Archive for February, 2008

Five Simple Rules

PJ, over at the Divine Low-Carb!, recently issued a challenge in a post, You Choose! The March of Madness for PJ, where she asks experienced low-carbers to present a plan for her to follow throughout the month of March.

So here is a challenge for the many experienced lowcarbers out there. March is coming up in 5 days. Present a plan for me that is:

1 – LOWCARB AND SIMPLE (not ‘cycling’ and not ‘moderate carb’ and not ‘atkins by the book according to OWL modified by xyz…’)

2 – HAS NO MORE THAN FIVE MAIN RULES (though a given rule can have details, e.g. if supplements is one of the rules it can have a list/dosage, if fat is one of the rules it can have types/quantity)

3 – WITHIN THE PARAMETERS ABOVE (no seafood or gluten etc.)

Here’s what I will do:

1. I will choose one of them and officially follow it for March, from the 3rd to the 31st, four full weeks starting on a Monday — because that is how my weight spreadsheet is set up LOL.

2. I will track and graph my weight every day

3. AND how I feel every day

4. AND what I ingest/do every day (I use a digital gram scale for measures)

5. AND do measurements before/after,

and at the end of the month we will all see how well that given plan worked out for my body. I may not be perfect on it but I’ll track what I do so it’s fairly known what degrees of it I may have screwed up.

MY THEORY IS, that since I don’t have ANY given goal-setting plan that inspires me enough to make a commitment to it, that instead, I will make a commitment to someone ELSE: the commitment just happens to involve a given lifestyle plan.

Can you do it?

RULE 1: NO SPECIFIC GRAM COUNTING – just eat what’s allowed & simply enjoy your meals

In the current state of affairs, eating is becoming terribly complicated by an under-current that suggests we feel guilty for eating, seek to limit our desire and pleasure from good food, and contantly count calories, grams of this or that and worry about everything we place in our mouth.

No more of that – eat and enjoy what is allowed and simply pass on anything not on your list of good foods to eat.

In addition, we don’t live and eat in a world of grams – it isn’t even natural to have to divvy up portions by cups, ounces or any other measure. We’re supposed to just simply eat, but somehow we’ve come to a place where that’s no longer a simple affair.

Rather than fight that totally, I’m going to present information to calculate minimums for some things, that have to be included each day, ranges for others, and optional add-ins – these are to be calculated out for an individuals current weight so they’re eating enough each day to avoid a state where the body conserves energy in the face of famine conditions, while also providing variety and good habits to build upon over time.

RULE 2: Eat Enough – Starvation Level of Calories Doesn’t Work Long-Term

In order to eat enough, one has to know how many calories they need, at minimum, each day – over the years I’ve found the basal metabolic rate (BMR) to be a good minimum to use. Online calculators, like the one at Discovery Health, are accurate enough for this purpose. Once you enter your information, it will return how many calories you need each day for basic metabolic function, before any movement or physicial activity.

This is the minimum calories to target eating each day and it allows a +/- 5% range, so if you miss by 5% one day that’s OK; if you’re over now and then by 5%, that’s OK too. Recalculate BMR with every 20-pounds of weight loss.

RULE 3: Consume Adequate Protein

Protein is, in my opinion, the most critical of foods/macronutrients to consume each day – it helps to regulate appetite, but more importantly provides the essential amino acids to repair and build within the body.

Calculating out a minimum amount of protein to be “adequate” is fairly easy – you take your body weight in pounds and multiply it by 0.40. This will allow for an adequate intake of amino acids for both essential needs, and for the production of glucose through gluconeogenesis.

But who lives in a world of grams? It’s easier then to take the gram target and convert it into ounces each day – makes it easier to decide what to eat! So, to determine how many ounces each day, you simply divide the grams by 6.5 – the average amount of grams of protein per ounce in meat, cheese, eggs, poultry, fish. Now some have 7g, some have 6g – I suggest using the 6.5 as an average.

Do not count plant protein in your minimum – so you can eat whatever cuts of meat, poultry, fish, game you want, and include eggs, cheese (real, whole milk cheese only – see below). You may also boost protein with whey or egg protein powder or RTD-shakes that contain only whey protein and less than 2g carbohydrate per serving. No soy protein isolates are allowed in the shake option.

Eggs ideally will be from organic, free-range chickens; meats (ideally) should be grass-fed, pastured.

Recalculate protein requirements with every 20-pound weight loss. Each day, eating enough protein is critical, so target eating at least the calculated minimum; eating more than that is fine if you’re hungry and often necessary if you’re active…so if you find you are hungry, eat more protein if needed, but avoid excessive protein consumption, which is hard to define, but generally means more than 35% of calories or greater than 0.8g-1g of protein per pound of body weight (depending on level of physicial activity).

Dairy is included in your protein, but do not consume more than a combined total of 4-ounces of dairy foods each day – this includes plain whole milk yogurt, real whole milk cheese (no processed cheese allowed), heavy cream and/or half & half. Dairy must be organic.

RULE 4: Choose fats wisely

For cooking and topping vegetables, use ONLY the following fats and oils:

Olive oil, organic butter, virgin coconut oil, avocado oil, walnut oil, sesame oil, macadamia nut oil, drippings from bacon, real mayonnaise, or rendered fats from chicken or meat.

What isn’t allowed is anything that contains canola, soybean oil, vegetable oil, partially (or fully) hydrogenated oils or corn oil.

Two exceptions: Salad dressing is one exception to this rule if one is using commercial dressing – canola based dressing is allowed in this case, if the carbohydrate content is 1g or less per 2-TBS serving. Real mayonnaise is the other exception if you cannot find one that is made with the acceptable fats/oils.

The meats and animal foods consumed have fat content, so added fats/oils should be used to top vegetables and salads and the amount should be individualized to meet calorie intake minimums. Adjust fats & oils as appropriate with weight loss. If you are using an online food journal to keep track of things, like FitDay.com, the percentage of calories from fat will be high – greater than 60% each day, sometimes as high as 70% or more.

RULE 5: Eat Enough Plant Foods

Plant foods – vegetables, nuts, seeds, fruits, legumes – provide variety and also are nutrient-dense. The same cannot be said for most grains, so while you’re losing weight, avoid grains, but eat enough of the allowed plant-foods each day to keep things interesting.

As a rule of thumb, absolute minimum of non-starchy vegetables each day is 3-cups – choose whichever non-starchy vegetables you wish and top with whatever fats/oils you like, season however you want.~ You may include up to 6-cups of non-starchy vegetables each day if you wish. Herbs and spices may be used as desired.

OPTIONAL ITEMS:

You may also include up to 1-cup of select fruits each day – any type of berries, canteloupe, honeydew melon or tomatoes.~ The caveat with the fruit is it must be accompanied by a protein-fat food, like cheese, yogurt or meat.~ For example, if you’d like 1/2 cup of blueberries, enjoy them in a 1/4 cup of plain whole milk yogurt topped with a tablespoon of walnuts or pecans, or in 1/4 cup of heavy cream.

You may also have up to 2-ounces of any nuts/seeds each day.~ Nuts you may have include: walnuts, pecans, pine nuts, pistachios, sesame seeds, pumpkin seeds, and macadamia nuts; also nut/seed butters are an option. Two that are not allowed are peanuts (legume) and cashews. If your current body weight is greater than 300-pounds, you may include up to 4-ounces of nuts if needed to bring calories up to meet BMR.

You may include up to 15 olives in a day – green or black; and/or 1/2 an avocado; and/or 2-TBS of legumes (chickpeas, red kidney beans, navy beans, peas, etc. – but no peanuts).

Essential Nutrient Insurance

While it’s definitely possible (and not all that difficult) to plan menus with 20g to 60g net carbohydrate and all the essential nutrients we need, it’s not something someone new to low-carb does well without practice, and even those who have followed controlled-carb for a period of time sometimes miss hitting nutrients that are essential because they don’t know which foods are best to include for nutrient-density. So, rather than write a book about this, an unofficial “rule” – it’s a good idea to include some “essential nutrient insurance” in your day….two key vitamin supplements:

A. Basic multivitamin-mineral complex that is not a “mega”….choose a capsule vitamin, not the brick-hard type; it should include 100% of RDA, but not “mega” levels.

B. Cod Liver Oil and/or Fish Oil; depending upon time of year and where you live. During the winter months – mid-October through mid-April, if you’re in a central or northern latitude, use cod liver oil; all others in sunny year-round locations, get sun and use fish oil instead; during mid-April to mid-October use fish oil if you’re in a central or northern latitude while also getting your sunshine!

Dose is generally 1-teaspoon per 50-pounds of body weight, with a maxiumum of 1-tablespoon per day.

For those with significant weight to lose – 50+ pounds – it can also help to include:

C. Chromium picolinate (200mcg)

D. Alpha Lipolic Acid (600mg) + L-Carnitine (1g)

E. Krill oil capsules (500mg) [do not include if you have a shellfish allergy]

February 29, 2008 at 4:27 pm 20 comments

What the World Eats

If a picture is worth a thousand words, than the Time photo-essay What the World Eats Part I speaks volumes.

To view the pictures from around the world: What the World Eats Part I

Months ago, when Diet Blog featured this subject, I took a picture of our weekly food but then didn’t have an opportunity to post it here. So, today – here’s what an average week of food looks like for us:

February 25, 2008 at 3:05 pm 9 comments

Comment Moderation Update

Just a quick reminder about comment moderation – the reasons a comment may be rejected include:

  • Trying to sell something to others via the comments
  • Personal attacks on another commentor
  • Comment has absolutely no relevance to the subject matter of the post nor any other comment on the thread of comments for the post
  • Attempting to re-direct traffic to a site selling products/services contrary to this blogs message
  • Profane and/or vulgar comments

All are absolutely free to disagree, challenge anything I’ve written and/or comment about their experience (with a product or service)….but the above guidelines are a reminder that I do moderate comments, and while I’m reluctant to reject a comment, occasionally I find myself having to. If a comment of yours is rejected (doesn’t appear) and you have a question about why, you can always email me and ask why.

February 23, 2008 at 3:28 pm 1 comment

Dr. Jamie Bailes: The Fat-Free Fallacy

Dr. Jamie Bailes, a pediatrician at Marshall Unieristy in Huntington, WV, recently penned an article for Diabetes Health – The Fat-Free Fallacy: Is it Obesity’s Great Enabler?

Obesity in the United States is increasing in epidemic proportions. This is true in children as well as adults. It’s estimated that the healthcare costs associated with obesity and its related complications will exceed $130 billion this year.

If something is not done to stem this burgeoning tide of obesity, then the healthcare system that we know will soon crumble.

Why are we seeing this dramatic increase in childhood obesity?

It is certainly true that children are not as active as they were 30 or 40 years ago. Television, video games and computers can entertain kids 24 hours a day. Parents are often relying on technology to babysit their children and are not spending as much time outdoors with them exercising or just playing.

Is this the only reason for the surge in obesity? As a pediatrician who specializes in childhood obesity, I see many children who are very active but they are also massively overweight. What about these children? I believe many of these children are victims of what I like to call the “fat-free fallacy.”

Scapegoating Fat Backfires

In 1977 the U.S. Department of Public Health issued a statement encouraging Americans to eat less fat. In 1988 the U.S. Surgeon General recommended that we restrict our consumption of dietary fat. The assumption was that as we eat less fat the thinner we would become. The multi-billion-dollar food industry was quick to jump on the bandwagon. The race was on to produce fat-free everything. If food didn’t have fat then it was OK to eat as much as you wanted.
Americans consumed more fat-free foods in the 90’s than the previous three decades combined. This fat-free philosophy is exactly why we are becoming so obese as a society. Obviously if fat were the problem, then obesity would have decreased during this time. Instead, obesity did not decrease but skyrocketed to unprecedented levels.

But fat is not bad for you. Being fat is. The two are not related! Fat actually helps to satisfy our appetites and keeps us from eating too much or too often. Fat is also an important flavoring for food.

I, too, was a victim of this fat-free fallacy. I had been taught (brainwashed) that in order to lose weight we must eat less fat. I was a huge proponent of cutting back fat intake and watching total calories. I recommended at least 30 to 45 minutes of vigorous exercise daily.

I knew that it was very hard to lose weight. I didn’t push overweight children to lose weight, thinking that if they could just maintain their current weight as they grew that would be significant progress. I felt like I was doing a good job. I believed whole-heartedly that I was explaining to these children the correct way to lose weight.

An Eye-Opening Study

In the late 1990’s, a first-year pediatric resident physician at Marshall University did a required research project in which he looked at about 100 children whom I had counseled about weight loss. The results were astonishing to me. Not only did these children not lose weight or even slow down their weight gain, most gained weight at the same rate and some even faster.
The results did not lie. All of this time and energy that I had been spending to help children lose weight had been a waste of time. It just didn’t work. A low-fat diet only worked for about one out of every 25 patients. Was this the best we could do?

I was determined to succeed. I began to look at other ways to lose weight. A third-year medical student at the time asked me about using a high-protein, carbohydrate-restricted diet for weight loss. At the time I knew very little about approach. This was not something that was taught in medical school. I couldn’t believe that this would be successful or that it could be good for you, so I was very skeptical. How could eating high-fat foods not be bad for you? This is what I learned in textbooks from professors in medical school.

However, I still could not ignore the facts. We had cut back our fat intake and yet we were becoming fatter as a nation.

Low Carbs Make a Case

I researched and relearned the physiology and biochemistry behind low-carb diets. As I began to take a closer look, my findings were not what I expected. It all came back to insulin. Insulin is what causes fat storage. Insulin is what drives weight gain. Insulin is what is secreted when we eat carbohydrates. Insulin is one of the most powerful and efficient substances that our body uses to control the use, distribution and storage of energy. Insulin is essential for life. Without insulin, we would quickly waste away and perish. Just ask the teenager with type I diabetes who has been hospitalized for diabetic ketoacidosis because of not taking his or her insulin.

Let’s look at what happens after a meal that is high in carbohydrates. Carbohydrates are broken down into thousands of molecules of glucose that are quickly absorbed through our small intestines into our bloodstream. Our body has the ability to monitor this rapid rise in blood sugar and quickly secretes insulin to counterbalance this. This is true if we do not have diabetes. Our nervous system keeps our blood glucose levels very steady no matter what we eat. These values almost never get above 120 or less then 70mg/dl. This is true whether we eat a meal that consists of pure sugar, a meal loaded with complex carbohydrates, a meal consisting of only protein or fat, or when we have fasted for two or three days. Almost all of our cells use glucose for energy.

Our bodies are extremely efficient energy machines. Only a small part of what we eat is actually used or needed by the muscles or other cells for energy. If these energy-using cells do not need any extra energy what happens to the majority of the glucose that we ingest? Insulin converts a portion of that glucose to another starch, called glycogen. Glycogen is stored in the liver and can maintain our blood sugar levels in the normal range for several hours after a meal. This is why we do not have to eat continuously. Glycogen can quickly be converted to glucose whenever glucose is not readily available in the bloodstream.

Why Low-Fat Diets Don’t Work

What about the rest of the glucose? Where does it go after a meal? Herein lies the answer to why most low-fat diets do not work. The extra glucose is converted to fat. Fat is our main storage area for energy. Let me say this again: insulin promotes the production and storage of fat. That’s right, even without eating fat our body produces fat from sugar.

Insulin is an extremely efficient hormone. It is the master hormone of our metabolic system. Its most important function may be the control and maintenance of our blood sugar, but insulin performs a myriad of other activities. In the appropriate amount, insulin keeps the metabolic system running smoothly and everything in balance.

However, in great excess it becomes a dangerous hormone wreaking havoc through the body. Mountains of scientific evidence implicate insulin as the primary cause or significant risk factor for high blood pressure, heart disease, arteriosclerosis and high cholesterol. It may also have a causative role in type 2 diabetes.

With type 2 diabetes our body needs extra insulin to help to maintain our blood sugar. The insulin that is available just does not work as well and we become resistant to its effects.
With type 1 diabetes we have a little different story. Our body can no longer make the insulin that we need therefore we have to take manufactured insulin to maintain our blood sugar. More carbs equals more insulin.

Teenage girls with diabetes know that insulin causes them to gain weight. Many recent studies have shown that in order to keep from gaining weight a very high percentage of teenagers with diabetes omit their insulin. We cannot continue to allow this to happen. This leads to uncontrolled diabetes and horrible long-term complications.

More Protein = Greater Insulin Control

So, how can we control our insulin requirements? The key to good blood sugar control, the key to weight loss and the key to lowering our insulin secretion is very simple. Eat fewer carbohydrates and eat more protein.

Protein keeps us from being hungry. A meal high in protein stays with us a lot longer than a meal high in carbohydrate content, which is quickly absorbed and does not satisfy our appetite as long. When we eat protein our body does not need as much insulin. Our blood sugar values are much steadier and we do not have the wide fluctuations that we see with high carbohydrate foods. This dietary approach works whether you have diabetes or not. It is perfect for anyone who is overweight or has type 2 diabetes. Type 1 people with diabetes can benefit by improved blood sugar values and lower insulin requirements.

I have seen hundreds of children actually lose weight with our plan. Eight and nine year old kids have lost 40 to 50 pounds. Obviously, the health benefits are tremendous, but the greatest improvement is what we see with self-esteem. Children’s energy and blood pressure improve, and their lipid profiles universally improve. Before-and-after pictures of these successful children can be viewed on our website http://www.nomorefatkids.com/.

In general, the fewer carbohydrates we eat the better. However, we should get a minimum of 30 grams of carbohydrates per day. The standard approach of 60 to 75 grams of carbohydrates per meal and 30 grams per snack is way too much. If you do not want to restrict carbs to 30 grams per day, then somewhere between 60 to 100 grams per day will still allow for weight loss if it is combined with exercise.

Remember: Eat all the protein you desire. Do not worry about where the protein comes from or how it is prepared. People who eat more protein end up eating fewer total calories. Protein keeps us from being hungry and satisfies our appetite more than any other macronutrient. This is the key for successful weight loss. It is hard to lose weight if you are hungry all the time.

February 23, 2008 at 2:05 pm 7 comments

More ACCORD

Laura Dolson, at About.com, recently posted about the ACCORD Trial mess in a Tale of Two Diabetes Studies. To get you started:

Many people who follow low-carb diets do it to achieve greater blood glucose control. Therefore, it was disconcerting when ten days ago the news was full of a large study of diabetics (“ACCORD”) which was halted when it was found that patients in the more aggressive treatment group, who had lower blood glucose as a result, had more deaths than the patients with higher levels of blood glucose.

Note that none of the researchers said that the lower blood sugar itself caused the result — it could have been the more agressive drug therapy that these patients were on, or some other factor. Nor are they clear on what caused the extra deaths at this point. And no one was recommending that treatment programs or goals be changed based on this preliminary data. In fact, the American Diabetes Association recommended not changing anything. However, this did not stop the media from producing headlines such as, “Diabetes Study Shows Lowering Blood Sugar Increases Death Risk” and “Diabetes Study Upends Another Long-held Belief“. In my opinion, these kinds of headlines are blatantly irresponsible, and I also wonder what is to be gained by blasting this story everywhere before we have a decent analysis of what was going on in the study.

The findings in the ACCCORD study prompted researchers in Austalia to peek into a similar study in progress there called ADVANCE. Were the results the same? No, not at all! Their data did not show increased deaths in the lower blood glucose group, despite the fact that twice as much data has been collected so far in the ADVANCE study. So the interim advice is to wait until the results of both studies, plus one additional similar one, are available.

What are we to think?

Continue reading full article…

February 21, 2008 at 3:35 pm 5 comments

Normal Blood Sugars; Type 1 Teens

Methods for achieving stable normoglycemia during an educational camp for youth with type 1 diabetes mellitus

Stan De Loach, Ph.D., CDE Certified Diabetes Educator and Clinical Psychologist in independent practice México, Distrito Federal, México

ABSTRACT
Objective
For children and adolescents with recent-onset DM1 to learn to quickly and safely achieve normoglycemia (71—99 mg/dl) and glycemic stability (MAGE score £ 95), using self-directed learning methods, insulin analogues, reduced concentration of dietary CHO, and ad libitum physical activity and SMBG, during an educational camp.

Methods
A 5-person international multidisciplinary team managed time, task, territory, technique, and technology boundaries, while responding to the educational and emotional needs of 9 Campers (8—17 years of age [11.8 ± 2.6]), with average diabetes duration of 1.62 years (± .88), during a residential 57-hour (3-day/2-night) diabetes camp.

Campers chose foods from meal buffets, calculated lispro insulin doses, and exercised and monitored BG at will. SMBG values documented in each Camper’s combined glucose/ketone monitor furnished statistical data.

Results
Mean arrival and departure BG was 209 mg/dl (± 101.5) and 87 mg/dl (± 23), respectively [P less than .0025].

Mean 3-day BG (95 mg/dl ± 21) and MAGE score (66 ± 27) validated stable euglycemia.

Conclusions
Integrating self-directed diabetologic education, basal/preprandial insulin therapy with analogues, elective physical activity and SMBG, and reduced concentration of dietary CHO rapidly and safely established routinely normal mean daily glycemic levels and stability in this sample.

February 19, 2008 at 2:50 pm 3 comments

Gary Taubes

Gary Taubes
Stevens Institute of Technology; February 6, 2008

February 17, 2008 at 1:52 am 17 comments

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