What diet is best for Perimenopause?
One of the most common complaints we get from women in perimenopause is unexplained weight gain. Their lifestyles have not changed in years, but all of a sudden, their weight keeps increasing. And if they try to lose the weight, their efforts fall short and often gain more weight in the process. An observation we see quite often is that many women are still tyring to “eat less and exercise more.” This might have worked when they were 25, but for women in their 40’s, this weight loss approach often seemed to backfire. Women in their 40’s typically have a good deal of stress already, so trying to exercise the weight off only adds to their stress. This makes the weight loss process very frustrating, if not seem impossible.
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PYHP 098 Full Transcript:
Dr. Maki: Everyone thank you for joining us for another episode of the Progress Your Health podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: So on this one, we are just going to dive right in, and we of course have a lot to talk about. We cannot not talk about perimenopause or menopause without discussing diet and weight loss at least to some extent. Would you agree with that?
Dr. Davidson: Absolutely when women, hit their 40s, they especially perimenopause and menopause. They always say it is like I put on 10, 12 pounds overnight like it, just where did it come from and they will point right to their stomach. I have had women, I love them dearly they will even grab their stomach and say, “I have never had a belly before where did this gut come from?” And things are different, of course, we all know obviously from when we are twenty, to when we are forty, to when we are sixty, we are always changing but it definitely comes from the change in hormones.
Dr. Maki: Yes, right and believe me that is very complicated and you and I, we have been doing this a long time and we certainly do not have all the answers when it comes to diet and weight loss and especially perimenopausal weight loss or menopausal weight loss for that matter. But the purpose of this episode is to kind of just shed some light on some of the observations that we have noticed and in some ways what does not work for people, we do know some of those things. Everyone is still trying to follow the same advice eat less, exercise more all the time. They are just trying to basically starve themselves and exercise a bunch and that strategy right there and we will kind of dive into that, what that strategy looks like little bit more specifically but that strategy clearly does not work. And in some cases that actually make their situation worse, they actually gain more weight. They are exercising five, six days a week and their weight is going up.
Dr. Davidson: Yes, you will see that I mean granted I was a child of the 80s. I remember the 80s and the 90s, if you were going to go on a diet, you just stopped eating or you just restricted your food or you keep it to like one Snickers bar a day. Everybody has had that caloric restriction put in their brain almost like its theory but now we are realizing that we want to eat food to lose weight, we want to eat more calories, When you under eat sure you might lose a few pounds initially and people say, “Oh, this is awesome. I lost 8 pounds, I lost 10 pounds.” But it always comes back and I work with a lot of women, especially with hormones is when you do that, sometimes I do not want to say it messes up your metabolism, but it is really hard to come back from when you have done a crash diet or chronically restricted your calories.
Dr. Maki: Yes metabolism, that term metabolism. Like I do not think anybody really understands what metabolism is like it is this kind of really obscure metabolism. What is that? Now granted, we could define that in a couple of different ways, but really kind of your resting metabolic rate. How much energy does your body utilize while you are just sitting there watching TV, right? Now that is your resting metabolic rate that is in some ways metabolism is a moving target. It does not stay static. It is very dynamic based on the information that your body is receiving your stress, your sleep, your activity, your diet your food, all these things that your body is taking in is then being translated into whether your weight management, whether you gain weight lose weight or maintain weight and that message is always kind of being re-evaluated. So and one thing I will say more from a biology perspective or from a survival perspective, you are on a chronic diet. The body is very, very sensitive the brain, the hypothalamus that is kind of the master gland in the brain. The hypothalamus is very sensitive to a significant drop in calories. It does better with an increase in calories. It does not do very well; it starts going to which we will talk a little bit about compensation mode when those calories drop too low for too long.
Dr. Davidson: And then like you had mentioned like we always know is, “Hey, I am going to eat less then I am going to exercise more which exercise is great, exercise is great for the body.” I love to exercise but especially Dr. Maki is very much an advocate of, you need to change the way that you exercise especially in your 40s and 50s if you are trying to lose weight.
Dr. Maki: Yes, right, and granted this is not a criticism. I really appreciate how disciplined and how dedicated a lot of women are. I mean literally they are working their butts off trying to achieve something, trying to achieve their goal, and they just get so frustrated because they just follow that same advice. Go on a 500 or 1,500 calorie or less calories a day they are measuring it in there MyFitnessPal or whatever app, they are using. So they are meeting that caloric goal and then they are exercising four to six days a week at doing some kind of a boot camp or some cardio class or some spin class or something along those lines. And months will go by, they might lose a little like you said, a little bit of weight initially then either it comes to a screeching halt they lose no more weight or they have been doing that for six months and they have gained 10 pounds. It completely is baffling as to why it works that way.
Dr. Davidson: And granted I like cardio, cardio is fun. It gets your heart rate up. You feel really good afterwards. You feel like you actually did something. So I love cardio but like you always tell me is, “Hey, you got a back down and do the weights.” And then I say, “I do not want to do the weights, weights are hard” But you are right, I need to do the weights.
Dr. Maki: Well, I think that by focusing a little bit, now granted this is not just about focusing on weight training and trying to convince women that weight training is the way to go but we talked about that metabolic rate, that resting metabolic rate. Women specifically because that is who you and I talked to most often and even some guys they kind of do the same thing. Guys can get away with it a little bit easier until they get to their mid-40s and 50s, and then they have the same challenges that women do. What used to work when you are 25, no longer works anymore. Now for guys and for some of your husband’s out there whenever they try to actively try to lose weight, they will lose double, triple what women lose which only frustrates them. They just have to stop drinking the beer, or some of those, Sunday NFL football tailgating foods and all of a sudden, or they do keto and they lose 20 pounds in a month and a half, that just frustrates women to no end because they are able to drop weight so rapidly. But from a long-term success perspective, how rapidly you lose it in some ways only guarantees and how quickly that weight is going to come back.
Dr. Davidson: And just like you are saying and I hear it all the time, too like, “Hey me and my husband, we are starting to walk a little bit more and we are eating better and course he loses 15 pounds.” And the wife will say, “I lost one.” You hear it all the time, so it does make you say well, “Click, click, click, light bulb, light bulb.” It must be a hormone issue going on which yes in some ways, female hormones are different. We have more estrogen and progesterone. As humans, we all have the same hormones it is just as ladies we have more estrogen and progesterone than men do, is that change in that estrogen and progesterone can facilitate that but there is so many other hormones that come in to play with that.
Dr. Maki: Yes, right. Now, we know that nowadays that keto and intermittent fasting are both very popular and we kind of aligned with both of those strategies. We like the lower carb strategy. We like intermittent fasting. Combining together it can be extremely effective. Unfortunately, what I think a lot of times those things translate into on a day-to-day basis is basically, another version of a low calorie diet. A keto diet and an intermittent fasting are not necessarily meant to be just basically another form of low calories. But when you are removing a whole macro-nutrient carbohydrates, inevitably for most people especially women calories are going to go down. Now, we wrote a little short e-book about this called A Keto Carb Cycling Program kind of in some ways intended to protect women from themselves. We wrote it for women because that is who we deal with most often. I think it can be very effective for guys, maybe more effective for guys. But it was intended for women because we see this; exactly what we are talking about right now is we have seen this happen over the last 10 to 15 years. As we have been in practice that this low-calorie thing always creeps back in your figure, as long as you are under 1500 calories, you are going to lose one to two pounds a week and you are going to meet your goal in three months. When we say that metabolism is kind of a moving target, we think people should focus more on stress level and sleep quality before they kind of dive into all of that because the results can be kind of compounded in a negative way.
Dr. Davidson: And one thing, ketosis, keto diets are really popular a couple of years ago. Intermittent fasting is super popular now, Now macros are back in the business, where it used to be macros worth of super in all. All this with dietary stuff, it is always changing and there is always different kind of things out there which is nice because not one thing works for everyone. But we did notice with doing ketosis, one of the reasons why people drop their calories, is your appetite goes down.
Dr. Maki: Yes, right. Now there is a few things there like you said your insulin drops, you are taking away the carbs and probably a lot of sugar for that matter out of that. In sugars one of those things right, the more you have the more you want. It is kind of like this feed-forward mechanism in your brain, so the more snacks and things and the sweet things you eat, the more your brain just wants to eat that stuff. You eliminate that and then it takes a few days and all sudden now your cravings are relatively gone, unless you are at a low calorie state for a long period of time and that long period of time is somewhat dependent on the person and dependent on the rest of their lifestyle. How well they sleep, what your stress level is and how much activity they do. How many women out there are exercising like crazy and you get done with an exercise session or in the evening after doing that on a workout day? And also, now you start getting the munch because you want chips, you want crackers, you want cookies, you want carbs–
Dr. Davidson: Sugar?
Dr. Maki: Yes, you want sugar and carbs galore. In some ways that activity basically tells your body to eat those things. So you are kind of battling against your own body’s innate mechanisms to protect itself from, starving to death and running from a tiger, right? That is what most women are telling their brains or literally on a daily basis they are starving and a grizzly bear is chasing them down the street. That of course is going to make your body respond a little bit of a different way than in a very calm relaxed environment and then that is when the weight loss tends to happen the most. It is not going to happen and that consistent day in day out, fight or flight response.
Dr. Davidson: Exactly because doing more cardiovascular like I said, it is really fun, I like it but it does rise up your cortisol. And when you rise up your cortisol, cortisol is a hormone from the adrenal glands, it has a connection with glucose and then which also has a connection with insulin so we could go down that rabbit hole. But one thing about that is when you raise up that cortisol and mess with your insulin and glucose, it makes you want to have sugar later on, I mean always does. I have women we talked, we giggle about it and say like eating in the evening time can be like an extracurricular activity because at 10:00 in the morning, nobody wants a brownie. Nobody wants and that is why a lot of times women will not even eat much during the day because they are running from that grizzly bear but come nighttime my goodness, it is a it is a free-for-all and willpower never wins, biology, you always want to bet on biology because willpower is very short-lived.
Dr. Maki: Yes, these mechanisms that we have in our body, between our liver, in our hypothalamus and our fat stores and all these different organs that regulate this, it is extremely complicated. Now, if you talk to the low carb people, they will say weight gain is all about insulin. If you talk to the neuroscience people, they will say that it is all a brain issue. I think that it is a combination of both of them. It is a peripheral, kind of insulin-based issue. Now insulin, I think it is a bad rap sometimes, I certainly any kind of bag on insulin but insulin is a critically important hormone. You need insulin for its anabolic or its energy storing effects. You need insulin, it is not necessarily about having no insulin whatsoever that is what a Type 1 diabetic is and they do not live very long. Insulin, I think was invented or discovered as a medication like in the early 20th century before that people had Type 1 diabetes, they live like two weeks. They do not live very long. So insulin is an essential hormone that our body actually needs. We just need to be able to manage it well and make sure that the body does not become resistant to insulin. And granted that is a whole other topic, we will talk about later on. But there is a lot of things under that insulin umbrella, PCOS, fatty liver, high cholesterol, high blood pressure, of course weight gain. Maybe more on the obese side of weight gain as opposed to what we are kind of discussing is people that are trying to lose, 20 25 pounds or less, right? I would not necessarily consider anybody in that category. If you had to ask of all your patients maybe not anybody specific but the common weight for a perimenopausal woman, what would you say it is?
Dr. Davidson: I would say for the perimenopausal patients, they do want to lose what I call them is vanity pounds. And really it is because their health is great, their blood work is great, their blood sugar is good, their liver enzymes are great, their cholesterol is good but that extra, 15 to 25 pounds that they never had, even though they eat better than they did back in their 20s that is what they are looking for. So, we giggle about it calling it vanity pounds, but in truth it kind of is because it is not something that is deterring from their health. It really is so we can feel good about ourselves and wear the clothes we want to and be able to get the results that we want.
Dr. Maki: Yes, right. Now granted if that is a left unabated as that process continues, I think it can turn into way more issues like I said high blood pressure, high cholesterol, all the things that lead to age-related disease diabetes, heart disease, Alzheimer’s, cancer, you know weight of course. Especially now with all the coronavirus stuff as well people have been talking about some of these other underlying risk factors that increase our susceptibility to those types of things. So, 15 20 pounds at some point turns into a bigger problem later on, so there is no diminishing the health effects of losing that 15 to 25 pounds. It has a significant impact on the overall health of that person.
Dr. Davidson: And I want to kind of go back a little bit to that caloric restriction, is you can see sometimes on blood work when someone is calorically restricting because when you lower your calories for a long period of time like, Dr. Maki says is your body goes into compensation mode is you will see the thyroid low. And it is not necessarily it looks like there is thyroid disease or diagnosable hypothyroid but you will see the free T3, which is the active form of thyroid drop down. It will easily be in the twos and I can usually look at that and say, that is because you are trying to calorically restrict and then it is dropping your thyroid function and then they wonder why they are so tired. And also you think thyroid has a huge, contributing effect towards weight loss, so if the T3 is going to drop down it is going to make it even harder to lose weight.
Dr. Maki: Yes, right. We are talking metabolism at T3 or thyroid function is not necessarily your metabolism specifically but it contributes to it, right? So on blood work, like you said exactly we want to see that free T3 to be high normal that means in some respects that their metabolic fire is kind of running nice and hot. So when there is energy coming in food your body is going to be able to utilize that energy very well and we are not doing something that is forcing the body, over-exercising and under eating or maybe not sleeping, maybe all three that is your typical we see that your typical perimenopausal women. They do not sleep, they have high stress, they under eat and they over exercise. Those are the four things we probably should have started with that. Those are the four things that we see all the time. So over-stressed, do not sleep, over exercise and under eat that is the four things that they are doing. So if you are doing those things to try to lose your weight, focus on the sleep and the stress first, lower your stress as far as the best you can that is easy for us to say but very hard to do, right? We all have stress but manage it well and part of managing stress well is just improving your sleep quality. We have got a quite a few blogs and podcasts that are about sleep quality, if you have not listened to those pay attention because that should be your number one focus. If you cannot reduce your stress, then you have to maximize your sleep quality that has to be number one because otherwise when it comes to losing weight, you are just basically walking uphill backwards. Weight regulation basically happens at night, all the hormones that keep your weight in check basically are related to having a good night sleep on a regular basis. Now the occasional bad night, okay, that is fine, right? But as long as the majority of your week is getting to bed at a reasonable time, falling asleep easy, staying asleep most of the night and then waking up feeling at least moderately refresh. Now the ability for your body to lose weight effectively you are having that effect on the nervous system from fight or flight, to rest and digest. We want that switch to happen a little bit easier than it does for most people.
Dr. Davidson: You are right. Yes, definitely with the sleep. We have patients that, I tell them do not get up at four in the morning to go to the gym, just keep the sleep because they are too busy, they are too stressed, they are going to bed at 11:00 11:30. And then they are trying to wake up between 4 and 5 to get to a cardio class. I said just take the time to sleep. You will probably notice, not only feel better, but that it is easier to lose the weight because nobody can get by on that little sleep.
Dr. Maki: Yes, right. Yes and not perpetually maybe short periods of time. Okay fine, but ongoing when you are having a sleep challenge anyways and you are forcing yourself. And you hear it from people, they say they are really gung-ho they are doing it, they are very disciplined, they are very consistent for a while and then little by little, the little voice in their head starts telling them, “Oh, I want to get up on a sleep little bit longer little bit.” So it goes from six days a week to five and then from five to four, and then from four to three. And then little while longer, they just do not have the energy to exercise at all. They kind of peter themselves out because their energy balance is completely out of whack. There is too much going out, too little coming in. Now granted that model energy in, energy out, we do not really agree with that necessarily. It is not just about calories. But in this context, it is about making sure that you are eating enough food, which is completely counter intuitive to a weight loss process thinking that you have to eat just the right amount in order to lose weight. And it is not really the right amount on a daily basis; it is the right amount over time. And when it comes to weight loss we all want, you included we want immediate results right away. We want to see that scale changing either daily or weekly. Otherwise we get demotivated and we do not want to continue or we have to think about kind of changing our strategy which with most people do is they just either increase or exercise or decrease the amount of food they are eating which then just sabotaged them even faster.
Dr. Davidson: Exactly and we definitely see that in females because especially once they hit right around the late 30s that early 40s and then menopause, too. Menopause is a huge aspect where they are talking about that weight gain. So definitely we ladies are quite a bit different than the boys.
Dr. Maki: Well, I hear the same thing for men. I think they do not focus on it as much. I think it is more socially acceptable for men to carry a little bit of extra weight. It is almost like; it is just normal where women are just that much more focused on it. They are trying to maintain something. They are little bit more urgent about that process. Men will finally get to that point of frustration, something will happen, some events, some scare, some whatever. And they will make a change where women just seem to be a little bit more, and maybe that is bias just because you and I are majority of the time, we are just talking to women, right? So they are little more hyper focused on that, on achieving whatever goal they are trying to set. Like I said that 15 to 25 pounds, they want to lose where men, we just do not hear it as often partially just because we are not dealing with as many men as we are women. We are dealing with more men; we probably hear the same thing. But percentage wise, we hear more from the wives versus the husbands.
Dr. Davidson: And I love the dedication, women, trying to exercise, five times a week trying to count their calories, see what they are eating, trying to eat healthy which you love that dedication. I just think like we talked about just making a few little changes like, “Hey, let us get a little bit better sleep, maybe would cut back on that cardio and like I need to do and you always tell me.” Let us work on a little bit more of the weights, doing some squats, working on that upper body, doing a little bit more weight training and then maybe not having to go to the gym so frequently because I think we need that rest and relaxation so we are not constantly feeling like we are being chased by a grizzly bear.
Dr. Maki: Yes, right. Yes, I think the recuperation and recovery part is drastically over missed all the time. And people do not realize you just cannot go, go, go all the time and then eat 1200 calories a day. Eventually, in some cases you are going to develop some serious symptoms from that, kind of like over-training syndrome, which is actually a real thing. You cannot push your body physically as much as you want with eating so little food and this is also very counter-intuitive. But again, if you are doing this keto or intermittent fasting on a regular basis and you are not getting the results that you want, then you need to eat more food. If you have been doing something for a while at a low calorie state and you are not, this is also what the KCCP kind of emphasizes, is if you have been doing that for a while and you are not getting consistent results on the scale, then you need to go through like a re-feeding process, you need to increase your calories, so now those hormones that are compensating against you, your body can resettle those hormones and then it is like taking a step backwards in order to continue to take a step forward. And that is an evolving process that happens on a consistent basis whether you do it, every couple of days as a re-feed or in a sense that is what carb cycling is. That is why we called the book the Keto Carb Cycling Program because keto people drop calories, carbs come back in calories go up. So it is this inevitable, kind of ebb and flow to your caloric intake that allows for weight loss to happen over time because the body never really, as we said metabolism is kind of this moving target. You are really not ever shutting off your metabolism or not, shutting off the fat burning process you are able to maintain that over time. So instead of eating less, exercising more we always is recommending to eat more and exercise less. That is hard to do, that is really hard to pull off would not you say?
Dr. Davidson: Oh, yes, hard to wrap your brain around it. It sounds like, “What does it make sense?” But as you are saying it is the body is very adaptable that is why we are so incredible. As human beings were just so incredible, we are so adaptable that if you are a changing up your calories, maybe on a weekly basis over all like you mentioned over all the caloric intake for that week might be a certain amount but you are kind of each day is a little different then your body cannot get adapted to it. Because that is one part that we always talk about with that starvation diet is your body becomes adapted to 900 calories and then oh my goodness you start to eat like a normal human being and then of course the weight comes right back on. So if you are always changing that there is a little bit of some viability to that to be able to get the goals that you want. And also be able to maintain it, nobody can maintain, a thousand calories for the rest of their life. They always end up binging or holidays or whatnot. We got to make this a lifestyle change. So it is maintainable and you can go out with your friends or cook dinner with your family or go have a family dinner or have a holiday or birthday party. You want to make this a lifestyle that you can adhere to.
Dr. Maki: Yes, right and I think and agree this is semantics, what everybody thinks it means something is based on the strategy. When you are trying to lose, 15 to 25 pounds or whatever the number is for you, it is really not about weight loss, it is more about body recomposition. We all want more muscle, less fat. Okay, maybe guys want more muscle, but they certainly want less fat. Women just want less fat. But the way you get there is by having more muscle that is where the resistance component comes in because when you are doing aggressive cardiovascular work all the time, you are talking about cortisol. Cortisol is a very catabolic hormone; it breaks down your muscle tissue. So the higher your cortisol is because of your stress level, your lack of sleep and you are over-exercising and lack of food. All you are doing is breaking down your number one fat burning tissue, which is your muscle mass. And I do not even know where I heard this, I heard this not that long ago might have been on a podcast or something and I have to look up this research to kind of validate this so take it with a grain of salt but it is one of the number one again, on a research level so it is not necessarily very practical on a day-to-day basis. But I remembered it kind of caught my attention and wherever I heard it, I know that was a fairly reputable source, is that one of the number one factors of aging is what they call Sarcopenia. Sarcopenia meaning Sarco meaning muscle, so penia meaning less, so losing muscle over time is one of the fact is one of the major contributors to the aging process. So I think there is going to be a shift over the next few years where in some ways strong is the new sexy kind of thing. I think that CrossFit try to do some of that, where women were lifting weights. They were getting ripped and jacked, in some respects in a very female sort of way. But they are increasing their metabolic rate and now the 23 and a half hours that you are not working out that resting metabolic rate is where you are burning all those calories so you do not have to kill yourself in the gym all the time. That is the advantage of doing a resistance based training workout versus something that is cardio where you do not get that back in benefit.
Dr. Davidson: That is really interesting especially I like that strong is the new sexy.
Dr. Maki: Yes, I saw something like that, while it kind of died off but I think that maybe it is not going to be the trend but I think it needs to be the trend–
Dr. Davidson: Mm-hmm.
Dr. Maki: I think it needs to be the trend because women we see it all the time. You are not going to exercise the weight off. It is about being consistent. If anything like we said, it is about eating more, exercising less but making sure that the exercise you do has that long-term advantage to it or that long-term impact which is by increasing muscle which then raises your metabolic rate. So on a scale, if you have more muscle mass comparatively, you might weigh a little bit more on the scale. You might not get down below 140 pounds, you might be at 145 or maybe at 147 but might be leaner than you were at a 130, and you have proportionally more muscle. And therefore, your clothes are going to fit quite a bit differently the leaner you are that is what everyone is trying to accomplish. It is just that how they go about that is almost exactly the opposite. There is a way to gain weight, everybody is doing it in that particular fashion, starve yourself and exercise a ton and then never sleep that is a recipe for disaster in some respects.
Dr. Davidson: Definitely and I think you made a really good point there about do not let the number on the scale be your goal. Everybody is, “I want to be 123. I want to be 127. I want to be 138.” Everybody has got this number and the scale is evil. So if anything I think you all should take it out back and bury it and have a nice little rite of passage.
Dr. Maki: Yes, it is nice to have some way to monitor success or monitor progress, right? So the scales and easy way, but when you are really close to your ideal weight anyways within 10 to 15 pounds and number you decide what your ideal weight is just I mean you have made up in your head. It is not really the real number because you are relatively close to that number anyways, but looking at percent body fat, that is why doing a DEXA scan, you can find some imaging centers around the country. If you are in a major metropolitan area, Seattle, Las Vegas, Los Angeles, Chicago if you are in a big area like that or even a suburb of a big city. You are going to find an Imaging Center that does body composition testing with the DEXA scan. And then now you get a real percentage of what your lean body mass is, your muscle, your bone, and then of course what your percent body fat is and now that can be tracked over time. And I think they do scan like that for a hundred bucks–
Dr. Davidson: Yes, I think when we have done it; it is like a hundred dollars.
Dr. Maki: Yes, hundred dollars, hundred and fifty dollars you do that. Maybe in the beginning to do it every three months just to see that as long as that body fat percentage is going down whatever strategy that you are employing is working. So that number will continue to go down if you have been doing something for three months and you have not seen any change that means you need to switch things up a little bit. And that just looking at your overall routine and modifying some things always we stress, stress level and sleep quality. Reduce your stress as much as you can and or increase sleep quality. Sleep quality has to go up and then the exercise two to four days a week at the maximum, four days a week so it could be done every other day or you could do two days with a day off and then two days. So you are allowing for enough rest to happen in there, especially if you are busy, you are taking care of the kids, you are working full time, you are taking care of the kids and working full time. It does not leave a lot of room for some of those things which we hear it all the time. Women are just trying to pack so much into their day and their week and they wonder why they are not having any success.
Dr. Davidson: And I know that we kind of originally started this podcast or this episode about, perimenopause and menopausal weight gain, but honestly everything I think we have talked about especially what you have talked about. Dr. Maki can apply to anyone that is really looking to lose to lose some weight, so just some thoughts there.
Dr. Maki: Yes, right. I think it certainly translates because everybody is trying to follow the same strategy, but this one is specific to this category or this demographic of people that is really having a tough time. So if you have any questions, this is a very complicated topic. We know enough to be dangerous but we do have some very specific things and how we approach these types of topics. So if you have any questions, you can send us an email at email@example.com. Do you have anything else to add Dr. Davidson?
Dr. Davidson: You had mentioned about the KCCP, the Keto Carb Cycling Program. Do we still have that available as a free download?
Dr. Maki: So if you just go to the website progressyourhealth.com/KCCP then you can find the download there. There is a part in there about putting butter and coconut oil in your coffee, it is optional, you do not have to do that. Well, what I have found is that most women do not enjoy that part. It is really intended as a way to bolster caloric intake especially if you are doing kind of a keto diet. So if you do download it, you can completely ignore, “the adding fat and into your morning beverage.” We have found it not to really be that popular with women anyways, that part is completely optional but the rest of it kind of summarizes some of the things we have talked about emphasizes making sure you eat enough. One last thing before we finish this, I think is important. The average male his maintenance level of calories on a daily basis is probably between 3,000 to 3,500 calories for the average male. Women are probably somewhere between 2,000 to 2,600 calories as their maintenance level, that is the amount of calories they need over time to survive. And when a woman is on a 1,500 calorie or less diet or 1,200 calories or less that is not even taking in any exercise. She is potentially under-eating biting or between 500 to a thousand calories. So if you do not have to count calories, but if you just focused on eating four meals a day 500 calories each, you would be at basically 2000 calories, which is I think kind of a ballpark where most women need to be. The more activity you have then the higher that number should be not lower. And if you did that, focus on that over time, I think you would have end up having a lot more success than 1200 calories doing that for months and exercising 6 days a week.
Dr. Davidson: And I am sure a lot of you ladies out there and myself included are probably like. “What that is a lot of calories, I have never heard, I am supposed to eat that much calories.” But it is true so we are changing some of those theories.
Dr. Maki: Yes, right. Yes, so now granted we are not going to eat that every single day that might ebb and flow a little bit like it is supposed to, some days are more, some days are less that is kind of what the premise of the KCCP is in the first place, is getting people to kind of think in those terms. So it is a feast or famine, you eat, you overeat, under eat, overeat, under eat and our DNA and our genes and everything is kind of evolved over time to respond very well to that environment. We do not really respond well to three square meals a day necessarily. So hopefully this was helpful, hopefully this was not more confusing. Hopefully this gives you a little bit more insight and until next time. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: Take care. Bye, bye.