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.

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.

Skewers on the grill: courtesy of FreeDigitalPhotos.netWe 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.

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).

Can a child be a low carb vegetarian or vegan?

Can I be a low carb vegan?  Short answer:  No.

How about a low carb lacto-ovo vegetarian?  Possibly, but really difficult.

Most of the low carb eating plans I’ve seen suggest that you can be a vegetarian or even a vegan.  I frankly don’t think this is really realistic even for an adult.  But for a child, a low carb vegetarian eating plan may be setting them up for failure.

There is a dizzying array of high carb food available–most of the food in the supermarket is high carb.  The cereal aisle.  The pasta and rice aisle.  The baking aisle.  The chips and crackers aisle.  The cookie aisle.  The bakery department.  The juice and soda aisle.  When you switch to low carb, your universe of acceptable food shrinks.  That’s the bad news.  The good news is that many of the choices are foods you might have wanted to eat but usually didn’t:  pork bacon, steak, cheeseburgers.  At first, the new eating plan is great.  Bacon, again?  Why Not?  After a while, though, you have to get creative with your meal planning.  No one wants to eat cheeseburgers three meals a day.

Now imagine the only protein and fat sources available to you are eggs, cheese and cream, and some tree nuts.   (In my opinion, substituting highly processed soy products, like tofu and tempeh, for animal-based protein is not a good idea).  Try to come up with 3 meals a day where most of your calories come from those fat and protein sources.  You can eat nut butter, but remember you can’t spread it on bread.  Yes, there are a lot of ways to prepare eggs, but probably not enough to keep your child on the eating plan.

My coach at my gym put it well while giving a nutrition talk.  She said she likes animals, and she doesn’t really want to eat animals, but she needs protein and fat, so she does.

The scale is a tool

What about the scale? Throughout her childhood, I had been afraid to put Juliana on a scale. I looked for “innocent” opportunities to check her weight. Doctor’s visits, obviously, but also the scales in the dressing room at the pool–I’d check my weight and ask all my kids if they wanted to check theirs. If I took in one kid to urgent care for an earache or something like that, all 3 of them came with me and we’d kill time by checking our height and weight while waiting for the doctor. But Juliana usually declined.

Since I didn’t check her weight regularly, I am guessing that she gained about 30 pounds in a year from the age of 12 to 13. By not checking her weight regularly, I also missed this steep weight gain as it was happening–more than half a pound a week.

Why was I afraid to put her on a scale? Eating disorders and self-esteem issues. I didn’t want her to tie her self-worth to a number on a scale. I didn’t want to create the impression that food was bad because it was making the number on the scale go up, or that it might be a good idea to starve herself to get to a lower number. When Juliana was 9, her BMI had spiked up again. I asked a family therapist about using a scale with a 9 year old, and she was emphatically against it, for the same sorts of reasons.

For some kids and teens not using a scale might be the right answer. But, the scale is a very valuable tool. Information from the scale allows you, as your child’s coach, to continually tweak what you are doing to help your child achieve a healthy weight. If your eating plan is effective, the numbers on the scale will demonstrate that by going down. If it isn’t, they won’t.

Yes, I know, muscle weighs more than fat and takes up less space. Your child could be adding muscle, staying the same weight, but slimming down. Could be. But unless he or she is on an exercise program that would justify a belief in added muscle, I would be wary of hoping that is happening, simply because the hope delays making tweaks to your eating plan to improve its effectiveness.

What about body composition measurements? We tried a home body fat monitor, but the numbers varied too much day to day to give useful information about the effectiveness of the eating plan. Unlike with a scale, there is far too much variation in the measurements of the body fat monitor from day to day to know if you are losing body fat. Juliana’s measurements bounced up and down between 25% and 35% from day to day.

We started with weekly weigh-ins, which was the procedure on the Packard pediatric weight control program. But now we weigh in daily, because we don’t want to waste time on a losing strategy. She feels great eating low carb, and she’ll eat this way the rest of her life, and yes, eventually she’ll reach her goal weight one way or the other; but she still wants to slim down without wasting time. I think everyone does. So if you can use the scale as a tool, and not obsess over the number, you should.  Juliana is doing well with the information from a daily weigh-in.  You have to judge for yourself whether using the scale is going to do more harm than good for your child.

Common medications can stop weight loss

We are learning that there are many things that can interfere with weight loss or cause weight gain, most of which aren’t commonly known, perhaps because of the dominance of the mainstream calories in/calories out model.

After about 4 weeks of eating very low carb, we added in some cheese and nuts. The Atkins approach is to add carbohydrate foods back to your eating plan in a specific order–called the carb ladder–until you find the number of grams of carbs you can eat per day and continue to lose or to maintain weight (whichever your goal is at the time). Juliana gained about 3.5 pounds over a few weeks.

We went back to very low carb, with most of her daily carb intake coming from green vegetables. The weight came off but more slowly than before. I kept reading and googling. I found that allergy medications (both over the counter and prescription) that she had started because of a seasonal allergy attack were believed by some people to cause weight gain, or to interfere with weight loss. She had started the medications on almost the same day she began eating cheese and nuts, and they, not the cheese and nuts, might explain the weight she had regained and the fact that she was now losing much more slowly. Later I was reading a book called “Mastering Leptin.” It includes a possible explanation for why antihistamines have this effect: histamines in the brain depress appetite (see Chapter 24, section “Histamine and Neuropeptide Y”).

She stopped the medications just as she was leaving for a 3 week teen service trip overseas. After 2 weeks, she reported that the pants she had brought with her were way too big. The trip posted pictures of the kids online. Juliana’s face looked noticeably slimmer.

What can water do for you?

water: courtesy of FreeDigitalPhotos.netYou hear it all the time–drink at least 8 glasses of water a day.  What does water do for you–and lack of water do–when you are eating low carb to lose or maintain your weight?  Three things.

1)   It’s the job of your liver to metabolize fat.  If your kidneys don’t have enough water to do their job, however, they send some of their work over to the liver.  Then the liver has less bandwidth to metabolize fat.

2)  On a low carb eating plan, you literally urinate out portions of fat molecules called ketones.  You are not only “burning” fat–you are also excreting fat in your urine. See page 170 of No More Fat Kids. Without enough water, this process slows down.

3)  If you don’t drink enough water, your body tries to conserve water, meaning you will weigh more.  If the body has plenty of water coming in, it won’t retain water.  So, paradoxically, drink more water to get rid of water bloat.

Drinking A LOT of water has been critical to Juliana’s progress.  When she came home from six weeks of traveling, in August, 2012, we found that Juliana had maintained her weight while growing half an inch.

She resumed a very low carb eating plan to give herself another weight loss jump start after a summer of less control over her food. But after five days, she had gained a pound. On the one hand, a pound could be normal variation. On the other hand, the more experience I get the more I feel that she is likely very sensitive to carbohydrate, and it is not easy for her to lose weight even on a low carb eating plan.

Unlike an adult who finds after the age of 40 that they can’t maintain their weight on a high carb diet after a lifetime of high carb eating–she was sensitive to carbohydrate already at a young age–she became obese over one year from 3.5 to 4.5. And she isn’t one of the many people you read about, if you poke around in the low carb community, who dropped 5 dress sizes in as many months eating low carb. So to me, a gain of a pound when we were trying to jump start her weight loss, when she hadn’t been doing a lot of strength training or the like that might argue she had added muscle, was significant.

We reviewed many tips and tricks. I zeroed in on water. Juliana has never felt much thirst, or drunk much water. I’ve encouraged her to drink more water for years.

We set a goal of a gallon per day. She has a 32 ounce water bottle she fills and empties four times. As her coach, I check in with her during the day to see how many water bottles she has finished. I frequently find the water bottle in the house, fill it with ice water, and bring it over to her.

After 3 days of drinking a gallon of water per day, she had dropped a pound and a half, and is now at her lowest weight ever since we started the low carb eating plan.