Interview: is low-carb for everyone?

Exercise, long walks, choral singing and meditating; there are numerous ways to increase ones well-being. Anyone who goes from feeling bad to finding something that works, is prone to believe that the solution found is a general one – but as we know, all methods are not suitable for everyone.

In analogy with the above, it is a reasonable question whether an in itself beneficial and working diet can also be considered general; are there groups for whom the model needs refining?

Lately, a discussion has been emerging about how various Low-Carb advocates view the generality of that particular diet. The aim of this post is to clarify which opinions are really represented in the Swedish Low-Carb community, and whether or not a minimized carbohydrate consumption is viewed as a general method for better health for everyone.

Three questions below have been sent to Dr. Annika Dahlqvist, Mr. Sten Sture Skaldeman, Mr. Lars-Erik Litsfeldt and Dr. Andreas Eenfeldt. I asked them for concise answers, and I also added my own opinions.

To put our replies in perspective, it is worth noting that the Swedish official dietary recommendations advice a diet with 25-35 energy percent fat, 10-20 E% proteins, and 50-60 E% carbohydrates. The actual average consumption is 36 E%, 13 E% and 51 E%, respectively. (The figures cited are from 2002).

The questions:

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.

My answer:

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 a 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.)

My answer:

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.

My answer:

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.

Finally: I don’t question at all that low-carb diets are working for many people. They can actually work great, providing good appetite regulation, a good nutrient intake, steady blood sugar, lower blood pressure, good hormonal levels, better vigour and last but not least, tasty food.

On the other hand, low-carb can be a very poor method for some, mostly because of the hormonal fluctuations induced. Some people may find that they gain weight on low-carb diets, or they might encounter problems such as low blood pressure, poor appetite, gloominess, low blood sugar levels and irregular menstruation. Side-effects from low-carb diets often pass if one stays on the diet, but sometimes they do not.

My concern is that low-carb, high-fat diets should not be viewed as more beneficial the more strict they are; by “strict” I mean a fat diet extremely low in carbohydrates, where even vegetables mostly fill decorative purposes.

Banning the fear of fats is a common interest, while banning carbohydrates can never be. It remains a special interest.

PS:
I would like to thank Mr. Arne Anderson for translating the actual interview part.

PPS:
This interview was also discussed in some detail in Jimmy Moore’s Livin’ La Vida Low-Carb™ Blog.

Eggs are still good for you

Recently, headlines like “Eating many eggs linked to elevated risk of earlier death” were pretty much all over the place. I, and many others with me, firmly believe that eggs are extremely beneficial – so what’s the deal here? Well, something is rotten in the state of Denmark.

For quite some time, most official dietary recommendations have been advicing against consuming more than one egg a day – the US Departement of Agriculture have been even more restrictive in their recommendations. The sole reason for this is the fact that eggs have a high cholesterol content, combined with the wide-spread myth that cholesterol per se increases the risk of cardiovascular diseases. I will dedicate an upcoming post to the debunking of this myth, but for now, let us just ascertain that the western world in general and the US in particular suffers from a severe case of cholesterol fear.

It is true that eggs are rich in cholesterol – but the bodily-specific production of cholesterol is lowered as we consume more in our food, so its really not an issue. What is an issue, is that eggs also are very rich in high-quality fats, essential minerals and vitamins.

So, this new alarming research report, what does it really say? It indicates elevated risk of death in those eating more than seven eggs a week, along with an elevated risk in diabetics eating eggs at all. But – and this but is big; the egg consumtion does not correlate with an increase in stroke or cardiovascular diseases – and hence the classical cholesterol myth, the myth which also forms the basis for official dietary advice against eating eggs, is not given any support from this report. On the contrary.

So when the claim is made that eggs are bad for diabetics, no model of explanation is provided. The study has lasted for twenty years, so we have to weigh in the atrocity propaganda aimed at eggs; during the study, eggs have been slandered. Those who ate eggs anyway probably share the common trait that they disregard dietary advice, and maybe this trait is associated with other dangerous behaviour? Maybe they exercise less, eat more candy, eat less vegetables and smoke more than the other participants? And reading the report, one finds that only 8% of the male doctors studied had an egg consumtion higher than seven eggs a week. The most egg-consuming group where older, smoked more often, had higher blood-pressure and exercised less. The study was also lacking in information on their other dietary habits.

Amazingly enough, this report has been used as an argument for recommending “heart friendly” egg-white omelets – even though the only conclusion to be made is yet another indication that the cholesterol hypothesis is dead wrong.

One should note that US eggs in general are not as beneficial as for instance Swedish eggs – they are lower in Omega 3 and higher in their content of Omega 6. Eggs are extremely beneficial food, and should be eaten in abundance – but don’t worry about cholesterol, worry about choosing the best quality eggs – that is where you can make a real difference.

Can fruit be considered primeval food?

Fruit is often considered the very definition of primeval food, and also as the very definition of healthy food. Many fruits are undeniably very attractive, with sweet taste, intense colors and beautiful shapes, and one might therefore make the assumption that eating fruit is an instinct in humans.

But humans are very affected by cultural influences as well, and it is difficult to tell what really is instinct. The fact that we find fruit visually appealing and well-tasting, does not prove that it is healthy, and neither does it say that it is primeval. If it was that simple, we could just as well claim that brightly colored candies is “natural food” – because our instinctive attraction to color and sweetness is also satisfied by such.

And as it turns out, there is more to the analogy; in many ways, the cultivated contemporary fruits have more in common with candy than with the wild fruits which where available to us during most part of our evolution!

I do believe that in some sense we have an instinct to look for colorful food, and that is probably a heritage of an evolution as fruit eating animals – our well developed color vision is probably not coincidental; predators rarely have color vision at all.

But still – the hypothesis of fruit being healthy because it is natural and primeval just does not hold. Think of a fruit, almost any fruit; I guarantee that your ancestors never ate anything like it. No Homo Habilis ever laid eyes on a water melon.

The natural appearance of wild, uncultivated fruits is more often than not rather ugly. Consider for example the water melon, the banana, the peach and the tomato; the water melon is a highly refined variety of the wild Tsamma melon, whose pulp is like the husk of the water melon. All cultivated bananas are seedless, the small seeds are sterile remnants. The wild counterparts look like this – small, inedible fruits stuffed with big, hard seeds. The wild peach is much smaller and much more bitter than the cultivated peach. The original tomatoes does not look much like the tomatoes at the supermarket, either. And naturally, the difference is one of content, not only of shape and taste. All of the above have a massively different nutritional value than their wild counterparts.

The cultivated fruits are not necessarily unhealthy – but seeing these images, we no longer have any reason to think of them as natural, primeval food; we have to analyse them one by one.

And we will find that all fruits are not equally wholesome. Quince (which can barely be eaten raw), the bitter grapefruit and the cumbersome pomegranate are three fruits which I rank higher than most of the other; they look and act more like their versions in the wild, they are not as sweet as many other fruits – and their beneficial effect have also been supported by scientific studies. Somewhere in the other end of the spectrum, green grapes and melons are to be found. (The web comic XKCD presented a funny graph the other day, ranking fruit by taste and difficulty; if we add the dimension of healthiness, we are probably most interested in the lower left quadrant… The exception is berries; uncultivated, always beneficial!)

Many vegans and vegetarians are extreme in their praise of fruit, and recommend eating loads of it, every day. But doing so, they reject animal products which have been part of our diet for millions of years, but arbitrarily postulate that our most natural food would consist of foodstuff which have been available for maybe a few hundred years. They also neglect the seasonal availability of fruit in the wild.

I don’t like the phrase natural food, because it might lead to the misinterpretation that anything coming from nature is wholesome – like toxic plants. It is better to look for a diet which has developed as an adaption to context. Primeval food is a better approach than natural food – but still, modern foodstuff does not have to be detrimental, but should be subject for study. Nevertheless, the more processed a food is, the more suspicious should we be.

Perhaps the myth of natural food has to do with a misunderstanding on where we come from. Many believe that our closest relatives are herbivores, but they are really omnivores. The chimpanzee, our closest relative, is mostly herbivore, but 5-10% of its diet in its natural environment consist of animals – primarily insects, but the chimpanzee also hunts down and eat smaller monkeys.

If we look to our physionomy, adaptions are everywhere to be found. Our jaws are typical for omnivores, for instance, and our intestines are more like the intestines of pigs (omnivores) than typical predator- and herbivore intestines.

So, I do not consider fruit in general to be primeval – in contrast to natural animal fat, for instance – because most fruit are so cultivated. But are they healthy still? I will return to this issue in upcoming posts, and issues like crop-spraying and fructose will be part of that discussion.

Paleolithic, primeval diet

Something of a predicament for people interested in diets, is that the subject is often associated with unreliability. It is common knowledge that many flourishing diets are mere crazes, living their short lives on the placards of the tabloids – and as if that were not enough, many other diets have more or less degenerated into religious movements, eruptions of pseudo-science from the new age and alternative medicine movements.

This entails a twofold problem. Firstly, when people listen to bad advice, these bad diets can be directly detrimental for their followers. Secondly, these diets tend to cast a long shadow on any criticism of the reigning order, even when such criticism is firmly based in sound scientific principle. It is not uncommon, for instance, to hear representatives of Departements of Agriculture mention the paleolithic diet in the same breath as some obscure pineapple diet, only to dismiss them both as craze and vogue.

I notice the same phenomenon when I discuss these matters in public; many distance themselves without even hearing the arguments, just because criticism of poorly performed research so easily is mistaken for criticism of science per se.

Because of this, it is a necessity to firmly disaffiliate from pseudo-science, and make sure at all times we do not find ourselves pledging allegiance to doctrines.

Many craze diets are easily identified as such, but matters are complicated by the fact that some of these shady diets market themselves with roughly the same rhetoric as the paleolithic diet – which is definitely not shady. Allow me to concretize:

Primeval diet is the hypothesis that we, just like other species, have a digestive system which has been evolutionary adapted to a certain diet, and that that diet therefore is one on which we would thrive.

Evolutionary medicine tells us that given a certain environment, the individuals with the best adaptations to this environment will reproduce more than the ones less fit. Hence, the genes of the better adapted will gain in frequency. In the genetical sense, we are almost identical to humans living in the Stone Age. Since the food available constitutes a big part of the environment, it follows that healthy food should mean the kind of food which has been available in our environment while our genes were selected.

This is logic. There is also a certain empirical support for it; contemporary cultures of hunter-gatherers live in an environment very similar to the paleolithic one, and studies have shown that these cultures are more or less spared from many of our widespread disease.

As previously have been stated, my approach to diet and healthy eating is based on the paleolithic or primeval diet. I have maintained the same approach for several years, but although my starting-point has been the same, my conclusions have evolved. The task of establishing what foodstuff were readily available during paleolithic time is not a trivial one. One has also to decide how those foodstuff are best approximated with the ones available today, and estimate the effect of certain deviations from this ideal.

The above line of reasoning on evolutionary adaption could carelessly be summarized as a summon to eat “naturally”. This should be avoided, because a similar argument is common in less reliable diets, but then very often as a doctrine without the supporting theory.

There is fashion in diets, and right now many diets want to wear a paleolithic shroud. Vegan diet, fruiterian diet, Montignac, Lindeberg, many GI methods, the mediterranean diet, Atkins, Low-carb diets; they all claim to be primeval diets – but too often, the paleolithic approach is reduced to a thin coating of berries and nuts, painted on the same old myths. These myths and include delusions such as the common fear of fat, the admirance of dietary fibre and the unnatural disgust for animal foodstuff.

“Natural food” is a poor description of what we are looking for, because there is an abundance of natural plants which are outright toxic. So, is “primeval” cutting it for us? It could of course be misinterpreted too. We are not looking for the most primeval, but rather “best matching our level of adaption”. If we choose a too primeval diet, from which we have actually adapted away, we end up in trouble. For instance; we share some common ancestor with the zebra, but whatever diet that creature thrived on, it would definitely not be suitable for us today (and neither for the zebra, I might add).

Our culinary timeline contains a number of breakpoints. We and our predecessing species have introduced fire, cooking, animal products, cultivated grain, dairy cattle, margarines, industrial food processing and trans fatty acids, to name a few – and for each and every one it is relevant to consider whether we are adapted to it.

We have eaten animals for approximately 40 million years. Australopithecus (2.5 to 3.7 million years ago) ate meat. Fire has been used for 1.5 million years, and we have cooked for at least 800 000 years.

When we discuss paleolithic diet we generally refer to the interval 2.5 million years ago and up to 10 000 years b.C, when agriculture was developed.

Of course, adaptions have been made during all this time; not only in our genes, but also in the genes of our surrounding species. For instance, our cultivated fruits of today look very different from the fruit of our ancestors – and their nutritional content differs as well.

To put these figures in some kind of perspective, one can consider that most of the current genetic polymorphisms in the human genome are believed to have evolved during the last 50 000 – 100 000 years.

We can also study the contemporary, healthy hunter-gatherer cultures – and we find that they all cook and eat animals, although their diet varies a lot in other aspects.

Let us take a closer look on one of my examples of unreliable diets – the fruiterian or raw vegan diet. This is a very extreme form of veganism, which advocates a diet of fruit only. Fruiterians always make the “it’s natural” argument, and they claim that it is natural compared not only to processed food, but even cooked and animal food.

The fallacy committed by fruiterians is the one of looking for “most primeval” instead of “best fitting our level of adaption”. They actually argue that “natural food” would be a diet which looks like nothing our ancestors have eaten, at least since our common ancestor with the lemurs! Why stop there, I wonder? Why not just make a bowl of Primordial Soup for dinner?

But even when we accept that animal and cooked food is definitely a part of the proper paleolithic diet, there is still room for interpretation. How well adapted are we to dairy? How well adapted are we to grain? Are the differences between cultivated and primeval fruit so vast that fruit has turned detrimental for our health?

I mentioned that my conclusions have evolved, and I meant my view on details of these issues, not in the model itself.

All of the craze diets mentioned above differ from the diet which actually reigned in paleolithic time; they make compromises, and often the compromise is inclusion of some modern foodstuff. Examples include: quorn beef, bananas, low fat milk, potatoes, protein bars, canola oil, beans, whole-grain pasta, soy pancakes, and bacon.

Many diets trying to call themselves paleolithic are low in fat, and oddly enough it is common to advocate oils rather than animal fat; vegetable fats have not been used in large volume until the 20th century.

So is there any diet which matches the actual diet of the Paleolithic? Well, actual diet would of course have been different in different places; some lived inland and some by the sea, and up north animal food would have played a bigger role than near the equator.

Globally, the diet is believed to have included vegetables, fruit, berries, meat, fish, birds, eggs, mushroom, insects, shellfish, nuts and root vegetables, and, possibly, small amounts of seed and beans. The available food must have been seasonally varying. Most difficult to assess is the proportion between different foodstuff.

Original populations remaining in the 20th century have had very differing proportions of the macro nutrients (fat, protein, carbohydrates) in their diet, but they all seem to have been healthy; hence, I believe a healthy individual can choose these proportions to his liking, and still thrive.

Even if we stick to the above list of foodstuff, they will differ from the primeval ones. Plants have been cultivated and animals have been bred. What we know for sure is that no paleolithic man ate potatoes, wheat, corn, skim milk, lettuce, sugar, carrots, banana or oranges – because none of these existed in their modern form. Almost every kind of bean, grain, fruit, root vegetable and vegetable have been cultivated beyond recognition (berries excepted), and a major effect of this process is an increase in the amount of sugar and starch they contain.

The meats are not unchanged either. Animals which roam freely – fair game for instance – will maintain a high content of minerals and good quality of fatty acids in their meat, milk and eggs alike. Raised meat can differ greatly in quality in these aspects, often because the animals are fed the same cultivated grain we are.

Whether or not people of the Stone Age ate animal fat is an issue which has been debated a lot. Nowadays, we often refer to fillet when we say meat; many parts of the animal we don’t eat. In the Stone Age, meat and fish probably was eaten with all accompanying fat as well as with the guts; contemporary hunter-gatherer cultures are seen to prefer the fatty parts over the lean meat.

One can speculate on the priorities of our ancestors, but it seems unlikely they would spend too much time collecting grain (which was wild and smaller in size than the grains of our time). It is widely believed that grains where not eaten in any significant amounts.

It is possible that animal milk where harvested from time to time, but it would have been much richer in fat and nutrients.

Many think that low-carb diets seem strange and artificial, but it must have been the norm in paleolithicum – seeing as the grain, the root vegetables and the fruit were so relatively low in carbohydrates.

Thinking primeval, paleolithic diet means to reconceptualise all opinions on what is normal. We have lived our entire lives with a certain kind of diet, a diet which impregnates our entire society and has been impregnating it for generations. But this is not enough to make it normal, not for our digestive systems and our genes; for them, it is just a craze…

What makes a diet great?

Let us consider the concept of healthiness; what elements of a diet makes it a healthy one? I would like to appoint two main components:

• How well the diet satisfies the dietary requirements
• How the diet affects the blood sugar

They are interdependent – for instance, more minerals are consumed when the blood sugar fluctuates, and a high insulin level increases the required intake of Chrome – but both components are necessary and none of them by itself sufficient to render the diet good and working in the long run.

First, let us discuss the dietary requirements, the need of nutrients. Many find it difficult to fill their requirements of vitamins and minerals, and the reason for this is essentially that the food is poor in nutrients.

Meat, fish and eggs are all very dense in nutrients, and adding such foodstuff to every main meal will simplify greatly the task of satisfying the dietary requirements. Grain and beans do provide plenty of raw energy – but fairly little nutritional value, in relation to the amount of energy. This goes for their wholegrain counterparts as well! Deficits in Vitamin D, Iron, Folate, and Magnesium are increasingly common, and to a great extent, a low intake of animal food is to blame for this. Folate is plentiful in liver and egg yolk, not only in green vegetables. (Folate is approximated in dietary supplements by folic acid.)

The problem of supplying the necessary nutrients can be formulated in an alternative way; as the problem of how to eat sufficiently nutrient densely. In other words; the problem of avoiding having to supply an unfeasibly large volume of foodstuff – and hence amount of energy – just to satisfy these dietary requirements.

The artificial solution would be the powder diets – meal replacements, such as Herbalife. They are claimed to provide all the required nutrients, and do indeed contain most of the dietary minerals and vitamins. But can it really be that simple?

No, far from it. First of all, there are some vitamins which just does not give any health effects when provided as supplements – such as Vitamin C. Folic acid works poorly, except as a remedy for meningomyelocele. Vitamin A as a supplement is outright detrimental. In general, minerals are easier to absorb than vitamins, but they require a context of natural fats in order for the absorbance to work – and these meal replacements are all very low in fat. To make an example – the requisition of calcium works best when the calcium is combined with animal fat and the vitamins A and D.

Over to the issue of blood sugar control. Many popular diets seem to ignore the dietary requirements. while focusing on providing blood sugar control (although many fail considerably at this task, as well). A stable blood sugar is the key factor in providing dietary well-being fast; usually the timeframe for compensating a nutritional deficit is much longer.

The average diet constitutes a roller-coaster ride for the blood sugar level. This causes mood swings in the short run and disease in the long run; the danger of high blood sugar and high insulin alike is that they act inflammatory in the blood vessels.

A first step to take and a solid foundation for everyone’s diet would be a total avoidance of margarines, shortening and trans fat, because all of these damage the blood sugar regulation badly.

The popular diets have their different ways of dealing with the blood sugar issue. Many claim nowadays that slow carbohydrates are the way to go, that is, carbohydrates which raise the blood sugar slowly after the meal. It is a good rule of thumb, but in practice, the misunderstandings flourish:

• Coarse and dark bread in general is not slow – unless it contains whole grains or a major component of sourdough.
• Food with a low glycemic index satisfies hunger worse; if this is compensated by eating a bigger serving, in the end, the glycemic load may actually increase.
• The blood sugar response can not be calculated as merely a function of mass and glycemic index of the carbohydrates eaten; it is also depending on the situation: if the stomach is empty, the order in which the food is eaten, et cetera.

Beside this, there are fairly significant individual differences in how a certain carbohydrate affects the blood sugar; slow carbs are in reality not behaving slowly for everyone eating them.

It is a common belief that a serving of parboiled rice can be replaced by half a serving of beans and halv a serving of mashed potatoes, and in the end the blood sugar response will be the same in the two cases since parboiled rice has GI above average, beans have a low GI, and mashed potatoes have high GI. This assumption is flawed! In reality, the blood sugar response is for the most part controlled by the highest glycemic index appearing on your plate, not the average GI. In my example, the mashed potatoes would influence both blood sugar and insulin levels the most. The following might be somewhat controversial, but if you have any intentions of staying full for some time after your meal, my advice is: eat nothing high-glycemic.

There is another prevailing and equally flawed solution to the blood sugar problem: the often cited advice to continously snack (to eat six times a day). The idea is to top up the blood sugar constantly, as to never find oneself with a dropping blood sugar level and in a bad mood. The difficulties in maintaining such an elaborate scheme are huge, however; every meal must be sufficiently small in size, and no snack time may be skipped. Add to this a growing frustration of never being allowed to eat until you are full, and sometimes having to eat when you do not feel hungry. No, a much better scheme is to actually pay attention to the signals of hunger and satiation provided by the body. On a side note, snacking increases the risk of damage to the teeth, and of constipation (the intestines signal to set to work is a full stomach).

The next patent method for maintaining a balanced blood sugar, is exercise. The blood sugar is decreased by exercise, but it is a short term effect. Exercise may lower blood sugar due to increased energy demand, but the exercise will also trigger exudation of glucagon, which in turn raises the blood sugar, an effect which is more or less substantial in different people. While some will be starving immediately after their workout, others have no problem going for hours without food – in this sense, exercise is properly considered more as a way of staying satisfied longer, than as a way of lowering an already high blood sugar level.

A different method is increasing protein consumtion, recommended by the Zone diet, among others. The general idea is to lower glycemic load. Proteins satisfies hunger well, and studies have shown a high protein consumtion to have weight loss effects. But – if you eat lots of protein, blood sugar will rise, especially so if the protein is of the quickly absorbed kind, found for instance in dairy products and egg whites. There are also drawbacks of maintaining a high consumtion of protein and at the same time keeping the fat consumtion low – this will be detrimental for the requisition of nutrients.

So what about a high intake of fat? Fat has barely any blood sugar raising effect at all, and hence the risk of a blood sugar level rising too fast and then dropping too low is drastically lowered by such a diet. Fat furthermore provides a longstanding feeling of satisfaction, but things may still go out of hand if it is combined with fast carbohydrates. The fat would signal satiety, while the carbs would trigger signals of hunger. A possible result a couple of hours after the meal is a stomach still feeling satisfied, but a brain aching for food. Our individual differences play a part here too; for some people, even slow carbohydrates will be too fast.

The low-fat version of the paleolithic diet (as made popular by Cordain and Lindeberg, among others – consisting of lean meat, fish, fruit, nuts and vegetables, but no grain or dairy) is a well working diet in the first sense, the nutritional sense (unless it is very low-fat), but it stumbles on the second criterion. The lean food in combination with the abundance of fruit and nuts easily renders cravings and feelings of unsatisfaction. (The diet is also a fairly expensive one to follow, because of the large volumes of foodstuff required, much of which being lean meat).

There are of course some diets which fail miserably at both the above tasks – neither provide enough nutrients or keep the blood sugar in check. Many official food recommendations issued by governments (such as the infamous “plate model” by the Swedish Department of Agriculture) are really designed with the aim of describing a cheap but feasible way of eating – they are not designed with the individual’s best health in mind! (This really is an essential insight whenever official food recommendations are considered.) They generally claim to take dietary requirements into consideration, but when adding up the recommendations, the result will be too few nutrients – because of too constrained fat intake.

The Weight Watcher method also fits the category of double failures. Their only goal is maximal weight loss, and whether the weight lost is only subverted muscle mass does not seem to be taken into consideration.

In my opinion, the ideal diet is a paleolithic kind of diet but with a high-fat profile. It satisfies the dietary requirements because of the fat-soluble vitamins and the nutrient dense foodstuffs, and the blood sugar level is also well maintained. If fruit, root crop, nuts, seeds and dairy are eaten sparingly and in moderation, I find that my appetite is well under control. Others may handle these foodstuff better, and some may actually need them to stimulate the appetite. You have to use a little trial-and-error to find out. Watch your cravings for hints!

A feasible diet has to work in practice too, of course, beside satisfying the two criteria listed above. This means that is has to be endurable. In comparative studies, it has been found that the drop-out frequency was significantly lower among Atkins diet followers than followers of low-fat diets, perhaps because of less tasty food and a continous struggle with cravings. The cravings induced often is what ends a low-fat diet.

I mentioned in the beginning that food which raise the blood sugar levels also causes inflammations in the blood vessels, and this increases the need of vitamins. The requirement of chrome is increased as well. In analogy with the above, if someone with too high blood sugar switches over to a Low-Carb High-Fat diet, they will require less of water soluble vitamins – such as vitamin C and folate – since the blood sugar response will drop and the need for protection against free radicals in the bloodstream will drop with it.

This means that the nutritional requirement is not a constant, it is very much depending on the type of food we eat. A diet high in unsaturated fatty acids will require more minerals and more fat soluble vitamins such as A, D and selenium, while a diet high in saturated fatty acids will require less, since the lack of double bonds in these make them more stable.

A final resume: the basic criteria of a good diet is that is provides a stable blood sugar, while at the same time not induce nutrient deficits. The nutritional requirements can be addressed in one of two ways: increase nutrient intake or lower nutrient need. The food has to be so dense in nutrients that the dietary requirements are met without overeating.