Since the advent of the first low carbohydrate diet in 1863, (the Harvey – Banting diet) physicians have been successfully helping patients lose weight with low carbohydrate diets. The folks most likely to benefit from this diet are those who have any of the abnormalities found in the metabolic syndrome, such as low hdl, elevated blood sugars, high triglycerides, or high blood pressure. By reducing carbohydrate intake to very low levels, folks will dramatically lower their insulin levels. This allows the fat in the fat cells to dissolve and move into circulation where it can be used to fuel the body’s energy needs. Moreover, insulin is a growth stimulating hormone which is associated with several types of cancer. Low insulin levels are associated with low cancer risk.

Let’s start with an excellent video which describes the basics of a low carbohydrate diet. It is an advertisement for a diet program but the video is well done. This is the cruise control diet by James Ward.

Dr. Eric Westergren from the Duke University Lifestyle Medicine clinic’s very low carbohydrate diet treatment program talks about their use of the Atkin’s diet here.

There are two basic ways to approach a low carbohydrate diet. One can target a specific number of grams of carbohydrates to consume each day or one can use a simple list of permissable and not permissable foods as a guide. Whichever path you choose, you must do it consistently and “cheat” only rarely (once a week or less). Each time you eat more than 20 grams of carbohydrate at one time your insulin levels will rise and shut down your fat metabolism for 12 hours or so. For comparison: 20 gm of carbohydrate is the equivalent of ONE piece of bread, 1/2 a hamburger bun, or one packet of oatmeal.  A 20 ounce regular soda has > 50 grams of carbohydrate and it is all sugar! Most soda contains fructose in a highly concentrated form which the liver metabolizes into fat. It cannot be burned as fuel. Excess fat in the liver causes a number of problems including fatty liver disease and insulin resistance.

Our goal is NOT to significantly increase the protein intake. Rather, we wish to replace your carbohydrate calories with healthy fats. Nuts, Coconut Oil, and Extra Virgin Olive Oil are the best. For folks who count, one should keep the daily protein intake to about 0.4 to 0.6 grams of protein per day per pound of “ideal body weight.” For example, a 170 pound man should eat about 68 to 86 gm of protein a day. 6 ounces of salmon has 34 grams of protein. One half cup of cooked lentils has 9 grams of protein.

Three strategies appear below:

Strategy One (for folks who want a moderate reduction in carbohydrates): The most simple low carbohydrate diet has only two rules:

1. Don’t eat any sugars (honey, molasses, table sugar, corn syrup, maple sugar, agave) or drink any drinks with calories including milk, juice, soda, any liquid with any calories. Easy: If a drink has more than zero calories – don’t drink it.
2. Don’t eat anything made from grains including wheat, corn, oats ( bread, pizza, pasta, cake, pie, protein bars, donuts, breakfast cereals, etc.)

What can we do? 

• Drink water, flavored waters, iced tea and coffee, diet soda (artificial sweeteners are controversial but recent studies don’t show that they elevate insulin levels significantly)
• Use Almond milk (30 calories) or coconut milk (45 calories). Avoid cow’s milk which contains 3 to 4 teaspoons of lactose (“cow sugar”)  To get your daily calcium and vitamin D take 2000 units of vitamin D3 daily and one Tums.
• Eat real food! Fruits contain fructose but lots of fiber which reduces the absorption of the fructose and reduces hunger.
• for alcohol, choose red wine over beer and mixed drinks (antioxidants in the wine reduce inflammation) and limit yourself to no more than 2 drinks a day for men and one for women. Alcohol is converted to fat in the liver so it is best to avoid it altogether if you can, especially if you have any signs of fatty liver disease or if cancer runs in your family history.
• read labels. Foods with more than a couple grams of “sugar” should be avoided. **
• Avoid grain based carbohydrates (bread,bagels,pizza, pasta, pita, breakfast cereal). If and when you do choose a grain based meal look for low sugar, high fiber content and whole grain. (e.g. shredded wheat, Irish oatmeal, “low carb” bread.)
• Avoid food with “trans fats.”  Any label which says “hydrogenated” on the label contains a transfat whether or not it is listed on the label. These fats are toxic to the liver and the lining of the arteries.
• When eating out decline the bread, potato, and order meat/fish with double vegetable sides to reduce your total carbohydrate intake.
• Skip dessert most days of the week or substitute fruit.
• Exercise. 15 minutes of exercise a day improved life expectancy three years in a large population based study. (Brisk walk 15 – 20 minutes after a big meal reduces absorption of calories and burns some of the just eaten carbohydrates reducing insulin production.)
• Follow the Okinawan Program rule: Eat until you are 80% full.
• A sample weekly meal plan can be found here

Strategy Two: Strictly following a list of foods to eat or avoid:

William Davis gives a simplified list of Do’s, Don’ts, and “Just a little bits:”

 Unlimited quantities of these foods are OK (Only if you are truly following the low carb diet)

• Vegetables and mushrooms
• RAW nuts preferred (not roasted in the hydrogenated oils which are toxic to your system)
• Healthy oils: Olive, coconut, avocado, canola. Avoid: sunflower, safflower, corn, vegetable oils (vegetable oil is high in inflammation causing omega six fatty acids). Minimise heating of oils. Use coconut oil for high temperature frying.
• Fish especially wild salmon, swordfish, tuna, mackerel, sardines (high fat fish)
• Meat. Try to eat grass fed animal meats and cook meat at the lowest possible temperatures. Available at a few local farms in Southeastern MA! (Some recent studies indicate that eating red meat, especially processed meats, more than once a week may increase modestly your risk of stroke, heart disease and cancer )
• Ground flaxseed (high in omega 3 fatty acids)
• Spices and cocoa powder (high antioxidant levels)
• For sweetener: Stevia is a natural plant product.
• Cheese
• Eggs

Consume in small portions (ex ½ cup grain, oats or a small piece of fruit)

• Dairy products including yoghurt, butter (limited – he states that the proteins in some dairy products raise insulin levels) greek yoghurt has lowest carbs (look carefully at sugars on the label).
• Soy: relatively limited quantities; best are fermented such as tempeh, miso, tofu, and edamame (boiled), soybeans.
• Legumes (beans) eat in small quantities at any one time (1/2 cup). high in carbs but slowly digested.
• Non wheat, gluten free grains: quinoa, millet, sorghum, amaranth, buckwheat, rice, oats. should be eaten in modest amounts (1/2 cup of cooked grain at a time) because in large amounts they will raise blood sugar and insulin levels significantly.
• Fruits in small amounts at any one time. buy small apples, etc. Avoid grapes, bananas.

Eat rarely in very small amounts:

• Dried fruits: figs, dates, prunes, raisins, cranberries. These are “candied” and often very high in sugar which actually preserves them.

Avoid altogether: This is critical to the successful switch to having your body burn mostly fat as fuel.

• Wheat products (Davis is concerned about wheat proteins known as glutens damaging the body’s cells as well as the high carbohydrate content)
• unhealthy oils: fried food (any), corn, sunflower, cottonseed, grapeseed, soybean which contain higher levels of omega 6 fatty acids which cause inflammation in the body.
• “Gluten free” processed foods made with starches (these raise blood sugar just as much as wheat starch does)
• Fried foods
• Sugary snacks, candy, ice cream, sherbet, fruit roll ups, energy bars
• sugary condiments including jelly, jam, preserves, ketchup (if it has HFCS sweetener or sugar) These often contain high amounts of sugar.
• Sugary fructose rich sweeteners such as honey, maple syrup, sucrose, etc.
• Processed foods like soups (tomato soup has tons of added sugar.)

Strategy Three: Targeting a specific carbohydrate level

Most patients with metabolic syndrome/insulin resistance can “cure” the insulin resistance with a low carbohydrate diet which targets 60  grams a day of total carbohydrate. This will reduce insulin levels dramatically and allow the fatty acids in the fat cells to be mobilized and burned for fuel.  Similar to folks who undergo gastric bypass surgery, folks with diabetes or high blood pressure may reduce or even eliminate the need for insulin and blood sugar reducing medication after a few months on the diet. A low carbohydrate diet has been proven to dramatically reduce insulin resistance and put the metabolic syndrome in remission.

The first phase of the Atkins diet targets 20 grams.

To read more about Sugars click here

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