No 56: The Diet Ladder

One of the first things you learn in medical school is that every condition has a “treatment ladder”. Not everyone will explain it this way and not every ladder is fully explained or documented, but if you are savvy this is how you would like about the treatments available.

You usually start with the weakest and the cheapest and the shortest, and then scale it up from there.

It has taken me 20 years of “dieting” and 13 years of medical training to finally think about turning the lists of available diets into a “treatment ladder”.

The higher up the ladder, the more effective the "diet":

1. SAD - Standard American Diet = 3 meals + snacks + sugary/milky drinks regularly 

2. Restricted diets - low fat, low carb, low sugar, low meat (vegetarian or vegan),

3. Keto/Paleo diets 

4. Time restricted eating = 12/12, 16/8, 20/4, 22/2, 

5. Intermittent fasting = 5/2, 2/5,

6. 500 calorie fasts and 1500 calorie fasts

7. Black coffee/tea fasts 

8. Water only fasts 

9. <3 day fasts 

10. <7 day fasts 

11. Longer fasts should only be under strict medical supervision 

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Obviously, this is a huge simplification and I suspect many people would disagree with some of the rankings in this ladder and some of the ethos behind some of the diets.

However, I would bet that this ranking would stand up to experimentation.

If you want to lose FAT, not just lose weight but lose FAT, then start at the top with the easiest diets and work your way up the ladder until you are fasting.

Discuss this with your doctor if you have medical conditions and please dont just do a 7-day fast because it might not be safe for you (this blog does not count as personal medical advice).

Fasting is one of those “cheats” that was discovered by almost every single society, civilisation, religion and culture around the world. It is something that Western Society thought we could remove because it wasn’t “rational”.

Now, we have once again discovered that fasting has incredible health benefits. Not only can you lose weight, but you can also reduce your blood pressure, reverse your diabetes and potentially even live longer.

If you don’t believe me (and if you believe in EBM then you should be sceptical), then I recommend the following:

1. Professor Roy Taylor

2. The Drive Podcast - Peter Attia and Jason Fung

3. The Fast 800 Diet Book by Dr Michael Mosley

But if you are a clinician or a patient, what have you got to lose by giving these a try?