Living Low Carb
Controlled-Carbohydrate Eating for Long-Term W eight Loss
Jonny Bo wden, P HD, CNS For ewor d by Barr y Sears, PhD, author of The Zone
STERLING and the distinctive Sterling logo are registered trademarks of Sterling Publishing Co., Inc. © 2010 by Jo nny Bowden All ri ghts reser ved. No part of this publicat ion may be r eproduced, st or ed in a r etrieval syst em, or transmit ted, in any for m or by any mea ns, electro nic, mech anical, ph otocopying, r ecor ding, or otherwise, w ithout prio r written permi ssion fr om the publisher. ISBN 978-1-4027-6825-5 (paperback) ISBN 978-1-4027-7683-0 ( eboo k) Library of Congress Cataloging-in-Publ ication Data
Bowden, Jonny. Living lo w Bowden carb : controll ed-carbohydrate eating fo r l ong-term weight loss / Jo nny ; for ewor d by Barr y Sears. p. cm. Includes biblio gr aphical r eferences and index . ISBN 978-1-4027-6825-5 (pb-wit h flaps : alk. paper) 1. Low-car bohydr ate diet. I. Title. RM237.73.B688 2009 613.2'83—dc22 2009019435 For infor mation abo ut custom edit ions, special sales, and premium and corporate purchases, please contact Sterling Special Sales at 800-805-5489 or specialsales@sterlingpublishing. com. Manufactured in the United States o f Amer ica
6 8 10 9 7 5 www.sterlingpublishing.com
Contents
Foreword by Barry Sears, PhD cknowledgments Introduction Chapter 1: The History and Origins of Low-Carb Diets Chapter 2: Why Low-Carb Diets Work Chapter 3: Fat, Cholesterol, and Health: Have We Been Misled? Chapter 4: So Why Isn’t Everyone on a Low-Carb Diet? (OR Why Your
Doctor Doesn’t Know about This Stuff) Chapter 5: Is There Such a Thing as t he “Metabolic Advantage” of Low-
Carb Diets? Chapter 6: The Biggest Myt hs About Low-Carb Diets Chapter 7: Thirty-Eight (M ostly) Low-Carb Diets and What They Can Do
For You 1. The Atkins Diet —Rober t Atkins, MD 2. The All-New Atkins Advantage—Stuart Trager, MD and Colette Heimowitz, M.Sc 3. The Biggest Loser—Maggie Greenwoo d-Robinson, PhD, et al. 4. The Carbohydrate Addict’s Diet—Rachael Heller, MA, M.Ph, PhD, and Richard Heller, MS, PhD 5. The 7-Day Low-Carb Rescue and Recovery Plan—Rachael Heller, MA, M.Ph, PhD, and Richard Heller, MS, PhD 6. Curves—Gar y Heavin and Carol Colman 7. Fat to Skinny (Fast and Easy) —Doug Varrieur
8. The Diabetes Diet—Richard K. Bernstein, MD 9. Dr. Gott’s No Flour, No Sugar Diet—Peter H. Gott, MD 10. Eat, Drink, and Weigh Less—Walter Willett, MD and Mollie Katzen 11. The Fat Flush Plan—Ann Louise Gittleman, MS, CNS 12. The Fat Resistance Diet —Leo Galland, MD 13. Dukan Diet—Pierre Dukan, MD 14. The Hamptons Diet—Fred Pescatore, MD 15. The Low GI Diet Revolution—Jennie Br and-Miller, MD, et al. 16. The Lindora Program: Lean for Life—Cynthia Stamper Graff 17. The Maker’s Diet and Perfect Weight—Jordan S. Rubin 18. Neanderthin—Ray Audette 19. The Paleo Diet—Lor en Cor dain, PhD 20. Protein Power—Michael R. Eades, MD and Mary Dan Eades, MD 21. The Rosedale Diet—Ron Rosedale, MD and Carol Colman 22. MD The 6-Week Cure the Middle-Aged Middle—Michael R. Eades, and Mary Danfor Eades, MD 23. The Scarsdale Diet —Herman Tarnower, MD 24. The Schwarzbein Principle —Diana Schwarzbein, MD and Nancy Deville 25. Unleash Your Thin—Jonny Bowden, PhD, CNS 26. The South Beach Diet—Arthur Agatston, MD 27. South Beach Recharged—Arthur Agatston, MD with Joseph Signorile, PhD 28. Sugar Busters!—H. Leighton Steward, et al. 29. The TNT Diet—Jeff Volek, PhD, RD, and Adam Campbell, MS 30. The Ultrasimple Diet—Mark Hyman, MD
31. Women’sHealth Perfect Body Diet—Cassandra For sythe, MS 32. YOU: On a Diet—Mehmet C. Oz, MD and Michael F. Roizen, MD 33. The Zone—Barry Sears, PhD Fitness Books—Short Takes 34. Making the Cut by Jilli an Michaels 35. The 5-Factor Diet by Harley Pasternak 36. The 3-Hour Diet by Jorg e Cruise 37. Deadline Fitness by Gina Lombardi 38. The Ultimate New York Diet by David Kir sch Chapter 8: My Big Fat Diet:The Town That Lost 1200 Pounds! Chapter 9: Supplements and Diet Drugs hapter 10: Frequently Asked Questions hapter 11: Tricks of the Trade: The Top 50+ Tips for Making Low-Carb
Work for You hapter 12: What We’ve Learned about Controlled-Carbohydrate Eating:
Putting Together Your Program Resources and Support for a Low-Carb Lifestyle Endnotes
For Anja who gives me wings
Foreword There are three things in life that induce powerful visceral responses: religion, politics, and nutrition. Each is based on assumptions, and the adherents of each want to believe in their hearts that they are right; and of course they refuse to be confused by the facts. In the world of nutrition, nothing has generated as much heartburn as lower-carbohydrate diets. To the nutritio n establishment, they are the equivalent of devil wor ship. To the medical establishment, they will cause massive increases in chronic disease and death. But to the millions of people who have used them, they seem to work. Obviously, there appears to be a disconnect between reality and fantasy. Are l ower -car bohydr ate diets actually safe? And what really is a lowercarbohydrate diet? Is a lower-carbohydrate diet the same as a highfat or high-protein diet? Are there any magical supplements that can make you lose excess body fat? Into this quagmire of controversy steps Jonny Bowden. I first met Jonny nearly thirteen years ago. I had just written my first book, The Zone, and I was speaking about it in New Yor k City. At the time, Jonny was a very well-recognized nutritionist working with a wide variety of clients ranging from those seeking weight loss to fitness enthusiasts. Like any typical New Yor ker, he was skeptical o f anything new, especiall y when it concer ned diets. His skepticism was on particularly high alert since my boo k not only recomm ended lo wer-car bohydrate d iets for patients with diabetes and heart disease, but also fo r world-class athletes. After all, he had been t raining athlet es for years using high-carbohydrate diets, and here was some po inty-head scientist telling hi m that all o f his nutritional advice for athletes was wrong . Needless to say, he was ready to rake me over the coals. That is, until he heard my lecture. For the first time, he was intro duced to the nuan ces of hor monal co ntrol theor y using foo d as a drug. A lthough t here was a lot of endocr inolo gy (the scien ce of hor mones) being thro wn around in the lec ture, there were enough key points thatfor Jonny had to take notice. After lecture, he(probably asked if we coul d talk. And the next two hours, I went intothe more detail more than he ever wanted to know) o n the intricate dance of hor mones that are
contr olled by the diet. Jonny then asked me, “If you ar e right about this, then everyone in nutri tion is pr obably wr ong .” My reply was “Yes.” While Jonny was intrigued, he still remained skeptical. Jonny was also trained as an academic with a background in psychology and statistics, which guaranteed that any references I gave him on lower-carbohydrate diets (there wasn’t much) as well as the science behind them (of which there was a lot) would be r ead and analyzed to the nth degr ee. As a result, he has not only become exceptionally adept nutritional science behind lower-carbohydrate diets, but he has on alsothe become my friend. It’s been many years since that fir st meeting with Jonny. The sci ence dealing wit h the molecular biolo gy o f obesity ha s become mor e complex, but the basic concept remains: if you lower the carbohydrate content of the diet, you get better weight loss and better health. The trick is doing it for a lifetime. I have always considered Jonny to be one of the better science writers I have ever met. That’s why this book is so important for the general public. He lays out the history of lower-carbohydrate diets, explaining in clear and concise language th e underl ying hor monal pr inciples of such diet s, and addresses the common misunderstandings of such diets, all in an entertaining and lively style. As Jonny cor rectly points out , there is no one cor rect diet for everyone, since we are all genetically different. However, the hormonal principles are unvarying fo r choosing an appro priate diet for your g enetics. Once you understan d the hormo nal r ules that gover n lo wer-car bohydrate diet s, you are i n a position to become th e master of yo ur future. This b oo k should be considered the starting point of that journey. —Barry Sears, PhD Author of The Zone March 2009
Acknowledgments Two sets o f thanks here. First … to my personal “br ain trust” who g ave so gener ously of their time. If this book is good, it’s largely because of their stunning knowledge base. Stacey J Bell, PhD, Suzanne Bennett, DC, C. Leigh Broadhurst, PhD, Colette Heimo witz, MSc, Mary Enig, PhD, Joseph Evans, PhD, Oz G arcia, PhD, John Hernandez, MD, Malcolm Kendrick, MD, Ann Louise Gittleman, PhD, CNS, Mark Houston, MD, MS, Susan Lark, MD, David Leonardi, MD, Shari Lieberman, PhD, CNS, Linda Lizotte, RD, Lyle McDonald, Joe Mercola, DO, Liz Nepor ent, MS, Harr y Preuss, MD, Uffe Rasvnskov, MD, PhD, Donald S Robertson, MD, MSc, Ron Rosedale, MD, Alan Schwartz, MD, Diana Schwarzbein, MD, Barry Sears, PhD, Stephen Sinatra, MD, Allan Spreen, MD, Anton Steiner, MD, Jeff S Volek, PhD, RD Very Special Thanks:
• To Dr. Anton Steiner for sharing his wealth of kno wledge about the neurochemistry of pharmaceuticals and his invaluable help with the section on weight loss medications • To my dear fr iend Dr. Dave Leonardi, who pu t up with my endless medical questions at all hours of the day and night and served as my personal Merck Manual of Diabetes • To the brilli ant Dr. C. Leigh Bro adhurst, a walking encylopedia of biochemistry and nutrition, who generously read and tweaked entire sections • To Dr. Mary Enig, for m aking sur e I knew my fats • To Dr. Mary Vernon, a gr eat pioneer and genero us dispenser of knowledge and compassion who is a living example of “speaking truth to power”
• To Dr. Jay Wor tman, whose terrific wor k served as the basis for the “Big Fat Diet” chapter and who generously contributed to this book • To Dr. Jeff Volek, who is always ready with an answ er and respo nse to even the most inane questions, and whose meticulous research contributes so much to all of us concerned with diet and health • To Dr. Eric Westman, a gr eat resear cher and wonder ful human being • To Dr. Eric Kosso ff, who was kind enough to detail his pioneeri ng work in using the ketog enic diet with childr en and to patiently answer all my questions • To Dr. Larr y McCleary, my “go-to” neurosur geon whose generosity and availability is matched only by his stunning i ntellect and encyclopedic knowledge • To Drs . Michael and Mary Dan Eades, who co ntinue to dazzle m e with their brilliance as well as their generosity and patience and whom I am blessed to say I can always count o n And a really special “general principles” thanks to Robert Crayhon, MS and Jeffrey Bland, PhD, who have spent their professional lives making a difference by educating physicians, nutritionists, chiropractors and other health practitioners, challenging their boundaries and expanding their horizons. They certainly did mine.
And second… to my family—chosen and otherwise—the special people in my lif e without whom I might have still wr itten boo ks, but without whom I would not be who I am: Aleta St. James, A. Waxman, Allegra Bowden, Anja Christy, Ann Knight, Cadence Bowden, Cassandra Cr eech, Christo pher Duncan, Danny Tro ob, Elli ott Bowden, Emily Chr isty Bowden, Glen Depke, Jeanine Tesor i, JeffrLiz ey Bowden, Kimber ly Wrig ht, Lauree Dash, Lee Knapp, Neporent,Kelly LynnWixted, Pentz, Max Creech-Bowden, Molly Fox, Nancy Fiedler, Oli ver and Jennifer, Oz Gar cia, Pace Bowden, Peter
Breg er, Randy Graff, Richar d Lewis, Scott Ellis, Sky L ondo n, Susan Woo d Duncan, Tiger lily Creech-Bowden, Vivienne Bowden, Woo dstock Bowden As always, to Howard, Robin, Fred, Gary and Artie for putting a smile on my face ev ery day for nearly four teen years. To Werner Erhard—wh erever you ar e, I love you and can ne ver begi n to r epay you fo r what you’ve contribute d to my life. To the writers who taught me everything I know about writing, especially William Goldman (who could make the tax code interesting), and Robert Sapolsky, the greatest living science writer in America. And a warm thanks to my fir st agent, Linda Konner, who put me o n the map. And to my curr ent (and future) agent, Colleen O’ Shea, who keeps me there. And to the fir st editor of this boo k, Susan Lauzau, who had the patience to allow me to rant and rave about every comma change, most of which she was ri ght about anyway And to the editor of the new expanded edition, Kate Zimm ermann—ditto! And especially to Michael Fragnito, who had the vision to imagine this book, the editorial skills to shape it, and an unfettered belief in me that allowed me to do the best work I’ve ever done And to the superstar of publicists, who does more on an off-day than most people do on their best, Heidi Krupp of Krupp Kommunications, and her entire staff, especially Chris Capra Also to the suppor t team at Barnes and Noble, especially Lindsay Herman And to m y mo ther, Vivienne Simo n Bowden. And… a very special thanks to Dr. Ann Knight … who knows why.
Introduction Sometimes the universe does, indeed, work in mysterious ways. As I was putting the finishing touches on the new revised edition o f Living Low Carb, the following e-mail arrived in my inbox. As I read it, I realized that nt there was noalong better waymy to answer. write an intro to this new edition than to r epri the letter with Here’s the letter:
Dear Jonny, I recently purchased Living the Low Carb Life (2005) and am a bit confused. Have you moved away or revised your thinking about low carbs since writing it? There doesn’t seem to be a huge emphasis on lowcarbs on your Web site ( http://www.jonnybowden.com) and some of the recipes in your subsequent books seem to be “at variance” with the “low-carb” theory. of the infoit,in some your book supports low-carb writing eating, but, unless I’mMost misreading of your subsequent seems to contradict that. Your 150 Healthiest Foods on Earth has plenty of fruits and even a few grains, and your Healthiest Meals on Earth book contains recipes that have foods like oats and berries in them. What’s the poor consumer to make of all this—especially when something as important as health is at stake? Sincerely, Doug Those are great questions. And I can think of no better way to introduce the thir d edition o f this boo k than to answer them. So here goes. I have not moved away from my thinking about low-carb since writing the srcinal book in 2004, but I have broadened my perspective. I think one of the biggest problems with the “low-carb movement” was
that it led p eople to treat “low-carb” as something of a religio n. Folks became more focused on carb content and less focused on the importance of g oo d food. And many people for go t about the overar ching, important message of control led-carb eat ing—control ling bloo d sugar and ea ting whole fo ods—and instead replaced that message with a simple (and inaccurate) so und bite: “carbs are bad.” That’s not the valuable message of controlled-carb eating. For oneofthing, it led to th e increasingly idea among some I members the low-carb community that commo “As longn as it has no carbs, can eat it” and to an explosion of junk-food products that had the carbs engineered out of them, but were still junk food nonetheless (echoes of the low-fat movement of the ’80s—remember Snackwell cookies?). It also led to the mistaken notion that as long as your carb intake was low, you would always lo se weight and be healthy . I think a mor e “twenty-first centu ry” co ntro lled-carb appro ach requires mor e nuance. And I think an enlig htened low-carb philo sophy—which is what I hope this boo k presents—needs to cr eate, as they say in po litics, “a bigger tent.” Let me explain. In America, we have long had a huge debate about guns. M any people like me have n o par ticular personal interest in—or use fo r—g uns; many of us have nev er handled a gun in our lives; and man y of us will pr obably live out our lives without ever going hunting. However, that being said, many Americans do not feel that way. And they are not bad people. For those of us who feel as I do to attack gun owner s as if they were the devil’s spawn not only alienates them and cr eates an “us ver sus them” mentality, but also accomplishes absolutely nothing. So, although I personally don’t like guns, I recog nize that not all g un owners are mass murderer s, that not all hunters are “bad people,” and that many people feel differently about their g uns. Far better, it seems t o me, to find the things we—non-g un owners and gun owne rs alike—ca n agr ee on. So I would prefer to unite with my gun-owning friends around the principle of making sure guns are used responsibly, that they don’t fall into the hands of psychopaths and distu rbed people, and tha t we get r id of the worst of them—like assault weapons—for which there is no good need anywhere in civilized society. That seems to me to be a more responsible
position that people acro ss a spectrum of beliefs and feelings about guns can get behind. In the same way, I think it’s foo lhar dy to assume that no o ne should ever eat carbs and that they’re across- the-boar d “bad.” Rather, I think that carbs should be eaten respo nsibly. I think it’s go od that we arm oursel ves with the knowledge of what they can do to our blood sugar and weight and their potential for damage—particularly in the “wrong hands” (e.g., those who are carb-sensitive). And I think we should fight morvery e to rinsulin-resistant id our diet of theorwor st of them—high-fructose corn syr up, processed cereals, and the like—rather than to try to “eliminate” all of them. I’ve also co me to feel that the quality of o ur fo od is just as imp or tant as which category of macronutrient it falls into. A high-protein, high-fat diet in which all th e pro tein comes fr om bo log na and all the fat comes fr om trans-fat s and fried foo ds is far mor e damaging than a h igh-carb diet in which all the carbs co me fr om vegetables. That quality distinction tends to get lo st in the arguments about “car bs” versus “pr otein.” I believe that a better—and far more useful—distinction would be between “whole food” and “junk foo d,” regar dless of which side of the macronutrient diet distri bution i t falls o n. When I wrote my later books, The 150 Healthiest Foods on Earth and The Healthiest Meals on Earth, there wasn’t a conscio us attempt to eliminate carbs o r to do exclusively low-carb r ecipes, but there was a conscious attempt to eliminate junk and sugar (except in a couple of cases where a small amount of sweetener was absolutely essential to the recipe). And there was a definite attempt to put all this in context, the context being this: we should all strive f or a diet high in healthful whole foods with a minimum of processing, a maximum of nutrients, and an elimination of trans-fats. As it happens, such a diet mimics that of our Paleolithic ancestors and is naturally low in car bs, or at least significantly lower than the averag e Western diet. And that’s the diet I support wholeheartedly—one that stresses foods f ro m what I call the Jonny Bow den Four Foo d Gr oups— foo ds you could have hunted , fished , gathered, or plucked . As I point out in this edition, it’s possible to achieve this kind of wholefood diet with a pretty wide range of carb intake. For some people,
the “induction” phase of Atkins—which is pr etty rigor ous—is the way to go , but others can easily consume five or mor e times that amount of carbohydrates and still be robustly healthy depending on many factors (activity level, metabolism , insulin sensitivity, weight issues, sex, ag e, etc.). Even our hunter-gatherer for efathers managed quite n icely on an assor tment of diet s that ranged fr om ver y low-carb to moder ately highcarb. What they did not manage on were diets that were high in sugar. So yes, my non-par emphasis hasphiloso shifted phy: from“don’t “don’teat eatjunk.” carbs”Sadly, to a more inclusio nary, tisan those statements are often the same thing —but not always. I still believe that the cornerstones of a healthful diet remain quality pro tein; a mix of fats; fiber (fro m vegetables and nuts); seeds; berr ies; and low-sugar fruit—all wrappe d together in a package o f modest calori es (this last component is another critical element of a healthful diet that tended to get lost in all the shouting over “low-carb” versus “high-carb”). I still believe that grains are optional in the diet, and that some grains—like oats—ar e better than o thers. And I believe—as I always have—t hat people are metabolically and h or monally and biolog ically uniq ue and respond differently to different eating strategies. And most of all, I believe that the most important thing to “fight” for is the elimination fro m o ur diet of the food equivalen t of “weapons o f mass destruction”—su gar, high-fr uctose co rn syrup, and processed junk carbs. Everything else is details! So where do we stand now? In the above paragraphs, I talked about eating carbs responsibly and about r especting what they can do to our bodies. Even the fact that we now talk about such things shows how far we’ve come since our wholehearted —and uncritical—embrace of hig h-car b dieting some forty years ago. Let’s recap.
The Biggest Nutritional Experiment in History The high-carbohydrate, low-fat diet has been the longest uncontrolled nutritional experiment in history. The r esults have not bee n go od.
Perhaps you’ve noticed. Perhaps yo u have been one of i ts victims. You’r e unable to lo se weight —or, if you have lost, it certainly hasn’t been easy. You found your self constantly fighting cravings, you were hungry a lot of the time, and you suffered with feelings of deprivation. You felt fatigued, like you were running o n empty, and were still always battling the bulge, mostly unsuccessfully. Maybe, likeisa dr loty,ofyour low-fat, dieters, you’ve that your hair nailshigh-carbohydrate brittle, y our energy lo w, and yournoticed vitality sapped. And guess what? For all that, the weight still doesn’t c ome o ff— or, if it does, it comes back on with a vengeance and you’re right back where you started, except this time you feel even more discouraged. Or maybe you’re lucky enough to have never been on this delightful seesaw that I’m descr ibing . Maybe you’r e just curi ous abo ut all the fuss that’s being made over low-carb diets and you want to learn more about how they wor k. Maybe you’r e thinking that you co uld stand to kno ck off a few pounds and are i nterested in low-car b dieting but don’t know w here to start. Or maybe you’re already convinced t hat low-carb diets are fo r you but are concerned about some of the health implications that well-meaning people have warned you about. Well, you’ve come to the right place. Living Low Carb will help you understand three things: 1. What low-carb diets actually do to and for your body, and how they do it 2. Why some prog rams work for some people (and don’t for others) 3. How you can adapt what you disco ver in this boo k to your o wn lifestyle While I’d love to think that everyone who reads this book will devour it fro m cover to cover for its scintillating co ntent and wealth of i nfor mation, realistically I know that, with the possible exception of my girlfriend and my mo ther, few people will actually appro ach it that way. So I have designed Living Low Carb to be used l ike the I Ching: open it anywhere, and it will—hopefully—give you information you want. I imagine that some of you will be interested in understanding more
about the differ ent popular diet plans, how they wor k, how they differ from one another, and what they offer. You guys should go straight for chapter 7, “Thir ty-Eight (Mostly) Low-Carb Diets and What They Can Do for You,” find the plan or plans you are interested in, and read about them. You may find that reading further will spark some questions, which you’re likely to get answered in chapter 10, “Frequently Asked Questions.” Maybe, as you dig deeper into the book, you’ll find yourself wanting to know more aboutloss; the hormonal mechanisms in the body that weight gain and weight you will find those issues addressed in drive chapter 2, “Why Low-Carb Diets Work.” Some of you may have already been on one of the plans discussed in chapter 7 but want mor e in-depth infor mation abo ut the questions, concerns, and cont ro versies you have been hearing about—for example, cholesterol o r ketosis o r bone loss o r kidney pro blems. You mig ht head straight for chapter 6, “The Biggest Myths about Low-Carb Diets.” When you get those concerns addressed, you may want to go back to chapter 2, “Why Low-Carb Diets Wor k,” to r ead mor e about the science beh ind lo wcarb eating and how it actually does its good work in the body. The permutations are endless. I also expect that there will be some dyed-in-the-wool low-carbers who have already experienced myriad health benefits, including weight loss, and simply want some tips for staying motivated, not getting bored, finding new things to eat, or breaking plateaus. All that information will be found in chapter 10, “Frequently Asked Questions,” and chapter 11, “Tricks of the Trade: The Top 50+ Tips for Making Low-Carb Work for You.” Because I have designed this book to be extremely user-friendly and because I want you to be able to skip ar ound as yo u like, som e of the information and issues will be discussed in more than one place. For example, the subject of ketosis, which used to be so central to the Atkins diet and has been such a focus of criticism from the establishment (and which has caused such misunder standing in the media), is discussed in three places. You will get a brief overview of ketosis in chapter 2, “Why Low-Carb Diets Wor k”; but a much mor e in-depth discussion, which answers the criticisms leveled at ketogenic diets, appears in chapter 6, “The Big gest Myths abo ut Low-Carb Diets.” You will al so find an
abbreviat ed discussion of ketosis in chapter 10, “Fr equently Asked Questions,” since ketosis is definitely one of the topics about which I get the most questions when it comes to low-carb dieting. Here’s a brief guide to what you will find in Living Low Carb.
Chapter 1: The History and Origins of Low-Carb Diets Guess what? Low-carb dieting did not begin with Atkins! Low-carb diets actually date back to 1864, when William Banting wrote his famous Letter on Corpulence (in essence, the very first commercial low-carb diet). But Banting’s diet wasn’t known as a “low-carb” plan; in fact, there was no such label until the USDA decreed, in its 1992 Food Guide Pyramid, that the perfect healthful diet for Americans includes six to eleven servings of grains and starches per day. From that time on, any program that disagreed with this extremely elevated high-carb orthodoxy of the dietary establishment was by definition disparaged as “low-carb.” This chapter covers the breadth and evolution of low-carb diets over the decades, including the disco very in 1940 by Dr. Alfred Pennington that some individuals simply cannot metabolize carbohydrates as efficiently as other people do; Dr. Herman Taller’s Calories Don’t Count (the highpro tein r eaction to the fashionable mania for counting calo ries); Dr. Irwin Stillman’s The Doctor’s Quick Weight Loss Diet ; and, of cour se, the intro duction in 1966 of the CEO of all low-carb plans, the A tkins diet. Told against the background of “mainstream” nutrition, the chapter also considers the ph iloso phy of the ü ber-dean of high-car b pro selytizers, Nathan Pritikin, and his heir apparent, Dean Or nish. I hope you’ll also begin to get a sense of why stances on nutrition can be so political. I also hope this chapter will help you gain a better understanding of where the lines in the sand are curr ently dr awn r egar ding theories of weight loss and healthful diet.
Chapter 2: Why Low-Carb Diets Work Low-carb diets are based on the fact that food has a profound effect on hormones—including the fat-storage and fat-release hormones. The hormone that gets the lion’s share of attention, with good reason, is insulin, but there ar e other s that come i nto play. The fo undation of the lowcarbohydrate movement has been the theory that controlling these
hormones with your food choices is at least as important for weight loss as calories are (the establishment continues to insist that “it’s the calories, stupid”). This chapter discusses: • How insulin oper ates and why regulating it is central to the theor y behind all low-carb diets • Contro lling bloo d sugar • Insulin resistance • The ro le of insulin in heart d isease and why a low-car bohydr ate diet can reduce your risks • Hypertension (high bloo d pressur e) and how it can be reduced with low-carbohydrate eating • Obesity and how low-car bohydr ate diets can help • Type 2 diabetes and low-carbo hydrate diets
Chapter 3: Fat, Cholesterol, and Health: Have We Been Misled? We all know about the fat that lives on our hips, butt, and thighs, but many of us remain confused about the nature of fat in our diet (and are particularly confused about the relationship of dietary fat to the fat around our middle). Since one of the biggest arguments against low-carb diets made by traditional and conventional dietitians and physicians centers around fear of fat, understanding exactly what fat is and what it does (and what it doesn’t do) is critical to understanding why low-carb diets are nothing to be afraid of. I’ve added this primer on fat and cholesterol to this edition o f Living Low Carb to arm you with knowledge about this terribly misunderstood component of the human diet and to hopefully get you to reco nsider so me o f the prevailing myths about fat , choleste rol, and health .
Chapter 4: So Why Isn’t Everyone on a Low-Carb diet? (OR Why Your Doctor Doesn’t Know about This Stuff ) If low-carb diets are so great, you might well ask, why isn’t everyone on them? Why does my doctor still warn me about them? Why do I still keep hearing how “unhealthfly” they are? There are many, many reasons why low-carb diets haven’t reached a
critical mass of acceptance in the general population, let alone in the medical and nutritional establishment (though huge progress has been made). This chapter briefly considers some of the many reasons why so many people continue to be misled or uninformed about what low-carb diets are (and aren’t). This includes, sadly, most doctors in America.
Chapter 5: Is There Such a Thing as the “Metabolicn Advantage” of Low-Carb Diets? The so -called “metaboli c advantage” i s the idea that you may be able to eat slightly more calories on a low-carb diet and still lose weight. It’s one of the most discussed (and controversial) concepts in carb-restricted dieting. It’s also highly misunderstood. This chapter tells you exactly what the metabolic advantage really means, what the science shows, and how to use it to your own personal advantage when it comes to losing weight!
Chapter 6: The Biggest Myths about Low-Carb Diets There are a lot of common beliefs about the dangers of high-protein or high-fat diets. Does a high-protein diet cause osteoporosis? How about damage to the kidneys? Is ketosis a dangerous condition that should be avoided at all costs? Doesn’t eating all that fat lead to heart disease? What about cholesterol ? In this chapter, I’ll share what the science really shows.
Chapter 7: Thirty-Eight (Mostly) Low-Carb Diets and What They Can Do for You In this chapter, 38 well-known diet plans are exhaustively analyzed and compared. Not all of them are truly low-carb programs (for instance, the Zone diet), but if they have been portrayed that way in the press, you’ll find them in this section. The format for each discussion allows you to see what the plan is in a nutshell and gives an in-depth look at how the plan works and the theory behind it. You’ll also learn who it might be good for (and who should look elsewhere). Finally, I give you my evaluation of each plan (“Jonny’s Lowdown”) and a rating of zero to five stars. In the years between the paperback edition o f Living the Low Carb Life and this revised edition, there have been hundreds—possibly thousands— of diet books and fitness plans published. Although some of the diet books reviewed in t his section make no real claim to being l ow-carb (and aren’t
even r epresented that way in the media), I wanted to examine so me repr esentative diet b oo ks fro m the past few years in o rder to see just how much of the valuable information we’ve learned about low-carb diets has made its way into the mainstream without much fanfar e. And in so me cases I’ve included books that take a firm stand (usually badly misinformed) agai nst low-car b: I tell you exactly what I think is wro ng with them. Worth noting is that some of the diets that were in the srcinal editions aren’t in use anyofmore—the Stillman and diets,may for example. Butmuch they’re interest historically, andScarsdale many readers remember them and want to co mpare them with what’s being written today, so I’ve left them in. And in so me cases, a diet was perf ectly sensible and workable but never caught on—fo r example, the GO-Diet—but I left that in too , just so yo u can see what it was about. Full disclosure: in nutrition, as in politics, it’s rare to find two people who agree on every dimension of every issue. I mention this because, after almo st twenty years o n the national scene, I’ve fo und that it’s not unusual to g et an e-mail saying something like “How can you r ecommend So-and So when he thinks soy is a great food and you don’t?” So let me be perfectly clear: my ratings and reviews are not based on whether I think the authors are 100% “right,” but rather if I think they’re making a valuable contr ibution to the field and have pretty much created something worth paying attention to—even when I may quibble over a detail or two. At the end of this chapter, you will kno w the exact differ ences among the vario us pro gr ams, and you’ll have a muc h better idea of which ones speak to you and which ones leave yo u cold. You’l l also lear n who each program might be good for (and who should look elsewhere). The thirty-eight plans and their architects are: 1. The Atkins Diet —Rober t Atkins, MD 2. The All-New Atkins Advantage—Stuart Trager, MD and Colette Heimowitz, M.Sc 3. The Biggest Loser —Maggie Gr eenwood-Robinson, PhD, et al. 4. The Carbohydrate Addict’s Diet—Rachael Heller, MA, M.Ph, PhD, and Richard Heller, MS, PhD 5. The 7-Day Low-Carb Rescue and Recovery Plan —Rachael Heller,
6. 7. 8. 9. 10. 11.
MA, M.Ph, PhD, and Richard Heller, MS, PhD Curves—Gar y Heavin and Carol Colman Dr. Tea Diet—Mark Ukra, AKA “Dr. Tea” The Diabetes Diet —Richard K. Bernstein, MD Dr. Gott’s No Flour, No Sugar Diet—Peter H. Gott, MD Eat, Drink, and Weigh Less—Walter Willett, MD and Mollie Katzen The Fat Flush Plan —Ann Louise Gittleman, MS, CNS
12. Fat Resistance Diet —Leo Galland, MD—Jack Go ldber g, PhD and 13. The GO-Diet: The Goldberg–O’Mara Diet Plan Karen O’Mara, DO 14. The Hamptons Diet—Fred Pescatore, MD 15. The Low GI Diet Revolution —Jennie Brand-Miller, MD, et al. 16. The Lindora Program: Lean for Life—Cynthia Stamper Graff 17. The Maker’s Diet and Perfect Weight—Jordan S. Rubin 18. Neanderthin—Ray Audette 19. The Paleo Diet—Lor en Cor dain, PhD 20. Protein Power—Michael R. Eades, MD and Mary Dan Eades, MD 21. The Rosedale Diet—Ron Rosedale, MD and Carol Colman 22. The 6-Week Cure for the Middle-Aged Middle—Michael R. Eades, MD and Mary Dan Eades, MD 23. The Scarsdale Diet —Herman Tarnower, MD 24. The Schwarzbein Principl e—Diana Schwarzbein, MD and Nancy Deville 25. Somersizing —Suzanne Somers 26. The South Beach Diet—Arthur Agatston, MD 27. South Beach Recharged—Arthur Agatston, MD with Joseph Signorile, PhD 28. Sugar Busters! —H. Leighton Steward, et al. 29. The TNT Diet—Jeff Volek, PhD, RD, and Adam Campbell, MS 30. The UltraSimple Diet —Mark Hyman, MD 31. Women’s Health Perfect Body Diet—Cassandra For sythe, MS 32. YOU: On a Diet—Mehmet C. Oz, MD and Michael F. Roizen, MD 33. The Zone—Barry Sears, PhD Fitness Books—Short Takes
34. 35. 36. 37. 38.
Making the Cut by Jillian Michaels The 5-Factor Diet by Harley Pasternak The 3-Hour Diet by Jorge Cruise Deadline Fitness by Gina Lombardi The Ultimate New York Diet by David Kir sch
Chapter 8: “My Big Fat Diet” What happens when an entire town goes on a diet that looks strangely like a version of Atkins? And stays on it for a year? And loses 1,200 pounds in the process? This chapter tells the fascinating story of a real-life experi ment at Aler t Bay, British Co lumbia.
Chapter 9: Supplements and Diet Drugs In this chapter, we’ll review the major drug treatments for obesity and overweight (phentermine, Meridia, and Xenical), and the first FDAapproved “over-the-counter” drug (Alli), and consider the arguments for and against them, as well as review the supporting science. We’ll examine the vast number of vitamins and supplements that are marketed for weight loss, such as 5-HTP, chromium, and L-carnitine. Which ones actually work, and which are bogus? And if they do work, how do they work? What exactly do they do in the body? Here you’ll find the science behind the advertising and discover whether there are any specific vitamins and minerals recommended for people following a low-carb lifestyle. You’ll get the real scoop on controversial herbs like ephedra as well as information about the new “ephedra-free” fat-burning formulas. And you’l l find out the number one supplement for weight loss .
Chapter 10: Frequently Asked Questions Got cravings? Constipated? Bored with chicken and vegetables? This chapter reviews some of the methods low-carb dieters use to combat common problems and make their program work for them. We’ll talk about the use of glutamine to fight sugar cravings, mineral supplements such as potassium to fight muscle cramps, how much is enough when it comes to water, and if any of the “fat-burning” supplements on the market actually work. For easy reference, FAQs are organized by topic, including ketosis, food and water, plateaus, exercise, and more.
Chapter 11: Tricks of t he Trade: The Top 50+ Tips f or Maki ng Low-Carb Work for You The tips are organized into several categories, including food and drink, motivation, and general topics. You’ll find more than fifty of the best insider tricks for making the low-carb lifestyle—and a weight-loss pro gr am in general—easier to stick w ith and more enjo yable, too .
Chapter 12: What We’ve Learned about Controlled-Carbohydrate Eating: Putting Together Your Program Now that you know the nuts and bolts and have decided that low-carb living is for you, how do you put it all together? Many of the authors of the top lo w-carb diet books disagr ee vehemently on some i ssues—coffee, artificial sweeteners, the number of grams of allowable carbohydrate, the need for ketosis, and the timing of meals, just to mention a few—and agree on others. But there are many basic principles that can be extracted from the literature as a whole. These principles can be used to craft an individual lifestyle pro gr am that incorpo rates the ba sic tenets of lo w-carb eating for vibrant good health and ongoing weight loss and maintenance. This chapter tells you how to individualize and customize your own plan to cr eate a per sonalized lowcarb li festyle using the principles discusse d in
Living Lowworld. Carb, as well as how to put the low-carb lifestyle into practice in the real Resources and Support f or a Low-Carb Lifesty le In this section, you will find a comprehensive listing of resources and infor mation per taining to low-carbohydrate living. Y ou’ll find sour ces for research; the most interesting low-carb–oriented blogs and Web sites; ways to calculate your body mass index; food databases in which you can look up calories, carbs, fat, protein, and fiber; articles about cholesterol and cooking oils; information on exercise; an extensive reading list of reco mmended books (and coo kbooks) o f interest t o the low-carber and to anyone interested in health; and even the name of the best food-delivery service I know of.
CHAPTER 1
The History and Origins of Low-Carb Diets
The first bona fide low-carb diet book came out in 1864, and it happened only because William Banting thought he was going deaf. Banting was a pr ospero us London undertak er of 66 who was so over weight that he couldn’t tie his o wn shoelaces. At 5 feet 5 in his stocking feet, he weighed in at 202 po unds and was so fat that he had to walk downstair s backward. On top o f that, his eyesig ht was faili ng and he was having pr oblem s with his hear ing. In August 1862, Banting too k himself to an ear, nose, and throat surgeon named Dr. William Harvey, who examined him and pr omptly decided that Banting’s pro blem wasn’t deafness; it was obesi ty. His fat was pr essing on hi s inner ear. Here’s what Banting was eating: “br ead and milk for breakf ast, or a pint of tea, with plenty of milk and sugar, an d buttered toast; me at, beer, and much br ead and pastry for dinner; more bread and milk at t ea time; and a fruit tart or bread and milk for dinner.” Harvey pr omptly put Banting on a diet, an d by December 1862 Banting had lost 18 pounds. By August 1863, he was down to 156 pounds. In a little less than a year, he had dropped almost 50 pounds and 12 inches from his waistline. Banting also repor ted feeling better than he had at any time in the previous 26 years. H is sig ht and hearing were now normal for his age, and his other bodily ailments had become “mere matters of history.” Here’s what he ate now. Breakfast (9 A.M.): 5 or 6 ounces of either beef, mutton, kidneys, broiled fish, bacon, or cold meat of any kind except pork or veal. A small biscuit or an ounce of dry toast. Large cup of tea or coffee without milk or sugar.
Dinner (2 P.M.): 5 or 6 ounces of fish, poultry, game, or meat, and any vegetable except potatoes, parsnips, beets, turnips, or carrots. An ounce of dr y toast. Fruit. Two or three glasses of go od clar et, sherr y, or Madeira (no champa gne, port, or beer ). Tea (6 sugar.
P.M.):
2 or 3 ounces of fruit. Toast and tea with no milk or
Supper (9 P.M.): 3 or 4 ounces of meat or fish as for dinner. A glass or two o f claret or sherry. Nightcap (if required): a tumbler of gin, whiskey, or brandy with water but no sugar, or a glass or two o f claret or sherr y.
The man did like to dr ink. Here’s what he did not eat: milk, sugar, beer, po tatoes, o r pastry. And what he ate way less of: bread (3 ounces total, about a slice). The calo rie as a measur ement was unknown at that time, but we know now that Banting was eating about 2,800 calor ies a day—not exactly a lowcalor ie diet. Banting may no t have known much about t he science and chemistry o f fo od and weight, but he knew enoug h to o bserve that the
amount of food he was eating didn’t seem to be the determining factor in his weig ht loss. In Banting’s wor ds, “I can now co nfidently say that quantity o f diet may be safel y left to the natural appetite; and that it is the quality onl y which is essential to abate an d cure co rpulence.” In other wor ds: it’s what you eat, not how much, an idea that even then flew in the face o f co nventional wisdom. (It’s worth no ting that Banting was not completely r ight—as it turns o ut, it’s both what you eat and how much.But he opened the doo r to the discussio n that quality mattered as much as quantity, and that was a sig nificant change fr om conventional thinking. Still is.) Banting became a man on a mi ssio n. Excited and inspir ed by his r esults on this high-calorie, low-carbohydrate diet—which was made up almost entirely of protein, fat, alcohol, and what was then called “roughage”—he published, at his own expense, the first commercial low-carb diet book, Letter on Corpulence .1
Banting identified sugar as the main cause of his own obesity, and his physician, Dr. Harvey, promptly put both flour and sugar on the forbidden list. It wor ked. The bo ok eventually went into 4 editions, with t he fir st 3 selling 63,000 copies in England alone, and it was translated into French and German and sol d heavily in those co untries, as well as i n the United States. The fo urth edition letters of testimony from atand least 1,800 written included to Banting to support his assertions praise thereaders diet. who had
Once I did some reading, I realized t hat low-carb diets aren’t brand-new—they’ve been advocated by some forward-thinking scientists for more than a century. —Gary S. Banting, by the way, kept the weight o ff and l ived co mfo rtably until the age of 81. With Banting’s book, the nascent debate—is it what you eat or how much you eat that makes yo u fat?—was bor n, and it continues, alive and kicking , to this day. But the contr over sy didn’t gather its full head of steam until Wilbur Atwater figur ed out how t o measure calor ies.
It’s the C alorie s, Stupid! The Domi nating Hy pothesis i n Wei ght Loss Is Born Sometime between 1890 and 1900, an agricultural chemist named Wilbur O. Atwater got the bright idea that if you stuck some food in a mini-oven called a calorimeter and burned the food to ash, you could measure the amount of heat it produced. He called the unit of measurement a calorie (technically, the amount of heat it takes to raise the temperature of 1 gram of water from 14.5 to 15.5 degrees centigrade). He went to town. He
constructed vast tables of the caloric content of various foods. (It’s impor tant to remember that calories are no t actually found in foo d; they’re a measure of how much h eat or energy can be produced by food.) The idea that the human body behaves exactly like the chamber used in Atwater’s experiments—that we all “burn” calories exactly the same way and our bodies behave like calorimeters—has been the dominating hypothesis in weight los s to this day. And is enterprising it wro ng. (Mor e com ing—stay tuned.) Later,man, some scientists extended the calorie theory even further. They began to measure how much heat was produced (read: how many calories were “burned”) in the course of daily activities, fro m resting to vigorous exercise, from sleeping to digesting food to running marathons. It was now possible to form an equation: calories in vs. calories out. The guiding concept of weight man agement was o fficially bor n. That theory is called the energy-balance theory, and it goes something like this: if you take in more calories than you burn up, you’ll gain weight. If you burn up more calories than you take in, you’ll lose weight. It doesn’t matter where those calories come from. It’s as simple as balancing a checkbook: spend more than you make, an d you’r e calor ically in the red (and dipping into your fat stor es to make up t he difference); make mor e than you spend, and you’re in the black (and buying bigger jeans). It was the fir st law of thermo dynamics in action. What go es in must either co me out in some othe r for m (like heat ) or stay in (in the for m of fat or muscle). What it can’t do is simply disappear. Yet Banting, unscientific though he was, had made an interesting obser vation, which was tha t what he ate made mor e of a difference t o his fat cells than how much he ate. This notion was heresy to the calorie theorists who believed, to paraphrase Gertrude Stein, that a calorie is a calo rie is a cal or ie. It wasn’t until much later that the idea surfaced that calories from certain kinds of food (or combinations of food) might have a greater tendency to be stored in the body than others, or that people might vary widely in t heir metabolic ability t o “burn” calor ies as o pposed to “saving” them, or that the type of food eaten might actually trigger bodily responses that say “stay” or “go.” Meanwhile, calo rie-co unting had taken off with a vengeance. I n 1917
(the same year, coincidentally, in which the ultraco nservative American Dietetic Association was founded), an L.A. physician named Dr. Lulu Hunt Peters published what had to be the first calorie-counting book ever, Diet and Health, with Key to the Calories. She sold 2 million boo ks, making it the firs t best-selli ng diet boo k in Ameri ca. And here’s the thing: by making calor ie-counting equivalent to weight control , she also injected her own view of morality into the equation. People who couldn’t control their calories therefore their weight) lacked self-discipline. We can thank Dr.(and Peters for popularizing thejust concept that being overweight is a sig n of m or al weakness. And the idea that people ar e fat simply because they lack self-control is still very much alive and well today—witness, for example, the recent wor k of Dr. Phil McGraw.2 Calories in/calor ies out r emains the dominant view of most mainstream weight-loss experts to this day, and it is even embraced to a degree by some of the gurus of the low-carb movement, albeit not nearly to the same extent as the mainstreamers, who have made it a virtual religion. All of the lowcarb theori sts have to be seen against the ba ckdrop o f this calor iecounting or thodoxy. But thro ugho ut the twentieth century and i nto the twenty-fir st, obser vations have indeed been made—and experiments performed—that have cast huge doubts on whether the calories in/calories out theory was the whole story or even the most important part of the stor y. Mind you, no one clai ms it is no t part of the story—the argument is whether or not it is the whole story. Answer: It’s not.
Eat and G row Thi n: Low-C arbing Reapp ears on the Scene In 1914, Vance Thompson, a nonscientist and the husband of a famous actress of the day, published a book called Eat and Grow Thin,3 which touted the virtues of a low-carb diet. It suggested that corpulence was caused by eating the wrong kinds of food, not merely the wrong amounts, and singled out “starches, sugars, and oils” as particular culprits—pretty much what you’d expect from a guy whose most famous saying was “To the scientist there is nothing so tragic on earth as the sight of a fat man eating a potato.” His list of forbidden foods included the fattiest meats
(like bacon); bread, biscuits, crackers, macaroni, and anything else made from the flour of wheat, corn, rye, barley, or oats, which included all breakfast foods and cereals; rice; potatoes, corn, dried beans, and lentils; milk, cream, butter, and cheese; oils and grease of any kind; pies, cakes, puddings, pastries, custards, ice cream, sodas, candies, bonbons, and sweets; and wines, beers, ales, and spir its. One can only i magi ne how many times he wa s asked the question we hear so, Accor what’sding left to to Thompson, eat? Asso it often turns otoday: ut, a lot. the only things that had really been taken away were sugar, starch, oil, and alcohol. The rest of his book consisted of menus that included: • • • • • •
All kinds of meat (except pig in any form) All kinds of game All kinds of seafood—fish, lobst ers, oysters, et c. All kinds of fr uit (except bananas and gr apes) All kinds of salad Vir tually all vegetables
The low-carb gurus of today would have loved this, except they would have added some good fat to the mix. The bo ok als o co ntained this little caveat: “Never, under any cir cumstances—even when you have r educed to the desir ed weight and have, to so me degr ee, discontinued the d iet—eat potatoes, rice, white bread, macaroni, or sweets.” Calories were never once mentioned in Thompson’s book, which went thro ugh 113 printings by 1931 and wa s still i n cir culation when a litt le problem arose at the DuPont company.
The Problem at t he DuPo nt Company: The Wo rk of Al fred Pennington , MD DuPont were g etting fat. Reallyexecutives fat. No kidding. Shortly after World War II, the medical department of E.I. DuPont, a
larg e American chemica l fir m, became concerned about t he gr owing obesity problem among the staff. The company hired Dr. Alfred Pennington and entrusted him with th e jo b of finding out why the traditional low-calorie diets of the time were bombing when it came to losing weight. Pennington applied his considerable brain power to an analysis of the scientific literature and came to the conclusion that our old friend—the formerly fat undertaker William Banting—had been right all along: obesi hydrates ty was due to over oeating, butmaking instead fat. to the body’s inabili ty to use carbo fornot anything ther than Pennington put the DuPont executives o n a high-f at, high-pr otein, lowcarbohydrate, unrestricted-calorie diet. He limited their carb intake to 60 grams a day, allowed them at least 24 ounces of meat and fat (more if they wanted it), and restr icted them to o ne por tion a day o f any one o f the follo wing: potatoes, r ice, gr apefruit, grapes, melon, bana nas, pears, raspbe rr ies, or blueberr ies. Pennington pub lished a numb er of articles in prestigio us jour nals such as The New England Journal of Medicine, 4 but he summed up his r esults with the fat executives best in an intervi ew he gave to Holiday Magazine. I’ve added the italics for emphasis. Of the twenty men and women taking part in the test, all lo st weight on a diet in which the total calorie intake was unrestricted. The basic diet totaled about 3,000 calories per day, but meat and fat in any desired amount were allowed those who wanted to eat still more. The dieters reported that they felt well, enjoyed their meals and were never hungry between meals. Many said they felt more energetic than usual; none complained of fatigue. Those who had high blood pressure to begin with [no longer did]. The[se] twenty obese individuals lost an average of twenty-two pounds each, in an average time of three and a half months. The range of weight loss was from nine pounds to fiftyfour pounds, and the range of time was from about one and a half months to six months. 5 Chalk up anot her o ne for the low-carb appro ach to weight loss. Then, in 1928, something r eally inter esting happened at the dietetic ward
of Bellevue Hospital in New York City. But to understand why it happened, you have t o understand t he experiences of a r ugged young explorer named Vilhjalmur Stefansson.
Stefan sson and the Eskim os: Al l Meat, Al l Fat, All the Time Kicked out of school at age 23 for inciting a protest within the student body, Vilhjalmur Stefansson picked up the pieces of his life and entered the world of his true love, anthropology. By 1906, at the age of 27, he had managed to get a master’s degree at Harvard, where he became an assistant pro fessor of anthropol og y and got really interested in the diets of other people. Not much for city life, Stefansson dumped Harvard and decided that it would be more fun to join the Anglo-American Polar Expedition, which was kicking off that year, and travel to the Arctic.
I’ve always found it easier to stay on a low-carb diet than on any other kind of diet. I j ust never feel as hungry so I don’t really feel like I’m dieting. —Doug M. A couple of years after his first foray, he persuaded the American Museum of Natural Histor y in New Yor k to gi ve him the money to do it agai n, and he departed o n his second expedition i n 1908; this time, he stayed 4 years. He discovered a previously isolated group of natives called the Copper Inuit (so named because they used copper to ols), and he lived with them for his entir e stay. His third and final expeditio n began in 1913 and lasted for 5 years. Later, he wrote: “In 1906 I went to the Arctic with the food tastes and beliefs of the average American. By 1918, after eleven years as an Eskimo among Eskimos, I had learned things which caused me to shed most of those belief s.”6 One of the beliefs Stefansson took to the Arctic was the prevailing
notio n that the less meat you ate, the bet ter off you’d be. The view then—as now—was that if you ate a lot o f meat, you would develop, amo ng o ther things, hardening o f the arteries, high blo od pr essure, and, v ery l ikely, a breakdown of the kidneys. But this is what he found: the Eskimos he lived with ate a diet that consis ted almost exclusively o f meat (or fish) and fat. And they were as healthy and robust as a bunch of wild horses. High blood pressure, cor onar y infarctions, strokes were tually unkn own. The rar ely suffered with b and reast-feeding provir blems, complicat ions i nwomen preg nancy, or difficult births. And prior to their contact with mainstream civilization, Eskimos seldom suffered from cancer. (Today, about a century after their contact with “civilization” and the modern diet, they routinely suffer from all o f the above.) Ever the anthropologist, Stefansson lived with an Eskimo family for much of hi s time in the Arctic and adopted all the ir eating habits. Tho ugh he had hated fish all his life, he ate it night and day. He ate it raw, baked, and boiled. He ate the heads and the tails. He even came to like the Eskimo delicacy o f rotten fish, which he likened to his fi rst taste of Camember t. It was the beginning of an aggregate of five years on a diet that consisted almost exclusively of protein, fat, and water. According to the prevailing dietary wisdom of the times, he should’ve been dead. He wasn’t. And, by the way, he never gained weight. He also never saw a fat Eskimo. He wrote: Eskimos, when still on their home meats, are never corpulent—at least, I have seen none who were. E skimo s in their native gar ments do give the impression of fat, round faces on fat, round bodies, but the roundness of face is a racial peculiarity and the rest of the effect is produced by loose and puffy garments. See them stripped, and one does not find the abdominal protuberances and folds which are so in evidence on Coney Island beaches and so persuasive an argument against nudism. 7 The guy did have a sense of humor. By the way, lest anyone think that Eskimos wer e so mehow g enetically
or racially immune to getting fat, Stefansson was quick to point out how quickly they fattened up when they ate mainstr eam Ameri can or Euro pean diets. In other wor ds, they stay nice and slim on a hi gh-fat diet; but as soo n as they start eating starch and sug ar, guess what happens? Stefansson was genuinely curious to see if this strange diet had pro duced any ill eff ects that he perhaps hadn’t noticed. And there were plenty of docto rs who were j ust as curio us as he. A comm ittee was convened, and naut Stefansson put through as rigorous examination as a potential astro would gwas et today. The finding s werean published i n The Journal of the American Medical Association on Jul y 3, 1926, in an ar ticle titled “The Effects of an Exclusive Long -Continued Meat Diet.” The result? The committee had failed to find even one trace of evidence of all the supposed har mful effects o f the diet. This brings us to the dietetic ward of Bellevue Hospital in 1928. Stefansson and Dr. Karsten Anderso n, a coll eague who had been on o ne of the expeditions with Stefansson, ag reed to act as human guinea pigs in a twoperson experiment. Stefansson had not only survived but thrived on a diet that was supposed to have killed him, but this experi ence had never really been verified under scientific conditions. So Stefansson and Anderson agreed to live in the dietetic ward of Bellevue Hospital under the strictest of medical supervision, eating an exclusive diet of meat, for a solid year. The aim of the project was not to “prove” something, but merely to get at the facts and answer the prevailing questions of the time: Would the men get scurvy? Would they suffer from other deficiency diseases? What would be the effect on the cir culator y system? On calcium levels? On the kidneys? On their weig ht? Lest anyone think this was a quaint litt le “exper iment” supervis ed by a couple o f countr y quacks, let’s loo k at the comm ittee assembled to supervis e this dietetic exper iment: fro m Harvar d University, Dr. Lawrence Henderson, Dr. Ernest Hooton, and Dr. Percy Howe; from Cornell University Medical Colleg e, Dr. Walter Niles; fr om the American Museum of Natural History, Dr. Clark Wissler; from Johns Hopkins University, Dr. William McCallum and Dr. Raymond Pearl ; fr om the Russell Sag e Institute of Patholog y, Dr. Eugene DuBois and Dr. Graham Lusk; fr om the University of Chicago , Dr. Edwin O. Jor dan; fr om the Institute of American Meat Packers, Dr. C. Rober t Moulto n; and a physician in pri vate
practice, Dr. Clarence W. Lieb. Not exactly “T he Gang That Couldn’t Shoo t Straight.” This is ho w the experi ment went: For the fir st 3 weeks, Stefansson and Anderson were fed the standard diet of the time: fruits, cereals, bacon and egg s, and vegetables. (Notice that there were no fast foo ds, no snacks, and no vending -machine far e available then, so by today’s st andards, the “or dinar y” diet was already li ght-year s better than what we eat now.) During those first 3free weeks, the two preliminary and were basically to come andguys go aswere theygiven pleased. After the checkups first 3 weeks, they went on the all-meat diet and were more or less under house arrest. Neither of them was per mitted at any time, day or night, to be out of sight of a supervising doctor or a nurse. One interesting sidebar: Anderson was able to eat anything he liked as often as he wanted, pro vided that it came under the experi mental definition of meat: steaks, chops, brains fried in bacon fat, boiled short ribs, chicken, fish, liver, and bacon. Bu t because Stefansson had repo rted in one of his books, My Life with the Eskimo, that he had become ver y ill when he had to go two o r three weeks on just lean meat (“caribou so skinny that there was no appreci able fat”), DuBois, who headed the ex periment, suggested that for a while they try a lean-meat-only diet on Stefansson to co ntrast the results with those of Anderson, who was eating what ever m ix of fat and meat he felt like. They continued to g ive Anderso n as much fat as he liked, but Stefansson was limi ted to chopped fatless meat. Stefansson wrote: The symptoms brought on at Bellevue by an incomplete meat diet (lean without fat) were exactly the same as in the Arctic, except that they came on faster—diarrhea and a feeling of general baffling discomfort. Up north the Eskimos and I had been cured immediately when we go t some f at. DuBois now cur ed me the same way, by gi ving me fat sirloin steaks, brains fried in bacon fat, and things of that sort. In two or three days I was all right, but I had lost considerable weight. If yours is a meat diet then you simply must have fat with your lean; otherwise you would sicken and die. 8
For the rest of the year, both men were kept on a diet of m eat and fat in whatever pro por tion they liked, and t he experim ent went off without a hitch. Every few weeks, with DuBois super vising , they would run aro und the reservoir in Central Park, then run up to DuBois’s house, going up the stairs two or three at a time, after which they would plop down on cots and have their breathing, pulse r ate, and other measur ements taken. These tests showed that their stamina i ncreased the long er they stayed on the meat diet. In 1930,Journal DuBoisofand asso ciates published the rtitle esults of the study merican Biological Chemistry . The o f the paper wasin the “Pro longed Meat Diets with Study of Kidney Functions and Ketosis.” Here’s a summar y of what they wrote: Stefansson, who was about ten pounds overweight at the beginning, lost his excess weight in the first few weeks on the all-meat diet. His total caloric intake ranged from 2,000 to 3,100 calories per day. His metabolic rate rose—from 60.96 to 66.38 calor ies per hour during the pe ri od of the weight loss, an inc rease of almost 9%. His blood cholesterol at the end of the year was 51 milligrams lower than it had been at the start. He wound up choo sing a ratio o f somewhere around 3:1 (in grams) of lean meat to fat. He continued the diet a full year, with no apparent ill effects. Stefansson wrote about his experiences in a fascinating and very long three-par t piece called “Adv entures in Diet” in Harper’s Monthly Magazine between November 1935 and January 1936. His conclusi ons wer e surpr isingly moder ate: “So you could live o n meat if you wanted to; but there is no driving r eason why you should. Apparently you can eat healthy on meat without vegetables, on veg etables without meat, or on a mi xed diet.” What he did not say, but undoubtedly would have had he been alive today, was this: you cannot eat “healthy” if most of your foo d comes fro m 7-Eleven. The low-carbers of today would’v e loved him. A postscr ipt: it seems that in the twenty-or -so-year interim between his days in the Bellevue dietetic ward and his life i n the 1950s as a scholar ly (and relatively sedentary) academic, Stefansson suffered a mild cerebral thrombosis, put on a few pounds, and became quite a grump. According to Mrs. Stefansson, her husband h ad mostly r ecovered fr om the thrombo sis but couldn’t dump t he extra weig ht. Her wor ds: “By will power and near
starvation, he had now and then lo st a few [pounds] but [t hey] always came back when his will power broke do wn.” Mrs. Stef also noted that he had become a real pain i n the butt. As she delicately put it , “Stef had g rown a bit unhappy, at times grouchy.”9 Stef then asked Mrs. Stef if she wouldn’t mind if he went on the “StoneAge Eskimo sort of all-meat diet” he had thrived on during the most active part o f his Arctic car eer. Mrs. Stef was no t exactly a s tay-at-home wife. She lectured, she wrote booksSeminar, about the Arctic, she in was the director of aShe course called the Arctic and she sang madrigal groups. had better things to do with her time than to prepar e two differ ent menus. But she bit her tongue and sai d, “Of co urse, dear. That will be fi ne.”
Everyone warned me that if I went on a highprotein diet my cholesterol and triglyceri des would go through the roof. Meanwhile, the exact opposit e happened. —Pamela R. So back it was to all meat, all fat, all the time in the Stefansson household. Mrs. Stef wrote: When eat as a primitive Eskimo live onsirloin lean and fatand meats. A you typical Stefansson dinner is a does, rare oryou medium steak coffee. The coffee is freshly ground. If there is enough fat on the steak we take the cof fee black, o therwise heavy cream is added. Sometimes we have a bottle of wine. We have no br ead, no starchy veg etables, no desserts. Rather often we eat half a grapefruit. We eat eggs for breakfast, two for Stef, one for me, with lots of butter. Startling improvements in health came to Stef after several weeks on the new diet. He began to lo se his o verweig ht almost at once, and lost steadily , eating as much as he pleased and feeling satisfied the while. He lo st seventeen pounds; then his weig ht remai ned stationary, although the amount he ate was the same. From being slightly irritable and depressed, he became once more his old ebullient, optimistic self. An unloo ked-for and remar kable change was th e disappe arance o f his arthritis, which had troubled him for years and which he thought of as a natural result of aging. One of his knees was so stiff he walked up and
down stairs a step at a time, and he always sat on the aisle in a theatre so he could extend his stiff leg comfortably. Several times a night he would be awakened by pain in his hip and shoulder when he lay too long on one side; then he had to tur n over and lie o n the other side. Without noticing the change at fir st, Stef was one day startled to fi nd himself walking up and down stairs, using both legs equally. He stopped in the middle o f our stairs; then walked down again and up agai n. He could not r emember which knee had beenStone-Age stiff! Conclusio n: The al l-meat diet is wholeso me. It is an eat-allyou-want reducing diet that permits you to forget you are dieting—no hunger pains r emind you. Best of all , it impr oves the temperament. It somehow makes one feel optimistic, mildly euphoric. 10 A post-postscript: Stefansson remained married to the former Evelyn Schwartz Baird (Mrs. Stef) for 21 years; continued his research, writing, and public speaking at Dartmouth Colleg e; and died, by all acco unts happy, on August 26, 1962, at the age of 83. Meanwhile, back at the ranch…. In 1944, cases o f o besity were being treated at New Yor k City Hospital by a cardiologist named Blake Donaldson. After a year of unsuccessful results with traditional low-calorie diets, he decided to investigate alternative methods. He too k himself to the American Museum of Natural History, where, using teeth as an indicator of both body condition in general and diet specifically, he hit the mother lode when he looked at skeletons dug from Inuit burial grounds. Looking further into Inuit diets, he consul ted with Vilhjal mur Stefansson and became co nvinced that a meat-only diet was t he answer for his o bese patients. Donaldson al lowed his patients to eat as much as they liked, but the minimum was one 8-ounce por terho use steak 3 times a day, with a cooked weight of 6 ounces lean meat and 2 ounces fat, the same 3: 1 ratio o f lean to fat that had wor ked so well in the Stefansson–A nderso n experi ment (and the same o ne that Pennington had used with his DuPont execs). Foreshadowing many of the low-carb diets of the 1990s, Donaldson kept his patients on a strict ver sion of the diet until they reached their targ et weight, at which point they could add back certain “pr ohibi ted”
foods, unless they began to put on weight again. Donaldson treated some 15,000 patients and claimed a 70% success r ate using this diet. He also claimed that the 30% who wer e unsuccessful failed to lose weight not because of any fault in the diet but because they couldn’t stay on it. He wrote a book in 1960 called Strong Medici ne,11 so named because Donaldson knew that his diet was not for the faint of hear t—it took a l ot of willpower and dedication to stick with it, and he kne w that not everybo dy would up toa the challenge. Thenbecame seminal moment in the history of low-carb theory, one that served as an ackn owledged inspiration to the main guru o f the low-carb movement of the late twentieth century, Robert Atkins. It happened in the 1950s and 1960s, and it happen ed in Lo ndon.
Inspiration for Atki ns Professor Alan Kekwick was director of the Institute of Clinical Research and Experimental Medicine at London’s Middlesex Hospital, and Dr. Gaston L. S. Pawan was senior research biochemist of the hospital’s medical unit. These two researchers joined forces in the middle of the twentieth century to perform some visionary experiments. 12 They wanted to test the theor y that different pro por tions of carbs, fat, an d pro tein mig ht have different effects on weight loss even if the calories were kept the same. In one study, they put obese subjects o n a 1,000-calor ie diet but varied the percentages of protein, carbs, and fat. Some subjects were on a diet of 90% pro tein, some 90% fat, and some 90% car bs. The subjects on the 90% pro tein diet lost 0.6 pounds per day, the ones o n the 90% fat diet lost 0. 9 pounds per day, and the ones o n 90% carbs actually g ained a bit. In another study, subjects didn’t lose anything on a so -called “balanced” diet of 2,000 calor ies; but when these same subject s were put on a diet of primarily fat with very low carbohydrate, they were able to lose even when the calor ies went as high as 2,600 per day. The Febr uary 1957 issue of the American jo urnal Antibiotic Medicine and Clinical Therapy repor ted: “If … calor ie intake was kept c onstant… at 1,000 per day, the most rapid weight lo ss was noted with high-fat diets …. But when the
calo rie intake was raised to 2,600 daily in these patient s, weight loss would stil l occur provided that this intake was given mainly in t he form of fat and rotein.” (Emphasis m ine.) Still, the criticism from the medical establishment was enormous—this work co ntradicted the mantra that a calori e is a calor ie is a calor ie. One of the criticism s leveled at the two resear chers was that the weight their patients lost was “just water weight.” So Kekwick and Pawan did waterbalance studies that showed lo ss be o anly part o fned thestudy total weight los t. Interestingly, aswater recently asto 2002, vera small y well-desig done at the Univer sity of Cincinnati and Childr en’s Hospital Medical Center13 compar ed weight loss on a ver y low-carbohydrate diet t o weight loss on a calorie-restricted low-fat diet, and found again that the greater weight loss experienced by the lowcarb dieters was not due to water loss. The exact wor ds: “We think it is ver y unlikely that differ ences in weight between the two groups… are a result of [water loss] in the very low-carb dieters.” Yet to this day, the myth pers ists that the majo rity of weight lo st on l ow-carbohydrate diet s is mainly fro m water.
Eat Fat and Grow Sl im and the Theory of Metabolic Disorder The dietary establishment remained firmly convinced, as it does to this day, that the only thing that mattered when it came to weight reduction was calories; but there were pockets of dissent popping up throughout the 1950s, ’60s, and ’70s. One of the leaders of this dissent was Dr. Richard Mackarness, who ran Britain’s first obesity and food allergy clinic and who in 1958 wrote Eat Fat and Grow Slim (which was revised and expanded in 1975). 14 He argued that it was carbohydrates, not calor ies, that were the culprit in weight gain. The fol lowing li nes, from the for ewor d to the book, give the reader some idea of what’s coming. They were written by Sir Heneage Ogilvie—a consultant surgeon at Guy’s Hospital in London, the editor of The Practitioner, and a former vice president of the Royal Colleg e of Surgeo ns, England. There are three kinds of foods—fats, proteins, and carbohydrates.
All of these provide calories. But the carbohydrates provide calories and nothing else. They have none of the essential elements to build up or to repair the tissues of the body. A man given carbohydrates alone, however liberally, would starve to death on calories. The body must have proteins and animal fats . It has no need for carbohydrates, and, given the two essential foodstuffs, it can get all the calories it needs from them. You hear d it here fir st, folks. And you’ll be hearing it again thro ughout this book: the body has no physiological need for carbohydrates. You cannot live without protein. You cannot live without fat. But you can survive perfectly well without carbohydrates. No one is saying you ought to, or that you have to—just that you can. This is simple, basic human biochemist ry. There is no “minimum daily r equir ement” for carbohydrates—which raises the question worth keeping in the back of your mind as you read through the rest of this book: why would the dietary establishment—including the American Dietetic Associ ation—continue to insist that the onl y healthful diet consists o f one in which the majority of the calor ies come fr om the one macronutrient for which we have no hysiological need? But I digress. Sentiments similar to those of Ogilvie were echoed in the Mackarness boo k’s introduction, wr itten by Dr. Frankli n Bicknell: The cure of obesity… can be, of course, achieved by simple starvation, but as Dr. Mackarness explains, this is both an illogical and an injurious treatment, while [a treatment] based on eating as much of everything one likes except starches and sugars and foods rich in these, is both logical and actively good for one’s health, quite apart from the effect on one’s weight. The sugars and starches of our diet form the least valuable part and contribute nothing which cannot better be gained from fat and protein foods like meat and fish, eggs and cheese, supplemented by green vegetables and some fruit. Such a diet provides an abundance… of vitamins, trace elements, and essential amino acids—an abundance of all those subtle, yet essential, nutrients which are often lacking in diets based largely on the fat-
forming carbohydrates. A little co ntext: ever since 1829, when William Wadd, Surg eonExtraordinary to the Prince Regent, proclaimed that the cause of obesity was “an over -indulg ence at the table” (i.e., eating too darn much!), the conventional wisdom was that fat people are fat because they eat too m uch foo d. Peri od. This view, that only the quantity and not the quality of food that people eat makes a difference, had a stranglehold on mainstream medicine—a str of angleho ld that continued th roug h the Association twentieth century the cooperation the sycophantic American Dietetic and iswith only no w, in the twenty-fir st century, beginning to lo osen. To g ive you a sense of the spiri t of the era, the med ical cor respondent of The London Times, on March 11, 1957, wrote at the time o f Mackarness’s boo k: “It is no use saying as so many women do: ‘But I eat practicall y nothing.’ The o nly answer to this is: ‘No matter ho w little you imagine you eat, if you wish to lose weight you must eat less. ’” (Emphasis mine.) Mackarness comes o ut swinging, r ight in his author ’s introduction, leaving no do ubt what “side” of the quality-versus-quantity argument he’s on: “Starch and sugar are the causes of obesity. Particularly modern refined and processed starches and sugars, the ever ready, highly publicized car bohydr ate foo ds of twentieth-century urban man.” He puts forth the interesting argument—foreshadowing much of what we hear today in the discussions o f metaboli c type—that there ar e two kinds of people, whom he characterizes as Mr. Constant-Weight and Mr. FattenEasily. According to Mackarness, if you give both types the same exercise and feed them the same fo od, o ne will stay the same weight while th e other will gain. When Mr. (or Ms.) Constant-Weight—people we hate who seem to be able to eat anything and no t gain an o unce—take in too much carbohydrate, the extra food simply causes a revving-up in their metabolism that burns the extra calo ries co nsumed, and they stay the same weight. Nothing is l eft over for laying down fat. “But,” Mackarness wr ites, “when Mr. Fatten-Easily eats too much bread, cake, and potatoes, the picture is entirely different: his metabolic rate does not increase. Why does he fail to burn up the excess? The answ er is the real r eason for his obesity: Because he has a defective capacity for dealing with carbohydr ates.”
Mackarness was suggesting a metabolic disorder, and he was on to something. He was really the first diet-book author to postulate some sort of metabolic defect in th e way some people pr ocess fo od (especially carbohydr ates) that causes them to send much of what they eat to their fat stor es. Dr. Alfr ed Pennington (o f the DuPont-execs study) had come to the same conclusion. Summing up a 1953 paper called “Obesity: Overnutrition or Disease of Metabolism?” published in the American
Journal of Digestive Diseases, Penningtonofwrote: “Analysis of the … appear[s] to necessitate an explanation obesity on the basis of results some intri nsic metabolic defect.” Writing for the general public, Mackarness had a simpler way of putting it. He came up with a g reat analog y: the steam engine. The orthodox view is that a fat man’s engine is stoked by a robot fireman, who swings his shovel at the same pace whether fat, protein, or carbohydrate is in the tender. This is true for Mr. Constant-Weight, but as he does not get fat anyway, it is only of academic interest to us. It is certainly not true for Mr. Fatten-Easily, with whom we are concerned. Mr. Constant-Weight has a robot stoker in his engine. The more he eats—of whatever food—the harder his stoker works until any excess is consumed, so he never gets fat. Recent research has shown that Mr. Fatten-Easily’s stoker is profoundly influenced by the kind of fuel he has to shovel. On fat fuel he shovels fast. On protein slightly less fast but on carbohydrate he becomes tired, scarcely moving his shovel at all. His fire then burns low and his engine gets fat from its inability to use the carbohydrate which is still being loaded into the tender. Mr. Fatten-Easily’s stoker suffers from an inability to deal with carbohydrate. At the back of his boo k, Mackarness lists fo ods that can be eaten without reser vation, which are meat, poult ry, game, fish and other seafood, dair y products, fats and oils, most vegetables, and some fruits; foods that can be eaten in moderation with some caution, including nuts and higher-carb vegetables and fr uits; and foo ds that could be eaten once a day, su ch as beans, beets, corn, potatoes, and bananas. While some low-carb theorists of today might quibble with the inclusion of dairy, what’s more interesting
is the Mackarness list of “never eat” foods. Are you ready? Don’t shoot the messenger. • • • •
breakfast cereals bread and rolls biscuits and crackers macar oni pro ducts, noo dles, spaghetti, and other pastas
•• • • • • • •
rice jellies, ja ms, and preser ves ice cream, cakes, pies, and candy sauces and gr avies thickened with flour o r co rnstarch beer sweet wines and liqueur s sodas (and all “sweetened fizzy drinks”) sugar
The Mackarness diet sugg ests that carbs be kept as low as possi ble—no mor e than 60 gr ams a day for most people (an d in some cases 5 0 gr ams or fewer a day). This fig ure is in the ballpark o f the recommendat ions o f many low-carb diet books of today. ( Life Without Bread15 r ecommends a maximum of 72 grams a day, and the ongoing weight loss and maintenance programs of the Atkins diet and Protein Power are in the Mackarness range, as is the b eginning pr og ram fo r overweight sede ntary people adhering to the Schwarzbein Principle. It is also practically identical to the gene ri c pro gr am for beginners tha t I reco mmend in chapter 12.) We shoul d not leave Mackarness without mentioning that he was one o f the fir st to note the emotional and psy cholog ical compo nent of o vereatin g. Here’s what he said, in words that will undoubtedly ring true for thousands of people today. So far, then, two big factors in the production of obesity have emerged. A defect in dealing with carbohydrates which makes a person fatten easily on an ordinary mixed diet; Overeating, especially of sugars
and starches as a result of loneliness, fear or emotional dissatisfaction. When the two factors are present, weight is gained very rapidly. So anyone who finds himself tempted to overeat for emotional reasons and who shows a tendency to get fat, should be careful to choose low-carbohydrate foods. 16
Overeaters A nonymous Mackarness was not the only one to notice the emotional component of over eating. Interestingly, on the other side o f the ocean, in 1959—less than a year after the publication of Mackarness’s book and 24 years after the founding of Alcoholics Anonymous—two women in Los Angeles began the fellowship now known as Overeaters Anonymous. A spiritual program to address compulsive overeating, it was based on the same 12-step principles as its predecessor, but with one significant difference. While alcoholics and drug addicts could conceivably abstain from their drug of choice, compulsive overeaters could not. They had to eat to survive. This pr esented an entirely different set of issues, sinc e for over eaters, complete “abstinence” from their “drug” (food) was not possible. Many of the or iginal par ticipants in OA attended because they were terr ibly overweight, but most understood that there was a compulsive emotional component to their overeating that could not be addressed by simple diets or by the prescription drug of the day, dextroamphetamine, sold under the brand name Dexedrine. What’s especially interesting for our purposes is a particular sub-group of OA that developed in Los Angeles in the early sixties. This group had noticed that, even though many people lost weight in Overeaters Anonymous, many were nibbling their way back to obesity and that certain foods seemed to feed the compulsion to eat more than others. Can you g uess what the culprits wer e? Yup. By 1963, there was a very vocal minority of OA members who were convinced that carbohydr ates sabotaged any weight-loss plan because they produced cravings and addictive eating behavior. The OA contingent
called them “binge foods.” One of the founders of this faction—which later came to be known as the Grey Sheet Group—wrote “I wonder if we have an allergy of the body too. Are we going to help the Doctors understand obesity just as the alco holi c had to educate the medical profession?” 17 Fro m that time on—althoug h it is little-known—t here has al ways been a faction of OA that believes strongly that “abstaining” from carbohydrates (with a ver sobriety y low-carbohydrate dietto) is a necessa of strategy emotional when it comes food, just asryit component is a necessary for weight loss in carbohydrate-sensitive individuals. Could this be another case of the patient profoundly understanding the disease far in advance of the medical pro fessionals?
Calori es, Carbs, or Just Plain Fat? T he Roari ng ’60s In the 1960s, two books came out in favor of the low-carb approach, both of which got a lot of attention. One of them deserved it; the other did not. The one that did was a thoughtful, if somewhat misguided, treatise called
Calories a New Taller. Taller had beenDon’t a fat Count man allbyhis life, York at onedoctor time named almost Herman 100 pounds over his ideal weight. He described himself as one of those who “only had to look at a platter of spaghetti to gain [weight].” He struggled with every version of the low-calorie diet available with virtually no results. A physician friend of his was sure that Taller had to be lying about how much he was eating, so Taller hatched a plan. Reading his experience will no doubt produce quite a number of nodding, sympathetic heads. I proposed an interesting vacation test [to the physician who was certain I was cheating]. We would go away together for ten days, stay in each other’s company continually, eat and drink the same things, and check the results. He accepted, and we went off to a resort. I fol lowed what was then the accepted method o f weight co ntro l: a lo wcalorie diet. I concentrated on salads, which I now know was a mistake, ate fat sparingly, another mistake, and, since this was a
vacation, drank a cocktail each night before dinner. My physician friend, who was slim, did the same. At the end of the vacation, he had lost a pound or two and I had gained nine pounds. “I don’t understand it” he said as we drove back to New York. Neither did I.18 Taller didn’t reject the calorie theory at all. On the contrary, he wrote, “No o ne, least of all m yself, would dispute the concept t hat led to the calor ie fad. n willelose weightlaw. wh Why, en he then, burnsdidn’t up mor e energy rie than he eats.Any Thisperso is a simpl chemical a low-calo diet wor k? Why did people lose weight on high-calor ie, high-fat diet s?” Taller postulated that all calories are not the same and that carbohydrates present a different problem to the body, at least f or some people. He rightly pointed out that low-fat diets were by nature high in carbohydrates, thus stimulating insulin and creating more fat, particularly in people who were sensitive to car bohydr ates. (It is no tewor thy that, almo st four decades later, Eleftheria Maratos-Flier, dir ector of obesity research at Harvar d’s prestigious Joslin Diabetes Center, said, “F or a lar ge per centage o f the population, perhaps 30 to 40 percent, low-fat diets are counterproductive. They have the paradoxical effect of making people gain weight.”) Taller completely agreed that the underlying reason people become fat is an imbalance between calories taken in and calories burned. But he suggested that for some people there is a disturbance in the metabolism, with three results, none of them good: (1) the body forms fat at a rate that is faster than normal; (2) the body stores fat at a rate that is faster than nor mal; and (3) the body disposes of stor ed fat at a rate that is slower than nor mal. Taller summed up: “The crux of the matter is not how many calories [we] take in, but what [our bodies do ] with those calo ries.”19 Taller did not recommend a diet devoid of carbohydrates—in fact, a typical day’s menu contained up to three sli ces of “gluten bread,” something no low-carb advocate today, including myself, would reco mmend (there ar e far mor e healthful starchy carbs to choose fro m, including spr outed-gr ain or gluten-free breads). The r est of the day’s foo d came from meat, poultry, seafood, and plenty of vegetables as well as some oi ls. There was no count ing o f calor ies. Now here’s where it gets interesting.
In the ’50s and ’60s, when Taller was writing, a scientist named Ancel Keys had begun stud ying heart disease and di et—resear ch that culminated in what has come to be kno wn as the diet-heart hypothesis. K eys co ncluded that cholesterol is a cause of heart disease, saturated fat causes a rise in cholesterol, and therefore saturated fat causes heart disease. Keys’s sevencountry study 20 became t he basis for dietary pol icy for mor e than three decades, indir ectly birthed the fat phobia o f the ’80s, and directly spawned an entire bureaucracy to lowering cholesterol (the National Cholesterol Educationdevoted Pr og ram) and also to pro ducing so me of the mo st profi table pharmaceut ical dr ugs in histor y (see chapter 9). Note for now that there are serious problems with this theory, and it is finally being r eexamined.21 Taller, a product of the time, accepted the demonization of cholesterol and believed that if you could reduce it in the diet, you could significantly lower hear t-disease r ates. He was ver y concer ned about the saturated fat in the low-car b diets of the past, so he came up with what he thoug ht was a perfect solution: h is versi on o f the diet would incorpo rate tons of polyunsaturated fats. Pro blem was, he lumped all unsaturated fats tog ether. He was correct in pointing out how healthful marine fats are (the famous omega-3’s from fish and flaxseed), but he was dead wrong in advocating excessive amounts of man-made r efined veget able oi ls li ke safflower, sunflower, and corn oils, which we now know are associated with a host of diseases, inflammatory conditions, and cancers. 22 Taller’s book went through eighteen printings and ultimately had more than a million copies in circulation, but his career came to an unfortunate end when he was convicted of six counts of mail fraud for using the book to pro mote a particular br and of safflo wer capsules, which the court called “a worthless scheme foisted on a gullible public.” 23 Too bad. By all repor ts, he was a go od g uy and very sincere in his effo rts to br ing health y low-carb li ving to the masses. The other l ow-carb boo k published in th e ’60s—also against a bac kdrop of the fledgling no-fat madness started by the flawed Keys research—was one that didn’t deserve much attention, though that little detail didn’t stop it fro m selling 5½ million copies. The Doctor’s Quick Weight Loss Diet,24 otherwise known as the Stillman diet, put forth a high-protein solution that
attempted, at the same time, to satisfy the low-fat contingent. On the Stillman diet, you ate nothing—and I mean nothing—but pr otein with every drop of fat trimmed from it. You could eat all you wanted from the following selection: lean meats with all possible fat trimmed; chicken and turkey without skin; all non-fatty fish; eg gs made in nonstick pans with out butter, marg arine, o il, o r other fat; cottage chees e and other soft cheese s made only f rom skim mil k; and at least eight glasses o f water a day. We know the Stefansson thatprecisely this diet, because if followed for any lengthfrom of time, would makeexperiment you very sick of the absence of fat. The Stillman diet was a dumb idea and should not be followed for any reason. Although the Stillman all-protein plan was in fact a low-carb diet, it’s important to remember that not all low-carb diets are high-protein diets. Even the Atkins diet, which will be discussed at gr eater l ength in chapter 7, is not necessarily high-protein. In fact, the average protein content of all three major phases of the Atkins diet is only 31% (the average fat co ntent is 56%); and duri ng the Atkins maintenance phase, t he averag e protein co ntent is only 5% hi gher than Weight Watchers (25% versus 20%)! 25 Some of the diets discussed in this book don’t even approach high-pr otein: for example, Barr y Sears’s Zone diet (see chapter 7) has often been called a high-protein diet by magazine writers who have either not read his boo ks or not understoo d them, and by members o f the American Dietetic Association, who have fr equently done neither. The point is that low-carb does not necessarily equal high-protein, and the Stillman diet is Exhibit A in making the case that all lo w-carb diets ar e not the same.
A tk ins, Yudki n, and the Q uestion of Sugar By 1970, the Keys r esear ch had been published and was being picked up by the media; the low—or no—cholesterol brigade was gearing up for an assault on the consciousness of the American public. In 1972, Robert Atkins published the first edition of the New Diet Revolution, the Cadillac of lowcarb diet plans, which became the de facto poster child for the lowcarb movement two decades later.
Atkins was the fir st popula r diet-book author to seri ously focus o n insulin as a deter minant in weight gain. H e preached the vir tues of something he called “the metabolic advantage”: benign dietary ketosis (a process that, because it is so central to the discussion of low-carb diets and so misunderstood, will receive much further attention in chapter 10). Because his high-fat, high-protein, low-carb diet went so dramatically agai nst the conventional “wisdom” of the times, Atkins was attacked mercilessly in the press vilified by the medical mainstream, whodr owned turned him into a par iahand in the medical co mmunity. His voice was out by the low-fat, nocholesterol, calorie-counting establishment, and although he r emained active, he didn’t catch on big-time until the ear ly 1990s, when an updated edition of the New Diet Revolution was published. The public, with its rapidly expanding waistlines, was growing weary of the low-fat dogma and beginning to realize that low-fat diets were accomplishing very little in the way of weight loss; people were finally ready to lo ok elsewhere for a solution. In the same year in which Atkins published the fir st edition of his boo k, which firmly took the position that the problem in obesity was carbohydrates, not fat, a brilliant English doctor named John Yudkin was making waves by politely and reasonably suggesting to the medical establishment that perhaps their emperor, while indeed cholesterol-free and low-fat, was nonetheless naked as a jaybird. A professor of nutrition at Queen Elizabeth College, London Univer sity, and the Surg eon-Captain of the British Royal Navy, Yudkin was a highly respected scientist and nutritioni st and the possesso r of both an MD and a PhD, with dozens o f published papers in such august peer-reviewed journals as The Lancet, Cardiovascular Review , Briti sh Medical Journal, The Archives of Internal Medicine, The American Journal of Clinical Nutrition, and Nature to his credit. Yudkin was typically po rtrayed by his detr actor s as a wild-eyed f anatic who blamed sugar as the cause of hear t disease, but in fact he was nothing of the sor t. In his 1972 boo k, Sweet and Dangerous, he was the embodiment of reason when he called for a reexamination of the data— which he consider ed hig hly flawed—that had led to the hypothesis that fat causes heart disease. (These dat a, as you will r ecall, came or iginally fr om
a study of six 26 and then seven countries 27 published by Ancel Keys, studies that conveniently o mitted a substantial amo unt of data that did not fit his hypothesis.)28 Yudkin pointed o ut that statistics fo r heart dis ease and fat co nsumption existed for many more countries than those referred to by Keys, and that these other figur es didn’t fit int o the “mor e fat, mor e heart disease” relationship that was evident when only the six selected countri es were consider ed. He pointed out that there was a better and truer relationship between sugar consumption and hear t disease, and he said that “t here is a sizable minority—of which I am one—that believes that coronary disease is not largely due to fat in the diet.” (Three decades later, Dr. George Mann, an associate director of the Framingham Study, arrived at the same conclusion and assembled a dist inguished gr oup o f scientist s and doctors to study the evidence that fat and cholester ol cause hear t disease, a concept he later called “the gr eatest health scam of the century.”29 Aro und the same time, the bril liant Danish schol ar Uffe Ravnskov, MD, PhD, reanalyzed the srcinal Keys data and came to the identical conclusion. His exemplary scholarship is supported by hundreds of referenced citations and studies fro m prestigio us, peer-r eviewed medical jour nals and c an be found in book form 30 and at the Web sitehttp://www.ravnskov.nu/cholesterol.htm.) While Yudkin did not write a lo w-carb diet boo k per s e, he was one o f the most influential voi ces of the time to put for th the positio n that sugar was r esponsible for far mor e health pro blems than fat was. His book called attention to countries in which the correlation between heart disease and sugar i ntake was far mor e striking than t he cor relation between heart disease and fat . And he poi nted to a number of studies—most dramaticall y of the Masai in Kenya and Tanzania—where people co nsumed copio us amounts of milk and fat and yet had virtually no heart disease. Interestingly, these people also consumed almost no sugar. 31 Yudkin patiently explained that sugar consumption is one of a number of indices o f wealth. Heart disease is associ ated with many of these indices, including fat consumption, overweight, cigarette smoking, a sedentary lifestyle, and televisio n viewing. It is definitely asso ciated with a high intake of sug ar. He never sai d that sugar causes the diseases of moder n civili zation, just that a case co uld easily be made that it deserved attention
and study—certainly as much as, if no t mor e than, fat consumption. (Yudkin himself performed several interesting studies on sugar consumption and co ronar y heart disease. In one, he fo und that the median sugar intake of a g ro up of cor onary patient s was 147 gr ams, twice as much as it was in two different groups of control subjects who didn’t have cor onar y disease ; these gr oups consumed only 67 a nd 74 grams, respectively.)32 As Yudkin putthe it, “It may turnon o utmetabolism that [many and factor incl uding s ugar ] ultimately have same effect so sproduce coronary disease by the same mechanism. ” What is that mechanism? Finger s are beginning to po int suspiciously to an overload of insulin as a commo n culprit at the root of at least some of these metabolic and negative health effects like heart disease; controlling insulin was the main purpose of the or iginal Atk ins diet an d has become th e r aison d’être of the lo w-carb appro ach to living . (In the next chapter, we will explor e som e of the connections between high levels of insulin and heart disease, hypertension, obesity, and diabetes.)
Chole sterol Madness Yudkin’s warnings against sugar and Atkins’s early low-carb approach to weight loss were mere whispers lost in the roar of anti-fat mania. By the mid-1980s, fat had been utterly and completely demonized, and fat phobia was in full bloo m, with hundreds o f no-cholestero l foo ds being fo isted on a gullible public (despite the findings that dietary cholesterol had little or no effect on serum cholesterol, a fact acknowledged even by Ancel Keys himself, who, in 1991, said that dietary cholesterol only mattered if you happened to be a rabbit!). 33 In November 1985, the National Heart, Lung, and Blood Institute launched the National Cholesterol Education Program with the stated goal of “reducing illness and death from coronary heart disease in the United States by reducing the percent of Americans with high blood cholest erol.”34 (Emphasis m ine.) Though high doesn’t cause hear t disease and,naut in fact, turned out to be cholesterol a r elatively poor predictor of it, the jugger washas already in full swing, and the cry of “hold the butter” was heard all over
America. Fat-free foods were everywhere. Snackwells replaced Oreos as the best-selli ng co okie in Ameri ca. In 1976, Nathan Pri tikin opened his Pritikin Longevity Center in Santa Barbara, California, and for the next decade he preached the super-low-fat dogma to all who would listen, which included most o f the country. Jane Fonda usher ed in a new generation o f aer obicized exercise fanatic s whose motto was “no pain, no gain” and who looked upon fat of any kind as a Tootsie Roll in the punch bowl. Apex, a supplement in Califo rnia, t a the strong(Later, foo thold in health clubs as company nut ri tion based “expe rts” larg ely by go being handmaiden of the American Dietetic Associ ation, and Apex’s peopl e taught gullible trainer s and their clients the dogma o f hig h-carbohydrate diets for weight loss while they railed against t he “danger s” of high pro tein and ketosi s.)35 It became a point of pride to exorcise any hint of fat fro m the diet: egg-whit e omelettes became de rigueur on every urban menu, and waiters across America became accustomed to orders without butter, oil, or fat of any kind. Pritikin died in 1985, but his mantle was quickly taken up by Dr. Dean Ornish. Ornish’s reputation—and much of the public’ s faith in the low-fat diet approach—was fueled by his famous five-year intervention study (the Lifestyle Heart Tri al), which demonstr ated that intensive li festyle changes may lead to r egr ession of cor onar y heart disease . 36 Or nish too k 48 middleaged white men with moderate to severe coronary heart disease and assigned them to two groups. One group received “usual care,” and the other gr oup r eceived a special, inten sive 5-part lifestyle int ervention consistin g of (1) aero bic exercise, (2) stress management training, (3) smoking cessation, (4 ) gr oup psycholo gical suppor t, and (5) a strict vegetarian, high-fiber diet with 10% of the calori es coming fr om fat. When Ornish’ s study showed some r eversal o f atheroscler osis and fewer car diac events in the 20 men w ho co mpleted the 5-year study, the public perception—reinforced by Ornish himself—was that the results were largely due to the low-fat diet. This is an incredible leap that is in no way suppor ted by his r esear ch. The fact is that there’s no way to know whether the results were due to the low-fat-diet portion of the experiment (hig hly unlikely in the view of many), the high fi ber, the whole fo ods, the lack of sugar, or some combination of the interventions. It is entirely
possible that Ornish would have gotten the same or better results with a pro gr am of exercise, st ress management, smoking cessat ion, and gro up therapy plus a wholefoods diet of high pr otein, goo d fats, high fiber, and low sugar. (Interestingly, critics of low-carb diets frequently proclaim with gr eat righteousnes s that the only r eason a lo w-carb diet works is because it is a low-calorie diet in disguise. They never level that criticism at Ornish, whose diet, in a recent analysis, turned o ut to be lower in calories [1,273 calories] than the Atkins weight-loss [1,627 ate calories], theDiet Atkins mai ntenance phaseongoing [1,990 calor ies], thephase Car bohydr Addict’s [1,476 calories], Sugar Busters! [1,521 calories], the Zone [approximately 1,500 calor ies], and even Weight Watchers [1,462 calor ies].)37
The Ti de Turns: A Reexaminati on of the LowCarb Soluti on By the 1990s, it was pretty obvious that low-fat dieting wasn’t getting results. The country was fatter than ever, diabetes was becoming epidemic, and people were getting more and more frustrated and confused. The time was right for another look at the low-carb wisdom that had been around in one form or establishment another since and Banting’s day in the 1800s.Association, To the chagrin of the medical the American Dietetic Atkins resurfaced with a vengeance with his newly updated New Diet Revolution in 1992, followed by perhaps the most influential nutrition book of the 1990s, Barry Sears’s The Zone, in 1995, a year that also saw the publication of the brilliant Protein Power by Drs. Michael R. and Mary Dan Eades. After massive resistance by the establishment, serious research was finally comparing low-carb diets to traditional diets, and the results were impressive. While it would be incorrect to say that low-carb diets always produced greater weight loss than the traditional kind, they often did; they frequently pro duced it faster (a huge mo tivating fo rce fo r many people); and they almo st always produced better health outcomes such as bloodlipid pro files, precisely the measures tha t the anti–low-carb fo rces had predicted would be disastrous on these regimens (see chapter 2). In what will pr obably turn o ut to be a si gnal event in the deat h of the high-
carb dictator ship, Dr. Walter Willett—chair man of the Department of Nutrition at Harvard University’s School of Public Health and one of the most r espected mainstream r esearchers in the count ry—r ecently came out publicly ag ainst the 1992 USDA Foo d Guide Pyr amid, which for a decade had promoted 6 to 11 servings a day of grains, breads, and pastas. 38 Internecine battles among advocates of different diets were hardly something new. What was differ ent this time was that the arg uments were finally takenhosted public.a On February 24, 2000, U.S.Nutrition Department of Agriculture major symposium, “Thethe Great Debate,” which featured, amo ng other s, Dr. Rober t Atkins (the Atkins diet), Dr. Barr y Sears ( the Zone diet), lo w-fat advocates Dr. Dean Ornish and Dr. John McDougall, and various representatives of the dietary establishment.39 Then, o n July 7, 2002, The New York Times published a cover stor y in its Sunday magazine s ection titled “What If It’s All Been a Big Fat Lie?” in which Gary Taubes, a brilliant science journalist and three-time winner of the National Association of Science Writers’ Science in So ciety Award, br oug ht to the table massi ve evidence that the lo w-fat diet had been the dumbest experiment in dietary histor y. The article created a pr edictable uproar, with de fenders of the faith rallying to discredit Taubes—not an easy task, I mig ht add—and the lo w-carber s beaming ear to ear with I -told-you-so gr ins. An interesting side no te: on the Dietitian Central Web site (a dietitian Internet community), the fol lowing po st was fo und on July 14, a week after the Taubes article appeared: “Please, dietitians, download from the NY Times Magazine section f rom last Sunday, July 7, the article ‘ What If It’s All Been a Big Fat Lie?’ by Gary Taubes. It is full of information that could rock our world. As dietitians, we need to be pr epared and info rmed re: changes that may be completely different from what we have learned and have been educat ing people about.” (Taubes has si nce published a superb full-length book based on that article called Good Calories, Bad Calories —highly recommended.) Low-carbi ng had co me back, but this time with a clar ity and a scientific validation that had simply not been pr esent in previo us decades. It’s time now for a reassessment of the twin sacred cows of dietary commandments —high carbohydrates and low fat —and for a clearer look at just what
could be gained in terms o f health a nd weight loss by fo llowing a diet more like the one that sustained the human genus for 2.4 million years and sustained modern man for at least 50,000 years. It’s time to r evisit the low-car b wisdom o f the past, evaluate the wisdom of the present, and see wh at they have to teach us about living healthy in the twenty-first century.
CHAPTER 2
Why Low-Carb Diets Work In other fields, do when do not stand, when aircraft do not fly, when machines notbridges work, when treatments do not cure, despite all the conscientious efforts on the part of many persons to make them do so, one begins to question the basic assumptions, principles, theories, and hypotheses that guide one’s eff orts. —Arthur R. Jensen, P hD Professor of psychology at the University of California at Berkeley, in Harvard Educational Review, winter 1969
On November 1, 1999, Woo dy Merrell—the Muhammad Ali o f doctors, loved, and admired across entire political spectrum of medicine andrespected, nutrition— wrote an article inthe Time magazine about weight loss. This is how it st arted: “In my 25 years of medical training and p ractice in Manhattan, I’ve seen a wide range o f diets come and go. Virtuall y none of them work .” A few parag raphs later, Merr ell wro te: “For most of my pr ofessional career, I adh ered to the generally r ecognized dict um of weight management. I advised my patients to count their calories and follow a low-fat diet .” He then talks about his experience with a few patients who weren’t getting anywhere, no matter what they tri ed. Skeptically, he put them o n a low-carb diet. Finally he wrote: “I have become a convert. Carbohydrates… are often prime saboteurs of our weight. [O]f all the diets I’ve seen over the past few decades, the moderate-fat, lower-carbohydrate ones are the most successful. They stress not how much food you eat but what kinds. Calorie
counting is not as important as carbo counting .” (All emphases mine.) The ar ticle is titled “How I Bec ame a Lo w-Carb Believer.”1 What convince d Merr ell—and what is convin cing mo re and mor e of his colleagues—is the fact that lower-carbohydrate diets really work for many, many people. The evidence of the senses is hard to argue with. People lose weight, feel better, and, equally important, have major improvements in their health. Chro nic co mplaints and ailments have been known to disappear. Sometional of these people had tried every possible diet, had adhered to every conven ch olestero l-lowering , fat-reducing pr og ram, and wound up in exactly the same place as when they started—and som etimes were even wor se. Yet on lo wer-car b diets, they do g reat.
GENIUS AND ANTI-AGING GURU CHOOSES LOW-CARB DIET !
Ray Kurzweil is a scientist, inventor, and recipient of the National Medal of Technology. Largely considered a genius ( The Wall Street Journal called him “the restless genius,” and Forbes called him “the ultimate thinking machine”), his fans range from Bill Gates to Bill Clinton. Recently Kurzweil teamed up with Terr y Gr ossm an, MD, the founder and medical director of the Frontier Medical Institute in Denver and the author of The Baby Boomers’ Guide to Living Forever. The two turned their not-inconsiderable br ain power and experience to studying the science of life extension. In their seminal book, Fantastic Voyage: The Science Behind Radical Life Extension, they discuss g enes, diet, exerci se, stress, genomics, and cut ting-edge r esearch on gene manipulat ion. They also discuss t heir per sonal dieta ry pro gr ams, arr ived at after consuming and digesting hundreds—if not th ousands—of research papers related to even the most obscure areas of health and longevity. These guys are serious about health and life extension. Would yo udiets. like to know they perso nallythan eat?80 grams a day Low-carb Both menwhat consume no more of car bs, or 1/6 (about 16%) of their total ca lor ies fro m
carbohydrates on a daily basis. Food for thought. How can something that is so co unterintuitive wor k? (And it is counterintuitive for most of us—after all, even Gary Taubes, in his seminal article “What If It’s All Been a Big Fat Lie?”,2 said he couldn’t quite get over the feeling that the bacon and eggs on his plate were going to so mehow jump up and kill him .) We need to r emember that low-carb eating is counterintuitive precisely because we have all been taught a number of “truths” that we have internalized as nutritional gospel but which may in fact be n utritio nal hog wash. We “know” low-car b diets can’t work because they are o ften high in fat or choleste ro l (which we “k now” causes heart disease), are o ften high in protein (which we “know” causes heart disease, bone loss, and possibly cancer), and may be higher in calories (which we “know” causes weight gain). Yet people eating the low-carb way are losing weight and lowering their risk for heart disease, hypertension, diabetes, and obesity. There is even some indicat ion that they may be lowe ring their ri sk for some cancers. 3 How do we explain this? I t is as though all three o f Chri stopher Columbus’s ships had back returned homeshook with great bountyinfrom the New World, but the people in Spain their heads disbelief, saying, “How can this be? It must be a trick. The ships have to have fall en off the earth, because we know the earth is f lat!”
My doctor kept telling me not to try a low-carb diet because he thought it was so dangerous. Then his wife lost 50 pounds on Protein Power and now he’s really done a 180. —Adele P. I’ve got news for you: low-fat is the flat-earth theory of human nutrition. See, all theor ies of weight loss fit int o o ne of two majo r categor ies of thought— all of them . Therimmediately e is no exception this r ule.than If you the two categories, you’re bettertoinformed halfunder the stand population on the subject of dieting and weight loss.
Let’s call catego ry one the Checkboo k Theo ry. This is the idea that when it comes to calories and weight loss, the human body is like a checking account. You eat a certain number of calories, and you burn up a certain number of calories. If you eat more than what you need, you gain weight. If you eat less than what you need, you lose weight. Much like a checking account: if I deposit (take in) mo re money than I write checks for, I have some extra cash (i.e., I gain weight). If I spend (put out) mo re than I take in, Iequals have to dipIinto thatI cash I lose weight). what I deposit what spend, have(i.e., a zero balance (i.e.,Ifmy weight staysexactly the same). Let’s call category two the Telephone Theory of weight loss, based on the game o f Telephone yo u may have played as a chil d. You l ine ten people up, then whisper something in the ear of the first person. That person whispers it to the second person, and so on down the line, until the words are repeated to the last perso n, who then says them out loud. Wh at usually happens is that you start out with something like “A rose is a rose is a rose” and you wind up with “Gardenias don’t grow on the planet Mars.” Applied to weig ht loss, the theor y go es som ething like this: th e stuff that goes on in between the calor ies coming i n and the calor ies go ing out is much mo re impor tant than the actual number of calor ies involved. There ar e so many enzy mes, cofact or s, energy cycles, h or mones, neurotransmitters, eicosanoids, genes, and other variables in the human body that determine the fate of the food coming in, that it is impossible to predi ct what’s going to happen to so meone’s weight just by kn owing the number of calories that go in. It would be like predicting the outcome of Telephone simply by knowing the phrase that was srcinally said. Sure, if everything g oes perfectly , “A ro se is a r ose is a r ose” comes o ut as “A ro se is a r ose is a r ose.” Mor e often, though, it comes out as “A dam Sandler ’s latest movie stinks. ” The checking- account model, kno wn as the energy-balance theory , has been the dominant theory of weight loss for years. The entire low-fat movement has been built on it: take in fewer calories and burn more, and you will lose weight. You have probably been hearing this advice for years. While this view is not entirely without merit, it’s so far from the whole picture as to almost constitute dietary malpractice. The thinking behind low-ca rbing belongs to the second cat egor y of theories about weight loss, the Telephone Theory. This view asks a critical
question: what goes on inside the body once those calories are taken in? Why do some people store everything as fat and others don’t? What determines whet her what you eat go es on yo ur hips or is burned up as energy and disappears as heat into the atmosphere? The answer is o ne wor d: hormones. Hormo nes control just about every metab olic event that goes o n in your body, and you control hor mones via your lifestyle. Foo d—along wit h several keyand lifestyle suchdirect as stress—is thetodrug hor mones, t hosefactors hor mones th e body stor that e or stimulates burn fat, just as they direct t he body to per for m a gazilli on o ther metabolic oper ations. (Dr. Barry Sears has said that “food may be the most powerful drug you will ever encounter[,] because it causes dramatic changes in your hor mones tha t are hundreds of times mor e powerful than an y pharmaceu tical.”) Hor mones ar e the air-traffic contro ller s determining the fate of whatever flies i n. If your food is stimulating the wrong hormones or creating a hormonally unbalanced state, you will fi nd it ext remely diffi cult, if not i mpossible, to lose weight and keep it off. In this chapter, you will lear n why it is so vitally impo rtant to balance your hormones if you want to lose weight. It is probably as important as— or mor e impor tant than—counting calo ri es, and it is certainly more important than reducing dietary fat. But managing our hormones has even bigger consequences. Insulin—the hormone most targeted by the low-carb diet plans discussed in this book—is at the hub of a significant number of diseases of civilization. When you control insulin, you hugely increase the odds that you will be able to control your weight. But, as you will see, you also reduce the risks for heart disease, hypertension, diabetes, polycystic ovary syndrome, inflammatory diseases, and even, possibly, cancer. So let’s get to know the players in our hormonal dance. If I’ve done my ob, at the end of this chapter yo u’ll have a much bett er understanding o f what has now come to be popularly known as “Endocrinology 101”: how the body makes fat, stores fat, and, finally, says good-bye to fat. You’ll also understand why the same eating pl an that helps you lose weight also has the positive “side effec t” of pr eventing you fr om becoming a medical statistic.
T HE STAR OF THE SHOW: EXPERTS WEIGH IN ON INSULIN
“Insulin is t he key to the vast majority of chronic illness.” —Joe Merco la, DO
“There is an epidemic of i nsulin resistance in the world at large.” —Gerald Reaven, MD
“When you have excess levels of insulin, it’s like a loose cannon on the deck of a hormonal ship.” —Barry Sears, P hD
“Insulin sensitivity is going to determine, for the most part, how long you are going to live and how healthy you are going to be. It determines the rate of aging more so than anything el se we know right now.” —Ron Rosedale, MD
The Good, the Bad, and the Ugl y: Insuli n and Its Discontents Insulin, a hormone first discovered in 1921, is the star actor in our little hormonal play. It is an anabolic hormone, which means it is responsible for building thin gs up—putting compounds (like g lucose and amino acids) inside storage units (like cells). Its sister hormone, glucagon, is responsible for breaking things down—opening those storage units and releasing their contents as needed. Insulin is responsible for saving ; glucagon is responsible for spending . Together, their main job is to maintain blood sugar within the tightly regulated range it needs to be in, to keep your metabolic machinery r unning smoo thly. And to keep you from dying. Without insulin, blood sugar would
skyro cket and the result would be metabolic aci dosis , coma, and death, the fate of vir tually every type 1 diabet ic in the ear ly par t of the twentieth century prior to the discovery of insulin. On the other hand, without glucago n, blood sugar would plumme t and the result w ould be brain dysfunction, coma, and death. So the body kno ws what it’s do ing. This little dance be tween the for ces that keep blood sug ar fro m soar ing too high and t hose that prevent it from g oing too lo w is essential for survival. It’s interesting blood to notesugar that while insulin is high, the only hormone responsible for preventing from rising too there are several other hor mones beside s glucago n—cortisol, adrenaline, n or adrenaline, and human gro wth hor mone—that prevent it fro m g oing too low. Insulin is such a powe rful hor mone that five other hor mones counte rbalance its effects.
How a Hi gh-Carbohydrate Diet Raises Both Cholestero l and T rigl ycerides Let’s follow the nutrients you eat on their journey through the body. When you eat food—any food—it mixes with acids and enzymes from the stomach, pancreas, and liver that break it down into smaller molecules. The nutrients are then absorbed through the intestinal walls, while the indigestible parts of the food pass through the digestive system as waste. Proteins break down into amino acids, carbohydrates into glucose, and fats into fatty acids. These pass through the intestinal walls into the portal vein, which is like their private passageway into the liver, the central processing plant of the body. After the liver works its magic, often repackaging these compounds into different forms, the new forms are released into the general circulation of the bloodstream, where they are transported t o cells and t issues to be either used or saved for a r ainy day.
As these smaller units pass through the portal vein en route to the liver, the pancreas immediately takes notice of the parade and responds by secreting our star player, insulin. It secretes some insulin in response to pro tein; but when it sees car bohydr ates in the passageway, its eyes lig ht up, and it bring s out the big g uns and go es to town. (Fat doesn’t even rate a “hello” from the pancreas and has no impact on insulin.) Under the influence of this incoming insulin, the liver does a number of things. Fir st, it decides how much of the sugar comi ng in is excess. It makes that decision based largely on how much insulin the pancreas has decided to send along to accompany the payload. If there’s a lot of insulin, the liver says, “Woo hoo, we’ve got a truckload of sugar on our hands; let’s get busy.” Some of the incoming sugar will pass right t hro ugh (as glucose) to the bloodstream to be transported to muscle cells—which can use a hit of sugar now and then for energy—and to the brain, which needs sugar (or ketones, which we’ll discuss in detail later) to think and do all the other good things that brains like to do. Part of the excess sugar will be converted t o the stor age fo rm of g lucose, called glycogen, much of wh ich
will stay right there in the liver. (Glycogen is also stored in the muscles, but muscle glyco gen is like a pr ivate bank account that can be used only by the muscle in which it is stored.) The liver doesn’t hold a lot of glycogen, so if there is still excess sugar, which there almost always is after a highcarbohydrate meal, it is packaged into triglycerides (fats found in the blood and in the tissues). The high level of insulin accompanying the highcarbohydrate meal stimulates the cholesterol-making machinery: the body starts churninginto outlittle morecontainers cholesterol, which it then(very packages (together with triglycerides) called VLDLs low-density lipoproteins), most of which eventually become LDLs (low-density lipopr oteins), or “bad” choleste rol. This is how a high-carbohydrate diet raises both t riglycer ides and cholestero l.
Whi ch Is W orse, Sugar or Fat? N o Contest! Why, you may ask, does the liver feel this compelling need to get rid of the excess sugar, anyway? Why doesn’t it just give it a pass and let it go into the bloodstream as is? Why create all this work for itself? Why bother to turn it int o trigl ycerides in the first place? That’s a very good question, and the answer is central to understanding the health effects of a lower-carbohydrate diet: sugar is far more damaging to the body than fat . In a very real sense, what the liver is doing is detoxifying sugar into triglycerides. As you just read, ea ting high-carb fo ods usually makes your cholestero l go up. Here’s why: insulin turbocharges the activity of a particular enzyme —with the unwieldy name of HMG-co enzyme A reductase, or HMG-CoA reductase—that runs the cholesterol-making machinery in the body. (Glucag on inhibits the HMG-CoA reductase enzy me, so yo ur body makes less choleste rol.) So high l evels of insulin basically signal the liver to ramp up the p ro duction li nes on choleste ro l, and high levels of sugar signal it to ramp up the pr oduction of trigl ycerides. (Interestingly enoug h, if you ate a diet of almo st 90% fat, your cholesterol numbers would probably drop, because there would not be enough insulin around to power the cholesterol-making machinery.) However, the American diet— high-fat and hig h-carbohydrate— virtually guar antees both high
cholesterol and high triglycerides. Your Honor, the body had motive, means, and opportunity . Motive—to g et ri d of the excess sugar. Means— fat and sugar. Oppor tunity—tons of i nsulin to dr ive the wor ks. Case closed: when there’s plenty of excess sugar and insulin around, trigl ycerides sky ro cket, and so does cholestero l. At this point, it may sta rt to o ccur to you that since sugar is made into trigl ycerides, t hen maybe one of the reasons bloo d levels of trig lycerides are n a lo w-carb is becausein t here’s less exc ess sugar coming in tol owered require opackaging intodiet triglycerides the first place. And you’d be absolutely, 100% right. (Cholester ol usually co mes down as well, but as you’ll see later, that doesn’t matter nearly as much.) This lowering of trigl ycerides is one o f the major health benefits of a lo w-carb diet—high trigl ycerides are far mo re o f a danger sign for heart disease than high cholesterol ever was. You may als o be thinking that t he higher levels o f fat that are fr equently (though not always) part of low-carb diet plans may not be so bad after all, if they’re not accompanied by the high insulin levels that go with highcarb diets. You’d be r ight on that count as well.
Insuli n Prevents Fat Los s
An important thing to remember just from a weight-loss point of view is that insulin isn’t only r esponsible for getting sug ar into the cells and out of the bloodstream: it’s also responsible for getting fat into the fat cells and keeping it there . Insulin actually prevents fat burning. That’s why a lowcarb diet usually produces mor e weight loss than a high-carb, lo w-fat diet with the same calorie count. By lowering insulin, you open the doors of the fat cells and all ow the body to r elease fat. One of the ways insulin interferes with fat burning is by inhibiting carnitine, an amino acid–like compound in the body that is responsible for escorting fatty acids into the little central processing units of the muscle cells, where those fats can be burned for energy. By inhibiting carnitine, insulin inhibits fat-burning. That’s one reason you shouldn’t eat a big meal befor e go ing to bed—t he resulting high levels of i nsulin virtua lly ensure that your body will no t be breaking down fat as you sleep, but inst ead will
be busy storing whatever is around in the bloodstream. (A side note: many years ago , an Ameri can health magazine de cided to do a weight-loss stor y on sumo wrestlers. The writers reasoned that the wrestlers knew everything there was to know about putting on weight, so if we could just learn what it was they did, we’d know what not to do if we wanted to slim down. One of the major ri tuals of the sumo wrestlers was eating a huge meal and then going right to bed.) So system—because o n a high-carbohydrate dieteventually , you’ve got all this sugar ming into your all carbs break down intoco sugar—and your liver can basically do o ne of three things wit h it: 1. Pass it right thro ugh and send it into the bloodstr eam 2. Transfor m it into g lycogen and st or e it (in the liver or the muscles) 3. Use it to make trig lycer ides Remember, as far as your body is concerned, the most important thing is to pr event blood sugar fro m getting too high. Your insulin may v ery well be able to keep y our bloo d sugar in the nor mal r ange, but the high level of insulin nee ded to do the job—plus t he high levels of trigl ycerides and VLDLs being created at the same time—are si lently laying the foundation fo r future damage: you are slo wly on your way t o becoming overweight and/or insulin-resista nt.
Insuli n Resistance: The Wo rst Enemy of a Lean Body Insulin resistance makes losing weight incredibly difficult and is a risk factor for heart disease and diabetes. It is not something you want, and you can do something about it. Here’s how insulin resistance develops: the muscle cells don’t want to accept any more sugar (this is especially true if you have been living a sedentary life). They say, “Sorry, pal, we’re full, we don’t need any more, we gave at the office, see ya.” Muscle cells become resistant the effects insulin. But fat doors, cells arand e still l istening to insulin’s song.toThey hear itof knocking on the their they say, “Come on in, the water’s fine!” The fat cells fill up and you begin to put
on weight. Meanwhile, back i n the bloo dstream, those little packages cal led VLDLs that we talked about earlier are car rying trig lycerides aro und trying to dump them. After the VLDL molecules drop off their triglyceride passengers to the tissues and the ever-expanding fat cells, most of them turn into LDL (“bad”) cholesterol. Now you’re overweight, w ith high tri glyceri des, high LDL cholestero l, and definitely levels of that insulin, which thethe pancreas keeps valiantly pumping o ut inhigh order to get sugar out of bloodstream. Fro m here, two scenario s are po ssible, n either of them goo d. In one scen ario , your hardworking pancreas will so mehow be ab le to keep up with the worklo ad and keep your bloo d sugar fro m getting hig h enough for you to be classified as diabetic. But you will be paying the price fo r that with high levels of i nsulin and t he increased risk factor s for heart disease that go with them. In the other scenario, your poor pancreas will eventually become exhausted—even its most valiant efforts to shoot enoug h insulin into the system won’t be adequate for the job. The sugar will run o ut of places t o g o, so it will stay in t he blood and your blood sugar levels will rise. Now you’ll have elevated insulin and elevated blood sugar, plus, of course, high triglycerides and abdominal obesity. If your blood sugar continues to rise even mor e, beyond the ca pacity of your insulin to r educe it, you’ll eventually have full-blo wn type 2 diabetes.
Welcome to fast-food nation.
What’s So Bad abo ut a Lit tl e Sugar? Obviously, the body knows how important it is to protect the tissues, the brain, and the bloodstream from excess sugar. So what exactly does sugar do that’s so damaging to the body that the body is willing to r isk the effects of large amounts of insulin and dangerously high levels of triglycerides ust to pr event it? Well, for one thing, excess sugar is sticky (think cotton candy and maple syrup). Proteins, on the other hand, are smooth and slippery (think oysters, which are pure protein). The slippery nature of proteins lets them slide around easil y in the cells and do their jobs effectively. But when excess sugar keeps bumping into proteins, the sugar eventually gums up the works and gets stuck to the protein molecules. Such proteins are now said to have become glycated. The glycated proteins are too big and sticky to get thro ugh small blo od vessels and cap illar ies, includ ing the small vessels in the kidneys, eyes, and feet, which is why so many diabetics ar e at risk for kidney disease, vision problems, and amputations of toes, feet, and
even legs. The sugar-coated proteins become toxic, make the cell machiner y run less eff iciently, damage the bo dy, and exhaust the immune system.4 Scientists gave these sticky pro teins the acr onym AGES—which stands for advanced g lycolated end-products—partially because these pro teins are so involved in aging the body. For another thing, high blood sugar is also a risk factor for cancer— cancer cells co nsume more g lucose than normal cells do. 5 Resea rcher s at Harvard Medical School suggested in the early 1990s that high levels of a sugar called galactose, w hich is r eleased b y the digestion of lactose in milk, might damage the ovaries and even lead to ovarian cancer. While further study is necessar y to definitively establish this l ink, Walter Willett, MD—chairman of the Department of Nutrition at the Harvard School of Public Health and one of the most respected researchers in the world— says, “I believe that a posi tive link between gal actose and o vari an cancer shows up too many times to ignore the possibility that it may be harmful.” 6 Sugar depresses the immune system. It makes the bloo d acidic, and certain white blood cells (lymphocytes) that are part of our immune system don’t work as well in an acidic environment. 7 A bloo d-sugar level o f 120 reduces the phagocytic index—a measure of how well immune-system cells gobble up bacteria—by 75%. 8 Since refined sugar comes with no nutrients of its own, it uses up certain mineral reserves of the body that are needed to metabolize it, which in turn throws off mineral balances and results in nutrient depletions. 9 (One of the minerals that refined sugar depletes is chromi um, which is need ed for insulin t o do its jo b effectively!) Since minerals are needed for dozens of metabolic operations, these mineral deficiencies can wind up slowing down your metabolism and creating havoc with your energy level. Finally, sugar reduces HDL, the helpful, “good” cholesterol, adding yet another risk factor for heart disea se to its résumé. 10 Is it any wonder that people dr astically impr ove their health when they switch to a diet lower in sugar?
Why Shoul d We Care a bout Hi gh Level s of Insulin?
Now you understand the problems caused by high levels of sugar in the blood. But what problems are associated with high levels of insulin ? See, insulin doesn’t just bring your blood sugar down, call it a day, and go home. It affects many other systems as well. Bringing in a huge amount of insulin t o fix the su gar pro blem is like impo rting twenty thousand wor kers to fix a broken power plant in your city. The city can’t run efficiently without electricity—hospitals are in danger, computers shut down, there’s no publicistransportation, and you At can’t cook. the prime of business to fix the emergency. first, city So officials aren’torder thinking about the effect of that influx of workers on the rest of the city’s business; they just want to get the immediate problem fixed. Yet all those workers are going to have a major impact: the roads will be overcrowded, pollution will increase, crime may go up, and there will be additional demands for housing and food. But the city is faced with a life-and-death situation, so it imports however many people are needed to fix the problem. The same thing happens when the body produces high levels of insulin to cope with high blood sugar: damn the torpedoes, full steam ahead—the body will wor ry about the consequences later.
Insulin and Heart Disease
One of insulin’s many effects on the body is to make the walls of the arteries thicker. It does this by encouraging growth and proliferation of the muscle cells that line those artery walls. Insulin also makes the walls stiffer, reducing the “flow space” inside and increasing blood pressure. Smaller arteries are also more prone to plaque. As we’ve seen, insulin also increases LDL cholesterol (the so-called “bad” cholester ol) in the blo od. But despite what you may have hear d, we don’t r eally car e about that until that LDL is depo sited on the lini ng o f the artery walls. In fact, we still don’t need to wor ry about it unless that L DL becomes damag ed. When it becomes damaged, then we have something to worry about. Damaged LDL attracts cells called macr ophag es, little PacMan–like cr eatures that come out to feast on the LD L like shar ks on a bleeding car cass. When LDL is no t damaged, the macro phages leave it alone, but as soo n as damage occurs, the macro phages zoom in and feed ,
gorging themselves until they’re full, at which point they’re called “foam cells.” These foam cells group together and make a fatty streak, the first step in the formation of plaque. How does the LDL get damag ed in the fir st place? By two pr ocesses— oxidatio n, the interaction with oxyg en that pro duces the same kind of “rusting” damage you see when you leave a cut apple out in the air; and glycation, bumping into s ticky sugar. We just discussed how gl ycolated pro teins cause all sor ts ofand damage in theLDL bodyattracts . This macrophages same process like o f red glycation damages LDL, damaged flags attract bulls. So insulin incr eases the amount of LDL in the system, and exce ss sug ar damages the LDL, leading ultimately to plaque. If this wer e not eno ugh to increase your r isk for heart disease, you’re also go ing to have lowered levels of magnesium, a mineral that is absolutely essential for the health of the heart. Why is your magnesium level lowered? Because insulin, in addition to stor ing sugar and fat in the cells, is also responsible for storing magnesium, so when your cells become r esistant to insulin, you lose the ability to store some of that magnesium. Magnesium relaxes muscles, including those in the arterial walls. When you can’t store magnesium, you lose it and your blo od vessels const ri ct, causing a fur ther i ncrease in blood pr essure. The loss o f magnesium can also lead to heart arr hythmia and other car diac problems. 11 And be cause magnesium is r equired for virtually all energy production that takes place in the cells, you may also find yourself with lowe r energy to bo ot.
How Does a Low-Ca rb Diet Lower Your Risk of Heart Disease? There are numerous ways in which a low-carb diet can significantly lower your risk for heart disease. Lowering your insulin levels is certainly one of the most important. Raising your HDL (“good” cholesterol) is another. A third—the importance of which it is difficult to overstate—is by lowering triglycerides. Researchers from the cardiovascular divisions of Brigham and Women’s Hospital and Harvard Medical School, in a study led by J. Michael Gaziano, looked at various predictors for heart disease
and found that the ratio of triglycerides to HDL was a better predictor for heart disease than anything else, including cholesterol levels. They divided the subjects into four groups according to their ratio of triglycerides to HDL and found that those with the highest ratio (i.e., high triglycerides to low HDL) had a sixteen times greater risk of heart attack than those with the lowest ratio (low triglycerides to high HDL). 12 There’s mor e. Most of us are f amiliar with “go od” cholesterol (HDL) and cholester ol (LDL), but what not asvery welldifferently kno wn is that types“bad” of cholesterol have sub-parts that is behave fromboth one another. What kind of LDL you have turns out to be much more important than just the amount of LDL you have (an LDL-gr adient-gel electrophoresis test is now widely available to tell you about your LDL). For example, LDL cholesterol comes in two basic flavors: it can be a big, fluffy, cotton ball–like molecule (LDL-A type), or it can be more like a dense, tight BB-gun pellet (LDL-B type). The big , fluffy LDL-As are pretty harmless. They are far less likely t o become o xidized or damaged an d cause pr oblems . But the little LDL-Bs are a differ ent stor y. Those ar e the ones that cause problems, and those are the ones you should be concerned about. The Gazian o study found tha t high trig lycerides cor relate stro ngly with high levels of the dangerous LDL-B particles, and low levels of triglycerides correlate with higher levels of the harmless LDL-As. In other words, the higher your triglycerides, the greater the chance that your LDL cholesterol is made up of the B-particles (the kind that is way more likely to lead to heart disease). The take-home point: reduce your triglycerides (and raise your HDL), and you r educe your ri sk of heart disease .
Insuli n and Hy pertension As you saw in the previous paragraphs on heart disease, high levels of insulin can narrow the arterial walls which, in turn, will raise blood pressure, since a more forceful pumping action is required to get the blood through the narrower passageways. But there’s an even more insidious way in w hich insu lin r aises blood pressure. It talks to the kidneys. Insulin’s messag e to the kidneys is this: hold on to salt . Insulin makes the
kidneys do this even if the kidneys w ould much prefer not to. Since sodium, like sugar, is controlled by the body within a very tight range, the kidneys fig ure, “Listen, if we have t o ho ld on to all this salt, we’d bet ter bring on more water to dilute it so that it stays in the safe range.” And that’s exactly what they do. Increased s odium retention results in incr eased water retention. Mor e fluid means more blo od vol ume, and mor e bloo d volume means higher blood pressure. Fu lly 50% of people wit h 13
hypertension resistance. Insulin willhave also insulin ultimately raise adrenaline, and adrenaline will raise both blood pressure and heart rate. We’ll discuss the insulin–adrenaline axis a little more, under the topic of obesity in the next section.
How Does a Low-Carb Diet Lower Your Risk of Hy pertensi on? Lowering insulin levels will intercept the message to the kidneys to hold on to salt. You will almost immediately lose water weight, and bloat and blood pressure will go down. Lowering insulin is actually such an effective strat egy fo r lowering blood pr essure tha t it sometimes works too well too fast. In rare cases, your blood pressure might dip too low, and you may experience lightheadedness or dizziness upon standing up. This is why some clinicians recommend increasing salty foods or adding a teaspoon o f salt to your foo d on a daily basis if you f ind this happening to you.14 When the kidneys dump excess sodium, potassium so metimes gets caught in the crossfire and you wind up dumping potassium as well. This is even truer if yo u exerci se and sweat a lot. You do n’t want to lose to o much potassium, because that ca n cause muscle cr amps, fatigue, and breathlessness. This is why I alw ays recomm end potassium supplements, especially during the first week of a low-carb diet, and particularly when you ar e on o ne of the very r estri cted carbohydrate plans su ch as the induction phase of Atkins or the first two weeks of Protein Power. Potassium supplements come in 99-milligram tablets, and you can get them at any drugstore or healthfood store. Take one or two at each meal. Foods r ich in potassiu m, such as liver, brocco li, and av ocados, are also a good idea, as is using over-thecounter salt substitutes like Morton’s Lite Salt or NoSalt, which are both potassium salts.
Insuli n and Obesity The connection between a high-sugar diet, high levels of insulin, and becoming overweight or obese should be painfully obvious by now. The more sugar—i.e., carbohydrates—you take in, the more sugar you need to store and the more your insulin levels rise. The more your insulin levels rise, the less fat you burn and the more sugar you store in fat cells, along with those from excess The more you extra store,triglycerides the fatter that you the get.liver Themade fatter you get, sugar. the more insulinresistant you become. When there are consistently high levels of insulin floating around, the body will put out more cortisol and adrenaline (the “breakdown” hormones) to counteract the “building-up” effects of insulin and to attempt to bring the body back into balance. Cortisol in part breaks down muscle, further r educing your metabolic r ate. Too much adrenaline can ev entually lead to even more insulin, as insulin will eventually be secreted to combat the effects of too much adrenaline! The interaction of insulin and cor tisol/adrenaline is the particular aspect of lo w-carbohydrate dietin g central to the metabolic healing work of Diana Schwarzbein, who feels that this kind of constant imbalance—often brought on by yo-yo dieting, high levels ofIfstress, dietparticular high in sugar—ultimately damages the metabolism. gettingand offathis seesaw sounds interesting to you, be sure to read about the Schwarzbein Principl e in chapter 7. Even if you don’t remember the basic biochemistry discussed here, tattoo the fo llowing on the inside of your eyelids: insulin is the fat-storage hormone. It is also the hunger hormone. When it finally does its job of lowering bloo d sugar, it causes blood sugar to go really low, setting you up for a cycle of cr aving (and eat ing) mo re high-carb fo ods. Result: higher blo od sugar, mor e insulin, and more fat st or age as the cycle continues.
How Does a Low-Carb Diet H elp You Lose Weight? When you eat a lower-carb diet, you stimulate less insulin but you also stimulate more glucagon, its sister hormone, which responds to protein (remember that neither hormone is stimulated by fat). more Glucagon liberates the fat from storage sites and gets it ready to burn for energy.
Meanwhile, since you no longer have elevated levels of insulin, you are not suppressing carnitine, which, you may remember, is the compound in the body r esponsible for escor ting fat into the central fur naces o f the cells, where it can be burned for fuel. Along wit h insulin an d glucago n, a pair of enzymes play s a major ro le in the whole fat-storage/fat-release equation: lipoprotein lipase and hor mone-sensit ive lipase. Lipopro tein lipase is r esponsible for storing fats: it breaks triglycerides in the shoves acid parts intodown fat cells. People who are bloodstream trying to loseand weight arethe notfattyfond of this enzyme. It’s very per sistent; in fact, w hen people l ose weight, the activity of lipoprotein lipase is ramped up, almost as if the body is fighting to hold on to fat. This is one of the reasons it’s so difficult to keep weight off. (Lipoprotein lipase is also suppressed when you smoke and increases when you stop smoking, one of the reasons people usually put on a few pounds when they fir st give up cig arettes.) Hormone-sensitive lipase, on the other hand, reaches into fat cells and releases fatty acids into the bloodstream when they are needed—for example, if you’re doing a lo ng aero bic exercise session and your leg s need some fuel . Its ability to li berate fat is r eally intense. Consider this: there’s a protein called perilipin that shields fat from the fat-burning effects of ho rmonesensitive li pase. Mice that don’t have any peri lipin to protect their fat from hormone-sensitive lipase don’t get fat, no matter what they eat!15 The f atburning effect of hor mone-sensit ive lipase is that intense. Insulin and glucagon have profo und effects o n both lipopr otein lipase and hor mone-s ensitive lipase. C an you g uess what effects they have? By now it should come as no surpr ise: insulin stimulates lipopr otein lipa se (the fat-storing enzyme) and inhibits hormone-sensitive lipase (the fatreleasing enzyme). If you want your fat cells to let go of fat, you want all the hormone-sensitive lipase activity you can scrounge up—you certainly don’t need high levels of insulin turning down the volume. Glucagon, on the other hand, has exactly th e opposite eff ect on these enzymes. I t inhibits the fatstoring enzyme and stimulates the fat-releasing one. This is just one more way that restoring a healthy balance between insulin and glucagon helps you to lose weight.
Fat Cells Know H ow to Protect Their Existence! When you do lose weight, you st ack the hor monal deck in your favor even mor e. We used to believe that fat cells wer e iner t little sacks o f blubber that basically didn’t do anything metabolically—they just took up space and held on to a gazillion calories’ worth of energy that never got burned up fast enoug h. We now kno w that fat cells ar e anything but inactive. They ar e actually endocrine that release host of hormones—including estrogen—and otherglands substances that cana have a profound effect on our weight. Many of the hormones that are released by the fat cells have one major purpo se—to keep those fat cells in business! In this way, you mi ght say that fat actually per petuates its own existence by releasing hor mones that make it harder fo r the body to g et rid of it. One of the hormo nes released by fa t cells is resistin . The more fat cells you have, the more resistin gets released into your body. Mice given extra dosages of resistin develop insulin resistance in two days; 16 and, as we’ve ust seen, insulin resistance is a major obstacle to fat loss. Another substance released by the fat cells i s TNF-alpha 1, also kno wn as tumor necrosis factor. This is a good guy: it’s part of the immune system’s arsenal, and, as you can tell by th e name, it’s invol ved in destro ying tumor s. But TNFalpha 1 is also found in fat tissue, and in the circulato ry system it appears to act like a ho rmone. In low amo unts, it inhibits the ability of insulin to lower bloo d sugar, essent ially making insulin’ s jo b harder to accomplish and thereby forcing the pancreas to put out even mor e insulin t o g et the job done. 17 Once again, a hor mone-like compound released by the fat cells raises insulin and makes fat loss difficult. As you can see, the fat cells themselves contribute to the difficulty in losing weight by releasing substances that offer “fat-protection insurance”—chemicals that, in essence, help your fat cells stay in business. By lowering your fat stores with a low-carbohydrate diet , you will also lower the amounts of these fat-protecting substances in the bloodstream.
A Low-Carb Diet Helps Reduce Insulin
Resistance When you are i nsulin-resista nt, your cells stop making insulin r eceptors to impor t sugar and fat in to the cells. This pro cess is called down-regulation. Receptors are like job recruiters. When the market is flooded with unemployed workers, companies don’t have to go hunting for job applicants, because there are so many knocking at the door. When you’re insulinresistant, you’ve hellfigofurea there’s lot ofenough insulin—applicants— knocking at t he cell doo r.got Theacells insulin hanging around, beating on the doors, so they stop sending out “recruiters” to the surface of the cells. When you bring your insulin down with a low-carb diet, suddenly there’s not so much insulin banging at the doors of the cells. Now you begin to lose weight. Eventually, the cells start to send up more receptors to bring in the fuel, a pro cess called up -regulation. The cells ar e now gradually becoming more insulin- sensitive —a condition you most decidedly want. Insulin sensitivity always impr oves when you l ose weight. There ar e other ways in wh ich a lo w-carb l ifestyle will help you lose weight. One way has to do specificall y with pro tein itself, which is usually mor e plentiful o n lower-car b diets. Pro tein has less of an effect on insulin, has a gr eater effect on glucagon, and increases meta bolic r ate considerably morplay e than carbo do. Sp ecificpapers amino by acids found in protein may also a role in hydrates weight loss. Several D. K. Layman demonstrated greater body-fat loss on a high-protein diet than on a high-car b diet,18 and in one paper he argued that leucine—an amino acid —may be one of the reasons.19 Other studies have also suggested the possible role of specific amino acids in weight loss. In one animal study, a diet deficient in the amino acid lysine resulted in the accumulation of larger amounts of fat both in the bodies of the animals and in their livers. 20 Increasing th e pro por tion of pr otein to car bohydrate s appears to be more satiating during weight loss—it makes you feel fuller. 21 And metabolic rate, technically called thermogenesis—the heat production in our bodies fr om bur ning calor ies—is turned up aft er eating pr otein. In one study, thermogenesis was 100% higher with highprotein meals—even 2½ hours after eating—in young, healthy women. 22 You may have heard that it is easier to stay on a low-carb diet than it is
to stay on a traditional high-carb, low-fat diet. Let me say one word about that: appetite . A low-carb diet co ntains built-in appet ite contr ols—it’s like having your own little diet pill built into the meals. Here’s how it works. One of the major hor mones involved in te lling the brain that you are full is cho lecystokinin (CCK ), which is secr eted in the intestines in r esponse to a meal. (You may have also heard, co rrectly, that it takes about twenty minutes for this hor mone to r each your br ain and tell you that y ou’ve had enough—an otherweight!) r eason to listen t o yo g randmother and part eat slowly you want to lose But here’s theurthing: CCK, being o f o ur if ancient digestive system, recognizes protein and fat very well because they’ve been the mainstay of our diet for as long as the human genus has been on the planet. But CCK does not r espond ve ry well to car bohydrate s. It barely recognizes them! That’s why it is so easy to overeat carbs—you really have no idea when you’ve had enough.
Insuli n Resistance and Diabetes Insulin resistance is a huge risk factor for the development of both heart disease and diabetes. 23 Eighty percent of the 16 to 17 million Americans who have diabetes are insulin-resistant. 24 Dr. David Leonardi, founder of the Leonardi Medical Institute for Vitality and Longevi ty in Denver, insists that insulin resistance is reversible and that many type 2 diabetics can be cured. He says: “Diabetics die from diabetes complications, all of which are a direct or indirect result of high blood sugar . Normalizing the blood sugar prevents disease, normalizes life expectancy, and profoundly enhances quality of life. Cured or not, they’re winners either way.” In case you hadn’t noticed by now, low-carb diets ar e all abo ut normalizing blood sugar. Insulin resistance is reversible. And it’s hardly a rar e phenomenon. The pr evalence of insulin resistanc e has skyro cketed 61% in the last decade alone, according to Daniel Einhorn, MD, co-chair of the AACE Insulin Resistance Syndro me Task For ce and medical director of the Scripps Whittier Institute for Diabetes. 25 In fact, the prevalence of insulin esistance pro bably bee n underest om the beginning. GeraldrReaven ofhas Stanford University did theimated srcinalfrwork on i nsulin r esistance in the 1980 s. Here’s how he appro ximated the number
of people who were insulin-resistant: He divided his test population— nondiabetic, healthy adults— into quar tiles and tested their ability to metabolize sug ar and carbo hydrates. He found that while the top 25% o f the population could handle sugar just fine, the bottom 25% could not— they had insu lin r esistance (or, in the pa rl ance of r esearchers, impair ed glucose metabolism). So for a long time, it was thought that the number of people with insulin resistance was one in four. But a problem. Whatthere’s happened to the 50% o f the peopl e between those two extremes? It turns out they had neither the terrific glucose metabolism of the top 25% nor the full-blown insulin resistance of the bottom 25%; instead, they fell somewhere in between. One coul d easily ar gue that since only 25% of the population had flawless glucose metabolism, the rest of us—up to 75% of the population—have some degr ee of insulin resistance ! Remember, too, that Reaven used young, healthy adults as subjects, an d their numbers are definitely not representative of the population as a whole—the fact is, insulin sensitivity actually decreases as you get older. The take-home point: insulin resistance isn’t just something that happens to other people. Recently, the American Association of Clinical Endocrinologists estimated that one in three Americans is insulin-resistant. 26
DIABETES AND COMPLICATIONS
• 80 percent of diabeti cs are insulin-resistant. • 2,200 people are newly diagnosed each day. • Diabetes is the seventh leading cause of death in the United States. • 60–70 percent of diabetics have mild to severe forms of nerve damage. • Diabetes is the leading cause of lower-extremity amputations in the United States. • 86,000 amputations a year are related to complications from diabetes.
• The five-year mortalit y rate aft er amputation is 39–68 per cent. • Diabetics are two to four times more likely to have heart disease. • Heart disease is present in 75 percent of diabetes-related deaths. • Diabetes is the leading cause of new cases of kidney disease. • Diabetes is the leading cause of new cases of blindness in adults. • Each year, 12,000–24,000 people lose their sight because of diabetes. Source: American Podiatric Medical Association, American Diabetes Association, CDC, American Association of Diabetes Educators, and National Diabetes Educational Program There are approximately 17 million diabetics in the United States, of which 5.9 million are not yet diagnosed. 27 Approximately 80% of them are insulin-resistant. Even if you are insulin-resistant and somehow manage to dodge the diab etes bullet, you ar e still at serio us ri sk for heart disease . Being o verweight (h aving a body mass index of gr eater than 25 or a waistline of gr eater than 40 inches for men, 35 inches for women) is a risk factor for insulin resistan ce—a big o ne. So ar e hypertension (high bloo d pressure), elevated triglycerides, and low-HDL cholesterol. 28 It’s estimated that 47 million Americans have some combination of these risk factors. 29 As you have seen in this chapt er, all o f them are r elated to insulin, and virtually all of them improve substantially on a low-carbohydrate diet .
How a Low-Carb Diet May H elp Prevent—or Even Reverse—Diabetes Dietary treatment for diabetes is currently one of the hottest topics of debate in the diabetes community.30 Some factions are passionately holding on to the old recommendations of a high-carb diet, while other clinicians are making strenuous arguments for lower-carb, higher-fat, higher-pr otein diet s.31 The precise dietary treatment for full-blown type 2 diabetes is beyond the scope of this book, though it is a fascinating subject and in my opinion has great relevance for nondiabetics as well. What can we say for sure? A number of studies have shown that people on low-
carbohydrate diets experience increased glucose control, reduced insulin resistance, weight reduction, lowered triglycerides, and improved cholesterol.
Excess Insuli n and PCOS One in ten women has polycystic ovary syndrome (PCOS), the most common reproductive abnormality in premenopausal women, which puts them at high risk for both cardiovascular disease and diabetes. 32 One of the major biochemical features of PCOS is the combination of insulin resistance and hyperinsulinemia (elevated insulin levels). The ability of obese women with PCOS to use glucose is significantly impaired, and they have a marked reduction in insulin sensitivity. 33 When we talk about insulin r esistance, we often for get that not all tissues and cells become resistant at the same time, and some do not become resistant at all. For example, over weight people may—at least in th e beginning—have very nonresistant fat cells. Their muscle cells refuse to take any more sugar, but the fat cells still have open arms. These cells are said to be insulin-sensitive. The ovaries also tend to remain insulinsensitive. If there’s a genetic predisposition for these glands to overpr oduce and rog en hor mones—as t here is with women who have PCOS—the that’ s sent into the in bloo deal with excess sugarexcess bathesinsulin these nonresistant tissues an dstream ocean oftoinsulin that the is way too much for their needs. One of the responses to all that insulin hitting the ovaries is that they produce even more testosterone and andro stene, which leads to hai r loss, acne, obesity, infer tility, and other symptoms of PCOS.
LOW-G LYCEMIC DIET AND DIABETES
Low-glycemic foods—beans, peas, lentils, pasta, rice boiled briefly, and breads like pumpernickel and flaxseed—do a better job of managing glycemic control for type 2 diabetes and risk factors for coronary heart disease than diets based around the “traditional” highfiber foods such as whole-grain breads, crackers, and breakfast cereals.
That’s the finding of a 2008 study published in the Journal of the American Medical Association.* Althoug h the American Dietetic Associ ation co ntinues to mindlessly parr ot the “conve ntional” wisdom about whole-gr ain breads and cereals, the truth is that most of these whole-grain products are fiber lightweights. (Read the label—whole grains typically offer 1–2 grams of fiber at best, compared to 11–17 in a cup of And you check between the glycemic index/glycemic tables, youbeans.) find that theif difference a processed grain likeload white rice and its whole-g rain counterpart (bro wn rice) is—fro m a blood-sugar point of view—a lmost neglig ible. Obvio usly, whole g rains ar e better than white junk, but only because they contain slightly more vitamins and other nutrients. From a bloodsugar—and from a food-sensitivity or allergy— standpoint, they’r e not that much of an i mprovement. If you’ve go t a gluten sensitivity—which is way more common than you might think —whole grains will be just as much a problem for you as the pro cessed kind . In the JAMA study, researchers found that hemoglobin A1c—a very impor tant marker fo r diabetes—decreased significantly more in subjects on the low-glycemic diet than it did for people eating the “traditional hig h-fiber” choices with cereal fiber. The low-glycemic gr oup also saw a significant increase in HD L (the so-called “go od” cholesterol) as well as a significant reduction in LDL (the so-called “bad” cholesterol ). The lo w-glycemic diet gr oup did eat some breads—like pumpernickel, rye pita, and quinoa bread with flaxseed—and some cereals—like r eal o atmeal—but they were all low-glycemic. Bottom line: just because a cereal or bread product says “made with whole g rains” doesn’t mean it’s t he best food f or you. Many of these products raise your blood sug ar to a level that is way too high, and manufacturer s ar e notor ious at trading o n the “whole g rain” buzz to cr eate r idiculous pro ducts like “whole gr ain Cocoa Capt ain Sugar Krispi es” (I made that one up, but you g et the poi nt). Glycemic i mpact is very i mpor tant and should be paid atten tion to
by anyone interested in his o r her heal th. And you do n’t have to walk aro und with a bunch of scientific for mulas to figur e out whether a foo d has high or low glycemic impact : just loo k for foo ds that have minimal pro cessing, maximu m colo r (the exception is o atmeal and cauliflower), and as much fiber as possible. * David
J. Jenkins, Cyril W. Kendall, Gail McKeown-Eyssen, et al.,
“Effect of aJournal lowglycemic or a Medical high-cereal fiber diet on 2 diabetes,” of the index American Association 300type (2008): 2742–2753. Interestingly, those affected with PCOS often have r elatives with adultonset diabetes, obesity, elevated triglycerides, and high blood pressure. 34 Sound familiar? This is why a low-carb diet is the dietary treatment of choice for PCOS. It’s a common enough problem that many of the community bulletin boards on the low-carb sites listed in the Resour ces section have specific ar eas for PCOS.
Excess Insuli n and Inflamm ation Essential fatty acids, notably members of the omega-6 and omega-3 family, are the parent molecules for an entirely different group of fascinating hormones called eicosanoids. Eicosanoids, formerly called prostaglandins, live in the body for only seconds and act on the cells that are in their immediate vicinity—they don’t travel in the bloodstream. They are very, very powerful modulators of human health. Like many other systems in the body, t hey need to be in balance. Sometimes, as a sho rthand, we’ll talk about “good” eicosanoids (the prostaglandin 1 series, or PG1), which inhibit clotting, promote vasodilation, stimulate the immune response, and are anti-inflammatory, versus the “bad” eicosanoids (the prostaglandin 2 series, or PG2), which have the opposite effects, promoting clotting, constriction, and inflammation. But this shorthand is not completely accurate, as you need a balance of the two. For example, if you clotted too much and too easily, you could have a stroke; but if you didn’t clot at all, you’d bleed t o death fr om a hemor rhage! Here, too, insulin leaves its mighty footprint. Insulin inhibits a critical
enzyme called delta-6 -desaturase, which is r esponsible for directing tr affic into the pro duction l ine for the “go od,” anti-inflammat or y eicosanoids. Inflammation has been implicated in a host of conditions, from heart disease to Alzheimer’s to arthritis to food allergies. In fact, the modulation of insulin for the purpo se of control ling eicosanoid pro duction and reducing the risk of heart disea se was the major reaso n for the development of the Zone diet by Barry Sears. If you’re interested in learning more about this diet, be sure to read about it in chapter 7. Excess Insuli n and Aging “If there is a single marker for life span,” asserts Dr. Ron Rosedale, author of The Rosedale Diet , “it’s insulin sensitivity.”35 He’s right. In 1992, researchers collected data on people who were both mentally and physically fit and were at least a hundred years old. The researchers looked carefully to find the factors these folks might have in common, the ones that could be predictors for a long and healthy life. They came up with three. The first was low triglycerides. The second was high-HDL cholesterol. Can you guess the third? A low level of fasting insulin! 36 You’ve learned in this chapter how a lower-carbohydrate diet almost always improves all three of these variables. Since this kind of diet is what our ancestors ate for eons, it ering makestosense that we would live the longest and stay the healthiest by adh it. By the way, the only dietary str ategy sho wn to actually increase life span in labor ator y animals has bee n calor ie r estri ction. When we humans try calor ie r estriction on a standard high-car b, low-fat d iet, we gener ally hate it—we’re hungry all the time. With a diet higher in protein, higher in fat, and lower i n carbo hydrates—and high i n fiber—we’re mo re satiated and our appetite is much mor e under control. In sulin—the hunger hor mone— is no long er o ut of contro l, blood sugar i s manageab le, and weight becomes s tabilized. We can actually wind up eat ing fewer cal or ies and feeling mo re satisfied in t he bargain. That ’s a recipe for an anti-aging, health-producing diet without creating cravings or hunger pangs.
Swi tching to a Fa t-Burning Metabolism: The Meaning of Ketosis
When you g o on a lo w-carbohydrate d iet, you r estri ct the amount of sugar coming into your system. That’s a good thing. But what happens when there’s a severely reduced amount of sugar coming down the pike? What does the body use for fuel?
SENIOR MOMENT? MAYBE IT’S YOUR BLOOD SUGAR !
Is the phrase “I ’m having o ne of those senior moments” b ecoming an increasingly common utterance? New resear ch suggests tha t it might be r elated to your sugar levels. The research, published in the December 2008 Annals of Neurology,* focused on a particular section of the hippocampus—an area o f the brain associated w ith memor y and learning. This section —the dentate gyrus—is typically affected by changes seen with aging. “In this study, we were able to s how the specific ar ea of the brain that is impacted by ri sing bloo d sugar,” said Sco tt Small, MD, the lead r esear cher on the study, which was par tly funded by the National Institute o n Aging. Usin g special high-r esolution br ain imagi ng, Small and his t eam found th at rising bloo d sugar was dir ectly associ ated with decreased activity in the dent ate gyr us. The r esult: you for get where you put your keys! The important point here is that the research strongly suggests that keeping blo od sugar under control could be th e key to prevent ing “senior moments” and lapses in memory, even in healthy individuals with no hint of di abetes! “Our findings suggest tha t maintaining bloo d sugar levels, ev en in the absence of diabetes, could help maintain aspects of co gnitive health,” said Small. Two o f the most e ffective measu res to manage blo od sugar are exercise and a controll ed-carb diet ! *
S. A. Small, Annals of Neurology, December 2008; online edition
The body does have basic glucose (sugar ) r equirement s. The brain, fo r example, needs about 150 to 200 grams of glucose daily. If you’re eating only about 20 grams of carbs a day—probably the lowest amount you would consume o n the first phase of the strictest diets—where does the other 130 t o 180 gr ams of g lucose come fr om? Equally important , where does the body g et the rest of the fuel it needs for its many other metabolic activities, such as exercise and breathing? Well, the body gets sugar m a pr ocess called gluconeogenesis , a is word that literally means “thefrocreation of new sugar.” Gluconeogenesis a metabolic pr ocess by w hich sugar is created from noncarbohydrate sour ces. For example, the body will make sugar by using the glycerol molecule in trig lycerides (making sugar fro m fat). It will also make some sugar from pro tein (e.g., from certain amino acids). And here’s t he really go od news for the over weight perso n: if carbohydrates in th e diet are sufficiently limited, the majority of the fuel the body needs for its day-today operations will come fr om fat, spec ifically fr om a br eakdown product of fat called ketones . The body loves ketones. The heart works fine on them, and so does the brain. Here’s how they work. Fats are oxidized, or broken down, by a process called beta-oxidation, in which the long chain of carbons that constitutes a fatty acid is split into pairs of two carbon molecules each, called acetyl fragments. These acetyl fragments join with a compound called CoA (coenzyme A) to form the appropriately named acetyl CoA. Incidentally, acetyl CoA is als o the end pro duct of the breakdo wn of carbohydr ates, so both car bohydr ates and fats eventually wind up as acety l CoA. When there are enoug h carbs in the pipeline, th e acetyl CoA do-si-do ’s into so mething call ed the Krebs cycle, in which the acet yl CoA is burned for energ y. But if there’s not eno ugh sug ar, acetyl CoA doesn’t get its allaccess pass into the Krebs cycle. I nstead, it accumulates at the doo r and eventually turns i nto three ketone bodi es (fir st acetoacetic acid, then betahydroxybutyric acid and acetone, for the science-minded among you). Most o f these ketone bo dies ar e sent to the tissues—including the hear t and brain—to be used for energy, and some are excreted in the urine and breath. This i s what the low-carb di ets that stress ketosis ar e talking abo ut when they speak of changing fro m a sugar -burning metabolism to a fat-
burning metabolism. Ketones are the by-product of fat breakdown. Ketosis—which happens when there ar e enoug h of these ketones to be detectable in the urine—is a topic of such misunderstanding, controversy, and criticism that it will get a much fuller discussion later on. For now, let’s just say that this process is a part of normal metabolism and is not—I repeat, not—dangerous. Ketosis is not necessary for weight loss. You could be in ketosis and not lose just stored as you fat could ht bodies withoutmade beingfrom in ketosis . You won’tweight, burn your (andl ose the weig ketone it) if you have a surplus o f fuel coming into the pipeline from the foo d you’re eating. If you’re eating 10,000 calories of fat and no carbs, you’ll definitely be producing a ton of ketones, but you won’t lose a pound. However, if you are eatin g a mo derate number o f calor ies and you are in ketosis, it is a g oo d sign that you ar e burning fat and n ot sugar as your primary energy source. If you switch to a higher -fat, higher -pro tein, lower-car b (and higherfiber !) diet, you won’t hav e enough sugar coming in to burn as fuel, and your body will have to make its own, mostly from fat and certain amino acids, and/or happily use ketones as fuel. If calo ri es ar e at reasonable levels at this point—which they probably will be because you’ll be a lot less hungr y and have a lot fewer cr avings—you w ill l ose weight. You will also improve your blood-lipid profiles (lower triglycerides, higher HDL) and your insulin sensitivity. Not only will you get slimmer, but your risk for heart disease, diabetes, and hypertension will plummet. Not a bad deal, right?
How a Low-Ca rb Diet Keeps You Heal thy and Slim We’ve talked about what sugar does to the body and why eliminating it is such a good idea. Obviously, a low-carb diet removes a great deal, if not all, of the refined sugar you’ve probably been eating. The health benefits of thissubst reduction a low-carb remove two other ances are thatenormous. are a hugeBut pr oblem, albeitdiet for can veryalso differ ent reasons. One is tr ans-fats. The o ther is wheat.
The subject of trans-fatty acids is one of the hottest topics in nutrition today and has been the center of a great deal of debate in the area of public policy regarding food and food labeling. It has been discussed extensively elsewhere, particularly in the writings of Dr. Mary Enig, a lipid biochemist widely considered to be the leading authority on trans-fats in the country, if no t the wor ld. For now, let’s just say that in the opinio n of m any experts, saturated fats have go tten a r aw deal and have in fact been blamed for damage do ne, ol, for pro thebably most way part, mor by trans-fats. We know r aise LDL cholester e than saturated fatsthat do, trans-fats and that these 37 damaged trans-fats actually increase the risk for type 2 diabetes. They also l ower HDL choleste ro l and r aise the risk for heart disea se. A prediction was made in th e pr estigio us medical jour nal Lancet as far back as 1994 that trans-fats would turn out to be a major factor in insulin resistance; 38 that was the same year that the Center fo r Science in the Public Interest petitioned the FDA to r equir e that Nutritio n Facts labels disclo se amo unts of trans- fat. On July 10, 2002, th e National Academy of Science’s Institute of Medicine is sued a r epor t that concluded that “t he only safe intake of trans-fats is zero.” After much hemmi ng, hawing, and stalling, the FDA finall y mandated that trans-fat co ntent be listed o n fo od nutrition l abels, a r uling that went into effect in 2006. The intelligent low-carb diet is almost always naturally low in transfats, which may be one of the many reasons i t can impart such health ben efits. Consider this: the top sour ces of trans-fat s ar e baked goo ds, muffins, cakes, cookies, doughnuts , gr anolas, crackers, pies, fast food, fr ench fries, anything deep-fried, partially hydrogenated vegetable oils, and most marg arines. The intelligent low-ca rb diet naturally contains almo st none of these foods—or, if it does, th ey are pr esent in extraor dinarily lo w amounts. The health benefits of this fact alone ar e incalculable.
After learning of the dangers of trans-fats, I began avoiding fast-food lunches—it’s better for me and my kids. —Gina D. The other i ngr edient that is either missing in action or has an extremely low profile on the low-carb diet is wheat. Now, most people are probably under the impression that wheat and grains are “good” for you. Maybe;
maybe not. Certainly, foods made with whole gr ains—which are far harder to find than you might think and most certainly do not include most commercially available “wheat breads”—are better than foods made with the refined g rains that constitute the vast majo rity of g rains we eat. But gr ains, particularly wheat , have a high pro pensity for turning into sugar quickly, and wheat is also one of the foods most likely to be implicated in foo d sensitivities.39 At one po int, it was believed that ce liac disease—an intoler ance of 1gluten, which is found in most ains—was y rar affecting only in 1,700 people. Estimates aregrnow runningfairl closer to e, 1 in 40 85, with some estimates as high as 1 in 33. And this doesn’t include the hard-to-estimate number of people who have delayed food sensitivities, very often to grains in general or at the very least to wheat. A recent book by clinician James Br aly sugg ests that gluten insensitivity may affect tens of millions of Americans. 41 Dr. Joseph Mercola, medical director of the Optimal Wellness Center in Illinois, contends that grains—along with starches and sweets—trigger a “hormo nal cycle of gr ain and sugar addiction, weight gain, a nd diabetes.”42 And numerous studies link carbohydrates that have a high glycemic load—the tendency to turn into sugar quickly—with increased risk of coronary heart disease 43 and with risk o f type 2 diabetes.44 Most high-glycemic pro cessed grains fall into this catego ry, but these gr ains are virtually eliminated on low-carbohydrate diets.
Insulin: The Smoking Gun Controlling insulin is the number one priority of all low-carb diets. The dietary approaches discussed in chapter 3 differ o nly in how they go about accomplishing it—w hat degr ee of carbohydrate r estriction the y believe is necessary to successfully control insulin, whether they emphasize protein or fat (or both) in the diet, what kinds of fat they recommend, other aspects of metabolism they stress, and whether or not they include a component on emotional eating and holistic self-care. Once you under stand what runaway insulin levels and unreg ulated sugar metabolism in general can do to your health, it’s easy to understand why cor recting those imbalances brings about not only weight loss but a myriad of wonderful health benefits.
In chapter 7, we’ll explore exactly how a number of popular diet plans approach the issu e of insulin control, and you’ll be able to determine which one is best for you. But fir st, let’s dispel a few myths about fat, cholesterol, and health.
CHAPTER 3
Fat, Cholesterol, and Health: Have We Been Misled?
Fat is the Rodney Danger field o f the moder n diet: it “don’t get no respect.” For years we tried to eli minate it fro m what we eat, even thoug h it’s been a basic (and necessary) part of our diet since at least the first recorded Homo sapiens in Africa about 200,000 years ago, and likely fro m the beginning of the genu s Homo r oughly 2.4 million years ag o. More recently, experts have begun—almost grudgingly, it seems—to admit that some fat is good, but a good number of them still continue to recomm end that you r educe it as much as po ssible. (And—with the exception of the universally appreciated omega-3 fats—many experts are still for the most part w oef ully uninformed abo ut which fats ar e actually “good” and why.) It’s common fo r health-consc ious people to collapse the terms “healthful” and “low -fat” as if they were synonyms (trust me, they’re not). And the majority of fitness books continue to repeat low-fat nonsense that should have gon e out of style a decad e ago . So it’s probably safe to say that fat is the single most misunderstood component of the modern diet. And our thinking about fat deeply colors the way we think about low-car b diets. Here’s why: Suppose, f or the moment, that you’r e eating a typical Ameri can diet of 2,500 calories (o r mor e), of which about half (or mor e!) comes fr om car bohydrate s. If you remove a big chunk of the carbohydrates from yo ur diet (the definition of a lo w-carb pro gr am, ri ght?), one of two thin gs has to happen: One, you simpl y cut out the car bs but keep everything else the same, effectively eating half as much food as befor e (this ne ver happens ). The second much mor e commo n and realistic option is that you r eplace some or all of those car bohydrate ca lor ies with
somethin g else. Since there ar e o nly three other calo ri e-containing substa nces on the planet that you can replace those carbs with (protein, fat, or alcohol) and since most people don’t replace their carbohydrates with a fifth of vodka, chances are your controll ed-carb diet is now higher in eithe r pro tein or fat (or both) than it was before and some Registered Dietitian will soon be screaming blo ody murder about how danger ous your diet is because of “allSo, that youall will die of as fat” you and can how see, it’s butquickly impossible to heart speakdisease. about low-carb diets and evaluate them properly without treading on a lot of preconceived ideas about fat. In case you’ve just joined us from another planet and haven’t heard the argument that’s been repeated ad infinitum for the last few decades, here it is in a nutshell: low-carb diets are bad because they have too much fat, and too much fat (especially saturated fat) is bad because fat raises cholest ero l, and high choleste rol is bad because it increases t he risk fo r heart disea se. Now, if your first thought on reading the above argument was “ Well, sure, that makes sense,” it’s only because you’ve heard this argument so many times that you no longer question whether any of it is true. The association of fat and heart disease has become what philosophers call a “meme”—a generally accepted cultural notion that is deeply embedded in the national consciousness. To question it almost puts you in the category of the cro wd with the tinfoil hats. Hence this chapter. Because we’ve been taught so much gi bberi sh about fat, and because the fear o f fat is intimately entwined with both the fear o f cholesterol and the general prejudice against low-carb diets, arming yourself with some basic info on fat may help you understand why a higherfat diet is nothing to fear. Sure, the “conventional wisdom” says other wise, but in this case the convent ional wisdom i s only conventional. I t is anything but wise. Bear with me if yo u alr eady know this stuff—and even if you think you do, it’s probably worth reviewing. I’m going to question some widely held beliefs now , including so me choice tidb its of info rmation yo u may be sure are true, but remember—sacr ed cows make th e best burger s! And one more thing: I promise to make this short and sweet, and my mission is to write it in such a way that your eyes don’t glaze over.
Interested? Read on.
A Brief Pri mer on Fat “Fat” is actually the general, colloquial term for a collection of smaller units technically (and properly) called fatty acids . Each of these fatty acids has a team identity—it belongs to a group (saturated, unsaturated). When we call something like butter or olive oil a “fat,” what we actually mean is that it’s a collection of individual fatty acids . (When a food is “high in fat,” that just means it’s go t a lot o f fatty acids in it.) Almost all fat s in fo od ar e some co mbination o f the three main type s of fatty acids—saturated, mono unsaturated, and pol yunsaturated—although we tend to identify a fat in food by the type of fatty acid that’s predominant in the mix. For example, many foo ds that we call “saturated-fats foo ds” (like butter o r steak) actually co ntain many “unsaturated” fatty acids, and most foods that we call “unsaturated fats” (like olive oil) contain some “saturated” fatty acids as well. And so metimes the mixture is actually quite differ ent than you mig ht think. (Would i t surpr ise yo u to know, for example, that a typical sirloin steak has more monounsaturated fat than it does saturated ? Or that fish o il—the ultimate unsat urated fat, and an omeg a-3 to boo t—is about 25% saturated fatty acids? Both are true.) In addition to belong ing to o ne of the three majo r “gr oups” of saturated , monounsaturated, or polyunsaturated fats, each individual fatty acid also comes with a molecular description (don’t ask), and a name (e.g., stearic acid, lauric acid). This is important because some individual fatty acids have impor tant health benefits and have distinct effects (or no eff ect) on the body. Lauric aci d, for example, is a saturated fatt y acid fo und in coconut that has immunesystem– boosting properties—it’s both antimicrobial and anti-viral. Stearic acid, another saturated fatty acid, has virtually no effect on cholesterol . Every single fatty acid on the planet—regardless of whether it’s saturated, monounsaturated, or polyunsaturated—is basically a chain of
carbon atoms linked together chemical Think of a little of circles (carbon atoms), holdingbyhands. Youbonds. can also imagine these row chains of car bon atoms as a bun ch of little sch oo l kids on a day outing, joined
together with one of those ropes that kindergarten teachers use when they take their kids on a field trip. Now just as each of those kids in the kindergarten class has two arms which can “hold” something (like a book bag), each carbon atom has two “places” to which so mething can attach . In the case of the carbo n atom, the only “thing” that can attach to those places are hydrogen atoms. When all the “places” to which hydrogen atoms can attach are “filled” (i.e., “nosaturated seats left with on thehydrog train”), fatty acid is said to m beat“saturated.” literally en.the There’s no mo re roo the table, soIt’s to speak. The places o n the individual carbo n atoms in the fatty acid ar e basically all occupied, so the fatty acid can’t hold any more hydrogen passengers. (Trans-fats are a kind of “hybrid” saturated fat that’s basically created in a lab by taking an “unsaturated” vegetable oi l and blasting i t with hydrogen atoms from the chemical equivalent of a turkey-baster, for cing so me hydrog en into the empty seats and pro ducing “partially hydrogenized vegetable oil”—or, as I like to call it, poison.) Are you wit h me so far ? Good. Now, when there is o ne seat or mor e that’s “unoccupied” on that chain link of carbons, the fatty acid is called un saturated—there are still places that could be occupied by hydrogen atoms. In other words, it’s not yet a “full ho use.” (If there’s only one spot “o pen,” it’s called a mono unsaturated fatty acid; and if there’s more than one spo t “open,” it’s called a poly unsaturated fatty acid. More on that in a moment.) So what happens when there’s still “seating” o n the carbo n chain? Well, instead of holding on to two hydrogen atoms, that carbon atom takes its two empty hands and creates what’s called a “double bond” with the next carbon in the chain. (Think of each school kid in the line holding both hands of the kid facing him. An d because both his hands are no w occupied, he can’t hold anything else.) When there’s just one such double bond in the chain, the fatty acid is call ed a—can you g uess?— mono unsaturated fatty acid.
Fat Architect ure Now clearone up rule—location, all this stuff about “omegas.” In fatty acids, in real estate,let’s there’s location, location. Recall that as if there’s only one double bond in our little carbon atom chain, we’re dealing with a
mono unsaturated fatty acid. And if the location of that single double bond is on the 9th carbon counting from the end of the line, it’s known as an omega-9 fatty acid. How simple is that? The most famous omega-9 (monounsaturated) fat is olive oil, believed by just about everyone to be a “healthful” fat. Polyunsaturated fatty acids si mply have more than one double bond (hence the name “pol y,” which means “many”). Those that have their very first doubleomega-3’s bond o n.the 3rd that po sition ing fr omdouble the endbond of the are called Those have(count their very first online) the 6th position (again co unting fr om the end of the line) are omega-6’s. Okay, just in case y our eyes are g lazing o ver, there r eally is a good reason to know this stuff, and it’s this: omega-6’s and omega-3’s are building blocks out of which the body makes distinct compo unds (called rostaglandins or eicosanoids ) that have differ ent—and oppo site—effects. For example, omega-3’s are the b uilding blocks for anti- inflammatory pro staglandins. Omega-6’s are building blo cks for inflammatory ones. You mi ght think, hey, if o mega- 6’s make inflam mator y compo unds, what do I need them fo r? Good question, and her e’s the answer: you need them because inflammation is a natural part of the body’s healing response. Let’s say you injure your foot by stepping on a nail. What happens? Your foot swells up, because the body mo unts a defensive reaction to that injury. Fluid and white blood cells rush in to surround the area, hoping to destroy any pathogens or bacteria that might have gotten in the wound, in an attempt to prevent an infection. You need the building blocks for that inflamma tion r esponse 1 in your body, or you wouldn ’t have gr eat “defenses” against what the body percei ves as an attack. But those inflammatory and anti-inflammatory prostaglandins need to be in balance in o rder fo r you to have an optimally fun ctioning body. If your “pr o-inflammation” fact or y is working o vertime an d your “antiinflammation” factory is understaffed, you’re in deep doo-doo. And that’s exactly what’s happened to mo st people eating a Western diet, which now has a ratio o f about 20:1 in favor of o mega-6 to omeg a-3. (The ideal ratio is between 1:1 and 4:1.) You can’t swing a r ope without hitting an omeg a-6 fat—they’re everywhere in o ur diet. Corn o il, soybean oil, vegeta ble oil, safflo wer oil,
canola oil—all high in omega-6’s. Those of us who have been taught the mantra “satur ated fat bad, vegetable o il good” might think for a minute about consuming huge amounts of “unsaturated” vegetable oils without an appropriate amount of anti-inflammatory omega-3’s to balance that intake. You mi ght think inflammation i s no bi g deal, but you’d be making a huge mistake. Most of us are walking around with low-grade inflammation in our bodies that flies below the radar. Inflammation damages our vascular and circulatory systems and contribut es to virto tually every degenerative disease known to humankind, from heart disease Alzheimer ’s, fr om cancer to diabetes. Not for nothing did Time magazine do a cover story called “Inflammation: The Silent Killer.” There’s a good deal of emerging evidence, by the way, that controlled-carb diets—even those higher in saturated fat—actually lower inflamm ation in the body.2 Here’s something else to think about: we’ve done such a good job of demonizi ng satur ated fat that it’s effectively been r eplaced in our kitchens (and in fast-food restaurants) with the supposedly more healthful “vegetable” fat, most of which is stunningly high in omega-6’s. The problem is that omega-6’s are “unstable” fats. When used (and reused) for frying as they are in most fast-food restaurants, they actually get badly damaged and create carcinogenic compounds. Researchers at the University o f Minnesota have shown th at when unsaturated (omeg a-6) vegetable oils are heated at frying temperature (365° F) for extended perio ds—or even, for g oo dness’ sake, for a half hour —toxic compounds will form. One in particular—HNE—is associated with a number of very bad chro nic diseases that y ou r eally do n’t want to have.3 Saturated fats—because they ar e hig hly stable —do not cr eate these toxic compo unds when heated to hig h temperatures. Many people who r eally understand fat chemistry will tell yo u that they would m uch prefer deep frying in r eal lard (no t Crisco!) to r eused canola oil any day of the week. It’s far less damaging to the body. (My favor ite oil fo r cooking at high temperatures in a wok or frying pan is Barlean’s or ganic coconut oil.) In addition to cr eating toxic co mpounds when heated repeatedly, vegetable oils used by fast-food restaurants often contain trans-fats , probably the most damaging fat on the planet (and one whose dangers dwarfs the supposed dangers of saturated fat). Up until very recently, foods
like margarine were loaded with the stuff. Kind of ironic, isn’t it, when you think that the whole r eason for the popularity of high o mega-6 vegetable oil pro ducts like marg arine was the desire to eliminate the “dangerous” saturated fat from our diet—talk about the “law of unintended consequences”! So we have nothing to fear fro m a higher percentage o f fat in our diet, particular ly when it’s “goo d” fat—by which I mean fat that has not been damaged by repeated high heat, fat and or oilall that is not highly (like some co oking and vegetable oils), man-made trans-fr efined ats. Some coldpressed unrefined omeg a-6’s in the diet are fine, o mega-9’s ar e fine, omeg a-3’s are better than fine, and—y up—saturated fat is fine too , especially when it comes fr om whole natural foo ds such as eggs, coconuts, organic butter, and the like. Now, here’s an interesting factoid abo ut fats: the only fatty acid that the body actually makes is palmitic acid—a s aturated fat! Then it tak es that palmitic acid and g ets to wor k on it with a system of enzymes. It adds carbons, thus lengthening the chain—these enzymes ar e called elongases (they elongate the chain). It also removes pairs of hy drog ens from so me of the carbons that are satur ated, thus creating new double bo nds. The enzymes that do this ar e called desaturases (by removing some o f the hydro gen passeng ers, they turn that saturated fat into an unsaturated one). Through this system of elongases and desaturases, the body—starting with saturated fat—winds up with a whole menu of f atty acids to ser ve differ ent purposes. (We also get a variety of different fatty acids directly from our diet—like, for example, omega-3’s directly fro m fish o r flaxseed.) If saturated fat were inher ently so bad fo r us, why would it be the very fat our body makes n aturally fr om fo od?
Saturated Fat and Heart Disease: What’s the Real Connection? In the context of today’s conventional wisdom, it almost sounds ludicrous to put that question out there, so deeply accepted is the idea that saturated fat and heart disease are married forever in some metabolic Universe of Bad Things. But more and more researchers are asking that identical question, who are wisdom looking honestly at 2008, the data not so convincedand thatthe theones conventional is right. In the are American Society of Bariatric Physicians, in conjunction with the Metabolism
Society, presented an entire two-day conference in Arizona named “Saturated Fat and Heart Disease: What’s the Evidence?” I attended that conference, in which some of the smartest researchers investigating this issue par ticipated; and I can sum up the answ er to the question “What’s the Evidence?” for you in two wor ds: Not much. (You can read an excellen t repor t on this conference w ritten for the gener al public by About.com’s official Guide to Low-Carb Diets, Laura Dolson. The ar ticle isbdiets. cal ledabout.com/ “Saturated b/2008/04/14/satu Fat: Not Guil ty” and can be founduilty.htm at http://lowcar rated-fat-not-g . I’m sure you’re thinking right about now, “ What about all those studies I’ve read about that ‘link’ saturated fat consumption with heart disease ?” Well, to unpack the pro blems with those studies is a bi gg er project than I can take on i n this boo k. But let’s consi der just a few of the issues wor th thinking about before you buy—hook, line, and sinker—the idea that saturated fat is always “bad.” First—and this is an incredibly important point—the “fate” of saturated fat in the body var ies sig nificantly, depending o n what else is eaten. “Saturated fat is a compl etely neutral fat,” says my fr iend Mike Eades, MD. “It burns l ike any other fat.” If you’r e eating a hig h-car b diet, the effect of saturated fat may indeed be deleterio us, but if you’re eating a low-carb diet
it’s a whole different ballgame. “If carbs are low, insulin is low and saturated fat is handled mo re effi ciently,” said Jeff Volek, PhD, RD, one of the major resear chers in the area of diet compariso ns. “When carbs ar e low, you’re burning that saturated fat as fuel, and you’re also making less of it.” One recent study tested what happens when you take obese patients and put them o n a high-s aturated-fat diet—b ut without starch. The r esearchers took 23 patients with atherosclerotic cardiovascular disease and put them on a high- saturated-fat diet , but one in which all the starch had been removed. Here’s what happened: body weig ht decreased, bo dy-fat percentage decreased , total trig lycerides decreased. The researcher s concluded that a “high-saturated-fat/starch-avoidance” diet resulted in weight loss after 6 weeks without adverse effects on serum-lipid levels .4 I suspect the results would have been ve ry differ ent indeed if the participants had been eating a lo t of car bs alo ng with that saturated fat.
The Paradox Remember, when you’re dealing with a diet in “free-living” humans—as opposed to lab rats—you have four dietary variables (at least) to deal with: total calories, percent protein, percent carbs, and percent fat. It is impossible to change one without changing the others . So whenever you “test” a diet that’s high in one of those elements, it’s by definition also
lower another (and vicethat versa). Let’sinsay, for example, you have a 1,500-calor ie diet made up of 70% carbo hydrates, 15% fat, and 15% pro tein. If you now r aise the fat intake by 20% (fr om 15% to 35%), keepin g over all calor ies and pro tein the same, you’ve automatically lowered the carb i ntake by the same 20% (fr om 70% o f the diet to 50%). That lowering o f carb intake may produce —in cer tain populatio ns—a very beneficial effect, lowering both insulin levels and triglyceride levels (and possibly increasing HDL in the process). In such a scenario, it would be entirely possible to say that an increase in fat (even saturated fat! ) was asso ciated with a lowered risk for heart disease. And that’s exactly what one study showed. Research by epidemi olog ist Dariush Mozaffar ian, MD, at Harvar d found that a “higher saturated fat intake asso ciated grIn ession of cor onary artery se.”can What? isSaturated fat with goodless fo r pro you? research done at Ha rvardisea d? How this possibly be explained? Well, some folks at the prestigious American Journal of Clinical Nutrition wondered the same thing. They wrote a fascinating editorial in the November 2004 issue titled “Saturated Fat Prevents Coronary Artery Disease? An American Paradox.” The authors posed the not-unreasonable question, “ How can this paradox be explained?” How, indeed. Since, as the author s po int out, it’s an article of faith that saturated fat raises LDL cholester ol and accelerates coro nary artery disease, how ar e we to acco unt for a study that shows the exact oppo site? The answer that keeps emerging from the research is this: the metabolic fate of saturated fat—what it actually does or does not do in the body— depends largely on what else is eaten. Eat way fewer carbohydr ates and way less sugar, and ho w much saturated fat you eat may not matt er so
much.5 This is the explanation most scientists who are now researching lowcarb diets believe accounts for their findings that higher saturated fats aren’t a problem, as long as people are not eating high amounts of carbohydrate . But once you’re eating a ton of carbs, all bets are off. If you’re eating the standard Western mixed diet, high in sugar, high in processed carbs, high in fast food, and hugely high in calories, then yup, adding more saturated fat is a really badned idea. Addedand to awill high-calorie, high-carb diet, saturated fat won’t be bur as “fuel” tend t o g et stor ed on yo ur hips. In the context of that kind of diet, the “low-fat” folks are probably right. But a much better approach would be to cut out the sugar and processed carbs! In that case, the amount of saturated fat you’re consuming probably wouldn’t matter so much. Remember that in the ear ly par t of the twentieth century, the American diet was much higher in saturated fat, and w e had much lowe r rates of hear t disease. Of cour se we also co nsumed less foo d in g eneral , fast foo d hadn’t been invented, we ate much less sugar, and we moved ar ound mo re. The point is that it’ s not the saturated fat t hat’s the demon here. A second r eason that saturated fat has been demonized, in my opi nion, is that much of the resear ch on diet and disease has lumped saturated fat together with trans-fats. Trans-f ats weren’t even a health issue unt il relatively recently, and for decades researchers didn’t distinguish between the two when doing studies of diet patterns. Why does this matter? Because manmade trans-fats really are the Spawn of Satan. They clearly raise the ri sk for heart disease and stroke, and, accor ding to Harvar d professor s Walt Willett and Alberto Ascherio, are responsible for 30,000 premature deaths a year,6 so obvio usly a study that lumps trans-fats together with saturated fat is going to show some nasty associations. The question is: are those nasty health effects caused by the trans-fats, or by the saturated fats? I think it’s pretty clear that it’s the trans-fats; and if you s eparate the two and look at their effects on the body as two distinct entities, you’re going to see some very big differences. If you lump them together—as many researchers did before we knew what we know now—saturated fats are likely to be tainted by t he negative actions o f trans-f ats. It’s as if your terr ific kid wa s in a classro om with a really bad gang of
troublemakers (let’s call them “The Gang”) who kept getting arrested. Your kid would have a r eally bad r eputation, even thoug h he hadn’t done anything wro ng except being in the w ro ng ho mero om: his bad reputa tion would be caused only by asso ciation. Saturated fats unfor tunately are found in a lot of eating patterns (gangs) that also contain trans-fats, and have therefor e been unfairl y blamed for a lot o f the damage caused by their neighbors. the cholesterol-raising of saturated may be influenced by theEven presence o f trans- fats. One effect study showed th at fat palmitic acid (a satur ated fatty acid) had no effect on cholesterol when the intake of omega-6 is gr eater than 4.5% of cal or ie intake, but if the diet contained t rans-fats, the effect was completely different—LDL went up and HDL went down.7 (How much this even matters is a whole different controversy—see below—but the fact that the com bination o f saturated fat and trans-fats has a dif fer ent effect than saturated fat alone is still impo rtant to poi nt out.) The thir d reason satur ated fat has such a bad reputat ion is that much of the saturated fat people consume comes fr om really cr ummy sources. Fried fo ods ar e not a gr eat way to get fat in your diet. Neither are processed deli meats nor hormone-treated beef. But the saturated fat from healthy animals (like gr ass-fed be ef or lamb) or the saturated fat in or ganic butter or in egg yo lks is a different s tory. I’ve never seen one convincing piece of evidence that saturated fat from whole-food sources like the ones I just ment ioned has a singl e negative impact on heart disease, health, or mortality, especially when it’s part of a diet high in plant foods, antioxidants, fiber, and the rest of the good stuff you can eat on a controll ed-carbohydrate eat ing plan!
The Big Reason Saturated Fat Has Been Demonized And finally, the zinger—the major reason saturated fat has been demonized over the years is this: cholesterol . The per ception that saturated fat always raises cholesterol is enough to scare anyone exposed to conventional health “wisdom,” and is so embedded in the national (and international) consciousness that it would take more than a crowbar to pry it loose fr omabout o ur belief systfat em.raising cholesterol is this: Sometimes it The truth saturated does. And som etimes it doesn’t.
And the bigger truth—hold on to your hats—is this: it may not even matter.
The Chole sterol Controv ersy As of this writing—September 2008—two events occurred recently that may serve to illuminate the whole cholesterol controversy far better than any scientific, eye-glazing discussion ever could. One was in popular culture; one was in the economic and financial sector. Event number o ne: the intro duction of the new iPhone. Shortly after the now-iconic iPhone first came out in 2007, it was selling nationally for $399. The new, improved version—which ran on the faster 3G network and carried a list price of $199—came out in 2008 with a slogan that was repeated endlessly on radio, print, and television ads that aired thousands and thousands of times. The slogan? “ The new iPhone: Twice as fast at half the price .” Sounds good, right? Except it wasn’t true. The new iPhone was indeed twice as fast, but it was hardly half the price. The cost of the monthly service charge had gone up by $10, so by the end of the typical 2-year contr act, you had actually paid an additional $240 for the exact same ser vice you would have had with the ol d iPhone. Together with the initial co st, that made the total pr ice yo u’d have to spend to g et the new phone (indepe ndent of the basic ser vice charge) $440, or ro ughly 10% more than the initial, “ol d” iPhone. The “half the price” didn’t really tell the whole story at all. Now hold that thought for a moment. Event number two: the subpri me lending disaster and the coll apse of the housing mar ket. This event —which was mor e of an ongo ing cr isis than a single even t— was basically the result of unscrupulous lenders telling folks that they could buy houses that they clearly couldn’t afford. Through ridiculous “no interest” lo ans, they were able to sel l peopl e on the idea that they could live in mult i-millio n-dollar homes in Be verly Hills for approximately what it would cost them to r ent a studio apar tment in Gavenspor t,
Louisiana. Which was sort of true. For the first year. When the real cost of the mortgage showed up after that first “teaser” year, the dog-poo hit the proverbial fan, and the rest is history. The initial cost didn’t tel l the whole story . It was true that your mor tgage would be really cheap fo r the first twelve months—bu t it was also quite irrelevant . Which brifocus ngs uso to cholest ero When we n choleste rol,l.we’re not telling the whole story . In fact, we’re not even telling the most important par t of the stor y, and— according to many—the part of the story we are telling may actually be virtually ir relevant . Here’s why. You do n’t real ly care what your cholesterol level is; what you care about is your r isk for heart disease . And you’ve co me to believe they’r e essentially the same thing. The only reason you even know your cholesterol level is that it has become embedded in your consciousness (as it was in mine) as an important marker for heart-disease risk . In fact, for many people, it is synonymous with heart-disease r isk. (Doubt that? Try this party trick: ask five friends to say the first thing that comes to mind when you say the term “risk for heart disease.” Case closed.) But here’s the thing: Fully half o f the people with heart disease have perfectly “normal” cholesterol levels. And half the people who have what’s considered “elevated” cholesterol have perfectly normal hearts. As long ago as 1994, a study published in the conservative and august Journal of the American Medical Association (JAMA) demonstrated a complete lack of association bet ween cholest ero l levels and cor onar yheart-dise ase mor tality in perso ns over 70 years o ld. It also demonstrated a complete lack of association between cholesterol levels and mortality from any cause in that same populatio n.8 Since we already know that the rate of heart diseas e in 65-year-old men is many times that of 45-year-ol d men, does it make sense that cholesterol suddenly “stops” becoming a risk factor when you get older? It makes more sense that it wasn’t that big a risk factor in the first place! As a terr ific ar ticle in t he online jo urnal “The Healthy Skeptic” po ints out, this is aki n to sugg esting that smoking causes
lung cancer in yo ung men, but somehow stops doing i t in older men! 9 Consider also a classic st udy conducted in France over a four -year period from March 1988 to March 1992 and published in the journal Circulation in 1999.10 The study—called the Lyon Diet Heart Study— looked at 605 patients who had alr eady had a fir st heart attack. These fo lks were not in g reat shape —they had classic r isk factor s, high cholesterol, many were smokers, the whole ballgame. Half of the 600 or so subjects were g iven the standard advice abo ut eating a “prudent” diet (lower fat, lower cholesterol), and the oth er half were given instruct ions o n following what we call the “Mediterranean Diet”—high in olive oil, vegetables, fruits, and so on. (Neither group was given the standard treatment for high cholesterol, a statin drug.) Are you r eady for the results? Those following the Mediterranean Diet had a 72% decrease in cor onar y events and a 56% decrease in over all mo rtality. The r esults were so stunning that the study had to be stopped in the middle so everyone could g o o n the diet prog ram that had produced such outstanding results. But that’s not even the best part. Get r eady for the kicker: Though peo ple were dying at less than half the rate expected, and were having coronary events at about one quarter the rate expected, their cholesterol levels hardly budged . Did you get that? An almost 75% decrease i n heart disease without a budge in cholesterol levels ! Now let’s fast-fo rward to a dr ug study completed in 2006, t he widely publicized ENHANCE trial. If you were f ollowing the news in 2008, you couldn’t have missed this one, because it made the fro nt pages of the newspapers and all of the televisio n news shows. Here’s what happened. A combination cholesterol-lowering medication called Vytorin had been the subject of a huge research project, the results of which were finally coming to light and being given enormous negative attention. One of the many r easons fo r this negative attention—besides the act ual r esults, which I’m go ing to shar e with you in a m oment—was the fact that the companies ointly making the drug (Merck and Schering-Plough) waited almost two years before releasing the results of the study.
No wonder. The results stunk. Which was the other r eason this drug test made the front pages. The new “wonder” drug lowered cholesterol just fine . In fact, it lowered it better than a standard statin dr ug. So yo u’d think everyone would b e jumping for joy, right? L ower cholestero l, lower heart disease—let’s have a party for the shareholders! Not quite. Althoug h the people taking Vytor in saw their cho lestero l plummet just fi ne, they actually had more plaque gr owth than the people taking the standard cholesterolhad drug. The twice patients on Vytorin—low cholesterol and all—actually almost as great an increase in the thickness of their arterial walls, a result you definitely don’t want to see if you’re trying to pr event heart disease. So their choleste ro l was wonderfully lo wered and their r isk for heart disease went up: sh ades o f “the o peratio n was a success, but the pat ient died.” Taken tog ether—and there are countless o ther examples—I th ink we mig ht be able to at least question the widely accepted dogma that cholesterol is what we need to be focused on when it comes to heart disease . But wait! If chol estero l is not the huge deal everyo ne thinks it is, then it’s reasonable to ask the question: so, why are we so afraid of saturated fat? After al l, isn’t the big “r ap” against saturated fat t hat it raises cholesterol? If that’s not as big a deal as we thought, why are we so afraid of saturated fat? Now you’r e beginning to get it. Fact is, accor ding to a ton o f resear ch by Jeff Volek, PhD, RD, and other s, saturated fat sometimes r aises cholest ero l and sometimes doesn’t . And then there’s the question of exactly what “kind” of cholester ol it does raise. Most people are familiar with the concept of “good” cholesterol (HDL) and “bad” cholesterol (LDL). Problem is, that concept is woefully out of date, as “yesterday” as last mo nth’s headline in People magazine. There are several different subtypes of HDL cholesterol and several different subtypes o f LDL. The subtypes of LDL have differ ent effects on the bo dy and are far more interesting to us than the overall LDL number, even though that’s the number that most people fo cus on. LDL cholester ol—the unfor tunately named “bad” kind—act ually co mes
in several “flavors”; it is not one ho mog enous substance which is “bad.” There are LDL molecules that are “large” particles, and there are LDL molecules that are “small” particles. The large particles—think of them as big fl uffy cotton balls—are fair ly harmless. The small ones—t hink of them as hard li ttle BB gun pellets—are no t. What often happens on a hig h-saturated-fat diet is that LD L goes up —but this is not the whole story (no mo re so than the cost of your no interest tgage fo r scientists the fir st six month s isactual the whole storsizes y of what you owe themor bank). When look at the particle of that LDL cholester ol, they find that higher saturated-fat int ake (in the context of a low-carb diet) usually results in a significant shift to more of the harmless big fluffy particles and fewer of the much more danger ous little ones. Let’s say, for the sake of argument, you are a person with an overall cholester ol of 200, 130 of which is “LDL” and 50 of which is “HD L” (the remainder i s other stuff t hat we’re not goi ng to g o i nto r ight now an d isn’t germane to the discussion). Furthermore, let’s hypothesize that your LDL of 130 is actually the harmless stuff (the big fat fluffy particles) and the bad stuff (the BB gun pell ets).You g o o n a lo w-carb (hig her-fat) diet and boom, your cholesterol is no w 230 and your doctor is having a fit , furio usly scribbling a prescr iption fo r statin drugs and r eading you the ri ot act. Not so fast. What may have happened—in fact, what most often has happened—is that your HDL has go ne up (go od) and yo ur LDL has go ne up also , but something even better has happened as well, som ething that flies beneath the radar unless your doctor knows to check for it: the pro por tion of “goo d” (fluffy cott on balls) and “bad” (little BB pellet s) LDL has shifted dramatically . You might now have an HDL of 60 and an LDL of 150, but 100 of that LDL is no w the big harm less fl uffy par ticles and only 50 o f it is the bad stuff. Your total number (and even your LDL) has go ne up, but the overall li pid profile has i mproved substantially . And we haven’t even begun to talk about trig lycer ides. Triglycerides, which don’t get nearly as much attention as cholesterol, are a far g reater r isk factor for heart disease than cholesterol is. 11 (They’re also a sig nificant ri sk for strokes.) 12 And tri glyceri de levels always come do wn on a lo w-carb diet. Always. Not “sometimes”: all the
time. (Which makes sense—the body takes all that excess sugar and packages it into triglycerides; so the less sugar in the diet, the fewer trigl ycerides in the blood.) Furthermo re, accor ding to a Harvar d study published in Circulation ,13 the r atio of trigl ycerides to HD L cholestero l is a much better predictor of heart disease than cholesterol is. Also, according to many experts (including the Metabolic Syndr ome Institute), that ratio can serve as a go “surr nogwith ate”amarker i nsulin resist ance. if yousmoke, show meod a perso r atio offo2r(trig lycerides to HDPersonally, L) who doesn’t works o ut, isn’t overweight, an d has low mar kers o f inflammation (CR P and homocysteine, for example), I’ll bet you my life savings he’s not going to have a heart attack, and I don’t care what his cholesterol numbers are. But hey, that’s just me. Now let’s reexamine the effects of this mythical low-carb diet on our mythical pat ient whose do ctor is fur iously pr escribing statins. P re–lo w-carb diet
P os t– low -carb diet
Tri glyceri des 175
Tri glyceri des 100
TOTAL CHOLESTEROL: 200
TOTAL CHOLESTEROL: 240
HDL:50
HDL:60
Triglyce ride to HDL ratio: 3
Trigly ceride to HDL ratio: 1.66
LDL cholesterol : 130
LDL cholestero l: 150
LDL “fluffy” particles: 65
LDL “fluffy” particles: 110
LDL “small” particles: 65
LDL “small” particles: 40
Post–low-car b diet, this g uy should be taking that b lood test home and umping for joy. His lipid pro file is vastly impro ved. By every measure, he’s doing way better than he was befor e the diet. But his chol estero l went up. To which I say: so what ? There ar e curr ently tens of millions o f Americans on cholesterollowering medications. As of 2006, two of the five top-selling
drugs in America were cholesterol-l owering medications, and th ey collective ly r ang up sales of over 18 billion do llars. Ev en without throwing in the annual budget of the National Cholesterol Education Pro gr am, it’s safe to say that well over 20 billion dollar s a year r ides on the effor t to get Ameri cans to lower their choleste ro l and fat. Curr ent guidelines are to reduce saturated fat to 7% of the diet, 14 and there’s a movement a foo t to reco mmend lowering i t even mor e. The American Academy Pediatrics recommends olesterol childr en asofyoung as 2, now and treatment withchstatin drugsscreening to lower for some 15 cholesterol fo r so me children as young as 8. Are we likely t o see a mor ator ium on the demonizat ion o f fat and cholesterol and a move toward eliminat ing the real health-ro bbers in o ur diet, like sugar and processed carbs? Not bloo dy likely, and pro bably not any time soo n. As the author Upton Sincl air put it: “It is difficult to get a man to understand something wh en his s alary depends upon his not understanding it .” The bottom line is that if you’re eating a very-low-carb diet, I don’t think you have much to worry about if it contains a relatively high amount of saturated fat (see “My Big Fat Diet,” chapter 8), and you certainly don’t have anything to wor ry about if it contain s a nice mix of fats fro m omeg a3’s, 6’s, 9’s, and saturated. Now, befor e we wrap this up, let’ s be clear about one thing : I’m not saying you should go out and start drinking oodles of saturated fat. (I am saying you shouldn’t be terrified of it, but that’s a different statement.) The important thing to remember is this: the metabolic effect saturated fat has on your body—its “fate,” i f you wil l—depends entirely on what else i t’s consumed with. In the early part of the twentieth century, the American diet was much higher in saturated fat, and we had much lower rates of heart disease. Of cour se, we also co nsumed less foo d in general, fast food hadn’t been invented, we ate much less sugar and we moved aro und mor e. The po int is that it’s not fat—not even saturated fat—that’s the demon her e. In 2000, Walter Willett, MD, PhD, arguably the world’s most respected nutritional epidemiologist, chairman of the Department of Nutrition at the Harvard School of Public Health and the lead researcher on the Nurses’ Health Study and the Health Pr ofess ionals Fo llo w-Up Study, was
interviewed by Harvard’s World Health News. This is what he said: “We have fo und vir tually no r elationship between t he percentage of calories from fat and any important health outcome .”16 Amen to that.
CHAPTER 4
So Why Isn’t Everyone on a Low-Carb Diet? (OR Why Your Doctor Doesn’t Know about This Stuff )
A couple o f years ag o, I was lect uring to a lar ge audience in t he Midwest on the topic o f lo w-carb nutri tion when a woman i n the audience stood up. “I went to my doctor when I was almost 100 pounds o verweig ht and he read me the rio t act. He told me the danger I was putting myself in and ho w impo rtant it was for me to lo se weight. He wanted to put me o n some medication, but I wanted to try it on my own. I went on Atkins, and o ver the course of the next yea r I lost almost 70 pounds.” Delighted, I asked her what happened next. “Well,” she said, “My doctor co uld hardly be lieve how different I looked. My triglycerides ha d dropped to under 100, my ch olesterol ratio was way improved, and my blood sugar was normal.” “Then what happened?” I asked. “He was just thrilled,” she replied. “He told me that what I had accomplished was amazing. And then he asked me how I had done it. I told him I had go ne on Atkins.” “And?” “He said to me, ‘O h, you’ve g ot to g et off that immediately. That diet is dangerous.’” I sighed. The kind of thinking demonstrated by this lovely lady’s physician is closer convict ion it is toreligious a scient ifically position, and wetoallr eligio know us how hard it is than to change beliefs.held People who will not bu dge fr om their po sition that low-carb eating is dangero us
simply have not looked at the emerging science—and many refuse to. For tunately, mor e and mor e health-care pr actitioners ar e beginning to open their minds and take a second loo k at the dietary str ategy that, up until a few short years ago, was considered nutritional heresy. In the last few years, som e thirty-plus studies or papers have been published invest igating var ious aspect s o f lo w-carb regimens. Some o f these have looked at w eight loss; so me have looked at serum biomar kers (triglycerides, HDL, and so on). Some have looked inflammatory markers (C Reactive Protein). Many have looked at at cholesterol, and not ust the total number (which is fairly meaningless; see chapter 3, page 68) but at the different fractions, HDL and LDL and the ratios. Some have even looked at the emerg ing data on LDL particle s ize, which tells us even mor e. The r esults ar e pretty clear. Low-carb diets perfor m as well as lo wfat ones on virtually every parameter. In many cases, they perform better in terms o f weight loss. I n vir tually all cases, low-ca rb eating lowers trigl ycerides (w hich in my opinion is a far mor e important ri sk factor for heart disease t han cholest ero l). In a ver y lar ge number of cases, it impro ves the overall cholestero l r atio, o r at least the triglycer ide-to-HDL ratio (an impor tant measure fo r heart-disease risk). I t frequently impr oves glucose co ntro l in diabetics an d bring s down a diabet ic r isk factor called hemoglobin A1C. Folks, low-ca rb living is not dan ger ous. And it works. Maybe not fo r everybo dy. Maybe not in every situation. (Remember, I’m the guy who has been preaching for the last fifteen years that everybody’s different and that no one diet works for everyone.) But a low-carb diet works for many, many people. And a large percentage of the people who are consciously controlling their carbs report that they find the diet easy to stay with.
Fad Diet? Or T im e-Old Traditi on? Low-carb isn’t a fad. In fact , when I hear peo ple clai m that it is, I’m always amused; because when you think about it, controlled- (or lower-) carb eating is what we humans have done for the vast majority of our time on
the planet. For goodness’ sake, agriculture was only “invented” ten thousand years ago (the human genus has been around for 2.4 million years!). Our Paleolithic ancestors didn’t eat low-fat woolly mammoths or low-fat caribou. The artificially low-fat, high-carb diet, from the point of view of anthropology and history, is the true “fad” diet, and it’s been less than a r ousing success. The point is this: low-carb eating is not a fad; it is here to stay, and none too soon. Obesity to smoking as the number one preventable cause is ofquickly death incatching America.upDiabetes is approaching epidemic pro por tions. Nearly two th ir ds of Americans are o verweight a nd a third o f them are obese. Low-carb living can help. So, why is there such entrenched resistance to the idea of low-carb diets, particular ly amo ng what I like to cal l the “Diet Dictocr ats” and the conventional medical pr ofession? To ful ly answer that quest ion intellig ently, I think the fir st place to start is with some definitions.
What Is a Low-Carb Diet, Anyway? Talk to ten different “experts” about low-carb diets and you’re likely to find at least nine differ ent meanings o f the term “lo w.” Much like the terms “hot” and “cold,” “low” and “high” don’t have any real objective definitions and tend to be defined in the way the person speaking about them tends to define them. In weather, one person’s “hot” is another pers on’s “warm.” It’s the same thing when talking abo ut diets. Which reminds me of a stor y. Actually, it’s not a stor y, but a scene fro m a mo vie— Annie Hall, my favorite film of all time—and it has a lot to tell us about the whole “lowcarb diet” thing. (It also has a lot to tell us about “high-protein” or “lowfat” or any other diet that has “low” or “high” in front of it. Stay with me for a moment and I’ll show you why.) In this classi c 1977 Woo dy Allen movie, Alvie Singer (played by Woody) and his girlfriend Annie (played by Diane Keaton) are both in therapy with different therapists, and are both complaining about their sex
life. In the scene I’m talking abo ut, the mo vie sho ws a split scr een, and you see both characters each talking to their respective shrinks. On the left side, Alvie is saying to his therapi st, “We hardl y ever have sex!!” Over on the right side of the screen, Annie is complaining to her ther apist, “He wants to have sex all the time!!” Annie’s therapist asks her, “Well, how often do you actually have sex?” “All the time!,” she wails. “Three times a week!” Alvie’s therapist asks him, “Well, how often do you actually have sex?” “Hardly ever,” he mo ans. “ Only three times a week!” Which bri ngs me to the mea ning o f “a lot.” Or of “hig h” (as in protein). Or o f “low” (as in carbs). I’m frequently struck by how discussions about highpro tein/lowcarbohydrate diet s so und a lot like that sc ene fro m Annie Hall.
Definitions, Please! So one of the biggest problems we have in discussing low-carb diets rationally is agreeing on some definitions. What constitutes a “low-carb” program really depends on your reference point. Sure, we can probably all agree that the first stage of the Atkins Diet 1972 edition (20 grams of carbs or less a day) is clearly a low-carb plan; but beyond that the definitions ar e up for gr abs, and they tend to r ange all o ver the map. I’ve seen published studies of “low-carb” diets where people were eating 120 grams of carbs a day. Sure, that’s a lot lower than the average American consumes, but “low-carb”? Another example: time and again, I’ve heard people who should know bet ter refer to dietary plans like Barr y Sears’s “The Zone” as a l ow-car b plan, when in fact on “The Zo ne,” 40% of calories come from carbohydrates! On what planet is a diet in which almost half of the calories come from carbohydrates considered a “lo wcarb” diet? 1 Well, if yo u’re a go vernment a gency or a conventionally trained
dietitian whose belief system is that 65% of your calories should be coming fro m carbohydrates and only 10 % fr om pr otein, then, yes, “The Zone” with its 30% protein and 40% carbohydrates is a “low-carb, highprotein” diet—just like if you’re Annie Hall and you think you should be having sex once a mo nth, then three times a week is “ all the time .” So, sure: if your basic belief system is that carbohydrates should make up at least 50% or more of daily intake (the position clearly taken by most conventional health organizations, the USDA, and the moribund American Dietetic Association, which never had an srcinal thought in its collective head), then anything less than that 50% (or 60%) is go ing to lo ok like a “lowcarb” diet and be ver y suspect. If you believe that fat causes heart disease (it does not), then any diet that allows mo re than a modest amount of fat is going to be equally suspect and likely to be labeled “high-fat.” And if you believe that any amount of protein over 10% of the diet is go ing to cause your kidneys to immediat ely fail and you to die an ear ly death, then any diet that provides more than 10% to 15% of calories from pro tein is go ing to be demonized . The problem is that these beliefs are in need of a reexamination— because if they turn o ut to be untrue, then the whole r ationale fo r being against low-carb diets unr avels. Understand again—I’m not saying that all low-carb diets are created equal, or that everyone i n the worl d belongs o n a lo w-carb r egimen. All fat isn’t created eq ual, all pro tein is far from equal, and all carbs cer tainly aren’t. But we’ve spent far too much time wor rying abo ut the percentage of calories that comes from each of the three macronutrients (protein, fat, and carbs) and far too little wor rying about t he overall quality of the food we eat. If we want to be healthy (and slim) , we real ly need to be mo re concerned wit h where o ur calo ries come from, not just what category they belong in. Take two “hig h-protein” diets: let’s call them “High-Pro tein Diet A” and “High-Pr otein Diet B.” And let’s agr ee, just for fun, that both reall y are high in pr otein by anyone’s standards. B ut in Diet A, all that pro tein comes fro m ballpark fr anks and deli meat an d is g enerally eate n with a side of white bread and some ketchup. In Diet B, the protein co mes fr om wild caribou and gr ass-fed lamb an d is invariably ser ved with a hearty side of gr een veggies. These t wo diets are not comparable, though they may well
share the same percentage of calories from protein, a fact that is pro bably irrelevant compared to the quality of the food eaten. This little detail tends to get lost in the shouting about “high-protein,” “low-carb,” and the rest of it. The question always needs to be asked: what’s the actual quality of the foo d that’s being eaten? It’s simply not enough to celebrate—or demonize—a diet based solely on the percentages of calor ies fro m pro tein, fat, or carbs.
The Omnivore’s Dilemma This book isn’t designed to rebut all the arguments against low-carb diet strategies; rather, it’s simply intended to make you think about why those arguments exist and to suggest some areas where they might be lacking. There’s a ton of research and consumer writing available if you’d like to explore this more for yourself, starting with Gary Taubes’s magnificent 500-page treatise Good Calories, Bad Calories and followed with a visit to the THINCS Web site (The International Network of Cholesterol Skeptics, http://www.thincs.org). But here’s the bottom line: we humans ar e omni vor es, quite elegantly engineered to survive well on a r ange of diets and ma cro nutrient (pro tein, fat, and carb) per centages. Healthy people have sur vived quite nicely on high-fat diets (the Trobriand Islanders), high-carb diets (the Bantu of South Africa), and hig h-pro tein diets (the Inuit of Gr eenland). In the 1920s, a researcher named Weston Price investigated about 15 of the surviving hunter–gatherer societies still eating their native diet, and found robust go od health among all of them. They ate a wide variety of foods and got varying per centages of their calor ies fr om pr otein, fa t, and carbohydrate. Some exist ed mainly on fr esh cream. Ot hers o n seafood. S till others o n plants. Some on meat. But all these people had two things in co mmon—they didn’t eat rocessed food, and they didn’t eat sugar. What we humans are no t designed to do is thri ve on a diet that’s high in both.
N utriti onal Bi partisa nship In the spirit of bipartisanship, it’s worth pointing out that the negative effects of a diet high in sugar is one concept just about everyone agrees on, from Dean Ornish to Robert Atkins. As my friend Mike Eades, MD says, “There are diets that allow you to eat all the fat you want. And there are diets that allow you to eat all the protein you want. But I’ve not yet
seen one—ever—that ossibly consume.” allows you to feast on all the sugar you could That’s a take-home point worth noting. Fat is not the enemy in the American (o r Western) diet: sugar is. I don’t care how high your diet is in fat: as long as that fat isn’t damaged fats or trans-fat s, and as long as your diet is very very lo w in sugar, t he ercentage of fat in your diet is go ing to make absolutely no diff erence to any major health outcome. But the amount of sugar and processed carbs is most definitely go ing to make a difference. And this is the beauty of controlled-carb eating. Once you get all of the sugar and most of the pro cessed carbs o ut of your diet, what you’r e left with is what I call the “Jonny Bowden Four Food Groups”: food you could hunt, fish, gather, or pluck. And whatever you want todiet. callAnd that,a that’s that’s lower in carbs than the typical American wholealodiet t better.
So, If Low-Carb Diets Are So Great, Why Isn’t Everyone in the World Eating Low-Carb? Well, aside from the fact—which can’t be stated too many times for my taste—that everybody is different and no one diet strategy suits all people, the answer can be broken down into three factors: • Economic factors • Social factors • Pervasi ve myths
Some the most common and pervasive mythsecono about mic low-carb will be coofvered i n the next chapter, so let’s tackle and sodiets cial factors here. Since people following a low-carb lifestyle often feel that
they are “running upstream”—or at least going against t he prevailing social grain and dietary “wisdom,” I hope this discussion may help pro vide some perspectiv e for you.
Economic Factors As of this writing—September 16, 2008—the world’s population is a staggering 6,843,985,355. (In the time it took me to type this sentence, it ust went up by 84 people—you can watch the numbers yourself at http://www.ibiblio.org/lunarbin/worldpop .) There is no way we can feed 7 billion people on grass-fed meat, wild fish, vegetables, nuts, seeds, and fruit. Without cereal grains, humanity wouldn’t survive. This is the thesis put forth by Pro fessor Loren Cor dain, PhD, in a seminal paper called “Cereal Grains: Humanity’s Double-Edged Sword.” Cordain basically says that without agriculture and cereal grains, we wouldn’t have civilization as we know it. Grains (and agriculture) allowed people to form towns and not be dependent on hunting. Grains allowed populations to grow because they made it possible to feed much larger numbers of people than could be fed by hunting a finite stock of wild animals. But that doesn’t mean we can’t be honest about the health costs of a diet that’s very high in g rains. In over 100 pages o f car efully arg ued and copiously fo otnoted resear ch, Cor dain links d iets very hig h in cereal grains with nutrient imbalances, vitamin D deficiencies, autoimmune disor ders, and even psycholo gical and ne uro log ical problems. “Cereal grains obviously can be included in moderate amounts in the diets of mo st people without any n oticeable, deleteri ous health effects,” says Dr. Cor dain, “and herein li es their str ength. When combined with a variety of both animal- and plant-based foods, they provide a cheap and plentiful calor ic sour ce, capable of sustainin g and promo ting life. The ecologic, energetic efficiency wrought by the widespread cultivation and domestic ation of cer eal gr ains allowed for the dramatic exp ansion of worldwide human populations, which in tur n, ultimately led to humanity’ s enormo us cultural and technolog ical accomplishmen ts. The downside of cereal grain consumption is t heir abilit y to disrupt healt h and well being in
virtually all people when consum in excessive quantity . This infor mation has only been empirically known ed since the discovery of vitamins, minerals and certain antinutrients in the ear ly par t of this century.” (Emphasis mi ne.)
Cereal gr ains now pro vide 56% of the wor ld’s foo d calor ies and about half of its pro tein.2 And therei n lies the r ub and the “double-edg ed swor d.” They’re not universally go od fo r us, despite over whelming mar keting effo rts to make us believe they ar e. But without them, we wouldn’t have a planet. Without them, as Dr. Cor dain notes, “our species would l ikely have never evolved the complex cultural and technological innovations which allowed our departure from the hunter–gatherer niche. However, because of between evolutionarygras nutritional requirements andthe thedissonance nutrient content of human these domesticated ses, many of the wor ld’s people suffer disease and dysfunction directly attributable to the consumption of these foods.” So g rains and gr ain pr oducts ar e here to stay. But the fact that they are essential to the survival of a planet that is on track to hold 9.3 billion people by the year 2050 3 shouldn’t blind us to the fact that—for some of us, anyway—they oughtn’t be the pr imary sour ce of calor ies in o ur diet. For some of us, they ought to occupy much less space on the dinner plate (and breakfast plate, and lunch plate) th an they curr ently do. And for still others of us—not all, mind you, but many—they don’t belong in o ur diet at a ll.
High-Carb Diet s and Economics If you think the collapse of major financial institutions like Bear Stearns, Morgan Stanley, and Lehman Brothers was a seismic event, just imagine what would happen if the agribusinesses and Big Food companies collapsed because the demand for bread, grains, pasta, wheat, and sugar suddenly plummeted. It’s not going to happen. The point here is for us to separate the economic reasons we’ve come to rely on (and justify) highcarb diets from the supposed health reasons. And no wonder we believe they’re so good for us! There would be a huge disconnect if most of the world was sustained on calor ies fr om pro cessed ca rbo hydrates, and a t the same time everyone believed they were bad for us. So i t’s alm ost inevitable that we have to believe t hese things are go od for us. Otherwise the mental dissonance would be too great. Imagine living and working in an economy based w holly o n tobacco—your job and livelihood depend on it, your family’s well-being depends on it, your traditions ar e based on it, your kid’s college education is paid for by it—
while at the same time you’r e told o n a daily basis that this pr oduct that your life is based aro und—cigar ettes—is killing you and everyone you love. You’d be in co nstant mental confl ict.4 So it’s unlikely that we’re going to have big government agencies telling us how bad sugar is any time soo n. Case in point: in 2003, the pretty conservative an d mainstream Wor ld Health Or ganization issued a r eport titled Diet Nutrition and the Prevention of Chronic Diseases (T RS916), which made the very would recommendation that gentle peopleand—one “limit their dailythink—noncontroversial consumption of free (added) sugars to less than 1 0% of calor ies.” If you thin k no o ne could possibly argue with that, think agai n. One o f the loudest pro tests came fr om the Ameri can go vernment, at the urg ing of the sugar industry and the ir wellfinanced lobbyists. So don’t expect government agencies to tell you to cut back on Cocoa Krispies any time soon. But the fact that industries producing sugared cereals and white bread, snack cakes and crackers are a huge part of the global economy—and will fight tooth and nail against any recommendations to consume less of their crap—shouldn’t blind us to the fact that they may not necessarily be producing products that are good for our health. We can certainly understand why they’ll fight for their market share. But we don’t have to dr ink the (sugar ed) Kool -Aid. The Social Basis for High-Carb Diets That said, there are many reasons besides effective marketing that we like to eat carbs, starting with this one: sugar tastes g oo d. It’s also associated with a lot of good things—celebrations, feasts—and frequently with love and family—grandma’s homemade cookies, bake sales, Mom’s apple pie, bir thday cake; the list is endless. And let ’s face it, our sweet tooth is vor acious, as anyone w ho’s spent any time fighting a cr aving for a box of Lorna Doones while watching late-night television knows all too well. As it happens, nature gave us a sweet tooth for a very g oo d reason— survival o f the species. We humans don’t make o ur own vitamin C, and most the foods vitamin C—like fruits—are indeed naturally sweet.ofAlso, whenthat our contain cavemen ancestor s wandered the earth trying to fig ure out what to eat, sweetness and bitterness were g oo d guides as to
whether a food was safe. Many foods that are poisonous are also very bitter, so your ancestor s’ ability to distinguish between sweet and bitter— and their stro ng pr eference for the for mer—helped en sure that you are here today to read these words. The problem is tha t we no longer get our sugar from the occasional sweet fruit or by shimmying up a tree in the jungle to get a rare taste of bee’s honey. High-sugar foo ds now line th e shelves of every g ro cery stor e in town. Wethat getdon’t sugarcontain from virtually processed food we eat, and even those a lot of every sugar are so highly processed that they convert to sugar in the body so quickly that you might as well be pouring the contents of a sugar bowl straight into your gut. And sugar creates its own cravings. The more we eat, the more we crave, adding to our increasing health problems and our expanding waistlines. Again, I’m not saying there isn’t a place for recr eational fo od, and I’m certainly not arg uing that we should o utlaw Ben and Jerry’s. My only po int here is for us to start t o decouple t he social and economic justifications for high-carb diets (w hich are numerous and powerful) fr om the healt h ustifications (which are flimsy). Unfortunately, just as we’re not going to wean the world off of oil any time soon, w e’re also not going to wean the wor ld off o f carbs or junk food. That’s not my purpose in this book (plus it would be impossible anyway). My purpo se instead is simply to help you educate your self abo ut what carbs do and don’t do, what you “need” in yo ur diet and what you don’t need, and to ultimately empower you to do your best to lower your overall sugar (and processed-carb) intak e, no matte r what eating plan yo u ultimately choose. In the next chapter, we’ll look at some of the prevailing beliefs and comm on myths about lo w-carb diets. We may no t be able to put them to rest forever—beliefs are stubbornly resistant to change—but maybe we can make a dent in the arg uments they’re based o n. At least that’s a start.
CHAPTER 5
Is There Such a Thing as the “Metabolic Advantage” of Low-Carb Diets?
Here’s a riddle for yo u: Two g roups of people go o n a weightloss pro gr am. Group one eats high-carb, low-fat. Group two eats lo w-carb. They eat the exact same number of calories. Who loses more weight? If you guessed the low-carb group, you’d be right most of the time. But if it’s true, as so many say, that “a calorie is a ca lor ie,” then two gr oups eating the same amount of foo d should lose th e same amo unt of weight. If it’s all about the calories, e veryone should com e out even. Right? Maybe not.(William Ever since the publication the f irst commercial low-carb diet in 1862 Banting’s Letter onofCorpulence ), people have been noticing that the kind of foo d they eat—not just the amount—seems to make a profo und difference in terms o f whether or not they gain or lose weight. Probably no statement so energized and polarized the weight-loss community than this early statement by Robert Atkins, MD: “You can lose more weight and more fat, calorie-for-cal orie, on the Atkins diet than on any other diet you’ve ever tried .” Hyperbole? Maybe a little. But it made— still makes—conventional dietitians cr azy, and her e’s why: Atkins was saying that weight loss is not just a matter of how many calories you consumed—it’s also influenced by what kind of calor ies you ate. That’s nutritio nal her esy. Still is . So why does the simple statement “the kind of calo ries matters” continue to meet with a passionate resistance that borders on the religious? Let’s go to the videotape.
For years, many scientists have argued that losing weight is all about the calor ies. Accor ding to them, a calor ie is a calor ie, and to ar gue otherwise is to violate the first law of thermodynamics, which can be summed up as follo ws: a calor ie is a calor ie. If you take in mor e calor ies than you burn up, guess where it winds up? Ex actly. On the stor age si tes in your body: namely, the stomach, hips, thighs, and butt. If, on the other hand, you “burn up” mor e calor ies than you take in, t he excess energ y will come o ut of those verthat y same stores. I call the “checkbook” theor y of the human body, one that treats calories exactly like money. When you put more money in your checking account than you spend, you have an excess (exactly what you want with money, exactly what you don’t want with fo od). When you spend more than you take in , you have a deficit (exactly what you don’t want with money, but what you want very badly when y ou’r e trying to lose weight). The problem is, the human body doesn’t really behave like a checking account. It behaves mor e like a chemistry s et. What you put in mixes and bubbles and interacts and creates different results depending not just on the amount you put in, but also the ingredients. “The metabolic advantage” is simply the theory that food has a hormonal effect on the body, and that certain foods are more likely to trigg er hor monal and enzy matic r esponses t hat lead to fat gain than oth ers. Certain kinds of foods simply take more energy to deal with than others, and “waste” a bunch of calories in the process. “There ar e numerous example s of lo w-carbohydrate diets being mor e effective than low-fat diets with the same number of calor ies,” says Dr. Richard D. Feinman, PhD, pro fesso r of biochemi stry at the SUNY Downstate Medical Center. “Everyo ne with go od sense believes there’s a metabolic advantage,” adds my fr iend Mike Eades, MD. The question—and the debat e—is o n how much o f an advantage. And therein lies the rub. In the beginning of the low-carb “movement,” people were so excited to lear n that calor ies weren’t the whole pi cture that they went over boar d. Like many of the patients Atkins srcinally treated, they knew from personal experience that even on very low-calorie (usually low-fat) diets, they had a hell of a time losing weight. They were delighted to learn that it wasn’t all about calo ries. They fel t vindicated. And—perhaps understandably—they
went a little overboard in the message they took away from the whole brouhaha. From “calories aren’t the whole picture” they went to “calories don’t count at all.” This was a big mistake. The truth lies somewhere in between. Calories are not the whole picture, but they are still a major player in the w eight-loss g ame. One of the best studies I know of to demonstrate this is an ingenious one done Penelope Greene at the Harvard School of Public Health in 2003. Here’sbywhat she did. Dr. Greene studied three g ro ups of dieters. The first gr oup went on a 1,500-calor ie-per-day low-fat diet (1,800 for men). The second gr oup went on an 1,800-calorie low-carb diet (2,100 calories for men). If all calor ies ar e created eq ual, the second gr oup—which consumed more calo ries—shoul d have weighed a bit mor e at the end of the study than the first gro up. They didn’t. Though both groups lost weight, the low-carb (highercalorie) group actually lost a little more, despite the fact that over the 12-week study they ate an averag e of 25,000 calor ies more than the lowfat group. But, you say, what about the third gr oup? Glad you asked, because here is where it gets interesting. Sharp-eyed readers might have noticed that the two groups discussed above actually differed in two variables, not just one. They ate different amounts of calories (1,500–1,800 for group one, 1,800–2,100 for group two), but they also ate different food—low-fat for gr oup one, low-carb for gr oup two. What would happen, Dr. Greene wondered, if there was a third group that ate the same type of foo d as gr oup two (l ow-carb) but t he same number of calo ries as gr oup one (1,50 0–1,800)? And that, indeed, was the third gr oup i n the study. Low-calo rie and lowcarb. That gr oup lo st the most we ight of all. Mor al of the st or y: calor ies do count—but they’re not the whole stor y. Low-carb diets may have a metabol ic advantage, but it’ s not unlimited. In fact, it’s probably pretty small (200–400 calories, suggests Mike Eades). You can’t eat 12,000 calor ies a day o f fat and pro tein and think you’r e going to lose weight just because you’re on a low-carb diet. You still need
to pay attention to cal or ies. But you do have a bit—and I do mean a bit —of wiggle r oom o n low-carb. Mike Eades actually has a terrific analogy to explain the whole metabolic advantage thing. H e poi nts out that lots of people l ike to use the car as an analogy for the human body—put in the gas and you can predict the mileage. Which is true, all thing s being equal. But to r eally be a fair analog y to what happens with fuel i n the human body, you have to i nclude oneHere’s important missing pieceabout of thea pie: the driver. Dr. Eades talking personal driving experience and using it as a splendid analogy for the metabolic advantage:
A few years back MD (Dr. Mary Dan Eades) and I were driving through the Ozarks in southwest Missouri where I grew up. We were riding in an SUV, and as we motored along, I suddenly noticed that the gas gauge was banging on empty. Then it dawned on me that it was a Sunday, and it was likely that in rural America there weren’t going to be a lot of service stations opened. Especially out where we were. And I didn’t even know exactly where we were relative to any towns because I hadn’t been paying cl ose attenti on. I went int o gas conserve mode. As we approached hills, I timed my speed so that we would barely make it to the top, then be able to coast down and halfway up the next hill before I had to hit the gas pedal. I let my coast speed build up to way more than I felt comfortable with given the winding roads and blind curves, all the while trying to ignore MD’s sharp intakes of breath, her legs and feet pushed against the floorboard braced for colli sion, and her death grip on the handhold. Even though I was driving a gas-guzzling SUV, I’ll bet I milked 40 miles to the gallon out of that sucker until we finally found an open service station, and the day was saved. Once we were filled up, and I was back at the wheel driving normally, we probably dropped back down to the 18 mpg range. If I’m running late and in a hurry, I get a lot less gas mileage than normal. I race up to stoplights, slam on the brakes, floor the accelerator when the light changes—all activities that minimize gas mileage, but get me wherever I’m going a little sooner.
In other wor ds, you can’t predict t he mileage just fro m knowing how many gall ons o f gas ar e in the tank. You have to also know how the car is going to be driven—or, in the case of calories and the body, how the body is go ing to pr ocess those calor ies. And all calor ies are not pro cessed in the same way. This is the basis o f the metaboli c advantage. Mor e than a few studies have r aised questions abo ut the whole “ calorie is a calorie ” orthodoxy. At Cincinnati Hospital, Dr. Bonnie Brehm put two groups of obese women was put on Atkinshigh-carb Inductiondiet. (very low-carb), the other was on putdiets: on a one conventional low-fat The Atkins dieters lost more weight even though both groups tended to consume the same number of calories. Dr. Stephen Sondike did a similar study with two groups o f obese teenaged bo ys—the Atkins dieters consumed an average of 1,800 calories, while the low-fat kids took in 1,100. Guess who lost more. Now, it’s also true that in a lot of studies where one group is on a lowcarb diet and the other is on a conventional diet, the low-carb folks lose more weight at first (like for the first 4–6 months), but the differences often even out over time (like after a year). We’ll get to the reasons for that in a moment. First, let’s demolish the idea that being able to eat somewhat mor e calor ies on a carb-r estri cted diet and still lose weight violates t he sacred “First Law of Thermodynamics.” Which it seems to do. The operative w or d here is “ seem.” But if you ask peo ple who actually understand the laws of thermo dynamics, you co me up with a quite different take on it. According to a paper published by Richard Feinman, PhD, professor of biochemi stry at the SUNY Downstate Medical Center and founder of the Nutritio n and Metabolism Society, it appears that the naysayers may not understand thermodynamics nearly as well as they think they do. The naysay ers don’t account for another part of the laws of thermo dynamics which basically talks about w aste and inefficiency (see Mike Eades’s driving experiences above). Turns out, lots of calories are actually wasted during the processes of metabolism, an d some calor ies tend to be wasted more than others. That’s because some forms of “energy” (calories) are more efficient ; gl ucose molecules, for example, tend to be used for energy right away. They’re like coins you have in your
pocket—easier and faster to use than if yo u have to g o to the ATM to g et your cash. If you’re using mainly protein and fat for fuel, it’s like having to go to the ATM. You still use cash, but you’ve wasted a lot of time (and energ y) co nverting that ATM swipe into som ething the cler k at the cashonly supermarket will accept. Those extra calories that low-carbers may consume do n’t actually “disappear ” at all—they’re just “burned” in the pro cess of being converted t o usable fuel fo r the body. it works.about Suppose you have cars, with equal size gasHere’s tanks how and engines, to depart on a two trip similar of a given distance, neither of which has Mike Eades at the wheel. Both have to go thro ugh the same toll booths and obey the same speed limits. However, one driver is given “exact-change tokens” to drop in the toll-booth basket as she cruises by. The other dr iver is g iven a stack of $50 bills and told she has t o use one at every single booth. Who do you think is going to get to the destination first? You see, dr iving thro ugh the toll bo oth with the exact-change tokens is very efficient . But dri ving thr oug h with $50 bills is not. A lot of time and energy is wasted—you have to stop the car for a minute, wait for the change, co unt out the money, and finally put the t oken in the basket befor e you can get started again. In their paper “Thermo dynamic Edge fo r Low Carbohydrate D iets,” Feinman and his co lleag ue Eugene J. Fine, PhD , explain that the same thing is true on low-carb diets. Carbohydrate is an efficient fuel; i t’s like having exact-change tokens. Protein and fat, on the other hand, is more like having $50 bills. To turn it into tokens takes energy (burns calories), and it is this “wasted ” ener gy that accounts for what we might call “the metabolic advantage.” And that extra waste is precisely what allows people on very-low-carb diets to consume somewhat mor e calor ies than they did on lo w-fat, highcarb diets, and still lose weight. As Dr. Feinman puts it, “The human body is a machine and the efficiency of the machin e is controll ed by hor mones and enzy mes. Carbohydrate s incr ease insulin and other hor mones that regulate enzy mes, leading to stor age r ather than bu rning of fat.” I mentioned earlier that a number of studies showed that low-carb diets have an advantage r ight out of the starting g ate, when compar ed with
conventional diets for weight loss. Time and again, we see low-carbers beating the competition at t he six-mo nth mark, onl y to see no s ubstantial difference between the two groups by the end of a year or two. Why does this happen? I don’t know, but I have a theory. I think what happens is this: People do r eally well o n their “pr otein and fat” carb-limited pro gr am, and stick with it pretty religio usly for a few months. ThenIthey get com TheyBefore think, hey, thingsit, arthey’re e going pr etty good, maybe can add someplacent. carbs back. you know eating that same “meat and eggs” breakfast, but now they’ve go t a few slices of toast with it, and maybe a glass of orange juice. They’re back to a high-calorie “mixed” diet, even though they’re still technically being treated by the researchers as members of the “low-carb” group. It’s no surpri se that these fo lks g ain their lost weight back. It’s actually a tr ibute to how well lo w-carb do es that even staying o n it even a little pr oduces better results than not staying o n it at all. Take the famo us “A to Z” diet study done in 2007 at Stanfor d University.1 Back in March o f that year, you couldn’t swing a bat without seeing a headline somewhere about this study, a year-long affair that compar ed fo ur diets. “Atkins beats Zone, Or nish and U.S. diet advice,” proclaimed CNN. “Atkins Diet Tops Others In Study,” said the Washington Post. The study got a lot of press and generated a fair amount of controversy. It was also the subject of a fair amount of misinterpretation in the press. But what actually happened has a l ot to tell us abo ut dieting in general. First, some background: Researchers at Stanford University took 311 premenopausal w omen, all o f them overweight or obese, and a ssigned them to four diet gr oups: Atkins, Or nish, the Zone, and t he LEARN plan, a conventional-eating prog ram based o n U.S. dietary g uidelines. “We wanted a range of diets fro m high car bohydrate t o l ow,” explained lead researcher Christopher Gardner, PhD. The Atkins diet, of course, is famously low in carbohydrates (and can be high in either fat, pro tein, or both). The Or nish diet is extremely low in fat (about 10% of intake); and the Zone is right in the middle (technically, 40% of the diet comes fr om carbs and 30% each from protein and fat; see page 258). The LE ARN diet is based o n
conventional recommendations of about 55% to 65% carbs and less than 10% saturated fat. The r esearchers were interested p rimaril y in weight loss, th ough o ther measur es were taken as well (mo re on that in a moment). “ In the weightloss department, there was a modest advantage for the Atkins group,” Dr. Gardner told me. Those in the Atkins group lost the most weight (10 pounds, on average); those in the Zone group lost the least (3.5 pounds, on 2
averag e)—and thesodifference between he two was statistically But there were me problem s. For tone thing, the women in sig the nificant. st udy were far f ro m meticulous about follo wing the dietary r egimen to whic h they were assigned. While the women in the Atkins group were aiming for between 20 and 50 gr ams o f car bohydr ate a day, by the end of the study they were eating well o ver 125 gr ams, which, while defini tely less than the average American daily car b consumpt ion, is nonetheless hardly a strict “lowcarb” diet. The Ornish group, meanwhile, aiming for 10% fat, was actually eating almost 30%. Zone dieters shooting for 30% protein wound up eating 20%, and even the w omen attempting to f ollow the conventional LEARN diet wound up r educing their carbs to just over 47%. Critics— including the designers of the diets that bore their name—complained loudly that the study resul ts were not valid because the diet strategi es under investigation had no t been follo wed to the letter. Well, maybe no t. But as Dr. Gar dner convincing ly po inted out to me in an intervi ew, this was a study of what people actually do with dietary advice. As such, it sheds a lot o f light about “r eal-wor ld” dieting. Here’s what Gardner said:
We purposely didn’t just hand them the diet book and tell them to come back in a year. We made sure they understood it. Each group had 8 weeks of classes with a dietitian who went over the principles of the books, section by section, so everyone knew exactly what to do. Furthermore, these were educated women in the Stanford University area—they were highly motivated and had a lot of support. For the last 10 months of the 12-month study, the women were left to follow the diets on their own without any additional support or guidance from staff. So what we’re seeing here, in terms of deviation from the
exact principl es of each diet, i s a very ‘real-world’ scenario—it’s what happens when even motivated people follow diet books. We think that’s extremely relevant. And so do I. If most o f the women in this study—w ho wer e given information and support (including financial incen tives for finishing)— couldn’t fo llo w any of the diets to the letter, what chance do mer e mortals have? Not much. But that hardly m eans the study is ir relevant. In fact, it might be even more relevant because it’s repr esentative o f the way diets are actually followed in reality. See, critics o f the study missed a ver y impo rtant point: while the women may not have f ollowed the diets to the letter, they did made changes in some impor tant areas according to the principles of the respective plans. For example, the Atkins women had started the program consuming about 215 grams of carbohydrate a day (about 45% of their diet), which is still lower than average (the “average” American consumes about 300 gr ams a day or mor e, at least 50% of their diet). By the end of the 12 months, t he women in the “Atkins gr oup” were down to about 34%. That’s a big deal. Sure, it was higher than what was recommended for their group, but it was still a substantial chang e in the low-car b dir ection. They may not have achieved perfection, but they did achieve results , and those r esults shouldn’t be overlooked simply because the women didn’t follow the diets perfectly. After all, who can? It’s also wor th mentioning that the women in the Atkins gr oup also improved a lot of other things besides their weight. Their HDL (“good”) cholesterol at 12 months was significantly higher fo r the Atkins gr oup members tha n for the Or nish folks, and t riglycer ides were lo wer in the Atkins group than in the Zone group. In fact, triglycerides for the Atkins gr oup went down by 29%, mor e than twice the percentage o f any other gr oup. And the decrease in average bloo d pressure fo r the Atkins gr oup was signi ficantly g reater than any o ther. By the end o f the 12-mo nth study, LDL (“bad”) chol estero l, the type that many health pro fessio nals warned would wor sen on the Atkins diet, was statistically about the same among the four diet gro ups. These are i mpor tant findings, particularly in view of the negative press low-carbohydrate diets have gotten for their supposed
bad effects on car diovascular health. In this study, at least in the shor t term, the opposite appeared to be the case. “It’s increasingly clear that the average person may not be able to make huge shifts in their diet without a lot of help ,” Dr. Gar dner said. “ You have to ask yourself , is the (diet ) book too complicated? Or , do some people have certain limitations—physiological or psychological—that are just too diffi cult t o overcome, even when they know what they are supposed to do?
nd tthen to look at t he food we it liveextraordinarily in and the f act that hereyou arehave constant messages aboutenvironment food that make difficult to stay with any plan that is healthful and suggests limitations on the amount you eat.” A person aimi ng fo r 10% fat who wor ks in an office where the only available food is standard cafeteria-and-snackmachine fare doesn’t get a lot of suppor t for staying on their plan. So what’s the take-away? “I think one advantage that the Atkins diet had was the simplicity of t he message,” Dr. Gar dner to ld me. “ A lot of people say that the main Atkins message is to eat all t he steak and brie that you want, but that’s not it. Their main message is this: you can’t have any refined sugar. None. No soda, no white bread, no high-fructose corn syrup. It’s simple and direct and easy to understand, and I think it may turn out to be one of the most important messages of all .” The bottom l ine is this: y ou can lo se weight on low-carb; but if you want to keep losing, you need to stay on the program. You can also lose weight on a “r egular ” diet, but guess what: you also have to stay on the program. (In case you hadn’t noticed, there’s really no way around staying with the prog ram, whatever the pro gr am is!) So no w the question becomes: how easy is it to stay with the pro gr am? And the answer i s: it depends on the perso n. Or, mo re accur ately, on the “match” between perso n and pro gr am. For many people with blood-sugar issues, “staying on the pro gr am” is go ing to be a whole l ot easier on lo w-carb. That doesn’t me an you can’t get results on the standard low-fat regimen—obviously people do, just as they do o n raw foo ds, on veg an diets, and on mi xed diets. But not if i t’s highcalorie, and not if they don’t stick with it. For many people, lower carb intakes mean fewer blo od-sugar fluctuations, fewer cr avings, an d better bloo dlipid profi les (since glucose and insu lin ar e better managed, and triglycerides are always lowered). Many people find it easier to
manage their appetite on low-carb. Does this mean you can’t ac hieve weight loss o n other pr og rams? Of course not. But for an awful lo t of people, stick ing to a modest calor ic intake on a low-carb pro gr am is going to be easier, more filli ng, and ultimately mor e healthful. The tr ick is to keep calo ries where they need to be—whatever your particular number is—and to keep your intake of the low-carb vegetables (and estimate fruits) asthe high as can be advantage”—but (while minimizing all the rest of it). Don’t under “metab olic don’t overestimate it either! That’s a prescription that makes sense for both health and weight loss.
CHAPTER 6
The Biggest Myths about Low-Carb Diets
Over the years, there have been many criticisms leveled at lowcarbohydr ate diets. Some of these have been repeated so o ften that they are now taken as gospel, even though some have never been closely examined; while others have long ago been proven false, although they continue to be r epeated as if the r esear ch debunking them had never happened. Some of these beliefs are based on complete misunderstandings of biochemist ry and physiolo gy, some on an astonishing distortion o f the pro gr am being cr iticized. (For example, one supposedly reput able healthinfor mation Web site cri ticized “The Zone” o n the basis o f the “fact” that “the Zone diet contains l ess than 1,000 calor ies,” which is patently false.) Some of these beliefs are nothing l ess than cultural “memes,” a term meaning an idea that takes o n a life of its own a nd is passed down from generation to g eneration, like t he ideolog ical versio n of a g ene. These memes are r arely examined — they just “are.” Examples of memes are tunes, catch-phrases, the way you make a bridge, or a basic foundational belief—i.e., something “everybody knows” (like “the world is round,” “bir ds fly,” and “saturated fat cau ses hear t disease”). Some memes are useful and true, but some are in dire need of reexamination and should ultimately be dumped in the cultural wastebasket. You’d think “science,” with its reli ance on exper iment and validation and objective measurement, would be immune to the vagaries of beliefs and prejudices. Howeve r, you’d be sadly wr ong . Scientists are fir st and foremost people, and they can be just as shockingly petty and proprietary and stubbor n as the rest of us. And entrenched beliefs and theor ies don’ t die easily. The histor y of science is li ttered with theor ies that lasted 50 or
100 years or more before people finally came to accept that they weren’t valid.1 And the prevai ling medical and dietetic beliefs can be summed up in six words: low-carb diets will hurt you. It’s going to take a while for popular opinion on that to shift, but let’s take on a few of the most commonly held assumptions here and see where it takes us. At the very least, per haps some of what I’m about to say will give pause as theifnext time you hear great you authority it was gospel truth.one o f these myths repeated with
MYTH #1: You “Need” Carbs When I do live workshops and talks, I often do the following demonstration: I tell everyone in the audience to pretend they are on the show Survivor and we’re going to divide the room into two teams. Everyone in the roo m is g oing to be on a desert island for one year. Then I draw an imaginary line down the middle of the room and make everyone to the left of the line “Group One” and everyone on the right “Group Two.” Then I say the following: “Everyone in Group One will be fed absolutel y nothing but protein and fat for one year. You will get zero carbohydrates in your diet. Everyone in Group Two will be fed nothing but carbohydrates for one year. You will get zero protein and zero fat.” Then I pause for the punch line, which is th is: “Everyone in Group Two will be dead within the year. Everyone in Group One will be doing just fi ne.” The fact is—h old o n to your seats now—there is no physiolo gical need for carbohydrates in the human diet. 2 None. Now, befor e you thr ow this boo k down and decide that I’m co mpletely crazy for making such an outrageous statement, take a look at what the august and esteemed Inst itute of Medicine of the National Academies has to say about this in their reference manual, Dietary Reference Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and
mino Acids. In case you do n’t want to bo ther lo oking it up, here’s what it says on page 275: “The lower limit of diet ary carbohydrate com patible with l ife apparently is zero, provided that adequate amounts of protein and fat are consumed.” 3 The Institute of Medicine goes on to say: “There are traditional populations that ingested a high fat, high protein diet containing only a minimal amount of car bohydrate for extended perio ds of time (Masai), and in some cases a lifetime infancy (Alaska and Greenland Natives, Inuits, andfor Pampas indigafter enous peo ple) (Du Bois, 1928; Heinbecker, 1928). Ther e was no apparent effect on health or longevity. Caucasians eating an essentially carbohydrate-free diet, resembling that of Greenland natives, fo r a year to ler ated the diet quite well (Du Bois, 1928).” You’ve probably heard that the brain requires a minimum 120 grams of carbs a day in o rder to function. Actually, that’s technically inaccur ate—it does indeed ne ed 120 grams o f glucose (sugar) to function, but it can make that glucose perfectly w ell fr om certain amino acids (found in pro tein) and fro m the glycero l backbone of trig lycerides. Let’s not confus e dietary carbs with glucose. They’re not the same thing. Okay, now that we’ve got that out of the way, let me back up a minute. The fact that there is no dietary need for carbohydrates simply means we can survive without them. It does4not mean—and I am not saying—that we shouldn’t eat them (see myth #2). I’m simply pointing out a basic fact in biology. Our bodies will and can run on ketones 5—quite nicely, thank you ver y much—and whereas we will die without pro tein and fat, we will not die without car bohydr ates. However, we would no t die without hot and cold running water, nor without indoor plumbing. Nor without someone to cuddle with every nig ht. That doesn’t mean we shouldn’t have them. I do think it’s curious that groups like the American Dietetic Association continue to r ecommend t hat the lion’s share of our calor ies come fr om the one macronutrient we could actually survive without! But don’t get me started.
MYT H #2: In a Lo w -Carb Diet, Y ou’ll Be Missing A ll the V itall y Impo rtant Nutrients tha t
You Get from Carbs Well, this myth would have some validity if low-carb advocates actually suggested cutting out all carbs. But they don’t. Not a single advocate of controlled-carb eating thinks we should eat a no-carb diet. Carbs—from vegetables and fruits and legumes—provide fiber, phytochemicals, andmean a wealth of nutrients, Contro lled-carb does not no-carb, and I amvitamins, certainlyand notminerals. advocating a no-carb diet for anyone. A no- junk diet: you bet. A low-sugar diet, absolutely. But a no-car b diet? Not on your life. What’s mo re, you can eat a ton—and I mean a ton—of vegetables and even fruits, and still be on the “low” end of the carbohydrate spectrum. Consider this: you could eat— on a daily basis —all the follo wing carbohydrate foo ds and still be co nsuming under 140 grams of carbohydrate, which is less than half of what most Americans now consume: • 5 cups of spinach = 5.45 grams carbs (3.5 fiber ) • 2 cups of coo ked bro ccoli = 22 .4 gr ams carbs (10 .1 fiber) • 1 cup of raspberr ies = 14.69 grams carbs (8 fibe r) • 1 medium apple = 25.13 grams carbs (4.4 fiber ) • 20 gr apes = 17.74 gr ams carbs (0.8 fiber) • ½ sweet potato = 11.8 gr ams carbs (1.9 fiber ) • ½ bowl of o atmeal = 13.5 gr ams carbs (2 fib er) • ½ cup of Brussels sprouts = 5.54 grams carbs (2 fiber) • ½ cup of blueberr ies = 10.72 grams car bs (1.8 fiber) • 2 medium carr ots = 11.68 gr ams carbs (3.4 fiber) Considering that most people in America aren’t even getting 5 (let alone 7 or 9) servings of fruits and veget ables, and considering that the above
list represent s ro ughly 16 servings , you can see that I picked a pretty extreme menu. But even so—16 servings of carb foods and you’re still under 140 gr ams (138.63 to be exact, but who’s counting?). But wait: it gets better. Most people in the low-carb world don’t count fiber as part of their “carbohydrate” intake, since it has absolutely no effect on blood sugar. They subtract fiber from total carb count, and call what’s left either “net carbs” or servings “effective carbs,” is pr etty the of way it should The above 16 g ives youwhich a whopping 37.much 9 gr ams fiber, one ofbe.the most important nutrients for health on the planet. (The average American gets between 4 and 11 grams, and every major health organization recomm ends between 25 and 38 gr ams.) If you subtract those 37.9 gr ams of fiber from the overall carb total of 138.63, you ar e left with about 100 gr ams of carbs a day. That might be enoug h to make the Ameri can Dietetic Associ ation apo plectic, but who cares? I defy anyone o n the planet to show me ho w a diet that includes the above 16 servings of fruits and vegetables, plus plenty of pr otein (gr assfed meat, wild salmon) and fat like olive and coconut oil, nuts, avocados, and even a glass of red wine and a bite of dark chocolate, is “unhealthful.” Show me. Please. I’ll be r ight here waiting. And I’ll be waiting a hell of a long time. Now, some people in the low-carb wor ld would not consider 140 gr ams of car bs a “low-carb” diet , and, to be sur e, for some people—particu larl y the very insulin-insensitive, or those with metabolic conditions in which every single gr am o f car bohydrate must be counted—this mig ht be too high. But let’s talk for a minute about the gener al r eader: you, per haps. A diet that reduces car bs to that very reasonable amo unt, and at the same time fro ntloads it on vegetab les and fruits, is going to r epresent an improvement that’s literally light-years ahead of what most folks are curr ently eating. It’s g oing to extend your life, increase yo ur energy, stabilize your weight, and improve yo ur health.
KILLER CARBS
Ever wonder why you’re hungry for more after you eat a high-carb
snack or meal? Research by Zane Andrews, MD and his team at Monash University in Australia identified key appetite-control cells in the human brain. These appetite-control cells are attacked by free radicals after eating, but the attack is bigger and stro nger foll owing a meal r ich in sugar and carbohydrates. “The mor e carbs and sugars yo u eat, the mor e your appetitecontrol cells are damaged,” The result? You eat said more.Andrews, the lead researcher on the study. The forces that compel you to eat and the forces that tell the brain “Hey, this dude is full!” ar e constantly at war. When your stomach is empty, it tri gg ers the release of a hunger hor mone called ghrelin. When you’re full, a set of neurons known as POMC’s (proopiomelanocortins) kicks in. Free radicals normally created in the body attack both the “hunger” neurons and the “anti-hunger” neurons, but the “hunger” neurons are naturally protected. This tips the scale in the direction of hunger and cravings. And carbs create the most damage of all. According to Andrews, people aged 25 to 50 are most at risk. “The neurons that tell people in th at crucial age r ange not to over eat are being killed off.” Yet another r eason to limit your sugar and processed carbs if you don’t want to be the victim o f constant cravings.
MYT H # 3: Low-Ca rb Diets Induce Ketosis, a Dangerous Metaboli c State I will admit that in the last few years—between the publication of previous editions of this book and now—the subject of ketosis has faded somewhat from center stage. Once an important feature of low-carb diets (since Atkins promoted as part of his diet, srcinal diet),that ketosis longer a “required” part ofit any low-carb unless diet isis no being studied scientifically or used therapeutically (it’s a mainstay of dietary treatments
for childhood epilepsy ,6 for example, and is st ill ver y effective for weight loss i n recalcitrant cases). So although ketosis was once the focal point of the arguments against low-carb diets, it no lo nger is. It’s now widely accept ed that most peopl e— if not all—do no t have to be in ket osis i n or der to lo se weight; conversely , you can be in ketosis and not lo se weight. Nonetheless, I include this section simply to dispel many of the remaining myths about ketosis, and also perhaps as an object lesson in which concept can persist stubbor nly for years. we can see how a misunderstood And the best way I know to ill ustrate this is to tell you a stor y. Follow me on this, and you will under stand mor e about ketosis than half the doctors in America. Back in the 1990s, a lo t of r estaurants in New Yor k City served a delicious fish that nobody would order. In fact, the presence of this fish on the menu caused more than a little distress in some circles and led to some heated exchanges between customers and restaurant managers. Animalrights activists—who were frequently baby boomers with enough disposable income to keep the restaurants afloat—were the most vitriolic in their condemnation o f the establishment s that served this fish, but the outcry fro m “reg ular” fo lks was not much mor e muted. The fish was dolphin. You can, I’m sur e, see the pro blem. No one wanted to patro nize an establishment th at was so heartless as to serve up Flippe r for the gastro nomical whims of its cust omer s. Quite understandable. Problem was: “dolphin” isn’t “Flipper.” Dolphins were, and ar e, quite or dinar y but tasty fish that look exactly like fish: they bear not even a passing resemblance to the bottle-nosed dolphins that delig ht us at Sea Wor ld and with whom they happen, by some weird taxono mical scr ewup, to shar e the same name. In fact, they aren’t even the same species (one being, of course, a fish, wh ile the oth er is a mammal). Plus, the dolphin (fish) does not perfo rm ador able tricks and does not appear to have much rapport with the average human being. (Some sources, in fact, refer to the dolphin fish as “dolphinfish,” to distinguish it from the mammal.)
But go tell that to the table for four in the back where the kid is crying and the parents are threatening to never come back to this restaurant, ever. Waiters explained, pr obably as many times as they had to say, “H i, I’m Jason and I’ll be your server for today,” that dolphin was not dolphin . Yes, they did in fact share the same name, but one was a fish and one was the lovable marine mammal, and the dish on the menu, sir, was not Flipper. Didn’t matter. No matterthe how many thisthroughout conversation repeated in restaurants throughout city, and times probably thewas country (though I can pers onall y attest only to the number o f times I heard it in New Yor k City), it fell on deaf ears. So r estaurant own ers did a smart thing. They changed the name of the fish. “Dolphin” no w became known as “mahi-mahi,” which is the Haw aiian name for the dolphinfish. End of pr oblem. Which brings us to ketosis.
Ketosis: Friend or Foe? It is very difficult to read about—or write about—low-carbohydrate dieting without dealing with the term ketosis . If you’ve been around lowcarb diets at all—if you’ve experimented with them, talked about them to your friends, read about them, read warnings about them—you’ve surely heard of ketosis. You’ve probably heard that it’s some kind of metabolic state that accompanies these diets and that you should avoid it—and those “high-protein” fad diets that produce it—at all costs. Several years ago, in a column at iVillage. com, I wrote the following, which is still true today: Ketosis is so misunderstood and maligned that I really feel it’s worthwhile to go into it in some detail. For those o f you who ar e new to this, ketosis is something that happens in the body when you eat very, very few carbohydrates. Since there’s very little sugar coming in, your body burns fat for fuel almost exclusively—this is called “being in ketosis.” Many popular diet programs have made use of this “metabolic advantage,” most famously the Atkins program, and dietitians (and doctors) have been screaming about how dangerous it
is ever since, although they can never seem to tell us why. It’s been popular among dieters because, among other things, even the most metabolically resistant people usually lose weight on a ketogenic diet, and many people, after an initial adjustment from a sugar-burning to a fat-burning metabolism, feel great, with increased energy and a noticeable sense of well-being. Atkinso himself wrote of ketosis in the second editions f his New Dietrhapsodically Revolution, calling it “one of first life’sand charmed gifts…. As delightful as sex and sunshine, and it has fewer dr awbacks than either of them.” It was Atkins who gave ketosis the nickname “the metabolic advantage.” (For more on the metabolic advantage, see chapter 5, page 85) So how can something so harmless and benevolent (and so conducive to weight loss) be widely considered one of the most dangerous states the body can be in? (If you doubt that this is the prevailing opinion, try asking your mainstream doctor what he or she thinks of it. Or ask a dietitian.) The reason is quite simple, actually. For the better part of thirty years, mainstream medicine, dietitians, and most of the critics of the low-carb diet have completely confused two conditions , as different fro m each other as the dolphin (fish) and the dolphin (Flipper). One of those conditions is ordinary, benign, dietary ketosis, of which we’re speaking here. The other is a life-threatening condition called diabetic ketoacidosis (mor e on this in a minute). Getting the mainstream to understand the differ ence has been harder than getting the kid at the table to understand that the restaur ant really isn’t serving co oked Flippe r. Atkins, in the last edition o f New Diet Revolution, pr etty much gave up the thir ty-year fi ght to g et the medical establishment to under stand the difference; he stopped using the term ketosis. He switched to the term lipolysis (fat breakdo wn). Only time will tell i f the name change is as successful as the switch t o mahi-mahi has been.
The Real Deal on Ketosis SoNote: what is this thingtocall ed ketosis, why should we I’ll car try e? to make it I’m going go into a little and biochemistry here. painless, though I understand that, for many, the term painless
biochemistry is an o xymor on. If you want to ski p the next few parag raphs, believe me, I won’t be off ended. If, however, you’d like to skewer the next person who tells you how dan ger ous your low-carb diet is bec ause of ketosis, you mi ght want to read the next few hundred wor ds. Your body has t hree main so urces o f fuel: carbohydrates (glucose), proteins (amino acids), and fats (fatty acids). These are broken down and combined in different w ays—fats and carbs to pr oduce energy o r to be saved as fat; pro that tein the to buil d uppurpose tissues,of bones, muscles, and the like. Remember whole a low-carb dietenzymes, is to make your metabolism mo re of a fat-burning machine than a sugar -burning machine. As Lyle McDonald, o ne of the best-known author ities o n the ketog enic diet, says, “Ketosis is the end result of a shift in the insulin/glucagon ratio and indicates an overall shif t from a glucose- (sugar)-based metabo lism to a fat-based metabolism .” (Emphasis mine.) In other wor ds, the whole idea is to get your body to swit ch fuels fr om pr imari ly carbs, it s prefer red immediate sour ce of energ y, to primar ily fat. Carbs, or sugar, are the first source of energy used by the body, with fats providing the best long-term source of energy. Yet high levels of carbohydrate pro duce, for many people, higher levels than desirable of the hormone insulin, and fat cannot be “burned” or “released” to any significant de gr ee in the p resence of insulin. So fo r someone with a w eight pro blem, high carb intake w ill pr ovide all the fuel th ey need for living (and probably plent y for storag e as fat in addit ion) and will r aise insulin levels enough so that fat isn ’t released or burned. Normally, carbs are broken down into glucose, and then pyruvic acid, and then a substance called acetyl CoA. Fats ar e broken do wn into their component parts, fatty acids and glycerol, then further broken down (by a process called beta-oxidation) into two carbon fragments which also combine to make acetyl CoA (see illustration on page 104). On a “nor mal,” hig h-car b diet, two things happen to the acet yl CoA. First, some of it gets broken down in the liver into ketone bodies. It’s important to remember that this is a normal par t of metaboli sm. You ar e making ketone bodies right now while you sit there reading this book. The liver is always pr oducing ketone bodies. As McDonald says, “Ketones should not be considered a toxic subst ance or a by-product of abnor mal human metabolism. Rather, ketones are a normal physiological substance
that plays many important roles in the human body.” (This, of course, did not stop Jane Bro dy of The New York Times—one of the biggest apologists for the highcarbo hydrate/low-fat d iet in America—fr om calling ketones “toxic co mpounds that can damage the brai n” and “pollute the blood.”) So the liver makes ketones—which are essentially by-products of fat metabolism (specifically the breakdown of acetyl CoA)— all the time . What’s the other thing that happens to the acetyl CoA? Well, o n a diet with plenty of car metabolism bohydr ates, called the acetyl CoA combines with a by-product of carbohydrate oxaloacetic acid . When acetyl CoA combi nes with oxalo acetic acid, it enters an energ ypro duction cycle called the Krebs cycle. (This is what is meant b y the old saying “Fat burns in a flame of carbohydrate.” Without the carbohydrate necessary to produce the oxalo acetic acid, the acetyl CoA cannot gai n admission to this energy cycle and be burned.)
So thos by e arboth e thefat two pathways and that carbohydrate acetyl CoA (which, you r emember, produced breakdown breakdown) can take is when there’s car bohydr ate in the system.
But what happens when there isn’t? What happens when you go on a very restricted carbohydrate diet and there is not enough car bohydrate (glucose) coming down the pike to pro duce the oxaloacetic acid necessary to take the acetyl CoA into the Krebs cycle? Well, the acetyl CoA accumulates in the liver. And the liver promptly breaks it down into ketones (also known as ketone bodies—if you really want to get technical, there are three of these ketone bodies, and their names e acetoacetate, beta-hydroxybutrate, and acetone; i t’s the release of thearacetone that gives you that “fruity” breath). The major determinant of whet her the liver will pro duce a significant or neglig ible amount of ket one bodies is the amount of sugar (liver glycog en) that’s around. In a lo w-carb diet, there’s not a lo t. So al l of the acetyl CoA has to be broken down into ketones, and these ketones—products of fat breakdo wn—are now being m ade in sufficient quantit ies that you can detect them in the urine. The “normal” level of ketones in the blood is about 0.1 mmol/dl; mild ketosis is 0.2 mmol/dl. Ketogenic diets typically produce between 5 and 7 mmol/dl (see chart above).
Please remember: th ese ketones ar e benign pro ducts of nor mal metabolism, and the fact that you can actually see their presence in the urine (by the use of ketone test strips) simply means that your body is breaking down fat for energy i n measurable, significant amounts. So, how did ketone bodies get such a bad rap? There ar e two reasons.
Ketosis and Diabeti c Ketoacidosi s To understand the primary reason ketones have been vilified, we have to loo k at the type 1 diabetic. As you may r emember from earlier discussion, insulin is responsible for getting sugar out of the bloodstream and into the cells , thus keeping blo od sugar (glucose) within a tightly cont ro lled r ange. Insulin also keeps fat fro m being br oken do wn, which is why it needs to be in balance with its sister hormone, glucagon. Glucagon is responsible for releasing fat into the bloodstream, where it can be broken down and used for energy. Insulin is responsible for storing it. The type 1 diabetic cannot make insulin. With no insulin, two things happen, neither of them good. One, blood sugar rises to very dangerous levels. Two, with no insulin to put the brakes on g lucagon, fat is bro ken down and released int o the bloo dstream faster than it can possibly be used, and the production of ketone bodies is seriously r amped up. In addition, these ketones cannot be used by the body tissues like they can in normal dietary ketosis. This is because there’s tons of glucose around, which is the preferred fuel, so the ketones just keep accumulating at an alarming rate. This state is called diabetic ketoacidosis , and it is indeed very dangerous and life-threatening to an untreated type 1 diabetic. Remember, a ketogenic diet produces, on average, 5 to 7 mmol/dl of ketones, and does it in the presence of normal to low bloo d sugar. The untreated type 1 diabetic will produce ketones in the range of 25 mmol/dl (350 to 600 percent higher than normal!) and will do it in the presence of extraordinarily high and dangerous levels of bloo d sugar. There is absolutely no compar iso n between the two states. The per son without uncontrolled type 1 diabetes has a number of normal feedback mechanisms thatwith will the always keep the in a safe r ange, mechanisms that do not exist untreated typeketones 1 diabetic. Diabetic ketoacidosis cannot happen when there is even a small amount of insulin around, as
there always is in those no t sufferi ng fr om type 1 diabetes, even when the person is on a ketogenic diet .
The second reason ketosis has gotten a bad rap is a r eversal of a medical fact. Ketosis is o ne of the metaboli c adaptations to star vation. When you’re starving, the body uses ketones for fuel. Starving is bad. Therefo re, people w ho didn’t t hink about it very clearly r eversed th e or der and assumed that since ketosi s is (obe r, rather, can be) o f the reactions to something bad, ketosis itself must bad. That’s likeone assuming that umbrellas cause r ain. Ketosis in starvation is very, very different fro m ketosis in the ketogenic (high-fat or high-protein) diet. Why? In starvation, the body is breaking down muscle in the absence of dietary pr otein. In the low-carb diet, dietary protein is plentiful and prevents the loss of muscle that occurs with true starvation. The loss of body protein is actually what causes death from starvation. When you supply sufficient protein in the diet, this si mply do esn’t happen.
re Ketones Dangerous? Hardly. They’re a perfectly good source of energy. Drs. Donald and Judith Voet, authors of a popular medical biochemistry textbook, say that ketones “serve as important metabolic fuels for many peripheral tissues, particularly heart and skeletal muscle.” 7 And a recent paper coauthored by a number of distinguished researchers, including one from Harvard
Medical School, stated that ketones provide an efficient source of energy for the brain and that mild ketosis—the kind you achieve on a low-carb diet—could have a wide range of benefits for conditions ranging from Alzheimer’s to Parkinson’s. 8 A ketogenic diet should not be used by three groups of people: (1) uncontrolled type 1 diabetics (for the reasons outlined above); (2) pregnant or nursing women (not because h igher levels of ketones in th e blood are dangerous, butand just(3) because don’t know ki fordney suredisease if they (see have any effect on the bab y); peo plewe with existing myth #5 for a full explanation of the connection between protein and kidneys). If you are not in one of these three groups—type 1 diabetics, pregnant or nursing women, or people with existing kidney disease—the ketogenic diet is perfectly and utterly safe. Let’s take a loo k at the science. A recent study in the Journal of Nutrition looked at the effects of a sixweek ketogenic diet on risk factors for cardiovascular disease. 9 The study found improvements in tri glyceri des and ins ulin levels, plu s a slig ht increase in HDL cholester ol (the “go od” ki nd). Most impo rtantly, the type of LDL (“bad” cholester ol) tended to chang e fr om the kind that’s danger ous (pattern B) to the kind that’s no t (pattern A). Other studies have shown similar r esults.10
KETONES FOR ALZHEIMER’S ?
In Alzheimer’s disease, some brain cells have difficulty metabolizing glucose, the primary source of energy for the brain. Deprived of fuel, some of these valuable neurons may die.
Ketones to the Rescue Ketones are such good fuel for the brain that a Colorado biotech company called Accera is currently developing an oral liquid that helps the body produce more of them. * The drug—called Ketasyn— is currently in Phase II trials as a potential adjunct treatment for Alzheimer’s.
Ketones are a wonderful alternative fuel for the brain, which functions quite well on them after a brief period of adaptation. The patients enrolled in the Ketasyn trial showed significant improvement in memor y and cognition. * http://www.drugresearcher.com/Emerging-targets/Brain-energy-
boost-slows-Alzheimers A recent study at the Universi ty of Cincinnati and Childr en’s Hospital Medical Center in Cincinnati specifically looked at the effects of a verylowcarbohydrate diet on car diovascular r isk factor s in fifty-t hree o bese but otherwise healthy w omen. The women were placed o n either a ver ylowcarbohydrate diet with unrestricted calories, or a low-fat diet that was calor ierestricted. The low-carb g ro up lost significant ly mor e weight and, mor e important ly, mor e body fat than the lo w-fat gr oup. (Interestingl y, after the study, both groups of women wound up maintaining their weight loss on about the same number of calories—1,300.) This last-men tioned study is particularly interest ing fo r a couple of reaso ns. One, the low-carb g ro up was in ketosis, but as the au thor s noted, the level of ketones wasn’t even to that seen in stTwo, arvation o r diabetic ketoacidosi s and presented no prclose oblems whatsoever. the subjects on the ver y-low-carbohydrate diet ex perienced significant ly mo re weight lo ss than the low-fat group and maintained gr eat readings fo r blo od chemistries and cardio vascular r isk factor s while consuming more than 50% of their calories as fat and 20% as saturated fat . Curr ent standards for healthful eating include reducing total fat intake to less than 30% of total calories and decreasing saturated fat to less than 10%, which is supposed to both lower cholesterol and decrease the risk of obesity. These subjects accomplished the same thing while eating a heck of a lot more fat —and saturated fat—than the current standards, plus they lost mor e weight in the barg ain. The author s wisely conclude that “t his study pro vides a surpr ising challenge to pr evailing dieta ry practice.”11 Finally, ketogenic diets have been used as treatments for childhood epilepsy for more than seventy years. They are currently used at seventyeight centers in the United States alo ne, including Children’s
Hospital in Los Angel es, Johns Hopkins i n Baltimo re, the UCLA Schoo l of Medicine, Children’s Hospital in Boston, the M ontefio re Medical Center and Columbia Presbyter ian Medical Center in New Yor k, and the Lucille Packar d Childr en’s Hospital at Stanfor d, whose Web site states: “No patient has had serious complications.”
Do You Have to Be in Ketosi s to Lose Weight on a Low-Carb Diet? No. You don’t. Ketosis is actually only a feature of some low-carb diets, and not even that many. It is str essed in Atkins; it is l ikely (but not mandator y) in Pr otein Power; it is a feature of the Lindora program and the GO-Diet. Many other low-carb programs don’t even mention it. The point is that it is not something to fear. Many nutrition exper ts—myself included—feel that you don’t have to be in ketosis to get the benefits of a low-carb diet. You can “flirt” with ketosis, be on the cusp of ketosis, but unless you are very metabolically resistant, you may be able to get the benefits of low-carb eating without ever worr ying about your ketone levels. Perhaps the most sober and rational summary of the ketogenic diet is given by Lyle McDonald, who wr ote the definitive boo k on the subject and accumulated the greatest number of scientific references on ketosis ever seen in one place. He say s: “After year s of experi menting with the [ketogenic] diet myself, and getting feedback from hundreds and hundreds of people, abo ut the best anyone can say is that th e ketogeni c diet is a di et that wor ks very well for many but not for all.” Amen.
BOTTOM LINE Dietary ketosis is not the same as diabetic ketoacidosis. The ketosis of a low-carb diet is not the same as ketosis in starvation. Many studies have demonstrated the safet y of ketogenic diets, even for chil dren.
MYT H #4: Low-C arbohydrate Diets Cause Calcium Loss, Bone Loss, and/or Osteoporosis
This criticism of low-carb (or high-protein) diets is based on the fact that higher levels of protein result in higher levels of calcium in the urine, leading some people to the err oneous conclusion that p rotein cau ses bone loss. But a tremendous number of recent studies are showing something quite the oppo site.
Want Strong Bones? Eat More Protein! The Fr amingham Osteopor osis Study investigated pro tein co nsumption over a 4-year perio d among 615 elderly men and w omen with an averag e age o f 75. The amount of pro tein eaten daily ranged fr om a l ow of 14 grams a day to a high of 175 grams. And guess what? The people who consumed more pr otein had less bone lo ss! Those wh o ate less pr otein had more bone loss, both at the femoral bone and at the spine. The study also found that “higher intake of animal protein does not appear to affect the skeleton adversely .”12 (Emphasis mine.) Calcium gets absorbed better on a higher-protein diet, even if there is somewhat mor e urinary calcium excretion. High-protein diets in two recent studies resulted in signifi cantly more calcium absorption than the low-pro tein diets, which were asso ciated with decreased absorption. 13 Interestingly, the actual “low-pr otein” diet that caused decreased cal cium absor ption inrecommends these stud iesfor had aboutThe the same amount of pr that oteinthis thatfact the government adults! authors concluded “raises new questions about the optimal amount of dietary protein required for nor mal calcium metab olism and bone healt h in yo ung women.” 14 And a recent study in Obesity Research lo oked at a h igh-pro tein versus lowpro tein diet to deter mine whether the pr otein co ntent of the diet impacte d bone mineral density. It did. Bone mineral loss was greater in the lowrotein group.15 In other words, without enough protein, you just ain’t gonna build (and preser ve) strong bones, an d the definition o f “enough pr otein” may t urn out to be a lot more than we previously thought.
The Verdict on Protein: Not Guilty So, how did protein getstems this bad forincausing calcium and osteoporosis? It partly fromreputation something the body called loss the acid– base balance. All foods eventually digest and present themselves to the
kidneys as either acid or alkaline (base). When there is too much acid, the body needs to buffer it, and calcium is one of the best buffering agents. Meats—along with many other foods, especially grains—are known to be acid-producing; hence the deduction that high-protein diets would cause a leaching of calcium fro m the bone in or der to alkalize t he acid cont ent. But here’s the thing: we now kno w that if yo u take in enoug h alkalinizing nutrients, this doesn’t happen. If you balance your highprotein foods withAn calcium (and potassium), you will notalllose from your bones! interesting side note: you can take the calcium supplemental calcium you want; if you don’t get enough protein, it’s not go ing to make much difference to your bone healt h. The studies are very clear on this: extra calcium is not enough to affect t he skeleton when rotein intake is low .16 In short, it doesn’t matter if there is a little more calcium in t he urine as long as the body is holding o n to mor e calcium than it’s losi ng (i.e., is i n “posi tive” calcium balance). A nd it will do that when there’s plenty of protein plus calcium (and other minerals) in the diet.
BOTTOM LINE Higher protein intakes do not cause bone loss or osteoporosis, especially in the presence of adequate mineral intakes. In fact, lower protein intakes are associated with more bone loss.
MYTH #5: High-Protein Diets Cause Damage to the Kidneys You will often hear from ill-informed sources that a high-protein diet damages the kidneys. Not so. Consider the following: everyone knows about step classes and aerobics. They are great calorie burners, get the blood and oxygen flowing, are good conditioners of the cardiovascular system, and, with certain variations, can even be good for muscle toning. So they’re a g oo d thing, rig ht? Yes.
Except if you have a broken leg. If you have a bro ken leg, or a sprained ank le, or shin splint s, I’m go ing to sug gest that you not take a step class until the injury heals. Under these special circumstances, the very weight-bearing that does so much good for the nor mal perso n is go ing to be mor e stress th an you need d uring the healing phase. I’m going to tell you to stay off the leg, let it heal, and avoid putting additional str ess o n it at this time. Does thethe fact that stepled class is not good leg? for a person with a broken leg mean that step class to the b roken No. And ketogenic diets do not—I repeat, do not—cause kidney disease. If your doctor says they do, politely ask him or her to show you the studies. (They do n’t exist.) Ketogenic diets ar e, however, not a go od thing if you have an existing kidney disease, much the way a st ep class i s not a good thing if your leg is already broken.
High Protei n Causes Kidney Disease? Not. The oft-repeated medical legend that high-protein diets cause kidney disease came from reversing a medical fact. The medical fact is that reducing protein (up to a point) lessens the decline of renal (kidney) function in people who already have kidney disease. Because restricting protein seems to be a good strategy for those with existing kidney failure (or even some kidney weakness), some people drew the illogical conclusion that the obverse must also be true—that large amounts of protein lead to kidney failure. In any case, it is not proteins per se that cause problems, even for those who already have renal disease: it is the glycolated pro teins (see chapter 2). These sugar -sticky pro teins, you may r emember, are the r esult of excess sugar in the bloo d bumping into pro tein molecules. These sugarcoated proteins are called AGES, advanced g lycolated end-pro ducts. The AGES themselves then stick together, forming even bigger collections of molecules, w hich are too larg e to pass th ro ugh the filt ering mechanisms of the glomerulus , the network of blood capillaries in the kidneys that acts as a filter fo r waste pro ducts fr om the blood. This reduces GFR (glo merular filtration a mea surethis o f to kidney function. High protein intake rate), does not cause happen in normally functioning kidneys. A recent study of 1,624 women enr olled in the
Nurses’ Health Study concluded that “high pr otein i ntake was no t associated with renal function decline in women with normal renal function.”17 Another study in the American Journal of Kidney Diseases showed that pro tein intake had no effect o n GFR in healthy male subjects. 18 And a third study in the International Journal of Obesity compared a highpro tein with a low-pr otein weightlo ss diet and concluded that healthy kidneys adapted to pr otein intake and that the high-pr otein diet caused no 19
adverse effects. If you don’t currently have kidney disease, a low-carb diet is an ideal way to help control the blood-sugar levels that can eventually lead to kidney disease. Of course, just to be safe, check with your doctor to make sure you don’t have any undiagnosed kidney impairment; but if you don’t, you’re sur e not going to develop it fr om being o n a low-carb diet .
BOTTOM LINE Higher protein intakes do not cause any damage whatsoever to healthy kidneys .
MYTH #6: The Only Reason You Lose Weight on a Low-C arb Diet Is Because It’s Lo w in Calori es The short response to this myth is simple: so what ? This accusation—that low-carb diets work only because they are low in calor ies—is particularly amusing becaus e it is never made against highcarb weight-loss diets that are equally low in calories. In fact, there is only a 121-calorie difference between the most stringent induction phase of the Atkins diet and the Dean Or nish ultr a-lo w-fat diet. And after the fir st couple of weeks, when you get into the ongoing weight loss phase of Atkins, you’re actually consuming 354 calori es more than you would be on the Dean Ornish diet and 165 calories more than you would be on Weight Watchers.20 Yet you never hear the establishment say that the Ornish diet works nly becausediet it’s in lo the w-calor ie!you ultimately Look,low-fat on virtually everyoweight-loss world, wind up consuming fewer calories than you did while you were putting on
weight. I don’t care if the diet is low-fat, high-fat, low-carb, high-carb, vegetarian, Food Guide Pyramid, raw food, you name it—ultimately, they are all r educed-calor ie diets. One of the primar y reasons mo st of them fail is hunger. By now, we know that insulin is called the hunger hor mone fo r a very g oo d reason, and ins ulin is elevat ed most by high-car bohydrate diets. So if you have a choice of gritting your teeth and staying on a 1,200calorie, lowfat, high-carbohydrate diet that leaves you hungry and craving sweets all the time—or of going on a diet withfoods the same numberleave of calories that allows you to eat rich, satisfying, natural and doesn’t you hungr y all the time, which would you pick? Exactly. That’s why the shor t answer to this myth is “Who car es?” Even if it were true that low-carb diets work only because they are low-calorie, who gives a rat’s tail? If two “diets” with an equal number of calories produce equal weight loss but one is easier to stay on, why in the world wouldn’t you go with it?
More Food on a Low-Carb Diet? Because a low-carbohydrate diet is able to reduce insulin levels and is far more likely to induce hormonally balanced states than conventional highcarb diets, it is possible—though we’re not 100% sure—that you may be able to consume somewhat more calories on a low-carb diet than you would on a high-carb diet and still lose weight. One dramatic study compared a low-fat diet to an Atkins-type diet in two groups of overweight adolescent boys. After three months, the low-carb group lost more than twice as much weight as the low-fat group (19 pounds for the low-carb group and 8.5 pounds for the low-fat group); the low-fat group averaged 1,100 calor ies a day, while the Atkins gr oup aver aged 1,803! 21 Recently, a number o f studies have come o ut showing that weight loss is actually greater on a low-carb diet than on a conventional low-fat diet that has the same number o f calor ies. 22 To be fair, there are plenty of studies showing that both diets pro duce identical weig ht loss. (Interestingly, there are vir tually no studies that show that low-carb di ets pro duce less weight loss!) But even in the studies that show identical weight lo ss, trig lycer ides and HDL levels almost always improve on the higher-protein diets. For example, Alain Golay, a respected researcher who is no particular advocate of low-carb diets, recently tested a low-carb (25%) diet against a
typical higher-carb (45%) diet for weight loss and found that, while there was not much difference in weight loss, the low-carb group had significant ly gr eater impro vements in fasting i nsulin an d trig lycerides. 23 In another study, he pitted a lo w-carb (15%) diet agai nst a higher -car b (45%) diet and again found similar weight loss but marked improvements in gluco se, insulin, choleste rol, and trig lycerides on the low-carb diet only ; no such benefits were seen on the high-carb diet. 24 If two “diets”— high-pro tein/low-carb and high-carb/lo wfat—are equal in calor ies and produce equal weight loss but the first produces significantly improved blood chemistry and lowers the risk for heart disease and diabetes, why in the world wouldn’t you choose that one? Many studies have been done comparing all kinds of different diets for weight los s; but the truth is that very few studies have lasted mo re than a year, leading many experts to conclude that while you can basically lose weight on any diet, we really have no idea whether any particular regimen is easier to stay on o ver the long haul. The action is clear ly in maintaining weight loss, and since the lower-carb diets seem to be much more satiating, we can speculat e that they may turn out to be a l ot easier to maintain as a li festyle than a diet that simply r educes fat, which is tur ning out to be a lo t less im por tant than previo usly thoug ht. In fact, Dr. Walter Willett, chair man of the Department of Nutritio n at Harvard Univer sity’s School of Public Health and one of the most respected researchers in the field, recently declared in two articles—one in Obesity Reviews 25 and one in the American Journal of Medicine26 —that dietary fat is not a major determinant of body fat and plays virtually no role in obesity.
What about Calories? Since most low-carb-diet authors do not advocate counting calories (at least at first) and because most low-carb diets are based on the premise that it is critical to control the hormonal responses to food, many people have gotten the idea that low-carb theorists think calories don’t matter at all. This is simply not so. As I wrote in a previous book, calories are still on the marquee; it’s just that they are not the starring players anymore. Of
course calories still count—there isn’t a responsible low-carb diet writer out there who would argue the point. But controlling hormones counts at least as much , if not more. If I take in 1,500 calories a day from sugar and
insulin-raising carbohydrates, I will find it notoriously difficult to lose any weight, since the high levels of insulin I produce are going to effectively block fat from being released from my fat cells. Yet if I take in the same 1,500 calories—or even a few more!—from a diet with fewer carbs and more protein and fat, the resulting balance between insulin and glucagon is going to be much more favorable to fat “burning.” And I’m likely to lo se a lot mor e weight for the same calor ic price. thefat other to play devil’s advocate, I t ake in 15,000 calories, allOn from withhand, a little protein, producing the ifabsolute minimum amount of insulin, I’m still go ing to gain weight. Why? Because even thoug h the “door s” to the fat cells are now open for business, there is simply no reason for my body to release any of the fat inside them for fuel, because I’m already consuming way more fuel than I could possibly need. Now, can you lose weight on a low-calorie diet that is not low-carb? Of course you can. People do it all the time. But consider the following: most weight-loss diets—of any kind—wind up being lower in carbohydrates even if t hey are not “low-carb” diets . The averag e o verweight A merican man is easil y able to co nsume 3,500 calor ies daily, and let’s hypothetically say 65% of i t is fro m carbs. Tha t’s a total o f 2,275 calor ies fr om car bs, or 569 grams of carbohydrates a day. The National Weight Control Registry, which follows people who have successfully lost at least 30 pounds and kept it off for more than a year, has found that the average man on a successful weight maintenance diet consumes 1,724 calories, of which 56% come fr om carbo hydrates. 27 So our typical National Weight Control Registry man is consuming 237 gr ams of carbs a day , a 59% reduction in carbohydrates from what he was eating when he put the weight on! The averag e successfu l woman o n the r egistry maintain s her weight at 1,297 calories, 55% fro m carbo hydrates. 28 We can postulate that if she was 50 pounds over weight to beg in with, she was eating at least 2,000 calor ies a day minimum (probably mor e), and even if o nly 60% of that came fro m carbs, that’s 300 gr ams o f car bs a day. At her present maintenance level, she’s consuming 178 grams, a 41% reduction in carb intake, certainly enough to make a major impact on insulin leve ls. Yes, calor ies co unt. But so do hor mones, and way mor e than the dietary establishment believes.
BOTTOM LINE Calories count, but so do hormones. Many studies show more weight lost on low-carb diets than on high-carb diets with the same number o calories, and more of that weight comes from fat. Even those studies that show equal weight loss invariably show better blood chemistry on the lowcarb diets. Lowering fat in the diet i s not the answer to obesity.
MYT H # 7: Low-Ca rb Diets Increase the Risk for Heart Disease In Denmark, the number of storks is positively correlated with the number of babies b or n. This interesting fact was taught to me in graduate school by a wonderful psychology professor named Dr. Scott Fraser, who used it to teach a lesson about scientific studies that has allowed me to understand a great many things about r esear ch. I will pass it on to yo u, and you may never look at r esear ch studies in quite the same way. So let’s repeat: in Denmark, the more storks, the more babies. This positive corr elation hol ds up year in and year o ut. Okay, class, what shall we conclude fr om this? I hope yo u see what I’m g etting at. Here’s what’s actually g oing on. In the particular par t of Denmark where the study was do ne, singl e people live mai nly in the cities. Wh en they get married and decide to raise a family, they move to the suburbs. The architect ural design o f the suburbs in Den mark favor s angled r oo fs made of tar. Storks nest in angled roofs made of tar. Both storks and young married couples wanting to have children gravitate to the same area, albeit for somewhat different reasons. But they are found together , consistently, year after year. They ar e ositively correlated . The lesso n: correlation does not equal causation. When two variables are fo und together, it does no t mean that one caused the other. D iabetes
went way up duri ng the Clinton presi dency, so an i ncrease i n diabetes is posi tively cor related with the Clintons. Statistical studies have also no ted that the number of new radio and television sets purchased correlates with an increased n umber of deaths fr om co ro nary disease . 29 In Stockho lm, Sweden, there was a cor relation between the municipal tax r ate and cor onar y mor tality, leading to the interest ing pro position that if tax r ates were lowered, there would be less heart disease! 30
A LITTLE INTERNET HUMOR
1. The Japanese eat very little fat and suffer fewer heart attacks than the Briti sh or Americans. 2. The Mexicans eat a lot of fat and suffer fewer heart attacks than the Briti sh or Americans. 3. The Japanese drink very little red wine and suffer fewer heart attacks than the Briti sh or Americans. 4. The Italians drink excessive amou nts of red wine and suffer fewer heart attacks than the Briti sh or Americans. 5. The Germans drink a lot of beers and eat lots of sausages and fats and suffer fewer heart attacks than the Briti sh or Americans. Conclusion: Eat and drink what you like. Speaking English is apparently what kil ls you. One scholar described this as the “yellow finger” phenomenon. Men with yellow fingertips are mo re likely t o die o f lung cancer. The r eason: they are s moker s. That’s why they have yellow fingers. The yellowed tips of their fingers are the result of holding twenty cigarettes a day for twenty years. Washing off the yellow will not r educe their ri sk for lung cancer. This br ings us to cholesterol , heart disease, an d the low-ca rb diet.
The Birth of the Diet-Heart Hypothesis and the Demonization of Saturated Fat When the diet-heart hypothesis—the idea that saturated fat causes heart
disease—was first proposed in the 1950s by Ancel Keys (see chapter 1), very little was known about either fat or cholesterol. Cholesterol, which is actually not a fat at all but a waxy molecule classified as a sterol, is the parent molecule for all the sex hormones in the body. Without it, you would not have testosterone, the estrogens, progesterone, or DHEA, not to mention cortisol and aldosterone. Most of the cholesterol in your body is roduced by your body. Dietary cholesterol has virtually no effect on the amount of cholesterol in your blood. long-term studies, 31 they Framingham and Tecumseh, confirm thisTwo (see major tables above); show that those who ate the most cholesterol had exactly the same level of cholesterol in their blood as those who ate the least. Even Keys, the author of the diet-heart hypothesis, knew this and said, in 1991: “There’s no connection whatsoever between cholesterol in food and cholesterol in blood and we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit .”32
What we do know is that dietary fat has an effect on serum cholesterol. What is a lo t less clear is whether it matters much. (Michael and Mary Dan Eades call “Cholester ol Madness” the most impor tant chapter in their book, “not because we believe cholesterol is such an important problem but because everybody else does .” I’m with the Eadeses, as I discussed in mor e detail in chapter 3.) Fully 50% o f hear t attacks happen to peo ple with
complete ly nor mal choleste rol numbers. 33 The Tokelauan Islanders get 63% of their diet from the healthful saturated fat in coconuts, and, though their cholesterol levels are a bit high, they h ave virtua lly no heart disease.34
Fats: The Good, the Bad, and the Ugly We know a lot more about fat than we did back in the ’50s and even in the ’80s, when the message was “All fat is bad.” Most people are now aware that there are “good” fats and “bad” fats, and most people believe that the bad fats are saturated. Not so fast. It’s turning out to be even more complicated than that. We now know that there is a type of fat far more dangerous and insidious than saturated fat: trans-fat ; and virtually all of the data we have that “links” saturated fat with heart disease did not distinguish between saturated fats and trans-fats . Therefore, it is almost impossible to know whether or not saturated fats got the blame for something that was really being done by trans-fats. 35 Saturated fats, for example, lower lipoprotein(a), a risk factor for heart disease, and raise protective HDL cholesterol; transfats not only do the exact opposite but also raise LDL cholesterol! 36 Many of us now believe that saturated fats have gotten the blame for damage that is actually caused by trans-fats. Virtually every low-carbohydrate diet, by definition, contains incredibly low amounts of trans-fats. Furthermore, we also know that “saturated fat” is not a homogenous entity. It consists o f many diff erent types of fatty acids, and so me of them are do wnright beneficial fo r health. For example, lauric acid has antimicr obial and ant iviral pro perties and is able t o fight bacteria. Caprylic aci d is used to fi ght yeast. Shor t- and medium-chain saturated fatty acids like those found in coconuts are actually much more likely to be burned for fuel than stored as fat, and can be a great adjunct to a weight-loss prog ram. 37 And others, like stearic acid, have no effect whatsoever on cholesterol, except to possibly raise protective HDL. Consider this, as the brilliant investigative reporter and three-time National Associatio n of Science Writers’ Science in So ciety Award-winner Gary Taubes did in a recent article in Science. A porterhouse steak cooks down to abo ut half fat and half pr otein. Of that fat, 51% is
monounsaturated, mostly all from oleic acid, the same monounsaturated fat found in heart-healthy olive oil. Forty-five percent is saturated, but a third of that is stearic acid, which at worst is harmless and at best raises HDL cholester ol. The r emaining 4% is po lyunsaturated. Thus, a porterhouse steak may actually be better for your heart—especially if eaten with a generous helping of vegetables—than a no-fat meal of highglycemic, t ri glyceri de-raising pasta. 38
There’s More to Cholesterol than Just “Good” and “Bad” Most people are aware that cholesterol comes in two “flavors,” good (HDL) and bad (LDL). But most people do not know that both HDL and LDL have different subclasses, and that these subclasses behave quite differently in the body. For example, LDL cholesterol has at least five subtypes, two of which are very important for the purposes of our discussion —pattern A, which are lar ge, fluffy, cotton ball–like molecules, and pattern B, which are small, dense molecules that look like BB-gun pellets. It is these small, dense LDL molecules that cause plaque and contribute to heart disease; the fluffy LDL is fairly harmless. In recent years, studies have begun to look at the factors that affect these particle sizes. 39 We are finding out that while the traditional high-carb, low-fat diet may in fact lower overall LDL, it raises the molecules and lowers protective HDL cholesterol. So dangerous while yourpattern overallB cholesterol number may go down, your overall risk may go up. Not only that: highcarbohydrate diet s sig nificantly r aise trig lycerides—t his is i narg uable and has been shown in virtually every major study comparing high-carb to low-carb diets. The combination of high triglycerides and low HDL is far more predictive of heart disease (and far more dangerous) than an overall elevated cholesterol number. 40 In the following story, you can see cholesterol madness in action: I have a dear friend who is in great shape and exercises every day. He came to me because he and his doctor were very concerned becau se his cholestero l was “too high.” I looked at his blood tests. He had normal lipoprotein(a), a fasting g lucose unde r 100, a fasting insulin of 5, trig lycerides under 100, an HDL of 60 (giving him a triglyceride/HDL ratio of less than 2!), a cholesterol r atio i tself of 3, nor mal C-react ive protein (a measu re o f inflammat ion), and a homocysteine (a hu ge r isk factor for heart diseas e)
under 7—but his over all cho lestero l was 240. I wish I had those number s! This m an had a better chance of winning the lottery than he did of ever getting hear t disease. He will never have a hear t attack. Yet his do ctor was ready to put him on a lifetime of expensive medication with potentially damaging side effects to bring down a number that did not matter! You might reasonably ask at this point: if cholesterol is not as important an issue as we thoug ht, how is it that the statin drug s (which r educe cholesterol) save lives? Goo d question. The statin drug s pro bably do save some lives (though th e number is pro bably way less than you’ve been led to believe, and the cost remai ns to be seen). However, whether they do so by reducing cholesterol is an open question. What the statins do in addition to lowering cholesterol is reduce inflammation, which is a cause o f hear t disease. What they do to cholesterol, in my opinion, is the least important thing that they do in the body. You can r educe inflammatio n by consuming omeg a-3 fatty acids and reducing consumption of grains, without the possible statin drug side effects of liver toxicity and mitochondrial damage, and without the increased risk for death from other causes that is associated with cholesterol numbers that are too low.
Do Low-Fat Diets Prev ent Hear t Disease? So, then, what about that famous Dean Ornish study that showed that lowfat diets r everse heart disease? Actually, it showed no such thing. The Or nish study too k for ty-eight middle-aged w hite men with ex isting moder ate to severe cor onar y heart disease. The researchers then did five—count ’em, five —simultaneous interventions with these men. They put them on a stres s-r eduction pro gr am. They go t them to stop smoking. They gave t hem gr oup therapy and support. They had them do daily aerobic exercise. And they put them on a very high-fiber diet, which also happened to be low in fat. Why anyone—including Ornish—would conclude that it was the low-fat part of this multiple interventio n that caused their impr ovement is a mystery. If we put those same men on a t, prand og ram o f exercise, st ress r eduction, cessation, gr oup suppor meditation and included a pack of smoking M&M ’s in their diet every day, would we co nclude that M&M’s r educe heart dis ease?
I would argue that Ornish would have gotten the identical results—perhaps even better o nes—using all those g oo d interventions plus a diet loaded with fiber, absent trans-fats, absent sugar, co ntaining ver y low amounts of vegetable fats, and contain ing plent y of g oo d-quality pro tein from g rassfed animals plus saturated, mono unsaturated, and omeg a-3 fats. We’ll never know, because when five factors are involved, it is impossible to say which of them—or what combinat ion of them—is r esponsible for the 41
results. On a personal no te: in researching this book, I read th rough li terally hundreds of studies on cholesterol, fat, and heart disease. I could have rented a cot in the National Libr ary of Medicine. I read the papers that appeared in the medical journals, I read the re-analysis of the data by scholars who questioned the cholesterol/saturated-fat hypothesis of heart disease, I studied their arguments, I read the rebuttals to their arguments, and I read the rebuttals to the rebuttals . I have, I confess, come to believe—along with a growing number of health professionals—that saturated fat and cholesterol are, for the most part, innocent bystan ders. They were i n the wrong place at the wro ng time, Your Honor, and they hung o ut with the wrong crowd. As I mentioned earlier, virtually every epidemiological study that linked saturated-fat consumption with increased r isk of cardiovascular diseases failed to separate saturated fat from its extremely dangerous cohort, trans-fatty acids.42 Nor did the studies impli cating saturated fat distinguish the source of the saturated fat consumed: saturated fat from natural foods like butter, eggs, and gr ain-fed cat tle is not the same as saturated fat from fries and burger s; mo st people in indust rial nations consume th eir saturated fat fro m hot dogs, fast-food hamburger s, and pro cessed deli meats like salami and bologna. The people consuming the most saturated fat in those studies ate few frui ts and vegetables and li ttle fi ber. But they ate something like 150 pound s of sugar per year (the latest figur es fr om the USDA from 1997, projected to soon rise to 170 pounds). And for the most part, they did not exercise. Although it is extremely convenient to blame a single factor (like saturated fat) for heart disease, the fact is that a matrix of lifestyle and dietary characteristics such as the ones just mentioned are found together . In my opinio n, saturated fat and cholester ol are not the bad
guys here. New resear ch is beg inning to suppor t this. When a recent study in the British Medical Journal factored in fiber intake, the usual association between saturated fat and coronary-disease risk practically vanished. The study concluded that the adverse eff ects of saturated fat and cholestero l ar e “at least in part explained by their low-fiber content and their associations with other risk factors.” The researchers further stated that “benefits of reducing intakes of saturated fat and cholesterol areoflikely be imodest unless accompanied by an i ncreased consumption foodsto rich n fiber .” The study also commented on how the inclusion of omega-3 fats in the diet had a pro tective effect on the heart. 43 However… I realize that this is a radical position and a hard sell to a population that has been raised on the premise that saturated fat and cholesterol are basically the childr en of Satan. So let me put you at ease: t o do a low-carb diet, you do no t have to accept the position that cholestero l and saturated fat are relatively harmless. In fact, many of the low-carb authors don’t accept that position either, so you will be in good company (notable exceptions—with whom I agr ee—are the Eadeses, Schwarzbein, and Atkins). You can do the GO-Diet, in which almo st all o f the fat co mes from monounsaturated sources. You can do the Zone, which limits saturated fat and stresses omeg a-3’s. You can do the Paleo Diet, which is about as anti–saturated fat as you can get. Or you can do Protein Power or Atkins and just make sure yo u’re getting a ton o f omega- 3’s. (You can even do a vegan low-carb diet, for goodness sake. Just as this book was going to press, new research was published in the Annals of Internal Medicine testing a veg an ver sion of Atkins. This diet—dub bed the “EcoAtkins” prog ram—pro duced both weight loss and a reduction in “bad” cholesterol.) On virtually all low-carb diets, blood-lipid chemistries improve. That’s what is i mpor tant, and that is the tak e-home point here. Even those studies that showed identical weight loss with low-carb versus high-carb diets demonstrated this: low-carb diets beat the pants off high-carb diets every time, when it comes to lowering triglycerides and raising HDL, even in those few cases where weight los s was identical.44
And here’s the pièce de résistance. If you and/or your doctor are still concerned about the amount of fat in low-carb diets, consider the follo wing (see ta ble above): if you are a male who is 40 to 50 pounds overweight, you have probably been consuming a diet of at least 3,500 calor ies a day (probably mor e: one fast-foo d or der of fr ies alone is 70 0). Let’s say you’ve been adhering to the dietary guidelines of no more than 30% of your calor ies fr om fat, with no mo re than 10% of th e total diet from saturated fat. That means you have been consuming about 1,050 calor ies a day fro m fat, of wh ich 350 are fro m saturated fat. Now look at what happens if you go on a typical low-carb weightreduction di et. You woul d consume i n the ballpark of 1,700 satisfying, filling calor ies. Let’s g ive the wor st-case scenario , fr om your doctor’s point of view, and say that a full 50% of those 1,700 calories come from fat—that’s 850 fat calories, definitely a high-fat diet in anyone’s book. Say that 20% (twice the dietary g uidelines) o f your total calories comes from saturated fat (340). Even with these numbers, you would actually consume 20 per cent less overall fat on a low-carb diet than you were before, when you were following the dietary guidelines. This should put both you and your doctor at ease.
BOTTOM LINE Low-carbohydrate diets do not increase the risk for heart disease. I anything, they impro ve blood-lipi d profiles.
CHAPTER 7
Thirty -Eight (Mostl y) Low-Carb Diets and What They Can Do for You
Each of the or iginal sevent een prog rams I reviewe d in the first edit ion of Living Low Carb was selected for one of three reasons: it was extremely popular, it was extremely good, or it had gotten a lot of attention by the media. In this edition, I’ve greatly expanded the number of programs reviewed. Some o f them are not even technically low-carb pr og rams, but have incorporated enough of the “wisdom” that has been learned from the lowcarb, low-s ugar researc h of the past decade to mak e them wor th including and commenting o n. (And I’ve even included a few books that are just horr ibly wro ng about lo w-carb, co mpletely misr epresenting the truth.) My purpose here is to give y ou a go od sampling of th e diet books on the market and to evaluate them in terms of what we’ve learned about weight loss in the past decade. Since so many diet boo ks these days are actually fitness boo ks, I have also i ncluded a shor t section o n books that a re mor e fitness-or iented but that have a dietary program as an adjunct. Nearly all of these books have excellent wor kout prog rams, but some are far mor e accurat e than others when it comes to dispensing information about nutrition and diet ( The Ultimate New York Diet, for example), while so me ar e simply path etically out of date and completely misrepr esent contro lled-carbohydrate eat ing (The 3-Hour Diet and The 5-Factor Diet ). (I hope after reading the rest of this book, and checking the research references, you’ll understand the basis on which I make that statement.) One thing will become abundantly clear from reading these reviews: all
low-carb diets are not the same! When I give a program a rave review, I’ve spelled out exactly wh y that is; when I have res ervations, I’ve told you what they are; it’s always up to you to decide if you agree with me or not. With very few exceptions, the programs have something to recommend them; and even in those cases where I’ve given a less-than-glowing overall review, I’ve tried to represent fairly the strengths of the program as well as detailed reasons for my reser vations. As you will see, the outlines discussio ns ofidea these e detailed enough that you should be able and to get a very good ofdiets whatarthe pro gr am entails and dec ide whether it is a g oo d match for you, or at least determine whet her o r not you’d like to explor e it further by r eading the boo k on which it’s based. So that you can get a sense of the program at a glance, I’ve given you the “In A Nutshell” descr iption; after that, there’s a much mor e detailed explanation o f the diet itself, fol lowed by “Jonny’s Lowdown.” The programs are “rated” between one and five stars, but be sure to read the explanation in the Lowdown to see how I cho se the r ating. Understand that the r atings ar e my own opinions, based on the information I’ve sha red with you in the discussion, and of course they reflect my personal biases. (I’m pretty sure that my biases are the correct ones, although I suppose that everyone else thinks theirs are correct as well!) That, as the saying goes, is what makes a horse race. Or a political election. Or even a diet plan. Happy reading! 1. The Atkins Diet —Rober t Atkins, MD 2. The All-New Atkins Advantage—Stuart Trager, MD and Colette Heimowitz, M.Sc 3. The Biggest Loser —Maggie Gr eenwood-Robinson, PhD, et al. 4. The Carbohydrate Addict’s Diet—Rachael Heller, MA, M.Ph, PhD, and Richard Heller, MS, PhD 5. The 7-Day Low-Carb Rescue and Recovery Plan —Rachael Heller, MA, M.Ph, PhD, and Richard Heller, MS, PhD 6. Curves—Gar y Heavin and Carol Colman 7. Dr. Tea Diet—Mark Ukra, AKA “Dr. Tea” 8. The Diabetes Diet —Richard K. Bernstein, MD
Dr. Gott’s No Flour, No Sugar Diet—Peter H. Gott, MD Eat, Drink, and Weigh Less—Walter Willett, MD and Mollie Katzen The Fat Flush Plan —Ann Louise Gittleman, MS, CNS The Fat Resistance Diet —Leo Galland, MD GO-Diet: The Goldberg–O’Mara Diet Plan—Jack Go ldber g, PhD and Karen O’Mara, DO 14. The Hamptons Diet—Fred Pescatore, MD 9. 10. 11. 12. 13.
The GI Diet Revolution Brand-Miller, MD,Graff et al. The Low Lindora Program: Lean—Jennie for Life—Cynthia Stamper The Maker’s Diet and Perfect Weight—Jordan S. Rubin Neanderthin—Ray Audette The Paleo Diet—Lor en Cor dain, PhD Protein Power—Michael R. Eades, MD and Mary Dan Eades, MD The Rosedale Diet—Ron Rosedale, MD and Carol Colman The 6-Week Cure for the Middle-Aged Middle—Michael R. Eades, MD and Mary Dan Eades, MD 23. The Scarsdale Diet —Herman Tarnower, MD 24. The Schwarzbein Principl e—Diana Schwarzbein, MD and Nancy Deville 25. Somersizing —Suzanne Somers 15. 16. 17. 18. 19. 20. 21. 22.
26. The South Beach Diet—Arthur Agatston, MD 27. South Beach Recharged—Arthur Agatston, MD with Joseph Signorile, PhD 28. Sugar Busters! —H. Leighton Steward, et al. 29. The TNT Diet—Jeff Volek, PhD, RD, and Adam Campbell, MS 30. The UltraSimple Diet —Mark Hyman, MD 31. Women’sHealth Perfect Body Diet—Cassandra For sythe, MS 32. YOU: On a Diet—Mehmet C. Oz, MD and Michael F. Roizen, MD 33. The Zone—Barry Sears, PhD Fitness Books—Short Takes 34. Making the Cut by Jillian Michaels 35. The 5-Factor Diet by Harley Pasternak 36. The 3-Hour Diet by Jorge Cruise 37. Deadline Fitness by Gina Lombardi
38. The Ultimate New York Diet by David Kirsch
1. TH E A TKINS DIET ROBERT ATKINS , MD
WHAT IT IS IN A NUT SHELL n easy-to-follow, specific dietary plan in four distinct stages. Stage one is “induction”: a very low-carb (20 grams or less) approach to jump -starti ng weight loss. You move through the four stages, adding more carbs in specific increments until you find the level of carbohydrate consumption at which you can continue t o lose weight gradually and consist ently. You stay at that level of carb consumption until you are within a few pounds of your goal, and then you transiti on into a lif etime maintenance p lan.
About the Atkins Diet The Atkins diet was introduced in 1972 with the first edition of Dr. Atkins ’ Diet Revolution and immediately became an object of scorn and disdain by the conventional medical establishment. Why? Because it went completely against the accepted dietary truths of the time. In many ways it still does, though cracks in the cement are beginning to show, and the dietary establishment is finally becoming less certain that its nutritional commandments are actually true. As you may remember from chapter 1, the conventional wisdom that Atkins opposed incl uded the fol lowing: • • • •
To los e weight, you must eat a low-fat, high-car bohydr ate diet. High-fat diets cause heart disease. Low-fat, high- carbohydr ate diets prevent heart disease. All calor ies are the same.
Dr. Robert Atkins, a cardiologist and something of a visionary, was the fir st to bring to popular attention the influen ce of the hor mone insulin on weight loss and to intro duce the notio n that controlling insulin effectively
is the key to Carb l osing weight By now,with if you’ve r ead chapters and 2 contro of Living Low , you ar e .familiar the central r ole that 1insulin l plays in vir tually every carbohydrate-restricted diet an d the reasons it
occupies center stage. But in 1972, vir tually no o ne in America who wasn’t either a diabetic or a doctor had heard o f insulin, let alone und erstoo d its role in weight g ain and o besity. And it was not until much later that the public began to get a glimmer of i nsulin’s role in hear t disease, hypertension, and aging. Atkins explained that insulin causes the body to stor e fat, that some people are metabolically pri med to put out mor e insulin th an others in response the same foods, that sugar andand carbohydrates were theofprime offendersto when it came to raising insulin, that elevated levels this hormone invariably resulted in increased body fat. He argued that it is not fat in the diet per se that makes you fat, but rather sugar—even more preci sely, fat in combination with high sugar—and the resulting insulin that leads to weig ht gain. Atkins took ser ious issue with the idea th at fat causes hear t disease and claimed that his diet would actually improve blood-lipid pro files, measurement s that show up in bloo d tests as r isk factor s for heart dise ase. What is the actual diet that stirred such passio nate contro vers y? Well, the Atkins diet is, and always ha s been, a four -stage affai r, but most people think of it as synonymo us with the firs t stage, “induction.” D uri ng induction, you eat all the fat and p rotein yo u want, but you li mit carbohydrates t o 20 gr ams per day—an ex tremely low level of carbohydrate consumption equal to about 2 cups of loosely packed salad and 1 cup of a vegetab le like spinach, b ro ccoli, Brussels spro uts, or zucchini. At stage one, there is abso lutely no rice, potatoes, cereal, starch, pasta, bread, fruit, or dairy products other than cheese, cream, and butter. To anyone who has r ead a diet book i n the last ten years that wasn’t written by low-fat gur u Dean Ornish o r his follo wers, this list of prohibited foods sounds pretty familiar. But you have to realize that in 1972, banning these foo ds for even two weeks was the nutritional equivalent of suggesting that every school and office in the country burn the American flag. The se foo ds were the holy gr ail o f the low-fat relig ion. Bagels were the breakfast of choice fo r health-conscious Americans. Oils, fats, butter, cheese, cream, steak, and t he like wer e consider ed heart attacks on a plate, and here Atkins w as making them the centerpiece o f his eating plan. The establishment thought him quite mad.
If this weren’t enough, Atkins spoke in downright loving terms of something called ketosis, which he termed “the metabolic advantage” and compar ed to sunshine and sex. For Atkins, being i n ketosi s was the secr et to unlocking your fat stores and burning fat for fuel. Ketosis was the desired goal of the induction phase. Being in ketosis was a virtual guarantee that you were accessing your stubborn fat stores and throwing them on the metabolic fl ame, using yo ur fat, instead of your sugar, for energy. big par prog ram of involved chof ecking your urine fo r ketones,Awhich aret of thethe by-product this kind fat breakdown. The problem was that mainstream medicine considered ketosis to be not only undesirable but dangerous, a metabolic state to be avoided at all costs. For the most part, they still do—see chapter 6 for a full explan ation o f why the common belief that ketosis is dangerous is wholly without merit. The emphasis on ketosis, coupled with the recommendation to eat unlimited amounts of fat, was enoug h to make Atkins a com plete pariah i n the medical establishment, and it is o nly now, mor e than thirty-five years af ter the publication of the srcinal book and six years after his death, that we are beginning to see a slow turnaround in that evaluation. Briefly, ketosis works this way: when there is not enough carbohydrate (sugar) coming i nto the body an d when sugar stor es (glycog en) have been essentially use d up, the body is fo rced to g o to its fat st or es for fuel. Furthermore, because there isn’t enough sugar to get fat into the usual slow-burning energ y pro duction cycles of the body (known as th e Krebs cycle), the fat has t o be broken do wn in another pathway, with the result that ketones —byproducts of this inco mplete fat-burning—are made and used freely for energy by most of the tissues, including the brain and the heart. Forced to run on a fuel of fat, the body drops weight as the fat is burned off. The advantages of this plan are twofold. First, the severe restriction of carbohydrates and su gar in the diet immediat ely bring s down your level of insulin, the hormone that is released in response to carbohydrates (and to some extent protein). By dialing down insulin production, you are forced to burn your own fat, a situation Atkins refer red to as biolo gic utopia. Since insulin is a “storage” ho rmo ne, less insulin means less fat storage . Dietary fat has no effect on insulin, so, Atkins reasoned, even if there is a lot of fat coming into the diet, there’s not enough insulin to drive the “fat-
storing ” machinery . Second, going into ketosis was a way of “tripping the metabolic switch” fro m a sugar -burning metab olism to a fat-burning o ne. Excess calor ies cause weight gain only when you’re eating a lot of carbohydrates, said Atkins. Dump the carbo hydrates, and the fat in your diet is not a pr oblem. He also claimed, to the sputtering frustration of his detractors, that you could co nsume more calories on his prog ram and still lose weight, precisely the obesity fat-storing hor mone, remained at low levels.ng Atkins becaus ar gued ethat exists wh en theinsulin, metabolism i s not functioni cor rectly, but that metabolic di sturbances have li ttle to do with the fat we eat; rather, they are caused by eating too many carbohydrates. According to Atkins, if you’ve been overweight for a long time, it’s a virtual certainty that your body has problems pro cessing sugar. Atkins also believed that the biggest reason people gain back weight lost on a diet is hung er, and that hunger is just about inevitable on a reducedc alor ie, high-carbohydrate, low-fat d iet. On his pr og ram, hunger was virtually eliminated, as were cravings and blood-sugar instabilities. There ar e go od physiolog ical r easons th at the appetite is supp ressed on a low-carbohydrate diet rich in pro tein and fat—for example, the r elease of the hormone CCK (which tells your brain you are full) and the possible suppressi on o f a substance in the brain called neur opeptide Y, which stimulates appetite. The rules of his induction phase are straightforward and simple. You do not count calories. You do not count protein. You do not count fat. You do count grams of carbohydrate, an d you can have up t o 20 gr ams a day in the form o f either 2 cups of loosely packed salad and 1 cup of uncooked vegetables chosen fro m a specific list or 3 cups o f salad. Perio d. As mentioned earli er, you can’t h ave starches, gr ains, sugar, fruit, or alcohol. You cannot eat nuts, seeds, or “mixed” foods (combinations of protein and carbohydrate) like beans, chick-peas, or legumes. It is also suggested that you avo id the artifici al sweetener aspartame (Equal) and caffeine, the latt er because it can lead to low blood sugar and stimulate cravings. Weight loss in the induction phase is f air ly quick and dr amatic. Much, but not all, of the weight loss is water and bloat, largely because insulin’s message to the kidneys to stockpile salt (and therefore water) is no longer being s ent. But the induction phase is o nly meant as a jump-star t. Though
Atkins felt it was perfectly safe to stay in the induct ion phase for a month or so, he encouraged dieters to pro gr ess to stage two, which he calls ongoing weight loss, or OWL. The key to the success of O WL is fi nding what Atkins calls your Critical Carbohydrate Level for Losing , or CCLL. (Some version of this has been adapted by vir tually every l ow-car bohydr ate diet that uses the concept of “stages .”) Here’s how it wor ks. After compl eting the initial induction you slowly add back carbohydrates a very specific of 5 gr amsphase, per week (the amount of carbs in anotheratcup of salad, halfrate an avocado, or six to eight stalk s of asparagus, for example). This w ould put you at 25 grams of carbs per week. If you continue losing, in the next week you go up to 30 grams. You continue this progression upward until your weight loss stalls, and then you cut back to the pr evious l evel. That level is what Atkins calls your CCLL. The rules for OWL are simple: you still eat as much protein and fat as you want (stopping when you’re satisfied, of cour se); you i ncrease carbs by no mor e than 5 gr ams per week ; you add one new food gr oup at a time to see if it has any negative impact on cravings or symptoms (such as headaches, bloating, and so on); and you continue this way until you are close to your g oal weight . When you are 5 to 10 pound s fro m your g oal, you move to sta ge three, “premaintenance.” During premaintenance, you up your carbs by another 10 gr ams per week (t ypical 10-gr am por tions are ½ cup of almo nds, filberts, or macadamia nuts; ¼ cup of yams or beans; and 1 cup of strawberr ies or watermelon). Again, you’re lo oking fo r the level of carbohydrate consumption that will let you keep losing, albeit at a much slower r ate. If you oversho ot that level and st op lo sing co mpletely or even start gaining, you drop back down a level. Simple. Atkins stresses the impo rtance of the premaintenance stage, but I imag ine it’s the one peo ple r esist the most. Here’s why: when you’r e within spitting distance of your goal, you are naturally tempted to keep doing what you’r e doi ng until yo u get there. Atkins wants you to actually slow the weight loss down during premaintenance to less than a pound a week for 2 to 3 months. Premaintenance is seen as a kind of driver’s ed for lifetime mai ntenance. You’r e using this time to learn and master new habits of eating that w ill last the rest of yo ur life. You need to do a gr eat
deal of experi menting and tweaking, as the differ ence between your Critical C arb Level for Losing and your Cr itical Carb Leve l fo r Maintaining is likely to be very small. Finally, when you do arrive at your go al, you incr ease the carbo hydrate level—again in measured incr ements and very gradually and carefully—until you find the level that allows you to stay exactly at th at weight. Now you’r e in stage fo ur, “maintenance”; the number of grams of carbohydrate you’re consuming is your Critical Carb Level for Maintaining, and that ’s what you continue eating to stay at your go al weight. Atkins spends a lot of time discussing metabolic resistance to weight loss, which he defines as th e inability to bur n fat or lose weight. He identifies fo ur major causes o f metabolic r esistance, which ar e discussed at length in chapter 20 of his New Diet Revolution. Obviously, excessive insulin and insulin resistance is one of the causes (see chapter 2 for a full discussion on insulin resistan ce). Prescri ption dr ugs or hor mones are another, and an underactive or malfunctioning thyroid is another. The last is yeast. Atkins’s discussion of yeast is useful reading for everyone who has had trouble lo sing weight. I believe yeas t is a far mo re common factor in weightloss pr oblem s than was previousl y thought. Atkins explains that yeast overgrowth is commonly found in conjunction with a sensitivity to mol d, and that the com bination may easi ly suppr ess metaboli sm. Dr. Alan Schwartz, medical director of the Holistic Resource Cent er in Agour a Hills, California, has said that yeast creates its own food source by literally demanding sugar to feed on (i.e., cravings), a theory that would dovetail nicely with At kins’s. Yeast, a living o rganis m, also pro duces waste pr oducts and toxins, which can weaken the immune system and lead to food intolerances, another obstacle to weight loss. While the mechanisms ar e not com pletely understoo d, it’s a go od bet that Atkins was right about the yeast connection. Fortunately, the Atkins diet—at least the induction phase—virtually eliminates all of yeast’s favorite foods, and the classic antiyeast diet loo ks a lo t like Atkins’s induction. Atkins identifies what he calls three levels of metabolic resistance: high, average, and low. How easily your body responds to carbohydrate restriction defines your level of metabolic resistance. He suspected that most people with a high level of metabolic resistance would wind up with
a maintenance level of somewhere around 25 to 40 grams of carbs a day. Those with a low level of r esistance would be in the 60 -to-90-gram r ange, and regular exercisers would be a t 90-plus gr ams of car bohydrate p er day. Atkins has been one of the most misunderstood diet authors and has been the target of more attacks than any other low-carb proponent, probably because his was the first and the most commercially successful of the plans and also , to the constant chagr in of the establishment, becau se he simply away. While some diets of theand larger Atkins dietwouldn’t are appligo cable to all low-carb has criticisms been dealtof w the ith in depth in chapter 6, some ar e specific to At kins and are bri efly addressed here. One of the sources of misinformation about Atkins came because many people confused the induction phase with the whole pr og ram. Atkins was very clear that induction was for a limited time only. A common criticism of Atkins is that he doesn’t allo w you to eat vegetables and fr uits. Actually, he said no such thing. A tkins was a nutritio nist, and a very go od o ne at that —he did not want you to miss the incredible nutritional benefits of the phytochemical s fo und in vegetables and fr uits, which you add back to the program in the subsequent stages of his plan. He never said you couldn’t eat vegetables and f ruits. He did say you couldn’t eat junk carbohydrates. Another pr oblem with the public’s (and the medical establishment’s) perception of Atkins’s program is that it was based solely on the first (1972) edition o f his bo ok. In that edition, where Atkins fir st put for th the radical proposition that cutting carbohydrates was the key to controlling insulin, he di dn’t pay as much atten tion to what you wer e allowed to eat, concentrating instead on the foods you were not allowed. Atkins in 1972 was like the doorman at an exclusive club who is given the order “ don’t let in anyone wearing sneakers! ” and, as a r esult, is so fo cused on the gr ound that he doesn’t realize he is letting in all kinds of other riffraff that just happen to be wearing shoes. Atkins r evised the boo k twice (i n 1992 and 2002), and with each edition he became mo re outspoken about the need to emphasize omega-3 fats, eliminate trans-fats, and include plenty of vegetables and fiber in the diet. But he could never s hake the 1972 imag e as the diet doc who lets you eat pork rinds and lard. Finally, it bears mentioning that the fully developed Atkins program is a three-pronged approach to health that involves not just carbohydrate
management (he later called the diet a “controlled-carbohydrate approach to eating”), but also exer cise and nutritio nal supplementation. In his New Yor k clinic, only a small per centage o f patients came in solely for weight loss. Atkins should be remembered for his marvelous wor k in the field of complement ary and integrative medic ine as well as for his pioneering work o n diet.
The A tk ins Diet as a Lif estyl e: Who It W orks for, Who Sho uld Look El sewhere While his last book, Atkins for Life, is a pretty good template for healthy living that almost anyone could benefit from (and is not wildly different from the Zone or the last stage of the Fat Flush Plan), the Atkins diet proper is likely to be most successful with, and most appreciated by, those who really have a fair amount of weight to lose and have had a great deal of difficulty getting it off. People with only 10 or 15 pounds to lose could certainly do the program, but the exacting and cautious approach to adding carbohydrates bac k 5 gr ams at a time is likely to be over kill fo r them. In the next decade, I believe we will have a much better under standing o f the nascent concept of metabolic typing, but even now it appear s that there are so me types who do ver y well on higher -pro tein, higher-fat diet s and some who do not. Ob viously th e pro tein types are g oing to fare well o n this diet and not find it near ly as diffi cult and restr ictive as those with a different sor t of metabolic blueprint.
JONNY’S LOW DOWN Rereading the Atkins opus for the zillionth time in preparation for this book, I was once again struck by the disparity between what he actually said and what people think he said. The Atkins diet was never an “allrotein” diet; in fact, a recent statistical analysis put the induction phase at 35% protein and the maintenance phase at only 25%! 1 He stressed vegetables, talked about fiber, went to great lengths to emphasize individual responses and the need for customizing, and thought that both exercise and nutritional supplements were absolutely vital for optimal
health. The later version of his book—as well as the breezier Atkins for Life— is heavily referenced with a superb bibliography of scientifi c studies . Atkins’s only real mistake was in portraying ketosis as identical to fat loss and making it seem as though calories didn’ t matter at all. He kind of boxed himself i nto a corner on this one. Ketosis doesn’ t cause fat l oss; it is simply the by-product of fat-burning. Yes, ketosis occurs when you are burning fat for fuel, but you will dip into stored fat only if you are not getting fuel f rom the yourcertainly diet i s 10,000 madebut up of 90% fatenough and 10% protein, youdiet. w illIfmost be i n calories deep ketosis, ou will gain weight like crazy . I don’t think everyone who needs to lose weight must go on Atkins, but it is certainly a viable option and likely to be quite helpful for people with carb addictions, resistant metabolisms, signifi cant insuli n problems, and a fair amount of weight to lose. It deserves every one of its five stars .
2. TH E A LL-N EW A TKINS A DVA N TA GE STUART T RAGER, MD AND COLETTE HEIMOWITZ, M.SC
WHAT IT IS IN A NUT SHELL
modern update and expansion of the Atkins Diet suitable for all sorts o eople. More user-friendly than the srcinal. Benefits from the addition o terrific exercise and motivational sections .
About th e A ll-New Atk ins Adva nta ge The All-New Atkins Advantage was written by Stuart Trager, MD and Colette Heimowitz, M.Sc, and is subtitled The 12-Week Low-Carb Program to Lose Weight, Achieve Peak Fitness and Health, and Maximize Your Willpower to Reach Life Goals . It’s a tall o rder, but the boo k does an awfully good job of delivering on its promise. Trager is a boar d-certified orthopedic surgeo n; but what’s particularly interesting about him—from a low-carb-diet point of view—is that he’s an
Iro nman athlete. And not just any o ld Ironman athlete (no t that there’s such a thing as an “ordinary” Ironman!): he’s an eight-time Ironman and a topten finisher at the Ultraman Wor ld Championship. M eet him in per son and he’s a wiry, muscular guy who looks like he could pull a tugboat across San Francisco Bay. Why is this inter esting? Because Atkins—and low-car b diets in general—are frequently perceived as being antithetical to energy and athletic performance. If this were true,Heimowitz, someone foa rg ot to tell Trager,nutritio o r, fornist thatand matter, his coauthor, Col ette highly r espected educator who serves as vice pr esident for education fo r the newly r e-for med Atkins Nutritionals, and is herself a walking example of how to lo ok 15 years younger than your age without surg ery. Both Trager and Heimowitz credit the Atkins Nutritio nal Appro ach for helping them achieve peak fitness and health. This boo k, therefor e, is an int eresting departure fr om the standard Atkins diet, since it’s aut hor ed by two people who clear ly do n’t have a weight pro blem, and who have adapted the pri nciples o f what was once known only as a “weight-loss diet” to people wanting to lose a few pounds and get in great shape. In other words, almost all of us. The five principles of the All-New Atkins Advantage Program are as follows: • • • • •
Higher pro tein (especially at breakfast) Good fat (meaning no trans-fats!) Low sugar ( plenty of vegeta bles and low-sugar fr uits like berri es) High fiber (at least 25 gr ams a day) Adequate vitamins and miner als
Accor ding to the aut hor s, follo wing just these five principles w ill g ive you a huge advant age in atta ining your go als fr om the point of weight management and the poi nt of better health. It’s hard to disag ree with that. One thing that distinguishes The All-New Atkins Advantage from previous Atk ins boo ks (espec ially the ori ginal) is the emphasis o n motivation and fitness. There are some g oo d motivational tips, taken r ight out of the contem por ary l ife-coach playb oo k, including r elaxation techniques, journaling, and exercises to change negative thinking.
Stretching exercises ar e r ecommende d and clearly il lustrated, as are weight-training exercises. The exercise prescription is a tad conventional (cardio 2–4 times a week, strength training 2–3 times, stretching frequently); but if you follow it, you will see results. Later in the program, you also i ncorpo rate a “fitn ess challen ge,” such as se eing how long it takes you to walk a mile. It’s a pretty comprehensive program, well written, visually appealing and user-friendly. The four stages of Atkins are explained well and perhaps in a more approachable (and flexible) way than in and the clearly previous books, certainly more so than in the or iginal Atkins Diet Revolution. The whole look of the program—though not necessarily the fundamentals—has been moder nized and updated. As with the “srcinal” Atkins, the program begins with the “induction” phase. That’s the very f irst stage of Atkins, the one where yo u “induce” weight loss with a mer e 20 gr ams o f car bs a day. (It’s this stage which many people wr ong ly assume to be the whole Atkins diet.) As in the “or iginal,” you add bac k 5 gr ams of car bs a week. In this book, they’ve made the process of adding back carbs in 5-gram increment s r idiculously easy . There are week-long meal plans fo r each level o f car b intake, beginning with 7 days’ worth of meals and snacks that contain no mor e than 20 gr ams of carbs per day total, follo wed with a week’s worth of 25-gram plans, and so on up to the 80-gram-per-day level, which presumably would be for people well into the 3rd phase (“premaintenance”) or 4th phase (“maintenance”). Truth be told, by the time this boo k was written, Atkins had become a nutritional-products company, so there’s more than a little hawking of Atkins products (bars and shakes) incorporated into the suggested menus. This isn’t necess aril y a bad thing, beca use the pr oducts ar e go od o nes, among the best of the “low-carb” bars and shakes. They have no trans-fats, a fair amount of fiber, no sugar, and a decent amount of protein, plus they taste pretty good. Plus, if you wanted to, you could do the program without any products, since the menus that incorporate them are merely suggestions. The book has a nice clear description of what they call “The Atkins Carbohydrate Ladder.” These are carbohydrate foods in the suggested or der o f reintro duction into your menu. The fir st rung on the lad der is
salad and other low-glycemic vegetables like asparagus and spinach. The next rung is seeds and nuts, followed by berries. Next level is legumes, and the one after that is fruits other than berries (apples, oranges, grapes). Next comes starchy vegetables (sweet potatoes), and last is whole grains. In keeping with the w hole “individualized” appr oach to the New Atkins Advantage, the authors explain that there’s no “right” or “wrong” about which foods you must include in the carbohydrate ladder as you begin reintroducing carbs 2 to 4 of the eating plan.will “The of how high you canduring climb phases on the ladder—and when you do question so—will depend entirely on your metabolism and your activity level. Some people can climb quite high—and those individuals will be able to enjoy legumes, whole gr ains, and starchier vegetables in lat er phases o f the prog ram,” they write. “A few lucky individuals can even enjoy so me of these foo ds in Ongoing Weight Loss (OWL—or phase 2). Others may find that in Lifetime Maintenance, they cannot or rarely toler ate items at the top o f the Carbo hydrate Ladder. The point is t hat everyone needs to ascend gradually in order to fi nd out what he or she can tolerate without i nstigating weight gain or cravings .” (Emphasis mine.)
The A ll -New A tki ns Adva ntage: for, Who Should Look El sew here Who I t Works This program is likely to work for many people, but like the srcinal Atkins, it’s especially good for people who are terribly insulin-resistant and have a lot of weight to lose. These people seem to benefit the most from the rigorous first stage of induction. The later stages—particularly the maintenance phase—sound to me like a pretty good way to eat in general, and should have broad appeal to a wide range of people, including those who are very fit and active. If you’r e not one who does well w ith very careful mo nitor ing o f carb levels in 5-gram increment s, you’re likely to find this frustratin g; i f you like things spelled out for you and are g oo d at sticking to a pro gr am, you’ll pr obably find it very appea ling.
JONNY’S LOW DOWN breezier, friendlier, more-inclusive version of Atkins with an expanded reach, likely t o appeal not only to t hose who have a lot of weight to lose but to active, fit people who feel better on lower carb intakes. There’s a lot more recognition of individual dif ferences and a lot less ri gidity t han in the srcinal. The addition of the exercise program plus motivational and lifecoaching tips makes this a far more comprehensive program than the srcinal Atkins Diet .
3. T HE BIGGEST LOSER MAGGIE G REENWOOD -ROBINSON , PHD, ET AL.
WHAT IT IS IN A NUT SHELL The diet and exercise pr ogram designed by the cr eators of t he hit t elevision show The Biggest Loser. Surprisingly smart, effective, and easy to f ollow.
A bout The Bi ggest Los er
I’ll admit it—when I first heard the idea for the new television show The Biggest Loser , I thought it was a terrible idea for a television show. Weight loss as a spectator sport? That’s like watching paint dry. Once the show had its debut in 2006 and I actually saw it, I revised my opinion—I now thought it was not only a terrible idea but also that it sent a terri ble message to the general public. First of all, some people were losing 17 pounds a week, a completely ridiculous amount that could never be sustained and was only happening because so me of them were weighing in at over 400 to beg in with. Second of all: by the second w eek, folks wer e being “kicked off the island” if they “only” lost something like 12 pounds. Thir d of all, humiliat ion and embarr assment were key parts of the “entertainment,” and I thought the whole thing was pretty disgusting . Well, that shows you ho w good I am at predicting televisio n hits. The show’s been a runaway success and has given birth to a number of
spin-off cottage industries such as the book being reviewed here. Which, needless to say, I expected to hate. I was wrong. I still think some of what you see on the television show is unrealistic. But I’ve since tempered my opinion and come to realize that there are things about the show that many people find inspiring and motivating, not the least of which is the sense o f co mmunity and accountability that ’s encouraged, and much a partitof’sany successful pro gr am. And asthat for is thesobook—well, surpr isingly g weight-loss oo d. One might almost say t err ific. The Biggest Loser: The Weight Loss Program to Transform Your Body, Health and Life turns o ut to be o ne of the best of the fitness and diet b oo ks around. Although it’s short on technical information (which you probably don’t need anyway), it’s a real example of a program that has incorporated what we’ve learned about controlled-carbohydrate eating into a really smar t plan that many people will find ver y useful. Here’s how the authors characterize the diet:
The Biggest Loser diet is a calorie-controlled, carbohydratemodified, f at-reduced diet geared to help you burn pound after pound of pure fat—and do so without deprivation or loss of energy. What’s more the diet is high in protein. Protein has a hungercontrolling effect on the body—which is why higher-protein diets are so effective for weight loss and fat burning. They go t that rig ht. Let’s loo k at the specifics. First thing that go t my attention was the calor ie for mula. I’ve long said that the “for mulas” for how many calor ies you need ar e ridiculo usly over inflated. In the “old” days when I was the iVillag e. com “Weight Loss Coach,” I’d hear from women all the time who were telling me they w ere fo llowing the guidelines for their weight and height that they found on various Internet sites and could never lose weight. When I questioned them fur ther, I’d invar iably disco ver that they were eating way too many calories. Typically the “guidelines” would tell a 150-pound woman to eat over 2,000 calories a day. No wonder she wouldn’t lose weight! Remember, even in low-carb, calories do count.
The calorie formula for the “Biggest Loser” program is—hold on to your hor ses—present weight times 7 (for weight loss). Now I can almost hear you g asping “That’s so little!” Well, yes, it’s pretty low. But consider that for years nutritionis ts like me have been using the “target weight times 10” formula for weight loss, and consider that this for mula uses your pr esent weight—not your targ et weight—so they’re not far apart. For example, let’s say you were 180 pounds and your target was 130. formula (target weight 10), you’d be aiming for×130 × 10 be calorBy ies my or 1,300 calor ies. By their×for mula (present w eight 7) you’d aiming fo r 180 × 7 or … (drum r oll, please)… 1, 260 calor ies. Pretty simil ar, and, in my o pinio n, pretty on the money. (By the way, you’d be amazed at how much go od fo od you can eat for that amount of calor ies.) Note that these for mulas do break down a bit at the extremes of weight. For example, if you’re 110 pounds and want to be 100 pounds, the formula isn’t that great. But most people following “The Biggest Loser” are not going to be fighting the last five or ten pounds on what is already a tiny body. For most people t he for mula is fine, and a refreshing change fr om the bloated calorie formulas that predominate in magazines and on the Internet. The second thing I liked about the Biggest Loser program was the questions it asks yo u to answer. To wit: “Why do you want t o lose weight?” (By the way, this isn’t a dumb question. It gets you thinking about go als, mo tives, and what’s really impo rtant to you.) Or : “What can I do this week to increase my energy?” All good stuff, all part of the kind of pro gr am that is about more than just following a diet. And speaking of diet, it’s pretty darn good. They have something called “The Biggest Loser Pyramid”; and let me tell yo u, it’s a heck o f a lot better than the USDA versi on, even the new supposedly “impr oved” USDA Pyrami d (http://www.MyPyramid.gov). At the base of the pyramid are fruits and vegetables—4 servings daily. Next up, pro tein—3 serving s a day. Next up, whole g rains, 2 ser vings a day. And finally at the tippy top, a “discr etionar y” 200 calor ies to be “spent” on things like fats, oils, spreads, sugar-free deserts, reduced-fat foo ds, or condiments and sauces . Okay, it’s not perfect. We coul d do with more vegetables, so me peopl e could lo se the gr ains, we pr obably don’t need t he sugar-f ree deserts— but
look, this is not a strict “low-carb” plan: it’s a smart, sensible plan for the masses that is a huge—repeat huge—improvement over most of the dietary advice that’s routinely given. And it still manages to incorporate some of the p ri nciples of lo w-carbing. I particularly like the list of foods to avoid, which include everything that would be a l ow-car ber ’s nightmar e: white bread, white past a, white potatoes, pastries, po tato chi ps—you g et the idea. And a lovely mention o f the entire rcategory of “appetite-stimulating the definition of which everyone eading this book alr eady knows foods,” fro m experience! There’s a terr ific section called “how to structu re your meals.” Example: for br eakfast, ½ pro tein serving, 1 whole gr ain serving, 1 fr uit. For dinner, ½ protein serving, ½ whole gr ain serving, and 3 veget able servings. That kind of thing. Since a lot of the questions I routinely get on my Web site have to do with practical tips like ho w to put a meal tog ether, I think this section of the program addresses a big need, and does it quite well. The exercise section, needless to say, is exemplary.
The Big gest Loser: Who It Wo rk s for, Who Should Look Elsew here Since the greatest successes on “The Biggest Loser” have been with people who are seriously overweight, it’s likely that the seriously overweight will be exactly the group this book will appeal to. That’s the market the show has staked out. Of course, the usual caveats apply—many people who are seriously overweight have many other “co-morbid” conditions, such as high blood pressure. I would not suggest undertaking this rigorous an exercise program without clearing it with your health practitioner. Remember that on the TV show, everyone has medical clearance and there is a doctor aro und at all times.
JONNY’S LOW DOWN I like this book a lot. Strict “low-carbers” may find fault with the fact that it’s hardly an orthodox low-carb plan, but it’s a perfect example of what I
wanted this book to highlight—diet and nutrition programs that weren’t necessarily “strictly” low-carb in the “Old School” sense, but had nonetheless adapted successfully many of the principles of healthy lowcarb eating. This book fills the bill perfectly . Particular kudos for the highly motivating quotes from successful articipants on The Biggest Loser televisi on show, which should serve to inspire many a reader. And more kudos still for paying attention to the sychological with this book .and motivational aspects of weight loss. You can’t go wrong Five stars.
4. THE CARBOHYDRATE ADDICT’S DIET RACHAEL HELLER, M.A, M.PH, PHD, AND RICHARD HELLER, M.S., PHD
WHAT IT IS IN A NUT SHELL Those with a sense of humor call this plan “Atkins with dessert.” You eat two protein-and-vegetable meals a day and one “reward meal,” during which you can eat anything you like. On most variations of the plan, there are no snacks.
About the Carbohydrate Addict’s Diet The Heller s are pretty much responsible for adding the term carbohydrate addict to the popular lexicon. They define carbohydrate addiction as follows: “a compelling hunger, craving or desire for carbohydrate-rich foods; an escalating or recurring need or drive for starches, snack foods, or sweets.” Sound familiar? It does to a lot of people. Rachael Heller certainly recognized herself in that description. And she discovered the principles upon which the diet is based quite accidentally, through a for tuitous exp erience in her o wn life. At the time o f her disco very, Rachael weighed 268 po unds. She had had a weight p ro blem all her life, weighing mor e than 200 pound s by the age
of 12 and mor e than 300 pounds by ag e 17. She spent the better part o f 20 years on diets, on liquid fasts, in Overeaters Anonymous, you name it. She became a psychologist largely because she wanted to learn about the psychological causes of overeating. Her own eating was, to put it mildly, out of cont ro l. One day, because a m edical test that had to be do ne on an empty stomach was postponed from mo rning to late afternoon, Rach ael found herself not being able eatscale untilthe earnext ly evening. dinner, she astonishment, ate everythingthat in sig then got o ntothe day andAt found, to her sheht, had lost 2 pounds. E qually impo rtant—and somewhat surpr ising —was that on the day of the test, when she didn’t eat breakfast or lunch, she also wasn’t particularl y hungr y. She tried the same ro utine the next day—no breakfast, no lunch, no hunger, big dinner—and boom, off came another pound. She continued to experi ment and add refinements to the diet (which thankfully i ncluded putting br eakfast and lunch back int o the mix), and ultimately lost 150 pounds, which she has kept off to this day. It was out of this experi ence that the Carbo hydrate Addict’s Diet was bo rn and the theor y behind why it wor ks was developed. As with many low-car bohydr ate diets, the theor y centers ar ound the activity of insuli n, but with a slig htly differ ent twist. As we know fr om elsewhere in the book yo u’re r eading ri ght now, there ar e many people who o versecrete insulin in response to foo d (particula rly carbohydrates), and many who eventu ally beco me insulin-resistant , meaning that their cells no longer “pay attention” to the insulin in their bloodstream. This leaves them with elevated levels of blood sugar and of insulin (a situation that can easily pr ecede diabetes and certainly pr ecedes other health pro blems). We also know that elevated insulin prevents fat burning and encourages fat storage. The Hellers hypothesize one more chain in this link, which is critical to the understanding of the carbohydrate “addict.” According to the Hellers, too much insulin in the bloodstream prevents the ri se of the br ain chemical sero tonin. (Make sure yo u r ead Jonny’s Lowdown for a discussion: in my opinion, th is is a misr eading of the science.) Ser otoni n is the neuro transmitter that is intimately connected with feelings o f satisfact ion ( antidepressant s like Pr ozac and Zoloft wor k by basically keeping sero tonin hanging aro und in the brain). I f ser otonin
levels fail to rise, which is what the Hellers hypothesize in this scenario, the carb addict will no t feel satisfied and will attempt to satisfy the gnawing hunger by again consuming carbs, wh ich of co urse will spark another release of insulin, and the cycle will start again. “The repetition of this cycle,” say the Heller s, “for ms the physical basis of what we call carbohydrate addiction.” Meanwhile, o f course, the carb addict will get fatter and fatt er. Accor toisfied the Hfor ellers, a nor malhours, perso nwhereas can eat carb a carbohydrate -rich meal andding be sat four or five addicts , with their impaired car bohydrate -insulin-serotonin mechanisms, might feel hungry again in a couple of hours, or even less, and find themselves with a craving for more sweets. Another pr emise central to the development of this diet was t his: it isn’t only the amo unt of car bs you eat that matters; it is ho w frequently you eat them. (Ther ein lies the reaso n that Rachael felt less hungr y when she didn’t eat until dinnertime on those first few days of experimenting.) The Hellers believe that any weight-loss diet that prescribes three or more small meals each day that contain anything more than minor amounts of carbohydrates will ul timately fail with the car bohydr ate addict. In the Heller s’ view, hyperinsulinemia (high levels of insulin) is the best explanation for recurring cravings and hunger and the body’s tendency to store fat. In summary, the following applies to the carbohydrate addict: • For the amount of car bs consume d, too much insulin is produced. • The constant excess of insuli n eventually leads to insulin insensitivity . • Serotonin (a fee l-go od brain chemica l) does not rise enough to cau se the addict to feel satisfied and to pr oduce the signal to stop eating, so the addict continues to eat carb-rich food. • Pro duction of insulin ri ses with each subsequent carb intake. • Greater and gr eater amo unts of car bs may be consumed w ith no increase in satisfaction. The Hellers use the addiction model throughout their book. In the patients they have wor ked with, they identified thr ee levels o f addiction, characterized by an escalating need for carbs and sweets as you move up the “ladder.” In level 1, you ar e simply i nterested in eating all the time,
craving basically wholesome fo ods but lots of them; in level 2, th ere i s an increased desire fo r carbs, especia lly br eads and baked go ods; and in level 3, there is a much greater reliance on snacks and sandwiches as staples of the diet, with a high contribution from cakes, candies, potato chips, popcorn, cookies, pies, and the like. This is also accompanied by more and mor e compulsivenes s. Addiction “trigg ers” can come fr om emotional event s, day-to-day events, or foo d.depression, Examples of emo tional trigg anger, anxiety, a sense of being outers ofinclude control,unexpressed excitement, and frustration. E xamples o f daily-life tr igg ers are stresses of any kind, PMS, illness, or a change in ho me life. Finally, food tr igg ers are all the things dieters commonly report as deadly and that you would expect to be on a list like this: bread and other grain products, fruit, sweet desserts, snack foo ds, all kind s of pasta, french fries, and of co urse sugar. Carbohydrate addicts have the greatest difficulty controlling their eating when they consume car bohydr ates several times a day. Accor ding to the Heller s, when the number of carb meals (or snacks) is r educed, eating becomes far mor e controlled and t here is a dr amatic decrease in cravings. So here’s t he pro gr am they recommend: • Two lo w-carb meals per day (which they call “complem entary” meals) • One “reward” me al per day Complementary meals are defined as high in fiber, low in fat, and low in carbs. They are basically made up of protein and vegetables (with no fat added). The protein can be either 3 to 4 ounces of meat, fish, or fowl or 2 ounces o f cheese. You can have 2 cups of veg etables or salad, but you can’t use the vegetables on the “higher-carbohydrate” list. The vegetables on that list have mor e than 4 gr ams of car bs per ser ving, and y ou can eat them, but only at the reward meal. (Some o f the vegetables on the He ller s’ list don’t belong there, such as broccoli, which actually has only about 2 gr ams of effect ive carbohydrate * per serving, and avocado, wh ich is not even a vegetable and in any case doesn’t contain 4 grams of effective carbohydrate.) Other “high-carb per serving” vegetables not to be eaten during the complementary meals include potatoes and corn.
Reward meals, which happen once a day, usually at dinnertime, ar e made up of anything you like. Quantities are not limited. There are only three rules. 1. The meal must be equally balanced, in thirds, among pr otein, vegetables, and starch (or dessert). 2. The meal must be consumed within one hour o f starting. 3. You go equal back amount for seconds on all thisthree meal, butgoifries. you do, yo u still havecan to eat s fr om cate There is a one-hour time limit for the reward meal because of th e Hellers’ understanding of what is called the biphasic release of insulin (more about this in Jonny’s Lowdown). Insulin is released in two phases (hence the term biphasic). The first phase occurs within minutes of consuming car bs: the pancreas releases a fixed amount of insulin regardless of how much carbohydrate is being consumed at the time. The second pha se of insulin release—acc or ding to the H ellers but to no o ne else in the field—takes place about 75 t o 90 mi nutes after eating and is dependent on ho w much car bohydr ate you actually ate at the meal. I f the “initial jolt” of insulin release in phase one wasn’t enough to handle the carb load, the second phase shoots out more. Thus, they maintain, you want to consume your entire reward meal within sixty minutes to prevent that “second sur ge” o f insulin pr oduction. Alcohol is not prohibited on this diet, but it needs to be consumed as part of the reward meal. Artificial sweeteners are not permitted, and for a very g oo d theor etical r eason: it is hypot hesized that insulin release mig ht be subject to conditioned responses, much like salivation was conditioned in Pavlo v’s dogs, whose mouths watered when they heard a bell that had been rung every time dinner was served. The Hellers put forth the very interesting hypothesis that artificial sweeteners somehow trick the body into r eleasing insulin, pr obably because they tast e sweet and because the body becom es used to secr eting insuli n when the taste buds and the brain notice the sweet stuff coming in. In addition, the sweetness keeps the addictive cycle going and keeps you wanting more. No snacking is allowed between meals (except on a var iation call ed Plan A, which allows one “complementary” snack per day). The Hellers explain
that “one piece of fruit eaten other than during the reward meal can reverse the whole metabolic process that is emptying your fat cells. That apple or banana or whatever can be the difference between weight loss and weight g ain.” Ther e is a seventeen-item quiz you can take t o deter mine whether this diet is fo r you. It’s called the Carbohydr ate Addict’s Test, and it is also available in a shortened form (a ten-question “Quick Quiz”) on the Web site (http://www.carbohydrateaddicts.com). Your addiction,” score identifies you as having “doubtful addiction,” “mild carbohydrate “moderate carbohydrate addict ion,” o r “severe car bohydrate add iction.” The Heller s claim that they have refi ned the quiz so that it now identifies 87% of carb addicts and gives a “false positive” (i.e., mislabels a “normal person” as an addict) only 4% o f the time. They also po int out that their diet was not designed t o address the eat ing patterns or pro blems of those with “doubtful addictio n.”
The Carbohydrate Addict’s Diet as a Lifestyle: Who It Wo rk s for, Who Should Look Elsew here This program has a huge following and has helped many people. I suspect that those who sco re hig hest on the Carbohydr ate Addict’s Test are the best candidates for this diet. There are many people for whom the idea of giving up their favor ite foods, even if it’ s not for the rest of their lives and even if it will result in demonstrably improved health and a great deal of weight loss, is simply too great a sacrifice to contemplate. This program has great appeal to people who feel that way and who find enormous comfort in the fact that they’re never more than 24 hours away from any food they choose to eat. On the other hand, there are many people who are simply too carbsensitive or sugar-addicted to be able to handle trigger foo ds in any amount, even if it is o nly once a day. If this is yo u, you shoul d look for a more carbrestricted plan.
JONNY’S LOW DOWN
I have absolutely no doubt that there is such a thing as carbohydrate (and
sugar) addiction, but I’m not at all sure that the mechanisms behind it are fully understood. The Hellers are very sincere, very kind people who have helped thousands of people, but the theory behind the program is, depending on where you stand, either really weak or completely false. While it seems pretty clear that there are both insulin and serotonin abnormalities in the obese, it’s not at all clear that high levels of insulin depress levels of serotonin, as the Hellers hypothesize—in fact, the majority the evidence points t o the opposite responot nse.only rem oves sugar Currentofthinking is t hat it works li ke this: i nsulin from the bloodstream, but also removes amino acids (protein). Tryptophan, the building block of serotonin, is a little runt of a molecule that is constantly competing with the other amino acids for “elevator space” into the brain, where it can be converted to serotonin. As Kathleen DesMaisons, PhD, author of The Sugar Addict’s Total Recovery Program and an expert on addictive nutriti on, colorfully explains, it’ s as if a bunch of big bodybuilders and a li ttle runty guy are standing arou nd the gym, waiting for the bench press. All of a sudden, a really gr eat-looking chick walks i nto the gym and all the bodybuilders gravitat e to her, leaving the bench press empty for the runty guy. Insulin functions i n the body like the great-looking chick: it temporarily removes the competition, letti ng tryptophan get up 2
into the brain. Hence, it i s thought t hat more insuli n increases serotonin, not lowers it . The Hellers predict that the more insulin you have hanging around, the less serotonin in the brain, giving rise to all those terrible cravings. A recent articl e in the Journal of Clinical Epidemiology3 suggested exactly the opposite. It found that i nsulin sensiti vity (which would mea n lower levels of insulin) was positively related to suicide and accident rates—the authors postulated that accidents and suicide are frequ ently associated with lowered serotonin. In thi s model, less insuli n goes with less s erotonin. The Hellers, remember, postulate the opposite: for t hem, insulin resistance (higher levels of insuli n) equals less serotonin. Calvin Ezrin, MD, author of Your Fat Can Make You Thin, explains the mechanism rather well and shows why high levels of i nsulin lead to higher level s of serotonin, not lower ones .4 The two-shot, biphasic theory of insul in release seems to be comp letely
misunderstood by the Hellers. According to Dr. David Leonardi, who lectures worldwide on diabetes and is t he medical director of the Leonardi Medical Institute for Vitality and Longevity in Denver, insulin is indeed released in two phases, but there is not a 75-to-90-minute gap between the two. “If you eat a bunch of carbohydrates in fifteen minutes, believe me, ou’re not going to have t o wait sixty minutes to get t hat second phase of insulin release,” says, raisi nglimit questions bymeal many theory behind theheone-hour time on theshared reward .5 abo ut the Finally, I’m not comfortable with the short shrift exercise gets in this rogram. The Hellers are entirely right that exercise alone i s not a great weight-loss method, but it’ s vit al to both maintaining weight and to r aising metabolic rate . But sometimes a program works well even if it is not f or the reasons its designers believe. The Hellers have come up with something that works for a lot of people, even if they’re not 100% correct about why .
5. THE 7-DAY LOW-CARB RESCUE AND RECOVERY PLAN
RACHAEL HELLER, MA, M.PH., PHD, AND RICHARD HELLER, MS, PHD
WHAT IT IS IN A NUT SHELL six-st ep plan to get back on track if you’ve fallen off the low-carb wagon. lternately, this could be seen as a nonthreatening, step-by-step approach to getting on the Carbohydrate Addict’s Diet.
About the 7-Day Low-Carb Rescue and Recovery Plan The dedication in the book that outlines this plan tells you a lot. It reads: “To all of us who have been told to ‘just eat sensibly.’” According to the Hellers, who pioneered their theory in the Carbohydrate Addict’s Diet,
carbohydrate addicts are like nearsighted people in a farsighted world— the prescriptions that help others just don’t apply. And the subtitle of the book reveals its intention: For Every Low-Carb Dieter—On Any Program —Who Needs Real Help Right Now. That pretty much tells the tale. The 7Day Low-Carb Rescue and Recovery Plan i s about getting back o n track. The book is divided into 3 sections: the 7-day jump-start plan; a section on tips, troubleshooting, and restaurant tactics; and a third section on recipes. Thelevel 7 -day jump -start plan has onecravings purpo se:drop to bring bloo d sugar and insulin back into balance so that and motivation soars. The Hellers believe you can accomplish this by making a small change each day that builds o n the success o f the previo us day until, almo st without trying, yo u are back in cont ro l and on track. Those chan ges ar e lovingl y detailed in the 7-Day Plan. The six ste ps are as fo llows: 1. 2. 3. 4. 5.
Add pro tein to every meal. Add vegetables and/or salad to lunch, dinner, and snacks. Balance all meals (à la th e Zone diet). Eat only low-carb foods for all snacks. Eat only lo w-carb foo ds for all snacks an d at one meal.
6. Eat only lo w-carb foo ds for all snacks an d at two meals. Of course, if you follow these six steps you will wind up on—you guessed it—the Car bohydr ate Addict’s Diet! The Hellers offer “Five Vital Clues Low-Carb Diet Doctors Miss,” which is actually pretty thought-provoking—though, in my opinion, most of the statements they make ar e hypothetical at this poi nt. Let’s take a loo k: 1. Saturated fat can raise insulin. According to the Hellers, a diet high in saturated fat (and/or trans-fat s) is l ikely to increase your insulin levels (or increase insulin resista nce), leading to mor e cravings and decreased weig ht loss. I think this statement is pr etty contr over sial and I have not seen any science to suppor t it. And while no one thinks a diet that’s healthful has a ton of saturated fat, I think the movement to have all saturated fat condemned as “unhealthful” and the idea that we should lower it as much as possible is not a wise one. Why not
have a diet well balanced betw een saturated fats (many of which are actually down ri ght goo d for you), omega-3’s from fish and flax , and omega-9’s fro m such foods as o live oil and macadamia-n ut oil? 2. Sugar substitut es are carb act -alikes. This is an interesting statement that is purel y speculative, but, I must admit, bears further study. Isn’t it possible that—like Pavlov’s dogs, who salivated at the sound of a bell because they were associate theMaybe bell with food—we have a conditio nedconditioned response totosweet tastes? we are so conditioned t o secrete insu lin in r esponse t o somethin g sweet that we might—just might—secrete insulin in response to foods that are sweet, even if they have no calo ries! And some new evidence suggests that the consumption of artificially sweetened foods (and beverages like diet sodas) could disrupt our innate ability to judge the calor ic conten t of foo d and eat accor dingly, leading us to eat mor e when we’re consuming a lot of artificially sweetened stuff. Definitely foo d for thought. (The Hellers o ffer a quiz to det ermine if you ar e “addicted to diet drinks.”) I think this idea actually has a g reat deal of merit. 3. Glutamates are also carb act-alikes. The Heller s poi nt to a study that showed that applying MSG to the tongues o f animals causes them to release high levels of insulin within three minutes (MSG stands for monoso dium glutama te, a flavor enhancer that’s in a l ot of foo d, including , but not limi ted to, Chinese fo od). But MSG is far from the only glutamate. Food manufacturers add glutamates to a zillion things, including water-packed tuna. It’s also fr equently one of thos e innocuous-soundin g “natural f lavor s” you see o n labels. The Hellers make the point that glutamates ar e thought to be excito toxins, and that if you’ve ever wondered why you can’t stop eating something that tastes go od, even when it’s low in car bs, this might be the reaso n. 4. How often you eat carbs matters. Not surpr isingly for author s who pioneered the concep t of a “r eward meal,” the H ellers are of the belief that it is not just the total number of carbohydrates you eat in a day that makes a diff erence, but also the frequency with w hich you eat
those higher-carb foods. They believe that when you decrease the number of times in a day that you eat high-carb foods (even if the total intake of high-carb food for the day is the same), you can keep your insulin leve ls lo wer and your body in “spend ing mo de” for longer periods of time. 5. You sho uld eat to ward your carbs. The Heller s believe that the order in which you eat your matters. mealCarbohydrate contains a highcarb food—for example, thefood Reward MealIfina their Addict’s Diet plan, or any other m eal where yo u’ve decided to have a highcarb food—they feel you should eat it last. Their advice is to start the meal with the foods that are lowest in carbohydrates and finish with the foo ds that are highest. This advice makes sense on the face of it (i.e., you sho uld stay away fr om the br ead that comes befo re the main course), but it also seems to allow a meal of fish and vegetables to end with choco late cake. This f ifth “clue” is based on the Heller s’ belief—which I discussed in my r eview of the Carbo hydrate Addict’s Diet—that the second sur ge o f insuli n happens about sixty minut es after yo u begin eating, so if yo u finish your fo od within an hour of beginning your meal, you will do l ess damage. Their thinking is that if you start with protein and low-carb foods like vegetables, you’ll be satisfied before yo u get too enamored o f the dessert. The Heller s also discuss four very go od “Carb M yths” (my fav or ite: “You should have seen what I didn’t eat”), “troubleshooting,” and “restaurant tactics” and include recipes.
The 7-Day Low-Carb Rescue and Recovery Plan as a Lifestyle: Who It Works for, Who Should Look El sewhere I’m not 100% sure this book was meant to be a lifestyle—after all, the Carbohydrate A ddict’s Lifespan Prog ram is the Heller s’ “rest of your life” plan—but it’s excellent for those who want to try a lower-carb way of life
without giving up their favor ite foods. I t’s also terri fic fo r devotees of the Carbohydrate Addict’s Diet who have “strayed” and want to get back on track. For those who need more structure and whose bodies do well only on specific, measured amounts of net carbs, this plan might be too looseygoosey.
JONNY’S LOWDOWN I like this book better than the srcinal. I still have a lot of problems with some of the Hellers’ biochemistry, but this book offers some theories—like the one about artifici al sweeteners triggering hunger—that I thi nk are both interesting and worth investi gating. I didn’t agree with the Hellers about saturated fat in their other books, and I stil l don’t. But I l ike the st ep-by-step approach to getti ng back on track, which can be used even by someone who wants t o investi gate a lower-carb lifestyl e in a less ri gorous way. And the tips section is quit e good. I was going to give this plan t hree and a half stars, but I think t he low-carb myths and the hypothesis about artifi cial sweeteners moves this lan into four-star range .
6. CURVES G ARY HEAVIN AND CAROL COLMAN
WHAT IT IS IN A NUT SHELL n eating and exercise program targeted to “real women”: thirty minutes of exercise three times a week combined with one of two eating plans: lowcarb or low-calorie. Both plans have three phases: weight loss, transition, and maintenance.
A bout C urves The Curves pro gr am was developed for women, and it has a very definite sensibility. It targets “real” women, eschews the diet mindset that causes
women to bemoan their inability to be a size 2, and has the admirable goal of being easy to stick with while at the same time correcting metabolic problems created by a lifetime of dieting. How well does it succeed? As they say, “let’s go to the videotape.” Heavin explains that dieting eventually lo wers metabol ic r ate and causes the o pposite of the desired effect— by lowering your metabolism, you actually activate survival mechanisms, like your body’s ability to run on fewer calo ries, that cause youon to that ho ldinon to fat. Lowdown). He calls these mechanisms “starvation hormones” (more Jonny’s The Curves program promises to correct damaged metabolism, turning your body fro m a “fo od-burning machine” into a “champion fat-burning machine, ” and fixing your “slow meta bolism” i n the process. S ounds deliciously appealing. And certainly a worthwhile goal. How does the Curves diet accomplish this metabolic sleight of hand? Heavin asserts that the secret of the pr og ram’s success is that “we address the complicated biological issues that have been conveniently overlooked by conventional diets. ” This m ight be news to the other author s discussed in this boo k, many of whom have pr esented sophisticated and accurate discussions o f the hor monal and biolog ical issues involved in w eight loss, but that’s ano ther s tory. Curves is right on in its desire to “fix” (or, as Diana Schwarzbein would say, “heal”) a damaged m etabolism. Heavin stat es, however, that there are some people who have “des troyed” th eir metabolism thro ugh years o f low-fat, low-calor ie, or yo-yo dieting; and for these unfortunat es, “Metabolic Magic” (his term, no t mine) can’t happen until they r epair their metabolism and r estor e it to nor mal. For these people, he offers the “Metabolic Tune-Up,” a rather convoluted regimen in which you “eat normally” (2,500 to 3,000 calories!), weigh yourself every day, and try to stay between your “low weight” and your “high weig ht.” You should expect to gain 3 to 5 pounds during this phase. If you gain more, you’re to go back to phase 1 for no more than 3 days to “burn off the fat.” You repeat this cycle until it takes longer and longer to gain those extra 3 to 5 pounds and, consequently , you have fewer and fewer r eturns to phase 1. At this point, you can resume your weight-loss diet. And what is the weight-lo ss diet? Actually, there ar e two plans: a lowcarb versio n and a low-calor ie versio n. (The book o ffers test s to help
you determine which plan is rig ht for you.) In the low-carb versio n, you can eat unlimi ted amounts of pr otein, but you cut back on star chy and sugary carbohydrates. (The book states that “as long as you are eating the right foods, your caloric intake doesn’t matter,” which is complete nonsense and exactly the kind of silliness that gives thoughtful lower-carb plans a bad name.) The low-calorie version allows you about 1,200 calories a day, but is higher in protein than most conventional low-fat diets. And the k is co rrect in touting carbs the met abolism-r prabout oper ties of pr otein andboo d isdaining highglycemic like bagels foaising r just everyone. In the low-carb version of the program, there are three phases. Phase 1 is the strictest part of the prog ram. If you have fewer than 20 pounds t o lose, you follow it for a week. If you need to lose more than 20 pounds, you stick with it for 2 weeks. In phase 1, you are limited to 20 grams of carbs a day (exactly like the At kins induction phase, which the aut hor does not cr edit). You may eat unlimited amo unts of pr otein (incl uding l ean meats, cheeses, eggs, seafood, and poultry), and in addition you are allowed unlimited amounts of Free Foods (which are basically all the greens recommended in the Atkins induction). You are also allowed one protein shake a day, which is also counted as a Free Food (for reasons that are no t explained), which can cont ain 20 gr ams of pro tein and 20 gr ams of carbs. During this time, you will probably be in ketosi s, which, the author correctly points out, is not at all unhealthful if you don’t have a preexisting kidney pro blem and if yo u dri nk enough water. This phase, as expected, produces the most weight loss in the shortest time. In phase 2, you add mo re fo od. You co ntinue to eat an unlimited amount of protein, but you increase your carb intake to between 40 and 60 grams a day (exactly like At kins and Pr otein Po wer). Unlike those two plans, however, you continue to eat unlimited quant ities of Free Fo ods and that one protein shake a day which, for baffling reasons, doesn’t “count.” During phase 2, you should l ose 1 to 2 pounds per week. You stay on this phase until yo u reach your desir ed weight or until yo u want a break fro m dieting. In phase 3, you have attained your goal weight and can basically be rid of the “diet.” The author—astonishingly—recommends that you go back to a “normal” intake of 2,500 to 3,000 calories a day (!) and suggests that
you can stop counting both ca lor ies and ca rbohydrate s (mor e on this in Jonny’s Lowdown). The “built-in” safeguard against gaining more weight is much like my 4-pound rule (see page 374 in chapter 12). If you g ain mor e than a few pounds, you g o back to phase 1 until you take it off, then go back to eating “normally.” On the calorie-sensitive version, you eat 1,200 calories a day during phase 1, and no more than 60 grams of carbohydrates. It’s recommended that youallowed get 40%unlimit of your from protein. As with the plan, you’re edcalories Free Foo ds and the inexplicab le frlow-carb ee pro tein shake daily. In phase 2, you up the bar to 1,600 calo ries a day with the same freebies. You’re also allowed to ramp up the carb intake to 60 grams (not count ing, o f cour se, the Free Foo ds and the carbs in the protein shake). Much like with the lo w-carb plan, phase 3 sets you fr ee, telling yo u to eat “nor mally” and only return to phase 1 if your weight go es up mor e than 5 pound s or so. The exercise pr og ram is o n much mor e solid gr ound than the nutri tional advice. The Curves wor kout incor por ates strength training, cardiovascular training, and stretching in a simple 30-minute routine that you do 3 times a w eek. Though there ar e Curves gyms all o ver the count ry where exercise leaders take you th ro ugh the wor kout, the book pr ovides a pretty darn good at-home version. The only equipment you need is an exercise tube, which is like a rubber rope with a handle on each end. The workout is quite good: after a 3-minute abdominal warm-up, you alternate a strength exercise with a cardio interval. There are 8 such combinations, and each component is done for 40 seconds. For example, you do as many reps of the chest press as you can do in 40 seconds; then you do an “aerobic recovery” of 40 seconds (this is anything that keeps your heart rate up—jogging in place, for example). You then move on to the second strength exercise (leg extension) and the second aerobic recovery interval. Continue until you’ve done all 8 strength exercises (each followed by its “a ero bic reco very”) and th en do the whole cir cuit of 8 once ag ain. You fo llo w this with a cool -down and a few flexibility exerci ses, and you’r e done. Thir ty minutes out the door . As the British say, “Not too shabby!” The rest of the book is devoted to meal plans, shopping lists, recipes, and some basic discussion o f var ious health condit ions.
Curves as a Lifestyle: Who It Works for, Who Should Look Elsew here The program makes no bones about targeting busy women who want to get healthier and mo re fit, lose some weight, bu t not necessarily lo ok like a model (ho nor able go als for sure!). The studies are pr etty clear that thirty minutes of exercise three times a week—no matter how good the workout (and the Curves wor kout is goo d)—is probably not enough to make a real dent in your weight; but, in combination with a good eating program, it’s certainly a huge step in the right direction. The fact that it is so doable is a tremendous plus, and if you really watch your food, you may get great results. If you’re metabolically resistant, the low-carb plan may not be strict enough for you. On the other hand, the flexibility of the program is bound to appeal to many.
JON N Y’S LOW DOWN
½
I approached this book wanting to like it. I’d heard great things about Curves, and liked the “real women have curves” ethic of encouraging women to get fit, become happy with their bodies, and lose the aspiration to look like rail-thin models. I also liked what I had heard about the thirtyminute intense circuittraining workouts. And at first glance, the choice between two programs—one a low-carb program and one a “caloriesensitive” program—sounded int eresting . So I really wanted to like t his book. Unfortunately, it was hard to do. This is a t extbook example of what happens when a businessperson w rites a book on nutrition and fi tness. It’s so fi lled with god-awful voodoo nutriti on and snake-oil salesmanship that by page 23, I was downright angry. Want an example? The author t alks about t urning on “starvation hormones.” I’ve been working with the top nutritionists and endocrinologists in the field for 15 years, and I’ ve never heard the term “starvation hormones.” Wanna know why? ’Cause they don’t exist. The author claims that you can return to eating “normally” once you achieve your weight goal, “normally” being defi ned as 2,500 to 3,000 calories a day. Hello? This
statement pretty much be longs in t he same category of thinking as the “flat earth” theory. It’s utter ly ri diculous and very dis ingenuous. Virtuall y every study (incl uding the highly respected National Weight Control Registry) has shown that caloric levels f or weight maintenance for women ar e around 1,400 to 1,800 calories. In my experience, most women—members of the women’s Olympic volleyball team and Laila Ali being possible exceptions—would get fat eati ng 3,000 calories a day . The authorinto alsoquestion. makes aHere’s statement in theabout beginning that cal ledfrom his “expertise” whatright he says other programs, tkins to Zone to Weight Watchers. Ready? “These diets require you to make a lifelong comm itment. I don’t thi nk this i s realistic or fair—a diet should be temporary. It should not become a way of life.” Yet if there’s a single thi ng that every diet author agrees on—from those advocating the lowest low-carb to t hose promoting the lowest l ow-fat plan—it’s that to stay successful, you have to make lifestyle changes, and that these lifestyle changes have to be forever. Of course eating dif ferently has t o become a way of life. That’s what the maintenance phases of all the plans are about. nd the irony is that a page or so later, the author says, “The Curves rogram is designed with the knowledge that you are going to cheat.” How can you cheat if there’s no program to follow? The book is not all bad, however. The exercise program is great, and very doable. There’s some decent info about protein and cutting junk carbs, though nothing srcinal. I can’ t get past some of the scient ifical ly sil ly ideas like eati ng all the calories you want, or not “counting” certain foods, or the advice t o go back to “eating normally—2,50 0 to 3,000 calories a day.” But many women have been helped a lot by the Curves philosophy of balance and the way its centers welcome and emb race women of all sizes and get them started on a very decent f itness program. And the idea of metabolic healing—though much better articulat ed by Diana Schwarzbein, and with much greater sci entifi c credibility—is a good one.
7. FAT TO SKI N N Y (FAST AN D EASY) DOUG VARRIEUR
WHAT IT IS IN A NUT SHELL very easy to follow low carb plan somewhat resembling Phase One o tkins. Extremely effecti ve and refreshingly uncom plicated.
A bout Fat to Skinny The first thing you notice about “Fat to Skinny” is that it doesn’t look like a diet book. From the glossy paper to the personal photos to the font choices and the illustrations, everything about this says “personal ourney”—and that’s exactly what “Fat to Skinny” is. Which is the first of its many strengths. See, no matter how much we may understand a concept like “lo w-carb” intellectually, nothing speaks to us l ike a r eal-li fe stor y, and Fat to Skinny is just such a story. The book begins with a startling set of photos of the author, Doug Varrieur. In the fir st, he is obese—260 pounds at ag e thir tyfive—and in the second he is lean and fit and enviably muscular : 160 pounds at age fi fty! And he’s maintained that 100 pound los s for five year s. It gets yo ur attention. Doug’s own p erso nal story is one that thousands of r eaders will r elate to, a co mpelling one. was By age seventeen is nickname wasto “Por ky.” By and age it’s twenty, his waist size 38 and he wash fighting a battle keep it there. He lo st. By age thir ty his waist had gone to 44-46 and his weight had ballooned into 265 te rr itory. During this time he tried most of the traditional low-fat diets prescribed by the medical “authorities,” diets nearly everyone has tried at one point or another. Did they work? See above paragraph. The thing that makes t his boo k really special is that it’s not filled with a lot of biochemistry or technical stuff of any kind. Yet he manages to get the central point across very well: fat storag e is dr iven by the hor mone insulin, carbohydrate s dr ive up insulin, high levels o f insulin insure that you continue to store fat, while at the same time “locking” the doors to the fat cells so that they can’t open up and pro vide fuel (fat!) for the muscles. I’ve written and lectured about how insulin controls fat storage in the body, and read pro bably hundreds of explanat ions o f it fr om different authors, but I’ve never seen any better, clearer or more concise than
Doug’s: “Insulin is the gatekeeper for your cells. Each of your cells is a little furnace waiting for fuel to burn, but the fuel can’t get in without the gatekeeper o pening the g ate.” You can see where he’s go ing with this. nothere. the entire of foods is kno wne as carbo hydrates arefar the proIt’s blem The wclass or st offender pur sugar, but t he restthat aren’t behind. Rice, bread, pasta, cereal, and fruit juice all turn into pure glucose (sugar) in the body almost as fast as you can swa llow a tablesp oo n of pure table sugar. These foods—called “high-glycemic”—are exactly the ones you need t o g et rid o f o n this r ather simple ( but extrao rdinar ily effect ive) plan. Varrieur makes one o f the best and clear est cases I’ve yet seen for why sugar is the true demon i n the Amer ican diet (it’s cer tainly not fat, as we’ve been taught). His description of how starchy carbs turn into sugar is one o f the best I’ve seen, but even b etter are the charts showing the amount of sugar in popular foo ds not generally thought to be “sugar” fo ods (like pizza, for example). Varr ieur also does a r eally inte resting l ittle exercise where he analyzes the sugar content from a fairly typical day on the Standard American Diet. Taken tog ether, even with your “healthy” low-fat breakfast of dietitianendorsed fo ods, you’ve just consumed 10 9 teaspoons of sugar for the day, or a whopping 2 ¼ cups of the stuff! Now there’s stuff to quibble with in the book. “If you’r e fat and want to burn fat,” Doug writes, “you need to keep your total intake to no more than 5 teaspoons of sugar from all sour ces per day. This means your total carbohydrate int ake must be no mo re than 20 gr ams of total net carbohydrates for the entire day.” Well. Sure, this is standard Phase One Atkins. You’r e limi ted to 20 g rams o f carbs (during the Atkins “Induction” stage), and you’re aiming for a state known as nutritio nal ketosis. Ketosi s, as I’ve written elsewh ere in this book (see pages 53–56) happens when your body isn’t taking in enough dietary carbs to pro vide immediat e energ y.
Problem is that we now know you don’t have to be “in ketosis” to lose weight. And we also know that many people—not all, mind yo u, but pro bably most —do not need t o lower their carb intake q uite so drastically to g et results. Sharp-eyed readers may have noticed the admonition to eat no more than 20 gr ams o f “net” carbs a day. Net carbs is a term that was fir st coined by the Atkins folks to diff erentiate between car bs that have an impact on blood sugarsuggests and carbs that don’t. Varrieur, thewhen tradition started by Atkins, you basically disregardfollowing these carbs computing your daily allotment. You simply subtract the number of grams of fiber and/or the n umber o f gr ams of sugar alco hols fr om the total number o f carbs listed on the label. The remainder is called “net carbs” and these are the only ones yo u should be paying attention to, the only car bs that impact your bloo d sugar. So when Varrieur (or Atkins, for that matter) says to have 20 grams or less o f car bs a day, he’s talking abo ut net carbs, not total carbs. Another real cool thing about this book is the very excellent (and muchneeded) clarification of the difference between hunger and cravings. “Are you eating because it’s your lunch break?” he asks, “or are you eating because you’re hungry?” He speaks of the “false hunger” that occurs when you walk by a food court and smell the Cinnabons and all of a sudden “think” you’re hungry. “The best way to determine when you’re truly hungry is to experience hunger in your own body and learn from the signals,” says Varrieur. He suggests a three-day test during which you eat only one meal a day: breakfast. (And you don’t even eat t hat until you’r e hungr y!) The breakfast should be 2 eggs, 3 strips of bacon or ham, and 2 pieces of GG Bran Cris p-Bread with two tablespoo ns of peanut butter mixture (f eatured in the boo k). “Write down the time you ate, and then head back into yo ur day,” he sugg ests. “When you start to feel hung er, analyze it. Is it hunger or habit? Did you start thinking o f fo od and that’s what made you feel hung ry, or were you interr upted by your body telling yo u you’re hungr y?” Good stuff. Varrieur suggests that a good way to determine if a feeling is r eal hunger (or just a “craving”) is to see if the feeling passes in 15 minutes. If it’s a craving, and you drink a large glass of water or two and wait fifteen minutes, it should be go ne. If it’s real hunger, it will co me back
fairly quickly. This three-day experiment also gives you some useful information about how much food it actually takes to satisfy your needs. He believes it is also very useful in planning out a day-to-day eating schedule that works for you. For example, if you ate your breakfast at 8:30 AM on the “test day” and didn’t get hungr y again until 11, you’d have learned th at your body gets h ungry an hour or so befor e the noon lunch break, and you can deal with th is in the future by eating a smal l amo unt at 11.The boo k is lo aded with terr ific r ecipes, and comes wit h some o f the best charts I’ve ever seen telling you the exact sugar (and net carb) co ntent of dozens of different foods.
The Fat to Skinny Program as a Lifestyle: Who it Works f or, Who Shoul d Look Elsew here It would be hard to see how this program would work for vegans, and truthfully, I think even vegetarians would have some challenges with it (unless they were pretty flexible on the issues of fish, eggs and whey protein). It’s a program very well suited to meat eaters and others who really thrive o n higher l evels of pr otein and fat. The plan is also go ing to be somewh at challenging to people wh o simply can ’t see going “off” car bs for any real length of time. Those fo lks might be more suited to one of the plans that allows the reintroduction of foo ds like gr ains and starches albeit on a very l imited and control led basis (plans such as the ultramodern “Unleash Your Thin,” or even some of the older stand-bys like “Protein Power” or “Atkins”). But if you like a cutand-dri ed, no-nonsense ap pro ach to bring ing down insu lin and turbo charging fat-burning, and you don’t mind the somewhat challenging level of car b restriction, th is plan is gr eat. What makes Fat to Skinny one o f the best over all pl ans I’ve seen is that it has something going for it that many other plans do not: utter and compl ete simplicity. You do n’t even foll ow a diet; yo u definitely don’t count calor ies, gr ams, or points, anything else. consists All you do is eatprotein foods from the accepted ingredient lists,or which basically of any foo d, any fat, and any vegetable. It’s another variation o n the “caveman”
diet—eating from what I call “the Jonny Bowden Four Food Groups”: food you could have hunted, fished, gathered, or plucked. It’s that simple—and that’s the beauty of it. I suspect this program will be especially suited to men as well, partly because of how easy it will be for men to relate to Doug’s personal story, and also because, well, frankly, men are more likely to respond positively to a diet heavy in meat and fat. However, make no mistake—this is a ver y effective plan and a very sim ple one, and sh ould wor k for anyone.
JONNY’S LOWDOWN I’m going to give this plan five stars just on the basis of its simplicity, effectiveness, and presentation. It’s uniquely user-friendly, Doug’s personal story of triumph is inspiring and visually compelling, and the plan is just a breeze to follow. It’s hard to imagine how you wouldn’t lose weight on this lan. The only challenge is the rather strict level of carb restriction, but that’s more than balanced by the fact that restricting carbs to the recommended level (20 grams a day) is really all you have to do to make this work. That’s going t o appeal to an awful lot of people .
8. TH E DIA BETES DIET RICHARD K. BERNSTEIN , MD
WHAT IT IS IN A NUT SHELL definitive program for treating diabetes with a low-carb diet by one o the most respected thinkers in the field. Bernstein is a type 1 diabetic who developed this program for himself and his patients . The Diabetes Solution is much more detailed and technical; The Diabetes Diet is kind of like the Cliff ’s Notes version of what you need to know .
About the Diabetes Diet and the Diabetes Solution
Diabetes and obesity are so often found together that people working in the field have coined a new term that conflates the two: diabesity. About 80% of type 2 diabetics are overweight, about 80% of diabetics are insulin-resistant, and insulin resistance is the core symptom of Metabolic Syndrome (one feature of which is abdominal obesity). Given that, it’s easy to see how the two conditions can become entangled. For most of the diet-book authors discussed in this book, the low-carb diet is the treatment of It choice fo r diabetes and obesity. certainly is fo r Richard Ber nstein, MD. “The diet pr esented in these pages was or iginally desig ned as a diabetes diet ,” writes Bernstein. “[A]nd as effective as it has been for countless diabetics, it is much mor e than that. Indeed, as more information has become available over the last two decades on the toxic nature of a high-carbohydrate diet , it has never been clearer that the benefits of this diet are nearly as profound for those who do not have diabetes as f or those who do .” (Emphasis mine.) Fro m time to time, I get interviewed by magazines, newspap ers, and television shows about “t he ri ght diet” for all manner o f things—t o tr eat yeast, acne, obesity, diabetes, you name it. Interestingly, the pr escr iption i s almo st always the same—get the sugar out. As Bernstein himself po inted out in the above paragraph, you don’t have to have diabetes to benefit substantially from The Diabetes Diet. If you do, this book is a major find. If you don’t, it’s still loaded with incredibly important information that may help prevent you from getting it. At the very least, following the guidelines found within will most assuredly help you lose weight. Richard Ber nstein was diagnosed with diabetes at age 12 the year I was bor n—1946. Fro m that day for ward, he’s made unders tanding diabetes— its causes, prevention, and treatment—his life’s work. For as long as I’ve been in the field of nutrition, he’s been the “go-to” guy for diabetes and bloodsugar management; and he’s pretty much an icon in the low-carb community, for reasons that will become apparent shortly. Bernstein’s path from patient to healer tells us a lo t about the diabetes establishment. When he became a successful business executive and engineer, a car eer in medicine was the last t hing o n his mind. But after conscientiously fol lowing “doctor ’s order s” for mor e than two decades, he found his health failing badly. His own discoveries on how to manage his bloo d sugar —and the complet e lack of interest in those discoveries
from the “medical establishment”—prompted him to enter medical school at age 45 so that he could publish his fi ndings and eventually treat other diabetics. “What if I, a physician, t old you, a diabetic, to eat a diet that c onsi sted of 60 percent sugar, 20 per cent protein and 20 percent fat?” he asks in the boo k. “But this is just the diet to which I w as subjected for many years. The ADA (Ameri can Diabetes Associatio n) made this r ecomm endation to diabetics for decades.” Bernstein—and other knowledgeable aut hor According and doctor to who wr ites and provirtually motes a every low-carb diet and therefore bucks the “establishment”—the real dietary problem for diabetics is fast -acting o r larg e amounts o f carbo hydrate, which result in high bloo d sugars requir ing lar ge amo unts of insulin to co ntain them. The key to controlling and managing diabetes—and, as we’ll see, to controll ing and man aging weight— is in controlli ng bloo d sugar. And there’s no better way to do so than with a lo w-carb diet. This flies in the face of “conventional” wisdom and advice, which—as you m ay have g uessed by now—is anything but “wise.” “With some important exceptions carbohydrates have the same effect on blood glucose levels that table sug ar does,” Ber nstein writes. “The ADA has r ecently reco gnized officially that , for example, bread is as fast-act ing a carbohydrate as table sugar. But instead of issuing a recommendation against eating bread, its response has been to say that table sugar is therefore okay, and can be ‘exchanged’ for other carbohydrates. To me, this is no nsense.” The Diabetes Diet is actu ally a consumer ver sion o f Bernste in’s mor e comprehensive and still-classic wor k, The Diabetes Solution . If you want a really detailed explanatio n of diabetes (bo th type 1 and type 2) and want t o understand this disease and all its treatment options in g reat depth, The Diabetes Solution is the go-to bo ok. The Diabetes Diet is the Cliff ’s Notes version—it tells you just what to do and gives you just enough infor mation to understand why you are doing it. For the vast majority of people, The Diabetes Diet is all you’ll need t o co ntro l bloo d sugar, lose weight, and prevent (or treat) diabetes. Let’s get r ight to the actual diet plan fir st, which is actually pr etty simple once yo u understand the thinking behind it. B ernstein calls i t the 6–12–12 plan. His basic approach is to first set carbohydrate amounts for each
meal. Breakfast contains 6 g rams of carbs, lunch and din ner 12 gr ams each. “What I’m advocating is r eally as easy to co nceive as the old meat, potatoes, vegetable, salad picture—j ust leave out the potat o,” he explai ns. If you’re wondering why the carb allowance at breakfast is lower, it’s because of so mething Bernstein calls the “Dawn Phenomeno n.” Bernstein suggests that for reasons not entirely clear, the body “deactivates” more circulating insulin in the ea rl y mor ning hour s than at other times of the day. When there’s called not enough insulin, your abody makes sugar fromgo es up. pro tein (a process gluconeogenesis), nd your bloo d sugar Non-diabetics will simply make more insulin to handle the increased bloo d sugar, but type 1 diabetics can’t (and , accor ding to Bernstein, many type 2 diabetics als o show sig ns of the same phenomenon). That’ s why he halves the amount of car bs allo wed in the ear ly par t of the day. Whether the Dawn Phenomenon is a problem for non-diabetics is not addressed— the much mor e commo n approach among many nutritionists is to act ually allow a bit more carbohydrates in the early part of the day as opposed to, say, at night. If you’r e diabetic, I’d r ecommend fo llo wing Bernstein’s prescription. If you’re not, you could experiment. Snacks are fine, with a caveat. “For many peopl e with diabetes, snacks should be neither mandatory nor forbidden,” Bernstein explains. “Snacks should be a convenien ce, to relieve hu nger if meals ar e delayed or spaced too far for comfort.” Because many diabetics take fast-acting bloodsugar– l owering medications befor e meals, it may be ne cessary to take those medications before snacks as well. Even if you’re not on medication, his advice about snacks applies to anyone wanting to contro l bloo d sugar: “B e sure your prio r meal has b een fully digested before your snack starts (this usually means waiting 4–5 hours),” he cautions. “This is so that the effects upon blood sugar will not add to one another.” The same rule applies to snacks as to meals: carb limit of 6 gr ams during the first few hours after ar ising, and 1 2 gr ams of carbs afterward, whether it’s in a meal or a snack. There’s a list of all the “really go od” lo w-carbohydrate v egetables, a por tion of which ha ve about the same effect on bloo d sugar as 6 gr ams of carbohydrate, an d the list will come as no surpr ise to anyone familiar with low-carb diets. It’s the same list o f standbys—from artichokes to zucchini —that you’ll see in many plans, often under the heading “Free Foods.”
But Bernstein has some important points of disagreement with many “traditional” low-carb plans, and they’re very much worth reading and thinking about. For one thing, he’s very aware of the issue of carbohydrate addiction, and for that reason alone, there are no “treat” days here. “Many low-carb diet plans ignore the reality that much of overweight and obesity is directly related to carbohydrate addiction and constant snacking,” he writes. He correctly points out that many dietitians and doctors don’t really understand carb addictio n ataall. “Treatand daysthen are saying a little‘go likeahead having a have smoker go all week without cigarette and a cig arette on Saturday.’” In Bernstein’s view, for people with a histor y of over eating “treats,” it’ s much simpler just to gi ve up the treats than to have the self-discipline t o eat only one small por tion of sweets o r starches on a treat day. I couldn’t agree more. The second big difference between Bernstein and many traditional lowcarb plans—including , by the way, Atkins—is that there ar e no “phases,” and that’s not by accident. As we’ve seen thro ugho ut this bo ok, m any lowcarb plans begin with a highly r estricted r egimen and the n allo w you to gr adually reintro duce mor e carbs as you pro gr ess. For Bernstein, this approach is fraught with problems. “Just as you start to lose weight nicely, you change yo ur diet,” he says. “Many low-car b diets might as well add the caveat that after phase one, you’r e go ing to quit the diet because suddenly you’re back to the same old stuff that got you into trouble in the fir st place.” There’s a genuine difference of o pinion here, and neit her side is “wrong.” We’ve seen lots of studies over the years where people lose weight at a nice clip on the ea rly stages of car b restri ction, o nly to gain quite a bit of it back. Talk to a lot of the docs and researchers off the record and you start to hear the same story—people keep eating the higher-fat, higher-protein diet they lost weight on, but add back the foods that caused the problem in the fir st place. They fig ure that bacon and egg s are fine—why not add a litt le toast and potatoes, since they ’ve alr eady lost the weight? This defeats the whole pur pose and causes the reg ain so commonly seen in low-carb diet studies. “The amount of carbohydrate that you ought to eat will remain constant for life,” say s Bernstein. “For purposes of weight loss, or if you significantly increase or decrease your physical activity, protein amounts
can be adjusted, bu t that’s about it.” Tho ugh i t sounds like tough l ove, in this respect the Bernstein diet is much simpler to follow. On the other side of this argument are those who feel that judiciously and carefully add ing small amounts of carbs back w hile monitor ing yo ur weight and health is per fectly fine to do . The pr oblem may be that some people j ust can’t do it. It’s an open question that has no “r ight” answer other than “it depends on the person, the situation, and the individual
metabolism Bernstein.”also has a slightly different take on protein than many of the other low-carb-diet authors. While he’s hardly anti-protein, he doesn’t feel it should be unlimi ted. “A certain amount of pr otein do es get co nverted to bloo d sugar by the body, and that will r aise insuli n and build fat,” he p oints out.
The Diabetes Diet and The Diabetes Solution: Who It Wo rk s for, Who Should Look Elsew here Without a doubt, this is the program I’d use if I were diabetic. And for go od measure, I’d buy t he companion boo k, The Diabetes Solution , which goes into even more detail about things that can be of enormous help to any diabetic. But this program is also great for weight loss. It’s definitely a little strict —think Atkins Phase One, but indefinitely. (There are a number of distinctions betw een the Bernstein pro gr am and Atkins Phase One, but you get the idea). If you’r e the type who woul d rather pull the band-aid off all at once and be done with it, you’ll probably resonate to this book. There’s no “treat day,” there’s no cheating, and it’s tough love all the way. But it works. If you can’t fathom the idea o f pr otein, fat, and vegetables making up your diet for pr etty much the rest of your life, you might wa nt to l oo k at some of the other pro gr ams. If you’r e neither diabet ic nor serio usly overweight—and if you’re not what we might call “metabolically resistant ”—you may be in abthe le toDiabetes toler ateDiet. a bit mor e genero us carb allowance than the one And if you simply want t o make so me basic healthful changes to yo ur
diet and move in a mor e low-carb dir ection, this boo k is pro bably not for you.
JON N Y’S LOW DOWN You’re Diabetic)
(Especi all y If
very good no-nonsense program by the guru of low-carb approaches for diabetes. Yes, it’s strict, and yes, it could even be considered “hard,” but there’s a big upside: once you commit to it, it’s easy to do, and it will pretty much knock your cravings out of the ballpark. And it will control your blood sugar, whether you’re diabetic or not. Whether it’s necessary to go t his drasti cally low-carb forever is an open question. A lot of studies show disappointing weight reg ain after an ini tial success using carb restrict ion, and I suspect that’s because people simply start adding back carbs way mor e than they should. If you had high blood ressure that was controlled by medication, would you stop taking the treatment and expect your blood pressure to stay l ow? Low-carb diet s—in Bernstein’s view—are the treatment for diabetics (and perhaps for anyone with an insulin-related weight problem). For him, there’s no going back— the carb level of the di et is pretty much fixed, and that’s that .
9. DR. GOTT ’S NO FLOUR, NO SUGAR DIET PETER H. G OTT, MD
WHAT IT IS IN A NUT SHELL pretty underwhelming book that can be summed up in one sentence: don’t eat flour or sugar .
A bout Dr. Gott’s N o Flour, N o Sug ar Die t
This is a pretty uneventful and unsrcinal book that reads like it was
cobbled together from a few basic nutrition texts, circa 1959. It’s all partyline dietetics, with one big—and important—exception: no flour, no sugar. After the one g oo d recommenda tion to cut out su gar and flour, th e r est of the book i s the same ol d “anti-Atkins,” “anti-satu rated fat” stuff, with reactionary conventional medical advice on supplements that is as illi nfor med as any I’ve seen. Want examples? Chro mium pico linate is dismissed as “linked” (a weasel word if there ever was one) “with adverse side memo ry loss and DNA damage.” (Not a wordeffects about including the studiesanemia, of Richard Anderson, PhD, at the USDA on chromium and insulin sensitivity and glucose control.) Want more? “Grapefr uit in and of itself does nothing to increase weight loss or metabolism.” (Sor ry, doc. Scripps University studies show that it does just that.) And gr een tea extract is dismiss ed in two sentences, one of which is “Since green tea naturally contains caffeine, use of these supplements may suppress the appetite but may also cause nervousness or insomnia.” (Read about green tea in chapter 9, page 305.) So o kay, when it comes to nutr itional supplements, Dr. Gott knows nothing. Maybe we could fo rg ive him if he had something or iginal and interesting to say about diet and food. Unfor tunately, he doesn’ t. But the message “no flour, no sugar” is a good one, and it’s definitely a legacy of the “low-carb” revolution. I would have given this a “recommended with reservations” except for the party-line junk about saturated fat and the know-nothing appr oach to supplements. That and the fact that there are so many other good books that handle the “no sugar” recommendation better.
Dr. Gott’s N o Flour, N o Sugar Di et as a Li festy l e: Who It Wo rk s for, Who Should Look Elsew here Cutting out flour and sugar is always a good idea and would work for anyone. If you want a really basic, no-fril ls pr og ram, I suppose you could do worse lifestyle. than this one. But wanting it’s kind aofmore like kindergarten nutrition for the low-carb Anyone fleshed-out, well-thought-out plan should loo k elsewhere.
JONNY’S LOW DOWN There’s nothing much to recommend here except for the powerful recommendation to give up flour and sugar. (I gave it one star each for those two recommendations.) But that’s a pretty flimsy reason to buy a book, especially when so many other diet books deliver a similar message without the smug arrogance and filler material. You can do much better than this .
10. EAT, DR INK, A N D WEIGH LESS WALTER WILLETT, MD AND MOLLIE KATZEN
WHAT IT IS IN A NUT SHELL This is a great example of a “middle ground” book. Not a low-carb plan, but a mainstream book whose authors nonetheless question the dietary wisdom of the past decades, eschew the “food pyramid,” realize the ludicrousness of “low-fat,” and present a really s mart, sensible eating plan that incorporates a lot of lowcarb principles like eliminating trans-fats, rocessed carbs, and junk food. Plus it has the not-insignificant authority of the Harvard Medical School behind it .
A bout Eat, Drink , and Weig h Less Eat, Drink, and Weigh Less is one of a new breed of what I’d call “foodpositive” books—plans that emphasize what you do eat, rather than focusing on what you don’t. It’s the companion book to Eat, Drink, and Be Healthy, subtitled The Harvard Medical School Guide to Healthy Eating , so right away you know this plan comes with a healthy dose of prestige attached to it. But prestige doesn’t always translate to “cutting edge”—far from it. This is har dly a low-carb diet b oo k, and consumer publicat ions fr om Harvard (such as the Harvard Heart Letter or the Harvard Mental Health Letter) tend to be pr edictably conser vative and establishment. So why is
Eat, Drink, and Weigh Less included in this roundup of diet books? Read on. The lead author of this boo k is Walter Willett, MD, who is the chairman of the Nutritio n Department at the Harvard School of Public Health. As the lead r esear cher on the Nurses’ Health Study and the Health Pro fessio nals Foll ow-Up Study, he’s also one o f the most r espected nutritio nal epidemio logists in the wor ld. And he’s hardly a wild-eyed r adical. But Willett broke ranks many of hisFoo colleagues a few years ago, at when he came o ut against thewith idiotic USDA d Guide Pyr amid, which the time * represented the “collective wisdom” of the dietary establishment. For those of us who lean toward a more low-carb approach to eating, this was very bi g news, tantamount to a “Nixon in China” moment. One of the most respected nutri tional resear chers in the world, a pillar of the medical establishment, had actually come o ut and said that the hig h-car b, lo w-fat diet was pretty much a cro ck. Here’s Willett on the revised (and so-called “improved”) government foo d pyramid, curr ently known as M yPyramid (http://www.mypyramid.gov):
MyPyramid is riddled with misguided recommendations that ignore evidence about health and diet collected over the last forty years. It’s still anti-fat, without sufficiently acknowledging that some fats are good for you. It’s not discriminating enough about distinctions between good and bad carbohydrate sources, encouraging you to eat half your grains as refined starch. It lumps together animal- and plant-based protein sources as interchangeable, failing to distinguish between healthy proteins and those that are high in saturated fat. And it recommends more dairy products than you need. Willett argues ag ainst the pro cessed car bs that have become the mainstay of the American diet, points o ut the connection between highglycemic diets and cancer, and e ven questions the accepted dogma o n drinking three glasses of milk per day. He also takes a swipe at the idea that we shouldn’t eat egg s because of their cholester ol (okay, it’s just a swipe, rather than the clubbing I would have pr efer red, but still). And he’s
been an outspoken critic of trans-fats. All good stuff. Now, there’s stuff in her e to quibble with. Willett still co nsider s saturated fat a “bad” fat, alt houg h he’s way mor e thoughtful abo ut this than most, even saying that “[ S]tudies have sho wn that eating some saturated fat in the rig ht pro por tion with unsaturated fat is perfectly fine” and that “it ’s virtually impossible—not to mention unnecessary—to eliminate all saturated fat fro m your diet.” And for my taste, he’s a little too accepting of vegetable in all varietiesand (includ ing co rn, safflo wer, and soybean oils,oils which he their recommends I abhor). But I’m being overly picky. There’s great information in here, and a willingness to take on a lot of the conventional wisdom. Examples: on soy (go od, but not a silver bullet), on co conut (yes!), and on milk (no t reco mmended as a daily beverage fo r adults). Those ar e some big steps indeed coming from someone as mainstream as Willett and the Harvard Schoo l of Public Health. He’s anti-soda and pr o-water, and he gives ampl e space to the importance of both exercise and mindfulness. The book is fill ed with “foo d positivity,” a point of view that emphasizes the go od stuff you can eat and the enjoyment of food, rather than focusing on what you shouldn’t do. It’s refreshing. Best of all , he’s not dogm atic. “[O]ne simple plan does not work for all,
and… an approach to weight control will need to off er a variety of options for diff erent people—and even for the same peo ple, as their tast es and life circumstances change,” he says. Bravo. The plan itself i s a 21-day “diet” that features specific, dish-by-dish meal plans for 3 solid weeks. Recipes are provided—in a separate section —for each dish that needs to be prepared. If you’re too busy to co ok a given meal fro m the 21-day diet, or if you prefer a simpler appro ach, Willett offers a section call ed “Fallback Meals,” which you can always use as a r eplacement for any lunch or dinner. (Sample: 1 se rving o f pr otein, 2 servings o f gr een vegetables, 1 serving o f or ange vegeta bles, and ½ cup of whole g rains.) There’s also a “Portable Plan ,” a versio n of the diet especially for people who ar e traveling, or for colleg e students, or for anyone who can’t actually make the meals o n the 21-day diet (or doesn’t want to). It’s a nice option, feat uring things yo u can buy at the store, o rder fro m a r estaurant,
or whip together at home with minimal fuss. Hopefully, you’ll have lo st the weight you want to lo se after 21 days, at which point you can tr ansition to what Willett calls “Lifetime Maintenance.” On this “program,” there are no menus, just nine basic guidelines: • Eat lots of vegetables and fruits. •• • • • • • •
Say yes goocarbohydrates d fats. Upgr adetoyour . Choose healthful pro teins. Stay hydrated. Drink alcohol in moderation (optional). Take a multivitamin every day. Move more. Eat mindfully all day long.
That’s it. Not much to argue with there. A nice feature of the book is an optional “warm-up” plan—a kind of “pre-diet” which you can use either as an alternative eating plan or as a way of transitioning gradually into the actual 21-day diet. Willett offers the “warm-up” fo r people who might be o verwhelme d by anything mo re than ust a few bullet points, who want to star t doing something immediately, or who might like to move toward a more healthful diet without completely giving up what’s comforting and familiar. It’s totally simple and userfri endly, and it repr esents a majo r impro vement over the standard American diet without taking too much effort. Okay, so Willett doesn’t agr ee with us about ever ything. But let’s not quibble. He’s a smart guy who thinks for himself, and he’s blown more than a few myths out of the water in this excellent boo k; and fo r that, we should be grateful. That and the fact that—with few exceptions—the infor mation in this b oo k is go lden, and it offer s a terri fic approach to food and eating that can help you lose weight—and, more important, stay healthy. Those o f us who l ean toward a mo re l ow-carb approach to eatin g breathed a collective sigh of relief when Willett actually came out against the ill-advised USDA Food Guide Pyramid and began his own version,
The Healthy Eating Pyrami d, which was actually built by the faculty in the Department of Nutrition at the Harvard School of Public Health.
Eat, D ri nk, and Weigh Less as a Lifesty le : Who It Works f or, Who Shoul d Look Elsew here You couldn’t go wrong following this plan. Sure, it’s not low-carb, and you’re not going to build a Mr. Olympia body by following the exercise regimen; but as a general blueprint for living healthy and managing your weight, it’s on the money. The 21-day plan sho uld help mo st people dr op a few pounds. If you’ve got about 10 or 15 pounds to lose and just want to get healthier, this is an excellent program. But if you’re struggling with a lot of stubborn weight that you’ve had pro blems losing fo r a long time, t his might not be a drast ic enough reduction i n carbs to r eally get th e fat-burning circuits fir ed up. The dietary pr og ram doesn’t really address concerns like insulin resistanc e, which is at the heart of Metabolic Syndrome (a kind of pre-diabetes) and can stall even the most “sensible” weight-loss efforts. Insulin resistance— or carb intoler ance—is not likely to be o vercome by a diet that still gets the major ity of its calor ies fr om carbohydrates, alb eit much better o nes than the average American diet. If you’re insulin-resistant, you should pro bably loo k for a mor e structured and ca rb-restricted a pproach—at least in the beginning.
JONNY’S LOW DOWN terrific book for the general public, with good solid information and a smart diet plan. Especially good for people who don’t want to try anything too “far out,” who like knowing that this is backed up by the authority o the Harvard Medical School. It’s backed with good science and written in an easy, readable style. While i t’s not a “low-carb” diet prog ram, it is a low “junk carb” diet, and you’ll never go wrong eating the way the book prescribes. But it’s robably not the ideal place to st art for people who have a lot of weight to lose or have insulin resistance and any degree of carb i ntolerance. For
everyone else, i t’s fine. Bonus points for vari ations (l ike t he “Portable Plan” or the “W arm-Up Plan”) that make it easy for people on the go or for people wanting to make a few healthful changes without a huge commitment to a new way of eating .
11. THE FAT FLUSH PLAN ANN LOUISE GITTLEMAN , MS, CNS
WHAT IT IS IN A NUT SHELL 3-phase eating plan designed for both fat loss and detoxification. The idea is both to lose fat and to make your body more efficient at processing it effectively, largely by targeting a sluggish liver, the main organ for detoxification and fat metabolism in the body. The first phase is fairly (though not completely) carbohydrate-restrictive—you can still have two ortions of fruit a day and a ton of vegetables—with each subsequent hase adding back more carbohydrates until you reach maintenance.
A bout the Fa t Flush Plan The Fat Flush Plan started life as a 2-week eating program that was srcinally chapter 16 in Ann Louise Gittleman’s pioneering book Beyond Pritikin. Developed and expanded over the years, it eventually became the fully realized diet and lifestyle plan that is the cornerstone of this book. Fat Flush bring s a differ ent spin to l ow-carb dieting by concent rating o n what Gittleman calls the “five hidden weight gain factors”: an overworked liver; a lack of fat-burning fats; too much insu lin; stress; and something that Dr. Elson Haas has called “false fat.”
The Liver In addition to being the main organ for detoxification in the body, the liver is also responsible for fat metabolism. Bile, for example, is made in the liver (and stored in the gallbladder) and is responsible for helping the
liver break down fats. But bile can’t work efficiently if it doesn’t have the proper nutrients that make up the bile salts, or if it is congested or thickened with toxins, pollutants, hormones, drugs, and other nasty stuff. Hence, inefficient bile production can slow weight loss. Another example of how impaired liver function can slo w weight loss i s “fatty liver,” a co ndition that many over weight people develo p. It’s not lifethreatening, but it’s also not something you want to put on your holiday wish list. A very early symptom of possible liver disease frequently in alcoholics, it basically means that fat is backed up in the liver likeseen cars on a multilane freew ay trying to get through a sing le toll boo th. Moder n life puts a lot o f stress on the poor overwor ked liver. The number of commonly used substances (including medications and even some her bs) that can harm the liver is enor mous, and include s Tylenol, some choleste rollo wering medicat ions, some est rog ens used in hor monereplacement t herapy and in bir th-control pills, alcohol, and a host of other stuff. Getting the liver in tip-top shape is one goal of the Fat Flush Plan, and that’s something that virtually no other diet program addresses. Fat Flush does it by including well-known bile thinners like eggs (high in an amazing liver-supportive substance known as phosphatidylcholine, which also has the ability to br eak up fats in the barg ain) and hot water with lemon juice.
Fat-Burning Fats Gittleman was a pioneer in debunking the popular ’80s notion that a no-fat diet was a good thing ( Eat Fat, Lose Weight), and she was especially credible because she had been chief nutritionist at the Pritikin Center, which was (and still is) Command Central for the low-fat contingent. She specifically recommends supplementation with GLA (gamma-linolenic acid, a fatty acid found in evening-primrose oil, borage oil, and blackcurrant oil) because it stimulates a special kind of fat in the body called brown adipose tissue , or BAT. BAT is metabolically active fat that surr ounds vita l o rg ans and can act ually help burn off calories.
Excess Insuli n Virtually every low-carb diet plan exists precisely because of the theory
that too much insulin is the culprit behind weight gain for a huge number of people. The Fat Flush Plan addresses this with the now-familiar prescription of healthful fats, lean proteins, and low-glycemic carbohydrates.
Stress The connection between stress and fat gain is mediated by excess production of the stress hormone cortisol, is firmly established by research, and is now making its way into the popular consciousness (which you know is happening once it hits the women’s magazines), largely due to the pioneering work of Dr. Pamela Peeke. The connection is too lengthy to go into detail here—those interested should check out Dr. Peeke’s excellent book, Fight Fat After Forty, or read the very good explanation of the stress–fat connection in The Fat Flush Plan. Here’s the condensed version: stress makes you fat . The Fat Flush Plan addresses stress by offering suggestions on improving sleep, getting moderate exercise, and removing dietary cortisol boosters such as caffeine and sugar.
“False Fat” People love this term. When I wrote about it for iVillage.com, my article go t mor e hits than almo st anything el se I had ever written and was featured on the America Online home page. People are fascinated by the notion that they could actually be carrying around something that feels like fat, looks like fat, but maybe, just maybe, isn’t actually fat at all! The term is the invention of the wonderful integrative physician and author Dr. Elson Haas, who wrote a book about it ( The False Fat Diet ), and Gittleman honorably credits him with the concept, which is central to her discussion of the five hidden weight-gain factors. Here’s the d eal: food sensitivit ies can trigg er hor monal r eactions in the body that lead to both wat er retention and cr avings. Water r etention happens because incompletely digested molecules or peptides from the foo d you’re sensitive to enter the bloo dstream and ar e perceived as invaders by the immune system, w hich then mounts a full-f ledged PacMan–like attack, releasing histamine and flooding the area with extra fluid. (This extra fluid can be up to 10 or 15 pounds in some people—it’s not
really fat, but it sure feels li ke it, and it can easily make the differ ence between you being able to wear your “skinny clothes” and having to wear your “fat jeans.”) During this immune-syst em r esponse, t he body also over pro duces the hor mones cor tisol and aldost ero ne, which in turn incr ease sodium retention, attracting even more water to the cells and tissues. This whole immune casca de will cause you to r elease end or phins (natural “feel-goo d” opiates), which can, foods over time, easily give rise to a feeling that wheat, you’re addicted to the very you’re sensitive to. (Think of sugar, flo ur, and the like. Ever no tice how no o ne ever says they’r e addicted to Brussels sprouts?) Fina lly, your levels of ser otonin—the feel-goo d neurotransmitter—drop when the immune system goes into full alert, because the same white blood cells that carry serotonin are now too busy fighting o ff the inv aders to bo ther with sero tonin. Lower levels of sero tonin almost alw ays lead to incr eased cravings for high-carbohydrate foo ds, which in turn spikes your blo od sugar, leading to a vicious cir cle of higher levels of i nsulin an d mor e fat stor age. Get it? The Fat Flush Plan relies heavily on daily intakes of “cran-water,” a mixture of unsweetened cranberry juice (not the “cocktail” stuff commonly found in supermarkets) and water. The juice contains arbutin, an active ingredient in cranberries that is a natural diuretic (as is the lemon in the hot-water-and-lemo n-juice mix) . The Fat Flush Plan also deals with the “false fat” issue by restricting the “usual suspect” foods that are likely to trigger food sensitivities: wheat, dairy, and sugar. Phase one of the plan is about 1,100 to 1,200 calories (this is one of the few low-carb plans in which the author actually mentions the caloric intake) and is desig ned to jump-star t weight loss. It’s also meant to be a good cleansing program that supports the liver. You stay on it for two weeks; if you’ve got more than 25 pounds to lose, you can stick with it for a month, though it might get pretty boring. In phase one, yo u avoid: • hot spices (because of possi ble water retention) • oils and fats (other than daily flaxseed oi l and GLA supplementation) • all grains
• all starchy vegetables (potatoes, cor n, peas, carrots, beans, etc.) • all dairy • alcohol and coffee (you are allowed one cup of o rg anic coffee in the morning) Other than that, the diet is flexible. No counting carb grams, figuring out protein minimums, or counting calories. You eat: • up to 8 ounces a day of almo st any kind of pro tein • in addition , up to two eg gs a day • one ser ving of whey pro tein powder (no t in the book, but later added to the phase one fo od l ist on the Web site) • unlimited amounts of almo st any vegetable but the starchy ones (which get put back in duri ng the next phase) • up to two por tions of fr uit per day You can sweeten with stevia (xylitol wasn’t widely available when Fat Flush fir st came out, but I’m willing to bet xylitol would be acceptable). Each day, you have a fi ber supplement, a GLA supplement, flaxseed oi l, and the cran-water mixture. Phase two is for ongoing weight loss and ups the calories to between 1,200 and 1,500. You stay on phase two until you’r e at or near your go al weight. The mai n differ ence between phase one and phase two is that during phase two, you slowly add back some carbohydrates from the “friendly carb” list—one serving per day fo r the fir st week and two servings per day for the second week and beyond. The cran-water drink gets r eplaced with pure water, and most everything else stays the same. Phase three is 1,500 (or mor e) calor ies per day and is designed for ongo ing mainten ance. There ar e mor e liberal choices in the oil and fruit categor ies, and you can now ad d dairy pr oducts as well as choo se fro m a bigger list of “fr iendly carbs,” working up to fo ur ser vings a day. Most everything else r emains the same—there ar e some mi nor changes in supplementation that are discussed. The boo k also has sections o n exercise (g reatly expa nded in the Fat Flush Fitness Plan), jour naling, st ress reduct ion, r ecipes, reso urces, and gr eat FAQ.
The Fat Flush Plan as a Lif estyl e: Who It W orks for, Who Should Look El sew here This is such an all-around sensible plan that it’s hard to see how anyone wouldn’t benefit from it. Within certain parameters (like the carb restriction and the prohibition o n sugar ), it’s very fl exible, a nd it’s o ne of the few lowercar b plans where you can eat fruit rig ht fro m the beginning. Gittleman seems to have a particular gift for writing for women, who appear to co nstitute the majo rity of her audience. Men do well o n this plan, too, but need to make some adjustments. According to Gittleman, they should do phase one as is, but can usually jump to phase three so they can take in more carbohydrates right away. They also generally should increase the portion sizes of their protein and can double up on the whey pro tein po wder. People who need a lot of structure might find this plan too freewheeling for their tastes, and the maintenance plan allows more carbs than some people mi ght feel co mfo rtable with. In addition, if yo u suspect that you have a carbohydrate addiction, the amount of carbs allowed on the maintenance phase could conceivably trigg er binges.
JONNY’S LOW DOWN This is one of the half-dozen best low-carb approaches to health around. I have minor quibbles, with the emphasis on “minor”: there is a lot of talk about cellulite and how the plan can reduce it, which I think is highly speculative, as is the section on food combining. I’d like to have seen alpha-lipoic acid mentioned as an impo rtant supplement for liver healt h. In my opinion, there is disproportionate emphasis on flaxseed oil and not enough on fish oil, which provides equally important omega-3’s that are harder for the body to make on its own. But with that said, the basic template—limited starch, some fruit, unlimited vegetables, lean protein, and high-quality fats—is a great program and would benefit anyone. The henomenal success and public acceptance of this program is well deserved .
12. THE FAT RESISTANCE DIET LEO G ALLAND , MD
WHAT IT IS IN A NUT SHELL n absolutely first-rate program with an srcinal point of view and novel information that is not found in other diet books. Written by one of the great icons i n integrative medicine.
A bout the Fa t Resistance Diet The Fat Resistance Diet is a r arity in diet b oo ks: it actually offer s an srcinal and unique perspective on the whole issue of weight gain and health. This is all the more worthy of mention because the author—Leo Galland, MD—is literally one of the giants in the field of integrative medicine. Most o f what Galland has wri tten has been for other pro fessionals—he ’s been one o f the main educ ator s in ho listic medicin e, and has written extensively abo ut such issues as dig estive health, leaky gut, inflammation, and immunity. Once every so often, he writes for the gener al public. When he does, pay att ention. Galland believes that being unable to lose weight is a sign that some basic metabolic mechanisms are not wor king pr oper ly, generally due to choices we make. “The whol e premise o f the Fat Resistance Diet is that we have inborn, natural regulatory systems that support a healthy weight, but our foo d choices and our lifestyle interfere with their functioning,” he told me when I interviewed him r ecently. One of these inbor n regulatory systems t hat seems to go awry in obesity is a hormo ne called leptin . Leptin is a hormone that was first discovered in 1994 by researchers at Rockefeller University who were studying obese mice. It’s a protein hormone that lets your brain and body know how much fat you are storing. When leptin levels goes up, your appetite goes down. Leptin also speeds up y the ourleptin metabolism. o, fo r pro per weight management, we want cir cuitsSwor king well. “The pr oblem is that over weight people have developed r esistance to leptin,” Dr. Galland
explained. “Their leptin levels are high but it’s not depressing their appetite and it’s not stimulating their metabolism .” So why doesn’t leptin work so well in overweight people? Accor ding to Galland, one r eason is i nflammation. “Inflammation disables the leptin signal,” he told me. “It also contr ibutes to insulin resistance, a central feature o f obesity and diabetes.” Everyone has had a personal experience with inflammation. If you stub your toe—if you getif ayosore throat, you by have a mild asthma stuffed-up sinuses, u’ve been if stung a bee o r bitten byattack an antorat a picnic—you’ve seen firsthand what mild inflammation can look and feel like. And it’s not always bad—in fact, it’ s par t of the body’s healing pro cess. Fluid flows to th e area, whit e bloo d cells surr ound the injury i n an attempt to isolate and remove any foreign pathogens. It’s all your body’s r esponse to an injury o r insult and as such, some inflammator y processes can be important parts of the immune response. Your body makes inflammat or y biochemicals and anti-inflammat or y bio chemicals, and they need to be in balance in order for you to be healthy. But here is the problem: when your body’s inflammation factories are on overdrive, it’s not a good thing. We are constantly exposed to toxins, irritants, medicines, an d foo ds that cause or agg ravate mild inflammat ion. And this is an inflammation that flies under our pain radar but is nonetheless causing damage, especially to our vascular system. This is why Time magazine did a c over story o n inflammat ion so me years ago, in which they called inflamm ation “The Sil ent Killer.” Inflammation is no w reco gnized to be a component of ever y degenerativ e disease , fro m Alzheimer’s to cancer to obesity to diabetes to heart disease. Galland’s pr og ram is all about cont ro lling inflammat ion. In the Fat Resistance Diet, you do i t with the natural anti-inflam mator ies that are found in her bs, spice s, and a multit ude of fr esh whole foo ds like vegetables. Accor ding to Gall and, if you control inflammat ion, you’r e on the way to contr olling fat. “Inflammatio n is the cri tical link between obesity and chro nic ill ness,” Dr. Galland tol d me. In the presence o f inflammation, the “fat control mechanisms” simply don’t work. Another aspect of the inflammation equation has to do with what’s called nutrient density . You can help contr ol inflammatio n with nutrients (for example, omeg a-3 fats, which ar e among the most anti-inflamma tory
compo unds on the planet). “What matters mo st about the calor ies in any foo d are the nutrients that accompany them,” says Galland. “The mo st critical nutrients are those needed to stop the slow-moving avalanche of obesity/inflammation.” Calories are important, but not nearly as important as what else is in the food that contains those calories. “A weight-reduction program that only looks at calories completely misses the boat,” he says. “A ‘caloriecontroll ed’ the diet‘right’ consisting of 12 a dabut y of 100-calor ie Or eo co okies might have number ofpacks calories, you’d be completely screwed up by the lack of fiber, the lack of pr otein, and the resulting blood-sugar roller-coaster.” Some of the best anti-inflammatory spices and herbs include cloves, ginger, parsley, turmeric, cinnamon, and basil, all spices I spoke about at length in my book The 150 Healthiest Foods on Earth . In fact, many of the foods and spices that made the list of the most healthful foods on earth were included precisely because they were so rich in natural antiinflammat or ies (not to mention vitamins, minerals, pr otein, fiber, and omeg as). “We need to r e-educate our palate to learn to appreci ate the wonders of these foods,” Dr. Galland told me. The Fat Resistance Diet is a lifestyle based around great food, rather than the calorie restriction that is usually accompanied by the use of artificial s weeteners, sug ar substitutes, and fake fats. The boo k contains incredibly valua ble infor mation about t he ro le o f these chemicals in inflammatio n and the inflammation–o besity connection. You can g et a go od idea of what ’s in stor e for you by reading the ba sic 12 principles of the Fat Resistance Diet in the box that follows.
The Fat Resistance D ie t as a Life styl e: Who it Works f or, Who Shoul d Look Elsew here I think the principles of this program would actually benefit everyone. People looking for an extremely structured program might not find it to their if you like this understanding the principles behind why you’re eatingliking, what but you’re eating, is a great book for you. Weight loss in this book does not seem to be the main goal—rather, it’s a natural by-product
of the kind of healthful eating Galland recommends.
*
T HE 12 P RINCIPLES OF THE FAT RESISTANCE DIET *
• • • • • • • • • • • •
Choose foods that are loaded with nutrients. Avoid trans-fats. Consume foods with plenty of omega-3 content. Eat fish 3 times a week or more. Eat at least 25 grams of fiber per day. Eat at least 9 servings of vegetables and fruits daily. Average one serving a day of alliums (onions, scallions, garlic) and crucifers (broccoli, cabbage, kale, caulifl ower). Get no more than 10% of total calories from saturated fat. Use only unbroken egg yolks. Don’t follow a “low-fat” diet. Eat two healthful snacks a day. Use fruits for sweets.
*
Used with permission.
JONNY’S LOW DOWN really srcinal contribution to the weight-loss literature, with some important information about influences on weight that don’t ordinarily get addressed in most diet books. If you’ve been frustrated with the usual calorie-based meal plans and standard exercise programs and want a different take on some of the metabolic obstacles to weight loss (as well as some solid information about what to do about those obstacles), this book is highly recommended. It’s worth it just for the information on artificial sweeteners, chemicals, inflammation, and leptin control. Highly recommended.
13. DUKAN DIET PIERRE DUKAN , MD
WHAT IT IS IN A NUT SHELL low-carb plan with some interesting twists and novel recommendations. The diet itself is divided into four phases, all built around protein. Each hase has a specific purpose. Though choices are limited during the first hase (when you drop the most weight), the plan allows you to reintroduce foods like bread and starches in very controlled ways in the third phase. The final, fourth phase of the plan is different from all other four-phase lans (like Atkins, for example) in that there is a built-in mechanism for reventing rebound weight gain.
About the Dukan Diet The Dukan Diet was created by Pierre Dukan, MD, a medical doctor specializi ng in human nutri tion since 1973. It was fir st published in France, where it has been at the top of the best-seller list since 2006. The book is now being introduced across the pond with a brand new American edition. I expect it will g et a lot o f attention. Dukan started his work in the weight loss field as a young doctor practicing general medicine in Paris. One of his patients happened to be obese and asked Dukan how to lo se weight. “All I knew about nutritio n and obesity (in those days) was what my teachers had passed o n at medical school, which amount ed to simply sugg esting low-calor ie diets and miniature-sized meals so tiny that any obese person would laugh and run a mile in the opposite direction,” writes Dukan. Dukan—not unlike Dr. William Har vey who had treated our friend the British under taker William Banting in the 1850’ s (see pag e 3)—went on pure instinct and prescribed an all-meat diet for his obese patient. Five days later he had lo st 12 pounds. After 20 days his weight had dro pped an incredible 22t phases pounds.ofHis tests perfectly normal. “This is how the firs theblood Dukan dietwere wereall bor n,” writes Dukan. Over the years, Dukan noticed that the vast major ity of dieter s inevitably
lose the war against weight. This led to the creation of additional phases whose sole purpose was to protect the gains made in the first phases. According to Dukan, the program takes into account everything that is essential for the success of any weight loss pro gr am: 1. It offers over weight people trying to lo se weight a system with specific instructions that get them on track. 2. The initial weight loss is substa ntial and sufficiently r apid to launch theisdiet and instill lasting 3. It a low-frustr ation diet.motivation. Weighing foo d por tions and calor ie counting are banned, and it allows you total freedom to eat a certain number of popular foods. 4. It is a comprehensive weight loss pro gr am that you can take or leave. Let’s take a look at the specifics of the program.
Phase One: The “Attack” Phase: “The Pure Protein Die t.” The “Attack” phase is simple: pure protein. That’s it. You can eat meat, fish, poultry, whole eggs, and nonfat dairy products. The Attack Phase can last for as little as 1 day or can go fo r as many as 10. Most people do it for 2–7 days. (The number of days you stay on it has a lot to do with how much you need to lose.) Weight loss is rapid, and can be very motivating. The Attack Phase also contains three other “prescriptions,” but they’re easy to follow. You should drink at least 1½ quarts of water or mineral water. You should go for one (compulsory) walk a day for 20 minutes. And you sho uld eat the “oat br an gal ette.” What’s that, you ask? Well the third prescription for the Attack Phase involves a daily dose of 1½ tablespoons of oat bran, which you can add to your milk or yogurt. But Dukan recommends eating it in a way he calls “the oat bran g alette,” which he describes as a lig ht and easy pancake that’s a tasty way to eat your oat br an.
Phase Two: The “Cruise” Phase: “The
A lternating Protein Diet. ” On the “Cruise” phase, you alternate one day of protein only (just like in the first phase) with a day of protein plus vegetables. You can add any nonstarchy vegetables, raw or cooked. (Dukan has a suggested list in the book under the heading “100 Natural Foods that Keep You Slim.”) According to Dukan, this alternating cycle works like the “injectioncombustion cycle a two-speed engine,a burning up its calorie You stay on the of Cruise phase without break until your targ quota.” et weight is reached. “The alternating protein diet is still one of the diets least affected by resistance induced by previo us attempts at weight loss,” wr ites Dukan. During the Cruise Phase, the daily oat bran requirement increases to 2 tablespoons, and the recommended exercise increases by 10 minutes.
Phase T hree: T he Conso li dation Phase: “ The Transition Diet” (5 Days for Every Pound Lost). The purpose of this stage is to get you eating a wider variety of foods again, while specifically avoiding the traditional “rebound” effect experienced by so many people after losing a lot of weight. Dukan believes that gradually including a wider range of foods that are richer and more gratifying but in very limited quantities will allow your body’s metabolism to adjust to your new weight and stabilize your weight loss. Dukan makes a decent case for this reintroduction, pointing out that many people regain weight very quickly because they go from the “diet” to their old way of eating. His notion was that if you reintroduce the “nondiet” foods in a very controlled and structured way, you have less chance of experiencing the ex plosive weight gain th at comes fro m just go ing “off” the p rog ram co mpletely. One novel thing here i s that the length of time yo u stay on this “consolidation” phase is determined by how much weight you lost in the previous two stages. You stay on this third phase for 5 days for each pound you’ve In thelost. Consolidation phase you add 2 slices of bread and 1 portion of fruit and cheese into your daily diet, along with up to 2 servings a week of
starchy carbs (o r gr ains) and 2 “ce lebration” meals. There’s a specific structure to this reintroduction. Since you already know the length of your Consolidation Phase (the number of pounds you lost times 5) you now divide the total Consolidation Phase into two halves. The first half you’re allowed one serving of starchy fo ods a week; in th e second half, you can have two servings. “This approach avoids the risk of you starting to eat sugar -rich fo ods too suddenly,” says Dukan. Similar ly, the two “celebration” meals ar e ation phased in during iod. thedur firing st half, you can have one celebr meal a week,this andper can upDuring it to two the second half. The Celebration Meal deserves some explanation, as it could easily be confused with the “Reward Meal” in the Carbohydrate Addicts Diet. At each celebration meal you can eat whatever food you want during the weight loss period. But there are some very important caveats. Number one, never have second helping s of the same dish. Number two, when you can have 2 celebration meals a week (during the second half of this phase) never have them back-to-back. Third, everything is allowed but only one of each: 1 starter, 1 main dish, 1 dessert, and 1 glass o f wine. All in “reasonable” quantity—but only one of each. The Consolidation Phase has another critical feature, which it shares with all the other phases. During the entire consolidation phase you eat “pure pr otein” o ne day a week. This i s the same diet you ate ex clusively duri ng the Attack phase, and on alternate days duri ng the Cruise phase. During Consolidation you also continue with the 2 daily tablespoons of oatmeal a day, and with daily walking , though Dukan says you no w can lower yo ur walking time t o 25 minute s if you so choose.
Phase Four: Sta bil ization Diet The Stabilization Phase assumes you have now reached your target weight and have kept it fairly consistent throughout the long Phase Three Consolidation Period. So this phase is more like a “return to the real world” phase, and is much less defined than the three previous phases. This phase simply gives you mo re leeway to introduce mor e foo ds. Dukan believes that the consolidation phase allowed your body to adjust to the
new weight and stop “defending” the old one by holding on to every excess calorie and gram of sugar. One might say your weight has now reached a new “set point.” Dukan suggests you adopt the basic foods you ate during the Consolidation phase as your new “baseline” and just add back new foods udiciously. There is also a non-negotiable one-day-a-week commitment to “Pure Pr otein,” the same diet y ou ate daily dur ing Phase One. And finally, you must continue with 3 tablespoons of oat bran for the rest of your life.
Dukan Diet as a Lifestyle: Who It Works for, Who Sho uld Look El sewhere When I was a kid and Elvis Presley was first putting out records (that’s 33⅓ RPM records, folks), one of them had the legend written across it: “50,000 Elvis Fans Can’t Be Wrong!” Course, 50,000 was a lot back then, pre-Internet, but I couldn’t help thinking of that legend when trying to answer the question “Who would the Dukan diet work for?” Why? Because it’s sold over 3.5 million copies in 14 different languages and is the subject of hundreds of message boards and websites populated by devoted followers of all ages and both sexes. That alone is enough to safely say that it has a wide and bro ad appeal. It should al so appeal to people who ar e put off by the idea t hat they can “never” eat a certain kind of food again, or, if they do, that they would be abandoning the ir pro gr am. There ar e a lot of “real worl d” concessions in this plan that make it ver y appealing. I very much doubt tha t there ar e vegetari ans who would have an easy time of this plan, and I know for a fact it would be impossible for vegans. If you have a pro blem eating a fair amount of pro tein you should pr obably look elsewhere, especially since “all protein” one day a week is a lifelong feature o f the Dukan Plan. Those with real fo od addict ion pr oblems may wan t to loo k elsewhere as well. the concept of “celebration” sounds like an, it’s awfully go od,Though reaso nable “real world” idea, fact ismeals if yo u’re an addict go ing to be a pro blem, akin to telling an alcoho lic he can have one “celeb ration”
glass o f wine.
JON N Y’S LOWDOWN
½
I have a couple of reservations about this program, but for the most part I think it’s smart and srcinal. Let’s start with the reservations. Though Dukan seems incredibly savvy when it comes to nutrition and health, it is remarkable to me that he still buys into the low-fat thing, recommending nothing but nonfat dairy products, and non- or low-fat versions of any other protein. This is puzzling, as he seems to have a pretty good grasp o the hormonal impact of food, yet disregards the fact that fat has exactly zero effect on insulin (the fat-storing hormone) and that a good deal o research in the past decade has questioned the long-held assumption that saturated fat i ntake is li nked to higher death rates (it ’s not). The second reservation I have concerns the thi rd and fourth phases of the program. I completely understand the concept of adding things back in gradually, but t he recommendation t o include two slices of whole wheat bread daily at the start of the consolidation phase, strikes me as counterproductive. First of all , there’s the issue of gluten/grain sensi tivit y, which affects many people. Second of all, t here’s the blood sugar i ssue, as nearly all breads are high glycemic. I would have much preferred a more gradual approach and the ability to customize (i.e. dump the bread if it’s a roblem for you). Related is my issue with the “celebration” meal. In theory it’s a great idea. In practice, no one w ho is food-addicted will have an easy time of it . One person I spoke to said that if she were allowed this “celebrati on” meal it would be the beginning of a binge and I’m not sure she’s unique. The good news is that except f or those iss ues, this i s a really, really smart program. I’m especially fond of the “Protein Thursdays” notion (one day a week of protein to stabiliz e), and I particularly li ke the idea that t he diet is designed to be easy to follow for the rest of your life . In the “real” world, most dieters will eventually have their own “celebration” meals wher e they throw caution t o the winds and eat what they li ke. Problem is, when people do this, t hey feel they’ve “cheated,” and tend to have some troub le getti ng back on track. One of the rea l sel ling oints of Dukan is t hat he makes it possibl e to do what people are going to
do anyway (occasionally wandering off t he reservation, that i s) without actually going off the program. I’d give this program five stars, with half point off because he’s so wrong on fat. Other than that, thi s is a terrif ic program and should work well for a lot of people .
14. THE HAMPTONS DIET FRED PESCATORE, MD
WHAT IT IS IN A NUT SHELL lower-carb plan that’s a twist on the Mediterranean diet: high in vegetables, fish, nuts, and omega-3 fats, but favoring macadamia-nut oil instead of olive oil. You choose from three plans—A, B, or C—depending on how much weight you would like to lose. Each plan has slightly different amounts of carbohydrate. All plans stress lean protein, nuts, vegetables, fish, and—you guessed i t—macadamia-nut oil .
About the Hamptons Diet The Hamptons Diet starts with th e pr emise that the low-fat, lo wcholesterol message of the past couple of decades was—if not wholly wrong—terribly miscommunicated. No disagreement there: fat phobia gave rise to the ridiculous notion that we could consume as many fat-free foo ds as we wanted. By now practically ever yone r ealizes that this sill y philosophy led us into our curr ent predicament : near-epidemic levels of obesity and diabetes. The low-fat, high-carb diet, particularly as practiced by people using tons of pro cessed high-glycemic foo ds, produces increased lev els of trig lycerides, w hich increase the risk for cor onar y heart disease. And hig h-gl ycemic diets have been linked with diabet es and with several kinds of cancers. So far, so go od. Dr. Pescator e points to the fact t hat the American Hear t Association diet—which recommends limiting total dietary fat to less than
30% of the diet and saturated fat to less than 10%—fails to lower triglycerides and actually lowers HDL (good cholesterol). In addition, the AHA diet has never co nsistently shown lo ng-ter m impr ovement in any heart-disease outcome. The srcinal low-fat advice was also predicated on the simplistic idea that blood cholesterol was the whole picture when it came to car diac r isk. We now know that there ar e a host o f measur es that are far better predictors of heart diseas e than total cholestero l. These include triglycerides, cholesterol, LDL particle size, inflammat or y markerHDL s like (good) C-reactive protein, homocyst eine, bloo d pressure, lipo pro tein(a), and oth ers, many of which r espond qu ite poor ly to a hig h-car b diet, particularl y one hig h in sugar s. And, as Dr. Walter Willett recently proclaimed, research has shown that the percentage of fat in the diet—contrar y to the advice of the last two decades—has shown absolutely no relationship to any major health outcome. So why wor ry about fat at all? Having been the associate medical director of the Atkins Center for many years, Dr. Pescatore understands well that the demonization o f all fat was a r idiculo us idea. But rather than taking a stand for the wholehearted repeal of fat-phobia, the Hamptons Diet takes a more cautious approach. The author points to the benefits of the Mediterr anean diet, an eating r egimen that has lo ng been touted as healthy by many nutritioni sts. This di et is high i n fish, nuts, lean pro teins, vegetables, and especially mo nounsaturated fat. The classi c Mediterr anean diet “does not regard all fat as bad,” and, in fact, doesn’t limit fat consumption at all. It does, ho wever, specify which fats to eat and which to avoid (more on this in a moment). The primary monounsaturated fat in the Mediterranean diet is olive oil, which even fat-phobics have conceded is a “heart-healthy” fat. Dr. Pescatore has found an oil he feels is even better for you than olive oil, and this is the gimmi ck of the Hamptons Diet. Dr. Pescator e replaces olive oil with macadamia-nut oil, an oil he claims has miraculous benefits for several r easons. First, you can use it in bot h hot and cold r ecipes. Second, it has a perfect ratio of omega-6 to omega-3 fatty acids (1:1). Third, it has a higher concentration of the healthy monounsaturates (omega-9 fats) than olive oil. And fourth, it has a high smoke point, which decreases the risk of trans-fatty acid formation. Dr. Pescatore’s company, MacNut Oil, imports the macadamia-nut oil he recommends in his
resource section. That’s not necessarily a bad thing—macadamia-nut oil is a good food, and many of us sell products that we truly believe in and use ourselves—but it’s worth disclosing. Ther e are six basic tenets of the H amptons Diet: 1. Eat fish that is ri ch in omeg a-3 fats (for example, sardines, mackerel, salmon). 2. Eat not nuts.eat trans-fats. 3. Do 4. Do eat “healthful” fats (stay tuned). The author states: “In the Hamptons Diet, we use the most healthful o il—macadamia nut—and in the pure Mediterranean diet, olive oil is used.” 5. Consume ample quantities of vegetables and some fruits. 6. Consume moder ate amounts of alcoho l. There ar e also three levels, or pro gr ams, somew hat cutely labeled t he “A List,” the “B List,” and the “C List” in an amusi ng takeof f o n the soci al stratificatio n that is de r igueur i n the diet’s namesake hometown. The “A” pro gr am is for people who have mor e than 10 pounds to l ose, and limits carb intake to 30 grams a day. There is also a long, detailed suggested list of appropriate proteins, vegetables, fruits, spices, nuts, and nut butters for the A List. The B List is a transitional program for people who have fewer than 10 pounds to lose and ar e on their way to mai ntenance (the C List). On the B pro gr am, you consume bet ween 40 and 60 gr ams of carbs (less fo r women), a nd can choo se fr om another 8 pro tein sour ces and an ad ditional 3 dozen vegg ies. You can also now add some whol e gr ains and fr uits. And on the C program, which is for maintenance, you have an even wider range o f gr ains and fruits t o choo se fro m, as the daily carb conten t goes up to 55 to 65 grams fo r women and 65 to 85 gr ams for men. So why all the fuss about macadamia-nut oil? Well, like olive oil, it contains an omega-9 fatty acid called oleic acid. Oleic acid, according to Dr. Pescatore, increases the incorporation of omega-3 fatty acids into the cell membr ane, which is a g oo d thing. He postulates that this might decrease the incidence of br east cancer, thoug h he doesn’t tell us ho w. We do kno w, however, that oleic acid has been shown to decr ease total and LDL (bad) cholesterol, but, perhaps more important, it also lowers
triglycerides and raises HDL (good) cholesterol. Dr. Pescatore takes the posi tion that since we know that olive o il do es these things, and since macadamia-nut oil has even mor e of the active ingr edient (omega-9 o leic acid) than olive oil does, it stands to reason that the cardiac and perhaps anticancer benefits might be even more pronounced in the Hamptons Diet than in the classic Mediterr anean diet. The Hamptons Diet, to its cr edit, does say that “som e saturated fats are okay” andAlso recommends, for itexample, a gowe od need sour ce of “lean pro tein.” to its cr edit, makes theeggs poi as nt that to eat much less of those om ega-6 fats we were told wer e healthy in the days when low-fat was king—the polyunsaturated oils like grapeseed, corn, safflower, sunflower, soybean, and cottonseed. Kudos to Pescatore for making this point, oft en missed in oth er pro gr ams. I couldn’t agree mo re.
The Hamptons Diet as a Lifestyl e: Who It W orks for, Who Should Look El sew here This is a perfectly fine program for most people, though I suspect it’s going to appeal more to people who have fewer than 20 pounds to lose. Its recipes and food lists are not for those on a strict budget—reading the menus makes me think of four-star restaurants and red velvet ropes. And it is clearly meant to be marketed to those who see themselves as part of the glamorous set, though that’s more a statement about the marketing and the title. If you can afford the food and the exotic recipes appeal to you, and if you don’t have a ton of weight to lose, go for it. Those who prefer a little mor e basic stuff or a little mor e structure mig ht be put off.
JONNY’S LOW DOWN Full disclosure: I like Fred Pescatore. He’s a good guy. He means very well, he’s knowledgeable, and, as medical director of the Atkins Center, he did a great deal of good by showing how to apply the principles of the tkins approach to the treatment of children (his Feed Your Kids Well remains my favorite book on children and diet). And it’s hard to fault this rogram. The book has a definitive section on oils, is on the money on the
issue of trans-fats, urges organic foods, and limits processed junk. What’s not to like ? The Hamptons Diet is clearly Dr. Pescatore’s attempt to brand himself as an entity s eparate from his mentor Robert Atkins. I can understand this. My only real critici sm of the Hamptons Diet is a personal one—I wish he had taken a st ronger stand against t hose who deem all saturated f ats t he enemy. I guess I hold him to a higher standard than say, Dr. Agatston of South Beach fame. Unlike Dr.that Pescatore is a nutritionist, and aples veryin good one at that; he Agatston, has to know if you followed all the princi his book and stil l consumed saturated fats f rom healthful sources (à la tkins for Lif e), you would be just fi ne. My guess is that he opted for a rogram that is more acceptable to t he masses, who still believe that saturated fat i s the worst thing you can eat . The book is chock-full of great recipes, the information is on t rack, the information on oils is outst anding, and the supplement pr ogram is well thought-out .
15. T HE LOW GI DIET REVOLUT ION JENNIE BRAND -MILLER, MD, ET AL.
WHAT IT IS IN A NUT SHELL diet program based entirely around the concept of t he glycemic index .
A bout the Low G I Diet Revoluti on The Low GI Diet Revolution is based on the concept of the glycemic index, which has r evolutio nized the way we think about carbo hydrates. Brief ly, here’s how it wor ks. In 1981, David Jenkins and Tho mas Wolever of the University of Toronto came up with a system for classifying carbohydrates according to how fast t hey raise bloo d-sugar levels. At the time, people were still talking abo ut carbohydr ates in terms of “simple” and “co mplex,” an outdated syst em which still, sadly, persists to this day and is utterly irrelevant (more on that in a moment). The glycemic i ndex was a far more useful way to cl assify carbohydrate foods. In the “ol den” days—when I fir st studied nutritio n—we classified carbohydrates into two groups—simple and complex. Remember, all carbohydrates are made up of units o f sugar (called “sac charides”). The simple car bohydrate s contain eit her o ne unit of sugar (a monosaccharide —like glucose and fructose *) or two units (a disaccharide —like sucrose, which is simply one molecule of glucose plus one mo lecule of fr uctose). The “complex” carbs ar e even longer chains, known as polysaccharides (poly meaning “many”). We used to believe that the “simple” carbs were bad because they were so quickly digested and absorbed, and the “complex” ones (like, for example, pasta and bread and bagels) were “good” because they took longer to break dow n. Unfor tunately, that turned out to be wholly false. Many “complex” carbs (such as bread) break down so quickly in the bloo dstream that you mig ht as well be swallo wing table sugar. A nd conversely, many “simple” carbs (such as an apple) break down much more slowly and are loaded with nutrients and phytochemicals to boot. So
the old saw about “simple” carbs being ones to avoid and “complex” carbs being ones to consume turned out to be nonsense. Much more useful is to think about carbs in terms of whether they are “slow-bu rning” or “fast-burning”—in other wor ds, how quickly do the y raise your bloo d sugar, and how long do they keep it elevated? Enter the glycemic index. When scientists test a carbohydrate food to determine its glycemic index, pick aand fixed amount of carbohydrate—50 grams—and thenrate feed it they to people measure what happens to their blood sugar. They the results on a scale of 1 to 100, with 100 being the score for pure glucose (o r white bread). Foods test ed this way that scor e 70 or over are considered “high-GI foods,” foods that score between 56 and 69 are considered “medium-GI foo ds,” and foods that scor e 55 or under are considered “lo w-GI foods. ” Since the whole pr inciple of lo w- (or controll ed-) carb eat ing is based on the idea that you want to control your blood sugar, eating “low glycemic” makes a w hole lo t of sense. High bloo d sugar leads to high levels of the fat -storing hor mone, insulin, and low-glycemic (or low-carb) diets prevent that fro m happening Furthermo re, a l ot of resear ch has show n that low-GI d iets are r eally healthful. They help improve your body’s sensitivity to insulin (since your body produces less of it, the cells “listen” to it better); they improve diabetes control; they reduce the risk of heart disease; and they can also help people lose weight. What’s more, low-glycemic diets keep you full longer and help stave off hunger and cravings. And recent research has linked high-glycemic diet s to so me for ms o f cancer. So all in all, eatin g “low” on the glycemic scale makes a lot of sense. But the glycemic index has some problems. For one thing, the “rating” only applies to a food eaten alone. (Once you group foods together, the impact on yo ur blood sugar is very different.) Second of all —and maybe most important—the glycemic index number only tells you the effect of 50 gr ams of car bohydrate s, which doesn’t reflect real-wor ld por tions. For example, carr ots go t a bad rap for being so high o n the glycemic ind ex, but there’s only 3 grams of carbohydrate in a carrot, not 50. You’d have to eat a bushel of them to r eally raise yo ur blood sugar significant ly. And conversely, pasta—which has a “moderate” glycemic index—is rarely
eaten in 50-gram portions. You’re more likely to consume about 200 gr ams, which will send your blood sug ar o ff the charts. To co mpensate for this, scientists invented the “glycemic lo ad,” which is a far mor e accurate mea sure of a fo od’s “real-life” effec t on your bloo d sugar because it takes portion size into account. For example, carrots have a glycemic index of 92 (high!) but once you take into account the t ypical por tion size and figure o ut their g lycemic load, it ’s very lo w (under 10). Foods glycemic loads are between 0 and 10 are considered low, 10–20 whose medium, and over 20 high. Jennie Brand-Miller, the author of The Low GI Diet Revolution, is the research scientist who’s done the most to popularize the glycemic index and to bring it into the popular lexicon. She’s published a ton of research on the glycemic index, and her tables of glycemic index (and glycemic load) for hundreds upon hu ndreds of car bohydrate foo ds are wide ly consider ed the industry standard. (You can f ind the glycemi c index and glycemic load for just about any food that has been tested at http://www.mendosa.com/gilists.htm.) The Low GI Diet Revolution is Brand-Miller’s entry into the diet book world, and it’s her attempt to br ing l ow-GI eating to the masses. Except for a few misst eps, it’s a pr etty goo d pro gr am. First the missteps. She repeats a number o f myths about low-car b diets (much of the weight loss i s muscle mass, no t body fat; saturated fat c auses heart disease; the brain can only use glucose as a source of fuel). She also doesn’t do much to addr ess the fact that the glycemic load is a much better indicator than the gl ycemic index. But given the enor mity of her contribution to the conversation about carbs, insulin, and health, let’s overl oo k those mistakes for the moment and focus on what ’s goo d about this progr am. The Low GI Diet Revolution uses a novel approach to determining what you should eat. First you look at a table for your weight and determine what your “energy level” is. (By “energy,” the authors are not talking about “get up and go,” they’re talking about “calories,” which is the technically cor rect use of “energy” in nutrition. ) So, fo r example, women who weigh less than 154 pounds have an “energy” l evel of “1,” those who weigh 155 to 176 are “2,” 177 to 198 are “3,” and so forth. (There is a similar table for men.)
Once you know your “energy” number, you simply go down to the gr aph and loo k at the number o f ser vings of pro tein, carbs, an d fat you should consume. Each “energy level” (fr om 1 to 10) has a r ecommende d number o f servings fr om each of thes e three gr oups. For example, if you’re a woman who weighs 175, you look on the chart and see that your “energy r ating” is 2; for an energ y rating of 2, your r ecommende d daily intake would be 4 servings o f carbo hydrate-rich fo ods, 4 servings o f proAtein-rich foo ds, andser 2 servings f fat-rich foods.20 to 30 gr ams of carbs carbohydrate-rich ving is oone that contains (like gr ains and st arches). A pro tein-ri ch serving co ntains 10 to 15 gr ams of protein, and a fat-rich food contains 10 grams of fat. In addition, everyone eats at least 5 servings of vegetables (which tend to be very low in actual gr ams of carbs) and 2 servings of fruit each day . The author s consider this prog ram to be a very go od “compr omise” bet ween a lowcarb and a low-fat pro gr am. Once you know the carb, protein, and fat content of food—not hard to learn fr om r eading labels, us ing calor ie books, or checking online—it ’s pretty easy to follow.
The askaElsew Lifestyle: It WLow orks GI for,Diet WhoRevolution Should Loo hereWho Overall this is a good program. By limiting your “carb-rich” foods, you will automatically be reducing the high-ticket items like starches but will still be able to eat some of them, a big plus for people who don’t do well on—or don’t need—a very carb-restricted diet. The 5 servings of vegetables and 2 of fruit will make sure you get all the valuable nutrients and phytochemicals contained in the plant kingdom (though I’d argue that you co uld eat even mor e vegetables than that), and if yo u pretty much stick to the recommendations your calories will be moderately—but not painfully—low. However, if you ar e insulin-resistant , very car b-sensitive, or very overweight, y ou muc mormore e carbprr otein estriction this pro am pro vides, and youmay mayneed want or hneed or fatthan in your dietgrthan the amount recommended by the authors.
It’s also worth noting that this isn’t so much a weight-loss program as it is a g eneral g uide to eating. Those who have a lot of weight to lo se may need a bit mor e fine-tuning than the general guidelines of this pro gr am provide and may want to look elsewhere.
JONNY’S LOW DOWN The Low GI Diet Revolution is not really a weight-loss program per se—it’s much more of a general eating plan based on the principles of lowglycemic eating. For the average person willing to make the effort to learn the protein, carb, and fat content of their food, it’s a good program from which you will undoubtedly see some health benefits like appetite control and better energy. It’s a very good starting place for weight loss, but be repared to fi ne-tune the program a lot i f your main goal is t o lose weight . Four stars simply because the idea of low-GI eating is such a good one.
16. T HE LIN DORA PROGRA M: LEA N FOR LIFE CYNTHIA STAMPER G RAFF
WHAT IT IS IN A NUT SHELL six-week holistic weight-loss program with a big emphasis on self-help, motivation, behavioral remo deling, and journaling. The first four weeks are for weight loss (calories and carbs are limited); the next two weeks are a eriod of “metabolic adjustment.” You repeat the cycle until you reach our goal weight. After that, you go on the maintenance (“Lindora for Life”) program.
About the Lindora Program The Lindora program was started in 1971 by Dr. Marshall Stamper. The plan as detailed in the book Lean for Life is basically a do-it-yourself
version of the program offered in the 29 Lindora Medical Clinics in southern California. It’s a very structured program with a tremendous selfhelp component. The emphasis is on re-training behaviors and on reconditioning how you think about food, weight, and goals in general. That’s really th e strong point of the p ro gr am. The diet part is as follows: days 1 through 3 are “prep days.” The diet on the prep days loo ks like something you mig ht find in virtua lly any woman’s magazine at theasupermar ket. Sample ainstructio “Yourstarch, meals should include a protein, salad w ith dressing, potat o orn:other vegetables, fresh fruit, and milk.” The plan does, however, emphasize pro tein-based snacks like cheese, nuts, an d seeds. The idea is to use the prep period to gradually transition into the weight-loss diet that’s coming up for the next 28 days. During the prep days, you can also have “cravingbased foods” like pizza, an d you’r e encouraged to use this perio d to satisfy any nagging cravings yo u may have befor e jumping into the diet proper. During these 3 days, you also gather the stuff you’re going to need for the next 4 weeks: ketone strips, a food scale, measuring cups, a weight scale, and so o n. You als o weig h and measure yo urself and wri te down the results, and you do some mind–body visualization exercises. After the initial pr ep days, it’s time to star t the 4-week weight-loss phase of the cycle. You begin with a “protein day.” Actually, the first day of every week is a pr otein day, even in the maintenan ce phase. On the pro tein day, you have at least six protein servings and keep your carb intake in the range of 50 to 100 grams, or whatever it takes to get into ketosis (100 is most likely too high for the vast majority of people, and even 50 may be too high for some). You use the ketone sticks to monitor this. The “approved” protein choices are all pretty much low-fat selections (e.g., skim mil k, low-fat cottage cheese, fat-free co ld cuts, water-packed tuna). You can also choose fr om a millio n different Le an for Life products t hat the company sells, a nd/or pick fro m a list of accept able gr ocer y-stor e choices. After completing the initial protein day, you go on to the weight-loss plan fo r the rest of the week, then repeat that 7-day cycle for 4 weeks (1 pro tein day, 6 “weight-loss menu” days). The we ight-loss par t of the week means 3 meals and 3 protein snacks a day, but you are still aiming for both ketosis and the reduction of cravings (by cutting out foods that tend to
trigger them). The basic weight -loss menu consist s o f the follo wing: • pro tein 6 times a day (at all 3 meals plus 3 snacks) • 3 fruits a day (or 2 fruits and 1 gr ain) • 2 servings o f vegetables a day With this menu, you can have fat-free salad dressing, any calorie-free beverage (including diet sodas and t he like), pow dered cr eamer fo r your coffee, and vario us spices. After every 28-day weight-loss module, you go on to a 2-week “metabolic adjustment.” The purpose of this period is to gradually increase the amount of food you eat and let your body’s metabolism adjust to that increased amo unt without experiencing weight gai n. The stated purpose of the metabolic adjustment is not to lose weight, but to reset your body’s thermostat to deal with the additional calories. (There’s no science whatsoever to back this up.) The author reports that people resist this phase like crazy. Those who are losing want to keep losing and don’t want to change what’s working for them. Those who have arrived at their goal think they’ve cr ossed the fini sh line. But the Lindor a folks clai m that this period is absolutely necessary, because your body has learned, during the first 28 days, to live on a lower number of calories. What you want to do now is “teach” your body to adapt to more food without actually storing fat. During this 2-week metaboli c adjustment, the fir st day of each week is still a protein-only day, but it’s for focus, discipline, and of course weight control. You’re not in ketosis during this 14-day period. The food choices are the same as they were during the first 4 weeks, but the portions are different, and on day 8 you can add one more grain serving. Any time you have a weight gain of 1½ pounds or mor e, you have a pro tein-only meal that evening. You keep r epeating this until you’r e back on tar get, and you don’t move on to the next level of food addition until your weight is back on track. Once go you’re done, with however many 6-week it takes youfor to get to your al weight you’re ready for phase two,cycles the Maintenance Life pro gr am, which is a whole other bo ok. Basically, the pro gr am continu es
to stress low fat (what they call “lean foods”) and higher protein. The lifelong daily maintenance menu is this: • 6 pro tein serving s a day (one at each meal and each snack) • 2 vegetable servings a day • 3 gr ain servings a day (“don’t for get to choo se low-fat crackers,” t he book exclaims!) • 3 servings of fr uit a day • 3 servings o f fat a day The pro gr am tries to be all things to all people—it ma kes a valiant attempt at being both lo w-carb and poli tically cor rect, and tries not to offend anyone in the dietary pantheon. According to the book, during the weight-loss phase, you fol low a “lo w-calor ie, low-carbohydrate, low-fat , moderate-protein-structured eating plan.” The book has a section on “nine easy ways to r educe your fat intake” that could have been lif ted fro m the pages of any popular magazine of the ’80s. In truth, the entire sensibility of the book is that of a standard lo w-fat diet but with elevated pro tein intake. (All o f the acceptable pr otein choi ces ar e low-fat.) Interestingly, on the list o f “avoids” is hydrog enated fats “such as coffee cr eamers” (evidently they forgot that coffee creamers were on the allowed list a few pages earlier). Naturally, there is complete adherence to the politically correct mandate against animal fats of any kind. There’s some very oldfashioned ad vice (suc h as limiting egg s if your choleste ro l is hig h), and the list of approved cereals includes glycemic nightmares like cor n flakes and Special K. Of course, there is not a word about aspartame or the controver sy aro und artificial swe eteners. At the same time, the pro gr am is edg y enoug h to take a stand on the subject of ketosis, which the program makes good use of. The author argues that people who experience the benign ketosis of the weight-loss por tion of the prog ram lose weight mor e quickly than they would on traditional diets (undoubtedly true), which in turn increases their motivation to stick with the program until they achieve their goal (sure
makes sense to me). Participants experience r educed hunger and fewer cravings, a very co mmon effect on ket og enic diets. The book o ffers a shor t but accurate couple o f par agr aphs on why ke tosis is perfectly safe, then lists the three situations in which one would no t use a ketog enic diet (for a full explanat ion o f ketosis, see chapter 6). The Lindora folks recommend vitamin and mineral supplements (they sell their own, which is no surprise), essential fatty acids, potassium, and calcium—though are behind theting curve on thisl ike one,magnesium, failing to mention the importhey tance ofway bone-suppor minerals manganese, and boron and vitamins like vitamin D, not to mention weight training! Their reco mmendations on exercise ar e limited t o walking. Most exerci se specialis ts now feel that weight loss will not be achieved with walking alo ne, and nearly all reco mmend weight training as part o f any program. Weight training is not discussed at all in this book. The best part of the L indor a pro gr am is not the eating plan. It’s what the book has to say about motivation, behavior modification, and self-help. Jour naling is essent ial to the L indor a pro gr am. Your jour nal is your “daily action plan.” E very day there i s a specific “mind–body” item that you focus o n: it could be “r ecognizing rationalization,” “t he self-sabot age shuffle,” “turning obstacles into opportunities,” “values and vision,” “visualizations,” “affirming the positive,” or any of a few dozen other such exercises, all of which are noted in your daily action plan. The book is filled with pithy little sayings—most of them are pretty good, actually— some by Stamper (“The most impor tant wor ds you’ll ever hear are the ones you tell yourself”), some by Norman Vincent Peale (“Change your thoughts and you change your world”), and some that seem to be lifted directly fro m the reject pile of new-age gr eeting car ds (“Regr et is an appalling waste of energ y; you can’t bu ild on it; it’s only g oo d for wallowing in”). Early o n, the book l ists what the Lindor a pro gr am considers the “six essentials for success.” These include be ing clear that your g oal i s to be lean for life (not just for the duration of the diet), and learning to reco gnize and elimina te your defensive barr iers. Examples of bar riers ar e denial and r ationalizatio n, such as “One little bit w on’t kill me,” “I deserve this—I’ve been good all day,” or my personal favorite, “I don’t need to
write down what I eat—I have a great memory.” There is a lot of wor k on learning to manage an d control cr avings. Lindor a considers three main causes of cravings: physical, which includes insulin resistanc e and low sero tonin levels as w ell as lack of exercise; sychological , about self-image; and environmental, meaning conditioned responses to trigg ers such as even ts, people, places, an d emotions (an example o f an enviro nmental trig ger and its associated e ating behavior : movies andalso p opcor n). on relaxation techniques and the reduction of Lindora focuses stress, pointing out that people who have difficulty managing stress have difficult y losing weight, and if t hey do lo se, they regain. The pro gr am suggests tools to help individuals stop using food to self-medicate and manage stress. Finally, there are “success strate gies” fo r maintaining lifelo ng r esults: maintain a support system, continue exercising, maintain your daily action plan jour nal, weigh your self every mo rning, eat th ree meals a day , do o ne protein day a week (to maintain a sense of awareness and control over your eating and to help curb the appe tite), drink 80 ounces of calor ie-free liquid daily, take vitamins, and do mental training exercises.
The Lindora Program as a Lifesty le : Who I t Works f or, Who Shoul d Look Elsew here This is a program for people who really can commit to the whole selfhelp aspect of weight control. You can’t just do the diet part of it and be successful. The program requires journaling, homework, and a lot of mindful, thoughtful activity . Ther e is a ton o f suppor t available on the Web site; and if you live in southern California, the company encourages you to come to the Lindora centers on a regular basis. Lindora also sells a truckload of products and foods as part of the overall program. If this speaks to you, great. If it turns you off, look elsewhere. The diet itself is not for extremely carbohydrate-sen sitive people.
JONNY’S LOW DOWN
The strength of this plan is clearly in its holistic approach and its motivational “we’re all in this together” spirit. I’ve always been a fan o incorporating ways to increase consciousness about food into a program, and the program can’t be faulted for its emphasis on self-esteem, new habits, goal-setting, and the mind– body connection. And because it takes such an aggressive approach to raising consciousness, I can easil y see how it would be effective at re-training people to be aware of what they are eating and to bewith thoughtful and mindful about whether their eating habits are compatible their goals of permanent weight management. So far, so good. I’m not such a fan when it comes to the actual diet. You could certainly argue that it i s realistic and allows a lot of st uff t hat other, sterner taskmasters banish, which m akes it palat able for a l ot of people. Maybe. But for me, it’s a fail ed attempt to fi nd the polit ical middle ground, to satisfy the low-fat contingent, satisfy the low-calorie contingent, and, oh es, throw some more protein into the mix. The emphasis on protein is a step in the ri ght direction, but everything else about Lindora is very conventional and conservative. There ar e also f ar too f ew vegetables and way too many grains (in t he maintenance program) for my liki ng. I think this program has a place for people who want to really surrender to making the program a priority i n their li fe for as l ong as it takes to get the job done; it will be very good for people who respond well to the sel fhelp and psychological aspects. From a food point of view, there are many better diet systems and there are certainly a lot more sophisticated writers than Cynthia Stamper Graff when it comes to talking about f ood, hormones, and weight.
17. THE MA KER’S D IET A N D PERFECT WEIGHT JORDAN S. RUBIN
WHAT IT IS IN A NUT SHELL
biblical approach to eating and weight loss. The eating program is excellent, but the religious componen t is pretty heavy-handed.
About the Maker’s Diet and Perfect Weight Jordan S. Rubin—the author of both The Maker’s Diet and Perfect Weight merica— bills himself as “America’s Biblical Health Coach. ” If that puts you off, these books are probably not for you. Full disclosure: it’s difficult to separate the nutritional information in these two volumes fro m the heavy overlay o f faith and religi on in which they’re packaged. Reviewing this diet was a challeng e because—I admit it—I had som e strong prejudices about author Jor dan Rubin going into it. For one thing, I prefer some separation of church and state when it comes to diet (we’ll get into this mo re in a bit). For another, he runs a multimillion-doll ar supplement company (Garden of Life) and also manufactures a variety of healthrelated products , many of which are liberally recommende d in his programs. Truth be told, he has always st ruck me as a kind of slick mar keter, a kind of Kevin Trudeau in spiritual clothing. So, full disclosure—I didn’t want to like these books. But I did. Surprisingly—at least to me—Rubin comes pretty darn close to getting most everything right when it comes to food. And he won me over when he started taking o n the sacred co ws of the health establishment and t he diet “dictocr ats.” Here’s a sample o f what he says ear ly on: • I am in favor o f eating beef, lamb, and other “healthy” red meats. • You should spend time in dir ect sunlig ht. • Make sure you take your childr en out to play in the dirt. • You will be healthier if yo u consume saturated fat every day. That go t my attention. If you’ve read th is far in the boo k, you’re pr obably not surpri sed by the advocacy of healthy meat (meaning grass-fed, free-range, and the like).
But you might find the items on sunlight and dirt to be surprising. Actually, they make per fect sense and ar e in keeping with the wh ole sensibility of the books. Maverick health practitioners have long thought that we’re way too sun-phobic, particularly in the light of what looks to be a pretty endemic level of vitamin D deficiency in this co untry. And our obsession with avoiding germs (anti-bacterial soaps and the like) may be partly responsible fo r our less-than-robust immune syst ems which w e protect anyaschallenge that mig could them So me, theseanyway, “myth busters”from ar en’t nutty as they ht make seem at facestronger. value. For these reco mmendations were a br eath of fresh air. Rubin spends a lot of time in this book going into some of the myths about diet and health. Here’s a tiny sample of the myths he do esn’t buy into: • Vitamin B12 can be obtained fro m plant sour ces (nope, sor ry). • Meat-eating causes osteopor osis (nope, sor ry). • Our needs for vitamin D can be met by sunlig ht (nope, sor ry). Rubin’s philosophy about food and eating very much shows his debt to, and respect for, the Weston A. Price Foundation, a wor d about which would be in order. The foundation is named after nutrition pioneer Weston Pri ce (and is actually a nonpr ofit, tax-exempt charity founded in 1999 t o dissemina te his resear ch and nutritional philosophy). P ri ce wrote o ne of the seminal texts in nutri tion, Nutrition and Physical Degeneration. It’s a text that many of us who l ean toward lo w-carb eating str ategies cut our academic teeth on. Price was a dentist who was fascinated with the fact that cavities and tooth decay seemed to be so rampant in industrialized nations and so curiously absent in native, indigenous populations that were isolated from big cities. In the late 1930s, he did a ser ies o f fiel d studies o n hunter– gatherer societies, painstakingly chronicling their diets and lifestyles. He compared these native people who lived in comparative isolation to people from the same tribe and with similar genetics who had moved to the big cities dietus tophotogr their new surroundings in industrialized areas. and Andadapted he took their numero aphs. Price studied 15 societies, ranging from the New Zealand Maori to
Peruvian Indians, from Eskimos to the coastal Indians of Ecuador. The pictures tell the story better than any summary of the 500-plus-page textboo k, which has been repr inted in at least seven edit ions. In virtually every case, hun ter–gath erer people eat ing their native diet had gor geo us teeth and r obust healthy skin, and they exuded goo d health. Their “cousins” in the big city were a mess—broken and missing teeth, misshapen jaws, bad skin, and scraggly hair. While the 15 hunter–gatherer societies studied varied got widely in what they ate (the isolated Swiss mountaineers, for example, a large percentage o f calor ies fr om fr esh cream! ), they all had one t hing in common—none ate processed foo ds. The take-home message of the boo k —one that infor ms the Weston Pr ice Foundation and, by implicatio n, Jordan Rubin—is that native foods, relatively unprocessed, as they occur in nature, ar e the corner stone to go od health . These hun ter–gatherer folks didn’t eat “low-fat” diets. They didn’t avoid meat or cream or fat. They ust ate the foo d that was aro und them, as lo ng as it could be hunted, fished, gathered, or plucked. The Weston Price Foundation publishes a quarterly journal— Wise Traditions in Food, Farming, and the Healing Arts—that’s dedicated to exploring the scientific validation of dietary, agricultural, and medical traditions around the world. Its president and guiding force is the respected nutritional educator Sally Fallon, whose own book— Nourishing Traditions: The Cookbook that Challenges Polit ically Correct Nutrit ion and the Diet Dictocrats —is a classic. The title of that book says it all and explains volumes about the tradition from which Jordan Rubin comes: it’s not a dietary strategy that fears traditional foods or the things found in them. Meat, fat, cr eam, butter, vegetables, fr uits, nuts, ber ries—all on the menu. Foods with bar codes—not so much. Rubin has studied and absorbed this tradition well, and there’s more in this boo k to reco mmend than there is to cr itique. This pr og ram is completely focused on whole, real foods and is pretty much in line with the pr ecepts o f lo w-carb, lo w-sugar eating. I mentioned earlier that the book comes with a heavy overlay of reli gio n. This is no minor point. Everything about t his pro gr am has reli gio us over tones; eve n when the nutri tional infor mation is sound, it
always comes cloaked in Biblical dogma. For example: I’m not a big fan of eating po rk, because pigs are highly intelligent social animals and I can’t abide the unspeakably cruel conditions under which they’re raised in factory farms, even though their meat can be perfectly healthful to eat. Rubin’s not a fan of por k because the Bible says “Do not eat swine. These are unclean animals” (Lev. 11:7–8). Rubin and I reach simil ar conclusi ons, but for vastly different reaso ns. Even the non-nutritional of thetant program always justified Biblical scr ipture. Take rest,parts an impor part ofare any wellness pro grby am. Here’s how it’s presented by Rubin: “Our Cr eator has pro vided us with detailed inst ructions and sch edules for preser ving our own personal perfor mance. The Father kno ws best—we all need a Sabbat h rest.” And that’s just a mild example. The Bible is quoted a lo t, and many dietary rules co me not fro m science or even from a nutritional philosophy , but fro m “r evealed word,” and th at might be a problem fo r some people. F ull disclosure (i n case I wasn’t clear befor e): it’s definitely a pr oblem fo r me. The other negative in the book goes back to the whole marketing of the Jor dan Rubin empire, a multimillio n-dollar company that involves supplements, online membership sites, books, and retreats. Specific vitamins (made by his company) are recommended and part of the diet, as are special clean ing pro ducts (like Clenzolog y) made by his company . There’s a strong emphasis on “natural hygiene,” a movement that began back aro und 1850 and continued into the d ays of the eccentric J ohn Harvey Kellogg, founder of the Battle Creek Sanatorium (and yup, the founder of Kellog g’s cereals). To get a r eal feel for the Maker ’s Diet prog ram, check out the beginning of a typical day:
Morning Hygiene and Tune-Up Clenzolo gy Compr ehensive cleaning syst em fo r face and han ds (note: Clenzology is a product made by Rubin’s company) Morning Prayer Mor Exercise Mor ning ning Music Therapy
Breakfast Tomato-Basil Omelette 2–3 Living Multi Vitamins (Living Multi is made by Rubin’s company) Great meals, great food, plus mor e prayer, na tural hygi ene ritua ls, mor e exerci se, you g et the idea. The schedule would be what y ou might expect to find at a ChrWeight istian rAmerica” etreat. (Not there’s wro ng withy that.) “Perfect is that “T he Makeranything ’s Diet” specificall applied to the pro blem o f weight. It’s based o n the idea that everyo ne has a per fect weight, and that that is different for each person. “God created everyone differently, and our bodies change shape as we grow older,” he says on the Perfect Weight America Web site. “I don’t think anyone can tell you what your perfect weight should be.” Fair enough. There’s a fitness component to the program with the acronym FIT, which stands for Functional Interval Tr aining . It’s functional training because you train movements rather than muscles. Interval training alternates short peri ods o f hig h-intensity exercise (intervals) with “active r est” o r low-intensity r ecovery times—it ’s g enerally a ver y effective way to wor k out. Jor dan has a ser ies of shor t exercise videos on hisPerfect Per fectWeight WeightAmerica Americaisn’t Weba site g iveatyou sense o fa what’s in storate. bad to book all. aHe takes few swipes Atkins, but they’re not mean-spirited or ill-informed like many other books. For the most part, the eating program is spot-on and pretty much what you’d expe ct from the author of The Maker ’s Diet : low sugar, vanishingly low amounts of processed foods, and plenty of meat, fish, vegetables, fiber, fr uit, and nuts. Ther e’s no way you could g o wr ong with that. I particularl y like his sect ion o n Nutritional Typin g and his recog nition that differ ent people will fare differ ently on differ ent pro por tions of car bs, protein, and fat (but that no one far es well o n high-sugar foo ds). And his list of the most healing foods on the planet closely parallels much of what I’ve written since The 150 Healthiest Foods on Earth . The nutri tional infor mation in The Maker ’s Diet (and in Perfect Weight) trumps the garbage pseudoscience in The 5-Factor Diet or The 3-Hour Diet any day of the week. Rubin knows his stuff. He debt to the Weston
Price Foundation is in evidence everywhere (and that’s a good thing!). He’s a fan o f grass-fed beef, isn’t afr aid of saturated fat, doesn’t think the sun ri ses and sets on so y. Not being a bo rn-agai n Christian, I just h ave trouble with the rest of it.
Maker’s Diet and Perfect Weight as a Lifestyle: Who It Wo rk s for, Who Should Look Elsew here
If you’re a fan of nutritional or Metabolic Typing®, you’ll know what I mean when I say the eating portion of this book is well suited to “Protein Types.” This is not a program for vegetarians. Those who thrive on higher-meat, higher-fat diets with plenty of vegetables will find a lot to their liking here. The program isn’t as structured as some of the other diets we’ve looked at, but is rather a general lifestyle built around whole, traditional foo ds. The r eligio us overtones—and I ’m putting it mildly—w ill turn o ff a lo t of people. I personally found the relig ious do gma har d to take an d offputting. If yo u’re not o kay with statements like “Always obser ve Go d’s dietary laws” o r “Eat any fish with fins and scales but avoid f ish o r water creatures without them” (Lev . 11:9–10), you’d better look elsewhere. I doubt that this bo ok will appeal to people who do n’t identify themselves as either religious Christians or evangelicals. It’s a shame, because most of what he has to say about food is pretty darn good.
JON N Y’S LOWDO WN (Impossible to Rate) Two off-the-beaten-tr ack books that should appeal t o the “homeschooling” crowd as well as those who are suspicious of conventional medicine and conventional secular society in general. Perfect Weight America is The Maker’s Diet applied to weight loss, and has a nice fitness component. The info on food and diet in both is not half bad, and is rooted in the great tradition of following a native diet of unprocessed whole foods, avoiding sugar and processed carbs, and not being fearful of full-fatted options (as long as they haven’t been processed to death). But the religious context is all but impossible to separate from the
dietary recommendations. If that doesn’t put you off, there’s a lot in these books to recommend them.
18. NEANDERTHIN RAY AUDETTE
WHAT IT IS IN A NUT SHELL The simplest of the low-carb diets to follow; also one of the most restrictive. You don’t have to follow any formulas, compute any protein or carb allowances, look up any food counts, or figure out calories. Here’s what you do.
Eat: • meats and fish • fruits, especially berr ies • vegetables • nuts and seeds
Do Not Eat: • grains • beans • potatoes • dairy (especially milk) • sugar
bout Neanderthin The book has three premises. 1. A natural diet is best. 2. Nature is defined as the absence of technolog y. 3. Until the advent of ag riculture, gr ains, beans, potatoes, milk, and refined sugar were no t part of the human diet. So do n’t eat them. Hence, no gr ains, bea ns, potatoes, milk, or refined sugar. Perio d. The main theme of Neanderthin is that the root cause of numerous diseases of civilizat ion (i ncluding o besity) is eating pro cessed foods. More specifically, you should not eat foods that are inedible in their natural state and can only be eaten because th ey’ve been pro cessed (chief among them: wheat, dair y, and sugar ). In the late 1970s, Ray Audette was suffer ing from rheumatoid ar thritis (a crippling, painful autoimmune disease), which sidetracked his career in computer s and threatened to destro y his health. Later, at the age of 34, he was diagno sed with diabetes. He decided not to take these l ife sentences sitting down. He resear ched everything he co uld about the diseases and came up with a few basic observations and one major conclusion, which led to his development of the Neanderthin diet, another spin on “stone-age nutrition.” Observation number one: rheumatoid arthritis and diabetes are diseases of the autoimmune system—diseases in which the immune system wrongfully i dentifies somet hing in its own body as for eign matter or an invader and pr oceeds to attack it. (He happens to be com pletely wro ng about diabetes—it is not an autoimmune disease—but follow the argument anyway.) Obser vation number two: these diseases o ccur only within agr icultural (o r civilized) communit ies. (The mor e recently a population became agricultural, the more likely it is to have diabetic members.) Many of the foods that came into wide use during the agricultural era (such as wheat) ag gr avate these co nditions. Audette lo oked at these two observations and made a decision: he would modify his own diet to emulate that of preagricultural (Paleolithic) peoples. He’d go “back to nature.”
He decided to eat like a hunter–g atherer. Obviously it worked, or he wouldn’t have written his book. His bloodsugar levels returned to nor mal almost immediate ly. He had mor e energ y. His joints stopped hur ting. He needed less sl eep. He literal ly became a new man. One who was on a mission. The Neanderthin diet is pretty simple and follows one basic dietary guidel onlyIt’s what youiation couldo eat if “eat yo u only werewhat naked onco theuld savanna with a ine: sharpeatstick. a var n the you hunt, fish, gathe r, or pluck” mantra. For bidden foo ds are those that require technological intervention to make them edible. The book starts with a quote from the book of Genesis: “Do not eat the fruit of the tree of knowledge that makes the good the evil.” Using the Greek translation of the phrase tree of knowledge and Hebrew translation of the words good and evil , he r estates the quote this way: “Do not eat the fruit o f the technolo gy that makes the inedible the edible.” The appeal of the diet is that it’s sim ple. Really si mple. You don’t co unt calor ies. You eat all you l ike fro m fo ur basic food g ro ups (meat/fish, nuts/ seeds, fr uits/berr ies, and vegetables). You do n’t reduce fat (except some saturated fats such as the skin o f chicken). And you do not cheat. (One reason: the forbidden categories of foods have the innate ability to create cravings fo r themselves.) This is not a diet for the squeamish or the warm and fuzzy. When Audette says “fo rbidden fr uits,” he means business. Audette sugg ests six steps to success in Paleo eating . 1. Make a commi tment. Resolve that for some predetermi ned amount of time (three weeks would be great), you will not eat any grains, beans, potatoes, milk, or refined sugar. P erio d. 2. Rid your ki tchen of the forbidden fruits: beans, gr ains, dair y products, potatoes, and sugar, as well as any products made from them. 3. Limit your car b intake. Frui ts and vegetables are fi ne, of co urse, but he suggests choosing those that have a low sugar content—pears, or anges, plums, an d berr ies, for example, r ather than bananas, mango es, and dates. And he sugg ests raw fr uits and vegetables over steamed, cooked, or canned ones.
4. Increase fat consumptio n, preferably from omeg a-3 fats, which are described in Audette’s book in detail (see also chapter 4 of this book). 5. Drink a ton of water—8 glasses a day minimum, prefer ably 2 to 3 liters. 6. Increase physical activity . A “Neander-fit” pro gr am is included, wit h an emphasis on building muscle (rathe r than burning calor ies) and working at conside rably less than full-out “n o pain, no gain” intensity. You also shouldn’t drink alcohol, although he says that if you must, you can do damage contro l by making it fr uit-based alcohol such as wine or champagne. Of the forbidden fruits—grains, beans, potatoes, dairy, and sugar— probably the least taboo are dairy products (not milk, though—just butter, yogurt, and cheese). Notice that all of these forbidden fruits are foods that require technological intervention to make them edible. When you find them in the wild in their o riginal state, none o f them can be eaten. (One could ar gue about t he inclusion of milk here, as so me hunter–gatherer s— notably the Masai in Africa—do drink the unprocessed milk of animals.) To cr itics who say that our physiolo gy is perfectly ab le to handle “modern” foods, Audette answers that just because our physiology can handle a small dose of something doesn’t mean it can deal with a large dose of the same thing without problems developing. For example, we have the enzymes needed to process alcohol in small amounts, but look what happens when we drink a l ot. Maybe the same i s true o f fo ods l ike wheat, dairy, sugar, and other processed foods that nutritionist Robert Crayhon cal ls “ubiquifo ods.” At one time, these fo ods wer en’t in the human diet at all; no w they have become so ubiquitous that they are the very basis of the modern diet. That’s way too big an adjustment for our stone-age genes. And our bodies respond with the diseases of modern civilization, including obesity. Audette comes down firmly on the side of the calorie debate that holds that weight gain i s not simply a m atter of quantity of calo ries, but instead a matter of quality : “It cannot be o veremphasized that it is not the ca lories or fat content that produces the weight gain, as has been traditionally proposed; instead, it is the alien proteins present in the forbidden fruits that
cause an overweight condition.” A vegetar ian diet, says Audette, is about as natural to humans as a di et of Cheerio s is to a lio n.
Neanderthin as a Lifes tyle: Who It Works for, Who Should Look Elsewhere This is a simple, take-no-pr isoner s approach. I t will wor k well if you don’t want a lot of rules or complicated calculations and don’t want to have to weigh or measure or figure out how much of anything you’re eating. People who want a really simple, black-and-white, “eat this but don’t eat this” plan and are willing to put up with a fairly restrictive diet will like this program. What you give up in order to gain that simplicity is flexibility. There’s almost no wiggle room on this diet, and if you’re not comfortable with that, this program is not for you. Also, remember that the focus of the book isn’t primarily on weight loss: it’s on health. Eating unlimited quantities of anything, even the best food on the planet, can stall or prevent weight loss. There’s no discussion of what to do if that happens, or how to mo dify the plan to account for calor ie intake. If you have a tremendous amo unt of weight to lo se, you may find that a more structured plan works better, at least at the beginning stages.
JONNY’S LOWDOWN The book is a little weak in making the connection between obesity and autoimmune diseases. Whi le i t’s true that many immune system diseases ( or “diseases of civilization”) don’t happen in hunter–gatherer societies when eople eat a “native” diet devoid of processed foods, and while it’s also true that you don’t see much obesity in these same societies, it doesn’t necessarily follow that obesity is an autoimmune disease (and, as mentioned earlier, diabetes certainly isn’t). Audette points out that both obesity and autoimmune diseases respond well to Paleolithic nutrition, but this doesn’t mean that they are the same thing—just that t hey have the same enemy. That said, this book is a real delight. It has a terrific history of dieting, a very accessible history of Paleolithic nutrition, a great discussion of the anthropology of nutrition, a very good bibliography, and a great FAQ
section. While it’s a pretty stri ct diet, i t’s also very easy to foll ow—it doesn’t require any complicated formulas or have phases, calculations, calorie-counting, or even portion control. There’s just one simple rule: if ou could eat this food with a stick or a rock naked on the savanna, it’s allowed. If you couldn’t, it’s forbidden. While some people may find that a retty extreme positi on to take, i t’s also a pretty easy one to understand. nd the health benefits are likely t o be considerable.
19. THE PALEO DIET LOREN CORDAIN , PHD
WHAT IT IS IN A NUT SHELL ll the lean meat, poultry, fish, and seafood you want, plus unlimited fruits and nonstarchy vegetables. No dairy, cereals, legumes, or processed foods.
About the Paleo Diet The Paleo Diet is perhaps the most sophisticated example of the “stoneage” or “caveman” type of diet book ( Neanderthin, page 201, is another example), and Dr. Loren Cordain is one of the best-known resear chers in the field o f what might be called “nut ritional ant hro polo gy” or “Paleolithic nutrition.” The general theory behind the Paleo Diet—and others like it—is this: • Being fat comes p rimaril y fro m eating a diet that is completely unsuit ed to our ancient genes and digestive system. • The human genus spent a couple of milli on years adapting t o and functioning on a diet entirely different than the one we eat today. • Our dig estive systems—identical to those of our caveman ancest or s— are simply unsuited for the staples of today’s diet: dairy, refined sugar,
fatty meat, and processed food. • By returning to the diet that humans lived on for the vast majo rity of their time on earth, w e can corr ect a gr eat many of the problems in human health, including but not limi ted to obesity. The argument for this position is pretty strong. DNA evidence shows that genetically, humans have hardly chang ed in the 2.5 mill ion years the genus has been o n the planet. The human g enome has changed less than 0.02 percent (one f iftieth of 1 per cent) in for ty thousand year s. Most o f the diseases of modern civilization—cancer, obesity, diabetes, and heart disease—have happened at t he same time that we’ve experienced a sea change in our diet, and the modern diet is completely different from the one human s have lived on fo r the over whelming bulk of o ur time on the planet. Through fossil records and research on contemporary hunter–gatherer societies, we have a pretty good idea of what Paleolithic peoples ate—and it didn’t look like anything you’d find at Burger King. Consider the diet of o ur Paleo ancest or s, before the invention o f modern foods: they ate no dairy (how easy would it be to milk a wild animal?) and n o cereal g rains; they didn’t salt their foo d; the only sweetener they used was hodominated ney, whichtheir theydiet ate r(so arely (when they could find it); wild-animal foods protein intake was high and carb intake was low); and since all carbs came from wild fruits and nonstarchy vegetables, fiber was very high. Beginning to get the picture? On the other hand, the av erage Amer ican diet contains: • 31% calor ies from cereals • 14% calories fro m dairy • 8% calor ies fro m beverag es, especially sodas a nd fruit juices • 4% calor ies from o ils and dressings, esp ecially pro cessed oils and omega-6’s • 4% calories fro m sweets like candy, coo kies, and cake That means 61% of calor ies in the modern diet c ome fr om fo ods that
were larg ely unknown befor e the adoption o f agr iculture (a dr op in the time bucket, as far as evolution is concerned), and most of them weren’t even available unt il a co uple of hundred years ag o, when food pr ocessing became the norm. The remaining 39% of our calor ies come fro m animal foods, bu t ones that are very different fro m those of our caveman ancestors. The animal foo ds the average American is likely to consume are mo stly hot dogs, fatty ground and highly meats. at in this way,beef, is it bacon, any wonder ther e processed are studiesdeli linking “m(When eat” looked consumption in industrial societies to a number of health issues? Maybe meat as a catego ry has go tten a bum r ap, and it’s the kind of meats we eat that’s the problem!) Cordain claims that a return to the diet of our ancestors—what has been described elsewhere as eating what you could hunt, fish, gather, grow, or pluck—is the answer not only to obesi ty and over weight, but to a multitude of other health problems. Though it seems like he stresses protein as the most impor tant compo nent in the diet, in actuality he makes it clear that protein alone —without fat or the alkalizing influence of tons of vegetables and fruits—is a big problem. Add those and the problem disappears: “There is no such thing as too much pro tein as long as you are eating plenty of fr esh fr uits and vegetables,” C or dain says. And he is pr etty flexible about the possible balance among them, pointing out that some hunter–gatherer soci eties that survived into the tw entieth century lived healthy lives free o f chro nic disease w hile gett ing 97% o f their calor ies fro m animal foo ds (the Inuit of Alaska), w hile others g ot the majori ty of their calories (65%) from plant foods (the !Kung of Africa). Most Paleo soci eties fall so mewhere between these two extr emes. No Paleo peoples, however, ate refined sugar. On the Paleo Diet , fully 50 % to 55% of your calor ies come fr om l ean meats, organ meats, poultry, fish, and seafood. The rest come from vegetables (except for starchy ones like potatoes and yams) and “healthy” fats (mo re about these in Jo nny’s Lowdown). It’s simpl e and easy. There i s no calor iecounting, no pr otein-gram co unting, no fat-gr am counting, and no carb-gram counting. By staying within these guidelines, Cordain claims you will:
• have built-in protection against over eating, because protein (and fiber ) naturally feels mor e satiating • enjoy the incr eased metabolic activity (and incr eased calor iebur ning) that protein provides (see chapter 2 fo r studies that show this) • control insulin an d reduce insu lin r esistance, making weight loss a breeze The Paleo Diet itself allows “cheating.” There are three levels of commitment, with level one allowing you three “open” (read: cheat) meals a week, level two per mitting two such meal s, and level three o nly one. Many people not previously familiar with the material in chapter 2 of Living Low Carb will find Cor dain’s passionate argument against gr ains surpr ising, as we have b een so co nditioned to think of g rains, especially whole gr ains, as w onderful fo ods. Cor dain is particularly expert on this subject, having written the seminal paper “Cer eal Gr ains: Humanity’s Double-Edged Sword,” 6 and what he has to say o n the subject is wor th considering even if you don’t a dopt this particular dieta ry pr og ram.
The Problem with Grains Here’s the synopsis: the agricultural revolution began about ten thousand years ago in the Middle East. Dwindling food resources—especially wild game—and rising populations gave birth to the need for smarter, more efficient ways for people to support themselves and their families. Some enterprising people figured out how to sow and harvest wild wheat seeds. Then they tried bar ley. Then leg umes. Livestock—sheep, goats, and pigs— wasn’t far behind. Later, cattle. Domesticated farm animals were milkable. Over time, there was a complete change in the diet of mo st of humanity. Without the agricultural revolution, we would not have civilization as we know it. Our ability to farm—to domesticate animals for dairy products, to raise cattle, and especially to grow and cultivate grains—was responsible for allowing us to live in de nser conditions and e ncourag ed towns and cities to develo p. It allo wed us to beco me independent from o ur srcinal food source—hunted game. But this new lifestyle came with a price. Early farmers were shorter in stature than their for ebears had been. Examination o f their bones and teeth shows more infectious diseases and shorter lifespans. Egyptian mummies
frequently reveal obese bodies. There were mo re cases of o steopor osis, rickets, and vitamin- and mineral-deficiency diseases, in large measure because of cereal-based diets (whole grains and legumes contain “antinutrients,” pyridoxi ne gluco sides and phytates, that respectively block absorption of B vitamins in the intestines and chemically bind iron, zinc, copper, and calcium and block their absorption). And the skulls of those living on modern foods revealed teeth filled with cavities and jaws that were shapen and too for the teeth (Dr. Weston Primany ce’s seminal 1939 mis book, Nutrition andsmall Physical Degeneration , contains pictures that dramatically illustrate this phenomenon). Then came fermentation and salting. Grains were fed to livestock, making them fatter but also changing the quality of their meat and their fat. (Interesting, isn’t it, that grains are the food of choice for fattening livestock and yet are still recomm ended by the dietary establishment as th e foundation fo od o f a weight-loss pro gr am!) Meat was preser ved by pickling, salting, and smoking. Two hundred years ago, things got even worse. We now had ways to refine sugar and flour and to can foods, almost always with the addition or creation of trans-fats, sugar, refined oils high in omeg a-6’s, and high-fr uctose cor n syrup, not t o mention additives, preservatives, emulsifiers, and other toxins. As Cor dain says, imag ine Paleo m an with a Twinkie o r a pizza. He wouldn’t even recognize them as food. Cordain is one of the few writers to talk about something called the acid–base balance, a very hot subject in nutritio n these days. Brief ly, it go es like this: everything r epor ts to the kidne ys as eith er an acid or an alkaline (base). When t here i s too much acid, the body needs to neutrali ze it with alkaline s ubstances like cal cium. Meats are o ne of the top five acidpro ducing foo ds; but the other fo ur—gr ains, legumes, c heese, and salt— were rar ely or never eaten by our Paleo ancest or s, who buffered the a cid load of their meat with plenty of fruits and vegetables. The main “buffering” compound in the body is calcium, and the main storehouse for calcium is the bones; th is is how high-pro tein diets g ot their (false) reputation for causing bo ne loss. Cor dain corr ectly points out t hat loss o f calcium does not happen when there are plenty of fruits and vegetables in the diet, and especially when other acid-producing foods (like cereal gr ains and da ir y) are absent.
The Paleo Diet as a Lifestyle: Who It Works for, Who Should Look Elsewhere The straightforward simplicity of the Paleo Diet—all you want of these foods, none at all of those —makes it pretty easy to follow and a go od choice for those who are put off by counting grams, calories, and carbohydrates, figuring out protein allowances, or computing food blocks. But that same lack of rigidity makes it a poor choice for those who need more structure. And although it restricts nearly all of the usual pro blem foo ds for carbohydrate add icts, the unlimit ed fruit could easily be a problem for those who are insulin-resistant. In addition, since it is not primarily a weight-loss diet, it may be frustrating for those whose main focus for the immediat e future is o n losing fat.
JON N Y’S LOWDOWN
½
The Paleo Diet is a frustrating program to rate. On one hand, you have to give tremendous credit to a no-grain diet that eliminates sugar, dairy, and transfats and recommends tons of vegetables. How bad can that be? Most eople—especially those who eat the typical American diet—are going to reap such enormous benefits from this program that I want to give it five stars just for that alone. On the other hand, t here ar e some majo r pro blems. For one thing, Cordain completely buys into the cholesterol–heart disease hypothesis; I believe that this hypothesis, in its curr ent for m, is less than a decade away from being dumped on the pile of scientific flotsam and jetsam. He also accepts the dogm a that all satur ated fats are bad, larg ely because they raise cholesterol (some do; many don’t; and ultimately it may not matter much). Cordain put s egg s on the “av oid” list for their choleste ro l content (something we now know is completely irrelevant, since dietary cholesterol has vir tually no impact on serum cholesterol) and warns agai nst such natural tr aditional fats as butt er and cream, which he puts in the same category as such trans-fat nightmares as nonfat dairy creamer and frozen yog urt. He recommends can ola o il (I don’t agree; see pages 63 and 64). He puts sweet potatoes—a “g oo d” starch by almo st anyone’s standards—in the same class as fr ench fr ies and tapioca pudding. H e
makes the somewhat pro blematic statement that “frui t won’t make yo u fat on this diet even in unlimited amounts. ” And he compl etely misr epresents other lo w-carb diets, say ing that they call for complete restriction of all carbohydr ates to “between 30 and 100 gr ams a day,” which, though basically true, does not mean—as Cordain says it does—that “fruits and vegetables are largely off-limits.” In fact, this statement is not only demonstrably false but inconsistent; 100 grams of usable carbs a day buys you an awful lot ofa br occoli That said, he’s good guy!and a sincere and responsible scholar, and his overall r ecommenda tions will pr opel a perso n eating the average American diet light-years ahead in his quest for good health. Done with care, Cordain’s diet may also make you lose weight.
20. PROTEIN POWER MICHAEL R. EADES, MD AND MARY DAN EADES, MD
WHAT IT IS IN A NUT SHELL three-phase plan in which you: • Eat no less than a minimum calculated amount of pr otein per day (you are fr ee to eat mor e but not less) • Eat no mo re than a maximum amoun t of carbohydrates pe r day (you ar e free to eat less bu t not mor e) The maximum amount of carbohydrates depends on which phase of the diet you are in. Phase one is intervention and allows up to 30 grams of carbohydrate a day; phase two is transition and allows up to 55 grams; phase three is the maintenanc e phase, and the amount of car bs will var y according to the individu al.
A bout Protein Power
In the Eades plan, you first determine your protein needs through an easyto-follo w series of steps: 1. Measur e your wri st, then your waist. 2. Refer to a chart to estimate your body fat from these measurements. 3. Now you calculate your total number of fat pounds. For example, if you’r e 200 pounds with 20% body fat, you would have 40 fat pounds. 4. Subtract thelean number o f fat pounds om yo ur bone, total weight get the number of body-weight poundsfr(muscle, and thetolike). Using the above example, you would subtract 40 pounds from 200 and wind up with a lean bo dy weight of 160 po unds. 5. Multiply your l ean body weight by an “activity factor ” to get your minimum daily pro tein needs (in gr ams). The activit y factor rang es from 0.5 for someone who is completely sed entary to 0.9 for a competitive athlet e. For example, if the 200-pound g uy with 40 fat pounds and 160 lean pounds wer e sedentary, he’d multiply 160 by 0. 5 for a total of 80 gr ams of pro tein per day min imum. Knowing your lean body w eight also allo ws you to calculat e a r ealistic weight goal, which is done using the worksheets and very easy formulas. Note: In The Protein Power Lifeplan, the authors have simplif ied the process even more. You don’t even have to take your wrist or waist measurements, compute your lean body mass, or multiply by an activity factor. There’s a simple ta ble in whic h you lo ok fo r your height an d weight, and the table tells yo u immediately what your minimum pr otein requir ement is. It couldn’t be easier. I t’s not as r efined and accur ate as the method in the src inal Protein Power, but it will give you a decent estimate of yo ur mi nimum requirement an d is go od fo r people who just don’t w ant to do the calculations. (M y perso nal opi nion: the calculations ar e easy.) Once you know your minimum daily protein needs, you simply decide what phase of the diet you’re going to be on. Phase one, intervention, is for those who have a lot of fat t o l ose and/or who want to cor rect a health pro blem. In phase one, you ta ke in 30 gr ams or less of carbohydrate a day (in The Protein Power Lifeplan, this number is amended to 40) plus, of course, at least your minimum protein requirement. Phase two is the one to go with if you want to lose a little fat, recompose your body (i.e.,
change the ratio of fat to muscle or, as people often say, “tone up”), or improve your general health. In phase two, the maximum carb allowance is upped to 55 grams a day, in addition, of course, to the protein allowance determined above. You can eat more than your minimum pro tein requir ement but not less, and you can eat less than your maximum carb allotment but not more. The rest of the diet comes from fat. Nearly everyone will fall int o o ne of four catego ri es of minimum protein requirement—less grams day, between 60120 andgr80ams grams a day, between 80 and 100 g than rams60 a day, or abetween 100 and a day. You find the cat egor y you belong to and then refer to the corr esponding chart. The chart will tell yo u exactly what protein fo ods i n what amounts you can have per meal and snack . For example, if you’re in the 80-to-100gr am categor y, you should be gett ing about 34 gr ams of pr otein per meal. The char t shows you exactly how t o make any combination yo u can think of from meat, fish, poultry, eggs, hard cheeses, soft cheeses, curd cheeses, or tofu to g et the rig ht amount of pr otein per meal. Like nearly all the diet or lifestyle plans discussed in this book, Protein Power is all about controlling and balancing insulin. The Eadeses have a clever way of determining the actual insulin-raising (or active) carbohydrate content of foods. Even though fiber is not metabolically active, it’s technically co unted as a car bohydr ate on fo od labels and the like. But it doesn’t rai se insuli n at all, since i t’s not even dig ested. So the Eadeses have come up with a formula in which you subtract the fiber from the total car b content of a fo od to g et what they call the “effective carbohydrate content,” or ECC. That’s the only number you have to pay attention to when counting your carbohydrate gr ams. For example, 1 cup of fr esh raspberr ies has 14 gr ams of car bohydrate b ut 6 grams o f fiber, so you’d subt ract the 6 gr ams of fiber fr om the 14 gr ams of tota l carbohydrate t o g et a mere 8 gr ams of ECC, and only those 8 grams would count toward your carbohydrate allowanc e for the day. (This is now stan dard oper ating pr ocedure fo r most low-carb diets, some of which call the number “effective carbs,” some “net carbs.”) The book has charts of the EC C for a huge numb er of fo ods, so yo u don’t have to figure them out for yourself. You use these charts to put together your daily carbohydrate allowa nce (or, if a fo od is no t listed in
the chart, you can easily compute it yourself from the label’s listing of total carbs and total fiber). Counting only effective carbs, you could easily have 1 cup of br occoli , 1 cup of cabb age, 3 celery r ibs, 1 cup of g reen beans, 1 cup of lettuce, ½ cup of mushrooms, ½ cup of zucchini, 1 cup of spinach, and 1 cup of raspberries in one day on phase one. Even though the total carb content of these foo ds is about 44 gr ams, 16 of them are fiber ; subtracting the 16 from the 44 (all done for you in the charts) leaves you with 28 grams usable (effective) under cutoffonly for phase oneof and not even close tocarbohydrate, the cutoff forwell phase two.the Calories ar e barely ment ioned in Protein Power. The idea is that calor ies are self-r egulatin g i f you ar e eating the foods that put you in correct metabolic balance (an idea that runs throughout many low-carb diet plans). The Eadeses do war n you that since you m ay not be as hungr y on a lo w-carb plan as you were befor e, you can e asily under eat, so it’s important to be sure that your calories don’t fall below 850 to 1,000 a day. (The 850 figur e seems really, really lo w—nearly every o ther weight-loss expert, including myself, uses 1,000 t o 1,250 as the bare mini mum, and some even suggest not dropping below 1,250. If the food eaten produces a hor monally balan ced state and the calories ar e coming fr om g oo d stuff, most women will drop weight on 1,250 calories and most men on 1,500.) On the other hand, especially in The Protein Power Lifeplan, the authors explain that if you’re doing everything right (i.e., eating the minimum protein requirement and not exceeding the maximum carb allotment) and you’re still not losing weight, you might be c onsuming too many calor ies, especially calories from fat. Nuts seem to be a frequent culprit: since nuts are only fat and protein, many low-carbers munch on these with abandon because they have very little effect on insuli n. But while a 1-ounce por tion (which is pretty small!) may have only 160 calories and a few grams of carbs at most, t hree to fo ur po rtions can a dd an awful lot of calor ies (and carb g rams) to a diet plan an d could effect ively slow down or stop weight loss altogether. As with most low-carb plans, the message here is: though calories are not the whole story by a long shot, they still matter, so don’t ignore them. Phase three is the maintenance phase, w hich is what you stay on o nce you’ve reached y our go al. To get there, you add 1 0 gr ams of car bohydrate to your daily allotment in phase two, and stay there and stabilize for about
5 to 7 days. Then you add another 10 gr ams. You co ntinue in this way un til you find the amount of carbs you can take in and still keep your weight stable. The Eadeses have found that most people will stabilize when they’ve reached the point at which the number of carb grams equals the number of protein grams, but they discuss the exceptions to this general rule and tell you what to do if yo u don’t fit the template . The maint enance phase is pr etty cool. There is r eally no fo od you can’t have quantityput at it, some The trthat ickare is kno what you’r e doing.“in Assome the authors theretime.” are foods “sowing rich in sugars and starches, such potent unbalancers of your metabolic hormones, that you cannot have unlimited amounts of them any time you want unless you ar e willing to accept the consequences of that act ion.” They even have recovery guidelines for those times when you throw caution to the wind and have a “nutritio nal vacation,” such as on bir thdays, holi days, and the like. You simply return to phase one for three days (or until you have lost any of the weight you might have gained), move to phase two for the rest of the week, and then return to your maintenance level of carb consumption. The thing about The Protein Power Lifeplan, and to a les ser extent the srcinal book, is that it is about so much more than just a diet. There is absolutely fir st-rate information about cholesterol and the “cholest ero l hoax,” plus wonderful explanations of how insulin works in the body and its relationship to heart disease, high blood pressure, diabetes, and obesity. There is a terrific exposition on the Paleolithic Diet. And in Lifeplan, the authors go into even more detail on all of these topics, plus they include discussions of antioxidants, leaky gut syndrome and autoimmune responses, sugar, ir on o verlo ad, magnesiu m, brain health , and a furthe r expansion of the nutritional plan. Lifeplan also has a cool concept. It suggests three levels of “commitment” to health: the purist, the dilettante, and the hedonist. All of these approaches share the same requirements for protein, the same need for high-quality fat, the same prohibition on trans-fatty acids, and the same limitations o f carbo hydrate gr ams (depe nding on what p hase you’re in). (Even at the lowest level of co mmitment, the hedonist, you’r e still way better off than you would be following the standard American diet or, for that matter, the standard hi gh-car b, low-fat diet.) All o f the levels sho uld
theor etically gi ve the same weight -loss results. The differ ence is in o verall health benefits. The purist reg imen is r eally restrictive an d most resembles Ray Audette’s Neanderthin plan. Purists eat no cereal grains, or products made fro m them (à la The No-Grain Diet of Joseph Mercola). They eat no dairy or legumes (such as beans). They eat only or ganic fr uits and veget ables and only natural meat and poultry—no pro cessed foods, no sugar s (except occasionally ar tificial swineeteners, caffeine , and alco hol. It’s pro bably honey), the mostnohealthful diet the w orno ld to f ollow, butno also next to impossible for most folks. H owever, for people wit h serio us health issues, it may mean the diff erence between lif e and death. Next up is the dilettante. You aim for organic foods whenever possible but are not o bsessive about it. You still avoid so me gr ains (wheat, for example) but can eat other s (li ke oats and r ice). You eli minate highfructose corn syrup but can have some other sweeteners, even table sugar (in very limited amounts), and the prohibition against alcohol and caffeine is lifted. This is the program the Eadeses themselves follow. Finally, there i s the hedonist, where everything g oes, within the limi ts of your carbohydr ate allowance. You still have to keep to the b asic paramete rs of the pro gr am, but you can fulfill those r equirement s with just about any foods you wish. Obviously, the high-carb content of some foods, such as potatoes, may make it impossible to fit portions of those foods into the phase one plan, when carbs are limited to 7 to 10 grams per meal and snack. But once you’re on phase two or three, you can eat anything you want, as long as you don’t exceed the maximum number of carbs for the day.
Protein Powe r as a Lif estyl e: Who It W orks for, Who Sho uld Look El sewhere This is a g reat plan if you have a lot of weight to lose o r any of the he alth conditio ns discussed in the boo k. In its maintenance phase, it’s a g reat plan to follow, period. But you’ve got to be willing to do a little figuring. You can’t eyeball portions on the first two phases (which you can on the Zone
or on phase three of this plan). You’ve got to be exact about carb-gram content and about meeting your minimum protein needs. The calculations could put some folks off (although it’s a nonissue in Lifeplan). Having to check ECC for every foo d might be a pain, and could be a problem if you eat out often, unless you get familiar with the carb content of a lot of foods. If you’re willing to put in the effort, it’s worth it. If you’re not into counting, measuring, and keeping a record, this is going to be hard, and you’d be bet ter off with a simpler for mula.
JONNY’S LOWDOWN It’s hard to find anything wrong with this plan and the concepts and theories behind it. In some ways it’s like the Zone with an induction phase, which may be why Barry Sears, whose Zone diet is way higher in carbs and lower in fat, is still able to endorse it (phase three, the maintenance phase of Protein Power, is not far from Zone-like eating). The only credible argument I’ve heard against this type of plan is from endocrinologist Dr. Diana Schwarzbein, whose dietary regimen is not considered high-protein but is definitely still on the lower-carb side of the fence (see The Schwarzbein Principle on page 226). Her concern is that too much protein without enough carbohydrate will raise the hormone cortisol, which has a whole other set of problems attached to it. It’s a fair objection, and only time and additional resear ch will clarify these hazy areas. In the meantime, I’m continuing to recommend The Protein Power Lifeplan as a basic textbook to all my clients who just want to live a healthful lifestyle and manage their weight. It’s hard to find anything commercially available that’s more comprehensive.
21. T HE ROSEDA LE DIET RON ROSEDALE, MD AND CAROL COLMAN
WHAT IT IS IN A NUT SHELL
novel higher-fat approach to low-carb that focuses on leptin, a hormone involved in the regulation of appetite.
About the Rosedale Diet How can you fault any diet book that clearly states the following: “ The high carbohydrate–low fat diet being prescribed to diabetic patients is recisely the wrong approach”? Answer: You can’t. The Rosedale Diet is a gem . It’s the cr eation o f Ron Ro sedale, MD, the doctor who, when Mike and Mary Dan Eades (of “Protein Power” fame) left Colo rado to move on t o o ther pr ojects, took over the direct or ship of their clinic for metabolic medicine. Rosedale has long been one of the most soughtafter educators in nutritional and metabolic medicine, and this book is his first entry into the popular diet world. And it’s a winner on every count. While the Rosedale Diet is clear ly a “lo w-carb” plan, it takes a somewhat different approach to weight loss, one that is focused on a hormone called leptin . Here’s the deal with leptin. Back in the ’90s, resear chers were excited to discover this thatstop seemed to Rats regulate Leptin sig nals the brprotein ain thathormone it’s time to eating. thatappetite. were leptin-deficient ate a ton of food and, when injected w ith leptin, lost weight easily. The excitement in the r esear ch comm unity was palpable. Resear chers at the Rockefeller Institute believed they just might have found the holy grail of weight loss. They r easoned that obese people must be leptin-deficient, and that if leptin (or a drug that mimicked it) could be given to obese individuals, their appetite would be reg ulated automaticall y and the pounds would drop off. No such luck. Turns out that what wor ked in r ats didn’t wor k at all in humans. Obese peo ple, as i t happens, have plenty of leptin. The pr oblem is, their bodies don’t “liste n” to it. They are, to use the term Rosedale uses, leptin-resistant . “Leptin is produced by your fat cells,” Rosedale explains. “It tells your brain when to eat, how much to eat and most impo rtant, when to stop eating.” Just as type 2 diabetics have plenty of insulin (but their cells don’t respond effectively
to it), obese peo ple have plenty of leptin, but all that leptin falls on deaf cellular ear s. In obese or over weight people, lept in does not seem to be able to effectively co mmunicate its message to “sto p eating.” Rosedale explains it eleg antly: “When leptin l evels can be properly ‘heard,’ it al erts your brain and other body ti ssues that you have eaten enough and stored away enough fat, and it’s now time to burn off some excess fat. This f eedback system is designed to prevent you from getting f at.
In order forlow. leptin to be heard clearly, levelsyour mustcells remain stable and When leptin levels spi kehowever, too high,leptin too often, stop list ening to lepti n. In medical terms, they becom e ‘resistant’ to lepti n.” In other wor ds, your brain co ntinues to tell yo u “be hungry, eat , and store mor e fat!” The Rosedale Diet is all about getting rid of “leptin resistance.” Interestingly, the same fo ods that aggr avate insulin r esistance—the central factor in obesity, diabetes, and metabolic syndrome—also promote leptin resistance : sugar and high-carb diets. The Rosedale Diet abandons the outdated classification of carbohydrates into “simple” and “complex” and instead classes t hem into “fiber” ver sus “nonfiber” (o r what some people would call “slow-burning” ver sus “fast-burning”). F iber, go od; nonfiber, not so good. Not surprising, and totally accurate. On the Rosedale Diet, most gr ains are avoi ded (especially for the fir st three weeks), but nonstarchy vegetables ar e plentiful. Rosedale isn’t of the opinion that protein should be unlimited, and I think he may be right on this. He recommends limiting protein to 50 to 75 grams a day. Remember, protein doesn’t have a neutral effect on insulin (the way fat does). “Extra pr otein can be conver ted into g lucos e and burned as sug ar, which causes spikes in leptin and insulin levels, which in turn cause sugar cravings,” he points out. Rosedale’s variation on the low-carb theme is lower in protein than, for example, the Eades program, and—perhaps counterintuitively— concentrates o n fat. (Remember, fat is the one macr onutri ent that has virtually no effect on insulin!) Rosedale’s take on fat is some of the sharpest and most accurate writing I’ve yet seen, and should be read by everyone. For openers, he distinguishes between “go od” and “bad” fat, but he act ually kno ws what he’s talking about. Don’t expect the usual “saturated fat is bad, unsaturated
fat is good” platitudes. “Some types of fat are bad for you all the time,” he says, “and some types of fat are bad for you only some of the time. The health effects of fat often depend on what you eat with it.” Amen. He warns against too much omega-6 (found in vegetable oils that the conventional establishment thinks are healthful all the time), compl etely for bids trans-f ats, and even points out the fact that saturated fat sometimes has an advantage in the diet. But he doesn’t ecommend eating amount of saturated fat since, in gener al, “itr is the toughest fat t ao huge bur n.” “If you are looking to shed pounds, it is best to limit (not eliminate) your intake of saturated fat.” I have to give Rosedale credit also for being just about the only nutrition doctor I’ve ever read who actually questions the universal mandate that omega- 9’s (monounsatur ated fat such as that found in oli ve oil) is great. “I’m not convinced that monounsaturated or omega-9 fat has any special health properties, yet people who eat monounsaturated fats seem to be pr otected against certain co mmon diseases.” He suggest that the health benefits seen by people co nsuming the Mediterr anean diet (which is famously high in o live oi l) g et those healt h benefits mor e because of the amazing beneficial phenols and antioxidants in olive oil and nuts rather than the om ega-9 f at itself. “I believe that the major benefit of mono unsaturated fat is what it is not,” he says. “It is not bad for yo u and doesn’t have any of the negative effects of other oils.” Clearly, Rosedale is a guy who thinks for himself. The Rosedale Diet is divided into two levels: Level 1 and Level 2. “I consider Level 1 to be the healthiest possible diet,” Rosedale says, “and one that will not onl y help you lo se weight quickly, but will g ive you the best shot at longevity.” On the diet program, you stay on Level 1 for at least three weeks, though yo u can opt to stay on it for ever. “It is basicall y the diet that I follo w most of the time,” Rosedale s ays. Level 2 contains a wider variety of foo ds (a few m or e servings o f fr uits and starches), bu t is still a hug ely healthful diet. On the fir st three weeks of the Rosedale Diet (Level 1), you’l l eat nuts, nut butters, avocados, olives, all kinds of fish, poultry, game, veggie burgers, and even some selected dairy. Protein powders are okay, as is plain tofu, and there’s the usual list of “free” vegetables, from asparagus
to zucchini. A few high-fi ber s tarches, limi ted legumes, tea, and just about any spice you can name r ound o ff the list. You do n’t count calor ies, but eat until you’r e full, which winds up b eing less than “usual” because you don’t crave sweets and your body is becoming less leptin-resistant. After the first three weeks, you can opt to mo ve to Level 2 and begin to add a wider var iety of foo ds, inclu ding fr uits and legumes, coffee and wine. Off the menu—pretty much p ermanently—are mil k, most full- fat hard meats, certain legumesvegetables, (including sugar, peanut butter, whichcheeses, I’m notprocessed sure I agree with), very starchy commer cial fr uit juice s, soda, and all fri ed foo ds. (I have a few minor disagreements with some of the foods on the “banned” list, but for the most part I think he’s nailed it!) How long can you stay on the diet? The short answer is forever, if you want to. “I consider the Rosedale Diet the optimal diet for life and I urg e patients to stay on it fo rever,” he says. “If you keep your leptin levels down, you will not experience the constant hunger or food cravings that helped make you o verweig ht and sick in the fir st place, and that makes diets difficult or impossible to maintain.”
The Rosedale Diet as a Life styl e: Who It W orks for, Who Should Look Elsew here For those who are metabolically suited to a hunter–gatherer diet of protein, vegetables, and fat (with a few judiciously chosen extras thrown in for go od measure), this is a terr ific weight-loss plan th at you can act ually stay on for life. If you’re okay bucking the conventional-establishment “wisdom” on fat, this is a pr og ram definitely w or th looking at. The only danger here is the same danger that exists with Atkins—assuming that once you l ose the weight, you can co ntinue eating this way plus add back all the junky carbs you used to eat. This program works, but not when you add a bunch of useless carbs to it.
JONNY’S LOWDOWN
One thing you can say about the Rosedale Diet that you can say about few other diet books on the market is this: you will actually learn something from it. The information on leptin alone—and its relationship to insulin, stress, and aging—is worth the price of the book. The diet is designed to “turn off your hunger switch,” which certainly makes sticking to a plan a lot easier than gritting your teeth and relying on willpower all the time. Well worth reading, and well worth following.
22. T HE 6-WEEK CURE FO R TH E MIDDLEAGED MIDDLE MICHAEL R. EADES, MD AND MARY DAN EADES, MD
WHAT IT IS IN A NUT SHELL The authors of Protein Power turn their at tention t o the problem of visceral abdominal fat (VAT)—also known as the “spare tire.” VAT is an important factor in diabetes, obesity, and “middle-aged spread,” and it’s one that has enormous health consequences. Pa rticularl y suitable for those over 40.
A bout T he 6- Week Cure for the Mi ddle-Aged Middle Without question, two of the smartest advocates of low-carb dieting in the world ar e the husband-and-wife team of Mary Dan Eades, MD and Michael R. Eades, MD. (Their best-selling books Protein Power and The Protein Power Lifeplan are discussed on pages 210–215.) In their latest, The 6Week Cure for the Middle-Aged Middle, they focus their sights specifically on the pro blem of middle-aged gir th. Though mo st people ar en’t aware of it, fat really comes in tw o “flavors”—visceral and subcutaneous. The later is more unsightly—it’s the stuff that makes your thighs push against each other in your jeans, the
stuff that causes you to ask “Does my butt look big in this?” But the for mer —visceral fat—is far more dangerous. “Typically, in middle age, people are afflicted with visceral fat,” explain the Eadeses. While subcutan eous fat is basi cally co ntained within a nonri gid, r ubbery wall (the skin) an d tends to pudd le when go ing fr om vertical to horizontal, visceral fat is typically contained within the abdominal wall. It’s visceral (abdomi nal) fat that cor relates the most with bad health outcomes and conditions like insulin resistance and diabetes. That’s the reason you’ve heard (correctly) that “apples” (people who store their fat around th e middle) are at mor e risk for health pro blems than “pears” ( people who sto re it in the thighs and butt). While bo th can be “unsightly,” it’s the abdominal fat that is a r eal health concer n. Getting r id of visceral fat—or what is properly known as VAT (for visceral adipose tissue)—is the focus of The 6-Week Cure. This pro gr am couldn’t h ave arr ived at a mor e oppor tune time. Just as I was writing this r eview, the November 12, 2008 issue of the New England Journal of Medicine was published, featuring a widely reported study showing that belly fat was linked to early death. In the study, which follo wed 360,000 Euro peans fo r over 10 years, those who had th e most belly fat had double the risk of dying compared to people with the least amount of belly fat. That’s pretty striking . And that’s on top o f pr evious resear ch showing an associ ation between VAT (belly fat) and a ho st of other diseases including some cancers, diabetes, and even dementia. VAT al so cor relates with something that’s becoming endemic in this country, although at the moment it’s flying under the radar—NonAlcohol ic Fatty Liver Disease ( NAFLD). “A recent study on middle-ag ed people in the Dallas area who had no known health problems showed that 34 percent of this po pulation had liver fat accumulation,” Michael Eades told me. “And a recent autopsy stud y from San Diego found that 12 percent of adolescents who died from accidents already had fat accumulat ions in their livers. Those who were overweight had much greater accumulation.” “Cleari ng fat fr om the liver is essential to g etting rid of VAT,” explain the Eadeses. They g ive techniques to do this in the book. Su rprising ly, consumption of saturated fat helps rid the liver of fat, at least in animal studies. Here’s how we know: Researchers give animals alcohol to get them to develop fatty liver s quickly. If they add vegetable oi l and/o r
fructose to the mix, the liver s fatten mor e quickly. If they add saturated fat, it’s diffi cult to g et the animals to develo p fatty liver s, even in the face of continued alcoho l consumption. “If you lo ok at the epidemic of NAFL D in this country, it pretty much cor relates in time with the advice to r educe saturated fat and replace it with vegetable fat,” says Mike Eades, “not to mention the increase i n the consumption of fructose.” While the Eadeses are quick to point out that correlation doesn’t mean causation, it’s certainly easy toymake that leap, in light research. Earl in this boo k, I especially discussed the wor kofofthe ananimal ol d-time GP in New Yor k named Blake Donaldson, MD (see page 13). D onaldso n was a mainstream physician who experimented with all-meat diets for his patients, largely as an attempt to tr eat aller gies. The Eadeses discuss Donaldso n, as well as another old-timer named Walter L. Voegtlin who, quite independently, experi mented with the same all-m eat diet as a way of tr eating ulcer ative colitis and Crohn’s disease. Both serendipitously discovered an interesting “side-effect”: all their patients lost weight! In The 6-Week Cure for the Middle-Aged Middle, the Eadeses “deconstruct” the pri nciples behind the all-meat diet and put it back together in the form of a protein shake. You start on three shakes a day plus a pr otein meal, then mo ve to what is basically an al l-meat diet. In the last two weeks of the 6-week diet, you progress to a more typical low-carb diet. “Results have been pretty spectacular in the patients we’ve wor ked with, many of whose histories are described in the book,” Mike Eades told me. In vir tually every boo k on lo w-carb eating, th e focus is on the oversecr etion o f insulin. The mechan ism is now familiar to anyone reading this book—bloo d sugar ri ses, insulin is secreted, t he cells eventually become resistant to its actions, and the body secretes more and more insulin in an (often futile) attempt to get blood sugar back down. But insulin can build up in the bloodstream in two ways, not one. The first is oversecr etion; the o ther is undermetab olism. And un dermetabolism is a unique focus of the Eades pro gr am. Here’s how it works. One of the many jobs of the liver is to metabolize pro teins (one o f which is i nsulin). But when fat builds up in the liver, the liver slows down and doesn’t work as well. It becomes sluggish, much like a bloated com puter loaded down with unwanted prog rams. Ridding the
liver o f fat allows it t o wor k better and to mo re r apidly break down and metabolize circulating insulin. If the insulin that’s hanging around is metabolized more efficiently, by definition there will be less of it hanging around. Less insulin hanging around has the effect of making the cells more sensitive to the insulin that’s left. (This is, after all, one of the major go als of a sugar -and-insulin-lowering lo w-carb diet.) And mor e sensitivity to insulin means that we can pro duce less of it to get the job done. So by focusing on lowering fat buildup in the liver, the Eadeses have taken on an often-neglected piece of the metabolic puzzle. Their low-carb diet attacks high blood sugar and insulin from both the “manufacturing” side and from the “metabolizing” side. “Everyone in the low-carb field focuses on the over secretion br ought on by carb intake , but the other side of the equation is just as impo rtant,” Mike Eades told me. An d since elevated insulin not only increases fat buildup in the liver but also makes us store visceral fat in the fir st place, lo weri ng i nsulin help s interr upt the vicio us cir cle. Less insuli n, less viscer al fat and reduced fatty liver. It’s a double whammy. The boo k has some r eally int eresting stuff on the ev olutionary psychological basis for our attraction to a slim waistline. If you know the Eadeses as I do (or if you read Michael’s always-fascinating blog at http://www.proteinpower.com/drmike) you know that their interests are wideranging (as in o pera, coo king, travel, and ph iloso phy). So it’s no surprise that the book contains some really interesting stuff on the evolutionar y basis for our attraction to a slim waistline an d draws on material from anthropol og y to a kind of Lit erar y Darwinism. That part of the book won’t help (or hurt) you in your weight-loss effor ts, but readers like me find that stuff utterly fasci nating. Maybe you will too. Besides the diet itself, the book is filled with helpful hints for supporting your liver (always a go od idea) and helping it r id itself of unwan ted (and metabolism-slowing) fat buildup.
The 6-Week Cure for the Mi ddle-Aged Mi ddle as a Lifestyle: Who It Works for, Who Should Look
Elsewhere The Eadeses have treated probably several thousand people in their long career, and they’ve had pretty spectacular results. They’re two of the smartest and sharpest people I know, and it’s rare that I find anything significant that we disagree on (okay, sometimes politics and music, but that’s another story). That said, I would simply caution that in my opinion not everyone is metabolically to a very-high-protein diet. Ipeople don’t think there’s anything “bad” orsuited “dangerous” about it; I just think respond differently to dietary strategies, and some people just may not like such a high protein intake, especially when meat is involved. If you’re one of them, this might not be for you. But if you’re willing to give this a try, it might produce some very dramatic results. Remember, Vilhjalmur Stefansson went on just such a diet for a year while being supervised and monitored at Bellevue (see page 9), and by every single measure his health was robust and he had no problems.
JON N Y’S LOWDOWN t the time of this writing, The 6-Week Cure for the Middle-Aged Middle was still in the final editing stages, and the Eadeses weren’t quite done utting the finishing touches on it. They were able to share with me the basics of the program so that I could write about it, but I don’t know the final details of the actual diet plan (e.g., the composition of the protein shakes, or the exact natur e of the 4-week diet that f ollows the initi al 2-week all-meat phase). Given the Eadeses’ superb track record for putting together excell ent, smart programs that work, I don’t feel l ike I’ m going out on a limb to say that this is going to be an excellent program. And remember, the 2 weeks of “all-meat” is only the first third of the program. fter that, it reverts to a more conventional low-carb approach that I’m sure is loaded with vegetables and provides a lot more variety, while still holding blood sugar and insulin level s down. Visceral f at and fatty liver are both big prob lems to people wanting to stay healthy and lean. This program is a revolutionary approach to both. ll in all—if you’re not opposed to the idea of eating meat—this looks li ke a terrif ic program that should find a lot of advocates.
23. TH E SCARSDALE DIET HERMAN T ARNOWER , MD
WHAT IT low-fat, IS IN low-carbohydrate, A NUT SHELL A low-calorie, high-protein diet that specifies exactly what you can and cannot eat, with very lit tle room for flexibil ity. You go on the basic diet for 2 weeks; then you go on the sl ightly relaxed “lifeti me keep-slim program” for 2 weeks. If you st ill have weight to lose, ou repeat the cycle. Forbidden are sugar, full-fat dairy products, cakes, ies, cookies, candy, chocolate, potatoes, r ice, sweet potat oes, yams, beans, avocados, spaghetti, macaroni, fl our-based products, f atty meats, peanut butter, butter, margarine, oils, and any kind of fat used in cooking.
About the Scarsdale Diet Even by diet-book the Scarsdale diet as made laughable claims, pro mising a po und astandards, day of weight loss, tota ling much as 20 pounds or more in two weeks. Tarnower also claimed that the diet worked for everyone, from teenagers to octogenarians, and that 90% of them maintained their desired weight. The diet co nsisted of two 2-week segments: th e basic di et and the maintenance diet, or the “keep-slim program.” The idea is that you would do the basic diet fo r 2 weeks and then switch to the maintenance versi on. If, after 4 weeks, you still had weight to lose, you went back to the srcinal program and repeated the 2-week/2-week cycle. The first 2 weeks were rigidly specifi c, with every o ne of the 21 meals per week dictated by the book. Tarnower was a cantankerous control freak who insisted that the diet be followed strictly, with absolutely no variation permitted. During the maintenance phase, the rules were slightly—though only slig htly— relaxed; you could make certain substitutions, could add one alcoholic dri nk a day, and could eat nuts “spari ngly.”
Tarnower devoted a section in the book to “The Mystery of Diet Chemistry,” but he was either remarkably uninformed on the subject or ust downrig ht stupid. He explained that “a carefully desi gned co mbination of foods can increase the fat-burning process in the human system” and that the Scarsdale diet provided just such a combination of foods, making it possible to lose an average of a pound or more each day. He attributed this to the metaboli c state called ketosis (see chapter 6), which figur es pro minently inothe Atkins diet; however, Tarnower showed understanding f how it wor ked. Here’s what he said: “If youlittle ar e pro ducing [ketones], it is a sig n that your bo dy is burning o ff fat at an accelerated rate; you are enjoying Fast Fat Metabolism.” Of course, this statement igno res the fact that the body is pr oducing ketones at all times and that the production of ketones is a normal state of metabolism. Perhaps Tarnower was confusing the mere production of ketones with the dietary ketosis that Atkins addressed, but the pro blem was that it would have been completely impossible to get into dietary ketosis on the Scarsdale diet, as you will see in a m inute. The “Mystery of Diet Chemistry” s ection—which ran all of about 2 pages—mentioned nothing about insulin. The diet itself was about 1,000 calories or less per day and averaged 43% pro tein, 23% fat, and 35% carbs. With those numbers, a dieter wo uld be taking in 88 grams of carbohydrate a day, which by the standards of the American diet certainly qualifies as relatively low-carb, but would prevent virtually anyone from reaching the state of ketosis that Tarnower seemed to think necessary. Tarnower subscribed to the lowcalorie theory wholeheartedly, made no mention of the possibility of metabolic variances among people, and believed co mpletely in the diet heart hypotheses, wh ich holds that both fat an d cholester ol in the diet cause heart disease, so he kept both as lo w as possi ble. He also believed that fat made you f at, another reason he advo cated cutting fat consumption way down and for bade any oils, butter, dair y, animal fat, or avocado s. The diet then can be seen as a hodgepodge of low-fat, low-carbohydrate, an d low-calor ie thinking. Breakfast was the same each day: half a grapefruit, black coffee or tea, and one slice of pro tein bread with n o topping. (Tarno wer gave the recipe for the “protein” bread, though there is absolutely nothing in it that would distinguish i t as a “high-pr otein” br ead. It’s made of fl our, water, yeast, and seasoning .) Twice a week for lunch, you ate all the fruit yo u wanted,
period (plus the requisite black coffee, which seemed to be a part of every meal). The r est of the mea ls were so me combination of pro tein and vegetables. There was absolutely no sugar, potatoes, pasta, flour-based foods (other than his “protein bread”), full-fat dairy, or desserts. You were permitted to eat carrots and celery in any amount you wished, as often as you liked. In its heyday, the Scarsdale diet g ot a lo t of media attention, including an article New York Times by In Geor Dullea headlined f It’s Friday, It MustinBeThe Spinach and Cheese.” thatgia article, she enthused:“I“The Scarsdale Diet: This is where the losers live, the real losers. This is the home o f the famous 14-day Scars dale diet….Weight losses o f up to 20 pounds in t wo weeks are repor ted here. Rarely do dieters feel hungry o r cranky…. The Scarsdale Diet is spreading…. Requests are coming from as far away as California and Mexico. Now London is ringing up about the Scarsdale Diet…. Everywhere you go people are talking about [it].” Tarnower was something of a paternalistic jerk, given to statements like “Let’s face it—most over weight people love to eat. The very obese a re often gluttonous.” One of his readers wrote to him with the following question: “When I diet , I get cr anky and my husband says, ‘I like yo u better fat than cranky.’ Have you any sugg estions?” Tar nower wro te back, “You should be able to diet without g etting cranky. Your husband, I am sure, would li ke to have you attractive, lean, and pleasant! ” Tarno wer was ultimately shot to death in 1980 by his former lover, school headmistress Jean Harris, who, it was rumored, had run out of the amphetamines he prescribed for her.
JON N Y ’ S LOWDOWN (Zero Stars) This diet is a complete waste of time, and is only mentioned here because it is still in print and still has a following. This is the kind of book that gives low-carbing a bad name. It is based on no real knowledge of the hormonal response to food, tries to be all things to all people (low-fat, low-calorie, and low-carb), limits calories to an almost dangerous level, and on top o all that is unrealistically rigid. The only thing it brings to the table—done so much better by others—is a limitation on sugar, starch, and flour.
24. THE SCHWARZBEIN PRINCIPLE DIANA SCHWARZBEIN, MD AND NANCY DEVILLE
WHAT IT IS IN A NUT SHELL program designed not specifically for weight loss but for metabolic healing, which, when successful, results in weight loss. Schwarzbein says, “You need to get healthy to lose weight, not lose weight to get healthy.” In her second book in the series, The Schwarzbein Principle II, you compute our protein requirement and your maximum carbohydrate allowance for each meal and snack, then construct your menu accordingly.
A bout the Schwarz bein Principl e Let me start by saying this: if you are a dedicated low-carber, the srcinal Schwarzbein Principle should be in your library, regardless of whether you choose to follow the program or not. It’s as good a basic reference book on hormonal health, the need for good fats, the arguments against a low-fat diet, and the relationship of hormones to health and aging as we’re likely to see. If you’r e not yet familiar with the case against the low-fat diet and the concept of eating plenty of good fats (which include saturates!) and protein, this is a great place to start. If these concepts are old-hat to you and you want to actually try the program, the second book, The Schwarzbein Principle II , is the place to begin. The srcinal is the overview and will give you the basics; Schwarzbein II is a more fully realized eating plan. The Schwarzbein Principle can be summed up as follows: • All systems of the human body are connected. • One imbalance creates another imbalance. • Eating too many man-mad e carbohydrates is t he number o ne reason for hor monal imbalance s. • Poo r eating and lifestyle habits—not genetics—cause diseases of aging.
The actual eating plan depends on where you fit in a matrix of four metabolic types. W hat type you ar e depends on the oper ating health of two of the major hor monal syst ems in your body: your insulin metabolism and your adrenal metabolism. Most people reading Living Low Carb understand by now t he concept of i nsulin r esistance and the ro le elevated insulin l evels play i n weight gain. We saw in chapter 2 just ho w this mechanism operates, and it is the underlying concept in almost every one of plans so discussed i n thishealth. boo k. What has not been emphasized in anythe of diet the plans far is adrenal The adrenal glands are r esponsible for the secretion of tw o cr itical hormones: cortisol and adrenaline. These are also known as stress hormones—they are involved in the “fight or flight” response. Cor tisol is a major hor mone. It keeps your bloo d pressure fr om dr opping too lo w, and you need it in every cell of your body—without it, you would die. Adrenaline is an other major hor mone; it keep s your heart bea ting. Adrenaline is the primitive hormone that saved our butts from being eaten when confr onted with a saber-too thed tiger on the savanna. That’s why cor tisol and ad renaline are called th e “fight or fl ight” hormo nes—in response to stress (like a lifethreate ning emer gency), they prepare you fo r either picking up a club to fight off that s aber-toothed t iger or running like hell for the nearest t ree. These hormo nes served our Paleolith ic ancestor s well as a kind of “turbo” system for emerg ency response. The pro blem is th at our cur rent lifestyle causes t hem to charge aro und our systems far mor e than is strictly necessary. They are our constant companions. Our poor overworked adrenals respond to daily stresses and secrete them when we’re stuck in traffi c, when we have a repor t due, when we get into a fig ht with the hotel cler k, when the telemarketer interr upts our dinner, and when we have a fight with our boyfri end/girl fri end/husband/wife/son/daught er/bo ss. And just like our poor pancreas can eventually “burn out” from the constant demand put on it to pro duce enough i nsulin to deal with a chronically high-car bohydrate diet, so can our poor adrenals eventually reach a similarly exhausted state. This is what Schwarzbein and others call adrenal burnout. It is hardly uncommon. So if we’re interested only in weight loss, why should we care about our
adrenals? Well, fir st off, the adrenal hor mone cor tisol, like all hor mones in the body, sends a messag e. Several, actually. One is to br eak down muscle fo r fuel. If you break down muscle, you do two things: you lower your metabolic rate (since muscle is where the fat and calories are burned), and you reduce the number of muscle cells that are able to accept sugar, leading to mor e sugar being stored as fat and e ventually mor e insulin resistance . Cortisol also sends a message t o theeating. brain to “r efuel” for an emergency, leading almost inevitably to stress Since cortisol is involved in br eaking down t he bodily pro teins—both functional and structural—eventually, if levels of cortisol remain high, the body will do somethin g to pr otect itself against breaking do wn too much. Can you guess what hormone it sends in as a reinforcement? Insulin. Too much cortisol event ually tri gg ers i nsulin, the storag e hor mone, to co unter the catabolic (breaking-down) processes in an attempt to rebuild the ship. If this happens fr equently enoug h, you will eventually have high levels of insulin and will become insulin-resistant. Remember that adrenaline helps your body use up your biochemicals; insu lin helps y our body rebuild t hem—including the fat stores! Hence, chro nically hig h cortisol can wind up being a cause of insulin resistance. It gets wor se. Chronic o versecretion o f the stress hor mone cor tisol will cause you to use up serotonin. Less serotonin almost always goes hand in hand with cravings, especia lly fo r sugar and carbohydrate. Those cravings, a kind of bio chemical “mandate,” can be irr esistible even for people with amazing willpower. Give in to the cravings—as most people will—and the cycle co ntinues. You use up ser otoni n any time yo ur cor tisol and adrenaline levels get too high—when you don’t sleep, when you are stressed, and when you overuse stimulants (including refined sugar, nicotine, and caffeine). This is one reason why stress management figures so pr ominently in the Schwarzbein pro gr am. In the Schwarzbein Principle, you first determine which of four metabolic categor ies you fit into: 1. insulin-sensi tive with healthy adrenal s 2. insulin-sensi tive with burned-o ut adrenals 3. insulin-r esistant with healthy adrenals
4. insulin-r esistant with burned-o ut adrenals These four categor ies repr esent varying degr ees of metabolic damage and require ver y different eat ing plans fo r healing. The underlying thinking here is that you must heal your metab olism befor e you can begin to lose weight. The pro gr am consists of five elements : 1. 2. 3. 4. 5.
nutrition stress management cro ss-training exercise (usua lly of a lo w intensity level) elimi nating stimulants and drugs hor mone repl acement therapy, if needed
All five elements don’t have to be done at once. The transitio n into metabolic health is gradual and gentle and takes place in stages. You fir st determine your pro tein needs, using a very simple fo rmula. Those with healthy adrenals do not have to monitor protein; they can “listen to their bodies,” t hough g uideline s ar e given fo r those who want them. The formula and guidelines give minimum protein needs and should be divided among the three m eals (and usually two snacks) that you will eat every day. You can eat mo re protein if you want, but not less. Then you determine your carbohydrate allowance, which is also divided into three meals and two snacks. You do not count calor ies, and you do not measur e or count fat. Carbohydrate a llowances range fro m a low of 15 gr ams per meal and 7½ grams per snack (60 grams per day), to a hig h of 45 gr ams per meal and 20 grams per snack (175 grams per day), though the high end of the range is o nly for the r are person who is insulin-sen sitive with healthy adrenals and is very, very active. There are meal plans given for 15, 20, 25, 30, 35, and 40 gr ams of car bs per meal. There ar e vegetarian versions of all meal plans, and t here ar e even low-sat urated-fa t versions o f mo st of the meal plans for those very special cases where saturated fat has to be limited (Schwarzbein does not normally limit saturated fat). Carbs—though much more limited than in standard diets—are not elimi nated and, in Schwarzbein’s view , are essential to the success o f the pro gr am. The r eason is this: if you eat t oo many carbs (and too much
foo d), your insulin levels w ill r ise too hig h and you will become insulinresistant if you ar en’t already; if you alr eady are, too many carbs will certainly make matters wor se. But if yo u don’t eat enough carbs, you will raise adrenaline and cor tisol too high, using up your pr ecious biochemicals and eventually becoming insulin-resistant anyway.
The Schw beinShoul Princi as a Lifestyle: Works f orarz , Who d ple Look Elsew here Who It People who flock from all over the country to Diana Schwarzbein’s practice in Santa Barbara, California, are frequently people at the end of their rope—they have tried every diet, damaged their metabolisms, and turned their hormonal balance on its ear. She has an amazing success rate, but you clearly have to be patient. This is not a diet for weight loss; it is a program for metabolic healing, and in many cases you have to be prepared to actually gain weight before you begin to lose. In addition, the careful computing of grams of carbohydrate per meal and snack doesn’t appeal to everyone. If you’re willing to be patient and are looking at the long-term picture, you’ve probably come to the right place. If you need mor e immediat e r esults, if you’r e concerned only with w eight loss, if you can’t deal with counting carbs, or if you don’t feel you’ve damaged your metabolism all that much, this mi ght not be the best place to start.
JONNY’S LOWDOWN You simply cannot say enough good things about Diana Schwarzbein. She truly is a giant in the field and one of the most knowledgeable cutting-edge endocrinologists in the country. Interestingly, many of the people I interviewed for this book started with more basic plans like Atkins and then, when they got closer to maintenance, moved to the Schwarzbein Principle. As an overall plan for health, this is five-star material. But as a weight-loss diet—which it was never intended to be—it may not be the ideal entry-level plan, as it requires a good deal of patience and a lot o commitment.
25. UNLEASH YOUR THIN JONNY BOWDEN , PHD, CNS
WHAT ITThin” IS IN NUTprogram SHELL “Unleash Your is aA complete in a box, consisting of 2 hours of DVDs, 6 CDs, a full 166 page manual, a 300 plus page workbook plus a full six week menu plan and recipes. The plan is unique in that, in addition to a terrific eating plan, it attacks the psychological underpinnings o cravings, binges, failures, and plateaus and gives you real-world tools for dealing with t hem in a positi ve way. A bout the “Unl eash Your T hin” Program Unleash Your Thin is an updated, expanded, and improved version of the highly successful “Diet Boot Camp” program. UYT is a two-pronged approach to weight loss, and inAccording this regard, from virtually every other program I’ve reviewed. to different the authors, two major issues derail most weight loss efforts, and the Unleash Your Thin program addresses both equally. The fir st cause of weight gain is hor monal. It wor ks like this: foo ds you eat trigger specific hormones and enzymes in the body, which are either favor able to fat loss o r favorable to fat gain. Although calor ies do matt er, they are no t the whole picture, as calor ies fr om sug ar, for example, affect the hor monal enviro nment very differ ently than, say, calor ies fr om fat. The main player in this hor monal enviro nment—at least fro m a weight loss poi nt of view—is insulin. I nsulin, also known as “the hunger hor mone,” and , mor e insidiously , as “the fat-stor ing” hor mone—is released by t he body as soon as your bloo d sugar go es up, which it does every time you eat. Insulin’s purpose is to escort excess sugar into the muscle cells where it can be “burned” for energy. Unfortunately, for many people (at the very least 25% of the population and probably much more)
the system doesn’t work very well. For these folks, blood sugar goes up, insulin goes up, but the muscle cells aren’t having any of it. They basically shut their doors (a condition known as “insulin resistance”) which results in a number o f things happ ening, none of them go od (at least not if you’re trying to stay trim). Creating a ho rmo nal envir onment where insulin neve r gets high enough to create t he ideal en viro nment for fat stor age is the first go al of the Unleash Yourunderstand Thin Program. If you’ve theinsuli book, youmost is undoubtedly that the type ofread fo odthis thatfar raiinses n the carbohydrates. Unleash Your Thin wisely keeps carbohydrates at a fairly low level for two weeks, allowing your “fat burning switch” to stay permanently in the “on” position. But that’s just the first promise of the program. According to the manual, the major obstacle to weight loss isn’t just the hor monal enviro nment. No, the major obstacle to weight loss is poor mental conditioning—our inability to resist addictive foods that make us fat, sick and tired. The manual and DVD go into g reat detail abo ut exactly why this is so, and much of the information will make you piping hot mad. Food companies scientifically engineer their “food products” with just the right combinations of tastes that light up our craving buttons. Sugar, salt, and fat are added and laye red in precise pr opor tions to create a massive, toxic fo od envir onment which taunts us with the mocking slogan, “Betcha can’t eat just one!” The Unleash Your Thin program is predicated on the idea that unless you can master these cravings, the best information about what to eat won’t help you. If the first premise of the program is to eat in a way that turns “on” your fat-burning switch, the second, equally important premise of the program is that you have to r epro gr am your “behavior al control switch,” the one that gets lit erally disabled in the presenc e of craving-pr oducing fo ods.
The Four Phases Phase One rather of the than UYTon pr specific og ram ischanges unique in at ityou focuses on pr don’t eparation and habits in th what eat. “You go into battle without a battle plan,” writes the author. This week of
preparation is focused on buying the right food, “bulletproofing your kitchen,” eating meals with specific beginnings and endings, answering lots of questions in th e workboo k that will help clari fy your go als, clearly identifying your own trigger foods and toxic eating situations, and generally increasing mindfulness around eating. You can think of “Phase One” as the psychological equivalent of a warm-up that an athlete might do pri or to getting o n the field. If Phase One is like conditioning pr two-week ior to the big game, T wo is when the big game starts. During this phase you Phase will be eating only protein and vegetables with one piece of low sugar fruit a day (apples are r ecommende d). There is also one optional por tion of eithe r avocado or nuts. You can cook your veggies in any fat you like (butter, coconut oil, olive o il, etc), you don’t ha ve to co unt calor ies or gr ams, and you can eat till you’re full. It’s actually a very easy program to stay on and weight loss is noticeable. Phase Three lasts two weeks and is when you reintroduce foods like dairy, grains, and starches, but in a very controlled way. The first week of phase three is all about dairy, the second week is all about grains and starches. The purpose of each week is to gently reintroduce foods in these respective groups and notice what your reactions are. You’ll make notes in your food diary, which will help you decide exactly how much (if any) dairy, grain, and st arch fo ods you can keep in y our diet after the p ro gr am is over. Phase Four is only one week, and looks pretty much like what you’re “permanent” eating plan will look like. This final week allows you to assemble meal plans with just the right amount of those re-introduced foods to keep your fat burning switch in the “on” position, minimize symptoms, and keep food triggers at bay. Thro ughout the prog ram there ar e incredibly sophist icated exercises that allow you to “r econdition” your brain so that your “behavioral control circuits” aren’t disabled every time you smell a Cinnabon in the food court! The program gives you lots of “real-world” exercises—like pairing a really disgusting image with a food that makes you fat—helping to br eak the link between that foo d and unmitigated “pleasur e.” A unique feature of the program is detailed menu plans (found in a separate book) plus srcinal recipes especially created by Chef Jeannette
Bessinger, co-aut hor of The Healthiest Meals on Earth and several other boo ks. However, since the author s recog nize that it’s unlikely that anyone will follo w exact menu plans for six weeks, there is a ver y clear “r oll your own” section that shows you how to effortlessly assemble your own “Unleash Your Thin”-friendly meal fr om a list o f acceptable foo ds. Exercise is vital for health and for weight maintenance but not an emphasis. Why? Because focusing on one thing at a time improves the odds of both compliance (not toyou mention mastery!). If you’re not exercising when you and startsuccess the program, can certainly begin with one o f the beginner ’s wor kouts, but you can also put it off until you’re more comfortable with the eating plan. (Spoiler alert: when you do begin exercising, the au thor s r ecommend high-int ensity burst training o r circuit training as the best way to bur n fat efficiently and effectively. That seems to be in accord with most state-of-the-art recommendations on exercise and fat lo ss.)
Unl eash Your Thi n as a Lif estyl e: Who it Wo rk s Wel l f or, Who Should Look El sew here It’s hard to imagine any demographic for whom the Unleash Your Thin program wouldn’t be suited. It’s probably especially good for those of us who have issues around motivation and willpower and who are continually derailed in their weight loss efforts by cravings, binges, frustration, and stress. This pr og ram would defin itely be bet ter suited to non-vegetarians; protein figures prominently in this plan, and vegetarians by definition will have a mor e limited numb er of pro tein choices. H owever vegetarians who eat eggs and/or fish, and those who can tolerate whey protein powder should have a fairly easy time of it. Vegans should probably look elsewhere. WITH DISCLIMER
JO N Y’S LO WDOauthor, WN I can’t be wholly ( unbiased about this ) FullNdisclosure: As primary rogram. But I can honestly say that Unleash Your Thin is the most
complete syst em I’ve ever seen for l osing weight and, especially, for maintaining that weight loss in the real world. In its previous incarnation as “Diet Boot Camp” it has earned thousands of endorsements from real eople getting real results. The “Unleash Your Thin” program is like a turbo-charged Diet Boot Camp with greater depth, scope, and reach. I can honestly say that even if I had not had a thing to do with t his program, I would still consider i t a solidl y 5 star affai r! Highly recommended.
26. TH E SOUT H BEA CH DIET ARTHUR AGATSTON, MD
WHAT IT IS IN A NUT SHELL A three-phase diet plan. For the first two weeks, you completely cut out bread, rice, potatoes, pasta, baked goods, fruit, sugar, and alcohol. During the second phase, you add ba ck just enough carbs to let you continue t o lose weight. In the third phase, when you’ve reached your goal weight, you can add back stil l more carbs from any category of f ood you like.
About the South Beach Diet The South Beach diet is very… friendly . Written by a cardiologist, it has the benefit of a terr ific mar keting campaign, spor ts a gr eat-loo king cover, and borrows the cachet of a sleek, sexy, very “in” area of Miami known for its celebrities, models, and generally very good-looking people. That gets your attention. More important is the fact that the information deserves it. The author says the diet was designed not with weight loss as i ts main goal, but to improve heart health “by changing blood chemistry.” Agatston says his hear t patients—and his diabetic o nes—lost weight “like cr azy” (“10, 20, 30, even 50 pounds within months”), much of it fr om their midsections. The diet caught on and was featured on the lo cal ABC affil iate station in a seg ment in which Miami Beach residents who want ed
to lose weight were put on the diet and then followed around for a month. The station, WPLG, scor ed big with the feature, and it became an annual “South Beach Diet challenge” for three year s. Eventually, the South Beach diet became known nationally, and was enth usiastically endo rsed by a wide range o f people includ ing fo rmer president Bill Clinton. Here’s how it works. For the first 14 days, you are on a decidedly lowcarb regimen in which you cut out all bread, rice, potatoes, pasta, baked goods, dairy, fruit, sugar, and Eggs are You can have most kinds of cheese (except foralcohol. Brie, Edam, andunlimited. full-fat cheese), certain sugar-free desserts, and a couple of kinds of nuts. You can also drink coffee. According to Agatston, you will lose between 8 and 13 pounds in the first 2 weeks, and most of that will come off your midsection. In phase two, you reintroduce fruit, certain cereals, bran muffins, pasta, whole-grain breads, and other starches, albeit in small amounts. On this phase, you continue to lose weight at the reasonable rate of 1 to 2 pounds a week. When you g et to yo ur g oal, you g o o n phase three, which is your lifetimemai ntenance “for ever” plan. At this po int, you can eat anyt hing— there are no restrictions on what kind of carbs you can take in, which, of course, makes it very att ractive for some people. R egar ding these “foods you lo ve,” the author says, “you won’t be able to have all o f them, all the time. You’l l lear n to enjo y them a little differ ently than befor e—maybe a little less enthusiastically. But you will enjo y them agai n.” Agatston starts with the same basic premise as the low-carb theorists: high amounts of insulin are r esponsible for weight gain, and limit ing carbs stabilizes both blood sugar and insulin. He explains: “The equation behind most obesity is simple: the faster the sugar and starches you eat are processed and absorbed into your bloodstream, the fatter you get.” He suggests eating foods and combinations of foods (i.e., proteins and fats, with minimal car bs) that cause gradual rather than sharp increases in blood sugar. He makes distinctions between good carbs (low-glycemic, whole-g rain) and bad (pro cessed, sugary, high in starch). So far, so go od. The author is a cardio log ist and takes a traditional appro ach to “g oo d fats” and “bad fats.” Though one could dispute his wholesale demonization of saturated fats, one could also argue that that condemnation is likely to
make him more acceptable to the medical establishment, which is a good thing, as his thinking on the subjects of carb consumption, blood sugar, insulin, and weight gain i s right on the money. And while he and I might have a friendly disagreement over saturated fats, we concur that trans-fats are the worst, and Agatston hammers this important point home time and again. And no o ne is go ing to o bject to his inclusion of plenty of go od marine fats like fish oils. The popularity of the diet the is probably how realistic is.bring (“It’s important for people to like food theydue eat.toEating is meantit to pleasur e even when you’r e trying to lo se weight. That’s a sensible way to think about food and it’s one o f the basic pri nciples o f the South Beach Diet.”) Agatston has some great recipes for desserts, like a tiramisu made fro m r icotta cheese and cocoa powde r, as well as some g oo d side dishe s, like “mashed potatoes” made fr om caul iflo wer. But the most appealing part o f the diet may be the fact t hat after the initial Atkins-like Spar tan regimen, you can add back just about any carbs you want, as long as you keep the portions small and continue to lose weight; when you get to your goal, you can eat anything you want as long as you don’t gain. This co uld be a pr oblem fo r some people. Su ch unstructured eating loo ks gr eat on paper and works g reat for many, but it can be a slippery slope for others. Start by adding one slice of br ead or one piece of choco late cake, and for many people, the ballgame i s over. It’s like letting an alcoholic have one drink. But if you can follow his advice and stick to the moder ate por tion doctrine, you’ll allo w those “favor ite foods” to become occasional treats rather than mainstays of your diet. In this scenari o, you’ll l ove the foods you’r e eating, you won’t fee l o verly restricted, and the health benefits you receive are likely to be enormous. This is tr uly healthful, realistic, cont ro lled-carb eatin g for the masses.
The South Beach Diet as a Lifestyle: Who It Works f or, Who Shoul d Look Elsew here People who want to have their cake and eat it too, literally , will love this plan. Because it makes a lot of concessions to “real-life” eating habits and,
after the weight-loss period, does not restrict any food whatsoever, it’s bound to have a ton of appeal. And if you are the kind of person who can do moderation, it’s a great diet, providing plenty of protein, good fats, vegetables, and just enough carbohydrates to keep the demons at bay. However, this liberal way of doing things is potentially problematic for people who like specified amounts and clear instructions and want to know exactly what they can and can’t eat. If you fal l into this catego ry, you m ight be better o ff either o n the firto st South phase aBeach bit longer or starting with a more structured planstaying and graduating later on.
JONNY’S LOWDOWN This is a decent program, although it shares many of conventional medicine’s prejudices and misconceptions (including a phobia of saturated fat). Although some of my colleagues have criticized it for “not being anything new” (one Internet pundit call ed it “Atkins f or the fir st two weeks and then the Zone”), I’m not sure this criticism is fair. Sure, much of the information on insulin and weight control has been out there for a while— but those of us who have been preaching it have remained outside the mainstream. The genius of Agatston is that he has taken this information and made it extremely user-friendly and accessible, and has done so while making sure not to alienat e his mo re conservative colleagues in the med ical pro fession. This makes it much more likely that his important message will actually be heard. The friendly tone, accessibility, and overall permissiveness of the plan practically guarantees that its intelligent, lower-carb message will reach thousan ds of people who mig ht have igno red the mor e “militant ” platforms. For that we owe Agatston a lot of thanks. Adopting some form of the South Beach Diet would represent a giant step forward for most Americans, and because it is presented in such an unint imidating way—and possi bly even because it is no t substantially o utside the medical mainstream in its avoidance of saturated fat—it’s more likely that people will adopt it.
27. SOUT H BEA CH RECHA RGED ARTHUR AGATSTON, MD WITH JOSEPH SIGNORILE, PHD
WHAT IT IS IN A NUT SHELL The South Beach Diet plus an exercise program.
A bout South Bea ch Recharged Let me be honest : in the fir st two editions o f the book you’r e r eading ri ght now (when it was titled Living the Low Carb Life), I rated the srcinal South Beach Diet a little higher than it deser ved (I gave it five stars). Here’s why. At that time, any deviation f rom the god- awful “wisdom” o f conventional dietetics was a blessi ng, and So uth Beach was certainly a departure from the mainstream. I felt it deserved kudos for its emphasis on protein and vegetables and for its movement away from processed carbs. It was also (still is) an extremely user-friendly diet, and one to which conventional docs would not r aise major objections since it was so l ow in saturated fat. But truth be told, the or iginal So uth Beach diet could easily (and no t entirely unfairly) be characterized as “Atkins for two weeks followed by the Zone.” It wasn’t or iginal. It “bought into” the demoni zation o f saturated fat, and it was downrig ht uninfo rmed about supplements. But, still. In that market—which, r emember, wor shipped the go d-awful USDA Foo d Health Pyrami d—it was a br eath of fr esh air. South Beach Recharged is quite a bit bette r than the or iginal. It still suffers from conceptual incoherence (although it’s in three “stages,” the third stage is unclear and virtually impossible to explain), and it’s still very convent ional o n saturated fat ; but overall the boo k has some r eally go od things to reco mmend it, and I’d take this version o ver the or iginal any day of the week. The most obvious difference between the srcinal South Beach and South Beach Recharged is the addition o f an exercise pr og ram based on my favor ite type of wor kout, interval tr aining (mo re on that in a moment ).
It’s also clearly meant for people who are fairly new to exercise, which is not necessarily a bad thing at all—the program is uncomplicated, doesn’t requir e equipmen t, and is easy to follo w, thus r emoving some sig nificant barrier s to exe rcise for a lot of people. The exercise portion is based on walking, but it’s not just your usual exerci se pr escription (e.g., “30 minutes walk”). Instead, the prog ram uses the principles of interval training. You walk at one of four intensities— easy pace, moder “superchar all intervaltraining prate ogpace, rams,“revved the ide aup,” is toand alternat e shor tged.” burstsLike of highintensity exercise wit h slightly long er and mor e laid-back p erio ds of “active rest” (which means continuing to exer cise, but at a much lower level o f intensity while yo u catch your breath). In the case of South Beach Recharg ed, you alternate fast walking fo r between 15 and 60 seconds with longer “recovery periods.” You can buil d up intensity and difficulty by making the “fast” peri ods longer and the “relaxed” periods shorter. Gym rats take note: you can also use aerobic equipment like an elliptic al machine for the interval pro gr am if yo u want. Agatston favors interval training because “it sen d(s) your metabolism soaring when you work your body at higher intensities, but you have to work hard for only a short time to achieve that result.” He’s right. I’ve written a lo t about interval—or “burst”—training in my boo k The Most Effective Natural Cures on Earth, and I’ve been a big f an of this kind o f wor kout for years. To acco mpany the interval walking , Agatston has a str engthandflexibili ty compo nent called the “Total Body W or kout.” (You do the interval walking and the Total Body W or kout on al ternate days.) The Total Body Workout is comprised of basic exercises, all of which can be done at home with minimal equipment (a chair, a step, a t owel, and so f or th). They’r e well descr ibed and well illustr ated. Both the interval walking and the Total Body Wor kout pro gr am have a Phase One, a Phase T wo, and a Phase Thr ee, presumab ly to accompany t he diet por tion of the pro gr am. Everything you’r e supposed t o do is laid out for you with elegant clarity— Phase One: week one, week two; Phase Two: week one, week two; and so on. There’s also a welcome section on belly fat and inflammation and a
discussion o f the different me tabolic ri sks for “apples” (who store their fat around the middle) and “pears” (who store it around the thighs, hips, and butt). And he’s bullish o n fish oil, which is always a plus. Plus there’s an excellent recipe section—always a selling point of the South Beach franchise—w hich is terr ific as usual.
South Recha rgedd as a Lifestyl e: Who It WorksBeach f or, Who Shoul Look Elsew here This is a perfectly acceptable program that will work for most people, especially those who find very-low-carb programs to be unmanageable. It’s also perfectly suitable for those who just have an extra 10 or 20 pounds to lose. Those who have a lot more than 10 or 20 pounds to lose and those who are insulin-resistant might find a better fit with another program. The diet is often frustrating to people who prefer a lot more specific instruction about what they can and can’t eat. If you’re okay with more general g uideline s, you might like this pro gr am a lot.
JON N Y’S LOWDOWN
½
The dietary program is pretty much the same as the srcinal South Beach Diet. He’s still anti-saturated fat, he’s still pretty liberal on bread, he’s still ust a tad short of “cutting-edge” on the latest research on low-carb diets, and I still can’t figure out for the life of me what “Phase Three” is. But all in all, this is a very userfriendly program made a whole lot better by the addition of a very “doable” exercise program. It will appeal to a lo t of peo ple, deservedly.
28. SUGAR BUSTERS! H. LEIGHTON STEWARD, M.S., MORRISON BETHEA, MD, SAMUEL ANDREWS , MD, AND LUIS BALART, MD
WHAT IT IS IN A NUT SHELL Lower-carb for dummies—technically, it’s not a low-carb diet at all. A basic plan that essentially focuses on reducing or eliminating sugar from the diet. No counting of calori es, carbs, protein, or fat.
About Sugar Busters! Sugar Busters! was the brainchild of a Fortune 500 CEO and three respected New Orleans doctors—a cardiovascular surgeon, an endocrinolo gist, and a g astro entero log ist—whose success with this way of eating led to the publication of the book. Legend has it that it was srcinally a self-published manuscript that circulated, got enormous attention, and eventually landed the author s a real bo ok deal. The four basic premises of Sugar Busters! are r eally simp le. 1. Too much insulin w reaks havoc on our bodies and is a huge playe r in the weight-loss game. 2. Sugar produces insulin. 3. Sugar is toxic. 4. If you reduce sugar with t he Sugar Busters! diet, y ou will co ntro l insulin. Like many of the authors discussed in this book, the authors of Sugar Busters! subscribe to the theory that calories are not as important as the type of foo ds eaten. They cite a study fro m the American Journal of Clinical Nutrition that concluded that calorie intake alone is not sufficient to predict w eight gain o r loss in any given individu al. 8 They also subscri be to the theor y that it is not dietary fat that makes you fat, so m uch as it is di etary sug ar. (By now, you under stand the reason: excess carbohydrates fee d the pro duction mill for trigl ycerides, t he for m of fat that is sto red in the fat tissues. ) Not only does dietary sugar get converted into fat, but, as you remembe r fr om chapter 2, lots of sugar and carbs in the diet pro duce increased levels of insulin, t he hor mone that c reates fat st or age and blocks
fat-burning (technically called lipolysis). The authors say, quite correctly, that “we cannot survi ve without insulin, but we can survi ve a lo t better without too much insulin.” That’s a darn good quote. Dietary sugar is now reco gnized as an ind ependent ri sk factor for cardiovascular disease, largely through the mechanism of its effect on insulin secretion. Insulin also causes r etention o f salt (increasing blo od pr essure) and a thic kening of the ar terial walls (see chapter 2 fo r details). The author s state that it also causes enlargement of the left whichthe is development the chamber involved 99 percent o f hear t attacks, andventricle, that it causes o f plaqueinin or on the walls of blo od vessels. Glucagon, the sist er hor mone o f insulin, also pr oduced by t he pancreas, has the opposi te effect of i nsulin. It tells the body to br eak down fat. It is a “releasing” hor mone, not a “ storing ” hor mone. Glucagon tend s to ri se after a higher -pro tein meal and is inhibit ed by high levels of insulin. So it is no surprise that the stated purpose of the Sugar Busters! diet is this: controlling i nsulin by controlling sugar . To eliminate or reduce the sugars that are so detrimental to your health and your waistline, the author s r ely heavily on the glycemic index , a measure o f how quickly blood sugar is raised in response to a food (mor e on this in Jonny’s Lowdown). The author s state that knowledge o f the glycemic index is key to understanding the Sugar Busters! diet concept. There is a list of acceptable and unacceptable foods, based largely on the glycemic index. (This list of acceptable foods is way larger than that of many of the plans in Living Low Carb.) So far, so g oo d. The author s recommend a diet composed of natural, unrefined sugars; whole, unpro cessed grains; vegetables; fruits; lean meats; fiber ; and alcohol, in moderation. There ar e a few dozen fruits th at are all owed, as ar e whole-gr ain breads and pas tas, virtually all dairy products, lots of vegetables, and of course meats, fowl, and fish. There is no counting of car bs, calor ies, fat gr ams, or pro tein, but the author s do recomm end cutting saturated fats. Foo ds to avoi d include potatoes, whit e ri ce, all kind s of cor n, carr ots, beets, white bread, and of course sug ar. The authors state that if you follow their recommendations, you will wind up with a diet of about 40% carbohydrates (of the low-glycemic variety), 30% protein, and 30% fat (exactly what Barry Sears recommends in The Zone, though the authors of Sugar Busters! do no t credit h im).
They recommend not eating after 8 p.m.; and they also recommend eating multiple (three) meals, because they believe several small meals pro duce less over all insulin secretion th an one or two l arg e meals. They believe portion control is key, and they state that if you place proper servings on the plate, counting grams is not necessary. Other than offer ing g eneral r ules of what to stay away fr om, there is no specific “diet,” though they offer a sample 14-day meal plan and many recipes.
Sugar Busters! as a Lifestyle: Who It Works for, Who Sho uld Look El sewhere Sugar Busters! is not really a diet and is very loosely constructed. As an alternative to the standard American diet, it’s a move in the right direction. The basic concept—less white sugar and fewer foods that contain it—is a good one, though awfully simple, and not necessarily one that by itself will produce results in metabolically resistant people. If you need more structure, or if you are ver y carb-sensit ive or carb-addict ed, this is not the best place to start.
JONNY’S LOWDOWN It’s funny—when the first Sugar Busters! book came out, the conventional nutrition establishment (dietitians, etc.) attacked it for blaming sugar and insulin for overweight instead of putting the blame where it “belonged”— on calories. On the other hand, we on the “left wing” didn’t think very highly of the book because it didn’t go far enough. It’s filled with some half-baked concepts, such as the idea that fructose is a “good” sugar because it doesn’t raise blood sugar a lot (ignoring the fact that it raises triglyceri des more than any other sugar and actually rai ses insuli n through a different means). The book doesn’t—even in the newer edition—make any distinction between the glycemic index and the glycemic load, a difference that Livinga Low Carbabout will understand very fruit important age readers 187). Itofmakes big deal carrots but is allows juice (see and “whole-grain pasta” (let me know if you can find a real-life example of t he
latter). The first sample meal on day 1 is “orange juice, 1 package instant oatmeal with skim milk, Equal and coffee,” which is ridiculous from a glycemic and insulin-control point of view. But with that said, the authors are very clear that they tried to design their way of eating for compliance, not cheating. For most of America, it’s a step forward. People who are knowledgeable about carb intake, insulin resistance, chronic weight roblems, and the like will probably find this program far too lenient and somewhat unsophisticat ed. The stars are awarded for effort.
29. THE TNT DIET JEFF VOLEK, PHD, RD AND ADAM CAMPBELL , MS
WHAT IT IS IN A NUT SHELL n excellent program of low-carb eating and intense workouts particularly suited for guys.
About th e TN T Diet In the acknowledgements section of The TNT Diet, co-author Jeff Volek, PhD, RD, thanks Dr. Robert Atkins, calling him “a man of great vision” with the “perseverance and willingness to challenge the conventional dogma of the time at the expense of ridicule.” The reason for the acknowledgement to Dr. Atkins soon becomes clear. Volek has been resear ching lo w-carb diets for a long time, and—unlike most researchers—he’s an athlete and an exercise physiologist (and a Register ed Dietitian to bo ot). And he kno ws what he’s talking about—Dr. Volek is pr obably responsible for mor e careful, pub lished research o n low-carb diets than almost anyone else in academia today. His co-author is the noted feat ures editor for Men’s Health , Adam Campbell, an exerci se physiologist in his own right. Full disclosure: I am on the Editorial
Advisory Board of Men’s Health , and I work with Adam on projects from time to time. I firmly believe he is one of the most knowledgeable people writing about nu trition fo r the gener al public t hat you’r e likely to find. “Ther e!,” as Chris Rock would exclaim, “I’ve said it!” You know th is is no o rdinary “how to lose weight” book fr om the moment Volek and Campbell begin exploding some of the common myths of low-carb diets and e xercise. list:most “the body fat-burning zone.” The authors correctly outFirst that on youthe lo hit se the fat wh en you exer cise in the “carb- point burning” zone, exercising hard as you can fo r 30 to 60 seconds at a time. Busting the myth on the fat-burning zone—an urban legend if there ever was one—is an enterprise close to my heart. Early on in my career, I remember Daniel Koscich, PhD, then a major educational presenter for IDEA (one o f the major personal tr aining or ganizations in the count ry), saying, “If you want to lose weight, you should exercise as hard and as long as possible. ” Fatburning zo ne, hoo-hah! Volek and Campbell also take on the age- old myth that “fat makes yo u fat,” quoting research showing that people who get 60% to 70% of their calories from fat actually lose weight faster than those who get just 20% of their calories from fat! Behind the excellent practical advice in this boo k is this basic science: your body stor es both ca rbo hydrates (in th e for m of glycog en) and fats. But the glycogen stores are limited to about 1,800 calories. If you continue eating car bohydrate s once your glycog en tank is full, those carbohydrates have to be either used as immediate fuel, or stored by the body as fat. According to Volek and Campbell, by keeping glycogen stores low (with a low-carb diet), you prime the body to use fat as a fuel source. You become a mor e efficient fat -burning machine. The “TNT” i n the title stands for Targ eted Nutritio n Tactics. While a low-carb diet is defin itely at the cor e of their pr og ram, the au thor s show you how to maximize fat loss while buildin g muscle by inc or por ating “reloading” periods when you can eat carbs (even pizza!), and “musclebuilding” intervals that fuel your workout and help you recover. Their idea: use carbs most effectively to manipulate insulin levels, signaling your body to build muscle while not turning off its ability to burn fat. They emphasize what they call “well-timed ” carbs, as opposed to “ poorly timed”
carbs, a novel approach to the a ge-ol d pro blem of building muscle wh ile losing fat. The author s depart slightly fro m the conve ntional wisdom about “goo d” carbs and “bad” carbs. “While we certainly believe that some sources of carbohydr ates are better than others, we believe that the total amo unt of carbs, and w hen you eat t hose carbs, ar e mor e-impor tant factors to focus on,” they write. The TNT Diet r evolves ar ound the fact that there are “welltimed” carbs andyour “poorly-timed” carbs. “Eat carbsyour at the wrong time —for instance when glycogen tank is full—and body stops burning (and starts storing) fat,” they say. To address this issue, the TNT Diet takes a novel approach, focusing on what they call Time Zones. “The Fat B urning Time Zone” is a basic l owcarb diet that speeds fat loss and regulates yo ur appetite. You eat this diet most of the week. It includes all the vegetables, meat , cheese, and egg s you want (no wonder the Atkins folks love Volek!). An example of di nner? “A hunk of prime r ib served wit h a Caprese salad of tomatoes, mozzarella, and basil, and topped off with a glass of red wine.” The purpose of this “Time Zone” is to maximize fat-burning—and, surprisingly to many—to actually reduce your r isk for heart disea se. Then there’s the “Reloading Time Zo ne,” and this is wher e it gets interesting (and will probably gain more than a few converts). “The Reloading Time Zone” is basi cally a hig h-car b diet. You use this up to 2 days a week, depending on your goals. On this phase, you’ll eat plenty of pro tein and—believe it or not—lots of car bs includ ing “g uy favorites” like pizza, pasta, and ri ce. “Althoug h any type of car b is acceptable, we promote the healthiest ones, such as the 100 percent whole grain versions of bread, pasta and rice, as well as beans, sweet potatoes, yogurt, fruit and milk,” write the authors. How can the pro gr am pro mote a high-carb diet even for 2 days a week? Simple—for the very r eason many p eople shy aw ay fro m it—a surg e of insulin. Remember, this pro gr am is g eared toward people who are working out hard and trying to maximize muscle. And remember that insulin do es a number of things in the body, not all o f them bad. Just as it “escorts” sugar into the muscle cells to be burned as fuel (and into the fat cells, for those who ar e insulin-resistant ), it also escor ts the nutri ents like amino acids fr om pro tein foo ds r ight into the muscle cells. “It’s like your
internal traffic cop is no t only dir ecting these nutrients toward your pecs, lats and quads, it’s as if he opened up a couple of more lanes for them to travel,” write Volek and Campbell. Granted, you won’t burn fat as fast on the Reloading Time Zone. But your muscles will “so ak up carbs like a sponge,” causing them t o feel pumped and look larger almost immediately. “This is a great strategy to coo rdinate with a trip to the beach,” say the author s, while warning that the trick is en to avoid glycog tank. overeating th ose carbs and producing an “overflo wing” Finally, there’s the Muscle-Building Time Zone—a short period from an hour befor e you lift we ights to 30 minu tes after your training session. This phase is based on the well-established fact that there’s a “go lden hour” when your muscles just soak up nutrients right after a workout. The authors cite Australian research showing that men who consumed a protein shake just before and right after their weight workout gained twice as much muscle i n 10 weeks as guys who had the same shakes but downed them at least 5 hours outside their exercise session. How long do you stay in eac h Time Zone? D epends on yo ur go als. Ther e are actually five “Plans” (A thro ugh E), and you select the one that is most app ropr iate for you, depending in lar ge measure on how much weight you have to lo se. How long you stay in each “Zone” depends on what plan you’r e on. For example, if you’ve go t 25 or mor e pounds t o lose, you won’t be on the “high-carb” phase at all—unless you’re willing to go slower fo r the benefit of mo re flexibility (in which case y ou’ll choose plan C, which gives you 1 day a week on the high-carb plan). Though the book is clearl y aimed at me n, it has gr eat value for anyone wanting to tone up and lo se bo dy fat at the same time, som ething that Volek and Campbell claim is completely possible due to the science of nutrient artitioning . Nutrient partitioning r efers to the pro cess in wh ich calor ies are diverted away fr om fat cells and redir ected toward muscle cells. We alr eady know how to do this with far m animals; the question is, can we do it with humans? Accor ding to Volek and Campbell, the answer is a r esounding “yes.” Exercise is not incidental to this program, it’s central to it. There’s a ton of workout information, complete with photos and instructions on how to do all the muscle-building workouts.
It’s a terrific addition to any library and an especially valuable gift for the men in your life.
The TN T Di et as a Lifestyl e: Who It W orks for, Who Sho uld Look El sewhere Though diet-book to believewould his oragree her with program is good for every everyone, I thinkauthor Volek likes and Campbell me that this is definitely a book aimed at men, particularly guys interested in maximizing their muscle growth (and fat loss). Volek and Campbell both write regularly for Men’s Health , and it’s easy to s ee why—they’re ver y in touch with the needs of that audience. This boo k is definit ely best for men who ar e willing to wor k out hard and time their meals for maximum fat -burning and muscle gr owth. I’ve never been a fan of the “cheat day” philosophy, and while Volek and Campbell don’t call the “Reloading Time Zone” a “cheat day” (or two), it still allows an awful lot of foods that—for some people—can lead to addictive cravings. And for those who are really metabolically unsuited to a high i ntake of carbs, even the one o r two days a week on this phase of the plan might upset their blood-sugar applecart. Those wh o are insulinresistant, have tendencies toward carb addiction, and/or are not willing to work out hard—or not interested in it—might want to look elsewhere. Hard exer cisers who ar e into muscle-b uilding and fat loss will find a lo t here of g reat valu e.
JON N Y’S LOWDOWN
½
Solid research credentials and a sound grasp of the science behind lowcarb diets and exercise i nforms this book. It ’s a valuable counterpart to t he dozens of workout books that stress high-carb, low-fat diets. Men will benefit the most, particularly younger men for whom muscle-building and looking great at the beach is a high pri ority.
30. THE ULTRA SIMPLE DIET MARK HYMAN , MD
WHAT IT IS IN A NUT SHELL Exactly as advertised: a very simple basic program that’s relatively lowcarb, easy to follow, and nutritionally sound. It’s packed with great information about two factors t oo infrequently covered in other weight-loss books: toxicity and infl ammation.
A bout the UltraSimple Diet The UltraSimple Diet is one of a new generation of weight-loss boo ks— others include The Fat Resistance Diet and The Rosedale Diet—that focus on lesser-known but inc redibly impo rtant factor s in the weight-loss equation. In the case of The UltraSimple Diet , the culprits are twofold: toxicity and inflammation. “For many of you,” wri tes the author, Mark Hyman, M D, “toxici ty in particular may be frustrating your weight-loss attempts. You may be carr ying ar ound a truckload of toxins th at are disrupting your body’s natural mechanisms for health.” And getting healthy, as Hyman explains, is the key to losing weight. I’ve long been a fan of Mark Hyman. A former yoga teacher and “country doctor” who continues to practice in New England, he’s someone with impeccable cr edentials who is actively affili ated with the Institute for Functional Medicine, one o f the premier or ganizations br inging nutrition, medicine, and holistic healing together under one conceptual roof. His previous book— UltraMetabolism —was a best seller (deser vedly so ), and The UltraSimple Diet is a distillation of the principles of that book, applied to the task at hand— weight lo ss. “Just restricting calo ri es is a r ecipe for disaster and inevitably leads to failur e,” Hyman says. Accor ding to Hyman, toxicity can fr equently explain why people seem to reach a plateau or “hit the wall” when attempting to lose weight, where, after an initial drop in weight, further weight loss
proves next to impossible. “Unless you get rid of this toxic load,” he writes, “you might find yourself continually hitting this wall.” The UltraSimple Diet is subtitled Kick-Start Your Metabolism and Safely Lose Up to 10 Pounds in 7 Days. The usual objection to this kind of pro mise i s that when you l ose weight this quickly, it ’s “just water weight.” “The tr uth is that you want to lose water weight,” he says. “Inflammation and toxicity cause fluid r etention.” By cleaning up your system with this type of quickly. detoxifying and anti-inflammatory you will dropand—even fluid (and toxins) You’l l be on yo ur way to adiet, healthful weight more important—better health. After losing the initial toxic fluid and inflammation, you can continue to drop fat at the reasonable rate of about ½ pound to 2 pounds per week. So ho w do yo u do it? Simple. You take away the things that make you toxic and inflamed. The “major toxins,” according to Hyman, are not much of a surpr ise: coffee, sugar, alcohol, pr ocessed foo d, fast foo d, junk food, trans-fat s, and high-fructose corn syrup top the list. “By eliminating [these] major sour ces of inflammat ion in your diet—food allerg ens, sugar and flour products, and bad fats—your body can heal,” he promises. This book lives up to the promise of its title: it’s really “UltraSimple.” Here ar e the six basic steps in a nut shell: • Get rid of bad foo ds (i.e., those that create toxicity and inflammatio n). • Add go od foo ds (foods that are both det oxifying and ant iinflammat or y). • Detoxify (Hyman teaches you how to make a special cleansing and detoxifying “UltraBroth”). • Reduce Inflammation (here you use his recipe for “UltraShakes”). • Relax (“Take a fabulously rel axing and detoxifying ‘UltraBath’ every night before bed”). • Reflect (“Read and write in your journal abo ut what you’r e doing and how you’re feeling during the program”). That’s it. There’s a special recipe for a “liver-detoxification” cocktail to promote bile flow, some simple stress-reduction techniques, a very easy
exercise prescription (30 minutes a day of walking), and a few recommended nutritional supplements. Couldn’t be easier. Before starting, you take a Toxicity and Inflammation Quiz, designed to help you determine just how toxic and inflamed you really are. You’ll answer questions about common sympt oms r anging fr om nausea, constipation, and bloating to mood swings, energy, and headaches. The quiz takes only about 10 minutes to complete and should give you a good idea what you need toyou work on. Best all, you your pro grofess by seeing how score after of a week oncan themonitor pro gr am. Most people scor e sig nificantly better! According to Hyman, the toxic load you’re carrying—mostly, by the way, in your fat cells, where toxins tend to get stored—can undermine weight loss in a variety of ways: • By impair ing two key metabolic or gans—the thyroid and the liver • By damaging ene rg y-producing cellular struct ures called mitochondria • By harming br ain neuro transmitter and hor mone signaling tha t affects your appetite • By incr easing inflamm ation and oxidative stress, both of which pro mote weight gain A central part of the program is identifying food sensitivities, which Hyman (and others, including me!) believe are a huge part of the chronic health and weight problems many people suffer with. “Though they are real and well-document ed in medical literat ure, they a re generall y igno red by conventional m edicine,” Hyman sta tes. Part o f the benefit you’ll see fro m fol lowing this plan u ndoubtedly has to do with giving your body a break fr om “the usual suspects” for foo d sensitivities (and allerg ens)— gluten, dair y, yeast, eggs, co rn, and peanuts. Hyman gi ves an excellent and very easy-to-understand explanation of the difference between classic “allerg ies” and the far mo re common (and fr equently undiagnosed) fo od sensitivities or delayed food reactions that can easily sabotage weight loss. Like many of the plans in Living Low Carb, you’re a li ttle stricter during
the fir st “phase,” which in this case l asts just 7 (r elatively easy) days. A fter that, you go into “Reintroduction” mode. There’s a list of foods to “reintroduce” during Phase One Reintroduction (which continues over 2 weeks). After that, you’r e in Phase Two Reintro duction and you can begin to test your reaction to some o f those “usua l suspect” foo ds which for many people (but n ot all) ar e trig ger s for delayed food sensitivit ies. Hyman smartly suggests adding those foods one at a time so that you can really mo“foo nitords” yoare ur bo reaction to them. Some perdy’s manently banned—high-fructose cor n syrup, transfats, artificial sweeteners, and the like. Good riddance.
The Ul traSimple Diet as a L ifestyl e: Who It Works f or, Who Shoul d Look Elsew here This is a book that lives up to its name—it’s truly UltraSimple, especially if you don’t mind making a nice homemade soup/broth and whipping up a couple of rice protein shakes. Be aware that with the UltraSimple diet— like with most “detox” plans—there’s always the possibility of a short (but possibly uncomfor table) “healing cr isis” whe re you feel a l ittle cr ummy at first as your body gets rid of the stuff it shouldn’t be holding on to in the fir st place. So if yo u’re about to tac kle a huge pro ject or give an impor tant presentation, this might not be the week to try this program—you’d be better off waiting for a less stressful week . “Though mo st people can safely do th e pro gr am, there ar e a few people who sho uld not do it or should do it only under a doctor ’s supervision,” Hyman cautions. Among those for whom it’s not recommended are anyone with cancer or a terminal illness, anyone with kidney failure or bor derline kidney fun ction, an yone who is underweight or malnouri shed, children und er the age o f 18, and pregnant or nursing women. That said , virtually eve ryone could benefit from a pro gr am that stresses a reduction in toxic load and inflammation, and the book is worth reading ust for what you’ll learn about the impact of those two variables on weight and overall health.
Jonny’ s Lowdow n Hyman was co-medical director for Canyon Ranch, one of the premier health spas in the United States, and the program reflects that sensibility. It’s a program that easily could serve as the basis for a week at a spa: easy exercise, whole foods, nutrient-dense broths and shakes, and a healthy dollop of relaxation and reflecti on. What’s not to li ke?
31. WOMEN ’SH EA LT H PERFECT B ODY DIET CASSANDRA FORSYTHE, MS
WHAT IT IS IN A NUT SHELL An excellent plan for women that allows you to tailor the dietary component depending on your level of carb sensitivity, which you determine fr om some ver y smart quest ionnaires included in the b oo k. Stro ng o n both dietary i nfor mation and exercise, and highly recommended.
A bout Women’s Heal th Perfect Body Die t Without a doubt, this is o ne of the best diet an d exerci se boo ks ever. You might think of the Women’sHealth Perfect Body Diet as a kind of companion book to the TNT diet (which is more geared to men). It’s no coincidence that the books share a common sensibility, since the author— Cassandra For sythe—is a close resear ch associate of T NT Diet co-author Jeff Volek at the Universi ty of Connecticut. This boo k is sm art, well informed, and practical, and it contains incredibly useful information that reflects a great deal of what we’ve learned about low-carb eating these past years. It’s easy to see why th is bo ok will appeal to women and why it deser ves a wide audience. It begins with a foreword from the editor of
Women’sHealth, Kristina M. Johnso n, in which she states clearl y the goal s they had in mind when de ciding to publish a Women’sHealth official diet and exercise guide, goals that are likely to appeal to a lot of women: • The Women’sHealth Perfect Body Diet should be cust om-fit for every woman. (“After all,” she adds, “hormo nally speak ing, o ur bodies vary tremendo usly. I want the best plan fo r me.”) • The Women’sHealth Perfect Body Diet should make me feel strong. Not weak. Not starving . • The Women’sHealth Perfect Body Diet should be easy to m aintain as a perm anent lifestyle change. (“St udies show that 95 percent of di eters gain back the weight they lo se within 1–5 years,” she adds. “Give me something I can stick to for life.”) If these goals interest you, read on, because Cassandra Forsythe’s book delivers on its p ro mise. The “diet” is actually two distinct dietary plans. Forsythe recognizes that we’re hor monally and meta bolically differ ent, and that some people ar e go od at metabolizing sug ar (car bohydrate s) and some aren’t. Carbohydrate s ar e particularly detriment al fo r women who don’t metabolize them well, Forsythe correctly explains. “Too many carbs actually slow down your fat-burning furnace so that your metabolism is not running as hot as possible,” she says. A clue to which group you’re in (and which diet plan to follow) is found by looking at your body shape. You’ve probably heard about “apples” and “pears,” a common way of describing body types that focuses on where your fat is stored. “ Apples” are r ounder and ten d to store their fat around the middle. “Pears” are bottom-heavy and tend to store their weight around the butt and thighs. To this well-known dyad, F or sythe offer s a third bo dy type—“avocados.” These are folks who co uld go either way (mor e on this in a moment). It’s pretty well kno wn at this point that there are some peopl e who absolutely thri ve on a vegetarian diet w hile others dr ag ar ound all day feeling tir eddiet all the time; and feel somebloated peopleand absolutely ri ve there on a are highprotein while others heavy. th Clearly huge individual and metabolic differences in how we respond and adapt to
differ ent diet strategies . Your body type—apple or pear—actually says a lot about your metabolism and suggests wh at kind of dietary pr og ram you’ll r espond best to. To decide which of the tw o dietary plans to fo llo w, you take an ingenious test for “Carbohydrate Intolerance.” The test is simple. There are two breakfasts—a high-carb breakfast and a low-carb breakfast. On the fir st day (say, Monday), you eat the high-car b breakfast; o n the second (Tuesday), yousimply eat th eansw lo w-carb o ne. At timed inter vals after eating breakfast , you er a series of6easy questions r elating to how you feel—your energ y, your mo od, your hunger, an d so fo rth. (The whole process of answering the 10 questions probably takes less than 2 minutes, so even filling out the quiz six times is a time commitment of less than 15 minutes!) On Wednesday, you eat your regular breakfast and go about your business. You repeat the process on Thursday (high-carb breakfast) and Friday (low-carb breakfast) just to confirm the results, and you take an average o f your scor es for high-carb and low-carb days. (Incidentally, though the process may sound involved as you read this, trust me, it’s simpli city itself and takes very li ttle time.) Once you disc over your l evel of carb intolerance, you’re r eady to begin the program. (Incidentally, there’s nothing like actually experiencing the comparison between how you feel with a high-carb breakfast versus how you feel with a low-carb o ne. Experiencing it for yourself is better than any theoretical explanation, and will help mo tivate you to stick with the plan that’s best for your metabolism.) Apples are also mo re likely to scor e higher o n the “carb-intoler ant” scale and should start on the Greens and Berries Plan (see below). Pears, on the othe r hand, can usually tolerate r elatively higher levels of car bs, and should begin on the Grains and Fruit Plan (see below). Those avocados among you who could go either way will lear n a lot fro m doing the 5-day breakfast test , and it will be pr etty clear which plan to start o n. The go od news is t hat you r eally can’t go wrong on either plan; and if one doesn’t quite wor k, you can adjust it t owar d the other. The Greens and Berries Diet (best for apples) is the one that’s lowest in carbs, most o f which come fr om—as you might expec t—gr een veget ables and berries.
Here are the specifics:
The Greens and B erri es Diet (for Appl e Shapes) 20–30% carbohydrates 35–45%fat 30–35%protein
90–125grams 60–70grams 120–140grams
The Gr ains and Fruit s Diet is similar to the Zone in its distribut ion o f pro tein, fat, and carbohydrates , and it allows for some g rains and a w ider variety of fruit. Here are the specifics:
The Grains and Fruit Diet (for Pear Sha pes) 35–45% carbohydrates 25–35%fat 25–35%protein
150–180grams 50–55grams 100–120grams
Two things become immediately apparent, both of them good. One, there’s a range of r ecommende d percentages, allowing for some flexibility within the plans and discouraging too obsessive an approach to meal planning. Two, both plans have considerably fewer carbohydrates than the averag e American diet, and consider ably fewer than the u sual amount recommended ac ro ss the board by or ganizations li ke the American Dietetic A ssoci ation. And that’s good news. There’s more Never secret ingredient inRead the Women’sHealth Perfect Body Diet: glucoone mannan. hear d of i t? on. If you skip ahead to chapter 9, Supplements and Diet Drugs, yo u’ll
notice that there’s o ne sing le supplement that trumps all the others when it comes to weig ht los s: fiber. And that’s exactly what gluco mannan is. “It makes your stomach full wit hout adding any extra calor ies to yo ur diet, and it’s an indispensable tool for helping you stick to the Perfect Body Diet,” For sythe says. The benefits of fiber are leg ion, and I recount some o f them in chapter 9. Suffice it to say that using g lucom annan is a terr ific i dea. It’s the most sol uble help fibering found it can expand tofeel 100full times its o wn weight, yo uin tonature: eat fewer calor ies and lo nger. Thewater book tells you exactly how to add this super fi ber to your diet easily. Come to think of it, supplementation with fiber from glucomannan isn’t a bad idea for people on any diet. The boo k also co ntains an exce llent exercise section for strength building and toning that is photographed and described well.
Women’s Heal th Perfect Body Diet as a Life styl e: Who It Wo rk s for, Who Should Look Elsew here This is an all-aro und excellent fit ness-and-diet boo k for women, probably one of the best I’ve ever seen. While there are very good exerciseandfitness books around, many of them are lacking in the kind of thorough, well-thought-out and scientifically accurate nutrition program that Women’sHealth Perfect Body Diet offers. Similarly, many good nutrition books are a little light on the exercise component. This one has both, and, as such, it’s har d to think of a woman who woul dn’t benefit.
JONNY’S LOWDOWN smart, well-written, scientifically accurate program that takes into account individual differences and offers two distinct plans, depending on our level of carb intolerance. Both plans are excellent, with one plan being a little higher in carbs than the other. Both plans permit some flexibi lity and within the ranges recommended amounts of protein, carbs, and fat, should appealof the to people wanting to individualize their rograms.
The exercise pr og ram is terr ific, the explanations ar e clear, and t he information about both nutrition and exercise is first-rate. I especially like the way they make use of the fiber supplement gl ucomannan and integr ate it into the program. Bonus points for an excellent recipe section.
32. YOU: ON A DIET MEHMET C. O Z, MD AND MICHAEL F. ROIZEN , MD
WHAT IT IS IN A NUT SHELL good solid all-purpose book on eating and exercise by two of the most respected doctors in America. While it’s not a low-carb approach by any means, it’s an eating plan that is light-years better than the typical merican diet. Benefits from the extremely user-friendly, conversational tone of these best-selling authors.
About YOU: On a Diet The first thing you need to know about YOU: On a Diet is that the “Diet” part is far less central to this book than the “ YOU” part. In fact, if you’re looking for the actual “diet,” you won’t find it until chapter 12, the very last chapter in the book, which should give you an idea of its importance (not very). Far more central to the book’s mission is to teach you what you need to know about how your body works, how it gains (and loses) both fat and health, and what you can do to tip the scales in the rig ht directio n. YOU: On A Diet is one o f a fabulously success ful series o f “YOU:” boo ks by the fabulously successful Mehmet Oz, MD (he of Oprah fame) and his writing partner, Michael R oizen, MD. (The o thers ar e YOU: The Owner’s Manual, YOU: Staying Young, and some assor ted spin-offs li ke the YOU: Staying Young Workout.) All the books seem to go immediately to the Amazon best-seller list, where they take up permanent resi dence.
Unlike many other popular publishing mega-hits, they actually deserve their success. Mehmet Oz is the Suze Or man of health (or perhaps i t’s the other way around—Suze Or man is the Mehmet Oz of f inancial advice). H e has a way of breaking stuff down for you and making even complex processes fun to read about and interesting . He’s one of the smartest doctor s I know, he’s fri ghteningly cr edentialed (Harvar d University gr ad, a cardiothoracic surg and professo r Medicine of car diacProgram surger yatatNew Columbia Un iversity, founder of theeon Complementary York-Presbyterian Hospital, and holder of an MBA from Wharton School of Business, which one assumes he picked up in his “spare time”), and he has a gift for communication, a great sense of humor, and a terrific writing style. He’s not stuffy or pompous, and—possibly most important of all—he’s a gifted healer. I have nothing but respect fo r Dr. Oz and consi der hi m a national treasure. YOU: On a Diet is a book about your body and how it w or ks—and (only incidentally) about how to lo se weight. It’s hardly a lo w-carb diet boo k, but it is packed with such good information and it’s so comprehensive and accessible that I felt it had to be i ncluded in this chapter. The Introduction comes out swinging, and the target is the bad (or let’s say woefully incomplete) information most of us have been fed about weight loss all our lives—starting with the idea that the “secret” of weightloss success is simply to eat less and sweat more. “Straightforward enoug h,” say the author s, “[b]ut if it r eally wor ked that way, our bodies wouldn’t be large enough to be spotted by Google Earth.” No, say the author s, most diets hav e it all wrong . “When it comes to dieting, tryi ng to whip fat with [the] weapon of willpower is the food equivalent of holding your breath under water,” say the author s. “You can do it fo r a while, but no matte r how psyched up you get, at some point y our body—your biolo gy—for ces you to the surface gasping fo r air.” Hearing this fr om such an est eemed source has go t to be welcome validation for the thousands of people who have failed miserably on di ets and feel there’s go t to be a better way. We could debate the pros and cons of willpower, and—believe it or not —there’s a lot to be said on both sides of the argument. (One psychologist, Deirdre Barrett, PhD, made a brilliant and unconventional case for the
willpower arg ument in her excellent b oo k Waistland: The (R)evoluti onary Science Behind Our Weight and Fitness Crisi s. But I digress.) Oz and Roizen’s philosophy is that the “secret” of dieting is to work smart, not hard. They argue that if you “look under the hood” and really understand the systems that make our bodies fat, as well as the ones that “slam the brakes on those danger ous co okie-and-ca ke collisio ns that take place every day,” you’ll be harnessing your body’s natural bio log ical for ces (like l hor mones) to assist or king body ratherappet thanite-contro fighting it—and be better ableyou, to crw eate a leanwith andyour healthy you. YOU: On a Diet is the textbook on your body you wish you’d had when you took hig h-schoo l bio log y. Take chapter 2, “The Biolo gy o f Fat,” for instance: it’s got a terr ific s ection called “T he Anatomy o f Appetite” that literally explains—w ith terri fic i llustrations and fr iendly and amusing examples—how the brain wo rks to cr eate satiety. You’l l learn which biochemicals stimulate the brain to increase metabolism and reduce appetite (and which ones have the oppos ite effect). Or consider chapter 3, “Eater ’s Digest,” which takes you on a tour of what happens in your digestive “highway”—how your body breaks down nutrients, and how and why different kinds of foods have different metabolic effects. There ar e also terri fic explanations of co mmon pro blems shared by many people who struggle with weight, such as thyroid issues and GERD (gastroesophageal reflux disease). Subjects like inflammation, toxicity, and the appetite-affecting ho rmone l eptin, which ar e the central issues i n books like The Fat Resistance Diet, The UltraSimple Diet , and The Rosedale Diet ar e cover ed here as well, in easy-t o-understan d language. And there’s a good section on the role of stress in health and weight. And what about the diet itself? W ell, i t’s har dly r evolutio nary, but it is easy to fo llo w. You’l l eat standard “healthful” fare l ike oatmeal, salad, soups, whole grains, nut butters, salmon, and chicken. There are sample menus, eating plans, and a lot of options for snacks (and even a dessert every two days). There’s even a sectio n called “When You Need the FastFood Fix” tha t helps you do damage control in r estaurants like McDonald’s and Domi no’s Pizza. All in all, a ver y “guy-fr iendly” program that can get you healthy (or at least healthi er), one that doesn’t leave you feeling like the only hope is to move to a Yoga Ashram and eat macro biotic food all day .
Is there stuff in her e to quibble with? You bet. You’l l find a fair amount of residual pr ejudice against meat, a lot o f unquestioning cheerleading for “whole g rains,” even a recommendat ion fo r Cheerio s as a breakfast optio n. But there’s so m uch “go ld in them thar hills” that I’m rel uctant to dwell too much on these minor points of variance with my own views. Basically this book is a winner, even if the recommended diet is not exactly the perfect “hunter–gatherer” fare.
YOU: On a Diet as a Lifestyle: Who It Works for, Who Sho uld Look El sewhere This is a terrific book that would make a great addition to the library of any person interested in how the body works. It’s fun, it’s filled with terrific illustrations, pop-culture and sports examples, and analogies, and it’s eminently r eadable. If you’re a generally healthy person who wants to make some relatively easy changes, understand why you’re making them, and manage your waistline, this is an easy plan to f ollow. Like Eat, Drink, and Weigh Less (see page 165), it com es with the added bonus of being written by an impeccable, highly respect ed source, so you can feel confident of being o n solid g round and you’ll never have t o “defend ” yourself fo r being on a “fad” diet or for bucking the dietary establishment. And for the infor mation alo ne—which ranges from explanations o f GERD to stress to hormones to appetite—it’s worth the price of admission. But I don’t think it ade quately addresses the needs of people who are truly metabolically resistant or carb-intolerant. People with a lot of weight to lose—especially those who have had an impossible time of it with conventional di ets—may not find what they need here in ter ms o f an overall weight-loss plan. If you’re insulin-resista nt, have serio us issues with blood sugar, are carb-addicted, or can’t lose weight with conventional pro gr ams (even ones like this, w hich don’t de monize fat), you should pro bably loo k elsewhere.
JON N Y ’ S LOWDOWN
This is a very “different” kind of diet book—both in its focus on detailed information about how your body handles food, and in its focus on the whole person. Oz and Roizen are clearl y fr om the philosophical schoo l that believes knowledge is power—if you co uld clearly see what smoking does inside your body and understood in depth the damage it does to every cell and every system, it would be easier to throw away your cigarettes. And if you could clearly understand whyyou’d somenaturally foods stimulate storage, energy, and create cravings, gravitatefattoward thezap healthful choices that do just the opposite. Maybe, maybe not. Certainly we wish it would work that way. The book is really a terr ific little d esk encyclopedia for those who ar e interested in w hat goes o n inside our bodies in g eneral, and particu larl y in the fate of the foo d we eat and what happens to it once it passes o ur lips. There ar e terr ific sections o n the ro le of stress, as w ell as sect ions o n mental and emotional health and their contribution to fat gain (and loss). And a very decent section on exercise, as well as an appendix full of easyto-make recipes. Buy the book (or one of the others in the series like YOU: The Owner’s Manual) just for the fabulous information on how the body works. But if you’ve st rug gled with weight loss fo r what seems like fo rever, and if you have a lot of weight to lose, you’ll probably get better (and faster) results with a more structu red (and lower-carb) pro gr am.
33. THE ZON E BARRY SEARS, PHD
WHAT IT IS IN A NUT SHELL n eating plan consisting of 40% carbohydrates, 30% protein, and 30% fat. Zone orthodoxy calls for eating five times a day—three meals and two snacks, each of which should contain the 40/30/30 distri bution.
About the Zone Tell Barry Sears, creator of the Zone, that his eating plan is a hig h-protein diet, and you’re likely to be met with either an icy stare or a frustrated sigh, depending on his mood. Most often, you’ll get a resigned explanation that you sense (correctly) he’s given a thousand times. “The Zone,” he says patiently, “is not a hig h-protein diet : it is a pro tein-adequate diet. The amount of recommended on The the Zone is very similarand to what Americans areprotein currently consuming. amount of fruits vegetables that are recommended on the Zone diet is nearly three times the amount recommended by the U.S. government, even though the amount of total carbohydrates is lower.” He’s got a point. This just might be the most misunderstood and falsely maligned popular dietary approach of all time, considering the fact that it has probably had the most influence on changing the dietary tenor of the times, especially in alter ing the pr evailing attitude about fat as the demon behind obesity and disease. L et’s go over just what the Zone is and what it isn’t. The Zone is not a high-protein diet , despite the fact that critics—
who never in to popular have read the book—continue refer to it on as such,seem especially magazines. The amountto of protein the Zone diet could hardly be considered high (except by the intransigent right wing of the dietary establishment, the American Dietetic Association). On a 1,500-calorie diet, 30% protein—the amount recommended by Sears—works out to 112 grams of protein (roughly 16 ounces) a day. That’s about 4 ounces per meal and 2 ounces per snack for the average man, nowhere near an excessive amount. The Zone is also not a low-carb diet. Do the math—you’re always eating slightly more carbohydrates at every meal than you are eating protein or fat. In fact, 40% of your meal is
carbohydrates, the same 1,500-calorie 150 grams of carbs ayielding, day. Justwith for comparison, Atkins only intake, allows 20 grams per day on the induction phase of his program. The Zone
allows more than seven times that amount. The Zone diet gets most of its carbohydrates from fruits and vegetables and uses the starchy carbohydrates—breads, pastas, rice, cereal, and the like— sparingly: almost, says Sears, “as condiments.” The Zone was never meant solely as a weight-loss diet. It was designed to reduce heart disease through the control of inflammation, and its success and popularity surprised Sears as much as anyone. The fact that so many people lose weight and feel terrific on it—and that it has been adopted by a number of celebrities—put it in the public arena and made Sears either a hero or a monster, depending on what academic pundit you listen to.
The Theory Behind the Zone: A Short Lesson in Nutritional Endocrinology Think of your body and its organs, glands, hormones, and other chemical compounds as one huge biological Internet, where messages (sometimes conflicting ones) are constantly being sent out, received, interpreted, misinterpreted, and acted upon. Hormones are particularly potent messengers; when you receive a message from a hormone in your biological e-mailbox, you pay attention. Insulin is a hormone—a major one. It’s secreted by the pancreas in response to the increased blood sugar that you get after you ingest food (particularly carbohydrates). Insulin is intimately tied to levels of blood sugar. If you eat a Snickers bar, your blood sug ar ri ses and the pancreas says, “ Uh-oh, dude ate a Snickers; let’s get to work .” It secretes some insulin. The job of that insulin is to bring the blood sugar back down into the normal range. It does this by “escorting” the sugar out of the bloodstream and into the cells. According to Sears, excess insulin is the culprit behind skyrocketing rates of obesity, a premise he shares with all low-carb diet writers. There are two basic ways to raise insulin levels. One is to eat too many carbohydrates. The other is to eat too much food. Americans do both. The word “zone” in the title actually refers to an optimal range of insulin leve ls. The diet c laims to keep insu lin levels fro m r ising too high by repl acing so me of the carbs in the typical Amer ican diet with fat (which
has no eff ect on insulin) and pr otein (which has some ef fect, but not as much as carbs). The balance among carbs, protein, and fat at each meal and snack is designed to prevent blood-sugar levels (or insulin levels) fro m g oing too hig h (or too lo w). This, combined w ith the fact that the diet is not too hig h in calor ies, is responsible fo r the weight-loss effects of the diet. The health effects of the diet are caused by a different—though related —pathway. Remember that the wasfield birthed in the midst a highcarb, low-fat diet mania. AllZone of usdiet in the of nutrition wereof seeing clients who had virtually cut fat out of their diets (and almost always replaced it with carbohydr ates). They thoug ht they were eating healthfully. It was not unusual in those days (and even no w, for that matter) to see a woman eating a bagel and or ange juice for breakfast , a salad for lunch, a nonfat frozen yog urt for an afternoo n snack, and pasta for dinner, then wondering why she wasn’t losing weight. The Zone almost singlehandedly put the argument for inclusion of good fats in the diet back “on the table.” And it is thro ugh the inclusio n of this fat that the Zone diet is thought to have one of its most significant health effects. Here’s how it works. The body makes an entire class of “superho rmo nes” called eicosanoids out of the “raw mat erials” o f essential fats. Eicosanoids are made by every one of the 60 trillion cells in your body. They don’t cir culate in the body—they’re made in a cel l, they do their action in the near by vicinity, and then they self-destr uct, all within a matter of seconds, like those little tapes they used to give Peter Graves on Mission: Impossible—so they are virtually undetectable in the bloodstream. But their importance on human health is incalculable. The 1982 Nobel Prize in Medicine was awarded for eicosanoid research. Your doctor may not know much about eicosanoids, but he or she has undoubtedly heard o f pr ostaglandins. Pro staglandins ar e eicosanoi ds made by the prostat e gland and w ere o ne of the first gr oups of eico sanoids to be studied. The type of fat you eat influences the kinds of eicosanoids you make. Eicosanoids come in many “flavor s” and types, but for our purposes we’ll identify two major classes: the “good” and the “bad.” The good are responsible fo r preventing blo od clo ts, reducing pain, and c ausing dilat ion (opening) o f the blood vessels, among o ther things. The ba d are
responsible for pro moting bloo d clots, pro moting pain, and causing constriction (closing) of the blood vessels. The point is not t o g et rid of all the bad ones, but to have a balance between the good and the bad. (For example, if you didn’t have eicosanoids that promoted blood clots, you would bleed to death from a minor wound.) Aspirin works by knocking out all eicosanoid pr oduction fo r a while, which is a litt le like killing a fly with a sledgehammer. Corticosteroids do the same thing. The fat included in Zone diet spe cifically of go od eicosanoi ds and an the optimum balance betweenfosters t he gothe od creation and the bad. The insuli n connection i s this: insulin stimulates t he key enzyme involved in p ro ducing arachidonic acid , which is the “building material” of the bad eicosanoids. So by controlling insulin levels with the Zone diet, you not only lose weight, you also reduce many of the symptoms and health risks that come fro m an imbalance of g oo d and bad eicosanoids. The pro mise of the Zone is th at controlli ng insulin will result in increased fat loss, decreased likelihood o f car diovascula r disease, and gr eater physical and ment al perfo rmance. By contro lling eicosanoids, you will have decreased inflammation and increased blood flow, which will help impro ve virtually eve ry chro nic disease condit ion and impr ove physical performance.
So, What Can You Eat? A lot. The best protein choices on the plan are skinless chicken, turkey, all kinds of fish, very lean cuts of meat, low-fat dairy products, egg whites, tofu, and soy meat substitutes. For carbohydrates, Sears likes all vegetables except corn and carrots and all fruits except bananas and raisins. The heavy starches, such as pasta, bread, cereals, rice, and the like, are used very, very sparingly. For fats, use olive oil, almonds, avocados, and fish oil. It’s reall y simple to m ake a Zone meal, actually , and doesn’t requir e a lot of complicated calculations. All you have to do is divide your plate into thirds. On one thir d of the plate, put some low-fat protein—a typical portion would fit in the palm of your hand and be about the thickness of a deck carOnce ds. Then l thewhile, other two ds of thethirds platecan withcovegetables and frof uits. in a fil g reat par tthir of that two nsist of pasta or rice, but again more as a condiment than a main dish. Add a dash of fat,
and you have the basic Zone meal .
The Zone as a Lifesty le: W ho It Works for, Who Should Look Elsew here The one cr iticism you hear about t he Zone fro m the averag e perso n is that it is difficult to follow.that’s Technically, if you’re forreally the exact proportions of 40/30/30, correct. The fact is trying that you don’t have to achieve Zone-perfect proportions to get the beneficial effects—an approximation works perfectly well—but the lack of precision may be a problem for people who like their diets very exact and specific. Some people find that thinking about food in terms of Zone “blocks” is cumbersome. If you happen to love doing the math, and the computations of g rams, calor ies, and so o n is somethin g yo u eat for breakfast , this is the perfect die t for you. This is a g reat pro gr am if you ar e not overweight bu t just want a healthful way of eating th at will in all likelihood r educe your ri sk for a number of unpleasant diseases and conditions. If you are only moderately overweight and believe you are not insulin-resistant (i.e., do not have a particular problem with carbohydrates), it’s a great way to eat, but you will have to watch calor ies. If you are ver y over weight or very sedent ary—or both—this pro gr am is pro bably too high in car bohydrate s for you, and you might be b etter o ff using one of the mor e carb-limited p rog rams (such as Protein Power or Atkins), at least to begin with. The other thing to consider is whether you can tolerate this level of carbohydrate. If you ar e carb-addict ed, getting 40% of your calor ies fr om carbs may seem out rageously high. The pro gr am does allo w things that trigg er carb cr avings—like bread and even p asta, albeit in small amounts —but for some people, small amounts are too much. Remember, it is entirely possible to create Zone-perfect meals using only vegetables and fruits as carb sources, and if you can live with that, you will do fine.
JONNY’S LOWDOWN It’s hard to underestimate Dr. Sears’s contribution to the current nutritional
zeitgeist. He almost single-handedly forced the dietary establishment to reevaluate the prohibition on fats. I have a few minor disagreements—I don’t believe saturated fats from natural sources like butter and eggs are a roblem, and I also don’t agree with his position that supplements aren’t necessary if you are eating correctly (a position, to be fair, that he has modified considerably in recent years). That said, the Zone template o 40% carbs, 30% protein, and 30% fat is darn close to ideal as a starting ointnot forina the healthful I’mall” a huge in biochemical individuality and “one diet. size fits dietbeliever mentality, but we still need a basic template from which to individualize our diets; the Zone is as good a basic template as exists anywhere. Some people may need fewer carbohydrates; some may even need more. But the 40/30/30 plan sure beats the USDA Food Guide Pyramid as a place from which to begin constructing an individual diet plan.
FITNESS B OOKS—SHORT TAKES Every week, it seems, a new “get in shape” book hits the stands, each promising the answer to the question: how do I get in shape as quickly as possible? Since it’s impossible to change your body without tackling your diet, most of these books o ffer dietary advice—or even an entire dietary pro gr am. But unlike the oth er pro gr ams covered in this boo k, these pro gr ams are primar ily focused on ex ercise and fit ness. True, many of the “diet books” I review in Living Low Carb have exercise components, and some of them even have well-thought-out fitness programs that are integral to the plan. But they’re still essentially books on nutri tion and diet . The boo ks in this sect ion ar e primar ily boo ks on fitness. And yes, there’s an overlap; and yes, some books could have fallen into either categor y; but if an aut hor is pr imari ly known as a fitn ess pro fessional r ather than a nutritionist , I included him or her in this section. My primar y purpose her e is to evaluat e for you the nutritional compo nent of the plans discussed, alth oug h I’ll tell you what I think of the exercise pro gr am as well. Fair warning : I’m much mor e predisposed to
like the exercise gurus who admit they’re no experts on nutrition and don’t try to be; I’m much less predisposed to like the ones who pretend to know everything. Interestingly, it’s the latter group that aggressively promotes the worst and most out-of-date infor mation. And one more thing. I’m including these books because many readers will use a fitness-oriented book to get in shape rather than a diet-oriented boo That’s fine. I just want you to kno w which o nes have decent dietary infok. and which ones don’t.
34. Maki ng t he Cut JILLIAN MICHAELS Jillian Michaels rose to fame by being the trainer on the hit TV show The Biggest Loser . Her fitness book has a lot of the same wisecracking sassy charm that she has on the show. The dedication is “To The Inner Badass Living Inside Us All,” which should pretty much tell you all you need to know! It’s fitness (and diet) with an attitude. Andarit’s not half bad! There e seven basic rules. • Stick to your magic number (i. e., figur e out how many calor ies you need and stick with it) • Eat for yo ur metaboli c type (mor e on this in a moment—it’s the key to the dietary par t of the pro gr am) • Eat every four hour s, and no skipping meals • No Processed or J unk Foo ds—Perio d! (Love the “Peri od!” with an exclamation point—nice touch) • Beat the Bloat—Sodium and Water Consumption (gui delines for consuming bo th) • No Booze
• Get It in Writing (you’re go ing to kee p a foo d diary) The key to the whole dietary pro gr am is r ule number 2, eatin g fo r your metabolic type. Now, let’s be cl ear: discussing the whole concept of metabolic type (and the controversies around the different systems for determining it) would fill another book. The point here is that “one size doesn’t fit all,” and Jillian gets points for embracing this. Her take on the issue is to divide p eople into th ree bro ad metabolic g ro ups—Slow Oxidizers, Fast Oxidizers, and Balanced Oxidizers—and to provide different diet ary g uideline s fo r each. The terms “slow oxidizer,” “fast oxidizer,” and “balanced oxidizer” didn’t or iginate with Michaels—they’ve been around since the fir st system of “metabolic typing” started coming out, and nutritionist Oz Garcia used the same division in an ear ly boo k called The Balance. “Oxidizer” is r eally shor thand for metabolism, and you could r ead “slow oxidizer” and “fast oxidizer” as code for “slow” and “fast” metabolism, with “balanced” being a kind o f middle-of-the-roader. (M y go od fr iend, nutritionist and naturopath Glen Depke, created an interesting variation on it called “Nutritional Typing,” which I discuss in my bo ok The 150 Most Effect ive Ways to Boost Your Energy). The point is that different people respond differently to different combinations of protein, carbs, and fat; and, according to the premise of Making the Cut, you can get much better results by determining which “category” you’re in and then eating appropr iately (as opposed to simply follo wing a “o ne size fit s all” diet ary plan). You determine which group you’re in by taking a test given in the early part of the book. Once you know your “type,” you simply follow the plan. “Slow oxidizers” require a hig her percentage of carbs to lo se weight and feel energized, “fast oxidizers” do better on a lo wer-carb (higher -pro tein) program, and “balanced oxidizers” are in between. She’s got shopping lists for each of the three types plus sample menus, and she’s not dogmatic about any of it, which is good. There’s plenty of good stuff in here about the mind–body connection. And the exercise program is excellent, with plenty of variations, as you’d expect fro m a top trainer.
It’s a 30-day pro gr am, clearly aimed for people wh o want to dr op the “last stubborn 10–20 pounds.” People who are really insulin-resistant or considerably mor e overweight might n eed a more structu red lo w-carb pro gr am, but for many people— especially those wh o resonate with Michaels’s “no nonsense, empowerment” philosophy, this book will be ust what the doctor ordered.
35. T he 5-Factor Di et HARLEY PASTERNAK I have an editor friend at Men’sHealth who once told me that he has a shor thand way of evaluating the dozens o f diet and fitness books that come his way to review every week: he simply picks a subject he knows a lot about, then goes to the section of the book where the author discusses that topic. He can tell pretty quickly whether the book is any good or not. I didn’t have to look very far for my “representative chapter.” Chapter 2 of The 5-Factor Diet is titled “Why Low Carb Diets Don’t Work.” And it’s pretty darn awful. In paper fact, the chapter mightevery have myth, been lifted a high-school term in whole dietetics. It repeats everyfrom untruth, and every party line ever stated by the mor ibund American Dietet ic Associatio n, and there isn’t an srcinal thought in it. Some samples: “Instead of losing fat you’re losing muscle and water,” he tells us authoritatively, even though all the resear ch by Jeff Volek, PhD, RD and others has sho wn just the oppo site. Want mor e? “Low carb diets ar e hig h in saturated fat, ” he tells us, despite the fact that many low-car b diets ar e extremely low in saturated fat (unnecessaril y, in my opi nion). And of cour se, the stupidest and least infor med line of all: “L ow carb diet s raise your cholestero l level and increase your risk of stroke, heart disease and diabetes” (that last one is particular ly funny, and as a statement of fact it’s right up there with “the earth is flat”). Pasternak also reminds us that “low carb diets can cause a permanent loss of kidney function ,” a complete misr eading o f a study that showed that people with existing kidney disease should not overdo protein. (As I point
out on pag e 112, there is no t a single publi shed study anywhere in the liter ature that indicates that low-carb diets impair kidney function in any way—for people with healthy kidneys. His statement is l ike saying that because a person with a br oken leg shouldn’t do aer obics, aero bics caus e bro ken legs.) He even calls The Zone a “rigid high protein low carb diet” when even his most conservative colleagues and opponents of low-carb have stopped calling that. Therthat e’s not a wor d about heisrepeats the mantofra that the it only thing c auses weight lossinsulin—and on T he Zone the r eduction calories. The whole “selling poi nt” of the pro gr am is that you eat five t imes a day. Now you know. Harl ey Pasternak is a good-lo oking young Holl ywoo d trainer who lucked out with some terrific marketing and an A-list of superstar clients, which evidentiall y has caused him to think that he knows a gr eat deal about nutrition. He doesn’t. The book g ets a star becau se the exercise pro gr am itself is okay (although nothing remotely innovat ive or unusual) and th e fo ods he does reco mmend are not bad . And because I’m feeling generous.
36. The 3-Hour Diet JORGE CRUISE I’m not r eally sur e what the difference between t his bo ok and The 5-Factor Diet is—the big “concept” of the 5-Factor Diet is that you eat five times a day, and the big “concept” of this one is that you eat every three hours. If someone could point out the difference to me, I’d appreciate it. It’s hard not to compar e this to The 5-Factor Diet , because they have so much in common. They h ave the same for mula: take one go od-loo king, media-friendly trainer with some celebrity clients, add book deal, and market brilliantly. Both are written by trainers with enormous selfconfidence who know somewhat less about nutrition and metabolic
complexity than they think they do, and both are fairly ordinary books that did incredibly well. The 3-Hour Diet is basically a g oo d magazine article stretch ed into a full-length book. The premise—eat ev ery three ho urs—is no big deal and certainly no magic formula, though it may be a structure that helps ward off hunger and overeatin g fo r some people. F or others, like th ose who respond with a ton o f insulin to every m eal, it may not even be t he best idea. The fir st half o f the book is text ; the rest is basically a jour nal you write in, where you keep track of the meals you eat every three hours. Cruise’s ear lier success, 8 Minutes in the Morning , was an exercise book that was geared toward getting the most out of a minimal comm itment to exer cise, and was actually quite go od. Here he explains that he wrote The 3-Hour Diet for people who didn’t want to exercise but still wanted results. (Maybe his next book will be for people who want results and don’t want to exer cise or diet. Just kidding.) Full disclosure: I know people who know Jorge quite well, and from all reports he’s a terrific guy, very dedicated and very sincere. I don’t doubt that for a minute. What anger s me is when a trainer claims to have “the answer” about nutrition and pro ceeds to trash the pr inciples of low-carb eating without unders tanding them very well. So if I’m hard o n this boo k it’s onl y because it makes me mad. With all his influenc e, Cruise could be a r eal for ce for change i n the way Americans think about diet an d exer cise; but—in this boo k, at least—he misses the boat and blows a terrific opportunity. Example: he proclaims with utter confidence and authority that “Low Carb Diets Make You Fat” (huh?) and pro ceeds to list all the things that low-car b diets can “cause, ” including (I’m not making this up) loss o f fer tility and a shor tened lifespan. (Interesting ho w he would know the effect of a l ow-car b diet on lifespan, since there’s no o ngo ing study anywhere that’s even investigated that, much less demonstrated it.) Sorry. Because of the total misinformation on low-carb eating—and the aggressiveness with which it’s put forth—it’s very hard for me to reco mmend this book.
37. Deadli ne Fi tness GINA LOMBARDI This book is a refreshing change—an excellent “get in shape” book by a Hollywood trainer who is actually humble about what she knows, doesn’t pretend to be expert at what she doesn’t know, and is great at what she does. Gina Lombardi, truly someone worthy of the much-abused title “Trainer to the Stars,” has a very successfu l Los Angeles per sonal-training practice and a terrific television show on the Discovery Channel, and is a columnist for Health magazine. This is her first book, and it’s a winner. The thing about Gina is that she’s a “real person.” People relate to her. She’s in her early fo rties, she’s had a baby, she’s fo ught to get “back in shape,” and she understands the mult iple and o verl apping demands o f work, family, and how har d it can be to g et (and stay) in shape in the midst of a busy life. Since a lot of Holl ywoo d types go to her specifica lly to g et in shape for a r ole, a wedd ing, an event , a television co mmercial where they have to be in their under wear, she premised the boo k— Deadline Fitness, get it?—on having to get r esults quickly. The subtitle says it all: Tone Up and Slim Down When Every Minute Counts. One of the things that makes this book particularly good is that she spends a lot of time preparing yo u for the pro gr am. The book starts wit h a go od, soli d chapter on mo tivation, which is alway s a g oo d place to start. Gina offer s ten “rules” fo r the pro gr am that are several notches a bove the usual motivational pep-talk many fitness books offer. The rules include advice on how to “create small win s,” how to tailor the pro gr am to your specific lifest yle, and h ow to develop a clear method for measuring yo ur results. She moves on to g eneral r ules about food and about sab oteurs o f weight loss (li ke not get ting enoug h sleep), and she gives a lo t of go od information about body-fat testing and the use of a heart-rate monitor. Lombardi is big o n numbers—she has you take me asurement s of all your body parts befor e you start, w hich is a g reat idea since it provides objective feedback and a way of measuring results. She provides a formula that lets you calculate your basic daily caloric intake. One might quibble with the for mula—I think for some people it’s going to gi ve too
high a caloric recommendation—but it’s a decent place to start, and you can always adjust. The neat part of the p ro gr am is that you put your calo ric go al into a formula, and you can then choose which of two plans you want to follow, depending o n how many times a day yo u want to eat. (Plan A is 4 meal s; plan B is 3 meals plus 2 mini-snacks.) The calories are the same for both. Both plans are 45% carbs, 35% protein, and 20% fat, making it far from a “low-carb” diet, but definitely huge improvement standard reco mmendations and one th atawill wor k for many on people who dietary ar e not especially metabolically resistant or carb-addicted. The choices of fo od ar e go od (o kay, she recommends egg whites and soy ho t dogs, which I’m not a fan of, but I’m being picky), and she even has a pretty good section on supplement basics. (Full disclosure: I consulted with her on the section o n supplements, but she did a goo d job!) And on some issues—like caffeine—she gives a fair and non-dogmatic reading o f the “pro s” and the “cons” an d lets you decide for yourself. The exercise pr og ram is well ill ustrated, well thought-out , and thoroug hly effective. You have the option o f using machines, dumbbells, or in some cases body weight, so it’s a highly adaptable program. And she gets bonus points for includin g sections on how to make t he exercises harder (or easier), adapt ing it so that it’s appro priate for three differ ent levels of exercisers—beginners, intermediates, and advanced. The book is all fo cused on deadlines an d on coaching you thro ugh to the “finish” line. I t’s fil led with pithy little mo tivational saying s (“A goal is a dream with a deadline,” “You mi ss 100 percent of the shots you don’t take”), and it has a really cool section in the end on how to “speed things up,” including “Body-Emerg ency: One Week Deadline.” This book is highly rated not just for what it is—an excellent book on fitness and motivation, with some ver y decent nutritio nal basics—but for what it is no t. She knows a lo t, and she knows how to shar e it. She isn’t dogmatic, doesn’t trash low-carb diets, and doesn’t pretend to know more than she does. In a crowded field of authors who promise more and deliver less, this alone makes Deadline Fitness a welcome standout. And if a low-carb diet is working for you and you don’t want to change it, there’s no reason you couldn’t still use Deadline Fitness for its excellent fit ness pro gr am and fr iendly motivat ional co aching.
38. The Ultimate New York Diet DAVID KIRSCH If you read my reviews of The 5-Five Factor Diet and The 3-Hour Diet, you might be forgiven for thinking that I have an unfair bias against dietbook authors who are young, good-looking personal trainers with celebrity clients and great publicity machines. However, if you did happen to have that thoug ht, let me just say t wo wor ds: David Kir sch. Kirsch—a y oung, go od-loo king perso nal trainer wit h a celebri ty clientele and a gr eat publicity machine—is ter rific. And he’s written a smar t, appealing boo k that deserves to be read. It’s an effective wor kout routine coupled with excellent nutrition information, written in a very friendly style made all the more engaging by the fact that Kirsch—unlike many of his colleagues (e.g. , Jor ge Cruise and Ha rley Pasternak) is remar kably free of “full-o f-himself-itis. ” The Ultimate New York Diet actually grew out of Kirsch’s experience on the famous television show Extreme Makeover, where participants willingly part in self-r einvention and image makeover with help of a team took of experts—inc luding pro fessionals fr om the wor lds ofthe makeup, surgery, lifestyle, life coaching, fitness, and diet. (His previous book, The Ultimate New York Body Plan, was based on that experi ence and was designed as a t ough 2-week “ balls to th e wall” pr og ram fo r shor t-term results.) The Ultimate New York Diet is a fo llow-up book tha t also focuses on immediate results, b ut takes a longer view—it’s a long-term pro gr am of controlled-carb healthy living on which you could sustain a healthy life for decades. The Kirsch program builds on the 3-phase structure that has served so many classic books in the low-carb literature well: Atkins (although that’s technically a four-phase program), Protein Power, the Fat Flush Plan, South Beach, and so o n. In fact, “Phase One” o f The Ultimate New York
Diet is ver y much like “Phase One” o f Atkins (the Induction Phase) and very similar to the first sta ge o f South Beach. The reason fo r this is elegantly simple: it works!
The novel twist on the classic-3 stage approach comes from a clever idea Kirsch calls the A–E’s of nutrition: A is for Alcohol, B is for Bread, C is for starchy Carbs (and also Coffee), D is for Dairy, and E is for Extra Sweets. On Phase One, yo u eat absolutely no thing o n the A–E list: not a drop of alcohol, bread, starchy carbs (which includes the usual suspects— cereal, pasta, rice), dair y, and certainly no sweets. Toug h? Sure. But effective as heck. Kirsch also has what mastered thesomething concept ofthat giving unambiguous instructions about to eat, will clear, go over very well with an enormo us number of people. The breakfast opt ions o n Phase One , for example, are elegantly simple: either a protein shake or an egg-white omelette * (with various vegetable options). Period. Other staples on Phase One include salmon, chicken, nuts, mushrooms, asparagus, and the usual list of what would be co nsidered “free foo ds” (non-st archy vegetab les like kale and spinach) that are pretty much unlimited on all but the most stringent of pr og rams. Cauliflower g ets special at tention for its versatilit y as a starch substitute, and there are some nice recipes (for “faux” mashed potatoes, among other things) using cauliflower as a base. (This cauliflower-as-mashed-potato was an early favorite on the South Beach diet, and it’s interesting that cauliflo wer was the one veg etable they couldn’t keep on the shelves in the grocery store in Alert Bay during the “Big Fat Diet” experim ent—see chapter 8, page 273. A word to the wise.) The fi rst two weeks of the Ultimat e New Yor k Diet are decidedly l owcarb, and follow what Kirsch calls the 7–7 plan—you eat from 7 A.M. to 7 p.m., and not afterwards. General ly this wor ks out to about three meal s and two snacks, but within that 12-hour time peri od yo u can be flexible as lo ng as you stick to the acceptable foods (about which more in a moment). The old “don’t eat after 7” rule has had its share of detractors, but I don’t know of any hard-core trainer in the trenches who hasn’t had success with it. A word about timing, which is a big part of the program. (Not only do you no t eat after 7 p.m., you also eat your carbs befor e 2 p.m.) Dietitians will ar gue that it doesn’t matter when you eat (just how much), but if yo u were inclined t o listen to dietitians parr oting their same o ld party line on diet and weight loss, you probably wouldn’t be reading this book. I don’t think “not eating after 7” has to be followed obsessively, and clearly it
isn’t the single major “secret” to successful weight loss, but the rule can be an enormo us help to those who are able to do i t. (For the reco rd, one famo us study tested two gr oups o f peopl e eating the identical 2,000calor ie meal o nce a day. Group o ne ate it in the morning, g roup two ate it at night. The morning gr oup lo st weight, the evening g ro up actually gained some.) The Ultimate New York Diet follows the tried-and-true formula of gr adually adding back foo stages. ds thatFollowing are disallowed in thmodel, e earl yduring stages,Phase as you move through subsequent the A–E Two yo u may add one daily serving o f any A–E food, fr om a sli ce of bread to a glass of wine. It’s strongly recommended that the added serving come fr om f oo ds like beans , berr ies, lentils, quinoa, or sweet potatoes, but you’ve got some flexibility here. And in Phase Three you can add—on top of that single A–E food you added in Phase Two—a 150-calorie snack of any carb you choose during yo ur mo rning snack. Kirsch has a sophisticated understanding of the individualities of human metabolism and psychology, and points out that—program be damned— some people may no t be able to add that one “A–E” serving a day (not to mention the extra 150-calorie carb snack). That’s fine. The book encourages yo u—to paraphrase the S aab commercial—to “find your own road.” Kirsch is one of the few trainers to speak about carb addiction, and he understands that for some people even a “little” bit of something can set off cravings and fo r that reason should be avoided ent irely, a point of view I happen to ag ree with completely . That said, he does all ow “cheat meals.” I’m not a huge fan o f cheat meals, simply because many people who need to be on low-carb diets find that an “anything g oes” meal der egulates their blood sugar so severely th at they’re a mess o f cr avings for days afterward. But some people do well on them. Kirsch’s formula is a concession to the reality that many people just aren’t goi ng to say “no” to favor ite foods fo rever. And his solution is to offer some r eally goo d “damage-contro l” options. Example: if you’r e go ing to have pizza , go for one slice wit h a side salad , and you g et extra points for veggie toppings. Pract ical, concise, and use r-fr iendly. The worko ut pro gr ams—as you’d ex pect fro m a top New Yor k trainer —are excellent. Illustrations are clear and well done, instructions are easy to follo w, and he even has some terr ific extras like “w or kouts for office,”
“wor kouts for active vacations,” and (get this) “w or kouts for parents using baby” (baby bench-press, anyo ne?). I particular ly like the 10-minute express worko uts. The bo ok is the only o ne of its kind that I’ve seen that actually has the nutrition-data info for each recipe (and snack) so you’ll know exactly what’s in everything you’re eating. And there are some neat cooking strategies (“how to make the perfect hard-boiled egg”) that are as unexpected as they areYork del Diet ightful. The Ultimate New gets kudos for attitude, quality of information on healthy low-carb eating, overall design, and attention to detail. On every level, this is a five-star book. * To g et
the “effec tive” (or “net”) carb co ntent of a fo od, you simply lo ok at the label and subtract the number of grams of fiber from the total number o f car bohydr ates. What’s left is the net amount of car bs, which is all you need to count. For a fuller discussion of effective/net carbs, see page 98. * By the way, the “revi sed” pyr amid—known as MyPy ramid—is not much better than the old o ne. Just so you kno w. * Shortly after The Fat Resistance Diet was published, Dr. Galland and his son Jonathan Galland published an excellent accompanying cookbook —The Fat Resistance Diet Cookbook. * Fructose is a “simple” su gar that doesn’t raise bloo d sugar very much at all; but when it’s iso lated fro m fr uit and made into a l iquid sweetener, it does a lo t of damage in other ways. * Sharp-eyed readers will note that I’ve railed against the egg-white omel ette both in this boo k and for the last ten years; but at least in Kirsch’s case, he advocates it not for any cockamamie fear of cholesterol, but simply because egg whites have fewer calories than the whole eg g. I still do n’t like egg -white omelettes as a diet ary staple, but at least he’s not idiotic o n the subject.
CHAPTER 8
My Big Fat Diet: The Town That Lost 1200 Pounds!
If you’r e intereste d in weight loss—or
even if you’r e not—the headline
is virtually guaranteed to grab your attention: “The Town That Lost 1200 Pounds!” That’s exactly what reader s fir st saw when they picked up the M arch 16, 2008 Sunday edition of the Canadian newspaper The Province. Here’s how reporter Lena Sin started the story:
His town was shrinking, and Greg Wadhams was determined to shrink with it . So on a cold December night in 2006, the 55-year-old commercial fisherman sat down to say goodbye to the past. He devoured a spread of chicken chow mein, frie d rice and deep-fried prawns to triumphant delight. Then, with the final bi te, he bade farewell t o his favorite foods. Intrigued? Read on. Greg Wadhams lives in the small fishing village of Alert Bay, off the nor thern tip of Vancouver Island in British Columbi a. Most o f the inhabitants of this sleepy town (2006 p opulatio n: 556) are member s of the ‘Namgis Fir st Nations peo ple—the Canadian counterpar t to what we would call Amer ican Indians. Obesity and diabetes are rampant here, about 3 to 5 times greater than the national average. Understanding why this is so can teach us a lo t about diabetes and obesity—and about t he value of l ow-car b diets. The ‘Namgis have always been fishermen. But the local fishing industry was collapsing. Wild salmon supplies were diminished, largely because sea lice fro m the increasing number of salmo n farms were making th eir
way into the oceans and kill ing thousands of the wild fish. F uel pr ices had made it difficult, if not impossible, for local fisher men to r egular ly travel out and back to their usual fishing sites. Meanwhile, super markets had sprung up and convenience foods were everywhere. Paralleling the experience of the for merly lean Pima I ndians on the Arizona r eservations —now amo ng the mo st obese and diabetic people in the world—the ‘Namgis had begun to consume vast amounts of packaged convenience foods, and effects other supermarket “staples.” The sugar, disastrous of this Canadian version of the “Standard American Diet” were even more pronounced with these First Nations people. Genetically , they are per fectly well adapted t o a wor ld in which food is hunted, fished, gathered, and plucked. They are supremely illequipped—as are most of us—to deal with a food supply that comes mostly from the 7-Eleven. Jay Wortman, MD, a researcher from the University of British Columbia, had more than a passing interest in what was happening on Cormo rant Islan d, which consists primar ily o f the village o f Alert Bay. Several years ago, he had noticed that he was gaining weight. His blood pressure was rising, and he was constantly tired and thirsty. A vigorous guy who exud es go od health fro m every por e, he slowly realized tha t he was exhibiting all the classic symptoms of type 2 diabetes. “I stopped eating sugar and starch just to get my blood sugar down,” Wor tman said when I inte rviewed him. While he did no t intend this dietar y change to be a treatment for diabetes, a curio us thing happened. “Cutting out sugar and starch literally r eversed all my signs and symp toms of diabetes,” he told me. His blood pressure normalized and his energy came back. He began to wonder if similar dietary changes could make a differ ence to the First Nations people o f Aler t Bay. With funding fr om Health Canada and the University o f Bri tish Columbia, he decided to find o ut. Wor tman—along with colleag ues Mary Vernon, MD, Eric Westman, MD, and nutritio nal biochemi st Stephen Phinney, PhD—designed a oneyear study to see what would happen if the First Nat ions people returned to their “native” abor iginal diet. “People here tr aditionally g ot their calories mostly from protein and fat,” Wortman told me. “If you
‘reverse-engineered’ their traditional diet, you would come up with something that looks—in modern parlance—like the Atkins diet.” Wortman enrolled about 100 people in his study and got to work. One of the first things he did was to go into people’s homes and perform an exorcism on their kitchen. Gently but firmly, he removed all starch, cereals, rice, popcorn, flour, pasta, sugar, and breads. Gradually the participants g ot the idea. Burg ers were served, but without the buns. Fries were on thebanished. menu. Salads came without cr outons. Butter and cr eam were back The First Nat ions people traditionally go t a larg e percenta ge o f their calor ies fr om eulachon g rease—a rich monounsatu rated fat ex tracted from a little smelt-like fi sh (the eulachon) that was a staple o f the native diet. In the “old” days, they ate tons of the stuff; but they had effectively banished it from their diet, believing all fat was bad. Eulachon oil—back on the table! Ditto with any kind of fish and traditional inland absrcinal foo ds like dee r and roast elk. Salmon wa s coo ked on an open fire and gener ousl y dipped in eulacho n oil. Potatoes, bye-bye. “We supplemented the traditional diet with ‘market fo ods’ like baco n, cheese, and all the vegetables yo u could buy,” said Wor tman, “but the main thing was the avoidance of starch and sugar, because these were not components of the traditio nal diet.” And then a funny thing happened. People who had struggled with weight for years started to shed pounds —lots of them. Jill Coo k, a school principal who had struggled with weight all her l ife and who had previously managed t o dr op all o f 7 pounds on a strict 4-month Jenny Craig routine, lost 58 pounds (not to mention 9 inches o ff her waist and 7 off her chest). Art Dick, a tribal chief who had been on a ton of medications for diabetes, was able to get off 75% of his meds within 4 days of starting the program. Andrea Cranmer lost 22 pounds and went from a size 16 to a size 12. The aforementioned Greg Wadhams lost 40 pounds an d no lo nger requir es drugs to treat h is diabetes. “Our forefathers sur e must’ve known something we didn’t know , because when you eat [this] way you j ust feel g oo d!,” he told The Province. While this might sound like the stuff of which infomercials are made, it all went into the database of the rigorously designed study. “The average weight loss was 7.5 kg (16.5 lbs) over three mo nths, 11 kg (24.2 lbs) over
6 months,” Wor tman repo rts. “We saw a change in diabetes symptoms in as little as three days. Triglyceri des went down about 30%—better than any drug we have. People lost weight, their lipid profile improved, their bloodsugar control go t better, their A1c [a long-term measure o f bloo d sugar and a risk factor for diabetes] went down,” he told me. “All the things we hoped would happen seem to be happening.” As well as so me things that were unexpected. “Thergood. e was“All a real inemotional, attitude,” Wor tman told me. People star ted feeling mychange mental, spiritual, and physical aspects are finally feeling like they’re in some kind of unity together, and that’s so coo l,” said Andrea Cranmer. “What we didn’t anticipate was the tremendo us impact on the mental health of the community,” Wor tman told me. “People were happier. They spontaneously started forming support gr oups. It became a community affair.” So her e’s the question: how can a diet so filled with fat and p rotein— foods that the traditional health establishment tells you are “bad” for you —and lacking the cornerstone o f mainstream dietary recommendatio ns (gr ains, carbohydrate s, cereals)—produce such impressive results in so many people? A couple of reasons suggest themselves—besides the obvious one (that the mainstream dietary r ecommenda tions are fo r the most part boneheaded). First, there’s more and more evidence that saturated fat has a profoundly differ ent fate in the body when it’s consumed in the context of a very-lo wcarb diet. This i s a cr itically im por tant point, one that has bee n made by a number o f resear chers , notably Jeff Volek, PhD, RD, of the Universi ty of Connecticut, who has done so me of the most extensive and compr ehensive resear ch on l ow-car b diets. “Saturated fat is r elatively passive,” Volek told me. “[The thing that] co ntro ls what happens with saturated fat in the diet is the carb content of the diet. If carbs ar e lo w, insulin is l ow and saturated fat is handled mo re effi ciently. It’s burned as a fuel. “In contrast,” he continued , “when carbs are hig h, insulin is hig h. Then you’re inhibiting the burning of saturated fat and potentially making a lot mor e of it, so you tend t o see harmful athe ro genic effect s.” According to Volek—and many others—you can’t really talk about saturated fat without considering the background levels of carbohydrate.
“What happens with saturated fat is completely dependent on whether you’re on a low-carb or a high-carb diet,” says Colette Heimowitz, M.Sc, a nutritional scientist and co-author of The Atkins Advantage. “Despite ingesting more saturated fat on low carb, the amount in the plasma (blood) is significantly less. Fat oxidation (‘fat burning’) is increased and fat synthesis (m aking new fat) is decreased.” So why do so many studies seem to show negative health effects of saturated fatexplained. intak e? “All thoseyou’re studiesonaraehigh-carb in the context misaturated xed diets,” Heimowitz “When diet, of your fat should probably be exactly what’s recommended—no more than 10% of total calories, 1/3 of your fat. But when you’re on a very low-carb diet, it’s a whole differ ent stor y.” Whenever I’m asked to explain this seeming parado x, the example I use is house paint. Pick your favori te color —mine is r ed—and then consider how it loo ks when you put it on a nice clean white surface. N ow imag ine that same colo r mixed with another o ne—say purple, or blue or gr een. Some of those co mbinations pr oduce really hideous r esults. How the colo r “behaves” depends completely on what it’s mixed with (if anything) . By itself i t’s g or geo us, but mixed with a non-complement ary colo r… not so much. “Although people on a high-fat, low-carb diet eat more saturated fat, their blood levels (of saturated fats) actually go down,” explains Stephen Phinney, PhD, the nutritional biochemi st who worked with Wor tman on the Alert Bay study.1 While the exact reason for that paradox is still being investigated, accor ding to Phinney, “the interi m answer appear s to be that when you take carbohydrates out of the diet, it causes less interference with the body’s natural ability to handle fats and that t he saturated fats ar e burned and no t retained.” And what about the “side effect” of the dietary experi ment, the fact that well-being improved and people seemed—well, happier? One hypothesis has to do with inflamm ation. “When you have insulin resistance and metabolic syndrome, you have high inflammatory levels,” Wor tman refl ected. “You have poo r energ y and you just feel cr appy and you’re irritable.” Not so coincident ally, when you g o on a lowcarbohydrate diet , many of th e pro -inflammat or y foo ds in your diet are
eliminated. Research comparing the metabolic effects of low-fat and low-carb diets on inflammatory marker s (such as TNF -alpha an d interl eukin-6) confir ms this inflam mation connection. A study by Jeff Volek and his associ ates published in the January 2008 issue of the scientific journal Lipids concluded that “a very low carbohydrate diet resulted in profound alterations in fatty acid co mposition and r educed inflammat ion compared 2
to a lowDownstate fat diet.” Medical Richard Center Feinmaand n, PhD, professor ofchers biochemist ry at SUNY o ne of the resear invol ved in the study, comments: “The infl ammation r esults open a new aspect of the problem. From a practical standpoint, continued demonstrations that carbohydrate restriction is mo re beneficial th an low fat c ould be go od news to those wishing to forestall or manage the diseases associated with metabolic syndrome.” 3 Another hypothesis has to do with oxi dative stress, the technical name for what happens when nasty rogue molecules called “free radicals” attack and damage cells and DNA. Oxidative stress i s known to be a sig nificant component of aging, and it figur es pro minently in a host of diseases including atherosclerosis. “Inflammation might be one way the body has of responding to oxidative stress,” Wortman suggests. Research has shown that a ketog enic (very-low-carbohydrate) diet “u pregulates” (or turns on the production factory) for glutathione (GSH), a powerful antioxidant in the body, helping to pro tect DNA from damage. 4 Could all these metabolic mechanisms help account for why the people of Alert Bay seemed so energized and felt so dar n go od? Who knows? W eight loss has so many overl apping dimensions—social, inte rper sonal, met abolic, hor monal— that it’s har d to so rt out what’s responsibl e fo r what. One thing that’s clear is that people l ost a lo t of weig ht, felt better about themselves, and—as a “side” benefit—seemed more connected and supportive as a community. The “town that lost 1200 pounds” also seemed to have g ained an awful lot in the process of lo sing.
CHAPTER 9
Supplements and Diet Drugs The soil. modern farmer treats the plant but the true farmer treats the —John Hernandez, MD
Let me guess. You’d l ike me to cut rig ht to the chase and answer the question: “Are there pill s that can make me lo se weight?” Well, the shor t answer is: “Not by themselves.” To pro duce an effect, virtually any d rug o n the market has to be used as pa rt o f an over all pro gr am of calor ie reduct ion, lifesty le change, and behavior modification. If there were a drug you could take that would make weight drop off without your having to do anything at all or change anything about the way you eat or exercise, pe ople would be lining up for miles to get it. But there There are isn’t. some drugs th at have been shown t o make a difference in weight-loss prog rams for the obese. How much of a difference is a whole other matter. Normally, I wouldn’t spend a lot of time discussing the drug options for weight loss for four reasons: (1) I don’t t hink they produce enough weight loss to make much of a difference to mo st people; (2) they are ver y, very expensive; (3) my own personal o ri entation to drugs is “The less, the better”; and (4) the r isks fr equently outweigh the benefits. But there is a special r eason for taking the time to g o o ver the pro s and cons of each of the drug s covered here (including so me that doctor s rarely use much an y mor e). That special r eason can be summed up in two wor ds: the Internet. I get at least three e-mail spams a day offer ing all sor ts of drug s— including every o ne of the “diet” dr ugs mentioned here. A ll ar e easily available from online pharmacies without a prescription. It’s easy to see how peopl e mig ht be tempted to buy them, especially when they r ead the
merchandising and advertising on these drugs, which often say things like “77 percent of obese patients lost a significant amount of weight” (Meridia). The agg ressive marketin g and easy av ailability of these drugs make it mandator y that we take a clo ser look at just what it is the y actually do (and don’t do). What you should know ab out me before r eading fur ther (full-disclosure department): my position, as someone involved in nutritional and natural medicine for more decade, is this: the fewer drugs you take, theple’s better . That’s not tothan say athere ar en’t medications that can chan ge peo lives; obviously there are, and obviously they have a place in treatment. It’s just that I would like to see nutritio nal and lifestyle mo dificatio ns used as often as possible, w ith drugs used as a last reso rt rather than a fir stchoice i ntervention. And if yo u do use drugs—and t here ar e doctors who use them with some success—then they must be p art of an overall progr am that involves lifestyle and behavioral changes.
A re You a Candidate for Medi cation? In 1999, $321 million was spent on medications for obesity, a figure that will undoubtedly grow as the obesity epidemic continues and newer drugs come to market. 1 The medications for obesity currently approved by the FDA are very specifically limited for use in adults with a body mass index (BMI) of 27 or mor e who also have obesity-related medical conditions, or for adults with a BMI of 30 or more who do not have obesity-related medical conditions. 2 (To compute your BMI easily, go to the Web site listed in Resources.) In other words, if you just want to tone up or lose 10 pounds, these meds are not for you. You should also know that only two of the following medications, Meridia and Xenical, have been approved by the FDA for long-term use. The others are approved for “a few weeks,” which is widely interpreted to mean up to three months. That doesn’t mean they aren’t safe for longer use—just that long-term use o f these drugs has never been studied. Nor does it mean that doctors don’t prescribe them for longer than three m onths—they do. It’s called “o ff-label ” use, and it’s done all the time. In fact, the prevailing opinion of many bariatric physicians (those who specialize in treating obesity) is that obesity is a chronic
disease just like diabetes and that it needs to be treated (with medication if necessary) indefinitely. They frequently say something to the effect of: “You wouldn’t expect someone being treated with medication for high blood pressure to have their blood pressure under control if they go off their meds, would you? It’s the same thing with obesity.” In fact, the sad truth is that the biggest problem with obesity meds is that people gain the weight back—or at least a lot of it—once they go off the pills. Dr. George Bray, a recognized leader in the has fieldtoof treatment, says: “Obesity is a chronic illness—medication beobesity used long-term.” Now that you know that these drugs work only for as long as you take them, if you buy them of f the Internet and self-medicate indefinitely by using stimulant pharmaceuticals that have never been tested for long-term use, you are essentially playing Russian roulette with your health. Weight-loss dr ugs fall into r oughly two cat egor ies that wor k by different mechanisms. The first category is appetite suppressants. The second might be called “digestive inhibitors.” All of the following except for Xenical, which is a dig estive inhibitor, ar e appetite suppressants. And again all, excep t for Meridia and Xe nical, are approved for shor t-term use only. Some innovative physicians are treating obesity and overweight with drugs that are not conventionally used for weight loss but seem to produce it as a side effect. We’ll talk about those l ater.
A ppetite Suppres sants All of the appetite suppressants are called noradrenergic drugs, which means that they do their work by causing the release of two chemicals, norepinephrine and epinephrine. The release of those chemicals causes you to feel less hungry or not hungry at all. Obviously, if you’re not fighting hunger, it’s a lot easier to eat less. The most common side effect of the appetite suppressants is jitters—people sometimes feel wired and have a sense that their heart is beating faster, as if they had drunk a whole pot of coffee. Some people, by the way, like this feeling. They feel they have more “energy.” Some people hate it. The feeling usually goes away in time. The consumer versio n of the Physicians’ Desk Reference, or PDR, says
that you should take these drugs only for a “short time,” and when you build up a tolerance for them, you should stop using them. It specifically warns not to compensate for the tolerance by upping the dose. Doctors differ in their experience of the “tolerance” aspects. Some feel that in small dosag es, patients can stay on these indefinitely and keep g etting results. Others cycl e the treatment. Dr. Anton Steiner, director of the Tri State Medical Clinic in Los Angeles, has had good results using pharmacology part of on histhese treatment of obesefor patients, willto nine frequently keepaspatients medications periodsand of up months. When tolerance to the lower dosages is reached, he will up the dosage periodically until the maximum dose is reached and then put the patient on a “dr ug ho liday.” But he is adamant about using dr ugs as part of an overall pro gr am of lifestyle change: h e feels ext ended use gives the patient more time to learn a new lifestyle, get guidance and support for that lifestyle, and build co nfidence that he or she can maintain it. Dr. Jay Piatek of the Piatek I nstitute in Indianapoli s is one o f the doctor s who believe that obese and o verweig ht patients fr equently have brainchemistry issues that make it particularly difficult for them to adhere to a change in lifestyle, especially when it comes to their eating behavior. He sees pharmaceuticals as a way of helping his patients modify their brain chemist ry so it is easier fo r them to stay on a diet, resist compulsions to eat, and feel good about themselves while changing their behavior. Piatek has been using the antiseizure drugs topiramate (Topamax ) and zonisamide (Zonegran and has had ve ry go od r esults, especially when they ’re used in co mbination with a stimulant such as phentermine. He also uses nutritio nal supplements and beh avior modification as pa rt of an overall pr og ram o f lifesty le change. His book The Obesity Conspiracy discusses his t reatment pro tocol in mor e detail. With the exception of Steiner and Piatek, virtually every ho listic, integr ative, or nutritionally ba sed doctor I spoke to r ecoiled in horr or at the mention of diet drugs. The most frequently cited objections were dependency, adrenal stress and burnout (the drugs are, after all, stimulants), and the fact that you have to keep taking them in or der to keep the weight off. Dr. Diana Schwarzbein points out that all stimulants (including coffee) can lead to insulin resistance, which is precisely what you don’t want if you’re trying to lose weight! Stimulants do this by
increasing adrenaline, which will eventually results in a “backlash” of insulin production to prevent the breakdown of too many structural and functional proteins in the body.
The drugs my doctor prescribed helped me get to a point where I could really look at my life, reorder my priorities, and change my relationship with food. Now it’s time to think about getting off them. —Patty MacV. Considering all those negatives, the gains are pretty unimpressive. When you do the math—which we’ll l oo k at in a mo ment—you see that the best any of these drugs can do is maybe add 1½ pounds per month to your weight lossa efforts, few of them can highest even do dosages that. That’s less most than ½ pound week, and and very that’s only for the in the successful studies. More typically the results are 1 pound a month, or ¼ pound per week. A big portion of this weight is regained when you stop taking the meds. To this I’d like to add that the drug i ndustry doesn’t exactly have a stellar record when it comes to obesity treatments. Take a look at this chart, adapted from Bray’s Contemporary Diagnosis and Management of Obesity. Get my drift? Following is an examination of the main appetite suppressants on the market.
Phentermine This is number one on the Hit Parade of appetite suppressants. It’s a schedule 4 drug, which means that the government considers that it has
some potential for abuse, even though virtually all doctors who prescribe it believe it has none. One of the ingredients in phen-fen, this is the part of the combo that was not associated with the valvular problems attached to its partner, fenfluramine. Fenfluramine was pulled off the market, but phentermine remains. It works in an entirely different way from fenfluramine, which increased serotonin release in the brain (serotonin, you may remember, is the “feel-good” neurotransmitter involved in appetite names forphentermine phenterminecalled are Adipex-Pand andbehavior Fastin. control). There’s The also trade a resin-based Ionamin. Typically, these three drugs may produce a couple of pounds of additional weight loss a month when compared with a placebo, but frequently they produce less. None of them are cheap.
Phendimetrazine Phendimetrazine is a schedule 3 drug, which means that the government thinks it has higher potential for abuse than a schedule 4 drug. Phendimetrazine has been around since the 1960s, but very few doctors
use it any more. Again, the best you’ll get is ½ pound a week more weight loss than with a placebo, and that’s on a good week. There have been reports of problems (ischemic stroke, a fatality) going back to at least 1988. One of its trade names is Bontril. You can find it on the Internet for $89 a month.
Diethylpropi on This schedule 4 drug is sold under the trade name Tenuate. It’s another appetite suppressant that few docs ar e using these days, but it is hawked on my fr iendly local Int ernet pha rmacy for $99 per month.
Benzphetamine A schedule 3 controlled substance, benzphetamine is closely related to amphetamine and has a high potential for abuse. The brand name commonly seen is Didrex. It’s highly addictive and very expensive. One Internet site sells it fo r $99 a month. Avoid it like the plag ue. All of these medications except phentermine are somewhat oldfashioned and are rarely used these days. Phentermine, however, remains very popular. Phen-Pro refer s to the combinat ion o f phentermine and Pro zac, a combo that some docs exper imented with after phen-fen was t aken off the market. Phen-Pro isn’t used much anymore, but many doctors have noticed that phentermine in co mbination with a mild antidepressant is a winning combination. The combinations most often cited are phentermine with Lexapro and phentermine with Celexa.
Sibutramine (Meridia) Sibutramine is one of the two drugs approved by the FDA for long-term use. It was srcinally studied as an antidepressant but performed very poorly. However, during the studies on depression, it was found to cause a mild amount of weight loss—between 2.2 and 4.4 pounds during the course of the studies. 3 It works by a slightly different mechanism than the appetite suppressants like phentermine. It’s called an SNRI because it is both a serotonin and norepinephrine reuptake inhibitor. The norepinephrine is responsible for the appetite suppression. Sibutramine works directly on the centers in the brain that tell you you’re satisfied.
According to Dr. Anton Steiner, you are satisfied sooner when you take sibutramine—one might th ink of it as a kind of “por tion control” pill . Sibutramine has also been said to “raise metabolism” because it stimulates brown-fat metabolism. Brown fat is a particular kind of metabolicall y active fat that actually causes the body to bur n calor ies. Everyone got very excited about this thermogenic effect because in lab studies with rodents, there was a 30% increase in metabolism; however, with humans,but it’sonly an entirely ent4% storand y. Itfor may stimulate metabolism, by aboutdiffer 2% to less than 24 brown-fat hours. 4 So how go od is sibutramine? The major clinical stu dy that bro ught this drug onto the radar screen was called the STORM trial—Sibutramine Trial of Obesity Reduction and Maintenance.5 The r esearchers—and t he markete rs of the drug , sold as Meridia—proudly pr oclaimed tha t 77% of the pe ople taking it lost a significant amount of weight. Sounds good, right? But let’s look at what really happened. The initial trial lasted six months, but the overall study continued for two year s. Eight Euro pean centers recruited 605 obese patients and pu t them on sibutramine combined with a reduced-calorie diet (reduced by 600 calories per day). Of those patients, 467 (77%) lost 5% of their body weight. So far, so go od. But what happened afterward? T hose 467 patients stayed on the program for another eighteen months. Of these, 115 were taken off the medication and put into a placebo group—they regained weight. The r emaining 352 were kept o n the meds. Out of that 352 , 148 dro pped out. Now we’ve g ot 204 patients left on the meds. Of these 204, 115 were not able to maint ain 80% or mor e of their o riginal weight loss, but 89 people wer e. If you lo ok at the number who were lef t on the meds (352) versus the number who were able to maintain 80% of their weight loss (89), you’re left with—at the end of two year s—a 25% success rate . Big deal. And that, remember, is just for the people who r emained on medica tion for two years, no t for the people who didn’t. Impressive? Not ver y. It’s interesting that the people who so sol emnly pr oclaim that this medication was a success due to its first six months are the very same ones who trashed r ecent studies o f the Atkins diet in the New England Journal of Medicine6 because, in one of the studies, the low-carbers (along with
everyone else in the study) regained weight after the first six months, just like the people in the sibutrami ne study did. And how much weight loss ar e we talking abo ut here, anyway? In the STORM trial, the srcinal average weight loss was a respectable 24 pounds over the fir st 6 months (although some people lo st much less). That’s about a pound a week—not too shabby. But after the full 2 years, the average weight loss in the sibut ramine gr oup—those who r emained in th e study, only 12nth. pounds mo re than thetrplacebo g roup, an with averagthat e ofis—was ½ pounds a mo In another 1-year ial, patients treated 8 sibutrami ne lo st between ½ pound and /10 pound per month more than the placebo group, depending on what dosage they were given, 10 or 15 milligrams. 7 And in other studies, 8 weight loss after o ne year aver aged about 1 pound a month for the folks on 10 milligrams a day, up to a big 1½ pounds a mo nth (or 4/10 of a pound a week) for those taking 30 mill igrams a day. A review of all studies lasting 36 to 52 weeks found an average weight loss of about ¼ pound a week. 9 Not much of a barg ain, conside ri ng the price. On a typical Internet pharmacy site at the t ime o f this wri ting, a mo nth’s supply of the 10-milligram dose of Meridia was running $189 a month. A month’s supply of the 15-millig ram dose woul d set you back $239. That’s almost $8 a da y for at best ½ pound a week (at wor st ½ pound a month) more than you could do with a placebo. Oh, one mo re thing. Sibutrami ne was taken off the market in Italy after 50 adverse events and 2 dea ths fr om cardiovascular causes were r epor ted in that country. In the United Kingdom , there wer e 215 r epor ts of 411 adverse reactions (including 95 serious ones and 2 deaths). Between February 1998 and September 2001, the FDA in the United States received repor ts of 397 adverse event s, includin g 143 cardiac arr hythmias and 29 deaths (19 of them due to car diovascular causes). Ten of those deaths involved people under 50 years of age, and 3 involved women under 30. 10 Are we having fun yet?
Orlistat (Xenical) Marketed under the trade name Xenical, orlistat is the only member of the second category of weight-loss drugs, a category that could be called
“digestive inhibitors.” And it’s the only drug other than sibutramine (Meridia) currently approved for long-term use. Xenical works by blocking some of the fat that you eat from being digested and assimilated. It does this by blocking up to 75% of the digestive enzyme lipase (which breaks down fat), resulting in as much as 30% of the fat you eat not going to your hips. What should be immediately apparent is that it does nothing for the fat that is already on your hips. People lose weight on Xenical— especially in conjunction with a lower-calorie diet—because essentially lowers caloric intake automatically. If you, for example, were it eating 2,000 calories a day and 30% of them were from fat, you would normally be taking in 600 fat calor ies. By taking Xenical with a fatty meal, you ar e now essentially taking in only about 400 calories from fat. Stick to that plan and you’d be consuming about 1,400 fewer calories a week, which adds up to… about 4/10 po und a week. The fir st big study to put Xenical on the map was a t wo-year Euro pean study.11 During the fir st year, participan ts were put on a lo wer-calo ri e diet; duri ng the seco nd year, they adhered to a mai ntenance diet. The Xenical group lost between 2 and 3 percent more weight than the placebo group. In a second two-year European trial, obese patients were put on a reducedc alor ie diet (reduced from their r egular intake by 600 calor ies a day) and given 120 milligrams of Xenical three times a day. 12 At the end of the year, they had lost about 9 pounds more than the placebo group (about ¾ pound a mo nth). A simil ar desig n was used in a two-year study in the United States that pro duced an average of a mer e ½ pound a month mor e in the Xenical gr oup than in the pla cebo gr oup. 13 Does it get any better? Not much. Another study showed that 120 millig rams three times a day produced w eight loss o f no mo re than 1/3 to ½ pound per week gr eater than placebo, and another sho wed 6.6 pounds gr eater than placebo over the course o f a year (basically pound a month).14 Xenical has a g reat safety profi le, but there’s a catch. Because the drug keeps some fat fro m being absor bed, it can have a bunch of very unpleasant side effects, euphemistically grouped under the term anal leakage . Typical symptoms: flatus w ith discharg e, oil y spotting, fecal urgency, fatty/oily stools, oily diarrhea, fecal incontinence, and increased
defecation and spotting. When you’re laying out anywhere from $169 to $259 a month for that extra ½ pound of weight loss, don’t forget to stock up on Depends.
Starch Blockers Starch blockers are a recent addition to the ever-expanding list of overthecounter potions sold for weight loss. Introduced in the 1970s, starch blockers were found to be ineffective and were taken off the market in 1982. But the new breed of starch blocker—appropriately named Phase 2 —has a lot of promise. Made from a refined, potent extract of white kidney beans, the starch blocker binds to an enzyme called amylase, preventing it from breaking starch down into sugar. The company that makes Phase 2, which is the ingredient in most commercial formulas you’ll find at the store, claims that when you take it immediately before a starch-heavy meal, up to 66% of the starch in the meal is blocked from absorption. The studies on Phase 2 have not been published and were commissioned by the manufacturer of the starch blocker, so we need to wait and see about the long-term efficacy of this product. The plus side: it lets you do a lowcarb diet and occasionally hav e some pasta or other hig h-carb dish. The negative side: the amount of starch you do absor b may still be too much for some very sugar-sensitive people, and the illusion that you can now eat these foo ds “safely ” may be a really slippery slo pe for carb, sugar, and grain addicts. Finally, not absorbing most of the calories doesn’t mean that you’re pro tected fr om the effects o f co mpounds in some starches that ma y be allergenic (such as gluten). With very careful use, these products might have a place, but I’ll have to wait an d see befor e recomm ending them.
Ephedra Virtually all of the commercial dietary “miracle” products—TrimSpa, Metabolife, Ripped Fuel, Xenadrine, and the rest—work by two pathways: suppressing appet ite, and increasing metabolic rate (called thermo genesis, which is the production of heat from food). They do so with varying degrees of success. The active ingredient in all of them is—or at least used to be—ephedra. A ton of information has come down the pike recently about ephedra, much of it inflammatory and a great deal of it inaccurate.
When ephedra has been used in supervised weight-loss research studies, it’s been given in the d osage of 60 milligr ams per day in three divided dosages o f 20 millig rams, each combined w ith 200 milligr ams of caffeine. In any supervis ed study using this do se, ephedra has not sho wn itself to be danger ous, and the side effect of “the jitters” was usually pr etty well tolerated. 15 It is not—I repeat, not—for people with high blood pr essur e or for people who ar e sensitive to ephe drine o r caffeine or for people who have any kind of heart,over-the-counter kidne y, or liver meds pro blems or you for people taking any medication, including (unless check with your doctor). Ephedra works by stimulating brown-fat metabolism, thereby increasing the bodily pro duction o f heat (upping your metabolism slightly ), and by suppressing your appetite. The possible side effects are very annoying and include nervousness, insomnia, and possibly dizziness. The benefits in the w ay of f at loss ar e very m ild but do exist. Ephedra can definitely r aise your bloo d pressur e and may inte ract with other medications. One of the problems with ephedra is that people are using amounts that are way higher than the recommended dosage, which is generally about 25 millig rams. Ephedra pr oducts with as much as 25 0 millig rams per tablet are available at every mall and drugstore. Many people take it for “energy” or as a party drug, and man y high school and college ath letes take it because they think it will enhance athletic perfo rmance. Pro bably mor e than a few of them don’t pay any attention to the conditions under which you shoul d never take the stuff. There ar e many nutritionally or iented health practitioner s who are fans of ephedra when it’s used pro perly (though they are cer tainly a mino ri ty), notably Dr. Shari Lieberman, author of The Real Vitamin and Mineral Book, and Dr. C. Leigh Bro adhurst. But it pro bably doesn’t matter any more. “Its time is over,” says Broadhurst. There’s just too much bad publicity and public o utcry about it, and it w ill almo st certainly be taken off the market soon. The new ephedra-free diet pills have simply replaced ephedra with Citrus aurantium (bitter orange), which has many of the same “fat-burni ng/ appetite-suppressi ng” eff ects but doesn’t yet have th e bad rap. (See page 307 for mor e about bit ter or ange.)
If ephedra does manage to dodg e the bullet and stay on the market—and you decide to tr y it—make sure that you do no t fit into any o f the categories mentioned above, and never take more than the recommended dosage. When all is said and done, it is still an adrenal stimulant—a kind of legal speed, if you will—and it’s hard to believe that longtime use can have any beneficial effects on your health.
lli—Promise: 10; Delivery: Not so much In February 2007, amidst huge fanfare and accompanied by an almost obscenely expensive marketing campaign, the FDA approved Alli as the firstever officially sanctioned weight-loss drug to be sold without a prescription. Alli is actually Orlistat , which is actually Xenical . Xenical (see page 286) has been around for a while, didn’t work very well, and has now been given a facelift; they took it off prescription-only status and repackaged it as Alli. This is not the first time the clever marketers at Big Pharma have done this. Not too long ago, Eli Lilly took Prozac, dressed it up in nice pink and purple colo rs, and r echristen ed it “Sarafem” fo r PMS. So, what do we know about Xen ical ( oh, excuse, me, Alli)? Well, l et’s star t with this: it didn’t wor k ver y well in the fir st place when it was known as Xenical. I’m no t sure why changing the name and making the dosage smal ler would fix the pro blem, but hey, what do I know? Alli (Xenical) is a member o f a catego ry of weight-loss drug s that mig ht be called “digestive inhibitor s.” It blocks some o f the fat that you eat from being digested and assimilated, and it does this by blocking the digestive enzyme lipase —which breaks down fat. The r esult? As much as 30% of the fat you eat doesn’t go to your hips. Quick-thinking r eaders might be forg iven for asking the obvious question: “What does it do to the fat that’s alr eady on your hips?” And the answer i s… let’s see … Zip-i-dee-doo -dah. People lose weight on Xenical—’scuse me, Alli —because it essentially lowers caloric intake automatically. If you, for example, were eating a nice hefty 2,500normally calories abeday and 30% offat them happened to come fat,if you would taking in 750 calories. So the appealfrom is this: you keep over-eating the same junk you’ve always eaten, you’re actually
taking in a few fewer calories for the same bad meal. By taking Xenical with a fatty meal, for example, about one third of those fat calories aren’t absorbed, so the 750 calories becomes, theoretically, about 500 calories. You’ve “saved” 250 calo ries while eating the same meal (no te the operative w or d theoretically ). Stick to that plan fo r a week, and you’ve “saved” 250 times 7 c alor ies, or a gr and total of 1750 calori es, or … let’s see … ummm… one half pound? Yup. And that’s theoretically . Remember, the fir st big study to put Xenical o n the map was a two-year European study that showed that patients on Xenical lost between 2% and 3% more weight than those on a placebo. A second two-year European trial put obese patients on a reduced-calorie diet and gave them 120 mg of Xenical, 3 times a day. At the end of the year, they had lost about 9 pounds mor e than the placebo gr oup. Read that carefully. Nine pounds a year , which translates to ¾ pound a m onth. A simil ar study in the U.S. produced ½ pound per month for Xenical users. So is Alli the answer? Hardly. Unless maybe you’re a stockholder in Glaxo. To their cr edit, Glaxo has not tried to sell this as a “magi c pill” so lution, and has tried t o package it a s part of an overall pro gr am. The drug i s sold with a lot of support materials that discuss the importance of a healthful diet and exercise. If you’re motivated to do an overhaul in your eating and exerci se patterns, it might be consider ed helpful. But it’s impo rtant to know that Alli is not going to cause any weight to come off just by taking it and doing nothing el se. Truth be told, I think you co uld achieve exactly the same results by doing the overhaul and skipping the pill. Save your money and use it for something better—like better-quality food and some decent supplements. The bottom line is this: medications don’t cause you to l ose weight. They may—and this is a big “may”—make it easier for you to choose better foods, such as proteins over carbohydrates, and they may help you to keep por tions unde r control. M edications may help yo u fol low a lifestyle plan, and yo u have to be willi ng to see them in that light. Steiner summed it up best: “Pills don’t wor k alo ne. Programs, however, do.”
Supplements Memorize this: there are no supplements you can take for weight loss that will cause the pounds to just melt off without your having to do anything at all. That doesn’t mean there ar en’t supplements you need to take. Ther e are. What supplements can do is correct deficiencies and help with metabolic issues that might be standing in the way of your losing weight. In that sense, they are essentia l to your over all pro gr am. Normalizing blo od sugar and insulin response is one of t he most important keys to weight loss for many—if not most—people. Making a positive impact on the blood sugar–insulin continuum is the main purpose of the low-carb diets discussed in this book. Other conditions that get in the way of weight loss are low energy and fatigue, nutrient deficiencies, adrenal stress, yeas t overg ro wth, thyroi d pro blems, de pression, sleep disor ders, fo od cr avings, and eve n an over taxed liver. Pro per supplements can make a serious positive impact on many, if not all, of these conditions. Some of the supplements discussed here will help with blood-sugar control; others wit h energy, liver health , or relaxation and sleep ; and still others with cravings o r appetite. Some will do double duty, helping a number of conditions simultaneously. Remember that improving one or more of these things can have a profo und effect on your ability t o fo llow a pr og ram, but there isn’t one that you can simpl y take and watch the weight dro p off. (If there were, I would pro bably be selling it and w ri ting this boo k fro m a villa o n the beach in St. Martin. Then again, as my father used to say, if my grandmother had wheels, she’d be a wagon.) One mor e note: virtu ally no supplement—vitamin, mineral, o r herb— does just one thing in the body. Most work synergistically and on a number of different pathways, doing good all over the place. A full discussion of the benefits and purposes of, say, vitamin C or vitamin E would fill a small book (fo r those interested , there ar e several excellent books on supplements listed in Resources). So understand that, for the purposes of Living Low Carb, I’m just goi ng to di scuss the aspects of the following supplements that affect weight loss and closely related issues. That should no t be taken to mean that these fellows do n’t do a heck of a l ot
mor e than the things we’re talking about, just that this discussio n is intentionally narrowed to the scope of this book.
Whenever a doctor tells me that there is “no good research” on vitamin supplements, I know he has neveronbothered to do a literature search PubMed. —Constantine X. At the bare minimum, a highquality multivitamin and mineral formula should be part of everyone’ s health regimen, even b efor e considering any of the supplements discussed below. People eating grain-based diets can easily suffer from mineral depletions (see “What’s Wrong with Grains” on page 332), and so can people on low-carb diets, especially in the introductory phases. Mineral depletions can decrease activity in the energy-production cycles of the body, effectively slowing down your metabolism. 16 You want to make sure you’ve covered that base right at the beginning.
The Number One Supplement for Weight Control: It’s Going to Surprise You It’s not expensive, it’s not exotic, and it’s not sexy, but it works like a charm. It’s plain, old-fashioned fiber. More than a dozen clinical studies have used dietary fiber supplements for weight loss, most with positive outcomes. 17 When you take the fiber supplement with water before meals, the watersoluble fiber binds to water in the stomach, making you feel full and less likely to overeat. It also suppresses hunger. 18 Fiber supplements have also been shown to enhance blood-sugar control and insulin effects and even to reduce the number of calories (adding up to about 3 to 18 pounds a year) that the body absorbs. 19 And a study in the prestigious New
England Journal of Medicine found that a diet with 50 grams of fiber per day lowered insulin levels in the bloo d.20 One of the most impressive studies of all followed 2,900 healthy subjects for 10 years and looked at the relationship between fiber, cardiovascular disease, weight, and insulin. The results were spectacular. Fiber was inversely associated with insulin levels and weight, and low fiber intake turned out to be a better predictor of heart disease than saturated-fat consumption! subjects hoyears co nsumed the most gained less weight over the The course of thewten than those who fiber 21 consumed the least. Guar gum seems to be one of the most effective fiber supplements, but other studies have used gl ucomannan, which can be t aken in pill f or m. If you choose this form, make sure to buy the capsules rather than the tablets, since you do n’t want the fiber comi ng in contact with water until it gets into your stomach. Another way of adding fiber is with a powdered supplement like psyllium husks, flaxseeds, or even the ol d standby, sugar free Metamucil. Some o f my per sonal favor ite fiber supplement s ar e Cellulose Fiber by Vital Nutrients, Superseed by Garden of Life, or plain gr ound flaxseed . In addition, fiber has a ton o f o ther wide-ranging positive effects on the body, like helping to prevent certain kinds of cancer and lowering cholesterol and triglycerides. Americans currently get a paltry amount of fiber in their diets, estimated at 10 gr ams a day. Most health or ganizatio ns like the American Cancer Society recommend about 3 0 gr ams, and our caveman anc estor s g ot much more (maybe around 50 or 60 grams). You can—and should—add fiber by eating as many fibr ous veg etables and fruits as yo u can, but it’s doubtful you’ll get enough to have the kind of therapeutic effect I’m talking about. So eat those veg etables, but supplement your intake as well. Incidentally, all the gr ain foo ds and cereals tha t we’ve been taught are a gr eat source of fiber are actually fiber lightweights. Most commer cial br eads have a couple of g rams at best , and most c ereals have emba rr assingly low amounts. The only two commercial cereals worth talking about when it comes to fiber are All-Bran and Fiber One, both of which ha ve aro und 10 gr ams per serving. N ice. Oh, one m or e thing. I have a theor y that I’ll shar e with you. In those f ew
studies where a high-carbohydrate, low-fat diet has been shown to help with weight loss or impro ve blood-lipid pro files, usu ally in cont rolled conditions like a clinic or other supervised setting, I believe that what created the benefit was not the lo w-fat diet but the fact that the r esear chers gave their subjects high-fi ber foo ds. I believe it was the fiber that made t he difference, as most of those studies substituted high-fiber carbohydrates for the ones the subject s had usually been eat ing. One o f the reaso ns the GO-Diet high rating in thisasbook is that it isofone of theloss fewand programsgot thatsuch trulya emphasizes fiber a constituent weight health.
Supplements Overview The supplements discussed in the following pages are the ones that have the strongest credentials for use in a weight-loss program. In most cases they have a sizable amount of research to back up their use, or they have been used successfully in clinical practice by responsible and thoughtful practitioners for a long enough time to warrant their inclusion in the discussion, or both. (Clinical observation should never be ignored. Remember that t here was no g oo d scientific r esearch on aspir in until ver y recently—for decades, it has been used simply because it has been observed to work.) There are also a few supplements that I have listed under the category of ossible use , which will be discussed br iefly at the end of the chapter. These supplements have some research behind them, but in my opinion the ury is still out—the research is either not yet strong enough, the clinical evidence not solid enough, or the results have been mixed. These supplements, however, bear watching and may turn o ut to be ver y useful. Supplements of possible use: • gymnema sylvestre • hydroxycitrate • banaba leaf extract (cor oso lic acid) The chart on page 295 shows the influence of various supplements on areas of concern to people on low-carb (or other) weight-loss programs.
B Complex
I put the majority of my clients on B vitamins. Energizing for many people, B vit amins are necessary fo r metabolizing carbohydrates, fat s, and proteins, and your need for them increases significantly when you are under stress. A lot of people just plain feel better on them. Certain members of the B vitamin family, like B5, B6, choline, and inositol, have special importance to people on weight-loss programs. Choline is important in the transport and metabolism of fats, while inositol is important forprevent, the uptake of fatty fatty acidsliver. by theThey cells. haveincluded been shown to alleviate, or improve areBoth usually in a B-complex for mula; “fat-b urning for mulas” may hav e increased amounts.
B5 (Pantothenic Acid) B5 is “mother’s little helper” for the adrenal glands. It is used in the production of stress hormones, and some studies have shown that supplemental pantothenic acid can help us resist or withstand stress in general. 22 If you are under stress or your adrenals are in danger of being burned out or exhausted, you most certainly need this supplement. I recommend taking it separately from the B complex, which you should take in addition. A go od amo unt is 250 millig rams, twice a day. B6 Vitamin B6 is one of the most important supplements you can take, and if you are a woman, it’s especially important. It helps convert estradiol, a very active form of estrogen, into estriol, a very benign form. Birthcontrol pills deplete the body of B6, and supplementing can help relieve the depression that sometimes accompanies use of birth-control pills. 23 This may be because, for both women and men, B6 is necessary to convert tryptophan into serotonin, as well as for the synthesis of dopamine and norepinephrine, all neurotransmitters that affect weight and appetite. Remember that low serotonin states are almost always associated with carbohydrate cravings.
In addition, in so me (but not all) animal studies, vitamin B6–deficient rats that were fed a high-protein (70% protein) diet developed fatty liver. A low intake of B6 can impair glucose toler ance.24 And in a lo wcarbohydrate diet , the body make s needed glucose fr om noncarbohydrate sour ces (like p ro tein), a pro cess called gluconeog enesis (for a full explanation of this process, see chapter 2). During gluconeog enesis, B6 levels are deplet ed fro m muscle, anot her r eason for supplementing with B6 while on a low-carb diet. 25 As with B5, I reco mmend that if yo u do supplement with B6, you take it at a differ ent time than yo u take your Bcomplex vitamin. A good amount is 50 milligrams once a day, as long as you are also taking your B complex .
Vitamin C Vitamin C basically helps almost everything. When you have high blood
sugar, vitamin C can’t travel into the cells. 26 While by itself vitamin C probably does not promote weight loss, it is depleted by stress— understandable, since it is found in very high levels in the adrenals and the brain 27 —and, like vitamin B6, is necessary for making serotonin.28 If stress or depression contribute to your weight issues, you should definitely be supplementing with vitamin C, 1,000 to 2,000 milligrams per day.
Vitamin E Vitamin E has a demonstrable effect on insulin resistance. 29 According to diabetes expert Dr. Richard Bernstein, vitamin E in dosages of up to 1,200 IU a day has also been shown to reduce glycosylation, one of the most destructive and aging effects of high blood sugar (see chapter 2 and “Alpha-Lipoic Acid” belo w). Bernstein r ecomm ends 400 to 1,200 IU a day to many of his patients. Note that the most commonly sold vitamin E is alpha-tocopherol, but this is only one of eight different components in vitamin E, and there’s a lot o f evidence that just taking al pha-tocopher ol by itself does not give you the maximum benefit. You should look for a combination o f alpha-tocopher ol and gamma-tocopherol , or even gammatocopherol alone. You should also look for a vitamin E supplement that contains tocotrienols, another set Natural of veryvitamin important heart-healthy compounds in the vitamin E family. E is unquestionably mor e effective than any of the synth etic kinds. The studies that showed benefit for insulin metaboli sm used 900 IU. Vitamin E is g eneral ly so ld in 400-IU capsules. If you’r e using vitamin E for its general protective effect, add at least 400 IU to your daily regimen, prefer ably 800. If you’r e using it for its therapeutic effects on bloo d-sugar metabolism, take at least 800 IU.
Omega-3’s Along with magnesium and alpha-lipoic acid, omega-3’s are the supplements I recommend for just about everybody. The impact of omega3’s on so many areas of human health are so enormous that it would require a whole book to fully explain them (and several have been published, notably The Omega Rx Zone by Dr. Barr y Sears and The Omega3 Connection by Dr. Andrew Stoll). For our purposes, let’s talk about
blood-sugar regulation and insulin resistance. The evidence that omega-3 fats incr ease insulin sensit ivity and help wit h bloo d-sugar reg ulation is no t perfect—some studies show that they have no effect, 30 and a couple show that they do.31 But virtually every clinician, including myself, who uses nutritional supplements with clients recommends omega-3’s—although, because of their numerous overlapping positive effects on the body, it’s difficult to say just what their specific role is in terms of blood sugar and insulin. Nonetheless, the clinical evidence for their use is overwhelmingly positive. Dr. Shari Lieberman, author of The Real Vitamin and Mineral Book, says it’s hard to say whether omega-3’s have a specific bloodsugar–lowering effect, though they probably do; but she points out that they definitely lower C-reactive protein, a measure of inflammation and a risk factor for heart disease that is often elevated in diabetics. “Personally, I think they pro tect the cells in the pancreas,” she says. Dr. David Leonar di of the Leonardi Medical Institute for Vitality and Longevity in Denver, uses omega-3’s routinely with his diabetic patients precisely for the antiinflammatory effects. “Diabetes is a disease of inflammation, among other things,” he says. Omega-3’s also reduce triglycerides and increase good cholesterol. Omega-3’s are the first of the fatty acids to be depleted when you lose fat, so the need for supplementation increases even more when you’re on a weight -loss pro gr am. There has been some controversy about how to supplement with omega3’s. There are basically three omega-3 fatty acids we are interested in: ALA (alpha-li noleni c acid), which is found i n flaxseeds; and EPA (eico sapentaenoic aci d) and DHA (docasahexaenoi c acid), both of which are fo und in fi sh. The latter two, EPA and DHA, are the mo st impor tant, and the body is supposed to make them from the first one (ALA). Unfortunately, it doesn’t do this very well: only a very small fraction of ALA eventually winds up as EPA and DHA. This has led many experts to favor supplementing with fish oil, since it contains ready-made EPA and DHA. Some, ho wever, arg ue that even thoug h only a sm all per centage of the ALA in fl axseed oil actually gets transfo rmed successfully i nto EPA and DHA, ALA has valuable pr oper ties of its own (including antiinflammat or y ones), and for that reason flaxseed oil still deserves a place at the table.
I do agree with the prevailing notion that the most important omega-3’s for the body are EPA and DHA, and that if you had to take either flaxseed oil or fish oil, fish o il would be t he better choice. For vegans or vegetarians or those who simply cannot stand the idea of fish oil, it’s still possi ble to g et some needed EPA and DHA from flaxseed o il, but you’ll have to take a lot more than a couple of gel caps. If flaxseed oil is your only sour ce of omeg a-3’s, I strongl y suggest at least a couple of tablespoons so much). a day. It goes very well on salads and vegetables (fish oil, not Flaxseeds have benefit s beyond their omeg a-3 content, thoug h. The seeds themselves contain valuable plant che micals cal led lignans which have some anti-cancer activity, as well as fiber (which none of us get enough of). The flaxseeds do have to be ground, since they’re pretty indigestib le as whole seeds. One particularly fine-gr ound flaxseed pro duct is Barlean’s Forti-Flax, which I personally sprinkle on everything—I even throw a spoonful or two into smoo thies.
When I take supplements, I know I’m doing something really good for myself, and that helps me focus on the other things I need to be doing for my health, like eating right and exercising every day. It seems to all go together. —Maryanne DiC. I continue to believe that the best recommendation is to take fish oil (as a liquid) or fish-oil supplements (as capsules) on a regular basis, and to add ground flaxseeds to just about everything, including protein shakes. I also use fl axseed oi l o n salads as well, often mixe d in with oth er dressings
or with olive oil. For your EPA and DHA, you could also opt for cod-liver oil, which is an excellent source oil, which is an excellent source of both. There has been some suggestion recently that the ratio of vitamin A to vitamin D in many cod-liver-oil products may be too heavily weighted toward vitamin A, and this is a leg itimate concer n. (You can al leviate some of the imbalance between A and D in many cod-liver-oil products by simply taking more supplemental vitamin D, something I think just about everyo ne should be do ing anyway.) GLA (Gamma-Linolenic Acid) If you’re taking omega-3’s, which I hope you are, some GLA (at least 80 milligrams) should be taken daily to balance them. GLA may also help with weight loss. GLA is gamma-linolenic acid, an extremely important omega-6 fatty acid that the body makes in the presence of an enzyme (delta-6-desaturase) that is inhibited by insulin as well as by trans-fatty acids. Hence, most people don’t get enough GLA. It’s important to our discussion because it stimulates brown adipose tissue—which translates to less bodyfat accumulation and more fat-burning. 32 Ann Louise Gittleman has said for years that she has seen clients break weight plateaus just by adding GLA. Robert Atkins reported on one study in which half the overweight people lost weight just by taking 400 milligrams per day of GLA.33 While I doubt that GLA by itself will do anything much, I don’t doubt that together with a lower-carb, moderate-calorie diet and a pro gr am like those discussed in t his book, it w ill mo ve things along . For women with PMS, GLA is just about a necessity. It has been used for decades as a treatment for PMS and is an essential par t of the “PMS cocktail” I recommend in my practice with great success: GLA, magnesium, B6, and neptune krill oil. Since cravings and carb binges are often part of PMS, improving PMS symptoms becomes a big part of successful weight lo ss fo r most women. With the PMS cocktail, you should see results within three menstrual cycles. The usual sources for GLA are evening-primrose oil and borage oil, but I much prefer that you g et the actual pur e GLA supplement. Althoug h there are typically a couple hundred milligrams of GLA in each 1,000millig ram evening-pri mrose-oil capsule, which is goo d, the rest of the oil is vegetable oil, which you don’t want or need. So it makes far more sense
to simply take straig ht GLA.
Magnesium I consider magnesium one of the most important supplements you can take and recommend it to virtually all my clients, especially if there is any chance of blood-sugar problems or insulin resistance. The minimum amount is 40 0 millig rams daily, a nd I prefer 800 milligr ams. The co nnection between magnesium and i nsulin was pointed out recently in a superb lecture at the annual Boulderfest Nutrition Conference by diabetes expert Dr. Ron Rosedale o f the Rosedal e Center for Metabolic Medicine.34 Insulin stores magnesium, and when and if your cells become resistant to insulin, y ou’r e not goi ng to stor e magnesium very well. Magnesium is also necessary fo r the action of i nsulin, so the more magnesium you lo se, the mor e insulin-resistan t you become. The mor e insulin-resistant you become, the more magnesium you lose. It’s a nasty little circle. And since, among other things, magnesium relaxes muscles, when you lose it, your blood vessels constrict and you may have higher blood pr essure and reduced e nerg y. Not a good scenario. The importance of magnesium to heart health and bone health have been written about ext ensively, so if fo r some r eason you’r e not alr eady taking it for those r easons, then take it for its effec t on your bloo d sugar (which in turn influences the amount of insulin your body secretes and therefore impacts weight loss). Magnesium is absolutely essential for managing blood sugar, and magnesium deficien cy cor relates wit h insulin resistance. 35 (Even the American Diabetes A ssoci ation admits “stro ng associ ations… between magnesium defi ciency and insulin r esistance.”) Many nutritionists estimate that as much as 80% o f the population doesn’t get enough magnesium (and it could easily be more). As an added benefit, magnesium supplementation can bring down LDL (“bad”) cholesterol and bring up HDL (“go od”) cholesterol , 36 not exactly a bad “side effect”!
lpha-Lipoic Acid If there is a supplement other than fish oil that I feel safe recommending for just about everyone, it is alpha-lipoic acid. Aside from its impact on blood sugar, insulin sensitivity, and liver health, this superstar nutrient
does “double whammy” magic by acting as a powerful antioxidant on its own and by protecting other antioxidants such as vitamins C and E, making it a powerful anti-aging nutrient. While alpha-lipoic acid is not specifically a nutrient for weight loss, it can help with two areas that can stall your weight-loss progress. The first is insulin resistance. Alphalipoic acid has been shown to improve insulin sensitivity, 37 and, if for no other reason than that, it belongs in the program of anyone who has a lot of Along weightthose t o lo se. same lines, some o f the most impressive resear ch with alpha-lipoic acid has been done on diabetic neuropathy, the peripheral pain most diabetics feel in their extremities. Glucose (sugar) causes neur opathy. It does this by a nasty litt le pr ocess cal led g lycation, which is when ex cess sugar literally sticks t o pro tein in the blood, gumming up the works, impairing signals to ner ves, making cir culation difficult (espec ially in the tiny capillar ies in the eyes and toes), and cr eating the aptly named AGES (advanced g lycolated end-pro ducts). (For a full discussion o f g lycation, see chapter 2.) Alpha-lipoic acid is, among other things, an antiglycation agent; hence, we can assume it does good things to elevated levels of blood sugar. Another way alpha-lipoic acid may help weight loss is with its protective effect on the liver. The liver is the body’s main fat-processing factor y, and if th ere’s a traffic jam there, fat-b urning is not go ing to be optimal. Fatty liver—a condition many very overweight people have— and/or an excess of m edications, toxins, pol lutants, and the like that have to be detoxified by the liver can definitely slo w things up. Alpha-lipo ic acid is a powerful liver protector. In one spellbinding report by Dr. Burt Berkson, an emergency treatment with alpha-lipoic acid played a central role in saving the lives of two young patients whose deaths from mushroo m poi soning/li ver toxicity would hav e been a vir tual cer tainty. Berkson has also r eported on a successfu l treatmen t for the serio us liver disease hepatitis C t hat uses alpha-lipoi c acid, selenium, and mi lk thistle.38 For overall health and protection, I recommend 50 to 100 milligrams of alpha-lipoic acid daily as a supplement; but for effects on blood sugar, insulin, and the liver, I suggest at least 600 milligrams per day. The only “downside” to alpha-lipoic acid is that it is relatively expensive.
Chromium I recommend chromium for anyone I suspect has problems with blood sugar and/or insulin resistance or who is chronically unable to lose weight. Chromium is insulin’s helpmate: it makes insulin do its job of getting sugar out of the bloodstream and into the cells more effectively. We’ve already seen how high levels of insulin contribute to both weight gain and the inability to lose fat. If your body doesn’t need to overproduce insulin, you will have a more favorable and balanced hormonal environment for both health and weight loss. Indeed, chro mium as a supplement has been te sted in a number o f studies, spec ifically fo r its weight-loss and muscle-b uilding pr oper ties. The studies are conflicting. By itself, chromium probably does not “cause” you to lose weight. But by having a positive effect on blood sugar via its ability to increase the effectiveness of insulin, it is automatically helping to control one of the biggest obstacles to weight loss. Dr. Harry Preuss, one of the mo st distinguished and respect ed chro mium r esearchers i n the world, summed it up this way: “If you have a properly functioning glucose and insulin system, the tendency is to l ose fat and build muscl e.” In fact, one o f the most impressive stu dies of chromi um was done by Preuss himself on 28 overweight African-A merican women. T wo g ro ups took part in a modest d iet-and-exercise pr og ram; one g ro up was given niacinbound chromium (200 micr og rams three times a day), and t he other was given a placebo. The women getting the chromium had a significant loss of fat and a spa ri ng o f muscle. 39 Other studies have also demonstrated chromium’s positive effects. In one study, 1,000 micrograms a day of chromium given to type 2 diabetics pro duced a beneficial effect on gl ucose, insulin, ch olestero l, and hemoglo bin A1c levels (an impor tant measure for diabetes).40 Another study showed that while chr omi um supplementation didn’t have an effect on everyone, it had a significant positive effect on fasting insulin levels in those subjects who had high fasting levels to begin with (fasting insulin is measured by a blood test performed when you have not had anything to eat or drink except water for at least eight hours). High fasting insulin levels are a sign that there’s too much insulin in the system and a good indication that there are blo od-sugar pro blems. 41
But is chromium safe? Here’s the deal. There has been a lo t of media attention recently on the supposed link of chromium picolinate to DNA damage and precancerous conditions. Indeed, a number of somewhat disturbing studies have come out that have raised eyebrows. 42 However, there are two things you should know. One, the studies are all focused on the possible—I repeat, possible— damaging of picolinic the “picolinate” of chromium picol inate.effects hese studies do notacid—i.e., cast any doubt wh atsoeverpart on the safety of chromium itself, which has been shown time and again to be one of the safest nutrients you can take.43 Doses of chromium that are about 300 times the currently recommended daily dietary intake have been found safe in animals. 44 Two, not everyone agrees that these studies are meaningful. Shari Lieberman, a certified nutrition specialist and author of The Real Vitamin and Mineral Book , calls them “junk science. ” She says, “Show me where the amount of picolinate used in those hamster cell studies has any bearing whatsoever on what a human being would consume if they took chromium picolinate in the ranges we’re recommending.” Dr. C. Leigh Broadhurst, who worked with Dr. Richard Anderson on the development of chromium picol inate at the USDA, agr ees. Others ar e more cautious. “I’m abo ut 99.9 percent sure that chromium picolinate is safe,” says Dr. Harry Preuss. “But if there’s ev en a gli mmer of doubt, and it’s something you’r e go ing to be taking fo r years, wh y not stick w ith a for m of chro mium where there’s no question whatsoever about the safety?” So, what to do? Should you take ch ro mium if yo u are strugg ling with weight, blood-sugar, and insulin-resistance issues? Absolutely. And if you want to be absolutely 100% on the safe side, choose a form other than picolinate. Three that come to mind are chromium polynicotinate (niacinbound chro mium, availab le, for example, in a br and called Chro me-Mate), GTF ch ro mium, or chromi um arg inate. The recommended d ose for chro mium is 20 0 microg rams, 3 times a day, though it is frequently used in dosages up to 1,000 micrograms with no negative effects.
High-Dose Biot in
Biotin is associated in the public’s mind with shiny hair, clear skin, and healthy nails, but when used in megadoses (100 or more times the amount found in your typical B complex), it can be very effective for lowering blood sugar. It enhances insulin sensitivity and increases the activity of an enzyme called glucokinase, which is responsible for helping the liver use sugar. 45 One study that used 9 milligrams a day of biotin produced significant decreases in fasting blood-sugar levels in type 2 diabetics, 46 47
and another did the same by using 8 to 16 grams a day. Dr. David Leonardi treats a large number of diabetics at the Leonardi Medical Institute fo r Vitality and Longevi ty in Denver, and fr equently sees excellent results in those patients taking 15 milligrams a day. And it was recently suggested that high-dose biotin taken with chromium may be a viable treatment for insulin resistance. 48
Carnitine Carnitine, also known (and refer red to interchangeab ly) as L-carnitine, is a very interesting nutrient with a fascinating pedigree. I frequently recommend it for weight-loss clients in the dosage of 1 to 2 grams a day. However, you’re unlikely to get the full weight-loss benefits from it unless you use it in the form and dosages described at the end of this section and in conjunction with a low-carb, reduced-calorie diet. And there are many other terrific things that carnitine does for the overweight patient that you should kno w about while we’r e at it. Carnitine is a spectacular nutrient because of its demonstrably positive therapeutic value for the heart, 49 because it increases energy and combats fatigue, and because it has been shown repeatedly to lower triglycerides as well as lipopr otein(a), a serio us risk factor fo r heart dise ase. 50 In one trial, people with diabetes were given carnitine, and both their cholesterol and their triglycerides dropped 25% to 39% in just 10 days. 51 Fro m the basic raw material of carnitine, the body naturally makes acetyl-L-carnitine, a particular for m of car nitine that is enor mously pro tective for the brain. Relative to our concerns her e, carnitine impro ves insulin sensit ivity in insulin-r esistant diabetics and helps w ith gluco se uptake in no ndiabetic patients.52 But although this amino acid–like nutri ent has a r eputation as a
weightloss aid, until recently study after disappointing study failed to show an effect on weight loss o r body composition. There were some studies that indicated o therwise,53 but they were few and far between. Many clinicians believ e that while car nitine is amazing for a number o f applications, its use as a weight-loss supplement is questionable. Many others, however, do not agree. Some of the greatest clinicians in America routinely use it, have seen terrific results with it, and sing its praises fr om the recommended r oo ftops. Theirfrom experi ence can’t be ignor ed. fo r Atkins routinely 2 to 5 grwith amsit(sometimes more) patients at his clinic. Patrick Quillin, PhD, R.D., called carnitine a “‘wonder nutrient’ that could make weig ht reduction j ust a bit easier.”54 And one of the country’s most revered nutritionists and educators, Robert Crayhon of the Crayhon Resear ch Institute, calls i t “the best nutrient there is fo r pro moting weight loss. ” He even wrote a boo k about it c alled The Carnitine Miracle . So what’s the deal? It is well established that carni tine is absolutely necessary for “fat-burning.” There’s no disagreement about what it does in the body—carnitine is the “escort” for fat on its journey into the little “furnaces” of the cell (the mitochondria), whe re it is burned fo r fuel. The only question is whether carnitine supplementation actually increases the amount of fat “burned.” It’s beginning to lo ok li ke it does. An extremely im press ive study with nor mal subjects demonstr ated that supplemental carni tine actually increased fat-burning , even in subjects without carnitine deficiencies. 55 Some r ecent animal s tudies sho wed that supplemental carni tine significant ly i ncreased weight loss 56 and reduced fat gain. 57 Here’s what you should keep in mi nd about carnitine. • Carnitine wor ks best with a lower -car b diet (insuli n blunts its action). • Carnitine needs to be taken in the tartr ate form. • The amount of carnitine usually included in commercial “fatburning” for mulas is complete ly meaningless and ineffective; if you’r e go ing to give car nitine a fair trial, you need to use meanin gful do ses (see below). • The main source of carnitine is an imal foo ds. If you’r e a vegetarian, it’s
a vir tual certainty that you should be supplementing with carnitine, especially if you’r e trying to lo se weight. If your main source o f pr otein is so y, be aware that unless it’s for tified, it’s lacking in methionine, o ne of the two amino acids from which the body makes its own carnitine. • Carnitine lowers cor tisol levels (a nd can therefor e be helpful for adrenal health), 58 and adrenal activity affects weight gain and loss. Carnitine alone cannot pro mote weight lo ss. But in combination with diet, it can and will decrease body fat and body weight, probably more than diet alone would. Carnitine in conj unction with a lo w-carb diet and an exercise pro gr am makes a win ning combination. If you are a vegetarian, there’s no question that you should use it, and if your plan calls for ketosis, you sho uld definitely use it as well, since when ca rnitine is deficien t, conversio n of fat to ketones is impaired. 59 Plan to use no less tha n 1 gr am, preferably 2 gr ams or mor e, and remember to get the tartrate form. A great time to take it is on an empty stomach before working out. The best carnitine is the tartrate form marketed by both Designs fo r Health and Crayhon Resear ch. The powder makes higher doses very easy and palatable (it tastes like lemony Tang). One teaspoon equals 2,800 mill igrams (2.8 gr ams). Be aware that it’s expensive.
CoQ10 (Coenzyme Q10) CoQ10 is not a weight-loss supplement per se, but is vitally important in the production of energy, and if you are low or deficient in it, it may keep you from losing weight. 60 CoQ10 is short for coenzyme Q10. Technically, it’s not a vitamin (because it’s synthesized in the cells), but it acts like a vitamin in the body because it is involved in so many metabolic functions. It is found in high concentrations in the heart (also in the kidneys, liver, and pancreas) and is considered a very important nutrient for heart health, largely because of its importance in the creation of molecules of energy (known as ATP), which are required in large amounts by the heart. 61 It can also decrease blood sugar in diabetics. CoQ10 is frequently depleted by medications, especially statin drugs. (If you’re on a statin, you should definitely be o n CoQ10.)
If energ y and fatigue ar e an issue for you, I often recommend t he “energy cocktail” of carnitine, CoQ10, and ginseng. Remember, however, that lack of energy is often due to lifestyle—not enough high-quality sleep, the wrong diet, and adrenal burno ut. You need to addr ess those issues and not take the “cocktail” as a substitut e for doing something about them.
Green Tea (EGCG) Dr. Shari Lieberman, author of The Real Vitamin and Mineral Book, considers the active compound in green tea to be one of the best weightloss supplements available, and I agree. Compounds in gr een tea can r aise your metabolism. The particu lar compound responsible fo r the increase in fat-burning ability is called EGCG (epigallocatechin gallate), and it works by increasing the pro duction o f nor adrenaline, w hich turns up your metabolism. 62 EGCG also stimulates br own-fat met abolism, thus increasing thermo genesis. 63 Green-tea extracts have been shown to increase fat-burning as well as metabolic r ate (the amount of calor ies you burn) fo r up to 24 hour s. 64 In animal studies, they have been shown t o have a mild antio besity effect; 65 and if that were no t enough, the EGCG in g reen tea has recently been shown to enhance insulin activity.66 You’d need to drink five or more cups of the tea a day to get the amount of EGCG r equir ed to pr oduce an effect , so high-qualit y supplements ar e probably the way to go.
Ginseng Ginseng is what is known as an adaptagen, which means it can help you restore equilibrium to something that is out of balance. In that sense, it’s like the thermostat on your central air-conditioning/heating unit—if the room is too hot, the thermostat tells the unit to cool things off, but if the room’s too cold, the thermostat signals the unit to warm things up. Ginseng is traditionally used for energy, es pecially du ri ng times of stress or fatigue, but recent evidence has shown that it is amazing for helping to r egulate blood sugar, and may possibly be of value in weight loss as67well. In one study, it elevated mood and r educed fasting blo od sugar. In two animal studies, it improved glucose tolerance while the animals lost weight, 68 and in another it produced a significant amount of
weight loss, an increase in calories expended, and a reduction in the amount of calo ri es consumed. It also decreased cholest ero l! 69 This may be why Asian ginseng is commonly used in traditional Chinese medicine to tr eat diabetes. In animal r esear ch, it has been shown to increase th e number of i nsulin recept or s, 70 and r ecent studies sho wed that even nondiabetics taking American ginseng before eating had lesselevated bloo d-sugar readings after they ate.71 Siberian ginseng might be w or th a try if you’r e fatigued, or try Ameri can ginseng if you’re co ncerned ab out your blo od sugar. Alternatively, you can g et the mor e stimulating Panax typ e, also known as Chinese or Korean ginseng.
5-HTP This supplement (a metabolite of the amino acid tryptophan) has been found to have an effect on weight loss in several impressive studies, even sometimes without dietary changes. 72 5-HTP (5-hydroxytryptophan) is the immediate precursor to serotonin and has been found very useful as an antidepressant. It’s thought to exert its influence over eating behavior by affecting serotonin. Studies have shown that 5-HTP decreases food intake (predominantly carbohydrates) and promotes weight loss. 73 If you’re currently taking antidepressants, make sure to check with your doctor before adding 5-HTP to your supplement regimen. I recommend always including B6 along with your 5-HTP, since B6 is needed for the conversion to serotonin.
Bitter Orange Bitter or ange ( Citrus aurantium ) is the ingredient found in most of the new “ephedra-fr ee” diet pill s. It’s an her b that contains the active ingredient synephrine . Synephrine is chemically very similar to ephedrine and pseudoephedrine and has similar effects in terms o f pr oviding an energy boost, suppressing the appetite, and increasing metabolic rate and calor ic expend iture. By stimulating specific adrenerg ic r eceptor s, synephrine i s thought to stimulate fat metabolis m without the negative cardiovascular side called “ma huang .” effects experienced by some people with ephedra, also Bitter orange usually contains about 1% to 6% synephrine, but some
manufacturer s boo st the content to as m uch as 30%.74 It does have a thermo genic (fat-bu rning ) effect 75 ; in animal studies, synephrine caused weight loss but also increased th e ri sk of car diovascular pro blems. 76 Bitter orange can also increase the side effects of many medications, including (but not limited to) Xanax, Zoco r, Sudafed, Buspar, Celexa, Zoloft, Allegra, pr ednisone, Meridia, Viagr a, and a nu mber o f bloo dpressure medications. 77 Do not take bitter o range if you have high bloo d pressure or are pregnant. The bottom line is this: bitter orange is a stimulant, and the same cautions about other stimulants (like ephedra) apply.
Glutamine Glutamine is your secret weapon against carbohydrate cravings. I use it all the time with my clients—I have them combine a couple of grams of the powder with a little heavy cream and xylitol for sweetener. This has a remar kable ability to curb the urge for somethin g sweet. Glutamine’s usefulness as a cravings-buster was first discovered when it was shown th at about 12 gr ams of glutamine curbed alcohol cravings. 78 Its effect on sugar cravings was acknow ledged by a r esearch director at the National Institutes of Health as far back as 1986. 79 Atkins r outinely used it with his patients to co mbat the compulsi on to eat sugar .80 Dr. Ron Rosedale explains that glutamine acts as a brain fuel , so i t can help eliminate carbohydrate cravings while you are in that “transition” period. 81 Glutamine (also known as L-glutamine) comes in capsules or powders, but I prefer the powder for its versatility and fast-acting ability. Neptune Krill Oil Neptune krill oil (NKO) is a relatively new supplement that shows tremendous promise in the treatment of PMS. It’s basically a fish oil, a low-temperature extract of the abundant Antarctic krill ( Euphausia superba ). Reportedly, it has an ORAC value (antioxidant rating) of 378— more than 300 times that of vitamins A and E and 48 times greater than most fish oils. A recent study evaluated the effectiveness of NKO for the management of PMS in an outpatient clinic. In 70 patients, a significant improvement was found after 3 menstrual cycles. The authors concluded that NKO can significantly reduce the emotional symptoms of
premenst rual syndro me.82 The dosage is 3 grams a day. You can also take NKO together with the 3 products I have been successfully using for PMS with my clients fo r years: B6, magnesium, and GLA.
CLA There have been some very promising studies on CLA, a fatty acid found in grass-fed beef, lamb, and dairy products from grass-fed animals. A substantial amount of research has shown it to reduce the incidence and size of tumors. 83 But a pretty impressive amount of research has shown that it also helps with fat loss. Best of all, the type of fat it seems to impact the most is abdominal fat, the most “dangerous” and metabolically active fat on the body. In one study on middle-aged men with metabolic syndrome, there was a significant decrease in abdominal diameter in the group given CLA supplementation for four weeks. 84 Research at Ohio State University has found that CLA delayed the onset of diabetes in rats and helped improve the management of type 2 diabetes in adult humans. 85 Another study on human subjects, published in the Journal of Nutrition in 2000, showed that CLA reduced body-fat mass in overweight and obese subjects.86 CLA appears to also have anti-inflammatory properties. The dose that seems to help with weight is at least 3.4 grams daily, and one study got good results using twice that dose. 87 Again, the results won’t be dramatic or magical, but the supplement could certainly help, and its many other benefits—e.g., to the immune system, for inflammatio n, and possibly as an anti-cancer agent—make it worth considering.
Of Possible Use Gymnema Sylvestre
Gymnema sylvestre is an herb with an interesting double relationship to sugar. In Sanskrit, gymnema means “sugar destro yer.” If you place it on the tongue, it blocks the sensation of sweetness! But if you take it internally, it seems to help control blood-sugar levels, at least in diabetics. It may well turn out to have a place in the supplement regimen of those trying to control blood sugar and increase insulin sensit ivity.
Hydroxyc itrat e (Hydr oxycitr ic Acid) Hydroxycitric acid, an extract from the plant Garcinia cambogia, is often sold and promoted as a weight-loss aid. In animal studies, it suppressed appetite and encouraged weight loss, and it has also been suggested that hydroxycitric acid interferes with the body’s ability to produce and store fat. But a lot of human studies have been very disappointing. It does, however, have its supporters, among them vitamin expert Dr. Shari Lieberman, who argues that some of the disappointing studies were badly designed. As far as I’m concerned, the jury is out on this one. I haven’t personally seen much success with it, but I’m willing to be proven wrong.
Banaba Leaf Extract (Corosol ic Acid) Banaba leaf extract contains a compound called corosolic acid, which has been used for centuries as an aid to weight loss and blood-sugar control. Corosolic acid is used routinely in the weight-loss protocol of Dr. Alan Schwartz, medical director of the Holistic Resource Center in Agoura Hills, California, and it is now beginning to get some attention nationally for its ability to lower blood sugar when taken in the range of about 48 milligrams a day. A very thorough discussion of the actions of corosolic acid and the research so far can be found in the September 2000 issue of
Life of the Life Extension article is Extension, the magazine also available Foundation. The online: http://www.lef.org/magazine/mag2000/sep2000_report_blood.html .
CHAPTER 10
Frequently Asked Questions n this chapter, I’ve posed and then answered the questions that I see I most often on my Web site, as well as those I’m asked most fr equently in seminars and workshops around the country. I’ve also incorporated the questions that I’ve seen co me up time and time ag ain o n Internet sites dealing with lo w-carbohydrate diets. The questions are organized into categories, such as Losing Weight on Low-Carb, Food and Drink, and Exercise. If you have a question that’ s not answered her e, you’r e always welcome to po st it to me directly thro ugh my Web site, http://www.jonnybowden.com.
Losing Weight on Low-Ca rb How Long Will I t Take Me to Lose 10 (or 100) Pounds? There is absolutely no w ay to know the answer to this question. A lot depends on how much you have to lose an d how you respond to your program. Everyone is fundamentally different on metabolic, genetic, and biochemical levels, and each body responds differently. Even people on identical programs are likely to experience different amounts of weight loss on different timetables. Rule of thumb: in the first week or so of a low-carb diet, you may lose a bunch of weight—maybe even 7 to 10 pounds if you are considerably overweight—but eventually you should settle in to an average of 2 pounds of weight loss per week, more or less. Don’t be discouraged if your weight loss is less—man y other things could be going on. And even at the rate of 1 pound a week, you’ll still lose 50 pounds a year.
Is a Low-Carb Diet for Every one?
Memorize this and tattoo it behind your eyelids: no single diet is for everyone. The Bantu of South Africa thrived on a diet of 80% carbs, and some groups of Eskimos thrived on a diet of nearly zero carbs. However, here in America and in most industrialized nations, it’s fairly safe to say that nearly everyone would benefit from a lower-carb diet than is currently the norm. And everyone would benefit from changing their carbs from the highly processed, sugarladen, fiberless fare of convenience, fast, and packaged foods to what could pluck, gat her, or grwe ow.might call “real” carbohydrates—things you How low in carbohydrates you perso nally nee d to g o must be determined by trial and er ro r. If you ar e a basically healt hy person lo oking to stay that way and weight loss i s not a r eal issue fo r you, the best template to start with is the one advocated by B arry Sears, which is approximately 40 % of your foo d as carbohydrates, 30 % as pro tein, and 30% as fat. Interestingl y, this is ver y clo se to what many of the plans discussed in this boo k—among them the Atkins diet, Pro tein Power, and the Fat Flush Plan—recommend for maintenance after your weight target has been achieved. Sugar Busters! recommends this proportion from the beginning , although the auth or s don’t cr edit it to Dr. Sears. And no less a luminar y than the reno wned Harvar d epidemio logist Dr. Walter Willett has said, without actually mentio ning the Zone diet, that a diet co ntaining 40% carbs, 30% pro tein, and 30% fat may well be the most healthful alternative to the moribund USDA Food Guide Pyramid’s recommendations.
Once I Reach My Goal Weight, Can I Add Carbs Without Gaining Weight? Posts on Internet bulletin boards respond to this type of question with the acronym YMMV, which means “your mileage may vary.” Translation: everyone responds differently, so try it out. All of the classic programs basically suggest adding carbs back in a controlled and measured way until you discover for yourself the “magic” amount that allows you to maintain your go al weight .
Should I Weigh Myself Regularly? Yes. The scale is a great way for you to check in with reality, as long as you know how to use it right. You need to learn not to beat yourself up
about the number. You need to understand that water retention can mask fat loss. You need to understand that body composition can change with weight training exercise, and that you could be losing fat while gaining muscle (which would not necessarily show up right away on the scale). And you need to understand that everyone loses at a different rate. You may go for a period of time with no change whatsoever and then all of a sudden have a “whoosh” of weight loss. That said, the scale will keep you honest. Eventually the scale fat loss. It will you—in combination with ,other cues, will like reflect how you’re feeling andtell what your measurements are—whether what you’re doing is working or not. If you want to figure out your critical carb level, you’ll have to use the scale at some point to find out whether additional carbs are slowing you down. Many people have been deli ghted to fi nd out that they actually co uld have a few more carbohydrates than they previously thought, and that it didn’t slow down their weight loss appreciably or, if they were already at their go al weight, it didn’t cause them to g ain. But you’ll never kno w any of that if yo u don’t watch the numbers.
What Are Net Carbs? What’s the Difference between Net Carbs and Effecti ve Carbs? There is none. carbs effective two different phrasesasfora the same thing.Net The ideaand is that fiber,carbs evenare though it’s “counted” carbohydrate on food labels, isn’t absorbed, so it shouldn’t really be counted. To get the net, or effective, carbohydrate content of a food, simply go to the lab el and subtract the number of gr ams of fiber from the number of grams of carbohydrate . For example, 1 cup of raspberries has 14 grams of carbohydrate, but 8 of those are from fiber. Subtract the 8 grams of fiber from the 14 grams of total carbohydrate, and you get the number of net carbohydrate gr ams per cup: 6.
What Is the Minimum Daily Requirement for Carbohydrates? Zero. There is no biological requirement for dietary carbohydrate in human beings. You would die without protein and you would die without fat, but you can live just fine without carbohydrate. I’m not suggesting that you sho uld—just that you can.
Low-Ca rbing and the Body Why Am I Getting Headaches during the Induction Phase of My Diet? Headaches are a frequent side effect of switching abruptly from a highcarb to a low-carb diet. One of the reasons for this is that your body and your brain need t o adapt to using fat and k etones as a pr imary fuel sour ce after being accustomed to using sugar. Your brain can certainly use ketones, but it takes a few days to make the adjustment, during which you may get a headache. It usually goes away by itself, but one thing you can definitely do is drink more water. In fact, if you don’t drink enough water, you may get a “ketone headache” even after your body has adapted to the diet. The other thing you can do is up your carbs by 5 to 10 grams a day until you’re feeling better, then lower them gradually. Preventing some of the side effects is one reason for doing a three-day transition from your previous way of eating into this new low-carb lifestyle.
I’m Gett ing Leg Cramps, Especial ly at Night. Why? This is almost always due to a mineral deficiency, particularly potassium, calcium, and magnesium. Remember that insulin tells the body to hold on to salt and water. When your insulin levels fall, especially during the first week on your low-carb diet, the kidneys will release that excess sodium— and you will begin to lose a lot of water. This will usually result in a loss of potassium as well, and one of the symp toms of potassiu m lo ss is muscle cramping (as well as fatigue). Dr. Alan Schwartz, medical director of the Holistic R esource Center in Agour a Hills, Ca lifor nia, recommends tak ing one or two potassium supplements (99 milligrams) with each meal, especially in the first week of your low-carb diet. Magnesium supplementation is also a go od idea. Note: nuts help prevent potassium and mag nesium imbal ances. While you have to watch your intake of nuts during the weight-loss phase of your pro gr am, they nonetheless are chock-full o f these va luable minerals.
Does a Low-Carb Diet Cause Kidney Proble ms? No. This is one of the great myths about low-carbing, but it is exactly that: a myth based on an incomplete understanding of the facts. It is true that
people with preexisting kidney or liver problems should not go on very high-protein diets, but it is not true that either high-protein diets or lowcarbohydrate diets in general cause kidney problems. If your doctor tells you o therwise, ask h im o r her to sho w you the resear ch that confir ms that finding. Your doc will not be able to, because there is none. There is not even a problem with protein in the diet of diabetics, who are frequently given to kidney problems. “There is no evidence that in an otherwise healthy person with diabetes eating protein disease,” says Frank Vinicor, director of diabetes researchcauses at thekidney Centers for Disease 1 Contro l and Pr evention. (For a mor e detailed expla nation, see chapter 6).
Is Low-Carbing Good for Diabetes? It is not only good; it is essential . “Diabetes is a disease of carbohydrate intolerance,” says physician and diabetes specialist Lois Jovanovim, chief scientific officer of the Sansum Medical Research Institute in Santa Barbara, California. “Meal plans should minimize carbohydrates because eople with diabetes do not tolerate [them] .”2 (Emphasis mine.) Dr. Richard Bernstein, author of The Diabetes Solution and a diabetic himself, has been fighting the medical establishment over this since the 1970s. “What is still considered sensible nutritional advice for diabetics can over the long run be fatal,” Bernstein writes. 3 The American Diabetes Association’s high-starch diet is so behind the curve that it’s ludicrous. Jovanovim sums up the conventional high-carb advice for diabetics in one word: “Malpractice!”
Can Stress Stall Weight Loss? You bet. Not only can stress stall weight loss, it can reverse it. Stress— which can come fr om lack of sleep, ext remely lo w-calor ie dietin g, and, of course, from life itself—causes the release of hormones such as cortisol and adrenaline. These stress hormones send messages to the body to break down muscle for fuel, resulting in a lower metabolic rate. They send compelling messages to the brain to eat (e.g., the well-known “stress eating” phenomenon). Cortisol also tells the body to store fat around the middle. Because cortisol basically breaks down biochemicals in the body, chronic elevated levels of cortisol can trigger a protective reaction from
the body in the form of insulin secretion (since insulin builds up structures in the body, including, of course, the fat cells). This makes chronically high levels of co rtisol one possible cause of insulin resistance . Another way stress can screw up weight loss is by its effect on serotonin. Stress eats up ser otonin. Less sero tonin is pr oduced bec ause stress i nterfer es with the go od, deep, res tful sleep needed by t he body to replenish its sero tonin stock.4 The deman d for sero tonin becomes gr eater, while the production of it as is lower. Serotonin depletion never, ever conducive to weight loss, it works against you in veryispowerful ways.
What Is Leptin? Leptin is a hormone involved in appetite control. Early research at Rockefeller University showed that obese mice were very low in leptin, leading to a lot of excitement about the possibility that giving leptin to obese people would somehow result in weight loss. No such luck. It turned out that obese people have plenty of leptin. What seems to be happening is that they have what might be called leptin resistance—their cells don’t respond to it, in a scenario not unlike that of insulin resistance. Leptin is pr oduced by fat cells—when t he fat cells ar e full, they rel ease leptin, which sends a sig nal to the brain to stop eating—but this mechanism doesn’t seem to work in obese people. Less leptin means more appetite; as body fat is lost, leptin levels drop, 5 which in turn sends a message to the brain telling you to eat more. This mechanism may be one of the many that make regaining weight after a diet so easy; it’s as if this feedback mechanism is hard at work to preserve you at a set weight. Drugs to treat this “leptin resistance” are in development and, if they prove promising, may one day help to fi ght obesi ty.
This Is My First Week on a Low-Carb Diet. Why Do I Feel Lightheaded? Loss of minerals could be the culprit. Remember that when you lower your insulin levels, you lose salt and water (but, in the process, you lose potassium as well). This, plus the tons of water I hope you’re drinking, could conceivably result in enough electrolyte loss to lower blood pressure to the point where you might feel lightheaded or even faint. Replace some of the lost salt with either salty foods or some table salt. Try ¼ teaspoon of potassium chloride (Morton Lite Salt) and ¼ teaspoon of
table salt to start, and see if that helps. Don’t forget to take potassium supplements.
How Do I Know if I’m Insuli n-Resist ant? The best way is with a fasting insulin test. This test tells you what your baseline lev el of insulin is wh en no foo d is ar ound to spike it . If you’r e not insulin-resistant, you shouldn’t have a lot in your bloodstream when you haven’t eaten. Lab ranges will vary; you should not be above seventeen, and the optimal level is below ten. A blood-sugar test won’t tell you if you’re insulin-resista nt. You co uld have blood sugar in the normal range, but it could be taking an enormous amount of insulin to keep it there. Without a fasting i nsulin test, the best “low-tech” w ay is to look at yo ur body’s “insulin meter”—your waistline. If you’re storing a bunch of fat around your middle, chances are you’re somewhat insulin-resistant. And though the argument about which comes first—obesity or insulin resistance—continues to rage, the fact is that they are so often found together that for all intents and purposes, if you’re extremely o verweight , you can assume you ar e also insulinresista nt. (There ar e exceptions; some heavy people are insulin-sensitive, and some thin people—who usually exercise a ton and never overeat—are insulinresistant. These are not the typical cases.) Does a High-Prot ein Diet Cause Bone Loss or Osteoporos is? No. If anything, a diet high in protein does the opposite, particularly in the presence of adequate calcium intake and plenty of alkalinizing vegetables. There are a tremendous number of studies now showing that protein is essential for healthy bones and that, indeed, low protein intake can be an obstacle to bone-building. (For a more in-depth discussion of calcium, high protein, and bone loss, see chapter 6.) It’s also worth remembering that the total amount of protein consumed on the typical low-carbohydrate diet of 2,00 0 calor ies (or less) is in no way excessive, even if it is a hig her percentage of your diet than it had been before you revised your eating habits.
Can a Low-Carb Diet Cause Gallbladder Problems? No, but if you have been overweight and have been on a very low-fat diet
for a long time, a high-fat diet can make your gallbladder problems—like gallstones—apparent. Here’s why. The gallbladder basically responds to fat in the diet with contractions that release the bile necessary to digest fat properly. When you’ve been on a very low-fat diet, there’s not much for the gallbladder to do, so it gets lazy; deposits sometimes accumulate and form stones, kind of like sediment forming in stagnant waters. When you suddenly go on a high-fat diet, the gallbladder now has work to do—it contracts response fat, the and stones; it may pass high-fat (low-carb)in diet didn’tto the cause they these were stones. alreadyThe there and developed most likely in response to your very low-fat diet! But switching to a high-fat diet could trigger an attack. The solution: a moderate-fat version of the low-carb diet will trigger gallbladder contractions that are strong enough to release bile, but not vigorous enough to dislodge any stones.
What Can I Do about Constipation? The two main causes of constipation on low-carb diets are not drinking enough water and not eating enough fiber, both of which you should be doing even if you’re not constipated. Drink more water (see “How Much Water Should I Be Drinking?” on page 325), and make sure the vegetables and fruits youallconsume are high in fiber—spinach, broccoli, and raspberr ies are g oo d choices. Consider a fiber supplemen t (even sugar free Metamucil, though I prefer PaleoFiber or Cellulose Fiber, both available on my Web site, http://www.jonnybowden.com). Exercise almost always helps. And drinking hot water with a squeeze of fresh lemon juice fir st thing in the morning can help get things g oing as well. A terrific “cure” for constipation is magnesium. Get the magnesium citrate form, start with 400 milligrams a day for a few days, and then, if needed, increase to 800. That almo st always does it.
Cravings Why Do I Get Cravings? Cravings have many causes. Some are caused by nutrient deficiencies (see chapter 9 for information on supplements). In this case, what you crave is
a clue to what’s missing; for example, craving fatty foods could indicate that you’re not getting enough essential fatty acids. Try adding omega-3 fats like fish oil; women can also try flaxseed oil. Many cravings are caused by bloodsugar imbalances. The common craving for carbohydrates in the evening can be caused by not having eaten enough protein and/or fat earlier in the day. Frequent small meals that contain protein and fat will help control the blood-sugar roller-coaster that is often responsible for cravings. If a carb craving is absolutely irresistible, as a transition technique you should satisfy it with fruit (though you can blunt the insulin effect by adding so me peanut butter or turkey). A lot of cravings are caused by low serotonin states. Eating highcarbohydrate foo ds in this scen ario is a kind of self-medica tion. The problem is that it creates a vicious cycle that results in weight gain and mor e cr avings. Some supplemen ts can help boo st sero tonin naturally (see chapter 9), and there are a number of lifestyle ways to boost it as well, such as having a pet, being o ut in the sun, and making love! You al so need to understand that some cravings are simply conditioned responses to stress and are more emotionally driven than anything else. That’s why “comfort foods” are so named—we have been conditioned to eat them when things aren’t going well so we need a little TLC. The more you work on developing alternative behavioral responses to these situations—like taking warm bath s or go ing fo r a walk—the better off yo u’ll be.
What Can I Do to Combat Sugar Cravings? There are two supplements that are phenomenal fo r sugar cravings. One is glutamine—I recommend that you take a spoonful or two of the powder in water (available in health-food stores or through Internet sources). A spoonful of glutamine mixed with the sweetener xylitol and dissolved in a few tablespoo ns of half-and-half or heavy cream will knock th e socks o ff even the wor st sugar cr aving.
I don’t care how much the experts say it’s harmless, I know how sugar makes me feel: crazy. I start craving it like an addict, and
once I start eating it I can’t stop. —Jean N. You might also investigate a new product called Crave Arrest, a blend of ingredients such as tyrosine (a precursor to dopamine), 5-HTP (a precursor to serotonin), and B6, which is necessary for the conversion of tryptophan to serotonin. (Crave Arrest is made by Designs for Health and can be purchased through a link on my Web site, http://www.jonnybowden.com.) Here are the top five techniques for busting cravings. 1. Contro l bloo d sugar by eat ing pr otein and fat every few hours, at every meal and snack. 2. Avoid any junk carbohydrates made of white stuff (rice, bread, pasta), as well as those that contain hig hly concentr ated sweeteners, even if their car bohydrate content is permissible on your pr og ram. 3. Never let your self become famished. Carr y protein-based snacks like nuts, cheese, and hard-boiled eggs with you at all times. 4. Get enough sleep. L ack of sleep incr eases appetite and stimulates stress eating. 5. Learn to r ecognize th e emotional t rigg ers fo r cr avings, s uch as fear, tension, shame, anger, anxiety, depression, loneliness, resentment, or any unmet needs. Don’t pr etend they’re not there—r ecog nize them, accept them, embrace them, and own th em. Then explor e behavior al ways of dealing with them besides eating.
Supplements Do I Need to Take Supplement s? The technology exists to give you health-protective and therapeutic amounts of vitamins, minerals, phytochemicals, antioxidants, and other
compounds, ma ny of whic h simply are not availab le fr om o ur fo od supply or, if they are, not in the amounts needed to make a difference to your health and wellbeing. You don’t need to take vitamins, but then you don’t need electrici ty either. The question is, why would yo u do without either o f them if you didn’t have to? (See chapter 9 for complete recommendations on supplements.)
Doesn’t Taking Vitam ins Just Resul t in Expensive Urine? If it does, then why bother to dr ink water? You just uri nate it out at the end, right? Do you see how ridiculous this concept is? The expensive-urine comment, which is perpetuated by doctors who don’t really understand nutrition and vitamins, implies that just because something eventually winds up in the urine, it didn’t accomplish anything in the body. Why does a drug addict take drugs or an athlete take steroids? Drugs, both recreational and prescription, are detected in the urine, right? Does the fact that they’re detectable in the urine mean that they didn’t work ? If that were the case, there’s an awful lot of people wasting an awful lot of money on drugs and medications! It’s funny how the same doctors who cry “expensive urine” in response to vitamin therapy never make the same remark about their prescription drugs that are just as detectable in the urine as vitamins are!
I definitely noticed a difference in my skin when I began to supplement with fatty acids like fish oil. My hair and scalp weren’t as dry and even my fingernails got stronger. —Bernice D. The fact that drugs—or vitamin residues—are detectable in the urine means absolutely nothing except that those substances went through the
body and did their job. They didn’t pass through and accomplish nothing, or else steroids wouldn’t be banned by athletic organizations! The body takes what it needs, uses it, and excretes the rest. In addition, there’s no way to know exactly how much of a given vitamin a specific individual actually needs. It’s a lot better to take too much (with a few exceptions that might be toxic in very lar ge amo unts over an extended perio d of time, such as very high-do se vitamin A or selenium) and let the tissues decide how much t hey need and much is “Hey, excess.I As Crayhon answer to how this question, wantnutritionist expensive Robert urine! In fact, I says want in the most expensive ur ine mo ney can buy!”
What About Ephedra? A recent post on an Internet diet board asked the following question: “Do people die from taking ephedra?” The question produced the single best response I’ve ever seen: “No, people die because they are morons.” When ephedra has been used in supervised weight-loss research studies, it’s been use d in the dosage of 60 millig rams per day in three divided dosages (20 millig rams each), combined w ith 200 milligr ams of caffeine per dose. In every super vised study using this dose, it has not shown itself to be danger ous, and the side effect of “ji tters” was usually pretty w ell tolerated. is not —I repeat, not—for with; high blood who pr essur e; for people whIto ar e sensitive to ephed ri ne people or caffeine fo r people have any kind of heart, k idney, or liver pr oblems; or for people who ar e on any medication, including o ver-the-c ounter meds (unles s clear ed by a doctor ). Ephedra works by stimulating brown-fat metabolism, thereby increasing the bodily pr oduction o f heat (upping your metabolism slightly ) and by suppressing your appetite. The possible side effects are very annoying and include nervousness, insomnia, and possibly dizziness. The benefits in the way of fat loss ar e very mil d but pro bably do exist . But here’s the thing. While I’m no g reat fan of ephedr a, it has also been blamed for an awful lot of things it doesn’t deserve. When a college athlete dies on the football field while practicing in 100° heat in full uniform, dehydrated, with a few hundred milligrams of ephedra plus who knows what else in hi s system, it’s not exactly fair to blame ephedr a. A recent field trip to my local vitamin shop uncovered ephedra pills with 250 milligrams per pill—more than ten times the recommended do se—and
believe me, there are people who are taking several of these pills at a time. Let’s also keep in mi nd that there are a couple o f thousand deaths dir ectly related to aspirin per year. Ephedra in small amounts, un der controll ed conditions, is no t danger ous. I’m mor e concerned about t he adrenal burnout fact or with ongo ing ephedra use. This drug is a metaboli c stimulant, and like any stimulant, it taxes the adrenal glands, which over the very long haul can not only hamper your weight-loss effo moot, rts buthowever. damage your health. This discussion is probably “Its time is over,” says Dr. C. Leigh Br oadhur st, who has her self used ephedr a without incident. Ther e’s just too much bad publicity and public o utcry about it, and it w ill almost certainly be taken off the market soon. The new “ephedra-free” diet pills have simply replaced ephedra with Citrus aurantium (bitter or ange), which has many of the same fat-burning/appetite-suppressing effects but doesn’t yet have the bad rap. (See next question.) If you do use ephedra, make sure you do not fit in any of the categories mentioned above, and never take more than the recommended dosage.
What About Over-the-Counter “Ephedra-Free” Diet Pills? The new “ephedra-free” diet pills have simply replaced ephedra with bitter orange ( Citrus aurantiumis), chemically an herb thatvery contains ingredient synephrine. Synephrine similarthetoactive ephedrine and pseudoephedrine and has similar effects in terms of providing an energy boost, suppressing the appetite, and increasing metabolic rate and caloric expenditure. By stimulating specific adrenergic receptors, it is theorized that synephrine stimulates fat metabolism without the negative cardiovascular side effects experienced by some people with ephedra (also called “ma huang”). Bitter or ange usuall y contains between 1% and 6% synephrine, but some manufacturer s boo st the content to as m uch as 30%.6 It does have a thermo genic (fat-burning) effect.7 In animal studies, synephrine caused weight loss, but it also increased cardio vascular pro blems. 8 Bitter orange can also increase the side effects of many medications, including (but not limited to) Xanax, Zoco r, Sudafed, Buspar, Celexa, Zoloft, Allegra, pr ednisone, Meridia, Viagr a, and a nu mber o f bloo d
pressure medications. 9 Do not take bitter or ange if you have high bloo d pressure or are pregnant. The bo ttom l ine is this: it is a stimulant, and th e same cautions about other stimulants (like ephedra) apply. Just because the pill is “ephedr afree” does not mean that you should use unlimited amounts of it.
What’s in Those “Fat-Burning” Formulas I See Everywhere, and Do They Help with Weight Loss? A recent field trip to my local vitamin store to inspect a dozen of these for mulas—la beled everything fro m “metabolism boo sters” to “fat burners” to “lipotro pics”—revealed a prett y standard revolving door of ingredients. Most used some combination of: • bitt er orange (Citrus aurantium ), a stimulant that increases metabol ism (thermogenesis) slightly and is discussed above (see “What About Over-the-Counter ‘Ephedra-Free’ Diet Pills?”) • guarana , which is herbal caffeine • white willow bark, which is basically aspirin and really doesn’t add anything to the mix • green tea extract, a.k.a. EGCG (epigallocatechin gallate), which does have thermog enic pro perties (see chapt er 9) Combinations of these ingredients can definitely suppress appetite, give you the jitters, and maybe, just maybe, burn a few extra calories. Some “fat-b urner s” include a mix of car nitine and chromium (bo th of which are discussed in chapter 9). They almost never contain the best form of car nitine (tartr ate) and rar ely contain mor e than 500 millig rams (mo st nutritionists think the minimum amount necessary to impact fat-burning in an overweight pe rso n is 1,500 millig rams). As far as chro mium is concer ned, while I have seen for mulas with 200 micro gr ams (the ab solute minimum needed), I saw one that loudly proclaimed “contains chromium” and actually had a ridiculously low 13 micrograms. Understand that the amount most ofte n given to people with blood-sugar pro blems is in the
neighborhood of 600 to 1,000 micrograms; 13 micrograms would do absolutely nothing and is only there so that the manufacturer can say “contains chromi um”—a complet e r ip-off. Other ingredients that show up in the formulas, especially the ones labeled “lipotropics,” are inositol, an essential nutrient and relative of the B family, and choline, another relative of the B family that mobilizes fat. Both choline and ino sitol (plus methionine) are involved in the liver ’s ability process fats, there’sit. reason to thinkliver that these nutrients might help thetoliver mo ve fatsothrough If a sluggish is part of the reason you’re holding on to fat, these nutrients could be helpful. As lipotropics go, I like the Fat Flush Weight Loss Formula from http://www.unikeyhealth.com, which contains reasonable amounts of choline, inositol, and met hionine, plus t he go od fo rm of carnitine, 4 00 micro gr ams of chro mium, and an herbal mix tha t’s go od fo r the liver. The other pair o f ingr edients often found in these for mulas are ty rosine, an amino acid helpful for impro ving mo od, and phe nylalanine, an essential amino acid that can be conver ted into tyr osi ne. Both of these ar e precursors to dopamine, a neurotransmitter that makes you feel peppy and brig ht. Tyro sine is needed for the making o f thyro id hor mone, but it is highly unlikely that tyrosine will boost low thyroid, even though some supplement makers claim it does. The important thing is to read the ingredients on the labels of the pro ducts you ar e considering . These for mulas vary widely in t heir effects, depending o n the amounts and quality of the ing redients included. At worst, they do no thing. At best, they’ll g ive you a bit o f a speedy feeling and maybe increase metabolic rate by a very small amount.
Ketosis What Is Ketosis? Ketosis is a term used to describe what happens when the body switches to fat as its main source of fuel, which is exactly what you want to happen when you’re using a low-carbohydrate diet to lose weight. When fat is the main source of fuel, there is an increase in the number of ketone bodies
made as a by-product of fat metabolism. Ketones can be measured in the urine by means of ketone test strips.
Is Ketosi s Dangerous? Absolutely not. Ketones are a natural part of human metabolism—your body is always producing ketones. When you are in benign dietary ketosis, you are j ust making more of them, because fat, rather than sugar, has become the main source of fuel for your body. A strict ketogenic diet has been very successful in treating epilepsy in children and has been used for years at the Children’s Hospital of New Yor k-Presbyter ian.10 Children have been kept on it for years at a time. If there were dangers associated with ketosis, we would have heard about it by now . (For a full di scussio n, see chapter 6.)
It was absolutely amazing to me when I really studied ketosis and found out that almost everything I had heard about how dangerous it was was utter hogwash. —Dana McG. Do I Need to Be in Ketosi s in Order to Lose Weight? No. First of all, ketosis doesn’t cause weight loss. You can easily be in ketosis eating 10,000 calories of fat a day, but you’ll never lose any weight that way. Ketosis is simply a by-product of fat burning. There have been many people who’ve lost weight on low-carb diets without being in ketosis, and there are many who have been in ketosis and not lost weight. Ketone loss, in the urine and the breath, accounts for only about 100 11
calories a day. whoThat are some metabolically resistant people trulysaid, seem there to do much betterextremely on Atkins-like induction plans in which they are in ketosis, carbohydrates are kept to very low
levels (20 to 30 grams or so a day), and calories are moderately low. You may want to go into ketosis just to get started, but the vast majority of people can lose weight over time on a low-carb diet by hovering around the border of ketosis. And as we saw in chapter 7, many of the programs don’t emph asize ketosis at all—some pro gr ams deliberately ke ep you at a slightly higher carb level (50 to 90 grams a day) to prevent it. The point is this: if you keep your carbs low enough (and your calories reasonable), you and to breaking downisfat. Exactly how will low be theylowering have to your be forinsulin you tolevels continue lose weight something you will have to exper iment with.
Why Don’t My Ketone Test Strips Show a Positive Reading? There are a number of reasons you may not get a positive reading, and you probably don’t need to be too concerned about it. There are three ketone bodies—beta-hydroxybutyric acid, acetoacetic acid, and acetone— and the strips detect only the latter two, which are less than 1/5 of the total ketones produced. Beta-hydroxybutyric acid goes completely undetected. So it’s entirely possible that you might not test positive on the ketone strips, yet if you performed a more sophisticated urinalysis, you’d find plenty of ketones flo ating aro und! Other things can influence whether the strips change color, such as how much water you’re drinking. I f you’r e drinking a lot, which you should be, that’ll very likely keep t he strips fr om turning a deep color. Of course, the possibility exists that they’re not turning color because you’re not in ketosis, pr obably beca use you are eating mo re carbs than you think or there ar e hidden carbs in your fo od choices.
Food and Water How Many Calories a Day Should I Be Eating? For weight loss, a good rule of thumb is to take your goal weight and multiply by 10. If you’ve got more than about 25 pounds to lose, multiply your current weight by 10 and then deduct 500 calories from that number. This formula doesn’t work as well if you are at a relatively low weight—
say 125 pounds—and are trying to drop only a few pounds. You should never, ever let your calories fall below 1,000 per day. If you’d prefer not to do any calculations, you can remember it this way: the average weight loss diet for men is about 1,500 calories and the average fo r women is about 1, 200. Remember that these formulas are only approximations. Every person’s situation is going to be different, based on one’s own metabolic and histor genetics, hor monal pr ofiles, muscle mass, act ivity levels,ical andfact so or on.s,The calorieage, calculators found on diet Internet sites woefully overestimate how many calories you “need,” especially for weight loss. Ignore them. And remember that calories are important, but they’re not the whole picture; the kinds of food you eat determine what messages are sent by y our hor mones, and t he hormo nes contro l the whole shebang.
I’m a Vegetari an. Can I Low-Carb? Yes, depending on the type of vegetarian diet you are following. If you’re a vegan, it’s going to be next to impossible; but if you can eat eggs and whey protein, it’s definitely doable. If you can also eat fish, it’s a snap. Check out The Schwarzbein Principle Vegetarian Cookbook (see “The Schwarzbein Principle,” page 226), as well as the cookbooks in the Resour ces section. A note on vegetarianism: if you’r e avoiding eating animals for spiritual, ethical, or moral reasons, I am in great sympathy with you. I myself am a believer in animal r ights, am a card-carr ying member of PETA, and understand your feelings pro foundly. But if you’r e doing it for health reasons, I urge you to rethink your position. Most people do better with some animal foo ds, and some people do a lot better on a lot of animal foo ds. Maybe one way to r econcile th is for yourself i s to patro nize only those who sell meat from animals that have not been factory-farmed, have been organically r aised, and have had a goo d and happy life. Just something to think about.
Why Is Water So Important for Fat Loss? Drinking plenty of water is absolutely necessary for fat loss. When you’re not drinking enough water, the kidneys can’t work properly, so they start
dumping part of their load onto the liver. The liver is the main fatprocessing plant in the body, but if it has to take over some of the kidneys’ work, it can’t work at full operating capacity. It metabolizes less fat, so more fat remains in the body and weight loss stalls. 12 Water is also necessary to g et rid o f the toxic wastes r eleased from fat stor es. Water is also the absol ute best treatment for water retention. The less water you drink, the more the body perceives this as a danger and sends signals that result in holding on to scarce water possi ble. Sometimes this shows upasasmuch swollofenthat hands, feet, and as leg s. When you’re drinking enough water, this doesn’t happen. There’s no more “emergency,” and the body releases stored water instead of retaining it.
How Much Water Should I Be Drinking? More than you think. “Larger people have larger metabolic loads,” says Dr. Donald Robertson. “Since we know that water is the key to fat metabolism, it follows that the overweight person needs more water.” Robertson recommends 3 quarts a day. Many personal trainers recommend a gallon. I think the absolute minimum is 64 ounces (½ gallon) plus an additional 8 ounces for every 25 pounds of excess weight you are carrying.
How Can I Get More Fiber in My Low-Carb Diet? If your program permits it, include a serving of All-Bran or Fiber One cereal, which are the only commercial cereals that have a significant amount of fiber. Get some wheat or oat bran (not the cereals, the actual bran; you’ll find it in the section of the health-food grocery that sells dry bulk items). You can mix the brans together in different proportions and cook it to make your own hot cereal mix, or you can use it as a breading or a filling. I also recommend adding fiber supplements (like psyllium husks or flaxseeds) to your program, but don’t take them at the same time as other medications or supplements, because the fiber can inhibit absorption.
What Are Sugar Alcohols? Do They Count as Sugar? Sugar alcohols—also called polyols—are sugar-free sweeteners that are carbohydrates but are not sugar. Common ones include maltitol, mannitol,
sor bitol, and x ylitol. They have fewer calor ies per g ram than sugar: sugar has 3 calories per gram, while sorbitol has 2.6, xylitol has 2.4, and mannitol has 1.6. They don’t cause sudden increases in blood sugar; instead, they are slowly and incompletely absorbed from the small intestine into the blood, and the portion that is absorbed requires little or no insulin. Since they aren’t technically sugar, manufacturers are able to say “sugar-free” when they use sugar alcohols as sweeteners, but they’re required to include these sweeteners in the carb count on the nutrition label (though not everybody does). Scientists call them sugar alcohols because part of their structure chemically r esembles su gar and part chemically r esembles alcohol. They’re certainly a lot better for you than pure sugar. Xylitol actually has health benefits. But some of them can cause slight gastric upset for some people, li ke a little gas o r a mild l axative effect. And you have to be careful with portion sizes—even though the food may be technically sugar-fr ee, the calori es and grams o f sugar alcohol can add up. And some fol ks—particular ly car b addicts—say that pro ducts sweetened with sugar alcohols can trigg er cravings just like pro ducts sweetened with sugar.
What Are the Best Oils? There’s a new star on the horizon: coconut oil. question). It can be used for anything and has amazing health benefits (also see next For cooking, I recommend extra-virgin olive oil, virgin coconut oil (especially Barlean’s 100 % Or ganic Ext ra-Vir gin Coconut Oil), gr apeseed oil, or butter (I know it’s not an oil, but it is fine for cooking and sautéing). Peanut oil is stable and can be used occasionally for stir-fries, but it is very high in omega-6, so don’t overdo. You can use sesame oil, which is very good for frying, but remember that it contains a larger proportion of omega-6’s, so don’t use it ex clusively. Almond o il is go od fo r baking. Flaxseed oil is terri fic, of co urse, but never use it for cooking . It is a gr eat sour ce of alpha-linolenic acid (an omega-3 fat ), but for that reason it can’t be heated (though it can be poured or drizzled on hot foods such as vegetables). Omega-3 fats are very unstable and become extremely damaged when heated. Another terrific new oil that is a great source of the same omega-3 fat is perilla oil (a plant extract), but it should not be used for cookin g.
For salads, try coconut oil, ext ra-virg in oli ve oil, any of the nu t oils (macadamia, hazelnut, almond, walnut), avocado oil, or sesame oil. You can also use flaxsee d oil or perilla o il. I don’t recommend can ola o il. To be used commercially, it has to be partially hydrogenated, refined, and deodor ized, and in the process its omeg a-3’s become a potent source of trans-fatty 13 If you do use it, ma ke sure to get or ganic, cold-pressed, or expellerpressed canola oil (such as Spectrum), and only use it cold. Oilscor you say good-bye to permanently include safflower, sunflower, acids. n,can so ybean, and cottonseed. B uh-bye.
What’s the Story with Coconut Oil? I Heard This Is a “Bad” Fat! You heard wrong. Virgin coconut oil is a good, stable, healthful fat that actually has a number of healing properties, not the least of which is that it is anti-inflammatory. 14 The srcinal bad rap for coconut oil came four decades ago, when researchers fed animals hydrogenated coconut oil that was purposely altered to render it devoid of essential fatty acids. The animals that were fed the hydrogenated coconut oil (as the only fat source) naturally became deficient in essential fatty acids, and their serum cholesterol increased. 15 Early commercial coconut oil was often hydrogenated (loaded with trans-fats), and all the good, healing stuff had been removed. That altered, damaged coconut oil wasn’t very good for you. But real coconut oil is a health bonanza. The Pukapukans and the Tokelauans of Polynesia, for whom the coconut is the chief source of energy, have virtually no heart disease, and research on these populations concluded that there was no evidence that their high saturated-fat intake (fr om coconut) had an y harmful effects. 16 The saturated fat in coconut oil comes mainly from MCTs (medium-chain triglycerides), which are preferentially burned as energy and less likely to be stored as fat, making them a good choice for a weight-loss program. 17 Coconut oil also contains a high pr opor tion of the ant ivir al and antimicrobial laur ic acid, as well as the antimicrobial capric acid and the potent “yeast fighter” caprylic acid.18 Be sure to pur chase the virg in or cold-pressed kind. In my opinio n, there is none better than Barlean’s 100% Organic Extra-Virgin Coconut Oil, which I use for almost everything.
What Are the Good Fats? Good fats include all the oils mentioned above as “good” plus natural, undamaged fats like butter, coco nut, avocado , nuts, and the fat in fish. The dietar y establishment has lo ng foster ed the myth that fats are “good” or “bad” depending on whether or not they are saturated: saturated fats = bad, unsaturated fats = good. Not so. A much better way to categor ize fats is by whether they are damaged o r undamaged. You can damage fats in a number of ways. One way is by over heating any vegetable oil by frying at high temperatures—this creates toxic substances known as lipid pero xides. Another is thro ugh an indust ri al pr ocess known as partial hydrogenation, which creates something called trans-fats, by far the most dangero us of all fats. Trans-fat s ar e found in almost all fast foods (fr ench fries, for example, are doused in the m), most marg arines, virtually all commer cially bak ed goo ds (includ ing childr en’s coo kies), and movie popcorn, and in any products containing partially hydrogenated vegetable oils (loo k for these in the ingredient s list on the pack age). Trans-fats ar e the true demons o f the fat wor ld, and the ones we want to avoi d compl etely, as they are asso ciated with all the degener ative diseases common in the modern world.
MORE ON KETONES AND THE BRAIN
Dr. Mary Newport is the medical director of the newborn intensivecare unit at Spring Hill Regional Hospital in Florida. And her husband Steve had early-stage Alzheimer’s. “I was watching my husband of 36 year s fade away,” said Dr. Newpor t. Then she disc overed co conut oil. Dr. Newpor t began resear ching clinical trials and discovered a new medication that had shown unbelievable results in clinical trials. While the best that can generally be hoped for with Alzheimer’s is to slow the prog ressio n of the disease, t his drug had produced act ual memory improvement, something rarely seen in Alzheimer’s patients. Unfortunately, her husband wasn’t eligible for the trial—according to the results of an MMSE test (a test comm only used to ass ess cog nitive impairment), h e scor ed too low and ha d too g reat a level of
impairment. But Dr. Newport didn’t give up. She resear ched the active ingr edient in the new medication and found an in-dept h discussion of its primar y ingr edient, a par ticular for m o f fat called MC Ts—medium-ch ain trig lycerides. This is precisely the k ind of fat found in coconut oil. She decided to try i t. purchased ttleisoBarlean’ f non-hydro genated, extra-vir ginOil, coconut oilShe (one excellent ab bo rand s Extra-Virgin Coconut available ever ywhere at health-food stores). She started by adding a couple of tablespoons into her husband’s oatmeal. Almost immediately, her husband started showing improvements. He scored higher on the exam than he had scored in a year. More than 5 months afterward, his tremors had subsided and he had become mor e social and interested in th ose ar ound him. The secret seems to be in ketones. The body converts some of the MCTs into ketones, which are an additional so urce of fuel fo r starving brain cells. No one is claiming that ketones—or MCT oil, a purified form of the fat found in coconut —will cure Alzheimer ’s. But this inspir ing stor y is yet another example of the way ketones can be helpful as an energy source for the brain. “I started using 100% M CT oil for kids with brain pro blems about 25 years ago ,” says renowned n eurosur geo n Larr y McCleary, MD (author of The Brain Trust Program). “This generates mor e ketones and does it fast er than coconut oil (and has fewe r calor ies for the same amount of MCTs). It was part of a vigorous nutritional support pro gr am for kids with brain issues of many sor ts—tumor s, trauma, drowning, hemorrhage, etc. It produced dramatic results in them and it should help older people wit h disor ders l ike Alzheimer ’s disease.” Ketones also appear to help children with epilepsy. Eric Kossoff, MD is assist ant professor of neurolo gy and pediat rics at Johns Hopkins and the medical director of the Johns Hopkins ketogenic diet program. He’s been using the ketogenic diet for years as a treatment option for epilepsy, and in 2003 he developed a slightly gentler
version of the diet called the MAP—Modified Atkins Program. “In 2008, the ketog enic diet is not viewed as an al ternative diet any more,” said Dr. Kosso ff. “It’s viewed as an o ption to meds, but mo st docs kno w it’s an effective therapy fo r epilepsy.” Unfor tunately, until r ecently, there has been no separatio n in the resear ch between saturated fats and t rans-fats, so satur ated fats have been blamed for a great deal of the damage to the body that is actually the fault of trans-fat s.19 This has changed, as identifying trans-fats in the Nutrition Facts on fo od packaging has been required of manufact urer s as of January 2006, and resear chers are starting to make a distinction betw een the two very differ ent classes of fats. Many labels alr eady carr y this infor mation, so be sur e to check the pro ducts you buy. There probably are pr udent reasons to keep saturated-fat intake at a reaso nable level; for one thing, in some people, it can increase insulin resistance. For another, the nonorganic and fast-food meats that are our biggest sour ces of saturated fat are loaded wit h bovine gr owth hor mone, steroids, and antibiotics, not to mention toxins from the grains that factor y-farmed catt le consume. The danger is pr obably not so much fr om saturated itself, fr oom what’s in in othe of saturated fat weand typically consume.fat Also , thebut lack f balance ur kinds diet between omega-6’s omeg a-3’s is a big health concern that has many ramif ications. Fats that are too high in o mega-6’s, such as vegetable oil s (cor n, safflowe r, sunflo wer, soybean), just add to the t remendous im balance between omega-6’s and omega-3’s (found in fish) and should be avoided for that reason alone.
Every time I drink [alcohol], my diet goes out the window and I eat way more than I ever intended to. Cutting out alcohol—at least for now—has been the best thing I ever did for my waistline.
—Kelley F. What About Alcohol? Here’s the deal with alcohol: the body has no way to store the energy in it (7 calories per gram), so all “fat-burning” is put on hold while the body burns off the alcohol. Alcohol can also produce cravings, both for itself and for carbohydrates—Kathleen DesMaisons, PhD, an expert in addictive nutrition, considers alcohol dependence simply an extension of sugar sensitivity.20 She also believes that although hard liquor is not technically a sugar, t he beta-endor phin effe ct is a pow erful tr igg er fo r cravings. 21 That said, a lot of lo w-carb plans permit some alcoho l, particularly r ed wine (in 4-ounce servings), which contains about 3 grams of net carbohydrate. Do the math and see if it works for you.
What Is the Glycemic I ndex? The glycemic index is a numerical way of describing how carbohydrates in foods affect blood-sugar levels (an even more accurate measure is the 22
glycemic load ; see next question). The index measures how quickly a 50-gram serving of a particular food converts to sugar. Foods with a high glycemic index cause a dramatic rise in blood sugar (and subsequent demand on insulin levels). That’s why all low-carb diets suggest that you eat low-glycemic carbohydrates; these carbs (green vegetables, for example) have a much lower impact on your bloo d sugar and insulin.
What’s the Difference Between the Glycemic Index and the Glycemic Load? The glycemic load is a more accurate predictor of what’s going on with bloo d sugar and insulin than the glycemi c index. Here’s why. Suppose I put an empty bucket under a faucet and I want to know how much water is go ing to wind up in the bucket. You can see im mediately that there ar e two variables I need to know: the water pressure (how high I turn on the faucet), and how long I’m going to leave it on. In the same way, if I want to know the impact of a particular food on blood sugar and insulin, I need to
know two things: the glycemic index, and how much of that food I’m go ing to eat! The glycemic index tells you the impact that a 50-gram serving of a particular foo d will have on your blo od sugar. The glycemic load, on the other hand, also takes into account the amount of car bs actually in the food. Remember that all the low-carb plans consider the number of net, or effective, carbo hydrates in a ser ving, because we need t o kno w that infor mation o rder to determine e total is ogofing to have on yourin blo od sugar. S ome fothods haveimpact only a the fewfood grams available carbs; so even if their g lycemic ind ex is high, th eir overall impact will be reduced because there are so few of them. The glycemic load is a measure of that overall impact. To find the gl ycemic lo ad, multiply the glycemic index by the number of net carbohydrates in a standard serving (find the glycemic inde x for vario us foods at http://www.glycemicindex.com). Consider the difference between carrots and pasta. Carrots have a glycemic index of 47, higher than that of whole-wheat spaghett i, which is only 32. If this was the only information you based your decision on, you’d think carr ots were much wor se, fro m a bloo d-sugar po int of view. But while there ar e only 6 net (or effective) gr ams of car bs in a carr ot, there ar e a whopping 48 g rams o f net carbs in the pasta! Let’s calculate the glycemic load (index times net carbs): carrots would be 47 times 6, which is 282. But the calculations for the spaghetti would be 32 times 48, which is 1,536—more than 500% higher than carrots!
What’s the Best Type of Protein Drink to Use? Whey. It seems to be the best all-around source of protein, followed by soy that has been enriched with methionine (an amino acid not found in soy). Whey is absorbed the best and is the most available; it also increases levels of glutathione, perhaps the most powerful antioxidant in the body. There are a lot of people on the anti-soy bandwagon right now, but I think soy protein in moderation is fine. Whey, however, is better.
What’s the Difference Between a Protein Drink and a Meal-Replacement Shake? Protein powders are 100% (or almost 100%) pure protein. You can drink them by themselves or make a “meal-replacement” drink with them by
adding a controlled amount of carbohydrates (berries are a good choice) and maybe some fat like nuts or nut butter (women can add flaxseed oil if they don’t mind the taste). Designs for Health makes an excellent protein powder called PaleoMeal that is enriched with omega-3’s and a number of other terrific ingredients (available on my Web site, http://www.jonnybowden.com). Meal-replacement shakes have carbs, protein, and fat in different pro porare tions depe nding on bs. the philoso phy of the company making the m. Many very high in car
What’s Wrong with Grains? Aren’t They Supposed to Be Healthful? Grains, grain pr oducts, starches, an d sugars all shar e some commo n links: they turn into glucose (sugar) in your body very quickly, they promote addictive eating habits in a large percentage of people, and they trigger insulin release. All of these things result in weight gain and other health problems. 23 Grains also contain compounds called phytates and pyridoxine glucosides that block absorption of B vitamins, iron, zinc, copper, and calcium and lead to possible mineral deficiencies that can slow metabolism. (For a full discussion of grains, see “The Problem with Grains” on page 207 in “The Paleo Diet.”) In addition, both gluten and certain protein fractions of gluten are a big problem for many people. It used to be thought that celiac disease—a sensitivity to gluten—was rare. We now know that it probably affects one in thirty-three people. That’s a lot. There are an amazing number of toxins used in the processing of wheat and grains, and it is entirely possible that some of the problems that people have with wheat are actually caused by these toxins. (Other problems are definitely caused by the wheat itself.) 24 Clinically, an awful lot of problems seem to just magically “clear up” when you take grains, especially wheat, out of the diet. While whole grains are in theory better than refined grains, they’re not nearly as common as you might think. The making of flour is itself a refining process. And the “wheat breads” in your grocery are no better than white bread. Couple this with the fact that grains usually have a very high glycemic load, and you can see the potential problem. Obviously, not everyone will have a problem with grains, but cutting them out during the initial stages of a low-carb weight-
loss program is definitely a good idea.
Is Coffee Okay? Pro bably. Those who ar gue ag ainst coffee are concerned wit h its possible effects on insulin and the adrenal glands. Atkins didn’t like it because he felt it caused unstable blood sugar. There is some research that suggests that caffeine increases insulin resistance 25 and that it raises insulin 26
levels. How much this matters as a practical consideration debatable— the insulin insensitivity it produces in studies may be anis insignificant amount as a practical matter and may be only temporary. There is also research showing that coffee actually improves insulin sensitivity 27 and contributes to reducing insulin, 28 as well as some research that says it has no effect on insulin at all. 29 And in one study, coffee was actually associ ated with a much lower risk of type 2 diabetes. 30 While coffee is o bviously a stimu lant, drinking i t is also a very pleasant experience for a lot of people, and that has to be factored into the mix. Those who are very concerned about adrenal health (Dr. Diana Schwarzbein) recommend dumping it, but others say it’s fine. From a weight-loss per spective, it’s pr obably not go ing to hurt at all; but if yo u’re looking to go the last mile for ultimate health, you’d be better off without it. Impor tant note: it’s not just the caffeine that ’s a pr oblem (ther e’s caffeine in g reen tea too , and that doesn’t seem to hur t anyone): it’s the enormous amount of toxins in the coffee plant. You can go a long way toward reducing any negative health impact of coffee by purchasing organically grown beans.
re Diet Sodas Acceptable on My Low-Carb Diet? You’d be much better off without them. If you can’t give them up right away, put it on your goal list and at least start cutting back. Most of them use aspartame, which should definitely be eliminated (see next question); in addition, diet soda can stall weight loss in some people (up to 40% to 50%, by some estimations), po ssibly due to the citric aci d they contain. Many people do drink soda addictively (I had one client who routinely consumed sixteen cans a day), and t he amounts consumed by peopl e like
this have never been tested for safety in long-term studies. Through a classical conditioning mechanism, like the one used to teach Pavlov’s dogs to salivate at the sound of a bell, drinking diet soda may well trigger insulin pro duction ( as may the consump tion of other ar tificial swe eteners). And the chemicals, food col or ings, flavor ings, and other stuff in diet soda make it no picnic for the liver, either.
What about Aspartame? Aspartame, the most common of the artificial sweeteners and the one used in most diet sodas, is a real problem. Even though it has been declared “safe,” the FDA has received numerous reports of seizures and other pro blems that have been linked to it.31 There’s also good reason to believe that aspartame may be neurotoxic. 32 In a report to the Senate Labor and Human Resources Committee, Dr. Richard Wurtman, professor of neuroendocrine regulation at the Massachusetts Institute of Technology, stated that the most common side effects linked to aspartame include dizziness, visual impairment, disorientation, ear buzzing, a high level of SGOT (a liver enzyme), loss of equilibrium, severe muscle aches, episodes of high blood pressure, and other not-so-lovely stuff. 33 Other reports claim that in susceptible people, aspartame can produce symptoms ranging from sleep disturbances to headaches to fuzzy thinking to mood disturbances, and one recent article in the Townsend Newsletter for Doctors and Patients suggested that in susceptible people (called aspartame responders), the substance could be somewhat addictive. Kathleen DesMaiso ns, PhD, an exper t in addictive nutritio n, believes that th e taste of any sweetener, for sugar-sensitive people, evokes a beta-endorphin response in the body which will create cravings. 34 No integrative or holistic practit ioner I interviewed had an ything g oo d to say about aspar tame. The consensus: stay away.
What about Artificial Sweeteners in General? You basi cally have seven cho ices. • Aspartame (Equal), is pro bably the most commo nly used artificial sweetener these days, but it’s also one that I cannot r ecommend (se e
previous question). • Saccharin (Sweet’n Low) has been around for about a hundred years, and at one time it had a reputat ion as a cancer- causing ag ent because of studies in which rats got bladder tumors when they were fed incredibly high amounts (equivalent to what a human would get drinking eight hundred cans o f diet so da a day). Recently, sacchari n was declared safe, and probably is—in reasonable amounts. Next to sucralose and stevia, it’s probably the best choice. (Sugar Twin, Sucaryl) also continues to have a cloud of • Cyclamate smoke around it concerning cancer in rats, but it too has been added to food and beverages since the 1950s and is probably safe in small amounts. • Acesulfame-K (Sunette) is in the same family as s acchari n but isn’t widely available in the States. • Sucralose (Splenda) was once the most promising of all, but recent investigations have raised serious concerns about its composition. Until the jury is in, I no longer recommend Splenda. It is basically a slightly chemically altered versio n of sucrose (sugar) and is 600 t imes swee ter. The chemical alteration prevents the digestive system from “recog nizing” it and a bsor bing it, so it doesn’t cause the rise in blo od sugar and insulin associated w ith sucro se, unless of cour se it turns o ut to cause an insulin rise through a conditioned response mechanism. The pro blem with Splenda—and it is th eor etical but disturbing —is that the chemical “alteration” involves adding chlorine molecules. As of this writing, th ere is a gr owing mo vement among “natural health” people to ban Splenda, due to enormous concerns about that chlorine molecule. The situa tion is evolving, so it bears keeping an eye on. • Erythritol is, in my opinion, one of the most pro mising “ar tificial” sweeteners currently available. It’s a natural sugar alcohol, has virtually no g lycemic im pact, and tastes gr eat. And you can use it in bever ages. Several companies are co ming to market with erythritol i n individu al serving packets. Keep an eye out fo r them. • Stevia is an herb sold as a food additive, which has basically no downside except a somewhat weird after taste that some people do n’t mind at all. You can g et it at any health-foo d stor e.
Note that the onl y ones you can co ok with ar e Sweet’n Low, Sugar Twin, Sunette, and Splenda.
Is Fructose Okay? No. Fructose doesn’t raise blo od sugar a lot, so i t used to be thought of as the perfect sweetener for diabetics. Bad idea. Even though it doesn’t raise blood sugar very fast, it induces insulin resistance in both animals 35 and 36
humans. is turned to fatisin liver, so itof raises your triglycerides.Fructose High-fructose corn syrup thethe worst offender all. When you consume fr uctose, make sure it comes in its natural container—fr uit— surrounded by fiber. Never use it as a sweetener, and don’t make a habit of eating fo ods that are sweetened with it.
What about Protein Bars? The problem is that many of these products are deceptively labeled. A lot of them will tell you they have only 2 or 3 grams of “usable” carbs, but don’t be too quick to buy it. They are sweetened with sugar alcohols, which the manufacturers often decide not to count when telling you how many carbs the bar contains. The argument is that sugar alcohols don’t have the same effect on blood sugar, which is true. But they’re still carbs. Nutrition-labeling regulations don’t require manufacturers to put the number of grams of sugar alcohols per serving unless they are making a claim related to sugar content, in which case it’s mandatory. Since most of the low-carb bars don’t claim to be sugar-free, they can get around this mandatory clause. Even Atkins does not count the glycerin (glycerol) that sweetens his Atkins Nutritional Bars as part of the carb gram count. The problem is that like all sugar alcohols, glycerin is a carbohydrate. The FDA’s Office of Food Labeling states: “FDA nutrition labeling regulations require that when glycerin is used as a food ingredient, it must be included in the grams of total carbohydrate per serving declaration.” So although sugar alcohols do behave differently in the body than sugar, you should still be aw are of their presence. The other co ncern about low-carb bars i s calor ies. Just because they are low in carbs doesn’t mean they’re low in calories, so factor that in. In sugarsensitive people, they can easily trigger cravings; these bars are, after al l, ver y sweet, which is why they taste so go od. And while mos t of
them ar e better than c andy bars, none is as go od as r eal foo d. So use them occasionally if you must, but beware. Some low-carbers have found that these bars can stall weight loss; so if you’re eating them a lot and you’re stuck, they might be a goo d thing to let go of.
Can I Eat Dairy Products? For many people, dairy—especially milk and cheese—will slow or stall weight loss. Many holistic practitioners recommend eliminating wheat, dairy, and sugar as the th ree big gest trigg ers o f foo d reactions, sub clinical allerg ies, and t he like. I don’t believe homogenized, pasteurized milk is a good food. In addition to the pus cells (the FD A allo ws 1.5 mill ion per cc o f mil k as “safe”), factory-farmed cows are treated with antibiotics, bovine growth hormone, and other drugs to fatten them and keep their milk production elevated to unnatural levels. The gr ain they eat, which is no t their natural foo d, is irr itating to their stomachs (one r eason for the antibiotics) and contains a whole different set of toxins. (Raw organic milk, which may be available fr om l ocal far mers, is a whole different st or y, but note that some states pro hibit the sale of r aw milk. For mor e infor mation, see http://www.realmilk.com.) If you’re not r eady to elimi nate milk, or if you want to cosubstitutes nsume it inare small unts, atlike thealmond very l east buyorthe ganic kind. Excellent the amo nut milks, milk; tryor goat’s milk, which does not present t he same problems fo r most people, for reasons that are not fully understood. Many people who have a problem with milk ar e still able to toler ate fer mented dairy fo ods like kefir and yogurt. Cheese has stalled many a low-carber’s weight loss. Although some plans allow it , if your weight loss isn’t pro gr essing, th is mig ht be one food to cut back on.
I’m Gett ing Bored with the Usual Low-Carb Fare. What Else Can I Eat? Here are some terrific suggestions from low-carb chef and Internet guru Karen Barnaby. • Thinly sliced radicchio , endive, and fennel with a fresh basil dressing , sprinkled with crisp baco n and go at cheese. Eat with roasted chicken.
• Raw, sautéed, or g ri lled mush roo ms on r omaine with blue cheese dressing. Eat with a steak. • Fried pepp ers, mushroo ms, and garl ic. Serve on arugula, sprinkled w ith feta cheese, and eat with goo d Italian sausag e. • Thinly sliced cucumbers, radi shes, and celer y. Toss with lemon mayonnaise and serve on butter lettuce, along with a piece of salmon. Sprinkle wit h fr esh dill. • Cooked asparagus and Swiss chard. Serve a piece of halibut, cod, or sole on top and drown it in Hollandaise sauce. • Sautéed spinach or julienned daikon seaso ned with soy sauce and a few dro ps of sesame oil. S erve with gri lled tuna on top and mayonnaise mixed with wasabi as a sauce. • Marinated cubes of feta, Brie, or Camember t in basil, gar lic, and lots of olive oil. Eat with sliced cucumbers as a snack or sprinkle on a salad. Have it alongside a hamburger. Use as an omelette filling with one four th of a tomato, chopped . • Make a cabbage slaw and jazz it up with mint, cilantro , gr een onio ns, and a bit of lime juice. Put canned tuna or salmon and hard-boiled eggs on top. Here ar e some other ideas. • Make omelettes with filling s like bacon and Swiss cheese, mushr oo m and avocado, goat cheese and mushrooms, spinach and feta, or bacon and avocado. • Add chopped nuts or sunfl ower seeds to cottage cheese. • Make a “wrap” out of sliced tu rkey with cream cheese inside. • Make a “wrap” out of sliced r oast beef with cheddar, scallio ns, and a drop of sour cream (if d airy is on your prog ram). • Try deviled egg s.
• Use low-carb tortillas and make your own breakfast burr itos. • Keep varying the toppings o n your salads. Try warm meats or shrimp, crab, or lobster. Try differ ent cheeses, if th at’s on your pro gr am. Mix and match. • Make a low-carb bur ger by putting a hamburg er patty between two lettuce leaves (or red cabbage leaves). Add mayo and mustard if you like. • Pan-fr y some chicken and add feta cheese and olives. • Eat a hot dog mi nus the bun and use mayo and mustard as dipping sauces. • Steam some veg gies and add butter, lemon, a handful of nuts, and maybe some soy sauce. • Fill celer y sticks with peanut butter, cream cheese, or tuna salad. • Try beef je rky, turkey jerky , or vegg ie jerky. • Mix sugar -fr ee, all-natural peanut butter with whey pro tein powder, and roll in cocoa powder. • Combine whey protein powder with sour cr eam and Splenda; kneading this mixture renders a pr etty inter esting taffy. You must eat it within a couple of days, but it is great. And here’s one of my favor ite ideas cour tesy of the diet Web site http://www.3fatchicks.com: “muffin s” made with eggs and your choice of sausage, hambu rger, shredded zu cchini, mushroo ms, onions, bro ccoli, cheeses, etc. Just pour the mixture into muffi n tins, bake, and freeze f or easy breakfasts on the go!
Plateaus What Could Be Causing My Plateau? The underlying pr emise of this boo k, and my philosophy of weight loss in
general, is that everybody’s different (the theory of biochemical individuality). So you will not be surprised to find that I wholeheartedly believe there ar e at least a dozen or mor e reasons fo r the dreaded plateaus that you will inevitably reach in your weight-loss efforts. The Drs. Eades have called plateaus “the purgatory of dieting” for good reason. They drive everyone crazy (the plateaus, not the Eadeses, who are very lovely people). Nevertheless, you need to learn to expect them and to deal with them. There is virtually no one who first has successfully lost weight who rule has not experienced them. And the very (and maybe most important) of dealing with them is this: don’t panic, and don’t give up. Here are the top twelve reasons plateaus occur. 1. You are lo sing fat but building muscle. If you ar e exercising, especially for the first time, you may be putting on muscle while you are losing fat. This change for the better will not show up on the scale, though it would definitely show up in a body-composition analysis. You will likely no tice a small but definite change in yo ur shape or the measurement of your waist, even though the scale isn’t really moving. Don’t worry—eventually, the scale will reflect the loss of body fat. 2. Water retent ion masks fat loss. You may be lo sing fat while ho lding on to water. This happens mo re often than you mig ht imagine. Make sure you are drinking plenty of water (see page 325). Not drinking enough wat er is o ne of the top reasons fo r plateaus and stalls. 3. You are experiencing a period of adjustment. Remember that when it comes to weight, your body operates something like the feedback loop of a thermostat. Your body needs periods of adjustment to catch up with the differ ent amount and type of fuel it’s getting, just like the thermo stat needs to “catch up” wit h changes i n the temper ature o f the air in your apartment. If you’re resetting your “set point,” it happens not all at o nce, but in stages. Being s tuck at a certain weight for a few weeks may jus t be your body’s way of repr og ramming itself. Eventually, the scale will move ag ain. 4. Your carbohydrate level is too high. The plans discussed in this book ar e contingent on car eful monitor ing o f car bohydrate s. Your carbohydrate intake may simply be too high for what your body needs
so it can lose weight. You could easily be taking in more carbs than you’re aware of, as many foods and drinks have what are known as “hidden carbs.” There is a great hidden-carb counter listed in the Resour ces. If you suspect this may be the pr oblem , check it out. 5. Your carbohydrate level is too low! This is one of the gr eat paradoxes o f lo w-carb dieting, because it is completely counteri ntuitive. Nonetheless, I’ve seen it in action many times. Mor e than one person wrote to they me ofwere weight stalled at again a carbby intake of 20 grams per day, which ableloss to get going simply moving their carb intake up to about 40 or 50 g rams. One possible explanation for this comes from the work of Dr. Diana Schwarzbein, who would arg ue that too low an intak e of carbs cr eates higher levels of adrenaline and cor tisol (which ult imately wor k against we ight loss). While t his scenario may not be t rue fo r everyone, upp ing yo ur carbs is certainly worth a try. 6. You are undereating. Remember that the body responds to too few calor ies by simply be coming mo re efficient at extracting every single ounce of energ y fro m its limited food supply . Too few calor ies literally slow down the metabolic rate. 7. You are o vereating. At some point, ev ery lo w-carber has to lo ok at calor ies. Low-carb diets don’t usu ally stress calor ie counting, because you’re much less likely to overeat on healthful proteins and good fats than you are on junk carbohydrates. Nonetheless, calories still co unt to so me degr ee. You may be eating to o many of them. 8. You aren’t eat ing enough prot ein. If you don’t eat enough protein, you’re mo re li kely to br eak down your body’s ow n protein for fuel. That means muscle loss, whic h in turn means a lowering of your metabolic r ate. Make sure yo u’re eating at least the minimum recommende d amount of pr otein for yo ur plan. 9. You are not exercising. Though weight loss is 80% diet, exercise definitely helps things along. The many things it does for both your health and your weight loss (and weight maintenance!) efforts are too lengthy to g o into here. Just trust me. Do it. 10. Medications are preventing optimum weight loss. Many medications can interfere with weight loss. Steroid medications like prednisone ar e among the wor st offende rs, but there ar e plenty of
other s. Check this o ut with your doctor. 11. You are experiencing food intolerances. The usual suspects are foo ds that are g enerally r educed or eliminated on low-carb programs; if you’re consuming them, try your own version of a modified elimination diet : remove the susp ect food fo r a week or two and see what happens. The “sensitive seven” ar e wheat, mil k, sugar, peanuts, soy, eggs, and corn. 37 You may want to expand the wheat catego ry to include all gr sains cat ego include ch eese. Other well-kno wn staller thatand youthe mimilk ght want to ry cuttoout for a while include artificial sweeteners, especially aspartame (Equal); citric acid, found in diet sodas; glyceri n, found in many low-ca rb mealreplacement bars, including those by Atkins; and alcohol. 12. You have nut ritional deficiencies. A deficiency in so me nutrient or nutrients may very well be interfering with how smoothly the energymaking cycles in your body r un. This could easily account for your not burni ng fat at an optimal level. (See th e section o n supplements in chapter 9.) At the very l east, take a hig h-potency multivitamin and mineral, although this is only the first line o f defense— you pro bably need a lot mo re. Just as an example, in a paper in Medical Hypotheses , Dr. L. H. Leung noted that for reasons no t completely understoo d, he had had a lo t of success with weightloss patients by simply addin g pantothenic acid to their pr og ram.38 (Nutritionist Barbara Marquette, M.S., who teaches nutritional therapeutics in the University of Bri dgepor t’s master ’s prog ram in nutrition, ha s seen the identical eff ect.) Thi s could be because o f pantothenic acid’s dir ect effect on the adrenal glands. However, this is only one example; there are easily a dozen other vitamin or mineral deficiencies th at could prevent optimal fat loss.
How Do I Break a Plateau? You can try a lot of things. You could up your carbs if the amount you’ve been eating is very low, or you could try lowering them (see the list of reasons for plateaus in previous question). Try cutting out treats and going back exclusively to unprocessed meat and dark green vegetables for a few days. Cut out the low-carb bars. Drink a lot more water. Or try one of the
following techniques, which have been known to knock people off plateaus. Try a veget able-and-fru it fast . Eat nothing but vegetables and som e fruit fo r about three days. This is very alkalinizing, in addition to being low in calories and very high in nutrients. Eat all you want, and feel free to add some goo d fat like flaxsee d oil (fo r women), olive oi l, or butter. Try a veg etable-juice fast . This is a favorite of Dr. Allan Spreen, the “Nutrition Physician,” and it’s one ofvegetable my favorites as well. Go atalking day orV8 two o n nothing but fr eshly squeezed juices. I’m not here; I’m talking the kind you m ake at home with a juicer. You can al so drink hot water with lemon juice and, of course, all the fresh water you like. Try raw foo ds for a few days. Be aware that not all peo ple can toler ate this, and if your digestion isn’t great, this may not be the best intervention for you. Add dig est ive enzymes. Dr. John Hernandez, medical director of the Center for Health and Integr ative Medicine in San Antonio, Texas, has found this to be one of the most useful weapons he has in his weight-loss arsenal (see also chapter 9). Try t he all-meat diet for a few days (no more than t hree). Eat nothing but meat and drink plenty of water. (The Lindora program uses a variation on this technique once a week, only with more choices for protein.) Another var iation o n this technique is to use the St illman diet, which I consider to be absolutely ridiculous as an eat ing pr og ram but perhaps useful fo r a couple of days to get things g oing again. On the Stillman vers ion of the meat fast, you eat only lean meats, chicken, turkey, all l ean fish, eggs, and cottage, farmer, or pot cheese made with skim milk. No extra fat, zero carbohydrates, and nothing but water to drink. Do the Fat Fast. This i s an Atkins technique, but it should be r eserved for only the most metabolically resistant people who have been absolutely unable to move the scale any other way. It’s based on the Kekwick and Pawan study in which researchers placed patients on a 1,000-calorie diet that was 90% fat and got better fat lo ss than on any o ther plan. 39 In the Atkins version, you eat only 1,000 calories, with 75% to 90% of it coming fro m fat. Atkins reco mmends five small meals o f about 200 calor ies each.
Sample 200-calorie choices include 1 ounce of macadamia nuts, 2 ounces of cr eam cheese or Brie, or 2 deviled eggs with 2 teaspoons o f mayo. (For more choices and a full explanation, see Dr. Atkins’ New Diet Revolution, pages 272–274.) Atkins emphasizes that this is actually dangerous for anyone who is not metabolically resistant—the rate of weight loss is too rapid to be safe. Atkins used it only with people who co uld not lo se weight any other way, to encour age them and to show them that weight lo ss was possible—but even then, he used it for only four or five days.
Exercise What about Exercise? Exercise is probably the most important predictor of whether or not you will keep weight off. Unfortunately, it doesn’t really account for a great deal of the weight you will lose (maybe a few pounds a month), but if you don’t do it, the odds of keeping the weight off tumble. Some lucky people are able to lose weight just by adding a lot of exercise to their daily routine without changing their diets much, but these are very rare people who usually don’t have an awful lot of weight to lose. That being said, there are many, many excellent reasons to begin an exercise pro gr am if yo u are not exercising alr eady. The health benefits alone are legion, and exercise is one of the things that helps change your biochemistry to that of a leaner person. Exercise has an insulin-like effect on l owering bloo d sugar, it increases ser otonin, and— except when very high-inte nsity—it decreases stress hor mones. Low-carb exercise g urus Gr aeme and Kate Street recommend full-body circuit training for beginners (plus ca rdio interval training fo r all l evels) as the ideal pro gr ams for low-carbers. I agr ee. These prog rams will maintain or even build a little muscle; yet they are not so overwhelmingly intense that you won’t have the energy for them. You can supplement with cardio as you see fit: probably the more, the better. And don’t worry about the fat-burning zone (see the following question). Just go as long and as hard as you can without exhausting yourself; or mix short, intense workouts wit h long er, slower o nes.
Whatever you do, do not neglect weight traini ng. Walking by itself is ust not go ing to cut it as an exercise pro gr am for weight loss. W ithout using and challenging your muscles, you will lose them, slowly but surely, and that will slo w down your metabolism. Weight training is the best way to boo st a sluggish metabolism. The more muscle you have , the mor e calories you burn.
Do I Need to Exercise in the Fat- Burning Zone? The need to exercise in the so-called fat-burning zone is a complete myth. You should exercise for as hard and as long as you safely and reasonably can, and go for the maximum amount of calories you can burn. It makes no real difference whether those calories come from fat or from sugar, any more than it matters if you pay for something with a check or with cash. The average person uses about 70% fat and 30% sugar as “fuel” while they’re sitting, sleeping, or relaxing. As they become more active, the percentages shift—t he harder they exercise, th e lo wer the pr opor tion of fuel fro m fat and the higher the p ro por tion of fuel fr om sugar. This is where the misunderstanding comes from. While the percentages of fuel do indeed change, so does the amount of calories burned. So, sure, at low levels ofoexer I’mof burning about 70% of my calor ies fr om I’m burning nly acise, couple calor ies a minute ! When I exercise har fat, der,but I may be burning only 40% fat, but I’m burning a lot more calories. Would you rather have 90 % of all o f my money, or 10% of Donald Trump’s?
I Have No Stami na for Exercis e When I’m on a Low-Carb Diet. What Gives? Lyle McDonald, one of the foremost experts on the ketogenic diet and author of a textbook in the field, works with many athletes, particularly bodybuilders. He believes that with very high-intensity exercise, the ketogenic diet can present a problem as far as energy goes. He therefore reco mmends that on exercise days you consume mo re carbo hydrates than usual, then go back to your usual amo unt at the next meal. It’s impo rtant to realize that he’s talking only about super-high-intensity exercise. For more “reg ular” fo lks, a ketogenic—or any reduced -carb—diet will supply mor e than enough energy for circuit training, conventional weight training,
and/or moderate aerobics. If it doesn’t, it may be that you’r e not eating enoug h fat. If, however, you still find th at getting through yo ur worko uts is nearl y impossible, try eating a small amount (5 to 25 gr ams) of carbohydrate about t hirty minutes before your workout and see if that helps. If it does, you’ll know that you ar e one o f those people w ho need mor e carbs to wor k out effectively.
I’ve recently started both lowimpact circuit training and a low-carb diet, and I haven’t had any problems. As long as I don’t overdo my workout, I have more energy than ever before. —Janice K. I’m a Runner and I Like to Run Races at My Local Runner ’s Club. I Thought “Carb-Loading” Was a Must for Athletes. Can a Low-Carb Diet Work for Me? Remember that the fuel you most want to use during endurance exercise is fat, not sugar. “Carb-loading” simply ensures that your glycogen stores are full, which translates into using sugar for fuel. The better you are at fatburning, the longer you’ll be able to go. For what it’s worth, Stu Mittleman, an exercise physiologist, nutritionist, ultra-marathoner, and one of the greatest endurance athletes of all time, generally eats a diet of about 40% carbs, 30% protein, and 30% fat, but when he is in training for an event, he ups the fat to about 50%—not the carbs.
CHAPTER 11
Tricks of the Trade: The Top 50+ Tips for Making Low-Carb Work for You
I’ve put together more than fifty of the most useful tips for making low-carb eatin g a par t of your life. The tips a re or ganized int o three categories: food and drink, motivation, and general. Occasionally, a tip in the “general” category may seem like it has nothing to do with low-carb eating; but believe me, i f it’s there, it has everything to do with making lowcarb weight loss a success. Remember that no program that results in changing your body and your life can be based just around what foods to eat or not eat. We also need to know how to deal w ith the kinds of issues— boredom, anxiety, disapp ointment, failure, persev erance, and so on—that inevitably come up when we’re talking about chan ging lifelong habits. By the way, befo re we get st arted, let me tell you the f irst and most impor tant tip of all….
Don’t Try to D o Al l the Ti ps In low-carb dieting, as with many other things in life, you can easily and quickly get intellect ually fatigued fro m infor mation overl oad, a pitfall tha t causes many people to j ust throw up their hands and gi ve up. Don’t do this. Use the tips that make sense to yo u and that you can incor por ate easily into your life. Don’t worry about the rest. You can always go back and revisit them. Now, let’s get started!
Food and Dri nk Drink Water No kidding. This tip has been all over this book in various forms, including in the FAQ chapter, but it’s so impo rtant that I’m go ing to stick it everywhere you might possibly see it. Water can—and does—affect fat loss . If you’re on a ketogenic diet (Atkins induction phase, Protein Power phase one, etc.), it’s essential to flush out the ketones and waste products from the fat you’re losing. Even if you’re not on a ketogenic diet, it’s essential to prevent constipation and to optimize kidney and liver function (remember that the liver is the main fat-processing factory in the body, and if it’s not working properly, neither is fat metabolism). Eight glasses a day is the minimum and is not enough for most overweight people. For more specific recommendations on how much water to drink, see page 325. P.S.: If you need mor e motivation, water is number one i n the anti-ag ing arsenal of Dr. Nicholas Perricone, formerly of Yale University and the chairman of the International Conference on Aging and Aging Skin. Perr icone says, “If I could teach my pat ients and students three things that would keep them forever young, they would be: one, drink water; two, drink water; and three, drink more water.”
Watch Out for Protein Bars You gotta be careful with these. I definitely don’t recommend them during the first two weeks, when you’re adjusting to this new way of eating. For one thing, the market has been saturated with this new class of candy—I mean, snack food—and predictably, the bars vary in quality from complete unk to not so bad. Some of the best are PaleoBar, (available on my Web site, http://www.jonnybowden.com), Sears Labs’ Omega-3 Zone (don’t confuse them with the Zone bars found in every grocery store), and the Atkins bars, available everywhere. All protein bars are not created equal, and the term energy bar is a complete marketing scam. “Energy,” in the parlance of nutrition, simply means “calories,” but manufacturers want you to think that eating one of their bars will make you feel like running a marathon. Not so. In fact, most “energy” bars are loaded with carbs. Almost all have hydrogenated fats (trans-fats). Protein bars specifically have more protein and often fewer
carbs, but you still have to read labels. Some are as high as 330 calories, not exactly snack food. I n addition, they have sweeteners like so rbitol o r mannitol, which are sugar alcohols that still need to be counted if you’re counting car bs. Mannitol, especiall y, may gi ve you g as. And even dear Dr. Atkins doesn’t count the glycerine (also known as glycerol) when he tells you there’s o nly 2 or 3 gr ams of effective carbs in his bar s. That’s controver sial: glycerol —an odor less, color less, sweet-tasting l iquid—is used as a sweetener andimpact is classif ied as a carinbohydr ate,way but Atkins claims that because it does not blood sugar the same sugar does, it shouldn’t be counted as part o f the net (effective) car b content in his bars. Maybe; maybe not. Many low-car bers do find that it slows down their weight loss; others don’t. In any case, stick with real food and hold off on the bars for a few weeks until you get your bearings in this new way of eating.
Consider Salmon for Breakfast… or Lunch or Dinner I told you that not all tips would be applicable to all readers, but if you can make this one work, you’ll reap a lot of results. Unfortunately, farmed salmon—which is what you’ll get most often in restaurants—has all the problems other farm animals have. The fish are raised in pens, fed grain, and given antibiotics. As a result of the grain diet and the lack of exercise, their omega-3 fat content is not nearly as good as that of their wild brethren. However, with wild fish there is always the slight risk of mercury. So what to do? There are such huge benefits to eating salmon that I recommend it anyway. If you can get Alaskan wild salmon, that’s great. Consider, however, some amazingly healthful varieties of canned salmon, which also taste delicious. The red sockeye kind is the best. You can get my absolute favorite, the hard-to-find gourmet Vital Choice salmon (which is also the choice of many other well-known nutrition and health gurus), through a link on my Web site, http://www.jonnybowden.com. They even have a special “Dr. Jonny Introductor y Package” o f salmo n fill ets, the best canned tuna on the planet, and three different kin ds of o rg anic berri es.
Eat Breakfast Every Day When you skip breakfast, among the many other negative things that
happen is that insulin release is greater at the next meal than it would otherwise have been. Blood sugar is destabilized. You’re more likely to be subject to cravings. In all likelihood, you’re running on empty and masking it with coffee. If you’re one of those people who has no appetite in the morning, it’s probably because you’ve conditioned yourself to this unnatural way of eating. A good place to start with the rehabilitation of your appetite is with a protein shake. Even people who are not hungry in the cangood get one of these babies or down, especiallyofifpeanut it’s delicious and morning made with extras like berries a tablespoon butter. Eventually, you should tr ansition to a r eal-food breakfast (at le ast for most days), and make sure it contains protein and some good fats. If you need so me additional motivation: at least seven stud ies have found a correlation between being overweight and skipping breakfast. 1
Memori ze This: Water Retent ion Can Mask Fat Loss! This is one of those paradoxical situations that don’t make sense on the surface—the less water you drink, the more water you retain. Why? Because when not enough water is coming into the body, a hormone called vasopressin acts on the kidneys to tell them to reabsorb the existing water in the body rather than urinating it; another hormone, aldosterone, tells the body to conserve so dium, lead ing to mor e water retention. Other factor s— such as medicat ions, hor mones, menst rual cycles, an d bir th-control pills— can also affect water retention. So sometimes your body is actually dropping fat, but because you’re holding on to water, you might not notice it on the scale. Once again, the best advice is to keep dr inking water.
Shop for Color I read the women’s magazines all the time so I can stay up to date on the kind of nutrition information being disseminated (I read the men’s magazines too—but only, of course, for the articles). One of the very best tips I ever read was this one: shop for color. If you don’t want to memorize a whole bunch of antioxidants and proanthocyanidins and phytochemicals, the easiest way to ensure you’re getting the best nutritional bang for your money is to look at what the contents of your cart look like on the checkout counter. Does it resemble one of those great postcard pictures o f a Euro pean outdoor market? It should be overflo wing
in greens, reds, oranges, and even blues. All those colorings in fruits and vegetables are there because they are natural antioxidants that will serve a similar purpose in your body. If everything you buy is the color of cardboard, you’re doing something wrong.
Shop the Outside Aisles Want to magically reduce the number of calories you’re eating from sugar, processed foods, and junk carbohydrates? Here’s a simple trick: step away from the inner aisles of the supermarket. All the good stuff is on the outside. Spend your time in the periphery of the supermarket. (It also seems to be the secret to a good singles pickup; after all, no one ever turned to a stranger to ask, “How do yo u tell if this cereal box i s fr esh?”)
Carry Prote in-Rich Snack Food with You Forget the vending machines, the airport kiosks, and the 7-Eleven stores. Start thinking of snack food in terms of real food, and start thinking of real food in terms of protein (and fat)—just what your hunting and gathering ancestors would most likely have been munching on while taking a break from stalking wild game. Think nuts, cheese (string cheese is a great choice), hard-boiled eggs, jerky, or some leftover chicken in a plastic bag. You can occasionally add a piece of fruit to the mix if your particular plan permits it, but what you can’t do is grab a bag of chips or pretzels or a chocolate chip cookie—not if you want t o get or stay slim!
Buy Some Cookbooks If I had a mere nickel for every client who asked me “What can I eat?” or who complained of being bored with the same old choices, I would be one very rich nutritionist! The answer to the question became abundantly clear to me while r esearching this book. There ar e dozens—I me an dozens —of amazing cookbooks and recipes out there for virtually every level of ability and interest in cooking, from complete novice (me) to gourmet chef. (Look at some of the marvelous suggestions for meats and snacks from Internet chef superstar Karen Barnaby on page 337, or visit http://www.lowcarb.ca; and those are only the beginning!) The best of the cookbooks are listed in Resources, and there are more coming out every month. In addition, the Web sites (see Resources) that I list nearly all have recipe sections, some of them incredibly diverse and interesting. There’s a
lot more to low-carb eating than just chicken and vegetables. STARBUCKS GOES “LOW-CAR B ”
In an example of low-carb going mainstream without much fanfare, Starbucks—which previously offered only extremely high-calorie, highcarb products—now offers a number of food items suitable for lowcarbers, including nuts, cheese, and fruit. My personal favorite is the high-protein snack plate to go, which is just about the best “mini-meal” I’ve seen in a large chain store. It beats just about any snack I ’ve seen ar ound, and I sometimes “recreate” it using my own ingredients when I want a high-protein meal of fewer than 300 calor ies. The Starbucks “High Pro tein” meal-t o-g o consists of a whole egg , some g rapes, some cheese, an d a mini whole-gr ain bagel and pean ut butter. Total calories: 260, with 13 grams of protein, 4 grams of fiber, an d 9 gr ams of fat. Now that’s a healthful “fast-fo od” o ption!
Don’t Do Anything Else While You’re Eating You’re trying to bring mindfulness and consciousness to the table when it comes to eating, so that you can reduce some of the automatic eating that takes place when you’r e thinking about other things. A go od way to do that is to make eating time eating time , not reading-the-paper time or watching- television time. The mo re you can do this, the better, and the less likely you are to consume food while you barely no tice you’r e consuming it! Eat Slowly, and Savor Every Bite Here’s another tip you can file under “Grandmother knew best.” The fact is that chewing your food slowly and thoroughly, putting your fork down between bites, and actually enjoying what you’re eating can help you lose weight. Here’s why. The brain doesn’t really get the message “Hey, he’s full!” from the stomach until about twenty minutes after you’ve eaten
enough. That’s how long it takes for the hormone CCK to do its job and signal “Enough!” to the brain. So fast eaters frequently overeat before their brain gets the signal that they’re not really hungry any more. You can go a long way toward enhancing natural appetite control by taking advantage of your body’s excellent communication network, but you need to give it enough time to work! Also, eating slowly and actually experiencing your food works against the kind of unconscious, mindless eating that caused y ou to put on weight in the fir st place. Eat the Bulk of Your Food Earlier in t he Day Adelle Davis used to say, “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” She was right. One important study showed that when people were fed a 2,000-calorie meal for breakfast (and nothing else during the day), they lost weight, but when they were fed the exact same meal at nig ht, they gained. 2 Spread your fo od o ut during the da y to control your blood-sugar and insulin levels, but try not to eat too much in the evening.
dd Yogurt or Kefir t o Your Daily Pr ogram Cultured milk products restore healthful bacteria to your body and are usually well tolerated even by people who have problems with dairy. You need to eat the plain yogurt with the real live cultures (not the junk food with the tons of fruit on the bottom). Even better, use kefir. Here’s the deal with the car b content: it’s not as hig h as the package says. In fact , for ½ cup of yo gur t, kefir, or buttermi lk, you nee d to count only 2 gr ams of effective carbohydrate! How can this be? It’s because of the way the go vernment measur es carbs. They measure everything in the food—water, ash, protein, fat—and then assume that what’s left is carbohydrate. This works fine for almost everything, including milk, but it doesn’t work for fermented milk pro ducts. As Dr. Jack Goldber g o f GO-Diet fame points out, w hen you ferment milk, you inoculate it with lactic-acid bacteria, which then “eat s up” almost all the milk sugar (lactose) and converts it into lactic acid, the stuff that curds the milk and g ives the pro duct its unique taste. So the mil k sugar that the gover nment thinks is left in the pro duct is real ly just about gone—it’s been “converted” in the fermenting process by the lactic-acid
bacteria. The “real” amount of carbohydrate left in ½ cup of plain yog urt or kefir is o nly 2 grams—this h as been measured by Goldbe rg in his own lab. I recommend that you get the full-fat variety of kefir or yogurt and enjoy it on an almost daily basis.
Repeat After Me : Fruit Juice Is Not—and Never Was—a Health Food One of the many triumphs of marketing by the giant food conglomerates was convincing America th at fruit juice is go od fo r you. There ar e ads that proclaim proudly that some stupid sugar-laden soft drink is actually 10% real fruit juice . Fruit juice is not fruit (and for carb addicts, even fruit itself has to be watched, at least in the beginning). Fruit juice is, plain and simple, junk food. It’s loaded with sugar, it has none of the fiber of real fruit, it has a high glycemic load, and it contributes absolutely nothing of value to your diet except for a few measly vitamins that you can easily get elsewhere.
Eat Protein at Every M eal
Every single meal should have protein in it. Ideally, so should every snack (but see “Choo se Your Battles” on page 369). Pro tein has less of an effect on insulin than ca rbs do, is mo re satisfying, 3 and requ ires mor e energy (calo ri es) to br eak down and assimilat e. The body r ecognizes protein (and fat) as something you have a need for; therefore, the appetitecontrol mechanisms that send messages fro m your gut to yo ur br ain signaling that you’ve had enough food work well with protein (something they do no t do with carbohydr ates, as we saw in chapter 2). A greater ratio of pr otein to car bohydrate a t a meal stabilizes blood sugar and reduces insulin response. 4 And new research suggests that leucine, an amino acid found in protein, specifically helps you to maintain muscle mass while losing body fat during weight loss. 5 WEB MD RECOMMENDS STEAK ?
In what has to be considered the ultimate “turnaround,” the ultraconservative WebMD recently published an article called “Bad Foods that Are Good for Weight Loss.” * Eggs and steak were at the
top of the list. Just remember that while both foo ds are i ndeed gr eat for weight loss, co mmercial meat may not be so g reat for your health. Get the weightloss benefit s of pro tein by choosing gr ass-fed meat and cagefree eggs! *
http://www.webmd.com/diet/slideshow-bad-foods-that-are-good-
for-weight-loss
“All-Natural” Doesn’t Mean All-Good Another triumph of the marketers was convincing us that “natural” on a food label actually means something. The term all-natural is a wholly unregulated, utterly meaningless term. Anyone can use it on anything. What’s all-natural about frozen dinners, “energy” bars, or even cut-up chicken parts in the meat section of your supermarket? You mean they were “naturally” fed a diet they normally wouldn’t eat, fed “natural” antibiotics, and then all by themselves just “naturally” morphed into chicken parts in little yellow “all-natural” Styrofoam containers? Forget the term natural. Toxic mush ro oms ar e all-natural, and so is crude oil, but we don’t eat those. Look for real food, preferably without a bar code. Think about what you could have hunted, fished for, gathered, plucked, or grown if you were with your srcinal ancestors on the savanna. That’s natural fo od. Eat it.
Replace Grains with Greens There ar e lots of reaso ns why gr ains may not be t he most hea lthful foo d in the world for most people. According to Dr. Joseph Mercola, grains contain little vitamin C and no vitamin A, and two of the major B-vitamin deficiency diseases are almost exclusively associated with excessive grain consumption. 6 Fiber—with very few exceptions—is present in paltry amounts in most processed grain products like cereals and breads and, in any case, can be gotten from vegetables and other sources. Though some people do okay with grains, if you’ve got a weight problem, you are probably not one of them. Get your carbohydrates from vegetables, at least most of the time. C. Leigh Broadhurst, PhD, author of Diabetes:
Prevention and Cure, once told me that if she could have her overweight and diabetic clients make only a si ngle change, the one that w ould have the most impact on their lives would be to remove wheat from their diets. Think abo ut it. Bring Your Own (Food, That Is) One problem for a lot of my clients is that they don’t know how to stay on their eating plan once they’re out and about, running around, or stuck at the office. That’s probably because the whole world is set up for quickandeasy junk food, and chicken breasts don’t fit in a vending machine. Don’t be a victim of circumstance. Take control of your own life. Start thinking about packing your own lunches, or at the very least your own snacks. Bodybuilder s have been doing it for decades. You can too .
Use Green Drinks
Green drinks is the general category name for juices from barley, wheatgrass, or any combination of whole green foods. Green drinks pack an incredible nutritional wallop and usually have amazing phytonutrient and vitamin profiles. They are very alkalizing (and are thus a terrific balance to a higher meat diet), they’re usually made from or ganic sour ces, they’re very low in calories, and most have no more than 3 to 4 grams of (low-glycemic) carbohydrate, an insignificant amount unless you are on the strictest of inductionstage diets (and even then, you can work them in). You can find them in most health-food and whole-food supermarkets, and you should definitely consider making them part of your program. My personal favorite hands down is Barlean’s Greens (available on my website, http://www.jonnybowden.com, or at health food stores everywhere).
Consider Eggs Rocky-Style That’s right. Raw eggs. I put two in a glass just about every day and drink ’em down. When I tell my clients this “tip,” most look at me like I just stepped off a spaceship, but here’s the deal: there is no more perfect food on earth, and there is no mor e healthful way to eat it . Dr. Joe Merco la says, “Raw whole eggs are a phenomenally inexpensive and incredible source of high-quality nutrients that many of us are deficient in, especially highquality protein and fat.” He also believes that the reason eggs are often
allergenic is that they are cooked: heating the egg protein changes its chemical shape, which can lead to allergies. When consumed raw, the incidence of egg allergy virtually disappears. One great way to consume them—if you don’t want to drink them straight—is in a protein shake. It’ll add a creamy, delicious texture to the drink and beef up the protein and nutrient co unt. What about salmonella ? Well, first of all, understand this: the risk of 7
getting anoegg contaminated witheggs salmonella isom 1 insick 30,000. nearly all f those cont aminated co me fr hens; ifSecond, you g et organic, freerange (and preferably omega-3-enriched) eggs, the risk virtually disappears. Third, even if you get it—and you probably won’t— salmonella is a r elatively benign, self-limitin g illness in health y people. 8 Ninety-four percent of those who get it don’t even see a doctor. 9 And befor e you dismiss t he idea of a r aw egg or two as just too weird, remember how an egg cream was made at v irtually every soda fo untain in the world back in the “old days”: chocolate syrup, seltzer, milk, and a raw egg!
Use Cabbage Leaves for “Bread” You could use lettuce leaves, but red cabbage is stronger. You can make a “sandwich” a grain-free virtually any meat you like—deli turkey, real (or turkey, chicken,“wrap”) even a of hamburger—by wrapping it in a big, hard leaf of cabbage or an outer leaf of lettuce. Try chicken with a few avocado slices or beef with tomato. Consider using this tip in conjunction with “Bring Your Own”!
Get a Coffee Grinder and Use It for Flaxseeds This is just an all-around great health tip in general, but it can be especially useful to low-carbers for the following reason: flaxseeds (as opposed to flaxseed oil) ar e a significant source o f fiber, wh ich is not only protective against diseases like colon cancer but is also demonstrably related to weight loss. Fiber blunts blood-sugar response and adds to a feeling of fullness. At least a dozen clinical studies demonstrate the effect of fiber on weight loss (see chapter 9). In addition, flaxseeds ar e one o f the best sources of the omega-3 fat ALA (alpha-linolenic acid), which has documented heartprotective effects as well as being anti-inflammatory.
Inflammator y chemicals (cyt okines) ar e pro duced, among other places, in the fat cells, so if you’re very heavy, you’re also l ikely to have a pro blem with inflammation. All in all, freshly ground flaxseeds are a terrific addition to your program. I use Barlean’s FortiFlax on everything, from oatmeal to veggies, and even throw a spoonful or two in my protein drinks.
Sardines: The Health Food in a Can You simply cannot beat sardines as a quick, easy, inexpensive source of first-class protein and omega-3 fats. I learned the usefulness of sardines as a fast and easy pick-me-up when I was traveling in Flo rida with the famo us New York nutritionist Oz Garcia and giving seminars. We had a brutal schedule and almost no time between events to grab anything to eat. Whenever Oz felt his blood sugar dropping or his energy flagging, he would stop and run into the nearest convenience store or bodega and grab… a can of sardines ! I learned firsthand how energizing and satisfying this foo d can be, rig ht out of the can ! If your particular lo w-carb program permits it, eat sardines with some low-carb, low-sugar crackers like Wasa bread. If you’re in somewhat more relaxed circumstances than we were, sar dines over any kind of gr een salad mak es the perfect low-carb meal. The best kind (if you can find them) are packed in sardine oil. Do not buy the kind in soybean or cottonseed oils, as these are way too high in omega-6’s.
When Eating Out, Send Back the Bread Don’t even let the waiter put it down. If it sits there, two things can happen to it—you can eat it, or you can not eat it. If you send it back, you eliminate the first possibility.
Eat Almonds—but Porti on Them Out Nuts are a great addition to the low-carb lifestyle—but they can also slow weight loss because t hey are so easy to o vereat and are so high in calor ies. If you’r e go ing to eat t hem duri ng the weight-loss phase of yo ur pr og ram, divide them into appropriate portions. Fifteen almonds is a portion. If you buy those big convenience bags, don’t take the whole bag with you to “snack” on—portion out your serving, put it in a little bag, and put the rest away.
Craving Sugar? Try Sautéed Almonds Here’s a neat treat that’ll satisfy a craving for dessert: sauté some raw almonds in butter, or bake them and melt a little butter on top. Use a bit of sea salt if you like. Remember to watch the portion size (see previous tip).
Try This Super Craving-Buster Mix together 1 tablespoon each of sesame tahini and organic soy miso, and use the mixture as a spread on celery, lettuce, or even low-carb crackers like Wasa. It’ll satisfy cravings and help reduce mineral deficiencies.
Crave-Bust with This Amino Acid A tablespoon of powdered glutamine (an amino acid) sweetened with xylitol and dissolved in a tablespoon or two of heavy cream or half-andhalf will disarm even the most de manding sugar craving.
Do Damage Control wit h Pasta You don’t have to give up pasta forever, especially once you’re at your goal weight. But lower the glycemic load significantly by cooking it al dente. The less time you boil it, the more the long chains of starch molecules in the pasta remain closely packed, making it difficult for enzymes to br eak them down and thus lo wering the impact the pasta has on your blood sugar. Better yet, get one of the new lower-carb, higher-fiber pastas and cook that al dente.
Here’s a Way to Become a Vegetable Lover Instant ly Even the most ardent anti-vegetable person is won over by a plate of ro asted vegeta bles. Take a bunch of vegg ies (all kinds o f peppers and r oo t vegetables like carrots, parsnips, beets, and onions respond well to this method), cut them up, and arrange them in a roasting pan. Drizzle with olive oil and put ’em in the oven for thirty or forty minutes. The roasting brings out sweetness and flavor you never knew existed.
Read Labels and Be a Sugar Detect ive Manufacturer s are r equired to list ingr edients in or der o f amount; t he first ingredient makes up the largest proportion of the product, and the last ingredient is present in the lowest proportion. Most manufacturers don’t
like saying that sugar is the main ingredient, even though it’s true. So they label their products with small amounts of a ton of different forms of sugar—sucrose, glucose, corn syrup, corn sweetener, dextrose, fructose, lactose, maltodextrin, invert sugar, concentrated fruit juice, sorbitol, xylitol, mannitol, barley malt, malt extract, and the absolute worst of all, highfructose corn syrup. By putting in small amounts of a mix of these, they can legally disguise the fact that the main ingredient in the packaged food you of areadded holding is are … in sugar! If you you are want to know how many teaspoons sugar a food eating, just divide the number of grams of sugar on the label by 4. You’ll be amazed to find that some cereals have 7 teaspoons of sugar per serving, and those serving sizes are tiny!
Giving up sugar was almost as hard as quitting smoking, but after about three months I found I didn’t crave it any more, and I felt 100% better. —Patricia M. Watch Those “Legal” Desserts Just because something is low-carb does not mean it is no-calorie and definitely does not mean you can eat unlimited amounts of it. Don’t make the same mistake the low-fat dieters did when they consumed massive amounts of junk food, thinking it was perfectly okay because it was lowfat. There are plenty of delicious low-carb desserts, and it’s nice to be able to have them once in a while, but if they trigger eating binges, then step away from the dessert! It’s also not a good thing if they start to replace real fo od on a reg ular basis (same p roblem with low-carb ba rs).
If You Need Dessert, Ask for Cheese and Berri es or Berri es and Cream
Dr. Jack Goldberg of the GO-Diet recommends this one, and adds that you can sweeten with the no-calorie sweetener on the table if you like. If it fits into your carb allowance and you’re doing the berries and cream at home and you must have sweetener, try xylitol ( see Resour ces).
Motivation Keep a Journal Virtually all of the successful low-carbers I interviewed for this book routinely kept food diaries, and journaling is one of four key behaviors consistently cited as a winning strategy by people who were successful in losing weight (at least 30 pounds, kept off for at least a year) in the National Weight Contr ol Registr y. It’s also pro bably the one technique that every specialist, no matter where they stand on the “dieting” spectrum, recommends. In my own “Diet Boot Camp” pro gr am, (available o n my Web site, http://www.jonnybowden.com), the journal is essential. Here’s why. You can’t change something unless you know what it is you’re changing— keeping recor ds of what you’re eating allo ws you to see what ’s wor king and what’s not; it allows you to track changes in your eating behavior against changes in your weight (and energy, mood, and sleep); and it causes you to be aware o f what you’re eating, which k eeps you ri go rously honest. In addition, for those who ar e so inclined , the jour nal can also be a terri fic tool fo r self-discovery, and has been for many great artist s thro ugho ut time. You can add r ecol lections o f the day’s events as well as notations about your feelings, your moo ds, your r esentments, your anxieties, and your joys. But don’t feel that you have to—all y ou r eally need to do to make this work from a weight-loss perspective is to keep a recor d of what you eat and d rink—every si ngle day. You do n’t have to do it for ever, but the mor e you do it, the mor e success ful you ar e likely to be.
Visit a Support Community Online One of the best things about the Internet—besides instant messaging—is the way it has allowed people with similar interests to form long-distance
communities of support and information sharing. I’ve spent literally hundreds of hours on the Internet exploring the various online communities for low-carbing, and I’ve distilled the best (and steered you from the worst) in the Resources. Take a look. You’ll find bulletin boards with posts from people just like you (no matter what level you’re at, your particular interest or concern, how much weight you have to lose, your age, or how sophisticated or unsophisticated you are about this stuff). If you like the first oneatyou go to, just of pick eventually, find don’t one where you feel home. Many theanother; low-carb sites alsoyou’ll have links to the diet journals, called diet blogs, of people just like you who have been successful at losing weight. And many of the sites listed in the Resources are personal sites and journals of individuals whose lives have been transformed by low-carb living. If one day you happen to feel unmotivated, look at some of their pictures! Expect Stalls and Plateaus There is no one on the planet who has lost weight who hasn’t experienced these. They’re a natural part of weight loss. Think of them as your body’s way of “catching up” with the changes you’re introducing to your lifestyle, kind of like a “reset” of the thermostat. They can occur for a million different reasons (see “Plateaus,” page 338), but the important point is that they do and will occur, and you will be better off if you’re prepar ed so that you don’t get thro wn when they happen.
Find a Diet Buddy This works for both exercise and dieting. It may even be the secret behind the success of personal training. If you have a commitment that involves another person, you are far more likely to actually do it. A diet buddy is like your committed listener. By stating your goals—saying out loud to another person what you’re going to eat, do, or accomplish today (or this week, or whenever)—you are giving your word a much greater reality than it might have if all you did was make a vague promise to yourself. And with the omnipresence of the Internet, there is no longer any reason not to take advantage of this secret dieting weapon. You can find a diet buddy up theAsground rules to include “checkins” asanywhere, frequentlyand as you you can bothsetneed. a frequent contributor to the iVillage.com online community, I’ve seen this tip work time and time
again.
Don’t Let Yourself Get Too Tired, Angry, Hungry, Lonely, or Bored Emotional eating is a huge factor in weight gain, as most people reading this book know. In many ways, it is virtually impossible to separate the emotional component from the physiological components. All these states of being—anger, sleep deprivation, hunger, loneliness, and boredom, not to mention anxiety, fear, nervousness, and stress—have been known to trigger overeating, nervous eating, comfort eating, or binge eating. The best cure in this case is a healthy dose of prevention.
Give Yourself a Nonfood Treat Remember that changing your lifestyle is about breaking some old habits and replacing them with more empowering ones. One of the mental habits most in need of overhaul is telling yourself that food is your only reward and comfort. That doesn’t mean there won’t be a place in your life for comfort food or recreational eating, but you definitely need to increase your r epertoir e of things t hat make you feel go od. Start loo king for things that make you feel goo d besides foo d, and start finding time to do them! Give them to your self as a r eward, eithe r for reaching a weight-loss g oal or just for the hell of it. (I had one client w ho cut out a picture o f the Armani suit he was goi ng to buy when his waist got down to a 34 and put it on his refrigerator.) It might be a trip to a day spa, a manicure, some time on the golf cour se, reading a bea ch novel, or g oing to a museum. Better yet, take a tip fr om Julia Camer on’s The Artist’s Way and make a “play date” wit h your self: just you, do ing whatever you want, no ag enda, no gr eater pur pose than to have fun. It doesn’t have to be an allday deal. It would be really great if you could come up with a number of little things you co uld do that don’t take a lo t of time and that can be incor por ated into your daily life—t ake a bath, or spend some time meditating o r even listening to o ne absolut ely gr eat song fr om the disco era (“To Be Real” bri ghtens almo st every day). When you feel the need to compulsively dig into the cookie jar, start to train yourself to substitute one of these nonfood treats. You’ll be conditioning a new repertoire of behaviors that has nothing to do with food.
Focus on the Weight You Have Lost and Kept Off—and Remem ber “the
Bowden Equation” Focusing on the we ight you have lost is a g em of a tip fro m Internet gur u and low-carb chef Karen Barnaby. I can’t tell you the number of times I have seen a weight-loss eff or t bite the dust because the perso n continued to focus on how far she still had to go rather than how far she’d come. Many studies have shown that weight-loss expectations tend to be greatly out of sync with what can realistically be attained. For example, most obesity programs consider the loss of 10% of srcinal body weight a success; but when clients who are entering the program are asked what they think would be a successful outcome, they typically say that anything less than 25% would be a failure. This does not mean you should set your sights low—not at all. Go to some of the “real people” sites listed in Resources and look at some of those pictures. They are amazing! You can do this, too. But if you’re expecting to lose 7 pounds a week consistently, you are going to be very, very disappointed; and if you are disappointed, you are going to feel like you failed—and if you feel like you’re failing, you’re much more l ikely to g ive up. Remember my famous “Bowden Equation”: disappointment equals the differ ence between expectation and reality. If you focus on the weight you have lost so far—even if it’s just a pound or two—you will be way better off in the long run and much more likely to keep going. Even better, focus on nonscale-related benefits, such as how you feel, lack of bloat, increased energy and well-being, lack of headaches, no more brain fog, or, best of all, lost inches and a changing shape. Remember that you lose weight exactly the same way you put it on—o ne pound at a time.
If You Get Stuck, Do Something Differe nt While stalls and plateaus are to be expected, they can be very frustrating. You may need to do something counterintuitive to start weight loss back up again. Some people have found that, strangely enough, adding more carbs gets things going again. Or try the Fat Fast outlined in Atkins or an “all-meat” day. Alternatively, go the other route and try a fruit-andvegetable fast for a few days. None of these techniques will hur t—the fr uitand-vegetable one will probably do a lot of good—and any one of them may push you off a stall.
Take the Word “Cheating” Out of Your Vocabulary Cheating implies lying or dishonesty. It’s much more empowering to think about the low-carb lifestyle in terms of being “strict” or “not so strict.” You may have so me days when you ar e “not so stri ct.” More than one very successful low-carber told me that he would occasionally have days when he just had to have pizza, so he did. Then he’d get back on the “strict” track at the next meal. Usually, he didn’t lose much momentum, and over time, the occasional lapse became meaningless. These people still lost a ton of weight over time by being strict more often than they were “not so strict.”
Look in the Mirr or and Talk to Yourself Here’s another one from Dr. Jack Goldberg, who is clearly of the toughlove school of weight loss. He says that you shouldn’t be angry with yourself if you lapse from your diet. Just look at yourself in the mirror and say the following to your image, in a loud voice so you can really hear your self: “ Are you serious about losing weight? Then I don’t want this to happen again. You are not a child. Grow up and take responsibility for ourself. There was no reason to eat t hat unhealthful junk.”
General Ti ps Read a Book Actually, that’s good advice for life in general, but it’s essential for lowcarbing. I’ve had dozens of people tell me they were “on Atkins,” yet they had absolutely no idea what Atkins really said and had heard only diluted information thirdhand from their hairdresser. Obviously you’re not averse to the act of reading, or you wouldn’t have bought this book, so in a sense I’m preaching to the choir. But let this book whet your appetite for more info. Although you can clearly do the basic low-carb approach outlined in chapter 7 and get great results, one (or more) of the structured programs discussed in this book may have spoken to you in some way or piqued your interest. Consider my discussions of the diet programs in chapter 7 like Cliff’s Notes. Find a plan that appeals to you and invest in the book itself—it will give you far more detail, you’ll know how to do the pro gr am cor rectly, and you’ll pro bably lea rn a lot in the bargain. E ven
if you don’t wind up sticking with that exact program, it’ll give you a great umping-off po int.
Take Your Measurements You want to know where you’re starting from so you can monitor your progress. Keeping your head in the sand accomplishes nothing. Many people lose inches before they lose pounds (or they lose both, which is even better). If you measure your waist, at the very least you’ll be able to track changes that may be happening independently of the scale, and that can be a big motivator during those times when your actual weight doesn’t move (and there will be those times—see “Plateaus,” page 338). M easur ing your chest, waist, hip, upper thigh(s), and upper arm(s) is best. Don’t look for a significant change in measurement every week, but check in every now and again to see how far you’ve come. You won’t be able to do that if you don’t measu re fir st!
Use the Scale Yup. This suggestion meets with a lot of protest, so let’s first deal with the objections. Many people, especially those who have suffered eating disorders in the past, have experienced the tyranny of the scale and have been obsessive about using it, driving themselves crazy in the bargain. For these people, throwing the scale out—and relying on how they feel and how they look—has been nothing short of a psychic liberation. I get that. But here’s the thing: there’s a way to use the scale as an ally, as a means to an end, as a tool for empowerment. First of all, you have to get that the readout is just a number and no t make it “mean” anything other than what it is. That number is not a statement about your self-worth, who you are, or anything else— it’s just the number of pounds you weigh at the moment. Second, you have to r ealize that, imper fect as it may be, the scale is yo ur reality check. I’ve seen clients assume that they must have lost weight because they jog ged that day or, conver sely, that they gained all kinds o f tonnage because they over -ate at the family bar becue. Don’t kid your self. Check in with the scale. Sure, yo u may gain so me muscle while yo u’re losing fat, and that won’t be r eflected on the scale, but event ually fat lo ss will be reflected in that digital readout! Using the scale also keeps you accountable and honest: if you see your weight go up the morning after
you did some midnight pigging out, it’s a goo d lesson in associating cause and effect. And don’t think fo r a minute that you won’t feel gr eat when you finally see the scale move toward your goal, even if it is a pound at a time.
Speaking of the Scale, Use It the Right Way Don’t compare your weight on different scales at different times of day (like how much you weighed at the doctor’s office versus how much you weighed at the gym). Scales are like clocks: no two agree perfectly; but if you keep checking the same one, it will accurately tell you how much time is passing. I recommend daily weigh-ins. There are two rules to using the scale correctly. One, always do it in the morning, wearing no clothes, before eating. Let that number be your reference. Two, average the results of the week. There are simply too many variables that can be responsible for a halfpound to pound variation, day to day, and it can make you crazy to see these minor variations (especially when they’re in the wrong direction). Use the average for the week to compute where you’re going. (With all that said, some people may find daily weigh-ins emotionally just too tough. If that’s you, at the very least do a weekly weigh-in, which will help you stay on track and prevent you from obsessing too much about the numbers.) Incidentally, I have seen clients of mine completely transform their weight-loss results simply by making everyday weigh-ins a part of their progr am.
Eat Before You Shop for Food Ever go shopping when you’re hungry? Then you know why people buy things like chocolate-covered artichokes. Anything sounds good when you’re starving. When you’re hungry is not the time to hit the supermarket. You won’t make any kind of rational decision about food. Much better: go after yo u’ve eaten, when your choices won’t be dictated by a gr owling stomach an d a craving brain.
Get a Calorie/Carb Counter This is just part of the overall mandate for conscious eating. You need to know what’s going into your body. It will keep you honest. If you’re counting carbs, a carb counter is a must. It’s nice to know the calorie, protein, and fat content as well. My own Living the Low Carb Life Pocket Carb Counter gives you net carbs, calories, protein, fat, fiber, glycemic
load rating (where applicable), and my assessment of how a particular food fits into the low-carb lifestyle. Both Atkins and Protein Power also have very g oo d pocket carb g uides.
Get Enough Sleep There is no way to overstate the effect sleep can have on your weight-loss efforts. Sleep, and lack of it, affects the body in several ways. One, lack of sleep is a stressor. Stress raises cortisol, which in turn sends a message to the body to store fat around the middle. (Chronically high levels of cortisol also produce a counterresponse from the body in the form of insulin release.) Two, the absence of deep, restful, restorative sleep prevents the body from building up a reserve of serotonin. Low serotonin states are associated with cravings and overeating (not to mention good old garden-variety depression). Three, without deep, restful sleep, your pituitary will not produce any significant amount of growth hormone, which assists in the building of muscle and the loss of fat. Fourth, lack of sleep causes people to be hungry and to overeat during the day. Some experts feel so stro ngly about t he ro le of a full nig ht of uninterrupted sleep in successful weight loss that they will even prescribe medications (typically trazodone, brand name Desyrel) to regulate sleep patterns. They feel that you are much better off taking a fairly innocuous medication than you would be with not gett ing enoug h sleep.
Volunteer Nothing contributes t o your own life mo re than contribut ing to the lives of others. Too many of us have mad e weight our sole fo cus for too lo ng. Try putting the focus on others. Choose an activity in which your weight is of no significance, like putting in some volunteer time in a hospital or an animal shelter, moderating an Internet group, mentoring a kid, or even helping out a friend or family member with a yard sale. Get out of the house and g et out of yo ur head. It’ll hel p keep things in per spective.
Buy or Rent an Exercise Video (Then Use It! ) One great thing about living in a city is that there’s always at least one video r ental place, an d vir tually all o f them carr y exercise videos. There’ s a million of them, for every possible taste and style, from Dancing to the Oldies to the latest, hippest body-shaping video by the Firm. You’ll find
everything from hardcore boot-camp stuff to the gentlest stretching. Try them on for size. If you’re a beginner, just do one for a few minutes and watch yourself progress until you can do the whole thing. The best part of videos is that you don’t have to be intimidated by anyone else in the class. (And if you’re not intimidated—and why in the world should you be, anyway?—there’s always an exercise class at the local gym, YMCA/YWCA, or studio. Try one.)
Clean Out Your Kitchen Cabinets and/ or Your Refri gerator Man, I can’t tell you how many clients I’ve had who have lost weight just by doing this one thing! I call it bulletproofing your environment. In fact, whenever I go up a few pounds and need to lose it, this trick has been my salvation. For many people, the attitude about food—at least in the beginning, before they’ve really adopted this new Way of Life—is this: i it’s there, I’m gonna eat it. Since a lot of our sabotage happens at night, when defenses are down (with television snacking or even midnight refr iger ator raids), the be st defense is a g oo d offense. If it ain’t t here, you can’t eat it. So get it out of there. That’s not to say you couldn’t get dressed, get in the car, go to the 24-hour convenience store, and buy some unk, but most of us won’t go that far, even for a carb or sugar fix. We will, however, go as far as the freezer. So dump the junk fro m your house and give yourself an advantage. If you live with other people and this isn’t really practical, try sectioning off parts of the fridge for your stuff and theirs, then think of the sections as truly separate. Pretend you’re living with roo mmates who will get mad if you eat th eir foo d. Stop Watching Television (Okay, Okay, Then Cut Back) I know it seems like heresy to suggest this, but study after study has linked increased television watching with expanding waistlines, 10 not to mention the development of childhood obesity. 11 No one is quite sure exactly why, but it’s true nonetheless. Speculation has ranged from the obvious—more TV watching means less activity and more snacking—to the slightly more subtle (e.g., the number of overt cues to eat that come with the commercials). Even the esoteric has been postulated, like the idea that certain brain states induced by staring mindlessly at the tube might be linked to a g eneral slo wdown of the metabolism. 12 Whatever. The bottom
line is: you watch more TV, you tend to be fatter. Try picking a few absolute favorites and then sticking with them. Watch them, enjoy them, then shut the TV o ff. And try turni ng it off when no one i s watching it.
“Listening to Your Body”: Not Always a Good Idea Face it: our bodies lie. They’re especially deceitful if we’ve been on the standard American diet for a long time. If we were living back in the caveman days, eating only the food that was available to us by hunting, fishing, or gathering, our bodies would tell us exactly what we needed. Our sweet too th, for example, was or iginally a gr eat survival mechanism. It caused us to seek out sweet-tasting plants, which were generally safe to eat, and fruits, which we needed because we humans do not make our own vitamin C. Now it causes us to roam the aisles of the 24-hour supermarket looking for cookies and ice cream. Our foolproof appetite regulators— such as cholecystokinin, the hormone that is released in the small intestine when our stomachs are full and we’ve had enough food—responds to protein and fat. It doesn’t recognize carbohydrate, which is why it is so easy to overeat carbs. So “listening to your body” may not always be such a great idea, as you can’t count on it to tell the truth, especially when you begin this new way of eating. Our bo dies o ften tell us what we want, which is a conditioned response, and confuse us by making us believe that it’s what we need. They’re not necessarily the same thing. We need to reeducate our bodies to tell us the truth, and we do that the same way we teach our kids to be honest—by training them. Once our bodies have been reconditioned to respond to real food, we can begin trusting them to give us reliable signals. Finally…
If You Fall Off the Wagon Don’t let it be a big deal. Acknowledge that it happened, and just get back on, begi nning with the very next meal.
CHAPTER 12
What We’ve Learned about ControlledCarbohydrate Eating: Putting Together Your Program
So, let’s talk about putting tog ether the perfect lo w-carb diet. The fir st step is to memor ize the foll owing: there is no perfect diet . There’s also no perfec t dress si ze—the one that’s perfect is the one that fits. If there’s o ne nugg et of truth that we can hang our collective philosophical hats on, it’ s the wisdom of the Rom ans: De gustibus non disputandum est , which means “Of taste, there i s no disputing.” Transl ated to the area of weight loss and diet, it means quite simply this: everybody’s different . Each individual has his or her own emot ional, psychological, and physical bluepri nt, as unique and special as fing erpri nts. No two people respond exactly the sa me way to anything—not to life, not to medicine, not to food, not to diet. In interviewing dozens of people who have been low-carbing successfully for years, I was struck by the number of people who have done their o wn versio ns of pro gr ams discu ssed in this book, or who have come up with their own solutions, spins, and variations to make lowcarbing work for them. Rick, for example, lost 50 pounds in 5 months by using the basic Atkins program, but deviated from Atkins orthodoxy by drinking a g lass of r ed wine per day rig ht from the beginning and n ever bothering to check for ketosis. Laurie lost 144 pounds and went from a size 26 to a size 8 not by following any specific plan but by eating “only low-carb food, exercising every day, and, for the last 25 pounds, lowering
the fat in my diet.” Ari , who lo st 50 pounds, did the Pro tein Power pl an but monitor ed calor ies with an online diet t racker, making sure “not to go over 2,500 a day.” Leigh—40 po unds, 10 inches down and still co unting— is a strict lacto-ovo vegetarian and lost her weight on a pretty unusual lowcarb diet without meat. She attributes her success to co mpletely cutting out sugar i n all for ms. Carl, an award-winnin g amateur figur e skater fr om Alaska, has dropped 116 pounds by lowering his carbs to 50–80 grams a day—higher onhe days he has t o train hard—and monitori calo ries, which keeps to about 1,500 to 1,800caarefully day . And Annie,ng a lo wcarber from England, lost 50 pounds on the Atkins program but found that she had to increase her carbs to continue losing weight. When she reached her goal weight, she switched to the Schwarzbein Principle. Many people begin with a s trict version o f one o f the pro gr ams discussed in this book and then “graduate” to a more customized variation of their o wn making. That is a terr ific way to g o fo r many people. The or iginal structure ser ves a purpose, like training wheels on a bike. F or some o thers, a pr og ram “o ff the rack” is goi ng to fit the m just fine an d they can follow the recommendations of the plan precisely and get great results. Some of us are lucky enough to be able to buy clothes off the rack with no alterations. For most, custom tailoring will be necessary. One-size-f its-all diets ar e a thing o f the past. In the not-so- distant future, we will probably be able to determine, through a kind of functional genetics, which patients are most likely to respond to which medicines and nutrients and, possibly through a metabolic typing, who does better on what kinds of foo ds. But for now, we have only the low-tech way , a kind o f infor med versio n of trial and err or : if it works, gr eat. If not, move on t o somethin g else.
Low-Ca rb Is Not a R el ig ion Don’t treat a low-carb lifestyle as a religion; it’s much better to think of it as a strategy . Like any strategy, you use it to achieve a goal, and you use it until it stops Your to go lose pounds or 100, and to maintain that working. goal weight forgoal ever.may Or be your al 10 may be to live a health ier, richer life, free of many of the risks from heart disease and diabetes that
come with the standard American diet. In either case, or in both cases, you might find that you do much better on a more restricted plan, at least in the beginning. If that’s the strategy that works for you, great. If you have less weight to lose and are less metabolically resistant, you may find that you get great results with a plan that is a little less restricted from the beginning: more like the second, ongoing weight-loss phase of some of the three-phase plans (like Atkins, Protein Power, or Fat Flush). These plans allow near anywhere between 40 don’t and 90 grams carbs problems per day. If you are already your goal weight, have any of serious with sugar metabolism, and simply want to improve your health and maintain your weight, the Zone, or the third phase of one of the three-phase plans, might be the perfect place for you. Find what works for you, and do it. If it stops wor king, reassess.
Reassessment 101 Most people will lose weight on a low-carb program, whether it be on the restricted induc tion phase, t he mor e lenient ongoi ng weight-loss phase, or a more general 50-gram-a-day starting plan. If you aren’t losing any weight, or if your weight loss has stalled for more than a few weeks, it’s time to go back to the drawing boar d. You may be stalled because you need to r educe carbs fur ther (say, to 20 to 30 grams). In some cases, it may even be because your carbs are a bit too low—remember, everybody’s differ ent! Equally likely is the possibility that your calories are too high, in which case you will need to begin measuring po rtions and keep ing an eye on the amoun t of fo od you’re taking in. You may have some nutrient or mineral deficiencies that could be slowing metabolic processes; consider, at the very least, supplementing with a hig h-quality multivitamin, essential fatty acids, and magnesium, and go back and read chapter 9. You may have sensitivities to some of the foods you are eating—a good game plan would then be to cut out all the usual suspects (especiall y wheat, dairy, andtosugar) seesugar if the alcohols scale begins to move. Maybe you’re sensitive some and o f the fo und in those low-carb pr otein bars —they’ve been known to stall weight loss in so me people. So has the
citric acid in diet sodas. The point is to be willing to experiment, fine-tune, and tweak your program. And, in the words of Winston Churchill, “Never give up!”
Choose Your Bat tl es When you first begin low-carbing, don’t allow yourself to be overwhelmed by too much information. It’s especially easy to get caught up in the small battles among low-carb diet theorists about things like coffee, artificial sweeteners, diet sodas, sugar alcohols, protein bars, cheese, wine, and other minor areas of disagreement. Don’t get sucked in. I’ve had clients who simply can’t imagine giving up coffee; I tell them not to give it up. Same with diet sodas, wine, or even raspberry mocha– flavor ed coffee creamer s! The important thing to r emember is that you are trying to make changes on a continuum. The name of the game is direction , not perfection. If all that’s standing between you and a more healthful low-carb diet is a couple of diet colas, keep the colas for now— maybe you’ll give them up later (or maybe you won’t). Learn to choose your battles. You do n’t have to do everything al l at once.
Invest Ti me in the Kitchen In 1970, we spent $6 billion on fast food. In the year 2000, we spent $110 billion —vir tually 150% of the entire Califor nia budget deficit. Fully 90% of the money spent on food in this country is spent on processed fo od. The typical American eats three fast-food burgers and four orders of fries per week. “We are,” says Dr. Joe Mercola, “exchanging our health for convenience.” It’s time to stop. Spend a little time in the kitchen. Prepar e your own food. Make your own snacks. Cook your own breakfast. Begin to look at foo d as a prescription drug. As one Zone dieter on the Internet said, “Treating food in this new way is definitely a challenge and a learning experi ence—but it cer tainly beats my old way o f eating that left me fat, tired, and depr essed.”
Junk Is Junk, H ig h-Carb or Low-Ca rb Americans’ taste for simple solutions and a food industry more than willing to accommodate them could easily result in the following scenario: a vast, overweight population of “low-carbers” with swelling waistlines and skyrocketing health problems. A typical specimen of this committed “low-carber” strolls through Disneyland, one hand grasping a vat-size cup of sugar-free soda, any zillion “carbohydrate-free” snack foods yet the to beother inventholding ed—hot dogofs oan lo w-carb buns, low-carb cotton candy , low-carb candy bars, low-carb popcorn. You get the picture. And it’s not pretty. Cutting carbs is not enough. We have to cut the junk . We have to learn, unfor tunately, that in most cases the foo d industry is no t our friend. If “carb-free” becomes just another slogan like “low-fat” did and we become a nation addicted to carb-free, high-calorie, chemically enhanced junk foo d, we will have t raded one idiotic notion for another, and our health will be in the same bad shape it w as befor e. This br ings us to the question on the table: how should we proceed? What general principles can we extract from the collective wisdom of the diet author s discusse d in this book and fr om the pri nciples of contro lledcarbohydrate eat ing that a llgrsubscribe to iks n for one fashion o rthat another? How can you put together a pro am that wor your life, will allow ou to lose weight, and that will promote and optimize your health for years to come? Glad you asked.
Ten Sim ple Pri ncipl es for a Successful Low -Carb Life Principle #1: Begin with a 2-Week “Boot Camp” Period Many of the diets discussed in this book make use of an initial restricted eating period of at least 2 weeks—what Atkins called the induction phase. This idea is common to many of the plans, and I recommend it highly and use it with my own clients all the time. D uri ng this time yo u:
• Eat as much meat, poultry, and fish as you like. • Eat unlimited vegetables. • Eat as much of the healthful fats—butter, avocados, oli ve oil, coco nut oil, fish oi l—as you like. • Eliminate all potatoes, rice, pasta, breads, cereals, and other starches. • Eliminate grains. • Eliminate sugar. • Eliminate dairy. • Eliminate alcohol.
Optional: the strictest versio n of this 2-w eek prog ram also tempor aril y eliminates fruit. (On an “induction-lite” program, I allow my clients one or two small daily portions of ber ri es.) You can have a cup or two of coffee, prefer ably or ganic; and, if you like, you can sweeten your coffee with xylitol, stevia, or erythritol and lig hten it with 2 tablespoons o f cr eam. You need to dr ink at least 8 glasses of water a day, plus an additional 8 ounces for every 25 pounds of extra weight you are carrying. Hot water with lemon juice is fine, as are teas (green, black, and oolong). I personally do not object to caffeinated teas, though you ar e welcome to use herbals. If you prefer mor e specific guidelines for amounts, keep your pr otein por tions to 3 to 4 o unces per meal and oils and but ter to 4 table spoons a day. Vegetables are essentially unlimited. You can eat 2 eggs a day with no pro blem, and you should use the whole egg , preferably fr om fr ee-range chickens.
I always wondered why I felt tired after eating pasta and wide awake after eating meat. Now I know.
—Bill W. Principle #2: In the Beginning, Don’t Be Concerned with Calories First you want to make sure you’re eating the right foods. There’s plenty of time later to start fiddling with portion sizes. At this point in the game, I’m not concerned with calories; centering the diet around protein, fat, and fiber will generally cause you to be full before you’ve overeaten anyway. For some lucky people, that’s all that’s necessary—calories will selfregulate. For most people, it will be necessary to deal with calories i weight doesn’t come off ( see principle #9).
Principle #3: Find Your Own Personal Level of Carb Restriction Though to the nutritional establishment low-carb is low-carb, the truth is that low-carbing exists on a continuum. As you have seen, that can mean anything from the restrictive induction phase of Atkins (20 grams or less of carbs a day) to the much more lenient Zone (in the neighborhood of 150 grams a day for a man on a reduced-calorie program). That’s a big range. Where you will fall on this continuum at any given time depends on a number of things:
The whole concept of mindful eating—not doing 20 things while I was stuffing things into my face unconsciously—was really helpful to me. It just meant learning to put some time aside to actually enjoy and experience my food.
—Melissa McN. • how metabolicall y resistant you are
• how much weight you have to lose • how you feel, physically and mentally, at various levels of carb restriction • whether your curr ent strategy is working for you I suggest you begin at about 50 gr ams of car bohydrate a d ay for the fir st week; use that as a baseline fr om which to determ ine whether the amount needs to be lower (o r if you can tolerate mor e). If you’re not into count ing gr ams, simply eliminat e all o f the “for bidden foo ds” on the ind uction l ist (pastas, grains, starches, dairy, sugars, and fruits), and you will easily be where you should be to g et goo d results without counting car bs.
Principle #4: After the First 2 Weeks, Begin Adding Carbs Back Little by Littl e After the initial “whoosh” of loss during the 2-week induction phase, your weight loss should stab ilize, and you will pro bably wind up losing aro und 2 pounds a week. Some people find that they need to stay on an inductionphase eating plan to accomplish this, but most others can begin adding back small portions of foods on the “forbidden” list at this time. Virtually all of plans agree principle andThis differ on which foods should bethe added back andoninthis what amounts. is only the place where you customize and individualize. I suggest that you constantly monitor how you feel, how you look, and what you weigh and, based on these factors, determine what can go back into your diet, as well as how much and how soon.
Principle #5: Add Back Foods According to the “Ladder of Desirability” My suggestion is that you begin with low-glycemic fruits like berries. Some people will be able to add small amounts of cheese. Many will be able to add small amounts of nuts. (Remember that nuts and cheese, while perfectly okay for low-carb eating plans, are very dense in calories and very easy to overeat. When you get “stuck” at a plateau, it is often these foods that need to go first.) Grains should be the last on your “regular” diet to be added back in, if at all, and then only truly whole grains. The spro uted variety is best . Pro cessed grains yo u can say goo d-bye to for ever.
Recreational foods include the ones we all know are not great for us but without which life would be just too boring—I include pizza, ice cream, and cheesecake on my list; you may have your own favorites. Obviously, they should be eaten infr equently! Find the level o f car bohydr ate intake that suits you and allo ws you to keep losi ng co nsistently at a moder ate rate (1 to 2 pounds a week, 3 at the most if you’r e very over weight), and stay at that level. Remember to expect plateaus and stalls (see pag e 338).
Principl e #6: When You Add Back Foods, Add Them One at a Time and Watch for Reactions One of the delightful unexpect ed “side effects” experienced by many lowcarb dieters is that symptoms they’ve had for years—symptoms that are unrelated to weight—begin to clear up: notably headaches, allergic symptoms, inflammation, and assorted aches and pains. This is often
because the lo w-carb diet, by its nat ure, eliminates many of the foo ds that are trig ger s for unrecog nized food sensit ivities as well as those that contribute to inflammation and pain (namely, grains and many of the omega-6 r efined ve getable o ils). When you begin to add back your car bs, don’t do it haphazardly. Watch what you’re adding, do it one food group at a time, and monit or yourself fo r any reactions. If you start to feel worse, the food you added back is not right for you. Dump it.
Principle #7: The Hard Work Begins with Maintenance Difficult as it may seem, getting to a goal weight is not the really hard part. Staying there is. And, believe it or not, developing a strategy for maintenance can actually begin while you are still in the losing phase. When I work with someone on a weight-loss pr og ram, she inev itably asks me if she will have to “eat this way for ever.” The dieter who asks this question is invariably gritting her teeth and simply toughing it out, waiting to g et to the goal so that she can r elax and eat what she wants. This is almost always a prescription for a disastrous result. You need to look at the weightloss period as a kind of driver’s ed for weight maintenance. The strategy you adopt for losing is like the strategy of an athlete training for an event; it’s tougher and mor e r igo rous than the “off-season” (maintenance). But every athlete also knows that getting to the top i s only the fir st part of the jour ney; staying t here is where the real action is. So the answer to the question “Will I have to eat this way forever?” is “No.” But you will have to eat differ ently. To think that you can go back to eating the way you did when you go t fat and get a com pletely differ ent result is o ne definition o f insanity. You will pro bably not have to be as restrictive and structured and disciplined as you have to be during the weight-loss phase, but you will have to be fo rever vigilant ab out preventing regain, wh ich leads to pr inciple #8. Principle #8: Use the 4-Pound Rule There will be times in lif e when recr eational eating has an ir resistible pull —weddings, bir thdays, holidays, and just the plain old urge to get a couple of pizzas and beers once in a while. These situations do not have to be the end of the world; in fact, to never allow yourself these little pleasures
would be a big mistake. The trick is to not allow these occasional “planned lapses” to generate a slide into chaos that culminates in a complete departure from the eating plan that allows you to keep your weight where you want it and maintain optimal health. So check in with the scale frequently. Choose a set number of pounds—let’s use 4 as an example. If and when you see your weight climb 4 pounds above goal, immediately go back to your 2-week induction phase, and use tha t restr ictive plan until you get down to goaleating. or even a couple of pounds under. Then you can go backback to mai ntenance
Principle #9: Don’t Ignore Calories Because some of the best-known low-carb plans do not make a big deal about calories (Atkins, Protein Power, Schwarzbein, Zone, Fat Flush), many people wrongly interpret this to mean that calories are irrelevant. No responsible low-carb author has ever said this. The lack of emphasis on calories per se has been because most of us believe that the regulation of hormones (namely insulin and glucagon) takes precedence over caloriecounting, which is an inefficient and unproductive (not to mention oldfashioned) way to lose weight.
The prejudice against fat people in the country is unbelievable. People always assume I have no self-control and they look at me like I’m somehow morally bankrupt. —Emma T. This does not mean that calor ies do n’t count at all—they do. B ut the way calor ies behave in the human body is far mor e complicate d than or iginally thought and way more individual than any formula could convey. (An interesting side note: when Dr. Jack Goldberg and Dr. Karen O’Mara first
did a clinical test of the GO-Diet in a Chicago hospital, the person who lost the most weight on the diet consumed only 1,200 calories a day—but the runnerup consumed 2,600!) Just as your level of carbohydrate restriction has to be determined by trial and error, so does your calorie intake. Many low-car bers have been stalled because, although they are eating all the right foods, they are just eating too darn many of them! This is where monitoring calories in handy. the point made strongly enough that can eachcome individual has Though to determine the cannot be appropr iate number fo r his o r her body, in general women will lo se on 1,200 to 1,300 calor ies per day and men on 1,500 t o 1,600. There will pro bably come a point at which it will be pr oductive for you to know how man y calor ies you ar e actually consuming so you can make adjustments if necessar y.
Principle #10: Low-Carb Doesn’t Mean No-Carb There is not a single low-carb diet writer who ever recommended a nocarb diet. You wouldn’t know it from all the people who chatter on about their “all-protein” diet, but such a diet does not exist anywhere in the responsible literature. Low-carb diets restrict carbohydrates, sometimes to very low amounts (especially in induction phases), but never to zero, and even the induction phases are not meant to last indefinitely. You can always have vegetables. You should always have vegetables. And even at the strictest induction levels, you can eat a fair amount of them for your 20 to 30 grams of effective carb content (much, much more when you move up to ongoing weight loss and finally to maintenance phases).
It was almost like a religious experience for me when I finally gave up all the “white stuff”—potatoes, rice, pasta, bread. For the first time in 20 years I didn’t feel bloated all the time.
—Brian C. Make Low-Ca rb Part of a System of Sel f-Care If you think of low-carbing as nothing more than a way to get skinny, you are missing out on one of the great benefits of this lifestyle. Low-carbing does no t have to be m erely a weight-lo ss strategy. It can, and should, be the cornerstone of an entire system of self-care that enhances your health and your life in dozens of ways. Keeping carbs low is only the first step, and not even the most important. You can use the tools in this book to change your entire relationship to food and, by extension, to the whole notion of how you care for yourself. Some of the terrific benefits noted by lowcarbers have to do with other changes in their diet and lifestyle that have accompan ied their switch t o low-carbohydrate foo ds. Here are ten important ways in which you can make low-carbing work for you forever. 1. Eliminate trans-fats. Because trans-fats are found in most of the foo ds that are eliminate d on lo w-carb diets, low-ca rbers automatically reduce their intake of this dangerous, health-robbing fat, which is found in baked goods, cookies, cakes, snack foods, and especially foods deep-fried in vegetable oils. Avoid anything that includes partially hydrogenated oil o n the label. Fats are vitally impor tant for the int egr ity of the c ells and as precursor s to impor tant hormones in the body, but if the good stuff isn’t around, the body will make those structures out of the reject materials. Don’t feed your body damag ed go ods. Give it the goo d stuff. Dump the trans-fats. 2. Consume more omega-3’s and way fewer omega-6’s.Omega-3’s are found in fish and flax. Omega-6’s are found mainly in the highly pro cessed vegetable oi ls o n your gr ocer ’s shelf. Many nutritionists believe that one of the greatest health problems of our time is the imbalance between these two classes of fats in the diet. Our Paleo ancestors consumed omega-6’s and omega-3’s in a very healthful 1:1
ratio. We curr ently consume somethin g like a 20: 1 ratio in favor of the omega-6’s. Those polyunsaturated, highly processed vegetable oils contribut e to a wide range of health pro blems. By reducin g your consumption o f vegetable oil s and increasing your consumption o f fish and flax (with food, supplements, or both), you help to restore the ideal r atio of fatty acids and go a long way toward impro ving your o verall healt h. minat sug ar. Theby 3. Eli destructive effects on human health have beene addressed nearly every one of of sugar the low-carb–diet authors and have been discussed in so me depth in chapter 2. For those who want to delve deeper into the subject, there ar e several excellent books about sugar (see Resour ces). There is absolutely no—I repeat , no—need for refined sugar in the human diet. You may not be able to completely eliminate sugar from your diet, but you can sure try. The gr eater your success, the gr eater the benefit to your over all health a nd well-being. 4. Eliminate processed foods. In the ideal diet—low-carb or otherwise —you would eat only what you co uld hunt, fish, g ather, pluck, grow, or possibly milk. W hile that may not be p ractical or possible in today’s world, it’s the bull’s-eye to aim for. The more you can make
foo ds with bar codes a smaller par t of your diet, the better off yo u’ll be. With food processing, the rule should be none is best and less is better . The clo ser a food is to the way nature created it, the better it is for your health. Eliminating pr ocessed foods also g oes a lo ng way toward eliminating a big so urce o f exogenous toxins like chemicals, preservatives, deodorizers, colorings, flavorings, and especially trans-fatty acids. 5. Build your meals aro und prot ein, fat, and veget ables. As you can see from the Jonny Bowden Healthy Low-Carb Life Pyramid on page 379, these three fo od g roups should for m the basis o f your diet. The exact propor tions of the t hree will vary fr om per son to perso n. There have been hunter–gatherer societies that existed on almost all protein and fat (like the Inuit) and others that existed primarily on plant foods, but there have been no hunter–gatherer societies that thrived on TV dinners. Your individual metabolism and preferences will determine how much of a contribution each of these three categor ies—protein,
fat, and vegetables—makes to your over all diet, but whatever the mix, these should be the three major sour ces for yo ur calor ies. 6. Drink plenty o f wat er. Water has been discussed i n many places in this book, but drinking it still earns a place on the top-ten list of health habits to cultivate in order to make low-carb living synonymous with gr eat health. Get in the daily habit of washing o ut metaboli c waste products as well as the t oxins i n the fat cells yo u’ll be emptying. Refresh, replenish, and restore your body’s fluids on a constant basis with water. Just do it. 7. Get plenty o f sleep. All together now, one more time: stress makes you fat . And one of life’s biggest stressors is lack of sleep. Important hor mones (like huma n gr owth hor mone) and n eurotr ansmitters (like serotonin) simply don’t get made in sufficient quantities if you’re not sleeping soundly and d eeply for at least seven or eight hours a night. Sleep is a weig ht-loss dr ug. It has no bad si de effects. And it’s free! 8. Exercise every day. Not only will this increase your metabolic r ate and burn calor ies, but doing it on a r egular basis—at least five days a week—is the single best predictor of whether or not you will be successful in keeping weight off. E xercise will change yo ur moo d, keep you lean, and very likely extend your life. Do you really need a better reason to get out and move? 9. Get 25 to 50 grams of fiber every single day. Getting the ri ght amount of fiber will help you lo se weight, help stabilize your bloo d sugar, lower the glycemic load of food, keep hunger at bay, and in all likelihood help protect against certain cancers. You get fiber in vegetables, nuts, an d fiber supplements (see chapter 9), which are highly r ecommende d. Don’t forg et the possibility of coo king up a daily “ce real” made from pure wheat, oat, or cor n bran. 10. Expand joy in your life. In the words of Robert Crayhon, “Pleasure is a nutri ent.” Never fo rget that sadness is no t a Pro zac deficiency. Natural serotonin boosters include playing with kids, petting a dog, making love, being in the sunshine, and doing things for others. Find the things in your life that raise your spirits, lift your soul, and make you happy—then do them. Often!
You Can Lose W eig ht: Beli eving Is Seeing Until 1954, it was generally believed that human beings could not run a mile in fewer than 4 minutes. The world agreed that there was an innate physiolo gical l imitation that p revented anyone fro m br eaking th is bar ri er. But the world forgot to tell Roger Bannister, a neurologist who, on May 6, 1954, ran a mil e in 3 minutes, 59.4 seconds, the fir st sub-4-minute mile. But that’s not the interesting par t of the stor y. The inter esting par t is that the next guy after Bannister to break the 4minute-mile barrier—John Landy—did it 46 days later. For decades it had never been do ne, and then it was done twice in less than 2 months. By the end of 1957, 16 runners had surpassed the record. The number who’ve done it as of the writing of this book is in the hundreds.
What happened? Certainly, the aero bic capacity of human beings di dn’t suddenly expand in 1954. What happened was that the shared belief that it was not possible to run that fast evapor ated. As soo n as people saw that it was possibl e, they believed it could be done. Those sixteen runners who bro ke the 4-minute barr ier were never stopped by a physiolo gical bar ri er —they had been stopped by their belief in a phy siolo gical barr ier. When they saw that it could be done, they believed it was po ssible.
I was eating like a bird and still not losing a pound. I knew it had to be about more than the calories. —Jim R. And then they did it. This boo k has been about giving you the best information available today about weight loss and diet. But in the long run, successful weight loss has never been just about information. Information is the first step. Information puts you on a level playing field. But the real action is what you do with that information—how you let it empower you, how you apply it to your life. Weight loss is about ta king contro l o f your life. If you can see it for yourself, as Bannist er did, you can believe in it. And if you can believe in it, you can do it. Weight loss is just the medium in which you can pr actice maste ry—of your environment, y our mind, and your body. Master these things and you master your life. The only limits that are there fo r you ar e those you believe in. Enjoy the journey.
Resources and Support for a Low-Carb Lifestyle The follo is a int co mprehensive collection of info rmation that you o f might findwing helpful, eresting, or even esse ntial in your investigation low-carbing. Though I have tried to visit virtually every Web site currently available for low-carb dieting, inevitably by the time this book comes out there will be o thers. (And just as inevitably, others will either go away or simply chang e their Web addresses [URLs]. The URLs pr ovided belo w are as current as possible at the time this book went to press; we apologize if you can’t find o ne because it has changed. U se your Web sear ch facili ty to search for the name of the site you’re looking for, not the URL.) The Web sites listed here should give you a great place to start. I have also included books that are specifically about low-carbing, as well as what I consider to be essential books about general health and nutrition; the ones I’ve reco mmended are ver y fri endly to a l ow-carb way of l ife. In this r esource section yo ulinks will also find co okbo (with the same caveat that and applies to Web sites), to research, caloroks ie counte rs, B MI calculators, some of the best blog s aro und. http://www.jonnybowden.com Stay in touch with me for the latest updates on the info rmation co ntained in this book and for information on products, books, tapes, supplements, and new things co ming down the pike. My favor ite supplements and foo ds— many of which are discussed in Living Low Carb—are available through direct links with the companies that produce them. And you can buy gr assfed beef, pemmican (the Paleolithic energy bar made from meat), and completely safe salmon from pristine Alaskan waters, plus lots of other go odies. TheProgram re are also ee audio cour ses, a newsletter, the popular Diet Boot Camp andfrlots of other goodies.
Some of the mor e interest ing blo gs with a low-carb bent : The blog of Michael R. Eades, MD: http://www.proteinpower.com/drmike/ Dr. Mary Vernon’s site, “Ask Dr. Vernon”: http://rjr10036.typepad.com/askdrvernon Jimmy Moore’s “Living La Vida Low-Carb”: http://www.livinlavidalowcarb.com/ Connie Bennett’s “Sugar Shock Blog ”: http://www.sugarshockblog.com / Jackie Eberstein’s “Controlled Carbohydrate Nutrition”: http://www.controlcarb.com Regina Wilshir e’s “Weight of the Evidence”: http://weightoftheevidence.wordpress.com
Low-Carbing Web Sites http://www.lowcarbdiets.about.com Star Feature: Overall excellent introduction and “everything you need to know” http://www.chtalk.com Star Feature: Gr eat por tal to lo w-carb fo rums http://www.lowcarbeating.com Star Feature: Lots of recipes, blogs, and active forums http://www.lowcarb.ca (www.lowcarber.org) Star Feature: Terrific carb counter, excellent support forum, “Low-Carb News” current-events section http://www.carbhealth.com Star Feature: Downloadable tools, such as a grocery list, a meal planner, and mor e
http://www.geocities.com/alabastercat/lowcarb.html Star Feature: Excellent section on sugar alternatives http://www.beyondveg.com Star Feature: Thought-provoking articles and debate, excellent postings fro m Dr. Lor en Cor dain (author of The Paleo Diet) www.paleodiet.com Star Features: Comprehensive information o n Paleolithic diet , recipe for pemmican www.carbwire.com Star Feature: Gr eat news section! www.lowcarbtransformation.com Star Feature: All about the message boards! www.holdthetoast.com Star Feature: O utstanding FAQ section www.lowcarbiseasy.com Star Feature: A unique interactive low-car b coo kboo k that allo ws you to reset the ingredients Cholesterol A long, multipart, very well-referenced article from the excellent “Second Opinions” site of Barry Groves (see “Health and General Interest Sites of Value to Low-Carber s,” page 385) called “T he Cholestero l Myth”: http://www.second-opinions.co.uk/cholesterol_myth_1.html Be sure to visit the site of the International Network of Cholesterol Skeptics: http://www.thincs.org
Ineffectiveness of low-fat/low-cholesterol diet: Repri nt of a 199 7 article fr om T he Euro pean Heart Jour nal: http://www.deanesmay.com/corr.html
Some of the best writing about the cholesterol myth can be found at http://www.thehealthyskeptic.com Coconut Oil and Ot her Oi ls A great article on the health benefits of real coconut oil, titled “What is Virgin Coconut Oil?” by Dr. Mary Enig, author of Know Your Fats: http://www.coconut-info.com/mary_enig_cholesterol.htm . “The Oiling of Ameri ca” is a classic paper about th e vegetable oil industry. The piece i s by Sally Fallo n, of the Weston A. Pri ce Foundation, and Dr. Mary Enig, an internationall y respected lipid bio chemist. You can find it o n the Weston Pr ice Foundation s ite: http://www.westonaprice.org/knowyourfats/oiling.html .
Evolutionary Diet , Vegetari anism A great article outlining the premise that the modern, high-carbohydrate, highprocessed food diet is completely out of sync with our ancient genes: http://www.thenutritionreporter.com/stone_age_diet.html . “The Myths o f Vegetar ianism” by Stephen Byrnes, PhD is ano ther interesting essay to be fo und on the Weston Pri ce Foundation site: http://www.westonapr ice.or g/mythstruths/mtvegetar ianism.html.
Sugar Addiction Thought-provo king ar ticle by one of the country’s lead ing experts, Nancy Appleton, PhD: http://www.whale.to/w/appleton3.html.
Exercise Let me be very clear: when it comes to personal training, the person I turn to for author itative infor mation is Ch arles Po liquin, found at http://www.charlespoliquin.com. There are few people in the country who know more about exercise than Poliquin. In addition to training countless Olympians, bodybuilders, and sports teams, Poliquin knows so much about nutrition he frequently lectures medical andynaturo pathic schools. I f you’rthat e r eally serio us about getat ting in shape, ou should visit his Web site.
Helpf ul Tools Calculate your BMI (body mass index): BMI is the accepted way of calculating whether o r not you are over weight or obese; 25–2 9.9 is considered over weight and over 30 is o bese: http://www.nhlbisupport.com/bmi/.
Glycemic Index and Load: The definitive site for glycemic values can be found here: http://www.mendosa.com/gilists.htm. The good thing is that if you forget the address, this is the site that usually comes up fir st on Goo gle when you put in t he words “g lycemic inde x” or “glycemic load. ” Remember, in my opinion, the load is far mor e important than the index. For a nice, useful list of foods divided into categor ies o f “high,” “medium, ” and “low,” go to: http://www.mendosa.com/common_foods.htm .
Nutritional Data: You can fi nd the nutritio nal facts on just about any foo d you can think of at this site: http://www.nutritiondata.com/, which also features a great tool that lets you search the database for foods with the most amount of any particular vitamin, essential fat, or mineral. Another way to look for nutrition facts is the good old USDA database: http://www.nal.usda.gov/fnic/foodcomp/search /, where you can search fo r any food and get the most complete nutrient analysis available: carbs, calories, fat, protein, and fiber are just the beginning. It also tells you the amount of every vitamin, mineral, and fatty acid.
Meal Delive ry Servi ce The Healthy Pantry fills the enormous need for food that is both healthy and convenient. Unlike “meal delivery” services that give you prepared meals that you have to heat up, or frozen dinners that are loaded with chemicals, Healthy P antry deliver s ever ything you need to make the meal your self in l ess than 30 minutes (and in many cases a lo t less). Everything you need is shipped to you; you simply put it together, add a perishable ingr edient or two (like an egg ), and prepare as dir ected. They have a
special “Dr. Jonny” line that feat ures the meals fo und in The Healthiest Meals on Earth, and by the time yo u read this, the Low-Carb l ine will be available as well. This is a unique co mpany with a unique visio n, and one of the most affor dable opt ions fo r people who want first-class, d elicious, and healthful food that is almost as convenient as the drive-through! Go to http://www.thehealthypantry.como r find them through the link on my site, http://www.jonnybowden.com.
Healt h and General-Inter est Sit es of Value to Low-Carbers The Weston A. Price Foundation, a nonprofit educational organization, is a clearing house of infor mation o n healthful lifesty les, ecolog y, sound nutri tion, alt ernative med icine, hu mane farming , and or ganic g ardening: http://www.westonaprice.org.
Ravnskov and THINCS: These are the site s of iconoclast resear cher Uffe Ravnskov, MD, PhD, author of The Cholesterol Myt hs (see “Recommended Reading,” page TK). His sites are dedicated to disproving the idea that too much animal fat and high cholesterol are dangerous to your heart and vessels. While the establishment dismisses Ravnskov, h e is very much worth a listen for low-carb dieters (and other intereste d people) who want another view of the cholesterol demon. His site is copiously resear ched and refer enced. THINCS is the International Networ k of Cholesterol Skeptics: http://www.ravnskov.nu/cholesterol.htm and http://www.thincs.org.
Second Opinions: Barry Groves, an Englishman with a PhD in nutritional science, r uns this site, which was called, by the London Sunday Times Magazine (October 2002), one of only five r eliable and informative W eb sites fo r dietary i nfor mation. Gro ves devotes his site t o “exposing dietary and medical misinformation” about such things as low-calorie diets, fats, cholesterol, heart disease, and other “dietary and medical bits and bobs.” The (lo ng) article tit led “The Cholest ero l Myth,” copiously r eferenced, is a highlight. Highly recommended: http://www.secondopinions.co.uk. Vitamins and Supplements
I once wor ked in a doctor ’s o ffice that had the fol lowing sig n posted: The top three things not t o bar gain-shop for : Parachutes Scuba Equipment Vitamins All vitamins and supplement s are not cr eated equal. Two ingr edients lists may lo ok si milar , but that does no t mean they’r e of the same quality: both Mercedeses and Hyundais have engi nes, but they ar e hardly the same animal. Fish oils may become rancid or may contain the same pollutants fish do unless they are scrupulously tested; minerals like magnesium and calcium come in a half dozen different chelates (magnesium oxide, magnesi um g lycinate, etc.), so me cheap, so me expensive. A supplement may officially contain carnitine, but it may be present in a meaningless amount. The vitamins I reco mmend ar e the ones that are mar keted to health pro fessio nals o nly, and they are m any cuts above what is found in the average store, even a health-food store. All the companies linked on my Web site ar e of this quality—I hope yo u will check them out at http://www.jonnybowden.com.
Recommended Reading
The 150 Healthiest Foods on Earth (Jo nny Bowden, PhD, CNS) is no w in its seventh printing and has become someth ing o f a classic boo k on healthful foods, written from a low-sugar perspective. Contains essays on why the lo w-fat movement has it backward, why we don’t need to eat eg gwhite omel ettes, why coco nut oil is misunder stood, and why soy and gr ains are no t always health foods! Heart Sense for Women (Stephen Sinatra, MD). Sinatra is a cardiologist with multiple board certifications who has written a must-have primer for all women who want to under stand the prevention and tr eatment of heart disease fr om the point of view of a physician who understands that the conventional wisdom i s woefull y inadequate. While the diet he
reco mmends is not te chnically lo w-carb, he has a lo t of g reat things to say about heart health, mind-body co nnections, vitamins and supplements, an d getting the focus off cholesterol and onto the right kinds of tests.
The Hungry Gene: The Science of Fat and the Future of Thin (Ellen Ruppel Shell). Science journalism at its best. An account of obesity research thro ugh the years, it makes a case that obesity is not a matt er of weak will or gluttony but of vulnerable genes preyed upon by a ho stile env ironment. It also exposes the unholy alli ance between schools and Coke, Pepsi, Pizza Hut, and McDonald’s. Nutrition Made Simple (Robert Crayhon, M.S., C.N.). If you buy just one book fr om which to learn the basics of nutrition, this is th e one to g et. Crayhon is one of the best and most acclaimed teachers in America, writes in an extremely readable and friendly voice, is deadly accurate, and is quite humorous in the bargain. I cannot recommend this book highly enough. What Your Doctor May Not Tell You About Hypertension (Mark Houston, MD, Barry Fox, PhD, and Nadine Taylor, M.S., R.D.). Mark Houston is to hypertension what Muhammad Ali is to boxing. There is no one I know who is mo re knowledgeable abo ut the subject. In addition to bei ng a nationally known and respected cardiologist, he is one of the most expert nutritioni sts on the planet. Hypertension o verl aps with heart disease, diabetes, and obesity in many ways, and t his boo k should be o n the shelf of anyone interested in a more modern and enlightened approach to its treatment. Eat Fat, Grow Slim (Barry Groves, PhD). This book is based on the pri nciple that the diet on which it is mo st difficult to lo se weight is a lo wfat, high-carbohydrate diet. The Carnitine Mi racle (Robert Crayhon, M.S., C.N.). Don’t be put off by the unfor tunate title, which I believe was the triumph o f the mar keting director over the author (just a theory). This is an utterly indispensable guide on how to eat, period. Crayhon, in addition to being universally
recognized as one of the outstanding nutritionists in the country, was once a stand-up comic; he has the rare ability to write about science and make it seem like beach reading. His wit and user-friendly style shine through this terr ific bo ok. Includes top-ten lists such as “t he top ten things wro ng with the Foo d Pyrami d” and “the top ten things to do to lose weight.” Do not miss.
The Encyclopedia of Nutritional Supplements (Michael Murray, N.D.) This is exactly what it says it is—a co mplete encyclopedia o f supplements that is thorough, well researched and documented—written by the premier naturopath in America. The Real Vitamin and Mineral Book: A Definitive Guide to Designing Your Own Personal Supplement Program (Shari Lieberman, PhD, C.N.S.). Lieberman literally wrote the book on vitamin and mineral supplementation. This remains the authoritative guide that everyone should have as a refer ence. The Vita-Nutrient Solution (Robert Atkins, MD). A virtual textbook on supplementation for a wide variety of health conditions. The book was actually written, with Atkins’s input of co urse, by Rober t Crayhon, who took his name off the cover over a disagr eement about the recommende d amount o f mang anese. Other than that, the text is absol utely exemplary. Dangerous Grains: Why Gluten Cereal Grains May Be Hazardous to Your Health (James Braly, MD, and Ron Hoggan, M.A.). An excellent and thought-pro voking bo ok about g luten sensitivity by a renowned foodallergy expert and a respected patient advocate. The book goes way beyond the “traditional” model that links gluten sensitivity only to celiac disease; the author s discuss t he impact of gr ains on a r ange of conditions, including autoimmune disease, ch ro nic pain, osteopor osis, dig estive problems, and brain disorders. The Gluten Connection: How Gluten Sensitivity May Be Sabotaging Your Health (Shar i Lieber man, PhD, CNS). An absol utely indispensable boo k by one of the great nutritionists of our time, delineating how undetected
sensitivity to grains can undermine our health.
Fatland: How Americans Became the Fattest People in the World (Greg Critser). While Critser is not exactly kind to the low-carb gurus like Atkins, the boo k is never theless a fascinating r ead and a scathing indictment of the sugar industry, the marketing of “supersizing,” and the health impact of high-fr uctose co rn syrup. Get the Sugar Out (Ann Louise Gittleman, M.S., C.N.S.). One of Amer ica’s top nutritionists gives you 501 practical, easy ways to reduce or eliminate sugar fr om your diet. Waistland: The (R)evolutionary Science behind our Weight and Fitness Crisis (Deirdre Barrett, PhD). A Harvard psychologist takes a novel and fascinating look at exactly what makes us fat and what w e can do about it. Sugar Shock! (Connie Bennett) is a terrific book on sugar addiction. Ms. Bennett, a first-clas s repor ter who her self suffered fr om sug ar addiction, interviewed the top health professionals in the country for this first-rate book o n the true nat ure o f sugar and its effects. Livin’ La Vida Low-Carb: My Journey from Flabby Fat to Sensationally Skinny (Jimmy Moore). An inspiring story by a man who went from 410 pounds to 180 pounds on a low-carb pr og ram and became one of the country’s leading crusaders for the lowcarb poi nt of view. The Sugar Addict’s Total Recovery Book and Your Last Diet: The Sugar ddict’s Weight Loss Plan (Kathleen DesMaisons, PhD). DesMaisons, also the author of Potatoes Not Prozac, has her PhD in addictive nut rition and takes a unique approach to making brain and body chemistry work for “sugar sensitives.” She also maintains http://www.radiantrecovery.com, a Web site for sugar addicts that contains a ton of terr ific infor mation. Eat Fat, Lose Weight (Ann Louise Gittleman, M.S., C.N.S.). One of America’s most popular nutritionists, the creator of the Fat Flush Plan (see page 169), a nd the for mer nutri tion director of the Pritikin Longevity Center, Gittleman is a reformed low-fat advocate who explains in easy-to-
understand terms no t only why fat is necessar y in the diet but how it can help you lose weight. An excellent introduction to the concept of “good fats” and “bad fats.”
The False Fat Diet (Elso n Haas, MD). An excellent boo k on the connection of fo od sensitiv ities and foo d allerg ies to weight gain. Fight Fat After Forty (Pamela Peeke, MD, M.P.H.). Largely responsible for making people awa re of the connection o f stress to weight gain, th is boo k is based on three years o f g roundbreaking r esearch on the links bet ween stress and fat that she did as a senior research fellow at the National Institutes o f Health. Peeke has made so me excellent co ntributions to the study of obesity. While all of her recommendations are not necessarily in agreement with the low-carb way of life, and some minor points can be arg ued with (she still r ecommends limitin g egg yolks becaus e they are high in cholest ero l), there is so much goo d information so br illiantly presented that this book still rates a must-read recommendation. Tired of Being Tired (Jesse Lynn Hanley, MD). This boo k is o ne of my alltime greatest finds. This primer on stress, adrenal burnout, and healthful eating emphasizes lowcarb choices, mor e pro tein, and the rig ht kind of fats (which does not mean a ban on saturated fats—her sectio n on healthy fats and oils is excellent). The Cholesterol Con: The Greatest Scam in t he History of Medicine (Dr. Malcolm Kendrick). An utterly spellbinding account, heavily referenced, of the shakiness of the evidence that animal fat and cholesterol are the true causes of heart disease. The Cholesterol Myt hs (Uffe Ravnskov, MD, PhD). A detailed, systematic expose in which Ravnskov , a bri lliant Swedish scientist and resear cher, takes on the cholesterol establishment and literally debunks every major premise of the anti–saturated fat and cholesterol dogma. He also turns his scathing lens o n the statin drug s and examines the true reasons why they work (which may very well have little to do with lowering cholesterol). A highly condensed ve rsion o f this bril liant book is available o n Ravnskov’s
Web site: http://www.ravnskov.nu/cholesterol.htm.
tkins Diabetes Revolution (Mary C. Vernon, MD, C.M.D., and Jacqueline A. Eberstein, R.N.). This book was essentially written by two highly respected medical associates o f Dr. Rober t Atkins, and if there is any ustice in the wor ld, it will become the bible fo r diabetes treatment. Dr. Mary Vernon and Jacqueli ne Eberstein, a nurse, buil t on Dr. Atkins’s copious notes and treatment protocols, added their own spin, and came up with nothing l ess than a blueprint for the way diabetes should be treated. An absolute must-read. Syndrome X (Jack Challem, Bur ton Berkso n, MD, and Melissa Diane Smith). Though there have been a number of books written about metabolic syndrome, o r Syndro me X (a precurso r to diabetes that centers around insulin resistance), this is one of the best. In addition to discussing all of the ways in which too much insulin contributes to the diseases of aging, i t also co ntains two different diet ary approaches: a moderate-carb, moderate-protein app ro ach for pr evention, and a higher-pr otein, low-carb diet for treatment of both Syndro me X and type 2 diabetes. Also co ntains an excellent discussion o n supplements and herbs and how they fit into a treatment plan. Cookbooks
The Healthiest Meals on Earth (Jonny Bowden, PhD, CNS with Jeanette Bessinger). While not specifically low-carb, this book takes a wholefoo ds, low-s ugar approach to preparing meals that are nour ishing and delicious. Decidedly not a low-fat approach! 15-Minute Low-Carb Re cipes: I nstant Recipes f or Dinners, Desserts, & More! (Dana Carpender). The latest by the popular author of How I Gave Up My Low-Fat Diet and Lost 40 Pounds and 500 Low-Carb Recipes. Carpender also r uns the popular lo w-carb site http://www.holdthetoast.com 500 Low-Carb Recipes: 500 Recipes, from Snacks to Dessert, That the Whole Family Will Love (Dana Carpender). From the pro prietor of the popular site http://www. holdthetoast.com and the author of How I Gave Up
My Low-Fat Diet and Lost 40 Pounds. Some sample far e: Hero in Wings (so named because they are supposedl y addictive!), Mockahlua Cheesecake, Meatza (pizza without the cr ust), and the secr et to lo w-carb stuffing. Baking Low Carb (Diana Lee). Dana Carpender o f http://www.holdthetoast.com says this book “is utterly indispensable for the low-carber who is tired of egg s for breakfast , for the vegetarian lowcarber who doesn’t want to live o n tofu, and for anyone who just wants to eat muffins and brownies and zucchini bread again.” ’Nuff said. Back to Protein: The Low Carb, No Carb Meat Cookbook (Barbara Doyen). More than 450 protein recipes, including things like lasagna without pasta, beef stroganoff without noodles, crusted beef Wellington without pastry, BLT chicken without the bread, and chimichangas without tor tillas. No sugar, no refined flour, and no artificial sweeteners (except for two recipes). Also includes 22 “exotic” recipes using alligator, bison, etc. Everyday Low Carb Cooking (Alex Haas). This has 240 r ecipes fr om two dozen cuisines t ransfor med into lo w-carb fare. Includes hamburger s, chicken wings, pizza, clam chowder, and chocolate pudding (all reco mmended by http://www.low-carbohydrate-food-guide.com ). The Everything Low-Carb Cookbook (Patricia M. Butkus). Rates recipes as low-to-no carb and low-to-moderate carb. Offers alternatives to pasta, bread, and cake recipes, and features such fare as chicken cacciatore, beef teriyaki with mixed vegetable stirfry, arugula salad with grilled beef medallion, and Pacific coast seafood stew; http://www.low-carbohydratefood-guide.com calls it “one of our favor ites.” The Gourmet Prescription for Low-Carb Cooking (Debor ah Friedson Chud, MD). By a physician who wri tes about foo d and scor ed big with her first book, The Gourmet Prescription, this book has recipes that emphasize high-fiber vegetables and fr uits. Lauri’s Low-Carb Cookbook: Rapid Weight Loss with Satisfying Meals!, 2nd edition (Lauri Ann Randolph). The more than 230 recipes all have
fewer than 10 gr ams of carbs per serving. Re cipes for both the beginner and the gourmet.
Lose Weight the Smart Low-Carb Way: 200 High-Flavor Recipes and a 7Step Plan to Stay Slim Forever (Bettina Newman, R.D.). Features “Smar t Low-Carb fo od substitutions.” The Low-Carb Gourmet: A Cookbook for Hungry Dieters (Ha rr iet Brownlee). A really nice recipe boo k that covers everything fr om soup to nuts. Lose Weight the Smart Low-Carb Way (Bettina Newman, R.D., David Joachim, and L eslie Rev sin). This boo k is a mo re moder ate approach to low-carb. It explains why low-carb does not mean no-carb, promotes lowglycemic fo ods, and emphasizes unsaturated fat. It’s especially useful fo r those ho memakers who want to incor por ate low-c arb dishes into family meals and make low-carb substitutions for conventional recipes. Nice charts, in cluding o ne of flo urs li sted in desce nding or der o f effective carb counts (ECC). At least 200 go od r ecipes. The Low-Carb Cookbook: The Complete Guide to the Healthy LowCarbohydrate Lifest yle—with Over 250 Delicious Recipes (Fran McCullough). Written by a well-known cookbook editor and writer who lost more than 60 pounds herself the low-carb way, this book has been a favorite for a long time and has a foreword by Drs. Michael and Mary Dan Eades. Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats (Sally Fall on with Mary G. Enig, PhD). While this is technically a cookbook, it is also a lot more. Wonderful recipes using whole nat ural fo ods (no fatfree var ieties here) and a r unning commentary that challenges conventional dietary wisdom. Be forewarned that this is not specifically a low-carb book, but it belongs on your boo kshelf anyway. The Smart Guide to Low-Carb Cooking (Mia Simms). Contains 150 recipes with an emphasis on the “anti-aging ” effects of low-carb eating. Nice
touch: how to make your own protein bars. The follow-up book, Lose Weight the Smart Low-Carb Way,featu res 200 high-flavor recipes and a 7step plan to “stay slim forever.”
Endnotes Chapter 1: The H istory and Ori gi ns of Low-C arb Diets 1. William Banting, Letter on Corpulence (self, 1864), http://www.lowcarb.ca/co rpulence/cor pulence_1.html. 2. Dr. Phil McGraw, The Ultimate Weight Solution: The 7 Keys to Weight Loss Freedom (New Yor k: Free Pr ess, 2003). 3. Vance Thompson, Eat and Grow Thin (New York: E. P. Dutton, 1914). 4. Alfr ed Pennington, New England Journal of Medicine 248 (1953): 959; American Journal of Digestive Diseases 21 (1954): 69. 5. Alfr ed Pennington, Holiday Magazine, June 1950. Quoted in Richar d Mackarness, Eat Fat and Grow Slim (London: Harvill, 1958). 6. Vilhjal mur Stefansso n, “Adventures i n Diet,” Harper’s Monthly Magazine (November 1935, December 1935, January 1936). 7. Ibid. 8. Ibid. 9. Evelyn Stefansson, pref ace to Eat Fat and Grow Slim, by Richard Mackarness (London: Harvill, 1958). 10. Ibid. 11. Blake Donal dson, Strong Medicine (New Yor k: Doubleday, 1960). 12. Alan Kekwick and Gaston L. S. Pawan, “Calorie Intake in Relation to Body Weight Changes in the Obese,” Lancet 2 ( 1956): 155; “Metaboli c Study in Human Obesity with Isocalo ric Diets High in Fat, Protein o r Carbohydrate,” Metabolism 6, no. 5 (1957): 44 7–460; “The Effect of High Fat and High Carbo hydrate Diets on Rates of W eight Loss in Mice,” Metabolism 13, no. 1 (1964): 87–97. 13. Bonnie J. Brehm, et al., “A Randomized Trial Co mparing a Very Low Carbohydr ate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” Journal of
Clinical Endocrinology and Metabolism 88, no. 4 (2003): 1617–1623. 14. Richar d Mackarness, Eat Fat and Grow Slim (London: Ha rvill ,
1958). 15. Christian B. Allan and Wolfgang Lutz, Life Without Bread (Los Angeles: Keats, 2000). 16. Richar d Mackarness, Eat Fat and Grow Slim (London: Ha rvill , 1958). 17. Anonymous, Beyond Our Wildest Dreams: A History of Overeaters nonymous as Seen by a Cofounder (Rio Rancho, N.M.: Overeaters Anonymous, 18. Herman1996). Taller, Calories Don’t Count (New York: Simon & Schuster, 1961). 19. Ibid. 20. Ancel Keys, “Cor onar y Heart Disease in Seven C ountri es,” Circulation 41, suppl. 1 (1970): 1–211. 21. Uffe Ravnskov, The Cholesterol Myt hs (Washington: New Trends, 2000); Malcolm Kendrick, “Why the Cholesterol-Heart Disease Theory Is Wrong,” http://www.redflagsweekly.com/kendrick/2002_nov28.html (November 28, 2002); Uffe Ravnskov, “Is Athero scler osi s Caused by High Cholesterol?” QJM 95, no. 6 (June 2002): 397–403. 22. Mary Enig, “The Oiling of America,” http://www.westonaprice.org/know_your_fats/oiling.html ; C. V. Felton, et al., “Dietary Pol yunsaturated Fatty Acids and Composi tion o f Human Aortic Plaques,” Lancet 344 (1994): 1195–1196; P. A. Godley, et al., “Biomarkers of Essential Fatty Acid Consumption and Risk of Prostatic Carcinoma,” Cancer Epidemiology Biomarkers & Prevention 5, no. 11 (November 1996): 889–895; M. S. Micozzi and T. E. Moon, Investigating the Role of Macronutrients, vol. 2, Nutrition and Cancer Prevention Series (New York: Marcel Dekker, 1992). 23. Laura Fr aser, Losing It: False Hopes and Fat Profits in the Diet Industry (New York: Plume, 1998). 24. Irwin Stillman, The Doctor’s Quick Weight Loss Diet (New Yor k: Dell, 1967). 25. Marjorie R. Freedman, et al., “Popular Diets: A Scientific Review,” Obesity Research 9 suppl. (2001): 5S–17S. 26. Ancel Keys, “Athero scler osis: A Pro blem in Newer Public Health,” Journal of Mount Sinai Hospital New York 20 (1953): 118–139. 27. Ancel Keys, “Cor onar y Heart Disease in Seven C ountri es,”
Circulation 41, suppl. 1 (1970): 1–211. 28. George V. Mann, Coronary Heart Disease: The Dietary Sense and Nonsense (Londo n: Janus, 1993). 29. Ibid. 30. Uffe Ravnskov, The Cholesterol Myt hs (Washington: New Trends, 2000). 31. George V. Mann, et al., “Atherosclerosis in the Masai,” American Journal of Epidemiology (1972): 26–37. 32. John Yudkin, Sweet95 and Dangerous (New York: Wyden, 1972). 33. Ancel Keys, “Letter: Nor mal Plasma Cholestero l in a Man Who Eats 25 Eggs a Day,” The New England Journal of Medicine 325 (1991): 584. 34. National Heart, Lung, and Bloo d Institute, National Chol estero l Education Pro gr am, http://www.nhlbi.nih.gov/about/ncep. 35. Apex Fitness Gr oup, Apex Fitness Systems Certification Manual, 3rd ed. (Tho usand Oaks, Calif.: A pex Fitness Gr oup, 2001). 36. Dean Ornish, “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease,” Journal of the American Medical Association 280, no. 23 (December 16, 1998): 2001–2007. 37. Marjorie R. Freedman, et al., “Popular Diets: A Scientific Review,” Obesity Research 9 suppl. (2001): 5S–17S, tables 6 and 7, http://www.atkinsexposed.org/atkins/107/ United_States_Department_of_Agr iculture.htm. 38. Walter Willett, “R&D: Discover Dialogue,” Discover 24, no. 3, online edition, http://www.discover.com (March 2003); “Too Many Carbs in Your Diet?”, http://www.ABCnews.com(9 J anuary 2002); Walter Willett, Eat, Drink, and Be Healthy (New Yor k: Fires ide, 2001). 39. USDA Millennium Lecture Series Sympos ium o n the Gr eat Nutritio n Debate, http://www.cnpp.usda.go v/Publications/O therPr ojects/SymposiumGr eatNut Transcript.txt (February 24, 2000).
Chapter 2: Why Low-Carb Diets Work 1. Woo dson Merr ell, “How I Became a Low-Carb Believer,” Time, 1 November 1999.
2. Gary Taubes, “What If It’s All Been a Big Fat Lie?”, New York Times Magazine, July 7, 2002. 3. Sharo n H. Saydah, et al., “Abnor mal Gl ucose To ler ance and the Risk of Cancer Death in the United States,” American Journal of Epidemiology 157 (June 15, 2003): 1092–1100; B. A. Stoll, “Upper Abdominal Obesity, Insulin Resistance and Br east Cancer Risk,” International Journal of Obesity and Related M etabolic Disorders 26, no. 6 (June 2002): 747–753. 4. Nancy Appleton, Lick Diabetes: the Sugar Prevention Habit (Newand YorCure k: Avery, 5. C. Leigh Bro adhurst, (New1996). York: Kensington, 1999); Chr istian B. Allan and Wolfgang Lutz, Life Without Bread (New York: McGraw-Hill, 2000). 6. Walter Willett, Eat, Drink, and Be Healthy (New Yor k: Firesi de, 2001). 7. C. Leigh Bro adhurst, Diabetes: Prevention and Cure (New York: Kensington, 1999); W . M. Rings dor f, et al., “Sucrose, neutr ophil ic phagocytosis and resistance to disease,” Dental Survey 52, no. 12 (1976): 46–48; E. Kijak, et al., Southern California State Dental Association Journal 32, no. 8 (September 1964). 8. Ron Rosedale, “Insulin and Its M etabolic Effects,” lectur e given at Boulderfest Nutrition Conference, Boulder, Colo., 1999. 9. J. Lemann, “Evidence That Glucose Ingestion Inhibits Net Renal Tubular Reabsorption of Calcium and Magnesium,” American Journal of Clinical Nutrition 70 (1967): 236–245. 10. John Yudkin, et al., “Effects of High Dietary Sugar,” British Journal of Medicine 281 (November 22, 1980): 1396. 11. Ron Rosedale, “Insulin and Its M etabolic Effects,” lecture given at Boulderfest Nutrition Conference, Boulder, Colo., 1999. 12. J. Michael Gazi ano, “Fasting Tr iglycer ides, High-Density Lipoprotein, and Risk of Myocardial Infarction,” Circulation 96 (1997): 2520–2525. 13. Gerald Reaven, “An Interview with Ger ald Reaven,” interview by Louise Mor rin, The Canadian Association of Cardiac Rehabilit ation Newsletter, September 2000. 14. Calvin Ezrin, with Kristen L. Caron, Your Fat Can Make You Thin (Lincolnwood, Ill.: Contemporary Books, 2001). 15. Adam Marcus, “Low-Fat Mice Hold Clue to Obesity Treatment,”
Reuters Magazine, December 7, 2000. 16. Mitchell Lazar, et al., Nature, Januar y 18, 2001; N. Seppa, “Pro tein May Tie Obesity to Diabetes,” Science News 159 (20 Januar y 2001): 36. 17. Calvin Ezrin, with Kristen L. Caron, Your Fat Can Make You Thin (Lincolnwood, Ill.: Contemporary Books, 2001). 18. D. K. Layman, et al., “A Reduced Ratio of Dietary Carbohydrate to Pro tein Improves Body Composition and B loo d Lipid Profiles During Weight Loss in Adult of Nutrition 133, no. 2 (Februar y 2003): 411–417; D. K.Women,” Layman,Journal et al., “Increased Dietary Protein Modifies Gluco se and Insulin Homeo stasis in Adult Women During Weight Loss,” Journal of Nutrition 133, no. 2 (Febr uary 2003): 405–410. 19. D. K. Layman, et al., “The Role of Leucine in Weight Loss Diets and Glucose Homeosta sis,” Journal of Nutrition 133, no. 1 (January 2003): 261S–267S. 20. Y. O. Chang and C. C. Soong, “Effect of Feeding Diets Lacking Various Essential Amino Acids on Body Composition of Rats,” International Journal for Vitamin and Nutrition Research 45, no. 2 (1975): 230–236. 21. D. K. Layman, et al., “A Reduced Ratio of Dietary Carbohydrate to Pro tein Improves Body C omposition and Blood Lipid Pro files during Weight Loss in Adult Women,” Journal of Nutrition 133, no. 2 (February 2003): 411–417. 22. C. S. Johnson, et al., “Postprandial Ther mog enesis Is Increased 100% on a High-Pr otein Low-Fat Diet vs. a High-Car bohydr ate, Low-Fat Diet in Healthy, Young Women,” Journal of t he American College of Nutrition 21, no. 1 (Febr uary 2002): 55–61. 23. American Association o f Clinical Endocrino log ists, “Findings and Recommendations on the Insulin Resistance Syndrome” (American Association o f Clinical Endocr inol og ists, Washington, D.C., August 25– 26, 2002). 24. Ibid. 25. Ibid. 26. Ibid. 27. National Diabetes Fact S heet, Centers fo r Disease Contro l, August 20, 2003. 28. American Association o f Clinical Endocrino log ists, “Findings and
Recommendations on the Insulin Resistance Syndrome” (American Association o f Clinical Endocr inol og ists, Washington, D.C., August 25– 26, 2002). 29. John E. Gerich, “Contri butions o f Insulin-Resistance and I nsulinSecretor y Defects to the Pathogenesis of Type 2 Diabetes Mellitus,” Mayo Clinic Proceedings 78 (April 2003): 447–456; E. S. Ford, et al., “Prevalence o f the Metabolic Syndro me Among US Adults,” Journal of
the30. American Medical Association 287 (2002): 356–359. Dara Myers, “Diabetes Diet War,” U.S. News & World Report, July14, 2003, 48–49. 31. Richar d Bernstein, The Diabetes Solution (New York: Little, Brown, 1997); C. Leigh Br oadhur st, Diabetes: Prevention and Cure (New York: Kensington, 1999). 32. American Association o f Clinical Endocrino log ists, “Findings and Recommendations on the Insulin Resistance Syndrome” (American Association o f Clinical Endocr inol og ists, Washington, D.C., August 25– 26, 2002). 33. Laure Morin-Papunen, “Insulin Resistance in Polycystic Ovar y Syndro me,” PhD diss., University o f Oulu, Finland, 2000. 34. Mark Perloe, “Polycystic Ovary Syndrome,” http://www.ivf.com/pcostreat.html. 35. Ron Rosedale, “Insulin and Its M etabolic Effects,” lectur e given at Boulderfest Nutrition Conference, Boulder, Colo., 1999. 36. Vincenzo Mari gliano, et al., “Nor mal Values in Extreme Old Age,” nnals of the New York Academy of Sciences 673 (December 22, 1992): 23–28. 37. J. Salmeron, et al., “Dietary Fat Intake and Risk of Type 2 Diabetes in Women,” American Journal of Clinical Nutrition 73, no. 6 (June 2001): 1019–1026. 38. B. V. Mann, “Metabolic Consequences of Dietary Trans-Fatty Acids,” Lancet 343 (1994): 1268–1271. 39. Elson Haas, The False Fat Diet (New York: Ballantine, 2000). 40. Joseph Mercola, “Celiac Disease (Wheat Intolerance) More Common,” http://www.mercola.com (July 2, 2003). 41. James Bral y with Ron Hogg an, Dangerous Grains (New Yor k: Avery, 2002).
42. Joseph Merco la with Alison Rose Levy, The No-Grain Diet (New Yor k: Dutton, 2003). 43. S. Liu, et al., “A Prospective Study of Dietary Glycemic Load, Carbo hydrate Intake, and Risk of Cor onar y Heart Disease in U.S. Women,” merican Journal of Clinical Nutrit ion 71, no. 6 (June 2000): 1455–1461. 44. Walter Willett, et al., “Glycemic Index, Glycemic Load, and Risk of Type 2 Diabetes,”American Journal of Clinical Nutrition 76, no. 1 (July 2002): 274S–280S.
Chapter 3: Fat, Cho le sterol, and H ealth: H ave We Been Misled? 1. In fact, one particular omega-6 fat—linolenic acid—is actually an essential fatty acid, meaning that it’s required for health but your body can’t make it, so you must get it from your diet. 2. http://www.sciencedaily.com/releases/2007/12/071203091236.htm. 3. http://news.bio-medicine. or g/bio log y-news-3/Food-fr ied-invegetable-oil-may-contain-toxic-compound-11958-1 . 4. James H. Hays, Angela DiSabatino, et al., “Effect of a High Saturated Fat and No-Star ch Diet on Ser um Lipid Subfr actions in Patients with Documented Atherosclerotic Cardiovascular Disease,” Mayo Clinic Proceedings 78, no. 11 (November 2003): 1331-1336. 5. Jeff Volek and Cassandra Fo rsythe, “The Case for Not Restricting Saturated Fat on a Low Car bohydr ate Diet,” Nutrition & Metabolism 2 (2005): 21, http://www.pubmedcentral.nih.go v/ar ticler ender.fcgi ? artid=1208952. 6. Walter C. Willett and Alber to Ascher io, “Commentar y: Trans-Fatty Acids: Are the Effects Only Marg inal?” American Journal of Public Health 84 (1994): 722–724. 7. M. A. French, K. Sundram, and M. T. Clandinin, “Cholesterolaemic Effect of Palmi tic Acid in Relation to O ther Dietary Fatty Acids,” Asia Pacific Journal of Clinical Nutrition 11 Suppl 7 (2002): S401–S407. 8. H. M. Krumholz, S. S. Seeman, et al., “Lack of Association between Cholesterol and Coronary Heart Disease Mortality and Morbidity and All-
Cause Mor tality in Perso ns Older than 70 Years,” Journal of t he American Medical Association 272, no. 17 (November 2, 1994), 1335–1340, http://jama.ama-assn.org/cgi/content/abstract/272/17/1335 . 9. Chris Kr esser, “Cholestero l Doesn’t Cause Heart Disease” (June 10, 2008), http:// thehealthyskeptic.org/cholesterol-doesnt-cause-heart-disease . 10. Michel de Lor ger il, et al., “Mediterr anean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications After Myocardial Infarction: Final Report of the Lyon Diet Heart Study,” Circulation 99. (1999): 779–785, http://circ.ahajournals.org/cgi/content/full/99/6/779 11. Antonio M. Gotto Jr., “Trig lycer ide: The For go tten Risk Factor,” Circulation 97, no . 11 (1998): 1027–1028. 12. J. Michael Gazi ano, et al., “Fasting Tr iglycer ides, High-Density Lipoprotein, and Risk of Myocardial Infarction,” Circulation 96 (1997): 2520–2525. 13. J. Michael Gazi ano, et al., “Fasting Tr iglycer ides, High-Density Lipoprotein, and Risk of Myocardial Infarction,” Circulation 96 (1997): 2520–2525. 14. Cleveland Clinic, Miller Family Hear t & Vascular Institute, Nutrition–C holesterol Guideline s, http://my.clevelandclinic.org/heart/prevention/nutrition/atp3.aspx . 15. Stephen R. Daniels, Frank R. Greer, and the Committee on Nutrition, “Lipid Screening and cardiovascular health in childhood,” Pediatrics 122, no. 1 (July 2008): 198-208, http://aappolicy.aappublications.org/cgi/content/full/pediatrics;122/1/198 (note that the “122/1/198” at the end is par t of the URL). 16. Walter Willett, World Health News, March 29, 2000, http://www.diabetesincontro l.com/r esults.php?stor yarticle=243.
Chapter 4: So Why Isn’t Everyone on a LowCarb Diet ? (OR Why Your Doctor Doesn’t Know about This Stuff) 1. I always wondered why th e critics didn’t refer to the Zone as a lo w-fat diet. After all, the Zone actually r ecommends the exact same amount o f fat
as the USDA Food Guide Pyramid recommends: 30% of calories. (The exact wor ding on the USDA Web site is to “choo se a diet lo w in fat,” defined as 30% or less of calories.) From that perspective, the Zone is right in keeping with government recommendations. Yet I never once heard any spokesperson fr om the American Diet etic Assocation (or any other conventional health organization) call the Zone a “low-fat diet.” They’ve been far too busy attacking it for being “low in carbs” (translated: “spawn of Satan”). 2. Loren Cordain, “Cereal Grains: Humanity’s Double-Edged Sword,” in Ar temis P. Simopoul os, ed., Evolutionary Aspects of Nutrition and Health. Diet, Exercise, Genetics and Chronic Disease. World Review of Nutrition and Dietetics vol . 84 (Basel: Karger, 1999), 19–73, http://www.thepaleo diet.com/ articles/Cereal %20article.pdf. 3. Negative Po pulation G rowth Web site, http://www.npg.org/facts/world_pop_year.htm . 4. Social psychologists call this state “cognitive dissonance” and theorize that people will do everything they can to “reconcile” conflicting beliefs to avoid the discomfort that comes from holding two antithetical positions such as “I eat a ton of sugar” and “sugar is bad for me.” A tried and tested way to resolve that particular dissonance is to think “sugar’s not so bad after all” (o r “everything in moder ation”).
Chapter 5: Is The re Such a Thi ng as the “Metaboli c A dvantage” of Low-Ca rb Diet s? 1. Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women, T he A TO Z Weight Loss Study: A Randomized Tr ial, Chr istopher D. Gardner, et al., Journal of the American Medical Association 297, no. 9 (2007): 969–977, http://jama.ama-assn.org/ cgi/content/full/297/9/969 ; http://med.stanfor d.edu/news_releases/2007/mar ch/diet.html. 2. The difference among the three non-Atkins groups was not sig nificant, and the differ ence between Atkins and either Ornish (4.9 lbs, on average) or LEARN (5.7 lbs, on average) was not significant either.
Chapter 6: The Bi gge st Myths about Low-Ca rb Diets 1. Two recent examples come to mind. One, when Kilmer McCully, MD of Harvard first hypothesized that homocysteine was at least as great a risk factor for heart disea se as cholest ero l, he was literally r idiculed out of his lab at Harvard. Twenty-five years later, homocysteine tests are routinely perfo rmed; homo cysteine is widely recog nized as a risk fact or for heart disease, stro ke, and Alzheimer ’s; and McCully is back at Harvard. Second example: when Jonas Folkman, MD proposed angiogenesis as a mechanism by which cancer cells were able to thrive, he too was ridiculed, laughed at, and ostraci zed fr om the scientific co mmunity. (Establishment medicine , contrar y to popular belief, does not like maveri cks.) Angio genesis is no w widely accepted, and Folkman—now dead—is recognized and acclaimed as the brilliant and innovative pioneer that he was. Doctor s, unfor tunately, do no t always take kindly to those who question their most cherished assumptions (see, for example, how the brilliant scientists who populate the International Network of Cholesterol Skeptics ar e treated by the conventional medi cal establishment, most of i t documented on their Web site, http://www.thincs.org—it’s not pretty). 2. Anssi H. Manninen, “Metabolic Effects of the Very-LowCarbo hydrate Diets: Misunderstoo d ‘Villai ns’ of Human Metabolism,” Journal of the International Society of Sports Nutrition 1, no. 2 (2004): 7– 11, http://www.pubmedcentral.nih.go v/ar ticler ender.fcgi ?artid=2129159; Ekhard E. Ziegler and L. J. Filer (eds.), Present Knowledge in Nutrition: Seventh Edition (Washington: ILSI Press, 1996), chapter 5: Carbo hydrates (Szepesi). 3. Institute of Medicine (IOM) of the National Academies, Dietary Reference Intakes: Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Washingto n: National Academies Press, 2002); http://books.nap.edu/openbook . php? record_id=10490&page=275. 4. And I don’t mean to imply that the Institute of Medicine thinks we shouldn’t eat them eith er. They’re simply saying that we appear to be able to sur vive quite well without them, pointing out: “The amount of di etary
carbohydrate that provides for optimal health in humans is unknown.” 5. Anssi H. Manninen, “Metabolic Effects of the Very-LowCarbo hydrate Diets: Misunderstoo d ‘Villai ns’ of Human Metabolism,” Journal of the International Society of Sports Nutrition 1, no. 2 (2004): 7– 11, http://www.pubmedcentral.nih.go v/ar ticler ender.fcgi ?artid=2129159. 6. I recently interviewed Eric Kossoff, MD, medical director of the Johns Hopkins ketogenic diet program. Dr. Kossoff has been using both the ketog enic diet andfor hisyears. o wn versio Atkins D effective iet—in his treatment of epilepsy “Mostn—the doctorsModified now know it’s an therapy” he tol d me. He also mentioned that he has an adult patient w ho has been on the ketogenic diet for 27 years. “His cholesterol is better than mine,” he said. 7. Donald Voet and Judith Voet,Biochemistry (New York: John Wiley and Sons, 1998). 8. Richard L. Veech, et al., “Ketone Bodies: Potential Therapeutic Uses,” IUBMB Life 51 (2001): 241–247. 9. Matthew J. Sharman, et al., “A Ketogenic Diet Favorably Affects Serum Biomar kers fo r Cardiovascular Disease in Normal-W eight Men,” Journal of Nutrition 132, no. 7 (July 2002): 1879–1885. 10. Eric C. Westman, et al., “Effect of 6-Month Adherence to a Very Low Carbohydrate D iet Prog ram,” American Journal of Medicine 133, no. 1 (2002): 30–36. 11. Bonnie J. Brehm, et al., “A Randomized Tr ial Compar ing a Very Low Carbohydr ate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” Journal of Clinical Endocrinology and Metabolism 88, no. 4 (2003): 1617–1623. 12. Marian T. Hannan, et al., “Effect of Dietary Pro tein on Bone Lo ss in Elderl y Men and Women: The Fr aming ham Osteopo rosis Study,” Journal of Bone and Mineral Research 15, no. 12 (December 2000): 2504–2512. 13. Jane E. Kerstetter, et al., “Dietary Protein, Calcium Metabolism, and Skeletal Homeostasis Revisited,” American Journal of Clinical Nutrition 78, no. 3 (September 2003): 584S–592S; Jane E. Kerstetter, et al., “Dietary Pro tein Affects Intestinal Calcium Absor ption,” American Journal of
Clinical Nutrition 68, no. 4 (1998): 859–865. 14. Ibid. 15. Annebeth Rosenving e Skov, et al., “Effect of Pr otein Intake on Bone
Miner alizatio n During Weight Loss: A 6-Month Trial,” Obesity Research 10 (2002): 432–438. 16. Rober t P. Heaney, “Editor ial: Pr otein and Calcium: Antago nists o r Synergists?,” American Journal of Clinical Nutrition 75, no. 4 (April 2002): 609–610. 17. Eric L. Knight, et al., “The Impact of Protein Intake on Renal Function Decline in Women with Nor mal Renal Function o r Mild Renal Insufficiency,” Annals of Internal 138 Changes (2003): 460–467. 18. Thomas B. Wiegmann, et al.,Medicine “Contro lled in Chr onic Dietary Protein Intake Do Not Change Glomerular Filtration Rate,” merican Journal of Kidney Diseases 15, no. 2 (Febr uary 1990): 147–154. 19. Annebeth Rosenvinge Skov, et al., “Changes in Renal Function During Weight Loss Induced by H igh- vs. Low-Pro tein Low-Fat Diets in Over weight Subjects,” International Journal of Obesity and Related Metabolic Disorders 23, no. 11 (November 1999): 1170–1177. 20. Marjorie R. Freedman, et al., “Popular Diets: A Scientific Review,” Obesity Research 9 suppl. (2001): 5S–17S. 21. Stephen B. Sondike, et al., “Effects of a Low-Carbohydrate Diet on Weight Loss and Cardiovascular Risk Factor in Overweight Adolescents,” Journal of Pediatrics 142, no. 3 (March 2003): 253–258. 22. Gary D. Foster, et al., “A Randomized Tr ial o f a Lo w-Carbohydr ate Diet for Obesity,” New England Journal of Medicine 348, no. 21 (May 22, 2003): 2082–2090; Frederick F. Samaha, et al., “A Low-Carbohydrate as Compar ed with a Low-Fat Diet in Sever e Obesity,” New England Journal of Medicine 348, no. 21 (May 22, 2003): 2074–2081. 23. Alain G olay, et al., “Weight-Loss with Low or High Car bohydr ate Diet?” International Journal of Obesity and Related Metabolic Disorders 20, no. 12 (December 1996): 1067– 1072. 24. Alain G olay, et al., “Similar Weight Loss with Low- or HighCarbo hydrate Diets,” American Journal of Clinical Nutrition 63, no. 2 (Februar y 1996): 174–178. 25. Walter C. Willett, “Dietary Fat Plays a Major Role in Obesity: No,” Obesity Reviews 3, no. 2 (May 2002): 59–68. 26. Walter C. Willett and Rudolph L. Leibel, “Dietary Fat Is Not a Major Determinant of Body Fat,” American Journal of Medicine 113, suppl. 9B (December 30, 2002): 47S–59S.
27. Jackie L. Boucher, et al., “Weight Loss, Diets, and Supplements: Does Anything Wor k?,” Diabetes Spectrum 14, no. 3 (August 2001): 169– 175. 28. Ibid. 29. John S. Yudkin, “Diet and Cor onar y Thr ombosis : Hypothesis and Fact,” Lancet 2 (1957): 155–162. 30. Uffe Ravnskov, The Cholesterol Myt hs (Washington: New Trends, 2000). 31. Malcolm Kendrick, “Why the Cholesterol-Heart Disease Theory Is Wrong,” http://www.redflagsweekly.com/kendrick/2002_nov28.html (November 28, 2002). 32. Ancel Keys, “Letter: Nor mal Plasma Cholestero l in a Man Who Eats 25 Eggs a Day,” New England Journal of Medicine 325, no. 8 (August 22, 1991): 584. 33. Eugene Br aunwald, “Shattuck Lecture: Cardio vascular Medicine at the Turn of the Millennium: Triumphs, Concer ns, and Oppor tunities,” New England Journal of Medicine 337, no. 19 (November 6, 1997): 1360–1369. 34. Ian A. Pri or, et al., “Cholestero l, Coco nuts, and Diet on Pol ynesian Atolls: A Natural Experiment: The Pukapuka and Tokelau Island Studies,” merican Journal of Clinical Nutrit ion 34, no. 8 (August 1981): 1552– 1561. 35. Alberto Ascherio and Walter C. Willett, “Health Effects of Trans Fatty Acids,”American Journal of Clinical Nutrition 66, suppl. 4 (October 1997): 1006S–1010S. 36. Mary G. Enig, Know Your Fats: The Complete Primer for Understanding the Nutri tion of Fats, Oils and Cholesterol (Bro okhaven, Penn.: Bethesda Press, 2000). 37. Ibid. 38. Gary Taubes, “The Sof t Science of Dietary Fat,” Science 291 (March 30, 2001): 2536. 39. Darlene M. Dreon, et al., “A Very-Low-Fat Diet Is Not Associated with Improved Lipoprotein Profiles in Men with a Predominance of Large, Low-Density Lipoproteins,” American Journal of Clinical Nutrition 69, no. 3 (March 1999): 411–418. 40. J. Michael Gazi ano, “Fasting Tr iglycer ides, High-Density Lipoprotein, and Risk of Myocardial Infarction,” Circulation 96 (1997):
2520–2525. 41. Dean Or nish, et al., “Intensive Lifestyle Changes fo r Reversal o f Coro nary Heart Disease, ” Journal of the American Medical Association 280, no. 23 (December 16, 1998): 2001–2007. 42. Alberto Ascherio and Walter C. Willett, “Health Effects of Trans Fatty Acids,” American Journal of Clinical Nutrition 66, suppl. 4 (October 1997): 1006S–1010S. 43. Alberto Ascherio, et al., Fat of Coronary Heart Disease in Men:Coho rt Foll ow“Dietary Up Study inand T heRisk United States,” British Medical Journal 313 (13 July 1996): 84–90. 44. Alain G olay, et al., “Weight-Loss with Low or High Car bohydr ate Diet?” International Journal of Obesity and Related Metabolic Disorders 20, no. 12 (December 1996): 1067–1072.
Chapter 7: Thi rty-Eig ht (Mos tl y) Low-Ca rb Diets and What They Can Do for You 1. Marjorie R. Freedman, et al., “Popular Diets: A Scientific Review,” Obesity Research 9 suppl. (2001): 5S–17S. 2. Kathleen DesMaiso ns, perso nal co mmunication with auth or, August 2003. 3. Beatrice A. Golomb, et al., “Insulin Sensitivity M arkers : Predictor s of Accidents and Suicides in Helsinki Heart Study Screenees,” Journal of Clinical Epidemiology 55, no. 8 (August 2002): 767–773. 4. Calvin Ezrin, with Kristen L. Caron, Your Fat Can Make You Thin (Lincolnwood, Ill.: Contemporary Books, 2001). 5. David Leonar di, pers onal co mmunication with aut hor, August 2003; Richard K.Bernstein, The Diabetes Solution (New York: Little, Brown, 1997), 43. 6. Loren Cordain, “Cereal Grains: Humanity’s Double-Edged Sword,” in Ar temis P.Simopo ulos (ed.), Evolutionary Aspects of Nutrition and Health. Diet, Exercise, Genetics and Chronic Disease. Basel: Karger,
World Review of Nutrit ion and Dietetics 84 (1999), 19–73, http://www.thepaleo diet.com/ articles/Cereal %20article.pdf.
7. Michael R. Eades and Mary Dan Eades, The 30-Day Low-Carb Diet Solution (New York: John Wiley and Sons, 2002): 11. 8. P. Webb, “The Measurement of Energy Exchange in Man: An Analysis,” American Journal of Clinical Nutrition 33, no. 6 (1980): 1299– 1310.
Cha 8: My Bi g Fat Diet: The Town T hat Lost 1200pter Pounds 1. Mary Bissell, My Big Fat Diet (document ary fi lm), http://www.mybigfatdiet.net. 2. Cassandra E. Forsythe, Stephen D. Phinney, et al., “Comparison of Low Fat and Low Carbo hydrate Diets on Cir culating Fatty Acid Composition and Markers of Inflammation,” Lipids 43, no.1 (Januar y 2008): 65–77. 3. No author given (“Adapted from materials provided by Suny Downstate Medical Center”), “Lo w-Carb Diet Reduces Inflammation and Bloo d Saturated Fat in Metabolic Syndr ome,” Science Daily Web site, December 4, 2007, http://www.sciencedaily.com/releases/2007/12/071203091236.htm. 4. Stuart G. Jarrett, Julie B. Milder, et al., “The Ketogenic Diet Increases Mitochondrial Glutathione Levels,” Journal of Neurochemistry 106, no. 3 (August 2008): 1044-1051.
Chapter 9: Suppleme nts and D ie t Drugs 1. C. Wilhelm, “Gr owing the Market for Anti-Obesity Drug s,” Chemical Market Reporter (May 15, 2000). 2. Steven R. Peikin, The Complete Book of Diet Drugs (New Yor k: Kensington, 2000), 62; Physicians’ Desk Reference, 55th ed. (Montvale, N.J.: Medical Economics, 2001). 3. F. Kelly, et al., “Sibutramine: Weight Loss in Depressed Patients,” International Journal of Obesity and Related Metabolic Disorders 19, suppl. 2 (1995): 145.
4. Donna Ryan, “Review Article: Use of Sibutramine to Treat Obesity,” http://www.MDConsult.com. 5. W. Philip T. James, et al., “Effect of Sibutramine on Weight Maintenance After Weight Loss: A Randomised Trial,” Lancet 356 (December 23, 2000): 2119–2125. 6. Frederick F. Samaha, et al., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” New England Journal of Medicine 348, no. 22, 2003): 2074–2081; D. Foster, al., “A Randomized Trial21of(May a Low-Carbohydrate Diet forGary Obesity,” NewetEngland Journal of Medicine 348, no. 21 (May 22, 2003): 2082–1090. 7. Walker S. Carlos Poston II and John P. Foreyt, “Review Article: Successful Management of the Obese Patient, ”http://www.MDConsult.com. 8. D. H. Ryan, et al., “Sibutramine: A Novel New Agent for Obesity Treatment,” Obesity Research 3, suppl. 4 (1995): 553 S–559S; Geor ge A. Bray, et al., “A Double-Blind Randomized Placebo-Co ntro lled Tr ial o f Sibutramine,” Obesity Research 4 (1996): 263–270. 9. Gary Glazer, “Long-Term Pharmacotherapy of Obesity 2000: A Review of Efficacy and Safety,” Archives of Internal Medicine 161, no. 15 (August 13, 2001): 1814–1824. 10. Eric Wooltorton, “Obesity Drug Sibutramine (Meridia): Hypertension and Cardiac Arrhythmias,” Canadian Medical Associati on Journal 166 (May 14, 2002): 10. 11. Stephan Rössner, et al., “Weight Loss, Weight Maintenance, and Improved Cardiovascular Risk Factors After 2 Years Treatment with Orlistat for Obesity,” Obesity Research 8 (2000): 49–61. 12. Lars Sjöström, et al., “Randomised Placebo-Controlled Trial of Orlistat for Weight Loss and Prevention of Weight Regain in Obese Patients,” Lancet 352 (1998): 167–172. 13. Michael H. Davidson, et al., “Weight Control and Risk Factor Reduction i n Obese Subjects Treated for 2 Years with Orl istat: A Randomized Controll ed Trial,” Journal of t he American Medical ssociation 281, no. 3 (January 20, 1999): 235–242. 14. Walker S. Carlos Poston II and John P. Foreyt, “Review Article: Successful Management of the Obese Patient, ” http://www.MDConsult.com. 15. C. N. Boozer, et al., “Herbal Ephedra/Caffeine for Weight Loss: A 6Month Randomized Safety and Efficacy Tr ial,” International Journal of
Obesity and Related M etabolic Disorders 26, no. 5 (May 2002): 593–604; D. Kalman, et al., “An Acute Clinical Trial Evaluating the Cardio vascular Effects of an Herbal Ephedra-Caffeine Weight Loss Pro duct in Healthy Over weight Adults,” International Journal of Obesity and Related Metabolic Disorders 26, no. 10 (October 2002): 1363–1366. 16. John Hernandez, “Weight Loss Protocols,” lecture at Boulderfest Nutrition Conference, Boulder, Colo., 2002. 17. The complete lis t of studies can be fo und inn,Dr. Michael Encyclopedia of Nutritional Supplements (Rockli Calif.: PrimMurray’s a, 1996, p. 318) or in Dr. Murray’s Encyclopedia of Natural Medicine, 2nd ed. (Rocklin, Calif.: Prima, 1998, p. 690). 18. Andrea Sparti, et al., “Effect of Diets High o r Low in Unavailable and Slowly Digestible Car bohydr ates on the Pattern o f 24-h Substrate Oxidation and Feelings of Hunger in Humans,” American Journal of Clinical Nutrition 72, no. 6 (December 2000): 1461–1468. 19. G. A. Spiller, Dietary Fiber in Health and Nutrition (Boca Raton, Fla.: CRC Press, 1994). 20. Manisha Chandalia, et al. , “Beneficial Effects o f Hig h Dietary Fiber Intake in Patients with Type 2 Diabetes Mellitus,” New England Journal of Medicine 342, no . 19 (May 11, 2000): 1392–1398. 21. David S. Ludwig, et al., “Dietary Fiber, Weight Gain, and Cardio vascular Disease Risk Factor s in Young Adults,” Journal of the merican Medical Association 282 (1999): 1539–1546. 22. Grego ry S. Kelly, “Nutritio nal and Botanical Int erventions to Assist with the Adaptation to Stress,” Alternative Medicine Review 4, no. 4 (August 1999): 249–265. 23. Robert Atkins, The Vita-Nutrient Solution (New York: Simon & Schuster, 1998). 24. D. P. Rose, et al., “Effect of Oral Contraceptives and Vitamin B6 Deficiency on Carbohydrate Metabolism,” American Journal of Clinical Nutrition 28 (1975): 872–878. 25. Maurice Shils, et al., Modern Nutrition in Health and Disease, 9th ed. (Baltimor e: Lippincott, Willi ams & Wilkins, 1999). 26. Ron Rosedale, per sonal comm unication with author, August 2003. 27. Maurice Shils, et al., Modern Nutrition in Health and Disease, 9th ed. (Baltimor e: Lippincott, Willi ams & Wilkins, 1999).
28. Ibid. 29. D. W. Laight, et al., “Antioxidants, diabetes and endothelial dysfunction,” Cardiovascular Research 47, no. 3 (2000): 457–464; A. Ceriello, “Oxidative stress and g lycemic reg ulation,” Metabolism 49, 2 suppl. 1 (Februar y 2000): 27–29; Patri ce Faur e, et al., “Vitamin E Impro ves the Free Radical Defense System Po tential and Insulin Sensitivity of Rats Fed High Fr uctose Diets,” Journal of Nutrition 127, no. 1 (1997): 103–107. 30. A. A.and Rivellese, al., “Long- Term EffectsPatients of Fish with Oi l o n Insulin Resistance PlasmaetLipoproteins in NIDDM Hypertriglyceridemia,” Diabetes Care 19, no. 11 (November 1996): 1207– 1213. 31. C. Popp-Snijder s, et al., “Dietary Supplementation o f Omega-3 Polyunsaturated Fatt y Acids Impro ves Insulin Sensitivity in Non-InsulinDependent Diabetes,” Diabetes Research 4, no. 3 (March 1987): 141–147; Margar et T. Behme, “Dietary Fish Oi l Enhances Insulin Sensitivity in Miniature Pigs,” Journal of Nutrition 126, no. 6 (1996): 1549–1553. 32. Y. Takahashi, et al., “Dietary Gamma-Linolenic Acid in the Form of Borage Oil Causes Less Body Fat Accumulation Accompanying an Increase in Uncoupling Pro tein 1 mRNA Level in Bro wn Adipose Tiss ue,” Comparative Biochemistry and Physiology, Part B: Biochemistry and
Molecular Biology 127, no. 2 (October 2000): 213–222. 33. K. Vaddadi, et al.,Journal of Medical Science 7 (1979): 52. 34. Ron Rosedale, “Insulin and Its Met aboli c Effects,” lecture at Boulderfest Nutrition Conference, Boulder, Colo., 1999. 35. Suzanne Humphries, et al., “Low Dietary Magnesium Is Associated with Insulin Resistance in a Sample o f Young , Nondiabetic Black Americans,” American Journal of Hypertension 12, no. 8 (August 1999): 747–756. 36. F. Cor ica, et al., “Effects o f Or al Magnesium Supplementation o n Plasma Lipid Concentrations in Patients with Non-Insulin-Dependen t Diabetes Mellitus,”Magnesium Research 7, no. 1 (March 1994): 43–47; J. Lal, et al., “Effect of O ral Magnesium Supplementat ion on the Lipid Pro file and Blo od Gl ucose o f Patients with Type 2 Diabetes Melli tus,” Journal of the Association of Physicians of India 51 (Januar y 2003): 37–42. 37. S. Jacob, et al., “Or al Administratio n of RAC-alpha-lipo ic Acid Modulates Insulin Sensitivity in Patients with Type-2 Diabetes Mellitus: A
Placebo-Controlled Pilot Trial,” Free Radical Biology & Medicine 27 (August 1999): 309–314; J. L. Evans and I. D. Goldfine, “Alpha-Lipoic Acid: A Multifunctional Antioxidant That Impro ves Insulin Sensitivity i n Patients with Type 2 Diabetes,” Diabetes Technology & Therapeutics 2, no. 3 (Autumn 2000): 401–413. 38. Burt M. Berkso n, “A Conser vative Triple Antioxidant Appro ach to the Treatment of Hepatitis C,” Medizinische Klinik 94, suppl. 3 (October 15,39. 1999): 84–89. et al., “Effects of Niacin-Bound Chromium V. Crawford, Supplementation on Body Composition in Overweight African-American Women,” Diabetes, Obesity and Metabolism 1, no. 6 (November 1999): 331–337. 40. Richard A. Anderson, et al., “Elevated Intakes of Supplemental Chro mium Impro ve Gluco se and Insulin Variables in Individuals with Type 2 Diabetes,” Diabetes 46, no. 11 (November 1997): 1786–1791. 41. Bruce E. Wilso n and Anita Go ndy, “Effects of Chr omium Supplementation o n Fasting Insulin Levels and Lipid Param eters in Healthy, Non-Obese Young Subjects,” Diabetes Research and Clinical Practice 28, no. 3 (June 1995): 179–184. 42. Dion D. D. Hepburn, et al., “Nutritional Supplement Chromium Picol inate Causes Sterility and Lethal Mutations i n Drosophila melanogaster,” Proceedings of the National Academy of Sciences of the United States of America 100, no. 7 (April 1, 2003): 3766– 3771; Diane M. Stearns, et al., “Chromium(III) Picolinate Produces Chromosome Damage in Chinese Hamster Ovary Cells,” FASEB Journal 9, no. 15 (December 1995): 1643–1648; Kevin R. Manygo ats, et al., “Ultrastr uctural Damage i n Chro mium Picol inate-Treated Cells: A TEM St udy,” Journal of Biological Inorganic Chemistry 7 (September 2002): 791–798. 43. Richar d A. Anderson, et al., “Lack of Toxicity o f Chro mium Chloride and Chromium Picolinate in Rats,” Journal of t he American College of Nutrition 16, no. 3 (June 1997): 2 73–279; Harry G. Preuss and Richard A. Anderso n, “Chromi um Update: Examining Recent Literature 1997–1998,” Current Opinion in Cli nical Nutrit ion and Metabolic Care 1, no. 6 (November 1998): 509–512. 44. Walter Mertz, “Chromium in Human Nutrition: A Review,” Journal of Nutrition 123, no. 4 (1993): 626–633.
45. A. Reddi, et al., “Biotin Supplementat ion Impro ves Gl ucose and Insulin To ler ances in G enetically Diabetic KK Mice,” Life Sciences 42, no. 13 (1998): 1323–1330. 46. M. Maebashi, et al., “Therapeutic Evaluation of the Effect of Biotin on Hyperglycemia i n Patients with Non-Insulin Dependent D iabetes Mellitus,” Journal of Clinical Biochemistry and Nutrition 14, no. 3 (1993): 211–218. 47. J. C. Cogg eshall, et New al., “Biotin Stat us and Plasma Gluco se in 389– Diabetics,” Annals of the York Academy of Sciences 447 (1985): 392. 48. M. F. McCarty, “High-Dose Biotin, an Inducer of Glucokinase Expression, May Synergize with Chromium Picolinate to Enable a Definitive Nutritio nal Ther apy for Type II Diabetes,” Medical Hypotheses 52, no. 5 (May 1999): 401–406. 49. Stephen Sinatra, L-Carnitine and the Heart (New Canaan, Co nn.: Keats, 1999); Gr ego ry S. Kelly, “L-Carnitine: Therapeutic Applications of a Conditionally-Essential Amino Acid,” Alternative Medicine Review 3, no. 5 (1998): 345–360. 50. Giuseppe Dero sa, et al., “The Effect of L-Car nitine on Plasma Lipoprotein(a) Levels in Hypercholesterolemic Patients with Type 2 Diabetes Mellitus,” Clinical Therapeutics 25, no. 5 (May 2003): 1429– 1439. 51. M.T. Abdel-Aziz, et al., “Effect of Carnitine on Blood Lipid Pattern in Diabetic Patients,” Nutrition Reports International 29, no. 5 (May 1984): 1071–1079. 52. Gertrude Mingrone, et al., “L-Carnitine Improves Glucose Disposal in Type 2 Diabetic Patients,” Journal of the American College of Nutriti on 18, no. 1 (1999): 77–82. 53. He Zhi-Qian, et al., “Body Weight Reduction in Adolescents by a Combination of Measures Including Using L-Carnitine,” Acta Nutrimenta Sinica 19, no. 2 (1997): 146–151. 54. Patrick Quillin, Healing Nutrients (New Yor k: Vintage, 1987). 55. D. M. Müller, et al., “Effects of Oral L-Carnitine Supplementation on In Vivo Long-Chain Fatty Acid Oxidation in Healthy Adults,” Metabolism 51, no. 11 (November 2002): 1389–91. 56. S. A. Center, et al., “The Clinical and Metabolic Effects of Rapid
Weight Loss in Obese Pet Cats and the Influence of Supplemental Or al LCarnitine,” Journal of Veterinary I nternal Medicine 14, no. 6 (November – December 2000): 598–608. 57. K. Q. Owen, et al., “Effect of L-Carnitine and Soybean Oil on Growth Perfo rmance and Body Composition of Early-Weaned Pigs,” Journal of Animal Science 74, no. 7 (1996): 1612–1619. 58. Diana Schwarzbein, per sonal comm unication with author, August 2003. 59. C.J. Rebouche, “Carnitine,” in Modern Nutrition in Health and Disease, 9th ed., by Maurice Shils, et al. (Baltimor e: Lippincott, Williams & Wilkins, 1999), 505. 60. L. Van Gall , et al., “Explor ator y Study of Co enzyme Q10 in Obesity,” in Biomedical and Clinical Aspects of Coenzyme Q10, 4th ed., edited by Folker s and Yamamur a (Amsterdam: Elsevier, 1984), 369–374. 61. S. Greenberg and W. H. Frishman, “Coenzyme Q10: A New Drug for Cardiovascular Disease,” Journal of Clinical Pharmacology 30 (1990): 596–608. 62. Shari Lieberman with Nancy B runing, The Real Vitamin and Mineral Book (New Yor k: Avery, 1997). 63. Joseph R. Cro nin, “Gr een Tea Extract Stokes T herm og enesis: Will It Replace Ephedra?” Alternative and Complementary Therapies 6, no. 5 (October 2000): 296–300. 64. Stacey J. Bell and G. Ken Go odr ick, “A Functional Foo d Pro duct for the Management of Weight,” Critical Reviews in Food Science and Nutrition 42, no. 2 (March 2002): 163–178; Abdul G. Dulloo, et al., “Efficacy of a Gr een Tea Extract Rich in Catechin Polyphenol s and Caffeine in Increasing 24-h Energy Expenditure and Fat Oxidation in Humans,” American Journal of Clinical Nutrition 70, no. 6 (December 1999):1040–1045. 65. Masayuki Yoshikawa, et al., “Salacia reticulata and Its Pol yphenolic Constituents with Lipase Inhibitor y and Lipo lytic Activities Have Mild Antiobesity Effects in Rats,” Journal of Nutrition 132 (2002): 1819–1824. 66. Richard A. Anderson and Marilyn M. Polansky, “Tea Enhances Insulin Activity,” Journal of Agricultural and Food Chemistry 50, no. 24 (November 20, 2002): 7182–86. 67. E. A. Sotaniemi, et al., “Ginseng Therapy in Non-Insulin-Dependent
Diabetic Patients,” Diabetes Care 18, no. 10 (October 1995): 1373–1375. 68. J. T. Xie, et al., “Ginseng Berr y Reduces Blood Glucos e and Body Weight in db/db Mice,” Phytomedicine 9, no. 3 (April 2002): 254–258. 69. Anoja S. Attele, et al., “Antidiabetic Effects of Panax ginseng Be rr y Extract and the Identificatio n of an Effective Co mponent,” Diabetes 51, no 6 (June 2002): 1851–1858. 70. T. Zhang, et al., “Ginseng Ro ot: Evidence for Numero us Regulator y Peptides and Insulinotr opic Activity,” Biomedical Research 11 (1990): 49– 54. 71. Vladimir Vuksan, et al., “American G inseng Impr oves G lycemia in Individuals with Normal Glucose Tolerance,” Journal of t he American College of Nutrition 19, no. 6 (November –December 2000): 738–744. 72. Carlo Cangiano, et al., “Eating Behavior and Adherence to Dietary Prescr iptions in O bese Adult Subjects Treated with 5-Hydro xytryptophan,” merican Journal of Clinical Nutrit ion 56, no. 5 (November 1992): 863– 867. 73. Carlo Cangiano, et al., “Effects of Oral 5-hydroxy-tryptophan on Energ y Intake and Macro nutrient Selection i n Non-Insulin Dependen t Diabetic Patients,” International Journal of Obesity and Related Metabolic Disorders 22, no. 7 (July 1998): 648–654; F. Ceci, et al., “The Effects of Oral 5- hydroxytryptophan on Feeding Behavior in Obese Adult Female Subjects,” Journal of Neural Transmission 76, no . 2 (1989): 109–117. 74. Natural Medicines Comprehensive Database, Monograph: Bitter Orange (Stockton, Calif.: Therapeutic Resear ch, 2003). 75. M. Blumenthal, et al.,Herbal Medicine Expanded Commission E Monographs (Atlanta: Integr ative Medicine Co mmunications, 2000). 76. Gio acchino Calapai, et al. , “Antiobesity and Cardio vascular Toxic Effects of Citrus aurantium Extracts in the Rat : A Prel iminar y Repor t,” Fitoterapia 70, no. 6 (December 1, 1999): 586–592. 77. Natural Medicines Comprehensive Database, Patient Handout: Bitter Orange (Stockton, Calif.: Therapeutic Resear ch, 2003). 78. L. Rogers and R. Pelton, Quarterly Journal of Studies of Alcohol 18, no. 4 (1957): 581–587. 79. F. Goodwin, APA Psychiatric News (December 5, 1986). 80. Robert Atkins, The VitaNutrient Solution (New York: Simon & Schuster, 1998).
81. Ron Rosedale, “Insulin and Its M etabolic Effects,” lectur e given at Boulderfest Nutrition Conference, Boulder, Colo., 1999. 82. F. Sampalis, et al., “Evaluat ion of the Effects of Neptune Kril l Oil on the Management of Premenstrual Syndrome and Dysmenorrhea,” lternative Medicine Review 8, no. 2 (May 2003): 171–179. 83. Clement Ip, et al., “Mammar y Cancer Prevention by Conjug ated Dienoic Derivative of Linoleic Acid,” Cancer Research 51, no. 22 (November 15,in1991): 6118-6124; Martha A. Band elurMechanisms y, “Dietary Conjug ated Linoleic Acid Health: Physiological Effects of Action,” Annual Review of Nutrition 22 (July 2002): 505–531. 84. Vassili s Moug ios, et al., “Effect of Supplementation with Conjug ated Linolei c Acid on Human Serum Lipids and Body Fat, ” Journal of Nutritional Biochemistry 12, no. 10 (October 2001): 585–594. 85. Author not listed (“Adapted from materials provided by Ohio State University”), “Fat That May Benefit Diabetics Reduces Weight, Blood Sugar,” http://www.sciencedaily.com/releases/2003/01/030129080354.htm. 86. U. Risérus, et al., “Conjugated Linoleic Acid (CLA) Reduced Abdomi nal Adipose Tissue i n Obese Middle-Aged Men w ith Signs o f the Metabolic Syndrome: A Randomised Controlled Trial,” International Journal of Obesity and Related Metabolic Disorders 25, no. 8 (August
2001) : 1129–1135. 87. Author not listed (“Adapted from materials provided by Ohio State University”), “Fat That May Benefit Diabetics Reduces Weight, Blood Sugar,” http://www.sciencedaily.com/releases/2003/01/030129080354.htm.
Chapter 10: Frequentl y A sked Questions 1. “Health and Medicine,” U.S. News & World Report (14 July 2003). 2. Ibid. 3. Ibid. 4. Calvin Ezrin, with Kristen L. Caron, Your Fat Can Make You Thin (Lincolnwood, Ill.:Shell, Contemporary Books, 2001). 5. Ellen Ruppel The Hungry Gene: The Science of Fat and the Future of Thin (New York: Atlantic Monthly Press, 2002).
6. Natural Medicines Comprehensive Database, Monograph: Bitter Orange (Stockton, Calif.: Therapeutic Resear ch, 2003). 7. M. Blumenthal, et al.,Herbal Medicine Expanded Commission E Monographs (Atlanta: Integr ative Medicine Co mmunications, 2000). 8. Gio acchino Calapai, et al. , “Antiobesity and Cardio vascular Toxic Effects of Citrus aurantium Extracts in the Rat : A Prel iminar y Repor t,” Fitoterapia 70, no. 6 (December 1, 1999): 586–592. 9. Natural Medicines Database, Patient Handout: Bitter Orange (Stockton, Calif.:Comprehensive Therapeutic Resear ch, 2003). 10. Joanne Carroll and Dorcas Koenigsberger, “The Ketogenic Diet: A Practica l Guide for Careg ivers,” Journal of the American Dietetic ssociation 98, no. 3 (March 1998): 316–321. 11. Lyle McDonald, The Ketogenic Diet, http://www.theketogenicdiet.com, 1998. 12. Donald S. Robertson, The Snowbird Diet (New Yor k: Warner Books, 1986). 13. Mary Enig, “Letter to Dr. Mercola,” http://www.mercola.com (January 16, 2000). 14. S. Sadeghi, et al., “Dietary Lipids Modify the Cytokine Response to Bacterial Lipopolysaccharide in Mice,” Immunology 96, no. 3 (March 1999): 404–410. 15. Mary Enig, Indian Coconut Journal, September 1995. 16. Ian A. Pri or, et al., “Cholestero l, Coco nuts, and Diet on Pol ynesian Atolls: A Natural Experiment: The Pukapuka and Tokelau Island Studies,” merican Journal of Clinical Nutrit ion 34, no. 8 (August 1981): 1552– 1561. 17. Jor dan Rubin, “Extra Virgin Coconut Oil—the Go od Saturated Fat,” Total Health 25, no. 3 (June–July 2003): 30. 18. Mary G. Enig, “Coconut: In Suppor t of G oo d Health in the 21st Century,” http:// www.coconutoil.com/coconut_oil_21st_century.htm. 19. Mary G. Enig, Know Your Fats: The Complete Primer for Understanding the Nutri tion of Fats, Oils and Cholesterol (Bro okhaven, Penn.: Bethesda Press, 2000). 20. Kathleen DesMaisons, The Sugar Addict’s Total Recovery Program (New York: Ballantine, 2000). 21. Kathleen DesMaisons, Your Last Diet (New York: Ballantine, 2001).
22. Jennie Brand-Miller, et al., The New Glucose Revolution (New York: Marlowe, 2002). 23. Joseph Mercola, The No-Grain Diet (New York: Dutton, 2003). 24. John Hernandez, “Weight Loss Protocols,” lecture given at Boulderfest Nutrition Conference, Boulder, Colo., 2000. 25. Gerben B. Keijzers , et al., “Caffeine Can Decrease Insulin Sensitivity in Humans,” Diabetes Care 25, no. 2 (February 2002): 364–369; M. Sachs, et al., “Effect Caffeine on Various Metaboli Vivo,”181– Zeitschrift fürofErnahrungswissenschaft 23, no.c3Parameters (SeptemberIn1984): 205. 26. Terry E. Graham, et al., “Caffeine Ingestion Elevates Plasma Insulin Response in Humans During an Oral Glucose Tolerance Test,” Canadian Journal of Physiology and Pharmacology 79, no. 7 (July 2001): 559–565. 27. S. P. Tofovic, et al., “Renal and Metabolic Effects of Caffeine in Obese ( fa/fa(cp)) , Diabetic, Hypertensive ZSF1 Rat s,” Renal Failure 23, no. 2 (March 2001): 159–173. 28. Koutar ou Muro yama, et al., “Anti-Obesity Effects of a Mixture of Thiami n, Argi nine, Caffeine and C itri c Acid in Non-Insulin Dependent Diabetic KK Mice,” Journal of Nutrit ional Science and Vitaminology 49, no. 1 (Februar y 2003): 56–63. 29. A. Pizzio l, et al., “Effects of Caffeine o n Gluco se Toler ance: A Placebo-Contr olled Study,” European Journal of Clinical Nutrition 52, no. 11 (November 1998): 846–849. 30. Rob M. van Dam and Edith J. M. Feskens, “Coffee Consumption and Risk of Type 2 Diabetes Mellitus,” Lancet 360 (November 9, 2002): 1477– 1478. 31. L. Tollefson and R. J. Barnard, “An Analysis of FDA Passive Surveillance Reports of Seizures Associated with Consumption of Aspartame,” Journal of the American Dietetic Association 92, no. 5 (May 1992): 598–601. 32. Russell L. Blaylock, Excitotoxins: The Taste That Kills (Albuquerque, N.M.: Health Press, 1996). 33. David Vor eacos, “Exper ts Tell Panel o f Continued Concer n over Use of Aspartame,” Los Angeles Times, November 4, 1987, p. 19. 34. Kathleen DesMaisons, The Sugar Addict’s Total Recovery Program (New York: Ballantine, 2000).
35. Sharon S. Elliott, et al., “Fructose, Weight Gain, and the Insulin Resistance Syndro me,” American Journal of Clinical Nutrition 76, no. 5 (November 2002): 911– 922. 36. M. Dirlewanger, et al., “Effects of Fructose on Hepatic Gluco se Metabolism in Humans,” American Journal of Physiology, Endocrinology and Metabolism 279, no. 4 (October 2000): E907–E911. 37. Elson Haas, The False Fat Diet (New York: Ballantine, 2000). 38. L. Hunger, H. Leung, “Pantothenic Acid as aMedical Weight-Reducing Agent: Fasting Without Weakness and Ketosis,” Hypotheses 44, no. 5 (May 1995): 403–405. 39. Alan Kekwick and Gaston L.S. Pawan, “Metabolic Study in Human Obesity with Isocaloric Diets High in Fat, Protein or Carbohydrate,” Metabolism 6, no. 5 (1957): 447–460.
Chapter 11: Tri ck s of the Trade: The Top 50+ Ti ps for Maki ng Low -Carb Work for You 1. C. D. Summerbell, et al., “Relationship Between Feeding Pattern and Body Mass Index in 220 Free-Living People in Four Age Groups,”
European Journal of Clinical Nutrition 50 (Aug ust 1996): 513–519; R. M. Ortega, et al., “Difference i n the Breakfast Habits of O verweig ht/Obese and Normal Weight Schoolchildren,” International Journal for Vitamin and Nutrition Research 68, no. 2 (1998): 125–132; R. M. Ortega, et al., “Associations between Obesity, Breakfast-Time Fo od Habits and Intake of Energy and Nutrients in a Group of Elderly Madrid Residents,” Journal of the American College of Nutri tion 15, no. 1 (Februar y 1996): 65–72. 2. F. Halberg, “Chronobiology and Nutrition,” Contemporary Nutrit ion 8, no. 9 (1983): 2 pages (unpaginated). 3. Donald K. Layman, et al., “A Reduced Ratio of Dietary Carbohydrate to Pro tein Impro ves Body Composition and B loo d Lipid Profiles dur ing Weight Loss in Adult Women,” Journal of Nutrition 133, no. 2 (February 2003): 411–417. 4. Donald K. Layman, et al., “Increased Dietar y Protein Modif ies Gluco se and Insulin Homeo stasis in Adult Women during Weight Loss,”
Journal of Nutrition 133, no. 2 (Febr uary 2003): 405–410. 5. Donald K. Layman, “The Role of Leucine in Weight Loss Diets and Glucose Homeosta sis,” Journal of Nutrition 133, no. 1 (January 2003): 261S–267S. 6. Joseph Mercola, The No-Grain Diet (New York: Dutton, 2003). 7. B. K. Hope, et al., “An Overview of the Salmonella enteritidis Risk Assessment for Shell Egg s and Egg Pro ducts,” Risk Analysis 22, no. 2 (April 2002): 203–218. 8. Joseph Merco la, “Raw Eggs fo r Your Health—Major Update,” http://articles.mercola.com/sites/articles/archive/2002/11/13/eggs-parttwo.aspx. 9. B. K. Hope, et al., “An Overview of the Salmonella enteritidis Risk Assessment for Shell Egg s and Egg Pro ducts,” Risk Analysis 22, no. 2 (April 2002): 203–218. 10. Larry A. Tucker and Maril yn Bagwell, “Televisio n Viewing and Obesity in Adult Females,” American Journal of Public Health 81 (1991): 908–911. 11. W. H. Dietz, Jr., and S. L. Gortmaker, “Do We Fatten Our Childr en at the Television Set?” Pediatrics 75, no. 5 (May 1985): 807–812. 12. Michael Murray, et al., Encyclopedia of Natural Medicine, 2nd ed. (Rocklin, Calif.: Prima Health, 1998): 681.
