Wednesday, July 10, 2013

The Nutrition Debate #124: A Lamentable Confusion Between Diets

From my perspective there are two popular movements on the ascendancy among the alternative diets. They are very broadly speaking Low Carb and Paleo. Lamentably I think there is confusion among  neophytes as to which is “right” or “best” to follow and for what reasons. I will attempt to explore the differences and communalities to clarify the options.

The modern era of the low carb diet is largely associated with Dr. Robert Atkins. Beginning in the early 1970s his diet was associated with a regimen in which carbohydrates were severely restricted (only 20 grams a day in his Induction Phase). The purpose of the diet was weight loss. It worked very well but was widely criticized, unjustly in my opinion, as dangerous. Other physicians, notably Dr. Richard K. Bernstein, developed specialized practices in which the low-carb diet was specifically tailored to diabetics, both Type 1s and Type 2s.

In July 2002 award-winning science writer Gary Taubes revived the Atkins controversy and substantially broadened the debate with his influential piece in the NY Times Sunday Magazine titled, “What If It’s All Been a Big Fat Lie?” In 2007 he produced his seminal tome, “Good Calories – Bad Calories” (“The Diet Delusion” in the UK), that further explicated his “Alternative Carbohydrate Hypothesis.” Among Taubes’s 10 “certain conclusions” (pg. 454) was, #2: “The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight and well-being.”

There are many practicing clinicians and researchers and bloggers out there today who espouse a low carb or even a very low carb diet for those diagnosed with Metabolic Syndrome, insulin resistance, carbohydrate intolerance, impaired glucose tolerance and any glucose control issue having to do with a disregulated metabolism. Severe restriction of dietary carbohydrates will improve glucose regulation and regularize your metabolism very effectively. It will also result in easy, hunger-free weight loss and greatly improved blood lipids, especially triglycerides and HDL lipoproteins, and, as a consequence of weight loss, improved blood pressure.

The low carb diet can still also be used as Atkins originally intended, which is principally for weight loss.  All of the attendant benefits (improved glucose regulation and blood lipids, and improved blood pressure after weight loss), will accrue. Frankly, I would recommend the principles of the Atkins diet to the entire U. S. population.

The modern Paleo movement in the U. S. came along much later than Atkins and about the time of Taubes’s 2002 seminal NY Times piece. In a few short years it has made a very big splash (in a certain niche: the “real food” crowd). An early proponent was Loren Cordain. Rob Wolf, an exercise physiologist who worked with Cordain, followed. Michael Pollan’s “Omnivore’s Dilemma” (2006) gave it a big boost. My favorite in this area is Dr. Kurt Harris, who came along a little later. He had an epiphany after hearing Taubes and reading his book (GC-BC). His Archevore program, originally dubbed Pa-Nu, is to avoid the Neolithic Agents of Disease (NAD): wheat, excess fructose and excess linoleic acid (Omega 6s). Several Paleo researchers, among them Paul Jaminet (PHD diet), Stephan Guyenet, Peter D. (Hyperlipid), J. Stanton (, and Chris Kresser blog regularly. Many Paleo fans regularly debate the issues at the PaleoHacks website.

The Paleo movement has also benefitted recently from a little organizing. The Ancestral Health Society held two wildly popular symposia (2011 in San Diego and 2012 in Cambridge, MA), the latter one selling out many months in advance. All of the major “players” were there, and YouTube videos of the various sessions are now available. The next AHS meeting will be in Atlanta, GA, August 15-17, 2013.

The Paleo movement, like low carbing, has many variants. However, it is not a program designed for glucose regulation, for people whose glucose metabolism is “broken,” or who need to regulate their blood sugar by diet. It will not produce the benefits needed if you are insulin resistant, carbohydrate intolerance, have Metabolic Syndrome, or are pre-diabetic or have been diagnosed with Type 2 diabetes. Many of the Paleo diet variants, for example, permit root vegetables (very starchy carbohydrates!) and even white rice! Rice is a non-wheat grain and therefore gluten-free, but it is still a very starchy food. For people who have insulin resistance and are carbohydrate intolerant, root vegetables and white rice will cause your blood glucose to go through the roof!

To summarize, Paleo is an appealing approach to eating a healthy diet, if you have a healthy glucose metabolism. I would definitely follow it if I did, but you have to know if your metabolism is “broken” before you decide. Get to know your health markers and don’t be in denial; if you are pre-diabetic, eat to your meter. If your metabolism is “normal,” then go “whole hog” with Paleo. Eat “real” (unprocessed) food, the way we all used to!
Do you have a meter? Have you tried any Paleo type meals? What are your favorite low carb or Paleo websites?

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