Living Low Carb (57 page)

One of the first things he did was to go into people’s homes and perform an exorcism on their kitchen. Gently but firmly, he removed all starch, cereals, rice, popcorn, flour, pasta, sugar, and breads. Gradually the participants got the idea. Burgers were served, but without the buns. Fries were banished. Salads came without croutons. Butter and cream were back on the menu.

The First Nations people traditionally got a large percentage of their calories from eulachon grease—a rich monounsaturated fat extracted from a little smelt-like fish (the eulachon) that was a staple of the native diet. In the “old” days, they ate tons of the stuff; but they had effectively banished it from their diet, believing all fat was bad. Eulachon oil—back on the table! Ditto with any kind of fish and traditional inland aboriginal foods like deer and roast elk. Salmon was cooked on an open fire and generously dipped in eulachon oil. Potatoes, bye-bye. “We supplemented the traditional diet with ‘market foods’ like bacon, cheese, and all the vegetables you could buy,” said Wortman, “but the main thing was the avoidance of starch and sugar, because these were not components of the traditional diet.”

And then a funny thing happened.

People who had struggled with weight for years started to shed pounds—lots of them. Jill Cook, a school principal who had struggled with weight all her life and who had previously managed to drop all of 7 pounds on a strict 4-month Jenny Craig routine, lost 58 pounds (not to mention 9 inches off her waist and 7 off her chest). Art Dick, a tribal chief who had been on a ton of medications for diabetes, was able to get off 75% of his meds within 4 days of starting the program. Andrea Cranmer lost 22 pounds and went from a size 16 to a size 12. The aforementioned Greg Wadhams lost 40 pounds and no longer requires drugs to treat his diabetes. “Our forefathers sure must’ve known something we didn’t know, because when you eat [this] way you just feel good!,” he told
The Province.

While this might sound like the stuff of which infomercials are made, it all went into the database of the rigorously designed study. “The average weight loss was 7.5 kg (16.5 lbs) over three months, 11 kg (24.2 lbs) over 6 months,” Wortman reports. “We saw a change in diabetes symptoms in as little as three days. Triglycerides went down about 30%—better than any drug we have. People lost weight, their lipid profile improved, their bloodsugar control got better, their A1c [a long-term measure of blood sugar and a risk factor for diabetes] went down,” he told me. “All the things we hoped would happen seem to be happening.”

As well as some things that were unexpected.

“There was a real change in attitude,” Wortman told me. People started feeling good. “All my mental, emotional, spiritual, and physical aspects are finally feeling like they’re in some kind of unity together, and that’s so cool,” said Andrea Cranmer. “What we didn’t anticipate was the tremendous impact on the mental health of the community,” Wortman told me. “People were happier. They spontaneously started forming support groups. It became a community affair.”

So here’s the question: how can a diet so filled with fat and protein—foods that the traditional health establishment tells you are “bad” for you—and lacking the cornerstone of mainstream dietary recommendations (grains, carbohydrates, cereals)—produce such impressive results in so many people?

A couple of reasons suggest themselves—besides the obvious one (that the mainstream dietary recommendations are for the most part boneheaded).

First, there’s more and more evidence that saturated fat has a profoundly different fate in the body when it’s consumed in the context of a very-low-carb diet. This is a critically important point, one that has been made by a number of researchers, notably Jeff Volek, PhD, RD, of the University of Connecticut, who has done some of the most extensive and comprehensive research on low-carb diets. “Saturated fat is relatively passive,” Volek told me. “[The thing that] controls what happens with saturated fat in the diet is the carb content of the diet. If carbs are low, insulin is low and saturated fat is handled more efficiently. It’s burned as a fuel.

“In contrast,” he continued, “when carbs are high, insulin is high. Then you’re
inhibiting
the burning of saturated fat and potentially making a lot more of it, so you tend to see harmful atherogenic effects.”

According to Volek—and many others—you can’t really talk about saturated fat without considering the background levels of carbohydrate. “What happens with saturated fat is completely dependent on whether you’re on a low-carb or a high-carb diet,” says Colette Heimowitz, M.Sc, a nutritional scientist and co-author of
The Atkins Advantage.
“Despite ingesting more saturated fat on low carb, the amount in the plasma (blood) is significantly less. Fat oxidation (‘fat burning’) is increased and fat synthesis (making new fat) is decreased.”

So why do so many studies seem to show negative health effects of saturated fat intake? “All those studies are in the context of mixed diets,” Heimowitz explained. “When you’re on a high-carb diet, your saturated fat should probably be exactly what’s recommended—no more than 10% of total calories, 1/3 of your fat. But when you’re on a very low-carb diet, it’s a whole different story.”

Whenever I’m asked to explain this seeming paradox, the example I use is house paint. Pick your favorite color—mine is red—and then consider how it looks when you put it on a nice clean white surface. Now imagine that same color mixed with another one—say purple, or blue or green. Some of those combinations produce really hideous results. How the color “behaves” depends completely on what it’s mixed with (if anything). By itself it’s gorgeous, but mixed with a non-complementary color… not so much.

“Although people on a high-fat, low-carb diet eat more saturated fat, their blood levels (of saturated fats) actually go down,” explains Stephen Phinney, PhD, the nutritional biochemist who worked with Wortman on the Alert Bay study.
¹
While the exact reason for that paradox is still being investigated, according to Phinney, “the interim answer appears to be that when you take carbohydrates out of the diet, it causes less interference with the body’s natural ability to handle fats and that the saturated fats are burned and not retained.”

And what about the “side effect” of the dietary experiment, the fact that well-being improved and people seemed—well, happier?

One hypothesis has to do with inflammation. “When you have insulin resistance and metabolic syndrome, you have high inflammatory levels,” Wortman reflected. “You have poor energy and you just feel crappy and you’re irritable.” Not so coincidentally, when you go on a low-carbohydrate diet, many of the pro-inflammatory foods in your diet are eliminated.

Research comparing the metabolic effects of low-fat and low-carb diets on inflammatory markers (such as TNF-alpha and interleukin-6) confirms this inflammation connection. A study by Jeff Volek and his associates published in the January 2008 issue of the scientific journal
Lipids
concluded that “a very low carbohydrate diet resulted in profound alterations in fatty acid composition and reduced inflammation compared to a low fat diet.”
²
Richard Feinman, PhD, professor of biochemistry at SUNY Downstate Medical Center and one of the researchers involved in the study, comments: “The inflammation results open a new aspect of the problem. From a practical standpoint, continued demonstrations that carbohydrate restriction is more beneficial than low fat could be good news to those wishing to forestall or manage the diseases associated with metabolic syndrome.”
³

Another hypothesis has to do with oxidative stress, the technical name for what happens when nasty rogue molecules called “free radicals” attack and damage cells and DNA. Oxidative stress is known to be a significant component of aging, and it figures prominently in a host of diseases including atherosclerosis. “Inflammation might be one way the body has of responding to oxidative stress,” Wortman suggests. Research has shown that a ketogenic (very-low-carbohydrate) diet “upregulates” (or turns on the production factory) for glutathione (GSH), a powerful antioxidant in the body, helping to protect DNA from damage.
⁴
Could all these metabolic mechanisms help account for why the people of Alert Bay seemed so energized and felt so darn good? Who knows? Weight loss has so many overlapping dimensions—social, interpersonal, metabolic, hormonal—that it’s hard to sort out what’s responsible for what. One thing that’s clear is that people lost a lot of weight, felt better about themselves, and—as a “side” benefit—seemed more connected and supportive as a community.

The “town that lost 1200 pounds” also seemed to have gained an awful lot in the process of losing.

CHAPTER 9

Supplements and
Diet Drugs

The modern farmer treats the plant but the true farmer treats the soil.

                  
—John Hernandez, MD

L
et me guess. You’d like me to cut right to the chase and answer the question: “Are there pills that can make me lose weight?”

Well, the short answer is: “Not by themselves.” To produce an effect, virtually any drug on the market has to be used as part of an overall program of calorie reduction, lifestyle change, and behavior modification. If there were a drug you could take that would make weight drop off without your having to do anything at all or change anything about the way you eat or exercise, people would be lining up for miles to get it.

But there isn’t.

There are some drugs that
have
been shown to make a difference in weight-loss programs for the obese. How
much
of a difference is a whole other matter.

Normally, I wouldn’t spend a lot of time discussing the drug options for weight loss for four reasons: (1) I don’t think they produce enough weight loss to make much of a difference to most people; (2) they are very, very expensive; (3) my own personal orientation to drugs is “The less, the better”; and (4) the risks frequently outweigh the benefits. But there is a special reason for taking the time to go over the pros and cons of each of the drugs covered here (including some that doctors rarely use much any more). That special reason can be summed up in two words: the Internet.

I get at least three e-mail spams a day offering all sorts of drugs—including every one of the “diet” drugs mentioned here. All are easily available from online pharmacies without a prescription. It’s easy to see how people might be tempted to buy them, especially when they read the merchandising and advertising on these drugs, which often say things like “77 percent of obese patients lost a significant amount of weight” (Meridia). The aggressive marketing and easy availability of these drugs make it mandatory that we take a closer look at just what it is they actually do (and
don’t
do).

What you should know about me before reading further (full-disclosure department): my position, as someone involved in nutritional and natural medicine for more than a decade, is this:
the fewer drugs you take, the better
. That’s not to say there aren’t medications that can change people’s lives; obviously there are, and obviously they have a place in treatment. It’s just that I would like to see nutritional and lifestyle modifications used as often as possible, with drugs used as a last resort rather than a first-choice intervention. And if you
do
use drugs—and there are doctors who use them with some success—then they
must
be part of an overall program that involves lifestyle and behavioral changes.

Are You a Candidate for Medication?

In 1999, $321 million was spent on medications for obesity, a figure that will undoubtedly grow as the obesity epidemic continues and newer drugs come to market.
¹
The medications for obesity currently approved by the FDA are very specifically limited for use in adults with a body mass index (BMI) of 27 or more who
also
have obesity-related medical conditions, or for adults with a BMI of 30 or more who do not have obesity-related medical conditions.
²
(To compute your BMI easily, go to the Web site listed in Resources.) In other words, if you just want to tone up or lose 10 pounds, these meds are
not for you.
You should also know that only two of the following medications, Meridia and Xenical, have been approved by the FDA for long-term use. The others are approved for “a few weeks,” which is widely interpreted to mean up to three months. That doesn’t mean they aren’t safe for longer use—just that long-term use of these drugs has never been studied. Nor does it mean that doctors don’t prescribe them for longer than three months—they do. It’s called “off-label” use, and it’s done all the time. In fact, the prevailing opinion of many bariatric physicians (those who specialize in treating obesity) is that obesity is a chronic disease just like diabetes and that it needs to be treated (with medication if necessary) indefinitely. They frequently say something to the effect of: “You wouldn’t expect someone being treated with medication for high blood pressure to have their blood pressure under control if they go off their meds, would you? It’s the same thing with obesity.” In fact, the sad truth is that the biggest problem with obesity meds is that people gain the weight back—or at least a lot of it—once they go off the pills. Dr. George Bray, a recognized leader in the field of obesity treatment, says: “Obesity is a chronic illness—medication has to be used long-term.”

Now that you know that these drugs work only for as long as you take them, if you buy them off the Internet and self-medicate indefinitely by using stimulant pharmaceuticals that have never been tested for long-term use, you are essentially playing Russian roulette with your health.