The Art And Science Of Low Carbohydrate Living

with contributions by: Eric Kossoff, MD | Jacqueline Eberstein, RN | Jimmy Moore

Copyright © 2011 Beyond Obesity, LLC All rights reserved. ISBN-13: 978-0-9834907-0-8 / E-Book ISBN: 978-0-98349-073-9 Visit us at www.artandscienceoflowcarb.com to order additional copies.

TABLE OF CONTENTS

Section 1: Introduction

Introduction

Chapter 1: Overview of Low Carbohydrate and Ketogenic Diets

Section 2: Perspective

Chapter 2: Low Carbohydrate Lessons from Aboriginal Cultures

Chapter 3: The “Modern” History of Carbohydrate Restriction

Chapter 4: Common Concerns at a Glance

Chapter 5: Dietary Carbohydrates: Scientific and Cultural Perspectives

Section 3: Physiology

Chapter 6: Basic Human Energetics and Fuel Partitioning

Chapter 7: Insulin Resistance

Chapter 8: Lipoprotein Effects

Chapter 9: Effects of Carbohydrate Restriction on Fatty Acid Metabolism

Chapter 10: Body Composition and Physical Performance

Chapter 11: Personalized Nutrition

Chapter 12: Low Carbohydrate Research Pitfalls

Section 4: Clinical Applications

Chapter 13: Clinical Use of Very Low Calorie and Low Carbohydrate Diets

Chapter 14: Metabolic Syndrome

Chapter 15: Treating Type-2 Diabetes as Carbohydrate Intolerance

Chapter 16: The Importance of Dietary Fat in Long-term Maintenance

Chapter 17: The Joy of Cooking (and Eating) Fat

Chapter 18: Ten Clinical Pearls

Section 5: Guest Chapters

Chapter 19: Ketogenic Diets in Seizure Control and Neurologic Disorders - By contributing author Eric Kossoff, MD

Chapter 20: Robert C. Atkins, MD – 30 Years of Clinical Practice - By contributing author Jacqueline Eberstein, RN

Chapter 21: Dear Doctor – A Patient’s Perspective - By contributing author Jimmy Moore

Acknowledgements -About the Authors -References

Section 1

INTRODUCTION - Interesting Times

For those of us doing research on low carbohydrate diets, the last decade has given truth to the ancient Chinese curse: “may you live in interesting times.” There has been a flood of scientific publications on everything from clinical studies of carbohydrate-restricted diets to underlying molecular mechanisms that explain how and why they work. And in the public domain, books and articles have critically examined the current dogma that ‘carbohydrates are necessary and good, whereas dietary fats are bad’.

Meanwhile, our population just keeps on gaining and gaining: not just adults, but children as well – not just in the US, but elsewhere in the developed and developing world as well. Of course, we are not alone in being concerned about this epidemic of obesity. All sincere doctors, dietitians, scientists, and policy-makers want to turn this process around, but there is as yet no common consensus on what to do and how to do it.

There is a glimmer of hope, however. Just as we have seen the consensus change on dietary trans fats and more recently on the high fructose content in our diet, we are beginning to see movement away from diets high in carbohydrates – especially refined carbohydrates and simple sugars. But many of the mainstream experts still warn against ‘going too far in the other direction’, stating that there are still too many questions about the safety and efficacy of low carbohydrate diets. But is this really true? Are there still too many unanswered questions, or has this position lost traction when the flood of recent research is taken into account?

This is an important question that we feel uniquely qualified to address. Collectively, the two of us have designed, conducted, and published several dozen studies of low carbohydrate diets. These results have consistently drawn us forward to do further research because of the positive outcomes we have observed.

We have counseled thousands of patients on low carbohydrate diets and tracked clinical outcomes. And as evidence of our personal convictions, both of us have chosen to follow a low carbohydrate lifestyle. In short, we believe that the most important issues about low carbohydrate diets have now been resolved. But perhaps because we are ahead of the consensus on this, we indeed find ourselves ‘living in interesting times’. Rather than being daunted by the intensity of the dialogue about low carbohydrate diets, however, we are delighted by this process, and it is this energy that has motivated us to write this book.

We ask not that you accept our position presented in this book because of our accumulated academic degrees or publications, but rather because our analysis of a broad range of information makes sense. As a place to begin, let’s look at some of the obvious discords to be found in the case for maintaining the current high carbohydrate, low fat paradigm.

Five Discords

First, the ‘low fat message’ has been pushed in the popular media and in academia for three decades, while in this same period the prevalence of obesity in the US population has grown dramatically.

A ‘low fat diet’ – even one restricted in calories – is high in carbohydrate, which drives up blood insulin levels. Insulin is a hormone that drives fat into storage (i.e., into fat cells) and stimulates hunger. A low carbohydrate diet, on the other hand, allows insulin levels to remain low and fat stores to be burned in the context of reduced hunger and cravings. Dietary saturated fat has been demonized in the media, textbooks, and in national policy; whereas published scientific data shows no connection between dietary saturated fat intake and either saturated fat levels in the body or the long term risk of heart disease.

The strongest correlation between a major dietary nutrient and blood levels of saturated fat is with dietary carbohydrate – not with saturated fat intake! On average,