Is LC Morphing to HAES? Part I: Define Healthy
After returning from the LC Cruise, Jimmy Moore - arguably the most prominent Atkins-inspired low carber out there these days - scrubbed the weekly weigh-in scroll from his blog and wrote this:
After the Low-Carb Cruise and hearing all the stories of the people in Sweden eating a low-carb, high-fat (LCHF) diet not for weight loss but their health, I've decided to refocus this menus blog by taking the spotlight off of my weight and back on the quality of the food I'm consuming. That's not to say I no longer care about my weight, but it's not the single obsession of why I eat the way I do. Sure, your weight can be an incredible marker for tracking your progress, but your blood sugars, cholesterol, and other such cardio-metabolic markers are much MORE important.
As I'm tracking my low-carb meal plans, I will likely track my blood sugar levels more than I have been doing because I think that will be more revealing about what my diet is doing for my health.If you've listened to any of Jimmy's new podcasts (Low Carb Conversations) the whole "health" angle is woven throughout. I'm going to address some of these in future part(s) of this series.
I can't help but feel this has partly evolved in response to increasing questioning over Jimmy's continuing weight battle, regain and cycling and awareness that so many long term low carb advocates are remain overweight or even obese. So it seems the response is a re-packaging of the message. (That and the attempted co-opting of Paleo, but that's a topic for another day). People are now being convinced, because Gary Taubes tells us so, that if they don't become reasonably lean on low carb it's because they've done some sort of permanent damage to their metabolisms and this is the best they can do. For us, it's even the lettuce that's keeping us fat. For the overweight to continue to sell their message, this must be coupled with a compelling reason to keep eating this way despite no further weight loss: Enter the "Eat this way for your health" rebranding of the message.
Have others seen this trend?
This fits in perfectly with the Health at Every Size movement, HAES. An odd marriage at that, because low carb remains a "weight loss diet" where success/failure and all that goes with that (eating disorders, yo-yo dieting) are at least as prevalent as they are in the mainstream ELMM-based arena.
So for Part I, I get to thinking. What does that mean? How does one define *health*. Is it:
Blood Lipid Test Results:
Low carbers like to celebrate that eating this way reduces fasting triglycerides and increases fasting HDL levels and LDL particle size. LDL concentrations that often rise are generally written off as "meaningless" anyway.
- I tend to agree that LDL in general has been overblown as a CVD marker. But *IF* one believes certain markers indicate greater or lesser risk, then all must be considered, you can't point to one with a woo hoo and poo poo the other.
- We've discussed here before how elevated triglycerides on a high carb diet, per se, may be benign, as the metabolic mechanisms of this phenomenon differ from those indicative of insulin resistance.
- By the same token, the lower triglycerides on VLC may be an artifact of the liver downregulating the esterification of surplus free fatty acids (NEFA/FFA). Lipid profiles rarely quantify this biomarker, but it is correlated with LDL so if you're one of those experiencing elevated LDL on low carb, you probably have high circulating NEFA.
- Long Term Diet Trials: There have been a few longer term - 6mo to 2 years - trials conducted pitting Atkins-style diets against low fat and other popular diets. Although LC generally "outperforms" the others in terms of triglycerides and HDL, the effect is generally quite minimal. If I get a chance I'll come back and link this section, but usually we're talking nominal differences. I would also note that in calorie deficit, higher carb diets generally produce decreased triglycerides, contrary to expectations. Is a 3 point difference in HDL elevation indicative of better health?
- Anecdotal: Low carb forums, websites and blogs are rife with anonymous reports of huge improvements in lipids. This is fine. But there are many who post of troubling changes in their's. These sorts of reports should be viewed with extreme caution. For example Jimmy Moore will post periodically about emails from unidentified readers about their amazing results. I'm sure he gets "Jimmy I'm troubled by my labs" type emails as well, but I can see why he wouldn't pass these along to his readers. Such posts pop up on various forums and often go unanswered.
- Ambiguous Anecdotal: I read a variety of blogs that refer to the healthy lipid profiles of various prominent low carbers, but there's no numbers really put to the various reports. When a commenter expressed dismay at the obesity of Laura Dolson and Mary Vernon, Jimmy Moore described their bloodwork as IMMACULATE. Ummmm ... what does that mean? Dana Carpender seems to talk a lot about her good bloodwork but I've not seen the details.
- Published Results: Well, we have 10 year low carber Gary Taubes' results. And we have Jimmy Moore's here and here. Taubes' lipids look fine. He's also not overweight. Jimmy's are a bit more scary, and I'm not sure the reassurances he's gotten from Drs. Westman and Vernon are responsible. Just my opinion there.
Blood Glucose Levels?:
Basically I think this comes mostly from Bernstein and Davis, that somehow a steady blood glucose level that doesn't change more than a few points postprandially is inherently healthier. That if an HbA1c of a certain level is good, a lower one is better.
What's Healthy v. The Evidence?
- I think we can all agree that hyperglycemia is not healthy mainly due to the effects of glycation. But what evidence is there of rampant glycation in carbohydrate consumers? Glycation requires sustained hyperglycemia. Glycation makes you wrinkled they say. Well, I'm just not seeing - outdated and professionally photographed images aside - where any of the prominent low carbers look any younger and less wrinkled than age-matched counterparts or people I know of similar ages.
- Steady blood sugar levels are "healthy" because this prevents insulin resistance. There's no evidence for this that I've found. Hyperglycemia is an endline manifestation, not the cause of IR issues. Once one becomes hyperglycemic this can feedback and exacerbate the problems but there's no evidence that "glucose spikes" cause IR. Long term steady blood glucose levels haven't kept low carbers from being diagnosed with IR-related disorders.
- Steady blood sugar levels are "healthy" because this will prevent diabetes while glucose spikes over time will cause it, especially in those predisposed. Again, there's no evidence for this. See the last sentence above.
Low Insulin Levels?:
Low carbers believe that because hyperinsulinemia generally accompanies obesity, metabolic syndrome/IR and the onset of T2 diabetes, insulin plays a causal role. Therefore low insulin levels are to be sought to reduce insulin's negative impacts on the body.
Some Confusion to Clear Up First:
These discussions are always difficult because they confuse basal hyperinsulinemia with postprandial hyperinsulinemia. The theory being "spiking" insulin throughout the day leads to elevated fasting insulin. So eliminate the carbs, reduce fasting insulin. This would seem to be what Grey and Kipnis demonstrated. There were dramatic drops in fasting insulin even during weight maintenance for the obese women studied. However these were short term studies and many overweight low carbers have reported being baffled by their FI remaining high despite VLC eating.
What's Healthy v. The Evidence?
- Elevated fasting insulin is indicative of insulin resistance and all of the unhealthy complications thereof. Therefore lower fasting insulin is an indication of good health. I would agree with this, but in light of the dramatic swings G&K demonstrated in obese women, I think this has to be viewed in the same light as blood lipids. Is the reduced FI indicative of improved insulin sensitivity?
- Low carb is the only way to eat to treat IR and lowered fasting insulin is evidence of this, therefore LC is a "healthy" way to eat. I've yet to come across any evidence of non-megadose-fructose carb-induced IR. If anything the high fat diets of VLC'ers would exacerbate IR. This is obscured by the very real health benefits of losing a considerable amount of weight. The jury is still out as to whether this physiological IR has any of the health implications of pathological IR.
- Low insulin spikes eating low carb are "healthier" because of the negative effects of insulin on the body. All fine and good, except insulin seems to have mostly beneficial impacts on the body. Rather than increasing BP, insulin is a vasodilator. Rather than being inflammatory, it is anti-inflammatory. Rather than being atherosclerotic, it is possibly anti-athero. A healthy person mounts a substantial insulin response to a mixed meal that works on just about every tissue and organ. Is it healthier not to have this? Erring on the side of caution, I don't think so.
- I think we can all agree that if hyperinsulinemia is unhealthy, no insulin or impaired insulin is too. Deadly even. So there's no "dose response" type relationship here. It's more the reason than the result.
So ... I could keep adding to that list - inflammatory markers, skin issues, epilepsy, etc.etc. But I think the three above are what most LC'ers hang their hats on most that convinces them that LC eating is healthy in and of itself, independent of weight loss, and inherently healthier than any other diet.
OK well ... Compared to what? It's always compared to how the person was eating previously that is generally some version of the SAD. I mean of COURSE Jimmy is healthier now than he was at over 400 lbs swigging Coke and stuffing down Little Debbies. How about let's compare apples to apples. Because if someone is eating a whole foods version of low carb and avoiding frankenfoods then likely this is healthier than a Coke swigging vegetarian eating granola all day long. But if you're that person eating McD's burgers and sausage egg & cheese McMuffins and thinking tossing the buns makes that fare healthy, I've got news for you.
Most do lose some weight on low carb and the immediate effects have us attributing it all to the diet and not the weight loss itself. I used to think LC cleared up my face, but even when I was still doing the VLC thing two years ago, the breakouts returned periodically. I get emails all the time from ex-low carbers who initially felt great but started to decline but were reluctant to change their eating in response. This is the problem with demonizing a macronutrient, but that's a subject for another day. I see this in low carb advocates all the time. I'm amazed at how many hypothyroids have their situation go haywire on low carb, for example, but wouldn't even consider that VLC is not good for them. Or whose sleep patterns have been disrupted, experience mood changes, etc. etc. and wouldn't even remotely consider their diet as a culprit. Jimmy Moore insists he doesn't get sick often, but I think he's deluded himself on that one a bit because he actually does get sick rather often and the colds hang on. A healthy person rarely gets sick and gets better quickly when they do.
So, if low carb is going to now be promoted as *the* healthy way of eating, and that it is healthy irrespective of weight loss, we have to first define what healthy is.
It is true that size and health are not necessarily inversely correlated. Indeed the underweight suffer more ill health when in vulnerable circumstances than do the overweight. But I also don't believe we can be healthy at every size. Some can get away with more excess weight than others.
To be continued ...