About the Blog

“The high-carbohydrate, low-fat diet has been the longest uncontrolled nutritional experiment in history.  The results have not been good.  Perhaps you’ve noticed.”  – Jonny Bowden, PhD, CNS,  Living Low Carb

I’m a private practice Board Certified pediatrician.  I developed a special interest in diet and nutrition in 2007 after developing my own personal health problems.  It was at this time that I came to the realization that the conventional medical wisdom on nutrition (Low Fat/High Carb or Calories In/Calories Out) was making me sicker despite my rigorous compliance.  I was able to successfully turn these problems around with the help of some very special people at the ZG Zacharias Ganey Health Institute in Richmond, VA. It is one of the most successful obesity/metabolic syndrome/diabetes treatment centers in the country. Dr. Madge introduced me to the Low Carb diet.  After intensive research on the topic of diet and nutrition, I began successfully counseling the patients in my practice 2 years ago.  My goal is to teach my patients proper dietary habits that will provide a foundation for lifelong wellness.  I am married with 3 boys and all of the nutritional advice on my blog is utilized in our own home. 

Modeling good eating habits for our children is critical!  They watch every move that you make!  In addition, as the caring adult, you have more control over your child’s eating habits than you give yourself credit for!  To that end, this blog will be a mix of both evidence-based and anecdotal reports on child and adult nutrition.  I would like to keep the blog as interactive as possible.  Keep in mind that I keep a busy clinical schedule and my response to your posts, questions and criticisms may be irregular.  If you are able to provide evidence to support or refute an argument, I ask that you please do so.Finally, keeping the posts respectful to all is absolutely of the upmost importance. Thank you!

Brad Hoopingarner MD, FAAP

Please Note: All of the blog entries are written and posted by Dr. Hoop

Comments

  1. Dr. Hoop, I love your blog and I love what you are doing! I hope it becomes popular. I will be linking to it everywhere I can. I will also be asking Jimmy Moore and others to interview you for their podcasts and blogs. It’s good to get the word out that this way of eating is safe and good for children, too.

    I was also on the Low Carb Cruise. I wish I had spent time talking with you. Maybe next year! If you are on Facebook, we have several active groups there, so ‘friend’ me and get connected there. You will find a great community for networking.

    Again, thanks for starting this blog!

  2. P.S. It would be great if you could add an easy way to subscribe and also some contact info.

  3. Thank you, Becky! Peggy and I really enjoyed the cruise! We are seeing great success with the children in the office. We are excited about the added dimension of using the blog to educate our patients/families and hope the pediatrician’s perspective on this will be useful. Best, Brad.

  4. concerned mom says:

    I find the food plate disturbing and favor the Finnish food circle for good nutrition. Just because it results in adult weight loss doesn’t mean it’s good for children.

    • I’ve found the LCHF diet to be of tremendous benefit to many patients. I’ve been able to reverse both pre-diabetic and Type II diabetic patients. In addition, it has helped many others with weight problems and has improved their level of energy. What are your specific concerns?

  5. concerned mom says:

    What thinks Dr. Hoop of the below Turkish study? http://jama.jamanetwork.com/article.aspx?volume=284&issue=8&page=993

    • I took a quick glance at the study. I have a couple of concerns right off the bat. First, the intervention (low-fat) group was noted to have higher triglycerides and lower HDL. Since we know that triglyceride/hdl ratio is a better predictor then total cholesterol for atherogenesis, I am concerned about the children in the intervention group. Also, they did not specify LDL type at all (type a vs. type b). We know that small, dense LDL type B is a problem. But that type A (large, fluffy LDL) is normal and beneficial. When you put people on LCHF diets, 3 things will happen: 1. Triglycerides drop 2. HDL rises 3. LDL will either drop or rise, but LDL A/LDL B improves. The study would seem to support an LCHF diet, but I will have to look at it more closely. Thank you for showing it to me. I don’t see where weight has been analyzed, do you think this was overlooked or left out for a specific reason? Again, I will look more closely later.

      • Ok, I looked at this study. My comments above still stand. Since this study was published in 2000, it is possible the researchers were not aware of the importance of triglyceride/hdl ratio. Perhaps that is why they did not comment on it. For the same reason, that is probably why they did not run a VAP to break the LDL into subtype A and B components. Total cholesterol is a poor predictor for CVD. Half of people who have a heart attack have normal cholesterol levels. Trig/HDL and LDL subtype are better tests — and they are all driven by high carb diets.

      • concerned mom says:

        I think that you could make similar criticisms of the high HDL, low carb method, not identical, but similar. Personally, my entire family—husband, self and kids—are very healthy and thin, and we eat high HDL, but not specifically low carb or high protein/fat, rather more a mediteranean type style. It’s the latest “rage/trend” to say carbs are the killer, and obviously obesity and junk food are the killer. But, we should be skeptical of the latest trends, as we are skeptical of older trends. High HDL is no guarantee of heart health (though it’s a good sign.) People with risk factors (including overall cholesterol) should see a cardiologist, such as for a plaque scan or other non-invasive test and not rely on gimmic diets alone whether they are high fat or whatever else. There’s value to what you say, but it’s not the answer. No study I give you will be perfect, but likewise the studies you rely on are not perfect. I think the diet you recommend might be better presented as an option rather than the answer. Of course, that’s my opinion. http://www.nytimes.com/2012/05/17/health/research/hdl-good-cholesterol-found-not-to-cut-heart-risk.htmlf

    • concerned mom says:

      Well, that is a true testament, and if it works it works. I just think that for the already thin kid or for long-term this “Atkins/South Beach” sort of diet may actually not be the healthiest thing going. It seems too low on fiber (could cause colon cancer), and too low on veg, as well as overly critical of lower fat options, like skim milk, for instance.

  6. My husband and I have been doing LCHF for 4 months with excellent results. Besides the weight loss our skin & hair are glossy and my gut feels calm. Our 3 year old may also benefit from the feeling that results from of this type of eating but is this healthy for her? I am concerned about the transition from carbs and what her daycare may think of this given her age. Thoughts? Ideas?

    • Congratulations! Unfortunately, a high carb diet is based on culture and not on science. If your daycare provider has a problem with you feeding your child real food, including meat, veggies, fruits, dairy, etc. while withholding processed wheat, corn and sugar (which is not essential to the human diet), you can take the opportunity to teach them. Show them the website or the reading material! Normal dietary saturated fat has been shown to provide greater health benefit than the lowfat diet. Remind them that they are still getting some carbs in the veggies and fruit.

  7. @ concerned mom – I’m not sure what you mean by “High HDL Diet” I assume you mean “High Fat.” All of the available evidence would support that Low-Fat, High -Carb is indeed the fad diet. A Low Carb, High Fat diet is merely what our genes are programmed to eat:

    http://www.proteinpower.com/drmike/peta-cspi-and-other-menaces/are-we-meat-eaters-or-vegetarians-part-i/

    http://www.proteinpower.com/drmike/low-carb-library/are-we-meat-eaters-or-vegetarians-part-ii/

    http://www.proteinpower.com/drmike/low-carb-diets/are-we-meat-eaters-or-vegetarians-part-iii/

    Which would mean that LCHF has been a fad for about 2 million years.

    Here is another study highlighting the predictive value of the trig/hdl ratio in kids:

    http://onlinelibrary.wiley.com/doi/10.1111/j.1399-5448.2008.00406.x/abstract;jsessionid=4068ED5A99235FF66AE0B7487D9F7E86.d01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false

    Here are some other good studies. Remember that only Lchf can reduce Trig/hdl ratio (and shift from Pattern B Ldl to pattern A Ldl)

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2664115/

    http://www.ncbi.nlm.nih.gov/pubmed/14578319

    http://www.em-consulte.com/article/79798

    http://www.ncbi.nlm.nih.gov/pubmed/16054467

  8. Hi dr hoop, great blog! I have been eating low carb, but have just in the past few months started to move my whole family in that direction. Any recommendations for good low carb friendly doctors in the mid-Michigan area for adults? Id love to find a doc for myself who doesn’t think I’m creating health problems for myself because I eat lots of grass fed beef and don’t trim the fat!

  9. Also, here is the paleo physician/dietician network: http://www.paleophysiciansnetwork.com/doctors/MI

  10. Hi Dr. hoop! I love this site… Very interesting. I was able to get Dan to commit to trying this for a month. He loves ice cream and cake/brownies/cookies etc… So it will be especially tough for him. BUT, he is the one that needs the change the most. I am looking forward to trying this, but I have some questions about off limits foods. Maybe I am missing it, but what about beans? I googled and found conflicting info. , What about hummus? Onions (root veggie, right?) Quinoa?

    • Hi Shannon! Thank you! You bring up some very good questions. First, regarding beans – they can be a bit carby (again have been genetically modified for taste). Beans are not considered paleo. If you are going to go the Atkins route and count carbs, they are inccluded. If using the latter method, drop your carb to 20 grams per day and then slowly add back carbs until you achieve a desired level of weight and/or healthiness (you would have to count the carbs in the beans). The same can be said about quinoa.

      Regarding onions, go for it. They are considered paleo and are not usually consumed in amounts large enough to matter. I use onions all day long.

      Hummus is ok depending on the brand (read the labels). I’ve made homemade hummus using the paleo recipes – very delicious.

  11. Hi Dr. hoop! I love this site… Very interesting. I was able to get Dan to commit to trying this for a month. He loves ice cream and cake/brownies/cookies etc… Here are some other good information about Child Specialist in Delhi:

    http://www.helpingdoc.com/pediatricians/delhi/

    • Thank you! Nice job making that first decision – it takes 6-8 weeks and then you start to not miss it. Be sure to look at the recipes and cookbooks on other lowcarb sites as well. I hope to post some sample growth charts soon. :-)

  12. Hi Dr. Hoop, I have been reading through your site for the last couple of months and have changed my eating habits to reflect this. I have 2 sons that come to your practice and have recently had my oldest (17 yrs) cut out wheat from his diet. He has pretty bad acne and I was hoping that might help him. I have the book “Wheat Belly” and it makes a lot of sense. Our next step for him is Accutane, which I am really hesitant to put him on. Can you shed any light on what your thoughts are with this? He has not cut out carbs, just wheat carbs. He is a High school athlete in swimming right now. His acne does seem better, but I thought we would see a difference right away. He has been wheat free for about 8 days. I have also been doing the low carb high fat and have not seen any weight loss, I have actually gained a few pounds…any thoughts? I do feel better and so does my son, so I know that this is the right thing to do, just disappointed in the results so far. Any help would be greatly appreciated!

    • I don’t have a lot of experience with the low carb diet and severe acne. It makes sense to me that it would help and I am glad he is trying this approach. It may take longer than 8 days for you to see a difference. In addition I would be sure to cut out other refined carbohydrates including sugar and high fructose corn syrup. Regarding your own diet, in the beginning, waist size is a better indicator then weight itself. Weight can sometimes be a poor indicator because you’re converting fat to muscle and muscle is more dense than fat. Sometimes this can take a couple of months. It is not uncommon to see the weight loss begin to drop well after your waist size shrinks. Be sure to keep a food diary to ensure you are eliminating all refined carbs.

  13. Thanks for the quick reply! I appreciate your insight. When you say refined carbohydrates, do you mean white rice, etc? Could he have brown rice? What about oatmeal? I’m afraid he may not want to stick with anything that is too strict, so I haven’t had him limit anything except the wheat, however we are finding wheat is in so much food that you would never expect! For me, my waist size has not changed either, so in his book Dr. Davis recommends trying an iodine supplement. What are your thoughts? I have had trouble losing weight in the past 5 years and have had my thyroid checked multiple times and every time they say it’s normal, but I wonder because I do have some of the symptoms of iodine deficiency. Do you have any thoughts on that? Thank you so much for this blog, it’s incredibly helpful!

    • I cannot give patient specific advice, but I will say this: If you are not seeing the results that you are looking for, be sure to do a couple of things:

      1. Keep a food diary for yourself and/or family member. This may seem unnecessary, but you would be surprised what gets missed or “left in” a low carb diet. I’ve done this myself and found it to do be extremely valuable.
      2. Although refined wheat is important to remember, any refined carbohydrate can be detrimental depending on the carbohydrate tolerance of a specific individual. I would look at the “Getting Started With LCHF” link as well as the “Food Choices” link to get a more complete overview of what a Low Carb diet should exclude.

  14. Hi Dr, Hoop. I have another question for you. I went to see my Dr. recently and she is very against this type of eating style. She says a balanced diet is healthier and says low carbohydrate diets are not good for you at all. I am still inclined to believe your way of thinking because of the obesity epidemic in our country and the general ideas behind it just make sense to me. Why are some physicians so against this?

    • I am asked this question often. I cannot speculate on why your physician believes what she believes. I can tell you that nutritional science is undergoing a paradigm shift based on extremely persuasive scientific evidence. That is what leads me. Based on the science, the old methodology – “Calories In, Calories Out” or “Low Fat Diet” – has failed. I would encourage you to read on your own – in addition to the books I’ve listed on my blog, I would also read Robert Lustig’s “Fat Chance” which just recently came out a few weeks ago. If you do indeed follow a Low Carb approach and you succeed, I would encourage you to let your physician know. You could also provide her with the materials. This can be done in a respectful manner and it certainly would provide her an opportunity to review the evidence.

  15. Thank you Dr. Hoop, your responses are much appreciated!

  16. One more question…my physician also said that if you go on a low carb diet and lose weight you will gain it all back as soon as you start eating carbs, even low glycemic ones. Do you have any experience with that?

    • Yes, I do have experience with that. Please see the example growth charts I’ve posted on my blog.

      “if you go on a low carb diet and lose weight you will gain it all back as soon as you start eating carbs, even low glycemic ones”

      I have a couple of thoughts on this statement.

      1. I don’t take my patients off of carbs. I take them off of fast carbs and keep them on slow carbs (the most carbohydrate sensitive patients, I will limit even the slow carbs). So there is no “stopping” and “restarting.”

      2. In terms of gaining weight back, I would ask where that information came from. Was it anecdotal – in other words from a patient or a friend (or 2 or 3)? If so, how can we be sure what diet the patient is actually following? Did they truly stay on a slow/low carb diet or not? I have patients who are honest with me when they slip or are not compliant with the low carb diet. At the same time, I am sure that I have patients who are not completely honest. So, as you can see, this information is useless.
      Did the information come from a study? If so was this an observational study? Did it use food frequency questionnaires? If so, than if you’ve read my posts on observational studies and food frequency questionnaires, you know this information is useless as well. Was the study a Controlled study? In other words, the patients were randomized and their low/slow carb food intake was rigorously controlled? This would ideally be the best information. If so, please have her forward me the study.

      3. There is the issue of “weight” – which, in the end, is essentially a meaningless number. Remember the term “density.” That means everything. Fat is less dense than muscle. BMI gets you closer – but this too is not completely accurate. So when “weight” changes, what caused this? Was it a change in body fat? If so, was it subcutaneous or visceral fat? The latter being more important for overall health. Was it a change in muscle tissue? This would add weight and change BMI, but it would not change appearance (except for the better!). In the end, I believe waist circumference gives us the best measure (it gets use closer to visceral fat). Dietdoctor.com discusses this recently in a post (see #4 – measure your progress wisely) http://www.dietdoctor.com/how-to-lose-weight. In addition, Dr. Robert Lustig discusses this in his new book “Fat Chance.”

      I will finish by sharing an example, myself. I started low carb 4 years ago. I was out of shape, tired, low on energy – you name it. Within 3-4 months I lost about 25 pounds. At the same time, my pants size went down 2 sizes. I had to throw out my pants. In addition, I had to go buy smaller belts. After that, I was gradually able to tighten the new belt further. Now since then, I’ve gained about 20 pounds back. However, I’m still pulling the belt just as tight and my smaller pants still fit. When I look at pictures from 4 years ago and compare them to pictures now, I still look skinnier. So what explains the 20 pounds? That is likely muscle gain. I know that I’ve not gained the visceral fat back. I feel much more energetic and overall, “healthier.” Yes, this is anecdotal, but I hope it reassures people who are going through a similar experience.

      Some of my teenage patients will come back into the office for follow up visits. At times, their overall weight has not changed. This occasionally brings them to tears until I ask them what has happened to the belt size or waist size. Then there is a pause, the tears stop, and they start to laugh. This is because they did not stop to think about the waist size. In the case of a teenager, the lack of weight change may result from increasing height as well as a change in the muscle/fat composition.

      Fred Hahn writes about this as well:

      http://slowburnfitness.com/weight-lift-to-lose-weight/

      I hope this helps

  17. Thank you! You gave me a lot to think about and a lot to research. I appreciate your time.

  18. Hi Dr. Hoop – this is a fantastic blog! I’m a pediatrician in Canada and my colleague and I have recently switched to the Paleo way of eating. We decided to blog our journey, trying to figure out how to make it work for our kids as well as ourselves. I’ve never had much exposure to blogs, but now that I’m searching them for recipes, I’m delighted to see how many people are getting on board with this lifestyle. It has made a huge difference for me already, and I’m so thrilled to find a like-minded colleague who can speak to the longer-term benefits. I am curious what are they ways in which your diet differs from the Paleo diet? Thanks for taking the time to blog, and for including so many great resources!
    Dr. Laura Gerber (www.paleopeds.com)

    • Thank you Dr. Gerber! I am excited to see fellow pediatricians/physicians getting involved with this dietary lifestyle and talking openly about it. On my blog I tend use “paleo” and “low carb” interchangeably which, I admit, I probably should not do. I personally eat a modified paleo diet in that I include dairy. Certainly some people choose not to do this due to intolerance or otherwise. I too, feel much healthier overall. When I talk to my patients/families I stress the importance of removing refined wheat, sugar, corn, soy and vegetable oils. With regards to dairy, I leave that up to them but urge them to use whole milk if they include it. During my consults, I aim to overcome the fear of normal saturated/monounsaturated fat. Most of the families are very receptive to this. The early middle school and older kids tend to show a lot of enthusiasm!

  19. Hi doc,

    I am a pediatrician in the South whose eyes were recently opened to the potential of LCHF in treating pediatric obesity. I have read through your blog and I really admire how you are pioneering this in children. I have a question for you: do you counsel your patients to count their carbs, or just eat within general guidelines? If they are counting, what count do you use as a starting point? Do you do an induction-type phase?

    Thanks for leading the way!

    • Hi! Thank you for your response. My approach is to encourage my patients to eat within the guidelines. In the very beginning I tried to teach carb counting but it was, in my opinion, too complex especially for the teens. It may very well have been my teaching style that was the problem. I soon switched over to advising “Foods to Avoid.” I let them know that if they can follow the advice 80-90% of the time, they will be successful. This is true for all but the most carb sensitive kids. In the end, I don’t think either approach – carb counting vs. pure refined carb avoidance – is superior over the other. I think the most important factor in success is that the health professional should firmly believe in the low carb approach because the patients/families are more likely to follow the advice. Have a good day!

  20. Dr. Hoop,

    I am looking for a new doctor for my sister, who is disabled and lives in Dearborn. She is pre-diabetic, is on tons of meds, and her doctor has her on a “low sugar” diet. I put the words “low sugar” in quotation marks because she is still eating upwards of 200 grams of carbs in the guise of bread, potatoes, orange juice, cereal, etc. The only things they’re limiting are cookies, ice cream, cake, etc.

    Might you be able to recommend a “low carb” doctor in the area of Livonia, Dearborn, Wayne, Westland, Farmington, Ann Arbor? Anywhere in that general vicinity?

    I live in Maine and trying to find her a new doctor from 1,000 miles away is rather difficult.

  21. What is your opinion on lchf in younger children (6year old)? Is there any evidence you know of that suggests a stunt in growth due to lower carb intake or the opposite? Thanks!

    • No! Isn’t that most frustrating?! There have been no well controlled trials for the low-fat diet or the low-carb diet in children. Of course, we know that the American Academy of Pediatrics fought the low-fat guidelines as long as it could – until 1998 before adopting the guidelines under social/political/financial pressure. There certainly was not any scientific evidence to support the AAP low-fat recommendations. The AAP was extremely concerned about the absence of any trial data on children before the guidelines became the official public health recommendation. So the low-fat public health recommendations, in essence, are one big uncontrolled study. I’m sure you would agree that the results have not been good. For what it is worth, there were never any adequate trials performed in adults prior to low-fat public health recommendations.
      With regards to LCHF (or Real Food or food with normal amounts of saturated fat), we know that prior to the USDA food pyramid children were growing normally. Since saturated fat has been significantly removed from our food supply and replaced with trans fat/increased refined carbs/vegetable oil, our children have not been growing normally. With regards to limiting carbohydrates, an understanding of basic physiologic principles with regards to macronutrient metabolism certainly is reassuring. From a scientific point of view, it would appear that low-fat proponents have really painted themselves into a corner.

      • Also, I am seeing WONDERFUL results in my office with Real Food/LCHF with children of all ages! Including those under 6! 😊

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