Mass Media Acceptance

The evidence that the Low Carb Age is upon us keeps amassing, albeit with the usual caveats to assuage guilt. As the authors of Mistakes Were Made (But Not by Me) tell us, people in positions of authority rarely admit they were wrong.

Nevertheless, the truth begins to squeak out. This week the NY Times’ Tara Parker-Pope’s Phys Ed column reports on a significant new study from Johns Hopkins to be published this Friday:

With the memory of Memorial Day cheeseburgers and bratwursts still lingering, many of us may be relieved to hear that a new study suggests that a meaty, high-fat, Atkins-style diet can do more than contribute to rapid weight loss. It may also be less unhealthy for the heart than many scientists had feared — provided you chase the sausage with a brisk walk.

So Close, Yet So Far

Parker-Pope makes the mistake of insisting exercise was proven to be part of the solution, but the study shows no such thing. It specifically compares a low fat to a “low carb” diet, both with the same amount of exercise. As The Behavioral Medicine Report explains:

Low-carb dieters showed no harmful vascular changes, but also on average dropped 10 pounds in 45 days, compared to an equal number of study participants randomly assigned to a low-fat diet. The low-fat group, whose diets consisted of no more than 30 percent from fat and 55 percent from carbs, took on average nearly a month longer, or 70 days, to lose the same amount of weight.

Both groups had an exercise component. In the absence of a correlating study showing that the same diets without exercise has a different outcome, Parker-Pope’s assertion is without any foundation. Pre-conceived notions are hard to shake.

How Low is Low

As we’ve seen in other studies, the term “low carb” used here is inexact. The low carbohydrate group consumed up to 30% of their calories from carbs. Considering this a low carb diet is a bit of a stretch. Most people adhering to a low carb diet to lose weight start with about 40 grams of carbohydrates per day, or 160 calories from carbs. For a healthy man consuming 2,500 calories per day, carbs during Induction on Atkins represent about 7% of calories. That same man on the test diet in this study would be consuming about 185 grams of carbs. That’s higher than many people on a low carb maintenance diet.

This study did reduce calorie content by about 700 calories over the baseline for each individual. Even for a 2,000 calorie diet, the “low carb” dieter is consuming 150 grams of carbs.

Why Calories Don’t Matter

This study provides yet another example why the “calories in / calories out” model is flawed, as the low carb group lost weight 30% faster than the low fat group. They both consumed 700 fewer calories per day than before, but the low carb group lost weight faster. If the body reacts to all food the same way, as a strict “calories in / calories out” model suggests, then both groups would have lost weight at the same rate. But in study after study, we find that the low carb group loses weight faster and with less hunger than the low fat group. What you eat matters as much as how much you eat.

The Original Purpose

The trial was designed to test the differences in vascular function for people on both diets, and both showed no change. It is the first study to actually test vascular function among a group of people. That is good news for people considering a low carb diet. As lead investigator exercise physiologist Kerry Stewart, Ed.D, says:

“Our study should help allay the concerns that many people who need to lose weight have about choosing a low-carb diet instead of a low-fat one, and provide re-assurance that both types of diet are effective at weight loss and that a low-carb approach does not seem to pose any immediate risk to vascular health,” says Stewart. “More people should be considering a low-carb diet as a good option,” he adds.

The study is due to be published Friday, June 3.

Never Too Late

Richard at Primal Fed has a thought provoking post on “When is it Too Late to Get Healthy”. At least it got me thinking not only of my journey, but also of attitudes toward diet and exercise from different perspectives.

Richard states he is a 26 year old male, and his personal bio on the site shows his amazing quick transformation simply living a primal lifestyle. His wife, Amanda, is a few years younger and also has an inspiring story.

Kids today …

In their cases, change was quick and satisfying. Like most who adopt a low carb / paleo lifestyle, they can’t imagine going back to their old ways. But coursing through their bodies are the hormones of youth, making weight loss easier and exercise more beneficial. That’s not to diminish the dramatic improvements they have made; its just a biological fact. For women generally, and especially after menopause, losing weight is much harder. Men over 50 have much the same problem. And for both sexes, middle age brings biological changes that make it harder to build muscle mass. There are individual exceptions, but in general, a 50 year old man is going to have a harder time than a 25 year old building muscle. Sorry folks, that’s just the way it is.

Richard mentions in his post that his grandmother stated it was “too late for her” 15 years ago, when she was 50 years old. Too late?

Is it Too Late?

If you are thinking about having a perfectly fat tummy, yeah, 50 is probably too late. If you are thinking about having defined abs, huge arms and massive muscles, yeah, 50 is probably too late. But if you are thinking about getting healthier, jettisoning all those pills for high blood pressure, GERD and cholesterol, then 50 is not too late. 60, 70 and even 80 years old are not too late.

Here’s the thing: body composition changes as we age. The alternative to this happening is to die young. So you won’t look like a 26 year old if you are 50. You might get close with a ton of work, effort, hair dye and plastic surgery. But you won’t really have the body of a healthy 26 year old.

The focus for the over-50 set should be getting healthier. Following a low carb or primal lifestyle will result in weight loss, but not to the same extent as a 26 year old. The goal should be to be healthier, and the key to that is to reduce processed carbohydrate rich foods, reduce triglycerides, fasting blood sugar, and yes, lose weight if in the obese category. But don’t lose too much weight.

The Myth of “Normal Weight”

As we’ve shown before, the charts and formulas used for “ideal weight” are wrong. Studies have shown that BMI, the formula used by most doctors, reveal that those in the overweight category are 17% less likely to die than people in the “normal” weight category. That’s right; the reason you see so many fat old people is that the skinny ones died already. It is better, statistically, to be in the overweight category when using BMI than in the “normal” weight category.

Two years ago, I was 53 years old, weighed 248 pounds and had triglycerides of 344, high blood pressure, GERD and didn’t sleep at night. Six weeks after starting a low carb diet, I had lost a little weight, but my triglycerides fell to 106, I was off high blood pressure medicine and my GERD was gone.

I lost weight steadily that first year, then plateaued at just over 200 pounds, where I am now. I could lose more weight with some effort, but I’m now simply “overweight” rather than “obese”, my blood panel is much better and I no longer have a diagnosis of metabolic syndrome or pre-diabetic. I’m pretty satisfied with that. So I’ll continue on this road.

And if I lose more weight, that’s great. If I don’t, that’s OK too, because I’m improving my health. I’d rather be alive and have an overweight BMI at 85 than assume room temperature in a prettier body at 70.

Its Not Too Late

Managing expectations is probably as important as managing your diet. Don’t beat yourself up if you’re a premenopausal female and your male partner loses more weight while eating more food (the bastard!) Unless you want to grow facial hair and deepen your voice by taking testosterone supplements, that’s the way it is.

Don’t beat yourself up if you are over 50 and you aren’t getting the same results as a 25 year old. They have youth as an advantage, and its one that you can’t borrow, buy or otherwise obtain, no matter how many late night infomercials you view.

He’s not your enemy. Most of the time, anyway.

You can improve your health, often dramatically, by adopting a low carb or paleo lifestyle. Ask your doctor about it, and phrase it this way: “Are they any health problems I currently have that would be exacerbated by eating a low carb diet?” Get the straight answer to that question. Certain health conditions like kidney or liver disease, gout or digestive disorders may argue against adopting a higher protein diet, and only you and your doctor really know if you have those.

Beyond that specific question, your doctor may recommend the standard, low fat bound-to-fail diet they are so fond of in medical circles. Barring a specific medical reason to avoid a low carb diet, see if your doctor will work with you to adopt either of the low carb diets featured below.


Leptin Resistance

What is Leptin?

Leptin is a hormone released by fat cells that helps regulate hunger. And it may hold the key to why a low carb / paleo diet works for so many people.

Role of Leptin in Hunger Signals
Leptin and Hunger
(Click Image to Enlarge)

Success on a low carb / paleo diet is often attributed to “never feeling hungry”, an effect not seen on other diets. People point to the satiating aspects of fat or protein in eliminating hunger, but dieters may be suffering from a rarely diagnosed condition called leptin resistance that is corrected by the low carb diet.

Leptin circulates through the bloodstream in an amount directly proportional to the amount of fat you have. In theory, the more leptin you have circulating the less you will eat, because it signals that you have enough stored energy for all your metabolic processes. When leptin levels dip, it signals the brain that you are hungry.

So, that means fat people should never be hungry, right? Not so fast, grasshopper.

Resistance is Futile

Most low carbers are familiar with the concept of insulin resistance in those with type two diabetes and metabolic syndrome. In a healthy individual, insulin signals the cells that glucose is available, and the cells respond and allow the glucose to enter the cell (if they need the energy). Insulin resistance is a condition where the cells become resistant to the effects of insulin, requiring more and more insulin to deal with blood sugar levels. If a regular cell opens the door to a gentle knock, the insulin resistant cells respond only to ferocious pounding on the door with a battering-ram’s worth of insulin. The pancreas, which produces insulin, cannot keep up with the demand for more and more insulin, and dangerously high levels of blood glucose result.

A similar thing happens with leptin resistance, but through a different mechanism. There’s no shortage of leptin in an otherwise healthy obese person, and the fat cells never grow tired of producing it. But the circulating leptin is blocked and cannot turn off the hunger signal. The fat person remains hungry. And hungry people eat.

What Causes Leptin Resistance?

Some have theorized that dietary fat and blood glucose levels interfere with leptin. While there is a link between leptin resistance and the levels of fat circulating in the blood (triglycerides), eating dietary fat doesn’t seem to have an effect. Recent evidence showing a diet high in fructose contributes to leptin resistance adds to the growing body of evidence against high levels of fructose in the diet. The amount of fat in the diet did not matter; leptin resistance peaked with the high fructose diet, and reversed itself to normal levels when the rats ate a sugar free diet, no matter how much fat they had. Lucky rats.

We know that leptin signals our brain that enough energy is present, and the body does not need any more food. Leptin is able to cross the “blood brain barrier” (BBB) to do this. The BBB is a protective system of small capillaries that protects the brain from most chemicals but allows the important ones through. It works like a filter. So what causes the curious case of leptin resistance, where this essential hormone is blocked by the BBB? As Dr. Mike Eades explains:

Research done a couple of years ago in St. Louis and in Japan pinpointed the problem. Triglycerides – fat circulating in the blood – interrupts the passage of leptin across the BBB. If trigylcerides are high, which they are in most obese people, then, basically, they block the movement of leptin into the brain. So, leptin levels are elevated in the blood, and triglycerides keep the leptin from getting to where it needs to get to shut off hunger.

One Solution

Controlling trigylceride levels can reverse leptin resistance. In my own experience, hunger evaporated on my low carb diet as my triglycerides fell from 344 to 105. Before that, I was often hungry, even after eating past the feeling of fullness and often to discomfort. On my low fat diet 15 years before, I was miserable because I was always hungry. But that, as they say, is a personal testimony and not a scientific finding. Too bad I’m not a rat.

The easiest way for most people to lower triglyceride levels is to adopt a very low carb diet (less than 50 grams of carbohydrate per day), then transition to a moderate carb diet devoid of most grains. Niacin and fish oil have also proven to be effective in many people, even those with genetic reasons for high triglycerides (familial hypertriglyceridemia). I combine all three approaches, and have found the eliminating any one of those results in my triglycerides rising again. Management of triglycerides in this way is done in concert with a physician and blood tests. Those with chronic health problems should check with their doctors first, of course, especially those with reduced liver or kidney function, or those suffering from conditions such as gout that require specific diets.

Resisting Resistance

Humans are adapted to eat a certain diet, and in terms of adaptation, the modern agricultural era is a blip on the radar screen. We simply haven’t had time to adapt to large quantities of grain and other carbohydrates in our diets. The inexpensive access to readily available carbohydrates is new, barely 10,000 years old, and our biological machinery is not able to handle it. That’s the philosophical framework under girding the modern low carb / paleo diet movement. The rise of leptin resistance is just one more metabolic condition that supports the effectiveness of a low carb / paleo lifestyle.

Other Resources

MegaSearch: Leptin Resistance

Heart Scan Blog: Niacin

Heart Scan Blog: Fish Oil

Protein and the Low Carb Dieter

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

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

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?

Jan’s Low Carb Pumpkin Muffins

Those wonderful looking muffins at the coffee shop pack a minimum of 60 grams of carbohydrates, and sometimes over 100! That makes them unsuitable for a diet with a goal of 30 – 40 grams of carbs per day. The alternatives we’ve tried all seem dry or just not very tasty.

But Jan has come up with an alternative muffin that comes in at less than 6 grams of carbohydrates per muffin. At 6 grams, the muffins can complement any meal, and serve as a good snack. As in all of these lower carbohydrate recipes, a balance between taste and carbohydrate levels has to be reached. I think Jan has nailed it on this recipe!

Because these contain a small amount of flour, sugar, brown sugar and commercially produced spices, they may not be appropriate for paleo dieters. They are also not gluten free. Substituting more almond meal for the white flour does work, and removes the gluten, but makes the muffins denser. We like them this way — low carb and tasty!

These have a firm texture like a bran muffin, but with a smoother, not-so-sweet pumpkin bread taste. They are especially good sliced down the middle, slathered with butter, and then heated for 15 seconds in the microwave. The coconut and brown sugar topping provides a satisfying crunch, complemented by the crunchy walnuts. Our tastes have changed, and we don’t like “too sweet” desserts any longer, but increasing the sweetener may be appropriate for some. This recipe makes 24 muffins.


Dry Ingredients
2 1/2 Cup Almond Meal Flour
1 Cup Flaxseed Meal
1/2 Cup Coconut Flour
1/4 Cup White Flour
1 teaspoon Baking Soda
3 teaspoons Baking Powder
2 Tablespoons Pumpkin Pie Spice
1/8 Cup Sugar
1/2 Cup Chopped Walnuts
Wet Ingredients
9 Large AA Eggs
1 15 Oz Organic Canned Pumpkin
1 Tablespoon Dark Molasses
2 Tablespoons Vanilla Extract
18 Drops EZ-Sweetz Liquid Sucralose (equal to 5/8 Cup of Sugar)
1/3+ Cup Water
Topping Dry Ingredients (Optional)
3 Tablespoon Unsweetened Shredded Coconut
1 Tablespoon Brown Sugar


Pre-heat oven to 350° F.

Grease cupcake pans with butter, coconut oil or (gasp) vegetable shortening, then flour them. See This Link for a tutorial on greasing a cupcake pan (“The Internet has everything, Wilma!”) You’ll need enough cupcake pans to make 24 muffins.

Combine dry ingredients (except for the optional topping and walnuts) in a mixing bowl and mix well. Combine wet ingredients in a larger bowl and mix well, then mix in the dry ingredients, adding them slowly. You can adjust the water from 1/3 to 1/2 cup as needed while mixing; the mixture should be thick, about the consistency of cooked oatmeal. When fully mixed, fold in the chopped walnuts.

Fill the greased cupcake pans with the mixture, nearly to the top. Combine the topping ingredients in a small bowl and mix well, then sprinkle on top of the mixture in the cupcake pans. This topping rests on top and forms a crunchy, crumble-like topping as it is baked, so don’t fold, spindle or mutilate it — just sprinkle it on top.

Place filled cupcake pans into the oven for 20 minutes. When done, a wooden toothpick inserted into a muffin will come out clean.

Net Carbs Information

Our carbohydrate analysis is calculated using the labels on the packaged ingredients (pumpkin, etc.) and Internet sources for things like the eggs. We have subtracted the fiber grams from the US labeled product to achieve the net, digestible carbohydrate count.

We did not calculate the grams of fiber, protein and fat in this recipe, as we rarely worry about those in our daily diet. Those of you who care, and use nutritional calculators at sites like FitDay, are welcome to chime in with your analysis in the comments.

Eliminating the topping brings the muffins down to 5 grams of carbs each. You may find other places to save, such as substituting more EZ-Sweetz Liquid Sucralose for the sugar (saving another 24 grams of carbs), and bring these in at about 4 grams of carbs. But we would rather save that gram of carb elsewhere.

Net Carbs in Ingredients
Amount Measure Ingredient Net Grams of Carbs
2 1/2 Cup Almond Meal Flour 20
1 Cup Flaxseed Meal 0
1/2 Cup Coconut Flour 16
1/4 Cup White Flour 20
1 teaspoon Baking Soda 0
3 teaspoons Baking Powder 0
2 Tablespoons Pumpkin Pie Spice 0
1/8 Cup Sugar 24
1/2 Cup Chopped Walnuts 0
Wet Ingredients
9 Large AA Eggs 4
1 15 Oz Organic Canned Pumpkin 21
1 Tablespoon Dark Molasses 15
2 Tablespoons Vanilla Extract 0
18 Drops EZ-Sweetz Liquid Sucralose 0
1/3 Cup Water 0
Topping Dry Ingredients (Optional)
3 Tablespoon Unsweetened Shredded Coconut 2
1 Tablespoon Brown Sugar 12
Full Recipe 134 grams
Per Muffin 5.58 grams

Good Stuff Inside

We like coconut and almond flour, as well as flaxseed meal, but used alone, they can rarely replace white flour in a recipe. We find flaxseed muffins dry and tough. Combining the three “alternative flours” in the proportions above works well in this recipe. One note about coconut flour: it is very thirsty, so if you use more, expect to add more water.

We haven’t had good success baking with any of the alternative sweeteners except for EZ-Sweetz Liquid Sucralose. The problem with granular Splenda, Stevia, Truvia and other sweeteners is that they turn bitter when baked at 350°F. Each drop of EZ-Sweetz equals a teaspoon of sugar in sweetness without any malitrol, dextrose or other “carrier” to turn bitter.

Let us know how you like these muffins, and if you come up with other modifications.

Vitamin D-isappointing?

Low carb dieters have emphasized the need for supplements from early on, and one of the supplements growing in importance has been Vitamin D. This is largely due to the growing body of cutting edge research showing its benefits for a wide range of disorders, from asthma to parkinson’s disease.

The SunDrs Mike and Mary Dan Eades recommend regular sun exposure, without sunscreen, in The Protein Power Lifeplan, and the paleo community regularly touts the importance of being outside and active in the sun just like our ancestors. Today’s office dwellers realize their fluorescent lit lives do not allow enough sun time each day, and supplement with vitamin D.

The Institute of Medicine’s (IOM) Food and Nutrition Board (FNB) was asked to look at vitamin D in order to evaluate if the current recommendations, expressed as “Daily Recommended Allowance” (RDA) in health literature, was adequate. After reviewing the current state of the science they surprised all of us by “staying the course” with vitamin D RDA the same as stated by the NIH in 2009 – just 600 IU per day for most people.

Cardiologist Dr. William Davis of the Heart Scan Blog commented:

Instead of a careful, science-minded conclusion that meets the painfully conservative demands of crafting broad public policy, the committee instead chose to dogmatically pull the discussion back to the 1990s, ignoring the flood of compelling evidence that suggests that vitamin D is among the most important public health issues of the age.

How can this happen when so much has been discovered about this important vitamin in the last few years? With possible implications for asthma, autism, auto-immune disorders, cancer, depression and mental illness just to name a few, its hard to understand the findings. Even my family practitioner commented to me that sunscreen may have caused more cancer than it prevented by blocking synthesis of this vitamin in many people. Part of the reason for the FNB’s ultra-conservative recommendation may be found in the approach they took:

In sum, with the exception of measures related to bone health, the potential indications examined are currently not supported by evidence that could be judged either convincing or adequate in terms of cause and effect, or informative regarding dose-response relationships for determining nutrient requirements.

Other than bone density, they really didn’t consider any of the other benefits researchers have found, for two reasons. The first is that studies showing a beneficial effect of the nutrient don’t provide enough evidence that the vitamin is the reason for improvement. While that is debatable, I think the second reason is the most important: studies that do show a benefit do not provide a “dose-response relationship for determining nutrient requirements”. What does that mean? It means that the studies did not provide an easy way for the committee to develop new standards for how much vitamin D you need.

Public policy is often too careful, conservative to a fault, and lags years behind the state of the art.

The Vitamin D Council, a private group of doctors, researchers, and patients, issued a statement:

Disturbingly, this FNB committee focused on bone health, just like they did 14 years ago. They ignored the thousands of studies from the last ten years that showed higher doses of vitamin D helps: heart health, brain health, breast health, prostate health, pancreatic health, muscle health, nerve health, eye health, immune health, colon health, liver health, mood health, skin health, and especially fetal health.

The committee’s findings are more understandable when you realize they are looking only at bone health, and discarding the emerging research showing benefits for an array of other conditions.

Grassroots Health, a public health organization with a large panel of scientists from prestigious universities and hospitals, provided space for several of their colleagues to comment on the report. Dr. Robert P.Heaney, MD, John A Creighton University Professor and Professor of Medicine at Creighton University, said:

There is an impressive body of scientific evidence supporting levels higher than the IOM panel is currently recommending, and for reasons that are not entirely clear, the panel has discounted that evidence. The public needs to know that that evidence exists so that they can make up their own minds. It’s helpful in making those decisions, to know that intakes higher than the IOM [FNB] recommends are safe. For me, that makes the decision easy. Even if the evidence for a higher intake were uncertain (and I don’t believe it is), intakes 2-5 times the IOM recommendations would carry a good chance for benefit at essentially no cost and no risk.

The committee provided their recommendation for a “safe upper limit” of supplementation at 4,000 IU for most people. This recommendation is a low risk proposal, intended for the general public, and most people think it may be due to the prospect of vitamin D toxicity. As a “fat soluble vitamin”, vitamin D is one that can build up and present the ultimate “too much of a good thing.” Yet the same report indicates vitamin D toxicity does not occur in studies except in those supplementing at 50,000 IU and above.

The committee had to deal with a variety of studies showing different “bad effects” for different groups, with black and Asian women differing from white women in increased bone fractures with higher levels of vitamin D (due to the way the vitamin and calcium interact in the body), higher and lower cardio-vascular disease rates in men, etc.

The gold standard of vitamin D supplementation is to test the blood serum levels to dial in the optimum, at least 40 – 60 ng/ml, according to Grassroots Health. They point out that in people taking just 1,000 IU a day, serum levels ranged in people from 15 ng/ml to 85 ng/ml, a wide range that highlights the problem in establishing an RDA (or even an upper limit that is safe for everyone).

How do you get tested? There are some on-line sources for vitamin D testing, taking a simple pin prick to elicit a drop of blood onto a test blotter that you mail in; these are legal in many states. You can also ask your doctor, although your insurance may not cover “voluntary” tests.

For those in the US who cannot convince their family doctor to test for vitamin D levels, Grassroots Health is conducting a 5 year study and preforms the necessary tests every six months. The cost is a recurring $60 per test, and is legal in every state except for New York. See this page for details.

Key Lime Yogurt Pie – Low Carb?

For some reason, this recipe for Key Lime Yogurt Pie has been tweeted and retweeted frequently using both the #lowcarb and #paleo hash tag. But is it low carb or paleo?

The recipe doesn’t provide nutritional information. But we can see it isn’t in any sense “paleo”. The list of ingredients includes items that are certainly not in line with a traditional paleo diet, even if you do include dairy. Ingredients such as fat-free cream cheese, Smart Balance Buttery Spread and reduced fat whipped topping are in no way paleo. These are heavily processed “frankenfoods”. Let’s take a look at the chemical soup in the ingredients:

Fat free cream cheese
Market leader Philadelphia Fat Free Cream Cheese ingredients:
Protein Concentrated Skim Milk, Cultured Skim Milk, Skim Milk, contains Less than 2% of Sodium Tripolyphosphate (Ingredients Not in Regular Cream Cheese) Sugar (Ingredients Not in Regular Cream Cheese)Xanthan Gum, Pasteurized Milk and Cream (Trivial Source of Fat) Salt, Artificial Color (Ingredients Not in Regular Cream Cheese) Carrageenan, Potassium Sorbate (Ingredients Not in Regular Cream Cheese)Calcium Propionate (Ingredients Not in Regular Cream Cheese) as Preservatives, Cheese Culture, Sodium Phosphate (Ingredients in Regular Cream Cheese)Artificial Flavor (Ingredients in Regular Cream Cheese)Carob Bean Gum, Vitamin A Palmitate.

Smart Balance Buttery Spread
Natural Oil Blend (Palm Fruit, Soybean, Canola Seed, and Olive Oils)Water, contains Less than 2% of Salt, Whey, Vegetable Monoglycerides and Sorbitan Ester of Fatty Acids (Emulsifiers)Soybean Lecithin, Potassium Sorbate, Lactic Acid (to Protect Freshness)Natural and Artificial Flavor, Calcium Disodium EDTA, Vitamin A Palmitate, Vitamin B6, Vitamin B12, Vitamin D, Vitamin E (DL-a-Tocopheryl Acetate)Beta-Carotene Color.

Reduced Fat Whipped Topping
Cool Whip Lite, the market leader’s ingredients:

Quite a list of ingredients there. I couldn’t find the ingredients for Yoplait’s Light Thick & Creamy Key Lime Pie Yogurt, but did find the nutritional information; judging from the carbs in the mix, I suspect we would see a similar chemical soup base if we had the label in front of us.

OK, so its not paleo, but at least it’s low carb, right?

It is not really low carb, but it is lower than the full-sugar alternative. In comparison to a regular slice of key lime pie that weighs in at 58 grams of carbohydrates, I calculate a slice of this pie at a little less than half the carb count at 23 grams (rounded down in the chart below). For someone following a low carb lifestyle, 23 grams of carbs in one food at the table is still probably too high.

The recipe doesn’t specify brand names for some of the ingredients, so I have used brands that are widely available and market leaders in their category. With that caveat, let’s look at the net grams of carbohydrate content in the carby ingredients:

Ingredient Grams in Pie   Grams per Serving
Fat Free Cream Cheese
Key Lime Pie Yogurt
Cool Whip Lite
Reduced Fat Vanilla Wafers

Alert readers may note I didn’t not include the 5 grams of carbs from the 1/2 teaspoon of sugar in the recipe, but this is close enough for our little review here. And, you can easily substitute liquid sucralose or Splenda for the sugar.

Can we improve on this recipe even more?

Replacing the “frankenfoods” listed above with real food alternatives like fresh whipped cream and regular cream cheese, we can trim the pie’s carbohydrate count down to 97 grams (17 grams per slice). And substituting out the Vanilla Wafers crust with our own Low Carb Pie Crust reduces the carb count by another 24 grams, to 73 grams of carbs for the entire pie. That’s about 12 grams per slice. That comes close to being low carb enough to earn the #lowcarb hash tag.

I may try this recipe with the almond meal Low Carb Pie Crust linked above, and low carb alternatives. If I do, I’ll publish the results here.

Knockout: Low Carb vs. Low Fat

The New England Journal of Medicine noted the results of a study examining the best way to maintain weight loss:

We enrolled overweight adults from eight European countries who had lost at least 8% of their initial body weight with a 3.3-MJ (800-kcal) low-calorie diet. Participants were randomly assigned, in a two-by-two factorial design, to one of five ad libitum diets to prevent weight regain over a 26-week period:

  • a low-protein and low-glycemic-index diet
  • a low-protein and high-glycemic-index diet
  • a high-protein and low-glycemic-index diet
  • a high-protein and high-glycemic-index diet
  • or a control diet

Low carb diets generally fit into the two “low glycemic index” diets, with most low carbers getting toward the relative high end of protein.

One of the interesting facts about the study is that the low carb dieters adhered to the diet at a much greater rate than their counterparts; the study says about 26% of the dieters eating a low carb variant dropped out, compared to 37% who dropped out of the higher glycemic-index diets. And these were diets where the people could eat until satisfied, not adhere to a limit imposed by the study authors. You would think a diet that allowed you to eat foods rating higher on the gycemic-index would be easier, right?

Not so, and Dr. John Briffa notes the reason:

This helps to explain why individuals who adopt lower-carbohydrate approaches (generally low-GI and usually quite-rich in protein) find they’re less hungry, and eat less as a result. Never mind that – having worked with literally thousands of real people over 20 years I have become convinced that this way of eating really does, overall, trump others (e.g. low-calorie, low-fat) in terms of sustainable weight loss. And this is why it forms the basis of the advice I offered in my latest book Waist Disposal

I have seen countless individuals get on and off ‘diets’ and therefore suffer cycles of weight loss and weight gain. What is it that causes individuals to default back to their original diet? Lots of things, but one factor that almost always plays a part is hunger. It’s a plain and simple fact that unless forced, individuals tend not to tolerate hunger at all well in the long term.

So which diet was the least successful in maintaining the weight loss? As the study tells it:

In the analysis of participants who completed the study, only the low-protein–high-glycemic-index diet was associated with subsequent significant weight regain (1.67 kg; 95% confidence interval [CI], 0.48 to 2.87).

That “low-protein-high-glycemic-index diet” is the standard American diet, with 60 to 70% of calories from foods high on the glycemic index, like whole grains, whole wheat bread, pasta, fruit juices, etc.

For most people, a diet that focuses on adequate protein, higher fat intake and reduced carbohydrates satisfies hunger more. And as Dr. Briffa notes, hunger just isn’t tolerated well. Even if you can eat all the “whole grains” you want.

Chronicling the End of the Low Fat Craze