Where Are We Today?

When I started this blog back in 2005, in my second post, Hunter-Gatherers, I looked at a review by Loren Cordain et al, about the maronutrient estimations in worldwide hunter-gather diets.

I noted,

Their findings included

• Most (73%) of the worldwide hunter-gatherer societies derived >50% (56–65% of energy) of their subsistence from animal foods, whereas only 14% of these societies derived >50% (56–65% of energy) of their subsistence from gathered plant foods.
  
  
• This high reliance on animal-based foods coupled with the relatively low carbohydrate content of wild plant foods produces universally characteristic macronutrient consumption ratios in which protein is elevated (19–35% of energy) at the expense of carbohydrates (22–40% of energy).
  

So, most of the hunter-gathers are eating 56-65% of their energy from animal foods, providing 19-35% of their calories as protein and just 22-40% of their calories from carbohydrate.

In a "real world" 2000-calorie a day diet, what does such a macronutrient mix look like?

19-35% of calories from protein = 380 to 700 calories or 95g to 175g of protein, with most coming from animal foods

22-40% of calories from carbohydrate = 440 to 800 calories or 110g to 200g of carbohydrate

The remaining calories, from fat = 500 to 1180 calories, or 25-59% or 55g to 131g of fat

And continued by stating that "[t]hese ratios are very much in line with controlled-carbohydrate nutrition ratios, which generally holds that carbohydrate is limited to 40% or less for daily calorie intake. The mix of fat and protein calories in a controlled-carb approach is highly individualized and the goal is to include quality protein in adequate amounts and only include quality fats and oils."

Six years later, I still hold the opinion that today, controlled-carb nutrition can model the diet of our ancestors; typically called Paleo and/or Primal eating. In fact, I'd say it would be difficult to consume a diet high in carbohydrate (greater than 40% of calories from carbohydrate) without specifically focusing on eating a high level of carbohydrate each day.

Has this become clearer in the years since I started this blog?

Not really.

In truth, time has created a variety of differing opinions that leave many confused; worse is that some seek to create divisions where none need be.

Recently Jimmy Moore posted AHS12: A Dichotomy Of Differing Interpretations Of What Paleo Is. In it, he writes, "However, when it comes to starchy carbohydrate sources of nutrition such as white potatoes, sweet potatoes or white rice (the toxin-free “safe starches” identified as such by Paul Jaminet), there’s a definite divide between those who avoid them because they raise blood sugar and insulin levels as well as lipid numbers to unhealthy levels (...) and those who believe these starches provide the adequate glucose your body needs to perform and function as it was intended to. That’s quite a division within the Paleo community that doesn’t have an easy answer to bridge the chasm."

Is this really a division within the Paleo community? Is this really a chasm that needs a bridge?

Honestly, I don't think so.

As I noted in my comments on his link to the blog on Facebook, "Paleo is a guideline to the types of foods one can eat, not the amount one *should* eat of any particular macronutrient; low-carb is one dietary approach which fits in with a paleo diet. Both focus on quality protein, good fats and nutrient dense carbohydrate. What level of carbohydrate you consume is your business, Paleo is basically just the framework for what foods to choose from. I don't think paleo has to be low-carb to be effective. It really is dependent on the individual."

One of the things I've learned over the last decade is that nothing is set in stone when it comes to macronutrients - the diets of healthy, normal weight individuals, around the globe vary greatly, what matters most is the micronutrient composition in the overall diet; it's habitually meeting or exceeding essential fatty acids (EFA), essential amino acids (EAA), essential vitamins, minerals and trace elements. The Japanese do that by consuming copious amounts of fish and pork, but their overall diet is lower in fat than those in France, who also do that with a wide variety of meat, full-fat dairy and a boatload of non-starchy vegetables and fruits. Both diets also have starchier foods too, yet these populations are not, nor have they ever been, suffering alarming rates of obesity.

Why?

If you look at diet quality, both Japan and France are eating serious quality foods, real foods, compared to the US and other nations with exploding obesity rates.

Quality matters; it is the heart-and-soul of Paleo, it is the heart-and-soul of Primal. The focus of ancestral eating (Paleo and Primal) is real food, shunning the processed and choosing quality. It defines no specific level of macronutrients by gram or percentage, but does point to nutrient density and meeting essential nutrient requirements. While one can follow a low-carb diet and eat Paleo-Primal style, that does not mean Paleo-Primal is low-carb per se; although, as noted i the paper by Cordain et al, Paleo-Primal diets are lower in carbohydrate than the Standard American Diet (SAD).

I do not think we have this deep divide, I think what we're seeing is a wide variety of approaches to reach the same goal - eating healthfully for the long-term. For some that includes soaked and fermented grains (Weston A. Price Foundation), for others eliminating grains is important, but dairy and legumes, along with other foods that are newer in our history may be included (Primal), and still there are those who hold that those foods, eaten by others in the spectrum of eating "real food", are simply unacceptable, just say no (Paleo). At the end of the day, the common theme amongst all - eat real food!

As one commenter noted on Jimmy's blog, "We do not currently understand everything about the variation in individual response to carbohydrates, such as sex differences, or dependence on history of metabolic dysfunction. We also do not completely understand how an individual’s dietary needs may change as a function of time depending on external
conditions. In addition, how much carbohydrate a person will do best on will depend on their goals (performance, longevity, reproductive health), but once again we do not understand the complete picture!"

I concur! Many things factor into weight loss and long-term health, eating real food is the one thing that continues to be the most important aspect of a healthy diet.

Chris Kresser nailed it last year, in his post Beyond Paleo: Moving from a Paleo Diet to a Paleo Template.

Rules to Drink it Up!

Three rules specify the importance of adequate hydration and choosing beverages wisely.

Rule 9:

• Avoid foods or drinks sweetened with aspartame. Instead, use sucralose or saccharin. Be sure to count each packet of any of these as 1 gram of carbs.

Rule 10:

• Avoid coffee, tea and soft drinks that contain caffeine. Excessive caffeine has been shown to cause low blood sugar, which can make you crave sugar.

Rule 11:

• Drink at least eight 8-ounce glasses of water each day to hydrate your body, avoid constipation and flush out the by-products of burning fat.

Starting with the last one, drinking eight 8-ounce glasses of water, provides direction to make sure we consume enough fluids each day.

It's universally accepted that water is important; with disagreement as to whether fluid intake must be water itself or any beverage that helps provide hydration. I tend toward the belief that all fluids count toward water intake - if someone wants to drink water, great!; if someone wants to consume iced tea with lemon or a diet beverage, great! It's all good as long as we also are mindful of the other rules which have important considerations when choosing what to drink.

Rule nine limits consumption of artificial sweeteners and specifically suggests that we avoid aspartame (NutraSweet, Equal) because evidence suggests it stimulates insulin and may cause lowering of blood sugars. This in turn would trigger hunger and leave one open to eating more than desired. Else where in Atkins book he provides an allowance of three packets of articifical sweetener each day of the two he recommends. This limit isn't to say you can't have something sweet, but rather forces selection and limitation as you're starting a low-carb diet.

That one must count each packet of any artificial sweetener as 1g of carbs - this alone places a limit on how much you can have in a day, without stating it, if you're following rule three and getting the majority of your carbs from vegetables and salads. Long-term, into maintenance, this is an excellent rule - it limits your exposure to chemical sweeteners and lessens the chance you'll use them in excess if you continue to follow this rule for the rest of your life.

The potential of caffeine to affect insulin and blood sugars is also included in the rules. Each time you have caffeine, your body has an insulin response and the potential for cravings to be triggered. In addition to the potential for cravings being induced by caffeine, there is also the risk of feeling more hungry and eating more than you would had you not had the caffeine. While initially caffeine may supress the appetite, later after its effects are waning, you may actually feel more hungry than you would have had you not had the caffeine.

It is especially important in the first two weeks to do all you can to limit your cravings; as you can see from the above rules that are in place, many of them aid in limiting the cravings to keep you on track. It is also important to begin to fully understand "hunger" and how much sates your appetite rather than leaving you stuffed. By avoiding caffeine, limiting artificial sweeteners and keeping yourself hydrated you're accomplishing this goal.

Dehydration when following a low-carb diet, due to ketosis, is to be avoided. It will increase the concentration of ketones in your body and the result is less efficient buring of fat for energy. You'll also run a greater risk of getting constipated, as well as, a greater risk of painful headaches. Proper hydration while you're in ketosis will help to eliminate the ketones from your body in your sweat, urine and respiration - you need the water intake to accomplish this each day.

As an aside, I've found caffeine has little effect on me. Over the years I've noted that it's a "your mileage may vary" type thing and usually recommend an individual see how they feel with and without caffeine in their daily menu.

Keeping Our Eyes on the Ball

Today I'd like to interrupt my series on understanding the short and long-term lessons found within the Rules of Induction (Atkins) and provide space for my husband, Dr. Gil Wilshire, MD to share his thoughts in a guest commentary. So, without further ado:

Keeping Our Eyes on the Ball
Gil Wilshire, MD, FACOG

Back in 2006, Regina and I were interviewed and asked about our thoughts on the future of dietary science and policy. We speculated that carbohydrate restricted diets would be an accepted, main-stream concept by the year 2040. I believe we are well on our way to seeing our goal fulfilled well before this arbitrary temporal milestone.

I try to remain constantly vigilant with regard to new scientific information, and it seems that in every month good, new information is published. Recently, Matt Hayes and colleagues (J. Nutr. 137:1944-50, 2007) drilled deeper into out understanding of carbohydrate restriction, metabolic syndrome, and the biochemistry behind satiety. I am pleased to see that our current shared clinical experience of spontaneous caloric control and rapid reversal of metabolic syndrome is now being bolstered by more clinical data. Although the study in question was rather timid with respect to carbohydrate restriction (it was a South Beach-type protocol) I still found the information valuable.

It is another, peer-reviewed paper to the ever-growing pile of scientific evidence supporting our position.

I would also like to add that my ever-growing clinical experience in my new home of Central Missouri continues to be very gratifying. It seems that not a month goes by where something good happens very quickly after a patient begins their new life style (I dislike the thought of "diets"...this implies a temporary change, instead of a whole new way of being). In my obese, "infertile" patients, it is fairly common for women to become pregnant before instituting hormone therapies. Women who appeared destined for the bariatric surgeon are losing huge amounts of weight...and now are making appointments with the plastic surgeons!

I must say, there are many doctors in the surrounding communities who are truly scratching their heads as our mutual patients make healthy progress eating "high fat" diets. Now, after some period of suspicion, I am actually getting requests to learn more about what we do in my office!

Positive results are very persuasive.

Nothing succeeds like success.

Being married to Regina is never boring, and I am privileged to hear all the latest details occurring within the nutritional community every night when I get home from the office. We are a disparate lot in the "low carb" community, with much independent thinking and talented, innovative thought leaders. I suspect that the field of nutrition and metabolism will never be one of lock-step agreement. However, I would like to take this opportunity to reiterate our common goals and to reinforce our shared understanding:

1) Current dietary recommendations that promote low-fat and low cholesterol diets are unscientific, unproven, and fatally flawed; and,
2) The vast majority of modern humans appear to function best when eating nutritionally dense, whole foods that most closely resemble those foods on which we evolved.

I believe it is these principles that unite us all. There will always be bumps in the road, and we must always be prepared for unexpected turbulence. That's life.

Let's keep our eyes on the ball! Slow, steady progress always wins the race.

Good health to us all!

Gil
Mid-Missouri Reproductive Medicine & Surgery

Handing you the Keys to Success

All weight loss diets come with some sort of rules; how much to eat, what to eat, when to eat, how to control portions, etc. The weight loss diet that enabled me to finally lose the excess weight was Dr. Atkins' New Diet Revolution (1992/1999), and like all other diets had its rules to follow - the Rules of Induction.

While Induction is heavily criticized by many, it is the period I call "back to basics" for the individual just starting out. While one is to carefully count carbohydrate, eating no more than 20g each day, they are also encouraged to view foods once subject to elimination or strict limitation differently; foods like whole eggs, red meat, full fat salad dressings, cream and real cheese are allowed, while "low-fat" products are strongly discouraged.

Within the books published by Dr. Atkins, the list of foods allowed during the first two weeks includes almost any red meat, poultry, fish, shellfish, fowl or game; with caution to limit or avoid nitrates and processed meats. Real whole milk cheese, cream and half & half are allowed within the dairy group, with limits on intake each day if one is consuming them; a long list of non-starchy vegetables and fruits (that is fruits that are fruits that we often don't recognize as "fruit" but are fruits - olives, macadamia nuts, summer squash, cucumber, tomatoes, etc.); all herbs and spices, and finally what to drink and what types and quantity of artificial sweetener is allowed.

One reason I call this the "back to basics" period in the diet is because it is focused on whole foods and provides for the most important essential nutrients our metabolism needs each day - quality protein (essential amino acids), quality fats (essential fatty acids) and nutrient-dense carbohydrates (essential vitamins, minerals and trace elements). The plan also encourages one to supplement with a high quality multi-vitamin (with minerals including potassium, calcium and magnesium; without iron) and provides additional information about other supplements if necessary.

In addition to the basic foods allowed during the period of Induction, the diet focuses the individual to follow what are called the Rules of Induction as a way to help them follow the diet correctly.

The Rules of Induction, from the 1999 publication of Dr. Atkins' New Diet Revolution are as follows: (they differ slightly from those published online by the company since his death in 2003; to read the updated version, published by Atkins Nutritionals, click here)

1. Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating.
2. Eat liberally of combinations of fat and protein in the form of poultry, fish, shellfish, eggs and red meat, as well as pure, natural fat in the form of butter, mayonnaise, olive oil, safflower, sunflower and other vegetable oils (preferably expeller-pressed or cold-pressed).
3. Eat no more than 20 grams a day of carbohydrate, most of which must come from in the form of salad greens and other vegetables. You can eat approximately three cups - loosely packed - of salad, or two cups of salad plus one cup of other vegetables.
4. Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.
5. Eat nothing that isn't on the Acceptable Foods list. And that means absolutely nothing! Your "just this one taste won't hurt" rationalization is the kiss of failure during this phase of Atkins.
6. Adjust the quantity you eat to suit your appetite, especially as it decreases. When you're hungry, eat the amount that makes you feel satisfied, but not stuffed. When you're not hungry, eat a small controlled carbohydrate snack to accompany your nutritional supplements.
7. Don't assume any food is low in carbohydrate—instead, read labels! Check the carb count (it's on every package) or use a carbohydrate gram counter.
8. Eat out as often as you wish but be on guard for hidden carbs in gravies, sauces and dressings. Gravy is often made with flour or cornstarch, and sugar is sometimes an ingredient in salad dressing.
9. Avoid foods or drinks sweetened with aspartame. Instead use sucralose or saccharin. Be sure to count each packet of any of these as 1 gram of carbs.
10. Avoid coffee, tea and soft drinks that contain caffeine. Excessive caffeine has been shown to cause low blood sugar, which can make you crave sugar.
11. Drink at least eight 8-ounce glasses of water each day in addition to anything else you may drink, to hydrate your body, avoid constipation and flush out the by-products of burning fat.
12. If you are constipated, mix a tablespoon or more of psyllium husks in a cup or more of water and drink daily. Or mix ground flaxseed into a shake or sprinkle wheat bran on a salad or vegetables.

You may be wondering why I'm posting this here, today, on my blog?

The reason is simple - over the years of following a diet that is controlled-carb, and maintaining my weight loss, I've realized that the above Rules of Induction contain the keys to long-term maintenance. The critical points needed to succeed in the long-term are right there if we look closely and examine why they are in place for the first two weeks, and why they are necessary throughout weight loss and maintenance.

Years ago I wrote an article for a publication that has since gone out of business, and my original copy is long gone. So, without that in hand to simply re-post here, I'm going to re-write it from my longer-term perspective today, some years later, continuing to follow a controlled-carb approach.

In the coming days and next week, I'll take one or two (if they are related) rules and explain why they are critical in the first two weeks, and the lesson I believe they are teaching us for the long-term. I'll begin tomorrow with the first rule, "Eat three regular-size meals a day or four or five smaller meals. Do not skip meals or go more than six waking hours without eating;" and provide data as to why it is important not only in the short-term, but also for long-term success.

As you'll learn in the upcoming posts, each of the rules looks to foster one or more things, including:

1. Your responsibility in what you eat
2. Breaking habits that contribute to weight gain
3. Establishing a solid foundation for healthy eating in the future
4. Providing the tools & strategies you'll need to maintain your weight loss
5. Creating good habits that lead to better health
6. Your health and well-being is in your hands and is your responsibility in the long-term

UPDATE: Thank you to a reader who sent me an archived copy of the original article, which i will link to at the end of the upcoming series, for my readers to compare my changes to with my additional years perspective to add to!

Is There a Secret to Success?

Lou Shuler, over at Male Pattern Fitness wrote about the article in Slate yesterday and asked What if Nothing Works?

Weight loss advice almost never helps anyone lose weight.

And yet, something must work. We all know people who've lost weight and kept it off. We've all known non-exercisers who became exercisers. We all know people who've turned their lives around by eating better and exercising more, or at least more effectively.

[...]

Instead, researchers tend to discover, over and over again, that whatever we're doing now just isn't working for most of the people who try it. And sometimes the results are worse than they would've been if the dieters hadn't tried at all.

His observation is dead on if you ask me.

True, I know some people who have lost weight and maintained their lower weight for years (myself included), but I know many, many more who were able to lose weight effectively in the short term, but then as time passed, the weight was regained, sometimes leaving the person heavier than before they dieted to lose weight.

If we look at data from the National Weight Control Registry (NWCR) a self-reported database of "successful losers," we're told they have four similar behaviors post-weight loss:

1. They eat a low-fat diet (23-24% fat) with just 1300-1500 calories a day
2. They eat breakfast everyday
3. They monitor weight frequently with 75% weighing themself once a week
4. They engage in a high level of physical activity - 60 to 90 minutes a day

Me?

None of the above - daily I eat almost twice as many calories each day with a lot more fat; I skip breakfast more often than not; if I remember I might weigh myself once a month and my activity is daily routine stuff, not a formal exercise program specifically to meet certain targets each day.

For me, it's been eating adequate calories to meet, yet not exceed, my active metabolic requirements each day with primary focus on consuming sufficient quality protein - whatever fat that includes, so be it; eating breakfast if I'm hungry, but not forcing myself to do so if I'm not; I weigh myself occasionally and if my clothes feel a bit snug, weigh to see what's up - if I'm a few pounds up, I review what I'm eating daily and make adjustments if necessary; and I maintain a level of activity that really isn't much more than day-to-day things, but I do have to say includes keeping up with an extremely active almost three child!

Which leaves me wondering - how do you maintain weight once you've lost weight?

If you've lost weight and are able to maintain that loss, share here how you've done it...if you've lost to only re-gain the weight, what do you think is the problem?