News! Page Added

Low Carb Age has added a news aggregator to the site!

Our News! aggregator combs the internet looking for new blog posts, information and news about the low carb way of eating. Entries from paleo, primal, and low carb blogs appear daily, with small excerpts of the actual articles. Each link leads back to the original author’s site.

Low Carb Age News! is a great way to see what’s new today, and click through for those articles that interest you.

New MegaSearch Feature

Low Carb Age has partnered with Google to provide a customized search engine, the Low Carb Age MegaSearch. Internet searches usually provide results from the entire Internet, including all the sites run by promoters, hucksters and even those low fat advocates. But here’s an example of search results for “Fish Oil” in our MegaSearch page:

Targeted results mean less time weeding out the inappropriate links, and finding the information from the sources you trust. Our MegaSearch engine provides results from selected low carb sites, including:

About Low Carb Diets
At Darwin’s Table
Body by Science
Dr. Briffa
Dr. James Carlson’s Blog
Carb Wars
Diabetes Update
Fathead
Heart Scan Blog
Hold the Toast
Livin’ La Vida Low Carb
Low Carb Age
Low Carb Confidential
Low Carb Doctors
Low Carb Links
Low Carb For You
Mark’s Daily Apple
Modern Paleo
PaNu
Protein Power

Have a favorite low carb web site you want included? Let us know in the comments!

Diets are Hard

Diets are hard. That is, going on a restricted calorie diet is hard, and not only because it takes a lot of willpower. From CNN Health:

Last year, Karen Daniel was feeling great about her weight. She had gone from 375 pounds to 200 in 24 months.

She was working out nine times a week and thrilled to have turned her life around. She no longer had to purchase two seats on an airplane. She went hot-air ballooning for the first time.

Daniel, one of Fit Nation’s first success stories, said in February 2009, “Fit feels so good.”

That feeling didn’t last long.

Daniel started feeling bad after a trip to New York. She had a sinus infection, upper respiratory infection and bronchitis, she said recently from her home in Arizona. She started feeling better, but then got sick again. And healthy again. And sick again.

She went to two doctors who told her that her body was in “starvation mode,” she said.

“I went way under on calories, and I got really sick,” she said. “I went to under 1,000 calories a day, and I was working out between two and three hours a day. It was not a smart decision.”

She felt like she was eating right, but she was gaining weight.

Ms. Daniel’s experience is not unique, and her tale rings familiar for many of us.

“Starvation mode” is a real phenomenon, although there are many myths surrounding it. Your doctor is probably clear on the issue: as the human body enters into starvation mode, it reacts by slowing metabolism, using up fat stores, then consuming muscle and other valuable tissue. Health effects from starvation mode include vital organ damage and increased infections as Ms Daniel experienced.

I have been critical of the “calories in / calories out” weight loss plans, mainly because counting calories is horrible proxy for determining how we metabolize food. But that doesn’t mean that we can’t use calories to measure the total amount of food a person consumes; we could also use the physical weight of food, the volume it occupies before being chewed, etc. The value of the calorie is that it has been standardized and everyone knows what it means. And we have an idea of how many calories we need to consume, on average, to maintain weight.

It is generally accepted that if you consume less than 50% of that maintenance level your body will enter starvation mode. If you require 2,000 calories a day, and you consume 1,000, you will, most likely, go into starvation mode.

Those that advocate very low calorie diets (VLCD) will explain part of this away. Studies show that even on lower-than-50% diets, the metabolic rate doesn’t slow to zero; it can slow up to 40%, as shown in the famous Ancel Keys study (where he “imprisoned” men and “starved them” in an experiment that would never pass muster with any medical ethics board today). So you will still lose weight, but at a slower pace. And, there is some evidence that you don’t start to seriously consume your muscle and organs until you fall under 5% body fat.

The problem, the advocates say, is that very low calorie diets work great, but people are bad. Its a little like making square tires for a car: they may be the highest quality rubber, with the best overall quality, but your car won’t go very far on them. Weight Watchers, in denying that starvation mode exists, says: “Over-restriction of calorie intake, known as high dietary restraint is linked to periods of overeating, hindering successful weight loss.” Well, they should know.

Diet plans like Weight Watchers, and others bound to fail, usually aim for a “calorie deficit”, with a reduction of about 25% of your normal intake, with the goal of losing 1 pound a week. There is some slowing of your metabolism as the body reacts to the lower food intake (actually, during the first 48 hours, the metabolism actually speeds up, and then slows down), but it isn’t as severe as the slowing in full-on starvation mode.

This slowing of the metabolism is temporary; as soon as you start eating your “maintenance level” of calories, the normal basal metabolic rate is restored. If, like Ms. Daniel, you have lost about half your body weight, the amount of food needed to maintain your weight is somewhat less. But habits die hard, and resuming the same food intake when you are finished with the diet has trapped many a dieter.

The transitory nature of weight loss diets, the “suffer until I reach goal” mentality, argues against long term weight loss and health maintenance. The yo-yo dieter follows a familiar pattern: extreme effort to exercise more, eat less, and then, inevitably “falling off the wagon” and eating like they always have. Or binging for a short time, only to face guilt and resumption of the low calorie diet. It is a vicious cycle that endangers health.

“Falling off the wagon” is not a moral failure; it is a biological imperative. You are starving, so it is time to get up, chase down an animal, kill it and eat. Eat until you are sated, eat all you can, and make up for the past days of low calorie intake. That’s how we are built. In designing diets based around the idea of starving the fat off of you, the advocates of this approach are working against at least 200,000 years of human adaptation to diet (and more likely, millions of years of adaptation).

A better solution is to avoid weight loss diets, per se, and focus on a new paradigm. A permanent change to the way of eating that benefits you the most is in order. Carbohydrate restriction is the easiest way for many to change their food outlook; in either The Protein Power Lifeplan or the New Atkins for a New You plans, you count only the grams of carbohydrates (restricting them) and the grams of protein (making sure you get enough), and don’t worry too much about the overall calories in the diet. Most people lose weight without hunger on a low carb way of eating.

Some people find a mind-shift necessary to counter-act all the bad dietary advice over the last 50 years. While both Protein Power and the The New Atkins are founded solidly on the most recent science, it is hard to ignore the headlines from the latest observational study that links saturated fat to obesity or health issues. For them, adopting a paleo or primal diet provides the intellectual framework they need: we have evolved or adapted to eat certain foods, and modern processed foods (including wheat and bread) have only been around about 10,000 years.

Metabolic Syndrome and Cancer

Metabolic syndrome, the combination of risk factors that 1 in 5 Americans share, may be implicated in the development of cancer in the digestive system.

Known by several different names, such as syndrome X, insulin resistance syndrome, Reaven’s syndrome, and even CHAOS in Australia, metabolic syndrome (MetS) is usually diagnosed if the patient has three or more of the following: obesity (measured by BMI greater than 29 or a waist to hip ratio), triglyceride levels above 150 mg/dL, HDL cholesterol below 40 mg/dL, high blood pressure (diastolic greater than 130), and fasting blood sugar over 100. Other factors, such as insulin resistance, may be used to determine the diagnosis.

The Cooper Clinic in Dallas, TX provided 33,230 men for the study on digestive system cancers. The men were followed for over 14 years. Adjustments were made for cardiorespiratory fitness to remove a common difference between the physically fit and those with MetS. The study concluded that having MetS did correlate strongly with cancer of the digestive system. In particular, two of the common MetS factors, obesity and high blood sugar, were associated with cancer:

Our results support the hypothesis that metabolic syndrome is positively associated with mortality from cancers of the digestive system. Interventions that reduce abnormalities associated with the syndrome could reduce risk of premature death from these cancers.

Treatment for MetS is varied; many doctors try a reduced calorie, low fat diet to reduce one or more of the risk factors (usually, weight and blood pressure). A high failure rate is seen, usually attributed to “lack of compliance” by the participants. Drugs for blood pressure control, cholesterol, and triglycerides are often used. In my case, those attempts failed to achieve a good result. But a low carbohydrate diet combined with niacin (to help reduce triglyceride levels which did not respond to diet alone) removed all of the risk factors.

Low carbohydrate diets seem to work better for most people. Many, myself included, are not inclined to cheat on the diet because they never feel hunger. One study in the journal Nutrition & Metabolism noted:

Carbohydrate (CHO) restriction is one of several strategies for reducing body mass but even in the absence of weight loss or in comparison with low fat alternatives, CHO restriction is effective at ameliorating high fasting glucose and insulin, high plasma triglycerides (TAG), low HDL and high blood pressure.

The Glycemic Index Fraud

People are often alarmed at my low carb diet, predicting all sorts of dire consequences for my future health. Often, the well meaning recommendations come in the form of platitudes like “eat a balanced diet”, yet the people can rarely tell me what that means. Would a balanced diet be one exactly equal in the percentage of calories from the three macronutrients? If so, that would be a relatively low carb diet, with about half the carbohydrates the low fat devotees recommend. Usually people use this term interchangeably with “normal diet”, another meaningless term.

But the more informed about nutrition will prescribe specific foods they think are appropriate. The new favorite is to recommend “low glycemic index” foods. The idea is that you need carbohydrates so you eat the good ones, not the bad ones. And that might work for some people, even though you don’t really “need” carbohydrates.

People consuming the standard American diet of 400 or so grams of carbohydrates might benefit from thinking about the type of carbs they are consuming. But it isn’t an appropriate substitute for reducing total carbohydrates. Especially for someone overweight, with metabolic syndrome, high triglycerides or blood sugar issues.

The reason is the very nature of how the glycemic index is created. As Dr. Eades explains:

Young, healthy subjects consume a test dose of glucose (or sometimes 50 grams of carb from white bread, which is also a common standard) and have their blood sugar curves measured. They then come in on subsequent days and consume the test foods (the potato, beans, tomatoes, whatever) and have their blood sugar checked over the next two hours to create the blood sugar curves driven by the carbs in these foods. These curves are compared to the pure glucose curves and a glycemic index is created.

I am no longer a “young healthy subject”, so the glycemic index isn’t appropriate for me. Not only that, but even if you are a “young healthy subject” (or think you are), it might not apply to you either. The index itself is an average of hundreds of people, and in every study and trial you always have “outliers”, those who fall out of the average range of responses. Humans are complex beings, and we react differently to foods. Starches like potato might send your blood sugar into the stratosphere, as could be expected, but so might oatmeal. Diabetics, who test their blood sugar regularly, can tell you the foods that trigger an increase in blood sugar in them, but may not in others.

A study published in the American Journal of Clinical Nutrition noted that the glycemic index was not useful in improving the markers for metabolic syndrome. The following is a slightly edited conclusion from the report (the original is at the link, and includes the exact lab values of each marker mentioned in the quote):

At the end of the 11-wk intervention periods, the decreased GL test foods did not change fasting plasma glucose … or insulin concentrations compared with increased GL test foods. Serum total cholesterol, LDL-cholesterol, HDL-cholesterol, and triacylglycerol concentrations were also not significantly different for decreased and increased GL test foods, respectively. Finally, proinflammatory (high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-{alpha}, monocyte chemoattractant protein 1) and prothrombotic (plasminogen activator inhibitor 1) markers were not affected. Glucose and lipids were also analyzed after 1 and 5 wk of intervention and were not affected by the intervention.

What does work to reduce these markers? Total carbohydrate restriction:

The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS [metabolic syndrome] and cardiovascular risk.

The glycemic index may have its uses, but it is no substitute for carbohydrate reduction in those trying to improve weight, metabolic syndrome or blood sugar issues.

Site News: Feedburner

We’ve added Feedburner to publish our posts here at Low Carb Age. It should work “out of the box” and be “transparent” (and “one size fits all” isn’t a lie either). If you have any problems with the feeds, please let me know!

Protein Intake: Special Cases

In our Protein Requirements article we looked at the minimum protein requirement as stated in Protein Power Lifeplan and how that compared to new research in the optimum daily protein values. But there are “special cases” that should be remembered: children, pregnant women, and those with other health issues. Remember, general rules of thumb cannot take the place of your family doctor.

Do the minimum protein values in low carb diets put women and children at risk?

The Perfect Health Diet blog commented on this recently. They are a bit different from other low carb, paleo advocates:

At PerfectHealthDiet.com we’re advocates of protein restriction. We recommend:

  • Avoiding all protein-containing plants, as plant proteins tend to be toxic
  • Striving to eat fatty, not lean, meats and fish, in order to keep protein intake down and fat intake up

Protein restriction helps protect against viral and bacterial infections by promoting autophagy, the process of intracellular protein scavenging, digestion, and recycling. During autophagy, bacteria and viruses, as well as junk human proteins and damaged organelles, are digested. Autophagy has been strongly linked to longevity and is protective against many diseases.

Our advocacy of low protein intake separates us from many other Paleo bloggers.

Of special concern is a protein-rich diet for infants and children; Perfect Health Diet points out that breast milk contains just 7% of its calories in protein, showing, in their view, that we evolved for lower protein intake as infants and children (they also cite other research showing problems with protein levels that would be appropriate for adults, but harmful for children). Pregnant women should also be careful of eating too much protein. Perfect Health Diet quotes Dr. Loren Cordain:

[Y]ou probably should increase your fat and carbohydrate consumption, and limit protein to about 20-25% of energy, as higher protein intakes than this may prove to be deleterious to mother and fetus for a variety of physiological reasons….

“Protein intakes above this [25% of total calories] threshold may affect pregnancy outcome through decreased mass at birth and increased perinatal morbidity and mortality.”

The physiological basis for this aversion stems from a reduced rate of urea synthesis during pregnancy that is evident in early gestation as well as increases in the stress hormone cortisol. Hence, pregnant women should include more carbohydrate and fat (i.e. fattier meats) in their diets and limit dietary protein to no more than 20-25% of their total caloric intake.

Perfect Health Diet recommends an even lower level of protein for pregnant women, to just 10% of their total calorie intake.

So how do you calculate the protein allowance as part of your total caloric intake? To simplify things, remember that each gram of protein has 4 calories. In this example, we’re using a woman who maintains her weight on a 2,000 calorie diet when not pregnant; most authorities say she should add an additional 300 calories during her baby’s gestation.

For a woman eating 2,300 calories a day, 20% of calories is 460, or 115 grams of protein (460 calories divided by 4 calories per gram equals 115 grams of protein). For the lower level, 10% of calories is 230 or about 58 grams of protein.

So how does the low carb Protein Power diet match up in this case?

First, remember the warnings about starting any new diet during pregnancy; they are in every low carb book I have seen. You simply should not begin any diet that isn’t approved by your physician during pregnancy. (Even if not pregnant, you should always talk to your physician prior to starting any diet, just to make sure you don’t have a condition that could be aggravated by the new diet.)

But again, we find that Protein Power is not a “high protein” diet plan. The recommendations on low carb diets for non-pregnant adults fall within the ranges cited above. For a 5′ 8″ non-pregnant woman weighing 140 pounds, the Protein Power Lifeplan chart recommends 27 grams of protein per meal, for a total of 81 grams. That represents 324 calories out of the daily total, or about 16% of the total for a 2,000 calorie intake.

I am not convinced Perfect Health Diet is right about reducing protein levels below these levels, especially for healthy adults. Satiety, the feeling of satisfaction or of being satisfied after eating, is said by many low carb advocates to come from getting a good proportion of your calories from fat. But research also shows that primates will increase their food intake to obtain more protein if only low protein foods are available. If hunger is a problem, you will cheat on your diet and consume more food than you should. Adequate protein intake may help provide a measure of satiety as well.

Eat Less, Move if You Like

We have heard the admonitions to “Move More, Eat Less” from fitness gurus and other scoundrels. The implication is that if you are fat, it is your fault. “Get up off the couch, you lazy bastard.”

The problem with “Move More, Eat Less”: it is a lie.

It seems logical though, doesn’t it? After all, you rarely see fat marathon runners. But, as Gary Taubes has noted, you also rarely see short NBA players. And no one thinks playing basketball makes you taller.

What does science say? You might be surprised.

Dr. Briffa recounts a conversation after a lecture:

Over lunch, after my presentation, I was talking to the one of delegates who expressed doubt about my ‘opinion’ that aerobic exercise does not generally promote weight loss. On what basis? He told me that there are no overweight elite marathon runners. So, marathon running must lead to weight loss.

So commonly and strenuously have we had the idea that aerobic exercise drummed into our psyches, that perhaps it’s no surprise that this man held this opinion. However, the thinking here is obviously limited, and in more than one way.

[…]

In other words, I was asking him to consider that people don’t get thin because they are marathon runners, but are marathon runners because, at least in part, they are thin.

(Also, I did point out that my view on exercise and body weight is not really an ‘opinion’ – it’s actually based on quite overwhelming evidence in the scientific literature.)

This is not a new revelation. Exercise can bestow many benefits on the individual, including better overall health. It just won’t lead to weight loss. Science has known this for a long time.

Dr. Briffa points to a recent study looking at activity levels and obesity in children. If the study just looked at fat kids, and measured their activity level, it would show that they tend to be more sedate than their skinny counterparts. You would think that validates the belief that the active kids burn off more calories and are therefore thin. But this study is different; it looked at activity levels as the kids became obese.

The study followed 202 seven year olds in Plymouth, England for three years. They were drawn from 40 different schools, and 53% were boys. It was a good mix of children. There was no “intervention” in this study. They didn’t counsel them on nutrition, exercise, or anything else. Over the course of the study they measured their height and weight, and had them wear special activity meters for seven day periods.

Some segment of the population will gain weight over any three year period. Some of these kids did just that. And it is with these kids that the interesting facts come out. Comparing the physical activity to weight found there was no correlation between physical activity and weight gain. The kids who gained weight did not reduce their physical activity first. But there was something else found. After the kids gained weight, physical activity decreased.

That’s right: active kids got fat and then got less active. They didn’t get fat because they were less active.

As the study puts it:

Physical inactivity appears to be the result of fatness rather than its cause. This reverse causality may explain why attempts to tackle childhood obesity by promoting [physcial activity] have been largely unsuccessful.

For most people, especially obese people, exercise stimulates hunger. And what you eat is, in our opinion, more important than how much you eat. In a typical western person’s daily life, an increase in exercise often leads to increased food intake … and usually the worse food is used to “reward” the successful completion of good healthy exercise.

Part of the reason is simple math. So let’s say we decide to cycle for exercise. Instead of driving to Starbucks, we’ll ride our bicycle. And the Starbucks isn’t really that close! It will take us an hour to get there, as its over 4 miles away. We hop on our bicycle, and pedal four and a half miles to a Starbucks. We will expend approximately 260 calories. Great job!

We feel so good about ourselves, we order a Grande Caffe Mocha instead of our plain black coffee. It has 260 calories. Grab a muffin, a mint, or anything else, and if you accept the idea that calories matter, you are worse off than before.

What if we sat home and didn’t cycle? In that hour you would have expended 55 calories sitting on the couch knitting. Not exactly exercise, but if knitting keeps you from drinking that Grade Caffe Mocha, you are ahead of the game.

And that’s accepting the flawed idea of “calories in and calories out” used by so many of the same people that say “get off your fat arse and exercise”.

The truth is that we are more complex than machines. We don’t have gas tanks, and we don’t burn fuel. We digest food and metabolize it. In Loser, Biggest Loser we recounted Dr. Doug McGruff’s horror at seeing the TV show “The Biggest Loser” while on shift in his ER. The mistreatment of the contestants on the show, combined with the erroneous ideas promulgated by the sadistic “personal trainers”, is a prescription for failure.

Exercise conveys many benefits, but if you have to choose between adopting a better diet and exercise to lose weight, choose the diet. And the best diet we have found is the low carb diets, such as Protein Power, The New Atkins, or one of the other paleo diets now popular.