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Medicine Research Center (FMRC) in Gig Harbor, Washington, monitor-
ing patients undergoing clinical trials for diabetes, insulin resistance, and
other medical conditions. Her special interest was expressed in her thesis,
“The Unique Role of Carbohydrate Metabolism in Regulation of Glyce-
mic Index.” Subsequently, she was instrumental in the development of the
low-glycemic-index dietary program for the FMRC. Barb frequently lec-
tures and is the coauthor of a number of articles on such topics as manag-
ing diabetes and metabolic syndrome with low-glycemic-indexdiets, and
diagnosing and managing food allergies. She is a gourmet cook who enjoys
developing healthy recipes and menu ideas.
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Copyright © 2009 by Scott Rigden, MD
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Library of Congress Cataloging-in-Publication Data
Rigden, Scott, 1948-
The ultimate metabolism diet : eat right for your metabolic type / Scott Rigden,
Barbara Schiltz. — 1st ed.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-89793-510-4 (pbk.)
ISBN-10: 0-89793-510-1 (pbk.)
1. Reducing diets. 2. Weight loss. 3. Metabolism—Regulation. 4. Low-fat diet.
I. Schiltz, Barbara. II. Title.
RM222.2.R52 2009
613.2'5—dc22 2008024261
Project Credits
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Book Production John McKercher
Developmental and Copy Editor Mary Miller
Proofreader John David Marion
Indexer Nancy D. Peterson
Editor Alexandra Mummery
Senior Marketing Associate Reina Santana
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Production Assistant Amy Hagelin
Rights Coordinator Candace Groskreutz
Customer Service Manager Christina Sverdrup
Order Fulfillment Washul Lakdhon
Administrator Theresa Nelson
Computer Support Peter Eichelberger
Publisher Kiran S. Rana
Printed and Bound by Bang Printing, Brainerd, Minnesota
Manufactured in the United States of America
987654321 First Edition 08 09 10 11 12
Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction:
Why Do We Need Another Weight-Loss Book? . . . . . . 1
Asking the Wrong Question . . . . . . . . . . . . . . . . . . . . 2
Let’s Get Out of the Box . . . . . . . . . . . . . . . . . . . . . . . 3
Who Am I to Say So? . . . . . . . . . . . . . . . . . . . . . . . . 3
1 What Is Switched Metabolism? . . . . . . . . . . . . . . . . .
Glossary of Medical Terms Used in Chapter 1 . . . . . . . . . .
5
5
Dynamics of Functional Medicine . . . . . . . . . . . . . . . . 9
The Obesity Crisis Is an Opportunity . . . . . . . . . . . . . . . 17
Screening Questionnaires Are the Key . . . . . . . . . . . . . . 19
How to Proceed after Completing the Questionnaires . . . . . 23
What If I Have Multiple Areas of Switched Metabolism? . . . 24
2 Ready. . . Set...Go! . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Glossary of Medical Terms Used in Chapter 2 . . . . . . . . . . 25
Weight Loss and Hiking the Grand Canyon . . . . . . . . . . . 25
Good Preparation Is Your Key to Success . . . . . . . . . . . . 26
3 Carbohydrate Sensitivity . . . . . . . . . . . . . . . . . . . . . 48
Carbohydrate Sensitivity Screening Questionnaire . . . . . . 48
Glossary of Medical Terms Used in Chapter 3 . . . . . . . . . . 49
What Is the Significance of Lifestyle? . . . . . . . . . . . . . . . 50
What Is Carb Sensitivity? . . . . . . . . . . . . . . . . . . . . . . 51
A New Understanding of Metabolism . . . . . . . . . . . . . . 52
v
vi The U lti mate Metabolism Diet
Your Genes Make You Eat Like a Caveman . . . . . . . . . . . 53
Three Ways to Get Moving . . . . . . . . . . . . . . . . . . . . . 58
Warming Up/Cooling Down . . . . . . . . . . . . . . . . . . . 60
Don’t Overshoot Your Target Heart Range . . . . . . . . . . . . 60
Get Motivated! . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Make Daily Activities Part of Your Workout . . . . . . . . . . . 63
Treatments for Carbohydrate Sensitivity . . . . . . . . . . . . . 69
Introducing Barb Schiltz . . . . . . . . . . . . . . . . . . . . . . 74
4 Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . 80
Metabolic Syndrome Screening Questionnaire . . . . . . . . . 80
Glossary of Medical Terms Used in Chapter 4 . . . . . . . . . . 81
What Is Metabolic Syndrome? . . . . . . . . . . . . . . . . . . . 85
Ethnicity and Metabolic Syndrome . . . . . . . . . . . . . . . . 91
The Relationship of Metabolic Syndrome
to Other Conditions . . . . . . . . . . . . . . . . . . . . . . . 92
Check the Family Tree for Metabolic Syndrome . . . . . . . . 100
Laboratory Findings for Metabolic Syndrome . . . . . . . . . 102
Treatment Options for Metabolic Syndrome . . . . . . . . . . 103
Two Dietary Interventions . . . . . . . . . . . . . . . . . . . . . 111
Tips for Dieters . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
5 Hormonal Imbalances . . . . . . . . . . . . . . . . . . . . . . . 124
Hormonal Imbalances Screening Questionnaire . . . . . . . . 124
Glossary of Medical Terms Used in Chapter 5 . . . . . . . . . . 126
Thyroid Hormone Imbalances . . . . . . . . . . . . . . . . . . . 127
Why the Diagnosis Is Missed . . . . . . . . . . . . . . . . . . . 129
Dr. Rigden’s Favorite Protocol . . . . . . . . . . . . . . . . . . . 131
Problems of Estrogen Dominance . . . . . . . . . . . . . . . . 131
Treatment Strategy for Estrogen Dominance . . . . . . . . . . 132
Polycystic Ovary Syndrome (PCOS) . . . . . . . . . . . . . . . 133
The Goals of PCOS Treatment . . . . . . . . . . . . . . . . . . . 134
The Cortisol-Stress Connection . . . . . . . . . . . . . . . . . . 138
Phases of Adrenal Response to Stress . . . . . . . . . . . . . . . 138
Understanding Stress and Weight Gain . . . . . . . . . . . . . 139
Stress Reduction Lowers Cortisol-Related Weight Gain . . . . 140
Nutritional Support for the Adrenal Glands . . . . . . . . . . . 141
Contents vii
6 Food Hypersensitivities . . . . . . . . . . . . . . . . . . . . . . 142
Food Hypersensitivity Screening Questionnaire . . . . . . . . 142
Glossary of Medical Terms Used in Chapter 6 . . . . . . . . . . 143
The Physician’s Perspective . . . . . . . . . . . . . . . . . . . . . 143
How Food Hypersensitivities Cause Weight Gain . . . . . . . 145
Seeing the Picture Clearly . . . . . . . . . . . . . . . . . . . . . 147
Treatment Options for Food Hypersensitivities . . . . . . . . . 148
7 Weight Gain with Chronic Illness
and Impaired Liver Detoxification . . . . . . . . . . . . . . . 160
Chronic Illness and Impaired Liver
Screening Questionnaire . . . . . . . . . . . . . . . . . . . . 160
Glossary of Medical Terms Used in Chapter 7 . . . . . . . . . . 161
A Common Story . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Inactivity and Prescription Medications . . . . . . . . . . . . . 163
Impaired Liver Detoxification . . . . . . . . . . . . . . . . . . . 164
Phase 1 and Phase 2 Liver Detoxification . . . . . . . . . . . . 165
Liver Detoxification Test . . . . . . . . . . . . . . . . . . . . . . 165
How Liver Detoxification Helps Weight Loss . . . . . . . . . . 166
The Role of Leaky Gut Syndrome . . . . . . . . . . . . . . . . . 167
Leaky Gut Syndrome and Liver Detoxification . . . . . . . . . 167
The Four “Rs” Program . . . . . . . . . . . . . . . . . . . . . . . 169
Achieving Effective Liver Detoxification . . . . . . . . . . . . . 170
8 Dealing Effectively with Emotional Eating . . . . . . . . . 176
Research on the Ineffective Lifestyle Syndrome . . . . . . . . . 177
Daily Relaxation . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Assess Stress in Your Life . . . . . . . . . . . . . . . . . . . . . . 180
The Importance of a Positive Mental Attitude . . . . . . . . . . 183
Do You Like Yourself? . . . . . . . . . . . . . . . . . . . . . . . 184
Techniques to Improve Your Self-Image . . . . . . . . . . . . . 186
Your Positive Attributes List . . . . . . . . . . . . . . . . . . . . 187
Getting in Touch with Denial . . . . . . . . . . . . . . . . . . . 189
Are You Too Nice? . . . . . . . . . . . . . . . . . . . . . . . . . . 189
The Vicious Cycle of Being Passive and Manipulated . . . . . . 190
Techniques to Improve Assertiveness . . . . . . . . . . . . . . 191
Three Important Lists . . . . . . . . . . . . . . . . . . . . . . . . 192
Help for Compulsive Eaters . . . . . . . . . . . . . . . . . . . . 198
viii The U lti mate Metabolism Diet
Weight-Loss Mind Games . . . . . . . . . . . . . . . . . . . . . 199
Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Victims of Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
It’s about Time! . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Time to Review . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Get Professional Help . . . . . . . . . . . . . . . . . . . . . . . . 208
What Do You Have to Lose? . . . . . . . . . . . . . . . . . . . . 208
Recipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Foreword
I have been in the fields of preventive and nutritional medicine for
33 years. I have known Scott Rigden, MD, for 30 of these years. He
has always been a “clinician’s clinician,” providing the best of family
medicine to his patients. He is a unique blend of a pragmatic doctor
who is concerned more about what improves his patient’s health out-
come than convention, coupled with the pursuit of what lies at the
evolving frontier in health sciences that he can add to his skills.
He is a true expert in metabolic medicine and bariatrics, or the
science of weight loss. He has been a leader in the field for more than
25 years, having successfully treated thousands of patients who had
failed to be successful in regaining their health through the best ef-
forts of many doctors. He has successfully treated the most difficult of
the “walking wounded” type of patient—those with chronic fatigue
syndrome, fibromyalgia, and long-term obesity and the attendant ef-
fects of insulin resistance, type 2 diabetes, and vascular disease. These
are not the type of patients that most doctors would like to build a
practice or reputation upon because their traditional outcome is so
poor. However, Dr. Rigden has made a reputation of successfully
treating these types of patients, resulting in long-term positive health
outcomes for them.
Why has he been successful where most doctors have not? In get-
ting to know Dr. Rigden very well over the past three decades, I be-
lieve it is a result of two factors. One is his indomitable spirit that
coaches the patient to success, and the second is his remarkable
program that differs considerably from the “standard of care” that
most doctors employ with patients of this type. Dr. Rigden has never
“bought in” to the concept that people who gain weight do so solely
as a consequence of a lack of self-control and excess calorie con-
sumption. As you will learn in this book, he has taken a larger view of
ix
x The U lti mate Metabolism Diet
the obesity-fatigue-chronic pain complex than to conclude that it is
simply a result of eating too many calories.
It is very interesting that if you explore the medical literature, you
will find no data indicating we have increased our per capita intake
of calories to a level that accounts for the increase in obesity we have
witnessed in the past 30 years. In fact, during this period we have
seen lower calorie, low-fat diets and foods being promoted more than
ever, but the prevalence of obesity-related health problems continues
to increase. Dr. Rigden is on top of the latest research that indicates it
is more than just “calories” that are the cause of the problem. In fact,
it might be that obesity is the effect and not the cause of the problems
we are witnessing today, such as the rising epidemic of type 2 diabe-
tes, sleep apnea, high blood pressure, fatigue, and immune problems.
The calorie is a unit of heat energy and, as such, has “no personal-
ity” when it comes to its influence on our metabolism. Recent medi-
cal science discoveries are finding that when we eat, we eat more than
calories. We actually eat information that comes from the composi-
tion of our food. This information is “read” by our genes and alters
our metabolism and how we look, act, and feel over years of eating
and living a certain way. Our body shape is a reflection of what we
eat, how we live, the environment we are exposed to, and the stress
we are under. Dr. Rigden approaches his patients with this concept
as the principle way with which he develops a personalized program
for their needs. The combination of genetic background, lifestyle,
diet, and environmental assessment gives rise to a different under-
standing of the patient than just the evaluation of their calorie intake
and their activity patterns.
Our bodies are controlled by complex metabolic processes. The
calorie content of our diet is only one small part of what influences
how our bodies store or utilize energy. We all know that a person
who is overweight looks as if they are storing too much energy in the
form of body fat, but they often behave as if they don’t have enough
energy to get through the day. This “switched metabolism” is a result
of more than eating too many calories. Rather, it reflects a complex
message that the body is translating from the diet and environment
that results in a situation of storage of energy as fat rather than utili-
zation of the energy from food for activity.
Foreword xi
This is much more complex than just saying a person has hormone
problems. In this book you will learn that this switched metabolism
contributes to an alteration in physiological function that results not
only in storing body fat, but also has an effect on fatigue, insulin re-
sistance, muscle and joint pain, low energy, and digestive problems.
You will learn how Dr. Rigden, like a detective, has pieced this puzzle
together during his three decades of dedication to his patients and
his pursuit of discovery.
The field of medicine is changing rapidly. What we often thought
were “truths” only a few years ago are now frequently found to be in
correct. The primacy of the calorie as the solution to the obesity epi
demic is one of those “truths” that is under revision. If it were so simple
that reduction of calorie intake could solve all the health problems sur-
rounding obesity, the problem would have been solved long ago with
the advent of reduced calorie foods and beverages.
Because food carries information to our genes to tell them how
to express themselves, the issue is one of delivering the wrong infor-
mation to the body. This information that comes from the food, life-
style, and environment of today then signals to the body to respond
by storing calories as fat, producing an inflammatory response, and
altering our appetite and digestive function. Dr. Rigden provides not
only a detailed explanation of this remarkable change in thinking
about the origin of our chronic health problems, but also a detailed
program based upon his decades of clinical experience and a plan as
to how to use this program in an individualized manner.
The world does not need another diet book. There are already too
many of them. In fact, none of the best-selling diet books really de-
liver on providing long-term health solutions. This book is different.
It does not focus on weight as the primary problem, but rather as the
result of inappropriate messages the body is receiving. You will learn
how to recognize these inappropriate signals and how to change them
from messages of alarm to messages of physiological harmony. This
book represents a new approach to weight management. It is not a
recapitulation of what everyone else has been saying about the topic,
opinions that have never demonstrated to be successful. Rather, this
book provides a fresh and innovative approach based on the latest
discoveries in the health sciences, coupled with Dr. Rigden’s 30 years
xii The U lti mate Metabolism Diet
of real clinical successes with difficult patients and his unique ap-
proach that you will learn how to apply. The information in this book
is groundbreaking. It has the potential to change health and health
care if it were understood and applied by medicine. The change in
medicine may take years, but for you, the reader, the benefit of Dr.
Rigden’s experience and expertise is available now. I am pleased that
you will be a reader of this book and an ambassador for many others
who will benefit from your experience in applying this information
successfully in your life.
— Jeffrey Bland, PhD, FACN, FACB
Fellow, American College of Nutrition
Acknowledgments
Some key teachers from early in my medical training who inspired
me greatly include Duane Hagen, MD, at St. Louis University Medi-
cal School, Dr. Skip Ruth at the E. W. Sparrow Hospital Family Prac-
tice Residency Program in Lansing, Michigan, and the late Dr. Evarts
Loomis, Hemet, California. I greatly appreciate the editorial assis-
tance provided by Sara Benum. My long-standing colleague and
friend, David Brunworth, MD, has patiently read early manuscripts
and made helpful suggestions. Many colleagues in the American So-
ciety of Bariatric Physicians have helped me become a better baria
trician, and I especially would like to acknowledge the late Peter
Lindner, MD, and Robert Stark, MD, for nurturing and encourag-
ing me.
Many colleagues at the Institute for Functional Medicine have
taught me much through the years. Contributing author Barb Schiltz
has generously shared many ideas that have influenced me and helped
my patients. Jeffrey Bland, PhD, has been a constant inspiration to me
for the past 28 years and has been my main teacher regarding nutrition
and nutritional biochemistry. My clinical staff has provided great sup-
port in implementing the ideas in this book at our office in Chandler,
Arizona, and I want to acknowledge LaRue Lepetich, Marie Hopper,
Evita Quintos, Geri Julin, Lisa Davis, and Tracy Baginski. Last, but
not least, I would like to thank my patients for their encouragement
and input regarding the book; their success stories have inspired and
helped me persist for many years in a difficult and challenging field.
xiii
DEDICATION
This book is dedicated to my best
friend
and the love of my life, Jean.
Thank you for all of your support
and belief in me and in this project.
Important Note
The material in this book is intended to provide a review
of information regarding weight loss. Every effort has been
made to provide accurate and dependable information. The
contents of this book have been compiled through profes-
sional research and in consultation with medical and men-
tal-health professionals. However, health-care professionals
have differing opinions, and advances in medical and scien-
tific research are made very quickly, so some of the infor-
mation may become outdated.
Therefore, the publisher, authors, and editors, as well
as the professionals quoted in the book, cannot be held re-
sponsible for any error, omission, or dated material. The
authors and publisher assume no responsibility for any out-
come of applying the information in this book in a program
of self-care or under the care of a licensed practitioner. If
you have questions concerning your nutrition or diet, or
about the application of the information described in this
book, consult a qualified health-care professional.
Introduction
Why Do We Need Another
Weight-Loss Book?
The United States is experiencing an obesity epidemic. One aspect of
this epidemic is an alarming increase in the incidence of type 2 dia-
betes mellitus. For the first time in U.S. history, this disease, which
used to be called “adult-onset diabetes,” is occurring in children and
teens. Another sign of the times is the fact that ambulance compa-
nies, hospitals, makers of children’s car seats, and even casket manu-
facturers have been forced to supersize their equipment and products
to accommodate larger American bodies. According to the Centers
for Disease Control and Prevention (CDC), more than 71 percent of
American men weigh too much, along with 61 percent of women and
33 percent of children. Obesity is fast approaching tobacco as the
number one cause of preventable death in the United States. The
price tag to taxpayers, according to the CDC, is $117 billion a year.
Moreover, Americans are spending a whopping $33 billion a year in
their often futile attempts to become thinner.
It is time for a revolutionary approach to weight loss! Weight-loss
books and diet franchises are a standard part of our culture, but they
have had little impact on the obesity epidemic. The lack of success
of previous books on this subject stems from three factors: First, au-
thors, and experts in general, are asking the wrong question about
obesity; second, the old paradigms accepted as gospel regarding
weight management revolve around calorie-counting and exchange
lists, concepts that do not work for 60 to 75 percent of overweight in-
dividuals; and finally, many authors are not sufficiently experienced
