Eat Fat, Get Thin_Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health
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These are general principles that I live by because I want to live a long, healthy life. I also am in good shape and at my ideal body weight and body composition so I can enjoy a bit more varied diet. However, if you are trying to reverse diabetes, lose a lot of weight, reverse chronic health problems, and do a total body reset, then the jump-start metabolism reset Eat Fat, Get Thin Plan is the place to start. Think of it as a twenty-one-day program to reboot your body and mind and turn your body back to its original factory settings.
Once you have achieved your goals, you can begin to expand your way of eating to the full Pegan Diet approach. It is more of a philosophy with guidelines than a rigid way of eating; it incorporates the latest science and insights about nutrition and supports your body to thrive for the long term. So what is the Pegan Diet?
Let’s focus first on what Paleo and healthy vegan have in common. They are both based on real, whole, fresh food that is sustainably raised; rich in vitamins, minerals, and phytonutrients; and low in sugar, refined carbs, and processed foods of all kinds. An apple doesn’t have a bar code, an egg doesn’t have a nutrition facts label, and an almond doesn’t have an ingredient list. They are all real foods.
Here are the characteristics of a healthy diet almost everyone agrees on:
1. Ideally organic, local, fresh, whole foods.
2. Very low glycemic load—low in sugar, flour, and refined carbohydrates.
3. Very high in vegetables and fruits—the deeper the colors, the more variety, the better (although the Paleo camp recommends sticking to lower-glycemic fruit, such as berries).
4. Low or no pesticides, antibiotics, or hormones and no GMO foods.
5. Very few to no chemicals, additives, preservatives, dyes, MSG, artificial sweeteners, and other “Frankenchemicals.”
6. Higher in good-quality fats from olive oil, nuts, seeds, and avocados. Omega-3 fats for all! If you are a vegan and don’t want to eat anything with a mother, that’s perfectly okay. But it’s critical to get omega-3 fats, and not just ALA found in plants. You need DHA directly from food, rather than hoping your body converts the ALA to DHA. The good news is that you can get DHA from algae.
7. Low in refined, processed vegetable oils. Extra virgin olive oil is a delicious, healthy alternative.
8. Moderate protein for appetite control and muscle synthesis, especially in the elderly (though, obviously, there’s debate as to whether this should come from vegetable or animal protein sources).
9. Animal food. While of course vegetarians and vegans don’t agree that eating animal products is okay, those who do approve are in agreement that meats should be sustainably and humanely raised, grass-fed, and antibiotic- and hormone-free.
10. Fish. Ditto for fish when it comes to vegans, but if you fall into the camp that eats fish, the consensus is that you should choose low-mercury and low-toxin fish such as sardines, herring, anchovies, wild salmon, and other small fish and avoid tuna, swordfish, and Chilean sea bass because of the high mercury load. Fish should also either be from sustainable “organic” fisheries, or sustainably caught in ways that do not deplete natural fisheries.
THE AREAS OF CONTROVERSY
Here’s where things start to get a little hairy. These are the areas of controversy in the nutrition world that many are still debating:
1. Dairy. Both the Paleo and vegan camps (and yours truly) shun dairy, for good reason. While some can tolerate it, for most it contributes to obesity, diabetes, heart disease, dementia, and cancer and may increase (not decrease) the risk of osteoporosis, not to mention allergies, asthma, eczema, postnasal drip, acne, and irritable bowel syndrome.2 While some data suggest that it can be helpful in weight management and diabetes prevention, it is not clear if that is because milk drinkers have less soda or sugar-sweetened beverages, because of the dairy itself, or because the Dairy Council funded the studies! We’ll go into more detail about dairy in Chapter 13, and why, with the exception of grass-fed butter or ghee, it’s excluded from the Eat Fat, Get Thin Plan.
2. Grains. For millions of Americans (and millions in the rest of humanity!), gluten contributes to inflammation, autoimmunity, digestive disorders, mental illness,3 autism,4 depression, schizophrenia,5 obesity, heart disease, dementia,6 and cancer.7 Celiac disease affects 1 percent of all people, but gluten sensitivity might affect up to 10 percent, or more than 30 million Americans. Less than 1 percent are diagnosed.8 Gluten is in refined, high-glycemic foods like bread or baked goods and contributes to weight gain and insulin resistance. Even whole wheat bread spikes your blood sugar more than table sugar; any grains can increase your blood sugar, for that matter. But grains can be part of a healthy diet, just not in unlimited amounts, especially if you have diabesity or are carbohydrate intolerant. For type 2 diabetics wanting to get off insulin and reverse their diabetes, those with autoimmune disease, or those with a lot of weight to lose, a grain-free diet is a good experiment.
3. Beans. Beans are a great source of fiber, protein, and minerals. But they do cause digestive problems for some, and if you are diabetic, a mostly bean diet can trigger spikes in blood sugar. Again, moderate amounts are okay—meaning up to 1 cup a day. Some are concerned that beans contain lectins,9 which can create inflammation, and phytates, which impair mineral absorption.10 In Eat Fat, Get Thin, we avoid beans during the initial twenty-one days, much for the same reason as we do grains.
4. Meat. No shocker here: Meat is a sticking point for many. I cover meat in detail in Chapter 7. But the upshot is that research on meat is fuzzy, because most studies don’t look at the quality of the meat. Some studies show that red meat increases heart disease and death rates,11 but other studies show the opposite. In truth it depends on how the study was done, but the evidence in my mind is trending toward meat not being linked to disease. On the other hand, there are many ethical and environmental reasons to downsize your meat consumption. Focus on quality, not quantity.
5. Eggs. I’ve already shared with you all the reasons why eggs have been unfairly maligned, and why they have finally been exonerated. The bottom line is that eggs, especially organic and omega-3 eggs, are a great nutrient-rich, low-cost source of protein, and they have no impact on cholesterol or heart disease risk.
So what’s an eater to do?
First and foremost, don’t worry about focusing on how much you eat. If you focus on what you eat, and choose the right foods in the right balance, your body’s natural appetite control and healing systems kick into gear. I vote for resetting your body completely with the Eat Fat, Get Thin Plan, and then transitioning to the Pegan Diet as your long-term maintenance plan. A Pegan diet is a sensible and balanced way of eating without a ton of restrictions; it is satisfying, easy to follow, and based on the best science to date.
Here are the Pegan principles I follow, which you’ll learn much more about in Chapter 14:
Unlimited amounts of nonstarchy veggies (greens and crunchy veggies), which should make up about 50 to 70 percent of your diet by volume (how much room it takes up on your plate). See here for a list.
Moderate amounts of nuts and seeds, including almonds, walnuts, pecans, macadamia nuts, pumpkin seeds, sesame seeds, and hemp and chia seeds
Moderate amounts of low-glycemic fruit
Sustainably farmed and low-mercury wild fish (sardines, mackerel, herring, wild salmon)
Grass-fed beef, bison, lamb, organic poultry
Pasture-raised or organic eggs
Small quantities of gluten-free grains (brown or black rice, quinoa, buckwheat)
Small quantities of beans, if tolerated
No dairy (except organic goat or sheep cheese or yogurt if tolerated and ghee or grass-fed butter)
Plenty of good fats, including avocados, extra virgin olive oil, coconut oil
Occasional treats of real sugar, maple syrup, or honey
Moderate alcohol intake: maximum 1 glass of wine at night or 1 ounce of hard liquor, or ideally fewer than five drinks a week. Beer is a problem because of the sug
ar and gluten. Think “beer belly.”
Coffee or tea (1 to 2 cups a day maximum)
Minimal amounts of gluten (but only in the form of whole grains such as steel-cut oats, whole-kernel rye bread, barley) and dairy (ideally goat or sheep and always organic), only if tolerated (but my vote is to avoid or significantly limit dairy). These are optional and only if you find you have no reaction when you reintroduce them. They do not need to be part of a healthful diet, and for most people they cause inflammation and chronic symptoms.
What it doesn’t include: processed foods, artificial anything (especially sweeteners), liquid sugar calories, and juices except green juices
That said, I have created the Eat Fat, Get Thin Plan as a way to jump-start health and weight loss. It takes three weeks (twenty-one days) to change habits, to learn new patterns, and to allow your biology to completely reset, cool off the inflammation, renew your gut, and adapt to a higher-fat way of eating. Think of it as the “pre-Pegan” diet to reset your brain chemistry, hormones, and metabolism.
The Eat Fat, Get Thin Plan starts you off by removing the grains, beans, sweets, dairy, and gluten (however minimal), and includes lots of healthy fats and clean, sustainable animal products and seafood. This helps most people hit the biological reset button. Think of it as returning your body to its original factory settings. Then, as you’ll learn in Chapter 14, after twenty-one days you get to add back beans and grains in moderation—and, a few weeks later, if you want, small amounts of gluten, dairy, and treats like dark chocolate and wine—so you can see how your body responds. Pay attention. Notice how you feel. Good? Or bloated? Do you gain weight or lose weight? Does your brain fog or achiness come back or do you feel awesome? Let your body tell you. We all need a personalized approach, a way of eating that works best for us.
PERSONALIZING YOUR DIET
Even if you understand all the distinctions between the different types of fat and their effects on the body, you can’t know for sure the effects these foods will have on your body. We are all unique and each of us requires a different, individualized approach to our health. One-size-fits-all medicine is a thing of the past.
There is no single prescription for what to eat that works for everyone. The truth is that some people do better with more fat, even up to 70 or 80 percent fat, while others do better with more starch and carbohydrates such as whole grains or beans or sweet potatoes (although no one does well with large amounts of sugars and refined carbs). The best doctor is your own body. Listen to it. Pay attention. What makes it feel good or feel bad? Learn the medicine that works. As I’ve said many times, food is medicine, not just calories. It contains information or instructions that regulate your genes, your metabolism, your immune system, and even your gut flora.
There are some emerging tests that can help you find out what pattern of eating might work best for you. High-fat, low-carb or lower-fat, higher-carb? Even what type of exercise you might benefit from most. This is the study of nutrigenomics, which we use in Functional Medicine to personalize our approach.
A few companies are now offering genetic tests that you can do on your own to help you make more personalized decisions. Much of the information you need is contained right in your own body—what I like to call the smartest doctor in the room. Your own body will give you direct and often immediate feedback about what works and what doesn’t, if you need more or less fat, more or less carbs, more or less protein. It can even tell you what type of exercise works best for you. Throughout the twenty-one days on the Eat Fat, Get Thin Plan, it’s up to you to monitor how your body is responding. In Chapter 13, I give you clues on what to look for to know if you need more or less fat, carbs, or protein.
Your own blood work and your own story and family history all are amazing guides to personalizing treatment. People who are more carbohydrate intolerant (see carbohydrate intolerance/diabesity quiz, here) typically do better on a higher-fat, lower-carb diet. That’s an easy way to tell what makes the most sense. Almost everyone does better on a higher-fat, lower-carb diet compared to the average American diet, but some may be able to tolerate a bit more healthy carbs, including whole grains and starchy veggies and beans (which, again, you’ll test for yourself in the transition-to-Pegan stage in Chapter 14).
Checking your blood work also can be very helpful in identifying carbohydrate intolerance. Ideally you need a special cholesterol test called NMR done by LabCorp or the Cardio IQ test done by Quest Diagnostics to check particle number and size. All other cholesterol tests are inadequate and provide incomplete information. Here’s what to look for to determine if you are carbohydrate intolerant:
High triglycerides (over 100 mg/dl)
Low HDL (less than 50 mg/dl for a man and less than 60 mg/dl for a woman)
High triglyceride to HDL ratio (over 1:1 or 2:1)
Many LDL particles (over 1,000)
Many small LDL particles (over 400)
High insulin (over 5 fasting)
High blood sugar levels (over 90 mg/dl)
Elevated hemoglobin A1c (over 5.5 percent; measures average blood sugar)
Abnormal insulin tolerance test: fasting blood sugar and insulin levels at thirty minutes and one and two hours after a 75-gram drink of glucose
Fasting blood sugar should be less than 80 mg/dl. Thirty-minute, one-hour, and two-hour glucose should not rise above 110 mg/dl; some say 120 mg/dl
Fasting insulin should be between 2 and 5 µIU/dl; anything greater than 10 µIU/dl is significantly elevated. Thirty-minute, one-hour, and two-hour insulin levels should be less than 25 µIU/dl to 30 µIU/dl; anything higher than 30 µIU/dl indicates some degree of insulin resistance
If you have abnormal values on these tests you will tend to do better on a higher-fat, lower-carb diet. If they are totally normal, you may be able to include more healthy starchy veggies, whole grains, and beans once you transition to the Pegan Diet. You can monitor those numbers and see how different approaches to eating affect you.
TESTING YOUR GENES
Many of us would like to blame our parents or our genes for our weight or health problems. It would be easy to say that you have the genes for obesity or diabetes, that your parents and grandparents were overweight or had diabetes or heart disease, so you do, too. But the world of genetics is much more complicated than that.
Each of us has about 20,000 genes. Approximately 99 percent of those genes are identical to every other human on the planet; the other 1 percent is what makes us unique. You have about 112 million variations on those genes, called single nucleotide polymorphisms (SNPs for short), which influence every function of your body, including your need for vitamins, your ability to detoxify, and your tendency toward inflammation, heart disease, cancer, and much more. These SNPs also influence your weight and metabolism and your ability to process or manage fat in your diet.
Every day we are learning more about these SNPs and how they influence our health. We know enough today to start using genetic tests to help personalize our approach to health and nutrition. Soon we will be able to take a swab of our cheek, send it in, and for a few hundred dollars know our whole genome and match our food, supplement, and exercise needs to our own genes, optimizing function and metabolism. Up to 40 to 50 percent of the variance in body weight among people may be due to genetic factors, which is why different people respond differently to different diets.12
For some of my patients, I order genetic testing to help guide me in personalizing recommendations. There are some genes that help me tailor my approach for each person. These specific genes are linked to obesity and the tendency to gain weight, and how cholesterol profiles may respond to a high- or low-fat diet,13 metabolic rate, absorption of dietary fat, mobilization of fat from cells, and the ability to burn fat for energy. There are genes that regulate dopamine receptors in the brain, which control your likelihood of craving carbs and sugar, and genes that can predict levels of insulin resistance, inflammation, cholesterol metabolism, and even how your body responds
to different types of exercise.
I’ve listed below some of the genes I test for (and that you can easily test for with a home test kit—see www.eatfatgetthin.com for details):
FABP2: influences your absorption and metabolism of fat
PPARG: affects your insulin function, fat burning, and cholesterol levels
ADRB2: affects how your body mobilizes fat from fat cells for energy
ADRB3: affects how your body breaks down fat
APOA5: regulates your triglycerides
APOA2: affects the risk of obesity, cholesterol metabolism, risk of heart disease, and risk of diabetes
MC4R: affects your energy intake and expenditure and appetite control
FTO: regulates appetite, temperature, and nervous and hormonal systems
TCF7L2: regulates blood sugar, including insulin secretion and action
ADBR3: affects your responsiveness to exercise and fat burning
PLIN: affects fat storage related to obesity
TNF-A: affects inflammation, which can affect blood sugar control and cholesterol abnormalities
LDL: removes cholesterol from circulation
CETP: regulates metabolism of HDL and the levels of blood cholesterol
APOA1: regulates the production of HDL (good cholesterol)
APOC3: plays a key role in cholesterol and triglyceride metabolism
APOE: plays an important role in the breakdown of triglycerides and cholesterol
DRD2: affects the dopamine receptors in your brain and your risk of addiction to sugar and refined carbs
Since I am interested in this area, and because I have a strong family history of heart disease and tend to have higher cholesterol, I wanted to see what my tests showed. Let’s go through my own results so you can see how this can play a practical role in personalizing your own approach to health.