Sunday, September 2, 2012

The Nutrition Debate #64: Very Low Carb Eating: Ten Years Later

In August, 2002, I had been a morbidly obese Type 2 Diabetic for 16 years when my physician, who had tried for years (without success) to get me to lose weight on a “balanced” diet, said “Have I got a diet for you!” At 375 pounds I had been taking progressively more and more oral diabetes medications since my diagnosis in 1986. I was maxed out on a sulphonylurea (20 mg micronase), maxed out on Glucophage (2000mg metformin) and had recently started to take Avandia in failed attempts to control my progressively worsening blood sugar. When Avandia didn’t work, I was then (in 2002) going to be left with only one option: become an insulin dependent T2, injecting both basal and mealtime boluses.

It turns out, though, that my doc had recently read Gary Taubes’s July 7, 2002 cover story “What If It’s All Been a Big Fat Lie?” in the New York Times Magazine, and had decided to try the recommended diet for himself. I think it was the New York strip steak pictured on the cover that got him hooked. He’s an internist and cardiologist and had probably been carefully watching his saturated fat and dietary cholesterol intake for years. Anyhow, the Very Low Carb diet advocated in the cover story worked for him, and he thought it might work for me too. And as he walked me down the hall to schedule a follow-up appointment, he said, “It’ll probably be good for your diabetes too.”

Gary Taubes’s 2002 NYT Magazine cover story was a “game changer” in the world of Very Low Carb eating. It reached his target audience: clinicians, or at least mine. Taubes went on to write “Good Calories – Bad Calories” (“The Diet Delusion” in the UK), but he admitted in an Afterwords to the paperback edition that he considered he had failed to reach as many clinicians as he would have liked. Very Low Carb dieting is a tough sell. It is not the “standard of practice,” and the Public Health Establishment in the US and Britain and almost everywhere else (Sweden excepted) has not waivered much from the Lipid Hypothesis popularized by Ancel Keys about 50 years ago.

Taubes’s cover story touts, indeed lauds the principles behind The Atkins Diet, and that is the diet that my doctor had successfully tried himself, at least from a weight loss perspective. He lost 17 pounds. I don’t know if he did a complete blood chemistry and lipid panel on himself or even if he had been on it long enough to make a difference. But, I give my doctor his due for testing it on himself before departing from the “standard of practice” and recommending it to me.

Of course, within a day or two on strict Atkins Induction (20g carbohydrate a day), as a heavily medicated Type 2 diabetic I was experiencing “hypos” (dangerously low blood sugars). I called my doctor and he told me to stop taking the Avandia. The next day, when I was still having hypos, he said to cut the micronase and metformin in half and a few days later to cut them in half again. After that he saw me monthly for a year to monitor my blood and kidneys and other health markers. In the course of that year I further reduced the micronase from 5mg to 2.5 to 1.25mg and finally phased it out completely. I still take 500 metformin with dinner to suppress gluconeogenesis if (when) I eat too much protein.

In the first 9 months on The Atkins Diet I lost 65 pounds. I then retired from work and kept that weight off for several years. Then I slowly added back about 20 pounds (mostly from eating ice cream before bed, as I recall). By this time I had also been participating in an online diabetes forum, Dr. (Richard K.) Bernstein’s Diabetes Forum to learn all that I could about eating Very Low Carb. I had also read Bernstein’s “Diabetes Diet” and the first edition of his “Diabetes Solution,” so I decided to try his program. It is similar to Atkins but a lot more focused than Atkins was on blood sugar control.

On Bernstein I lost 100 pounds in just under a year (50 weeks). Altogether I lost 170 pounds, settling in at 205 pounds. Today, I have regained some of that weight. Frankly I have been “off the ranch” for long awhile, but I am still much healthier than before. I eat very low carb most of the time and have retained most of the health benefits. My average HDL has more than doubled (from +/- 40 to +/- 84) and my triglyceride average has been cut by more than 2/3rds (from +/- 150 to +/- 42). I try to limit my carbs to about 5% of my diet and my protein to 25%, leaving 70% for fat. I do not limit salt, dietary cholesterol or saturated fat. I eat eggs and bacon and coffee with half and half and Splenda for breakfast, and a can of sardines for lunch. For dinner, it’s just meat and a low carb veggie with lots of butter or tossed in olive oil and roasted. In a restaurant I’ll have a drink (or 2) or two glasses of wine. The only dessert I’ll eat is berries (with cream) on a very special occasion. I love a cheese plate, but it’s just too much food. I always regret if I occasionally order it.

I still see my doctor 3 times a year, and as I said at the beginning he only stayed on Atkins for a few weeks 10 years ago. I’ve been trying to get up the courage to suggest he go on Atkins again. He really should, for his health. Not just to lose weight (he’s got a big ‘carb belly’) but to improve his own lipid profile. I’ll bet it would. It really did work for me.              
© Dan Brown 9/2/12


  1. Thats great Dan, It seems though your calorie count is very low? I dont eat alot and people keep saying I need to eat more? But when I do I gain weight. I try to be low carb, but certinaly not under 20. I kill that with a salad and veggies. I have coffe with sugar free creamer and a a fruit for breakfast. Lunch is usually Chicken and hummas, Diner is grilled chicken on salad or steak with veggies. I excersise by riding my bike to a and from work 2 or 3 times a week(15 miles day) and once a week do 30 mile ride. I also ride horses 4 to 5 times a week depending the needs. I just cant figure out what I am doing wrong. I should be 30lb lighter and seem to keep gaining.

    1. I don't mention calories but you're right, it is low. My goal is 1200 calories a day. 20 gross/15 net carb grams, 65 protein grams and 90 fat grams, plus say 10 calories in fish oil supplements = 1200 calories. I can easily do 1000 calories a day and not be hungry, but it is less fun. As a 71 year old male who is mostly sedentary (I don't exercise at all), I figure that my metabolism burns about 2200 cals a day, so the deficit will be provided by body fat AS LONG AS I KEEP MY CARBS SO LOW THAT MY SERUM INSULIN DOES NOT BLOCK FAT BURNING. I also leave 14 hours between dinner and breakfast to make sure if I am not in ketosis during the day, which I probably am, that I definitely will be at night. That is when my body burns fat for sure, although with very low carbs for breakfast and none for lunch I am probably ketogenic all day. With a 1000 calorie a day deficit (7000 a week), I will lose 2 pounds a week pretty easily if I stick to the plan.

      You need to look at the carbs you are eating.YOU ARE EATING TOO MANY,in my opinion. Sugar free creamer is not low in carbs; it may be higher than sugar! I use heavy cream or half and half. Fruit is sugar, period! (and a little fiber). It will induce an insulin response, and the insulin in your bloodstream will 1)prevent fat breakdown and encourage fat synthesis. You have to avoid carbs to burn fat and lose weight. Salad is okay but pretty empty in calories. It's bulk also just distends the small intestine with negative effects (search Chinese Restaurant Effect at Dr. Bernstein's Diabetes Forum). And there are veggies and then there are veggies. Some are loaded in carbs. Besides all the starchy ones, I completely avoid corn, beets, carrots and peas. They are loaded with sugar. Try to eat nutrient dense whole foods, avoid wheat and all breads, pasta and rice; eat mostly protein with lots of fat. Don't be afraid of saturated fat. Monounsaturated fat (including chicken skin) is good. Polyunsaturated fat, especially corn and soy oil, is bad.

  2. Glad to see you give credit to GT and his observations/books which have helped so many people (including) me look at food for what it is. It can nourish you, but as it is pervasively now a minefield of toxins that assault us on the playground or in the cafeteria.

    Your very honest, continuing journey to undo years of damage and maintain a sane approach to critical nourishment is 50% priority--the other is joy doing this.

    As I type this comment I'm watching 60 minutes. Morley Safer is interviewing people who work for food producers designing, addictive chemicals to make us return to some of the very foods destroying our health.

    If only people recognized that food companies will sell you grains in the form of cereal, hydrogenated oil in peanut butter/Crisco, and HFCS with an orange taste--(all since the turn of the 20th century with Kellogg onward) to make them rich and you poor/sick.

    Atkins was of course right. Stay away from the packages. Eat real food.

    This appears to be another provocative, balanced expose' from 60 minutes, which is remarkable considering millions from the food industry spent there for advertising. Still, I see they gloss over the serious repercussions of what is becoming of food and people who eat these artificial and manipulative ingredients every day.

    1. Thanks, again, for commenting, Stan. Taubes is as you say 'right,' and so was Atkins, and so is Bernstein who writes from a diabetic perspective. His program is a fine-tuned approach to blood sugar control. He's a Type 1 but his approach can be used successfully by Type 2s and adapted by anyone who 'eats to the meter.' See the next two columns which I just wrote over the weekend.

      PS: It was good to see '60 Minutes' pick up on the subject of 'flavorings.' It is a Stephen Guyenet subject that has been batted around the Paleo/Ancestral community since at least the Ancenstral Health Symposium in California in August 2011. Palatability and food reward is what any animal wants to decide if the food is okay to eat. That's why kids are so fussy and generally don't like bitter things. It is, basically, a survival technique and how we choose one food over another. That profit-oriented producers figured that out is no surprise and, in my opinion, not to be condemned. That's what they should be doing, as long as we buy the stuff. The solution, as you say, is for us NOT to buy the stuff. Then they will sell what we buy. I believe in the marketplace. And that's the job of muckraking programs like 60 Minutes. I was a good segment.

    2. "I believe in the marketplace."

      Without getting into debating any pitfalls of embracing Libertarian/let-the-markets-decide allegiance--I, of course use the marketplace as we all do in this economy.

      However, letting food corps or any corps operate in a society that becomes increasingly dangerous to our environment/food supply because they claim profit is the only consideration is IMHO foolish, irresponsible and cruel. It always sounds good on paper, but the lawless consequences are inescapable.

      If we must wait until enough smart citizens are educated sufficiently to impact the market with wiser buying choices while FM philosophy allows the unregulated (that horrid word according to many capitalists), forces to rape us--we, it appears we are doomed as a civilization.

      Hyperbole? Dan, I don't need to remind you we have a globe that is dying along with the people eating and reaping what free markets have license to do.

      I enjoy reading your informative treatises on the better journey to fixing our damaged health and I appreciate them, though I must take issue with the idea that a better, informed populace will be our only salvation. Alas, how many of us must die fat, without healthcare, and drowning in polluted oceans to prove corporations will operate with moral integrity for everyone's good?

      They simply run with the money and must require oversight (that horrid word), to do otherwise continuing forward is too depressing and repugnant to contemplate.

    3. This blog is not about politics or even a larger world view. I do what I can wrt diet and health because I believe in individual empowerment. I do not aspire to change the world or even see it through a collective prism. I'm glad you enjoy my ramblings and are a follower. In fact, I value it, so lets leave politics to others.

    4. Thanks Dan for thoughtfully acknowledging my comments.

      I responded to your premise about the marketplace resolving the contamination of our food--whereas I pointed out even an informed, educated populace might not be successful against such economic control of our food supply. When people like me know what works through careful study of what's in a box or package and then take measures to avoid those groceries--have you noticed the battle we wage is not in our favor?

      I simply come to and read many weight loss, low carb, paleo sites like yours to learn about these things and care not to hear economics philosophy interjected. After all, it would seem presumptuous to think all those following a proactive, healthy lifestyle to improve themselves (and thus the world) would endorse free-reign abuse of consumers forced to buy food so pervasively adulterated. Ever visit a food pantry and sort through a donated box of 45 items for the cash-strapped, eager recipients and then look at the obvious signs of metabolic derangement sitting/standing there? The labels on the cans and wrappings tell the story.

      If you want an echo chamber and/or silence from your readers--it is your blog.

      I honor, respect and condone yours, others and my own struggle to be whole in body/mind respectfully.

  3. All right, Stan. If you want to continue the "debate," I'm game. I certainly don't "want an echo chamber and/or silence from (my) readers."

    You see the glass as half empty. I see is as half full. You see "the battle we wage is not in our favor." I see us making enormous progress. True, we are still a mere whisper in the roar of processed food manufacturing, but we are making a difference and we are making progress.

    I see the "enemy" as a triumverate. Big ag/food producers, big government (who has the wrong message and is trying to impose it on us all (everyone), and the public health establishment (doctors, dietitians, the AMA, The AHA, the ADA, etc.). I think the press will go in whatever way the wind blows.

    Obviously there is a "corrupt bargain" between all three of these forces. They influence each other in ways that are detrimental to our health and well being.

    Our job (as individuals) is to make all of the above clear to the public in general. If researchers, like many we both read, got funding to demonstrate the benefits of our Way of Eating and the harm of the present recommendations of the HHS and the USDA (the "food pyramid" and "Dietary Guidelines for Americans," for starters), we would see manufacturers change what they offer to the public.

    As a layperson, I can't do that, but I can get the message of the right-minded professional out there. That's why I source my columns generally. They are not just diatribes (sorry). If you doubt my commitment to this purpose as an individual, look at my Index of Columns between #59 and #60, or at the upper right-hand corner (Favorite Links) of the blog. This is the basis of the whole blog. I just don't think that anger or a big government response is the way to go. Call me a Civil Libertian in this, if you want. We just differ in the approach to the same end.

  4. "You see the glass as half empty."

    but with some organic wine for thy stomach's sake.

  5. Did you see the story about organics on the networks and cable this mornint? I can't wait to see the response from the organic community.

  6. No, but there is an article covering the rationale for it

    Again, the issue is so entangled with political/economic sides that people like you, me and the healthy-interested that care find it interesting, but contentious.

    Mark Sisson, (from MDA website), and other paleo advocates have made some good arguments for sustainability of land and water resources because non-factory farming (organic/grass-feeding practices) actually use less of those precious, depletion-intensive production requirements.

    That Midwest farmer at the ancestral symposiums and featured in a film about the damage of factory farming (can't remember his name or movie) cleverly does a number of things on his farm-family business.
    He rotates, the pigs and chickens in special wagons from field to field, for instance, to ensure they not only get the highest quality, natural foraging, but his soil is kept revitalized and sustained.

    I swear in my past life (or future) I'm a sod-buster.

    The shame is that most of the world's population will find any true organic, superior quality, natural food out of reach, whether its integrity is well-established or not.

  7. You're talking about Joel Salatin from Polyface Farm in Virginia. He's a real trailblazer. In a separate email (oops, I don't have your email). I was going to send you a newsletter from a couple who've been going to the Ft. Pierce Farmers' Market for a few years. They are retailers, basically, but they are now teaming up with other farmers who produce grass fed -- grass finished beef, free range, pastured chickens, etc. In the email the make a very good and detailed case for the economics of paying another dollar (their number) for the local, organic, grass finished product. If you want to see it, you can send an email to

    1. Thanks, Dan-he's the one. E-mail on the way.