A No Carbohydrate Doctor?

Dr. Childers, I understand you are a low carbohydrate doctor.  Does this mean you recommend your patients eat no carbohydrates at all?

Stanley W.

Dear Stanley,

Thank you for your question.  I am asked this a lot.  

In fact, I do not recommend a near-zero carbohydrate diet.  The vast majority of people in the US do not eat the parts of animals that provide the nutrition needed to sustain a near-zero carbohydrate diet (raw meat, fat, bone marrow, bone broth and the guts and brain, also known as offal; the "snout to tail" dietary approach of carnivorous cultures like the traditional Inuit).  Fortunately we can derive vitamins, minerals and other dietary elements our bodies need from select animal foods (choline, so essential to health and so richly available in offal, can also be obtained from eggs and liver, e.g.) and carefully selected plant-based carbohydrate sources, which are more acceptable to our culture.

I do recommend limiting carbohydrates.  My proposed carbohydrate limit is less than 40% maximum of the daily diet, or less than 800 Calories in a 2000 Calorie-per-day diet.  America’s history suggests we began gaining weight and became mentally and physically sicker when we stopped eating traditional fats from meat, fish, poultry, eggs and milk, while increasing our carbohydrate intakes to greater than 40% of our diets, or more than 800 Calories of carbohydrates in a 2000 Calorie-per-day diet. Holding carbohydrate consumption to 40% or less of Calories should make a healthy difference.

Over the past three decades we've been so preoccupied with eliminating natural dietary fats from our diets we allowed a dietary villain, refined carbohydrate (starch and sugar, e.g.), to invade our food supply.  According to the American Heart Association the average American adult now consumes 22 teaspoons of added sugar each day.  If this sugar is consumed over and above an adult’s daily caloric requirements, 22 teaspoons of added sugars translate to a weight gain of nearly 36 lbs. per year.   The average adolescent boy consumes 35 teaspoons of added sugar, or 560 Calories per day.   If this sugar is consumed over and above an adolescent’s daily caloric requirements, 35 teaspoons of added sugars translate to a weight gain of nearly 57 lbs. per year!   Most Americans do not realize they eat so much sugar.  We are so distracted by worries over how much fat is in our food we lose sight of the added sugars pervasive in our low-fat processed foods, juices and soft drinks.  Yet research now suggests it is the sugars, along with rapidly digested carbohydrates (starches, cereals, baked goods, crackers, etc.), and not naturally occurring saturated fats from animals and tropical plants, that cause heart disease and strokes.  

We don't think of malnourishment when it comes to Americans, but in fact our wealthy nation is malnourished on a mammoth scale.  Two-thirds of Americans are now overweight or obese; once a disease of older people, Type II diabetes now affects adolescents; and fatty liver disease, once a disease of alcoholics, now affects as much as 20% of adults and nearly 5% of children:

Non-Alcoholic Fatty Liver Disease, American College of Gastroenterology

As a doctor it is my responsibility to exercise as much damage control for my malnourished patients as possible.  To this end I am specific about the carbohydrate foods I recommend.  All carbohydrates are not created equal.   Some dietary carbohydrates cause a rapid rise in blood sugars, and others do not.  Food science tried to address this problem with recommendations to follow the glycemic index or glycemic load, but these are imperfect measures of carbohydrate toxicity.   For example, fructose, a type of sugar that is implicated in fatty liver disease and metabolic syndrome, has a low glycemic index.

For my patients’ carbohydrates I promote vegetables first, and whole fruits a sparing second, with berries most recommended in the fruit category (See Laura Dolson’s Food Pyramid in the column to the right of this article).  I recommend sprouted grains; for example, in my locale Dave's Killer Bread, and Ezekiel Bread have sprouted varieties, and sprouted grain cereals are available at food co-ops and whole foods stores.  I also recommend sourdough (fermented) breads. Sprouting and fermenting are ancient methods of handling grains in civilizations surviving without benefit of modern medicine.  Prepared in this fashion, grain products are naturally lower in carbohydrates than most modern commercial breads, and lower in toxins such as phytates which prevent absorption of key minerals.  

Such grain preparations may provide some health benefits, or at least do less harm than commercial cereals, baked goods, candy, etc.  Topping such breads with real butter slows the release of sugars even further, providing added assurance that carbohydrates will digest slowly enough for the body to manage them without undue stress.

Research is scant on the subject of sprouted and soured (fermented) grains, but here are a couple of links of interest:

Effect of pre-germinated brown rice intake on diabetic neuropathy in streptozotocin-induced diabetic rats (from the journal Nutrition & Metabolism):
Pre-germinated ("sprouted") brown rice lowered blood sugars and helped damaged nerves recover in diabetic rats.


The Impact of Ingestion of Breads of Varying Composition on Biomarkers of Glucose Metabolism in Overweight and Obese Adults
Ironically, in this study whole wheat bread caused the greatest blood sugar rise, significantly greater than that of white bread.  Sourdough yielded the safest blood sugar profile.

In addition, there is strong evidence to advise my patients that, "If it rots your teeth, don't eat it.":

Dietary Carbohydrates and Dental-Systemic Diseases
Fermentable carbohydrates that rot teeth in the short term promote pre-diabetes and diabetes in the long run. Examples include sweets, crackers, soft and sticky fruits, pretzels and potato chips.