Tag: 4hb

A doctor’s experience with the Slow Carb Diet

A doctor’s experience with the Slow Carb Diet

A doctor’s experience with the Slow Carb Diet

by Cyrus Peikari, M.D.

I love recommending this variation of a slow carb diet to my intermediate-level patients. It is an “easy mode” diet that keeps you full and satisfied, allows unlimited desserts one day per week, and works for nearly everyone. “Slow” carbs are those that are absorbed slowly as sugar into your bloodstream.  For example, white hamburger buns will spike your blood sugar very high and very quickly, whereas beans won’t. Both are carbs, but the white bread provokes a stronger “insulin response” from your body.
Popularized and refined by author Tim Ferris, this variation of the slow carb diet has simple tenets:
Rule #1: Avoid “white” carbohydrates
We will get into specifics below, but for now, this is the general rule: ry to avoid any carbohydrate that can be considered “white” carbs. That includes rice, potatoes, cereal, bread, pasta, or any breaded fried foods.
There are two exceptions to this rule. First you can have white carbs within 30 minutes of finishing a resistance based workout of at least 20 minutes in length; this includes weight lifting, yoga, etc. Second, you can have fast carbs on your “cheat day”, described below.
Rule #2: Eat the same few meals over and over again
The most successful dieters try to eat roughly the same foods every day, especially at the beginning of the diet. Numerous studies show that the more choices you have to make, the more likely you are to overeat. At the very least, try to keep breakfast the same, so that your mind is not clouded with superfluous decisions early in the day.
Rule #3: Never drink calories
Liquid calories (with the exception of certain kinds of protein shakes) are among the fastest absorbed, and they can give the most severe sugar spikes. Drink as much water as you like, but stay away from sugared beverages. Milk and fruit juice both have a lot of sugar, so strictly avoid them. You can have unsweetened iced tea, tea, coffee (without cream, or other no-calorie beverages).
Rule #4: Take one day off per week

This is the “dieters gone wild” part of the week. On Saturdays I’ll load up on as many chocolate croissants as I want. Anything goes on your cheat day, including sugary cereal with milk, cheesecake, and cupcakes. This is when others will think you’ve lost your mind.
However, spiking your insulin one day per week not only helps with compliance, but also prevents the diet from failing. Why? Because on nearly every diet, the body adapts and down-regulates your metabolism over time, putting the body into “starvation” or survival mode.
You have tried diets in the past, which worked for a few weeks or months, but eventually you gained the fat weight back. That is partly because of your lowered thyroid and leptin levels, two of the hormones that help control your level of metabolism. Worse, you now feel deprived, and you may tend to binge eat: which is all the more dangerous now that your metabolism is lower. The cheat day, then, is programmed to prevent this.
Psychologically, it is also far better to plan your cheat day in advance, rather than “slipping up” and then feeling guilty for blowing your diet.
What foods are allowed?
The following list includes foods which you are allowed to eat as much as you like; at the beginner level, there is no need to count calories or portion sizes:
1) Eggs
2) All meat not treated with hormones or antibiotics (fish, poultry, pork and beef)
3) Turkey bacon, organic bacon, organic sausages
4) All fish and seafood
5) All beans (but chickpeas and hummus only in moderation)
6) All vegetables (except yams, potatoes, and sweet potatoes)
7) Hot sauce
8) Salsa (without added sugar)
9) Any oil
10) Butter
11) Spices and herbs
12) Mustard
13) Non-creamy, low-sugar dressings
14) Brown rice protein, hemp protein, pea protein
15) Unflavored whey protein isolate
16) Unsweetened cocoa

What foods are NOT allowed on the diet?

The following foods should only be eaten on a cheat day:
1) Milk
2) Milk products including cheese (except cottage cheese)
3) Refined soy products (soy milk, tofu, tempeh, soy protein shake)
4) Fruit, except for tomatoes and up to one medium avocado per day
5) Potatoes (any starchy vegetable, including sweet potatoes, yams, yucca)
6) Bread, rice, grains, quinoa, oatmeal, tortillas
7) Ketchup
8) Creamy dressings and dressings with sugar
9) Sugar, honey, corn syrup, maple syrup, fructose, agave
10) Deep-fried breaded food
11) Corn, popcorn
12) Alcohol, in any amount or frequency (note: I STRONGLY recommend avoiding this completely, even on cheat days)

The following foods may be eaten in moderation:
1) Mayonnaise
2) Peas
3) Tomatoes
4) Avocado (1 medium sized avocado per day)
5) Peanut butter and almond butter (max: 1 or 2 tablespoons per day)
6) Nuts (one small handful per day)
7) Hummus and chickpeas (garbanzo beans)
8) Coffee or tea. You may add up to 2 tablespoons of heavy cream per day.
9) Unsweetened almond milk
Advantages of the Slow Carb Diet
I usually see massive improvement in a patient within days of starting them on this slow carb diet. Over the first few weeks, both high blood sugar and high blood pressure often come down to a normal range. The pasty complexion vanishes from their skin, and a healthy, ruddy glow replaces it. They already look thinner, since water weight is shed first. After several weeks, cholesterol drops as well. Patients who have been on medicines for high cholesterol (statins), diabetes, and high blood pressure may be able to stop their medicines (IMPORTANT: check with your doctor first).
Within a few months, most patients have lost inches from their waist. Note that the scale may not change, but rather your body composition has changed from fat to muscle.

A problem to consider: you may need to go shopping for smaller clothes!
One of the real drawbacks to this diet is psychological: a day or two after your cheat day, the scale temporarily will rise by a few pounds due to water retention from the spike in carbs on the prior cheat day. This water weight will come off over the next few days, but if you don’t have faith in the process, it can be psychologically devastating. Most of us, particularly women, have been brainwashed to be slaves to the scale; even if we are losing inches and looking great, we start to panic if the scale weight doesn’t go down. For example, I helped one of my patients (a high school girl who had struggled with PCOS and weight gain for years) drop from 214 down to an athletic 175 with this diet. Unfortunately, her mom made her stop the diet because she felt it made her daughter “bloated”. In other words, her mother had forgotten about the 39 pounds of fat loss, and was obsessed only by the 2-3 pounds of temporary water weight after a cheat day.
Other issues can occur in women with PCOS, or polycystic ovarian syndrome. Many women have PCOS, or a partially expressed (“subclinical”) form of PCOS, characterized by various symptoms including irregular periods, excessive weight gain, increased body and facial hair, decreased fertility, and a tendency towards diabetes. To be clear, the slow carb diet is amazing for women with PCOS: it works really well for fat loss. It may even improve insulin resistance (thus staving off diabetes) and can improve fertility. However, with PCOS, ANY diet that causes fat loss can result in a flare of acne. That’s partly because estrogen is produced by fat cells; as you lose body fat, your estrogen dominance is reduced. Less estrogen means a higher relative concentration of male hormones, causing acne. Luckily, there are ways to address the acne if it occurs.
For vegans, this can be a tough diet. Eliminating fast carbs for 6 days per week means that you will have to get creative in your food choices. Without rice, bread, chips, and potatoes, your carbs must come from other sources such as beans.
Expert Tips for the Cheat Day
There are various ways to limit the damage that you do on your cheat day. The most important trick is to break your fast with a large serving of protein, 30 grams or more. If you charge right into breakfast with sugary cereal and donuts, you are likely to get dizzy and stay that way all day. In fact, I prefer to have servings of protein before each meal or large snack throughout the entire cheat day. That way, I end up eating fewer chocolate croissants, and thanks to the protein buffer I don’t feel as bloated or dizzy.
Another method is to start the cheat day later, or end it earlier. For example, you can wait until after lunch to start your cheat day, and then continue it until dinnertime.
After several weeks or months, you actually may start to dread the cheat day, because you’ll miss the mental sharpness that you’ve developed on your slow carb days. In this case, you may want to do the cheat day only ever second or third week.
Do I Need to See a Doctor?
It is standard to always recommend seeing a doctor before starting any new diet. Practically speaking, there are some cases where it is a big advantage to get supervision from a provider familiar with nutrition. These cases include, but are not limited to, the following examples:
If you are over the age of 50, or taking meds for high cholesterol, high blood pressure, or diabetes, then you definitely want to involve your healthcare provider in your plans. Diabetics can get into trouble on this diet, since your blood sugar levels can drop back to the normal range within days of starting it. In this case, diabetes meds can drop the blood sugar too low, causing hypoglycemia. For example, passing out when you are driving can be deadly for you and others.
If you have symptoms of low thyroid, you may need to have that treated; otherwise, weight loss can stall. Symptoms of low thyroid include fatigue, difficulty losing weight, hair loss, constipation, irritability, memory loss, decreased libido, or sensitivity to heat or cold temperatures. There are many well established forms of thyroid replacement, including synthetic thyroid, and the more traditional “dessicated thyroid”.
If you suffer from chronically low testosterone, it can be very difficult to lose body fat without treatment. It would be like trying to swim upstream. Both men and women can have low testosterone, particularly after the age of 50. Symptoms of low testosterone include trouble sleeping, reduced sex drive, fatigue, hot flashes, loss of muscle, depression, mood swings, and a pot belly.
Scared That it Won’t Work?
Of all the diets I’ve used with patients over the years, this slow carb diet seems to have the highest success rate long term. You’ll stay full and satisfied every day. And you still get to eat all the desserts and foods that you love, as much as you want, on your cheat day every week. Please take a second to leave your comment below!
DISCLAIMER: The information provided is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your own healthcare provider with any questions or concerns you may have regarding your condition. The safest and only proven way to lose weight is through regular moderate exercise and appropriate diet, as prescribed by your own healthcare provider. RESULTS NOT TYPICAL.


Losing weight with chocolate chip cookies!

by Cyrus Peikari, M.D.

In this video I share three of the top diet strategies I use to help patients lose weight, and keep it off long term, while still being able to enjoy the foods that you love… such as chocolate chip cookies!


Lose nearly 50 pounds FAST: Doctor’s TOP 20 weight loss tips

Lose nearly 50 pounds FAST: Doctor’s TOP 20 weight loss tips

In this video I show how Dr. Rick lost 47 pounds in just 5 months, while getting stronger and enjoying big, delicious meals every day. 20 of our top tips are included.


Holiday Overeating Fix

Holiday Overeating Fix

Q: What if I overeat during the holidays? What should I do?

A: Don’t worry. Enjoy it and move on. The extra calories were good for you. Your leptin levels are up, and your metabolism is ready to burn fat  faster.

If, accidentally, you eat 5,000 calories in one day, you probably won’t gain a full pound of fat.

Forget the guilt! Tell yourself that you deserved it. The worst thing you can do is to fall into a shame cycle. This is why many people start extreme diets and exercise binges after the holidays.

I know, because I’ve made the same mistake many times. I’ve tried the crash diets and the cardio binges.  You may see short term improvement, but then you hit a plateau, and the weight gain comes crashing back with a vengeance.

Weight loss is like a marathon, not like a sprint. Slow, smart, incremental changes in diet and exercise win in the long run. Listen to your brain, rather than your emotions.

Please post your questions below, and share this with a loved one who struggles with food guilt.

Cyrus Peikari, M.D.

How to shed 10 pounds of fat by eating at Chipotle

How to shed 10 pounds of fat by eating at Chipotle

By Cyrus Peikari, M.D.

A question I get often is this: Do I have to give up the foods that I love, to lose body fat? The answer is, “No!” For those of you who have been following me, you know that I’m currently eating chocolate and potato chips every day, while still shedding body fat and getting stronger…all without doing any cardio whatsoever.

Your next question might be, will this work for me? Yes, if you follow the correct plan for your body, the results should come fast. The trick is answering, “What is the best plan for me right now?” With my patients, the answer takes a little testing and tweaking. Before the more advanced “Netflix and potato chips diet”, I teach patients about other diets, such as the slow carb diet, or a vegan diet. And as we will see, using Chipotle Mexican Grill, you can do both slow carb and vegan at the same time, on the run.

The first diet, and one of the best, is the “slow carb” diet, popularized by Tim Ferris’ on his 4 hour body (4HB) blog. If Mr. Ferris ever wins the Nobel Prize, I suspect it will be for his efforts in promoting this diet. Of Tim’s accomplishments, his diet has the potential to do the greatest good.

Why does the slow carb diet work? Perhaps because Tim designed it for fallibility. Knowing that we humans will cheat on any diet, he built in a mandatory cheat day…a day of reckoning where you can (and should) eat as many donuts, Snicker’s bars, and pizzas as you want.

With this hedonistic cheat day, Mr. Ferris lets us think that we’re getting away with murder. However, he has a secret agenda: there are several hidden benefits to this day of carb reckoning. For one thing, it makes dietary adherence skyrocket. Because you know you can eat that chocolate cake on Saturday, you endure the other 6 days (which as we will see, really aren’t bad at all).

For another benefit, the cheat day helps to keep your metabolism from down-regulating. For example, most of you have tried a diet and lost weight for the first few months; however, you then reach a plateau, and the weight starts to creep back on, even if you eat less and exercise more. However, by using Tim’s method of carb overload to strategically spike insulin levels one per week, you can help keep up your metabolic hormone levels, particularly thyroid and sex hormones.

A third benefit of the cheat day is that eventually you start to get sick of it. After a few weeks or months, you notice that you feel mentally alert and energetic on regular days. However, cheat days are the opposite: you feel bloated, mentally foggy and tired. You even start dreading cheat days, which causes you to start cheating in moderation: for example, for just one meal. Because this is a natural weaning process, it works long term. Eventually, you may go a month between cheat days; although that’s the maximum gap, to avoid slowing your metabolism.

Having helped many patients shed many pounds over many years, I would make a few humble suggestions to Tim’s 4HB slow carb diet. For one thing, in his book, the Four Hour Body, Tim optionally recommends taking 4 supplements, known as a “PAGG” stack. “PAGG” is an acronym for the combination of the following four supplements: Policosanol, Alpha-lipoic acid, Green Tea Flavanols, and Garlic extract. Tim even suggests that these 4 supplements are the “four horsemen” of fat loss, which to him seem to work synergistically.

I disagree with Tim on this. (I think Tim himself might disagree now, since in later years he seems to recommend less supplements). In my experience, patients who took the PAGG stack lost a little bit extra fat initially, but the weight came back after a few months when their bodies adapted to the medication. Worse, it is a brutal schedule of four times per day dosing of drugs not studied extensively in humans. So it seems like much potential toxicity, with little long term benefit.

Another tweak to the 4HB slow carb diet that I would suggest to Tim is this: eliminate alcohol, even on the cheat day. I like to avoid conflict, yet this is the most controversial statement I’ve made to date. It gets some people angry to hear this; but I’d be remiss if I didn’t tell you. For many reasons, I feel that eliminating alcohol altogether is the single best move you can make for your long term health and success, exceeding the vast benefit, for example, of quitting smoking. I won’t belabor this point, but please take the time to think it over and arrive at your own decision.

The slow carb diet can be a bit challenging to follow at first, especially when you are traveling or on the run. That’s because fast food restaurants are based around high carbs. Now, let’s make it more difficult: is it possible to eat BOTH slow carb AND vegan at the same time?

Before my current “Netflix and potato chips diet”, I followed both a slow carb and vegan diet…at the same time! Talk about brutal! However, it is quite easy now, thanks to improving commercial menus. One of the best options is Chipotle Mexican Grill.

Several years ago, when I started with the combined slob carb/vegan diet, Chipotle didn’t have much in the way of vegan options. That’s because their beans, which are a slow carb mainstay, were made with pork. However, in late 2013, Chipotle converted all of their beans to vegan.

Let’s look at a sample from Chipotle’s menu, available in a convenient calculator on their website. In the first example we are eating slow carb, but not vegan. Our ingredients are a basic burrito bowl with black beans, chicken, salsa, guacamole, and lettuce. That equates to 555 total calories, with 30 fat grams, 36 carbohydrate grams, and 42 protein grams. By eliminating the tortilla and rice, we’ve made it slow carb, while retaining a lot of protein. The carbohydrates come from the beans, but luckily beans are “slow” carbs, so you’re fine.

Now for the vegan option: simply remove the chicken, and add extra black beans or pinto beans. For example, a burrito bowl with black beans, pinto beans, salsa, guacamole, and lettuce comes to 490 calories, with 24 fat grams, 37 carbohydrate grams, and 16 protein grams.

It’s delicious! So you can eat both slow carb and vegan, with friends, on the run: Chipotle makes it easy. But all this talk of slow carb and vegan is making me hungry, so I’m going to eat some potato chips and chocolate.

What do you think? Please take a moment to comment right now. Your responses make me so happy!



I screwed up…big time!

I screwed up…big time!

Ok, I screwed up. I admit it. For decades, I tried running to lose weight…but it only made me fatter. Skinnier? Yes, at times…but skinny fat. And because the stress of running increases “cortisol” levels in the bloodstream, if you ever stop or slow down, the fattening comes back faster and more furious than ever before.

Don’t get me wrong, running is a great stress reliever and feels wonderful. And I’m proud to have a couple of friends running in the Boston marathon. But for the rest of us, are we getting too much of a good thing?

Based on years of working closely with patients, it seems that too much cardio, in the long run, is often counterproductive.

I made this video to explain why:

I also touch upon adrenal fatigue, over-training, and catabolic hormones such as cortisol. (Cortisol is the stress hormone that can cause you to burn muscle and store belly fat instead).

So remember…the trick to getting a great physique is to BE LAZY!

Has anyone else been though a similar experience. I’d love to hear from you; please do comment below.