I'm very happy to announce that I am writing articles for the Authority Nutrition website. For a while, this will be the extent of my writing, given that I'm already very busy seeing clients and working on other projects.

Although I've already shared these articles on social media, I realize some of my readers aren't on Facebook and Twitter, so I intend to share them on my blog on a monthly basis. Also, not every article will be about low-carbohydrate diets, although my first one happens to be.

I appreciate your support very much and hope you enjoy the articles.

​A Guide to Healthy Low Carb Eating with Diabetes

Oxalate (Oxalic Acid): Good or Bad?

Mexican Eggs and Avocado Slices 
(1 serving)






Ingredients:

3 large eggs
2 oz (60 g) fresh tomato
3/4 oz (20 g) fresh onion (I used about 1/4 oz)
1/4 jalapeño pepper (I used 1 Tbsp chopped green chiles) 
3-4 sprigs fresh cilantro, chopped (I used 1 sprig)
2 tsp olive oil
1 medium California avocado
salt and pepper, to taste

Preparation:

Make the pico de gallo first: Finely chop and mix together the tomato, onion, jalapeño pepper, cilantro, salt, and pepper.

Peel and slice the avocado. Add salt and pepper, to taste.

Fry the eggs in a pan coated with olive oil. Salt and pepper as desired. When done, transfer to a plate and spoon the pico de gallo onto the eggs. Enjoy with avocado slices on the side.

Nutritional Analysis:

72% fat
13% carbohydrate
15% protein
592 calories
20.5  grams carbohydrate
13 grams fiber
7.5 grams digestible carbohydrate
47 grams fat
22 grams protein
810 mg sodium (assuming 1/4 teaspoon total is used)
1235 mg potassium

Diabetes Medications: One of Dr. Parker's goals is to help reduce the amount of medication needed to achieve optimal blood sugar control. In addition to a detailed plan for successful implementation of the Paleobetic Diet, he provides a section about all 12 classes of diabetes medications that includes their benefits, risks, and whether they have potential to cause hypoglycemia. He stresses the importance of speaking with a healthcare provider (doctor, nurse practitioner, or diabetes educator) prior to making dietary changes for those currently taking insulin or oral diabetes medications. 

Paleo Eating Tips: I really enjoyed the "Daily Life with Paleo Eating" chapter, which contains guidance on shopping, cooking, cravings for sweets and other high-carbohydrate foods, and weight loss. There's also a substantial list of online resources for low-carb Paleo recipes, nutrition analysis, and support. Despite the overall simplicity that characterizes a Paleo way of eating, there are still adjustments that will likely need to be made, based on each person's particular circumstances, and this chapter is very helpful in that regard. 

Exercise: Dr. Parker did a great job on the exercise section, including a subtitle declaring "Exercise Is Not Fun." (Did I mention how much I appreciate his wry sense of humor?) He gives practical tips for choosing activities that you'll stick with that provide health-related benefits. Again, he stresses consulting with your physician to obtain medical clearance before engaging in an exercise program.

Research: Here he explains that while there isn't a great deal of research on the paleolithic diet, what exists is quite promising for those looking to lose weight and improve blood glucose control and overall health. In addition to citing references, he provides detailed analyses of several studies, along with his own commentary on the results and suggestions for further research. In the final chapter, Dr. Parker discusses new theories about the cause of type 2 diabetes, which I found very interesting. There's considerable  disagreement among the experts on this topic, and I appreciate the opportunity to hear from all sides.

Paleobetic Diet provides a great framework for people with diabetes and prediabetes interested in a paleolithic-inspired way of eating. While my own diet is much closer to the one Dr. Parker recommends in The Diabetic Mediterranean Diet (for one thing, I enjoy at least one serving of dairy every day, often more), I understand the potential benefits for people with autoimmune disease or food intolerances. I like his guideline of aiming for 15-20 grams of net carbohydrate per meal, and using a glucometer to assess whether further reduction in carbs is necessary to optimize blood sugar control. He's done a wonderful job summarizing the research on paleolithic diets and constructing his own plan to help  people achieve a healthier lifestyle with a decreased risk for complications.

While much of the information contained in the book is available on the Paleo Diabetic website (in fact, the book has links to certain documents that can be downloaded directly from the site at no charge), I highly recommend purchasing the print or Kindle version of Paleobetic Diet for the additional material covered. I'd also encourage you to support the efforts of this low-carbohydrate MD who provides free, high-quality, well-researched  informative content on his websites.

 

Over the past few months, several women have contacted me  expressing frustration at being unable to lose weight despite strictly following a LCHF diet. When I ask whether they're including high-fiber plants like brussels sprouts, berries, nuts, and dark chocolate, the response is typically, "I avoid those because they're so high in carbs. I limit my carbs to less than 20 grams total." This is the trend I've noticed lately in the low-carb community: the belief that limiting vegetables and other high-fiber plants in an attempt to keep carbohydrate intake at an absolute minimum (sometimes as low as 10 grams of total carbohydrates per day) long term is the key to losing weight.

Soluble Fiber's Role in Improving Blood Glucose Regulation

A few weeks ago, Martina from the KetoDiet App website wrote an excellent blog post about counting net carbs vs. total carbs for those following a carbohydrate-restricted lifestyle. In the article, she correctly states that insoluble fiber passes through your system without being absorbed, so it should be subtracted from the total carbohydrate count. In addition, Martina explains that, unlike insoluble fiber, soluble fiber does not pass through the colon but rather is fermented into short-chain fatty acids (SCFAs) by our gut bacteria. 

The principal SCFAs are acetate, butyrate, and propionate. Of these, propionate is the only one that can be converted into glucose via gluconeogenesis (1). But would this have any significant effect on postmeal blood glucose given that most fiber is insoluble and only 15-40% of any soluble fiber will be converted to propionate (2)? Take brussels sprouts, for instance, one of the few foods that contains more soluble than insoluble fiber. A 1-cup serving has about 4 grams of soluble fiber. Less than 2 grams will be converted into propionate, and the amount of glucose produced from it via hepatic gluconeogenesis would be quite small, so serum blood glucose levels wouldn't be affected much.

More importantly, as Martina pointed out, De Vadder, et al, recently reported the results of a study on mice suggesting that SCFAs promote intestinal gluconeogenesis (IGN), with propionate acting as substrate and butyrate promoting the expression of genes necessary to induce this process. Compared with control mice fed their normal diet, mice who were fed diets enriched with SCFAs and fructo-oligosaccharides (FOS) experienced lower fasting serum blood glucose levels, improved glucose tolerance, and a significant reduction in the enzyme responsible for hepatic gluconeogenesis (3). Essentially, propionate is converted to glucose, which is used within the intestine, decreasing the amount of glucose produced by the liver, resulting in the above-mentioned benefits. Yes, this was an animal study, but it provides an intriguing explanation for the improvement in blood glucose levels seen in human studies examining the role of dietary fiber (4, 5).

Blood glucose response to fiber-rich food may differ among some people with Type 1 diabetes, whose blood glucose levels can reportedly rise as a result of higher food volume in the stomach or other stimuli, regardless of digestible carbohydrate intake. Dr. Bernstein and others with T1 have suggested such a response (what he calls The Chinese restaurant effect), but I know of no studies confirming this and would appreciate references if anyone has them.

Health Benefits of Fiber and SCFAs

We've known about the benefits of fiber on colon health for decades. Although it's believed these are due in part to insoluble fiber's ability to reduce intestinal transit time so potentially carcinogenic substances in our food spend as little time as possible in our GI tract, more recent research suggests that fiber's chemoprotective effects may be due primarily to the effects of one of the SCFAs, butyrate (6,7), which provides energy and nourishment for the cells of the colon.

In addition, higher fiber intakes may reduce levels of C-reactive protein (CRP) and other inflammatory markers, improve our immune response, and protect the gut from harmful microorganisms that can make us ill (8). In essence, fiber's fermentation to SCFAs helps keep our gut well nourished and working the way it should. 

Increasing High-Fiber Carbohydrate Intake May Be Helpful for Weight Loss

Let's go back to restricting intake to less than 20 grams of total carbohydrates in order to lose weight. When carbohydrate intake is this low, there's a limited number of foods that can be eaten: meat, cheese, fish, eggs, butter, cream, coconut oil, olive oil, and small amounts of greens and other very-low-carb vegetables. Yes, carbohydrate intake may be well below 20 grams of total carbs daily, but depending on portions consumed, calorie/energy intake  may be too high to promote weight loss. A serving of bullet-proof coffee contains 440 calories, zero carbs, zero protein, and zero fiber.

Aside from fiber's beneficial effects on overall health outlined above, consuming at least a moderate amount of fiber can facilitate weight loss, and both insoluble and soluble fiber can be helpful in this regard.

Insoluble fiber passes through the body without being absorbed. It adds volume to meals, but zero calories and zero carbohydrates. In fact, you could almost say that insoluble fiber provides negative calories, in that it may lower the amount of energy derived from fat and protein when all three are consumed at a meal (9).  Most foods are higher in insoluble than soluble fiber, with a few exceptions (Please refer to Martina's fiber chart in the blog post linked to above).

Soluble fiber does contribute calories/energy to the body, but no carbohydrates. The chief benefits provided by soluble fiber are due to its fermentation to the SCFAs acetate, butyrate, and propionate, which have been shown to promote satiety, reduce intake, and and decrease body fat (3,10-11).

Carbohydrate and Fiber: What's Optimal?  

Like carbohydrates, fiber is another substance where across-the-board recommendations can't be made, but I think it's best to aim for at least 20 grams daily, with 1/3 or more from soluble fiber. If you're limiting yourself to less than 20 grams of total carbohydrate, the maximum amount of fiber you can possibly get is 18 grams, and that's only if the carbs come from foods that are more than 90% fiber, such as chia seeds, flaxseed, or avocado. Generally speaking, those who consume diets containing less than 20 grams of total carbohydrate end up with 10 or fewer grams of fiber. Some people reportedly consume less than 5 grams on a consistent basis.

The goal of carbohydrate restriction is to keep blood glucose and insulin levels low, and this can be accomplished without reducing carbs to near-zero levels. I consume around 30-45 grams of fiber daily, and my net carb intake is around 35-50 grams, so my fiber to nonfiber carb ratio is roughly 1:1. This works well for me, but some people do better with 20-30 grams of fiber and slightly lower net carb intake. People with certain GI disorders* may require restriction of certain types and amount of fiber.

How do you get to 30 grams of fiber yet still maintain net carb intake of less than 40 grams? Here's one of the sample menus with recipes that will be included in my upcoming book, The Low Carb Dietitian's Guide to Health and Beauty. 

Sample Low-Carb, High-Fiber Menu

Breakfast:
Cinnamon Flaxseed Pudding*
1 cup blackberries 
Coffee or tea with 2 Tbsp half and half

Lunch:
Insalate Caprese*
1/2 oz dark chocolate (at least 85% cocoa)
Water, tea, or other sugar-free beverage

Snack:
3 celery stalks with 1 Tbsp almond butter

Dinner:
Chicken Curry*
Chocolate Avocado Pudding*
Water, tea, or other sugar-free beverage

Daily totals:
Calories: 1575
Protein: 88 grams 
Total Carbohydrates: 68 grams
Fiber: 31 grams
Insoluble Fiber: 20 grams
Soluble Fiber: 11 grams
Net Carbohydrates: 37 grams
Fat: 108 grams 

Recipes:

Cinnamon Flaxseed Pudding
Number of Servings: 1

Ingredients:
½ cup cottage cheese
2 Tbsp ground flaxseed
½ tsp cinnamon
3 Tbsp chopped toasted pecans
Stevia or other sweetener, if desired

Directions:
Combine all ingredients in small bowl.

Insalate Caprese
Number of Servings: 1

Ingredients:
4 oz fresh mozzarella cheese, sliced into ¼-inch rounds
1 large vine-ripened tomatoes, sliced ¼-inch thick
1/2 cup fresh basil leaves
Coarse sea salt, to taste
2 Tbsp cup extra-virgin olive oil

Directions:
On a plate, alternate mozzarella slice, then tomato slice, followed by basil leaf, and repeat sequence, overlapping each item slightly. Sprinkle salt and drizzle olive oil over top. 

Chicken Curry
Number of Servings: 4

Ingredients:
2 Tbsp coconut oil
1 cup chopped onion
2 tsp sea salt
2 tsp chopped garlic
2 tsp ground ginger
2 tsp coriander
1 tsp turmeric
1 tsp chili powder
4 cups broccoli florets
2 cups snow peas
2 cups mushrooms
½ cup coconut milk
1 lb chicken breast, cut into bite-sized pieces

Directions:
Heat oil in a wok or large saucepan over medium-high heat. Add the onion, then cook and stir until browned. Mix in garlic and spices. Add broccoli, pea pods, and mushrooms. Cook and stir for 1-2 minutes.
Add coconut milk and chicken. Reduce heat to medium and cook for 7 to 8 minutes, until chicken is no longer pink. Stir and remove from heat. Serve immediately.

Chocolate Avocado Pudding
Number of servings: 4

Ingredients:
2 medium very ripe avocados
½ cup unsweetened coconut milk
½ cup unsweetened cocoa powder
1 cup erythritol or other granulated sugar substitute equivalent to sweetness of ¾ cup sugar
2 tsp vanilla extract

Directions:
Cut avocado in half, remove pit, and scrape flesh into food processor or blender. Add coconut milk, cocoa powder, sweetener, and vanilla extract. Process until ingredients are well combined and there are no lumps of avocado. Divide into four dishes and refrigerate at least 30 minutes or until ready to serve.

                                                             
Roasted Brussels Sprouts Recipe

And for anyone who was hoping for a brussels sprouts recipe after seeing the photo and reading about their high soluble fiber content, please check out this delicious side dish, Roasted Brussels Sprouts with Pecans, from Kalyn's Kitchen.
                                                         
A Balanced Low Carb Diet: Eat Plenty of Plants and Animals


If you're consuming less than 20 grams of carbohydrate daily and achieving your weight loss goals, I'm very happy for you. But I would consider adding at least a few grams of high-fiber carbohydrates -- such as vegetables, berries nuts, and dark chocolate -- to optimize overall health and increase your likelihood of long-term success. And if your weight loss has stalled, I definitely recommend increasing your intake of these foods and perhaps decreasing fat and increasing protein intake, depending what you're doing currently. A  sustainable low-carb lifestyle consists of a balance of nutritious animal and plant foods, based on personal tolerance, preferences, and goals. 

                                                                                 * * *
*For those with small-intestinal bacterial overgrowth (SIBO) or other conditions requiring a low-reside diet, such as acute diverticulitis or other inflammatory bowl conditions, the recommendations for fiber intake provided in this article may be contraindicated. Consult your healthcare provider, who can provide guidance or refer you to a dietitian for recommendations.


References

1.Mithieux G, et al. Intestinal glucose metabolism revisited. Diabetes Res Clin Pract. 2014 Sep;105(3):295-301
2. Bergman EN, et al. Energy contributions of volatile fatty acids from the gastrointestinal tract in various species. Physiol Rev. 1990 Apr;70(2):567-90
3. De Vadder F, et al. Microbiota-generated metabolites promote metabolic benefits via gut-brain neural circuits. Cell. 2014 Jan 16;156(1-2):84-96
4. Post, RE, et al. Dietary Fiber for the Treatment of Type 2 Diabetes Mellitus. J Am Board Fam Med Jan-Feb; 25:16-23, 2012 
5. Aller R, et al. Effect of soluble fiber on lipid and glucose intake in healthy subjects: a randomized clinical trial. Diabetes Res Clin Pract. 2004; 65(1): 7-11
6. Cho Y, et al. Colon cancer cell apoptosis is induced by combined exposure to the n-3 fatty acid docosahexaenoic acid and butyrate through promoter methylation. Exp Biol Med (Maywood) 2014;239(3):302-310
7. Fung KY, et al. A review of the potential mechanisms for the lowering of colorectal oncogenesis by butyrate. Br J Nutr. 2012 Sep; 108(5):820-31
8. Levison ME, et al. Effect of Colon Flora and Short-Chain Fatty Acids on Growth In Vitro of Pseudomonas aeruginosa and Enterobacteriaceae. Infect Immun. Jul 1973; 8(1): 30–35
9. Baer DJ et al. Dietary fiber decreases the metabolizable energy content and nutrient digestibility of mixed diets fed to humans. J Nutr. 1997 Apr;127(4):579-86
10.Darzi J, et al. Do SCFA have a role in appetite regulation? Proc Nutr Soc. 2011 Feb;70(1):119-28
11. Lin HV, et al. Butyrate and propionate protect against diet-induced obesity and regulate gut hormones via free fatty acid receptor 3-independent mechanisms. PLoS One. 2012;7(4):e35240

A couple of days ago I received an email from the makers of a soy-based protein bar that began:

"Scientific research continues to show that a plant-based diet is a healthy dietary pattern. In fact, previous versions of the Dietary Guidelines for Americans have emphasized plant-based diets, and the 2015 Dietary Guidelines Advisory Committee appears to be supporting these previous conclusions."

I'd heard this before, after the US Dietary Guidelines Advisory Committee (DGAC) held their third public meeting on the subject this past May. The fourth meeting is scheduled to be held on the 17th and 18th of July, and there's an opportunity to participate online, if you're interested.

It does seem that plant-based diets -- which are usually, although not always, synonymous with vegetarian or vegan diets -- are gaining favor in terms of public perception of their health benefits and sustainability.  While I value the contribution vegetables, fruits, and nuts make to our diet, I disagree that most people would benefit from adopting a diet consisting solely of plant foods and have written about this before. And I'm disappointed that low-carbohydrate diets aren't being presented as an alternative at this point, particularly for the many groups of people who would benefit from them.

However, I dislike the confrontational and accusatory messages I've seen from many advocates on both sides in blog posts, comments,  and social media sites. I'm passionate about carbohydrate restriction (apparently I'm not supposed to use this phrase to describe myself, but I think it fits), and I get upset when people criticize it and make claims about the superiority of plant-based diets too. But in my opinion, being respectful of the other side -- who are often equally committed to their way of eating -- while letting the evidence in favor of low-carbohydrate diets speak for itself, is the best way to go. 

You may have already seen the debate between Dr. Eric Westman and Dr. T Colin Campbell held at the University of Alabama held in the spring of 2013. Both of these men have put many years into researching the effect of diet on various aspects of health. Each strongly believes that his way is the healthiest and most sustainable even though they are quite different. Dr. Campbell's view is that a plant-based, low-protein, low-fat, high-carbohydrate diet provides optimal nutrition, while Dr. Westman favors an eating plan that is very low in carbohydrate, moderate in protein, and high in fat. I encourage you to watch the video if you haven't already, or even if you have. Notice how Dr. Westman seeks to find common ground with statements like "There's more than one way to achieve excellent health," and then goes on to present the large body of evidence --including randomized clinical trials -- supporting carbohydrate restriction for diabetes, metabolic syndrome, and obesity, with early but promising research on ketogenic diets for cancer and neurological disease. I strongly agree with this approach and feel it's what will ultimately allow for more flexibility in the Dietary Guidelines -- specifically, including low-carbohydrate diets as an option.

I'm very happy to share the article I recently wrote for Diabetes Self-Management magazine. Like many dietitians and CDEs, I read this publication regularly and think it's a great source of information for people with diabetes. However, I often don't agree with the nutrition articles written by the RDs, as they generally recommend using MyPlate as a foundation for meal planning. I contacted the editor to ask about writing a piece on carbohydrate restriction as an alternative to MyPlate, and somewhat to my surprise, she invited me to write this article. Even better, she made only a few minor changes prior to publishing it, so it's very similar to what I submitted. One thing that wasn't included, though, was a sidebar I created that had a list of resources for people with diabetes, including websites like Blood Sugar 101 and The Low Carb Diabetic and books like The Art and Science of Low Carbohydrate Living and The Rosedale Diet. I think this was likely due to lack of space. But overall, I'm pleased with the way the article turned out, and I hope that many people with diabetes -- as well as dietitians, nurses, CDEs, and doctors -- get a chance to read it and discover that a low-carbohydrate diet can be very safe, effective, and sustainable.


 (The document below contains the cover of the March/April issue and my article. If you're interested in the other articles listed on the cover, you'll have to order the magazine from the publisher).



Copyright (c) 2014 Madavor Media
www.DiabetesSelfManagement.com