The first lines of information for diets are internet homepages, Google sidebars, blogs, and magazine racks in grocery store checkout lines. But when the diet goes wrong or weight loss stops, physicians become the next source of advice. Whether it is family members, friends, patients, or colleagues we are expected to have the answers on fitness and nutrition; however, there is a vast deficiency in nutritional education in medical school, leaving us unprepared to adequately advise patients on health and diet.
As a competitive athlete, I’m keenly aware of how nutrition affects performance. Over the years, I’ve experimented with multiple diets and exercise regiments to maximize performance. While I don’t portend to be an expert on the subject, and especially not for high-performance athletes, I have acquired bits of knowledge that have proven useful in both clinical and personal interactions. Here are 5 Rules for Dieting of them that may be helpful to physicians and patients alike in discussing diet:
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1. The RIGHT diet is any one you can stick to. Now, I know this seems intuitive, but studies have shown that for the majority of diets, weight loss occurs primarily as a result of paying attention to the amount and types of food being eaten, rather than the actual make up of the diet. For many people, recommend a diet that is low-calorie and stresses the importance of fruits and vegetables.
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2. A calorie is a calorie. It’s true that the basis of weight loss is that we must burn more calories than we take in. It is important for people to calculate their basal metabolic rate (BMR; multiple calculators available online and not to be confused with body mass index, BMI) and then estimate their daily caloric needs. A typical diet should focus on a deficit of ~500 calories per day, leading to ~1 pound of weight loss per week. I prefer the approach of taking a strict BMR and then estimating daily activity rather than using a pre-set multiplier.
3. Not all calories are equal. Unfortunately, there are some calories that are better than others. This reflects our choice of foods: a calorie from an apple or orange is better than that of a marshmallow because these foods contain important nutrients for your immune system, muscle rebuilding, and other bodily and metabolic functions.
4. Eat More Protein. The cows of Chick-Fil-A may be on to something. Dieters should strive for protein to account for approximately 25-30% of their caloric intake. Multiple studies have shown that protein intake is associated with preventing muscle breakdown that sometimes occurs with caloric restriction due to utilization of amino acids in muscle as energy source over fat. Additionally, recent studies have shown that protein may play an even more important role in feeling satiated, a role previously thought to be driven by fat intake. When choosing protein, opt for lean meats like fish or poultry and limit intake of red meats to once weekly.
5. Exercise is important. Exercise burns calories both during and after. A complete exercise routine should include both cardiovascular efforts where heart-rate becomes elevated (target HR for beginners should be 60-80% of the result of 220 – age), as well as strength work which will both promote muscle development and sustained elevated metabolism.
Obesity is a significant problem for America’s economy, health care, disease burden, and cultural perception abroad. Like treating smoking, a gambling addiction, or alcoholism, every step in a right direction; steps that improve weight and promote healthy lifestyles deserve our praise. Remind patients that weight loss often leads to increased energy and improved self-esteem, but don’t allow changes to go unacknowledged. Furthermore, when the changes stop is when we are needed most allay frustrations and instead, encourage maintenance of the healthy eating principles and continued exercise that were adopted during dieting.
If you have any experience with these diets or specific questions, leave your questions below. For more information on specific diets and dieting practices, read on below.
As a competitive athlete, I’m keenly aware of how nutrition affects performance. Over the years, I’ve experimented with multiple diets and exercise regiments to maximize performance. While I don’t portend to be an expert on the subject, and especially not for high-performance athletes, I have acquired bits of knowledge that have proven useful in both clinical and personal interactions. Here are 5 Rules for Dieting of them that may be helpful to physicians and patients alike in discussing diet:
·
1. The RIGHT diet is any one you can stick to. Now, I know this seems intuitive, but studies have shown that for the majority of diets, weight loss occurs primarily as a result of paying attention to the amount and types of food being eaten, rather than the actual make up of the diet. For many people, recommend a diet that is low-calorie and stresses the importance of fruits and vegetables.
·
2. A calorie is a calorie. It’s true that the basis of weight loss is that we must burn more calories than we take in. It is important for people to calculate their basal metabolic rate (BMR; multiple calculators available online and not to be confused with body mass index, BMI) and then estimate their daily caloric needs. A typical diet should focus on a deficit of ~500 calories per day, leading to ~1 pound of weight loss per week. I prefer the approach of taking a strict BMR and then estimating daily activity rather than using a pre-set multiplier.
3. Not all calories are equal. Unfortunately, there are some calories that are better than others. This reflects our choice of foods: a calorie from an apple or orange is better than that of a marshmallow because these foods contain important nutrients for your immune system, muscle rebuilding, and other bodily and metabolic functions.
4. Eat More Protein. The cows of Chick-Fil-A may be on to something. Dieters should strive for protein to account for approximately 25-30% of their caloric intake. Multiple studies have shown that protein intake is associated with preventing muscle breakdown that sometimes occurs with caloric restriction due to utilization of amino acids in muscle as energy source over fat. Additionally, recent studies have shown that protein may play an even more important role in feeling satiated, a role previously thought to be driven by fat intake. When choosing protein, opt for lean meats like fish or poultry and limit intake of red meats to once weekly.
5. Exercise is important. Exercise burns calories both during and after. A complete exercise routine should include both cardiovascular efforts where heart-rate becomes elevated (target HR for beginners should be 60-80% of the result of 220 – age), as well as strength work which will both promote muscle development and sustained elevated metabolism.
Obesity is a significant problem for America’s economy, health care, disease burden, and cultural perception abroad. Like treating smoking, a gambling addiction, or alcoholism, every step in a right direction; steps that improve weight and promote healthy lifestyles deserve our praise. Remind patients that weight loss often leads to increased energy and improved self-esteem, but don’t allow changes to go unacknowledged. Furthermore, when the changes stop is when we are needed most allay frustrations and instead, encourage maintenance of the healthy eating principles and continued exercise that were adopted during dieting.
If you have any experience with these diets or specific questions, leave your questions below. For more information on specific diets and dieting practices, read on below.
Tell me about…
o The Mediterranean Diet: Reaffirmed by the New England Journal of Medicine as one of the best diets for improving cardiovascular health, it focuses on eating fresh fruits and vegetables, legumes, nuts, and cereals as well as fish and poultry. It thrives on simply prepared dishes with olive oil and seasonal products and allows moderate alcohol intake with 3-5 drinks per week. The health benefits have been well documented and this represents an excellent choice for older patients and those who are looking for better lifestyles rather than weight loss.
o The Atkins Diet: this is a low-carb diet, where people count carbs and reduce their daily intake so that their body begins to use ketones from fat oxidation as the source of energy instead of glucose. Effective at burning fat and shown to improve insulin resistance, decrease LDL and increase HDL levels. Many people fail because the first two weeks are particularly rough, causing them to feel irritable, weak, fatigued, and some GI distress as their body switches to ketosis. Additionally, as people increase carbohydrate intake, they begin to store glycogen and water which contributes to weight regain.
o Intermittent Fasting: a method in which people spend long portions of time taking in no or little (<20% of normal) calories. This type of dieting is particularly popular right now as the 5/2 diet , in which dieters spend 5 days eating normal diet and 2 days fasting, taking in < 600 calories for men or <500 calories for women (also popular is the 19/5 diet with 19hours of NO intake and 5 hours to eat normal). Intermittent fasting has been shown to decrease IGF-1 levels, leading to encourage fat burning. Relatively new, there is little research on the long-term effects of this diet.
o Paleo Diet: A diet that is particularly popular amongst endurance athletes and nutrition-geeks, it is slightly more strict regarding acceptable foods and often considered a lifestyle rather than a diet. Briefly, this diet harkens back to eating foods that would have been available to our hunter-gatherer ancestors, prior to the agricultural revolution. http://www.thepaleodiet.com offers specific information and blogs that may help patients navigate the diet.
o Aztec Diet: Another fad diet, this one is based on the chia seed. Chia seeds are notable for their nutrition profile, which contain significant amounts of omega-3 fatty acids, calcium, iron, fiber, magnesium, and selenium. The diet is based on reducing intake of refined carbohydrates and progressively increases the number of allowed foods.
Where can I get more information?
o A Registered Dietician or Nutritionists can help patients develop a diet and meal-plan that will fit their needs.
o Podcasts- a less expensive route, and the one I chose, is listening to podcasts. You can get lots of information and a little entertainment from people struggling with dieting or finding ways to make it fit their lifestyle. Here are some favorites: Endurance Planet Nutrition with Ben Greenfield, Ben Greenfield Fitness Podcast, Rich Rolle Podcast
o For basic information and overviews of many diets, the site: www.dietsinreview.com. This is a great source for diets you are unfamiliar with as a clinician to get the basic gist of your patients questions and may help you identify the pitfalls of each diet.
o For clinicians, PubMed provides answers to some clinical questions; however, because many diets are not regulated by the FDA and are based on anecdotal evidence, you may not find a good answer to your question.
For more information or sources, email me using the email link or Tweet at me and I will provide any more information or help that I can.
o The Mediterranean Diet: Reaffirmed by the New England Journal of Medicine as one of the best diets for improving cardiovascular health, it focuses on eating fresh fruits and vegetables, legumes, nuts, and cereals as well as fish and poultry. It thrives on simply prepared dishes with olive oil and seasonal products and allows moderate alcohol intake with 3-5 drinks per week. The health benefits have been well documented and this represents an excellent choice for older patients and those who are looking for better lifestyles rather than weight loss.
o The Atkins Diet: this is a low-carb diet, where people count carbs and reduce their daily intake so that their body begins to use ketones from fat oxidation as the source of energy instead of glucose. Effective at burning fat and shown to improve insulin resistance, decrease LDL and increase HDL levels. Many people fail because the first two weeks are particularly rough, causing them to feel irritable, weak, fatigued, and some GI distress as their body switches to ketosis. Additionally, as people increase carbohydrate intake, they begin to store glycogen and water which contributes to weight regain.
o Intermittent Fasting: a method in which people spend long portions of time taking in no or little (<20% of normal) calories. This type of dieting is particularly popular right now as the 5/2 diet , in which dieters spend 5 days eating normal diet and 2 days fasting, taking in < 600 calories for men or <500 calories for women (also popular is the 19/5 diet with 19hours of NO intake and 5 hours to eat normal). Intermittent fasting has been shown to decrease IGF-1 levels, leading to encourage fat burning. Relatively new, there is little research on the long-term effects of this diet.
o Paleo Diet: A diet that is particularly popular amongst endurance athletes and nutrition-geeks, it is slightly more strict regarding acceptable foods and often considered a lifestyle rather than a diet. Briefly, this diet harkens back to eating foods that would have been available to our hunter-gatherer ancestors, prior to the agricultural revolution. http://www.thepaleodiet.com offers specific information and blogs that may help patients navigate the diet.
o Aztec Diet: Another fad diet, this one is based on the chia seed. Chia seeds are notable for their nutrition profile, which contain significant amounts of omega-3 fatty acids, calcium, iron, fiber, magnesium, and selenium. The diet is based on reducing intake of refined carbohydrates and progressively increases the number of allowed foods.
Where can I get more information?
o A Registered Dietician or Nutritionists can help patients develop a diet and meal-plan that will fit their needs.
o Podcasts- a less expensive route, and the one I chose, is listening to podcasts. You can get lots of information and a little entertainment from people struggling with dieting or finding ways to make it fit their lifestyle. Here are some favorites: Endurance Planet Nutrition with Ben Greenfield, Ben Greenfield Fitness Podcast, Rich Rolle Podcast
o For basic information and overviews of many diets, the site: www.dietsinreview.com. This is a great source for diets you are unfamiliar with as a clinician to get the basic gist of your patients questions and may help you identify the pitfalls of each diet.
o For clinicians, PubMed provides answers to some clinical questions; however, because many diets are not regulated by the FDA and are based on anecdotal evidence, you may not find a good answer to your question.
For more information or sources, email me using the email link or Tweet at me and I will provide any more information or help that I can.
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