Should you get tested for coeliac?

From Allergy and Autoimmune Disease for Healthcare Professionals October 9 2019

Apparently 70% of people who have coeliac have yet to be tested for it.

Who may have it?

4.7% of those with irritable bowel syndrome.

20% of those with mouth ulcers.

8% of infertile couples.

16% of type one diabetics.

7.5% of first degree relatives of people with coeliac.

About 50% of people who are diagnosed have iron deficiency diagnosis  at the time of coeliac diagnosis.

Other people who need to be tested may have:

Pancreatic insufficiency

Early onset osteoporosis or osteopenia

vitamin and mineral deficiencies

gall bladder malfunction

secondary lactose intolerance

peripheral and central nervous system disorders

Turner’s syndrome

Down’s syndrome

Dental enamel defects

persistent raised liver enzymes of unknown cause

peripheral neuropathy or ataxia

metabolic bone disorders

autoimmune thyroid disease

unexplained iron, vitamin D or folate deficiency

unexpected weight loss

prolonged fatigue

faltering growth

second degree relative with coeliac disease

My comment: I had years of  the mouth ulcers, iron deficiency anaemia and irritable bowel symptoms which all resolved completely on a wheat free diet. The problem is that if I did want tested I would need to go back on wheat for a minimum of six weeks to give my antibodies a chance to build up sufficiently to test positive.  Thus, best to get a test BEFORE you go on a wheat free diet.

 

 

Diet doctor: free online course with credit for medical professionals

This is a message from dietician Adele Hite:

I am thrilled to announce that Diet Doctor is now offering a free CME activity to all interested clinicians, patients and carers: Treating metabolic syndrome, type 2 diabetes, and obesity with therapeutic carbohydrate restriction.

Thanks to the support of our members, we can offer this CME at no cost to clinicians.

This fully referenced, evidence-based CME activity is certified for three AMA PRA Category 1 Credit(s)™. It is jointly provided by Postgraduate Institute for Medicine (PIM) and Diet Doctor and is intended for physicians, physician assistants, registered nurses, and dietitians engaged in the care of patients with metabolic syndrome, type 2 diabetes, and obesity.

The course was designed by clinicians for clinicians. As this course outline shows, it covers all clinicians need to know about dietary carbohydrate restriction and how to implement it safely and effectively with patients for whom it is appropriate. In keeping with Diet Doctor’s mission to “make low carb simple,” the course also comes with supplemental materials for clinicians and their patients to make it easy to translate evidence into practice.

We hope that this course will help reaffirm the scientific and clinical support for this approach and — along with other efforts by LowCarbUSA and expert clinicians — act as another step in solidifying a standard of care around low-carb nutrition. We would love it if you would share the news about this course with colleagues. You can forward this email to them or use this flyer to share or post.

Diet Doctor also has some new resources to help make low carb simple for patients and clinicians alike. For patients, we have:
‒ a sample menu
‒ shopping list
‒ a meal planning guide
‒ a substitutes for favorite foods handout
‒ simple meals and planned leftovers, and
‒ information about target protein ranges

For clinicians, we have handy one-pagers on:
‒ monitoring ketones
‒ fasting insulin and HOMA-IR ranges
‒ lab tests and follow-up schedule
‒ type 2 diabetes medication reduction, and
‒ a 5-day food diary for patients who need to monitor their intake

Of course, for those on the list who are not clinicians, anyone can register for and view the course. You just won’t be eligible for CME credits.

For clinicians, please let us know if we can help you help your patients in other ways. And if you are interested in supporting us as we continue to develop materials to make low carb easy for clinicians and patients, please think about becoming a Diet Doctor member yourself.

Finally, we are happy to hear suggestions for improvements moving forward. If you take the time to view the course, we’d love to hear what you think.

Best regards,
Adele

Nina’s plea: Would you write to Congress and change USA food guidelines?

This is a message from Nina Teicholz, writer and low carb activist:

My highest concern about the existing USA Food Guidelines is for the people who have no choice but to eat the food that they are given, which is based on what is thought of as “a healthy diet”. There are many essentially ‘captive’ populations in schools, hospitals, and prisons. Many of these people are the most disadvantaged among us. Native Americans on reservations have no choice about the food assistance they receive.

I’ve spoken with the Native American woman who for years has been trying to change the USDA food they get, and she cannot get even the tiniest change. They desperately need the food, yet it’s more than 50% carbs, and something like 40% of the kids on these reservations have diabetes.

The same is true for poor people, education programs, and feeding programs for the elderly. These people have no choice.  No other food  is given to them. Many doctors also say they have no choice, because  they are required to teach the guidelines to patients. It is the same thing in most federally funded institutions.

Thus, my hope is, if we have to have Guidelines for the time being, that they do as little harm as possible. The Guideline is coming up for review, but the committee have already decided not to review the evidence on low carb diet studies.  We are seeking to change this, and there is already some support for our position, that these studies should be included in the evaluation. Could we get in a low-carb option? Could we force them to consider all the science on saturated fats? This next set of Guidelines will come out by the end of this year, and I think there is still time to try to force change. Our actions now would build awareness around the issue that there is something wrong with the Guidelines. There is so little awareness of the problems. And actually I’m hopeful,  because in the last few months, we’ve worked with a number of groups to raise awareness to a level it’s never been before.

Here’s what I would suggest for now.
Both my group, The Nutrition Coalition and the group Low-carb Action Network,  have webpages that make it very easy for you (if American) to write/call your Members of Congress. This is super important and I urge everyone to do this. USDA is not budging. Congress is really the only body of power interested in change, and they need to hear from people. So I would urge everyone to contact their members of Congress. It can take just a few min.

Thank you,

Nina

My comment: If the USDA food guidelines are changed, it would make it so much easier for the UK to follow. The photograph shows the breakfast given to a diabetic patient in a US hospital who had just had a heart attack. The UK also dishes out abysmal food to its patients. Wouldn’t it be great if they had a low carb option?

Public Health Collaboration conference online a great success

The Public Health collaboration online conference 2020  was very successful.  The videos are available on You Tube for free making the conference even more accessible for everyone who needs advice on what to eat to stay healthy.

If you are able to contribute to the PHC fund to keep up our good work please do so. Sam Feltham has suggested £2.00.  This is via the PHC site.

This year there were contributions from mainly the UK but also the USA.

Visitors to this site will be very pleased to know that keeping your weight in the normal range, keeping your blood sugars tightly controlled, keeping your vitamin D levels up, and keeping fit from activity and exercise, are all important factors in having a good result if you are unfortunate enough to be affected by Covid-19. We have been promoting these factors in our book and website for several years now, mainly with the view to making life more enjoyable, especially for people with diabetes, now and in the future. The reduction in the severity  to the effects of   coronavirus is a side effect of these healthy living practices.

Several talks went into the factors and reasons for this, but in a nutshell, if you are in a pro-inflammatory state already, you will have a much more pronounced cytokine inflammatory response to the virus than is useful for clearing the virus, and you end up with inflammed lung tissue which leaks fluid thereby impairing your blood oxygen levels.

A talk that I found particularly apt was the talk from a GP who had had a heart attack at the age of 44 despite a lack of risk factors except for massive stress. He gives a list of self care practices that helped him. I would also include playing with your animals. Emma and I are cat lovers and can vouch for this!

My talk is about VR Fitness, which was the only talk this year which was specifically exercise related. The Oculus Quest has only been out a year and has been sold out since shortly after New Year. I was fortunate enough to buy one in anticipation of my imminent retirement, and it has been great as an exercise tool over the long, cold, dark winter and more useful than I had ever anticipated over the lockdown as a social tool.

There were several very professional cooking and baking demonstrations on the conference this year, and indeed, this could not have otherwise happened on a traditional stage format.  We had low carb “rice”, bread, pancakes and pizza demonstrations which may well help you if you prefer to see how it is done step by step or if you want to broaden your repertoire.

I was particularly taken with the pizza base idea from Emma Porter and I will follow up with this in a later post.  The whole video is available from the PHC  site which takes you to all the videos on You Tube.

 

 

 

Belinda Fettke: The origins of the food companies behind the grain based diet

This is part one of a three part series on how we have ended up with a cardiovascular disease epidemic, what treatments we are using which don’t work, and what treatments do work.

The in first episode Belinda Fettke discusses the history behind the 7th Day Adventists who genuinely believed that they were bringing health to the USA population by promoting a grain based diet.

This is a long video but entertaining as well as informative.

 

Dr Maryanne Demasi: What does “low GI” really mean?

The Low GI Label: sound science or a ploy for product promotion?
Mar 5, 2019 | Business, Comment Analysis

Is it ethical to promote the health benefits of “low GI” labelling? How about multinational food companies paying to have their products certified? At best, it provides little value to the consumer, writes science journalist Dr Maryanne Demasi, At worst, the low GI symbol is misleading and should pass the way of the Heart Foundation tick.
FOR DECADES, “low GI” foods have received the backing of high profile scientists and nutritionists, promoting them as the “healthier choice”.
A lucrative industry has evolved whereby food companies pay to showcase the low GI symbol on the front of product packaging, much like the now defunct Heart Foundation tick.
Recipe books, weight loss programs and nutrition health messages are often bound to the notion that low GI foods are “better for you”. But a closer examination of the science exposes fundamental flaws that threaten the credibility of the low GI industry. What is low GI and are consumers being misled?
What is Low GI?
According to the Glycaemic Index (GI) Foundation, the “GI” of food is simply a ranking of how quickly various foods cause a spike in your blood sugar levels.
The entire concept was based on the results of only 10 healthy subjects who ingested carbohydrate-laden foods and the effect on their blood sugar levels was assessed.
The GI scale ranges from zero to 100. A GI of ≤55 is classified as “low GI” because it causes a slower rise in blood glucose compared to “high GI” (see graph)

Does GI work in practice?
On the surface, the GI concept makes sense.
That is, the low GI symbol should guide consumers to choose products that will not spike their blood sugar levels too high, which is especially important for people with diabetes.
Except, the science doesn’t back it up.
Researchers have put it to the test and determined that the GI of food cannot predict, with any accuracy or precision, the way a person’s blood glucose will respond.
For example, when 63 healthy subjects ingested an identical meal of white bread in order to calculate its GI (based on the protocol), the results were highly variable. The range of individual responses to white bread saw GI calculations as low as 35 whereas others were as high as 103.
With such a large margin of error, the researchers concluded that there was “substantial variability in individual responses to GI, demonstrating that it is unlikely to be a good approach to guiding food choices.”
Registered nutritionist Anthony Power says these results demonstrate the futility of labeling products with the low GI symbol.
“The method for ranking the GI of food might work well in a test-tube but it does not translate to the human body,” says Power. “The variability in people’s response to GI does not make the tool useful”.
Prof Eugene Fine, a physician from at Albert Einstein College of Medicine, NY says “the whole point of the GI, is supposed to be its usefulness in predicting blood sugar levels. But since studies show such a broad scatter plot, it’s clinically useless”.
Prof Mary Gannon, nutrition researcher from the University of Minnesota, agrees.
“In our opinion, the clinical relevance is minimal. The reliability of the GI as a standardized index of food response is questionable,” says Gannon.
Another fundamental flaw in the GI labeling of food is that various situations will alter the GI properties of food once its ingested.
For example, the GI of a slice of bread will change if it is accompanied with butter or avocado, rendering the GI label redundant.
In defence of GI
Professor Jennie Brand-Miller, nutrition researcher and early pioneer of the GI concept, has defended the criticisms, although she does concede that low GI foods have variable results in people.
“It’s been known for a long time that glycaemic responses are highly variable between, and within, individuals,” says Brand-Miller in a written response. “But the Glycaemic Index is a property of the food – not the person – determined by testing 10 people according to a precise protocol of over 300 data points”.
Prof Brand-Miller adds, “The GI ranks foods according to their glycemic potential, gram-for-gram of carbohydrate.”
However, Richard Feinman, professor of biochemistry and medical researcher from SUNY Downstate Medical Center NY, says there’s no point assigning an index to food, if it doesn’t have any relevance in the human body.
“The studies demonstrate that there is no ‘true’ GI for any food that reliably predicts a person’s blood glucose,” says Feinman.
Prof Brand-Miller, who promotes the benefits of low GI foods, did disclose that she receives royalties from co-authoring low GI books along with other high profile nutritionists.
According to the University of Sydney, Prof Brand-Miller’s book sales “have gained her international acclaim, having sold over 3.5 million copies since 1996”.

GI for people with diabetes
Originally, the GI label was intended as a tool for meal planning for people with diabetes. Prof Brand-Miller says low GI diets have been shown to reduce blood glucose levels in people with diabetes.
“A large body of research shows that diets based on healthy low GI choices improve glycemic control in people with diabetes, and reduce the risk of developing diabetes in healthy populations,” says Brand-Miller.
However, Associate Professor Kieron Rooney, exercise and obesity researcher from the University of Sydney suggests that the GI ranking of food is likely to have very different outcomes in people with diabetes.
“It is possible that most products would be high GI for a person with diabetes by nature of the underlying disease,” says Rooney referring to the inability of people with diabetes to naturally control blood sugar levels.
Even if low GI food reduces the spike in blood sugar, the total “load” of glucose entering the blood stream still has to be processed, which requires substantial amounts of the hormone insulin. Symptoms from high insulin levels include food cravings, fatigue and weight gain.
Prof Gannon suggests a more practical alternative to focusing on the low GI diet. “A more clinically relevant approach for dietary treatment of high blood sugar would be to limit dietary glucose,” says Gannon.
Put simply, people should eat less starchy carbohydrates, which get converted into glucose once ingested.
Professor Feinman agrees. His recent study demonstrated that restricting dietary carbohydrates should be the first approach to managing diabetes, over the low GI diet.
In addition, Professor Eric Westman and colleagues at Duke University Medical Centre NC, conducted a study in people with type-2 diabetes and showed that restricting dietary carbs led to greater improvements in blood sugar control and reduction/elimination of medications, compared to the low GI diet.
A marketing ruse?
GI is focused on “glucose” and overlooks other sugars like fructose, which is often added to sweeten foods in the form of refined cane sugar, corn syrup or fruit concentrates.
“The standard methodology for assessing GI is to utilise a glucose drink as the reference food,” says Rooney, “but the most common sugars added to products will contain significant levels of fructose. Therefore, if one is only measuring blood glucose response to a food you are missing out on a lot of the story.”
Fructose has a low GI (doesn’t spike blood glucose levels). Therefore, food manufacturers have been able to exploit this loophole.
Products can be sweetened with concentrates containing fructose and rewarded with a low GI symbol, essentially giving a “healthy halo” to highly processed sugary foods.
For example, low GI foods include Golden North Good ‘n Creamy Vanilla ice cream GI = 31, Sanitarium™ Up & Go™ Chocolate drink GI = 28 or Nestlé® Milo® Energy Dairy Snack GI = 45.

Even pure table sugar is marketed with the low GI symbol, CSR LoGICaneTM, claiming that it’s a “healthier” sugar.
“I am not convinced that by consuming a lower GI form of another refined sugar product, the health of an individual will be improved,” says Rooney.
“We need to shift away from a culture of adding refined sugars and seek enhancing the palatability of our diets by consumption of natural unrefined/minimally processed foods,” says Rooney. “In any policy that hopes to inform people on foods and drinks to maintain or improve glycaemic control, I think fructose has to be considered.”
Chronically high levels of fructose have been associated with fatty liver disease and diabetes.
When asked whether fructose sweetened drinks like Sanitarium™ Up & Go™ Chocolate drink were considered “healthy” because of their low GI symbols, Prof Brand Miller declined to comment.
“Just because a product is low GI, it does not mean it hasn’t got a sting in its tail,” says Power. “As a practitioner who counsels patients to reduce their sugar, sweetener and carbohydrate intake, I find products like Low GI sugar to be unhelpful, misleading and possibly harmful to patients. It should not be allowed.”
Who supports GI?
Despite Prof Brand-Miller’s defence of GI, official guidelines do not endorse low GI diets.
For example, Health Canada has stated that “the inclusion of the GI value on the label of eligible food products would be misleading and would not add value to nutrition labelling and dietary guidelines in assisting consumers to make healthier food choices.”
In response to the question of whether low GI foods are healthier, UK’s National Health Service (NHS) states
“using the glycaemic index to decide whether foods or combinations of foods are healthy can be misleading”.
Closer to home, our National Health and Medical Research Council (NHMRC) dietary guideline’s committee, also does not officially endorse the low GI diet. And despite the GI Foundation lobbying the NHMRC to change its mind, the response was a direct one;
“The Committee agreed that there was insufficient significant evidence to support change. It was noted that this is a physiologically based classification, with large variability and several limitations.”
Meanwhile, the GI Foundation, the University of Sydney and its high profile advocates continue to profit from the marketing of low GI foods.
Will the “Low GI symbol” suffer the same fate as the “Heart Foundation Tick” which was scrapped after consumers complained it was “health washing” highly processed, sugary foods?
What remains now, is a question of ethics.
Is it ethical to promote the health benefits of low GI labelling? At best, it provides little value to the consumer. At worst, it misleads them.
——————–

Dr Maryanne Demasi
Dr Maryanne Demasi is an investigative medical reporter with a PhD in Rheumatology.
You can read more about Dr Demasi’s work on her blog, or follow her on Twitter @MaryanneDemasi.

#LowCarb Vegetarianism and other adventures

meat-free alternatives Maybe it’s the Extinction Rebellion folks gluing their hands to pavements, disrupting flights and parking their uncooperative crusty* posteriors on roads throughout central London.

Or it could be the underlying anxiety about eating meat that has always bothered me since I took it up again after more than 20 years of vegetarianism. But lately I have drastically cut down on the amount of it I’m eating and embraced the substitutes.

Vegetarianism and particularly veganism aren’t natural fits with a low-carb diet, the one I follow because I believe it’s the best one for helping people with type 1 and type 2 diabetes manage their blood sugar levels. Heck, the good Doctor Morrison and I even wrote a book about it!

Quorn slices

But the meat substitutes have come much further than the last time I ate them. Quorn makes decent fake ham slices. Cauldron sausages and marinated tofu work for me too—all of them low carb, though not as low-carb as the real thing. Even the Diet Doctor—the best source of everything you need to know about a low-carb diet in general—recognises that many people do want to follow a low-carb diet that they can square with their conscience and the website offers low carb vegetarian and even vegan plans these days.

While I question some of the health claims people make for a plant-based diet (and I’m picky about the word being used to mean ‘veganism’—I’ve always based the bulk of my diet around vegetables), poor Mama Earth’s resources will run out far too quickly if meat consumption continues at its current levels.

As I have no children, I can tick that big box on the green credentials list but the other two are eating a plant-based diet and not flying anywhere. As someone who’s not that fussed about travel, the latter might be easily achieved too. That just leaves me with what I choose to eat. As I don’t do absolutes any more, opting to be a vegetarian with limited dairy most of the time is what appeals.

Low-carb vegetarian recipes

How about you? Have you changed your diet because of environmental concern s or do you plan to? We do have veggie options on our website if you are looking for low-carb meat-free recipes. They include low-carb curried cauliflower cheese, aubergine and pepper parmigiana, baba ghanoush, Tofu with teriyaki sauce and crustless spinach and feta quiche.

*As Boris Johnson called them. Maybe he was attempting ‘wit’ as a distraction from the chaos he is in midst of creating in the UK.

Kris Kresser: The Carnivore Diet, is it really healthy?

The Carnivore Diet: Is It Really Healthy?
by Chris Kresser
Published on February 6, 2019

 

My comment: There has been a lot of publicity about the benefits of an all meat diet, the opposite end of the spectrum from veganism.  Dr Jordan Petersen’s daughter has overcome considerable health problems and she puts it down to an all beef diet. In this post Kris shares information, the good and the not so good about such an extreme diet.
The carnivore diet is a hot eating trend, and many people have reported significant benefits from adopting an all-meat diet. But is consuming only meat healthy in the long term? Read on to understand the mechanisms behind the diet, the potential consequences of not eating plant foods, and a few alternatives to going pure carnivore.

Is an all-meat, carnivore diet healthy? 
In my recent debate on the Joe Rogan Experience with Dr. Joel Kahn, I touched briefly on the carnivore diet. I’m a huge believer that meat is an essential part of a healthy diet, but eating an all-meat diet is an entirely different subject, and I think we need to be very careful about assuming that an intervention that works well in the short term will also be safe and effective in the long term.
In this article, I’ll discuss the diets of ancestral populations, how the carnivore diet affects the body, my concerns about the potential consequences of such a restrictive diet in the long term, and alternative dietary approaches that might offer the same benefits without having to go pure carnivore.
Are you considering going carnivore? The all-meat diet is trending, but completely dropping plant-based food off your plate could have a significant impact on your health. Check out this article for a breakdown on the strengths and weaknesses of the carnivore diet. #chriskresser

What Is the Carnivore Diet?
The carnivore diet is pretty straightforward: eat only animal foods and stay away from all plant foods. This means that you are primarily getting your energy from protein and fat and are consuming close to zero carbohydrates.
Many people who have adopted the carnivore diet report faster weight loss, improved mental clarity, healthier digestion, and even improved athletic performance. I certainly don’t doubt the anecdotal reports of people that have found remarkable relief from debilitating chronic health problems with this diet. For many of these people, nothing else they had tried worked.
However, when considering the health of a dietary or lifestyle intervention, I’ve long believed that we should look at the big picture: historical evidence from other populations, plausible mechanisms that explain its effect on our bodies, and scientific data regarding outcomes.
Were Any Ancestral Populations Carnivores?
Let’s start with a brief look at the diets of some supposedly “carnivorous” ancestral populations. Indeed, many ancestral groups thrived on large quantities of animal products. However, every single one of these groups also took advantage of plant foods when they were available:
The nomads of Mongolia nourished themselves on meat and dairy products, but also gained nutrients from their consumption of wild onions and garlic, tubers and roots, seeds, and berries. (1)
Gaucho Brazilians consumed mostly beef, but they supplemented their diet with yerba mate, an herbal infusion rich in vitamins, minerals, and phytonutrients. (2)
The Maasai, Rendille, and Samburu from East Africa primarily ate meat, milk, and blood. Young men almost exclusively ate these animal products but also occasionally consumed herbs and tree barks. Women and older men consumed fruit, tubers, and honey. (3)
The Russian Arctic Chukotka subsisted on fish, caribou, and marine animals but always ate them with local roots, leafy greens, berries, or seaweed. (4)
The Sioux of South Dakota ate great amounts of buffalo meat, but they also ate wild fruit, nuts, and seeds that they found as they followed the buffalo herds. (5)
The Canadian Inuit lived primarily on walrus, whale meat, seal, and fish, but they also went to great lengths to forage wild berries, lichens, and sea vegetables. They even fermented some of these plant foods as a way of preserving them. (6)
Every culture we know of that has been studied ate some combination of animal and plant foods. This does not necessarily mean that animal or plant foods are required to remain healthy, but it does speak to the ancestral wisdom of these cultures.
Five Reasons Why the Carnivore Diet Works
When any diet, drug, or other intervention “works,” it’s important to try to understand the mechanism behind it. In the case of the carnivore diet, there are several reasons that might explain the benefits people report.
1. The Carnivore Diet Can Restrict Calories and Mimics Fasting
Ever felt stuffed after you ate a huge steak? Protein is very satiating, meaning it fills you up and sends signals to your brain that you’ve consumed enough food. It’s no surprise that people report not feeling very hungry and start eating less frequently when they adopt an all-meat diet.
Food habituation may also play a role here. When you eat the same thing day after day, your brain doesn’t get as much reward value from food, so you start to eat less food overall—even if the food is usually something you find rewarding, like a big juicy steak.
The ultimate result is unintentional caloric restriction. Caloric restriction sets off a number of changes. When caloric intake drops, the concentration of insulin, insulin-like growth factor 1 (IGF-1), and growth hormone are significantly reduced. This condition triggers autophagy, which literally means “self-eating”—an internal process of cleaning up old cells and repairing damaged ones. Autophagy is also induced during fasting.
This may be why caloric restriction is so effective at reducing inflammation and alleviating symptoms of autoimmune disease. (7) Of course, caloric restriction also results in weight loss. These are arguably the two primary reasons that people seem to be drawn to the carnivore way of eating, but these effects might also be achieved through simple caloric restriction.
2. The Carnivore Diet Is a Low-Residue Diet
“Residue” is essentially undigested food that makes up stool. A low-residue diet is a diet that limits high-fiber foods like whole grains, nuts, seeds, fruits, and vegetables. It is often prescribed for people with inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS) to alleviate symptoms like diarrhea, bloating, gas, and abdominal pain. (8)
Meat is made primarily of protein and fat, which are absorbed high up in the GI tract, leaving little residue leftover to irritate or inflame the gut. In other words, an all-meat diet is effectively a very low-residue diet and gives the gut a rest.
3. The Carnivore Diet Is Often Ketogenic
If you’re eating large amounts of meat but are only eating once or twice a day and adding extra fat to the meat, your diet is likely ketogenic. A ketogenic diet is a high-fat, moderate-protein diet, with:
60 to 70 percent of energy from fat
20 to 30 percent of energy from protein
5 to 10 percent of energy from carbohydrates
While the carnivore diet has no such macronutrient ratios, it’s likely that some of the benefits that come with eating meat alone are due to the body being in a state of ketosis.
Ketogenic diets have been shown to be helpful for a wide variety of conditions, including multiple sclerosis, diabetes, and neurological conditions like Parkinson’s disease and Alzheimer’s. (9, 10)
4. The Carnivore Diet Changes the Gut Microbiota
Switching to an all-meat diet can also rapidly alter the gut microbiota. A 2014 study found that putting healthy human volunteers on an animal-based diet resulted in significant changes to the gut microbiota in less than 48 hours. (11) The animal-based diet increased the abundance of bile-tolerant organisms and decreased the levels of microbes known to metabolize different plant fibers.
The gut microbiota has been linked to virtually every chronic inflammatory disease that has been studied, so it’s no surprise that an intervention that drastically changes the gut microbiota could have significant implications for health. (12)
The Biggest Potential Problem with This Diet: Nutrient Deficiencies
Now that we’ve established some of the mechanisms involved, the big question is: is the carnivore diet safe?
The short answer is that we really don’t know, since there are no long-term studies that have tracked large groups of individuals on carnivore diets for any significant length of time. One of my chief concerns about it is that it lacks several nutrients that are crucial for health.
There are four micronutrients that are especially difficult to obtain on a meat-only diet. Based on a typical carnivore diet and the Dietary Reference Intakes (DRIs) established by the Institute of Medicine, these include:
Vitamin C: An antioxidant that boosts immune cell function and is important for stimulating collagen synthesis
Vitamin E: An antioxidant that prevents the oxidation of lipids and lipoproteins
Vitamin K2: A fat-soluble vitamin that reduces the calcification of blood vessels
Calcium: A mineral required for healthy bones, muscle contraction, and nerve transmission
If dairy is included in the diet, this will cover vitamin K2 and calcium. However, if you don’t like organ meats, the number of potential micronutrient deficiencies increases significantly. In that case, you can add to the list:
Vitamin A: A fat-soluble vitamin important for proper vision and maintaining immune defenses
Folate: A B vitamin important for cell growth, metabolism, and methylation
Manganese: A trace mineral needed for the proper function of the nervous system, collagen formation, and protection against oxidative stress
Magnesium: A mineral that supports more than 300 biochemical reactions, including energy production, DNA repair, and muscle contraction
It’s also important to note that vitamin C is extremely heat sensitive, so only fresh or very gently cooked organ meats will have appreciable amounts.
Many carnivore dieters claim that the nutrient requirements for the general population simply don’t apply to them. Anecdotally, I know of several individuals who have consumed a carnivore diet for three or more years without any overt signs of nutrient deficiencies.
Still, we’re lacking data. Currently, the DRIs are the best we have to go off of, and I don’t think we have enough evidence to unequivocally say that this diet has no risk of producing nutrient deficiencies in the general population.
Should We Be Aiming Higher Than the Daily Recommended Intake?
Even if the carnivore diet were sufficient to prevent outright deficiency, we should also consider metabolic reserve. Metabolic reserve is the capacity of cells, tissues, and organ systems to withstand repeated changes to physiological needs. In other words, it’s having enough nutrients “in the bank” to be able to deal with a major stressor, injury, or environmental exposure. (13) So if an all-meat dieter manages to meet a recommended nutrient intake, it still may not be enough for optimal health.
Other Reasons an All-Meat Diet May Not Be Healthy
It Lacks Beneficial Phytonutrients
Phytonutrients are chemicals that are produced by plants to protect against environmental threats, such as attacks from insects and disease. They can also have major benefits for our health. Curcumin, beta-carotene, quercetin, and resveratrol are all examples of common phytonutrients.
Some proponents of the carnivore diet suggest that phytonutrients are toxic to humans, and that it’s best to eliminate them completely from our diet. However, many of these “toxins” act as acute stressors that actually make us stronger through a process called hormesis.
Much like resistance training is an acute stressor that leads our muscles to adapt and get stronger, exposure to small amounts of phytonutrients is a hormetic stressor that activates several different pathways in the body, ultimately serving to reduce inflammation, enhance immunity, improve cellular communication, repair DNA damage, and even detoxify potential carcinogens. (14, 15)
It Might Affect Hormones, Fertility, and Thyroid Function
We have zero long-term data about how an all-meat diet impacts hormones, thyroid function, and fertility. I have written before about why carbohydrates are particularly important for female fertility and why very-low-carb diets may not be the best choice during pregnancy.
Carbohydrates are particularly important for supporting thyroid function since insulin stimulates the conversion of inactive thyroid hormone T4 to active T3. In fact, traditional cultures that ate largely animal products and had little access to plant foods often went to great lengths to support fertility, including eating the thyroid glands of the animals they hunted. (16)
My guess is that most modern “carnivores” are not consuming the thyroid glands of animals and are therefore at risk for suboptimal thyroid function and (at least temporary) infertility.
It Could Overtax Your Liver (If You’re Eating Lean Meat)
When you don’t eat sufficient carbohydrates and fat, your liver can make glucose from protein via a process called gluconeogenesis. This process creates nitrogen waste, which must be converted to urea and disposed of through the kidneys.
While this is a normal process that occurs in every human being, there is a limit to how much protein the liver can cope with safely. More than 35 to 40 percent of total calories as protein can overwhelm the urea cycle, leading to nausea, diarrhea, wasting, and, potentially, death. For pregnant women, this threshold may be as low as 25 percent of total calories. (17)
Interestingly, anthropological evidence suggests that hunters throughout history avoided consuming excess protein, even discarding animals low in fat when food was scarce. (18)
In short: When eating meat, it’s important to have a good amount of healthy fats or quality carbohydrates as well.
Is the Carnivore Diet the Ideal Human Diet?
In the last section, I outlined several potential concerns with the carnivore diet. But this leads me to another important question: even if the carnivore diet is safe, is it really the best diet for optimal health?
While you might be able to get away with a vegetarian or carnivorous diet for a short while, the evidence suggests that the ideal diet includes both animal and plant foods. Dr. Sarah Ballantyne broke this down in part three of her series “The Diet We’re Meant to Eat: How Much Meat versus Veggies.”
While you can theoretically get all of your nutrients from one group alone (and potentially supplement with any missing nutrients from the other group), we need both sets of nutrients to be optimally healthy, and consuming animal and plant foods in their whole form is the best way to accomplish this.
Five Alternatives to the Carnivore Diet
Here are some options that might provide the same therapeutic benefits that the carnivore diet can offer—but without as much potential risk.
1. A Low-Carb Paleo Diet
Some people trying a carnivore diet are going straight from the Standard American Diet to pure carnivore. Oftentimes, a low-carbohydrate Paleo template might provide some of the same benefits, including weight loss, improved insulin sensitivity, and an alleviation in autoimmune symptoms. (19, 20, 21)
2. A Fasting Mimicking Diet
A fasting mimicking diet can reverse type 1 and type 2 diabetes, alleviate age-dependent impairments in cognitive performance, and protect against cancer and aging in mice. (22, 23, 24) In humans, the fasting mimicking diet was found to significantly reduce body weight, improve cardiovascular risk markers, lower inflammation, and potentially improve symptoms of multiple sclerosis. (25, 26)
3. Periodic Prolonged Fasting
Undergoing a 72-hour fasting once every few months could also achieve many of the benefits boasted by the carnivore diet. Prolonged fasting causes organs to shrink and then be rejuvenated as damaged cells are cleared out and stem cell pathways are activated. (27)
4. A Ketogenic Diet
The ketogenic diet has been very well studied and has documented benefits for epilepsy, neurodegenerative disease, and autoimmune disease. Ketones themselves are potent anti-inflammatories. (28, 29)
5. Addressing Gut Pathologies
If a healthy lifestyle coupled with the dietary approaches above is insufficient to control your symptoms, consider working with a Functional Medicine practitioner who is knowledgeable about gut health. If you’re thinking about becoming a strict carnivore because you’re experiencing adverse reactions to even very small amounts of plant foods, that’s likely a sign of an underlying gut infection that should be addressed.
Share this with friends and family who might be considering an all-meat diet, and be sure to leave your thoughts in the comments below.
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Lamb in almond sauce #low-carb

woman using a pestle and mortar

My husband bought me a new pestle and mortar this week—mainly because we are watching Celebrity MasterChef on the Beeb and every time I spot one of the stars pounding their garlic, I sigh and wish out loud that I had such a big one…

Cue the delivery of a weighty package. I crushed eight cloves of garlic in it at once to celebrate. Vampire-proofed to the max, what else could I do? How about a lamb curry where I roasted whole spices and then pounded them to dust?

This lamb curry in almond sauce is a recipe I adapted from the Spice Sisters Indian cookbook. The whole spices are cumin and fennel seeds, and cardamom, all of which will scent your kitchen beautifully as you roast them. Serve your curry with cauliflower rice or this low-carb naan bread. Normal rice and naan bread will keep the carb-lovers in your family happy.

Lamb in almond sauce

  • Servings: 4
  • Difficulty: easy
  • Print

  • 500g diced lamb
  • 1 large onion, chopped
  • 6 cloves garlic, crushed
  • 1tbsp grated ginger
  • 2-3 chillies, chopped
  • 1tbsp cumin seeds
  • 1tbsp fennel seeds
  • 6-8 cardamom pods, split and seeds removed
  • 1tbsp turmeric
  • 1tsp ground black pepper
  • 1tsp ground cinnamon
  • 1tbsp salt
  • 1tbsp garam masala
  • 200ml passata
  • 1tsp lemon juice
  • 4tsbp natural yoghurt
  • 2tbsp ground almonds mixed with 50ml water
  • 1tbsp rapeseed oil
  1. In a small pan, dry-fry the cumin, fennel and cardamom for a few minutes. Pound to a powder in a pestle and mortar. Heat the oil in a large saucepan and fry the meta in batches until it is browned. Remove with a slotted spoon and add the onions.
  2. Fry until translucent. Add all the other ingredients (except the lamb and the lemon juice) and bring to a simmer. Cook for ten minutes and then use a hand-held blender to make the sauce smooth.
  3. Add the lamb back in, pop on a lid and allow to gently simmer for 30 minutes. Add the lemon juice at the end.
  4. Allow 15g carbs per portion.

The golden rule with curry is it almost always tastes better the next day.

Type ones on low carb diets experience less hypoglycaemia

Adapted from Why low carb diets for type one patients? Jun1 2019 by Emma Kammerer Pharmacy Doctorate Candidate Bradenton School of Pharmacy originally published in Diabetes in Control.

Both Dr Jorgen Neillsen and Dr Richard Bernstein have shown that insulin users have fewer attacks of hypoglycaemia and that the attacks are less severe.  A new randomised controlled study by Schmidt et al confirms this finding.

Studies have shown that when a high carb diet is consumed there 20% greater error in carbohydrate estimation compared to when a low carb diet is chosen. This then affects the insulin dose administered, and thus the resulting blood sugars.

Schmidt wanted to look at the long term effects on glycaemic control and cardiovascular risk in type one patients on a low carb diet compared to a high carb diet.

The study was a randomised open label crossover study involving 14 adults who had had diabetes for more than 3 years, to eliminate the honeymoon effect. The patients went on one diet for 12 weeks, had a washout period of another 12 weeks, and then took up the other diet.  This was done so that the glycated haemoglobin levels would not be carried over from one diet to the next.

A low carb diet was defined as less than 100g carb a day and a high carb diet as over 250g per day.

Patients were given individualised meal plans and education on how to eat healthy carbs, fats and proteins. They all were experienced insulin pump users. They were asked to record total carbohydrate eaten but not the food eaten. Measurements were taken on fasting days on the first and last day of the study periods.

Blood glucose levels were downloaded from continuous glucose monitoring devices.

Four patients dropped out of the study so ten completed the test which was considered satisfactory by the statistician involved.

Results showed that the time spent in normal blood sugar range 3.9 to 10 mmol/L ( USA 56-180) was not significantly different for each diet.

The time spent in hypoglycaemia, below 3.9 (USA 70) was 25 minutes less a day on the low carb diet, and six minutes less a day below 3.0 (USA 56).

On the low carb diet glycaemic variability was lower and  there were no reports of severe hypoglycaemia.

On the high carb diet, significantly more insulin was used, systolic blood pressure was higher and weight gain was more.

There was no relevant changes in factors for cardiac risk between the two study arms.

The study showed that a low carb diet can confer real advantages to type one patients but education on how to conduct a low carb diet and manage the lower doses of insulin is required.

Schmidt, Signe et al. Low versus high carbohydrate diet in type 1 diabetes: A 12 week randomised open label crossover study. Diabetes, Obesity and Metabolism. 2019 March 26.