Eat What You Want**, Lose Fat, and Keep it Off Forever

** except for a few foods which currently constitute 60% of the standard American diet

(disclaimer again - I'm not your doctor - you may have a particular medical condition so that this information does not apply to you. Talk to your doctor if you have questions, but make sure he/she knows what the Friedewalde equation is!)

All you have to do is follow a few dietary rules to be more hunter gatherer in your eating:

1) Eat veggies. May substitute fruits sometimes, but most of the time it should be veggies. Prepare the veggies any way you like, and most people can use coconut oil and butter (from pastured sources is preferred).
2) Eat protein several times a day, too. It is preferable for it to be wild caught fish, organic poultry (or pork, for most people), shellfish and shrimp, omega 3 or organic eggs or grass fed beef, bison, buffalo, goats, venison, etc.
3) Snacks can be nuts, veggies, fruit, veggies with almond butter - that sort of thing.
4) Avoid (for the most part) soy, peanuts, grains, corn, and any processed food or added sugar.
5) Avoid all processed vegetable oils (watch those salad dressings, and "real" mayonnaise at the store is soybean oil! Use olive oil and lemon juice or vinegar!)
6) Keep your dairy high fat, fermented if possible, and try not to have it for every single meal.
7) Avoid alcohol (for the most part)

*Now a few simple lifestyle rules:

1) Get plenty of sleep
2) Move around (I'll have another post on exercise with more details)
3) Don't get too stressed (Build anti-stress/enjoyable time into your daily life)

*A few specifics on medical conditions/medications which may affect these rules:

1) Antihypertensive medication: Most people who start to eat this way decrease their salt consumption dramatically (no processed food), and the weight loss can lead to lower blood pressures fairly quickly. Keep your pressure monitored and consult your doctor.

2) Diabetes - especially type II, on any sulfonylurea medications (glipizide (glucotrol) and glyburide (micronase) are the most common, but there are several more): Dropping your carbohydrates like this can lead to low blood sugars if you are on these medicines, which cause your pancreas to secrete more insulin. So again, consult with your doctor!

3) Any condition for which you have to be on coumadin (warfarin) - A diet high in veggies can increase vitamin K, which will make your coumadin less effective. A diet high in omega 3s relative to omega 6 fatty acids will make you more likely to bleed (omega 6 fatty acids are pro-thrombic and omega-3s tend to displace them in the diet and in tissues). So again, go slowly (see below), keep the INR in check, and CONSULT WITH YOUR DOCTOR.

4) Advanced Ischemic Heart Disease and Severe Type II Diabetes - *some* evidence suggests saturated fats may actually be bad for you. Focus on the olive oil and fish oil, and keep in mind that most animal fats (the fat on your steak and in your chicken skin) are actually very high in oleic acid (same fat as olive oil) and other "cholesterol neutral" fats. Plain old saturated fat would include: coconut and palm oil, high fat dairy, butter, beef tallow, lard. This advice may change as the science on this subject is expanding far more rapidly than the "official" advice. But even Staffan Lindeberg, my paleonutrition guru, advises against loads of saturated fat with these conditions. I'll have a whole post on this once I do more research and wrap my head around the theory of lipotoxicity. However, I must admit I am exasperated with the cognitive dissonance between the official recommendations and what might actually work to help improve insulin resistance and reduce atherosclerosis. As near as I can tell, the official way to eat recommended to diabetics is moderate or low carb, lots of fiber, and low in animals and animal fat. This means you are pretty much limited to salad, skinless chicken breasts, olive oil, and wood chips (fiber), with some token whole grains, potato, or fruit thrown in. But the truth of the matter is, we can either be low carb OR low fat. Protein can't really change that much. Wood chips are not a viable substitution for fat. Sigh. I'm a psychiatrist, and this kills me. I'm not sure how the heads of nutritionists, cardiologists, and endocrinologists just don't explode.

*How to Start Slowly:

Not ready to take the full plunge? Still have lots of pasta in the pantry?

1) Start by ditching the processed food, meaning anything with 10 zillion ingredients and anything with high fructose corn syrup in it. Get rid of fruit juice, soda, and other added sugars. Take your coffee black or with cream, switch to a touch of honey (preferably raw) instead of sugar. Reduce the amount of honey over time. Use real maple syrup on your pancakes. You'll use less because it costs more.

2) After you're comfortable with that, then reduce the grains/sugars to one meal a day. The other meals should follow the simple dietary rules. Your best bet is to have the high-carb meal happen within a two hour window after you exercise. Your worst bet is to have your high-carb meal every morning for breakfast. If you want a sugary treat, eat it within 30 minutes after exercise.

3) Then clean up your grains. Wheat is probably the worst offender, wild rice and quinoa are the least, though you can pack on quite a carb load with an anemic-looking amount of rice. Get rid of any non-organic sources (the others will be genetically modified which *may* have autoimmune implications - until they are more thoroughly tested, why risk it?). Corn may be more or less okay, but in processed food usually comes with a lot of corn oil, which is horrible. Sorry.

*I'm following all your rules and I'm still not losing weight!!

1) What is your insulin status? You may be sensitive to too many carbohydrates (if you have excess abdominal fat, love handles, high blood pressure, have trouble losing weight, and you've been eating the standard American diet, you're probably a bit insulin resistant). First, ditch any remaining grains. Then decrease the amounts of more sugary fruits like apples, oranges, bananas, pineapples - you're better off with lower carb fruits like plums, peaches, figs, those kinds of things, and then only once a day or every few days.

2) Are you intolerant to lactose or casein? Get rid of the dairy (except eggs) and see what happens.

3) Are you following the lifestyle rules too? Diet is probably only 80% of fat loss.

4) Are you vitamin D deficient?

5) Are you eating too much protein? If you are packing in five pounds of porterhouse a day, you could be making glucose via gluconeogenesis, resulting in fat gain.

*I'm following all your stupid rules, and I feel like crap!!

1) A sudden drop in carbohydrates can cause some people to feel sick and tired and grouchy. This can happen even without ketosis (which won't generally happen with the amount of carbohydrates you would eat from having lots of veggies and fruit). This usually passes within a couple of days, (after which you will tend to feel energetic, clear-headed, and fabulous) but go to the "How to Start Slowly" section if you like.

*Wait a minute - where are the portion sizes and calorie counts?

1) Hunter gatherers did not have FitDay. And many modern hunter gatherer societies have plenty of food about - no malnutrition, and yet still they are effortlessly slim. Our appetites regulate themselves, as long as we don't have foods about which likely throw off our hormonal appetite regulation (added sugar and wheat are the most likely culprits). Don't go hungry. If you are hungry, eat. If you aren't hungry, you don't have to eat. If you're like me, you might not trust your natural appetite after watching your food closely for a long time. Then go for a pile of veggies and a palm-sized amount of protein. The rest will take care of itself.

*I want a cookie!!!!!

Eat a cookie.

No, seriously, eat a cookie. The way of eating detailed above puts us into a fat-burning metabolic mode. As long as you spend the majority of your time eating according to the rules, you should be in fat-burning mode most of the time, and a cookie ain't gonna hurt much. You will be out of fat-burning mode for a few hours. Big deal. If you are insulin resistant, it will be harder to get into fat-burning mode, and harder to get out of fat-storing mode. So a cookie is going to do your diet more harm than someone who is insulin sensitive.

* The American Heart Association Or Other Official Grand Poohbas say that vegetable oils are fine and are preferred to animal fats! Why is that?

They are trying to get you to decrease the amount of saturated fat you eat by replacing it with vegetable oil. Corn oil will lower your total cholesterol lickety split, but here's a gem of an old study dug up on Hyperlipid showing it may also kill you and cause diabetes (1). I personally think it is unfortunate advice, as the seed oils such as corn oil are high in omega-6 and will cause your omega-3s and omega-6s to be out of balance, and this is most likely very bad for both your health and your brain. I'll do another post on the specifics of the PUFA fat balance.

* Won't I be missing vital vitamins and minerals if I am not eating grains?

No. You won't be. Tells you how important grains are to good health. If you drop grains, you don't need a single vitamin or mineral supplement to make up for it. Not the same story if you drop all animal foods! Speaking of...

* I'm a vegetarian

Why? Is it strictly for improved health? Then you might want to look into it some more and consider other approaches. Adult vegetarians are generally healthier than the average American on the standard American diet, but you will be missing some major vitamins and minerals (especially if you are a vegan), and you will find it very difficult to keep your omega 6 and omega 3 in balance. Is it for environmental, sustainability, or spiritual reasons? All those are very valid and important reasons to some people, though I would argue that if you consume conventional grains, that the environment suffers a great deal (2). Consider adding dairy, and especially consider adding fish. Flax oil is an okay omega-3 additive, though it is high in phytoestrogens, and many people have poor conversion from flax oil (ALA) to the shorter-chain omega 3 acids we need to use in our bodies (found in fish oil). Watch your corn oil and omega 6 intake like a hawk. Soak/use traditional methods to prepare your grains and beans. Nuts can be pretty high in omega 6, so steer towards macadamia nuts which are somewhat higher in omega 3s.