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Low Carbohydrate Renaissance

December 29, 2010 Written by JP       [Font too small?]

One of my favorite Christmas gifts this year came in the form of an article that my wife sent me via e-mail. The piece, “A Reversal on Carbs”, was written by Marnia Jameson and appeared in December 20th online edition of the Los Angeles Times. It features the voices of many of the leading nutritional scientists the world over. The general thrust of the publication is best summarized by Dr. Walter Willet, the chairman of the department of nutrition at the Harvard School of Public Health. He emphatically states that, “If Americans could eliminate sugary beverages, potatoes, white bread, pasta, white rice and sugar snacks, we would wipe out almost all of the problems we have with weight and diabetes and other metabolic diseases”. I would’ve added a few additional foods to that list, but otherwise I agree wholeheartedly. (1)

Anyone who regularly reads my columns knows that I frequently criticize foods and food products that contain high glycemic and/or refined carbohydrates. What’s more, many of you already know that I’ve lost over 90 lbs primarily by restricting my overall carbohydrate intake. But you may not be aware of the physiological underpinnings behind my general recommendation to follow suit. Here’s a brief overview of the importance of moderating carbohydrate consumption:

In the body, carbohydrates are converted into blood sugar. Certain carbs such as those rich in starches (grains, potatoes) and sugar (candy, fruit juice) lead to quicker and more dramatic elevations in blood glucose. In order to deal with this rapid rise in blood sugar, the pancreas must release insulin in order to transport sugar from the blood into cells to provide a form of stored energy known as glycogen.

The problem is that the human body isn’t well adapted to handle the estimated 250 to 300 grams of carbohydrates that are commonly consumed in the modern diet. Over time, our cells become tired of trying to keep up with this unnatural burden. This leads to a dangerous situation referred to as insulin resistance. In essence, the insulin the body produces becomes less effective. Then the pancreas attempts to compensate for this abnormality by producing excessive amounts of insulin.

The result of this destructive cycle is typically diabetes, obesity and several risk factors pertaining to heart disease known collectively as metabolic syndrome. The specific threats involved include abdominal obesity, high blood pressure and blood sugar, high triglycerides and low HDL (“good”) cholesterol. It is estimated that approximately 25% of the US population has at least three of these symptoms – the benchmark for establishing metabolic syndrome.

That’s the bad news. The good news is that a large body of research indicates that making modest changes in your diet can help reverse the danger that a high carbohydrate diet presents. Several recent studies attest to the safety and value of making this very shift. For instance, the latest issue of the British Journal of Nutrition reports that an egg-rich, high protein/high cholesterol diet improved antioxidant levels, blood sugar control and cardiovascular risk factors in a group with type 2 diabetes and impaired glucose tolerance. Another trial using a very low carbohydrate (ketogenic) diet found that this dietary intervention improved memory performance and reduced waist circumference and weight in a group of 23 older adults with mild cognitive impairment. The authors noted that chronic inflammation, high insulin (hyperinsulinemia) and problems relating to energy metabolism are frequently present in those most at risk for Alzhmeimer’s disease and other neurocognitive diseases. Ketogenic diets are documented as addressing all of these issues and more. (2,3)

Body Composition and Blood Marker Responses of Subjects at Baseline and Following the Two Low Carbohydrate Diets

Characteristic Baseline CRD-Saturated Fat
CRD-Unsaturated Fat
hs-CRP (mg/dl) 2.7 ± 2.3 1.8 ± 0.9 2.7 ± 1.8
IL-6 (pg/ml) 1.3 ± 1.1 0.9 ± 0.9 1.1 ± 1.2
IL-8 (pg/ml) 1.7 ± 0.6 1.5 ± 0.9 1.9 ± 1.1
TNF-a (pg/ml) 3.8 ± 1.5 3.4 ± 1.4 3.6 ± 1.6
MCP-1 (pg/ml) 251 ± 81 234 ± 94 269 ± 123
8-iso PGF2a (pg/mg creatinine) 629 ± 262 524 ± 146 425 ± 61

Source: Lipids. 2010 October; 45(10): 947–962. (link)

The question I’m most often asked in reference to carbohydrate restricted diets is: Are they really safe? The answer in most instances is ‘yes’. This point of view is increasingly shared by clinicians, as evidenced by the growing number of studies utilizing lower carbohydrate diets in vulnerable populations including pregnant women and young children. The general consensus is that higher protein diets that emphasize low sugar source carbohydrates tend to protect against obesity and the health concerns that accompany the current epidemic of overweight. I’m convinced that this is the trend of the future. If you haven’t already done so, I strongly suggest that you take a look at the number and type of carbs in your own diet. If you’re like most people, you’d do well to reduce the number of total carbohydrates and replace some of them with healthy sources of fat, fiber, low glycemic fruits, non-starchy vegetables and protein. (4,5,6)

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!

JP

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21 Comments & Updates to “Low Carbohydrate Renaissance”

  1. Mark Says:

    I practice a low starch diet, actively eating more fresh veggies and fruits. But I’m confused on potatoes. What’s the difference between a white potato and a sweet potato. Is it a difference in nutrition or fiber? I read a lot of articles about the benefits of sweet potatoes.

  2. Tiffany Says:

    I’m pregnant, and a big advocate of a low carb diet. I’m still overweight, and I’m not sure how low I should go. The doctor and nurses kinda flip out when they find ketones in my urine. My main concern during this time is the health of my unborn child, and me- I can deal with me later. If you have any of these studies regarding pregnancy, I’d love to read them. I have yet to dig up any truly valuable information.

    Thanks for the info – great read.

  3. JP Says:

    Mark,

    There’s a pretty significant difference in terms of their glycemic index, load and nutrient density:

    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2770/2 (potato)

    http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2667/2 (sweet potato)

    Sweet potatoes are clearly superior, IMO. They’re still too high in carbs for some low carbohydrate diets. But they can be enjoyed in moderation by many people.

    Be well!

    JP

  4. JP Says:

    Tiffany,

    I think your judgment is right on the money. Right now, you need to focus on your overall health and the health of your baby to come, IMO. I’d consider focusing on eating a low glycemic, whole food diet that contains a fair share of healthy fats, fiber and protein. Lots of non-starchy vegetables. I would also stay as active as your doctors will allow. Movement helps – not only in relation to weight but also re: insulin sensitivity. A few studies for you:

    http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7835434

    http://www.ajcn.org/content/92/6/1306.abstract

    http://tde.sagepub.com/content/35/6/1004.abstract

    http://jcem.endojournals.org/cgi/content/full/88/8/3554

    http://www.ncbi.nlm.nih.gov/pubmed/9540949

    Be well!

    JP

  5. Tiffany Says:

    Thank you JP –
    I felt like I was doing the right thing, but then yesterday I read a horrible tale of low birth weights and the mother starving her unborn child, but I really don’t think I’m in any danger of that!

    I’ll make my way through the links you posted – THANK YOU!

  6. JP Says:

    Tiffany,

    You’re most welcome! :)

    This is purely anecdotal … My sister-in-law recently gave birth to twin boys. She actually needed to modify her typical diet during the course of her pregnancy due to elevated blood sugar readings. For her, adopting a diet that contained fewer carbohydrates helped her stay well and avoid gestational diabetes. It wasn’t necessarily a low carbohydrate diet. But she did avoid many of the higher GI & GL foods and emphasized better options.

    Be well!

    JP

  7. Tiffany Says:

    JP-
    Perfect – I know I’m at a higher risk for GD. However, I think I’ll be fine, eating low enough to avoid GD, but high enough to avoid ketosis. I really think that’ll be the perfect balance and certainly a lot lower in carbs than the standard American diet. I’ve just been seeking that affirmation that I’m on the right track. Now I’m off to read more on the links.

  8. Bill Says:

    The LA Times article is significant. There is now a critical mass of respected nutritionists and researchers speaking up about the dangers of high-carb diets such that the media is starting to take notice.

    Gary Taubes really got the ball rolling in 2007 with “Good Calories, Bad Calories.” I’ve been allowing 10 years until 2017 before we see public policy revised to reflect reality. In the meantime, there will be many scientists, etc. that made their names by “proving” that fat is the enemy who will fight low-carb to the death.

    The real issue for people going low-carb is what to eat instead of white flour. The correct answer in my mind is to increase the consumption of high-quality fats, and because of the nature of our food supply, that is no easy task.

    As usual, thanks, JP, for sharing this.

    Good luck,

    Bill

  9. Pradip Gharpure Says:

    Though low carb diet has its relevance it is unfair to always that kind of diet. We need to take all sorts of diet and not only low carb diet.

  10. JP Says:

    Thank you, Bill. I tend to agree. But I think it can be done – provided we have resolve and the necessary resources. I’m all about making this dietary shift practical.

    A practical example: I just brought over some gluten-free, low carb cookies to a holiday party. They were well accepted and didn’t have a grain of flour in them. Plenty of healthy fats as well. I’ll add a link to the recipe once it’s posted tomorrow.

    Be well!

    JP

  11. JP Says:

    Pradip,

    I don’t think low carb diets are for everyone. But I do believe that high carb diets that are rich in starch and sugar do not promote health. Any movement away from the latter dietary trend would be a positive development, IMO.

    Be well!

    JP

  12. Bill Says:

    If your body responds to rapid glucose infusions by overproducing insulin, you will be a person who tends to easily put on weight from eating carbs, and you will be in danger of suffering from all the chronic maladies now being associated with chronic high insulin levels.

    If you are one of the unusual people who tolerates a high-carb diet well, I suspect you are a slender high-energy person.

    Good luck,

    Bill

  13. Adriana Says:

    Even when low carbs diet do have excelent results on weight loss, I do have some concerns about high protein diets and the probably kidney failure ( If we think that Obeses have more risk to suffer high blodd pressure).
    Greetings from Venezuela.

  14. JP Says:

    Adriana,

    Please keep in mind that many low-carbohydrate diets are not high in protein. The variety of low-carb eating I advocate is: high in healthy fats, fiber, non-starchy vegetables and select low-glycemic fruits; moderate in protein; and devoid of added sugar, refined carbohydrates and starches.

    I think you might enjoy my three-part interview with Dr. Richard Feinman. In that exchange, he explains away many misconceptions about what healthy low-carb dieting is and is not:

    http://www.healthyfellow.com/588/dr-richard-feinman-interview-part-one/

    http://www.healthyfellow.com/595/dr-richard-feinman-interview-part-two/

    http://www.healthyfellow.com/616/dr-richard-feinman-interview-part-three/

    Be well!

    JP

  15. Iggy Dalrymple Says:

    “Low-carbohydrate diet scores and risk of type 2 diabetes in men”

    Results: We documented 2689 cases of T2D during follow-up. After adjustments for age, smoking, physical activity, coffee intake, alcohol intake, family history of T2D, total energy intake, and body mass index, the score for high animal protein and fat was associated with an increased risk of T2D [top compared with bottom quintile: hazard ratio (HR): 1.37; 95% CI: 1.20, 1.58; P for trend < 0.01]. Adjustment for red and processed meat attenuated this association (HR: 1.11; 95% CI: 0.95, 1.30; P for trend = 0.20). A high score for vegetable protein and fat was not significantly associated with the risk of T2D overall but was inversely associated with T2D in men aged <65 y (HR: 0.78; 95% CI: 0.66, 0.92; P for trend = 0.01, P for interaction = 0.01).

    Conclusions: A score representing a low-carbohydrate diet high in animal protein and fat was positively associated with the risk of T2D in men. Low-carbohydrate diets should obtain protein and fat from foods other than red and processed meat.
    http://www.ajcn.org/content/early/2011/02/09/ajcn.110.004333.abstract?papetoc

  16. JP Says:

    Thanks for posting that, Iggy. I’d like to see the full text of the study to get a better handle on what they considered “low carbohydrate diets”.

    Be well!

    JP

  17. JP Says:

    Updated 07/20/15:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494562/

    Cureus. 2015 Feb 27;7(2):e251.

    The Efficacy of Ketogenic Diet and Associated Hypoglycemia as an Adjuvant Therapy for High-Grade Gliomas: A Review of the Literature.

    BACKGROUND: A high-fat, low-carbohydrate diet, often referred to as a ketogenic diet (KD), has been suggested to reduce frequency and severity of chronic pediatric and adult seizures. A hypoglycemic state, perpetuated by administration of a KD, has been hypothesized as a potential aid to the current standard treatments of high-grade gliomas.

    METHODS: To understand the effectiveness of the ketogenic diet as a therapy for malignant gliomas, studies analyzing components of a KD were reviewed. Both preclinical and clinical studies were included. The keywords “ketogenic diet, GBM, malignant glioma, hyperglycemia, hypoglycemia” were utilized to search for both abstracts and full articles in English. Overall, 39 articles were found and included in this review.

    RESULTS: Studies in animal models showed that a KD is able to control tumor growth and increase overall survival. Other pre-clinical studies have suggested that a KD sustains an environment in which tumors respond better to standard treatments, such as chemoradiation. In human cohorts, the KD was well tolerated. Quality of life was improved, compared to a standard, non-calorie or carbohydrate restricted diet. Hyperglycemia was independently associated with diminished survival.

    CONCLUSION: Recent clinical findings have demonstrated that induced hypoglycemia and ketogenic diet are tolerable and can potentially be an adjuvant to standard treatments, such as surgery and chemoradiation. Other findings have advocated for KD as a malignant cell growth inhibitor, and indicate that further studies analyzing larger cohorts of GBM patients treated with a KD are needed to determine the breadth of impact a KD can have on GBM treatment.

    Be well!

    JP

  18. JP Says:

    Updated 07/20/15:

    http://ajcn.nutrition.org/content/early/2015/07/15/ajcn.115.109116.abstract

    Am J Clin Nutr. 2015 Jul 15.

    Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial.

    BACKGROUND: Heart associations recommend limited intake of saturated fat. However, effects of saturated fat on low-density lipoprotein (LDL)-cholesterol concentrations and cardiovascular disease risk might depend on nutrients and specific saturated fatty acids (SFAs) in food.

    OBJECTIVE: We explored the effects of cheese and meat as sources of SFAs or isocaloric replacement with carbohydrates on blood lipids, lipoproteins, and fecal excretion of fat and bile acids.

    DESIGN: The study was a randomized, crossover, open-label intervention in 14 overweight postmenopausal women. Three full-diet periods of 2-wk duration were provided separated by 2-wk washout periods. The isocaloric diets were as follows: 1) a high-cheese (96-120-g) intervention [i.e., intervention containing cheese (CHEESE)], 2) a macronutrient-matched nondairy, high-meat control [i.e., nondairy control with a high content of high-fat processed and unprocessed meat in amounts matching the saturated fat content from cheese in the intervention containing cheese (MEAT)], and 3) a nondairy, low-fat, high-carbohydrate control (i.e., nondairy low-fat control in which the energy from cheese fat and protein was isocalorically replaced by carbohydrates and lean meat (CARB).

    RESULTS: The CHEESE diet caused a 5% higher high-density lipoprotein (HDL)-cholesterol concentration (P = 0.012), an 8% higher apo A-I concentration (P < 0.001), and a 5% lower apoB:apo A-I ratio (P = 0.008) than with the CARB diet. Also, the MEAT diet caused an 8% higher HDL-cholesterol concentration (P < 0.001) and a 4% higher apo A-I concentration (P = 0.033) than with the CARB diet. Total cholesterol, LDL cholesterol, apoB, and triacylglycerol were similar with the 3 diets. Fecal fat excretion was 1.8 and 0.9 g higher with the CHEESE diet than with CARB and MEAT diets (P < 0.001 and P = 0.004, respectively) and 0.9 g higher with the MEAT diet than with the CARB diet (P = 0.005). CHEESE and MEAT diets caused higher fecal bile acid excretion than did the CARB diet (P < 0.05 and P = 0.006, respectively). The dominant type of bile acids excreted differed between CHEESE and MEAT diets.

    CONCLUSIONS: Diets with cheese and meat as primary sources of SFAs cause higher HDL cholesterol and apo A-I and, therefore, appear to be less atherogenic than is a low-fat, high-carbohydrate diet. Also, our findings confirm that cheese increases fecal fat excretion.

    Be well!

    JP

  19. JP Says:

    Updated 07/20/15:

    http://www.jdcjournal.com/article/S1056-8727%2815%2900227-5/abstract

    J Diabetes Complications. 2015 Jun 9.

    Effects of a high-protein/low carbohydrate versus a standard hypocaloric diet on adipocytokine levels and insulin resistance in obese patients along 9months.

    OBJECTIVE: Recent dietary trials and observational studies have focused on the effects of diet on health outcomes such as improvement in levels of surrogate biomarkers. The aim of our study was to examine the changes in weight, adipocytokines levels and insulin resistance after a high-protein/low carbohydrate hypocaloric diet vs. a standard hypocaloric diet during an intervention of 9months.

    SUBJECTS AND METHODS: 331 obese subjects were randomly allocated to one of two diets for a period of 9months. Diet HP (n=168) (high-protein hypocaloric diet) consisted in a diet of 1050cal/day, 33% of carbohydrates, 33% of fats and 34% of proteins. Diet S (n=163) (standard protein hypocaloric diet) consisted in a diet of 1093cal/day, 53% carbohydrates, 27%fats, and 20% proteins.

    RESULTS: With the diets HP and S, BMI, weight, fat mass, waist circumference, waist-to-hip ratio, systolic blood pressure, total cholesterol, LDL-cholesterol, insulin and HOMA decreased. The decrease at 9months of (BMI: -2.6±1.3kg/m2 vs. -2.1±1.2kg/m2:p<0.05), weight (-8.4±4.2kg vs. -5.0±4.1kg: p<0.05), fat mass (-5.1±4.1kg vs. -3.4±4.2kg: p<0.05), systolic blood pressure (-5.1±7.1mmHg vs. -3.1±2.1mmHg: p<0.05), (insulin levels -4.0±4.8 UI/L vs. -2.2±2.4 UI/L; p<0.05) and HOMA (-0.8±1.0 units vs. -0.3±1.0 units; p<0.05) was higher in diet HP than Diet S. With both diets, leptin levels decreased.

    CONCLUSION: A high-protein/low carbohydrate hypocaloric diet shows a higher weight loss, insulin and HOMA-R decreased after 9months than a standard hypocaloric diet. The improvement in adipokine levels was similar with both diets.

    Be well!

    JP

  20. JP Says:

    Updated 07/20/15:

    http://ajcn.nutrition.org/content/early/2015/06/24/ajcn.114.103846.abstract

    Am J Clin Nutr. 2015 Jun 24.

    High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative.

    BACKGROUND: The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load.

    OBJECTIVE: We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression.

    DESIGN: This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women’s Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954).

    RESULTS: We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth vs. first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth vs. first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression.

    CONCLUSIONS: The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women.

    Be well!

    JP

  21. JP Says:

    Updated 07/20/15:

    http://link.springer.com/article/10.1007/s40292-015-0096-1/fulltext.html

    High Blood Press Cardiovasc Prev. 2015 May 19.

    Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study.

    INTRODUCTION: Obesity is a constantly growing illness in developed countries and it is strictly related to cardiovascular (CV) diseases, i.e. the main cause of mortality throughout industralised areas.

    AIM: To test the ability of trained general physician to safely and effectively prescribe a very-low carbohydrate ketogenic (VLCK) diet in clinical practice, with a specific attention to the effect of this approach on overweight related CV risk factors (anthropometric measures) blood pressure, lipid levels, glucose metabolism).

    METHODS: The study has been carried out on a group of 377 patients scattered across Italy and monitored during 1 year. The proposed VLCK diet is a nutritional regimen characterized by low-fat and low- carbohydrates formulations and a protein content of 1.2/1.5 g/kg of ideal body weight, followed by a period of slow re-insertion and alimentary re-education.

    RESULTS: All the predetermined goals-namely safety, reduction of body weight and CV risk factors levels-have been reached with a significant reduction of body weight (from baseline to 4 weeks (-7 ± 5 kg, p < 0.001), from 4 to 12 weeks (-5 ± 3 kg, p < 0.001), no changes from 12 weeks to 12 months; waistline (from baseline to 4 weeks (-7 ± 4 cm, p < 0.001), from 4 to 12 weeks (-5 ± 7 cm, p < 0.001), no changes from 12 weeks to 12 months; fatty mass (from baseline to 4 weeks (-3.8 ± 3.8 %, p < 0.001), from 4 to 12 weeks (-3.4 ± 3.5 %, p < 0.001), no changes from 12 weeks to 12 months; SBP from baseline to 3 months (-10.5 ± 6.4 mmHg, p < 0.001), no further changes after 1 year of observation).

    CONCLUSION: The tested VLCD diet suggested by trained general physicians in the setting of clinical practice seems to be able to significantly improve on the middle-term a number of anthropometric, haemodynamic and laboratory with an overall good tolerability.

    Be well!

    JP

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