a high-fat meal was very risky to endothelial function; one went so far as to suggest just one bite of a burger might kill you!

Seems some researchers thought maybe it's a good idea to see what effect a high-protein (low-carb) and low-fat (high-carb) habitual diet might have on endothelial function over a longer period of time - say, maybe a year?

Wonder why you haven't seen any headlines on the latest study - Effects of weight loss on a low-carbohydrate diet on flow-mediated dilatation, adhesion molecules and adiponectin - published in the British Journal of Nutrition?

Might be because the researchers found nothing significantly different between the two diets, and noted "weight loss does not improve FMD [flow mediated dialation]."

Paper gets published, media sees it, notes noting to see here, no sexy headlines....not quite juicy enough to waste readers time with (even though it contradicts those one-meal experiements), so let's just move on.

But wait!

Just because the study objective was to see effect (benefit or risk) on FMD, adhesion molecules and adiponectin, was there anything else they measured that did have significance and is worthy of our time to look at?

How about we take a look?

Two groups of subjects were randomized into two different dietary protocols - the first included 13 people assigned a low-carbohydrate diet (40% protein, 27% carbohydrate and 33% fat; 26g fiber daily); the second included 12 people assigned the high-carb diet (20% protein, 60% carbohydrate, 20% fat; 40g fiber daily).

Both groups were weighed, measured, poked and prodded and followed up with a 6-weeks, 12-weeks and 52-weeks. Measurements and testing included weight, BMI, blood pressure, cholesterol, glucose, insulin, CRP, VCAM1, sICAM1, E-selectin, P-selectin, and total adiponectin. In addition, vascular measurements were taken for blood pressure analysis and endothelium-dependent FMD, along with an assortment of other tests.

The various measurements were duly recorded for baseline and re-measured during follow-ups, and were included in the final paper. Some critically important measures were statistically significant, but not the focus of the study design; thus not highlighted in the abstract conclusions.

We hear a lot about how low-carb diets are bad for cholesterol.

In this study, like others, total cholesterol, LDL and triglycerides were lowered over the course of the year and HDL rose while following the low-carb diet.

Total Cholesterol:
Baseline = 5.3
52-weeks = 4.62
[low-fat group went from 5.7 to 4.94]

LDL:
Baseline = 3.5
52-weeks = 2.69
[low-fat group went from 3.8 to 3.07]

HDL:
Baseline = 1.3
52-weeks = 1.44
[low-fat group went from 1.3 to 1.34]

Triglycerides:
Baseline = 1.7
52-weeks = 1.07
[low-fat group went from 1.4 to 1.34]

Intriguing too was the improvements with glucose and insulin following the low-carb diet:

Glucose (fasting):
Baseline = 5.9
52-weeks = 5.19
[low-fat group went from 5.8 to 5.5]

Insulin (fasting):
Baseline = 16.9
52-weeks = 7.28
[low-fat group went from 12.1 to 5.22]

An interesting finding was that adiponectin, a hormone involved in a number of metabolic processes, including glucose regulation and fatty acid catabolism, "did not change significantly after 12 weeks of weight loss" (p=0.10), but increased (good) at the last measurement, 52-weeks, at the end of the study (p=0.05).

Blood pressure (not high at baseline) improved, from 122/75 at baseline to 115/68 at the 52-week measure; for those on the low-fat diet, blood pressure increased from 122/75 at baseline to 130/74 at 52-weeks.

It's clear in the data that both dietary approaches offered improvements with weight loss in the above measures of risk factors. Something though wasn't "right" to help with, improve, endothelial-dependent FMD. We'll explore potentials in a moment.

Somethign troubling that seems glossed over - the higher blood pressure in those following the low-fat diet - where at baseline their blood pressure averaged 122/75, at 6-weeks it improved to 115/72 and again improved at 12-weeks was similar at 118/70. What happened between the 12-week measure and the blood pressure reading at week 52, when blood pressure was now averaging 130/74?

This is something I would consider worthy of noting, even maybe point out and suggesting additional questions and investigation as to why!

In the discussion section, the researchers stated that "The main finding of the present study was that weight loss on a low-carbohydrate diet which brought about reductions in glucose, insulin and LDL-C did not improve FMD either after short-term weight loss or long-term weight maintenance. Irrespective of diet composition weight loss had beneficial effects in the short term on adhesion molecules and blood pressure and in the longer term on adiponectin and P-selectin. There appears to be a delay in improvement in both adiponectina nd P-selection as these molecules did not improve until weight loss had been maintained for a year."

They went on to add, "Lack of change in FMD in the present study confirms our previous finding that weight loss does not improve FMD...One of our goals with the dietary intervetion was a reduction in LDL-C which we achieves, 18% at 6-weeks and nearly 30% at the end of the study with no effect on FMD."

The researchers also noted that "The present study was also designed to achive a reduction in glucose in a 6-week weight loss intervention on a more moderate diet of 6000kJ and we achieved this but with no effect on FMD."

And, "A complex physiological response such as FMD may be related to LDL and glucose cross-sectionally and in post hoc analyses but these may not be casually related but correlate in some circumstances with the real unmeasured mediator of change. For instance, oxidative stress may be a major factor in reducing NO bioactivity but reducing LDL levels may have no effect on this even though the endothielial cell is clearly heathier as judged by a reduced adhesion molecules."

In the end, they concluded that "weight loss on a low-carbohydrate, low-saturated fat diet, does not improve FMD despite improvement in cardiovascular risk factors. The improvement in adiponectin was delayed."

So what was their error of omission?

Well, for one they failed to note the problematic rise in blood pressure observed in the subjects following the low-fat diet. But, let's set that aside for a moment.

They also failed to note that the above failure to improve FMD was also observed in subjects following the low-fat diet; one that happened to be designed well enough to match the American Heart Association recommendations!

Yet even that low-fat diet (20% of calories from fat) didn't help improve FMD, despite their weight loss, improvement in glucose, insulin and cholesterol; but this was left unsaid.

I'm not surprised.

So, what we're left with is the stated null finding of those on the low-carb diet, with no real statement that neither dietary approach did much for FMD.

I hate to say it, but there was also a lack of curiosity as to why this was.

It's pretty much accepted dogma that a low-fat diet improves the cardiovascular system, thus would exert a postive - significant - effect on endothelial-dependent FMD. It didn't, yet the researchers didn't say "hey, wait, this low-fat diet didn't help either" and instead highlighted that the low-carb diet didn't improve FMD in their conclusions.

Some questions really do need to be asked.

First, how did the low-carb diet look compared with the habitual diet?

We know subjects were consuming, on average, 11.4mJ each day (2725-calories) as their habitual diet. The weight loss diet was 6000kJ each day (1430-calories). They followed the weight loss phase of the diet for six weeks and lost 5.8kg, or 12.75-pounds.

Let's do math!

Each day, we're to believe, the subjects were in a calorie deficit of 1295-calories. Six weeks is 42-days, so over the period, a calorie deficit of 54,390 calories - enough to theoretically lose 15.5-pounds. Hmmm....Okay, so it's pretty clear they did not really follow the diet as planned, since it's clear they consumed more calories than was reported. Happens all the time, no biggie.

Except, we have no idea what the excess calories were, so we have a confounding variable here. Did they eat pie? Did they eat broccoli? Did they eat fatty meat instead of lean meat? Did they skip the oatmeal and eat eggs? Who knows?

It's also noteworthy that the low-fat dieters ate a habitual diet of 10.8mJ daily (2581-calories) and were placed on the same weight loss calorie level. So they were in a calorie deficit of 1150-calories each day, or a six week deficit of 48,342-calories. This theoretically would result in a weight loss of 13.8-pounds; they lost 5.9kg (13-pounds). Did they cheat less? Did they stick to the diet more carefully? Who knows?

But, we can be sure we have a confounding variable here - something doesn't add up, and it looks like that something is calorie intake. It appears it was higher than the dietary protocol called for; and an increased calorie intake we have no idea what foods/macronutrients it came from.

So then, is there anything else? Let's see how macronutrient intake changed on the low-carb diet.

At baseline, their habitual diet - 2725-calories - was from 39.6% carbohydrate (270g), 19.6% protein (133.5g) and 36.5% fat (110.5g). We do not know the baseline intake for fatty acids, but do know the dietary protocol was strict - saturated fat 7%, PUFA 6% and MUFA 13% of calories.So, while following the weight loss diet, the macronutrient profile changed to provide 1430-calories each day, of which 33% were carbohydrate (118g), 40% protein (143g) and 27% fat (43g) with 7% from saturated fat (11.1g), 6% from polyunsaturated fat (9.5g) and 13% from monounsaturated fat (20.7g).

The first glaring disparity is the protein-to-fat intake, for every 1g of fat, they were expected to consume 3.3g of protein; this is a highly unusual pattern, heavy with protein and too lean - if you review other studies on "low-carb" diets, the fat intake is usually higher than the level in this protocol and protein typically lower; of note, this intake ratio is next to impossible without some funky planning. I'd like to know how much soy was a part of this diet? How much of the diet was comprised of non-fat dairy? How much fish was allowed, and what type was it? Were protein shakes or supplements part of the protocol? If so, which type of isolate dominated?

Without this specific data, it's difficult to say one way or another if the foods included may have contributed to the null finding or not.

So here, we have a potential confounding variable that is unexplored.

Anything else?

Well, from the data we do know, it seems we find an inadequate level of polyunsaturated fats - with just 9.5g each day; a level at which the subjects are unable to meet essential requirements for omega-6 or omega-3 fatty acids!

I am really starting to wonder why researchers designing diet protocols that are inadequate for known essential nutrients?

The Institute of Medicine (IOM) clearly states in the Daily Recommended Intake documentation, the MINIMUM required each day from omega-6 is 5% to 10% of calories and the MINIMUM requirement each day from omega-3 is 0.5% to 1% - when calories are adequate to maintain weight. In absolute terms - absolute gram minimums - the IOM states that adequate intake of omega-6 fatty acid is 14g-17g for men (depending on age) and 11g-12g for women (depending on age); and that adequate intake of omega-3 fatty acids is 1.6g for men and 1.1g for women.

Combined, the absolute minimum intake for essential fatty acids is between 15.6g-17.6g for men and 12.1g-13.1g for women.

In this study, even if every last gram of polyunsaturated fat was an omega-3 or omega-6, these subjects were deficient for essential fatty acids with only 9.5g of polyunsaturated fats as part of the diet.

So, again, confounding variable - huge confounding variable!

And the researchers question why the diet didn't have an effect on FMD?

Perhaps the researchers haven't read the data showing improvement in cardiovascular health when essential fatty acid intake is optimized to meet or exceed current recommendations?

Recent evidence of the role of omega-3 polyunsaturated fatty acids on blood pressure control and hypertension-related complications

Omega-3 Fatty Acids: Role in Cardiovascular Health and Disease

Fish Oil and Endothelial Function

I can't say it enough - I love good data, but studies like this, with macronutrient intakes, as percentage of calories, is highly confounded data. Designing a dietary approach to lose weight or maintain weight, macronutrient percentages are often inefficient and do not meet essential nutrient requirements.

I'd really like to see some researchers start designing studies to ensure adequate intake of essential nutrients within the calorie deficits - until we start to look at the nutrient-quality of weight loss diets, I'm afraid we're not going to make much progress to provide the public with sound, scientifically supported recommendations.

The Devil in the Details - Low-Carb High Protein Diet Kills

A study - Low-carbohydrate–high-protein diet and long-term survival in a general population cohort - published in the May edition of the European Journal of Clinical Nutrition (originally available ahead of print, November 2006), concluded that "Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality."

When I read the first publication of the study, back in November, I decided not to write about it since I was focused on penning articles about diabetes throughout National Diabetes Month and this study wasn't about diabetes. It remained on my pile of studies to consider, but as time passed, it seemed less and less important to write about. Now, with it hitting the print edition, and a renewed interest in the findings, it's time to take a look at what the researchers found and how they reached their conclusions.

Jake Young, who writes at Pure Pedantry, thought it worthwhile to take a look too. In summing up the design of the study, he wrote "[j]ust to cross the t's and dot the i's, they also control sex, age, years of schooling, smoking, BMI, physical activity, ethanol intake, and (in the data I am going to talk about) energy intake;" thinking, I believe, that adjusting for these confounding variables leads to higher quality conclusions.

Except in this case, adjusting for some of these variables led to a leap-of-faith extrapolation from the data because without making adjustments there was no significant finding to speak of, "[i]n model 2, the LC/HP score (absolute values) was positively associated with mortality, although the association did not reach statistical significance (P=0.14)." [emphasis mine]

In other words the association was statistically due to chance and therefore a null finding.

But, let's not let that get in the way of a good chance to find statistic significance!

Rather than take the data at face value for absolute intake (what people were eating), the researchers decided to adjust energy intake and considered this adjustment "as they should be, isocaloric..." to show how, after adjusting for energy intake variables things change.

And change they did.

With this one adjustment, statistical significance magically appears and now "mortality was significantly associated with reduction of energy-adjusted carbohydrate intake and nonsignificantly with increasing protein intake."

But still, how exactly to find protein problematic?

Ah, one more adjustment just might do it.

The researchers noted that their "model 3" "does not specify the complementary changes that have to be introduced for the preservation of total energy intake, when carbohydrates and proteins change." So, they created "model 4" and said it was "the most appropriate" since it was both isocaloric (adjusted for energy intake) and now adjusted to reflect changes from less carbohydrate and more protein.

Viola!

"In this model, increasing LC/HP score was significantly associated with mortality (P=0.001)."

Except, no one in the cohort ate like the adjusted diet, the statistically significant findings are not from real people eating real food (absolute intake), but are only found upon adjustment of energy and intake from protein and carbohydrate. The researchers justified this adjustment as necessary with "[i]ndeed, many of contemporary public health policies rely on extrapolations, so that if something is detrimental at a certain exposure level, its effect is likely to be more detrimental at a more extreme level."

Perhaps this is part of the problem with our public health policy? We're basing recommendations on extremes, extrapolated from adjusted models, rather than real world eating habits.

This is how the American Heart Association comes up with recommending less than 7% saturated fat to all Americans, even those at low risk for heart disease; they take data from studies that found no benefit from reducing saturated fat to 10% or less of calories and do the mental gymnastics to leap to an idea that benefit will be seen when saturated fat is less than 7% of calories. No data, just pure extrapolation and wishful thinking.

But, I digress...

There'd be nothing to talk about with this study if the researchers only went with their cohort and their habitual diet. Remember, when the absolute intake data was crunched, there was no statistically significant finding.

It's only after the researchers play with the data and make adjustments - adjustments outside the "norm" of their population cohort - into the extreme models, that they find significance.

In the real world you'll be hard pressed to find someone eating a diet within the extreme models they created. That's because the fundamental flaw in their model adjustment was the belief that decreasing carbohydrate means increasing protein. As the researchers noted in their paper, their adjustment model "relies on opposite changes of two nutrients with equivalent energy values and tends to be unrelated to total energy intake."

Simply put, the assumption was that reduction of carbohydrate translates to an isocaloric increase in protein.

The problem with this is that in the real world, increasing protein beyond what the body needs is extremely difficult due to satiety hormones that effectively shut down hunger when protein intake is adequate and carbohydrate is restricted. So the idea that one is effectively replacing carbohydrate with protein has a limit. A limit that seems beyond the grasp of this research group, who didn't seem to ask the important question - why did those with higher LC/HP (low-carb/high-protein) scores consume less calories than those eating a higher carbohydrate diet?

Rather than delve into this, they adjusted protein as if this group could and would consume more calories and more protein in a linear progression, adjusted their habitual intake to reach an isocaloric level comparable with their higher carboydrate counter-parts. But, because protein is such a sating macronutrient, this adjustment is not based on reality, but is purely hypothetical; and a hypothetical situation that one is likely to find impossible in a real world eating situation.

My take - the researchers would have been better off publishing their findings from the absolute intake data and letting the data stand as it is rather than make various adjustments to convoluted extremes and try to make headlines. Nice try though.

Weight Loss, Cholesterol and Blood Sugar Improvements - What's the Wonder Drug Now?

While the media is hot and heavy to lead their headlines with junk science complete with amateurish conclusions, a study was quietly published Friday in the journal, Molecular and Cellular Biochemistry - Beneficial effects of ketogenic diet in obese diabetic subjects (abstract) - that's remains ignored.

No fanfare, no ballyhoo, in fact, not one headline to call attention to the significant findings, over the course of a year, of a dietary trial in obese subjects with and without type II diabetes.

Findings that included:

For both groups, diabetic and normal glucose:

• Weight loss of 24.55kg in 56-weeks (that's 54-pounds)
• Total Cholesterol down 19.3%
• LDL down 28.2%
• HDL up 52.3%
• Triglycerides down 59%
• Fasting Blood Glucose down 31%

For those with type II diabetes:

• Weigth loss of 24.4kg in 56-weeks (that's 53.7-pounds)
• Total Cholesterol down 28.5%
• LDL down 33%
• HDL up 63.4%
• Triglycerides down 40.8%
• Fasting Blood Glucose down 50.9% (yes, glucose fell more than 50%)

So, what exactly did the researchers have these subjects do that led to such impressive improvements over the course of 56-weeks?

Sixty-four subjects were divided into two groups - thirty one had abnormal glucose levels (type II diabetes) and the remaining thirty-three had normal glucose levels. Both groups were instructed to modify their diet to include only 20g of carbohydrate a day from a list of foods allowed along with 5-tablespoons of olive oil on salads, and allowed 80g-100g of protein from meat, eggs, fish, poultry and full-fat cheese each day. No alcohol was consumed by participants. At week 12, participants were allowed to increase carbohydrate to 40g per day. Throughout the 56-weeks some foods were forbidden - flour, bread, rice, macaroni, noodles, honey, sugar, sweets, cakes, potatoes, all fruit juices and all soft drinks.

Yes, shocker - the study was designed to measure the effects of a ketogenic diet in subjects with and without type II diabetes.

So, with the above findings, it's no wonder this one is being quietly ignored.

While the media, government policy makers and leading health organizations keep wishing for negative findings from studies of low carbohydrate diets, the opposite keeps happening - the pile of studies finding significant improvement keeps growing higher and higher.

How profound were the changes in real numbers?

Those with diabetes had baseline fasting blood glucose levels of 188.64mg/dl; by the end of the trial, at week 56, their fasting blood glucose averaged 87.66mg/dl. Even those with normal blood glucose, who started with a baseline fasting blood glucose of 92mg/dl, saw improvement; at the end of the trial they had a fasting blood glucose of 85mg/dl.

There is not one drug on the market today, recommended for those with diabetes, that shows such significant improvement in fasting blood sugar, sustained over a period of more than a year!

Oh, but it gets better. Cholesterol improvements in this trial were unmatched by any drug trial.

Those with diabetes:

Baseline Week-56

Total Cholesterol 265 190
LDL 203 131
HDL 39 62
Triglycerides 418 89

Those with normal glucose:

Baseline Week-56

Total Cholesterol 214 181
LDL 156 109
HDL 47 63
Triglycerides 160 77

No cholesterol medication reduces LDL by 33% while also increasing HDL by 63.4%; and reducing triglycerides by 59%.

If the above finding were for a new drug, not only would the headlines be screaming for everyone with dyslipidemia to be prescribed it immediately, but every last expert in the country would be making the rounds in the media to be heard about this new wonder drug!

Sadly this isn't a new wonder drug rich with potential for profits. Instead it's simple dietary therapy, with no bottomline enhancement for anyone, save for a few farmers and ranchers.

So no headlines, no urgent call to take a look at the data which validates previous studies, no demands for reviewing the evidence; nope, the powers that be will continue along, fingers in ears, singing "La La La" as they hope no one notices the mountain of evidence growing.

If you have diabetes, or are at risk for developing diabetes, get to know what a carbohydrate restricted diet is and how to integrate it into your health management, it may save your life.

UPDATE 4/24/2007

A reader brought to my attention a pretty glaring error in reporting of reduction of triglycerides. I posted the numbers from the full-text above as published - a reduction in triglycerides in those with high blood glucose = -40.8%

A review of the actual numbers shows a reduction over the 56-week period from 4.681mmol/l to 1.006mmol/l - a 78.72% reduction in those with high blood glucose; and from 1.827mmol/l to 0.861mmol/l in those with normal blood glucose - a 54.01% reduction.

What's so Special about Protein Anyway?

When we hear the word "diet" we often conjure up thoughts of deprivation, hunger and the frustration of short-term attempts to lose weight. But "diet" also means how we eat on a daily basis - so the diet we eat to lose weight should, ideally, be the diet we eat for the long-term.

I agree with this idea and strongly encourage those trying to lose weight to eat a dietary pattern they'll make habit over the course of their weight loss and beyond as they then maintain their weight.

Where I disagree with this idea is in the idea that our macronutrient (protein, carbohydrate, fat) intake should be set by percentage of our calories, in strict ratios with each other, in an attempt to keep the equation "balanced" - up to 35% of calories from total fat, less than 10% (or less than 7%) of calories from saturated fat, 55-65% of calories from carbohydrate, and the remaining 10-15% of calories from protein.

We're repeatedly told a "balanced diet" remains within these percentages of calories and to maintain them while in a calorie deficit if we're trying to lose weight; going beyond those percentages and consuming too much fat, saturated fat or protein is detrimental to our long-term health.

Yesterday I closed my post with "The first, and most important rule you need to know in the "diet game" is eat your protein; and make it complete protein."

Protein is the macronutrient we take for granted, underestimate the power of, and assume we get enough of each day in our diet.

By undervaluing protein in our diet, by making the assumption that most people eat more than enough, we fail to focus on not only the building blocks of life itself, but the building blocks of our endocrine system - our hormone system.

Without adequate intake of essential amino acids, we rob our metabolism of the building blocks to function normally.

When we diet to lose weight, restrict calories and maintain the ratios suggested to keep our diet "balanced," we willfully starve our metabolism and endocrine system of the critical elements required to maintain function.

This is because our requirement for protein, for essential amino acids, is not based on a simple percentage of calories, but on how much we weigh.

If a woman, who is 5'6" tall, 30-years old and weighs 250-pounds goes to MyPyramid.gov, she'll be presented with a food plan providing 1,800-calories a day to gradually lose weight.

She will find her recommendation includes:
6-ounces of grains (Aim for 3 whole grains)
2.5-cups of vegetables
1.5-cups of fruit
3-cups of milk
5-ounces of meat and beans
Aim for 5-teaspoons of oils a day
Limit extras (extra fats & sugars) to 195-calories a day

The first critical problem with the recommendation is the calorie level - our hypothetical woman above has a Basal Metabolic Rate calculated at 1900-calories a day.

As the Discovery Health BMR Calculator page says "You expend energy no matter what you're doing, even when sleeping. Thus your Basal Metabolic Rate is the number of calories you'd burn if you stayed in bed all day...depriving yourself of food in hopes of losing weight also decreases your BMR, a foil to your intentions."

But let's set that aside for this post and look at what she is presented with as a food plan and determine if it meets her nutrient requirements, as the site contends it will.

First let's pretend she laughs off the idea of eating beans instead of meat - this makes our task of examining her protein intake easier since we'll be able to determine her intake of complete protein without having to adjust for the limiting amino acids in grains or legumes (beans).

With 3-cups of milk and 5-ounces of meat, the total intake of complete protein (if this is followed to the letter) is 56-grams.

Now, some would contend that this is above the 46g DRI (Dietary Reference Intake) established by the Institutes of Medicine for a 30-year old female. Such a contention fails to consider the IOM basis of 46g of complete protein is based on a female who weighs 128-pounds. Our hypothetical woman weighs 250-pounds!

Protein intake - that is complete protein, providing all essential amino acids in the proper ratio - is based on the formula 0.8g/kg body weight. The IOM considers this the absolute minimum required each day. So, our hypothetical woman, who weighs 250-pounds is 113.6kg, thus requires a minimum of 91g of complete protein each day.

But wait, you might say, she has other things she'll eat that provides protein!

That is true. But, with 1800-calories, planned as recommended above, she'll consume about 80-90g of total protein, and depending upon what she actually eats, she is likely to miss adequate intake of all her essential amino acids; even with careful planning and optimal selections of whole foods, she'll also likely fail to meet DRI for Potassium, Vitamin D, Niacin, Magnesium, and Vitamin E; add to this she'll likely fail to meet omega-3 requirements while consuming an excess of omega-6.

But hey, her saturated fat intake is just 6% of her calories, her cholesterol intake would be about 100mg, and her fiber intake in the neighborhood of 35g - according to the recommendations, she's eating a "healthy diet," and reducing her risk of disease by keeping her saturated fat and cholesterol intake below the maximum allowed.

On paper her diet looks just great!

In her body, in her metabolism, it's a nightmare if followed for any length of time.

This is because chronic, habitual nutrient deficiency - whether it is a diet deficient in vitamins, minerals, or trace elements, essential amino acids, essential fatty acids, or a combination of deficiencies - places a burden on the metabolism to function without all of its needs.

Oh, you won't die with a shortfall in nutrients; atleast not immediately...no, your metabolism will continue limping along, as best it can with what you give it to work with.

But really, do you want to do that, or do you want to eat in a way that optimizes your metabolism?

How about we design a menu for our hypothetical women, one for her, that is designed specifically to meet her nutrient requirements rather than conform to a set of percentages.

Based on what we know her Basal Metabolic Rate is (what she needs for basic function before she gets moving each day), she should consume 1,900-2,000 calories and first focus on ensuring she eats 91g of complete protein each day.

If we start there, and include as part of her day 4-ounces of lean roast beef, 16-ounces of plain whole milk yogurt, 3-ounces of tuna in oil, 2 eggs, and 1/4 cup shredded natural cheddar cheese - we've included all her complete protein for the day - 91g - and started her menu with 946-calories. We have 954-1054 more calories to add to her menu.

Now we get to add in her vegetables, fruits and other foods to ensure she consumes adequate intake of the additional nutrients needed; the focus here should be first on vegetables since they're rich with vitamins, minerals and trace elements.

Let's add to her menu a salad for lunch, with 2-cups of romaine, 6 cherry tomatoes, 1/2 a sliced cucumber, 1/2 cup shredded red cabbage, and some crimini mushrooms and we'll let her top it with olive oil and vinegar; then she'll have 1-cup of steamed broccoli at dinner with her roast beef and she can indulge and include 1-tablespoon of butter to make it taste good.

As part of her breakfast, which includes the two eggs above, she'll also include 1-cup of baby spinach (raw amount to be added to egg omelet) and 1/4 cup of shredded cheddar cheese. Her breakfast will also include the one of the two cups of plain yogurt, in which she'll add 1-cup of strawberries.

Her snacks during the day will include 1-ounce of almonds with 1-ounce of sesame seeds; she'll include 1-cup of blueberries with the other 1-cup of plain yogurt, add some water and have a delicious smoothie; and she'll have 1/2 an avocado too, perhaps with her lunch or just a snack during the day.

At this point, her menu provides 1,931-calories.

But wait, she hasn't included any grains! Surely this menu is going to be deficient for essential nutrients if she isn't eating grains!

Not so fast.

The above menu provides all essential nutrients, including fiber, with one notable exception - vitamin D, the most difficult nutrient to obtain from food. She can, of course, go out in the sun for 20-minutes this time of the year each day and make all the vitamin D she needs in her skin. In months where we cannot produce vitamin D in our skin, she can add a vitamin D supplement or make different choices with foods rich with vitamin D or include cod liver oil.

But the above menu, even though it provides all essential nutrients, is a nightmare for those espousing the dietary recommendations - it's high in total fat, saturated fat and exceeds maximum allowance for cholesterol; the carbohydrate is lower than recommended (even though fiber is above recommendations), and it does not include any grains!

Which begs the question - what would you rather eat?

A menu designed to meet your calorie requirements to function before any activity but still a calorie deficit to enable weight loss - designed to provide all essential nutrients including the critical essential amino acids and essential fatty acids - or - a menu that looks pretty on paper but fails your endocrine system because it is nutritionally bankrupt?

Diet - Not a Numbers Game Afterall

When searching online for topics to write about, I often hit google news and conduct a search based on various keyword combinations - diet, health, obesity, weight, diabetes - and I'm never disappointed by the sheer number of results. On Friday I noted that the headlines are often contradictory and those I posted were all within the first five pages of results using just two keywords - diet and health - in a search of the news headlines.

So, what are we to make of dieting to lose weight? Is it a losing proposition? If it is, then why the repeated attempts to encourage the masses to diet? And, most importantly, does dieting really work?

I think it's safe to say that the most widely recommended diet for weight loss - a calorie restricted, low-fat, carbohydrate rich diet - fails the test long-term. While intially reducing weight, in the long-term, such diets do little to improve health and enable a stable, lower weight over time.

The failure of the dietary recommendations are no small matter, various agencies go to great pains to explain away the long-term failure and wind up making the issue one of personal failure rather than admit the flaw is in the recommendations.

Whether or not an individual is able to lose weight and maintain the weight loss becomes a moral issue - having willpower over hunger, taking responsibility for portions, just eat less, just exercise more, stop buying junk food, etc. When the outcome is positive, the diet worked; when the outcome is negative, the person failed to follow directions.

As Malcolm Evans summed up in his commentary, Dieting is Fine Because it is Becoming Official, "The argument goes like this - the state in its wisdom has spoken; overweight is a health issue and as such it becomes a moral issue concerning wellness, interdependencies and budgets. Weight is to be managed downwards and to disobey will result in an implicitly escalating scale of reputational and material penalties (including the denial of certain health care provision). Biomedicine currently prioritises a sense of cure over comfort. The emphasis in almost all cases is to be seen to be powerful in the chemical intervention, with much less emphasis on empathy in relation to the inevitable, or on the emotional and psychosomatic dimensions. It is a culture that allows ten minutes and the prescription of a tranquilliser. It is also a culture which disallows the complexity of overweight and seeks rapid intervention, preferably leading to the mapping of satisfactory digits to numbered targets. In the absence of a magic weight control pill (how Big Pharma would love to have one of those that was in any way remotely effective!), dieting is perpetuated despite the accumulating evidence that it is a largely ineffective alone as a long-term solution."

As I noted on Friday, Fred Hahn said it well, "Fat loss and health is NOT a numbers game - it's a hormonal game. And a game that requires full understanding of the rules."

Yet the government and leading health organizations continue to perpetuate a dietary approach based on numbers - calories, fat grams, saturated fat grams, milligrams of cholesterol, sodium intake, fiber intake, the size of portions, and the number of minutes you engage in exercise each day. It's all about counting one or more things each day in your diet and lifestyle.

All of the recommendations made to the masses come back to one single hypothesis - dietary fat is deadly and must be limited to not only keep calorie intake balanced - fat has nine calories per gram and carbohydrate and protein just four - but to prevent development of chronic disease.

Recently the obession with total fat has relaxed a bit, from strictly maintaining an intake below 30% of calories, to an allowance now of a range between 20% and 35% of calories. But this concession comes with a stricter limit on saturated fat; we're now told to limit saturated fat to less than 7% of our calories, making it next to impossible to meet nutrient requirements for essential amino acids in those who are overweight or obese.

Ah, the unintended consequences of playing, on paper, with macronutrient ratios.

You see, if we take the recommendation to consume less saturated fat to heart, and also strictly limit our cholesterol intake as also recommended, we are left with significantly less animal foods in our diet each day, now dependent on plant-based sources of protein to meet our essential requirements for amino acids.

Surely, you say, there must be strong evidence to support these recommendations? Surely we can easily meet our essential amino acid requirements with a plant-based diet? Surely a diet recommended by the government and leading health organizations must be soundly established by scientific data and be shown to lead to long-term outcomes in health and well-being?

Well, not so fast.

Here is where, as Fred Hahn called it, the "hormone game" comes into play and the rules are such that if you're not playing within them, your health suffers.

The first, and most important rule you need to know in the "diet game" is eat your protein; and make it complete protein.

Tomorrow I'll explain why and then discuss the other rules of the "hormone game" to give you insight into why everything we're told about diet is either wrong and causing more harm than good in your metabolism!

Then, throughout the week, we'll sort out what to eat if you're trying to lose weight and improve your health for the long-term.