I’m about to embark on a controversial topic. Perhaps it’s safer to avoid, but I can’t put it off any longer. We need to talk about diet.
Discussing diet, like politics, religion, or salary, is best done just with oneself. Yet, I’m compelled to share what I’ve learned. First, I’m agnostic. I don’t believe you need to be vegan or paleo to be saved. I eat plant-based foods. I also eat things that eat plants. I’m sure you’d find a fine film of gluten in my kitchen. What I’ve learned is that for me, it doesn’t matter.
You might approach diet in a strictly pragmatic way: food-as-fuel-to-burn to stay alive and see patients. You might also approach it as an essential component of a happy life, one where food is a core life pleasure and should be savored with others. As a pragmatist and an Italian-American, it is both for me.The diet that I have found most helpful is one that depends upon the day of the week. Mondays through Thursdays, I fast. Specifically, I have little or nothing to eat from when I wake until dinner. As a busy dermatologist, that may seem draconian, but in fact it is easier than you might think. Patients are a constant all day, while hunger is fleeting. Got a craving at 10:15 a.m.? Easy. Walk in to see the next patient. Then repeat. Most days, this continues until 6:30 p.m. or so, when it’s time to head home. It’s not that hard, particularly when you don’t have anything in your office to eat except Dentyne Ice gum and green tea.
Now, this doesn’t always work. Why? Meetings. How do I manage fasting on those days? I don’t. If I know I have a lunch meeting scheduled, then I eat a healthy breakfast before I leave home, such as a protein smoothie or a bowl of hot oats with a dollop of Greek yogurt, sunflower seeds, walnuts, and berries. By eating a wholesome, well-balanced meal of fiber, carbs, lean protein, and good fats, I’m not starving before the meeting and am less likely to overeat. (That’s because I have also learned I’m not one of those enviable people who can simply say “no” to a crispy fish taco and guacamole if I’m hungry. I’m gonna eat it.) So, I avoid fasting and the inevitable frustration of breaking a fast on those days.
On days when I fast, I monitor how I feel. Fortunately, I have rarely felt hypoglycemic; except for that one Tuesday a couple of months ago. I had completed a long, hard early morning workout, and by mid-morning my hands were shaking and I felt nauseous. I quickly downed two RX bars and felt fine within minutes. Better for me, better for my patients.
Right now, intermittent fasting is working for me. Here’s my weekly plan:
Mondays through Thursdays I fast. I have coffee with plant-based milk in the morning and don’t eat anything else until dinner. On those days, dinner is usually salad with a protein, most often fish, that is approximately 500 calories. Sometimes we have pasta or a curry, but they’re made from scratch with seasonal, whole foods. I avoid eating dinner after 8 p.m. as it tends to disrupt my sleep.
I don’t fast on Fridays or weekends or when I travel. I eat out rarely. On weekends, my wife and I shop at the local farmers’ and fish markets to prepare ourselves for a week of healthy eating. And on Sundays, we continue our treasured family tradition of Sunday supper, which is basted with nostalgia and drizzled liberally with comfort. Often it requires long preparation, which is part of the appeal, and short attention is paid to its nutritional value. That’s not the point of Sunday dinner. A delicious dunk of fresh Italian bread in grassy-green olive oil or fresh pasta doused with homemade tomato basil sauce is the best possible meal I can have to prepare for a long, hard week ahead.