LCHF & DS

[DuodenalSwitchaRoo]

Nutrition Authority is a good place to point them. He has tons of studies on his blog.

 

[hilary1617]

I think that the Low Carb High Fat diet is probably one of the more successful diets (though I believe all diets are flawed I that they are hard to maintain for a lifetime and cause dieters to feel deprived and isolated). It's an approach I would possibly even advocate for an individual who is slightly to moderately overweight and does not require a surgical solution or doesn't qualify for same. Unscientifically, I think the LCHF diet choice is more likely than other diets (pure calorie restriction, low fat) to result in weight loss because (a) Fat is dense and satisfying and has been unfairly villified (b) there is a whole insulin/glucagon cycle creating hunger and availability to readily be stored in our thighs around the carbs that I believe are the true villains behind most cases of obesity and food addiction (e.g. why is it so hard to have just one chip?) (c) low fat usually means modified with a bunch of chemical or carb-laden additives. Still we all know most diets fail, including LCHF, so surgery is what I'd recommend to anyone who is more than just overweight (if they will be compliant with aftercare).

In a way, the DS *does* make the case for the LC part of LCHF, as we can gain if we go high carb. Are they arguing that the HF is what causes the weight loss through ketogenic effect? Maybe, but that's not what causes the loss in the DS'ers. I would think a good portion of weight loss from LCHF would come from the reduction in carbs. And that DS'ers don't rely on high fat to create ketosis doesn't mean it wouldn't work. We just rely on a different, more sustainable mechanism.

Duodenal Switch patients *benefit* from LCHF diets in (1) that we still absorb carbs like normies so we can still gain weight if we ingest too many carbs, (2) many of us develop an intolerance for grains, rice, etc., and (3) our malabsorption of fats means that we can eat high fat with impunity, and we *need* to eat more fat to have enough to meet basic dietary needs for same. So it's nice to be included in the LCHF community even if our reasons for eating that way are different.

The only hesitation I have in recommending LCHF to a moderately obese normie is (3) above. I don't think it is likely a normie (or sleever) can eat unlimited fats with impunity - even if the caloric intake from such doesn't cause weight gain there are probably artery clogging implications / limitations.

 

[Parousia]

...Duodenal Switch patients *benefit* from LCHF diets in (1) that we still absorb carbs like normies so we can still gain weight if we ingest too many carbs, (2) many of us develop an intolerance for grains, rice, etc., and (3) our malabsorption of fats means that we can eat high fat with impunity, and we *need* to eat more fat to have enough to meet basic dietary needs for same. So it's nice to be included in the LCHF community even if our reasons for eating that way are different.

The only hesitation I have in recommending LCHF to a moderately obese normie is (3) above. I don't think it is likely a normie (or sleever) can eat unlimited fats with impunity - even if the caloric intake from such doesn't cause weight gain there are probably artery clogging implications / limitations.

I agree with everything you say except the last bit. Dr Atkins was a cardiologist and did a lot of research into this. According to him cholesterol in the body doesn't come from cholesterol in food. It is created in the liver, as I recall. The cholesterol levels of his cardiac patients dropped dramatically after following his diet for awhile. One thing about fat, is that it is very filling and keeps you feeling full for longer, so chances are you will eat less on a high fat diet anyway.

 

[hilary1617]

I agree with everything you say except the last bit. Dr Atkins was a cardiologist and did a lot of research into this. According to him cholesterol in the body doesn't come from cholesterol in food. It is created in the liver, as I recall. The cholesterol levels of his cardiac patients dropped dramatically after following his diet for awhile. One thing about fat, is that it is very filling and keeps you feeling full for longer, so chances are you will eat less on a high fat diet anyway.

I think the jury on the full cardiovascular impact of eating a high fat diet is still out. Beyond bad cholesterol (LDL), there are other heart disease risk factors to consider, like inflammation (C Reactive Protein), triglycerides, and blood vessel flexibility. Many studies on these are out there, but some corroborate Atkins, some contradict, and most have small sample sizes or don't extend for long periods or don't have a perfect test v. control model where the diet is followed exactly and no cholesterol lowering medications are used... More research is definitely needed.

 

[hilary1617]

Thinking about this more, here's what I'd probably recommend to my friends in general based on their habitus/history and my experience. Dietary fat doesn't really come into the picture for me, except as a byproduct of carb restriction and high protein dietary choices.

1. Slightly to moderately overweight or not a surgical candidate: Low carb, high protein lifestyle
2. Obese with no comorbidities: Gastric sleeve followed by low carb, high protein lifestyle
3. Obese with comorbidities or morbidly obese or super-morbidly obese and able/likely to be compliant with DS protein, vitamin and follow-up care requirements): Duodenal Switch followed by high protein lifestyle

What are your thoughts? What would you recommend?

 

[shann]

That's a really interesting question, Hilary. I'm thinking of my 12 year old as I type this. I'm seriously considering recommending a gastric sleeve for him when he gets of age since he lost the genetic lottery in a big way. I don't want to introduce malabsorption at such an early age, but he's probably going to need something. My guess is that he will come into your category 2 (but will he really be able to follow a low carb/high protein lifestyle in his late teens/early 20s?)

 

[Parousia]

Hilary, I think your recommendations are dead on! :icon_thumleft:

 

[Munchkin]

Thinking about this more, here's what I'd probably recommend to my friends in general based on their habitus/history and my experience. Dietary fat doesn't really come into the picture for me, except as a byproduct of carb restriction and high protein dietary choices.

1. Slightly to moderately overweight or not a surgical candidate: Low carb, high protein lifestyle
2. Obese with no comorbidities: Gastric sleeve followed by low carb, high protein lifestyle
3. Obese with comorbidities or morbidly obese or super-morbidly obese and able/likely to be compliant with DS protein, vitamin and follow-up care requirements): Duodenal Switch followed by high protein lifestyle

What are your thoughts? What would you recommend?

I would have problems recommending anything that's purely restrictive other than a basic low carb diet. If you are going to have surgery, get the whole thing. Restriction and malabsorbtion. Here's why. If I am fat today and have been fat most of my life, I will probably only get fatter as I age and develop worse comorbidities, faster. Also as I age it's quite possible I will develop other problems that limit my mobility, ability to exercise.

If I am going to submit to surgery I want the tradeoff of looking like a normal person and being able to eat like a normal person. I CAN eat anything without getting sick or miserable. I can go anywhere and do anything without worrying about food issues. If I go to a party, there is always something I can eat. And just like a normie, I can be extra careful with my diet today because I transgressed a bit yesterday! And if I want a piece of my own Birthday Cake, I can have it. I guess a lifetime of diets taught me to despise all those restrictive regimens where I could NEVER eat anything I wanted to eat. I could live with nothing but shakes for 6 months but not forever.

I have always believed LCHF was the best diet option out there. The worst had to be LFLC. Seriously all those fake foods and franken fat substitutes can't be good for you. And seriously, who can live the rest of their lives on dry salads? At least LCHF lets you eat real foods. And you don't have to live hungry all the time. I can live with LCHF but I found LFLC to be a miserable lifestyle. And the bottom line still is that diets seldom work long term.

But this is me talking. A lifelong fat girl who still never reached a normal BMI even WITH the DS.

 

[Jo777]

The ability to eat more cals, esp fat cals is great for those that need it- and imo, many do. I needed something to deal with portions, and to get away from carbo-overload in general. I had great success on HFLC, and low cal (separate occasions) before, and knew I just OVERATE and esp on wheat-y carbs.. my metabolism wasn't broken, my appetite was.

Got the VSG, switched my eating lifestyle (Todd went along by default, and also by a super-bad lipid profile test, despite being skinny.) I now eat about 60% or higher fats by % of cals, same or higher for him by benefit of him having a bigger stomach. His lipid profile (that our great, but still pharma pushing doc wanted him on statins for) reversed. Completely. Triglycerides in the 500's, now 60 something, HDL now high, LDL dropped. Mine too.. never had a tri-issue, but my HDL to LDL wasn't good, at all... now my HDL was 99, higher than my LDL.. and both our particle sizes switched to the "light & fluffy" better one (A? can't recall).. did nothing but hugely increase all fats, keep protein moderate- not high, as the liver will process excess protein into glucose.. which effectively raises insulin, leading to all the prior issues, and eat a ton (as much as my stomach will allow) of veggies.

 

[kirstabelle]

I think the jury on the full cardiovascular impact of eating a high fat diet is still out. Beyond bad cholesterol (LDL), there are other heart disease risk factors to consider, like inflammation (C Reactive Protein), triglycerides, and blood vessel flexibility. Many studies on these are out there, but some corroborate Atkins, some contradict, and most have small sample sizes or don't extend for long periods or don't have a perfect test v. control model where the diet is followed exactly and no cholesterol lowering medications are used... More research is definitely needed.

http://www.tunedbody.com/heart-surgeon-declares-really-causes-heart-illness/