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Diet Rules
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Diet Rules


I'm tired of nonsensical fitness and nutrition information.  I'm tired of every last goofball promising eat more and exercise less for slick, lean bodies.  Not to mention supplements.  Most supplements are trash that lead to, at the least, very expensive urine, and at the worst, liver failure, kidney failure, heart arrythmias, seizures, strokes, and/or death.


So today I am deconstructing diets and exercise.  What do I know?  I'm not a personal trainer or a nutritionist.  I don't have a perfect body - not quite yet, anyway.  But I am a physician, and in spite of the hype, there is a lot of nutrition taught in medical school but not under the class title of "nutrition."  Cardiovascular disease, obesity, and diabetes lectures and clinical experience are filled with nutrition info at least equal to the nutrition classes I took in college.  I have also done a lot of reading, and looking around, and have tried to get the best advice from people with lean and lovely bodies, including bodybuilders, personal trainers, dancers, and even a soccer player.


This rant is for me.  Its easy to get caught up and go with the latest detox diet, or to convince oneself that calories don't count - wouldn't that be terrific?  But I need a few solid rules to ground myself, to go back to when the fat starts creeping on or the plateau makes me a little crazy.  Here they are:


  1. Calories count.  How many calories do you need?  The best way is to find a way to get a measure of resting metabolism either through online calculations (try or the one at John Hussmans site or at your doctor's office, if she happens to have the little machine that measures oxygen consumption.  Some gyms have these, too.  If you are trying to lose fat, try to keep calories a few hundred above the resting metabolic rate (RMR) most days, and don't blow 3000 extra calories on a free day either.  Have a bowl of ice cream a couple times a week, or one night eating out with a piece of bread soaked in olive oil along with that yummy breaded sole, and don't sweat it.  Fat loss is so tiny and incremental, pocket change of burned calories that add up.


  1. Write down what you eat.  Everything.  Every day.  Count the calories.  There are a dozen low cost or free sites on the web.  I use the Slim-Fast site because I like the convenience of the nutrition log.  I don't use their products much, due to #3.


  1. Some calories are better than others.  Saturated and trans fats are bad.  Unsaturated and omega-3 and omega-6 fats are good (the omega just means that the unsaturated carbon-carbon bond is either 3 or 6 places away from the end of the fat molecule.  I learned that in medical school).  Vegetables are really good, fruits also - soluble fiber amen!  As for other carbs - oatmeal, yams, brown rice - music to my ears.  Bagel, sugar, and white bread, well, it's a sugar molecule waiting to be escorted by insulin directly to your ass, unless you run quick like a bunny rabbit and burn it up.  Pasta has protein, but it is calorie dense. Protein is tricky - lean protein is fantastic.  A lot of animal protein is not that lean, and a study of diets all over the world show that societies with diets highest in animal protein have the most obesity.  However, there's never been a time like this before, where many people have the money and education to choose mostly lean animal protein.  Most sources will advise between 0.6 and 1 gram of protein per day per pound of lean body mass.  Go for a balance of carbs and lean protein, and be sure to eat your fiber, both soluble (for your arteries) and insoluble (its a free colon scrub!).   Oh, and don't drink your calories.  I have a few exceptions to that rule - thick frothy protein shakes and skim milk.  Skim milk is a lovely food.  And finally, the fast food industry is your waistline's enemy.  But you knew that.


  1. Cycles happen.  Hit a plateau?  Eat a few hundred calories more a day for a while -- you will probably maintain, but that's okay.  Then go down again to near the RMR.  Mini cycles are easy to build into a calorie-counted week - I plan small meals and snacks all between 80-400 calories, so have an extra meal once a week and maybe two extra meals on one day a week.  My personal cycle is seasonal  - it's pretty easy for me to be very precise and cut calories in the spring and summer.  In the winter all I want to do is sit on the couch with a warm throw and eat popcorn, chocolate, and ice cream.  I don't fight that tendency too much, though avoid, for the most part, being a total winter slob.  I try to use the extra winter calories to my advantage and focus more on heavy weights in the winter and increase the cardio in the summer.


  1. Did someone mention exercise?  Ah, yes.  Exercise is good.  Don't be scared of weights or cardio. 


    1. Cardio. To maintain weight, different sources will recommend 10,000 steps a day (I've heard that described as 3-4 miles - my usual workday running around the hospital + 1.5 mile walk to and from work is about 18,000 steps, and don't try to use the stepcounter for stairs - it comes out all wonky).  Walking is terrific, burns calories, and adds up (remember that pocket change) with little to no chance of injury.  But be real - if you are a casual stroller, you probably have to walk an hour a day just to maintain weight (overall, not all at once).  Also, I have a stressful job, and the only way to get extra cardiovascular benefit plus the lovely endorphin stress relief is via moderate to high intensity cardio.  Running, the elliptical trainer, stairmaster, treadmill - whatever it takes to get to 60-80% of maximum heart rate and hang out there for a while.  Don't be afraid to go over 20 minutes, either.  20 is minimum, 30-40 is better and probably a good way to spend most of your cardio days, and an hour of moderate is great.   Mix up interval, high intensity, and moderate intensity training.  Throw in a circuit or a military style boot camp aerobics class with calesthetics.  The rule I've seen consistently thrown about the bodybuilder media is not to go over an hour of moderate cardio a day, or risk losing muscle.  And, unlike what a run every now and then does for my Dorito-binging Significant Other, running does not melt the fat off my body.  One mile is 100 calories, give or take.  That means 36 miles per pound.  Pocket change indeed.


    1. Weights.  Work out like a man.  You won't become a lunkhead like one, I promise.  I'm delighted to see almost as many ladies at the freeweights as guys these days, and though there are always the pink vinyl mini weight aficionados out there, more and more are blasting away the bicep curls at 15-25 pounds.  Yee hah.  Just as variety is important to cardio, it is also important for weights.  Far and away the best site for womens weight training is Mistress Krista at


  1. Supplements suck.  If you dont believe me, check out the May 2004 issue of Consumer Reports.  (I know it is March 2004 right now, but I got it in the mail yesterday.  I swear).  It boils down to this - the supplement industry has crap regulation and the FDA doesn't have the manpower or funding to regulate the zillions of potions out there, so often labels arent reliable as to amount of active ingredients or even what the ingredients are.  As to the ingredients - don't take thermogenics.  Bad idea.  Ephedra killed lots of people. Metabolife 356 alone got 14,684 complaints in five years, including 18 heart attacks, 43 seizures, and 5 deaths.  Bitter orange and theophylline mimic the effects of ephedra and are now used in the ephedra-free products since it was (finally) banned by the FDA.   Other ingredients to avoid are aristolochic acid (kidney failure and cancer), comfrey, chapparal, kava, germander (liver damage, deaths reported for the previous four supplements), androstenedione (cancer, bad cholesterol).  I've heard bad things about chromium, too, but nothing scientific or any studies, just magazine report type gossip.


  1. Some supplements don't suck.  Vitamins and minerals like calcium in moderation are probably good and probably don't do harm.  Omega three fatty acids are fabulous and hard to get in the Western diet without daily grinding of flax seeds or tons of heavy-metal poisoned wild fish (I take two fish oil tablets at dinner).  Glucosamine and chondroitin have also been shown to improve joint health. I don't know about creatine.


  1. Every day is a new day.  You can blow it today or you can cobble together some nutritious, exerciseful days in a row.  Same is true for tomorrow.  And if food is an emotional crutch for you, write about it, or talk to someone.  If you take it away you will have to replace it with something, so figure out what that something will be (exercise = good, credit cards = bad).



That's it.  And I will share what I am doing right now for spring as a little example (My RMR is somewhere around 1400 calories):


Nutrition 1400 calories of about 50/30/20 carb/protein/fat most days, 1700 once a week, and around 2000-2300 once a week.


Exercise 2 day on 1 off or 2 on 1 off 1 on 1 off weight split, depending on schedule.  20-40 min moderate to high intensity cardio after every weight session except legs day, and every off day either 20 min interval cardio, 45-60 min moderate cardio, or, for a rest day a week, 1 hour walk or nothing.    


I'm not an early riser so I have to wing it some days, with clever home weights and cardio.  There.  Done ranting.  And no, I was not paid by the pharmaceudical industry to pan supplements.  I'll pan the pharmaceudical industry any day of the week.

I may be a doctor, but I'm not your doctor.  Before you start any kind of moderate or high intensity cardio or weight program, get checked out by a physician - especially if you are sedentary or have a health problem.  And don't start out running three miles.  Run as far as you like and walk the rest.  It's cool.  You have a long time to be fit.  No need to rush.