Is low carb the new 'healthy eating'?
Low carb diets have been around for many decades but their popularity declined in the 70s, 80s and 90s due mainly to unsubstantiated concerns about their safety. However, research since then has shown these concerns to be scientifically groundless. In fact, better understanding of the science behind low carb diets and the link between high carbohydrate intake and obesity, heart disease and diabetes has led many researchers to believe that low carbing is actually more healthy than the low fat/high carb diet we are all currently advised to follow. An article which appeared in The New York Times on 7 July 2002 by journalist Gary Taubes, 'What if It's All Been a Big Fat Lie?' gives an excellent insight into this fascinating subject, as does Journalist Jerome Burn's article 'The Myth of the Low-fat Diet' , which appeared in The Independent on 8 May 2002. In his 22  November 2003 article 'Why the Atkins Diet is Healthy'UKdoctor Malcolm Kendrick discusses the role of fats in the diet. He explains how the belief that a diet high in saturated fat causes high cholesterol/lipids is wrong, and that the accepted truth that high cholesterol causes heart disease is incorrect in any case.
In 'The Dangerous Duo' Sheila Buff, health writer further explains the connection between high blood pressure, hyperinsulinism, insulin resistance, diabetes and heart disease and why refined carbohydrates such as sugar and flour, and not fat, are being hailed as the real villains. Teenage acne is also now being blamed on the insulin connection caused by high carbohydrate intake by some dermatologists, as explained in an article which appeared in New Scientist on 5 December 2002 'Plague of pimples blamed on bread'.
A sure sign that the low carb message is getting through to the US population at least is the falling level of grain consumption in the US. An article by Carey Gillam of Reuters on 18 March 2003 entitled 'Beef vs. Bagels: US Food Firms Take on Dr Atkins' illustrated the extent of the US grain industry's concern and its plans to prevent any de-emphasis of grain in the upcoming revision of the US healthy eating guidelines, or 'Food Guide Pyramid'. The grain industry is of course only one of a number of industries worldwide whose vested interests in the status quo will lead them to deny the findings of the latest research and to lobby against changes to governments' healthy eating advice for as long as they possibly can.
Meanwhile, attitudes continue to change in favour of a low carb way of eating. Take athletes for example, who for years have believed that only high levels of carbohydrate can supply their energy needs. Now, increasing numbers of amateur and professional athletes, especially endurance athletes, are rejecting the practice of 'carbohydrate loading' and turning instead to an individualised, controlled carb regime. There is even a team of 2004 Olympics hopefuls following the Atkins Diet, as can be seen in a November 2003 article 'Olympic Hopefuls Follow Atkins for Competitive Edge in Sailing'.
Low carb diets are not however just about reducing carbs. The Atkins Diet in particular teaches the benefits of plenty of salads and vegetables, fruits if you can tolerate their sugar content and other unprocessed wholefoods such as pulses or legumes (peas, beans and lentils) and wholegrains. It also warns of the havoc that the hormones and other chemical additives and residues that we increasingly find in our food can play with our metabolic processes. Genuine low carb diets are not fad diets or quick weight-loss diets - they are a nutritionally and hormonally based way of eating which promotes improved health, prevents and treats diabetes (type 2), improves heart disease risk factors and produces weight loss in the up to 60 per cent of the population who are carbohydrate-sensitive.
Low carb diet trials
Until recently there has been a lack of proper scientific studies investigating the efficacy and safety of low carb diets. However this situation is now changing. Results of trials published so far have shown that, contrary to popular belief, low carb diets such as Atkins are very effective and safe. These trials have also shown unexpectedly good improvement of risk factors for heart disease such as triglycerides, cholesterol and blood pressure. The consistency of these recent findings is causing more and more experts to question their long-held beliefs that to be healthy a diet must be low in fat. Amongst these studies are the Westman study published in the Cleveland Clinic Journal of Medicine (November 2002), the Foster study published in the New England Journal of Medicine (May 2003) and the Samaha study also published in the New England Journal of Medicine (May 2003).
In the UK a 6 month trial has recently been conducted by SurreyUniversity and others which compared four leading diets. These were: Rosemary Conley, Weightwatchers, SlimFast and Atkins. The trial was followed by a BBC series called 'Diet Trials' and the main conclusions relevant to the Atkins Diet (the only low carb diet amongst the four), quoted more or less verbatim from the final programme on 3 April 2003 were:
There is a lack of evidence of harm for Atkins - Atkins is   safe
Triglycerides fell more on Atkins than any other diet
Cholesterol improved more on the other diets but the Atkins   diet didn't make cholesterol any worse
We know Atkins is as effective as the other diets and it's   safe in the short term but there are still questions to be answered on the   long term position
The trial was conducted as a proper scientific study and will be written up as a paper for an academic journal in due course.
Another study published in April 2003 (J ClinEndocrinolMetab. 2003;88:1617-1623) reports that low carbohydrate dieters lost more weight than those on a calorie-restricted low fat diet even though the calorie load was similar. This refutes the commonly heard claim that low carb diets only work because the dieter takes in less calories. The article is available from Medscape (free registration required).
Yet another study in 2003 confirms that consuming a diet high in protein rather than one high in carbs makes it easier to shed fat while preserving muscle - as reported by Sheila Buff.
Pro-Atkins and low carb medical professionals
These recent landmark studies have caused many medical professionals to rethink their previously negative stance on the Atkins Diet and other low carb diets. Dr Trisha Macnair, who writes for BBC Health's 'Ask the Doctor' page, is but one example.
As the evidence grows, more medical professionals are starting to become familiar with the Atkins Nutritional Approach and other low carb diets. One example is Dr Sarah Brewer, who is a keen supporter of the Atkins Diet. Dr Brewer was a full time GP for five years and now works in nutritional medicine. She writes widely on complementary medicine and the sensible use of supplements, has written 40 popular self-help books and appears regularly on TV and radio. She is currently studying for an MSc in Nutritional Medicine at the University  of Surrey. Dr Dee Dawson, medical director at North London's Rhodes Farm Clinic, which treats children with eating disorders, is also using the diet, saying: 'The diet is good for youngsters. I think the basis of Atkins is a good diet for children whose priority is to get weight off.'
In the US the Atkins Physicians Council (APC) has been set up, consisting of medical experts in fields such as endocrinology, diabetes, cardiology, pediatrics, women's health, bariatrics and orthopedics. The mission of the APC is to help teach health care professionals to use the Atkins Nutritional Approach, to assist in educating consumers and to work with medical associations, parent and teacher associations and government agencies to address the obesity and diabetes epidemics by following this method of healthy eating. Also in the US, the newly founded Carbohydrate Awareness Council (CAC) aims to support the scientific basis of controlled-carb diet & nutrition. A not-for-profit organization, it is led by Dr Gil Wilshire, a reproductive endocrinologist with expertise in diabetes and metabolism and personal experience of successful weight loss the low carb way.
The science behind low carb diets
Low carb diets are based largely on the science of blood sugar control mechanisms. A very simplified explanation of the process is as follows: carbohydrate foods (starches and sugars) are converted by digestion to a form of sugar called glucose. The rising levels in the blood trigger the pancreas to release the hormone insulin. It is the job of insulin to keep the blood sugar levels stable and trigger the process by which excess glucose is removed from the bloodstream and, if not needed for immediate energy, stored as fat.
This storage mechanism was extremely useful in mankind's hunter-gatherer days. It enabled early man to survive in between his irregular and unpredictable meals. Unfortunately, this storage mechanism is not so useful where food, and carbohydrate in particular, is constantly in abundance. Our bodies were not designed to be fuelled by the highly refined carbohydrate-dense foods such as white sugar and flour that are now the staple foods of the Western world. In time the process of evolution might result in a population genetically adapted to such a diet, but this would take millions of years, not the tens of years that such foods have been available to us in the quantities in which we consume them today. Dr Atkins, New   York cardiologist and originator of the Atkins Diet, explains this more fully in his article 'The Caveman's Banquet'.
The trick is to stop this constant production of insulin. Low carb diets attempt to do this by avoiding glucose surges ('spikes') in the blood. This can be achieved by restricting carbohydrate overall, and by preferring those carbohydrates which rank low on the glycemic scale (ie which cause less rapid rises in blood sugar).
The Atkins Diet is probably the most well known and widely used low/controlled carb diet, but other examples include Dr Richard Mackarness' Eat Fat and Grow Slim Diet, SugarBusters, the Carbohydrate Addict's Diet, Protein Power, The Paleolithic Diet, Neanderthin, the Zone, the Go-Diet, Life Without Bread, the Eskimo Diet, the Stone Age Diet, the Schwarzbein Principle, the Specific Carbohydrate Diet, the South Beach Diet, Fat Flush Plan and the Radiant Health Programme. Although many of these diets have appeared relatively recently, the Atkins Diet dates back to the seventies and Dr Mackarness' back to the fifties. However, the first true low carb diet was around long before that - the Banting Diet. Used by William Banting in 1862 to lose 50lb in less than a year, he was so delighted to have found a way to solve his weight problem that he published a pamphlet "Letter on Corpulence" in 1864 at his own expense.
The link between high carbohydrate intake and obesity, heart disease and diabetes
At best, constantly high insulin levels may make it difficult for the individual to lose or maintain weight. However, if the overproduction of insulin is allowed to continue, insulin resistance may develop, more and more needs to be produced to get the same effect, and ultimately the stressed pancreas may cease to produce enough insulin or give up altogether, producing full-blown diabetes. Not only that, but there is a growing body of evidence to support the belief that it is these constantly high levels of circulating insulin (and not dietary or blood levels of fat) that are the real culprits in creating the damage that results in cardiovascular disease, whether or not diabetes is present.
This certainly helps explain why, despite more people than ever following the official 'healthy eating' guidelines (low fat/high carb), the incidence of obesity, heart disease and Type 2 diabetes is rising alarmingly fast. The pity of it is that those who are in the early stages of insulin resistance and pre-diabetes are quite likely to be unaware of the fact, although clinicians such as Dr Atkins report that these conditions are reversible at this stage by simply avoiding the cause of the problem - a carbohydrate intake that the individual is unable to handle. The UK Government recently estimated there to be over 1 million undiagnosed Type 2 diabetics in the UK alone, so the number of those at risk of developing the condition in the future must be considerably higher than that. And as explained earlier, even if these individuals ultimately escape the diabetes, the increased risk of cardiovascular disease still remains.
In other words, evidence is growing that the real villain in obesity, heart disease and Type 2 diabetes may be high dietary intake of carbohydrate, not fat. If this is the case, then it means that for many of us, following the current official 'healthy eating' guidelines may be entirely the wrong way for us to be eating.
Syndrome X/metabolic syndrome, PCOS and acne
A low or controlled carbohydrate way of eating is also increasingly being seen as beneficial in a number of other insulin-related conditions, whether or not weight loss is the primary aim, which include Syndrome X (also called insulin resistance or Metabolic Syndrome) and PCOS (Polycystic Ovary Syndrome). Teenage acne is also now believed to be related to insulin levels by some dermatologists, as explained in an article which appeared in New Scientist on 5 December 2002'Plague of pimples blamed on bread'.
Food allergy / food intolerance and candida
Low carb diets can also help where food allergies / food intolerances and candida (yeast overgrowth in the gut) are a factor in ill health. These conditions are increasingly considered by nutritional medicine practitioners to play an important role in inability to lose weight and other chronic problems ranging from headaches and indigestion to arthritis and irritable bowel syndrome. The literature demonstrates the largely unrecognised prevalence of these conditions and explains how they can be caused or fuelled by over-consumption of refined carbohydrates, leading amongst other effects to blood sugar/insulin imbalance and obesity.
The mainstream medical establishment, virtually untrained in nutritional and environmental medicine, remains to be convinced. However, this position is likely to change with the launch of a new pioneering course by the University  of Surrey to bring nutritional medicine into the mainstream of medical practice. Aimed at GPs, consultants, pharmacists and dieticians, the course offers Postgraduate Diploma and MSc qualifications in the use of nutritional methods to prevent and treat conditions such as food intolerance / allergy, cancer, diabetes and heart disease.
Dr Atkins and various other low carb diet authors acknowledge the existence of food intolerance / allergy and candida. They suggest they may be a reason why so many low carb dieters not only achieve weight loss but also find other health problems have improved or disappeared. Future research may confirm that these conditions are closely linked with the blood sugar / insulin regulation that is the underlying premise of low carb diets. What is for sure is that many low carb diets restrict or eliminate the foods that are most often implicated in these problems.
Ketogenic diets
By cutting carbohydrate intake to an extremely low level, the body can be made to 'change gear' and start raiding its fat stores for energy (called lipolysis). Diets which aim for this change of gear are called 'lipolytic' or 'ketogenic'. However, the change of gear will only happen once the body has used up its other, more readily available energy stores. One way of telling whether this has happened is to test for ketones, which are excreted as a harmless byproduct of this fat breakdown. This is called being 'in ketosis'. (Ketosis is commonly confused with, but has nothing to do with ketoacidosis, which is a serious complication of uncontrolled diabetes.) Testing for ketones can be done quite simply by using urine test strips. Further explanation of ketosis can be found on the Atkins Center website.
Of the numerous variations of the low or controlled carbohydrate diets around today, some are ketogenic and some not. Of the ketogenic type, the Atkins Diet is probably the best known and most widely used. SugarBusters, the Carbohydrate Addict's Diet, Protein Power, The Paleolithic Diet, Neanderthin, the Zone, the Go-Diet, Life Without Bread, the Eskimo Diet, the Stone Age Diet, the Schwarzbein Principle, the Specific Carbohydrate Diet, the South Beach Diet and Fat Flush Plan are some of the many other examples of low or controlled carb diets.
Epilepsy
The ketogenic diet is also being used in childhood epilepsy. Although the mechanisms are not fully understood, the ketogenesis alters the metabolism of the brain in a way that can reduce the risk of seizures. This treatment for epilepsy has long been known, but it had fallen out of favour over the years due to difficulty in keeping to the diet and concerns about cholesterol levels. However, much evidence now points to the fact that concerns about ketogenic diets increasing cholesterol levels were groundless and, as reported in The Telegraph on 9 March 2003, specialists at London's GreatOrmondStreetHospital are now urging the National Health Service to make the therapy more widely available in paediatric neurology centres. The explosion in popularity of ketogenic diets for weight loss purposes has spawned a plethora of low carbohydrate food substitutes and cookbooks and this should make it much easier for parents to cope with feeding a child on a ketogenic diet.
Low carb/GI vs low calorie diets
About the single worst thing you can do for long term weight loss is to restrict calories excessively. While very low calorie diets do take off weight quickly (which is what most people want), the long term results can be disastrous. The reason is that a severe reduction in calories (say to below 1200 a day) makes the body go into starvation mode, slowing metabolic rate. Once calories get below a certain point, even serious exercise will not prevent this slowing. And once you start eating again (as you can't starve yourself for ever), the lowered metabolic rate will cause you to gain weight even more easily than before. Additionally, significant calorie reduction triggers changes in fat storing enzymes, making them more active. Low carb and low GI (glycemic index) diets maintain calories at a high enough level to avoid this happening.
For many people, the effect of carbohydrates on their blood sugar levels is very much like an addictive drug, causing cravings which make dieting or even just controlling their eating effectively doomed from the start. Calorie-restricted diets do not address this problem, and may even aggravate it, if they emphasise intake of carbohydrates. Carbohydrate cravings usually disappear completely once past the initial few days of a low carb diet.
There are also significant differences in the type of weight lost on different types of diets. When you starve your body of calories, protein, and fat (as on the standard low fat/low calorie diet), it burns large amounts of both fat and muscle to provide energy. The loss of muscle reduces your basic metabolic rate, so you need to cut calories even more. On a low carb diet, your body burns fat, not your lean muscle tissue. If you do any exercise, you will even add lean muscle while still losing fat, thereby further increasing your basic metabolic rate, and enhancing the fat loss.
Low carb diets are not crash or fad diets. They are based on the scientifically proven fact that some people (possibly the majority of the population) are metabolically unable to handle large amounts of carbohydrate. The best low carb diets allow the dieter, once the excess weight has been lost, to find their individual level of tolerance for carbohydrates and to get used to the new way of eating. They also gradually guide the dieter to the realisation that going back to the old way of eating will not only put the weight back on but will also expose them to the other health risks that having this type of metabolism is increasingly being shown to involve.
Advances in knowledge since the early days of low carb diets have also shown that the carbohydrate restriction does not need to be as severe as was previously thought necessary to be effective. The new palatability and variety this has afforded low carb diets has made them enjoyable enough for long term use, ie for maintenance once the excess weight is lost. To illustrate the point, low carbers more often refer to their 'way of eating' than their 'diet'. This acceptability as a permanent way of eating is a significant advantage, as keeping the weight off in the long term is important and it is widely acknowledged that low calorie/low fat diets have failed dismally to deliver in this respect.
There is a tendency for those who 'do the diet without reading the books' to adopt a restricted, boring and monotonous way of eating. This is more reflective of a failure to understand how low carb diets work than a lack of variation inherent in them. It is also possible that low carbers who first encountered low carb diets in the bad old days of the seventies are unaware of the improvement on the variety front, both in terms of foods permitted and availability of low carb substitutes. Other factors that undoubtedly play their part are a widespread lack of knowledge of carbohydrate values, low carb substitutes and/or lack of time to learn how to cook the low carb way.
Low GI diets
Low GI (glycemic index) diets, of which Montignac is probably the earliest and best known, focus on foods which have a negligible or low impact on blood sugar/insulin levels. Although the 'rules' may look different, the foods eaten on a low GI diet are very similar to those eaten on a non-ketogenic low or controlled carb diet. The scientific reasoning behind these seemingly different diets is not contradictory. They are all based on the principle that many people cannot handle significant quantities of carbohydrates, particularly refined ones, which causes constant overproduction of insulin and high or unstable blood sugar levels.
Anti-ageing diets
The Perricone Diet (or Perricone Prescription) also emphasises low GI foods, although it is really intended to be a healthy eating programme that rejuvenates the body, the skin in particular, rather than a weight loss diet. Again, the idea that a diet emphasising low carb/low GI foods has an anti-ageing effect is not new - as can be seen from one of Dr Atkins' other books entitled 'Dr Atkins' Age-Defying Diet Revolution'.
The importance of breakfast
Don't skip meals, breakfast in particular. Research indicates that what you eat (or don't eat) at breakfast can to a great extent affect your metabolic status and blood sugar levels for the rest of the day. In a trial, those eating a protein and fat based breakfast felt less hungry and had more weight loss than those eating a carbohydrate based breakfast or none at all, even where total calorie intake and exercise for the day was the same.
Snacks - good or bad?
Snacking between meals or dividing three larger meals into a greater number of smaller meals is good, if this suits your own metabolism better. This is likely to be the case for those who do well on low carb diets.
Coffee and fizzy drinks
There is evidence that caffeine can stimulate the production of insulin and promote weight gain. This is one reason why cutting out coffee and cola drinks (even diet cola) is usually recommended on low carb diets.
Citric acid, which is found in many soft drinks, is also thought to hinder ketosis in some people.
The importance of drinking water
It is extremely important that you drink at least 64 oz (approx. 2 litres) of water per day, and it is suggested that you drink an additional 8 oz (approx. 250 ml) for every 25 pounds (approx. 11.5 kg) over your ideal weight. During hot weather, and any physically strenuous activity, you should drink even more. As Donald Robertson, an American doctor, explains:
"Studies have shown that a decrease in water intake will cause fat deposits to increase, while an increase in water intake can actually reduce fat deposits. This is because the kidneys can't function properly without enough water. When they don't work to capacity, some of their load is dumped onto the liver. One of the liver's primary functions is to metabolise stored fat into usable energy for the body. But, if the liver has to do some of the kidney's work, it can't operate at full throttle. As a result, it metabolises less fat, more fat remains stored in the body and weight loss stops.
Drinking enough water is the best treatment for fluid retention. When the body gets less water it perceives this as a threat to survival, and begins to hold onto every drop. Diuretics offer a temporary solution at best. They force out stored water along with some essential nutrients. Again, the body perceives a threat and will replace the lost water at the first opportunity. The best way to overcome the problem of water retention is to give your body what it needs - more water. Only then will stored water be released. The overweight person needs more water than the thin one.
Water helps maintain proper muscle tone. It does this by giving muscles their natural ability to contract and by preventing dehydration. It also helps prevent the sagging skin that usually follows weight loss.
During weight loss, the body has a lot more waste to get rid of - all that metabolised fat must be shed. Again, adequate water helps flush out the waste.
When the body gets too little water, it siphons what it needs from internal sources. The colon is one primary source. This can result in constipation, which is normally alleviated when enough water is drunk."
>SpecialDiets>LowCarbRecipes