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Monday, March 26, 2007

Where Can I Get Reliable Low-Carb Advice?

My e-mail box has been rockin' and rollin' lately with lots of outstanding questions and comments from people who are livin' la vida low-carb to lose weight, improve their health, and radically change their life for the better. That's exactly what it did for me and I am happy to provide a place of refuge where people feel comfortable enough to ask questions that will help them get to that same place in their own life.

As I have stated many times, though, I am not a doctor or a nutritionist (although I am looking into trying to become a trained dietitian--if only there were a program that was "low-carb" friendly to teach people like me the ins and outs of it all). So the information I provide here is from two perspectives. First, it is from my own empirical research and investigation into this amazing lifestyle change known as low-carb living. And second, it is from my own personal experience losing a ton of weight and improving my health with this remarkable nutritional approach.

With that said, I sometimes receive a much more complicated question from a reader desperate for an answer that I have no idea how to respond to it. That's okay because I never pretend to have all the answers. But I do know a few people in the low-carb community who DO have the knowledge and experience to accurately provide answers to the tough topics.

Here's the difficult e-mail I received late last week:

Dear Jimmy,

Thanks so much for your blog. I am enjoying and learning so much. Personally, i have been pregnant and/or nursing for the past 11 years, so my weight has been all over the place and low-carb living during the past 4 years has helped me so much with all of the typical issues.

Alas, this e-mail question is not about me, though--it's for my husband.

He has had extremely high cholesterol/triglycerides issues (total cholesterol is about 400 and triglycerides are over 1200). About 3 years ago he did the low-carb thing and lost about 30 pounds (was still overweight but no longer obese) and his numbers went way down to normal or almost normal (while taking the drug gemfibrozil). After resuming normal American eating habits again, he gained the weight back and was switched to another drug and the numbers are through the roof again.

I also have a question about another issue he has--kidney stones. These have been determined to be made from uric acid. In my research one of the recommendations for improving this is to avoid eating meat and even chicken. My husband wants to go back to his low-carb ways, but how do we know if this low meat thing is for real or if it is the standard government scare tactic that "saturated fats are bad" line?

So I suppose my general question in the end is when it comes to diet recommendations for specific medical conditions, where can I get reliable information that is "low-carb friendly?" Thanks for all your work in the low-carb world!!


WOW, where do you start with an e-mail like that?! I've never heard of cholesterol and triglycerides being that high, but it is obvious livin' la vida low-carb would SUBSTANTIALLY reduce both numbers as it has in the past. If it worked so well before, then why would this person subject themselves to the "normal American eating habits" again?

That's why you constantly hear me talk about making this way of eating a permanent lifestyle change. People sometimes look at me like I'm some kind of alien when I declare to them that I am still on the Atkins diet. What?! Why would you keep doing that "extreme" diet long after you have gotten your weight and health under control? My answer--precisely because I want to KEEP my weight and health functioning the very best it can for the rest of my life. Period. End of story.

Call it "extreme" all you want, but it's working EXTREMELY well for me. :)

Regarding my reader's question at the end about where to find reliable "low-carb friendly" medical advice, it is available from a couple of outstanding sources that I very highly recommend to you. I have previously discussed them here at my blog, but I'll share them with you again--the "Ask Dr. Vernon" blog from low-carb practitioner Dr. Mary C. Vernon (who helped me out with this e-mail today which I will share with you in a moment) and "The Salerno Strategy" blog from Dr. John P. Salerno who used to work directly with Dr. Robert C. Atkins at his Atkins Center for Complementary Medicine a few years back.

Additionally, there are people like Regina Wilshire from the "Weight Of The Evidence" blog, Protein Power author Dr. Mike Eades and his fantastic blog, Adam Campbell from "The Fitness Insider" feature at Men's Health magazine, and so many others. I know most of these people personally and rely on their many years of collective low-carb wisdom to guide me when I am stumped about how to answer an e-mail like the one I shared in this post.

Thankfully, Dr. Vernon stepped up to the plate to answer this one for me:

This is a common problem. Here's why-

Elevated triglycerides are a marker for abnormal glucose metabolism. I'd argue that evidence exists to show that the high levels of insulin tell the liver to make fat--that is, to synthesize triglycerides.

Get a 3 or 5 hour glucose tolerance test with insulin levels at the baseline (fasting) and 2 hour draw. Best is a 5 hour GTT with insulin drawn at every blood draw. The insulin and glucose normals are described in Atkins Diabetes Revolution.
I have seen many patients completely normalize their triglycerides and cholesterol levels by using carbohydrate control.

Now, about the kidney stones--

The kidney stone formation is linked to the underlying metabolism with the high insulin levels just like the trigylcerides are. It's not the protein, it's the carbs that cause the kidney stone formation in susceptible people. The Atkins diet gets blamed, I think, because if you cycle on and off of it, as your husband did, then you might form stones when you are off of the diet.

When you begin to control carbs enough to lose weight, usually one loses the extra water that high insulin levels pull into your body. This causes increased urine production and "washes out" the stone. So it seems to happen on the diet, but really happened before. I've followed lots of patients and I have only had one patient with "new" kidney stones in all these years!

OK, so let's hypothesize that my data and I are both wrong. What if some folks do form kidney stones on the diet? Potassium citrate can be used as a preventative. I discuss this with anyone who has a history of kidney stones because I want my patients to be healthy and feel good. Passing a kidney stone does not feel good.

So, check out the glucose tolerance test, get your husband to discuss potassium citrate with his physician, and keep the carbs controlled. Patients with the metabolic response to carbs like your husband has will always have it. Losing the weight doesn't make the tendency to have this problem go away. So make the changes lifestyle changes.

He is at risk for blood vessel damage based on what you have told me--so if he has chest pains take them seriously and get medical attention immediately.

Hope you find this helpful.

Mary Vernon


I learned a lot from Dr. Vernon's response and I appreciate her willingness to provide an answer to this very complex question by my reader. You can send your own questions to Dr. Mary C. Vernon anytime by visiting her "Ask Dr. Vernon" blog anytime. She may feature the answer to your question in a future post, so give it a try!

As always, I am happy to field your question about livin' la vida low-carb anytime at livinlowcarbman@charter.net. Of course, with over 1650 blog posts, it is possible I have already blogged about the issue you are concerned about (most of the time I have). If you do a Google search of "Livin' La Vida Low-Carb" and then the subject matter of your question, then most of the time you'll find my columns. If not, then give me a shout, okeydokey! SEE YA!

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7 Comments:

Blogger Rodney Robbins said...

Great response by Dr. Vernon. I have had kidney stones. Bad as they are, they aren't necessarily caused by a low carb diet. Mine were may have been caused by the the local water--the ER nurse said that people in our area have more kidney stones than anywhere else in the country. My stones may also have been caused by the drugs I take to control a rare genetic disorder called Periodic Paralysis. I need the drugs, extra potassium and a low carb diet or I am constantly weak and sometimes out and out paralysed! Weird, huh? You can read more about it at OnLifeAndLiving.com.

3/27/2007 12:35 PM  
Blogger Jimmy Moore said...

Excellent web site you have there, Rodney! Keep up the FANTASTIC work!

3/27/2007 12:39 PM  
Blogger Kevin said...

Great question and answer - and as Dr. Vernon noted, this problem is typical of many cases. This kind of informed professional intervention reflects the best of what blogging can be. That it is typical means that one such piece of advice can help educate many readers at once. Such a forum can help to make low-carb advice as much "standard knowledge" as low-fat advice already is.

3/27/2007 5:57 PM  
Blogger 49er said...

Loren cordain had a great article in this news letter

http://www.thepaleodiet.com/newsletter/newsletters/PDN_Vol2No4.pdf

on gout and uric acid production and elimination. It looks at and dispels a lot of misconceptions about what foods do or do not stimulate uric acid production.
Cheers;
John

3/27/2007 6:55 PM  
Blogger JeriD said...

Hey, Jimmy--with your knowledge base, you would make a great dietician. I found this on www.sheknows.com and it is by Dr. Pescatore. I looked up "low carb friendly" Dieticians and this was the article that popped up. The key thing for YOU is this excerpt:
"If you can only find a doctor who will tolerate your aberrant behavior, you may want to meet with a nutritionist. There are two excellent referral networks for nutritionists. The first one I am partial to as I am the president of the organization, the International and American Association of Clinical Nutritionists. Since I am the president of the organization, I know for a fact that each of the members is on board with the principles of a lower carbohydrate approach. The second organization certifies with a CNS designation and they can be reached at www.cns.org. I know far less about this organization but I know many good people who are part of them."

These may be places to start your search for a program that meets your needs. Good luck!

3/27/2007 11:23 PM  
Blogger JeriD said...

Sorry, Jimmy--here is another paragraph from that article:

For the most part, registered dieticians who do not have a CCN or CNS certification are probably not going to be sympathetic towards low carbohydrate lifestyles and may in fact be quite hostile."

Here is the link: http://sheknows.com/about/look/7005.htm

3/27/2007 11:26 PM  
Blogger Jimmy Moore said...

THANKS for the tip, JeriD! I remember Dr. Pescatore talking about those organizations previously in my interview with him, I had just forgotten about them. THANK YOU again and wish me luck!

3/27/2007 11:28 PM  

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