Low Carb Diet

From:

Why a Low-Carb Diet Should Be the First Approach in Diabetes Treatment

http://www.diabetesincontrol.com/articles/53-diabetes-news/17323-why-a-low-carb-diet-should-be-the-first-approach-in-diabetes-treatment#unused

  • Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.
  • During the epidemic of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates.
  • Benefits of dietary carbohydrate restriction do not require weight loss.
  • Studies show that carbohydrate restriction is the best intervention for weight loss.
  • Adherence to a low-carb diet in people with type 2 diabetics is at least as good as adherence to any other dietary interventions and is frequently significantly better.
  • Replacement of carbohydrate with protein is generally beneficial.
  • Dietary total and saturated fat do not correlate with risk of cardiovascular disease.
  • Plasma saturated fatty acids are controlled by dietary carbohydrates more than dietary lipids.
  • The best predictor of microvascular and to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control (HbA1c).
  • Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing HDL.
  • Patients with type 2 diabetes on carbohydrate restricted diets reduce and frequently eliminate medication and type 1 diabetics require less insulin.
  • Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment.

It makes sense that if carbs are creating lots of insulin, and that’s leading to weight gain, heart disease and diabetes, you want to correct the source of the problem by reducing the carbs. This approach should also apply to anyone with Polycystic Ovarian Syndrome, metabolic syndrome, high cholesterol, high triglycerides and hypertension.  Beware of studies that claim that low carb diets don’t work, they do and the well designed studies show that.  Poorly designed studies that consider 150-200 grams per day of carbohydrate “low carb” will not show a benefit because there’s nothing “low” about 150-200 grams of carbohydrate per day.  Low carb is 60-80 grams of carbohydrate per day.

Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition. 2015;31(1):1-13. Abstract

The 3 Worst Foods for Acne

There are three foods that I see causing problems with acne the most frequently:

  1. Dairy products – dairy is one of the most frequent food sensitivities there is.  These are mild immune system reactions to foods that create inflammation. Acne is a very inflammatory condition, anything that provokes or increases inflammation in the body would be best to avoid.  There is IgG Food Sensitivity testing that can be done to see if dairy is a food sensitivity for you, or you can try strictly avoiding dairy for at least 3 weeks to see what happens to your skin.
  2. Eggs – eggs fall under exactly the same category as dairy, they are a frequent food sensitivity and they create inflammation that seems to be centred in the skin.  Eczema, psoriasis and acne can all be skin manifestations of an egg sensitivity.
  3. Sugar and processed carbs – high glycemic index starches and sugar provoke a high insulin response.  Insulin in turn can increase the activity and/or the level of certain hormones, including testosterone.  Higher testosterone activity or level can cause deep, painful cystic type acne.

What Kind of Carbs Should I Eat?

The best kind of carbs are the ones that have minimal impact on blood sugar levels. High glycemic index and high glycemic load carbs (for example rice, wheat and wheat products) cause a sharp spike in blood sugar levels and insulin. A glycemic index of less than 55 is considered low and glycemic load of less than 10 is low. Rice, even if it’s brown rice, has a glycemic index of 58-84 and a glycemic load of 19-46. This will mean high insulin requirements to deal with the resulting spike in blood sugar.

So what’s wrong with that? Insulin’s job is to transport all of that sugar from the blood into the muscle, fat and other tissues and it causes the liver to store glucose as it’s storage form, glycogen. Once there is enough stored glycogen, the liver starts to produce fatty acids, which can be turned into triglycerides in fat cells, contributing to high blood lipids, atherosclerosis and fatty liver disease.

Insulin also preserves body fat, the more insulin the less breakdown of fat tissue. Not so good if you are trying to lose weight.

Insulin can also lower blood levels of potassium, a vital mineral for normal heart function.

Frequent insulin production, induced by frequent carb intake, can lead to insulin resistance or pre-diabetes. Insulin resistance can cause infertility, PCOS, heart disease, and is linked to an increased risk of cancer as both insulin and IGF1 have a role in tumor initiation and progression in insulin-resistant patients.1. How would you know if you were insulin resistant? Neither you nor your doctor would likely know until the point that your fasting blood sugar became abnormal, at which point you are diabetic. If you have PCOS you are already at a much higher risk of being insulin resistant and eventually becoming diabetic.

So what are the best kinds of carbs? Whole grain (not processed into bread, crackers, cereal, pasta), high fiber and lower glycemic index grains like quinoa, amaranth, lentils, beans and to a lesser extent spelt and kamut. Should you eat these at every meal? Probably not, best to give your body a break from the need to make insulin at every meal, even if it is a lower amount. Aim for small servings of lower glycemic index and load grains, once per day.

Have I Ever Put Anyone on a Zero Carb Diet?
No, because that is ridiculous. Unless you consumed nothing but water, you would have to be taking in carbs, even meat contains some amount of carbohydrate. For the average sedentary person, vegetables and fruit will supply sufficient carbohydrate for what your body needs. More active than usual? Great, add in a serving of one of the lower GI/GL carb sources listed above.

As a naturopathic doctor, it is my obligation to “do no harm”. If you suffer from a condition where frequent insulin production would do harm, like PCOS(2-6), I am bound by the Hippocratic oath to recommend decreasing carb intake and the need to make insulin. I’m happy to provide counselling and assistance in making the transition from a higher carbohydrate diet to a lower carbohydrate one.

1. Source: Exp Diabetes Res. 2012; 2012: 789174. Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms, Biagio Arcidiacono, Stefania Iiritano, Aurora Nocera, Katiuscia Possidente, Maria T. Nevolo, Valeria Ventura, Daniela Foti, Eusebio Chiefari, and Antonio Brunetti.
2. Low carb ketogenic diet improves weight, percent free testosterone, LH/FSH ratio & fasting insulin in women with obesity & PCOS over a 24 week period. (Mavropoulos et al, Int J Endocrinol Metab. 2012)
3. PCOS patients ingesting a high protein diet experienced greater weight loss & body fat loss than the standard protein diet. (Sorenson et al, Am J Clin Nutr, 2012 )
4. In women with PCOS, consumption of a diet lower in CHO resulted in preferential loss of fat mass from metabolically harmful adipose depots, whereas a diet higher in CHO appeared to promote repartitioning of lean mass to fat mass. (Gossa et al, Metabolism, Oct 2014)
5. Energy restriction & weight loss in PCOS improve ovulation rates, conception, hyperandrogenemia, glucose & insulin levels, insulin resistance & satiety hormones. A low carb diet has an additional effect to caloric restriction in terms of weight loss. (Frary et al, Minerva Endocrinol, June 2014)
6. A diet containing 25% carbohydrates improved insulin resistance, whereas a diet that included 45% carbohydrates did not. Source: International Journal of Obesity and Related metabolic Disorders 20 no. 12:1067-1072