Wurst und Käse Salat. Bring on the cheese!
First off, I hope all of you and your families had a wonderful Thanksgiving. Mine was really nice: delicious food and great conversation with family and dear friends. I've been wanting to write a post like this for some time now. My intention is not to criticize other people's beliefs but rather to explain my own and why I hold them. Looking over a number of "Paleo Thanksgiving" menus prompted me to finally address my ambivalence about Paleo, Primal, Weston A. Price Foundation, and other "real food" ways of eating. I know that several people who read this blog identify with one or more of these ways of eating. Please keep in mind that I strongly favor a whole foods approach over a diet containing processed foods. I'm a proud member of Real Food Dietitians, and I recently became a Primal Docs featured member. However, I think carbohydrate restriction is ultimately more important for people trying to manage diabetes, prediabetes, obesity, metabolic syndrome, and PCOS. Diabetes, Hyperinsulinemia, and Insulin ResistanceThere's a lot of convincing research supporting very-low-carbohydrate diets for people with Type 2 diabetes, metabolic syndrome, and polycystic ovarian syndrome. I'm planning a blog post on insulin resistance and hyperinsulinemia in the near future, but suffice it to say that many, if not most, overweight people have impaired insulin sensitivity, resulting in elevated blood sugar and insulin levels that cause hunger, damage blood vessels and nerves throughout the body, and promote fat storage. Keeping carb intake very low (less than 50 grams per day) will have a beneficial effect on insulin resistance and hyperinsulinemia in virtually everyone, whereas a diet containing twice or three times as much carbohydrate may work for a portion of this population, but most will need to restrict carbohydrates further to lose weight and achieve healthy blood sugar and insulin ranges. In general, the works of Drs. Steve Phinney, Jeff Volek, Eric Westman, Richard Feinman, Michael Eades, Richard K. Bernstein, and other low-carbohydrate researchers are more exciting and convincing to me than authors who classify themselves as Paleo or Primal.People with Type 1 diabetes or normal weight individuals with blood sugar issues (I'd place myself in the latter category) will also benefit from keeping carbohydrate levels very low. I followed a Primal, moderately low-carb (100 grams or so per day) diet for a while but continued to have postprandial blood sugars over 160 and sometimes as high as 200. Only when I began restricting carbohydrates to 15 or fewer grams per meal did my blood sugar response normalize, and it's remained this way for the past year and a half.
DairyI realize dairy is controversial in the Paleo and Primal community due to its lactose content, insulin-stimulating properties, and potential for allergies, but I personally consume quite a bit of it without any problems. In fact, I have Greek yogurt, cheese, sour cream, and/or cream every day and maintain a healthy weight. While there are certainly people with legitimate reasons to avoid dairy (such as true allergies or hypercalcemia), I think many others will do okay with it. If you have other symptoms that clear up when you eliminate dairy, then obviously you shouldn't eat it.
I understand the WAPF's position on the benefits of raw milk, but I disagree that pasteurized, homogenized dairy products are inherently bad. My parents are from Switzerland and grew up on pasteurized milk products, as did their parents, and continued consuming them throughout their lives. They're now in their 70s, active, and in excellent health, and I know there are many others like them. While raw milk may contain more nutrients and allow for better absorption of fat-soluble vitamins, I think pasteurized milk provides benefits as well. GrainsHere's where I may lose some of my readers (if I haven't lost you already). There was recently a very successful Gluten Summit, and two intelligent MDs, Drs. Davis and Perlmutter, have written books detailing the devastating effects gluten can have on susceptible individuals. But not everyone is gluten sensitive! I avoid grains because of their carb content and I don't really mind not eating them, but there are other low-carbers who consume low-carb bread, wraps, etc., without any problems. Dr. Steve Parker's Low Carbohydrate Mediterranean Diet allows grains for those who tolerate them. The Paleo Thanksgiving yam and sweet potato recipes I saw online contain a lot of carbohydrates. Eating a small amount would be fine, but many people tend to eat larger portions of foods they're told are healthy. I'm not saying that grains are good for you, but to be honest, I'd rather someone with diabetes eat a forkful of stuffing (about 3 grams of carb) than a cup of sweet potatoes (37 grams of carb if plain).SweetenersAnother controversial area among Paleo/Primal/WAPF devotees is sweeteners. Honey or pure maple syrup is often recommended as an alternative to table sugar. However, these items contain more carbohydrate per serving than sugar does, so they're not a good choice for people with diabetes or insulin resistance. Green leaf stevia is recommended as an option for those who need to limit carbohydrates. But have you tasted stevia? It's got an interesting flavor (reminiscent of anise, in my opinion), but it really doesn't work well as a sweetener for all types of food. I rarely use any sweetener at all, but when I do bake occasionally, I use erythritol, a sugar alcohol that isn't absorbed by the body and tastes very similar to sugar. Some have argued that erythritol is a processed product made from corn, but I think people with issues related to glucose intolerance would be better off consuming it -- or even saccharin -- instead of "natural" sweeteners, including fruit juice. Again, it's best to avoid all types of sweeteners except in limited amounts. I do eat a square of 85-90% cacao dark chocolate a few times a week. It's sweetened with sugar but only has about 2 grams of net carb.Pastured and/or OrganicAs a former vegetarian for ethical reasons, I strongly support raising animals as naturally and humanely as possible. I would prefer to always eat pastured, organic, or naturally raised meat, dairy, and eggs, and most of the time I do, at least at home. But there are many people who can't afford to eat this way on a daily basis. I've written about this before, but I feel even more strongly now that people on limited budgets shouldn't be made to feel that they're jeopardizing their health if they can't buy organic food. I've seen individuals on low-carb forums say that they have to quit eating low carb because it's too expensive. But there are lots of ways to eat low carb without spending a lot of money (also Google "low carb on a budget"). Replacing higher-carb items with conventionally raised animals, eggs, and cheese can have a profound positive effect on blood glucose and insulin levels, as well as weight. And at the end of the day, that's the most important thing.I hope I didn't offend any of the people I respect yet differ with on this issue, but I wanted to make clear where I stand. If folks with diabetes or weight issues can combine "real food" and low carbohydrate intake, this is ideal. But I'll always place carb restriction as the top priority for them because I truly believe it's the key to improving their health.
References1. Volek JS, Feinman RD.Carbohydrate restriction improves features of the Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005 ;2:31 2. Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 2008; 5: 9
3. Westman EC, et al. Low Carbohydrate Nutrition and Metabolism. Am J Clin Nutr 2007; 86(2):276-284
4. Mavropolous JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond) 2005: 2:35
The latest guidelines on treatment of diabetes, prediabetes, and cardiovascular disease
published by the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) are extremely comprehensive (48 pages) and contain over 500 references. Much of the discussion focuses on cardiovaascular risk factors and treatment, although a fair amount of time is spent on diabetes management itself. I'll confess that I didn't have time to read the entire document and certainly don't expect you to, but I did read the short section entitled "Prevention of cardiovasclar disease in patients with diabetes," paying particular attention to the "Diet" section. To say that I was disappointed with the recommendations would be an understatement.
A few quotes from the paper:
"Carbohydrates may range from 45-60% of total energy. Metabolic characteristics suggest thta the most appropriate intakes for individuals with DM are within this range. There is no justfication for the recommendation of very-low-carbohydrate diets in DM."
On the contrary, there are many studies (cited in previous blog posts, most recently this one
), along with anecdotal evidence from thousands of people with diabetes, demonstrating that VLCKDs can dramatically improve glycemic control to the point that diabetes medication can be significantly reduced or even eliminated in the case of T2 diabetes.
"Total fat intake should not exceed 35% of energy. For those who are overweight, <30% may facilitate weight loss."
Restricting fat to these levels guarantees that the diet will be high in carbohydrate, which does not benefit people with diabetes regardless of their weight.
"Saturated and trans-fatty acids combined should be <10% of total daily energy intake. A lower intake of <8% may be beneficial if LDL-C is elevated."
Grouping saturated and trans fats together is extremely misguided. One is highly processed and has been shown to cause a number of health problems, while the other is a healthy, natural fat that people have been consuming for thousands of years.
"Vegetables, legumes, fruits, and whole-grain cereals should be part of the diet."
I agree with vegetables and certain fruits being appropriate for people with diabetes, but there is no reason to consume legumes or whole-grain cereals, as they don't contain any nutrients that can't be found in other foods.
Last week I did an interview on TuDiabetes
about carbohydrate restriction for people with diabetes where I discussed these issues in more detail, among others, in response to questions from the audience. Feel free to give me any feedback, positive or negative, if you're able to watch. I apologize for sitting so close to the camera that my face pretty much takes up the whole screen and really looks pretty strange, but I'm new to this videotaped live interview thing.
Also, here's a link to my most recent Answers.com articles on a few low-carb breakfast ideas
I discussed in the interview.
A recent study by Kaiser Permanente and Yale Medical Center found that severe hypoglycemia is quite common in people with Type 2 diabetes who take insulin-stimulating medications. This was true regardless of level of control, meaning those with elevated blood sugar and A1c levels experienced low blood sugar as well as those who were within or below their A1c goal. Severe hypoglycemia is defined as a blood glucose level less than 50 mg/dL and is associated with increased risk for heart attack, stroke, loss of consciousness, and death, particularly when it occurs during sleep. Its symptoms can be frightening and include sweating, shaking, dizziness, unsteadiness, and heart palpitations.
Although having tight control (A1c <6%) is considered dangerous by many diabetes specialists because it suggests frequent low blood glucose levels, it's evident that anyone taking medications which cause the pancreas to secrete insulin is at risk for hypoglycemia as well. (For the record, I think having a lower A1c is good, provided it's not due to frequent lows). According to Dr. Kasia Lipska, an endocrinologist at Yale Medical Center, "It's important to note that it's not the HbA1c that directly causes hypoglycemia; it's the therapies we use to lower it." Exactly.
Insulin-stimulating medications cause unpredictable blood glucose response in several ways. Typically prescribed to be taken twice a day at meals in fixed dosages, they are unable to make the pancreas produce the precise amount of insulin needed to cover the carbohydrate ingested at a meal, nor do they start working at exactly the right time to match the digestion of carbohydrate. In the poorly controlled overweight person with diabetes, taking this type of medication practically guarantees at least occasional episodes of low blood sugar leading to overtreating with juice, soda, or candy, resulting in hyperglycemia and weight gain. It also places a burden on the beta cells of the pancreas by causing them to secrete large amounts of insulin, thereby increasing progression of the disease. Precisely the problems diabetes management is supposed to avoid.
I feel that carbohydrate restriction should be offered as an alternative to taking these types of medications, and I outline the basis for why this way of eating is ideal for diabetes management in my recent Answers.com article
. I have heard about or spoken with many people -- including Type 2 bloggers Dan Brown, Steve Cooksey
, and Eddie Mitchell,
as well as Dr. Jay Wortman
-- who have been able to stop their insulin-stimulating diabetes meds and improve their blood glucose control by following a very-low-carbohydrate ketogenic diet (VLCKD). In most cases, those who adopt a VLCKD require only metformin, an insulin sensitizer that does not place a person at risk for hypoglycemic events.
The message given by many of my fellow dietitians and CDEs is, "You can eat the same foods everyone else does as long as you take your diabetes medication." I don't feel comfortable naming names, but the vast majority of articles by RDs and CDEs that I've read advise individuals with diabetes to eat low-fat, high-carb meals and snacks and take whatever meds are needed to keep blood glucose in check. I realize many people may not want to change their eating habits, and that is of course their choice. But I think they should be told about the risks of these medications, including the strong likelihood that they will periodically experience low blood sugar when taking them. Some will want to assume the risk, but others may be interested in an alternative way of eating that involves less medication and no risk of low blood sugar. Every patient I talk to who has ever experienced severe hypoglycemia would prefer to avoid it all costs.
I'm not saying that there isn't a need for diabetes medication in some people. People with Type 1 diabetes obviously require long-acting and mealtime insulin, although considerably less of the latter when on a carbohydrate-restricted diet (Hypoglycemia is also minimized with this approach). Those with Type 2 who adopt a VLCKD may only need metformin and possibly a long-acting insulin, depending on how much beta cell function they have remaining. Dr. William Yancy and Dr. Eric Westman have demonstrated that insulin and oral diabetes medications can be reduced and in some cases eliminated in people following a VLCKD, and that blood sugar control improves across the board with this method. Why not encourage and support those who are interested in trying it?
* * *
I also want to let you know that I'm going to be participating in a live video interview with TuDiabetes
on Thursday, September 26, at 1:00 pm Pacific time. I'm sure many of you won't be able to listen live -- I'm taking the day off of work for it --- but it will be available on their archives. Hope you can watch :)
1. Kaiser Permanente. Severe low blood sugar occurs often in patients with Type 2 diabetes. Science Daily. July 30, 2013.
2. Westman EC, et al.A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab 2:34, 20053. Yancy WS, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab 5:36, 2008.
I wanted to share my most recent Answers.com articles with all of my readers. Please take a moment to click on them, and if you have time to read them and give feedback, that would be even better! Using Sugar Substitutes on a Low-Carb Diet: Pros and ConsThai Ginger Scallops with "Rice"
How Does Alcohol Fit Into a Low-Carb Diet?Tips for Eating Low Carb on a Budget
As I mentioned previously, my contract with Answers.com states that I'm required to write 10 articles a month for the next year. So 15 articles down, 105 left to go :)
This is what I'd love to get from any of you (via Facebook, Twitter, blog post comments, or using my website Contact page):
- Ideas for future articles (Fact-based rather than opinion, easy-to-understand pieces for new as well as experienced low-carbers)
- Original low-carb recipes (Nutritional information not required -- I can do the analysis)
- Feedback on the articles
If you're able to help me by providing any of the above, I'd greatly appreciate it! Thank you all again so much for continuing to share my website and message with others. I'm not a natural at self-promotion but recognize that it's necessary to some extent. Since I'll be going into private practice at the end of the year, I'm doing my best to figure out how to do it in a way I'll be comfortable with.
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
I published six more low-carb articles on the Answers.com site, so I've fulfilled my quota of 10 for August. (I didn't link to the Cinnamon Almonds one because there's already a blog post on that recipe available on this site). Please check out the others if you have time:Saturated Fat Intake on a Low-Carb DietFive Terrific Low-Carb Recipe WebsitesBeyond Atkins: Low-Carbohydrate Diet BooksTips for Staying Low Carb When Dining OutBest Dairy Choices for Low-Carb Diets
I should also make it clear that there are a lot of third-party articles on the site that I didn't write; only the ones with my name at the top are mine. However, I encourage you to read the others as well if it's convenient, and let me know what you think of them.
Mostly, though, I'd really appreciate hearing what topics you'd like me to write on! I enjoy writing, but these articles are a little different than my blog posts, where I just write about whatever moves me at the time. There are only a few formats to choose from (Do's and Don'ts, Briefing, Lists, etc.), and while I've got a few in the works for next month on diabetes, eating on a budget, and artificial sweeteners, I'd love it if you'd give me some more ideas. You can either use the "Contact" page on this site or the "Comments" section, write on my Facebook page, or send me a tweet. Thanks so much!
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
I have some very exciting news to share: I have been offered a position at Answers.com as their Low Carb Category Expert Writer! I'll be writing articles as an independent contractor for the website while I continue to work full time at the Veterans hospital as an outpatient dietitian. I'm required to publish between 10-20 articles a month (400+ words each) for the next year. This is such a fantastic opportunity to write about a subject I'm so passionate about! I'm still letting it all sink in.
Now the (sort of) bad news. Because I'm still working full time and will be writing at least 10 articles a month for Answers.com, I won't have much time to write my current style of blog posts, ie, voicing my own opinion on various issues. At least not if I want to have some kind of life outside of nutrition. I'll try to still write one blog post a month because I really enjoy the process.
I'm not much of a self-promotor, but I'm going to ask that when I link to my Answers.com articles that you please click on the link and (hopefully) read them. Most of the articles are pretty basic and will likely contain things you've heard before, but I would really appreciate your support on this.
One final bit of good news -- well, it's actually great news :) As of January, I will no longer be working at the VA hospital because I'll be going into private practice. While I will really miss talking to our veterans, I feel that I'm not really helping any of them get healthier. It will be such a relief to be able to counsel people and provide information based on my own beliefs obtained from reviewing current research rather than continuing to try to talk around our "Healthy Plate" handouts, to the extent I can without getting into trouble. My website will be updated to explain the services I'll offer. I'll also be developing some low-carb teaching materials for doctors and writing for Answers.com, of course.
At any rate, thank you to all my regular readers who have voiced your support for this blog. As I said, I'm going to continue to write my blog posts, just not as frequently for a few months.
Below are the links to my first three articles on Answers.com:8 Benefits of Low-Carb DietsHow to Choose the Right Amount of Carbs on a Low Carb Diet7 Healthy Low-Carb Snacks That Taste Great
Thank you so much for checking out those articles. Also, I won't have computer access for a couple of days, so if you leave comments, I promise to approve them once I'm able to.
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.