I'd like to apologize for the negative and somewhat unprofessional tone of my last few posts.  Although I get a lot of Facebook "Likes"and comments when I rant about low carb not being accepted as quickly as I'd like, I'm actually a pretty optimistic person most of the time, and I do realize that progress is being made. Patience isn't one of my strong suits, but I'm working on it! I'm really looking forward to going into private practice at the end of December, and I've got so much to be grateful for, including my wonderful and loyal readers.

Today's post is much less controversial: Answers.com articles for this month.  Some of these I've already tweeted or posted on Facebook, and I'll probably do the same with the others over the next few days. I know many of you don't do Twitter or Facebook and instead follow my RSS feed or just check back now and then, so here are all ten October articles in one place. Please take a moment to click on them and give feedback at the end of the article ("Helpful" or "Not Helpful") when you have time. Also, feel free to continue to send ideas for articles or additional feedback.  Thanks very much!


Six Myths About Low-Carb Diets

Is Exercise Compatible with a Low-Carb Diet?

Five Reasons to Add Chia Seeds to Your Diet

How Much Protein Should a Low-Carb Diet Contain?

Creamy Chicken Artichoke Spinach Casserole

Do Calories Count on a Low-Carb Diet?

Low-Carbohydrate Foods and Beverages to Consume When You're Sick

Keto-Adaptation: Tips for Acclimating to a Low-Carbohydate Diet

Low-Carb Oven-Baked Barbecue Chicken

Five Easy Low-Carb Breakfast Ideas

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.

References:
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

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.