When patients notice muscle loss and weight gain – and start worrying about their cholesterol – they want simple, actionable advice. To help providers respond, sports dietitian Lindsay Orbeta, RD, MS, shines a light on glycemic control – why it matters and how to attain it – and lays out specifics on protein and carbs (types, doses and even timing), offering her own tried-and-true hacks for meeting daily needs. Learn why she lives by the saying “no naked carbs,” and hear her food prep pointers, “Most Valuable Vegetable” nominees, and specific product suggestions.
Thanks, Michelle, for the introduction. Hi, everybody. So, um, I have had this idea at the top of my mind for months because I say similar things over and over again to my patients. And I was thinking, the biggest gap for me, at least how to close it, is between theory and practice. Meaning like, I wanna teach people. Like how to make better choices, but I also want them to have real tools so that they can have some ideas to like, go home and actually act on. And again, um, I want people to be better off as a result of just the information. So I like both, you know, I like to give people, um, the mechanisms behind and the reasons behind my advising. But again, I want it to play out in their life. So I, in an effort to, this is my first attempt at this, I threw this together in 2 hours. I'm in Colorado. So, um, I did my best with what I had, and I hope that it, it lands well. So with that being said, um, we'll go to the first slide. And this is what I'm gonna cover today. And if you do have questions again, to put them in the chat, I'm happy to save time at the end to answer. So, um, what and when to eat is really important, actually. And it's important for not only having good glycemic control, but also for activating our metabolism and I'll really get into what that means, activation. And then we'll take a look at um cardiovascular health, specifically, how to reduce your risk of CBD and lower LDL cholesterol. That's something I'm beginning to see very frequently as like a sub-reason that a lot of my patients are there. Most of them are for weight loss or building muscle, but like a secondary reason is we take a look at their labs and I see that they have chronically high LDL cholesterol. So, um, that's something that I think is prevalent. Um, especially when we're in our late 40s and beyond. And then, um, reducing inflammation is something that we can also attack through diet, and then I'm gonna wrap up with like how to put it all together. So, um, yeah, we'll go to the very first slide. OK. So, um, we know that obviously it's important to regulate blood sugar, and we want to be doing that throughout the day, not just on a meal by meal basis. And we know that it affects mood and energy levels and appetite, but specifically, it helps us lose body fat, and it helps us not store excess body fat. And I wanted to get to the crux of that. And it really all comes down to minimizing one hormone. And it's such a powerful hormone, and it's insulin. And insulin is not only released by the pancreas every time we eat carbohydrate and some protein, um, but there are counter regulatory hormones that are really constantly working to control the blood sugar response after we eat. And so, the less we have those volatile spikes, it with our meals or snacks, snacking is also important to have balanced snacks. The less we can call forth insulin and really rely on the need for that hormone, and this is why. Insulin's job of many jobs is to take all the sugar, the glucose from the blood and put it in the cell where it's usually stored as glycogen, right? And we use glycogen every time we're physically active and throughout the day. But there's a limit, there's a threshold for how much we can store as glycogen, and then we store sugar as fat, very easily in fact. So, um, again, with the propensity of insulin as a growth hormone, to really store all of that sugar away and oftentimes as fat, we wanna control insulin. So again, this is almost nothing to do with, um, preventing prediabetes, but it still plays out that way too. So controlling insulin, that can be done through balanced meals. And You know, bare minimum, what balanced means is eating enough protein that is um Satisfactory for our needs and our age, and having that be the primary macronutrient that we use to really anchor at a meal. So protein, it either gets overlooked or underlooked, almost by everybody. They're doing one of the two. They're just like going way off the charts protein, or they're just forgetting about it. So it's, I always seem to find one of the two. And then you're gonna add about 1.5 to 2 cups of non-starchy veggies. We'll look in depth at that later when we talk about fiber, and then of course the heart healthy fat. That's almost um easy to get. It's usually a part of lean meats. It's already in the meat, or we cook with like a tablespoon of olive oil. So that's balance. And something also that I repeatedly say to my patients as a catchphrase is no naked carbs. And so what I mean by naked carbs is plain and simple, eating a salad without protein, eating a piece of fruit without protein and fat. Um, drinking a soda, drinking juice, any of these things, obviously, they're gonna have that spike and drop in blood sugar and concomitant insulin coming into the body to take care of it and dispose of it. So, again, the benefits of protein are many, but in this context, they really slow down the release of all the sugars that we eat in the meal with it. Fats have the same benefit. They slow digestion and absorption. Of the sugars. And because of that, we have time released energy throughout the day. Our appetite is well controlled, so we don't have these hunger signals creeping in earlier than 4 to 5 hours, which is when we should start to feel hungry. Um, and then it helps us really prevent overeating at the next meal, and it helps with sugar cravings. It helps prevent all of that. So, balanced eating is hugely important for minimizing insulin and the likelihood of storing sugar as fat in a nutshell. OK, so that is literally what's going on underneath all of metabolism for weight control. So when we look at the quality of proteins, this is more of an argument or discussion around um plant versus animal-based because that's what protein quality refers to. And it's just about the source of essential amino acids, and how much at a given meal are coming in. So, um, you know, the most well absorbed or bioavailable proteins are animal-based, and they include eggs, meat, fish, poultry, and milk. And calorie for calorie, based on absolute portion size, plant-based or animal-based proteins are just much better at delivering vitamin B12, iron, and all those essential amino acids. And again, that's looking at an absolute rela versus relative quantity. So I'm gonna show you kind of what that looks like on the next slide. This is an example of 30 g of protein from different sources. And it's how much you would need to eat in calories. So just, we're talking about energy, pure amounts of energy to get 30 g of protein. And I circled a couple here. So way on the left side of the, um, graph there, you see fish, and this is only about 130 calories and about 4 to 5 ounces of fish, you're gonna get 30 g of protein. Easy, low calorie, great source, heart healthy. Now, moving along this um chart. The next one we see there is black beans. You'd have to eat a cup and a half of black beans to get 30 g of protein, and that's 440 calories. So, a lot more calories for the same amount of protein. And we're not even yet talking about all of the anti-nutritional factors that bind up the absorption of plant proteins, like inhibitors and lectins and tannins. All of these factors reduce absorption. So we're not getting the same um the same amount of available amino acids when we eat plants. This is not to say don't eat plant proteins. I'm just showing you very like black and white caloric math. And then looking at the right end of that chart, you can see peanut butter. So we need to eat 5 tablespoons of peanut butter to get the same 30 g protein dose, but 700 calories worth. No one is gonna eat that, but this is literally just to show you, like, it makes sense if you don't have ethical reasons and um ecological reasons, which are all important when we make diet choices, but Again, on a very absolute basis, um, and from a calorie standpoint, we get more protein that our body can use from plant-based sources. So that's what I mean by quality. So quality matters, and in short, if you're vegan or vegetarian, you need to be extra, extra careful about getting plenty of tofu and uh legumes as sources of, of good proteins, OK? So the next slide, please. So for all of us aged 35 and up, the thing that we're facing is this thing called anabolic resistance. And what it means is simply reduce capacity of our muscle to mount the same response of muscle protein synthesis, MPS, I might say that a few times, um, throughout. So our body is just not as capable when it gets the same dose of protein or to other usual anabolic stimuli like loading or weight training. So that's a problem. That means it's an uphill battle as we age, 35 and up, and it gets worse and worse exponentially, um, in our 40s and then menopause and beyond. And again, how do we, how do we counteract this uphill push against losing muscle? So again, we pay attention to everything you see on this slide. We just talked about quality, um, we're gonna talk about dose next and then timing and order. So, uh, Michelle, I'll have you go to the next slide. And give what Michelle actually had sent out to you all. I made this tip sheet. Um, I love it. It's so useful as a visual guide because it shows you if you were just aiming for the 35 to 40 g dose of proteins that are for optimal muscle protein synthesis, meaning If you care about building muscle and not maintaining and not losing, this is your dose that you're aiming for. There's a range, but 35 g is considered minimal for adults 35 and up per meal, per meal, plus high protein snacks. So again, looking at this, you can see like, if you just were going for the protein part, it would be like about 5 to 6 ounces of lean meat. Depending upon which you get, it's a full cup of dairy with stuff added, um, and then it would be like the whole brick of tofu. With lentils to get even more protein. I mean, you can see the different options here. And it's also the equivalent of 4 egg whites and 2 eggs. So, this is not to say just eat this. This is what you could kind of aim for in your mind knowing that vegetables bring little to the equation of protein. They maybe bring like 3 4 g. And then of course, whole grains would bring some, some extra protein too, but this is just a quick visual guide, if you just want to nail the protein part, OK? Keeping in mind, not everybody needs starch in their diet. They just don't. Um, that is also like maybe a point of contention around some people, but for sedentary folks, your body can get by just fine with vegetables, um, and non-starchy veggies and some, some low sugar fruits and get all the carbs you need. So starches is a kind of a different topic, but here are the protein parts. OK, moving along. So we talked about um food order and timing. This is another snapshot from a different tip sheet also in that batch um that Michelle sent. And this is just giving you some um quick tips about order and vinegar. So food order, we already said no naked carbs. So we know carbohydrate by themselves is a bad idea. The second thing that we can do that dramatically changes our postprandial blood sugar is eating food in the right order. And this has been um repeatedly uh established with continuous blood glucose uh research, so people that wear the CGMs. And what we see is by starting off with non-starchy veggies, I have a list of those for you later. Um, or starting off with a simple green salad with vinegar, vinegar, any kind, a tablespoon, actually blunts carbohydrate digestion in the mouth. There's, there are enzymes there called amylase, and they already start breaking down sugars in the mouth. It's so rapid. So vinegar can blunt that up to 60% and change your post-meal blood sugar by that degree if you start the meal with vinegar. You can even drink vinegar, 1 tablespoon and 16 ounces of water. And that would dilute it enough where you could get the same impact of the glycaemic effect. So let's say you're gonna have a high carb meal, you could actually like have the vinegar and water, and you would see a dramatic blunting of how much um insulin and glucose follows. So food order is best to start with um veggies and or protein, that's at the front of the meal and you end with the starchy carbs. I do this myself. Everything I tell you guys I'm doing and it's so practice. I don't even think. Done repeatedly over the course of a day, you get 3 choices a day for a meal and a snack. If you're, when you can, if you're not eating a burrito and it's all mixed up, it's on a plate, like, let's say you have eggs and sourdough. You get the eggs in first, you finish with the sourdough, and that can drop your blood sugar after the meal 60%. So there's variation, obviously. Individually and how, how um blood sugar sensitive we are, insulin sensitive, all that makes a difference. But in general follow that rule and it's, it's a good one to follow. And then finally having dessert. Um, at the end of a meal, like sweets or dark chocolate or even fruit, it's the best time right after a meal. Don't wait 1530 minutes, an hour. Right after means you have all the protein and the fat, taking their time to slow things down, and you won't need as much insulin. So, yeah, that works great. And then the next tip. Is on the next slide. Um, actually, did I, I might have skipped it, but I wanted to, um, just remind everybody about the doses. So the doses are 35 to 40 g for people age 35 and up. We talked about food order, starch last, carbs last, OK? And then timing is really important too, and sorry, Michelle, this is actually two slides back. I think I got ahead of myself, one more back, one more back. Thank you. OK. Oh yeah, one more forward, there we go. The next, the next slide. Yeah, perfect. Thanks, Michelle. So, um, timing, timing of protein is important too. So pairing protein, remember this, pair protein with exercise and creatine. Creatine is something that it is the, like the safest and has over 1000 peer-reviewed publications on how effective it is for, especially, um, regenerating ATP in the muscle. And that's important for weightlifting and for exercise involving sprinting, especially, so creatine is outstanding for maintaining lean muscle mass in aging adults. Creatine and high protein snack or meal, you wanna have both within one hour on either side of exercise. So, to recap the things I just said, no naked carbs. Uh, starch last or carbs last, pair your protein. With creatine and within an hour of exercise, OK? Then you have all this blood flow that's greater to the muscle, and it helps bring those amino acids in, so you capitalize on that timing effect. Um, and then order, we just talked about that. You want to start with protein, um, and non-starchy veg, and you want to do starch last. OK, so moving along, um, I think two slides. One more, yeah, thank you. 01 back. So, Thanks, Michelle. OK. So, in terms of metabolism, um, I just wanna like kind of gloss over the most important parts here, because metabolism means a lot of things, but it's really about how to activate it for us, right? We know that having more muscle mass means that we're gonna burn more just sitting at rest. So, strength training is obviously essential as we age, and lifting heavy is also important. And then how to turn on metabolism. The first one is simple. I call it wake up water. So this is like another catchphrase, wake up water. Every morning when you wake up, your body is totally dehydrated. You want to have 16 ounces of water before coffee, before you open your eyes. It's the first thing you should do. And obviously, following throughout the day is great, but get it in the morning. You're gonna feel so much better. And then secondly, in looking at intermittent fasting, we could like spend a whole talk on this. This is what I want to say about it. Intermittent fasting is not anabolic at all. It is the opposite. It's completely catabolic. So, if your goal is to lose muscle, then intermittent fasting could be a method to doing that and nobody wants that. But especially as we age, because remember, we just talked about anabolic resistance. So, if you wanna build muscle, you don't want to be fasting. It's just, it doesn't make sense. It's not anabolic in general. Um, the second thing is within an hour of waking, you want to eat at least a high protein snack. I'm super guilty of this and a lot of people are because I have zero appetite in the morning. So a major conundrum for me, and I'm 48, has been like, if I don't eat till like 11 or 12, I'm not, I'm catabolic. I'm breaking down. And that's going against my goal for myself. So I know I need to find a way to sneak it in. And for me, it can be as easy as a hard boiled egg, which, by the way, you have to make them on a Sunday night. Make a whole batch and then you just peel them and you just grab them out of the fridge. You can even buy hard boiled eggs at the grocery store pre-made. So whatever it takes for you, but this is a great hack. I'll eat a hard boiled egg and a tablespoon of peanut butter, almond butter. And then I know I got something in before coffee and before my day gets rolling too far. Um, if you're crazy lazy, the, the other thing you could do is just put in a 20 g scoop of whey protein isolate, unflavored into water, mix it up and drink it down. It tastes like nothing, and again, that's like the ultimate lazy way to get it in, but at least you did it. So, have protein within an hour of your day. All righty, I wanted to spend a quick blip on talking about HRV, which is heart rate variability. And for many people that have wearables like Garmin or a whoop strap, this is gonna give you that data. And essentially, it's just a measure of the variation in between each heartbeat. So the time between heartbeats, and it's controlled by the autonomic nervous system, which is really like if we're constantly in a fight or flight stress state, HRV is gonna be suppressed. It's gonna be lower. There's less variability. And all that means in the context of this talk is we are not as well recovered and we're not able to show up for exercise and training like we want. So, um, you don't need a wearable to tell you your HRV is low. You probably know when you show up for a workout, and examples like I'll go do pull-ups in the gym 3 times a week. Pull-ups are hard. I've been doing it my whole life. And I can do 6. I could do 3 sets of 6. If I look at that bar and I'm like, I like can't even imagine doing one, I just know I'm not recovered and I know that something I did the night before, what I ate or didn't eat or didn't sleep, it is affecting my HRV. So, um, again, it's really about readiness to be, you know, moving at your optimal the next day, thinking well and like exercising like you want to feel and feeling strong. It's, it's about all of that. And the reason I even brought it into this topic is because what we do with our diet has major inputs for HRV. So, the biggest ones are right here on the screen, and this is how you can nutritionally improve HRV. The first one, and this is another catchphrase, is called protect the bedtime window. And I talked to especially athletes about this. The 2 to 3 hours before bedtime, you want to be thinking about a couple things. One, finish your meal, ideally, ideally 2 to 3 hours before bed. And I know that's like damn near impossible for a lot of us. Like, we get off work at 6, we're home at 7. We're barely getting dinner started and we're gonna be in bed by 9:30, 10. We already are like way past the bedtime window. So I understand it's not doable for everybody, but it's still something that matters. So eating within 1 hour, 1.5 hours of bed is a killer for HRV and it'll affect how you feel the next day. So, um, eating, that's one. Um, and then secondarily, alcohol. So no matter how much alcohol or how little you drink, this can seriously suppress HRV and again, how you feel the next day to exercise. So even one serving of alcohol can drop your HRV by 22 milliseconds the next day. And the kicker is that it takes 4 to 5 days for it to actually stop being suppressed. Alcohol, it, it's, it's got a latent period and it just hangs out in the system for 4 to 5 days impacting us. Um, so that's 2. And then um 3 is hydration. So being chronically dehydrated, which almost all of us are, we're walking around, especially if your doctor. Um, you're with patients. You see 30 patients a day, and it's 15 minutes and you're back to back, like, where's the time for you to be like, excuse me. And drink, you know, drink 16 ounces of water. It's really hard. So you have to like put it in your life as a priority and carry the bottle with you in between patients. And, you know, if it takes away 30 seconds from the patient, you need to drink water. So that's one thing that we're all guilty of, but we feel terrible when we're dehydrated. So, Um, drinking 1 ounce of water per pound that you weigh is a lofty but a good goal, 1 ounce per pound. And so for a person that weighs 140 pounds, that's 816 ounce glasses a day. That's the tall glass, OK? All right, um, let's move along to the next topic. OK, so, Kind of switching gears here and talking now about how through nutrition, we can reduce our risk of cardiovascular disease with soluble fiber. And this is a real big, again, um, I spend a lot of time educating a lot of my patients about this because fiber doesn't just have this effect on heart health. It also improves our GI health, our colon health, and um it slows down absorption of food, much like proteins do. So it really helps us clamp down on appetite earlier in the meal. So it's a great strategy for not overeating. So fiber is like rock star nutrient for a number of reasons, um, but in this context, I want to talk about um LDL cholesterol and um the lipoprotein within that subclass, which is called apolipoprotein B, AOB. So, um, just some quick background, only 25% of the cholesterol that we absorb actually comes from our diet. Only 25%. The rest of our cholesterol is, we make it, we make it in the liver, so it's endogenously produced. And because we make it, some people have genetically high LDL, even LPA, which is another lipoprotein, and that's genetics, and that's like another topic. But that can be the case, so it's even more important to be addressing it through diet if you don't want to be on a statin later in life. So, um, we know again also that cholesterol transport goes two ways. LDL, it's regarded as the etherogenic type of cholesterol. It moves, um, cholesterol to all of our tissues and liver, whereas HDL reverses this, it moves excess cholesterol from the tissue back to the liver. And there's no good or bad cholesterol. I get that right off the bat with patients. It's only a bad outcome. Where too much LDL could end up inside the arterial wall and start that inflammatory cascade, which is where we have the obstruction of the artery and of course, heart disease and all the things that would follow. But there is no good and bad. It's just how they function, these types of cholesterol, right? So, um, we know that it has to be wrapped in a lipoprotein, and that's where the AOB comes in for LDL. And it is correlated with heart disease, and the other thing that's um kind of been revealed to us over the last decade is that HDL, even though it's still protective, having high HDL isn't a, you know, get out of jail free card. So it doesn't undo all the other risk that we might have in a lipid panel. So, um, you know, the last thing is thinking about reducing saturated fat in a diet is one aspect that I work with patients on, but what's more powerful in research is adding in soluble fiber. So, soluble fiber gets absorbed in the intestine, and then it binds the cholesterol and it helps kind of remove it from the body. And we know that 5 to 10 g is what's effective in lowering total cholesterol by up to 11 points and sometimes even more. So again, 5 to 10 g a day, and I'll show you what that looks like. I hope, oh yeah, it's the next slide. I was like, did I include it? Um, so some ways that you can get that, that are like, again, ultimately lazy hacks. The first is having 1 tablespoon of ground flaxseed in 16 ounces of water at night. You could do that for life and probably have zero effects, no constipation. And if anything, it gives people a nice like bowel movement in the morning. It's very gentle. So flaxseed must be ground in order to be absorbed. That's the one seed we need ground. And the next is, of course, good old fashioned psyllium husk fiber or Metamucil, and Metamucil, it only requires two rounded spoons to be mixed into again, a full 16 ounce, which is a double glass of water, at once, and the best time to do Metamucil is twice a day. Pick any two meals. I do it at breakfast and dinner. And you right before the meal, have it in 16 ounces of water, that's gonna give you 5 g of soluble fiber per meal, and it'll give you 10 in a day. So to show what impact this has on LDL, I'll have Michelle uh go to the next slide. And this is a study that the references in the bottom left corner there. It was a placebo-controlled RCT and it looked at people with a baseline high LDL cholesterol between 161 to 186 mg per deciliter. So when you get up to that number of 186, I'm sure you know that that's like high enough to like warrant a statin. If there are other um side effects, not side effects. Other risk factors present in the person. But again, that's where um like a cardiologist or a doctor might start to have a conversation with the patient like, hey, your LDL is very high. So these people were high and they were taking a statin for a month before they got randomized to one of three groups. And after they got randomized, in one of these groups, they continued the same statin dose. The only thing they did different was add 15 mg of Metamucil per day. Now, again, Metamucil as instructed is only meant to give you 10 g per day. 15 is a little higher. You have to go slow. When you add in fiber, you have to add Exorbitant amounts of water to your to your day and throughout the day, if you're adding fiber in small doses. So one thing I wanna say is, um, when we instruct our patients, we have to like always really, really reinforce going slowly by adding fiber and adding so much more water, like obscene amounts of water if you want to avoid constipation and side effects like gas and bloating. All right, back to the study. So they added on um a hefty dose per day, 15 g of Metamucil, and here's what happened. These people in that group were able to drop their LDL by an additional 6%, and what that means here would be that they took their LDL down by 11 points from 186 to 175 in a month. And they also reduced their AOB, that lipoprotein, that's very atherogenic. They took that down by an extra 4 points as well. So, these researchers really concluded that psyllium husk being added to a diet, whether or not it's with a statin, can be as effective as doubling a statin dose. So instead of getting more medication, we can just focus on foods in the diet. And adding psyllium husk. So, um, the last thing that was really cool is the people in the study had such low side effects that the placebo group was actually reporting statistically different side effects. So they were so low they were nonexistent. Um, so let's go to the next slide and look at how we can get soluble fiber from veggies. This is a slide, or I have it as a handout. I give it to every patient, every single patient, I talk about this. And the way that you can do this is literally pan roast it either in a glass rectangular pan or like a ceramic sheet pan with olive oil, salt, pepper, or any kind of seasonings like herbs. And 3 times a week, if you were to pick any of these veggies and roast like 4 cups of them. You'll have it all week. I mean it's like a no-brainer. Like my whole life I've been doing this and when people are like, I don't know how to get more veggies and I'm like, it's so easy. You just roast them. Like salads, you're not gonna get fiber in a salad. You have to get these veggies. So these are the ones that are like the heavy hitter. Because they're low in starch and low in um net carbs and high in soluble fiber, soluble being the one that's really tricky to get, and um that we know lowers LDL more effectively than insoluble. So, again, looking here, um, you can see that edamame, you can get it frozen. Um, sometimes I've seen it there. Obviously, sushi bars have it. Um, and then asparagus, you know, this is from area of high to low, and these are all in one cup cooked, uh, servings. So unless I noted otherwise here, these are the ones that you should be keeping in heavy rotation in your life. Shop for them, get them at the farmers' market when they're in the season. These are great, and um, they taste fantastic. You can add them to anything to salads. I'm gonna tell you at the end how I've been having these, but um, yeah, these veggies. The rock stars, they're high soluble fiber and they'll have an impact. OK, so moving along. So, um, this is something, what time we have one so, OK, so I'm gonna try and do this real quick, but thinking about how to reduce inflammation. Inflammation is, I mean, it's nebulous, right? It's systemic, it's internal, it's silent. It's all these things, but we know that as we age, we get, we have more inflammation. And that's part of that whole kind of um the anabolic resistance inflammation is a part of that. So, We can reduce inflammation in our diet by aiming for fats that are high in omega 3 fatty acids, and they're really hard to get. We get them from fatty fish and walnuts, and some seeds, and that's about it. So, um, in looking here at this, this chart, This is why it's so hard to get a dose that is, um, that gets to that critical threshold where it has an impact clinically on lowering um triglycerides, which is what fish oil does. So when you look here, you can see that you'd have to get 7 ounces of farmed Atlantic salmon or bluefin tuna to get a dose of 3.2 to 3.8 g of omega 3 fatty acids a day. That's a lot of fish, and it has to be wild. So the only one you don't need to worry about being wild is trout cause it's illegal. You can't get it wild unless you got it yourself out of a river. So, um, trout is a good one, but these are from high to low. The fishes that Americans are eating and can, can get at the grocery store. And um I guess what I'm trying to say here is they're lean fish. Very few of these are fatty enough that they get that critical dose of 3.4 g of omega 3 fatty acids a day, which is what the dose is that helps lower inflammation. 3.4 g a day is the low dose. It goes all the way up to 5 g a day for this specific um reason. So knowing that it's really tricky, I wanted to just quickly touch on these ones on the left side, salmon, black cod, trout, tuna, tinned fish, sardines and anchovies. These are the best ones to be aiming for. You can get them frozen, you can get them in those little like vacuum packed like filets. You just take it out in the morning. Um, you let them defrost in the fridge, a couple of them, and you roast it on the same sheet pan as veggies, the slide I just showed you, and you have a meal. Like it's so excellent and so great for health. This is literally what I eat like 5 out of 7 nights a week, fish and a ton of those veggies. So these are the ones you should aim for. OK, moving to the next slide. What if you can't get fish, you don't like fish, you can't, it's expensive, it's all that. What about that? So then we know we're aiming for the oil, we're not aiming for fish muscle, which is what we eat when we eat fish. We want the oils, we want the The fats. So these are the two that I recommend. They're both pharmaceutical grade. The omega 3s, um, from Nordic Nats are slightly less concentrated. You need to take one more soft gel to get the same dose, and it's twice the price of Quil. So Quil is made by Douglas Labs. They've been on back order for months. I can't get my hands on them myself. So, um, but I do want to say, Doctors and dieticians, all this brand, Douglas Labs, and um they're under the parent company of Pure Encapsulations, also Pharmaceutical greed. Um they give doctors and dieticians a, it's called like an, you do like a provider account, and they'll give you 50% off. Um, so this is fantastic. I've been ordering from them, now they're on backorder, so, so I take the Nordic naturals. Um, but again, to get that therapeutic dose for fighting inflammation, it's very high, it's 5 g a day. OK, moving along. Putting it all together, all the things that I just talked about. Um, I just wanna like kind of encapsulate it. So we just said, um, roasting those specific veggies as often as you can or putting them into salads, however you want to do it, is a great Uh, strategy for making sure you get enough soluble fiber, and then if you pair it with frozen and then defrosted fatty fish or lean meat like chicken breast, etc. slam dunk. That is a great dinner. You can take those veggies and you can use them for any other meal of the day. So the way that I've been eating that, and um this is under the breakfast here, I sent Michelle the veggie frittata recipe. That every patient I talked to them about the frittata. It's like you just take any veggies, saute it down, and then you have them in your like cast iron, you add a whole dozen eggs, and then I do a whole giant carton of liquid egg whites. Mix it all, pour it on top, let it set. You could put goat cheese in there. I don't care what you add to the top. It gives you a weekday breakfast that's high protein, high fiber. You don't have to make anything in the mornings, you just microwave it and you're out the door. 40 g of protein, I think it makes 5 servings, uh, the recipe that I sent. So, it'll get you through 5 days. And then the other thing I've been doing with my leftover veggies, especially with roasted artichoke hearts and Brussels sprouts, is I have them pre-cooked from the night before and then I'll have in the morning about a 1/3 cup to 1/2 cup depending of cottage cheese, and then I'll top it with 2 olive oil fried. Eggs, and then I have about 1 cup and a half of the artichoke hearts and the the shaved russels. And I put a little chili crisp on top or like jalapeno oil. And it's like this, like savory, high protein, high fiber, delicious. You're not hungry for like 6 hours. It's so good. So I've been doing that for a minute. Um, all righty. And then one more quick way to get in high calcium, vegan protein. Um, with none of the cholesterol is tofu. This brand, Hodo is so good. It's made in Berkeley. You can get it at Whole Foods, um, the whole brick. One adult needs a whole brick. I've been, um, stir-frying it in a little bit of coconut. oil, because it's high heat, and, uh, tamarai. And I use like a, I should just send you the recipe, but I've been using this like Leanto maple syrup. It's monk fruit based. It gives it that tiny sweetness. This recreates the same texture that you can get at a restaurant, like at a Thai restaurant. It's so good. So, um, crispy tofu, peanut sauce with like bok choy, red bell pepper, snap peas. I do that once a week. It's a great way to get in a very cheap. And heart healthy, high calcium protein source. OK. In closing, moving after meals, this is also something I talked to patients about because it's a great way to really affect your post-meal blood sugar. As soon as you're done eating, you can either walk 10 minutes, you can walk upstairs for 5 minutes. If you have a stairwell in your office building. I have one. I live in like a high rise in Oakland. I just, I walk, it takes me 5 minutes to go up to the 23rd floor, 5 minutes to come down. It's like around the corner from my unit. So like, why not? Why not do it? And now I feel guilty if I eat and I don't walk stairs. It's like getting neurotic, it's bad, but stairs. And then if you can't um walk, it's not convenient, you're at work. 20 air slots. So you can literally air squatted out for 20 low squats all the way full range, and that is more effective than a 30-minute walk at reducing blood sugar. So, yeah, all that, all that stuff put together translates again into reducing insulin levels, improving energy levels, and um getting all the fiber in that you need as well as the protein.
