Low Carb Dietitian
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Why I'm More Low Carb than Paleo/Primal/WAPF, etc.

11/30/2013

33 Comments

 
PictureWurst und Käse Salat. Bring on the cheese!
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.

Dairy
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. 


Grains
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).

Sweeteners
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.


References
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 

33 Comments
Anna
11/30/2013 04:23:31 am

I'm glad you wrote this post, because the same thing has been on my mind. While I was happy to discover Paleo/Primal/WAPF and their position on real food, I have been disheartened lately to find more and more recipes on Paleo sites that contain ½ cup of raw honey, or 1 cup of maple syrup, or a cup of tapioca starch or coconut sugar...

I still try to adapt some of the grain-free recipes, but in the end, I had to face up to the fact that I would never be able to keep up with Paleo. My body just can't handle the carbs. Like you, I do best with -15g carb per meal. I'm really grateful that I can still get by like this and not need medication to lower my blood sugar.

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Franziska Spritzler link
11/30/2013 05:00:59 am

Thanks so much for your comments, Anna! I'm glad you understand and have similar feelings and experiences. Best of luck to you!

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PhilT
11/30/2013 04:36:36 am

I don't see how honey or maple syrup can contain more carbs than sugar, as the latter is 100% carbohydrate and the former are 70%-ish solutions of carbs in water.

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Franziska Spritzler link
11/30/2013 05:08:05 am

Actually, honey is the most concentrated in sugar despite being in liquid form (not watered down, though), followed by syrup and finally sugar:

Carb per Tbsp:

Honey: 17 grams
Maple syrup: 13 grams
Table sugar: 12 grams carb

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Philt
11/30/2013 04:41:07 pm

ah, by *volume*. I forget you Americans are obsessed with measuring by volume.

PhilT
11/30/2013 04:43:25 pm

"However, these items contain more carbohydrate by weight than sugar does" - oops, you were wrong. You said by weight.

Judi
11/30/2013 04:45:52 am

Really great advice here. I am also a normal weight person with blood sugar issues. Low carb has given me my life back. You have to do what works for your metabolism. Honey doesn't work for me. It's fine - I'm a good cook and there are a ton of great recipes out there.

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Franziska Spritzler link
11/30/2013 05:10:38 am

Thank you so much, Judi! So glad you've learned how to manage blood glucose by eating the right way for you. Yes, there are more fantastic low carb recipes online than I have time to read!

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Jen
11/30/2013 04:57:28 am

Just want to say thank you for your articles about carb restriction!

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Franziska Spritzler link
11/30/2013 05:11:19 am

My pleasure, Jen! Thanks for commenting.

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Dan Brown link
11/30/2013 10:09:47 am

Great post, Franziska. I'm with you 100%. In fact, I wrote a blog post today (to be published 1/11/14 I think) titled, "Your blog is for type 2 diabetics, right?" that appoached the issue in a different way but reaches the same conclusion, I think. I like you, see the need to define my blog more definitively. I don't fear to offend, though. There are too many out there like us who need to get the best advice they can, and heed it. Keep up the good work!

Just today, at our local farmers' market, I met two people who had relatives who "were normal weight but were recently diagnosed type 2s (had blood sugar issues, in your words). I think it is especially important that credentialed people like you, who have blood sugar issues, speak out with your message. There are so many pre-diabetics and Metabolic Syndromers out there. They're either coming out of the woodwork, or out of the closet. Or maybe, it's just that they're being diagnosed by an increasingly aware medical community of MDs, RDs and CDEs like yourself.

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Franziska Spritzler link
11/30/2013 11:53:25 am

Thanks so much for the nice feedback and continued support, Dan! Of course I'll continue to speak out and know that you will as well. I'm looking forward to reading your article in January.

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Franziska Spritzler link
11/30/2013 08:39:38 pm

@ PhilT (Sorry, can't reply directly to replies),

You're right about the comparison by weight, and I'll correct it. But people don't weigh their sweeteners so much as spoon them out. Regardless, honey and maple syrup provide too many carbs and shouldn't be viewed as a good alternative to sucrose by people with diabetes, metabolic syndrome, etc.

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Andre Chimene link
11/30/2013 10:27:07 pm

You have my sentiments exactly.
To me nothing says he'll like low blood sugar low insulin and low leptin.
The only way to get that is to eat the way you prescribed.

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Franziska Spritzler link
11/30/2013 11:20:40 pm

Thanks so much, Andre! The concept is pretty simple, but unfortunately many don't see it that way.

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Roseanne Dolan link
12/1/2013 09:12:47 pm

Hi Franziska,
First of all I have to say I am delighted to find a dietician that promotes low carb. There don't seem to be too many that do yet although it does seem to be changing..

I follow the Atkins diet myself and have done for almost 3 years now. The Atkins diet is the original low-carb diet! Or more correctly, Dr Atkins was the first to popularize this approach although he certainly didn't invent it - it existed long before that and long before the notion of low-fat became popular 40 years ago.

I agree with you completely with the idea that other ways of eating - Paleo, low GI, Primal have merit. Anything that moves towards eating real food including fats and more veg and less carbs/sugar is a big step forward in my opinion.

I also agree with what you say about the amount of carbs being important. The reason that I like the Atkins diet is that people gradually increase their carb intake in phases 2 and 3 - that way they find out what works for them in terms of weight loss/maintenance and in terms of what foods do or do not agree with them. So for some people, more dairy will be fine and likewise for some people they will be able to reintroduce more grains. As you say, not everyone is intolerant to these foods. However, if they are intolerant to them and these foods cause an issue, they find this out too through the process.

But on the whole, I think it is more important to get the message out that it is carbs/sugar that are the major issue rather than fat. Its long time for the message about low-fat to be retired for good.

Roseanne

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Franziska Spritzler link
12/1/2013 11:28:35 pm

Thanks so much for your comments and sharing your story, Roseanne! I agree with everything you stated and am so happy low-carb has worked so well for you.

Despite what many people think of the Atkins diet, when done correctly it's a very healthy, balanced way of eating based on an individual's unique tolerance for carbohydrates, as you stated. Dr. Atkins was unfairly villified by many mainstream health professionals. Fortunately, he helped millions of people who read his book and followed his advice.

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Roseanne Dolan link
12/2/2013 03:30:11 am

That is true about Dr. Atkins. And the studies keep proving him right over and over again. The sooner health authorities switch their message to low-carb instead of low-fat as Sweden has just done, the sooner we start to reverse the terrible problem with obesity, diabetes and so many other illnesses.

In the meantime, our customers are fantastic walking advertisements for the weight loss and the health benefits of a low carb approach and we'll spread the word that way!

Franziska Spritzler link
12/2/2013 04:14:30 am

Sorry, I have to respond to your second comment here because this blog doesn't allow replies to replies. Yes, wholeheartedly agree that we need to follow Sweden's lead! Keep up the great work :)

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Gina
12/2/2013 06:10:46 am

Thank you! This has been most helpful and is where I think I am positioning myself. I have recently lost lots of weight by cutting out the carbs and sugar, but have allowed myself dairy (low sugar). The Paleo thing has been helpful and I love some of the recipes but what you are saying really sits well with me and my experience thus far :-)

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Franziska Spritzler link
12/2/2013 09:03:15 am

Thanks so much for your comments, Gina! So glad you identify with what I'm saying. Congratulations on the weight loss!

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Galina L.
12/2/2013 09:18:18 pm

When I started to eat a LC diet, from the "real food perspective" , my diet became worse - less fiber, less vegetables and no fruits, no whole grains, ample amount of processed meat , store-bought mayonnaise, artificial sweeteners, but removing most carbs from my diet rejuvenated me, and I immediately started to regain my health, because my new diet targeted the main issue - poor tolerance of carbohydrates. My pre-LC diet could easily fit the WAPF criteria (we mainly eat a traditional Russian food in my family ,fermented sauerkraut is always in my fridge, and I even bake a sourdough rye bread for my husband), even though I didn't know about them back then. Six years later my diet relies much less on the mayo and processed meat, I read nutritional blogs, and avoiding O6 oils seems to be a good idea in general, but I never really experienced any negative effect from eating it.
I think a gluten issue is a little bit like O6, even though many do experience immediately benefits of avoiding it. I am one of the people who have more than the average amount of allergies and autoimmune problems. For me it looks like that allergies are more wide-spread in a population and mimic different health conditions . Immune system could attack almost any tissue in a human body, and only symptoms would be treated by a regular doctor, unless the trouble gets way out of control. I personally believe that many cases of fatigue and a low-grade depression could be explained by a low-grade , therefor hard to identify allergy. I suspect that many people who have allergies, do not realize it.

From such perspective gluten looks quite suspicious. It doesn't mean everybody should avoid it, but I wish more people would check how the complete avoidance would be beneficial or not.

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Franziska Spritzler link
12/2/2013 10:15:04 pm

Hi Galina,

Thanks as always for sharing your experience and insights! I agree that some people do much better eliminating gluten from their diet, particularly those with autoimmune issues, but I can't make across-the-board recommendations that everyone should avoid it all costs. I don't eat gluten-containing foods as a rule, but occasionally I have a bite of an entree or dessert that contains wheat. No adverse health effects, and as long as carbs stay low, my BG and overall sense of well-being remains good.

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Jan link
12/5/2013 01:30:18 am

With apologies if I am stating the obvious to some of your readers, but, it's always good to read your articles and also the comments that follow. For me a low carb high fat diet is the key to improving health, and it works very well for diabetics.

All the best Jan.

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Franziska Spritzler link
12/5/2013 04:42:52 am

Thank you so much, Jan! Always appreciate your kind words and experience :)

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Lynda link
12/7/2013 01:52:41 pm

Wonderful blog post! I agree. I call myself low carb/wheat free/primal. I don't fully agree with being called low carb because so many low carbers eat rubbish food (fake, processed etc). I am wheat free but on occasion will have a tiny amount like breading or something. I don't feel bad about this at all. Finally I say primal because I do like whole, unprocessed foods plus dairy.

Basically all that you said. I've never like to be labelled one thing or another and blood sugar is my first most important concern. I am not diabetic but would have been given a little time. It was very refreshing to read your post.

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Franziska Spritzler link
12/7/2013 09:34:40 pm

Thanks so much for your very kind feedback, Lynda! We are indeed on the same page and appear to eat very similarly.

Wonderful blog, by the way! I enjoyed reading your story and congratulate you on your weight loss. Also, thank you for adding me to your blogroll. My very best wishes for your continued success!

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Terry
12/11/2013 07:57:39 am

I've not paid much attention to the various labels of diets. I was driven to a LCHF diet by my T1 diabetes and I absolutely know that I am carb intolerant. I can eat between 50-75 grams of carbs/day and still maintain reasonable blood glucose control. I'm now trying to lose some more weight so I've lowered my daily carb limit to 50 grams and my protein limit to 65 grams.

Keep up the good work!

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Franziska Spritzler link
12/11/2013 09:43:45 am

Always a pleasure to hear from you, Terry! Yes, it's the carbs that matter most when it comes to blood glucose and weight management. You keep up the good work too :)

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es
12/21/2013 04:46:05 am

What a great blog post. You hit the issue right on the head. I've been a low-carb high fat diet advocate since going on Atkins three years ago, and I have been concerned that the LCHF message was being obfuscated by other concerns. You've won a new loyal blog follower with this post. Keep up the good work! Ed

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Franziska Spritzler link
12/21/2013 05:27:14 am

Welcome, and thanks so much for your kind words of support, Ed! Very much appreciated.

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Nadja link
7/16/2016 07:44:33 am

Hi Franziska,
I just found your post while I was googling about Primal and Low-Carb. I prefer the best food I can get according to Paleo Standards, but Low-Carb comes first. I am ok with some more carbs (75-100g/d) though. I think Paleo and Primal is more of a blueprint than a strict rule so I do think your adaptations do actually fit in a primal pattern as well. You have to find your own rules anyway, however, eating real foods is the basis that unites us. No matter what the label is.
All the best from Germany, Nadja

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Franziska Spritzler link
7/16/2016 02:16:13 pm

Hi Nadja,

Thanks very much for your comments! I actually eat a few more carbs than when I wrote this article (probably 40-60 most days, sometimes less), which is still less than you but not VLC anymore. Yes, low carb, real food is best, with individual variation in macros, calories, and specific foods as needed. Labels end up dividing rather than uniting, it's true!

Best of luck, and thanks again for your thoughts :)

- Franziska

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