The patella—also called the kneecap—is a small, flat triangular bone that is located on the front of the knee. It is only 2 to 3 inches wide, yet it is a critical part of the extensor mechanism, the group of muscles, tendons, and ligaments that work together to make it possible to straighten the leg and perform such essential activities as standing and walking. Because the patella is such an integral part of the extensor mechanism, we often use the broader label of extensor mechanism discomfort to describe patella-related problems.

The extensor mechanism consists of the quadriceps muscles, the quadriceps tendon, the patella, the patellar tendon, the tibial tubercle, and the lateral and medial retiniculum.

From the top of the knee, the quadriceps muscles hold the patella against the femur, or thigh bone. From the side, the patella is held in place by fibrous bands called retinicula. From the bottom of the knee, the patella is connected to the tibia via the patellar tendon. The back of the patella is covered with the thickest layer of articular cartilage of any joint in the body, which gives the patella special properties.

The patella moves as the leg moves—it glides up and down, and rotates on the femur until it’s in its track, the trochlea. The patella helps to keep the knee joint properly aligned, and it is also important for muscle strength by giving the quadriceps the extra leverage they need to cope with the enormous force that runs through the knee with each step or run. In fact, if the patella is removed, the force of extension is reduced by about 30 percent, which severely hampers the efficiency of the quadriceps and increases the force exerted through the joint. The patella also cushions and protects the other bones of the joint. For example, in the case of a fall or blow to the knee, the patella may prevent the condyles (bony knobs) of the tibia or femur from being injured.

Nonspecific knee pain or extensor mechanism pain is one of the most common complaints among patients. (Your doctor may refer to it as anterior knee pain or extensor mechanism discomfort.) It is characterized by a dull ache while walking up stairs or squatting, or the knee may suddenly give way or may catch when flexing. Very often, patients complain of grating and creaking when they extend or flex their knee or discomfort after sitting in one spot for a long time, such as when watching a movie.

At one time, kneecap pain was routinely diagnosed as chondromalacia, which is really a pathological condition characterized by the softening and progressive breakdown of articular cartilage. However, autopsy studies and surgery of patients without knee pain have shown that chondromalacia is very common, particularly among older people and, in most cases, does not cause problems. Therefore, we now use the broader term of anterior knee pain to describe patellar discomfort. What precisely does cause patellar pain? There are several potential culprits.

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You may be thinking you should avoid carbohydrates at all cost since they can so easily increase insulin secretion, which packs on additional pounds of fat weight. Carbohydrates, however, are an essential part of the diet. As long as you enjoy them in balance with protein and fats, they will do just the job they were originally intended to do—provide energy to the body.

Carbohydrates, or sugars, are the fuels your body burns in each of its three trillion-plus cells to provide energy. The brain “runs” on carbohydrates (or sugars). Carbohydrates are the quickest, most readily available source of energy, and when carbohydrates are no longer available, the body burns fat, then protein. If carbohydrates are underprovided, the body is often forced to cannibalize lean body tissue to provide fuel. So it’s important to eat enough carbohydrates to satisfy the body’s energy requirement each day.

Select carbohydrates that are low on the glycemic index (see chapter 6 for this information) and avoid foods that precipitously increase blood sugar. You would do well to virtually eliminate all starchy foods, such as potatoes, yams, carrots, corn, grain products, and rice that so easily increase blood sugar. Feel free to indulge in as many “greens” as you wish. Green foods are free foods!

The problem most people have with this chart is learning what constitutes 71.5 grams of carbohydrates, or 65 grams of protein. Here are a couple of tools to put this information in a format you can use to prepare your meals.

Most animal-based proteins (seafood, poultry, veal, lamb, beef) contain about 9 grams of protein per ounce. If you require 65 grams of protein per day, plan to use about 7 1/2 ounces of seafood, poultry, or other protein per day, divided between breakfast, lunch, and dinner.

By the way, the premise of this book does not allow for a totally vegetarian lifestyle. Those who eat eggs and dairy products as part of the protein source can easily become allergic to these foods through overconsumption, and soy products will put weight on a person who is either estrogen sensitive or for whom soy pulls down the activity of the thyroid gland.

Another way to measure the amount of protein you will need at each meal is to use the palm of your hand. Plan to eat a protein portion about the size of the palm of your hand. Carbohydrates can fill up the rest of the plate, as long as you are not using any starchy vegetables, sweetened beverages, or fruit.

Remember this simple rule: You must include a protein portion with each meal if you wish to slow down the entry of sugars into your bloodstream and encourage your pancreas to secrete glucagon instead of insulin. Insulin = Fat! No more high-carb meals or snacks!

If you have indulged freely in carbohydrates (either the “good carbs” or the “bad” carbs), you are going to find this approach a little difficult to swallow, especially if you’ve been working with the vegetable/grain base type of diet. I’m going to offer you a little grace, a little leeway in starting your program, because for you this may be an enormous change in lifestyle.

When I counsel clients using this prototype, I watch their faces while I’m unrolling the plan. If they pale, if their expression goes blank, or they stand up and say, “I can’t do this! I’m outta here!” I change my approach! After all, I want them to succeed, not secede!

I encourage you to take one meal at a time (dinner, for example) and work on balancing that one meal until you are totally comfortable with the plan. This may take just a few days; it may take a few weeks. But in that one meal, make sure the proteins and carbohydrates are balanced so carefully that you begin to feel a difference. You may even start to lose a little weight!

The host of the party was serving fresh-sliced watermelon. “That’s okay. That’s okay,” I said. But after a while it just hit me. I saw those slices cut into fourths, and I said, “Just the heart.” I tried to find the biggest piece, took it, and stood there and ate the heart. I just let the juice run down my chin and over my hand, and I said, “I’m going to cherish this moment.”

J.H.

When you are totally comfortable with dinner, do lunch. Either enjoy leftovers from the evening meal or use some of the lunch suggestions in the recipe section of this book. Work with both lunch and dinner for a few weeks until this new way of eating is ingrained into your psyche. Before you know it, eating a balanced meal will seem like second nature to you.

And by the way, don’t worry if you “blow it” occasionally. We all do. Just start over again at the next meal and carry on. Your body is a wonderful organism; it has grace built into it. It can handle the occasional nutritional disaster. Just make sure you get back on track as soon as possible and make those occasional “slips” as infrequently as possible.

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