Diet, Nutrition, and Our Public Health

Well, at long last I've put <ahem> e-pen to e-paper and come up with a second life treatise. This one gives the straight poop about the state of our public health. I hope that it will clarify and simplify what is otherwise a large and confusing issue.

Enjoy!

Overview

Diet is such a vital and basic human concern that most of us want to understand what effect different foods have on us, and why. The second third of this treatise addresses these concerns with an in-depth description of Nutrition. We'll cover only the well-substantiated scientific evidence at the level of our metabolic and digestive biochemistry, and then condense the information into a useful understanding of what happens when we eat. We'll also expose the most harmful myth around today, the Fat Myth, as well as explain some typical patterns we fall into.

The last third of this page will be devoted to trying to give a clear overview of the forces at work in Our Public Health, why they are the way they are, and how we can deal with them. In particular, we'll focus on being overweight, a health condition that affects two-thirds of American adults (in 2002). The United States Center for Disease Control has classified obesity and diabetes as twin epidemics. I am perhaps the least alarmist person in the world, but when the CDC gets uppity about something, I listen. In fact, I'm rather puzzled by the lack of public response. The CDC announces that AIDS is an epidemic, and there is an enormous public response; AIDS today affects less than 1 million people. In 2002, 44 million people were obese, 17 million were diabetic, and an equal number pre-diabetic. What's going on? Why have we suddenly been afflicted with obesity and diabetes in the last couple decades? Why are we so blase about the most damaging preventable health issue of our times? And most importantly, what can we do about it now?

Eat Sensibly and Drink Water

What Everyone Needs To Do For A Healthy Diet

Follow the US Dietary Guidelines

Sadly, the dietary message of the US government is unheard, treated with suspicion, and misunderstood. First, most people know about the Food Pyramid but not about the Dietary Guidelines. I personally didn't know about the Guidelines until age 31, after a friend of mine in the public health industry kindly pointed them out to me. That was five years after I first became interested in diet and health issues. The very sound, incredibly useful message of the US DHHS just isn't getting out there to people like us, because it is swamped out by the maelstrom of other information that we are presented with. (More on that later.) A more explicit reason why their message is unheard is because people don't even read the guidelines. They assume they already know what the Food Pyramid and the Guidelines are about, and they don't even read the damn thing. Have you clicked on the link above and carefully read the guidelines? Do it now! (Hyperbole aside, you really do have to read the Dietary Guidelines or otherwise a great deal of this page won't make any sense. Take your time; I'll wait for you until you're finished reading them. ;-)

Second, there was a period around 1980 or so where the United States Department of Agriculture (USDA) became little more that a stooge for the interests of large agricultural conglomerates. At the time, The USDA was responsible for the Dietary Guidelines and conflict of interest occurred, because its fundamental mandate was basically to promote US agriculture. Considerable favoritism happened and the official government diet message drifted away from being for the public health and toward the sales of large food corporations. As a consequence, many people (quite rightly) began to call into question the integrity of the recommendations (at the time being the Four Food Groups). With the advent of the DHHS all that changed, vastly for the better. It is an organization with a mandate solely for the public health... but sadly, still not completely free from the subtle influence of large food companies.

Which brings us to part of the reason why the message is misunderstood even when it is heard and trusted. Much of the official language the US DHHS uses is couched in ambiguity ("Be moderate in...", "Reduce your intake of...") because it is still susceptible to the pressure exerted by food lobbyists, who fight tooth and nail over commas. Altogether, it leads to a rather wishy-washy set of guidelines that is easily misinterpreted. If you carefully read the guidelines "between the lines" the message is clear; but on a casual reading it can easily be misunderstood.

Fortunately, I have no affiliation with anyone and can tell it like it is, in no uncertain terms. The Dietary Guidelines are the soundest basis to start from; here are the specific amendments we should make to them.

AVOID SUGAR. Added Sugar is Evil. It is The Enemy. Excess Dietary Sugar is an Anathema to All That Lives

So what do we mean when we say "added sugar"? First, it includes all processed sugar, that is, sugar distilled from natural sources. Something many manufacturers are doing nowadays to mislead buyers is putting ingredients like "evaporated cane juice" or "all natural citrus extract" on their labels. These are basically just ways of saying added sugar, but without using the word sugar. Second, added sugar can also take the form of foods naturally high in sugar. "Honey" and "molasses" are two good examples in this category. Third, and perhaps most subtle, is artificial concentration. Apples contain naturally occurring sugar and applesauce is typically partially evaporated, thus artificially raising the concentration of sugar in the final product. It is important to keep in mind that the source of added sugar makes no difference to its effect; most processed sugar ultimately comes from natural sources. From a sugar perspective, it's just as bad to drink freshly-squeezed all-natural orange juice as it is to eat sugar from a bag. It's the unnatural concentration of sugar in food processing that is harmful, not whether the source is "natural" or "processed" itself.

Why do food manufacturers even bother with all this? The reason is obvious but bears stating: sugar tastes good and sells more products. Adding sugar to any food product is a cheap and easy way to increase its taste appeal, and thus its sales and profitability. One of the most stable and profitable companies in the world is Coca-Cola. Their main product? Caffeinated sugar water. With their acquisition of Minute Maid orange juice around 1960 and their release of decaffeinated drinks they solidified their focus on: just sugar water. Even the Altria Group (formerly Philip Morris) adds sugar to their cigarettes. Here are a few other companies they own; notice the trend toward sugary snack foods? Sugar is big money and will continue to be added to food products because it is highly profitable. So added sugar is obviously good for food companies; is it any good for our health?

Added sugar is completely unneeded in our diet. There are six essential nutrients: 1) water, 2) protein, 3) fat / oils, 4) carbohydrates, 5) minerals, and 6) vitamins. Sugar is a form of carbohydrate; however, every carbohydrate gets broken down into simple sugar by the body, making any sugar that we intake unnecessary. The only reasonable use of dietary sugar is for the tactical, immediate regulation of blood glucose levels. That might apply to, say, a sprinter or vigorous athletes who dangerously deplete their bioavailable sugar; or alternatively, to diabetics who need to micro-manage their blood glucose and other people with similar medical conditions. I don't know about you, but those are categories that a) I don't belong to and b) I don't want to fall into. Let me even go so far as to make a bold, inflammatory statement that I'm certain I'll get sued for: there is mounting evidence of real health risks posed by the repeated excessive intake of added dietary sugar, specifically: obesity and diabetes and all the consequent problems they entail. So not only do we not need sugar in our diet, when taken in excess it is harmful to us. Sugar today is where nicotine was 30 years ago, and sugar manufacturers will bitterly protest that sugar is harmless, the same way that cigarettes manufacturers did. Too much sugar is bad for your health.

Drink Water Instead of Sugary Drinks or Alcohol

Milk is a special case worthy of mention. Many Americans are surprised to hear that dairy products are a major source of both sugar and fat in our diet. We are brought up to believe that milk is the perfect drink and it doesn't even occur to us that there might be tradeoffs involved with its consumption. Milk is the primary source of calcium in our diet, and it is also the most readily bioavailable one. As such, it does indeed promote the growth of strong bones and do all the wonderful things we've been told. However, there are many other excellent sources of calcium that do the exact same thing. So, if you are going to drink milk, drink skim milk only and avoid products with added sugar (like chocolate milk). There are also other milk options available since people became aware of lactose intolerance. Most of the common types of milk (rice, soy, wheat, etc.) are calcium fortified, though sadly most brands add sugar to enhance the taste. The verdict on milk is: it does a body good, as long as it's not filled with sugar and fat. For men, target two (2) dairy servings a day, which can be one tall glass of milk, the milk in your bowl of cereal, or the cheese on a pizza. For women, target the same but take extra care to supplement your calcium with other calcium-rich foods. For older people, increase the target to at least three (3) dairy servings a day and take explicit supplementation like multi-vitamins.

Beware falling into the "fortification hype" that many food advertisers are pushing today. It goes something like this: "Vitamin C is Good For You! It is a natural antioxidant that the American Antioxidant Association says everyone needs! Orange Juice is plentiful in Vitamin C! So, you Must Drink More Orange Juice!" This type of rhetoric is invariably one-sided and doesn't show a complete picture of a product; how many bacon products have you seen that say: "The American Heart Association says that Cholesterol and Saturated Fat is the leading Risk Factor of Heart Disease! Bacon is plentiful in these Bad Fats! You must Eat Less Bacon!"? Virtually everything we eat has some small amount of something that is good for us, but that doesn't make a food healthy overall. Make food decisions on the basis of the complete health picture, including both benefits and drawbacks. The way to guarantee that we have enough nutrients in our diet is to eat a diverse variety of healthy foods. If you are really concerned about getting enough vitamins and minerals in your diet, take explicit supplementation. Don't suck down gallons of sugary drinks in order to get them, because the huge drawback of bioavailable sugar well outweighs the benefits of exceeding your daily requirement of a couple vitamins and minerals.

Returning to the topic of sugar, another useful habit we can get into is to replace snack foods with fresh fruits. Just the other day I had a grape/cherry that was just as tasty as any snack food I've ever had! Fruits have a significant amount of natural sugar in them, so this strategy is aimed more at reduction than elimination. It also incorporates more fresh fruit into our diet, which is a desirable end for other reasons. Remember, sugar is evil no matter what the form; it's just that in the case of fruits, the several healthy benefits of vitamins, minerals, antioxidants, and fiber outweigh the single drawback of sugar. (And we'll also see that eating the actual fruit, filled with cellulose and fiber, slows down the uptake of the sugar and thus dramatically reduces its damaging effects.)

As a final note, added sugar is everywhere and is difficult to avoid. Added sugar pervades even the most innocuous of foods, things that we might not even think contains it, like bread or peanut butter. (In fact, read the label of any processed food and you can bet dollars to donuts that sugar is one of the first three ingredients.) And sugar is the key component in most modern drinks that make them a) so incredibly tasty and b) so incredibly bad for us. So completely eliminating added sugar won't be easy; in fact, it's downright impossible. However, striving to do so reduces our intake to a more reasonable level, which is what counts. There are many obvious forms of sugar (sugary drinks, candy, dessert, and sugary snacks) that if we avoid make a huge difference in our health.

Follow Your Mother's Advice: Eat More Vegetables

As I've been reading more about diet and nutrition I've noticed a lot of stereotypes we have about food. To illustrate:

When We Hear	We Immediately Think	But It Also Means
Carbohydrates	Bread, Cereal, Pasta, Rice	Sugars, Sugary Drinks, Candy, Milk, Cheese, Vegetables, Potatoes, Alcohol, Baked Goods, Confections, Processed Foods, Snacks
Protein	Meat	Fish, Eggs, Nuts, Legumes, Soy, Whole Grains
Fat	Meat Fat, Grease, Fried Foods, Butter	Oils, Cream, Margarine, Baked Goods, Non-Skim Milk, Processed Cheese, Nuts, Peanut Butter, Avocado, Salad Dressing, Mayonnaise
Fiber	Wheat, Oats, Bran	Fruits, Vegetables

Not too long ago America was the land of "Milk and Honey" where we had a "Meat and Potatoes" diet. Nowadays, we are a "Fast Food Nation" with a "Processed Food" diet. These epithets reflect our tendency to eat just a narrow range of foods: meat, starch, dairy, and sugar. The best way to improve the robustness of our diet is to eat a wider variety of vegetables and fresh fruits. More specifically, that means to replace grains with a variety of vegetables and fruits and replace meat with a variety of vegetable protein. Now, for the remainder of the this page we're going to focus on the macronutrient categories: carbohydrates, proteins, and fat. Remember: we can eat vegetables to fulfill each of these categories; they don't mean just bread, meat, and grease. And as we shall see, vegetables are a far superior form of macronutrients: because they have lower glycemic-index carbohydrates, stomach-filling hunger-reducing proteins, and heart-friendly cholesterol-free fat.

Replace Some Carbohydrates with a Variety of Proteins (more than just Red Meat)

However, that might be enough to recommend a radical weight loss plan but says nothing about whether it is actually healthy in the short or long term. We could lose weight by drinking nothing but concentrated citric acid all day, but we'll ruin our health as a side effect. Let's take a closer look at Dr. Atkins' fundamental propositions:

What Atkins proposes	What a doctor / nutrionist would respond	My take on the situation
Lowering carb intake is the key to weight loss.	Excessive intake of any kind has been conclusively linked to weight gain. The American diet has both too many carbs and too much fat.	Hmmm... all the statements seem true and not really in contradiction.
By replacing carbs with proteins we can lose weight.	The evidence is as yet inconclusive as to what the specific relationship between the caloric intake profile and weight gain or loss might be.	Actually, I think Dr. Atkins is dead on here. We eat way too many carbs in our diet, and carbs make us get fat, just like fat does.
So to lose weight adopt an extremely low-carb diet. "No-carb" is best.	The US DHHS recommends a minimum 45% carb intake because low-carb diets have been shown to be harmful under some circumstances.	Whoa! I'm siding with the nutritionist on this one. We need a balanced diet, and a too "low-anything" diet seems suspicious to me.
Feel free to eat lots of meat...	Bad fats, found in high quantities in red meat, are a major risk factor in coronary heart disease.	Hmm... protein doesn't just mean meat. We can replace carbs with a lot more than just red meat.
... any fats you want...	All bad fats (LDL, saturated fats, and trans fatty acids) have been conclusively linked to increased risk of coronary heart disease. The US DHHS recommends no greater than a 35% fat intake.	Once again, I'm firmly siding with the nutritionist on this one. Good fat is good, and bad fat is bad, and way too much fat overall is also clearly ungood.
... and don't even worry about calories!	Overall caloric intake is the primary indicator of weight loss or gain.	Okay, now I think Atkins is just trying a sell here. Though he can probably get away with it, since a low-carb, high-protein, high-fat diet will make us feel full, and therefore eat less calories anyway.

In summary, Dr. Atkins' fundamental proposition is a sound one: we should replace some carbs with proteins. However, many of the ancillary propositions are suspect. So I would recommend an a la carte approach to Atkins; adopt the main point but forego the suspect ones. As far as moderation goes, the Zone is a much more reasonable application of the Atkins philosophy than the Atkins Diet Plan is! I recommend an a la carte approach toward everything in life, not just diet plans: adopt those principles that seem helpful and reasonable, but avoid the ones that are too extreme.

Along these lines we should also eat a variety of proteins, more than just red meat. Dr. Atkins himself would be unlikely to caution you; however, droves of cardiac surgeons would. There are many diverse sources of protein: other meats (like pork and lamb), poultry (like chicken and turkey), fish (of endless varieties), eggs, nuts and nut butters, soy (and the growing ranks of soy products), legumes (i.e. beans), seeds (like pumpkin and squash), cream cheese, brewer's yeast, whey, and specific whole grains (like quinoa, spelt, and brown rice). Virtually every other source of protein has negligible health risk relative to red meat; some, like fish with essential omega-3 fatty acids, are downright wholesome. ;-)

A Note on "High" and "Low" Carbs I'd like to draw attention to what I feel is the single biggest misinterpretation of the Food Pyramid, namely what counts as one serving of grains. One serving is much smaller than what people think. It's a single slice of bread, a cup of cereal, or a half cup of pasta. Let's get even more specific. For the standard 2,000 calorie diet, no more than 1,200 calories should come from carbohydrates. That means one serving is around 120 calories or 30 grams of carbs. So a Big Mac (45g of carbs), Large Fries (50g of carbs) and Soft Drink (42oz Super Size has around 560 calories from sugar) is ~7 servings, most of which came from the sugary soft drink alone. In one meal we've met three-quarters (75%) of our entire recommended daily intake of carbohydrates! Assuming we want each meal to have around one-third (33%) of our carbohydrate requirement, that means fast food has over twice the carbs than is good for us. I know that visually having grains at the base of the pyramid seems to be free license to eat as much as you want of it, but that's not what's the Food Pyramid is proposing. It's suggesting no greater than 1,200 calories / 300 grams of carbs a day, comparable to what you get from a single fast food meal.

The DHHS does not recommend a "high-carb" diet, even though it might look that way from the food pyramid. By the same token, the dietary guidelines don't recommend a "low-carb" diet, either, even though we are told to reduce our carbohydrate intake. This imprecision, over what constitutes a "high" or "low" anything diets, is what I believe to be the number one point of confusion among diet recommendations today.

Change Your Fat Intake to Vegetable and Fish Oils and Target a 55g / day Intake Overall

• Most FAT IS GOOD for us - Fat enables the absorption of key fat soluble vitamins. Fat is the primary building block of all our cellular membranes. Fat is the most concentrated source of energy for the body. I won't bore you with the litany of other necessary uses to fat; trust me, the list is long and dietary fat is important.
• A diet with no fat would be extremely unhealthy - Fat is an essential nutrient. As you can see from the list above, we can't do without it. In fact, the US recommended intake of fat is 20-30%; around a quarter of our calories should come from fat! So why the hell are we constantly bombarded with the message to eat less fat?
• We eat too much fat (and sugar and carbohydrates) overall - The three components of your canonical fast food recipe. Of the standard 2,000 calorie diet, we should be receiving less than 600 calories or 65 grams from fat. A single combo meal has around 31g + 19g = 50g from fat, or around 75% of our daily fat allowance in one sitting. That's pretty heavy handed. Again, if we expected 33% each of three meals, then fast food has over twice the fat than what is healthy.
• We eat too much "bad" fat - Okay, okay, okay. Some fats are, in fact, downright no good for us. Let's examine which ones, and why. These last two facts are the reason we are constantly told "eat less fat", because we eat too much fat overall and specifically too much bad fat. However, that message does not mean eat no fat; it means we should reduce our fat intake to the 20-30% guideline, and our intake of "bad" fat should not exceed one third of that, or 10% maximum, or 200 calories daily.

Let's <ahem> chew the fat about fat. There are many different types of fat, some good, some bad. Let's review them more carefully:

GOOD FATS	BAD FATS
High Density Lipoprotein (HDL) - The so-called "good" cholesterol	Low Density Lipoprotein (LDL) - HDL's evil twin brother
Mono / Poly Un-Saturated Fats - Basically all vegetable oils, including nut and seed oils	Saturated Fats - Basically all animal greases and meat fats; palm and coconut oils
Omega Fatty Acids - Most fish and fish oils; flaxseed, canola, and soybean oil	Trans Fatty Acids - Formerly "hydrogenated" or "partially hydrogenated" oils. Usually found in shortenings and margarines (and the products made from them).

The number one reason why "bad" fat is bad for us is because it unfavorably alters blood cholesterol levels, thereby increasing the risk of coronary heart disease. So bad fat either lowers HDL, raises LDL, or raises / lowers both unfavorably. That's it. That's the only compelling reason to avoid bad fat, and it has nothing to do with our weight or our body fat. And while it has been conclusively shown that bad fats are bad for us, the verdict is still out on whether they are always harmful in a complete diet. There is ample evidence that other dietary factors (like good fat) counters the effects of bad fat; there is also a growing murmur that other factors (like small amounts of red wine) might somehow neutralize the harmful effects. Now that doesn't mean we can eat an unlimited amount of good fat, either. Coronary heart disease has also been conclusively linked to high tri-glyceride levels in the blood ("blood fat"), which we get from an excess of any type of fat, good or bad. We get dangerously high blood fat levels from too many carbs as well, since high blood glucose gets converted to blood fat. That's the reason why fast food meals, with twice the amount of both carbs and fat, are a heart-risk double-whammy. Both the excess carbs and excess fats get converted to a spike in blood fat, which is what causes the increased risk of clotting. And for the sedentary, all that blood fat usually gets converted to, you guessed it: body fat.

In any event, the course of prudence suggests that we make decisions on the basis of the best well-established facts, not optimistic speculation. What is known is that: a) all fats provide us with essential benefits to our health and b) bad fats increase the risk of coronary heart disease. Said differently, bad fats don't seem to provide us with any unique benefit over good fats, and good fats actually reduce relative coronary risk. So, we should eat good fats and avoid the bad. That means change our ingested fat primarily to good oils, specifically fish, olive, flaxseed, canola, and soybean oils. When cooking, favor these oils over butters and margarines, and avoid greasy foods in general, since meat fat is a major source of saturated fat in our diet. We also want to target a 55g / day overall intake of fats. Our fat intake can't be too low, and it can't be too high. It should always be around one-quarter of our overall caloric intake (around 25% +- 5%) for a person of optimal weight.

A Note On Sodium. By the way, the situation with sodium parallels that of fat. It is known to raise blood pressure, and high blood pressure is a major risk factor for heart disease. Salt is also an essential mineral that we need in trace quantities every day, but we eat way too much of it. So the essence of the message "reduce sodium" does not mean eat no sodium, it means reduce our intake to the recommended level ( less than 2.4g = 2,400mg daily). Unlike the case of bad fats, this doesn't even imply sodium is bad for us in any way; it's not. Too much sodium is bad for us, because it increases the risk of heart disease.

You may have already noticed a pattern among the way the Dietary Guidelines are misinterpreted. The guidelines say something like "eat less of", which people misunderstand to mean "eat none of". So why do they phrase it that way? One reason is that large agencies are conservative. They like to accumulate overwhelming evidence about something before making definitive statements. The Surgeon General's Office and cigarettes is a good example; the SGO's official proclamations were perpetually about five years behind the generally accepted evidence about the cancerous hazards of cigarettes. Even then, the agencies still make honest mistakes: the American Heart Association reversed its previously hard-lined stance against eggs once the discovery of two different forms of cholesterol had been established. Another reason for the relative phrasing is cultural timeliness. In the 1930s, the amount of fat the average citizen received in their diet was too low, and thus the message at the time was "Eat more fat!". Nowadays, we eat too much fat, and so the message has changed to "Eat less fat!". So bear that in mind when you hear an official "Eat more of" or "Eat less of" message; it's always relative to the statistically averaged diet. Always refer to the actual quantities being suggested and compare it to your personal intake.

The Optimal Caloric Intake Profile is 53C:20P:25F:2A +- 10:10:5:2% for BMI 22

Recommended Caloric Intake Profile (for Adults) from Officially Trustworthy Sources

Energy Source	% Intake	Calories / Gram	Suggested RDI for 2000 Calorie Diet	Intake Range
Carbohydrates	< 60%	4 cal/g	1200 cal = 300g	45%-65%	Note Carb range includes Alcohol
Protein	> 10%	4 cal/g	200 cal = 50g	10%-35%
Fats	< 30%	9 cal/g	600 cal ~ 65g	20%-35%
Alcohol	~0%	7 cal/g	0 cal = 0g	0%-5%	Note Alcohol is "considered" a Carb

Let's take a closer look at this chart. The first thing that you should notice is that there are ranges for each one of the categories. The US DHHS has always recommended a balanced diet, and one of the ways they've quantified what that means is by giving a range of intake for each of the macronutrients. Something that surprises most people is that there is a minimum intake of fat. No one recommends a no-fat diet; a no-fat diet is unhealthy for us, the same way a no-anything diet is unhealthy. Another popular misconception is what the carbohydrate and protein allowances mean. In the case of carbohydrates, the Recommended Daily Intake (RDI) is near the high end of the range, and thus is a maximum allowance. In the case of proteins, the RDI is at the low end of the range, and thus is a minimum requirement. Let's be more clear and create a Ideal Weight profile, smack dab in the middle of the recommended ranges:

Recommended Ideal Weight Caloric Intake Profile (for Adults) from The Kimster :-)

Energy Source	% Intake	Calories / Gram	Suggested RDI for  2000 Calorie Diet	Further Elaboration
Carbohydrates	53%	4 cal/g	1,060 cal = 265g	Avoid Sugar. Favor slow (low Glycemic Index) and light (low Glycemic Load) in vegetable form. (See below for more info on GI and GL.)
Protein	20%	4 cal/g	400 cal = 150g	Eat a diverse range of protein
Fats	25%	9 cal/g	500 cal ~ 55g	Eat mainly good fats. Favor vegetable and fish oils
Alcohol	2%	7 cal/g	40 cal ~ 6g	A token glass of (red) wine every day (for men) / every other day (for women) taken with a meal has many health benefits

It might be helpful to discuss in finer depth how confident we are about each of the percentages. The main point of dietary contention in our times is the exact proportion of carbohydrates to proteins necessary for fat loss that is reasonably safe for the dieter. Now, despite the humorous bravado of my recommendation above, I honestly couldn't say whether the precise numbers used above are the absolute best ones to use. However, they are definitely in the right ballpark. The exact numbers are in question, but the confidence in the range is high (55% +- 10% for Carbs, and 20% +- 10% for Proteins). My suggestion is to try the profile, tweak them a bit within the range, and see what works best for you.

On the other hand, everyone is in complete agreement about fats and alcohol. 25-30% of our calories should come from fat, and a small daily drink is good for our health. The US government is a sober bunch with respect to alcohol (the US once put Prohibition right into its constitution!) and it is only in the face of overwhelming evidence that the DHHS grudgingly admits that a token amount of wine per day with a meal is good for our health. On the other hand, the confidence of the fat guideline is rock solid and hasn't changed in the last hundred years; it was numerically quantified in 1990. No-fat diets are dangerous to your health. Don't do them, because no official source endorses it as a good thing under any circumstance.

As a word of caution, all profiles should be considered as a guideline only. Our dietary needs change significantly over the course of our lives. Infants have different needs than children, than teenagers, than adults, than older people. Athletes have different concerns than the average person, and pregnant women are in a class all their own. Medical conditions can also dramatically affect our intake profile, as well as impose specific dietary constraints (like allergies). In all cases, make sure that you are meeting your needs and instead of the "average" person's. Stay informed, consult your doctor or nutritionist, and most of all: use common sense.

Now the astute reader will notice that I put a qualifier in the title of this section, namely "for BMI 22". The BMI is an objective measure of our weight called our Body Mass Index. Roughly speaking, a BMI of 19 or under means you are underweight, from 20 to 24+ is ideal, 25-29+ is overweight, and 30 or over is obese. So "BMI 22" means a person of ideal weight, and the profile above is optimal just for those people. But wait. If this profile is healthy for a person of ideal weight, shouldn't it be healthy for everyone? NO! This is the main point of confusion that pervades every health recommendation today. The optimal caloric intake profile changes with our overall caloric intake; said differently, it's different for people of different BMIs. Restated yet again, if you are overweight or obese, you need a substantially different intake in order to be healthy. So, since weight loss is the topic of our times, let's talk about the subject in more depth.

What To Do To Lose Fat

A Survey of the Confusion

Who, What	Known For	Their Position in a Nutshell
Atkins, Cardiologist	Atkins Diet	Carbohydrates are the key factor in weight gain. Extremely low-carb high-protein diets are the best path to weight loss; they have the added benefit of reducing hunger.
Sears, Biochemist	Zone Diet	Insulin levels are the key indicator in weight gain. Keeping our insulin in "the zone" is the best path to weight loss, which is achieved through a low calorie diet heavy on fruits and vegetables with a careful balance between protein and carbs.
Bethea, Cardiac Surgeon	Sugar Busters! Diet	Sugar is the primary factor in weight gain. Avoiding sugar, eating low glycemic index carbohydrates, and lean and trimmed meats is the best path to weight loss, because of its moderation of insulin and glucagon levels.
Ayoob, Nutritionist	Professor, AECM	Calories are the primary factor in weight gain. Periodic fasting is a viable alternative to crash diets. Long-term weight management through lifestyle choices is the real issue.
Bruner, Bariatrist	President, ASBP	There are many factors to weight gain. No one diet is universal, and each diet plan needs to be tailored to the individual. Permanent changes in lifestyle are the only effective path to weight loss.
McDougall, Internist	McDougall's Right Foods	Fat is the primary factor to weight gain. A diet low in fat and high in complex carbohydrates is the key to weight loss. Exercise is an essential component to an overall weight loss program.
Ornish, Clinician	Eat More, Weigh Less	Diet composition is the key factor to weight gain. Plant-based diets low in fat are the key to weight loss. They have the further benefit of making you feel full.

Each of the dieting authorities had exceptionally compelling evidence on their side. After pondering their different positions for a very long time and weighing the evidence they presented, I've come to the conclusion that they are all essentially correct and mostly in agreement. Each view contains a vital aspect to the total weight loss and health equation that we need to take into account. Furthermore, while they seem contradictory at first glance, they are complementary in execution. I propose the safest course is to focus on the 90% area that the different nutritional authorities are in full agreement, and to ignore the 10% of contention for them to figure out at a later date. So we have our work cut out for us, namely, how we are going to integrate the "low-carb" and "high-carb" messages we are being given, and what "low-fat" really means.

From Chaos, Order

Now, looking at the survey above the first few speakers were talking about what our Fat Loss diet should look like, whereas the latter speakers were addressing what our Ideal Weight diet should be; all of them made reference to the Fat Gain diet. The three diets are not the same. However, they are crucially related to one another in that our Fat Loss diet must look like our Ideal Weight diet once we've reached our ideal weight. Our weight loss won't be effective otherwise. A different way of looking at it is that our weight loss plan should be a gradual and permanent movement from the Fat Gain diet we are currently on, through the Fat Loss diet, finally ending up at the Ideal Weight diet. Temporary "crash" diets have temporary results, because if we return to our previous Fat Gain diet, we'll gain back the weight. Our long term diaita determines what our weight will be. We must permanently change our lifestyle in order to permanently change our weight.

The fundamental confusion regarding diet recommendations is because everyone jumbles the three diet contexts together. For example, suppose I were a sedentary 30 year old male, 5'9", and I were taking in a constant rate of 650 calories = 73g of fat a day. Depending upon my total caloric intake, I'll have a different weight. Consider:

"Average" Male with 650 calories = 73g / day

Calories	1,937	2,379	2,821	3,250
Weight	149 lbs	183 lbs	217 lbs	250 lbs
BMI	22	27	32	37
Class	Ideal	Overweight	Obese	Really Obese
% Fat	34%	27%	23%	20%

So here's the question. Is 73g of fat a day a "low-fat" diet or a "high-fat" diet? If we were coming from the perspective of an Ideal Weight diet (for BMI 22), then clearly this is too high-fat. It's 34% of our intake, well above the recommended 30%. Whereas, the BMI 37 person on their Fat Gain diet would feel proud that they reduced their fat intake down to 20%, as low-fat as they could go and still be within the DHHS ranges. A Fat Loss dieter could be anywhere in between. But wait, it gets worse! Our caloric intake also changes depending on our activity. So a fat intake that would be reasonable for a moderately active person would be "higher-fat" for a sedentary person of the same weight but "lower-fat" for a vigorously active one.

Do you see the problem? When people refer to "high-fat" diets or "low-fat" diets it is inherently imprecise unless we know which type of diet they are referring to and the specific conditions under which it applies. The dieticians come from different perspectives and thus give apparently contradictory advice. What ends up happening, of course, is that we are left confused and wondering what we should actually be eating. This is one of the reasons why the US Recommended Daily Intake (RDI) is stated in absolute numbers. It doesn't matter who you are on what weight loss plan, you need at least a certain amount of some things in your diet. However, in some cases the RDI is a minimum requirement and in others a maximum allowance, and it isn't always clear which is which. So let's see if we can start clearing up the confusion.

Perhaps the most important thing to realize is the that the "low-carb" of the Fat Loss diets is around the same intake of the "high-carb" of the Ideal Weight diets. It's about 200g-350g daily (depending upon your gender, height, age, and activity) of low-glycemic index carbs, which are mainly vegetables like legumes and pulses. Everybody agrees on that part: sugar and "fast" carbs like candy, snack foods, sugary cereals, and processed breads are key ingredients of the Fat Gain diet and should be avoided. Another thing that everyone is in agreement about is that too high a fat intake (over 65g-85g depending) is bad for you. Note that these numbers are absolute intakes. The confusion arises because 250g of carbs is "low-carb" to a Fat Loss diet but "high-carb" to an Ideal Weight diet; similarly for fats. As we shall see, when we take a close look at the actual intakes different sources recommend, the "high" and "low" messages are more in agreement than they are in opposition.

Overview of an Effective Fat Loss Approach

What does this approach look like? Let's take a broad look at what we need to do to lose fat and eat healthier:

Typical Diets

Diet Type	Fat Gain		Fat Loss		Ideal Weight
Physical Activity	Sedentary		Moderate		Active
Total Calories	High = 3,000+		Reducing from 3,000 to 2,000		Ideal ~ 2,000
Carbs: % = cals	55% =	1650+	27% to 40% =	800	55% =	1100
Proteins: % = cals	15% =	450+	53% to 30% =	1600 to 600	20% =	400
Fats: % = cals	30% =	900+	20% to 30% =	600	25% =	500
Has Rich Foods	Often		Sometimes, but decreasing		On Special Festive Occasions
Intake Focus is...	Calorie-dense Food (Carbs/Fats) and Drink (Sugar/Alcohol)		Hunger-satiating protein-rich Foods and Water		Highly-filling calorie-sparse Foods (Vegetables/Fruits/Whole Grains) and Water
Typical Foods (Large quantities Daily)	Sugary Drinks, Fast Food, High-Carb Snacks, Breads, Pastas, Red Meat, Dairy, Creamy Sauces / Soups, High-Calorie Dressing, Bad Fat		Fish, Poultry, Non-Red Meat, Legumes, Lentils, Nuts, Pulses, Hummus, Hearty Soups, Good Fat		Water, Vegetables (Carb and Protein), Fruits, Salads, Whole Grains, Fish, Tasty Low-Carb Sauces / Soups / Dressings, Good Fat
Occasional Foods (Moderate quantities Daily OR Every few days)	Fried Foods, Alcohol, Non-Red Meat, Poultry, Salads, Low-Carb Sauces / Soups / Dressing, Good Fat		Red Meat, Breads, Pastas, Fruits, Dairy, Carb-Vegetables, Fast Food, Creamy Sauces / Soups, Bad Fat		Dairy, Breads, Pastas, Poultry, Non-Red Meat, Hearty Soups
Rare Foods (Small quantities Daily OR Every few weeks)	Fruits, Vegetables, Fish, Legumes, Lentils, Nuts, Hearty Soups		NO Sugar, NO Alcohol, Fried Food, High-Carb Snacks		Sugar, Alcohol, High-Glycemic Carbs, Fried Foods, Fast Food, Red Meat, Creamy Sauces / Soups / Dressings, Bad Fat

The general dietary approach we will adopt is gradual reductions or replacements undertaken in tactical campaigns. Many people will propose that the best way to lose weight is to make drastic alterations to your lifestyle. The rationale behind it isn't that unreasonable, namely, that we need to "shake up the box" in order to get different results. I heartily endorse a completely different path, namely the successive incremental improvement of your lifestyle. Small changes give your body time to adjust to new conditions, making the likelihood that the weight you lose will stay off. I suggest a steady weight loss of 1 pound every 5-10 days; too fast, and you might yo-yo; too slow, and you aren't making enough changes that make a difference. This philosophy of making small, frequent changes also increases the probability that you can successfully implement your diet plan. Focus on only one, tactical change per week. The general that fights a battle on too many fronts loses the war. Whereas, if you keep your focus on one thing at a time, you are almost guaranteed to make the changes you want. Make small changes, each one a net improvement in your life, and make them frequently, and within a year they will have accumulated to a major health benefit that pays off for the rest of your life. So what if you "only" lose 36 lbs a year; you've lost that fat forever.

Let's illustrate why gradual reductions are more effective than drastic changes with an example. If you currently drink regular milk then you'll want to move to skim milk. If you took the drastic approach and switched abruptly one day, then skim milk will be horrible. It's like drinking chalky blue bile, and you will forever after have the association of ickiness with skim milk. Whereas, if you staged down to 2% milk for awhile, then to 1% after you get used to it, and then finally to skim milk, each stage will seem like a minor change. In fact, when done gradually over a few months by mixing the milks together (regular, 1/2 regular + 1/2 2%, 2%, 1/2 2% + 1/2 1%, 1%, 1/2 1% + 1/2 skim, skim), most people don't even notice the difference. If you get used to skim milk in this way and then drink a glass of regular milk, you'll be in for a surprise. Regular milk is like choking on liquid lard; it's repugnantly rich and caustically creamy. So the question is: which association do you want? Personally, I believe it is more useful to associate good tastes with the foods that are healthy for us and bad tastes with the ones that aren't. No small part of the reason why it is so difficult for us to change our diet is because we've associated such good tastes with unhealthy foods (high-sugar, fast heavy carbs, high-fat). In any event, we should favor gradual replacements over drastic change for no other reason than it is more likely to work. So don't worry about switching the worst foods to the healthiest ones right off the bat: focus more on gradual replacements each of which is a small improvement.

Here's the outline of the overall weight loss campaign we'll be following:

1. Phase 1: Recon, Planning, Logistics, And Mobilization - The first step in any war is to gather intelligence, set realistic goals, describe practical implementations, and enlist aid. This serves as a good paradigm for your War on Fat as well.
2. Phase 2: Water, Nature's Pure Refreshing Drink - We'll be staging our campaign according to what gets us the most benefit for the least effort. Drinking water instead of sugary drinks and alcohol gives us the greatest return on the smallest alteration in diet, and thus is our first tactical focus.
3. Phase 3: Open War on Sugar - In order to lose weight, we'll need to eliminate fast heavy carbs (high glycemic index and load) in all their various forms. The primary emphasis is on sugar, but this also includes most processed breads and baked goods as well.
4. Phase 4: Enjoyable Physical Activity - Taking enjoyable, fifteen minute constitutionals after meals will be the core of our physical activity program. We'll also discuss other pleasurable physical activities like dance, sports, and sex.
5. Phase 5: Changing Carbs for Proteins - This will be the longest phase of our weight loss program. It entails the steady replacement of carbs for protein, as well as the gradual overall reduction of caloric intake. Perhaps paradoxically, as long as we avoid high fat meats, our fat intake will take care of itself.
6. Phase 6: Mopping Up - Once we've reached our target weight, we stop making changes to our diet. What we're eating becomes our diet for the rest of our lives. We'll then replace a bit of fat for carbs to restore our profile to the DHHS recommended range and keep our weight stable.

Let's take a closer look at each phase.

Preparation: Recon, Planning, Logistics, And Mobilization

Something we can start doing right now is to construct your individual Ideal Weight diet profile and find two key Fat Loss parameters: your Target Fat Intake (TFI) and Target Carb Intake (TCI). Here's how you find them:

• Step 1: Decide on a Target Weight / BMI - You can do this one of two ways. You can decide beforehand what weight you'd be happy with, or you can lookup your ideal weight in a BMI chart. Take your height in inches and simply lookup what the 22 column says. There are slightly more sophisticated BMI calculators out there, but the chart is close enough.
• Step 2: Find your Total Caloric Intake at your Target Weight - The best way to do this is through a BMR Calculator. Fill out all the information and look at your Total Energy Requirement in calories. It should be about your weight in pounds x 12-17 (depending upon your physical activity). We'll call this your Target Total Intake (TTI).
• Step 3: Construct Your Ideal Weight Caloric Intake Profile - This is simple. Just multiply the your Target Total Intake by 55%, 20%, and 25% for your Ideal Carbohydrate, Protein, and Fat caloric intakes, respectively.
• Step 4: Find your Target Carbohydrate and Fat Intakes (TCI and TFI) - Once again, simply take your Target Total Intake and multiply by 40% and 30% to find your TCI and TFI, i.e. TCI = TTI x .4, TFI = TTI x .3. We'll want to know this in both calories and grams, so we'll want to divide by 4 and 9, respectively, i.e. TCI_grams = TCI / 4, TFI_grams = TFI / 9.

• Step 1: Looking at the chart my Target Weight is 166 lbs (i.e. column BMI = 22 of the 73 inch row).
• Step 2: My Total Target Intake is 2,327 calories, since I do about 240 minutes of Very Light activity a day and 30 minutes of Light activity. I'm just going to round this to TTI = 2,300 cal for simplicity.
• Step 3: My Ideal Caloric Intake Profile is 1,265 Carbs : 460 Protein : 575 Fats. Ultimately, when everything is said and done, that's what I want to end up eating. In grams, my Ideal Weight intake profile is 315g Carbs : 115g Protein : 64g Fats.
• Step 4: My TCI is (TTI = 2,300) x .4 = TCI = 920 cal and TFI = 690 cal. In grams, that's 230g Carbs and 77g Fat.

The last preliminary step we'll want to take is to involve your close friends and loved ones in your weight loss program. In fact, if you know someone else that also wants to lose weight you may want to consider a "buddy system". You could share information with one another, support each other, and keep the other strong when one's will is weak. Buddy systems are very effective for exercise programs, and diet programs are no different. Forming a support network of any kind for your weight loss project is a significant factor in improving its chance of success. It's almost a catch-22. Those people who keep their diets secret almost expect them to fail... and those same dieters might have succeeded had they made their intentions public and gotten support from their loved ones. Enlist aid. Make no mistake, the first couple steps that you will have to take will be a battle, and it always helps to have allies on your side. If you have a persistent medical condition, one of your indispensible allies is your doctor; always make sure to consult your physician before undertaking any major change in diet.

Test your Liquid Mettle and Drink Water

As a practical guide to implementation, I'd suggest a draconian phase-out staged over three weeks. Roughly estimate how much you drink in sugary drinks and alcohol. No need to break out calorie charts; a ballpark is fine. This week, drink one-third less than that. Next week, another third less. The third week, you should be sugary drink and alcohol free. Make sure that you approach the phase-out from as many angles as possible. When you shop don't buy any sugary drinks or alcohol. During the third week, give away all your stashes of sugary drinks and alcohol to friends (who will understand because you've already told them about your weight loss program). If you live with others who drink sugary drinks, see if you can convince them to join you; if not, physically separate their drinks from yours. Once you've taken the plunge to replace sugary drinks and alcohol with water, make no exceptions. Don't order combo meals anymore. Don't take social drinks no matter what the pressure. Even small amounts will inhibit weight loss.

Most people do not drink enough fluids in general and water in particular. The average person in a temperate clime should be drinking at least eight (8) 12-oz glasses of water a day. That number is further modified upwards for weight and activity, or for a dryer climate. To give you a good feel for what 96oz means, that is almost 3 Liters of water, or one and a half 2 Liter bottles per day. As a good test of your own intake, fill up a 2L bottle at work in the morning and see whether you finish it over the course of the workday. Another good rule of thumb is the hikers test of hydration: the darker your urine, the more you need water. Properly hydrated urine is clear or tinged yellow at worst; moreover, when fully hydrated it is common to urinate every 2-3 hours. In our quest for weight loss it is better to have too much water than too little; it makes us feel more full and helps in other ways. The only stipulation is to drink water away from meals, i.e. avoid drinking water while you are eating and immediately before or after. If you are comfortable with it, drink hot or warm water away from meals; much of the therapeutic effects of tea on digestion are from the hot water by itself. It's also no accident that the practice of having a hot soup before a main meal was independently developed all over the globe.

Now, just because you are drinking water instead of calorie-laden drinks doesn't mean that you have to drink only water. Many herbal teas are very tasty, as well as different coffees. (Save the war on caffeine for a later date. One thing at a time.) Vegetable juices like fresh carrot juice have little or no sugar, though be wary of store-bought brands that might blend the carrot juice with other sugar-rich juices. Just among water there are several different classical types: mineral, spring, seltzer, soda. Today there is a wide assortment of new water products, like oxygen or vitamin enriched, distilled water, or filtered water. My personal suggestion is to go the filtered tap water route. It is the most economical in the long run, and there is a certain convenience to being able to filter large quantities of water instead of having to carry around gallon jugs.

Depending upon your particular situation, drinks may or may not be the major factor in your caloric intake. If they aren't, accounting for, say, a mere 200 calories per day, then keep your food intake steady during the phase-out. However, if calorie-rich drinks account for more than 500 calories per day of your Fat Gain intake, then eat more foods as you switch to water (i.e. don't exceed a 500 calorie change in intake at any given time). In all cases, make sure your total caloric intake from start to finish doesn't increase. You can expect a rate of return over the next 2-3 months of a couple pounds of fat lost for every 100 calories you decreased, just from these initial changes alone. So if you were a heavy sugar or alcohol drinker, you should lose about ten pounds from drinking water alone.

Declare Open War on Sugar and All Fast Heavy Carbs

Let's try to get a feel for carbohydrates from a glycemic perspective. The ultimate resource on the web is hands down Rick Mendosa's Site; here's the most comprehensive glycemic list I've seen yet. Sadly, the picture is pretty complex. For some foods, it's clear that they are good or bad for us (beans: good, sugary cereals: bad). For other types of food, the GI and GL seem crucially dependent on the specific species of food and its special preparation. For example, American Russet baked potatoes are ludicrously fast and heavy carbs (GI 85, GL 25). However, Type NS8 White Potatoes boiled and then baked are much better for us (GI 50, GL 13) as mediumish carbs. So are baked potatoes good for us or bad for us? The answer: some types are, and some types aren't, and how you prepare them makes a difference. There's a similar situation with white rice. Some types and preparations are very bad for us, while others are quite good. So in many cases we must carefully scrutinize exactly what we are eating and how we are eating it in order to be able to make a firm statement about how fast or heavy the carb is.

That being said, we can still come up with some general guidelines. Here's a simpler (though less accurate) picture of things:

Glycemic Index (Glucose = 100)				Glycemic Load
Type	GI	Example Foods		Type	GL	Example Foods
Fast	90+	Simple Sugar, Sugary Cereals, Cornflakes		Heavy	20+	Confections, Most Candy / Snacks, Pasta, White Bread, Sugary Cereals, Cornflakes, Bagels, French Fries
Med Fst	75-89	Most Candy / Snacks, French Fries, Donuts, Waffles		Med Hvy	16-19	Most Cereals
Medium	60-74	Most Cereals, Most Baked Goods, Bagels, White Flour, White Bread		Medium	12-15	Most Baked Goods
Med Slw	46-59	Pasta, Rye Bread, Wheat Bread		Med Lgt	8-11	White Flour, Waffles
Slow	<=45	Beans, Lentils, Nuts, Fruits, Skim Milk, Bran Cereals		Light	<=7	Beans, Lentils, Nuts, Fruits, Skim Milk, Bran Cereals, Rye Bread, Wheat Bread

Replacing calorie-dense, fast, heavy carbs in your diet is the central crux of fat loss. On this point, every nutrition authority agrees, including those diet gurus that propose a low-fat high-carb diet. Now, some approach it from a calorie perspective and say we must reduce our overall intake. Others approach it from an insulin perspective and say we must reduce our fast heavy carbs. Still others focus just on carbs themselves and say we should limit all carbs. However, they are all saying essentially the same thing: Favor sparser, slower, lighter carbs, which invariably means vegetables and fruits. Now, each measure (calories, GI, GL) gives a useful picture but only a partial one. However, it's illuminating when you combine the three and find the area where they overlap. The worse thing imaginable for us? Sugar. Sugary drinks are high calorie and calorie-dense. Sugars have the highest GIs and are the fastest carbs. Sugar-rich foods tend to have high GLs and are generally too heavy. Declare open war on sugar. It is the crucial supply for your body fat, and you need to cut the supply lines to win your War on Fat. Eliminate added sugar from your diet in all its various forms. This is almost the verbatim message of the Sugar Busters! diet.

Keep in mind that we really want to be replacing _all_ our fast heavy carbs, not just sugar alone. Sugar just happens to be the best "poster child" to focus on, since it epitomizes all that is bad for us from a Fat Loss perspective. So let's talk about what we are trying to accomplish in this phase. The goal is to change the composition of our carbohydrates by embracing a plant-based diet. So, we want to trade carb calories from fast heavy carbs and replace them with slower, lighter carbs. Keep doing that, and make sure your overall caloric intake doesn't increase. Remember, the replacements you are making are ones you are going to be eating for the rest of your life. So weigh the considerations carefully. If something you really really want is too fast and heavy, eat it half as often. Don't worry about making huge sweeping changes to your diet: make small changes, each a net positive benefit. Now, for those of you out there like myself with a mean sweet tooth, make the transition using fruits. Don't go cold turkey on sweets all at once; trade them up for healthier sweets like fruits. Eventually, we want our diet to be extremely low in sugars and other fast heavy carbs, and plentiful in slow light carbs. If your overall caloric intake reduces during this phase, fine; but don't be concerned if it stays the same because you are gorging yourself on fruits and vegetables. Even with the same caloric intake you are bound to lose another 5-15 pounds from just this change in carb composition.

Now, in this quest to eat healthier I want to caution you about a fundamental flaw we have in our dietary reasoning. It goes something like this: "If some is good, then more faster must be better.". Let me give you a perfect example. Oranges are a great healthy fruit. They are generally slow (GI 31-51) light (GL 3-6) carbs filled with vitamins and important fiber. Oranges are good for us. Oranges concentrated in the form of orange juice is a completely different story. Orange juice is a faster (GI 46-63) heavier (GL 9-15) carb, usually without the fiber. Orange juice is worse for us that oranges, NOT better. Get out of the mindset that condensing things down into a little pill is the optimal form of nutrient delivery. Juices and pills give us concentrated forms of vitamins and minerals, it is true, but that is a one-dimensional view of diet. Actually eating the foods that were vitamin-rich to begin with has other tangible benefits, not the least of which is forcing us to slow down and pace our caloric intake. "More faster" is worse for us, not better. Accept bulk and inconvenience as a part of your diaita. Slow down, stop wolfing your calorie-dense food, and enjoy the stuff you are eating more. This is where Ornish is coming from in Eat More, Weigh Less.

Now, along these lines we should begin adopting permanent changes in the way we eat. First, stop eating when you are full. If you were to take in all your calories in eight small meals over the course of the day, it will be much better for your blood sugar than three walloping meals. Moreover, it gets you used to smaller portions. Eventually what will happen is you will eat fewer small meals a day, until you are left with something resembling three square meals. Second, dine with company. The ancient Greeks believed the highest form of civilization was community dining. Get a lunch buddy. Go out with friends. Dine with your family more (if you can pull that off). Talking with other people during meals naturally slows down the pace at which we eat. More to the point, it's fun, and that's precisely what we want our life to be filled with. Third, chew your food thoroughly. Many people are surprised by how many benefits we get from simply chewing our food until it becomes a mushy paste. We reduce indigestion and gas, promote the production of salivary enzymes, feel more full with less food, and slow down our caloric intake. I'm not proposing that we psychotically count to 32 for each mouthful. However, I would suggest taking smaller bites and giving ten more chews. It feels weird at first, but it's well worth the effort. And there are other reasons why the "four-chew wolf-it-down" method is less healthy for us than taking time to chew our food.

Get Off Your Fat Ass And Enjoy Life More

Let's adopt a completely different approach. Do the things that are really important to you Now! and accept that the most enjoyable parts of our life are inconvenient. True enjoyment comes at the cost of time and effort. Consider the afternoon picnic with a loved one. It takes a lot of time to prepare. It wastes hours of time. It's inconvenient to get to a good spot. And you know what? If you stayed focused on the quality time you are spending instead of what you aren't "getting done", it's a truly pleasurable human experience that you'll remember for years to come. The time pressure to "get things done" is only in our minds. A lot of us are worried about the world passing us by. We should be more worried about what's actually happening, namely, that our lives and the chance to enjoy them is daily passing us by. Seek to enjoy life.

So what does all this philosophizing have to do with our weight loss? We need to spend more time on enjoyable physical activity. The recommended daily activity was recently doubled to a full hour per day. Does this mean we should all start hitting the gym? Well, not really, not unless you are one of the fortunate few like my brother (read: freaks :-) that actually enjoys going to the gym all the time. What we should do is make time for activities that we enjoy doing. Perhaps the gravest problem with our convenience-ridden lifestyle is that we've forgotten how tremendously pleasurable it is to move our bodies when we are fit and healthy. And when we couple our activity with human social contact, we have a potent recipe for sheer enjoyment. The reason why we aren't more active is usually a mental one, not a physical one. We have to reorient our attitude toward exercise to become more active. "Exercise" doesn't mean a boring, repetitive, exhausting thing you force yourself do in the gym; it means the pleasant, engaging, active things you enjoy doing in your life.

So, let's talk recommendations. First, the timing of our activity is important. We'll get the most benefit by doing some light exercise ten minutes after we've eaten. The recommendation of the American Diabetes Association is to take a fifteen minute walk after every meal. This can be a light constitutional; the benefit we get is from the timing, not the intensity. Now, since you are going to be doing a lot of walking, I suggest coupling it with something you really enjoy doing. For me, I like reading, so I've trained myself to read while walking. Maybe you really like music but don't have the time to listen to it in your "hectic schedule". Buy a CD Walkman and now you can immerse yourself in a whole CD every day. Perhaps you haven't been able to spend quality time with your family. Take walks with your spouse and / or children to fun spots in the neighborhood. If you are fortunate enough to live near a rustic setting, explore the wilderness; for the urban bound, take a walk in the park. If we think of our need for exercise as an onerous burden that we must dutifully fulfill, then we will never enjoy doing it. But if our perspective on activity is that it is valuable time we can use for the things we've always wanted to do, we not only get the exercise we need but we'll also be happier. And most importantly, we'll rediscover the joy of using our bodies, which is a big part of this whole health and fat loss thing to begin with. Fat Loss is about more than just "reducing the risk of heart disease by 22.62904%".

Now, outside of our after-meal constitutionals, we should seek to increase our physical activity in other ways. The approach is the same: find things that you really enjoy doing but always thought that you didn't have the time for. The best activities are social ones, because they are more likely to be engaging and pleasant. Each of us is different so there are no universal prescriptions. However, three big categories that most people are attracted to are dance, sports, and sex. Dance is great physical exercise that most dancers swear by. For the competitive, there's nothing like a little sports challenge to get the blood moving. Plentiful sex with our partner is rousing, enjoyable exercise. And there are other relational benefits that come from slowing down, smelling the roses, and spending quality romantic time with your spouse. Start creating the active life that you want to live for the rest of your life, today. You have time for it, right now.

Exchange Carbohydrates for Filling Proteins

Here's where using the numbers comes in handy to give us a proportional feel for things. Referring back to the Typical Diets chart the typical Fat Gain diet has too high a carb and fat intake. In order to change our Fat Gain profile to the Fat Loss profile, we will need to more than halve our carb intake and replace it with more than triple our current protein intake. Depending on your particular situation, the factors may be even larger. Trust me, this will feel muy loco. We are so used to carbs as a staple and protein as a rarity that it will seem like you are pigging out all the time. Well, pig out. Somewhat counterintuitively, stuffing ourselves with protein will cause us to lose fat. And if we make those sources mostly calorie sparse ones like vegetable protein, then we'll feel full and sated all the time. Minimizing hunger is a major factor in the success of a Fat Loss diet.

The approach is very much the same as before, namely, slow and tactical. First, calculate how much your current carb intake differs from your Target Carb Intake. In the example above, it would be 1650 - 800 ~ 850 calories ~ 212g. That how much our "typical example person" needs to change into protein. So, make continual replacements in your diet to do that. As a general guideline, I'd suggest a steady 200 calorie replacement every week, i.e. replace 50g of carbs for 50g of protein every week until you are under your TCI. You'll notice weight loss within the first week. Now, once your carb intake is steady, then work exchanging fat intake to protein to meet your Target Fat Intake. Most of the time this is a non-issue at this point, because high-carb and high-fat foods are usually found together; when you reduced your carb intake you were likely reducing your fat intake as well. However, in the rare case where you still have a high fat intake for some reason, lower that as well.

You've now made the conversion to the full Fat Loss profile, and you will drop pounds steadily. We are nearing the heart of the highly controversial but undeniably effective Atkins diet: low-carb high-protein diets make people lose fat. Now, as you lose weight, you'll want to decrease your protein intake as well. As usual, slow and steady wins the race. I would suggest making micro-changes to the intake to keep your fat loss rate steady. If you are losing it to quickly (nearing one pound every 5 days), then slow down your protein descent. If you are losing it too slowly (almost 10 days per pound), reduce down your protein intake by 100 calories or so. Lather, rinse, repeat. The Fat Loss you should expect is dramatic near the beginning and slower near the end. That means that as you approach your target weight it might take substantially longer to lose a single pound. At that point, I don't think anyone will care. If you've just lost 60 lbs in a year, you can probably wait a couple months for the last 5 lbs.

Trimmin' The Fat aka There Is No End

So is the diet over? No! This is it. Whatever you were eating when you hit your target weight is what you should continue doing for the rest of your life. It's the diet that will keep you at your target weight indefinitely. But if you regress to your previous Fat Gain diet, then you will put the weight back on. It's that simple. You have adopted a new diaita, not just a temporary fad diet. Enjoy it!

Now, as you move forward from this point, you'll want to make sure that you maintain your target weight. As long as you keep your intake about the same, it shouldn't be a problem. However, if you begin drifting up again the solution is similar to the above phases. Replace carbs and fats with proteins until you reach your TCI and TFI. Lower your weight, and then recorrect to your Ideal Weight profile. Of course, you now have some more flexibility than before, so I suggest tweaking your diet within the recommended ranges until you find something that works best for you.

Excelsior!

Nutrition

Preliminaries

Our bodies are the ultimate authoritative source of all things nutrition, so let's see if we can understand them. Onward!

Bio-Chemistry Made Easy

Perhaps the single most important guiding principle of all biochemistry is that complex biochemicals are constructed from simpler building blocks. Here's a chart of building blocks that will get us started:

BioChemical Building Blocks

Complex Chemical	Proteins	Carbohydrates Starches	Fats Oils	DNA
Simpler Building Block	Amino Acids	Simple Sugars (Glucose)	Fatty Acids (Glycerides, Glycerol)	Nucleic Acids (A, T, C, G)

There are three major flavors of combining building blocks:

1. A Polymer is a big molecule of basically the same building block repeated over and over. This building block is called a monomer: mono = one, poly = many. Example: Glycogen is a polymer made of glucose.
2. A Sequence is a long chain of the same class of building block strung end to end. It is often accompanied by a substrate backbone that it latches onto. Example: Protein is a sequence of amino acids. The great biological discovery of the twentieth century was that nucleic acid sequences govern the creation of amino acid sequences, i.e. our genes make proteins.
3. An Arrangement is basically any other combination, or very short polymers and sequences. Example: Body Fat is a Tri-Glyceride, which is a glycerol center with (3) three glycerides hanging off it. As a shorthand, people write little equations to indicate an arrangement. Examples: {Table Sugar is Sucrose = Glucose + Fructose}, {Milk Sugar is Lactose = Glucose + Galactose}, {Malt Sugar is Maltose = Glucose + Glucose}.

Secrets of our Metabolism Revealed!

Overview of the Metabolic Energy System

Take Energy Inputs	Do Stuff To Them	And Service our Constant Energy Needs	By Maintaining...
Oxygen Carbohydrates Fats / Oils Protein Alcohol	Circulate Materials Use Materials Digest Food Store Excess Alter Blocks (as needed)	Maintaining our Basal Metabolic Rate is where most of our calories go. That includes Thermal Regulation (governed by thyroidal hormones), Brain Activity (a big consumer of blood sugar and blood oxygen), and Cellular Function, as well as other stuff like our heartbeat. In addition, our Smooth Muscles need energy for movement.	...Good Circulation, especially of the blood. ...Constant Body Temperature, despite environment and activity. ...Constant Blood Sugar Level, despite eating and fasting. ...Hormonal Balance, through self-regulation systems. ...Ample Stores, especially of energy rich fat and muscle.

We can think of our metabolism as a big molecular factory. With respect to food, it takes raw ingredients in the form of dietary inputs, breaks them down into their building blocks, and then uses those blocks for bodily function. Our metabolism is constantly taking those blocks and reconstructing new complex molecules out of them, as we need them. (The original "manufacture on demand". :-) Something that may surprise you (it surprised me!) was that the body can even alter some fundamental blocks into others. It can change some amino acids into glucose (via gluconeogenesis), or either amino acids or glucose into some fatty acids (via fatty acid synthesis).

However, our body can't change anything into everything. What a particular organism can change into what is called a metabolic pathway. Not all creatures have all pathways (for example, plants can synthesize sugars but animals can't). This gives rise to the idea of essentiality; a nutrient is called essential if the body can't construct it from simpler components on its own. That's the reason why proteins, fats, and carbohydrates are essential nutrients: we can't make most amino acids, some fatty acids, or glucose. We _can scavenge_ glucose from some large blocks, and some acids from others, but that's deconstruction of a larger thing into a smaller one, not building it from simpler materials. Now, of all the available pathways not all are active at any given time. Which pathways the body chooses to activate at any given time is called metabolic regulation, and the messages that determine how much a pathway is active is usually done through hormones. (BTW, we're going to ignore the very important role our nervous system has in metabolic regulation, since it would complicate an already over-complex description.) We'll be focusing later on the lipolytic pathway (the breakdown of body fat into fatty acids and glycerol) and which hormones regulate that process.

Here's another chart to give you a feel for what gets converted into what:

Overview of the Digestive System's Main Energy Pathways

Energy Input	Carbohydrates			Protein			Fats / Oils			Alcohol
Gets Broken Down Into	Glucose			Amino Acids			Glycerides / Fatty Acids Glycerol			Changed by liver...
And Stored As	Glucose	Bound Glycogen	Glycogen	Amino Acids	Body Structure	Amino Acids	Tri-Glycerides ("Body Fat")		Bound Fatty Acids	Not Stored
In (By)	Blood	Muscle	Liver	Muscle	Throughout the body	Muscle	Adipose cells ("fat" cells)		Muscle	N/A
And Can Become	Blood Fat	Never releases	Glucose	Glucose Precursors	Ketones		Fatty Acids	Glycerol	Never releases	...into Acetate
Which Ends Up As	Blood Ketone Bodies		Blood Glucose		Blood Ketone Bodies			Blood Glucose		Blood Glucose

Now, let's talk about the overall picture of nutrition. In general, the body uses the big three macronutrients (carbs, fats, protein) as fuel for energy, and the big three micronutrients (vitamins, minerals, water) as crucial helpers to maintain the body. More specifically, vitamins and minerals (and proteins the body manufactures all the time called enzymes) act as chemical catalysts. That means that they make the body more efficient, usually by speeding up (or slowing down) specific metabolic pathways. That's the essence of what we need nutrients for; here's a slightly more accurate picture:

What the Body Does	What the Body Normally Needs for It	What Else It Can Use
Produce Energy	Carbs, Ingested Fat, Proteins	Alcohol, Body Fat, Cannibalized Body Tissue
Create Body Structure	Proteins, Fats, Water, Minerals
Maintain Cellular Processes	Amino Acids, Vitamins, Minerals, Water	Cannibalized Cells

We'll be focusing our attention onto macronutrients and energy production, since that's the part most relevant to weight gain and loss. Energy in the body is produced by oxidation, which is when we combine carbon with oxygen. Carbs get broken down into simple sugars, specifically glucose, fats get broken down into both ketone bodies and glucose, and proteins can be broken down into either a ketone body or a glucose (a single amino acid can become either type, but must decide between the two). Every cell in the body can use either ketone bodies or glucose for its energy needs, with the exception of our nervous system and red blood cells, which can only use glucose. [Aside: The brain is the single biggest consumer of glucose and oxygen in the body. It has more than nervous tissue and thus in times of need can get up to half its calories from ketone bodies, which means it still needs at least half as glucose. Under normal conditions the brain only uses glucose.] So, in a sense, protein is the most versatile nutrient: it is used for body structure, cellular processes, "keto"-energy OR "gluco"-energy. Fat is used for body structure, and primarily "keto"-energy. Carbs are used solely for energy, primarly for "gluco"-energy. Now, to complicate the situation, when blood glucose levels are high, glucose gets converted to blood fats. So ultimately carbs can be used for either "gluco" or "keto"-energy; similarly, a small portion of blood fats (the glycerol) can be recouped for "gluco"-energy.

By just looking at the pathways we might conclude that any input could get used for any type of energy. However, that doesn't do justice to the kinetics of the situation, namely, which pathways are preferred at any given time. The body favors using carbs directly for energy because they are more efficient. Simple sugars are exactly the carbon stuff that it needs to oxidize, whereas fats need to be slightly changed and proteins need to undergo major alteration. So while all the sources can be used, the body prefers carbohydrates first, fats second, and proteins last for energy purposes. [Note on Alcohol: Alcohol falls outside this standard picture. Alcohol is interpreted as a toxin, changed by the liver into acetate, and eventually becomes blood glucose. So for our purposes alcohol can be considered a carbohydrate, though it takes a long strange trip through a non-digestive pathway to become blood sugar.]

An Important Note on Low-Carb: So, given that carbohydrates are only used for creating glucose, and that either proteins or fats can become glucose, does that mean carbohydrates are optional? In some way, yes; and in a big way, NO. Under normal circumstances we can get all our glucose requirements from proteins and fat. However, under changing circumstances we need the protein and the fat for other things more urgently, but the body still has to break it down into glucose, sometimes to its own detriment. A pregnant mother could die and have serious birth complications without enough carbohydrates in her diet. Similarly, during times of illness, high exertion, etc. our bodily needs can change on the timespan of hours, and unless we have a broad mix of available nutrients, we'll get hosed. So, approach the "low-carb" dogma with caution. Technically, it is true that "we can survive on proteins and fats alone", but that doesn't mean "we need only proteins and fats". This is the core reason why we need a good balance of all the essential nutrients to begin with: to have robust, good health under all circumstances, not just the normal ones. We can't foresee when abnormal circumstances are going to strike, so the course of prudence suggests always having a good mix of nutrients on hand at all times, even though some might be superfluous most of the time.

Workin' The Numbers

The standard measure of how much energy a food has is the calorie. Let's take a look at some numbers to give us a feel for what a calorie means:

This Many Calories	Is About
3,500	One Pound of Weight from Body Fat
3,000 / 2,000	Average Daily Calories Consumed by Men / Women
2,320 / 1,790	Recommended Daily Calories for the "Average" Sedentary Man / Woman
1,785	Basal Metabolic Rate (BMR) of 170lb 30 year 5'9" Man, henceforth = "Average" Man
1,377	Basal Metabolic Rate (BMR) of 130lb 30 year 5'5" Woman = "Average" Woman
300-600	Moderate Daily Physical Activity (PA)
200-400	Sedentary Daily PA
262	A Small Pina Colada
250	20oz of Soft Drink
~170-320	Thermic Effect of Food (TEF)

Let's start comparing things. Three pounds of fat (10,500 cal) can provide the complete energy needs for the average man for four [4] days; for the average woman, for almost six [6] days. (Starving is a bad weight loss program, by the way; this is just to show how much energy a pound of fat has.) That means that the conceivable upper limit on loss of body fat is at a rate of 3/4 a pound per day for men, and 1/2 a pound per day for women. Don't even bother listening to weight loss programs that propose that you can lose body fat faster, because the calories don't work out. Now, let's look at some more realistic estimates of the rates at which we could lose body fat. A small increase in Physical Activity (PA) is about 200 cal / day. Thus, it should take about seventeen [17] days to lose a pound through a moderate increase in exercise. Eliminating one extra 20oz soft drink a day (250 cals) loses a pound in only eleven [11] days. An huge increase in physical activity is around 800 cal / day; assuming we kept our diet the same that means we could expect a pound lost every four to five [4-5] days.

The overwhelming factor in our caloric expenditure is just maintaining our metabolism, which is called our Basal Metabolic Rate (BMR). Our BMR is usually 50%-75% of all our daily calories. You've got to spend money to make money, and you have to spend calories to get calories. Digesting food takes usually takes 10% of our overall intake, which is called the Thermic Effect of Food (TEF). The remainder of 15%-40% is usually Physical Activity (PA) (though what it often really goes into is weight gain). Besides the fact that this is great grist for a game of Trivial Pursuit, why do we care what our expenditure profile looks like? The reason is because that means that our weight loss projections might be as much as a factor of two off. So, a realistic estimate is on the order of one pound of body fat lost per ten [10] days; moreover, this is a target that we can actually achieve.

Now, some readers might be wondering what correlation the BMR has to our health. Let's take a closer look at this:

Caloric Expenditure Profile for "Average" Adult Male / Female

% of Total Intake		Sedentary PA	Moderate PA	Active PA	Very Active PA	Athletic PA	Intense PA
Walking per Day		60 min	90 min	120 min	150 min	180 min	210 min
OR Jogging per Day		40 min	60 min	80 min	100 min	120 min	140 min
Assumed Calories		400 / 300	600 / 450	800 / 600	1,000 / 750	1,200 / 900	1,400 / 1,050
BMR	1,785 / 1,377	74% / 75%	68% / 69%	62% / 63%	58% / 59%	54% / 55%	51% / 52%
TEF	220-320 / 170-270	10% / 10%	10% / 10%	10% / 10%	10% / 10%	10% / 10%	10% / 10%
PA	See Columns	16% / 15%	22% / 21%	27% / 28%	32% / 31%	36% / 35%	39% / 38%
Assumed Total Intake		2,404 / 1,845	2,624 / 2,010	2,844 / 2,175	3,064 / 2,340	3,284 / 2,505	3,504 / 2,670

Like all charts, this one makes some assumptions and is more to give a feel for things than exact specifications. The biggest assumption on this chart is the "average" person (our ideal couple the 170lb 30 year 5'9" man and 130lb 30 year 5'5" woman). The real average American is overweight; almost a third of them are obese. So how do things change depending on body composition? In general, leaner people have a higher percentage BMR than fatter people. Be careful how you interpret this. Fatter people have a higher absolute BMR (the rule of thumb is 10 x our body weight in pounds); leaner people have a higher relative proportional BMR. This force is counter balanced by activity: active people have a lower percentage BMR than less active people. So what does that mean? It means BMR by itself doesn't tell us squat about the health of a person. So take arguments which talk about "raising your rest metabolism" as a easy way to lose weight with a grain of salt; it's not even correlated to good health, let alone weight loss. So what do we use the BMR for? The main use of the BMR concept is to calculate what our typical caloric expenditure should be, for which it is highly accurate and very useful. There are many BMR calculators out there, you can take your pick.

The Straight Poop on Fat Loss

This is such an important idea I'm going to restate it, but in a different way. The key to weight change (loss or gain) is the regulation of our metabolic hormones; everything else (diet, activity, genetics, etc.) only matters insofar as it affects these hormones. Physical activity expends energy, it is true. It also causes the release of several hormones that makes us feel hungry. That causes us to eat just a bit more than we might have otherwise, balancing the increase in expended calories with an increase in intake calories, with net zero effect on our weight. There is a similar reason why starvation diets don't work in the long term. These cause our body to go into a temporary starvation regime where it reacts by carefully rationing our energy stores (including body fat) until it can gorge itself the next time it gets food. Crash diets are also really harmful to our health for other reasons. Most weight loss plans neglect to properly account for hunger, which plays a huge role, since a small change in food yields a large change in calories. For those of us with an iron will that can ignore our hunger pangs, great!... but those typically aren't the people who need to lose weight to begin with. Thus, we want to look for a weight loss approach that doesn't make us feel hungry all the time because we'll have a better chance of controlling our eating habits. This is the other compelling reason why diet is more important than physical activity on weight loss, because it can directly chemically manipulate our bodily hormones.

Snack-Time, Hunting the Food Coma Snark, and Hallelujah!

Years later I was a computer programmer in Silicon Valley. The place was jumping, everyone was in a rush, and time was at a premium. The standard office practice was to nominate someone every day to go on a fast food run for lunch; fast food was convenient, easy, and agreeable to everyone. During that time I noticed something interesting: at 2PM every day everyone would enter into a food coma. We'd all feel brain-fogged, sleepy, and some people would even take naps; needless to say, no work got done an hour after lunch. The food coma would pass in a half-hour or so... and then everyone would feel hungry again around 4PM. At the time I thought: ah, I guess this is the price of getting older, having to take a small nap after meals. Maybe it was my body needing blood in my stomach and pulling it away from brain or something. However, after many years I finally discerned a pattern: carb dense meals give a short burst, then a food coma, followed by hunger, the major factor in the "carb meal" being the sugary soft drink. Have you ever experienced such a food coma? Or perhaps noticed that orange juice makes you feel peppy for awhile... and then feel sleepy? It's reminiscent of the "hyper then crash" effect that sugar has on children, and it is very real.

The last piece of the puzzle was when I decided to try a combination Atkins / Zone diet, where I basically pigged out on protein and fat, with no sugar and reduced carbs. (I usually don't drink, by the way.) What happened? I felt great. I could eat a huge meal and never had a food coma, not once. Most importantly, I never felt hungry; in fact, I would occasionally need to force myself to eat because I knew in my head that I needed to, even though my body wasn't telling me to. In addition, my energy level increased. I felt more spry and zesty than I had in ages. Last but not least, as you can probably guess, I lost lots of weight without any change in physical activity. I'm a believer in gradual weight loss (as if you couldn't tell that by this point!), so I tinkered with re-introducing carbs to gradually control my descent. The profile I ended up with then was the 40C:30P:30F Zone diet, which is essentially what I'm proposing above (mixed in with a bunch of other diet plans, too).

Now, like any good little boy that's found a new toy, I experimented with my newfound diet discovery. The first thing I found was that sugar stops weight loss dead in its tracks. When I was eating pure protein and fat my weight loss was about 1 pound every 5 days, representing a caloric deficit of 700 calories a day. Yet, the addition of a single 12oz can of root beer (120 cal) halted that. From a pure calorie perspective, it should have merely slowed my rate of loss to 1 pound per 7 days, but it kept my weight stable for about four weeks, enough time to have noticed a difference. So, something was going on there besides just raw calorie counts. The second thing I noticed was that I could induce food comas at will. I would interrupt my Atkins-esque diet to eat fast food... and could get a food coma after only my second fast food lunch. The third thing I noticed was that eating fat made me feel full. Avocado became my new best friend, and I found that chicken and guacamole burritos were apparently the perfect food. (Thank you, Baha Fresh! 8^)

Expanding the Canonical Calorie Model

Caloric Intake - Caloric Expenditure = Fat Gained (or Lost) * 3,500 cal

Many dietitians promote this model as sacred canon and declare that weight loss reduces to just counting calories. The reality of the situation is, sadly, much more complex. The calorie model, while simple and appealing, is only an approximation. It fails to account for many significant factors, among them growth, mass transport, thermal variation, individual variation, the time-sensitive nature of physical processes, and hormonal effects. Before we get into each of these considerations I'd like to reiterate what I'm saying. I'm not saying the Calorie Model is useless; it's a great first estimate based soundly on scientific fact. What we need to realize is that other factors also influence weight loss, and these factors include both caloric and non-caloric considerations.

Let's consider the first assumption of the Caloric Model: "all energy nutrients we eat get used by the body for energy, either immediately or stored for later use". For adults that might be a reasonable assumption, but for children and other youths it is not. Why? Because quite a bit of protein and fat get used to create relatively permanent body structure. Isn't that also weight gain? Yes. However, the 3,500 cal figure is calculated for adipose fat storage (1 lb of body fat = 454g * 9 cal / g = 4,090 cal - 10% TEF and other minor stuff ~ 3,500 cal). For protein, the calculation would be something like (1 lb of protein stuff = 454g * 4 cal / g = 1,816 cal - who knows what ~ 1,500 or somesuch). The exact number doesn't matter; the point is that it differs by factor of 2 from the Calorie Model. Carbohydrate calories are only used as energy by the body, so the Calorie Model is dead on for carbs. But fats, and especially protein, can be used for other things by the body. So calories from carbs, fats, and proteins have different caloric multipliers associated with them. The different sources of calories have varying effects on the body. So, scientifically speaking: all calories are the same amount of energy. But practically speaking: not all calories have the same effect on body fat.

There is another subtle way that the first assumption isn't completely accurate. In a word, it's poop. Not everything that we eat gets fully digested. Under normal conditions some of our food is partially undigested; when we glut ourselves, that amount increases. That means that a calorie we took in never got used as one we expended, which breaks the calorie equation in a fundamental way. Fat in our poop under normal conditions can create a discrepancy of 60 cal a day; fecal protein as much as 40-80 cal per day, depending on protein intake. Among proteins, not all of them are equally digestible. Oh, and there's eighty-kabillion other niggling subtleties to the protein metabolism, some of which also affect our caloric equation in minor ways. There's also many disorders that can cause abnormal protein loss, in particular through the urine. These cases don't concern us normally; I bring them up only as further demonstration of the oversimplification Calorie Model, in particular with respect to protein.

Let's talk about another hairy subject: hair. Under normal conditions your body invests fats and proteins into the construction of hair, fingernails, and new skin. Healthy hair contains a robust composition of amino acids with a greasy coating: a recipe for calories. Hair grows at the rate of .4mm / day, which is a steady loss of ~ 4-7 cal / day. (Hmmm... that isn't too impressive, even to me, and I just calculated it!) The calculations for fingernails and skin is in the same ballpark [~5s of calories per day]. The litany goes on and on here. The thermic effects of some foods are net negative: it takes more energy to break them down than we get from digesting them [10s of cals]. Changes in ambient temperature can alter our caloric expenditure in real time [up to 80 cals]. Heat transport via sweat isn't accurately modeled by the basal metabolic rate [10s of cals]. Yaddah, yaddah, yaddah.

Anyway, the simple Calorie Model can be off by as much as 200 calories a day from purely caloric considerations, and seriously off if we are growing or bingeing. The numbers we are usually bandying about are 2,000 calories a day, so this represents at most a 10% error in the calculations. To be perfectly honest, that's really quite good for such a simple formula. And given that, in practical implementation, we mostly guess at the calorie values of what we eat, human error is probably a much greater source of inaccuracy than this fundamental oversimplification of the model. So let me reiterate: the Canonical Calorie Model is not exact, but it's a great first estimate from the caloric perspective. In fact, what we should be doing is incorporating the known factors into the model to make it more accurate. So, I hereby toss down the gauntlet to ye dietitians and nutritionists out there to come up with something like:

Expanded Caloric Model First Draft

Caloric Intake	- Caloric "Loss"	- Caloric Expenditure	= Weight Change
Carb Cals	* Carb Digestibility Index?	BMR Range	Weight of Body Fat * 3,500
Fat Cals	* Fat Absorption Index?	PA Range	Weight of Body Protein? * 1,500?
Protein Cals	* Protein Retention Index?	TEF Range?	Somehow account for Water Weight?

The situation with the non-caloric considerations is completely different, however; we can have direct changes in body weight that have nothing to do with calories. Consider, our total body water is on the order of half our body weight. Of this, a sizable fraction is so-called "water weight" that can be quickly gained or lost, through drinking, urination, changes in salt intake, perspiration, etc. These gains and losses have nothing to do with caloric intake or expenditure, and thus further skew the equation by tens of thousands of calories when innocently applied. Let me say that a different way. An atypical increase in caffeine intake will cause urination. One really big pee can be as much as a pound of water. So the occasional cup of tea has just messed up your calorie equation by a couple thousand calories, on the order of a whole day's worth of caloric intake. Assuming you are following the 500 Calorie Deficit rule, that's now four fictitious days of deficit that didn't change a gram of your body fat. This is the reason why dietitians today focus on body composition instead of body weight. We should be targeting a leaner body composition instead of a lower weight, because that is ultimately a better measure of long-term weight loss. An overweight person can easily yo-yo thirty pounds of water weight back and forth, with no substantial erosion of body fat. It looks like we are losing fat, but in reality we are just losing water weight.

Back to the calorie model. Genetic factors alter what metabolic pathways are available, as well as our "set-point" for weight. Again, this has nothing to do with calories, it has to do with our bodies inherent proclivity for processing food in certain ways. More specifically, it has to do with the kinetic equilibrium of our metabolic pathways, basically which pathways our bodies prefer to others. There are also two other huge factors that have been slowly discovered over the last couple decades: time-sensitivity and hormonal effects. Before we get into those, let's review the Calorie Model one last time. Caloric intake is a major factor in weight gain and weight loss, but it is only one of many. In particular, there are substantial non-caloric factors that influence the gain and loss of body fat.

Postprandial Constitutionals: OR, My Brush with Diabetes

Allow me to relate a personal story. In 2001 my mom was diagnosed with diabetes. At the time, I didn't know anything about it, or how seriously widespread a condition it has become. I just wanted to understand what she was going through and what I might do to help, so I went to the Diabetes.org website and started bumming around. I got to the page on the symptoms of Type II diabetes and was shocked. I had, not one, not two, but _all eleven_ of the common symptoms, including some pretty esoteric ones like "Wounds take a long time to heal". I later discovered that several of my family members also have diabetes, and thus I am at serious risk of developing it. Technically, I am classified as pre-diabetic, a recently created category to describe people just like me, someone in the process of developing diabetes. (At last count, there are 16 million of us in the US alone, and that number is growing.)

Anyway, on the website it said that the primary treatment of diabetes was activity and diet management; insulin injections were used only in Type I cases or extreme Type II cases. Quote: "a fifteen minute walk after every meal is a highly effective tool for the management of diabetes at any stage." A fifteen minute walk? I thought, what could that possibly do? However, they did recommend it, so I tried it out. And after a week every diabetic symptom that I had disappeared completely. I was just taking strolls, not even vigorous activity at all, and it had a profound impact on my well-being. Nowadays, I've scaled back to just a postprandial constitutional, just one fifteen minute walk after dinner, and it seems to be sufficient to keep the diabetic symptoms at bay. Fifteen minutes a day of activity, done tactically at the right time, has a substantial beneficial effect for me. Whereas, I've discovered, fifteen minutes of walking right before a meal doesn't do jack for my diabetic symptoms, though it's just as healthy for me as fifteen minutes of walking at any other time. By doing things at the right time we garner multiple benefits from the same effort.

If you think about it for a little bit, there is ample evidence that timing is pretty crucial, especially with respect to meals. Take medications, for instance. Every medication I've ever taken has come with a specific timing recommendation, like "Take every 4 hours". We also commonly see things like: "Do not take with meals", "Take before meals", "Take after meals", etc. A few even have very specific constraints: "Take at least one hour before any ingestion of lactose or dairy products". When you boil us down, we are basically big chemical factories. And just like any chemical reaction, timing is crucial. So, we'll want to understand what timing issues are going on in our body, focusing specifically on food digestion. That way, we can "work smarter, not harder", converting our knowledge into a plan that more effectively utilizes our effort in achieving what we want.

Breaking The Fat Myth

Understanding Blood Sugar

It turns out that different foods take different times to become glucose in the blood. Just among carbohydrates there is a metric called the Glycemic Index (GI) which measures how fast the food becomes glucose in the blood. The fastest thing that becomes glucose is dietary sugar. The more complex a carbohydrate is (like a whole grain) the slower it becomes glucose, and the slowest carbohydrates are vegetables like legumes and pulses. So, a high GI like sugar (90-105) represents a very fast rate, and a low GI (like under 50) is a slower one. Among proteins and fats there is no comparable measure, because whether they even become glucose at all is determined by whether specific pathways are activated. Those pathways are only activated when the body can't supply the necessary glucose from just carbohydrate intake alone.

So why do we even care about the Glycemic Index? The reason is: faster is worse for us and slower is better. Whenever we eat sugar, it gets dumped into the body quickly all at once. Since that makes the blood sugar level spike, the body has no choice but to a) consume it with exercise or b) store it as fat. Assuming you don't exercise after dinner (by, say, taking a fifteen minute walk) then your body stores all that sugar as fat. Whereas, slower carbs like vegetables take a long time before they become blood glucose. Since our body is consuming blood glucose all the time, that means that the curve gets "smoothed out". The blood glucose doesn't spike, it sort of wavers gradually up and down. And most saliently, less of our intake gets converted to fat.

The final piece of the puzzle is how the body knows to store things as fat. We have a organ called the pancreas that is constantly measuring blood glucose. When our blood sugar is too high, it releases a hormone named insulin which tells liver to convert glucose in the blood into tri-glycerides. That is so important I'm going to repeat it: excess glucose in the blood gets converted to fat by the liver. Moreover, this conversion is a one-way process. Once glucose gets converted into a fatty acid, it eventually becomes a ketone body, never a glucose. If you recall, body fat is a tri-glyceride, which is a glycerol and three glycerides. The glycerol part of body fat can be recouped as glucose, but the glyceride parts cannot. Thus, whenever we have an excess of carbohydrates around three-quarters of it gets irrevocably converted to fat. Since the insulin message is stronger the higher the blood glucose is, carbohydrates with a higher GI are more likely to get converted into fat, whereas carbohydrates with a lower GI are less likely. Sugar is the carbohydrate most likely to be converted to body fat.

Now, on the flipside, when our blood glucose levels are too low, the pancreas releases a hormone called glucagon. This hormone does many things. First, it tells the adipose cells to release tri-glycerides into the bloodstream. Second, it tells the liver to start changing that fat into glucose and ketone bodies. Third, it tells the kidney to pick up some of the slack for the liver and start changing a bunch of stuff (amino acids, lactate, fatty acids, and glycerol) into glucose. The part we're most interested in is the effect on the adipose cells: lower blood sugar makes the body burn fat. Now, that doesn't mean a zero blood sugar is best! We need a minimum blood sugar in order to keep the brain and other vital organs functioning well, the same way we need a minimum fat intake.

The keen reader might be asking herself at this point: wait, if carbohydrates get converted into fat, why do we need fats in our diet at all? Here's where the imprecision of the word leads us astray. Glucose get converted into tri-glycerides (with the help of some other body chemicals), which is what body fat is made from. Dietary fat, on the other hand, contains not only tri-glycerides but also small amounts of other types of fat. Those small amounts are important to our body, not just the tri-glycerides. So, once again, just because one thing can be converted to another doesn't mean the latter is unnecessary. In this case, the imprecise application of the word "fat" in so many contexts is downright misleading. The technical term for all fats is called lipids; triglyceride (body fat) is just one type of lipid (dietary fat).

Understanding Blood Fat

The situation with lipids in the blood is completely different. There are many types of lipids in the blood, the most notorious being cholesterol. However, we will be interested primarily in the tri-glycerides floating in our blood, since that's what can become body fat. Hence, we will dub "tri-glycerides in the blood" as "blood fat". Tri-glyceride levels lack restorative hormones that act to restore it to a fixed range. Consequently, the blood fat levels vary considerably. The fasting level is considered good if under 100, and it can be anywhere under 100. A level over 200 is now considered an indicator of increased heart risk. The number can climb to over 1,000 under some conditions (though cholesterol seems to be the salient factor in heart risk past 200, not increased tri-glyceride levels). The level of blood fat is not regulated the same way that blood sugar levels are, and thus vary without restorative bound.

So, what forces influence our blood fat levels?

Influences on Blood Tri-Glyceride Levels

Increases...	...In Response To	Decreases...	...In Response To
Intestines	Digestion of Ingested Fats	Muscles	Increase of Physical Exertion, Low Glycogen Stores
Liver	Insulin, Full Glycogen Stores (high blood sugar)	Adipose Cells	Insulin (high blood sugar)
Adipose Cells	Glucagon (low blood sugar), Thyroid Growth Hormone (thermal / growth regulation), Adrenal Hormones (dangerous situation)	Liver	Glucagon, Low Glycogen Stores (low blood sugar)

There are three key observations to make from this chart. First, our blood fat is mediated primarily by responses to our blood sugar levels, and specifically _not_ to blood fat levels. Second, that means that fat we ingest only becomes body fat when blood sugar levels are also high. Said differently, fat we ingest just gets dumped in the blood and stays there until something tells it to go somewhere else. If our blood sugar is low, glucagon tells it to go to our liver and muscles to be used for "keto"-energy. If our blood sugar level is high, insulin tells it to hop into our adipose cells. Third, low blood sugar level is the key to weight loss, because that's what tells our adipose cells to cough up their fatty goods into the bloodstream. (Or rather, of the hormones influencing lipolysis glucagon is the one most under our dietary control.) So, how do we do that?

The Essential Proposition

Now suppose that we restrict our caloric intake of "fast" carbohydrates (especially sugar) and favor "slower" carbs like vegetables. Right off the bat we smooth out the spikiness of our blood sugar curve, which leads to an overall decrease in the production of insulin, which leads to less of a conversion of glucose to blood fat after meals. Over time, we gradually change the kinetics of our blood glucose, lowering the average store of glycogen in the liver, which signals it to divert its energy into the production of ketone bodies. A dearth of blood glucose tells the body to release fatty acids and start converting them to ketone bodies, and release amino acids and convert them to glucose. That's fat burning right there. So the trick is to avoid high spikes of blood sugar and lower the fractional intake of our carbohydrates relative to protein and fat. Since we don't want an unlimited fat intake, either (no greater than 35% calories from fat), that means that our only available option is to trade carbs for protein. We are maxing out our fat and protein percentages because we need to reduce our carbohydrate intake, not because there's anything good about an excess of fats or protein.

Now consider a low-fat diet, which by definition must be higher carb. Nothing about a low fat diet tells the body to start releasing body fat from adipose cells. Blood fat changes are controlled by blood sugar levels, not by blood fat levels themselves. We can't even invoke a kinetic argument here (i.e. low-fat induces the body to release fat from the adipose cells because of a reduced amount of fat in the blood), for two main reasons. First, the body is already going to convert the excess carbs into tri-glycerides anyway because it needs to reduce its maximal blood sugar. That means that a low-fat, high-carb diet leads to just as much blood fat as a high-fat diet does. Second, there's no hormone currently known that tells the adipose cells to release tri-glycerides into the blood in response to low blood fat levels. So all that ends up happening with low-fat diets is our bodies become starved for the essential trace fats it requires for proper functioning.

I hope you are convinced that low-carb, high-protein diets are more effective at weight loss than low-fat, high-carb diets, as well as being more safe. However, if you are still skeptical, I suggest that the proof <ahem> is in the pudding. Try both! If this is your first attempt at weight loss, try both approaches, each for month, and see which one gives the results it predicts. If you've already tried low-fat diets and they haven't been long-term effective, what harm could there be to try a different one? I've seen this diet approach work for seven of my friends so far, and it has worked unerringly for each one. I've also spoken to dozens of people who swear by Atkins-esque plans... and still swear by them years later. Keep in mind, I'm not trying to sell you on anything here. I'm not a diet guru, and I don't plan on becoming one. I'm just a guy that's taken a hard look at the available evidence and come up with a reasonable conclusion to explain things. I suggest that you run your own diet experiment to determine whether this will work for you, too. I'm pretty confident that it will.

That's All She Wrote

However, this page is already over-full with pith. Maybe someday I'll get around to finishing it off, but for today I think we've covered enough useful ground. Perhaps I could be persuaded to finish it sooner than later if you sent me some supportive e-mail... 8^)

I hope this information helps improve your health. Bon Vivant!

Sincerely,
Kim E Lumbard
Mar 2003

P.S. If you liked this page, please e-mail the link to your friends! I feel that this is important information that everyone needs to know about because it affects our most precious resource: our health. Thanks!

FUTURE Write-up
Movement toward time and convenience
Dollar moving out of the home into restaurants
Products because of longer cycle time to buy foods
Food preparation being done on large-scale centralized because of efficiency
Need to make small-scale, local, personal food preparation "kitchens"
  Some centralization necessary for variety, too much is too impersonal
Want to focus on freshly-prepared dishes "buying convenience and health"


Pharmacueticals
Americans obsessed with "the pill"
We can change our biochemistry through behavior as effectively as drugs