January 18

More thoughts on why low-carb the second time around


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.

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  1. This is the first time I’ve done low carb, so I can’t really say it’s been more difficult for me. I have noticed that losing weight seems to be more difficult if you’ve yo yo’d on ANY previous plan, though, regardless of whether it is low carb or not. Have others found this to be true? That’s definitely been the case for me. I’ve gone up and down 30 pounds about 5 times in 15 years, mostly on Weight Watcher’s (a real nightmare of a plan, IMO). That makes it somewhat difficult. Part of it could be getting older, but I think my body has a “memory” of the previous dieting experiences.
    However, I’ve lost on low carb pretty effortlessly, I’ve got to say, even with this previous history of a lack of success. I kept carbs at around 8% of daily caloric intake for months. Being small and only eating around 1500 calories daily, I found that it was too tiresome. I lost 7.5 pounds pretty quickly but then just maintained. I suspect if I’d just cut out nuts, cream and cheese I would have continued to lose slowly. I decided on a different course. I’ve upped carbs to around 15% daily and incorporated intermittent fasting (without cheating on low carb) twice weekly, and brief high intensity workouts a few hours before breaking a fast. I dropped 7.5 lbs. recently this way for a total of 15.
    It’s important, though, that my diet is still pretty low carb. I don’t use the IF mechanism to cheat on the diet, unless you call drinking milk and eating fruit now and then cheating. 🙂 You could pretty much still call this a low carb diet, it’s just not uber-low carb. The most carbohydrate I usually have in a given day is a glass of milk and possibly some fruit or nuts, along with a salad and whatever trace amounts are in eggs or meat. At most, 60 grams. Usually less than that. I suspect I could have continued to lose weight on an all meat and egg diet, but it was getting too boring. So I’ve made a trade-off between doing relatively low carb (around 15% of daily intake in calories) 5 days weekly and enjoying things like cheese, nuts, and cream. This makes intermittent fasting a breeze. I get the benefit of slightly expanded foods on my eating days (I no longer avoid fruit like the plague) but I seem to be dropping weight faster now. I barely get hungry over the first 18 hours of the fast. (Of course, if I upped carbohydrate intake more I think I’d have a much more difficult time fasting because of the blood sugar issue. When I was on Weight Watchers, which is necessarily a moderate to high carb diet, I was always hungry. It was awful.) I think I’ve finally reached an eating plan I’ll be comfortable with for life. I don’t feel at all deprived eating these foods and have had little desire for any kind of junk over the past 6 months. 15 pounds down, roughly 20? more to go. It’s exciting.
    I sometimes follow the same kind of plan. If I’m attending some event or doing something where I know I’ll probably indulge in some carbs, I simply skip a few meals. Or don’t eat all day before, then follow rigid low-carb the next day. One can be pretty flexible.

  2. Can you explain more about why the liver needs to be functioning well for weight loss?
    Also is your basic recommendation to nix the caffeine until you reach weight loss goals? I could do that but never realized I needed to.
    The liver is the primary organ involved in metabolism. In order to lose weight successfully, you need to have a liver that is running on all cylinders. I recommend that people nix the caffeine for just a couple of weeks, which will give the liver time to repair itself.

  3. Never a drop of alcohol. Never a drop of coffee. Have always been medication shy (even natural childbirth five times!). But apparently plenty of fatty accumulation in the liver. Maybe it was the decade of low-fat/low protein with plenty of vegetable oils that did it. Anyway, how does one “baby your liver when you restart your low-carb diet”?
    By avoiding vegetable oils, sugar and high levels of carbs.

  4. Dr. Eades, are you familiar with the benign physiological insulin resistance that supposedly develops in LC eaters? Do you think it’s possible that this phenomenon could contribute to the long-term deceleration of weight loss on LC diets?
    (The link goes to Hyperlipid, which I’ve found to be a truly excellent source for information on diet research.)
    I’m aware of the idea of physiological insulin resistance. I’m not sure I believe it exists or is widespread.

  5. Thinking of that natural childbirth five times…between pregnancy and nursing that meant close to ten years of religiously taking pre-natal vitamins. Looking back on it I wish I had taken fish oil and a good liquid polyphenol supplement and skipped the vitamins. I’m thinking of encouraging my three daughters to take that route. Am I crazy?
    I would probably take the pre-natal vitamins AND the fish oil. And follow a good quality diet.

  6. I think there is something in this question of second time around weight lose difficulties. It’s real phenomenon I’ve witnessed it with my own eyes. There is something different after you have lost lot of weight first time on low carb. Only thing I’ve figured out is related to type of fat in the body after years of low fat dieting (weight watchers etc) vs. high fat (low carb) dieting. I think that after low fat diet person has lot of visceral fat that gives a super boost start for the first time; body has to compensate enormous FFA flow to the liver by accelerating ketoproduction. This leads to increased lipolysis control by ketones and triglycerides will go down and weight lose is quite rapid.
    On second time persons ability to burn excess fat isn’t so much damaged as was situation after years low fat low cal dieting. Control of lipolysis is more easily maintained with ketogenesis and insulin. There isn’t that much visceral fat?!
    I think best way to test if this is true is to give a FFA shock to body with a very high fat low carb and even low proteins. Medium chain fatty acids/triglyserides might help because they are water soluble and increase directly liver ketogenesis and fatty acid oxidation.
    So, I think second time difficulties might be related to different metabolic state after years of low fat/low protein vs. high fat/moderate carb dieting.

  7. Hi Dr Mike,
    Was going to post on this earlier, but the weekend was extremely busy, so the opportunity slipped me by. The following saga/rant might come out too long. (As Rudolfo says in Act 1 of La Boheme: “La Brevita gran’ preggio!”)
    I had the strange experience of going on Low Carb a second time the first time round. Let me explain.
    I used to work for Aussie’s largest Telco, in a software development section and, while partially privatised, there was still a bit of a public service “attitude” especially when it came to long Friday lunches. Our offices were strategically located between between the twin foodie axes of Sydney’s Chinatown and Darlinghurst. So most Fridays we would do our ordained lunch. We were a very ethnically diverse lot: one Malaysian guy had spent a lot of time in the South of France, so he was our sommelier. We had the usual smattering of Indians, Iraqis, Afghans, Egyptians*, Anglos, Chinese, etc., etc. One of the Chinese guys was actually a relative of mine through marriage. Our food choices were amazing: Yum Cha (aka “Dim Sum”), French Provincial, Belgium (with the real authentic Belgium beer on tap), great Thai cooked on the spot to perfection in a pub’s beer garden (washed down with Coopers Draft on tap, the meisterbier of Australia), a steak house with a genuine non-PC cigar room, the list goes on and on. When you eat out in our fair city, you can do really well. Bourdain loves the place.
    Where was I? Well, all this good life, plus the wife’s love of pasta, packed on the pounds, yada yada. Then I started passing kidney stones and let me tell you, that’s an experience to be missed at all cost. So then I stumbled upon G. Taubes’ “What If It Had Been a Big Fat Lie”. The Answer! So I started on Atkins (sorry) and did really well for 10 days. Then it struck again: another stone, in the middle of the night.
    For my reaction, you’ve got to remember that the climate of fear was even worse in those days (4 years ago) than today. Even Atkins was cautious or coy about how long you could stay on induction without shriveling up and dying — no more than 2 to 6 months as I recall. Anyway, here I was in intense pain (an understatement) and it was all that damn diet’s fault! I ate a lot of grapes to get out of that evil ketosis and drove myself to the local Emergency Room of Mona Vale Hospital.
    To be brief, the doctor who saw me, a lovely Asian guy, asked me how I was doing on Atkins, and did I have any energy, and so forth. And I said that besides this damn stone, I was feeling great and that me and the Mrs had been having a great time, nudge, nudge, wink, wink, say no more, say no more.
    So he gave me his opinion that I should stick with the low carb, given my history (I’d had a MRI a month or two before showing a liver that was almost completely infiltrated by fatty stuff except for two small loci). So I did. See, not all doctors were hostile, even then.
    But do you know that the rate of weight loss was never the same after I’d pulled on the ketosis brake in my panic. I know that the initial weight loss is always greater than that experienced after a month or two; but I had seriously crippled my chances of a quick transformation to the body beautiful.
    Four years it’s taken to get to my present 85 kg. Just a few more to go: 5 or 10. But I wish I hadn’t originally lost my nerve.
    Another point: it seems that I’m extremely sensitive to Balsamic Vinegar. But everyone here loves sloshing the stuff onto salads by the bucket load. For example I had a meal at my sister-in-law’s place last night and had an acrimonious row with her because, although I’ve said this I don’t know how many times until blue in the face (actually I was red in the face after a great day at the beach), that I can’t eat her salads if they have the dreaded B Vinegar. If I do, I put on a kilo (2.2 lbs) by the time I weigh myself that night and that my weightloss is stalled for a week. I was now definitely in a dynamic phase, and frankly I don’t want her stupidity to eff this up. She took it as a personal affront and I was pretty emotional as I want to get rid of the last excess weight. Can Balsamic (at roughly 15 g of carb per 100 ml, though some are more) be THAT detrimental?
    But it seems to be so in my case. I ranted and raved, but it worked and that night I was 0.2 kg down instead of 1 kg up. (Sorry, but I have lived with metric most of my life and converting to avoirdupois is too much of a pain for me.)
    “Una fermata! Zitto!”
    Michael Richards
    * I can’t resist a bad joke: we actually had two Egyptian Copts. We used to call them “the good Copt and the bad Copt.” 🙂
    Thanks for the interesting dietary history. I’ve never heard of anyone having a problem with balsamic vinegar (thank God I don’t because I love it), but people do have idiosyncratic reactions to common things all the time. It sounds like it is something to be avoided in your case. And I don’t think it’s because of the tiny amount of carb involved. Seems strange that you could have such a reaction, but
    credo quia absurdum est.
    Inquiring minds want to know, were the two Egyptians really Coptics or were they Muslim?

  8. I guess I am still unclear about why caffeine slows metabolism/weight loss/affects the liver. I drink all my black coffee (no cream or half and half) first thing in the morning about two hours before breakfast and then none at all for the rest of the day. A life long pattern. No diet colas or any other source of caffeine.
    By the time I begin eating, my liver should have processed all the caffeine, shouldn’t it? Since I don’t ingest any more caffeine during the day, why would my early morning “fix” affect the rest of the day? Or does it?
    So I guess I am not clear as to whether you are referring to caffeine ingested throughout the day or caffeine ingested only once a day in the morning. Would you please clarify?
    A cup in the morning probably doesn’t cause a lot of problems. And it is the caffeine, not the cream or half and half.
    Coffee is a beneficial substance that I highly recommend. You can put coffee in the search function of this blog and see how much I favor coffee. But it does have caffeine, which is normally not a problem. But caffeine does occupy the livers capacity to detoxify. If you avoid it in the early days while the liver is getting back to normal, you can pick it up again in a week or two.

  9. Dr. Eades,
    Have you (and MD) considered the value of Estriol (E3) in the bioidentical HRT regimens? E3 has a great safety profile, cancer protection and, I believe, heart protection. Dr. Cheryle Hart MD (Mayo-trained OB GYN, author of 2 books) now advises a higher proportion E3 to E2 compounded gels for her patients (one of whom is my patient and doing well on it).
    Thank you so much for your posts and new book! I’m looking forward to reading it soon… Uzzi Reiss as you mentioned is a practitioner and pioneer for female and health and well-being; my sister recently sent me his book for resolving my own hormone Mirena-induced iatrogenic issues. Can you smell frustration? Fortunately, it’s improving quickly 🙂
    Dr. Reiss reminds me of you and MD — opening people’s minds and lives to optimal health, vitality and longevity! And the science and stories that back it up! How our hormones, body and mind/mood work is explained very well by him.
    I appreciate everything you are trying to accomplish with the USDA. Our future generations will appreciate it too. I can’t tell you how difficult I find it to withhold wheat/whole grains, high carb foods from our children when they are at their after school care or other places out of my ‘reign’… their teachers (always obese) will always say ‘but whole grains are healthy *smile*!’ I tell them we have autoimmunity in our family (Grave’s, Hashimoto’s, NS, etc) and we cannot tolerate wheat/grains for our short- or long-term health… Inevitably I get the…
    *blank stare*
    Keep up the strong work and I wish you unflailing faith and punky perserverance!! I’ll be with you the WHOLE way…
    PS Once you mentioned the software to keep your mad icons/journal refs organized? I need something to keep my head straight! thanx!
    Estriol is the form of estrogen made primarily during pregnancy. For that reason, I’ve been reluctant to give it as a major part of a bio-identical regimen.
    I’m glad you’re doing better with Dr. Reiss’s book. I may give him a call to see if he has any updated information.

  10. What level of alcohol consumption becomes a problem for the aging liver?
    It varies with the individual. But I like to cut it to zilch when getting started back until the liver rejuvenates, then progress slowly from there.

  11. no coffee?? no booze?? you’re a real buzz kill, doc!
    I’m only a temporary buzz kill. Believe me, no one loves his coffee and his Jameson more than I, but even I give my liver a break from time to time. In fact, I’m giving it one this week.

  12. Dr. Eades,
    This may be a bit off topic… but it’s fascinating that this article, Carb addition blamed for bigger waistlines, appeared on the front page of our paper this morning (Edmonton is a city with a population of about 1 million, and this appeared in the major daily, the Edmonton Journal).
    While the article leaves what I believe is the most important point (about carbs driving up insulin production and insulin being responsible for fat storage) to a brief mention at the very end of the article, and it concentrates its discussion around the glycemic index and addiction, it is heartening to see something like this hitting mainstream media (front and center) pushing the idea that carbs may be responsible for the North American obesity epidemic.
    We put a summary of the article on our website.
    Keep up the great work… look forward with great anticipation to your posts!
    Someone else sent me this link from a newspaper in another Canadian city. Maybe there has been an unreported outbreak of good sense in the Canadian media.

  13. 1. Any tips on how to find a Dr. who is amenable to or conversant in bio-identical hormones? Secret handshake? Red lights in the window? Maybe a bat sign reflected against the clouds? My gyn. of years is deeply conventional and refuses to even test hormone levels, saying simply that all women my age should be taking Premarin. He roles his eyes at words like “bio-identical.”
    2. Any thoughts on the use of milk thistle or other supplement to support liver health in addition to avoiding caffeine and alcohol?
    3. Is there any evidence that a zero-carb libation, like good whiskey, is more or less compatible with low-carbing than dry wine? (Always acknowledging that whiskey is NOT enjoyed by the tumbler full.)
    Probably the best way to find a good doc is to find a compounding pharmacy in your area and ask the pharmacist for a recommendation.
    Milk thistle is good, but I prefer alpha-lipoic acid, which can always be taken along with milk thistle, providing the benefits of both.
    A little good whiskey is probably about the same as dry wine, assuming the amounts are about the same.

  14. Hi Dr Eades,
    Just wondered what you thought of natural progesterone – Dr John Lee proposed that it is progesterone that women are often short of and to that end he recommended natural progesterone cream (not a progestin) http://johnleemd.com/
    When I was still menstruating I always used to get migraine headaches just before a period – I don’t mean a headache so much as concentric geometric patterns of light swirling in my vision which, as they faded, turned into a headache. I read about natural progesterone and asked my doctor to prescribe it for me as nothing else helped. The natural progesterone cream worked ! And I sailed through the menopause, had just a couple of hot flushes that lasted all of a minute each and were fine. I have no weight problems….I’m slim at 55…also low carb Paleo for two years now, but I never put on weight during or after the menopause even though I didn’t eat low carb Paleo then. I’ve carried on with the natural progesterone cream….now been using it for over ten years 🙂
    I absolutely agree about the natural progesterones.

  15. Watch the fructose for liver- loving too!
    Absolutely. The combination of vegetable oils and fructose is deadly for the liver.

  16. I read the article on HyperLipid, but I’m not sure I got it all. It probably doesn’t matter, though.
    He speaks of an increase in blood glucose to 5.something, from 4.6 when he started. I realize that I usually have 5.7 or thereabouts, maybe a few decimals lower before breakfast. But I remember during my maternity (on a garbage diet) that I usually had vey low blood glucose, 3.8 or so, and now I’m thinking why?
    Could it be that I usually had a too strong insulin response to the carbs I ate (which I guess many of us nibbling, pear-shaped carb addicts are) so that it went too low. I’m also surprised that he thinks 5.7 is high. I thought 7.5 and stuff was high. I’m never up there, not even after any major fallong off the wagon…
    Can you tell us what in your opinion (which might be stricter than the general medical establishment’s) is a normal, good blood glucose value? Does it ideally differ as much as the “normal” range suggests. Or are they just being lenient?
    I like to see fasting blood glucose levels between 60-80. But they can be higher than 80 without getting me excited. But the 60-80 range is optimal, I think.

  17. Your comments about peri and menopause are interesting. I lost 50 pounds low-carbing pretty easily when I started five years ago, but then it stopped. Apparently, menopause was starting. The weight wouldn’t budge, although I continued with my WOL. I found a great doctor who put me on bio-identical hormones and everything is well balanced now. My thyroid needed a little tweak as well, and I’m on Armour, too. I was disappointed that it really didn’t make much difference to my weight, but I keep trying and hoping it’ll eventually start to drop. (Actually, it did drop a little after the last increase in the dose of Armour.)
    I’m curious to know what the difference between Tri-Est and Bi-Est is. I’ve been using Bi-Est. Perhaps you know?
    Tri-Est contains all three estrogens whereas Bi-Est contains only two, estriol and estradiol. Of the two, I prefer Bi-Est.

  18. De. Eades,
    Would you comment some more on the role of coffee and liver function? What exactly does the liver have to do with coffee that impairs the liver’s ability to function? I take it decaf is not as hard on the liver??
    Caffeine is a toxin,but a fairly harmless toxin because the liver does such a good job in breaking it down. The liver has a finite capacity to do the work it does, and if your are trying to free up all the liver’s energy to help process fat and get rid of its own fat, you don’t want part of its energy consumed in the breakdown of caffeine. The liver regenerates pretty quickly, so one doesn’t have to give up coffee forever, just for a bit so that the liver can devote all of its efforts elsewhere. Most people when young can drink coffee all day long and have a cup after dinner without much negative effect. They can get to sleep easily at bedtime because their livers are young and undamaged, so they can metabolize and detoxify the caffeine quickly. As people age, they typically find that they can’t drink coffee late in the day without having difficulty sleeping. This happens because the liver in its aged, damaged state can’t metabolize the caffeine as quickly as before, so the caffeine continues to circulate in the blood and acts as a stimulant impairing sleep.

  19. I dunno…I’m almost done with my 72 week course of treatment for hepatitis c, and my hepatologist has encouraged me to consume oodles of black coffee as its beneficial effects on liver function are well known, esp. in those whose livers are less than perfect…for example:
    There is much more in coffee than caffeine, and I suspect that one or more of these many other components are protective against liver damage. The caffeine doesn’t damage the liver, it simply occupies its work capacity. That’s why decaf is probably the best bet for a week or two while the liver is regenerating. You get the valuable parts of the coffee without the liver-detox-occupying part.

  20. I just got a notice from Amazon that the Middle-aged Middle book has been delayed til Fall. SAY IT ISN’T SO!
    It is so, and I am mightily pissed off. But, there is nothing I can do. I’ll post later on what happened and why. But I can tell you right now that it had nothing to do with the book not being turned in on time – it was. And we pushed hard to keep it in March, but the change of dates was a publisher’s decision.

  21. To “shutchings” above: you may want to try a different kind of vitamin (I assume you’re taking the typical, readily available, OTC-type stuff). There is a company called Standard Process which has been making whole food supplements for quite a while. They do not use synthesized vitamins (which can be toxic, according to the Weston A. Price foundation) but naturally-derived substances containing the real thing. You have to get them through a licensed naturopath or chiropractor, however. I recommend doing some research on the alternative health care in your area, and also looking at the Weston A Price website. http://www.westonaprice.org/. Just to warn you, they are not entirely orthodox regarding carbs, but they have excellent information anyway. Whole food supplements (and whole foods!) and cod liver oil are the best. Take those and you can definitely skip your run-of-the-mill prenatals.

  22. Hi Mike,
    Christian Copts. Angela and I went to one of their weddings to a Chinese girl in a Catholic Church with the Patriarch also present.
    Christian Copts?!?!?! There’s one for the Department of Redundancy Department. 🙂 Are there any other Copts other than Christian ones? I thought that was the definition.

  23. I would love to know if Dr. Reiss has updated his recommendations, please ask him! I read his book a few years ago, and it was a revelation to a seriously hormonally deprived perimenopausal woman (whose doctors told her everything tested “normal”, I was just getting older)! Finding someone who prescribed compounded hormones was a real challenge, but persistence definitely pays.
    I was, however, put off by Dr. Reiss’ then-recommendation of tri-est… about the last thing an overweight, perimenopausal woman needs is more estrone… at least that’s what my reading and common sense told me.
    I eventually found a great ob-gyn who not only was willing to replenish hormones via compounded bi-estrogen (estradiol and estriol), but also diagnosed and treated my hypothyroidism with Armour thyroid. Persistence pays, but it took me upsetting and demoralizing visits to about 10 negative and uninformed docs before I found the gem of a doc I have now, and was able to reclaim my health.
    I am still working on the weight put on during those horrible perimenopausal years, however the almost 50 gone thus far is a great thing. Low carb has certainly helped!
    Thanks for your interesting and insightful blog!
    I just put in a call to Dr. Reiss. I’ll ask him when he calls me back. I agree with you about the estrone.

  24. Saw somewhere that just a few bites of banana can help a lot with GERD (which badly reactivated from any type and any dose of Metformin, the one really good oral diabetic medication. But not for me. I eat very few fruits, but figured whether for real or as a placebo a quarter to a third of a banana wouldn’t hurt me. They are cheap, and I always loved them. My nightly dose seems to do a lot of good. I got up the middle of one night with an attack coming on, and had an extra quarter of a banana and it stopped it.
    Interesting. I’ve never heard of this as a treatment. I wonder if you have GERD or an esophageal spasm. They sometimes have the same symptoms. Esophageal spasms often respond to potassium and bananas contain a fair amount of potassium. Just a thought.

    1. How much potassium to try to relieve esophageal spasm (felt as pain in center chest bone — and seemed to be caused by ibuprofen and possibly wheat)?

  25. Can’t I be redundant redundant? The Coptic Church is the oldest surviving Christian community. But after sending that second email, an even more amazing coincidence struck me. The father of Michael, the guy who married Ying, used to be on the Sydney St Patrick’s Day organising committee, as was my wife’s uncle Norman and Rabbi Brasch, the guy who barmitzvah’ed me. (In case you ask the obvious, Rabbi Brasch used to be the Rabbi of Dublin Synagogue. He used to keep June 16th — Bloomsday — like a High Holyday! I think the idea was to have an excuse to visit 8 pubs in a single day.)
    Did all three members serve at the same time? Good chance, actually. A (Christian) Copt on the St Patrick’s committee? No, I don’t know why either! But that’s the Australian way — inclusiveness.
    That’s my lot,
    Michael Richards
    Bloomsday has got to be a great holiday for a Rabbi in Dublin. You’ve got Leopold Bloom (a Jew, although a secular one) and Dublin and drinking and reading…what more could a Rabbi want (maybe not a trip to Duglaz the pork butcher, but, hey, you can’t have everything). I don’t know if you’ve ever read Ulysses, but working through it on my own at an advanced age was the single best literary experience of my life. There is almost never a day that goes by during which I don’t think about something in that book. I had a great experience at a Renaissance Weekend a couple of years ago. We had one night off (all the rest of the nights dinner was a part of the deal), and on our way out to eat, one of the other participants asked MD and me if we wanted to go to dinner with him and his wife. We said, sure, so off we all went. During dinner we discussed what we did – he was a lit professor at Dartmouth. He ran through a list of writers he taught, and Joyce was among them. When MD told him I had worked my way through Ulysses as a non-student and loved it, he lit up and announced that he lectured far and wide on Ulysses, which was his great literary love. We spent the rest of the dinner discussing various points with his quoting long sections verbatim. As it turned out, he is one of the famous professors in a recorded lecture series that is sold here in the states in full page ads in all the major papers. He sent me his whole set of CDs of his Ulysses lectures, which made what I had read even better. It was one of those great meetings that we all stumble into from time to time. Sorry to drone on about it, but your mention of Bloomsday fired me up.

  26. When people give me blank stares when I tell them I don’t do wheat/grains, I just tell them I’m allergic to them (true, I think, I get lower GI symptoms from them).
    Since they don’t want to cart me to the ER after a reaction, they generally leave me alone about it.
    This exactly what I advise people to do.

  27. Now you tell me – after you got me hooked on espresso and Jameson. 🙂
    You only have to hold off briefly. When you go back it’s like the renewed vigor you experience after you’ve been away from your wife or girlfriend for awhile.

  28. Off topic, but I’m so excited!…
    Hey Doc… I just saw an ad on TV for iHop’s All-You-Can-Eat pancake promotion!
    Thought you’d like to know. ;-P
    Thanks for the heads up. Thank God there’s not one near my house.

  29. Hi Doc,
    Must read Joyce again. Haven’t for thirty or forty years. Yikes! Loved the Molly Bloom chapter (the last) because it just tumbles off the page without any punctuation. Am replying again as am in an idle phase at work at the moment because I’m getting a new laptop configured and it takes forever. Like all day! At this rate I’ll just have to hit the pool for another 20 laps freestyle to stave off boredom.
    P.S. Ever get to listen to VW’s 5th? I just love that work to bits.
    Never really listed to the 5th, but I’m going to get my fill of his Sea Symphony next year as my bride’s group is performing it with her group and orchestra. Right now she is up to her eyes in preparing for Verdi’s requiem, which her group is performing in a couple of months.

  30. (Written on new laptop!)
    The Sea Symphony is a very early work and not characteristic of his mature style (of which I’m a huge fan). The slow movements are rewarding, big time. The Bride’s choir will really have to put in the hard yards for the Scherzo as it’s hellish difficult. But if they pull it off, what a triumph! I wish them all the best. Hint: study Sir Adrian Boult’s recording.
    I passed along the info. Thanks.

  31. Oh no! Now people will think I’m lying about my actual diagnosed wheat allergy. 😉
    Only your blog doctor knows for sure.

  32. Hi Doc,
    I’m off on (yet) another tangent: You’ve probably seen this, but in case you haven’t …
    I’m not sure I completely understand it. Worth a blog post?
    I pulled this paper a couple of months ago when it first came out. It is extremely interesting, but very technical. I’ve thought about posting on it, but don’t know if I can convert the techno speak to blog speak easily. The article you linked to sums it up okay. The study shows that people on a low-carb diet get most of their sugar from gluconeogenesis, which didn’t really surprise anyone. What was kind of a surprise, though, was that the glycerol that comes from fat breakdown didn’t add a lot to the amount of sugar produced, even on the low-carb diet. The other thing demonstrated was a metabolic advantage to the low-carb diet.

  33. Is having a tachycardia attack every time I eat a lot of chocolate or drink a cup of coffee considered an allergic reaction?
    It’s doubtful, but how could I say for sure without examining you? Could be that you just have a sensitivity to caffeine.

  34. Hi Dr. does it have to be drip decaf coffee or is instant decaf alright for the benefits?
    Either is okay. Decaf espresso is the best of all.

  35. Dr. Eades,
    I was able to lose more weight after menopause than before. The key was counting carbs very carefully (45-55 optimal) logging food, measuring portions, and recognizing that calories counted, too.
    One warning Tri-Est can be very dangerous for some of us. I do very well on Menest which is plant-origen estradiol. One dose of Tri-Est from a compounding pharmacy sent my blood sugar up 100 mg/dl and got my blood pressure soaring too.
    I find that Menest estrogen works best at a dose of .3 mg (the lowest sold) every other day, with a week off every month. Without the week off, I seem to become resistant. I have done this with my doctor’s support for almost a decade. When I stop my blood sugar and pressure go up. With it blood sugar is much easier to control.
    As I’ve written before, I’m not crazy about Tri-Est myself, but in the old days of compounding pharmacies, that was easily gotten. For weight loss, I prefer estradiol alone, which is what Menest is.

  36. I have a very unscientific thought to add to the discussion on why it’s harder to lose weight as you get older: eating at restaurants vs. cooking at home. Whenever I go out to lunch or dinner I notice that a majority of the crowd is middle-aged or elderly.
    It’s a lot easier to control carbs when you cook your own meals.
    Very true. That’s another one I forgot to mention. As people get older, they are more financially able to eat at restaurants. And one never knows what kinds of fats and how many carbs are buried in restaurant food.

  37. To Theresa, Dawn Phenomenon
    Most people will dump glucose as part of the waking up process, normal folks will dump insulin to cover it. Some diabetics get it in spades, to a degree it depends on many things probably including genetics. For some the “diabetic progression” starts with fasting BG, for many this is the last to go after the postprandials have been going south for years (and your doctor has probably not diagnosed you until major damage has occurred unless (s)he is clueful enough to run a Glucose Tolerance Test). Naturally I am awkward, my FBG is still unaffected BUT my liver will lay in wait until I try to exert myself in the morning which can induce a spectacular glucose dump. In the afternoon it may choose to look the other way and not release any glucose when I need it to. IR can change on a diurnal cycle.
    Something little known but obvious when it’s pointed out, the entire blood circulation only contains around 5 grams of glucose at any one time (100 mg/dl x 5l) so the liver only has to meter out an excess 5g and your BG has doubled.
    I suspect insulin resistance at the muscle receptors, which responds well to exercise, and IR within the control circuit involving pancreatic alpha cells and glucagon as well as the liver, may be separate but connected phenomena. Alpha Lipoic Acid 150mg x 2/day works well for me in taming the latter but has no effect on some others’ BG control. Metformin probably works on both types of IR.
    Reducing the level of changes in the system (Bernstein’s Law Of Small Numbers) also seems to improve the predictability of the control circuits. And keeping this up over time has also improved the response (eating breakfast cereal has exactly the opposite effect).
    Much fascinating material in these threads. The endocrine system as a whole appears to be balanced on a knife edge: when one part malfunctions the rest can go down like a stack of dominos, then that will knock on to neuroendocrines and neurotransmitters through the hypothalamic-pituitary axis. Returning it to full working order can be a nightmare.

  38. Did you see this article in today’s NY Times?
    Essay – The Evolutionary Search for Our Perfect Past – NYTimes.comJan 20, 2009 … How much of the diet during our idyllic hunter-gatherer past was meat … one of the classic modern foods we supposedly aren’t meant to eat. …
    http://www.nytimes.com/2009/01/20/health/views/20essa.html?partner=rss&emc=rss – 16 hours ago – v
    Yep, saw it. Didn’t think much of it. The anthropologist Leslie Aiello mentioned in the article wrote one of the seminal papers showing that we developed as meat eaters. She probably wasn’t quoted correctly for this piece. Or at least not in context.

  39. Ddr. Mike, you said:
    “For weight loss, I prefer estradiol alone.”
    The commenter had written about Tri-Est, which you said you didn’t like. What about the Bi-Est with both estradiol and estriol? Didn’t you say earlier that you liked both estradiol and estriol together?
    I’m working with the compounding pharmacist now, and want to know what’s best for hormone balance AND for weight loss. I’ve already told them I want drops of Bi-Est and drops of progesterone. (The drops use propylene glycol as the base.)
    Would that be correct?
    Depends upon what your doc says after testing. As a general rule, I prefer Bi-Est over Tri-Est. Progesterone is fine.

  40. I’m several years post-menopause, but I lost the first 50 pounds in about six months. The next 10 took about five months, and now I’m lucky if I lose a pound a month.
    I’ve been inclined to wait and see if things shift, but these posts have got me thinking. Could hormones be at play here? If so, what has changed since last year? I can’t say that I’m eating any more artificial sweeteners or caffeine than I was at the beginning, but is it possible that I’m more sensitive to them?
    I tell people that I can’t eat wheat because it makes my knees hurt (which it does). They look very confused.
    Wheat (and corn) cause joint problems in many people.

  41. after almost 1 full year of about 25g or less of carbs i still carve sugar like crazy after a meal. even if im full. i know its a pyschological thing but its a constant battle not to reach for something super sweet.
    ive tried magnesium as per dr. eades suggestions, and eating some fruit or even a bit of peanut butter. but it doesnt really quell the lust for chocolate and ice-cream type intense sweetness. im starting to think i may just be like this as long as im on such a diet…. if it could just reduce down by about %50 id have no issue sticking to my diet.
    I’ve got a post coming up on psychological issues.

  42. Off topic response to vadim:
    If along with your tachycardia you’re experiencing other symptoms like chest pressure/pain, shortness of breath, stomach issues, and excessive rumination/worry, you may be experiencing an anxiety/panic attack.
    Caffeine and chocolate can produce body sensations that folks find alarming. The anxiety from this alarm tends to release adrenalin and cortisol, causing yet more body sensations and alarm. This circular triggering/worrying can escalate into anxiety/panic attacks.
    From one who’s had ’em for 34 years.

  43. Just wondering if a cricopharyngeal spasm is also helped with extra potassium or magnesium? I previously had a botox injection to weaken it, but that’s expensive and the results aren’t too predictable, especially when the botox seeps into surrounding tissue. Thanks!
    Give the potassium a whirl. Another thing that works well is a glucagon injection, but, of course, you’ve got to go to the ER or your doc for that. And many don’t know that it works and so may be reluctant to give it.

  44. Hi Doc,
    You write about Biest which I have taken for about 10 years. But you say nothing about progesteron? I take this for 10 days out of every month. Could one of these hormones keep me from losing weight?
    I am having a lot of trouble. I am 62 and this is the second time around for me. I lost 20 lbs the first time. It took me 3 months, but I kept it off for 5 years. This time it seems almost impossible. I started my diet 2 weeks ago and lost 8 lbs than gained 4 back. Very discouraging. Is that because it’s water loss?
    The right amount of progesterone doesn’t interfere, but progestins (the synthetic progesterone, i.e., Provera and others) probably does interfere.

  45. Dr. Eades,
    What do you think of Slim Fasts low carb drinks 6 carbs total. I know you recommend eating real foods, but when the cupboard is bare, or I simply can’t eat another egg I grab one of these drinks. What do you think?
    I don’t really know anything about the Slim Fast drinks, but if they contain only 6 gm of carb, they’re probably not too bad, assuming they have enough protein and no added bad stuff. As you can see from my week of food diaries I posted a month or so ago, I drink shakes a fair amount of the time in the morning, so I don’t see a problem with it. If you look through the comments on those posts, you can find the recipe MD and I use. We make our own.

  46. Unless I taper caffeine very slowly (say over 2 weeks), I get horrible headaches stopping caffeine even when my starting point is fairly low, e.g. two cups of strong tea just in the morning. Does this not happen to you or do you have a cure? You mentioned OTC headache meds can tax your liver just like caffeine does.
    This does indeed happen to some people, my wife included. For those, I recommend slowly tapering off caffeine.

  47. Steve….if you didn’t know this Arabian warriors would drink coffee on an empty stom. afore battle as they ‘knew’ it made them more aggressive in battle !

  48. i have found that when one ups the fat, esp, sat fat, ones cravings for carbs or sugar either go or are so abated they are easy to manage
    I find the same thing.

  49. On a related thread you mentioned insulin resistance as a factor contributing to weight gain as we age. The term insulin resistance doesn’t adequately encompass related factors such as insulin sensitivity (ISI) or beta cell function.
    A few days ago I came across the following study which has some startling implications:
    ‘Hypovitaminosis D is associated with insulin resistance and beta cell
    For the study healthy subjects were recruited from an ad placed in the University of California School of Medicine newspaper. Only glucose-tolerant subjects ( none of the participants had fasting plasma glucose > 100 mg/dl) were enrolled in the study, none were diabetic and none were taking medication on a regular basis.
    “Even though none of the studied subjects had clinical evidence of hypovitaminosis D, 47 subjects had 25(OH)D concentrations 20 ng/mL.”
    Comment: I think it reasonable to assume the subjects were from California and probably (relatively young) students.
    “Extrapolation from the observations in the current study suggests that increasing 25(OH)D from 10 to 30 ng/mL can improve insulin sensitivity by 60%, from 3.8128 to 6.1176 (micromol/L) This improvement in insulin resistance could potentially eliminate the burden on beta cells and reverse abnormal glucose tolerance. Furthermore, the 60% improvement in insulin sensitivity that results from vitamin D treatment indicates that that treatment is more potent than either troglitazone or metformin treatment (54% and 13% improvement in insulin sensitivity, respectively; 36).”
    Comment: Say what? Increasing vitamin D levels from 10 – 30 ng/ml will improve ISI more than metformin. Unbelievable! I believe the upper end as recommended by te Vitamin D Council is 80 ng/ml. if this result is valid one has to wonder why every MD is not ordering 25(OH) D tests for their patients. Here’s one reason. In western Canada where I live our health care system will not pay for 25 (OH) D tests. I just had one after reading the referenced paper and it cost me $120.00
    “Conclusions: The data show a positive correlation of 25(OH)D concentration with insulin sensitivity and a negative effect of hypovitaminosis D on cell function. Subjects with hypovita-minosis D are at higher risk of insulin resistance and the metabolic syndrome. Further studies are required to explore the underlying mechanisms. Am J Clin Nutr 2004;79:820–5”
    A dramatic positive correlation is just that: a correlation. And although correlation implies causation, it doesn’t mean causation. The study you reference is an observational study. I happen to believe that vitamin D is an important vitamin that does many of the things this paper implies that it does. But we can only know for sure if we do randomized control trials to see. Randomize those subjects who have low 25 (OH) D levels into two groups. Give on vitamin D3 to get levels up – give the other placebo. Then measure the change in insulin sensitivity. That’s the study that will tell us something.

  50. All these comments from this post and the previous one are interesting indeed. I’m a third time low carber (or maybe 4th? or is it the 2nd? LOL) I mentioned my story in a comment on a previous thread. Started PP in 1997 and lost 80 pounds over the next 14 months. Then my weight loss stopped COLD (even though I still had 70 pounds to go) and for the next 18 months, though I was following the diet religiously, doing cardio 4-5 times a week, and heavy lifting at the gym twice a week – I never did lose another ounce of the 70 pounds, and early in 2000 I finally fell off the wagon in despair and frustration.
    Over the next 8 years many things happened, including menopause! I made a couple attempted to go back on LC, but they were definitely half-fast attempts. I’m not sure they even really count as “attempts” – only a few weeks each and too many of the low carb Frankenfoods.
    But reading GCBC scared me back unto the straight and narrow – and and my son’s nagging me to do so, and the discovery that I will become a Grandma this year. This time it’s with a firm commitment and not a half-fast one, and real food and not Frankenfoods. Of course there is the little issue that I’m not crazy about cooking, especially cooking for just one. But I do want to have some variety in what I eat. I’m right back there to needing to lose half my body weight again.
    Yet here I am, three weeks into the diet, and so far no weight lost. I’d really had hopes of being down at least 10 pounds by now since I have so far to go. But my scale refuses to move.
    Hmm, I *do* have ONE cup of coffee in the morning at 7:30 AM when I arrive at work (black, no cream, no sweetener)
    Then my standard routine is:
    9 AM – down to the deli to get a swiss cheese omelet
    11 AM – a 1-oz bag of nuts, usually almonds
    1:30 PM – lunch, which is almost always just a can of sardines packed in olive oil. I love ’em!
    6 PM – dinner. Dinner is where I try to get a little variety. Right now, from example, I bought 1 one-pound chuck steak at Whole Foods, browned it, chopped it into bits, and dumped it in the crockpot with a small chopped onion, a bunch of sliced mushrooms, a couple sliced up yellow squashes, a can of diced tomatoes, and a few tablespoons of chili powder. That has been my dinner for 3 nights running and tonight will be my last night. The two nights before that I had shrimp salad with homemade mayo (using high-quality extra virgin olive oil), the 2-3 night before that I had chicken with cauliflower mashed with butter, garlic, and some cream cheese. (LOL, when I do cook it’s usually enough to last me days). Can’t think what I had before that, but similar sort of stuff. Once or twice I didn’t feel like cooking and just made a protein shake.
    That’s it, no other snacks. Other than my one cup of coffee I just drink lots of water all day, sometimes herbal tea after dinner. I feel like I’m doing it “right” – just that nothing is happening. 🙁
    And when you have so much weight to lose you want to see some instant gratification! , I suppose I can try switching to decaf.
    I’m not sure it’s just the one cup of coffee that is sabotaging your efforts. Why don’t you try a couple of protein shakes per day instead of the first meals, then eat you regular meal at night. That should get the weight loss moving. Once it is moving, it’s easier to keep it going. Sometimes drastic measures are called for.

  51. Dr. Eades,
    You mentioned the importance of sleep and the room being dark because of the pineal gland. Where is this gland located that it can sense the darkness of the room?
    It’s located at the base of the brain, and it receives info from everywhere about the light situation, but mainly from the eyes. Experiments have been done, believe it or not, that show that this gland can even sense light when it is being shined on an area behind the knee and nowhere else. It’s extremely sensitive and all the nerve connections haven’t been worked out yet.

  52. I understand what you’re saying about giving the liver a rest by cutting caffeine for a while. But do you know what percentage of the liver’s work capacity is taken up by two cups of coffee? I can’t imagine it’s much, at least compared to a pint of Jameson’s 🙂

  53. Hi Doc,
    Off topic, but not my usual way-off-topic this time.
    That bastion of low carb bashing, The Sydney Morning Herald, today has an article in favour of low carb. No sneering, at least as far as I can detect in a cursory first read. First time I’ve seen its like in years!
    Put the Halelujah Chorus on the iPod!
    Michael Richards
    It’s Halelujahing away. This article is about a study published in last November’s issue of the journal Hepatology. I have a copy right here beside me, and I’m trying to decide whether or not to post on it. It’s fairly technical in terms of what it really shows, but, for whatever reason, the media are all over it. I just can’t understand whey they’ve decided to rely on this study to prove the superiority of low-carb diets when so many others have done as good a job or better and have been ignored. Glad to see it’s made it to the SMH.

  54. Further to my earlier post on hypovitaminosis D and ISI the authors of the study commented that: “Hyperresponsive insulin secretion after a glucose challenge has been found in older men with hypovitaminosis D.” In other words the existence of a vitamin D deficiency results in excessive secretion of insulin secretion as a response to reduced insulin sensitivity while the vitamin D deficiency has a negative impact on beta cell function. Sounds like a progressive downward cycle to me.
    This isn’t observational and is good info. An experiment was actually performed and results tabulated.

  55. Just wanted to say thanks for the post. You answered some questions I’ve had for a long time and very thoroughly at that.
    Once again, it sounds as if it’s much better to not ever gain the weight in the first place!!!!
    I’m at a normal weight now and always have been more or less. Hope I can make it through menopause relatively unscathed.

  56. Hi Michael,
    Two things also off-topic, but I hope useful…
    1. Have you ever thought of releasing your books on an Amazon Kindle version? I know for one that I would instantly buy the only one I don’t have — because I’m traveling in a foreign country and can’t get it any other way. Just an idea, that might help sales as I’m sure Kindle is becoming much more popular these days.
    2. Can you recommend any blog or source for high-quality scientific reviews of the literature regarding muscle building research, that is high-quality like your blog?
    Thanks so much!
    I’m sure the new book will have a Kindle edition, but I have no control over the other books. That is up to the publisher. I think there is a way on Amazon that you can request a Kindle edition. I’m sure that Amazon then sends these requests to the publisher in hopes that the publisher will respond. So, request away. You’ll probably have more success than I would.
    I think the best source for serious information on body building is Fred Hahn’s site. He keeps up with the BB literature and is a smart, serious guy. I would look there first. Disclaimer: I’ve co-written a book with Fred, so I am biased. But I also know him well and respect his honesty and thoroughness.

  57. Dear Doctor;
    Could it be possible that aging will inhibit stomach acid production, which in turn will result in protein not being metabolized well, and weakening the “PROTEIN POWER”?
    Rabbi Hirsch Meisels
    Jewish Friends With Diabetes International
    Aging does indeed slow down stomach acid production, but usually not enough to really hamper protein digestion. But that’s not the case when people take medications for reflux and/or GERD that further inhibit the production of stomach acid or neutralize what is already there. These drugs should be avoided by everyone, but especially by the elderly. Not only is a good level of stomach acid required for the first phases of protein digestion, but for the absorption of vitamin B12 as well. Sadly, many people are in nursing homes with the diagnosis of Alzheimer’s when what they really have is a bad vitamin B12 deficiency that can be easily reversed.

  58. I went on LC in 2006 and lost a lot of weight very fast (but I was nearing 500# at the time, my high weight prior was ~520). Since that time, I have varied from on plan, off plan, on plan but at middling carbs unlikely to result in weight loss, undereating, overeating, carb cycling, you name it. I have ‘officially’ gone ‘back on lowcarb’ quite a few times–I’m an expert at so-called Induction (ref Atkins). Getting everyone in my house on the SAME eating plan has a great deal to do with maintaining it, I find.
    I find there are a couple things that affect how much weight I lose initially and how I feel about it. The first is that when I was eating insanely high carb and I went lowcarb, I lost an insane amount of water/glycol right off, of course–and because of my size that was a really substantial amount (probably 25#+). Now when freshly going LC after that, my diet even if offplan wasn’t anywhere near as horrible as it used to be, so I have a little less water weight to lose up front. (I currently carry about 20# water if I’m highcarb.)
    Worse, now I KNOW that this is the initial weight loss, so I no longer give it the “credit” I did the first time. On the whole, this made my first weight loss a lot more exciting than those which followed. I pretty much have to be lowcarb for at least 2-3 weeks before I can tell by my body that the carb-bloating is gone and now I can actually consider any weight lost to be actual weight lost.
    I’m around ~370 right now, and have kept off the weight loss (but about 20#) for a couple of years. I do find that each time I restart lowcarb, it seems less impressive in terms of weight loss. The time before last I was doing this, I got demoralized because I was eating the same way I had eaten to lose a lot of weight fast, previously, and almost nothing was happening. Allegedly my BMR should see rapid weight loss from just about eating sane eating plan, but that is not how it works at all. I don’t know if being 43 is part of that or not.
    One thing I didn’t see you mention, but I believe this has been an issue for me. First, I once carefully tracked intake and ate 1000 calories or less a day for 30 of 31 days (the other day was around 2k). At the end of that period I had lost 1 (one) pound. At my weight that’s insane. But when I kicked up the calories to ~2000-2300, I actually started losing weight again. So I think there is such thing as undereating, as part of the “anything worth doing’s worth overdoing” mentality that is more harm than help.
    I also found that even if I was losing weight fairly consistently, that if I added low-carb slim-fast to my intake all weight loss stopped abruptly. This might be because it’s 20g protein from caseine (which does a lovely job of making baby cows fat…), or it might be because I have some intolerance to caseine (which I suspect, as milk has a heroin-addictive affect on me, and I’m gluten-intolerant). Removed that and things continued as before. So there apparently are some things which can ‘stall’ weight loss for some people, although I wasn’t sure I believed in that until then.
    My primary problem with lowcarb is undereating. I’m just not hungry, I’m busy with work and single-mom stuff, and I end up not eating until nighttime. This might sound ok to IF folks, but that’s how I gained most of my weight–eating once a day–so in my case, eating regularly really seems to make a difference, as my body seems to have trained to deal with no intake by throttling back on energy expenditure. I don’t think that multiple meals are necessary for most people at all and many I know do great on IF. I just think if a person has caused distortion in their body’s operation by something like that, it makes it a little different, and the unique issues of each body and what you’ve entrained your body to do (for better or worse) probably matter.
    I also suspect (no real evidence tho) that for whatever reason my body may have higher nutrient requirements in some areas, maybe through more deprivation or just greater size or slightly variant functioning. I really feel great when I am carefully eating well and taking many supplements (the D3 you guys sell is great– hugely improved my ‘sense of well-being’ in about 6 hours!). It’s just difficult to do that! My first LC was mostly nuking mozz on pepperoni–but it worked! Now it seems like my body wants a lot more in order to let go of fat, and frankly it’s more work than it was the first time through!
    I think when people do LC initially they are real focused on what they’re doing. Now that it’s “old hat” for me and easy to “do”, I obsess less on it. I’m honestly beginning to believe that the mental state has something to do with this, because I find the times I am most focused on LC, I lose weight, while the times it is more in the background for me, not so important to me, it doesn’t seem to happen to the same degree if at all. I suppose it’s possible that my focus is affecting my body in some way. So ramping up the psychology for it seems important as well.
    Thanks for the dietary history and the insights. I’m glad your doing well on the vitamin D3.
    As you’ve noted, it’s a long, tough struggle, but it can be done. Keep it up. And keep me posted.

  59. They make it sound like we have the same glycogen reserves but are turning fat into sugar anyway. I thought we have less glycogen in reserve and that’s where the water loss at the beginning comes from. If we are truly in ketosis aren’t our glycogen reserves depleted? Do we keep some glycogen but just don’t use it?
    We are not necessarily glycogen depleted while in ketosis. According to Wolfe’s work, the glucose we make via gluconeogenesis goes to glycogen first before turning back into glucose.

  60. Dr. Eades,
    I am not sure how to get your take on something like the following two links, but I figure you will see this as well here as in e-mail or other avenues.
    First, exercise is still the key. The following site strongly endorses lifting weights and living clean the low carb way. If you are having issues with life and diet in any way I would highly recommend strength training.
    The diet most often cited on their forums and by the site owner (Mehdi) is the Metabolic Diet as put forth by Dr. Mauro DiPasquale.
    I would love your take on the PDF in another article or privately or as comments.
    Many thanks for all of your (and MD’s) work on this subject. Protein Power was my introduction to all of this and for that I am grateful.

  61. To add to your latest posts with comments switched off
    I kinda like John Brunner’s desription of the brain as a man riding on a dog riding on a lizard.
    I also have experiences when the three things go off in different directions simultaneously.

  62. I’ve mentioned about being discouraged about no weight loss after three weeks (well actually it’s more like done 2, down 3, up 4, up 3, down 1, down 5, up 4 ….. etc, LOL). But I will say how much better I *feel*. I feel like a totally new person compared to the one eating carbs, and being ill and tired all the time. Yet my business email keeps getting spammed with stuff from Weight Watchers, and wouldn’t you know that I got one of these spams today – “Fad Diets Revealed”. Usually I just pop these into my trash bin, but today I went to look to see exactly what “Fad Diets” they talked about.
    They defined what they consider “fad diets” in this fashion:
    ** “Fad diets are generally easy to understand and simple to follow (at least for a few days).
    Fad diets make great tabloid headlines and even better book titles.
    Since fad diets don’t last, there’s always room for a new one.
    The problem with fad diets is that they are…fads. And, when it comes to following today’s fad diets, the results run the gamut from disappointing to dangerous. Let’s take a look at some of the latest weight-loss fads.” **
    And wouldn’t you know? They only talked about *one*. Yes, LOW CARB DIETS. That was the only “fad” they chose to reveal, concluding: ** “Recommendations include avoiding carbohydrate-containing foods altogether by switching to protein-rich foods or fats, eating carbs at restricted times of the day or swearing off the most offending foods for life. The short-term health risks and negative side effects correspond with how extreme the fad diet is, ranging from marginal deficiencies of key vitamins and minerals to light-headedness and nausea. The bottom line is it’s an excess of calories that causes you to gain weight. Incorporating complex carbohydrates provides many important vitamins and minerals, and when eaten in moderation, are part of a healthy diet.” **
    Hmm, could it be that low carb diets are creating a dent in their business? Could that be why they are the only diet singled out? Do you think there are any seriously overweight folks who would not trade a minor short-term health “risk” of light-headedness and nausea (both of which I experienced in spades the first time I tried LC, but never again since) for a lifetime of better health?
    So I still have hopes of getting the scale moving in the right direction, but in the meantime I’m just enjoying how much better I feel. And I love what I eat! Unlike my diet the couple times I decided to give Weight Watchers a try.
    Hmm, methinks low carb dieting has been around far longer than Weight Watchers has. Maybe it’s WW which is the fad. 🙂

  63. Regarding your recommendation for Dr. Uzzi Reiss’ book. I would like to offer “The Natural Hormone Makeover” by Dr. Phuli Cohan for your consideration. I have also read Dr. Reiss’ book, just believe that Dr. Cohan’s book is more comprehensive and inventive in that she incorporates Eastern medicine approaches and goes into considerable detail about using bio-identical hormones from compounding pharmacies.
    It is well worth the read.
    I’ll take a look.

  64. I have been low carbing for 15 days now with no weight loss. about 2 years ago i lost 45 pounds and was down to 138 through low carb atkins. I am 48 almost 49 years of age and now weigh 156 pounds and i am 5.6 1/2 to 5 foot 7. not exactly sure. I went on the low carb atkins diet a few months ago and the scale would not budge. So now i am back and determined to make it work like i said day 15 scale will not budge. I am using the strips for ketones and they are saying a trace in the morning pee. How can this be. Also what is stalling my weight loss. Is it because i am only trying to lose 12 to 15 pounds? Is it because my body is use to this low carb diet. I tried carb limit of 20 a day first week. Nothing then I cut out cheese. Now i am eating mostly mayo (no carbs) eggs and meat. Could you please give me a suggestion on what to get this moving even just a little. I am a woman. and i would also like to add that I drink at least 64 ounces of water a day probably more. Please respond to this i really need some help. And is there any way for a menapausal woman to lose this weight if her hormones are out of whack if she keeps with whatever advise as far as diet goes. I am not a cheater and will not cheat. Been following atkins but now I am almost considering cutting out all carbs period. PLEASE PLEASE HELP ME ! Thanks so much for your help.
    It can be difficult for a middle-aged woman to easily lose weight if her hormones are out of balance. It can be done, it’s just more difficult. I can’t really recommend anything specific for you on this front because you aren’t my patient. But when my patients do hit a plateau, I usually put them on protein shakes to get the weight loss moving. You might try replacing a couple of meals with protein shakes and see what happens. I would bet your weight loss will pick up.

  65. Re: Sleep. I know we’re supposed to live in sync with the sun (as in “Lights Out”), but frankly I have always been nocturnal. Once I discovered that I could work a swing or evening shift, I’ve been there for literally decades. Oftentimes I will actually type faster after midnight.
    Yeah, I know it’s technically not good for me, but I seem to function better this way. I have also had intermittent problems with daytime sleepiness since junior high school.
    I finally did get some “blackout” curtains for the bedroom windows, which helps some, as up here in the desert, the morning sun is rather fierce.
    Re: Caffeine. I love the taste of coffee… but it doesn’t like me too much. I drink it when I need to stay awake for some reason (such as driving home from L.A.). The caffeinated stuff gives me some chest tightness, palpitations, gut cramps, and diarrhea.
    The decaffeinated stuff still gives me gut cramps and diarrhea. So, unless I really need it, I try to avoid it.
    Drinking a whole lot of caffeinated tea will do some of the same things to me.
    Re: Dairy. I’m one of those people who is lactose intolerant with pasteurized cows’ milk, although I tolerate raw cows’ milk and goats’ milk just fine. Haven’t been able to get any raw goats’ milk yet, but hope to do so eventually. I can handle cheese, though.
    Re: Fats. I’m trying to up my intake. I take cod liver oil every morning, plus fish oil capsules. I tolerate butter just fine, also coconut oil and rendered pork fat. However, when I try to use a significant amount of cream (even raw cream; also sour cream), it also sometimes gives me gut cramps and diarrhea, although I love the taste.
    I’ve been trying to keep the carbs down. Unfortunately, the more I try to avoid carbs, the more my significant other seems to want them. He doesn’t cook very much. If it were up to me, I would not even bring home stuff like bread and boxes of frozen taquitos.

  66. What type of protien shakes are we talking about. How many carbs do they have or are they all protein? Any brands you can mention for me to look for at the store? Thanks for all your help.
    We are working on our own protein powder and should have it ready soon, but in the meantime, here’s the recipe for the protein shake MD makes for me.
    6 to 8 ounces cold water
    1 ounce heavy cream or premium coconut milk
    1-3 scoops low-carb whey protein powder of choice, any flavor you like (no more than 3 grams of carb per scoop)
    1 cup of ice cubes
    1 ounce of sugar-free flavored syrup (optional)
    Put all ingredients into a blender and blend until smooth and creamy.

  67. Dr Eades,
    The MCT’s from coconut oil are also processed in the liver. Should I limit coconut oil when I want to give my liver a chance to recover?
    No, the coconut oil should actually help your liver recover.

  68. Any thoughts on n-acetyl cysteine supplementation? I believe this is what they give for acetaminophen overdose, wonder if supplementation might help support liver function.
    I think it does support liver function.

  69. Dr. Eades,
    In this post, you mentioned, “I’ve got another post that I’ll probably put up next week about a supplement that will knock reflux on its head quickly.” I searched for a follow-up on this, but didn’t see anything. I’d be very interested in this information, as I’ve been suffering from laryngopharyngeal reflux (LPR) for years. This is a little different from GERD, and often (as in my case) involves no heartburn symptoms — but the acid gets passed the *upper* esophageal sphincter and wreaks havoc on the vocal cords, so that I have a persistent hoarseness, even when otherwise healthy. If the supplement you have in mind can help, I’d really like to know about it.
    Thank you!
    It is the supplement Protexid. I do plan to post on it soon.

  70. Dr. Eades,
    Sorry for sticking this comment onto such an old post, but it was the most recent one I could find with the search feature where you mention coffee or espresso/americanos.
    In case you haven’t come across this yet, as a fellow fan of Espresso Americano drinks, I want to alert you to the aeropress espresso/americano maker. I think this would be right up your alley. I have no affiliation with the aeropress other than as a user.
    http://www.aerobie.com/Products/aeropress.htm Great reviews online on many sites.
    It’s an incredibly simple inexpensive espresso maker that makes espresso and Americanos that will rival very expensive espresso machines. It’s very easy to clean (just a quick rinse) and economical to use. It’s lightweight, sturdy, and perfect for travel so you don’t have to drink nasty drip coffee in your hotel room. The aeropress isn’t even electric; you press a plunger into the device by hand. All you need is a hot water source (165-175°F). You can make from one to four shots of espresso at one time, adding more hot water for Americanos (or hot milk for lattes).
    After 13,454 coffees, our “Italian Princess” (the nickname of our fancy automatic espresso machine) has a signaling problem and will spend about a month at the the espresso spa being rejuvenated. We were dreading a month of drinking drip coffee from the coffee maker stored in the garage. We have a stovetop espresso maker for camping, but that method has some downsides, too.
    On a coffee-loving friend’s strong recommendation I bought an aeropress espresso maker to tide us over. Wow! Now I’m even questioning sending the Princess to the expensive “spa”; perhaps instead I should retire her and reclaim the kitchen counter space!
    Thanks for the tip, Anna. I read all the stuff, but I could never find a price. Do you remember what you paid for yours? Also, does it make a crema on the espresso? I love the taste of espresso, but I particularly love the crema that floats on the top.

  71. To David MacPhail: Re Vitamin D Testing: I recently had my 25OH Vitamin D tested by LifeLabs in Victoria, B.C. ordered by an endocrinologist when I told her I was taking 6g for depression and it was covered (paid for). The range was 25-135nmol/L with >200 toxic. My result was 218 but the endocrinologist thought that was ok since that’s the level natives have at the equator. Still, I dropped to 2-3g per day. I wanted natural desiccated thyroid but she insisted on Synthroid which I can’t take, so I’ll have to find someone else.

  72. Dale,
    I also had my first 25-OH-D test done by LifeLabs. From I have read the toxicity issue has been overstated.
    I have recently joined a vitamin D study sponsored by D-Action. Every 6 months I complete a health survey and submit a blood spot sample for analysis. For those who are interested you can participate in the vitamin D study by joining D Action at http://www.grassrootshealth.net. There’s the Call to Action on the site from a consortium of concerned parties and scientists representing a number of universities.
    Vitamin D study participants must submit 2 tests per year at a cost of $40 US per test (I paid $120 to have a 25-OH-D test done by the local lab). The range recommended by D-Action is 100-150 nmol/L. The Vitamin D Council recommends 125-200 nmol/L (NBV: nmol/L is 2.5 x US values). The Vitamin D Council claims the body does not reliably store vitamin D when serum levels are <100 nmol/L.
    My first test in the study was 127.5 nmol/L which resulted from regular full body sun bathing for about 30 minutes close to noon (weather permitting) and D3 supplements of 5,000 units per day. I exchanged emails recently with a participant close to me area who has his own sun bed. He sun baths regularly but takes only 400 IU of D3. His serum levels were lower than mine but still within the recommended range. So you can just imagine what most people's levels are who are either avoiding the sun or using lots of sun block. Studies suggest that about 95% of Canadians are deficient in terms of the minimal 40 nmol/L recommended by Health Canada. Some have no detectable trace of vitamin D in them.
    There is a wealth of excellent information on the Grass Roots and Vitamin D Council (www.vitamindcouncil.org) web sites including some excellent lectures.
    And you will probably have to find another endocrinologist to get a script for dessicated thyroid.

  73. Hi Mike
    Thanks for the interesting post Dale too.
    There is a doctor online (Mercola is his name) who claims that washing with soap after sun-exposure washes away vit D3 that has just been synthesized. He said he used to think he had to wait 2 hours before washing so Vit D from the epidermis could be fully absorbed, now he says it’s 48 hours and recommends only washing with water! This seems a bit unlikely to me as I would assume everyone in western countries wash everyday with soap… and that would make everyone even in equatorial areas highly deficient in Vit D — Mike do you know of anything in the literature about this, or is it just baloney?
    On a side note — I supplement with 5000IU a day of vit D3, because my mother has MS and the neurologist said to keep levels about 100 nmol/L. My challenge is that my calcium levels end up getting too high — so I especially avoid milk (a cup of tea with lots of milk was my treat, kinda like my “desert”, on a low-carb diet… sometimes a few cups!)
    Anyway, thanks again for the link to the Vit D council.
    Take care and great blog as always Mike!

  74. I paid about $30-31 for the Aeropress at a local coffee roasting/coffee house, but I have seen it from Amazon-associated vendors for a few dollars less (but usually with shipping and not eligible for Prime). Some versions come with a zip travel pouch; mine didn’t.
    Mine also came with a huge number of the paper filters (350?) and actually, the filters are reusable at least 4-5 times if you give them a quick rinse (there are few grounds on them when you peel the filter off the “puck”).
    We found if we set our grinder just one or two notches less fine on our burr grinder than for our automatic espresso machine, it was perfect for the Aeropress (more coarse than for espresso but more fine than for automatic drip coffee or French press).
    We just did a northern CA road trip and the Aeropress was great! We heated water in the motel drip machines and made espressos and Americanos in our motel room. For the road, I made a 4 shot Americano in our Thermos container right before checking out. At one motel at North Lake Tahoe (the FireLite) the 4 cup Sunbeam drip coffee machine gave the water a plastic-y taste (which ruined the coffee), so we used the microwave to heat water instead. I tried an immersion heater in a 2 cu Pyrex before we left, but it was really slow so we didn’t bother with that.
    After brunch at the Squeeze In after we departured Lake Tahoe (thanks very much for that recommendation!) the waitress filled our thermos with hot water and I made “bumper” espresso Americanos at our car parked right outside. My son videotaped me making it but I haven’t done anything with that yet.
    Crema – I know what you mean, we love crema, too. The Aeropress does makes some crema, but not as much or as long lasting as the crema produced by our “Italian Princess” automatic machine. You can hear it at the end of the pressing process as the steam and air in the chamber is forced through the grounds and filter. Actually, what I discovered is that the crema forms mostly on the underneath side of the filter holder and clings there (I tend to scrape the bottom of the unit across my cup edge to catch the crema when I’m done pressing). My husband (the espresso drinker) says the crema forms better when there is more coffee and less water when brewing with the Aeropress. I usually make Americanos, so I tend to be liberal with the water.
    Thanks for the info. I just ordered one through Amazon and had it sent to where I’m going to be traveling next week. I’ll let you know how I like it after a few cups. Hope it’s as good as everyone seems to think it is. If so, it will make traveling a lot easier for us. No more lousy, in-room coffee in the various hotels.

  75. To David MacPhail: I find it interesting that out-of-the-ordinary tests can be covered if doctors choose to order them. Testing for thyroid is only the TSH for which I show normal, but one doctor (who’s moved) would test for free T3&4. Another doctor tested me for histamine and received a reprimand from the lab. I would like to have many nutritional/vitamin/mineral/digestive tests but don’t know who would order them. Are you in B.C.? Do you know anyone who prescribes natural desiccated thyroid? Also, LEF charges $47 for a Vitamin D test — but it may be difficult to get back and forth through customs (some of their supplements are restricted).

  76. Hi Dale, yes I am in BC. I don’t know a way to get you my email address on this blog without telling the whole world. So I hope Dr. Eades will indulge us on this issue.
    I have a great physician (female) who will order whatever tests I want within the political constraints she and all MD’s here in BC work under. The College of Physicians & Surgeons sets standards for treatment. MDs who don’t follow these standards can be called before the board. One way the College can check on the activities of a doctor is to run the MDs physician’s number to see how many prescriptions an MD has written and for what pharmaceuticals. When E-Health is up and running things will get really bad because it will be easy to run profiles to see what action is being taken in response to lab results. For example if an MD does not consistently prescribe statins for elevated cholesterol I think it probable that Big Brother will be quick to let them know they are not adhering to professional standards and could face the lose of their license.
    Patients may be able to initially sign some sort of release stating them don’t want statins or any drug. But I think it will only a matter of time before such patients will be labelled ‘liabilities to the system’ and will either face punishing premiums for health care or be made inelegible for coverage altogether. Big Brother has ways of motivating people to comply.
    As you are probably aware doctors in BC are under a directive to not write requisitions for 25-OH-D tests even though it is well documented that vitamin D deficiency affects about 97% of Canadians. You can get test kits from either the vitamin D council or GrassRoots Health. So far I have not had a problem getting the materials back and forth across the border for my 25-OH-D blood spot tests. However, I am holding my breath.
    One option is to try a private (you pay) clinic or travel into the US for tests you can not get through the plan. Meridian Labs is one that comes to mind. Perhaps Dr. Eades or others have some suggestions to offer.

  77. Dr Eades:
    Would you give David MacPhail my email or send me his email address?
    We could share local medical information.
    Done. Sorry it took so long.

  78. Dr. Eades,
    Have you treated any patients on valproic acid? Does this medication interfere with weight loss on low carb diets, and, if it does, can this be overcome?
    Thank you

    1. I’ve never treated a patient on valproic acid. I do know that it can cause weight gain, so I suspect it would probably hinder weight-loss on a low-carb diet, but I have no experience with it, so I don’t know for sure.

  79. A very beautiful, suspenseful duet of opposites thrown together in the persons of Greta and Dayne, were-cat and sorcerer. I’m not very familiar with this paranormal genre, but Ms Winters provides all the necessary exposition without drawing attention to it. I enjoyed the focus being primarily on just two people who aren’t quite sure of each other’s feelings and motives. Ms Winters didn’t go for the epic sprawl of army proportions, just a simple, yet compelling stage-play format I found extremelyrefreshing. Beginning with a brutal discovery, the implied danger provides plenty of fuel to sustain the character-driven, cat and dog dance that guides the reader masterfully through emotions, suspicions, and deductions that just don’t let up. Erotic and funny, KEPT kept me reading in one sitting. If you’re looking for a quick, satisfying read, I recommend KEPT.
    Romance Lover

  80. Two excellent posts thank you. Re hormone balancing: I am 66 years old, was diagnosed with hormone sensitive breast cancer 6 years ago, and thus cannot use any estrogen or progesterone (or similar) hormone replacement. There are many women in the same position. Any advice? Many thanks.

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