Refuse To Regain

The Menopause Myth: Why It Can Be EASIER to Lose Weight Later

by Barbara Berkeley, MD

It's always healthy to be skeptical, particularly where dietary pronouncements are concerned.  

In the past year, I've been asked dozens of times about HCG.  Everyone is talking. It's all over the media. Does it work?   The answer should be obvious to anyone.  If HCG was any kind of obesity cure, 3 out of 4 people you know would be taking it already.  The first pill or treatment that comes along and can really zap obesity will burn through America with such rapidity that we won't know what hit us!  Lesson?  Just because someone or some newspaper article says it's so, doesn't make it so.  Skepticism is healthy in the diet world.

What many years of obesity practice have taught me is that we should also be skeptical of what passes for conventional diet wisdom.  Alot of it is just plain wrong.  And because we accept it as fact, we lose out on many opportunities to change our lives.

One of my least favorite "wisdoms" is that weight gain is inevitable after menopause.   I wrote about this a couple of years ago in my post on weight loss after fifty.  As time goes on and I work with more and more peri and post menopausal women, I am more and more certain that lower weights can be maintained without difficulty despite age and hormonal status.  Further, I think it's often easier for women to get healthy when they are past 45. 

The key to weight loss and maintenance at any age is the same:  a complete overhaul of the foods you eat.  This seems so simple and obvious, but practically no one who goes on a diet does it.  The vast majority simply returns to a modified version of their original diet.  Because modern foods are addictive, this modified version becomes the full-blown version in very short order.

The key to weight control after menopause is the strict limitation of starches and sugars, and that includes grains, whole grains and the flour-based products made from them (pasta, breads, and so on).  As I explained in my earlier post, this is because we tend to be more insulin resistant as we age.  This causes us to make more insulin in response to these foods, which in turn causes easier fat storage and an inability for stored fat to be released.  If you can make the change to fruits and vegetables rather than grains, potatoes, breads and cereals (and you can learn how to do it in books like Refuse to Regain or others on Paleo or Primal diet) you will lose weight and your age will be immaterial.

But there are also reasons why weight loss and maintenance is actually easier for those who are post-menopausal.  

One of the major reasons is the empty nest.  Feeding growing children and ravenous teen-agers makes it extremely hard to adhere to personal dietary rules.  If you have kids but they are now out of the house, you will find it hugely easier to make your own plans and stick to them.  Most of my patients report (and this has been my own experience) that husbands are usually willing to be flexible about eating.  They will often follow along even if they've eaten differently at an earlier stage in life. 

A second reason that it's easier to make change is that social pressures begin to modulate.  A couple of years ago, Don and I took a trip to Las Vegas.  While sitting at one of the enormous breakfast buffets at the Mirage, I had to laugh.  All of the people under 45 were tucking into huge portions of bacon, eggs, danish, muffins and potatoes.  Those who looked to be over 50 were eating egg whites, little bowls of granola with skim milk, and prunes!  Getting further along in life puts you in mind of the final third of the journey.  You and your friends will start to be more conscious of health and longevity.  Sayng that you no longer eat foods that make you fat and that you want to reach 95 in good health will no longer elicit eye-rolls.  You'll be admired, not scorned.

Another factor that I mentioned in my earlier post is the greater ability to be yourself that comes at mid-life.  The opinions that others have of you matter alot less now, and your tendency to speak your mind and live life by your own rules increases.  Use this new freedom by declaring yourself and your rules for eating.  You've earned the right to make your own way.

If you no longer are feeding a family at home, it's a simpler task to clean your kitchen and vow never to allow fat-promoting starches, sugars and junk foods to enter.  The need to entertain and cook is often lessened.  You've probably had that role for many years and perhaps younger generations will take on all or part of it now.  Minimizing baking and complicated entertaining can be very helpful when you are trying to make permanent healthful changes.  Keep things simple for a while and see how much easier it is to control the food environment. 

Exercise is a vital component of health from mid life on.  You can get away with being sedentary when you're young, but it's for sure catching up with you by the time you pass 50.  The good news is that it's also a myth that exercise ability lessens with age.  While no one wants to get injured, many of us take to our couch at the first hint of soreness.  We are not as fragile as we think.  Unless you have a very real reason not to exercise, get out there and do activities that get you excited.  If this guy can run the marathon at 100, you can train to walk a 5K, shake your booty in a zumba class or conquer the downward dog.  

Finally, changing your life and eating habits requires belief in your ability to get things done.  That's not something many people have in their 20s and 30s.  But after you've built your career, your family, your life, you clearly know how to get things accomplished.  Make the same kinds of plans you did to get other important things done in your life and take on your goal with a passion.  This is an advantage for  mid and later lifers.  Use it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Habit and Reward: Good for Target, Good for Maintainers

By Barbara Berkeley, MD

Here's an article everyone should read.  In yesterday's New York Times magazine section, there was a long and eye-opening piece on the science of consumer behavior.  It seems that we buy things because it becomes our habit to do so.  Marketers rely on this habit and try to create it.  There are times in our lives when we are more susceptible to changing habits.  Target has found that pregnancy is one of those times, and it has gone to great lengths to identify pregnant women and to market to them.

Research with rats gives us insight into our own behavior.  It turns out that habits have three components:  a trigger, a behavior, and a reward.  The brain is actively engaged only during parts one and three.  What makes the habit a habit is that the behavior component, no matter how complex, is run automatically.  In other words, once the habit is triggered, it’s on autopilot. 

I’m sure that many of you will be horrified, as I was, by the extent of mind-control and manipulation that goes into modern marketing.  But if we leave that aside, the information on habit formation gives us some powerful tools for changing things we may want to alter in our own lives.  Changing habits is arguably the most vital task for maintainers.

So, I see two avenues to explore.

First:  Since habits are so automatic and ingrained, and since powerful rewards like the pleasure of eating junk and sweets have carved habits deep into our neuro-pathways, we must consciously avoid putting ourselves in situations that pull the trigger.  We’ve discussed this many times here, most recently in the last post.  As much as we’d all love to eat controlled amounts of the modern foods that everyone else is downing, we’ve mostly learned that we can’t.  We’ve also observed that when we do indulge, we are punished by a return of cravings.  This is addressed in the Times article:

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

“We’ve done experiments where we trained rats to run down a maze until it was a habit, and then we extinguished the habit by changing the placement of the reward,” Graybiel told me. “Then one day, we’ll put the reward in the old place and put in the rat and, by golly, the old habit will re-emerge right away. Habits never really disappear.”

 Habits never really disappear.  Words to live by.

Second:  Since habits are created all the time and since we know their components, why not create our own?  Rather than let someone else manipulate us with their chosen reward, how about deciding to reward ourselves? When I think about my own maintenance, I realize that I’ve set up many of these loops and that they are what keep me going.  Weighing myself every day is a reward in maintenance.  When I have to lose some weight because I’ve edged up a little, the scale is both my trigger to lose and my later reward.  I’ve learned to get pleasure out of the feeling of being hungry on days when I have to bring my weight down. How have I done that?  I associate that feeling with a pleasant day I’ve set up. I follow a pre-set reversal plan that I enjoy---usually to have a non-fat, skim mocha for both breakfast and lunch, a nutrition bar at 3 and to try to do some shopping if I can, which is fun and which distracts me. Then I have a huge salad and some protein for dinner.  I look forward to these days rather than dreading them.  The scale on the next morning’s weigh-in is a further reward.

I find that my Primarian eating style has become a reward in itself.  After forcing myself to stay away from starches and sugars for many years, I now truly enjoy eating chicken, fish, nuts, veggies and fruit with some low fat dairy mixed in.  I look forward to these meals and they have become their own reward.  Each day, the pleasure that comes from eating this simple good food ingrains the habit more deeply.  I have no doubt that if I started eating Mallomars again, I would immediately re-activate my chocolate cookie circuits.  Why do that?  I simply don’t want to.  

One of the toughest jobs I have is to convince non-exercising patients that fitness has rewards that are as strong as bread, chocolate cake and pasta.  I never used a muscle until I discovered aerobics in my late 30s.  Within a month or so, the music and the energy took over from the pain of using those veal-like structures for the first time.  Now, years later, I’ve found that I can create the same high from running to Michael Jackson’s “Jam” on a sunny day or playing a great set of doubles in tennis.  Nothing beats a high-energy, dance-y aerobics class though.  For me, the pinnacle is exercising when I am in the Bahamas: a place where dance, party and exercise all exist in one class at one time.  When setting up your new reward circuits, don’t forget to search for the bliss that is found in physical challenge.

The Times article makes the point that rewards can be subtle.  You are rewarded for backing out of your driveway successfully simply by the fact that you achieved that tricky maneuver.  A reward doesn’t always have to be a treat.  It can be a sense of balance, completion or satisfaction.  The trick with food is to eliminate the over the top rewards of drug-like sugars and starches.  It’s hard to compete with the hit of a drug to the pleasure centers, and these foods come way too close to that experience.  Don’t put them in competition with other rewards because lesser rewards will lose out.

In essence, the Times article leads to conclusions that are just the opposite of those in my last post (Tied to the Mast).  The two go well together because they demonstrate the two opposite faces of maintenance.  The first:  studious, focused avoidance of things that others find pleasurable.  The second:  the creation of a brand new world of habit and reward, based on one’s own rules…not those of the culture at large. Part Two completes Part One.

After all, there is no point in getting past the Sirens if you land in a grim place that no one would want to inhabit.  Make it beautiful and you will want to stay. 

Creativity is the basis of all art, even the art of maintenance.  

 

The Fat Trap: My Response

By Barbara Berkeley, MD

Once a month, in a small room off the lobby of Lake West Hospital in Willoughby, Ohio, a special group convenes.  For someone observing the group and unaware of its purpose, it might appear to be a simple mix of everyday people….young, old, racially diverse.  The members would seem to be old friends but with a particular seriousness of purpose, perhaps a community group attending a lecture or learning some new skill together.  What a casual observer would not guess is that each of these people was once obese, some having weighed over 100 pounds more than they do today. 

Our Refuse to Regain group is an experiment, a safe haven for maintainers who have lost weight in many different ways and now face the reality of reconstructing their lives.  We’ve had people from Weight Watchers, people who’ve undergone bariatric surgery, people I’ve treated in my  practice and others who simply did it on their own.  A weight loss diet is no different than emptying the trash.  It doesn’t matter which technique you use to toss out the garbage.   But learning how to avoid the reaccumulation of unwanted junk is a completely different skill.  There are many basics in this process that will be the same for everyone.  There are also many specifics that will vary from person to person and which must be individually discovered.  

Here’s some of what we’ve learned so far:

1. Weight maintenance is possible.  There is nothing in our group experience (or in my personal clinical experience) to suggest that the body “forces” one to regain.
2. Weight maintenance requires a separation from the world of “normal” American eating…which is not normal at all.
3. Some people are heavy simply because they are susceptible to the modern diet , no more no less.  Others are heavy because they use food for soothing or sedation.  Most people are a mix of both.   If psychological issues are a major part of weight gain—significantly beyond the common enjoyment of food for pleasure, they need to be addressed during the maintenance phase.
4. Weight maintainers are special people who live on a kind of food island.  It’s really nice to know that the island is inhabited, often with fascinating, determined people just like you.   Rarely do maintainers get to meet and talk with one another.

This week, I gave my group a reading assignment.  That was a first.  I asked everyone to read Tara Parker Pope’s article on weight maintenance called The Fat Trap.   This article is currently online and will appear in Sunday’s New York Times Magazine.   Our group will be discussing it at our January meeting, but I’ll give you a preview of my reaction here.  Many of you may be reading our blog because you read The Fat Trap and discovered Lynn Haraldson, my blogging partner on this site.  The fact that you got here likely means that you are interested in knowing whether we are bound to regain the weight we lose, so please, read on…leave comments and join the discussion.

For those of you who are new to this blog, you should know that I am a physician who has specialized in weight management since the late 1980s.  This is the only thing I do and that’s unusual.  Why?  Because most doctors are not particularly interested in obesity, and certainly weren’t back in the 80s.   Over the past twenty years, a continuing source of frustration for me has been the willingness of doctors and the general public to accept “truths” about weight loss that are the beliefs of everyone except those who actually work with overweight people.   

Scientific research needs to square with what we see in clinical practice.  If it doesn’t, we should question its validity.   “The Fat Trap” is an article that starts with a single, small research study and builds around it.   Its point?  That there are inevitable biological imperatives that cause people to regain all the weight they lose.

I don’t buy it.

Here is the opening paragraph of Ms. Parker Pope’s article:

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again.

At one time, this was my experience too.  But things have changed.  After years of focusing my practice much more on weight maintenance, writing a book about it, and trying to figure out how to teach and encourage it, I no longer see patients with an “entire effort come undone”.   Instead, I see more and more people learning how to become successfully anchored at their new weight. And these POWs (previous overweight people) are not from my practice alone.  They are people like Lynn Haraldson and her friends “The Maintaining Divas”.  They are the long term POWs who write to me via this blog, on Facebook and on Twitter.  They are the people I hear about with increasing frequency every day. 

I admire Ms. Parker Pope for acknowledging her own struggles with weight, but as someone who has not yet solved the maintenance problem I would submit that she is not the best person to rationally evaluate evidence that says that regain is inevitable.  After talking to a number of scientists who believe that the body fights weight loss, her concluding paragraph says:

For me, understanding the science of weight loss has helped make sense of my own struggles to lose weight, as well as my mother’s endless cycle of dieting, weight gain and despair. I wish she were still here so I could persuade her to finally forgive herself for her dieting failures. While I do, ultimately, blame myself for allowing my weight to get out of control, it has been somewhat liberating to learn that there are factors other than my character at work when it comes to gaining and losing weight.

Those of us who come from families which struggle with obesity can believe one of two things.  We can believe that biological and metabolic factors doom us to fatness or we can believe that we come from families who are very sensitive to the current food environment and perhaps need to live in a new and more creative way.  It has been my experience that all successful maintainers have learned how to live a life that exists outside the current food norms.   For some, this is a daily and difficult challenge and for others it becomes a simple and treasured way of life, but either way, it is not about some inevitable biological destiny.  Rather, these maintainers have come to terms with the fact that they are ancient bodies and souls living in a modern environment and that our food culture is capable of killing them.  Controlling that environment is their choice and their challenge. 

Where I do agree with “The Fat Trap” is in its assertion that obesity is much more difficult to deal with once it is established.  We would do well to focus intense and constant attention on healthful nutrition during pregnancy and in childhood.  I believe that we can do this much more easily than we believe, if we would only adopt the idea that we should eat more like we did originally as hunter-gatherers.  It has been my clinical experience that elimination (or major curtailment) of starches and sugars (including whole grains and the things that come from them, by the way) simply works.  And this clinical observation makes sense, since the ancestors whose genes we carry were not exposed to the large amounts of starch and sugar we now eat.  Along with consumption of real food…not things in boxes, cans, or packages.... this easy concept can change lives.  We could make things so much easier by teaching this lesson  to kids rather than endlessly focusing them on per cents of fat, protein and carbs and on counting calories.

But such approaches to weight maintenance are not easily sold.  Its far simpler to believe that weight must be regained.  I’m fond of using this example for patients:  If you were to tell your friends that you are becoming vegetarian and that you will no longer touch a drop of red meat, fish, or poultry, no one would blink an eye.  You’d probably be encouraged and congratulated.  If, on the other hand, you announced that you were giving up sugar and grain, the same friends would be horrified.  “You mean you’re never going to have another piece of bread???”

I believe that the resistance to finding the maintenance solution comes from the addictive nature of starch and sugar foods.  I also believe that most of America and other SAD (standard American diet) countries are operating “under the influence” of addictive carbs.  Life without them, or even with LESS of them, is too awful to contemplate. 

But I digress.  To return to my original point, I want to forcefully say that we must stop finding reasons we can’t maintain and start getting much, much better at teaching people how to do it.  Support networks, communication between maintainers, and many more books, advocates, and techniques that focus on maintenance are key.  

I believe I may scream if I see yet another book with a catchy title that touts yet another weight loss approach without ever talking about what happens in the after-diet world.   January is the month for those glossy little productions. 

Time to get serious.  Maintenance can be done, and if you want to meet the people who are doing it, hang around this blog. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What Causes Weight Gain? My Take

by Barbara Berkeley, MD

How do we lose weight?  The answer is--- cut calories until the body is forced to burn itself for energy.   This is so intuitively obvious that the converse would also seem to be true: if we lose weight by cutting calories, we must gain weight by accumulating them.  But is this true?  Perhaps weight loss has nothing much to do with weight gain.   Perhaps they are two quite different things.  '

For some time, I have been giving an introductory talk to new patients who enter my practice.  I wanted to record it so that they could hear the talk again if they chose, or share it with those at home.  At the same time, I thought that readers of this blog might find it interesting as well.  While I can't claim to know the ultimate truth, I have found that the model of weight gain I describe in these videos works well as a basis for treating most of the overweight patients I've encountered.  I hope you find it interesting.

 

 

 

Getting Past the R Word

by Barbara Berkeley, MD

While I don't take as much of a beating on the internet as some diet writers do (thank you for that, readers!), most of the negative comments I get are directed at the fact that my diet recommendations are too restrictive.

Restrictive is the R word.

I think that we often confuse structure with lack of freedom.  As our society increases its amount of available choice, we tend to bridle at the idea that any of these options might be taken away.  And we particularly hate the idea of any authority regulating choice...most especially the government.  But until recently, we never lived in a world with such abundant choice.  Life might have been less interesting, but it was certainly easier to negotiate. 

I've written in the past about decision fatigue, a state that seems to occur when we are forced to make too many selections.  It appears we may only have so much organizational ability and will power.  Our constant exposure to choice (mocha or latte?  grande or venti? whip or no whip? skim or soy? ...and that's just Starbucks) wears us down and makes us anxious.  Certainly this is no more evident than in our exposure to an ever-expanding food menu.  Our only defense is to have our own rules and our own plan.  We can then approach the market, the restaurant, and the vending machine using those guidelines.  

Interestingly, there is little R word push back regarding vegetarian or even vegan diets.  By R word standards, these are extremely restrictive.  But they are accepted in our society because they've been around for awhile.  In addition, most people remain unthreatened by vegetarianism.  It has the feeling of an eating style that is chosen by a select few...and vegetarians tend not to be very militant about pushing their diet on others.  Lastly, vegans and vegetarians can still eat sugar and starch (grains and other starchy carbs). For most of us, these are the toughest foods to give up.  It's more radical to suggest cutting out rice, pasta, corn and potatoes than it is to advocate giving up fish, meat and turkey.   And those who do suggest such a change may be subject to R word criticism. 

Just as we negotiate buying choice by adhering to a budget, just as we decide which moral choices to make by adhering to religious guidelines, just as we choose from the endless careers available to us by figuring out where we fit...so too should we view how we eat.  Prior to the last 30 years, eating was less easy to do and foods with the potential to hurt us far less available.  Since the advent of instant eating opportunity throughout the day, we need to apply the same sorts of guidelines to food choice.

People who write about me being too restrictive have not read me very well I think.  I have made it clear that I believe in whatever works for YOU.  The diet that I propose is one with which I have many years of personal and professional experience.  Take that for what it's worth.  Explore other possiblities too.  Choose, based on who you are and what works best.  As long as you are maintaining your weight loss and keeping hypertension, hyperlipidemia and high sugars at bay you are doing a fine job.  

Occasionally I am asked to restate what I believe is the most effective diet.  With trepidation, I'll do it again here.  But please don't view it through the lens of the R word.   Eating this way is a choice based on my own guidelines.  I have no desire to legislate, push or otherwise force this way of eating on anyone.

I prefer-- and see excellent results from--- a diet that is composed of lean animal proteins, vegetables and smaller amounts of fruits and low fat dairy.  I try to stay away from legumes like soy and starchy beans although I personally don't completely exclude them.  While dairy is not a part of most paleo style diets, I include it because I have found that it doesn't affect weight in most of my patients and it gives them greater choice.  Watch dairy products to make sure that they are low in sugar.  Sugar and grains are the two major things I like to keep out of the diet.  One other thing that people complain about with my diet is that it's inconsistent with "true" ancient eating.  I'm not really about being a purist.  I'm about getting the job of weight maintenance done.  If this means using sugar substitutes and low fat dairy, I'm ok with it, because in my world keeping weight low is the primary goal.  Health follows from that.  For those who are uncomfortable with that compromise, there are endless ways to vary such a diet plan.  

As you all know, I call this plan a Primarian diet.  You can find more detailed information in my book, Refuse to Regain and in the archives of this blog.  The degree to which you need to be completely Primarian varies from person to person.  I recommend that you use it as your default diet...meaning most of the time.  We all "go off' here and there, but it works better if deviation is rare.  That's because I remain impressed with the ability of grains, starches and sugars to take over in the brain (or gut).  Those who regain their weight have almost always been co-opted by these kind of carbs.  I believe them to be a strong drug and one that promotes insulin production and fat storage.

If other variations of eating work for you in maintenance, that's excellent.  Please share.  Each of us is a different entity and contrary to what some some have written, I don't believe in a one-approach-fits-all.  What I do believe, however, is that having rules and plans for eating is vital for healthy survival in our current environment.  None of these plans is about Restriction.  Each is about creating a way to eat that allows us negotiate the hazards of endlessly offered food choice. 

 

 

 

 

 

Novak Djokovic: The Diet That Conquered Tennis

by Barbara Berkeley, MD

For those of you who don't spend your days watching Tennis Channel, let me bring you up to date.  

Since the current professional men's season began last year, Serbian tennis phenom Novak Djokovic has dominated his sport in a way that is nothing short of astounding.  He has won 64 matches (including last week's U.S. Open) and lost only 2 and has ascended to the number one spot in the world  (view Djokovic's website here)  What makes this so incredible?  He's done it in the very midst of the dominant era of unbeatable superstars Rafa Nadal and Roger Federer.  Federer and Nadal have controlled the two top rankings in tennis since 2005 and, until recently, Rafa appeared poised to claim his spot as one of the greatest ever as he took over from a slightly slower 30 year old Federer.        

Before this season began, Djokovic sat in the number three spot.  His tennis was strong and sharp, but he often struggled with breathing problems, what seemed to be an episodic de-conditioning, and a mental attitude that made him prone to frustration and breaking things. 

That Djokovic could so completely turn things around in one short season is mind-blowing.  Sports writers chalk this up to a new confidence, a stronger serve, and a better mental game.  Less frequently discussed is another intriguing factor:  before this season began, Novak Djokovic gave up carbohydrates.

A piece written in May for the Wall Street Journal (see previous link) mentioned the diet change in its title, but gave it short shrift when discussing possible reasons for Djokovic’s near-miraculous improvement.  Surely the change must have occurred because he gained confidence.  Surely the dietary contribution is nothing more than a placebo.  

The article quotes David Levinksy, a nutrition professor from Cornell: 

Levitsky said a gluten-free diet might have benefits for those with mild allergies, or even no allergy at all. "The other part of the story is, if you believe in a cause of your disorder, it becomes the cause," he said. "We see this in many different studies. If you believe it, you change your behavior in the direction of being cured."

This explanation seems odd, considering that it appears in an article entitled, “Starch Madness: Novak Djokovic’s Domination of the Sport Has Coincided with His Gluten-Free Turn”.   It’s as if the writer posed the question, but didn’t dare go after the answer.  Is it possible that, in fact, cutting out carbohydrates made Djokovic into a better athlete?  Is it possible that everything we've believed about the importance of loading our muscles with tons of starches is untrue?  Is it possible that we can play endlessly taxing endurance sports without jamming ourselves full of pasta and potatoes?  And is it possible that we might be better off for it?

It seems that world number 4 Andy Murray thought so.  He has adopted the Djokovic diet.  How much do you want to bet that others follow.  By the way, Murray just became the second person to beat Djokovic this year (although Djokovic did have a shoulder injury and was forced to withdraw after a set).  Commentators for the match remarked repeatedly about Murray’s fitness and ability to move around the court.  Coincidence?

I have held a consistent view on diet and it is a view that I believe holds up when one examines Djokovic’s transformation.  Rather than worry about individual dietary elements, we should attempt to eat foods that are most like the ones are bodies understand genetically.  Since our genes are thousands of generations old, we need to look at the foods that were prevalent in those times:  lean proteins, fats that come from natural sources (and thus have higher omega 3-6 ratios), vegetable and fruit matter, seafood, nuts and other naturally occurring plant foods.  Sugars and starches (including grain) were not a part of that original diet and are processed poorly or even cause overt harm in those of us who are more “original” genetically.  In addition, our body has certain fuel expectations.  Large amounts of carbohydrates as fuel seem to me to be inconsistent with what our body was fine-tuned to expect.  

In my own practice I treat many tennis players and runners who are significantly overweight despite many hours of intense exercise.  When they change their diet to one that is primarily Primarian, they not only lose weight but they become more efficient at their sports.  For those who are interested in pursuing very taxing endurance exercise like triathalons or marathons, I suggest reading the book Paleo Diet for Athletes by Loren Cordain and Joe Friel. This addresses the particular needs of those who require some additional carbohydrate when training for specific endurance events. 

In my own life, I attribute the ability of my 63 year old body to run a 5K, play hours of tennis, and do aerobic exercise at high capacity to the right mix of fuels.  I have no doubt in my mind that it is Primarian eating, and not placebo, that has kept me lean and strong. 

Dietary beliefs die hard and unfortunately, our unwillingness to give up the conventional wisdom leads to real death, the death of those who develop diabetes, heart disease and cancer as a result of the profligate consumption of insulin stimulating carbohydrates.

Is the Djokovic diet phenomenon real?  You bet it is.