Low carb affects the whole family, and in surprising ways

Discovering Juliana’s intolerance for carbohydrates is like a string I pulled on in our family and all sorts of other interesting developments have followed.  I bought a cookbook/personal story called Eat Like a Dinosaur for the recipes.  In the prologue, the authors mention that their very young son’s marked ADD symptoms disappeared when they began to eat a Paleo diet.

My son Teddy, who is 8, does not have ADD, but he has something related called Sensory Processing Disorder (SPD), which some people think should be called “Brain Processing Disorder.”  His brain can’t make efficient use of some of the information from his senses.  So although he has 20/20 vision, he can’t “see” a soccer ball rolling toward him well enough to be able to kick it.  His condition is qualitatively different from a kid who is “uncoordinated,” or “not very athletic;” we had to pull him out of non-competitive soccer because he just couldn’t participate in the practices or games even when he was the oldest on the team.  Now he does sports without moving objects, like Tae Kwon Do and swimming.

Teddy had other traits typical of kids with SPD, particularly being very clingy for his age and difficulty with emotional regulation.  The smallest upset could lead to a 45 minute meltdown, and he was at best grumpy in the morning, usually worse.

I wondered whether a Paleo diet would be helpful for him.  Unfortunately, my attempt at a Paleo diet for him failed utterly.  He didn’t eat much to begin with, and most of what he liked was carbohydrate.  He likes meat, but only with bread or something else starchy.  He likes chicken nuggets, but hated the paleo chicken nuggets recipe that used coconut flour.  The only vegetable he’ll eat is mini carrots–he says regular carrots make him choke, and that seems to be literally true.  He has lots of temperature and textural sensitivities.  Trying to get him to eat without any starch was a disaster.

You know the line about if they’re hungry enough they’ll eat it?  I’m sure that’s right, but I challenge you to last through several days of screaming to find out.  Teddy, in particular, can’t regulate his mood if he doesn’t eat, and the whole family pays the price.

I retrenched.  I thought if he couldn’t go full-Paleo, maybe he could tolerate a gluten-free diet.

I had also just read Wheat Belly, a fantastic book by a preventive cardiologist who uses gluten-free diets in his practice.  It contains the first explanation I’ve ever seen of why a gluten-free diet often helps kids with ADD.  In brief, modern wheat, as opposed to ancient wheat, or even wheat from 50+ years ago, has many “rogue” particles that didn’t formerly exist–the result of hybridization.  Remember amber waves of grain?  Not anymore.  Think 18 inch high easy-to-harvest-and-transport stubby stalks.   Hybridization produces compounds that didn’t exist in either of the “parent” plants.  These particles are essentially floating around in our brains, and can wreak havoc in sensitive individuals.

The gluten-free diet has been a lot more successful.  Teddy eats lower carb than he used to–he eats gluten free chicken nuggets for breakfast instead of a giant bagel with butter–but not low-carb, and not paleo.  He eats more chicken nuggets or chicken chunks in broth for lunch.  He eats taco-type hamburger meat with corn chips.  I am flexible as long as it’s gluten-free: he eats fast-food hamburgers without the bun, and wraps the meat in french fries or potato chips instead.  He no longer gets German pretzels from the German baker at our school twice a week, but instead eats more chicken nuggets or chicken chunks as soon as I pick him up after school.

And what have I noticed?  His mood in the morning is completely transformed.  He wakes up happy and ready to face the day.  For years it’s been touch and go in the morning–would I get him out the door without a meltdown?  Something kids with SPD do called therapeutic listening (TL)–digitally altered music they listen to through special headphones– had already helped a lot with his morning mood.  He listened to a special piece meant to help with emotional regulation.  Every morning as soon as he woke up I would clap those headphones on his ears and hope.  But on the gluten-free diet, he doesn’t need the mood-regulating therapeutic listening.  Now he does his regular TL in the morning.  He can still have a meltdown if he doesn’t eat and suffers a disappointment, but in general overall I think his mood is better.

He seems to realize that he feels better too.  At least five times I’ve given him something to eat and he’s asked, “does this have gluten?” and sometimes it did but not as a major ingredient and I had not thought about it.  He is now more vigilant that I am, and refuses gluten food at school or parties even if I am not with him.

A few days after I posted this originally, I had a meeting with Teddy’s teachers at school.  They commented spontaneously that they thought his engagement and concentration had improved since the beginning of school.  Certainly he’s arriving at school in a better frame of mind, since his mornings now go smoothly.

 

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.

Most doctors won’t be able to help an overweight child

I asked many doctors over the years to help me with Juliana’s weight.  What was going on?  What do I do?  I got no help.  Her family practice doctor, whom I loved, told me frankly that doctors had no idea what was causing the obesity epidemic among children.  She asked Juliana what her favorite vegetable was.  Juliana replied “broccoli.”  That was the extent of our nutritional counseling.  All of the doctors I consulted prescribed “watchful waiting,” what I now think of as the hope that she would “grow into her weight.”

Why does the “grow into their weight idea” persist in the face of the evidence that most overweight children will become overweight adults?  In part because it’s almost impossible to lose weight and keep it off on the Standard American Diet if you are sensitive to carbohydrates (and all of us become more sensitive over time if we continue to eat carbohydrates–this is one of the reasons people tend to gain weight as they age).  Your doctor knows how little success he or she has counseling patients to lose weight–almost none of them do.  The myth allows everyone to postpone the day of reckoning for overweight or obese children.

A friend of mine provided a perfect example of this phenomenon recently.  She took her 14 year old to the doctor for a yearly physical, and wanted the doctor to help her discuss weight management with the teen.  The teen had recently gained a lot of weight without growing taller, and was clearly becoming uncomfortable with her appearance.  But the doctor didn’t.  Instead, she said that since the teen was “only” in the 80th percentile for Body Mass Index, she wasn’t overweight, and not to worry about it.  The doctor didn’t advise doing anything, even though the teen had gone from the 42nd percentile BMI at her last checkup a year prior to 80th percentile at this checkup.  I bet the doctor was relieved that the teen hadn’t crossed the 85 percent threshold, where she would technically be considered overweight, because the doctor knows she doesn’t have any effective information to offer on how the teen can slim down.

What does insulin resistance have to do with overweight and weight loss?

We observe all the time that some people seem to be able to eat anything and not gain weight, and others eat very little and are heavy.  The calories in/calories out dogma denies that this phenomenon exists, but we all know it does.  At the Packard pediatric weight control program, one of the most difficult things for the children there to handle was the fact that it seemed their peers could eat anything they wanted, including chips, candy, and soda, and be slim.  And they were right.

How is this possible?  How an individual will respond to the typical American diet is dictated by how insulin sensitive or insulin resistant they are.  The typical American diet is high in carbohydrates.  Carbohydrates cause the body to produce insulin to keep blood sugar in a normal range.  (An equal amount of energy consumed as fat causes virtually no change to insulin levels).  Some individuals are sensitive to insulin–they can process a given amount of carbohydrate with relatively little insulin release.  But some are insulin resistant–they require a lot of insulin to process that same amount of carbohydrate.

Insulin is also known in any biology textbook as “the fat storage hormone.”  Can you guess which individual is going to gain weight from the typical American diet?

Relative insulin sensitivity or resistance also explains how an individual is going to respond to different sorts of eating plans designed for weight loss.  The insulin sensitive individual can lose weight on a low fat, low calorie plan or on a low carb plan.  But the insulin resistant individual will find it very hard to lose weight on a low fat, low calorie plan:

“Insulin Resistance and Diet Success

In 2007, Gardner et al published a randomized, controlled trial called the A-to-Z Study involving 4 diets lasting a year given to groups of obese women[43]. At one end of this diet spectrum was the ‘Ornish diet’ which is very high in complex carbs and very low in fat. At the other end was the ‘Atkins diet’ (i.e., low carbohydrate). After 6 months, the women on Atkins had lost significantly more weight, but after 12 months they were still lower but not significantly so. Interestingly, blood pressure and HDL cholesterol were significantly better on low carbohydrate than any of the other diets, and this beneficial effect remained significant out to 12 months. After publishing this initial paper in JAMA, Dr. Gardner went back and examined his data based upon the subjects’ insulin levels before they started dieting. When the women on each diet were divided into three subgroups (tertiles) based on baseline insulin resistance, the results were striking. In the low carbohydrate diet group, weight loss was similar in the most insulin sensitive (11.7 lbs) and insulin resistant (11.9 lbs) women. However weight loss with the high carbohydrate (Ornish) diet was much greater in the insulin sensitive (9.0 lbs) than the insulin resistant (3.3 lbs) women. Thus the most insulin sensitive sub-groups of women experienced a similar weight loss when assigned diets either high (9.0 lbs) or low (11.7 lbs) in carbohydrate In contrast, the sub-groups that were insulin resistant fared very poorly when assigned a diet high in carbohydrate (3.3 lbs lost) compared to a low carbohydrate diet (11.9 lbs). Specifically, those women with insulin resistance lost almost 4-times as much weight when dietary carbohydrates were restricted[44].”

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. 85-86). Beyond Obesity LLC. Kindle Edition.

They may lose some, like Juliana did, because a low fat, low calorie plan is almost certainly also a lower carb plan.  But the insulin resistant people are going to be hungrier than the insulin sensitive people on an Ornish-type plan.  Why?  The more insulin, the more the cells get the message to store available energy as fat.  The more that is stored as fat, the less is available to use, and the sooner that person will be hungry again.

I have already taken Dr Dean Ornish to task for publishing a misleading opinion piece in The New York Times blasting low carb eating plans.  He would also do well to pay attention to his patients who cannot comply with his eating plan because of hunger, or don’t lose much weight even if they do comply.   He might learn something.

 

 

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.