Low-Carb Recipe: Waldorfian Salad

paleobetic diet, low-carb diet

One cup of Waldorfian salad. I doubled the cinnamon in this batch, so yours won’t look quite like this.

Today’s meal is inspired by the classic Waldorf salad, made famous by New York’s Waldorf Hotel over a century ago. Now the hotel is called the Waldorf-Astoria.

The primary ingredients are apples, walnuts, and celery.

The original Waldorf salad was made with mayonnaise, which I’ve left out of this recipe since I designed it for a paleo-style diet I’m working on. Most commercial mayonnaises are made with vegetable oil, so they wouldn’t be fully compliant with a pure paleo diet.

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Good source of omega-3 fatty acids

Instead of mayonnaise, we use a dressing—a vinaigrette—made with walnut oil. Walnut oil is attractive in part because it is rich in omega-3 fatty acids: 1.77 grams per tbsp (15 ml). Compared with Paleolithic diets, modern Western diets are too low in omega-3s and too high in omega-6s (thanks to vegetable oils). You can use your left-over walnut oil the way you’d use olive oil. If you don’t want to buy or can’t find  walnut oil, just use extra virgin olive oil.

paleobetic diet, low-carb diet, ketogenic diet

I made my dressing in this BPA-laden plastic container

This recipe makes two large servings of 2 cups (480 ml) each. Small or sedentary folks may well be satisfied with a 1- or 1.5-cup serving.

paleobetic diet, low-carb diet, ketogenic diet

Apples are the primary source of carbohydrates in this recipe.

Ingredients:

2 apples, raw, medium size, skin on, diced (I used Red Delicious; consider Granny Smith, Fuji, or Gala)

3 celery stalks, 8-inches long (20 cm), diced

1 cup (240 ml) walnuts, broken by hand into small chunks (Option for ? more flavor: toast in a skillet over medium-high heat for 7-10 minutes or in oven (350 F or 175 C) on baking sheet for 10 minutes

1/4 tsp (1.2 ml) black pepper, ground

1/4 tsp (1.2 ml) salt

1.5 tbsp (22 ml) walnut oil (or extra virgin olive oil)

1 tbsp (15 ml) cider vinegar

1/2 tsp (2.5 ml) cinnamon

1/4 tsp (1.2 ml) nutmeg

Instructions:

First make a dressing with the bottom six ingredients. I put mine in a small container with a lid, then shook vigorously. Or you can put them in a small bowel and whisk them.

paleobetic diet, low-carb diet, ketogenic diet

Walnut pieces

Place the walnuts, apples and celery in a bowel, add the dressing and toss thoroughly. You’re done.

Serve as is, or chill first in the refrigerator. Maybe it was my imagination, but I thought it tasted better after it sat on the counter for 10 minutes. Consider serving on a bed of lettuce (1-2 oz), but if you do, increase your digestible carb count by 1-2 grams.

If you want more calories or protein than this recipe provides, chicken or steak should go well with Waldorfian salad and won’t increase your carb grams.

Number of Servings: 2 (2 cups each)

Nutritional Analysis:

73% fat

21% carbohydrate

6% protein

500 calories

27.5 g carbohydrate

7.6 g fiber

20 g digestible carbohydrate

341 mg sodium

529 mg potassium

Prominent features: High in copper and manganese, low in sodium. On a 2,000 calorie diet, this provides only 15% of the Recommended Dietary Allowance for protein, so you’ll want to eat more protein at some point during the day.

Steve Parker, M.D.

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Which Tree Nut Provides the Most Omega-3 Fatty Acid?

David Mendosa says the answer is the macadamia nut.

Paleobetic diet

Macadamia nuts

A great thing about the macadamia nut is that it’s one of the few nuts with a good omega-6/omega-3 fatty acid ratio. In other words, it’s high in omega-3 and low in 6. This may have important cardiovascular health implications. Macadamias are one of the nuts I recommend in the Low-Carb Mediterranean Diet and  Paleobetic Diet.

David writes:

The first Australian macadamia plantation didn’t begin until the 1880s. And not until 1954 with the introduction of mechanised processing did commercial production became viable. Nowadays about 90 percent of the the world’s macadamia nut production comes from Hawaii, where it has become its third most important crop, according to The Wellness Encyclopedia of Food and Nutrition, University of California at Berkeley (1992).

Read the rest, where you’ll learn that macadamia nuts are the highest of all nuts in calories, gram for gram.

Steve Parker, M.D.

Paleobetic diet

Macadamia nuts on the tree

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Conquer Constipation on Your Ketogenic Diet

Georgia Ede, M.D., has a good article on constipation that is sometimes seen with ketogenic diets. Some think it’s related to low fiber content of the diet. But Dr. Ede found a study that indicates cutting down on fiber consumption helps alleviate constipation! A quote from the good doctor:

If you experience constipation on a ketogenic diet, it is not because you are eating less fiber; it is most likely because you have started eating something that you were not eating before (or a larger amount of something you didn’t eat much of before) that is hard for you to digest. In order to eat a ketogenic diet, which is a high-fat, limited protein, ultra-low-carb diet, most people find themselves turning to high amounts of foods that are notoriously difficult to digest, including nuts, low-starch vegetables such as crucifers, and full-fat dairy products.These foods just so happen to be 3 of the top 5 causes of chronic constipation, regardless of what kind of diet you choose to eat.

Read the whole enchilada for her tips on countering constipation. Another trick that works for many folks is cabbage soup.

A well-designed ketogenic diet is a great weight to reduce elevated blood sugars. Don’t let constipation dissuade you.

Steve Parker, M.D.

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Sulfonylurea Diabetes Drugs Linked to Heart Disease in Women

…according to this article at Diabetes Care. The study population was the Nurses Health Study. The longer the sulfonylurea was used, the stronger the association with coronary heart disease. CHD is by far the most common cause of heart attacks. On the bright side, the drugs were not linked to stroke risk. Remember, correlation is not causation, blah, blah, blah…

I rarely start my patients on sulfonylureas these days.

Steve Parker, M.D.

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Recipe: BLT Avocado Wraps + Pecans

paleobetic diet, paleo diet for diabetics

Ready to roll up and eat

BLT = bacon, lettuce, and tomato.

BLT sandwiches are classic American food. But if served on traditional white bread, they may provide more carbohydrate grams than may diabetics can safely handle. This recipe switches out bread for lettuce, making them compatible with the Ketogenic Mediterranean and Low-Carb Mediterranean Diets.

Some studies link processed meats like bacon with cardiovascular disease and cancer, other studies don’t. If you want to be cautious with your health, don’t go hog-wild with bacon or other processed meats like hot dogs, bologna, and liverwurst.

Avocados come in hundreds of varieties. In the U.S., we mainly have California avocados (aka Hass) and Florida avocados. Californians are by far the market leader. They reign at the Parker Compound.

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California or Hass avocado

paleobetic diet, paleo diet for diabetes

Florida avocado

California avocados are smaller dark green lumpy-skinned ones. Florida avocados are larger, smoother-skinned, and lighter green. Monica Reinagel has an article comparing the two, with notes on ripening and storage.

Oh, and by the way, avocados are fruits, not vegetables. But you knew that, right?

Ingredients:

1 California (Hass) avocado, raw, medium size (about 4 x 2.5 inches or 10 x 6 cm), peeled and seeded, cut into long strips

6 bacon strips, medium thickness

4 oz (115 g) lettuce (e.g., iceberg, romaine, bibb, or broad-leaf lettuce you prefer)

4 oz (115 g) tomato, raw (this is about one-and-a half roma tomatoes or one medium regular tomato), cut into long strips

1 oz (30 g) pecans (option: substitute your favorite tree nut except for cashews—too many carbs)

Instructions:

Fry your bacon in a skillet over medium to medium-high heat. Next you’re gong to build two wraps. Lay out about two oz (60 g) of lettuce and load it with three bacon strips, half your tomato, and half your avocado. Fold or wrap lettuce edges together and enjoy. Repeat with remaining ingredients. The pecans are for dessert.

paleobetic diet, paleo diet for diabetes

Parker Compound guard dogs waiting for bacon

Number of Servings: 1 (that’s 2 wraps plus nuts)

Nutritional Analysis:

74% fat

12% carbohydrate

14% protein

720 calories

24 g carbohydrate

15 g fiber

9 g digestible carbohydrate

1137 mg sodium

1507 mg potassium

Prominent features: Good source of fiber, sodium, protein, vitamin B6, niacin, thiamine, pantothenic acid, copper, manganese, phosphorus, and selenium.

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Recipe: Steak, Avocado, Olives, and Tomato

Paleobetic diet

I ate mine for breakfast. Who needs bagels, cereal, and donuts?

This meal has only 8 grams of digestible carbohydrate so it works in both the Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet. It was super-easy to put together because I used leftover steak. But I’ll assume you’re cooking your steak fresh. We bought ours as thinly sliced round steak, about a 1/4-inch thick (0.6 cm). Some places refer to this as a “minute steak” because it cooks so quickly. Minute steak also refers to a piece of beef, usually the round, that’s been pounded flat, about a 1/4-inch thick. Even if you start with raw meat, you can prepare today’s recipe in 10 minutes.

Paleobetic diet

It tastes as good as it looks

Ingredients:

4 oz (113 g) cooked thin round steak (start with 5 oz raw)

1 California (Hass) avocado, standard size (4.5 oz or 127 g), peeled, pitted, and chunked

14 black olives, pitted, medium size (Purist alert: probably highly processed)

1 tomato, medium-size (medium size or 2.5-inch diameter (6,4 cm), or a large roma tomato), cut into wedges

Salt and pepper to taste, or use commercial steak seasoning such as Montreal Steak Seasoning by McCormick (a favorite at the Parker Compound)

Instructions:

Sprinkle your steak with seasoning then cook over medium or medium-high heat in a skillet, about a minute on each side. Or heat your leftover steak in the microwave. If you overcook, it will be tough.

Place all ingredients artfully on a plate and enjoy.

Servings: 1

Nutritional Analysis (via Fitday):

60% fat

12% carbohydrate

28% protein

600 calories

20 g carbohydrate

12 g fiber

8 g digestible carbohydrate

587 mg sodium

1530 mg potassium

Prominent features: Lots of protein, vitamin B6, vitamin B12, copper, iron, niacin, pantothenic acid, phosphorus, selenium, and zinc

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Do Low-Carb Diets Cause Premature Death?

Adult life is a battle against gravity. Eventually we all lose.

Adult life is a battle against gravity. Eventually we all lose.

Japanese researchers say low-carb diets are causing premature death. I’m skeptical.

The potentially healthful side effects linked to low-carb eating include reduced weight, higher HDL cholesterol, and lower triglycerides and blood pressure. The Japanese investigators wondered if the improved cardiovascular risk factors seen with low-carb diets actually translate into less heart disease and death.

How Was the Study At Hand Done?

The best way to test long-term health effects of a low-carb diet (or any diet) is to do a randomized controlled trial. You take 20,000 healthy and very similar people—not rodents—and randomize half of them to follow a specific low-carb diet while the other half all eat a standard or control diet. Teach them how to eat, make damn sure they do it, and monitor their health for five, 10, or 20 years. This has never been, and never will be, done in humans. The Nazis may have done it, but it’s not published. In the old days, we could do this study on inmates of insane asylums or prisons.

What we have instead are observational studies in which people voluntarily choose what they’re eating, and we assume they keep eating that way for five or 10+ years. You also assume that folks who choose low-carb diets are very similar to other people at the outset. You depend on regular people to accurately report what and how much they’re eating. You can then estimate how much of their diet is derived from carbohydrate and other macronutrients (protein and fat), then compare health outcomes of those who were in the top 10% of carb eaters with those in the bottom 10%. (We’ve made a lot of assumptions, perhaps too many.)

Of the observational studies the authors reviewed, the majority of the study participants were from the U.S. or Sweden. So any true conclusions may not apply to you if you’re not in those countries. In looking for articles, they found no randomized controlled trials.

The observational studies estimated carb consumption at the outset, but few ever re-checked to see if participants changed their diets. That alone is a problem. I don’t know about you, but I’ve had significant changes in my diet depending on when I was in college and med school, when I was a bachelor versus married, when my income was higher or lower, and when I had young children versus teenagers. But maybe that’s just me.

The researchers looked at all-cause mortality, deaths from cardiovascular disease, and incidence of cardiovascular disease. They don’t bother to define cardiovascular disease. I assume heart attack, strokes, and peripheral vascular disease. (But aren’t aneurysms, deep vein thrombosis, and pulmonary embolism vascular diseases, too?) Wouldn’t you think they’d carefully define their end-points? I would. Since they were going to all this trouble, why not look at cancer deaths, too?

What Did the Investigators Conclude?

Very low-carbohydrate dieters had a 30% higher risk of death from any cause (aka all-cause mortality) compared to very high-carb eaters. The risk of cardiovascular disease incidence or death were not linked with low-carb diets. Nor did they find protection against cardiovascular disease.

Finally, “Given the facts that low-carbohydrate diets are likely unsafe and that calorie restriction has been demonstrated to be effective in weight loss regardless of nutritional composition, it would be prudent not to recommend low-carbohydrate diets for the time being.”

If Low-Carb Dieters Die Prematurely, What Are They Dying From?

The top four causes of death in the U.S. in 2011, in order, are:

  1. heart attacks
  2. cancer
  3. chronic lower respiratory tract disease
  4. stroke

You’ll note that two of those are cardiovascular disease (heart attacks and stroke). So if low-carb diets promote premature death, it’s from cancer, chronic lung disease, or myriad other possibilities. Seventy-five percent of Americans die from one of the top 10 causes. Causes five through 10 are:

  • accidents
  • Alzheimer disease
  • diabetes
  • flu and pneumonia
  • kidney disease
  • suicide

Problem is, no one has ever linked low-carb diets to higher risk of death from any specific disease, whether or not in the top ten. Our researchers don’t mention that. That’s one reason I’m very skeptical about their conclusion. If you’re telling me low-carb diets cause premature death, tell me the cause of death.

Another frustration of mine with this report is that they never specify how many carbohydrates are in this lethal low-carb diet. Is it 20 grams, 100, 150? The typical American eats 250-300 grams of carb a day. If you’re going to sound the alarm against low-carb diets, you need to specify the lowest safe daily carb intake.

For most of my career—like most physicians—I’ve been wary of low-carb diets causing cardiovascular disease. That’s because they can be relatively high in total fat and saturated fat. In 2009, however, I did my own review of the scientific literature and found little evidence of fats causing cardiovascular disease.

If you’re looking for a reason to avoid low-carb diets, you can cite this study and its finding of premature death. I’m not convinced. I’ll turn it around on you and note this study found no evidence that low-carb diets cause cardiovascular disease. The risk of cardiovascular disease had been the traditional reason for physicians to recommend against low-carb diets.

Steve Parker, M.D.

Reference: Noto, Hiroshi et al. Low-Carbohydrate diets and all-cause mortality: A systematic review and meta-analysis of observational studies. PLoS One, 2013; 8(1): e55050

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Filed under Carbohydrate, coronary heart disease, Longevity, Weight Loss