The Truth About Carb Cycling

This week I had an interesting conversation with a patient who was having trouble losing weight.  She was eating right and exercising and STILL the stubborn pounds wouldn’t budge.  She asked me if I had heard of carb cycling and what was my opinion about it.

I had to admit I’d never looked into the concept of carb cycling, but since she asked I started digging.

Carb cycling is a weight loss technique promoted by Chris and Heidi Powell, the duo behind Extreme Makeover, Weight Loss Edition.  I’m skeptical of anyone who states someone can or should lose 300 pounds in one year, but I gave it a look.

In his book Choose to Lose, Powell describes a food program that alternates days of eating plenty of healthy carbohydrates with days of eating almost no carbs.  Healthy carbs are foods like oatmeal, fruits, root vegetables, beans, whole grain breads and pastas, NOT processed starchy foods.  Both high and low carb days have lots of non-starchy veggies and protein, and on low-carb days you add small servings of healthy fats like avocado, nuts and seeds.  It involves sensible calorie restriction, targeting intake 500 calories per day below the body’s needs.

The concept of carb cycling seems like is a sound one.  Your body needs carbs for energy and to produce glycogen for muscle and liver function.  Your brain uses 600 calories per day of pure glucose, which is most easily produced from carbs.  However, carbs also stimulate production of insulin which promotes fat storage and weight gain.

Anyone out there who has tried a low-carb diet (You know you have!  I tried it too.) knows that while it’s great for appetite suppression and initial weight loss, it is very difficult to exercise and really tough to maintain.  Cravings are a big problem after a short time on a low-carb diet, and fatigue and brain fog (due to low blood sugar) are limiting factors for many people.

In principle, carb cycling would be safe from a medical standpoint.  The Powells certainly have lots of testimonials of people who have had major success with this diet plan.  I couldn’t find any research published validating or refuting the plan’s design.

I found a few things that may explain some of the success of the plan apart from the concept of carb cycling.  First, there is a robust exercise program included.  The plan encourages 9 minutes of HIIT 5 mornings per week and 30 minutes of aerobic exercise 5 days per week.  Also, the plan strongly discourages any type of junk food and alcohol except during “reward days” or “reward meals” (depending on which plan you choose).

If I could get my patients to exercise 5 days per week, incorporating both HIIT and aerobic exercise, AND give up alcohol and junk food, they would lose weight.  Period.  So I wonder how much of the success of the Powells’ clients has to do with just those two provisions BEFORE adding the carb cycling concept.

If you are trying to lose weight and are not seeing success, or were having success and are now stuck, by all means give carb cycling a try.  I checked, Choose to Lose is available from the Cuyahoga County Public Library both in paper copies and through the Overdrive app.

Whatever weight loss method is right for you, remember to be sensible and patient with yourself.  You didn’t get to your current weight overnight, and it’s going to take time to get the pounds off.  Rapid weight loss (more than 2 pounds per week) has its own set of risks so take it slow and steady.  Love your body, enjoy your journey to health, and remember it’s a marathon, not a sprint!

QUESTION: Have you heard of carb cycling before now?  Have you tried it?  What was your experience?


Lessons on Patient Safety

We had a great turnout this morning for UH Parma’s Quality and Patient Experience Conference.  A number of doctors and nurses, Board members, residents and medical students, as well as a number of members of the hospital and UH administration.

One big initiative at University Hospitals (and throughout the country) is to take a close look at patient safety.  Medical errors are a huge problem and the subject of intense scrutiny.  Because people are human and medicine is a human endeavor, it has been thought for a long time that medical errors are not entirely preventable.  Lately the thinking has shifted to an opinion that by building systems that include layers of checkpoints to catch mistakes, it is possible (and necessary) to prevent medical errors.

There was a lot of discussion today about how keeping patients safe while treating them will be taken into account when determining payment for medical treatment.  Doesn’t that make sense?  All else being equal, those doctors and hospitals that have excellent patient safety records should be rewarded.

I had 3 big takeaways about patient safety from today’s conference that I wanted to share with you.

Everyone’s responsibility

The first point was that patient safety is EVERYONE’S responsibility.  From the doctors and nurses to the dietary staff to the custodians, everyone contributes to safety and any person who notices a problem has a responsibility to speak up.  We also have a responsibility to listen to each other if there is a patient safety concern.

It’s important to realize that patient safety also relies on the patient.  If you or a family member is seeing the doctor or in the hospital and something doesn’t seem right, it is your responsibility to speak up, ask questions, and clarify the situation.  The days of thinking the doctor is always right and trusting that the medical system knows best are definitely over.

Make sure your team knows your medications, ALL your history, your habits and preferences.  Don’t assume something is unimportant.  If you had surgery when you were 3 years old, include it on your history.  If you are a recovering alcoholic and sober for 20 years, include it on your history.  (And you rock, by the way!)  If you’re SUPPOSED to be taking thyroid medicine but ran out a month ago and haven’t got around to getting it refilled, let us know that.

Building systems and checklists

Medicine is often compared to the airline industry in terms of complexity and the level of risk.  Makes sense, right?  If an airline mechanic screws up the plane might crash.  If a pilot makes a bad decision the plane might crash.  Many, many people have to do their job right to match a safe landing to every takeoff.

This comparison isn’t perfect.  After all, when was the last time a 747 decided to do a barrel roll during a nice orderly landing?  Airplanes can’t decide not to take their medications or eat food that’s not good for them!

However, what pilot would think of taking off without going through the preflight checklist?  There are procedures for speaking with the control tower, taxiing, takeoff, routing, landings, etc.  Everything is planned and done the same way every time.

That’s an advantage that medicine is really starting to understand.  We’re beginning to have protocols and checklists, standard order sets and procedures that are done the same way every time.  Training staff on these patient care procedures and providing doctors with proven treatment algorithms makes sure things are done right the first time and important steps aren’t missed.  Taking advantage of things our technology does easily, like setting alarms if a patient has a fever or her weight changes drastically, adds an extra layer of safety.

Happy patients are safer

I was surprised to see data suggesting that patient satisfaction data correlated somewhat with patient outcomes.  For instance, patients that were happier with their care were less likely to have problems with their care like being readmitted to the hospital soon after going home.

There isn’t an obvious or easy explanation for this correlation.  Since some of the patient satisfaction measurements involve how well the doctors and staff communicated with patients, patients who understand their care and their treatment plan better may be more likely to do well after going home.

We have a lot of work to do as an industry to continuously improve patient safety.  Errors are NOT to be accepted as part of the cost of doing business.

QUESTION:  Have you or a family member been affected by a medical error?


Fish Oil And Inflammation

Fish.  Everyone knows they should eat more fish?  Why is that?  Fish is good for your heart, but why?  And what kind of fish? Turns out FATTY fish intake reduces cholesterol and, more importantly, there is a strong link between fish oil and inflammation.

Seems I have been talking to EVERYONE this week about fish oil, diet and inflammation.  When a patient’s cholesterol is high I check a profile called an essential fatty acid (EFA) panel which gives a nice peek into their diet.  Often I just get confirmation of what I already know – their diet stinks and we need to get to work ASAP!

Ultimately I really don’t care about an individual’s cholesterol.  I really don’t.  High cholesterol in and of itself is not a disease.  I care about their risk of OTHER diseases either directly related to the high cholesterol levels (like pancreatitis from super-high triglycerides) or for which high cholesterol is a marker (like heart disease).

High cholesterol is like the fire alarm going off.  When the fire alarm goes off, do you just go turn it off and go back to bed?  No, of course not, you go figure out what made it go off in the first place.  Find the fire, right?  When a person’s cholesterol is high, that means we need to go search for the fire, and an EFA panel is one of my first steps in hunting for the fire.

One of the calculations I can make based on the EFA panel is a quick-and-dirty check of overall inflammation levels in the body.  The ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA) is directly tied to inflammation in the body.  The higher the ratio, the higher the levels of inflammation.

Why do we care so much about this ratio?  Higher ratios are also associated with higher risk of heart disease, as reported in the Journal of Cardiology.

I tell patients (and my students) that over the next 10 years I believe we’re going to be paying much less attention to high cholesterol and much more attention to inflammation.  Inflammation hurts the cardiovascular system over time.  It damages the insides of the artery walls and when they heal they scar, which causes plaque.

Arachidonic acid is a precursor for a lot of pro-inflammatory signaling molecules in the body.  EPA is a precursor for ANTI-inflammatory molecules.  So you want MORE EPA and LESS AA.

Where does EPA come from?  The richest dietary source of EPA is fatty fish, although it is also found in low levels in seaweed.  When I’m talking to patients I tell them there are 6 fish that are “fatty” fish: salmon, mackerel, anchovies, sardines, herring and tuna.  (The mnemonic is SMASH-T.)  All other fish (like cod, whitefish, tilapia, catfish, etc) are meat and should be eaten sparingly, if at all.  The human body can make small amounts of EPA from alpha-linolenic acid (ALA) which is found in walnuts, seeds like flaxseed and chia seed, and canola oil.

What about arachidonic acid?  AA can be made from another essential fatty acid, linoleic acid, which in humans must come from the diet.  The only dietary sources of AA are animal foods like meat, dairy and eggs.

Here comes the question I keep expecting: Dr. Jen, you keep telling us that the healthiest diet is completely plant-based.  If we need EPA and the best source is fish (which are undoubtedly animals), why is a completely plant-based diet so heart-healthy?

That’s a great question.  First of all, scientists are still working on the “why” but there is no doubt that a completely plant-based, whole-foods diet is the best choice if your goal is overall health and avoiding heart attacks and strokes.

My personal interpretation of current research is that if you give the body ALA and LA from plant sources, it will manufacture the EPA and AA that it needs for its purposes.  The ratio of AA to EPA will be low because the body won’t make extra AA.  However, if you eat a lot of meat you get a lot of AA from the diet and the body isn’t so much in control of how much is floating around.

The best choice for those who want to reduce their risk of heart disease is to eat NO animal foods at all.  Adding a small amount of fish oil as a supplement is good insurance to further reduce inflammation in the body.

If you have high cholesterol, ask your doctor to order an Essential Fatty Acid profile, CPT code 82542.  If it is coded with a high-cholesterol or high-triglyceride diagnosis code, it will almost certainly be covered by your insurance.The results should look something like what is shown at this link.  Calculate the ratio of arachidonic acid to EPA.  The goal is <3, an elevated level is >10 and a high level is >15.  I’ve seen it over 30.

Then look at the ratio of omega-3 to polyunsaturated fatty acids (w3:PUFA).  The healthiest people in the world have a ratio of about 50%, but we eat so many omega-6 oils in the USA that I’m usually content with a ratio of 15-20%.

The last thing to look at is the total saturated fat level.  If it is high you REALLY need to think about how much meat you’re eating.  The main sources of saturated fat in the body are animal foods (meat, dairy and eggs).  Palm kernel oil is found in many processed foods and is also a big dietary source of saturated fat.  Read your ingredient lists.

You are what you eat.  Your body is 100% created from the food and drink you put in your mouth.  Your health is 90% determined by lifestyle factors, mostly diet.  Now is the time to look at what you’re choosing to feed your body and make good choices.  It’s up to you!

QUESTION: Will you change your diet based on this information?  Will you ask your doctor to order the test for you?


The Effect Of Negative People

Do you have friends that make you feel like you can do ANYTHING? When you spend time with them, you’re energized and ready to take on the world.  They encourage you, celebrate victories with you, and are always there for a quick word of good advice.

How about friends that are complete downers?  When you are with them you feel tired, sad and worried about the future.

We all know negative people.  They seem to walk around under a cloud of doom and rarely have anything good to say.  Their relationships falter, their kids disappoint them, they are stuck in a dead-end job and are always complaining.

What do you do with the negative people in your life?

Monitor the energy drain

First of all we have to be mindful of the effect negative people have on our energy.  Be aware of how you’re feeling and see if you can pick up patterns.  Most of us can spot negative people when they’re sad Eeyore types.

It’s harder to spot people as negative when they’re funny.  Do you know anyone who naturally seems to set up “us-vs-them” dynamics?  Sarcastic people who snipe at others and put them down behind their backs?  Who make you glad you’re not the one they are on the outs with?

The Eeyore types make you feel sad and can be exhausting, but the prickly, sarcastic types can be more difficult to deal with.  It is easy to get pulled into their way of dealing with others and participate in their jokes and mean games.  This does not build up others and definitely doesn’t make you feel good about yourself, especially at the end of the day when you look back at the hurt feelings and strife that has been caused.

Once you have identified someone who is negative, you can take steps to limit their influence on your life.  Like watching the heating bill to see if your windows need weatherstripping, limiting your exposure to someone who drains your energy is a smart thing to do.

Seek out positive people

I’ve got good news for you!  YOU get to choose who you spend time with.  This may be a little bit of a shock, but if YOU don’t choose, then others will choose for you.  Who do you want to be in charge of who you hang out with?  YOU, of course!

You have to be intentional about who you allow to have influence over your life.  It’s been said that you become who you spend time with, meaning that you adopt their attitudes and values over time.  This is important for teenagers and I try to talk with them and their parents about monitoring their friendships to see if they’re hanging out with good kids.  It’s also important for adults and for the same reason.

Do this exercise for me, will you?  Sit down and make a list of the people you spend the most time with.  Start on Monday morning and think of all the people you see through the week, until Sunday night.  Your spouse will be at the head of the list, your children, your boss and coworkers, etc.

Now look at the list and put a number next to each name, rating them on a “positivity” scale, 0 being completely negative and 10 being completely positive.  Think of the things they say, the things they do, and the way you feel when you’re with them.

If you look at the list of people you spend the most time with, how does your scale look?  Do you have a lot of 2s and 3s?  A lot of 7s and 8s?

If you find that most of the people you see are on the negative side of the scale, you need to actively seek out positive people.  If you don’t run across them in the course of your daily life, you have to go find them.  Where are people happy?  That’s where the positive people are.  Go there, you’ll find them.  Some examples are yoga and fitness studios (endorphins galore!), art classes, music groups and Meetup groups where people share a common interest.

What makes you happy?  What do you choose to do just for fun?  Find people who share the same interest and hang out with them.

Be a positive influence

We are called not just to get through this life, but to make our world a better place.  Some people are called to improve the World-with-a-capital-W (like Mother Theresa, Gandhi and Nelson Mandela).  All of us are called to leave our little corner of the world better than we found it.

This is a little heavy, but once you are aware of the impact of our outlook on our lives and our happiness, you have some responsibility to help others improve theirs.

The next time one of your Eeyore friends is complaining about something, be sympathetic but also remind them of something good that happened or is going on in their lives.  Gently remind them of a blessing.  For instance, when Alison is complaining that she just can’t lose weight, and you know she had a big salad for lunch instead of a sandwich and potato chips, give her kudos for how hard she is trying.  Let her know you support her efforts and are proud of her.  Ask about the trip she and her husband just took, or how her daughter is doing at college, or something else you know is going well.

If someone’s negativity is directed outward, like the sarcastic friend who likes to put others down, the best thing to do is to refuse to participate.  Just walk away.  Take away the audience for their performance.  It takes a special kind of courage to stick up for their target, but sometimes distraction with a change of topic will help.

Spending time with those who are negative has a cost.  They will steal your energy.  If you count the cost and spend that energy wisely, over time you can help your friends, family and coworkers become more positive and help make your corner of the world a better, happier place.

QUESTION:  Do you spend time with a lot of negative people?  How do you handle them?