I’ve become a bit of a fan of Robert Lufkin (whom I keep confusing with Robert Lustig ("Metabolical“), of whom I am also a big, perhaps even bigger, fan), especially after I saw the promo for his soon-to-be released new book, ”Lies I Taught In Medical School." Apparently it’s due out next month, but now I am seeing something about December? Anyway, I aleady have a .pdf version of it and will share over the coming weeks. Here’s a quick run-down of his TOC just to tease you:

Chapter 1: I Did Everything Right and (Almost) Died Anyway

Chapter 2: Three Deadly Lies I Believed (and Taught) In Medical School

Chapter 3: The Obesity Lie

Chapter 4: The Diabetes Lie

Chapter 5: The Fatty Liver Lie

Chapter 6: The Hypertension Lie

Chapter 7: The Cardiovascular Disease Lie

Chapter 8: The Cancer Lie

Chapter 9: The Alzheimer’s Lie

Chapter 10: The Mental Health Lie

Chapter 11: The Longevity Lie

Chapter 12: The Plan (“when to eat, what to eat, how much to eat”)

In a recent Constant Contact type email from him, he was singing the praises of the new (but not super novel), sort of extreme intermittent fasting trend of eating one meal a day (OMAD), citing the benefits for metabolic health, digestive health, focus & productivity and, of course, meal planning/expenditure.

My first reaction was, heck, just about everyone I know/have known in this city since like the 1980’s has pretty much lived, however unintentionally, an OMAD existence: grab a coffee at the corner bodega (nowadays more likely some corporate chain) on the way to the subway or office in the a.m. and before you know it it’s quitting time and you exclaim to your co-workers, “God, I’m so hungry. I haven’t eaten anything all day but coffee and {X].”

Usually it’s a bagel. (Always a bad idea.) For the more indulgent types, TEOAR. (But is that cheese really cheese? And were those happy hens that could scratch & peck?? Better, if you must, to whip it up at home.)

It all fits so neatly into the modern, especially single-ish and DINK lifestyle. Less fussing with meals and meal planning. Less clean up. And depending on what and where that one meal is, perhaps a reduced monthly food bill. (Dining out is usually a bad idea unless you know the people well and they will let you into the kitchen.) And alcohol, sorry, is every day more of a no-no, best reserved for really expensive/small batch vintages and really special occasions— not a daily routine.

Lufkin enumerates the (well-documented) benefits of his new OMAD lifestyle to include:

  1. Improved insulin sensitivity

  2. Decreased inflammation

  3. Enhanced digestive health

  4. Simplified meal planning/expenditures

  5. Achievement of mild to moderate ketotic state (i.e., preferentially burning fatty acids over glucose for fuel), and its resultant ...

  6. Increase in focus, clarity, productivity

He adds the obligatory asterisk about how this might not be for everyone and that how you might want to speak with your healthcare provider or a dietician (do they really still make dieticians, these days??) before making any dramatic changes to how you eat. But here’s the big problem, or at least challenge, with OMAD: how in the world will you get all the nutrients— both macronutrients as well as micronutrients, not to mention FIBER!!— into your lovely body if you eat only once a day?

Heck, people who eat three meals a day can’t seem to get all the necessary nutrients in, especially given the way our food is grown, picked and stored these days! (Cue Cordain.)

Phytonutrients, minerals, fatty acids and fiber aside, we’re talking 50-150 grams a day of protein (from your LBM in kg (the IFM): for me that’s 77g of protein; to your LBM in pounds (Peter Attia): so 170 grams of protein daily!!??; to half your LBM in kg (I forget who exactly insists on this, arguing forecably that we eat and are told to eat way much more protein than we really need, sbut it was someone who speaks with great authority): a mere 37.5 gram of protein), depending on whose advise you follow. And the body is said to “not handle well” more than 20-30 grams of protein at a time. So there’s one big stumbling block out of the gate. And we haven’t even looked at daily fat intake requirements.

What is an aspiring (or de facto) OMAD-er supposed to do then?

I say lean hard into either a smoothie type blended “salad,” at a time of your choosing, or if you prefer something warm (which is better for almost everyone), a kind of poke or ramen bowl, but without most or all of the noodles. If you are methodical and a little creative with your ingredients, you can possibly check off just about every color in the rainbow as well as a substantial portion of your daily FIBER quota. (50-60 grams per day, or all the way up to 80-100 if you really want to have fun, mix of both soluble and insoluble, is the goal here.) Then when you are in full planning mode for that OMAD, you can concentrate more on getting the necessary protein and fat. (In the Dale Bredesen brain health eating plan I often reference, fat constitutes a full 75% of total daily calories. That’s like 150-200 grams (5 to 7 ounces) of fat a day! But more on that later...)

Such a plan, obviously, does not qualify as OMAD— because it’s, duh, two: your soup bowl or smoothie (for example, at morning, late morning or midday) packed with 10 or 12 gorgeous and fiber/nutrient-packed veggies/nuts/berries; and then a full-on prepared meal (at sundown or so). I really think that’s the best we can do.

A woman commenting on Dr. Lufkin’s LinkedIn page notes, “The eating schedule protocol that begins at birth has always concerned me and never made any sense.  I had never given it much thought until I breast fed. My pediatrician recommended that I wake my son every two hours in order to feed him. Waking a sleeping infant to feed him? It went against any and all maternal and intellectual thought processes.”

And perhaps the best and last word comes from a PhD nutritionist, "I used to eat around five small meals a day. They were largely high-protein, lots of leafy greens, healthy fats and very modest amounts of carbs. After lunch there were no carbs at all. The effect on body composition (i.e., losing fat, gaining muscle), energy and mood lasted over a decade— until menopause intervened. Point being that I have found frequency of feeding not nearly as important as the actual macronutrient composition of the diet. But yes, this is an ’N of 1.’"

So one meal a day? I love the idea, but it seems like a stretch. Maybe even impossible for optimal long-term health. But I still love/admire Dr. Lufkin and look forward to diving into his book. Will report back along the way.

Mike Barr, a longtime Poz Contributing Editor and founding member of and scribe for the Treatment Action Group (TAG), is a functional medicine practitioner and herbalist in NYC. Reach out to him here. Or sign up for his curated (and generously discounted) professional grade supplement store here.