When making a decision about diet or even just approaching new original nutrition research in a peer-reviewed journal article, it is crucial to understand what biases you may bring to the table as a reader.
The first time I thought seriously about nutrition was in the emergency room in Columbus, Ohio, on June 23, 2003. I’d come into the ER because I was exhibiting the unmistakable signs of a heart attack; centralized chest pain extending down both arms, uncontrollable sweating, shortness of breath. I had good reason to be concerned. I had stopped smoking only about a year before, I was eating crap and I was pushing 240 pounds. My lipid profile was off the charts, and I was given the 30-second lifestyle modification chat by an intern that had things he’d rather be doing. I was told that I needed to lose weight and reduce fat in my diet, especially saturated fat, which I learned was found in meat, cheese, dairy and all animal products. It is only natural that I approached lifestyle modification thinking with a plant-based, if not vegan, bias. I lost close to 80 pounds and returned my body to health using a vegan lifestyle modification. Armed with the physical evidence of what a vegan lifestyle modification did to my body, I held that bias until after I graduated from The Ohio State University and passed the national exam to become a Registered Dietitian. When I got out in the real world and started doing cooking demonstrations and dietetic counseling at the Whole Foods Market in Dublin, Ohio, I discovered that things weren’t as black and white as I thought they were. Over a relatively short time, I developed the same approach with nutrition that I have with recipes and cooking. I don’t believe that there is a right way to approach cooking anything, only the right way for this time, given the resources you have at hand right now. I approach cooking the same thing differently every time because I have more or fewer resources at hand. Time and money are two significant resources that affect the way you might approach cooking something. That makes adhering to a recipe in the kitchen simply a recipe for disaster and nothing else! I now apply that very same concept to help people select a lifestyle modification approach that is right for them given what is going on in their life right now, the resources they have at hand right now, and their willingness to change and ability to follow through right now. All of those influences may change over time, and your approach to lifestyle modification needs to change as well. This is the same language I used in last week’s Healthy Eating Tip entitled “Own Your Own Health.”
My approach to cooking and lifestyle modification is why the philosophy of Bruce Lee appeals so much to me. His fighting method, called Jeet Kune Do, or The Way of the Intercepting Fist, is a dynamic and fluid style that is not based on a single school of martial arts technique but borrows from them all based on a fighter’s strengths and weaknesses at a specific point in time. It is a bare-bones style designed to give practitioners a guide to success. It is not a pretty style; there are no style points awarded. There is just winning, over and over again. Bruce Lee didn’t like discussing technique. He recognized the value of knowing different fighting styles but preferred to be action-oriented the same way that you need to be focused on action if you want to be successful with both cooking and lifestyle modification. Taking action based on your knowledge, willingness and ability is a physical expression of your desire to experience healing. There is immense power in translating your intention to heal into action!
“Knowing is not enough, we must apply.
Willing is not enough, we must do.”
– Bruce Lee
Having a bias for the plant-based lifestyle modification approach goes hand in hand with having a bias against anything low-carbohydrate. I held that bias against anything low-carb for a while. It eventually gave way to the more Jeet Kune Do approach to lifestyle modification that I have described here.
For a dietitian, there are not many topics more controversial than low-carbohydrate diets. Many people have a tremendous amount of bias both for and against low-carb diets. Some have almost a religious-like fanaticism when they speak of low-carb diets. Armed with what I have written above and in last week’s Healthy Eating Tip, let’s wade into the low-carb debate.
The present-day low-carb diet trend started in 1972 with the book “Dr. Atkins’ New Diet Revolution” by cardiologist Robert Atkins. It was dubbed the Atkins’ Diet and found widespread popularity around the world. It has been updated and revised several times and became one of the bestselling diet books of all time. Some recent incarnations of the Atkin’s diet include the Zone Diet, the South Beach Diet, paleo diet, Eco-Atkins and the ketogenic diet.
“Low-carb” is a broad dieting concept involving reducing the number of carbohydrates a person eats and drinks.
Very low carb diet (Atkins or ketogenic diet) parameters are 20-50 grams of carbs per day.
Low carb diet parameters are 30-130 grams of carbs per day.
Reduced carb diets reflect more than 130 grams of carbs per day, with no more than 45% of total calorie consumption coming from carbs.
To put this into perspective, one slice of bread contains roughly 15 grams of carbohydrates. The DASH diet, a conservative and well-studied diet with suggested macronutrients of 27% calories from fat (6% saturated), 18% of calories from protein, 55% of calories from carbohydrates with no less than 30 grams of fiber. For a 2,100-calorie diet suitable for a 6-foot-tall male that 55% of carbohydrates is equal to 1,155 calories from 289 grams of carbs a day. Very low-carb diets suggest 80-200 calories from 20-50 carbs a day.
As a reminder, macronutrients are the nutritional components of food that the body needs for energy and to maintain the body’s structure and systems. Macronutrients supply calories.
Carbohydrate: 1 gram = 4 calories
Protein: 1 gram = 4 calories
Fat: 1 gram = 9 calories
Alcohol: 1 gram = 7 calories
Simple or refined and processed sugars are a rapid source of energy for our bodies. Examples include white rice, white flours, white sugar and candies. Although we get quick energy from simple sugars, it doesn’t last long, and we feel hungry soon afterward. People with diabetes will recognize that the measure of glucose in blood rises almost immediately after they eat simple sugar but comes down pretty fast too.
Complex sugars consist of long chains of sugar molecules. Fiber and starch are the common terms for complex sugars, and examples include whole wheat, brown rice, beans, pulses, oats, fruits, nuts and vegetables. Complex sugars tend to fill you up for longer, and they are considered healthier because they contain more vitamins and minerals.
Healthy complex sugars become simpler sugars when fiber is taken out during food processing. Whole wheat flour becomes white flour, brown rice becomes white rice and whole oranges with tons of fiber become orange juice with zero fiber and 100% simple sugar that quickly raises blood sugar. The Healthy Eating Tip post entitled “Understanding Carbohydrates” is a short but comprehensive explanation of carbohydrates.
Carbohydrates are sugars and starches, also known as saccharides. They represent the primary food source for most living things on the planet. There are various types of carbohydrates. They include monosaccharides, disaccharides and polysaccharides. One type of polysaccharide is glycogen. Glycogen is the way that animals, including humans, store energy. Glycogen is the fat we all see on our bodies.
Carbohydrates are broken down into monosaccharides, one of which is glucose. Our bodies want to burn glucose as fuel. In the absence of glucose, we go to carbohydrates stored as glycogen or fat. Ketones are created when fat is metabolized, and that is what our cells use as fuel when there is no glucose around. This is a daily occurrence. When we sleep, blood glucose levels drop and ketones are made from fat for our cells to use. Ketosis is the state the body is in when it burns fat and creates ketones. It is often confused with ketoacidosis, which is a dangerously high level of ketones in the blood most common with diabetics.
I am not going to start citing studies that show that low-carbohydrate diets work. There is enough consensus about that in the medical community to consider it true. Low-carb diets work. My concern is that we are still using the word “diet,” meaning that it works for the short term. You can lose weight with a low-carb diet, but can you keep the weight off for an extended time?
Let’s go back to the person I told you I had a conversation with last week. This person took off way more weight than I did. This person has an in-depth knowledge of physiology and in-depth knowledge about themselves; what they are willing and unwilling to do. They also come to the table with not a small amount of knowledge and ability regarding food, cooking and nutrition. They went through the lifestyle modification learning process thoroughly. What this person did to lose a tremendous amount of weight was use a very low carbohydrate diet to lose the weight in one go and then switch to a balanced diet including plants, whole grains and fiber emphasizing portion control rather than reducing fat or simple sugar. This person knew themselves so well that they knew if they eliminated certain foods that they liked, the “diet” wouldn’t work for them long-term, and the weight would come back. Three or four times a year, they reverted to the very low carb diet and did what I call a dietary reset. I do the same thing, but with a low-fat plant-based dietary reset. Both the very low-carb diet and the low-fat vegan diet are very hard to maintain for any length of time, but if you couple that with a more balanced approach to eating for the rest of the time, it will work. What this person was doing has to be defined as lifestyle modification. Moving between a balanced portion-controlled diet and a low-carb diet works for them because they are educated about physiology and nutrition. They are also highly motivated with the willingness and ability to do what has to be done to make their highly personalized lifestyle modification plan work.
Even though it isn’t suitable for me, I wouldn’t have been able to suggest anything more appropriate for this person! That is called owning your own health!
For the rest of us, there are some serious issues with the low-carb diet that you need to be aware of. First of all, and perhaps the most important, you don’t learn good eating habits that will sustain you for the long term. It is a diet, not a long-term lifestyle modification plan. If you can stick to the diet, you will lose weight, but unless you use the low-carb diet only for short periods and then revert back to a balanced eating plan that includes plants and complex carbohydrates with plenty of fiber, it is not healthy for the long term.
My second concern is that many people use being on a low-carb diet as an excuse to eat as much bacon, sausage and cheese as they want to. I see this all of the time. It’s a no-brainer! If you are already overweight and consume a diet high in saturated fat, your LDL cholesterol will skyrocket! Again, you are not learning healthy eating habits that will help you sustain health and weight loss. I will not quote studies that show increased mortality from long-term low-carb diets, but there are many, and I have quoted them before.
If you really need to find a carbohydrate villain, then make refined, processed sugar that villain. Eliminating things from your diet like brown rice, whole grains, beans and legumes and all the fiber and micronutrients along in them is insane and leads to poor health. The Healthy Eating Tip posts “Choose A Diet That Is Right For YOU” and “What Do I DO With New Low-Carb Diet Information” offers some practical carbohydrate diet advice.
We’ll revisit low-carb diets as a topic from time to time…have a great week!