I won’t go into the full history of low-carb nutrition. That has been written about elsewhere.
The current era of low-carb nutrition I would describe roughly (and tongue-in-cheek) as Low Carb 1.0, 2.0, 3.0 and Next:
Low-Carb 1.0 – the 60′s, 70′s, 80′s and 90′s – Low-carb weight loss diets presented in popular books. Careful instructions are given, gleaned from dedicated and detailed clinical work. Dr. Robert Atkins creates a contribution he will long be respected and appreciated for. In his work, he understands and writes about the broad medical benefits of low-carb eating and the great value of choosing low carb eating as a long-term lifestyle, but the message picked up by the public is overwhelmingly low-carb as a weight loss diet.
People often do, though, find it difficult fo follow. The scientific knowledge base is still fairly skimpy. People are more on their own with any difficulties they had, due to an absence of knowledgable clinicians and also their being much less likely to be in contact with others sharing their experiences.
Also, there is a great lack of support in society and in the health professions for people doing low-carb eating. Although many people have a great deal of initial success, and are very pleased and enthusiastic, and there is great potential for life-changing benefit, most people do not stay with a low-carb lifestyle. Some do and continue to receive benefit.
The tremendous promise of low-carb eating is obvious to those who benefit from it. There is a feeling that we are just so close to making it work long-term. This prompts numerous authors to come out with books promoting various tweaks to the low-carb diet. We still feel that a (world-changing) more workable version is just so close, but tantalizingly just beyond our fingers.
The missing concept (a broader adoption of a positive attitude to higher fat intake when not targeting weight loss) is yet to come.
Low-Carb 2.0 - the 2000s and continuing – Ground-breaking research is published. Practicing physicians gain more and more experience with the daily application of low-carb living. More researchers and more clinicians and more patients means putting heads together. There is greater and greater insight into trouble-shooting and individualized application. More is understood about adaptation to ketosis, about gluconeogenesis and about low-carb in the context of high exertion and athletic performance, among other topics. The physicians, researchers and others at the core of this carry forward and expand the understanding of low-carb eating having great potential for widespread health and medical benefit far beyond solely as a weight loss tool.
The single most important understanding is the evidence supporting the safety of high fat intake when, (specifically when) paired with a low intake of carbohydrates. Without mentally and emotionally accepting a high fat intake, long-term success on a low-carb eating plan is not possible.
This changes everything.
This is what really breaks open the doors to more wide-spread long-term use of low-carb as a sustainable health strategy and continuing lifestyle. This also is required to increase the recognition and understanding of low carb eating and nutritional ketosis as viable long-term tools with medical applications independent of whether the person is overweight or not, independent of whether they have metabolic syndrome or not.
It’s time for the broader public and wider medical/research community, beyond the more knowledgable core researchers, clinicians and happy low-carb lifestylers to take another look at low carb. Along comes growing use of the internet (special recognition to Jimmy Moore). The emergence of another popular author, Gary Taubes, who receives wide-spread and sustained media attention, plays a major role in resurgence of interest in the low carb option.
One other thing, the research clearly shows that eating a low carbohydrate diet is associated with a general broad shift in metabolism that goes well beyond just whether one is burning predominantly carbohydrates or predominantly fats/ketones for fuel. This means that medical research conducted on people who are eating higher amounts of carbohydrates cannot be just assumed to apply to people who are adapted to low carbohydrate nutrition. Research findings cannot be properly reported and interpreted without consideration of this.
Low-Carb 3.0 - the current time – Low-carb meets up with other dietary practices and principles, for example:
- whole foods, Paleo, Primal, Ancestral, Nourishing Traditions
- addiction or “addiction-like” responses to food – food addiction, sugar addiction, carb addiction, brain sensitization
- health issues with gluten, including celiac disease (studies have repeatedly shown about 1% of the population to have celiac disease and it can onset at any age) and gluten sensitivity (estimated to affect another 7% of the population)
- sports and physical fitness nutrition science
- diabetes care and greatly minimizing glycation damage (damage to body tissues from high blood glucose levels). Opening up of the concept of low carb as a lifelong strategy takes this beyond the already tremendously valuable use of low carb as a weight loss technique, with its benefits in improving, resolving, and preventing type 2 diabetes. More awareness comes to the decades of work by Dr. Richard K. Bernstein in using low carb nutrition to achieve fine control of blood sugar in both type 1 and type 2 diabetes, with dramatic impact on avoidance of the many severe complications that would usually develop in these conditions over time. Research is published showing that harm to health correlates in the general population to blood sugar levels well down into what is considered the normal range.
- ketosis as a medical intervention to help various symptoms and medical problems and as a strategy in high-performance athletics, in addition to its previously understood role in reducing appetite
- an expanded concept of the many health impacts of metabolic syndrome and insulin resistance.
- low carb for metabolic health, yielding also improvement in weight control; nutritional ketosis for reduction in appetite; together generally leading to substantial weight reduction – but not always enough to reach and maintain a normal body weight
- total body fat content has gotten too much of the blame in terms of the health consequences that are associated with obesity, the consequences of metabolic syndrome/insulin resistance/diabetes and inflammation are primarily to blame for much of the harm that has been attributed to obesity and these can be greatly improved with low carb nutrition. The majority of people with obesity have metabolic syndrome, so this has confused the picture.
Thus, an ever expanding community brings different experiences, concepts and understandings to the shared table.
Now we can better understand people’s different responses to low-carb eating and what can happen as they consume carb foods after eliminating them for awhile. Without considering these other dietary issues, the response to small intakes of carbs can be very difficult to understand. Figuring out why low-carb eating can be so life-changing might also be confusing.
If someone has brain sensitization to sugar or to starch (turns into sugar in the digestive tract), even a small intake that would not be expected to have much impact on ketosis or insulin levels might actually be very disruptive and precipitate an abrupt onset of craving and result in abandonment of low-carb eating (even after months of happy, productive and contented success). People who have such sugar or carb addiction-like responses have reported that long-term triumph requires not just abstinence from the more obvious food triggers, but carefully noting all addictions and addictive-like responses and maintaining abstinence from all triggers. Further, in this context the sweet taste of artificial sweeteners and sugar alcohols (in many ‘diet’ and commercially-made ‘low-carb’ products) might be disruptive in a confusing way.
A person with celiac disease (an auto-immune response triggered by gluten) or with gluten sensitivity (a different type of immune reaction to gluten) is very likely to be unaware of it. Most people who have these problems with gluten are blind to their situation. Thus, when they start a low carb eating plan, they might eliminate gluten and not truly understand that as being part of why they feel so much better. However, low-carb eating itself, even at a ketogenic level, does not actually require elimination of gluten grains (wheat, rye, barley), it just often is done that way in practice. Very small intakes of wheat, etc., (like scraping almost every bit of sauce off a meat served at a dinner, for example) then, might cause wild swings in symptoms that are confusing and discouraging. There would likely be accompanying large swings in weight as fluid retention accompanied the inflammatory response (or the opposite if diarrhea resulted).
What is Next? As I see it, what is next is a more complete recognition of the central importance of the special role low-carb nutrition plays as a satiety-focused intervention. Actually, that it is a set of satiety-focused interventions woven together (for example, lowering elevated insulin, more stable blood sugar, respite for those addicted to sugar/starches, gluten elimination, nutritional ketosis aiding appetite control)
Dr. Atkins has received recognition and admiration for many things, but I think that his stance of practicing low-carb specifically with a satiety focus, rather than a calorie-limiting focus, is his second biggest contribution. While recognized as the father of modern-day carb-controlled nutrition, to me he is also the father of satiety-focused weight health. We might take it for granted that he chose this route, but I would imagine that he came under considerable pressure to add a calorie-restriction to his recommendations. (A calorie restriction can be obviously stated, or less obvious such as set serving sizes and amounts.)
If you read my pages under “Satiety-Focused Weight Health” you will see my argument that there are only two dietary paths to consider when targeting weight health – either imposed calorie-restriction OR targeting optimal appetite/satiety system function. The two are mutually exclusive. The act of imposing calorie restriction intrinsically interferes with attaining optimal functioning of the appetite/satiety system.
The world of calorie-restricted dieting is imploding. The doctors and the agencies and the public are all discouraged. Rather than giving up, which is now being openly discussed seriously as a viable option within the medical system, wouldn’t it now be time to give satiety-focused weight health a proper chance?
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A full teaching regarding low-carb eating is far beyond the scope or intent of this blog. Many good resources are available.
Dr. Eric Westman, Duke University
Dr. Alessio Fasano, Director of the University of Maryland Center for Celiac Research, defines gluten and describes the spectrum of gluten intolerance. Dr. Fasano describes the symptoms and treatment of celiac disease.