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It seems in the Paleo community people are starting to come around and not demonize any specific macronutrient, but is low carb still the best way to go for the more metabolically deranged?

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5 Answers

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initially, yes. that has been my experience and observation. if for no other reason, it lets people slip into ketosis which naturally curbs the appetite which is key for obese people who need metabolic healing.

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That's what I was going to type. +1 – Chickenosaurus Rex Aug 17 2011 at 1:15
I saw this question and thought ~paging Lucky Bastard~, so glad you answered! – sherpamelissa Aug 17 2011 at 17:13
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Those people you speak of will still tell you that low carb can be and probably is the best way to lose weight for most people and most assuredly for someone who is "metabolically deranged" (I HATE that term!) The new claim is that carbs don't make you fat but once you are cutting them to next to nothing will undoubtedly help you lose the fat. I don't buy that argument but that's their claim. Either way for some of us this particular macronutrient must remain a demon.

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i feel your pain shari. my whole life i couldn't look at carbs without gaining 5lbs :(. i'm still trying to figure out how come i was able to get myself to a point where carbs are no longer an issue and other can't. i'm starting to think that it may be related to strength training and glycogen depletion. do you do any heavy lifting? – luckybastard Aug 17 2011 at 1:19
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And I am so happy for you that it's somehow turned around for you. Life is so much nicer with some carbs to eat, lol. I do not understand how this variation you noted happens. I do exercise. I do Kettlebell as a sport and I definitely get glycogen depletion. I think you are on to something though. I should note that to maintain my weight I can go up to about 75g carbs/day but to lose I have to go under 25 or so. I am still resistant to living at 75g since I still want to lose some more weight although after years of trying it may be time to hang that idea up and move on. – Shari Bambino Aug 17 2011 at 1:41
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if you're not happy with a result you think is realistically attainable, i don't think you need to give up on it, shari. i know what it feels like to be a hard loser- especially when thin ppl are the ones telling u how to get the weight off, hahaha. i figure that if the vlc is working to get it off, then stick with it. have you considered that maybe something like an iodine deficiency could be a confounding issue? women with hypothyroid issues seem to be notoriously hard losers. – luckybastard Aug 17 2011 at 1:53
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Yknow, I used to use it a bit myself but I have really come to think that "metbolicallt deranged" is a pretty harsh and just unnecessary term. Certainly "damaged" or just a more complete description is a better way of expressing it. Deranged is just silly. – ben61820 Aug 17 2011 at 3:49
I like metabolically challenged, lol. How about metabolically differently-abled. Deranged has such a hostile, negative connotation. I'd love to know who started this phrase so I could smack em in the head. – Shari Bambino Aug 17 2011 at 6:15
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There have been many controlled experiments of fat people trying to lose weight by following different diets. The results show that a lowish-carb diet is better than the mainstream low-fat/low-calorie approach. See the review paper by Hession et al. published in 2008 in Obesity Reviews, entitled "Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities".

However, the results do not show that the lowish-carb diets were all that great. They were moderately effective for fat people to lose weight. A typical obese person on a low-fat/low-cal diet will lose around 10 or 15 pounds in the first six months and then regain some of it in the next six months, ending up only a few pounds lighter at the end of twelve months than they started. A typical obese person on the lowish-carb diets in these experiments followed a similar pattern but a little better, losing maybe 20 pounds in the first six months, but then regaining some of it so they ended up merely a couple of pounds lighter than their friends on the low-fat/low-cal diet. Disappointing!

So according to these results, while you shouldn't get your hopes up too much about following a lowish-carb diet, you should be even less enthusiastic about following a low-fat/low-cal diet. These results also show something interesting: the lowish-carbers consistently lost more excess body fat than the low-fat/low-cal'ers, even though they were (in most cases) allowed to eat as many calories as they liked.

The lowish-carbers also generally had better improvements in their blood lipid profiles, which is consistent with everything we think in paleo and/or low-carb theory and inconsistent with what they think in the (rapidly fading) mainstream theory.

Now here is where I depart from the hard experimental evidence and give you my own guesses and intuition.

I suspect that there were a host of issues which undermined the lowish-carb dieters in these experiments. If, when embarking on your own personal journey, you avoid these problems, I suspect you will have much better results than the average test subject did.

  1. Many of the test diets asked the lowish-carb diets to add carbs back in (after a certain time, or after they had lost some of the excess weight that they intended to lose). In my opinion if you have a problem with obesity and you are serious about fixing it, you should plan to stay on your new diet for at least a couple of years, if not for the rest of your life. You should at least give a major change like going to very-low-carb four or six months just to see how it works.

  2. Many of the test diets asked the participants to aim for fewer than 30 grams/day, and some even higher than that. I would advise a fat person to try "as few carbs as possible" for as long as it seems to be working for you. I would definitely suggest that you target less than 20 grams of carb per day, and the "zero-carb" approach seems excellent. In my opinion, many fat people are a lot like alcoholics, but with carbs and/or sugar instead of alcohol. (I certainly was!) If an alcoholic goes on a "moderate alcohol" diet, in which they limit themselves to one drink per day, they are going to be a hell of a lot worse off 12 months later than if they go on a "zero alcohol" diet.

    (And by the way, I think people who find themselves feeling well and doing well on a relatively high-carb diet should be a little bit careful about recommending the same indiscriminately to others. By way of analogy, you may do great with a moderate intake of alcohol, but if the person you are talking to is a recovering alcoholic then you may do them harm by persuading them that a little alcohol is a fine and healthy thing.)

  3. These test subjects were given specific instructions, which were designed to test a hypothesis, and they were discouraged from doing anything else. You will, of course, experiment on yourself, do more of what seems to work well and less of what doesn't. You'll also feel free to combine multiple kinds of dietary changes and other forms of self-improvement.

  4. I would assume that most of the test subjects kept eating the low-carb industrial-era foods such as seed oils even while they reduced the high-carb industrial-era foods. I would encourage a dieter to explore the gamut of "paleo diet" principles in concert with low-carb.

  5. Similarly, I suspect that a lot of people who try low-carb are still under the impression that animal fat is unhealthy and so they avoid fatty animal meats even while avoiding carbs. We have plenty of evidence now that this is a big mistake, making the diet less healthy, less effective for weight loss, and probably inducing problems like constipation and tiredness. Eat plenty of fatty animal meat!

  6. In general, the test subjects may have been under the impression that low-carb was an inherently unhealthy and unnatural diet which they should use as sparingly and briefly as possible while still achieving their weight loss goals. Certainly many of the researchers who organized the studies believed that, and they may have given that impression to their test subjects. This misapprehension makes it harder to eat right, be happy, and live well. I would advise you that the low-carb diet you are about to start is—as far as science has been able to determine so far—a perfectly healthy and sustainable lifestyle. It offers numerous benefits apart from just losing weight. Embark on your new life with joy and enthusiasm, not with worry!

Okay, that's my answer. I suspect that most fat people can experience wonderful improvements on a diet which is very low in carb, and is also healthy in other ways, and which you intend to monitor and adapt, but also to remain committed for the long term, and which you approach with an attitude of anticipation and joy.

If you re-read this answer, notice the break between what I know from hard evidence—repeated experiment—and what I believe from various other kinds of evidence.

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Stanford did a study a couple years ago comparing four diet types ranging from high fat Atkins to low fat Ornish. They found that the effectiveness of the dietary approach was related to genetics. My takeaway was that everyone did better on either diet as they increased their protein. – thhq Aug 17 2011 at 17:57
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Here's the corporate write-up for the post-study study done on the Stanford research. I am a huge believer in genes and gene expression affecting our health, but I'm also deeply skeptical that we're anywhere near knowing enough to make the kind of confident assertion Interleukin seems to be making here. I'd love to know exactly what the "low-carb" genotype consists of: ilgenetics.com/content/news-events/newsDetail.jsp/… – Rose Aug 17 2011 at 18:24
thhq and Rose: thanks for bringing it to my attention! I see that they contacted subjects who had previously completed the "A to Z Study" and sampled those people's genes. Very interesting! But it looks like they didn't publish it for peer review, just reported on it at a conference and put out this press release. Is that right? Are there more details about this somewhere than just this press release? That press release omits critical details, like what they meant by "a genotype matching a diet". – zooko Aug 17 2011 at 21:15
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P.S. But yes, like Rose I'm skeptical that we can really rely on this information. The most reliable information at this time is that low-carb dieting is the healthiest way to lose excess weight. Of course there are a lot of unanswered questions about that, and of course it is possible that something else would be better, but we don't yet have reliable scientific evidence about something better. – zooko Aug 17 2011 at 21:17
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Paleo adherants are being more friendly to higher carb because we're all no longer glucose addicted, and are instead ACTIVE and FIT, so we can reintroduce more carbs into our diet without issue. But in order to get to this point, we all needed to start off as low carb!

Paleo is definitely low carb and should always remain that way.

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After you're not metabolically deranged, there's no point in low-carb paleo. In fact, some people can't do low-carb (IMO). Most paleo adherents now take a stance of "real food", not worrying about the carbs. It's about specific needs, not general recommendations. – Jake Aug 17 2011 at 9:03
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During the period of my metabolic derangement (8 A1C and 200 fasting blood glucose) I restricted all carbs. I eliminated the high glycemics completely - white rice and the dry breakfast cereals of any kind were the worst. The ultimate solution to recovering insulin sensitivity was getting my weight down, but that took months. Eliminating high GI carbs got blood glucose down in less than a week.

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