Monday, January 27, 2014

Low carb, super low carb, ultra low carb, what does it all MEAN?

Ordinary words can seem so clear.  "Low carbohydrate" sounds precise, right?  But it really isn't. No standard definition can be found for "low carbohydrate diets."

The "Standard American Diet" (or SAD for short; the irony should not be lost on us) has somewhere around 250-350 grams of carbohydrate according to USDA recommendations, with the "bare minimum for women" being 130 gm. Remember that there are about 4 Kcal (kilocalories, also called a Calorie with capital C) per gram of carbohydrate, so that recommendation comes to 1000-1400 Calories per day from carbohydrates. From this article, 130 gm/day would be "low carb."

Take down your copy of The New Atkins for a New You.  In the initial, induction phase, the authors recommend 20 grams/day of carbohydrate.  20 grams is only 80 calories!  Now that's low carb!

Other people say 50 gm/day, 75 gm/day, etc.  All call their diets "low carbohydrate." 

It's all a bit confusing.  Let's look at a couple of physiologic facts to gain some perspective.

Our brains are real energy hogs. The three pounds of brain, 1-3% of our body weight, burns 400-600 Calories/day.  If our brains really burned only glucose, as legend says (like the legend I learned at Mr. Duke's Medical School) then we would need 100-150 gm of glucose/carbohydrate per day just to stay alive. How on earth can we live on only 20 grams of carbohydrate per day, like I've been doing many days for a year and a half?  (I'm going to cheat. The answer is, Ketone Bodies!  Our brains love them. When your body learns to burn fat instead of carbohydrate, your brain burns ketones like beta hydroxybutyrate.)

Another fact for perspective. A high-normal blood sugar is 100 mg/dl (milligrams per deciliter.)  That is 1000 mg, or 1 gm/ per liter of blood. Most of us walking around have about 5 liters of blood volume, and so our total circulating glucose at any point in time is about 5 grams. 5 grams. If that doubles, we have a toxic blood sugar of 200 mg/dl and are considred diabetic. And yet 5 grams of glucose is almost nothing at all. In fact it is just over two teaspoons of table sugar (which is half glucose and half fructose.)

Another confusing concept is "net carbohydrates" or net carbs. When you look on a label, you'll see total carbohydrate and fiber. Fiber is just another name for a complex chain of simple sugars that our bodies don't have enzymes to break down. Many in the low carb world think you should count "net carbs" instead of total carbs. For example, a cup of broccoli contains about 4 "net carbs" plus 2 grams of "fiber" for a total carb count of 6 gm.

As you read about low carbohydrate diets, remember to ask the question about just how much carbohydrate is really in the diet? Also keep in mind your diet needs--if you are a 5'7 buff 59 year old 155 pound powerhouse of ripped muscle like me, you might need 2500 calories a day to stay huge while a little slip of someone with a totally sedentary job might only need 1600 Cal/day.

Maybe next time we'll take on an even more emotional topic: What is a low fat, moderate fat, or high fat diet???

Saturday, January 25, 2014

What other than weight loss has eating low carb done for people?

Here is a post from a forum I sometimes haunt. There is a surprising list of health and life improvements that people report.

A big surprise for me was that I stopped snoring within a few weeks of going low carb. PaleoPathologistMate was incredibly delighted with this and when the Mate is happy (and ahem rested,) so am I.  My reflux disease stopped being a problem fairly quickly as well. (It returns if I eat too many carbs or have wine with dinner. Kind of a bummer but for me the benefits of no GERD are huge.) I also got my first case of sinusitis in a long time this year after a week in smoke, dust, wind, heat, humidity in Managua, Nicaragua; first real sickness in a good while, seems like my sinuses are a lot healthier. And last spring was supposed to be a heavy pollen load, and my usual hay fever actually seemed better controlled.

I know of people who claim that depression has decreased, digestive problems improved, skin healthier, increased perceived energy level, and many other things. One young woman told me she is completely off antidepressants and no longer has terrible irritable bowel symptoms.

Don't know what to do with all this as yet; as a doc I'm FULLY aware of the power of the placebo effect and suggestion. I also know the word "anecdotal."

On the other hand...if it IS all anecdotal and placebo...and I feel better...who really cares? These are good hypotheses for someone to test (if they can overcome their biases, and the funding organizations' biases--see previous post.)

Cholesterol, courage, and normal human biases.

Chris Masterjohn, Phd is an interesting young man. I heard him on one of Jimmy Moore's interviews. He has a sharp mind, enthusiasm, and seems willing to listen to all sides. He has an informative website that I'm just starting to get into.  Warning: your preconceptions about cholesterol are very likely wrong. It is an essential molecule, present in every cell membrane in your body, the raw material for many hormones. It is NOT an intrinsically toxic evil substance created by Satan to tempt you to evil delicious tasting foods and then kill you before your time with crushing chest pain.

One of the most important myths Dr. Masterjohn discussed was that people seem to take on faith that industry (food and drug, for example) are terminally biased whereas universities and government are not. 

Bull. What an unbelievably faith based thought this is!

Government subsidizes the corn and soybean industries; therefore they are biased. Government is interested in increasing their control over each of us (if you don't believe this you really are naive.) That's why people put up with all the garbage they have to put up with to get elected! The desire to tell us all what to do for our own good is behind the "food pyramid" which very likely fed the obesity epidemic worldwide and has caused enormous harm.

Governments are also incredibly risk averse in many ways. Our own FDA has been known to delay approval of new drugs and allow Europeans to risk their lives first. Sounded OK to me, until I realized that thousands of Americans won't get needed treatment for several extra years because some FDA dude doesn't want to get blamed for the next Thalidomide. My father's life was turned around thirty years ago by a drug available in Europe and Canada but held up here; he could easily have died.

Universities increasingly get big dollars from patents from their research and have big donors to satisfy. They are biased. Universities and government funding have done a lot of good, but they also tend to fossilize "conventional wisdom" and, again, risk aversion leads them to not fund things that are "too radical." They want a safe payoff for their investments.  Part of the incredibly sordid and contaminated "global warming" tale has to do with biased grants.  I'm not claiming any expertise in climate science, but having been, years ago, part of a medical research team, anyone who wants to get a grant learns the buzz phrases you must insert into your applications.

In truth we all are biased; I am too (read the above.)  Some biases I know about firsthand include beneficence bias (the desire to do good overwhelms my objectivity) and confirmation bias (I give extra weight to things that confirm my previous opinions.)  Maybe I'll look into biases in an upcoming post!  Could be interesting.  (Wikipedia has a short list of various biases here, a place to start.)

A good place to start with ourselves is, what are my biases?  (NOT "do I have any biases?".  I promise you that you do.)  What are my biases and how do they hamper my life?

Tuesday, January 21, 2014

What? Calcium supplements might do more harm than good?

Just came across this from Chris Kresser. Seems that several recent studies have punctured the myth that taking supplemental calcium is good for you!  What's next?  How am I going to break this to PaleoPathologistMate?

Actually as a kidney stone sufferer (and suffer is the correct word for kidney stones) this intrigues me. Supplements have their place and I take some, but more and more studies which perhaps I can look into later seem to show that supplementing with pure chemicals just doesn't work as well as eating foods that contain the same chemicals.

Scientific humility is called for here. We assume that our scientific approach can figure out exactly what chemicals are doing good for us (trace elements, vitamins, antioxidants) and if we just pop those we're good and can live on McDonalds plus pills! 

But nature is ALWAYS a step more complex.  Always. And then when you figure out the next step, she surprises you again with yet another level of complexity. There are probably, who knows, dozens? hundreds? more chemical compounds in plants, meats, that we need to thrive. 

I'm going to continue taking my vitamin D, glucosamine until I get my bone broth factory going at home, vitamin K2 and some others, but in the past year plus I've really increased my vegetables, colored foods, organ meats, etc.  (I would wager that very few pathologists or other docs eat liver!)

Another tribe to add to the list of lowcarbers

So last week was spent doing pap smears on a desperately poor population of women, Nicaraguan prostitutes. There is a faith-based Christian outreach down there and we go twice a year for a week long trip. It's incredibly rewarding.

My roommate, Richard, and I got to talking. We're about the same age and he was bemoaning how he just can't lose weight despite having hired a personal trainer. The PaleoPathologist began evangelizing Richard on the virtues of low carb for losing weight. He was fascinated and said he would be ordering the Atkins book when we got back to the states.

He then began talking about the two years he spent among the Gabbra of northern Kenya. He mentioned that they were desperately poor nomadic pastoral people who packed up their tents a few times a year and moved their herds. To imagine where they live, Americans should just think of the "lush" desert terrain of southern Arizona!

As I told him about the Inuit and their almost total lack of plant foods, he exclaimed that the Gabbra seemed to live off milk from Camels and Goats, with the occasional bit of meat from a worn out goat or camel. (He loved the camel's milk, said it was incredibly delicious.) He said he never saw them eat ANY plant food at all, and they were tall, strong, good looking, healthy happy people. In fact he said if you made it out of childhood (tough in any primitive setting) the people had good long lives.

In fact, the only plant food they get is wheat and sugar they trade for, unfortunately.

Tuesday, January 7, 2014

Forgiveness and reconciliation will be needed

We who have been thinking about the health benefits of Low Carb have, understandably, been acting a bit like a guerilla force with language like "we have to attack the (fill in the blank; drug companies, organized medicine, Food Pyramid or Myplate, etc.). We tend to make disparaging comments about our physicians and how they are stuck in the past, don't read the medical literature, etc. (We also attack each other for not sticking precisely to whichever Paleo church we belong to: safe starches vs low carb, dairy vs no dairy, sprinting vs high intensity weight lifting, etc.  That is for another day!)

Yes, I'm a physician and former scientist but also am a believing Christian and something shocking came to me over the weekend.  Have you ever thought what an emotional bombshell it will be for my colleagues to change their minds to Low Carb/Paleo? How much forgiveness will it take?

For years or decades, we (I include myself) have been dispensing bad advice. Yes, our intentions were good (well, mostly good; see this post) but we all know which road is paved with good intentions, right?  Good intentions and five bucks will get you a Venti at Starbucks.

For me to accept that I've potentially harmed, or maybe even killed, many patients in my past would be an incredibly bitter pill to swallow. This is not a purely intellectual problem; the emotional resistance to letting this in could be quite striking for many people.

Even worse may be the policy makers, who have affected FAR more people than any individual physician. Congress rushed to judgement. The population became sick and fat. Diabetes is now estimated at causing nearly a quarter of a million deaths annually, just in the US. Over forty years, that might be 10 million deaths. That does not count the excess deaths from metabolic syndrome sufferers who don't quite become diabetics. For comparison, the CDC estimates 440,000 smoking related deaths annually.

A case could be made that the misguided high carbohydrate low fat uncontrolled experiment inflicted on us by well meaning but badly educated leadership killed as many of us as cigarettes, as many as Adolf Hitler executed.

A message of forgiveness and reconciliation will HAVE to be part of our communications. The emotional barrier may well be stronger than the intellectual barrier to bringing rational diet back to the human race.