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.