Fat moms make fat babies; and thin, high-carb eating moms might make fat kids too…

Juliana is the oldest of three kids, and the only one of my three kids who was ever overweight.  Indeed, at the moment, my son Teddy is technically underweight, with a BMI in the 3rd percentile.

When I was pregnant with and nursing Juliana, I ate a vegetarian diet.  When I was pregnant with her sister Molly, I had an overwhelming desire for chicken, and abruptly stopped eating vegetarian after 18 years.  So I got to wondering whether there might be a relationship between what I ate while pregnant and nursing and Juliana’s metabolism and ability to handle carbohydrates versus her siblings.

And there could be.  Fat mothers produce fatter babies; diabetic mothers (whose blood sugar is on average higher than non-diabetic mothers) produce fatter babies.  And the incidence of fat babies is increasingly dramatically, in step with the increase in obese and diabetic adults.

“The probable explanation is that as women of childbearing age get heavier and more of them become diabetic, they pass the metabolic consequences on to their children through what is known technically as the intrauterine environment. The nutrient supply from mother to developing child passes across the placenta in proportion to the nutrient concentration in the mother’s bloodstream. If the mother has high blood sugar, then the developing pancreas in the fetus will respond to this stimulus by overproducing insulin-secreting cells. “The baby is not diabetic,” explains Boyd Metzger, who studies diabetes and pregnancy at Northwestern University, “but the insulin-producing cells in the pancreas are stimulated to function and grow in size and number by the environment they’re in. So they start over functioning. That in turn leads to a baby laying down more fat, which is why the baby of a diabetic mother is typified by being a fat baby.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 8167-8174). Random House, Inc.. Kindle Edition.

Juliana wasn’t actually a fat baby.  But her intrauterine environment was with me eating a vegetarian diet, which was necessarily higher carb than when I switched to being an omnivore with Molly and Teddy’s pregnancies.  She was also nursed for several years with me eating a vegetarian diet.  I’m not diabetic, but that doesn’t mean Juliana didn’t suffer the consequences of my high-carb eating style:

“There’s no reason to think that the hormonal and metabolic consequences of high blood sugar—from what James Neel in 1982 called the “excessive glucose pulses that result from the refined carbohydrates/ over-alimentation of many civilized diets”—do not pass from mother to child through the intrauterine environment, whether the mother is clinically diabetic or not.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 8189-8192). Random House, Inc.. Kindle Edition.

I can’t prove that my eating style contributed to Juliana’s carb sensitivity and subsequent overweight–but it’s an interesting association that she is the only one of three kids who experienced my high-carb eating style and she’s the only one with excess weight.

Really, you don’t need carbohydrates

I keep running across comments like this one, from “Ending the Food Fight,” by David Ludwig, MD, PhD: “[Low carb diets] do produce more weight loss than low-fat diets, but only temporarily.  After one year, people following both diets gain back nearly all of the weight they lose.  These approaches ultimately fail because our bodies and our minds rebel against severe restriction of any major nutrient, whether fat or carbohydrate.  (How long do you want to keep eating that bacon double cheeseburger, hold the bun, thank you?)”

First off, I assume Dr. Ludwig is referring to people who stop eating low carb and then gain back their weight, which of course, they will.   Continuing to eat low carb at the level of carbohydrates your body can handle, which might be 20, 50, or 100 grams a day, is one of the most successful ways to maintain weight loss.

Second, why does Dr. Ludwig assume that all macronutrients (fat, protein, carbohydrate) are equal, or equally required?  They’re not.  Carbohydrates in the form of agricultural grains did not even exist in the human diet until several thousand years ago.  People who eat a “Paleo/Primal” or “Caveman” diet eschew all grains, legumes, and dairy.  They eat mostly vegetables and meats, and a small amount of fruit.  (Modern fruit is larger, sweeter, and available for more of the year than ancient fruit).

It’s maybe not surprising then, given that they are so new, that carbohydrate is the only macronutrient your body does NOT require.  It can get along just fine on zero carbohydrate, unlike fat or protein.  “…animal foods contain all of the essential amino acids (the basic structural building blocks of proteins), and they do so in the ratios that maximize their utility to humans.* 94 They also contain twelve of the thirteen essential vitamins in large quantities…The thirteenth vitamin, vitamin C, ascorbic acid, has long been the point of contention. It is contained in animal foods in such small quantities that nutritionists have considered it insufficient and the question is whether this quantity is indeed sufficient for good health.”

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 6551-6557). Random House, Inc.. Kindle Edition.

 It turns out that the tiny quantity of vitamin C in animal foods is sufficient, provided you aren’t eating a diet high in carbohydrate.  In other words, you only need to supplement the vitamin C available from animal foods if you eat a lot of non-animal foods.

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Location 6630). Random House, Inc.. Kindle Edition.

Another argument you sometimes hear is that dietary carbohydrates are required to provide glucose for the brain.  But this is not so.  The liver manufactures the fuel it needs from other nutrients if dietary carbohydrate falls below a certain level.

Taubes, Gary (2007-09-25). Good Calories, Bad Calories (Kindle Locations 6492-6498). Random House, Inc.. Kindle Edition.

And what about Dr. Ludwig’s opinion that people can’t live forever without the hamburger bun?  A great effect of a low carb eating plan is that the desire for carbohydrates greatly diminishes, or disappears altogether.  And in sensitive individuals, eating the bun after getting used to the low carb style will probably make you feel sick and tired.  Go ahead and try it once, like Juliana did with a scoop of ice cream, and you won’t be so tempted the next time.

Dr. Ludwig instead advocates a low-glycemic diet, which I bet works better than a low fat diet for many people.  But in sensitive individuals like Juliana it would not work because it includes more fruit and grains (even if they are whole grains!) than her system can handle.

Juliana has to learn what a “normal” appetite is

After a lifetime of high-carb eating, which overwhelmed Juliana’s system before she was 3, she doesn’t know what her “normal” appetite is.  We’ve been paying a lot of attention lately to whether she feels hungry; whether she feels full; and whether she feels overfull.  We’re trying to learn how much she has to eat to not be hungry and to maintain her energy level depending on what she’s doing.  If she’s running a lot, playing soccer and then refereeing a soccer game, she might need to eat more than if she has a sedentary day.  But we want her to eat no more than she has to so that her weight will continue to drop.

A well-functioning appetite should make these adjustments automatically.  Juliana’s appetite has been elevated for so long that she has to concentrate to tune in to the new information she is getting from her body.  She also has to get used to the fact that a smaller quantity of food is adequate.  A high carb diet produces extreme hunger in a sensitive individual, and I believe it is truly painful, especially for a child.  She still has a bit of fear of being hungry if she eats a smaller amount of food.

She was very hungry on the Packard program, so that is one of her touch points.  She should not be that hungry, ever.  She should try not to feel stuffed ever either.  She’s started eating her meals a lot more slowly than she used to–I think this development is mostly unconscious, but it helps her to avoid eating more than she needs.  She’s not starving when she sits down to eat, as she was on a high carb eating plan, so it’s more possible and easier to eat slowly.

Juliana’s playing soccer at recess

Among the many transformations in Juliana on the low carb eating plan, one of the most amazing to me is that she is now voluntarily organizing and playing in soccer games at school during recess.  I have been trying to get her to do that for years, because, like most schools these days, she doesn’t have a lot of PE time.  The only way she can get in some movement during the day is to move at recess.

I didn’t push her to start playing soccer during recess.  On the contrary.  A few weeks ago she asked me to buy her a soccer ball to keep in her locker at school so she could play, since the school soccer balls are always getting lost.

As I explain here, she wasn’t getting fat because she was lazy and tired; she was lazy and tired because she was getting fat.  Now that process is reversed.  She’s full of energy because she’s getting thin, and all that stored energy is available to play soccer, every day.

I think of myself as Juliana’s coach

There’s a bit of a fad now about parents who have been successful at forcing their children to lose weight with “strict and punishing” methods.  While the daughter in the article, now 8, is a healthy weight, you have to wonder if the mother’s methods are going to come back to haunt her later.

To me, it makes more sense to think of yourself as a coach.  No child or teen wants to be overweight.  If you provide them a path to a healthy weight that doesn’t require semi-starvation, they will embrace it.  The key is low carb eating–but there are many other things you may need to tweak.  Juliana’s weight loss was abruptly halted by allergy medications.  It took me 6 weeks to figure out that they were a problem.  Another time we decided she needed to drink much more water, and that got her weight loss going again.  In the Calories In/Calories Out model, these sort of hidden obstacles to weight loss do not get much attention.

Before she started eating low carb, I used to worry about everything she ate, and hope she would eat smaller portions.  Now, we think of weight loss as a big puzzle.  We need to continuously work on the the puzzle to get her to a healthy weight.  I keep reading, and make suggestions of new things to try.

The mother in the above article, Dara-Lynn Weiss, reportedly once tried the Atkins eating plan.  I’m willing to bet she didn’t do it correctly, or she would have finally understood what she had gone through with all the different diets she had tried, and what was going on with her daughter’s huge appetite.

Your child isn’t going to become an expert on low carb eating without your help.  As the coach, you need to learn everything you can to help your child work out his or her own weight loss puzzle.

Get a gas grill.

We have always liked to grill.  Since starting a low carb eating plan, however, the grill gets used constantly.  It only takes a few minutes to grill 3 pounds of skirt steak, or 6 pork chops, or a tri-tip, and then you have enough for a main meal and leftovers for several days of lunches and breakfasts.  And you haven’t made a mess of your stove top.

We’ve experimented with more complicated grilled items, like dry-rub ribs.  While we enjoy the slow-cooked grilled items, we mostly use it for quick cooking of a lot of food.

I don’t always grill at night, either.  If I’m caught short packing lunches, I might take something out of the freezer and grill it at 6:00 in the morning.

The grill is not just for meat.  Asparagus is a relatively low carb vegetable that is great when par-boiled and finished on the grill with olive oil and salt, but it does not store well, in my opinion–you should eat it right away.  Summer squash, zucchini and mushrooms are low-carb, delicious grilled, and do store well for several days in the fridge.

A charcoal grill will not cut it–waiting 30 minutes for the charcoal to be ready will not make your life easier, especially at 6 in the morning.

What does a weekly meal plan look like?

A friend asked me for a sample weekly meal plan.  Juliana and I are still eating very low carb, keeping net carbohydrate under 30 grams per day, and this meal plan reflects that.  Most of Juliana’s carbohydrates come from what are called “foundation vegetables” in the Atkins plan–very low carb, very high nutrient vegetables such as broccoli, romaine lettuce, green beans, cauliflower.  I eat those as well but get some carbs from almonds and tomatoes, which Juliana does not like.

As Juliana gets closer to her goal weight, we will begin adding back more foods, starting with berries, which are a relatively low carb fruit.

The first thing you’ll see is that breakfast is dinner and dinner is breakfast.  Really any meal can be eaten at any time of day, so the categories “breakfast, lunch, and dinner” are arbitrary.  Juliana likes eggs for breakfast.  Eggs in the morning make me nauseous, but I like eggs for dinner.   We eat hard boiled eggs with salt and pepper or deviled eggs for snacks all day long.  Juliana has eaten cheeseburgers for breakfast, and I regularly eat last night’s leftovers for breakfast and pack them for Juliana in her lunch for school.   We try to eat carbohydrates, fat, and protein at each meal.  Even if you are only eating 30 grams of carbohydrate per day, it is preferable not to eat them all at the same time.

Breakfast	Lunch	Dinner	Snacks
3-egg omelet filled with leftover roasted cauliflower	Pork Chop and mashed cauliflower	Pork Chops, broccoli with garlic, mashed cauliflower	Deviled Eggs or Hard-boiled eggs with salt and pepper
Leftover skirt steak and mashed cauliflower; sliced tomato with salt	Cheeseburger with roasted cauliflower	Quiche with mashed cauliflower	Salami and Cheese Rollups
No-sugar added chicken Italian sausage with mashed cauliflower	Salad with romaine lettuce, tomato, cucumber, avocado, salami, cheese and almonds on the side	Beef with broccoli, mashed cauliflower	Ounce of Almonds
Salami and eggs filled with cooked broccoli	Tuna salad* romaine lettuce “sandwiches”	No sugar added pork Italian sausage, green beans with garlic, mashed cauliflower	Egg Quiche with sausage, broccoli, and cheese
Leftover tri-tip and mashed cauliflower	Egg salad* romaine lettuce “sandwiches”	Chicken with green beans, mashed cauliflower	Scoop of chicken salad*
Broccoli, tomato, bacon and egg scramble	Taco meat with toppings	Pizza chicken with roasted broccoli	Turkey and cheese rollups
Grilled chicken breast (no-carb marinade is ok) and grilled asparagus	Roasted chicken with roasted cauliflower and roasted broccoli	Skirt steak, brussel sprouts with tamari, mashed cauliflower	Bacon slices

*Made with no-sweetener-added mayonnaise.

We check in with the Packard Program

Juliana and I visited with the staff from the Packard Program yesterday.  They are doing great good in the world trying to help obese kids achieve a healthy weight, and they have good success.  Nonetheless, I believe that the calories in/calories out model that underlies the program is wrong.  So why does it work as well it as it does?

The Packard Program teaches kids to substitute lower-calorie yellow or green foods for higher-calorie red foods.  In many cases, those substitutions are from super-high-carb foods to less-high-carb foods.

From a glass of apple juice, for example, to an apple.  8 ounces of apple juice has about 29 grams of carbs; one medium apple has about 16 grams of carbs and it also has 4 grams of fiber, for only 12 grams of “net carbs.”  (When counting carbs, you subtract the fiber grams from the total carbohydrate grams, because fiber does not provoke the same insulin response).

Or from a high-sugar cereal to a low-sugar cereal.   Changing from raisin bran (36 grams of net carbs per cup) to cheerios (19 grams of net carbs per cup) cuts the carb load almost in half.

Both those substitutions are lower calorie changes, but they are also lower-carb changes.  So is it the carbs, or the calories?   I think it’s the carbs.  See chapters 19 and 20 of Gary Taubes‘ “Good Calories, Bad Calories” for a full discussion of this point.

The real power of the realization that carbohydrate restriction is the most important part of the eating plan is that your child will not be constantly hungry on a low carb plan, as they will be on a low calorie “balanced” plan.  At Packard yesterday I really emphasized this point:  Juliana complied perfectly with the program and did lose 6 pounds in 10 weeks.  But she was hungry all the time and I didn’t see how she could possibly keep it up.

A low carb eating plan doesn’t require superhuman restraint to follow.  That makes it a lot easier to coach your child on a low carb eating plan than a low calorie eating plan.

After losing a lot of weight in the beginning, Juliana’s weight loss rate has slowed on the low carb eating plan.  But even if she only loses an average of a 1/2 pound a week, as she did on the Packard Program, she will eventually get to her goal weight WITHOUT suffering constant hunger.  And in the meanwhile, her energy level is high, she has a completely new level of physical stamina, and her mood is consistently good.

Juliana’s “low” moods disappear

From a young age, Juliana was prone to dips in her mood.  Mood disorders run in my family so I assumed she had just inherited this trait from me.  We noticed that if she didn’t exercise, she was much more likely to suffer a low mood, so we taught her that she needed to move every day to help keep her on an even keel.  And that helped her.

Then we tried low carb eating, and her mood problems have disappeared.  I also feel an elevated mood eating low carb.  Both of us still exercise, but neither of us feels as dependent on doing so to regulate how we feel.

 

Plan ahead, and pack your meals

We have a busy family life with lots of activities.  I used to pack low-calorie high-carb meals.  Now I pack low-carb meals.  The packing hasn’t changed, but the planning has.

For a teenager, you always want snacks in the fridge she can grab and eat.  Juliana’s favorites are crust-less quiche (eggs, sausage, broccoli, sometimes cheese); and deviled eggs (boiled eggs, slice in half, mash the yolks with mayo, salt, pepper, and if you have time, home-cooked bacon bits).  Cheese and salami, or cheese and turkey, or cheese and your favorite deli meat (make sure it’s low carb, many aren’t!) roll ups are also a good option.  Juliana doesn’t like nuts, but if your child does, almonds are a great option.  Roasted salted are ok, rather than raw, but don’t overdo it–an ounce of almonds is a good-size snack.  They are easy to overeat if your child likes salty crunchy snacks.

For lunch, I usually pack last night’s dinner leftovers, reheated in the microwave and sent in a thermos pack.  I make sure to cook enough the night before that I’ll have lunch ready to go the next day.  With a couple of deviled eggs for snack time.  And two quart bottles of water.

If you’re on the road at dinner time, it’s the same drill.  Quiche is a really easy thing to pack for dinner, because it has a good balance of fat, protein, and carbohydrate (mostly from low carb vegetables) in one compact package.

If you do have to eat out, it’s a lot easier to eat out low carb than low calorie in a restaurant.  I don’t recommend a fast food hamburger (minus the bun and ketchup) because the quality of the meat is so low, but in a pinch, even that will do, perhaps with a fast-food salad on the side (skip the high-carb dressing).