As the old year comes to an end I thought it would be appropriate to answer some questions that have been posted as comments. I’m so dilatory in getting to the comments that by the time I answer them there are many more posts so the comments (and my answers) don’t get seen by many readers. If everyone thinks this is a profitable thing to do, I’ll periodically go through these as Q and A’s. Let me know.
Comment: Hello I tried to find something on Thyroid in your blog but could not. My husband has lost 30 lbs LC and a coworker told him that after 6 years LC both he and his wife’s thyroid’s are shot and this guy said both he and his wife’s doctor believe it was from low carbing for the last 6 yrs. I do not believe this so I asked my DH (Darling Husband?) if their weight went up and down over the last 6 yrs because I know alot of people lose and gain over and over and that maybe this could be their problem and not because of LC . He said they did the best they could but that they did go up and down in weight. Just wondering about this.
MRE: Wonder no more. There is absolutely no evidence that low-carb diets (nor any other diet that I know of) can destroy a person’s thyroid. I’ve learned over the years from bitter experience that you can never trust what someone says his or her physician said. All patient/doctor conversations have two parts: what the doctor says and what the patient hears or understands. In many cases the two are worlds apart. Granted, sometimes doctors aren’t the world’s greatest communicators, but some of the things patients take away from the conversation are almost unbelievable. Once I took care of a patient who was extremely upset with his regular physician (who was a good friend of mine), and had come to me for a second opinion. He had a cough, some sinus congestion, and all the rest of the signs and symptoms of a typical viral upper respiratory infection. I told him what I thought he had and how he should treat it. He then confided in me that his other doctor (my friend) had told him he had something that was incurable. After this patient left my office, I called my friend. He remembered the patient well, and told me that he had told this patient that he had a virus and that there were really no medicines to treat a virus; one just needed to rest, drink a lot of fluids, etc., in short, all the same things I had told the same patient a day or two later. What the patient heard was that he had an incurable disease.
Comment: As an apnea sufferer I read with interest your latest posting. About a year ago I read that bariatric stomach surgery affected apnea. They were not claiming cure, but that lower levels of CPAP usage were possible(?). The only improvement on CPAP usage is to not need it (CPAP) at all! You state pretty positively apnea can be cured by low-carb diet. Where can I find out more about this and what’s involved to affect this cure? When I looked into the claims of the bariatric surgeons I expected to find improvements were from weight loss, which seemed to be the case. This is against conventional wisdom (re:Mayo Clinic)which stated once you had it, you had it, weight loss or not. Your statments of a cure are extremely heartening! (I am knowledgeable about low carb in general; would like more info related to apnea specifically.)
MRE: Unfortunately, there is very little information out there about low-carbohydrate diets as a treatment modality for sleep apnea. I was basing what I wrote on my own clinical experience taking care of a number of patients with sleep apnea all of whom responded nicely to a low-carb diet.
Comment: I have had reflux for many years and my most recent endoscope shows ‘no problems’, whatever that means…except now there is a hiatus hernia. My wife seems to be the one that hears these things …like Barrett’s most often starts in a hiatus hernia sufferer. Plus there was a recent comment that connected diarrhea (which I always have big time) with reflux medication use. Please comment.
MRE: A hiatus hernia happens when the upper part of the stomach pushes up past the muscular ring that separates the esophagus from the stomach. When this happens the acid produced by the acid-producing cells of the stomach burns the unprotected cells that line the esophagus. In my experience most diagnoses of hiatus hernia are really another way of putting a name to GERD. The diarrhea you are experiencing can come from a couple of sources. First, many reflux and/or antacid medications can themselves cause diarrhea. Second, a couple or recent studies have shown that patients who take reflux medicines and/or antacids can develop infections of Clostridium difficile, a type of bacteria that often cause diarrhea. In my opinion the best way to treat GERD is with a low-carb diet. Not the easiestâ€”the easiest is to take a pill and eat whatever you want.
Comment: A very timely entry, because my husband is scheduled for a sleep study in a few weeks to assess for suspected sleep apnea. He has an extremely narrow airway – when he had surgery last year, the anesthesiologist had to use the smallest adult-size endotracheal tube. He is at a normal weight for his height (5’10” and 170 pounds) and his physician believes there is an anatomical cause of his suspected apnea. In your experience, would a low-carb diet be effective for him? Just curious; we will of course be adhering to any treatment method his physician suggests.
MRE: It wouldn’t hurt to give the low-carb diet a try while waiting for the sleep study. It’s been my experience that such a diet makes an enormous difference pretty quickly.
Comment: What is the stand on products already on store shelves come January first? Do these products need to be pulled? Or is there a grace period for these and other products? Plus do restaurants need to put trans-fat on the menu?
MRE: No, any products on the shelves come January first won’t be pulled. In fact, products can continued to be labeled the old way until the manufacturer runs out of the old labels. Then, theoretically, the manufacturer will print new labels reflecting the new law.
And, no, the new trans fat labeling law does not apply to restaurants. Caveat emptor.
Comment: Re my writing the following: “If anyone is interested I’ll be happy to post on p values and confidence intervals and what they all mean in simplified terms. Just let me know.”
Yes! please do!
MRE: After giving this a little more contemplation it might be a little more difficult than I originally thought to make it really understandable to the mathematically disinclined. But, I’ll try within the next few weeks to make a run at it.
Comment: I did not see a contact link on your sight so I would like to ask a question here in the comments. I have been debating a guy on another message board on the causes of diabetes. I contend that it is an over-consumption of carbohydrates that is causing the large increase in diagnoses and he is arguing that it is fat consumption and the increase in obesity caused by fat consumption that is causing the increase. I have done a search of the web and can find no human studies that support the theory that fat consumption causes obesity or diabetes. Are there any such studies out there? I found many health sites that make the statement that fat consumption is the cause but they do not site any studies to back up there contentions. As far as non-human studies there is a new one out that I was wondering if you could comment on. Here is the link: http://news.yahoo.com/s/nm/20051228/hl_nm/diabetes_dc
MRE: Without commenting on this link, which is a news report (and we’ve seen how inaccurate those can be) of a couple of animal studies that have very little relationship to what happens in humans, I can say that at this time most scientists believe that the root cause of insulin resistance and type II diabetes is a defect in the insulin receptor caused by an intracellular accumulation of fat. The question is, what causes the intracellular accumulation of fat? We know that one thing for sure does: fructose. Carbohydrates in the diet cause the liver to produce more VLDL, which in turn leads to increased levels of triglycerides and increased intracellular fat. I would put my money on the theory that overconsumption of carbohydrates, especially fructose, is the culprit.
Comment: Is the South Beach Diet a good diet to stay on for life? I just started it and I’m doing quite well but by Phase 3 of the diet, it allows more carbs. What do you think?
MRE: Uh, it’s a better diet to stay on than the Ornish diet. If I had thought the South Beach Diet was a good diet to stay on for life I would have written the South Beach Diet instead of Protein Power. Protein Power was an outgrowth of the many years that MD and I took care of thousands of patients (including ourselves) on low-carb diets. Over the years we fiddled with this and that and tried all kinds of variations, and what ended up in Protein Power and then the Protein Power LifePlan was the version that we found worked the best and was the easiest to stick to for the greatest number of patients.
I have a couple of problems with the South Beach Diet. One is that the author goes around the country saying that his diet is categorically NOT a low-carb diet while anyone with half a brain can see that it is. By denying that his is a low-carb diet and doing so in pejorative terms he denigrates the low-carb diet, which is being shown in more and more studies to be the most efficacious diet to treat not only obesity but high blood pressure, diabetes, lipid disorders, and a host of other problems. Off the top of my head a couple of other gripes I have are that the author of the South Beach Diet promotes the use of fructose because it is a low-glycemic” sugar and badmouths saturated fat. The problem with this is that whereas the medical literature is full of articles showing in great detail the metabolic derailment brought about by fructose consumption it fails to show any correlation between saturated fat consumption (particularly on a low-carbohydrate diet) and heart disease or anything else for that matter.
Comment: Hi Doc…I really enjoy your blog. I was doing some shopping this morning…and came across a product with the trans fat label. It was a lo carb coffee creamer. However, thanks to you and Mary Dan, I have learned to read labels….and this supposedly non trans fat product has listed partially hydrogenated oils. Hmmmmm….very curious….
MRE: Good eye. You’ve got to be careful because manufacturers will abide by the letter of the law but not the spirit. As the law is written anything containing less than one gram of trans fat per serving can be labeled as zero trans fat. What do the manufacturers do? They make sure the serving size is such that it contains less than one gram of trans fat and, Voila!, zero trans fat. If the ingredients section lists partially hydrogenated oils, then you’re looking at a trans fat.
Comment: I’ve read through all the archives on here but really didn’t see much addressing the actual carbs in “low-carb” except the passing mention of your typical low-carb fruits. It’d be great to get more insight on the good carbs from time to time and also address the issue of getting enough fiber for a healthy digestive system. Just a couple suggestions.
MRE: Okay, here are my insights. There are no good carbs and bad carbs. Carbs are carbs. They all run up your insulin levels and play havoc with your metabolic system. They are all sugar. Once you accept that, then the question becomes what is my trade off for eating all these metabolically disruptive carbohydrates. If they are packaged as pure sugar, then there is no good trade off. If they are packaged as, say, blackberries then the small amount of carbohydrate is offset by all the antioxidants and other healthful phytochemicals in the blackberries. Same with blueberries, asparagus, tomatoes, and all the rest. It’s a trade off. How much good stuff can I get to make eating the metabolically disruptive carbs worth it.
As far as how much fiber is required for a healthy digestive system, the more I study the situation and think about it, the less fiber I think we need. In fact, if pressed, I would say we don’t “need” any at all. I plan a major post on this very issue early next year.
I think that is all of the comments that are outstanding; if I’ve overlooked someone, it was unintentional. And, I don’t have time to go back and look because we’ve got guests coming for a New Year’s Eve party, and MD is hounding me to put an end to this and help her get everything ready.
I hope everyone has a safe and enjoyable New Year’s Eve.