I read with some amusement the debates in the blogosphere about whether the insulin/obesity hypothesis (as espoused by my friend Gary Taubes) accurately explains the obesity epidemic or whether some other mechanism is at work, like the food reward hypothesis (as promoted by Stephen Guyenet). Although I clearly fall into the Taubes camp on this, I also think there is a lack of real world sensibility in having the debate at all (I think Gary might agree with me on this). So far, as I see it, the whole argument revolves around what causes obesity. While I agree that obesity is a big problem and that there must be some kind of valid explanation for why this epidemic has taken off over a few recent decades, what is missing is recognition that it’s not just about weight. The weight gain is associated with other chronic conditions which are actually the real issue. The current paradigm implies that weight gain is a causal link in the chain that connects to diabetes, cardiovascular disease and a host of other common conditions. I think that weight gain is not, in and of itself, causal. It is another of the conditions that are symptomatic of the underlying cause which is related to carbohydrates in the diet. The fact that you can have thin people develop hypertension, diabetes and heart disease suggests that weight gain is not causal. The fact that you can have obese people with normal cardiometabolic markers and outcomes reinforces this observation. So, when it comes to applying a therapy that is effective in offsetting the harms associated with weight gain (note I said “associated with”, not “caused by”) it is important to address the actual underlying cause. The evidence supporting the highly effective therapeutic use of LCHF diet for these conditions reinforces the idea that dietary carbohydrates are, in fact, the cause. Perhaps we need to add the qualifier, “in susceptible people”. In any case, clinicians who use this approach report remarkable results that go beyond the effectiveness of the usual drug based therapies. It all hinges, of course, on compliance.
The benefits of LCHF actually extend into other realms of pathology that have been hitherto unexplored in terms of a potential dietary cause. I have collected a few anecdotal reports of the kinds of things that continually amaze me when it comes to the benefits of LCHF.
Arthritis
A few years ago, after I had just figured out that a LCHF diet had fixed my own diabetes and metabolic syndrome, I began to speak out about its potential benefits for others. At the time, I was the Regional Director of the Pacific Region of First Nations and Inuit Health Branch of Health Canada. I was asked to speak at an annual meeting of the nurses who worked in rural and remote First Nations communities so I gave a talk about my experiences in reducing carbs and proposed that it might be useful for the management of their diabetic patients. After the meeting ended, I was approached by a nurse who told me a remarkable story. She was caring for a First Nations woman who had severe, debilitating osteoarthritis. The disease was so severe that the woman could not get off a chair without assistance. The woman was overweight so, for whatever reason, the nurses put her on the Atkins diet. After an initial weight loss of a few pounds, the woman relapsed and regained the weight and then tried the diet again. What was remarkable about this was that, as soon as the diet was started the arthritic pain virtually vanished. It returned when the diet was discontinued and vanished again as soon as it was re-started. Clearly this amazing recovery was not associated with weight loss, but rather was directly attributable to the diet. Later, when I met with Dr Eric Westman for the first time, one of the questions I asked was whether he had seen anything like this in his patients. He said he had. I have since heard similar case reports from others who use LCHF diets in their research or clinical practices. So far, I am not aware of a study that has looked at this specific finding but I continue to hear anecdotal stories of this kind of benefit from LCHF.
Milroy’s Syndrome
When we did the trial in Alert Bay, one of the subjects was a man who suffered from Milroy’s syndrome. This is a rare condition where the lymph system malfunctions and fluid accumulates, usually in the lower limbs. The only treatments are mechanical massaging to force the fluid out and the use of devices such as support hose to minimize the accumulation of fluid. In this man’s case, the condition had progressed to the point where he didn’t want to be seen in shorts because of the disfiguring swelling of this legs. After a few months on the LCHF study diet, his condition had almost completely resolved.
Hemochromatosis
Recently, I was contacted by a physician who has implemented a successful diet program in the small village in which he practices. We have been collaborating in an effort to ensure that the considerable weight loss achievements of his patients is sustainable over the long haul by re-introducing fats into their diets once they reach their weight loss targets. He has more recently been starting people on a LCHF diet at the outset. He contacted me to share the details of a woman who he was treating for hemochromatosis. This is a pathological condition where the body has excess iron stores. Left unchecked it can damage major organs and leads to other serious diseases including diabetes, cirrhosis, cardiomyopathy and arthritis. The most effective treatment is phlebotomy, ie blood letting. The woman he was treating was in constant pain and needed phlebotomy every 2 to 4 weeks. After she started the Atkins diet, she went into remission. The pain went away and she no longer needed phlebotomy. She relapsed on the diet and the pain and hemochromatosis returned. After some more phlebotomies, she re-started the diet and has been symptom free and has required no phlebotomies now for the past eight months.
Crohn’s Disease
I received a recent update from another successful diet project that I have been assisting in another small community. The results are pretty good for weight loss but, again, the most remarkable story is about a different condition. In this case it is Crohn’s disease. This is a very debilitating inflammatory condition of the bowel that makes life miserable for the sufferer and which is treated with a variety of drug and surgical interventions. There is no cure. A woman who had suffered from Crohn’s for twelve years went into complete remission after switching to a LCHF diet. Her symptoms completely resolved and her most recent endoscopy found no signs of the disease. She apparently cried upon hearing those results. I can understand why.
Obviously these are just case reports and more research would be needed to verify that these and possibly other conditions can be treated or cured by switching to a LCHF diet and to rule out other possible confounding factors. For the time being, however, those who suffer from these conditions should be encouraged to try the diet. As we now know, there is no downside and the potential upside could be seriously life-altering.
LCHF is about so much more than just weight loss. Eventually the research will be done to explore these other benefits. In the meantime, these squabbles about the various arcane explanations for weight gain that overlook both the well-documented and the anecdotal accounts of the other benefits of LCHF are seriously missing the mark. The proof is in the LCHF pudding, IMHO. And, as you can see from the photos of what I eat in earlier posts, you would have to agree that there is no shortage of “food reward” in the LCHF diet that I follow.
Thanks Dr. Jay
Relief of arthritis like symptoms is one of the effects that I received from giving up wheat. This is a common report on http://www.wheatbellyblog.com/ .
Any LCHF diet will not have much wheat.
Dr Jay’s Reply:
You raise an important point. A low-carb diet eliminates different types of carbs. Some may be more important than others in terms of the aetiology of the various conditions that respond to a LCHF diet. It will take a lot of research to figure this out. In the meantime, individuals can experiment to discover which foods they can tolerate and which they cannot. I do note, however, that the diet recommended in Wheatbelly eliminates more than just wheat.
You might also be on the lookout for dental improvements. I have seen a number of reports on LC forums about cures for gum problems.
Personally, I have been LCHF for about 10 months, but gluten-free for 10 years. Nowadays, denticians survey “pocket” depth around your gums which is a measure of gum attachment (I understand). Although none of mine were severely degraded to begin with, what is remarkable is that when the survey was re-taken last month, the whole mouth had basically improved by one notch (scale of 5). They normally see these values only get worse.
Knowing about the work of Weston Price, I wouldn’t be surprised if you saw significant dental improvements in people returning to a more traditional diet.
Dr Jay’s Reply:
I agree. In my own case, I have had maybe two bouts of gingivitis in the past nine years and gum recession and pocket depth changes have been arrested since I started LCHF.
Some observed minor improvements–nothing miraculous as I was generally healthy before going LCHF:
A friend and I have noticed the disappearance of background ringing in the ears since going LCHF.
The same friend and I have noticed increased suppleness of skin and better skin condition generally.
I have also not had cold sores since going LCHF, which I used to suffer regularly.
My scalp hair had already started greying when I went LCHF and this has since reversed. Dr. Luan Pho claims greying is not a sign of aging but a sign of excess carbohydrate consumption.
Dr Jay’s Reply:
I used to get cold sores regularly from UV exposure at the high altitudes when skiing. Now it is very rare and if it does happen it is very mild. Unfortunately, the curative effect for grey hair has not kicked in yet.
I’ll be glad when you fully broach the mind and mental aspects in all this, as well as the psyche and spirit and our emotions and senses and feelings, and the effects on our innate responses and instincts and adrenaline glands, our being, what we see and think and feel, that’s when I will be happy. “The Stimulant Drug Factor”.
You have touched on it from the beginning and often refer to these phenomena, so I know you are there and just taking this in steps, as deems appropriate.
A very solid and valid approach to be sure.
Keep up the great work.
You are vital to this cause.
Hey Jay: It has been sometime since I visited your site and am thrilled to see your recent posts. Thank you for your continued good work. It has revitalized my interest in LCHF eating. In January I had routine blood work done. (I was concerned after the holiday overload.) But the good news was that my blood glucose levels which had been slightly elevated last year had dropped to normal range. Unfortunately my weight loss has plateaued, so I have signed up for an exercise class in my small Island community and will have to return to induction to continue on the weight loss and health journey.
I enjoy seeing your photos of your diet right meals. We have completely changed our use of carbs in our home. Unfortunately many of my signature dishes were carb rich such as salmon en croute and the much loved buttermilk biscuits that would accompany boeuf bourguignon for potluck dinners with friends. My husband is known far and wide for his excellent paella…and we do indulge in that occasionally.
I have just made a venison stew and am pondering about thickening it with flour or cornstarch. I fear when the carbs start creeping in it is the first step on the slippery slope. Also, we entertain a lot and often have cold smoked spring salmon as an appy and the temptation is to go for crackers which we no longer purchase. Somehow, a piece of lox with cream cheese doesn’t work as an elegant finger food, without the artisan bread or crackers. Any suggestions for alternatives?
The greatest benefit to my kitchen has been using home made and home canned stocks, chicken, fish, prawn, venison,etc. We keep any number of different ones on hand and find the flavour boost is amazing. (I find the commercial ones diluted in flavour and high in sodium.) We also often use wine in our cooking which adds another dimension to the flavours. Unfortunately I have had to give up a new favourite of mine…chicken vino cotto. The sauce is made up of a reduction of red wine and honey. I felt I had just started to perfect it when we decided to eliminate carbs. Oh well.
I would love to hear any suggested substitutions to keep my cooking interesting as I fear falling back on pasta and rices.
Appreciate your good work. Cheers, Ardyth
Dr Jay’s Reply:
Nice to hear from you. Sounds like you eat really well. Those stocks sound especially yummy.
Be careful with the use of exercise for weight loss. The evidence doesn’t support it. In fact, it may slow down weight loss because it increases appetite. Interestingly, the research suggests that exercise will cause you to overeat but overeating won’t cause you to exercise. Who knew! Best to bear down on the carbs and no cheating.
Try making my ice-cream recipe. It can stave off the temptation to eat something you shouldn’t, especially in the evening after a nice low-carb dinner. That works wonders for me. You can play around with the flavours – chocolate, vanilla, maple walnut, you name it. Use flavour extracts not the real thing. I store in the freezer in little Glad 1/2 cup containers. Other than that, I don’t think I hold a candle to your culinary prowess. I basically make hearty meat, fowl and fish dishes with salads or different veggies for dinner. I am stuck on the beanless chilli for lunch and my frittata for breakfast. Sounds boring but I never tire of it.
Good luck!
Hello Dr Wortman,
Taubes argues that whatever causes obesity also causes the other diseases associated with obesity. I agree. However, obesity is not always present. This means the other diseases can still be treated with the same therapy we use for obesity. In this case, LCHF.
Conversely, obesity can remain to some extent while other diseases are taken care of by LCHF. This would be attributed to adipocyte proliferation due to chronic hyperinsulinemia over many years. Like diabetics type 1 who inject insulin in the same spot for years and develop insulin-induced lipohypertrophy, merely going on a diet won’t make those fat lumps go away.
I doubt we could create obesity on its own without creating any other disease though.
Dr Jay’s Reply:
That may be true although here are people who become fat without the cardio-metabolic risk markers. For them, there must be something else driving the weight gain while not driving the other risk factors. All this means is that obesity is associated with the risk but does not cause the risk. I have seen people normalize their risk markers while remaining obese on a LCHF diet. I haven’t seen this on a conventional low-cal/low-fat diet. In bariatric surgery patients, the correction of the markers can happen before weight loss occurs. I have seen this with LCHF, too.
Hi, I was directed to this from someone on the same candida programme as me. I am on a high fat, low carb regime but I have gained quite a lot of weight, not lost. I was underweight to start with so that might have something to do with it. How is it that some people lose and others gain? Apart from hormonal factors, is there anything else that I should be aware of? Many thanks, and, yes, I sure did enjoy my bacon this morning!
Dr Jay’s Reply:
I don’t claim expertise in the area of candida infection. I do understand that the yeast can drive you in a harmful direction, metabolically speaking, so getting rid of it may be the tipping point for some people in terms of achieving metabolic health. If you were underweight because of a yeast infection and if you have corrected that problem, I would not be surprised that you would gain on a LCHF diet. For instance, if you have wasted muscle you will find that it rebuilds on LCHF. Some people who have had metabolic syndrome for a long period of time have wasted muscle while gaining fat so that when they start LCHF they don’t lose weight initially since they are adding muscle while burning off the fat.
These are some ideas that come to mind from what you have said in your post. To determine what is really going on I would need much more information. I hope you have a supportive physician who can help you sort this out.
Hi Dr Jay,
I have another story of healing.
My husband was diagnosed with an enlarged prostate (BPH). He needed to get up sometimes over 4 times a night. He also frequently urinated during the day making it hard to go anywhere. His stream was slow and weak. We considered surgery but opted out because we were told it could often end in erectile disfunction. He was put on a medication to improve flow and it worked for a while.
He went on the LCHF diet and after about 6 months he was back to peeing like he was before the BPH. Also his stream was stronger.
We went to Italy for 6 months and ate more carb, while not a huge amount enough to put us out of ketosis.
After about 6 months he started to pee often again.
We went back on the diet when we returned home and after about 3 or 4 months he returned to peeing almost like young bloke again.
Next year I am going to get him looked at again to see if his prostate has really shrunk.
It does seem that BPH is another Neolithic Disease. This is Dr Jack Kruse term for all diseases that are caused by our LFHC diet
Dr Jay’s Reply:
Thank you for sharing that. I recall there have been a couple of studies, one in rats and another in humans, that looked at low-carb and prostate cancer. In both cases, the application of a low-carb diet was beneficial.
I ve lost 25lbs since Jan 2 going LCHF. Had same experience 2 years ago but slipped of diet on a holiday. One of the pitfalls then was feeling sheepish about being on a fad diet. This time round feels a bit different because I have been reading more of the science background on nutrition and as a result no longer see it as a “diet” let alone a fad diet.
Your and Mr Taubes’ research have really helped in this regard. Thanks.
One dramatic change I noticed both times I went low carb is the disapearance of my heartburn/acid reflux. I mean gone, after 10 years of chronic and 30 years of intermittent heartburn. I would not go any where with out at least Tums before, and haven’t take one in 3 months.
There are other improvements, less energy swings, no post meal “coma”.
And now that you mention it, I do notice I have less joint stiffness after prolonged sitting, I don’t know if I was pre arthritic (I am 50) but I used experience major stiffness after sitting or crouching for an hour or so. So much that others would notice my stiff movement. But I can’t recall that happening recently.
Dr Jay’s Reply:
There are many reports of gastro-esophageal reflux disease (GERD) completely resolving on a low-carb diet. This is contrary to what we were taught during medical training that it was dietary fats that caused this problem. We used to recommend a low-fat diet and antacids. There are at least two studies now that have looked at this and both report improvements in GERD and reductions in stomach acid secretion when a LCHF diet is used. I now recommend LCHF to anyone suffering from GERD. Thanks for sharing your story and good luck with the dieting.
I’m very excited. I just found out about the LCHF diet and I’m starting it today. I’m 31 years old, fit and athletic (I do P90X regularly), I can maybe lose 10 lbs of body fat (just guessing). I found out about this diet through research. I have been suffering from nighttime nausea (just before I go to sleep) for about 3 years now. It’s just too much now, it’s driving me crazy. It’s off and on, lately it’s been more on. I’m thinking it’s actually a gallbladder issue, but who knows, right? I found online that the LCHF diet can improve gallbladder function. So I started researching it, and it just makes total sense anyway! So I figured I would give it a shot. I ALSO have GERD. I have had GERD since I was 15 years old. I’ve been on omeprazole for 16 freaking years!!! This post above that says GERD symptoms improve on this diet is so motivational. So that’s ANOTHER reason I’m trying it now. The omeprazole works great, but I always wanted to stop taking it, hoping there is a diet that can fix my issue. So we’ll see. I can go for one day without my pills (if I’m lucky), and like clockwork it comes back and stays strong until I start taking my pills again. So…I’m going to skip my pills tomorrow morning (Sunday), and we’ll see. If my heartburn is gone tomorrow, it’s definitely a hurdle. But if it’s gone on Monday…it’s BIG news for me. If it’s still gone come Tuesday and Wednesday, I’m going to feel like I won the lottery. I will come back to this thread and post my progress and if my nausea and GERD symptoms are improving while on the LCHF diet. Crossing my fingers!
Dr Jay’s Reply:
Many people report early resolution of their GERD symptoms on a LCHF diet. Good luck with that and do keep us posted on how it goes.