Tag Archives: low-carb diet

David and Goliath: Dr. Briffa Versus National Health Service on Low-Carb Diets

The United Kingdom’s National Health Service last year published guidelines favoring low-fat weight-loss diets over low-carb ones. Dr. John Briffa objects:

See here for a comprehensive review of 23 studies which demonstrates superior results achieved by low-carb diets with regard to weight loss and disease markers. To my mind, dietician Sian Porter and the NHS Choices website have done a bad job of communicating the facts and summarising the evidence. I wish to formally complain about the inaccuracies in this article and its (to me) clear bias and lack of balance.

Read the whole enchilada (plus this update).

Steve Parker, M.D.

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Recipe: Apple, Pecan, Blueberry Lunch Bowl

paleobetic diet, diabetic diet, low-carb diet

So simple even a redneck like me can make it

My wife and I initially put this together for the Paleobetic Diet, but since I provide the nutritional analysis you can easily incorporate it into the Low-Carb Mediterranean Diet.

Ingredients:

2.5 oz (70 g) apple, diced (“red delicious” variety works well) (this is half a medium-sized apple)

2.5 oz (70 g) pecans, crumbled into small pieces

2.5 oz (70 g) raw blueberries

Instructions:

Mix all together in a bowl, then enjoy.

Servings: 1

Nutritional Analysis:

76% fat

20% carb

4% protein

570 calories

30 g carbohydrate

10 g fiber

20 g digestible carb

1.4 mg sodium

421 mg potassium

Prominent features: Quick and easy. Rich in copper, manganese, and thiamine. Inadequate protein to get you through the day, but you’ll make up for it at breakfast or dinner.

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Recipe: Spaghetti Squash Spaghetti

 

paleobetic diet, diabetic diet, low-carb diet, spaghetti squash, spaghetti

Meaty low-carb spaghetti sauce over spaghetti squash

Making a wholesale switch from the Standard American Diet or most diabetic diets to a very low-carbohydrate diet can be difficult for some under the best of circumstances. For those used to eating carb-heavy pasta, I thought it might be comforting to offer something similar to pasta but with a lower carb count. Hence, spaghetti pasta. The tomatoes in the sauce are an additional source of blood glucose-elevating carbohydrates. So I’ve tried to minimize them by creating a meat-heavy sauce. Nevertheless, a reasonable portion size—two cups 0f squash—tipped me over my usual “20 grams of carbohydrate per meal” limit. In contrast, a single cup of cooked spaghetti pasta by itself—no sauce—has 40 grams of digestible carbohydrate and 220 calories. Add some sauce and the combo could wreck your blood sugar control for a few hours. 

 

paleobetic diet, spaghetti, squash, low-carb diet, diabetic diet, paleo diet

Cooked spaghetti squash partially teased apart with a fork

Ingredients:

3/4 cup (240 ml) low-carb spaghetti sauce

2 cups (480 ml) cooked spaghetti squash

Instructions:

Prepare the ingredients after clicking on links above. Assemble as in the photo. Enjoy.

Number of Servings: 1

Nutritional Analysis: 

52% fat

33% carbohydrate

15% protein

408 calories

36 g carbohydrate

7 g fiber

29 g digestible carbohydrate

1,398 mg sodium

1,201 mg potassium

Prominent features: Rich in B12, copper, iron, niacin, thiamin, B6

I think you’ll find the two cups of spaghetti squash filling and satisfying. If that’s not enough calories for you, munch on some leftover high-protein food such as chicken or steak.

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New Podcast Episode Features Professional Low-Carb Diet Proponents

Jimmy Moore posted an interview with Dr. Troy Stapleton and Franziska Spritzler, R.D. They both advocate carbohydrate-restricted diets for management of blood sugars in diabetes. Dr. Stapleton, by the way, has type 1 diabetes; I’ve written about him before. Franziska is available for consultation either by phone, Skype, or in person.

Steve Parker, M.D.

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Low-Carb Recipe: Turkey Tomato Bowl plus Macadamia Nuts

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Not enough tomatoes here to spike your blood sugar

With the high price of hamburger and steak, we’re eating more turkey at the Parker Compound. This is what I did with some of our leftover Thanksgiving turkey last year. If you don’t have leftover turkey, I bet leftover chicken or steak would be  fine substitutes. I’m tempted to try it with salmon or canned tuna or chicken. In addition to the flavor, what I like about this meal is that it’s crazy quick. You can easily work this meal into the Low-Carb Mediterranean Diet or Ketogenic Mediterranean Diet.

Ingredients:

6 oz (170 g) cooked turkey chunks, light meat (or 8 oz (225 g) if you’re starting raw and planning to cook it)

5 oz (140 g) raw tomato (2 small roma tomatoes, for example), cut into chunks

2 tbsp (30 ml) balsamic vinaigrette

black pepper to taste

1 oz (30 g) roasted macadamia nuts

paleobetic diet, low-carb, diabetes, diabetic diet, paleo diet

These roma tomatoes were amazingly flavorful for late Fall in the northern hemisphere. Before cooking, my wife injected the bird with olive oil, massaged periodically over 30 minutes, then popped it in the oven.

Instructions:

Toss the turkey and tomato chunks in a bowl, splash on the vinaigrette, then microwave for 60-80 seconds. Pepper as desired. Drink the leftover juice right out of the bowl. Enjoy with macadamia nuts for dessert and you’ve got a full meal.

Discussion:

paleobetic diet, low-carb, diabetes, diabetic diet

Grok wouldn’t have access to this

I was lazy when I made this so I just used a commercial salad dressing rather than making my own vinaigrette. I like the flavor of Wish-Bone Balsamic Vinaigrette Dressing “with extra virgin olive oil.” Here are the top ingredients, in order: water, balsamic vinegar, soybean oil and extra virgin olive oil (sic), sugar, salt, spices, etc. So the oil could have been soybean oil with one drop of EVOO for all I know. Olive oil is a rich source of monounsaturated fatty acid, so you might be able to calculate how much EVOO was in the dressing if I tell you there were five grams of fat per two tbsp (30 ml) serving, of which 1.5 grams were monounsaturated. That serving also has three grams of carbohydrate (all sugar) and only 60 calories. Right there on the bottle is says” gluten-free” and “no high fructose corn syrup.” I bet it had HFCS in it three years ago and there would be no mention of the trendy “gluten-free.”

I don’t know any home cooks who add water to vinaigrettes. They are essentially oil and vinegar (in a ratio of 3:1) and spices. The ones I make have quite a bit more than 60 calories per two tbsp (30 ml); more like 220 cals. All of the oils you would use have about 120 calories per tbsp, all from fat. If you make this recipe with home-made vinaigrette, add 150 calories to the nutritional analysis below. It won’t affect the carb count.

Note that of the common vinegars, balsamic has the most carbohydrates—some vinegars have zero. If you use typical amounts of balsamic vinaigrette, you shouldn’t need to worry about the carbohydrates unless perhaps you’re on a strict ketogenic diet and limited to 20-30 grams of carb daily.

Servings: 1

Nutritional Analysis:

58% fat

7% carbohydrate

35% protein

620 calories

11.5 g carbohydrate

3.7 g fiber

8 g digestible carbohydrate

743 mg sodium

877 mg potassium

Prominent features: High in protein, vitamin B6, iron, manganese, niacin, phosphorus, selenium, and zinc.

paleobetic diet, low-carb, diabetic diet, paleo diet

Bonus pic! A horse at the Parker Compound, an old-style Morgan. I call him Java but his formal name’s Espresso.

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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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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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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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Recipe: Eggs, Bacon, and Honeydew Melon

 

Bacon, eggs, black coffee, and Cholula hot sauce. A caveman wouldn't recognized any of this except for eggs.
Bacon, eggs, black coffee, and Cholula hot sauce

If you follow nutrition science literature, you’ll see periodic references to “processed meats” like bacon contributing to increased risk of cardiovascular disease, cancer, or premature death. I think the associations are pretty weak. Health-conscious cautious people aren’t going to go hog-wild on processed meats. I don’t. We may never have a definitive science-based resolution of the issue.

If you want to control the degree of processing in your bacon, make your own. The recipe at the link includes pink salt (sodium nitrite), maple syrup, and dark brown sugar. Many other recipes are available. My understanding is that sodium nitrite is a preservative and gives bacon meat that pink color. (Does it contribute to flavor?) If you’re not storing your bacon for a long time, you may not need the pink salt.

In any case, I thoroughly enjoyed three strips of bacon with my eggs recently. Mine was the Kirkland brand from Costco was $3.80/pound (USD). Two slices provide 80 calories (uncooked) and zero grams of carb although, if I recall correctly, it was honey-cured bacon.

Ingredients:

3 large eggs

3 strips of bacon, standard thin slices

Salt and pepper to taste

1/2 cup raw honeydew melon, cubed

Instructions:

Fry the bacon over medium or medium-high heat. If there’s too much grease leftover in the pan after cooking, poor out what you don’t want, for later use or drizzle over your dog’s dry kibble food. Leave a little grease in the pan so your eggs don’t stick. Then fry your eggs over medium heat. Enjoy with raw honeydew, which will cleanse your palate after eating bacon.

You can pay a lot more than $3.80 a pound for bacon
You can pay a lot more than $3.80 a pound for bacon

Servings: One

Nutritional Analysis per Serving: (from FitDay.com)

63 % fat

10 % carbohydrate

26 % protein

319 calories

9 carb grams

1 fiber grams

8 digestible carb grams

845 mg sodium

423 mg potassium

Prominent features: high in B12, riboflavin, selenium, protein, pantothenic acid, and phosphorus. Although this is low in calories, it’s adequately satiating because of the rich protein and fat content. The calorie count will be higher by 50 if you eat all the bacon grease.

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How to Eat Low-Carb at Fast-Food Joints

Laura Dolson tells you how over at About.com. For example:

Occasionally, you’ll see salads with other protein, but chicken is the mainstay of fast-food meal salads. Tips: 1. Skip the croutons, tortilla strips, and similar additions. 2. Be very careful about sugars in the dressing. 3) For best nutrition, look for salads with a mixture of greens, and a variety of vegetables. 4) Make sure the chicken is grilled, not “crispy fried”, or other chicken with breading.

On the Advanced Mediterranean Diet for non-diabetics, you have the option of:

  1. Traditional portion- and calorie-controlled eating, or
  2. Low-carb eating with the worlds’ first Low-Carb Mediterranean Diet

If you’ve read Conquer Diabetes and Prediabetes, you’re already familiar with #2.

Steve Parker, M.D.

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