4.  Avoid Prolonged Fasting (avoid Intermittent Fasting): no significant difference compared to calorie restriction with consistent mealtimes

     - Some fasting is good such as when you are sleeping and when you are not hungry.  Prolonged fasting may break down muscle, slow metabolism, and decrease repair.

     - Prolonged starvation mode may paradoxically lead to increased storage of fat when you do eat.  This is why it is not uncommon for those with anorexia to have high cholesterol.  Think bear versus horse.  Bears hibernate for prolonged periods and store more fat versus horses that graze year round and are lean.  

5.   Adjust Portion Size by 5% and periodically reassess based upon results.

6.   Avoid fad diets.

      - Very Low Carb / Very High Fat (Ketogenic): not recommended, not good long-term strategies because the preferred fuel is glucose.  Ketogenic diets are catabolic so burns fat, yet also burns muscle and consumes more water and energy to convert to glucose.  People lose weight, but usually yo-yo up and down with these diets and there a considerable amount of weight lost is from water.  We are relatively ketogenic when we are sleeping.  Excess fasting can put you into starvation mode so you store more fat when you eat.  For this reason, it is not uncommon for anorexics to have high cholesterol.  Atherosclerosis risk.

      - Low Carb / High Fat (Atkins, South Beach, Zone): not recommended because limits fruits/vegetables, atherosclerosis risk (Dr. Atkins had a heart attack)

      - Paleolithic: wholesome, less processed, restricts grains/legumes, coconut oil is still highly processed and high in saturated fat, this combined with more meat may pose higher atherosclerosis risk

      Healthier Fad Diets:

      Low Fat / High Carb (Ornish, Rosemary Conley): moderate-low evidence of effectiveness

      Points Based (Weight Watchers): moderate-low evidence of effectiveness

7.   + Reinforcement (behavioral therapy)

      + Set a goal with a reward.  Do not give yourself the reward without achieving the goal.  You may inform the doctor so we can write this down and check back on the progress,  This is super powerful and we have seen phenomenal results with this.

8.   Exercise

      - Lose Weight -> increase Aerobic with limited Strength training

      + Gain weight -> increase Strength training with limited Aerobic

9.   Enjoy your food.  Small bites.  Chew carefully (certain foods digest better with saliva than in stomach).  Limit talking while drinking, chewing, swallowing.

10. Meal Replacement Shake

     especially if high Body Mass Index (overweight/obese), also great after exercise

     convenient (just add water)

      example:  Sprouts Vegan Protein (20g protein, 4g carbohydrate, 2.5g fat without saturated fat so lean high quality protein with some carbs and low fat): Pea, Organic Brown Rice, Natural Vanilla, Flax Seed, Stevia, Chia Seed, Sprouted Black Rice, Organic Hemp Seed, Sea Salt, Potassium Chloride, Grape Seed/Skin, Blueberry, Raspberry, Cranberry, Prune, Cherry, Bilberry, Strawberry, Broccoli, Spinach, Tomato, Carrot, Onion, Monk Fruit, Alpha-Galactosidase, Prodigest Enzyme

11. Numbers

     500kcal per day: decreased intake or increased activity -> lose 1 lb per week

12. Timing

     When eating, it is best to eat more around during the time of day you are active.  For example, if you are more sedentary in the evening then rather than eat a heavy meal before lounging around or going straight to bed, eat more during the daytime.  This way the food will be better burned as fuel and less likely to be stored as fat.