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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6053_Библиотеки_им_академика_М_И_Перельмана.pdf
Pick a day or use yesterday and note what you ate, drank, and took (supplements),
and when.
Note the date, time, and your answers when you are collecting data so that you have
your answers for easy reference when you reassess.
Assess your choices against the four pillars of better nutrition, which here we will
look at in order of quantity, balance, timing, and quality.
Quantity
Here we assess how much of a macronutrient or other food and nonnutritive ingredients
you are giving your body at one time.
Looking at each pit stop independently, determine if your total consumption (food
and beverages) was inside or outside these ranges (remember, better is not perfect, but
35 is closer to 30 than 40):
15–30 grams of carbohydrate
15–30 grams of protein
5–15 grams of fat
Answer yes if any of the following are also applicable:
I ate fewer than two colors of the rainbow (from fruits, vegetables, herbs, or
spices, not added colors).
My total added sugar from foods, supplements, and beverages was more than 2
teaspoons (1 teaspoon is 4 grams, so 2 teaspoons is 8 grams of sugar).
My total “natural” nonnutritive sweetener intake from foods, supplements, and
beverages was more than one serving (1 packet, 1 spoonful, 2–3 drops, or 1
serving size per label of stevia, monk fruit (Luo Han Guo), allulose, erythritol,
sorbitol, maltitol, mannitol, isomalt, lactitol, etc.).
I consumed a serving or more of alcohol.
Balance
Specifically, here we are looking at the combination of your macronutrient—carbs, fats,
proteins—intake to see if you balance them each time you fuel up.
Looking at each pit stop independently, was your total consumption (food,
beverages, and supplements) at each pit stop not in balance?
Answer yes if:
Your number of servings for each macronutrient was not the same (example: 1
carb, 4 protein, 3 fat).
Answer no if:
You had the same number of servings for each macronutrient (so in total at your pit
stop: 1 carb, 1 protein, 1 fat, or 3 carbs, 3 proteins, 3 fat servings).
Timing
Your caloric window is the period in the day over which you take in calories via both
food, beverages, and supplements. Answer yes if any of the following apply to you most
of the time:
On waking, I don’t feel hungry for at least one hour.
I typically wait for more than three hours after waking to consume nutrients.
I drink noncaloric beverages (coffee, tea, flavored water) to keep from needing
breakfast.
Before I have breakfast, I have to ignore or distract myself from hunger.
When I do have breakfast, I overeat because I am really hungry.
Following breakfast, I often go less than three hours or more than three hours
without eating or drinking (a caloric beverage).
I eat or drink caloric beverages less than two hours before I go to bed.
Most days my caloric window is less than ten hours or greater than fourteen hours.
Now, evaluate your answers on quantity, balance, and timing to identify your better
next steps.
For any question you answered with yes, consider that pillar one to optimize in the
coming weeks. It gives you insight on where to focus. For questions that you answered
with no, you appear to be in good shape with respect to that aspect of that pillar. Take a
moment and review your answers for these three pillars and make notes toward your
action plan, considering choices you think will help in meeting your body’s current
needs.
Quality
Quality, the fourth pillar, we’re going to look at differently. There are two categories of
quality:
Quality we know
Quality we don’t know
We can assess the quality we know: Is it better or not? The or-nots, especially those
we consume regularly, we identify for upgrade.
We can’t easily assess the quality we don’t know—coffee and a sandwich at a
coffee shop or a meeting; food you’re served in a restaurant.
When developing your plan, we’ll assess the quality where feasible. Where not
feasible, we’ll assess the share of your intake that comes in as quality unknown. Right
now, let’s familiarize ourselves with how to recognize better and not-better quality
choices.
Think about the things you consume most often—foods, beverages, supplements, and
their ingredients. Familiarize yourself with the table on the next page. The left side is
the list of items that from a quality standpoint are likely a better choice. The hit list, on
the right, covers stuff to reduce where possible. My mantra, with all things in life but
especially nutrition, is “Better, not perfect.” The goal isn’t to avoid all sources of not-
better quality but to be aware of them and work to reduce them, especially in what you
consume more often. Consider how often your choices include ingredients from the “Not
Better” column. In the next section, you will get guidance on replacements.
OPTIMIZING YOUR NUTRITION—THE FOUR PILLARS
Balance
Homeostasis—you’ve probably heard the term or been quizzed on it at some point. It’s
the body’s big, audacious goal. But because the body is a dynamic being, it never quite
achieves the balance it craves and was designed for. By design, the body wants balance
in nutrients, tastes, and textures. Your body has needs—lots of them—and they work
together, not in isolation. That’s why it makes zero human health sense when one nutrient
or type of activity gets more attention than another. Yes, fuel goes into the tank and air
goes into the tires—but a major factor in gas mileage is tire pressure, so they both need
to be optimal for the car to run better. The body runs on countless synergies like this,
only more complex. Your body’s fuel (carbs), air in the tires (protein), and oil in the
engine (fats) cooperate to help you run optimally throughout your day.
© The Better Nutrition Prograam
No whole food exists in nature as a single macronutrient. Not. A. One.
Beans, grains, and some dairy have carbs and proteins.
Eggs, meats, fish, and some dairy have proteins and fats.
Fruits and vegetables may have carbs, proteins, and fats, for example, an apple,
has some amino acids (proteins) and fatty acids (fats).
Even butter—the ultimate fat—has amino acids (proteins).
If you identified balance as a pillar to focus on, let’s review the following and see
how you can experiment to improve the balance of your choices:
If you have an 8-ounce latte with whole milk, the body is thrilled you gave it
protein, fat, and carbs, but less thrilled when you throw at it more carbs—so many
more—in the form of oatmeal, fruit, and maple syrup.
If you have beans, the body is getting protein, carbs, and fiber, so it doesn’t need
chips, corn, rice, fruit, oat milk lattes, juice, or plantains, too. It wants you to have
guacamole, meat or eggs or fish, maybe a little cheese, some water, and loads of
non-starchy vegetables, nuts and seeds, and herbs and spices.
If you serve the body a burger—beef, bison, or salmon—it really wants some
greens, mushrooms, onions, even mustard, sweet potato fries or a bun, black beans
or beets; but it feels pretty overwhelmed if you serve it an egg or bacon on top of
the burger for more protein (and getting more fat). If you want to round out the meal
with a dessert, your body would go for more colors in the form of berries,
upgraded with a scoop of ice cream, in a trade-off for the bun or fries.
Here’s an analogous balance story that plays a bit differently. Two comparative
days, looking at how choices balance:
NOT B ALANCED BETTER BALANCE
Oatmeal with fruit, coffee with cow/oat milk (8
ounces)
Oatmeal with nuts and seeds (nut/seed butters);
option to add cacao nibs and spices; coffee with
unsweetened almond/hemp milk (if you prefer
the oat or cow’s milk, then choose a different
breakfast option, such as eggs or cottage cheese
with berries)
Sandwich with turkey and cheese; sparkling
water
Half a sandwich with extra turkey and avocado;
cut cucumbers with yogurt dip; sparkling water
Sweet tea/coffee latte, “energy” bar: 45 grams
of carbs, 5 grams of protein, 7 grams of fat
Unsweetened iced tea, “better energy” bar: 15–
30 grams of carbs, 15–20 grams of protein, 7–10
grams of fat
NOT B ALANCED BETTER BALANCE
Water, salmon with potatoes or corn and
sautéed spinach, ½ pint of ice cream or 1
popsicle
Water; salmon with sautéed spinach, tomatoes,
and onions (if you want the potato or corn, pass
on the ice cream); 1 scoop ice cream or frozen
berries and 1 ounce dark chocolate
While foods have multiple macronutrients, most contain less than what we deem a
full serving of each of the macronutrients, so we count and categorize them accordingly.
As an example, we get protein in grains such as oatmeal and quinoa, but each suggested
serving contains 15 grams of carbohydrate and only 2 to 3 grams of protein, much less
than the suggested serving size minimum of 15 grams of protein. Thus, these grains get
listed under “carbohydrates.” To meet your protein needs in a meal or pit stop that
includes them, pair a serving of oatmeal or quinoa with a serving of a protein and a fat
rather than with more carbohydrates. (To see how foods are categorized, including
categories with multiple macronutrients, see the nutrition plan in the “Operator’s
Manual.”)
Looking at your pit stops, how could you balance them better more of
the time?
A scene from the ’90s played out in my office recently, reminding me that our fat-
phobic roots run deep. I was helping a patient with perimenopause-attributed weight-
health issues. Her complaints included dryness; fatigue; declining quality of hair, skin,
and nails; belly weight gain; and elevated levels of unhealthy inflammation (hsCRP
greater than 1.0; hers was a 5.0). I suggested we experiment with hemp seeds—“the
wild salmon of the plant kingdom”—for protein, fats, fiber, and minerals; and adding a
fish oil with specialized lipid pro-resolving mediators. She morphed into a twenty-
year-old circa 1995 I knew all too well. “Ashley, they (hemp seeds) have a lot of fat.
So many calories. It’s going to make things worse, not better!” So, we had the BIG.
FAT. CHAT.
“Like me, you were raised in the diet and fat-free era,” I said. “Not only was it a
disaster for our blood sugar but it also starved our hormones, hair, skin, nails, and gut
lining. We need these fats. They will help you burn fat, and look and feel better.” Today
I would add that a failure to consume fats hampers Switch and ecosystem operations.
Another patient had sushi for lunch most days. He was trying to lose belly fat, so he
had gotten rid of carbs and would eat sashimi, cauliflower rice, and steamed
vegetables. But he soon paid for it with irresistible sweet cravings and energy crashes
in the afternoon. His CGM showed his blood sugar was great through the meal but then
dropped two hours after, which he would respond to with office candy or Diet Cokes
(multiple). Adding some organic edamame (soybeans) to his meal, or a bowl of berries
as his dessert, helped his blood sugar stay in range and kept him from needing the post-
pit-stop pick-me-ups.
One of my least favorite terms has always been portion control. First, it conjures up
those prefab meals in a container from WeightWatchers or Jenny Craig; second, and so
much worse, it reinforces the myth that all that matters is the amount.
One of the superpowers of nutrient balance? It ushers in portion control 2.0.
Nutrient balance encourages the body’s system of satiety, so the body knows it’s in full
receipt of the resources it needs at that pit stop. For my “sashimi, cauliflower rice
lunch” guy, it wasn’t him but rather his body that was crying out for energy.
So what about keto or paleo? What about lower carb plans? What about higher
protein needs? Do you personally feel the need to eat imbalanced to achieve your
desired health outcomes?
Maybe.
Balance does not look the same for everyone, and not even for one person at all
points in their life.
With your balance assessment completed, you now have the tools to optimize your
choices for better balance.
Quantity
Do you ever wake up or get to work and find yourself immediately confronted by way
too much to do? Panic, dismay, and fear kick in. Next comes irritation and overwhelm.
Those moods and mental states are the pillars of paralysis. They impact how you
perform. Tasks take longer to do and get done less well. You look for a way to cross off
an item that’s really not vital or push one that’s nonurgent to another day. While you’re
working on your to-do list, no work gets done. Things fester. Soon enough you will
consider quietly quitting. Or if you’re your own boss, you’ll consider cutting yourself
from the payroll. For most people, overload like this is a regular occurrence. It has a
severe impact on our performance. It drags down confidence, engagement, and self-
esteem.
When we overload our body, it responds much the same way. It, too, winds up as a
workplace casualty or rebels in other ways. This rebellion is everything but quietly
quitting: excess body fat, metabolic dysfunction, and digestive complaints, oh my!
Mainstream nutrition offers its one-size-fits-all solution: portion control. Diet
programs and guidelines bully us with “Call on your innate willpower (and grow up).”
That sells diet books and plans. It ignores how the body works. We aren’t built with a
“willpower” system. We are equipped with a Switch that directs a weight-health
ecosystem. And that’s what we’re here to fix.
When the body gets what it needs:
It can deliver to meet all demands and requests.
It doesn’t have to prioritize where to send resources, depriving itself over here to cover a more pressing need
over there.
Systems that need operational support at the moment get what they need, and things that are nonurgent but “nice
to have” for cleanup and prevention can get their needs met, too.
On the flip side, with better quantities and no excess, stuff doesn’t get “set aside for a rainy day”—that is, stored
as fat.
Your Quantities: How You Make Them Better
Your yes answers in the quantity assessment identify pit stops when your quantity of a
nutrient under- or overdelivers. Those are prime opportunities for you to experiment by
adjusting choices or amounts. To evaluate how your body feels about any new
quantities, use your body’s signals: mood, digestion, energy, weight composition, hair,
skin, nails, and so forth. Reminder: At any pit stop, you’re looking at your total nutrition
—food, beverages, and supplements.
The following two quantity case studies may feature you if you answered yes to:
Taking in less than 15 grams of protein at a pit stop. We want to up it to at least 15
grams, possibly up to 30 grams. The pit stop in question is avocado toast with an
egg, which currently delivers 10 grams of protein: 2 grams from the toast, 2 grams
from the avocado, 6 grams from the egg equals 10 grams.
Some options to get to 15–30 grams include: another egg, 6 grams; ½ cup of
cottage cheese, 14 grams; ½ cup of silken tofu, 9 grams; 3 ounces of chicken
sausage, 14 grams; 2 tablespoons of almond butter, 7 grams; 3 tablespoons of
hemp seeds, 9 grams.
Getting more than 30 grams of carbohydrates at a pit stop: We need to check out
how your body responds when choices align to put carbs in the range of 15–30
grams per pit stop. You’ve shifted breakfast to a smoothie, to get your protein in.
The base of the shake—a cup of oat milk—is 16 grams. A ½ cup of blueberries, 10
grams, keeps things aligned. The issue is the banana: 30 grams all by itself.
Some options: Switch to unsweetened almond milk (1 gram) or coconut milk (2
grams) and go with half a banana, and in place of the other half of the banana, add
a ½ cup of frozen cauliflower (1 gram; you won’t taste it as long as its frozen, but
it gives a great texture and delivers as much potassium as the half banana); or
drop the banana entirely and just do the ½ cup of frozen cauliflower.
A listing of a variety of foods and nutrients, with quantities noted, is available in the
“Operator’s Manual.”