Books

1. Good Calories, Bad Calories by Gary Taubes.  This is the most important book written on nutrition since William Banting wrote Letter on Corpulence in 1863.  I’ve heard rumors that Taubes wrote this book specifically for physicians who notoriously get poor nutritional training in med school.  I think it should be required reading for every medical student today.  It is a long read, but worth it (If the size of the book is too intimidating, then read the slimmed down version Why We Get Fat).Taubes meticulously documents the last 150 years of nutritional study starting with Banting and ending with the ill-fated decision to make the Low Fat, High Carb diet the official recommendation.  This led to the disastrous “Food Pyramid” and, later, “The Food Plate” (which is no better).  This was the first time the government took an official position on diet.   He does a great job debunking the cholesterol myth and also explaining the pathophysiology on what really causes obesity–insulin.  He also touches on other ailments felt to be related to high carb diets, including cancer and alzheimers disease. 

2. Why We Get Fat by Gary Taubes.  An easier to read version of Taubes’ treatise Good Calories Bad Calories.

3. The Art and Science of Low Carbohydrate Living

Jeff Volek, PhD, RD and Stephen Phinney MD, PhD have a combined 50 years of clinical and research experience in the area of diet and nutrition. I had a chance to sit down and read their book The Art and Science of Low Carbohydrate Living.  I had heard great things about the book, but after reading it, it far exceeded my expectations.  I put this right next to Gary Taubes’ Good Calories, Bad Calories as must-read nutritional material for any healthcare professional who is serious about counseling patients on proper diet.  Volek and Phinney are upfront with the fact that they wrote this book for physicians, although anyone with an interest in diet and the scientific evidence will do themselves a service by picking up a copy and reading it.  One thing that sets this book apart from the others is that it is self-published.  Volek and Phinney were able to write the book exactly as they wanted to write it without a publishing editor interfering with their message.  For that reason you may not find it in the bookstore, however it is available on kindle.

There is an open letter to physicians from Jimmy Moore towards the back of the book.  I would read this first.  In his letter, Jimmy openly describes his struggle with his weight and his diet.  He was successful in losing weight using the “calories in/calories out” approach.  But he describes it as pure torture and it took every ounce of will-power he possessed.  In the end, that approach failed him (as it so often does).  Fortunately, Jimmy soon discovered the LCHF approach and he was able to successfully heal himself by eating real food without feeling hungry.  That propelled him to become a courageous leader in the low carb approach. On behalf of patients who struggle today with weight and other carbohydrate related problems, Jimmy urges physicians and other healthcare professionals to review the evidence and include low carb in their treatment options.

The beginning of the book discusses the history of low carb eating.  It includes an exploration of aboriginal culture including the Inuit, Lakota and the Masai.  These cultures thrived on LCHF diets for millenia.  The most detailed history comes from Harvard-trained anthropologist Vilhjalmur Stefansson who studied the Inuit culture in the early part of the 20th century.  This complements the history that Taubes details in his books.  It is important to note that these cultures were free of most modern disease until their cultures were introduced to refined sugar and refined grain.

Volek/Phinney then go on to discuss the more modern history of diet and nutrition.  There is mention of Ancel Keys (would a nutritional book based on science be complete without mentioning him?) and his role in the decision to incorrectly recommend the low-fat diet. They highlight low carbohydrate iconoclasts like Robert Atkins, Mike and Mary Dan Eades, and Richard K. Bernstein.  

One of the more wonderful chapters in this book discusses the most common concerns regarding low carb eating.  Claims such as “carbs are essential”, “the fear of dietary fat”, “Confusion about ketosis”, “The confusion about saturated fat and cholesterol”, and “Moderation madness” are included, along with several others.  

They discuss modern dietary culture: “Who rules our thinking about dietary principles? Is it the academic nutrition community (aka, scientists)? Doctors? Dietitians? Agri-business? The US Department of Agriculture? We don’t have a definitive answer to this question. But if we look objectively at where the money and power lie, there is little doubt that culture, industry and government are complicit in the subjective decision to discount the science supporting low carbohydrate diets.”  They go on to devote a chapter to what you should think when doctors or dietitians state that humans need to eat a lot of carbohydrates — they believe this is based on culture rather than science.  

The majority of the information in this book is included in the section titled “Physiology” and “Clinical Applications.”  This is the science, and all of the references are included in the back of the book for those who are interested.  I hate to do an injustice here by paraphrasing, so I will refrain.  There is a thorough and detailed discussion on basic human energetics and fuel partitioning.  Topics include insulin resistance, cholesterol/lipoprotein effects, effects on fatty acid metabolism, body composition, physical performance, and personalized nutrition. Also included is a chapter on the clinical use of low carb diets.  Metabolic syndrome and Type-2 Diabetes are addressed specifically.   The concept of “carbohydrate intolerance” is introduced. This is an important concept – whether you are overweight or not, many of us are carbohydrate intolerant.  They stress the importance of dietary fat in long-term maintenance of your health and well-being.

The book wraps up with some of the authors’ favorite recipes and some clinical pearls of wisdom.  There are 3 guest chapters.  The first is Dr Eric Kossoff, MD who writes on low carb diets in seizure control and neurologic disorders.  Jacqueline Eberstein, who was Dr. Atkins nurse for 30 years, writes a wonderful chapter on the guru himself.  The book ends with the open letter from Jimmy Moore entitled “Dear Doctor.”  

If you are serious at all about learning or teaching low carb nutrition, than this is a must-read book.  Check out the references.   It is one of those books that you will read again. I know I will.

4. The Paleo Solution: The Original Human Diet by Robb Wolf.  A student of Loren Cordain (a leader of the Paleo movement), Wolf writes an outstanding book on how our ancestors ate, and why we should consider eating the same way.  The Paleo Diet is one form of the Low Carb diet; it eliminates sugar, wheat, corn and dairy (for what it is worth, I eat a modified Paleo diet – I do include dairy).  For many, this is an easier way to approach LCHF (you don’t have to worry about “counting carbs”).  Even if you aren’t interested in eating this way, I think the book is worth reading! Note: Wolf will be the headline speaker for 2013 Low Carb Cruise

5. Wheat Belly by William Davis, MD.  If you think that you can eat a healthy diet by eliminating sugar only, think again. Davis examines the effects of wheat on our health.  He explains how the wheat that we eat today is not the same wheat that was eaten 50 years ago.  Modified to be a high yield wheat, modern dwarf wheat hardly resembles Einkorn wheat (the wheat believed to be eaten during Biblical times) which is not available today.  The gliadin protein in modern wheat binds to opiate receptors in the brain.  In addition, 2 slices of modern wheat bread results in a higher blood sugar spike then  2 tablespoons of table sugar!  Also, wheat is put into EVERYTHING now as opposed to 30 years ago. Clearly, wheat is not good for my young pediatric patients when it comes to their BMI or their behavior!

6. The Omnivores Dilemma by Michael Pollan.  I don’t agree with everything that Pollan believes regarding diet (in other books he overemphasizes eating more “plants” which is high-carb), but this book is a must-read.  He does a wonderful job explaining how corn has taken over our food supply.  Remember, corn is a grain, not a vegetable.  Once refined, corn is as bad as wheat in terms of blood sugar spikes.

7. The Cholesterol Delusion by Ernest N. Curtis MD. Dr. Curtis does a masterful job of explaining why cholesterol has no bearing on heart disease. Why have physicians and patients been led to believe in this faulty theory?

Comments

  1. concerned mom says:

    You’ve said that trigs versus ldl are key, but isn’t overall cholesterol still a factor?

    Another doc answer the following questions (and I repaste the answer for your review.

    1) Which is the biggest indicator of problems or risk?
    * The Total Cholesterol number or,
    * The ratio of LDL/HDL

    Both are associated with cardiac risk. However, the LDL/HDL ratio is
    a bigger indicator. The components of a measured total cholesterol
    (LDL, HDL, triglycerides) includes HDL (“good” cholesterol) which
    correlates inversely with cardiac risk.

    From Best Practice of Medicine:
    “Although useful in screening large populations for dyslipidemias,
    serum cholesterol cannot be considered the sole measure of risk for
    CHD attributable to serum lipids. This is based on our current
    understanding of lipoprotein cholesterol subfractions and the
    availability of standardized laboratory methods to measure them in
    clinical practice. Serum total cholesterol tends to index
    low-density-lipoprotein (LDL) cholesterol, which varies directly with
    CHD risk (Figure 6) and is considered atherogenic.
    High-density-lipoprotein (HDL) cholesterol varies inversely with CHD
    incidence and is considered anti-atherogenic or protective.”

    http://merck.micromedex.com/bpm/bpm.asp?page=CPM02CA335§ion=report&ss=2

    Here is a definition of the LDL/HDL ratio:
    “Another ratio is LDL/HDL. The LDL/HDL ratio is actually a more pure
    ratio than total cholesterol/HDL. Because LDL is a measure of bad
    cholesterol and HDL is a measure of good cholesterol, whereas the
    total cholesterol is the sum of HDL, LDL, and the VLDL. Yes, adding up
    the HDL, LDL and VLDL makes up the total cholesterol measurement.”

    http://my.cardiovalens.com/featured/featuredisplay.asp?featureid=155

    The data from studies suggests that the LDL/HDL ratio is more
    predictive of cardiac risk:
    “Data from the Lipid Research Clinics and the Framingham Heart Study
    suggest that the total cholesterol (or
    LDL-cholesterol)-to-HDL-cholesterol ratio may have greater predictive
    value for CHD than serum total or LDL-cholesterol . . . In contrast,
    serum total or LDL-cholesterol did not add independent predictive
    value to the ratio.” (1)

    2) How is the Total Cholesterol number calculated?

    This is derived from the Friedewald formula for LDL cholesterol:
    LDL-cholesterol = Total cholesterol – (triglycerides/5) –
    HDL-cholesterol

    Thus, doing some basic algebra:

    Total cholesterol = LDL-cholesterol + HDL-cholesterol +
    (triglycerides/5)

    3) What may be some valid reasons for why a Total Cholesterol Number
    (say
    286 but an extremely low ratio for LDL to HDL, say 1.2, a ratio that
    places
    a woman in the 1/2 average risk range) might cause an insurance
    company to either rate up or deny coverage – based on the Total
    number without regard to the low risk ratio?

    I cannot say for sure since I don’t work for any insurance companies,
    but I can hypothesize it is because of the triglycerides. What is not
    accounted for in a LDL/HDL ratio is the triglycerides (i.e. fat
    content in the blood). Even though the ratio is low, the fact that
    the total cholesterol is high suggests that the triglycerides are
    high. High triglycerides are a negative predictor of cardiac risk.
    From UptoDate:
    “Hypertriglyceridemia is associated with an increased risk for
    cardiovascular disease . . . In the Physician’s Health Study, the risk
    of myocardial infarction (MI) was highest among men with the highest
    tertile for both triglyceride and the TC/HDL-C ratio.” (2)

    From Best Practice of Medicine:
    “Data from several studies, including the Framingham Study, suggest
    that serum triglycerides may be important predictors for CHD in men or
    women, but not consistently in both sexes. Despite these observations,
    the current consensus holds that elevated levels of serum
    triglycerides represent a risk marker for obesity, glucose
    intolerance, and low HDL levels, all of which confer risk for CHD and,
    to the extent possible, deserve preventive attention.”

    http://merck.micromedex.com/bpm/bpm.asp?page=CPM02CA335§ion=report&ss=2

    Please use any answer clarification before rating this answer. I will
    be happy to explain or expand on any issue you may have.

    Thanks,
    Kevin, M.D.

    Internet search strategy:
    No internet search engine was used in this research. All sources were
    from objective physician-written and peer reviewed sources.

    Bibliography:
    1) Kinosian, B, Glick, H, Garland, G. Cholesterol and coronary heart
    disease: Predicting risks by levels and ratios. Ann Intern Med 1994;
    121:641.
    2) Stampfer, MJ, Krauss, RM, Ma, J, et al. A prospective study of
    triglyceride level, low-density lipoprotein particle diameter, and
    risk of myocardial infarction. JAMA 1996; 276:882.

    Links:
    Best Practice of Medicine – Cardiac Risk Factors

    http://merck.micromedex.com/bpm/bpm.asp?page=CPM02CA335§ion=report&ss=2

    Cardiovalens.com – Cardiac Risk Factors

    http://my.cardiovalens.com/featured/featuredisplay.asp?featureid=155

Trackbacks

  1. [...] The political pundit recently commented about his weight loss by eliminating wheat.  If you read a couple of books from our list, namely Wheat Belly and The Paleo Solution, you know why this is important.  2 [...]

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