Some Surprising But True Facts....
Low carbohydrate diets raise good cholesterol, lower triglycerides, improve blood sugars, and lead to weight loss with less hunger.
Based on my own recent experience and a review of multiple sources of nutritional information, for my patients who have not successfully followed a conventional low fat, calorie restricted diet (like Weight Watchers or the American Heart Association diet) or a relatively high carbohydrate Mediterranean diet, I am recommending a lower carbohydrate, higher fat and moderate protein diet. I am also making this recommendation because you either have high triglycerides/low HDL, have the metabolic syndrome, or have type II diabetes. It will be helpful to understand how your food choices can either partially or completely reverse these problems or make them get worse.
Knowing that foods are made of different macronutrients: carbohydrates, fats, and proteins.
Knowing how the macronutrients affect your blood sugar and then insulin levels. Carbohydrates stimulate insulin much more than proteins, and fats do not stimulate insulin or raise blood sugar at all.
Knowing the negative effects of too much insulin include the inability to lose stored fat, storing more fat, and possibly an increase in hunger.
The effect of a lower carbohydrate diet on your cholesterol, or lipids (triglycerides, HDL, and LDL) is complex and surprising to most people. Low carbohydrate diets are higher in fats, including saturated fat (depending if you eat mammal or fish protein and your choice of oils). Your triglycerides will go down, your HDL will increase, and the LDL cholesterol may go up or down. The measured volume of the LDL may increase, but if it does it will be less dense (more buoyant and fluffier, and less likely to lead to artery blockages) with fewer overall number of LDL particles—even if you eat saturated fats.
When it has been studied, having a low HDL and high triglycerides predicts heart disease much more than a high LDL or total cholesterol level. For many years it has been known that a low carbohydrate diet will improve triglycerides and HDL, but most dieticians and physicians have been reluctant to recommend this dietary change (even though the American Heart Association [AHA] diet may actually lower HDL and raise triglycerides while only lowering the LDL to a very small extent). Instead of recommending a low carbohydrate diet, physicians and nutritionists have recommended weight loss and exercise to improve HDL and triglycerides, even though following the AHA diet generally does not reliably lead to weight loss and adding exercise without dietary changes does very little to affect the lipids. The reasons for not recommending a low carbohydrate diet have more to do with academic culture, and government research policies than an honest interpretation of the science of nutrition, in my opinion and that of many others.
Animal fat is actually a mixture of different forms of fat, and the slight majority of beef fat is actually the healthy monounsaturated fat, not saturated fat. Saturated fat can increase both the HDL cholesterol and LDL cholesterol. It is likely to be neutral in terms of health while on a low carbohydrate diet. Monounsaturated fat, like in olive oil, raises HDL, lowers triglycerides, has little effect on LDL, and it may improve insulin resistance. The Atkins diet allows for a variety of fats while the South Beach diet encourages less saturated fat. Either one is likely to improve your lipid profile and lead to weight loss. You can decide for yourself whether you want to lower saturated fats (animal fat, dairy fat, and coconut oil), but I, among others, believe there is no evidence of harm from saturated fats while on a low carbohydrate diet. Trans fats should always be avoided.
I do not expect my patients to completely avoid all foods listed on page 4, but if you do, you will lose weight very quickly and have very little hunger. Because I realize most people will not avoid all of these foods, I recommend counting carbohydrates for a couple weeks only, just to educate yourself on the carbohydrate content of your food. I recommend using eitherwww.sparkpeople.com or www.fitday.com, and limiting yourself to a total of 30-50 grams of carbohydrates from the non-preferred foods that are in Groups One, Two, or Three listed on page 4. Your total carbohydrates per day using this approach will be about 50-100 grams of carbohydrates including carbs you are not counting from non-starchy (healthy) vegetables and fiber rich fruits like apples and berries listed on page 3. After you have reached your weight loss goal and/or are instructed to cut the doses or stop some of your diabetes medications or insulin, you can add back more healthier, unrefined carbohydrates (like recommended in the South Beach Diet books). You can be sure you are not reversing the helpful metabolism changes you have made by making sure you do not gain weight and checking your blood sugar to be sure it is remaining under control.
In summary: You should avoid sugars (table sugar and high fructose corn syrup) and refined carbohydrates (flour and pasta) and vegetables/grains which are high in carbohydrates with very little fiber (like rice, potatoes, and corn). Decrease your carbohydrates more if you are not losing weight or reaching your blood sugar goals. You must not intentionally overeat or eat when you are not hungry. It is not helpful, and it is harmful to your health to eat both a high fat and high carbohydrate diet, so be sure you have not taken my advice to mean increasing fats without decreasing carbohydrates.
Your particular metabolic tendencies (diabetes, pre-diabetes, high triglycerides or low HDL cholesterol) are based on your genetics and will not change during your lifetime, regardless of weight loss or diet changes. A diet is a short term solution with weight loss alone as a goal, something to endure and then give up. The change I am advocating for you is motivated by more than a short term goal of losing weight and should be maintained for the benefit of your metabolic problems (diabetes, lipids, etc).
WARNINGS FOR DIABETICS:
If you have diabetes and are on insulin or a sulfonylurea, you should know and recognize the symptoms of hypoglycemia (low blood sugar). The pills which stimulate the pancreas to release insulin even with a normal blood sugar are called sulfonylureas (glipizide, glyburide, and glimepiride/Amaryl and metglitinides (repaglinide/Prandin and neglitinide/Starlix). If you are on one of these medications or insulin, your should seek specific advice regarding your risk of developing hypoglycemia and an action plan to prevent it or modify your medications (at times decreasing doses by up to 50% or more) before decreasing carbohydrate intake significantly.
If you have diabetes and are on insulin or a sulfonylurea, you should keep your carbohydrates between 50 and 100 grams a day. You should have one small serving of carbohydrates with each meal (one slice of bread, ½ cup of cereal, ½ cup rice, or ½ a medium potato) to be sure you get enough this amount of carbohydrates in addition to the carbohydrates you get in a healthy selection of non-starchy vegetables and less-sweet fruits.
If you are following one of the popular diet books like the Atkins Diet or South Beach Diet, you should begin the programs in the second phase and avoid the extremely low carbohydrate first phases, called “Induction” in the Atkins diet and begin in the “Ongoing Weight Loss” second phase. Your should begin in “Phase 2” of the South Beach diet. The fist phases of the Atkins or South Beach Diets diet recommend less than 20 grams of carbohydrates a day and would lead to dangerous and unpredictable insulin reactions or hypoglycemic reactions if you are treated with insulin or a sulfonylurea.
WARNINGS FOR PATIENTS WTH KIDNEY PROBLEMS:
If you have kidney disease (chronic renal insufficiency, kidney failure, protein in the urine, elevated creatinine, or low GFR) you should be more cautious about eating an excess amount of protein and remember to drink an adequate amount of water (64 ounces a day). I recommend that you discuss obtaining blood work to check for any worsening kidney function a few weeks after starting on a low carbohydrate diet. The risk of harming your kidneys by the diet is still very low and the harm of a high protein diet to kidney function is controversial. Many kidney specialists no longer recommend protein restriction for most of their patients. However, I would count protein grams for at least a couple weeks to be sure you are not getting more than about 0.4 to 0.5 grams of protein per your pound of weight seems prudent (about 90 grams of protein for a 200 lb person). Six ounces of very lean meat contains about 90 grams of protein. It is probably safe to exclude protein from eggs, vegetables, and beans from this total.
Foods can be eating and things you should be doing:
Meat, Eggs, and Tofu
is a great value and healthier (more omega 3 fatty acids) than corn/grain fed beef you can get at the grocery store and it can cost as little as $3.50 per pound.
Oils, Fats, and allowed treats
See my discussion of saturated fats on page one of this handouts. You may choose to eat these or not based on your preferences.
oil to cook with. It has a high smoking point.
Time and water
Foods you should try to avoid and things to read:
Group One Foods
Generally avoid for maximal metabolic and weight loss benefits
carbohydrates, even if “high fiber”
Group Two Foods
Avoid if possible―only as very special treats
Group Three Foods
Eat in moderation
The South Beach Diet, by Anthony Agatston, MD
New Atkins for a New You, by Eric Westman, et al.
Primal Blueprint, by Mark Sisson
Good Calories, Bad Calories, by Gary Taubes.
Beginner Web Sites/Blogs
www.nmsociety.org The Metabolism Society
http://tinyurl.com/veganlowcarb Vegan Low Carber
More Advanced Web Sites/Blogs
www.paleonu.com Paleolithic Nutrition
Journal article entitled: Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal
My Personal Experience
After being inspired by my father who lost 80 pounds (260 lbs to 180 lbs) and cut his insulin from 140 units to none, I knew I had to lose weight. I eat meat, eggs, veggies, fruit, cream, and cheese, and I have lost 25 pounds. My blood sugar went from 118 to 105. My hemoglobin A1c decreased from 5.8 to 5.3 (a drop of 15 blood sugar points on average). These improvements were in spite of stopping metformin (Glucophage) a medicine which would lower my blood sugar even further. My triglycerides decreased to 135 from 204, my HDL increased to 52 from 46, and my LDL increased to 109 from 74. I do not feel hungry and I love the food I am eating.