Deep Thoughts

(This blogpost is mostly about me and not about science. For those who come here for the science, please feel free to skip it.)

As time passes, it becomes more and more obvious that the low-carb lifestyle offers many metabolic benefits. It reduces blood sugar and blood insulin, lowers blood pressure, decreases triglycerides and raises HDL cholesterol. For a summary of these effects, check out my blogpost reviewing three low-carb studies published in three well-respected journals.

Nevertheless, the reason most of us started doing low-carb was not for its health benefits but for weight loss. And unsurprisingly the three studies also showed that low-carbing works as well or better than other forms of dieting for weight loss and weight maintenance.

Nearly eight years ago I read Dr. Atkins' New Diet Revolution (DANDR)and was struck by the fact that his approach to dieting was based on solid science and was presented in a way that was easy to understand. Before long, I knew the book inside out and followed it to the letter. I did indeed make my goal weight and have (almost) maintained it since then. (For those who like to see if I practice what I preach, I report my weight weekly on the Maintain Lane at Low Carb Friends.) Recently I began re-reading DANDR and had a couple of thoughts that I'll share with those of you who are using the low-carb lifestyle to lose weight. You can decide if they're deep thoughts or not.


1. Low-carb is good for weight loss, but it's not perfect.

The low-carb boards on the internet are populated with hundreds of people who have lost some weight doing low-carb, but have not managed to make it to goal. It goes without saying that if you lose weight on low-carb, you have to keep doing low-carb or the weight will come right back. But why is it so hard for us to get all the way down to our goal weight even if we keep our carbs strictly below 20 or even very close to zero?

In DANDR, Dr. Atkins says to count carbs not calories. One of the reasons this works is that low-carbing produces what Dr. Atkins called a "metabolic advantage." As we change over from metabolizing carbs for energy to metabolizing fat for energy, our bodies perform somewhat inefficiently. If we use Ketostix, we'll see that we excrete a large amount of unused energy in the form of urinary ketones. We also tend to experience an increase in body temperature. However, after a year or so of low-carbing, we become fully keto-adapted and our bodies are able to utilize nearly every scrap of the energy we consume. The Ketostix no longer change color.

One of the things that doesn't change over time is that low-carbing keeps our insulin levels lower than they would be on a high-carb diet. This means that our bodies are better able to mobilize our stored fat, and we don't experience the constant hunger that results when we can't properly access our fat stores. In addition, foods that are high in fat and protein tend to satitate us much more quickly than do carb-rich foods. Finally, the ketosis produced by low-carbing has the wonderful side effect of decreasing our appetite.

So by counting carbs we can lose some weight, and we may even lose a large amount of weight. However, the sad truth is, Calories Count. In the long run, the number of calories we take in must be less than the number of calories we expend. Granted, when we low-carb we may be able to burn more calories than our peers thanks to a faster metabolism, a greater willingness to exercise, and the loss of ketone calories by excretion. But we can't fool Mother Nature. In order to lose weight, the calories in must be less than the calories out.

I had suspected this before, but just this week I've proven it to myself by using Dr. Atkins' Fat Fast. I have done low-carb and I've done zero-carb, but the most weight I could get off was a fraction of a pound a week. By doing the Fat Fast, I've stayed at 1000 calories per day and the weight has fallen off. Yes, it's nearly zero carbs, but as I said, I've done zero-carb and have lost weight at a snail's pace, if at all. What I haven't done before is intentionally cut my calories. To be sure, the Fat Fast is not a healthy long-term weight loss plan, but it does show that if carb counting alone isn't producing a weight loss, carb counting plus calorie counting is the next necessary step.


2. Too much protein can act like too many carbs.

While Dr. Atkins had lots to say about controlling our carb intake, for some reason he didn't warn his readers that eating too much protein can mimic the effect of eating too many carbs. People who have type 1 diabetes, or people who have type 2 diabetes and are using insulin, know something that most of the rest of us don't know. Eating excess protein raises your blood sugar.

Back in the summer of 2009 I wrote three blogposts on this topic: Protein Intake and Blood Glucose Levels, Observations on Protein Intake in Low-Carbers and How Can Eating Excess Protein Raise Blood Glucose? My readers participated in gathering data for these posts, and what we discovered was that when excess protein is consumed, it is converted to glucose. In younger people this did not show up on the blood glucose meter. In most cases they were able to secrete enough extra insulin to maintain a postprandial blood sugar in the vicinity of 85 mg/dl. However, in both low-carbers and zero-carbers over 50, it was not unusual to have a 30-40 mg/dl rise in blood glucose after consuming a large amount of protein.

Dr. Atkins did say that eating lots of protein has never been shown to cause kidney damage. And consuming good quality protein is essential to maintain our bones, muscles and organs. But for those of us who watch our carbs religiously, it's also important to watch our protein intake. A large excess of protein acts like carbs and can have a similar effect, especially in people who are prone to diabetes.



In closing, most of what Dr. Atkins said in his books has stood the test of time. But from my personal experience, a couple of points seemed to go missing. For those who are having a hard time making it to their goal weight, it might be helpful to consider (1) the importance of counting calories and (2) the carb-like effects that can be caused by excess protein intake.

Bigger

Thanks to the work of TV doctors, the American Heart Association and the American Diabetes Association, most Americans are convinced that a high fat intake is bad and exercise is good. As a result, knowledgeable Americans try to avoid fat and get at least some exercise. They eat meat that is as lean as possible, they use butter substitutes on their toast, and they do their best to emphasize high-fiber, low-cholesterol foods. They try to walk or jog regularly, and some even manage to buy memberships at a gym. How's that working out for us?

Not very well, according to a recent study in the British journal Lancet. The article carries the rather long title National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. The authors measured worldwide obesity in terms of BMI or body mass index, which compares a person's weight to his or her height. A BMI between 25 and 30 is considered overweight, and a BMI over 30 is considered obese.

Worldwide vs. U.S. obesity
The bottom line of the study was that, between 1980 and 2008, worldwide obesity has approximately doubled. For adult men, the percentage has gone from 4.8% to 9.8%. For adult women, the percentage went from 7.9% to 13.8%. And that wasn't all. Obesity-wise, America has left the average world citizen in the dust. In 2008, the number of obese American adults was not just one in ten. It was one in three.

Not only that, during nearly thirty years, the U.S. saw the fastest rise in BMI, about 1 full BMI point per decade, to an average BMI of 28 in 2008. In an interview, one of the lead authors of the study, Majid Ezzati of the Imperial College in London, suggested that remedies might include taxing sugar-containing foods and encouraging transportation by bicycle.

Some good news
Dr. Ezzati noted that, despite their increasing BMIs, the richer countries of the world had reduced average systolic blood pressure and average total cholesterol during the years of the study. This is surprising because, according to the National Health and Nutrition Examination Survey (NHANES), overweight and obesity raises the risk of hypertension and high LDL cholesterol. Dr. Ezzati suggested that improved screening and treatment, using less salt and eating unsaturated fats may have contributed to the decline in average blood pressure and cholesterol in the face of steadily increasing BMI. He did not give a relative value to each of these variables and did not note that the richest countries of the world tend to rely heavily on prescription drugs for the treatment of both hypertension and high cholesterol.

Even worse than the U.S.
Do you remember my first blogpost of 2011, suggesting that my readers observe the food choices of the people around them and the health status of the same individuals? The South Pacific island nation of Nauru provides some interesting data in that regard. The Lancet study noted that the people of Nauru have an average BMI of about 34, the highest in the world. Traditionally Nauruans ate ibija fish, coconuts (a very high-fat food) and the fruit of the pandanus tree. After phosphate was discovered on the island, they started selling it and using their income to buy Western foods. Today their most popular dish is chicken marinated in cola, fried, and accompanied by lots of Coke to wash it down. In 1991 the World Health Organization reported that half of Nauruan adults aged 30-64 had diabetes. Although Nauru has free health care, the life expectancy at birth is 59 for men and 64 for women.

Food for thought
One wonders if the rapid rise in obesity in the U.S. might be related to the media-promoted drive to shun fats and embrace carbohydrates, beginning in about 1970. Or if the amazing obesity rate of the Nauruan people may have something to do, not with fat alone, but with the addition of copious quantities of sugar to a fat-rich diet. Just observations, not proof. But it's something to think about.