Dealing with doctors

Introduction

Over the past few years all sorts of concerns have been raised about what are perceived as 'unhealthy' diets — the ones like this diabetes diet that don't conform to the tenets of 'healthy eating'.

The Diabetes Diet allows all foods — including carbs, fruits and vegetables — and, while carbs are restricted somewhat, there is no restriction on the total amount of food you can eat. That should be enough to stop anyone objecting to it. However, not only the public but nutritionists and doctors, too, have been so brainwashed over the past couple of decades that no doubt someone will.

The hardest ones to convince are the 'experts'. You will not be surprised to learn, therefore, that I am often asked how to deal with doctors. It really can get annoying after a while, can't it?So if you have the same problem, you may find it comforting to know that you're not alone. Let me put your mind at rest with answers to typical concerns that have been raised by doctors, nutritionists and sceptics of low-carbohydrate diets recently, to show how we are misinformed and misled. If you would like some ammunition with which to retaliate. Here it is:

Q: Won't eating more fat with the diabetes diet raise my cholesterol and triglycerides and increase my risk of heart disease?
A: No, quite the opposite. The whole vexed question of fatty diets, cholesterol and heart disease is a myth. This is explained at Diet and cholesterol. (See also another website, Cholesterol-and-Health, for more detail.)

Q: Will eating more protein increase my risk of heart disease?
A: No, quite the reverse! I should make clear that the diabetes diet is not high-protein, merely moderate or adequate protein. Having said that, however, researchers at the Harvard School of Public Health answered this question when they studied 80,082 women aged between 34 and 59 without any previous indication of heart disease.[1] When all other risk factors for heart disease were controlled for, and irrespective of whether the women were on high- or low-fat diets, the results showed that both animal and vegetable proteins contributed to a lower risk of heart disease. The researchers concluded: 'Our data do not support the hypothesis that a high protein intake increases the risk of ischemic heart disease. In contrast, our findings suggest that replacing carbohydrates with protein may be associated with a lower risk of ischemic heart disease'.

Q: Will everyone's blood fats respond the same way to reducing carbohydrates and increasing protein and fat?
A: Why not? Although we do have slightly different reactions to different foodstuffs because of our different evolutionary backgrounds in different parts of the world, we are all one species and all designed to eat essentially the same foods. All the trials of low-carb diets, for over a century, have found dramatic benefits wherever, and on whom, they have been conducted. But if you are concerned about this, have a blood test before you begin this way of eating and another three or four months into it to reassure yourself.

Q: Will eating more protein and less carbohydrate damage my kidneys?
A: No. The claim that protein intake leads to kidney disease is another popular myth that is not supported by the facts and there is not one study in which kidney damage has been demonstrated — not one. Although protein restricted diets may be helpful for men who already have kidney disease, eating meat does not cause kidney problems.2
    With women the situation is different: It doesn't seem to matter whether women have kidney disease or not, protein neither causes nor worsens the condition. Furthermore, the fat-soluble vitamins and saturated fatty acids found in animal foods are necessary for properly functioning kidneys.3
    In an Israeli study, the kidney function of a group of healthy individuals consuming an unrestricted high-protein diet was compared to a group of healthy vegetarians eating a low-protein diet. At the end of the study, the authors concluded that protein did not affect kidney function in normal kidneys, and it did not influence the deterioration of kidney function with age.4 They say 'These results suggest that, in contrast with the important therapeutic effect of low-protein intake on the progressive deterioration of kidney function in diseased kidneys, such a diet does not significantly affect kidney function with "normal aging" in healthy subjects.'
    On the other hand, sugar has been implicated in kidney disease.5 So the answer is to give up simple sugars — table sugar, honey and fruits.6
    If you're unsure whether your kidneys are healthy, consult your doctor before changing your diet.
    There is one other point. The diabetes diet is not a high-protein diet. So this question is not really relevant.

Q: Can a reduced-carbohydrate / higher-protein plan lead to osteoporosis?
A: No, a low-carb diabetes diet reduces the risk of osteoporosis. In certain sections of the nutritional world, there seems to be a belief that if we eat animal protein this will cause our bones to lose calcium. This question is of particular interest in light of Palaeolithic diet research for two related reasons. The first is because estimates of the levels of animal protein in the hominid diet during at least the last 1.7 million years of human evolution (from the time of Homo erectus ) are much higher than is considered 'healthy' in some sectors of the nutritional research community today. The second is because the fossil evidence shows that Palaeolithic humans had a higher bone mass that would have been more robust and fracture-resistant than modern Western human's bones.
    When studies were done with people eating meat together with its fat, no calcium loss was detected, even over a long period of time.7 Other studies confirmed that meat eating does not adversely affect calcium balance 8 and that protein actually promotes stronger bones.9
    For example, researchers at Tufts University in Boston studied the bone density of elderly men and women who were taking calcium and vitamin D and found that bone density improved most in the participants who ate the most protein, including animal proteins.10 The lead researcher, Dr Bess Dawson-Hughes, said: 'Excess protein intake should be bad for bone, but the results of the study suggest that concerns about protein intake are probably unfounded.' She admitted that the study and other published research 'go a long way toward refuting' concerns that animal protein is bad for bones.
    A year later researchers at the Bone Metabolism Unit, Creighton University School of Medicine, Omaha, looked again at this question concluded that 'the results of the present study in postmenopausal elderly women suggest that a higher protein intake as a percentage of energy is associated with higher BMD [bone mass density] in the presence of an adequate calcium intake. . . Our results suggest that in the elderly, who are at the highest risk of osteoporosis, a higher protein intake is important for the maintenance of good bone health.' 11
    Other evidence shows that men and women who ate the most animal protein had better bone mass compared to those who avoided it.12 The evidence also showed that vegan diets containing no foods from animal sources placed women at a greater risk for osteoporosis.13 .

Q: Does the Diabetes Diet contain all the nutrients I need to protect my bones?
A: Yes. The Diabetes Diet is high in protein and calcium- and magnesium-rich foods like cheese, fish, green leafy vegetables and nuts.
    There is just one caveat: Vitamin D is needed to metabolise calcium and there is very little Vitamin D in any foodstuffs. Our bodies make it from the action of sunlight on the skin. It is also made in other animals the same way. Vitamin D is a fat-soluble vitamin. It is found in the fat of animals that have been allowed to graze in sunshine, but you won't find any in plant foods. This is why the best foods are animal fats and full-fat dairy products — as long as animals that supply these have been kept outside. These days, that is not guaranteed, so it is also a good idea to get out in the sun often so that your body can make vitamin D naturally.

Q: I have heard that you can eat more meat on a reduced-carbohydrate plan. I am concerned about eating more meat because I've also heard that there is a link between meat and cancer. Is this true?
A: No. The evidence suggesting that meat-eaters have more cancer came largely from just one study that looked at vegetarian Seventh Day Adventists.16 They did have less cancer than the average American population. But a similar study among meat-eating Mormons found that, in them, cancer was even lower than that of Seventh Day Adventists.17 It seems that stress plays a large part in cancer and many other conditions. What the various studies show is people who belong to supportive groups, such as tightly knit religious groups, have a lower incidence of these diseases regardless of what they eat. Traditional Inuit and Maasai, eating nothing but meat, have no cancer at all. This is probably because cancer is a response to a high-carb diet.

Q: But doesn't the latest research prove that a high animal fat diet increases the risk of breast cancer?
A: No, it doesn't. If eating animal fat increased the risk of breast cancer, one would expect that populations that eat more animal fat would have more breast cancer. Yet they don't. Populations from the Maasai in Africa to the Inuit in the Arctic, who eat diets where eighty percent of the calorie intake is in the form of animal fats, don't get breast cancer or any other form of cancer.
    The evidence shows that the fats which increase cancer risk are the 'healthy' polyunsaturated vegetable margarines and cooking oils (see Unhealthy fats ).

Q: Does restricting carbohydrates reduce energy and cause fatigue?
A: Quite the reverse. Fatigue and energy loss are usually signs of low blood sugar (hypoglycaemia). The Diabetes Diet approach will keep your blood sugar levels stable. Carbs are usually thought of as 'energy foods', and it is true that carbs do provide energy. But they don't provide the best energy. Fats do that. And fat is what you should eat to replace the energy lost from carbs.
    The people who experience fatigue at the beginning are those on other plans which cut carbs too low to start with — levels as low as 20 grams are common. This is why I recommend 60 grams. At this level these symptoms are avoided.
    That means cutting down on carbs — but not cutting them down too much.

Q: Does restricting carbohydrates cause headaches?
A: Not if you don't cut down too much. It was thought that the brain used only glucose as an energy source. But recent research from Japan has demonstrated that it can also use fats just as well.21 All the reports of headaches are associated with diets which cut down drastically on carbs at the start. The transition from one kind of fuel to another can cause problems if that change it too drastic. This is another reason not to cut carbs too quickly to begin with.

Q: Is my breath going to smell funny on this diet?
A: No. The 'badgers' breath' associated with one popular low-carbohydrate diet is not a problem on the diabetes diet because the carbs are not as restricted. The Diabetes Diet is a lower -carb approach by avoiding refined carbohydrates. It is only very severe carb restriction that triggers the extreme 'ketosis' which causes smelly breath.

Q: But doesn't any low-carb diet cause ketosis?
A: Yes and No. 'Ketones' are a class of compounds that are quite normal products of fat metabolism. With this and other low-carb, high-fat plans, ketones are used in the body to provide a source of energy for the cells that would otherwise use glucose. However, raising levels of ketones in excess of what is needed is not a good idea.
    When glucose appears in the urine of a diabetic, it is their body's way of getting rid of excess glucose — which is why giving diabetics even more carbs is such a ridiculous protocol. Raising ketones in body tissues to such high levels that they have to be disposed of by excretion in urine, as is advocated on one popular low-carb plan, is exactly the same: the body getting rid of something it has too much of. And in a similar way to feeding diabetics more carbs when they are already getting rid of excess glucose, feeding fats to people whose bodies are already rejecting ketones, is equally stupid in our opinion.
    There is also an economic side to this. Ketones are made from foods that you buy. You have paid for these — and the foods they came with are relatively expensive. Why flush them down the toilet?
    So while a ketogenic diet is healthy, we do not believe overt ketosis is desirable, and we have not found it necessary, to go to such extremes. The 30-50 grams of carbohydrate a day that are included in the Diabetes Diet are more than enough to avoid this.
    NOTE: A condition called ketoacidosis may occur in diabetics. This should not be confused with ketosis which is quite different.

Q: Should I expect to be constipated?
A: No. The liberal use of green, leafy vegetables, both cooked and as salads, will ensure that you are not constipated. Drinking at least 2 litres (3 ½ pints) of water will also help to avoid the condition.

Q: My friend had to have a gallstone operation and was told go on a low-fat diet. I have also been told that eating lots of fat causes gallstones. Will I develop gallstones eating this Diabetes Diet?
A: Quite the reverse — a fatty diet actually prevents gallstones. Fair, fat and forty. That is the general perception of someone with gallstones. For this reason, gallstones, often found in fat people, are usually attributed to a diet high in fats. In fact this is the opposite of the truth: Gallstones are caused by eating too little fat rather than too much.
    Fats are not soluble in water. Before dietary fat can be digested, it has to be emulsified. That is what bile is used for. The liver makes bile continuously and stores it in the gall bladder until such time as it is needed. Gallstones are formed when the gall bladder is not emptied on a regular basis — because you aren't eating fat.
    Low-fat slimming diets are probably the major cause. All such diets restrict fats. In people who eat a low-fat diet, bile is stored for long periods in the gall bladder — and it stagnates. In time — and it can be really quite a short time — a 'sludge' begins to form. This then coagulates to form small stones, called 'gravel' which then become bigger. The speed with which this happens was dramatically demonstrated in a trial at several American university hospitals.22 None of the subjects had any sign of gallbladder disease at the start of the study. However, after only eight weeks of low-fat, weight-reduction dieting, more than a quarter had developed gallstones. Where they were fed intravenously, half developed gall bladder sludge after 3 weeks, and all had developed sludge by six weeks. Nearly half of those who developed sludge also developed gallstones. This is an alarming finding as gallstones are not only painful, the operation to remove them is potentially life-threatening. The more one uses low-fat diets, the greater is the risk.
    The pain that someone with gallstones gets is when these are passed with the bile in response to a fatty meal and get stuck in the bile duct.
    So, it is a low-fat diet which causes the gallstones but it is eating a high-fat diet that makes them apparent. If you eat a low-fat diet and never eat fat again, then you probably won't get the pain, even though the stones are there.
    If someone suffers from gallstones, a low-fat diet 'prevents' the symptoms, so doctors often suggest such a diet. But it makes the cause of the symptoms (gallstones) worse. Doctors are often loath to operate to remove the stones, so just preventing you knowing about them seems to them to be a good compromise — despite the fact that you will then be miserable and hungry as a result!

Q: But how can this Diabetes Diet that cuts out a whole food group be a balanced diet?
A: There is no concept so dear to a nutritionist's heart as that of a balanced diet. Those who complain that this way of eating is not a balanced diet, or that it cuts out a whole food group, simply don't understand what a balanced diet is. You will realise just how necessary a 'balanced' diet is when you consider that in many parts of the world large groups of hunters live quite healthily on nothing but a small part of one group: fat meat. There is an enormous body of evidence from all over the world that people can and do remain entirely fit and healthy on diets that are restricted to meat alone. Obviously, the 'balanced' diet so beloved of dieticians is not so important after all.
    The truth is that a balanced diet is any diet that supplies all the nutrients the body requires, in the correct proportions. A diet of fresh meat alone, if fat is included, can do just that. And offal helps too: weight for weight, liver, for example, contains four times as much vitamin C as either apples or pears, and kidney is nearly as good. The Diabetes Diet, however, goes much further in that carbohydrate intake is not cut out, merely reduced. The diabetes Diet is, in all respects, a balanced diet.

Q: But eating a lot of fat makes me queasy
A: Some people say that they find a high-fat diet nauseating. They associate the word 'fat' with blubber or greasy food. It is noticeable, however, that they usually have no difficulty eating fat if that fat is called 'butter' or 'cream'. And the person who cannot stand 'greasy food' usually has no problem eating chocolate.
    Strangely, although people have been professing to want leaner meat since the end of food rationing in Britian in 1954, the actual consumption of fat in Britain has been rising steadily throughout this century. The problem with this, as far as health is concerned, is that the increase has not been of healthy animal fats but of unhealthy hydrogenated vegetable oils .
    If you really cannot stand the sight of visible fat on a succulent piece of meat, you can avoid offending your palate by choosing foods that are high in invisible fats, or the acceptable fats that you eat now. After a while you will find that you will come to relish the crackling on pork, the skin on chicken or the fat on a piece of roast beef and you will be back to the ideal way of eating. At this stage fat will only make you feel nauseous if you try to eat more of it than your body wants. And that is what we want it to do: it's your body's signal that it has had enough. Listen to your body, stop eating when it tells you, and fat will not be a problem — either in your food or on your body.
    You may even find that your diabetes diet is 'healthier' in the conventional sense. One client told us that before she started to eat this way she didn't like vegetables. She did eat them but only because she was told that '5 portions' of vegetables were 'healthy', not because she liked them. Now that she can fry vegetables or put olive oil or butter on them, she enjoys vegetables so much that she is actually eating more than she did before. 'It's opened up a whole new world to me' she said.

Q: But doesn't the diabetes diet cost more?
A: It can actually work out cheaper! Carbohydrate foods such as potato crisps or bread and jam tend to be more readily available for snacks than meat and cheese. This can be a problem when you are eating what you are used to, and when well-meaning friends press such food on you. Sweet and starchy foods are also cheaper to buy as far as bulk is concerned. But you have to eat a lot more of these to supply the nutrients your body needs.
    Eating the diabetes diet way can actually cost less. For example, at the time of writing, three bell peppers — one red, one yellow and one green, which is how supermarkets seem to sell them — cost the same as six extra-large eggs or six duck eggs. The better value in the eggs is demonstrated below:

                     Peppers              Eggs
Energy         150 kcals            480 kcals
Protein         5.7g ;               43.2g
Carb             35.4                  3.2g
Fat               0.0g                   28.8g
Calcium       61.5mg             170.4mg