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The Low-Carb Community Is Its Own Worst Enemy

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I followed a low-carb high-fat diet for 5 years with good success in controlling blood glucose and, once I added WW Freestyle tracking, with good success in weight loss. I particularly like as a resource, and I still prefer his ketchup recipe to any commercial ketchup (because it tastes really good, because I enjoy cooking in general and making condiments in particular, and because it does not include any refined sugar such as high-fructose corn syrup). Still, I eventually became concerned, and I did switch to my current whole-food plant-based diet.

But because I had enjoyed the LCHF diet, I read with interest this article in Medscape by Yoni Freedhoff, MD:

Physicians have been recommending low-carb diets to patients since at least the 1860s, when Dr William Harvey encouraged the British royal family’s undertaker, Mr William Banting, to adopt one. He in turn penned the world’s first known blockbuster diet book — the not particularly excitingly named Letter on Corpulence, Addressed to The Public.

And yet today, one of the loudest laments of low-carb-promoting physicians is that the medical community, as a whole, purposefully eschews their favored diet. Perhaps one of the reasons for this is the low-carb community itself.

Self-righteous, Indignant Vitriol

Unfortunately for physicians who appropriately see low-carb diets as one of many reasonable options for their patients, the larger medical community may struggle to take them seriously. For instance, it took until 2019 for the American Diabetes Association to include low-carbohydrate diets as a therapeutic option in its nutrition therapy consensus report, and JAMA recently published an opinion piece designed to pour cold water over a diet that has and is helping many people manage weight and various diet-responsive comorbidities.

I would argue that at least part of the blame here lies with the ways in which low-carb diets’ loudest champions promote them. In virtually every other area of medicine, physicians are comfortable with the existence of multiple treatment options and modalities, and they also recognize that each patient responds differently to different treatments. When it comes to diets, however, for many vocal low-carb MDs, there can suddenly be only one.

And it’s not just the overzealous promotion of one diet at the exclusion of all others that the low-carb community bizarrely champions. Their self-righteous and often indignant vitriol is frequently on display, whether it’s trotting out the tired trope of medical organizations and dietary guideline committees purposefully manipulating or ignoring evidence (see the extensive corrections and clarifications for this piece), described by a prominent low-carb physician as being representative of a “conspiracy by a ‘matrix of agendas’ to promote a plant-based diet“; or asserting that the overwhelmingly unfollowed low-fat dietary guidelines are responsible for the obesity epidemic (refutation available here); or stating that older dietary guidelines posters will one day appear in “museums recording history of human genocide“; or publicly fat-shaming dietitians and researchers with obesity; or even food-shaming a chemo-receiving cancer patient who posted online that she enjoyed (gasp) an ice cream cone.

And it’s not just random, angry public trolls pushing these narratives. Some of the low-carb community’s most visible and vocal physicians drive these very messages, along with others that may be dangerous and/or incredibly misleading. From stating that fruit should be treated like a poison, to publishing op-eds promoting statin denialism (a thoughtful discussion on this topic can be read here), to coauthoring books with marginalized medical conspiracy theorists with large platforms (more on Dr Mercola here), to stating that sugar is eight times more addictive than cocaine, to producing and selling tea purported to improve weight loss outcomes, to even amplifying anti-vaccination messaging in order to imply that low-carb, high-fat diets treat “vaccine-damaged” autistic children, the low-carb medical community makes it exceedingly easy to not take them — and by extension, their chosen diet — seriously.

That’s a shame, of course, as low-carb diets are just as good as other diets when it comes to weight management, whereby those who enjoy them enough to adhere to them can maintain large, clinically meaningful losses and may also see benefits beyond those attributable to simple weight loss, including improved glycemic control in patients with type 2 diabetes.

Less Hyperbole, More Collaborations

If the low-carb community wants to make inroads into the medical community as a whole, I have two recommendations for them. First, . . .

Continue reading.

Written by LeisureGuy

9 August 2019 at 4:34 pm

Posted in Food, Low carb, Medical

Why the low-carb diet is bad

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This is quite interesting, particularly to me since I was on a low-carb diet for a few years:

Written by LeisureGuy

1 August 2019 at 4:24 pm

Making your own mayo

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Making your own mayo, the only way to go:

  • Requires one immersion blender and the plastic beaker that comes with it.
    • This one is quite good ($30)
    • Immersion blenders are terrific for making soups like broccoli soup, or vichyssoise, or gazpacho, or any soup for which you would use a blender because blending in the pot has two advantages:
      • Easier: not having to transfer the pot contents to the blender container
      • Easier: cleanup is a snap with an immersion blender: fill beaker with hot water, add a squirt of dishwashing detergent, and blend…
  • Recipe makes 1 cup mayo – NOTE: this is 1 cup US measure = 8 fl oz, NOT the UK cup (10 fl oz)
  • Eggs must be at room temperature—if eggs are cold, you end up with liquid, not mayo
  • Put the following into the beaker: (to expand, click the “+” to the left of the bullet; to collapse, click the “-“)
    • Two egg yolks
      • Some people say 1 yolk and 1 whole egg, but I do 2 yolks.
      • You can cook the leftover whites (scrambling is easiest) for a protein snack.
    • 3/4 teaspoon salt
    • 3/4 teaspoon ground white pepper
    • 1 tablespoon Dijon mustard
    • 1-2 anchovy fillets (to add umami—does NOT impart a “fish” taste)
      • Get anchovy fillets that are packed in glass, not in a can
      • Get anchovy fillets that are packed in olive oil (not sunflower oil or soybean oil or the like)
    • grated zest of one lemon
    • juice of that same lemon
    • optional ingredient (which I seldom use): any one of the following:
      • a few pitted ripe olives (and try pitted green olives, too); or
      • 2 teaspoons drained horseradish; or
      • 2 teaspoons smoked paprika; or
      • 1 1/2 teaspoons Old Bay seasoning in place of the salt—very good in fish salad, shrimp salad, chicken salad, potato salad, etc. (and Old Bay is also excellent on popcorn); or
      • a handful of fresh tarragon leaves (extremely tasty); or
      • 4-5 large basil leaves; or
      • 1/2 ripe avocado; or
      • a lime in place of lemon (zest and juice), perhaps with cilantro; or
      • 1 tablespoon tomato paste; or
      • 2 teaspoons curry powder; or
      • 1 slice crisp bacon (with 2 tablespoons bacon fat, 7/8 cup olive oil)
      • 2 Tbsp toasted sesame oil plus enough olive oil to make 1 cup total—and you might add 1 tsp soy sauce, though I’ve made it without the soy sauce—and it’s very tasty
      • Not a raw garlic clove, at least not for me; roasted garlic might be okay
  • Blend the bejesus out of the beaker’s contents; they must be well blended before adding oil
  • Add 1 US cup (8 fl oz) oil, a little at a time, blending well after each addition
    • I always use 1 cup extra-virgin olive oil (except in the variations above, as noted)
      • Quality and taste of olive oil is very important.
      • Note that not all oil labeled “olive oil” is actually olive oil. Here’s a link to an entertaining and informative book
      • Here’s a list of good and bad olive oils:
      • If you have an olive-oil store that allows tasting, taste a variety and use one that you like. Different people have different preferences.
      • I did try canola oil, the usual recommendation. Unfortunately, the result is a totally bland mayo. Not good.
        • I also did an avocado oil version (too expensive, not so tasty as the olive oil); however, avocado oil is excellent for sautés and stir-fries because it has an extremely high smoke point (520ºF / 271ºC) and no real taste of its own.
        • Be careful about seed oils (grapeseed, safflower, peanut, corn, soybean, cottonseed) because the omega-3 to omega-6 ratio is not so good in such oils. Don’t even consider soybean oil or cottonseed oil. See the link just above for more information.
          • Store-bought mayo and salad dressings generally are made of soybean oil and/or cottonseed oil because those oils are cheap and the companies that make the foods don’t care about your health.
      • I haven’t tried these, but I might at some point:
        • 2/3 cup olive oil and 1/3 cup pecan oil, perhaps with a few pecans among initial ingredients
        • 7/8 cup olive oil and 2 tablespoons (which equals 1/8 cup) bacon fat, with a slice or two of crisp bacon included in initial ingredients
    • Add small amounts of oil at first, blending well after each addition. You can add larger amounts toward the end. The mayo gets thicker as you add oil.
      • With experience you can start with larger amounts. I now start with first addition of oil being almost 1/4 cup but initially I would start with 1-2 teaspoons of oil.
      • Blend—and blend well—after each addition.
  • After it’s done, the mayo might be quite stiff. If so, blend in a little water. Start with 1 teaspoon of water, blend, and see how it is. It will stiffen somewhat more in the fridge as it cools.
  • Keep in the fridge. It seems to last well (except it’s so tasty, which works against that).
  • Make ketchup, too! It’s delicious.
    • Tastes much better than store-bought, plus you can tinker with it (e.g., add 1 tsp liquid smoke; or add 1 tsp crushed red pepper)
    • Recipe:
    • It takes at least 40 minutes of simmering, not 20, to reduce it to thickness (at least for me). Ignore the time and instead go for the thickness you want.
    • Immersion blender works fine
    • I recommend San Marzano tomatoes, and I used 3 cloves of garlic, not 1
    • Make a double batch: a single batch is only about 1 cup and doesn’t last; and San Marzano tomatoes are easy to find in 28-oz can. Use whole tomatoes.

Written by LeisureGuy

21 June 2019 at 2:16 pm

Finally: My current diet advice is once again current

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It took a while—learning first, then writing and editing—but at (long) last my current diet advice matches now my current diet.

Take a look and see what you think.

Written by LeisureGuy

25 May 2019 at 12:58 pm

New findings on cholesterol that contradict old recommendations

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Written by LeisureGuy

23 May 2019 at 9:58 am

Theme meal, in theme of “C”

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Tonight’s dinner ingredients:

coconut oil

Sounds good, eh?

Written by LeisureGuy

21 May 2019 at 12:02 pm

Posted in Food, Low carb, Recipes

Canada’s new dietary advice is to avoid sugar substitutes. Will U.S. follow suit?

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I avoid sugar substitutes because once I decided to avoid refined sugar, it made sense to me to retrain my taste to prefer savory to sweet. (I do not like artificial foods in general, and that includes artificial sweeteners in spades.)

The gut microbiome can drive food cravings, and cutting sugar and simple starches from your diet quickly results in a change in the gut microbiome population: those microbes that depended on sugar and simple starches give way to others.

To develop a taste for the savory, rather than the sweet try this: after tasting the foods on your plate, construct your “last bite.” That is a bite-size portion of the food(s) in the meal that you want to be the last taste you have of the meal. Cut out and move aside that bite and save it for the end. That bite will be the final taste of the meal.

If you consistently make that last bite savory, you’ll train your taste to prefer to end a meal with something savory—i.e., not with dessert. It will seem natural to enjoy the savory ending, and you won’t want to spoil the last-bite taste. For example, the last bite may be (depending on the meal), a bite of turkey with a little dressing; or a good combination of vegetables and sauce; or a small piece of bacon with a bit of egg; or a bite of steak or chop from the best part; and so on.

If you do want a dessert, go for fruit that is low in net carbs. I thaw mixed berries (raspberries, blackberries, and blueberries) and eat 1/2 cup of that for dessert. See this post for the best low-carb fruits.

Christy Brissette writes in the Washington Post:

As a Canadian dietitian who works and lives in the United States, I like to keep up with health policy in both countries. So, I was quite interested to see that Health Canada, the governmental agency responsible for public health, is charting a new course when it comes to dietary advice, particularly in the area of sugar substitutes. It’s a track that sharply diverges from the one the United States is on.

In a significant departure from the past as well as from the U.S. approach, Canada’s new food and dietary guidelines, released this year, say zero-calorie or low-calorie sugar substitutes are neither necessary nor helpful. “Sugar substitutes do not need to be consumed to reduce the intake of free sugars,” the guidelines say, adding that, because “there are no well-established health benefits associated with the intake of sweeteners, nutritious foods and beverages that are unsweetened should be promoted instead.”

In contrast, the 2015-2020 Dietary Guidelines for Americans(DGAs), issued by the U.S. Agriculture and Health and Human Services departments, suggest sugar substitutes may have a place in helping people consume fewer calories, at least in the short term, though “questions remain about their effectiveness as a long-term weight management strategy.” The guidelines neither encourage nor discourage their usage.

The differences may seem subtle, but dietary guidelines in each country shape what is served at public institutions such as schools and influence the recommendations made by health-care professionals. Language matters. But before we try to explain the difference in advice, let’s have a quick primer on sugar substitutes.

What are sugar substitutes?

Sugar substitutes include many categories, such as high-intensity sweeteners that are at least 100 times as sweet as sugar. They can be “artificial,” such as aspartame and saccharin, or “natural,” such as stevia and monk fruit. They can contain a negligible number of calories or be classified as low-calorie sweeteners, such as sugar alcohols.

In much of the research and in most policy documents, sugar substitutes are often discussed as a single category rather than a heterogenous group of compounds. This makes it challenging to know whether certain types are preferable.

Most concern seems to focus on artificial sweeteners. Six are approved by the U.S. Food and Drug Administration as ingredients in foods and drinks and as table sweeteners people can add themselves. The most ubiquitous is aspartame (sold as brand names NutraSweet or Equal), which is found in more than 6,000 food products, followed by sucralose (Splenda), acesulfame K (Sweet One or Sunett) and saccharin (Sweet’N Low or Sugar Twin), and the lesser-known neotame and advantame. You’ll find artificial sweeteners in a range of foods and drinks, including light yogurt, diet sodas, protein bars and chewing gum as well as baked goods and frozen desserts. Carbonated drinks are the top source of artificial sweeteners in the American diet.

What does the research say?

Research suggests that stevia and monk fruit, the natural sugar substitutes, are safe for human consumption, though it’s not clear that they lead to weight loss. There has been conflicting research, however, about the safety of artificial sweeteners. Some studies have suggested that artificial sweeteners could increase the risk of Type 2 diabetes, heart disease, kidney disease and cancer, and may have a negative influence on the microbiome and mental health.

For example, research based on data from 37,716 men from the Health Professional’s Follow-up study and 80,647 women from the Nurses’ Health study published in Circulation last month found that consuming artificially sweetened beverages is associated with a greater risk of death as well as death from heart disease. The risk was found specifically for women consuming four or more servings of artificially sweetened beverages a day. The authors say this finding needs to be confirmed by future research, but it does raise questions about whether artificial sweeteners are necessary — or should be recommended at all.

As for the U.S. contention that sugar substitutes might help people cut back on calories and sugar to improve their health or lose weight — that seems doubtful.

review by the nonprofit research foundation Cochrane, conducted for the World Health Organization, examined 56 studies into the effects of sugar substitutes on health. It found that there is no evidence sugar substitutes provide any benefit — and that they may even have some risks.

An analysis of U.S. dietary intake from 2003 to 2004 shows that people tend to add artificial sweeteners to their diets rather than using them to replace sugary foods and beverages.

The same seems to be true for children. This month, researchpublished in the Pediatric Obesity journal revealed that in U.S. children, drinking artificially sweetened beverages is associated with consuming more calories and sugar.

Why the difference in advice?

U.S. and Canadian health officials are looking at the same research and have populations with similar health issues. So why the difference in guidelines regarding sugar substitutes?

The new Canadian approach seems to be that if a food or beverage doesn’t have a demonstrated health benefit, it doesn’t belong in your diet. Their 2019 guidelines suggest that people’s taste buds will adapt to less-sweet tastes when they reduce their consumption of sweetened foods and beverages — and using high-intensity sweeteners delays that process.

This is a marked change from Canada’s last dietary guidelines, released in 2007, which advised the general population to consume sugar substitutes in moderation and cut back on them if they noticed any digestive symptoms such as gas and bloating.

The new Canadian recommendations may seem tougher, but I see them as being clearer and something for people to aspire to. (Canada’s latest Food Guide takes a stand on several other divisive nutrition issues. For example, it promotes whole grains as the only grains to put on your plate, while the U.S. guideline is that at least half your grains be whole grains.) The U.S. view seems to be focused on encouraging health behaviors that are thought to be more achievable.

Alice H. Lichtenstein, a professor of nutrition science and policy at Tufts University and member of the 2015-2020 DGA committee, seems skeptical of an all-or-nothing approach to sugar substitutes. She expressed her stance in an editorial in Circulation, responding to the study that said consuming artificially sweetened beverages is associated with a greater risk of death. “To a certain extent, as a community, we can take the high road about beverage recommendations: Drink water (or flavored water) in place of [sugar-sweetened beverages]. However, continuing this simple approach would be disingenuous because we know that it has not worked well in the past and there is little reason to expect that it will work well in the future.”

Over email, Lichtenstein said: “For some people, I suspect the use of high-intensity sweeteners is helpful in avoiding excess energy intake. For others, it might not be helpful.”

2018 advisory from the American Heart Association also takes a more middle-ground approach to sugar substitutes than Canada’s, stating that they can play a role in helping people to reduce the amount of sugar-sweetened beverages they’re drinking. The advisory also says that beverages containing low-calorie sweeteners could be especially useful for people who are used to sweetness and find water unappealing at first.

For insight, I turned to Marion Nestle, a renowned American author and professor emerita of nutrition, food studies and public health at New York University. She said over email: “What we know about artificial sweeteners is for sure that they are not necessary. On a population basis, they do not seem to help people lose weight, but they may help some individuals. So, both approaches are valid. Personally, I follow a food rule not to eat anything artificial, so these sweeteners are off my dietary radar.”

When I asked what she thought was the reasoning behind the differing approaches to sugar substitutes taken by the U.S. and Canadian governments, she responded, “One can only speculate that the lobbying for artificial sweeteners worked better in the U.S. than in Canada.”

Whatever the reason for the disparate approaches, I found one hint that the viewpoint in the United States might be changing.  . .

Continue reading.

Written by LeisureGuy

15 May 2019 at 9:41 am

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