Metabolism Conference: The History of Low-Carb Diets

Following the obesity conference, I attended the annual symposium of the Metabolism Society (used to be the Nutrition and Metabolism Society and is considering returning to that name). This group is, as far as I know, the only organized group which focuses on the science of how diet influences metabolic processes such as those that affect diabetes, metabolic syndrome, etc. Although the organization has been very small to this point, they have an agenda to disseminate this information more widely, including to decision-makers in nutrition-related areas. Carbohydrate reduction is one of the main themes that keeps coming up in the research, but certainly other dietary factors are important (protein, fats, etc.). I encourage my readers to check out this group, and join if you can to help spread the word about the value of low-carb eating!

Anyway, on to the conference!

Again, a highlight was a talk by Gary Taubes, this time on the history of low-carb diets. (I am definitely going to write an article about this.) The main point is that basically since we have had records of people dieting, the primary method has been limiting carbohydrate. Gary cited numerous examples in the historical record. In fact, the ONLY time this hasn't been the case is the last 35 years - and almost the second the recommendations changed, people started gaining weight.

I was fascinated by the description of a very tightly-controlled series of studies done by Diane Stadler, focusing on the affects of diet on appetite hormones such as leptin, ghrelin, etc. The researchers meticulously figured out exactly how many calories the participants needed to eat to maintain their weight, provided food, and carefully measured what was not eaten. Some interesting observations: People on the low-carb diet spontaneously reduced their calorie intake by 30-40%, while those on the DASH diet (which was higher in protein than baseline, and also high in (complex) carbs) reduced their intake by about half that amount. And their appetite hormones (although there were some interesting variations) seemed to be consistent with this change.

Jackie Eberstein gave an informative talk to help the physicians understand low-carb diets. I really liked her section about ketones (which are produced as part of fat metabolism). She explained how the body uses ketones and how the heart and brain actually run more efficiently using ketones than sugar. She also provided a nice little chart of various conditions and associated levels of blood ketones (overnight fast .3 mmol/L, ketogenic diet 1-3, 20-day fast 10, uncontrolled diabetic ketoacidosis 25). Also, if your ketostrip isn't turning purple, don't worry (as long as you know your carbs are still low!) - your body has probably just gotten better at using the ketones for fuel.

Mary Vernon blitzed the doctors with her usual impressive barrage of facts and figures about low-carb eating. But she ended with something I'd not heard her talk about before. She said that the medical profession has contributed to "learned helplessness" by prescribing a diet that doesn't work for a lot of people, and then blaming the patient as being "non-compliant" when it didn't work.

Richard Feinman, professor of biochemisty at SUNY Downstate College of Medicine, and director of the Metabolism Society, spoke about how low-carb diets should be the one tried first (and if it doesn't work, then go to something different). He said that we know that no diet is better for obesity and diabetes, and that it's better than any other for many things. He said, "carbohydrate is not just a fuel; it's a control element" - meaning that it triggers insulin, which in excess triggers not only fat storage, but other negatives. He also said, "if you do a moderate diet, you get moderate results".

Jay Wortman talked about traditional diets, particularly speaking of those in North America, but a few others as well. He talked about the emphasis on fats in these diets and how each had their own "stable fat", be it bear fat, pemmican, or "oolichan grease" - this last which he has studied extensively. (He was the principle researcher of the study in the excellent video "My Big Fat Diet".)

Eric Kossoff works with children with seizure disorders at Johns Hopkins and spoke about the success they have had using ketogenic and modified Atkins diets for children with epilepsy and other neurological disorders, and how there is preliminary evidence that they may help some adults as well.

Fat expert Steve Phinney's talk, "Why Saturated Fats Exist" had many points to ponder. Here are three of them:

- The fats in the phosolipid layers in our cell membranes are half saturated fats.
- When our bodies make extra glucose into fat (de novo lipgenesis) it makes mostly saturated fats. Why? (And is this why people on low-fat/high-carb diets may have more saturated fat in their blood, despite eating less of it than people on low-carb diets?)
- Saturated fats are very easily turned into monounsturated fats by our bodies. If the monos are so much better, why don't our bodies do this more?

Donald Layman spoke about the importance of protein, partly as a "metabolic signal" in the body telling the body to make more muscle - this is particularly true by middle age and older. The "minimum" protein recommendations are not at all "optimal" - optimal is probably something like 1.5 grams of protein per day per kg of body weight (though Layman thinks probably not quite as much as this for obese people, as the amount of lean mass factors in). He also feels strongly that a big problem with the typical U.S. diet is that we do not eat enough protein at breakfast, in order to get us out of the muscle and bone-wasting mode of the night. We tend to load our protein into the last meal of the day, which is really not optimal - it should be much more balanced. 30 grams of protein at least three times a day is a kind of threshold. If you eat enough calories to justify it, four times is even better. Also, animal sources of protein do the job better than plant protein - if eating you're eating plant protein, you probably need to eat more of it.

Of course, one of the highlights of the conference for me is just getting together with authors, researchers and bloggers who know so much and are willing to share. It's such a breath of fresh air to not be fighting "current dogma" or whatever you want to call it. I talked to a man who has been diabetic for 17 years. He brought his HA1C from 18 to 5.2 by eating low-carb. His doctor tells him that he is "cheating" to do it with low-carb! This man cannot find an endocrinologist in all of Southern California who will support him in this way of eating (can anyone help?) It is absolutely nuts out there, and it makes me all the more grateful for my readers and all in the low-carb community.

And I will close with a quote by Donald Layman when pointing out that in most diet studies people don't actually follow the prescribed diets and then get very little in the way of results: "All diets that you do not follow are equal."

Image Courtesy of the Metabolism Society