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Were any dietitians consulted in preparing this diet?
It doesn’t seem like there have been any nutrition professionals consulted in preparing the protocol for the study. MDs do not receive sufficient training in nutritional science.
Dr. Jay’s Reply:
Thank you for you comment.
Your observation that MDs generally do not get adequate training in nutrition is something I would agree with. I think my profession, in embracing the pharmaceutical approach to disease management, has allowed the very important issue of nutrition to be side-lined. As physicians, we are taught to examine the research that guides our practice to ensure it is done to high standards. The double-blind randomized controlled trial is considered to be the gold standard with which drugs and other interventions must be evaluated. In deferring to other professionals in the area of nutrition, we assume that they conform to the same standards. In reality, it appears that they do not. Gary Taubes’ excellent book, “Good calories, Bad calories†details the areas in which nutritional science has been deficient and how the consequences of this can be found in the modern epidemics of obesity and related conditions.
Were there any dieticians on my research team?
No. However, we did have Dr. Eric Westman from Duke University who has done a number of studies on low-carb diet and who does have a dietician on his team. The diet he used for his recent research was very comparable to the one we used. We also had Dr. Mary Vernon, who has had years of experience designing low-carb diets for her diabetic and metabolic syndrome patients and successfully managing these conditions. We had Dr. Steve Phinney who is an internist with a PhD in nutritional biochemistry from MIT who has been doing research in this area for over 30 years. We also involved Dr. Abby Bloch who has a PhD in nutritional science and who has been a contributor to the standard textbook of nutrition used in American universities.
With this kind of expertise in place, I don’t think that the fact there was no dietician involved would constitute a significant deficiency.
At the end of the day, regardless of who was on the team, the most important question is whether the intervention delivered a beneficial result. Although we haven’t completed a final analysis, from our interim analysis, I am happy to report, it appears that it did.
In the past I have lost over 50lbs using a low card diet.
I was 40 at the time.
Now I am 48 with high blood pressure (around 155 over 110) I am on diovan. I would like to go on another low card diet. Any suggestions on how I should start this diet and what I should be aware of ? I weigh 285 now and would like to go down to 200 .I am 5’11” tall
Do you have a diet plan that I can use?
looking forward to hearing from you
Dr. Jay’s Reply:
Thanks for your comment.
Your story highlights an issue that is common to most diets including low-carb – how to maintain long term compliance?
It is something my colleagues and I have been discussing. I think it depends on the fat portion of your diet. While you are losing weight on a low-carb diet, your appetite drops because you are burning off your stored fat. At some point your weight loss will plateau and you will need to replace those internally stored calories with additional calories from the food you are eating. Most people have been counseled to avoid fat and if you are trying to avoid carbs, too, that leaves protein. The problem is that if you increase protein beyond a certain point it will make you feel ill. If you start to increase your carb intake you run the risk of getting on that slippery slope of cravings and eventual weight regain.
So, that leaves fat. It does make some sense that since you are replacing an internal energy source in the form of fat, you might consider adding fat to your diet. The question then is what kind of fat. In the literature so far it appears that additional saturated fat is not a problem as long as the carbs are kept low. Perhaps the best type of fats, though, are the mono-unsaturates like olive oil. A big proportion of human fat is mono-unsaturated.
As to offering you specific guidance on your own diet plans, I am not comfortable doing that here as it comes too close to practicing medicine over the net. Until I and my colleagues get around to writing a book of our own, I think the best low-carb diet resource out there is still an Atkins book.
I hope this helps.
thanks
Hi Dr. Wortman,
A reader notified me of your site via my blog, and I’m glad she did. I think you’re doing vital work, and I want to congratulate you on persevering and getting your study going!
I’m a low-carber myself, and have a particular interest in traditional diets, especially of our native population here in Canada. I’m fascinated by Stefansson’s experiences working and living with traditional Inuit in the early 1900’s (reading “My Life With The Eskimo now) and his subsequent Bellvue study (the year-long, all meat diet he undertook with his colleague).
As a writer and independent filmmaker, I hope to undertake a study of my own, albeit informal! The answer to so many of our current health “crises” seems so simple, yet meets with such vehement opposition that I just can’t wrap my head around it. People like you (and Taubes, Dr. Vernon, etc) help get the word out to the public that there are easier, natural ways to health that require little more than altering the composition of our diets. My goal is to do the same, however I can.
I’ll be reading your site with interest, and am looking forward to the CBC doc tomorrow night! Thanks for all your hard work.
Tracy
Dr. Jay’s Reply:
My good friend Dr. Phinney was the first one to tell me about Stefansson. I have read accounts of his work with the Inuit and the Bellevue experiment. It is a fascinating story. Phinney figured out very early on that the conventional wisdom that low-carb led to poor exercise tolerance was wrong by studying the diaries of arctic explorers. He then did his PhD at MIT by putting bicycle racers in a metabolic ward and feeding them a diet of protein and fat modeled on the Inuit diet. He demonstrated that exercise tolerance did drop but that if you stuck with the diet, it returned to baseline levels. He coined the term “keto-adaptation” to explain the process of adjusting to a low-carb diet. Phinney and I compare notes on our personal feats of endurance that we are convinced are possible only because we burn fat and ketones in our muscles rather than glucose. He rides his bike great distances on the California roads while I ski like a maniac, non-stop down Peak-to-Creek at Whistler.
Glad to see you reference Gary Taubes new book, Good Calories, Bad Calories — Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. I found the book provided an excellent overview of the history of nutritional “science” — amazing what we accept as self-evident. For those who like a good “who-dunnit” with a little conspiracy theory tossed in, this is as close to a page-turner as we’re likely to see on the subject of diet and nutrition.
As a writer for Science magazine, Taubes has meticulously documented the research in his book, with over 110 pages of notes and references in the bibliography. It will be interesting to see which academic naysayers will dump on your program in the name of science, given that you too threaten the conventional wisdom and established “experts” on the subject. I hope you are ready to fight back and issue the challenge: “Prove your own damn science”.
Best of luck.
Dr. Jay’s Reply:
Good to hear you are a Taubes fan. I highly recommend his book and I have also been telling people it is a “whodunnit”. Great minds …
Dr. Wortman,
I agree with the low standard of nutritional information from Universities. We expect useful, UNBIASED information from our learning institutes.
While attending the University of Manitoba, I was amazed at the nutritional ignorance or rather the fear of literally “going against the Grain” of the Canada Food Guide. I mean how can anyone expect First Nations people to go from wild plants and high protein and fat to high starches and sugars within less than half of a century. (Middle Eastern countries spent thousands of years adapting to heavy grain diets.)
Also, I have read research correlating alcoholism with low levels of protein and fish oils, that might also contribute to First Nations problems of alcoholism and drug abuse.
When some old, tough-as-nails labourer insists that part of his health is from wild berries and say, apple cider vinegar, I tend to pay attention. On the other side of the coin, when a Phd in Nutrition, who has a mouth full of bad teeth and has to struggle up 3 flights of stairs and claims, “There is no junk food.”, I question that authority. When an RD insists that they must serve ice-cream, processed cereals and pastries at a camp for diabetic children, I have to ask where did they get their funding.
Even a cardiologist, whom I was sent to visit explained that he learned “nothing about nutrition from medical school” and had to learn nutrition on his own.
Food for thought.
Keep up the good work.
–Doug Setter
Dr. Jay’s Reply:
Thanks for you comment.
There is some interesting research out there that may tie carbohydrate consumption to addiction in some people. It appears that the same parts of the brain are involved. There was a recent study that showed that overweight women self-medicated with sugar to elevate their mood. I know that when I first started restricting carbs I experienced something akin to drug withdrawal. It took some will power to get through it but the cravings do die down. I think cold turkey is the best approach for that (no pun intended).
Congratulations on the success of your study and bringing hope to Aboriginals. I hope a similar study can be launched in the general population in Canada using meat without the fat carved off, all the eggs you want, vegetables and fruit and the elimination of sugar and junk food. Doctors and dieticians, in general, shun the words “red meat and saturated fat”. They would not approve this diet. You being a doctor, can perhaps change this perception by what you have shown. This change in diet will save millions in health care. Best of luck in your continuing success.
Dr. Jay’s Reply:
Thank you for your supportive comment.
Dr. Wortman,
I look forward to seeing the documentary. Thank you for allowing us to follow your important research in the area of traditional diets and the low carb approach to disease control/management!
My question relates to the area of liver disease. Some of the statistics show that as much as 100% of the population who are obese and who are diabetic also have fatty liver disease. Can you comment on the the percentage of prevalence in the Alert Bay population?
There are very few published studies that detail the long term effects of diet on liver disease at this point in time. Did you look at this area of your patients’ health and if so, did it change during the duration of the diet?
I am hoping to hear that low carb diets not only help diabetic patients to experience remission of the disease but also help to reverse fatty liver congestion. Any information you can give me in this area would be appreciated.
I currently follow a low carb diet.
Dr. Jay’s Reply:
Thanks for your query.
Non-alcoholic fatty liver disease (NAFLD) and Nonalcoholic steatohepatitis (NASH) are the liver manifestations associated with metabolic syndrome (which some people call “pre-diabetesâ€). In our study, if people had high liver enzymes indicating a compromised liver we excluded them.
In other studies which looked specifically at NAFLD and low-carb diet (there are two of them, I believe) there was an improvement in liver function associated with carb restriction. One of the studies, in which my colleague Eric Westman was a co-author, actual liver biopsies were done to document the improvements in liver health as a result of the low-carb diet.
I am sorry I don’t have the references handy as I am traveling at the moment but if you did a pubmed search you should be able to find them.
Hello, I have a couple of questions about your diet.
I am currently trying to follow the “Zone” diet. It proscribes a 40-30-30 carbohydrate-protein-fat caloric ratio. I am getting my carbohydrates primarily from fruits and vegetables, and my fats from olive oil, nuts, and peanuts. I don’t eat dairy.
Anyway, the questions. I’m wondering about your personal opinion of these–if it is backed up by literature that’s great, but I understand that in some cases there might not be enough studies to provide an “official” answer one way or the other.
1) What are your thoughts on the caloric breakdown of the Zone diet? 40% of intake from carbs is lower than a normal American diet, but it sounds like it’s much higher than that of the diets of the people in your study.
2) Were people allowed to eat fruits? Do you eat fruits? Do you feel fruits are an acceptable source of carbohydrates? Do you have a preference of berries versus oranges, or some fruits over others?
3) What about non-liquid milk dairy products, such as cheese and cottage cheese? Do you allow yourself intake of these items?
4) Is it correct to estimate that caloric intake on this diet (and your diet) comes primarily from fats? Do you feel, personally, that it is better to get fat intake from nuts and nut butters, olive oil and coconut oil, fatty meats, or is fat from butter and dairy products OK in your book?
Dr. Jay’s reply:
Good questions. Here are my thoughts:
1) From the published literature it appears that benefits accrue as carb content drops. In the OMNI-Heart study, they replaced a little bit of carb with fat or protein and found a benefit with both, a bit more with protein vs fat. I also think that if you shift the glycemic value downward you will get a benefit. This is what Walter Willett’s idea about glycemic load addresses. Glycemic load is a multiple of glycemic index and amount of carb so to get your GL down you can shift to lower carbs with lower glycemic value. I think this is similar to what you are doing with the Zone.
2) In our study diet we didn’t include fruits. We advised people that if they were going to start eating fruits they should stick to berries, partly because they were a traditional food and partly because berries tend to be lower in natural sugar content than other fruits. When I indulge in fruit, I stick to berries. I think the darker ones are the best because they tend to be low in sugar and full of other good things like resveratrol.
3) We allowed cheese in the study because there is little lactose in most cheeses (the hard cheeses are the best) and they are a good source of calcium, fat and protein. I avoid cottage cheese as it has a little more carb.
4) Once you have stopped losing weight on a low-carb diet, you need to replace your internal fat calories by adding fat to your diet. The oil in nuts is okay but it comes with some carb so you have to be careful not to overindulge. Oils that are high in omega-6 should be avoided which means most of them except olive oil and canola oil. I eat fatty meats and dairy fats like cream, cheese and butter because the literature I have seen suggests that these are not detrimental if you keep the carbs low. Having said that, I cannot say whether or not the level of carb you are eating is low enough. If you are eating these types of saturated fats you might want to check your cholesterol to make sure it is okay.
Hi Dr Jay. My story is similar to yours. I’m a white male, age 57, 6’1″ tall. By age 52 my weight had climbed to 215 lbs, waist measured 40″, fasting blood sugar was 145 or higher, and blood pressure had climbed to 155/95. My doctor wanted me on Metformin for diabetes, Vytorin for Cholestorol, and a Beta Blocker for blood pressure.
I declined all the medications and decided to try a dietary approach. I got Atkin’s book and carbs to try to immediately reduce blood sugar. My results, like yours, found impressive gains in all the target areas. Within a year my weight had dropped and stabilized to 160 lbs, my waist is now 32″, my blood sugar is rock stable at around 100 at any time it is measured, and my last blood pressure check was 98/63 – all without medication.
I was inspired by Steffansson’s story about 3 years ago and decided to give a little more radical all meat diet a try. For over 2 1/2 years now I’ve eaten nothing but uncooked or lightly cooked (rare) grass-fed beef, pork, or bision. It is amazing but I feel better than I’ve ever felt before and show no signs of any deficiencies. When I started, I was told that meat would not supply critical vitamines like “C” and was to low in calcium. None of the predicted deficiencies has materalized.
I also find that I’m rarely sick any more, even though those around me often suffer from colds and flu symptoms. I also suffered from weekly debilitating migraine headaches since I was a teenager, and since converting to an all meat diet these have gone away completely.
I’ll be following your reasearch with great interest,
Lex
Dr. Jay’s Reply:
Thanks for sharing your story.
You know, if you told me about your all-meat diet six years ago, I would have said you were crazy. Now that I have been exposed to the scientific literature in this area, including the study where Stefansson and his colleague ate nothing but meat for a year, I am not surprised by your account of improved health from this way of eating. I’m not recommending this to anyone but I no longer think it is necessarily an unhealthy way to eat. One of the things that led to the challenge to Stefansson was the belief that we need to have significant sources of vitamins that are available mainly from fruits and vegetables. It turned out that by completely eliminating carbs, Stefansson’s need for these vitamins dropped and he remained healthy. There are similar stories of European arctic explorers dying of scurvy while their Inuit companions remained healthy. It appears to have been because the Europeans were eating carbs while the Inuit were not.
Your diet would be considered a little extreme for most people but good for you for pushing the envelop and good luck with it.
Dr. Jay
I am Type 2 controlled on insulin daily. I am very active, running 40 -50 km per week. I weigh 165 lbs I am 6 ft.
I was diagnosed 4 yrs ago. My question to you would be On this diet… ” How do I achieve energy levels adequate for my lifestyle without having serious lows”. I do not need to loose weight, I need to have better A1C’s and lower blood cholesterol levels which are not high at all but need to be better than normal.
I do not take lipitor anymore, it makes me feel bad and I am better off since discontinuing 6 weeks ago.
I appreciate your taking the time to write back.
Yours truly,
Yves
Dr. Jay’s Reply:
Thanks for your query, Yves. I cannot give you medical advice on the management of your diabetes. However, from what you have told me, ie that you are fairly recently diagnosed, not overweight and are exercising a lot, I am a little surprised that you require insulin. The more insulin you take the higher the risk of hypoglycemic episodes so it is a good idea to try to reduce the need for insulin. Reducing carbs does this. Stamina should not be affected by reducing carbs after a period of initial adaptation (see other post on this). I would recommend Dr. Richard K Bernstein’s website (see links) for more information on how to manage diabetes using a very low carb diet approach.
Congrats on study and this site. I’m a type 2 diabetic looking for alternatives to deal with this condition, so your ideas are very interesting. I need to try something, as I’m drifting up in weight because I’m just so weary of the struggle, I have little willpower, and yet I want to control or reduce my weight and sugars. I live to eat and enjoy all foods, love those carbs, all of them. Of course, I feel hungry all the time. I know drugs are not the answer. In a cautious manner, I’m going to adapt my diet to greatly reduce the carbs I love so much. Thanks for your good work. It’s hard to get the message out to we t2ds, as we are very shy and don’t talk to each other or about our diabetes. We have learned to feel shame for our “lifestyle” disease.
Dr. Jay’s Reply:
I would recommend the book, “Atkins Diabetes Revolution”. It was co-authored by Dr. Mary Vernon and Jacqueline Eberstein. It is an excellent guide on how to use low-carb dieting in the management of type 2 diabetes. I also recommend the links I have posted here.
It is a lifestyle disease but nothing to be ashamed of. We tend to buy into the current model that being overweight is the result of “gluttony and sloth” when, in fact, it is more likely due to a disturbance of our metabolism caused by excess consumption of carbohydrates. Have a look at Gary Taubes’ lecture link to learn more about this.
You have mentioned that exercise tolerance temporarily dropped in one study with the bicycle racers and that others went through temporary sugar withdrawals/cravings. I’m wondering if there is a range of time we can expect these side affects to last? Three days, two weeks, a month or longer?
Is it possible that this diet can eleviate arthritic aches? (I wake up stiff in the morning and have trouble opening faucets and door knobs,etc but within 1/2 hour I’m okay unless I sit still for a period of time.)
Also, are tomatoes considered an acceptable vegetable or do you have them in the fruit list? I just finished looking in my fridge and pantry and now I can certainly see why I feel the way I do!
Dr. Jay’s Reply:
I believe Phinney’s study was 2 weeks duration. It appears that keto-adaptation occurs within that time frame, some people would be faster in adjusting than others. Earlier experiments in this area were terminated before people had time to adapt, hence the belief that carbs were necessary for stamina.
For me the cravings were intense for a couple of weeks and began tapering off over the following months. I think if you can get past the intense early period it quickly becomes more manageable. One of my tricks was to eat a little treat every evening before bedtime. It started with diet Jello with a little cream (how pathetic is that!) and then I developed my own low-carb ice cream recipe and that was my reward for fighting off the cravings every day.
I have heard lots of anecdotal reports of improvements in arthritic symptoms when carbs are restricted. I have not seen a study on this but, based on all the stories I hear, I think one is warranted.
I love tomatoes but they are more of a fruit than a vegetable so I don’t over-indulge. I also make a great tomato sauce that can be used in small quantities. I usually eat a small tomato with my eggs in the morning.
Dear Dr. Wortman
I would like to commend you for taking the time to raise First Nation nutrition awareness.
I am First Nation, 37 years old, and I was once 245 lbs. I am now down to 165 lbs. I know exactly what it feels like to feel “heavy” and “sick”, and being told by my doctor that I will need to take high blood pressure medication forever, and I have a high chance of being diabetic, and so on. Being First Nation, I simply accepted it all as “fact” and that that was how my cards were dealt.
I decided “hog wash”, and wanted to change but where would I start? I went on a journey of self-discovery 5 years ago.
Change did not happen overnight. I became aware of calories, fats, energy (joules), fitness, exercise, natural supplements and better living. I cut back nearly completely on junk foods, fast foods, heavy fat foods, learned about what is healthy, what isn’t, ate more balanced diets, and I began doing lots of cardio and working out. I refused to do another desk job and got a job that keeps me active physically and mentally. I completely quit coffee, alcohol, dairy products, and chose to eat foods that were “living” and not “dead” being laced with chemicals and preservatives.
I have to say that I have done very well. I have never been in better physical shape, ever. I feel stronger, more energetic and I’m told that I look great. I can’t help but feel “sorry” for everyone when I go home for visits and seeing how obese everyone is, how kids I grew up with have died because of diabetes and other fat related illnesses.
There was one extra surprise benefit. My mental/emotional state has changed dramatically. I no longer get long bouts of depression, anxiety and panic attacks any more.
I’ve recently read about a study that links the cumulative effects of chemicals in our bodies that can cause mental/emotional imbalances. The chemicals can include alcohol, caffeine, salt, sugar, preservatives, hormones, antibiotics, and many others that are added to foods. Such additives can cause chemical imbalances that could lead to depression, drug/alcohol addiction, anxiety, irrational thoughts such as suicide and other mental problems. This makes sense being that our ancestors never came in to contact with such dietary additives making us even more prone/susceptible to mental problems today.
I believe that our new “diet” is what is possibly the main source for most of the ills of First Nations people, but no one has really done any research (to my knowledge) to link diet to the emotional/mental well-being of First Nations. My own return to a more “traditional” diet and active lifestyle has personally helped me, and I could see it helping others.
It’s about time this happens.
Les
Dr. Jay’s Reply:
Thanks for sharing your story and congratulations on your achievements.
I agree that there is a big relationship between mental health and diet. If you watch “My Big Fat Diet”, you will see that this is one of the things that people comment on in Alert Bay, that there was a noticeable improvement in mood in that community. I think it is an area that deserves more research.
Breakfast is my favourite meal of the day-, full of carbohydrates-cereal, toast, pancakes, porridge etc. I am just wondering what you eat for breakfast? You can only eat so many eggs.
Any good breakfast ideas?
Laura
Dr. Jay’s Reply:
Thanks for your query.
I used to eat a big pile of waffles with fruit and yoghurt drizzled with maple syrup. Delicious, but in hindsight, that’s probably what pushed me over the edge into full-blown diabetes.
Now I eat a lot of eggs (the ones with omega-3). I have them over-easy with lots of salt and pepper and a dash of cayenne or in omelets and frittatas with cheese and a little onion. I usually include a small tomato on the side smothered in Hellman’s mayo. If I’m skiing I’ll also have a little piece of steak otherwise it’s usually bacon, the thick farmer’s type. All this chased with a mug of hot breakfast tea. And you know what – I don’t miss the waffles one bit. Ditto the toast and hash browns.
I just heard about your research on CBC radio this afternoon and look forward to watching the documentary tonight.
Having been a healthy, very active vegetarian for 17 years, I am proud to say that complex carbohydrates are my best friends. I eat very little simple sugars and carbs and very little dairy (preferring goat milk products to cow), I consume a lot of beans and legumes, and I prefer my fruits and veggies whole and raw.
I recognize that the research you are conducting is specifically dealing with a population that traditionally ate a diet containing few to none of the carbohydrates of the Canadian diet. However, I get a bit nervous when research results like yours, obtained from a specific population, is misunderstood and/or misused by the general population as the ultimate answer and quick fix to their diet and health woes. Although the low carb diet may work for some, it may not work for everyone because we are all different because of our genetics, our lifestyle, our willingness to change more than just our diet, etc.
So, my question is: do you see a role for complex carbs, such as brown rice, beans and legumes, or ancient grains, in the diets of both low-carb aboriginal and non-aboriginal people in the long term? Is it something that you think could be successfully incorporated into the diet of the people of Alert Bay eventually?
Thank you very much!
Dr. Jay’s Reply:
Thank you for you comments.
I think the quantity of carbohydrate one can tolerate is probably genetically determined at both the individual and populations levels. Would a low-carb diet work for non-native populations? I once asked my colleague, Dr. Steve Phinney, that question. He said that he had treated over 3000 patients in his clinic at UCDavis and didn’t find any ethnic variation in response to a low-carb diet.
As to unrefined complex carbs, yes they are better than the refined versions. If one ate only these types of carbs (plus protein and fat, of course) from an early age, I would venture that the likelihood of developing obesity and diabetes would be greatly reduced. And, if you did develop these conditions, reverting to unrefined complex carbs would, I think, improve things. However, the research on low-carb diets suggest to me that the most effective therapy once problems develop would actually be carb restriction. For the people in the study, I expect some of them will start introducing complex carbs. If they do, my advice will be to watch what happens and if any of the problems start to return, to back off again. In my own case, the lower I go with the carb content of my diet, the better I feel.
I am so very interested and wanting to do the diet. Where do I get oolichan grease? I need all the details for this diet so I can begin asap. Can you forward me all I need to know,what I should buy,etc? Can you send me it in an email please and thank you.
Dr. Jay’s Reply:
Unfortunately, the protocol for the study diet is not generally available since it was designed to be used in a specific medically supervised research setting. I am often asked to provide a diet plan to people and, since I and my colleagues have not written a book (yet), I usually recommend the Atkins diet. The first phase of Atkins, the induction phase, resembles the diet we used in our study. My friend, Jacqueline Eberstein, who was Dr. Atkins nurse for 30 years tells me that he kept some people on induction indefinitely. If you think of the Inuit, they, too, ate virtually no carbs over their whole lifetimes so this is not unheard of.
I think oolichan grease is a remarkably healthy fat and would be good for people other than the coastal First Nations who currently eat it. Unfortunately, it is not commercially available. The fishery itself is dwindling and the amount of grease produced probably doesn’t entirely meet the demands of First Nations people who still use it. In the absence of this wonderful food, you might consider adding things like butter, olive oil and canola oil to your diet instead. An omega-3 supplement is also a good thing if you aren’t eating a lot of cold water fish.
If you are taking any medications to control blood sugar or blood pressure you need to consult your doctor before starting carbohydrate restriction. Also, if you have any serious illness like unstable heart disease, cancer or liver or kidney failure, you should see your doctor before making a big dietary change.
Dr. Wortman,
I was very much interested in hearing about your research on CBC 1’s “The Current.” My dietary choices are very limited due to celiac and multiple food allergies so it is good to hear that some of my favourite indulgences–whole milk products and butter–might actually be better for me than the low fat alternatives which I’ve all but abandoned.
I do have a few questions–
I was wondering whether it is the type of fat that you are recommending that is key here. Wild salmon is high in omega 3s and vitamin D and I imagine oolichon grease would be as well. I’ve read that wild game and grass fed beef contains more omega 3s than does typical supermarket meat (although I’m not certain how significant the differences are). My question, then, is would eating a diet in omega 6 fatty acids have the same health benefits as the diet you’ve studied?
It also occurred to me that the fat to carbohydrate ratio was not the only major change in the diet—-the traditional Inuit diet is high in vitamin D (which is all the more important in a northern climate). The role of vitamin D in regulating immune function isn’t well understood, but it seems to me that it is a ‘hot topic’ in medicine right now. Some autoimmune conditions like allergies and multiple sclerosis are much more prevalent in northern climes (possibly because of a lack of sunshine in winter months.) It could be the case that diabetes is also more prevalent in Canada than, say, in southern California?
Lisa
Dr. Jay’s Reply:
Omega-3 and -6 are polyunsaturated fatty acids (PUFA) and are also known as essential fatty acids (EFA) since we must get them from our diet. There is a lot of interest in omega-3 because of its association with things like reduced risk of cardiovascular disease. There is some interesting literature on how omega-3 supplements are therapeutic for a range of mental health problems. Omega-3 is a big component of brain tissue, hence the idea that fish is brain food. While omega-6 is also an EFA, it turns out that the ratio of 3 to 6 is important and that if 6 is too high relative to 3, this can lead to health problems. They both compete for same enzyme pathways and if there is too much 6, it overwhelms 3. Omega-6 is the precursor to some powerful immune system molecules like the leukotrienes. What this means that too much omega-6 can be pro-inflammatory. Rather than a balance of 3 vs 6 in the range of 1:1 or 1:2, most people are getting excess 6 in the range of 1:20 or 1:30. The source of the excess omega-6 is the commodity vegetable oils like soyabean oil, corn oil, etc. I advise people to use only olive oil or canola oil. You also have to watch the labels on prepared foods as they tend to use the cheap commodity oils, as well.
In the case of oolichan grease, we found that it was mostly monounsaturated like olive oil and that it actually had a very low omega-3 content. In the supermarket, meat from grass fed animals will be higher in omega-3 and those that are corn fed will be higher in omega-6.
I think an omega-3 supplement is a good idea if you aren’t eating a lot of cold water fish. In term of fats as an energy source, the ones I eat are olive oil, canola oil, dairy fats and animal and marine fats.
Would this diet be suitable for someone with VERY high total cholesterol, low triglycerides, no diabetes. Yes, aboriginal. Yes, omnivore.
Dr. Jay’s Reply:
The typical cholesterol pattern found in metabolic syndrome (some people call this pre-diabetes) and type 2 diabetes is characterized by high LDL (the bad cholesterol), low HDL (the good cholesterol) and high triglycerides. Within the LDL, there would be more of the small, dense athrogenic subfractions. When someone with this pattern goes on a very low carb diet what usually happens is that there HDL goes up, their triglycerides go down and their LDL may rise a little, stay the same or go down a little. The sub-fractions of the LDL would shift away from the athrogenic type to a more healthy type. The ratio of total cholesterol to HDL is usually greatly improved due to the rise in HDL. The drop in triglycerides is a fairly reliable indicator of how much carb-restriction the person is actually doing. Dr. Vernon has case reports of patients with very high triglycerides getting them back into the normal range through carb restriction.
In your case, I don’t know the answer to your question. If you already have low-triglycerides you are probably not over-eating a lot of bad carbs (correct me if I’m wrong). As to total cholesterol being high, it would depend on which component was causing this, LDL or HDL, what measures would be effective in managing that problem.
I do eat carbs, but only whole grain and unprocessed. Life long. I eat and cook the old way. But I am always told to eat little meat, no butter, no eggs, etc by physicians who are pop eyed at my TC.
Don’t know quite what would bring my cholesterol level down. Although I qualify as FH, I don’t have any xanthomas etc. And then there’s my high, really high, hdl.
Statins nearly killed me, while the chorus was “never heard of (whatever side effect I was experiencing). Stay on or you’ll get cardiovascular disease”.
I took myself off, but am still kind of worried about a TC of 14 or so.
Dr. Jay’s Reply:
I know of a couple of people with familial hypercholesterolemia who were able to achieve good control through very low-carb dieting. I think you would want to do it under medical supervision, though, and the problem you are likely to encounter is that most doctors don’t have training in how to manage carbohydrate restriction. My colleagues and I are working on that.
Congratulations on your work and please keep it up.
I have had diabetes for about 10 years and have been overweight for a good portion of my life. Most recently I have gone on a low carb, low fat, low sugar diet (commercial and Dr. supervised). The results are much like those experienced in the documentary “My Big Fat Diet”, an excellent documentary, by-the-way.
I am completely off my medication for diabetes. I am also all my hyper-tension medication except for 1/2 of a diuretic pill and I expect to come off that as well. I have lost 40 pounds in 2 months and approximately 6 inches around the apple.
I am noticing low energy and have been on a K-Lite supplement with a multiple vitamin. Some days I also experience anger/rage which concerns me but apparently is not uncommon. Do you have any information on that?
Otherwise I was veryencouraged with your research and would like to learn more and will watch your site.
Dr. Jay’s Reply:
Since your diet is medically supervised, I am reluctant to meddle. I am somewhat concerned, though, when I see low-carb and low-fat together. This suggests to me that you may be eating too much protein in order to get sufficient calories. When people eat too much protein, they don’t feel too well. I am tempted to think your feelings of rage might be related to this. You might also ask your doctor if he would recommend a magnesium supplement. In my experience, by the time someone had developed diabetes they probably have a magnesium deficiency, also. Since virtually all of our magnesium is intracellular, a blood test won’t detect it. Usually it makes itself known when you develop leg cramps at night. If your doctor checks your reflexes and finds them to be hyper, that would nail the diagnosis. The remedy is a slow release magnesium pill, like SlowMag. For whatever reason it is hard to find in Canada. I get mine at Costco in the US. The have a good knock-off called Mag64.
The program was EXCELLENT! I hope this show becomes accessible through the Internet so people from other countries can see it. I know there any many Americans, Brits and Australians who would love to see the documentary.
Congratulations, Dr. Wortman for having big enough kahunas to take on this project. Hopefully the ball will continue to keep rolling and we can start heading in a direction as a nation to overcome the epidemic of obesity that has resulting from the Canada food guide, the Canadian Diabetes Association and the Canadian Heart Association recommendations.
Oh yeah, I am living proof that this stuff works. I have lost 93 lbs as well as all of my meds for hypertension on a low carb, high fat diet. I currently eat a diet where I get 70 – 80% of my calories from fat. I feel great, I look great and I am healthy. This is not a diet, it has become a lifestyle choice.
Pass the butter and cream, I need to make a sauce for my fatty steak!
Dr. Jay’s Reply:
I am glad you enjoyed the documentary. Thanks for adding your interesting experiences and observations to the debate.
Hi, Glad to see someone is finally paying attention. About 4 years ago my blood sugar was outof control. Had been taking metformin for several years and it worked for a while but then my level went up and doctor doubled the dose. No effect. I went to book store and bought Dr. Atkins book on the diabetic revolution. Started the diet and within a week my level was normal and I stopped medication. I stilll watch my diet and get an a1c test every 3 months and it has always been in the 6 range, but now if I want I can eat anyting and it has little effect on my blood sugar level. My doctor is pleased with my results but has never asked what I’m doing. Keep up the good work. I know there is a lot of resistance to this method. I believe it is mainly from the drug company funded organizations. Oddly enough on one of the blood minitoring device (test strips) web site they say that the Atkins diet will work but that our doctors won’t agree with it. They just love giving us all those pills.
Dr. Jay’s Reply:
Thanks for your comments. I am glad my friends’, Dr. Vernon and Jacqueline Eberstein, book, Atkins Diabetes Revolution, was helpful to you.
I watched the program tonight and as a diabetic I am very interested in this approach.
I have tried Weight Watchers, and just trying to watch my calories, etc., but nothing has been sustainable. In order to maintain my weight loss, I had to exercise strenuously one hour every day, and restrict my calories so much that I was feeling deprived. When my weight was down, my sugar was great, but my weight has been creeping back up and so has my sugar.
Are there any fruits and vegetables that are not allowed on this diet? What about cheese and nuts?
I have not read any Atkins information yet – will the Atkins plan reflect the diet that was followed by those in Alert Bay?
Thanks,
April
Dr. Jay’s Reply:
See my response to Tachour’s post above on the Atkins diet. You should have a look at “Atkins Diabetes Revolution” by Vernon and Eberstein.
In the study diet, we stayed away from root vegetables as they tend to be higher in starch and sugar content while we encouraged the cruciferous vegetables like broccoli and cauliflower and all the salad vegetables, of course. Nuts are good food but you have to eat them only sparingly if you are avoiding carbs. I generally recommend zero nuts for awhile at the beginning.
Greetings from Calgary!
I loved the show and I think you did an amazing job at bringing this information to the table, so to speak!
Although, I hear everyone pushing the “Atkins” diet! I was hoping you would be willing to have a look at Suzanne Somers Eating plan as it is very comparable and had different medical documentation. I know it sounds funny that Suzanne Somers would have such a book, but she speaks the same way about the plan as you do and I quite enjoy the eating~ I just can’t seem to find anyone with more backround or a professional opinion about her stuff.
Respectfully,
Chuck
Dr. Jay’s Reply:
I am not that familiar with her diet. One of the reasons why a low-carb diet is successful is that the reduction in carbs leads to a significant drop in the insulin your pancreas produces. One of the functions of insulin is to store fat and to keep it stored so your cells can burn off the glucose resulting from the digestion of all those carbs. Too much glucose is not good so your body sidelines fat burning while it deals with the glucose first. Dropping your carb intake reduces the supply of glucose and lowers insulin. If you can get your insulin below the threshold where it tends to keep fat stored in your fat tissue, then the fat is released and can be burned. When this happens you have an increase in energy and you will experience a decreased appetite. In a nutshell, that is the secret of the success of low-carb (for a much more complete explanation, read Gary Taubes’ excellent book, “Good calories, Bad calories”). If Somers’ diet gets the initial carb content low enough, it would work in a similar way. However, from what I gather, it would seem that there are still significant amounts of carb allowed as fruit.
I think the bottom line with any diet is whether it works for you and whether you can stick with it.
Dr Jay…. Just finished watching the documentary “My Big Fat Diet”. I must say it has perked my interest… I am a mother of 4 who was told I had diabetes when I was pregnant with my last child…I took medication till just lately and have also developed high blood pressure, I have been taking diet pills on and off for years…I take merdia as it has shown the best results but I am finding it to difficult to pay for them much longer… I am extremmly overweight…I stand 5 6′ and weigh about 370lbs…actually I am not sure on the weight as I cant find a scale that goes over 300 lbs but at last weigh in at a local center that uses a special commerical scale I was about 350… I have also had my stomach stapled (gastroplasty) for the weight loss and it has not happened the way I wanted it….
I was wondering about meal planning? and a sample diet plan? I would like to try it out and see what the results would be….please let me know…thanks Darlene
Dr. Jay’s Reply:
As you may have seen from other replies, I generally recommend the Atkins books. I find their meal plans and recipes tend to be the best guide to low-carb eating currently available. We didn’t offer specific meal plans in our study; we just provided a list of the foods that could be eaten. In the documentary you would have seen how people gathered for meals and how they shared recipes and techniques. This created a supportive environment that helped people make the adjustment to a new way of eating.
I am concerned that you have already had gastric bypass and still cannot get your weight down. A bariatric surgeon friend tells me that he has seen this occur when his patients drink sugar-laden beverages. You might think about what you are drinking in terms of carbohydrate content. This would include anything from pop to smoothies to fruit juice, even milk, as it contains lactose. All these drinks contain significant calories in the form of carbohydrate.
Dear Doctor:
I happened to see your comment regarding your choice of Canola oil and was somewhat surprised as Canola is the least of healthy fats. I just wondered if you were familiar with Sally Fallon and Mary Enig PhD and the Weston A Price Foundation? They have a huge body of scientific facts on good fats at http://www.westonaprice.org and thought to let you know of them as I believe it would add another great dimension to your work.
Respectfully,
Maria Atwood
Dr. Jay’s Reply:
My recommendation of canola is based on the fatty acid composition of this oil and the fact that it is fairly low in omega-6 (see posts above re the problems of too much omega-6). I have heard objections to canola suggesting that it is suspect because of possible GMO content or because of the refining process. If you have these concerns, I would suggest falling back on olive oil and butter.
I am familiar with Weston Price and find his work fascinating.
I find the whole concept quite interesting. I am a heavy woman – currently on a campaign here in Nanaimo to lose 100 pounds in 12 months and raising money for a school and Haven Society by doing so. I am keeping track of my progress and failures at http://singleparentbootcamp.blogspot.com. As someone who quite heavy I have, like most other people, tried numerous times to lose weight. What I have discovered is that, pretty much, anyone can lose weight doing any kind of diet. Physically weight loss is possible. Where it becomes difficult is with the mental game – with continuing to eat one’s chosen method. It becomes challenging due to either boredom, self-sabotage, and particularly the feeling that one is “denying” one’s self something. Certainly this time around I am choosing to view weightloss much as I viewed quitting drinking – a gift that I am giving to myself. “I am not punishing myself by eating this way, I am celebrating the radiant gloriousness that is me.” Hey, so far it’s working!
In a diet that is restrictive to certain food groups, as low-carb (or low-fat) eating certainly is, I wonder about the long term possibilities of success. Is this something that can be sustained by the majority of people for a substantial period of time? And sustained in a healthy manner? I have done low-carb dieting and had fabulous success with it – it’s, like, magic!, but then failed to maintain it for more than a few months.
I find the public documentation of this effort in Alert Bay quite compelling and am delighted that both you and the residents there were willing to both undertake this and share the results with us.
Kyla
Dr. Jay’s Reply:
Thanks for your comments. What you are doing is admirable, like the people in the documentary who shared their innermost thoughts and feelings and who were willing to make their struggle public to benefit others.
As to long-term compliance, I have been eating this way for over 5 years and, for me, there is simply no question about going back. I think with low carb, the ability to stick with it over the long haul has a lot to do with the fat component of your diet. Once your weight plateaus and you need to increase your calorie intake, if you increase protein or carb, rather than fat, you risk falling off the diet and regaining the weight. If you eat fat, and the right mix of fat, you should be able to go indefinitely. Olive oil, canola oil, dairy and animal and marine fats are good. You need to avoid the other oils that contain too much omega-6. An omega-3 supplement is a good idea if you aren’t eating a lot of cold water fish.
Good luck with your weight loss.
I’ve recently become aware of the possible positive effects of using duck fat in my cooking. We’ve always loved duck but have carefully rendered the meat completely and until recently have thrown away the fat. I’ve read that it might be a factor in the French Paradox (we call it the French Pair’ O’ Ducks). I wonder if maybe it might be a reasonable substitute for the oolichan grease?
Dr. Jay’s Reply,
Although I don’t know what kind of fatty acid mix you get in duck fat, I would not be surprised to find that it was a healthy fat. In my travels, I have been discovering that indigenous people around the world valued certain sources of fat. Here it was oolichan grease, up north they render the fat from moose and bear, in Labrador it was caribou fat, on the prairies is was buffalo fat to make pemican, among the Australian aborigines it was emu fat and among the Inuit it was whale fat. And these are just the ones where I have had a chance to personally observe or to hear first hand accounts. I think, in the modern setting where we tend to see everything through the lens of the current low-fat dogma, we overlook this important phenomenon or perhaps underestimate its significance. It appears to me that these ancient practices validate what I believe to be the secret to sustaining a low-carb diet over the long haul – getting the right fats and making them the central source of energy in your diet. Enjoy your duck grease!
I have done the Atkins diet many times without losing weight and I felt bad.. no energy… tired… very bad breath.. headaches… ketosticks would be the darkest purple.
I would eat lots of cheese, chicken wings, steaks and lots of mayo and some days add 3 cups of romaine lettuce… with diet 7up and water…
What am I doing wrong, and when you mention things like bacon… it has carbs (sugar..glucose…corn syrup..) in it …???
I would appreciate any and all comments/answers.
Dr. Jay’s Reply:
Thanks for your query. Some people report adverse effects when they significantly reduce carbs. One of the first things that comes to mind in your case is salt. When you stop eating carbs your kidneys will release sodium into your urine. If you are not getting adequate salt in your diet you will experience the symptoms of sodium depletion. One of my colleagues recommends drinking a cup of bouillon twice a day to replace electrolytes when on low-carb. Since we are taught that salt is bad for blood pressure (and it likely is if you are eating a lot of carbs) many people try to limit salt intake and if you continue this as you restrict carbs you can develop symptoms like the ones you describe. Constipation is another symptom related to salt depletion. The bad breath is because you are exhaling ketones. I recommend a little sugar-free gum to offset that slightly annoying problem. It should eventually get better as time passes. I wouldn’t hesitate to eat lots of salad veggies and to be liberal with the olive oil. Mayo is okay as long as it is made with olive or canola oil.
Dear Dr. Wortman,
I would love your thoughts on this: about six months ago, a relative of mine had a heart attack where one of his arteries was completely blocked. The doctors report showed that his trycleride levels were high, which i’ve learned is largely caused by an excess of carbs, something which his diet was indeed high in. Since his heart attack, she has been taking the following medications (one daily), on the request of her doctor:
Cardicor 2.5MG
Tritace 1.25MG
Plavix 75MG
Nu Seals Aspirin 75MG
Lipitor 40MG (Nightly)
The person in question exercises frequently and eats what he believes is a good diet, as do most people who have been mislead for years, namely a diet low in aminal foods and fat, but high in carbs and processed fats. I desperately want to help this person on the road to better health. I don’t want him to take any unnecessary medications. I think that a diet high in good fats and low in carbs would be ideal, and may even allow the person to forgo his medications, but since i am not a doctor, i am unsure as to advise him to change his diet and give up his meds. Do you have any thoughts on this, or do you know of anyone who has had a heart attack that successfully switched to a diet high in fat and low in carbs?
Lastly, do you yourself eat the fat of animal protein. For instance, do you eat the fat that tends to run along the edges of a steak?
Look forward to hearing from you,
Peter
Dr. Jay’s Reply:
Thanks for your query and I appreciate your desire to help your relative. As I am sure you can appreciate, I am very reluctant to get involved in the medical management of someone who is in the care of another physician nor can I practice medicine over the net. Whatever your relative decides to do should be done under the supervision of their doctor.
Having said that, I do think that cardiovascular disease is part of a disease continuum that includes obesity, metabolic syndrome and diabetes. And, it is evident that all these conditions improve with carbohydrate restriction. In the documentary, one of the subjects had had a heart attack prior to enrolling in the study and he did quite well. His cardiologist decided he needed bypass surgery while he was on the study diet but didn’t discourage him from continuing to restrict carbs. After the surgery he attributed his rapid recovery to his improved health on the diet and he is so happy with his results, including improved cholesterol, that he is committed to continuing eating this way indefinitely.
were there any vitamins such as b12 or any other vitamins given to the participants of this venture?
Dr. Jay’s Reply:
In the study, we provided a multi-vitamin to participants. As it turned out, I don’t think most people actually took them.
I hope the program will be on YouTube, or available for online viewing at CBC.ca. I don’t have tv.
About fat yes every culture ate fat. A couple not mentioned: schmalz (East European and Jewish, chicken fat), and last not least, the Scots with deep friend Mars bars. Kidding. But northern Scots and Brits did/do have heir fried bread, or bread spread with rendered fat or from the bacon grease pot at the back of the cabin’s cookstove.
But if fat is so good, why is it that Americans of African descent who have such high cholesterol would like to continue to eat that country southern diet that is swimming in fat?
Memories of bear grease on my chin long ago.
Dr. Jay’s Reply:
I don’t know what is planned in terms of making the documentary available beyond broadcast. When I find out, I will post a notice here. You should also bookmark Mary Bissell’s website (Mystique Films, on my links here) as she will be working on this.
The thing about dietary fat and cholesterol; it seems to hinge on how much carb you eat with the fat. In the example you mention, those African Americans who love to eat that southern country high fat diet are also including a lot of sugar and starch. The current research tells us that that is a bad combination and their obesity and diabetes rates are evidence of that. I think our Scottish friends, dipping their fried bread in the bacon grease might eventually have similar problems, maybe manifested more as cardiovascular disease. If they were to drop the carbs, I think their high fat diets would be a lot healthier without the need to reduce the fat or the saturated fat. This is the part that gets everyone annoyed at me, as the conventional wisdom is that you need to cut down on fat and saturated fats, especially.
Great program last night. Look forward to the book!
I have a question. My son is on a diet for Candida (Stomach yeast bloom), and he eats very close to your diet, except that he eats a lot brown rice. The point of the diet is to eliminate the sugars that the yeast live on, but he is concerned about having grains as a complementary protein. Is there an alternative other than Cauliflower (He gets upset stomach from it)?
Also, I suffer from Gout, and I find the the recent research from UBC on sugar’s role in bringing on gout attack very interesting. Over the past month, I have noticed the correlation. I suspect if I was to try your diet, that I could eat more beef and chicken and not experience the gout with the sugar eliminated.
Dr. Jay’s Reply:
I am not familiar with “stomach yeast bloom” but I do know that diabetics can be more susceptible to candida infection since they tend to have more glucose in their system, if not well controlled. It would follow, then, that a diet that lowers glucose levels would be beneficial in reducing the problem of candida, even in a non-diabetic. So, if your son’s candida problem is better on a low-carb diet, this would not surprise me. On the other hand, brown rice is still a high-carb food, although not as high glycemic as the more refined products. It may be that his eating pattern is more low GI than low-carb. I think there are definitely benefits in moving down the glycemic scale when you do eat carbs. As to something other than cauliflower, I eat all kinds of veggies, as long as they aren’t too high in starch or sugar content. A good resource to check on this is on the Atkins website. Go there and search “carb counter”. Look at the “net carb” values to determine how much digestible carb a particular food contains.
With respect to gout, as I understand it, when you initially reduce carbs the presence of ketones inhibits the excretion of uric acid in the kidney so there would be a theoretical risk of gout with low-carb. It appears, however, that the kidney adjusts to ketosis as you progress on your low-carb diet as ketone excretion diminishes while blood ketone levels remain elevated. As the kidney adjusts to stop excreting ketones, the inhibition of uric acid excretion would stop, as well. This is probably why I haven’t seen any reports of gout in the many published low-carb diet studies. Some critics point out that gout is associated with the consumption of purine containing foods, the same types of foods that you can eat while doing low-carb, basically animal and marine sources of protein. They overlook the fact that the diet doesn’t significantly increase the absolute amount of protein that is eaten, although it appears higher as a proportion, because carbs have been reduced. I suspect that sugar will turn out to have a bigger role in the etiology of gout than purines, but that is just my opinion for now.
I think you’ve talked me into trying it. But please; stop talking about maple syrup and waffles and French toast. :))
Dr. Jay’s Reply:
I know – I haven’t had maple syrup in over 5 years and my wife is from rural Quebec! She loves my low-carb maple walnut ice cream, though. I’ll post the recipe.
Dr. Jay
Thanks for your comments…Everyone around me is concerned about my health and weight. I have a few questions about the veggie thing…where do tomatoes fit into the whole scheme of things, cucumbers, cheeses…things like mustard, cranberry sauce…if made from fresh berries. I will look into the Atkins book that I have and how will this effect hyernias that I have developed in my stomach region….
Thanks Darlene
Dr. Jay’s Reply:
Tomatoes are okay but you should eat them in moderation. Cukes and other green veggies are okay, too. Cheeses are okay except for the processed cheeses. The hard cheeses are the best. Look on the labels of condiments to see what is the carb content. On a very low carb diet you would be aiming for less than 30 gm per day. You subtract the fibre from the total carbs to come up with the number you need to consider. Also look at the serving size. For instance, ketchup will list the amount of carb in 1 Tbsp (it is usually 5 or 6 gms). That is high given the small serving size. Most ketchup has added sugar, about 1 tsp of sugar for every tablespoon of ketchup. My son likes it so we get sugar-free ketchup from the US. My wife orders it on the web and it is delivered by courier. I digress. I am not sure what a low carb diet would do to your hernias. If you are experiencing gastric reflux (heartburn), however, there are lots of reports of this problem going away when carbs are restricted. There have been two recent studies that confirm this, as well. In Alert Bay, a number of people told me that they had stopped taking medication for heartburn after they got on the study diet.
hello
I got saw your documentary yesterday it was very interesting. I am 20 years, weigh 150 pounds – I have gained over 25 pounds in the last year from stress and snacking throughout the day without a eating a proper meal. I have tried to regulate my constant eating – try to bring fruits and vegetable but its not working for me. I would like to lose the 25 pounds and maintain it.
How long should this diet last and where can I find recipes that are reliable and stay true to low carb diet.
Your diet include: Vegetables, Meat, Eggs, Cream
No sugar, bread, rice, potatoes, milk, pasta
What about ? Oatmeal, Lentils, Tofu, Nuts, Dry fruits, Olive oil, ketchup and salad dressing.
I would like to start over the weekends so I can get used to it. please advise
Dr. Jay’s Reply:
The study diet was a low-carbohydrate diet modeled on the traditional diet of the Namgis people. For everyone else, I am currently recommending the Atkins diet and, particularly the “induction” phase of Atkins. This resembles the study diet. It should be easy to find an Atkins book as there were about 25 million of them sold over the years. This works best if you don’t think of it as a temporary measure just to lose weight but as a permanent change in the way you eat.
The whole concept is based on reducing foods that contain starch and sugar. Of the foods you mention: oatmeal, lentils, dry fruits (and fresh fruit, too) and ketchup would be a no-no. They all contain too much carbohydrate. Tofu and nuts are healthy foods but they do have some carbs and you would avoid them at the beginning. Olive oil is good and I recommend you use it to make your own salad dressings. I like to mix it with a little Hellmans mayo, salt and coarse pepper, a splash of white wine vinegar and a few drops of balsamic vinegar plus a pinch of Equal. I never get tired of this dressing and it is easy to whip up and very low in carbs. Eat lots of greens and cruciferous vegetables but avoid root veggies. Eat all the meat, chicken and seafood you want. Dairy fats like cheese, butter and cream are good. So are eggs. But, as I say, get an Atkins book to guide you. I also recommend the Atkins recipe books. You can also check out http://www.Atkins.com and the other links I have here. Most of the low-carb forums have recipes. Good luck.
Hi Dr. Jay: I am 38 years old and have been diagnosed with polycystic ovarian syndrome. It has gone untreated for quite a while as I have had these symptoms since I was a young teenager. Concurrently, I also have polycystic kidneys and hypothyroidism and I seem to be insulin resistant, something which seems to go hand-in-hand with PCOS. I am currently about 90 pounds overweight, something that the PCOS seems to facilitate, despite obsessive efforts (diet and exercise) to the contrary. I am very aware that losing weight is a key factor in controlling PCOS but that in turn makes it very difficult to do so. I have recently been hearing that a low-carb diet might finally be the answer but my personal physician is very against the idea. I am not yet on any form of medication such as antiandrogens or birth control pills, which have been discussed with my doctor but not yet started. Can you please comment on this situation?
I missed your original airing of the documentary but plan on watching it on Saturday when it airs again.
Dr. Jay’s Reply:
I hate to come between you and your doctor. I am sorry he/she does not approve of low-carb dieting but I don’t find fault with him/her. It is an emerging area in terms of acceptance by the mainstream. Most physicians struggle to keep up with the scientific literature over a broad range of illnesses. They rely a lot on Continuting Medical Education (CME) programs to update them. There are no regular CME programs that devote any time to teaching the science of low-carb nor do they provide guidelines that physicians can use to manage their patients this way. In fact, the major authoritative sources that physicians rely on for guidance are emphatically opposed to low-carb diets. Under these circumstances, I am amazed that any of my physician colleagues are supportive at all. That may change, though, with the inclusion of low-carb diets in the most recent guidelines published by the American Diabetes Association. This has opened the door to the development of a clinical practice guideline for physicians, something some of my colleagues have already started to work on. The thaw will be slow, however, so I am going to stick my neck out and give you some information you may want to take to your doctor.
There is a school of thought that PCOS is a gynecological manifestation of metabolic syndrome. PCOS usually goes hand in hand with the other signs of metabolic syndrome like obesity, high cholesterol, hypertension and, as you say, insulin resistance. Metabolic syndrome and type 2 diabetes are part of a disease continuum that usually begins with overweight and obesity and then progresses along as the other conditions develop. Most people won’t argue when I say that type 2 diabetes is an intolerance to carbohydrates, however, although I find the evidence compelling, not everyone agrees with the concept that metabolic syndrome might also be a manifestation of carbohydrate intolerance. The evidence that convinces me is the fact that every feature of metabolic syndrome heads towards normal when you eliminate carbs from the diet (Jeff Volek and Richard Feinman wrote a paper on this in Nutrition and Metabolism – see link). All that to say that your PCOS may be amenable to low-carb diet therapy. In my study, one of the women who had PCOS began to get better after a couple of months and some weight loss. My colleague Dr. Mary Vernon (see link) also has told me of cases in her practice where PCOS has responded to low-carb. I hope you can gain the support of you doctor to try this diet for your PCOS.
Should a person go on a traditional diet depending on their heritage? I have been on low carb diet for years and never did get down to a desirable weight. I am in my range but not close enough to the bottom or middle of my range to feel or look my best. I was 118 before and after children, then developed hypothyroid and have been 130-140 ever since. On a low carb-natural foods diet, I do feel fine and my meds were reduced but never eliminated. I never lost much weight besides the initial 4-5 lb loss, which eventually, I regained while still ON the diet.
I am Danish, English, French, and Choctaw. What would be my “traditional” diet?
Dr. Jay’s Reply:
Sorry to hear you haven’t been able to get down to your desired weight. Thyroid is one of the first things to consider when everything that should work, doesn’t. I would wonder in your case whether you are getting enough thyroid hormone replacement. The next thing I would look at is whether some carbs are sneaking into your diet. I don’t think you need to focus so much on what might be a traditional diet for your particular ethnic mix. My colleagues tell me that carbohydrate restriction is effective for weight loss across the racial and ethnic spectrum.
Dr. Jay, you are my new hero. I gather from your story that in deciding to tilt at this particular windmill, you didn’t realize what you were getting into. So bravo for having persevered! To have obtained Health Canada funding to support a low-carb diet is an accomplishment in itself, but in terms of the implications for thousands of Canadians, Aboriginal and non-Aboriginal, it takes my breath away.
I do have one question. I was saddened to see on the documentary that one of Art Dick’s daughters had to go off the diet because of gallstones and acid reflux. She is such a sweet young woman, but I’m afraid she needs your diet to save her life. Was that the decision made because the diet is “controversial� From what I’ve read on Dr. Eades’s Protein Power website, and the experience of a number of people who frequent the Low-Carber Forums (http://forum.lowcarber.org/), a low-carb diet can prevent or reverse both conditions.
I’ve returned to a low-carb diet after five years of stupidly ignoring my increasing weight and the inevitability that I would develop diabetes. Fortunately, I have also figured out that wheat makes my knees hurt, so a return to my bad old ways is less likely. I’m also older and wiser.
I was prompted to write to you when I read your comments in the online edition of The Globe and Mail challenging the conventional nutritional wisdom of Leslie Beck. Thank you for that.
Dietitcians need to be challenged at every turn (there’s a “fact” sheet on the Dietitians of Canada website that warns of heart disease, high blood pressure, osteoporosis, gout, kidney stones, and constipation if you follow a low carb diet).
Dr. Jay’s Reply:
Thanks for the supportive comments. Both of Art’s daughters are lovely people and I was disappointed we weren’t able to do more to help them. You are right about gastric reflux, by the way. Most people report a resolution of their heartburn when they do low-carb. In the study, several people said they were able to discontinue their GERD medications.
Leslie Beck and I don’t always see eye to eye, as you know. It is one of my guilty pleasures to post comments when the Globe and Mail runs her columns or other items that unquestioningly promote the status quo. Sometimes I meet really nice people that way, but I also take my lumps, too.
It sounds like you are plugged into some good websites and low-carb forums. And it also sounds like you are on the right track. Good luck with it all.
Hi,
I am a type 1 diabetic…I did try the induction phase of the Atkins diet for about 2 weeks (this was about a month ago) and I was amazed at how quickly I had to reduce my Insulin doses (basal insulin was reduced by 1/3 and I took almost no bolus insulin at all before meals. My blood sugar was pleasantly stable as well (for a change).
For some reason I stopped, but I’m going to start again today. (Chicken Ceasar Salad here I come). My question has more to do with the effect of reduced insulin. Am I correct in assuming that as I lower my total daily (or perhaps weekly) insulin dose, the amount of fat stored must also be reduced, or is the relationship more complex than that?
Also, if you happen to know anywhere one could go in Calgary with experience in Low Carb for Type 1 diabetes management, would you mind sharing the information?
Thanks,
Jason.
Dr. Jay’s Reply:
Although my experience with low-carb is with type 2 diabetes, what you describe does make sense. Perhaps the leading authority on the use of low-carb to manage type 1 diabetes is Dr. Richard K Bernstein (no connection to the Bernstein weight loss clinics here). He has type 1 diabetes himself and runs a clinic in New York where he takes patients from all over the world and gets them sorted out on a very low-carb diet. He’s a long way from Calgary, unfortunately, but you can check out his website for more info (see link).
Hi Dr. Jay,
Since I am in the US, I have not been able to see the documentary. I have, however, read as much information I could find, watched the YouTube clips and listened to your radio interview.
Great work!
I have managed to cure my own hypertension (from 149/95 down to 101/62) with a low carb diet and have lost 37 pounds so far. During the last month, as an experiment, I began following the traditional diet of the Tokelau atoll natives even though I am a pasty white chick with Irish, Norwegian, and Polish ancestry. This was inspired by reading “Good Calories Bad Calories” by Gary Taubes and the works of the Weston Price Foundation. I feel fantastic!
I believe there are a variety of “pre-contact” diets that will work wonders for people, not because there is anything magical to them, but because they all have a common factor…the lack of refined carbohydrates and starches. Returning to an ancestral way of eating may provide more of a benefit because of easier to find local low carb foods, and the spiritual component of connecting with the past may add an extra advantage.
I sincerely hope more First People and other indigenous peoples can shake the sickness and disease introduced by a high carbohydrate diet and more work like yours comes to the public’s attention. I will be spreading the word through my forum postings and on my blog.
Thank you!
Linda (aka Wifezilla)
P.S. Please tell me this is coming out on DVD some day?
Dr. Jay’s Reply:
I agree that Gary’s book provides excellent insight into the world of nutritional science and how we got into such a fix. I think he’ll be a little surprised when I tell him you started the Tokelau diet after reading it, though.
I don’t know when the documentary will be available in the US. Mary Bissell, the producer, tells me she has had some discussions with American broadcasters. The CBC has been very happy with the response and, as you can see, are already planning a re-broadcast. Perhaps if you, and your fellow bloggers, start pestering the networks down there, they might get interested in airing it. She may also make the DVD available commercially. If that happens, I’ll post a note here. You should also watch the Mystique Films website (see link).
Love your handle, by the way.
Dr. Wortman,
Thanks for the speedy response to my previous query. I have two more questions for you, which i’d love your thoughts on. Firstly, what advice would you give to a person who frequently complains of having feelings of heaviness, tiredness, and cramping in their legs? Secondly, what are your thoughts on the paleo diet, consisting of lean meat, fruit, veg, nuts and seeds, in comparison to the strict low-carb diet you follow? For instance, do you think that the greater quantity of fruit, nuts and seeds allowed on the paleo diet offers more health advantages that a strict low-carb diet rich in fat?
Really look forward to hearing from you. Keep up the great work!
Peter
Dr. Jay’s Reply:
The symptoms you describe, if you are restricting carbohydrates, could be the result of electrolyte imbalances. When you cut the carbs your kidney excretes salt and you need to make sure you are getting enough to avoid sodium depletion. Another possibility is a magnesium deficiency which cannot be diagnosed by a blood test as most of our magnesium is intracellular. If your doctor detected hyper-reflexia, that would suggest magnesium deficiency. One of my colleagues recommends drinking a cup of bouillon twice a day to replenish electrolytes and, if the leg cramps don’t resolve, to take a slow-release magnesium supplement like SlowMag or Mag64 (the Costco knock-off that seems to be available only in the US).
The so-called “Paleo” diet is based on the idea that our paleolithic era ancestors ate lean meat, nuts, seeds, etc. I’m not so sure. The indigenous populations I have worked with all valued animal and marine fats and used them for the bulk of their calories. Have a look at the Jared Diamond article I have in the links section: “Worst Mistake …”.
Hi again,
I went to his site and checked out some of the chapters of his book. I’m amazed that I’ve never heard of this guy…I’m going to grab that book for sure. Thanks for your advice, and thanks for the caveat re: Bernstein Weight clinics, I would have probably assumed they were the same thing.
Jason.
Dr. Jay’s Reply:
Dr. Richard Bernstein is a fine person, he’s about 73 years old, still practicing and sharp as a tack.
Dr. Jay,
Further to our discussion on the Globe & Mail website, you mentioned toxic levels of protein in the Wisconsin study. What level of protein would be toxic and what are the principal effects of exessive protein? I take some protein powder supplements after workouts and sometimes in lieu of dinner working late in the office. How would I know when I am nearing undesirable levels of protein? Do I measure in calories per day, percent calories per day?
I appreciate your critique of the Wisconsim study I mentioned. It is difficult for a lay person to make sense of all the conflicting data.
Murray
Dr. Jay’s Reply:
I have read your many on-line comments on various Globe and Mail health stories and you do very well for a “lay person”. My good friend Dr. Steve Phinney tells me that eating more than 200 g/day of protein will make you feel “lousy”. The Inuit actually had a word for this because in the spring, when the sea ice was unstable and they couldn’t get fish or sea mammals, they would eat arctic hare. At that time of the year the rabbits were quite lean and the Inuit figured out that after a few days they would feel sick. The Inuit would normally get most of their calories from fat.
I think this is why some people cannot sustain a low-carb diet over the long haul. When they are losing weight they are getting a significant amount of their calories from stored fat. When weight loss plateaus, if they are afraid to eat fat, as most of us are, they will try to make up those calories by increasing protein. This makes them feel ill and they are likely to give up. If they get those calories from carbs, they risk falling off the diet and regaining the weight. So, the logical course of action is to replace those stored fat calories with dietary fat calories.
Great Job
I’m 65 and have been on Atkins for nine years. I lost 85 pounds in 4.5 months (39% body fat) and never looked back. There is no doubt in my mind that I would have hit the 400 lb mark. I just couldn’t stop eating! I was totally addicted to carbs.
The greatest thing about being on Atkins is that you aren’t even allowed to be hungry. Before Atkins, I was hungry all the time.
This is the only nine years in my life that I haven’t even had a cold or the flu. I have never felt so good.
I know everyone wonders about the “long term” effects of this diet. But ask yourself this question. How long would I have been around weighing 400 lbs?
I have never felt as good as I have the last nine years.
Thanks Again
Mike Scott
Dr. Jay’s Reply:
Thanks for sharing your amazing story. We need some long-term studies to validate this kind of experience so that low-carb dieting can be accepted by the mainstream.
I just wanted to stop by and thank you.
Although I’ve ‘done’ Atkins since the 70s, the recent spin control of the low fat believers even had me, a true low carber, wondering.
Unfortunately, my blood pressure got out of control, and four years ago I was diagnosed with hypertrophic cardiomyopathy, my ejection was 25%. Dire.
I first was put on DASH diet. Didn’t lose weight, but bp dropped… too low. So, it was suggested Weight Watchers. I was also borderline diabetic and the crazed hunger and fuzzy-headedness was too much for me. Not to mention I gained weight.
Finally, last May, at 301 pounds I met a Dr (not going to say who, but you can contact me for details) who told me to go on Atkins to save my life.
That day I did exactly that. I’ve since lost 115 pounds. I am no longer borderline diabetic and I’ve just had my results from my echo (drumroll please):
“Negligible”
I can barely believe it. I went from not being able to put on shoes without getting winded, coughing all night (ended up as CHF), to working full time, full of energy and ready to continue eating this way all the time.
The fabulous doctor, a nephrologist, said to me when I thanked him: You’ve done the easy work–losing–now stay on low carb to stay alive.
Goal weights, I remind myself, are not finish lines.
Thank you again, Dr Jay. I look forward to the rebroadcast.
Dr. Jay’s Reply:
Wow! That’s an amazing story. Good for you and your nephrologist! The funny thing is that there are doctors out there hiding in the woodwork who have figured this out and are actually quietly helping their patients with a low-carb approach. I run into them from time to time. Wouldn’t it be great if we could get them together and pulling in the same direction? That might make a difference.
Dr. Wortman,
With regards to my previous post regarding to having the following feelings in my legs–heaviness, cramping and tiredness, i discovered that my problem is not a magnesium deficiency or a deficiency of sodium, but a consequence of having varicose veins, pointed out to me by a friend. I’m sure the low-carb diet will be helpful in terms of this condition, because if i understand correctly, fat increases the amount of water in cells which improves circulation.
Lastly, just a quick question. Do you eat the fat that tends to run along the outside edge of steak?
Peter
Dr. Jay’s Reply:
I don’t know about your idea that fat leads to improved circulation. A colleague, Jeff Volek at the University of Connecticut, has demonstrated that restricting carbohydrates can improve blood vessel function. It can also lower blood pressure, something I discovered myself and hear about from a lot of other people. I wish I could tell you that low-carb cures varicose veins, too, but that might be a bit of a stretch.
Yes, I do eat the fat that surrounds the steak.
Hi dr. jay
I am wondering if you would advise someone to use this food plan if they had had one episode of gall bladder attack and now have a tube into it and it drains into a bag. i too am awaiting surgery for a year now and have had no more symptoms. The Dr who treated me thought i caused the problem by exchanging some of the flour in my bread (homemade) with ground nuts. i have been trying for one year to lose so I could have less risk during the surgery with no success. I took all white things out of my diet (when I eat white flour I get real dopey and sleepy)
Do you think this plan but with less fat would still help me lose. How do you feel about veggies like zucchini and turnips, cukes. I am an emotional eater and don’t think I eat a lot of fast foods but am static at 340 lbs. If a person eats too much protien does it turn to sugar in your system? if so how much is enough?
I am caucasian but was taught to cook by my mother in law who was native so learned all the cheap stuff that keeps well. We lived out in the toolies. Thanks for your response.
Dr. Jay’s Reply:
Sorry to hear of your gall bladder problems. In the study we didn’t include a young woman because she had had an acute attack and was waiting for surgery. After you have developed gall stones, high fat intake can trigger an attack because fat in the diet causes the gall bladder to contract to squirt bile into your intestine to help with the digestion of the fat. This can cause a stone to block the duct which causes a lot of pain and makes you feel quite ill. If you eat a very low carb diet without increasing your fat intake you should not have a problem. Once you have stopped losing weight, however, you will need to increase your fat intake and this may be when a problem could develop. Or not, it’s hard to predict. Some people think that going on a low-carb diet will help resolve the gall stones. I can’t say that I know one way or the other. If you were really disciplined and ate the so-called good carbs instead of fat you might be able to prevent a further attack. Either way, you shouldn’t be increasing your protein beyond 200 g/day as it will make you feel ill.
I generally stay away from root veggies but eat zucchini, cucumbers, salad veggies, broccoli, cauliflower, etc. Good luck with it all.
I apologise if this has already been asked and answered. I found it impossible to read all the questions and answers.
My partner and I have been following Suzanne Somer’s low carb diet with considerable success but have reached a plateau. After seeing the program MBFD I feel we can improve on our diet.
My son recently began a ‘Paleolithic Diet’, found on ‘Wikepedia’ which appears to be very similar to your program. This program, however, warns agains nitrites and sulphites in prepared foods such as bacon, ham and sausage.
How do you feel about these additives and do you consider it safe to eat these somewhat prepared foods in order to add fat to our diet?
Dr. Jay’s Reply:
Someone did ask about the Suzanne Somers’ diet. I am not that familiar with it but my impression is that it allows more carbs, especially fruit, so it wouldn’t be as low in carbs as Atkins or what we did in the study.
The issue of cured meats always comes up when discussing this type of diet and probably more so when I tell everyone that I eat bacon with my eggs in the morning. Here’s my take on sulfites and nitrites: sulfites were used to keep all kinds of food fresh, including vegetables, and had generally regarded as safe (GRAS) status with the FDA until the mid-80’s. This was re-evaluated because it was becoming apparent that a small number of people were allergic to sulfites. It is now used much less and people who have allergies are more aware, so the number of severe allergic reactions to sulfite containing foods is relatively low. It is still found in products like baked goods, beer, wine, etc. but should show up on the label. So, if you are not allergic to sulfites, you don’t need to worry about this additive. Now, to nitrites, which are found in things like bacon, hot dogs and cured meats, the concern is that nitrites added to keep the meat safe from harmful bacterial growth will turn into nitrosamines which are considered carcinogenic. In reviewing the literature on this, I don’t find a clear answer. One interesting thing you do find is that most of the nitrites we get come from all those green healthy veggies we are supposed to eat. Those who think that nitrites are bad for you suggest that the ones in the veggies tend not to get converted to nitrosamines because they travel in the company of vitamins. There was a study that seemed to show that nitrites might actually protect you from damage to the heart muscle during a heart attack. This would be because nitrites also get converted to nitrous oxide, something that causes the blood vessels to relax and improves blood flow. Bottom line: while I don’t find a clear answer in the scientific literature, I guess I vote with my fork, as I do like to eat a little bacon for breakfast. If you aren’t comfortable with nitrites, there are now more products out there, including bacon, that advertise that they are nitrite-free.
Dr. Jay,
I am a 5 ft 7 inch Caucasian Canadian, retired, and 66 years old this month. Genetically I am 68.75% European, 25% Middle Eastern, and 6.25% Native American. I have always been physically active. I run and work with weights. Ten years ago I began to have weight, cholesterol, and blood pressure problems. The problem culminated in 2002-2003. My weight was up to 220 pounds. Also during this time and reaching a peak in 2003 was the occurrence of severe leg pain when walking. I walked stooped over, and slow, like a very old man. My family doctor warned me about getting the cholesterol under control.
I did some research on weight and diet. Studied the Atkins and Zone diets, but also started looking at some new research available on leptin. I found the book “Mastering Leptin” by Byron Richards and begin applying the principles to my diet. I also incorporated some of The Zone ideas of at least reducing poor carbohydrate intake. The main idea of the Leptin diet is to NOT EAT BETWEEN MEALS. Richards suggests leaving 3.5 to 4 hour between meals with nothing to kick up body insulin levels between these meal times. I found that eating breakfast at the beginning of the day and dinner in the late afternoon was best for me. It took me a good part of a week to start feeling really great with the new eating habits. Within a month my legs started feeling really good, and it was easy to jog and move around. My weight dropped from 180 to around 120 and cholesterol levels and blood pressure have been good since the Fall of 2003. I eat meat, carbohydrates, and occasional deserts with no problems. I try to keep processed foods to a minimum, but don’t avoid them completely.
I was wondering if you did any comparison studies with 1) absolutely eliminating food between meals with 2) the elimination of most carbohydrates.
Some of the things that I read about Dr Atkins’ cardiovascular condition after his death didn’t sound too good to me.
I would be interested in your comments about Leptin and perhaps some of your readers might be interesting in looking at the Richards book.
Dr. Jay’s Reply:
The body has complex internal signaling systems designed to keep us in a state of energy equilibrium. Things like leptin and grehlin are being investigated now as they are part of the regulatory mechanisms that control appetite. I tend to take more of a macro view. I know from my own experience, clinical observations and from the research literature that, when someone stops eating carbohydrates, their appetite drops dramatically. While I am sure leptin and grehlin and other factors are in play to make this happen, I am more concerned that the result is that stored fat is burned and the person feels better. I make the analogy to a television set. If you want to change the channel to watch a Sopranos re-run, you push the button on the remote and get the desired result. Sure, it would be neat to know all about the electronic circuits and infrared signals, etc, that made it all happen but you don’t need to, as long as you get to watch Tony and his pals. With low-carb dieting, the fact that it works so well will be better understood as more work is done in this area, to be sure (we already have a good book on the subject, Gary Taubes’ “Good calories, Bad calories”, by the way). I read the developments on leptin and the other factors with interest but also a nagging worry that the main impetus for this research is to find a “magic-bullet” drug that will let people continue to eat a crappy diet and still lose weight.
From what you have told me, your dietary approach does reduce carbs and/or increase the quality of the carbs you eat and you have lengthened the intervals between meals, and, most importantly, it seems to be working well for you. I think you should stick with it.