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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Low Carbohydrate Living

July 16th, 2011 · 6 Comments

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The new book titled The Art and Science of Low Carbohydrate Living can help almost anyone. But those of us who have diabetes stand to benefit the most.

The lead author is Stephen D. Phinney, who in Germany would be called “doctor doctor.” He has both an M.D. and a Ph.D. degree. The co-author is Jeff S. Volek, who is a Ph.D. and R.D., a registered dietitian.

Dr. Phinney gave me set of galley proofs of the book when I had a low-carb dinner with him early last month. Since then I have been reading all 316 pages of the book and considering what to write.

The first point that I have to make is that the book is clearly written and easy to follow. This is something that I have learned not to expect from writers with doctor’s degrees!

The accessible writing style is just the first of several surprises in store for anyone who reads this book. It is surprisingly witty at times while being both rigorous and practical.

I have followed a very low-carb diet since 2007. Before and after going low-carb I read all the relevant diet books, including those on the closely related paleo diet.

The two reasons why I waited so long after learning in 1994 that I had type 2 diabetes was that I imagined that low-carb eating might not be safe or sustainable. My study convinced me that it was safe, but whether I could stick with the diet was a question until about the time that I wrote “Why I Low-Carb” for Diabetes Self-Management.

By now, my experience will convince anyone that this is sustainable. But I was lucky.

Essentially, I followed what Drs. Phinney and Volek call “the casual approach.” Too many people start eating this way with the assumption that “anyone can use common sense to figure it out.”

But low-carb eating isn’t just about avoiding most carbohydrates. It is about what you do eat instead and how much of it. Specifically, what and how much fat and protein. And more specifically, what type of fat.

Here is where the book really shines. It addresses two of the most insidious dietary myths. One is that a low-carb diet is necessarily high in protein. The other is that saturated fat is bad for us.

Both myths are dead wrong, but the satfat myth causes the more grief. We need both satfat and monounsaturated fat in our diet.

The dangerous fats, Drs. Phinney and Volek write are the polyunsaturated ones. They are largely talking about the standard cooking oils, soybean, corn, canola, and cottonseed. Unfortunately, they fail to write about the advantages of those polyunsaturated oils that are rich in omega-3 that our bodies need.

But, of course, satfat is that fat most demonized by the medical establishment. Here, Drs. Phinney and Volek wisely address the social aspects of living a low-carb lifestyle.

“The ability to sustain such a low intake of carbohydrate indefinitely is synonymous with eating higher than usual amount of fat for a long, long time,” they write. “The individual needs to live in a supportive social and clinical sphere. If the individual is constantly told by family, doctor, or dietitian that eating a high fat diet is dangerous, only the most curmudgeonly among us will succeed.”

That’s why the decision by Drs. Phinney and Volek to include a chapter by Jimmy Moore was particularly fortunate. Jimmy is one of the biggest loosers on a low-carb diet and has a great website. A couple of years ago he even interviewed me about my decision to follow a low-carb diet. Yet, a big surprise to me in the new book is the link to Jimmy’s directory of medical professionals who are knowledgeable and willing to support a low-carb lifestyle. Jimmy’s directory is a huge step forward to providing the support many of us need.

The existence of that directory was, I admit, a big surprise to me. Yet another surprise that I am still puzzling over what Drs. Phinney and Volek write about salt.

They write that when our bodies adapt to a low-carb diet, our kidneys fundamentally change how they handle sodium by aggressively secreting sodium.

“A continuous moderate intake of sodium is necessary to keep your circulation adequate to handle ‘heat stresses’ like hot weather, endurance activity, or even a hot shower,” they write. “If you are eating less than 60 grams of carbohydrate per day, you need to purposefully add 2-3 grams of sodium to your daily intake (unless you are still taking diuretic medication under a doctor’s direction for high blood pressure or fluid retention.”

After reading Dr. Loren Cordain’s The Paleo Diet, I adopted the paleo diet. But I also follow a very low-carb diet.

I literally threw out my salt shaker, just as he recommended:

“Do your body a favor and throw out your salt shaker along with all the highly salted, processed, packaged, and canned foods in your pantry,” he wrote.

Those prepared foods were already long gone. I have been getting very little salt since I adopted the paleo diet.

So, I contacted Dr. Cordain. His reply left me still confused:

“Above all, listen to your body and determine what strategy works for you,” he replied. “ If you become hypotensive (rarely a problem in the western world) a bit more salt may help. Clearly our ancestors generally consumed a low glycemic load diet, but not necessarily less than 60 grams per day. Except for hunter gatherers living near the ocean, salt simply was not available until Neolithic times. Hence, the evolutionary template does not suggest the addition of supplemental salt to our diet under normal hunter gatherer environments. It could be that a western lifetime of a high salt/low potassium diet affects kidney function in a manner that makes it difficult to normalize function when acute changes in other dietary parameters are made.”

Now, I am hoped to set up a dialogue between Dr. Phinney or Dr. Volek and Dr. Cordain and see where this works out. If they can agree, I’ll let you know here.

Meanwhile, please do yourself a big favor. Get The Art and Science of Low Carbohydrate Living. Amazon.com has it available here. Digest this book completely. Then, you will be able to digest the food that will help you control your diabetes much better.

This is a mirror of one of my articles that was originally published on Health Central.

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6 responses so far ↓

  • 1 Javed Alam // Jul 16, 2011 at 10:48 am

    I have also read the book and found it very informative about low carb diet. It provided the scientific evidence in support of low carb diet. That is very self reassuring in light of current support of high carb/low fat diet. I also thought that low carb diet is high protein diet at first but now getting the correct understanding that it low carb high fat diet while protein remains the same. However, for weight loss fat still counts. I am still worried that high fat content will raise my triglycerides and cholesterol levels. I will find out soon.

  • 2 Peter Silverman // Jul 17, 2011 at 5:00 am

    What struck me in the book is the idea that if you eat between 30% and 60% fat your insulin resistance increases. So a person might be better off eating very low fat or very low carb, but not in between.

  • 3 maria // Jul 17, 2011 at 8:08 am

    I have been following this diet for years also- eggs every day (with olive oil & avocado!)

    cholesterol, blood fats are FANTASTIC! :)

  • 4 David Mendosa // Jul 21, 2011 at 5:04 pm

    Dear Peter,

    You make an interesting point. So I contacted an expert who provided this answer:

    “Steve Phinney is pretty direct that at least in laboratory animals, there’s some kind of mess-up that occurs when the rodents are in the middle zone, rather than on one extreme or another. It could be that metabolically, the mechanisms for burning fat and burning sugar are hard to have operating smoothly at the same time, and the “middle zone,” puts the two forms of fuel in conflict too often. I’m not sure that the insulin resistance issue shows up in humans the same way, and it seems to me there are likely to be many confounding factors, such as, is the carbohydrate fructose, or fast-digesting carbs, or slow-digesting carbs, etc.

    “I think there are studies in humans that indicate that the less modern-day carb, the more likely a person’s to live longer (at least in the big studies such as women’s health initiative), but I’m not remembering exactly which of those studies says what. Often, the studies reporting more insulin resistance are referring to the lab rodent models, and rodents are much more adapted to grains that humans are, so that confounds the studies as well!

    “I also wonder whether the middle-ground promotes insulin resistance in someone who’s not insulin resistant yet, or if the big issue is that 30-60% fat sustains insulin resistance in someone who’s already insulin resistant? My guess is that these studies that say the 30% – 60% fat diets promote insulin resistance are examples of people who are already tired and overweight . . . and insulin resistant, continuing to eat enough carbohydrate to stay stuck in fat storage mode. Then when that person eats a higher amount of fat, it doesn’t get burned. It gets stored. And since fats do have more calories than carbs, they gain weight, and the weight gain becomes the proof of greater insulin resistance (I don’t know whether the people claiming this causes greater insulin resistance are measuring insulin levels in the blood compared to blood sugar levesl, or rather “insulin resistance” become a catch-all term for things like weight gain and a wider girth and high blood pressure, etc). On the other hand, someone who eats less than 30% fat, if they’re counting calories, might indeed eat fewer calories total. That would mean that in some parts of the day, their body might be burning its own fat stores perhaps. OR, if they eat more than 60% of calories as fat, they’re probably eating less than 100 grams of carbs, or some other lower amount which means they’re low enough on the curve to lower their insulin levels and stay in fat burning mode more often, and be less hungry, and thus become more insulin sensitive….

    “This is all conjecture, of course. Another way to look at the 30-60% issue is that, adding a moderate amount of fat into a lab animal, or a person’s, diet, then seeing weight gain, is often used as a justification for saying higher fat just won’t work. The low carbers, I think, are emphasizing that when a little bit more fat doesn’t work, sometimes it’s because the person really needs a LOT more fat.”

  • 5 Chuck // Jul 23, 2011 at 11:00 am

    I was diagnosed Type 1 or 1.5 at age 30, 29 years ago. I was fortunate to have a physician who was on the forefront of “tight control” and fared well, according to my subsequent physicians – I move every 5 years or so.

    Three years ago I began using a pump and my weight increased by 40 lbs. Even with 1 hour workouts of cardio and strength, 5 times a week, I couldn’t drop the weight.

    Then I discovered Paleo/Primal via Cordain, Wolf and Sisson and at the urging of Sisson’s writtings I tried it for 30 days. After seven days of remarkable mg/dl there was no going back.

    In the last four months I’ve lost 40 lbs of fat, gained two lbs of muscle and my last A1c was 5.3. May basal insulin has been reduced by 33% and I bolus only if I eat +20 g CHO of fruit. Lipid panel was normal.

    I’m working toward a 12-15% body fat. This is important as I enjoy long distant bicycling and this will provide me with a good power to weight ratio. I completed a133 miles in 9.5 hrs last week with energy to spare. I use an adaption of Cordain’s recommendations for Paleo endurance eating when I ride, which includes high glycemic foods and for me the slightest and occasional bolus.

    My physician was concerned about lows but looking at my numbers he was comfortable with what was going on because the occurrence of lows was less frequent than his general diabetic population.

    While I’m not given to conspiracy theories, the USDA and ADA are at the very least negligent in their recommendations.

    David, is there a Paleo Diabetic website? If not, maybe you could add a section to yours.

    Thanks for all you do provide.

  • 6 David Mendosa // Jul 23, 2011 at 11:16 am

    Dear Chuck,

    Loren Cordain has a blog at http://thepaleodiet.blogspot.com/ but it has not had any recent activity.

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