
Medical guidelines don’t include a diet low in carbohydrates - andrewl
http://www.nytimes.com/2016/09/11/opinion/sunday/before-you-spend-26000-on-weight-loss-surgery-do-this.html
======
nxc18
Whether or not you believe in low/no carbs for everyday health, it is uniquely
horrifying that the Diabetes association is promoting a high carb diet.

Having recently made changes to my own eating, which still includes carbs but
at a much less extreme amount, I'm amazed at the differences. I don't have
diabetes and the doctors say my blood sugar control is very good, but the
energy differences I feel before and after eating high carb food is insane.

Diet soda, although technically not containing carbs, prompts a similar
insulin response to drinking sugared soda- the result is a blood sugar drop
and a loss of energy that makes me want to eat and do nothing; not the best
for weight loss.

I would like to see more attention given to what insulin really does: prompt
your body to store blood sugar as fat. No wonder filling our bodies with sugar
and then using insulin to 'remove' it is a bad idea.

~~~
CPLX
> Diet soda, although technically not containing carbs, prompts a similar
> insulin response to drinking sugared soda

Is there any scientific basis for this claim?

~~~
luketych
I get annoyed when people stop a discussion dead in its tracks by asking for
references like this, especially when they can easily look it up themselves if
they actually cared about the answer rather than winning.

If you think about it, any molecule that isn't sugar but tastes like sugar
will have a similar molecular shape to sugar. Hmmmm I wonder if this will fit
into receptors in other places in the body, not just on the tongue. Maybe it
will affect gut bacteria. Maybe even trigger other events within our bodies.

If we would stop and think with an open mind, many of these arguments would
become discussions, and we wouldn't need to play the baby card by asking for
proof.

Remember how long it took to finally get enough proof in order to show others
how wrong our mainstream religions are? And even with all the evidence we have
accumulated, still people say, "show me the proof. I'm a reasonable man."
Bullshit.

Let's not fall into this trap again. Many of these questions can be answered
without slow, hard science. We don't need to hit everything with the biggest
hammer in our toolbox before we can move forward.

~~~
apathy
> If you think about it, any molecule that isn't sugar but tastes like sugar
> will have a similar molecular shape to sugar.

I'm going to go out on a limb here and propose that you may not be a
professional medicinal chemist.

Many theories conveniently support your position. Of course, many theories
conveniently support the other side. How can we objectively determine who is
right?

Well, let's look at (among many, many other experimental studies)
[http://www.ncbi.nlm.nih.gov/pubmed/25786106](http://www.ncbi.nlm.nih.gov/pubmed/25786106)
which is a recent study of metabolic differences between self-reported
aspartame sensitive and non-sensitive individuals. Double-blind, randomised
crossover study -- the gold standard. Any differences in metabolic profile
between either control/aspartame or sensitive/not? None seen.

However, perhaps all non-nutritive sweeteners are not alike. The same senior
author as above ran a separate study in a small sample of athletic males where
aspartame in addition to carbohydrates resulted in lower insulin response
during exercise:
[https://jissn.biomedcentral.com/articles/10.1186/1550-2783-9...](https://jissn.biomedcentral.com/articles/10.1186/1550-2783-9-36)

Meanwhile, and in a different (grossly obese, NNS-naive) population, sucralose
(Stevia) appeared to do the opposite:
[http://care.diabetesjournals.org/content/early/2013/04/30/dc...](http://care.diabetesjournals.org/content/early/2013/04/30/dc12-2221)

> Many of these questions can be answered without slow, hard science

Sure, if we don't care whether the answers are credible.

Proof by analogy is fraud. If we didn't need evidence to make decisions we
wouldn't bother accumulating it.

~~~
buu700
> sucralose (Stevia)

s/Stevia/Splenda/ (stevia is entirely different from sucralose).

~~~
apathy
Oh wow I fucked that one up. Thank you for correcting it.

------
firasd
Low carb is like magic for my health, fitness, and mental acuity. Reasons it's
hard for me to stay on the bandwagon (1) it's more expensive to eat only meat,
vegetables, eggs and fats v.s. eating stuff together with bread, rice etc. (2)
Eating lots of vegetables means more fussy cooking of them (3) Carbs are nice
'comfort food' for when you're stressed.

~~~
EpicEng
It really doesn't have to be an all or nothing proposition though. Have you
tried sticking mainly to low GI carbs, e.g., sweet potatoes, whole grain
breads, etc? It takes a lot longer to digest these foods and, as a result, you
get a smooth energy release instead of a huge insulin spike.

I've been into fitness, mostly around powerlifting and contact sports, for
most of my life. Your body needs carbs; the problem is typically the form in
which we consume them.

~~~
flipchart
This paper [1] shows that the glycemic index is not necessarily a reliable
indicator for an individual's insulin response

[1]:
[http://ajcn.nutrition.org/content/early/2016/09/06/ajcn.116....](http://ajcn.nutrition.org/content/early/2016/09/06/ajcn.116.137208.abstract)

------
raverbashing
Thank the "low-fat/fat-free" craze for that.

Associating dietary fat with body fat has been one of the worse mistakes in
"nutrition" in the past decades.

Now most "low-fat" food has added carbs to deal with the loss of consistency.
And even regular foods (especially in the US) have added sugar.

~~~
dogma1138
The sugar free/carb free Atkins diet of the 90s and its modern versions isn't
any better.

Pretty much any diet which is free of anything should be avoided.

~~~
wpietri
I strongly disagree with this:

> Pretty much any diet which is free of anything should be avoided.

For the couple of years, I've been trying various elimination diets so that I
can see what effects particular foods and food groups have on me. Even if I
had ended up with exactly the same diet, it would have been worth doing, as I
learned a lot about my body and my relationship with food.

As it happens, though, I want to keep some pretty big changes. After doing my
3rd Whole30 [1], a paleo-esque 30-day elimination diet, I'm just finishing a
week where I returned to eating refined carbohydrates. My conclusion: as much
as I enjoy those foods, they make me feel terrible. My mood and energy were
much less even. They put big demands on my self control, and make me prone to
binging. I sleep less well. Starting tomorrow, I'm going to spend a few months
without refined carbohydrates again (sugar, flour, juices). I'll probably drop
dairy again too.

I don't know that I'd recommend my particular choices for anybody else, but I
strongly encourage curious people to experiment with elimination diets. If
nothing else you get the sort of exercise in self-control that religious
people get from Lent, which I think is valuable on its own. But I learned a
ton along the way, and wish I had done this years ago.

[1] [http://whole30.com/](http://whole30.com/)

~~~
dogma1138
Good for you, want to try it without a link to a commercial diet?

~~~
wpietri
It started out non-commercial, and all their recommendations are available on
their site. I've never given them any money, and you are welcome to do the
same.

------
thoughtsimple
I've been on a low carb diet since June. I've lost 30 pounds and my high blood
pressure is now gone (I read 97/63 last week).

My glucose went from 134 mg/do to 96 in 2 months. A1C from 6.5% to 5.5%. Now
normal again.

If you've been diagnosed with type 2 diabetes you should try a very low carb
diet before anything else. It really seems to work.

~~~
tzs
> If you've been diagnosed with type 2 diabetes you should try a very low carb
> diet before anything else.

What do you mean by "very low"?

One year ago I lowered carbs, with a target of a maximum of 40% of daily
calories from carbs. Results: 120 pounds lost, A1C from 8.1% (on Metformin and
Actos) to 5.2% (no Actos, Metformin dose cut in half, and would not be
surprised if my doctor suggests cutting it further when I see him next week).

Averages for this year so far: 2050 calories/day, 174g carbs/day (45g of which
is added sugars), 112g protein/day. So that's an average of about 34% of
calories from carbs (9% from added sugars), 22% from protein, and so 44% from
fat.

Does this count as low carb?

~~~
seekingcharlie
I wouldn't say that 174g is low carb.

On Keto, for example, low carb is < 40g, but ideally < 20g per day. The
macros, while different for everyone, are more like 75% fat, 20% protein, 5%
carbs.

Your personal macros will be dependent on your exercise levels, BMI, and
calorie intake though.

------
soneca
This is a good image to describe high low carb high fat diet works. For the
critics, it shows that it does indeed work (also) because of pshycological
effects and it doesn't go against the idea that less calories is important to
weight loss. But it represents how LCHF diet achieves it better than any diet.

For the supporters, this list all the headlines of the science involved if you
want to dig it further.

[http://bjjcaveman.com/wp-content/uploads/2015/11/How-Low-
Car...](http://bjjcaveman.com/wp-content/uploads/2015/11/How-Low-Carb-Diets-
Actually-Work.png)

------
juandazapata
I have been doing Keto for 3 months and lost 20kg without any exercise at all.

~~~
crispyambulance
That's good, but don't make it sound like 3 months of Ketosis is "easier" than
a full and strict exercise routine. That's an extraordinarily hard diet to
follow.

~~~
ng12
Says who? I did very strict Paleo and didn't find it that difficult.

Remember the saying "abs are made in the kitchen". Working out is fine and
good, but if you don't control your diet first you won't get anywhere.

~~~
crispyambulance
If by "keto" we're talking about "ketogenic diet" that's means the body has
fundamentally changed its metabolism away from using glucose and instead uses
ketones for energy. That's what ketosis actually is. Getting to this state and
maintaining it is far harder than, say, paleo or mere "low carb".

I don't have anything against any diet, just saying that ketosis isn't
necessarily an easy alternative, it is an extreme practice. Most folks can do
just fine with a bit of moderation in eating and regular exercise over the
long-term (by long-term, I mean forever).

~~~
DrScump

      instead uses ketones for energy
    

Mostly free fatty acids, actually; also ketone bodies.

Some organs _require_ glucose, which can be made from protein via
gluconeogenesis.

------
dylanz
I decided to start lifting heavy shit... everyday. When I say heavy shit, I
mean getting close to the max I can lift in one lift, each day I dedicate to
that lift.

I've tired no-carb days, lifting on fasts, lifting on protein heavy mornings,
etc... and it comes down to carbs being mental energy for me wanting to lift
heavy. If I don't have carbs, I feel less energetic, and less willing to
continue my lifting regimen for that day.

Eat a lot of carbs when you want to accomplish a lot of shit... physically.

~~~
itchyouch
Carbs are very popular in the lifting community. And for good reason.
Ultimately, one needs ATP in order to exert movements and the ATP generated
from carb sources is the most efficient for anything physically intensive.
Protein has to go through gluconeogensis to get converted to carbs and lipids
require double the oxygen to be converted to ATP.

I think the religion of food would be much better understood if food was
approached as workloads. CPU bound, memory bound, IO bound, etc. But in
general, carbs for physical activity and fats for mental activity.

------
OilDerek
I've been at or near ketosis levels of low carb since around 2013; I used it
to get over a fourteen-year eating disorder (anorexia->bulimia->BED->freedom).
If I had infinite money/time, I'd love to run trials on its effects on impulse
suppression completely separate from weight loss. There are some interesting
parallels between it and the off-label uses of anti-epileptics.

It's been fun watching the sea change towards acceptance of it. When I first
started, most people I encountered were weirdly confrontational about it, but
now it's pretty pedestrian. Granted, I had a now-embarrassing proselytizing
phase at the beginning and quickly learned to keep my mouth shut unless asked.

------
dvcrn
I've been on a low carb diet for a couple of months now. Went a tad stricter 3
weeks ago and am currently 11kg down.

My bodyfat drastically reduced, my belly disappeared and I am feeling a lot
healthier. Problem are the more expensive meat-heavy meals that go so far that
I just don't enjoy or want to eat anymore - and of course very easy
degeneration of muscle mass if you're not careful.

Nevertheless, I'm loving it. I wish I tried this earlier instead of a half-
assed diet. I won't be doing it forever but to fast chop down on some body
fat, it's amazing.

~~~
GordonS
Many cheess make good alternatives to meat - cheddar, feta, mozzarella, paneer
to name a few

------
analog31
While the article is about diabetes, it's been my understanding that the low
fat diet thing was a response to an epidemic of heart disease.

I recently eliminated a number of things from my diet: Butter, my daily cheese
sandwiches with mayo, processed meats, and pretty much all restaurant and
vending machine food. I went from 175 to 150 pounds in six months, and have
felt no urge to put it back on. I eat more lean meat, and have found
alternatives for my lunches that are good enough.

The change in fat intake doesn't explain my weight loss. I simply eat less
food overall because those ingredients were what made it tasty. I won't
pretend that I enjoy eating as much as I did. On the other hand, I'm a good
cook, and I like vegetables, so I'm far from miserable.

All these things support the fact that diet is not just a biochemical problem,
but a psychological and social one. Doctors know that sending someone home
with a diet is going to kill them, because the diet won't happen. The people
whose conditions improve on a diet are only the people who manage to follow
the diet. So instead they load us up with statins, or prescribe surgery.

~~~
scholia
Cutting out most or all processed foods is a great start.

There are plenty of nourishing high-fat foods that you can eat, and that are
good for you. This includes eggs, avocados, salmon and mackerel, macadamia
nuts etc [1]

 _> All these things support the fact that diet is not just a biochemical
problem, but a psychological and social one._

Yes. Decades of experience has shown that "dieting" doesn't work, and it often
results in people gaining weight (after losing weight temporarily). [2]

It's better to make permanent lifestyle changes that result in long-term
weight loss and increased fitness, even if it takes a few years. I assume this
is what you've actually done.

If you change what you eat, and the way you eat it, then you don't have to
"cut down" on food -- which is how most people understand dieting. It's really
easy to over-eat doughnuts but quite hard to over-eat on salad and veggies....

[1] [https://authoritynutrition.com/10-super-healthy-high-fat-
foo...](https://authoritynutrition.com/10-super-healthy-high-fat-foods/)

[2] [http://www.nytimes.com/2016/05/02/health/biggest-loser-
weigh...](http://www.nytimes.com/2016/05/02/health/biggest-loser-weight-
loss.html)

~~~
analog31
Thanks. That's pretty much what I've done. When I was younger, I ate better,
in no small part thanks to my mom getting into healthy cooking when I was a
kid, and teaching me to cook. Then I gradually got into some bad habits over
the years. When I had a wake up call regarding my cardio condition, it wasn't
particularly painful to mend my ways. It helped a lot that I had neither an
education problem nor a culture problem to overcome.

~~~
scholia
Being able to cook -- or being willing to learn -- is a big advantage. People
who eat fast food all the time are usually going to end up in a bad way.

Dieting is usually bad because people have a goal (they want to weigh X
pounds).

The key thing is to change the system, not to have a goal.

Scott Adams has written a whole book (which I haven't read) and some blog
posts about this, but there's a potted summary:

Why you should focus on habits and systems, not goals

[https://crew.co/backstage/blog/habits-and-systems-not-
goals](https://crew.co/backstage/blog/habits-and-systems-not-goals)

------
pzh
I found Lyle McDonald's "The Ketogenic Diet" really helpful in explaining why
low-carb diets work. It's also a great starting point for your own research
into these diets (with lots of great references).

------
colanderman
"This" being a low-carb diet. Even NYT stoops to click-baity headlines these
days; what is the world coming to.

~~~
fabiandesimone
if the content of the article is valid then getting the most people to read it
seems like a good objective.

If Clickbait helps, why not?

~~~
Waterluvian
Because a headline is meant to let the reader decide if it's worth reading.
The newspaper doesn't get to make that call via. trickery.

------
geomark
Or if you really need surgery get it done for about a third of that price at a
hospital that's probably done more than any other.[1]

[1] [http://medicaltravelsite.com/blog/gastric-banding-at-
yanhee-...](http://medicaltravelsite.com/blog/gastric-banding-at-yanhee-
hospital/)

------
richardboegli
I laugh to myself whenever I see weight loss articles like this.

Just Eat Less! Worked for me*

Shameless plug

My Weight Loss Story 40kg in 40 Weeks (90lb in 9 months) Without Exercise

[http://40in40book.com](http://40in40book.com)

The book is more for motivational reading of my story.

*DISCLAIMER: The information and opinions set out in this publication are provided only to convey the author’s personal experiences and opinions for information purposes only and are not intended to constitute medical advice, guidance or recommendations as to the reader’s actions or omissions. Disclaimer truncated for brevity of comment. The rest of the disclaimer is available here: [http://40in40book.com/disclaimer](http://40in40book.com/disclaimer)

------
tkyjonathan
Enough with this dumb Paleo stupidity. Sure you lose weight temporarily. But
its not sustainable and greatly reduces your chances of... being alive. Whole-
foods plant-based - I know its boring, but there are decades of science behind
it. Eat your greens.

~~~
strommen
The biggest dietary change involved for Paleo is eliminating heavily-processed
high-carb foods: bread, pasta, donuts, pizza, candy. This is a major
nutritional improvement for everybody.

The high-fat aspect just helps people stick with it by making them feel full
and also allowing them to indulge.

~~~
tremendo
Paleo is macro-nutrient agnostic. Eliminating heavily processed foods, yes,
but no need to sneak in the "high-carb" part. That heavily processed foods are
commonly high carb (the examples you give) is not central to the principle.
Yams would be a completely natural, non-processed high-carb whole food. As are
potatoes. The high-fat aspect is not to help with satiation (protein does that
better), it's just the reality of many un-processed or minimally processed
whole foods, especially of animal origin but also nuts for example.

