Low Carbohydrate Living

by David Mendosa Patient Advocate

The new book titled The Art and Science of Low Carbohydrate Living can help almost anyone. But those of us who have diabetes stand to benefit the most.

The lead author is Stephen D. Phinney, who in Germany would be called "doctor doctor." He has both an M.D. and a Ph.D. degree. The co-author is Jeff S. Volek, who is a Ph.D. and R.D., a registered dietitian.

Dr. Phinney gave me set of galley proofs of the book when I had a low-carb dinner with him early last month. Since then I have been reading all 316 pages of the book and considering what to write.

The first point that I have to make is that the book is clearly written and easy to follow. This is something that I have learned not to expect from writers with doctor's degrees

The accessible writing style is just the first of several surprises in store for anyone who reads this book. It is surprisingly witty at times while being both rigorous and practical.

I have followed a very low-carb diet since 2007. Before and after going low-carb I read all the relevant diet books, including those on the closely related paleo diet.

The two reasons why I waited so long after learning in 1994 that I had type 2 diabetes was that I imagined that low-carb eating might not be safe or sustainable. My study convinced me that it was safe, but whether I could stick with the diet was a question until about the time that I wrote "Why I Low-Carb" for Diabetes Self-Management.

By now, my experience will convince anyone that this is sustainable. But I was lucky.

Essentially, I followed what Drs. Phinney and Volek call "the casual approach." Too many people start eating this way with the assumption that "anyone can use common sense to figure it out."

But low-carb eating isn't just about avoiding most carbohydrates. It is about what you do eat instead and how much of it. Specifically, what and how much fat and protein. And more specifically, what type of fat.

Here is where the book really shines. It addresses two of the most insidious dietary myths. One is that a low-carb diet is necessarily high in protein. The other is that saturated fat is bad for us.

Both myths are dead wrong, but the satfat myth causes the more grief. We need both satfat and monounsaturated fat in our diet.

The dangerous fats, Drs. Phinney and Volek write are the polyunsaturated ones. They are largely talking about the standard cooking oils, soybean, corn, canola, and cottonseed. Unfortunately, they fail to write about the advantages of those polyunsaturated oils that are rich in omega-3 that our bodies need.

But, of course, satfat is that fat most demonized by the medical establishment. Here, Drs. Phinney and Volek wisely address the social aspects of living a low-carb lifestyle.

"The ability to sustain such a low intake of carbohydrate indefinitely is synonymous with eating higher than usual amount of fat for a long, long time," they write. "The individual needs to live in a supportive social and clinical sphere. If the individual is constantly told by family, doctor, or dietitian that eating a high fat diet is dangerous, only the most curmudgeonly among us will succeed."

That's why the decision by Drs. Phinney and Volek to include a chapter by Jimmy Moore was particularly fortunate. Jimmy is one of the biggest loosers on a low-carb diet and has a great website. A couple of years ago he even interviewed me about my decision to follow a low-carb diet. Yet, a big surprise to me in the new book is the link to Jimmy's directory of medical professionals who are knowledgeable and willing to support a low-carb lifestyle. Jimmy's directory is a huge step forward to providing the support many of us need.

The existence of that directory was, I admit, a big surprise to me. Yet another surprise that I am still puzzling over what Drs. Phinney and Volek write about salt.

They write that when our bodies adapt to a low-carb diet, our kidneys fundamentally change how they handle sodium by aggressively secreting sodium.

"A continuous moderate intake of sodium is necessary to keep your circulation adequate to handle 'heat stresses' like hot weather, endurance activity, or even a hot shower," they write. "If you are eating less than 60 grams of carbohydrate per day, you need to purposefully add 2-3 grams of sodium to your daily intake (unless you are still taking diuretic medication under a doctor's direction for high blood pressure or fluid retention."

After reading Dr. Loren Cordain's The Paleo Diet, I adopted the paleo diet. But I also follow a very low-carb diet.

I literally threw out my salt shaker, just as he recommended:

"Do your body a favor and throw out your salt shaker along with all the highly salted, processed, packaged, and canned foods in your pantry," he wrote.

Those prepared foods were already long gone. I have been getting very little salt since I adopted the paleo diet.

So, I contacted Dr. Cordain. His reply left me still confused:

"Above all, listen to your body and determine what strategy works for you," he replied. " If you become hypotensive (rarely a problem in the western world) a bit more salt may help. Clearly our ancestors generally consumed a low glycemic load diet, but not necessarily less than 60 grams per day. Except for hunter gatherers living near the ocean, salt simply was not available until Neolithic times. Hence, the evolutionary template does not suggest the addition of supplemental salt to our diet under normal hunter gatherer environments. It could be that a western lifetime of a high salt/low potassium diet affects kidney function in a manner that makes it difficult to normalize function when acute changes in other dietary parameters are made."

Now, I am hoped to set up a dialogue between Dr. Phinney or Dr. Volek and Dr. Cordain and see where this works out. If they can agree, I'll let you know here.

Meanwhile, please do yourself a big favor. Get The Art and Science of Low Carbohydrate Living. Amazon.com has it available here. Digest this book completely. Then, you will be able to digest the food that will help you control your diabetes much better.

David Mendosa
Meet Our Writer
David Mendosa

David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.