1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727
732 268-7663
Search

PATIENT PORTAL

1670 ROUTE 34 N. 3R FLOOR SUITE 3C WALL • NJ 07727
732 268-7663
michael rothman md, image of logo 2024
REQUEST AN APPOINTMENT
michael rothman md, image of logo 2024
Search
Close this search box.
michael rothman md, image of logo 2024
Search
Close this search box.

Weight-Loss Services

A Metabolically Directed Approach

Fix What is Wrong

  • Eating too frequently
  • Eating a low fat, high carb diet
  • Thyroid issues
  • Sex hormone imbalances
  • Chronic Stress
  • Chronic inflammation
  • Circadian dysfunction – poor sleep-wake cycles

Health is Achieved Toward the Middle of the Curve

The Food Pyramid, Which is Based on a High Carb-Low Fat Diet
Contributes to High Blood Pressure, Diabetes, Obesity and Heart Disease

Problem–Eating too Frequently

  • Myth – eating small, frequent meals will “boost your metabolism”
  • Fact – every time you eat, your pancreas secretes insulin and excess insulin is a root cause of weight gain
  • Solution – Eat no more than 3 times each day, no snacking

Problem–Eating a Low Fat Diet

  • Myth – eating fat makes you fat
  • Fact – Excessive carbohydrates (and even excessive protein) can raise your insulin levels leading to weight gain
  • Solution – eat a substantial portion of healthy fats with each meal

Numerous Studies “Proving” That Cholesterol is the Root Cause
of Heart Disease were done on Rabbits

Problem–Eating the Wrong Fats

  • Myth – saturated fat and cholesterol cause heart disease and obesity. Unsaturated fats (like nuts and seeds and avocados) are the “good” fats
  • Fact – Unsaturated fats are very fragile, increase oxidative stress, contribute to mitochondrial dysfunction and slow down your metabolism
    Saturated fats are very stable and increase your HDL. Cholesterol is the building block for your sex hormones, adrenal – cortical hormones, vitamin D, bile salts and cell membranes

The Hype: “Everybody Knows”

“Everybody knows” there are good fats and bad fats

  • Saturated fats are the “bad” fats
  • Unsaturated fats (like fish oil) are the “good” fats
  • Saturated fats will clog your arteries
  • Saturated fats cause cancer
  • Saturated fats are evil and cause every disease know to man…high blood pressure, diabetes, obesity, heart disease

Put a Log on the Fire

  • You must eat a sufficient amount of fat at every meal
  • These nutrient dense foods will stabilize your blood sugar
  • A stable blood sugar improves autonomic nervous system functioning
  • These healthy fats provide building blocks for adrenal cortex and sex hormones

All Sex and Adrenal Cortex Hormones are Made From Cholesterol

Saturated Fats Have no Double Bonds, They are very Stable and Tend to Stimulate Your Metabolism

Unsaturated Fats Have Double Bonds – They are unstable and tend to Slow Down Your Metabolism

Problem – Undiagnosed or Poorly Treated Thyroid Problems

  • Myth – “All my thyroid labs are within normal limits” means “there is nothing wrong with my thyroid”
  • Fact – The ranges for thyroid hormones (and many other ranges) by definition are based on a statistical analysis such that 95% of all patients will always be within the “normal” range.
  • Solution – work with a doctor that understands the complexity of thyroid hormone management

There are a Few Forms of Thyroid Hormones

  • T4 = levothyroxine, four iodine molecules, also known as Synthroid, most commonly prescribed thyroid hormone. NOT the active form of thyroid hormone
  • T3 = liiothyronine, 3 iodine molecules, also known as Cytomel, rarely prescribed by primary care doctors and endocrinologists. THE active form of thyroid hormone
  • RT3 = Reverse T3, a mirror image of T3. BLOCKS T3 effectively putting the brakes on the active hormone by blocking the T3 receptor. Rarely measured by primary care doctors and endocrinologists
  • Natural forms of thyroid hormone (dessicated porcine hormone)
  • Gluten free T4 = Tirosint
  • Gluten free T3 – not commercially available – needs to be compounded
  • Gluten free dessicated procine thyroid hormone – available commercially as NP thryoid or can be compounded

Significant Percentages of Thyroid Patients are Inadequately
Treated with Inappropriate Medications

  • T4 only Thyroid Hormones are inactive and must first be activated by your liver and peripheral tissues to be biotransformed to T3 (active)
  • Many people, do not properly biotransform T4 to T3 and make significant amounts of Reverse T3 (blocks active T3)
  • Many factors can contribute to Reverse T3 syndrome – excessive estrogen, excessive insulin, excessive cortisol,

Several Factors can Contribute to Reverse T3 Syndrome

Adrenal Stress, graphic image example

Problem – Sex Hormone Imbalances

  • Myth – Estrogen in women is the “good hormone”
  • Fact – Excess estrogen is very common and contributes to thyroid dysfunction, fluid retention, cancer, auto-immune issues and weight gain
  • Solution – Your sex, adrenal and thyroid hormones need to be properly balanced

All Sex and Adrenal Cortex Hormones are Made From Cholesterol

Low Intake of Saturated Fat

  • Lowers Sex Hormone Levels

Decrease of serum total and free testosterone
during a low-fat high-fibre diet

  • Hämäläinen EK, Adlercreutz H, Puska P, Pietinen P.
  • The concentrations of serum total and free testosterone were studied in 30 healthy, middle-aged men during a dietary intervention program. When men were transferred from their customary diet to an experimental diet, which contained less fat with a higher polyunsaturated/saturated ratio (P/S-ratio) and more fibre, there was a significant decrease in serum total testosterone concentrations (22.7 +/- 1.2 vs 19.3 +/- 1.1 nmol/l SEM, P less than 0.001). Furthermore, serum free, unbound testosterone fell from 0.23 +/- 0.01 to 0.20 +/- 0.01 nmol/l SEM (P less than 0.01). The hormonal changes were reversible. This observation suggests that testosterone activity in plasma can at least partly be modified by changing the composition of the diet.
  • When men were transferred from their customary diet to an experimental diet, which contained less fat with a higher polyunsaturated / saturated ratio (P/S-ratio) and more fibre, there was a significant decrease in serum total testosterone concentrations.

Soy is not a Health Food, It is a Hormonal (Estrogenic) Poison

Problem–Chronic Stress

  • Fact–excessive cortisol impairs thyroid function, increases blood sugar, contributes to insulin resistance, reduces production of sex hormones and can lead to significant weight gain
  • Myth–taking supplements that purport to control or reduce cortisol are helpful
  • Solution–identify and reduce stressors like poor quality diet (edibolic stress), environmental stress, immune system stress, situational and emotional stress, circadian stress

Problem–Chronic Stress

If You Crave Sugar, You Are Addicted to Sugar

Most Breakfast Cereals are Overloaded With Sugar

Problem–Circadian Dysfunction

  • Fact–lack of sleep, poor quality sleep, poorly synchronized sleep-wake cycles (like night shifts or staying awake too long and and sleeping too late, daytime napping) contribute to insulin resistance, hormonal imbalances, metabolic imbalances and weight gain.
  • Solution–Good sleep hygiene. Sunlight during day (especially in the morning) avoidance of excessive artificial light after sunset. Sleeping in pitch black. Minimizing stimulating activities and food intake after sundown can help restore normal circadian rhythm.

Unfiltered Sunlight is Vital to Your Health, Sunlight has a Powerful
Effect on YourHypothalamic/Pituitary/Adrenal Axis

Problem–Chronic Inflammation

  • Fact–Chronic inflammation as a result of various stressors increases your cortisol, contributes to insulin and leptin resistance leading to weight gain
  • Solution–Fix what is wrong! Unhealthy foods, unhealthy air quality, stealth organisms, food sensitivities, unhealthy relationships, negative
    thoughts, metabolic imbalances need to be rectified

Benefits of Intermittent Fasting

What is intermittent fasting?

  • Intermittent fasting is way of timing your meals to allow you to be in a non-fed state for relatively long periods of time.

What is a “non-fed” state?

  • A non-fed state also known as the “post-absorptive state” is a physiologic state where your body has consumed easily accessible energy sources like sugar and glycogen. When you have depleted those stores, your body will start using fat as an energy source. You will need to abstain from eating for at least 8-12 before you actually reach the “non-fed” state
  • What is the advantage of being in the “non-fed” state?
  • While in the “non-fed” state, you will burn your own fat for energy; this will help you to reduce your body fat. More importantly, fasting (being in
    the non-fed state for extended periods of time) will reduce your insulin levels. Chronically elevated insulin levels (resulting from lack of being in
    the non-fed state) leads to insulin resistance (IR).

Why is Insulin Resistance (IR) so detrimental to health?

  • Research is demonstrating that insulin resistance (IR) is the root cause of many chronic diseases including heart disease, high blood pressure and type II diabetes. IR also contributes to weight gain, hypothyroidism, cancer, mortality from covid-19 and other chronic inflammatory diseases.

Doesn’t a calorie-restricted diet do the same thing?

  • No! Calorie restricted diet eventually will fail because your metabolism slows down under conditions calorie restriction. Intermittent fasting dose not restrict caloric intake, instead IF restricts the timing of your meals. IF does not slow your metabolism. Improving your insulin sensitivity will actually increase your metabolism.

Transitioning to Intermittent Fasting

  • Step 1–stop snacking – eat three meals each day – do not eat between meals
  • Step 2–stop consuming sugar, reduce excess carbohydrate intake
  • Step 3–Do not eat your first food of the day (breakfast) until you are hungry
  • Step 4–Eat your breakfast later and later in the morning as you start to become more fat adapted
  • Step 5–Eat two meals each day
  • Step 6–eat your first meal later and your last meal earlier to increase the amount of time that you are in the non-fed state
    Caution–extended fasting should be done under strict medical supervision
    Beware–excessive fasting can be stressful and therefore increase your cortisol levels leading to high blood sugars, suppression of thyroid
    function and failure to lose weight.
  • Step 7–Eat one meal a day (OMAD)
  • Step 8–Continue to extend your fast to greater than 24 hours

Tips for success

  • Reduce your carbohydrate intake levels-carbohydrates stimulate insulin
  • Avoid excess amounts of protein-protein can be turned into carbohydrates, which then increase insulin
  • Eat healthy fats-Meat, eggs, cheese, coconuts, chicken, pork … Avoid polyunsaturated fats (PUFA)-PUFA are found in nuts and seeds, nut butters margarine, commercial mayonnaise and salad dressings (usually in the form of canola oil or soy oil) and many processed foods
  • Eat real food-avoid protein powders, power bars, avoid processed foods. Protein powders often contain BCAA (branched chain amino acids) that can spike your insulin levels
  • Drink plenty of water-avoid juice, diet drinks
  • Avoid artificial sweeteners-they can spike you insulin levels
  • Get enough restorative sleep-poor sleep is very stressful, raising your cortisol levels, leading to high blood sugar, elevated insulin and finally
    insulin resistance
  • Reduce your stress-any aspect of your life that contributes to excess stress can raise your cortisol levels, leading to high blood sugar, elevated insulin and finally insulin resistance
  • Do short bursts of high intensity training (HIT). HIT will help to increase your metabolic rate
  • Do not try to starve yourself – this is not sustainable and will slow your metabolism
  • Do not overeat when breaking your fast-eat slowly in a calm, relaxed atmosphere.
  • Be flexible with your eating schedule
  • Plan ahead with what you are going to eat to break your fast-Do not just “grab something” because you are tired or hungry or time pressured

What Should I Eat?

  • Put a “Log on the Fire” every meal
  • The “Log on the Fire” = Good Fats
  • What kind of fat should I consume?

Saturated Fats, Won’t They Hurt Me?

  • This is not true
  • The notion that saturated fat is bad was created by the food industry to sell margarine, vegetable and seed oils

Meta-analysis of prospective cohort studies evaluating the
association of saturated fat with cardiovascular disease

Patty W Siri-Tarino, Qi Sun, Frank B Hu and Ronald M Krauss 1 From the Children’s Hospital Oakland Research Institute
Oakland CA Harvard School of Public Health Boston MA.

 

ABSTRACT


Background: A reduction in dietary saturated fat has generally been thought to improve cardiovascular health.
Objective: The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD; CHD inclusive of stroke) in prospective epidemiologic studies.
Design: Twenty-one studies identified by searching MEDLINE and EMBASE databases and secondary referencing qualified for inclusion in this study. A random-effects model was used to derive composite relative risk estimates for CHD, stroke, and CVD.
Results: During 5–23 y of follow-up of 347,747 subjects, 11,006 developed CHD or stroke. Intake of saturated fat was not associated with an increased risk of CHD, stroke, or CVD. The pooled relative risk estimates that compared extreme quantiles of saturated fat intake were 1.07 (95% CI: 0.96, 1.19; P = 0.22) for CHD, 0.81 (95% CI: 0.62, 1.05; P = 0.11) for stroke, and 1.00 (95% CI: 0.89, 1.11; P = 0.95) for CVD. Consideration of age, sex, and study quality did not change the results.
Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

Harvard Medical School Published in the American
Journal of Clinical Nutrition January 2010

  • Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD

 

Breast Milk

  • 55% of the calories from breast milk come from Saturated Fats
  • Also high in Cholesterol

 

Low Intake of Saturated Fat

  • Lowers Levels of HDL “good cholesterol”

Effect of low-fat diets on plasma high-density
lipoprotein concentrations

Katan MB.
Department of Human Nutrition, Wageningen Agricultural University, The Netherlands.

Low concentrations of HDLs in plasma are a strong predictor of risk for coronary as well as other cardiovascular diseases. There is increasing evidence that this relation is causal and that interventions that change HDL concentrations also change risk. One such intervention is exchanging fat and carbohydrate. In controlled trials, low-fat, high-carbohydrate diets decrease HDL concentrations. The effect is strongest when carbohydrates replace saturated fatty acids, but is also seen when carbohydrates replace mono- and polyunsaturated fatty acids carbohydrates. The effect is seen in both short- and long-term trials and therefore appears to be permanent. This finding is supported by epidemiologic studies in which populations eating low-fat, high-carbohydrate diets were shown to have low HDL concentrations. Weight losses with consumption of low-fat diets could theoretically counter effects on HDL, but in published trials weight losses have been modest and insufficient to offset the decrease in HDL concentrations induced by carbohydrates. Thus, replacement of saturated fat by carbohydrates adversely affects plasma HDL concentrations; replacement of saturated fat by unsaturated fatty acids deserves consideration as an alternative.
PMID: 9497172 [PubMed – indexed for MEDLINE]

American Journal of Clinical Nutrition

  • In controlled trials, low-fat, high-carbohydrate diets decrease HDL concentrations. The effect is strongest when carbohydrates replace saturated fatty acids

Metabolic Syndrome

  • A syndrome of high blood pressure, diabetes, obesity and heart disease initially recognized by Dr. Reavens
  • One of the most important causes of disease in the world

High Carbohydrate Diets, Triglyceride Rich Lipoproteins,
and Coronary Heart Disease Risk
– American Journal of Cardiology 2000

Abbasi F, McLaughlin T, Lamendola C, Kim HS, Tanaka A, Wang T, Nakajima K, Reaven GM.
Stanford University School of Medicine, California, USA.

In this study we compared the effects of variations in dietary fat and carbohydrate (CHO) content on concentrations of triglyceride-rich lipoproteins in 8, healthy, nondiabetic volunteers. The diets contained, as a percentage of total calories, either 60% CHO, 25% fat, and 15% protein, or 40% CHO, 45% fat, and 15% protein. They were consumed in random order for 2 weeks, with a 2-week washout period in between. Measurements were obtained at the end of each dietary period of plasma triglyceride, cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, remnant lipoprotein (RLP) cholesterol, and RLP triglyceride concentrations, both after an overnight fast and throughout an 8-hour period (8 A.M. to 4 P.M.) in response to breakfast and lunch. The 60% CHO diet resulted in higher (mean +/- SEM) fasting plasma triglycerides (206 +/- 50 vs 113 +/- 19 mg/dl, p = 0.03), RLP cholesterol (15 +/- 6 vs 6 +/- 1 mg/dl, p = 0.005), RLP triglyceride (56 +/- 25 vs 16 +/- 3 mg/dl, p = 0.003), and lower HDL cholesterol (39 +/- 3 vs 44 +/- 3 mg/dl, p = 0.003) concentrations, without any change in LDL cholesterol concentration. Furthermore, the changes in plasma triglyceride, RLP cholesterol, and RLP triglyceride persisted throughout the day in response to breakfast and lunch. These results indicate that the effects of lowfat diets on lipoprotein metabolism are not limited to higher fasting plasma triglyceride and lower HDL cholesterol concentrations, but also include a persistent elevation in RLPs. Given the atherogenic potential of these changes in lipoprotein metabolism, it seems appropriate to question the wisdom of recommending that all Americans should replace dietary saturated fat with CHO.

 

  • The 60% CHO diet resulted in higher (mean +/- SEM) fasting plasma triglycerides (206 +/- 50 vs 113 +/- 19 mg/dl, p = 0.03), RLP cholesterol (15 +/- 6 vs 6 +/- 1 mg/dl, p = 0.005), RLP triglyceride (56 +/- 25 vs 16 +/- 3 mg/dl, p = 0.003), and lower HDL cholesterol (39 +/- 3 vs 44 +/- 3 mg/dl, p = 0.003) concentrations, without any change in LDL cholesterol concentration
  • 2 weeks on the lower carbohydrate/higher saturated fat diet cut triglycerides almost in half, while at the same time increasing HDL

Manifestations of Low Saturated Fat Diet

  • Lowers HDL (“good” cholesterol)
  • Lowers sex hormone levels
  • Contributes to metabolic syndrome (weight gain, high blood pressure, diabetes, heart disease)
13 Ways Healthspan Guide, image of guide to be downloaded
exit intent logo, image of arrow icon

Wait! Before you go, subscribe to receive our FREE GUIDE, “13 Ways to Increase Your Healthspan,” and start living healthier today!

We hate spam as much as you do and will keep your information private.