Living Low Carb (65 page)

A recent post on an Internet diet board asked the following question: “Do people die from taking ephedra?” The question produced the single best response I’ve ever seen: “No, people die because they are
morons
.”

When ephedra has been used in supervised weight-loss research studies, it’s been used in the dosage of 60 milligrams per day in three divided dosages (20 milligrams each), combined with 200 milligrams of caffeine per dose. In every supervised study using this dose, it has not shown itself to be dangerous, and the side effect of “jitters” was usually pretty well tolerated. It is
not
—I repeat,
not
—for people with high blood pressure; for people who are sensitive to ephedrine or caffeine; for people who have any kind of heart, kidney, or liver problems; or for people who are on
any
medication, including over-the-counter meds (unless cleared by a doctor). Ephedra works by stimulating brown-fat metabolism, thereby increasing the bodily production of heat (upping your metabolism
slightly
) and by suppressing your appetite. The possible side effects are very annoying and include nervousness, insomnia, and possibly dizziness. The benefits in the way of fat loss are very mild but probably do exist.

But here’s the thing. While I’m no great fan of ephedra, it has also been blamed for an awful lot of things it doesn’t deserve. When a college athlete dies on the football field while practicing in 100° heat in full uniform, dehydrated, with a few hundred milligrams of ephedra plus who knows what else in his system, it’s not exactly fair to blame ephedra. A recent field trip to my local vitamin shop uncovered ephedra pills with 250 milligrams
per pill
—more than ten times the recommended dose—and believe me, there are people who are taking several of these pills at a time. Let’s also keep in mind that there are a couple of thousand deaths directly related to aspirin per year. Ephedra in small amounts, under controlled conditions, is not dangerous.

I’m more concerned about the adrenal burnout factor with ongoing ephedra use. This drug
is
a metabolic stimulant, and like any stimulant, it taxes the adrenal glands, which over the very long haul can not only hamper your weight-loss efforts but damage your health.

This discussion is probably moot, however. “Its time is over,” says Dr. C. Leigh Broadhurst, who has herself used ephedra without incident. There’s just too much bad publicity and public outcry about it, and it will almost certainly be taken off the market soon. The new “ephedra-free” diet pills have simply replaced ephedra with
Citrus aurantium
(bitter orange), which has many of the same fat-burning/appetite-suppressing effects but doesn’t yet have the bad rap. (See next question.) If you
do
use ephedra, make sure you do not fit in any of the categories mentioned above, and never take more than the recommended dosage.

What About Over-the-Counter “Ephedra-Free” Diet Pills?

The new “ephedra-free” diet pills have simply replaced ephedra with bitter orange (
Citrus aurantium
), an herb that contains the active ingredient synephrine. Synephrine is chemically very similar to ephedrine and pseudoephedrine and has similar effects in terms of providing an energy boost, suppressing the appetite, and increasing metabolic rate and caloric expenditure. By stimulating specific adrenergic receptors, it is theorized that synephrine stimulates fat metabolism without the negative cardiovascular side effects experienced by some people with ephedra (also called “ma huang”).

Bitter orange usually contains between 1% and 6% synephrine, but some manufacturers boost the content to as much as 30%.
⁶
It
does
have a thermogenic (fat-burning) effect.
⁷
In animal studies, synephrine caused weight loss, but it also increased cardiovascular problems.
⁸

Bitter orange can also increase the side effects of many medications, including (but not limited to) Xanax, Zocor, Sudafed, Buspar, Celexa, Zoloft, Allegra, prednisone, Meridia, Viagra, and a number of blood pressure medications.
⁹
Do
not
take bitter orange if you have high blood pressure or are pregnant.

The bottom line is this: it
is
a stimulant, and the same cautions about other stimulants (like ephedra) apply. Just because the pill is “ephedra-free” does not mean that you should use unlimited amounts of it.

What’s in Those “Fat-Burning” Formulas I See Everywhere, and Do They Help with Weight Loss?

A recent field trip to my local vitamin store to inspect a dozen of these formulas—labeled everything from “metabolism boosters” to “fat burners” to “lipotropics”—revealed a pretty standard revolving door of ingredients. Most used some combination of:

•  
bitter orange
(
Citrus aurantium
), a stimulant that increases metabolism (thermogenesis) slightly and is discussed above (see “What About Over-the-Counter ‘Ephedra-Free’ Diet Pills?”)

•  
guarana
, which is herbal caffeine

•  
white willow bark
, which is basically aspirin and really doesn’t add anything to the mix

•  
green tea extract, a.k.a. EGCG
(epigallocatechin gallate), which
does
have thermogenic properties (see chapter 9)

Combinations of these ingredients can definitely suppress appetite, give you the jitters, and maybe, just maybe, burn a few extra calories.

Some “fat-burners” include a mix of carnitine and chromium (both of which are discussed in
chapter 9
). They almost never contain the best form of carnitine (tartrate) and rarely contain more than 500 milligrams (most nutritionists think the minimum amount necessary to impact fat-burning in an overweight person is 1,500 milligrams). As far as chromium is concerned, while I
have
seen formulas with 200 micrograms (the absolute minimum needed), I saw one that loudly proclaimed “contains chromium” and actually had a ridiculously low 13 micrograms. Understand that the amount most often given to people with blood-sugar problems is in the neighborhood of 600 to 1,000 micrograms; 13 micrograms would do absolutely nothing and is only there so that the manufacturer can say “contains chromium”—a complete rip-off.

Other ingredients that show up in the formulas, especially the ones labeled “lipotropics,” are inositol, an essential nutrient and relative of the B family, and choline, another relative of the B family that mobilizes fat. Both choline and inositol (plus methionine) are involved in the liver’s ability to process fats, so there’s reason to think that these nutrients might help the liver move fat through it. If a sluggish liver is part of the reason you’re holding on to fat, these nutrients could be helpful. As lipotropics go, I like the Fat Flush Weight Loss Formula from
http://www.unikeyhealth.com
, which contains reasonable amounts of choline, inositol, and methionine, plus the good form of carnitine, 400 micrograms of chromium, and an herbal mix that’s good for the liver.

The other pair of ingredients often found in these formulas are tyrosine, an amino acid helpful for improving mood, and phenylalanine, an essential amino acid that can be converted into tyrosine. Both of these are precursors to dopamine, a neurotransmitter that makes you feel peppy and bright. Tyrosine is needed for the making of thyroid hormone, but it is highly unlikely that tyrosine will boost low thyroid, even though some supplement makers claim it does.

The important thing is to read the ingredients on the labels of the products you are considering. These formulas vary widely in their effects, depending on the amounts and quality of the ingredients included. At worst, they do nothing. At best, they’ll give you a bit of a speedy feeling and maybe increase metabolic rate by a very small amount.

Ketosis

What Is Ketosis?

Ketosis is a term used to describe what happens when the body switches to fat as its main source of fuel, which is exactly what you want to happen when you’re using a low-carbohydrate diet to lose weight. When fat is the main source of fuel, there is an increase in the number of ketone bodies made as a by-product of fat metabolism. Ketones can be measured in the urine by means of ketone test strips.

Is Ketosis Dangerous?

Absolutely not. Ketones are a natural part of human metabolism—your body is always producing ketones. When you are in benign dietary ketosis, you are just making
more
of them, because fat, rather than sugar, has become the main source of fuel for your body. A strict ketogenic diet has been very successful in treating epilepsy in children and has been used for years at the Children’s Hospital of New York-Presbyterian.
¹⁰
Children have been kept on it for years at a time. If there were dangers associated with ketosis, we would have heard about it by now. (For a full discussion, see
chapter 6
.)

It was absolutely amazing to me when I really studied ketosis and found out that almost everything I had heard about how dangerous it was was utter hogwash.

—Dana McG.

Do I Need to Be in Ketosis in Order to Lose Weight?

No. First of all, ketosis doesn’t
cause
weight loss. You can easily be in ketosis eating 10,000 calories of fat a day, but you’ll never lose any weight that way. Ketosis is simply a by-product of fat burning. There have been many people who’ve lost weight on low-carb diets without being in ketosis, and there are many who have been in ketosis and not lost weight. Ketone loss, in the urine and the breath, accounts for only about 100 calories a day.
¹¹
That said, there are some extremely metabolically resistant people who truly seem to do much better on Atkins-like induction plans in which they
are
in ketosis, carbohydrates are kept to very low levels (20 to 30 grams or so a day), and calories are moderately low. You may want to go into ketosis just to get started, but the vast majority of people can lose weight over time on a low-carb diet by hovering around the border of ketosis. And as we saw in
chapter 7
, many of the programs don’t emphasize ketosis at all—some programs deliberately keep you at a slightly higher carb level (50 to 90 grams a day) to prevent it. The point is this: if you keep your carbs low enough (and your calories reasonable), you will be lowering your insulin levels and breaking down fat. Exactly how low they have to be for you to continue to lose weight is something you will have to experiment with.

Why Don’t My Ketone Test Strips Show a Positive Reading?

There are a number of reasons you may not get a positive reading, and you probably don’t need to be too concerned about it. There are three ketone bodies—beta-hydroxybutyric acid, acetoacetic acid, and acetone—and the strips detect only the latter two, which are less than
¹
/
₅
of the total ketones produced. Beta-hydroxybutyric acid goes completely undetected. So it’s entirely possible that you might not test positive on the ketone strips, yet if you performed a more sophisticated urinalysis, you’d find plenty of ketones floating around!

Other things can influence whether the strips change color, such as how much water you’re drinking. If you’re drinking a lot, which you should be, that’ll very likely keep the strips from turning a deep color.

Of course, the possibility exists that they’re not turning color because you’re not in ketosis, probably because you are eating more carbs than you think or there are hidden carbs in your food choices.

Food and Water

How Many Calories a Day Should I Be Eating?

For weight loss, a good rule of thumb is to take your goal weight and multiply by 10. If you’ve got more than about 25 pounds to lose, multiply your
current
weight by 10 and then deduct 500 calories from that number. This formula doesn’t work as well if you are at a relatively low weight—say 125 pounds—and are trying to drop only a few pounds. You should never, ever let your calories fall below 1,000 per day.

If you’d prefer not to do any calculations, you can remember it this way: the average weight loss diet for men is about 1,500 calories and the average for women is about 1,200.

Remember that these formulas are only approximations. Every person’s situation is going to be different, based on one’s own metabolic and historical factors, genetics, age, hormonal profiles, muscle mass, activity levels, and so on. The calorie calculators found on diet Internet sites woefully overestimate how many calories you “need,” especially for weight loss. Ignore them. And remember that calories are important, but they’re not the whole picture; the kinds of food you eat determine what messages are sent by your hormones, and the hormones control the whole shebang.

I’m a Vegetarian. Can I Low-Carb?

Yes, depending on the type of vegetarian diet you are following. If you’re a vegan, it’s going to be next to impossible; but if you can eat eggs and whey protein, it’s definitely doable. If you can also eat fish, it’s a snap. Check out
The Schwarzbein Principle Vegetarian Cookbook
(see “The Schwarzbein Principle,” page 226), as well as the cookbooks in the Resources section.

A note on vegetarianism: if you’re avoiding eating animals for spiritual, ethical, or moral reasons, I am in great sympathy with you. I myself am a believer in animal rights, am a card-carrying member of PETA, and understand your feelings profoundly. But if you’re doing it for health reasons, I urge you to rethink your position. Most people do better with some animal foods, and some people do a
lot
better on a
lot
of animal foods. Maybe one way to reconcile this for yourself is to patronize only those who sell meat from animals that have not been factory-farmed, have been
organically
raised, and have had a good and happy life. Just something to think about.