The two videos below pretty much tell the whole sad tale of doctors and nutrition.  Taken together, they confirm the widespread notion that doctors, in general, know very little about nutrition and seem to be proud to keep it that way.

This first video has made the rounds on the internet.  I’ve had it sent to me or recommended to me a dozen times, but I had never watched it until just a few days ago.  I was put off because of its length, which, at a little over 17 minutes, seems like an eternity in internet viewing time.  But I hope anyone reading this post doesn’t make the mistake I did and avoid watching because of the length.  It is a spectacular talk given by Dr. Terry Wahls, a female physician who was struck down by a relentlessly progressive neurodegenerative disorder.  She describes how she was able to restore her health by revamping her diet in in a way designed to properly feed her mitochondria.*  The transformation is almost unbelievable, especially considering the disease she was battling.  If you haven’t already seen this video – watch it.  I guarantee you’ll be glad you did.  And while you watch, pay careful attention to what her diet doesn’t contain much of.

Click here to view the embedded video.

After you’ve seen the above video, take a look at the one below.  It is a little over 2 minutes long and was developed to give doctors – who, for the most part, don’t give a flip about diet – advice they can pass along to their obese or overweight patients.  Watching the longer video above first will give you more context to better appreciate the one below and show you just how lame mainstream medicine can be.

This video came from Medscape, a subscription service for doctors to keep them abreast of all the latest and greatest news and updates from the world of mainstream medicine.

Click here to view the embedded video.

Pitiful, isn’t it?

Links:

The Medscape article containing this video.  (Although Medscape is a free subscription service for physicians, non-physicians can sign up as well.  For free.  Register if you would like to see the article, which is nothing more than a transcript of the video above.)  It is amazing to me that an online newsletter designed for physicians would regurgitate dietary information from a newsweekly and pass it off as serious medical information.  Especially in such a condescending and patronizing way.  The whole thing is infuriating.

The list of the 22 nutritional ‘experts’ who came up with the dietary rankings mentioned.

The US News and World Report article that inspired the video.

Power, Sex and Suicide  A pretty thorough book on mitochondrial function that is accessible to the non-scientist.  I read this book 6 or 8 years ago and learned a fair amount about mitochondrial DNA.  I had been interested in the issue of mitochondrial rehab for a while, and this book filled in some, but not all, of the blanks.  A good place to start if your interested.

Why Are Cells Powered by Proton Gradients?  Full text of a paper written by Nick Lane, the author of the above book, discussing how mitochondria work by creating an energy gradient across the inner membrane.  Accessible to non scientists.

Source of photo of mitochondria at top of post.

* Mitochondria are the little sausage-shaped organelles inside the cells that convert the energy stored in food to ATP, the energy currency of the body. I think the idea of correctly feeding mitochondria is an important one.  If your mitochondria don’t work well, you don’t work well.  I’ve got a couple of posts in the works on this subject of just what does keep the mitochondria fit and what happens when they become unfit.  And what it takes to rehab them if broken.  Based on my own pretty extensive review of the scientific literature over the past few years coupled with my clinical experience, I have a few minor quibbles with Dr. Wahls’ notions of what constitutes a perfect diet for the mitochondria, but I’ve got to say that her results speak for themselves.  I just think her diet could be even better with a little judicious tweaking.

These were observational studies and, as such, can’t be used to determine causality.  But they are interesting nonetheless because according to one of the authors there have been other clinical trials showing the same thing.  One of the authors of the study, Dr. JoAnn Manson, Professor of Medicine and Harvard Medical School commented on the findings of this study and what they mean to doctors who put patients on statins.  Dr. Manson’s commentary was provided by Medscape, a site for physicians to go to learn about the latest in medical wizardry.  The site requires registration, but if you are interested, you are allowed to register even if you aren’t a physician.

I decided that instead of commenting on Dr. Manson’s video after the fact, I would do it in real time right on the video.  This is my first effort at anything like this, so you can let me know what you think of it.  If you find it enjoyable and/or helpful, please drop a note in the comments, and I may be inspired to try it again.

You’ll notice my repeated assertions that statins don’t provide any benefits.  What I’m talking about is the fact that statins have never been shown to decrease all-cause mortality. (See the first sentence in the Lipitor product insert above.)   In other words, if you take a statin, you gain no increase in life expectancy.  If I, myself, am evaluating a drug that I might have to take, I would certainly want to make sure it didn’t simply replace one risk factor for another.

Click here to view the embedded video.

Note: The comments on this video made by me are my opinions based on my reading of the medical literature.  They are no substitute for consultation with your own physician, and should in no way be construed as medical advice.  The decision to start, continue or discontinue any drug regimen is a serious one and should be a decision made after careful discussion with your own physician.

As I mentioned in the video above, I just read a book by a cardiologist practicing the California who has dived deeply into the scientific evidence and feels the same way about the lipid hypothesis as I do.  And about statin drugs.  And this a real cardiologist.  Ernest N. Curtis, M.D. has written The Cholesterol Delusion, a book that takes a different approach to dismantling the lipid hypothesis than The Great Cholesterol Con, but is just as effective.  If you’re still in the camp that worries about cholesterol, you may take solace from the information in this terrific book.  If you need to persuade a friend or loved one, this is the book.

If you enjoy the way I sometimes dissect studies on this blog, you will love Dr. Curtis’s book because that’s what he does.  He dismembers the studies that the lipophobes rely on to maintain their fantasy that cholesterol really does cause heart disease.

Take for example the Lipid Research Clinics Coronary Primary Prevention Trial (LRCCPPT), the authors of which made the oft repeated claim that each 1 percent reduction in cholesterol gives a 2 percent reduction in cardiac risk.  Dr. Curtis eviscerates this study and describes how the authors dishonestly spun their experiment’s end result, which was essentially meaningless, in such a way that it has become one of the mainstays in the argument for cholesterol lowering.

During the study, 7 percent of the subjects on a cholesterol-lowering drug died while 8.6 percent of those on placebo died.  Dr. Curtis describes how this minuscule difference can be converted into a relative risk difference of 19 percent, which is what the authors were crowing about.  But that number isn’t nearly as important as the absolute risk, which is the difference between the 8.6 and 7, or 1.6 percent.  So those subjects on the drug (which is not without side effects and costs if the subjects had been paying for it themselves) ended up with a 1.6 percent lower absolute risk than those who didn’t take the drug.

But that’s not the end of the story.  Was the 1.6 percent difference even statistically significant?  Here’s where things get interesting.

How significant is the difference between 7.0% and 8.6%? Common sense tells us that this difference is of no practical significance.  But what about the more esoteric criterion of statistical significance?  According to the pretrial protocol, which called for a level of certainty with p<0.01, it didn’t even come close.  If one applies the more lenient criterion of p<0.05, it still fails the test when the typical two-tailed test is employed.

If one applies the p<0.05 criterion and uses the less rigorous one-tailed test, however, this difference barely qualifies as statistically significant.  This is, in fact, what the investigators did.  In one of the most flagrantly dishonest acts ever seen in a major medical study, the authors apparently changed the criteria for significance after reviewing the data.

The is absolutely shameful behavior way beyond the pale.  When researchers design a study, they set on the front end the statistical parameters by which the outcome of their experiment is to be measured.  They do this at the start so there can be no fudging at the end when the results are in.  Everyone agrees to the standards and off they go to do the study, and the outcome either reaches the level of statistical significance by the predetermined measure or not.  In this case, the standards were set, but when they weren’t reached, the standards were reduced once and then again before the results barely were able to claim statistical significance.  Shameful indeed.  And this is one of the major studies, quoted daily, showing that a reduction in cholesterol brings about a reduction in heart disease.  Jesus wept.

Why didn’t other scientists say anything about this.  One did and wrote  a withering critique in the Journal of the American Medical Association, but the journal kept it under wraps for a year before publishing.  By that time, the LRCCPPT had gotten so much coverage and the cholesterol-lowering-prevents-heart-disease mantra had swept the nation, so everyone pretty much ignored the grousing of a scientist who saw the emperor without any clothes. (You can’t tell much from the abstract I linked to, but Dr. Curtis reprints some of the juicier parts.)

This study isn’t the only one with warts all over it nor the only one routinely misinterpreted.   But it’s not surprising given the vast amount of money at stake in the business of reducing cholesterol by drug therapy whether that cholesterol reduction is important or not.

After you read Dr. Curtis’s book you will become as big a skeptic as I am of medical studies and regard them all with a jaundiced eye.

I get feedback on the posts I write from three sources.  First, MD looks at them and tones them down if I’ve gone off on some sort of political tangent or if I’ve scattered in a bit of too colorful language.  After she gives me the go, I put the posts up and wait to see what the commenters have to say.  The third source for feedback is my friends, some MDs and/or PhDs and some not, who pick up the phone and call me.

MD okayed what I wrote. The readers who commented seemed to realize what I was trying to say.  But the phone calls were a different story.

One friend called to say she had been low-carbing since Jan 1, and when she read my post she became so depressed she almost quit.  “How can you tell people it’s hard,” she said.  “It’s the easiest thing I’ve ever done. I can eat till I’m full.  I’m losing weight; I’m losing the water I’ve been retaining; I feel great.  What a downer that post was.”

I heard different versions of that rant from three other people.  They all wanted to know why I would be idiotic enough to put up such a post right at the time everyone was trying to commit or recommit to losing weight.  Depressing was a word everyone used.

I guess I got off easy with the written comments on the blog.

I didn’t really mean for the post to be a downer.  Really.  I wanted to tell people who might be struggling to lose that MD and I fall prey to all the same problems.  We gained weight over the holidays.  We are back on the straight and narrow.  I was trying to say that we were right in there with everyone else working away to reestablish our own thinner selves.  (In fact, we’ve made great progress in the week or so we’ve been on the plan.)  I just wanted people to be aware that long-term weight loss requires effort and constant vigilance.  And to view the process as a life change and not a quick one-time fix. My goal was to get people to recommit seriously, not to depress them.

Obesity is a medical problem caused by a damaged metabolism, which is why one person, without the damage, can eat the same foods without gaining weight that pack the pounds on someone else.  Once you realize you have the underlying problem that leads to obesity, you simply have to recognize that you have to deal with it for the long term.

Let’s look at it in terms of another medical problem: high blood pressure.  For argument’s sake, let’s ignore the fact that about 80 percent of cases of high blood pressure can be reversed with a low-carb diet, and let’s just assume that the case we’re talking about is responsive only to high blood pressure medication.  If you were the patient with the high blood pressure, and I gave you a pill that brought your blood pressure down to normal, you would consider the medication effective.  Would you then say, Hey, my blood pressure is normal, yippee! now I can quit taking the medicine?   I doubt it.  You would say, Great, the medicine is working.  Furthermore, if you quit taking the medicine and your blood pressure went back up to what it was before you started taking the medicine, would you say the medicine didn’t work?

Of course not.  Your high blood pressure was kept in check with the medicine, and your BP, not surprisingly, went back up when you quit taking the medicine.  The medicine itself was effective.

Same thing with dieting.  If you have an obesity problem that responds to a low-carb diet and you lose to your target weight, then go back to your old way of eating and gain your weight back, it isn’t the low-carb diet’s fault.  You have a problem that responds to a low-carb diet, and you pretty much have to stick with a low-carb diet (although not in nearly as extreme a structure as when you are trying to lose) for the long haul.

Having said all that, I can tell you that in my experience there is nothing that helps people lose weight more quickly and with less deprivation than a good quality, whole food low-carbohydrate diet.  You don’t have to be hungry.  You can eat rich, delicious foods, you’ll get rid of heartburn, drop your blood pressure, ditch excess fluid, and feel remarkably better.  You’ve just got to hang in there until you lose what you need to lose (which process you can speed along if desired with a little Metabosol), then you can loosen up and start adding some of the foods you’ve been foregoing.  And continue to eat them in moderation on maintenance.

Virtually all the studies in the medical literature show that at worst the low-carbohydrate diet equals the low-fat diet in all parameters and at best completely leaves it in the dust.  As far as I’m concerned, there is no faster, safer, more delicious way to lose weight. Hell, a study was just presented recently showing that women who did low-carb just two days a week lost almost twice as much weight as women following a calorically-restricted Mediterranean diet daily.  So, to be clear: Is weight loss tough?  Sure.  Is it easier when you cut the carbs? Absolutely! Low carb rocks!

Which brings me to the book that started this post.  In my opinion, The Art and Science of Low Carbohydrate Living is simply the best how-to book on low-carb dieting ever written.  As I wrote above, it is the book I wish MD and I had written.

The reason we didn’t write it is because a) some of this information wasn’t available when we last wrote a book (much of it is now available thanks to the work of Drs. Volek and Phinney), and b) no mainstream publisher would pay an author for this book.  If a mainstream publisher would buy it, the editor would force the authors to change it.  What do I mean by that?

All books fall into different genres, as they’re called in publishing.  One genre is diet/nutrition books.  So if you come to a publisher offering a diet/nutrition book, it gets pigeonholed into that genre and has to conform structurally to that genre’s standardized format.  Editors of mainstream publishing houses believe that the great mass of readers of nutritional books are not very bright and so have to be served real scientific information in small, small bites and not very many of them at that.  So the genre formula for a diet book is to have the actual diet regimen way up front because these editors don’t believe the readers of these books are smart enough or patient enough to wade through the explanations of why a particular diet works in order to get to the plan.  They want the plan up front within the first couple of chapters so people can get started without really having to read the book.  They also want a ton of recipes and meal plans to fill up the last half of the book.  Squeezed in between the plan and the recipe section is where they want to meat of book cubbyholed, and, in their view, with as little science as possible.

MD and I fought this structure tooth and toenail with Protein Power and ended up beating our editor down by agreeing to write a summary of each chapter called The Bottom Line that explained what each chapter said in non-scientific terms.  (Fortunately, we’ve been able to use this strategy in most of our books.) We worked well with our first editor, but we ended up in the hands of another editor when the paperback came out.  Editor Number Two hated all the stuff on the Paleolithic diet and the data from the ancient Egyptians.  This info was the first time in the popular press that the pre- verses post-agricultural diet was used as an argument for low-carb dieting.  And she wanted to ditch it from the book.  We went postal on her, so she ended up agreeing to leave it but only if we buried it in the very back of the book as an Epilogue.  That was one of the chapters of the book I wrote, and I thought it was pretty exciting information.  So, apparently did many others. But not this editor.  Sadly, she is not unusual.  Most want to conform to the genre.

Drs. Volek and Phinney self-published their book, and, as a consequence, could write it however the flip they wanted.  It is extremely well written and suffers none of the usual flaws of a self published book.  And it lays out the rationale for a low-carb diet as the treatment of obesity and other related disorders in a linear fashion instead of adhering to the typical diet book format.

As I finished writing the above paragraph, I clicked over and checked for comments on my latest post and found one with the following line:

This low-carb world can be a lonely place if one needs a navigator…

I can think of no better navigators than the authors of this book. Both of them have done a large part of the hardcore research on low-carb dieting that is in the medical literature today.  Go to PubMed and enter Volek JS or Phinney SD in the search window, hit ‘Search,’ and you will be rewarded with more peer-reviewed scientific papers on low-carb dieting than you will have time to read.  Many of the experiments described in these papers are explained in easy to understand language in their book.

Disclosure: Both Dr. Volek and Dr. Phinney are friends and colleagues of mine.  But they did not send me a copy of their book for review.  I purchased it from Amazon and paid the full price of $29.95 (it is now $19.95).  I bought it months ago and carried it with me all over Europe and on a half dozen other trips since but didn’t have time to even crack it until I was on the last leg back from our holiday trek.  It sounds cliché, but I couldn’t put it down.  I read and annotated the entire book over the course of two long flights.  Virtually anything anyone could want to know about the science behind low-carbohydrate dieting can be found in this book.

I’ll give you just one example.  It is common knowledge among many nutritionist, doctors and journalists that saturated fats are bad for us.  Most believe eating saturated fats leads to higher levels of saturated fats in the blood, which they inevitably describe as ‘artery-clogging saturated fat’.  Drs. Volek and Phinney, who certainly don’t believe this nonsense, understand adaptation to a low-carbohydrate diet changes the way the human body metabolizes different fats.  Eating more fat on a low-carbohydrate diet speeds up the burning of fat in general and saturated fat in particular.

There are only three things the body can do with saturated fat from the diet (or saturated fat made from dietary carbohydrate — and, yes, the body can and does make saturated fat from dietary carbohydrate).  It can burn them, store them, or convert them to a mono-unsaturated fat.  When people go on low-carbohydrate diets, they reduce their insulin levels, which in turn allows fat to escape from the fat cells to become the body’s primary fuel.

But what happens when a person increases saturated fat intake as part of a low-carbohydrate diet?  Drs. V & P knew that saturated fat burning would increase, but would enough burn to offset the extra amount of saturated fat coming in as part of a high-fat, low-carbohydrate diet?

To find out, they put 20 subjects on a low-carbohydrate diet for 12 weeks and another 20 subjects on a low-fat, high-carbohydrate weight loss diet for the same length of time.  The subjects in the low-carb group consumed three times the saturated fat per day (36 g vs 12 g) as did those in the low-fat group.  The blood from the subjects in both groups was then tested to determine total triglyceride level and specific fatty acid composition.

What did the good docs find?

In the serum samples done at baseline and again after 12 weeks, serum triglycerides  in the low fat group went from 187 to 151 mg per 100 ml, a tidy 19% reduction.  But in the low carb group, the before and after values were 211 and 104, a whopping 51% fall.  Both visually (just looking at the numbers) and statistically, the low carbohydrate group had a much greater (better) reduction in serum triglycerides.

The above should come as no surprise, because everyone knows that a low-carb diet reduces triglyceride levels.  But what about the amount of saturated fat in the blood?

As a proportion of the total, the low carb group had 33% saturates [saturated fatty acids] at baseline and 29% after 12 weeks, whereas the low fat group started at 30 and ended at 29%.  So after 12 weeks of dieting, the proportion of saturated fats in the blood triglycerides was the same for both groups despite the fact that the low carb group was eating three times as many grams per day of saturated fat in their diet.

But there’s more.  Because the low carb group ended up with blood triglycerides of 104 mg per 100 ml compared to the low fat group’s 151, they actually had about 30% less total triglycerides circulating in their serum.  So although the two groups had similar relative proportions of saturates, this means that the absolute serum content of saturates in the low-carb group was 30% lower than the low fat diet group.  So what we found, in a nutshell, is that despite a higher intake of saturated fat, the proportionate blood level of saturated fats did not increase, and their absolute levels fell dramatically with the low carbohydrate diet.

The bottom line on this point is that when our metabolism adapts to a low carbohydrate diet, saturated fats become a preferred fuel for the body, and their levels in blood and tissue triglyceride pools actually drops.

To summarize, a three times higher intake of saturated fats leads to a 30% drop in saturated fats in the blood of those following a low-carb diet as compared to those following a low-fat, high-carb diet.

Which means, of course, that if you want to decrease the artery-clogging saturated fats (should that be what you want to call them) in your blood, a low-fat, high-carb diet, the very diet almost every health care professional recommends for the job, isn’t the way to do it.  All you have to do is simply follow a low-carb diet.

The description of what happens to saturated fats in the blood during a low carb diet took two pages out of a 300 page book, so you can imagine how much content the entire book contains.

There is so much invaluable information in this book that I’m having to fight back the impulse to quote the whole thing.  You’ll learn

why you need more sodium on a low-carb diet and why the sodium prevents lean tissue loss,
why you need to increase fat intake during maintenance,
why a low-carb diet decreases inflammation,
why the low-carb, high-fat diet improves gall bladder function,
why excess carbohydrate converts to saturated fat and how,
what all the lipid parameters mean and how they’re affected by a low-carb diet,
and what the Paleolithic evidence tells us about diet.

And this list is just scratching the surface.  As I read this book, I kept marking parts that I needed to use for this blog.  In going back through, I would have to practically reprint the whole thing to give you just the important parts because the entire book is a gem.

Unlike most traditional diet books, The Art and Science of Low Carbohydrate Living doesn’t contain a lengthy section on how to execute a low carb diet.  There are plenty of books out there – some written by MD and me – that do that.  The book does have about 10 pages of the authors’ favorite recipes for low-carb foods and a seven day meal plan incorporating many of these recipes. (Another disclosure:  The authors recommend Protein Power as a good book on low-carb dieting, but I would have written this review the same had they never mentioned our book.)

The strength of this book isn’t in its meal plans and recipes, although those are delicious, it is in the wealth of information about all aspects of low-carb dieting.  If you have a question, almost any question, about any facet of low-carbohdyrate dieting, this book will have the answer.  And the answer will grounded in science, and in many cases from work done by these two scientists on the front lines of low-carbohydrate research.

As far as I am concerned, if you are planning on going on a low-carb diet and can afford only one book, make The Art and Science of Low Carbohydrate Living that one book.  If you are a long time low-carber, this is the one essential reference book you should have on your shelf.

If you are getting going on a low-carb diet the first part of this year, grab this book before you do another thing.  Once you see the world of benefits that will accrue to you from following such a diet, you will probably be able to overcome any depression that may have been inflicted on you from my last post.  So don’t hold off, grab a copy of this book today.  You will be very glad you did.

The best and easiest way to stay slim is to never become obese in the first place.

What I mean by making this seemingly obvious statement is that when a person goes from being normal weight to being overweight it is an indication that something metabolically has gotten broken.  At this point, no one knows for sure what gets broken, but many (and I count myself in this ever growing group) believe the damage occurs in the mitochondria, the organelles within the cells that are the energy furnaces.  Once whatever it is that gets broken breaks, it is difficult from that point on to lose weight and maintain weight loss without effort.

The study I mentioned above showed that the non-obese didn’t really gain anything over the Thanksgiving through New Year’s holidays, and I’m sure it’s not because they didn’t go face down in the fudge.  They didn’t gain because their metabolic systems were working properly.

MD and I both had our struggles with excess weight starting a few of decades ago.  We were both thin, both ate whatever we wanted, and both never gained weight.  Until, that is, our metabolic systems became damaged.  Once that happened, we ballooned, then lost, then have fought it since.  We both have kept our weight under control for years now with a few exceptions here and there by judiciously following a low-carbohydrate diet.  Since we’ve both stayed pretty much in the normal weight range for at least the last several years, we decided to try an experiment over the holidays.  And not over the entire Thanksgiving to New Year’s stretch but for a fairly short stretch between Dec. 20-Jan 2.  We had planned to make a multi-state trek to visit relatives over this period, so we decided that while we were traveling, we were going to eat like normal Americans just to see what would happen.

We didn’t go out of our way to overindulge in anything.  We had a maybe two hamburgers with the bun and had two or three orders of fries (I’m talking about during this entire period – not every day).  We had a Christmas cookie or two, downed several pieces of fudge, drank a bunch of eggnog, ate some fruitcake, and had a couple of bowls of ice cream.  And MD had a little more wine than usual while I probably doubled up on my Jameson.  Other than those indulgences we ate what would be considered sensibly by most people.  We ate some mashed potatoes, grits (we were in the South), beans (not the green bean variety), more fruit than usual and meat of one sort or another.  Pictured below is my plate (which I doubled down on) on New Year’s day.

As you can see, I ate ham, cheese grits, black-eyed peas, curried fruit, and corn bread.

The point of this exercise was to see what would happen to us if we followed a sort of modified typical American diet.  We avoided trans fats and vegetable oils as much as we could and had absolutely no soft drinks.  We had no breakfast cereals of any kind and took it easy on the wheat, but we did eat a little bread occasionally.  Except for the bits of fudge and other Christmas goodies we consumed – all of which were homemade using butter and/or lard as the fat source – we didn’t really go overboard on the sweets.  Our fructose intake was doubtless considerable less than that the average American, especially during that time of year.

So what happened to us during this couple of weeks of much better than average typical American dieting?

We gained weight!  And a fair amount of it.

I don’t know exactly how much we each gained because neither of us ever weighs – we go more by how our clothing fits.  (We didn’t plan on starting this little experiment before we left or we probably would have weighed.  We started it once we were already on the road.)  When I left on the plane, I wore a freshly laundered pair of jeans that fit loosely around my waist and that scrunched up a bit when I tightened my belt.  When we flew home, I wore the same pair of jeans (also freshly laundered), and they were tight around my waist and my belly actually spilled over a little.  MD had the same experience except her weight distribution was a little different.

If I had to guess, I would say we both gained somewhere around five or six pounds.  We were clearly at the top of the range of weight gain as described by the study I linked to earlier, and it happened in two weeks not the six weeks as it did in the study.  Which would indicate that we fall into the obese category, since the obese are the ones who most readily gain weight over the holidays.

But we aren’t really obese, or at least weren’t when we started.  But we obviously have the same metabolic defect that the obese have.  Our metabolic machinery has been damaged.  And even though we’ve keep our weight under control for years, the problem is still there, lurking in the weeds, ready to strike the moment we drop our defenses.

The take home message here is, to paraphrase Wendell Phillips, eternal vigilance is the price of thinness.  At least after you’ve once become obese.

So, MD and I are back on a rigid version of our own program, we are taking Metabosol, and, with the exception of a party we attended last night, are eschewing booze until we get back to our regular sizes.  Some of my GERD symptoms re-appeared during our modified debauch and I was thankful I had an old bottle of out-of-date Protexid to see me through.  One day of solid low-carb, and no more GERD, thank God.  And already after just a few days our clothing is starting to fit again.

If you are one of the many who are committed to a program of weight loss and rehabilitation this January, know that MD and I are right in there with you.

I want to forewarn you, though, that you’ve got to get your head right if you seriously plan to succeed.  Don’t be a Tara Parker-Pope.

I’ve had a number of people send me the link to her long piece in last week’s New York Times Magazine (Parker-Pope is a health columnist for the New York Times) about her struggles to lose weight and to maintain her weight loss once she is finally able to shed a little.  In the article she describes her despair as she tried first this program then that to lose weight.  She fits perfectly the description of so many patients I’ve dealt with over the years.

Once your metabolism is broken, it’s difficult  to lose weight (other than the first time or two you try it) and even more difficult to keep it off.  In order to be successful, you’ve got to make a real commitment and stick to it.  You can’t drift here and there as Parker-Pope has done looking for some magic regimen that is going to ‘melt the fat away.’  It ain’t going to happen.  It takes a lot of hard work and resolve to see it through.  Even with a low-carb diet.

As you can see from the vintage ad above, Tara Parker-Pope is not the first to look for a miracle cure for excess ‘flesh.’  But she is at a bit of a disadvantage in that by virtue of her position she can pick up the phone and call the head of nutrition at Harvard, Yale, Johns Hopkins or any big institution and ask for advice for a column she’s writing.  Unfortunately, the advice she will get from most of these people is totally the mainstream academic party line and more than likely incorrect.  And, if she’s like many patients I’ve dealt with, as soon as she discovers that whatever she is doing entails real work, she will start looking for the next magic fix, only to be disappointed in that.  She will, as she describes, roller-coaster around weight-wise, quickly regaining whatever she loses, and end up fat, sad and miserable.  The only difference between Tara Parker-Pope and the millions of other people out there in her shoes is that she has a powerful platform to express the despair and hopelessness she feels to a large readership.  (I noticed that for a few days her piece was the most emailed of all the articles in the New York Times, which speaks to just how many people are struggling.)

The underlying message of her piece is that she has tried everything, and it has all been for naught.  Her obesity is a condition beyond her control because she has worked with all the greatest minds in the academic world of obesity treatment and has ended up fatter than when she started.

My contention is that if she would undertake a low-carb diet composed of whole foods (with maybe a shake or two thrown in here or there) and stick with it judiciously she would ultimately achieve success.  At least considerably more success than she has achieved thus far.  But if she followed the best low-carb diet known to man and lost to her ideal weight and body fat percentage, she would still have to continue to watch what she eats for the rest of her life if she were to want to maintain her new slim self.  MD and I just proved that over the past couple of weeks.
I have never been able to understand the mindset of people who think that once they lose to their ideal weight and body fat percentage they can then go back to their old way of eating without regaining all the weight they originally put on by their old way of eating.  It baffles me even more that people can lose considerable amounts of weight on a given diet, then go back to their old way of eating, regain all their weight, and view it as a failure of their weight loss diet.  But they do.

I always took a detailed dietary history of all my patients.  Many had been through two or three (or more) weight loss programs before they came to see me.  I would ask them about all the different programs they had tried, and they would list them out.  And most had had some measure of success on one or more (if not all) of these programs, in many cases having lost anywhere from 60-80 or more pounds, but they, almost to a person, considered these programs failures because they had regained their lost weight.

These people, like Tara Parker-Pope, MD and me, and anyone else who has crossed the Rubicon into the land of obesity have dysfunctional metabolic systems that will probably never be completely normal again.  They, like we, will always have to exercise vigilance to maintain what we maintained so easily before the damage took place.

As I wrote above, the easiest way to deal with obesity is to never become obese in the first place.

Which brings me to a real pet peeve of mine.  I want to go for the throats of people who let their kids eat and drink tons of sugary crap and justify it because their kids don’t gain weight from it.  Who knows when the irreversible damage begins to occur?  I feel the same about adolescents and young adults who seem to feel invincible and are face down in all kinds of crap all the time because they never gain weight.  And they assume, stupidly, that they never will.  But when they do, most will struggle with it for the rest of their lives.

In preparation for my own weight loss, I went back an reread a few of my old posts to gain inspiration.  If you are in the let’s-lose-weight boat this month with MD and me, you might want to read them, too.

Here is one of my favorites about a good friend who really committed to losing weight and turned her life around.  The post also tells you why you should gain control not just for yourself but for others.

Another old post gives some psychological insights as to why it can be difficult right now to give yourself over to a low-carbohydrate diet and some psychological tools to make it easier.

Here is one that gives a few more psychological tools to make dieting easier.

Years ago I wrote a regular column for a now-defunct low-carb magazine.  This piece on what it takes to really make a low-carbohydrate diet work may help with your struggles.

There are the two fairly recent posts on all the tips and tricks you can use to start (or restart) a low-carbohydrate diet.

I’m frequently asked on radio, TV and print interviews what my daily food intake is.  A couple of years ago I decided to do a photo diary of a week’s intake of food during a normal week.  The food I ate that week pretty much mirrors the food I eat now with a couple of exceptions.  The quality of the cooked food is better now because almost everything we eat at home is prepared sous vide for obvious reasons.  I go through periods from time to time in which I really like to have shakes for breakfast.  Then I burn out on them and almost can’t bear the thought.  During the non-shake periods I typically eat three eggs and three or four slices of bacon (Mangalitsa bacon if I can get it) every day for breakfast.  During my week’s photo log, I was in a shake phase, so realize that I am not now in shake phase, so it’s bacon and eggs, but that’s about the only difference.  The week’s diet you’ll see if you take a look is what keeps me at my normal weight.  It’s pretty much what I’m back on now minus the booze and a few of the little extra carb tidbits. Plus, I’m scrupulously avoiding wheat just to see what happens.  As soon as I lose the few pounds I picked up and my jeans are loose again, I’ll be back to this diet in full.

• Photo food diary day 1
• Photo food diary day 2
• Photo food diary day 3
• Photo food diary day 4
• Photo food diary day 5
• Photo food diary day 6
• Photo food diary day 7

If you, like we, have been noshing on more carbs than normal over the holidays, then start anew with us this January.  As I have discovered this first few days, the time I spent dallying with carbohydrates over the previous couple of weeks has reinvigorated my long dormant urge to eat even more carbs.  I’m sure I’m not the only one in this boat.  We all have to remember that this urge is one we have to overcome first by effort and ultimately by habit.  I’m back on track.  Hope you are as well.

I also want to use this post to do a little housekeeping and let everyone know I’m going to try my hardest to post more frequently in 2012 (one of my resolutions, in fact).  But given my horrendous schedule lately (which shows no signs of letting up anytime soon), the only way I can post more regularly is to devote way less time to dealing with comments.

When I first started this blog six or seven years ago (June 2005, I think), I had almost no comments.  Before I kicked it off, I read a few niche blogs about the whole concept of blogging.  Many of those bloggers had readers asking about how to get more comments.  Some were asking if it were kosher to write comments under fake names so it would look like the blogger had a greater readership.  I don’t think I got a comment on the first bunch of blog posts I wrote, so I was wondering about that myself.

Then comments started trickling in.  I was so ecstatic that I would often write responses to those comments that were longer than the comments themselves.  I made it a practice to respond to practically every comment.  Once people started noticing this, I began to get medical questions submitted as comments.  The medico-legal situation is such that licensed physicians can’t really be providing medical advice online to patients they haven’t established a physician-patient relationship with.  It’s strange, but someone with absolutely no medical knowledge can give all kinds of medical advice without ever having to worry about legal consequences whereas a licensed physician can get in a world of legal and medical board hot water doing the same thing.  Even if the advice is spot on.  So I had to be careful in what I answered.  I usually simply told those commenters that I couldn’t give medical advice over the internet.

Not only did the medical questions start coming in more frequently but the comments in general began arriving in torrents.  Since I had been replying to practically every comment, people writing the comments structured them more as questions than comments.  Before I knew it, each post I wrote was generating dozens of comments (now it’s in the hundreds), and I was spending more time dealing with the comments than I was writing the posts.

But I soldiered on trying my best to keep up.  Finally it reached the point at which I simply didn’t have the time to do it.  I would respond to comments here and there that didn’t require long answers or that asked questions that I thought the answers to would be of interest to everyone.  Softhearted guy that I am, though, I would always worry that someone who didn’t get a question answered would think, Why did he answer so and so’s question but not mine?

And the biggest problem of all is that sometimes I would come across a comment/question that I really wanted to answer but didn’t have the time when the comment came in.  As I was waiting to answer the question, a load of other comments would come in.  Since the comments are posted chronologically based upon when they came in (not when I answered them), if I simply posted the comments that came in after the one I was waiting to answer, then when I finally answered that one, it would be buried way above all the others I had already posted.  Consequently, I would hold all in moderation until I got around to answering the one.  But over the last few years, the comments pile up so quickly that before I knew it there would be literally a hundred or so comments stacked up.  As I scanned through them, I would find several others I wanted to respond to, but couldn’t until I responded to the first one.  Finally, I would do a marathon of comment answering and get them all posted.  Then people would start writing back with comments and questions on the comments I had written, and in short order there would be fifty more comments awaiting moderation.

A couple of months ago, I wrote a post and ended up with over 300 comments in moderation.  I almost couldn’t bring myself to look at my own blog because of all the comments stacking up.  I had a few free days over the holidays (and had almost 400 comments by then), so I resolved to get them all posted.  Which I did.  I answered a few here and there, but for the most part I simply approved them without comment.

I am resolved now to spend more time in posting and less time in dealing with comments.  I will occasionally answer a question if I can do it in a short answer, but I simply don’t have the time for long explicit answers and engaging in back and forth arguments.  So if you submit a question and don’t get an answer, don’t get your feelings hurt.

And please, please, please don’t ask specific medical questions because you absolutely won’t get those answered.  Don’t feel bad if you see me answering what appears to you to be a medical question and not answering one you might submit.  There is a fine line between what constitutes giving medical advice and what is simply an answer to a medical question.  I’ve been around long enough to know what that fine line is, so rest assured that if you see what appears to you as my answering a medical question, it really isn’t.

One last thing about the comments.  In the not too distant past I would scrounge through all the spam in the spam folder looking for legit comments that got disposed of there.  Now I can’t do that because I get about 1000 spam hits per day (just checked and there were 1738).  If you submit a comment and it doesn’t show up, it may have been gobbled up by my spam catcher, so resubmit.  If you have a lot of links included in your comment, it increases the odds the spam filter will get it, so if it doesn’t show, resend without so many links or make it into two or three comments.

Finally, there have been a ton of questions about specific products (and their availability) that I have approved in my last great mass approval.  Here is the current status of those products.

Protexid

We have no supplies of Protexid at this time.  I hope to have some made and available within the next month or so.  Keep checking the website for availability or I may stick up a quick post.

Metabosol

Metabosol is now available in the products section.  Thanks to everyone for their feedback on it.

Pentabosol

Pentabosol is no longer being made.  We have replaced it with Metabosol, which is made of the same active ingredients but with a natural sweetener instead of an artificial one.

Thanks to all of you who have hung in there with me despite all my absences.  I’m going to work hard to not be AWOL again.

And once again, a Happy New Year to all.

Vintage Happy New Year card above from Daisy Fairbanks.

The Santa Barbara Choral Society performs Handel’s Messiah

Composed for a fundraiser for a Dublin prison, Handel’s Messiah has become a perennial Christmas favorite everywhere. The entire performance is in three parts and takes over two hours for the entire performance.  MD’s choral group, the Santa Barbara Choral Society, typically performs all of Part I, and selections from Parts II and III.  I’m crazy about the whole thing, but the selection that people are most familiar with is the Hallelujah Chorus from Part II.

Here is the Santa Barbara Choral Society performing the Hallelujah Chorus.

Hallelujah

(Click on the Hallelujah, wait a few moments for it to load, then enjoy.)

MD and I both wish everyone a Merry Christmas and a Happy New Year.

First, I noticed in both talking with people at the Ancestral Health Symposium last August and attending a number of the talks that many followers of their own version of the ancestral diet are dismayingly including more and more carbohydrates.  And recommending more to their followers.

When MD and I wrote Protein Power in the mid 1990s, we used the Paleolithic diet as an argument for the efficacy of the low-carb diet.  If pre-agricultural man evolved in a milieu devoid of carbohydrate-dense foods, we posited, then natural selection should have culled those who didn’t thrive on such fare, leaving us, the descendants, powered by metabolic processes that performed better on protein and fat substrates.  If the rampant obesity and diabetes (we just thought it was rampant then) was a consequence of a diet we weren’t designed for, then switching to one that better suited us metabolically should produce substantial changes to the good.  Which it undeniably does.

I can’t help but recall the great quote by Dr. Blake Donaldson, who changed the complexion of his practice in New York after spending some time with Vilhjalmur Stefansson.  Wrote Dr. Donaldson in Strong Medicine, his book about an almost all meat diet:

During the millions of years that our ancestors lived by hunting, every weakling who could not maintain perfect health on fresh meat and water was bred out.

Now, it seems, many who have taken to the Paleo diet have started to drift from the Paleo-is-basically-low-carb paradigm into the Paleo-is-anything-that-isn’t-Neolithic paradigm.  And although Neolithic man grew all sorts of crops, most Paleo dieters consider only grains to be truly Neolithic foods.  Some Paleo dieters take it a step further and argue that since pre-agricultural man couldn’t have domesticated animals (other than perhaps canids of some sort), then he couldn’t have eaten dairy products.  So, those Paleo purists avoid grain and dairy products.  Both the dairy and non-dairy Paleo dieters, however, are starting to include larger amounts of carbohydrates – primarily starch – into their diets on the presumption that Paleo man would have eaten it.

I have no doubt that Paleo man would have been face down in a box of donuts had he been given the opportunity.  But he wasn’t.  Nor was he often presented with the opportunity to indulge in a carb fest composed of high-starch fruits and vegetables. Maybe in the fall when the fruit ripened (if he could beat the birds and bugs to it), but not much of a chance during the rest of the year.

(I am aware that Denise Minger put up a post not too long ago showing all the high-starch, high-sugar tropical fruits available in tropical areas, intimating that early man must have consumed these and, therefore, should have evolved to do okay on high-carb diets.  Problem with this reasoning is that archaic homo sapiens migrated out of tropical areas anywhere from 60,000 to 150,000 years ago and went through the crucible of natural selection in other less fruit-laden climes.  People of European descent certainly had ancestors who could not avail themselves of tropical fruits at any time.)

The second event driving me to write is a line out of a guest post on Richard Nikoley’s Free the Animal blog by Darrin Carlson titled “The Five Failings of Paleo.”  In Mr. Carlson’s own words, here is Paleo Fail #1:

We Don’t REALLY Know What Our Ancestors Ate. [Bold and caps in the original.]

I disagree for a couple of reasons.  First, we can be pretty certain what our European ancestors didn’t eat.  They didn’t eat dwarf wheat, Red Delicious apples, bananas, Bartlett pears or any other hybridized or tropical fruits commonly available today. As far as we know, there were no Paleo Luther Burbanks grafting and hybridizing plants to make them bigger and sweeter.  Our predecessors would have eaten whatever plant foods were at hand, which is pretty much what you still find if you go out in the woods today. They would have had to battle the birds and other wildlife to get to these fruits, and would have had them available only seasonally.

The second reason I disagree is alluded to in a way by Mr. Carlson in his explanation of Fail #1: Said he:

We have yet to find a magic phone booth that will transfer us back through time–Bill and Ted notwithstanding–to directly observe how our great-times-450-grandparents lived.

Actually we do have such a ‘magic phone booth’ available to us, or at least to those of us who know how to use it.  It’s an isotope ratio mass spectrometer, and its use has been refined over the past 30-40 years to allow us to peer back in time and calculate what our ancestors ate.

I learned about this ‘magic phone booth’ in the fall of 2000 in Hamburg, Germany where MD and I attended a great conference titled Meat and Nutrition.  After the last talk, on a cold, dreary, foggy, drizzly afternoon, MD, Loren Cordain and I lit out to  make a pilgrimage to Indra and the Kaiserkeller, the dives where the Beatles had gotten their start in the early 1960s.  We asked Michael Richards, a professor at the University of Bradford to join us.  On the first morning of the meeting, Michael had given a riveting talk on the use of stable isotopes to determine the diet of early man, and I wanted to find out more.

After roaming the Beatles early haunts, we decamped to a Hamburg coffee house to get warm.  I asked many questions about the stable isotope methodology and have followed the growing literature on it since.  Michael has turned into an academic superstar and is now at the prestigious Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, where he continues to publish his work on the isotopic analysis of the diet of early man.

Let’s take a look at the ‘magic phone booth’ of stable isotope analysis and see what it shows.  The whole notion is fairly complex so I’m torn between making its science simple enough for Homer Simpson to understand, which really doesn’t do the technique justice, or making it unnecessarily difficult. I’m shooting for something in between.

As most everyone knows, atoms are composed of protons, electrons and neutrons.  The number of protons gives an element its atomic number.  A given element always has the same number of protons but can have varying numbers of neutrons.  Carbon, for example, has six protons (and an atomic number of 6).  But the carbon atom can have 6, 7 or 8 neutrons.  All three versions are still carbon, but the atoms vary by the number of neutrons.  These different versions are called isotopes, so basically isotopes are atoms of the same element with the same number of protons but differing numbers of neutrons.  The atomic mass of an atom is determined by the number of protons and neutrons it contains, so although carbon always carries the atomic number of 6, carbon has three different atomic masses: ¹²C, ¹³C and ¹⁴C.

Carbons with an atomic mass of 12 and 13 (¹²C, ¹³C) are stable whereas ¹⁴C (pronounced carbon 14) disintegrates radioactively over time.  This radioactive decay is what allows scientists to determine the age of organic materials up to about 40,000 years old. The discovery of natural radioactivity of ¹⁴C and its usefulness in determining age garnered Willard Libby the 1960 Nobel Prize in Chemistry.  Although the unstable isotopes such as ¹⁴C have their uses, we are concerned here with the stable isotopes.  Primarily ¹²C and ¹³C and ¹⁴N and ¹⁵N (nitrogen 14 and 15).  From these four stable isotopes, we can learn a lot about the diet of early man.

Nuclear weapons started adding ¹⁴C into the atmosphere in the mid 1900s, so the average ratio of ¹²C, ¹³C and ¹⁴C have change slightly.   Since ¹²C and ¹³C are stable, there has been virtually no change in the ratio between them over time.  But the ratio of the two has been found to differ from one carbon-containing material to another.  For instance, carbon dioxide generated from marine limestone contains more ¹³C than does carbon dioxide generated from burning wood.  In general, marine sources have greater amounts of ¹³C than do terrestrial sources.

Just to make it a little more complex, when researchers run samples through a mass spectrometer to determine the ¹³C/¹²C ratio, this ratio is compared to an agreed standard.  Then the difference between the sample and the standard is called the relative ¹³C content, which is designated by δ¹³C and measured in parts per thousand. (‰)  So if the sample has a ratio less than the standard by 5 parts per thousand, it is defined as having a δ¹³C value of −5‰.

Don’t worry about all the above – just remember when you see δ¹³C from now on, it refers to the ratio of ¹³C to ¹²C.  Don’t despair.  It will be easier as we go along.

Of the dry weight of bone, a little over 25 percent is collagen, and it is collagen that is the tissue of choice for stable isotope analysis.  Virtually all of the carbon and nitrogen in collagen comes from protein, and since most protein in the human body ultimately comes from protein in the diet, the carbon and nitrogen isotopes in the collagen reflect the protein sources in the diet.  And since the stable isotope composition of collagen turns over very slowly, the ratios of carbon and nitrogen stable isotopes reflect diet over about an eight to ten year period.

Stable isotopes of both carbon and nitrogen occur in varying proportions in different foods, and these proportions are passed along to the animals, including humans, that ate these foods.  By knowing the proportions of the stable isotopes in various foods, we can determine these foods by analyzing the stable isotopes in human collagen.

Researchers are able to extract valuable data from the collagen of ancient bones.  Unfortunately ancient bones are not thick on the ground, and since a part of the bone has to be destroyed to perform the stable isotope analysis, these analyses are not done by the thousands.  Each time a skeleton or group of skeletons is unearthed, Michael Richards and other stable isotope researchers try to snare a little piece of bone and go at it with the mass spectrometer.  This kind of work has been done for several decades now, and the results – though painstakingly obtained one specimen at a time – are accumulating, and there is now a fairly substantial body of data.  And this data is remarkably uniform in what it shows of the dietary habits of our ancient European ancestors.

The δ¹³C and δ¹⁵N figures reveal different information about the diet of Paleo man.  Since the ¹³C isotope is found in greater quantities in the marine environment than in the terrestrial, a larger δ¹³C indicates a diet higher in seafood protein whereas a lower δ¹³C is associated with a diet composed primarily of protein foods from the land.  Researchers have accumulated considerable data on the δ¹³C of seals and other such animals that spend their lives in the oceans consuming other marine life to compare with the data gleaned from bones of animals living on the land far from the sea.  By noting how the δ¹³C from ancient human bone compares to these extremes determines whether the human dined on protein from terrestrial or marine sources of from a combination of the two.

The δ¹⁵N tells a different story.  δ¹⁵N basically tells us where an animal or human is on the food chain.  Basic plant foods maintain a fairly constant δ¹⁵N value.  When animals, typically herbivores, eat these plant foods, the stable N isotope in the plant food tends to concentrate by anywhere from 5-8 percent in the collagen of the animal.  So if the collagen of an animal is found to have, say, a 7 percent greater δ¹⁵N than the local flora, one can say the animal was an herbivore.  Animals that are known herbivores, when analyzed, fit this spectrum.

Any animal, including man, that dines on herbivores will have collagen sporting a δ¹⁵N that is about 7 percent greater than that found in the herbivores that are the meal, a fact confirmed by stable isotope analysis of known carnivores.  A super carnivore (for lack of a better name) that dines on other carnivores and herbivores would have an even greater δ¹⁵N level.

So, δ¹⁵N pinpoints us on the food chain while δ¹³C tells us whether the protein we eat is surf or turf or both.

Now that we have a full understanding of the ‘magic phone booth’ of stable isotope analysis, let’s take a look at what the data show.

The data taken as a whole show the following:

Early man was a high-level carnivore. (As was his distant relative the Neanderthal, who lived contemporaneously with ancient man in Europe.)  A higher-level carnivore, in fact, than foxes, wolves and other known carnivores.  The earliest anatomically modern humans got most of their protein from animals of terrestrial origin.  As time passed and the populations of large game thinned due to heavy hunting by both humans and Neanderthals, the human position on the food chain didn’t change, but sources of protein changed from all terrestrial to more and more marine (which includes fresh water fish, mussels, clams, etc., all of which have a similar δ¹³C as animals from the ocean).  Irrespective of whether the protein came from the land or the sea, early man occupied a super-carnivore niche in pre-agricultural days.

Here are a couple of graphics of stable isotope studies done by Michael Richards – one on Neanderthals; the other on early modern man – I presented at the Ancestral Health Symposium back in August at UCLA.

As you can see from this slide, the Neanderthal subjects were ranked a bit above the wolf and fox on the predator/meat eating scale.  As Michael Richards commented in the paper cited above:

…the European Neanderthal diet indicates that although physiologically they were presumably omnivores, they behaved as carnivores, with animal protein being the main source of dietary protein.

When we take a look at another study evaluating ancient humans, we see much the same thing.

As compared to the Arctic fox, you can see that early humans were way off the chart to the right.  Michael Richard’s commentary:

We were testing the hypothesis that these humans had a mainly hunting economy, and therefore a diet high in animal protein.  We found this to be the case…

The bulk of the stable isotope studies show both Neanderthals and ancient humans were, at their robust cores, meat eaters to the max.  What the stable isotope studies don’t show, is how much carbohydrate these folks ate along with their meat.  (Actually some stable isotope studies do show what kind of carbs in the sense that they can differentiate between grains and non-grains, but since there were no grains in Paleo times, that isn’t a concern.) But since we do know that wolves and foxes are predators that consume mainly food of animal origin, and we know that early humans have an even more carnivorous stable isotope footprint, it seems unlikely that these humans would have consumed many calories from non-animal sources.  Remember, natural sources of protein are virtually always associated with fat (copious amounts of fat if the protein is from large game and the entire carcass is consumed), so it’s doubtful there would be either the capacity or the necessity for complementing the basic diet of fat and protein with much carbohydrate.  But, nonetheless, even if our ancient ancestors did eat some carbs they could scrounge while in season, the stable isotope evidence clearly demonstrates they were not vegetarians.

If you would like to read more about stable isotope analysis for determination of the diet of early man, a good place to start is with the publications of Michael Richards.

Other good sources for basic information:

Katzenburg MA (2008) Stable isotope analysis: a tool for studying past diet, demography, and life history. In Katzenburg MA, Saunders SR (eds) Biological Anthropology of the Human Skeleton. (Hoboken, Wiley-Liss) 2nd Edition pp 413-441

Schoeninger MJ, DeNiro M (1984) Nitrogen and carbon isotopic composition of bone collagen from marine and terrestrial animals.  Geochim Cosmochim Acta 48:635-639.

Schoeninger MJ (1995) Stable isotope studies in human evolution. Evolutionary Anthropology 4(3): 83-98.

van der Merwe, NJ (1982) Carbon isotopes, photosynthesis, and archeology. American Scientist 70: 596-606.

“The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered.”

Dr Diamond was referring, of course, to the devolution of human health that took place as mankind suffered the corporal transformation driven by the mismatch between hunter-gatherer genes and an agricultural diet and lifestyle. Smaller stature, decreased cortical bone thickness, obesity, increased incidence of infectious diseases, dental caries, periodontal disease, vitamin deficiencies, and even famine – all common in agriculturists – were not, for the most part, the lot of pre-agricultural man.

Humanity doubtless gained more than it lost in this hunter to farmer changeover when viewed in a big-picture sort of way.  Farming made possible larger communities filled with workers, workers who, for the first time, made specialization of labor a possibility.  And fewer people could till the fields and provide food for the many, freeing the others to pursue the arts, business, politics, and warfare.

Stephen Budiansky, author of one of my favorite books, Covenant of the Wild, describes how domestic animals formed a pact with humans in which the animals traded a period of safety and survival for their lives.  Had this covenant not been made, it is highly likely – virtually a certainty – that cows would now be extinct.  Big, slow, stupid and tasty, had they not been amenable to domestication and entered into the covenant with their domesticators, cattle would have been hunted to extinction long, long ago.  But they did – however unwillingly – make the covenant and so exist by the tens of millions today.  The deal they cut was a phenomenal deal for cattle as a species, but not a particularly good deal for the individual cow when the time comes to pay up at slaughter.

Homo sapiens entered an almost mirror image of this same covenant when they domesticated cereal grasses.*  We gave up our independence and mobility for the promise of a constant and plentiful food supply.  But, as with our covenant with domestic animals, there is a catch.  And this time it’s with us.  Humans emerged from this deal with the short end of the stick.  In the same way as did cattle, we made a good-for-humans-as-a-species/bad-for-the-individual-human trade.  Like it or not, we traded the health of the individual human for the overall good of mankind and the development of civilization.

We traded a diet based primarily on fat and protein with a little carbohydrate thrown in from roots, shoots and tubers for one centered predominantly on carbohydrate.  The main source of the carbohydrate was cereal grains, chiefly ancient forms of wheat, the predecessor of the wheat that now occupies a large part of the human diet everywhere.  Ancient forms of wheat didn’t do our forebears a lot of good, and, according to Dr. William Davis’s new book Wheat Belly, the modern forms of the grain do us even less good.

Before we get to the problems modern hybrid wheat causes us, let’s take a look at the afflictions a diet of primitive wheat visited upon our predecessors.

The ancient Egyptians consumed a diet that would be considered optimal by many people today.  Both wealthy and poor Egyptians consumed primarily bread and a type of cloudy, almost gruel-like beer.  To these staples were added a variety of vegetables (mainly onions), and a small selection of game, fish and meat.  The bread was made from coarse ground, whole grain emmer wheat, a primitive, high-protein wheat.  Sugar didn’t come on the scene until about 1000 AD, so the Egyptians used honey sparingly (it was expensive) as a sweetener along with figs.  In short, these people consumed a diet the vast majority of modern nutritionists would prescribe to people to prevent obesity, heart disease, obesity and the rest of the diseases associated with the Western diet.

But, as their mummified remains and their contemporary artwork demonstrate, the ancient Egyptians were often fat and were riddled with heart disease, dental caries, bad periodontal disease and no doubt diabetes and hypertension.  Many people have argued that since only the wealthy were mummified, the mummy data applies only to them, and since the wealthy ate more red meat, the rates of obesity, heart disease and the other disorders common to them didn’t apply to the rest of the population.  Even the common man, however, was often portrayed as obese in Egyptian artwork, and despite greater consumption of meat, the main staple of even the wealthy was bread and beer. And it didn’t do them a lot of good.

The 5,300 year old mummy of Ötzi the Iceman found in the Italian Alps showed a bad case of dental caries and periodontitis along with a stomach-full of einkorn wheat (another primitive variety). Said the researchers who examined Ötzi:

Although the Iceman did not lose a single tooth until the his death at an age of about 40 years, he had an advanced abrasion of his teeth, profound carious lesions, and a moderate to severe periodontitis.

In particular, the molars of the upper jaw showed loss of alveolar bone as a sign of periodontitis (inflammation of the ligaments and bones that support the teeth), while evidence of “mechanical trauma” was found on two teeth.

…the most surprising find is the high frequency of cavities.

These dental pathologies are a sign of change in the Neolithic diet.

We already know that he was eating grains, such as einkorn or emmer. The contained carbohydrates clearly increased the risk of developing dental diseases

One would assume these findings would be common among the rest of Ötzi’s contemporaries, who doubtless consumed a similar diet.

Sadly, these same findings are also common among modern man who consumes a more malign version of primitive wheat.

Until I read Dr. Davis’s book Wheat Belly, I didn’t really think much about wheat other than its being a major source of carbohydrate in the American diet.  It never had occurred to me that the wheat we eat today is not the same wheat of our great-grandmothers cooked with nor probably even our grandmothers.  And it really hadn’t dawned on me how pervasive wheat is in the diet.  Since reading Michael Pollen’s The Omnivore’s Dilemma I had been conscious of the amount of corn in our modern diet, but I hadn’t thought much about wheat.  As Yogi Berra supposedly said, “You can see a lot just by looking.”  So I went out and looked.  And I can tell you that we are much more Children of the Wheat than we are Children of the Corn.

In most grocery stores, an entire aisle is devoted to nothing but bread in all its forms.  Then there is typically another large aisle full of cakes, cupcakes, cookies, pies, tarts, sweet rolls, bagels, croissants, brownies, and other sweet baked goods.  The vast majority of the cereal aisle displays products containing primarily wheat.  And if you look at processed foods of all kinds, you’ll find wheat in there.  If you make or buy gravy, roux, or just about any kind of sauce, you’ll find it’s thickened with wheat flour. (MD bought some demiglace a few days ago, and noticed as she was removing it from the container that even it had added wheat.) Then there is the aisle full of different beers, many of which are made with wheat.  These are just a few of the items you can find containing wheat in a grocery store; don’t even get me started on restaurant fare.  Wheat is everywhere – corn should be so lucky.

When I was roaming around looking for pictures of dwarf wheat (more about which later), I came upon the website for the Kansas Wheat Commission that listed a few facts about wheat.  Here are several that caught my eye.

Wheat is the primary grain used in U.S. grain products.  Approximately three-quarters of all U.S. grain products are made from wheat flour.

More food is made with wheat than any other cereal grain.

U.S. Farmers grow nearly 2.4 billion bushels of wheat on 63 million acres of land.

About half the wheat grown in the United States is used domestically.

A little back-of-the-envelope calculating using the above statistics tells us that each of us in the United States consumes about four bushels of wheat per year.  Another statistic from the linked website states that each bushel of wheat makes about 90 one-pound loaves of whole wheat bread.  So, we all eat the equivalent of 360 loaves of bread per year, or approximately one loaf per person per day. That’s a lot of wheat, in fact, it’s almost approaching ancient Egyptian levels. (Moreover, since MD and I don’t eat any, that means two other people out there are each eating two loaves per day.)

It would be bad enough if we consumed all this wheat as emmer or einkhorn or other primitive varieties, but we don’t.  We get most from a hybrid of Triticum aestivum – our great grandmother’s wheat – called dwarf (or semi-dwarf) wheat, which now comprises more than 99 percent of all wheat grown worldwide.

As Dr. Davis tells it, the hybridization of wheat came about in an effort to improve yield, which is now about tenfold greater per acre than it was a century ago. Older strains of wheat were taller and more prone to damage from wind and rain.  And

When large quantities of nitrogen-rich fertilizer are applied to wheat fields, the seed head at the top of the plant grows to enormous proportions.  The top-heavy seed head, however, buckles the stalk.  Buckling kills the plant and makes harvesting problematic. A University of Minnesota-trained geneticist…is credited with developing the exceptionally high-yielding dwarf wheat that was shorter and stockier, allowing the plant to maintain erect posture and resist buckling under the large seed head.  Tall stalks are also inefficient; short stalks reach maturity more quickly, which means a shorter growing season with less fertilizer required to generate the otherwise useless stalk.

In the photos below you can see the difference between wheat grown in the Middle Ages and the dwarf wheat grown today.

Dr. Davis writes that modern wheat is approximately 70 percent carbohydrate by weight.  The carbohydrate is in the form of a starch called amylopectin A.

The most digestible form of amylopectin, amylopectin A, is the form found in wheat.  Because it is the most digestible, it is the form that most enthusiastically increases blood sugar.  This explains why, gram for gram, wheat increases blood sugar to a greater degree than, say, kidney beans or potato chips.  The amylopectin A of wheat products, “complex” or no, might be regarded as a supercarbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all the other carbohydrate foods, simple or complex. [Italics in the original.]

But what about the much vaunted whole grains.  Won’t ‘whole grain’ bread or wheat products be better?  Not according to Dr. Davis:

…the degree of processing, from a blood sugar standpoint, makes little difference: Wheat is wheat, with various forms of processing or lack of processing, simple or complex, high-fiber or low-fiber, all generating similar high blood sugars.  Just as “boys will be boys,” amylopectin A will be amylopectin A.  In healthy, slender volunteers, two medium-sized slices of whole wheat bread increase blood sugar by 30 mg/dl (from 93 to 123 mg/dl), no different from white bread.  In people with diabetes, both white and whole grain bread increase blood sugar 70 to 120 mg/dl over starting levels.

And aside from the blood sugar and, consequently, insulin problems caused by the consumption of too much wheat, there are other problems.  As with almost any food, the newer the food, the greater the likelihood that it will be problematic to some humans who consume it.  Since dwarf wheat has been around for less than 50 years, it should come as no surprise that it does indeed cause it’s share of problems.  Dr. Davis spends the better part of his excellent book detailing many of these problems and describing his clinical experience in helping many of his patients shuck their wheat habit.  He describes the increase in celiac disease over the past 50 years and believes, as I do, that celiac disease is a continuum.  The severe form of it that is recognized as celiac disease is pretty easy to diagnose (if a doctor has sense enough to look for it), but there are milder forms that manifest themselves as anything from mysterious rashes that come and go to diarrhea and other GI disturbances to arthritic aches and pains. And we can’t forget a number of other afflictions that may well have their basis in wheat intolerance that include osteoporosis, acne (bagel face?), neurological disorders, and the creepily- dubbed ‘man boobs.’

It’s good to learn in Wheat Belly that Dr. Davis has finally shucked his bred-in-the-bone cardiologist’s antipathy toward fat in general and saturated fat specifically and has come over to what most of his peers must view as the dark (read: low-carb) side:

The fat phobia of the past forty years turned us off from foods such as eggs, sirloin, and pork because of their saturated fat content — but saturated fat was never the problem.  Carbohydrates in combination with saturated fat, however, cause measures of LDL particles to skyrocket.  The problem was carbohydrates more than saturated fat.  In fact, new studies have exonerated saturated fat as an underlying contributor to heart attack and stroke risk. [Italics in the original.]

Dr. Davis wraps up his meticulously researched book with a straightforward plan to help free the reader from the tyranny of wheat, while at the same time providing instructions for a delicious and satisfying wheat-free diet.  He furnishes an extensive list of wheat-containing foods that should be avoided and imparts his caveats about going facedown in products advertised as being gluten-free.  And best of all, he provides a short section filled with matchless wheat-free recipes for many meals that would otherwise be wheat-laden. (MD and I have tried a few of these recipes and found them to be superb.  I especially enjoy his wheat-free granola recipe even though I go a little easy on the rolled oats part of it.)

Wheat Belly hit the New York Times Bestseller list shortly after it came out (and has been there for two weeks now), which I can tell you from experience, is not an easy thing to do.  As a result (because being on the NY Times list means a book has had big sales numbers), the wheat producers have not taken their hits lying down.  They’re fighting back with full venom, because a book like this one can do them serious economic damage. Expect it to get worse. (Remember all those shelves in the grocery stores stuffed with wheat-containing products? They don’t want to see that go away.)  You can read about some of their tactics here and read Tom Naughton’s interviews with Dr. Davis here and here.

I can’t recommend this terrific book highly enough.  Wheat Belly is fully referenced and indexed (unless you somehow got the little freebee paperback review version that I received from the publisher), and is a must have for the library of any serious low-carber or anyone concerned about health.

*MD and I wrote about this domestication of humans by grains in The Protein Power LifePlan.  In that book we referenced an interesting paper by a couple of Australian researchers on the hypothesis that the addictive nature of cereal grains helping this domestication along.

A glass of Tinto de Verano pictured at left. A great way to hydrate. (See note at bottom of post.)

As I said, you need to really crank up the fat intake to push yourself over the adaptation divide as quickly as possible.  If you don’t like fatty cuts of meat, you can add a little medium-chain triglycerides (MCT) to your diet.  MCT are absorbed more like carbohydrates and are used quickly by the body.  They are almost never incorporated into the fat cells, so they burn quickly, and any extra that might be hanging around are converted to ketones.  So, MCT will drive the ketone production process.  And so will coconut oil if you prefer that.

You can find MCT oil at most health food or natural grocery stores.  It has never bothered me, but some people can get a little nauseated if they take too much of it, so if you decide to give it a try, start out slowly.  Or go with the coconut oil.

Aside from the occasional carb cravings, which we’ll deal with later, the most common symptoms experienced by those getting started on low-carb diets are fatigue, headaches, light-headedness or dizziness, and cramping.  I would say these four symptoms probably comprise 98 percent of the complaints we get from our patients we put on low-carb diets.  Not everyone experiences these symptoms – especially those who do what we tell them – but of those who do have symptoms, these are almost always the ones they have.  Let’s look at what to do to avoid them or treat them should you already be experiencing on or more.

Electrolytes

The most common cause of virtually all the symptoms listed above is an imbalance in electrolytes.  Following a low-carb diet results in a rapid lowering of insulin levels, which – though a good thing – can create problems in the early days.  We’ll address the electrolytes in the order of importance.

Sodium

When you are overweight and insulin resistant, you have a lot of insulin circulating in your blood most of the time.  This excess insulin does a number of bad things to you.  Gary Taubes wrote an entire book about how excess insulin makes you store fat in your fat cells.  But the story doesn’t end there.  Excess insulin also drives the kidneys to retain fluid, which is why many obese people retain a lot of extraneous fluid and experience pitting edema in their lower legs.

What is pitting edema?

If you push your finger into the tissue in the front (or just to the side of) your shin bone and your finger leaves an indentation – almost a finger print – that takes a while to fill back in, you have pitting edema.  Most overweight people experience this phenomenon late in the afternoon and/or at night after being on their feet all day.  The excess fluid pools around the lower legs and seeps into the soft tissues. In the morning, after the body has been horizontal through the night, the fluid redistributes, and the pitting edema goes away but then reoccurs as the day goes on.  Even people who aren’t all that overweight but who do have elevated insulin levels will have some degree of excess fluid accumulation even if they don’t experience pitting edema as evidence of it.

One of the first things that happens when people go on low-carb diets is a rapid improvement in insulin sensitivity.  Because the low-carb diet starts to quickly banish the insulin resistance, insulin levels fall quickly.  And as insulin falls, the stimulus to the kidneys to retain fluids goes away, and the kidneys begin to rapidly release fluid.  One of the common experiences at the start of low-carb dieting is the incessant running back and forth to the bathroom to urinate this excess fluid away.  Which is both good news and bad news.

The good news is that it’s great to get rid of the excess fluid but it comes at a cost, which is the bad news.  As the excess fluid goes, it takes with it sodium an extremely important electrolyte.  When sodium levels fall below a critical threshold (which can happen within a short time), symptoms often occur, the most common being fatigue, headache, cramps and postural hypotension.

Postural hypotension happens when you stand up too quickly and feel faint.  Or even pass out briefly.  It’s a sign of dehydration.  So if you’ve started your low-carb diet, made your multiple runs to the bathroom, and jump up off the couch to answer the phone and feel like your going to faint (or actually do pass out momentarily) and have to sit back down quickly, you’ve got postural hypotension.  It’s really easy to fix – you simply need to take more sodium and drink more water.  Salt your food more.  Increasing sodium is just another one of the many counter-intuitive things about low-carb dieting.  Just like eating more fat to lower your cholesterol.  You’ve got to start thinking differently.  The low-carb diet is one that absolutely requires more sodium.  A lot more sodium.

If you’ve got the brutal headaches that some people get when starting on a low-carb diet, add sodium.  And drink extra water.

Even if you don’t have pitting edema, postural hypotension or headaches, you still need more sodium if you are starting out on or following a low-carb diet. It’s critically important that you get extra sodium.  I can’t make this case too strongly.

An easy way to get extra sodium along with magnesium and potassium (a couple of other electrolytes we’ll discuss in a bit) is by consuming bone broth.  Unfortunately, you typically have to make the good stuff yourself because it’s difficult to find commercially.  You can get chicken broth and beef broth at most grocery stores, but it’s not nearly as good as the broth you can make yourself.  At the end of this post I‘ll give you a spectacular recipe that we have for a great bone broth we made at our now-defunct restaurant.  It is beyond good.  It requires a little time, but you can make a bunch and freeze it in small containers and keep it forever.

Short of making your own bone broth, you can use commercially available bouillon, which contains plenty of sodium and makes a nice hot drink.  Plop a cube in a cup of hot water and throw it back. Many patients have reported that drinking a cup of hot bouillon helps them get through carb cravings.  It’s easy and convenient, but can’t compare in taste to the real bone broth you make yourself.

In addition to broth, get some Celtic Sea Salt, Himalayan Salt or one of the other grayish, pinkish kind of grungy looking salts and replace your normal salt with these.  And don’t use them sparingly.  These salts have been harvested either from ancient sea beds or obtained by evaporation of sea water with high mineral content and contain about 70 percent of the sodium of regular salt (which has been refined, bleached and processed until it is pretty much pure sodium chloride, often with anti-caking agents added).  The other 30 percent of the volume is other minerals and micronutrients (including iodine) found in mineral-rich seas.  Consuming these salts is not just following a Paleolithic diet using modern food, but, depending upon the origin of the salt, it is consuming the same food your Paleolithic ancestors ate.  I much prefer these salts taste-wise to regular salt, and I salt the heck out of all my food with it.

Magnesium

The low-carb diet doesn’t really cause a massive depletion of magnesium like it does with the sodium and potassium (the next electrolyte on the list), but most people who are overweight, insulin resistant and/or hypertensive or diabetic are deficient in magnesium.  Even people with lipid problems are often magnesium deficient.  In fact, even people who don’t seem to have health problems can often be magnesium deficient because most people don’t get enough.   The last I read on the subject, about 70 percent of people don’t even get the minimum recommended daily intake of magnesium (which isn’t all that high).  So, in my opinion, it’s important to supplement this vital mineral.  Good magnesium levels help regulate potassium as well, so keeping your magnesium adequate helps with your potassium as well.

Nature has designed us so that approximately 300 plus of our enzymes require magnesium as a co-factor to make them work properly.  Which tells us that we evolved in a time when magnesium was readily available, otherwise the forces of natural selection wouldn’t have made such wide use of it.

Where did it come from?  I would bet most of it came from the water.  Most natural sources of water have a high magnesium content, so when you drink bottled water and softened and treated water, you get short changed.  Magnesium salts in water are one of the substances that tends to make deposits on your water pipes and makes it difficult to get a good lather with soap.  This problem is solved with water softeners, but the process gets rid of the magnesium.  In the old days when we all drank well water or stream water, we got a lot more magnesium.

Since magnesium is used in 300+ different chemical reactions in the body, a shortage of magnesium can cause problems.  One of the most common ones is an increase in cravings.  Often simply replenishing magnesium gets rid of many of the food cravings people have.

The best way to get magnesium is from supplements.  Get a good chelated magnesium supplement and take 300-400 mg per day.  We’ve found it best to take these supplements in the evening because magnesium is relaxing and taking it in the evening helps you sleep.  About the only problem people ever have with magnesium is loose stools, i.e., the milk of magnesium effect.  If that happens – and it is unwelcome – simply reduce your dosage until your stools normalize.

Purchasing magnesium supplements can be a little tricky because of the way they’re labeled.  First, a chelated magnesium supplement is one that ends with an ‘-ate,’ as in magnesium aspartate or magnesium citrate or magnesium citrimate.  The -‘ate’ ending tells you the magnesium is chelated, which means it’s attached to another molecule (the chelating agent..aspartate, citrate, or whatever) that helps with absorption.  Second, with magnesium supplements, the manufacturers sometimes list the dosage of both the magnesium and the chelating agent combined.  Since the chelating agents are a lot heavier than the magnesium, this labeling often ends up saying the dosage of each pill is, say, 1000 mg of magnesium aspartate.  This isn’t the amount of magnesium you’re going to end up getting because the magnesium is only about 15 percent of the weight of the total pill.

About the only way you can really tell how much actual magnesium your getting is to look on the label on the back and see how much of the RDI (Recommended Daily Intake) the dose is.  The RDI for magnesium is 400 mg per day so if you find the dose of the supplement you are considering contains 50 percent of the RDI, then you know each dose contains 200 mg of magnesium irrespective of what the dosage is on the front of the bottle.  As I say, I recommend 300 to 400 mg of magnesium per day.  The only downside of magnesium is loose stools.  Doesn’t happen to everyone, but does to a few.  For many people the magnesium seems to offset the constipation that some experience when starting a low-carb diet.  If you do experience loose stools, simply back off your dose of magnesium until things unloosen.

Magnesium is natures relaxant.  It makes many people sleepy, so we always recommend taking it at bedtime.

Potassium

Potassium is linked to sodium.  If you lose a lot of sodium through the diuretic effect of the low-carb diet, you’ll ultimately lose a lot of potassium as well.  Keeping your sodium intake up as mentioned above will help preserve your potassium as well.  And keeping your potassium levels up helps to ensure that you don’t lose a lot of lean muscle mass during your weight loss.  Plus, just as with sodium, adequate potassium prevents cramping and fatigue.

You can replace your potassium by taking potassium supplements.  In our clinical practice, we gave all patients starting the low-carb diet a prescription for potassium.  You can get the same dosage by taking four to five of the over-the-counter 99 mg potassium supplements you can purchase at any health food or natural grocery store.

There are a couple of prescription medicines that you’ve got to be aware of if you markedly increase your potassium intake, so if you’re on blood pressure medicines, ask your doctor if it’s okay for you to take potassium.

Before we move on to other supplements we can use to help with low-carb dieting, I want to address the subject of dehydration.

Hydration

A few years ago, I learned the lessons of adequate hydration the hard way, so take this as a cautionary tale and benefit from my painful experience.  I had always pooh-poohed the notion of drinking a lot of water in addition to coffee, tea and other non-caloric beverages because I always figured (and probably have even written in the pages of this blog somewhere) that coffee, tea, etc. are nothing but water with a little flavoring in them.  I mean, if you start out with a glass of water and put tea bag in it, the water doesn’t go away.  It’s still there; it just becomes tea-flavored water.  Well, turns out that’s not actually the case.

My daily ritual was as follows: Get up, stagger to the refrigerator and take a big gulp or two of sparkling water.  Then make my way to the espresso maker and crank out a cup of Americano.  Followed by four or five more Americanos over the course of the morning and early afternoon, interspersed with a gulp here and there of sparkling water.  A snort of Jameson in the early evening, maybe a glass of red wine with dinner and a decaf Americano after dinner.  If I watch a movie or read a book, I usually nurse another glass of Jameson.  I typically take my supplements at bedtime, so I throw back another half glass or so of sparkling water then.  Plenty of liquids, right?

Well, not exactly, as it turned out.

I began developing severe cramps in my hands and feet that I had a hell of a time massaging out.  That was just the beginning.  I started being awakened at night with brutal leg cramps, requiring my springing from the bed and walking them out.  My potassium is too low, thought I, so I started taking potassium.  No change in the cramping situation.  In fact, if anything, it got worse.  I was complaining to a friend who told me calcium had helped his cramps.  So I downed calcium at bedtime.  No improvement.

Another friend told me that tonic water had helped her with cramps, but I only half believed it, so didn’t really try.  Then MD and I had family visit us in Tahoe for skiing.  I upped my booze intake, kept the coffee intake about the same, and probably decreased my consumption of sparkling water (or water of any kind, for that matter).  The cramps increased dramatically.  And what was worse, they stopped limiting themselves to the night.  When MD and I were driving over to Napa one day, the cramps were so severe I could hardly drive.  I had to keep the seat back as far as I could get it so I could straighten my leg when one hit me.  Then my hands started cramping just holding them on the steering wheel.  I pulled off the freeway and made a beeline for a convenience store and grabbed a one liter bottle of diet tonic water and proceeded to chug the entire thing as I drove down the road.  Miraculously, my cramps subsided.  So, I figured tonic water (quinine) was the solution.

One night – after being out of tonic water for a few days and being failed by my bride in resupplying – I had another brutal night of cramps.  The next day I was scheduled for blood donation.  After going through the long list of questions that must be answered verbally (and fighting down the impulse to tell my interrogator that I had recently paid for sex while imprisoned in Africa – those who have given blood lately will know what I mean), I was sent to actually have the blood taken.  The phlebotomist couldn’t find my vein, which had never happened before because I usually have rope-like veins in my forearms.  She asked if I was dehydrated.  I told her I didn’t think so since I had had my normal four of five cups of coffee that morning along with my gulp of water.  She brought me a couple of 16 ounce bottles of water that I drank, and, bingo, there were my veins.  Big and robust as usual.

It finally occurred to me that my cramping problem might be due to dehydration and that the diet tonic that solved the problem did so not because of the quinine but because I was drinking all the water the quinine was dissolved in.  And it occurred to me that the cramping was worse in the middle of the night because a lot of water is lost through the breath at night. (See my second post on the Anthony Colpo Smackdown to read more about this.)  You can lose a couple of pounds during sleep simply by breathing water vapor away, which was, I’m sure, what was happening to me.  I was barely hydrated enough to prevent cramping while awake, but when I slept and my fluid level fell due to my breathing water away, I hit some critical threshold of fluid that kicked off the cramps.

I started rehydrating first thing in the morning and throughout the day.  Now I get up, drink anywhere from 16 to 32 ounces of remineralized water (more about which later) first thing.  Then I head to the espresso maker and start my daily Americano regimen.  But I consume at least 8 ounces of sparkling water after each cup of coffee.  And I drink water after each shot of Jameson and/or glass of wine (or any other alcoholic libation),* and I’m proud to report that I have been cramp free since upping the water.

My brush with cramping misery inspired me to hit the medical literature to read about hydration.  And I learned many wonderful things. For example, I learned coffee is a diuretic (which I already knew but had chosen to forget), but that some acclimation occurs over time.  Still, due to the diuretic effect, you don’t get the full fluid from a cup of coffee that you would from an equal amount of water.  Same with alcohol.  Once I started calculating how much fluid of that I drank throughout the day I was actually retaining, I was amazed that cramping was the worst that happened to me.

I learned that water has a lipolytic effect (fat burning).  I read this in a number of papers that had studied it, and the data clearly showed that those who took in a lot of water had increased lipolysis.  I didn’t deny the data, but I couldn’t figure out the mechanism (and apparently neither could any of the authors because none described it).  I thought on it a while and finally came up with what I think is a plausible scenario.

When you drink water, especially cold water, you require some increase in caloric burning to bring the water to body temperature, but that increase doesn’t amount to all that much (the authors did describe this phenomenon), but you also dilute your blood for a bit until the water equilibrates with the fluid in all the tissues, and effect that takes some time.  During this time, while the blood is more dilute, the concentration of the various substances carried in the blood decreases.  Which would mean that insulin levels would fall.  The typical blood volume is about 5 liters, so drinking a liter of water would increase the blood volume temporarily by about 20 percent, which would mean the concentration of insulin and other molecules in the blood would fall by about 20 percent.  A 20 percent drop in insulin levels would allow fat to escape the fat cells and would facilitate its transfer into the mitochondria for burning.  At least that’s my explanation for the lipolytic effect seen in numerous studies of subjects increasing water intake.

Those starting a low-carb diet are prone to dehydration because excess ketones are gotten rid of via the kidneys along with a lot of fluid.  So, when you start your diet, consciously increase your fluid intake.  Do like I do now and come up with some sort of regimen that ensures you consume plenty of water throughout the day.  You’ll feel better; you’ll avoid cramping; and you’ll actually burn a little more fat.  And don’t make the mistake I did and assume that drinking a lot of coffee, tea, booze or other diuretic fluid is a replacement for water intake.

Since I drink either bottled water or water that comes through our RO filter, both of which are depleted of minerals, I always remineralize my water by adding a pinch of Celtic Sea Salt or one of the other such salts to each bottle.  I add enough so that the water just barely hints of a salty taste.

Supplements

Every patient whom we started on a low-carb diet left our clinic with six supplements:  lipoic acid, CoQ10, Vitamin E, magnesium, a good multi-vitamin and a prescription for potassium. (Now I would add a substantial dose of vitamin D3 to the list, a dose based on vitamin d levels and sun exposure.) We’ve already dealt with the potassium and magnesium, so let’s consider the others.

First, the good multi.  I’m a believer in getting most of what’s needed vitamin- and mineral-wise from food.  And I’m also a believer that I’m an excellent driver.  Yet I always purchase car insurance.  I see a good multi-vitamin as the same thing – cheap insurance against any kind of deficiency.  I would rather have my patients urinating away fifty cents worth of vitamins a day than risk that they have a deficiency in one.  And I feel the same way about myself.  So, find a good multi-vitamin without iron and take it.  Based on the experiences of my own patients, I can almost guarantee you’ll feel better. Why without iron?  Because most people on low-carb diets get plenty of iron in a very absorbable form.  And too much iron isn’t a good thing, so don’t take it in your multi.

Alpha lipoic acid (ALA)

ALA is, next to magnesium, just about my favorite supplement.  It acts as both a fat-soluble and water-soluble anti-oxidant so it can pretty much weasel its way in anywhere in the body and stamp out inflammation.  It protects fatty membranes and even acts as a cellular nutrient.  It also helps the body deal with blood sugar, which helps the whole low-carb adaptation process along.  Many studies have shown an improvement in blood glucose levels and insulin sensitivity with ALA supplementation.  ALA can rejuvenate other anti-oxidants, and has so many virtues that entire books have been written about it.  My standard dose is 300 mg per day for patients starting low-carb diets.  There is a newer, more potent version of ALA available now called r-alpha lipoic acid.  The standard stuff is a combination of the r and l varieties, and since the r isomer is the active one, a supplement made entirely of the r variety is going to be more potent.  And more expensive.  If you use the r-ALA you can take 100 mg a day.

CoQ10

Another superstar supplement, especially for those who have been on or are on statins.  Statin drugs interfere with the body’s synthesis of this important nutrient, and those who have been or are taking statins are usually depleted to some degree.  If you’ve been taking a statin, I would take 300 mg per day of CoQ10.  If you haven’t, 100 mg per day should do.

Vitamin D3

I would also add at least 1000 IU per day of this nutrient.  You need to have your levels checked at some point to make sure you don’t overdo it, but at 1000 IU per day, this is unlikely.  If you do test and find you’re deficient, I would take 5,000-10,000 IU per day until 25 (OH) vit D serum levels are up to at least 50 ng/ml.  Along with all the other benefits vitamin D3 provides (which I have written about elsewhere on this blog), there is some evidence that it even boosts weight loss a bit.

5-hydroxytryptophan

The last supplement I’ll mention is one I’ve had much success with in treating people who tend to have carb cravings late in the day.  5-hydroxytryptophan (5-HTP) is the precursor to serotonin.  Most people who have carb cravings have them because their serotonin levels fall.  Taking 5-HTP will bring them back up.  It also helps with sleep.  Best time to take it seems to be about 4 or 5 PM for those who go to bed at the standard 10-12 PM.  You can move the dose around to find a time that helps the most with your carb cravings yet doesn’t make you sleepy other than when you want to be.  I usually recommend 50-100 mg.  It’s available at most health food stores and natural food grocers.

Fatty liver

The last bit of advice I’ll give is that you need to work to defat your liver as quickly as possible.  The good news is that you can do it quickly on a low-carb diet.  Studies have shown major improvement in just 10 days or so.   It’s important to defat your liver to help you lose weight more quickly because the liver breaks down insulin.  If your blood sugar goes up, the pancreas makes and secretes insulin to drive it down. It does so by driving the glucose into the cells.  At the same time, insulin drives fat into the fat cells and keeps it there.  As long as the insulin is in the circulation, it’s going to be preventing fat from leaving the fat cells.  The liver is the organ that breaks down and gets rid of the insulin.  And a healthy liver does it a lot better than a liver full of fat.

One of the liver’s most important jobs is detoxification of harmful substances.  We all (at least I) consume medications, food and drink that is toxic.  We (I) drink coffee, tea and alcoholic beverages.  The caffeine and alcohol are toxins.  They don’t really hurt us in the quantities that most of us ingest, but they are toxic nevertheless.  The liver detoxifies them.  Same with many drugs – both prescription and over-the-counter.  Tylenol puts a major detoxification burden on the liver.  When you drink coffee, tea, and/or alcohol and take OTC meds, you occupy much of your liver’s detoxification capacity.  Which means it can’t get rid of insulin as well and can’t regulate metabolism in general as well as it does when it isn’t busily detoxing toxins.

So, if you really want to hit it hard in the early phases of your low-carb diet and reach low-carb adaptation at warp speed, I would recommend avoiding – or at least limiting – coffee, tea, alcohol and OTC meds.

I am a huge lover of coffee and alcohol (coffee more so than alcohol despite my constant talk of Jameson) so I know this is a sacrifice.  One way to have it both ways is to switch from caffeinated coffee to decaf espresso.  Decaf coffee to me sucks taste-wise.  But decaf espresso ain’t so bad.  If you don’t want to go completely cold turkey, you can switch from coffee to espresso since espresso has double (or triple) the taste of coffee yet only about half the caffeine.  My favorite way to drink espresso is as Cafe Americano.  I love it so much that I even made a video of how to make it to send to people.  Take a look if you haven’t seen it yet.  It’s the best cup of coffee you’ll ever have. (I have one on the table next to me as I write these words on the patio in Cuenca, Spain.)

That’s about a wrap on my tips and tricks for kicking off a low-carb diet.  I’m sure many of you have tips and tricks of your own.  Please feel free to share them in the comments section.

The bone broth recipe at the very bottom of this post is from our defunct restaurant that I wrote about here.  We had this going on the stove all the time and used it as a base for about half the dishes we served.  It is absolutely spectacular.  I would eat is as a soup (we didn’t serve it that way) and take home bags of it and freeze it.  You can do the same.  I’ll provide the restaurant-sized version so you can either make a large amount in a big stock pot and freeze a bunch of it in individual packages.  Or you can cut it down to a smaller recipe.  If you do, just make sure to cut all the ingredient amounts proportionally.

A note of interest: I wrote the first part of this post flying between San Francisco and Dallas.  The middle part during a flight from Dallas to Atlanta.  And the last part (along with the words I’m typing now) over the Atlantic on a flight from Atlanta to Madrid.  I’ll transfer it to WordPress, put in all the links and photos when I get to the hotel in Madrid.  So you’ll end up with a post that was written about halfway around the world.

Another note of interest: I’m finishing this post in Cuenca, Spain (including some of the edits I made above) because the internet connection in our hotel in Madrid sucked.  The hotel was great, the food was pretty good, but the internet was abysmal.  I kept getting kicked off, so I abandoned all but the most necessary internet functions (email, mainly) until I got to more reliable service.  Here we are in Cuenca where the hotel sucks, the food really sucks but the internet connection is great.

One housekeeping note: Since the internet has been so unreliable, I have been unable to deal with the 100 or so comments that have accumulated.  I’ll get to them as soon as this post is up.  I did perform one of my most-hated tasks last night and went through the spam filter to fish out legit comments that had gotten snared before deleting the zillions of spam comments.  So if you’ve been waiting a long time for a comment to appear, it was probably one of the handful that I rescued from the sea of spam.  I’ll get it up as soon as I can. Just bear in mind that I’m headed for my next stop, Zaragoza, as soon as I hit the ‘Publish’ button on this post and will be on a forced march for a bit. So, be patient with me on the comments.

This is the restaurant recipe for massive quantities, so you can reduce accordingly.  Just make sure you reduce all ingredients proportionally.

2 oz roasted garlic (weight)
10 oz roasted red onions (weight)
4.5 gallons water (volume)
22 oz tomato paste (weight)
4 oz cilantro with stems
2 pounds chicken back bones (weight)
16 oz tomato pulp (weight)*
6 oz salt (weight) I would use Celtic Sea Salt or other such salt here
1 oz black pepper (weight)
1 oz olive oil (volume)

Roast onions and garlic in olive oil for approximately 15 to 20 minutes.

Add all ingredients to water, chicken and tomato paste.

Let simmer over medium fire until cooked.

Approximate yield is 640 ounces or 5 gallons.

*We used a ton of diced Roma tomatoes in the restaurant for just about everything.  We removed the pulp from these tomatoes before dicing them.  We saved the pulp and used it in the stock.

*Here in Spain I have discovered a wonderful way to drink wine and stay hydrated.  They have a drink called Tinto de Verano (see photo at top), which is half fruity Spanish wine and half sparkling water poured over ice with a slice of orange and slice of lemon thrown in.  It’s kind of sangria lite.  Each time you drink a glass of it, you get half wine and half water, so you rehydrate the water lost from the little alcohol in the half glass of wine.  It’s tremendously refreshing, and I’ve drunk my weight of it since arriving.

As anyone who has done it knows, getting started on a low-carb diet can be a little rough.  Not for everyone, but for some.  All too often these little front-end bumps in the road–coupled with the spirit of the times in which the well-intentioned but ignorant friends and relatives of low-carb dieters tell them their diet is going to croak their kidneys, clog their arteries and weaken their bones–can be enough to make many people abandon the most sincere efforts.  Drawing on my almost 30 years of experience treating patients using the low-carb diet, I can give some tips and tricks for dealing with these difficult early days.

Listen to your body?

The surest road to failure in the first few days of low-carb dieting is to listen to your body.  The whole notion of listening to your body is one of my major pet peeves.  In fact, just hearing those words makes me want to puke.  In my experience, they are usually uttered by females with moist, dreamy looks in their eyes, but not always.  I just read a ton of comments in recent Paleo blog post in which vastly more males than females actually wrote this drivel.

Listening to your body is giving the elephant free rein. If you’re three days into your stop-smoking program, and you listen to your body, you’re screwed.  If you’re in drug rehab, and you listen to your body, you’re screwed.  If you’re trying to give up booze, and you listen to your body, you’re screwed.  And if you’re a week into your low-carb diet, and you listen to your body, you’re screwed.  Actually, it’s okay to listen to it, I suppose, just don’t do what it’s telling you to do because if you do, you’re screwed.

Okay, end of rant.  I just had to get it out of my system.  You just can’t imagine how many times people who have tried low-carb diets then abandoned them early on have said those words to me.  Wait.  I’m about to get started again. Stop!

Low-carbohydrate adaptation

Probably the best explanation of low-carb adaptation (also called keto adaptation) was written by a Lt. Frederick Schwatka (pictured above left) over a hundred years ago.

When first thrown wholly upon a diet of reindeer meat, it seems inadequate to properly nourish the system and there is an apparent weakness and inability to perform severe exertive, fatiguing journeys. But this soon passes away in the course of two or three weeks.

Lt. Schwatka was a doctor, a lawyer, and an explorer of the Arctic, the Great Plains and northern Mexico.  The above quote comes from his book on the unfruitful search for the Franklin party in 1878.  (For all his experience and gifts, and understanding of low-carb adaptation, the good doctor listened to his own body a little too much and did himself in with an overdose of morphine at age 42.) You can read more about Lt Schwatka, low-carb adaptation, and his time with the Inuit in a post I wrote a few years ago.

The period of low-carb adaptation is that time between starting a low-carb diet and feeling great on a low-carb diet.  It can take anywhere from just a day or so to two or three weeks.  During this adaptation period people tend to fatigue easily, experience a slight lack of mental clarity and be tormented off and on by the unbidden lust for carbs that seems to rise up out of nowhere.  Why does this happen early on with a diet that ultimately works so well to increase exercise capacity, mental clarity, and feelings of satiation?

It happens because both your body and brain are going through a profound change in the way they get their energy.  You can’t run your car designed to burn gasoline on biodeisel…unless you install a converter.  Then you can.  We humans have the design for our carb to fat converters coded in our DNA – the low-carb adaptation period is simply the time it takes for the converter to be built and installed.

Our bodies are simply giant piles of chemicals heaped together in a human-shaped form.  Most of the chemicals will react with one another, but only extremely slowly.  If we didn’t have something to help these reactions along, life wouldn’t exist.  The helpers are called enzymes.  These enzymes – which are large folded proteins – catalyze all the chemical reactions that allow us to function.  Mix a couple of body chemicals together and you might have to wait twenty years or more for them to interact or combine in some way to form another body chemical product.  Throw the correct enzyme into the mixture, and you get a reaction in a fraction of a second.

When you’ve been on the standard American high-carb diet, you’re loaded with enzymes ready to convert those carbs to energy.  You’ve got some enzymes laying in the weeds waiting to deal with the fat, but mainly dealing with it by storing it, not necessarily burning it.  All the pathways to deal with carbs and their resultant blood glucose are well-oiled and operating smoothly.  Then you start a low-carb diet.  Suddenly, you’ve idled most of the enzyme force you have built to process the carbs in your diet while at the same time you don’t have a ready supply of the enzymes in the quantities needed to deal with your new diet.  It would be like a Ford automobile factory changing in one day into a plant that made iPads.  All the autoworkers would show up and be clueless as how to make an iPad.  It would take a while – not to mention a lot of chaos – to get rid of the autoworkers and replace them with iPad workers.  In a way, that’s kind of what’s happening during the low-carb adaptation period.

Over the first few days to few weeks of low-carb adaptation, your body is laying off the carbohydrate worker enzymes and building new fat worker enzymes.  Once the workforce in your body is changed out, you start functioning properly on your new low-carb, higher-fat diet.  The carbs you used to burn for energy are now replaced to a great extent by ketones (which is why this time is also called the keto-adaptation period) and fat.  Your brain begins to use ketones to replace the glucose it used to use pretty much exclusively, so your thinking clears up.  And the fatigue you used to feel at the start of the diet goes away as ketones and fat (and the army of enzymes required to use them efficiently) take over as the primary sources of energy.  Suddenly you seem to go from not being able to walk out to get the morning paper without puffing and panting to having an abundance of energy.  Because of this low-carb adaptation period, we never, ever counsel our patients to start an exercise program when they start their low-carb diets because a) we know they’ll be too fatigued to do it, and b) we know that in a short time they will start exercising spontaneously to burn off the excess fat on their bodies once the skids are greased, so to speak.

Anyone with good sense contemplating a low-carb diet would ask the question, How can I make this low-carb adaptation period as short as possible?  Good question.  Why would anyone want to prolong the agony?

The secret to making it shorter is in the second part of what Lt. Schwatka wrote about low-carb adaptation.  Immediately after the above quoted sentences, he follows with:

At first the white man takes to the new diet in too homeopathic a manner, especially if it be raw. However, seal meat which is far more disagreeable with its fishy odor, and bear meat with its strong flavor, seems to have no such temporary debilitating effect upon the economy.

In other words, the white man, used to flour, sugar, boiled meat and all the other staples of the mid 19th century American diet, balked at the consumption of raw meat, especially raw and malodorous seal and bear meat.  And so took it in tiny portions (in a  “homeopathic manner”) instead of going face down in it.  Compared to reindeer meat, both seal and bear meat are loaded with fat, which is why the consumption of those fattier meats didn’t produce the “temporary debilitating effect.”  In those who did eat the fattier meats, the low-carb adaptation period was very short or even non-existent.

Eat more fat

If you want to reduce the time you spend in low-carb adaptation, crank up the fat.  If you go on a high-protein, moderate-fat diet (Schwatka’s reindeer diet), your body will convert the protein to glucose via gluconeogenesis, so you’ll still have glucose to keep the glucose worker enzymes busy and will prolong the conversion to fat and ketones as your primary energy source.

So Rule Number One to reduce the time spent in low-carb adaptation purgatory is: Don’t be a wuss when you start your low-carb way of eating.  Keep the carbs cut to the minimum and load up on the fat. Eat fatty cuts of meat, cooked in butter or lard if you want, and force your body over to using the fats and ketones for energy as nature intended. I mean, don’t try to be noble by eating boneless, skinless chicken breasts – instead insert some pats of butter under the skin of a chicken leg and thigh before cooking, and wolf them with your fingers while the fat drips down your arms.  Do not trim the fat from your steaks – eat them from the fat side in.  If you leave anything on your plate, make sure it’s the meat and not the fat.  If you don’t already, learn to love bacon, and don’t cook it ‘til the fat is all gone: eat it wobbly.  Wallow in Mangalitsa lardo.  And whatever you do, for God’s sake, don’t listen to your body during this adaptation period or you’ll never cross the chasm between fat and miserable on your high-carb diet and slim, happy, energetic and low-carb adapted on the other side.

In my next post, I’ll give you the rest of the tips and tricks to get through low-carb adaptation that MD and I have learned in our combined 50 plus years of taking care of patients on low-carb diet. And I’ll include a recipe worthy of killing for that you can prepare to help you get through.