On August 1, 2012 I retired from the United States Army a few weeks shy of having 21 years of active military service and after 4 combat deployments. The science of health has always been my passion but for many years I frankly didn’t have the time to do much more than read journal articles summarizing the latest finding and suggesting clinical applications and attending lectures by experts who summarized the latest research and suggesting guidelines for my practice. I just didn’t have time to critically assess the actual studies themselves. I was busy raising a family (3 children) managing a busy Family Medicine Practice and working extra shifts evenings and weekends at urgent visit clinics to provide for the family and the level of lifestyle I thought we should be living and made the mistake of relying on these expert sources. At The University of Texas Medical Branch in Galveston, Texas, the oldest Medical School west of the Mississippi River, I had been taught little about nutrition and it had not been emphasized in patient care, probably because the interventions we had, the American Diabetic Association (ADA) diet, the DASH (Dietary Approach to Stop Hypertension) diet and other diets we had at the time, in the literature and in my experience were poorly tolerated by patients and produced at best temporary mild weight loss which in far less than 10% cases lasted for more than a year. As 40 percent of Americans I have I inherited the metabolic syndrome, honestly, as both my parents were morbidly obese. People with this syndrome are much more likely to become obese and have high blood pressure, diabetes and heart disease. During my Internship at Bethesda Naval Hospital in 1986 I spent 2 months on the experimental cancer treatment ward that the National Institute of Health maintains at Bethesda Naval to do phase 1 and 2 clinical trials on new cancer medicines. These patients are showered with candy and pastries by their families which with their lack of appetite would inevitably wind up on the nurses conference table where I wrote my notes and orders and ultimately consumed by myself. Here’s a picture of me at about 280 lbs with my son on my lap taken right after completing residency.
For the next 30+ years I struggled with my weight, losing weight by starving myself and jogging mile after mile only to see the weight return every time I let up the least little bit. I was never able to do better than about 216 pounds with the most extreme diets which were mostly low fat and running 30-40 miles per week. From time to time due to increased stress at work or with family crises I would let my weight get out of control as in this 2003 photo from a visit to South Africa.
Then in 2008 in desperation I tried the Atkin’s diet. The weight melted off and I was able to get down to around 215 pounds without experiencing the hunger, irritability and fatigue I had experienced with so many other diets. I discussed this with my physician colleagues and got warning after warning about how dangerous a low carbohydrate diet was and given my love of carbohydrates was persuaded back to the low fat school. In 2011 I happened to be browsing in a book store and came across “Why We Get Fat and What to Do About It” by Gary Taubes. I didn’t just take his word, I went and checked the actual studies and found to my mind that the experts that had interpreted the data and were writing the chapters in textbooks and deciding which studies to fund seemed to be turning a blind eye to the increasingly strong evidence that carbohydrate intolerance was the main driver of the obesity epidemic and many of the chronic disease of the developed world such as heart disease and cancer. Now that I am financially independent and no longer need to hold a regular position, I feel that I am in a position to spend much of my time reviewing and summarizing the literature in this blog and hopefully giving presentations to both medical professionals and laymen on the benefits of a very low carbohydrate, moderate protein, high-fat diet and share how I have successfully implemented that in my life – getting my weight under 200 lbs and keeping it there for over a year while eating as much as I want with increased energy, no hunger, better sleep, complete resolution of my chronic gum disease, no new cavities (a chronic problem for me all my life). I literally feel 10 years younger and know that many of you can also. I will try to respond to your postings in a timely manner. I will not allow posts that are character assaults or insult members of either the low carb or low fat community. We need to make this a rational discussion for the good of all. Otherwise I welcome you questions or comments. Here is my diet:
Certainly you need to see your doctor before going on a diet like the one I propose because you might need to have your medicines adjusted as you lose weight and your blood pressure comes down. Your provider may want to run blood tests to rule out thyroid disease, inherited Cholesterol abnormalities or other medical conditions.
HERE IS MY DIET: The only nutrient that I think you need to watch closely in your diet is protein. If you eat too much protein your body will convert it to sugar which leads to insulin secretion negating many of the benefits of a low carbohydrate diet. In my opinion unless you are are a bodybuilder or world class endurance athlete 0.6 to 1.0 grams of protein per kilogram of body weight is a good level to maintain in your diet. I recommend 50 grams of protein per day for the average woman and 70 grams per day for men. An easy way of doing this is to use the “rule of sevens”. In general, one ounce of meat, fish or poultry contains 7 grams of protein. A cup of fermented dairy like yogurt or buttermilk, an ounce of cheese, 2 ounces of nuts, a cup of homemade broth or a large egg contain 7 grams of protein. You don’t need to get paranoid about counting protein and even if you eat twice what I am recommending you will still gain significant benefits over the standard American diet, the point I want to make is that eating a lot of low fat protein sources like chicken breasts, tuna fish, low-fat yogurt, lean ground beef, lowfat cheese or protein powder shakes can negate a lot of the benefits of a low fat diet. Why…because you want to get at least 70-80% of your calories from healthy fats (to be discussed later). If you eat a lot of lean protein sources like I just discussed your going to wind up eating too much protein and not enough fat.
I recommend keeping your carbohydrate intake below 50 grams per day whether you are overweight or not. Even if you are not overweight and were blessed with a super metabolism and pancreas that lets you eat whatever you want and stay thin, I feel that there are three extremely good reasons to avoid carbohydrates, even if you are not overweight. First is the increase in abdominal fat caused by a high carbohydrate diet (which can often be seen on dexascans even in individuals who are not particularly overweight to look at who are on high carbohydrate diets). Abdominal fat secretes numerous toxic inflammatory mediators that are associated with diabetes, heart disease, cancer and other degenerative diseases. The second is the process where sugar molecules in the blood attach to proteins throughout the body, irreversibly destroying their ability to do their jobs which is called non-enzymatic glycation. This process is one of the major contributors to the common diseases of the developed world and is probably the root cause of many. Diabetics have high levels of sugar in the blood most of the time and the resulting glycation contributes significantly to many of their problems like blindness, kidney failure and loss of feeling in the feet. Since all carbohydrates are converted to sugar by the body the more carbs you eat, the more sugar will find it’s way into your blood and the more health destroying glycation will take place. The third reason is that when you burn sugar for energy you produce a lot more cell damaging free radicals than when you burn fat or ketones, These also contribute to the diseases of the developed world and their antidote, antioxidants are relatively absent in starchy carbohydrate laden foods. I therefore recommend that your not eat any of the following foods - AT ALL!: cereal grains such as wheat (public enemy #1 – Read “Wheat Belly” by William Davis MD for the story), oats, corn, rice, millet etc., starchy vegetables such as potatoes, sweet potatoes, or tapioca, any fruit that tastes sweet like apples, oranges or sweet berries, (I don’t eat sweet fruits because I don’t like to count carbs and I feel the vitamins and minerals found in these foods can be better obtained from vegetables and fruits with less sugar). If you want to count your carbs you can probably fit small servings of these foods safely into your diet) or anything containing sweeteners such as high fructose corn syrup (public enemy #2 - See “Fat Chance” by Robert Lustig, MD for the story), sugar, honey, fructose or agave. Eat ALL YOU WANT of the following: meat, eggs, cheese, seafood, nuts(remember peanuts are not nuts but legumes which are addressed later), and all the non-starchy vegetables like, spinach, carrots, broccoli, cauliflower, onions, lettuce tomatoes, squash,cabbage and other greens you want. Legumes (beans, peas, peanuts etc.) have enzyme inhibitors that allow undigested carbs to reach the colon upsetting the normal gut flora which I suspect is very bad for health. We are just beginning to study the gut flora and really don’t understand much about this balance. Legumes also often contains high levels aflotoxins which are highly carcinogenic, a risk I don’t feel is worth taking since most legumes are also high in carbohydrate. If you do eat them you will need to count carbs to be sure they are not pushing you over the limit. And finally regarding fat, I believe it should comprise the vast majority of calories burned for energy since a high fat diet is the natural state for the human species. Since our species began 120,000 years ago until the development of widespread grain cultivation 10,000 year ago we got most of our calories from fat. And as I said fat is much cleaner burning than carbohydrate, producing far fewer destructive free radicals, it does not lead to abdominal fat deposits, and fat cannot cause the destructive glycation of proteins that sugar from carbohydrate containing food does. That having been said there are 3 kinds of fat that I think should be avoided as much as possible – vegetable oils containing omega-6 fatty acids. I have read several places that the average American gets 70% of his fat calories from soybean oil and this causes me to rank it as public enemy #3 (See “Toxic Oils” by David Gillespie for the details on this). Other oils high in Omega 6 are safflower, rapeseed, wheat germ, corn, walnut, peanut and cottonseed oils. True, we require small amounts of omega-6 in our diets and cannot make it ourselves but we easily reach this minimum requirement by eating the healthy fat sources sources I recommend. Omega-6 fatty acids are the base material from which many of the chemicals that trigger the inflammatory responses in our body are made and eating a large proportion of omega-6′s in relation to the healthy and anti-inflammatory omega-3 oils can lead to inflammatory diseases like heart disease arthritis, asthma and many skin diseases like acne. I recommend avoiding foods like mayonnaise margarine, peanut butter, and the millions of commercial pastries and sauces that are full of omega 6 oils. The other 2 forms of fat I recommend avoiding are trans fat and partially hydrogenated oils. Everyone is pretty much in agreement on that. There is no evidence from controlled trials that a low fat diet prevents heart disease though hundreds of millions of dollars have been spent in an attempt by the vested interests to prove just that (see ”The Great Cholesterol Myth” by Board Certified Cardiologist, Stephen Sinatra, MD for the details). The trials of low fat diets have shown no benefit or a negative benefit. Studies have shown that humans store fat in a consistent pattern: Monounsaturated 50%, Saturated 31% and polyunsaturated 16%. Since I can find no controlled experiments to suggest a better intake ratio and studies of hunter gather diets suggest a similar ratio of fat intake, this is the ratio I recommend. by the way a 50:50 mixture of butter and olive oil approximates this ratio. I recommend using exclusively lard, palm or coconut oil for frying and sauteing You should buy the fattiest meat you can find. My favorites are pork ribs, 20% fat hamburger, rib eyes, prime rib and T-bones. Nitrite free sausage and bacon are good choices. If you can’t find the sausage, buy ground pork, shake in your favorite spices and saute it with onion and green bell pepper. Boiling meat on the bone in stews and soups is incredibly healthy because you get the glycans from the cartiladge which is great for joint health. Fried eggs are a great source of fat. I add sour cream or cream cheese to most casseroles and mix a little minced garlic, horse radish and paprika in them and use them as a creamy sauce on meats. Avocados are high in omega-3 fatty acids, antioxidants vitamins and minerals and I eat one on most days. Here are some tips on eating out. Most fast food restaurants are glad to sell you their hamburgers or breakfast sandwiches in a plastic box without the bun. They will give you a plastic knife and fork. At McDonald’s you can order breakfast items like scrambled eggs, sausage patty, steak meat,or a slice of cheese individually and it is much cheaper than buying the corresponding sandwich or big breakfast. Likewise most restaurants will be glad to substitute a vegetable for the starch and hold the bread. Many now even have a low carb menu. I know many of you will recoil in horror at the suggestion of eating meat and vegetables from large industrialized farms, with thoughts of hormone, chemical, and pesticide laden meats and vegetables dancing in your head. My own opinion is that though organic produce and free range fed meat are probably preferable, the few controlled studies that have been done on the subject have not demonstrated any clear benefit. I feel that it is most important to eat a low carbohydrate, moderate protein high fat diet which has good controlled evidence to support it. If you are able to do this using organic produce and grass fed beef, that’s fine and may give you some small benefit but I think I can do more good convincing people to eat more healthy fat than to go organic. Why am I doing this blog? I have been on this diet for a year and a half. My weight hadn’t been less than 220 lbs for more than 40 years before I started the diet despite extended periods of running 30-40 miles/week, playing tennis and starving myself on a high carbohydrate/high protein/low fat diet. I suffered severe bouts of reactive hypoglycemia (the sudden onset of feeling weak and shaky with rubbery knees and difficulty concentrating). I had severe acid reflux and terrible chronic gingivitis (gum disease). I caught every cold that came along. If I let up on the exercise and diet routine at all my weight would balloon up. As a doctor I attended lectures and conferences where they would talk about the latest advances in weight loss and would glow with pride over studies showing a 5-10% weight loss which would inevitably vanish in 95% of patients within a year. I had little to no success with these diets either personally or with my patients. To make a long story short I finally discovered the diet I have described above through the works of Dr. Yudkin, Dr.Atkins, Dr. Phinney and Gary Taubes (pictured above) and others. My weight dropped to 200 lbs for the first time since high school and has remained stable within 1-2 pounds of that mark since. I enjoy seemingly boundless energy and am able to play 5 sets of singles tennis on a hot day with no ill effects. I have not experienced a single episode of low blood sugar or acid reflux since starting this diet. My gum disease cleared up and I have not had a cold or sniffle on the diet. I am currently retired from active medical practice and I hope to help people improve their health by getting the message out that a simple dietary change can restore health and cure or prevent most of the chronic diseases of the industrialized grain fed society than I could do in a traditional medical practice. That’s the reason I’m starting this blog. Future plans include speaking in front of both medical professionals and laymen, podcasting and possibly authoring a book. I look forward to your feedback and I will attempt to answer any comments made in a civil tone. Paul Mabry, MD.