In the last post we discussed ramping up the fat intake as the single best way to hurry the low-carb or keto adaptation along.  I didn’t mention it in the previous post, but another little secret is to keep an eye on the protein intake. Too much protein will prevent the shift into ketoses because the liver will convert some of the protein into glucose – this glucose will then be used first and slow down the ketogenic process.  Which, if course, prompts the question, how much protein is too much?  As long as you’re getting your protein from meat, especially fatty cuts of meat, you’re probably okay.  If you go for the extremely lean cuts of meat, say, skinless chicken breasts, or if you are supplementing your diet with low-fat protein shakes, you could have a little more trouble low-carb adapting.  If you’re going the shake route, I would recommend you add some coconut oil to the shakes for a couple of reasons.  First, you’ll hasten the keto-adaptation, and, second, the fat it coconut oil will help remove the fat from your liver (which I’ll discuss more later in this post).

A glass of Tinto de Verano pictured at left. A great way to hydrate. (See note at bottom of post.)

As I said, you need to really crank up the fat intake to push yourself over the adaptation divide as quickly as possible.  If you don’t like fatty cuts of meat, you can add a little medium-chain triglycerides (MCT) to your diet.  MCT are absorbed more like carbohydrates and are used quickly by the body.  They are almost never incorporated into the fat cells, so they burn quickly, and any extra that might be hanging around are converted to ketones.  So, MCT will drive the ketone production process.  And so will coconut oil if you prefer that.

You can find MCT oil at most health food or natural grocery stores.  It has never bothered me, but some people can get a little nauseated if they take too much of it, so if you decide to give it a try, start out slowly.  Or go with the coconut oil.

Aside from the occasional carb cravings, which we’ll deal with later, the most common symptoms experienced by those getting started on low-carb diets are fatigue, headaches, light-headedness or dizziness, and cramping.  I would say these four symptoms probably comprise 98 percent of the complaints we get from our patients we put on low-carb diets.  Not everyone experiences these symptoms – especially those who do what we tell them – but of those who do have symptoms, these are almost always the ones they have.  Let’s look at what to do to avoid them or treat them should you already be experiencing on or more.

Electrolytes

The most common cause of virtually all the symptoms listed above is an imbalance in electrolytes.  Following a low-carb diet results in a rapid lowering of insulin levels, which – though a good thing – can create problems in the early days.  We’ll address the electrolytes in the order of importance.

Sodium

When you are overweight and insulin resistant, you have a lot of insulin circulating in your blood most of the time.  This excess insulin does a number of bad things to you.  Gary Taubes wrote an entire book about how excess insulin makes you store fat in your fat cells.  But the story doesn’t end there.  Excess insulin also drives the kidneys to retain fluid, which is why many obese people retain a lot of extraneous fluid and experience pitting edema in their lower legs.

What is pitting edema?

If you push your finger into the tissue in the front (or just to the side of) your shin bone and your finger leaves an indentation – almost a finger print – that takes a while to fill back in, you have pitting edema.  Most overweight people experience this phenomenon late in the afternoon and/or at night after being on their feet all day.  The excess fluid pools around the lower legs and seeps into the soft tissues. In the morning, after the body has been horizontal through the night, the fluid redistributes, and the pitting edema goes away but then reoccurs as the day goes on.  Even people who aren’t all that overweight but who do have elevated insulin levels will have some degree of excess fluid accumulation even if they don’t experience pitting edema as evidence of it.

One of the first things that happens when people go on low-carb diets is a rapid improvement in insulin sensitivity.  Because the low-carb diet starts to quickly banish the insulin resistance, insulin levels fall quickly.  And as insulin falls, the stimulus to the kidneys to retain fluids goes away, and the kidneys begin to rapidly release fluid.  One of the common experiences at the start of low-carb dieting is the incessant running back and forth to the bathroom to urinate this excess fluid away.  Which is both good news and bad news.

The good news is that it’s great to get rid of the excess fluid but it comes at a cost, which is the bad news.  As the excess fluid goes, it takes with it sodium an extremely important electrolyte.  When sodium levels fall below a critical threshold (which can happen within a short time), symptoms often occur, the most common being fatigue, headache, cramps and postural hypotension.

Postural hypotension happens when you stand up too quickly and feel faint.  Or even pass out briefly.  It’s a sign of dehydration.  So if you’ve started your low-carb diet, made your multiple runs to the bathroom, and jump up off the couch to answer the phone and feel like your going to faint (or actually do pass out momentarily) and have to sit back down quickly, you’ve got postural hypotension.  It’s really easy to fix – you simply need to take more sodium and drink more water.  Salt your food more.  Increasing sodium is just another one of the many counter-intuitive things about low-carb dieting.  Just like eating more fat to lower your cholesterol.  You’ve got to start thinking differently.  The low-carb diet is one that absolutely requires more sodium.  A lot more sodium.

If you’ve got the brutal headaches that some people get when starting on a low-carb diet, add sodium.  And drink extra water.

Even if you don’t have pitting edema, postural hypotension or headaches, you still need more sodium if you are starting out on or following a low-carb diet. It’s critically important that you get extra sodium.  I can’t make this case too strongly.

An easy way to get extra sodium along with magnesium and potassium (a couple of other electrolytes we’ll discuss in a bit) is by consuming bone broth.  Unfortunately, you typically have to make the good stuff yourself because it’s difficult to find commercially.  You can get chicken broth and beef broth at most grocery stores, but it’s not nearly as good as the broth you can make yourself.  At the end of this post I‘ll give you a spectacular recipe that we have for a great bone broth we made at our now-defunct restaurant.  It is beyond good.  It requires a little time, but you can make a bunch and freeze it in small containers and keep it forever.

Short of making your own bone broth, you can use commercially available bouillon, which contains plenty of sodium and makes a nice hot drink.  Plop a cube in a cup of hot water and throw it back. Many patients have reported that drinking a cup of hot bouillon helps them get through carb cravings.  It’s easy and convenient, but can’t compare in taste to the real bone broth you make yourself.

In addition to broth, get some Celtic Sea Salt, Himalayan Salt or one of the other grayish, pinkish kind of grungy looking salts and replace your normal salt with these.  And don’t use them sparingly.  These salts have been harvested either from ancient sea beds or obtained by evaporation of sea water with high mineral content and contain about 70 percent of the sodium of regular salt (which has been refined, bleached and processed until it is pretty much pure sodium chloride, often with anti-caking agents added).  The other 30 percent of the volume is other minerals and micronutrients (including iodine) found in mineral-rich seas.  Consuming these salts is not just following a Paleolithic diet using modern food, but, depending upon the origin of the salt, it is consuming the same food your Paleolithic ancestors ate.  I much prefer these salts taste-wise to regular salt, and I salt the heck out of all my food with it.

Magnesium

The low-carb diet doesn’t really cause a massive depletion of magnesium like it does with the sodium and potassium (the next electrolyte on the list), but most people who are overweight, insulin resistant and/or hypertensive or diabetic are deficient in magnesium.  Even people with lipid problems are often magnesium deficient.  In fact, even people who don’t seem to have health problems can often be magnesium deficient because most people don’t get enough.   The last I read on the subject, about 70 percent of people don’t even get the minimum recommended daily intake of magnesium (which isn’t all that high).  So, in my opinion, it’s important to supplement this vital mineral.  Good magnesium levels help regulate potassium as well, so keeping your magnesium adequate helps with your potassium as well.

Nature has designed us so that approximately 300 plus of our enzymes require magnesium as a co-factor to make them work properly.  Which tells us that we evolved in a time when magnesium was readily available, otherwise the forces of natural selection wouldn’t have made such wide use of it.

Where did it come from?  I would bet most of it came from the water.  Most natural sources of water have a high magnesium content, so when you drink bottled water and softened and treated water, you get short changed.  Magnesium salts in water are one of the substances that tends to make deposits on your water pipes and makes it difficult to get a good lather with soap.  This problem is solved with water softeners, but the process gets rid of the magnesium.  In the old days when we all drank well water or stream water, we got a lot more magnesium.

Since magnesium is used in 300+ different chemical reactions in the body, a shortage of magnesium can cause problems.  One of the most common ones is an increase in cravings.  Often simply replenishing magnesium gets rid of many of the food cravings people have.

The best way to get magnesium is from supplements.  Get a good chelated magnesium supplement and take 300-400 mg per day.  We’ve found it best to take these supplements in the evening because magnesium is relaxing and taking it in the evening helps you sleep.  About the only problem people ever have with magnesium is loose stools, i.e., the milk of magnesium effect.  If that happens – and it is unwelcome – simply reduce your dosage until your stools normalize.

Purchasing magnesium supplements can be a little tricky because of the way they’re labeled.  First, a chelated magnesium supplement is one that ends with an ‘-ate,’ as in magnesium aspartate or magnesium citrate or magnesium citrimate.  The -‘ate’ ending tells you the magnesium is chelated, which means it’s attached to another molecule (the chelating agent..aspartate, citrate, or whatever) that helps with absorption.  Second, with magnesium supplements, the manufacturers sometimes list the dosage of both the magnesium and the chelating agent combined.  Since the chelating agents are a lot heavier than the magnesium, this labeling often ends up saying the dosage of each pill is, say, 1000 mg of magnesium aspartate.  This isn’t the amount of magnesium you’re going to end up getting because the magnesium is only about 15 percent of the weight of the total pill.

About the only way you can really tell how much actual magnesium your getting is to look on the label on the back and see how much of the RDI (Recommended Daily Intake) the dose is.  The RDI for magnesium is 400 mg per day so if you find the dose of the supplement you are considering contains 50 percent of the RDI, then you know each dose contains 200 mg of magnesium irrespective of what the dosage is on the front of the bottle.  As I say, I recommend 300 to 400 mg of magnesium per day.  The only downside of magnesium is loose stools.  Doesn’t happen to everyone, but does to a few.  For many people the magnesium seems to offset the constipation that some experience when starting a low-carb diet.  If you do experience loose stools, simply back off your dose of magnesium until things unloosen.

Magnesium is natures relaxant.  It makes many people sleepy, so we always recommend taking it at bedtime.

Potassium

Potassium is linked to sodium.  If you lose a lot of sodium through the diuretic effect of the low-carb diet, you’ll ultimately lose a lot of potassium as well.  Keeping your sodium intake up as mentioned above will help preserve your potassium as well.  And keeping your potassium levels up helps to ensure that you don’t lose a lot of lean muscle mass during your weight loss.  Plus, just as with sodium, adequate potassium prevents cramping and fatigue.

You can replace your potassium by taking potassium supplements.  In our clinical practice, we gave all patients starting the low-carb diet a prescription for potassium.  You can get the same dosage by taking four to five of the over-the-counter 99 mg potassium supplements you can purchase at any health food or natural grocery store.

There are a couple of prescription medicines that you’ve got to be aware of if you markedly increase your potassium intake, so if you’re on blood pressure medicines, ask your doctor if it’s okay for you to take potassium.

Before we move on to other supplements we can use to help with low-carb dieting, I want to address the subject of dehydration.

Hydration

A few years ago, I learned the lessons of adequate hydration the hard way, so take this as a cautionary tale and benefit from my painful experience.  I had always pooh-poohed the notion of drinking a lot of water in addition to coffee, tea and other non-caloric beverages because I always figured (and probably have even written in the pages of this blog somewhere) that coffee, tea, etc. are nothing but water with a little flavoring in them.  I mean, if you start out with a glass of water and put tea bag in it, the water doesn’t go away.  It’s still there; it just becomes tea-flavored water.  Well, turns out that’s not actually the case.

My daily ritual was as follows: Get up, stagger to the refrigerator and take a big gulp or two of sparkling water.  Then make my way to the espresso maker and crank out a cup of Americano.  Followed by four or five more Americanos over the course of the morning and early afternoon, interspersed with a gulp here and there of sparkling water.  A snort of Jameson in the early evening, maybe a glass of red wine with dinner and a decaf Americano after dinner.  If I watch a movie or read a book, I usually nurse another glass of Jameson.  I typically take my supplements at bedtime, so I throw back another half glass or so of sparkling water then.  Plenty of liquids, right?

Well, not exactly, as it turned out.

I began developing severe cramps in my hands and feet that I had a hell of a time massaging out.  That was just the beginning.  I started being awakened at night with brutal leg cramps, requiring my springing from the bed and walking them out.  My potassium is too low, thought I, so I started taking potassium.  No change in the cramping situation.  In fact, if anything, it got worse.  I was complaining to a friend who told me calcium had helped his cramps.  So I downed calcium at bedtime.  No improvement.

Another friend told me that tonic water had helped her with cramps, but I only half believed it, so didn’t really try.  Then MD and I had family visit us in Tahoe for skiing.  I upped my booze intake, kept the coffee intake about the same, and probably decreased my consumption of sparkling water (or water of any kind, for that matter).  The cramps increased dramatically.  And what was worse, they stopped limiting themselves to the night.  When MD and I were driving over to Napa one day, the cramps were so severe I could hardly drive.  I had to keep the seat back as far as I could get it so I could straighten my leg when one hit me.  Then my hands started cramping just holding them on the steering wheel.  I pulled off the freeway and made a beeline for a convenience store and grabbed a one liter bottle of diet tonic water and proceeded to chug the entire thing as I drove down the road.  Miraculously, my cramps subsided.  So, I figured tonic water (quinine) was the solution.

One night – after being out of tonic water for a few days and being failed by my bride in resupplying – I had another brutal night of cramps.  The next day I was scheduled for blood donation.  After going through the long list of questions that must be answered verbally (and fighting down the impulse to tell my interrogator that I had recently paid for sex while imprisoned in Africa – those who have given blood lately will know what I mean), I was sent to actually have the blood taken.  The phlebotomist couldn’t find my vein, which had never happened before because I usually have rope-like veins in my forearms.  She asked if I was dehydrated.  I told her I didn’t think so since I had had my normal four of five cups of coffee that morning along with my gulp of water.  She brought me a couple of 16 ounce bottles of water that I drank, and, bingo, there were my veins.  Big and robust as usual.

It finally occurred to me that my cramping problem might be due to dehydration and that the diet tonic that solved the problem did so not because of the quinine but because I was drinking all the water the quinine was dissolved in.  And it occurred to me that the cramping was worse in the middle of the night because a lot of water is lost through the breath at night. (See my second post on the Anthony Colpo Smackdown to read more about this.)  You can lose a couple of pounds during sleep simply by breathing water vapor away, which was, I’m sure, what was happening to me.  I was barely hydrated enough to prevent cramping while awake, but when I slept and my fluid level fell due to my breathing water away, I hit some critical threshold of fluid that kicked off the cramps.

I started rehydrating first thing in the morning and throughout the day.  Now I get up, drink anywhere from 16 to 32 ounces of remineralized water (more about which later) first thing.  Then I head to the espresso maker and start my daily Americano regimen.  But I consume at least 8 ounces of sparkling water after each cup of coffee.  And I drink water after each shot of Jameson and/or glass of wine (or any other alcoholic libation),* and I’m proud to report that I have been cramp free since upping the water.

My brush with cramping misery inspired me to hit the medical literature to read about hydration.  And I learned many wonderful things. For example, I learned coffee is a diuretic (which I already knew but had chosen to forget), but that some acclimation occurs over time.  Still, due to the diuretic effect, you don’t get the full fluid from a cup of coffee that you would from an equal amount of water.  Same with alcohol.  Once I started calculating how much fluid of that I drank throughout the day I was actually retaining, I was amazed that cramping was the worst that happened to me.

I learned that water has a lipolytic effect (fat burning).  I read this in a number of papers that had studied it, and the data clearly showed that those who took in a lot of water had increased lipolysis.  I didn’t deny the data, but I couldn’t figure out the mechanism (and apparently neither could any of the authors because none described it).  I thought on it a while and finally came up with what I think is a plausible scenario.

When you drink water, especially cold water, you require some increase in caloric burning to bring the water to body temperature, but that increase doesn’t amount to all that much (the authors did describe this phenomenon), but you also dilute your blood for a bit until the water equilibrates with the fluid in all the tissues, and effect that takes some time.  During this time, while the blood is more dilute, the concentration of the various substances carried in the blood decreases.  Which would mean that insulin levels would fall.  The typical blood volume is about 5 liters, so drinking a liter of water would increase the blood volume temporarily by about 20 percent, which would mean the concentration of insulin and other molecules in the blood would fall by about 20 percent.  A 20 percent drop in insulin levels would allow fat to escape the fat cells and would facilitate its transfer into the mitochondria for burning.  At least that’s my explanation for the lipolytic effect seen in numerous studies of subjects increasing water intake.

Those starting a low-carb diet are prone to dehydration because excess ketones are gotten rid of via the kidneys along with a lot of fluid.  So, when you start your diet, consciously increase your fluid intake.  Do like I do now and come up with some sort of regimen that ensures you consume plenty of water throughout the day.  You’ll feel better; you’ll avoid cramping; and you’ll actually burn a little more fat.  And don’t make the mistake I did and assume that drinking a lot of coffee, tea, booze or other diuretic fluid is a replacement for water intake.

Since I drink either bottled water or water that comes through our RO filter, both of which are depleted of minerals, I always remineralize my water by adding a pinch of Celtic Sea Salt or one of the other such salts to each bottle.  I add enough so that the water just barely hints of a salty taste.

Supplements

Every patient whom we started on a low-carb diet left our clinic with six supplements:  lipoic acid, CoQ10, Vitamin E, magnesium, a good multi-vitamin and a prescription for potassium. (Now I would add a substantial dose of vitamin D3 to the list, a dose based on vitamin d levels and sun exposure.) We’ve already dealt with the potassium and magnesium, so let’s consider the others.

First, the good multi.  I’m a believer in getting most of what’s needed vitamin- and mineral-wise from food.  And I’m also a believer that I’m an excellent driver.  Yet I always purchase car insurance.  I see a good multi-vitamin as the same thing – cheap insurance against any kind of deficiency.  I would rather have my patients urinating away fifty cents worth of vitamins a day than risk that they have a deficiency in one.  And I feel the same way about myself.  So, find a good multi-vitamin without iron and take it.  Based on the experiences of my own patients, I can almost guarantee you’ll feel better. Why without iron?  Because most people on low-carb diets get plenty of iron in a very absorbable form.  And too much iron isn’t a good thing, so don’t take it in your multi.

Alpha lipoic acid (ALA)

ALA is, next to magnesium, just about my favorite supplement.  It acts as both a fat-soluble and water-soluble anti-oxidant so it can pretty much weasel its way in anywhere in the body and stamp out inflammation.  It protects fatty membranes and even acts as a cellular nutrient.  It also helps the body deal with blood sugar, which helps the whole low-carb adaptation process along.  Many studies have shown an improvement in blood glucose levels and insulin sensitivity with ALA supplementation.  ALA can rejuvenate other anti-oxidants, and has so many virtues that entire books have been written about it.  My standard dose is 300 mg per day for patients starting low-carb diets.  There is a newer, more potent version of ALA available now called r-alpha lipoic acid.  The standard stuff is a combination of the r and l varieties, and since the r isomer is the active one, a supplement made entirely of the r variety is going to be more potent.  And more expensive.  If you use the r-ALA you can take 100 mg a day.

CoQ10

Another superstar supplement, especially for those who have been on or are on statins.  Statin drugs interfere with the body’s synthesis of this important nutrient, and those who have been or are taking statins are usually depleted to some degree.  If you’ve been taking a statin, I would take 300 mg per day of CoQ10.  If you haven’t, 100 mg per day should do.

Vitamin D3

I would also add at least 1000 IU per day of this nutrient.  You need to have your levels checked at some point to make sure you don’t overdo it, but at 1000 IU per day, this is unlikely.  If you do test and find you’re deficient, I would take 5,000-10,000 IU per day until 25 (OH) vit D serum levels are up to at least 50 ng/ml.  Along with all the other benefits vitamin D3 provides (which I have written about elsewhere on this blog), there is some evidence that it even boosts weight loss a bit.

5-hydroxytryptophan

The last supplement I’ll mention is one I’ve had much success with in treating people who tend to have carb cravings late in the day.  5-hydroxytryptophan (5-HTP) is the precursor to serotonin.  Most people who have carb cravings have them because their serotonin levels fall.  Taking 5-HTP will bring them back up.  It also helps with sleep.  Best time to take it seems to be about 4 or 5 PM for those who go to bed at the standard 10-12 PM.  You can move the dose around to find a time that helps the most with your carb cravings yet doesn’t make you sleepy other than when you want to be.  I usually recommend 50-100 mg.  It’s available at most health food stores and natural food grocers.

Fatty liver

The last bit of advice I’ll give is that you need to work to defat your liver as quickly as possible.  The good news is that you can do it quickly on a low-carb diet.  Studies have shown major improvement in just 10 days or so.   It’s important to defat your liver to help you lose weight more quickly because the liver breaks down insulin.  If your blood sugar goes up, the pancreas makes and secretes insulin to drive it down. It does so by driving the glucose into the cells.  At the same time, insulin drives fat into the fat cells and keeps it there.  As long as the insulin is in the circulation, it’s going to be preventing fat from leaving the fat cells.  The liver is the organ that breaks down and gets rid of the insulin.  And a healthy liver does it a lot better than a liver full of fat.

One of the liver’s most important jobs is detoxification of harmful substances.  We all (at least I) consume medications, food and drink that is toxic.  We (I) drink coffee, tea and alcoholic beverages.  The caffeine and alcohol are toxins.  They don’t really hurt us in the quantities that most of us ingest, but they are toxic nevertheless.  The liver detoxifies them.  Same with many drugs – both prescription and over-the-counter.  Tylenol puts a major detoxification burden on the liver.  When you drink coffee, tea, and/or alcohol and take OTC meds, you occupy much of your liver’s detoxification capacity.  Which means it can’t get rid of insulin as well and can’t regulate metabolism in general as well as it does when it isn’t busily detoxing toxins.

So, if you really want to hit it hard in the early phases of your low-carb diet and reach low-carb adaptation at warp speed, I would recommend avoiding – or at least limiting – coffee, tea, alcohol and OTC meds.

I am a huge lover of coffee and alcohol (coffee more so than alcohol despite my constant talk of Jameson) so I know this is a sacrifice.  One way to have it both ways is to switch from caffeinated coffee to decaf espresso.  Decaf coffee to me sucks taste-wise.  But decaf espresso ain’t so bad.  If you don’t want to go completely cold turkey, you can switch from coffee to espresso since espresso has double (or triple) the taste of coffee yet only about half the caffeine.  My favorite way to drink espresso is as Cafe Americano.  I love it so much that I even made a video of how to make it to send to people.  Take a look if you haven’t seen it yet.  It’s the best cup of coffee you’ll ever have. (I have one on the table next to me as I write these words on the patio in Cuenca, Spain.)

That’s about a wrap on my tips and tricks for kicking off a low-carb diet.  I’m sure many of you have tips and tricks of your own.  Please feel free to share them in the comments section.

The bone broth recipe at the very bottom of this post is from our defunct restaurant that I wrote about here.  We had this going on the stove all the time and used it as a base for about half the dishes we served.  It is absolutely spectacular.  I would eat is as a soup (we didn’t serve it that way) and take home bags of it and freeze it.  You can do the same.  I’ll provide the restaurant-sized version so you can either make a large amount in a big stock pot and freeze a bunch of it in individual packages.  Or you can cut it down to a smaller recipe.  If you do, just make sure to cut all the ingredient amounts proportionally.

A note of interest: I wrote the first part of this post flying between San Francisco and Dallas.  The middle part during a flight from Dallas to Atlanta.  And the last part (along with the words I’m typing now) over the Atlantic on a flight from Atlanta to Madrid.  I’ll transfer it to WordPress, put in all the links and photos when I get to the hotel in Madrid.  So you’ll end up with a post that was written about halfway around the world.

Another note of interest: I’m finishing this post in Cuenca, Spain (including some of the edits I made above) because the internet connection in our hotel in Madrid sucked.  The hotel was great, the food was pretty good, but the internet was abysmal.  I kept getting kicked off, so I abandoned all but the most necessary internet functions (email, mainly) until I got to more reliable service.  Here we are in Cuenca where the hotel sucks, the food really sucks but the internet connection is great.

One housekeeping note: Since the internet has been so unreliable, I have been unable to deal with the 100 or so comments that have accumulated.  I’ll get to them as soon as this post is up.  I did perform one of my most-hated tasks last night and went through the spam filter to fish out legit comments that had gotten snared before deleting the zillions of spam comments.  So if you’ve been waiting a long time for a comment to appear, it was probably one of the handful that I rescued from the sea of spam.  I’ll get it up as soon as I can. Just bear in mind that I’m headed for my next stop, Zaragoza, as soon as I hit the ‘Publish’ button on this post and will be on a forced march for a bit. So, be patient with me on the comments.

This is the restaurant recipe for massive quantities, so you can reduce accordingly.  Just make sure you reduce all ingredients proportionally.

2 oz roasted garlic (weight)
10 oz roasted red onions (weight)
4.5 gallons water (volume)
22 oz tomato paste (weight)
4 oz cilantro with stems
2 pounds chicken back bones (weight)
16 oz tomato pulp (weight)*
6 oz salt (weight) I would use Celtic Sea Salt or other such salt here
1 oz black pepper (weight)
1 oz olive oil (volume)

Roast onions and garlic in olive oil for approximately 15 to 20 minutes.

Add all ingredients to water, chicken and tomato paste.

Let simmer over medium fire until cooked.

Approximate yield is 640 ounces or 5 gallons.

*We used a ton of diced Roma tomatoes in the restaurant for just about everything.  We removed the pulp from these tomatoes before dicing them.  We saved the pulp and used it in the stock.

*Here in Spain I have discovered a wonderful way to drink wine and stay hydrated.  They have a drink called Tinto de Verano (see photo at top), which is half fruity Spanish wine and half sparkling water poured over ice with a slice of orange and slice of lemon thrown in.  It’s kind of sangria lite.  Each time you drink a glass of it, you get half wine and half water, so you rehydrate the water lost from the little alcohol in the half glass of wine.  It’s tremendously refreshing, and I’ve drunk my weight of it since arriving.

A couple of weeks ago, through the agency of a friend, I ended up spending the evening in a commercial kitchen preparing food.  The restaurant was closed for business that night, but had a full kitchen going for the dozen or so people who turned out to try their hands at being chefs.  We all cooked various portions of a four or five course meal. That’s me at the left in my chef’s attire chopping scallions for garnish for one of the dishes.

Sad to say, but this wasn’t the first time I’ve ever labored in the back end of a restaurant.  Both MD and I are very familiar with those duties.  One of the truly bad moves of my financial life was investing in a franchise restaurant years ago.  I still don’t know what came over me, but whatever did, it cost me a lot of money.  I distinctly remember how it all happened.  I was sitting in the kitchen of our house in Little Rock going through the mail and came upon a magazine buried in the pile.  I don’t remember now what magazine it was, but it had an article on hot new restaurant concepts.  One of the hottest, and one that was taking Dallas by storm, was a Mexican restaurant franchise called ZuZu.  ZuZu Handmade Mexican Food, to be exact.

I read the article and inexplicably reached around behind me, picked up the phone and dialed the number to get more info.  (A phone call, I might mention, that cost me hundreds of thousands of dollars before it was all over.)  The person on the other end – a honcho from ZuZu corporate office in the Rolex Building in Dallas – painted a wonderful picture of restaurant ownership, and before I knew it, MD, our eldest son and I were headed to Dallas to see a ZuZu restaurant in the flesh and try the food.

The food was dazzlingly good – all fresh, all handmade.  We tried just about everything and didn’t find anything that we didn’t love.  And much of it was low-carb, to boot.  Our eldest was just out of college and looking for something to do and our middle son was going to graduate soon.  After discussion with them, we decided to take the plunge.  Bad, bad, bad mistake on many fronts, but we learned a lot.  And that’s about the best face I can put on it.

The kids all went to Dallas and underwent the training program.  MD and I purposely avoided learning how to operate the cash register or do anything in the front of the house.  We had a large medical practice in Little Rock (a relatively small city) and didn’t want to be doing a pelvic exam or a rectal exam on someone in the morning, and then greet them that evening wearing a ZuZu hat and a big smile with ‘For here or to go?’

Consequently, whenever things went crazy – as they always do in the restaurant business – MD and I got dragooned into working the back of the house where we could do our part yet stay out of sight. One day during the first couple of weeks of being open was particularly memorable. MD and I both had presentations to make to a large medical meeting in Seattle, but the day before those presentations, we were scheduled to be on CBS The Early Show and the day before that on the Sally Jesse Raphael show.  I was busy putting together my slides for the medical presentation while MD was working on patient charts when we got the call.  MD headed to the restaurant while I stayed at the office and finished my slides.  By the time I got to the place, it was a true hellhole. MD was surrounded by piles of dirty plates, glasses, pots and pans and was deep into catching up on the dish washing so I jumped in and started prepping by chopping tomatoes, limes, onions, cilantro, you name it.  As soon as the dish washing was caught up (which took over six hours), MD started helping me prep. I was on a roll with all the stuff I was slicing and dicing, so she grabbed the peppers that I hadn’t gotten to yet and began.

As closing time approached, we began preparing the stuff for the next day.  In doing so – and I don’t remember now how I did it – I burned the bejesus out of my hand and had an enormous half-dollar size blister pop up.  After closing, MD and I got home and got into bed to get a few short hours of sleep before our 6 AM flight the next morning.  As we lay there recounting the day and wondering about our sanity for ever embarking on such a folly, MD said that her hands were starting to burn.  In just a few minutes, her hands were on fire.  She had been chemically burned by the juices from all the peppers she had prepped, and, like a sunburn, it had taken a few hours before she started feeling the effects.  She jumped up, held her hands under the cold water for about five minutes, then slathered them with a cortisone cream we had at the house.  She came back to bed and worried all night that her hands would end up red and grotesquely swollen by the morning, and that she would have to appear on national TV with lobster hands along with her husband with his giant blister.  What a nightmare!

Her hands were okay by morning – a little red, but nothing all that noticeable.  I still had the enormous blister I was trying to keep intact so that the skin would act as a dressing, but I figured I could probably keep it out of sight of the cameras.  We caught our flight, went on with Sally Jesse that afternoon and the CBS morning show the next day without incident.  Then it was off to Seattle for that gig.

In addition to our labors on the above-mentioned disastrous day, MD and I have both washed thousands and thousands of dishes using the commercial dishwasher, which has a lot of hands-on effort that goes along with it.  It seemed that it always fell to me to do the prep work.  I’ve sliced and diced rosemary, cilantro, garlic, onions, tomatoes and peppers by the car-load lot. ( And along the way I developed pretty good knife skills without sacrificing any of my fingers in doing so.)  So the two of us have spent plenty of back-breaking time in the bowels of a commercial kitchen.

But never in an enormous kitchen designed to service a fairly high-end restaurant like the one we found ourselves in the other night.  I was eager to see how it all worked.

I learned plenty.  For one thing, it’s really easy to cook in a big commercial kitchen because you have everything at your disposal.  And you don’t have to dig all the stuff out when you need it – it’s already there.

If you need to quick chill something, the giant ice bath is right there.  If you need to throw an entire tray of stuff into a big fridge, you’ve got it available without having to rearrange everything so it will fit.  If you need to quickly blanch something, there is the giant strainer and the pots of boiling water are at the ready.  It really makes cooking much more hassle free than it is at home.  And the best part of all is that you have (or at least we did during this event) staff who clean up behind you.

In between my various tasks assigned tasks, I snooped around, and my worst fears were confirmed.  Before we get to that, though, let me tell you what I’ve learned about chefs.  What I’m about to say doesn’t apply to every chef who cooks, but I would guess it applies to most.

Chefs are not particularly health conscious. They cook for flavor, not for health.  If there is a choice between making something taste a little better or making it a little more healthful, taste will win every time.  Which is a good thing in many cases because chefs – like most other people – have been brainwashed as to what is healthful and what isn’t.  Most doubtless believe that saturated fat is unhealthful, but, fortunately, that doesn’t deter them from using butter, heavy cream, bacon, and all the other tasty high-saturated  fat foods in their cooking. If butter tastes better – that’s what they use.

But many things are deep fried and cooked using vegetable oils and shortenings because these products don’t impart much of a taste.  That was the big advantage of Crisco when it came out: it was pure and while and left no taste the way lard did.  Same with processed vegetable oils today, so chefs use the heck out of it.

Part of my job was to make some egg rolls for an appetizer.  I filled them with shredded chicken, shredded crab, a snow pea, some ginger and a little salt and pepper.  Then I deep fried them.  I asked the main chef, who was keeping a watchful eye on all of us pretend chefs, what kind of oil he used in the deep fryer. (The deep fryer, like everything else in the kitchen, is running all the time, and people pop stuff into it all night long when the restaurant is busy.)  He told me it was canola oil.  I asked him if canola was commonly used in deep fryers; he said that canola was used in every restaurant he had ever worked in.

I was surprised because I wouldn’t think canola oil would hold up to a deep fryer.  I asked how often they changed the oil – he told me they did so once a week. I made a note to research it a little when I got home.

I knew polyunsaturated fat made up somewhere around a third of the fatty acids in canola oil.  Polyunsaturated fatty acids (PUFA) are the ones most harmed by heat and oxygen, so it really made me wonder why anyone would use an oil containing so many PUFA for deep frying.  I just imagined all the oxidized fats in the oil I was dropping my newly made egg rolls into.

(There is a misconception in the minds of most people about what happens to PUFA when they are kept hot and bubbling for a long time as they are in deep fryers.  A lot of people think the PUFA convert to trans fats.  They don’t.  It requires heat, pressure and a catalyst to transform normal PUFA to trans fats.  What does happen, however, is that the PUFA become oxidized.  Then when you eat them, you are consuming oxidized fats that your body has to deal with.)

When I got home after our dinner, I went to the USDA Nutrient Database to look up canola oil to see if I had remembered correctly about the percentage of PUFA. I found the following entry:

Oil, industrial, canola (partially hydrogenated) oil for deep fat frying

When I looked up the fatty acid breakdown, I discovered that this industrial canola oil made for commercial deep fat frying contained almost a third of its fatty acids (27 percent to be exact) as trans fats.  Which is why it worked for the deep fryer.  During the processing of this oil, most of the PUFA had been converted to trans fats.

I looked at the other canola oils listed in the USDA list and found this one:

Oil, industrial, canola with antifoaming agent, principal uses salads, woks and light frying

Sounds just like what you would want to eat on your salad, doesn’t it?

This particular canola oil had just a couple of grams of trans fats per 100 grams of oil, so it wasn’t nearly as bad as the deep fryer canola oil, but it still doesn’t sound particularly appetizing.

At most of the stations in the kitchen there were containers of a salt and pepper mix and containers of oil with ladles.  If frying (not deep frying, but regular frying) were to be done, you threw a ladle of oil on the grill or in the skillet.  If you were whipping up a salad dressing, you started with the oil and worked from there.  This oil is the industrial oil with the antifoaming agent.

So, the take-home message from my experience is that if you eat in a restaurant you are going to get a lot of oils that you would probably rather not have.  At worst, you’re going to get a load of trans fats; at best, you’re going to throw back plenty of omega-6s. Omega-6 fats are, for the most part, pro-inflammatory, and we get way, way too many of them in our diet as it is. Most of the readers of this blog know how harmful omega-6 fats are in large quantities, so I won’t go in to it here.  Suffice it to say, however, that the medical literature is full of articles pointing out the hazards of too many omega-6 fats.  Then there is the American Heart Association that has inexplicably come out in support of omega-6 fats for heart health (Harris, WS), which advice you can put up on your shelf right beside the advice to avoid saturated fats.

In the 6-Week Cure we wrote about how vegetable oils – at least in lab animals – drive the development of fatty liver.  Researchers give rodents large regular doses of alcohol to get them to develop fatty livers.  They have found that if they give the rodents vegetable oils, they can accelerate the development of liver disease.  If the rodents get saturated fats, however, they almost can’t get fatty livers no matter how much alcohol they take in.  Does this apply to humans?  Who knows?  These kinds of studies would be unethical to do in humans, so we can’t test to find out.  But, the evidence is clear enough in rodents that I’m not all that eager to go face down in the vegetable oil.

I suspect that one of the reasons non-alcoholic fatty liver disease is reaching epidemic proportions worldwide is the ubiquitous substitution of vegetable oils for saturated fats every where.  When we were doing research for the book, I scoured the literature to find studies in which people with fatty liver disease were treated with diet and found only two such studies.  In both of them the fatty livers of the subjects reversed quickly – in just a matter of a few days – when the subjects went on low-carb diets.  I suspect that the increase in saturated fat helped things along markedly.  And, I suspect the unwarranted avoidance of saturated fats by our bamboozled fellow citizens is one of the reasons there is so much fatty liver disease.

If you prepare your food in your own kitchen, you control exactly what goes into it.  If you go out to eat, you lose that control.  I suspect most restaurants operate about like the very upscale one I just played chef in, and so if you go to even a nice restaurant, you’re going to be consuming stuff you would probably rather not consume.  In the old days (when I was a kid, for example), going out to eat was a big deal, and it almost never happened. Everything was prepared at home.  Now people eat out more than they eat at home.

According to the National Restaurant Association, more people are dining out than ever, even in tough economic times.  On a typical day, restaurant sales in the US average $1.6 billion. The average household spent $2,698 for restaurant food in 2008.  Forty percent of adults say that eating out or getting take-out food makes them more productive in their lives. The majority of adults – 78 percent – believe that dining out with family and friends is a better way to make use of their leisure time than cooking and cleaning up.

To the left is a graph from the USDA Economic Research Service showing the increase in the home budget dollar spent on food away from home.  It just about parallels the graph showing the development of the obesity epidemic.  I’m not necessarily making the case that eating out has caused the obesity epidemic, but I’m not sure it hasn’t played a significant role in it.  Especially now that I know what kind of oils restaurants use.

One of the statistics I read while researching for this post was that 73 percent of adults say they are trying to make more healthful choices at restaurants now than they did just two years ago.  Assuming this is true, it probably means they are ordering more salads, which seem to equate in everyone’s mind with a more healthful choice.  But if the dressings are made for the salad with the oils used in bulk in most restaurants, it’s probably not the best thing you can eat where your health is concerned.  But I always ask for my dressing on the side so that I can control how much I put on, you say?  That’s the big joke among chefs.  It’s been shown that when salads are tossed by the chef, much less dressing is used as compared to when people ask for it on the side and add it themselves.

The point of all this is that when you go out to eat, no matter how upscale the restaurant, you lose control over what goes in your mouth.  Short of bulling your way into the kitchen, you are clueless as to what oils are going into and onto your food.  If you eat out a lot, you are doubtless taking in a fair quantity of trans fats and oxidized fats and plain old omega-6 fats – all fats you can stand to do without.  The only way you maintain control is if you do the cooking yourself.  Plus, you’ll save a lot of money because it’s almost always less expensive to prepare it yourself.

One of the best things you can do for your health (and your pocketbook) is to spend more time in your own kitchen.

ADDENDUM:  Geez, one post later and I’ve already forgotten about the book list.

Since the last post, I’ve polished off Predictably Irrational, the Kate Atkinson novel and the Shenk book on genius.  I’m still working on the others.

I’ve added the following to my list:

I See Rude People by Amy Alkon.  The subtitle says it all: One woman’s battle to beat some manners into impolite society.  Amy is a friend of mine who writes an advice column, and I can tell you after spending a lot of time with her, that she is unfailingly polite and gracious herself to everyone she meets…except for boors.  I’ve dipped into her excellent book numerous times, but now I’m reading it from front to back.  I wish I had the gumption she does to confront the rude people I’m (we all are) confronted with daily.  With this book, I can do it vicariously.  An excellent read.

Naked by the Window by Robert Katz.  A book about the death (was is murder, suicide or accident?) of the diminutive Cuban artist Ana Mendieta, who plunged 34 stories to her death in 1985.

The Invention of Air by Steven Johnson.  I hope I love this book as much as I loved his The Ghost Map.

As I was thumbing through the weekend edition of the Financial Times (my favorite newspaper) on a lazy Sunday morning, my eye fell on a little boxed off squib titled Dr Mehmet Oz on the January Detox (scroll to bottom to see the piece).  If I ran across something like this in a local daily newspaper, I wouldn’t think much about it, but in the venerable Financial Times?  Since we all know how much good the wonderful Dr. Oz has done Oprah (as evidenced by the photo to the left – were I she, I certainly wouldn’t be toasting him), I decided to read it to see what he had to recommend on detoxing.  I wasn’t disappointed.  He lives up to his billing.

How does Dr. Oz recommend we detoxify our livers?  Let’s read and see.

I like a simple cleansing fast as an easy, inexpensive means of flushing out toxins and rebooting the system (a juice detox, say, which involves a short-term diet of raw vegetables, fruit juices and water). But it is important to remember that detoxifying the liver, the organ responsible for detoxing our bodies, would take a month of healthy living.

Brilliant!

Let me see if I get this straight.  You detoxify your liver by a fruit-juice fast, right?  Which means throwing back at least three or four glasses of fruit juice a day.  Okay, got it.

Sounds great.  But bit of critical thinking.

What happens to the liver to cause it to need detoxifying?  How about fat accumulation?  A fatty liver is one that needs detoxifying.  Fatty livers are way more common than you might expect.  Studies have shown that about a third of Americans are walking around with fatty livers, a disorder called non-alcoholic fatty liver disorder (NAFLD).  No one really knows what the long-term effects of this problem are going to be, but it is known that fatty accumulation in the liver can lead to an inflamed liver, which can then go on to develop cirrhosis and possibly even liver cancer.  Since this epidemic of NAFLD has arisen fairly recently, it’s unknown how it will play out over the long haul, but I doubt that it will be a good result.

So where does all this fat in the liver come from?  Most researchers think it comes from excess fructose consumption.  The pathways of the metabolism of fructose lead to fatty accumulation in the liver, and giving laboratory animals a lot of fructose gives them fatty livers.  If you couple this information with the fact that fructose consumption has skyrocketed over the last three decades, it makes sense that at least part of the NAFLD we’re seeing comes from too much fructose.

With these facts in mind, let’s take a closer look at Dr. Oz’s recommendation to undertake a juice fast to cleanse or detox the liver.

If you go on a juice fast, how much juice do you drink.  Three or four glasses a day, I would imagine.  And I would also guess that these would be decent sized glasses.  Most people don’t drink an eight ounce glass of anything.  Eight ounces is only a cup, which really isn’t all that much.  Even those little weenie juice boxes that parents put in their kid’s lunches are 8.45 ounces, and most glasses of juice that people drink are larger than that.  A regular-sized soft drink can contains 12 ounces, which is probably much closer to the size of a glass of juice most of us would drink, especially if we were on a juice fast.  Four glasses of juice – a not unreasonable amount to drink in a day if that’s all you’re drinking – would end up being 48 ounces of juice.

I went through the USDA database of foods looking for all the juices I could find that had fructose broken out from the total carbohydrate figure and tabulated them.  Take a look at the chart below which is total carbs and fructose in grams.  And remember that 100 grams equals a half a cup.  So when you see something listed at 111.6 grams of fructose, that means more than a half cup.

It should be clear from this chart that a fruit juice fast provides a whole lot of fructose and a whole lot of carbs.  The fructose is particularly problematic in that it encourages fat accumulation in the liver.  The amounts in 48 ounces of any of these fruit juices would be more than enough to stimulate the synthesis and storage of fat in the liver.

How Dr. Oz thinks this would detox the liver is beyond me.

One other note on his cleansing fast.  It’s not just fruit juices; it includes raw vegetables, too.  I assume Dr. Oz recommends the raw vegetables for all of the flavonoids, carotenoids, lycopenes and other phytonutrients.  I guess he never learned that most – if not all – of these nutrients are fat soluble.  Consuming raw vegetables and fruit juices without some fat along with them means you don’t absorb any of the nutrients.  Dr. Oz must have missed that day at medical school.

So, the actual result of his cleansing detox that is supposed to “flush out toxins [while] rebooting the system” is that more fat accumulates in the liver, insulin goes up thanks to all the carbs and you don’t even absorb the phytonutrients.  Sounds like just a hell of a deal to me.

Let’s spend just another moment looking at yet a different piece of idiocy in this small, small piece of writing.

Says Dr. Oz:

Caffeine throws off all the systems, so drink green tea, which has only a quarter of the caffeine of dark tea or coffee but packs a powerful energy punch.

Oh dear.  Where do we start?  Green tea has almost as much caffeine as coffee, not a quarter of the caffeine.  And, please tell me Dr. Oz, where do we get the “powerful energy punch” from green tea if it’s not from the caffeine?
No sooner had I finished reading the Financial Times Oz recommendations, which, by the way, struck me much more as a prescription from a witch doctor than from a trained physician, than MD pointed out that the same Dr. Oz was on the cover of the Sunday magazine that comes with our local paper.  Yep, USA Weekend features our friend expanding on his recommendations.

I’m not going to go through them all (you can read them here), but one did catch my attention:

Ditch extreme diets. People almost always fail to lose weight because they try diets that are too radical to stick with. For a lifestyle change to succeed, it must be sustainable. So instead of eliminating all foods that fit into a certain category or counting every calorie, try making changes that are less noticeable but no less significant. If you can eliminate just 100 calories from your daily intake, for example, you will lose about a pound per month. How hard is that?

This is a blatant attack on the low-carb diet without saying it in so many words.  And the notion that “if you can eliminate just 100 calories from you daily intake’” you will lose weight over time is the ultimate recommendation of someone who is clueless about the operation of the energy balance equation.

Pitiful.

I’m going to leave you with a poem that I believe is prophetic for Dr. Oz and his nutritionally-unsophisticated compadres.  Sooner or later science will out and these folks will be shown for the idiots they are, and they will be left as part of the detritus of the desert of faulty nutritional thinking.  Too bad they will leave a lot of corpses in their wake.

The poem by Shelley is titled, appropriately enough, Ozymandias

OZYMANDIAS

by Percy Bysshe Shelley

I met a traveller from an antique land
Who said: Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,
Half sunk, a shattered visage lies, whose frown
And wrinkled lip, and sneer of cold command
Tell that its sculptor well those passions read
Which yet survive, stamped on these lifeless things,
The hand that mocked them and the heart that fed.
And on the pedestal these words appear:
“My name is Ozymandias, king of kings:
Look on my works, ye Mighty, and despair!”
Nothing beside remains. Round the decay
Of that colossal wreck, boundless and bare
The lone and level sands stretch far away.

*Said by Great and Powerful Oz
in The Wizard of Oz

All of you commenters have done your job.  You’ve brought up several issues that I neglected to address in my last post.  Let me address them now.

First and foremost is the question about peri- and post-menopausal hormonal balance.  From long experience I can tell you that it is difficult for many women to lose weight in the peri- and post-menopausal years, especially the peri-menopausal years, without some hormonal balancing. It can be done, but it is more difficult.  MD keeps promising to post on the subject in detail, but right now she’s up to her eyes in another couple of projects that are consuming most of her time.  That time not consumed by her projects is consumed by little ole me, who needs his fair share.

There is a book on balancing hormones that I feel is the best one of the bunch out there right now.  It is by an acquaintance of mine, whom I run into at medical meetings all over the place.  His name is Uzzi Reiss, M.D, and he is the gyn doc to the stars.  I’m not kidding.  He probably takes care of half the peri- and post-menopausal Hollywood crowd.  He has an enormously busy practice.  I pushed him to write a book early on, but he deferred saying that he couldn’t afford the time away from his practice.  But he finally did come out with one.  It was published about 7 or 8 years ago, and so isn’t completely up to date, but, as I said, I think it’s the best of the bunch out there, written by someone who certainly knows what he’s doing.

At the time he wrote this book, he was using Tri-Est, which is a blend of all three forms of estrogen found in the normal female.  MD prefers more estradiol than found in Tri-Est for weight loss purposes; in fact, she, herself, uses only estradiol.  At the time Dr. Reiss’s book was written compounding pharmacies weren’t as common as they are today, so it wasn’t as easy to get estrogen compounded so specifically.  I think for those of you interested, Dr. Reiss’s book will give you a lot of information to get you started on your own quest.  Many women – MD included – started out on Tri-Est and starting fiddling from there.  The most important thing is to work with a physician who knows what he/she is doing to get your hormones working for you instead of against you.

Another subject I left off is sleep.  Numerous studies have shown that more good quality sleep will help with weight loss.  As we age, it becomes more and more difficult to get good quality sleep.  Often regaining the formerly lost weight brings on acid reflux and GERD, which tend to cause awakening in the middle of the night.  And once we get going again on a low-carb diet, we usually get into a little ketosis, which makes falling asleep a little more difficult yet.  There are a few things to be done.  First, the low-carb diet – even the second time around – typically gets rid of the reflux and GERD pretty quickly.  (I’ve got another post that I’ll probably put up next week about a supplement that will knock reflux on its head quickly.)  You can help with falling asleep, which is what most people are troubled with, by doing a couple of things.  First, get some low-dose sublingual melatonin tabs.  These you can dissolve under your tongue as you turn in.  It’s important that you take the melatonin right before you turn out all the lights – don’t take it and stay up and watch TV or read.  You want the room to be dark.  The pineal gland releases melatonin as a response to darkness, and its function is to help you get to sleep.  It has antioxidant properties, along with many other functions, but you will be taking it to sleep.  There is a fall off in melatonin release by the pituitary with aging, which is one of the reasons people have more difficulty sleeping as they get older.  So, try the melatonin if you’re having trouble.   The other thing you can do is to have a cup of herbal tea right before bedtime.  And sweeten the tea with either sugar or honey.  That’s right.  Real sugar.  A teaspoon of sugar is about 5 grams of carb, which won’t do a lot to hinder your weight loss, but it will be enough to shut down ketone production long enough to get you to sleep.  And if you think a teaspoon of sugar isn’t all that much, remember, it’s the total amount circulating in your blood if you have a normal blood sugar.

Another reason people have difficulty losing as they get older is that their livers don’t function as well.  As we get older we tend to have more aches and pains, and we take more Tylenol and Advil and similar OTC medications for them.  These drugs are metabolized in the liver, and, consequently, they consume some of the liver’s capacity.  Same goes for coffee.  No one likes coffee more than I.  But when I want to pick up my weight loss after I’ve gone off the wagon for a while, I cut back on my coffee.  Why?  Because caffeine is metabolized in the liver just like the above drugs.  It also consumes some of the liver’s capacity.  I switch to decaf for a few days whenever I’m getting back on the straight and narrow.  If you can’t stomach the thought of decaf coffee (and I don’t like it, myself) drink decaf Cafe Americano.  (Here is a YouTube on how to make an Americano starring yours truly.)  There is not as much difference (at least to my palate) between decaf and regular espresso than there is between decaf and regular coffee.  Finally, as we age, we tend to drink more.  Most people drink like fish during college, then slack off.  They start to pick it back up (never to college levels, though, thank God) as they drift into middle age.  Alcohol is detoxified in the liver just like caffeine and OTC pain relievers.  All these things add up to put quite a load on the liver.  And if you’ve regainded weight, you’ve probably got some fatty accumulation in your liver and it’s not working at peak levels anyway.  All these added substances that compromise the liver even more don’t help.

Insulin stays in the circulation because it is put there by the pancreas and because it isn’t metabolized in the liver.  A liver that isn’t functioning up to snuff won’t break down insulin as rapidly as it should.  Consequently, higher levels of insulin mean more difficulty in losing weight.  Plus, since the liver is the major organ involved in the entire metabolic process, it works a whole lot better to stabilize everything when it is unhindered by having to detoxify a lot of unnecessary stuff.  Which is why you need to baby your liver when you restart your low-carb diet.

I’m sure I’ve still forgotten some other factors, and I’m sure you all will remind me.  I think I’ve got some of the smartest readers in the blogosphere.  Thanks for chiming in.

As I was flying back from France a few days ago I had one of those experiences touchy, feely types call synchronicity. I was reading the International Herald Tribune and came upon an article entitled “The ethical calculus of foie gras” about the ongoing battle between animal rights activists and foie gras producers, and how they were both, strangely enough, working together. Legislators with the help of foie gras producers are drafting a bill that would basically put these same producers out of business in 2016. The activists are signing on, figuring that 2016 will ultimately arrive and the producers will be finis. The producers are signing on because such a bill will give them breathing room to move their business somewhere more simpatico without a lot of hassle in the intervening years.

I have never seen ducks force fed, and had always imagined it to be pretty brutal, so I was interested to read the following:

To animal welfare groups, the obscenity of force-feeding, known by the French word “gavage,” is self-evident. But Ginor and his partner Izzy Yanay, who runs the farm, accuse their critics of anthropomorphism and ignorance of duck anatomy and behavior. They say the practice is as benign as it is ancient, since waterfowl lack a gag reflex and have sturdy throats that easily tolerate grains, grit, stones and inflexible gavage tubes. To understand gavage, they say, is to accept it – as they insist poultry researchers have, after examining birds for signs of undue suffering during gavage and finding none.

I visited Hudson Valley Foie Gras recently, seeing gavage for the first time. I saw no pain or panic in Yanay’s ducks, no quacking or frenzied flapping in the cool, dimly lighted open pens where a young woman with a gavage funnel did her work. The birds submitted matter-of-factly to a 15-inch tube inserted down the throat for about three seconds, delivering about a cup of corn pellets.

The practice, done three times a day, for a month, followed by slaughter, seemed neither gentle nor particularly rough. It was unnerving to see the tube going down, and late-stage ducks waddling bulkily in their pens, but no more so than watching the epic gorging at an all-you-can-eat buffet, where morbid obesity is achieved voluntarily with knife and fork. (my italics)

The synchronicity of all this came when just as I was reading the last words of the article, the flight attendant put before me a plate of – you guessed it – foie gras. (It was Air France, after all) I’ve had foie gras a few times before, and I can take it or leave it. But, admittedly, I ate this batch with a little more interest.

When I looked closely at the piece of almost solid fat before me, I reflected on the author’s comment about how humans can make their own livers foie gras-like with knife and fork. He’s absolutely right. I’ve taken care of many, many overweight patients who had fatty livers, and, in fact, fatty liver is becoming a major health problem.

People who consume too much alcohol over too long a time period develop first a fatty infiltration of their liver cells, then inflammation that progresses to fibrosis, then ultimately, if the drinking doesn’t stop, to cirrhosis and possibly even liver cancer. This same exact progression takes place in the livers of many people who are overweight and/or insulin resistant. It is indistinguishable from the alcoholic variety, and is diagnosed only by the fact that the patient doesn’t drink to excess. The disorder is called non-acoholic fatty liver disorder (NAFLD) and is widespread. How widespread? A recent study in the American Journal of Physiology determined that 33.6% of subjects from an ethnically diverse population in Dallas County (Texas) had fatty infiltrations of their livers to a significant degree. Thats one third of the people!

I can across a report of an even more alarming statistic. Jeffrey Schwimmer, MD, a pediatrician and director of the fatty liver clinic at Children’s Hospital and Health Center in San Diego presented data at a Digestive Disease meeting in New Orleans earlier this year that is truly frightening. In an autopsy study of 238 children ages 9-19 from the San Diego area, 17% were found to have fatty livers. Among obese children, the statistics were even more dreadful: 45% had NAFLD. As Dr. Schwimmer noted, based on those statistics and with an estimated 9 million obese children in the US today, “that’s a lot of kids walking around with liver disease that no on knows about.”

How is it treated? In my opinion it is treated most effectively with a low-carb diet. My wife and I have both treated many hundreds of patients with NAFLD with a low-carb diet. And we’re not the only ones who believe in this kind of nutritional therapy. A study was published late last year by researchers from Johns Hopkins University in Digestive Diseases and Sciences who concluded:

There were no significant associations between either total caloric intake or protein intake and either steatosis [fatty infiltration], fibrosis, or inflammation. However, higher CHO [carbohydrate] intake was associated with significantly higher odds of inflammation, while higher fat intake was associated with significantly lower odds of inflammation. In conclusion, present dietary recommendations may worsen NAFLD histopathology.

So there you have it. As you’re pondering all this, remember, they don’t gavage the ducks with steak, eggs, and ham – they gavage them with GRAIN, that wholesome stuff that most of the brain-dead nutritional advisers recommend you eat a half dozen times a day (the ducks only get it three times per day, and look at their livers). So, to avoid having the fate of the gavaged ducks befall you, avoid grains and other high carb fare and eat your steak and eggs. Or even eat your foie gras, just don’t become it.