The World Turned Upside Down: The Second Low-Carbohydrate Revolution (4 page)

Rule 3. If you have diabetes
or
metabolic syndrome,
carbohydrate restriction is the "default" approach, that is, the one to
try
first.

Almost everyone is now within two
degrees of separation of
somebody who has diabetes. Diabetes is a disease of carbohydrate
intolerance.
In type 1, there is a substantially reduced or total inability of the
pancreas
to produce insulin in response to carbohydrate. Type 2 is characterized
by poor
response of the cells of the body to the insulin that is produced
(insulin resistance)
as well as progressive deterioration of the insulin-producing cells of
the
pancreas. The defining symptom and major cause of the pathology is high
blood
sugar. The idea for treatment is simple. If diabetes is a disease of
carbohydrate intolerance, it seems reasonable that adding dietary
carbohydrate
would make things worse. This expectation is generally borne out. It
may seem
odd to appeal to common sense in an age when the CEO of a failed public
company
can pay himself a hundred million dollars, but that's how it is. There
are
people with diabetes who can tolerate greater or lesser amounts of
carbohydrate
but, for most people, it works exactly as it is supposed to and dietary
carbohydrate restriction may even be best for those people who can
tolerate
higher carbohydrate. And there are no experimental or clinical data
that show a
contradiction. I will make the case that diabetes, because of its ties
to
insulin represents a kind of extreme case of other metabolic
conditions, like
obesity.

It is amazing that anyone would
suggest anything other than
carbohydrate restriction for people with diabetes, but the low-fat
propaganda
is very pervasive. Many "diabetes educators" still recommend reducing
fat
rather than reducing carbohydrates for people with diabetes, a
testament to the
triumph of politics over science.

If you are on medication, you have to
do a low-carbohydrate
diet with your physician: carbohydrate restriction will have the same
effect in
lowering blood glucose as many medications and you need to avoid
hypoglycemia
(low blood sugar). Some people see this as the single best argument for
carbohydrate restriction; in most diseases, reduction in medication is
considered a sign of success. Generally, your physician, if he or she
has any
experience with carbohydrate restriction, will reduce or eliminate your
medication before putting you on a low-carbohydrate diet.

Doing it:
Eat to the
meter
.

This is the principle used by people
with diabetes. The
meter is the glucometer which does what it sounds like. It measures
blood
glucose. If the food you just ate causes a spike in blood sugar, that
is a sign
to avoid that food. Oddly, diabetes educators may tell you that if the
food
spikes your blood glucose, that means you need more insulin to deal
with that food.

Those of us with a weight problem
might sensibly eat to what
I call the ponderometer, the bathroom scale. More generally, eat for
results as
in the butcher, above, who is not out of pork chops. If the experts
tell you to
eat more whole grains and they seem to be making you fat, stop!

Doing it: The best
exercise is the one that
you Do.

The nutrition world agrees on very
few things but there are not
many detractors from the principle that exercise is inherently
beneficial. It
is not really good for weight loss by itself unless you're a
professional
athlete or in basic training, but it does enhance the benefits of
dieting. Some
of the effects are vascular, that is physiologic rather than
biochemical, so it
is hard to pin down the relation to nutrition but finding any agreement
in any
field is always a good thing.

The best exercise, like the best
diet, is the one that you
can get yourself to do regularly. That may be an individual thing.
Proponents
of each type of exercise think that the others are no good but you can
find one
that fits your style or, more important, one that you get in the habit
of
doing, even if it is not your style. I am personally a believer in
slow-burn
(slow repetition with heavy weights)
[15]
.
It is probably
best for people who think that they are entering old age, in that it is
efficient: you can get perceptible benefit from one set of 90 seconds.

An encouraging development in
exercise physiology is the
technique that they call "periodization," a pretentious way of saying
that it
is good to mix up different types of exercise on different days. You
now have
official sanction for switching between different types of exercise
because you
are bored.

Doing it: Prepare for
battle. Prepare for
victory.

Even the easiest diet has problems,
ups and downs and
temptations. You do have to think about what you are going to do in
different
situations. If you know that the celebratory business meeting will be
serving
pizza, go in with a plan. (Eat beforehand, decide if you are
comfortable enough
with the group to eat the top off the pizza, etc.) There are techniques
for
staying on your diet and dealing with hunger, but you also have to
prepare for
success, that is, what to do, if you actually aren't hungry. If you
decide to
do a low-carbohydrate diet and you sit down to the recommended broccoli
and
steak and you are full after eating one quarter of what you usually
eat, you
should be prepared to stop. In restaurants, doggie-bags are good unless
it is
your first date but then you'll probably be on your best behavior
anyway. What
should you do if the birthday cake looks disgusting and you don't
want
to eat it? It is,
after all, your boss's birthday. There are many techniques. Put the
birthday
cake on your plate. Walk around the room stabbing at it with your fork.
After a
while you can put in on the sideboard with all the other half-eaten
pieces of
cake.

Doing it: Minister to
yourself. Cross-examine
experts.

Doctors don't study nutrition.
Nutritionists don't study
medicine. Neither study much science. It is a stereotype, or at least
an
exaggeration – there are many great scientists trained as MDs – but
stereotypes
come from someplace. There are no special requirements for being able
to do a
good scientific experiment. Having an MD, however, is not sufficient to
qualify
you as an expert on anything except your medical specialty. You have to
learn a
lot yourself and you have to ask the experts to justify their opinions.
In the
end, you are your own expert. Go for results rather than experts. Isn't
this
the same as
Rule 4
"Eat to the Meter"? Let's call
it a corollary.

Perhaps the hardest thing to deal
with is the idea that the
whole field of professional nutrition might be fundamentally flawed. It
is
genuinely hard to understand that the progression of warnings about how
red
meat or white rice will kill you might not only be contrary to your own
intuition but might actually be scientifically meaningless. It is hard
to
accept the idea that the dozens of publications coming out of the
Harvard
School of Public Health and published in the New England Journal of
Medicine
are of extremely poor scientific quality. Where's peer review? Where's
expert
training? All we can say is that there are many precedents in medicine
and you
have to be open to the possibility.

Doing it: The
low-carbohydrate principles.

My personal preference is for
principles over formal
"diets." However, if you like diets, that is, something with formal
instructions, there are millions: The American Diabetes Association
diet (they
deny that they have one but they do), The Russian Air Force Diet which
is very
effective if you don't go AWOL; typical breakfast is a cup of coffee.
(Undoubtedly better than during WWII but it is not a good idea to go
AWOL in
the Russian Armed Forces). There is also The Goomba Diet, by and for
Italian-Americans (could I have made this up?). The paleo diets are
like the
Mediterranean diet in that nobody really knows what they are but they
are
generally low-carb. Numerous books and websites will give you precise
instructions.

For low-carb diets, The New Atkins
diet
[16]
,
Protein Power
[17]
and the
Art and Science of
Low-Carbohydrate Living are a good start. Numerous books and web-sites
give you
excellent recipes. If your MO is to just fit the general strategy to
your own
lifestyle, these are the big principles:

Doing low-carb: Your
carbs come from
vegetables.

The simplest way to break into
carbohydrate restriction is
by brute force: no rice, no potatoes, no bread and no pasta... and, of
course, no
dessert beyond small amount of fruit. As above, if you normally eat a
steak
with potatoes and broccoli, leave out the potatoes. This may be all you
have to
do. If you are now full on this lower amount of food, put the rest in
the
refrigerator, or throw it out (if you're worried about starving people,
give
money to the appropriate charity). If you want to add something back,
you can
have more steak but, in fact, most people don't want more steak even if
they
can afford it. So, it's usually more broccoli. Vegetables contain some
carbohydrate but the important thing is that you don't really have to
count
anything. You are likely to have real success with this simple
approach. If you
have diabetes or metabolic syndrome, you are virtually guaranteed to
get better
although, again, if you are taking medication, you have to do this with
a
physician.

To go beyond the basic principles you
need to understand
that there is both a graded response ― the benefit is roughly
proportional to the amount of carbohydrate that you remove from your
eating
― as well as a breakpoint. The breakpoint, where there is enhanced
weight
loss, is generally considered to be marked by the presence of ketone
bodies in
the blood (ketosis) and urine.

Strictly speaking, the presence of
ketone bodies in the
urine is called ketonuria (although frequently taken as a sign of
ketosis). The
ketone bodies indicate a significant switch from reliance on
carbohydrate as an
energy source to a new predominantly fat-based metabolism. At this
point, you
will have to attend more precisely to how much carbohydrate you
actually
ingest. The simple rules will likely get you in the range of 100 g/day
which is
a big switch for most Americans. To go into ketosis you will have to go
below
20-50 g/day (different people have different cut-offs).

The popular Atkins diet recommends
that you stay in ketosis
for two weeks and then gradually add carbohydrate back presumably for
reasons
of taste although possibly on the principle that you want to be close
to what
you are used to but not making yourself fat. Many people stay in
ketosis
indefinitely but it requires more attention and usually a period of
adaptation.

My survey of the Low-Carber Forums
(an internet support group)
found that most people on low-carb diets eat all the non-root
vegetables that
they want and don't really count grams of carbohydrate
[18]
even though most of these people thought that they were on the Atkins
diet. At
least thinking that you are on a formal diet may not be too
restrictive.

If you eat at home a lot it is good
to learn how to cook
vegetables. Like most such tasks, cooking vegetables involves investing
large
amounts of time in deep thought and procrastination and a relatively
small
amount of time actually doing the job. The solution is usually to time
yourself. It's always way less time than you think. So find the
appropriate
vegetable dishes for either quick cooking or for cooking in advance.
Cauliflower
is a kind of representative of low-carb diets and you can make a
steamed
cauliflower in a few minutes. Eat it straight or use it later for other
very
quick recipes. Cooking vegetables has a number of peculiarities
described in
Chapter 25
which
includes a few recipes to get you started.

Doing low-carb: Don't
be afraid of fat.

Fat
is what people eat.
The anti-fat campaign has been one of the truly
bizarre phenomena in the history of science – in this most scientific
of
periods, we have simply ignored the failures of the numerous
experimental tests
of the low-fat idea. Proponents of fat reduction have done all the big,
expensive studies. They've put it to the test. The experiments almost
always
fail, but they keep doing them on the chance that something new will
happen, on
the chance that some unexpected change in the universe will make the
saturated
fat that they know is so bad, actually have a bad outcome. It's got to
be.