Recently someone once again asked for diet advice… here is Doctor Silverstein‘s answer:
There are many ways to skin the proverbial cat. That is another way of saying different strokes for different folks. The best diet is the one that works. As we age, the “twitch” factor that burns so many calories goes away. We sit more calmly, react more calmly, become more efficient, and even if we exercise, we still burn fewer calories. And then there are those damn (loss of) hormones that get in the way. The human body, whether we like it or not, is essentially vegan by design, like chimpanzees, gorillas, and goats. Do you remember on TV Ed the Talking Horse or Francis The Talking Mule? Those vegan animals had a mouth just like yours and mine.
All vegans are essentially trim with rare exception. If the patient is losing weight by having 2 eggs in the morning, a tuna fish sandwich at lunch, and a chicken breast at dinner, I do not argue. The first law of gambling is the first law of medicine: “Never get off a winning horse.” But that type of diet does not fit with our biology. You know the recent “everywhere” news about our microbiome which if it is the wrong kind (which is determined by what FOOD comes down the intestines) sets us up for rheumatoid arthritis, multiple sclerosis, various cancers, and heart disease, etc: those diseases do not even exist in cultures that are pre-technological and primarily, but not absolutely, vegan.
“All drugs are poison including the ones I prescribe including vitamins minerals, herbs, and supplements: be well use as few as possible” is something I have said a gazillion times to my patients. Simply with intuition and experience over the years I developed a medical fear of all weight loss medications except the diabetes medications: metformin, Ozempic, and Rybelsus. The others are slow poison upsetting nature’s internal biology profoundly in my best guess. The phentermine type of medication kicks the heart like “Speed” does.
The diet that I give to my patients to build on is simple, high fiber, filling, easy to do, but is a change from what most people are used or addicted to: berries, cooked vegetables, vegetable soups with no potatoes, and beans as the ideal protein with animal protein once or twice a week depending upon activity level. “Do not buy and bring home what you should not eat.” If you are craving a doughnut, go to Dunkin’ Donuts get 5 and eat them there but do not bring any home. Same for a hamburger: have 2 or 3 but do not bring any meat home.
KEEP A (simple) DIET DIARY written on paper. Most people begin to lose weight when they keep an honest diet diary. Do not eat at least 6 hours before going to bed. Regarding that last discussion of intermittent fasting, I have one patient who is being remarkably successful doing the following, but it does take significant discipline. He will eat any (any) animal protein at lunch and as much as he wants and as long as he wants for up to 2 hours: no bread, no potato, no pasta, processed or fried food, plus as many vegetables as he wants during that time. Animal protein plus vegetables for ONLY 2 of the 24 hours in a day. He could not lose weight any other way and that discipline plus the intermittent fasting is working for him. All shortcuts and tricks including medications trade success now for significant risk of disease down the road.
The diet that I give to all of my patients as a backbone is for BREAKFAST tons of BERRIES in a cereal bowl with any vegan plain or vanilla milk except soy or cashew milk. Four whole walnuts or almonds chopped up for CRUNCH in that cereal bowl and, once again, as much as you want of the berries but not cherries. Then ALL DAY LONG tons of COOKED vegetables but no potatoes: steamed, grilled, stir fried, flavored with all kinds of herbs and spices if you wish, and a tiny bit of organic extra virgin olive oil. SOUPS which are more vegetables-but not much water so they should be THICK and more FILLING like a stew. I believe salads stimulate appetite so I do not recommend them, but if you are successful in losing weight, you can have salads with a small amount of oil and vinegar or the tiniest amount of any other non-milk based dressing, but no animal protein In that salad. 4 ounces of beans at lunch, 3 ounces of beans at dinner. Personally, I prefer lentils, chickpeas, black-eyed peas, great Northern beans and have less interest in the darker beans. Taking probiotics and digestive enzymes may help with abdominal issues during the transition from where you are to where you should be. I especially like the product “DIGEST GOLD” 5 days a week. AVOID multivitamins, they stimulate appetite. Get a dietitian to check in with. I see my patient in 2 WEEKS and if they have lost 2 POUNDS, I see them in 4 weeks, and if they lose 2 more pounds I see them in 8 weeks, and then every 8 weeks. Anytime there is not a 2-pound weight loss, we start over.
The proper goal for weight loss is abdominal clear lines of definition and demarcation. It is not a number and fat is like cancer, so to speak, that if there is any left over, it will regrow. The key is the MIND-CHANGE from what you are to what you should be with no arguments and frankly no exceptions. That is difficult, but that is the goal & it is not impossible. It is not about perfection, it is about normal humility and perseverance as well as the recognition of reality = direction. How much of your future freedom, and time in the consuming jail of medicine with the loss of your health NOW, are you willing to trade versus the freedom from all that by doing it correctly? An implied lesson for us all in everything we do.
Here is a quote included in the question that inspired this reply, and can be applied to this:
“Fight for the things that you care about, but do it in a way that will lead others to join you.” Ruth Bader Ginsburg
Note: this post was updated and added to on 8/5/2021, some words were put in all caps to emphasize their importance.
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