April 01, 2005

Why don't you include cholesterol counts with your recipes?

Frequently Asked Question:

Why don't you include cholesterol counts with your recipes?

Simple: I don't want to perpetuate the fiction that cholesterol is something to be avoided. There simply is no good reason to believe that dietary cholesterol causes health problems, and there is at least some reason to consider it beneficial.

You need to understand the difference between dietary cholesterol and blood cholesterol. There has been, for the past few decades, a belief that high blood cholesterol is a cause of heart disease. That belief is questionable - most people who have heart attacks have never had high blood cholesterol. Renowned heart surgeon Dr. Michael DeBakey puts the number of coronary artery disease victims with high blood cholesterol at between 30 and 40%. He has been quoted as saying, "If you say cholesterol is the cause, how do you explain the other 60% to 70% with heart disease who don't have high cholesterol?" Indeed, it's beginning to appear that inflammation is the root cause of the clogging of arteries, with blood cholesterol merely an innocent bystander.

But even if high blood cholesterol is in some way causative in heart disease, there's little evidence that eating cholesterol increases your blood cholesterol. We need cholesterol. It's essential for every cell in our bodies. Cholesterol insulates nerve fibers, maintains cell walls, produces vitamin D, various hormones, and digestive juices. If we eat less cholesterol, we make it in our liver. If we eat more, we make less. It's a clever natural balance.

The reason why a low carbohydrate diet causes a drastic improvement in blood work in most people is that high blood insulin levels can interfere with the body's ability to balance cholesterol production with cholesterol intake, causing runaway production of cholesterol in the liver. When you stop eating a lot of carbohydrates, and your insulin levels drop, your body regains its balance.

There is a minority of people who are "saturated fat responders," producing more cholesterol in response to some kinds of saturated fats, especially hydrogenated vegetable oils, the artificially saturated fats that we were told for so many years were better for us than naturally saturated animal fats like butter and lard, or tropical oils like coconut oil and palm oil. There is a big problem with much of the research, since food questionnaires often lump together commercial baked goods and fried stuff, nearly always made with trans-fat-laden hydrogenated oils, with things like cream, butter, cheese, and eggs, containing natural saturated fats and cholesterol.

But there's little evidence that eating cholesterol increases coronary risk. A 1994 study in the Journal of Internal Medicine looked at 12 men and 12 women, each eating 2 eggs per day for 6 weeks. Their total cholesterol did rise by 4% - but their HDL (good) cholesterol rose by 10% - meaning that their theoretical coronary risk had decreased. In an article in the American Journal of Clinical Nutrition, researchers looked at the Framingham study - the biggest, longest lasting study of heart disease to date. They found no relationship between egg consumption and coronary disease. For that matter, the Framingham Study turned up an interesting but little-mentioned fact: The study showed that those who weighed more and had higher blood cholesterol levels were more at risk for heart disease. Weight gain and cholesterol levels, however, had an inverse correlation with dietary intake of fat and cholesterol. In other words, the more fat and cholesterol subjects ate, the lower their rate of heart disease. Dr. William Castelli, MD, headed the study and had to admit in 1992:

In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people's serum cholesterol . . . we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least and were the most physically active.

And The Journal of Nutrition ran an article last year showing that even men who had an abnormally strong response to dietary cholesterol stayed within National Cholesterol Education Program Guidelines when adding 640 mgs of egg cholesterol per day to their diets.

On the other hand, as long ago as 1974, a Dr. Kummerow of the University of Illinois published an article called "Nutritional value of Egg Beaters compared with "farm fresh eggs"", detailing a study where he fed some rats lab chow, others real, farm fresh eggs, and still others Egg Beaters "99% real egg!" egg substitute - you know, the ones with no cholesterol. The rat pups fed the lab chow and the rat pups fed the real eggs did fine, while the rat pups fed Egg Beaters developed diarrhea, failed to gain weight properly, and all died within a month of weaning. As the researchers stated: "The general appearance of the rats fed Egg Beaters indicated a gross deficiency in one or more nutritional factors as compared to those fed whole egg." I'd eat the real eggs and brave the cholesterol, if I were you. (Says the girl who had three real eggs for breakfast this morning!)

A study done in Australia looked at the diets of women and children known to have either high, medium, or low blood cholesterol levels. No difference in cholesterol intake was found. (Nor was there a difference in fat or protein intake. I couldn't find information about carbohydrate intake!)

Too, it's important to note that the dramatic rise in heart disease in the 20th Century (and it was dramatic; coronary artery disease was rare before the 1900s) was not accompanied by any increase in dietary cholesterol intake, or, for that matter, animal fat intake. Just the reverse is true - the rise in heart disease came along with the shift from a diet heavy in butter, cream, eggs and lard, to one where those traditional fats were largely replaced with vegetable oils. This is particularly interesting because vegetable oils, and particularly polyunsaturated oils like corn oil, safflower oil, and soy oil, increase inflammation in the body - and inflammation is, you recall, now the most likely culprit in heart disease, not blood cholesterol.

Weighing on the other side is the fact that low cholesterol diets appear to cause depression and violent behavior in lab animals, and at least a tentative link between low cholesterol diets and cognitive problems. This is not surprising, since your brain is largely made of cholesterol. (And if you're pregnant, you really, really shouldn't limit dietary cholesterol - what will your baby make his or her brain from?)

In short, I'm convinced that, while there may be some reason for some people to limit some kinds of saturated fats (and every reason for everybody to completely eliminate hydrogenated oils,) limiting dietary cholesterol isn't good for anyone, and may be a very bad idea. I do not wish to encourage anyone to cut their dietary cholesterol intake, even by default. So I leave cholesterol numbers out of my nutritional breakdowns.

Posted by HoldTheToast at 01:26 PM

January 18, 2005

What the heck is ketosis? And how important is it to my low carb diet?

You hear the word "ketosis" bandied about a lot. Some low carbers consider it to be the Holy Grail, while anti-low-carbers claim it's the ultimate proof that a low carb diet is horribly unhealthy. So what the heck is ketosis, anyway?

More accurately called "dietary ketosis," the term simply means a state when enough ketones are being produced in your body that they are spilled in your urine in detectable amounts. They're detected by means of test strips, available at any drug store, which you pass through your urine stream.

"Oh, great," I can hear you groan. "So what the heck is a "ketone," why would my body make one, and is it dangerous?"

A ketone is a perfectly normal byproduct of metabolism. They're made in your liver, and your liver is actually manufacturing ketones all the time. They're a by-product of fat metabolism. However, since your body will always choose carbohydrate for fuel over fat, if you give your body some carbohydrate every few hours, as most people do, you don't burn much fat, and you don't make many ketones. When you restrict carbohydrate intake, your body switches over to burning fat for fuel - a good thing! - and as a result, makes more ketones. Your body then uses those ketones for fuel - the vast majority of tissues in your body can burn ketones for fuel as happily as they would burn glucose or free fatty acids.

So spilling ketones in your urine is proof that your body is burning fat as its primary fuel, and this is why Dr. Atkins wanted people to test their urine for ketones - it was a sure-fire way of knowing whether they'd cut their carb intake low enough to be running a fat-burning metabolism instead of a glucose-burning metabolism.

Being in ketosis has some interesting effects. Most people find that ketosis suppresses appetite, always a good thing when you're trying to lose weight. And many folks, me among them, have found that ketosis causes a mild euphoria, a state of high energy and feeling very "clear." Since we know that the body goes into ketosis during starvation, because in the absence of food all it has to burn is body fat, I suspect that this state of cheerful energy and focus is a survival mechanism - it helped our ancestors get out there to hunt and gather.

Some low carb critics turn this around, and say that a low carb diet puts your body into "starvation mode," as if this were some sort of terrible thing. As my pal Johnny Bowden says in his superb book Living The Low Carb Life (a book that is so well-written and informative, I keenly wish I had written it myself), saying that because starvation is bad, ketones are bad, is like blaming umbrellas for rain.

It is very important to understand that while testing for ketones in your urine can give you an idea if you're burning fat, it cannot tell you whether you are burning body fat or dietary fat. You can burn fat all day long, and if you're taking in 10,000 calories a day, you'll gain weight - because you're not burning anywhere near as much fat as you're taking in. So please, don't just test your urine, think "Oh, I'm in ketosis, I'm burning fat!" and assume that "burning fat" is the same thing as "losing weight." It is not.

Too, not testing positive for ketosis is not proof that you're not burning fat - you may just not be burning enough to test positive, or you may have burned up a lot of your ketones by exercising, or you may have drunk so many fluids you diluted your urine to the point where you tested negative. The point is, ketosis is a useful tool, but not the be-all and end-all of low carb dieting.

Not all low carb diets involve ketosis anyway. I generally eat 50 or so grams of non-fiber carbs per day, mostly as vegetables, and that's enough that I'm not in ketosis. If you're on one of the diets that stresses "good carbs" over restriction of the total quantity of carbs, you may not go into ketosis, either. If you feel good and you're losing weight, not to worry.

What about those horrible, dire warnings about ketosis? There's even a warning on the jar of ketosis test strips! Breathe easy. The warnings are about ketoacidosis. This is a very dangerous thing, but it only happens to type 1 (insulin dependant) diabetics.

Here's the deal: There are two opposing hormones - insulin, which you've heard of, and glucagon, which is less well known. Insulin is responsible for storing fat, and glucagon is responsible for releasing it into the bloodstream to be burned. In the total absence of insulin, which only happens in type 1 diabetics, the body dumps too much fat into the bloodstream and starts to make ketones. But at the same time the diabetic, because he or she has no insulin, is running very high blood sugar levels. Since the body will always burn glucose first, the ketones pile up in the bloodstream to extreme levels that cannot occur with a low carb diet. There is simply no reason to equate what is a disease state to dietary restriction in a healthy person.

So there you go: Ketosis is a way of knowing if you're burning fat for fuel. It is a useful indicator, and can even be an aid to dieting by making you less hungry and more energetic. But it is not proof that you are burning body fat, and it is not essential to low carb success, though it can be helpful.

And ketosis certainly isn't a dangerous, abnormal state - indeed, there's every reason to believe that our hunter-gatherer ancestors were frequently in ketosis.

Posted by HoldTheToast at 09:40 PM

November 17, 1999

Isn't this an all meat diet? How can that be healthy?

This is one of the most common misconceptions about a low carb diet, and one that I'm afraid many of the leaders in the low carb field haven't handled too well. Dr. Atkins protested recently that vegetables weren't needed for health (true on one level, extremely questionable on another), while the Hellers have people convinced that broccoli is high carb, which is most emphatically is not. (It has about the same carb count as green beans, which they consider a low carb vegetable. Go figure.)

A low carb diet is not, and was never meant to be, a NO carb diet. Even during its most restrictive Induction phase, for instance, the Atkins diet allows 2 cups a day of low carb vegetables, which is far more than the average American is eating. And many low carbers eat low carb vegetables in pretty much whatever quantities they want, to good effect. There's no reason in the world you can't have peppers and a few onions (easy on the onions, they're a borderline veg) in your scrambled eggs for breakfast, put celery in your tuna salad at lunch, and serve it on a bed of lettuce, or stuffed into a tomato, and have mushrooms on your steak and broccoli on the side with your dinner -- even all in the same day.

It's not even true that you can't have any fruit on a low carb diet, although more fruits are high carb than are vegetables. Strawberries, blackberries, raspberries, blueberries, cantaloupe, honeydew -- all these are very low carb fruits. Grapefruit is about 10 g a half, and a fresh peach is about the same, a plum is slightly less. You don't want to pig out on fruit, but a 2" wedge of melon, or a half-dozen strawberries for dessert is just fine.

You do, of course, want to be aware of the few high carb vegetables --
things like peas, corn, winter squash, and potatoes -- but that should just be part of an ongoing policy of knowing approximately what the carb count is of everything you eat. Get a food count book, and use it! Knowledge is power.

What about that assertion that "You can be healthy without vegetables" is, on one level, true? Well, the Eskimo ate just about no vegetables in the winters, although they ate fruits and vegetables in season (short season!), and they didn't get any horrible deficiency diseases. But then, they ate a lot of their meat raw, and ate all the organs and such, as well as the muscle meats. Also, despite not having heart attacks or diabetes or obesity or rotten teeth, they didn't necessarily live to great ages -- easy to die of an accident living where it's that cold -- so we don't know about some diseases that come with age. I'm not sure it's a good idea to base our diet completely on the diet of the Eskimo.

There is considerable evidence that vegetables have very valuable phytochemicals along with their vitamins and minerals, and they also add
far more variety, volume, and fiber to your diet for the carbs they carry than anything else could. Further, while it has now been shown that fiber, in and of itself, does not prevent colon cancer, eating vegetables -- a very specific source of fiber -- seems to. So eat your low carb veggies!

Posted by HoldTheToast at 08:14 PM