Follow up on the Israeli low-carb study

I want to discuss a couple of interesting follow ups from the Israeli low-carb study that I posted on a couple of weeks ago. But before I do, I’ve got to apologize for the lack of posting and comment answering for the past week or so. Since we got back from our trip our computers have been acting up. Our internet connection keeps drifting in and out. With the blogging software we use, if we try to save during a time that the internet isn’t connected, everything new gets lost. MD didn’t know that, so she actually managed to put up a post in between outages, which, I suppose, is the luck of the ignorant. I haven’t because I didn’t want to take the risk. Instead I’ve been beating my head against the ground trying to solve the problem. I finally gave up and called the cable company. The guy came out today and discovered that it was a faulty cable modem. He replaced it, so I’m back in business with a lot of catching up to do on all fronts.

One of the questions many people had about the Israeli study was why the recommendation to follow a vegetarian low-carb diet instead of a more meat-heavy low-carb diet? And, in view of this recommendation, what was the final diet the subjects on the low-carb arm consumed? [full text of the study]

Eric Westman, M.D. from Duke University corresponded with the lead author of the paper and asked these questions. Here is the response:

Hello Eric,

This is kind of funny that some could think of a “vegetarian low-carb” diet. Is it a new suggested strategy? could be interesting idea but this wasn’t the case here. Our low-carb diet was based on Atkins, the participants read the book and the recipes were more or less comparable to what you know in the states. Beef is the main red meat. What could be different? People here would not mix in the same meal meat and butter, a salad is considered a very rich one and not a lettuce based, and the main dressing is olive oil. As for beverages, same industry that makes money everywhere.

For example, a plate could include : fish or fried/not bread coated chicken/or red meet, broccoli and mushrooms coated with eggs, roasted eggplants, vegetable salad (peppers, cucumber, green leaves, not lettuce) with olive oil dressing. I understand that some of the low-fat people find it hard to believe that such a low-carb diet was tremendously favorable within 2 years in a well designed study, but these are the facts and the science of tomorrow, with the next long term studies in the pipeline, may confirm or not these findings.

Best regards, Iris [Shai]

As I mentioned in my previous post, I figured it had something to do with the dietary restrictions followed by observant Jews. For those who don’t know, one of the major dietary restrictions is the avoidance of mixing meat and dairy products. Observant Jews go to great extremes in adhering to this tenet of Jewish law. They have separate dishes, silverware, and pots and pans for meat and for dairy. Those who can afford it have two dishwashers – one for meat, one for dairy. Kosher restaurants are either meat or dairy. If you go to a dairy kosher restaurant you can have all the milk, butter, cream, ice cream, cream sauce, etc. you want. You can have pasta, fish (not considered meat), and pretty much anything not made of meat. Cheese, although obviously a dairy product, is often missing because cheese is made using rennet, which is an animal product and considered meat. At a kosher meat restaurant you can eat all kinds of meat (as long as it’s kosher), but you can’t have butter or cream for your coffee or any kind of cream sauce. Or anything made from milk or cream. You can have faux dairy products, i.e., margarine and trans fat-laden non-dairy creamer for your coffee or in desserts. There are pretty high rates of heart disease in Israel, and many believe one of the causes is the large amount of trans fats Israelis consume in an effort to follow Jewish law.

John Tierney in his New York Times blog posted an interviewed with Gary Taubes about the findings of this low-carb study with respect to saturated fats. Here is what Gary had to say:

These trials are fundamentally tests of the hypothesis that saturated fat is bad for cholesterol and bad for the heart. They’re not just about which diet works best for weight loss or is healthiest, but what constitutes a healthy diet, period. (This is the point I made in my Times Magazine story six years ago). Specifically, these low-fat/low-carb diet trials, of which there are now more than half a dozen, test American Heart Association (A.H.A.) relatively low-fat diets against Atkins-like high-saturated-fat diets.

In this last test, the A.H.A. diet was about 30 percent calories from fat, less than 10 percent calories from saturated fat; the low-carb diet was almost 40 percent calories from fat, around 12.5 percent saturated fat. In this particular trial, as in all of them so far, the high-saturated-fat diet (low-carb or Atkins-like) resulted in the best improvement in cholesterol profile — total cholesterol/H.D.L. In this Israeli trial, the high-saturated-fat diet reduced L.D.L. at least as well as the did the A.H.A. relatively low-fat diet, the fundamental purpose of which is to lower L.D.L. by reducing the saturated fat content.

So here’s the simple question and the point: how can saturated fat be bad for us if a high saturated fat diet lowers L.D.L. at least as well as a diet that has 20 to 25 percent less saturated fat?

It could be argued (and probably will be) that the effect of the saturated fat is confounded by the reduction in calories, but the A.H.A. diet also reduces calories and in fact specifies caloric reduction while the low-carb diet does not. It will also be argued, as Dean Ornish does, that the source of the saturated fat was not necessarily meat or bacon, but beans or other healthy sources.

But the nutritional reason why meat has been vilified over the years, is that it’s a source of unhealthy saturated fat. It’s not that meat per se is bad — unless you buy the colon cancer evidence, which has always seemed dubious — it’s that the saturated fat in meat makes it bad. So the argument about the source of the saturated fat is irrelevant.

The question hinges on whether saturated fat raises cholesterol and causes heart disease. One way or the other this trial is a test of that hypothesis. It’s arguably the best such trial ever done and the most rigorous. To me that’s always been the story. If saturated fat is bad for us, then these trials should demonstrate it. They imply the opposite.

Why does the A.H.A. continue to insist that saturated fat should be avoided, if these trials repeatedly show that high saturated fat diets lead to better cholesterol profiles than low-saturated fat diets? And how many of these trials have to be done before the National Institutes of Health or some other august institution in this business re-assesses this question? After all, the reason the food guide pyramid suggests we eat things like butter and lard and meats sparingly (and puts them high up in the pyramid) is that they contain saturated fat. This is also the reason that the A.H.A. wants to lower even further what’s considered the safe limit for saturated fats in the diet.

More here.

It’s nice to know that at least one person at the New York Times has good sense (nutritionally, at least). Tierney had a piece in today’s Science section that debunks a handful of what he considers scientific myths that people spend time worrying about. I don’t know if I agree with him that all these ‘myths’ are really myths, but I completely agree with his take on the hot dog.

Killer hot dogs. What is it about frankfurters? There was the nitrite scare. Then the grilling-creates-carcinogens alarm. And then, when those menaces ebbed, the weenie warriors fell back on that old reliable villain: saturated fat.

But now even saturated fat isn’t looking so bad, thanks to a rigorous experiment in Israel reported this month. The people on a low-carb, unrestricted-calorie diet consumed more saturated fat than another group forced to cut back on both fat and diet, but those fatophiles lost more weight and ended up with a better cholesterol profile. And this was just the latest in a series of studies contradicting the medical establishment’s predictions about saturated fat.

If you must worry, focus on the carbs in the bun. But when it comes to the fatty frank — or the fatty anything else on vacation — I’d relax.

On a you’ve-just-got-to-shake-your-head note, go back to the Tierney piece containing the long quote from Gary and read through the hundred plus comments that follow. Doing so gives you an idea of the total nutritional ignorance out there. These are the misinformed people that politicians and bureaucrats pander to when establishing the nutritional guidelines. A sorry state of affairs indeed.

Please note: I reserve the right to delete comments that are offensive or off-topic.

Leave a Reply

Your email address will not be published. Required fields are marked *

39 thoughts on “Follow up on the Israeli low-carb study

  1. Very good post: Is it possible that genetics rule the day regardless of diet with respect to heart disease since most cholesterol is produced by the body? After all there are those who are lucky and their cholesterol is overwhelmingly HDL so diet may not matter to them so much (provided it is healthy for them); and there are those who produce to much small particle LDL and a high fat diet may be beneficial for them, but not enough to avoid medical intervention such as statins. People need to see what diet works for them and have underlying cholesterol subfractions measured: if ok stick to diet your on; if not adjust your diet; if that does not work perhaps medical intervention such as statins. What is your view?

    In my own case i eat no starch, sugar have low triglycerides, 37, and hi small particles, 1795, and LDL-P 1795 and HDL of 40. I eat fish chicken turkey, limited amount of red meat (don’t care for it) and only use olive oil, ground flax, canola oil. No weight issue and plenty of exercise. How long being on a diet like this should it take until large fluffy LDL dominate over small patern B LDL?

    Unless I were a male under 65 years old (which I am) who had had a heart attack (which I haven’t), I wouldn’t take statins irrespective of what my cholesterol level and lipid profile looked like. The only group that has been shown to receive any benefit in terms of survival from statins are men under 65 who have been diagnosed with heart disease (not elevated cholesterol, but heart disease.) Men over 65 with or without heart disease and women of all ages with or without heart disease have never been shown to receive any sort of benefit from statin drugs. All people in all these groups do lower their LDL-cholesterol, but they don’t change their risk for death from all causes, which is really the name of the game.

    It seems to me that maybe you’re going a little heavy on the polyunsaturated fats. Adding saturated fat seems to help raise the large fluffy LDL level.

    Cheers–

    MRE

  2. Hey did you catch the grief my pal Albert Stern’s been giving me in the Tierney blog comments? It’s hard out here for a dipsomaniacal low carb zealot! Even your friends pop up in internet forums and harass you.

    Sorry. I didn’t catch it. I probably got too depressed reading the comments that came before and, consequently, fed my own dipsomania.

    Cheers–

  3. Dr.Mike: Thanks for input on statins; will use less of flax,canola and olive oil- don’t really use much; tablesppoon of flax, and no more than tablespoon of olive or canola in any given day.

    Is only way to diagnose heart disease through a scan? does IMT count? mine shows slight thickening for age. Does fish have to many poly’s and not enough sat fat?
    Thanks again.

    In my opinion the best way to diagnose arterial plaque is with an EBT scan. (Even an angiogram – which is invasive – only shows the lumen of the artery, not the plaque.) IMT works okay, but a recent study showed that the scan was better.

    Fish have some saturated fat, but more poly.

  4. Sir am plodding through Senor Taubes work ( and phuq me what an insanely amazing piece of investigation it is..each page is jaw dropping in its depth )

    So you agree i take it about the mechanism for weight gain etc given yr books, blog etc BUT in GCBC ( and yr the science honcho here so i might well not understand correctly ) the refs seem to suggest that calories don’t count per se but i know have read you say you do have to have some deficit to lose fat and so the two seem to slightly contradict each other.
    If you’ve covered this and am being thick in finding this can you be a love and tell me roughtly when it was please ?

    Sorry to bother.

    Thanks for being a ‘good egg’ and keeping this free for the masses

    Calories do count. And Gary agrees that they do. You’ve got to have a caloric deficit to lose weight. The confusion arises because it’s difficult to lose weight by counting calories even though a caloric deficit brings about the weight loss. Problem is there is the whole calories-out side of the equation that isn’t independent of the calories-in side. When people volitionally reduce calories coming in (by dieting) they also decrease calories going out involuntarily. If they try to increase calories going out voluntarily, they end up increasing the calories coming in by eating just a little more (it doesn’t take much to compensate for the amount lost due to exercise). On low-carb diets people spontaneously consume less because they lower their insulin levels allowing fat to escape from the fat cells to meet the body’s needs. But they do create a caloric deficit by eating less, but at the same time don’t decrease their energy expenditure because the body doesn’t view the caloric deficit of a low-carb diet as starvation. I can see how this could be confusing. I should do a regular post on it because I’m sure others wonder as well.

  5. And yet while the FTC is going after advertisers for promoting “junk food” to kids, the always-annoying Tom Harkin wants them to sell kids more carbohydrates:

    http://www.msnbc.msn.com/id/25914206

    “This study confirms what I have been saying for years,” Harkin said. “Industry needs to step up to the plate and use their innovation and creativity to market healthy foods to our kids. That $1.6 billion could be used to attract our kids to healthy snacks, tasty cereals, fruits and vegetables.”

    Hmmm, a senator from Iowa wants kids to eat more cereal. No conflict there.

    By the way, Mike, I spent part of this month with a music producer, mixing and mastering music for the film. He’s been overweight for some time, and since we spent long hours together, he got a good sense of how I eat. He couldn’t believe I was eating sausage-egg sandwiches for breakfast and cheeseburgers for lunch (no bun in either case) and maintaining my weight. So he tried it and told me yesterday that he’s lost seven pounds in under two weeks. His comment: “Dude, you are so onto something with this film! I’ve never lost weight like this without going hungry!”

    My composer was also at the sessions and decided to cut back on carbs. He didn’t have much to lose, but he’s dropped four pounds anyway.

    They are both now proud owners of The Protein Power Lifeplan so they can educate themselves as to why this works.

    Thanks for the help in selling books. I need it.

    Yeah, the whole FTC – Harkin deal is abominable. It’s our federal government at work. One branch vilifying those who promote junk food; the other encouraging it. And we pay the bill for it all.

    Cheers–

    Mike

  6. I’m slightly heartened by the replies. A nutritional article in a venue such as the NY Times no longer “preaches to the choir” as this PP blog does. More like “preaching to the congregation” in my opinion. Most of the replies were stubbornly wrong and had poor focus but I detected an element of truth seeking in them that was head-and-shoulders above the rabid ignorance of the true general populace. This sermon must be repeated again and again over time before it is accepted.

  7. Just wanted to pop in to say that the low-carb wars in Sweden are pretty much over. Almost all media outlets have jumped on the low-carb bandwagon. Keep up the good work and the same should soon be true in the states. (The US always has more inertia than a small country like Sweden, for good and ill)

    I’m keeping my fingers crossed.

  8. Thank you for the link to the actual study Dr Mike, I read it with great interest. Most impressed with the controls and comparisons done and with the conclusions. What struck me with the study design was the calorie restriction on the Mediterranean and the low fat diet but unlimited calories for the low carb diet. The finding that the women did better on the Mediterranean diet than the low carb is, I believe, an interesting finding. I think it is far more important for women to control calories than men while on a low carb diet. It has been so for me and for many other women who post on your discussion board.
    So I can only wonder if the findings would have been the same if the low carb female group had been restricted to 1500 calories a day just as the other women, in the other groups, were. Just an interesting question based on the findings. Otherwise it was an impressive bit of research.

    Pam

    I’m pretty certain the women would have done better on the low-carb diet had it been restricted to 1500 calories per day.

  9. I read the article right before this one. I just had to shake my head at the comments. There were some gems in there though. Probably same people who read this blog. I’ve practically given up trying to educate the zealots and vegetarians. Though sometimes when I’m drinking a little too much, I like to have “fun” with them.

    Correction: “At a kosher meat restaurant you can eat all kinds of meat (as long as it’s kosher), but you can have butter or cream for your coffee or any kind of cream sauce.” I think you meant “…but you can’t have butter…”

    Off topic, I have a question. Do you know of any studies, could point me at some source, or have any recommendations (I know you need to protect yourself here) for someone who has just started chemo treatments because leukemia as far as diet or supplements. Let’s assume they eat the SAD with maybe a little (way to much for healthy, i.e. low carb) too emphasis on the desserts and soda.

    Hey Joe–

    Thanks for the heads up on the typo. It’s fixed now.

    I do have a study for you. It just appeared in the International Journal of Cancer showing that taking antioxidants during chemotherapy reduced the toxicity from the chemo. Here is the abstract of the article.

    Best–

    MRE

  10. Hey, I’m in the Tierney comments as well. #53 is me.

    Here’s the thing. We KNOW that the Times’ Health Section is a bunch of Gina Kolata’s and other low fat drones who ceased thinking critically some time back in the 70’s (oddly, a time of much critical thinking, so an odd time for people to stop… they were ahead of the curve, I guess). The folks who read Tierney are probably also going to read The Health Section. It’s hard to unwash your brain when you have a weekly section of the newspaper devoted to continually brainwashing you all over.

    FWIW: I think Tierney does a service, not just for the public, but for the Old Gray Lady herself. By providing balance to the wackness in the Health Section, he puts the Times on a more even keel. Now, if only some of those low fat apologist journalists would have some serious health issues that prevented them from writing, the Times might be put at full sail, rather than just even keel. My money is on Jane Brody. After all, she’s on statins now, has high cholesterol, eats really low fat. By everything we know, she should be at least too brain fuzzed to contribute regularly.

    Problem is she contributes her brain-fuzzed ideas on a weekly basis, and, unfortunately, zillions of people hang on her every word. I wish Tierney would contribute more on a regular basis instead of just here and there (and his blog, of course, which most readers of the Times probably don’t read).

  11. Crap. Now that I looked up dipsomania, I could have made a wittier comment about when I’m drinking too much. Well, I learned my “something new” for today. No more learning for me. Wait, scratch that, I need to help keep the average up for the rest of the people. Damn, that’s a lot of slack :(

  12. Food and diet is becoming a highly political topic.

    Reading the comments in the various NY Times postings showed me how people are quick to ignore facts in favor of defending their dietary dogmas. (unintended alliteration).

    I appreciate your sticking to the facts and actually talking to the lead researcher in the Israeli low-carb study. Most people were content to base their arguments on assumptions and frantically defended beliefs.

    I will be signing up for your feed.

    Hi DR–

    Actually, I didn’t talk to the lead researcher. That was Eric Westman, who is a friend of mine, so I guess I talked to the lead researcher once removed.

    Cheers–

    MRE

  13. This is somewhat OT. There is an interesting post on Junkfood Science on nitrates and nitrites (i.e. that they are not as dangerous as reported). Would love to hear what you think of this!

    I’ll take a look when I get a breather, but even having not seen it, I agree if your characterization of the post is correct.

  14. Considering the apparent level of formal education of some of the posters on the Tierney blog, the depth of ignorance and complete absence of objectivity they display is truly appalling. It gives cause to consider whether the process of college education education is perhaps imminently more effective at diminishing cognition than a frontal lobotomy.

  15. Type correction: <<>> You surely meant to write CAN’T have butter or cream.
    And as a BTW i have been strongly instrumental in having some kosher companies change from using hydrogenated fats to palm oil. My bi-weekly lecture with has a currently estimated 47 thousand listeners, has made a tremendous impact in the Jewish community. While it’s true we won’t use butter to fry meat products, and we won’t use chicken fat for dairy products, we could easily use olive oil or any other healthy oil which are neutral, palm and coconut oils are also good options for baked items.
    Thanks for being here to educate us all.

    Rabbi Hirsch Meisels
    Jewish Friends With Diabetes International
    http://www.FriendsWithDiabetes.org

    Thanks for the heads up on the typo. It is now corrected.

    I”m glad to hear you’re making progress in moving people away from trans fats. Keep up the good work.

    Cheers–

    MRE

  16. CORN FED red meat is probably not that good for you. I seem to remember Micheal Pollan saying that corn fed cows/steers (?) would die from eating the corn if they weren’t killed and butchered early on in their lives. I eat grass fed beef when I eat beef, hoping I’m doing the right thing. Unfortunately, given the larger amount of land needed for grass fed, I can forsee a problem supplying my local Safeway store’s meat counter.

  17. I read some of the comments too, and found it absolutely mind boggling–the lengths people will go to resolve their cognitive dissonance! Some guy even called the avoidance of butter and lard “intuitive.” Are people really so naive that they believe they live in an “intuitive” vaccuum, their “sense” of what is right or wrong completely formed without regard to prevailing attitudes?

    I’m picking up my order this week of 1/2 a pasture raised steer and 1/2 of a pastured pig who roamed 200 acres and ate acorns and chestnuts while happily frolicking with it’s buddies–can you tell I’m just a little excited? Thanks for all of your great posts Mike!

  18. Ok, I’ve been sucked into the Atkins/Taubes/Enig dietary advice, and I wholeheartedly agree with it. However, from what I understand, growing meat and fat is less efficient per acre, and a planet-wide conversion to low carb might pose an even greater burden on our planet. Therefore, maybe we “in the know” should simply be content with our personal dietary choice, educate our families, and let everyone else eat corn – for the sake of our planet.

  19. Mike, I couldn’t get passed the first 5-6 comments (with the exception of one)… I know, I know… I should be more patient and understand the years of misinformation behind such comments. I guess a lot of people commenting on Tierney’s blog are having a great deal of cognitive dissonance to deal with after the evidence is hitting the medical and nutritional establishments on their face…again.

    I agree, Gabe. That’s why I didn’t make it all the way through the comments myself. I kind of took a random sampling and got the gist of the average response.

  20. Mr ..thanks taking the time to respond.
    Funny thing is that if i want to lose my excess i have to up my eating which of course is more than satiated on the paleo-style so paradoxiacally to lose extra i have to be eating when i don’t really want to be !

    All good things,

    Nosher Fellows

  21. Ebby, it’s not the planet-wide conversion to low carb (which is more accurately stated a planet-wide resumption of our native diet) that will be the problem. It is the overpopulation of the planet that is the issue. But even then it may not to turn out to be a problem in the end.

    Take a look around you at the manifestations of the high carb, high junk food diet – a burgeoning (literally) epidemic of obesity, super obesity, diabetes CVD etc. Like the plot of a Hollywood B flick, it is Jones Town on steroids as a good part of the occupants of this planet are voluntarily committing what amounts to mass suicide. The problem for the low carb camp may turn out to be that we end up paying the medical bill.

  22. There are a lot of counter-arguments to the “It would take too much land to grow the meat to feed everyone” camp, although I haven’t seen EITHER side quantified significantly, and I may be mis-understanding some of these points:

    Management-intensive, sustainable grass farming may produce more, and certainly more widely varied, food crops per acre over the course of a year (The same plot of land can produce some veggies/fruits, beef/dairy, poultry, eggs, pork, etc. each in different seasons/rotations). Also, it uses fewer resources (especially petroleum-based products and chemical pesticides/fertilizers) than large-scale grain farming, (This is a BIG hidden cost of ‘factory farming’) and produces FAR less waste (what is ‘waste’ from one animal/crop is nourishment for another). It’s also possible to utilize types and areas of land that aren’t fit for large-scale grain farming.

    Then there’s the environmental impact, without having the need for artificial fertilizers, pesticides, and other chemicals sprayed over large swaths of mono-cropped land, eventually running into the waterways (look up some info on the ‘dead zone’ in the Gulf of Mexico, largely related to crop runoff as far north as Iowa). In addition, most ‘high yield’ crops are from genetically modified seed grains, and the grain that’s actually grown can NOT be used as seed for the next generation (at least, as I understand it).

    Also, apparently it takes fewer calories to provide a healthy, balanced human diet on a primarily meat/fat based diet than a primarily grain based one. The reduced health care and pharmaceutical costs are another benefit.

    There are, of course, a lot of contingencies, too. When people talk about eating beef, they usually just mean the steaks/roasts (Muscle meats). A LOT of nutrition is in the organ meats, marrow, broth made from the bones, etc. And management-intensive sustainable farming requires a lot of effort year round, even if it saves on outside inputs (Fertilizer, pesticides, etc.) and waste runoff/disposal. There are also a lot of other options besides just cow, chicken and pig, too. Outside of the US, I think either sheep or goat is the most common land animal consumed. And sustainable fishing and ocean/waterway preservation is another issue entirely.

    Again, I’ve never seen the arguments for either side actually quantified, and there’s so much ‘spin’ in the economic and political realm that it’s hard to discern any hard ‘facts.’ But I hope those present some ideas for further research (I know I’m still reading more about them, too!)

  23. Dr. Mike: If/when you do put up a regular post (as referenced in one of your replies) on the caloric-deficit-to-lose-weight issue (w/ LC being the easiest way to maintain the deficit), then you might include your thoughts on the role of glycogen depletion/replenishment. I do great on very-low LC during normal daily activities, but have finally had to admit that I must consume between 75g to 125g carbs during the eight hours after heavy exercise (weights, mountain climbing, etc.) in order to avoid mood and energy crash and facilitate recovery. This is especially true if I go into the workout after several days of LC.

    I know that this may run counter to the LC paradigm and I myself didn’t want to believe it after having given up the carbs for so long. But I had gotten to the point of giving up on weight training and didn’t like that either.

    Maybe most of your readers don’t work out at this level (and I generally only do it once a week, along with sprints on another day) so possibly not germane to this blog. However, I do see references to this on other sites, including those who follow CrossFit and similar workouts. Comments to the effect that strict LC will kill your performance, etc.

    Just grist for the blogging mill, if you need any. Thanks.

    I don’t disagree at all. About 15 years ago Dr. Charles Gray, a Navy doc in San Diego, did a lot of work with recruits (and some animal studies with pigs) showing that even after allowing for low-carb adaptation, many subjects required a little glucose during and immediately after a period of intense exercise or their performance deteriorated. Unfortunately, most of Dr. Cutler’s work was not published in the medical literature, but was published in ‘in-house’ naval and government publications. Fortunately, he sent me most of these. Unfortunately, I don’t know where they are right now. Fortunately, I’m going through a grand and glorious cleaning out of stored stuff so I should find them. When I do, I’ll post on them and quote from them liberally.

    If one is in good shape (at least in shape enough to be able to do periods of intense training) then I suspect one is fairly insulin sensitive. Also, during and immediately after an intense workout, insulin sensitivity is at its highest, which drives any glucose immediately into the cells for use and/or storage.

    It must be remembered, however, that what holds for young, healthy Navy recruits and people who can do intense training may not hold for aged, out of shape, obese people, most of whom should stick to their low-carb diets during and after exercise.

  24. Hi Dr Mike

    You are making progress. On Wednesday 7-30-08 on the Medical Line Radio program
    on KELO Radio in Sioux Falls,A Dr. Jerry Walton said we were wrong about the fat
    it is the carbs that cause high cholesterol. Wow!
    Keep up the good work.
    Ellis Bliley,
    Yankton, SD

    Great to hear!

  25. Of the 57.5 million square miles of land on the planet, only 7.65 are arable, that is, suitable for farming.(Wikipedia) Far more is actually suitable for GRAZING! So when we’re told that we would have to give over arable land to feed livestock, it “ain’t exackly” true.

    Anybody want to guess who’s giving us this message?

  26. Dear Dr. Eades,

    I would like to second Judy B.’s request for your assessment of nitrate/nitrite issue.

    I generally ignore health and cooking advice in our newspaper’s cooking section (for the obvious reasons), but a couple of months ago an article caught my eye and it was about nitrate/nitrites. The article said that all the research on preservatives was definitive and that one should avoid them (or keep them to a minimum) and they said that included the “natural” preservatives like celery powder.

    I don’t buy preserved meats with the exception of bacon. About twice a week I cook bacon that is preserved with celery powder and lactic acid starter culture. After reading that article I’m concerned about this, particularly since my 3 1/2 year old son thinks I make the 10 oz. package just for him. :)

    (By the way, I feel the same way that “Ebby” does but then realized that Mr. McPhail makes a good point. )

    Thank you, Dr. Eades. Glad your computer is up and running again!

    I’ll put this on my list for a post in the future.

    Thanks–

    MRE

  27. “In my opinion the best way to diagnose arterial plaque is with an EBT scan. (Even an angiogram – which is invasive – only shows the lumen of the artery, not the plaque.) IMT works okay, but a recent study showed that the scan was better.”

    For an individual patient, the best way to answer the question “do I have coronary artery plaque, and if so, how much do I have?” is with a Coronary CTA as it shows both the lumen and the wall. This is much better than asking the question “what is my RISK of having coronary artery plaque?” The trade off is that the CCTA is more expensive than the calcium score scan (done with either EB or CT), involves an IV, and more radiation exposure. However, it’s far more accurate as it “sees” both calcified plaque and soft (non-calcified plaque). And, it’s the soft plaque that will kill you. Radiation exposure is the same as with a nuclear medicine stress test- price is about 1/2 or less of a nuc med stress test, too, and those are done at the drop of a hat.

    I’ve seen many, many patients with loads of soft plaque in their coronaries and NO or almost no calcified plaque – who would be otherwise categorized as low risk. I’ve also seen many patients with normal carotids and bad coronaries. Guess it all depends on whether you want to keep guessing if there is plaque, or if you want to know if there is.

    Hi Ebby–

    I both agree and disagree with you. A coronary CTA scan, especially the 64 slice variety, subjects the patient to a pretty horrendous amount of radiation whereas the EBT subjects patients to a little more radiation than they would get from a chest X-ray, but not by much. Granted, the info obtained from the coronary CTA is more conclusive, but I don’t think it is the best test for screening. An EBT takes about 5 minutes in the machine, the patient doesn’t have to disrobe, and it is much less expensive than the coronary CTA. I would never ever recommend the coronary CTA as a screening test to determine the presence or absence of coronary disease. I would recommend that people get an EBT as a screening test. If the resulting calcium score is indicative of disease, then a cardiologist would need to follow from there, perhaps with the more expensive CTA exam.

    Cheers–

    MRE

  28. “I should do a regular post on it because I’m sure others wonder as well. ”

    I think that’s a great idea, even though I feel I understand the argument pretty well. I understand the idea of how the body tries to maintain an energy balance when you try to change the calories in/out equation, but I still question if exercise can’t be effective in helping lose weight during a low-carb diet.

    I understand that exercise has failed in previous studies, but maybe it’s possible that exercise fails because no amount of exercise you do can overcome a hormonal imbalance. Or: exercise isn’t more powerful than an endocrine system determined to store fat.

    But if everything is in working order (insulin is low), I see no reason why exercise combined with low-carb can’t produce a greater weight loss than low-carb alone. I can understand that the body will still want to return to being fat, but while it may have the motive it no longer has the means (insulin). After all, the idea of exercise is merely to cause the body to burning energy. But we burn energy merely breathing. The body doesn’t know that running on a treadmill is different than walking down the hallway to get somewhere else.

    Further, since exercise lowers insulin, shouldn’t it cause even more fat to be released and burned for energy? My understanding is that the your appetite doesn’t really know if energy (fat) is coming from food or released from fat cells. Once it’s in the bloodstream, it’s just fat. So if there’s more energy coming from the fat cells, shouldn’t less external energy be needed?

    I could be wrong about some of this stuff, so I hope you’ll correct me if I am, but that’s my understanding of things.

    Steve–

    This is a complex subject that I can’t possibly address in the comments section. All the points you make seem valid, but they haven’t been substantiated with carefully controlled studies. In fact, just the opposite has been found, i.e., that exercise doesn’t really bring about an increase in weight loss. Having said that, however, I can tell you that I’m not aware of any studies looking at exercise on a low-carb diet. I have my own ideas based on my experience with a whole lot of patients that I will post about soon.

  29. Hmm…Mike, not to go too far OT here, but there is plenty of kosher-compliant cheese in a kosher dairy restaurant. As long as it’s made by a kosher cheesemaker–not a gentile–and the rennet used is from animals slaughtered in compliance with kosher meat slaughtering and preparation, animal rennet is perfectly legal to use in making kosher cheese. Other cheeses are made from the rennet from vegetable sources, which is a prime source of vegetarian-compliant cheeses for the non-kosher vegetarian.

    This article may help clarify:
    http://www.kosherquest.org/bookhtml/CHEESE.htm

    I understand that the Israeli study LC dieters were using Atkins–but there is a highly developed kosher vegetarian culture which evolved from the foods available in kosher dairy meals (including fish, which is not considered meat.) Kosher dairy based vegetarian food is pretty easy to make low-carb, and was/is the foundation of many of my own vegetarian low carb meals.

    No, I’m not Jewish–but I did keep an orthodox-compliant kosher kitchen for a year in college. We were broke and kosher meat was pretty much out of our budget, except for the occasional celebratory roast chicken, so it was maybe an 80% dairy kitchen, including as much fish as we could afford (oh, the days of 5 for $1 tuna…). With that experience I ended up cooking the Sunday supper for the university’s kosher kitchen (to cover the regular weekend cook’s day off.) Apparently it’s okay for a gentile to prepare a dairy meal that conforms to all dietary rules, as long as I didn’t *make* the kosher cheese I used in my blintzes. 😉

    Pat (aka Gaelen)

    Hey Pat–

    You’re right about their being plenty of kosher-compliant cheeses out there. I was set straight by a number of my Jewish friends who had read the post. Observant Jews avoid cheese unless they know it is kosher. Rennet (used to curdle milk) often comes from pigs, which, of course is a major no no. But as long as the rennet comes from other acceptable animals (cows, for example) that are slaughtered properly (in kosher fashion), then the cheese made from such rennet is okay.

    Inquiring minds wonder why anyone who is not Jewish would go to the time and trouble to keep a kosher kitchen?

    Cheers–

    MRE

  30. “When people talk about eating beef, they usually just mean the steaks/roasts (Muscle meats). A LOT of nutrition is in the organ meats, marrow, broth made from the bones, etc. ”

    Exactly, I think as an example that while people in a future “low carb” culture may eat more “meat” per day the would eat less cows/year. The “low fat” culture trimms away the fat and organs from the cattle and are less effective in utilizing the output of herding.

    And why not use other sources of “meat” in the future? In many countries there is a tradition of eating insects and scrubs, perhaps other types of “cattle” can produce better nutrition with less input?

    Here in Sweden we had a problem a few years ago with a type of swarming beetles eating tree’s after they had been felled by a landwide storm. My thought as i read that was “here is an opportunity for future farming”.

    Hey David–

    You are on the money. Most primitive societies consume the entire carcass sans hair and bones. And eat insects as well. And we were once they.

    Cheers–

    MRE

  31. To Joe Matasic:

    I’m no expert on cancer but this guy is:

    http://hubpages.com/hub/How-I-Cured-Stage-4-Cancer-in-Two-Weeks-For-Less-Than-The-Cost-Of-A-Night-At-The-Movies

    He cured himself from stage 4 cancer in under two weeks, without the chemo of course.. It seems to have helped a lot of other people as well. The protocol is simple and is based on 60-year research of another doctor, Dr. Revici. It is interesting that it also uses a lot of butter, among other things (plus other fats like cod liver oil).

    He has a book too but he’s giving all the information for free and he replies to readers’ questions. It can’t hurt if you take a look. Good luck.

  32. For those interested, there is a study published in 2004 by Steven Phinney (Ketogenic Diets and Physical Performance), where he discusses his own work with professional cyclists that not only recovered their performance after a period of adaptation to a ketogenic diet but they even increased it. Here’s the link and I hope it works:

    http://www.nutritionandmetabolism.com/content/1/1/2

    Cheers.

  33. hi dr eades,

    was wondering if you could expand on your response to scott who wrote about needing 75 g carbohydrate after intense workouts. do you think low carbohydrate diets needs the additional subclass of “low carbohydrate, high fat”? my experience is that most people are unaccustomed to eating the quantity of fat necessary to perform athletically. by example, a chicken breast with salad and a marbled ribeye steak with buttered vegetables are both low carb, tho’, the latter has way more calories and fat.

    after all, i think there is a documentary showing (“untrained”) bushmen in the kalahari running down prey on foot. so grueling was the chase, they had to hire an olympic rower to run with the camera. also, if i remember correctly, v stefansson reported that french trappers in the 19th century paddled in canoes 14 hours a day, every day, consuming about 14,000 calories a day of pemmican(80% calories from fat, 20% protein).

    from an evolutionary perspective it doesn’t make tons of sense to me that arduous activity would require a glucose supplement…

    so, is it possible that the “bonking” that occurs during exercise on LC diets is a fat/calorie deficiency? could it be potassium related, too? i remember speaking to you after your lecture at boulderfest 2004 and you mentioned something about potassium being anti-catabolic and how hypokalemia is common on strict LC diets…..

    thanks for your great blog.

    You make good points. I suspect that, if anything, the adaptation period varies considerably among individuals. I know that a lot of people don’t necessarily need the extra glucose, but some seem to. Maybe they haven’t totally adapted yet.

  34. “Inquiring minds wonder why anyone who is not Jewish would go to the time and trouble to keep a kosher kitchen?”

    LOL–Mike, were you never a starving student who needed everyone’s share in order to eat at all? :-)
    When I first moved off-campus, I moved into an apartment where one roommate was orthodox, and they already had a kosher kitchen. Only neither of them could cook very well–I was replacing the roommate who had made most of the meals. I was the only one with any kind of steady job, but all of us realized that kicking in $5 apiece every week would buy us a lot food that going it alone to support separate meal choices. So we pooled our cash and I learned how to keep kosher.
    Some friends of my father’s were Jewish and ‘Aunt Sadie’ actually had two kitchens.
    So I decided to try it–called Aunt Sadie for some recipes and guidance, picked up a Jewish cookbook, and jumped in. After a month, the other six people in the house suggested that they’d be willing to kick into the food budget if I was willing to cook for all three apartments. My own diet was already almost completely meatless at that point, so kosher dairy wasn’t much of a stretch, and it was just as easy to cook and shop for nine as it had been for three.

    I only choked on the process of keeping kosher when our orthodox roomie wanted to use a blow torch on the apartment’s ancient (gas) oven to make the kitchen kosher for Passover…I had this mental picture of her blowing up the kitchen and suggested she could do that job herself!

    Now inquiring minds know. Thanks.

    MRE

  35. Hi Dr. Mike. I’m an Exercise Physiologist from Spain.
    From what I read in the scientific literature and from my 7 year experience training people, the main reason why diet (eg. high protein, low carb or high fat, low carb, or moderate carb, but low GI) leads to weight loss is not because you ingest fewer calories, but because you decrease insulinemia, which in turns allows Hormone Sensitive Lipase (the enzyme that breaks tryglicerides into free fatty acids and glycerol) to do its job, and lypolisis starts happening again (insulin decreases HSL activity). Besides high insulinemia causes insulin resistance (decreases the number of insulin receptors in the muscle cell). On the contrary, when insulin levels are low, your muscle cells become sensitized to insulin again.

    It is also important to remind that one of the reasons why elderly people have insulin resistance is because of sarcopenia (loss of muscle mass).

    This is the main raeson why weight training works for fat loss (just look at those chubby aerobic and cardio enthusiasts and the lean, muscular drug free bodybuilders to see what I mean). Weight Training increases muscle mass and hence increases insulin sensitivity, which in turn also decreases insulinemia (more insulin sensitivity in the muscle cell means that you need less insulin), leading to an increase in lypolisis.

    Hi Miguel–

    Thanks for writing. I pretty much agree with you across the board. But gaining a lot of muscle mass – although it helps – is not a cure all for obesity. I’ve spent a fair amount of time in gyms over my life, and I have seen a lot of heavily muscled guys with large, protuberant, obese abdomens.

    Cheers–

    MRE

  36. Just bought your 30 day book. I am fairly new to low carbing… I feel I am practically allergic to carbs. I notice I am more satiated eating higher fat content foods and feel better but I am concerned about the saturated fat being that I am very overweight… its just scary. Would the diet recommendations be the same for someone who is obese? What about if someone has heart issues… not that I do… just curious.

    I read another book by an MD that was promoting a low carb diet and claimed saturated fat was fine unless you were obese and then should follow a low saturated fat diet until the weight was lost.

    As you can see from all my writings both in the books and on this blog, I think saturated fat has gotten a bad rap. I eat a lot of it myself and don’t see anything wrong with overweight people eating it as well. If you really want to see what the scientific status is of the whole idea that saturated fat is bad, read Gary Taubes’ Good Calories, Bad Calories. It’s an eye opener.

  37. Thank you Dr. Eades. Your generosity is astounding and very appreciated. I just orderd Taubes’ book as well as yours, Slow Burn. I did a lot of weight training as a young woman (before it was hip) and loved it. I am excited at the prospect of learning the science behind it and getting back into it.

    I am enjoying these blogs so much I am hardly getting any work done!

    Hi Kris–

    I’m glad you’re having fun with them.

    Cheers–

    MRE

  38. Dr. Eades,
    I have been on the low carb diet twice and lost weight both times in fact reached my goal
    both times. It also got my A1C below six. Slowly I went off the diet and gained about
    30 lbs. back. my diabetes came back and am back on insulin (five shots a day) and still do not
    have control of blood sugars. A!C was 9 and is now 7.7 and holding. Of course I have put
    on another 30 lbs. I have been using juice Plus which has given me more energy and I do feel
    better but still find it hard to control my appetite. Is it safe to just start over with the low-carb diet? I feel best when I fast . I do exercise every day and it helps the sugars come
    down. I first heard about low-carb from, “Diabetes Solution”, by Dr. Bernstein. I also got
    “Protein Power”. Help! I’m 63 years young and would like to see 80. Thanks, Rose

    Hi Rose–

    I think it is totally safe to start over with a low-carb diet. It worked for you in the past, so there is no reason to think that it wouldn’t work for you now. You should check with your doctor, though, because many medications need to have their doses altered or even be stopped upon starting a low-carb diet because the diet works so quickly to stabilize blood sugar levels.

    Good luck.

    MRE