PRATICAL GUIDE TO LOSING BODY FAT AND MAINTAINING LEAN BODY MASS-MUSCLE MASS BONE DENSITY
One important fact that must be carved in stone is that in every species, including all sapiens-caloric0 restriction of an unhealthy diet increases longevity (54)(55). Th important fact regarding your diet. The goal of this text is to teach you how to decrease body fat and maintain muscle mass and bone density using the knowledge learned from this text. Lowering calories causes the brain to try to prevent weight loss. The brain will increase your hormone ghrelin to increase your appetite [36]; and to lower your metabolic rate [resting calories used by your body] [37] by decreasing the thyroid hormone triiodothyronine [38]. The brain fights your attempt to lose weight and tries to keep your body weight constant. The brain has a weight "set point" like a thermostat [79] that is based upon and results from your diet, exercise, hormones, and sleep. To be successful, you must use all the tools in the toolbox to increase metabolic rate and decrease appetite and counter-act the brain. The tools are diet, medication, exercise, supplements, hormones and sleep. All are important and work together to change the "set point".
THE QUICK DIET REVISITED
The weight reducing diet-the "quick"diet is high in protein and fat and low in carbohydrates. This diet is not a ketogenic diet. Ketogenic diets can cause loss of lean body mass [80]. A ketogenic diet is high in fats and very low in carbohydrates [less than 20 g per day] and forces the body to use body fat instead of dietary sugar as a fuel source [80]. The speed of weight loss is an important factor in the preservation of lean body mass [81]. Losing 1lb per week or 0.7% of your body weight is ideal.
Calculate your "quick diet". Create a diet plan by going to the Mayo Clinic calorie calculator (www.mayoclinic.org/calorie-calculator/itt-20084939) to calculate your daily calorie needs. This is your resting energy expenditure (REE)-the number of calories your body uses every day. Now subtract 500 calories from this number to determine your one-pound loss-per-week daily diet calories. Since our goal is to lose body fat and build/ maintain muscle, we need 1.6 grams of protein per pound of body weight per day [82]. Since protein in nature is always accompanied by fat, you'll have sufficient fat. Please purchase a food scale to be able to calculate your protein calories.
Calculate daily calorie needs-500=calories per day on the "Quick" diet.1 to 1.6 grams of protein x body weight in pounds=grams of protein needed. Each gram of protein=4 calories. Daily calories needed minus protein calories=carbohydrate calories. The protein calorie number includes fat. Carbohydrates are very important to fuel your gym exercises and cardiovascular exercises. Keep a daily journal of everything you eat every day and weigh yourself and measure your waist. If it runs, flies, walks or swims you can eat it, but it must be weighed. Eggs are good at 60 calories per egg with 6 gm of protein. If it is green and grows in the ground, you can eat it. The low glycemic green vegetables and salads have calories, but their metabolism uses approximately the same number of calories. Healthy intermediate glycemic carbohydrates: sweet potatoes, old fashioned oatmeal made with water, brown rice, and berries and should be weighed and converted to calories.
Fiber in your diet is essential for optimal body function. This is new and exciting information that redefines the role of fiber. In the past fiber has been described as indigestible plant carbohydrates that kept your bowel movements regular. We do not digest fiber, but your gut bacteria need fiber. Think of your gut bacteria as an essential organ the size of one kidney and more metabolically active than your liver. Our gut bacteria ferment fiber and produce short chain fatty acids that are absorbed through the large intestine [colon] into the blood stream and effect our hormones, metabolism, body fat, and our immune system. In addition, fiber slows the absorption of all the nutrients in your diet and lowers peak insulin so you make fat more slowly [67]. Our ancient ancestors- hunter-gatherer's- ate much more fiber than we do today.
YOUR DAILY JOURNAL-EXAMPLE
40-year-old male, 5'9", weight 160 pounds, who is active three to five days/week, will need 2,400 calories per day to maintain his weight. In order to lose one pound per week and build/maintain muscle he must decrease his calories to 2400 minus 500 or 1900 calories per day.
FOOD-AMOUNT - PROTEIN - FAT - CARBS - CALORIES
1 large boiled Egg - 6 grams - 5 grams - 0.6 grams - 78 calories
½ cup Quaker Oats - 5 grams - 3 grams - 27 grams - 150 calories
Sirloin Steak 1 oz - 6.6 grams - 1.3 grams - 0 grams - 38 calories
Chicken Breast100 grams - 31 grams - 3.6 grams - 0 grams - 165 calories
Chicken leg 100 grams - 28 grams - 5.7 grams - 0 grams - 172 calories
Pork loin 1oz - 5 grams - 0.8 grams - 0 grams-28 calories
Sweet Potato 150 gram - 2.3 grams - 0.3 grams - 42 grams - 177 calories
Brown Rice 1 cup - 5.5 grams - 1.9 grams - 44 grams - 216 calories
Blue Berries 1 cup - 1.1 gram - 0 grams - 19 grams - 80 calories
Keeping a journal of everything you eat is cumbersome but essential. If your weight loss program stops working, you have the tools in your journal to make corrections. After the first week you will notice that you will repeat the same meals and keeping the journal is much easier. Myfitnesspal.com and the app is an electronic version of a daily journal and can be shared by both patient and physician. The value of the journal occurs when your diet and exercise do not give you the results you expect. At some point your weight loss will plateau and the only objective way to reevaluate this by reviewing your journal and make improvements.
MEDICAL WEIGHT-LOSS
Medical weight loss involves the use of a prescription drug and a healthy diet to lose weight. A person in need of weight loss has a diet that is not working well and needs to be changed. Medical weight loss is indicted for patients with a BMI of 30 or higher or a BMI of 27 with signs of metabolic disease including, insulin resistance, type 2 diabetes, hypertension, and cardiovascular disease. BMI is not the best tool to gauge visceral body fat. The height to waist ratio is a better measure than BMI in predicting cardiovascular risk. A waist to height ratio greater than 0.5 can be used to establish center body obesity.
The glp-1 agonist semaglutide is associated with the better initial weight loss when compared to most other medications FDA approved for medical weight loss [95]. Semaglutide increases insulin release from the pancreas and slows down the passage of food leaving the stomach [94]. This increases satiety and decreases ghrelin, the hunger hormone [96]. The side effects of semaglutide include bloating, nausea, vomiting and constipation. The best results for medial weight loss occurs with tirzepatide, a gip and glp-1 agonist [133]. Tirzepatide also slows down the passage of food leaving the stomach. This increases satiety and decreases ghrelin, the hunger hormone. The side effects of tirzepatide include bloating, nausea, vomiting and constipation.
If semaglutide or tirzepatide are not available, phentermine or phendimetrazine in conjunction with the "quick" diet will cause weight loss without affecting performance or work-related fatigue. The brain will attempt to decrease metabolic rate and increase hunger during any decrease in calories. The fat and protein in the diet will attempt to counter the brain by increasing metabolic rate and decreasing appetite. Adding the stimulant phendimetrazine or phentermine will be successful at countering the brain and keeping you feeling normal at work and in the gym by increasing your metabolic rate and decreasing your appetite. Phendimetrizine or phentermine have the same side effects as drinking coffee, so if you can drink coffee, you will be able to tolerate 35mg phendimetrizine or 37.5mg phentermine.
When you reach your goal weight the medication can be gradually eliminated. Phendimetrizine is relatively inexpensive at approximately $24 per month, compared to compounded semaglutide at approximately $250 per month and tirzepatide at $1000 per month.
If you choose phentermine or phendimetrazine for medical weight-loss, this involves a modest but essential change in lifestyle: get up in the morning 30 minutes earlier; taking your first phendimetrazine or phentermine pill on an empty stomach and go for a 30-minute power walk. Any form of cardiovascular exercise for 30 minutes will work. The benefit of exercising while fasting occurs in individuals new to exercise [83]. If on 35mg of phendimetrazine, take your second pill before lunch. In refractory patients a review of the patient's journal may be best before any change in medication. If you are accustomed to exercise and regularly go to the gym, your body will adjust to the diet and phendimetrazine or phentermine in 7 to 10 days. Increased fluid intake is recommended to prevent dehydration. Another option for initial inexpensive medical weight is the combination of 35mg phentermine and 25mg naltrexone twice daily.
THE ROLE OF EXERCISE IN MEDICAL WEIGHT-LOSS
Exercise is essential and your body was designed for movement and needs exercise [84][85]. The Centers for Disease Control and Prevention recommend 150 to 300 minutes per week of moderate cardiovascular exercise or 75 to 150 minutes of...
