While much of the diet and health debate around the world is still caught up and enamored by the imaginary allure of the high-carb, low-fat diet as a means for losing weight and improving health, there is something rather remarkable happening in Sweden. An open dialog about the merits of a high-fat, low-carb diet has ensued ever since Dr. Annika Dahlqvist was vindicated by the Swedish National Board of Health and Welfare on January 16, 2008 when that government-led institution concluded that a low-carb diet is "in accordance with science and well-tried experience for reducing obesity and Type 2 diabetes."
Yep, that's right! Livin' la vida low-carb is now promoted by the government of Sweden alongside the low-fat diet as an option for people desiring weight loss and improvements in their health. However, as Dr. Dahlqvist noted in my interview with her in January 2008 , they're not very happy about it and neither are the so-called health "experts" who desperately tried to get a ruling AGAINST low-carb--but it backfired on them!
I've been trying to get organizations like the American Medical Association, the American Heart Association, and even the USDA (creators of the infamous Food Pyramid, set to be revised and updated for 2010 by Brian Wansink and his team) to consider low-carb alongside low-fat diets so that the general public will have an informed choice rather than all the needless scaremongering about the healthy low-carb lifestyle. Although it didn't go far enough in the opinion of most supporters of low-carb, the change in recommendations by the American Diabetes Association (ADA) in January 2008 in favor of supporting low-carb diets for diabetics for weight loss is indeed a positive step in the right direction that I think will put pressure on these other health groups to follow suit. In light of all the evidence that has come out, they'll have no choice.
In fact, at the recent ASBP/Nutrition & Metabolism conference in Phoenix , an entire lecture was dedicated to why the ADA suddenly changed its tune regarding low-carb living for diabetics. Their conclusion: the science has shown it to be safe for weight loss over the span of at least one year. Of course, you and I know the science says a LOT more than that about low-carb and there was plenty of evidence of that during that weekend of lectures from the best and brightest in the world of low-carb research. As this evidence continues to mount, it will be impossible for the ADA, AMA, AHA, or any old "A" to ignore anymore!
And this brings me back to Sweden for a moment. The "science and well-tried experience" behind low-carb is what has led Dr. Dahlqvist and many of the most famous advocates of carbohydrate restriction from around the world to call for a critical appraisal of this way of eating for the purposes of treating metabolic syndrome and Type 2 diabetes. We really have come to an impasse in the hyperbole against low-carb where an all-out discussion is now sorely needed about this nutritional approach. It happened in Phoenix among a couple hundred bariatric physicians, but the scale of the conversation needs to become larger--MUCH larger!
That's why I was pleased to see Johanna Söderlund take it on at her blog last week by interviewing some of Sweden's most intelligent and articulate proponents of the high-fat, low-carb hypothesis. This is the kind of open-minded conversation that needs to take place in the United States, Canada, the UK, Australia, and around the world. It MUST be done if we are wanting to get serious about dealing with obesity, diabetes, and diseases that plague modern society. The question is no longer a matter of if we will, but rather when. That's why we should take our cue from what is happening in Sweden and get the conversation started.
Special thanks to my Swedish low-carb blogging friend Arne Anderson for translating Johanna Söderlund's interview into English so we can enjoy the answers provided to some rather pertinent questions about livin' la vida low-carb. As you read through these answers from the leading low-carb experts in Sweden, imagine the same thing happening in Congressional hearings on Capitol Hill in Washington, DC from such notable researchers as Dr. Eric Westman, Dr. Mary C. Vernon, Dr. Richard Feinman, Dr. Jeff Volek, Dr. Stephen Phinney, and others. A clear unbiased presentation of the data would speak for itself.
Here's that interview with the Swedish low-carb experts:
1. In terms of fat, protein and carbohydrates, how much of each of these macronutrients should people who are healthy and free from illness (Defined as free from insulin resistance and feeling well) eat?
Annika Dahlqvist: I recommend healthy people eat liberal amounts of natural fat. Then they automatically consume less carbohydrates because they have normal appetite regulation. If you count on it I guess the intake of carbs will be half of what is recommended (by the health authorities). Protein should be consumed "normally"--that is 1g per kilo of normal body weight.
Lars-Erik Litsfeldt: Healthy persons have a greater freedom of how they put together their diet. For example, people keeping a diet low in the glycemic index make it fine with that. The more insulin resistant you are, the less freedom you have to eat if you want to regain your health. I can't see any reason for a healthy person to keep up a specific level of carbohydrates in his diet. Carbohydrates are the only macronutrients we don't need to eat. I think most people realize what level is most suitable to them.
Andreas Eenfeldt: I think across the board recommendations like 55:25:20 (carbohydrate:protein:fat) become arbitrary and in the end are not very meaningful. I believe it is arbitrary because there are no comparing studies looking at the different amounts of carbs within the definition of "low-carb." Therefore, that recommendation is just a personal opinion based on anecdotal stories. It's not meaningful at all because it is a very small minority of people who actually keep up with the breakdown of macronutrients of their daily dietary intake.
It is my opinion that healthy persons who don't feel they need to lose weight should exclude sugar from their diet. The rest of the carbohydrates ought to be natural and not refined--that is carbs with a low glycemic index. Plus, the less physical activity you engage in, the more careful you must be with the total amount of carbohydrates consumed.
Sten Sture Skaldeman: For healthy persons, the most important thing is to eat food that is natural and not processed. How it is divided in macronutrients you don't have to feel distressed about. Fat must be the primary source of energy intake and protein and carbohydrates can divide the rest. Your diet should look like this: 20% protein, 10-20% carbohydrates and 60-70% fat. This will give you a lot of freedom in making up your diet.
Johanna Söderlund: Many proportions can work well, but most people would get the best health if they had an intake of 40–60% fat, 20–30% protein and 10–20% carbohydrates. Muscular persons need to eat more protein than others and inactive people ought to eat less carbohydrates than others. The distribution of macronutrients also varies based on how much you eat. A person who eats smaller portions may need to have a larger percent of protein than a person who eats larger portions because protein gets stored in the body as energy.
2. In your opinion, will some people feel bad following a low-carb, high-fat (LCHF) diet because it is too low in carbohydrate intake or is this diet that can work well for everybody?
Annika Dahlqvist: I know some people say that they are not feeling well while on a low-carb, high-fat (LCHF) diet and I usually give them this advice: Increase the carbs and decrease the fat and then go back slowly to see what level of carbohydrates suits them best.
Lars-Erik Litsfeldt: I don't know, but I believe feeling bad on a low intake of carbohydrates is only temporary. But it is all about individuals and you can't exclude the possibility that some people need a certain intake of carbs in order to feel fine. I have heard that people who workout a lot need carbohydrates to recover faster after their workout.
Andreas Eenfeldt: I think it is possible that some people feel more tired and weak even after been on a low-carb, high-fat (LCHF) diet for a longer time, although it's not very common. I think practical issues arise because people on these diets are eating different from others or different from their previous diet and that's what presents an even bigger problem.
Sten Sture Skaldeman: No, nobody can feel bad from eating a low-carbohydrate diet, except for the first two first weeks. When we are adapted to operating on fat for fuel, the need for carbohydrates is zero. (No, a low-carb, high-fat (LCHF) diet is not for everyone. It demands people have both willpower and intelligence.)
Johanna Söderlund: I see a strict low-carb, high-fat (LCHF) diet as a method for insulin resistant people. Insulin resistance means that insulin regulation doesn't work properly, probably because of too much stress on the system because of too much high-glycemic food. As a result of too high insulin levels in the body, the organs have decreased their sensibility to insulin. That leads to problems with high levels of blood glucose that can be remedied with a low-carb diet because it is mostly the carbohydrates that raises the glucose level in the blood. (Insulin resistance depends on the diet and lifestyle mostly, but heredity is also a factor. The more insulin resistant you are the more important is minimizing carbohydrates.)
If you start a strict low-carb diet and have no problems with insulin resistance, then your blood glucose level will fall. Different hormone systems will be activated to keep the blood glucose at a normal level. There are different hormones that can be activated to normalize the blood glucose levels and some are more desirable than others. Cortisol and glucagon are both working to increase the blood glucose level. Cortisol is a stress hormone but glucagon will be activated when you workout.
If you change to a new diet suddenly, there may be major changes in the hormone systems and that can make you feel bad. Insulin resistant people usually have no problem when changing to a strict low-carb diet. You may have a good production of blood glucose even before you start a low-carb diet and there will probably no problems when changing and you will feel better after you reduce the carbs.
3. Which differences–if any–can you distinguish between the kinds of carbohydrates (for example, sugar and starch) and do you differentiate these differences in your dietary advice?
Annika Dahlqvist: They are all the same to me. Future research will perhaps point out the differences that may be there.
Lars-Erik Litsfeldt: I don't see any differences. Fiber may be harmless for most people, but the point is it is still about the amount of carbohydrates.
Andreas Eenfeldt: Yes, there are a lot of things indicating that an excessive intake of sugar (sucrose) is worse than a high intake of starch because of the fructose in the sugar. If the carbohydrate intake isn't very low, then the glycemic index comes into play.
Sten Sture Skaldeman: Sugar and starch are equally bad. The addiction is as equally strong in both sugar and starch. I accept the carbohydrates that come from animal products without limitations. For example liver, seafood, eggs and cheese. Vegetables (grown on top of the soil) can be eaten without limitations by most people. I myself restrict tomatoes and peppers, but I'm very liberal with onions. I think the healthy benefits of the onion are more important than the few carbohydrates that are in them.
Johanna Söderlund: I think there is a big difference between the different kinds of carbohydrates. I wrote earlier about insulin resistance and a lot of the science that tells us that different sources of carbohydrates influences our body differently. Most important is that sugar releases more insulin than starch. That means that insulin resistant persons should reduce starch and non-insulin resistant persons should reduce sugar intake first.
Fructose should not be consumed in any larger amounts at all by anyone. In short: When the glucose stores are filled, there will be problems with the surplus of fructose. Diabetics should not eat very many carbs at all, but for those who are not insulin resistant and want to eat carbs I recommend them to eat most of it as starch. Sugar is also a problem for those who are addicted to carbohydrates. Sugar seem to cause addiction easier than starch does. Sugar also stimulates your appetite mostly because of its content of fructose.
Fructose activates ghrelin and ghrelin stimulates your appetite. Of course, you should pay attention to the glycemic index of those starchy foods and how easily the carbs are digested. Parboiled rice increases the blood glucose level slower than sticky rice. You must understand that foods containing sugar (like fructose and lactose) have a relatively low glycemic index, but it is not healthy to eat a lot of fructose and lactose.
What a truly fascinating interview that was! I welcome your comments about the answers provided by these health pioneers in Sweden who are blazing the trail and setting a precedent for how the rest of the world of low-carb supporters should be addressing the misinformation that exists about the healthy low-carb lifestyle. In fact, I'd love to ask these exact same questions to the low-carb experts in the United States. Wouldn't that be a great follow-up to what Johanna Söderlund did with her interview? And I could even give my own answers to these questions too. What do you think?
While it can sometimes seem discouraging when you see an anti-low-carb story in the media, be encouraged my friends. We have the truth on our side and the science speaks for itself. Even more importantly, in my not-so-humble opinion, are the scores of people like you and me who have been changed for the better because of the positive impact of low-carb. This is the testimony of livin' la vida low-carb that the ADA, AMA, AHA, and those in the government who make dietary recommendations need to hear. We should never stop sharing our stories because one-by-one we are making a difference.
I will soon be blogging about how we can band together in an effort to put pressure on the United States Congress to take a closer look at the current dietary recommendations in light of the latest science that has come out regarding low-carb diets. We need to encourage our U.S. Representatives and U.S. Senators to call for Congressional hearings on this subject because it is a vitally important issue that directly impacts such political hot potatoes such as healthcare, Medicare, and other aspects of public policy. Waiting on the sidelines for them to act on their own is no longer acceptable, so we must provide public pressure on them to do something. More on that coming soon.
For now, I want to publicly acknowledge and applaud the brave researchers and practitioners in Sweden who support the high-fat, low-carb diet for their courage in the face of opposition to stand up for what is right. We need this kind of testicular fortitude to rise up in the United States, Canada, the UK, Australia, and around the world if we truly care about the health and well-being of the world population. If we choose to remain passive and simply allow the same old, same old to continue, then it will be our own fault when we reach the point of no return in this debate.
The time to act is NOW and I'm ready to step up the pressure on the powers that be. Won't you join me in this effort?