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My favorite diet

Take a look at Dr. Nagler’s Favorite Diet under the Diets tab.  It’s the best  way for most patients lose 10 pounds their first week.

The ideal protein to carbohydrate ratio per meal for maintenance

In general, the more protein you eat at a meal, the better you feel and the more energy you have throughout the day.  But most patients also need to eat a certain amount of carbohydrate at each meal in order to feel at their best.  In general, most patients start out eating too much carbohydrate and not enough protein.  My usual recommendation is that patients should not eat meals of protein only (except for 500 calorie a day, protein only, very rapid weight loss periods), as most feel best eating a certain amount of carbohydrate.  My usual recommendation is to halve the amount of carbohydrate and double the amount of protein in the average American serving.  For example, when eating a sandwich, double the amount of protein and don’t eat the top slice of bread.  

Advanced eating windows and eating every other day

The best and fastest way to lose weight is to eat up to 500 calories a day of canned or pouched fish, seafood or poultry only, eaten during a 2-4 hour window.  Don’t eat anything else and do this for as long as you can.  2 hour windows work better than 4 hour windows (you will be less hungry and have more energy, especially the next day), but 4 hour windows work.  When you can’t do up to 500 calories a day of protein only anymore (most patients can do this for 1-4 weeks, until it’s just too hard to do), switch to every other day dieting, but keep the window.  One day (during your 2-4 hour window) eat what you want, and don’t be crazy.  Try to eat 80-160 grams of protein during your window, best from fat-free Greek yogurt, fat-free or 1% or 2% cottage cheese or egg whites or Egg beaters.  Don’t go over 160 grams of protein in your window, but the more protein you eat the better you will feel and the less hungry you will be throughout the day.   The next day, stay in a 2-4 hour window and go back to up to 500 calories of canned or pouched protein only.  The reasons to limit your fish, shellfish and poultry to cans and pouches only is portion control.  It is essential to limit your total calories of protein to no more than 500 a day.

The best weight loss – eating windows and eating every other day 

By combining eating windows and eating every other day, you get the best weight loss.  Limit your eating to a 2-4 hour window every day and you will be far less hungry.   2 hour eating windows works better than 4 hour eating windows, but 4 hour windows are easier to do.  Limit your calories to 500 calories (also in a 2-4 hour window) every other day and you can also really speed up your weight loss.   Most patients eat what they want (within reason) during their 2-4 hour window and lose 2-3 pounds a week.  The more low calorie protein you eat during your window, the less hungry you will be and the better you will feel throughout your day.  The best sources of low calorie protein are fat-free or 1% or 2% cottage cheese, fat-free Greek yogurt, eggwhites or Eggbeaters, seafood (crab, shrimp, lobster, clams, oysters), canned or pouched fish (tuna, salmon, sardines), and canned or pouched poultry (chicken, turkey).  Cans and pouches make it easier to control calories and portion size.

The advantage of eating windows

The advantage of eating windows is that many patients are able to lose 2-3 pounds a week and eat whatever they want (within reason) during a 2 hour eating window each day.  The more sugar you eat, the worse you are going to feel, but you know that.  If a 2 hour eating window is too hard to do, try a 4 hour eating window.  If you find yourself in a social situation where you must eat, make the social situation your eating window or order a vegetable only salad without dressing and treat the food like a prop.

Eating windows AND eating every other day

Eating windows make it easier for many patients to lose weight.  By doing all of their eating for a day in a 2 hour or a 4 hour window (2 hour windows work better than 4 hour windows), many patients steadily lose weight.  The advantage of eating windows is that most patients are far less hungry the day after a 2 hour eating window.  During their 2 hour window, patients generally eat what they want, without going crazy.  Protein intake of 80-160 grams during the eating window makes most patients feel better and do better as they are far less hungry throughout the day.   For some patients, 2 hour eating windows are much easier than traditional intermittent fasting (eating 500 calories one day and eating freely (within reason) the next).  Extremely motivated patients combine both of these approaches with spectacular results.  The strategy is to eat 500 calories one day in a 2 hour eating window, and freely feed the next day (within reason) also in a 2 hour eating window. 

2 hour eating windows to lose weight – 4 hour windows to maintain

Many patients expand their eating window from 2 to 4 hours when they want to stop losing weight.   The advantage of 2 or 4 hour eating windows is how not hungry patients feel the following day.   By continuing to follow eating windows for maintenance, patients continue to take advantage  of experiencing very little hunger.  But expanding eating windows to 6-8 hours causes most patients to lose the lack of hunger the following day.

What to eat in social situations when intermittent fasting?

The easiest thing to order in a restaurant if you feel you need to order food to be polite is a side or dinner salad.  No dressing, no cheese, no croutons, no nuts, no meats, no seeds, no poultry, no seafood, etc.  A side salad can have as few as 35 calories.  I say this because a whole head of iceberg lettuce is 35 calories.  You can also order a half head of iceberg lettuce for 17.5 calories.  You are always best just ordering ice tea or diet pop or ice coffee or hot tea or hot coffee instead of a salad.  Use as much artifical sweetner as you like – Equal, SweetnLow or Truvia.  No creamer in coffee or tea.

A 2 hour or a 4 hour window?

A 2 hour eating window makes you feel less hunger the following day than a 4 hour eating window, but 4 hour windows are much easier to follow for most patients.  The advange of a 4 hour eating window is that it gives you leeway to stay on track.  Let’s say that your eating window yesterday was 6pm-8pm.  But today it’s 4pm and you’re hungry.  A 4 hour window makes it perfectly okay to start eating again at 4pm and extend your eating period to 8pm.  Play with 2 hour and 4 hour windows and incorporate both in your lifestyle.

The magic of eating windows

2 hour eating windows allow many patients to stay on 500 calories of protein only for several weeks without cheating.  It is amazing how less hungry patients are the day after a 2 hour window.  There is no caloric advantage of a 2 hour eating window.  But there is a compliance and no cheating advantage.  Patients who have been stuck begin to lose weight because they are so full the day after a 2 hour window that they stop cheating.  In terms of calories, it doesn’t matter what time you eat or how many meals you eat.  It’s like going to a gas station.  You can go to a gas station once a day or you can go 4 times a day.  It makes no difference.  You can go to a gas station at 8 in the morning or at midnight.  It makes no difference.  What does make a difference is sticking to a diet and not cheating because you are hungry.  2 hour eating window effectively decrease hunger for most patients the following day.

Fastest weight loss with eating windows

Most patients experience the fastest weight loss and do best on 500 calories a day of protein only (canned or pouched poulty, fish or seafood) with a 2 hour eating window.  They are far less hungry every day and able to stay on this very restrictive regime for 1-4 weeks.  If you’ve never been able to successfully stay on 500 calories or protein only a day, try it with a 2 hour eating window.  Eat all of your food during one 2 hour period.  If 2 hours is too difficult, try a 4 hour eating window.  6-8 hour windows are not as effective for most patients.

Eating windows

A 2 hour eating window works best.  Patients are almost always far less hungry the following day when they restrict their eating to a single 2 hour period a day.  This is true for both eating days and fasting days.  It makes sense from an evolutionary standpoint.  3 square meals a day did not exist for most of human evolution.  Human beings ate when we were able to find food and the body adapted to this schedule.  Homo sapiens have been on the planet for 600,000 years.  We have only been farming and eating 3 squares for less 10,000.   If you can’t do a 2 hour window, try a 4 hour window.  6-8 hour windows are nowhere near as effective in decreasing hunger the following day.

Timing is important

Most patients do most of their damage the same 2 hours every day.   Figure out when you are in trouble and schedule a 2 hour eating window during the period.  I continue to be amazed at how less hungry patients are the following day after a 2 hour window eating day.  It is contrary to common practice to limit eating to only a 2 hour period a day.  But many patients on intermittent fasting feel so much better with eating windows they never go back to traditional meal timing.  For social occassions and restaurant eating they order vegetable salads without nuts, cheese, croutons or oil which are usually 25-50 calories.

More on eating windows

Eating windows (limit your eating to the same 2 hours every day) are an interesting way to lose weight loss because we really don’t understand how or why they work.  It may be as simple as that by limiting your eating to the same 2 hours every day you take in fewer calories.  But I think something else is going on.  Patients are almost always far less hungry the day after a 2 hour eating window.  It may be than insulin levels are lower.  I don’t know.  But patients do best with a 2 hour eating window.  If a 2 hour window is too hard to do, try a 4 hour window.  If a 4 hour window is too difficult, try a 6 hour window.  In my experience, 8 hours eating windows don’t help patients lose weight.

More on eating 2 hours a day

A 2 hour a day feeding window keeps insulin levels lower throughout the day so most patients are less hungry.  In addition to being able to do less damage in a 2 hour window than in a 16 hour window, by limiting their feeding period to 2 consecutive hours a day, many patients feel less hungry and fuller on the following diet day.  Patients are often far less hungry and do better and feel better the following diet day by eating one giant meal on their eating day instead of two, three or four smaller feedings.

Limit your eating to 2 hours a day

Another intermittent fasting option that helps some patients lose weight is to limit their eating on their feeding day to a 2 hour period.  It’s unclear why this works other than you can eat alot less food in 2 hours than in 16 hours, but limiting feeding to a 2 hour window helps many patients who are stalled lose weight.   Some patients carry this 2 hour feeding window over to their 500 calorie day as well and find that this helps too.  There may be a metabolic advantage to limiting feeding to a 2 hours window but it’s unclear exactly what the biochemical advantage is.  But limiting feed to a 2 hour window helps some patients lose weight who are not losing weight on traditional every other day intermittent fasting.

Faster but harder

Super motivated patients do one day of total fasting (the only thing allowed are sugar-free cough drops and sugar-free Jols, and at least a gallon (128 ounces) of water or calorie-free fluid) –  followed by a 500 calorie protein only day –  followed by a free feeding day that includes 1000 calories of protein.  The best protein to eat is egg whites, fat-free Greek yogurt, fat-free cottage cheese, and canned or pouched fish, seafood and poultry.  Average weight loss on this program is 3-4 pounds a week.  This approach is harder because the liver is not kept full of glycogen on a day of total fasting and a day of 500 calorie protein only, so it requires determination and will power.  The advange is that weight loss is rapid and most patients have more energy on their 2 days of protein.

Protein or carbohydrate on your fasting day?

Most patients do best on 500 calories of pure carbohydrate on their diet day to keep the liver full of glycogen and minimize binging on the following eating day.  This said, some patients do better and feel better on 500 calories of protein only.  500 calories of protein only is harder to do as liver glycogen levels decrease on your fasting day, but some patients feel better with more sustained energy.  There’s no right or wrong way to intermittently fast.  The key (and healthy thing) is not eating every other day.

More on fastest weight loss

Fastest weight loss is almost always on up to 500 calories a day of canned or pouched poultry, fish or seafood.   Cans and pouches guarantee portion control and calorie control.  The problem is that most patients cannot stay on this very restrictive Walk, Swim or Fly diet for more than 2-3 weeks or a month.  When 500 calories a day of protein only becomes too hard to do, the best solution is to add a freely feeding eating day, every other day.   Patients do best eating what they want (within reason) every other day, or eating 500 calories of protein only Monday through Friday, and eating what they want on Saturday or Sunday or both.  

If you can’t lose weight

If you can’t lose weight dieting every other day, your problem is most likely that you are eating too many calories on your eating day.  The strategy that is most effective to solve this problem for  many patients is to first eat 160 grams of protein on their eating day.  The most popular way to do this is make sure that the first thing you eat on your eating day is 1 quart of fat-free or 2% fat cottage cheese AND 1 quart of fat-free Greek yogurt.  Each quart contains 80 grams of protein and eating both quarts before eating anything else makes most patients feel so full that they are able freely feed (within reason) the rest of the day without going crazy.  Go back to eating no more than 500 calories on your diet day and you should lose 2-3 pounds a week intermittent fasting this way.

Fastest weight loss

Fastest weight loss for most patients is on up to 500 calories a day of canned or pouched protein only.  They choose from chicken, turkey, tuna, salmon, clams, mussels, sardines, shrimp, crab or lobster.   When they can’t do protein only anymore, they take the weekend off and eat what they want on Saturday and Sunday but don’t go crazy.  Then they go back on 500 calories of protein only Monday through Friday and take the weekend off again.

Another helpful strategy

Another helpful strategy for some patients is to eat 300-400 calories of protein only, once or twice a day on their diet days.  This approach takes more will power as the liver is not kept full of glycogen eating protein only, so there is increased risk of binging if you are not commited to the program.  But many patients have more energy and are better able to stick to this kind of intermittent fasting because of the protein loads.  On this approach, most patients eat their 300-400 calories of protein only, once or twice a day, Monday through Friday.  Protein is eaten once or twice a day depending on how hungry you are on a particular day.  Take the weekends off and eat what you want without going insane.  Average weight loss is 3-4 pounds a week.

SAMe helps some patients lose weight

SAMe (S-Adenosyl Methionine) is a nutritional supplement that is available over the counter from Amazon and from your local drug store or health food store.  It’s usually cheaper on Amazon when I’ve price shopped.  Two 1500mg capsules, three times a day, has an  antidepressant effect that makes it easier for some patients to stick to intermittent fasting.  Almost every other nutritional supplement available over the counter has no effect on weight loss.  But SAMe’s antidepressant lift makes it easier for some patients not to cheat.

When 500 calories a day gets too hard to do

When 500 calories a day gets too hard to do, a trick that sometimes helps is to increase your calories to 1000 on your diet day.   This increase usually still allows weight loss in the range of 1-2 pounds a week.  Another helpful tactic is to switch from the classic 500 calories of fresh fruit on your diet day to 500 calories of canned or pouched poultry or fish, once or twice a day.  It’s surprising how doubling your calories and switching from fruit to protein can help you get back on track.

An effective alternative to every other day

An effective alternative to every other day dieting that works well for motivated patients is to eat 400-600 calories of protein only (canned or pouched poultry, fish or seafood) Monday through Friday, and take the weekends off and eat whatever you want, within reason.  This Monday through Friday, weekends off approach is often good for 3-5 pounds of weight loss a week.  It takes iron will to stay on 400-600 calories for 5 days in a row, but knowing that the weekend is free is enough to keep a suprising number of patients motivated and staying on track.  Most patient eat their 400-600 calories in 1 or 2 meals.  Some patients find 4-6 100 calorie meals of protein throughout the day more satisfying.

The most common benefit besides weight loss

The most common benefit besides weight loss of every other day dieting is dramatic improvement of arthritis and allergy symptoms.  Within 2-3 weeks, most patients report significant improvement in joint pain and arthritic symptoms and a decrease in allergic rhinitis and nasal congestion.  This is because by eating fruit only every other day, allergic withdrawal occurs from foods that patients are sensitive to and chronic inflammation decreases.  

My recommendation to most patients who want to lose weight

I almost always recommend that patients lose weight as quickly as possible.  Rapid weight loss is the best way to motivate continued compliance on a very restrictive weight loss diet.  For this reason, patients are almost always started on 400-600 calories a day for as long as they can comply with this extremely restrictive regimen.  Most patients can stay on 400-600 calories a day for 1-3 weeks.  When patients can no longer do 400-600 calories a day every day, I switch their program to 400-600 calories one day followed by freely feeding (within reason) the next.  

If you want to try 2 days of fasting followed by an eating day

If you want to try 2 days of 400-600 calorie protein only fasting followed by an eating day, there are several tricks that can make this easier.  Sugar-free Jols and sugar-free cough drops can help alot.  You can eat as many as you like, within reason, all day long.  Jols are 25 calories per box and Luden’s Sugar-free Cough Drops are 6 calories each.  If you eat too many, you’ll get diarrhea.  The other thing that can help is to eat 400-600 calories of canned or pouched salmon only.  One of the fastest and most compliant protein only weight loss studies was done on patients who ate nothing but salmon for 30 days.    

Very fast and a little dangerous

This is a very fast way to lose weight, but it’s a little dangerous because it is easy to fall off the wagon and binge and sabotage your weight loss.  After you can no longer do 400-600 calories of protein only a day (most patients are good for 1-3 weeks on this fastest of all weight loss programs) – do 2-3 days of 400-600 calories of protein only followed by an eating day.  This is my variation of what is known as 5-2 intermittent fasting.  On classic 5-2,  you eat 400-600 caloriest 2 days a week and eat what you want (within reason) the other 5 days.  2-5 is faster because it’s 2-3 days of fasting twice a week.  Some patients need to keep track of 5-2 and 2-5 approaches on a calendar as it can get confusing.  2-5 dieting is also one of the hardest ways to intermittently fast, as it can take iron commitment not to binge and over do it on your eating day after 2-3 days of 400-600 calorie protein only.

Other high end weight loss options

Interestingly enough, lox (smoked salmon) only works almost as well as sashmi for the quickest weight loss, but the problem is most patients are able to do lox only for 3-4 days before they tire of it.  Sashimi only is more difficult (you have to go to a restaurant to get it, as opposed to Lox you can buy at the grocery store or Costco), but patients are often able to happily live on sashimi only for 2-3 weeks and lose a pound a day.  Another option that works almost as well as sashimi is sushi without rice, but it does not work as well as sashimi only.  You can order any kind of sushi you like and have the sushi chef prepare it without rice.  The usual way is in a small cone of nori that looks like a minature ice cream cone.  The reason that weight loss on sushi without rice if slower than sashimi only is that patients eat more sushi without rice than sashimi.  Sushi without rice it’s alot more fun but the weight loss is slower as calories are closer to 1000 calories a day than the 500 calories a day patients tend to eat on sashimi only.

High end weight loss

The most popular high end weight loss program in my office is on sashimi.  The local Kroger grocery stores prepare medium sashimi trays for $16 that contain 5 ounces of raw tuna (30 calories per ounce, 150 calories) or raw salmon (40 calories per ounce, 200 calories) with lettuce, cucumber, wasabi, ginger and avocado (don’t eat the avocado).    Patients lose about a pound a day eating 2 medium trays a day.  When this gets too hard to do, patients double their sashimi intake to 4 medium trays a day and usually continue to lose about a pound a day.  When this gets too hard to do, patients increase their sashimi intake to 2 medium trays 3 times a day and usually continue to lose 5 pound a week.

Fastest weight loss at my office

Fastest weight loss at my office is 400-600 calories of canned poultry or canned fish or canned seafood for 1-3 weeks.  Then 1-3 weeks of alternating one day of 400-600 calories of c