Louisville Medicine Volume 60, Issue 8 | Page 21

the hunter-gatherer’s above (now more like 52%/33%/15%). That hard-earned honey helped simple sugars make up two percent of the hunter-gatherer diet. In 2013 we eat 15-30% of our diet as fructose and glucose and have gone from 100 grams of fiber a day to ten. Authors, journalists and nutrition scientists are making a strong case against carbohydrates. The pure weight loss merits of low-carb and very-low-carb diets appear to be well-founded, though the duration of success has been questioned. Journalist Gary Taubes (Why We Get Fat) and Cardiologist William Davis (Wheat Belly) have written well-researched books to suggest that almost complete elimination of dietary carbohydrate causes weight loss and other health benefits. By placing the blame on hormones rather than the lack of willpower of obese people, Taubes explains how to shift from fat storage mode to fat breakdown (bottom line – insulin is the enemy). William Davis agrees but takes a specific aim at wheat and gluten, implicating this dietary staple in diseases from acne and arthritis to diabetes and coronary disease. Jeff Volek, a dietitian, and Steve Phinney, a physician, have written many scientific articles and a few books about the benefits and apparent lack of ill effects related to carbohydrate restriction. All four authors have composed rigorous but readable books detailing the benefit of low carb lifestyles, intending to have more than a transient yo-yo diet effect on readers (our patients and …us). These are not new ideas. Many physicians remember the initially ostracized Dr. Atkins who used valid but underappreciated data to successfully convince millions of people with his first book in 1972. I have recently adopted the attainable goal of less than fifty grams of carbohydrate per day. Having lost ten pounds, I must say I feel great, do not crave starch and sugar all day, and still enjoy food as much as ever: anecdotal support for the low carb lifestyle -check. Instead of examining and describing the literature regarding weight benefits of carbohydrate elimination, I wanted to focus on whether these dietary changes would help us live longer and have less (mismatch) diseases. The authors mentioned above use the scientific literature to state their cases for health benefits beyond obesity. These can be broken up into body composition of the three major molecules: protein, fat, carbohydrate. tabolism in general clearly benefits from carbohydrate restriction. Though genetic differences can allow some people to indefinitely consume large amounts of refined carbohydrate with no adverse effects, a great deal of our patients will eventually develop what has been aptly referred to as carbohydrate intolerance. Evolution has not yet selected genes allowing the pancreas to pump out insulin for 80 years without fail. This carb intolerance is a spectrum, as we know from definitions of prediabetes to type 2 diabetes to insulin dependent type two diabetes. The physiology and the literature support low carbohydrate intake to manage diabetes in any form, and I am excited to read about a possible role in disease prevention. Improved lipid metabolism may present one of the most surprising, exciting, but potentially misleading benefits of carbohydrate restriction. Most low carb recommendations involve quite high proportions of fat. This activates an unfoun