Last week several of my patients returned to the office for follow up after starting LCHF diets. Its really fun to engage with a person who is making a real effort to improve their own health. I love celebrating victories on the scale/ with the tape measure or with their labs. When the gains are not as much as can be desired I have to put on my CSI detective coat to figure out the problem.
A big problem is with fake food and "diet" food. I have people tell me they are using Slimfast shakes or Cliff Bars or Isagenix meal replacements with low carb. It usually doesn't go well. These things do nothing to suppress insulin and fat storage continues. I see the wisdom of Dr. Westman.
Dr. Eric Westman, a leading low carb researcher and practitioner at Duke University has a mantra he repeats to his patients. "If it's not on page four, don't eat it."
This refers to his diet instruction packet he provides to his patients. The list of approved food appears on page four.
The people who came back struggling are likely to feel that the diet doesn't work if they don't see much results in the first month. I tell them to not pass judgement until the diet is given a proper try and that means staying in the boundaries of the diet.
Here's the link to Dr. Westman's instructions: THE NO SUGAR, NO STARCH DIET
Men’s Fitness features a great article about the ketogenic diet – including experts, therapeutic uses and how the US military uses it.
Men’s Fitness: The Truth Behind the World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: the Keto Diet
It’s good to see that low-carb and ketogenic diets keep increasing in popularity.
It is increasingly acknowledged that the environment that fetuses are exposed to in utero is very important is calibrating the genes that regulate weight and energy expenditure. Overweight mothers beget overweight children not just through genes but through epigenetics.
What is epigenetics you may ask? Certain changes can be made to chromosomes to affect gene expression. Think of it as gene calibration to fit the environment. The environment can cause long term and even permanent changes in gene expression that lead to obesity. Mothers who consume too much refined starches and sugars it may be setting up their babies to expect the same throughout life. Babies who marinate in a super insulin rich environment inside the mother may become insulin super-producers who gain weight easily for the rest of their lives. What is even scarier is that epigenetic changes can be passed to offspring. Check out this New York Times article: nyti.ms/29ypHDI
The most sensible diet for a woman who may become or who is pregnant is one that keeps maternal insulin relatively low. Excessive maternal weight gain is associated with unusually large babies. Focus on nutritionally dense real food that satisfies that provides all essential nutrients, vitamins and minerals, Eliminate low quality processed "foods" that stimulate excessive insulin release.
Ever notice that there are some people who can eat anything they want without gaining weight and other people who can't? Some people manage to stay fat even without overeating. What makes this possible? Its insulin. The pancreas in skinny people makes a small amount of insulin and as a result they make small amount of fat. Obese people make 4-10x more insulin than skinny people and that insulin causes the fat to grow and prevents it from burning off. Insulin in fat people is even higher in the fasted state and spikes higher with meals. Elevated insulin levels shut off fat burning. Fat people simply can not burn fat because their insulin levels are high all the time.
Check out the graph. The three humps represent the insulin bump that occurs with meals, brakfast, lunch and dinner. The normal subjects have much smaller spikes with meals. Even between meals, lean people have lower insulin levels. This is it. The reason why the lean are lean and the fat are fat.
The best way to reduce the insulin spikes is to cut out carbs. Carbs strongly stimulate the pancreas to make insulin. Fat doesn't.
I was very pleased with the labs of one of my diabetics recently, a 69 year old guy who was seeing another doctor before coming to me. He wasn't paying close attention to diet and was on a couple diabetes pills including metformin. His Hemoglobin A1c, that blood test that roughly correlates to general level of blood sugar (glucose) over the last three months. Lower A1c is better was alarmingly high. Less than 5.5 is considered normal. 5.5-6.4 is pre-diabetes and diabetes is 6.5 and up. The American Diabetes Association thinks < 7 is good enough. It is difficult to get a1c less than 7 safely when using medications. Medications can accidently drop the blood sugar dangerously low on occasions. They permit sugars to run higher to avoid going too low.
Back to my patient: When his initial blood work showed his A1c to be an alarming 10.5 I gave him two options. 1. The usual ADA diet (45-60% carbs) and increase his dosages of pills and maybe add some more pills. Option two: eat less carbs/sugar and eat more wonderfully satisfying fat. Oh, and I would not increase his dosages. He quite wisely chose option 2. Improved diet is the only way to truly treat diabetes, meds just mask the problem.
RESULTS IN THREE MONTHS:
By cutting carbs and increasing healthy fats his A1c dropped from 10.5 (pretty bad) to 6.5 That's almost out of the diabetic range. If sticks with it, he will drop lower. When I called him to tell him the good news he says that he feels great, the food is good and he is not hungry. By not using meds there is no risk of side effects and hypoglycemia; And one more thing, no pharmacy bill. Did I mention diabetes pills are expensive? Insulin is really expensive. I forgot to ask him what happened to his weight. It's probably down. With meds, it usually goes up.
Eric Sodicoff MD
Member: Obesity medince Association