A couple of months ago, I wrote a blog post entitled, Why Are Many Dietitians So Critical of Low-Carbohydrate Diets?
Subsequently, someone asked me if I thought dietitians were more bothered by the low carb or high fat aspect of a carbohydrate-restricted diet. I said it would really depend on the RD, but because most have been trained and therefore believe that that the brain needs a minimum of 130 grams of carbohydrates per day to function, that would probably be the primary concern. However, I'm starting to rethink that answer, particularly with respect to saturated fat.
My friend and fellow RD and CDE Aglaee Jacob wrote a wonderful article for this month's issue of Today's Dietitian entitled "Coconut Oil: Learn More About this Superfood that Contains Healthful Saturated Fats.
" In it, she outlines the many benefits of coconut's medium-chain triglycerides (MCTs) on neurological health, weight, and cardiovascular disease, among other issues. Aglaee previously wrote an article for the same publication on carbohydrate restriction for diabetes management which didn't prompt much of a response from their readership (although her previous article about a high-fat elimination protocol for gut health didn't sit well with one RD
). Apparently, characterizing coconut oil as a "superfood" and explaining the benefits of saturated fats went a little too far for many other dietitians. Aglaee received a message from the Today's Dietitian editor informing her that many RDs were upset by her article, particularly her assertion that saturated fats are not associated with heart disease. The editors are allowing her to publish a response, although they are uneasy about the extent of the criticism. Several other progressive RDs and I have written the editor in support of Aglaee's article and her position, along with providing supporting literature on saturated fats, and I'm confident that her published response will be as clear and convincing as the previous one defending her approach to gut health.
I find it concerning that saturated fats and trans
fats are repeatedly lumped together as "bad fats," when their properties and effects on health are very different. The former are natural and most are healthy, depending on the chain length and type, and have been consumed by human beings for thousands of years. Trans
fats, on the other hand, are highly processed, inflammatory, cause unfavorable changes to serum lipids, and frankly our bodies don't know how to deal with them. Unfortunately, many dietitians believe saturated fat contributes to heart disease and must be minimized, if not avoided altogether, despite the lack of evidence in this regard.
It's interesting that Today's Dietitian -- a publication I read and enjoy, as it often provides a lot of great information for RDs -- recently offered a guide from SCAN (Sports, Cardiovascular And Wellness Nutrition Dietetic Practice Group of the Academy of Nutrition & Dietetics) entitled 10 Simple Steps to Make Good Nutrition More Delicious
, yet very few dietitians took issue with the fact that this resource is funded by a grant from the makers of Country Crock and I Can't Believe It's Not Butter! margarines. Although these margarines no longer contain trans
fats, they do contain interesterified fats, which are highly processed and, according to early research, may be just as problematic. Natural fats like butter and coconut oil should be discouraged, and we as RDs are supposed to promote these manufacturated fats instead? This doesn't make sense to me.
For the record, while I'm disappointed in some of the corporate sponsors of Today's Dietitian, I truly appreciate their publishing of Aglaee's forward-thinking articles despite the controversy they ignite. I believe they strive for a balanced approach that will appeal to a broad range of nutrition professionals, which is laudable given the recommendations that come from many of the major health organizations.
When I see dietitians writing columns about low-carb recipes , the overwhelming majority are promoting foods that are low in both carbohydrates and fat. I'm very happy that some are willing to offer meal planning ideas that limit grains or starches, but the fat content is often unnecessarily low. Egg whites, low-fat cheese, and extra-lean turkey figure prominently in the low-carb recipes I've seen from dietitians online. I will agree that certain people with familial hypercholesterolemia, a relatively rare condition, may need to limit fat intake. Also, for individuals consuming a high-carbohydrate diet, cutting back on saturated fat may be wise. But on a carbohydrate-restricted diet, fat is required as the primary energy source, with saturated and monounsaturated fats being the preferred forms for this purpose. There is a limited amount of protein the body can use effectively, and a very-high-protein, low-carbohydrate, low-fat diet is unsustainable and unhealthy.
I propose that it's time to stop the fat phobia and encourage our patients and clients to eat natural sources of saturated, monounsaturated, and (in smaller quantities) certain polyunsaturated fats in order to optimize rather than jeopardize their health with processed fats that have known and unknown adverse side effects. And the "natural" list includes coconut oil, for all the reasons so eloquently stated by Aglaee in her article.
1. Siri-Tarino P, et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91:535–546, 2010
2. Lawrence G. Dietary fats and health: dietary recommendations in the context of scientific evidence. Adv Nutr 1;4(3):294-302, 2013
3. Sundram K, et al. Stearic acid-rich interesterified fat and trans-rich fat raise the LDL/HDL ratio and plasma glucose relative to palm olein in humans. Nutr Metab (Lond)15;4:3, 2007
Burrata with heirloom tomatoes, arugula, olives, olive oil
While doing research for one of my Answers.com articles, Defending Your Low-Carb Diet,
I found an interesting article on WebMD. I know that much of the information found online is critical of carb restriction, but I was unprepared for the claims made on this website, which is extremely popular and considered a trusted source by many Americans.
First of all, the article
discusses "high-protein, low-carbohydrate diets" and defines "high protein" as 30-50% of caloric intake. Aside from the Stillman diet
and perhaps the diets of a few bodybuilders, I don't know of any other popular low-carb plans that recommend more than 30% of calories from protein. On a 2000-calorie diet, 30% is 150 grams of protein, and 50% is 250 grams. Most low-carb diets are moderate in protein, although some people may consume higher amounts. This article purports to talk about the risks vs. benefits of high-protein, low-carbohydrate diets, but the "benefits" are glossed over, and several of the statements seem to denigrate carb restriction in particular.
According to Web MD, high-protein, low-carb diets can cause many health problems:
- Kidney failure This is untrue in the case of people with healthy kidneys. Although individuals with advanced kidney disease may need to restrict protein, there is no evidence that a high-protein, low-carb diet damages renal function (1).
- High cholesterol The article states "It is well known that high-protein diets (consisting of red meat, whole dairy products, and other high fat foods) are linked to high cholesterol. Studies have linked high cholesterol levels to an increased risk of developing heart disease, stroke, and cancer." First off, low-carb diets don't always result in elevated cholesterol levels. And in the vast majority of cases, lipid profiles become more favorable in terms of particle size and number, improved HDL to cholesterol ratio, and lower triglycerides, resulting in less risk of cardiovascular disease and stroke. The exception would be people with familial hypercholesterolemia, who may need to limit dietary fat and cholesterol and replace most foods high in saturated fat with items containing monounsaturated fat like olive oil. With respect to cancer, older and recent research has demonstrated that it is associated with lower rather than higher cholesterol levels (2,3).
- Osteoporosis Studies indicate this is not a concern with high protein consumption provided intake of plants -- ie, nonstarchy vegetables -- is adequate (4).
- Cancer It's irritating to repeatedly read the assertion that low-carb diets don't provide vitamins, minerals, fiber, and antioxidants. There are loads of micronutrients in animal products, and the vegetables, berries, nuts, and avocado consumed on carbohydrate-restricted diets supply plenty of fiber and antioxidants.
- Unhealthy metabolic state (ketosis) The information on ketosis in this article was contradictory but predominantly negative. On the one hand, the benefits of ketosis (switching to fat burning, weight loss, reduced appetite) are discussed early in the article, but later: "During ketosis, the body forms substances known as ketones, which can cause organs to fail and result in gout, kidney stones, or kidney failure." Where is the evidence for this statement? Children with epilepsy following extremely low-carb ketogenic diets (about 10 grams of carb per day) were found to be at greater risk of developing kidney stones (5), but as far as I know, this hasn't been seen in adults following VLC diets that include nonstarchy vegetables and berries. As far as gout, people who already have the condition will need to continue to monitor their uric acid levels, and they would benefit from eating alkalizing plant foods like vegetables in addition to protein and fat. However, there is no evidence that ketogenic diets cause gout, and because this condition is related to insulin resistance, outcomes may actually improve on a carb-restricted diet. Finally, there is no evidence that ketogenic diets cause kidney failure; in fact, preliminary research suggests they may actually reverse kidney damage (6).
In the summary, "Is Low Carb Right for Me?" the writer states that carb restriction is dangerous, particularly for those with heart disease, and that low-carb diets don't allow a high intake of fruits and vegetables. I strongly disagree. I believe this way of eating is beneficial for people with heart disease for the reasons listed above, as well as improvements in hyperinsulinemia, hyperglycemia, and hypertension. And there are plenty of plant foods allowed on a low-carb diet. I eat vegetables at every meal, a few servings of nuts a day, berries once a day, and avocado just about every day on my VLC diet. I probably get more vegetables than most people do, along with more fiber and antioxidants.
Although I guess I shouldn't be surprised, it concerns me that such a highly critical and inaccurate article was published on WebMD. Perhaps there are even worse articles written on medical sites considered reputable? In my opinion, using scare tactics to discourage people from adopting a carbohydrate-restricted diet is troubling, particularly since this way of eating has had such a positive impact on a significant number of people and has the potential to improve the lives of so many others.
* Although low-carbohydrate diets are safe and healthy for most people, it's important to speak with your doctor prior to adopting a low-carb diet or making other dietary changes.
1. Friedman AN, et al. Comparative effects of low-carbohydrate, high-protein vs. low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012 Jul;7(7):1103-11
2. Kritchevsky SB, et al. Serum cholesterol and cancer risk: an epidemiologic perspective. Annu Rev Nutr. 1992; 12:391-416.
3. Strohmaier S, et al. Total serum cholesterol and caner incidence in the metabolic syndrome and cancer project (ME-CAN).J Epidemiol Community Health 2011; 65:A302 doi:10.1136/jech.2011
4. Barzel US, et al. Excessive dietary protein can adversely affect bone. J Nutr 128:1051-1053, 1988
5. Sampath A, et al. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol. 2007 April:22(4):375-378
6. Poplawski MM, et al. Reversal of nephropathy by a ketogenic diet. PLoS One 6:1–9, 2011
We just returned from a two-week European vacation and thoroughly enjoyed it! We visited London for the first time and were very impressed by this amazing city that has the energy and culture of New York along with the history and architecture of other European cities. We also spend a few days in Zurich visiting my relatives, as we do whenever we're on the other side of the Atlantic.
In England, my husband and I met up with a UK-based dietitian named Annette Henry who is currently working on her PhD conducting research on carbohydrate restriction, appetite regulation, and weight loss. We also spent an afternoon with Eddie and Jan Mitchell from The Low Carb Diabetic
website. Eddie has Type 2 diabetes and eats a low-carb diet in order to maintain healthy blood glucose levels, weight, and lipids. Jan follows the same way of eating. We had a fantastic time with each of these fellow low-carb advocates and shared a real sense of camaraderie and purpose.
In terms of carb-friendly dining options, the airlines apparently don't have much of an understanding. Here's a photo of the dinner I was served on the plane. I ordered a "diabetic meal," and this is what it consisted of (carb content approximated):
5 oz grilled chicken breast
1 large roll (30 grams carb)
1 cup white rice (45 grams carb)
1 cup mixed fruit (15 grams carb)
1/2 cup cooked vegetables (5 grams carb)
Mixed salad with fat-free vinaigrette (8 grams carb)
I ask you: Is this meal containing around 100 grams of carbohydrates appropriate for someone with diabetes? I don't even want to think of what my blood sugars levels would have risen to had I eaten the high-carb foods. My husband didn't make a special request for a diabetic meal and was served a nearly identical tray. The difference? He was given regular salad dressing, while I received the fat-free vinaigrette that was higher in carbs!
Overall, the food in Europe was very good, and it was quite easy to stay very low carb no matter where we ate. I had eggs and/or bacon with spinach or mushrooms for breakfast, and meat, poultry, fish, or cheese with vegetables at lunch and dinner. This kept me well under my usual 30-40 grams of carbs for the day, and I often had raw hazelnuts, almonds, and chocolate made with 100% cacao for dessert, as well as tea with cream or half-and-half at or between meals.
One of my favorite meals in Switzerland was Wuerst und Kaese Salat (sausage and cheese salad), which I've loved since childhood. I had this three times in Zurich. It's simply sliced sausage, cheese, lettuce, cucumbers, tomatoes, cabbage, and carrots topped with a cream-based dressing. Delicious, nutrient-dense, filling, and less than 5 grams of digestible carbs!
I've been following a very-low-carb diet for over a year now, and I truly love this way of eating. I can tell you with 100% honesty that I didn't feel at all deprived throughout our entire vacation because I ate nourishing high fat, moderate protein foods to satiety, along with liberal amounts of delicious fresh vegetables. How could I feel anything but satisfied on such luxurious fare?
Bottom line: Stay on plan during vacation by choosing low-carb foods unique to the area you're visiting, and enjoy!
Off topic, I posted another article on Answers.com, and this one is a recipe for chili. Not really European, I know. Chili is typically served in the colder months, but I find that it tastes good year-round, and cooking on the range keeps the kitchen from getting too hot.Easy Low Carb Chili
As someone who tries to read a wide variety of blogs devoted to carb restriction, I often see negative statements about dietitians not understanding the science behind energy balance, hormonal regulation, and blood glucose control. I frequently get e-mail from people saying something to the effect of, "I didn't know there was such a thing as a low-carb dietitian!" There are actually several registered dietitians I know of personally who believe in at least moderate carbohydrate restriction and higher fat intake than currently recommended by government health organizations. However, the majority of RDs favor low-fat diets that are inherently higher carb given the relatively narrow protein range of 15-30% that is almost universally agreed upon.
Why are so many dietitians against low-carb? It's usually one or more of the following beliefs -- some of which I used to share, by the way:
1. They think it's dangerous.
Ketosis. Just hearing the word makes most dietitians uneasy. The thought of someone eating fewer than 130 grams of carbohydrates per day is generally considered unhealthy and insufficient to support brain health. Never mind that our ancestors were often in ketosis for long periods of time and many scientists, physicians, athletes, people with diabetes, and others eating low-carb diets use ketones as an alternative energy source with excellent results. There are studies demonstrating that ketone bodies are the preferred fuel for the heart, adrenal cortex, and other tissues in addition to the brain. Aside from people with Type 1 diabetes who can develop the very dangerous condition of diabetic ketoacidosis from illness coupled with inadequate levels of insulin, levels of ketones do not rise to dangerously high levels in the blood because they are efficiently used for energy by the body.2.They believe the diet-heart hypothesis.
Despite much evidence to the contrary, many dietitians think that fat, particularly saturated fat, raises LDL ("bad") cholesterol and increases heart attack risk. 3. They think the diet is unbalanced.
I've heard the following comments many times: "How do you get enough vitamins and minerals if you don't eat whole grains? And what about the fiber?" A low-carb diet can provide high amounts of all vitamins and minerals (animal products are the best sources, despite what's promoted in the media), as well as adequate fiber from nonstarchy vegetables, berries, nuts, and seeds.4. They think no one will follow it long term.
Some of my colleagues say that while low-carb diets may help people lose weight, they don't really stick with it and just end up regaining all the weight plus more. Well, for some folks this may be true, but I tend to believe they'd behave the same way after losing weight on any other diet. There are many people who follow a carbohydrate-restricted diet for life and stay healthy doing so, and their experiences shouldn't be discounted just because others end up abandoning it.
Again, these are beliefs held by many, but not all, dietitians. I'm obviously very much in favor of LCHF diets, and there are at least five other RDs I know of who more or less share my view:Valerie Berkowitz,MS,RD,CDE,
and her husband, Dr Keith Berkowitz, worked with Dr. Atkins at the Atkins Center for several years. She offers carbohydrate restriction as an option for her patients and has also written low-carb articles for various magazines.Algaee Jacob, MS, RD, CDE
, is a Paleo dietitian with expertise in digestive health and diabetes management using a low-carb approach. She recently wrote an article on the benefits of low-carb diets for diabetes
published by Today's Dietitian -- very encouraging!Adele Hite, RD, MPH
, educated patients about carb restriction while working at the Duke Lifestyle Medical Clinic with Dr. Eric Westman and is currently working on low-carb research and pushing for policy change in the area of nutrition.Cassie Bjork, RD, LD
, is the co-host of the Low Carb Conversations with Jimmy Moore podcast and a proponent of eating lower-carb, higher-fat real foods.Lily Nichols, RD, CLT
, is a whole foods dietitian and Pilates instructor who specializes in digestive health, follows a moderately low-carb diet, and understands the benefits of carb restriction for weight and diabetes.
There are many others out there as well, along with more conventional RDs who don't advise their patients to follow a low-carb diet but don't discourage them if they're achieving good results. I understand the frustration with dietitians not "getting it," but we need to remember that the women I just listed, myself included, weren't always so favorable toward carb restriction either. There is always hope that more will come over to our side, and I think that's likely to happen if we continue speaking out about the research supporting LCHF and the benefits so many have experienced from adopting this way of eating.
I received a link from one of my coworkers at our hospital the other day encouraging me to try Super Tracker
, an online food and activity tracking program. I wasn't expecting much after seeing that it was created by the USDA and part of ChooseMyPlate.gov,
but I decided to try it out anyway.
My first entry was breakfast. I started by entering "1 cup whole milk ricotta cheese," and as expected the calories came in at a little over 400 and saturated fat at 20 grams. But before I could enter my 1/2 cup of blackberries, I realized that 259 of my calories, or 60%, had been marked as "empty calories." This confused me. Empty calories? To me, that phrase conjures up images of soda, chips, cookies, etc. Ricotta cheese -- rich in protein, healthy fat, CLA, calcium, magnesium, vitamin K2, and other micronutrients but very low in carbs -- contains more than 250 empty calories?
Then I noticed an asterisk next to "Empty Calories" and its definition below:
"Calories from food components such as added sugars and solid fats that provide little nutritional value. Empty Calories are part of Total Calories."
Super Tracker's saturated fat limit for the day is 22 grams, so at least I had a couple of grams to spare for the rest of the day. But the idea that a cup of ricotta cheese is classified as having any
empty calories, much less 60%, is pretty disturbing. This tracker was designed for educating the public about healthy eating strategies as part of ChooseMyPlate, and it's teaching people that consuming any meal containing more than 8 grams of saturated fat is equivalent to eating junk.
I decided to try inputting a different meal. 1 cup of raisin bran with 1 cup skim milk and 16 oz orange juice provides 500 calories, only 44 of which are classified as "empty" -- the 3 tsp of added sugar in the cereal. Super Tracker doesn't specify carbohydrate amounts, but I estimate this meal has well over 100 grams of carbs and very little fat to modulate the inevitable blood sugar spike and insulin surge. In the "Fruits" section at the top, 16 oz of orange juice is considered "OK," despite the fact that all of its calories come from sugar and a good portion from fructose.
Now, I understand that some of you may disagree that consuming dairy is healthy, but I think it's largely a matter of personal tolerance. I eat a lot of it and stay slim and energetic with no GI problems, so for me it's a staple food. Your mileage may vary, as they say. Regardless, it shouldn't be relegated to "empty calorie" status.
While it's great to see a lot of low-carb, high-fat, whole-food proponents trying to counter the low-fat
message, it's discouraging to learn that the USDA is continuing to drive home the idea that a high-sugar breakfast is preferable to one high in saturated fat. Never mind that saturated fatty acids increase satiety, are vital for cell membrane structure and hormone synthesis, protect our liver and other organs, and provide many other health benefits -- and that research has exonerated them as a factor in heart disease.The creators of ChooseMyPlate are determined to make sure that folks choose a "healthy," low-fat breakfast and avoid "empty calories" in foods like cheese, coconut oil, butter from grass-fed cows, etc. We need to continue our efforts to dispel this misinformation, and I'm grateful to all of you who are willing to do so.
Low carbohydrate diets are often criticized for being high in fat, particularly saturated fat, which is widely believed to raise cholesterol levels and increase risk for heart disease, despite recent
and older studies
demonstrating that saturated fat is not to blame. However, many lipidologists believe that LDL particle number (lower number is better) and pattern (larger size is better) do correlate with heart disease risk.
My total, HDL, and LDL cholesterol have always been on the high side, even back in 2007 when I was a pesco-vegetarian who threw out egg yolks rather than eating them. The only time my LDL was in the “optimal” range (less than 100) was the year I ate a vegan diet. However, I was also very hungry and sick a lot that year.
Recently, someone commented on another blog that “Every low-carb Paleo blogger has nightmarish cholesterol levels," or something very similar. That’s a pretty broad generalization and one I don’t agree with. In many (most?) cases, elevated cholesterol levels are due to something other than diet. And are moderately elevated cholesterol levels always bad anyway? From all the research I've seen, it's inflammation that appears to be at the root of heart disease. In addition, low cholesterol levels have been linked to depression
, poor memory
, and other health issues.
But I was still curious to see what my lipid numbers are like now, 11 months after beginning a very-low-carb, high-
fat diet that includes a fairly high percentage of saturated fat. I decided to order an NMR Lipoprofile test so I could get information about particle numbers, size, and pattern, which I've never had measured before, since I believe this is more important than just looking at LDL and HDL.
My results: LDL Particle Number
LDL-P: 1174 Reference range: Moderate 1000-1299
Borderline High 1300-1599
High >1600 Lipids
LDL-C: 124 Reference range: Above optimal 100-129
HDL-C: 97 Reference range >40
Total cholesterol:226 Reference range <200
Triglycerides: 24 Reference range <150 LDL and HDL particles
HDL- P(total): 43.8 Reference range >30.5
Small LDL-P: 103 Reference range <527
LDL size: 21.7 Reference range 20.6-23.0 (Pattern A, Low Cardiovascular Disease Risk) Insulin resistance score
LP-IR score: 1 Reference range <45
Honestly, these numbers are better than I’d expected. My HDL has always been good, around 65-70, but it’s increased significantly, while my LDL-C has actually gone down a bit. The particle size and numbers are also very good, as are the triglycerides. I guess I shouldn't really be too surprised given research suggesting that a low-carb-high fat diet results in a less atherogenic lipid profile.
My results occurred nearly a year after eating eggs, butter, cream, cheese, and/or coconut oil every single day. Did I also eat a lot of monounsaturated fats in the form of nuts, olives, and avocado on a daily basis and omega-3 fats in fish several times a week? Absolutely -- I eat a lot of all types of fat. But I don’t think the saturated fat has done me any harm; on the contrary, I’ve written before about the benefits of many saturated fats
. And limiting my carbs to less than 50 grams a day has resulted in finally normalizing my post-meal blood sugar, which I was unable to do at a moderate low-carb level of 80-100 grams. My weight remains 125 pounds, give or take a pound.
So what do I eat? Here’s yesterday's intake and nutrient analysis courtesy of FitDay.com: Breakfast:
4 oz sardines
3 cups spinach with ½ tsp sea salt cooked in 1 Tbsp coconut oil
½ cup blackberries with 2 oz sour cream and 1/3 cup chopped pecans
Green tea Lunch:
1 sliced red bell pepper with Greek yogurt-guacamole dip (1/2 cup Greek yogurt mixed with 2/3 cup guacamole)
Chia seed cocoa pudding (1 oz chia seed mixed with ½ cup water, 1 Tbsp cocoa powder, ½ tsp sea salt, ½ tsp cinnamon)
Vanilla hazelnut herb tea with 1 tsp half-and-half Dinner:
Filet Oscar: 6 oz beef filet, 2 oz crab, 3 Tbsp Bearnaise sauce, 1/2 cup each pea pods and summer squash (pictured above)
Water Calories: 1762 Fat: 133 grams (65%) Saturated: 48 grams (24%)
Polyunsaturated fatty acids(PUFA): 23 grams (11%)
Monounsaturated fatty acids (MUFA): 53 grams (26%)
Protein: 97 grams (23%)
Carbohydrates: 56 grams (12%)
Dietary fiber: 33 grams
Effective carbs: 23-40 grams
(There are different schools of thought on how to count fiber. If subtracting all fiber from carbohydrate grams, effective carbs are 23 grams; if subtracting half the fiber grams, effective carbs are 40 grams)
This is pretty typical intake for me in terms of macronutrient percentage, fiber, and calories. The majority of my fat intake always comes from MUFA and saturated fat, and most of the PUFAs are the omega-3 fatty acids found in seafood.
So I'm having great results all around on a low-carb, high-fat, whole foods diet. Everyone is different, of course. I'm not arguing that some people have reported increases in LDL cholesterol after switching to a low-carbohydrate diet, although it seems to occur more often in the initial stages, particularly with folks who lose weight rapidly. But the oft-repeated message that a LCHF approach automatically increases cholesterol and risk for heart disease is not borne out by the research, my n=1 results, and those of many others.
If you haven't seen Justin Smith's movie "Statin Nation" yet, I highly recommend that you check it out and share it with anyone you know who takes a statin or whose doctor is recommending one. The film can be viewed in its entirety here
at no charge.
Although I'm sure most of you reject the cholesterol hypothesis as I do, the medical establishment's pressure to lower people's LDL cholesterol is growing stronger, and many people feel resigned to taking statins after repeatedly hearing the positive spin on studies cited by the drug manufacturers. This film investigates the cholesterol and diet-heart hypotheses, demonization of saturated fat, and devastating health consequences many people have experienced as a result of taking statins. A few notable interviewees in the film include researcher Dr. Uffe Ravnskov (Director of The International Network of Cholesterol Skeptics and author of "The Cholesterol Myths," among others) cardiologist Dr. Peter H. Langsioen (expert on Coenzyme Q10), heart disease specialist Dr. Martin Kendrick ("The Great Cholesterol Con"), and Dr. Natasha Campbell-Mc Bride (creater of the GAPS diet). Dr. Campbell-Mc Bride's comment, "Your body knows what it's doing. Whatever level of cholesterol you have in the moment in your bloodstream is the right level for you. Don't mess around with it,"really resonated with me, as someone whose cholesterol has always been considered too high by most doctors. Not unsurprisingly, British governmental health organizations who support the use of statins and pharmaceutical companies who manufacture them declined to be interviewed for this film.
If you're unable to watch due to time constraints or other reasons, go to the Resources page
of the Statin Nation website, where you'll find much of the information contained in the film.
5/6 Edit: I'm sorry to break the bad news, but I was just informed that the video is now private and unavailable for free viewing. As of yesterday, it was still free to the public. You can see a preview
or rent the entire movie for $4.99.
Here we go again. A new study
appears to link high fat intake to insulin resistance and postmeal blood sugar spikes. All study participants had Type 1 diabetes and were assigned to consume either two low-fat meals and one high-fat dinner or three low-fat meals. Researchers reported that those receiving the high-fat dinner required more insulin (12.6 units vs. 9 units for the low-fat dinner) and that their postprandial blood sugar and insulin levels were higher and stayed high for several hours after eating.
There are a few red flags regarding this study. First of all, the sample size was extremely small (seven people). And this line is revealing:
"The two dinners received by each subject had identical carbohydrate and protein content but they differed in fat content (10 grams vs. 60 grams)."
Now, the amount of carbs each meal contained wasn't reported (or at least I couldn't find it), but the amount of calories was. So by doing some math, we can get a ballpark estimate:
The low-fat dinner contained on average about 600 calories, 10 grams of fat (90 calories), and let's say 25% protein (38 grams, 150 calories), which is probably being generous. That would leave approximately 90 grams (360 calories) of carbohydrate to make the 600 calorie total.
So given the high carbohydrate content of the meal, these results aren't surprising. Fat delays the absorption of carbohydrate and makes accurate dosing of insulin extremely challenging (as CDE Gary Scheiner explains in discussing how to bolus for pizza
). Previous studies have demonstrated the deleterious metabolic effects of consuming a high-fat, high-carbohydrate meal, which include insulin resistance, delayed postprandial hyperglycemia, and elevated triglycerides.
However, there is research indicating that a high-fat, low-carbohydrate diet does not produce the same response; in fact, it results in lower insulin needs, less insulin resistance, and better postmeal blood sugar and lipid response in both Type 1 and Type 2 diabetes. And there's enough anecdotal evidence to support these findings many times over.
So this study simply confirms what we already know: The combination of high fat and high carbohydrate is unhealthy. The best chance people with diabetes have of achieving better blood sugar control and decreasing insulin needs is to adopt whatever form of carbohydrate restriction works best for them.
1. Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low-fat diet. Lipids 2009 Apr;44(4):297-309.
2.Volek JS, et al. Effects of dietary carbohydrate restriction vs. low-fat diet on flow-mediated dilation. Metabolism
3. Nielson JV, et al. Low carbohydrate diet int type 1 diabetes, long-term improvement and adherence: a clinical audit. Diabetol Metab Syndr 4: 23, 2012
One of the questions that comes up repeatedly for me -- from colleagues as well as friends -- is whether following a low-carbohydrate, high-fat diet could be detrimental to heart health. A chief concern is that eating foods high in fat, particularly saturated fat, will raise cholesterol levels, thereby increasing the risk of atherosclerotic heart disease. It doesn't really surprise me; after all, for more than 30 year fats have been considered the primary food we should all be cutting back on if we want to avoid coronary artery disease. The USDA's Dietary Guidelines for Americans
and My Plate
promote whole grains, nonfat milk, fruits, and other foods that are high in carbohydrates and low in fat as a way of decreasing cardiac risk. On the other hand, there is a large body of research showing that lowering carb intake and increasing consumption of fat (both saturated and unsaturated) can result in favorable changes in serum lipids.
Below are a some of the cardioprotective benefits of low-carbohydrate, moderate-protein, high-fat diets:
1. Significant decrease in serum triglycerides
. Carbohydrates are a potent stimulator of hepatic triglyceride synthesis and plasma concentration, particularly in the presence of insulin resistance. Lowering carbohydrate intake can reduce triglyceride levels, resulting in lower cardiac risk.
2. Increase in HDL cholesterol.
Higher fat intake is positively correlated with improvements in HDL levels, and high HDL cholesterol is considered cardioprotective.
3. Improvement in LDL particle size, glycation, and oxidation
. While triglycerides levels almost invariably decline with carbohydrate restriction, LDL cholesterol response appears to be more individualized. LDL has been classified as the "bad" cholesterol for years, and elevated levels are often seen as increasing one's risk of arterial plaque formation and heart disease. However, looking at the amount of serum LDL itself gives us very little information about cardiac risk. It is primarily when LDL is oxidized and its particle size small that this lipoprotein becomes a problem. Restricting carbohydrate intake has been shown to reduce glycation and subsequent oxidation of LDL. A lower-carb, higher-fat diet tends to produce an increase in LDL particle size (known as Pattern A), whereas an abundance of dietary carbohydrate typically results in smaller, denser particles (Pattern B) that increase the likelihood of atherosclerosis.
I also often hear, "If people don't eat whole grains and legumes, how can they consume adequate fiber?" Fiber, particularly the soluble type, has many health benefits. A low-carb diet can easily supply sufficient fiber if it contains plenty of nonstarchy vegetables, nuts and nut butters, seeds, and avocados. Technically a fruit, an average avocado contains about 12 grams of fiber, as well as 16 grams of monounsaturated fat.
As a registered dietitian, I can't endorse a low-carbohydrate diet consisting of 6 eggs fried in butter with 4 slices of bacon for breakfast, 3 hamburger patties for lunch, and a 20-oz steak with a tiny green salad for dinner. While certainly nearly carb-free, it's missing a lot of beneficial phytochemicals found only in plant foods and contains only a couple of grams of fiber. But I firmly believe that a carbohydrate-restricted plan that includes the high-fiber plant foods listed above can be a very heart-healthy way to go.
1. Tay, J., et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. J Am Coll Cardiol
, 2008. 51:59-6
2. Volek, J.S., et al. Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Prog Lipid Res, 2008, doi: 10.1016/j.plipres.2008.02.0033.
3. Hayek, T, et al. Dietary fat increases high density lipoprotein (HDL) levels both by increasing the transport rates and decreasing the fractional catabolic rates of HDL cholesterol ester and apolipoprotein (Apo) A-I. J Clin Invest, 1993; 91(4);1665-1671
4. Siri-Tarino, P.W., et al. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr