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
I rarely write book reviews on this blog, but this is the first of several I'll be doing over the next few months. As a dietitian, I'm frequently asked to plug a certain book, product, program, etc., but unless I feel right about it, I decline. The author of the book I'll be discussing today didn't even request that I review it, and rather than receiving a review copy, I purchased the book myself. I decided to write a review on my own because (1) I think it's a wonderful book with valuable information; (2) the author self-published, which takes a lot of time and effort and, compared to going with a publisher, considerable expense; and (3) the author does little self-promotion, so I want to make sure everyone knows about it.
If you're not already familiar with DJ Foodie, he's a formerly obese, self-described foodie who lost 150 pounds by following a low-carb lifestyle. He's also very funny, bright, and an extremely talented chef who trained at The Culinary Institute of North America and worked in the food industry for many years.
Why am I recommending that you buy a cookbook when there are so many low-carb recipes online, including those on DJ Foodie's website? I love recipe sites like his and the ones maintained by other low-carb culinary geniuses who never fail to amaze and delight me with their creations. But I really like having a collection of fantastic recipes in hard-copy form too. Plus I feel it's important to support the efforts of those whose online content and hard work we admire. Also, as fantastic as the recipes in this book are -- and they certainly are -- there is so much more included in Taking Out the Carbage. From the moment you take off the wrapping paper (hint: bacon lovers may want to save it) and open this beautiful 570-page, 6-pound hardback book filled with DJ's signature illustrations and engaging writing style, you're in for a real treat (low carb, of course!)
Here's what I love about Taking Out the Carbage:
Explanation of low-carb diets and the DJ Foodie "Low-Primal" approach DJ succinctly explains why energy/calorie deficit is essential for weight loss and that while people can lose on a variety of diet plans, the insulin-modulating, satiating effects of carbohydrate restriction (around 30 grams of net carb per day) make it the best strategy for sustained weight loss and future maintenance.
Rather than being restrictive, his "Low-Primal" lifestyle allows for a wide variety of animal and plant foods, including some wheat products, sugar substitutes, and peanut products that many people have been led to believe should be avoided. DJ's viewpoint mirrors my own: These foods may not be the epitome of healthful fare, but many people find that including them makes it much easier to follow a low-carb way of eating, particularly in the initial stages. Recipes can work for those who wish to follow a Paleo or ketogenic diet as well, with only a small modification of ingredients.
Aside from providing great information, DJ is an excellent writer, whose witty commentary made the book a pleasure to read. His honest, low-key, non-hype style really resonates with me.
Detailed sections about sugar substitutes ( including recipes to make your own sugar-free blends) and net carbs: There's a very balanced discussion on various sugar substitutes and why "natural" sweeteners aren't always better than "artificial" ones, particularly if you're trying to keep carbs down in order to lose weight or control blood sugar levels. DJ provides a great strategy for calculating net (digestible) carbs: total minus all fiber minus 50% of carbs from sugar alcohols (except erythritol, where all carbs can be subtracted).
"Bag of Tricks": Hidden carbs? Cravings? Weight-loss stalls? Getting organized to cook? DJ's got you covered on some of the most common diet challenges.
Organizational and planning tools: Another helpful section of the book contains 2 weeks of sample meal plans with 30 or fewer grams of net carb per day. DJ also provides detailed recommendations for customizing your own food plan. There are ingredients lists and removable grocery lists with net carbohydrate counts for each food. Everything is color coded and organized for ease of use -- all the information you need is at your fingertips.
Creative, easy, nourishing recipes with gorgeous color photographs and comprehensive nutritional analysis of each recipe: Of course, the highlight of the book is the recipes themselves. DJ made certain that each of the 226 recipes met the following criteria:
2. Easy and cost effective
3. Efficient and time saving
4. Never strays from the diet, while still allowing for some "legal cheats"
Each recipe is accompanied by an enticing large color image. The photography is absolutely stunning throughout! Each recipe lists both imperial and metric measurements. The low carb movement is growing internationally, which is very encouraging. Americans use imperial measurements (ounces, pounds, etc.), but most of the rest of the world is on the metric system (grams, milliliters, etc.), so it's great to see both here.
Some of the recipes are available on the DJ Foodie website, but others are exclusive to the book. And despite its subtitle, "The Big Book of Bacon," there are many tantalizing recipes in "Taking Out the Carbage" that don't include bacon, such as:
Asian Sweet 'n' Spicy Chicken
Torta di Rotello
Sausage, Tomato, and Fresh Mozzarella Tower
Raspberry–Cream Cheese Swirl Frozen Custard
Naturally, there are a number of recipes that do feature bacon, including the sensational grilled shrimp-and-bacon entree I prepared this weekend. Wow, was it delicious and satisfying! Even the pieces that got charred (my fault -- heat was up too high) were really tasty, and my husband asked if I would please make it again very soon.
BBQ'd Bacon-Wrapped Basil Shrimp
1 lb. (454 g) shrimp (16/20), peeled and deveined (I used slightly smaller shrimp, 26/30)
1/4 cup (60 mL) Sweet ‘n’ Tangy BBQ Sauce
6 slices (150 g) raw bacon
18 fresh basil leaves
18 bamboo skewers, soaked in water for 30 minutes (I only used 5 skewers)
salt, pepper, and chili flakes to taste
2 Tbsp (30 mL) coconut oil for grilling
1. Marinate the shrimp in the BBQ sauce for about 20 minutes.
2. Preheat the grill.
3. While the shrimp is marinating, cut each slice of bacon into thirds. This will result in 18 approximately two to three-inch (6 cm) slices of bacon. Squish each slice of bacon with the side of a knife or the bottom of a pan. Don’t tear it up. You want 18 nice thin “sheets” of bacon.
4. Set each sheet of bacon on a cutting board, and place a basil leaf on top of each sheet.
5. Place a marinated shrimp above each basil leaf. Season with a small amount of salt and pepper (add chili flakes for extra heat!)
6. Wrap each slice of bacon around the shrimp, and use a thin, premoistened skewer to hold the bacon in place. You can also put up to 3 per skewer, for a different look. (I put 3-4 on each skewer, since I was using smaller shrimp)
7. Brush the oil on the grill to help prevent sticking. Grill the shrimp over medium-high heat until the bacon is crisp and the shrimp are cooked through.
Nutrition information per serving:
Total Carbohydrates: 3 grams
Fiber: 0.5 grams
Net Carbohydrates: 2.5 grams
Protein: 18.5 grams
Fat: 17 grams
To sum up, Taking Out the Carbage is outstanding on every level and would be a wonderful resource for anyone interested in easy-to-preapre recipes that support a low-carb lifestyle. In all honesty, I can't imagine that you'll be anything but delighted with this book.
Starting today, DJ has arranged a second pre-sale where he's offering the book at the discounted price of $29.99 (regular price will be $49.99 on Amazon): Taking Out the Carbage pre-sale. I think it's an incredible bargain considering the quality of this book. If you already have your own copy, feel free to include your thoughts about it below in comments.
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
Have you ever cut calories drastically in an attempt to lose weight quickly? I did that repeatedly in my teens, and it never turned out well; I felt hungry and miserable while I was dieting and ended up gaining back all the weight I lost because my appetite was out of control. The promise of rapid weight loss is enticing, particularly for people who have a significant amount to lose. But are the consequences worth it?
In a recent small study that hasn't yet been published, researchers from the Netherlands looked at body composition changes in people losing weight rapidly on a 500-calorie diet for 5 weeks vs. more gradually on a 1250-calorie diet for 12 weeks. Of the roughly 19 lbs lost on average between both groups, at the end of the study, the 500-calorie group had lost almost 3 times as much lean muscle mass as the 1250-calorie group (3.5 lbs vs. 1.3 lbs, respectively). This isn't surprising, since when caloric needs aren't being met, the body uses protein for energy, and muscle mass is broken down to provide amino acids that are essential for survival. After 4 weeks, the numbers looked a little better, which the study authors attribute to improved hydration and glycogen repletion (No mention of how much water weight was regained), but the 500-calorie group was still down about 2 lbs of muscle mass from where they started.
The results of this study made me think about the very-low-calorie HCG diet, which people follow for 3 to 6 weeks at a time, often in several rounds. First popularized in the 1950's by British endocrinologist ATW Simeons, the diet protocol involves taking injections containing HCG, human chorionic gonadotropin -- a hormone produced by pregnant women and approved for use as a fertility treatment -- and restricting calories to 500 per day. (There are also HCG drops, but apparently they contain negligible quantities of the hormone). HCG purportedly has appetite-supressant properties that make subsisting on such low energy intake bearable, and although studies suggest otherwise, many proponents claim it also increases fat burning and weight loss. The HCG diet fell out of favor years ago when researchers reported that the dramatic weight loss of up to a pound a day was due to starvation-level caloric intake rather than the hormone injections. However, within the past few years, there has been a resurgence in its use (thanks in part to the diet being featured on the Dr. Oz show), particularly among anti-aging doctors.
The HCG Diet: The Basics
In addition to containing very few calories, the HCG diet is extremely low in fat. The original HCG diet menu below specified the following menu every day, although some updated versions allow people to move some of the foods around to different meals:
Tea or coffee in any quantity without sugar. Only one tablespoon of milk allowed in 24 hours. Saccharin or stevia may be used.
1. 100 grams of veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp. All visible fat must be carefully removed before cooking, and the meat must be weighed raw. It must be boiled or grilled without additional fat. Salmon, eel, tuna, herring, dried or pickled fish are not allowed. The chicken breast must be removed from the bird.
2. One type of vegetable only to be chosen from the following: spinach, chard, chicory, beet-greens, green salad, tomatoes, celery, fennel, onions, red radishes, cucumbers, asparagus, cabbage.
3. One breadstick (grissino) or one Melba toast.
4. An apple, orange, or a handful of strawberries or one-half grapefruit.
The same four choices as lunch (above).
This is what dieters are instructed to eat for 4 weeks straight while undergoing HCG injections. Not much to look forward to at mealtimes, which is probably by design in order to prevent overindulging. Characterizing the diet as unappetizing would be an understatement.
The plan provides roughly 55 grams protein, 50 grams carbohydrate, and 9 grams fat. So the macronutrient percentages are about 44% protein, 40% carbohydrate, and 16% fat. 44% of calories from protein sounds like a lot but isn't in this case, and when calories restricted to 500, the protein will be used for energy rather than preservation of muscle mass anyway. After a 6-week break from the diet (I couldn't find any specific dietary guidelines to follow during this period), those who want to lose additional weight often resume the HCG injections and 500-calorie diet for another 4 to 6 weeks.
A Sustainable Alternative to HCG
Doctors recognize that loss of lean mass results in a lower resting metabolic rate. So why are many anti-aging physicians promoting a diet that will, if anything, accelerate the aging process by causing significant muscle loss and other health problems? Some claim that HCG allows people to burn their own body fat for fuel and prevent muscle breakdown, but there is no evidence for this. Studies going as far back as the 1970s indicate that the weight loss achieved on this diet is due to its very low calorie content rather than the HCG injections. (As an aside, I had to laugh at some of the "benefits" claimed on the HCG Doctors Directory site, such as "Improves one's singing voice." Really? And I would like to see clinical evidence that thyroid and adrenal function improve in people consuming 500 calories a day for weeks at a time.)
On the other hand, we have research suggesting that a carbohydrate-restricted diet with adequate calories and protein preserves muscle mass during weight loss, including an analysis of 87 studies that found greater fat loss and better retention of lean mass at lower carbohydrate and higher protein intakes. In addition, carb restriction tends to increase satiety, and most people report enjoying the diet and the wide variety of foods they can eat every day. Many experience rapid weight loss at the beginning, which typically slows down to a more gradual pace after the first week or two. Another benefit of a well-balanced low-carbohydrate way of eating is its suitability for long-term use, both for weight loss and maintenance.
I understand how difficult it is to lose weight and how rewarding it can be to lose rapidly. But it concerns me that there are doctors prescribing a diet so low in calories and nutrients along with hormone injections that were discredited years ago. Rather than encouraging immediate gratification with claims like "Lose up to 30 pounds in a month," why not recommend a sustainable way of eating that not only promotes safe weight loss but is highly pleasurable as well? Carbohydrate restriction has all of these things going for it, and more. In a nutshell, it doesn't feel like being on a diet, and that's one of the primary reasons it works well for so many people.
1. Stein MR, et al. Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study. Am J Clin Nutr. 1976 Sep;29(9):940-8.
2. Rabe T, et al. Risk-benefit analysis of a HCG 500-kcal reducing diet (cura romana) in females.
Geburtshilfe Frauenheilkd. 1987 May;47(5):297-307.
3. Lijesen GK, et al. The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. Br J Clin Pharmacol Sep 1995; 40(3):237-243
4. Volek JS, et al. Comparison of energy-restricted very-low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutr Metab (Lond). 2004 Nov 8;1(1):13
5. Krieger JW, et al. Effects of variation in protein and carbohydrate intake on body mass and composition during energy restriction: a meta-regression. Am J Clin Nutr 83: 260–274, 2006.
First off, I hope all of you and your families had a wonderful Thanksgiving. Mine was really nice: delicious food and great conversation with family and dear friends.
I've been wanting to write a post like this for some time now. My intention is not to criticize other people's beliefs but rather to explain my own and why I hold them. Looking over a number of "Paleo Thanksgiving" menus prompted me to finally address my ambivalence about Paleo, Primal, Weston A. Price Foundation, and other "real food" ways of eating. I know that several people who read this blog identify with one or more of these ways of eating. Please keep in mind that I strongly favor a whole foods approach over a diet containing processed foods. I'm a proud member of Real Food Dietitians, and I recently became a Primal Docs featured member. However, I think carbohydrate restriction is ultimately more important for people trying to manage diabetes, prediabetes, obesity, metabolic syndrome, and PCOS.
Diabetes, Hyperinsulinemia, and Insulin Resistance
There's a lot of convincing research supporting very-low-carbohydrate diets for people with Type 2 diabetes, metabolic syndrome, and polycystic ovarian syndrome. I'm planning a blog post on insulin resistance and hyperinsulinemia in the near future, but suffice it to say that many, if not most, overweight people have impaired insulin sensitivity, resulting in elevated blood sugar and insulin levels that cause hunger, damage blood vessels and nerves throughout the body, and promote fat storage. Keeping carb intake very low (less than 50 grams per day) will have a beneficial effect on insulin resistance and hyperinsulinemia in virtually everyone, whereas a diet containing twice or three times as much carbohydrate may work for a portion of this population, but most will need to restrict carbohydrates further to lose weight and achieve healthy blood sugar and insulin ranges. In general, the works of Drs. Steve Phinney, Jeff Volek, Eric Westman, Richard Feinman, Michael Eades, Richard K. Bernstein, and other low-carbohydrate researchers are more exciting and convincing to me than authors who classify themselves as Paleo or Primal.
People with Type 1 diabetes or normal weight individuals with blood sugar issues (I'd place myself in the latter category) will also benefit from keeping carbohydrate levels very low. I followed a Primal, moderately low-carb (100 grams or so per day) diet for a while but continued to have postprandial blood sugars over 160 and sometimes as high as 200. Only when I began restricting carbohydrates to 15 or fewer grams per meal did my blood sugar response normalize, and it's remained this way for the past year and a half.
I realize dairy is controversial in the Paleo and Primal community due to its lactose content, insulin-stimulating properties, and potential for allergies, but I personally consume quite a bit of it without any problems. In fact, I have Greek yogurt, cheese, sour cream, and/or cream every day and maintain a healthy weight. While there are certainly people with legitimate reasons to avoid dairy (such as true allergies or hypercalcemia), I think many others will do okay with it. If you have other symptoms that clear up when you eliminate dairy, then obviously you shouldn't eat it.
I understand the WAPF's position on the benefits of raw milk, but I disagree that pasteurized, homogenized dairy products are inherently bad. My parents are from Switzerland and grew up on pasteurized milk products, as did their parents, and continued consuming them throughout their lives. They're now in their 70s, active, and in excellent health, and I know there are many others like them. While raw milk may contain more nutrients and allow for better absorption of fat-soluble vitamins, I think pasteurized milk provides benefits as well.
Here's where I may lose some of my readers (if I haven't lost you already). There was recently a very successful Gluten Summit, and two intelligent MDs, Drs. Davis and Perlmutter, have written books detailing the devastating effects gluten can have on susceptible individuals. But not everyone is gluten sensitive! I avoid grains because of their carb content and I don't really mind not eating them, but there are other low-carbers who consume low-carb bread, wraps, etc., without any problems. Dr. Steve Parker's Low Carbohydrate Mediterranean Diet allows grains for those who tolerate them. The Paleo Thanksgiving yam and sweet potato recipes I saw online contain a lot of carbohydrates. Eating a small amount would be fine, but many people tend to eat larger portions of foods they're told are healthy. I'm not saying that grains are good for you, but to be honest, I'd rather someone with diabetes eat a forkful of stuffing (about 3 grams of carb) than a cup of sweet potatoes (37 grams of carb if plain).
Another controversial area among Paleo/Primal/WAPF devotees is sweeteners. Honey or pure maple syrup is often recommended as an alternative to table sugar. However, these items contain more carbohydrate per serving than sugar does, so they're not a good choice for people with diabetes or insulin resistance. Green leaf stevia is recommended as an option for those who need to limit carbohydrates. But have you tasted stevia? It's got an interesting flavor (reminiscent of anise, in my opinion), but it really doesn't work well as a sweetener for all types of food. I rarely use any sweetener at all, but when I do bake occasionally, I use erythritol, a sugar alcohol that isn't absorbed by the body and tastes very similar to sugar. Some have argued that erythritol is a processed product made from corn, but I think people with issues related to glucose intolerance would be better off consuming it -- or even saccharin -- instead of "natural" sweeteners, including fruit juice. Again, it's best to avoid all types of sweeteners except in limited amounts. I do eat a square of 85-90% cacao dark chocolate a few times a week. It's sweetened with sugar but only has about 2 grams of net carb.
Pastured and/or Organic
As a former vegetarian for ethical reasons, I strongly support raising animals as naturally and humanely as possible. I would prefer to always eat pastured, organic, or naturally raised meat, dairy, and eggs, and most of the time I do, at least at home. But there are many people who can't afford to eat this way on a daily basis. I've written about this before, but I feel even more strongly now that people on limited budgets shouldn't be made to feel that they're jeopardizing their health if they can't buy organic food. I've seen individuals on low-carb forums say that they have to quit eating low carb because it's too expensive. But there are lots of ways to eat low carb without spending a lot of money (also Google "low carb on a budget"). Replacing higher-carb items with conventionally raised animals, eggs, and cheese can have a profound positive effect on blood glucose and insulin levels, as well as weight. And at the end of the day, that's the most important thing.
I hope I didn't offend any of the people I respect yet differ with on this issue, but I wanted to make clear where I stand. If folks with diabetes or weight issues can combine "real food" and low carbohydrate intake, this is ideal. But I'll always place carb restriction as the top priority for them because I truly believe it's the key to improving their health.
1. Volek JS, Feinman RD.Carbohydrate restriction improves features of the Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005 ;2:31
2. Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 2008; 5: 9
3. Westman EC, et al. Low Carbohydrate Nutrition and Metabolism. Am J Clin Nutr 2007; 86(2):276-284
4. Mavropolous JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond) 2005: 2:35
I'm going to preface this post by saying that I realize there are a number of registered dietitians ( including several whom I consider friends as well as colleagues) who favor intuitive eating for the treatment of obesity and can provide many testimonials as to its effectiveness. I admire their work and do not want to take anything away from the success they have had with this method.
Intuitive Eating is an approach to developing a healthy relationship with food. Created by registered dietitians Evelyn Tribole and Elyse Resch, Intuitive Eating involves listening to your body, becoming attuned to hunger and fullness cues, and consuming a wide variety of foods. No foods or food groups are off limits, and people are encouraged to honor their hunger and eat what they desire, be it berries or brownies, although trying to make primarily nutritious choices is also advised.
While Intuitive Eating has proved very successful for many, it's my belief that there are a number of individuals for whom it is not the best choice. One of the "10 principles" outlined on the Intuitive Eating website is "Honor Your Hunger." The description of this principle reads "Keep your body biologically fed with adequate energy and carbohydrates. Otherwise you can trigger a primal drive to overeat." While I agree that adequate (albeit somewhat reduced) energy/caloric intake is crucial to preventing a profound drop in basal metabolic rate, I have a different take on the need for "adequate carbohydrates." In fact, I would argue that in many cases carbohydrates are what may trigger the drive to overeat. The reasons for overeating are complex and involve not only behaviors but also hormones like insulin and leptin, which are highly responsive to the type and quantity of food consumed.
There is a growing body of research suggesting that reducing carbohydrate intake may result in improvements in blood sugar control, appetite, and insulin resistance. Leptin also plays a role in appetite and obesity. It is released by fat cells under the direction of insulin, which is produced in largest amounts following carbohydrate intake. Once leptin enters the brain, its effects include appetite reduction, satiety, and an increase in metabolic rate. Interestingly, the obese tend to have higher leptin levels than those of normal weight, which has led researchers to hypothesize that they are resistant to leptin. This theory suggests that leptin resistance prevents the hormone from reaching the brain, confounding one's attempts to regulate intake and facilitate weight loss. In 2004 researchers discovered that elevated triglycerides block the transport of leptin into the brain. Many studies have demonstrated that reducing carbohydrate intake, especially refined carbohydrates, leads to significant decreases in serum triglycerides, and a recent study implicates high carbohydrate intake in the development of leptin resistance and obesity. To be honest, I am not very knowledgeable about leptin and leptin resistance but plan to review more research on this issue, as I find it extremely interesting.
While I truly appreciate the philosophy behind the Intuitive Eating approach to making peace with food and accepting a person's genetic body shape, I feel that telling someone that no foods are off limits may not be best for everyone. Advising somebody with impaired blood glucose regulation to eat whatever they feel like eating may result in unstable blood glucose levels. In the leptin-resistant obese, encouraging high intake of trigger foods (which often contain large amounts of the very macronutrient that perpetuates their struggle to modulate intake) may lead to a vicious cycle of overeating, rebound hunger, and overeating again.
I am a person for whom an intuitive eating approach would probably not work. I'm extremely regimented, and counting calories every day has allowed me to maintain a 30-lb loss for more than 25 years. Although carbohydrate restriction didn't come into play for me until about a year and a half ago when I began experiencing elevated post-meal blood sugar, limiting carbs has allowed me to see first hand what getting blood glucose levels under control can do. I long ago resigned myself to feeling somewhat hungry at times after dinner when I'd consumed my allotment of calories for the day. I'd adapted to chronic mild caloric restriction (a healthful practice, particularly with respect to longevity) but retained some of the feelings of hunger that accompany it. Once I began following a low carbohydrate diet, I was amazed at the increased satiety I experienced without any change in my total energy consumption, which remains somewhere between 1400-1800 calories every day. I can honestly say that after a meal I simply do not feel hungry anymore.
I feel strongly that a low-carbohydrate diet should not be characterized as a "fad diet" that is too difficult to maintain. I have met many people and read hundreds of online accounts of those who have lost weight and maintained their loss long term by following a low-carbohydrate plan which allowed them to regulate their energy intake. In some cases, these losses are 100 pounds or more. The number of people who have achieved excellent blood glucose control on such plans is no less impressive. A low-carbohydrate diet can include many healthy, luxurious, highly palatable and satiating foods; the assertion that it will result in feelings of deprivation is misguided. I personally plan to continue eating low carb for the rest of my life. However, I understand that this lifestyle is not for everyone. I would never tell anyone that they "had to" eat low carb in order to lose weight. There are many people who reach their goals by following a vegetarian or vegan way of eating, and as I stated initially, Intuitive Eating has worked brilliantly for others. I think that's terrific! We are all unique and our responses to food are highly individualized.
I realize that the majority of people reading this have had favorable outcomes with carbohydrate restriction, but for the reader who has been unsuccessful with low carb and would like to try an Intuitive Eating approach, I know several dietitians who specialize in this area I could refer you to (use the Contact Me page). My goal as a dietitian is to make sure that people find a way of eating that works best for them in order to achieve their own goals.
1. Boden G, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with Type 2 diabetes. Ann Intern Med. 2005 142:403-411
2.Westman EC, et al. Low carbohydrate nutrition and metabolism. Am J Clin Nutr. Aug 2007; 86(2): 276-284
3. Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. July 2012; 2012(5):175-189
4. Lopes IM, et al. Effects of Leptin Resistance on Acute Fuel Metabolism after a High Carbohydrate Load in Lean and Overweight Young Men. J Am Col Nutr. Dec 2001; 20(6)
5. Banks WA, et al. Triglycerides induce leptin resistance at the blood-brain barrier. Diabetes.May 2004;53(5):1253-60
6. Hansen, BC. Calorie restriction: Effects on body composition, insulin signaling, and aging. J Nutr. 2001:131, 900S-902S
As a child growing up in the '70s, I remember seeing a TV commercial for a diet that promised you could "Eat all you want and still lose weight!" I'm not sure what diet it was (back then it seemed like new diets came out every week), but to me this sounded like a great plan if I ever needed it in the future, as I was a skinny child with a huge appetite.
A typical eating day for me as a child:
Breakfast: Large bowl of granola cereal with a few tablespoons of Nestle's Quik AND a few tablespoons of sugar plus milk, with additional milk to drink. Or four donuts or a large stack of pancakes with butter and syrup on the weekends.
Lunch: Peanut butter and jelly sandwich, Twinkie or cookies, chocolate milk
Snack: Cookies and milk
Dinner: Large portion of meat or poultry, potatoes/rice/noodles, salad, chocolate milk, cookies or pie
Snack: Cookies or ice cream
What a sweet tooth! I don't even want to think about counting up all those carbs and calories.
In addition, I remember being hungry a lot and often digging into my school lunchbox around 10:30 a.m. to sneak a few cookies or chips. Somehow my body was able to use all those calories as energy (and I wasn't even particularly athletic) instead of storing them as fat...
...until shortly after I hit puberty at age 12. All of a sudden, I began to put on weight. I was eating the same way I always had, but now I was growing wider as well as taller. In a panic, I began crash dieting to try to get my weight under control. But I could only limit myself to 500 calories per day for short periods of time, so I would inevitably binge. By the time I turned 14, I would hit my all-time-high weight of 160 pounds.
I'm 5'8", and although that may not sound like much, I'm pretty small framed and not very muscular, so it was a lot for me. Worse than that, though, was my dysfunctional relationship with food. For the rest of my teen years, I fluctuated between 130-160 pounds, alternately starving and eating the same way I had for the first 12 years of my life.
Around age 18 I started reading about the importance of health and decided I really wanted to start eating better once and for all. I also realized that feeling good and being happy with the way I looked was more important to me than consuming junk food and overeating. I began to think of food as nourishment and made sure I consciously enjoyed every morsel rather than overindulging or depriving myself. I think some hormonal changes and brain chemistry shifts occurred around this age as well. But by changing the way I thought about food and walking at least 30 minutes daily, I lost the weight. I've remained between 125-130 pounds consistently for more than 25 years.
What have I been eating all this time to keep my weight where I want it? My approach has varied from simply reducing portion sizes of everything except vegetables to veganism (for ethical reasons) to pescatarian (eating eggs, dairy, and fish but no meat) to, most recently, low carb. Always lots of veggies, though, regardless of whatever else I was eating. With the exception of my vegan phase, I usually felt satisifed after meals and rarely hungry in between unless I went too long without eating. I became more and more interested in health, striving to make each meal as nutrient-dense as possible.
By the time I became a dietitian in 2008, a typical day looked something like this:
Breakfast: 6 oz nonfat yogurt with 1 cup berries and 1 Tbsp walnuts, 1 slice whole wheat toast with peanut butter, coffee with sugar sub
Lunch: peanut butter OR tuna salad sandwich made with light mayo on whole wheat bread, 2-3 cups salad with olive oil vinaigrette, a piece of fruit, and diet iced tea
Dinner: 4 oz fish/tofu/beans; 1 cup brown rice/potatoes/whole grain pasta; 2-3 cups nonstarchy veggies, 2 Tbsp olive oil , 6 oz nonfat yogurt , 1 cup fruit, nuts, water
My weight stayed the same, and I was happy eating this way and continued doing so until February of 2011, when I found out that my blood sugar was spiking after meals and I had mild hypothyroidsim to boot. Given soy's negative effect on thyroid function and the impact of carbohydrates on blood glucose, I realized I needed to make some dietary changes in order to address both issues. I stopped eating soy, cut my carb intake gradually until I reached 60-80 grams per day, added humanely raised chicken and grass-fed beef, and continued eating lots of nonstarchy veggies. Doing my own research online and in books prompted me to make additional changes like eating whole eggs, using butter instead of margarine, and getting rid of sugar substitutes. My blood sugar improved, and I felt full and satisfied. I've been eating this way for several months and plan to continue for the foreseable future.
My typical day now looks like this:
Breakfast: 4 oz sardines/salmon OR 2 eggs with 2 cups kale or spinach cooked in 1 tsp coconut oil; 1/2 cup fruit OR 1/2 cup sweet potato, 2 Brazil nuts, green tea
Lunch: Usually leftovers from dinner (same amount) OR 1 cup plain Greek yogurt, 2 cups chopped raw vegetables, 4 olives, and 3 Tbsp guacamole; 1/2 cup fruit, 1 Tbsp almond butter with small square of dark chocolate, water
Dinner: 4-6 oz beef/fish/poultry, 2-3 cups raw or cooked nonstarchy vegetables with 1 Tbsp olive oil, 1/2 cup fruit, 1 Tbsp almond butter, water
Despite cutting carbs considerably, I didn't lose weight, nor did I want to. Unlike many who start a low-carbohydrate diet, my caloric intake didn't decrease. Restricting carbs often results in an intial large loss of water (proportional to the size of the individual) in addition to fat. Those who eat low carb tend to automatically eat fewer calories since ketones reduce appetite and fat and protein are more filling and satiating than carbohydrates. In addition, lower insulin levels that occur with carbohydrate restriction antagonize fat gain. I'm definitely less hungry between meals, which I attribute in part to more stable blood sugar levels. But my caloric intake remains about the same, 1500-1800 per day, sometimes a little more.
I follow a low-carbohydrate diet because it allows me to prevent blood glucose spikes, thereby decreasing my risk of progressing to diabetes. I think it's by far the best way to manage all types of blood sugar issues. I also believe the same diet can be extremely helpful for weight loss and maintenance. But I don't think it should be an "Eat as much protein and fat as you want as long as your carbs are low" plan. I'm fairly confident that if I were to significantly increase my portion sizes of meat and add large amounts of fat to everything I eat, I would gain weight. For instance, coconut oil may contain medium-chain fatty acids that are easily burned for energy, but it also has 120 calories per tablespoon that will be stored instead if caloric needs have already been met. Eating 16 oz of beef provides
900-1300 calories depending on the fat content, and about 110 grams of protein. In the liver, a portion of that protein will be converted to glucose, which will be stored as fat unless needed for immediate use.
Below are suggested menus from Dr. Richard K. Bernstein and Mark Sisson:
Dr. Berstein's own menu from Diabetes Solution:
Breakfast: 2 oz Nova Scotia salmon, 1 ounce cream cheese, 2 Bran-a-Crisp crackers
Lunch: Leek soup, 3 1/2 ounces hamburger meat
Dinner: 1 medium artichoke with melted butter, 4 1/2 ounces meat, fish or poultry
Total calories (estimated): 1200
Mark Sisson's plan for Ken Korg in The Primal Blueprint:
Breakfast: "Primal Omelet": 3-egg omelet with 1 ounce cream and 1 tablespoon cheddar cheese, chopped mushrooms, red onions, and red peppers (1/4 cup each); 2 ounces avocado, 2 Tbsp fresh salsa, 1/4 cup fresh blueberries, black coffee
Lunch: "Primal Salad": 2 cups salad greens, 2 ounces each chopped onions, carrots, jicama, red peppers and cherry tomatoes, 3 ounces chicken, 1/3 ounce sesame seeds, 1/2 ounce walnuts, 2 Tbsp oil-based dressing
Dinner: 6 ounces broiled salmon, 6 ounces each steamed zucchini and asparagus with 1 Tbsp butter, 5-ounce glass red wine
Snacks: hard boiled egg, 17 macadamia nuts, 4-inch strip venison jerky
Total calories (as listed in book): 2045
Notice the portion sizes. Dr. Bernstein is older, of short stature, and doesn't exercise much, so his caloric intake is too low for me and presumably most people reading this (I think he probably eats a little more than this, at least on occasion). On the other hand, Mark Sisson is pretty athletic (He probably consumes around 3000 calories a day), but he advises people to consume only 0.7-1.0 gram of protein per pound of lean body mass. He recommends 104 grams of protein for Ken based on 148 lbs of lean mass. The protein and fat portions at each meal are quite modest and appropriate.
Do I believe that those who follow a low-carb diet develop a "metabolic advantage" that allows them to eat large quantities of high-calorie but low-carb foods and still lose weight, aside from the initial loss? I'm not discounting it 100%, but at this point I don't see the empirical evidence for it. Just a couple of examples that argue against this idea can be found on the Bye Bye Carbs and Mark's Daily Apple websites. I've read many comments on other sites about people who stopped losing weight on low-carb plans. Calories do count, regardless of the macronutrients in question.
I think many different ways of eating can result in weight loss and long-term maintenance. I know several vegans; some have been slim for years, while others remain heavy. There are some prominent low-carbers who are overweight or obese, while many others have found that carbohydrate restriction is the only way they can maintain their ideal weight. My mother's weight history and pictures are very similar to mine, although she has maintained her 30-lb loss even longer, excluding pregnancy, simply by keeping portion sizes in check and limiting sweets.
As someone who has lost weight and been able to keep it off, I feel that you can't really "eat all you want and still lose weight" -- unless "all you want" is fewer calories than you actually need. Unfortunately, it takes some discipline along with choosing whatever eating plan works for you. For everyone who is losing weight or maintaining weight lost on a low-carb plan, I couldn't be happier -- we need more success stories! But for those who are finding sustainable weight loss elusive, I recommend taking a look at the amount of calories you're consuming rather than adding another tablespoon of coconut oil to your meal.
Franziska Spritzler, RD, CDE