Eating Right

I was trained the same way most physicians are trained in nutrition, and I suspect the same way that most other people in the health care industry are indoctrinated.  For years, I thought the equation for weight was simple.  Input equals output.  If your input in terms of calories are greater than your output, then you gain weight.  If your output was greater than your input, you lost weight.  Simple.  I recited the food pyramid to my patients diligently, and suspected that most people who thought they were following the correct diet and who did not lose weight were really not as strict as they thought.  If they only counted calories, they would lose weight.  I was the typical 35% cards, 35% protein, 30% fat diet guy.  When I started to hack my own diet and exercise, I discovered that at least for me, what I had been taught was all wrong.  Now I eat at least 50% of my calories from fat, and approximately 30-35% protein, with the rest being carbs.  I don’t eat bread or pasta.  I eat sweet potatoes only on a leg or back workout day (large muscle groups).  I have lost body fat, my waist size is less than 30 inches, and I am 56 years old (soon to be 57). Turns out there is new science validating some of this information.  As we get older, the body does not like to let go of fat.  You have to trick it into thinking there is lots of fat around.  It really works.  If you are a male in your 40’s or older, change the way you eat.  Combine it with variations of high intensity interval training.  You will feel better, and you will lose the body fat.  I should add I suspect the situation is more complex for women.


High Intensity Intervals For Old People Like Me Part II

Monday was my leg day, and after testing the out limits of my quadriceps weight bearing abilities, the last thing I wanted to do was to get on the stair stepper or treadmill and run.  So I experimented with the incline and speed on the treadmill.  I took my baseline heart both with a stop watch and the machine and it correlated well at around 68 beats per minutes (bpm).  Then I started off at 3 degrees incline and at 2.5 miles per hour (mph) on the treadmill.  With each change in the variables, I correlated the machine readout of my heart rate with my stopwatch, and they were actually quite comparable.  I increased my incline sequentially by a few degrees, and increased my walking rate to 3 mph.  at 15 degrees incline and 3 mph, my heart rate was persistently in the 130+ range.  At 10 degrees, it was in the 120 range.  So I varied the incline every 2-3 minutes, and kept the speed at a comfortable constant 3 mph for 40 minutes.  At the end, my legs did not hurt, and I had a good cardio workout.  It also did not seem as onerous as pushing myself hard on the treadmill or stair stepper for 30 minutes, and I achieved the same calculated calorie goal.  For those who say that they don’t have 40 minutes to do this type of experiment, you can split it up into 2 20 minute sessions, one in the morning and the second at night.  In fact, there is research that suggests splitting up cardio into 2 shorter sessions rather than 1 long session boosts your metabolic rate higher than just one session.

High Intensity Intervals for the Elderly!

So sometimes I get out of work, and my legs just don’t want to cooperate in terms of running or doing significant cardiovascular work.  So how to get my cardio in and keep my heart rate above 130 for one minute intervals at least 10 times?  I find that if I try and grind it out by running fast on days like this, I get discouraged.  Its not my heart rate and shortness of breath withe exercise that limits my running on days tike this, it my legs that just feel tight and fatigued.  For example, every Tuesday I am in the clinic all day, on my feet seeing patients.  I have been in practice for 25 years, and I see 50-60 patients on Tuesday.  So my hack is when I get on the treadmill, I get my heart rate up by running slower on a steep incline, say 5-8 degrees at 4 mph.  I usually cycle every 2 minutes, meaning I run at 4 mph at 8 degrees incline, then 4 mph at 1 degree for 2 minutes.  I repeat this cycle for 40 minutes, and get a nice work-out.  I vary the incline on how I feel.  Usually, I will start off at 5 degrees incline, but as I run longer and feel better, I increase the incline on my higher intensity segments.  Try it, it really does work.


I unfortunately have to agree that deadlifting is probably the most bang for the buck weight lifting maneuver.  As much as I don’t like doing it, the move really improves my core and strengthens my upper body.  As with most other type A personalities, I get addicted to the exercise easily, and try and pack on more weight in order to outdo myself.  I think that why I tore my rotator cuff on the incline dumbbell press.  So I try to think like a mature 56 year old and do reasonable weights.  I learned a lot from listening to Pavel Tsatsouline, the chairman of StrongFirst.  Pavel apparently introduced the west to the kettle bell training program.  A few tricks I learned from him include gripping the bar really hard helps recruit muscles during a lift.  Also concentrating on tightening the core muscles just prior to the actual lift seems to make the effort easier.  He also mentions that the Russian powerlifters usually stick to 6 reps in order to build mass.  There are a ton of videos on Youtube on deadlifting technique by Mark Rippetoe, Dan John, and Ed Coen.  The  one I think that is most informative for us normal sized folks is at the link by Mark Rippetoe.   

Lean Body Mass

I used to think that weight control was just an issue of calories in versus calories out.  Now I have to face the fact that what I was taught many years ago, and spouted off with regularity may not be exactly correct.  I know from my own personal body hacks that the old paradigm of low fat diet did not work, especially after age 50.  I actually eat much more fat in my daily diet.  My morning  starts of with 2 cups of coffee with a single teaspoon of brown sugar, and a spoonful of MCT oil.  I then drink a 42 g Myoplex EAS protein shake (Chocolate of course!) in between seeing patients.  A couple of spoonfuls of natural peanut butter helps.  I also eat 2 handfuls of pistachios, and well as 2 handfuls of almonds.  For lunch, I have protein such as chicken breast and salad.  I have a mid-afternoon snack of greek yoghurt, and then hit the gym.  I usually lift weights for 50-60 minutes, but I don’t take more than a 3-5 minute break between sets. I then do 30-40 minutes of cardio, either treadmill or stair stepper.  I try and do high intensity intervals if at all possible, but sometimes my body just is too tired, so i just try and be persistent and complete 40 minutes of some type of cardio with a minimal heart rate of 100.  As I am finishing my weight lifting part, I take 25 grams of cold ultra filtered whey protein, 25 grams of casein, and 5 grams of creatine in about 12 – 16 ounces of water.  I learned a lot by researching proteins before I made my purchase.  A good general rule of thumb is look at the ingredients on the side of the protein package.  If it is high in cholesterol (greater than 10-20 mg per serving), it is not a good quality protein.  Then I have dinner, usually protein and vegetables.  By sticking to this regimen, my waist size is 30, and my body fat is the lowest it has ben since I was a teenager.  By the way, interesting factoid that most people don’t know.  Waist size of 40 inches or greater in men an 35 or greater in women is an independent risk factor for cardiovascular disease.  In plan English, this means that even if you are not diabetic or have high blood pressure, you are at an increased risk for heart attacks and strokes if your waist size is greater than 40 inches or 35 inches in a male or female, respectively.

Diet and Exercise Over Age 50

My epiphany moment was 7 years ago at age 49 when I woke up at 5 am as I had done for many years, got out of bed and thought to myself “why do I feel like crap?” I have lifted weight since I was 18 years old and have always done regular cardiovascular activity. As a physician, I knew a good bit about nutrition, and felt that I was following a good diet. I ate a low fat diet, balanced carbs and proteins. My paradigm was the old input equals output equation, which I quoted to my overweight patients. But despite what I thought was the correct way of eating and exercising, I realized at age 49 that I did not feel good. I went to Las Vegas to the Cenegenics Institute for anti-aging, was evaluated, and actually took the course and was certified by them in anti-aging medicine. To be perfectly honest, I did not like the gist of the course. They pushed hormone replacement rather than trying to root out the cause of testosterone deficiency in a young male. That introduction led to years of hacking myself and my body with different ways of eating and exercising. I trained for a year with a professional bodybuilder, and got jacked up to 185 pounds on a 5’8” frame. I could barely fit into my lab coat. Then I tore all 4 of my rotator cuff muscles on my left arm doing incline dumbbell press with 80 pounds, and had to have a surgical repair 3 years ago. After years of trying different ways of eating and exercising, I realized that my old paradigm of a low fat diet, input versus output concept was just not correct. So now I eat a diet high in selected fats, and weight train and exercise with much more focus on the outcomes I want to achieve. The results have been nothing short of spectacular.

Ketogenic Diet Week 8 or so

I have not kept up with my documentation of my ketogenic way of eating.  I use way of eating on purpose instead of diet, since the word diet implies some degree of suffering in my mind.  I had my regular check-up last week, blood work results pending.  From my physical examination the results are as follows

  1.  BP 120/70, heart rate 66
  2. Weight 166 pounds, down from 173
  3. No changes in how I feel physically
  4. Stronger grip since incorporating more calisthenics into my work-out routine. On that note, I would really recommend a Youtube channel I subscribed to called Calisthenics and weight training with Kris.  If I was smart enough with a computer I could attach a link to the website, but the guy is awesome and knows his stuff, from a surgeons standpoint
  5. Mentally, I feel much sharper, not hazy and foggy like I used to feel
  6. I sleep a great 5 hours, then wake up at 3.30 every am.  Thought about just getting up and working but I force myself to go back to sleep for another 2 hours
  7. Overall, I feel much better at this weight, and the ketogenic way of eating is easy to follow and really quite delicious


Ketogenic Diet End of Week 5

OK several observations after 5 weeks of ketogenic eating

  1.  I really don’t miss the carbs.  I never had much of a sweet tooth, but I really don’t miss it
  2. My body fat is at its lowest level as far back as I can remember.  It seems absolutely counter-intuitive to me after years of a low fat diet that eating higher fats actually does help you lose body fat.  I still try and stay away from the animal fats, maybe old habits die hard, but I have crammed myself full of almonds and avocados, natural peanut butter, hummus, olive oil etc.
  3. My 5 week picture shows a fairly well defined 6 pack, and the veins are starting to pop out in my left lower quadrant
  4. Splitting my cardio into a 20 minute light work out in the am and a harder 30 minute workout in the pm I think has helped
  5. I still have lost about 30% of my maximal strength, but I don’t look much smaller, and my body weight is down about 5-6 pounds.  A friend of mine tells me my power will come back.  Not too sure if I am interested in a lot of power anymore at age 55
  6. Eating ketogenic is actually very easy, by far the easiest change in my eating habits, because the foot is palatable and I don’t hungry often
  7. 2 teaspoons of Metamucil in 8 ounces of water really does cut your appetite
  8. Going to get new lab work done this month, we will see if the blood work looks good.  My last total cholesterol was 156, HDL 59, and LDL 93 on no cholesterol meds.   Strong family history of hypercholesterolemia

Ketogenic Diet, End of Week 4

Just completed week 4, and I have numerous observations to report

  1. I have lost about 5 pounds, going from 175 to 170 pounds, age 55, height 5’8″
  2. My waist size has decreased, and I am probably a waist 30 from a 32/33.  My 32 khaki shorts are now big on me.  (For all the men and women out there, remember that a male waist size of 40 inches and a female waist seize of 36 inches are independent risk factors for cardiovascular mortality)
  3. I estimate that I have lost about 30% in terms of my max for weight lifting, although curiously I have not lost that much weight, and my body fat percentage is lower. Not sure if that is due to over-training, worse recovery post training, or just a temporary change that will reverse itself with time.  I am not too worried about it but will see how things progress
  4. Really hesitant to show picture of my 4 week  progress on the internet, but I can tell a huge difference in terms of definition

Medium Chain Triglyceride (MCT) oils

OK so I am in my third week of about 3 teaspoons of MCT oils.  I must confess I have not noticed a big difference in the way I feel, but I will reserve final judgement until I have completed 6 weeks of using the MCT oil, and then make a decision about continuing to take it daily as a supplement.  The possibilities are either:

  1.  It does not really make you feel better or give you more energy as its proponents claim
  2. The effects are subtle, and not clinically detectable, but maybe the blood work will be a better indication of the effects of MCT oil
  3. I am not taking enough of the MCT oil to make a clinical difference in the way I feel
  4. I altered too many factors at the same time as staring the MCT oil, including starting on a ketogenic lifestyle, doing more cardio, splitting up cardio into 20 minutes in the am, and 20-30 minutes in the pm
  5. The MCT oil I am taking is not “therapeutic enough” and there are better ones on the market

I am inclined to think it is #1, but I will reserve judgement until I have taken it for 6 weeks, and then stop to see if there are any changes.  Stay tuned…