Reconsidering my low-carb diet — and moving up from it

Background: Because I am a type 2 diabetic, I was following a low-carb high-fat diet, which I would occasionally describe in a post on Quora. It seemed to work — my blood glucose readings were fine — but one day a doctor commented that the reason the blood glucose looked good was that I was eating essentially no carbs (around 30g/day net carbs). He warned me that the long-term effects of such diets were not good (see video below), and as  result I started doing some investigation, which led to this post. /background

After some email exchanges with UC Davis Integrative Medicine, I’m ready to move toward a more plant-based diet—vegetarian rather than vegan, since my interest is specifically in the food rather than animal welfare; “evidence-based eating” is another phrase that describes my new approach. – Update: After reading How Not to Die, I have eliminated meat, dairy, and eggs from my diet and now eat a whole-food plant-based diet. /update

The emails started with a post they had on the importance of B12 and their recommendation of using a supplement—the only recommendation they made. That made no sense to me: one serving of clams provides enough B12 to last two months (the liver stores B12 so you don’t have to eat it daily), and a serving of beef liver is enough B12 for at least 3 weeks. Why were these natural sources not even mentioned? That was my first query.

The initial response I received mentioned two drawbacks: neither clams nor liver have any dietary fiber and they both have cholesterol. I fear I overreacted: a B12 supplement also has no dietary fiber, and to say that my choice of a B12 source was bad because it lacked dietary fiber and they offer a choice that also has no dietary fiber made me crazy. And I did point out that the Harvard School of Medicine had recommended that dietary guidelines discontinue warning about cholesterol in food.

But then I got an enlightening response:

I believe that the Harvard article you mentioned argues that dietary cholesterol is not a concern because cholesterol biosynthesis in the body is regulated. When the body has adequate cholesterol, it will stop producing cholesterol, and thus, cholesterol levels will not rise. However, blood cholesterol levels are not the only concern when considering cholesterol. Cholesterol oxidation also has serious consequences on our health. I recommend you see this article to learn more: https://nutritionfacts.org/video/dietary-cholesterol-and-cancer/

I understand your point that it would take very little of these foods to meet your vitamin B12 requirement. However, it is important to remember that some of the pollutants we are discussing are endocrine disruptors. For example, the plastics that can be found in shellfish do not need to be present in large quantities to have significant effects on the body, due to the nature of amplifying pathways in the body.

As for the regulation by the government, I am afraid I am unable to comment. However, it is important to remember that the government also considers economics and industry when creating nutritional policy.

Overall, I understand that you have suggested two natural foods that are very high in vitamin B12. However, we still recommend supplementation because it provides B12 without the risks mentioned above. Of course, what we suggest are simply recommendations, and we encourage you to do your own research and decide what is best for you.

I did watch the video at the link in the email, and I was impressed. NutritionFacts.org recommends the eating of a Daily Dozen of foods (with a detailed discussion of the foods and why in Part 2 of How Not to Die), and they have a free iPhone/Android app to track that. I read more on the NutritionFacts.org website, and I was intrigued enough to do a Google search to see what I was dealing with: on searching “Michael Greger MD” I found this brief article by Joe Schwarcz PhD on the website of McGill University’s Office of Science and Society, and though Dr. Greger is strongly committed to a plant-based diet, he provides some strong reasons in support of it. From the post:

You will never see Dr. Greger refer to a study that shows anything positive about meat, but you will see plenty of studies that point out the pitfalls of consuming animal products. While there is some zealotry here, the studies that Dr. Greger enthusiastically talks about are from respected journals and merit our attention. I think his videos are worth watching, but keep in mind that there is some cherry picking of data. Of course that doesn’t mean the cherries he picks are rotten; they’re fine. Here is some of his work; you can also sign up for a free subscription to his daily videos.

http://nutritionfacts.org/video/eggs-choline-and-cancer/

I highly recommend watching that video. Until today, I ate 2 eggs a day. No more. And at the link you can subscribe to his videos.

The trick will be to see whether a plant-based diet will allow me to increase carbs and still keep my blood glucose levels under control. I am chilling starches (intact whole grains and beans, mainly, but also yams [update: yams turned out to raise my blood sugar even after chilling (as do other potatoes), so no more yams—too bad, because I really like purple yams /update] ) after I cook them, to make the starch resistant, and I continue to avoid fruit juices, all foods that contain refined sugar and/or are made from refined flour, and white potatoes, corn, and rice in any form. [update: After 10 weeks on the whole-food plant-diet my doctor had me discontinue all my medication for diabetes and hypertension, saying I no longer needed it. My new diet includes a good amount of net carbs but no refined carbs, so I also consume around 60g dietary fiber a day (whole plant foots — for example, beans, greens, and the bran in intact whole grain — provide a lot of fiber). Since switching to my new diet, my HbA1c has run 5.2% to 5.3%. And I really like the food. /update]

It will take a while to figure this out, but I’m starting now from where I am. I’ve now figured out my new standard breakfast, which is just my old standard breakfast with the two eggs replaced by 1/2 cup of cooked oat groats or cooked hulled barley or cooked beans, plus I add 1 tablespoon of flaxseed, which I grind just before adding it. (I cook a batch of them ahead of time and keep in the refrigerator.)

Update: Here’s a full day of plant-based meals (including recipe—and the dinner recipe didn’t quite work the way I pictured; next time I’ll serve squash by itself and the rest separately). And take a look at these meal plans (including shopping lists, cost, menus, and recipes). — And an update to this update: see this post for how I manage meals in general. It describes the way I worked out to implement Dr. Greger’s Daily Dozen.

Update 2: Here are the restrictions I’m observing and my new storage method, along with a comment on Greger’s book How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease.

Update 3: I would have liked to see the documentary What the Health [and now, more recently, the documentary The Game Changers) when I was reconsidering my diet, but the documentary came out after I had already switched to my whole-food plant-based diet. This one-hour talk by Dr. Michael Greger on evidence-based weight loss is worth watching:

Update 4: Long-term drawbacks of low-carb diet

UPDATE again. This is exactly the information I would like to have had before I started the keto/low-carb diet, in two videos:

And:

And also: