One Mom reads Eat to Live by Joel Fuhrman

Published October 12, 2012; reformatted 4.7.2013
I'd heard of Fuhrman and his book, Eat to Live but had never read it. So I borrowed the ebook from the library it to take look. What follows is based on my thoughts and observations as I read the book. It's mostly a series of notes.

Fuhrman has appeared on PBS fundraisers periodically, hawking his way of life. The forward is written by Mehmet Oz, which, for some, will automatically disqualify it. I have the book You, on a Diet, which Oz helped write and which my daughter and I found useful, for what it's worth. That noted, on we press.

My pre-reading impressions are that it's an all but vegan diet, low fat, low protein and lots of fruits and vegetables. At base, I have no problem with that concept. While not a fatphobe I don't add extra fat just to "meet some macro" and while I eat meat, I am tending to eat less protein overall. I do eat lots of fruits and vegetables.

The book begins.

I'm not going to go by chapters, and since I'm reading an epub version on my computer there won't be any page numbers. What follows are based on notes made while reading. The book is readily available (I borrowed it from the library) and Fuhrman has several websites, so there is no need for me to rewrite the book. These are impressions only and things that occurred to me as I read.

The backbone of his philosophy is the formula health = nutrients/calories or H=N/C. The idea is to eat nutrient dense foods. His pitch is that if you do this you can eat more (volume) food and never be hungry.

He advocates larger portions of lower calorie foods (so the energy balance is still in force here).

Or maybe it's not. He goes on to say in Chapter 1 it's not how much you eat, it's what you eat. That might be true for nutrition, but weight is the energy balance or CICO. Yeah, genes play a part, I'm never going to be rail thin. But I'm a normal BMI, and that range is large enough that MOST people could be as well. But not and make 3 trips to the all you can eat buffet.

Fuhrman's saying that eating large amounts of the right foods won't matter- but that is still a calorie argument. You can eat veggies all day and have fewer calories than if you had big macs all day.

He points to the Bogalusa Heart study circa 1992 (the same study that HBO's Weight of the Nation referenced extensively) for some of his "proof". Fuhrman was not part of that HBO's presentation, as I recall.

Fuhrman uses Bogalusa to show that we are killing our kids with fast food and refined carb fats. None of this is surprising (meaning that it is not surprising that he would say that).

Anyway, he points to autopsy evidence that is showing the kids and young adults already have fatty streaks and fibrous plaques in their arteries. (There are footnotes, where the references are listed. He claims there are over 2000 references listed throughout the book, and that he's read even more articles in writing the book.)

He claims that leaner people live longer (after controlling for smoking— ie looking at nonsmokers) He's not on the same page as Freedhoff. He says the optimal weight is 10% below the standard weight tables. In other words, he's close to CRON (calorie restriction optimal nutrition) territory.

Whoa. According to Fuhrman, at my height, I should be 95 lbs. I'm almost 30 lbs overweight by that standard, and have spent the last 30 years being more than 50 lbs overweight. He gives only 4 lbs per each additional inch, so E would be about 107 on his scale. As a dancer, she is much closer to his ideal. For men he says 105 for 5 feet, then 5 lbs per inch, or 60 pounds for a foot, so K should weigh 165 by that score.

That's fairly extreme.

CRON

Ah, but then he goes into CRON and lifespan extension. Anybody on CRON can't be fussed about low metabolism resulting from low calorie intake because it's a feature of the lifestyle.

Romaine lettuce a nutrient rich plant according to Fuhrman. This isn't what I understood. But a quick Google visit shows him to be correct. To be clear it is based on nutrient per calorie, and romaine has very few calories.

Fuhrman is NOT a fan of portion control or weighing food. He's all about the volume of food. Eat less calorically dense food and you can eat more of them for the calories. I don't disagree... I just include that as part of counting calories. It's a matter of semantics.

I agree with his argument that trying to look at nutrient per weight can be confusing, and I agree that the food providers want it to be confusing. As noted above, nutrient per calorie is how he likes to think of it. This makes me wonder about the liver comparisons paleo writers are always going on about.

The so-called "Kraken" scale put liver on top. Kale was in the top 10, but it wasn't number one. I don't know how the scale was put together. And I can't find out by googling, apparently the "Kraken" (Mat Lalonde- I have NO idea what that nickname is meant to suggest) has not yet published it, though he did present it at the ancestral health society conference.

The greater paleo community (which is mostly big meat eaters and otherwise low carbers) are looking for it to be a counter point to Fuhrman's nutrient density line. Actually, upon further googling, (and though his does not present it in this book) it is the Fuhrman's ANDI scale they are fighting against the Aggregate Nutrient Density Index. Whole Foods has adopted it, and it aims to show people that the most nutrient dense foods are plants.

Fuhrman pegs the increase in cancer and heart disease directly to the consumption of animal products-- or at least to the increased consumption of animal products that followed the creation of the "4-square meal" which emphasized meat and dairy in positions one and two.

He didn't like the MyPyramid remake of the dietary guidelines either (not many did). He didn't like it because meat and dairy still had a prominent position (meat and dairy industries are huge in the US, and obviously they wanted a voice in making the decision.) Actually, it was the grain people who scored the big win with MyPyramid.

Fuhrman says the base of the pyramid should be vegetables. Then finally he says it. Your diet should be 90% (of calories) from unrefined PLANT foods. That leaves very little room for animal foods. Oils are plant foods-- but they are refined, so that would be included in the 10%. So his is a VERY low fat, low protein diet.

And now I'm waiting to read about B12.

The Dark Side of Protein

So Now I'm to chapter 4, the dark side of animal protein. Which should be interesting after the summer's meat-fest (which I still need to write up) to which I listened that was presented by Sean Croxton.

He's going to tout the China Project (which gets regularly trashed by "paleos" because of all the confounders in the data). But at least the China Study released their data so that others could study it. Most others do not.

Fuhrman points to the China Study as showing that where animal food consumption was lowest, caner rates and heart disease were lower. I don't know about the cancer, but the heart disease data was definitely disputed by meat lovers. He also points to many other studies that show that eating more plant food is best for health-- EVEN if you also eat some meat. Veganism is not required to gain the advantage.

The easiest change he's suggested so far is to eat more romaine lettuce salads. I LIKE salads, but was under the mistaken impression that I was not getting good nutrients from lettuce. So. Romaine goes on the Costco list again...

Then he talks about the "Protein Myth" and seems to equate rapid growth (populations that eat protein tend to be taller and larger than those that don't) with more rapid aging. IGF-1, which is something in meat that was mentioned in the BBC Horizon program on 5:2 fasting diet regime (which I wrote about here) also— speeds up tumor growth and is a topic I need to further research.

It's interesting (to me at least) that Fuhrman says to limit protein, and so lately do the low carbers (LCers), in their case because protein can be used to produce glucose (which is what the body prefers to run on). A huge difference of course is that the LCers make up the difference in fat (even drinking oils if need be to get to the desire amount) rather than eating vegetables. Because carbs, protein and fat are the 3 macro options. If you're going to limit 1, then you have to eat more of the other 2. And if you're going to limit 2 (the current LC (and LP) thus HF or low carb high fat diets some follow) then you have to eat more of the third macro.

I GENUINELY don't get the high fat diets. Fat is the easiest macro for the body to store, because it doesn't have to do anything to it. Excess Carbs and protein (beyond what's needed for function) eventually get stored as fat. But fat starts it's journey as fat, and stays that way. The thinking seems to be that if only fat is present, the body will live off the fat, including the fat in fat cells (adipocytes). But to me it just sounds ghastly.

Back to the book:

So faster growth = faster aging. Faster metabolism = faster aging (Fuhrman is not talking about anorexia, he mentioned that explicitly earlier when talking about CR. Anorexia is a neurological disorder that has CR as a symptom. )

Fuhrman quotes studies that show faster growth in puberty leads to cancer and other disease later in life:

• Excluding malnutrition or serious disease, the slower we grow and mature, the longer we live.
• The BBC's 5:2 show mentioned that lowering protein intake was a good way to slow the effects of aging. So he lists some studies that link meat consumption to cancer, but does note that cancer is complicated and multifactorial.
• Other points on cancer:< Exercise reduces cancer risk. (We can hope!)
• Breast cancer is the first one listed. (Once again, the most powerful advice is "Don't get fat." )

His list of dietary factors that induce Ca loss:

• Animal protein (obviously, that's what the chapter is about) My intake has actually increased with time, but is slowly decreasing again.
• Salt In our case, we eat a low salt diet
• Caffeine I think my intake is moderate, could be less
• Refined sugar again, moderate
• Alcohol My personal has lessened with age, but I am no teetotaler.
• Nicotine Never did, never would.
• Al containing antacids Never
• Drugs (steroids, thyroid hormone) Never
• Vitamin A supplement Almost never (exceptions are multivitamins I took when pregnant, and for awhile in my 20s before I swore off horse pill sized vitamins)

Other facts he notes include:

• The effect of animal foods is to produce a heavy acid load in the blood, and so the body releases Ca from the bones to neutralize this effect. Vegetable protein doesn't do that.
• A study in 1992 showed that hip fractures are highest in countries with high animal protein ingestion.
• Fruits and vegetables can help buffer the acid load and reduce Ca loss. So eat your veggies! (This is part of the paleo diet too.)
• He claims eskimos (who are much vaunted by paleo dieters) Inuit have the highest hip fracture rate in the world because they eat so much protein. And he provides a reference, which I didn't copy down before returning the book.
• No surprise, Fuhrman says the best food for bones is fruits and vegetables. And he says that you need less Ca if you limit animal protein, salt, sugar and caffeine. He's not anti-supplement and allows that they will help get Ca into you.
• Greens are most important for bone health. For Vitamin D he says a supplement is best. Or go outside for a bit. But in northern climates that isn't gonna cut it, so supplement (which are usually animal products. I don't think he's all but vegan for moral reasons, it's for health).

Dairy

• He then goes into the associations with milk and cancer. Actually he's conflating milk and dairy (by which I mean he's not giving cheese a pass, or at least hasn't yet.) Cheese and butter are high in saturated fat, and he's not a saturated fat fan.
• Cheese, Fuhrman says, induces an acid load, which increases Ca loss further. That is also part of Paleo Guru Loren Cordain's brief against it. Fuhrman claims cheese is a major source of dioxin exposure too (I've never heard that one, another topic to research). Dairy also increases the IGF-1 in the blood. (Cordain mentions IGF-1 as well.)
• Romaine is a source of Ca too, and is almost as good as kale, and much better than broccoli. Not as good as collards though. Bok Choy is the best source he lists. Obviously my osteoporosis (and lactose intolerance) makes this section of interest to me.

I think that's the end of the "why our diet is killing us stuff" (I think he said that would be chapters 1-4)

Calorie Density vs Nutrient Density

• So the focus is UNrefined carbohydrates. His macro breakdown within plants is not what I understood it to be. Greens he says are 50% protein, 25% carbs and 25% fat. Legumes and beans are 50% carbs, 25% protein and 25% fat.
• He's not a big macronutrient (macro) guy though, basically saying don't worry about it. Just make your diet 90% plant. 90% based on what though? Volume? I'm guessing not. I'm guessing it's total calories. Which means VERY little meat or fat.
• The big issue is that everything (or most things) needs to be unrefined. Which of course, guarantees a lot of fiber.
• Now we're getting to the calorie density argument. Meats, dairy and oil are dense in calories. Which means you can't eat too many of them before blowing through your calorie numbers.
• He claims that 100 calories of ingested fat can be converted to 97 calories of body fat. So fat is stored easily, which is how I understood it and why people (except for high fat LCers) tend to say to limit it when you're losing weight.
• Bulk means fewer calories-- which is a volumetric argument, and only works if you'll actually eat the vegetables and fruit. It takes 23% of the carb energy ingested to turn it into glucose.
• This is absolutely a volume argument. Fill your stomach with high fiber low calorie foods, and you'll eat fewer calories. Fill your stomach with higher calorie meat and fat, and you automatically have higher calorie amounts. And even if you get hungry later, you can do the whole thing again, and still be ahead of the game.

So his "rule of thumb" is 1 pound raw and 1 pound cooked (by which he means steamed) vegetables a day.

And he allows that might be too much for some, but it's a goal to work towards. So that's not quite a kilogram of veggies a day.

On the other had, it doesn't sound all that crazy, if you actually know anything about vegetables and how much they weigh. I'm thinking of the tomatoes I bought where 2 weighed over a pound. Cucumbers and onions also are heavy. So this amount might not be that big a deal. And tomatoes, cucumbers and onions have very few calories.

Nutrient Density

Next he talks about a Nutrient-density line (this is what "the Kraken" scale was supposed to be answering). He provides an example list of foods.

First animal product that makes the list is fish at 18. Dark leafy vegetables score 100 (kale, chard etc). Romaine scores a 95. Candy scores 0, and red meat scores a 6.

The food examples noted are just to give an idea of his presentation.

The bottom line is eating any fruit and vegetable is better on this scale than eating ANY animal product.

And hence I now understand the paleos fixation on nutrient density. They are trying to thwart (answer) Fuhrman. And I guess Terry Wahls, who did more to get me to eat a ton of kale than anyone else. And for a paleo follower (which Wahls claims to be), she spoke of eating very little meat. Mostly bone broth and organs. Furhman doesn't mention organ meats, probably because few eat them anyway.

So next Fuhrman talks about how animal foods fail the nutrient/weight scale that he created, especially for the anti-cancer nutrients. So obviously, the "Kraken" must have altered the formula somehow— or rejiggered what was being considered. Paleos are big on "essential fats" which the book has not covered yet.

Essential Fats

But wait, the next section is called "Fats are Essential." Fuhrman says that eating too little fat is a problem too. It's PUFA time! PUFA means polyunsaturated fats.

• Essential fatty acids are ones the body can't make. The body needs them for cell membranes and hormone production. They also help prevent disease. The two he mentions Linoleic acid (omega-6) and alpha-linolenic acid (omega 3)
• The body makes other fats from these two. The numbers 3 and 6 have to do with where the double bond is along the carbon chain. Fuhrman talks about the optimal balance between these 2 acids (paleo diet sites do too). High levels of Omega 6 means high production of arachidonic acid, which promotes inflammation that root of all bodily evil. O3 produces DHA (that acronym is undefined in the chapter.)
• So it's the ratio of O6:O3 that matters. Fuhrman says to consumer 1 to 2 grams of O3 a day. His sources of O3 are all plant: flaxseeds, walnuts, edamame, tofu.
• Animal products he says are a big source of O6 That's a problem for heavy on the meat paleos. Except they point to the refined crap and industrial oils as the primary O6 source. This is why there is a big "grass fed" push among paleo followers, to offset this. Grass fed animals (beef) are higher in O3, though O6 s still there.

But if you eliminate refined and processed foods (and both Fuhrman and paleo does so), then meat would be the remaining main source of O6, wouldn't it?

So then there's a graph of O6:O3 vs prevalence of type 2 diabetes. It's a straight line up as the ratio increases (more O6 in the diet), so does type 2. But that's not animal meat, that's refined crap ingestion, and higher body weight. It's a multi-factorial problem, I don't think the evidence presented is strong enough to say high O6 ingestion leads to type 2 diabetes.

Fuhrman claims that saturated fat also interferes with DHA conversion, so he's in the camp that saturated fat causes heart disease and cancer.

I think it was in the Real Food summit it was claimed that without the fat, the nutrients weren't absorbed. And I know they said that certain nutrients were only in animals. Vitamin A for one, but he already said you can over dose on vitamin A, so you should never supplement it.

Fuhrman claims the oil in fish oil pills is rancid, and tastes like gasoline, and thus stresses the liver. I have never heard that before. I do think eating food will always be better than a supplement, and it seems that every time they try to document a supplement's usefulness it falls short. But I've always been told fish oil supplements are not only safe, but supremely helpful. Not that I take any, I strive always to get my nutrients from food. The one supplement I do take was prescribed (Ca + vitamin D) for osteoporosis.

Fish oil was in the news not too long ago, because a new study suggested that O3's are not protective against heart disease or strokes (cerebrovascular events) as thought. Omega 3's interfere with clotting like aspirin and that's how it's supposed to help with heart disease. He gives more detail, but that's all I'm copying.

Points out that fish is one of the most polluted foods we eat. Yum. Fish, of course, is an excellent source of omega 3 fatty acids. So he doesn't say to avoid fats altogether, but this is definitely a low fat protocol. He doesn't like to use oil at all, and of course, animal fats aren't even an option.

Funnily enough he uses the same "If you're fat you'll be on a high fat diet as your body utilizes the excess fat in you" line that some low carbers use, though they also eat a lot of fat.

Anyway, he's big on ground flaxseeds and suggests sprinkling it on things. We used to have flax, but used it all. I guess I'll put that back on the list too.

Low fat diets and stroke

This section is an open acknowledgement that this is low fat diet. Fuhrman allows that there is evidence that animal fats are protective against stroke (because the brain is made of cholesterol). He says the data are confused and confusing (because they don't support his hypothesis?) I don't know enough to know.

• Nuts and seeds: Walnuts, peanuts, almonds and others have been show to lower total cholesterol and LDL (low density lipoproteins).
• High fat diets increases the risk of cancer, but based on his point 1, that's because they lead to obesity, which is positively correlated with cancer.
• Omega 6 fatty acids in excess is bad (but some is essential).
• Saturated and transfats are most dangerous
• You get enough fat from whole grains, nuts and seeds.

Between lean meats and cheese, he'll take lean meats. His bottom line though is: If your diet is rich in unrefined foods, then (unless you're fat) you don't need to worry about fat.

Talking protein

Fuhrman notes that plants have protein, and broccoli more per calorie than steak. The per calorie thing is important and represents the lynch pin of this eating thesis. Broccoli has a lot fewer calories per unit of weight than steak, so you need to eat a LOT more broccoli to get the same amount of protein as that in a steak. And if you're not a fan of broccoli, that could be a problem.

How much protein is needed? Current RDA (recommended daily amount) is 0.8g/kg of body weight or 44g for a 120 lb woman and 55 for a 150 lb man NOTE: in the book, there is a typo. It says .8mg/kg— but then his example numbers are for .8g/kg body weight, which is what I've seen elsewhere.) The minimum is .5g/kg (The book again says mg/kg but that's just not correct).

In the following sections Fuhrman goes through the usual, "this is great for you, but it might suck at first because you have an addiction." argument that seems to be in every diet plan. He's not a graze all day guy. He's an eat 3 meals and do NOT eat after dinner guy.

Eating all the nutrients is supposed to help your body learn when it's hungry. He notes that we do not need to eat as much as we do, but rather than calculating a target calorie count for your size, he says eat the vegetables and let your body decide how large it should be. And it will be smaller than you think on this low fat diet.

So it's not a raw, eat all day diet. He says to not count calories, instead work to maximize the nutrient density (which will leave you eating a lot of green vegetables).

He's not a fan of portion control because it usually doesn't work. Inevitably portion size increases, and the weight comes back. I obviously disagree with this-- though it's still early days for me. I think it comes down to deciding what size you want to be. But he's not wrong that you have to stick with new smaller portions. If you eat more, you will gain. Losing weight doesn't change that reality for anyone.

He's saying that if you eat the way he suggests, your body will naturally shrink to the correct size. But that would mean truly changing how you eat for life. I'm not sure even I am that dedicated. We have made many of the changes that he suggests-- though certainly we don't eat anywhere near the amount of veggies that he (or Terry Wahls) suggests is optimal.

I can get on board with the eating more vegetables as a matter of course, and I've already lowered my protein intake. Ingesting huge amounts of fat is NOT appetizing to me, so carbs has to be the answer. We eat mostly unrefined carbs, but I'm also not willing to completely give up alcohol or caffeine, or all refined carbs. I'm going to eat bread and desserts when I choose as well. All of this is written before I even get to the halfway point in the book-- but the last third is likely to be recipes (it is a diet book after all) and I think I have the gist of his argument.

• Fiber intake is a big part of his message. Most people don't get enough fiber. We don't get as much as he thinks we should have, but we get more than the average American.
• Portion control is harder with calorie dense foods, which is why we are eating more veggies. That part of his plan makes sense to me.
• Then he moves on to trashing high protein (lo carb) diets. Then reiterates that animal foods cause cancer. I don't know if anyone in the paleosphere talks about cancer. They talk about weight, diabetes and heart health, but not cancer.

To sum up:

• A diet of Nutritional Excellence:
• 80+% high nutrient plant foods
• 10% animal food
• 10% = ?? treats?

He does not suggest a vegan diet, says that its long term advantage is not proven. And I guess that's how he gets around the B12 issue (which he has not mentioned) because it's not animal free.

Here's what he lists that all should do:

• large bowl of green salad daily
• large serving of steamed greens daily (how about dehydrated?)
• a cup of beans a day (does this mean cooked?)
• 1 oz of raw seeds and nuts
• 3 fresh fruits daily
• tomatoes, peppers, onions, mushrooms, herbs, and garlic daily.

Disease while aging should not be the norm per Fuhrman. Superior nutritional changes can prevent or treat many conditions. Here he sounds the same notes that paleo doctors do. Food is the cure. He notes that doctors are resistant to the idea that nutrition plays a role in most common diseases, more so he says than genetics or age.

Certainly my IBS responded to a diet change. The jury's still out on the osteoporosis. Fuhrman does claim that osteoporosis is caused by diet. (along with a host of other diseases, including appendicitis. I'm not copying the list, only the diseases of direct impact for me. Osteoporosis IS the disease I have, I'm only interested in that. FWIW psoriasis or psoriatic arthritis did not make the list, which I'm certain is not supposed to be exhaustive.)

So he talks about how the diet works and how others (especially doctors) don't believe that it works as he claims it does. But more doctors are getting interested in nutrition too.

Heart Health

The he talks about the incidence of heart attacks, which I read at Guyenet's blog have NOT declined since the 1950s instead, we have gotten better at helping people survive. People who would have died in the 1950s (and earlier) now live thanks to cardiac surgeons. This I did not know (and is not a point Fuhrman makes).

He says that the conventional guidelines from the heart association are not enough to reverse the disease (His isn't a small change, it's a fairly big one).

Okay. So he says I likely have the beginnings of atherosclerosis. Is THAT reversible? He says specifically that the Americanized low fat diet will not help. When it comes to diet changes after heart attach, he says, "Moderation kills."

Whoa.

He says the Ornish diet isn't extreme enough because it allows processed grains, salt and other low nutrient density processed foods. He points out that 30% fat (the AHA says less than or equal to 30%) is considered high fat by most of the world.

He points out that switching from red to white meat (chicken ) does not lower blood cholesterol (because of the O6?) sufficiently (but clearly it must then lower it some). And Americanized low fat diets are low in fiber, because people don't start eating more veggies, they eat "low fat" processed foods or wheat products (naturally low fat) and pat themselves on the back.

Fuhrman says lowering fat intake is not sufficient. Just lowering fat can raise triglycerides and lower HDL (perhaps this is part of the paleo argument— though a brief review while reading this suggests that for paleos it's all about 03:06 PUFAs. I'll have to dig deeper to look into the sat. fat stuff. Maybe they just think that saturated fat isn't bad as opposed to being good? I think the fat is good stuff stems from carbs are bad. Ya gotta get calories from somewhere, and too much protein can be bad for you. At least per Chris Kresser, it is all about O6 and reducing it, rather than saturated fats. So because O6 is so bad, it's better to use saturated fat. Or at least, that's my impression from that link. Pork is high in O6. Grass fed beef is supposed to have a better O6:O3 ratio, but grain fed beef (most sold) has more O6 ). But Fuhrman says the bad cholesterol effects only happen when low fat includes refined foods and not enough fiber.

I think I've read arguments that too much fiber is bad, but maybe that was regarding grains?

Anyway, Furhman says grain-based low fat diets won't cut it. Eat fruits and veggies and all will be well. Fiber does tend to fill you up. But he's adamant about the nutrient level playing a role too, not just the fiber.

Triglyceride levels drop as weight drops, low carbers see this effect too. It's an effect of losing weight.

Yes it's Extreme

Fuhrman knows what he's presenting is extreme, but he says so what, for those that want it and follow it the results are extreme— as in extremely good. He says that removing most of the artery fat (the cholesterol that causes the problem) only occurs after weight loss. The body only goes for them after the excess fat stores are are used up.

If this true, how in the hell does stuffing yourself with fat work???? This again reflects my confusion with the low carb high fat craze.

Fuhrman's standards:

Total cholesterol below 150 (This is a tough target for me with HDL at 99, but my LDL could go down a tad.) This seems to be what hunter-gatherers have.

BP 115/70 Everything above that puts you at greater risk for heart trouble. Again, this the BP they fin in hunter-gatherer (HG) societies. In societies without heart trouble, BP does not increase with age. Next topic is type 2 diabetes, but it doesn't include much I didn't know.

His discussion on hunger is interesting, because the description matched my feelings. Hunger isn't the first feelings you get, what it is is your body responding (a la Pavlov's dog) to the anticipation of a feeding. "Cravings" are NOT hunger. What I found is a lot of time the feeling passes with or without water (but that's why most diets say to drink a lot of water). I don't know about "increased sensation of need in the mouth and throat area" that he mentions, but I do know that the "ravenousness" so many dieters complain of is more mental than physical.

People simply do not need to eat as much as they do and they surely don't need to eat continuously. But the brain has to be on board with this choice, or misery results. I lost weight when I decided that I was going to eat like a human of my size should. I don't think there's anything magical about this diet. The energy balance still rules. But nothing wrong with eating more fruits and veggies in my opinion.

So then he talks about hypoglycemia (which means feeling ill when you delay eating for a while). He relates to the liver and toxins (from protein, salt, caffeine, sugar, trans fats etc.). And he points out that most Americans have never been truly hungry (which is something to celebrate, actually). Most people with hypoglycemia are told to eat high protein food every few hours, but he thinks that's the cause not the solution. Neither fat nor protein is ever going to be his answer to cure anything. For autoimmune treatment, vegan is his suggestion, mostly to avoid known allergens. Obviously as a vegan supplements are essential.

And finally the "Eat to Live" plan

He has an "induction period" like all diets that lasts 6 weeks. He divides food into those that can be eaten in unlimited quantities, limited and forbidden (at least during induction).

UNLIMITED:

• Raw vegetables. (includes salads with a tsp of oil in the dressing)
• Cooked vegetables (not starchy ones )
• Beans or legumes (1 cup per day is the goal)
• Fresh fruit, at least 4 a day

LIMITED

• Cooked starchy vegetables or whole grains - This includes squash, turnips, corn, all potatoes, bread and cereals(1 cup per day) He also suggests soaking grains overnight.
• Raw nuts and seeds (1 oz max per day)
• Avocado (2 oz max per day)
• ground flaxseeds (1 Tbsp max per day for omega 3 fats)

Do NOT eat (only for the 6 week plan):

• dairy products
• animal products
• fruit juice
  
• oils (except for a tiny bit in the salad)

All spices are okay to use, except salt. Mustard is the only condiment he likes. He's a huge fan of salads.

The Life Plan:

Here's where the 90% rule comes in (or whatever % you choose): Follow the plan 90% , the last 10% is animal and other things on the "no" list, such as cheese, eggs or fish.

His "average" calorie count for the average woman (who is taller than me) is 1600-- that's LESS than what I need to eat by Hall and Chow, though perhaps not if I'm sedentary. It's at this point that CRON starts to be brought to me mind (Calorie Restriction Optimal Nutrient). For men, he says the average calorie count is 2300.

The Life plan basically means you commit to maximizing the nutrient value of your food. I do think there's value here, especially if you aren't too doctrinaire about it.

So at 1600 cals per day, that 150 cals of that total can be low nutrient, which isn't a lot of beef or cheese. If I were to try this plan, I might shoot for 70% adherence at first. Actually, Furhman says that 60% adherence is probably enough to make a difference. He does then allow that if you exercise, you get more calories of all types.

Fuhrman has his own pyramid with veggies on the bottom. He's not big on grains though he doesn't forbid them. Then as expected we get into meal plans and recipes.

The recipes are mostly vegetarian and don't look too bad, but I don't need recipes, really. I know how to cook vegetables, I just need to recommit to making sure the meal is based around the veg, not the meat.

The Bottom Line

All in all, for a diet book, not bad. Many won't like the low protein and low fat part of it, but it's hard to argue with the admonition to eat more veggies. And it's also hard to argue that you won't be eating a greater volume of food, but less calories.

And I'm sure Jimmy Moore's head did almost explode (he reviewed the book at his website)— though in the comments of that post he admits he never tried Fuhrman's plan. Moore did the Americanized low fat plan and hated it. Meaning he didn't eat a ton of nutrient filled veggies.

A chacun son gout.

Final thoughts

So there's a FAQ at the end, in which he does recommend a B12 supplement, along with vitamin D, zinc and iodine. and Omega 3. Except for the D and B12, this seems at odds with the rest of his thesis that his diet is so fabulously filled with nutrients. Iodized salt is where most people get theirs and since he doesn't like to use salt in the diet he assumes that people will need to supplement. He doesn't talk about what the zinc (Zn) needs to be supplemented. Elsewhere I have learned that zinc is mostly found in animal products.

Fuhrman says it's not clear if vegetarian is better than small amount of meat, reiterates, vegetables are the focus.

On his diet, you don't need to drink tons of water if you don't prefer it. The H=N/C formula doesn't change, though not everyone can eat the same. He ;lso notes that the plan is too calorie restricted and too fat restricted for athletes and kids-- which is another refreshing change from most diet books.

Fuhrman also discusses hunter-gatherer diets. He notes people ate whatever was available. Some ate meat, some ate plants. He points to Katharine Milton at UC Berkeley. Her conclusion is that most primitive peoples eat plants. Boyd Beaton presented that too at AHS recently, and also offers a plant heavy paleo aproach, I think.

Most primitive people don't eat high fat foods like cheese and oil, and refined grains. Fuhrman's okay with edamame and tofu, but no other processed soy, such as soy milk or cheese.

Fuhrman says use no salt, which is a nonstarter for me. I don't add much, but some is necessary in my view. I do however agree with his point that the palate adjusts after the diet is changed. Most processed food tastes salty to me now.

On coffee he says 1 cup per day. Here again, meh. I might cut it back to 1 mug a day, but I enjoy it, and I'll include it my 10%, thanks. He doesn't like alcohol either, but he says 1 drink a day if you must.

Just to (finally) end these notes, all in all neither as extreme or as impossibly difficult to implement as I expected. Granted, if you're the type that has to be a pound of steak at dinner to feel like you've had a meal, this would have no interest for you. But I find it hard to condemn a diet plan that in essence says, eat real food, not too much, mostly plants.

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