How the food quantity recommendations were calculated

Our dietitians calculate nutritional requirements individually when patients come for consultations.  However, we have simplified the recommendations for presentation in the book. The recommendations for food quantities in Chapters 5 and 6 were determined using standard dietetic methods by registered dietitians at the Block Center.   On page 101, for instance, readers are directed to choose a caloric level based on weight (for weight of less than 120 pounds, use the 1,200 – 1,400 calorie level, for instance).  Dietitians actually calculate caloric requirement based on height, weight, age, gender and activity level.  These are determined using the Harris-Benedict equations.  If you would like to calculate your own caloric requirements using this method, you can find a calculator at the following site:

Once a caloric level is chosen, we must calculate how many calories of fat, protein and carbohydrates you should eat to determine food quantity recommendations.  These values are determined as follows:

For the Core Diet:

The general percentage distribution of carbohydrates, protein and fat in the Core Diet is 60%, 20% and 20%. 

Recommended fat percentage = 15-20% of calories

Recommended protein level = 0.8 grams per kilogram of ideal body weight (IBW, which is calculated on the basis of height), as recommended by the World Health Organization. Once this has been calculated, it is transformed into calories (1 gram protein = 4 calories.  Note that one gram of fat = 9 calories!  Fat is much more calorically rich than protein).

Recommended carbohydrates:  After calculating the number of calories that are allocated to fat and protein, the rest of the calories are allocated to carbohydrates.  Grams of carbohydrate are back-calculated from the equation 1 gram carbohydrate = 4 calories.

However, this is not very useful in determining how much food you should eat!  To determine what you should actually eat, our dietitians developed exchange lists, much like those used by diabetics.  Exchange lists tell how to trade off different foods based on how much protein, fat and carbohydrates they contain.  A separate exchange list was made up for each of the food categories in the LOC diet – whole grains, vegetables, protein, dairy alternatives, fruit and fat.  Exchange lists take into account nutrient and caloric density in foods.  For instance, a quarter-cup of grapes contains many fewer calories than a quarter-cup of raisins.  Our exchange lists cover a wide variety of whole, natural foods that are part of the LOC diet.  Our dietitians sometimes use exchange lists in counseling patients who are accustomed to using this approach.

However, exchange lists are too detailed for many patients, so we also present food in terms of servings or volume measurements (i.e. cups or teaspoons), as is done in the book (pages 104-105 for the Core Diet).  You will note in the column “Trade-off approximations” that equivalent amounts of a variety of foods are listed.  For instance, in the Fruit section, ½ cup fresh food is said to be equal to ¼ cup dried fruits.  Thus, ½ cup fresh grapes and ¼ cup raisins will contribute about the same amount of calories and carbs to your diet. Similarly, ½ cup cooked legumes and 3 ounces seitan contribute similar amounts of protein (and calories) to your diet.  Our dietitians calculated the amounts of food shown for different levels in the Food Quantity Recommendations using our exchange system and the recommended levels of calories of fat, protein and carbohydrates for each caloric level (with a few adjustments made for practicality).

Chapter 6, Individualzing Your Diet, discusses situations in which patients have higher nutrient requirements than the basically healthy people who should use the Core Diet.  Patients who have cancer cachexia or accelerated weight loss due to catabolic cancers should use the High Intensity Diet, which is higher in protein and fat than the Core Diet.  Patients who are in treatment (surgery, radiation or chemotherapy but not hormonal therapy for breast or prostate cancer) should use the Treatment Support Diet, which is higher in protein than the Core Diet. This is because You will see in Chapter 6 that readers are coached to choose a calorie level based on their height and frame size, and that women and men choose their calorie levels separately.  The same basic calculations are used for the High Intensity Diet and the Treatment Diet as are used in the Core Diet, but the protein, fat and carb percentages are changed. 

High Intensity Diet:

Recommended fat percentage:  30% or under (this is because fat is a more concentrated source of calories, and patients with cancer cachexia need to eat calorically dense foods to replace the weight they are losing).

Recommended protein level: 1.8 grams per kilogram ideal body weight

Treatment Support Diet:

Recommended fat percentage:  30% or under

Recommended protein level:  1.3 grams per kilogram ideal body weight