<![CDATA[Low Carb Dietitian

What have I been eating all this time to keep my weight where I want it? My approach has varied from simply reducing portion sizes of everything except vegetables to veganism (for ethical reasons) to pescatarian (eating eggs, dairy, and fish but no meat). Always lots of veggies, though, regardless of whatever else I was eating. With the exception of my vegan phase, I usually felt satisifed after meals and rarely hungry in between unless I went too long without eating. I became more and more interested in health, striving to make each meal as nutrient-dense as possible.

By the time I became a dietitian in 2008, a typical day looked something like this:
Breakfast: 6 oz nonfat yogurt with 1 cup berries and 1 Tbsp walnuts, 1 slice whole wheat toast with peanut butter, coffee with sugar sub
Lunch: peanut butter OR tuna salad sandwich made with light mayo on whole wheat bread, 2-3 cups salad with olive oil vinaigrette, a piece of fruit, and diet iced tea
Dinner: 4 oz fish/tofu/beans; 1 cup brown rice/potatoes/whole grain pasta; 2-3 cups nonstarchy veggies, 2 Tbsp olive oil , 6 oz nonfat yogurt , 1 cup fruit, nuts, water

My weight stayed the same, and I was happy eating this way and continued doing so until February of 2011, when I found out that my blood sugar was spiking after meals and I had  mild hypothyroidsim to boot. Given soy's negative effect on thyroid function and the impact of carbohydrates on blood glucose, I realized I needed to make some dietary changes in order to address both issues. I stopped eating soy, cut my carb intake gradually until I reached 60-80 grams per day, added humanely raised chicken and grass-fed beef, and continued eating lots of nonstarchy veggies. Doing my own research online and in books prompted me to make additional changes like eating  whole eggs, using butter instead of margarine, and getting rid of sugar substitutes. My blood sugar improved, and I felt full and satisfied. I've been eating this way for several months and plan to continue for the foreseable future.

My typical day now looks like this:
Breakfast: 4 oz sardines/salmon OR 2 eggs with 2 cups kale or spinach cooked in 1 Tbsp butter or coconut oil; 1/2 cup fruit OR 1/2 cup sweet potato, 2 Brazil nuts, green tea
Lunch: Usually leftovers from dinner (same amount) OR 1 cup plain Greek yogurt, 2 cups chopped raw vegetables, 4 olives, and 3 Tbsp guacamole; 1/2 cup fruit, 1 Tbsp almond butter with small square of dark chocolate, water
Dinner: 4 oz beef/fish/poultry, 2-3 cups raw or cooked nonstarchy vegetables with 2 Tbsp olive oil, 1/2 cup sweet potato OR fruit, 1 Tbsp almond butter, water

Despite cutting carbs considerably, I didn't lose weight, nor did I want to. Unlike many who start a low-carbohydrate diet, my caloric intake didn't decrease. Restricting carbs often results in an intial large loss of water (proportional to the size of the individual) in addition to fat. Those who eat low carb tend to automatically eat fewer calories since ketones reduce appetite and fat and protein are more filling and satiating than carbohydrates. I'm definitely less hungry between meals, which I attribute in part to more stable blood sugar levels. But my caloric intake remains about the same, 1500-1800 per day.

I follow a low-carbohydrate diet because it allows me to prevent blood glucose spikes, thereby decreasing my risk of progressing to diabetes. I think it's by far the best way to manage all types of blood sugar issues. I also believe the same diet can be extremely helpful for weight loss and maintenance. But I don't think it should be an "Eat as much protein and fat as you want as long as your carbs are low" plan. I'm fairly confident that if I were to significantly increase my portion sizes of meat and add large amounts of fat to everything I eat, I would gain weight. For instance, coconut oil may contain medium-chain fatty acids that are easily burned for energy, but it also has 120 calories per tablespoon that will be stored instead if caloric needs have already been met. Eating 16 oz of beef provides
900-1300 calories depending on the fat content, and about 110 grams of protein.  In the liver, a portion of that protein will be converted to glucose,  which will be stored as fat unless needed for immediate use.

Below are suggested menus from Dr. Richard K. Bernstein  and Mark Sisson:

Dr. Berstein's own menu from Diabetes Solution:
Breakfast: 2 oz Nova Scotia salmon, 1 ounce cream cheese, 2 Bran-a-Crisp crackers
Lunch: Leek soup, 3 1/2 ounces hamburger meat
Dinner: 1 medium artichoke with melted butter, 4 1/2 ounces meat, fish or poultry
Total calories (estimated): 1200

Mark Sisson's plan for Ken Korg in The Primal Blueprint:
Breakfast: "Primal Omelet": 3-egg omelet with 1 ounce cream and 1 tablespoon cheddar cheese, chopped mushrooms, red onions, and red peppers (1/4 cup each); 2 ounces avocado, 2 Tbsp fresh salsa, 1/4 cup fresh blueberries, black coffee
Lunch: "Primal Salad": 2 cups salad greens, 2 ounces each chopped onions, carrots, jicama, red peppers and cherry tomatoes, 3 ounces chicken, 1/3 ounce sesame seeds, 1/2 ounce walnuts, 2 Tbsp oil-based dressing
Dinner: 6 ounces broiled salmon, 6 ounces each steamed zucchini and asparagus with 1 Tbsp butter, 5-ounce glass red wine
Snacks: hard boiled egg, 17 macadamia nuts, 4-inch strip venison jerky
Total calories (as listed in book): 2045

Notice the portion sizes. Dr. Bernstein is older, of short stature, and doesn't exercise much, so his caloric intake is too low for me and presumably most people reading this. On the other hand, Mark Sisson is pretty athletic, but he advises people to consume only 0.7-1.0 gram of protein per pound of lean body mass. He recommends 104 grams of protein for Ken based on 148 lbs of lean mass. The protein and fat portions at each meal are quite modest and appropriate.

Do I believe that those who follow a low-carb diet develop a "metabolic advantage" that allows them to eat large quantities of high-calorie but low-carb foods and still lose weight, aside from the initial loss? I'm not discounting it 100%, but at this point I don't see the empirical evidence for it. Just a couple of examples that argue against this idea can be found on  the Bye Bye Carbs and Mark's Daily Apple websites. I've read many comments on other sites about people who stopped losing weight on low-carb plans. Calories do count, regardless of the macronutrients in question.

I think many different ways of eating can result in weight loss and long-term maintenance. I know several vegans; some have been slim for years, while others remain heavy. There are some prominent low-carbers who are overweight or obese, while many others have found that carbohydrate restriction is the only way they can maintain their ideal weight. My mother's weight history and pictures are very similar to mine, although she has maintained her 30-lb loss even longer, excluding pregnancy, simply by keeping portion sizes in check and limiting sweets.

As someone who has lost weight and been able to keep it off, I feel that you can't really "eat all you want and still lose weight" -- unless "all you want" is fewer calories than you actually need. Unfortunately, it takes some discipline along with choosing whatever eating plan works for you. For everyone who is losing weight or maintaining weight lost on a low-carb plan, I couldn't be happier -- we need more success stories! But for those who are finding sustainable weight loss elusive, I recommend taking a look at the amount of calories you're taking in rather than adding another tablespoon of coconut oil to your meal.