The use of an ancestral elimination diet for the treatment of inflammatory arthritis: a case report

The use of an ancestral elimination diet for the treatment of inflammatory arthritis: a case report

This is a case report of a patient who experienced dramatic improvement of her inflammatory arthritis by following an ancestral or paleo elimination diet.  I've shared the details of implementation, supplementation, and the reintroduction process.  Check this out if you're interested in learning more about an approach to improving inflammatory medical conditions.

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Evidence for The Paleo Diet, and the Top 3 Myths

It’s no secret that there is an epidemic of chronic disease in the modern world.  Western nations continue to experience sharply rising rates of obesity and diabetes, while cardiovascular disease remains the leading cause of death (1, 2, 3, 4).  The public is looking for answers and many of them are looking to ancestral or ‘paleo’ diets as a way to improve their health.  However, ancestral diets are often dismissed by professional nutritionists as a ‘fad diet’ – leaving the public to turn to the internet, popular press, or lay nutritionists for advice.  Unfortunately, the guidance they find is often poor or even dangerous. 

This is a shame, considering that a well-designed, individualized ancestral diet can be an incredibly powerful healing tool.  As an example, Dr. Terry Wahls used her version of an ancestral diet to reverse her debilitating Multiple Sclerosis (10, 23).  I use ancestral diets with great success in my private practice, as a part of a broader functional and integrative approach.  Here I will share some of the research behind ancestral diets and will describe how they can be used professionally.

What are Paleo/Ancestral Diets?

For over 200,000 years, humans subsisted on a diet consisting mostly of meat, poultry, seafood, eggs, fruit, vegetables, nuts, seeds, herbs and spices.  Although there was some variation by area, there were obviously no processed foods.  Then, agriculture began around 11,000 years ago.  That is only 366 generations ago, or 0.5% of human history. (6)

The premise behind ancestral diets is that there has not been enough time or genetic pressure for humans to adapt to the foods that came with agriculture.  Examples of these ‘Neolithic’ foods include grains, industrial seed and vegetable oils, soy, processed sugar, and food additives (i.e. dyes, gums, and preservatives).  Dairy and legumes (beans) remain a grey area based on genetics, personal tolerance, and types/preparations of those foods. 

We now consume at least 70% of our energy from foods that were never consumed by our ancestors (14).  The idea behind ancestral diets is to return to eating the foods that our bodies are genetically programmed to expect.

Show Me the Data

The benefits of abandoning these Neolithic foods in favor of ancestral ones are no less than astounding.  Scientific studies have shown that ancestral diets:

  • Improve risk factors for metabolic syndrome.  Ancestral diets lower waist size, total cholesterol, LDL cholesterol, blood pressure, liver fat, and fasting blood glucose while increasing HDL.  This effect is found for a wide variety of test subjects – healthy controls, obese postmenopausal women, type II diabetics, and cardiovascular disease patients (9, 14, 16, 18)
  • Improve glucose tolerance and decrease waist size more powerfully than a Mediterranean Diet (15)
  •  Lower risk factors for cardiovascular disease – body weight, BMI, waist circumference, blood pressure, plasminogen activator inhibitor-1 (a marker of atherosclerosis) and CRP (a marker of inflammation) (12, 14, 24)
  • Improve blood glucose control and lower hemoglobin A1C in type II diabetics (12)

Amazingly, these impressive results were found in relatively short studies – 10 days to 3 months in duration. 

But I Heard that Paleo Diets….

Myth: They are overly-restrictive

Ancestral diets should be used like an elimination diet.  This is where a RD’s ability to provide individualized care is so essential.  The professional’s role is to decide if a trial may benefit the patient, then to design a personalized diet to be followed for a specific period of time.  Finally, they should guide the patient through reintroducing foods in a calculated way.  As an example of this, quality dairy foods are well-tolerated by many people of northern European ancestry.  I will often trial dairy foods of increasing lactose content after 30 days dairy-free.  The end goal is to get the patient to the broadest possible diet while maintaining their health improvements.

Also note that ancestral diets provide increased nutrient density.  The nutrient-rich foods that are added are just as (if not more) important than the foods that are removed.  Some of the original research of ancestral diets found that patients experienced remarkable health improvements just by adding traditional foods, even when they did not remove flour and refined sugar (17).  Keep in mind that to say that ancestral diets are nutrient-deficient is to say that humans went 99.5% of their history without sufficient nutrients.

 Myth: They contain way too much animal protein.

In fact, a well-balanced ancestral diet is composed of mostly plants, with a small to medium serving of high-quality meat, poultry, seafood, or eggs at most meals.  Interestingly, though, hunter-gatherers did consume 65% of their energy from animal sources on average and were relatively free from signs or symptoms of cardiovascular disease and diabetes (7, 13).  A well-planned ancestral diet usually does not increase animal protein, but does emphasize quality and nose-to-tail eating.  For example, liver is encouraged as a source of vitamins A and K, iron, copper, zinc, selenium, potassium, folate, and vitamin B-12.  Notably, these nutrients are often lacking in the modern diet (19).

Myth: They contain way too much fat and, thus, may increase risk of cardiovascular disease. 

Modern-day hunter gatherers eat fairly high-fat diets, at least as high as is currently consumed by western societies, with rare incidence of cardiovascular disease (7, 8, 13).  The amount of dietary cholesterol that they consume is similar or even higher to that of Americans (8).  It is important to understand, though, that dietary cholesterol has been shown not to have a major effect on serum cholesterol and risk of heart disease (13, 19).  In fact, dietary fat in general has been exonerated as being unhealthful for most individuals when it comes from appropriate sources and is part of an overall healthful diet (11, 22).

Hunter gatherers consumed much more omega-3 and less omega-6 fats, at a ratio of 1:2 instead of the modern ratio of 1:10 (8).  Omega-3 fats reduce inflammation, while excess intake of omega-6 fats (such as found in canola, corn, or vegetable oil) promotes inflammation and, thus, heart disease.  Traditional societies consumed only game animals, which have more mono and polyunsaturated fats and less saturated fat, as well as more omega-3 and less omega-6 fats (13). Hence, grass-fed and free range meat should be consumed if at all possible.

Traditional societies also consumed high amounts of plants, which are cardio protective.  They consumed no refined carbohydrates, which increase risk factors for cardiovascular disease (19).

Myth: They are really low in carbohydrate. 

Ancestral diets are agnostic with regard to carbohydrate, and there is massive variation among ancestral populations with regard to their carbohydrate intake.  Traditional societies remain lean with a large range of carbohydrate intake (6).  However, most ancestral populations consume high amounts of dietary fibre; some groups consume in excess of 100 grams per day (8).  On average, adults in the UK consume 18 grams per day (5).

Thus, an important feature of ancestral diets is that they support a healthy gut microbiota, which is protective against chronic disease (20). The fibre in ancestral carbohydrate sources nourish the microbiome, whereas refined grains/flour and sugar starve the microbiome and promote leptin resistance (20, 21).  Unfortunately, refined carbohydrates make up the vast majority of the carbohydrate consumption of modern societies (21).

Ancestral diet ‘beginners’ often unintentionally eat too few carbohydrates; they aren’t used to eating the amount of fruit and vegetables that is required.  Thus, professionals should ensure that carbohydrate intake is appropriate for that individual (accounting for their activity level, insulin sensitivity, gender, and age).

 Worth a Second Thought

Ancestral diets play an important role in a broader integrative and functional approach to nutrition.  They are, in fact, the original diet.  Overall, people are catching on to the fact that old paradigms do not protect them from chronic disease, and they are looking for health professionals who can help them find an effective approach.  I am happy to share more details and resources with colleagues.  You can contact me via my website: www.RealNutritionRX.com

Warm wishes, 

 

References:

1.     DiabetesInfo Facts and Figures about Diabetes. Available at: http://www.diabetes-info.co.uk/what-is-diabetes/facts-and-figures-about-diabetes.html (Accessed: 11 October 2016).

2.     Macmillan Cancer Support (2016a) Cancer statistics - evidence - Macmillan cancer support - Macmillan cancer support. Available at: http://www.macmillan.org.uk/about-us/what-we-do/evidence/cancer-statistics.html (Accessed: 11 October 2016).

3.     NHS Choices (2014) Latest obesity stats for England are alarming. Available at: http://www.nhs.uk/news/2013/02February/Pages/Latest-obesity-stats-for-England-are-alarming-reading.aspx (Accessed: 11 October 2016).

4.     NHS Choices (2016b) Coronary heart disease. Available at: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx (Accessed: 11 October 2016).

5.     NHS Choices (2016c) Why is fibre important? Available at: http://www.nhs.uk/chq/pages/1141.aspx?categoryid=51 (Accessed: 11 October 2016).

6.     Carrera-Bastos, P. and Fontes (2011a) ‘The western diet and lifestyle and diseases of civilization’, Research Reports in Clinical Cardiology, p. 15. doi: 10.2147/rrcc.s16919.

7.     Cordain, L., Eaton, S.B., Miller, J.B., Mann, N. and Hill, K. (2002) ‘The paradoxical nature of hunter-gatherer diets: Meat-based, yet non-atherogenic’, European Journal of Clinical Nutrition, 56(s1), pp. S42–S52. doi: 10.1038/sj.ejcn.1601353.

8.     Eaton, S. (2006) ‘The ancestral human diet: What was it and should it be a paradigm for contemporary nutrition?’, The Proceedings of the Nutrition Society., 65(1), pp. 1–6.

9.     Frassetto, L.A., Schloetter, M., Mietus-Synder, M., Morris, R.C. and Sebastian, A. (2009) ‘Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet’, European Journal of Clinical Nutrition, 63(8), pp. 947–955. doi: 10.1038/ejcn.2009.4.

10.   Gnuechtel, A. (2016) Next event. Available at: http://functionalforum.com/september-2016-functional-forum/ (Accessed: 6 October 2016).

11.   Hyman, M. (2016) Eat fat, get thin: Why the fat we eat is the key to sustained weight loss and vibrant health. United States: Little, Brown & Company.

12.   Jönsson, T., Granfeldt, Y., Ahrén, B., Branell, U.-C., Pålsson, G., Hansson, A., Söderström, M. and Lindeberg, S. (2009) ‘Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: A randomized cross-over pilot study’, Cardiovascular Diabetology, 8(1), p. 35. doi: 10.1186/1475-2840-8-35.

13.   Konner, M. and Eaton, S.B. (2010) ‘Paleolithic nutrition: Twenty-Five years later’, Nutrition in Clinical Practice, 25(6), pp. 594–602. doi: 10.1177/0884533610385702.

14.   Kowalski, L. and Bunko, J. (2012) ‘Evaluation of biological and clinical potential of paleolithic diet’, Rocz Panstw Zakl Hig, 63(1), pp. 9–15.

15.   Lindeberg, S., Jönsson, T., Granfeldt, Y., Borgstrand, E., Soffman, J., Sjöström, K. and Ahrén, B. (2007) ‘A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease’, Diabetologia, 50(9), pp. 1795–1807. doi: 10.1007/s00125-007-0716-y.

16.   Manheimer, E.W., van Zuuren, E.J., Fedorowicz, Z. and Pijl, H. (2015) ‘Paleolithic nutrition for metabolic syndrome: Systematic review and meta-analysis’, American Journal of Clinical Nutrition, 102(4), pp. 922–932. doi: 10.3945/ajcn.115.113613.

17.   Price, W.A. (1939) Nutrition and Physical Degeneration: A Comparison of Primative and Modern Diets and Their Effects. PB Hoeber, Incorporated.

18.   Ryberg, M., Sandberg, S., Mellberg, C., Stegle, O., Lindahl, B., Larsson, C., Hauksson, J. and Olsson, T. (2013) ‘A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women’, Journal of Internal Medicine, 274(1), pp. 67–76. doi: 10.1111/joim.12048.

19.   Scientific Report of the 2015 Dietary Guidelines Advisory Committee Part D. Ch 1: Food and nutrient Intakes (2015) Available at: http://health.gov/dietaryguidelines/2015-scientific-report/06-chapter-1/d1-2.asp (Accessed: 5 June 2016).

20.   Sonnenburg, J. and Sonnenburg, E. (2016) The good gut: Taking control of your weight, your mood, and your long-term health. United States: Penguin Books.

21.   Spreadbury, I. (2012) ‘Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity’, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, , p. 175. doi: 10.2147/dmso.s33473.

22.   Teicholz, N. (2014) The big fat surprise: Why butter, meat, and cheese belong in a healthy diet. United States: Simon & Schuster Children’s Publishing.

23.   Terry Wahls M.D. (2016) Available at: http://terrywahls.com/ (Accessed: 6 October 2016).

24.   Österdahl, M., Kocturk, T., Koochek, A. and Wändell, P.E. (2007) ‘Effects of a short-term intervention with a paleolithic diet in healthy volunteers’, European Journal of Clinical Nutrition, 62(5), pp. 682–685. doi: 10.1038/sj.ejcn.1602790.

A+ Liver Pate

A+ Liver Pate

If you look at the diets of ancestral populations, you will find one commonality – they all prize and consume organ meats or offal.  The reason is simple – this is nature’s multi-vitamin.  Liver is rich in the nutrients that most modern diets lack - vitamins A, D, E, and K, vitamin B-12, folate, iron, and copper.  If there was a true super food, this would it be it, people.  Feeling squeamish?  No worries – pate is the most appetizing and easiest way to get started with liver.  Unfortunately, most grocery stores are short on a clean option.  This recipe lays out a clean, delicious version, so that you can get that A+ rated diet.  Make sure to use a clean (organic and free-range) liver source if possible.  Enjoy!

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Gestational Diabetes - A Diet and Meal Plan

Gestational Diabetes - A Diet and Meal Plan

Diagnosed with gestational diabetes?  Conventional wisdom is unlikely to resolve it.  Learn an evidence-based, ancestral approach that will improve your blood sugar control.   This article provides a specific, sane diet and meal plan. 

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Re-Mixed Paleo Waffles

Photo credit: Erika Liu

Photo credit: Erika Liu

It’s rare, but once in a while being disorganized really pays off.  I have a grain-free waffle recipe that I’ve used for ages, and my kids love it.  One day I promised them the waffles, then reached into my fridge to find…not enough eggs.  By half - the recipe calls for six and I had three.  Fortunately, I had an extra banana.  The old recipe also called for melted coconut oil but I only had ghee.....  

So, I tried this new version and it worked out great.  However, if you are organized enough to have six eggs in your house, feel free to revert to the old version.  Remember to only use one ripe banana in that case.  It's your choice on coconut oil versus ghee.  

I have a spice blend called Cinnamon Plus that is basically pumpkin pie spice with dried orange peel added.  It tastes great in these but feel free to substitute pumpkin pie spice blend or just cinnamon.

Overall, I love how this recipe is a 'paleo' replacement of a grain food but WITHOUT a lot of grain-free flour - just 1/3 cup total, from coconut flour.  It's full of clean protein, fiber, and ancestral, beneficial fats.  There's no inflammation-promoting fat or refined flour and they taste great.  I like to top these with a little bit of nut butter, and the kids love maple syrup.  Berries are also great on top.  Experiment and enjoy!

Oh, and a big shout-out to food photographer Erika Liu!  As you can see, her pictures are gorgeous.  Thanks for the help, Erika!


Photo credit: Erika Liu

Photo credit: Erika Liu


Re-Mixed Paleo Waffles 

Hands-on time: 15 minutes / Total time: 15 minutes 

Ingredients:

  • 3 eggs
  • 2 ripe bananas, mashed
  • ½ teaspoon (2.5ml) baking powder
  • ½ teaspoon (2.5ml) sea salt
  • ½ teaspoon (2.5ml) Cinnamon Plus, pumpkin pie spice, or cinnamon
  • 1 Tablespoon (15ml) whole chia seeds (optional)
  • 1/3 cup (80 ml) coconut flour
  • 1 tsp (5ml) cinnamon
  • 4 Tbsp (60ml) ghee or coconut oil (melted)

Directions:

  1. Pre-heat your waffle iron (this recipe can also work as pancakes).
  2. Whisk the eggs in a medium bowl.
  3. Add the mashed bananas, baking powder, sea salt, coconut flour, cinnamon, and chia seeds and mix well.
  4. Add melted coconut oil and mix again.   
  5. Cook in waffle iron using ~1/3 cup batter per waffle.
  6. Serve with your topping of choice.  A few of our favorites are nut butter, pure fruit preserves, maple syrup, coconut whipped cream, pan-fried apples, or a little honey.

Did you give this recipe a try?  I'd love to hear how it went in the comments below!  You can also contact me or get more tips from the social links below.

Announcing - Fat Loss 40!

Announcing - Fat Loss 40!

Make 2016 the year you finally lose it - for good.  Easily.

Here’s what to expect:

  • Lose 5-15 lbs in 40 days
  • Better sleep
  • Better digestion
  • Clearer head – less ‘brain fog’
  • Better skin
  • Have the tools to keep losing and feeling better on your own

And here's what you get:

  • A choice of two tracks - get better results with an approach that's best for YOU.
  • Access to members-only 'Fat Loss 40' Facebook group - I'll post tips and challenges, plus answer your burning questions!
  • Weekly email with additional tips and encouragement - implement the secrets from these emails to keep losing as long as you need to!
  • ZERO risk - get a full refund within the first 10 days, no questions asked.
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The Paleo Plate

Hello, I'm super excited to share another eBook sneak peek with you today!  I call this the Paleo Plate.  It's a good starting point for following an ancestral diet.  Tons more helpful tips for making this easy will be included in the FREE eBook.  Make sure to join the newsletter to be the first to receive it! 

paleo_Plate

Ancestral Foods 101

paleo_foods_101.jpg

Sneak peek!  The first Real Nutrition RX free eBook will be released soon.  It includes a 3-step process for starting and consistently following an ancestral diet - without a ton of extra work!  This infographic is one of several that it will include.  Join the newsletter (in the margin) to get first access to this simple system for revolutionizing your health!

Want more on 'paleo pantry' basics?  Check out the following quick primer on ancestral foods.  Remember, you don't need to spend hundreds of dollars on a pantry make-over just to get started.  Here are the BASICS you need to get going, whether you're going it alone or starting a Real Nutrition RX plan:

  • Eliminate: flour

Also known as: white, wheat, cake, or self-rising flour, bran, pancake mix, bread, bread mix, cereals, and baked goods

Purchase: Coconut flour and Almond flour (start with the beige flour and not the brown meal)

  • Eliminate: refined sugar

Also known as: white sugar, brown sugar, syrup, and powdered sugar

Purchase: honey and real maple syrup

  • Eliminate: soy

Also known as: soy sauce, meat substitutes, tofu, tempeh, and soy milk

Purchase: almond and coconut milks (check ingredient labels! Avoid sugar and carrageenan), coconut aminos

  • Eliminate: industrial seed oils

Also known as: vegetable or canola oil, margarine, shortening, butter "substitute", spreads

Purchase: coconut oil, extra virgin olive oil, and grass-fed animal fat/lard

  • Eliminate: legumes

Also known as: beans, peanuts, and peanut butter

Purchase: almonds, walnuts, almond butter, and cashew butter (check for no added sugar)

  • Eliminate: dairy proteins (note - you may tolerate some forms of dairy, but I recommend starting out eliminating it, then seeing how you feel once you add it back to an ancestral diet template)

Also known as: milk, yogurt, sour cream, cream cheese, cream, and butter

Purchase: Ghee, coconut cream, coconut milk, and almond milk

And that's a good starting place!  Of course, there's more to add, and quality is an important issue - stay tuned for more details on that.  Bottom-line, you don't have to be perfect and spend a fortune to change your diet - and your health.  These are some great first steps to take.  Don't forget to join the newsletter and check out our plans for an easy, personalized way to use all your new pantry items!

The Diet Myth that Even the Experts Believe

Can I get personal with you for a minute?  I love to eat.  That's why I usually eat all day long - I guess you could call me a 'grazer'.  My snacking habit has always been totally justified in my mind - I've been an 'athlete' of some fashion for the past 18 years, and I've been pregnant and/or breast feeding for nearly 5 years continuously.  I also usually snack on healthy food.  Further, I've always been able to lose weight while still snacking.  And, finally, nutrition 'experts' often recommend snacking!  Need any evidence?

It turns out, I'm not alone with my snacking habit.  Americans have become snack-o-holics.  Americans now snack twice as often as in the 1970s, and consume nearly 1/4 of their energy from snacks (1).  They now eat for at least a 15 hour window, with most of their calories consumed after 6:00 PM (2). 

In fact, snacking is so big that you can subscribe to receive automatic, custom-picked snacks delivered right to your door! 

So, what's the problem?  Well....I'll share a personal experience with you.  The final year of my dietetics program was pretty crazy and I gained a couple (OK, five) pounds.  Yes, I see the irony there.  After graduation I endeavored to lose them with my traditional "5-6 small meals/day" approach.  The results?  Nothing!  No progress.  Hmmmm.....this got me thinking about the evidence in support of intermittent fasting for weight loss.  Studies have shown that fasting periods can be at least as effective for weight loss as a reduced-calorie diet (3). Fortunately, you don't have to go all day without eating.  Just a 12-hour fast has been shown to be effective (4).  This basically just means you don't eat between dinner and breakfast.  In fact, longer periods of fasting can actually be harmful, especially for women (5).

So, could snacking actually not be a great idea?  It turns out, there's quite a bit of evidence that it's not:

  • Obesity is linked to frequent snacking, and snacking increases total energy intake (6, 7
  • The idea that frequent eating increases metabolism and fat loss has been proved false (8, 9)
  • Frequent eating causes elevated blood glucose levels throughout the day (10)
  • Lower meal frequency improves appetite control and satiety (11)

However, other studies have shown weight loss and metabolic benefits with snacking (12).  In total, the research is mixed on the benefits of snacking.  One reason for this fact is that the quality of snacks contributes to their effect (12).  In other words, planning to eat something healthy between meals is usually fine.  Poor planning, then bingeing on any junk sitting around the office/house is another story. 

Now we're faced with a decision - to snack or not?  When faced with a conflict like this I always find it helpful to view it through an 'ancestral lens'.  That just means I consider the way humans have lived and eaten for the vast majority of our existence.  It turns out that hunter/gatherers likely weren't consistently eating 5 to 6 times per day every day.  They experienced more of a 'feast or famine' situation, with periods of surplus food (a successful hunt), and other periods of lack (seeking food) (13).  This implies that an ancestral approach is to eat less snacks.

So, back to my personal dilemma.  I tried my own version of fasting which, literally, just meant not eating between meals, or after dinner.  The exception is after a workout.  Don't laugh - this alone was really hard for me (read: HANGRY).  Until it wasn't.....after a couple of weeks.  My appetite adjusted and, surprisingly, so did those stubborn 5 pounds - they disappeared. 

Now, I'm not saying that snacking is never appropriate.  If you work out at a moderate to high intensity, if you are pregnant or breast feeding (don't judge - my 'baby' is almost weaned and OLD/19 months), if you have a medical condition such as diabetes or a glycogen storage disease, or if you are a child/adolescent, you absolutely should snack!

However, I DO think snacking culture has gotten out of control.  Unfortunately, the deluge of 'health advice' encouraging everyone to snack isn't helping.  

What about you?  Have you bought into the idea that you should snack?  Maybe you snack and it works great for you - that's fine!  However, if you've been struggling with weight loss, or are looking to improve your metabolic health, consider kicking that snack habit.  Make sure you get a full, healthy breakfast, lunch and dinner each day and leave it at that.  A few tips:

  • Fix WHAT you eat first: I DO recommend snacks in most of my meal plans.  This is because switching from a standard American diet to an ancestral diet is change enough.  However, if you already have your diet dialed in and are struggling to meet your goals, you may want to analyze your snacking habit.
  • Control hunger between meals by following an ancestral template when you eat.  Refined carbohydrates and lack of healthy fats causes blood sugar to spike and fall - leaving you starving.
  • Practice mindful eating during meals - eat slowly and enjoy your food (yes I have small children and NO I don't always accomplish this!)
  • Don't take skipping snacks a license to go crazy at meals.
  • If you do snack, make sure it's planned and appropriate, i.e. a post-workout recovery meal.

Try it for four weeks, or take the 4-Week Real Food Challenge if you need support.  I'd love to hear how it goes.  Good luck!