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  The daily bag of popcorn in her lunch has been replaced by cashews.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.

 

 

 

 

 

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.

 

Juliana has to learn what a “normal” appetite is

After a lifetime of high-carb eating, which overwhelmed Juliana’s system before she was 3, she doesn’t know what her “normal” appetite is.  We’ve been paying a lot of attention lately to whether she feels hungry; whether she feels full; and whether she feels overfull.  We’re trying to learn how much she has to eat to not be hungry and to maintain her energy level depending on what she’s doing.  If she’s running a lot, playing soccer and then refereeing a soccer game, she might need to eat more than if she has a sedentary day.  But we want her to eat no more than she has to so that her weight will continue to drop.

A well-functioning appetite should make these adjustments automatically.  Juliana’s appetite has been elevated for so long that she has to concentrate to tune in to the new information she is getting from her body.  She also has to get used to the fact that a smaller quantity of food is adequate.  A high carb diet produces extreme hunger in a sensitive individual, and I believe it is truly painful, especially for a child.  She still has a bit of fear of being hungry if she eats a smaller amount of food.

She was very hungry on the Packard program, so that is one of her touch points.  She should not be that hungry, ever.  She should try not to feel stuffed ever either.  She’s started eating her meals a lot more slowly than she used to–I think this development is mostly unconscious, but it helps her to avoid eating more than she needs.  She’s not starving when she sits down to eat, as she was on a high carb eating plan, so it’s more possible and easier to eat slowly.