Is long time adherence really possible?

[JeffN]

I am posting this as I will be updating this thread soon. It was originally posted here....

https://www.drmcdougallforums.com/viewt ... 75#p630470

I heard something new from Dr. Lisle on his most recent Q&A with AJ (January) which made me sad on the one hand, but a little more forgiving on the other. It’s that he says after 40+ years of clinical experience, very few people can really do this. It takes a certain type of personality. Most people just can’t; the Pleasure Trap is too powerful for them.

Doug and I have talked about this quite a bit over the years and I agree.

We may be the two people with the most experience working directly with clients over the longest time. For me, it's been 35 years.

It's not just the pleasure trap, but that we live in an environment that surrounds us with calorie dense, highly palatable, pleasure trap foods. It has been called a toxic and obesogenic environment.

"The term toxic food environment was coined by Kelly D. Brownell in his book, Food Fight: The Inside Story of the Food Industry which describes American culture at the end of the 20th century as one that fosters and promotes obesity and unprecedented food consumption. In the United States, the food environment the citizens are encompassed in makes it far too hard to choose healthy foods, and all too easy to choose unhealthy foods. Some call this food environment "'toxic' because of the way it corrodes healthy lifestyles and promotes obesity"."

https://en.wikipedia.org/wiki/Toxic_food_environment

The term, "‘obesogenic environment’ has been coined to refer to the influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals and populations".

https://bmcmedicine.biomedcentral.com/a ... 20-01538-5

There are steps we can take and habits we can develop to minimize the impact but it is not easy.

And, those who come to our programs here are usually a self-selected group, usually highly motivated and well educated.

There are a few posts that review these steps in my forum. Here is a thread that contains a lot of the discussion and some links to other ones.

viewtopic.php?f=22&t=44133

Knowing this, perhaps we could have more compassion on those who are not able to do it.

In Health
Jeff

[JeffN]

The following question was asked recently on the Beat Your Genes podcast. I thought it was a great summation of the way many of you, especially those trying to manage their weight, may feel.

Here it is...

"As a woman in my 50s who has eaten crap her whole life and fought her weight the whole time too, I have found that unless I quit my job, divorce my husband, drop all my friends, move to a cabin in the woods in total isolation with no form of communication or entertainment and never leave while growing my own whole foods, controlling everything in my environment is impossible and triggers and cravings are everywhere. (and some appear without any noticeable provocation and with a connection that only my brain can seem to find.). What can I do? I am trying to deprogram over 50 years of programming and habits and are surrounded by people who aren’t even trying and surrounded by an industry and environment that is bound and determined to make me sick and fat."

You can hear the question and the response they give here.

https://beatyourgenes.org/2023/06/01/30 ... lize-more/

It starts at 17.28 and ends around 40 minutes

Feel free to post any comments here.

I will be responding with my thoughts next week or two.

In Health
Jeff

[Artista]

Jeff, Thank you so much for posting a link to this podcast. I've listened to it twice now and found it very illuminating. What Drs. Lisle and Howk describe is exactly what happens to me when I try to follow MWL. The craving for higher calorie dense food eventually becomes so strong that the diet becomes unsustainable and I end up in a binge-restrict cycle. That's been the source of my adherence fatigue rather than my environment and the influence of people around me. I've tried MWL numerous times and I can never make it beyond a couple of months. I thought something was wrong with me, with my commitment or resolve, but this podcast has given me hope again. A MWL-type diet that includes some higher calorie dense foods like the ones Dr. Lisle suggested (e.g. tofu and avocado) I find much more sustainable and it's a relief to know that that is a viable option. He called it the one good move left on the chessboard for some people and for me I think that's true.

[Ejeff]

Thank you for bringing this podcast to our attention for discussion. I have also listened to it twice. I have never fully committed to doing the MWL program as I haven’t been willing or able to give up nuts, tofu and bread. Dr. Lyle really reinforced how nuts are so very high in calorie density. It’s good to know that he “spikes” his diet with tofu, avocado and pasta.

It seems like people such as Chef AJ can eat very low fat over the long term and not have any issues with long term adherence.

I like the part about putting aside the monitoring of the diet. We shouldn’t be racing toward a goal line, but instead making a deal with ourselves that we can live with. This diet/lifestyle is not meant to be a time limited experiment, therefore Dr. Lyle says we can evaluate it later. This podcast is very timely for me because I have recently undertaken steps to build more strength. I want to have a bit more muscle and less fat. Of course I set some short term goals, but I am rethinking that. This will likely take much more time than I thought and I am fine with that. I am not doing anything extreme. Three days a week of some push-ups and weights and 3 days of some HIIT cardio. When I establish a routine I always ask myself can I maintain this schedule for at least 5 years. To me there is no point in overdoing it and then quitting.

I think that is sort of what this podcast is saying. You can try to maintain a very low fat diet and you can be successful for quite a while. Several years even, but eventually you may go back to binging on nuts and nut butters as the overall diet is too low in calorie density. I guess this podcast attempts to assist people that have done MWL and reached their goal weight. What’s next? Should they add in some tofu and perhaps more pasta? It would seem that doing so will result in better adherence over the long term. At least that was my takeaway from the podcast.

Erin

[JeffN]

I will be responding with my thoughts next week or two.

Or three or four

After this was first posted, Mark, Goose and I had some great discussions on it and this post is a compilation of our thoughts.

Doug made some great points including (paraphrasing) that humans are not biologically vegans though we may choose to be vegan, that what we are asking people to do is very hard in this environment, to be good to ourselves on the path and to honor our improvements along the way.

I also agree with Doug on the point that tying to maintain a diet below 300- 400 cal/lb can be very difficult due mainly to a lack of calories and satiety.

This is why, when I teach my lecture on calorie density, I recommends aiming for a “Sweet Spot” within the range of 400-800 cal/lb that can be successfully maintained. That is why that area of the graph is coded green. That is also why the Sweet Spot graph is coded yellow and orange for going under 400 cal/lb and for going over 800 cal/lb. The best way to find one’s Sweet Spot within that range is by shifting the ratios of the recommended foods on your plate. (See Sweet Spot graph below)

What I liked about the question from the patient is that it covered virtually everything that we hear about why it is so hard to do this. It reminded me of many emails and conversations I have had with clients, participants, patients, etc over the years all summed into one. It raised many important topics we deal with including the environment, family members, eating out, restaurants, time, socializing, access, triggers, old habits, the food industry, etc.

My concern with the response is that it seemed to focus on whether humans (or our ancestral diet) were biologically vegan or not, and how best to spike the diet to make it more like our ancestral diet. However, even if someone was to adopt the recommendations to spike their diet, or whether they were vegan or not, they would still have all the above mentioned issue to deal with. Therefore, spiking the diet with some tofu or avocado is not the solution nor will it solve all the above issues.

Some points...

- While an interesting comparison, this is not a Stone Age vs “Modern Diet" issue. Why? There was no one Stone Age diet. Its compositions varied depending on location, geography, etc

- The largest increase in obesity, and our largest increase in total calories, was from ~1980 to ~2000. So, therefore why not just compare the diet from 1960 to 1980 (when obesity was fairly rare) to the 1980-2000 diet when obesity soared.. During that time period, calories went up ~20% with 48% of those calories coming from fat, 34% from refined grains, and 10% from added sugar. This is also the time period that the toxic and obesogenic environment emerged (see original post above).

- The meat back then would have been truly free-range, and grass-fed making it much lower in the percent fat and calorie density then stated. I am not sure where the stated 1000 cal/lb came from. It does appear on my calorie density chart which lists animal protein as 1000 cal/lb. However, as I always say when presenting the info, this refers to a modern fatty steak you might get in a restaurant, not free-range grass-fed wild game. I ran the numbers at the USDA Nutrition Database (https://fdc.nal.usda.gov) and here are some examples....

Wild Game // Calorie Density // %Fat

Elk// 503 //12%
Moose // 463 // 7%
Deer // 717 // 18%
Antelope // 517 // 16%
Bison // 649 // 15%
Rabbit // 517 // 18%
Squirrel //544 // 24%

As you can see the average of these examples of wild game is ~600 cal/lb and ~15% fat. (I also discuss this issue in the Fat Lecture.)

- To prove that the calorie density of the Stone Age diet was 700 cal/lb, they said, if you take the calorie density of the starches/potato (400 cal/lb) and the calorie density of the meat (1000 cal/lb) and add them together (1400 cal/lb) and divide by 2, you get 700 cal/lb. However, this is not how calorie density math is done. When using calorie density, that math would only be correct if they ate the exact same weight of meat and potatoes every day (or on average), which is highly unlikely. A higher contribution of weight from potatoes would lower the overall calorie density and a higher overall contribution of weight from meat would raise the calorie density as seen in these examples (using their numbers).

- If the weight of each was the same…

2 lbs potatoes = 800 calories
2 lbs meat = 2000 calories
4 lbs 2800 calories

2800/4 = 700 cal/lb


- If there was more meat than potatoes….

1 lbs potatoes = 400 calories
3 lbs meat = 3000 calories
4 lbs 3400 calories

3400/4 = 850 cal/lb

- If there was more potatoes than meat…

3 lbs potatoes = 1200 calories
1 lbs meat = 1000 calories
4 lbs 2200 calories

2200/4 = 550 cal/lb

- Once we correct for the average calorie density of grass-fed wild-game and for the way calorie density math is done, the concept of a spike and its benefit, fades away..


- The estimated Calorie Density of pasta, tofu and beans used in the podcast are also inaccurate and there is also more to satiety than the % fat and calorie density. Both of these are clarified here...

https://www.drmcdougallforums.com/viewtopic.php?f=22&t=62161

Here are two example of foods that have the same calorie density but different satiety and impact.

Tofu vs Potatoes
https://www.drmcdougallforums.com/viewtopic.php?f=11&t=60912&p=615809&#p615809

Avocado vs Garbanzo beans
https://www.drmcdougallforums.com/viewtopic.php?f=11&t=59073&p=594904&#p594904


A few more points

- “Wet" starches are not a good description as the actual issue is water rich or high water content starches with intact fiber. For example, dip a cracker in water and you have a wet cracker but not a water rich or high water content cracker. We could say the term "wet" starches is all washed up.

- We currently have several diets out there that are WFPB and allow for (and even recommend) the inclusion of higher calorie dense and/or higher fat plant foods and/or the occasional animal products (ie, McDougall, Ornish, Pritikin, Gould, 7th Day Adventist, E2, Greger). Do they have better long term compliance or success? I know of no research showing they do and they have been around for decades. If anything, it seems the stricter versions of some of these programs (MWL, Ornish Reversal, Esselstyn) have the better results and compliance.

- There are 3 McDougall studies over time, the McDougall 7 Day Program Study and the McDougall 1 year MS study, both of which used the regular McDougall program, and the Broad Study, which used the MWL principles. The Broad study had the best outcomes of the 3 and of any similar type study.

- Adding a spike of tofu or avocado to a diet that has a calorie density of </+ 400 cal/lb will have little impact on its overall calorie density or % fat, regardless if figured per meal, per day or per week.

- If avocados are a great spike food, let's compare them to garbanzo beans.

https://www.drmcdougallforums.com/viewtopic.php?f=11&t=59073&p=594904#p594904

It seems to me, if we are going to spike the diet, garbanzo beans would be a much better choice than avocado and almost the true perfect choice.

- I am not a fan of the word “spike” as many of the spike foods are common trigger foods and can be risky for many people. What I am recommending for those who need it, is a “shift" and not a spike. That’s the way I have always taught this. We can “shift" the diet slightly higher in calorie density and satiety by using more intact starches and beans and/or less fruits and veggies. The result is a more stable and more effective way of approaching the Sweet Spot and of being successful.


Bottom line…

Remember, it is also not all or nothing and there is a continuum between the McDougall regular program and the MWL program as also taught in the CD lecture at the 12-Day. Some people do full MWL during the Week and the regular McDougall program on weekends. Some people do the MWL program breakfast and lunch and the regular McDougall program for dinner. Our experience has taught us the most people do best in the beginning, and when losing the majority of their weight, to do the MWL program as some of the foods allowed on the regular McDougall program (bread products, dried fruit, nuts/seeds, sugars) can be triggers and result in binging. Instead, shifting the diet to more intact starches and beans and less veggies and fruit, shifts the calorie density and satiety of the diet higher.





- After this was done, Goose sent me the following comment...

"I was just thinking about how I’ve done this in practice, without really thinking about it.

I make a crockpot full of Mary's smashed beans (2 lb. dry pinto beans, onions, garlic, water, cooked all day on High, partially drained, then smashed) every few weeks and always have some on hand. When I’m feeling edgy, hungry, borderline craving, I take a big bowl and layer either brown rice or chopped pre-cooked Yukon golds in the bottom, followed by a thick layer of Mary's beans, a thick layer of broccoli and a topping of salsa. It comes out about 60/40 starches to veggies, and with fruit for dessert, it really works.

It follows your idea of bumping up the calorie density with intact starches and beans (we just happen to really like Mary's smashed beans instead of garbanzos), and it "smooths out" any feelings of excess hunger or tendency to stress-eat that I may be having."



PS. I hope Artista is doing well. I would like to formally invite them, if they wish, to post and document their experience here in a journal. It would be fascinating to see if any of the above discussion, as well as the exploratory process of journaling and recording progress, helps them.

[Artista]

Jeff, I very much appreciated reading your response to Dr Lisle’s podcast, you made some interesting and compelling points, some great suggestions too. I think I’m somewhere on that continuum you mentioned between MWL and the regular McDougall program, probably closer to MWL. I did try tofu and avocado for awhile but found I didn’t really need them. I’m glad it’s not all or nothing. I do believe I would have better results the closer I could get to MWL, but for now I’m not pushing it. I have an equilibrium with food and I’m making slow progress. I'm afraid of ending up completely mired in the Pleasure Trap as happened before, so I'm trying to take it slowly. Thank you for the suggestion to keep a journal. I'm going to follow up on that.