Category Archives: Low-Carb

The Mellberg Study: Paleo Diet and Obese Postmenopausal Women

Sweden's Flag. Most of the researchers involved with this study are in Sweden

Sweden’s Flag

Swedish researchers compared a Paleolithic-type diet against a lower-fat, higher-carb diet so often recommend in Nordic countries and in the U.S. Test subjects were obese but otherwise healthy older women. The study lasted two years. Dieters could eat as much as they wanted.

They found that the paleo-style dieters lost more weight, lost more abdominal fat, and lowered their trigyceride levels. When measured six months into the study, the paleo dieters had lost 6.5 kg (14 lb) of body fat compared to 2.6 (6 lb) kg in the other group.

Measured at two years out, the paleo dieters had lost 4.6 kg (10 lb) of body fat compared to 2.9 kg (6 lb) in the other group, but this difference wasn’t statistically significant.

The greatest weight loss was clocked at 12 months: Paleo dieters were down 8.7 (19 lb) kg compared to 4.4 kg (10 lb)  in the other group.

But this study was about more than weight loss. The investigators were also interested in cardiometabolic risk factors and overall body composition.

The Set-Up

I don’t know what the researchers told the women to get them interested. Weight loss versus healthier diet versus ?  This could have influenced the type of women who signed up, and their degree of commitment.

A newspaper ad got the attention of 210 women in Sweden; 70 met the inclusion criteria, which included a body mass index 27 or higher and generally good health. Average age was 60. Average BMI was 33. Average weight was 87 kg (192 lb). Average waist circumference was 105 cm (41 inches). The women were randomized into one of two diet groups (N=35 in each): paleolithic-type diet (PD) or Nordic Nutrition Recommendations diet (NNR). There were no limits on total caloric consumption. (Were the women told to “work on weight loss”? I have no idea.)

We don’t know the ethnicity of these women.

Here’s their version of the paleo diet:

  • 30% of energy (calories) from protein
  • 40% of energy from fat
  • 30% of energy from carbohydrate
  • high intake of mono- and polyunsaturated fatty acids
  • based on lean meat, fish, eggs, vegetables, fruits, berries, and nuts
  • additional fat sources were avocado and oils (rapeseed [canola] and olive) used in dressings and food preparation
  • cereals (grains), dairy products, added salt and refined fats and sugar were excluded
  • no mention of legumes, potatoes, or tubers

The NNR diet:

  • 15% of energy from protein
  • 25-30% of energy from fat
  • 55-60% of energy from carbohydrate
  • emphasis on high-fiber products and low-fat dairy products

Over the 24 months of the study, each cohort had 12 group meetings with a dietitian for education and support, including “dietary effects on health, behavioral changes and group discussion.”

Various blood tests and body measurements were made at baseline and periodically. Body measurements were made every six months. Body composition was measured by dual energy x-ray absorptiometry. Diet intake was measured by self-reported periodic four-day food records.

Stockholm Palace

Stockholm Palace

Results

30% of participants (21) eventually dropped out by the end of the study and were lost to follow-up, leaving 27 in the PD group and 22 in the NNR cohort.

Food record analysis indicated the PD group indeed reduced their carb intake while increasing protein and fat over baseline. Baseline macronutrient energy percentages were about the same for both groups: 17% protein, 45% carb, 34% (I guess the percentages don’t add to 100 because of alcohol, which wads not mentioned at all in the article.) Two years out, the PD group’s energy sources were 22% protein, 34% carb, 40% fat. For the NNR group, the energy sources at two years were 17% protein, 43% carb, and 34% fat. As usual, dietary compliance was better at six months compared to 24 months. The PD group failed to reach target amounts of protein energy (30%) at six and 24 months; the NNR group didn’t reach their goal of carbohydrate energy (55-60%). The PD group ate more mono- and poly unsaturated fatty acids than the NNRs.

In contrast to the food record estimates of protein intake, the urine tests for protein indicated poor adherence to the recommended protein consumption in the PD group (30% of energy). Both groups ate the same amount of protein by this metric. (This is an issue mostly ignored by authors, who don’t say which method is usually more accurate.)

“Both groups had statistically significant weight loss during the whole study, with significantly greater weight loos in the PD group at all follow up time points except at 24 months.” Largest weight loss was measured at 12 month: 8.7 kg (19 lb) in the PD group versus 4.4 kg (10 lb) in the NNRs.

The PD group lost 6.5 kg (14 lb) of body fat by six months but the loss was only 4.6 kg (10 lb) measured at 24 months. Corresponding numbers for the NNR group were 2.6 and 2.9 kg (about 6 lb). So both groups decreased their total fat mass to a significant degree. The difference between the groups was significant (P<0.001) only at six months. The greatest weight loss was clocked at 12 months: PD dieters were down 8.7 kg (19 lb) compared to 4.4 kg (10 lb) in the NNRs. Both groups saw a significant decrease in waist circumference during the whole study, with a more pronounce decrease in the PD group at six months: 11 versus 6 cm (4.3 versus 2.4 inches).

Fasting blood sugars, fasting insulin levels, and tissue plasminogen activator activity didn’t change.

Both groups had improvements in blood pressure, heart rate, c-reactive protein, LDL cholesterol, PAI-1 activity, and total cholesterol. The PD group saw a greater drop in triglycerides (by 19% at two years, but levels were normal to start with at 108 mg/dl or 1.22 mmol/l).

Reported daily energy intake fell over time for both groups, without statistically significant differences between them.

paleo diet, Steve Parker MD, diabetic diet

Sweet potato chunks brushed with olive oil, salt, pepper, and rosemary. Ready for the oven.

Discussion

As measured at six months, the paleo dieters lost 10% of their initial body weight, compared to 5% in the NNR group. That’s worth something to many folks. However, the researchers didn’t find much, if any, difference in the groups in terms of cardiometabolic risk factors. They wonder if that reflects the baseline healthiness of these women. Would a sicker study population show more improvement on one of the diets?

I’m surprised the NNR group lost any weight at all. In my experience it’s hard for most folks to lose weight and keep it off while eating as much as they want, unless they’re eating very-low-carb. We’ve seen short-term weight loss with ad libitum paleo diets before (here for example, and here, and here). I bet the women signing up for this study were highly motivated to change. 

Legumes and potatoes are a debatable part of the paleo diet. Most versions exclude legumes. We don’t know if these women ate legumes and potatoes. Other than this oversight, the study paleo diet is reasonable.

The authors noted that the paleo diet group failed to reach their protein intake goal (30% of total calories), and suggested reasons “such as protein-rich foods being more expensive, social influences on women’s food choices or a lower food preference for protein-rich food among women.”

The results of this study may or may not apply to other population subgroups and non-Swedes.

The authors write:

In conclusion, a Palaeolithic-type diet during two years with ad libitum intake of macronutrients, including an increased intake of polyunsaturated fatty acids and monounsaturated fatty acids reduces fat mass and abdominal obesity with significantly better long-term effect on triglyceride levels vs an NNR diet. Adherence to the prescribed protein intake was poor in the PD group suggesting that other component of the PD diet are of greater importance.

Does this study have anything to do with diabetes? Not directly. But it suggests that if an overweight diabetic needs to lose excess body fat without strict calorie control, a lower-carb paleo-style diet may be more effective than a low-fat, higher-carb diet. I would have liked to have seen lower fasting blood sugar and insulin levels in the paleo dieters, but wishing doesn’t make it so.

Steve Parker, M.D.

PS: Carbsane Evelyn has taken a look at this study and blogged about it here and here. I’ve not read those yet, but will now.

Reference: Mellberg, C., et al (including M. Ryberg and T Olsson). Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. European Journal of Clinical Nutrition, advance online publication January 29, 2014. doi: 10.1038/ejcn.2013.290

Low-Carb Diet Works in Japanese With Type 2 Diabetes

Mt. Fuji in Japan

Mt. Fuji in Japan

I don’t know much about Japanese T2 diabetes. I’ve never studied it. Their underlying physiology may or may not be the same as in North American white diabetics, with whom I am much more familiar. Physiologic differences are suggested by the fact that Japanese develop type 2 diabetes at lower BMIs (body mass index) than do Western caucasians.

For what it’s worth, a small study recently found improvement of blood sugar control and triglycerides in those on a carbohydrate restricted diet versus a standard calorie-restricted diet.

Only 24 patients were involved. Half were assigned to eat low-carb without calorie restriction; the other half ate the control diet. The carbohydrate-restricted group aimed for 70-130 grams of carb daily, while eating more fat and protein than the control group. The calorie-restricted guys were taught how to get 50-60% of calories from carbohydrate and keep fat under 25% of calories. At the end of the six-month study, the low-carbers were averaging 125 g of carb daily, compare to 200 g for the other group. By six months, both groups were eating about the same amount of calories.

Average age was 63. Body mass index was 24.5 in the low-carb group and 27 in the controls. All were taking one or more diabetes drugs.

The calorie-restricted group didn’t change their hemoglobin A1c (a standard measure of glucose control) from 7.7%. The low-carb group dropped their hemoglobin A1c from 7.6 to 7.0% (statistically significant). The low-carb group also cut their triglycerides by 40%. Average weights didn’t change in either group.

Bottom Line

This small study suggests that mild to moderate carbohydrate restriction helps control diabetes in Japanese with type 2 diabetes. The improvement in hemoglobin A1c is equivalent to that seen with initiation of many diabetes drugs. I think further improvements in multiple measures would have been seen if carbohydrates had been restricted even further.

Steve Parker, M.D.

Link to reference.

h/t Dr Michael Eades

Recipe: Sunny’s Super Salad

diabetic diet, Paleobetic diet, diabetes,

You won’t be able to eat this in one sitting if you’re small or sedentary

This huge salad is a full meal. It fills a 10-inch plate (25 cm). Since it contains five vegetables, you should feel virtuous eating it. Who says the paleo diet’s all about meat?

Ingredients:

8 oz (230 g) raw chicken breast tenderloin (it cooks down to 5 oz)

1/4 cup (60 ml) canned mandarin orange wedges (6-7 wedges) (if you can only find these packed in syrup or light syrup, add 3 g to the digestible carb count below)

1/4 tsp (1.2 ml) lemon pepper seasoning

4 oz (110 g) hearts of romaine lettuce

1 oz (30 g) baby spinach

2.5 oz (1/4 cucumber or 70 g) cucumber, peeled and sliced into discs

2 oz (60 g) California avocado, peeled and seeded, cut into wedges (1/2 of standard-sized avocado)

3 oz (85 g) fresh tomato (a typical roma or small tomato)

1 oz (30 g) walnuts

6 tbsp (90 ml) extra virgin olive oil

2 tbsp (30 ml) vinegar (we used balsamic)

1/4 tsp (1.2 ml) salt

1/4 tsp (1.2 ml) fresh ground black pepper

1/4 tsp (1.2 ml) crushed dried rosemary

diabetic diet, Paleobetic diet, low-carb, seasoning

Like Deborah on “Everybody Loves Raymond,” my wife often makes lemon chicken

Instructions:

First cook the chicken breast over medium heat in a skillet. If you think the meat will stick to the pan, add a smidgen (1/2 tsp or 2.5 ml) of olive oil to the pan. Don’t overcook or the meat will get tough. It’ll take five or 10 minutes.

While that’s cooking, prepare your vinaigrette. In a jar with a lid, place the olive oil, vinegar, salt, pepper, and rosemary, then shake vigorously for 20 seconds. Not 21 or you’ll ruin it. You’re done.

If you use a commercial vinaigrette instead, use one that has no more than 2 g of carbohydrate per 2 tbsp. You may have trouble finding that since so many of the commercial guys add sugar.

Place the lettuce and spinach on a plate then add the cucumber, avocado, tomato, cooked chicken, walnuts, and mandarin orange wedges on top. Drizzle two or three tbsp of the vinaigrette over it (nutritional analysis assumes three). Enjoy.

Servings: 1

(Actually, you’ll have enough vinaigrette left over for one or two more salads or vegetable servings. Save it in the refrigerator.)

Nutritional Analysis:

57 % fat

12 % carbohydrate

31 % protein

710 calories

25 g carbohydrate

10 g fiber

15 g digestible carb

990 mg sodium

1,570 mg potassium

Prominent features: Rich in protein, vitamin A, B6, C, copper, iron, manganese, magnesium, pantothenic acid, selenium, and phosphorus.

low-carb diet, diabetic diet, Paleobetic diet, balsamic vinaigrette,

I like this and use it. The lower left corner says “with EXTRA VIRGIN OLIVE OIL.” In order, the listed ingredients are water, balsamic vinegar, soybean oil and extra virgin olive oil, sugar….  2 tbsp has 3 grams of carb. Which oil would you guess predominates? BTW, balsamic has the most carbs of all the vinegars.

Consider Low-Carb Eating Instead of Drugs for Your GERD

How about this one?

It’s easier to pop a pill than change your diet, especially if someone else is paying for the pills

Dr. Michael Eades has a recent post on gastroesophageal reflux disease (GERD) and it’s treatment with carbohydrate-restricted eating versus drugs. A quote:

Most people who have GERD, have it for the long term. It’s not something that comes and goes. So these folks go on GERD therapy for the long term, and the most prescribed medications for long-term GERD treatment are PPIs [proton pump inhibitors], which, you now know, keep stomach acid neutralized for the long term, and, as you might imagine, creates a host of problems.

The scientific literature has shown long-term PPI therapy to be related to the following conditions:

  • Anemia
  • Pneumonia
  • Vitamin B12 deficiency
  • Impaired calcium absorption
  • Impaired magnesium absorption
  • Increased rate fractures, especially hip, wrist and spine
  • Osteopenia [thin brittle bones]
  • Rebound effect of extra-heavy gastric acid secretion
  • Heart attacks

Read the rest if you or someone you love has GERD. Acid-reducing Nexium is the second most-prescribed drug (by sales) in the U.S. We have stomach acid for a reason. It’s not nice to fool Mother Nature eliminating it.

Here’s a scientific report supporting Dr. Eades’ clinical experience that carbohydrate restriction helps with GERD. Carbs were reduced to 20 grams a day.

Steve Parker, M.D.

European Guidelines Reject Very Low Carbohydrate Diets for Diabetes

Conquer Diabetes and Prediabetes

“Really?”

A recent diabetes treatment guide from European doctors states “there is no justification for the recommendation of very low carbohydrate diets in diabetes mellitus.”

I disagree.

The 2013 guidelines are from the European Society of Cardiology and the European Association for the Study of Diabetes. I compiled the following articles in favor of carbohydrate restriction a couple years ago. You won’t find anything newer listed. Admittedly, all or nearly all of the patients involved had type 2 diabetes, not type 1. We do have a handful involving type 1s.

Enjoy!

♦  ♦  ♦

Accurso, A., et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutrition & Metabolism, 9 (2008). PMID: 18397522. One of the watershed reports that summarize the major features and benefits, based on 68 scientific references.

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. Annals of Internal Medicine, 142 (2005): 403-411. In these 10 obese diabetics, a low-carb diet spontaneously reduced calorie consumption from 3100 daily to 2200, accounting for the weight loss—1.65 kg (3.63 pounds) in 14 days. Blood sugar levels improved dramatically and insulin sensitivity improved by 75%.

Daly, M.E., et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial. Diabetes Medicine, 23 (2006): 15-20. Compared with a low-fat/reduced-calorie diet, weight loss was much better in the low-carb group over three months, and HDL ratio improved.

Davis, Nichola, et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care, 32 (2009): 1,147-1,152. The Atkins diet was superior—for weight loss and glycemic control—when measured at three months, when compliance by both groups was still probably fairly good. After one year, the only major difference they found was lower HDL cholesterol in the low-carb eaters. 

Elhayany, A., et al. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes, Obesity and Metabolism, 12 (2010): 204-209. In overweight type 2 diabetics, a low-carbohydrate Mediterranean diet improved HDL cholesterol levels and glucose control better than either the standard Mediterranean diet or American Diabetes Association diet, according to Israeli researchers.

Haimoto, Hajime, et al. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutrition & Metabolism, 6:21 (2009). DOI: 10.1186/1743-7075-6-21. A low-carbohydrate diet is just as effective as insulin shots for people with severe type 2 diabetes, according to Japanese investigators. Five of the seven patients on sulfonylurea were able to stop the drug. 

Nielsen, Jörgen and Joensson, Eva.  Low-carbohydrate diet in type 2 diabetes: stable improvement of body weight and glycemic control during 44 months follow-up. Nutrition & Metabolism, 5 (2008). DOI: 10.1186/1743-7075-5-14. Obese people with type 2 diabetes following a 20% carbohydrate diet demonstrated sustained improvement in weight and blood glucose control, according to Swedish physicians. Proportions of carbohydrates, fat, and protein were 20%, 50%, and 30% respectively. Total daily carbs were 80-90 g. Hemoglobin A1c, a measure of diabetes control, fell from 8% to 6.8%. These doctors had previously demonstrated that a 20% carbohydrate diet was superior to a low-fat/55-60% carb diet in obese diabetes patients over six months.

Vernon, M., et al. Clinical experience of a carbohydrate-restricted diet: Effect on diabetes mellitus. Metabolic Syndrome and Related Disorders, 1 (2003): 233-238. This groundbreaking study demonstrated that diabetics could use an Atkins-style diet safely and effectively in a primary care setting.

Westman, Eric, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5 (2008). DOI: 10.1186/1743-7075-5-36. Duke University (U.S.) researchers demonstrated better improvement and reversal of type 2 diabetes with an Atkins-style diet, compared to a low-glycemic index reduced-calorie diet.

Yancy, William, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men]. Nutrition & Metabolism, 2:34 (2005). DOI: 10.1186/1743-7075-2-34. A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients. The authors recommend that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar  dramatically.

Yancy, W., et al. A pilot trial of a low-carbohydrate ketogenic diet in patients with type 2 diabetes.  Metabolic Syndrome and Related Disorders, 1 (2003): 239-244. This pioneering study used an Atkins Induction-style diet with less than 20 grams of carbohydrate daily.

So there!

Steve Parker, M.D.

h/t to Reijo Laatikainen for tweeting the European article.

Physician With Type 1 Diabetes Thriving on Low-Carb Paleo-Style Diet

"Put down the bread and no one will get hurt!"

Could you give up bread for life?

ABC Radio provides the audio and transcript of an interview with Dr. Troy Stapleton, who was diagnosed with type 1 diabetes at age 41. He lives in Queensland, Australia. At the time of his diagnosis, he says…

I was advised to eat seven serves of bread and cereals, two to three serves dairy, fruit, starchy vegetables, and to balance that intake with insulin. If you add up all those serves, they were recommending a diet of up to about 240 grams of carbohydrates a day, and to balance it with insulin. I was going to be the best patient, and there has been some important trials that show that if you do control your blood glucose well then you can reduce your incidence of the complications.

Dr. Stapleton believes we evolved on a very low carbohydrate diet; the Agricultural Revolution led to our current high carb consumption. He was concerned about the risk of hypoglycemia with standard diabetic diets.

There was a different approach where essentially you went on a very low carbohydrate diet, this made a little bit of sense to me. Why would I eat carbohydrates and then have to balance it with insulin?

Here’s what the diabetes educators told him:

What they say is you need to estimate the amount of carbohydrate you’re going to eat, and then you need to match that carbohydrate dose essentially with an insulin dose. So you sort of look at your food and you go, okay, I’m having 30 grams of carbohydrate and I need one unit of insulin per 15 grams of carbohydrate, so two units. It sounds really quite straightforward, except that it’s very, very difficult to estimate accurately the amount of carbohydrate you’re eating. The information on the packets can be out by 20%. Most people say that your error rate can be around 50%.

And then of course it changes with what you’ve eaten. So if you eat carbohydrates with fat and then you get delayed absorption, then that glucose load will come in, and then the type of carbohydrates will alter how quickly it comes in to your bloodstream. And then of course your insulin dose will vary, your absorption rate will vary by about 30%. Once you think through all the variables, it’s just not possible. You will be able to bring your blood glucose under control, but a lot of the time what happens is you get a spike in your glucose level immediately after a meal, and that does damage to the endothelium of your blood vessels…

Norman Swan: The lining.

Troy Stapleton: That’s correct, it causes an oxidative stress to your endothelium, and that is the damage that diabetes does, that’s why you get accelerated atherosclerosis.

Here’s what happened after he started eating very low carb:

It’s been amazing, it’s been the most remarkable turnaround for me and I just cut out carbohydrates essentially completely, although I do get some in green leafy vegetables and those sorts of things. My blood sugar average on the meter has gone from 8.4 [151 mg/dl] down to 5.3 [95 mg/dl]. My HbA1c is now 5.3, which is in the normal range. My blood pressure has always been good but it dropped down to 115 over 75. My triglycerides improved, my HDL improved, so my blood lipid profile improved. And I would now have a hypoglycaemic episode probably about once a month after exercise. [He was having hypoglycemia weekly on his prior high carb diet with carb counting insulin adjustments.]

He was able to reduce his insulin from about 27 units a day down to 6 units at night only (long-acting insulin)! He admits his low insulin dose may just reflect the “honeymoon period” some type 1s get early on after diagnosis.

Norman Swan: So when you talk to your diabetes educator now, what does he or she say?

Troy Stapleton: Look, they’re interested, but they’ll tell me things and I’ll say, well, that’s actually not true. I’m quite a difficult patient, Norman.

He says he’s eating an Atkins-style diet. Combining the transcript and his notes in the comments section:  1) he doesn’t eat potatoes or other starchy vegetables or bread, 2) he eats meat, eggs, lots of non-starchy vegetables, some berries and tree nuts, olives, and cheese, 3) an occasional wine or low-carb beer, 4) coffee, and 5) he eats under 50 g/day of carbohydrate, probably  under 30 g. This is a low-carb paleo diet except for the cheese, alcohol, and coffee.  Cheese, alcohol and coffee are (or can be) low-carb, but they’re not pure paleo.

He notes that…

There is an adaption period to a very low carbohydrate diet which takes 4–6 weeks (ketoadaption). During this time symptoms include mild headaches, lethargy, cramps, carb cravings and occasional light headedness. These symptoms all pass.

Read or listen to the whole thing. Don’t forget the comments section. All the blood sugars you see there are in mmol/l; convert them to mg/dl (American!) by multiplying by 18.

Steve Parker, M.D.

Dr. Georgie Ede Defends Meat-Based Diets

…in an interesting blog post on the health of traditional meat-eating cultures such as the Masai and Inuits.

Of the Canadian Eskimos of a century ago, Dr. Ede writes:

Their diets were therefore extremely low in fiber most of the time, and very high in animal protein and animal fat.  These traditional ways of eating would terrify the USDA, the American Heart Association, the American Cancer Society, not to mention the Harvard School of Public Health, which remains a staunchly anti-meat, anti-saturated fat, anti-cholesterol institution.  How in the world did these uninformed fringe types manage to get all their vitamins and minerals without the heaping helpings of colorful fruits, vegetables, and whole grains without which we are told we shall surely perish?

Weren’t they cancer-riddled, heart-clenching, constipated, fat slobs who died young from scary deficiency diseases like rickets and scurvy?

[Apparently not.]

This post was not designed to provide an airtight argument for meat and health, but I do hope that it has at least prompted those of you who remain skeptical about meat to rethink what you’ve been led to believe. If you’ve got a hankerin’ for more information about meat and health, take a look at my meat page.

Check it out.

Is the Paleo Diet Truly Low-Carb After All?

Lifextension argues that very case in a recent blog post. If the paleo diet is low carb, then it’s going to be heavily animal-based. According to Lifextension:

Diachronic and comparative analysis of the skeletal data of human hunters and cultivators from across the globe has revealed that – prior to the onset of agriculture – carbohydrates must have comprised only a rare and occasional component of ancestral eating patterns. Furthermore, the impact of the introduction of carbohydrates to human diets was almost immediate in its deterioration of human health and biology.

However, paradoxically, many proponents of a ‘Paleo’ (i.e.: pre-agricultural) diet have promoted the use of tubers and other starches as – not only benign – but necessary health foods to consume for the correction of metabolic and endocrine disorders. Potatoes, rice, and other oxymoronically-labelled ‘safe’ starches, are being promoted in spite of the fact that they are exclusively Neolithic foods. Consequently, it is the conflation of starches, safe, and ancestral that I now wish to address, and hopefully correct.

Lifextension concludes:

The intake of plant foods by hominids was most plausibly and conceivably minimal. This is due to their limited, seasonal availability; the physiological ceiling on fibre and toxin intake; the biological evolution of early Homo physiology; along with the technological, spatial and temporal limitations of obligatory pre-consumption preparations. Consequently, evolutionary arguments for the consumption of what are quite blatantly Neolithic foods are rendered paradoxical and absurd. Starches are neither ‘Paleo’; nor does our evolutionary biology sanction them as ‘safe’.

Lifextension neither pulls punches nor takes prisoners. This could get interesting.

Read the rest.

Potential Problems With Severe Carbohydrate Restriction

VERY-LOW-CARB  EATING

First, let’s talk about ketogenic diets, which require reduction of digestible carbohydrates to 50 grams a day or less for most folks.  The iconic ketogenic diet is the induction phase of the Atkins diet, which restricts carbs to a max of 20 g daily.  Note that the average American eats 250 to 300 grams of carb daily.

Your body gets nearly all its energy either from fats, or from carbohydrates like glucose and glycogen. In people eating normally, 60% of their energy at rest comes from fats. In a ketogenic diet, the carbohydrate content of the diet is so low that the body has to break down even more of its fat to supply energy needed by most tissues. Fat breakdown generates ketone bodies in the bloodstream. Hence, “ketogenic diet.” Also called “very-low-carb diets,” ketogenic diets have been around for over a hundred years.

WHAT COULD GO WRONG EARLY ON?

Very-low-carb ketogenic diets have been associated with headaches, bad breath, easy bruising, nausea, fatigue, aching, muscle cramps, constipation, gout attacks, and dizziness, among other symptoms. “Induction flu” may occur around days two through five, consisting of achiness, easy fatigue, and low energy. It clears up after a few days.

Other effects that you might not even notice immediately (if ever) are low blood pressure, high uric acid in the blood, excessive loss of sodium and potassium in the urine, worsening of kidney disease, deficiency of calcium and vitamins A, B, C, and D, among other adverse effects.

A well-designed ketogenic diet should address all these potential issues.  My Ketogenic Mediterranean Diet is an example.  I followed it for for six months and blogged about it.  (The KMD is not a paleo diet.)

Athletic individuals who perform vigorous exercise should expect a deterioration in performance levels during the first three to four weeks of any ketogenic very-low-carb diet. The body needs that time to adjust to burning mostly fat for fuel rather than carbohydrate.

Competitive weight-lifters or other anaerobic athletes (e.g., sprinters) will be hampered by the low muscle glycogen stores that accompany ketogenic diets. They need more carbohydrates.

WHAT ABOUT THE LONG RUN?

Long-term effects of a very-low-carb or ketogenic diet in most people are unclear—they may have better or worse overall health—we just don’t know for sure yet. Perhaps some people gain a clear benefit, while others—with different metabolisms and genetic make-up—are worse off.

If the diet results in major weight loss that lasts, we may see longer lifespan, less type 2 diabetes, less cancer, less heart disease, less high blood pressure, and fewer of the other obesity-related medical conditions.

Ketogenic diets are generally higher in protein, total fat, saturated fat, and cholesterol than some other diets. Some authorities are concerned this may increase the risk of coronary heart disease and stroke; the latest evidence indicates otherwise.

Some authorities worry that ketogenic diets have the potential to cause kidney stones, osteoporosis (thin, brittle bones), gout, deficiency of vitamins and minerals, and may worsen existing kidney disease. Others disagree.

It’s clear that compliance with very-low-carb diets is difficult to maintain for six to 12 months. Many folks can’t do it for more than a couple weeks. Potential long-term effects, therefore, haven’t come into play for most users. When used for weight loss, regain of lost weight is a problem (but regain is a major issue with all weight-loss programs). I anticipate that the majority of non-diabetics who try a ketogenic diet will stay on it for only one to six months. After that, more carbohydrates can be added to gain the potential long-term benefits of additional fruits and vegetables.

Or not.

People with type 2 diabetes or prediabetes may be so pleased with the metabolic effects of a ketogenic diet that they’ll stay on it long-term.

Steve Parker, M.D.

 

Which Vegetables Are Low in Carbohydrate Content?

Laura Dolson over at About.com has a helpful list of low-carb veggies.  Helpful if you experience excessive

blood sugar spikes from high-carb items, or if you’re restricting carbs for weight management.

-Steve