Protein and the Low Carb Dieter

By , March 31, 2011

Even the American Diabetes Association has seen that, to use the stilted language of one study:

… a joint committee of the American Diabetes Association, North American Society for the Study of Obesity and the American Society for Clinical Nutrition suggested that a low-carbohydrate diet may be preferred to a low-fat diet for the induction of weight loss and glycaemic control in subjects with type 2 diabetes.

That study, published in the Diabetes/Metabolism Research and Reviews journal in March, 2011, represents a bit of a turn-around for the ADA, which has long suggested a medium carb diet for type 2 diabetics.

How Much Protein?

There are concerns expressed, mostly by friends, that too much protein will cause kidney stones, impair liver function, contribute to bone loss, and cause other problems.

Historically, the recommended amount of protein has been expressed using a grams per kilogram ratio, with .66 to .8 grams of protein per kilogram of lean body mass total body weight. A man weighing 200 pounds weighs 91 kilograms, so the total protein recommended would fall into the 60 to 73 gram range. For a woman at 140 pounds (63 kg), the range is 42 to 50 grams. But it’s common to read recommendations on low carb forums that up to 150% of those levels is fine.

When I weighed 250 pounds, my minimum protein requirement according to The Protein Power Lifeplan was 120 grams per day, or about 1.1 grams per kilogram of weight. That’s a bit more than the .8 grams per kilogram recommendation. At .66 grams, the recommended protein level would be 75 grams. Expressed in terms of caloric content, 120 grams of protein represents 480 calories, or about 19% of a 2,500 calorie diet. (Note, the paragraph above was edited on April 3, 2011 to correct the numbers given in the Protein Power Lifeplan).

Dissenting Views

The Perfect Health Diet Blog advocates limiting protein to about 10% 15% of total caloric intake, a number very close to the .66 grams of protein per kilogram of weight. That blog post also has important information regarding protein maximums for pregnant women and children … a warning to those with “paleo babies” who, evidently, want to duplicate the insanity of vegan couples who starve their babies with inadequate diets, a problem that a Google search indicates happens every few years. (Babies are not just “little people”; they have unique nutritional needs. Nature itself provides a low 7% protein diet in breast milk).

Real Protein Requirements?

But, for non-pregnant, adult women and men, are the protein levels satisfactory? There is some evidence that we may have been wrong all along with the .66 to .8 gram of protein per kilogram of weight calculation.

In January, 2010, a study examined the method of determining the protein requirements of adults, and concluded that the proper amount of protein may be .93 to 1.2 grams per kilogram of body weight. Our 200 pound man is now expected to eat up to 109 grams of protein (17% of the caloric intake on a 2,500 calorie diet).

Problems with Protein?

But is that too much? What about our friend’s concern that our kidneys will produce stones, our livers will cease to function, and our bones will leech calcium and become brittle? A study published in December, 2010, in the Nutrition Journal concluded:

… protein-enriched meals replacements as compared to standard meal replacements recommended for weight management do not have adverse effects on routine measures of liver function, renal function or bone density at one year.

In this study, the subjects on the high protein diet consumed 2.2 grams per kilogram of LBM, more than twice the amount recommended on most low carb diet plans. It looks like the low carb forum participants may have been right all along; you can safely go 150% of the minimum protein requirements without too much concern.

But, there are caveats

These studies look at healthy, adult men and women, free of liver, kidney or other disease. Anyone with any chronic condition, or on any medication, should check with their doctor before adopting any diet.

And remember, children and pregnant or nursing women are unique and the same rules simply don’t apply.

Conquer Diabetes and Prediabetes

By , March 17, 2011

Dr. Steve Parker is a leading expert on the Mediterranean diet. With two decades experience treating patients with diabetes, pre-diabetes and metabolic syndrome, Dr. Parker has developed a modified version of the Mediterranean diet. His new book Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet provides a comprehensive overview of the diet.

Dr. Parker is no stranger to the low carb lifestyle, and has seen dramatic health improvement from it in some of his patients. His low-carb Mediterranean diet is an attempt to marry the heart-healthy benefits of the traditional Mediterranean diet, with its emphasis on natural foods, omega-3 rich olive oil and plenty of complex carbs, with the superior blood sugar control and weight loss of a low carbohydrate lifestyle.

How can these two diets, seemingly incompatible, come together without compromising both? I was concerned that Dr. Parker might give a pass to “complex carbs” in the same way the American Diabetic Association does. But he doesn’t mince any words about carbohydrates:

We’ve done an atrocious job for type 2 diabetics and prediabetics.

We’ve recommended they eat precisely what their bodies can’t handle: carbohydrates. We’ve urged them to take poison: carbohydrates. We’ve cooperated with the drug companies to encourage diabetics to eat foods that increase drug company profits: carbohydrates.

Dr. Parker relates that how, over the past 10 years, the medical literature and his clinical experience has led to a change in his thinking, and better treatment of his patients.

The book is a medium format, 5.5″ x 9″, quality paperback with 216 pages. It is economically priced at $16.95. The last 26 pages are devoted to a list of print and on-line resources, an annotated bibliography complete with URLs to medical journal articles, and a five page index.



Dr. Parker’s low-carb Mediterranean diet follows a familiar pattern: a very low carb starting phase called the Ketogenic Mediterranean Diet (KMD), and a maintenance phase dubbed the Low-Carb Mediterranean Diet (LCMD). He includes a week of meals suitable for the KMD, with a list of additional foods that can be added, slowly, once weight loss and blood sugar levels are in control.

What is different about Dr. Parker’s book? He includes a robust list of drugs and possible interactions during the ketogenic phase of the diet. Other specific recommendations for diabetics, such as the chapter devoted to the dangers of hypoglycemia, are a must read for someone looking to control blood sugar via diet. And I found the book eminently readable. Dr. Parker writes in a conversational style, explaining terms in a way that does not come across as condescending.

His chapter on “Daily Life with Low-Carb Eating” addresses several issues, including “cheating”. What do you do when presented with that Cinnabon you can’t resist? His answer is surprising, but workable. If you must indulge, compensate by replacing a meal with the treat, adding extra exercise or medication, or reverting to the KMD diet for a few days after. While purists will insist they never cheat, I did exactly this on a recent European cruise, and came back weighing less than when we set sail. (As Dr. Parker points out, you have to know your limits; just as a reformed alcoholic never tastes alcohol again, some “carbohydrate addicts” can’t afford to cheat.)

Dr. Parker’s easy approach to developing a reasonable exercise program might get me started in that direction. (Niacin, taken to help lower my triglyceride levels, also increases insulin resistance, and the antidote for that is exercise.) I loathe exercise, but Dr. Parker’s no-nonsense approach to the subject may get me walking in the evenings.

I found another personal benefit. While not diabetic, I do struggle with blood sugar control, and have been diagnosed with metabolic syndrome (now abated with low carb living). We often get stuck in our choice of foods, and simply removing carbs from our standard diet can get boring. Dr. Parker notes that the popularity of the standard Mediterranean diet includes the benefit of both taste and variety. Adopting a low carb Mediterranean diet approach could introduce some variety to what has become a routine diet. And as my wife tells me, variety in everything in life, except partners, is a good thing.

Disclaimer: Dr. Parker provided a complimentary review copy of the book, but did not attach any editorial restrictions to the review. Low Carb Daily is also listed as an on-line resource in the Resources section of the book.

Metabolic Advantage

By , March 3, 2011

The concept of a metabolic advantage with low carb diets is hotly debated. A quick MegaSearch shows hundreds of articles and blog posts, including some spirited debates. So what is this so-called metabolic advantage?

Dr. Michael Eades explains it this way:

When two groups of subjects both eat the same number of calories (but provided by diets of different macronutrient compositions) and maintain the same activity level, yet one group loses more weight than the other, the group losing the greater weight is said to have a metabolic advantage. Or, more specifically, the diet driving the weight loss is said to provide a metabolic advantage.

The debates among doctors, researchers and advocates sometimes gets heated. I won’t post a link to the profane and, in my opinion, irrational posts by Dr. Eades’ opponent in that particular debate, but Dr. Eades includes it in his blog post.

The literature does show an apparent metabolic advantage in studies. Just this week (March 2, 2011) the American Journal of Clinical Nutrition published a new study, Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction:

The aim of this study was to determine the effectiveness of 2 wk of dietary carbohydrate and calorie restriction at reducing hepatic triglycerides in subjects with NAFLD [Non-Alcoholic Fatty Liver Disease].

NAFLD, or “Non-Alcoholic Fatty Liver Disease” is a condition where the liver “gets fat”, resulting in reduced liver function. It is growing at an alarming rate, with some pointing towards increased fructose consumption as a likely cause (fructose is metabolized by the liver).

Like other studies, this one notes a “metabolic advantage” with a low carb diet:

Two weeks of dietary intervention (≈4.3% weight loss) reduced hepatic triglycerides by ≈42% in subjects with NAFLD; however, reductions were significantly greater with dietary carbohydrate restriction than with calorie restriction. This may have been due, in part, to enhanced hepatic and whole-body oxidation.

The phrase “significantly greater with dietary carbohydrate restriction than with calorie restriction” is the evidence the researchers note as a “metabolic advantage.”

The hotly contested debate will continue, of course, but as evidence mounts that lower carb diets result in greater weight loss and less hunger than calorie reduced calorie diets, can the debate sustain itself for very long?

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