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Thursday, May 14, 2009

Moderate Low-Carbing Revisited

Most low-carbers are the diehard kind - i.e. Atkineers - by far the majority of people choose Atkins. However, there are many people who are afraid of the high fat diet (at least to the extent that Atkins is) or cannot tolerate the high fat for whatever reason. These people might still be overweight and somewhat insulin resistant and could benefit from a lower carb diet. Personally, I think everyone is different, but the important thing is to achieve a healthy weight (not perfect - simply healthy) and to find a way of healthy eating that suits the individual. My personal conviction is that we eat too many refined carbohydrates in our society. It benefits everyone to cut down on the white flour and sugary products. The late Dr. Atkins said that they are anti-nutrients. They will actually deprive the body of nutrients as it tries to digest that garbage - oops, I meant carbage! I believe low-carbing is a healthy way to eat, however, the level of carbohydrate is really an individual thing. If someone is a true believer in low-carbing, then even if they veer from the diet for a while, they will always return with a renewed commitment to healthier eating.

Perhaps the views of this doctor below will ring true with a few folks reading my blog. This article was in the health section of the Time magazine.

How I Became a Low-Carb Believer
After seeing results in his patients, a once skeptical doctor is now a convert
BY WOODSON C. MERRELL, M.D.

In my 25 years of medical training and practice in Manhattan, I've seen a wide range of diets come and go. Virtually none of them work. Of course, they may work for a few weeks or months, but my experience follows the national statistics that 90% of dieters regain their weight within two years of weight loss. The ones who have been successful are those who have made a permanent commitment to altering their eating habits and continuing to be active physically. A major problem is that the dedication it takes to stay on a diet, especially for those significantly overweight, is usually too much for most people. So the weight-loss gurus are always looking for a diet that requires little or no self-discipline.

Diets that drastically reduce caloric intake leave most people feeling too physically and emotionally deprived to continue. Also, the body is often quick to recognize caloric deprivation and adjusts by lowering the metabolic rate, thus sabotaging the effect of a lower caloric intake. I saw this when I was a consultant in a hospital weight-loss center that specialized in liquid diets. I was astonished at the number of people on 600-to-800-calorie diets whose weight loss seemed to stall after just a few weeks. Even worse, when you come off such a diet, the metabolism often remains at that lower level, making weight gain inevitable.

For most of my professional career, I adhered to the generally recognized dictum of weight management. I advised my patients to count their calories and follow a low-fat diet. So when low-carbohydrate diets experienced a resurgence in the mid-'90s, I dismissed them as another fad. But a funny thing began to happen. Many of the people who went on the modern Zone or Atkins diets lost weight, didn't feel deprived, and were more successful in the long term.

Then I sat down with a cardiologist who not only espoused the Atkins diet but also had been on it himself and lost 40 lbs. over five months. He argued that the insulin-lowering effect of the diet was essential for allowing the body to burn fat more effectively. He also contended that reducing insulin levels could help prevent many diet- and weight-related diseases, including high cholesterol, hypertension and diabetes. Atkins is a cardiologist too, but he is selling books. This physician, with no vested interest, made it clearer to me that carbohydrates are often the culprit. Certainly the majority of my overweight patients are carbohydrate junkies.

I tried the low-carbohydrate diets on a few patients for whom nothing else had worked. To my surprise, they did well. I chose the more cautious Zone and Heller systems, with moderate-to-low fat intake, though I noticed that the patients who were experimenting with the Atkins system of high saturated fat and ultra-low carbohydrates seemed to lose weight even faster.

So I have become a convert. Carbohydrates in the amount we commonly consume them (particularly sugar and other refined carbos) are often prime saboteurs of our weight. What's more, cutting back on them--especially on wheat--seems to produce improvements in energy, mood and sleep for many patients. It is hard to do--our culture is carbo- and wheat-driven. But of all the diets I've seen over the past few decades, the moderate-fat, lower-carbohydrate ones are the most successful. They stress not how much food you eat but what kinds. Calorie counting is not as important as carbo counting. They are not so much diets as a permanent change to a more balanced eating pattern.

I still have a difficult time recommending an Atkins-style, high-saturated-fat diet to my patients. Though the diet does provide a quick weight loss and is very satiating, I am concerned about its possible effects on people with serious heart, liver or kidney disease and cancer. As long as you are healthy, a high-fat diet is usually fine for a while. But after about a month, you should go off it. (My comment: I think Dr. Atkins would have taken serious offense to this statement, but anyway he has some other things right) That's the problem. When people begin to go off the strictest form of the diet, they have to be extremely careful as they increase the amount of carbos and dramatically cut back on fats. For most people, this is too much of a metabolic swing, and weight regain is all too common. The more moderate diets of Sears and the Hellers--cutting carbohydrates by about one-third and eating moderate amounts of fat, preferably monosaturated ones like olive oil--are more gentle to the system.

So we now have a new set of tools that can help reduce food cravings, lose weight, and often provide a better sense of well-being. But remember, amid all the talk about carbos and fats, that all responsible diets, low carbo or not, recommend a minimum of five helpings of vegetables and fruits a day. And there is not a diet in the world that is a substitute for that good old-fashioned metabolic jump starter called exercise.

DR. WOODSON MERRELL is executive director of the Beth Israel Center for Health and Healing in New York City

6 comments:

DAR said...

I follow Dr. Bernstein's plan, so there's no increasing carbs and raising weight and BGLs. I eat about 20 net carbs per day every day. I've been doing this for over 6 years, have lost 60 lbs, my triglycerides have plummeted, my HDLs are at an all-time high (which I was not able to achieve no matter how much I exercised), and I maintain my BGLs at a nondiabetic level though I'm a type 2 diabetic.

To those who say it's dangerous to keep carbs very low long-term, I say it's dangerous for me to NOT keep my carbs low for my lifetime!

Vikki said...

I think he got most of it right. I do think we have to be very very careful when adding carbs back in and Dr. Atkins knew that. That's why there are 4 steps. Two of those are to help you add back the carbs slowly and to find your individual level. The level where you personally can maintain your weight.
Another reason, Low Carb diets work is because they do not pigeon hole us all in to one set of numbers. Dr. Atkins repeated over and over in his book that we all needed to find our own levels. Our levels for weight loss, for leveling out and for maintenance. Smart Man huh?

Thanks for another great read!
Vikki

Jennifer said...

Dar, your personal story is an incredible success story! Wow! I am amazed by your determination and how you have achieved phenomenal weight loss and better yet how you have reclaimed your health and how you are now technically a latent diabetic. Congratulations! Thank you for putting the record straight here and basically proving that this doctor is out to lunch with his fear of a very low-carb, high fat diet. Again - wow! Thanks for taking the time to share and to reassure other readers so powerfully.

Jennifer said...

Hi Vikki,

Thank you for confirming the part that this doctor got right - i.e. about the caution required to slowly add carbs back in and how Dr. Atkins cleverly devised a plan to do just that.

I agree - everyone will have a different carb level that suits them best. Considering many low-carbers used to eat 300 grams or more of carbohydrate a day, it is easy to imagine that they would be much better served eating under 100 grams a day.

ethyl d said...

Now how do we convince Dr. Merrell that saturated fat is not the demon he has been bamboozled into believing it is?

Jennifer said...

Years of brainwashing, hey? On the other hand, it could simply be a case of sour grapes or pride. It's pretty tough to accept that one has been handing out incorrect advice for most of one's medical career. He made some substantial changes to his thinking but on the one core issue of "saturated fat being the demon", he was unable to completely bend.

LOL I don't know, Ethyl, I was just running with what you said. It would be a hard sell indeed is my guess. :-)