Protein Slows Digestion? Nope.

By Jordan Feigenbaum MS, Starting Strength Staff, CSCS, HFS, USAW Club Coach

In response to this gem of an article. I answered this on the Starting Strength nutrition forum, but I thought I’d repost it here. The article’s claims are italicized and my responses are in bold. 

The food that we consume is absorbed and its nutrients are subsequently sent to different organs through the blood.

The food that we consume is absorbed and its nutrients are subsequently sent to different organs through the blood. Not really the case literally. Protein and carbohydrates get absorbed as amino acids and monosaccharides through the small intestine’s brush border> into the enterocyte (cell)> into the portal vein> to the liver first before going anywhere else, then they get distributed based on lots of factors.

Fats get absorbed as fatty acids directly into the enterocyte (cell) and packaged into the chylomicron (with cholesterol, phospholipids, etc.)> into the lymphatic system> into the venous circulation and then go to some tissues, but mainly those who express high levels of mitochondria for beta oxidation or peroxisomes for long chain fatty acid oxidation. Principally, these are the liver and skeletal muscle.

However, a slow or sluggish digestive system isn’t able to perform its assigned function effectively. That is why a person experiencing a bout of slow digestion is bound to feel extremely uncomfortable post lunch or dinner. Nausea, bloating and vomiting are the most common symptoms of sluggish digestive system that occur after having meals.

Notice they do not define a normal GI transit time for a mixed meal, a slow GI transit time for a “bad” meal, nor do they distinguish between a pathologically slow state like gastroparesis or ileus or obstruction and a “slow” transit time occurring due to a specific meal composition. Yes, there is a marked difference.

Constipation or common digestive problems like diarrhea and irritable bowel syndrome can make the digestive system sluggish.

Diarrhea is actually the GI contents moving too fast. IBS has physiological symptoms of a combination of diarrhea, constipation, abdominal pain, and abdominal bloating. Seems like it might not make the digestive system sluggish, right? Though if you’re constipated, sure (and fiber and/or some probiotics tend to improve symptoms by increasing motility and osmotic pressure in the intestine to propel the contents)

Although protein is good for health, excessively high amounts of protein in the diet can slow down the digestive health. This is because, the body has to really work to digest protein.

Not the case at all. Proteins are initially broken down via the acidic pH of the stomach (and further in the small intestine by pancreatic enzymes that are all part of our normal physiology) and are absorbed very rapidly into the portal circulation. Whey, for instance- spikes blood plasma levels of amino acids (digestive end products of protein) within 20 minutes of ingestion.

Mixed meals confound the “speed” component, i.e. what is the fat content (slows gastric emptying), fiber content (soluble slows, insoluble speeds), total kCal content (larger is slower), tonicity of the meal (isotonic empties faster than hypo or hyper tonic from the stomach to the small intestine), etc. In addition, the hormonal milieu at the time with respect to previous meals also influence gastric transit time. Ghrelin, for instance- increases when you’re hungry and increases the motility of the gut.

Don’t forget about existing food in the GI tract. See how this is quite complicated to talk about? Let’s not forget about drugs….

At any rate, Carbohydrate rich and protein rich foods empty at about the same rate, but normal gastric emptying following a meal is 2-6 hrs….so yea- perhaps this whole article is a bit silly, eh?

Unlike simple carbohydrates, proteins are heavy, hence are not easy to digest and so when its presence is alarmingly high in everyday meals, the consequence is a slow digestive system.

Now this is easy to see that this is wrong…

People with intestinal problems such as Crohn’s disease tend to have a sluggish digestive system besides bowel dysfunction (diarrhea or constipation), vomiting and stomach pain. In this condition the lining of the small and large intestine are inflamed. However, in most cases, the swelling infiltrates in the inner layers of the bowel tissue. This chronic inflammatory disease considerably slows down digestion as the food tends to move at a very slow pace through the intestine.

Fuark. Crohn’s is, currently, a dysregulation of inflammation in response to bacteria in the walls of the GI tract, which results in proinflammatory substances causing direct mucosal injury.

Crohn’s usually presents with diarrhea, fatigue, weight loss, and crampy abdominal pain plus oral ulcerations, perianal fissures, perirectal abscesses, and malabsorption BECAUSE THE FOOD CAN’T BE ABSORBED BECAUSE IT’S MOVING at a normal speed but the mucosa can’t absorb it.

A point to note that although food is digested in the stomach, most of the digestion occurs inside the intestine. Experts say that the intestine is the place where nutrients are observed and eventually circulated in the bloodstream to various parts of the body. However if the food stays for longer time in the stomach, this can affect the digestion process. This condition is known as gastroparesis, in which the stomach takes more time to transfer the ingested food to the intestine. This happens because the stomach muscles that are assigned the task of pushing the food to the intestine, lose their ability to work efficiently. Gastroparesis is the result of malfunctioning of the vagus nerve that regulates movement of muscles lining the stomach wall.

Most common KNOWN causes of gastroparesis:

1) diabetes mellitus
2) idiopathic
3) post-surgical (especially if vagus nerve damaged)

Other causes:

-meds
-etoh and tobacco, weed
-surgery
-infection (mono, chagas, rotavirus)
-CNS injury like a tumor or cerebrovascular event
-PNS pathology (parkinson’s or guillan barre)
-other issues (cancers, hypothyroid, lupus, intestine obstruction, portal hypertension, HIV, stroke and migraines)

So…yea, protein is UNLIKELY to be the cause of “slowed” gi emptying….

-thefitcoach

The Ultimate Top 5 List

By Jordan Feigenbaum MS, CSCS, HFS, USAW CC, Starting Strength Staff

I’ve been doing a lot of work with clients, the new website,  and others (see Reddit AMA #1 and #2) and it’s got me thinking: What are the most important things in training that people are doing wrong?

Facepalm_1

Obviously this also tends to include things like nutrition, lifestyle factors, etc., but I’ve really been seeing a lot of common threads amongst people who need some help. So, without further ado here’s my Ultimate Top 5 List:

  1. Eat More Protein
Mom, where's the protein?

Mom, where’s the protein?

All things being equal, more protein is better from a performance and aesthetic standpoint with the following caveat: if you’re weighing and measuring all your food anyway, this does not apply. Most people eating ad libitumdo not eat enough protein. This also includes people who are specifically looking to increase their protein intake on a daily basis, however, this generally results in 4-5 days of a decent protein intake but 2-3 days of sub optimal protein intake. It’s just not that palatable in and of itself and few people actually crave protein unless they haven’t had some animal flesh in a while.

That being said, I’ve consistently seen better results when it comes to strength increases, better body composition, and compliance on a dietary strategy when it has more protein in it. Don’t get this confused with me telling you that you need 400g a day to make gains, as this is hardly the case. What I’m saying is that most people, male or female, should be between 200-300g of protein/day based on their age (older=more protein), size (bigger=more protein), sex (females=more protein), and training status/frequency (more frequency/harder training= more protein). In addition, if you suffer from compliance issues, i.e. you fall off the wagon frequently, then more protein tends to help this as it is very satiating. Above all else, hit your protein numbers for the day and most other things will take care of themselves.

Lifestyle Hack: Immediately after training drink a protein shake. Repeat again before bed. This get’s you at least halfway there.

2) Do The Correct Conditioning Work

What's better, walking on an incline or this?

What’s better, walking on an incline or this?

Most people undertaking a body recomposition phase in their life immediately start to do some sort of conditioning work concomitantly. Unfortunately, this often tends to be of the low to moderate intensity variety, i.e. walking on a treadmill, jogging, riding the bike, etc. While I applaud people for making healthy-ish changes in their lives, I think they could do a better job MORE EFFICIENTLY with some well structure high intensity interval training (HIIT).

The argument most people make about low intensity cardio being > HIIT is that “it burns more fat calories” and “burns more calories total”. Here’s the rub, low intensity cardio only burns a higher percentage of calories from fat than HIIT does. It does not burn a greater number of fat calories unless the total work done is grossly disproportional, i.e. someone is comparing doing 1 hour of cardio vs. 5 minutes of HIIT. Additionally, I’ll concede that traditional cardio burns more calories during the actual activity, however HIIT burns more calories over the course of the next 16-48 hours (+/- 8 hours) via metabolic increases systemically.

The only really good rationale for incorporating low to moderate intensity cardio in someone’s regimen (who isn’t an endurance athlete) is to just provide a calorie burn without expending the effort of HIIT (it’s much harder so you can’t do it all the time, especially if you’re on a massive deficit), or the person simply cannot muster the requisite effort or drive to push themselves to the limit during the HIIT. The magic is in the intensity. If the intensity isn’t there, then don’t bother.

Lifestyle Hack: On your off days (optimal) or at the end of your training sessions (okay) do the following protocol: 5 minute warm up, then 7 rounds of 30 second sprints followed by 3 minute rest periods. Cool down with 10 minutes easy effort.

3) Train Economically

Most people screw the pooch on this one, thinking they need to hit all sorts of variety and complex training to reach their goals when in fact, some form of either linear progression or rudimentary periodization will work just fine (outside of competitive lifters).

If you’re a beginner/novice, all you need to do is hit the big exercises 2-3 times per week and add weight to the bar each week, BECAUSE YOU CAN. If you can no longer do this, you’re not a novice anymore and thus, should not be on a novice program.

After the novice program ends, you do not need a 4 day split with all sorts of fancy accessory exercises in order to drive progress. What you need is consistent exposure to the movement at various levels of intensity (weight) and volume (reps x sets). Complexity can come later, when you need it.

Lifestyle Hack: Pare down your training template to the bare bones: squat, deadlift, press, bench press, chins, and power cleans. If you’re going to add anything, it better be a curl variation, a triceps exercise, and some abs. Everything else can stay in everyone else’s crappy program.

4) Eat the Right Amount of Energy

Bacon vs. Pasta? Easy. Bacon by unanimous decision

Bacon vs. Pasta? Easy. Bacon by unanimous decision

This should go without saying, but it’s not fat OR carbs that make you fat. It’s too much of either, or more often, too much of both. For the strength or anaerboically inclined athlete, carbohydrate is a much more effective fuel bioenergetically and I’d try to persuade this population to shift to a high protein, moderate to high carb, and low fat style diet. On the other hand, someone who’s not really into strength or is an endurance athlete would benefit from being efficient at using fat as a fuel in addition to carbohydrates, as fat is very important in long endurance efforts. For this population, I’d lean towards a high protein, low to moderate carb, and higher fat style diet. The biggest takeaway from this is that if overall energy is high, i.e. both carbs and fat are high, this will likely lead to unwanted “changes” in the body unless you’ve specifically added small amounts of carbs and fats to the diet incrementally.

Note: both diets are high protein

Of course, all of these recommendations are in relative amounts and not exact. High carb to one person might be low carb to another and vice versa. The important thing is to choose which way you’re going to go and choose appropriately based on what you do and what you can comply with.

Lifestyle Hack: Eat lean proteins and veggies at most meals of the day. Add starch pre and post workout. Add enough fat to suit your needs at meals outside of the periworkout window.
5) Eat Enough Fiber

We’ve heard for so long from the mainstream medical community that we should “Get more fiber in!” Surprisingly, I’m mostly on board with this statement. Here’s why:

The rationale behind having a “fiber goal”  is multifactorial. One, fiber is thermogenic in that it requires lots of energy to move it to the large bowel where the resident bacteria ferment it into a short chain fatty acid. Two, three, and four it tends to be very satiating, all things considered, lowers the glycemic index of meals, and controls for how much junk you can eat and still be compliant, i.e. 200g of carbs is different from 200g of carbs with the caveat you’re getting 35g of fiber/day too. Five, fiber levels have been linked to many healthy outcomes. Whether or not this is correlation, i.e fiber within the diet means you’re eating “healthy”, or causation, e.g. fiber ingestion itself is healthy, is unknown to me but it is what it is. Finally, fiber just eliminates one more variable in macro recs. If fiber intake is changing but carbs stay the same then the two inputs are not exactly equal in effect.

So there you go, the five things you and your friends need to be doing to take your performance and aesthetics to the next level! I’d love to hear from people reading this blog. What do you want to hear about next??

-thefitcoach

The Truth About Gluten

By Jordan Feigenbaum MS, CSCS, HFS, USAW CC, Starting Strength Staff

Unless you’ve been living under a rock or living off the grid for some time, chances are you’ve at least heard about gluten and gluten-free diets. There is good reason for this as gluten and similar nutrients have been the subject of a flurry of recent research efforts and clinical observations. To begin, let’s talk about what gluten is and why we’re even bringing it up.

Gluten is a protein that’s found in all products containing wheat, barley, rye and other foods as a binding agent and even in some prescription drugs. Gluten generally increases elasticity of the dough and improves its texture to aid in palatability. It lets bread rise and maintain its shape as well.

Gluten is made up of what we call prolamin proteins. This essentially means that gluten is made of constituents rich in proline (prol-) and glutamine (-amin) and in wheat’s case, these prolamin proteins are gliadin and glutenin [1]. The prolamin proteins in barley, rye, and corn are: hordein, secalin, and zein, respectively. Oats also contain a prolamin protein known as avenin, although this is a rather minor constituent in comparison to the others.

I will detail how these prolamin proteins interact with our bodies later on in this article, but for now we can say that these proteins resist being broken down in the small intestine by the usual proteases and peptidases [2]. Proteases and peptidases are enzymes that help the body break down proteins from food we ingest for absorption in the small intestine. We can intuit that this might possibly be a bad thing as I’ll discuss later.

As mentioned before, gluten is a hot topic these days. Using the Google search engine and typing in “gluten free” results in over 82 million hits. Originally the topic of gluten intolerance or using a gluten free diet was limited to those suffering from celiac sprue disease. However, the number of those diagnosed with celiac disease has been increasing steadily in recent times, affecting approximately 1 in 133 Americans and countless undiagnosed people. It is important to understand that this disease commonly goes undiagnosed, for almost 11 years in most cases [3]. The issue isn’t a lack of a formidable test to diagnose celiac or gluten intolerance, the test exists and it is very specific, however it is not very sensitive- or at least not as sensitive as some clinicians would prefer. At any rate we cannot deny that “gluten” and “gluten-free” are buzzwords in today’s health and fitness world.

Consider this, in 2003 there were approximately 135 “gluten-free” food products were introduced to the market and in 2008 alone there were 832 introduced. The growth in the gluten-free food sector has recently been estimated to be 15-25%. Then there’s the bevy of research coming out of the medical field.

A New England Journal of Medicine (NEJM) article catalogued 55 diseases associated with gluten intake including : osteoporosis, irritable bowel syndrome, anemia, cancer, fatigue, canker sores, rheumatoid arthritis, lupus, multiple sclerosis, numerous autoimmune diseases, anxiety, depression, schizophrenia, dementia, migraines, epilepsy, neuropathy, and autism [4]. Government agencies associated with Celiac disease also report a decrease in symptoms for patients going on a gluten free diet with the following diseases: rheumatoid arthritis, Parkinson’s disease, neuromyelitis, Down’s syndrome, peripheral neuropathy, multiple sclerosis, seizures, ataxia and late-onset Freidreich ataxia, brain fog, osteoporosis, type 2 and type 1 diabetes mellitus, and anemia [5].

There are many reasons to believe that some people have become more intolerant of gluten as the generations go by. Celiac disease prevalence is increasing and reports of increasing sensitivity to gluten have also come to light. Plausible causes of this include the genetic manipulation of wheat and other grains, increased exposure to gluten, prolamin proteins in more and more food products at higher concentrations, and increased public knowledge of gluten intolerance or celiac itself[6].

While going gluten-free hasn’t been established as a weight-loss protocol in and of itself, anecdotal evidence disputes this with many people seeing weight loss as a nice byproduct of utilizing this diet. Some experts postulate that this is because without gluten in the diet overall calorie intake is decreased, while others claim it’s because gluten drives one to consume more palatable food. I tend to agree with this sentiment.

There is little certainty whether or not gluten is directly correlated to weight loss or gain, except in celiac patients that is. celiac patients often present with nutritional deficiencies stemming from malabsorbtion of digested food in the gut. When they switch to a gluten-free diet, however, their gut lining is repaired and they absorb more nutrients. So we could imagine that if a celiac patient ate a similar amount of food before and after the switch to a gluten free diet and now they are absorbing more nutrients than before, they might potentially gain some weight.

Interestingly enough, gliadin, which is found in gluten, exhibits what’s known as an ­insulin-mimetic effect. Gliadin mimics insulin’s effect on fat cells, that is, it attaches to the same receptor that insulin does on fat cells and causes it to incorporate glucose from the bloodstream into the tissue and store it as fat, just like insulin does. Insulin normally has a negative-feedback loop that keeps it in check. So when insulin levels rise more and more blood glucose is shuttled into the fat tissue and when blood sugar has been returned to a normal level insulin levels fall as the hormone (insulin) no longer interacts with its receptor. Gliadin, however, does not exhibit this negative-feedback loop and stays attached to the receptor and continues to exert its effect [7]. Also gliadin interacts with digestive hormones such as cholecystokinin (CCK), which is involved in regulating appetite control. This gliadin exerts a negative effect essentially blocking appetite control and potentially causing storage of fat via its insulin-mimetic effect [7].

With all that out the way let’s delve in to what foods contain gluten, how gluten and prolamin proteins interact with the body, and what, if anything, we should do about it! Gluten, as mentioned before, is in all products made of wheat, processed with wheat, or anything that uses wheat, barley, rye, or modified food starch. These foods include:

-beers, breads, candies, cakes/pies, cereals, cookies, crackers, croutons, gravies, imitation meats, pastas, processed lunch meats, salad dressings, sauces (including soy sauce), self-basting poultry, soups, maybe oats during production, modified food starch, medications/vitamins may use gluten as a binding agent, play dough

Foods that don’t contain gluten include:

– corn, gluten-free flour, polenta, rice, tapioca, fresh meat, fruits, most dairy, potatoes, vegetables, wine/liquor/cider/spirits

When we take in any food it’s usually through the mouth (hopefully) and digestion, but not absorption, starts immediately. From the mouth the food is compacted into a bolus as it moves down the esophagus and to the stomach. In the stomach some digestion takes place but it and all the previous digestion pales in comparison to what is to come, digestion-wise, in the small intestine. After passing through the stomach the partially digested food enters the small intestine which is about 21 feet long and comprised of three different parts listed here from beginning to end: the duodenum, jejunum, and ileum.

Digestion primarily occurs in the duodenum, whereas absorption primarily occurs in the jejunum and ileum. We can think about the small intestine as a long tube with finger-like projections known as villi. The layer of cells covering the inside of this digestive tube are called enterocytes and these cells interact with any and all of the digested food particles including gluten and its components gliadin and glutenin. Enterocytes are sealed off between each other by what’s known as a tight junctions (zonula occludens), which is made up of three distinct proteins: cadherins, zonulins and occludins. We can generally think of the tight junctions in the gut as being impermeable or resisting the transmission of any molecule, substance, or compound between the cells. In a healthy person this would mean that absorption of nutrients happens directly across the enterocyte (transcellular) and not in between them (paracellular).

We already know that gliadin and gluttenin are not digested by the enzymes in the small intestine, via proteases and peptidases, and as such they interact with the enterocytes directly [2]. When these prolamin proteins interact with enterocytes they cause a disruption of the tight junctions of the small intestine. They do this by binding to a zonulin receptor on the enterocyte which causes a release of zonulin, which was previously bound tightly, and a subsequent remodeling of the enterocyte’s structure and a loss of occludin. So we no longer have zonulin and occludin doing their job binding tightly to one another and we get an opening in the small intestinal wall, or permeability of the digestive tube [8].

Chronic exposure to gliadin from gluten or similar substances can cause a down-regulation in production of zonulin and occludin, which further increases small intestine permeability [8]. This permeability allows molecules and substances to move freely into the body’s circulation or blood stream. Now these things are foreign and wherever these particles end up are recognized by the body’s immune system and this is bad news.

With this permeability other gliadin, glutenin, and prolamin proteins initiate an immune response, both the innate and cell-mediated immune cascade to be exact. The innate immune response causes the body’s inflammatory cells to be attracted to wherever these foreign materials end up. The innate immune response also ends up signaling inflammatory chemicals to be released to help destroy the invading foreigner. An enzyme called transglutaminase helps modify gliadin and gluttenin so that it more effectively stimulates the immune system [8]. We could envision a situation where all this inflammation in remote areas that these foreign substances have relocated could cause some serious damage and it’s not hard to see why the New England Journal of Medicine has associated 55 diseases with gluten intake and reactions.

With a permeable gut due to faulty tight junction functioning we get antigenic materials into our circulation. Some clinicians refer to this as leaky-gut syndrome, although it’s not widely recognized in Western medicine. Gut permeability has been linked to allergy induced autism, nutritional deficiency, increased absorption of toxins, liver inflammation, infection, rheumatoid arthritis, asthma, multiple sclerosis, vasculitis, Crohn’s disease, colitis, Addison’s disease, lupus, thyroiditis, chronic fatigue syndrome, and fibromyalgia [9].

So what do we make of all this? The research and anecdotal evidence seems to suggest eliminating gluten and similar prolamin protein-rich foods from the diet is probably a good idea. Eliminating wheat products, barley, rye, and other potential trouble sources like corn and oats is not very difficult to do, just don’t eat the products and use grass-fed meats, wild-caught fish, vegetables, nuts, fruits, roots, tubers, and seeds to make up your diet. By committing to 30 days of this elimination diet you will be able to accurately assess what effect, if any, these foods have on you. Do you feel better, look better, perform better at the end of this period of time?

After the elimination period you can try and revisit one of the eliminated foods to see what happens. Does it make you feel sick, gassy, or bloated? If so, you might be better off without it. Essentially you are drawing a line in the sand and setting a baseline for your own nutrition. By establishing a “normal” level of digestive health you can tweak the parameters to fit your own goals. If fat loss is the goal avoiding the wheat products might be smart due to the insulin-mimetic effect, their potential hyperpalatability, as well as avoiding processed foods in general. If you are looking to put on some size then you should also think about optimizing your ability to absorb the foods you eat so perhaps taking in potentially noxious food stuffs isn’t a good idea. Hopefully you liked this article! Please share it with friends, family, and coworkers if you did!

-thefitcoach

References

1) http://www.celiac.com/articles/8/1/What-is-gluten-What-is-gliadin/Page1.html

2) Lammers KM, Lu R, Brownley J, et al. (July 2008). “Gliadin induces an increase in intestinal permeability and zonulin release by binding to the chemokine receptor CXCR3”. Gastroenterology 135 (1): 194–204.e3. doi:10.1053/j.gastro.2008.03.023. PMC 2653457. PMID 18485912.

3) http://www.celiac.com/

4) http://www.nejm.org/doi/full/10.1056/NEJMra010852

5) http://www.glutenfree-diet.org/benefits.htm

6) http://www.huffingtonpost.com/david-katz-md/gluten-free-diet_b_907027.html

7)  http://intelegen.com/nutrients/lectins_their_damaging_role.htm

8)  S. Drago et. al Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac  intestingal mucosa and intestinal cell lines. Scandinavian Journal of Gastroenterology, 2005; 41: 408-419

9) http://www.ei-resource.org/illness-information/environmental-illnesses/leaky-gut-syndrome-(lgs)/

The “New” Mayo Clinic Diet??

By Jordan Feigenbaum MS, CSCS, HFS,  USAW CC, Starting Strength Coach
First order of business today: I’m teaching a Starting Strength pulling camp at Crystal Coast Strength and Conditioning. You can check it out on Facebook here, and register for it ($150.00) here. It’s being held February 9th from 1-5pm and we’ll cover the mechanics, anatomy, coaching, etc. of the deadlift and powerclean in the classroom and on the platform. If you’re looking to check out one of the best gyms in the country, improve your own lifting or coaching, or just learn more about training in general, don’t miss out on this!!
Okay, now let’s talk about the “New Mayo Clinic Diet“, which you can check out in the picture below or here.     
Screen shot 2013-01-21 at 4.11.23 PM
So what do I think about it???
The gist of the diet:
They are trying to push a low-ish carb, low calorie diet with the idea that since they’re including satiating fats and proteins at each meal that they’ll improve compliance by: a) people not being  hungry, b) not be too low calorie (which reduces REE and performance very quickly), and c) not being too restrictive  with classically “unhealthy” foods* like bacon, seasoning, butter, etc.
*Unhealthy in the “appeal to authority”, sheep-like conventional wisdom that people who should know better, like physicians, RD’s, etc., fail to rebuke.
 
The criticisms:
Of course this diet “could” work if it improves compliance for someone while also reducing their caloric intake to the appropriate level, which obviously varies based on diet composition, i.e. is it a high carb, low carb, high fat, low fat, high/low/moderate protein diet, etc?
On the other hand, I think it’s deficient in protein, which has been shown to improve body composition in isocaloric diets, i.e. diets with the same calories but different macros (pro/carb/fat). Pro-tip 1: Bump up the protein
It also may or may not be low in fats for a long term intervention depending on how much a person was using at their meals to cook or put on salads. You definitely need some help with the essential fatty acids, so I’d supplement with either fish or cod liver oil. Pro-tip 2: Either eat fish or supplement with fish oil.
The grapefruit thing has a little backing behind it as the flavonoid “naringin” does alter the cytochrome P450 liver detox pathway which is used to clear, among other things, caffeine. By combining this with coffee or tea, the half life of caffeine is extended which theoretically increases lipolysis rate. The unsweetened juice, unless it’s grapefruit juice, does not contain significant amounts of this enzyme so that’s pretty pointless.Pro-tip 3: Grapefruit would be the fruit to choose if trying to maximize caffeine’s activity.
Now let’s pick apart the “instructions” one by one:
 1. At any meal you may eat until you are full, and you can not eat anymore. You must eat the minimum listed listed at each meal.

Without any sort of way to keep accountable this could, over time, result in a spontaneous increase in calorie intake just like any other diet thereby preventing any weight or fat loss. On the other hand, most carbohydrate restricted diets do result in a spontaneous reduction in calories due to both palatability/mouth-feel of the foods changing (decreasing in palatability, food-reward) and increased satiation. Overall, I don’t have a super big problem with the claim you can eat ad libitum on this diet, although it is technically inaccurate.

2. Do not eliminate anything from the diet, especially don’t skip the bacon at breakfast or omit salads. It is the combination of foods that burn the fat.

This is BS. The “combination” of foods most certainly does not burn fat, the decreased energy intake and slight benefit in hormonal function burns fat. There’s nothing special about eggs, grapefruit, bacon (ok well maybe bacon) etc. At the end of the day, it will come down to the 3 C’s, calories, compliance, carbs :-).
3.The grapefruit is important because it acts as a catalyst that starts the burning process.
No. As discussed above, this has a mild, if any, effect on lipolysis whereas caffeine and coffee are the real deal. You still will occasionally see “naringin” included in fat burners because it excites the bro-scientists.
4.Cut down on coffee, it affects the insulin balance that hinders the burning process. Try to limit to one cup each meal.
No. Coffee (regular and decaf) is perhaps the strongest appetite suppressant out there (except for maybe nicotine). It doesn’t negatively affect insulin balance or insulin sensitivity in the long term and in fact, can preferentially help shuttle glucose into skeletal muscle, which would be very nice (Borat voice) post workout. It also improves lipolysis, which is another obvious plus. I’d skip it at dinner if it kept me awake tho and opt for decaf then.
5. Don’t eat between meals, if you eat the combination of food suggested, you will not get hungry.
This doesn’t really matter. 6 meals a day vs 3 vs 1 meal a day, it doesn’t matter. There is no “stoking” the metabolism with more meals. Use the frequency that makes you most compliant, prevents hypoglycemic and ravenous feeding episodes, etc. Eating too frequently though may prevent significant lipolysis from occurring if too many cals/carbs are taken in too frequently, thereby precluding fatty acids from being burned for fuel.
6. The diet may eliminate sugars and starches. Fat does not form fat, it helps burn it, so you can fry food in butter and use butter generously on vegetables.
Fat most definitely forms fat and does so  easier than carbohydrates and much easier than protein because it does not need to be modified as much to form, you guessed it, fat. That being said, increased intake of dietary fat also improves beta oxidation, the metabolism of fatty acids for fuel. If a diet is lacking in fat, then the enzymes responsible for this process decrease, which may lead to decreased satiety (not being able to access your own body’s fat stores for fuel between meals making you hungry) and decreased vitamin and sex steroid status. Fat intake can be “high” or “low” depending on the type of diet being used and in this instance, a low carb diet, it should be higher obviously. On the other hand, if it’s too high, the calories may or may not be conducive to bodyfat loss just like if carbs or protein were too high.
7. Do not eat desserts, breads and white vegetables of sweet potatoes. You may double or triple helpings of meat, salads or vegetables. Eat till you are stuffed. The more you eat the more weight you will lose.
In a word, No. You will not lose more weight the more you eat. If eating a bit more meat/fat keeps you more compliant and improves your adaptation to ketosis then you’ll see an uptick, but overall you’ll still have to be calorically restricted with your hormones/metabolism functioning correctly. God I sound like a broken record.
8. There may be no weight loss in the first 4 days, but you may lose 5 pounds on the 5th day. You may lose 1 and 1/2 pounds every two days until you reach your goal.
If you don’t lose any weight on this diet on day 1, you’re doing it wrong. The diuresis (water loss) from cutting the carbohydrates should be significant within the first day.
9. DRINK EIGHT 8oz GLASSES OF WATER EVERY DAY. 1/2 GALLON.
At a minimum.
-thefitcoach
Other comments:
Citrus fruits vs berries debate: actually, blueberries (7.3)/strawberries (8.0)/blackberries (8.1) have more sugar than grapefruit (6.3)- although you’re correct if we were talking about apples (13.3) or grapes (18.1). All amounts per 100g.I like your recommendation for oil/vinegar dressing, too. The trans fats, lecithins, soybean oils, and other “sh!t” in the dressings are something I like people to avoid.