We live in a world where food is accessible all the time, in all settings, and on-demand. Unfortunately, despite all that we know about how to prevent many lifestyle diseases, their numbers remain high. Heart disease, diabetes and Alzheimer’s remain among the top 10 causes of death in the United States. Fad diets offer quick-fix solutions for weight loss that are often not sustainable. What about long-term health outcomes?

In 1962, James Neel developed the concept of “thrifty genes” to explain how humans have the ability to survive through calorie extremes like feast and famine; that our bodies are highly effective at storing extra fuel as fat. One could make the argument that fasting has been part of lives throughout history. Fasting is still an integral part of five major religions across the world.

It’s only recently that the popularity of fasting has resurfaced among the health-conscious as a way to drop weight or kickstart some healthy new lifestyle habits. With the majority of Americans trying different forms of fasting, from intermittent fasting to time-restricted eating, and prolonged fasting diets, confusion can lead to questions that eventually end up in a doctor’s office.

Fasting is the abstention of calories from food and beverages. From a biological standpoint, fasting entails not eating foods that trigger the nutrient “sensing” pathways. Since that can be active for 24 hours after the last meal, biological fasting really begins 24 hours after the last meal. Some people think a juice fast is a fast because you are not chewing your calories, but the calories—not the state of matter—are what count.

Why fast? Some people do it for healing or spiritual purposes. Research shows that fasting can support overall metabolic health, supports cellular cleanup (autophagy) that leads to cellular regeneration, and increases in circulating stem cells.¹ Also, fasting impacts markers and risk factors for aging. There are three main types of fasting: intermittent, time-restricted eating/feeding, and prolonged fasting.

During intermittent fasting, a person will refrain from consuming calories during a full day. It can be done anywhere from one to three, non-consecutive days per week. There have even been several articles and books published around the 5:2 plan. Time restricted eating is a daily pattern of calorie consumption between a window of 8–12 hours each day.

Prolonged fasting is usually done for five consecutive days. This has traditionally been done using water only. Water-only prolonged fasting demonstrates those positive biochemical markers; however, it has a high dropout rate among participants and it can be dangerous because it deprives the body of macronutrients, leads to muscle wasting and increases the risk of gallstones.

Prolonged water fasting is also challenging to do. It was this hurdle that led Dr. Valter Longo to develop a “fasting with food” concept now known as the Fasting Mimicking Diet, which he details in his book, “The Longevity Diet.” The Fasting Mimicking Diet gives you the same health benefits of prolonged water fasting, but it’s more sustainable to do over the recommended five days because the stomach sees food, while the cells see fasting. You will likely drop weight with this diet, but the other health and longevity benefits are so profound that TIME magazine named Longo as one of the 50 most influential people who are transforming health care. Benefits of prolong fasting include protection of lean body mass, maintaining healthy levels of metabolic markers and increased circulation of stem cells.² Currently, the only Fasting Mimicking Diet available is called ProLon www.prolonfmd.com which has been clinically shown to result in an average of 5–8 pounds of fat loss without losing lean body mass in the process.

Here what happens on each day on the ProLon Fasting Mimicking Diet:

Day 1: Fasting State: the body is being primed to transition into the fasting state for cellular optimization;

Day 2: Fat Burning: the body, depleted of glycogen, switches to fat burning mode; cellular recycling and clean up begin;

Day 3: Cellular Cleaning: cellular clean up continues and most people reach full ketosis;

Day 4: Cellular Regeneration: cellular clean up continues and enhanced stem cell production begins; and

Day 5: Regeneration Continues: promotes self-repair through the increased circulation of stem cells.

The results have been fascinating: Reductions in circumferential body fat from 5–8 pounds in five days, preservation of lean mass (muscle mass and bone density), and decreases in the IGF-1 hormone, which has been implicated in aging and disease. In those subjects who returned to normal eating yet did the ProLon Fasting Mimicking Diet for three consecutive months (for five days per month), they were able to realize the following health benefits: weight loss, decreased waist circumference, maintained lean muscle mass and improved metabolic measures.

So now you must be wondering, what exactly are the foods that are consumed using ProLon Fasting Mimicking Diet? First of all, the entire program must be purchased online at: www.prolonfmd.com because the meal plan is specific and provides scientifically researched micro- and macro-nutrients in precise quantities and combinations that nourish you, but are not recognized as food by your body and therefore mimics a fasting state. This way there is no guessing or question of incorrect portions because all the food needed for the five days comes in assigned boxes for each day. It is a plant-based eating plan that consists of bars, soups, crackers, olives, and herbal teas. Just add water and you are good to go.

Technically, individuals can return to their usual "diet" in the weeks between doing the Fasting Mimicking Diet. As a clinician who attended the first global fasting summit at the University of Southern California, and has been doing some consulting work with L-Nutra, the company behind the ProLon Fasting Mimicking Diet, I can tell you I plan on using this in my practice, and for myself. I would encourage people to take a good look at their calorie intake—both in foods and beverages. I am an advocate of eating flexitarian, which is predominantly plant-based with small amounts of animal-sourced protein. I would pair all of this with time-restricted eating as a means of regular eating behavior. Be mindful of how many hours you eat each day, and what your calories consist of.

Right now, high protein diets are popular because they encourage weight loss and satiety, but in looking at long-term health outcomes, the research has shown that lower protein consumption is actually better for longevity. We know the benefits of eating more plants are that they promote a healthy gut microbiome and that the phytonutrients in plants have many chemoprotective qualities.

I'm looking forward to the continued research in the fasting space, and where it will take us in the future of healthcare. We are truly at an impasse when it comes to obesity and disease in this country. As health care professionals, we have to get to the root cause of obesity, which is essentially what we are eating or not eating.

References

1. Wei et al., Sci. Transl. Med. 9, 15 February 2017
2. Ibid

There is probably nothing—and I mean nothing—like unrelenting stress to sabotage weight loss. Stress really does a number on your body. The sad thing is that stress, no matter where it comes from, will have the same detrimental biochemical effect—a spike in cortisol, your body's premier fat storage hormone. Cortisol is released by the adrenal glands as part of our "fight or flight" mechanism. While you may be aware of stress—whether it is physical, emotional, or psychological—you may be completely unaware of steadily accumulating "silent" stress caused by electropollution thanks to our smartphones, tablets, cordless phones, routers, smart meters and even baby monitors. All of these digital wonders emit biologically active, disruptive man-made radiation that surrounds us 24/7 in a sea of invisible energy—a major autonomic nervous system stressor that nobody is talking about.

It turns out that our DNA is exquisitely sensitive to even the minutest amount of non-ionizing (non-heating) electromagnetic radiation from wireless technology. Our bodies respond to this type of radiation in a number of ways including the secretion of heat shock proteins—around 20 to be exact—with a corresponding elevation of cortisol.

Out of control cortisol levels and non-stop stress can send your health into a downward spiral resulting in a series of negative consequences besides stockpiling on tummy fat. Practically every single disease known to man is due to unmanaged stress. Your brain can actually shrink; the happy hormone serotonin can take a nosedive, your bone density and strength can diminish, and mental illness can set in.

The two hormones that are most impacted by various types of stress are the ultimate fat promoting cortisol and insulin. Remember, the stress hormones, more than any other hormones, will inhibit your ability to lose weight even if you are on the best diet and exercise program!

STRESS HORMONE # 1 – CORTISOL

This fat storage stress hormone is blocked by omega-3 rich oils:

• Walnuts and walnut oil
• Camelina (wild flax) oil
• Fish and fish oil

When cortisol—your main stress hormone—is behaving itself, it truly is your BFF hormone. It gives you that "get up and go" and provides you with just the right surge of energy in emergency situations whether you are emotionally upset or physically challenged or suffering from low blood sugar. But when you can no longer hit the pause or refresh button, and that cortisol surge won't quit, then you run the risk of some very unpleasant side effects—including weight gain.

The human brain contains more than 60 percent fat. It also happens to need more omega-3 fatty acids than any other organ or system in the body. The EPA and DHA (docosahexaenoic acid) fats are major players in regulating emotions, mood and warding off depression. These Smart Fats can help to reduce aggression and hostility in a number of clinical studies. They can help to fortify your system so you can mentally handle and cope with stress more efficiently to minimize the damage created by elevated levels of cortisol.

OMEGA-3 FATS EASE STRESS
According to the National Institute of Health, omega-3s help to balance stress hormone levels and provide direct weight loss benefits. They can be supplied by ALA-rich walnut and walnut oil, Camelina oil, as well as fatty fish and fish oil.

Walnuts and walnut oil contain high levels of the omega-3 plant-based ALA, which have many added benefits besides their ability to regulate stress hormones. Camelina oil is also a rich source of ALA, but contains an amazingly high amount of stable monounsaturated fatty acids (omega-7s), as well as vitamin E, which makes it a very beneficial oil for medium-heat cooking. Due to its high antioxidant content, it's known as the "better" flax. Of course, an even more direct source of the omega-3 fatty acids is fatty fish like wild caught salmon, sardines, anchovies and mackerel.

Walnuts, however, unlike fish or fish oils, are rich in trace minerals like zinc, selenium, calcium, copper, and manganese. Walnuts and walnut oil also pack a serious dose of vitamins B1, B2, B3 and vitamin E— all notably worthy vitamin stress relievers that soothe the nervous system. Walnuts are also one of the richest natural sources of melatonin—second only to tart cherries. Melatonin is the hormone that regulates your body's sleep-wake cycle. It ensures that you get the sleep you need for restorative rest that also prompts weight control.

Omega-3 rich foods right before bed—like a couple of walnuts or walnut oil in a smoothie—will come in very handy when you consider that just one night of poor sleep can raise cortisol by 45 percent.

As it turns out, sleep and cortisol are intimately entwined. Chronically high cortisol levels disturb sleep, and lack of sleep can make you fat.

SLEEP: THE SECRET WEIGHT LOSS AID
Sleep deprivation has reached epidemic proportions here in the US. Approximately 7 out of 10 Americans report sleep-related problems. Lab tests show that cortisol levels are much higher in sleep-deprived people. A landmark study in 2000 by the University of Chicago's Department of Medicine revealed that not only does sleep deprivation affect tiredness and immunity, but too little sleep impairs the way your body actually handles food, creating impaired glucose tolerance. This can result in insulin resistance and obesity.

And it's not just cortisol and insulin that become out of whack without proper rest. A lack of quality sleep also impedes surges of growth hormone, resulting in increased fat tissue and reduced muscle mass—just what you don't need. Growth hormone is released while you sleep, raising gradually from about 10 PM and peaking at about 2 AM. It also prompts your body to burn fat in order to repair the tiny tears in your muscles caused by exercise. This gives you a higher muscle-to-fat ratio, which boosts your metabolism, helping you to lose weight and keep it off.

In order to boost growth hormone, even more, eat a light cortisol-containing snack of walnuts or a smoothie with walnut oil or even an omega-3 deviled egg—providing your gallbladder can tolerate eggs—just before you retire.

CORTISOL AS FAT MAKER
Cortisol is such a primary fat storage hormone because it activates enzymes to store fat when it comes into contact with any and all fat cells. Abdominal fat has four times the amount of cortisol receptors than any other fat cells and so is a telltale sign of cortisol imbalances that your body can't hide.

High cortisol levels over a long period of time have huge consequences, such as chronically high blood pressure, memory changes, depression, insomnia, slow wound healing and diabesity (diabetes + obesity, a term coined by my buddy, the late, great Dr. Atkins).

Elevated cortisol levels also depress thyroid function, interfere with progesterone (your body's natural anti-depressant), raise blood sugar and cause your body to break down muscle tissue to be used for energy—a big setback for weight loss since muscle is a natural calorie burner. The less lean muscle mass you have, the lower your metabolism and the easier you gain weight.

In contrast, extremely low cortisol levels are associated with thinning skin, brittle bones and fibromyalgia—probably due to burned out adrenals. Maintaining balanced cortisol levels that are not too high and not too low is truly a lifetime balancing act and one I find my most challenging!

Cortisol has a nasty habit of making you wake up in the middle of the night. Intermittent frequent awakenings—especially at 3 AM or 4 AM in the morning are often related to cortisol surges, which should be lower to allow you to sleep through the night. When melatonin levels naturally rise, cortisol should be lower. Taking melatonin before bed or drinking several ounces of diluted tart cherry juice may help neutralize excess cortisol and prevent it from keeping you up at night—when you need to be stacking ZZZs and snooze to lose.

FLOWER POWER FOR EMOTIONAL STRESS CONTROL
Repressed emotions can trigger over-eating and bingeing as many of us know. Also, this can impede our best weight loss efforts unless we can learn to cope with emotional issues. Impatience, discouragement, bitterness, frustration, and anger are often common triggers. Granted for many psychotherapy may a viable solution. For those that want to either augment this therapy or find a natural alternative, I would recommend the Bach Flower Remedies. They are a kind of energy medicine similar to homeopathy that offsets emotional turbulence that can be at the root of physical disorders. Developed in the 1930s by Dr. Edward Bach, an English immunologist, the most renowned formula, Rescue Remedy is a five-flower extract combo that is used to help alleviate trauma, whether emotional, physical or psychological.

COMMUNITY CALMS CORTISOL
Women, in particular, benefit from the support of others in being able to handle all aspects of life including stress. A landmark study from UCLA proves something that many of us have already suspected: a unique bond forms between women. A circle of friends makes life brighter and the tough times easier.

The researchers at UCLA demonstrated that women that were under stress produced brain chemicals that opened them up to making and maintaining friendships with other women.

It was generally assumed that when a person experiences stress, the hormonal release creates the typical "fight or flight" response. Women have a very distinct response to stress, as opposed to men. In women, the hormone oxycotin is released which acts as a buffer to cortisol and encourages females to gather with their girlfriends. Men do not have this response because of the high amounts of testosterone they produce. So, when men are stressed they tend to go off by themselves, and when women are stressed they gather others around them.

SMART TIPS: CORTISOL

Here are some smart tips to balance cortisol levels and tame the stress hormone monster so it can't scare away your best weight loss efforts:

1. Eat walnuts and enjoy walnut oil. This omega-rich nut can be popped into salads and side dishes. The oil—when roasted—is absolutely delicious (one of the tastiest oils I have ever used) and packs serious health benefits. Roasted walnut oil will lift an ordinary salad to the sublime with a basic mix of Romaine lettuce, chopped green onion, cilantro, celery and Celtic sea salt. Serve one tablespoon of roasted walnut oil per salad.
2. Count on Camelina! Camelina is also an excellent oil for those with heart issues—because of its high vitamin E content, it works wonders for blood clots! It's a tasty salad dressing and can be used in medium-heat sauteing.
3. Eat fatty fish and take fish oil supplements. Try to consume some wild caught fish at least twice per week and also supplement with fish oil on a daily basis to help manage stress better. Just make sure that the fish oil you buy is molecularly distilled and free of heavy metals. Do be aware, however, that fish oil is a natural blood thinner so caution should be taken if you are also taking blood-thinning meds. Choose the newer orange and lemon flavored fish oil liquids or softgels, which seem to be better tolerated.
4. Shake MORE salt. Yes, you heard that right. Most of us are sodium deficient and the right type of salt (I like Celtic sea salt) can support adrenal function and help your body better cope with stress. It may then indirectly balance elevated or depleted cortisol levels. I would recommend at least 1/4 teaspoon in warm water first thing in the morning. Gargle with this and then swallow, as the salt is anti-bacterial to your mucous membranes.
   For an extra boost, try my Adrenal Cocktail. I have used this for years for my overstressed and overworked clients. It's best taken mid-morning and/or mid-afternoon. Mix four ounces fresh squeezed orange juice, 1/4 teaspoon cream of tartar and 1/4 teaspoon Celtic sea salt. Take a blood test to actually measure your serum sodium so you can better take care of your body's sodium needs. Without sodium, muscles become stiff and hardened. Sodium relaxes soft tissue and is incredibly important when you are under stress.
5. Lights out! Let's talk sleep—a key underlying cause for stress fat. Do try to be in bed by 10 PM when your cortisol levels diminish to their lowest levels (three hours after sunset), and to give muscle-building growth hormone a fighting chance to properly release. Ideally, your body will start to lower cortisol between midnight and 4 AM. If this important cycle is interrupted at all, you can kiss the prospect of ever melting that belly fat goodbye!
6. So, by all means, shut off lights and start to dim them after dark to prepare your body for sound sleep and melatonin activation. Unplug all electronics and keep digital gadgets out of the bedroom to reduce invisible EMF stress. Disable wireless routers before bed and put your cell phone on airplane mode. Aim for seven to nine hours of peaceful, restorative rest.
7. Eschew the blue—at night that is. On the light spectrum, blue light is great for helping you stay alert. One reason: studies show it suppresses melatonin production. As you get ready for sleep, it becomes increasingly important to filter out blue light to keep melatonin production at its peak. That's why dimming lights before bed may be so helpful to protect melatonin so it can do its job. And, that also means that you should avoid the blue light emitted from computer screens, iPads and your smartphone at night—especially in the hour or two before bedtime.
8. Go barefoot. Going barefoot on your lawn or on the beach for at least 15 minutes a day can help your body get grounded. When you are grounded you discharge chaotic electromagnetic energies and absorb healing electrons from the earth through the body. These healing electrons can start to repair stress damage from elevated cortisol and curtail inflammation and pain by quelling free radicals.
9. Curb the caffeine. Caffeine is an underestimated cortisol spiker that gives you instant energy in the short term but will come back to haunt you later. It also makes you lose key minerals like calming magnesium and calcium due to its dehydrating effects. It is a known blood sugar disruptor and contributes to anxiety and sleepless nights. While a tablespoon of high MCT oil like coconut can help regulate coffee's blood sugar peaks and valleys, it is even better to opt for a decaffeinated green tea or dandelion root tea, both of which will help give you energy without the crash and fall effect. If you MUST drink your Morning Joe, however, along with that coconut oil, you can spike your coffee with vanilla whey protein powder for a dose of Smart Fats and healthy protein to prevent cortisol spikes.
10. Axe the alcohol. It can raise cortisol and dial down metabolism by greater than 70 percent. You may hate me for this, but alcohol (yup, even wine) makes it difficult for your liver to keep up with its other metabolic duties so it's not able to balance the rest of your hormones properly.
11. Walk, don't run AWAY stress. If you are a fitness buff, then you know that intensity, not duration, is the current exercise hot button. Yet, any type of daily movement with deep breathing is a terrific combo to beat stress. Think yoga, Pilates or Tai Chi. But, DO give up that long-distance running. It elevates cortisol—as will any continuous exercise over a two-hour stretch. Burst running is a different story though, so mix it up. As far as I am concerned, I prefer brisk walking or jumping on my mini-trampoline to get my lymph flowing and thoughts in order. At least 20 minutes a day—and 40 minutes is even better—of consistent movement and frequent breaks from sitting at the computer are in order here. Exercise can help you cope with stress more effectively while you rev your metabolism, increase lean muscle mass, burn off belly fat, improve bone mineral density and reduce insulin resistance. You can't afford NOT to move.
12. Take supplements to relieve tension. In this regard, the very best dietary supplement of all, which controls over 350 bodily processes, is magnesium. It literally acts like a tranquilizer in a bottle. You can take an Epsom Salt Bath (two cups to a tubful of water) to relax your muscles, or consider an easily absorbable magnesium supplement. I am especially a fan of magnesium formulas, which contain a mix of the best co-factors for absorption like the glycinate, malate, taurinate and orotate forms that target blood sugar, muscles, cardiovascular health and ATP energy. I am also a fan of adrenal tissue glandulars and pair this with the highest quality Rhodiola (an adaptogenic herb from Siberia), ideally taken at 7 AM, 11 AM and 3 PM —the times when blood sugar can be at a low ebb, creating physiological stress.

Some of my clients also swear by phosphorylated serine—taken at least four hours before bed—to dampen cortisol surges that disturb peaceful sleep.

The official start of summer is just around the corner. Many people might find themselves entrenched in diet and detox programs to shed those extra pounds for tank top confidence. My tried-and-true Fat Flush Plan offers daily detox, healing foods, metabolism-revving spices, calming rituals, and more that has helped thousands around the world find lasting success. When you're at home, sticking to your healthy eating plan is easy, with the right weekly preparation. But, what about when you're traveling or enjoying a dinner out? I have found that times like these can be the most challenging for folks and are a venerable time to "fall off the wagon." In this preview from my book, The NEW Fat Flush Plan—a full update of The New York Times Best Seller—I share my tips to make three popular genres Fat Flush-friendly while dining out.

ITALIAN FOOD

This is the cuisine where, at least in the type of Americanized Italian food in the United States, you have to watch to not overdo carbs such as pasta, beans, and that delicious garlic bread. Thus you might want to have the server take the bread basket away as soon as you sit down. If you are really hungry, then order an appetizer right away. Grilled Portobello mushrooms or an artichoke (hold the breading) is a tasty starter. You may want to indulge in a Caesar salad, which is perfectly Fat Flush legal. Just ask for it without croutons and get the dressing on the side. And if you have a taste for anchovies in the Caesar dressing, go for it! They are high in the omega-3s, although a bit on the salty side. The best news at an Italian restaurant is that you usually can get a wide variety of delicious, colorful veggies that are not as easily available elsewhere, such as zucchini, peppers, cauliflower, eggplant, and spaghetti squash. In addition, you can typically get a leafy green, such as spinach or escarole, here as well. Sautéed with onions, fresh garlic, and a little lemon in olive oil or chicken broth, these vegetables are out of this world and very Fat Flush friendly.

And oh yes, there's that cheese—the mozzarella, ricotta, and provolone. For those of you on the Lifestyle Fat Flush eating plan, keep them to a tasty minimum and use them as a condiment, please. You can even have your pesto (that sensational combination of olive oil, garlic, basil, pine nuts, and Parmesan cheese) and eat it too. Ask for it on the side so that you can enjoy a couple of tablespoons slowly and deliberately. Do not overlook the veal dishes (the Marsala, piccata, or scaloppini), which are usually quite outstanding in the finer Italian restaurants. Watch to make sure you are adhering to high-quality oils like olive oil, and learn to lemonize by ordering several lemon wedges that can help emulsify excess oil.

CHINESE FOOD

Things are really simple when you go to Chinese restaurants. Just find out which dishes can be made to order and request no MSG, sugar, salt, or soy sauce. If you must, you can always add your own soy sauce at the table. If the oil is anything other than sesame or peanut oil (and there's no allergy to peanuts), then order your food steamed. I always request a stir-fry that uses chicken broth and is made from such combinations as beef, chicken, seafood, or tofu with snow peas, water chestnuts, bean sprouts, broccoli, scallions, bamboo shoots, and bok choy (Chinese cabbage).

If you are in the Lifestyle phase and want a good vegetarian meal, try Buddha's Delight, a mix of vegetables and rice cellophane noodles that can be stir-sautéed in vegetable broth. Buddha's Delight can be modified for any Fat Flush phase by omitting the noodles. You can have tofu added to the dish with a side of steamed veggies topped off with scallions, garlic, and a bit of Chinese fivespice powder, a delightful mixture of unique spices related to cinnamon. Most of the soups offered in a Chinese restaurant are made with lots of cornstarch—including egg drop soup—so it is best to skip the soup course. On the Lifestyle Fat Flush, lo mein dishes—cellophane or mung bean noodles with some chicken, beef, shrimp, or other kinds of seafood—also might be appealing. Just remember that those oyster and black bean sauces are loaded with salt, which can result in boggy, watery tissues. Try a bit of the hot mustard, minced garlic, scallions, and even some Chinese five-spice powder instead. As for the fortune cookie—by all means have fun and open it. Read your fortune, and then leave the cookie behind. Also, try eating with chopsticks. It may help to slow you down and enhance your digestion as a result.

MEXICAN FOOD

You may want to select such entrées as chicken, shrimp, or beef and eat them without the tortilla unless you are on the Lifestyle Fat Flush. Look for main dishes with fish, chicken, or beef that can be prepared with onions, tomatoes, and peppers (such as Veracruz snapper), or look for dishes that can be sautéed in olive oil with a touch of garlic. If you are on the Lifestyle Fat Flush, a tasty Mexican soup (such as black bean soup) would be a great way to start your meal. If not, then how about some guacamole (loaded with the healthy monounsaturated fats) with lots of fresh lemon or lime juice? Salsa is probably your best all-over topping. Use the sour cream and cheese as condiments, with just a dollop or a few sprinkles here and there for flavor. If you are fortunate enough to locate an authentic Mexican restaurant, such foods as squash blossoms, jícama, and chayote cactus are treats for the palate. If you happen upon a restaurant on the other end of the American-Mexican food spectrum, like Tex-Mex, you can order a beef, chicken, or seafood fajita with extra vegetables, and if you are not yet in the Lifestyle Phase, eat your fajita without the corn tortilla. Be sure, as always, to watch the kind of oil that the restaurant uses to cook the fajita meat and veggies, and ask them to use as little oil as possible.

To take back your health and reach your goals, at home or away, pick up your copy of The New Fat Flush Plan.

It is New Year's resolution time and one of the perennial resolutions for many Americans is, "this year I am going to lose weight and keep it off."

Literally two thirds of Americans are overweight or worse, so there are a lot of such resolutions being made. Like gym memberships, however, there are far more resolutions initially undertaken than followed through. Nevertheless, this time around things can be different. One key is that the weight loss strategy adopted should also be one that can be continued as a normal everyday diet pattern. There is no reason that this should not work as long as realistic goals are adopted. Life, as the observation goes, is a marathon, not a sprint. Moderate, yet well thought-out changes in the diet regarding the ratios of protein, carbohydrate and fat can yield durable results over a span of three to six months. Similarly, care in terms of the timing of food intake, consumption of fiber and phytonutrients, and so can yield big rewards.

High Protein Beats High Carbohydrate During Weight Loss

Let's start with the initial weight loss goal. Ads for diet products and programs often promise "ten pounds in ten days," but such promises, even were they true, are never lasting. The body resists extreme changes and, in the end, the body always wins. A better approach is to coax the body in the desired direction so that it becomes more metabolically flexible and thus can burn fat for energy rather than storing it. This means overcoming roadblocks such as poor blood sugar control dieting-induced loss of lean tissue. The protein-to-carbohydrate make-up of meals is important here. Indeed, this ratio and not the amount of fat in the diet is determining.

Realistically, reducing energy intake by approximately 500 calories per day is sufficient for many dieters initially to experience weight loss of 1 – 2 pounds per week. The catch is that weight loss based only on restricting calories has a poor record for improving impaired glucose tolerance and typically leads to a loss of the more actively calorie-metabolizing lean body tissues. A study with obese subjects published in the journal BMJ Open Diabetes Res Care demonstrates that this need not be the outcome of dieting.¹ One hundred percent of obese adults using a high protein (HP) moderately calorically-restricted diet, but not those on a similarly restricted high carbohydrate (HC) diet achieved a return to normal glucose tolerance in addition to benefits in their markers for cardiovascular and inflammatory health. On the HP diet there was an increase in the percentage of lean body mass and a decrease in the percentage of fat body mass with weight loss whereas the HC diet led to a decrease in the percentage of lean body mass along with a decrease in the percentage of fat body mass. The change in glucose tolerance/blood sugar levels and the improvement in the percent lean body mass demonstrated with higher protein intake and restricted carbohydrate intake are highly desirable outcomes. The key was substituting protein for carbohydrate calories.

For this study, researchers randomized 24 women and men with elevated fasting glucose levels in the pre-diabetic range to either a HP diet (30 percent protein, 30 percent fat, 40 percent carbohydrate; n=12) or a HC diet (15 percent protein, 30 percent fat, 55 percent carbohydrate; n=12) for a study lasting six months. All meals were provided to these subjects for the six months. At the start of the study and at its conclusion, tests were performed to determine oral glucose tolerance and serum insulin levels as well as a variety of other parameters indicative of metabolism and inflammation. X-ray scans were conducted to determine body composition in terms of the percentage of lean and fat tissue.

The differing diets led to dramatically different results. According to the authors of the paper, on the HP diet 100 percent of the subjects exhibited remission of their pre-diabetes to normal glucose tolerance whereas only 33.3 percent of subjects on the HC diet exhibited this remission. Moreover, the high protein arm subjects exhibited significant improvement in (1) insulin sensitivity (p=0.001), (2) cardiovascular risk factors (p=0.04), (3) inflammatory cytokines (p=0.001), (4) oxidative stress (p=0.001), and (5) increased percent lean body mass (p=0.001) compared with the HC diet.

In terms of the findings likely to be of particular interest to most dieters, it should be pointed out again there was an increase in the percentage of lean body mass and decrease in the percentage of fat body mass with weight loss on the HP diet. In contrast, there was a decrease in the percentage of lean body mass with weight loss on the HC diet although the percentage of fat body mass did decline as expected. Importantly, both metabolic parameters and inflammation markers were improved only on the high protein / reduced carbohydrate, moderately calorically restricted diet.

Doesn't Eating Fat Make You Fat?
Keeping weight off after a diet is the real challenge. The fact that in dieting it is mostly the caloric restriction that leads to weight loss and not diet specifics has been known for decades.² For instance, in 1996 a study was published that compared diets much more disparate than the one described above.³ Forty-three obese adults were randomly assigned to receive diets containing 1,000 calories/day composed of either 32 percent protein, 15 percent carbohydrate, and 53 percent fat or 29 percent protein, 45 percent carbohydrate, and 26 percent fat. There was no significant difference in the amount of weight lost. Nevertheless, just as in the study above, fasting plasma glucose, insulin, cholesterol, and triacylglycerol concentrations decreased significantly in patients eating low-energy diets that contained 15 percent carbohydrate, but neither plasma insulin nor triacylglycerol concentrations fell significantly in response to the higher carbohydrate diet.

A more recent study looked at moderate energy intake on a very high-fat, low-carbohydrate (73 percent of energy from fat, 10 percent of energy from carbohydrate and 17 percent of energy from protein) or low-fat, high-carbohydrate (30 percent of energy from fat, 53 percent of energy from carbohydrate and 17 percent of energy from protein) diet for 12 weeks.⁴ Unlike most modern diets, these were diets involving only minimally processed carbohydrates and fats. Despite expectations, the high fat diet did not raise LDL cholesterol; however, it did raise HDL cholesterol. According to one of the co-authors of the study, "the very high intake of total and saturated fat did not increase the calculated risk of cardiovascular diseases." "Participants on the very-high-fat diet also had substantial improvements in several important cardiometabolic risk factors, such as ectopic fat storage, blood pressure, blood lipids (triglycerides), insulin and blood sugar."⁵

Therapeutic diets usually restrict either carbohydrates or fats. If fats are restricted, then the diet will tend towards an increased protein content. Most dieters will find that in the early stages, this high intake of protein will reactivate the thyroid and make life easier. There is plenty of clinical evidence to the effect that high protein snacks reduce calorie intake more than do snacks of carbohydrate, fat or alcohol for overweight individuals accustomed to the usual American mixed diet. And increasing protein intake to 25 percent of calories clinically has been demonstrated to increase both weight loss (by 75 percent) and fat loss (by 57 percent) more than was found on a protein intake of 12 percent. Still, eating protein is not a panacea (too much is too much⁶) and protein needs to be matched with goodly intakes of fruit and vegetables as well as the avoidance of refined carbohydrates for best results. Moreover, decades of research, as indicated above, demonstrates that carbohydrates need to be replaced by protein for best results.

Does Gut Bacteria Play a Role in Weight Regain?
Preserving lean tissue and improving various metabolic parameters certainly help to make dieting results more stable and lasting. An additional factor, one seldom considered, is the role of gastrointestinal bacteria in weight maintenance. Human experiments have demonstrated that changing the diet to artificially induce blood sugar regulation issues surprisingly quickly results in changes in the gut microbiome that cause these bacteria to release more calories from food than normally would be the case, for instance, by digesting supposedly indigestible fiber. Similarly, it is well established that individuals who are overweight, obese and/or diabetic often have substantially different gut microflora than individuals who are lean.⁷ Therefore, so-called yo-yo dieting and recurrent obesity might be at least influenced by the microbes found in the gut.

A recent report in Nature casts further light on an aspect of this issue.⁸ As observed by one of the authors, Dr. Eran Elinav from the Weizmann Institute of Science in Israel, "we've shown in obese mice that following successful dieting and weight loss, the microbiome retains a 'memory' of previous obesity." Co-author Professor Eran Segal elaborated, "this persistent microbiome accelerated the regaining of weight when the mice were put back on a high-calorie diet or ate regular food in excessive amounts." One of the findings of this research is that the post-diet gut biome destroys certain flavonoids from the diet that influence energy metabolism. This interferes with energy release from fat. In post-dieting mice this leads to an accumulation of extra fat when they are returned to a higher-calorie diet. Experimentally, according to the paper, "flavonoid-based 'post-biotic' intervention ameliorates excessive secondary weight gain." This suggests that microbiome-targeting approaches may help with weight regain.

Putting It Together
Diets similar to the 30 percent protein, 30 percent fat, 40 percent carbohydrate diet described above have been proposed for several decades.⁹ In addition, the role of phytonutrients now is strongly supported. Both these aspects of good meal planning need to be addressed. A simple approach to meals is to make sure that roughly one third of the plate is covered with a protein source and one half or even two thirds of the meal plate is covered with the lightly cooked vegetable of your choice (salad does not count here; corn and carrots are counted as carbohydrates). Always eat this vegetable serving, which should be at least two cups of vegetables. Eat protein before eating any carbohydrates in the main meal for better digestion and better appetite control. (Classic European, Chinese and Japanese meal planning often arranges protein courses before carbohydrate courses.) Remember that vegetables are perfectly good carbohydrate sources and may well be consumed in the place of concentrated carbohydrates, such as rice and potatoes. Dieters also should consider supplementing with probiotics in conjunction with prebiotics. Finally, as noted in previous TotalHealth articles, when meals are eaten may be as important and what is eaten; never skip breakfast and avoid eating late in the evening or before bedtime.¹⁰

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