The Food Group You May Be Missing

When strict diets don't work

Jul 10, 2023

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Earlier this summer I saw a patient in her mid-50s who was struggling to lose weight and was experiencing significant afternoon fatigue despite her best efforts to eat more healthfully and up her regular exercise routine.

What am I doing wrong? she asked me. My metabolism seems stuck. Am I just getting old?

We reviewed her exercise routine: cycling plus strength training a few times a week. We talked about sleep, a crucial ingredient in metabolic health. No issues there. Did she feel rested in the morning? Rested enough, she reported. Did her partner report her snoring? (Sleep apnea can slow metabolism and cause fatigue.) No. What about alcohol use? Very little. She had cut back on alcohol to try to improve her energy, but it hadn’t helped.

Her physical exam was normal. Her laboratory testing showed no evidence of anemia, inflammation, organ dysfunction, vitamin deficiency, or metabolic abnormalities.

“OK,” I said, putting pen to paper. “Let’s go through a ‘day in the life’ of your eating.”

She rattled off an average workday:

Breakfast: coffee with milk, plus or minus a spinach and fruit smoothie
Mid-morning snack: maybe a granola bar
Lunch: usually nothing
Mid-afternoon snack: pretzels and a Diet Coke
Dinner: salads, pasta, and soups—plus two servings of veggies
Dessert: ice cream or cookies

It was clear that my patient’s version of “healthy eating” was decently high in fiber, vitamins and minerals—but woefully deficient in protein. It turns out that there is no amount of carrots and celery alone to keep our motor running efficiently. My patient had inadvertently jacked up her cortisol levels, lost touch with her hunger cues, and slowed her metabolism. In short, she was running on fumes.

So when she asked me, “Do you think I need to cut out the cookies or do a juice cleanse?” I replied, “Not at all!”

Sometimes we don’t need a diet to be healthy. Sometimes we just need to eat lunch.

A healthy metabolism requires tuning into hunger, meeting our metabolic needs, and experiencing fullness at regular intervals during the day. Specifically, we need regular hits of dietary protein, fiber, healthy fats, and whole grains.

Protein is like premium gasoline. It is crucial for:

satiety (the feeling of fullness)
energy
weight management
maintenance of lean muscle mass
post-exercise recovery
immune function
focus, concentration, cognitive health
mental health

So, how much daily protein does a body need?

Ideally we should consume 0.7 to 1.0 grams of protein per kilogram of body weight. (Please note the correction from pounds to kilos - my sincere apologies for this mistake!)

My patient, for example, weighs 160 pounds. That’s 73 kg. So she needs between 50 grams (73 kg x 0.7 gram/kg) and 73 grams (73 kg x 1 gram/kg) of protein per day.
To determine your daily protein intake, you can multiply your weight in pounds by 0.36, or use this online protein calculator.

Here are some excellent sources of lean dietary protein along with their approximate grams of protein per serving:

Chicken breast (skinless, boneless) - A typical boneless, skinless chicken breast usually weighs between 4 to 8 ounces. A 3 ounce (85g) breast contains around 21 grams of protein (which is less than half of the low end of my patient’s daily protein needs).
Turkey breast (skinless, boneless) - 3 ounces (85g) provides approximately 26 grams of protein.
Fish (such as salmon, tuna, or cod) - 3 ounces (85g) generally contains 20-25 grams of protein, depending on the type.
Lean beef (such as sirloin or tenderloin) - 3 ounces (85g) typically provides around 22-26 grams of protein.
Pork tenderloin - 3 ounces (85g) contains approximately 22 grams of protein.
Eggs - One large egg contains about 6 grams of protein.
Greek yogurt (plain, non-fat) - 1 cup (245g) generally provides around 20 grams of protein.
Cottage cheese (low-fat) - ½ cup (113g) contains approximately 14 grams of protein.
Tofu - ½ cup (126g) of firm tofu typically contains around 10 grams of protein.
Lentils - 1 cup (198g) of cooked lentils provides approximately 18 grams of protein.
Quinoa - 1 cup (185g) of cooked quinoa contains about 8 grams of protein.
Edamame - 1 cup (155g) of cooked edamame typically provides around 17 grams of protein.
Chickpeas - 1 cup (164g) of cooked chickpeas contains approximately 15 grams of protein.
Almonds - ¼ cup (35g) of almonds generally provides around 6 grams of protein.
Peanut butter (natural) - 2 tablespoons (32g) contains approximately 8 grams of protein.

(Note that these values are approximate and may vary slightly depending on the specific brand and preparation method.)

So I gave my patient some specific examples of meals to try (hat tip to my friend Dr. Kwadwo Kyeremanteng!):

Breakfast: oatmeal with Greek yogurt, walnuts and blueberries
Mid-morning snack: string cheese or peanut butter and apples
Lunch: a piece of fish, chicken, or lean meat with a side of green beans and brown rice
Mid-afternoon snack: carrots and hummus or a handful of almonds
Dinner: a veggie and cheese omelet with a side of rice and beans

“It’s also okay to eat dessert!” I reminded her. A healthy diet has to first be sustainable and non-punitive.

Four weeks later, she came in to see me. She reported finally feeling full after meals. Feeling full at meals meant less irritability and a deeper sleep (which also meant less Diet Coke to stay alert at work). With more sleep and less caffeine, she was having an easier time tuning into to her hunger cues and meeting her body’s metabolic needs.

Good health is about more than just eating our veggies. It is about ensuring that we are meeting our basic biological needs first. It is about having awareness of the facts, acceptance of the things we cannot change, and agency over the areas we can control.

Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.

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