Low-Carbohydrate Dieting:
Exposing the Myths and Realities
By: Fred Pescatore, MD, MPH

Introduction

Everywhere we look, we see something about low-carbohydrate dieting—television, radio, bookstores, and newspapers. Everyone we know seems to be on a low-carbohydrate diet. But what is low-carbohydrate dieting and how do we know which diet to follow, which is the healthiest, and most important, does it really work? In this brief article I am going to show you exactly what low-carbohydrate diets are and compare and contrast the most popular ones currently available with a diet I have been working with for the past few years.

I used to be the associate medical director of the Atkins Center for Complementary Medicine. Yes, that is the same Dr. Atkins whose very popular diet plan has swept the nation. In the five years I worked there, I was able to learn, first-hand, the health benefits of low-carbohydrate eating, but I was also able to learn which aspects were healthy and which ones were just hype.

When I first started working there, I had just finished residency training and knew nothing about nutrition. After all, they didn’t teach nutrition in medical school, nor was it emphasized when you were working in a hospital trying to handle life and death emergencies. Nutrition was something that was always left up to the dieticians. The doctor had to order the diet, but none of us really knew what the diets we ordered ever consisted of. Looking back, I now know what a terrible mistake this was.


Low-Carbohydrate Dieting

In a nutshell, low-carbohydrate dieting consists of eliminating most forms of carbohydrates. Carbohydrates come in many forms. They can be sugars, breads, pastas, pretzels, crackers, fruit, vegetables, and soda and fruit juices. Many people can’t believe that fruit and fruit juices are carbohydrates because they are really mostly sugar. Several recent studies even go so far as to suggest that the rise in obesity in our population is directly attributable to the rise in the consumption of fruit juices.

Sugar
For those of you who may not be aware of how fattening fruit juices can be, apple juice has more sugar in it than the same amount of soda. Sugar is the food that is eaten the most in this country. We eat 150 pounds per person, per year. That translates to 33 tablespoons each day. That may seem like an unrealistic amount, but when you begin to understand what you are eating, it is really quite easy to get to that level quickly without even realizing it. When I place my patients on the diet program I use in my practice, they come back in two weeks into the program, after having read all the food labels, and tell me that they can’t believe certain foods actually contain sugar. What’s worse, there are more than 300 foods that are not required by the federal government to list sugar as an ingredient, when in fact, they do contain sugar. As Americans, we consume more calories of sugar than we do of meat, chicken, vegetables, and breads combined.

Different forms of sugar
One of the main reasons we don’t know how much sugar we consume is because sugar has many disguises, such as brown sugar, corn syrup, honey, molasses, maple syrup, high-fructose corn syrup, dextrin, raw sugar, fructose, polyols, dextrose, hydrogenated starch, galactose, glucose, sorbitol, fruit juice concentrate, lactose , brown rice syrup, xylitol, sucrose, mannitol, sorghum, maltose, and turbinado. Essentially, any word on a food label that ends in -ose, or -ol is a sugar in disguise.

Carbohydrates
Why is keeping a low carbohydrate level so important? The explanation requires a little understanding of the basics of how food is metabolized in the body. Our bodies metabolize food in the same manner as the bodies of our prehistoric ancestors. The body preferentially uses sugar for fuel since the body doesn’t have to expend any energy to break it down for fuel. Next, the body will utilize simple carbohydrates such as pasta, bread, pretzels, and the like, simply because it doesn’t take much energy to convert these into sugar for fuel. Next, the body uses complex carbohydrates such as vegetables, brown rice, legumes, and whole-grain starches as fuel because the body has to expend energy to process these foods back into sugar in order to be used by the body. The body will then use protein for fuel, and use fat last.

Fat
The reason the body uses fat last is because fat is the perfect storage molecule for the body. Fat holds more than twice the amount of energy than either a carbohydrate or a protein, so the body, in its infinite greatness, will store those bits of energy (also known as calories) for a rainy day. For most of us in this country, that rainy day never comes and it is our hips and waist that suffer the brunt of this storage of energy.

The next logical assumption should be to eliminate fat from the diet and by doing so would solve the fat problem—right? Wrong! Because our bodies create stores of fat molecules, namely triglycerides, we have an excess of sugar in our bodies. The real key to dieting is therefore to eliminate the bottom of the food chain—sugar and simple carbohydrates—thus, forcing our bodies to utilize the complex carbohydrates, protein, and fat that we consume. Our bodies then begin to operate as they were meant to operate. Our prehistoric forefathers never had processed foods, and that is all sugar and simple carbohydrates are.


Losing Weight

By eliminating sugar and simple carbohydrates, we can lose weight easily and efficiently. I explained this concept to a patient I will refer to as Susan. She was 43 years old and was a strict believer in the low-fat philosophy, yet no matter how strict she was, she gained weight, felt less energetic each day, and needed to lose about 60 pounds. In order to explain the concept of how food is metabolized, I often measure blood insulin levels. Her insulin level was twice the normal amount when she was fasting and more than four times the normal amount two hours after she had eaten.

Insulin levels
High insulin levels have been linked to a variety of diseases: Diabetes, blocked coronary arteries, high cholesterol, high triglyceride levels, high blood pressure, strokes, and most important, obesity.

Insulin is the hormone in your body that reduces your blood sugar. When there is too much blood sugar, in a condition known as insulin resistance, your body becomes overwhelmed and can’t do its job. A high-carbohydrate, low-fat diet can never correct this insulin imbalance or any underlying cause of obesity because it is too high in sugar. When you eat a low-carbohydrate, high-protein diet, your body can better metabolize the food that you eat and the insulin levels return to normal, and the weight comes off. Even if you are not overweight, the proper regulation of insulin levels is the key to avoiding some of the deadliest diseases that we face in this country.


Safe and Healthy Eating

I keep emphasizing low carbohydrate rather than no carbohydrate because that is the real key to dieting in this way in a safe and healthy fashion. Bill, a 54-year-old executive came into my office about 40 pounds overweight. He had tried all of the more popular low-carbohydrate diets and had lost about 50 pounds, but he suddenly got stuck, and for the past six months, was unable to get the scale to budge, despite having increased his sessions with his personal trainer.

I explained to him my theory as to why the body needs some good carbohydrates—in order to get the metabolism to function efficiently. I also explained to him that when the body is placed into ketosis, for example, for an extended period of time, that gimmick stops to work. Ketosis is actually what happens to your body when it is starving and your body begins to break down muscle protein. Your body will adapt and the ketosis becomes less effective at helping the body to lose weight. You can only fool Mother Nature for so long. I gave him the program I use, which consisted of more carbohydrates than he had been consuming for over a year, and within three months, he lost the remaining 40 pounds and an extra 10 to “play around with,” as he put it. He was able to do this because he had learned which carbohydrates to eat, and was not told, “eat all you want.”


Moderation is the Key

Many of the low-carbohydrate diets that are currently popular encourage the notion of “all you can eat.” While this certainly works in Las Vegas, it can’t possibly be expected to work over the course of someone’s lifetime. You simply can’t tell an overweight person to eat all of anything. It is the wrong message to send out.

The message to eat all the fat you want without worrying about it is also wrong. The most important thing I learned while at the Atkins Center was that the amount of fat does play a role in how much weight a person will lose. Also, the type of fat is vitally important. There are good and bad fats available for us to consume. I just don’t buy the belief that eating all the bacon fat you want is healthy for you.

The medical literature supports the theory of “good” and “bad” good fats such as omega-3 fatty acids—the type you find in fish. The medical literature similarly supports the theory that there are fats you shouldn’t be consuming, like the trans fats found in margarine and the hydrogenated fats found in most oils, except for olive oil and canola oil. The current fad-diet books do not take any of this research into account when helping you devise an eating plan that is supposed to make you healthy and stay that way.

Another popular book tells you that you should eat a meal that consists of anything you want as long as you do it in a certain time frame and that it is a certain set number of meals. For example, every third meal, you are allowed to eat all you can eat for an hour. That is a gimmick if you ask me. As you cannot tell an overweight person to eat all of anything, you cannot tell an overweight person they can eat any kind of food and still lose weight healthily. In medical school, I went on a chocolate pudding and French-fry diet and managed to lose weight, but it was not a healthy way to do so. Many people want to lose weight. More than half of us are seriously overweight. If you want to do something about it, you need to learn how to eat a proper diet.


The Thin Mind

Thin people think and treat food differently than we do. We need to learn how to eat and think like they do if we want to have any hope for success in the long run. And isn’t that what it’s all about—a lifetime of good health and looking good?

I should know, as I was once 80 pounds heavier than I am today. For the first time in my life, I can actually say that I have been thinner for longer than I was ever overweight. It is because I have been able to incorporate a sensible low-carbohydrate diet into my life.


Conclusion

Don’t be afraid of low-carbohydrate dieting—it is healthy and it does work. Be afraid of gimmick diets. They may just be snake oil after all.



Link: http://ajc.healthology.com/focus_ar...ruthlowcarddiet

This is a good article.....but

1. If this doc worked at the Atkins Center for 5 years, he should know that "In a nutshell, low-carbohydrate dieting consists of eliminating most forms of carbohydrates." is true.....but only part of the story!

2. He should also know that "I just don’t buy the belief that eating all the bacon fat you want is healthy for you." is NOT what Dr Atkins promotes!

3. "Ketosis is actually what happens to your body when it is starving and your body begins to break down muscle protein. Your body will adapt and the ketosis becomes less effective at helping the body to lose weight. You can only fool Mother Nature for so long." This is a PHYSICIAN???? Here's the definition of ketosis taken from the Merck Manual:

It is true that few medical schools teach nutrition, which is wrong, but that's why they DO refer their patients to nutritionists and dieticians! and they ARE taught how the body breaks down certain nutrients and what happens (and why) when the body goes into ketosis.

I also take exception to the references to patients being told to "eat all they want". What Dr A says in his book is "eat until you're satisfied, not full".....which is a different thing all together. In Protein Power, it's emphasized that you CANNOT eat all you want! There's one story about a woman who complained that she wasn't loosing fast enough....and sure enough, she was eating all the right foods, but in much larger quantities than recomended! As Dr Eades put it, he was amazed she lost ANY weight at all!

This guy obviously doesn't have a clue. For starters:

1) In his list of "hidden" sugars, he lists Polyols [which is a blanket term for all Sugar Alcohols] and then lists a number of Sugar Alcohols. He then states anything ending in -ol is a Sugar. Not true at all. While most things ending in -ose are Sugars [like he said]...Anything ending in -ol is an Alcohol. If it ends in -anol, it is a standard Alcohol. For example: Ethanol (Grain Alcohol,) Methanol (Wood Alcohol,) or Isopropanol (Rubbing Alcohol). If it ends in -itol, its a Sugar Alcohol. For example: Sorbitol, Xylitol, and Erythritol. I think it is a mistake for the FDA to classify Sugar Alcohols and Glycerine as Carbohydrates. They should create a new listing: "Total Alcohols" with sublistings: "Ethyl Alcohol," "Sugar Alcohols," and "Glycerine."

http://www.chemicalland21.com/aroko...co/GLYCEROL.htm
http://www.chemicalland21.com/aroko...co/MANNITOL.htm

2) He states there are TWO bad fats: Trans-Fats and Hydrogenated Oils. Uhh dude, Trans-Fats and Hydrogenated Oils are the same thing. Hydrogenated Oils are the primary Trans-Fat we run into. Pure oils will also Hydrogenate if heated to a high enough temperature...This is true of pretty much all oils, but especially those that are heavily Polyunsaturated. Canola Oil is not immune to creating TFAs. I'm not sure, but I think Olive Oil will also yield TFAs if heated high enough. This is one reason Atkins suggests against letting oils smoke/burn. Polyunsaturates should also be avoided for other reasons [high in w6, go rancid quickly, lower HDL, etc...] Strangely he does not bring any of these issues up.

3) Ketosis is simply Fat Burning. In order to lose fat a person MUST enter Ketosis. Those on Successfull Low Calorie diets typically go in and out of Ketosis. You can lose weight without Ketosis...But, you can't lose fat without it. Even if the test strips don't show excess Ketones, you can still be in Ketosis, just not Deep Ketosis. Some folks seem to think that since Low-Calorie dieters don't always register excess ketones that they aren't in ketosis and thus ketosis is unnecessary to fat loss.

4) Bacon Fat ??? Come on dude...At least read the book. If this guy had actually worked with Dr. Atkins, he would be aware that Atkins not only doesn't say to eat lots of Bacon...But, that Atkins suggests against it due to the Nitrites and sugars. He would also be aware Nitrite-Free/Sugar-Free Bacon is so damned expensive, most folks can't afford to eat it on a regular basis.

5) Eat all you can eat ??? Again, he should be aware [assuming he isn't lying through his teeth about his credentials] that Atkins says to eat until satisfied, not full. Any plan that tells you to eat less than is needed to satisfy your hunger is DOOMED TO FAILURE. People simply cannot live the rest of their life in a constant state of hunger. Weight Watchers is evidence of this. Their drop-out rate is through the roof.

this part rings true to my experience:

"Your body will adapt and the ketosis becomes less effective at helping the body to lose weight. You can only fool Mother Nature for so long."

I dont know why, but Atkins worked great for me for the first 6 months, the pounds melted off, but then with about 20 pounds to go, the magic ended. A little more than a year of eating this way, I still stick with it because at least I can maintain my
current weight, and I like to eat this way, but I have to say I am disappointed it didnt take me all the way. I am slowly casting about looking for a way to drop the next 20 pounds without going hungry and maybe this guy is onto something, who knows? I wouldn't reject his ideas out of hand without looking into them a little more.

Speaking of reading the book, how many of you read Dr. Pescatore's book (Thin For Good) before categorically trashing him? I read his book. Although I found some parts I didn't agree with (some of which are pointed out here), I also found that there were some parts that goes beyond the Atkins book in trying to address certain issues of low carb dieting. Namely, psychological aspects / barriers of weight loss which some dieters (low carb or otherwise) face. Dr. Pescatore (in my reading's impression) wrote his book not so much to cross swords with issues of ketosis/calorie limitations (you guys are reading WAY too much into your wrongly thinking he's advocating a low-cal diet - he's simply trying to beef up more than Dr. Atkins' only having a brief one-or-two-liner comment in his entire book about eating till you're full, not stuffed - Pescatore dug a bit deeper into the psychological issue some have with this, to his credit. Fortunately, some of us (including me, thankfully) find low carb eating such an appetite suppressant that it pretty darn well regulates itself quite nicely in that regard. But let's not overlook the portion of our group that may be bringing some heavier psychological baggage to the plate. A *lot* of Pescatore's book deals with self-image/psychological issues to help keep us low carb dieters marching forward. He correctly stated in his book that his experience at the Atkins Center noticed that this component was mostly lacking in the treatment program there. To my partial knowledge, he's right. If you want to get into how much that matters for most patients who dropped by the Manhattan center, you're welcome to (I'd be open to varying opinions) but let's please keep in mind that he might have been even more right about the many who didn't even have the benefit of getting so much hands-on clinical supervision like the lucky folks who were able to be direct patients of the good doctor (Atkins). Rather, I'm speaking of people who picked up the Atkins book, or just some partial cliff notes/cheat sheet, tried what they thought was the diet, messed up, went off it for all the wrong reasons, and needlessly became a negative statistic.

One reason why we have value-added literature/message boards/support forums is because they are useful extensions of the Atkins Diet and low carb dieting. Several of you quoting the Eades' Protein Power is just such an example... it has some goodies that the Atkins book doesn't. And let us not overlook the superb book by Laura Richard with all the extra tips. I for one am *not* saying I expect any low carb author to write about every aspect of low carb dieting (quite the opposite) - if a few of you will let your guard down a moment (smile) you might agree that there are a few areas where Atkins and other authors could have "spoken" up more forcefully about certain topics which might have made it easier for some of the newbies to get a clue about those particular topics. Sure, us old hands rotely point out chapter and verse of where Dr. A et al made a one-liner statement in such and such edition, but come on - wouldn't it have ideally been "better" if he'd mentioned it more often, since those certain topics seem to be stumbling issues time after time with some folks? I'm somewhat astounded how prejudiced we are at allowing certain low carb authors into the sector yet all too easily shut out others that are in fact on our side. Also, making sweeping judgments of any given low carb author based on ONE article is unbecoming of us. Rachael Heller of the Carbohydrate Addict's Diet (CAD) seems to help some portion of low carb dieters, and my reading of two of their books were in the pro-low-carb family. Yet, would it surprise you to know that Rachel Heller on more than one quick radio interview came out appearing to be one of the anti-low carb "bad guys" in using cheap, intellectually lame classic scare tactics against ketosis? Tis true. If one was station-flipping and only heard that one sound-bite, you'd have sworn she was bosom buddies with the anti-low-carb quacks that are our real enemies (let's keep our focus, people).

Those of you who know my posts recognize me as a staunch pro-Atkins and pro low-carb evangelist, so please realize that when on the one hand, I say:
So sure, go ahead and critique Pescatore's nutshell article where you feel appropriate, but for the same reason you bash others for not bothering to read DANDR, please realize Pescatore wrote a damn good book himself that I and others found to be part of the wider solution for the varying needs of the low carb community as a whole - and deserves more than calling him a career liar and personal attacks (sheesh, you guys!). Fair 'nuff?

I agree with what you have to say about all the different LC plans out there....and I think a lot of us are using a mish-mash of two, three or even more plans.

My problem is that he got some info wrong. I didn't check his credentials, I was commenting directly on his article. He got some things wrong.

As a nurse, I know what I was taught in school....and having worked in nursing for over 25 years, I have a pretty good idea of what docs are taught in school. And in his article, he gave a wrong explaination of what ketosis is. Any (good) first year nursing student should knows what ketosis is...and any person that has graduated medical school and finished even the simplest of residency programs should know what ketosis is!

When people state things that I know is wrong, their credibility goes down. Sorry, but that's me.

BTW....I strongly agree that Dr A doesn't address the psychological aspects of being overweight, loosing weight, and maintaining weight well.

I've read Thin for Good and enjoyed many parts of it but Dr. Fred is sounding just as misinformed as the many low-carb bashers out there or people who read but don't really take the time to absorb what they're reading, or bother to read the whole book or ever refer back to it.
Really? The Heller's said that? Please Dr. Fred, read the bleedin' book before deciding to misinterpret it.
Huh?

Karen

LOL Well put Karen! Thanks

Back to the bacon-bashing: Its important to acknowledge that pork fat (lard) consists of somewhere around 40% monounsaturated fat-a good fat that constitutes olive oil . The Eades new book "Protein Power Life Plan" on page 320 lists lard as a "good fat" for cooking and frying. Also it's highly disingenuous to imply that its even possible to binge on fat. We all know that fat quickly satiates our appetites. Fat is mainly guilty of providing "cover" for carbs in foods like french fries and potato chips.

The main problem with Lard nowadays is that 99% of the Lard you can find in the Stores, namely the Manteca Brand, lists its ingredients as: Lard and HYDROGENATED Lard. That word "Hydrogenated" kills any chance of me using their product. Hydrogenated (in reference to a fat) = Trans-Fat. Now, why the hell someone would partially hydrogenate a solid fat, such as Lard is beyond me.

We are able to furnish old fashioned, plain rendered lard from a USDA processor. Non-hydrogenated, it requires frozen storage for long term stability or will turn rancid. See link to website under my profile.

cc: they aren't hydrogenating lard, they're hydrogenating vegetable oil (ok, grain oil to be more correct) and passing it off as a substitute for lard and butter. Why? Cheap!