Molly de-pudges by eating fewer carbs

Juliana’s younger sister, Molly, has never been overweight.  She has always had a smaller appetite and more energy than her sister.  She did get grumpy if she didn’t eat, but often felt no hunger even when she needed food.

Molly’s height and weight always tracked girls’ clothing sizes.  When the size 6s got too snug, they were also too short, then 8s, then 10s.  A few months before Juliana and I started eating really low carb, Molly’s size 12 pants got too tight, but the size 14s were much too long.  I also noticed she had a bit of a double chin developing.

Although Molly didn’t adopt low carb eating when Juliana and I did, she now eats many fewer carbs because I’ve totally changed the food I prepare.  Now she has eggs and bacon for breakfast, but there’s no toast.  There’s no French toast, no pancakes, no bagels.  The daily bag of popcorn in her lunch has been replaced by cashews.  Her peanut butter or ham sandwich by a “fried rice” mix that has mostly sausage and egg, and a little rice and carrots.   She rarely eats pasta, and if she does, it’s usually because she’s not feeling well and has some asian style soup with a few rice noodles–not a big plate of spaghetti.  We still eat what we call “pizza chicken,” but the chicken is no longer breaded.  Yesterday I made meat balls without bread crumbs in them, and cauliflower on the side instead of pasta.  The most carbs she eats in a day come from gluten-free breaded chicken nuggets, or an ice cream bar.  She is not as sensitive as Juliana is to carbohydrates, and not as sensitive as Teddy is to gluten, so she sometimes eats a pumpkin muffin from my favorite coffee store, Peet’s.  We don’t tell Teddy, who really likes pumpkin muffins. This flexibility helps to keep her on board with following the eating plans for the other two the rest of the time.

And what’s happened?  Molly has slimmed right down.  Her size 12 jeans fit fine again, and her double chin has receded.  In Molly’s case, eating “less carb,” rather than “low carb” doesn’t create craving problems or excessive hunger, and returned her to her longstanding height/weight ratio.  But for an overweight, probably insulin-resistant child, less carb has a lot of potential pitfalls.

 

 

Advanced Low Carbing–Calories Do Count

Many low carb eating plans leave you with the impression that you can eat any amount of food, as long as you don’t exceed a certain number of carbs, and lose weight.  I suspect this is a conscious or unconscious counter-balance to the calories in/calories out model, where calories are ALL that matter.  The low carb plans want to make clear that what different foods DO in the body is more important than how many calories they contain.  Low carb plans in general suggest letting your appetite be your guide about how much to eat.  But the appetite of insulin-resistant children and teens may not automatically adjust on a low carb eating plan.

For children and teens who have suffered the gnawing hunger of insulin resistance combined with a high-carb, Standard American Diet, it’s worthwhile to pay attention to how much they eat as well as what they eat, even on a low carb eating plan.  Why?  Because they are afraid of being hungry.  They’ve been hungry a lot on the Standard American Diet, even if they were gaining weight all the while.

They can do fine, without hunger, on much less food if the carbohydrates are controlled.  The extra energy they need is made up, without hunger, by using up stored fat.  But they may not believe it at first.  They may think if they don’t eat a giant breakfast they’ll be starving, and stuck, in the middle of 2nd period math.  This is exactly what happened to Juliana on a low-calorie “balanced” eating plan.

So let’s compare a few approaches to limiting overall food intake.  How much is enough?  How much is too much?  If you are controlling your carbs, have tried all their other suggestions for getting weight loss going, and are still not losing weight, the Atkins eating plan suggests counting protein units.  The protein units come packaged with fat, without you having to count the fat.  For example, one egg is one unit.  It has approximately 7 grams of protein, and 5 grams of fat.  45 of 73 calories come from fat.  For a 5’4″ woman, the protein range for weight loss on the Atkins eating plan is 10 to 17 units.  That’s 3 to 4 units at 3 meals a day, and one or two 1 to 2 unit snacks.  Eat more if you are not satisfied at meals; less if you are satisfied. (And remember to wait 20 minutes to determine if you are or are not satisfied).

In Living Low Carb, Jonny Bowden offers a formula:  if you don’t have a really large amount of weight to lose, try multiplying your goal weight times ten to get the number of calories you can consume per day and lose appreciable weight.  For Juliana, for a goal weight of 120, that would be 1200 calories per day.

So how would a typical day’s Atkins plan of counting protein units compare to Bowden’s equation in terms of total calories?  Imagine these meals and snacks:

Breakfast:   2 eggs, 1 ounce cooked bacon, cauliflower roasted with oil

Snack:  1 ounce peanuts

Lunch:  3 ounce hamburger with 1/2 ounce melted cheese, broccoli, roasted with oil

Snack:  1 deviled egg

Dinner:  3 ounces roasted chicken, 1 cup green beans with 1 teaspoon butter

That’s 11.5 units on the Atkins eating plan, and about 1300 calories on the Bowden formula.  Pretty close to the 1200 calories Bowden suggests for Juliana’s goal weight.  By the way, 63% of the day’s total calories come from fat.

Fat is satiating, and the carbs that create rampant hunger are controlled.  But a day’s meals and snacks are a much lower VOLUME of food than Juliana was used to eating before she started eating low carb.  In her head, she has to get comfortable with the fact that she can eat so much less food AND NOT BE HUNGRY.

Kids and teens have less control over their lives than adults.  They may overeat when the food is available in case it’s not available later.  I can remember as a child eating as fast as possible so that my brothers wouldn’t gobble it up and leave nothing for me–the amount I ate didn’t always have a lot to do with appetite.   And up until now, you may have been encouraging your child to limit her intake even if she was hungry.  On a low carb plan, she shouldn’t be hungry.  But now she’ll have to learn to recognize true hunger, and trust that if she is hungry, she can always eat.

 

 

 

 

 

Life Without Bread

Great title, huh?  This is the English-language, updated version of the 1967 book “Leben ohne Brot.”  Published in 2000, it reviews the evidence from 40+ years of Dr. Wolfgang Lutz’s clinical practice in Germany treating patients using low carbohydrate diets.

While the specific information and extensive long-term data from Dr. Lutz’s practice is truly valuable, to me the most valuable part is the book’s calm tone.  I infer that Dr. Lutz was not subjected to the ridicule and ostracism that U.S. doctors working with low carbohydrate diets experienced in the same period (and continue to experience today).  There is none of the hysteria you encounter in the US about using low-carbohydrate diets to treat obesity in general, and obesity in children in particular.

“In Dr. Lutz’s practice, a low-carbohdyrate diet was always successful in children’s weight loss.  Weight loss in adults was more variable–that is, many were successful, but not all.  In treating more than 100 extremely overweight adolescents, not one case ended in failure.*    In patients who appeared not to respond, it was always discovered that the diet had either not been strictly followed or had been given up too soon.  Apart from very extreme cases, a normal, slender figure was achieved within a year.”

*Lutz, W.  ”Das endocrine Syndrom des adipoesen jugendlichen” Wien. Med. Wschr. (1964): 451.  (The Endocrine Syndrome of Adipose Youth).

Christian B. Allan, Ph.D and Wolfgang Lutz, M.D.; Life Without Bread, p. 140.

Before World War II, the bulk of the research work on obesity and its causes was done in Germany and Austria, and the leading hypothesis at the time was that obesity was caused not by overeating but by “lypophilia,” a defect in fat metabolism.  The underlying hormones weren’t yet isolated or understood, and much of the literature was based on clinical observations.  I am guessing that as the science became better understood, Dr. Lutz, if he even knew about the US research, was insulated from the distorted interpretations of the research that occurred in the US and that Gary Taubes documents in Chapters 21 and 22 of Good Calories, Bad Calories.  In the US, any information or research that didn’t conform to the conviction that overeating causes obesity–calories in/calories out–was discarded or ridiculed.

Therefore Dr. Lutz in 1967, and his colleague in 2000, didn’t feel the need to publish a polemic disguised as a diet book, as Dr. Robert Atkins did in 1972 with Dr. Atkins Diet Revolution.  Even as recently as 2011, Dr.s Phinney and Volek, who also co-wrote The New Atkins for a New You, wrote a one-sided review of low-carb eating plans to counteract the flood of low-fat eating plan dogma:

“Critics will correctly state that our arguments in favor of carbohydrate restriction seem one-sided and smack of advocacy. But we ask you: what is the proper response when three decades of debate about carbohydrate restriction have been largely one-sided and driven more by cultural bias than science? Someone needs to stand up and represent the alternate view and the science that supports it.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable . Beyond Obesity LLC. Kindle Edition.

The state of war that exists in the United States between low-fat and low-carb makes parental decisions about eating plans for our children fraught with anxiety.  There are many personal stories in the low carb community of people giving up the low carb lifestyle because of pressure to do so from the low-fat, “balanced diet” eating side of the fence, even though the individuals felt unambiguously better eating low carb.  Life Without Bread reassures me, because it tells me things are likely more harmonious in Germany, and it matter-of-factly recommends a low carb eating plan for overweight children.

Cross Fit Gyms–A low carb community

One of the first things I did after I discovered how much better Juliana felt eating low carb was to go looking for a community for her.  The path was circuitous–Jimmy Moore’s livinlavidalowcarb blog had a list of “low-carb friendly” health practitioners, and Susan Jimenez was on it.  Turns out she is a nurse practitioner, but now she’s become a cross-fit trainer at the gym she runs with her husband Saul, Mad Dawg School of Fitness.  Cross-fit gyms recommend a Paleo, or Primal eating style–basically what we would have eaten before the advent of agriculture.  In other words, no grains, sugar, dairy, and limited fruit.  The eating plan consists mostly of animal protein in various forms and vegetables.  Paleo isn’t designed to be low carb, but it ends up being low carb.

A low carb gym sounded good to me, and we went to meet them.  Susan did a functional movement screen with Juliana, something they do at Cross Fit gyms to establish baseline mobility.  Then I joined them and poured out my questions–why hadn’t anyone ever told me carbs could be the problem for Juliana?  Was there a health care practitioner who could help me navigate this new environment?  Susan said it was unlikely we would find support for a low carb eating style amongst the health care establishment.  I knew from experience that my somewhat alternative family practice–they were willing to discuss the benefits and risks of commonly administered vaccines, unlike the pediatric practice I had left when Juliana was 2–would not know anything about it.

Juliana started training with Susan.  Even though she was a teenager in a gym for adults, she felt welcome and really enjoyed it.  She had to take a break over the summer and then for soccer season.  I started training there in September, and although I have historically disliked group exercise classes, cross-fit is totally different.  It’s the exercise equivalent of low carb eating–it does not recommend exhausting cardio sessions to control weight, as most other gyms do–rather cross-fit, generally speaking, recommends duplicating the likely physical feats of our ancient ancestors.

Lengthy cardio sessions leave you depleted and a tasty target for predators.  In cross-fit you do a lot of work on mobility, everywhere (hips, shoulders, wrists, ankles etc.) so that you become more agile and less prone to injury; you sometimes lift really heavy things; and you sometimes sprint really fast.  Cross fit may make it possible for me to succeed in my life-long project to get my shoulders to stay back instead of hunch forward.

Excellent resources to learn about Paleo/Primal eating and exercise are The Primal Blueprint, by Mark Sisson, and Mark’s blog:  Mark’s Daily Apple.

 

Low Fat attacks Low Carb

Dr. Dean Ornish, in an opinion piece in the New York Times, slammed low carb eating plans with a review of a recent study containing so many half-truths it is hard to know where to start.  It is exactly this sort of misleading information that kept my daughter overweight, tired, and often sad for so many years before I figured out how to help her.

The study tested the efficacy of a low fat diet, a low glycemic diet, and a low carb diet in maintaining weight loss.  The Atkins-type diet has been shown repeatedly now to produce the most weight loss (and in an interesting twist, in this study it showed the most energy expenditure), but Ornish wants to argue that just because it makes you thinner doesn’t mean it makes you healthy.  Ornish reviews evidence that his eating plan has successfully reversed severe coronary artery disease and halted the progression of Type 2 diabetes.  In contrast, Ornish reports, accurately, that the low carbohydrate eating plan in this study resulted in higher levels of C-reactive protein and cortisol, both associated with increased risk of heart disease and other chronic diseases.  He fails to mention that the study showed that the low fat diet produced the worst outcomes for insulin resistance, triglycerides, and HDL (the good cholesterol), while the Atkins-style diet produced the best.  Furthermore, there are many studies of low carb diets that do show improvements in C-reactive protein: “Not all low carb diet studies have shown significant reductions in biomarkers like CRP or IL-6, but many have. We suspect the variable results seen in other studies may be due to both questionable compliance with the assigned diet, plus the diets not being low enough in carbohydrate to achieve these anti-inflammatory effects.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (p. 85). Beyond Obesity LLC. Kindle Edition.

He fails to cite any of the voluminous evidence that Atkins-type eating plans have also reversed coronary artery disease and type 2 diabetes, as well as many other chronic health conditions.  See these descriptions of research results from “The Art and Science of Low Carbohydrate Living” (and for more information I highly recommend reading the whole book):

“Type-2 Diabetes

Concurrent with this and subsequent cases that we generated in Vermont, Dr. Bistrian completed a series of seven closely monitored cases in Cambridge/Boston[120]. It was his very low carbohydrate ketogenic (VLCKD) diet protocol that we used in the case study above. All seven of the subjects in his published report were obese, insulin-using type-2 diabetics, and all were able to be withdrawn from insulin therapy (up to 100 units per day) in an average of 7 days after starting the VLCKD. All of these subjects went on to lose a considerable amount of weight, an achievement that is decidedly uncommon in diabetics who are using injected insulin.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (pp. 193-194). Beyond Obesity LLC. Kindle Edition.

“In 1994, the Lyon Diet Heart Study [48] was terminated prematurely at 27 months due to a dramatic decrease in mortality in the group that consumed a 40% fat Mediterranean-type diet compared to a group that was prescribed the American Heart Association’s ‘prudent diet’. This dramatic difference in heart disease and overall mortality occurred despite the fact that there were no differences in the two groups’ LDL-C responses to the diets.”

Phinney, Stephen; Volek, Jeff (2011-07-08). The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable (p. 91). Beyond Obesity LLC. Kindle Edition.

Ornish then cites evidence from another study that low carb, high protein diets promote coronary artery disease.  But the Atkins diet is not a high protein diet.  Most of the calories from an Atkins type eating plan come from fat.  Ornish does this for a living.  I’m just a part-time blogger.  I don’t believe he doesn’t know the difference between a high protein and a high fat diet.

Ornish cites evidence from the Nurses Health Study that red meat consumption, which he calls “a mainstay of the Atkins diet,” is associated with “increased risk of premature death, as well as greater incidence of cardiovascular disease, cancer, and Type 2 diabetes.”  And that may well be true.  Lots of things are bad for you in the presence of too much carbohydrate.  I’m pretty sure most of those nurses were eating a typical high carb American diet, not a low carb one.

Ornish ignores the carbohydrate restriction of the Atkins eating plan, and that is where all the action is, as I’m sure he is aware.  Even fat, the real mainstay of the Atkins diet, is bad for you with too much carbohydrate.  In the presence of too much carbohydrate, insulin will direct your body to store the fat calories as fat, rather than burn them for fuel as your body would do on the low carb plan.

Ornish shows a puritanical streak, arguing that low carb eating plans are popular because people want to hear that “cheeseburgers and bacon are good for you.”  On the other side of the opinion spectrum, low carb eating plans are criticized as being too restrictive:  “how long do you want to keep eating that bacon double cheeseburger, hold the bun, thank you?”  (In the small world of this research, the second comment happens to come from Dr David Ludwig, who is also the author of the study Ornish is reviewing.  Ludwig advocates a low glycemic diet).  Clearly, low carb eating plans can’t win:  they’re both too yummy and too limited at the same time, depending on which eating plan you favor.

So What is Ornish pushing?  A mostly plant-based, “low in fat,” low in unhealthful carbs and red meat eating plan.  He reviews the results of a randomized controlled trial of his program.  Participants lost an average of 24 pounds over a year, and maintained a 12 pound weight loss over 5 years.  Sorry, but weight loss of 24 pounds in a year, and gaining half of that back over 5 years, is not that impressive.

Ornish recycles the idea that by replacing fat with carbs, you can eat the same amount of food and still lose weight.  That might be true, if you are successful in eating the same amount of food.  But on a low fat, high carbohydrate diet, (even of “healthy” whole grain carbs), you’re apt to be hungrier than on a high fat, low carb diet, and you won’t be able to hold your food intake constant.

Juliana lost 6 pounds in 10 weeks on a diet similar to Ornish’s.  To comply with the philosophy of the Packard weight loss program, we went heavily into a plant-based low fat diet, without any refined carbohydrates.  She was constantly hungry.  Then we switched to a low carb plan.  She lost 3.5 pounds in a week (most of the early weight loss is water—the first thing that happens on a low carb plan is that you dump excess retained water).  Now she is losing 2 pounds steadily per week, without hunger.

I know Juliana is an “n” of 1; our experience is not a randomized controlled trial.  If Ornish’s patients are satisfied, that’s great for them.  But I don’t see the need for him to publish a misleading attack on low carb plans to tout his program.  If you find that an Ornish-type eating plan works for you and your children, that’s great.  But if you find it doesn’t, then consider joining the low carb club.