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?
Disclosure: I was contacted by the author, who sent me a review copy of this book free of charge.
The ability to see is something we usually take for granted until we start having problems. Loss of vision due to cataracts, glaucoma, and macular degeneration becomes more common as we age, but eye problems can develop throughout the life cycle. I've had several eye disorders: bilateral strabismus ("lazy eye") requiring surgery when I was seven, medium myopia (nearsightedness) since around that age, and most recently presbyopia ("old eyes" -- farsightedness after the age of 40). I also have a strong family history of glaucoma, so doing whatever i can to preserve the sight I have is extremely important to me.
Dr. Bruce Fife is a naturopath, certified nutritionist, and director of the Coconut Research Center. He's a prolific author, having written 20 books based on his extensive review of the literature on the benefits of coconut oil and its medium-chain triglycerides (MCTs). In his latest book, Stop Vision Loss Now!, he provides evidence that a well-balanced, nutrient-rich, very-low-carbohydrate diet supplemented with coconut oil may help to prevent and even reverse some of the most common eye disorders associated with aging.
The major concept of the book is that the eyes are an extension of the brain, so whatever keeps the brain healthy and well nourished will do the same for the eyes. There's a growing body of research demonstrating that maintaining blood glucose and insulin levels as close to normal as possible can help preserve brain function and reduce the risk for Alzheimer's disease and other forms of dementia. According to Dr. Fife, many researchers now believe that although increased intraocular pressure is involved in glaucoma, its primary cause is that nerve cells within the brain become damaged, similar to what happens in Parkinson's and Alzheimer's disease. He explains that coconut oil increases brain-derived neurotrophic factor (BDNF), a gene that stimulates the growth, maintenance, and repair of these nerve cells.. Dr. Fife suggests that the increase in ketone levels that occurs in response to MCT can protect eye health and improve or potentially reverse degenerative eye disorders as a result of increased BDNF. In addition to age-related conditions like glaucoma, cataracts, macular degeneration, and diabetic retinopathy, coconut oil can also be used for dry eyes, eye infections, and other non-vision-limiting conditions.*
In addition to generous amounts of healthy fats and moderate amounts of protein, Dr. Fife recommends including a wide variety of nonstarchy vegetables and berries to reduce oxidative stress that can lead to eye disease. He advises selecting from three different levels of carbohydrate intake based on blood glucose levels and provides a sample menu for a typical day, along with guidance on meal planning and dining out. Lists of protective low-carbohydrate foods and a comprehensive net carb counter are included. I agree with his suggestion to add coconut oil slowly, one tablespoon per day to start, in order to prevent GI symptoms and determine personal tolerance.
I learned several things I didn't know as a result of reading this book, including:
I found Stop Vision Loss Now! very well-researched, comprehensive, and interesting. Dr. Fife has a gift for making advanced nutrition concepts and physiological processes easy for the average reader with an interest in health to understand. It was truly a pleasure read for me. There are many personal accounts throughout the book, including the author's story of how he reversed his own early-stage glaucoma. Although there isn't a lot of published research on the benefits of coconut oil for eye disorders, he makes a great case for including it as part of a whole-foods-based, low-carbohydrate diet in Stop Vision Loss Now!
*Regardless of whether these changes in diet and lifestyle improve your vision, if you have an eye disorder, you should continue to see your ophthalmologist at least once a year for monitoring.
For quite a while, whenever I've said I eat a low-carb, high-fat diet, I've felt a little conflicted. Certainly the highest proportion of my calories comes from fat, but "high fat" is a relative term. Unlike many people in the very-low-carb community who consume a diet containing 65-85% fat, mine is around 50%. The truth is, I eat a lot more protein than is currently in vogue: generally 100 grams or more per day, which is about 1.8 to 2 grams per kg of total body weight. And after recently watching this 2013 lecture by one of the leading experts on protein, Dr. Donald Layman, and doing a lot of reading on the subject, I'm more convinced than ever that a high-protein version of carbohydrate restriction is best for me and most others.
"High protein" is a relative term as well, and Dr. Layman believes that truly high protein intake is over 170 grams per day. Now, I'm not suggesting that people eat more than 170 grams of protein on a regular basis unless they're very muscular and lift heavy weights several times a week. But I think my diet would qualify as relatively high in protein by many people's standards.
If you don't have time to watch the excellent video above, here are some key points made by Dr. Layman:
There's plenty of research in favor of moderately high protein consumption, including a study Dr. Layman published earlier this year expanding on many of the concepts above, such as the amount and type of protein required at mealtimes to optimize leucine's effects on MPS: 3 grams of leucine per meal, or a minimum of ~25 grams of protein per meal (1).
Also, while insulin is viewed by many in the low-carb community as a "storage" hormone, it's actually also an anabolic hormone that promotes growth in children and increased muscle mass in adults. Chronically high levels of fasting and postmeal insulin are indeed unhealthy, but along with leucine, a small rise in this hormone after meals is vital for MPS. Also, research suggests that much like insulin resistance, aging may produce "leucine resistance," which requires additional amino acids in order to promote MPS signaling (1).
Muscle protein breakdown (MPD) and MPS occur in everyone and should be in balance in order to maintain muscle mass. If your goal is to increase muscle size, the ratio of MPS to MPD must be increased through strength training as well as sufficient protein intake. Loss of lean muscle due to inadequate amino acid intake is one of the major drawbacks of fasting, which results in an extended period of MPD, and "fat fasts," where a 1000-calorie, 90% fat diet is consumed for several days to break out of a weight loss plateau.
Weight loss: There's been much talk lately about striving for nutritional ketosis in order to lose weight. I've seen people encouraged to keep protein "moderate" (i.e., 1 gram per kilogram lean body mass) and increase fat intake in order to drive up serum ketone levels. But all the studies on low-carbohydrate diets supporting weight loss have used high protein intakes, whether ad libitum or prescribed (2-6), including the ones described as "very-low-carbohydrate ketogenic diets," whether urinary ketone levels were measured and reported or not. And for the record, I don't believe ketogenic diets promote weight loss any better than low-carbohydrate diets do and can in fact be counterproductive for weight loss at low protein and energy intakes.
Protein has the highest thermic effect of food (TEF) of the three macronutrients, meaning its digestion and absorption cause metabolic rate to increase significantly more than with carbohydrates or fat. An older study linked this effect to protein's high satiety value (7), and many studies have confirmed that with higher protein intake, people end up eating less as a result of feeling full and satisfied (8-10).
Retention of muscle mass: During weight loss, there's a risk of losing lean muscle tissue in addition to fat. However, research has shown that increasing protein intake can protect against muscle loss during the process of losing weight (11). Higher protein intake can also decrease sarcopenia, or the loss of lean mass that occurs as a natural part of the aging process, estimated at 3-8% per decade after the age of 30 (12), and it's particularly effective when combined with resistance exercise. Dr. Bill Lagakos of Calories Proper wrote a great blog post demonstrating that nutritional ketosis in the absence of adequate protein (~100 grams per day for most) does not prevent a decline in muscle mass during weight loss. Bill has written many other excellent articles on protein and other topics, so please check out his blog if you haven't already.
Over the past few years, I've seen a disturbing trend in people who are trying to lose weight limiting protein to 50-60 grams per day in an attempt to achieve beta-hydroxybutyrate values over 1.5 mmol/L. (Fasting, of course, limits protein to zero grams for the duration of the fast). For therapeutic purposes such as epilepsy, brain cancer, neurological or mood disorders, this may be warranted. But I strongly disagree with this tactic for weight loss or diabetes management, the population group I primarily work with.
Protein is a satiating, self-limiting nutrient that increases metabolic rate, increases satiety, and helps maintain muscle health. So my question is why would we want to intentionally limit it if the goal is fat loss?
What about kidney health, bone health, and blood glucose levels?
There's a misconception that high protein intake is bad for the kidneys, but this seems to be based on the results of an older study on individuals who already had renal disease (13). Subsequent studies have demonstrated that high protein consumption (more than 1.5 grams per kg body weight) doesn't adversely affect the health of kidneys in people without preexisting renal disease (14). In fact, recent research suggests that even individuals with renal disease may not need to limit protein as previously believed, depending on the stage of disease. In 2013, researchers looked at the effect of a "moderate" protein diet (90-120 grams) vs. a "standard" protein diet (55-70 grams) in overweight and obese men with type 2 diabetes and impaired kidney function (15). This was a long-term study lasting two years, and in addition to weight loss and better blood glucose control, both groups saw an improvement in renal function.
I've written about the effects of high protein diets on bone health recently. It's a very long blog post, but if you skip to the "Protein" section at about the halfway point, you'll see that high-protein intake is actually beneficial rather than harmful for bone density, provided intake of minerals such as calcium are optimized and alkaline foods like vegetables are included in the diet.
And what about the effect of high protein intake on blood glucose levels in people with diabetes and prediabetes? Like the studies on weight loss discussed above, all of the carbohydrate-restricted research verifying its benefits on glycemic control have been high in protein (often ad libitum amounts of meat, poultry, and eggs) (16-19), including one coauthored by Dr. Eric Westman in which 17 out of 21 subjects were able to eliminate or reduce dosage of insulin and/or oral diabetes medications over the course of the 16-week study(20). Although the amounts of food consumed weren't listed, most if not all of these participants were likely eating at least 100 grams of protein daily, given that their carbohydrate intake was less than 20 grams and portion sizes of protein foods weren't limited.
When the term "very-low-carbohydrate, ketogenic diet is used" in weight loss and diabetes research, it's referring to carbohydrate restriction -- not extremely high fat intake and definitely not protein restriction.
In 2004, Mary Gannon and Frank Nuttall studied 8 men with type 2 diabetes who followed a moderately low-carbohydrate (~100 grams net carbohydrate), high-fiber (~36 grams), very-high-protein (~200 grams) diet. After 5 weeks, fasting and postprandial blood glucose levels, insulin levels, and HbA1c had significantly improved (21). Of course, this was a very small study, but the results are pretty encouraging, given that dietary protein intake was roughly twice the amount consumed by most people.
Going with Science
When I say I'm in favor of high-protein, low-carbohydrate diets, I'm not recommending that most people eat anywhere close to the amount of protein consumed in the Gannon study. In fact, I don't think most of us could eat that much and feel well. Protein needs vary from person to person based on size, age, activity, and certain medical conditions. But I think we need to base low-carbohydrate recommendations on what the science shows, which is moderately high protein intake -- particularly during weight loss and aging -- on an ad libitum basis for most people.
1. Layman, DK. Defining meal requirements for protein to optimize metabolic roles of amino aids. Am J Clin Nutr. 2015 Appr 29. poi:ajcn084053. [epub ahead of print]
2. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab. 2003 Apr; 88(4):1617-23
3. Foster GD, et al. Weight and Metabolic Outcomes After 2 Years on a Low-Carbohydrate vs. Low-Fat Diet: A Randomized Trial. Ann Intern Med. 2010;153(3):147-157
4. Brinkworth GD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months. Am J Clin Nutr. 2009 Jul;90(1):23-32
5. 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
6. Ebbeling CB et al. Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA. 2012;307(24):2627l-2634
7. Crovetti R, et al. The influence of thermic effect of food on satiety. Eur J Clin Nutr. 1998 Jul;52(7):482-8
8. Anderson GA, et al. Dietary proteins in the regulation of food intake and body weight in humans. J Nutr. 134:974S-979S
9. Rolls BJ, et al. The specificity of satiety: the influence of foods of different macronutrient content on the development of satiety. Physiol Behav. 1988;43(2):145-53
10. Halton TL, et al. The effects of high protein diets on thermogenesis, satiety, and weight loss: a critical review. J Am Coll Nutr. 2004 Oct;23(5):373-85
11. Soenen S, et al. Normal protein intake is required for body weight loss and weight maintenance, and elevated protein intake for additional preservation of resting energy expenditure and fat free mass. J Nutr. 2013 May;143(5):591-6
12. Arentson-Lantz E, et al. Protein: a nutrient in focus. Appl Physiol Nutr Metab.
13. Brenner BM, et al. Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med. 1982; 307:652-659
14. Martin WF, et al. Dietary protein intake and renal function. Nutr Metab (Lond). 2005;2:25
15. Jesudason DR, et al. Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts. Am J Clin Nutr. 2013 Aug;98(2):494-501
16. Nielsen JV, et al. Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up. Nutr Metab. 2006 Jun 14;3:22
17. Yamada Y, et al. A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes. Intern Med. 2014;53(1):13-9
18. Unwin D, Unwin J. Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: experience from one general practice. Practical Diabetes 2014, 31: 76–79
19. Tay J, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. Am J Clin Nutr. 2015 Jul 29pii: ajcn112581.[epub ahead of print]
20. Yancy WS, Westman EC, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab. 2005 2:34
21. Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004 53:2375–2382
Could returning to the foods our paleolithic ancestors consumed (or modern versions thereof) tens of thousands of years ago be used to treat diseases that are all too common today, particularly diabetes and prediabetes?
In Paleobetic Diet: Defeat Diabetes and Prediabetes with Paleolithic Eating, Dr. Steve Parker and Sunny Parker provide compelling evidence that it very well could. I'm a big fan of Dr. Parker's previous book, Conquer Diabetes and Prediabetes: The Diabetic Mediterranean Diet, as well as his website, Diabetic Mediterranean Diet. He's an expert on the Mediterranean Diet and one of a small but growing number of physicians who recommend a low-carbohydrate diet based on whole foods for people with diabetes and prediabetes. A few years ago he created another website, Paleo Diabetic, covering the beneficial aspects of a carbohydrate-restricted based on paleolithic food principles. Paleobetic Diet is an extension of that website. It's a very well-written, informative book that's easy to understand, even for those unfamiliar with paleolithic nutrition or carbohydrate restriction. Dr. Parker's writing style is professional, low key, and subtly humorous. He's also very up front about saying "I don't know" rather than engaging in conjecture or hype, which I really appreciate. His wife Sunny "served primarily as the editor, food maven, recipe mastermind, and Steve's muse."
Here are several topics addressed in Paleobetic Diet:
What did people actually eat during the paleolithic era? After introducing us to the modern "Paleo Diet" and a number of people (including doctors and other health professionals with both type 1 and type 2 diabetes) who have experienced health improvements as a result of following it, Dr. Parker discuses the foods that our ancestors subsisted on from roughly 2.5 million to 10,000 years ago, prior to the Agricultural Revolution. During this time the food of our hunter-gatherer ancestors was primarily meat, fish, nuts, roots, grasses, and berries. The omega 3 to omega 6 ratio of polyunsaturated fatty acids was about 1:1 or 1:2 versus 1:10, which is a conservative estimate of what most people currently consume. While the total carbohydrate content was low-moderate (roughly 30-40%, although some sources argue it was somewhat higher), digestible carbohydrate would have been considerably lower given the amount of fiber contained in the plant foods -- 70 or more grams, in sharp contrast to our average modern-day consumption of 20 grams or less of total fiber.
Diabetes: There's an excellent section on the root cause of diabetes and the many complications that can result from long-term uncontrolled blood glucose levels. Dr. Parker stresses that of the three macronutrients (protein, carbohydrates, and fat), carbohydrates have by far the largest impact on blood sugar and insulin levels, and that his own experience with patients who adopt a low-carb diet is congruent with studies demonstrating its effectiveness for diabetes management.
Paleobetic Diet: Dr. Parker's Paleobetic Diet is based on low-carb ancestral foods like meat (including organ meat), fish, vegetables (primarily nonstarchy), fruit, nuts, and oils. No processed foods, dairy, or artificial sweeteners are allowed. The recommended daily carbohydrate range is 40 to 80 grams of net carbohydrates (total carbohydrates minus all fiber), with advice to aim for a lower carbohydrate amount at breakfast, when insulin resistance is typically the most severe.
There's a one-week sample meal plan to be used as a guide, along with recipes for each meal that include both imperial and metric measurements. Comprehensive nutritional information is included. The recipes are quick, simple and tasty -- much like the kind I prepare on a daily basis. Some of my favorites are the Brian Burger with Bacon, Brussels Sprouts, Tomato, and Pistachios; the Turkey Tomato Bowl; and the Mexican Eggs and Avocado Slices pictured below with accompanying recipe.
Mexican Eggs and Avocado Slices
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
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.
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
Cinnamon Flaxseed Pudding*
1 cup blackberries
Coffee or tea with 2 Tbsp half and half
1/2 oz dark chocolate (at least 85% cocoa)
Water, tea, or other sugar-free beverage
3 celery stalks with 1 Tbsp almond butter
Chocolate Avocado Pudding*
Water, tea, or other sugar-free beverage
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
Cinnamon Flaxseed Pudding
Number of Servings: 1
½ cup cottage cheese
2 Tbsp ground flaxseed
½ tsp cinnamon
3 Tbsp chopped toasted pecans
Stevia or other sweetener, if desired
Combine all ingredients in small bowl.
Number of Servings: 1
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
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.
Number of Servings: 4
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
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
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
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.
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
Last month, Diabetes Care, a journal of the American Diabetes Association, published an article linking sulfonylurea use to increased risk of cardiovascular disease in women. Sulfonylureas stimulate the pancreas to produce insulin and include glipizide (Glucotrol), glyburide (Micronase), and glimepiride (Amaryl) in the US, as well as gliclazide (Diamicron), available in Great Britain and Australia. Although many newer medications are receiving a lot of attention in the media, sulfonylureas remain among the most widely prescribed diabetes medications on the market. Dr. Steve Parker wrote a nice overview of sulfonylureas a few years back.
A few pertinent facts about the study referenced above:
I find this quite concerning, but I've only read the abstract and would like to read the entire study before commenting further. (If anyone is willing to share the full text with me, it would be much appreciated.) However, the well-known side effects of sulfonylureas are precisely what I saw in many patients in my former position as an outpatient dietitian in a large hospital:
Contrast these undesirable effects with those of metformin, a diabetes medication which is relatively safe, improves insulin sensitivity, decreases hepatic glucose output, and doesn't result in hypoglycemia or weight gain.
A very important point is that sulfonylureas are only used to cover postprandial blood glucose in response to a carbohydrate-containing meal. If minimal carbohydrate is consumed, sulfonylureas aren't necessary and can definitely cause hypoglycemia. So someone following a very-low-carbohydrate diet would need to discontinue sulfonylurea treatment but might continue taking metformin indefinitely, depending on fasting and postprandial blood glucose levels.
I realize most dietitians and diabetes educators advise people with type 2 diabetes that they should consume the same foods as everyone else and take insulin or insulin-stimulating medications to control the inevitable postmeal rise in blood glucose. But with all of the side effects listed above -- and now a potential increase in CHD risk -- I think that's a very misguided approach. It also places a large burden on the beta cells of the pancreas and may increase the rate of disease progression. Let's compare the risks of these medications to carbohydrate restriction for diabetes control. As long as the diet contains ample protein, healthy fat, plenty of vegetables, and smaller amounts of slow-digesting carbs from foods like nuts and berries, there are essentially no adverse effects than perhaps constipation, which is easily treated. And the benefits of low-carbing for someone with diabetes? No risk of hypoglycemia, increased satiety, and easier weight loss -- exactly the opposite of eating a "normal" amount of carbohydrates and taking sulfonylureas or insulin for coverage.
At the Low Carb Down Under conference in Melbourne at the end of September, I said that being respectful and courteous is the best way to convince dietitians and diabetes educators to recognize the benefits of carbohydrate restriction, and I stand by that statement. Remember, up until a few years ago I was one of those dietitians who promoted a low-fat diet with plenty of whole grains. But as we continue to find out about the drawbacks of various diabetes medications -- including several of the newer ones -- I understand people's frustration at being told they're a necessary part of diabetes management instead of being presented with an alternative solution. Since you're reading this, I hope you're someone who has benefitted from a low-carbohydrate lifestyle or would like to. The best that we can do is to continue speaking out and sharing our experiences, knowing that the evidence is on our side and at some point most health professionals will understand that carbohydrate restriction is the best and safest option.
1. Li Y, et al. Sulfonylurea Use and Incident Cardiovascular Disease Among Patients With Type 2 Diabetes: Prospective Cohort Study Among Women. Diabetes Care 2014 Aug 22
2. Braatvedt GD, et al. The clinical course of patients with type 2 diabetes presenting to the hospital with sulfonyl-induced hypoglycemia.Diabetes Technol Ther 2014 Jul 10
3. Fonseca V, et al. Determinants of weight gain in the action to control cardiovascular risk in diabetes trial. Diabetes Care 2013 Aug;36(8):2162-8
4. Madiraju AK. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature 2014 Jun 26;510(7506):542-6
5. Feinman, et al. Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Nutrition 2014 July 16
A couple of days ago I received the August issue of Today's Dietitian and was excited to see "The Top 10 Diabetes Meal Patterns" on the cover. My excitement faded, however, when I realized that the list was the same one published by US News & World Report in January, which ranked the Atkins and Paleo diets 25 and 31, respectively. Still, I held out a glimmer of hope that something about the benefits of carbohydrate restriction for diabetes would be mentioned in this article. Unfortunately, that wasn't the case.
The author of the Today's Dietitian article reviewed the diets that made the Top 10 and included commentary by dietitians with expertise in diabetes management. With the exception of Dr. Andrew Weil's Anti-Inflammatory Diet and the Mediterranean Diet, all of the plans are low to very low in fat, and none are low in carbohydrates. The dietitians discussing the diets in the article seem to think that calories are more important than carbohydrates because "people with diabetes and prediabetes typically require weight loss." Perhaps that's why a Academy of Nutrition and Dietetics spokesperson gave high marks to the No.1 ranked Biggest Loser diet, which limits calories to 1200 per day and encourages vigorous exercise. I have several issues with the Biggest Loser approach to weight loss that will have to wait for another day, but for now I'll say that almost everyone with diabetes will get hungry eating a low-fat, high-carbohydrate diet that contains 1200 calories (I certainly would), so they're unlikely to stick to it for any length of time. In addition, not all people with diabetes or prediabetes require weight loss, and many will struggle to achieve adequate glycemic control eating 50+ grams of carbohydrate at every meal. And although it appears that the diets are being discussed in terms of their effectiveness for type 2 diabetes rather than type 1, this should have been clarified.
Several of the plans are plant-based: Engine 2, Flexitarian, Ornish, and Vegetarian. There is some positive research on plant-based diets for diabetes management, so I understand the inclusion of these diets here. If people with diabetes want to follow some form of vegan or vegetarian diet, that's certainly their right. But others will find it difficult to adhere to the diet. There are many studies supporting carbohydrate-restriction for diabetes as well, and it deserves a mention somewhere in the Today's Dietitian article. Perhaps after the following quote:
"Every year since 2010, US News & World Report has ranked the year’s most popular diets. Using a panel of experts, including RDs and physicians specializing in diabetes, heart health, and weight loss, diets are ranked in eight categories, such as diabetes and heart disease prevention and control, as well as easiness to follow and likelihood of weight loss. According to the 2013 ADA nutrition recommendations, there are several meal patterns that have shown good results in people with diabetes."
Or even better, after this one:
"The 2013 ADA nutrition recommendations show that the quantity and type of carbohydrate in food impacts blood glucose levels, and the total amount of carbohydrate eaten is the primary predictor of glycemic response."
I realize that acceptance of low-carbohydrate diets is difficult for many dietitians, but a it is listed in that ADA paper (page 6) as an option. I've written a few journal and magazine articles about the benefits of carbohydrate restriction for diabetes (listed on my About Me page), and last August Today's Dietitian published an excellent article on this subject authored by my friend and fellow dietitian Aglaee Jacob. We're not advocating anything extreme; we both believe in a whole-foods-based approach with a flexible range of carbohydrate intake based on personal tolerance, preferences, and goals. I'm going to be speaking about carb restriction for diabetes at the Low Carb Down Under conference in Melbourne later this month, and it's going to be great to meet another low-carb dietitian who's presenting at the event, Dr. Caryn Zinn from New Zealand, along with the other speakers. I'm also very encouraged by the number of dietitians I've been in contact with over the past couple of years who support a low-carbohydrate lifestyle for people with diabetes or are at least open to the idea.
The American Diabetes Association has taken a big step in the right direction by recognizing carb restriction as an option for the millions of people who struggle with this often devastating disease, and I'm hopeful that more dietitians will come around to realizing how effective and sustainable this way of eating can be before it's time to rank diets for US News & World Report's 2015 list.
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
I love eating the types of natural whole foods my grandparents grew up on: a wide variety of meat and seafood, eggs, cheese, yogurt, fresh vegetables, nuts, and berries. Overall, I consider myself whole-foods based and concerned about food quality. However, for me, avoiding processed food is secondary to keeping carb intake very low, protein and fiber moderate, and fat fairly high, as this controls my blood sugar and makes weight maintenance easier as I age. As I mentioned in a previous post a few months back, I don't really identify as Paleo, Primal, or Ancestral. Carbohydrate restriction has had such a positive impact on my own life and that of countless others. I know many of you follow a Paleo/Primal way of eating, and in many respects I do as well. A typical food day for me is quite whole-foods based, as you can see from my intake yesterday:
Eggs and kale cooked in coconut oil
Berries with ricotta cheese
Coffee with cream
Arugula with Greek yogurt, avocado, olive oil, and sea salt
Hot cocoa tea
Salad made with diced turkey, cucumbers, tomatoes, olive oil, and vinegar
Square of unsweetened chocolate
Hot cocoa tea
But there are some decidedly non-Paleo items in my diet and lifestyle as well. Here are my food "confessions," although I don't really like using that term here because it implies I've done something wrong. If any of you can think of a better word, let me know, and I'll change it.
I use saccharin every day.
I mentioned using erythritol when I bake in the post referenced above, and explained that baking is a rare occurrence for me. I do have a cup of coffee and a few cups of sugar-free cocoa tea every day, though, and I use saccharin to sweeten them. But instead of Sweet 'n Low, which contains dextrose (sugar), I use Nectasweet, pure saccharin tablets with no carbohydrates. Saccharin has been around for over 100 years -- it was the original sweetener used by people with diabetes prior to the discovery of insulin -- and there is no evidence whatsoever that it increases cancer risk in humans. Each Nectasweet tablet provides the equivalent sweetening power of 1 teaspoon of sugar, at a cost of only a penny per serving. Yes, stevia comes from a plant and is therefore "natural," but we know less about its long-term safety than we do about saccharin, and it's much more expensive.
Here's my delicious and easy "Hot cocoa tea" recipe:
Pour boiling water over tea bag of choice (I like Rooibos red or vanilla) and let steep 2-3 minutes. Add 1 tsp unsweetened cocoa powder, 1 Nectasweet tablet, and 1 tablespoon heavy cream or half-and-half. Stir and enjoy.
I make my husband low-carb Cheez-its from processed cheese.
I have Laura Westman, Dr. Eric Westman's daughter, to thank for this one. I was telling her that one of my clients had asked about a substitute for crackers. "Have you heard about low-carb Cheez-its?" she asked. "You make them from American cheese, they're super easy, and they taste like the real thing!" Googling "Low-carb Cheez-its" led me to this recipe for Crispy Cheese Crackers. I've never been much of a Cheez-it fan, but I made a batch for my husband. He said they were very good, "pretty close" to the original, and I could make them again sometime, which I've done. That's high praise coming from my extremely finicky (but otherwise wonderful) husband. Yes, American cheese is technically a processed food, but it's not much different from regular cheese in terms of ingredients, and apparently none of them are controversial from a health perspective.
I like Shirataki noodles better than zucchini noodles.
I love zucchini. One of my favorite ways to prepare it is sautéed with mushrooms and onions topped with spicy beef chili. But while some people enjoy substituting zucchini and other vegetables for pasta -- by julienning them manually or using a "Zoodler" or other device intended for this purpose -- I'm not wild about the results. Although I rarely crave pasta the way I imagine some people on low-carb diets do, occasionally I enjoy making low-carb noodle entrees like Thai Chicken and Noodles and Beef Stroganoff. In my opinion, Miracle Noodles are ideal for these dishes and many others. Shirataki (also called glucomannan) comes from the konjac plant, which is native to Japan. It's essentially all fiber and contributes less than 5 calories and 1 carb per serving, yet provides a lot of volume. There's some evidence it may promote weight loss and reduce high cholesterol levels. Maybe it would actually be Paleo approved because it's not really processed other than being ground up and formed into strands before being packed in liquid. At any rate, I enjoy eating these sometimes.
Tip: Rinse Miracle Noodles really well and pan-fry them without oil or other liquid in order to remove as much water as possible. The less water that remains, the better the texture will be.
I use mayo on beef patties.
Conventional mayonnaise is made with soybean oil and a little bit of sugar, although the amount of carbs in a tablespoon is less than zero. Yes, this is the type of oil that's made from GMO soybeans and is high in omega-6 polyunsaturated fatty acids (PUFAs). I'm not saying it's healthy and I don't eat it that often, but if I'm getting a protein-style burger and there's no guacamole around (which is usually the case), I'll top it with mayonnaise without a second thought.
Sometimes I eat nuts roasted in peanut oil, cottonseed oil, etc.
Peanut and seed oils are high in omega-6 PUFAs as well. I usually have raw almonds, macadamias, hazelnuts, and pecans on hand at home. But my husband likes the roasted type, and let's face it: They do taste better. So sometimes I'll grab a few from his stash and eat them instead of the raw nuts. I eat a lot of sardines and salmon -- usually about four fish meals per week -- so I'm definitely getting plenty of omega-3s for balance.
I'm not a fan of Cross-Fit.
In all honesty, I'm about as far from a Cross-Fitter as you can get. I realize not everyone who follows a Paleo diet does Cross-Fit, but enough do to mention it here. I prefer walking and doing Ellen Barrett's Pilates, yoga, and light resistance routines to stay fit and energized. From my understanding of what Cross-Fit entails and online reports of people (particularly women) developing problems when combining it with carbohydrate restriction, it appears that the two aren't compatible.
I reheat food and beverages in the microwave.
I've read articles online cautioning people about the dangers of microwaving food, and at least a few have been from members of the Ancestral community. I need to see convincing evidence for the assertion that microwaving alters food in a different way than occurs in other cooking methods. This article is one of several that explains why microwaving is safe for cooking and reheating foods and beverages when guidelines are followed (i.e., no metal, plastic tubs, etc.).
So now you see the way I truly eat and live. Particularly in the context of my balanced, very-low-carbohydrate diet, I really don't think any of these behaviors will do me any harm. In fact, I hope you can relate to a few of them.
Franziska Spritzler, RD, CDE