Carbo Libre is a friend of a health care provider who is giving introductory dietary modification classes to patients with metabolic syndrome. He has asked me to provide some information for the alumni of those classes so they can review class material and in case they lose their paperwork.
Once again, a big fat disclaimer has to be said: this blog does not provide medical advice, only general information. If any reader needs medical advice, they should consult their physician. This handout is provided for the convenience of patients who have already received medical advice on a one-on-one basis.
All credit for this handout belongs to Dr. Eric Westman of Duke University, who wrote the last edition of the Adkins book and who has been a leader in low carbohydrate dieting, weight loss and reversal of metabolic disease for decades. Go to his website if you would like to be really enlightened.
All mistakes are mine.
To good health!!
Yours Truly:
Carbo Libre's MD friend.
“No Sugar, No Starch Diet”
Introduction:
This diet is low in sugar and carbohydrates. It may also be called a “keto diet”. Starches and plants, when digested and absorbed, do so and act as sugar and should also be restricted. This diet is about eating “real food”, stressing meat, fish, fowl, cheese and some vegetables. This diet will provide all the nutrients your body needs and will allow you to start burning fat.
Sugars and starches are also known as “carbs” and are usually measured in grams. Carb intake in this diet will be kept below 20 grams per day. Any food that has carbs will be avoided in this diet. This includes bread, sugar, fruits, flour, pasta and any other food, natural or artificial, that has carbohydrates. This diet will cut back on hunger, reverse hormonal abnormalities and allow weight loss.
Medical supervision is wise when starting this diet. Especially if you are taking medications. We will support you during transition to this diet and hopefully guide you in eliminating prescription medications, as your health and metabolic profile improves.
Side effects of Keto adaptation:
As you transition to low carbohydrate diet, a condition commonly known as the “Keto Flu” may occur. This is a period of adaptation in which patients may experience headaches, dizzy spells, muscle cramps, constipation and overall decrease in well-being. This is secondary to hormonal changes, fluid and electrolyte loss, and withdrawal from carbohydrates. "Keto Flu" can be considered the withdrawal syndrome of carbohydrate addiction. This next section will help you handle these side effects.
Constipation: this occurs almost universally. Decrease in fiber intake, new and unfamiliar food and fluid shifts are responsible. This is completely avoidable. 2 tablespoons of milk of magnesia before going to bed will correct the problem in a couple of days. As bowel movements become more loose, you can taper back to maintain desired regularity. If you have experience with other stool softeners feel free to use them, but for many other reasons, Milk of Magnesia should be the laxative of choice.
Headaches, dizzy spells, and palpitations: these are secondary to loss of fluid and electrolytes. As you transition to a low carb diet, a lot of fluid, along with electrolytes will be lost in one's urine. Rapid weight loss may be noted as well, though it will be mostly water weight. The first line of defense is to increase intake of salt in your diet. Your salt shaker will become your best friend. Do not be afraid to salt your diet liberally. Drinking a cup of bouillon with every meal will also replace electrolytes and fluid. Maintaining good hydration is also important, but let your thirst be your guide. As you replace sodium, thirst will increase to maintain normal fluid and electrolyte balance.
Muscle cramps: these are secondary to Magnesium depletion. Taking Magnesium supplements every morning will correct the condition. At least 2-3 tablets every morning when starting diet will help. If cramps occur even with morning supplement, take 2 additional tablets when cramps occur. As keto adaptation progresses, magnesium level will become stable and cramps will fade away.
Do not accept “Keto Flu”. It is preventable by following these above mentioned simple rules.
Other “side effects” of keto adaptation: some patients may notice a change in their breath. It may smell somewhat sweet. Some patients consider it bad breath. If it happens it only means your body is burning fat. If one is distressed by it, feel free to disguise it with sugar free mints, more frequent teeth brushing, or sugar free gum. Sugar cravings are very common. Most patients switching to this diet are sugar addicted. Using artificial sweeteners, sugar free pop, or sugar free jello helps patients get through this stage. If you decide to test your ketones at home, and you are able to prove ketosis, congratulations!!! Keep in mind this is what we want. If family or friends tell you “ketoacidosis is bad” please reply that is a very different thing from ketosis. Ketosis is a normal physiological state of fat burning. Ketoacidosis is a runaway disease process of very different origin. Do not let them scare you.
Myths and Urban legends of low carbohydrate diet:
You will get renal failure from all that meat: ABSOLUTELY NOT TRUE.
Your cholesterol will go up and you will have a heart attack: ABSOLUTELY NOT TRUE.
You need carbohydrates for your brain and to stay alive: ABSOLUTELY NOT TRUE.
Answering these urban legends will take a whole post for each. I will cover those issues in the very near future. For the time being, take my word for it...
Frequently Asked Questions:
1) Do I need to exercise on this diet to help me lose weight: NO. Exercise is recommended for fitness and psychological reasons, but it is not necessary. During keto adaptation, especially if you have symptoms of keto flu, it's best to rest and relax rather than to exercise and compound malaise.
2) What happens if I “slip” up: NOTHING. Most of us will “slip” at one time or the other. Just pick yourself up and start again tomorrow.
3) Do I need vitamins and supplements?: Not really. A meat based diet will provide all the necessary nutrients you will need. If you want to take a multivitamin, make sure it is iron free, unless your doctor has you on iron supplements for other reasons. Magnesium will need replaced in adaptation period as we discussed before.
4) I need sugar for my brain: NO YOU DO NOT. This is pervasive myth that refuses to go away. We can make all the blood sugar we need from scratch. No carbohydrate is essential.
Now, lets get to the meat of this post:
NO SUGAR, NO STARCH DIET (page 4, Dr Westman)
List of permitted foods:
This diet is focused in providing your body with the nutrition it needs, in the form of protein and fats, while minimizing foods that the body does not need-carbohydrates. To be most effective, you need to keep the dietary carbohydrate at less than 20 grams per day. Your diet is to be made up exclusively of foods and beverages from this handout. It doesn’t matter how the food is cooked. Food can be cooked in a microwave oven, baked, boiled, stir fried, sautéed, roasted, fried (without flour, breading or corn meal) or grilled.
WHEN HUNGRY, EAT AS MUCH AS YOU WANT OF THESE FOODS:
Meat: beef, hamburger, pork, bacon, lamb, veal, sausage, pepperoni, hot dogs or other meats.
Poultry: chicken, turkey, duck or any other fowl. Eat the skin as well!!
Fish and Shellfish: any fish including tuna, salmon, catfish, bass, trout, shrimp, scallops, crab and lobster.
Eggs: whole eggs are permitted without restrictions.
Animal fats: lard, butter, and tallow are ok. Do not avoid animal fat. Plant based oils like coconut and olive are also ok. Fats will satisfy hunger and make you feel full. Do not avoid them, do not try to eat a low fat diet.
FOODS THAT ARE LIMITED IN QUANTITY:
Salad greens and nonstarchy vegetables. These are optional. If you decide to eat them, they have to be measured and limited as follows: Arugula, bok choy, cabbage, chard, chives, endives, beets, collard greens, kale, lettuce, parsley, spinach, radicchio, radishes, scallions and watercress: 2 CUPS PER DAY MAXIMUM!!
Nonstarchy vegetables: artichokes, asparagus, broccoli, brussels sprouts, cauliflower, celery, cucumber, eggplant, green beans, jicama, leeks, mushrooms, okra, onions, peppers, pumpkin, rhubarb, shallots, snow peas, sprouts, sugar snap peas, summer squash, tomatoes, wax beans and zucchini: 1 CUP PER DAY MAXIMUM!!
OTHER FOODS THAT ARE LIMITED IN QUANTITY:
Cheese: up to 4 ounces per day.
Creams and oils: whipping, heavy, light or sour cream. Up to 2 tablespoons per day.
Mayonnaise: up to 2 tablespoons per day.
Olives: up to 6 per day.
Avocado: up to ½ per day.
Lemon/lime juice: up to 2 teaspoons per day.
Soy sauce: up to 2 tablespoons per day.
Pickles(sugar free): up to 2 servings per day.
Zero carb snacks: sugar free jello-unlimited.
Other zero carb snacks you have to be careful regarding quantities: Pork rinds, pepperoni slices, turkey jerky, beef jerky and deviled eggs. The reason why these snacks have to be restricted is because they are either very high on calories, or because of manufacturing reasons they are inevitably spiked with sugar. I am not telling you how little of them of you have to eat, only to use them as a last resort when very hungry and there is not real food to be had for awhile.
MAIN RESTRICTION: CARBOHYDRATES.
In this diet, no sugars and no starches are eaten.
Sugars are simple carbohydrates. AVOID THESE KIND OF FOODS: white sugar, brown sugar, honey, maple syrup, molasses, corn syrup, beer, milk, flavored yogurts, fruits and fruit juice.
Starches are complex carbohydrates. AVOID THESE KIND OF FOODS: grains (even “whole”grains), rice, cereal, flour, cornstarch, breads, pastas, muffins, bagels, crackers and starchy vegetables such as slow cooked beans (pinto, lima, black beans), carrots, parsnips, corn, peas, potatoes, French fries, potato chips.
Industrial (AKA “vegetable”) oils are to be avoided: Crisco, margarine, canola, rapeseed, soybean and cottonseed. These are artificial substances originally created for lubrication of heavy machinery, not for human consumption. DO NOT USE THEM.
Salad dressings are to be consumed with caution. Most commercial salad dressings, especially if “lite” or “heart healthy” are heavily contaminated with sugar or industrial oils. If you must use a commercial salad dressing, please read the ingredient table carefully and measure portions. Using a sugar contaminated salad dressing will tip your carbohydrate content over 20 grams easily. It is best to make your own vinaigrette salad dressing with olive oil, vinegar and seasoning. Chopped eggs, bacon and cheese make for wonderful addition to salads.
Sweeteners: If you feel the need to eat or drink something sweet, you must select the most sensible sweeteners available, as long as they are not sugar. Some available alternatives are Splenda, Nutrasweet, Truvia, Sweet and Low and sugar alcohols like sorbitol and maltitol (sugar free chewing gum) Excess sugar alcohols may cause upset stomach, cramps and gas.
DRINKS AND BEVERAGES:
Drink as much as you want of water, sugar free pop and sugar free carbonated water.
Coffee and caffeinated beverages may interfere with weight loss in some patients. To be in the safe side, limit coffee intake to no more that 3 cups per day.
Alcohol is a special case. In some patients, it may be metabolized just like sugar. Therefore, it is always wise to restrict alcohol in initial phase and re-introduce it slowly, once some of your goals are met to assess your body’s response.
BEER IS NEVER OK. IT IS LIQUID BREAD!!!
IMPORTANT REMINDERS:
The following items are not in the diet: sugar, bread, cereal, flour containing items, fruits, juices, honey, whole or skimmed milk, yogurt, canned soups, dairy substitutes, catsup, sweet condiments and relishes.
BEWARE OF COMMON MISTAKES:
Beware of “fat free” or “lite” diet products, as well as foods containing hidden carbs such as coleslaw or sugar free cakes and cookies. Check the labels of liquid medications, cough syrups, cough drops and other over the counter medications that may contain sugar. Avoid “heart healthy” or “great for low carb diet” labels. All items you may buy in the grocery store that come from the center aisles, in a box, bag or can, have to be assumed to be contaminated with sugar. Anything that has shelf life, is definitely contaminated with sugar, it is a great preservative!!
When reading a label, use total carbs, NEVER NET CARBS.
NO SUGAR NO STARCH DIET REMINDERS:
“CARBS MAKE YOU HUNGRY”
“FRUIT MAKES YOU FAT”
“FRUIT IS NATURE’S CANDY”
“THERE IS ONLY ONE TEASPOON OF SUGAR IN THE HUMAN BLOODSTREAM”
“EAT FAT TO BURN FAT”
“DON’T FEAR THE FAT”
“IT MAKES SENSE TO EAT FAT WHEN YOUR BODY IS A FAT BURNING MACHINE”
“CORN IS FED TO ANIMALS TO MAKE THEM FAT”
“IT IS NOT YOUR FAULT, IT IS THE CARBS FAULT”
“YOU DON’T HAVE TO EAT EVERYTHING IN YOUR PLATE”
“EAT WHEN HUNGRY, DRINK WHEN THIRSTY”
Comments