Sunday, April 22, 2012

Excellent Questions From a Fellow Low-Carber!

Dear Dr. Carlson,

I have been reading the chapters of your book online. I'm writing to buy an electronic copy of your book and also to ask for your advice if you're able to give it. I want to thank you in advance for spending your time responding to my questions. I think you've done a very valuable thing writing your book.

I am a 49 year old woman who was obese for over 10 years. I have lost most of my extra weight and I've been researching how to keep it off and be healthy long term. I am also experiencing long-term (years) fatigue and mild depression symptoms, and I was diagnosed this January with mild sleep apnea, which is being successfully treated with cpap at this point.

I've been eating very low carb (high fat and protein) for over two years now. I eat organic dairy and grassfed meat and mostly organic veggies/fruit/nuts. Low carb eating is a big part of how I lost all the weight, and it's definitely the only thing that keeps the weight off -- it still keeps trying to sneak back on, very difficult to maintain, wish I understood better how to maintain. It's hard to pinpoint what foods are causing me to gain. I weigh every day and chart it, and I do write down what I eat, but I think some very low-carb foods, like almond flour recipes, or homemade crustless quiche (eggs/cream/cheese/veggies), still do trigger weight gain for me. The only sugar I eat is a little in dark chocolate. I don't eat any grains. I have a serving of strawberries or an apple every day or two, no other fruits. I just wish I could actually figure out what I "can" eat, and settle down to that, so my weight wouldn't keep creeping up again!

I am 5'6", 159 lbs right now. My highest was 242 lbs, 3 years ago. My lowest was 143 lbs last April, but couldn't keep it there. I exercise 2-3 times a week (mild circuit training- Curves) trying to work up to more times, but I have a tricky right knee and lower back, so have to go kind of slow to not mess them up and have to stop again.

From my reading, It seems like my test results are looking pretty good. I'd like to know if you see what might be missing still in my understanding of all this and how I can keep the weight off easier and feel better. I know you can't advise me as a doctor. Please advise me as a researcher, trying to understand the science of how all this works. In case it fills in any blanks, I will tell you that I have also had shingles and active Epstein-barr virus in the past 10 yrs, that I have an autistic son, that my father was malnourished as a baby, and that my paternal grandmother was also very obese, and apparently at about 40 "went to bed" and wasn't really able to do much the rest of her life. I think that was the direction my health was going, before I started on this quest, and I am determined to stay active and get healthier and healthier.

Fasting blood sugar most days is around 90 (this makes me really happy - a year ago it was 103)
Cholesterol, total - 140
Triglycerides - 53
HDL cholesterol - 74
VLDL cholesterol Cal - 11
LDL cholesterol Calc - 55
T. Chol/HDL Ratio - 1.9
C-Reactive protein, Cardiac - 0.71 (ref 0-3.00) - this was up in the danger range when I was obese.

I've been reading your book and also Gary Taubes, Robert Lustig, Mary Fallon, and others, and as I understand the scope of the health emergency here, and how all roads lead to the same answer - stop eating carbs and sugar - I'm finding myself needing to tell other people what I know about how they can be healthier for the rest of their lives. I know you can relate, as you are on that mission, too. Most adults, even very smart ones, know so little, and hear so much misinformation! I hate it that they're still being told to eat low-fat and whole grains, it just kills me to see my young adult kids eating lots of flour and sugar, and also friends who are my age eating in ways that will make them sick. It doesn't work to just tell someone what they're doing wrong, though. With my own kids, I'm thinking I can at least ask them to get their lipids tested, fasting blood sugar and BMI, and what to do if they are not in range. With others, I'm not sure how I can effectively help. Do you have any advice for me? I'm not sure they'd read a whole book if I handed it to them, but maybe they would read a booklet, something shorter, especially if it seemed really credible and scientific. What do you think? Have you had luck getting your family and friends to change their eating?

I am done with the first 10 chapters, so I guess I need to buy an electronic copy of your book!

Please let me know how I can do this.


My response;

Hi There!

Your story is so like all the thousands upon thousands of e-mails I have received over the last few years since I had written my book. You are so not alone. It is indeed difficult to eat the correct way because we are inundated on a daily basis about the 'accepted' diet which in reality is simply killing more and more of us. A few words of caution...get rid of the fruit and berries, they contain glucose and fructose and this will slow down our ability to lose weight and can be used to create not only fat, but cholesterol as well.

Your lipid panel is awesome! Interesting how eating more fat and cholesterol actually makes us more healthy....hmmmmmm :-)

As far as your young adult children are concerned, that's a difficult prospect because diets have become unfortunately a belief, rather than based on scientific fact, so people continue to eat the way they believe is the right way, despite the voluminous evidence to the contrary. Your children will need to come to an understanding of the correct way to eat and then wish to implement a change in their dietary habits, proselytizing rarely works.

I hope my response was helpful and even though my response to you is for educational purposes only, I implore you to continue to eat the scientifically correct way :-)

Oh, as for the rest of my book, simply send $9.99 to PayPal using and I'll e-mail a copy right on over. Now I'm off to have a nice grass feed cut of beef!

dr jim :-)

And some follow-up questions....

Hi There Again!

See my italicized responses after your questions below :-)

I am happy to support your work! I'm excited to get going on more reading. I've been diagramming some of the processes out as I go through, to help the information sink in so I can internalize it well enough to explain it to someone.

If you are willing and have just another couple of minutes, I was wondering if I could ask a few questions. These are the nagging things that I worry about:

1. Cutting fruit entirely from my diet sounds scary to me. Is there anything fruit adds to the diet that is essential to being healthy? Aren't there some flavonoids in fruit/berries that are anti-cancer, and are not in veggies? I definitely want to cancer-proof my body as much as possible. I also understand that raw fruit has enzymes in it that help digestion.

Nope, fruit adds very little to our diets other than sugar. It is virtually devoid of nutrients due to all the processing so all it really provides us with is, again, sugar. As far as the phytonutrients/flavanoids stick with berries, but stay with blue, black and raspberries avoiding strawberries which tend to contain more sugar. As far as digestive enzymes I'm not aware of that.
2. Is there anything that grain and carb foods provide for health that I am missing by not eating them for years on end? Same question as above - any healthy nutrients in grains that are essential? Seems intuitively to me that if people have been eating them for so many years, there must have been a nutritional reason.

There is nothing essential in grains that you are missing. Just because people have been consuming them for years does not equate with them being healthy. Along the same line of thought, is there an intuitive health reason people have been smoking or drinking soda pop for so many years, that's certainly not healthy. I guess it all goes back to the realization that low fat, low cholesterol diets are unhealthy; then we look around and see all the major medical organizations, doctor TV shows, magazines, medical schools, most doctors/nutritionists/dietitians, major university studies (like Harvards latest red-meat study) and then we look at how we're eating (which is correct) and then we wonder how 'they' all can be wrong and how could 'we' possibly be right? So then we step back and wonder about the possibility of nutrients in say grains and apples or whatnot...Coming to the realization that low fat/cholesterol diets are not just wrong but essentially will wipe out the human race is a very scary realization...but a true one. Remember, beliefs can be right or wrong....the facts just are....

3. If I am able to eat small amounts of nutritious carbs and not gain weight, are they an ok addition to my diet? In other words, would 1/2 cup of brown rice or a potato or a piece of sprouted wheat bread now and then be ok, or even be a smart idea for some health reason, as long as my numbers stay good, or is my goal really, really to cut grains/carb-foods completely? Just trying to understand where that "line" is that I'm trying to end up on the right side of! What about ketones? Is it really ok to be in a ketogenic state on a semi-permanent basis? Maybe this is in the part of the book I haven't read yet...

Excellent question. OK, so first off let's re-emphasize I am not talking about zero carbs, you'll need to get some. If you suffer from heart disease, obesity, diabetes, heartburn, asthma, allergies, colitis, irritable bowel, eczema, psoriasis, any connective tissue disease (including fibromyalgia), have a family history of any type of cancer (and this list goes on and on) will need to stay around 20 to 30 grams of carbs a day; and yes, watch your biochemistries because the proof lies there (HDL, triglycerides, liver, kidney, blood sugar, HgBA1c etc). As far as benign dietary ketosis is concerned, well, it's benign, so you can stay in this state for your entire life and the only thing that'll happen is you will stay at a healthy weight, your biochemistries wont stray into the danger range, you most likely will not need medications and you will live a very long and healthy life.

4. I'm not sure I agree with you about non-nutritive sweeteners. Have you revised your opinions about them at all since you wrote your book?

Yes, I have. My favorite remains the sweetener sucralose, ie Splenda. But when cooking with it beware that Splenda also contains dextrose and maltodextrin which, depending on how much Splenda one uses, can increase the carb content significantly. In the interest of revealing to the public I do not know everything (some people actually think I do :-) I just learned that about Splenda a few weeks ago told to me by Judy Barnes Baker expert low carb author and chef and has a few books of her own out there ('Nourished: A Cookbook for Health, Weight Loss, and Metabolic Balance' & 'Carb Wars: Sugar is The New Fat') which are excellent sources for delicious low carb cooking.

I just did an interview with the Salt:NPR blog on the metabolism of sucralose & Stevia, both of which remain inert and have minimal to no effect on our physiologies when ingested, so I gave them a thumbs up at this time. And certainly better/safer to consume than sugar/carbs.

A quick word about Aspartame, aka Nutrisweet. It is a sweetener created by joining phenylalanine with aspartic acid. Allegedly the only people who will have trouble with this sweetener are those lacking the enzyme necessary
to break these 2 molecules apart rendering phenylalanine and aspartic acid. They are referred to as phenylketonurics. Here in America, most children (and notice I used the word most, not all) are screened for the absence of this enzyme at birth. If the enzyme is absent, the parents are immediately told that their child needs to avoid not only aspartame but phenylalanine containing foods.Sounds simple enough but here's where it gets tricky; analysis of the nutrisweet molecule reveals yes, one molecule of aspartic acid and one molecule of phenylalanine, but off to the side is a molecule of methanol, which is a poison in our systems when consumed in even a small quantity. Once cleaved from the larger molecule methanol will be metabolized to formaldehyde (yes, you read that right) and then to formic acid which in the quantities consumed in say a diet soda, passes through the body without causing any damage. Hmmmmm. If that doesnt sit right with you than we are on the same page. I have to state in the literature I perused it was stated that the change from formaldehyde to formic acid was almost instantaneous so those two species dont stay in our bodies long; and yes, i am still squirming a bit uncomfortable in my seat right I do tell my patients to try and avoid nutrisweet in large amounts, but again, what is the lesser of 2 evils nutrisweet or carbs...oh yeah, I am writing all this as I open up another diet Pepsi...shhhhh, hey, nobody's perfect :-)

Hope these answers help!

dr jim


  1. Some interesting discussion about Splenda here:

    To my mind, it's questionable enough to avoid.

  2. Thanks for the information; your blog is really helpful to me.

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