Low Carb Tomato Recipes
April is National Florida Tomato Month! Wherever you live, I hope you enjoy these 5 fantastic low-carb recipes featuring this amazing fruit that's loaded with vitamin C, lycopene, and great flavor.
Bacon Spinach Tomato Ricotta Frittata from Stacey at Beauty and the Foodie (1 gram net carb)
Easy Caprese Chicken from Carolyn at All Day I Dream About Food (less than 2 grams net carb per serving)
Easy Keto Marinara from Melissa at I Breathe…I'm Hungry (3 grams net carb per half-cup serving)
Low Carb Tex Mex Soup from Martina at KetoDiet (6.4 grams net carb per serving)
Sun-Dried Tomato Garlic Dip from Kyndra at Peace, Love, and Low Carb (1.5 grams net carb per serving)
Low Carb Vail Presentation by Dr. Michael Eades:
Paleopathology and the Origins of the Paleo Diet
Be sure to watch this video of the presentation Dr. Michael Eades gave at Low Carb Vail in February when you have a chance. I'm really looking forward to meeting him at the Low Carb San Diego event in July, where we''ll both be speaking.
March Articles Written for Authority Nutrition
Here are my latest Authority Nutrition articles for the month of March. Not all of them have a low carb focus, but I did my best to provide balanced, accurate information about nutrition and health. I hope you enjoy them!
9 Proven Ways to Fix The Hormones That Control Your Weight
Anti-Inflammatory Diet 101 – Fight Inflammation Naturally
14 Simple Ways to Stick to a Healthy Diet
Dukan Diet 101: What it is and How it Works
The 10 Worst Foods to Eat in the Morning
How Low-Carb and Ketogenic Diets Boost Brain Health
8 Evidence-Based Health Benefits of Papaya
Low-Carb Peanut Butter Recipes
March is National Peanut Month. While I like peanuts, I love peanut butter and am so happy that it fits nicely into my low-carb way of eating.
Here are 5 fantastic sugar-free, grain-free peanut butter recipes from a few of my favorite low-carb culinary wizards.
Each treat contains between 1.5-7 grams of digestible carbohydrate per serving. Enjoy!
No-Bake Peanut Butter Bars from All Day I Dream About Food (less than 4 grams net carb apiece)
Chocolate Peanut Butter Mini Cheesecakes from Beauty and the Foodie (less than 2 grams net carb per serving)
3-Ingredient Peanut Butter Popsicles from Sugar-Free Mom (less than 4 grams net carb per serving)
Peanut Butter Texas Sheet Cake from All Day I Dream About Food (7 grams net carb per serving)
No-Bake Peanut Butter Cheesecake from Low Carb Yum (6 grams net carb per serving)
Blog Post Series on Low Carb vs. Keto from Amy Berger
My friend and fellow low-carb nutritionist Amy Berger has written a great three-part series about the difference between being fat adapted vs. "in ketosis." Amy's posts are a little lengthy, but in my opinion no one does a better and more thorough job of explaining this than she does.
February Articles Written for Authority Nutrition
Lastly, here my latest Authority Nutrition articles on a variety of topics. None of these are about carbohydrate restriction per se, but you'll see that I made sure to feature low-carb foods wherever possible.
How Eating More Slowly Can Help You Lose Weight
How Cooking Affects the Nutrient Content of Foods
6 Foods That Cause Inflammation
Inulin 101: A Prebiotic Fiber with Powerful Health Benefits
13 Most Anti-Inflammatory Foods You Can Eat
10 Evidence-Based Health Benefits of Magnesium
6 Supplements That Fight Inflammation
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?
I am so excited to announce the publication of The KetoDiet Cookbook by my good friend Martina Slajerová. You may know Martina from her very popular KetoDiet website, where she blogs about low-carb, keto-, and other nutrition-related topics and shares creative, delicious recipes to support low-carb lifestyles. Martina is an extremely talented chef -- definitely one of the top culinary wizards in the low-carb community. Yes, I'm a huge fan of her work and always encourage my readers and clients to check out her website or purchase the KetoDiet App for her complete collection of recipes, calorie and macronutrient tracking, and help staying on plan.
And I'm happy to say that the KetoDiet Cookbook is equally impressive. To start with, it's a beautiful book, well organized, and contains high-quality photos of most of the recipes.
After a brief discussion of keto diets -- including macronutrient ratios, lists of foods to include vs. avoid, and some great advice for getting started -- Martina gets right to the heart of the matter: fantastic, easy-to-prepare recipes that present beautifully, taste delicious, and are healthy to boot. Although some of the 150 enticing recipes can be found on her website, she has created dozens more for this cookbook, including Chocolate and Orange Spiced Granola, Slow-Roast Pork Belly with Quick "Potato" Salad, and Turkey Leg with Tarragon. I'm really enjoying looking at the pictures and reading the descriptions, along with the tips sprinkled throughout the book.
Each recipe contains nourishing ingredients that Martina masterfully combines to create luxurious, satisfying meals to help you achieve your weight, blood glucose management, and other health-related goals. She not only provides complete nutrition information (protein, carbs, fat, fiber, and calories per serving) but also the macronutrient ratio for each recipe. For instance, Danish Meatballs with Tomato Sauce contains 6% carbohydrate, 22% protein, and 72% fat as a percentage of calories.
All of the recipes in The KetoDiet Cookbook are grain free and sugar free. In order to address food sensitivities and preferences, Martina provides dairy free and nut free options as well. As a companion to the book, she has created six meal plans and an allergy table that are available to download for free from the KetoDiet website.
One of the best things about the recipes is that most are very family-friendly, even for members of your household who are not following a low carb or ketogenic diet. My own husband, who will freely admit to being a picky eater and preferring traditional comfort foods, chose Paleo Chicken Nuggets as the first recipe to try from the cookbook. I'm happy to say that he smiled after trying it and told me I could make it again anytime. Trust me, that's high food praise from him as far as food goes! I loved it as well, and I couldn't wait to share with everyone.
Recipe: Paleo Chicken Nuggets
Number of Servings: 4
1.5 lb (680 g) boneless, skinless chicken breast
1/2 teaspoon salt
1 large egg
1 Tablespoon (15 ml) almond milk or coconut milk
1 cup (100 grams) almond flour
1 teaspoon paprika
1 teaspoon garlic powder
1/3 cup (30 g) grated Parmesan cheese (or 1/3 cup additional almond flour)
2 Tablespoons (30 g) melted coconut oil or ghee
Preheat oven to 400 degrees Fahrenheit/200 degrees Celsius. Using a paper towel, dab any excess moisture from the chicken. Dice the chicken breasts into medium-sized pieces and season with half of the salt.
Mix the egg with the almond milk and season with the rest of the salt. Pllace the chicken pieces into the egg mixture.
Mix the spices, almond flour, and grated Parmesan cheese together. Pour mixture onto a large baking sheet.
Lift up each piece of chicken, letting some of the egg mixture drip off, then transfer to the baking sheet containing the almond flour mixture. (Avoid letting any excess egg mixture dribble in or else it will clump up the dry ingredients). Cover all sides of the chicken pieces with the dry mixture. Do this in batches and do not overfill the baking sheet.
Move the coated chicken nuggets to a baking sheet lined with parchment paper, drizzle with ghee, and transfer to the oven. Cook for about 15 minutes, until lightly golden.
Remove the tray from the oven and let cool for a few minutes. Serve with Spicy Chocolate BBQ Sauce (pictured), mayonnaise, ketchup, or Dijon mustard.
Nutrition Facts per Serving:
Total Carbohydrates: 6.3 grams
Fiber: 2.8 grams
Net Carbs: 3.5 grams
Protein: 46 grams
Fat: 28.3 grams
Macronutrient Ratios: 3% carb, 41% protein, 56% fat
I honestly have nothing but praise for this cookbook, from beginning to end. I highly recommend it for all low carb and keto enthusiasts who want to prepare delicious, simple, nourishing meals. The book is definitely well worth its cost, and I would encourage everyone who enjoys Martina's recipes, meal plans, and blog posts to purchase this book in support of all that she offers free of charge.
Click here to purchase The KetoDiet Cookbook.
(Just for the record, although I occasionally use affiliate links for Amazon products, I decided not to for this cookbook. My only interest in writing this review is making sure that people are aware of it and Martina's other work.)
Recently, I've been eating breakfast out more often than usual because I was out of town on vacation for a few weeks, and I've also started doing breakfast appointments with a few of my clients at home. I realize that most restaurants cater to the general population rather than people on low-carb diets, but generally speaking there are plenty of great breakfast options at most dining establishments. However, I'm concerned that diners are being led to believe that a breakfast very high in carbs and sugar is the healthiest way to go.
It's not just restaurants who do this, of course. The photo above? That's an image I purchased from Shutterstock entitled "Healthy Breakfast." But people are most likely to encounter this message at their favorite eateries.
You may have never eaten at the restaurants whose menus are listed below, but I'm sure you'll find similar offerings and descriptions at breakfast places in your own city.
"Lighter/Healthy/Smart" Breakfast: Where's the Protein?
Let's look at the third one, "The Health Nut Breakfast" under "Lighter Side," in terms of macronutrient composition. I took a conservative estimate of the amount of oatmeal at one and a half cups, 1 teaspoon of brown sugar, half a cup of low-fat milk, 2 Tablespoons raisins, a 3-ounce bran muffin and an 8-ounce (never-empty?!) glass of orange juice, then entered everything into the My Fitness Pal app. The grand total of carbohydrates for this meal is 129 grams, with 11 grams of fiber, for a net carb count of 118 grams, most of which are rapidly digested and absorbed into the bloodstream. On the other hand, the protein content for this meal is only 15 grams, primarily from grains, which are considered an inferior source of protein compared to the type found in animals, including eggs, dairy, and meat. Compare this to a meal of three pancakes with a quarter cup of syrup, and you'll see that the amount of net carbohydrates and protein is very similar.
In my opinion, advertising the three meals above as being the best choices on the menu for the health conscious is very misleading. If someone wants to have waffles at the Waffle House and eat them with the realization that their meal isn't all that nutritious, I have no problem with that. But I do take issue with restaurants advertising carb-heavy breakfasts with juice as "healthy," because it's the people who have made a conscious decision to eat well that end up ordering them. This often results in similar high-carb meals consumed at home as well, compounding the problem. I can't count the number of people with diabetes or weight issues who have looked at me suspiciously when I've told them that their breakfast of cereal, nonfat milk, banana, and juice is exactly what they should not be starting their day with and that they'd be much better off if eating bacon and eggs instead.
Begin the Day with a High-Protein Meal
There have been several recent studies demonstrating the benefits of a protein-based breakfast with low to moderate carbohydrates. In one study of overweight women, those who consumed 30-40 grams of animal protein (sausage and eggs) and less than 15 grams of carbohydrate at breakfast had better satiety, lower blood glucose and insulin levels, and lower calorie intake at lunch compared to women who ate more carbohydrates and less protein in the morning (1). Studies looking at overweight children and adolescents have had similar findings with respect to high-protein breakfasts (2-3). As I stated in a previous post, getting a minimum of 25 grams of protein at each of three meals is particularly important for preventing loss of muscle mass during weight loss (4) and aging (5-6).
Truly Nourishing Breakfast Options
I personally think breakfast is the easiest meal for remaining low carb when dining out. It's not hard to find delicious, satiating, blood-glucose-stabilizing breakfast options -- even at restaurants whose claim to fame is pancakes or waffles -- as long as you stay away from most of the ones classified as" healthy."
Waffle House, IHOP, Bob Evans, Cracker Barrel, and other restaurants: I had a delicious very-low-carb, high-protein breakfast at the Waffle House when we visited Florida last month: poached eggs, bacon, tomato slices, and coffee with half and half -- around 7 grams of net carb for the meal. My husband tweeted about it and even got a retweet by Waffle House.
Best Bets: Eggs with bacon, sausage, ham, or cottage cheese, with tomato slices on the side; or an omelette with cheese, spinach, mushrooms, chiles, bell peppers, and/or other nonstarchy vegetables. Each option provides about 10 grams digestible carbs or less for the entire breakfast*
*Caution: Be careful of the scrambled eggs and omelettes at IHOP if you're watching your carbs or staying gluten free, because pancake batter is added to make them fluffy. This information is printed on the menu. Other restaurants sometimes add batter to their eggs as well, so be sure to inquire about this before ordering. Some of them may allow you to order eggs freshly made without anything added, if you ask.
If they're available, you can also order a side of avocado or berries, which would further increase your meal's nutritional value yet keep net carbs fairly low.
Fine-dining restaurants typically have fantastic breakfast options, including many entrees that can easily be modified for a low-carb lifestyle. This is a lovely smoked salmon plate I ordered at the Monte Carlo Hotel in Las Vegas: smoked Pacific salmon, herbed cream cheese, capers, sliced red onion, tomatoes, and cucumbers. The only change I had to make was asking for no bagel. Again, there were less than 10 grams of net carbohydrate in the entire meal, and in addition to being delicious it was extremely nutrient dense, with omega-3 fatty acids in the salmon and several types of phytonutrients in the vegetables.
Buffets are one of the easiest and most satisfying ways to dine out for breakfast because there's usually a great variety of healthy choices, and you can control the portion sizes of each item so that you end up with a delicious, high-quality breakfast uniquely tailored to your own tastes and appetite. At left is my well-balanced breakfast from a buffet aboard a recent progressive rock music cruise (no, not the Low Carb Cruise): smoked salmon, herring, eggs with cheese and herbs, pico de gallo, and cucumbers topped with whipped cream cheese. You could also create a more traditional breakfast plate with bacon, sausage, ham, cheese or cottage cheese in place of the fish, of course.
Breakfast: In Favor of Informed Choice
Again, I understand that people aren't always interested in choosing the most nourishing breakfast. Trust me, I've dined with plenty of friends and family members who fall into that camp, at least occasionally. But I object to terms like "healthy" being used to describe meals that don't deliver in terms of satiety, nourishment, or blood glucose control, and their effects on customers who order them under the assumption they're making the "best" choice.
1. Rains TM, et al. A randomized, controlled, crossover trial to assess the acute appetitive and metabolic effects of sausage and egg-based convenience breakfast meals in overweight premenopausal women. Nutr J. 2015;14:17
2. Bauer LB, et al. A pilot study examining the effects of consuming a high-protein vs. normal-protein breakfast on free-living glycemic control in overweight/obese "breakfast skipping" adolescents. Int J Obes.(Lond). 2015 Sep;39(9):1421-4
3. Baum JI, et al. Breakfasts higher in protein increase postprandial energy expenditure, increase fat oxidation, and reduce hunger in overweight children from 8 to 12 years of age. J Nutr. 2015 Oct;145(10):2229-35
4. 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
5. Paddon-Jones D, et al. Protein and healthy aging. Am J Clin Nutr. 2015 Apr 29 [Epub ahead of print]
6. Arentson-Lantz E, et al. Protein: a nutrient in focus. Appl Physiol Nutr Metab.
A while back, a dietitian colleague of mine reluctantly agreed that carbohydrate restriction could improve blood glucose control and help people lose weight. Still, she wasn't a fan for several reasons, and her primary criticism was that most of our patients wouldn't be willing to stick with this way of eating long term. "What about Thanksgiving, Christmas, and other holidays? It would just be too hard being around your favorite foods all day and watching everyone else eat them while you just ate plain turkey and salad."
In all honesty, I know several people who are happy to eat meat and leafy greens all the time, including holidays. But the majority who follow a low-carb lifestyle enjoy the wide variety of foods and flexibility this way of eating offers.
Christmas wouldn't be Christmas without ______.
Here's a dilemma I often hear from readers and clients around the holidays. You've been doing great and feel fairly confident about staying on track from November through December, but there's one dish that you absolutely have to have in order to make the holiday feel like a holiday. Whether it's your mom's apple pie, your cousin's "top-secret recipe" stuffing, or your sister's sweet potato casserole, the item is invariably high in carbs. It's best to decide ahead of time how to deal with the situation, and there are basically three options, all of which can work:
1. Eat a normal-sized portion and enjoy it without guilt
2. Eat a couple of bites and fill the rest of your plate with non-carby options
3. Forego it altogether and find a new favorite to love
Celebrating with a Non-Low-Carb Family
I realize it's tough when you have family members who show their love through cooking delicious carb-rich food for you. In order to avoid hurting anyone's feelings, if you've decided on option 2 or 3 above, I'd let the person cooking the item in question know well in advance that while you love them and appreciate the time and effort they put into making the dish, it's important that you stick with your way of eating all the time, including holidays. Hopefully they'll understand because they want what's best for you, but even if they don't, you should never feel obligated to eat something in order to please someone else.
I didn't really have any issues with my family being offended about me not eating something they'd prepared, but I did get quite a bit of pushback when I decided I'd no longer be baking my gingerbread cookies for the holidays. I'm not one to pat myself on the back, but these cookies were pretty amazing, and I realize several of my friends and family members were disappointed when I stopped delivering them around the second week of December. The thought of making a low-carb version briefly occurred to me, but I didn't feel like experimenting with something people might not end up liking.
A Low-Carb Version or The Real Thing?
I'm staunchly low carb and -- aside from an occasional bite of my husband's dessert -- haven't eaten any off-plan foods since I started low-carbing in early 2011. I personally feel it's healthiest and easiest to remain low carb consistently, and I can truthfully say I never feel deprived. However, I understand that for some, being able to enjoy higher-carb food during the holidays makes it easier to stick to carbohydrate restriction long term. If you've decided to take a break from low-carbing, enjoy a small serving of your favorite dish(es) and then get right back on the low-carb wagon the next day! (Eating a large amount of carbs when you're not used to them can cause some very unpleasant symptoms, in addition to raising your blood glucose, insulin, and blood pressure). If you do want to maintain your way of eating throughout the holiday season, make sure you're prepared with plenty of delicious low-carb foods in order to avoid temptation.
Low-Carb Menu Planning for the Holidays
Turkey, goose, ham, and other meats are ideal and should form the foundation of your meal, along with greens or other very-low-carb vegetables. But it's the sides and desserts that tend to cause the most trouble! Here's a collection of low-carb versions of all your favorites created by several very talented low-carb culinary wizards I have the great privilege of knowing. There's also one from me, although I must admit to being one of the least creative low-carbers around!
Mashed "Potatoes" aka Faux-tatoes
Mashed potatoes contain about 17 grams of net carb per half cup serving but have little fiber or other nutritional benefits. Fortunately, there are several lower-carb vegetables that are ideal stand-ins for potatoes.
"Better than Potatoes" Cheesy Cauliflower Puree from I Breathe…I'm Hungry (4 grams net carb per serving)
Turnip Cauliflower Mash from Holistically Engineered (less than 7 grams net carb per serving)
Amish Turnip Bake from 24/7 Low Carb Diner (less than 4 grams net carb per serving)
The amount of carbs in stuffing varies widely because there are so many different ways of preparing it, but any with bread or corn are sure to be high. Check out the amazing low-carb options below, all with less than 5 grams net carb per serving.
Keto Primal Thanksgiving Stuffing from KetoDiet Blog (less than 4 grams net carb per serving)
Low Carb and Gluten Free Turkey Stuffing/Dressing from I Breathe…I'm Hungry (4 grams net carb per serving)
Savory Herb Turkey Stuffing from Low Carb Luxury (4.5 grams net carb per serving)
With only 4 grams of net carb per cup, green beans are an excellent side, but Campbell's Green Bean Casserole has 17 grams net carb per serving. I like keeping the carbs down when it comes to vegetables with green beans prepared simply with salt and butter, or delicious alternatives like the ones below.
Bacon and Onion Green Beans from Low Carb Layla (4.5 grams net carb per serving)
Green Bean Casserole from Peace, Love and Low Carb (8 grams net carb per serving)
Dottie's Green Bean Casserole from Linda's Low Carb Menus and Recipes (3-4 grams net carb per serving)
A half-cup serving of cooked yams or sweet potatoes contains 16 grams of net carbohydrate and is rich in phytonutrients. Depending on your personal carbohydrate goal, this could be worked into your holiday meal. However, realize that half a cup isn't very much, and this is for the plain cooked vegetable only. Candied yams have 42 grams of net carbohydrate.
The easiest way to make yams or sweet potatoes without adding carbs is to top them with butter, cinnamon, nutmeg and optional sugar substitute of choice after boiling or baking.
For fancier desserts made with sweet potatoes and/or healthy lower-carb substitute vegetables, check out these recipes:
Candied "Yams" with Marshmallows from KetoDiet Blog (5 grams net carb per serving)
Sweet Potato Casserole from Low Carb Luxury (6.5 grams net carb per serving)
Maple Glazed Delicata Rings from 24/7 Diner (8 grams per serving based on 4 servings)
Fresh cranberries are actually pretty low in carbohydrates at around 4 grams of net carb per half cup. However, they're extremely bitter and require a lot of sweetening for most palates. A quarter-cup serving of canned cranberry sauce has 25 grams of net carb -- pretty high for a small portion. Here are a few sugar-free versions that can fit into just about everyone's carb budget.
Cranberries from Linda's Low-Carb Menus and Recipes (5 grams net carb per serving, if using liquid sweetener)
Jellied Cranberry Sauce from Low Carb Luxury (3.5 grams net carb per serving)
Low Carb Orange Cranberry Sauce from Holistically Engineered (3.5 grams net carb per serving)
Easy low-carb holiday drinks include Pumpkin or Candy Cane tea with 1-2 Tablespoons heavy cream or half and half, sweetened with sugar substitute of choice. For more creative ideas, see the links below.
Raspberry Truffle Mochas from All Day I Dream About Food (4 grams net carb per serving)
Healthy Nutella Hot Chocolate from Dessert with Benefits (1 gram net carb per serving)
Cranberry Frozen Frappuccino from Your Lighter Side (2 grams net carb per serving)
Eggnog and Cocktails
Although hard alcohol doesn't contain any carbs, the sweet mixers that often accompany it definitely do. Holiday drinks can be particularly high in carbs; for example, traditional eggnog has 34 grams of carb in an 8-ounce serving. It's still possible to enjoy a festive and tasty low-carb drink, though!
Low Carb Eggnog from Fluffy Chix Cook (2 grams net carb per seving)
Pumpkin Pie Martini from All Day I Dream About Food (1.5 grams net carb per serving)
Refreshing Daiquiri from KetoDiet Blog (less than 4 grams net carb per serving)
With a carbohydrate-restricted lifestyle, snacking generally isn't necessary. But if you end up skipping meals because you're too busy and find yourself hungry mid-afternoon when everyone else is munching on chips or pretzels, it's good to have something on-plan available to dig into if needed.
Rosemary Sea Salt Crackers from Holistically Engineered (3 grams net carb per serving)
Low Carb Cinnamon Almonds from Low Carb Dietitian (3 grams net carb per serving)
Kickin' Orange Marinated Olive Recipe from DJ Foodie (less than 1 gram net carb per serving)
Holiday Pies and Desserts
Traditional desserts are obviously high in carbs, but be careful with "sugar-free" and "no-sugar-added" pies and cakes as well. For instance, Marie Callender's No-Sugar-Added Apple Pie contains 46 grams net carb per slice.
For a delicious low-carb alternative, consider making one of the following desserts instead.
Crustless Low Carb Pumpkin Pie from Low Carb, So Simple (just over 4 grams net carb per serving based on 8 servings per pie)
Low-Carb Pumpkin Cheesecake Mousse from Sugar-Free Mom (less than 3 grams net carb per serving)
Zucchini "Apple" Pie from KetoDiet Blog (6 grams net carb per serving)
Low Carb Pecan Pie from Holistically Engineered (just over 5 grams net carb per serving)
Mincemeat Tarts with Hard Sauce from All Day I Dream About Food (3 grams net carb per serving)
Fudge and truffles seem to be everywhere the entire month of December! Good thing those talented low-carb bloggers have created sugar-free versions that rival the standard offerings.
Pecan Pie Truffles from All Day I Dream About Food (2.5 grams net carb per truffle)
Sugar-Free Maple Nut Fudge from Maria Mind Body Health (less than 1 gram net carb apiece)
Coconut Almond Mocha Fudge from Beauty and the Foodie (2 grams net carb for low carb version)
The aroma of freshly baked cookies makes them nearly impossible to resist, and these low-carb treats are no exception.
Walnut Cardomom Snowballs from All Day I Dream About Food (1.5 grams net carb per cookie)
Raspberry Thumbprint Cookies from Low Carb Yum (just over 1 gram net carb per cookie)
Low-Carb Classic Gingerbread Men from All Day I Dream About Food (2 grams net carb per cookie)
That last one sounds especially intriguing, from my own perspective! Based on the reviews in the comments section, I'm definitely going to try making those gingerbread men this year. With a little luck, they'll turn out to be everyone's new healthy favorite.
Bottom Line: Enjoy!
Holiday eating should be pleasurable when following a low-carb lifestyle. Regardless of whether you choose to eat small amounts of traditional recipes, low-carb versions of the classics, or just stick to meat and vegetables, enjoy your celebrations! I wish you and your family safe, happy, and healthy holidays.
What names come to mind when you hear the term "Ketogenic Diet Expert"? For me, that list includes researchers Steve Phinney, PhD, Jeff Volek, PhD, RD, Thomas Seyfried, PhD, Adrienne Scheck, MD, Eugene Fine, MD, Dominic D'agostino, PhD, and Colin Champ, MD. There are many others who've conducted studies on ketogenic diets or use them in practice and understand their benefits -- and limitations -- for metabolic and therapeutic purposes.
Although I understand the science, have read much of the work of the people listed above, and have worked with several clients who choose to follow a very-low-carbohydrate ketogenic diet, at this point I wouldn't consider myself an expert in this area. In fact, I've spent the last year or so clarifying that my own approach to diabetes and weight management is low carb but not necessarily ketogenic. I make this distinction because I believe a very-high-fat ketogenic diet isn't necessary and in some cases can be counterproductive for weight loss and blood glucose control if energy/calorie intake from fat is too high. I find that a diet moderately high in protein and fat with limited carbohydrates (25-70 grams digestible or "net" carbs per day, depending on the person) works best for most. It's also the type of diet I've followed for several years, with great results.
"The More Fat You Eat, The More Fat You'll Lose"?
Now, a ketogenic diet containing less than 20 grams of net carb daily can produce weight loss provided energy intake is reduced, which often occurs spontaneously with carb restriction. There's no denying that many people experience dramatic weight loss with minimal carb intake, are able to maintain the loss, and feel great eating this way. But some of the statements I've read about keto being a miracle for dropping unwanted pounds are simply untrue, such as:
Very-low-carb ketogenic diets don't work that way. As just one example, a doctor friend of mine has diabetes, is of normal weight, and has been following a very-low-carb ketogenic diet for several years. He recently experimented with increasing the amount of coconut oil in his already high-fat diet. Although his ketone levels increased to well above 3 mm, he put on several pounds over the course of a few months, which he lost by cutting back on the coconut oil. Adding too much butter, cream, olive oil, or any other fat can have the same effect, as can eating excessive quantities of protein or carbohydrates.
Also, think about the group following a very strict traditional ketogenic diet: children with epilepsy that have failed medication therapy. This diet is about 90% fat, 2-4% carb, and less than 10% protein, which results in a level of ketonemia that in many cases significantly reduces or even eliminates seizures (The Modified Atkins Diet is very low in carbs but does not restrict protein, is much easier to adhere to long term, and has also shown effectiveness for seizure management). Children don't lose weight on the ketogenic diet when calorie intake is adequate, and for that and other reasons, it's very important that specially trained dietitians (true ketogenic diet experts) work closely with patients and their families to ensure energy and nutrient needs are met, which involves weighing food to the gram on a kitchen scale. In fact, in the book "Ketogenic Diets: Treatments for Epilepsy and Other Disorders" by Dr. Eric Kossoff and other specialists, there's a section devoted to potential weight gain -- or weight loss -- that may occur during ketogenic diet therapy.
Therapeutic Applications for Ketogenic Diets
While the results of studies investigating the effects of ketogenic diets (KDs) on performance are impressive (1), what I'm most enthusiastic about is their use as an adjunct to traditional therapy in treating serious, often life-threatening diseases where only mediocre results have been achieved with medication or other non-nutritional therapy alone. There's so much established and emerging evidence on their benefits (2), and it's growing monthly as researchers continue publishing their findings.
One of the best-known applications for KDs is cancer, particularly certain types of brain cancer like glioblastoma (3,4). Cancer is a very complex disease, and there are conflicting opinions as to its primary cause(s). Dr. Thomas Seyfried and others in the field of cancer research believe that it results when cells develop dysfunctional mitochondria that are unable to generate energy the way normal cells do (oxidative phosphorylation) and must instead use a different pathway reliant on large amounts of glucose (anaerobic glycolysis) in order to meet energy demands. (For anyone interested in reading more about the science behind this -- along with potential risk factors and ways to address them -- please check out the excellent cancer series by nutritionist Amy Berger on her blog, Tuit Nutrition.)
Based on several studies, Drs. Seyfried, D'Agostino, Champ, and others believe that increasing serum levels of the ketone beta-hydroxybutyrate via a diet very high in fat and moderate in protein with minimal carbohydrates results in an unfavorable environment for cancer cells. According to these researchers, calories must often be somewhat restricted as well in order to achieve a therapeutic level of ketonemia while simultaneously keeping blood glucose levels low enough to reduce cancer cell growth and inflammation.
For a personal account of what it's like living with brain cancer and using a KD in combination with traditional therapy, I highly encourage you to read the blogs of two insightful and inspirational people I follow online: Alix Hayden in Canada and Andrew Scarborough in the UK. These two are truly experts on what day-to-day management of cancer (and in Andrew's case, epilepsy as well) entails.
There's a growing body of research suggesting that people with with Alzheimer's disease, traumatic brain injury (TBI), ALS (Lou Gehrig's disease), Parkinson's, and other neurological diseases may also benefit from ketogenic diets (5-9). While much of the evidence comes from studies on mice and other animals, the results of human research are also promising (10-12), including the case of a 64-year-old woman who experienced significant regression of an advanced glioblastoma tumor (nearly unheard of in a woman her age) when a calorie-restricted, ketogenic diet was combined with standard therapy (13). Unfortunately, as Dr. Seyfried discusses in his excellent presentation Cancer: A Metabolic Disease with Metabolic Solutions, the tumor came back once she went off the diet and began taking the drug Avastin.
Below is another lecture from radiation oncologist Colin Champ discussing the role ketogenic diets, calorie restriction, and fasting can play in cancer treatment. The presentation isn't overly technical, and Dr. Champ covers a lot here in his typical engaging style.
And if you're interested in learning about the latest research on the wide-reaching effects of ketogenic diets for neurological disorders and certain cancers, check out Dr. Dominic D'Agostino's talk Metabolic Therapies: Therapeutic Implications and Practical Application. Notice that the KD is used in combination with medication or hyperbaric oxygen therapy in order to provide maximum benefit.
I realize that there is still much that is unknown in the field of ketogenic diets, and I don't want to make premature statements about the extent of their ability to prevent or treat disease . For instance, the KD may not be appropriate or effective for all types of cancer, including some brain cancers (14). Anecdotally, some people have experienced great benefit from being in sustained ketosis while others haven't. But what I've read and heard about their potential uses is certainly encouraging.
After I finished my dietetic internship and became a dietitian, I worked at a large Veterans Health Administration hospital for five and a half years. The first two were spent in the Spinal Cord Injury unit and the remainder in outpatient care. During that time I saw hundreds of patients with cancer, TBI,'s ALS, Alzheimer's, Parkinson's, and other debilitating conditions. The main goals for nutrition therapy were to prevent weight/lean mass loss and ensure nutritional adequacy by making appropriate dietary recommendations -- if they were even capable of eating (some required tube feeding). It was heartbreaking to see the devastating effects of disease and treatment on patients and their families, knowing there was little I could do beyond trying to prevent loss of muscle mass and micronutrient deficiencies by prescribing high-protein foods and supplements.
The possibility that ketogenic diets may one day become part of standard therapy for various types of serious illness -- reducing the current reliance on toxic therapies, improving outcomes, and elevating people's quality of life -- makes me eager to continue learning as much as possible about them so I can provide "expert" nutritional guidance that may truly make a difference.
1. Phinney SD. Ketogenic diets and physical performance. Nutr Metab (Lond). 2004;1:2
2.Paoli A, et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate ketogenic diets. Eur J Clin Nutr 2013 Aug;67(8):789-96
3. Seyfried TN, et al. Metabolic therapy: a new paradigm for managing malignant brain cancer. Cancer Lett. 2015 Jan 28;356(2 Pt A):289-300
4. Varshneya K, et al. The Efficacy of Ketogenic Diet and Associated Hypoglycemia as an Adjuvant Therapy for High-Grade Gliomas: A Review of the Literature. Muacevic A, Adler JR, eds. Cureus. 2015;7(2):e251
5. Paoli A, et al. Ketogenic Diet in Neuromuscular and Neurodegenerative Diseases. BioMed Rese Int. 2014;2014:474296
6. Greco T, et al. Ketogenic diet decreases oxidative stress and improves mitochondrial respiratory complex activity. J Cereb Blood Flow Metab. October 2015 (epub ahead of print) DOI: 10.1177/0271678X15610584
7. Seyfried, TN. Ketone strong: emerging evidence for a therapeutic role of ketone bodies in neurological and neurodegenerative diseases. J Lipid Res. 2014 Sep;55(9):1815-7
8. Stafstrom CE, Rho JM. The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders. Front Pharmacol. 2012;3:59
9. Hartman AL. Neuroprotection in Metabolism-Based Therapy. Epilepsy Res. 2012;100(3):286-294
10. Gasior M, Rogawski MA, Hartman AL. Neuroprotective and disease-modifying effects of the ketogenic diet. Behav pharmacol. 2006;17(5-6):431-439
11. Allen BG, et al. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biology. 2014;2:963-970
12. Champ CE, et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neuroncol. 2014 Mar;117(1):125-3
13. Zuccoli G, et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond). 2010;7:33
14. Dang MT, et al. The Ketogenic Diet Does Not Affect Growth of Hedgehog Pathway Medulloblastoma in Mice. Xie J, ed. PLoS ONE. 2015;10(7) e0133633
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 equates to at least 1.75 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 an inevitable loss of lean muscle tissue in addition to fat, regardless of diet and exercise. However, research has shown that increasing protein intake can minimize the amount of muscle lost 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 carb0hydrate-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.
Franziska Spritzler, RD, CDE