Chapter 6
Your Thyroid Diet: What and How to Eat

Tell me what you eat, and I will tell you what you are.

—JEAN-ANTHELME BRILLAT-SAVARIN

When you’re dealing with a metabolic issue such as thyroid disease, as well as the many other possible impediments to weight loss, finding a successful approach that will work for you is part science and part instinct. You and your body know how to lose weight; it’s just a matter of trying out the likeliest approaches, observing your body’s responses, and monitoring how you feel until you find an approach that works, then tweaking it so that it fits you.

We all know people who stay slender and don’t vary in weight, and let’s face it, we can be green with envy about them sometimes. But if you’re really honest about it, except for the rare freak of nature or teenage athletes with a supercharged metabolism, you will rarely see them wolfing down everything in sight and loading up on junk food. They’ve most likely come up with a way of eating that works for them, and they are usually physically active in some way.

My friend Jane is like this. Jane used to wear a size 18, and as a gourmet cook, she regularly entertains and makes the most amazing meals for friends and family. But she also listened to her body and figured out what it needed. She cut almost all processed foods out of her diet and increased her protein, fiber, green vegetables, and good fats. She regularly purchases fresh organic produce, and she started her own vegetable garden, where she grows tomatoes and other produce all summer. She almost always cooks from scratch, using whole foods. She almost never eats fast food, and when she does dine out, she often chooses a big salad, with a grilled meat or fish as her entree. She rarely snacks between meals, and she rarely eats after dinner. She drinks purified water all day long—friends laugh at the giant travel cup she carries around, which she refills multiple times a day—but she is drinking at least 100 ounces of water daily. I don’t know if I’ve ever seen Jane have a soft drink.

Jane also made a major change—she started moving. Jane’s not an exercise hound or gym rat, but she walks daily. She started with shorter walks around the neighborhood. Now, she power-walks several miles every morning. She rarely misses a day. As a concession to cold weather, she got an elliptical machine for her family room, and uses that when it’s too cold to walk outdoors.

In two years, Jane walked and ate her way from a size 18 to a size 6. She has low cholesterol and terrific blood pressure, and at this point she doesn’t count calories, weigh herself daily, or watch what she eats.

The key for her is consistency. Almost every day she eats well, in a way that allows her to maintain her healthy weight loss. And when she has a treat here and there, she goes right back to eating regularly the next day. She’s following what some people call the 90/10 (or sometimes 80/20) rule of weight management—because she maintains healthy eating habits and activity levels at least 80–90 percent of the time, she can enjoy an occasional splurge at other times.

People who didn’t Jane know before look at her now and say, “Oh, you can eat anything you want and not put on weight,” or “You’re skinny, you have such a good metabolism—you’re so lucky.” Jane is not a metabolic miracle; nor is she luckier than anyone else. She simply found the precise formula that takes care of her body in the best way possible. Your job is to find the system that is going to work best for you.

So let’s take a look first at the structure, and then what to eat.

THE PLANS

I have not set out one specific plan and presented it as the plan that will work for you and everyone else with a thyroid problem, because I’ve discovered that there simply isn’t one plan that will work for everyone. Some thyroid patients are carbohydrate-sensitive and find that they can only lose weight when strictly limiting starchy foods. You could potentially be a thyroid patient who actually gains weight on a low-carb Atkins approach. Or you may be more calorie-sensitive and find that you only lose weight when you take your calorie levels lower. Or you may need a very balanced approach of proteins, starches, vegetables, fruits, fat, and so forth.

If all this sounds confusing, relax, because I’ve outlined a number of approaches that you can try. Your objective is to find the plan that works best with your unique metabolism.

WHICH PLAN IS RIGHT FOR YOU?

Complete the following checklists to help determine which one of the plans is the best starting point for you.

___ You have tried a low-carb diet such as Atkins, or a low-glycemic diet such as South Beach, and gained weight while following it.

___ You truly enjoy eating vegetables and fruits.

___ You feel your best after a meal that contains protein, starch, fat, and some vegetables or fruit.

___ You need variety in your diet.

If you have checked two or more of the previous statements, then you should start with the Free-Form Plan.

___ You frequently crave things such as pasta, bread, rice, potatoes, sugary drinks, and desserts.

___ Once you get started eating things such as pasta, bread, rice, potatoes, sugary drinks, and desserts, you find it hard to stop.

___ After you eat things such as pasta, bread, rice, potatoes, sugary drinks, and desserts, you find yourself feeling hungry again fairly quickly.

___ You find that after you eat a piece of cake or a bowl of pasta, you temporarily end up a pound or two heavier on the scale the next day.

If you checked two or more of the above statements, then it’s likely that carbohydrates are a problem for you. You should start with the Carb-Sensitive Plan.

___ You have tried a calorie-controlled diet such as Weight Watchers and gained weight while following it.

___ You have tried a low-glycemic plan such as South Beach and gained weight while following it.

___ You suspect that you probably eat too much, but you don’t keep track.

___ You find that you can gain weight on what others would consider a diet or “cutting back.”

If you have check two or more of the above statements, then you should start with the Calorie-Sensitive Plan.

If you found yourself agreeing with many of the statements in all of the categories, then start out with the Free-Form Plan.

While the checklists can help you choose a plan to start with, read through all the plan guidelines. You will probably have an instinctual sense of which plan may be the best for you to try first. If we really listen, we know what our bodies really need.

As you can see, recipes are not included in this book. There are thousands of popular cookbooks out there, and hundreds of thousands of recipes available on the Internet, featuring low-carb, vegetarian, low-fat, low-glycemic, and other sorts of foods, as well as every possible category of food from every possible cuisine. Given the variety of foods thyroid dieters will eat, there’s no possible way that one book can provide recipes to cover everyone’s preferences and needs. Instead, I encourage you to develop a list of a few favorite go-to cookbooks or websites. The Resources section has some you can investigate as a start.

Follow the plan suggested by your checklists, or try whichever plan makes the most sense for you. Give it at least four weeks. I mean it—four weeks. I know the temptation is to try it for four days, and if you don’t notice the scale going down, you’ll abandon it for the next plan. But give it four weeks. See how you do. Note how you feel. Keep a food journal and track types of foods, carbohydrate intake, fat (including saturated fat), your moods, exercise level, menstrual periods, water, supplements, and daily weight so that you can see how you’re doing and what might be affecting your weight.

After four weeks, if you’ve lost a few pounds (and remember, when you’re dealing with a thyroid problem, consider it a resounding success if you have lost one pound in a week), you’ll want to stick with the plan you’re on. But go back and look at the notes you’ve kept. Did you find that you didn’t have any weight loss on the days after you ate dairy, or you even bloated up and gained a bit? Think about cutting down on dairy as you move forward. Did you notice that if you met your goal for drinking water one day, the next day you saw some weight loss on the scale? This tells you that you really need to keep your water intake high. In contrast, if you felt terrible quite a bit of the time, or haven’t lost anything or have even gained weight, then try one of the other plans. And give that plan four weeks.

I’m not offering a quick fix. If there were a miracle diet, you and I wouldn’t need to be here. It usually takes quite a bit of time to become hypothyroid and for metabolism to get off track. It can take just as much time or more to get your thyroid back toward balance and help reenergize your metabolism so that you start losing weight. And once you’re hypothyroid, you’re likely to remain that way, so we’re looking for a way of eating that is going to work for life.

But have faith. You will find that one of the plans featured in this book has an approach that will work for you!

THE FREE-FORM PLAN

The Free-Form Plan is straightforward and gives you quite a bit of leeway. It’s a balanced, healthy starting point. If you already know you are extremely carbohydrate-sensitive, this may not be the place to start, but if you’re not sure, this is a good plan to follow. Daily charts to help you keep track of your progress are available to download at the website ThyroidDietRevolution.com.

•  Protein: each meal should include a seving of lean protein, and you should eat 4 to 6 serving of lean protein total per day

•  Low-glycemic vegetables: eat all you want, and make sure you’re getting at least 6 servings a day

•  Low-glycemic fruits: 1–2 servings a day maximum

•  Low-glycemic starches: 2–3 servings a day maximum

•  Good fat: a serving with each meal and snack

•  Snacks: 1–2 per day only if needed (and avoid eating after 8:00 p.m.)

•  Water: 64 ounces, minimum

•  Fiber: 25 grams, minimum

•  Supplements: your choice, as per your practitioner’s recommendation

You don’t need to count calories with this diet, but focusing on lean proteins, plenty of vegetables, good fats, and limited starches and fruits naturally keeps the calories at a healthy level.

CARB-SENSITIVE PLAN

•  Protein: some lean protein at each meal, for a total of 6 to 8 servings of protein a day

•  Low-glycemic vegetables: eat all you want, and make sure you’re getting at least 6 servings a day

•  Low-glycemic fruit: 1 serving a day

•  Good fat: a serving with each meal and snack

•  Snacks: 1–2 per day, only if needed (and avoid eating after 8:00 p.m.)

•  Water: 64 ounces, minimum

•  Fiber: 30 grams, minimum

•  Supplements: your choice, as per your practitioner’s recommendation

While you don’t want to go overboard with calories on the carb-sensitive plan, you don’t have to be particularly concerned about them, either. One pilot study followed three groups: one on a low-fat calorie-controlled diet, the second on a low-carbohydrate diet at the same calorie levels, and the third on a low-carbohydrate diet at 300 more calories per day. Statistically, all the groups lost about the same amount of weight, despite the fact that the third group technically should have lost seven pounds less than the other groups.

THE CALORIE-SENSITIVE PLAN

Some people simply can’t lose weight without cutting calories. With the calorie-sensitive plan, you’ll need to do more tracking of foods, and unless you’re a math whiz, you’ll want to invest in a computer program or smartphone app that will help you keep track of your intake fairly closely. (A number of recommendations are featured in the Resources section.)

Your aim is to stay around your calorie target and to get approximately 35 percent of your calories from lean protein, 20 percent from low-glycemic vegetables, no more than 15 percent from low-glycemic fruits and starches, and 30 percent from good fats.

How Many Calories Do You Need?

Ultimately, the number of calories you need to eat daily in order to lose weight depends on several factors:

• Your targeted body weight

• Your activity level

• Your metabolic efficiency

The rough rule is that to get your calorie target, you take your targeted body weight in pounds and multiply it by a number that’s based on your activity level.

• Sedentary (you get no exercise; you sit at a desk all day; you’re a couch potato): 10 × target weight = calories per day

• Moderately active (you get some gentle or moderate form of exercise three to four times a week): 12 × target weight = calories per day

• Highly active (you get regular intense exercise more than four times per week): 14 × target weight = calories per day

Let’s say your target weight is 140 pounds. Here are some sample calculations:

• Sedentary: 10 × 140 = 1,400 calories a day

• Moderate: 12 × 140 = 1,680 calories a day

• Active: 14 × 140 = 1,960 calories a day

Keep in mind that these are rough numbers. Computer tools and smartphone apps have more sophisticated calculators that can help you determine a much more specific calorie target. An even more valuable tool is a metabolic assessment. Bariatric physicians, health clubs, fitness coaches, and weight-loss counselors have elaborate and accurate metabolic test equipment that can calculate your resting metabolic rate (RMR). This sort of stand-alone metabolic testing typically costs between $100 and $200, but it’s very useful to get a picture of what is actually going on in your body.

Keep in mind that experts recommend never going below 1,200 calories a day. If you are at 1,200 calories a day with a moderate level of activity and you are not losing weight, then you are likely suffering from an abnormally low metabolic rate or some sort of hormonal resistance—including potential thyroid resistance—that will require treatment and medical intervention.

If you are a repeat dieter or a yo-yo dieter, or if you are insulin- or leptin-resistant, your metabolic efficiency also may be substantially reduced, which means that weight-loss success ultimately will require that you medically address the underlying metabolic dysfunction.

Dr. Kent Holtorf checks the resting metabolic rate in his weight-loss patients, and he notes:

Interestingly, many of our overweight patients, and in particular those with elevated leptin levels indicative of leptin resistance, have RMRs that are consistently below normal. These patients are often burning 500 to 600 calories less each day than someone of equal body mass.

IMPLEMENTING YOUR PLAN

What Is Your Optimal Weight?

I can’t tell you at which weight you’ll feel the best, and there are many different expert opinions. One of the simplest formulas is this: for women, allow 100 pounds for the first five feet and 5 pounds for each additional inch; for men, allow 110 pounds for the first five feet and 5 pounds for each additional inch. More sophisticated charts take into account height and frame size. I have links to various calculators to identify your optimal weight at the website ThyroidDietRevolution.com.

Ultimately, I know you have a number in your mind. It may be based on a calculation. More likely, it is based on a weight at which you felt and looked your best in the past. Now, I want you to put that number in the back of your mind. It may be your final goal, but you need to set realistic goals along the way. One of the best ways to decide on a target weight is by identifying your current and target body mass index, or BMI. Take a look at the chart below and identify your BMI. (You can also use the calculator at ThyroidDietRevolution.com.)

• Generally, a healthy BMI is 19–25.

• Overweight BMI is 26–30.

• Obese BMI is 31–40.

• Morbidly obese is above 40.

Identify your current BMI. If you’re a 198-pound person, for example, and you are five feet seven inches, your BMI is 31. That would be considered overweight to slightly obese. Your target weight should be no higher (and possibly lower) than 159, which is a BMI of 25, the top end of the healthy range for that height.

If you belong to a gym, work with a fitness trainer, or see a nutritional expert, they can also perform more detailed BMI calculations that take into account important fat measurement spots.

Excess fat in the abdominal area is a risk factor for insulin resistance and other diseases. The waist measurement at which there is a definite increase in risk is 40 inches or more for men and 35 inches or more for women. So you should also focus on reducing waist size.

Setting Realistic Goals

•  Phase 1: If you have a BMI over 30, your first goal should be to lose enough weight to get into the BMI range of 25–29. This will automatically reduce the risk of various diseases and help make your metabolism more efficient. You should also target a waist measurement reduction of 5 percent.

•  Phase 2: If you’re in the 25–29 BMI range (or if you’ve lost enough weight in Phase 1), then your goal should be to get down to a BMI of just below 25, plus an additional reduction in waist measurement. At this point, you are no longer overweight. You have greatly reduced your health risks and improved your metabolism; no doubt you look and feel better, and have more energy and greater fitness.

•  Phase 3: If your ultimate goal weight is less than where you are with a BMI of a little under 25, then keep working on weight loss until you reach that objective.

In each phase, you should target a 5 percent reduction in waist measurement. The following chart may be a help:

ABOUT THE TIMING

Did you know that just thinking about eating can actually trigger changes in your insulin levels and hormones that stimulate appetite? So your goal is to stop thinking about eating. (These days, I even switch off the television when I see the beginning of a particularly enticing food ad, so that my hormones don’t get interested!) But one of the most important ways you can stop thinking about eating is to know when you’re going to eat. If you eat on a fairly predictable schedule, you won’t have to think about food between meals.

Most of the experts in the area of insulin and leptin resistance are now recommending that, rather than frequent mini-meals or grazing, people who are overweight focus instead on eating two or three meals a day. This allows enough time between each meal for the appropriate hormonal response to occur so that food is properly digested and nutrients absorbed, followed by an appropriate metabolic shift into fat burning before the next meal appears.

Research studies have also found a correlation between more meals per day and obesity. Studies found that women who were obese ate one meal more per day on average than those who were not obese. The overweight women tended to eat more between-meal snacks than the women who were of normal weight.

Another critical component to timing is not to eat after dinner if at all possible—ideally, nothing after 8:00 p.m. You should even try to go to bed a bit hungry—not so famished that hunger pangs will keep you awake, but your stomach should feel nearly empty. Your body is looking for fuel to burn during the night, and rather than have it burn undigested dinner or after-dinner snacks, you really want it to pull from your fat stores. Nutritional psychologist Marc David says that allowing time between eating and going to bed means that “you’ll also do what you were meant to do while lying in bed—healing, detoxifying, rebuilding, and so forth—without sidetracking vital metabolic force into digestion.”

If you go to bed with your stomach nearly empty and insulin levels are low, your body is much more likely to go to your fat stores and start burning. But if you have a big meal or a large snack before bed, you have insulin flooding your system and glucose circulating all night that will be stored in your fat cells.

According to experts, how or why a person gains weight is very complicated, but it clearly is not just calories in and calories out. One study found that eating a high-fat diet during the typical sleep period results in far greater weight gain than eating the same high-fat diet during normal waking hours. Another study comparing obese women and women of normal weight found that the overweight women tended to eat more food later in the day and evening than their normal-weight counterparts.

Given how often we hear about “stoking the metabolism with frequent eating,” this may sound quite radical. But we now know more about how food is processed in people (and cultures) where low metabolic efficiency is rampant, versus those with less of a problem. Look at the French, for example, who do not have nearly the obesity problem that we have in the United States. Experts studying the French diet have found that the French tend to eat three meals a day, slowly. The French rarely snack, and they take in fewer calories at a meal than most Americans. The typical slim French person is simply not having six mini-meals and additional snacks throughout the day to keep the metabolism “stoked.”

In the beginning, you may still need to snack. But try cutting back to one snack a day, and eventually see if you can give up your snack entirely. And if you absolutely must have a snack between meals or in the evening before bed, make it a small one, and consider a handful of nuts or a small serving of protein.

In my own case, I had to get used to not snacking before bedtime. Before, I could easily down a dozen crackers and a piece of fruit before bed (and wake up bloated and up half a pound on the scale). But I adjusted to going to bed with an empty stomach, and I started waking up with no bloating and with the scale showing some weight loss. After switching to two to three meals a day, I also noticed that I feel more energetic than when I was eating multiple mini-meals. I also find that knowing generally when I will eat made me stop thinking about what snack I could have between this meal and the next, what time I should snack, and so on.

THE MOST IMPORTANT THING ABOUT YOUR FOOD

If there is a most important factor that you should consider when choosing your food, it would be the advice of nutritionist Marc David, author of the book The Slow Down Diet. David says, “No matter what food you eat, choose the highest-quality version of that food.”

There are many reasons for this, and he explains them thoroughly in his terrific book and in his coaching, but here’s the quick version. The highest-quality versions of foods—fresh, organic, local, hormone-free, and pesticide-free, and foods that are raised and grown under positive situations, for example—are more nutritious and in the end may have fewer negative effects on your weight than their lower-quality counterparts. There is so much to say about this, and it’s more than we can get into here in The Thyroid Diet Revolution. But it’s an important guiding principle.

WHAT TO EAT: LEAN PROTEINS

One of the key components of your diet should be lean proteins. These can include animal proteins, seafood, dairy products, eggs, and plant proteins.

Animal Protein

When choosing animal proteins, your objective is to choose lean proteins, from hormone-free, free-range, organically raised, grass-fed meat whenever possible. For beef, lamb, and bison (buffalo), grass-fed meat is particularly important, because grass-fed meats are substantially lower in saturated fat than feedlot-fattened animals. Some of the best proteins include:

• Lean cuts of beef (sirloin, top round, tenderloin)

• Bison (all cuts)

• Poultry (skinless): turkey breast (including ground), chicken breast, turkey bacon, ostrich

• Lean pork (pork loin)

• Lean cuts of lamb (loin, shank, leg)

Some of the proteins you want to avoid, or eat rarely, include:

• Beef brisket, liver, ribeye steaks, and other fatty cuts of beef

• Bacon, other fatty cuts of pork, honey-baked ham, processed cold cuts

• Lamb blade, ground lamb

• Chicken and turkey wings, legs, and thighs

• Duck and goose

One of the least familiar meats on the recommended list may be bison, also known as buffalo. If you haven’t tasted bison, don’t discount it! Bison tastes like rich, lean beef, with a bit of the savory aspect of lamb. Bison, however, is leaner, much lower in fat, and higher in protein than beef, making it a healthier option. Much of the bison available on the U.S. market is also organic and grass-fed. My local Trader Joe’s and Whole Foods markets have precooked bison burger patties—two minutes in the microwave, and they’re ready. They’re absolutely delicious, and one burger with a salad fills me up for hours.

While we’re on the topic of meat, let’s look at pork loin. This is lower in fat, calories, and cholesterol than many other meats and poultry; in fact, any cut from the loin—such as pork chops, pork roast, and pork tenderloin—is actually leaner than skinless chicken thigh, according to U.S. Department of Agriculture data. I love cooking a pork loin roast as a special Sunday dinner. It’s easy (a dash of Worcestershire, some garlic, and a few tablespoons of olive oil, and I pop it into the oven to roast, basting periodically while it’s cooking). And if you make a large enough roast, you’ll have terrific leftovers for lunch or dinner.

Keep in mind that in addition to natural foods stores, kosher and halal markets may be good sources for higher-quality, natural meats and seafood.

Seafood

Fish and shellfish can be complicated, because one day we hear how healthy they are, and then the next we hear about mercury, toxins, and cholesterol levels in some favorite seafoods.

Generally, healthy seafood choices that have the lowest level of contaminants include:

• American shad

• Anchovies

• Atlantic croaker

• Atlantic haddock

• Atlantic pollock

• Butterfish

• Canned salmon

• Catfish

• Chub mackerel

• Clams

• Crab

• Crawfish (crayfish)

• Flounder

• Hake

• Herring

• Mussels

• North Atlantic mackerel

• Ocean mullet

• Ocean perch

• Pacific oysters

• Pacific sole

• Plaice

• Sardines

• Scallops

• Shrimp

• Squid (calamari)

• Striped bass (farmed)

• Tilapia

• Trout

• Whitefish

• Whiting

• Wild salmon (coho, sockeye, Atlantic)

Some fish do contain higher levels of mercury, so they are best eaten in moderation—several servings a month maximum for adults—and most experts recommend that children and pregnant women avoid them entirely. They include:

• Chilean sea bass

• Spanish mackerel

• Bluefish

• Canned light tuna

• Cod

• Grouper

• Halibut

• Lobster

• Snapper

• Yellowfin tuna

Mercury and PCB contamination have resulted in some seafood being so contaminated that experts recommend you avoid it entirely. Seafood to avoid includes:

• Ahi (bigeye) tuna

• Canned white albacore tuna

• King mackerel

• Marlin

• Orange roughy

• Salmon (farmed)

• Shark

• Swordfish

• Tilefish

• American oysters (wild)

• Eastern oysters (wild)

• Striped bass (wild)

Eggs

Eggs, in particular organic omega-3 eggs, are a healthy protein source. Omega-3 eggs are from regular chickens that have been fed a diet of grains high in flaxseed. As a result, the eggs are high in alpha-linolenic acid, an omega-3 essential fatty acid that can have positive health effects. Omega-3 eggs are not genetically engineered. In studies, even eating two a day did not raise LDL cholesterol and actually was shown to raise HDL (the “good” cholesterol) and lower triglycerides. Eggs also rank high on satiety—they’re filling. One study found that dieters who ate two eggs for breakfast typically ate as many as 300 fewer calories per day on average, compared to those not eating eggs.

Eggs are actually considered a near-perfect protein, because they contain a wealth of amino acids. Omega-3 eggs are somewhat more expensive than regular eggs, but the health advantage justifies the cost. They are available at many grocery and health food stores.

Dairy Foods

With dairy, one of the key issues is to make sure that you choose organic, hormone-free dairy products whenever possible.

There are various forms of dairy that you can use as healthy proteins. Remember that some dairy products (particularly nonfat versions) may include additional sugars and carbohydrates, so check the label. Some of the best dairy proteins include:

• Low-fat cottage cheese

• Plain yogurt and Greek yogurt

• Lebneh (yogurt cheese—a thickened, strained form of yogurt popular in Middle Eastern cuisine)

• Low-fat cheeses

• Feta cheese, goat cheese, Indian paneer cheese, and Neufchatel cheese (lower in fat than other types of cheese)

Laughing Cow also has a line of lower-fat cheeses that come packaged in little triangular wedges, and they’re delicious.

Plant Proteins

Plant foods are a healthy source of protein. Some of the highest-protein plant foods include the following:

• Soybeans and soy products such as tempeh, tofu, miso, and natto

• Lentils

• Peanuts and peanut products

• Beans, including broad beans, kidney beans, lima beans, and chickpeas (garbanzo beans)

• Seeds, including pumpkin, squash, flax, sunflower

• Nuts, including walnuts, pine nuts, almonds, pistachio nuts, cashews, walnuts, hazelnuts, and brazil nuts

• Grains: quinoa, oats

• Protein powders based on plant proteins such as peas, rice, or hemp

While nutritionally, we know that these foods can be healthy, you’ll need to determine whether your particular circumstances will allow you to lose weight while using fermented soy products (miso, tempeh, natto, certain kinds of tofu), beans, and grains. And generally, when it comes to plant proteins, it’s wise to avoid unfermented soy products (including unfermented tofu), processed soy products (soybean oil, soy flour, soy lecithin, soy-based meat substitutes and burgers, soy cheese, soy ice cream, dried soybeans, soy milk, soy protein shakes or bars, soy protein powders), and peanut products.

The Debate over Animal Protein Versus Plant Protein

Some experts are now suggesting that the truly optimal diet for health is a diet that eliminates meat and fish and instead gets its protein only from plant-based sources. This has been an ongoing debate for several decades, with experts making convincing cases and studies offering convincing evidence on both sides of the argument.

As far as weight loss is concerned, what we do know is that depending on the dieter and his or her physiology, both animal- and plant-based diets can result in successful weight loss. So that aspect of the diet wars needs to be put to rest. We also know that low-carbohydrate diets—as compared to low-fat, higher-carbohydrate diets—can also be an effective way to lose weight. In some cases, controlling carbohydrates appears to be more effective than higher-carbohydrate diets in terms of the amount of weight lost and maintained over time.

But the diet wars still rage over whether a low-carbohydrate diet that relies on animal protein can be healthy, even if it’s a successful weight-loss strategy. Some experts say yes, pointing to changes in cholesterol levels that suggest improved cardiovascular health. Others say no, suggesting that the evidence points to plant-based protein being healthier.

The compromise solution? A modification to low-carbohydrate diets that replaces animal protein with plant-based protein. Labeled “Eco-Atkins,” it’s a vegan diet that limits carbohydrates to 100–150 grams a day (high by Atkins standards, but lower than the typical 300 grams a day of the typical American diet). And those carbohydrates are primarily vegetables and fruit; processed carbohydrates such as bread, rice, potatoes, sugar, and pasta are not included. In the Eco-Atkins diet, the protein sources are primarily gluten, soy, and nuts.

One study compared Eco-Atkins to a lacto-ovo-vegetarian low-carb diet, where tofu, eggs, and cheese were the main sources of protein. It found that the Eco-Atkins group had significant improvements in risk factors for heart disease, plus a drop in bad cholesterol.

One of the more recent additions to the debate is a study reported on in the Annals of Internal Medicine in September 2010, which looked at the long-term risk of mortality for people following animal-based and vegetable-based low-carbohydrate diets. The focus was not on whether cholesterol was lowered or triglycerides improved, but simply on mortality. They found that “diets that emphasized animal sources of fat and protein were associated with higher all-cause, cardiovascular, and cancer mortality, whereas diets that emphasized vegetable sources of fat and protein were associated with lower all-cause and cardiovascular mortality.” They concluded that the health effects of a low-carbohydrate diet may depend on the type of protein and fat, and a diet that includes mostly vegetable sources of protein and fat is preferable to a diet with mostly animal sources of protein and fat.

It would seem to be case closed, then: plant-based protein wins over animal-based protein.

But is it closed?

I would argue that what we really need to compare—apples to apples, so to speak—is a plant-based, carbohydrate-controlled diet with a diet that includes sufficient—but not excessive—amounts of protein that is organic, hormone-free, pesticide-free, and grass-fed, as well as a controlled amount of organic, low-glycemic carbohydrates. A low-carb diet where the protein sources are grass-fed organic beef, wild salmon, and organic locally grown vegetables, for example, is likely to have a very different impact on overall health, inflammation, hormones, cancer risk, and mortality than a diet where the protein sources are fatty cuts of hormone-laden beef, processed cold cuts, additive-riddled sausages, mercury-laden fish, poultry pumped full of toxins, and vegetables and fruits coated in pesticide residues and loaded with perchlorate.

There are also two key issues to consider regarding the thyroid impact of an Eco-Atkins type of diet that relies on gluten, soy, and nuts as primary proteins. First, we know that gluten is a common allergen, and sensitivity to it—or even a complete intolerance, such as seen in celiac disease—is on the rise and is at the root of many cases of thyroid and autoimmune disease. An increasing number of physicians are now advocating a gluten-free diet to help calm thyroid autoimmunity and to aid in weight loss. For those who have sensitivity or celiac disease—most of whom are undiagnosed at present—shifting to a diet that relies on gluten as a key form of protein could worsen underlying health issues.

Second, soy is a phytoestrogen, and it can in some cases block the body’s ability to absorb thyroid hormone. In small quantities—for example, as a condiment—and in its fermented forms, it can probably be a safe part of the diet. But in the high quantities necessary for it to be a primary protein in a protein-sufficient diet, soy can function as an goitrogen in those who still have a gland, meaning that it can slow the thyroid down and promote formation of a goiter. Soy can also impair absorption of thyroid medication in anyone on thyroid hormone replacement medication whether or not they have a gland. Add to that two other issues: much of the soy available these days is genetically modified, and soy too is a common allergen.

So if thyroid patients switch to a diet based entirely on plant protein, will they find its health benefits cancelled out by worsening hypothyroidism or by sensitivity to gluten, soy, or nuts? I think we need a far better understanding of whether such a diet is beneficial in the long term for weight loss and overall health for people with thyroid issues. And until we have definitive information, if you are a thyroid patient who wants to eat only plant-based proteins, I recommend that you carefully monitor your response, not only in terms of weight loss but also in terms of your thyroid antibodies and thyroid function. If you are including meat in your diet, try to choose the best-quality meats—lean, grass-fed, organic, and hormone-free—whenever possible.

WHAT TO EAT: LOW-GLYCEMIC CARBOHYDRATES

The term low-glycemic refers to the glycemic index (GI). The GI basically is a measure of how quickly your blood sugar levels will rise after you eat a particular food. Both a food’s chemical composition and its fiber content typically affect its GI rating—how quickly your body takes that carbohydrate and converts it to glucose.

To determine a food’s GI rating, portions of the food are given to people who have fasted overnight. Their blood sugar is then monitored over time, and the rise in blood sugar is calculated. Foods with a lower glycemic index will create a slower rise in blood sugar, and foods with a higher glycemic index will create a faster rise in blood sugar.

Low-Glycemic Vegetables

Some of the lowest-glycemic vegetables that you can safely include in your diet are:

 

• Artichokes

• Beans and legumes

• Brussels sprouts

• Celery

• Eggplants

• Green peppers

• Mushrooms

• Tomatoes

• Asparagus

• Broccoli

• Cauliflower

• Cucumbers

• Green beans

• Lettuce

• Spinach

• Zucchini

 

The higher-glycemic vegetables that you should limit are:

 

• Beets

• Celery root

• Parsnips

• Rutabaga

• Turnips

• Winter squash

• Carrots

• Corn

• Red potatoes

• Sweet potatoes

• White potatoes

• Yams

 

A great way to get your veggies is by starting meals with a healthy vegetable soup. Researchers have found that blending vegetables and water into a soup makes you feel full and satisfied, compared to eating the soup’s ingredients—i.e., the solid foods and water—separately. It sounds strange that eating vegetables and water together as a soup can make you feel more full than eating the same vegetables with a glass of water, but according to scientists, after you eat a meal, the pyloric sphincter valve at the bottom of your stomach holds food back so that digestion can begin. Water passes through the sphincter to the intestines, so water on its own doesn’t help fill you up. But mix the water with other ingredients into a soup, and the whole mixture stays in your stomach, because the stomach “reads” the soup as a food. This keeps the stomach fuller for longer and helps reduce hunger. The full, stretched stomach also communicates to the hypothalamus to stop producing the hunger hormone ghrelin, so the longer the stomach remains full, the longer you feel satisfied and the less you are likely to eat.

And don’t forget that capsaicin, the compound responsible for the heat in cayenne, jalapeño, and other hot peppers, can stimulate metabolism—by as much as 40 percent in the short term, according to some experts. So pile on the peppers!

Low-Glycemic Fruits

The best fruits generally for thyroid dieters are berries—including strawberries, blueberries, blackberries, raspberries, and other types. They have a lower glycemic index than other fruits, and they are rich in antioxidants. Choose organic berries whenever possible, however, as berries can carry pesticide residues, and do not have a peel or skin to protect the fruit.

Some other low-glycemic fruits include:

 

• Apples*

• Cantaloupes

• Grapefruits

• Peaches*

• Apricots

• Cherries*

• Nectarines

• Plums

 

Fruits that you should limit or avoid, because they have a higher glycemic index, are:

 

• Bananas

• Grapes

• Oranges

• Papayas

• Tangerines

• Clementines

• Honeydew melons

• Pineapples

• Watermelon

• Raisins, dates, other dried fruits*

 

* These fruits are higher in fructose, and may have a more glycemic effect on some individuals.

Low-Glycemic Starches

Your best choices are low-glycemic-index starches, including:

• Sprouted bread (try the Ezekiel line of products)

• High-fiber multigrain bread

• Bulgur

•Whole-grain wheat bread

• Whole-grain rye bread

• Pumpernickel

• Whole-grain crispbreads, such as Wasa, Ak-Mak, and Kavli

• Low-carb bread

• Quinoa

• Amaranth

• Wild rice

Note that millet, while considered a low-glycemic grain, is highly goitrogenic and is not recommended.

Slightly higher-glycemic starches that may be eaten on occasion, depending on how sensitive you are to them and whether they slow or stall weight loss for you, include:

• Plain cooked oatmeal (old-fashioned, steel-cut, or Irish; not instant)

• Spinach pasta

• Brown rice

• No-sugar-added, high-fiber cereals

Starches you should avoid:

• Bagels or breads that are not high-fiber

• Cakes

• Cold cereals (except high-fiber)

• Cookies

• Corn bread, corn tortillas

• Crackers

• Granola, granola bars

• Muffins

• Pretzels

• Refined flours

• White rice

• Rice cakes

• Pasta (from white or wheat flour)

• White sugar

When you’re looking to cut out sugar, don’t forget about sugar-sweetened drinks—they are pretty much like mainlining sugar straight into your veins. You know the drill: there are 10 teaspoons of sugar in one can of cola. And don’t overlook the macchiatos and sweetened coffee drinks at your favorite coffee bar—these drinks can be as sugary and high-calorie as a milk shake. Even pure fruit juices can be problematic. If you must have a glass of orange or other fruit juice in the morning, consider juicing it yourself and leaving the pulp in so that you get some fiber and more nutritional value from it. Or if you are using prepared juice, consider diluting it with half water to help cut the sugar content. You’ll still get some flavor from it, but with less of the sugar and calorie impact.

One option for juice lovers is to get unsweetened fruit juice, then add your own no-calorie sweetener. For example, I buy unsweetened cranberry juice concentrate (which is rather sour as is), but I add stevia and water and have a low-cal, low-carb, nutritious cranberry juice cocktail. Occasionally I like to mix a bit of stevia with unsweetened fruit juice and seltzer and make my own sugar-free “soda.” Or try Emergen-C drinks, which are single-serving vitamin drinks that come in small packets. You add water, and you have a slightly fizzy, naturally sweetened, low-carbohydrate, low-calorie vitamin drink that contains 1,000 mg vitamin C, along with potassium and other nutrients.

WHAT TO EAT: FATS

Fat in your diet can be of several types:

•  Monounsaturated fatty acids (MUFAs). Monounsaturated fats lower total cholesterol and LDL cholesterol (the bad cholesterol) while increasing HDL cholesterol (the good cholesterol). Nuts (walnuts, almonds, and pistachios), peanuts, seeds, avocados, and olive oil are high in MUFAs. MUFAs have also been found to help in weight loss.

•  Polyunsaturated fatty acids (PUFAs). Polyunsaturated fats fall into two categories: omega-6 fats and omega-3 fats. Omega-6 PUFAs are found primarily in vegetable oils such as sunflower oil and cottonseed oil. Omega-3 PUFAs are considered the heart-healthiest and are concentrated in fatty cold-water fish (such as salmon, mackerel, and herring) and fish oil. They are also found to a lesser extent in flaxseeds, flaxseed oil, and walnuts.

•  Saturated fats. Saturated fats are mainly found in animal products such as meat, eggs, dairy products, and seafood. Some plant foods are also high in saturated fats, including coconut oil and palm oil. There is a continuing controversy as to whether saturated fats are dangerous to health or in fact heart-healthy.

•  Trans fats. Trans fats are chemically created fats that are used because they provide a longer shelf life for processed and packaged foods. Trans fats are found in many commercial baked goods (such as crackers, cookies, and cakes), many commercially fried foods such as french fries and doughnuts, packaged snacks such as microwave popcorn, and some types of vegetable shortening and stick margarine.

Fats are a contentious, controversial topic, and if you talk to different nutritional experts, you’ll hear very different stories. The conventional wisdom is that saturated fat is bad because it raises total cholesterol and LDL (bad cholesterol) while lowering HDL (good cholesterol). Conventional nutrition thinking urges us to avoid all saturated fat and trans fat and get our dietary fat from MUFAs and PUFAs.

At the same time, some nutritionists are pointing to cultures that traditionally have diets high in saturated fat yet also have low rates of heart disease. Furthermore, there are increasing numbers of respectable studies showing that diets rich in saturated fat can result in a lower or unchanged concentration of total and LDL cholesterol and an increase in HDL cholesterol.

So the advice you get on fat will probably depend on whether you’re reading something from the generally dietary-fat-phobic American Heart Association or Dr. Dean Ornish, or the dietary-fat-friendly Weston A. Price Foundation or researcher and writer Gary Taubes.

What should you do? My recommendations are as follows:

• Make the majority of fat in your diet healthy MUFAs and PUFAs.

• Don’t be afraid of some saturated fat in whole foods, but eat them in moderation as part of a calorie-controlled diet.

• Avoid trans fats. Everyone agrees they have no place in a healthy diet or a diet designed for weight loss.

• Avoid corn, soy, canola, safflower, and sunflower oils, especially in cooking, due to their risk of contamination, rancidity, and inability to remain stable at high temperatures.

You can’t go wrong with olive oil as a key fat in your diet. And while we’re on the subject of olive oil, let’s mention vinegar.

Vinegar has been a folk remedy for obesity for many years, and it appears that the old wives’ tale may have some truth to it, based on some studies of vinegar’s properties. Various studies have shown that vinegar may help slow down fat accumulation and weight gain. Some animal studies conducted in Japan have shown that animals fed a high-fat diet plus acetic acid, the ingredient that gives vinegar its strong smell and sour taste, developed 10 percent less body fat than animals not receiving the acetic acid. Another recent study found that diabetics who took 2 tablespoons of apple cider vinegar before bed lowered their morning glucose levels by 2 to 4 percent.

Apple cider vinegar, red wine vinegar, and balsamic vinegar have a great deal of flavor with minimal calories, so you may want to regularly mix up a fresh olive oil vinaigrette for your salads or vegetables.

WHAT TO DRINK: WATER

Even if you’re eating exactly the right things and working out, if you’re not getting enough water you may find it difficult, if not outright impossible, to lose weight. This is because the liver, which converts stored fat into energy, acts as a backup to the kidneys in detoxifying the body. If the kidneys are not functioning optimally because they are deprived of water, then the liver is diverted away from fat conversion and toward detoxification.

Drinking enough water:

• Helps the metabolism work efficiently

• Helps reduce appetite

• Helps skin appearance and tone

• Helps muscles work more efficiently

• Helps digestion, reduces constipation, and encourages regular elimination

Ideas about how much water you should drink depend on whom you ask, but many agree you should get eight 8-ounce glasses a day. Some experts say that you should drink an additional 8-ounce glass for every twenty-five pounds of weight you need to lose. So if you are fifty pounds overweight, you should drink two more 8-ounce glasses of water, for a total of ten 8-ounce glasses. If it’s particularly hot out or if you are exercising intensely, the American College of Sports Medicine suggests drinking even more—adding 6 ounces for every fifteen minutes of activity. Philip Goglia, author of Turn Up the Heat: Unlock the Fat-Burning Power of Your Metabolism, recommends drinking 1 ounce of water per pound of scale weight. For most of us, this is substantially more than eight glasses. If you are a 160-pound woman, for example, that’s 160 ounces a day, which is equal to twenty 8-ounce glasses a day, or the equivalent of almost three 2-liter bottles. And if you are a 200-pound man, that’s twenty-five 8-ounce glasses a day.

I know that for the first few days after increasing water intake, you feel as if you’re living in the restroom. But this will calm down. As your body begins to recognize that you are finally taking in enough water, it gives up the water it’s been holding on to. This is also the mechanism behind the counterintuitive but true theory that if you want to stop feeling bloated and retaining water, you need to drink more water! You’ll know you’re getting enough when your urine is pale yellow or nearly colorless. If it’s darker, increase your water intake. (Keep in mind, however, that certain vitamins darken your urine, even if you’re getting enough water.)

Spread out water consumption during the day as much as possible. One rule that some experts recommend is that you not drink water while you are eating. The theory is that if you are drinking water with your meal, you may be using it to help swallow food without fully chewing your food. You may want to drink a glass of water before your meal. It’s even better if you can have a big glass of water with some sort of fiber (e.g., psyllium, or Dr. Levine’s Ultimate Weight Loss Formula) before you eat. (Don’t forget, however, to make sure that supplemental fiber is taken several hours apart from your thyroid medication.)

Ideally, you want to make sure that your water is as clean and pure as possible. At a minimum, filter your drinking water. You can get decent, inexpensive, quality pitcher or sink-based filters, such as Pur or Brita. If you want a more elaborate system, reverse osmosis systems purify water and remove many toxins.

Some people find electrolyte-enhanced water to be especially helpful. Electrolyte-enhanced water contains extra amounts of minerals, including magnesium, potassium, and sodium. It’s a bit like Gatorade, though without calories and flavor, in terms of helping to replace minerals and rehydrate the body. You may recognize the brand SmartWater by Glaceau, which is a popular electrolyte-enhanced water. Many grocery and natural food chains also have their own house brands of electrolyte-enhanced water. Typically, these waters start with purified water, which is then vapor-distilled and enhanced with minerals.

Finally, should you drink your water cold or at room temperature? There is anecdotal evidence that the stomach absorbs cold water more quickly and that cold water may enhance fat burning. The idea is that your body has to use extra energy to heat the cold water up to body temperature—98.6 degrees—so this may help you burn more calories. However, there is also some thinking that cold water stimulates appetite and that warmer water is far easier to drink in large quantities. Since there is no real agreement, the right temperature is the one you like best and find easiest to drink. Personally, I have found that I can drink far more room-temperature water, and I am quite used to it this way. My favorite? Room temperature SmartWater.

WHAT TO EAT: FIBER

Fiber is essential to digestion and will optimize your weight-loss efforts. Sometimes called roughage, it is the part of plant foods that is not digestible. Fiber comes in two forms: (1) soluble, which dissolves in water, and (2) insoluble, which does not. Foods that are high in soluble fiber include oats, barley, beans, and citrus fruits. Soluble fiber is also found in psyllium seed and oat bran. Good sources of insoluble fiber include wheat bran and certain vegetables.

Fiber:

• Absorbs water and helps create softer, larger stools, promoting regularity

• Can help prevent or minimize digestive tract problems and their consequences, such as hemorrhoids, diverticular disease, irritable bowel syndrome, and even rectal cancer

• Can slow the digestive process, preventing dramatic swings in blood sugar

• Can help lower cholesterol

There is evidence that fiber helps with weight loss. Fiber has minimal calories but can fill you up by adding bulk. When consumed with carbohydrates, it helps modulate the insulin response and normalize blood sugar. There is a fair amount of scientific support for fiber’s ability to increase the feeling of fullness after you eat. One study found that adding 14 grams of fiber per day was associated with a 10 percent decrease in calorie intake and a weight loss of five pounds over four months.

In another study of fifty-three women who were moderately overweight and followed a 1,200-calorie-a-day diet over twenty-four weeks, half were given a fiber supplement and half received a placebo. The fiber group was given 6 grams of fiber a day to start, then 4 grams. The fiber group lost a mean of 17.6 pounds versus 12.76 pounds in the placebo group.

Fiber can be incorporated into food, but you need to keep in mind the trade-offs between fiber-rich foods and the calorie or glycemic impact. Some ways to incorporate fiber into your diet include:

• Raw fruits and vegetables, which have more fiber than cooked or canned

• Dried fruits, especially dried figs (note, however, that dried fruits are high in natural sugar and can have a high glycemic index, so use them with caution)

• Whole grains (such as quinoa) or whole-grain bread

• High-fiber cereals (a ½-cup serving of All-Bran, for example, has 90 calories and 10.4 grams of fiber)

• Nuts—many are high in fiber (¼ cup almonds, for example, provides 2.4 grams of fiber)

• Beans (1 cup black beans provides a whopping 19.4 grams of fiber)

Other high-fiber foods include apples, oranges, broccoli, cauliflower, berries, pears, Brussels sprouts, lettuce, prunes, carrots, and potatoes.

Men younger than fifty require 38 grams of fiber a day, and women should get 25 grams. Men over fifty should get at least 30 grams and women at least 21 grams. The typical American diet, however, includes 10 grams of fiber a day or less. You’ll probably have to add a fiber supplement, in addition to emphasizing fiber-rich foods. Start slow because you need to give your intestinal system time to adjust. Adding too much fiber too quickly can cause discomfort.

Some fiber supplements to consider include

•  Psyllium. One study found that women who took 20 grams of psyllium before a meal ate less fat and felt full more quickly during that meal, helping with weight reduction. Psyllium husk is found in Metamucil products (but watch for sugar or artificial sweeteners such as aspartame in these products). I prefer plain psyllium powder, but even better is psyllium in capsule form. Taken with a big glass of water before a meal, the fiber helps slow the glycemic response of your food and helps you feel full longer than usual.

• Guar gum (i.e., Benefiber), which dissolves with no grit or bulk into drinks

• FiberCon tablets, which use polycarbophil, a synthetic fiber; it has the filling and stool-softening effects of fiber but may not lower cholesterol or blood sugar like other types of fiber

Important warning: If you switch from a low-fiber diet to a high-fiber one, be very careful that you are taking your thyroid medication at least an hour before eating in the morning so that absorption of the medication is not impaired. High-fiber diets can change your dosage requirements, so six to eight weeks after starting a high-fiber diet, you may wish to have your thyroid function retested.

In addition to fiber supplements, a great high-fiber food product is Gnu Bars. These are bars that contain 12 grams of fiber each—the fiber in one bar equals three to four doses of most fiber supplements. Gnu Bars come in a variety of flavors, including Chocolate Brownie (the only one I’ve actually tasted). They’re decent. They don’t taste like brownies, but they are chewy and chocolatey, and definitely do not taste like they have 12 grams of fiber. You can get Gnu Bars at local health food stores or online.

My favorite fiber product is Dr. Levine’s Ultimate Weight Loss Formula (which I’ll call DLUWLF for short). It’s the highest-fiber supplement I’ve found on the market—one serving provides 35 grams of fiber, which comes from five different healthy fibers, including psyllium. It has no calories and comes in a variety of flavors. I have more information on DLUWLF in chapter 7.

WHAT IS A SERVING SIZE?

I can almost guarantee you that the recommended serving size of whatever food you are eating is probably smaller that you think it is! When I first started keeping track of serving sizes, I was amazed to find that my idea of a serving of pasta was actually two to three servings. That plump chicken breast? Two servings. And one of those really nice, big, fat-free blueberry muffins from Starbucks? Four servings of starch! The fundamental truth here: you will often overestimate the serving sizes of foods, but you’ll rarely underestimate them.

You can walk around with a food scale in your pocket (not particularly practical) or you can learn to fairly accurately eyeball a serving by comparing certain foods and serving sizes with common objects. Let’s start with the definition of a meal-size serving.

One serving of vegetables is basically:

• ½ cup raw, chopped, or cooked

• ¾ cup vegetable juice (try to stick with the low-sodium varieties, or juice it yourself)

• 1 cup raw leafy greens (salad, spinach, etc.)

One serving of starch is basically

• 1 slice whole wheat bread

• ½ whole-wheat bagel or muffin

• ½ cup cooked whole-grain cereal, pasta, brown rice, beans, corn, potatoes, rice, or sweet potatoes

• ½ of a small white potato or sweet potato, or 1 red potato

• 2 slices unseasoned Melba toast

• ½ Ak-Mak cracker

• ½ small corn tortilla

• 2 cups popcorn

For protein, one serving is:

• 3 ounces beef, pork, or lamb

• 5 ounces fish

• 6 ounces poultry

• 1 ounce regular cheese, or 2 ounces low-fat cheese

• 2 eggs

One serving of fat is:

• 1 tablespoon oil (i.e., olive, flaxseed, coconut)

• 1 tablespoon low-fat mayonnaise, or 1 teaspoon regular mayonnaise

• 1 tablespoon oil-and-vinegar dressing

• 5 large olives or 7 smaller olives

• 1/8 medium avocado

• 1 pat or 1 teaspoon butter

• 1 ounce of nuts without the shell; 2 tablespoons of peanut butter

One serving of fruit is:

• 10 fresh cherries

• 2 small tangerines or clementines

• 1 cup berries

• 1 small peach, apple, or orange

• 1 medium plum or nectarine

• ½ medium-large grapefruit

• ½ cup canned fruit

• ½ cup cut melon or papaya

• ¾ cup juice

• ¼ cup dried fruit

One serving of dairy is:

• ½ cup low-fat milk

• 1 cup low-fat plain yogurt

• ½ cup lowfat ricotta or cottage cheese

Not quite convinced that you’re underestimating how much food you’re eating? How many cups of popcorn do you think there are in one medium-size container of movie popcorn? Would you be surprised to hear that it has 16 cups of popcorn, which is eight full 2-cup servings? Have you ever shared a medium popcorn with eight people? More likely, you’ve eaten a whole bag yourself (I have)!

How about that prime rib and baked potato dinner out? The typical restaurant gives you 13 ounces of prime rib, or more than four servings of beef. And the large baked potato on the side? It’s equivalent to four actual potato servings. So your restaurant plate is enough to feed a family of four!

What about those giant cinnamon buns that assault us at malls and airports? One is the equivalent of four starch servings (not to mention all the extra sugar).

How to Eyeball Portions

Now that you’re more familiar with the concept of a real portion size versus portions in our supersized food culture, let’s talk about how to eyeball portions.

Finally, here are two important tips to remember about portions:

• Be careful when you’re dealing with any prepackaged foods that you assume are single servings, such as bottled juices, sweetened teas, a bag of chips, and so forth. Read the food label to see what the serving size is, then check to see the total size of the product. You may be looking at calories for a serving of juice or chips only to discover that the bottle or package you have is actually two servings.

• Whenever you can, measure out one serving and put it on a plate. Don’t put the entire box, bowl, bag, or platter on the table in front of you, or you will overestimate the serving amount. If a serving of cereal is ½ cup, take the time to measure it in a measuring cup, because until you are very good at eyeballing and are familiar with sizes, if you just shake the cereal into a bowl, you’re likely to overestimate.

OTHER ISSUES

Sweets and Treats

Generally, good health and weight loss mean that most “desserts” will need to go by the wayside. Ideally, as you retrain your taste buds and balance your blood sugar, those raging cravings for sugary, carbohydrate-rich treats will diminish. When you must have a treat or dessert, try a small bowl of berries, a piece of low-glycemic fruit, a yogurt parfait, or a small piece of good-quality dark chocolate. Eat your treat slowly, and savor every bite.

Snacks

Ideally, you’ll want to focus your approach more toward three meals a day, and eliminate frequent snacking, But when you do need to snack, avoid processed carbohydrates and typical snack foods—chips, popcorn, and so on—and instead reach for some of the following foods, which are primarily protein and good fat:

• Low-fat cottage cheese

• Celery with cream cheese or nut butter

• Hard-boiled eggs

• Seeds

• Guacamole

• A handful of nuts

• A handful of olives and a small piece of cheese

Coffee and Tea

Coffee, to be honest, is a huge question mark. Some studies have shown that coffee may help with blood sugar and therefore potentially aid in weight loss. Recent studies comparing coffee and caffeinated water found that both drinks had positive effects on insulin sensitivity and fatty liver. One study also found that while drinking caffeinated water lowered “leptin expression in adipose tissue,” coffee was not found to have the same effect. Researchers are looking into this discrepancy.

A number of recent studies have shown specifically that consumption of coffee may help reduce the risk of developing type 2 diabetes. It’s now thought that coffee may function as an antioxidant and anti-inflammatory as well.

Regular coffee also contains caffeine, which is proven to raise metabolism.

At the same time, in people with diabetes, coffee can sometimes cause a short-term increase in blood sugar levels, and some dieters may find that reducing coffee intake or even eliminating coffee may actually help with weight loss.

Nutritionist Marc David says that people who drink coffee regularly should know that coffee can actually mimic the body’s own stress response and cause abdominal weight gain. In his book The Slow Down Diet, David says:

This doesn’t mean coffee is bad. It just means that when you combine lack of food (survival response—elevated cortisol), anxiety (stress response—elevated cortisol), and caffeine (mimics stress response—elevated cortisol), you have three factors that powerfully synergize to send cortisol production through the roof, suppressing digestive metabolism and depositing weight.

My advice? Coffee puts additional stress on what is usually already an overtaxed adrenal system, and I’ve heard so many anecdotal reports from thyroid dieters—myself included—who simply don’t lose weight when we overdose on coffee daily. I think a normal-size cup or two (and no, a cup is not a 32-ounce mug, or a venti triple espresso) is probably manageable, but pay close attention to how you feel after you’ve had a cup of coffee. If you later feel shaky, jittery, or hungry, that’s your sign to cut back on coffee or cut it out entirely.

As for tea, if you’re a heavy tea drinker, you may want to watch your intake of black tea. One study has found that the high concentration of fluoride in black tea may be a thyroid risk for those who drink more than 3 or 4 cups of black tea daily. (Note to southerners: that includes iced tea as well!)

At the same time, research suggests that green tea may aid in weight loss. One study found that green tea resulted in a significant increase in energy expenditure—known as thermogenesis—plus also had a significant effect on fat oxidation. Specifically, people who drink 5 cups of green tea a day typically burn 80 more calories over a twenty-four-hour period. The component responsible for the increased fat-burning is epigallocatechin gallate (EGCG), which is also a potent anti-inflammatory compound.

Oolong and white tea have also been the subjects of studies, some of which have found that these types of tea may help prevent fat accumulation and stimulate fat burning.

If you’re a tea drinker, you may want to think about switching from black tea to green, oolong, or white tea.

Sweeteners

Should you use sweeteners on your diet? Ideally, your best choice would be to avoid all sweeteners—nutritive and non-nutritive—entirely, or as much as possible. A nutritive sweetener has 4 calories per gram and provides energy like other simple carbohydrates. Nutritive sweeteners include white and brown table sugar, molasses, honey, maple syrup, agave, and corn syrup. Sugar alcohols are also nutritive. These are derived from fruits or produced commercially and include sorbitol, mannitol, xylitol, and maltitol.

Generally, you’ll want to avoid sugar products—including honey and agave—as much as you can. As far as sugar alcohols, some experts suggest that these are metabolized somewhat more slowly than straight glucose-based sugars, but they can still affect your blood sugar, and may cause abdominal discomfort in some people.

As for artificial low- or no-calorie (non-nutritive) sweeteners, including those in diet sodas, we now know that they may actually sabotage your efforts to lose weight. There is still ongoing controversy over the safety of the various artificial sweeteners, including saccharine (Sweet’n Low), aspartame (NutraSweet, Equal), and sucralose (Splenda), however, because of alleged relationships with cancer, neurological problems, and other symptoms including headaches, nausea, insomnia, dizziness, diarrhea, depression, anxiety, memory loss, and even vision changes.

Purdue University’s Ingestive Behavior Research Center did animal studies showing that eating yogurt sweetened with saccharin caused more calorie consumption, weight gain, and later gain of body fat than eating yogurt sweetened with plain sugar. It seems counterintuitive, but if you look at the idea behind it, it makes sense. Sweet foods provide a very specific stimulus that causes digestive reflexes to prepare for the intake of higher calories, including an increase in metabolism and raised body temperature. But when an artificial sweetener is used, the taste of sweetness is “false,” meaning that it isn’t followed by a higher-calorie food. When this happens, the system gets confused. Over time, this leads to a blunted response to any sweet-tasting calories. So even after eating a sweet-tasting, high-calorie meal that does not use artificial sweeteners, the blunted digestive reflexes don’t kick in, metabolism doesn’t increase, and body temperature does not change, which translates to impaired fat burning and more weight gain. Basically, artificial sweeteners train your body to overconsume refined carbohydrates.

The more you get blood sugar under control, the less you will likely crave sweet foods and drinks. Ideally, you should focus on retraining your taste buds away from sweet foods, even those that are artificially sweetened. But if you do occasionally need a sweetener, what should you use? For the occasional cup of coffee, some experts suggest that you use an actual teaspoon of a nutritive sweetener such as sugar, so that the body does not become acclimated to the idea that sweet tastes are associated with low or no-calorie foods and beverages. As for the artificial sweeteners, almost every natural health expert I know recommends that you stay away from aspartame. They are less adamant about saccharine and sucralose, and very occasional use of these products is probably not a problem for you. Some experts feel that sugar alcohols are a good choice. Personally, I get stomach upset from all of them, including xylitol, so I avoid them. Many healthy eating proponents are suggesting that for occasional use, stevia may in fact be the safest no-calorie sweetener.

Stevia has no calories and is not a carbohydrate. It comes from a plant native to Paraguay. I use a little bit in my tea or coffee. Stevia is versatile and can be used in hot and cold beverages, on fruit and cereals, and as a sugar replacement in baking and cooking. I also occasionally use stevia to naturally sweeten plain yogurt. If you take plain low-fat or fat-free yogurt and mix in fruit and some stevia, you have healthy, low-fat fruit yogurt without a chemical sweetener.

With stevia, just like when you first switch to any sweetener besides sugar, it takes a few days to adjust to the flavor. But once you’re used to it, it tastes fine and satisfies your sweet cravings. You may want to carry single-serving packets of powdered stevia to work, to restaurants, and when you travel.

For the most part, experts have concluded that stevia and the derivatives of stevia are safe. The World Health Organization conducted a thorough evaluation of all the research and said that stevia shows no evidence of being a cancer risk. Other studies show that stevia may improve insulin sensitivity and lower blood pressure.

Fruit and Fructose

One of the reasons you won’t find recommendations in The Thyroid Diet Revolution to eat many servings of fruit each day is that fruit is high in fructose, a type of sugar that is easily and quickly converted into body fat. High-fructose corn syrup—made up of half glucose and half fructose—is even more problematic, and is a key ingredient in many processed and fast foods.

Recent studies have shown that the liver is less able to prevent fructose (as compared to glucose) from being converted to fat. In one study, individuals had to drink a breakfast drink that was 100 percent glucose, then in another test a drink that was half glucose and half fructose, and in a third test a drink of 25 percent glucose and 75 percent fructose. The research showed that lipogenesis, the process by which sugars are turned into body fat, increased substantially at the point when even half the glucose was replaced with fructose. Interestingly, even if the fructose was given at breakfast, the body still stored fat more easily as late as lunchtime.

If you want to minimize fructose, there’s one key thing to do: if you see high-fructose corn syrup listed as a packaged food’s ingredient, cut that item out of your diet completely. You will also want to eliminate processed and packaged foods that list crystalline fructose, honey, or sorbitol as key ingredients.

Don’t forget drinks—commercial drinks are loaded with high-fructose corn syrup. You’ll find it in sodas, fruit juices, sports drinks, lemonade, iced tea, and almost every sweet drink on the market. Apple juice, apple cider, and pear juice are made from higher-fructose fruits, so you may want to limit them or avoid them entirely. Also watch your intake of pears, cherries, peaches, plums, grapes, dates, prunes, and apples, as these fruits are higher in fructose.

Alcohol

Alcohol is empty calories, and whether it’s a part of your diet plan is going to be up to you. If you do choose to drink, the heart-healthiest option is a glass of red wine. And make it a point to avoid liqueurs, cordials, and frozen restaurant drinks—such as margaritas—which can have hundreds of calories a glass and sometimes are loaded with sugar. Alcohol may slow or even stall your weight-loss effort, so if you think you are doing everything right but you’re still not losing weight, try even a week or two without any alcohol and see if it gets the scale moving again.